Date of Award


Document Type

Restricted Access Thesis

Degree Name

Master of Arts in Nursing (MAN)



First Advisor

Joyce P. Miller DNP, RN

Second Advisor

Deborah Schuhmacher DNP, RN

Third Advisor

Jacqueline Njoki Sumner DNP, RN


Chronic kidney disease is a devastating illness; these patients have high mortality rates and often suffer from numerous comorbid conditions. As patients transition into receiving renal replacement therapy such as dialysis, they experience profound and life altering disruptions requiring guidance from medical providers. Patients often have difficulty coping with this diagnosis and exhibit fear, depression, and anxiety. Unfortunately, nursing care is often focused on procedural activities rather than addressing the psychosocial and emotional needs of the patient. One way dialysis providers are trying to improve health outcomes in chronic kidney disease patients is with home dialysis modalities. These methods of delivering kidney replacement therapy are proven to raise health outcomes, decrease costs, and provide a better quality of life. To ensure the psychosocial and emotional needs are met, the nurses at a large Midwestern tertiary healthcare center are provided an educational opportunity. The educational presentation is developed based on the concepts of Margaret Newman’s Health as Expanding Consciousness Theory and its use in a holistic assessment. It is hoped this activity will inspire a paradigm shift in the nursing care of patients receiving home dialysis from a procedural one to a holistic one focused on recognizing the psychosocial aspects in the patient. This education will help to guide the nurses to better understand the patient’s personal goals, discover the reasons of the disconnect between desired outcomes and actual results, find the motivation to change behaviors, and ultimately lead to better health outcomes for home dialysis patients.


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