This paper will discuss the importance of health literacy and correct communication and how the nurse demonstrated this while caring for Kate. It will then go on to look at the importance of the nurses personal philosophy of practice and the ways in which she demonstrated this relating back to the Treaty of Waitangi. Lastly it will discuss important reasons to provide culturally appropriate care for people relating this back to the nurse.
Health literacy is defined as a person’s ability to understand and process basic health information (Lambert & Keogh, 2014; McMurray & Clendon, 2011.) This also includes being able to the access health information (Lambert & Keogh, 2014). Health literacy involves three components: comprehension, participation and literacy, meaning patients must have a full understanding of all elements including social, language, reading and numerical thus giving a full ability to interact with health professionals (Lambert & Keogh, 2014). Having a good understanding of health allows people to make informed choices on their or loved one’s health and care (Lambert & Keogh, 2014; McMurray & Clendon, 2011).
To ensure Kate’s whānau fully understood Kate’s health and treatment the nurse attended family meeting’s in the morning and evening, this was a time when they could ask any questions and raise any concerns they had regarding Kate’s care (Cherrington, 2011). This allowed time for the family to ask the nurse questions or make comments on Kate’s condition and time for the nurse to explain any changes. When the decision was made by the whānau to care for Kate at home, Peri asked their trusted nurse who had helped them previous if she would help them again. The nurse had to set up support systems by gathering information on the families values and the medical information (Cherrington, 2011). This was to ensure Kate had the most comfortable transition home, the nurse made sure there was always an open line of communication between the family and hospital resulting in a smooth transition.
McMurray and Clendon (2011) states that when people have an interest in their health, health services and have a better understanding of the situation they are able to make more informed choices of treatments. This was demonstrated by Kate’s daughter Peri wanting to care for her mother at home. It was important the nurse described and explained everything in detail so she would understand the importance of the treatment and the correct way to deliver it (Cherrington, 2011). Peri was educated on Kate’s drugs learning their effects and possible reactions and shown how to correctly perform any procedures (Cherrington, 2011).
Peri was also shown how to monitor Kate’s saline to avoid her getting dehydrated and what to do in case of an emergency if the nurse was not there. (Cherrington, 2011). The nurse not only explained how to administer the medication, but also why it was needed, the effects it would have therefore giving Peri a full understanding. This was clearly shown when Kate’s syringe was not placed in properly and she began to show signs of distress. Peri was clearly able to ring the nurse and explain what the machine was doing, indicating it was working but also able to notice the fluid had not lowered (Cherrington, 2011). This showed that Peri was a wear of what was normal and what was not.
GO INTO ALL 3 PRINCIPLES The Treaty of Waitangi has made New Zealanders a wear and value Maori values ensuring everyone one is treated fairly and as equals (McMurray & Clendon, 2011; Wepa, 2005). Part of Maori culture see’s whānau and extended whānau come together in times of need in order to offer support and stay with loved ones when they are ill (Cherrington, 2011). Principle two of The Treaty of Waitangi states that Maori are entailed to care for the things they value as taonga/ treasure, this includes people (Cherrington, 2011; McMurray & Clendon, 2011; Wepa, 2005). This partnership between the crown and Maori was demonstrated well when Kate was admitted to hospital. Kate’s whānau explained to the nurse on duty who was Pākeha off their beliefs and what they needed.
This included a room large enough to house all the whānau and extended whānau to stay as one enabling them to monitor and control Kate’s health, the nurse in turn respected their culture and provided this (Cherrington, 2011). The two elders of the whānau were kept informed on Kate’s condition and were able to ask questions as they wished (Cherrington, 2011). Although the larger room would no longer be available Kate’s whānau asked for their options this included their choice to take Kate home to die (Cherrington, 2011). The staff at the hospital provided culturally appropriate care the entire time showing they value other beliefs that are not their own. This could have been more difficult however there was clear communication between both parties ensuring Kate’s and her whānau received culturally appropriate care (Cherrington, 2011).
At one point during the nurses care of Kate the issue arose of what would be the best treatment to prevent Kate getting dehydrated. The options were and intravenous fluid (IV) or subcutaneous fluid (Cherrington, 2011). The nurses personal philosophy was always to go with what the family wanted (Cherrington, 2011). Although Kate’s grandchildren wanted intravenous fluid in order to keep her alive as long as possible it was up to the kaumstua to make the decision choosing subcutaneous fluid (Cherrington, 2011).
Principle one of The Treaty of Waitangi enables Maori to have authority over their health which the nurse understood and respected (McMurray & Clendon, 2011; Wepa, 2005). During the time the nurse cared for Kate she remained true to her personal philosophy this was demonstrated when Kate was in pain and required a dose of morphine though an IV. The nurse stated she was uncomfortable with performing this procedure as she was unsure of her legal rights being a volunteer for Kate and her whānau (Cherrington, 2011). The nurse was aware of what she felt comfortable doing and worked within her scope of practice by contacting a doctor for this procedure.
A health profession must be able to reflect back and understand their own personal culture and values and see how it relates to other peoples values in order to practice safely (McMurray & Clendon, 2011). The nurse had a very good understanding of her own personal values and beliefs therefore this made her able to accept and understand Kate’s whānau she was able to reflect back on this after she had finished caring for Kate (Cherrington, 2011; Denehy, 2001). The nurse also believed by her actions she not only would off respected Kate and her wishes but gave her whānau the chance to say goodbye (Cherrington, 2011). The nurse was also able to reflect back to her own personal experiences of death and was able to see huge differences, this made her want to stay knowledgeable on death so families can be well informed of their options when the time comes ensuring a dignified death (Cherrington, 2011; Denehy, 2001).
Not respecting a patients culture identity may impact on their wellbeing and undermine their culture beliefs, negative impacts on their culture may in turn have negative impact on their health and recovery (Nursing council of New Zealand, 2009). The Treaty of Waitangi was used when developing cultural safety in New Zealand as it reflecting back on the past poor Maori health and experiences (Wepa, 2005). Cultural safety has been defined as a nurse effectively caring for a person’s/family with another culture who can reflect on their own personal culture values without it impacting their work and without it demeaning the patient (Wepa, 2005). Nurse’s must reflect back on their personal beliefs so their personal cultural beliefs do not impact their work (Nursing council of New Zealand, 2009).
Nurses must be able to recognise their own culture in order to be safe (Nursing council of New Zealand, 2009). As New Zealand is a multi-culture country it is important for health care professionals to learn and understand all aspects of Treaty of Waitangi. By looking at the personal holistically including the Treaty of Waitangi nurses are able to provide culturally appropriate care promoting the person’s health (Oda K & Rameka, 2012). However it is important that health professions are a wear of different sub-cultures between groups of people to ensure they remain safe to practice (McMurray and Clendon (2011).
In the article the nurse provides culturally appropriate care for Kate and her whānau in the wake of Kate’s death. The nurse explains Maori rituals according to the laws of tapu, these rituals are passed on from generation to generation (Cherrington, 2011). These rituals become more sacred with a death the nurse witnessed this with Kate’s death when the women prepared her body for the undertaker by washing her (Cherrington, 2011). Special detail is taking ensuring there are separate buckets of water for the body and head including towels (Cherrington, 2011).
The nurse stated in this time unless asked by the women to help she just watches offering encouragement for the whānau. Although she does support and ensure they treat the dead with respect as if they were still alive, making sure they are not exposed at anytime during the washing and preparation time (Cherrington, 2011). Maori see items used to care for the head as very sacred and in Kate’s death these items including a hairbrush were wrapped to be buried with her (Cherrington, 2011). After Kate’s death the nurse also ensured all spiritual steps were taken to avoid any evil spirits affecting the whānau and their home. In this case she called a minister to the house to bless the dirty laundry this is done in relation to the laws of tap and noa (Cherrington, 2011).
In conclusion the nurse in the article showed the importance of ensuring the whānau fully understood all aspects of Kate’s health this enabling them to have a full health literacy. The nurse was also fully a wear of her personal philosophy of practice she demonstrated this correctly never overstepping her personal boundaries. The nurse was fully understood and respected the principles of the Treaty of Waitangi and was able to ensure they were incorporated into Kate’s care. The nurse also new the importance of providing this culturally appropriate care for the whānau and made sure they felt commutable and understood Kate’s care ensuring they were in charge of their own health and care.