Childhood Obesity Literature Review Capstone

Construct the first draft of your 4- to 5-page Mini Literature Review. It should include the following:

  • A brief introduction that provides information about the scope and nature of the issue, at least 5–6 body paragraphs that provide sufficient detail, and a conclusion. Your paper should evidence the 6–8 resources from your Annotated Bibliography. You should include both parenthetical (in-text citations) as well as your references at the end of the document (i.e., your Annotated Bibliography sources that apply) in proper APA format.
  • Use the remaining instructions in this Project Template to develop the subtopics of this Mini Literature Review, which form the body paragraphs of your Mini Literature Review. For example, in the Introduction, you can provide epidemiological and statistical data about your issue. You can also discuss how this issue transcends borders, etc.
  • Summarize and analyze these resources. Paraphrase them in your own words. List the key arguments and findings, describing how you think they apply to your topic, and what the implications of the findings may be for your Capstone Project.  Running head: CHRONIC KIDNEY DISEASE
    Chronic Kidney Disease: Problems, Perceptions, and Strategies for Intervention
    David Brown
    Walden University
    HLTH 4900, Section 2, Capstone
    November 16, 2013
    Instructor: Dr. Jody Early
    1
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    2
    Abstract
    Chronic kidney disease is considered one of the most significant health issues affecting
    morbidity and mortality and contributes heavily to the state of global health. Chronic kidney
    disease (CKD) and end-stage renal disease (ESRD) are chronic illnesses that have a dramatic
    impact on the cost of health care delivery in the United States. Early detection and intervention
    are critical to the long-term prognosis of this patient population; however, a health disparity
    exists because not everyone who is at risk for CKD has access to resources for screening and
    treatment. One of the goals of community-level and national programs is to create parity of care
    by focusing attention on marginalized communities that are at a statistically higher risk for CKD.
    The global impact of CKD and ESRD is significant because long-term survival depends on
    expensive technology and many regions of the world lack the resources needed to treat this
    disease. Health behavior and culture are known contributors to the long-term survivability of the
    disease. Since early detection is the key, creating screening programs that target populations at
    greatest risk will have the highest impact, and be the most cost-effective solution to combating
    this chronic illness.
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
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    Chronic Kidney Disease: Problems, Perceptions, and Strategies for Intervention
    Chronic kidney disease (CKD) is considered one of the primary global health issues and
    contributes significantly to the social burden of care. CKD, along with cardiovascular disease,
    diabetes, chronic respiratory disease, and cancer, is a chronic illness that is classified as a noncommunicable disease (Healthy People 2020, 2013). Non-communicable diseases have a
    significant societal impact to domestic growth, productivity, and health care costs and are the
    most common cause of morbidity and premature death in the United States (Couser, Remuzzi,
    Mendis, & Tonelli, 2011). Chronic illnesses are also characterized by physical and emotional
    stressors that can become overwhelming when simultaneously coping with multiple
    comorbidities (Moulton, 2008). Although the World Health Assembly has determined that noncommunicable diseases contribute heavily to the state of global health, they concede that public
    health policy can dramatically affect patient morbidity and mortality (Couser et al., 2011). CKD
    is a public health threat that is on the rise and will likely not slow without deliberate intervention.
    This literature review will describe the impact that chronic kidney disease and end-stage renal
    disease have on the global burden of care, as well as detail the issues that contribute to health
    care disparities affecting this patient population. Factors that affect morbidity and mortality will
    also be discussed and a solution will be presented that has the potential to reduce the health
    system burden and improve the prognosis of many who suffer from this chronic disease.
    Chronic Kidney Disease Statistics and Epidemiological Data
    The impact of chronic kidney disease and end-stage renal disease (ESRD) on the federal
    Medicare budget is staggering. In 2008, CKD cost $60 billion and ESRD totaled $39.5 billion,
    which was 27% of the annual Medicare budget (Rettig, 2011). Recently, studies have reported
    that approximately 26 million Americans have some degree of CKD (Navaneethan, Aloudat, &
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    Singh, 2008). Only 5% of the people in the most treatable early stages of CKD are aware they
    have the disease, and almost 50% of those in stage 4 remain unaware unless diagnosed with a
    comorbid condition such as hypertension or diabetes (Couser et al., 2011). As with many
    illnesses, prevention and wellness programs that offer CKD screening can improve long-term
    outcomes.
    Prevention and Wellness Strategies for At-Risk Populations
    Prevention and wellness strategies do much for mitigating the physiologic damage from
    CKD, and can extend the productivity and mortality within this patient population. The greatest
    benefits are realized when detection and intervention occur early in the disease cycle; however,
    limiting factors such as genetic, environmental, and social barriers interfere with efforts to
    deploy prevention and wellness strategies that can also screen for health issues (Pearson, 2008).
    Although CKD is an illness that affects all cultural, geopolitical, and socioeconomic classes, not
    all groups have the same clinical outcomes. Native Americans, Asian and Pacific Islanders, and
    Hispanics have a greater likelihood of progressing to ESRD, and African Americans are four
    times more likely than Caucasians to suffer renal failure requiring a kidney transplant (National
    Medical Association, n.d.). The data indicates that a significant disparity exists between
    Caucasians and other ethnic groups in the diagnosis and treatment of CKD. Evaluative and
    preventative strategies are a part of high quality health care delivery, and involve interventions
    that incorporate a diet plan, exercise routine, and medication protocol. Intervention strategies
    should be tailored to the particular community since each of the disparate groups has ethnic and
    cultural differences that must be factored to ensure interventional plan compliance.
    The Impact of Quality Health Care Delivery on CKD
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    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    5
    High quality health care delivery can have a dramatic impact on the morbidity and
    mortality of people suffering from CKD. A study conducted by the National Kidney FoundationKidney Disease Outcomes Quality Initiatives has proven that hospitalizations are reduced, and
    mortality is improved if patients are referred to a nephrologist within one month of new onset
    CKD (Navaneethan et al., 2008). This study also discovered that individuals were more likely to
    be delayed in getting a referral if they were part of a minority, uninsured, less educated, or
    elderly. Access to service, proper screening, and appropriate follow-through are challenges that
    must be addressed if this disparity is to be eliminated. Evaluation and comprehensive counseling
    on social and environmental factors that negatively impact health are important acute
    interventions, and long-term health benefits are seen when early referral to a nephrologist and
    access to follow-up care are provided (Collins, Gilbertson, Snyder, Chen, & Foley, 2010).
    Currently, numerous programs exist that focus on high-risk populations and are designed to
    provide access to screening and follow-up care. The National Kidney Foundation (2013)
    sponsors KEEP Healthy, which is an extension of their Kidney Early Evaluation Program
    (KEEP) and brings a nationally sponsored, community-based initiative designed to screen and
    educate in regions that have statistically higher CKD populations. The Kidney Care Prevention
    Program (KCPP) is a regional community-based program in North Carolina that staff trained
    kidney care coordinators and educators who can intervene early in the disease process, and can
    offer support through early-stage CKD intervention and management (Harward & Falk, 2008).
    These are only two examples of community-based programs designed to provide individuals
    with the best chance at early detection and intervention. Many such programs exist, and more are
    being offered as federal funding becomes available.
    The Global Impact of CKD
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    6
    Although the impact of CKD on the United States and most developed countries is
    significant, it is much worse in less developed countries. Screening programs are essential for
    early detection, but many areas of the world lack the infrastructure to be able to offer these
    services. Limited access to care and technology, poor living conditions and diet, and an
    inadequate supply of pharmaceuticals results in rapid conversion from CKD to ESRD, which is
    quickly followed by death (Couser et al., 2011). When CKD progresses to ESRD, the only cure
    is a kidney transplant. Renal replacement therapy, which is also known as hemodialysis, can be
    used as a bridge to transplant. There are 2 million people currently on hemodialysis worldwide,
    which constitutes only 12% of the global CKD population, and nearly all of them are treated in
    just five countries, including the United States, Japan, Germany, Brazil, and Italy (Couser et al.,
    2011). This means that 88% of the world population does not have a bridge to transplant, nor do
    they have access to renal transplantation surgery. When viewed from this perspective, it becomes
    clear just how devastating a diagnosis of CKD can be to most of the world’s population.
    Health Behavior and CKD
    Health behavior plays a significant role in an individual’s ability to cope with and
    manage chronic illness. Health behavior is so important in disease management that many health
    behavior models have been created in an effort to understand the link. One of the oldest health
    behavior theories is the Health Belief Model (HBM). The HBM asserts that people have an
    inherent readiness to act, which is built from life experiences, self efficacy, the perception of
    vulnerability to a given health problem, the severity of the issue, and the barriers and benefits to
    taking positive action (Williams, Manias, Liew, Gock, & Gorelik, 2012). Life experiences fall in
    the category of mediating factors, which also includes demographics, level of education,
    structural, and social variables. It is theorized that mediating factors that greatly impact CKD are
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    7
    primary causes of the current health disparity (Williams et al., 2012). Recognizing these
    variables and creating practices that mitigate them are the keys to creating health parity across
    the different CKD population groups. Culture can also affect health behavior and should be
    considered when creating screening and intervention programs.
    Culture and CKD
    An individual’s culture influences their perspectives on health and wellness, which can
    subsequently affect how well they manage their disease. One of the challenges with managing
    patient populations that have a high incidence of undiagnosed and undertreated CKD is that they
    tend to be culturally and linguistically diverse (CALD) groups (Williams et al., 2012). Chronic
    disorders such as CKD, diabetes, and cardiovascular disease require a strict adherence to lifestyle
    modification instructions and medication protocols. Limited health literacy, poor cognition, or a
    language barrier inhibits effective communication and has been shown to result in poor health
    outcomes (Norris & Nissenson, 2008). These communities are also at risk because they cannot
    afford health care, have decreased access the health system, and have little or no access to
    screening and testing facilities (Rettig, Norris, & Nissenson, 2008). These communities often
    shun modern health services because historically conditioned biases have created in an inability
    to trust or feel safe in contemporary health care delivery centers (Rettig et al., 2008).
    Establishing community-based health clinics that are staffed and managed by lay health advisors,
    especially in regions that have heavy racial and ethnic populations, will not only create
    community buy-in, but also create agents of change. Lay health advisors are community
    members who have a natural tendency to help, and are provided training and support so they can
    assist and advise others in their community on various health issues (Pullen-Smith & Plescia,
    2008). Overcoming health care disparities will require lay health advisors to be recruited from
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    within the affected patient population. Recruiting members from within the community has
    resulted in improved attitudes as community members gain control over their own health issues.
    The Role of Technology in Treating CKD
    Patients with CKD and ESRD rely heavily on technology to manage their disease
    process. Point-of-care testing that can measure creatinine, glucose, albumin, and other critical
    blood values allows clinics to mobilize and bring much needed health care into the community
    instead of waiting for members of at-risk groups to be proactive and seek screening centers
    (Harward & Falk, 2008). The mobile centers have been instrumental in finding individuals who
    are in the early stages of CKD and respond best to early intervention.
    When CKD progresses to ESRD, the person must learn to embrace the technology that
    will sustain his or her life until renal transplantation can be offered. Being tethered to a dialysis
    machine several days a week for six hours at a time, constant testing, and living with a dialysis
    catheter or fistula create a technological burden that can be overwhelming. Embracing
    technology is not easy for patients to do because machine dependency runs contrary to the
    freedom and autonomy that the individual previously enjoyed. Acculturation occurs when the
    patient conforms to behavior patterns and routines that are needed in order to exist indefinitely
    on machine dependency (Harward & Falk, 2008). At the point of acculturation, the patient fully
    embraces the new technology and accepts it as an integral part of life.
    Legal and Ethical Issues Impacting CKD
    Besides technology concerns, there are many legal and ethical issues surrounding the
    condition of CKD that can impact an individual’s ability to obtain the necessary treatment. In
    October 1972, the federal government passed the Social Security Amendments, which extended
    Medicare coverage to the disabled, and officially recognized ESRD as a disability (Vassalotti,
    8
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    9
    Gracz-Weinstein, Gannon, & Brown, 2006). In 2009, the American Recovery and Reinvestment
    Act (ARRA) shifted the focus from reactive and therapeutic intervention, to a proactive and
    preventative model (Menzin et al., 2011). Currently, instead of waiting and treating the terminal
    disease of ESRD, which is ineffective, inefficient, and costly, clinicians are screening for CKD
    in at-risk populations so that appropriate intervention can occur at a stage where the disease
    process can be halted or even reversed.
    There are other federal programs that help those suffering from CKD. A second example
    of a public policy that focuses on active intervention is the Medicare Improvements for Patients
    and Providers Act of 2008 (MIPPA), which provides funding to education programs for
    individuals with stage 4 CKD (Menzin et al., 2011). The MIPPA has proven successful at
    providing funding that creates highly effective targeted education.
    The Interdisciplinary Team’s Approach to Treating CKD
    The process of screening, treatment, and education need the involvement from many
    disciplines within health care. An interdisciplinary team approach can be the best way to manage
    complex illnesses such as CKD. Working within culturally and linguistically diverse
    communities require teams that can provide a range of health care needs, facilitate
    communication, and serve as patient advocates and representatives. Interdisciplinary teams
    typically include physicians, technicians, linguists, social workers and case managers, and
    community advocates, among others (Sinasac, 2012). These teams must also collaborate with
    community agencies, which can enhance the effectiveness of health promotion efforts (Sinasac,
    2012). Public health strategies can also include non-traditional groups such as community
    service organizations, American Indian tribes, boys and girls clubs, and faith-based
    organizations, which can penetrate deeper into the communities and reach individuals where they
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    10
    live, work, play, eat, and pray (Pullen-Smith & Plescia, 2008). Interdisciplinary teams allow for
    the breadth of services needed to make a significant impact on CKD screening and intervention.
    The Scholar-Practitioner’s Role in Treating CKD
    My role as a scholar-practitioner is to be aware of social disparities and endeavor to
    correct observed societal imbalances. CKD is considered one of the most significant health care
    disparities that exist in America today. As a scholar-practitioner, I must be a leader and advocate
    for positive social change within my community. Becoming involved with organizations such as
    the National Kidney Foundation’s KEEP Healthy program, the Minority Intervention and Kidney
    Education (MIKE) program, or local organizations like the Kidney Care Prevention Program
    (KCPP) are ways that I can influence social change as it relates to CKD and ESRD.
    Opportunities exist for me to become a trained kidney care coordinator/educator and lead efforts
    to promote health and wellness activities (Harward & Falk, 2008). Being a scholar-practitioner, I
    can be involved with identifying a need and targeting the appropriate patient populations by
    researching health status statistics and epidemiology studies, developing focus groups, assessing
    social marketing strategies, and analyzing current evidence-based practices to be used in creating
    new public health policies (Sinasac, 2012). As a scholar-practitioner, a worthy goal would be to
    spearhead the formation of a new organization that brings health care services to minority
    communities, socioeconomically depressed people, and the uninsured and underinsured. Another
    way I can have an impact in my community and make a positive social change is to involve
    myself with an existing organization whose goal is to eliminate racial and ethnic health
    disparities for chronic illnesses such as CKD. Through these types of actions, I can fully embrace
    the role of scholar-practitioner and become an agent of positive social change.
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
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    References
    Collins, A. J., Gilbertson, D. T., Snyder, J. J., Chen, S. C., & Foley, R. N. (2010). Chronic
    kidney disease awareness, screening and prevention: Rationale for the design of a public
    education program. Nephrology (Carlton), 15 Suppl 2, 37–42. doi:10.1111/j.14401797.2010.01312.x
    Couser, W. G., Remuzzi, G., Mendis, S., & Tonelli, M. (2011). The contribution of chronic
    kidney disease to the global burden of major noncommunicable diseases. Kidney
    International, 80(12), 1258–1270. doi:10.1038/ki.2011.368
    Harward, D. H., & Falk, R. J. (2008). The Kidney Care Prevention Program: An innovative
    approach to chronic kidney disease prevention. North Carolina Medical Journal, 69(3),
    233–236.
    Healthy People 2020. (2013, April 10). Chronic kidney disease. HealthyPeople.gov. Retrieved
    November 8, 2013, from
    http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=6
    Menzin, J., Lines, L. M., Weiner, D. E., Neumann, P. J., Nichols, C., Rodriguez, L., … Mayne,
    T. (2011). A review of the costs and cost effectiveness of interventions in chronic kidney
    disease: Implications for policy. Pharmacoeconomics, 29(10), 839–861.
    doi:10.2165/11588390-000000000-00000
    Moulton, A. (2008). Chronic kidney disease: The diagnosis of a “unique” chronic disease.
    CANNT Journal, 18(1), 34–38.
    National Kidney Foundation. (2013). Kidney early evaluation program publications. Retrieved
    November 8, 2013, from http://www.kidney.org/news/keep/index.cfm
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
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    National Medical Association. (n.d.). Chronic kidney disease in the African American
    community. Consensus Report of the NMA.
    Navaneethan, S. D., Aloudat, S., & Singh, S. (2008). A systematic review of patient and health
    system characteristics associated with late referral in chronic kidney disease. BMC
    Nephrology, 9(1), 3. doi:10.1186/1471-2369-9-3
    Norris, K., & Nissenson, A. R. (2008). Race, gender, and socioeconomic disparities in CKD in
    the United States. Journal of the American Society of Nephrology : JASN, 19, 1261–70.
    doi:10.1681/ASN.2008030276
    Pearson, M. (2008). Racial disparities in chronic kidney disease: Current data and nursing roles.
    Nephrology Nursing Journal, 35(5), 485–489.
    Pullen-Smith, B., & Plescia, M. (2008). Public health initiatives to prevent and detect chronic
    kidney disease in North Carolina. North Carolina Medical Journal, 69(3), 224–226.
    Rettig, R. A. (2011). Special treatment–the story of Medicare’s ESRD entitlement. The New
    England Journal of Medicine, 364, 596–8. doi:10.1056/NEJMp1014193
    Rettig, R. A., Norris, K., & Nissenson, A. R. (2008). Chronic kidney disease in the United
    States: a public policy imperative. Clinical journal of the American Society of
    Nephrology, 3, 1902–10. doi:10.2215/CJN.02330508
    Sinasac, L. (2012). The community health promotion plan: A CKD prevention and management
    strategy. CANNT Journal, 22(3), 25–28.
    Vassalotti, J., Gracz-Weinstein, L., Gannon, M., & Brown, W. (2006). Targeted screening and
    treatment of chronic kidney disease: Lessons learned from the Kidney Early Evaluation
    Program. Disease Management & Health Outcomes, 14(6), 341–352.
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    Williams, A., Manias, E., Liew, D., Gock, H., & Gorelik, A. (2012). Working with CALD
    groups: Testing the feasibility of an intervention to improve medication selfmanagement in people with kidney disease, diabetes, and cardiovascular disease. Renal
    Society of Australasia Journal, 8(2), 62–69.
    13
    CAPSTONE PROJECT
    HLTH/PUBH 4900
    B.S. IN HEALTHCARE
    MANAGEMENT
    TITLE OF PROJECT
    NAME; DATE; TERM
    LEARNING OUTCOMES 1 AND 2
    • Explain your topic and the rationale for your project.
    • Provide a few researched facts about your chosen healthcare issue.
    • Specifically discuss how it impacts the context and quality of healthcare delivery inside
    and outside of the United States.
    • How does this health issue transcend borders? In other words, explain how this issue
    impacts the global society—not just your local community, state, or country.
    • Make sure that all data and research are properly cited within your PowerPoint slides.
    LEARNING OUTCOMES 1 AND 2 CONTINUED
    • Explain your topic and the rationale for your project.
    • Provide a few researched facts about your chosen healthcare issue.
    • Specifically discuss how it impacts the context and quality of healthcare delivery inside
    and outside of the United States.
    • How does this health issue transcend borders? In other words, explain how this issue
    impacts the global society—not just your local community, state, or country.
    • Make sure that all data and research are properly cited within your PowerPoint slides.
    LEARNING OUTCOME 3
    • Explain how behavioral, demographic, and cultural factors impact your selected
    healthcare issue.
    • Which groups are most impacted?
    • What are some of the cultural biases of this healthcare issue?
    • Give at least 2 examples of culturally and linguistically appropriate health services to
    avoid unequal treatment when delivering healthcare to your chosen group.
    LEARNING OUTCOME 3 CONTINUED
    • Explain how behavioral, demographic, and cultural factors impact your selected
    healthcare issue.
    • Which groups are most impacted?
    • What are some of the cultural biases of this healthcare issue?
    • Give at least 2 examples of culturally and linguistically appropriate health services to
    avoid unequal treatment when delivering healthcare to your chosen group.
    LEARNING OUTCOMES 5 AND 6
    • Describe the critical issues in acute and long-term care from patient and provider
    perspectives in order to reduce this problem, and give an example of how an interprofessional “team” approach can be used to address this problem.
    LEARNING OUTCOMES 5 AND 6 CONTINUED
    • Describe the critical issues in acute and long-term care from patient and provider
    perspectives in order to reduce this problem, and give an example how an interprofessional “team” approach can be used to address this problem.
    LEARNING OUTCOMES 4 AND 7
    • Describe one technological, one legal, and one ethical issue related to your chosen
    healthcare issue.
    • Give an evidence-based example of how a healthcare organization’s performance,
    quality, and safety can be improved to overcome the technological/legal/ethical issue.
    LEARNING OUTCOMES 4 AND 7 CONTINUED
    • Describe one technological, one legal, and one ethical issue related to your chosen
    healthcare issue.
    • Give an evidence-based example of how a healthcare organization’s performance,
    quality, and safety can be improved to overcome the technological/legal/ethical issue.
    LEARNING OUTCOMES 8 AND 10
    • What are some of the healthcare costs, specific to economic evaluation and financial
    management associated with this issue, and how do they impact the quality of health
    service delivery?
    • Give an example of how human resource methods of managing healthcare employees
    could lead to cost-effective care and improved outcomes for patients.
    LEARNING OUTCOMES 8 AND 10 CONTINUED
    • What are some of the healthcare costs, specific to economic evaluation and financial
    management associated with this issue, and how do they impact the quality of health
    service delivery?
    • Give an example of how human resource methods of managing healthcare employees
    could lead to cost-effective care and improved outcomes for patients.
    LEARNING OUTCOMES 8 AND 11
    • Explain how your healthcare issue impacts, or is impacted by, insurance, reimbursement,
    prospective payment, and value-based purchasing.
    • Give evidence-based examples of how fraud and abuse impact delivery and access to
    care.
    LEARNING OUTCOMES 8 AND 11 CONTINUED
    • Explain how your healthcare issue impacts, or is impacted by, insurance, reimbursement,
    prospective payment, and value-based purchasing.
    • Give evidence-based examples of how fraud and abuse impact delivery and access to
    care.
    LEARNING OUTCOMES 2 AND 9
    • Research and list one healthcare organization addressing your health issue.
    • Apply strategic planning methods by describing the organization’s mission, vision, and
    values, and analyze the strengths, weaknesses, opportunities, and threats of the
    healthcare organization.
    LEARNING OUTCOMES 2 AND 9 CONTINUED
    • Research and list one healthcare organization addressing your health issue.
    • Apply strategic planning methods by describing the organization’s mission, vision, and
    values, and analyze the strengths, weaknesses, opportunities, and threats of the
    healthcare organization.
    LEARNING OUTCOMES AND WALDEN’S MISSION
    • Provide 2–3 examples of what you’ve learned in your program to advance social change
    by addressing this healthcare issue as an effective healthcare administrator as it relates
    to the areas of strategic planning, budgeting and fiscal evaluation, management, human
    resources, or leadership.
    LEARNING OUTCOMES AND WALDEN’S MISSION
    CONTINUED
    • Provide 2–3 examples of what you’ve learned in your program to advance social change
    by addressing this healthcare issue as an effective healthcare administrator as it relates
    to the areas of strategic planning, budgeting and fiscal evaluation, management, human
    resources, or leadership.
    REFERENCES
    • Make sure all of your references follow APA formatting.
    • You may use additional slides for references as needed.
    Running head: OBESITY
    1
    Childhood Obesity
    Childhood obesity continues to present itself as a significant public health challenge.
    With various elements and dimensions available to study, evaluate, and tackle the problem,
    extensive literature provides research into various aspects of childhood obesity. Also, being a
    global problem, it is crucial to approach the issue from an ideologically diversified perspective. It
    is critical to understand and acknowledge that various environmental disparities ranging from
    culture, media influence, to socio-cultural status impose influence on the prevalence and control
    of the issue. With the presence of magnified risks such as later-life health problems, there exists
    a gap in addressing childhood obesity. The gap requires a multifaceted approach that covers
    broad influential elements such as physiological and psychological factors – also, the
    comprehensive study and evaluation of approaches such as prevention and management are
    critical.
    Annotated Bibliography
    Anderson, K. (2018). A Review of the Prevention and Medical Management of Childhood
    Obesity. Child and Adolescent Psychiatric Clinics of North America, 27(1), 63-76. doi:
    10.1016/j.chc.2017.08.003
    A Review of the Prevention and Medical Management of Childhood
    Obesity by Anderson (2018) is an article that addresses the management and
    prevention of childhood obesity. It observes that childhood obesity is a pressing
    healthcare issue that remains a public health priority. The article reveals the need
    for an integrated chronic care approach. With this in mind, the article stresses the
    need for prevention efforts. It further proposes that these efforts must be directed
    and focused on healthy modifications of the family-based lifestyle. Anderson
    OBESITY
    2
    highlights some of the recommendations outlined by the United States Prevention
    Services Task Force, such as obesity screening for children above the age of six.
    The article is recent as it was published two years ago. It, therefore,
    indicates that the research and data are relatively up-to-date, therefore providing a
    fresh approach to the issue of childhood obesity. Anderson analyzes various
    elements of childhood obesity and its comorbidities and how they influence and
    affect various medical specialties. The article provides a critical review of
    childhood obesity, and it presents a critical and informative input to the project.
    Anderson presents the ideas solidly and systematically, that creates ease of
    evaluation.
    Greydanus, D., Agana, M., Kamboj, M., Shebrain, S., Soares, N., Eke, R., & Patel, D. (2018).
    Pediatric obesity: Current concepts. Disease-A-Month, 64(4), 98-156. doi:
    10.1016/j.disamonth.2017.12.001
    Greydanus et al., in the article Pediatric obesity: Current concepts present
    a refreshing approach to childhood obesity. It concentrates on concepts of the
    early twenty-first-century timeline. The article delves into a broad discussion of
    the various critical elements of childhood obesity. It reflects on the definition,
    history, and principles of management, among others. For example, it creates an
    increased emphasis on exercise and diet – which is primarily inclined on the
    clinical application and research approach. Bariatric surgery and pharmacotherapy
    are other primary issues that Greydanus et al. address within the article with
    observations of their increased applications – although with adult and adolescent
    populations combating obesity and overweight related problems. The broad
    OBESITY
    3
    analysis that touches on the issue of obesity, along with age progression, presents
    a base for juxtaposing and critically analyzing the issue of childhood obesity.
    The article was also published two years ago, which makes it clear that the
    arguments and ideas presented within are recent. The ideas and arguments are
    adequately presented and analyzed. With a broad scope of elements relating to
    childhood obesity being analyzed, the article is a vital resource in the research
    process. It recognizes the need to address this issue. Various elements and
    concepts, such as diagnostic perspectives and psychosocial considerations, among
    others, are analyzed through an in-depth approach. These create a robust and
    informative data source for the project.
    Jones, A. (2018). Parental Socioeconomic Instability and Child Obesity. Biodemography and
    Social Biology, 64(1), 15-29. doi: 10.1080/19485565.2018.1449630
    Jones discusses an essential aspect of childhood obesity. In Parental
    Socioeconomic Instability and Child Obesity, Jones uses extensive data that
    ranges from 1986 to 2010 as per the National Longitudinal Study of Youth
    (NLSY) and NLSY Child and Young Adult Supplement. Socioeconomic status is
    a dimension that is often overlooked but which has a significant influence on
    childhood obesity. The article reviews this data and establishes a vital relationship
    between childhood obesity and the socioeconomic status of parents over time. The
    research and analysis presented in the article point at various findings. For
    example, a comparison of the maternal and paternal educational progressions and
    employment transitions has been presented and analyzed concerning childhood
    obesity – which is a critical and differentiated approach to the issue of childhood
    OBESITY
    4
    obesity. The issue of social class and the implications of policy related to
    childhood obesity have been discussed in the article.
    The article is two years since publication, which reflects that it is recent
    research. An observation of the data applied and analyzed reveals that extensive
    data is evaluated and analyzed to support the ideas within the article. Jones goes
    as far back as 1986. The ideas are systematically laid out with comprehensive
    idea-related analyses of the primary research data. It is vital for the project in that
    it presents a different but critically informative aspect of external elements
    influencing and affecting childhood obesity.
    Kumar, S., & Kelly, A. (2017). Review of Childhood Obesity. Mayo Clinic Proceedings, 92(2),
    251-265. doi: 10.1016/j.mayocp.2016.09.017
    Kumar and Kelly recognize that childhood obesity is a pressing public
    health problem. Interestingly, their approach identifies that this is an issue that
    cuts across globally. A major issue they identify in this article is the comorbidity
    of childhood obesity with other conditions and diseases that were previously
    considered to be exclusive to the adult demographic. These include hypertension
    and type 2 diabetes mellitus. The analytical and conservative nature that this
    article takes is vital as it presents another critical issue, which is the disease
    comorbidity element. The article delves into various other aspects of childhood
    obesity, such as the causal aspect. The article reviews various fundamental ideas
    such as endocrine and genetic causal factors and the part they play in childhood
    obesity. Literature has been reviewed, ranging from the year 1994 to 2016 from
    OBESITY
    5
    the PubMed database. The extensive research data is critical to the projects as it
    ensures robust and well-founded findings and inferences.
    The article was published three years ago and therefore offers relatively
    recent data on the subject issue. As a review of the etiology, epidemiology, and
    comorbidities relating to childhood obesity, the article plays an essential role in
    the project review. It provides an in-depth review and analysis of vital elements.
    The data and ideas are well elaborated and can be effectively evaluated. Kumar
    and Kelly present a very informative perspective that is key to childhood obesity
    study and analysis.
    Lee, E., & Yoon, K. (2018). Epidemic obesity in children and adolescents: risk factors and
    prevention. Frontiers of Medicine, 12(6), 658-666. doi: 10.1007/s11684-018-0640-1
    Epidemic obesity in children and adolescents: risk factors and prevention
    by Lee and Yoon are densely informative on various aspects of childhood obesity.
    It analyzes the prevalence of childhood obesity while also including adolescents.
    The approach is a fine element that offers a basis for comparative analysis. Lee
    and Yoon identify the issue of childhood and adolescent obesity as an epidemic.
    Rightly so, they offer various critical issues such as the influence on adult
    prevalence and comorbidities. Further, risks such as premature death and
    adulthood mortality as related to childhood mortality are addressed. Some vital
    causal factors are analyzed and evaluated. Elements ranging from environmental
    factors to socio-environmental and biological factors are addressed. The
    complexities involved in the issue of addressing risk factors are identified and
    OBESITY
    6
    dwelled on in terms of treatment strategies and options for this vulnerable
    demographic.
    The article is a two-year-old publication and is therefore relatively recent.
    Lee and Yoon present vital ideas and concepts that provide fundamental ideas and
    arguments for the project. A critical analysis of the work identifies the fact that
    information and ideas are well presented within the paper. The article is
    significant to the projects in that it analyzes, from a different perspective, the
    ideas that are fundamental to the project.
    Styne, D., Arslanian, S., Connor, E., Farooqi, I., Murad, H., Silverstein, J., & Yanovski, J.
    (2017). Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine
    Society Clinical Practice Guideline. The Journal of Clinical Endocrinology &
    Metabolism. doi: 10.1210/jc.2016-2573
    The objective, as presented by Styne et al. in this article, is the formulation
    of clinical guidelines for practice in assessing, treating, and preventing childhood
    obesity. The article acknowledges that pediatric obesity is a great health concern
    internationally – a threat to adult health. The article identifies various critical
    elements that include the mental health aspect of the disease, which is an
    important observation. It is a critical perspective of addressing the issue of
    childhood obesity. The idea of prevention, where possible, is, therefore,
    highlighted as vital. Styne et al. address the issue of genetics as a culprit. They
    further acknowledge the limited research in aspects of pharmacotherapy and
    behavioral studies and present a recommendation towards enhanced research in
    these elements. The article identifies various aspects that need further research,
    OBESITY
    7
    including biological and genetic factors. The article urges further investigations
    and research to be directed towards the identification of more effective strategies
    and processes of treating preventing childhood obesity.
    The article is three years old from publication and, being relatively recent,
    contains viable guidelines towards handling and evaluating childhood obesity.
    The research is co-sponsored by primary stakeholders in the related healthcare
    field. The data is well presented with effective and informative points of view, as
    evidenced by the guidelines presented. The article is important to the project as
    these recommendations are robust results of in-depth research in childhood
    obesity. It offers an invaluable perspective on the project.
    Small, L., & Aplasca, A. (2016). Child Obesity and Mental Health. Child and Adolescent
    Psychiatric Clinics of North America, 25(2), 269-282. doi: 10.1016/j.chc.2015.11.008
    Child Obesity and Mental Health is critical to the project research. The
    article is a critical analysis of the mental health aspect of childhood obesity. Rates
    of child obesity increased massively in the last 3 decades according to Small and
    Aplasca. The article identifies the frequency of childhood obesity, the heightened
    focus on the national level, and, most critically, the various mental health
    elements that are comorbid with it. As a result, Small and Aplasca highlight the
    need to consider this as a public health concern – which it is. The article analyzes
    and evaluates the obesity and mental health relationship, though complex, to try
    and identify and remedy their interdependencies and severity. The article
    evaluates the connection between the two conditions through the evaluation of
    OBESITY
    8
    research literature. It further works towards identifying various treatment options
    that may influence and affect both health issues.
    The article is four years old since publication and is also relatively recent.
    The approach it offers is important for the project. The non-direct influences on
    childhood obesity, such as mental health that are easy to miss and overlook – they
    are some of the critical dimensions of research that offer informative perspectives
    in combating the problem effectively. The article is critical to the research in that
    it presents a basis for a multifaceted approach and analysis of childhood obesity.
    Stanford, F., Tauqeer, Z., & Kyle, T. (2018). Media and Its Influence on Obesity. Current
    Obesity Reports, 7(2), 186-192. doi: 10.1007/s13679-018-0304-0
    The external environment and its effect on childhood obesity are critical to
    understanding the problem. These extra-clinical approaches to childhood obesity
    are critical in identifying trends and patterns that influence factors such as
    prevention and prevalence, among others. The article reviews the media’s role in
    shaping and influencing the public’s perception concerning childhood obesity.
    The element of information diffusion and its influence on the understanding of
    obesity as an issue in society. The article delves into the areas of harm that arise
    from the lack of sufficient awareness, such as fat-shaming and weight bias. The
    issues of health science reporting concerning issues of physical activity to obesity
    tend to fuel inappropriate misunderstandings and myths.
    The article is two years old since publication and is also relatively recent.
    The issue of information presents another critical dimension to combating
    childhood and other types of obesity. The article addresses the issue of
    OBESITY
    9
    information accuracy in creating awareness. It stresses the fundamental impact of
    accurate information on public health and combating this chronic issue of obesity
    and its related bias and stigma. The information and evaluation of ideas are
    effectively and efficiently presented. The ideas handled by this article are
    important as they add a unique perspective to the project.
    Tucker, S., & Lanningham-Foster, L. (2015). Nurse-Led School-Based Child Obesity
    Prevention. The Journal of School Nursing, 31(6), 450-466. doi:
    10.1177/1059840515574002
    Sharon and Lanningham-Foster present a model of school-based obesity
    prevention programs. They identify various elements that range from reduced
    child physical activity (PA) to skyrocketing obesity rates in children. Quantitative
    research evaluating these programs has indicated that these school-based
    programs are efficient and effective in obesity prevention, intervention, and
    treatment. The article quantitatively offers a systematic review of the effect of
    school nurses participating in these programs, which presented positive results. It
    further encourages research in the line of a school nurse, or other health
    professionals led intervention programs targeting obesity.
    The article is five years old from publication, and although the most dated
    among the articles outlined in this bibliography, it presents a functional and
    practical method of combating childhood obesity. The approach is critical and
    presents various elements that are useful to the project. The article presents ideas
    that are informative towards the development of preventive and intervention
    oriented practical programs.
    OBESITY
    10
    Running head: CHRONIC KIDNEY DISEASE
    Chronic Kidney Disease: Problems, Perceptions, and Strategies for Intervention
    David Brown
    Walden University
    HLTH 4900, Section 2, Capstone
    November 16, 2013
    Instructor: Dr. Jody Early
    1
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    2
    Abstract
    Chronic kidney disease is considered one of the most significant health issues affecting
    morbidity and mortality and contributes heavily to the state of global health. Chronic kidney
    disease (CKD) and end-stage renal disease (ESRD) are chronic illnesses that have a dramatic
    impact on the cost of health care delivery in the United States. Early detection and intervention
    are critical to the long-term prognosis of this patient population; however, a health disparity
    exists because not everyone who is at risk for CKD has access to resources for screening and
    treatment. One of the goals of community-level and national programs is to create parity of care
    by focusing attention on marginalized communities that are at a statistically higher risk for CKD.
    The global impact of CKD and ESRD is significant because long-term survival depends on
    expensive technology and many regions of the world lack the resources needed to treat this
    disease. Health behavior and culture are known contributors to the long-term survivability of the
    disease. Since early detection is the key, creating screening programs that target populations at
    greatest risk will have the highest impact, and be the most cost-effective solution to combating
    this chronic illness.
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    3
    Chronic Kidney Disease: Problems, Perceptions, and Strategies for Intervention
    Chronic kidney disease (CKD) is considered one of the primary global health issues and
    contributes significantly to the social burden of care. CKD, along with cardiovascular disease,
    diabetes, chronic respiratory disease, and cancer, is a chronic illness that is classified as a noncommunicable disease (Healthy People 2020, 2013). Non-communicable diseases have a
    significant societal impact to domestic growth, productivity, and health care costs and are the
    most common cause of morbidity and premature death in the United States (Couser, Remuzzi,
    Mendis, & Tonelli, 2011). Chronic illnesses are also characterized by physical and emotional
    stressors that can become overwhelming when simultaneously coping with multiple
    comorbidities (Moulton, 2008). Although the World Health Assembly has determined that noncommunicable diseases contribute heavily to the state of global health, they concede that public
    health policy can dramatically affect patient morbidity and mortality (Couser et al., 2011). CKD
    is a public health threat that is on the rise and will likely not slow without deliberate intervention.
    This literature review will describe the impact that chronic kidney disease and end-stage renal
    disease have on the global burden of care, as well as detail the issues that contribute to health
    care disparities affecting this patient population. Factors that affect morbidity and mortality will
    also be discussed and a solution will be presented that has the potential to reduce the health
    system burden and improve the prognosis of many who suffer from this chronic disease.
    Chronic Kidney Disease Statistics and Epidemiological Data
    The impact of chronic kidney disease and end-stage renal disease (ESRD) on the federal
    Medicare budget is staggering. In 2008, CKD cost $60 billion and ESRD totaled $39.5 billion,
    which was 27% of the annual Medicare budget (Rettig, 2011). Recently, studies have reported
    that approximately 26 million Americans have some degree of CKD (Navaneethan, Aloudat, &
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    Singh, 2008). Only 5% of the people in the most treatable early stages of CKD are aware they
    have the disease, and almost 50% of those in stage 4 remain unaware unless diagnosed with a
    comorbid condition such as hypertension or diabetes (Couser et al., 2011). As with many
    illnesses, prevention and wellness programs that offer CKD screening can improve long-term
    outcomes.
    Prevention and Wellness Strategies for At-Risk Populations
    Prevention and wellness strategies do much for mitigating the physiologic damage from
    CKD, and can extend the productivity and mortality within this patient population. The greatest
    benefits are realized when detection and intervention occur early in the disease cycle; however,
    limiting factors such as genetic, environmental, and social barriers interfere with efforts to
    deploy prevention and wellness strategies that can also screen for health issues (Pearson, 2008).
    Although CKD is an illness that affects all cultural, geopolitical, and socioeconomic classes, not
    all groups have the same clinical outcomes. Native Americans, Asian and Pacific Islanders, and
    Hispanics have a greater likelihood of progressing to ESRD, and African Americans are four
    times more likely than Caucasians to suffer renal failure requiring a kidney transplant (National
    Medical Association, n.d.). The data indicates that a significant disparity exists between
    Caucasians and other ethnic groups in the diagnosis and treatment of CKD. Evaluative and
    preventative strategies are a part of high quality health care delivery, and involve interventions
    that incorporate a diet plan, exercise routine, and medication protocol. Intervention strategies
    should be tailored to the particular community since each of the disparate groups has ethnic and
    cultural differences that must be factored to ensure interventional plan compliance.
    The Impact of Quality Health Care Delivery on CKD
    4
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    5
    High quality health care delivery can have a dramatic impact on the morbidity and
    mortality of people suffering from CKD. A study conducted by the National Kidney FoundationKidney Disease Outcomes Quality Initiatives has proven that hospitalizations are reduced, and
    mortality is improved if patients are referred to a nephrologist within one month of new onset
    CKD (Navaneethan et al., 2008). This study also discovered that individuals were more likely to
    be delayed in getting a referral if they were part of a minority, uninsured, less educated, or
    elderly. Access to service, proper screening, and appropriate follow-through are challenges that
    must be addressed if this disparity is to be eliminated. Evaluation and comprehensive counseling
    on social and environmental factors that negatively impact health are important acute
    interventions, and long-term health benefits are seen when early referral to a nephrologist and
    access to follow-up care are provided (Collins, Gilbertson, Snyder, Chen, & Foley, 2010).
    Currently, numerous programs exist that focus on high-risk populations and are designed to
    provide access to screening and follow-up care. The National Kidney Foundation (2013)
    sponsors KEEP Healthy, which is an extension of their Kidney Early Evaluation Program
    (KEEP) and brings a nationally sponsored, community-based initiative designed to screen and
    educate in regions that have statistically higher CKD populations. The Kidney Care Prevention
    Program (KCPP) is a regional community-based program in North Carolina that staff trained
    kidney care coordinators and educators who can intervene early in the disease process, and can
    offer support through early-stage CKD intervention and management (Harward & Falk, 2008).
    These are only two examples of community-based programs designed to provide individuals
    with the best chance at early detection and intervention. Many such programs exist, and more are
    being offered as federal funding becomes available.
    The Global Impact of CKD
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    6
    Although the impact of CKD on the United States and most developed countries is
    significant, it is much worse in less developed countries. Screening programs are essential for
    early detection, but many areas of the world lack the infrastructure to be able to offer these
    services. Limited access to care and technology, poor living conditions and diet, and an
    inadequate supply of pharmaceuticals results in rapid conversion from CKD to ESRD, which is
    quickly followed by death (Couser et al., 2011). When CKD progresses to ESRD, the only cure
    is a kidney transplant. Renal replacement therapy, which is also known as hemodialysis, can be
    used as a bridge to transplant. There are 2 million people currently on hemodialysis worldwide,
    which constitutes only 12% of the global CKD population, and nearly all of them are treated in
    just five countries, including the United States, Japan, Germany, Brazil, and Italy (Couser et al.,
    2011). This means that 88% of the world population does not have a bridge to transplant, nor do
    they have access to renal transplantation surgery. When viewed from this perspective, it becomes
    clear just how devastating a diagnosis of CKD can be to most of the world’s population.
    Health Behavior and CKD
    Health behavior plays a significant role in an individual’s ability to cope with and
    manage chronic illness. Health behavior is so important in disease management that many health
    behavior models have been created in an effort to understand the link. One of the oldest health
    behavior theories is the Health Belief Model (HBM). The HBM asserts that people have an
    inherent readiness to act, which is built from life experiences, self efficacy, the perception of
    vulnerability to a given health problem, the severity of the issue, and the barriers and benefits to
    taking positive action (Williams, Manias, Liew, Gock, & Gorelik, 2012). Life experiences fall in
    the category of mediating factors, which also includes demographics, level of education,
    structural, and social variables. It is theorized that mediating factors that greatly impact CKD are
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    7
    primary causes of the current health disparity (Williams et al., 2012). Recognizing these
    variables and creating practices that mitigate them are the keys to creating health parity across
    the different CKD population groups. Culture can also affect health behavior and should be
    considered when creating screening and intervention programs.
    Culture and CKD
    An individual’s culture influences their perspectives on health and wellness, which can
    subsequently affect how well they manage their disease. One of the challenges with managing
    patient populations that have a high incidence of undiagnosed and undertreated CKD is that they
    tend to be culturally and linguistically diverse (CALD) groups (Williams et al., 2012). Chronic
    disorders such as CKD, diabetes, and cardiovascular disease require a strict adherence to lifestyle
    modification instructions and medication protocols. Limited health literacy, poor cognition, or a
    language barrier inhibits effective communication and has been shown to result in poor health
    outcomes (Norris & Nissenson, 2008). These communities are also at risk because they cannot
    afford health care, have decreased access the health system, and have little or no access to
    screening and testing facilities (Rettig, Norris, & Nissenson, 2008). These communities often
    shun modern health services because historically conditioned biases have created in an inability
    to trust or feel safe in contemporary health care delivery centers (Rettig et al., 2008).
    Establishing community-based health clinics that are staffed and managed by lay health advisors,
    especially in regions that have heavy racial and ethnic populations, will not only create
    community buy-in, but also create agents of change. Lay health advisors are community
    members who have a natural tendency to help, and are provided training and support so they can
    assist and advise others in their community on various health issues (Pullen-Smith & Plescia,
    2008). Overcoming health care disparities will require lay health advisors to be recruited from
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    within the affected patient population. Recruiting members from within the community has
    resulted in improved attitudes as community members gain control over their own health issues.
    The Role of Technology in Treating CKD
    Patients with CKD and ESRD rely heavily on technology to manage their disease
    process. Point-of-care testing that can measure creatinine, glucose, albumin, and other critical
    blood values allows clinics to mobilize and bring much needed health care into the community
    instead of waiting for members of at-risk groups to be proactive and seek screening centers
    (Harward & Falk, 2008). The mobile centers have been instrumental in finding individuals who
    are in the early stages of CKD and respond best to early intervention.
    When CKD progresses to ESRD, the person must learn to embrace the technology that
    will sustain his or her life until renal transplantation can be offered. Being tethered to a dialysis
    machine several days a week for six hours at a time, constant testing, and living with a dialysis
    catheter or fistula create a technological burden that can be overwhelming. Embracing
    technology is not easy for patients to do because machine dependency runs contrary to the
    freedom and autonomy that the individual previously enjoyed. Acculturation occurs when the
    patient conforms to behavior patterns and routines that are needed in order to exist indefinitely
    on machine dependency (Harward & Falk, 2008). At the point of acculturation, the patient fully
    embraces the new technology and accepts it as an integral part of life.
    Legal and Ethical Issues Impacting CKD
    Besides technology concerns, there are many legal and ethical issues surrounding the
    condition of CKD that can impact an individual’s ability to obtain the necessary treatment. In
    October 1972, the federal government passed the Social Security Amendments, which extended
    Medicare coverage to the disabled, and officially recognized ESRD as a disability (Vassalotti,
    8
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    9
    Gracz-Weinstein, Gannon, & Brown, 2006). In 2009, the American Recovery and Reinvestment
    Act (ARRA) shifted the focus from reactive and therapeutic intervention, to a proactive and
    preventative model (Menzin et al., 2011). Currently, instead of waiting and treating the terminal
    disease of ESRD, which is ineffective, inefficient, and costly, clinicians are screening for CKD
    in at-risk populations so that appropriate intervention can occur at a stage where the disease
    process can be halted or even reversed.
    There are other federal programs that help those suffering from CKD. A second example
    of a public policy that focuses on active intervention is the Medicare Improvements for Patients
    and Providers Act of 2008 (MIPPA), which provides funding to education programs for
    individuals with stage 4 CKD (Menzin et al., 2011). The MIPPA has proven successful at
    providing funding that creates highly effective targeted education.
    The Interdisciplinary Team’s Approach to Treating CKD
    The process of screening, treatment, and education need the involvement from many
    disciplines within health care. An interdisciplinary team approach can be the best way to manage
    complex illnesses such as CKD. Working within culturally and linguistically diverse
    communities require teams that can provide a range of health care needs, facilitate
    communication, and serve as patient advocates and representatives. Interdisciplinary teams
    typically include physicians, technicians, linguists, social workers and case managers, and
    community advocates, among others (Sinasac, 2012). These teams must also collaborate with
    community agencies, which can enhance the effectiveness of health promotion efforts (Sinasac,
    2012). Public health strategies can also include non-traditional groups such as community
    service organizations, American Indian tribes, boys and girls clubs, and faith-based
    organizations, which can penetrate deeper into the communities and reach individuals where they
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    10
    live, work, play, eat, and pray (Pullen-Smith & Plescia, 2008). Interdisciplinary teams allow for
    the breadth of services needed to make a significant impact on CKD screening and intervention.
    The Scholar-Practitioner’s Role in Treating CKD
    My role as a scholar-practitioner is to be aware of social disparities and endeavor to
    correct observed societal imbalances. CKD is considered one of the most significant health care
    disparities that exist in America today. As a scholar-practitioner, I must be a leader and advocate
    for positive social change within my community. Becoming involved with organizations such as
    the National Kidney Foundation’s KEEP Healthy program, the Minority Intervention and Kidney
    Education (MIKE) program, or local organizations like the Kidney Care Prevention Program
    (KCPP) are ways that I can influence social change as it relates to CKD and ESRD.
    Opportunities exist for me to become a trained kidney care coordinator/educator and lead efforts
    to promote health and wellness activities (Harward & Falk, 2008). Being a scholar-practitioner, I
    can be involved with identifying a need and targeting the appropriate patient populations by
    researching health status statistics and epidemiology studies, developing focus groups, assessing
    social marketing strategies, and analyzing current evidence-based practices to be used in creating
    new public health policies (Sinasac, 2012). As a scholar-practitioner, a worthy goal would be to
    spearhead the formation of a new organization that brings health care services to minority
    communities, socioeconomically depressed people, and the uninsured and underinsured. Another
    way I can have an impact in my community and make a positive social change is to involve
    myself with an existing organization whose goal is to eliminate racial and ethnic health
    disparities for chronic illnesses such as CKD. Through these types of actions, I can fully embrace
    the role of scholar-practitioner and become an agent of positive social change.
    CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION
    11
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