Self-Care Management in Adults
Undergoing Hemodialysis
Cleo J. Richard
lients with end stage renal dis-
C ease (ESRD) require continual
care. Daily self-care includes
managing a complex treat-
ment regimen of dietary restrictions,
fluid limitations, medications, and
vascular access care (Richard, 1986).
This day-to-day care is the responsi-
bility of the client. The purpose of
this article is to review the research
literature on self-care management
(SCM), also known in the literature
as self-management, for adults with
ESRD treated with hemodialysis
(HD). The intent is to ascertain the
current state of knowledge, identify
gaps, and propose future research.
Background
During the late 1970s and 1980s,
self-care HD was introduced into the
nephrology community because of a
rising number of people who needed
dialysis, a nursing shortage (Lein-
weber, 1981; Paradiso, 1985;
Williams, 1979; Zinn, 1986), rising
costs of the ESRD program funded
by Medicare, and legislation
(Bernbeck, 1981; Kirschenbaum,
1987; Wineman, 1978). Legislation
was enacted to decrease the rising
expenses of the ESRD program by
providing a fiscal incentive to create
outpatient self-care HD facilities that
were more cost effective than the
inpatient hospital HD units.
Self-care HD involved the client
doing as much of the HD procedure
as possible. This included preparing
the machine, monitoring oneself dur-
ing HD, deciding on interventions
based on signs and symptoms (such as
Cleo J. Richard MSN, RN, is Doctoral Nursing
Student, University of Texas Health Science Center,
School of Nursing, Houston, TX. She is a member of
the Gulf Coast Chapter of ANNA.
Acknowledgments: The author would like to
acknowledge Nina Selz, PhD and M.J. Worst, MS
for their support.
NEPHROLOGY NURSING JOURNAL ■ July-August 2006
The research literature on self-care management for adults with end stage renal disease being
treated with hemodialysis was reviewed to ascertain the current state of knowledge, identify
gaps, and propose future research. Sixty-four studies were reviewed. Many studies focused on
compliance and whether subjects were meeting predetermined values of outcome variables set
by professionals. Self-care management of ESRD is multidimensional and warrants further
research from the client, professional, and health care system perspectives.
Goal
To review the research literature related to self-care management of adults with
end-stage renal disease on hemodialysis.
Objectives
1. Describe the current literature available related to adults with end-stage renal
disease self-managing their hemodialysis.
2. Identify gaps in the literature about self-care management by adults with
end-stage renal disease on hemodialysis.
3. Propose future research projects involving self-care management by adults
on hemodialysis.
administering a fluid bolus and More recently, self-care has been
changing machine setting with suggested as an alternative to replace
hypotension), and discontinuing HD the focus on compliance. Self-care
(Richard, 1986). Hence, clients used management is a newer strategy for
information and skills to make deci- clients with ESRD (Curtin, Svarstad,
sions about when to implement cer- & Keller, 1999), and self-management
tain interventions. has been added to the latest edition of
Outside of the HD treatment, the Nephrology Nursing Standards of
clients were expected to follow a Practice and Guidelines for Care
complex, prescribed treatment regi- (Burrows-Hudson & Prowant, 2005;
men and be in compliance with med- p. 396 in this issue of NNJ). Self-care
ications, special diets, fluid limita- management encompasses compli-
tions, and vascular access care ance and adherence and advocates
(O’Brien, 1980; Richard, 1986; clients being partners in their treat-
Snyder, 1983). Compliance involved ment, having the knowledge and
clients meeting goals set by clinicians. skills to care for themselves, making
This offering for 1.5 contact hours is being provided by the American Nephrology Nurses’
Association (ANNA).
ANNA is accredited as a provider of continuing nursing education by the American Nurses
Credentialing Center’s Commission on Accreditation.
ANNA is a provider approved by the California Board of Registered Nursing, provider number CEP
00910.
The Nephrology Nursing Certification Commission (NNCC) requires 60 contact hours for each
recertification period for all nephrology nurses. Forty-five of these 60 hours must be specific to nephrology
nursing practice. This CE article may be applied to the 45 required contact hours in nephrology nursing.
■ Vol. 33, No. 4 387