Within the current Primary Health System how easy is it for Registered Nurses employed by Māori Health Care Providers to work in a holistic way with people who have type II diabetes?

Abstract

Background: Over the last 20 years Government policy has re-orientated health service delivery toward Primary Health Care (PHC) through a political agenda designed to address health inequities, increase access and improve health outcomes. Re-affirmation of Māori cultural identity and the emergence and development of Māori Health Providers has occured during this time. Despite these advances statistics continue to demonstrate significant health inequity between Māori and non-Māori and this is starkly apparent when observing the incidence and complications of type II diabetes. Research related to the nature and contribution of Registered Nurses (RNs) clinical practice within the context of PHC in Aotearoa/New Zealand is limited. This thesis illustrates how the current PHC system supports RNs who are employed by Māori Health Care Providers to work holistically with people who have type II diabetes.

Aims: Within the context of RNs employed by Māori Health Care Providers: • Identify elements of current PHC that facilitate or create barriers to holistic clinical practice with people who have a diagnosis of type II diabetes. • Identify how RNs integrate biomedical quality indicators with holistic care of individuals and whānau who have a diagnosis of type II diabetes.

Methods: Ethics approval was obtained from the Central Regional Ethics Committee. RNs from three Māori Health Care Providers in the Wellington Region participated in focus group interviews. Consent was obtained from participants. Data was generated from transcribed interviews, policy documents, observation and field notes. Critical inquiry informed the research and provided a framework to interpret data. Case study was used to explore phenomena that emerged from thematic analysis of data and to develop understanding of the complex interactions influencing RN participants’ clinical practice. Data source and investigator triangulation were employed to ensure accurate data interpretation.

Results: Three overarching themes emerged. These related to funding and contracts, the PHC context and type II diabetes. Significantly each theme and sub-theme acted as either a facilitator or a barrier depending on the context. The current funding/contract environment had the greatest impact and revealed the subtle power in the relationship between Māori Health Providers and Government Agencies. The way that RNs and Māori Health Providers continue to evolve to meet the needs of their communities was evident. Much of the innovative practice currently undertaken is unrecognised and unfunded due to the narrow focus of contract and reporting requirements.

Conclusion: The specific aims of the research were achieved by identifying RN participants’ holistic practice and aspects of the current primary health care system that facilitated or created barriers. Inconsistencies between Government policy and the funding/contract environment were apparent. Funding and contract formulae are yet to evolve to meet Government strategic direction. Health inequities persist and the structural determinants of health contribute to this illustrating institutional racism inherent in the current system. RNs’ ‘voice’ must be represented and contribute to Government policy as Māori Health Providers work toward improving health outcomes for Māori.