Whānau hui (meetings) - Whanaungatanga (building rapport), whakarongo (listening)

Whānau meetings are essential, and space and time should be set aside for introductions and discussion. Although it might be helpful to know if patients/whānau identify as Māori, be mindful that ethnic identity can be a very sensitive subject for Māori. Any enquiry needs to be done sensitively. Listen carefully as patients and whānau introduce themselves. They may want to share their whakapapa (genealogical connections) with the health care team. In return, health professionals can share something about themselves (where they are from, and who their people are). This will help to establish connections and build rapport. In many cases it will be appropriate for Māori staff to lead the hui.

Hui can be used to explain the health organisation’s tikanga, systems and processes, as well as providing more information about the kaumatua’s life-limiting illness and palliative care treatment. However, most importantly, this is a time to listen to kaumātua and their whānau. What are their concerns?

Whānau hui may include karakia (prayers, chants); these are ussually said at the beginning and the end of meetings and are often accompanied by waiata (singing) either before or after prayers and/or mihi (speeches).  During the hui a whānau spokesperson may speak on behalf of the ill kaumātua and their whānau. They may formally address the staff who are present and lay out any questions or concerns the patient and their family has. Listening to whānau, having a non-judgemental approach, and using excellent communication skills are critical in caring for whānau.

Joy (health professional) explains the importance of whānau support, particularly attending consultant appointments:

...I think too they [hui] can support [whānau], they support patient... by taking on board what’s been told so when they go home, they usually have a meeting and talk about what’s been discussed at the consultation. Also, for them to know what services are out there as well, that can benefit the patient.... Sometimes it’s just a whānau hui but if they want me to be part of that then I’m more than happy to do that.”

Ipukutu (former hospice cultural advisor) reflected on his involvement having hui with gang members who had māuiui whānau members. Ipukutu talked about acting as a mediator to reinforce how the hospice operates however, this requires a high level of communication skill:

I think what we look at in terms of the hospice and they [gangs] come in the door is we have to mediate that... And to actually bring them to consensus with, you know, ‘what happens in your whare happens in your whare, but this is our whare and this is how we [do things]’. And that sort of things you know what I mean? And we’ve done that here. Like for instance, some gang members come in there and you had a [name of gang] and a [name of gang] … Well it’s a thing that is, ‘Okay, hei konei. Your thing is about your thing, nē? And this is the whare… so you come here for… those things, all the other differences [are] outside. Your gang differences, leave it outside with your boots.’… Well, they seem to respect that; they’re coming in too now and remove their patch… but you do get kaki maro, you know, people who don’t want to move from that thing. And I think communication is, you know… how you sort of communicate to them is you explain to them, I think… that’s an art in itself, isn’t it?

Good communication with whānau, Matilda (community health professional) explained, was important in gaining the trust of whānau:

Okay, when I’ve walked in… gone through the introductory [side] and then the family are gathered around there but the… moment I’ve opened my mouth and said something [told them who I was] the family have settled and calmed down and felt like they were in good hands. Suddenly within five minutes I have been able to just, yeah, allow them to be.

When health and social care professionals can put important information into lay person’s terms this can support the whole whanau by increasing their understanding of the diagnosis, symptoms and treatment plans. Whaea Betsy reflected how a health professional provided a helpful metaphor to enable her whānau (and mokopuna) to understand her husband’s condition when he was diagnosed:

[W]hen he got sick, [the people] said, ‘He needs to be eating… things that will oxidate you.’ So, they go through that. And I said to them, ‘What I learned from the specialist is that it’s the factory that’s broken… And we can’t fix the factory you know. It can’t be renovated, it’s the factory. It doesn’t matter what you put through the factory, it’ll never get any better, it’ll always be there. All we can do is try and manage it.  And I let you know that, because I said to him [the specialist], ‘What do you mean? I’ve read all these books. Tell me what you’re saying.’ And he said to me… ‘This is my simplest way [of explaining it]; the factory is broken. You can’t fix it. But what I can suggest is that we can try a drug that will help manage it’… Nothing else is going to do it. ‘So, when my mokopunas are sitting there going, ‘But Nan, can they renovate the factory?’ And I say, ‘No, they can’t. It’s [his] body and that’s where it is. And Papa can’t be renovated. But what we can do is try this [drug and] see whether it’s improved Papa’s lifestyle and see whether we can support it.  I’m not saying we don’t eat beetroot; I’m just saying that we need to do a few other things to get to that stage’.

Recommendations

For health and palliative care professionals, we recommend:

  • Routinely informing kaumātua and whānau of any cultural support that is available at hui (Kaupapa Māori spaces or cultural services, for example).
  • Inviting whānau to record their cultural preferences during hui.
  • Become familiar with cultural and spiritual assessments or Advanced Care Planning documents. If you have not done so already, your organisation should use existing cultural and spiritual assessment tools (or develop your own), and ACP documents, to record their cultural care preferences. For example, does the whānau require access to water to conduct their cultural practices at end of life (whakawātea, whakanoa)?
  • Having access to a large room to host a whānau hui, particularly if it will involve many people.
  • Supporting whānau to use their protocols during hui. Whānau may wish to partake of nourishment at the conclusion of a meeting to break the tapu or remove the spiritual protection and restrictions covering the meeting; this will likely involve karakia (prayers, incantations, chants) at the end of the meeting.

Standards and Guidelines for Nurses

Nursing Council

https://www.nursingcouncil.org.nz/Public/Nursing/Standards_and_guidelines/NCNZ/nursing-section/Standards_and_guidelines_for_nurses.aspx?hkey=9fc06ae7-a853-4d10-b5fe-992cd44ba3de

The Health Navigator

The Health Navigator website provides one place for New Zealanders to find reliable and trustworthy health information and self-care resources. It is a non-profit community initiative combining the efforts of a wide range of partner and supporter organisations and is overseen by the Health Navigator Charitable Trust.

https://www.healthnavigator.org.nz/about/

Health and Ageing

Although many young people fear getting old, for most people the latter part of their life can be a time of great enjoyment, activity and usefulness. As we get older our bodies change, but there are a few things that we can do to prevent those changes from becoming problems.

https://www.healthnavigator.org.nz/healthy-living/s/senior-health/

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