Pasefika Nurses: Student Experiences in NZ

The literature review reveals a significant gap in research focusing on the experiences of Pasefika nursing students in Aotearoa New Zealand and internationally. The dissertation highlights the limited amount of published studies examining the unique challenges and successes of these students. This lack of research underscores the need for further investigation into this under-researched area to understand the specific needs and support structures required for this population. The existing literature mostly centers on the general difficulties faced by Pasefika students in assimilating into tertiary education, often failing to address the unique aspects of the nursing pathway.

A key theme emerging from the literature review is the struggle of Pasefika students to integrate into the predominantly Western academic environment of tertiary institutions, both in Aotearoa New Zealand and abroad. This section explores the complexities faced by these students as they navigate the academic system and its cultural norms. However, the review also emphasizes the importance of a 'Pasefika way of learning', which often involves a more collective and collaborative approach to learning and achieving success. This contrast between individualistic Western learning styles and the more communal Pasefika approach highlights a critical need for culturally responsive educational practices that support this alternative learning style.

The literature review reveals significant socioeconomic barriers impacting Pasefika students' success in tertiary education. Studies cited show that these students often face unrealistic academic expectations, inadequate preparation at the high school level, and high family expectations, all of which contribute to lower graduation rates compared to their middle and high-income peers. The review emphasizes the role of tertiary institutions in actively addressing these challenges by promoting inclusivity, providing adequate support structures, and removing financial and cultural barriers. Studies by Harris, Cormack, & Stanley (2013), Mara (2006), Toumu’a & Laban (2014), and Petelo (2003) highlight the responsibilities of institutions to better meet the needs of their Pasefika students, promoting participation, retention, and degree completion. The need for outcomes-based measures of Pasefika success is also highlighted.

This section of the literature review examines the crucial role of culturally relevant support systems and learning environments in improving Pasefika student outcomes. The literature emphasizes the importance of creating culturally inclusive spaces where Pasefika students feel comfortable expressing their identities and learning styles. The review discusses the need for institutions to understand and cater to Pasefika ways of knowing and acting, including recognizing that students may hesitate to ask questions in class out of respect for the teacher. The need for culturally relevant peer support programs, mentoring, and academic counseling is also highlighted, alongside the benefits of incorporating Pasefika values, cultural knowledge, and language into the curriculum. Studies such as those by O'Regan (2006), Kalavite (2010), Kepa (2011), and Fletcher et al. (2009) provide strong support for these arguments.

The literature review examines the specific challenges and successes of Pasefika students within the health profession education pathway, specifically nursing. Studies like Wikaire et al. (2017) demonstrate how secondary school grades, foundation programs, and socio-demographic factors disproportionately impact Pasefika and Māori students' academic outcomes. The institutional focus on individual learning is identified as a barrier to supporting the collective learning needs of Pasefika students. Furthermore, experiences of cultural isolation, racial discrimination within predominantly white institutions, and the lack of culturally responsive pedagogies are highlighted as significant barriers. The successful programs such as those at Whitireia New Zealand and Manukau Institute of Technology, which explicitly incorporate Pasefika values and practices, demonstrate the importance of culturally tailored approaches. Studies by Scott (2018) and Penn (2014) are mentioned in this context.

This study utilized a qualitative approach to explore the experiences of Pasefika Registered Nurses who successfully completed their Bachelor of Nursing degrees in Aotearoa New Zealand. The primary data collection method was a Talanoa focus group, chosen for its cultural appropriateness in gathering information from this specific population. The researcher aimed to understand the factors contributing to success and identify barriers encountered during their studies. The focus group setting allowed for a natural flow of conversation, fostering open sharing of experiences among participants. This methodology was selected for its suitability in exploring subjective experiences and in-depth understanding of the phenomenon under study.

Due to the limited time and scope of the dissertation, a purposive sampling method was employed to recruit participants. This non-probability sampling technique relied on the researcher's judgment to select Pasefika Registered Nurses in the Canterbury region who met specific criteria. The purposive sampling approach aimed to ensure a focused sample relevant to the research question, selecting individuals with characteristics of interest. Snowball sampling was also used to supplement the purposive sampling. Although purposive sampling is suitable for restricted samples, a limitation noted was the smaller pool of eligible participants in Canterbury compared to larger urban centers. This resulted in a smaller sample size than might be ideal for broader generalizations.

The study involved nine Pasefika Registered Nurses who initially expressed interest in participating, with six attending the focus group session in March 2018. All participants were female, ranging in age from their early twenties to late forties. Four participants were born in Aotearoa New Zealand. The ethnic backgrounds of the participants included a mix of those from four island nations: Cook Islands, Niue, Samoa, and Tonga. One participant self-identified as mixed Pasefika and Palagi (of European descent), and another as mixed Pasefika and Māori descent. This demographic information provides context for understanding the participants' backgrounds and potential influences on their nursing student experiences. The small sample size does, however, limit the generalizability of the findings.

Ethical considerations played a central role in this research, emphasizing the importance of safeguarding participants and ensuring culturally sensitive research practices. The study recognized that traditional institutional ethics frameworks may not fully address the nuances of conducting research within Pasefika communities. This section discusses the need for researchers to have a strong understanding of cultural practices and protocols to conduct ethical research involving Pasefika participants. The study received valuable cultural input from the University of Canterbury's Kāiarahi Pasifika (Academic leader) and the Pacific Development Team advisors, ensuring the research adhered to cultural norms and ethical considerations within the Pasefika community. The researcher sought to minimize risk and maximize benefits for participants.

Thematic analysis was the chosen method for analyzing the data gathered from the Talanoa focus group. Following transcription of the focus group discussions, the researcher employed a systematic approach to identify, analyze, and report patterns within the data. The process involved familiarization with the data, repeated readings, and the development of initial codes. These codes were then collated and categorized into potential themes, ultimately revealing key factors influencing the experiences of Pasefika nursing students. This approach allowed for a comprehensive understanding of participants' lived experiences and the factors driving their success or hindering their progress within the nursing education system. The use of thematic analysis facilitated a detailed and nuanced exploration of the qualitative data.

The findings from the Talanoa focus group highlighted several key facilitators that positively impacted the participants' journeys through their nursing programs. Strong support networks, including family (aiga), friends, fellow students, and community members, consistently emerged as crucial elements of success. Participants emphasized the invaluable emotional, practical, and academic support they received from these networks. Furthermore, the experience of attending a nursing program with a Pacific stream, as described by one participant who attended an institution in Wellington, illustrated the significant positive impact of culturally sensitive and supportive institutional environments that actively integrated Pasefika values and practices. This wrap-around support provided by family, tutors, and classmates is presented as a model for improved outcomes.

Despite the positive influences of support networks, the study revealed critical barriers hindering the Pasefika nursing students' progress. A recurring theme was the lack of consistent and culturally appropriate support from the educational institutions themselves. Participants described inconsistent support from institutional staff and a lack of proactive communication from designated Pasefika support teams. This lack of communication made it difficult for students to access available resources and support. Examples mentioned include the lack of responsiveness to inquiries about Samoan language courses and the absence of welcoming messages acknowledging their Pasefika identity. This points to a disconnect between institutional support services and the actual needs of Pasefika students.

The findings revealed the importance of fostering relationships in both the professional and personal spheres. Participants emphasized the strength of connections with fellow students and healthcare professionals as a significant factor in their academic success and overall well-being. These relationships provided crucial academic and emotional support and a sense of community. They also highlighted the significance of cross-cultural connections in clinical placements, with participants noting positive interactions with Māori and Filipino nurses due to shared family values and understanding. These relationships are presented as a key factor for both improved well-being and successful learning.

The study highlighted the immense sense of achievement felt by the participants upon completing their nursing degrees. This achievement was not just a personal accomplishment but also a source of pride for their families and communities. However, the findings also showed the challenges of balancing academic pressures with cultural expectations and maintaining their Pasefika identity during their studies. Some participants reported neglecting their Pasefika identity to focus on academics while others actively sought ways to integrate their culture into their studies. The importance of collective success and family support in navigating these challenges was strongly emphasized.

Based on their experiences, participants offered several recommendations for improving the pathways for future Pasefika nursing students. They highlighted the critical need for institutions to develop a more functional and culturally sensitive Pasefika support system. This includes having dedicated staff members who understand the Pasefika worldview and can provide both academic and pastoral support. Participants also emphasized the need for improved communication, easier access to financial resources and scholarships, and for a curriculum that better acknowledges and celebrates Pasefika culture and identity. The importance of mentorship from established Pasefika nurses is also emphasized, along with the need for institutions to actively recruit and retain Pasefika students.

The central recommendation emphasizes strengthening relationships among all stakeholders involved in the Pasefika nursing student journey. This includes fostering stronger connections between students, families, educators, and the wider Pasefika community. A key aspect is establishing a functional Pasefika support role within tertiary institutions. This dedicated role would provide crucial academic and pastoral support, assisting students in accessing essential learning resources and financial aid. The role's success relies on the individual's understanding of the tertiary environment and the Pasefika student worldview while maintaining neutrality within the close-knit Pasefika community to foster trust and open communication.

The research suggests that institutions should provide more opportunities within the nursing curriculum to allow Pasefika students to embrace their culture and confidently challenge the education system. This includes integrating more education on diverse cultural perspectives and fostering a deeper understanding of Pasefika communities in Aotearoa New Zealand throughout the program. The findings support the integration of cultural pedagogies into mainstream curricula, acknowledging traditional learning models. Furthermore, the study strongly recommends increased clarity and accessibility of scholarship information, as well as offering scholarships specifically to encourage Pasefika students to pursue nursing, addressing the financial barriers highlighted in the findings.

To better support Pasefika nursing students, tertiary institutions must foster culturally inclusive learning environments where students feel a strong sense of belonging and can fully embrace their Pasefika identity. This includes addressing the homogenization of 'brown' students and ensuring that Pasefika perspectives are not subsumed by those of Māori students, even in contexts where both groups' needs are addressed within a single department. The research highlights the importance of acknowledging the unique cultural complexities and diversity within Pasefika communities and ensuring that support mechanisms actively acknowledge and celebrate this diversity. The study points to the need for institutions to not only recognize but also actively address issues of potential racism and discrimination experienced by Pasefika students.

The findings underscore the significant value of mentorship programs connecting current Pasefika nurses with prospective and current students and their families. This peer-to-peer support can offer crucial guidance and encouragement throughout the academic journey. The successful implementation of the Pacific Dedicated Education Unit (DEU-PLUS) at Counties Manukau Health (CMH) in Auckland is highlighted as a model to emulate. The initiative provides a culturally safe environment, promotes confidence, and encourages students to embrace their cultural heritage. Collaboration between tertiary institutions, school districts, health providers, and hospitals is seen as crucial for improved recruitment and retention strategies. The study emphasizes partnerships that promote diversity and provide necessary support to increase the number of Pasefika nurses.

The research concludes by recommending further investigation into the factors contributing to the attrition rate of Pasefika nursing students and the experiences of Pasefika nurses pursuing postgraduate studies. This further research would enhance the overall understanding of the Pasefika nursing student journey and inform the development of even more effective support strategies. The findings suggest the need for a comprehensive and ongoing effort to identify and address the systemic and individual barriers that currently hinder Pasefika success in nursing education, ultimately contributing to achieving health equity for all New Zealanders.

The conclusion emphasizes that while individual effort is crucial for student success, a shared responsibility exists among all stakeholders to support Pasefika nursing students. This collective responsibility extends beyond the individual student to encompass institutions, communities, and families. The goal is to create a well-supported environment where each student's journey is achievable, leading to increased representation of Pasefika nurses within the profession. This collaborative approach is seen as vital to fostering a supportive and inclusive learning environment that enables students to thrive academically and personally.

The dissertation highlights the need to address systemic gaps in support for Pasefika nursing students, particularly in institutions without dedicated Pasefika nursing streams. The research identifies the need for tailored interventions and resources to address the specific challenges faced by this population. These interventions should not only address academic needs but also recognize and support the cultural identity and well-being of these students. The conclusion reiterates that this is not a conclusion to the effort, but a step on the journey towards the improvement of Pasefika health equity in Aotearoa New Zealand.

The concluding remarks emphasize that this research marks a step in an ongoing journey towards improving Pasefika health and achieving health equity for all New Zealanders. The findings call for continued efforts to understand and address the barriers and facilitators influencing the success of Pasefika nursing students. The need for further research, particularly into the experiences of Pasefika students in postgraduate nursing programs and those who drop out before completing their degrees, is underscored. The concluding statement uses a Samoan proverb to emphasize the collective effort needed to pursue this ongoing crusade for improved health equity.