Strategies to Improve Māori Health Outcomes, in Private Surgical Settings, by Understanding the Perceptions and Experiences of Māori Nurses

Abstract

In Aotearoa New Zealand, a disconcerting decline in Māori health outcomes persists, echoing historical roots dating back to the early days of colonisation. This enduring decline manifests in a stark life expectancy discrepancy between Māori and non-Māori. The WAI 2575 Health Services and Outcomes Kaupapa Inquiry underscored the widening health disparities over a quarter-century, revealing alarming rates of disease incidence for Māori. Although much research has occurred in the public sector to explore this disproportionate burden, little is known about Māori patient and whānau (family and extended family) outcomes within the private surgical environment. This study seeks to address this gap by delving into the perceptions and experiences of Māori nurses who work in private surgical settings, aiming to develop strategies to enhance Māori health outcomes within the private health sector. It strives to answer the following research question: How can the current experiences and perceptions of Māori nurses expose and reshape future realities for Māori patients and whānau when engaging in private surgical services?

This thesis adopts a research design grounded in kaupapa Māori methodology, employing a qualitative approach alongside autoethnography. The study leverages critical theory to unravel the intricacies and lived experiences of colonialism within the Māori experience of private surgical care. Te Ao Māori (Māori worldview) and mātauranga Māori (traditional Māori knowledge) permeate the various stages of the research process, including project consultation, autoethnography, researcher reflexivity, recruitment, interviews, data collection, analysis, and dissemination of findings.

In the autoethnography segment, insights from a practice-focused journal are utilised and analysed through Gibbs' reflective cycle and highlights the nuanced intersections of personal and professional aspects along the cultural identity continuum.

The qualitative phase involves interviewing Māori nurses in the private surgical setting. This research employs reflexive thematic analysis to interpret semi-structured interview data within the framework of kaupapa Māori research. The findings emphasise the value of Māori nurses, the need for collaboration, and enhanced education to improve cultural awareness.

The discussion highlights the transformative potential of incorporating Māori values into private healthcare practices. The recommendations advocate for comprehensive solutions, urging private healthcare organisations to prioritise cultural safety education, authentic collaboration, and policy reforms. The implementation of Māori mentorship programs, targeted recruitment strategies, and whakapapa leadership principles is proposed to cultivate a culturally responsive healthcare workforce and improve patient experiences in private surgical settings. Additionally, integrating co-design, mahitahi (kaupapa Māori initiative approach), and the Critical Tiriti Analysis framework into private healthcare initiatives is deemed crucial for promoting culturally responsive and equitable care for Māori.

In conclusion, this research provides a comprehensive examination of Māori nursing experiences in private surgical healthcare services, highlighting the profound impact of historical and contemporary factors. The study reveals how these elements contribute to racism and discrimination, hindering cultural health literacy and relationships between Māori patients/whānau and healthcare professionals. Despite these challenges, the research demonstrates the importance of understanding historical complexities for informed progress and advocates for ongoing research.