Dying is a spiritual matter for those who are transitioning and for those remaining. The field of spirituality is vast and it is beyond the scope of this website to provide an in-depth account of wairuatanga (Māori spirituality) or other forms of spirituality, however we draw on Pae Herenga study participants to describe the depth and breadth of its meaning as it moves beyond religious philosophies and practices.

In their interview, Whaea Rihi and Matua Ned discussed the meaning of wairua and how they go about explaining it to health professionals:

Rihi: Oh yeah there’s ‘wai’ and ‘rua’ I mean it depends on, on your bringing up.

Ned: For non-Māori it’s deep for them to understand.

Rihi: Yeah well, the coming together of the two waters is the wairua which is about the life force and how we’re made. I mean that’s one teaching I’ve been taught. You know we are water, like cousin [name] said ‘we’re made from water’ so wairua can mean that in that sense. Some people it’s about a spirituality for want of a better word.

Ned: Oh yeah, yeah. I say to them, ‘you know the kindred spirit?’ They go, ‘yeah’ –wairua!

Rihi: [W]e try and help our staff understand… from our perspective what it means in their terms.

Ned: Because they are- they have a spirit, you know.

Rihi: They have a spirit; they have a wairua.

Ned: We call it a ‘wairua’, you’ve got a spirit. Some people have got a bad spirit, you know eh?’ And they go oh ‘yeah.’

Rihi: And they do know.

Ned: So, they get that, so we have a bit of fun with it. We don’t make it too heavy…We actually laugh about it and have jokes about it, but they actually understand it by the end of the day.

Whaea T. (health professional) spoke about working with whānau and sometimes having to explain the difference between wairua and Pākehā understandings of spirituality:

Well spirituality is more like their hāhi [religion] you know. For using Māori kupus it’s about… your wairua [spirit]… it’s about your feelings and that, the emotional stuff and what you really need to do in terms to get to that other end. Or you’ve got something you know… but you can’t [express that] because you might be, too whakamā [embarrassed] or something. Or you don’t know, or you haven’t got any knowledge or you’re just too whakamā… to get help and things like that. So, it’s about that wairua that need…

Whaea Marama (rongoā healer/tohunga) spoke about the meaning of ‘pōhara.’ She made the point that being pōhara (impoverished) does not just pertain to the financial or material part of life as we can be spiritually impoverished. Being pōhara’ can refer to any area where a person feels they are lacking or not in balance:

And so sometimes we can relate that to pōhara financially, but for Māori, it covers everything. It’s our wairua; it’s the lack of- so that lack of love and lack of direction or guidance perhaps from your own whānau. Where, you know, our people can feel that lack of support, whether it be spiritual support, that emotional support, mental support and that physical support. So, for us as a whānau hapu iwi, we can be lacking that. Hence why we have all those conditions around our chronic illnesses...

When asked for a definition of wairuatanga, Kuia K. offered the following explanation for discussion:

The wairuatanga, I find, is that in each of us, in everyone on this earth… at birth… we’re born with a spirit… and that gives us our wairuatanga. That gives us that feeling to do good. And sometimes we listen, and sometimes we ignore it. Now, I don’t know whether I’m, ex-explaining it right… I give you another example, [a] practical one. If I want to go to the marae… I believe I need to get into the right wairua for the marae. Ah because you got your wairua, but your wairua operates in different ways depending where you are, what you want. So, if I want to go to the marae, if I’m going to a tangi for instance, I prepare at home. I dress accordingly, I put on my pango [black] clothes for the marae. When I put on my pango clothes… I also say my prayers. And the prayers I say again is the whakawātea (cleansing prayers). That’s all part of spirituality. Spirituality is not, I don’t believe there’s one word for it. We’re not Pākehās.

But, you can, you can explain it… in your actions… it starts from dressing and preparation. You say your karakia, ‘whakawātea ia koe, ka haere koe. Because when you go to the marae it’s not about the living only; it’s about [the] living and those that have passed on. And so, you have to, I believe, prepare yourself for that… to accept what you’re going into and how you’re going to operate… and usually… I operate… as a kaikaranga. Or even if I’m not, you’re still… in that realm I call it. And, and then when you are operating it, then, you know your whole outlook is one of, and I’m talking about myself, not of others, is that you’re aware of the spirituality, you’re in there and, and for me the spirituality is about my Māoritanga. And so, I remain in that role while I’m there. It’s the Māoritanga, and I come back to my values; respect, manaakitangata, tiaki, whakawhanaungatanga, those sorts of things. That’s what I can tell you about wairua. It’s not one word…

If the health and social care professional’s role involves working with Māori who are close to dying, they should become familiar with the policy guidelines or protocols developed for that phase of life. For example, ‘Te Ara Wahakapiri – Principles and Guidance for the Last Days of Life’ provides guidance on the best form of care that can be given in the last days of a person’s life. In addition, the older person’s health care team (health care records), should have a copy of their end of life care preferences as these will ensure the best possible outcome for them no matter where they die or what they die from.

It is usual for at least one person in a whānau to lead spiritual care however, like many other New Zealanders, some contemporary whānau manaaki may lack strength in this area. It is helpful for health professionals to recognise that there are many different spiritual faiths observed by Māori; these can include beliefs and practices handed down from ancestors; variations of Christianity, Buddhism and New Age spiritual beliefs and practices. It is important to become familiar with the various faiths as these can have a significant role to play in the whānau administration of end of life care and dying process. For example, people of the Rātana faith may wish to lock the door before their prayers commence and then open them afterwards, no one enters or leaves during prayer. A health professional who is unaware of different cultural and spiritual norms might be confused when something unexpected happens. Getting to really know a whānau will help with developing an understanding about their spiritual beliefs and preferences at end of life.

Building a good relationship with whānau through sitting and listening to them can mean that whānau feel comfortable to share information about themselves, including information about the older person’s spiritual beliefs and care preferences. Mary Te Awhi (hospice kaitakawaenga) explains:

Because one of the things I tell my colleagues, ‘Please do not go out into the community and ask people, the tūroro [patient] and their whānau, ‘what is your spirituality?’ Ask me the question? I’ve got no idea because actually; what does it mean? And what do you as a health professional think it actually means because it’s actually different for everybody.’ So, in other words, there’s no [exact] question and there’s no [exact] answer. And it’s the conversation that you’re going to derive the meaning from.

So, it’s about having a conversation with people. Yes, you might be pressured to ask 20 questions on the first visit, and I try to warn whānau that when the nurse comes she might want to ask you a number of questions, but she won’t need to ask you those questions again after that.’ But for me I said, ‘I don’t want the answer to anything. I might ask you something about, you know, ‘are you from name of iwi?’ or ‘are you from somewhere else? Are you from [name] because…? I’m from there… I’m so and so. And these are who my people were.’

It can take a long time for whānau to share personal information:

Well I know with one of my kuia’s, I’ve been visiting her for quite some time and thought I knew everything about her. And then one day… she had just come out of hospital and so she hadn’t quite healed physically. And so, we were in her bedroom and then after we had talked about a number of things, I just happened to look up on the wall and I said, ‘Oh my goodness Nan, who’s that handsome man?’ And she said, ‘Oh that was my father, but he died a young man.’ And he was a handsome man, and as our men dressed in those days with their suit and their tie, their collar and tie. I say, ‘Wow! He’s handsome.’ She said, ‘Yes, he is.’ I said, ‘Where, where is he?’ So, she told me where he was and she said, ‘And my, my twin sister’s beside him.’ I said, ‘What? You’ve got a twin sister?’ So, yes, and it turned out she had a twin sister… I said to her, ‘I thought I knew everything about you Nan, but you’ve just told me a couple of really valuable things that are really important to you… and you’ve shared them with me.’

Good spiritual care covers every aspect of end of life care including pain and symptom management, emotional and social support (especially for the whānau), and environmental support. Providing a private space can help to protect the tapu (sacredness) of the dying person and it also cares for the whānau as they gather when someone nears the end of life is good spiritual care.

Having a private room at hospital was important for Ripeka in the last few months of her life. Her husband Jeff commented:

… at the hospital, you know, when she was really sick, on odd days- so her last three months was in and out of hospital, they gave her a private room. Because she got sick and was in the ward and it was a mixed ward. And didn’t like males around her because of her personal hygiene, you know, and you can pull the curtain but [the male patient’s] still there… [The hospital staff] found her a private room.

The hospital was flexible and supported Jeff and the whānau with room and space and to do what they needed for Ripeka:

It was sufficient. You know we asked the nurses, ‘You know there’s going to be a lot of whānau that will want to come.’ And they say’s, and it’s like this, ‘We change the policy. You can fit, squeeze as many into this room as you can, and we’ve got the day room as well.’… [They can be flexible] when they need to be. And they actually just left us to our own devices. They came in and checked to make sure, you know, she had her pain relief ’cause by that time she was unconscious.

Although not a Chaplain, Ipukutu (former Māori cultural advisor) talked about taking on a very similar role to a chaplain or minister at times, providing awhi and support from a cultural perspective, beyond that which is offered by the kaitakawaenga. He expressed that hospices in areas with a high Māori population needed to be able to have someone with the ability to support Māori whānau with tikanga, wairua and te reo:

That one was part of my mahi… there were some whānau, especially elderly whānau, that- so they thought ‘Oh gee.’ And then of course… kōrero Māori. And, so I used to go in there and I used to kōrero with them and you know, waiata with them, karakia with them… because they would have preferred a Māori. You know because there was none of that ability within hospice itself. No one able to do that. So that was one of my things also… that I wanted to see [hospice]… But at times of the tikanga, wairua and all that stuff, te reo and all that hospice [doesn’t have that depth of cultural knowledge and tikanga] … Where you’re heavily populated with Māori, you need some people like that… in your hospice.

Yeah, you know… that cultural [wairua] aspect side… they’ve got good reo.

Recommendations

For health and palliative care professionals, we recommend:

  • Sensitively enquiring about the type and level of cultural and spiritual support the kaumātua and their whānau will need from your services. Would they like a Māori chaplain to visit them?
  • Becoming familiar with a helpful book that explores the various faiths that inform end of life spiritual values and beliefs in New Zealand. This book also has a traditional perspective of end of life as well as a more contemporary perspective. See Last Words by Margot Schwass (2005).
  • Becoming familiar with the guidance provided in ‘Te Ara Whakapiri – Principles and Guidance for the Last Days of Life’ as this document highlights the best form of care that can be given in the last days of a person’s life.
  • Being trained in cultural and spiritual assessments; these should be open and use an enquiry approach as spirituality is different for everyone.

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