Quality of Life in African Americans With the End-Stage Renal Disease

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Introduction

This article focuses on the need to improve quality of life in African Americans with ESRD. Many patients who suffer from end-stage renal disease (ESRD), particularly those who do not access renal transplantation, have critical shorter life expectancy than others who have renal transplant. Prior to the introduction of dialysis, people who suffered renal conditions faced an inevitable death. However, improvements on treatment of renal conditions have improved in term of transplant and dialysis.

As a result, lives of people with renal diseases have improved significantly. In fact, the US Renal Data System (USRDS) report of 2009 noted that ESRD is the “only disease-specific condition that is explicitly guaranteed Medicare coverage, with Medicare costs for the condition reaching $23.9 billion in 2007” (U.S. Renal Data System, 2009). It also noted that the rate of all-cause mortality for ESRD were about “six to eight times higher for dialysis patients than for the general population in the year 2007” (U.S. Renal Data System, 2009). During the year 2007, cases of ESRD decreased by 2.1 percent or 527,000 cases. This was the major decline rate since the year 2005.

However, racial differences have persisted. For instance, in 2007 the African American had a high rate of 3.8 times compared to that of Native Americans, which was 1.8 times. Still, Hispanic populations had “1.5 times higher than that of other non-Hispanic population” (Vassalotti, Stevens and Levey, 2007). It is obvious that such improvements and prolonged lives have not reached all patients. There are several challenges, which patients with renal problems still face because of their conditions. Such challenges leave the patient with “feelings of depression and fatigue” (Ivey and Lane, 2011).

Patients may experience changes in the body image due to “fistula or grafting for dialysis access” (Ivey and Lane, 2011). There are financial challenges because of weekly scheduled treatments and other emergency admission costs, which may result from renal complications. The condition also affects or threatens family relations and patient’s independence. Ivey and Lane noted that researchers have conducted several studies to identify factors, which may improve the quality of life of patients with ESRD.

Discussion of the epistemological and ontological congruence between currently accepted scientific world views, the nursing paradigmatic world view, and your own perspective of nursing for your area of interest

Stakeholders in ESRD management have carefully formulated the current methods or world views of managing and improving the quality of life among ESRD patients based on the recent knowledge in the field. However, according to the American Medical Association, these guidelines are “not standards of care, but are intended to assist practitioner and patient to make decisions about appropriate health care for specific clinical circumstances” (American Medical Association, 1996).

These practices recognize that every clinical condition has unique attributes with several factors, which are more than what researchers have published from their studies. Some of these factors may include “patient characteristics, choice of physicians, cultural beliefs, personal values, and education” (Kliger and Haley, 1999). In addition, other factors are mainly constraints, which include financial and public policies on a given condition among others.

Such guidelines have helped care providers make to complex clinical decisions when delivering care to ESRD patients. In most cases, the effectiveness of any clinical guideline for managing a given condition depends on specific attributes of the guideline. The ESRD guidelines derive their strengths from the prevalence of the ESRD condition, mortality, and morbidity, costs, competence of the existing scientific evidence, and potential improvements in ESRD patients.

Nurses have based their paradigmatic world views on existing best practices of improving quality of life among patients with ESRD. Kliger and Haley noted that improving “daily practice of medicine requires making changes in the processes of care” (Kliger and Haley, 1999). As a result, nurses have adopted the “process of plan, do, study, and act” (Kliger and Haley, 1999) when implementing the clinical guidelines for ESRD, which is an iterative process.

Studies have identified disparities in health care provisions with regard to racial and ethnic factors (Vassalotti et al., 2007). In order to improve quality of life for African American with ESRD condition, health care providers should “prioritize and implement guidelines based on the attributed evidence” (Kliger and Haley, 1999). The process must provide effective ways of improving practices, dissemination of such information, method of developing such evidence, and implementation strategies. Moreover, there should be clinical performance measures for evaluating such practices, outcomes, success, and proposing best practices.

Health care providers should take initiative, utilize the available dialysis facilities effectively, and apply continuous quality improvement methods when managing ESRD conditions among African Americans. Still, it is necessary to understand specific factors that influence the high rates of ESRD conditions among African Americans in order to develop clinical measures for them. In this process, health care providers and policymakers should participate in this process alongside their African American patients with ESRD conditions. Overall, they should acknowledge that these guidelines are not standard for Africa American patients with ESRD, but are provisions for helping clinicians make right decisions when providing care to improve the quality of life among patients.

Overall, Paraskevi Theofilou concluded that ESRD patients faced several challenges such as “physical symptoms, special diet schedules, changes in their body image while the outcome of treatment is not standard” (Theofilou, 2011a). In addition, there are sociodemographic factors like personal, social, professional, financial, and psychological aspects of life that ESRD patients experience regardless of race (Theofilou, 2011b).

How the quality of African Americans with ESRD diverge (ontological and epistemological incongruence) from world views

Most studies have shown that “African American patients with kidney disease in the US disproportionately bear the burden of this illness” (Unruh et al., 2004). The US Renal Data System report of 1999 noted that although African Americans made up “13 percent of the US population, they accounted for 30 percent of all kidney failure cases” (U.S Renal Data System, 1999). In addition, Max Reif noted that African Americans tended to “have higher rates of hypertension and diabetes, and one would expect a higher rate of kidney disease” (Reif, 2001). This also implied that African Americans had higher chances of developing ESRD conditions than other races.

World views focus on the provision of optimal care for ESRD patients. However, several claims have emerged, which inhibit best practices for African Americans patients with ESRD. For instance, Porter and colleagues noted that health-related Quality of life (HRQOL) practitioners and other stakeholders have poorly understood “patients with chronic kidney disease (CKD) prior to end-stage renal disease” (Porter et al., 2012).

In addition, studies have not fully explored the relation between the HRQOL and psychosocial factors, particularly among African American ESRD patients. Specifically, studies have concentrated on epidemiology, impacts, and treatment of depression among African Americans with ESRD. Kimmel, Patel, and Peterson noted that diminishing provisions of care to African Americans with ESRD were responsible for different outcomes as compared to other ESRD patients in the US (Kimmel, Patel and Peterson, 2002).

Other studies have also demonstrated that few studies have focused on management of depression among African Americans with ESRD. As a result, Kimmel and his colleagues recommended that treatment trials should also focus on “minority patients, patients with medical comorbidities, and the elderly, and assess function and quality of life as outcomes” (Kimmel et al., 2002). In addition, these authors also noted that studies have not determined other factors related to “age, marital status and satisfaction, ethnicity, and perception of quality of life and depressive affect level and diagnosis of depression, and medical outcomes in African-American patients with ESRD” (Kimmel et al., 2002) and other patients with similar conditions.

Overall, African Americans do not receive the best ESRD care due to poor understanding of their conditions, few studies in the area, diminishing quality of care, and multiple factors that contribute to their ESRD conditions.

The philosophical implications of using your selected world views (scientific, nursing and personal) to do the type of clinical research you envision with your population (qualitative)

African Americans bear the largest burden of ESRD conditions in the US. The condition progresses much faster among this population than the rest of the US population. Many factors causes ESRD among African Americans and the rapid progression of the condition, but earlier diagnosis and subsequent therapy can result in increased quality of life among African American patients with the ESRD condition. One must also understand that ESRD is a complex condition with numerous contributing factors. In the case of African Americans, studies have indicated that they experience high rates of “diabetes, hypertension, and cardiovascular diseases” (Unruh, Mark et al., 2004).

As result, a high rate of ESRD is likely to be common among them. In this regard, it is necessary for patients, health care providers, and other stakeholders to understand overall challenges, which African American with ESRD face. This is critical for improving the overall care for African Americans with ESRD. Such challenges arise due to unmet needs of African Americans with ESRD conditions during care provisions.

Given this knowledge and little research in ESRD among African Americans, a comprehensive care to African Americans can improve the quality of life among ESRD patients.

A qualitative study provides a comprehensive and aggressive focus on risk factors that aggravate ESRD in African Americans can enhance their quality of life. Psychological intervention for African American patients with ESRD is necessary because of high rates of depression (Kimmel, Patel and Peterson, 2002). In this context, communication with patients concerning risk factors is critical to their improvement. However, one must note that nurses and other care providers can greatly influence effective communication with such patients. Thus, developing a sense of trust is significant for ESRD patients. Family members can also take part by reinforcing the message in order to enhance the level of communication with the patients for optimum health care outcomes (Martins, Agodoa and Norris, 2012).

It is also important to monitor blood pressure among patients with elevated blood pressure levels and damaged organs. In addition, a combination of therapies to manage multiple factors among African American patients with the ESRD is also an appropriate approach. The patient management process should account for outcomes, complications, and observation of changes based on the required clinical guidelines. This is the best way of ascertaining the progress of the patient.

After effective clinical diagnosis of the patient, nurses must provide specific treatment options based on specific health care needs of the patient. Moreover, it is also necessary to account for the available resources for effective provision quality of care. This suggests that health care providers must assess each patient’s needs and then developed appropriate treatment. Nurses must also apply clinical guidelines on the effective treatment and management of ESRD among African American patients.

The researcher believes that a comprehensive qualitative approach to the study of ESRD management among African Americans can provide valuable information for improving the quality of life among these patients. A qualitative study would allow the researcher to provide in-depth information concerning the ESRD condition among African Americans. The author has based this argument on the philosophical perspective of Karl Popper, which notes that if certain conditions take place then the expected outcomes will also take place.

A summary the philosophical defense of the study through Karl Popper’s perspective

The researcher based this study on the prophecy idea of Popper i.e., one can know what “the future has in store for us, and that one can profit from such knowledge by adjusting our policy to it” (Popper, 1963). This philosophical claim posits that an effective application of the law of natural science can “lead to the successful prediction of such future events” (Popper, 1963), then it is appropriate for social scientists to apply such knowledge and assume that such concepts can lead to successful prediction of the future outcomes.

In this case, the researcher assumes that a qualitative study to ESRD conditions among African Americans would yield in-depth knowledge, which would be useful for improving the quality of life among African Americans with the ESRD condition. Popper’s concept looks at predictive factors and notes that if certain events take place, then other events will also take place, and this is “conditional scientific predictions and unconditional scientific prophecies” (Popper, 1963).

According to Popper, conditional scientific predictions fall under natural science, which may have a limited scope and conditions. Therefore, it assumes hypothetical concepts, which assert that the desired changes may only take place if specified prerequisite conditions are presents. In this regard, the researcher believes that African Americans with the ESRD condition can only realize improved quality of care and life when studies have identified factors that are responsible for their poor quality of life, and health care providers must implement such improvements in order to improve the quality of life.

Consequences and Relevance for Nursing Practice and Research

This article has demonstrated that African Americans have the highest prevalence of ESRD and renal conditions among the US populations. A number of factors are responsible for this condition. As a result, optimal care must account for conditions that worsen ESRD, such as barriers to health care, lifestyle, family support, communication, and other unhealthy behaviors, among African Americans. It is important to note that researchers have not evaluated “the long-term effectiveness and impacts of some interventions and their influences on clinical outcomes among patients of ESRD” (Kimmel et al., 2002).

Understanding these factors is important to health care providers, the patient, and other stakeholders like the family. Such knowledge is critical in enhancing the quality of life among ESRD patients. This study highlights how health care providers can improve the quality of patient’s health care and life by focusing on factors that aggravate ESRD conditions among African Americans. It also shows that patients are critical actors that health care providers must account for during medication. Patients must understand what risk factors may have adverse effects on the quality of their lives.

The study also highlights that the most important approach to enhancing the quality of life ESDR conditions should be based on an individual’s health conditions, risk factors, economic factors, and racial consideration because these factors influence adherence to medication and treatment.

References

American Medical Association. (1996). Attributes to Guide the Development, and Evaluation of Practice Parameters/Guidelines. Chicago, IL: AMA.

Ivey, T., and Lane, B. (2011). Quality of Life in Patients with End-Stage Renal Disease on Hemodialysis. Web.

Kimmel, L., Patel, S., and Peterson, A. (2002). Depression in African-American patients with kidney disease. Journal of the National Medical Association, 94(8), 92S- 103S.

Kliger, A., and Haley, W. (1999). Clinical Practice Guidelines in End-Stage Renal Disease: A Strategy for Implementation. Journal of the American Society of Nephrology, 10(4), 872-877.

Martins, D., Agodoa, L., and Norris, K. (2012). Hypertensive chronic kidney disease in African Americans: Strategies for improving care. Cleve Clinical Journal of Medicine, 79(10), 726–734.

Popper, K. (1963). Conjectures and Refutations: The Growth of Scientific Knowledge. London: Routledge.

Porter et al. (2012). Quality of life and psychosocial factors in African Americans with hypertensive chronic kidney disease. Transl Research,159(1), 4-11.

Reif, M. (2001). Kidney Failure Among African Americans. Web.

Theofilou, P. (2011a). Quality of Life in Patients Undergoing Hemodialysis or Peritoneal Dialysis Treatment. Journal of Clinical Medicine Research, 3(3), 132–138.

Theofilou, P. (2011b). The role of sociodemographic factors in health-related quality of life of patients with end-stage renal disease. International Journal of Caring Sciences, 4, 40–50.

U.S Renal Data System. (1999). USRDS 1999 Annual Data Report 1999. Bethesda: National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases.

U.S. Renal Data System. (2009). USRDS 2009 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

Unruh, M. et al. (2004). Racial differences in health-related quality of life among hemodialysis patients. Kidney International, 65, 1482–1491.

Vassalotti, A., Stevens, A., and Levey, S. (2007). Testing for Chronic Kidney Disease: A Position Statement From the National Kidney Foundation. American Journal of Kidney Disease, 50(2), 169-344.

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