Date of Award

Summer 2022

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP) in Family Nurse Practitioner



Faculty Chair

Laura Barrow


Victoria Smeltzer


Background: Hyperphosphatemia, also known as excess phosphate in the blood, is a problem that continually causes health issues for the outpatient hemodialysis population. Hyperphosphatemia yields multiple health comorbidities and can increase mortality (Rastogi et al., 2021).

Purpose: Hyperphosphatemia is directly correlated with end-stage renal disease (ESRD) (Goyal & Jialal, 2020). This project aimed to decrease the incidence of hyperphosphatemia in the chronic outpatient hemodialysis setting. The primary objective of this project was to increase adherence levels to diet, drinks, drugs, and dialysis (4Ds) in those receiving chronic outpatient hemodialysis in the pursuance of achieving and maintaining blood serum phosphorus levels between 3.0 and 5.5 mg/dL as recommended by the Centers for Medicare and Medicaid Services. Participation in a standardized motivational education program will aid in lowering phosphorus levels in those on hemodialysis, therefore reducing morbidity and mortality. As a result, this project implements and evaluates how delivering effective teaching will lower the occurrence of hyperphosphatemia in the ESRD population.

Results: There was a statistically significant difference (W = 51.0, p = 0.019) between pre-assessment and post-assessment performance with the average pre-assessment score of 66 out of 100 (standard deviation 19.1) and the average post-assessment score of 78 (standard deviation 13.2). The average phosphorus level before the intervention was 7.3 mg/dL (standard deviation 1.5) with a mid-intervention level of 6.2 mg/dL (standard deviation 2.2), and a post-intervention mean phosphorus level of 6.9 mg/dL (standard deviation of 2.4), no statistical difference was noted (H = 1.47, p = 0.479). The intervention had no impact on dialysis treatment compliance rates.

Included in

Nursing Commons


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