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Nurse-Led Renal Diet Education to Improve Dietary Adherence in Hospitalized Adult Patients with Chronic Kidney Disease

Yailin Ramirez

Florida National University

MSN Capstone Project-DAX-DL01

Dr. Carmen Lazo

May 21, 2026

Nurse-Led Renal Diet Education to Improve Dietary Adherence in Hospitalized Adult Patients With Chronic Kidney Disease

Chronic kidney disease is a progressive disease of the kidneys in which, over time, they lose their ability to properly filter waste and excess water from the blood, resulting in serious and life-threatening complications. CKD affects more than 1 in 10 adults in the United States, with approximately 37 million adults, or 14% of the adult population, estimated to have the condition, and many individuals remaining undiagnosed until advanced stages of disease progression (CDC, 2026).The cost of CKD to Medicare in 2022 alone was over 86 billion dollars (NIH, 2025). At the local level, adults in Spartanburg County, South Carolina, are affected by several risk factors associated with CKD, including diabetes, hypertension, poverty, limited health literacy, and reduced access to nutritional education. These factors may contribute to poor disease self-management and difficulty adhering to renal dietary recommendations.

The practice problem this paper investigates is the poor adherence of hospitalized adult renal patients to their diet. Failure to follow dietary recommendations for kidney disease, particularly sodium, potassium, phosphorus, and fluid, can lead to an imbalance of electrolytes, fluid overload, and more rapid progression of disease. Non-adherence is also associated with preventable hospital readmissions and higher health care costs (Surasura et al., 2024). The purpose of this capstone project is to evaluate whether a nurse-led renal diet education intervention using a simplified one-page handout improves dietary adherence among hospitalized adult renal patients in a community hospital setting over an eight-week period.

PICOT

Patient compliance with severe diet changes is a major factor in the management of CKD. While it is well recognized that nutrition is an important component in slowing the progression of disease and preventing complications from the hospital environment, there is a lack of knowledge and practical means for many renal patients to follow the nutritional recommendations in a consistent manner. This lack of patient education is a major and correctable clinical issue. The guiding question for this capstone project is: In hospitalized adult renal patients with CKD (P), does providing nurse-led education using a simplified one-page renal diet handout (I), compared to usual care with no structured dietary education (C), improve dietary adherence (O) over eight weeks (T)?

The population includes hospitalized adult patients diagnosed with chronic kidney disease (CKD) receiving inpatient care in a community hospital setting within Spartanburg County, South Carolina. This population is especially vulnerable as care of CKD involves adherence to complex dietary limitations affecting salt, potassium, phosphorus and fluid intake . CKD patients often have many chronic illnesses, such as diabetes, hypertension, and socioeconomic determinants of health, including low health literacy, lack of access to nutritional counseling, and financial constraints, may adversely impact diet adherence and health consequences. Therefore, it is necessary to have simple and systematic education in order to successfully treat the disease after discharge.

The proposed intervention is a one-page education handout adapted in a simplified format with a nurse-led bedside education session. The handout offers simple information on how to limit sodium, potassium, phosphorus, and fluids. This session is designed to be about 15-20 minutes in length and is provided by the bedside nurse or advanced practice nurse during hospitalization. An educational intervention targeting specific components of CKD management, such as dietary restrictions and knowledge assessment at pre- and post-intervention, is found to be an effective element of a comprehensive CKD management program (Atraca et al., 2025).

The comparison intervention is usual care, consisting of standard discharge instructions without structured or nurse-led dietary education. Currently, many hospitalized renal patients receive generalized education that lacks the individualization and clarity needed to produce meaningful dietary behavior change.

The expected outcome is a change in dietary adherence measured by a validated dietary adherence questionnaire at baseline and at 8 weeks. Improved adherence is expected to reduce electrolyte abnormalities, prevent fluid overload, and decrease unplanned hospital readmissions (Surasura et al., 2024).

The timeframe for this project is eight weeks. This is enough time for the intervention to be delivered while hospitalized and for patients to transfer the dietary education to the post-hospital environment, while compliance is assessed at the end of the 8-week period.

Vulnerable Population and Setting

The population being addressed in this capstone project includes hospitalized adult patients diagnosed with chronic kidney disease (CKD) receiving inpatient care in a community hospital setting within Spartanburg County, South Carolina. This population is considered vulnerable because CKD management requires adherence to complex dietary restrictions involving sodium, potassium, phosphorus, and fluid intake. Additionally, many patients experience multiple chronic conditions, including diabetes, hypertension, and cardiovascular disease, which may complicate disease self-management. In Spartanburg County, social and economic disparities, including poverty, limited access to specialty care, reduced access to renal nutrition counseling, and lower health literacy, may contribute to poor disease management and increased risk for complications and hospital readmissions.

Social determinants of health are a key factor in determining the dietary behaviors and health outcomes of this population. Low health literacy is widely reported in people with CKD and is linked to weak self-care in the disease, poor health outcomes, higher mortality, and a lower quality of life (Billany et al., 2023). A significant number of people in this context are poorly educated, do not have the same access to nutritional advice, and have difficulties in buying foods suitable for the kidneys due to their financial situation. Additionally, increased scores in health literacy are significantly associated with enhanced self-care behaviors among patients with CKD, such as diet management and follow-up of clinical recommendations (Yu et al., 2021). These findings underscore the importance of easy-to-use educational resources to assist in educating patients on the difference between recommendations and understanding.

This vulnerable population has well-defined risk factors. Advanced CKD patients have to deal with multiple medications, comorbid conditions, and dietary restrictions, making them more susceptible to non-adherence. Surasura et al. (2024) further verified that poor self-management and low compliance with the CKD treatment plan, including diet components, significantly contribute to hospital readmission in CKD patients. For this population, change is vital as preventable readmissions, reduced quality of life, and increasing health care costs are the result of failure to address dietary non-adherence, as documented. A low-cost nurse-led educational intervention delivered during hospitalization represents a timely and feasible opportunity to reduce these outcomes and empower patients in their own care.

Proposal and Intervention Plan

The Intervention. The intervention is a brief, 15-20-minute nurse-led bedside education session for each eligible hospitalized adult CKD patient. The session is facilitated with a one-page handout that has basic information on how to control sodium, potassium, phosphorus, and fluid. The handout is written at a low literacy level to ensure accessibility. Jagodage et al. (2024) showed that structured education sessions delivered face-to-face to CKD patients are linked to better dietary adherence and self-management outcomes than other unstructured usual care approaches.

Resources Needed. Minimal resources are required the estimated budget for this intervention is minimal because the educational materials consist of a one-page handout produced at low printing cost. Estimated expenses include approximately $20 for educational handout printing, $10 for questionnaire materials, and no additional staffing costs because the intervention will be incorporated into routine nursing workflow. The estimated total cost of implementation is approximately $30–$40, making the intervention feasible and sustainable in a community hospital setting.

Feasibility for the Advanced Practice Nurse. This is an advanced practice intervention that can be incorporated into the hospital workflow. The simplicity of its cost, resource, and time make it a viable and sustainable element to ongoing nursing practice in a community hospital setting.

Those Involved. Bedside registered nurse, advanced practice nurse, and dietary staff (when available) are the primary individuals involved. Charge nurses will assist in consistent implementation during the intervention period, across shifts.

Timeline

Weeks 1 & 2 will be used for staff preparation. In this stage, the one-page handout is finalized, and nursing staff are given a brief training in conducting the education session, and baseline dietary adherence data are obtained from enrolled patients.

Weeks 3-6 are the active implementation phase, in which the nurse-led education session and renal diet handout are provided at the bedside to all eligible hospitalized adult CKD patients.

The outcome measurement and evaluation occur in weeks 7 and 8 when post-intervention dietary adherence questionnaires are completed, data are analyzed, and the effectiveness of the intervention is evaluated to inform practice decisions.

Theoretical Framework

Self-Care Deficit Nursing Theory by Dorothea Orem is the main theory that forms the basis for this capstone project. The focus of the Orem theory is on the patient's self-care abilities, which are assumed to be within the patient's control and responsibility, and the role of the nurse when the patient cannot meet these needs on his/her own. After discharge, patients face complex dietary restrictions, but many do not know or feel confident in how to do this effectively within the context of CKD. Changsieng et al. (2023) demonstrated statistically significant improvement in knowledge, dietary adherence, and self-care agency among patients who received supportive-educative programs from nurses using Orem's theory compared with those who received conventional care. In this project, the nurse-led education session and one-page handout are direct representations of the supportive-educative model of nursing by Orem, which emphasizes the reduction of the self-care deficit by providing relevant and actionable dietary information for the patients.

This project will be implemented and evaluated using the Iowa Model of Evidence-Based Practice. The Iowa Model is designed to assist nurses in working systematically, beginning with identifying an issue or opportunity, stating the purpose, forming a team, assembling, appraising, and synthesizing the body of evidence, designing and piloting the practice change, integrating and sustaining the practice change, and disseminating (Cullen et al., 2022). The Iowa Model Revised is a well-defined framework for Iowa nurses to use in converting a quality improvement project into a nursing evidence-based practice development project, and has been successfully used in hemodialysis and nephrology settings to develop nursing interventions that aim for improving patient outcomes. This capstone focuses on the Iowa Model guiding the entire process, including identifying poor dietary adherence as a clinical issue and measuring post-intervention adherence scores for the nurse-led handout intervention.

Together, these two frameworks strengthen the foundation of this capstone. The patient-centred design of the educational intervention and the role of the nurse in closing the self-care gap is guided by Orem's theory and substantiated by the Iowa Model, which offers evidence-based, systematic, and rigorous design and evaluation of the project. Both concepts are consistent with the ultimate aim of increasing adherence to good dietary habits and enhancing the quality of nursing for hospitalized CKD patients.

Conclusion

Nonadherence to diet among hospitalized patients with adult CKD is an important and expensive clinical issue that is linked to electrolyte disturbances, fluid overload, CKD progression, and avoidable hospitalizations. This capstone project's purpose is to develop an educational intervention for nurses, with a simplified one-page renal diet handout, to be implemented over an 8-week period among hospitalized adult patients with CKD in a community hospital setting as a feasible and evidence-based intervention to fill this gap. The intervention is based on Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice, ensuring both patient-centered design and systematic implementation. The proposed dietary adherence outcome is attainable and measurable in the specified time period. Addressing this problem carries far-reaching implications for CKD patients, including improved quality of life, reduced burden on the healthcare system, and fewer costly and preventable hospitalizations.

References

Atraca, E., Solinho, L., Pires, S., Braga, V., Gomes, I., & Ramos, A. (2025). An Educational Nursing Program to Improve Self-Care in Chronic Kidney Disease: A Multiple Case Study. Journal of Ageing and Longevity, 5(3), 30–30. https://doi.org/10.3390/jal5030030

Billany, R. E., Thopte, A., Adenwalla, S. F., March, D. S., Burton, J. O., & Graham-Brown, M. P. M. (2023). Associations of health literacy with self-management behaviours and health outcomes in chronic kidney disease: a systematic review. Journal of Nephrology, 36(5). https://doi.org/10.1007/s40620-022-01537-0

Changsieng, P., Pichayapinyo, P., Lagampan, S., & Lapvongwatana, P. (2023). Implementation of Self-Care Deficits Assessment and a Nurse-Led Supportive Education Program in Community Hospitals for Behavior Change and HbA1c Reduction: A Cluster Randomized Controlled Trial. Journal of Primary Care & Community Health, 14. https://doi.org/10.1177/21501319231181106

Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa implementation for sustainability framework. Implementation Science, 17(1), 1–20. https://doi.org/10.1186/s13012-021-01157-5

Jagodage, H., McGuire, A., Seib, C., & Bonner, A. (2023). Effectiveness of teach‐back for chronic kidney disease patient education: A systematic review. Journal of Renal Care, 50(2). https://doi.org/10.1111/jorc.12462

NIDDK. (2023). Kidney disease statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease

NIH. (2025). Healthcare Expenditures for Persons with CKD. USRDS. https://usrds-adr.niddk.nih.gov/2024/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckd

Surasura, A., Kumar, B. G. S. K. P., Chinamanagonda, S., Durga , D., & Gubbala, S. (2024). Understanding Hospital Readmissions: Insights, Patterns, and Interventions for Improvement in Chronic Kidney Disease. Curēus. https://doi.org/10.7759/cureus.59524

Yu, P.-S., Tsai, Y.-C., Chiu, Y.-W., Hsiao, P.-N., Lin, M.-Y., Chen, T.-H., Wang, S.-L., Kung, L.-F., Hsiao, S.-M., Hwang, S.-J., & Kuo, M.-C. (2021). The Relationship between Subtypes of Health Literacy and Self-Care Behavior in Chronic Kidney Disease. Journal of Personalized Medicine, 11(6), 447. https://doi.org/10.3390/jpm11060447