RESUMEN
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 Maori) nurse practitioners (NPs) practice patient safety is key to enhancing Indigenous health outcomes in predominantly westernized healthcare systems. AIM: To describe Maori NPs perspectives on patient safety when caring for Maori and understand how Maori NPs deliver safe health care. METHODOLOGY: A group of five Maori NPs worked alongside a Maori 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 Maori principles, using reflexive thematic analysis. RESULTS: Maori NP experiences, expressions and understandings of patient safety envelop cultural safety and have many facets that are specific to the needs of Maori populations. The three themes showed: (1) Te hanga a te mahi: the intersection of cultural and clinical expertise; (2) Matauranga 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 Maori NPs navigated the westernized health system's policies and practices while acting autonomously to advocate for and deliver culturally safe care. CONCLUSION: The Maori NP lens on patient safety is vital for promoting culturally responsive and effective health care. By recognizing the unique needs of Maori patients and families and incorporating cultural perspectives into practice, Maori 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.
RESUMEN
BACKGROUND: Climate change is already affecting Aotearoa New Zealand (Aotearoa-NZ). The public health effects are varied and complex, and rural primary care staff will be at the front line of effects and responses. However, little is known about their understanding and experience. OBJECTIVES: To determine understanding, experiences and preparedness of rural general practice staff in Aotearoa-NZ about climate change and health equity. METHODS: A mixed-methods national cross-sectional survey of rural general practice staff was undertaken that included Likert-style and free-text responses. Quantitative data were analysed with simple descriptive analysis and qualitative data were thematically analysed using a deductive framework based on Te Whare Tapa Wha. RESULTS: A proportion of survey respondents remained unsure about climate science and health links, although many others already reported a range of negative climate change health impacts on their communities, and expected these to worsen. Twenty to thirty percent of respondents lacked confidence in their health service's capability to provide support following extreme weather. Themes included acknowledgement that the health effects of climate change are highly varied and complex, that the health risks for rural communities combine climate change and wider environmental degradation and that climate change will exacerbate existing health inequities. CONCLUSIONS: The study adds to sparse information on climate change effects on health in rural primary care. We suggest that tailored professional education on climate change science and rural health equity is still needed, while urgent resourcing and training for interagency disaster response within rural and remote communities is needed.