Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C


Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C

Vanessa Loyd, DNP, PhD, RN

Annette Hood, DNP, APRN, ANP-BC



Problem: Patients with long-term medical conditions represent a significant public health issue. Therefore, patients diagnosed with a chronic illness must have a high level of health literacy (HL) to manage their condition effectively. This Quality Improvement (QI) project evaluated the impact of an existing education-based program for stage 4 and 5 chronic kidney disease (CKD) patients and its effect on laboratory values compared before and after an NP-led education program that included vascular access, and modality choices.

Methods: A retrospective chart review was completed on 20 patients with an inclusive diagnosis of CKD stage 4 or 5 from October 21, 2019, through January 21, 2020, using a descriptive observational design and paired sample t-test analysis.

Results: The paired sample t-test revealed only two laboratory results: globular filtration rate (GFR) (Pre) M=16.15, SD=3.86, (Post) M=10.35 SD=3.86 t (19)5.949, p=.000 and phosphorus level (Pre) M=4.161, SD=1.288, (Post) M=5.26, SD=1.293 t (19) 2.796, P=.012.

showed a significant difference. All other remaining laboratory values did not reach a significant difference.

Implications for Practice: QI project findings revealed improving HL slows the course of CKD and prepares patients for optimum dialysis start. Therefore, future dialysis population studies should include all nephrology services as part of their scope. Additionally, a comprehensive instructional program for all chronic kidney disease patients is needed, not only for those in stages 4 and 5.