Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Northern Region Te Whatu Ora (Health New Zealand), Auckland, New Zealand.
J Adv Nurs. 2024 Apr;80(4):1545-1558. doi: 10.1111/jan.15912. Epub 2023 Oct 27.
Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care.
A qualitative Māori-centred research design using a Thought Space Wānanga (learning through in-depth group discussion, deliberation and consideration) approach.
Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audio-recorded and then inductively coded and developed into themes.
Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (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 Māori patients and whānau when acutely hospitalized.
The experiences and priorities of Māori patients and whānau 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, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. What were the main findings? Māori patients and whānau 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 Māori, 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.
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).
Māori patients and their whānau interviewed about their experiences were involved in data interpretation.
调查毛利人（新西兰的原住民）患者及其亲属在参与急性住院患者服务时的体验，以及他们对以毛利为中心的关系护理模式的优先考虑。
采用以毛利为中心的定性研究设计，使用思维空间万纳加（通过深入的小组讨论、审议和考虑进行学习）方法。
2022 年 5 月至 6 月期间进行了两次万纳加，参与者包括过去 12 个月内急性住院的 13 名毛利患者及其家属。第一次万纳加利用讲故事和旅程图来收集数据。第二次万纳加完善了最初的主题。万纳加进行了录音，然后进行归纳编码，并发展成主题。
13 名患者及其家属参加了第一次万纳加，而 10 名患者及其家属参加了第二次万纳加）。确定了四个主题：（1）Whakawhanaungatanga（建立联系和关系），（2）Whakamana（提升毛利人的地位和尊严），（3）Whakawhitiwhiti kōrero（沟通、讨论和审议的重要性）和（4）Kotahitanga（有目的的合作），这些主题都深入探讨了在急性住院期间与毛利患者及其家属有效接触和联系的重要性。
毛利患者及其家属的经历和优先事项证实了国际文献，表明土著关系概念对于建立关系、联系和信任至关重要。尽管存在与土著人民合作的医疗保健模式，但它们的应用不佳导致在整个医疗保健过程中患者的医疗体验都不佳。以参与和建立联系为重点的关系模式更好地满足了与住院医疗服务合作的土著人民的需求。
对专业和/或患者护理的影响：尽管存在土著护理模式，但土著人民在获得住院医疗服务时仍然报告缺乏参与和联系。如果不建立关系，应用护理模式是具有挑战性的。
影响（针对）：该研究解决了什么问题？在国际上，医疗保健系统始终难以为土著和边缘化人群提供文化安全的护理，这体现在持续存在的健康不平等现象中。与其他关于土著人健康服务体验的报告一样，毛利人对急性住院环境中的护理服务不满意。本研究调查了毛利患者及其家属在参与急性医院住院服务时的体验，以及他们对以毛利为中心的关系护理模式的优先考虑。主要发现是什么？毛利患者及其家属讲述了与缺乏有效关系和信任的医疗保健专业人员接触的负面体验。当与卫生保健专业人员的接触类似于考虑他们整体、集体和动态世界观的土著文化相遇仪式时，满意度就会产生。虽然之前的关系护理模式有所帮助，但它们不是土著模式，因此无法满足他们的需求，例如将参与作为一种实践模式（如何）实现这一目标。这项研究将在哪些地方和哪些人身上产生影响？这项研究对土著人民的健康结果，特别是毛利人，以及在急性住院和其他医院环境中工作和互动的护士和临床医生产生影响。土著研究方法通过转化实践、政策和理论发展，支持共同构建知识以转化为实际成果。
我们使用了《加强与土著人民有关的健康研究报告的一致性标准》（CONSIDER）声明（见文件 S2-CONSIDER 检查表）和《定性研究报告的一致性标准》（COREQ）指南（见文件 S3-COREQ 检查表）。
接受过有关其体验的采访的毛利患者及其亲属参与了数据解释。
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