Establish rapport

Establishing and maintaining good connections with kaumātua and their whānau is essential for health professionals to be included as extended whānau manaaki. Knowing who the whānau spokespeople are could save time and prevent whānau experiencing a loss of trust in the health professional. This is essential should things get busy and urgent decisions need to be made. Relationships are two-way – however, when people are feeling vulnerable, fearful, stressed, and financially stretched or poorly resourced then someone has to make the first move. Be that caring and courageous person!

Recommendations

  • We recommend that you have a list of who the main contacts are for the whānau and their specific roles.
  • We recommend that if you are new to the care team, make sure that the regular carer, or someone known to the whānau, introduces you to the kaumātua and whānau manaaki.

First contact – Establish trust

Engage with whānau in a way that helps to build trust and develops a relationship where the kaumātua and their whānau feel a sense of connection with you as a health professional, and with your team. Humour is a good way to break the ice with kaumātua and whānau manaaki who could be feeling like they are a fish out of water in a strange health setting. Being sincere when meeting people for the first time and taking the time to introduce yourself in a meaningful way that moves beyond name, role or profession is a great start. Health professionals often comment on how busy they are. Being present, warm, kind and finding your own way of connecting in the time given is a challenge but is so powerful when you find a way of doing it – be the talent!

Mary Te Awhi, a hospice kaitakawaenga describes how she sets up the first whānau visit with hospice nurses. She opens the door and removes the barriers, allowing the nurses to bring in their clinical knowledge:

And so, I made it my, my job to go up there [to place]. And then, slowly, the nurses that I worked with over the years have found it actually a valuable asset. And you know the two most recent [nurses] that I’ve worked with over years, I’ve heard them talking to other people, ‘We let her go in first. We let her do what she needs to do and then she hands it back to us.’ And I’ve seen people respond in a way, ‘But… you’re the Nurse Practitioner,’ or, ‘you’re the Clinical Nurse. You should be the lead.’ ‘No, no, no. We don’t go into that area and tell her how to do it or tell those people how to do it. We’ve had the message, ‘don’t do it.’ She [Hospice Kaitakawaenga] takes us in… introduces herself to the whānau and then she introduces us as a colleague, and we just let her do all the talking and the connecting. And then she’ll say, ‘so the reason why we’re here today’ you know,’ have you been spoken to by oncology or your GP or-?’ And then away we can go. We’ve just learned to wait.’

Mary Te Awhi (hospice kaiwhakahaere) continues her story. She highlights the value and the connection that can be made by greeting whānau in a genuine and appropriate way:

And some of the staff have told me that they have found it quite useful that I can just walk in, and they can feel the tension in the air, they can feel that, ‘Oh, it’s those scary people coming from hospice. Oh, who’s her … she doesn’t look white.’ In fact, one of our patients one day said to my colleague… (We’d done some work, introduced some medication). Went back, we heard that it worked well. We achieved what we needed to achieve. Went back the next time, we walked through the door, ‘Kia ora matua!’ And he says, ‘Kia ora. I’m good.’ And then he said to my colleague, ‘You’re not bad for a white girl.’ You know what… she took it as an amazing compliment.

Also, from this good connection made by the nurse, other issues can be identified, commented Mary Te Awhi:

And I said, ‘You actually addressed an issue that the GP was pointing out. We need to decrease the number of times that this patient’s coming into hospital.’ ‘How can we actually do it?’ We actually looked at the issue, ‘But do you know the other thing that you found out that neither you or I picked up on the first two visits?’ She said, ‘What was that?’ ‘He’s illiterate. He can’t read.’ A family member arrived when we were there… we just looked at this box of mish mash [medication]. Some weren’t even his medications; they were his mother’s that had died a few years earlier and they were just like old stuff and they were relevant. Couldn’t get our heads around it. Slowly [it dawned on her] … he’s actually illiterate. He couldn’t read.

Matilda (community health care assistant) talked about respectful communication from health professionals to whānau:

… All communication is respectful. I’ve listened to specialists and they just have this thing about them that is just kind [of], it’s very straight up. It’s just really, really good yeah.

The use of simple English by health professionals is as an important part of building good relationships. Matilda commented:

I think they [ill person/whānau] need to be good mates with their palliative team. I think the GPs and from hospital to palliative, I think they all need to be with the families but to, but to express it in a way that we can call ‘simple English’; simple, simple yeah. Um and so far, I’ve seen some really, really good interaction between the whānau and GPs, hospital staff, palliative [staff].

Joy (health professional) highlighted the importance of communication

[F]or staff, the way staff communicate with them [whānau manaaki] is really, really important to be kind, to listen. And just to have that that trust for them to gain that trust in that person. Yeah. [Kindness means], I think it’s the way you talk to people and, you know, it has to be genuine. And you have to be consistent and follow up with anything that you say to them that you’re going to do. You've got to be really, really, you’ve got to be on the ball to be honest and be kind and yeah just to be honest in the way that you deal with people.

For health and palliative care professionals, we recommend:

  • “Kia ora, my name is William and I’m your nurse today. I’m originally from Scotland and I moved to New Zealand in 2015 and I came to work here a year ago” is much friendlier than saying, “Hello, my name is William and I’m your nurse today.”
  • Taking things slowly; there is a lot to absorb for whānau; a new situation, a new environment, new people, and a new future that may be bringing lots of challenges and heartaches.
  • Giving whānau access to information (if they want it); be ready to tell them what is likely to happen at the early stage of an illness, how it is likely to progress to an advanced stage and the palliative care support that that is available to help kaumātua and whānau before and at time of death
  • The timing of everything is important; not everyone can absorb or understand everything the first time something is told to them (particularly around diagnosis, treatments, and changes that happen). Take it slowly and remember to encourage whānau to ask questions. Silence does not mean that people get it; it may mean they are in shock or are too fearful or embarrassed to ask for clarification.
  • Using every-day common language to explain things to whānau and go slowly. Avoid using medical terms and jargon including acronyms (most lay people have never heard of acronyms).

© Copyright 2021 Te Ipu Aronui

Website crafted by bocapa. Design by Sasha Maya