Co-Developed Indigenous Educational Materials for Chronic Kidney Disease: A Scoping Review.

BACKGROUND: Canadian Indigenous populations experience significantly more chronic kidney disease (CKD) than the general population. Indigenous people who live in rural and remote areas may also have difficulty accessing both information and care for their CKD. Informed decision making about treatment options for advancing kidney disease may be delayed, which can result in poor health outcomes and decreased quality of life. Moreover, Indigenous people may experience marginalization within Western health care systems. OBJECTIVE: The objective of this scoping review is to identify culturally appropriate and co-developed Indigenous educational tools that will ultimately support CKD learning and end-stage kidney treatment decision making. DESIGN: Scoping Review. SETTING: Databases included Embase, CINAHL, Medline (OVID), ERIC, and the Canadian Agency for Drugs and Technology Gray Matters. STUDY PARTICIPANTS: Community-based Indigenous patients, families, health care workers, and community members. METHODS: We systematically reviewed the literature to explore the availability of co-developed Indigenous educational tools and material for CKD treatment options. Titles, abstracts, and full texts were reviewed independently by 2 reviewers with disagreements resolved through a third. All aspects of this project, including searching the databases were done in consultation with an Indigenous Elder. RESULTS: Only one retrieved article identified a comprehensive CKD tool co-developed by researchers, health care providers, and an Indigenous community. Three themes emerged from the scoping review that may inform characteristics of co-developed tools: cultural appropriateness; appraisal of utility and effectiveness and; content informed by co-development of traditional and Western chronic disease knowledge. LIMITATIONS: Consistent with scoping review methodology, the methodological quality of included studies was not assessed. In addition, it was difficult to synthesize the findings from the research and gray literature. CONCLUSION: Little is known about the co-development of Indigenous educational tools for CKD. Further in-depth understanding is required about how to best engage with Indigenous communities, specifically to co-develop contextualized CKD tools that are acceptable to Indigenous people.Trial registration: Not applicable as this review described secondary data.

CONTEXTE: Au Canada, l'insuffisance rénale chronique (IRC) touche les populations autochtones davantage que la population générale. Qui plus est, l'accès à des soins et de l'éducation sur l'IRC s'avère plus difficile pour les autochtones vivant en régions rurales et éloignées. Une situation susceptible de retarder la prise de décision informée quant aux options de traitement et donc, de compromettre les résultats de santé et la qualité de vie. Les autochtones pourraient également être marginalisés dans les systèmes de santé occidentaux. OBJECTIFS: L'étude visait à répertorier des outils de sensibilisation culturellement appropriés et développés conjointement avec les autochtones qui, en définitive, viendraient appuyer l'éducation sur l'IRC et la prise de décision quant au traitement de l'insuffisance rénale terminale. TYPE D'ÉTUDE: Étude de cadrage. SOURCES: Les bases de données Embase, CINAHL, Medline (OVID) et ERIC, et l'outil Matière grise de l'Agence canadienne des médicaments et des technologies de la santé (ACMTS). SUJETS: Des patients autochtone de la communauté et leurs familles, des travailleurs du secteur de la santé et des membres de la communauté. MÉTHODOLOGIE: Nous avons procédé à une revue systématique de la littérature pour vérifier la disponibilité d'outils d'éducation développés conjointement avec les autochtones et de matériel relatif aux options de traitement pour l'IRC. Les titres, abrégés et textes complets ont été révisés indépendamment par deux examinateurs; les désaccords ayant été résolus par un troisième. Un aîné autochtone a été consulté pour tous les aspects de ce projet, y compris la recherche dans les bases de données. RÉSULTATS: Parmi les articles retenus, un seul faisait état d'un outil complet développé conjointement par des chercheurs, des fournisseurs de soins et une communauté autochtone. L'étude a dégagé trois thèmes susceptibles d'éclairer les caractéristiques d'un outil co-développé: l'adaptation culturelle, l'évaluation de l'utilité et de l'efficacité, et un contenu éclairé par le co-développement des connaissances traditionnelles et occidentales sur les maladies chroniques. LIMITES: Conformément à la méthodologie d'une étude de cadrage, la qualité méthodologique des études incluses n'a pas été évaluée. De plus, il a été difficile de synthétiser les résultats provenant de la recherche et de la littérature grise. CONCLUSION: On en sait peu sur le développement d'outils d'éducation sur l'IRC conjointement avec les membres des communautés autochtones. Une compréhension plus approfondie des meilleures façons de collaborer avec les communautés autochtones est nécessaire, particulièrement pour l'élaboration d'outils d'éducation sur l'IRC contextualisés et acceptables pour les autochtones. ENREGISTREMENT DE L'ESSAI CLINIQUE: Sans objet puisque cette étude discute de données secondaires.

Characteristics and residence of First Nations patients and their use of health care services in Saskatchewan, Canada: informing First Nations and Métis health services.

RATIONALE: In Canada, Aboriginal people, particularly First Nations experience significant health disparities and a lower health status compared with the non-Aboriginal population. AIMS AND OBJECTIVES: The purpose of this study was to examine the demographic and clinical characteristics of First Nations patients admitted to hospitals in Saskatchewan, and the acute care services used by First Nations compared with non-First Nations, specifically hospital length of stay. Primary residence of patients was also mapped to determine geographic patterns that would inform health service provision. METHODS: A retrospective medical chart audit was carried out to collect data on patient demographics and clinical characteristics of 203 First Nations and 200 non-First Nations patients admitted to two urban hospitals in Saskatchewan from 2012 to 2014. RESULTS: The most common reason for admission of First Nations and non-First Nations patients was infection (24.6%) and cardiology conditions (19.5%), respectively. There was no significant difference in mean length of stay for First Nations (10.44 days) compared with non-First Nations (10.57 days). After adjusting for age, mean length of stay for First Nations was nearly 3 days longer than non-First Nations. First Nations patients' residence was from across the broad geography of Saskatchewan, with 45% living in rural communities or on reserve. CONCLUSIONS: The outcomes of this study are clinically meaningful and support the need for research, in collaboration with Aboriginal patients and families, to further examine and improve the care experience in order to decrease health disparities for Aboriginal patients in Canada.

Thinking ecologically for safer healthcare: a summer research student partnership.

As leaders for nursing education, nursing research, healthcare administration and patient safety, we asked one another: How do we use our collective resources to build health system capacity for clinically based research training and safer healthcare? Drawing on knowledge from the field of ecological restoration, which is the study and repair of damaged ecosystems, we partnered the Safer Systems research program of the Faculty of Nursing, University of Alberta, with Capital Health's Royal Alexandra Hospital (RAH), the Caritas Health Group, the Canadian Patient Safety Institute (CPSI) and several funding agencies to provide hands-on training in clinical research, infection control and patient safety policy development for nursing students during the summer months. As we plan ahead, our student and staff evaluations show that together, we can make concrete, vital contributions to student education, nursing research, evidence-informed practice, clinical quality improvement and national policy. We are using what we have learned to continually expand the range of undergraduate, graduate and post-doctoral clinical learning opportunities in healthcare safety that are available year round. Our shared goal is to support current and future nurses in leading the way for safer healthcare systems and the safest possible healthcare.