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Abstract
There are lots of studies that have been conducted on health disparities in dialysis care when it comes to African Americans, and they have revealed interesting facts. Some of them include; End life decision making, racial perceptions of the medical staff, impact of improving the process of care, prevalence of end stage renal disease (ESRD), and improving cultural competencies. The goal of this study would be to explore how bridging the gap of racial disparities in African American dialysis patient can improve their overall health. Chronic kidney disease (CKD) is a national public health problem. While the prevalence of early stages of CKD is similar across different racial/ethnic and socioeconomic groups, the prevalence of end-stage renal disease (ESRD) is greater for minorities than their non-Hispanic white peers. furthering our understanding of the unique connection of biological, genetic, environmental, socio-cultural, and health care system level factors should promote change in our approach to health promotion and disease prevention. Treating African American dialysis patients with no bias, or stereotypes could really improve their wellbeing. Treating patients equally when it comes to treatment and respect plays an intricate role in how successful the treatments can be. There is no research on how being culturally sensitive can improve the health in African American dialysis patients. If it is found that African American dialysis patients have improved health due to bridging the disparity gap it would open the door for future researchers to determine the right course of action in bridging that disparity gap.

Keywords: disparity, dialysis, cultural sensitivity, ESRD
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Bridging the Gap of Health Disparities Among African American Dialysis Patients

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Dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. Dialysis is used in patients with rapidly developing loss of kidney function or Kidney disease, typically from diabetes and high blood pressure. Due to high rates of diabetes, high blood pressure and heart disease, and African Americans have an increased risk of developing kidney failure. Most people need 3 sessions of hemodialysis a week, with each session lasting around 4 hours. This is done in the hospital, or at home. Two thin needles are inserted into the graft and taped into place. One needle will slowly remove blood and transfer it to a machine called the dialysis machine. The dialysis machine is made up of a series of membranes that act as filters and a special liquid called dialysate. The membranes filter waste products from the blood, which is passed into the dialysate fluid. The used dialysate fluid is pumped out of the dialyzer, and the filtered blood is passed back into the body through the second needle. There are 5 stages to kidney disease the mildest are stages 1 and 2. In these early stages of kidney disease, the kidneys are damaged and not working at full strength. At stage 3, about half of kidney function has been lost, stage 4 is considered to be chronic, and stage 5 also called end stage renal failure (ESRD).
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Background and Significance

Creatinine is a waste product that forms when creatine, which is found in your muscle, breaks down. A creatinine test determines the stage of kidney failure. Creatinine levels in the blood can provide the doctor with information about how well kidneys are working. Glomerular filtration rate or GFR is how the kidney function is measured; GFR tells the physician your stage of kidney disease and helps the physician plan your treatment. If the GFR number is low, then kidneys are not working as well as they should. The earlier kidney disease is detected, the better the chance of slowing or stopping its progression. GFR and the creatinine test are tools that help figure out what stages of kidney failure a patient is at. Stage 1 GFR>90ml/min, the urea in the blood is slightly elevated, protein or blood in the urine, and signs of kidney damage in a CT scan, MRI, contrast, or ultrasound. Stage 2 GFR is between 60-80 ml/min and the same side effects as stage 1. Stage 3 the GFR is between 30-59ml/min, the symptoms include; Severe fatigue, edema, fluid retention, and shortness of breath, foamy, brow or tea-colored urine, blood in the urine, severe kidney pain, and restless legs or muscle cramps leading to sleep problems. Stage 4 GFR is between 15-29 ml/min, this stage is severe and it categorized as Chronic Kidney Disease (CKD). CKD has some of the same symptoms that are associated with stage 1, 2, and 3 with some additional signs of kidney damage, which include urination changes, vomiting, nausea, change of taste in the mouth, loss of appetite, bad breath, difficulty in concentrating and nerve problems causing tingling/numbness in the fingers or toes. Stage 5 kidney disease or ESRD has a GFR of >15 ml/min. The most common symptoms in the end stage of kidney disease include nausea, loss of appetite, tiredness, itching, headaches, and under production of urine. You may also notice swelling around the ankles and eyes with muscle cramps, changes in skin color, and increased skin pigmentation.
Out of all these stages African Americans disproportionately die more often at stage 5 kidney disease than any other race here in America. At every transplant center in the nation, African Americans are the least likely to receive a kidney from a living organ donor, according to findings published in the June issue of the American Journal of Kidney Diseases (Reese et al., 2012), the official journal of the National Kidney Foundation. The study, based on data gathered from all 275 transplant centers in the U.S., also showed that those facilities serving predominantly African American populations had even higher rates of living donor transplant disparities. At transplant centers with the highest disparities pertaining to living organ donation, African Americans had 76 percent lower odds of obtaining a kidney from a living donor. Even at the facilities that came closest to equality, African Americans were still 35 percent less likely to obtain a transplant from a living donor. There are more than 92,000 people waiting for a kidney in the United States, and over a third of those are African Americans. In 2011, there were 5,771 living donor transplants performed –the lowest rate in ten years — but only 813 of those kidneys were received by African Americans.
H0: Bridging the gap of racial disparities will improve the health of African American patients
Racial tension has always been a part of America history. This racial tension has reared its ugly head toward all minorities, but none more than African Americans. Africans shipped here as slaves to work the fields. African Americans have contributed 300 billion dollars to the economy and at every turn where discriminated against. The healthcare industry was no different. From the horrendous medical experiments that took place on the ships that brought the human cargo from Africa to the crude practice of medicine on enslaved Africans to the unequal, segregated health care system during the Jim Crow Era to current disparities in health outcomes, African Americans have enough cause to mistrust and be suspicious toward the U.S. medical system. The now infamous U.S. Public Health Service’s syphilis study in Tuskegee is perhaps the most widely known study exclusive to African Americans. It was conducted from 1932 to 1972, and researchers withheld treatment from about 400 Black men in Macon County, Alabama, to study how the disease progressed. It continued all those years without treatment, even after penicillin became the standard cure. The study has become a classic and historical case of blatant governmental racism against African Americans and is one major reason why so many African Americans’ distrust the health care system. With distrust in the healthcare system results in late diagnosis, a serious problem that needs addressing
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Method
This study aims to target and correct health disparities in African American dialysis patients. African American dialysis patients, and medical professionals in direct contact with dialysis patients, will be asked a series of questions. These questions are geared toward getting to the root of disparities in African American dialysis patients.
Variables
Independent variable: Bridging health disparity in African Americans
Dependent variable: Improved health
Research Design
Qualitative exploratory research is the research method for the proposal. Participant in my study will be asked a series of questions.
Participants
African American participants will be selected from dialysis clinics in rural areas, suburbs, and inner cities. They will be asked a series of questions after treatment. At the same facilities all medical professionals will be given a questionnaire. The goal is to have 1000-2000 participants for the patients, and 500-750 participants for the medical employees. If consented, participants will be given the informed consent to read, ask questions, and sign before being enrolled (See Appendix A)

Materials
Two different questionnaires will be handed to patients prior to their dialysis treatment. The second questionnaire will be filled out by all employees who come into physical contact with dialysis patients.

Procedure
Prior to dialysis treatment patients will be asked questions about their dialysis care, outlook on the health care system, and some basic medical questions. The medical staff in direct contact with dialysis patients will be asked questions about treatment, and bias.
Questionnaire for Patients
1. In what stage of kidney disease are you?
2. How long have you been on dialysis
3. Are you on the transplant recipient list? If so how long have you been on it?
4. Do you feel like your voice is heard?
5. Does the physician explain treatment to you?
6. Have you ever felt neglected by the staff?
7. Has your physician explained your options for transplantation and dialysis?
8. On a scale of 1-10 how important of a impact does the medical staff have on your mental health?
9. Has your physician treated you differently because the color of your skin?
10. On a scale of 1-10 how much do you trust the healthcare system
11. Do you have any bias, or negative feeling towards the healthcare system?
12. Do you feel like your opinion matters?
Questionnaire for the Medical Staff
1. Do you take time to listen to your patients, and explain treatment?
2. Have you ever witnessed racial bias at the workplace?
3. Do you believe in fair treatment regardless of color or culture?
4. Have you ever caught your stereotyping your patient?
5. Have you ever taken a health diversity course?
6. Do you believe that white privilege exists?
7. Do you believe there is a bias in dialysis care?
Timeline
The study will span over 6 months, and then data collection will begin.
Data Collection and Analysis

Data will be collected in the form of questionnaires; patients, and medical staff. These will be completed at the beginning, middle, and end of the six-month participation period. Upon collection, data will be used to draw conclusions about where the disparities began, this will be achieved by reviewing the questionnaires and carefully examining the results.
Conclusion
There is a great need to understand and fill the health disparity gap among African Americans. We may not know that we are implying bias when we see people who are different from us. Having preconceived notions about someone before you truly know them should be a practice that ends immediately. Imagine if we could do a better job of prescreening employee so that they don project their stereotypes on bias on people of color.
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