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

Abstract

Aims: Identify the experiences of Māori nurses and priorities for a Māori model of relational care working with Māori patients and their whānau (extended family network) in acute hospital services. Background: Māori, the Indigenous peoples of Aotearoa (New Zealand), have a relational and holistic worldview fundamental to establishing relationships with Māori patients and their whānau. Increasing the Indigenous Māori nursing workforce can improve Māori patient experiences but is challenged by ongoing recruitment and retention issues. Design: A qualitative Māori-centred research methodology with 12 Māori nurses.Methods: Data were collected using wānanga (learning through discussion, deliberation and consideration) using he aha ō hikoi (journey mapping) and kōrero mai (storytelling). Inductive thematic analysis was undertaken using a mahi a roopū (group process) approach. This study was conducted between May 2022 and June 2022.Results: Three key themes: (1) Māori first, nurse second, (2) Cultural loading and (3) Compromised realities were identified. Māori nurses' praxis used their complex cultural and clinical intelligence to engage in a mana-enhancing way (strengths-based) to improve the care delivery for whānau Māori during their hospitalization journey.Cultural loading meant Māori nurses were often burdened with unrecognized workloads as they provided care for Māori patients and whānau, which often compromised their cultural integrity. Conclusion:Nurses' commitment to care for whānau 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 Māori entering the hospital. These findings signal issues and areas nursing leaders need to heed, necessary for addressing the retention of Māori in nursing and improving workload equity.

Whakawhanaungatanga—Building trust and connections: A qualitative study indigenous Māori patients and whānau (extended family network) hospital experiences

“…However, patients and their whānau commented on staffing and time being issues. Reports of disengagement from nursing staff in this study are reflected in literature elsewhere that signals how stretched the current healthcare system is and the cumulative impacts of unsafe staffing and burnout on patient's hospitalization journeys (Brunetto et al, 2013;Henikx et al, 2022;Komene et al, 2023;Malinen et al, 2020). As highlighted, nursing shortages and a culturally reflective workforce are critical issues that severely impact the available time nurses have with patients to engage clinically and culturally.…”

“…This paper reports findings from two wānanga (in‐depth group discussion, deliberation and consideration) (learning through in‐depth group discussion, deliberation and consideration) held with Māori patients and whānau (extended family network) about their experiences of engaging with acute hospital inpatient services, and their priorities for a Māori‐centred relational model of care. The research was part of a study that also included Māori nurses and their experiences caring for Māori patients and whānau (Komene et al., 2023).…”

From Kaimahi to Enrolled Nurse: A Successful Workforce Initiative to Increase Māori Nurses in Primary Health Care

“…The expectation of success at an individual level maintained the mana motuhake of kaimahi to redress inequities and promote generational hauora (Reid et al, 2019). Being Māori was instrumental in shaping culturally appropriate support (Komene et al, 2023). This included flexible work placements, responsive modes of learning, cohorting tuakana-teina (peer mentoring) support models, and various academic entry points (Oetzel et al, 2021;Wikaire et al, 2017).…”

What are ‘emerging methodologies’ in nursing research? Our perspectives as early career researchers

“…JAN is at the forefront of recognizing the importance of culturally appropriate qualitative methods and ensuring diversity in qualitative nursing research teams. A recent example of this is JANs publication that used Māori‐centred research methodology (Komene et al, 2023). Although this methodology has been around since the 1990s; the importance of conducting culturally appropriate research has gained significant attention in recent years.…”

“…nurses amidst the challenge to address global health in the context ofincreasedcomplexityinnursingresearch.Toaddressthisdemand, JAN is increasingly publishing 'borrowed' qualitative research approachesfromotherfields,suchaslongitudinalqualitativeresearch (LQR) methodology(Abrams et al, 2023;Grant et al, 2023) and qualitativerealistevaluations(Strachanetal.,2022). LQR methodology answers questions about 'how' and 'why' nursing phenomena changeovertime,whilerealistevaluationaddresses'how'and'why' complexnursinginterventionsdoordonotwork.Ultimately,publishing methodology like LQR in JANchallengesqualitativeresearch normswheredataareoftencollectedatonetimepoint.InsteadLQR leads to richer understandings of patient experience across time.JANssupportforthese'borrowed'qualitativeapproachesiscriticalto promoting more holistic qualitative inquiries of critical issues in nursing.JANisattheforefrontofrecognizingtheimportanceofculturallyappropriate qualitative methods and ensuring diversity in qualitativenursingresearchteams.ArecentexampleofthisisJANspublication that used Māori-centred research methodology(Komene et al, 2023). Although this methodology has been around since the 1990s;theimportanceofconductingculturallyappropriateresearch has gained significant attention in recent years.…”