A University of Adelaide review of more than three decades of kidney care literature has revealed significant gaps in culturally safe practices for Indigenous communities.
The study published in Nursing Inquiry and led by Senior Lecturer Melissa Arnold-Ujvari with Elizabeth Rix and Professor Janet Kelly identifies both progress and persistent challenges.
"Thirty years ago, kidney care literature was purely biomedically focused, with culture, family and community viewed as potential barriers to patient compliance with treatment," Ms Arnold-Ujvari said.
The study found that from the mid-1990s, cultural awareness in kidney care began to emerge, becoming a central focus from 2014 onward.
However, Ms Arnold-Ujvari said cultural safety involves understanding how personal beliefs and biases impact healthcare delivery.
"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," she said.
Practising cultural safety requires healthcare professionals to reflect on their worldviews, acknowledging how these may affect patient care.
"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," Ms Arnold-Ujvari said.
"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."
Since 2000, there has been an increased recognition of Indigenous voices in kidney care.
"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," Ms Arnold-Ujvari said.
Despite progress, miscommunication remains a major barrier.
"Indigenous patients described how miscommunication was pervasive, and staff needed training in intercultural communication," she said.
The CARI guidelines for kidney care cite addressing institutional racism and supporting dialysis on Country as key priorities.
"The CARI guidelines cite addressing institutional racism as the number one priority, recommending dialysis on Country and support to grow an Indigenous workforce," Ms Arnold-Ujvari said.
The review concluded cultural safety can help reduce individual-level racism, though institutional buy-in is essential to tackle racism systemically.
"The mitigation of institutional racism requires the institution to buy in and prioritise and build accountability for cultural safety at the system level," Ms Arnold-Ujvari said.
Ultimately, culturally safe kidney care depends on meaningful patient involvement and systemic commitment to change.
