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Decreasing Health Disparities Among African Americans Essay

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Updated: Mar 15th, 2020


The United States still remains the most powerful country in the world in this 21st century. According to the research by Sagar (2012), this country has the highest number of immigrants making it a country with almost all the ethnic groups from all over the world. One such immigrant group that came to this country several years before the independence were the blacks.

They later became part of the citizens of this country, known as the African Americans. The United States has witnessed a long period of racial discrimination for a very long period. It is the African Americans who have been on the receiving end in this racial discrimination. They are the group that for a long time were considered inferior to any other race in the world.

They have been receiving the poorest of services in all the facilities such as hospital care, schooling, and such other related activities. This vice has been fought for several years, and although the current society is considered free from this vice, there is still some level of mistrust that a section of the African Americans feels towards medical facilities in this country.

There is a need to eliminate this mistrust that is in existence in this country as a way of providing ethics in the healthcare sector. To achieve this, health disparities among African Americans who are diagnosed with ESRD. There is a need to ensure that this group that has felt neglected for a very long period, receives better healthcare when in medical facilities within this country.

The nurses within these facilities have the responsibility of ensuring that just as other groups receive personalized attention, this group should also receive the attention that is unique to itself. It is through this that ethics can be maintained in this sector within this country. It is through this that African Americans would feel that they are considered part of the citizens of this country.

This is the only way that the mistrust that has existed for a long time can be eliminated. The focus of this essay is on decreasing health disparities among African Americans with the diagnosis of ESRD by providing an ethnic-specific education in their diet regimen as a way of speeding up their recovery while making their stay at the hospital or home more comfortable.

Research Study

This study involved 400 African American males who were born between 1932 and 1972. The choice of this age group was defined by the fact that they experienced the favoritism that existed during that time. During this time, the United States was at the heart of racial discrimination. The country was considered the most developed and the most democratic country in the world, but discrimination against blacks was something that could not be hidden.

One of the places where this discrimination was exhibited, as mentioned above, was in the hospitals. Leininger (2002) says that there are cases where patients would not be given anti-biotic drugs that would help speed the recovery process. This created a massive mistrust towards the health facilities as this group felt that these places were not concerned about their health.

This research would try and investigate how this affects the black Americans in this country. Previous researches have indicated that this mistrust was massive among the male African Americans in this country. This guided the decision to use this group in this study. The research would take a quantitative approach.

According to Andreana (2003), although qualitative analysis is also good when conducting research, it is not always possible to conduct an empirical study using the qualitative approach. For this reason, quantitative data analysis would be used to deduce the desired results in this research.

The researcher hopes to get a detailed view of the respondents, and how they feel that this vice should be approached with a view of eliminating it. The researcher will get the opinions of the selected group within the United States in order to get how they view health practitioners, especially the nurses within this country. This will help foster trust which was lost between the nurses and the African American patients.

Paradigm Shifts

There is a complete paradigm shift from the approach that was common in the United States hospitals when racial discrimination was rife in this country. This may be credited to Kuhn who is considered as one of the earliest theorists in this field. Kuhn is known to have insisted that old ways that have been used to make sense do not hold in the current society.

In the current United States, racial discrimination has completely been eliminated, as people feel that the country should be more united. Civil societies have come out strongly to fight all forms of discrimination in the country as a way of ensuring that the society is always peaceful.

There is goodwill from the political fraternity, and this has helped in eliminating this discrimination in various other sectors. The need to have this positive change has been witnessed in various other sectors in this country. The health sector is one such sector that has been influenced by this shift.

According to Dayer (2011), Diabetes or ESRD are some of the most common health complications that affects African America, especially the middle-aged and the old. However, this scholar says that this complication can be managed by having a proper diet as soon as one is diagnosed of the disease. This is one of the ways that one who has been diagnosed by this health complication can be helped manage this new condition.

In order to achieve this, the nurse practitioner in charge of the patient should be culturally sensitive to the origin and cultural practices of the patient. A patient who is suffering from ESRD may need to change the lifestyle, including eating habits.

The patient may not know of the right food that would be most appropriate for him or her, given the new condition brought about b the disease. It is upon the health practitioner to offer guidance on the best approach the patient can take in dealing with this condition.

For a long time, the nurses would base their advice on rigid structures outlined to suite the majority of the Americans who are the whites. When the blacks were given such prescription, especially the diet, they would find it difficult to cope with the new condition, and some would die out of this poor understanding that the nurses had about their culture.

A lot of awareness has been witnessed in this field, and as such, the practitioners have had pressure from various players to be sensitive to the needs of the African Americans. As Dayid (2011) says, when it comes to the diet, every ethnic group has a specific type of food they identify with. When one gets sick, there is always a need to ensure that the prescribed food is one which meets the expectation of the patient.

The diet should be one which the patient would find easy to adapt to given the changed bodily condition. Prescribing a diet common among the Hispanics to the African Americans does not help in elevating the condition of the Black American patients. According to Luckmann (1999), it is a fact that within the array of foods eaten by a specific group of people, there are specific foods that are preferable for those suffering from ESRD or Diabetics.

This scholar says that a nurse practitioner should focus on these foods that are normal and preferred to such patients other than considering options that a patient would consider strange. The scholar further states that the role of the nurse will be to elevate the health status of the patient in a way that would be comfortable to him or her, other than making them feel that they are in some form of punishment.

For this reason, there should be personalized attention given to these patients. There should be a concerted effort by all the concerned stakeholders in this sector to provide ethnic sensitive healthcare services to patients as a way of making them feel that they are cared for within the health facility. The researcher intends to provide ethnic-specific teaching in the diet regimens for the African Americans.

There has been a paradigm shift in the contemporary philosophy of nursing. It is true that an individual would always determine the best behavioral pattern in one’s life, Leininger (2005) says that the environment in which one lives has a massive impact on this behavioral pattern. Resent researches have been focused on how to reduce health disparities gap emanating from the ethnic and racial minorities especially in rural set-ups and with limited financial capacity. According to Goran (2010), a paradigm shift would always occur when scientists encounter any form of anomaly that may not be fully explained by universally accepted paradigms. It always come when the old scientific ways of making sense can no longer hold due to radical environmental changes that could have taken place over a specific period.

Epistemological and Ontological Congruence in the Scientific Worldviews and the Nursing Paradigmatic World

Leonard (1989) defines epistemology as the process of ‘knowing’, while Ontology he defines as ‘the state of dialoguing’. There is a need to know the state of the African American patients suffering from ESRD by engaging them in dialogue. This scholar says that scientific worldviews are changing as the world experiences changes in various sectors.

Technology has changed this field a great deal, and it is one of the agents of change that should be analyzed when conducting such research. There is a need to ask the right questions that would lead to the right answers that would help transform this field for the better. For instance, there would be the need to know the quality of life that African American patients suffering from ESRD.

Most of the African American ESRD patients have always stated that their quality of life after contracting this disease has been very poor. Most of them have stated that the main reason for this has been a lack of individualized attention. This confirms the claim that the nursing practitioners are yet to give this group sensitive ethnic healthcare whenever they visit health facilities.

The health practitioners, therefore, need to define what should be known about this group and how this knowledge may help improve their practice. The only way their practice would be improved, will be when they can give these group of patients attention that would be based upon their cultural practices.

There is a need to decrease the disparity in service delivery for the patients. This may not be just for the nurses along, but also to other relevant officers who are part of the healthcare system within the United States.

According to Andrews and Boyle (2008), ontological and epistemological incongruence diverge from the worldviews in various ways. This scholar says that when conducting research, respondents would always give their idea of how an ideal world should be. The worldviews are always about having perfect situations where things happen as per the desire of the involved parties.

However, whenever there is ontological and epistemological incongruence, it becomes difficult to achieve this desired perfection. This is especially so because the involved parties lack knowledge of what should be done to achieve this perfection. When a nursing practitioner has limited knowledge about a given cultural practice, they would always tend to use the knowledge they have and generalize it to include this new phenomenon.

This may work at times, but in most of the cases, such moves would not yield the desired results because the patient may not identify with the approach applied by the practitioner. It is this that at times leads to the widening of the gap, a gap that the researcher wishes to eliminate.

To some degree, nursing accepts these world views, especially from the social perspective when there is a need to ensure that this field is made understandable to the public. However, it is important to note that this is a science, and some of the worldviews may not be realistic from the scientific angle.

As Leininger (2002) says, there is a need to achieve congruence in the manner in which phenomenologist view the world in general, and nursing paradigm in specific.

Majority of the respondents indicated the need to initiate nurse-led interventions that are culturally tailored to meet and improve the quality of the services offered to minority — reducing healthcare disparities should involve embracing change at multiple levels, giving focus on how the new health condition may have changed the normal way of life of the individual, and how this may impact on him or her given the ethnic background.

Carl Rogers is one of the theorists who is known to support the need to fight healthcare disparities. He proposed several strategies that can be used to achieve this. He supported such strategies as culturally tailored improvement of quality service offered to patients.

Philosophical Implications of Using the Selected Worldviews Interpretive phenomenological Metaparadigm of Nursing

Madeleine Leininger is one of the theorists that have come out strongly to explain the current paradigm shift in the nursing sector. According to her theory, society is increasingly becoming diverse in values, norms, beliefs, behavior and other cultural practices. Given the environmental and internal stimuli, there will be a gradual but consistent change in the behavior, values, norms and cultural practices of an individual.

This would then result in what is generally referred to as culture. Sagar (2012) defines culture as the values and beliefs of a given group of people defined by their religion and social structures, coupled with internal stimuli that are common within the area. Culture would always dictate the mind of individuals and the conviction he or she may have towards life. As was mentioned earlier, worldviews would always be based on ideal phenomenology.

It involves things happening to perfection. As was witnessed from the respondent’s answers, society expects the best from every facility they visit. The situation is even complex when it comes to their expectations in the medical sector. The worldviews expect a scenario where health experts would understand the needs of their patient even before the patient fully explains the condition.

The nursing practitioners are expected to know what is in the mind of the patient as he or she handles the patient within the hospital. This is an ideal situation which may not be very easy to fulfill in a scientific world. As this theory holds, the world is experiencing massive changes brought about by the changing system within society. This has resulted in a society that is highly diversified.

This means that there is an implication of using the worldview that nursing practice should involve perfection. This may bring some complication because when one tries to meet the increasingly changing cultural practices, meeting the perfection mark may be a challenging task.

Interpretive phenomenological may be important in this case. When one uses the experience gathered over the years, it becomes possible to meet the needs of the ever-changing environmental factors in a way that can be considered satisfactory. For a nurse, this would help in giving patients of different cultures individualized attention.

Madeleine Leininger’s Theory of Culture Care has widely been accepted in society. A nurse, unlike a medical doctor, should understand the culture of the patient, especially in cases where the disease the patient is suffering from is likely to change the life of such a patient.

Leininger emphasizes on the need for the nurses to ensure that they involve culture in their care for their patients. This is in support of the worldviews of the need to achieve perfection in the process of offering care to the patient. This theory evokes what Leininger calls Trans-cultural Nursing. This may be the solution to the problem that this research was based on.

Trans-cultural Nursing propagates a scenario where the emphasis is laid on combining culture and care in nursing. A nurse would, therefore, need to understand the culture of the patient to deliver the desired care for the patient. And as this theorist holds, culture is not universal within the United States of America.

There are varying cultural practices that these practitioners should understand when offering care to patients. In this profession, knowledge is important in order to offer quality healthcare to patients. Specialized attention can only be offered when one has the right knowledge of the health complication of the patient, and the cultural background.

Consequences and Relevance for Nursing Practice and Research

As shown in the above discussion, there is a positive consequence of using Trans-cultural Nursing in Nursing Practice because of the need to offer individualized attention to the patients. The world is increasingly becoming diversified as different cultures get modified by different environmental factors.

A nurse can only be in a position to offer quality nursing services to patients when he or she has an understanding of the culture of the patients. This is relevant in helping the nurse understand the practices cherished by the patients and some of the activities that bring irritation. This is the knowledge that is needed to eliminate the gap that exists in offering quality healthcare to the African American ESRD and Diabetic patients within the United States.


Andreana, J. (2003). Transcultural concepts in nursing care. Philadelphia: Lippincott Williams & Wilkins.

Andrews, M. & Boyle, J. (2008). Transcultural concepts in nursing care. Philadelphia: Wolters Kluwer Health.

Dayer, L. (2011). Cultural competencies for nurses: Impact on health and illness. Sudbury: Jones and Bartlett Publishers.

Dayid, B. (2011). Cultural competencies for nurses: Impact on health and illness. Sudbury: Jones and Bartlett Publishers.

Goran, S.F. (2010). A second set of eyes: an introduction to Tele ICU. Critical Care Nurse 30(4)46-55.

Leininger, K. (2005). Culture Care Diversity & Universality: A Theory of Nursing. New York: Cengage.

Leininger, M. (2002). Transcultural nursing: Concepts, theories, research, and practice. New York: McGraw-Hill, Medical Publishers.

Leonard, W. (1989). A Heideggerian phenomenology perspective on the concept of the person. Journal of Nursing Science 11(4): 40-55

Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar Publishers.

Sagar, P. L. (2012). Transcultural nursing theory and models: Application in nursing education, practice, and administration. New York: Springer Publishers.

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