Tikaka Best Practice Guidelines

To care for people safely who are members of many different cultural groups we need to show tolerance, patience and understanding. At all times we should be guided by our values.

We should always show:

  • Compassion
  • Hospitality
  • Respect
  • Integrity
  • Excellence
  • Justice

It is helpful to know something about the perspective of people from a culture that is different to our own.  Because we have a commitment to be in partnership with Maori through the Treaty of Waitangi, we worked with the mandated representative from our local Runaka / Runanga to establish guiding principles for the provision of Tikaka / Best Practice.

  • These are guidelines rather than rules to be applied in all circumstances.
  • The needs of the patient and their family must always be considered,
  • We need to check the circumstances to find the best response
  • We must of course always behave in the best interests of the patient.

The following guidelines are currently being considered by the Otakou Runaka.

Information and Support

The aim is 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 health of the patient. Best Practice for Maori patients and whanau/family is usually appropriate for most other cultures and also attends to many spiritual needs of patients so we incorporate these principles as Tikaka / Best Practice for our patients and their families.

 

Staff Action:

Make sure the patient and whanau / family understand what is happening and what resources and support are available including translation services, chaplaincy services and pastoral care and the support available through Health and Disability Advocacy Services.

 

Support this by:

  • Clearly introducing yourself and your role or service
  • Ensuring names are pronounced correctly and asking when unsure
  • Ensuring that all information is given clearly and is understood by the patient and whanau / family
  • Understanding that for Maori and many other cultures the concept of ‘next-of-kin’ may be broadly interpreted
  • Offering an interpreter where appropriate
  • Ensuring the patient and whanau / family are aware of available accommodation services, preferably prior to admission
  • Ensuring you are aware of Mercy Hospital Cultural Policy

Whanau / Family Support

Whanau / Family are of fundamental importance to Maori and to people of most other cultures. The concept of whanau / family extends beyond the nuclear or biological family. Whanau / Family support can be crucial to the patient’s well-being.

 

Staff Action:

The patient and whanau / family should be actively encouraged, supported and included in all aspects of care and decision making.

 

Support this by:

  • Checking the section on the Admission Form identifying those people who may be given information about the patient
  • Finding appropriate space where the family / whanau can wait when they are not with the patient.
  • Ensuring the visiting times are flexible enough to meet both the patient’s and whanau / family needs.

Karakia (blessings, prayers)

For many Maori, and those from many other cultures, karakia / blessings prayers are essential in protecting and maintaining their spiritual, mental, emotional and physical health – particularly in the health care setting.

Staff action:

Verbally offer patients and whanau / family the opportunity of having a karakia / blessings / prayers as part of their care.

Support this by:

  • Allowing time for karakia / blessings / prayers, especially at times of particular importance such as just before going the theatre
  • Not interrupting karakia / blessings / prayers unless the physical care of the patient would be compromised
  • Ensuring access to people who can support the patient and whanau / family in karakia

Food, Linen and Bedpans

Tapu and noa are key concepts that underpin many practices.  For example it is important to keep things that are tapu (restricted) separate from things that are noa unrestricted).  In many cases, these concepts align with good health and safety practices.

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 the patient’s head
  • Not using pillowcases for any other purpose
  • Using colour coded linen correctly (e.g. oatmeal pillowcases for the head and white pillowcases for all other parts of the body)
  • Using different flannels for washing the head and body
  • Following a strict order when washing, starting from the neck, then moving down to the genital and then anal areas
  • Keeping separate from food anything that comes into contact with the body or body fluids, for example:
    • Use lift on right for transporting food and lift on left (with entrance front and back) for transporting deceased patients, patients to and from theatre, as they often have drips and drains and thus involve body fluid, and cleaning trolleys and all waste.
    • Don’t place combs and brushes on the surface where food is placed
    • Don’t sit on tables or workbenches on surfaces that are used for food or medication
    • Clearly identify fridges and freezers used for food or medication and don’t use them for any other purpose
    • Don’t use drinking water containers for any other purpose
    • Only use tea towels for drying dishes and wash them separately from all other soiled linen
    • Don’t have bedpans/urinals and food present at the same time
    • Only place bedpan/urinals on the correct equipment (not where food trays are placed) and always store them in their own designated area

Taoka / Taonga (valuables)

Taoka / Taonga are extremely important to Maori and have much more significance than just sentimental value.  The same is true for pious objects, such as a medal or cross worn around the neck, which have particular spiritual significance.

Staff action:

Be aware and respectful of taoka / taonga, and where possible discuss any need to handle these with the patient and the whanau / family.

Support this by:

  • Where possible, securely taping the taoka to the body of the patient rather than removing it
  • If risk is involved, obtaining the patient’s consent before removing the taoka and where possible have the patient or whanau / family remove it
  • Give the whanau / family the option of caring for the taoka and if it is to be stored give full details of how and where this will occur

Body parts, tissue and substances (removal, retention, return or disposal)

Regardless of how minor the body part, tissues or substances is perceived to be an informed discussion should occur about the options available.

Staff action:

There should be a full and clear explanation about options available for all tissue (e.g. nail clippings, hair, blood, tissue removed during surgery)

Support this by:

  • Offering appropriate support to the family e.g. cultural advisor or pastoral worker
  • Returning the body part, tissue or substance in a way that is consistent with tikaka (best practice) and Mercy Hospital policy
  • Disposing of tissue and body part in an appropriate way if the patient and whanau family do not want it returned or retained.
  • Documenting carefully the patient and whanau / family decision in relation to all body parts, tissue and substances.

Pending and following death

Family / whanau should be notified immediately, and supported and involved at all time, when the death of a patient is expected or has occurred.

Staff action:

Be guided by the whanau/ family on the cultural and spiritual practice appropriate for them at this time.

Support this by:

  • Including whanau / family and involving them at all times especially in relation to appropriate support people e.g. chaplain, pastoral team, cultural advisor.
  • Making every effort to have a single room available and only taking food and drink into the room after consultation with whanau / family
  • Allowing time for the whanau / family to grieve and exercise their beliefs before moving the deceased and before any post-mortem.
  • After death a bowl of water is placed outside the room for whanau / family to sprinkle themselves prior to entry and on exit, which is a symbolic way of keeping the world of living and the dead separate.
  • Most patients who die at Mercy Hospital will require a post-mortem and the implications of this need to be outlined to the whanau / family
  • Handling the deceased discreetly, feet-first along the predetermined pathway, using designated lifts and avoiding public areas.
  • Ensure the room and equipment is blessed before being reused.

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