Page 189 - ACCCN's Critical Care Nursing

166 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

Where possible these should be accommodated, Māori have a collective, rather than an individual, orien-
although there may be instances when this is not tation, with whakapapa and kinship having an important
119
possible. In such situations, the patient and family place. Reilly outlines the variations that occur in the
119
should be fully informed of the rationale for this. contemporary social organisation of Māori. The whānau
is the social group that critical care nurses will generally
Considerations when caring for indigenous people are
reviewed in the next section. Closely related to cultural interact with. Turia stresses that whānau encompasses
120
aspects of care is spirituality, which for some is based in more than the common notion of the family. Whānau
religion. Aspects to consider when patients have religious are inclusive and are made up of multiple generations,
needs are reviewed later in this chapter. extending widely to include those who have ‘kinship’ ties.
This contrasts with the ‘nuclear’ family concept. Elders,
WORKING WITH MĀORI PATIENTS especially kuia (older respected women) and kaumatua
(older respected men) possess mana (power, authority
AND FAMILIES and prestige) and important status that commands
Māori are the indigenous people of New Zealand, and respect. Because of the status of kuia and kaumatua in
like other indigenous people who have survived the pro- Māori society, if they become ill it is especially important
cesses of colonisation, they experience poorer health for the whānau and wider Māori community to support
status, health outcomes and socioeconomic disadvantage them during this time.
than other groups in the New Zealand population. Māori
were not a homogeneous group of people before settle- Because of the collective orientation of many Māori,
ment by European people, and contemporary Māori con- whānau support is exceedingly important. Thus, critical
tinue to be diverse in their iwi (tribal) affiliations, cultural care nurses often have to explore how they manage rela-
116
identity, backgrounds, beliefs and practices, and in the tionships with large numbers of people within confined
colour of their hair, eyes and skin. The critical care nurse physical spaces, which may necessitate establishing rela-
ideally needs to recognise the diversity that exists, and tionships and identifying one or two people who will be
have a sociopolitical and historical analysis of contempo- the point of contact through which information can be
105
rary Māori. This positions the critical care nurse to under- communicated. Establishing connections and links can
stand the importance of, and respecting the need to be a positive way of engaging with Māori patients and
undertake assessments with Māori patients and whānau whānau; this is often called whanaungatanga, and Māori
regarding their cultural needs (see Table 8.3). will do this by sharing their whakapapa, or genealogy. This
means identifying where you have come from and who
The Treaty of Waitangi (commonly known as ‘the Treaty’) you are. It is crucial that the critical care nurse be able to
is based on an agreement between Māori and the Queen demonstrate a genuine intent and a willingness to listen
of England, Queen Victoria, which establishes the rights to what the whānau feel is important. Forming effective
of Māori as tangata whenua, or people of the land. There working relationships with Māori whānau can never be
are two versions of the Treaty – one in English and one underestimated. It is also useful for critical care nurses to
in te reo Māori (Māori language). Māori understood that establish working relationships with Māori health ser-
while they gave governorship to the Queen, under Article vices within their health service and to get to know the
One of the Treaty, they would retain their right to control local Māori community.
and self-determination over their lands, villages and
taonga (which includes health) under Article Two. Under Many Māori view themselves as spiritual beings, 116,121 and
Articles Three and Four Māori are guaranteed protection ill-health may therefore be seen to have a spiritual as
and the same rights as British citizens, including the pro- opposed to a physical cause. The way Māori interpret the
tection of beliefs and customs. Nurses working within the world is a unique blend of cultural artefacts from the past
New Zealand health setting can be considered agents of and present, also the nature of their interactions within
116
the Crown, 67,117 and therefore have a responsibility and contemporary society. Despite the diversity that exists,
obligation to honour the Treaty when working with many Māori have a world view that is holistic and eco-
Māori. The principles of partnership, participation and spiritual in nature. 92,120 This holistic and spiritual world
118
protection are used to apply the Treaty in practice view interconnects the physical world and the world of
120
within health settings such as critical care. others. Māori creation stories are cosmological in
nature, and establish the link Māori have to the atua
The commitment that critical care nurses have to estab- (gods) and tupuna (ancestors) who created the world and
lish, and maintain, a positive relationship with Māori all living things through the separation of Ranginui (the
patients and their families, is as important as being ‘sky father’ in mythology) and Papatuanuku (the ‘earth
willing to facilitate the inclusion of cultural beliefs and mother’ in mythology). 122 For some Māori, acknowledg-
practices in the care of the patient. Such a commitment ing atua and tupuna in karakia (ritual chants or prayer) is
can influence the outcome of the critical care experience spiritually important, as well as maintaining their strong
for Māori patients and their whānau. It is not the purpose links to others and the land. Some Māori also have reli-
of this section to provide a ‘recipe’ for working with Māori gious faiths originating from the processes of colonisa-
in the critical care setting. An overview of the fundamen- tion, and may include Christianity or the Māori-based
tal issues to consider, and the importance of critical care Ratana and Ringatu faiths. 121
nurses establishing working relationships with local
Māori health services and/or local iwi and Māori com- The activities of individuals and groups of Māori that
munity groups, is stressed. serve to control human activities and life, and maintain