Healthcare Assignment on Holistic Health Care for Maoris

Question

Task: Prepare a healthcare assignment presenting a literature review on Maoris holistic healthcare as well as changes in their lifestyle due to impact on diabetes.

Answer

Introduction
Maori holistic healthcare
As per the research on healthcare assignment, quality improvement can be considered to be an integrated, holistic philosophy or culture through which the organizations can empower the workers to work towards the service delivery process as well as respond to the needs and expectations of the patients. It has been found that till the 1930s, the Maoris have resided in the rural communities, and hence the varied type of employment opportunities had led to the large-scale migration in the urban and the rural areas. This has developed changes in the economy of New Zealand thereby shifting from the agricultural focus to the manufactured goods (Moeke-Maxwellet al. 2019). Further, the most common aspect of health disparity between the Maoris and the non-Maoris included the genetic factor which occurred due to differences in ethnicity or race. The non-genetic explanations also play a crucial role in the health differences between the Maoris and the non-Maoris based on socio-economic factors such as discrimination, access to health care as well as lifestyle factors. This has increased the number of deaths among the Maoris and thus changes were brought in the New Zealand society with the help of the Social Security Act, 1938 that has removed the differences between the charity cases and the other factors considering the repayment of the fees of Maoris (Gauld, 2020). With the development of these new health technologies as well as the growth in the consumer expectations for operating public hospitals, the commitment of the healthcare providers has also increased to provide an improved level of care to the Maoris (Gauld, 2020). This study has carried out an analysis of the five research articles associated with holistic healthcare in the public hospitals of New Zealand for the Maoris. The five articles have been chosen because they were peer-reviewed and have a close association with the topic. Moreover, all these five research articles have highlighted the importance of holistic healthcare including the mental health of the Moaris. The review of these research articles has also assisted the researcher to arrive at a valid conclusion.

Impact of individual lifestyle i.e. diabetes choices on healthcare services
As it has been found that the rate of type 2 diabetes is alarming among the Maoris, there should be careful attempts made for the implementation of varied lifestyle programs at an increased rate. The different consequences of developing type 2 diabetes can be considered to be large with vascular complications that are responsible for the mortality and the morbidity linked with the disease (Oetzel et al. 2020). Moreover, it has been found that diabetes is one of the crucial causes of kidney failure, blindness as well as different types of amputation of the limbs among the citizens of New Zealand. It has been found that the different types of lifestyle modification of the Maoris lower the progression due to the impaired tolerance of glucose as type 2 diabetes lowers the risk of cardiovascular factors (Ndwiga et al. 2018). Further, the lifestyle program also involves risk reduction that is similar to the European citizens. However, the varied challenges that are witnessed by the Maoris include the development of an improved lifestyle intervention that can be considered to be convincing to lower the chances of diabetes. On the other hand, it has been found that the primary outcome that is associated with the lifestyle modification of the Maoris includes the sensitivity to insulin as this resistance to insulin is one of the vital risk factors for the development of type 2 diabetes (Reilly et al. 2016). There has been a critical analysis of the five peer-reviewed articles that are related to the impact of the individual lifestyle i.e. diabetes on the healthcare care services of the Maoris. After going through these articles, it would be easier for the researcher to understand the analysis on the lifestyle of the Maoris due to diabetes.

Discussion
Academic articles and their relation to the topic
Maori holistic healthcare
Masters-Awatere et al. (2017) have highlighted that holistic healthcare to the Maoris is possible only through an improved level of collaboration as well as the provision of opportunities among the health professionals. The engagement of the Maoris with the mainstream health structure lays an impact on the Maoris health and thus it can be gauged with the help of mainstream perceptions. Further, in the delivery of the healthcare practices to the Maoris, it has been found that there exists an improved level of accessibility for the provision of clinical services as well as connecting with patients at the cultural level. This article is related to the research topic as it has discussed holistic healthcare and the role of public hospitals in the provision of care to patients.

Wepa and Wilson (2019) stated that the interpersonal experiences of the Maoris in receiving healthcare services can be considered to be consistent compared to the other citizens of New Zealand. The study has also highlighted the role of the Maoris in their engagement with the healthcare services when supporting the family members or their peers who are sick. The varied form of traditional practices in the provision of healthcare services have been highlighted in this study and thus there exists sufficient time and space for the establishment of improved relationships with the patients. This article can be linked with the research topic as it has focused on the provision of holistic healthcare of the Maoris including their physical and mental development.

The article written by Graham and Masters?Awatere (2020) has focused on the experiences of the Maoris in availing the public health services in New Zealand. This public health hospitals provide free in and out-patient services as well as subsidies in the provision of primary healthcare and wider support service. The crucial issue that has been faced by the Maoris includes the higher rate of psychological distress such as mental disorders. On the other hand, Gifford et al. (2018) stated that the socioeconomic factors, as well as the health differences among the Maoris and the non-Maoris, were observed among men of 15-64 years of age. Both these articles can be linked to the research topic as it focuses on the holistic level of care received by the Maoris in the public hospitals.

Masters-Awatere (2019) has carried out a study on the government intervention in the healthcare provision for the Maoris followed by the signing of the Treaty of Waitangi. The Maoris have higher chances of hospitalization based on varied conditions including heart failure, stroke, cardiovascular disease, and pulmonary disease. This article has focused on the holistic level of healthcare services as well as the engagement and the involvement of all the citizens of New Zealand who are sick visiting the hospitals for an improved level of care.

Impact of individual lifestyle i.e. diabetes choices on healthcare services
Mason et al. (2019) have opined that the Maoris suffer from a higher rate of obesity and this problem can be witnessed both among children and adults. It has been observed that the obesity rates of the Maoris have not changed since 2006-2007. One in five children i.e. 17% of the Maoris and two in five i.e. 44% of the adults are considered to be obese. With the help of this article, it would be easier for the researcher to understand the effect of diabetes on the children and the adults in Moari community.

Zambas et al. (2020) highlighted that Maori adults smoke more than normal adults. It has been estimated that two in five i.e.,41% of the Maoris smokes even when the national average smoking rate has fallen in 2012 from 2006, but the smoking percentage of the Maoris did not change with time. Further, Harris et al. (2019) have stressed the poor oral health of the Maoris as it has been estimated that almost 12% of the adults and 6% of the children suffer from tooth decay which occurs due to higher levels of glucose secretion or diabetes in their body. This estimation rate is almost 1.7 times higher than the non-Maoris and thus it is suggested by the healthcare professionals to go for regular diabetes check-upsto detect the symptoms of tooth decay early. Both these articles have highlighted the change in the lifestyle of the Maoris due to diabetes.

Mclachlan et al. (2017) have stated that changes in the diets of the Maoris suffering from type 2 diabetes are also likely to affect their lifestyle. The diets that are generally prescribed to the Maoris are designed for a sustained and gradual reduction of weight where its compliance is to be measured with the help of their diets. The records of the diets are to be analyzed with the help of a diet cruncher and thus the Moarisis to be educated on which food to consume and avoid. According to Gifford et al. (2017), have opined that the intervention programs also affect the lifestyle of the Maoris suffering from diabetes. In most cases, it has been found that the Maoris hesitated to participate in exercise programmed before diabetes, but the duration of their activity has changed after being detected with diabetes. With the help of both these articles, it would be easier for the researcher to arrive at a valid conclusion on the changes in the lifestyle intervention of the Maoris.

Critical examination of the data collection in the research article
Maori holistic healthcare
Data in Masters-Awatereet al. (2017) has been gathered with the help of pilot phase interview i.e. qualitative secondary research associated with the hospital transfer of the Maoris. Moreover, the experiences of the family members and the support groups have also been gathered with the secondary research. The data collection process in the article published by Wepa and Wilson (2019) has been carried out through primary research i.e. through conducting interviews accessing the primary healthcare and the hospital-based services. The interviews that were carried were auto-recorded and thus it was checked for accuracy with the identification of the removed features. Comparative analysis was done with the data collection process so that it becomes easier for the researcher to arrive at a valid conclusion. Data collection in the article published by Graham and Masters?Awatere (2020) was secondary where different databases of Waikato’s university have been used to gather the data. These data collected from those secondary resources were from 2014-2018 and there were several inclusions and the exclusion area of the data collection. The focus of the experiences and the perspectives of the Maoris were laid greater stress and thus this has made it easier to focus on physical health. On the other hand, the data in Masters-Awatere (2019) has been gathered through primary data collection i.e. by conducting interviews among the Maoris. This has made it easier to understand the experiences of the Maoris from home hospitalization and hospital transfers. These interviews were found to be transcribed and thus it has been carried out by the researcher with the help of surface-level analysis accordingly. In Gifford et al. (2018), the data has been gathered through secondary research. There has been used of the specific framework and thus this has assisted in accommodating the varying levels of flexibility without losing integrity. The theme linked to control has been considered to be significant with the findings of the study.

Impact of individual lifestyle i.e. diabetes choices on healthcare services
The data in Mason et al. (2019) has been collected with the help of secondary research. The different approaches of the Maoris realtered to the end-of-life-care in case of diabetes has been taken into consideration and thus a comparative study has been carried out accordingly. On the other hand, Zambas et al. (2020) have opined that data has been gathered from varied sources such as Google Scholar, CINAHL Plus, Scopus as well as varied other databases that are associated with the Maori keywords and the databases. With the help of these databases, it has become easier to focus on the different aspects of the individual lifestyle of the Maoris due to diabetes.

Harris et al. (2019) have stressed the secondary method of data collection where the data has been gathered through varied peer-reviewed articles. It has been found that with the help of these peer-reviewed articles, it would be easier for the researcher to analyze the effect of lifestyle changes due to diabetes. In the study carried out by Mclachlan et al. (2017), the data has been gathered through primary data collection where the Maori participants were asked to highlight the changes in their lifestyle due to diabetes. The theme was represented to the Maoris and therefore collaboration with the group members can be considered to be essential to analyze the data.

Analysis of the research methodologies and methods applied to the evidence-based healthcare practices in New Zealand

Maori holistic healthcare
Masters-Awatere et al. (2017) have highlighted that qualitative research methodology has been carried out in this study with the help of the semi-structured interview. The crucial focus of this interview is to identify the ways engaged in the hospital care during the transfer and the hospitalization process. Moreover, the hospitalization perspectives were also analyzed based on the engagement process between the Maoris and the varied medical teams. On the other hand, the qualitative methodology has been used in the study conducted by Graham and Masters?Awatere (2020). Moreover, the use of a structured approach along with the PRISMA protocols can be considered to be effective in the systematic literature search, the appraisal, and the selection of the studies through improved ways. Moreover, this study has also made use of the analytical approach that can be considered to be critical to thematic analysis as well as the simplistic understanding of the varied complexities of culture. Gifford et al. (2018) have also focused on the qualitative research methodology where the study has been carried out by using the case design approach that will assist in analyzing the chronic stage of the Maoris. The effective utilization of the data source with the help of an outcome framework can also be considered to be relevant in this case.

The methodology that has been applied to the study carried out by Wepa and Wilson (2019) includes the constructive grounded theory that assists in the exploration of the cultural processes that are engaged with effective healthcare services. With the help of the constructive grounded theory, it has been found that the inductive analysis becomes easier to be carried out accordingly. Further, purposive sampling has been used to choose the interviewers at the beginning of the study to spread the knowledge. Moreover, the article published by Masters-Awatere (2019) has focused on the qualitative methodology as it includes different policy support, the application as well as hospital policies. It has been found that the research team has also tried their best to be engaged with the changing nature of self-identity as well as the other constituent parts of the Maoris. Further, there have been environmental scanning of the interviews across a wider range of issues linked with the application and the hospital policies affecting the ability to remain involved in the provision of care. The review has also been conducted of the hospital transfer team through the effective level of submissions highlighting the key issues and the recommendations accordingly.

Impact of individual lifestyle i.e. diabetes choices on healthcare services
In the article published by Mason et al. (2019), the author has utilized qualitative secondary research to find out the changes in the lifestyle of the Maoris suffering from diabetes. It has been found that the mortality rate of the Maoris about diabetes is much higher than the non-Moaris and thus there should be careful attempts made to carry out their analysis accordingly. On the other hand, Zambas et al. (2020) have focused on the secondary method of data collection from different leading databases with the help of a qualitative approach. The study has also utilized the mixed-method design to analyze the factors influencing the Moaris suffering from diabetes as well as the change in their lifestyle. Mclachlan et al. (2017) have focused on the qualitative method of data collection along with thematic analysis. The different steps that were considered to be important for conducting the thematic analysis have assisted the researcher to arrange the processes linked with the changes in the lifestyle of the individuals due to diabetes. This study can be considered to be linked with the evidence as it has focused on the values, practices, and identity of the Maoris suffering from diabetes. Gifford et al. (2017)has highlighted that after carrying out the interview, the reflexive notes, descriptions, and conversations were jotted down. All the varied types of information along with the quotes during the research process have provided insights into the healthcare access, the changes in the lifestyle that were considered to be crucial in delivering the healthcare services. On the other hand, it has been found that the researcher during the process of conducting the research had to be aware of the positionality as well as the influence during the research interviews. The additional health services and the maintenance of connection were also considered to be instrumental in carrying out the research.

Conclusion
Maori holistic healthcare
The findings from the above-mentioned study will motivate me to change my healthcare practice in the future by understanding the issues and the sentiments of the Maoris in the provision of treatment. As the economic status of the Maoris is not up-to-the-mark, it is the responsibility of the public health professionals to provide an effective level of treatment without any discrimination. On the other hand, it has been found that the nursing workforce assists in the provision of 80% of patient care and thus they play an active role in the reduction of health disparities. As a nurse, I will try to incorporate cultural safety in the provision of patient care along with the advocacy and the Maori-centered care models supporting the nurses in the adoption of an improved level of approach.

It is the responsibility of the nurses to consider the individual health problem of the Maoris as they mostly feel threatened by their family members. On the other hand, it has been found that most of the Maoris get admitted to public hospitals thinking that the best level of treatment is provided in the public hospitals. In such a case, the nurses or the healthcare providers must not make any such discrimination in the provision of care to the Maori patient.

I can also link the findings of the study from the above literature to my nursing practice in the future as these studies will help me to provide an overview of the Maoris, their lifestyle, their standard of living thereby making me aware accordingly. The nurses must also make use of the improved technology that will shift the spending of the Maoris to simple and practical solutions rather than investing in a higher level of technology. This will help the nurses to adjust to the changing pattern of the diseases backed through the principle of equity by the effective relocation of the funds. Thus, it can be said that the nurses must try to adopt the intersectoral approach in the provision of a holistic level of care to the Maoris seeking treatment in public hospitals.

Impact of individual lifestyle i.e. diabetes choices on healthcare services
The findings from the above-mentioned study will affect my healthcare practices as a nurse in future as I will be aware of the different types of lifestyle intervention program that is common among the Maoris suffering from diabetes. As I have witnessed that collection of feedback from those Maoris suffering from diabetes will make it easier for me to provide them the correct level of treatment, I will try to be closer to them and thus understand the behavioral changes that are essential for the change in the lifestyle. On the other hand, I will also find it easier to understand the varied dietary aspects that are considered to be effective for the Maoris in achieving a safe, appropriate and improved exercise program.

As a nurse, I can recommend that it is essential to make frequent contact with the patient suffering from diabetes as this requires a sufficient amount of time to understand the changes in their lifestyle. Moreover, I will also try to check that the patients are provided with the appropriate dietary advice as per their symptoms. This level of support can be considered to be essential to the Maoris as it will be easier for them to make changes in their lifestyle accordingly. Therefore, as a nurse, it is essential to undertake vital strategies for the improvement of the health status of the Maoris suffering from diabetes.

References
Gauld, R. 2020. The New Zealand health care system. International Profiles of Health Care Systems.New York, pp.149-158.

Gifford, H., Batten, L., Boulton, A., Cragg, M. and Cvitanovic, L., 2018.Delivering on outcomes: the experience of Maori health service providers. Policy Quarterly, 14(2).

Gifford, H., Cvitanovic, L., Boulton, A. and Batten, L., 2017. Constructing prevention programmes with a M?ori health service provider view. K?tuitui: New Zealand Journal of Social Sciences Online, 12(2), pp.165-178.

Graham, R., and Masters?Awatere, B. 2020. Experiences of M?ori of Aotearoa New Zealand's public health system: a systematic review of two decades of published qualitative research. Australian and New Zealand journal of public health, 44(3), pp.193-200. Harris, R.B., Cormack, D.M. and Stanley, J., 2019. Experience of racism and associations with unmet need and healthcare satisfaction: the 2011/12 adult New Zealand health survey. Australian and New Zealand journal of public health, 43(1), pp.75-80.

Mason, K., Toohey, F., Gott, M. and Moeke-Maxwell, T., 2019. M?ori: living and dying with cardiovascular disease in Aotearoa New Zealand. Current opinion in supportive and palliative care, 13(1), pp.3-8.

Masters-Awatere, B., Boulton, A., Rata, A., Tangitu-Joseph, M., Brown, R., and Cormack, D. 2017. Behind the label: Complexities of identifying M?ori wh?nau in an away from home hospital transfer.

Masters-Awatere, B., Cormack, D., Brown, R., Boulton, A., Tangitu-Joseph, M. N., and Rata, A. 2019. The hospital transfer project: Supporting wh?nau engagement during hospitalisations. TeArotahi, 4, pp. 4-14.

Mclachlan, A., Pitama, S. and Adamson, S.J., 2020. Kia whakat?muritehaerewhakamua: engaging M?ori rural communities in health and social service care. AlterNative: An International Journal of Indigenous Peoples, 16(3), pp.202-210. Moeke-Maxwell, T., Mason, K., Toohey, F., Wharemate, R., & Gott, M. 2019. He taongatukuiho: indigenous end of life and death care customs of New Zealand M?ori. In Death Across Cultures (pp. 295-316). Springer, Cham.

Ndwiga, D.W., MacMillan, F., McBride, K.A. and Simmons, D., 2018. Lifestyle interventions for people with, and at risk of type 2 diabetes in Polynesian communities: a systematic review and meta-analysis. International journal of environmental research and public health, 15(5), p.882.

Oetzel, J., Rarere, M., Wihapi, R., Manuel, C. and Tapsell, J., 2020. A case study of using the He PikingaWaiora Implementation Framework: challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in M?ori men at risk of diabetes, cardiovascular disease and obesity. International journal for equity in health, 19(1), pp.1-11.

Reilly, R., Evans, K., Gomersall, J., Gorham, G., Peters, M.D., Warren, S., O’Shea, R., Cass, A. and Brown, A., 2016. Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: a systematic review of mixed evidence. BMC health services research, 16(1), pp.1-15.

Wepa, D., & Wilson, D. 2019. Struggling to be involved: An interprofessional approach to examine M?ori wh?nau engagement with healthcare services. Journal of Nursing Research and Practice, 3(03).

Zambas, S.I., Dutch, S. and Gerrard, D., 2020. Factors influencing M?ori student nurse retention and success: An integrative literature review. Nurse Education Today, 91, p.104477.