Cultural safety in paramedic practice: experiences of Maori and their whanau who have received acute pre-hospital care for cardiac symptoms from paramedics.

ABSTRACT

Background Cardiovascular disease is a major health issue for Maori that requires timely and effective first-response care. Maori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Maori and their whanau who received acute pre-hospital cardiovascular care from paramedics. Methods Utilising a qualitative descriptive methodology and Kaupapa Maori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Maori patients and/or whanau, and a general inductive approach was used for analysis. Results Three key themes were identified (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Maori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion Maori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Maori.