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Journal of The Royal New Zealand College of General Practitioners
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RESEARCH ARTICLE (Open Access)
Contents Vol 16(2)

Cultural safety in paramedic practice: experiences of Māori and their whānau who have received acute pre-hospital care for cardiac symptoms from paramedics

Sarah Penney https://orcid.org/0009-0009-2285-676X 1 * , Bridget Dicker https://orcid.org/0000-0002-8151-7356 1 2 , Matire Harwood https://orcid.org/0000-0003-1240-5139 3
+ Author Affiliations
- Author Affiliations

1 Department of Paramedicine, Faculty of Health and Environmental Science, Auckland University of Technology, AUT South Campus, Private Bag 92006, Auckland, 1142, New Zealand.

2 Clinical Audit and Research, Hato Hone St John, 600 Great South Road, Ellerslie, Auckland, 1051, New Zealand.

3 Department of General Practice and Primary Care, Faculty of Medical and Health Sciences, University of Auckland, Building 507, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand.

* Correspondence to: sarah.penney@aut.ac.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care 16(2) 180-189 https://doi.org/10.1071/HC24010
Submitted: 31 January 2024  Accepted: 8 April 2024  Published: 3 May 2024

© 2024 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

Background

Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics.

Methods

Utilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis.

Results

Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics’ clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health.

Conclusion

Māori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori.

Keywords: emergency medical services, experience, health disparity, indigenous health, kaupapa Māori, Māori health, pre-hospital, qualitative research.

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