Become an extended whānau manaaki member

Health professionals bring their own skills and experiences to the whānau manaaki partnership. In our Pae Herenga study, we heard many stories about health professionals showing kindness, understanding and taking the time to listen to whānau manaaki. Going the extra mile signals to whānau your willingness to walk alongside them and adding to their end of life kete (basket) of knowledge. Your willingness to develop strong and trusting relationships with whānau, on a whānau-by-whānau basis, is appreciated; it can help to open the health organisation’s door for whānau.

Whaea Linda (hospice kaiwhakahaere) talks about the importance of getting to know whānau, spending time with them so they feel comfortable to talk and share what they need:

Well, the first thing you have to do really which I think I’m pretty good at it, is to get to know the patient, and to see if they really want me to work with them first and foremost. You know. And I don’t like- can’t assume. And even the families, because you can get some really difficult families out there. So, it’s just making [and] building that relationship up with, especially with the patient and the family… they’ve got to be comfortable; they have to be comfortable with me. And I have to be comfortable with them too. If I feel that I’m not comfortable with them, I just say, ‘Look, it’s okay if you don’t, we don’t, you know come and visit.’ Then next minute they go, ‘Yes please come,’ you know they go by that so.

The professional support that health and social care professionals provide can helpfully assist whānau to move through the challenges that can accompany the journey through Te Pō (changes and transformations). Joining with whānau means becoming an important part of the whānau manaaki partnership. There is a standard of care that we are promoting and these respects and protects the values and customs of Māori which are protected under the Treaty of Waitangi (1840). This whānau manaaki partnership is needed. When health and social care professionals appreciate their own identity, cultural values and spiritual beliefs they are in a better position to respect and care for older Māori and their whānau manaaki.

While talking about the tikanga and kawa that whānau draw on while using hospice services, Kui (hospice health care assistant) reflected on caring for a Rātana Minister and the approach she used that protected his mana while showering:

… We just actually we just had a man that was in and he’s gone home now. But he was Rātana and they came to church every night… Sunday they had a big church and they came and had a big feast out in the lounge and then they had their church service and you could hear them singing it was beautiful. You know it’s like ‘oh, awesome’. And he was a Minister… and he was very like, ‘Kia ora bub.’ And I said, ‘Kia ora.’… I said, ‘Would you like to come with me for a shower?’ ‘No.’ I say, ‘Okay, next time.’ Then the next day, ‘Would you like to come with me for a shower?’ ‘Oh, I suppose.’ You know? And I said, ‘No, it’s alright,’… I said, ‘Yeah, here’s a towel.’ I said, ‘You go in there and you can wash yourself, and you can call me’. And his wife was thinking, ‘You okay?’ And I say, ‘I’m fine. You have a rest because you need a rest yeah.’ She goes, ‘You know what? That’s the first time he’s let any of his carers give him a shower.’ And I said, ‘Oh wow that’s cool.’

A health and social care professional who becomes part of the whānau manaaki is empathic, kind and compassionate; there is no judgement of others; their aim to be open and transparent in caring relationships so that any concerns that arise can be openly discussed with whānau members. When issues arise, they can calmly help whānau manaaki to overcome these by sharing their knowledge of the processes and procedures to follow in different situations. Likewise, they can share their knowledge about a given situation, process or procedure. Knowing the community and keeping track of who is unwell and could need support is essential to support kaumātua and their whānau manaaki at end of life.

Joy (health professional) checks the database every morning to familiarise herself with patients coming into hospital. The Faster Cancer Tracking Programme database, which Joy also works with, allows her to watch out for Māori patients coming into hospital. The tumour stream nurses (Clinical Nurse Specialists) also identify the patients they think will need Joy’s support:

I do have a system every morning I go through at work, like I’ve got a database. I know all the patients who are coming in. And because I work with the faster cancer tracking programme as well and we’ve got a database for that, so I’m always watching out who’s the Māori coming through ah, where they’re at, working with the tumour stream nurses and making [contact] you know, because they will identify patients they think would need support which is just about everyone.

Joy feels it’s important to make patients feel safe. She likes to contact her patients just before they come in for their oncology appointments. Joy sees this as a personal role she can do, that's important for helping patients feel safe. She lets them know where to come and she will be there to meet them:

My role is also supporting patients in the oncology unit. So I always check who’s coming in for to see the doctors on the day and if I’ve got some of my patients that are coming through that I make sure or even tell them before they even come over, [I] say ‘look I’ll watch out for your appointment because I work with the booking clerk and make sure when they’ve got their appointment.’ I ring them personally to tell them. So, they know. And I tell them where to come. Although it’s a booking clerk role, that I do, like an admin role, it’s still a personal role and I think it’s really important. Just to make sure that they’re safe, they feel safe and that I will meet them there. When they come in.

Māori Kaiāwhina, Kaiwhakahaere and Whānau Ora Kaimahi are all terms for Māori support people; they provide a valuable link between health services and whānau in the local community. They usually can walk in both worlds and are often mandated by, and supported by, their own community to do this work.

With up to ten to twenty patients (or more), coming onto the database each month Joy (cancer nurse coordinator) cannot just up and go to rural places. By keeping her community connections, she contacts the iwi provider nurses and other community services for help. Joy (health professional) highlights the importance of keeping good community connections as she says she cannot do this job on her own:

I still work closely with the iwi provider nurses because I’m the only one in all of the DHB area. So, I kept those connections because I find I need them to help me out there because there’s lot of whānau sometimes. You know I can’t just, get up and go off to [name of distant rural town. So, I have a, the [name of hauora] nurses up there that I can call on… and say, 'hey can you help me find this whānau?' Especially if they’re already registered with their medical centre because of the privacy act and that so you know very careful on that aspect...[I rely on the district nursing support] it’s really important I think that you know [who to contact] otherwise I just can’t do it on my own.

Māori health workers can also be a useful resource in supporting the health organisation and staff to become more culturally supportive with a Māori worldview as this is needed to support kaumātua and whānau manaaki. Whatever plans are implemented by the health services, it is advisable to make sure that whānau have an opportunity (at an appropriate time following a death) to evaluate their experiences of using the health services.

Whaea S. (health professional) commented on her knowledge of her community and the networks she had within the community. Having a Māori staff member who was well connected to the local community helped whānau to access hospice services:

I think it was… 99 deaths in the 18 months that I was there [at hospice]. And of them… [Māori were at the] low end of death, [about 40%] Māori, but they were quite involved in hospice prior. So that made the big difference… they’d been diagnosed and come to hospice earlier where the Māori used hospice services. I found that if Māori were diagnosed, and it was only through my own networks… having whānau over there and then my whānau knowing that I was [working] in hospice… That brought, that brought these people to my attention. So, the usual referral thing would come along, but you know I would already know about them… because of my whānau out in the community. So, you know, I’d be at a hui or somewhere and they’d say, ‘Oh have you heard so and so [has] got- might have cancer or-,’ you know. And so, prior to the official referral coming into hospice… I’d already know that they were [coming]. And so, I brought that into the secondary care as well. So, I said to my doctors, I said to my colleagues at the hospital, ‘I’m going to tell you that these ones are on the radar. That if they come with a diagnosis of cancer that you need to be talking to them about [hospice], prior to them needing us.’ And so, we were trying to raise awareness around that.

Recommendations

For health and palliative care services, we recommend:

  • Consulting with Māori Kaiāwhina, Kaiwhakahaere and Whānau Ora Kaimahi can help develop your relationships with local Māori communities. This will support your organisation and staff to become more effective team members in the whānau manaaki care system. Local Māori are familiar with their communities and can provide good cultural advice as they have established relationships with kaumātua and whānau. Remember to observe manaakitanga (hosting) responsibilities as well as koha (gifts) befitting the occasion.

For health and palliative care professionals, we recommend:

  • Encouraging whānau manaaki to reflect on their satisfaction with the care they have received, and to give feedback to you or your organisation. This is a good way to continue to improve the care and support you offer to future kaumātua and whānau manaaki, while recognising of course, the diversity between, and within, whānau manaaki.
  • Becoming a good whānau manaaki partner by adopting a patient-centred and culturally sensitive approach which supports the family’s care system because the kaumātua and whānau manaaki are at the centre.

‘Mana’ and ‘manaaki’

The term ‘mana’ means prestige, control, authority, status and spiritual power - it is a supernatural force in people and objects. Everything has mana. To manaaki’ means to take care of people, ensuring they can reach their potential by supporting them and by showing respect. ‘Manaaki’ has a reciprocal element as sincere relationships are mutually beneficial and have interactive exchanges that help to lift the esteem and potential of others. Manaakitanga is the process of actively caring for people, providing hospitality and showing kindness and generosity. Whānau manaaki who provided end of life care in the Pae Herenga study highlighted in their pūrākau (stories) that health professionals can become part of the whānau manaaki care system – they have an important role to play.

Matua Hugh (hospice volunteer) describes how his presence can make a difference for Māori whānau when he visits them:

What have I been able to, to, to change at hospice [name] is it’s not just the ‘routine boys’ you know we’re not just going on a van and we’re going to deliver the bed and the toilet and the all everything else to this place. It, it, it’s not just about that you know. It’s about the people, it’s about the people in the house it’s about the wairua… I’m a Māori and I’m probably the only Māori lifter driver that’s in our team.

… We’ve gone to pick up a bed from somewhere [from name of place] quite a few times. We’ve been down there you know and you get down to, to our whanaunga’s [relative’s] whare, who had buried, it would be the wife in this case, you know very solemn and you know she, she’s hurting you know the husband’s passed away and they’ve gone through all this hassle of, of the hui [mate - funeral] and all of that she’s trying to settle back into her whare [house]… So, she sees me as you know being another Māori and she [makes a hugging motion] … Oh you know, you can, you can feel that, that, that um, that wairua. You know the wairua oh.

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