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 University of Adelaide Nursing School Senior Lecturer Melissa Arnold-Ujvari, Senior Research Fellow Elizabeth Rix and Professor Janet Kelly, was published in Nursing Inquiry,

“Thirty years ago, kidney care literature was purely biomedically focused, with culture, family and community viewed as potential barriers to patient compliance with treatment,” said Arnold-Ujvari.

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

“Inherent 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.

“Health professionals enter their professions with their own set of beliefs, values, and attitudes. Practicing in culturally safe ways requires critical self-reflection of one’s worldviews and culture and how one’s own biases and assumptions can impact clinical practice.

“The importance of building two‐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.

“Both individual health professionals and health services and institutions are encouraged to reflect on their practice, behaviors, and responses to patient/client feedback.

“The recipient of care determines whether care is safe or unsafe and patients/clients have the right to experience empathy and dignity in everyday relationships.”

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

“From 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,” she said.

“In 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.

“For the kidney care workforce, culturally safe care requires ongoing critical reflection, deep active listening skills, decolonizing approaches and the eradication of institutional racism.

“Until 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.”

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

“The CARI guidelines cite addressing institutional racism as the number one priority, recommending dialysis on Country and support to grow an Indigenous workforce,” said Arnold-Ujvari.

“Ensuring all health care 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.

“If we act with cultural safety within our nursing practice, we will minimize individual‐level racism; the mitigation of institutional racism requires the institution to buy in and prioritize and build accountability for cultural safety at the system level.”