JCPSLP Vol 23 No 3

and equal”. Four responses spoke to tãngata whaiora’s role focused around “talking about experiences” and “sharing their stories… advising on how to ensure client centred care”. Four responses spoke to the role being focussed

around “providing feedback” and being of an “advisory capacity”. One response indicated that for their particular program they would like to see tãngata whaiora involvement be “more than a once off”. Focus groups Ten tãngata whaiora attended group 1, three clinical educators attended group 2 and five tãngata whaiora and one clinical educator attended group 3. Selected details are shown in Table 1. The groups were asked to discuss the role of tãngata whaiora in clinical education and to consider ways in which the role could be more active. Following the third, combined group, three themes and four subthemes were created (Table 2). Discussion We explored the ways in which the voices and experience of tãngata whaiora are used in the clinical education of health professionals in NZ. We found that in general tãngata whaiora hold a passive role in the design, development and delivery of health professional education, often limited to the role of the “patient” in clinical interactions. The NZ educators we surveyed identified lack of funding, time, collegial and organisational supports, and access to patients as barriers

Table 1. Selected focus group participant characteristics

Sex and Age

Health conditions or services experienced Cancer Surgery Orthodontics Parkinsons disease Speech-language therapy Audiology Cancer Parkinsons disease Speech-language therapy General medicine

Group 1: Tãngata whaiora

Six males, four females Two aged 25-30 years, two aged 40–49 and rest were 55+ One female, two males Aged 30–49

Group 2: Clinical educators

Group 3: Mixed All male

Three aged 40–49 Three aged over 60

Table 2. Themes and subthemes created from the three focus groups Theme and subtheme Description

Exemplar

Theme 1: Building a dedicated relationship

“Some populations have good feedback ... but I can’t trust all patients to provide feedback in the appropriate manner…” (CE 1) “reflective listening, summarising, mirroring, so that clinician and patient feel comfortable” (TW 12) “Values behind the person ... conflict between the different values” (TW 11) “Health professional has a personal belief in the worth of each human being” (TW 12) “Can teach ...to say certain things ... but no heart behind it” (TW2) “We can encourage students to think about good professionals they had in their life … but some students haven’t had problems” (CE 4) “Rapport isn’t at a high level to understand different cultures” (TW 5) “Students need flexibility, some do want to enquire but other cultures/people may not expect or want that” (CE 4) “I don’t think it matters if they are nervous—I realise that is part of their education—need to show they are listening and valuing me as a person” (TW12) “Students need to know about reduced eye contact, and saving of face” (W14) “Limitations is the time ... where would you fit it in?” [CE 2] “I don’t think you can do it in 15 minutes…” (TW 3) “Student independence side is interesting ... not there [because] we have no time ... good to get patient involvement at that point” (CE 2)

Fostering a relationship, allows for open and trusting communication crucial for client-centred health care.

Subtheme: Recognising individual values in everyone

To identify the “real problem”, health care students must understand the tãngata whaiora values and see the “whole” human being, rather than just a diagnosed person who “needs treatment”. Students can develop their ability to listen and “hear” the person, and it takes time for some.

Subtheme: Empathy needs to be learnt over time

Theme 2: Effective cross-cultural communication Skills

One’s ability to listen and reflect, and to build upon the essence of what has been shared in that engagement.

Subtheme: Need of further development in students’ non- verbal communication

Non-verbal communication strategies, especially eye-contact, were key skills for effective communication with the broad tãngata whaiora community.

Theme 3: Pressure within the system that de-prioritises relationships. Subtheme: Never enough time and always “in a hurry”

Developing relationships should be a professional and institutional priority.

Time constraints from the institution resulted in frustration and stress for all concerned.

159

JCPSLP Volume 23, Number 3 2021

www.speechpathologyaustralia.org.au