Indigenous hospital experiences: a New Zealand case study

Abstract

To explore Māori (Indigenous people of New Zealand) experiences of hospitalisation in surgical or medical settings and how these might influence length of stay. Globally Indigenous peoples with histories of colonisation suffer health disparities compared with other groups. They experience higher levels of morbidity, premature mortality, lower life expectancies and differential access, use and quality of health services. In Indigenous communities' negative anecdotal accounts of hospital experiences indicate more research is needed about their hospital experiences. A Māori (Indigenous) centered approach using case study methodology and three data sources: medical-surgical discharge data, interviews with Māori and a literature review. Using statistical data from the New Zealand Health Information Service from 1989-2006, a retrospective interrupted time series design was used to examine length of stay for Māori patients in medical and surgical hospital settings. Semi-structured interviews with 11 participants identifying as Māori who had experienced hospitalisation in a medical or surgical setting were transcribed and thematically analysed. A structured review of the research literature on Indigenous hospital experiences was also analysed. These data were analysed individually, triangulated and interpreted. Māori consistently have a shorter average length of stay than non-Māori using public hospitals in New Zealand. Marginalisation of Indigenous peoples in public hospitals was evident in both the interviews undertaken and the literature reviewed. Participants believed hospitals were not conducive to healing and negative experiences contributed to decisions to seek an early discharge. Given the disparities in Indigenous health status, health professionals can address negative hospitalisation experiences by attending to the quality of care delivered and nature of the hospital environment. RELEVANCE TO CINICAL PRACTICE: Nurses can play an important role improving health outcome disparities for Indigenous peoples linked to health service delivery, especially the delivery of culturally responsive and quality nursing care.