As I read through the article, the first question that came into my mind was why African-Americans treated by hemodialysis lived longer than whites. Another question that came into my mind was why whites withdrew from dialysis treatment and preferred replacement therapy more than African-Americans.
As I continued reading the article, I found out that African-Americans had a higher health-related quality of life (HRQOL) than non-African-Americans, and this contributed to their long survival. Some factors that influenced the level of HRQOL among the two groups were psychological wellbeing and overall life satisfaction. According to Unruh, Miskulin, Yan, Hays, Benz, Kusek, and Meyer (2004), the psychological well-being of African-Americans seemed more preserved on the treatment of chronic hemodialysis than non-African-Americans, and African-Americans seemed to take kidney failure as comparatively less of a problem than non-African-Americans. Consequently, African-Americans experienced fewer kidney disease symptoms and better physical well-being than non-African Americans.
I also found out that racial differences in life quality influenced the continuation or withdrawal of dialysis therapy. According to Unruh et al. (2004), non-African-Americans withdrew from dialysis treatment more regularly than African-Americans. On the other hand, African-Americans seemed less susceptible to a decline in life quality than non-African-Americans, even as comorbidity exacerbated. Also, better HRQOL on hemodialysis among African-Americans influenced renal replacement therapy choice and made them delay listing for kidney transplantation.
Discuss how content in the Article Relates to Issues we have discussed and the Course Objectives in Predicting Potential Areas of Conflict with Patients and Families
Treatment and characteristics of end-stage renal disease (ESRD) are usually devastating, and they affect activities of daily living as well as social relationships (Steele, 2010). Differences in expectations during social support between patients and their relatives occur when patients anticipate reduced lifestyle changes, but their support system is unaware of how to handle the patients’ treatment and nutritional needs.
Appreciating that dialysis patients need diverse forms of social support has significant clinical inferences. Clinicians should adapt intervention programs to enhance social support depending on the needs of patients needs. Examples of intervention programs may include psycho-educational programs and self-help groups intended to support self-value in managing dialysis. Clinical caregivers should also explain to family caregivers and patients the relational factors drawn in lifestyle change, besides giving suitable medical information about lifestyle changes caused by dialysis. Families and patients should get informed on possible conflicts that could occur when communicating support and encouragement for lifestyle changes.
The perception of patients about the efficiency of their social support could be used to foresee mortality. Diverse social support features have different heights of significance to the patients. Besides, the social company is significant to patients suffering from chronic diseases. Patients feeling separated, socially, may experience anxiety and stress, which in effect can create physiological changes like the weakened immune system. A weakened immune system is likely to cause high rates of mortality and morbidity. Anxiety and stress among these patients may arise from guilty feelings for being a burden to others. To enhance the long-term effect of patients with dialysis, the psychological preparation of patients for the demands of dialysis treatment should form a basic element during clinical care.
When giving care to dialysis patients, clinicians and other caregivers must pay attention to language and culture. The greatest mistake that clinicians can make is to assume that cultures are similar. Clinicians must know that patients hold different beliefs and that the ethnicities of patients could differ from their cultures. It would be extremely wrong for any caregiver to assume that the beliefs of a patient are similar to his, or to ignore the cultural practices of the patient. Regarding language use, it would be wrong for any clinician or caregiver to use informal languages in the area of treatment. Besides, caregivers must avoid using jargon and technical language during communication with these patients. Again, caregivers should not think that patients with limited English ability have inferior levels of cognition.
There are several practices that clinicians and caregivers can adapt when treating dialysis patients. To start with, caregivers and clinicians can look for information on the cultural beliefs and extent of acculturation of the patient in efforts to create rapport, sincerity, and a trusting relationship. Besides, caregivers and clinicians can make use of alternative beliefs held, by the patient, to create solutions to possible obstacles and meet the patient’s needs. In other words, they can try to comprehend patients’ beliefs ahead of trying to change the health practices of patients. Comprehension of such beliefs could be realized after considering the individuality of the patient against his or her cultural group.
Also, caregivers and clinicians can communicate understanding and acknowledgment of the patient’s worldview. This may entail helping the patient to perceive education as culturally relevant to him, or her by explaining that the materials and care given to them are universal. Lastly, caregivers and clinicians should respect family members or relatives and define their roles in the healing process. Professional care and concern are valuable while carrying out these practices.
Steele, C. (2010). Whistling Vivaldi: And other clues to how stereotypes affect us. New York, NY: Norton & Company.
Unruh, M., Miskulin, D., Yan, G., Hays, R., Benz, R., Kusek, J., & Meyer, K. (2004). Racial differences in health-related quality of life among hemodialysis patients. Kidney International, 65, 1482-1491.