Maori
Children
with
Asthma
Presented by
Sue Armstrong
RN BN PG Cert
Introduction
“Asthma affects Maori disproportionately to
other children in New Zealand” (Best Practice
Journal, 2008, p. 2).
•Contributing factors
•Focus on Te Whare Tapa Wha
•Nurses recognise the specific needs
•Healthcare appropriate & effective
•Nurse-led clinics
•Role of Asthma Nurse in Primary
Healthcare
Maori Health Status
•NZ has highest rate of childhood
asthma:1 in 4
•Greater prevalence in Maori
children
•More days off school
• Presenting with more severe
asthma
•Maori 2-3 times more likely to be
hospitalised
•Death from asthma uncommon /
preventable – Maori 4 x more likely
to die
(Ministry of Health, 2010)
Barriers to Healthcare
•Socio economic– affordability
housing and education
•Inadequate Access
•Lack of Asthma education
•Illness perception
•Household priorities
(Buetow, Richards et al, 2004)
(Cram, Smith & johnstone, 2003)
•Past bad experiences
(Ellison-Loschmann, Gray, Cheng & Pearce, 2008)
Risk Factors
Environmental
Exposure to second hand smoke greater disease severity
(Neogi & Neher, 2012)
Smoking most prevalent in Maori popn
•Half of Maori smoke, 60% women
•Maori 2 x more likely to smoke inside house
(Ash, 2012)
• Damp / cold housing (Etzel,2003)
Non-adherence with
preventer medications
(Seeleman, Stronks, Van
,
Aalderen & Bot, 2012)
Disparities in Clinical Care
•Lower rate of ‘easy to understand education
/ action plans
•Less likely to have regular GP
• Less likely to receive ICS / Rx not collected
•Maori children more likely to not have
action plan / spacer/ PF meter
(Best Practice Journal, 2008)
(Ministry of Health, 2012)
Spiritual has very broad meaning
Here we use it as a sense of identity
and place.
(Cram, Smith & Johnstone, 2003)
Improved asthma management
allows the child to feel a sense of
well-being.
Best Practice Journal, 2008)
Reflects on the emotional toll that comes from
having serious and a potentially life threatening
illness.
The level of emotional support in responding to such
a health risk can play a significant part in the
outcome
(Cram, Smith & Johnstone, 2003)
Improved asthma management gives confidence to
the child and whanau for managing future asthma
exacerbations and relieves anxiety.
(Best Practice Journal, 2008)
Reflects the need to prevent exposure to the
physical risks. Promoting smoking cessation &
warm housing.
(Cram, Smith & Johnstone, 2003)
Improved asthma management increases the ability
of the child to participate in physical activities. ie.
Playing with other children.
(Best Practice Journal, 2008)
Prevention education such as medication adherence are far less likely to
succeed if they are done individually. By taking into account the family or
social environment there is a greater likelihood of success.
Given the genetic links of asthma it is likely that asthma clusters in families
so identification of the development in one individual should encourage
screening and prevention programmes to the family as a matter of good
practice.
(Cram, Smith & Johnstone, 2003)
Improved asthma management results in less distress for the family
and can also result in more participation in family activities.
(Best Practice Journal, 2008)
Role of the Nurse
Large role to play in reducing barriers
Unique position providing 80% of direct care
Role of advocating for patients becoming ‘defender and
promoter’
Eg. Questioning Drs as to why pt not on a preventer providing recommendations
Eg. Referring pt on to appropriate services
Practising opportunistic nursing
The need to perform critical self-reflections on personal
practice - identify and resolves attitudes that put Maori
at risk of cultural harm
(Smye, Josewski & Kendall, 2010 cited in Theunissen, 2011).
Nurse-led Clinics
Nurse-led interventions are the MOST suitable
(Theunissen, 2011)
NZ studies shown benefits of clinics in increase patient
satisfaction, improved patient education & health
outcomes
(Manson, 2012)
Asthma education critical to effective self management
Dedicated time with clients to build rapport
Te Whare Tapa Wha - Discuss social issues affecting
whanau, smoking cessation, transport issues, housing
concerns
Kaipara Asthma Nurse
MOH funded – free
Strong education focus / interactive
•Asthma assessments - recommendations
•Booked appointments / opportunistic /
School visits / Te Ha/ Public Health nurses
RAPPORT -key facilitator
of Maori access to Healthcare.
(Cram, Smith & Johnstone, 2003)
Smoking cessation
Healthy Homes
Transport – health shuttle
Tyrone
Nana
12yr old
Youngest of 6
Abusive home / low self esteem
New to Dargaville
Living with Grandparents
55 yr old
Cx / CVD nurse
Smoking cessation programme
Health shuttle
Te Ha services
Preventer Meds
Flu vaccine
Self management / Action Plan
Healthy Homes Programme
IMMS updated
Smoking education
Tyrone’s cousin
School visit
Social Worker
Male mentoring programme
10yr old
Asthma assessment / IMMS
Preventer meds
Auntie
45 yr old
Smoking cessation programme
Referral for spirometry
Conclusion
•Barriers & risks factors identified
•Te Whare Tapa Wha widely recognised
•Nursing role / Nurse led clinics crucial
Be kind
Be clear
Be loyal
Keep promises
and Say sorry
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Ash, action on smoking and health. (2012). Maori smoking. Retrieved from
http://www.ash.org.nz/site_resources/library/Factsheets/09_Maori_sm
oking_ASH_NZ_factsheet.pdf
Asthma and chronic cough in Maori children. (2008). Best Practice Journal,
13, 20-24.
Buetow, S., Richards, D., Mitchell, E., Gribben, B., Adair, V., Coster, G. &
Hight, M. (2004). Attendance for general practitioner asthma care by
children with moderate to severe asthma in Auckland, New Zealand.
Social Science & Medicine, 59, 1831-1842. Doi:
10.1016/j.socscimed.2004.02.025
Cram, F., Smith, L. & Johnstone, W. (2003). Mapping the themes of Maori
talk about health. The New Zealand Medical Journal, 116 (1170) 1-7.
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Ellison-Loschmann, L., Gray, M., Cheng, S & Pearce, N. (2008). Asthma
severity in Maori adolescents. Australasian Epidemiologist, 15(2) 4-10.
Etzel, R. (2003). How environmental exposures influence the
development and exacerbation of asthma . Pediatrics. 112(1) 236-239.
Inequalities in asthma prevalence, morbidity and mortality. (2008). Best
Practice Journal: Special Edition, 2-3.
Manson, L. (2012). Racism compromises Maori Health. Kai Tiaki Nursing
New Zealand,18(3)30.
Ministry of Health. (2012) Maori health models. Retrieved from
http://www.health.govt.nz/our-work/populations/maorihealth/maori-health-models
Ministry of Health, (2010). Tatau Kahukura: Māori Health Chart Book 2010 ( 2nd
ed.). Retrieved from http://www.health.govt.nz/publication/tataukahukura-maori-health-chart-book-2010-2nd-edition
Neogi, T., Safranek, S. & Kelsberg, G. ( 2012). How does smoking in the
home affect children with asthma? The Journal of Family Practice, 61(5),
292-293
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Practical solutions for improving Maori health. (2008). Best Practice
Journal, 13, 10-14.
Seeleman, C., Stronks, K., van Aalderen, W. & Essink Bot, M. (2012).
Deficiencies in culturally competent asthma care for ethnic minority
children: a qualitative assessment among care providers. BMC Pediatrics,
12(47) 1-8. doi:10.1186/1471-2431-12-47
Theunissen, K. (2011). The nurse’s role in improving health disparities
experienced by the indigenous Maori of New Zealand. Contemporary
Nurse: A Journal For The Australian Nursing Profession, 39(2), 281-286.