Strengthening health and social care services ties with local Māori leaders and health professionals in the community will help to extend upon the cultural knowledge, skills, and resources of existing staff. Actively employing more Māori health and social care professionals and community support workers reflect the organisation’s level of commitment to increasing cultural safety within the health care setting.

Joy (health professional) comments on the key strengths that she provides for Māori at end of Life. She reflects on her 18 years of community nursing and her previous connections with whānau:

A lot of patients that have come through [to the hospital] I already know them [from] having worked out in the community for over 18 years. You know a lot of the patients I see coming through I’ve already been visiting them when I’ve been with [name of service]. And knowing the area, knowing the services that are out there....

Being a Māori nurse makes a difference for patients coming into hospital. Patients have expressed to Joy (health professional) how good it is to have a Māori nurse:

...being Māori makes a difference, a big difference as well because when they [Maori kaumātua and whānau] come into the hospital, it’s really, really scary for them still. But if you come up to them and talk to them one lady said to me 'oh you know it’s just so good because you’re Māori.' It makes a big difference and, you know I suppose it’s less scary for them then, yeah.

Māori workforce development is needed to increase Māori staff capacity in every area of health including management, advisory boards, research, cultural supervision, administration, clinical (every field), psychosocial support, spiritual care, allied health and voluntary workers. Kaumātua and whānau manaaki often feel safe and at home in the presence of Māori staff. Liaising with Māori community providers is valuable for establishing coordinated care when it’s needed.

Addressing the needs of the community was a key goal that Kim (community worker whānau manaaki) emphasised during her interview. She worked towards this by listening to what people said and then invited and coordinated relevant services to visit her community, and individuals:

It’s not about what I offer, it’s about what the community needs. You know? So, I listen to what people need and then I bring the right things out… So, my motto is, ‘Love is the key, so have a cup of tea.’ So people come in here and they have a cup of tea and a kōrero, and it’s over that [cuppa] that I am actually listening to all the things that are wrong with them and then I think, ‘Well there’s a lot of this going on, a lot of depression.’ So, I’ll bring mental health out [to our community to deliver an education session on mental health] … You know what I mean?

Because Kim can work independently in her community she is not constrained by any organisation’s protocols; she explained that she is able to intervene on behalf of different whānau members:

I have a nurse that comes here once a week and then I listen out. Because I’m not… [part of a health organisation]. I can actually say, ‘Aunty blah, blah, blah’s not well today; can you go down and check up on her? She’s fell over', or 'she dah, dah, dah, dah.’ And then I can ring the hospital and go, ‘Aunty blah, blah, blah’s in hospital. She went in last night on the ambulance. This and this is going [on]. Can you ring her and check up on her?’ You know. So that’s what I do.

Joy (health professional) highlights the important role of iwi nurses, coupled with a public health approach. Being able to visit whānau at home provides an opportunity for nurses to kōrero with whānau early, about concerns, fears and symptoms of possible cancer:

So, we need a lot of community awareness raising. I like to get the iwi provider nurses on board... because they have the luxury too of going into people’s homes at an early stage. A lot of kōrero could be had - a lot that diagnosis could be made earlier.

Finding the right Māori person or group to develop and deliver cultural training programmes will ensure that services and staff can pro-actively support kaumātua and their whānau to navigate the health sector more effectively. Health and social care professionals will be able to supply kaumātua and whānau with helpful information to support them with planning for end of life (see Advanced Care Planning guidelines, for example –see below).

Joy (health professional) navigates patients through the health system, making sure services and support are put in place at the start. Within secondary health care there are a lot of health professionals involved in the patient's care journey, even if they are at end of life, they can still be having treatment. Therefore, it is important that people have one key health professional they can phone for advice. This person could help and support them navigate and use the health system. Joy adds that this is a role she sees herself providing for whānau:

[A]s a clinician it’s just being there to support them [whānau], because sometimes, they don’t know who to go to. You know, even if they’re terminally ill they could still be having treatment, still ongoing care. So, it’s just having that one person they know the name [of]; they know the person to... help... that’s how I see myself as well for them.

...And I guess for me too is making sure they get the support right at the front end and know what they need to do and bringing in all those other services that they need.

Outwards facing, helping Māori to have a better understanding of Aged Residential Care or hospice for example, would be helpful. When care ‘homes’ are well managed and resourced and kaumātua are taken care of, it can have great benefits for patients and their whānau. In this story Mary Te Awhi (hospice kaitakawaenga) reflects on a kaumātua enjoying her time at an Aged Residential Care home:

Well I went to visit her [kuia], and this is a rest home where there may well be [other Māori], but I did not see any other Māori… And so, I went to visit her, and I said, ‘Nan, I could hear you when [I] was out at the reception.’ She was holding court…. After lunch she had her knitting, she had her crafts with her, she was talking with some other residents of the rest home and they were just waiting for the music lady to come along for a quiz. So, I said to her, ‘Nan, tell me what you’re doing every day?’ And she said, ‘We have exercises at 9 o’clock. I make jolly sure I’m up, dressed and ready to go. I’m down here for exercises, I participate in everything.’ She, a lady that has been involved with family and community, and, and I just think it was an amazing way to heal for her. She eventually came home, and I said to her, ‘How you doing? How [did] you [feel] at the end of your time in respite? How was that, in the Pākehā world, for you?’ She said, ‘Well, I came to the conclusion [that] I’m not ready to go into care full time, I would like to still be at home. And I know that I can’t do too much, I have to learn to accept some help. No, I enjoyed it.’

"Taking a collaborative approach will help to build a sincere partnership with Māori communities. "

Engaging with Māori community health providers, leaders, and kaumātua about the needs of local whānau and reviewing the evaluative cultural safety perspectives of whānau (via experiential evaluations carried out within health and social care services), as well as drawing on Māori health professionals’ knowledge, will help to identify whether cultural safety of mana whenua (the local Māori community) is being upheld. A consultative and collaborative approach will help to establish the cultural values and care preferences of local whānau and the level of cultural knowledge and practices that staff will need to attain. It can take time to identify who are the correct rangatira (the right people and leadership group) to consult, and for meetings to be organised. It can also take time to receive feedback. However, when the right people are in place and the right knowledge is shared it can be very beneficial to support the integration and coordination of cultural safety within health care.

These relationships will be valuable as your new partners will be able to share information about local people, history and customs and can alert you to new things that are on the horizon within the community.

Recommendations

For health and palliative care professionals, we recommend:

  • Whakawhanaungatanga (establish connections) and build sincere, trustworthy relationships with Māori individuals and their communities. Forming new relationships with the right people often develop slowly over time; when these connections are solid you will be better equipped to face ongoing challenges.
  • Be mindful not to overburden Māori communities, leaders and health professionals as they are in high demand by other organisations and groups who may also need their cultural leadership, support and advice.
  • Work with Māori groups patiently and respectfully as their timeframes are tight and they may be over stretched with their own community commitments. Ask for referrals to other individuals or groups who may be able to offer support.
  • Understand that your ideas to improve services may appear impressive to you however, a lack of feedback or silence from Māori communities is not sign of approval for your ideas. Silence may mean that more questions will need to be asked; be prepared to listen to the community’s ideas or advice.
  • Be mindful that local iwi may still be processing their Treaty of Waitangi claims or they could be in an early phase of post-settlement. There may not be the capacity to work collaboratively.

For health and palliative care services, we recommend:

  • Initiate appropriate cultural processes to find the cultural support needed to increase the level of cultural safety within your health and social care services. If you do not know the right (tikanga) customs to help you form partnerships with local Māori you might consider employing a Māori liaison or link person to help you – ask for guidance from people in your organisation or speak to local Māori health providers or advertise among Māori networks. It is better to be humble and fully prepared than cause offence through cultural ignorance. As a starting point, try talking to someone within your organisation who affiliates to local iwi, or make contact with a respected Māori kaumātua or a Māori community group; initiate dialogue and outlay what your organisation hopes to achieve (for example, supporting Māori access to health care services and to ensure quality, equitable, outcomes).
  • Māori services may lack resources (both financial and human); we recommend that health and social care services should be prepared to cover any costs (accommodation, travel, catering, room hire) associated with enlisting cultural support. Be mindful that hui (gatherings) to consult and implement strategies with Māori communities will need to be financially resourced; you will need to ensure time and expenses are taken care of (accommodation, food, travel).
  • Remunerate Māori kaumātua or liaison support people for their time and cover the costs of Māori staff who contribute to establishing or providing cultural safety training.
  • Include catering expenses into any hui (meeting) you arrange.
  • Ensure you have an appropriate place to run a hui (gathering); the space will need to be large enough to conduct a meeting comfortably and you will require kitchen facilities to enable you to serve kai (food) and beverages as this is an important part of your manaakitanga (hosting) obligations.
  • When invited to a hui (meeting) at a marae to progress any cultural education or training initiatives it is your organisations responsibility to provide a financial contribution towards the meeting. It is customary to offer a koha (gift) at the start of a meeting at a marae.
  • Listen deeply to the views presented by the Māori community you are consulting. They may have their own ideas about the problems whānau and their communities face (i.e. barriers to accessing and receiving palliative care). They may also have great ideas to resolve these issues.

Advance Care Planning (ACP)

Guide

https://www.hqsc.govt.nz/our-programmes/advance-care-planning/publications-and-resources/publication/3212

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