Whakawhanaungatanga-Building trust and connections: A qualitative study indigenous Maori patients and whanau (extended family network) hospital experiences.

AIMS: Investigated the experiences of Maori (the Indigenous peoples of Aotearoa, New Zealand) patients and whanau (extended family network) engaging with acute hospital inpatient services and their priorities for a Maori-centred model of relational care. DESIGN: A qualitative Maori-centred research design using a Thought Space Wananga (learning through in-depth group discussion, deliberation and consideration) approach. METHODS: Two wananga were conducted between May 2022 and June 2022, with 13 Maori patients who had been acutely hospitalized within the past 12 months and their whanau members. The first wananga utilized storytelling and journey mapping to collect data. The second wananga refined the initial themes. Wananga were audio-recorded and then inductively coded and developed into themes. RESULTS: Thirteen patients and whanau attended the first wananga, while 10 patients and whanau participated in the second wananga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Maori), (3) Whakawhitiwhiti korero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Maori patients and whanau when acutely hospitalized. CONCLUSIONS: The experiences and priorities of Maori patients and whanau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging. IMPACT (ADDRESSING): What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Maori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Maori patients and whanau experiences engaging with acute hospital inpatient services and their priorities for a Maori-centred model of relational care. What were the main findings? Maori patients and whanau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Maori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. REPORTING METHOD: We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2-CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3-COREQ Checklist). PATIENT OR PUBLIC CONTRIBUTION: Maori patients and their whanau interviewed about their experiences were involved in data interpretation.

A tohu (sign) to open our eyes to the realities of Indigenous Maori registered nurses: A qualitative study.

AIMS: Identify the experiences of Maori nurses and priorities for a Maori model of relational care working with Maori patients and their whanau (extended family network) in acute hospital services. BACKGROUND: Maori, the Indigenous peoples of Aotearoa (New Zealand), have a relational and holistic worldview fundamental to establishing relationships with Maori patients and their whanau. Increasing the Indigenous Maori nursing workforce can improve Maori patient experiences but is challenged by ongoing recruitment and retention issues. DESIGN: A qualitative Maori-centred research methodology with 12 Maori nurses. METHODS: Data were collected using wananga (learning through discussion, deliberation and consideration) using he aha o hikoi (journey mapping) and korero mai (storytelling). Inductive thematic analysis was undertaken using a mahi a roopu (group process) approach. This study was conducted between May 2022 and June 2022. RESULTS: Three key themes: (1) Maori first, nurse second, (2) Cultural loading and (3) Compromised realities were identified. Maori nurses' praxis used their complex cultural and clinical intelligence to engage in a mana-enhancing way (strengths-based) to improve the care delivery for whanau Maori during their hospitalization journey. Cultural loading meant Maori nurses were often burdened with unrecognized workloads as they provided care for Maori patients and whanau, which often compromised their cultural integrity. CONCLUSION: Nurses' commitment to care for whanau and their assigned patient load created extra burdens and threatened their cultural integrity. Their experiences highlighted modes of practice rather than models of care required to improve healthcare delivery for Maori entering the hospital. These findings signal issues and areas nursing leaders need to heed, necessary for addressing the retention of Maori in nursing and improving workload equity. PATIENT OR PUBLIC CONTRIBUTION: Maori nurses and service users were involved in the interpretation of the data.

Creating an Indigenous Maori-centred model of relational health: A literature review of Maori models of health.

AIMS AND OBJECTIVES: Identify the key concepts, principles and values embedded within Indigenous Maori models of health and wellbeing; and determine how these could inform the development of a Maori-centred relational model of care. BACKGROUND: Improving health equity for Maori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners' engagement with Indigenous Maori accessing health services is one area that could support improving Maori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whanau or family, and spirituality, important for Indigenous health and wellbeing. DESIGN AND METHODS: A qualitative literature review on Maori models of health and wellbeing yielded nine models to inform a Maori-centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews. RESULTS: Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio-political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Maori is a holistic and relational concept. Building relationships that include whanau (extended family) is a cultural imperative. CONCLUSIONS: This study highlights the importance and relevance of relational approaches to engaging Maori and their whanau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Maori. Key elements for a Maori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing). RELEVANCE TO CLINICAL PRACTICE: Culturally-based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Maori-centred relational model of care to address inequity.

The culture conversation: Report from the 2nd Australasian ILC meeting-Auckland 2019.

AIM AND OBJECTIVE: This paper reports on the proceedings of the second Australasian International Learning Collaborative conference and summit. BACKGROUND: In December 2019, over a hundred people attended the second Australasian International Learning Collaborative Conference and Summit. This was the first to be held in Aotearoa New Zealand, the land where cultural safety was developed, its origins being in nursing education. Perhaps not surprisingly, culture, cultural safety and the context of care featured highly in the presentations and workshops. DESIGN AND METHODS: Discussion paper. RESULTS: A key outcome of the conference proceedings and workshops was the call for nurses and the International Learning Collaborative to work in partnership with indigenous groups to iterate the importance of the Fundamentals of Care framework and evaluate the impact of that on health equity. Other essential messages were to value establishing relationships, to continue to talk about the fundamentals of care, to research and to own them. Nurses were reminded to use their humanity to create a climate and culture in which patients and staff feel valued, safe and trusted. CONCLUSIONS: Future iterations of the Fundamentals of Care framework must incorporate indigenous worldviews, which emphasise the importance of relationships, family and spirituality on wellbeing. Such additions will provide an opportunity for the International Learning Collaborative to optimally respond and direct nursing practice. RELEVANCE TO CLINICAL PRACTICE: International Learning Collaborative members and conference attendees learned, listened and worked on meeting the challenges of consistently implementing and applying the fundamentals of care in practice and its importance to education, research and policy. The takeaway message is, when this does not happen, nurses must speak up.