Tikanga best practice guidelines

For many Māori, karakia is essential in protecting and maintaining their spiritual, mental, emotional and physical health – particularly in a health care setting.

Staff action:

Verbally offer Māori patients and their whānau the choice of having karakia at all stages of the care process including heightened situations (e.g. psychotic incidents) and pending death.

Support this by:

• Allowing time for karakia.
• Not interrupting karakia unless the physical care of the patient is compromised.
• In extreme cases where karakia cannot occur, explain why, in a sensitive manner, and discuss possible options.
• Providing access to appropriate water and containers for the purpose of spiritual cleansing.
• Ensuring that Māori patients wishing to have karakia have access to the Māori Health Service Information pamphlet available in all wards.
• Facilitating Māori patients or whānau members access to a minister or lay person of their choosing.

Whānau is fundamentally important to Māori. The concept of family and friends extends beyond the immediate biological family. Whānau support can be crucial to the patient’s wellbeing.

Staff action:

Māori patients and their whānau should be actively encouraged, supported and included in all aspects of care and decision making.

Support this by:

• Sharing a copy of the care plan with the patient and whānau.
• Asking the patient or whānau if they wish to nominate a person to speak on behalf of the whānau.
• Acknowledging and involving the nominated person.
• Including appropriate Māori staff (e.g. Kaiawhina) in the care and decision making process, if this is agreed to by the patient and the whānau.
• Where possible, finding private space and adequate time when consulting with whānau throughout the care process and checking with whānau about suitable meeting times and their needs.
• Being flexible about visiting times and visitor numbers, where possible.
• Being supportive of whānau visiting when death is expected or imminent.

We aim to provide health care in an environment that is culturally sensitive to those using it. This is done out of respect for different cultural perspectives and needs, and also to support the total waiora (health) of the person receiving health care.

Staff action:

Make sure the patient and their whānau understand what is happening, and what resources and support are available, including speakers of Te Reo Māori, patient advocates, Kaiawhina and Chaplains.

Support this by:

• Clearly introducing yourself, your role and service.
• Ensuring you give all information clearly, and the patient and their whānau understand it.
• Understanding that for Māori the concept of “next of kin” may be broadly interpreted at registration.
• Notifying appropriate Māori staff of the patient in their care as soon as possible (e.g. on admission or referral).
• Offering an interpreter where appropriate.
• Ensuring the patient and whānau are aware of the available West Coast DHB accommodation services, preferably prior to admission.
• Keeping an up-to-date list of available resources (e.g. patient advocacy services, whānau rooms and other dedicated spaces, Māori chaplain, external Māori providers and support services) and informing the patient and their whānau about these.
• Ensuring the patient and whānau have access to the Māori Health Service Information pamphlets, available in all wards.

Tapu (sacred) and noa (not sacred) are key concepts that underpin many practices. For example, it is important to keep things that are tapu separate from things that are noa. In many cases, these align with good health and safety procedures that should be practised by staff.

Staff action:

Become familiar with the basic principles of tapu and noa, and practical ways of respecting these concepts.

Support this by:

• Not passing food over a person’s head.
• Not using pillowcases for any other purpose, and supporting whānau if they bring their own pillowcases.
• Using different flannels for washing the head and washing the body. Where possible use different coloured flannels to differentiate.
• Washing the body in a strict order starting from the neck, to the genital and then anal area.
• Keeping separate from food anything that comes into contact with the body or body fluids, for example:
  • Combs and brushes should not be placed on a surface where food is placed.
  • Don’t sit on the tables or workbenches, particularly surfaces used for food or medication.
  • Microwaves used for heating food will not be used for heating anything that has come into contact with the body.
  • Fridges or freezers used for food or medication storage should not be used for any other purpose.
  • Receptacles used for drinking water should be used solely for this purpose.
  • Tea towels will only be used for drying dishes and will be washed separately from all other soiled linen.
  • Bedpans/urinals and food will not be present at the same time.
  • Bedpans/urinals must be placed on the correct equipment (not where food trays are placed) and always stored in their own designated area.

Taonga are extremely important to Māori and have much more significance than just sentimental value.

Staff action:

Be aware and respectful of taonga and discuss any need to handle taonga with the patient and/or their whānau.

Support this by:

• Where possible, securely taping Taonga to the patient’s body rather than removing it.
• If risk is involved, obtaining the consent of the patient before removing Taonga.
• Giving the patient or their whānau the option of removing it themselves.
• Giving the whānau the option of caring for any Taonga.
• Informing the patient and whānau of the risk of storing Taonga and how it will be stored (in the identified valuables safe, where provided).

Some areas will be governed by Māori protocol and Tikanga Māori should be observed by all staff and other people using the facility. For example:

• Area designated as a whānau room for specific purposes.
• Area or room used for whānau group conferences.
• DHB Boardroom and other service facilities where pōwhiri ceremonies are conducted.
• Rooms where a Māori death has taken place.
• Chapel or viewing room when it is occupied by the tūpāpaku.

Staff action:

Staff must respect these areas set aside permanently or on occasion. All staff are made aware of appropriate Māori protocol at their orientation.

Staff action:

As with any patient, the correct process should be followed in communicating fully with the patient about the procedure, and consulting with the patient about options for removal, retention, return or disposal. Informed consent must be obtained where required.

In addition, staff should consider the following points where a Māori patient is concerned:

• Offering the option for further support from the appropriate Māori staff, e.g. Kaiawhina. Where possible this must happen prior to any intervention.
• Returning of body parts/tissues/substances in a way that is consistent with Tikanga and in consultation with appropriate Māori staff. For example, body parts/tissue/substances should be returned in containers that are durable and reflect tikanga best practices.
• Recording and carrying out the wishes of the Māori patient or whānau if the original purpose of retention changes. Returns should follow Tikanga best practices and protocols determined in consultation with Māori staff.
• Returning unconsented body parts/tissue/substances is expected to follow existing protocols. If return or retention is not requested, staff should discuss and agree to disposal or burial of the body parts/tissue/substances with the Māori patient or whānau. This should be carried out in a considered and consultative manner that respects tikanga processes.
• Document all discussions and decisions in the clinical notes.

Organ and tissue donation

Refer to West Coast DHB Tikanga Best Practice policy document.

As for any patient, whānau should be notified, supported and involved where the death of a patient is expected.

In addition, when a Māori patient is involved, staff should immediately notify support staff (e.g. kaiawhina) involved in the care of the patient.

Tūpāpaku (deceased)

• Where possible, do not leave the body unattended following death. It is acknowledged this is generally not possible in a Coroner’s Case.
• Immediately notify Kaiawhina involved in the care of the patient.
• Be guided by whānau on the cultural and spiritual practices for them at this time.
• Give whānau the opportunity to perform cultural and spiritual rites for “karakia tuku I te wairua” before tūpāpaku is removed, and in particular before a post mortem.
• A karakia should be performed in the area the patient died as soon as possible after the tūpāpaku is removed. From a Māori perspective the room is not spiritually cleansed until an appropriate karakia and cleansing with water has been performed.
• Do not take food or drink into the room following death.
• Where possible allow the whānau to take the tūpāpaku to a designated area, e.g. viewing rooms or chapel.
• Exiting of tūpāpaku to designated areas must avoid public corridors and food outlets.
• Always transport the tūpāpaku feet first.