Cultural Safety

Cultural Safety in Clinical Practice Part A

The Treaty of Waitangi was signed on 6th of February 1840 by 40 Maori chiefs to signify unity and peace between the Crown and Maori (Broom, et al., 2007). Today the treaty is used in all aspects of life in New Zealand, including healthcare. An important concept to remember in regards to tangata whenua, or the people of the land, is te taha whanau is an integral part of Maori life (Medical Council of New Zealand, 2012). The Nursing Council of New Zealand says that the articles of the Treaty of Waitangi contain principles of kawanatanga and tino rangatiratanga (NCNZ, 2011). These principles regard the right of the Crown to govern and the right of Maori to determine if the laws are ones they are willing to abide by.
When Mrs S. was first admitted to the hospital, her whanau should have been a part of the process from the beginning to the end. Principle Two says that Maori and health care staff should work together in a partnership to ensure positive health outcomes (NCNZ, 2011). When Mrs S??™s husband was denied information and her family was not allowed to stay with her, 2.3 of Principle Two was completely ignored. Essentially, the doctors and nurses were acting alone in deciding and planning of Mrs S??™s care. Maori determine individuality by the relationship with their whanau, and the whanau has the responsibility to care for the individual members (Wepa, 2005). Principle One refers to tino rangatiratanga which allows Maori rights over determining how their healthcare will be delivered (NCNZ, 2011). Maori are less likely to challenge healthcare staff even if they don??™t agree with the treatment (Medical Council of New Zealand, 2012). Everything should be carefully worded and explained in full to the patient and whanau so nothing is misconstrued. If any organs were to be removed during surgery, Mrs S and her family should have been consulted as to what they wanted done with the body part once removed (Medical Council of New Zealand, 2012).
The nurses should have made it a part of their care plan for Mrs S to include everyone in the treatment which may have had an overall better outcome other than death (Broom, et al., 2007). Principle Three discusses the protection of health and the responsibility of healthcare staff to uphold and acknowledge Maori beliefs and practices (NCNZ, 2011). When the specialist ignored the family??™s request for information, Mrs S and her family were not made to feel her health was taonga or that Maori principles were relevant to Mrs S??™s care. Principle Four refers to the recognition from nurses that Maori have just as much right to access and treatment in the healthcare system as everyone else (NCNZ, 2011). The nurses and doctor completely disregarded all the points of the Treaty in their care for Mrs S.
Death is an extremely personal and emotional time for all cultures, and for Maori there is an added spiritual meaning attached to it. Even Maori who don??™t practice their culture on a regular basis become more observant during the death and dying process (Medical Council of New Zealand, 2012). Mrs S??™s whanau needed time to be with her during her last moments so they could say goodbye. Many whanau would prefer to have their loved one at home rather than have them die in a hospital (Wepa, 2005). Death for most Maori mean a time of family togetherness so that rituals and farewells can be completed. A Maori belief is that the body, tupapaku, is still inhabited by the spirit, wairua, for a while after death (Medical Council of New Zealand, 2012). The spirit is thought to come and go at will several times. When Mrs S died, her family should have been allowed to not only be there during her final moments of life, but to prevent evil spirits from entering her body while her spirit was gone (Medical Council of New Zealand, 2012). A private room should have been made available for whanau if possible. write my college admissions essay
The whanau may wish to wash and prepare the body themselves, so healthcare staff has a duty to be aware and respectful of this (Broom, et al., 2007). The family should be allowed time to grieve before the body is moved, and they must be consulted with regard to how the body will be wrapped (Medical Council of New Zealand, 2012). The body should be released to the family as soon as possible so that it can be brought to the marae and the tangihanga can begin. Maori have a strong belief in kanohi kitea, the face that can be seen, so it would respectful for the doctors and nurses to show their faces during the tangihanga (Medical Council of New Zealand, 2012).

Cultural Safety in Clinical Practice Part B
Oxford Dictionary (2012) defines culture as being ???the ideas, customs, and social behaviour of a particular people or society??? (para. 2). The term cultural safety was identified in New Zealand at the Hui Waimanawa in 1988 by a young first year nursing student who queried why everyone was concerned with every other type of safety but not about cultural safety (Wepa, 2005). The key concepts of education surrounding cultural safety had already started being formed, and finally there was a name to attach with the concepts (Wepa, 2005). In 1991, the NCNZ decided to make it a requirement for 20% of the state exam consisting of questions regarding cultural safety (Papps & Ramsden, 1996). This meant that nurses not only had to be competent academically and clinically but also had to demonstrate a deeper understanding of what it meant to be culturally safe (Papps, 2002).
Mrs X is a 59 year old Maori woman who was admitted with multiple problems including metastatic carcinoma and end stage renal failure. Metastasis is the process where cancer cells spread from their tissue of origin to other sites in the body (Copstead & Banasik, 2010). I had assisted in Mrs X??™s care the week prior, and she was always smiling and friendly. On this particular day, she was extremely quiet and only spoke in short sentences. Her RN was attempting to contact Mrs X??™s family members, but wasn??™t able to get in touch with any of them. The RN then went into Mrs X??™s room and told her she was not able to reach any of them and did not have the time to spend trying to call them. The RN??™s tone of voice took me by surprise as this went directly against Principle Four in regards to maintaining equality in the power balance of partnership in healthcare (NCNZ, 2011). The RN closed all communication with Mrs X and prevented her from receiving effective service. She essentially told Mrs X that her needs were not worthy of the RN??™s time.
I was then asked to change Mrs X??™s linens. While I was changing them, I started inquiring about her grandchildren as a way to open communication. Whanau is an integral part of Maori life and shapes individual identity (Moeke-Pickering, 1996). Mrs X??™s eyes lit up when I mentioned them so she started talking animatedly. Her topic then moved on to her worrying about her daughter trying to find a new house to live in. She said they had been looking for a few weeks and she hoped they had managed to find one today as she wanted nothing more than to go home. With Mrs X being the elder in her whanau, this gave her the responsibility of leadership (Moeke-Pickering, 1996). At this point, I was doing more listening then talking. Mrs X then explained that her specialist had informed her today she only had at most 12 weeks left to live if she continued chemotherapy. Chemotherapy is the administration intravenously of anticancer drugs selected specifically for a targeted cancer (Copstead & Banasik, 2010). She had decided that she wanted quality of life over quantity because regardless her time was still short. She said she needed that last bit of time to spend with her whanau. I finished her bed and brought out her special quilt for her to cover in. Maori have a firm belief in kanohi kitea (Medical Council of New Zealand, 2012), so I made certain Mrs X knew I was available to listen and talk face to face. Afterwards, I informed her RN of our conversation so she could understand the importance of contacting Mrs X??™s family.
In reading all of the literature, I am still not certain if I handled the situation properly. The education I am receiving is supposed to prepare me in resolving tense issues between nursing culture and people who utilize the services (NCNZ, 2011). I know that I wanted to say more to the RN who totally disregarded the seriousness of Mrs X??™s circumstances. Unfortunately, I felt that in my status as a student nurse, I did not have the authority to confront the RN without causing additional tension to the situation. I have included this in my student portfolio so my clinical lecturer will be aware of what occurred. I realized I could have spoken with the nurse manager but feared I would become an outcast on the ward for speaking out against one of the staff.
If I were in the same position as Mrs X, I would have demanded the physicians look for more treatment options. My family is extremely important to me, and I would also want to spend as much quality time with them for as long as possible. Death is something that I fear and consider as the unknown, so I am not certain I will ever be ready to face it. In my view, Mrs X was extremely courageous in her decision to end chemotherapy. I doubt I could ever be that brave. She also managed to maintain her dignity and integrity in spite of the RN??™s demeaning manner.
Cultural safety is used in New Zealand for all people regardless of who are where they come from. It sets a social standard to improve healthcare for everyone and allows more accessibility for those who would otherwise not be able to receive adequate care (Wepa, 2005). While the Treaty of Waitangi was written specifically for Maori, the concepts of healthcare within the Treaty can embody all cultures and beliefs (Papps & Ramsden, 1996).

References
Broom, D., Bron, D., Dew, K., Durie, M., Germov, J., Kirkman, A., . . . Walke, S. (2007). Health in the Context of Aorearoa New Zealand. Melbourne: Oxford University Press.
Copstead, L.-E. C., & Banasik, J. L. (2010). Pathophysiology. St Louis: Saunders Elsevier.
Medical Council of New Zealand. (2012, April 6). Principles of Culturally Competent Care for Maori. Retrieved from Medical Council of New Zealand: http://www.mcnz.org.nz/Resources/Standardsandguidelines/BesthealthoutcomesforMaori/tabid/269/Default.aspx
Moeke-Pickering, T. (1996). Maori Identity Within Whanau: A Review of Literature. Retrieved from The University of Waikato Research Commons: http://researchcommons.waikato.ac.nz/bitstream/handle/10289/464/content.pdf.txtsequence=2
Culture. (n.d.). Retrieved April 8, 2012, from Oxford Dictionary Online: http://oxforddictionaries.com/definition/culture
Nursing Council of New Zealand. (2011). Guidelines for Cultural Safety, the Treaty of Waitangi and Maori Health in Nursing Education and Practice. Wellington: Nursing Council of New Zealand.
Papps, E. (2002). Nursing in New Zealand Critical Issues Different Perspectives. Auckland: Pearson Education New Zealand Limited.
Papps, E., & Ramsden, I. (1996, 13 August). Cultural Safety in Nursing: The New Zealand Experience. International Journal for Quality in Healthcare, 8(5), 491-497.
Wepa, D. (2005). Cultural Safety in Aotearoa New Zealand. Auckland: Pearson Education New Zealand.

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