Patient experiences of pictogram use during nurse-led rapid-access chest pain clinic consultations in regional Aotearoa New Zealand

Abstract
Ischaemic heart disease (IHD) is a leading cause of death for people in Aotearoa New Zealand and a highly-ranked cause of premature death. Māori have an increased risk of early heart disease, which can develop earlier than in non-Māori. Chest pain, which can be indicative of IHD, is subjective and obtaining a pain history can be difficult when verbal articulation is limited, delaying further investigations and treatment. This small, qualitative study aimed to explore whether the use of a nurse-developed pictogram during nurse-led rapid-access chest pain clinic consultations assisted patient communication. Participants’ experiences (five Māori and five non- Māori) of using the pictogram were obtained by audiorecorded interviews, which were transcribed and analysed for emergent themes. The themes from the qualitative data suggest that the pictogram helped to overcome communication barriers such as shyness, lack of confidence in verbal ability, and poor health literacy, with all participants providing positive feedback about the use of the pictogram. For the nurse, the pictogram facilitated the accurate description of chest pain or discomfort efficiently and effectively in a way that the participants felt was understood. As a result of the use of the pictogram, the participants appeared to have a greater sense of empowerment. Additionally, the data from the interviews identified ways to improve the pictogram. A second version of the pictogram was consequently developed and is now in use at the clinic. In conclusion, the use of the pictogram was beneficial, facilitating more accurate communication of chest pain symptoms which is essential for diagnostic purposes.

Ngā ariā matua
He pūtake matua te mate manawa pāpunitanga toto (IHD) o te mate o ngā tāngata i Aotearoa, ā, he pūtake mātāmua mō te mate tōmua. Kei runga rawa te mōrea o te māuiuitanga manawa mō ngāi Māori, ā, he tōmua kē atu tōna putanga i waenga i te iwi Māori, tēnā i a tauiwi. Kei tēnā tangata, kei tēnā tangata ana whakaaro mō ngā mamaetanga poho, he mamaetanga ka noho hei tohu pea i te IHD, ā, ka uaua te takutaku i ngā āhuatanga kua pā mehemea kua kopi te waha, e āraia ai te tūhura me te rongoā. Tā tēnei mātainga kounga iti he whai kia mōhio mehemea he āwhina tō te whakamahi whakaahua i roto i ngā toronga mamaetanga poho tomo hohoro nā te tapuhi i ārahi, i te taha whakawhitiwhiti kōrero ki te tūroro. I hopukina ngā wheako o ētahi tāngata whai wāhi (tokorima he Māori, tororima ehara i te Māori) mō te whakamahi i te whakaahua i roto i ētahi uiuinga ororongo i āta hopukina, i tuhia mārire, i tātaritia hoki mō ngā kaupapa e puta ake ana i roto. E ai ki ngā kaupapa matua mai i te raraunga kounga i āwhina anō te whakaahua ki te whakamahea i ngā maioro kōrero, pēnei i te whakamā mō te ngoikore ki te kōrero, te iti o te mōhio ki ngā take hauora. I huri ngā tāngata katoa ki te whakapai i te whakamahi i te whakaahua. Mō te tapuhi, nā te whakaahua i āwhina tāna whakamārama mō te mamaetanga poho, te hē o te tinana rānei, kia kamakama, kia whai take, me te mārama o ngā kōrero, e ai ki te hunga whai wāhi mai. Nā te whakamahi i te whakaahua, kua piki ake te whāinga mana o te hunga whai wāhi, te āhua nei. Waihoki, nā ngā raraunga mai i ngā uiuinga i waitohu ētahi huarahi whakapiki i te pai o te whakaahua. I whakawhanaketia tētahi putanga hou o te whakaahua i muri mai, ā, e whakamahia ana ināianei i te whare tiaki tūroro. Hei kupu whakamutunga, he whai hua te whakamahinga i te whakaahua, i ngāwari ake te whakawhiti kōrero mō ngā tohu o te mamaetanga o te poho, he mea hira tēnei mō ngā pūtake tohu tika i te mate.

Keywords / Ngā kupu matua
chest pain / mamaetanga poho; health literacy / mōhio ki ngā take hauora; health equity / ōritenga hauora; heart disease / māuiuitanga manawa; nurse-led / nā te tapuhi i ārahi; pictogram / whakaahua; qualitative / kounga