Table 1.

Publications Relevant to Cultural Safety Concepts Within the Context of Indigenous Kidney Care

Reference, Country	Research Question(s) or Purpose/Objectives	Research Design/Methods	Participants	Results and Connection to Cultural Safety
Richels et al17 (2020), Canada	Identify existing barriers to home peritoneal dialysis; provide insight for a culturally meaningful framework for future programs in First Nations communities in Saskatchewan	Qualitative research - sharing circles, individual interviews	67 participants in sharing circles	Themes included: logistics, education and information, training and support, community support, and culture and leadership; notes underuse of home-based peritoneal dialysis
Jansen et al19 (2020), Canada	Identify culturally appropriate and co-developed indigenous educational tools to support CKD learning and end-stage kidney treatment decision making	Scoping review	1 article; CKD tool co-developed by researchers	Engaging with indigenous communities requires in-depth understanding; the co-development of indigenous CKD educational tools is lacking
Hughes et al18 (2019), Australia	Describe health care experiences in relation to a government’s kidney health care	Qualitative interviews	26 adults	Acknowledges land and self-determination concepts; identifies complaint of lack of respect and empathy from health care providers; addresses needs to further health care quality
Walker et al21 (2019), New Zealand	Identify systemic barriers and understanding of cultural values that influence kidney transplantation	A systematic review of qualitative studies	225 indigenous participants in Australia, New Zealand, Canada, and the United States	Related to indigenous ways of knowing and being; identified barriers include distrust of health care systems, lack of knowledge of kidney transplantation processes, and discrimination; among indigenous participants, access to kidney transplantation was strongly desired
Conway et al23 (2018), Australia	Examine impact of mobile dialysis on health and well-being; facilitators and barriers	Semi-structured interviews	15 indigenous dialysis patients and 10 nurses	Country reference similar to a family bond, tradition, links with ownership and spirituality
Nelson et al20 (2018), United States	Examine efficacy of a home-based kidney care program	Clinical trail	98 rural adult Zuni Indians	A home-based intervention improved activation in own health and health care and may reduce CKD risk factors for disadvantaged rural area; interventions through community members who are trained furthered the educational process and helped engage patients in own care
Rix et al28 (2016), Australia	Aim to inform service improvement for Aboriginal kidney patients	Qualitative research; community-based research	18 Aboriginal hemodialysis patients and 29 kidney health professionals	Related to indigenous ways of being and knowing; land/self-determination colonialism; relationality; Cultural Safety requires listening to what people are saying
Reilly et al24 (2016), Australia, New Zealand, Canada	Examine benefits, cost-effectiveness, and suitability of CKD management programs for indigenous people, in addition to enablers and barriers	Systematic review of mixed evidence	10 studies were included	Describes the challenge of recruiting and retaining staff in remote communities, need for indigenous decision making, respect, ownership and health care workers
Kelly et al29 (2016), Australia	Develop a more responsive education program	Participatory action research	Kidney focus group of kidney and health care professionals	Related to knowledge of history/colonialism; humility and safety to be reflected through case studies; emphasis on indigenous Culturally Safe care
Walker et al22 (2012), New Zealand	Describe and discuss what predialysis nurses perceive to be key influences on effective predialysis nursing care	A descriptive exploratory approach	11 interviews with 11 nurses	Important to provide culturally appropriate and effective care; lack of culturally diverse educational resources identified as barrier to providing effective care; the Western approach of focusing on individuals is not always effective in this population
Rix et al27 (2014), Australia	Inform the provision of health care services as depicted by the indigenous people themselves	Qualitative stories	5 indigenous participants	Exemplifies Cultural Safety, uses storying, reflection on colonial historical past, unequal power relationships and indigenous ways of being and knowing within a kidney context
Shah et al25 (2014), United States	Identify barriers to health care in the Zuni Pueblo	14 one-hour focus group sessions	112 people	Recommends implementation of culturally community-based health promotion programs and preventive screening to improve access and reduce disparities
Walton30 (2011), United States	Describe differences regarding cultural knowledge and awareness in students before and after receiving education re indigenous experiences with hemodialysis therapy by a nephrology nurse; examine how students apply culturally relevant care when given a case scenario with CKD	Quantitative -pre- and post-tests based on 1-h presentation and qualitative-reflective paper	N = 95 nursing students	Indigenous ways of knowing and being are discussed; “Storytelling, networking, and involvement of Native American leaders, and the creation of new models that integrate cultural traditions in care may be keys to bridging the cultural gaps that exist”(p27)
Sicotte26 (2011), Canada	Compares health and care use of patients receiving tele-hemodialysis services	Pre-post design	N = 19	Telemedicine reduces the burden associated with access for hemodialysis
Walton30 (2011), United States	Explore what spirituality means to individuals receiving hemodialysis. and spirituality’s influence on their lives	Grounded theory	N = 21; 12 women and 9 men	Focus on spirituality, traditional approaches, consideration and recommendations for developing and transitioning into hemodialysis; also explores ways to decrease depression, reconcile past issues and further relationships

Abbreviation: CKD, chronic kidney disease.