Perspectives on Racism in Health Care Among Black Veterans With Chronic Kidney Disease.
Perspectives on Racism in Health Care Among Black Veterans With Chronic Kidney Disease.
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DOI：
10.1001/jamanetworkopen.2022.11900
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发表时间：
2022-05-02
影响因子：
13.8
通讯作者：
Long, Judith A.
中科院分区：
文献类型：
--
作者：
Jenkins, Kevin A.;Keddem, Shimrit;Bekele, Selamawite B.;Augustine, Karisa E.;Long, Judith A.
患有慢性肾病的黑人退伍军人如何描述他们在医疗保健环境中遭受种族主义的经历？在这项针对 36 名患有慢性肾病的黑人退伍军人的定性研究中，参与者描述了因遭遇种族主义而感到愤怒和怨恨并承受压力；一些退伍军人还表达了对医疗保健系统的强烈不信任感，并且在临床接触中需要保持高度警惕。当遇到种族主义时，退伍军人描述了使用消极和积极的应对策略。这些发现强调了教育和培训医疗保健专业人员实施创伤知情护理方法作为解决基于种族的压力和创伤的手段的重要机会。慢性肾病（CKD）和终末期肾病的负担不成比例地落在美国黑人身上，黑人退伍军人遭受了严重后果，而且健康状况和医疗保健方面的差异只有一部分可以用非生物因素来解释。在黑人中，种族主义可能是这些因素之一，这表明有必要研究种族主义的后果以及由此产生的建立和延续这些种族差异的社会结构。调查患有 CKD 的黑人退伍军人的医疗保健经历，并识别和探讨这一弱势群体所遭受的种族歧视。这项定性研究使用半结构化访谈指南调查了 36 名患有 CKD 的黑人退伍军人的医疗保健经历，这些退伍军人于 2018 年 10 月至 2019 年 9 月在宾夕法尼亚州费城的迈克尔克雷森茨下士退伍军人事务医疗中心接受护理。使用应用主题分析对访谈笔录进行了分析。在退伍军人事务部医疗中心的 36 名患有 CKD 的黑人退伍军人中，他们在接受护理时遇到了种族主义，他们的平均 (SD) 年龄为 66.0 (7.8) 岁； 35 名参与者（97.2%）为男性，1 名参与者（2.8%）为女性，19 名参与者（52.8%）已婚。平均 (SD) 兵役期限为 8.0 (7.0) 年。总体而言，15 名参与者（41.7%）不依赖透析，高血压是最常见的合并症（9 名参与者[25.0%]）。退伍军人描述了种族主义产生情绪和身体压力的方式，包括心理症状（例如愤怒和伤害）和生理症状（例如头痛）。退伍军人描述了对医疗保健系统的强烈不信任感，并且在临床遇到时需要保持高度警惕。退伍军人表示，当遇到种族主义时，他们会压抑自己的感受，这有时会导致适应不良的行为（例如药物滥用）。退伍军人还描述了应对种族主义压力的个人和集体积极策略（例如信仰）。在这项研究中，患有慢性肾病的黑人退伍军人在临床环境中经历了种族主义，这产生了身体和情感压力以及对医疗保健系统的强烈不信任感。这些发现强调了对医疗保健专业人员进行教育和培训的重要机会，以实施创伤知情的护理方法作为解决基于种族的压力和创伤的手段。这项定性研究调查了美国患有慢性肾病的黑人退伍军人的医疗保健经历和种族歧视。
How do Black veterans with chronic kidney disease describe their experiences of racism in the health care setting? In this qualitative study of 36 Black veterans with chronic kidney disease, participants described feeling angry and resentful and experiencing stress as a result of encounters with racism; some veterans also expressed a strong sense of distrust in the health care system coupled with a need to be hypervigilant during clinical encounters. When encountering racism, veterans described using both negative and positive coping strategies. These findings highlight an important opportunity for educating and training health care professionals in the implementation of trauma-informed approaches to care as a means of addressing race-based stress and trauma. The burden of chronic kidney disease (CKD) and end-stage kidney disease falls disproportionately on Black individuals in the US, with Black veterans experiencing substantial consequences, and only a portion of the disparities in health conditions and health care can be explained by nonbiological factors. Among Black individuals, racism is likely one of those factors, suggesting the need to examine the consequences of racism and the resulting social structures that establish and perpetuate these racial disparities. To investigate the health care experiences of Black veterans with CKD and identify and explore the racial discrimination encountered by this vulnerable population. This qualitative study used semistructured interview guides to investigate the health care experiences of 36 Black veterans with CKD who received care at the Corporal Michael Crescenz Veterans Affairs Medical Center in Philadelphia, Pennsylvania, from October 2018 to September 2019. Interview transcripts were analyzed using applied thematic analysis. Among 36 Black veterans with CKD who characterized racism in the context of their care at a Veterans Affairs medical center, the mean (SD) age was 66.0 (7.8) years; 35 participants (97.2%) were male, 1 participant (2.8%) was female, and 19 participants (52.8%) were married. The mean (SD) duration of military service was 8.0 (7.0) years. Overall, 15 participants (41.7%) were not dependent on dialysis, and hypertension was the most common comorbidity (9 participants [25.0%]). Veterans described the ways in which racism produced emotional and physical stress, including psychological symptoms (eg, anger and hurt) and physiological symptoms (eg, headaches). Veterans described a strong sense of distrust in the health care system coupled with a need to be hypervigilant during clinical encounters. When encountering racism, veterans described bottling up their feelings, which sometimes led to maladaptive behavior (eg, substance use). Veterans also described individual and collective positive strategies (eg, faith) for coping with the stress of racism. In this study, Black veterans with CKD experienced racism in the clinical setting that produced physical and emotional stress and a strong sense of distrust in the health care system. These findings highlight an important opportunity for education and training of health care professionals in the implementation of trauma-informed approaches to care as a means of addressing race-based stress and trauma. This qualitative study investigates the health care experiences and racial discrimination encountered by Black veterans with chronic kidney disease in the US.
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DOI：
10.1053/j.ajkd.2009.12.032
发表时间：
2010-06
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Crews DC;Charles RF;Evans MK;Zonderman AB;Powe NR
通讯作者：
Powe NR
影响因子：
5.5
作者：
Montgomery, Ann Elizabeth;Tsai, Jack;Blosnich, John R.
通讯作者：
Blosnich, John R.
影响因子：
5.5
作者：
Noonan AS;Velasco-Mondragon HE;Wagner FA
通讯作者：
Wagner FA
影响因子：
3.3
作者：
Beydoun MA;Poggi-Burke A;Zonderman AB;Rostant OS;Evans MK;Crews DC
通讯作者：
Crews DC
DOI：
10.1186/s40695-021-00066-3
发表时间：
2021-08-28
期刊：
Women's midlife health
影响因子：
--
作者：
Diop MS;Taylor CN;Murillo SN;Zeidman JA;James AK;Burnett-Bowie SM
通讯作者：
Burnett-Bowie SM