成人大片

A review of more than three decades of literature about kidney care in First Nation communities has found there's still a long way to go when it comes to cultural safety.

The review, written by 成人大片 Nursing School Senior Lecturer Melissa Arnold-Ujvari, Senior Research Fellow Elizabeth Rix and Professor Janet Kelly, was published in .

鈥淭hirty years ago, kidney care literature was purely biomedically focused, with culture, family and community viewed as potential barriers to patient compliance with treatment,鈥� said Mrs Arnold-Ujvari.

鈥淭he importance of culturally informed care was increasingly recognised in the mid-1990s, with cultural safety within kidney care specifically cited from 2014 onwards.

鈥淚nherent within cultural safety is the recognition that one's beliefs, values and attitudes are constructed through a person's social environments, linked to childhood and life experiences.

鈥淗ealth professionals enter their professions with their own set of beliefs, values, and attitudes. Practising in culturally safe ways requires critical self鈥�reflection of one's worldviews and culture and how one's own biases and assumptions can impact clinical practice.

鈥淭he importance of building two鈥�way trust and understanding in therapeutic relationships and the need for staff to engage with lifelong learning is a crucial step to achieving cultural safety.

鈥淏oth individual health professionals and health services and institutions are encouraged to reflect on their practice, behaviours, and responses to patient/client feedback.

鈥淭he recipient of care determines whether care is safe or unsafe and patients/clients have the right to experience empathy and dignity in everyday relationships.鈥�

Mrs Arnold-Ujvari said while the review found the increasing awareness and need for critical reflection on cultural safety practises had grown, there was still room for improvement.

鈥淔rom 2000 onwards, kidney health research began to reflect the importance of effective communication and of health services being guided by community reference groups, Elders, patients and Indigenous health workers to provide alternative models of culturally shaped care,鈥� she said.

鈥淚n 2002, Indigenous patients described how miscommunication was pervasive, and staff needed training in intercultural communication as this lack of shared understanding and miscommunication were identified as major barriers to the provision of effective dialysis and kidney care.

鈥淔or the kidney care workforce, culturally safe care requires ongoing critical reflection, deep active listening skills, decolonising approaches and the eradication of institutional racism.

鈥淯ntil we actively listen to patients, act upon their needs, involving them in decision making in their own health journey and kidney care, we will not know if we are providing culturally safe and responsive care.鈥�

The review was in part informed by an extensive literature search and review for the inaugural Caring for Australians with Renal Insufficiency (CARI) guidelines.

鈥淭he CARI guidelines cite addressing institutional racism as the number one priority, recommending dialysis on Country and support to grow an Indigenous workforce,鈥� said Mrs Arnold-Ujvari.

鈥淓nsuring all healthcare staff working in kidney care base their treatment and care on these guidelines is the next major challenge. Then, finding a way to evaluate cultural safety by Indigenous patients is the subsequent challenge.

鈥淚f we act with cultural safety within our nursing practice, we will minimise individual鈥�level racism; the mitigation of institutional racism requires the institution to buy in and prioritise and build accountability for cultural safety at the system level.鈥�