Building cultural bridges and two-way understanding: working with Australian Aboriginal people within mainstream renal services

Providing culturally competent treatment and care for Aboriginal people with renal failure requiring haemodialysis within mainstream renal services remains complex, challenging and poorly informed. This paper reports recommendations for improving cultural competence within renal units which emerged from a renal nurses' doctoral study conducted in rural NSW. This research project aimed to inform service improvement for Aboriginal renal patients. Provision of the knowledge, skills and cultural understanding to enable renal staff to deliver treatment and care that are acceptable to and appropriate for Aboriginal patients is discussed. Employment of Aboriginal health workers within renal units as patient advocates and to provide a cultural bridge between Aboriginal patients and their families and renal clinicians is promoted. Aboriginal patients, family members and Elders delivering on-site cultural education to the staff within renal units is recommended, with the goal of increasing two-way understanding and building strong and positive relationships. Alternative models of culturally competent care from remote northern Australia and a New Zealand model for culturally safe care of Maori people within renal units are also discussed.