Date of Conferral



Doctor of Nursing Practice (DNP)




Margaret Harvey


The impact of end-stage renal disease (ESRD) on healthcare costs is significant. In 2013, the cost of providing care for the ESRD patient population was 7.1% of total Medicare expenses. ESRD patients' non-adherence with the medical plan is a reason for the high cost of care and poor patient outcomes. Staff education can have a positive impact on patient adherence in terms of the management of chronic illnesses, such as ESRD. This DNP project was an education program for hemodialysis (HD) staff regarding empowering patients to learn about self-care strategies aimed at improving ESRD patients' adherence to fluid restriction and treatment schedules. The staff education project was developed using Malcolm Knowles' adult learning theory and Dorothea Orem's self-care theory. Three in-center hemodialysis (ICHD) clinics located in a large southeast inner city of the United States with predominantly African American patients participated in the DNP project. All the participating clinics were selected based on their underperformance in missed patient treatments and fluid goals. The goal of the educational program was to teach staff current evidence-based practice self-care strategies for patients to improve adherence to required fluid restrictions and treatment schedules. The program was delivered through 5 different sessions over 3 days at 2 locations. Thirty staff members participated in the program. Missed treatment rates and the intradialytic weight gain (IDWG) percent showed improvement 1-month post education for each of the 3 clinics. This project has the potential to promote social change through staff education on patient self-care strategies for adherence to fluid and treatment plans, thus improving patient outcomes and quality of life.

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