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Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus

BACKGROUND: Rates of End-Stage Kidney Disease among Aboriginal and Torres Strait Islander (Indigenous) Australians in remote areas are disproportionately high; however, haemodialysis is not currently offered in most remote areas. People must therefore leave their ‘Country’ (with its traditions and s...

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Autores principales: Conway, Jessica, Lawn, Sharon, Crail, Susan, McDonald, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311048/
https://www.ncbi.nlm.nih.gov/pubmed/30594208
http://dx.doi.org/10.1186/s12913-018-3849-4
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author Conway, Jessica
Lawn, Sharon
Crail, Susan
McDonald, Stephen
author_facet Conway, Jessica
Lawn, Sharon
Crail, Susan
McDonald, Stephen
author_sort Conway, Jessica
collection PubMed
description BACKGROUND: Rates of End-Stage Kidney Disease among Aboriginal and Torres Strait Islander (Indigenous) Australians in remote areas are disproportionately high; however, haemodialysis is not currently offered in most remote areas. People must therefore leave their ‘Country’ (with its traditions and supports) and relocate to metropolitan or regional centres, disrupting their kinship and the cultural ties that are important for their wellbeing. The South Australian Mobile Dialysis Truck is a service which visits remote communities for one to two week periods; allowing patients to have dialysis on ‘Country’, reuniting them with their friends and family, and providing a chance to take part in cultural activities. The aims of the study were to qualitatively evaluate the South Australian Mobile Dialysis Truck program, its impact on the health and wellbeing of Indigenous dialysis patients, and the facilitators and barriers to using the service. METHODS: Face to face semi-structured interviews were conducted with 15 Indigenous dialysis patients and 10 nurses who had attended trips across nine dialysis units. Realist evaluation methodology and thematic analysis established patient and nursing experiences with the Mobile Dialysis Truck. RESULTS: The consequences of leaving Country included grief and loss. Barriers to trip attendance included lower trip frequencies, ineffective trip advertisement, lack of appropriate or unavailable accommodation for staff and patients and poor patient health. Benefits of the service included the ability to fulfil cultural commitments, minimisation of medical retrievals from patients missing dialysis to return to remote areas, improved trust and relationships between patients and staff, and improved patient quality of life. The bus also provided a valuable cultural learning opportunity for staff. Facilitators to successful trips included support staff, clinical back-up and a co-ordinator role. CONCLUSIONS: The Mobile Dialysis Truck was found to improve the social and emotional wellbeing of Indigenous patients who have had to relocate for dialysis, and build positive relationships and trust between metropolitan nurses and remote patients. The trust fostered improved engagement with associated health services. It also provided valuable cultural learning opportunities for nursing staff. This format of health service may improve cultural competencies with nursing staff who provide regular care for Indigenous patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-3849-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-63110482019-01-07 Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus Conway, Jessica Lawn, Sharon Crail, Susan McDonald, Stephen BMC Health Serv Res Research Article BACKGROUND: Rates of End-Stage Kidney Disease among Aboriginal and Torres Strait Islander (Indigenous) Australians in remote areas are disproportionately high; however, haemodialysis is not currently offered in most remote areas. People must therefore leave their ‘Country’ (with its traditions and supports) and relocate to metropolitan or regional centres, disrupting their kinship and the cultural ties that are important for their wellbeing. The South Australian Mobile Dialysis Truck is a service which visits remote communities for one to two week periods; allowing patients to have dialysis on ‘Country’, reuniting them with their friends and family, and providing a chance to take part in cultural activities. The aims of the study were to qualitatively evaluate the South Australian Mobile Dialysis Truck program, its impact on the health and wellbeing of Indigenous dialysis patients, and the facilitators and barriers to using the service. METHODS: Face to face semi-structured interviews were conducted with 15 Indigenous dialysis patients and 10 nurses who had attended trips across nine dialysis units. Realist evaluation methodology and thematic analysis established patient and nursing experiences with the Mobile Dialysis Truck. RESULTS: The consequences of leaving Country included grief and loss. Barriers to trip attendance included lower trip frequencies, ineffective trip advertisement, lack of appropriate or unavailable accommodation for staff and patients and poor patient health. Benefits of the service included the ability to fulfil cultural commitments, minimisation of medical retrievals from patients missing dialysis to return to remote areas, improved trust and relationships between patients and staff, and improved patient quality of life. The bus also provided a valuable cultural learning opportunity for staff. Facilitators to successful trips included support staff, clinical back-up and a co-ordinator role. CONCLUSIONS: The Mobile Dialysis Truck was found to improve the social and emotional wellbeing of Indigenous patients who have had to relocate for dialysis, and build positive relationships and trust between metropolitan nurses and remote patients. The trust fostered improved engagement with associated health services. It also provided valuable cultural learning opportunities for nursing staff. This format of health service may improve cultural competencies with nursing staff who provide regular care for Indigenous patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-3849-4) contains supplementary material, which is available to authorized users. BioMed Central 2018-12-29 /pmc/articles/PMC6311048/ /pubmed/30594208 http://dx.doi.org/10.1186/s12913-018-3849-4 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Conway, Jessica
Lawn, Sharon
Crail, Susan
McDonald, Stephen
Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
title Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
title_full Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
title_fullStr Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
title_full_unstemmed Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
title_short Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
title_sort indigenous patient experiences of returning to country: a qualitative evaluation on the country health sa dialysis bus
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311048/
https://www.ncbi.nlm.nih.gov/pubmed/30594208
http://dx.doi.org/10.1186/s12913-018-3849-4
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