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Purpose: Patient education improves health and treatment adherence of patients with chronic kidney disease. However, evidence about the sufficiency of patients' knowledge processed in patient education is limited. The purpose of this study was to evaluate subjective and objective sufficiency of knowledge processed in patient education in dialysis care and treatment. Patients and Methods: A cross-sectional study design was used. The sample (n=162) comprised patients in predialysis or home dialysis. All eligible patients during the data collection timeframe (2016)(2017) in two university hospital districts in Finland were invited to participate. Subjective sufficiency was evaluated with a structured questionnaire having 34 items divided into six dimensions of empowering knowledge (bio-physiological, functional, social, experiential, ethical, and financial) on a Likert scale (1=not sufficient at all, 4=very sufficient). Objective sufficiency was evaluated with a structured knowledge test with 10 items (score range 0-10, correct=1, wrong/no knowledge=0) based on the multidimensional content of patient education emphasizing bio-physiological dimension. Results: In subjective sufficiency of knowledge, the mean was 3.27 (SD 0.54). The biophysiological dimension of empowering knowledge was the most sufficient (mean 3.52, SD 0.49) and the experiential the least (mean 2.8, SD 0.88). In objective sufficiency, the means ranged 5.15-5.97 (SD 2.37-2.68) among patients in different modalities of dialysis care and treatment. The least sufficient objective scores were bio-physiological and functional knowledge. The subjective and objective sufficiency did not correlate with each other. Conclusion: Patients' knowledge, either subjective or objective, does not seem to be sufficient. Hence, attention should be paid to supporting patients with more personalized knowledge. Furthermore, the relationship between subjective and objective sufficiency needs future consideration, as their non-correspondence was a new discovery.

SUMMARY Background Dialysis patients' experience of safety can be seen positively connected with their wellbeing and successful outcomes of their treatment and care. Therefore, it is necessary to identify the factors promoting and weakening the safety experiences and create a basis for empowering interventions. Objectives Analyse patients' experiences of safety with dialysis and the factors promoting and weakening their safety. Methods A descriptive study design was used. This study analysed Finnish patients' (n = 70) experiences of safety with dialysis and the factors promoting and weakening patients' safety. Data were collected using a questionnaire including one structured question and two open questions. Findings The patients experienced their care as safe. Thematic analysis provided three factors promoting patients' safety: certainty of patient's own competence in dialysis self‐management, competence of personnel in dialysis treatment and care, continuity of ensuring patients' state of health, as well as three factors weakening safety: patients' uncertainty of living with chronic kidney disease, insufficient patient education and uncertain realisation of dialysis treatment and care. Conclusion This study provided new insight into understanding patients' experiences of safety with dialysis. We show that the factors connected with patients' safety were related to the successful realisation of self‐management, support for the self‐management, and delivery of dialysis treatment and care anticipating high‐level outcomes. In light of this study, there are development needs in dialysis treatment and care as a whole in order to ensure patients' safety.

The aim of this descriptive study was to analyze the relationship between the sufficiency and usefulness of patient education from the perspective of people with chronic kidney disease. The goal was to discover whether both sufficiency and usefulness need to be analyzed in the quality evaluation of patient education. Patients undergoing predialysis or home dialysis care in Finland (N = 162) evaluated both the sufficiency and usefulness of patient education provided by nephrology nurses by using parallel structured questionnaires. A strong relationship was found between the sufficiency and usefulness of patient education. The relationship was significant across all dimensions of empowering knowledge, but no systematic association was found between the sufficiency-usefulness relationship and background variables. Depending on the purpose of evaluating patient education, either aspect, that is, sufficiency or usefulness, can be used, but it is not necessary to use both due to their strong inter-correlation. In terms of implications for practice, consideration of both sufficiency and usefulness is important when providing empowering patient education for people undergoing pre-or home dialysis, but only one aspect needs to be evaluated.