Scope and activities of Māori health provider nurses: an audit of nurse–client encounters
Kyle Eggleton 1 * , Ashleigh Brough 2 , Evelyn Suhren 3 , Jackie McCaskill 31 Department of General Practice and Primary Health Care, The University of Auckland, 28 Park Avenue, Grafton, Auckland 1023, New Zealand.
2 Capital and Coast DHB, Wellington, New Zealand.
3 Ki A Ora Ngātiwai, 420 Kamo Road, Whangarei, New Zealand.
Journal of Primary Health Care 14(2) 109-115 https://doi.org/10.1071/HC22022
Published: 27 June 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: The activities and consultations undertaken by Māori health provider nurses are likely broad and operate within a Māori nursing model of care. However, there is little quantitative evidence to document and describe these encounters with clients. The Omaha coding system provides a mechanism in which to quantify nursing encounters through classifying client problems by domain, interventions and specific targets relating to interventions.
Aim: The aim of this study was to document the types of encounters and interventions undertaken by Māori health provider nurses.
Methods: An audit was undertaken of patient encounters occurring within a Māori health provider between 1 January 2020 and 31 December 2020. Encounters were randomly selected and problems, activities and interventions coded utilising the Omaha coding system. Simple descriptive statistics were used.
Results: A total of 5897 nurse–client encounters occurred over the study period. Overall, 61% of the audited nurse–client encounters related to the physiological domain and only 6% of encounters were related to the psychosocial domain. And 29% of nursing interventions involved teaching/guiding/counselling and a further 29% of interventions were case management.
Discussion: The wide variety of conditions seen and the number of interventions carried out indicate the broad scope of Māori health provider nurses. However, there were likely undocumented problems, which could reflect the medicalisation of the electronic health record. Redesigning electronic health records to apply more of a nursing and Māori health provider lens may facilitate more inclusive ways of documentation.
Keywords: Audit, Consultations, Electronic health records, Māor health, Māori health providers, Nursing, Omaha system, Primary care.
References
[1] Anderson DR, St Hilaire D, Flinter M. Primary care nursing role and care coordination: an observational study of nursing work in a community health center. Online J Issues Nurs 2012; 17 Manuscript 3| Primary care nursing role and care coordination: an observational study of nursing work in a community health center.Crossref | GoogleScholarGoogle Scholar |
[2] Joyce CM, Piterman L. The work of nurses in Australian general practice: a national survey. Int J Nurs Stud 2011; 48 70–80.
| The work of nurses in Australian general practice: a national survey.Crossref | GoogleScholarGoogle Scholar | 20580362PubMed |
[3] Norful A, Martsolf G, de Jacq K, et al. Utilization of registered nurses in primary care teams: a systematic review. Int J Nurs Stud 2017; 74 15–23.
| Utilization of registered nurses in primary care teams: a systematic review.Crossref | GoogleScholarGoogle Scholar | 28595110PubMed |
[4] Halcomb E, Salamonson Y, Davidson P, et al. The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on. BMC Fam Pract 2014; 15 52
| The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on.Crossref | GoogleScholarGoogle Scholar | 24666420PubMed |
[5] Pipi K, Cram F, Hawke R, et al. A research ethic for studying Maori and iwi provider success. Soc Policy J N Z 2004; 23 141–54.
[6] Crengle S. The development of Māori primary care services. Pac Health Dialog 2000; 7 48–53.
| 11709880PubMed |
[7] de Lusignan S. The barriers to clinical coding in general practice: a literature review. Med Inform Internet Med 2005; 30 89–97.
| The barriers to clinical coding in general practice: a literature review.Crossref | GoogleScholarGoogle Scholar | 16338797PubMed |
[8] Monsen K, Honey M, Wilson S. Meaningful use of a standardized terminology to support the electronic health record in New Zealand. Appl Clin Inform 2010; 1 368–76.
| Meaningful use of a standardized terminology to support the electronic health record in New Zealand.Crossref | GoogleScholarGoogle Scholar | 23616847PubMed |
[9] Martin KS. The Omaha system: a key to practice, documentation, and information management. St. Louis, MO: Elsevier; 2005.
[10] Topaz M, Golfenshtein N, Bowles K. The Omaha System: a systematic review of the recent literature. J Am Med Inform Assoc 2014; 21 163–70.
| The Omaha System: a systematic review of the recent literature.Crossref | GoogleScholarGoogle Scholar | 23744786PubMed |
[11] Holt J, Brooke K, Pryor N, et al. Using the Omaha system to evaluate the integration of behavioral health services into nurse-led primary health care. J Community Health Nurs 2020; 37 35–46.
| Using the Omaha system to evaluate the integration of behavioral health services into nurse-led primary health care.Crossref | GoogleScholarGoogle Scholar | 31905304PubMed |
[12] Thompson C, Monsen K, Wanamaker K, et al. Using the Omaha System as a framework to demonstrate the value of nurse managed wellness center services for vulnerable populations. J Community Health Nurs 2012; 29 1–11.
| Using the Omaha System as a framework to demonstrate the value of nurse managed wellness center services for vulnerable populations.Crossref | GoogleScholarGoogle Scholar | 22313181PubMed |
[13] Plowfield L, Hayes E, Hall-Long B. Using the Omaha System to document the wellness needs of the elderly. Nurs Clin North Am 2005; 40 817–29, xiii.
| Using the Omaha System to document the wellness needs of the elderly.Crossref | GoogleScholarGoogle Scholar | 16324954PubMed |
[14] Neff D, Kinion E, Cardina C. Nurse managed center: access to primary health care for urban Native Americans. J Community Health Nurs 2007; 24 19–30.
| Nurse managed center: access to primary health care for urban Native Americans.Crossref | GoogleScholarGoogle Scholar | 17266403PubMed |
[15] Eggleton K. Measuring the quality of Māori health providers: a critique of Tauiwi paradigms. PhD Thesis, University of Auckland, Auckland, New Zealand; 2020.
[16] Wilkinson J. Nurses’ reported use of standing orders in primary health care settings. J Prim Health Care 2015; 7 34–41.
| 25770714PubMed |
[17] Taylor R, McKinlay E, Morris C. Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations. J Prim Health Care 2017; 9 47–55.
| Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations.Crossref | GoogleScholarGoogle Scholar | 29530187PubMed |
[18] Luna D, Quirós FGB, de, Garfi L, et al. Reliability of secondary central coding of medical problems in primary care by non medical coders, using the International Classification of Primary Care (ICPC). Medinfo 2001; 10 300
[19] Santo E, Vo M, Uratsu C, et al. Patient-defined visit priorities in primary care: psychosocial versus medically-related concerns. J Am Board Fam Med 2019; 32 513–20.
| Patient-defined visit priorities in primary care: psychosocial versus medically-related concerns.Crossref | GoogleScholarGoogle Scholar | 31300571PubMed |
[20] Pearson A. The role of documentation in making nursing work visible. Int J Nurs Pract 2003; 9 271
| The role of documentation in making nursing work visible.Crossref | GoogleScholarGoogle Scholar | 14531847PubMed |
[21] Blair W, Smith B. Nursing documentation: frameworks and barriers. Contemp Nurse 2012; 41 160–8.
| Nursing documentation: frameworks and barriers.Crossref | GoogleScholarGoogle Scholar | 22800381PubMed |
[22] Kidd J, Came H, Herbert S, et al. Māori and Tauiwi nurses’ perspectives of anti-racism praxis: findings from a qualitative pilot study. AlterNative 2020; 16 387–94.
| Māori and Tauiwi nurses’ perspectives of anti-racism praxis: findings from a qualitative pilot study.Crossref | GoogleScholarGoogle Scholar |
[23] Hunter K, Cook C. Cultural and clinical practice realities of Māori nurses in Aotearoa New Zealand: the emotional labour of indigenous nurses. Nur Praxis Aotearoa N Z 2020; 36 7–23.
| Cultural and clinical practice realities of Māori nurses in Aotearoa New Zealand: the emotional labour of indigenous nurses.Crossref | GoogleScholarGoogle Scholar |
[24] McCreanor T, Nairn R. Tauiwi general practitioners talk about Maori health: interpretative repertoires. N Z Med J 2002; 115 U272
| 12552261PubMed |
[25] Simon V. Characterising Māori nursing practice. Contemp Nurse 2006; 22 203–13.
| Characterising Māori nursing practice.Crossref | GoogleScholarGoogle Scholar | 17026427PubMed |
[26] Maloney-Moni J, North N. Innovations in service delivery to improve Maori health outcomes: a mobile disease state management nursing service. Pac Health Dialog 2003; 10 171–7.
| 18181430PubMed |
[27] Sheridan NF, Kenealy TW, Kidd JD, et al. Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative study. Health Expect 2015; 18 32–43.
| Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative study.Crossref | GoogleScholarGoogle Scholar | 23033910PubMed |
[28] McMurray A, Cooper H. The nurse navigator: an evolving model of care. Collegian 2017; 24 205–12.
| The nurse navigator: an evolving model of care.Crossref | GoogleScholarGoogle Scholar |
[29] Dow D. Maori health & government policy 1840-1940. Wellington: Victoria University Press; 1999.
[30] Eggleton K, Anderson A, Harwood M. The whitewashing of contracts: Unpacking the discourse within Māori health provider contracts in Aotearoa/New Zealand. Health Soc Care Community 2021; 1–8.
| The whitewashing of contracts: Unpacking the discourse within Māori health provider contracts in Aotearoa/New Zealand.Crossref | GoogleScholarGoogle Scholar |