End stage renal disease (ESRD) is the fifth and final stage of chronic kidney disease. Persons with ESRD face significant challenges to quality of life when undergoing renal replacement therapy with hemodialysis. Complex medical regimens accompanied by severe physical discomforts related to both ESRD and dialysis can take a serious emotional toll. Two manuscripts presented in this dissertation portfolio explore the issues facing this population. First, a comparative concept analysis explores three potential psychosocial responses for which nurses are uniquely positioned to intervene. A second manuscript details a multiple-case study with embedded units of analysis that aimed to test the Conceptual Model for Adaptation to Chronic Illness in persons on hemodialysis. The study also evaluated the use of a low-tech personal health record as a tool for self-management in persons undergoing hemodialysis. Study findings suggest a low-tech approach to self-management may be beneficial in a targeted population of ESRD patients.

Date of publication

Spring 4-27-2018

Document Type




Persistent identifier


Committee members

Dr. Barbara Haas, Dr. Melinda Hermanns, Dr. Zhaomin He, Dr. Della Connor


Doctor of Philosophy in Nursing

Available for download on Sunday, April 26, 2020