Caring for your own well-being

Some health professionals really know how to care for their own well-being. They recognise that self-care is essential if they want to be present, compassionate and competent in their roles.

A Māori male chaplain draws on a variety of things to care for himself in his role as a spiritual health care worker:

It’s a soul self-care thing. I think there are levels of trauma that we all experience, and some can be very, very high levels and low levels. And so, what I do about that? I do work for the Church, recently I’ve just… spent a week in a monastery. It’s available to me.

Then it’s ongoing support to try and clear my head and my soul really of [the] residue of what’s been happening with it - not just to do with death but all sorts of unanswered questions, you know that I might have. And so that’s what I do.

In the ritual side of things; I have a karakia that we use before we go into anything and when we come out of it which is a ritualistic thing. And that’s normally done with other Ministers, or if you’re by yourself, reciting it yourself, which comes from a Māori background. So, from a Māori framework, I do that. So, there is provision there really but, it’s like anything you’ve got to manage it and make sure it occurs. Otherwise there’s some things you see, and experience that you can never really get away from, it’s always going to be there in the background. And so, you know it just comes with the territory really.

Yeah, so you do [have] to watch yourself because people do burn out.

GP S. commented on the value of engaging in holistic self-care. She received this by attending a hui-a-tau run by Te Ohu Rata o Atoearoa (Te ORA), Māori Medical Practitioners Association:

Last year we had our Te ORA hui here, our Hui-a-tau, and so we had [name] and her rongoā Māori practitioners there. We had a tāmoko practitioner available… you could come for the academics, you could come for the educational [but] actually you can use this time to whakawhanaungatanga - find yourself again and just have some time [for yourself]. Yeah, and I’m embracing that more as I get older, as my experience grows, within this practice.

For time-out Joy (health professional) goes to the beach with her whānau. She also enjoys being involved in her rōpū when all the whānau get together. She talks about wellness and ways to look after yourself as a health professional:

Yeah [I walk] and I have a little talk with our moana. Good kai and water… fasting without food for a day is amazing, does an amazing thing.

Giving to people at end of life can be very tiring emotionally, physically and spiritually. For example, call outs to someone who is ill or dying can occur at any time of the day for some health professionals. Matilda (health professional) said she took ‘nanny naps’ to protect herself from getting fatigued:

To protect [me] so I don’t get fatigued, I’ve got to have my nanny naps.

Working in a hospice can be emotionally taxing. Huriana (hospice health care assistant) shared how she manages her emotions and self-care by taking time out to cry and she talks to her partner:

Sometimes it’s really hard. Sometimes I go home and just sit there and cry. I’m sad for the family that I might have been working with. Some of them could have been there for a couple of weeks, so you get to know them. Especially if you’re on a night shift. You’re in the kitchen making a coffee and the family’s there and you start having a yak with them. Sometimes it’s just really, really sad and I’ll go home, sit and reflect. I share a lot with my partner. He’s really good at listening. Well, I think he’s listening. He nods in the right places. But I don’t draw it out and I don’t tell him the real little ugly bits.  But, sometimes I need to share the sadness that I’m feeling and then I’m fine. The next day is a new day!

Huriana (hospice health care assistant) calls her mother (spiritual care professional) to reflect on what has happened at work, especially if she has encountered emotional mamae (pain) and needs wairua support:

When I feel sad [I phone Mum]. Pretty much [its] just talking, but she’ll also bless me through the phone. She’ll send ‘rays’ even to the hospice. We both have a laugh as well. Like, I’m there while they’re dying and she picks them up at the door and buries them, you know? So, we sort of have that [we’ve got it covered]. It brings out our sense of humour, which sometimes can be a bit dark. That’s how we get by, often using humour to hide really deep feelings of sadness. But I can talk to Mum about anything, and she makes me feel better. She encourages me and helps me to know that what I’m doing is worthwhile.  

Huriana (hospice health care assistant) talked about the support she gets from other staff to help her in her role:

I’m lucky in my role because we have a lot of support. You find out which staff members are going to be the most supportive. There are other people you can go to as well such as our Māori hospice manager as well as our two wonderful spiritual care advisors.

Some health professionals found that talking and debriefing helped to ease their minds. This includes talking with spiritual care workers. Talking with a clergy person was helpful for Matilda (health professional):

I like to talk to the clergy that are around at the time, that’s on the premises. Yeah.

Using reflexive practice is a method that health professionals can use to review difficult work experiences they’ve had. This is a useful tool for contemplating and working through challenging situations. Reflecting on what has happened, the part the health professional played, what they could have done better, or what could have improved the situation, is a helpful method for processing thoughts, feelings, and behaviours. Developing a deeper understanding about challenging situations is a first step in releasing pain, anger, doubt, and guilt that may arise. Using self-reflection was one way that Matilda cared for herself when there were challenging situations at work:

I like to just be quiet, just take that moment and just reflect on that - what’s just happened.

Health professionals who took part in the Pae Herenga study reflected that it was important to care for themselves when they are caring for kaumātua and their whānau. Spiritual self-care was viewed as being particularly important. Working in the wairua space, helping kaumātua transition from te ao mārama (natural world of life) towards the ārai (the veil between this world and the next) is deep wairua mahi. A Māori chaplain explains the importance of whakawātea (clearance rituals) in his wairua work:

I don’t talk about it often much, but I do have a woman and a man (the man’s related to me from Ngāpuhi) who deal with sort of wairua Māori stuff. I go to [them] when I’m really being affected [by] something and, which sits outside the Catholic position. But they deal with portals and about clearing stuff and reading [wairua]. And so, I’ve always been a receiver. So, I’ve been able to see things in another way, and receive things [tohu – spiritual signs], from an early age. I’ve always had that. And so, becoming an ordained Minister hasn’t changed that. I have a couple from [name of place] that manage that for me.

So, if I’m really stressed or whatever… I’ll go and see them, and they clear me and read the situation for me so I can get out of that. So, I think that’s another thing. I think that’s a whole validifying [aspect]; as Māori we always have to do [things] about te ao wairua.  That’s hard to explain for Pākehās because they just don’t get it. Oh, not all Pākehās, but generally Pākehā people, Kiwis just don’t understand that. Whereas for us it’s a day-to-day thing. It comes with your bread and butter in the morning; it just is us.

And how are you going to explain that to a Government Department, or to a so and so? And I think there’s a lot of work to be done there, I think people do the PC thing, ‘Oh… you know, Māori have this thing called wairua,’, but they don’t realise that our people, they live with it. It’s still [there] and we’re part of this land, we’re part of the DNA and makeup of the land. It’s here and that’s not going to change.

As part of her self-care routine, Huriana (hospice health care assistant) has karakia before and after work:

Yes, I thank him [God] every day I get home, and on my way to work.  I’m saying, ‘Please God help me look after these sick people today. And may it go smoothly; and help me get home safely tonight.’ And when I pull in the drive, I say ‘thank you,’ but before I even leave work, I use water on my hands and bless myself before I get in my car. I do not want to take any ghosts home, there’s enough there already.

Huriana (hospice health care assistant) calls on her tikanga (customs) when faced with challenging situations at the hospice where she works:

I am lucky to have God in my life. I often find myself asking for help for the patient and their whānau, and me. ‘Please God don’t let them be sad for too long’. Grief is so different for individuals and whānau alike.

I pull in my knowledge of tikanga when dealing with Māori patients and whānau. That’s because of what the patient’s whānau are going through. You’re not meant to judge anyone when you work at the hospice. It can be hard; we are only humans. I love our culture and sometimes I presume everyone practices it [tikanga], but no, some really don’t…

Matua John’s (Māori spiritual care worker) koroua [grandfather] taught him to trust his feelings and he follows this rule in his work as a spiritual minister:

My koroua always told me, ‘If you get stuck, don’t do it if you feel uncomfortable’. That’s what he always told me because he was a very powerful man in his karakia. Yeah, but you know I’m always trying to prepare myself before I’m on the move [in my spiritual work].

Along with karakia, Whaea M. (community health worker), uses holy water to bless herself:

I have it in my [bag]… And so yeah, when we’re all māuiui I’ll go, ‘Have you got your water or anything?’ But, if I’m māuiui and I can’t do myself, then I ring [my brother] or my baby sister and they do it [karakia] over the phone.

Whaea M. (community health worker) can ‘feel’ the māuiui [illness] of whānau when she enters a room. She emphasises the need for spiritual protection in her work:

I’m going on the wairua side. As soon as… you come through that door and you meet your whānau well [if] we have māuiui [illness], I ‘feel’. And I felt it as soon as I came into the room today. I could ‘feel’ it. And so, I ‘feel’ that until the end… but I know how to do myself. You know? I know how to look after myself… I bless myself and I have my tīpuna[s] around me. They’re with me all the time and I’m very lucky. They’re my protection… I have a karakia and I do myself [clean myself with blessed water].

And then, because I did that before I came in, but when I came through there I thought, ‘Oh something’s [wrong]’ yeah so that’s why I came back out. And if you notice I was by myself. Why? That’s why. I just took a stance back. And then I said to [name of Māori provider], ‘Just give me a bit more’. And then I’ll go and have something to eat [to clear the energy]. And that’s the wairua.

Prayer is a normal part of everyday life for spiritual ministers, Matua John and Whaea Heather. It is what prepares them to do their work:

Matua John: Oh we, we pray, we pray before.

Whaea Heather: And I think sometimes you just have to take a breath and pause before you go rushing in. Because if you do, you’re not [clear]. You clear yourself.  You’ve got to be clear. And that often used to happen in hospice [where I worked] …

Rongoā clinicians have their own spiritual rituals [whakawātea] that they use to cleanse themselves and to clear their healing space. Matua Ngawati commented:

We got a little process between us, in terms of cleansing ourselves… after a day [at the healing clinic], we go through a certain ritual to clear everything out; to clear our whare [work premises]. After each client, we clear. You know, just making sure that the next one is not affected by what’s gone on before them… Making sure everything is clean, to our knowledge anyway. [To remove] negative sorts of energy that could potentially hurt other people…

The practice of karakia is important to Joy (health professional) in her busy working role. She tries to integrate karakia into her work at the DHB:

…. I tell you that’s what I missed when I left [Māori health provider] and went to the DHB. Because at [name of previous workplace] every morning we had karakia, we had waiata. So, I missed all that and of course you try and integrate it into the DHB services but there’s only so much you can do. But I still do my karakia and that, you know, maintain all of that. And when we have pōwhiri[s] I enjoy a waiata down there.

If Pato (community health worker) is visiting whānau and they start karakia, her tikanga (customs) is to stop her mahi and join the whānau:

Mm, karakia āe, the family always has karakia. So, I involve myself in it [karakia]… I join in… you know, I won’t go and do mahi while they’re having karakia… I stop, and I join in.

Karakia is an important part of Pato’s (community health worker) daily self-care practice:

I do it [karakia] before I even get there… for myself. Yup, before I even…  I could do it just before when I start the car, warm the car up... ready to go to work, yup.

I just ask the Lord to ‘guide me and to give me that strength, in what mahi I have to do’… and to rid of all the raru [trouble, problems, conflict] that I end up with.

Pato’s (community health worker) mother taught her the importance of performing a spiritual cleansing ritual after giving someone a mirimiri (massage):

My mother taught me that, she goes, ‘When you miri [massage] somebody and you’re in a happy environment, and you’re all good, your āhua [appearance, character, condition] is good; it rubs off on them. And if they’re in a bad āhua… [in] a bad mood, your mirimiri rubs off on you’. So, I take the kaka (excrement) if you can say that, and take it with me. And then I go for a swim down the creek… [to get rid of it].

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