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Cultural Diversity and Competence in Hemodialysis Patients Essay

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Updated: Oct 25th, 2019


The United States of America is the world’s largest and powerful state of the 21st century. The country has diverse races and tribes with completely different cultural norms. The US entails several white and non-white communities living in either similar state towns or cities.

According to prior studies on the American indigenous people and immigrants, non-white and other white immigrants are the most economically and politically disadvantaged people (Goode et al., 2007).

For numerous past decades, several negro-white communities have been fighting for equity in the US with cases of racial and ethnical disparities increasingly posing challenges to such communities.

Healthcare and quality of life, as one of the most crucial aspects in human life in the current century, face challenges from racial and ethnical differences in the US. Therefore, with respect to this scenario, this essay seeks to investigate the influence of cultural diversity and competence in African Americans and Hispanic hemodialysis patients.

Synopsis of African Americans and Hispanic

African Americans and Hispanic communities are among the earliest immigrants into the US. They arrived in the US either through slavery or through personal business interests. The two communities currently form the largest minority groups in the US with these groups currently representing almost one-third of the entire US population.

Since their entry in the US, the two groups collectively with other immigrants that make up communities in the country have suffered racial, ethnical, and even political discrimination.

They share different cultural norms with the Native American communities, which really disadvantages them and Dees (2007, p. 35) defines this element as “the learned and shared beliefs, behaviors and attitudes by members of a group” (p.35).

However, according Pokras et al. (2009), there is a considerable change in racial and ethnical disparities issues in the US, with great political changes influencing the situation, as cultural issues are becoming the latest challenge in improving healthcare delivery.

Synopsis on Hemodialysis

Hemodialysis refers to a special treatment method that involves extra bodily and corporeal removal of waste products from patients, especially after complete renal failure. Principally, it entails providing care to patients suffering from End-Stage Renal Disease (ESRD).

Green and Brown (2010) posit, “ESRD is an incurable, life-threatening disease marked by permanent cessation of kidney function” (p.38). Due to this condition, patients suffering from this ailment normally receive treatment routinely in dialysis outpatient facility or less frequently at their homes from assigned caregivers/nurses.

ESRD is among the chronic diseases greatly threatening human life. Therefore, to provide optimal care to patients of this nature, it requires dedicated, non-biased, and caring healthcare workers who are capable of centering on “quality of life” as the primarily compelling objective.

According to Green and Brown (2010), hemodialysis is one of the medical technology advancements emerged with a primary aim of providing life-sustaining treatment, which influences human perceptions on end of life, especially to patients suffering from ESRD.

Health Disparities

Conventionally, all minority groups in the US have suffered racial, ethnical, and political disproportions for numerous decades since they arrived in the country.

Broad research has revealed great differences between immigrant communities and the Native American in social-economic aspects, including wealth, poverty, education, literacy, and occupation (Braveman et al., 2009). These factors greatly influence the level of care on minority groups.

The situation of alienation and racial differences grew gradually throughout decades and a relief of this situation became eminent in the recent past when human rights organizations protested against such acts.

Among the differences, the most seriously debated racial discrimination is one pertinent to healthcare issues, which has existed in several healthcare settings. According to Goode et al. (2007), healthcare and ethnical inequalities among minority groups, including African Americans and Hispanic communities are evident.

Like any other area of medicine, minority groups have experienced discrepancies in hemodialysis and other renal treatments in the US.

Healthcare discrepancies pertaining hemodialysis treatments amid African Americans and Hispanic have existed throughout the American healthcare system and many other departments associated with offering public services.

According to research studies conducted by Mead et al. (2008, p. 44), “minority Americans are more likely to have problems accessing high-quality health care than whites.”

Coupled with numerous socio-economical factors and challenges associated with insurance status, which are renowned significant and powerful predictors of the level of access to healthcare, these communities generally receive poor health care services and attention.

Despite biased studies retaliating with approaches to investigations undertaken on the prevailing health status of minority groups, disparities in access to health care still exists in different health care settings across the US (Mead et al., 2008).

Health disparities are mainly influenced by socio-economic and ethnical bias. Estimates reveal that families of African American and Hispanic background with incomes below 200 per cent of the poverty level are 26 per cent susceptible to chronic conditions.

Consequently, cultural and racial differences are likely to influence the socio-economic condition of African American and Hispanics.

Common Factors Influencing Disparities

The level of treatment and its success depends on certain factors, which are of both human and economical nature. Research has proved that several African Americans and Hispanics have exposure to similar factors that affect treatment and health care delivery in hemodialysis and kidney-related treatments.

Several cultural factors bar African Americans and Hispanics from being competent in hemodialysis.

Goode et al. (2007) comprehensively outlined cultural factors that affect dialysis treatment as, “patient’s health beliefs and practices, socio-economical status, adherence to therapy, previous experiences with discrimination, lack of trust in healthcare providers, provider’s bias, and linguistic incompetence” (p. 268).

With all these factors, health care providers in dialysis section meet different persons with different cultural norms and different racial and ethnic backgrounds.

For health care professionals to execute their duties diligently, there should be fewer barriers pertaining to cultural factors, since in most institutions, it is not always under the course requirements, thus standing out as a challenge to handle cultural issues in the healthcare profession.

Cultural/Ethnic Influences on Healthcare Delivery

In a bid to assess how cultural and ethnic differences influence treatment outcome in dialysis care, this paper begins by discussing the patients’ socio-economic status. Hemodialysis has proven as the most challenging process that requires extracorporeal removal of waste products when kidneys are in a state of renal failure.

According to Greene & Brown (2010), hemodialysis process routinely operates in a dialysis outpatient facility and sometimes done at home, and thus it requires special medical care that normally calls for stable financial wellbeing in both areas.

African Americans and Hispanic patients are socio-economically disadvantaged (Warrier, n.d.). According to Goode et al. (2007), there are quite big socio-economic differences between African Americans and Hispanic immigrants and their native white counterparts in the US.

In the United States, personal economic status further reflects on the type of healthcare services and access to health care amidst individuals since it depicts personal ability to maintain health care necessities like health care insurance, among others.

Still, on socio-economic factors, ethnic and racial disparities greatly attribute to the inability to finance healthcare insurance supportive services, unemployment, and low wage earnings, and thus, such factors are influential on this matter.

Goode et al. (2007) research estimates that clinicians are much aware that over 47 million Americans (approximately 90 per cent of white Americans have well-paying jobs), but without health insurance, while 20 to over 40 million of them are under-insured.

The situation is even worse to the American immigrants, as estimates reveal that 30 per cent of Hispanics and 20 per cent of African Americans in their entire populace in the United States are under-insured, compared to 12 per cent of white patients (Goode et al., 2012).

Similar investigations have demonstrated similar results on studies conducted on healthcare disparities. Dees (2007) affirms, “Currently, 12 per cent of the US population lives in poverty, and 15 per cent lacks health insurance, with more ethnicities disproportionately poor” (p. 38). Being among health care predictors, socio-economic factors are responsible for the non-whites incompetence in hemodialysis.

Communication and Linguistic Competence

Another important aspect in dialysis care that affects the quality and competence of African Americans and Hispanics in the US relates to communication and linguistic competence.

For any health care professional to execute proper treatment to patients requiring any form of treatment, including dialysis care, apposite communication is essential for better patient outcome.

Research has cited lack of patient’s communication competence as one of the factors that affect health care workers’ commitment to providing quality health care and solving patients’ problems.

With respect to African Americans and Hispanic patients within dialysis outpatient facilities and other areas of treatment, research conducted by Mead et al. (2008) demonstrates significant evidence over communication incompetence of the two minority groups.

Mead et al. (2008) further postulate, “Communication barriers due to language issues may also influence whether minorities can get high-quality health care” (p. p.10).

On the other hand, Dees (2007) recognizes differences in communication patterns among several immigrant and native communities as contributing factors to ethnic and racial disparities.

Lack of Trust in Healthcare Providers

For any successful medical treatment, there must be great trust and faith between the health care service provider and the patient.

Due to the long-term prevailing ethnic and racial disparities among African Americans and Hispanic communities against Native Americans, receiving quality treatment among the mentioned minorities remains a challenge (Dees, 2007).

Coupled with communication and linguistic barriers between the two groups and healthcare professional of which Native Americans form the majority, achieving better results in dialysis care for these groups becomes a contentious issue.

Following the experiences of injustices and inequalities practiced against the minority groups, including alienation and hostilities on African Americans, there exists high distrust and mistrust against white health care practitioners.

Dees (2007) affirms, “Others (referring to patients) mistrust the healthcare system, such as African-Americans who are keenly aware of past injustices” (p. 36).

Similar results are eminent in studies conducted by Pokras et al. (2009), which recognize mistrust as one of the inhibiting factors that have persistently hampered achievement of better patient outcomes in hemodialysis.

Provider’s Bias

Research has cited health care providers attitudes, perceptions, notions, and believes towards patients as key determinants of patients’ treatment outcomes.

For several decades, the ethnic and racial disparities that subsisted between the minority groups and the Native Americans resulted to negative stereotypes that consequently affected clinical decision making among clinicians.

It is important to note that the white Americans mostly occupy the majority of these clinicians’ positions. Stereotyping refers to the assumption that every individual of a culture must behave alike (Steele, 2010).

According to Pokras et al. (2009), stereotyping and biasness are major factors underlying health care disparities that have hampered efforts to achieve equity in medical care, including hemodialysis treatment.

Negative stereotyping affects the social, psychological, and cognitive functioning of practitioners, which influences their medical decision-making against patients, thus affecting critical decisions, including those pertinent to dialysis care.

According to Pokras et al. (2009), intellectual studies and reports documented by the National Healthcare Disparities and Physicians for Human Rights of America on healthcare disparities among American immigrants reveal that stereotyping and biasness persist in healthcare providers and clinicians.

Previous Experiences with Discrimination

Almost each individual from either African Americans or Hispanic communities in the US has suffered racial discrimination and prejudice practically or s/he has been affected by historical perceptions. Discrimination primarily defines unequal treatment, especially based on individual cultural group.

According to studies conducted by Braveman et al. (2009), individuals who have suffered racial discrimination before normally demonstrate signs of fear or psychological discomfort, while handled by service providers of their rival race.

Previous experiences of patients who suffered prejudice are most likely to affect their level of outcome, as their attitudes negatively affect their quality of care. End-Stage Renal Disease (ESRD) is one of the chronic diseases normally associated with poor financial conditions, which are part of racial discrimination.

However, Mead et al. (2008) assert that current efforts have focused on “quality measurement, provider feedback, and education resulted in significant improvement for all patients” (p. 96). Nonetheless, there is lack of proper evidence to substantiate the extent of government concern on this issue.


African American and Hispanics coupled with other minority groups residing in the US as permanent citizens have suffered racial and ethnical disparities for several decades.

Due to their cultural background, the two groups have undergone racial, social, political, and economic inequalities, which projects to important issues involving health care provision (Pokras et al., 2009).

Health care disparities have been eminent in almost all sectors of medical settings in the US, with their impact standing out conspicuously in the area of hemodialysis.

Hemodialysis, which is a medical technology that emerged primarily to enhance life-sustaining treatment, has been significant in improving the quality of care in suffering from End-Stage Renal Disease (ESRD).

According to Goode et al. (2009), several factors attribute to racial and ethnic disparities including “patient’s health beliefs and practices, socio-economical status, adherence to therapy, previous experiences with discrimination, and lack of trust in healthcare providers, provider’s bias, and linguistic incompetence” (p. 268).

However, despite the level of socio-economic disadvantage reducing to a certain extent due to enhanced quality measurement, provider feedback, and education between service providers and patients, racial discrimination against African Americans and Hispanics still exist.

Without proper interventions by the US government with the help of other stakeholders over healthcare disparities affecting minority groups in the country, especially on chronic infections, the situation might persist even in generations to come.


Braveman, P., An, J., Williams, D., & Egerter, S. (2009). Race and socioeconomic factors affect opportunities for better health. Princeton, NJ: Robert Wood Johnson Foundation.

Dees, L. (2007). Culturally competent care in the emergency medical services. Texas EMS Magazine, pp. 36-39.

Goode, D., Isaacs, R., & Hricik, D. (2007). Ethnic and racial diversity in transplantation: Does everyone benefit equally. John Hopkins Advanced Studies in Medicine, 7(9), 268-274.

Greene, M. R, & Brown, D. R. (2010). Cultural competence and health disparities: Seeking to make a difference in our communities. Web.

Mead, H., Cartwright-Smith, L., Jones, K., Ramos, C., Woods, K., & Siegel, B. (2008). Racial and ethnic disparities in the US health care: A Chartbook. The Commonwealth Fund, 17, 36-42.

Pokras, O. C., Lie, D., & Núñez, A. (2009). 2008-2009 physician update: Cultural Competency. Web.

Steele, C. (2010). Whistling Vivaldi: And other clues to how stereotypes affect us (Issues of our time). New York, NY: W. W. Norton & Company, Inc.

Warrier, S. Culture what it is, who owns it, claims it, changes it. Web.

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