A well-developed professional identity enhances nursing as a profession, contributing towards better healthcare delivery and outcomes. It is critically important how professional values are learnt within the culture of nursing. Tensions in clinical practice need to be understood better to avoid moral distress caused by dissonance between expectation and experience. It is advantageous to increase early positive socialisation.
In Aotearoa New Zealand there is limited research exploring the tensions for Indigenous Māori nurses when integrating cultural priorities into clinical practice. This study explores how Māori nurses navigate delivering culturally responsive care to iwi, hapū, and Māori whānau across different healthcare settings. A qualitative Indigenous narrative inquiry was used to obtain data. Semi-structured interviews were conducted with 12 Māori registered nurses and nurse practitioners. The thematic analysis was both inductive and deductive. The narratives provide insight into the nurses’ holistic Indigenous world view by contextualising their professional practice experiences. Four main themes were derived from data: te tuakiri Māori - cultural identity; kawenga taumaha - bearing the burden; te kaikiritanga - racism; and tauutuutu - reciprocity. Māori practitioners routinely experienced compromises within biomedically oriented healthcare services. Practitioners witnessed discriminatory practices that may negatively impact on healthcare outcomes. Sustained cultural dissonance may also negatively impact on retention of Māori nurses. Māori practitioners value tauiwi colleagues who work as allies and affirm culturally shaped care for Māori.
Background: Persistent healthcare emphasis on universal moral philosophy has not advantaged indigenous and marginalised groups. Centralising cultural components of care is vital to provide ethical healthcare services to indigenous people and cultural minorities internationally. Woods’ theoretical explication of how nurses can integrate cultural safety into a socioethical approach signposts ethical practice that reflects culturally congruent relational care and systemic critique. Aim: To demonstrate the empirical utility of Woods’ ethical elements of cultural safety within a socioethical model, through analysis of indigenous nurses’ practice realities in Aotearoa New Zealand. Research design: The study used a qualitative indigenous narrative inquiry. Participants and research context: Participants were recruited nationally. Twelve Māori registered nurses and nurse practitioners were interviewed. All participants provided direct care in either primary or secondary health services. Ethical considerations: Research approval was gained from the Human Ethics Committee of the lead author’s tertiary institution. Participation was voluntary, and written informed consent was obtained. Findings: Analysis highlighted the following: (1) cultural needs, which for Māori were integral to care, were easily subsumed by clinical care being prioritised; (2) ethical care by non-indigenous nurses requires critical reflection about broader equity issues that impact Māori disengagement from healthcare; (3) retention of indigenous nurses was seen as essential because their advocacy and the cultural ‘fit’ for Māori contributed to positive healthcare outcomes; and (4) committed leadership ensured culturally safe care was not eroded through workplace efficiencies. Discussion: The data provide rich representation of Woods’ model. The data indicate that nurses must engage reflexively with a relational ethic of care and social justice dimensions in order to deliver culturally safe care. Conclusion: Woods’ model provides a critical lens for nurses to examine their relational practice and systemic factors that enhance or detract from culturally safe care when caring for members of any indigenous group.
was a Māori nurse, educationalist, philosopher, and writer, who leaves an enduring legacy for the development of Kawa Whakaruruhau (cultural safety) both in Aotearoa New Zealand and globally. "The way in which people measure and define their humanity" (Ramsden, 1990a, p. 35) -is the central tenet of this article. "Moving on" was a speech given by Dr Irihapeti Ramsden to Diploma of Nursing graduands at Nelson Polytechnic on 17th November 1989. Ramsden brought together an appreciation of Florence Nightingale's achievements and legacy and our ongoing obligation to provide health services that are respectful and responsive to the humanity of the people needing those services. Of Nightingale, she said, "[i]t would seem appropriate to remember the woman who set up the British model of nursing which still underpins nursing in this country to some extent. We owe respect to Florence Nightingale" (p. 34).The paper offered a revision of Nightingale's historical 'noblesse oblige' nursing ideology, where privileged people provided care to 'others' irrespective of nationality, culture, creed, colour, age, sex, political, religious belief or social status. To facilitate a reduction in health inequities and improve Article 2 / Tuhinga 2
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