Date of Award

2025

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Amy J. Walker

Readers

Andrew T. Brockenbrough

Abstract

Missed dialysis treatments are commonly attributed to barriers such as transportation, mental health challenges, and limited health literacy. However, emerging evidence highlights the complexity of adherence behaviors, including psychological, relational, and ethical dimensions that remain underexplored—particularly from the perspective of dialysis providers and nurses. This qualitative descriptive study examined how nephrology providers and dialysis nurses perceive barriers to adherence, with a focus on patient autonomy, motivation, and decisionmaking.

Using Self-Determination Theory (SDT) as a guiding framework, an anonymous, open- ended survey was distributed to 17 clinicians via the Qualtrics platform. Responses were analyzed using deductive content analysis, categorizing findings into SDT’s core domains: autonomy, competence, and relatedness.

Participants confirmed the persistence of logistical challenges, but also identified deeper psychosocial stressors, including emotional fatigue, strained communication, and ethical tensions surrounding treatment discontinuation. While competence and autonomy-related themes were prominent, relatedness—despite its established role in motivation—was less frequently addressed in responses.

These findings suggest that effective adherence strategies must go beyond logistical interventions to include SDT-aligned approaches such as shared decision-making, individualized education, and relational communication. Future research should further investigate how provider-patient relationships and frontline staff interactions influence long-term engagement in dialysis care.

Download

Share

COinS