Background
Minority populations in the United States face challenges accessing health centers that are capable of solving their health problems. This is because many African Americans and Latinos do not have access to health insurance coverage. Research on African American and Latino’s access to coverage shows that 20% of African Americans and a third of Latinos do not have access to health insurance (Hounkpatin et al., 2020). This poses a significant health risk to their populations because it denies them the chance to discover and treat chronic kidney disease (CKD). According to research by Murphy et al., (2020), 13.1% of Latinos and 13% of African Americans develop CKD, which leads to a high number of deaths among adults.
Clinical Problem Statement
When the rates are compared with white Americans, the data shows that the disease is more common in marginalized populations (Longino & Kramer, 2020). This can be attributed to years of health disparities between white Americans and minority groups such as Latinos and African Americans. Research shows that economic and psychosocial barriers contribute to African Americans seeking help close to the last stages of the disease (Norton et al., 2016). Therefore, interventions need to be developed to ensure that the rates are reduced in minority groups.
Purpose of the Change Proposal
The purpose of the change proposal is to recommend a solution that will help address the problem of chronic kidney disease among African Americans and Latino communities. Research indicates that there is a significant discrepancy in the occurrence and outcomes of CKD among black and white Americans (King et al., 2018). It is important to address the problem because chronic kidney disease leads to high mortality rates among minority groups (Dean, 2020). In most American hospitals there is a lack of nurses who are adequately trained to handle patients with kidney disease (Hounkpatin et al., 2020). Nurses are central in helping patients understand their ailments and access the care they need.
PICOT Question
In African American and Latino populations, does the implementation of specialized education on CKD in these populations for nurses, compared to no specialized education, improve patient outcomes for people with CKD, in six months? The aim is to assess whether improving nurse’s education can have an impact on the occurrence and outcome of CKD in the two minority groups. Nurse education has been identified as the intervention measure that can solve the problem of CKD (Tachtsoglou et al., 2019). This is after a review of the literature showed that there is a deficit of nurses who are specialized in kidney disease in American hospitals.
Literature Search Strategy
The literature search was conducted on two topics that are central to the issue being addressed. The criteria used for choosing the journal articles involved three key elements which are the year the journal was published, the research design, and the method/instrument used. The search was focused on journal articles that were not more than 5 years old. The research design was important because it was essential to find relevant information on the occurrence and outcome of kidney disease and diabetes among African Americans and Latinos. One of the topics was diabetes and kidney disease among African American and Latino communities. It is essential to understand the impact of the problem before coming up with a solution. The next topic used for the literature search was how specialized nursing education can reduce deaths through kidney disease in minority groups. The aim was to identify the current knowledge on specialized nursing education as a way of reducing kidney disease.
Evaluation of Literature
Health promotion behaviors are an important aspect in preventing and reducing the occurrence of lifestyle diseases in older adults. Research by Iddrisu et al., (2020) indicates that factors such as eating habits, ethnicity, and education level correlate with older adults being diagnosed with diseases. Helping elderly people understand the causes of kidney and diabetes can help reduce mortality rates. A study by Ali et al., (2016) shows that people with a younger immigration rate in the African American community were likely to develop kidney disease. However, the study focused on 100 immigrants who were from sub-Saharan Africa. The African American community is disproportionately affected by chronic kidney disease because of years of health disparities (Levey et al., 2020). According to Dean (2020), there is a positive correlation between race and predisposition to kidney and diabetes. High-quality service by nurses improved the conditions of the Hispanic and African Americans who participated in the study (Dean, 2020).
Patients with CKD and diabetes may experience unmet needs which may limit their ability to recover. Research by Anders et al., (2018) shows that cardiovascular mortality and progression of kidney disease to tertiary stages are the two main unmet needs in patients with CKD and diabetes. Nurse education can help address the unmet needs of patients with kidney disease and diabetes (Thaha et al., 2019). African Americans are less aware of CKD which makes the mortality rates higher in the community (Murphy et al., 2020). Communication is one of the ways which nurses can use to help increase awareness of CKD in minority communities. Patients with CKD have a risk of developing other illnesses such as diabetes and cardiovascular illnesses (Melgaard et al., 2018). Improving the health facilities closer to the African Americans and Latinos can help reduce the occurrence of CKD.
Nursing Theory Utilized
The nursing theory applied in this project will be the self-care nursing theory developed by Dorothea Orem. The theory notes that the nurse’s role should be focused on helping patients be self-sufficient and responsible for their care (Santos et al., 2017). The self-care theory propagates the idea that people should know about their health issues to enable adequate self-care (Santos et al., 2017). This theory will be essential to the project because it requests nurses to provide patients with information that will enable them to achieve self-care once they leave the hospital. This can be an important step in reducing the rates of occurrence of kidney disease among African Americans and Latinos.
Implementation Plan
The project aims to improve the quality of services for patients with chronic kidney disease among African Americans and Latinos. Specialized courses will be created for nurses so that they can acquire more knowledge about kidney disease. Hospitals will be required to transition fully to electronic medical record systems to enable patient’s information to be stored and retrieved easily. Most of the clinics close to the African American and Latino communities will benefit by having electronic medical records. To assess whether the measures are working data will be collected and analyzed. It is expected that the rate of occurrence of the disease within the two communities will reduce. Nurses will be more prepared to handle patients with kidney disease. The occurrence rate of kidney disease and mortality rate due to the disease will be assessed.
Evidence-Based Practice
The intervention plan is based on two issues which are nurse education and electronic record keeping. One of the problems identified is that nurses handling kidney disease are not adequately trained. Nurses are supposed to undergo continuous training that covers emerging issues in their fields (Tachtsoglou et al., 2019). This will enable them to broaden their knowledge about key issues on renal disease. Electronic record management in hospitals has assisted hospitals to prevent misdiagnosis and increase efficiency (Reis et al., 2017). Hospitals are advised to migrate their records to the electronic system to enable proper planning.
Evaluating the Proposed Intervention
The nurses will be given a questionnaire that will help provide information on the process of intervention. The community will also provide their feedback through surveys that will help in understanding whether their awareness of CKD has increased. Patients who access the hospitals for treatment of kidney disease can fill out a questionnaire at the end of treatment. Data on the occurrence rate of the disease over a period of 6 months will be collected to assess whether the rates are reducing.
Potential Barriers
One of the potential barriers may be a lack of cooperation from the nurses. This can happen when the proposed change is not communicated clearly to the nurses. People react differently to change and it is important to ensure that all the people are aware of the proposed intervention (Coleman et al., 2017). This barrier will be averted by providing all the needed information to the nurses participating in the change. Another barrier may be a lack of trust from the community. The community being focused on may harbor differences which may make it hard for the intervention to work properly. However, by using community health workers as a bridge between the hospitals and the community it will be easy to gain their trust.
References
Ali, M., Mwendwa, D. T., Sims, R., Ricks, M., & Sumner, A. E. (2016). Age at immigration and kidney function among self-identified healthy Africans in the United States. Journal of Immigrant and Minority Health, 18(1), 194-201.
Anders, H., Huber, T. B., Isermann, B., & Schiffer, M. (2018). CKD in diabetes: Diabetic kidney disease versus nondiabetic kidney disease. Nature Reviews. Nephrology, 14(6), 361-377.
Coleman, S., Havas, K., Ersham, S., Stone, C., Taylor, B., Graham, A.,… & Bonner, A. (2017). Patient satisfaction with nurse‐led chronic kidney disease clinics: A multicentre evaluation. Journal of Renal Care, 43(1), 11-20.
Dean, E. (2020). Acute kidney injury: Who is at risk and how to care for patients. Nursing Standard, 35(5), 67-68.
Hounkpatin, H. O., Fraser, S., Honney, R., Dreyer, G., Brettle, A., & Roderick, P. J. (2020). Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review. BMC Nephrology, 21(1), 217.
Iddrisu, M. A., Abdelhak, S., Saidatulakmal, M., Ramendran a/l SPR, S. C., Yip, C. Y., & Lau, L. S. (2020). The impact of HPB on elderly diseases (diabetes mellitus, hypertension, hypercholesterolemia, minor stroke, kidney failure, and heart problem): A logistic analysis. Ageing International, 45(2), 149-180.
King, C. J., Moreno, J., Coleman, S. V., & Williams, J. F. (2018). Diabetes mortality rates among African Americans: A descriptive analysis pre and post-Medicaid expansion. Preventive Medicine Reports, 12, 20–24.
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Melgaard, L., Thure, F. O., Skjøth, F., Christensen, J. H., Larsen, T. B., & Gregory Y.H. Lip. (2018). Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: A nationwide cohort study. ESC Heart Failure, 5(2), 319-326.
Murphy, K. A., Greer, R. C., Roter, D. L., Crews, D. C., Ephraim, P. L., Carson, K. A., Cooper L. A., Albert M. C., & Ebony, B. L. (2020). Awareness and discussions about chronic kidney disease among African-Americans with chronic kidney disease and hypertension: A mixed-methods study. Journal of General Internal Medicine, 35(1), 298-306.
Norton, J. M., Moxey-Mims, M. M., Eggers, P. W., Narva, A. S., Star, R. A., Kimmel, P. L., & Rodgers, G. P. (2016). Social determinants of racial disparities in CKD. Journal of the American Society of Nephrology: JASN, 27(9), 2576–2595.
Reis, Z. S. N., Maia, T. A., Marcolino, M. S., Becerra-Posada, F., Novillo-Ortiz, D., & Ribeiro, A. L. P. (2017). Is there evidence of cost benefits of electronic medical records, standards, or interoperability in hospital information systems? Overview of systematic reviews. JMIR Medical Informatics, 5(3), e7400.
Santos, B., Ramos, A., & Fonseca, C. (2017). Training to practice: Importance of Self-Care Theory in Nursing Process for improving care. Digital Repository of Scientific Publications.
Tachtsoglou, K., Lera, M., Iliadis, C., Frantzana, A., & Kourkouta, L. (2019). Evaluation of continuing nursing education. Progress in Health Sciences, 2, 37-42. 10.5604/01.3001.0013.7223
Thaha, M., Kadariswantiningsih, I. N., & Empitu, M. A. (2019). Association of high blood pressure with elevated oxidative stress, an inflammatory marker, and albuminuria in chronic kidney disease patients. Journal of Medicine, 20(1), 12-18.