Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary

Introduction: First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. Main recommendations: These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2 , and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. Changes in management as result of the guidelines: Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.David J Tunnicliffe, Samantha Bateman, Melissa Arnold-Chamney, Karen M Dwyer, Martin Howell, Azaria Gebadi, Shilpa Jesudason, Janet Kelly, Kelly Lambert, Sandawan William Majoni, Dora Oliva, Kelli J Owen, Odette Pearson, Elizabeth Rix, Ieyesha Roberts, Kimberly Taylor, Gary A Wittert, Katherine Widders, Adela Yip, Jonathan Craig, Richard K Phoo

Antimicrobial stewardship programs and renal units in 2019 and beyond

Editorial.Approximately 30% of antimicrobial doses administered in hemodialysis units are considered unnecessary (D’Agata et al 2018). Therefore implementing an antimicrobial stewardship program (AMS program) in our renal units could optimize antimicrobial therapy and at the same time improve patient safety and patient quality of care. AMS programs can be seen as a key tool in facilitating the appropriate use of antimicrobials and help address the problem of antimicrobial resistance and other unintended consequences, such as antimicrobial toxicity and adverse drug reactions (Morency-Potvin, Schwartz & Weinstein, 2017).Melissa Arnold-Chamne

Challenges facing the renal nursing workforce

Editorial.There has been extensive research investigating stress in the nursing workforce, known as a ‘caring’ occupation, to assess the impact of the emotional labour of caring. Most of the recent evidence cites increasing nursing workloads contributing to the phenomenon of nursing stress, and this is widely predicted to continue to increase. The current shortage in the renal nursing workforce has largely been considered a ‘subset of overall supply’; however, with hundreds of registered nurse (RN) vacancies in renal globally, as well as increases in population level end stage kidney disease (ESKD), the renal specialty is under additional pressure (Wolfe, 2014).Kathy Hill and Melissa Arnold-Chamne

Once we knew it, we couldn’t unknow it

Nari Sinclair, Jared Kartinyeri, Melissa Arnold-Chamne

Improving Aboriginal people's kidney care journeys - Kanggawodli hostel dialysis

Session 3B: Kidney Health - Abstract #238Ms Kelli Owen, Ms Nari Sinclair, Dr Janet Kelly, Ms Melissa Arnold-Chamney, Dr Samantha Bateman, Dr Kim O'Donnell, Amy Graham, Kynesha Temple Varco, Dr Kim O'Donnel

Reporting and conducting patient journey mapping research in healthcare: A scoping review

Published online: January 2023AIM: To identify how patient journey mapping is being undertaken and reported. DESIGN: A scoping review of the literature was undertaken using JBI guidance. DATA SOURCES: Databases were searched in July 2021 (16th-21st), including Ovid's Medline, Embase, Emcare and PsycINFO; Scopus; Web of Science Core Collection, the Directory of Open Access Journals; Informit and; ProQuest Dissertations and Theses Global. REVIEW METHODS: Eligible articles included peer-reviewed literature documenting journey mapping methodologies and studies conducted in healthcare services. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full-text articles. A table was used to extract data and synthesize results. RESULTS: Eighty-one articles were included. An acceleration of patient journey mapping research was observed, with 76.5% (n = 62) of articles published since 2015. Diverse mapping approaches were identified. Reporting of studies was inconsistent and largely non-adherent with relevant, established reporting guidelines. CONCLUSION: Patient journey mapping is a relatively novel approach for understanding patient experiences and is increasingly being adopted. There is variation in process details reported. Considerations for improving reporting standards are provided. IMPACT: Patient journey mapping is a rapidly growing approach for better understanding how people enter, experience and exit health services. This type of methodology has significant potential to inform new, patient centred models of care and facilitate clinicians, patients and health professionals to better understand gaps and strategies in health services. The synthesised results of this review alert researchers to options available for journey mapping research and provide preliminary guidance for elevating reporting quality.Ellen L. Davies, Lemma N. Bulto, Alison Walsh, Danielle Pollock, Vikki M. Langton, Robert E. Laing, Amy Graham, Melissa Arnold-Chamney, Janet Kell

Akction: Aboriginal kidney care together - improving outcomes now, Lighting Talk Presentation

Background: Aboriginal people are over-represented in kidney care and have complex care needs. There is increasing recognition of the importance of Aboriginal consumers’ active involvement in Health Service redesign. Methods:This collaborative project involved community consultations, patient journey mapping, interviews, focus groups, strategy implementation workshops, yarning circles, artwork sessions and storytelling within urban, rural and remote locations to identify and respond to gaps in care. A strong Aboriginal community reference group worked alongside an enthusiastic research team, clinicians and key decision makers. Innovative and responsive models of kidney care were co-designed within and across health and support services to improve access to kidney care, dialysis and transplantation, enhancing wellbeing. Results: This resulting evidence is informing local and state-wide renal services and systems change, including; the implementation of a renal dialysis chairs at Kanggawodli Aboriginal hostel in Adelaide; partnering with dental services. ; improving cultural safety and knowledge of staff and is also informing national renal Indigenous clinical guidelines. This important work will continue to transform kidney care through an Ideas Grant with Aboriginal patient experts positioned as Chief Investigators. Conclusion: Aboriginal kidney patients and our families, and individual clinicians, have been advocating for improvements in kidney care as individuals, but with little success. AKction has become a catalyst for collective and meaningful health systems change.M Arnold--Chamney, S Bateman, K Owen, S Jesudason, S McDonald, O Pearson, N Sinclair, I Williamson, K O, Donnell K, J Kell

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study

Background: The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. Design and objectives: This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. Setting and participants: Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. Data analysis: Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. Results: Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. Conclusions: The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered.Janie Brown, Susan Slatyer, Samantha Jakimowicz, Jill Maben, Pauline Calleja, Helen Donovan, Lynette Cusack, Dawn Cameron, Vicki Cope, Tracy Levett-Jones, Moira Williamson, Karen Klockner, Alison Walsh, Melissa Arnold-Chamney, Olivia Hollingdrake, Debra Thoms, Ravani Dugga

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study

Background The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. Design and objectives This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. Setting and participants Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. Data analysis Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. Results Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. Conclusions The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study.

BACKGROUND: The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. DESIGN AND OBJECTIVES: This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. SETTING AND PARTICIPANTS: Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. DATA ANALYSIS: Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. RESULTS: Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. CONCLUSIONS: The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered