Improving cultural and clinical competency and safety of renal nurse education

In South Australia, Aboriginal people make up 2.4% of the total population and experience chronic kidney disease (CKD) at disproportionately higher levels, and at younger ages, than non-Aboriginal people, linked to a complex mix of chronic conditions and lower access to social determinants of health. Nurses providing care for Aboriginal people in urban, rural and remote dialysis and renal units bring various levels of experience and knowledge. Renal educators/facilitators strive to prepare nurses to respond to the unique individual, family and cultural priorities as well as clinical needs of all patients, but are challenged by a lack of local and Aboriginal-specific resources and supportive theoretical frameworks. This project aimed to develop a more responsive education package to increase cultural and clinical competence and safety of new, existing and future staff. It involved a renal focus group reviewing the current renal education curriculum and resources available within South Australia, and comparing the information within these to recent Aboriginal patient journey experiences. Participatory action research and concepts of symbiotic clinical education and mutually reinforcing relationships underpinned all activities. A draft education package that included recent case studies and patient journey mapping tools developed through the Managing Two Worlds Together project was tested with students, reviewed and adapted. A supportive theoretical framework was developed that brought together Benner's five stages of clinical competence, a range of cultural models, and Aboriginal patient journey priorities. How and why the framework was developed by the renal group is discussed, with rationale given to the placement of clinical and cultural models within it.