Being present and observant

Being present and observant means using all one’s senses when caring for kaumātua at the end of their lives. Kaumātua and whānau can sense the health professional’s wairua (spirit) and care intentions. They will either consciously or unconsciously assess your interest in them by the way you interact with them and how you treat them. They will read your mauri (energy life force, vital essence) for signs of calmness and aroha (love and compassion). Māori health and social care professionals are aware of the importance of having a sincere heart and being present with kaumātua and whānau. They know this helps to build trust.

All living beings have their own energy frequency; positive and negative energy forces are easily felt by kaumātua and their whānau. A happy person need not say or do anything, but we can feel a calm energy when we are around them. Angry or stressed-out people need not say or do anything specifically, but we can feel their negative energy. These feelings are transmitted in the way health professionals’ deliver care via their verbal and non-verbal communication, and through their physical actions and behaviours. When health professionals carry out their work in a calm, caring, respectful and skilful manner everyone will benefit from their presence. Working with a sincere heart (ngākau pono) is noticeable and beneficial. Connecting with the mauri of whānau is a way in which Kahu (health professional) knows what whānau need:

Well I think everyone is different, but from what I [‘ve] seen is people-… because I work… on my vibration, feelings, I can’t tell until I see the person [what they want] … I think definitely though you can suss out what, what different whānau want you know… I’m really good at micro, micro expressions. So, I can see if somebody really detests something straight away. You know. Or if they are- it’s like a second look. Everything slows down, like real slow to me. And I can see it and I’m like, ‘Oh they didn’t like that. Okay maybe I won’t, ah I’d better just tone that down or you know,’ Ah yeah, just certain things, or I can feel that’s not going right or yeah they need to be upfront, they need to be treated softly, they need to be - yeah, whatever.

You [Māori] know when someone’s going to hurt you real quick because you can see it in a flick of their eye. And you can tell if someone’s genuinely kind too, because there’s that flicker too. Yeah.

Matua Hugh discussed how he approaches Māori and non-Māori as part of his voluntary work for hospice. He also noted different approaches when entering peoples’ homes. He guides his co-workers on how to enter Māori homes and he takes his cues from his Pākehā work colleagues when entering the homes of Pākehā families:

With the Māori there’s a tendency to be a little bit more observant… That’s something I tell my fellow [non-Māori] drivers, ‘You go to a house, a Māori house… though no words will pass between you, there are certain things that are required of you and if you don’t observe them, then they could very well tell you to get on your bike...’ Because it’s a period in their [home] space that’s very, very important to them… Because I must say that when we go to a Pākehā house… I wouldn’t say it’s not so important, it is important, but it hasn’t got that… cultural thing behind it… I tend to take the lead from my Pākehā brothers.

Matilda (community health care assistant) uses her former nursing assessment skills to quickly evaluate what is needed when she walks into a home. Her observance and attention to detail helps to bring comfort to the ill person and it also helps to reassure the whānau:

Yeah, my eyes are doing the walking around the room and among the people and the ears are listening. And then I would go to the client yeah. It’s just something [I do automatically] when I come in there… I can’t be sure what it is I say, but maybe it’s like [I notice] the position of the [ill] person you know… looks a little bit comatosed. [I’ll tell the whānau] ‘Maybe we raise the head of the bed a little bit here’ or we talk. I don’t know what it is, but it just brings a [bit of peace].

GP K. understands whānau and knows when something is wrong from their body language and āhua (appearance, condition):

I guess my [strength is my] ability to read the whānau. So, I can you know, just reading [their] body language, knowing when something’s just not quite right, or when it’s really right… Yeah, I can. I definitely… I can sense the āhua of the room… and where you can step in, and where you just need to be quiet and gentle and calm and careful. You know so it’s a- I don’t think it’s like a sixth sense… what I’m talking about more is the ability to understand and read a situation, the room, who’s who, and knowing how to approach that.

Recommendations

For health and palliative care professionals, we recommend:

  • Reflect on your own identity and respect your own cultural ethnicity, values and beliefs as this will help you respect other peoples’ cultures and their ways of doing things.
  • Use a humble yet professional approach to reveal your māhakitanga (humility) as this is a helpful way to reduce the fear some kaumātua and whānau may have towards engaging with the health system and health professionals, particularly at the end of life when things can feel uncertain.
  • Cultivate a sense of calmness by engaging in practices that can help you be present and centred. This will help to clear and stabilise your energy before entering into, and out of, the therapeutic caring relationship and space. This may include rongoā practices, karakia (prayer), meditation, mindfulness, walking or other relaxing or energising pursuits.

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