Relationships at end of life

When we refer to the ‘end of life’ we recognise that this period can span years where adults and kaumātua can often live relatively independently during the early stage of a life-limiting illness. They can also have multiple and complex health issues. When their illness progresses to an advanced stage, the older person’s health can decline over a period of months or weeks until their last days of life bring them to the point of death. Demonstrating skilfulness in the art of care, which encompasses ngākau aroha (empathy, compassion, benevolence, kind-heartedness, sympathy, consideration) in caring for a kaumātua at end of life, involves caring for the older person and for their whānau as well.

Kaumātua are important members of the immediate and broader family. Health and social care professionals are encouraged to build caring relationships with the entire family. When the older person sees and feels the warm interactions health and social care professionals have towards their whānau, particularly mokopuna (grandchildren), this can have a positive effect on them. They will feel more comfortable and peaceful using health services, or staying in a health care setting, particularly as they approach the ārai (veil) to begin their transition (wairua/spirit leaving the body to begin its homeward journey to its spiritual home).

Mary Te Awhi, a hospice kaitakawaenga, helps non-Māori staff understand the value of whanaungatanga for whānau, and the importance of connecting and listening to whānau in a very real way:

… When you’re going into homes, you sit, and you observe your surroundings. You observe because the surroundings will tell you something about those people. There was a couple, he was the patient and she was the carer. And I did a joint visit and I took the music therapist out with me, and I said, ‘Is this the first time you’ve visited, you know, a Māori whānau?’ And she said, ‘Yes, it is.’ I said, ‘Okay then, come on then I’ll go with you. I know of this couple. I’ve met him, but I haven’t met her.’ So off we went to this place and we were invited in. So immediately her and I engaged and, and we sat down. And I could hear [her] talk, and I said, ‘Tell me how was it for you?’ And so, she [patient] started to talk about all sorts of things and I thought ‘yeah you’ve got a lot going on here, all sorts of things.’ But there was also a part of her that wanted, in her way, to get it right. We’d been there about an hour; I said to her [patient], ‘Who’s that?’ It was a beautiful kuia, this beautiful photo of a kuia up on her wall. And she said, ‘Oh that’s my Nan, she brought me up.’ And so [the] conversation goes around those sorts of things. Long story short, when we eventually left, and we both promised to return again but maybe at separate times. When we hopped into the car, the Music Therapist said to me, ‘Gosh you’re amazing.’ And I said to her, ‘What’s amazing, tell me?’ And she said, ‘Well, how did you know, how do you know what to ask?’

The hospice kaitakawaenga also explains that building relationships with whānau is not about asking them questions, it’s about listening to stories, acknowledging these and having meaningful conversations:

There are no set questions; we have this thing in our world called 'whanaungatanga' and it’s actually about building a relationship with people. And how you build relationship is- part of it is you need to be a good listener. And you need to pick up on, not the things that are going to annoy you or what you might want to criticise or what you think is a fault about someone, but pick up something that actually might be really important and you can make something from it… Well, we [a colleague and I] were sitting there, we were listening to a whole lot of things, including this, [that] this wahine’s had quite a traumatic life, actually. All sorts of things going on in her life… but what I noticed was that beautiful photo up on the wall and it’s a big photo. I wanted to know who that kuia was… and then she told us… [I asked my colleague] ‘Well did you observe her behaviour when she started to talk about the kuia?’ And she said, ‘Oh, yes. She got quiet and she just talked about her in quiet [way].’ I said, ‘Yes because the kuia meant a lot to her… that’s part of healing, that’s actually part of their life journey'. Many of our people are like that…. I often look for things… sometimes when you go into a whānau’s home you might see some craft there or some flax work or something, yeah. You might see a whole lot of this sort of thing… it’s a part of who they are. And it’s what gives them strength in their life. Now they won’t often talk to you about things like prayer or karakia. You might have to tease that a little bit out of them. They’ll eventually tell you. And you realise actually, there’s more to this person.’

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