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Māori nurse practitioners: The intersection of patient safety and culturally safe care from an Indigenous lens

Abstract

Background

Dynamic and complex health systems require innovative and adaptive solutions to support patient safety and achieve equitable health outcomes for Indigenous populations. Understanding the ways by which Indigenous (and specifically Māori) nurse practitioners (NPs) practice patient safety is key to enhancing Indigenous health outcomes in predominantly westernized healthcare systems.

Aim

To describe Māori NPs perspectives on patient safety when caring for Māori and understand how Māori NPs deliver safe health care.

Methodology

A group of five Māori NPs worked alongside a Māori nurse researcher to explore their perceptions of patient safety. Together, they held an online hui (focus group) in early 2024. Data were analysed collectively, informed by kaupapa Māori principles, using reflexive thematic analysis.

Results

Māori NP experiences, expressions and understandings of patient safety envelop cultural safety and have many facets that are specific to the needs of Māori populations. The three themes showed: (1) Te hanga a te mahi: the intersection of cultural and clinical expertise; (2) Mātauranga tuku iho: the knowledge from within, where safe practice was strongly informed by traditional knowledge and cultural practice; (3) Te Ao hurihuri: walking in two worlds, where Māori NPs navigated the westernized health system's policies and practices while acting autonomously to advocate for and deliver culturally safe care.

Conclusion

The Māori NP lens on patient safety is vital for promoting culturally responsive and effective health care. By recognizing the unique needs of Māori patients and families and incorporating cultural perspectives into practice, Māori NPs contribute to a more comprehensive and inclusive approach to patient safety that goes beyond westernized principles and practices.

Patient or Public Contribution

No patient or public contribution.

An integrative review of racism in nursing to inform anti‐racist nursing praxis in Aotearoa New Zealand

Abstract

Aim

To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand.

Design

An integrative literature review was undertaken, integrating Indigenous Kaupapa Māori methodologies to ensure a cultural and philosophical lens.

Methods

Peer-reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Māori principles.

Data Sources

Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023.

Results

Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing.

Conclusion

Nurses are well-positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti-racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism.

Reporting Method

This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.

Patient or Public Contribution

No patient or public contribution.

Implications for the Profession

Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti-racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care.

Impact

This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti-racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place.

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