Indigenous Māori experiences of fundamental care delivery in an acute inpatient setting: A qualitative analysis of feedback survey data

Abstract

Aim and Objectives This study aimed to explore inpatient healthcare delivery experiences of Māori (New Zealand's Indigenous people) patients and their whānau (extended family network) at a large tertiary hospital in New Zealand to (a) determine why Māori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; (b) identify what aspects of care delivery are most important to them; and (c) contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well‐being. Background Bi‐annual Fundamentals of Care audits at the study site have shown that Māori are more dissatisfied with aspects of fundamental care delivery than other ethnic groups. Design Retrospective analysis of narrative feedback from survey data using an exploratory descriptive qualitative approach. Methods Three hundred and fifty‐four questionnaires containing narrative patient experience feedback were collected from the study site's patient experience survey reporting system. Content analysis was used to analyse the data in relation to the Fundamentals of Care framework and Māori concepts of health and well‐being. The research complies with the SRQR guidelines for reporting qualitative research. Results Four themes were identified: being treated with kindness and respect; communication and partnership; family is the fundamental support structure; and inclusion of culture in the delivery of care. Conclusion The current iteration of the Fundamentals of Care framework does not reflect in depth how indigenous groups view health and healthcare delivery. The inclusion of an Indigenous paradigm in the framework could improve healthcare delivery experiences of Indigenous peoples. Relevance to clinical practice Research around the application and relevance of the Fundamentals of Care framework to Indigenous groups provides an opportunity to refine the framework to improve health equity, and healthcare delivery for Indigenous people.

Fundamental care: An evolutionary concept analysis

“…There is a connection between patient and the family's needs and fundamental care (Haslund‐Thomsen et al, 2021; Rey et al, 2020). Caring for patients and their families and solving their needs is important to develop an interactive process based on three dimensions named as the key to fundamental care: create a trusting relationship (Alderman et al, 2018; Bagnasco et al, 2020; Pene et al, 2021), integration of care (Mudd et al, 2020; Palese et al, 2021) and the context of care (Conroy, 2018; Kitson et al, 2010; Meehan et al, 2018; Pavedahl et al, 2021). The nurse and patient relationship based on trust is fundamental and this relationship is an attribute, an antecedent and a consequence of the fundamental care.…”

“…The consequences are not only for the patients and the family, but also for the nurses. In fact, implemented fundamental care improves patient care (Rey et al, 2020; Voldbjerg et al, 2020; Zwakhalen et al, 2018), promotes critical thinking (Lillekroken, 2019) and ensures a safer environment over time to generate a high‐quality context of care (Aspinall et al, 2020; Collier et al, 2020; Jackson & Kozlowska, 2018; Jeffs et al, 2018; Kitson, 2018; Pene et al, 2021).…”

“…Attributes are described as the key aspects that describe a given concept (Rodgers, 2000). Based on our search, fundamentals of care could be described as a multidimensional and multifaceted phenomenon (Feo, Donnelly, et al, 2018) of nursing activities (Palese et al, 2021; Rey et al, 2020) based on patient and family centred care needs (Aspinall et al, 2020; Avallin et al, 2018; Jeffs et al, 2018; Pene et al, 2021; van Belle et al, 2020; Zwakhalen et al, 2018). The fundamentals of care are holistic (Avallin et al, 2018; Jackson & Kozlowska, 2018; Meehan et al, 2018), compassionate (Feo, Donnelly, et al, 2018; Jeffs et al, 2018), invisible, complex nursing activities (Parr et al, 2018) and yet they are straightforward for nurses to carry out (Feo et al, 2019; Feo, Donnelly, et al, 2018).…”

“…These different aspects were already expressed in the Fundamentals of Care Framework (Mudd et al, 2020;Palese et al, 2021;Voldbjerg et al, 2018) that was described by Kitson (2018) and identified as below. The centre of this framework is the relationship between nurse and patient based on trust (Aspinall et al, 2020;Feo, Donnelly, et al, 2018;Hansen & Jørgensen, 2020;Jeffs et al, 2018;Kitson, Dow, et al, 2013;Kitson, Robertson-Malt, & Conroy, 2013;Meehan et al, 2018;Pavedahl et al, 2021;Pene et al, 2021;Pinero de Plaza et al, 2021) to establish a continued interaction; the 12 basic needs (Table 1)…”

Early Opportunities to Explore Occupational Identity Change: Qualitative Study of Return-To-Work Experiences After Stroke

“…The current study highlights the importance of unique, tailored approaches to early conversations and interventions aimed at supporting RTW following stroke. Many participants strongly endorsed including family and support networks in discussions and service delivery, particularly relevant in NZ ( 32 , 33 ). Occupational identity was, for many, enacted through, and mediated within, the whole family system and support network relationships, contributing to how a person could express their occupational identity across time.…”