In the contemporary society, diabetes is one of the chronic diseases that can seriously affect the well-being of different individuals and communities. At the same time, another negative issue associated with this disease is its ability to cause dysfunctions of different organs and systems. Apparently, kidney injury and chronic kidney disease are one of the main risks for different patients, who have diabetes. At the same time, some ethnic communities, such as African Americans, have a higher risk of developing a kidney dysfunction in the case of having diabetes. For this reason, this population group requires a community support program based on the analysis of statistic and scholarly evidence related to the correlation between diabetes and chronic kidney injury or chronic kidney disease. The analysis of this correlation for the patients of African-American ethnicity demonstrates that they represent a risk group for having kidney damage as they have diabetes. Therefore, this community would benefit from participating in a program, which combines the education of nurses and patients of the means of avoiding the development of chronic kidney disease, as well as having increased access to the health care services of high quality.
The community selected for the research of the correlation between diabetes and chronic kidney damage is the US individuals of the African-American descent. According to the popular statistic resources, the percentage of African Americans in the US constituted 12.4% of all the population in 2014 and is projected to reach approximately 13% in 2060 (“Percentage Distribution of Population in the United States”, 2017). The reason for the selection of this community is the fact that it is a risk group for different adverse chronic health conditions when compared to other ethnic and racial groups in the US. The most recurrent health disorders for African Americans in the US include various endocrine disorders, among which a statistically high incidence of diabetes is the most actual issue (Spanakis & Golden, 2013). The common risk factors that make this problem relevant to the African-American population in the US include biological causes, such as insulin resistance, obesity, poor glycemic control and genetics (Spanakis & Golden, 2013). In its turn, a close connection between the incidence of diabetes and chronic kidney disease allows presuming that the investigation of the issue would lead toward the development of an effective proposal that decreases the revealed risks.
The analysis of the correlation between the incidence of diabetes and chronic kidney disease (CKD) revealed that this correlation is positive, which is why African Americans should be the focus of research devoted to the search for the prevention of CKD. The relationship between the two adverse health conditions is positive due to specific molecular mechanisms that damage cells, organs, and body systems responsible for glycemic and blood pressure control, increasing the pressure on kidneys (Reidy, Kang, Hostetter & Susztak, 2014). Thus, in the case of the development of an effective evidence proposal directed toward the reduction of health risks for African Americans, the selected community would become free from the risk of CKD.
The Major Public Health Threat
According to scholarly and statistic investigations, diabetes-associated chronic kidney disease or damage is a major risk factor in the representatives of African-American ethnicity with diabetes. For instance, according to the retrospective research of 180,429 hospitalizations by Heung, acute kidney damage was in 23.2% of the African-American patients whereas in their Caucasian counterparts, this ratio was 18.5% (Charnow, 2015). Similarly, African-American ethnicity was independently associated with a 26% increased risk of acute kidney injury compared to the Caucasian population (Charnow, 2015). Other investigations revealed that the relevance of this health disparity for the African-American patients is even graver. African-American representatives are twice as likely to be diagnosed with diabetes and have an increased incidence of CKD by 35% if compared to Caucasian patients (“African Americans and Kidney Disease”, 2016). Similarly, the individuals of African-American descent are more likely to develop complications induced by diabetes than the representatives of other races and ethnicities (“African Americans and Kidney Disease”, 2016). These complications are often serious and decrease the quality of life of a person or lead to a disability.
Numerous modern investigations revealed that African-American ethnicity faces a risk factor for chronic kidney disease, which is often connected with diabetes due to various aggravating factors. For instance, African-American individuals have a five-time higher risk for developing a hypertensive end-stage renal disease (ESRD) caused by diabetes and CKD, which leads to increased cardiovascular morbidity and mortality (Kazancioğlu, 2013). In addition, the modern investigations of this problem revealed that “the lifetime risk of ESRD was 7.8% for 20-year-old black women, 7.3% for black men, 1.8% for white women, and 2.5% for white men” (Kazancioğlu, 2013, p. 370). In addition, the representatives of the analyzed community have other risks that add to the problem increasing its statistic incidence.
The most recurrent risk factors that aggravate the incidence of CKD associated with diabetes in African Americans include genetics, family factors, and excessive body weight, smoking and other. Thus, for the analyzed population, the genetic causes of CKD are especially relevant. For example, according to the report of the American Society of Nephrology, the individuals of African-American ethnicity often carry specific gene variants such as apolipoprotein L1 and other, which are associated with the degradation of kidney functions as well as diabetes (“Blacks Face a Higher Risk of Kidney Failure than Whites, Regardless of Genetics”, 2016). Along with this, experts presume that the increased incidence of diabetes-associated CKD is also linked to poor a socioeconomic status and poor quality care, which aggravate the problem of iatrogenic acute kidney injury (Grams et al., 2014). Consequently, scholars are aware of the problem of special relevance of diabetes and CKD for the African-American individuals. Although some of the experts state that the knowledge of the exact etiology of acute kidney damage still lacks evidence, they recognize that there is a clear connection between race and ethnicity and the statistic of recurrence of CKD and diabetes (Grams et al., 2014). Therefore, this problem requires developing a specific approach that would lessen the risk of developing CKD by the African-American patients, who have diabetes.
The Implications of QSEN Initiative
For the mitigation of the selected public health threat, the QSEN initiative is a valuable step that allows achieving different positive outcomes in the African-American patients. Such a perspective is real due to the fact that it is directed toward preparing nurses, who have the required knowledge, skills, and attitudes for the continuous development of care and safety of the healthcare systems (“QSEN”, 2017). The mission of QSEN is the collaboration with different clinical professionals for the improvement of quality and safety of healthcare systems (“QSEN”, 2017). As a result, it can organize and promote the collaboration between healthcare scholars and practicing clinicians in order to reduce the risks of developing CKD in patients of African-American ethnicity. It can achieve this effect by teaching core QSEN competencies, offering effective strategies for teaching the target population, providing resources for the support of the selected goal and other (“QSEN”, 2017). Therefore, the QSEN initiative can be a mediator and facilitator of the improvement of the healthcare issues related to a high incidence of diabetes-associated CKD in the African-American citizens of the US.
An Evidence-Based Policy Proposal
The analysis of diabetes-associated chronic kidney disease as the major health threat for the representatives of the African-American population revealed that it would require a policy that would allow lessening the number of the most typical risk factors associated with CKD and ethnicity. Since it is impossible to change genetic and family history-associated risks for CKD in African Americans, the proposed policy should allow mitigating the problem in other ways. In this respect, Grams et al. (2014) offer a valuable insight into the problem presuming that, for African Americans, health care use and implementation are positively associated with the risk for the development of acute kidney disparities. In particular, the scholars revealed that African Americans have restricted care access to care when it comes to using Medicare insurance (Grams et al., 2014). This restriction leads to the fact that African Americans often cannot afford to buy medications they require for controlling their glucose level in blood or blood pressure as well as using different medical services. Consequently, the African-American population should be recognized as the one endangered by higher risks for diabetes and acute or chronic kidney disease. In its turn, such recognition should lead toward the reduction of the cost of care for the African-American patients, who cannot afford to pay for medications and procedures that constitute comprehensive CKD-prevention programs.
Furthermore, the second part of the proposed policy should be directed toward the education of the strategies for the prevention of CKD of the African-American patients with diabetes. The proposed education program should be designed in cooperation with QSEN, which may supply different I systems used for nurse and patient education purposes, training of interdisciplinary teams, the promotion of autonomous care etc. The reason for it is that for the prevention or restriction of the development of CKD, the target patient community has to increase awareness of such areas as “vigilance for the onset of proteinuria, aggressive control of blood pressure, drug treatment to block the renin-angiotensin system, and attention to lifestyle factors” (Martins, Agodoa & Norris, 2012, p. 726). Thus, patients require education in the spheres of blood pressure control and reduction, the approaches to monitoring the work of body systems related to CKD, the aspects of the autonomous use of medications and other. In its turn, this knowledge should be given to patients by competent nurses, who should undergo specific CKD-related training in assistance with QSEN.
The proposed policy should lead to positive outcomes in the African-American community as it would protect it from a variety of risk factors associated with diabetes-induced chronic kidney disease and kidney injuries. On the one hand, such patients would have increased access to care related to glucose and blood pressure level monitoring and mitigation or prevention of negative health conditions, such as hypertension. On the other hand, the patients would obtain the education of the basics of autonomous self-monitoring, healthy lifestyle, and care related to kidney function and the functions of organs and systems related to CKD. Consequently, the proposed evidence-based initiative would allow individuals of African-American ethnicity with diabetes to avoid the risks of developing kidney injuries leading to CKD.
The analysis of the problem of the correlation between diabetes and chronic kidney disease in the patients of African-American ethnicity revealed that this community requires considerable support. The reason for this support is a high statistic prevalence of CKD in patients of African-American ethnicity with diabetes due to the number of specific risks. These risks include family history, genetic factors, lifestyle habits, smoking, and education, access to the high-quality health care services and medications and other. Consequently, this population group requires an evidence-based community support program directed toward the increase of education of nurses, who treat patients with CKD and diabetes. At the same time, the analyzed community requires an improved access to health care services and medications due to the fact that they often face restrictions in this sphere. Consequently, the proposed program would allow meeting the healthcare needs of the target community, as they would avoid the risks of developing diabetes-associated kidney dysfunctions and complications.
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