Cultural Safety in Paramedic Practice: Perceptions of Māori and Whānau

Penney, Sarah
Dicker , Bridget
Harwood, Matire
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Master of Philosophy
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Auckland University of Technology

Aim: This thesis sought to explore and understand Māori experiences of cultural (un)safety in acute pre-hospital cardiovascular care provided by paramedics.

Methods: The research utilised a qualitative descriptive approach underpinned by Kaupapa Māori Research (KMR). The decision to use qualitative descriptive was based on the subjectiveness of experiences and the ability of qualitative descriptive research to discover and comprehend phenomena, processes, perspectives, or worldviews, particularly when information is required directly from those experiencing them. Furthermore, KMR was important to avoid perpetuating feelings of alienation and disempowerment that are common for Māori throughout colonial research. The application of KMR principles, outlined by Smith (1992), ensured the research was beneficial for Māori, under Māori control, and informed by mātauranga Māori.

First, a narrative review was completed to synthesise evidence on access to, and quality of, emergency medical services (EMS) cardiovascular care for Māori. The narrative review helped to establish the context and to understand what is currently known about Māori and whānau access to and experiences of acute pre-hospital cardiovascular care by paramedics. Following the narrative review, semi-structured in-depth interviews using open-ended questions were completed with ten participants and/or whānau. The interviews were then analysed using a general inductive approach to explore the experiences of cultural (un)safety for Māori who received acute pre-hospital care for chest pain or cardiac symptoms from paramedics and/or the experiences of whānau. An exploration of the participant's own experiences when utilising the ambulance and the care they received was completed as part of the data analysis.

Findings: The narrative review highlighted longer delays between the onset of symptoms and first medical contact (FMC) for Māori patients experiencing acute coronary syndrome (ACS) (Garofalo et al., 2012; Kerr et al., 2019). This included Māori being more likely to self-transport to hospital or present to their general practice or Accident and Medical centre before being transported by ambulance (Garofalo et al., 2012). This finding is critical, as delays in defibrillator availability and reperfusion therapy result in, poor, and inequitable outcomes for Māori. No research regarding Māori experiences of accessing EMS care for cardiac symptoms could be found.

From the semi structed interviews, three overarching themes were identified, including interpersonal factors, service and access factors and active protection of Māori, as well as nine key sub-themes. It was noted significant gaps exist regarding the interpersonal interactions between Māori and paramedics, including clinically and culturally appropriate communication, connection, and rapport. Furthermore, systemic, and structural barriers such as timely access to pre-hospital care and representation of Māori within the pre-hospital workforce were reported.

Conclusion: Māori experience culturally unsafe care throughout the health system, including pre-hospital care. Addressing these poor experiences for Māori and whānau requires a comprehensive approach of cultural safety training, increased Māori representation in the paramedic workforce, and systemic changes to improve pre-hospital healthcare access for Māori communities. Ultimately, Māori co-design and a by-Māori approach must be utilised as partnership between Māori non-Māori is pivotal in honouring te Tiriti o Waitangi (te Tiriti) and improving outcomes for Māori.

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