Creating an Indigenous Maori-centred model of relational health: A literature review of Maori models of health.

AIMS AND OBJECTIVES: Identify the key concepts, principles and values embedded within Indigenous Maori models of health and wellbeing; and determine how these could inform the development of a Maori-centred relational model of care. BACKGROUND: Improving health equity for Maori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners' engagement with Indigenous Maori accessing health services is one area that could support improving Maori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whanau or family, and spirituality, important for Indigenous health and wellbeing. DESIGN AND METHODS: A qualitative literature review on Maori models of health and wellbeing yielded nine models to inform a Maori-centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews. RESULTS: Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio-political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Maori is a holistic and relational concept. Building relationships that include whanau (extended family) is a cultural imperative. CONCLUSIONS: This study highlights the importance and relevance of relational approaches to engaging Maori and their whanau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Maori. Key elements for a Maori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing). RELEVANCE TO CLINICAL PRACTICE: Culturally-based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Maori-centred relational model of care to address inequity.

The culture conversation: Report from the 2nd Australasian ILC meeting-Auckland 2019.

AIM AND OBJECTIVE: This paper reports on the proceedings of the second Australasian International Learning Collaborative conference and summit. BACKGROUND: In December 2019, over a hundred people attended the second Australasian International Learning Collaborative Conference and Summit. This was the first to be held in Aotearoa New Zealand, the land where cultural safety was developed, its origins being in nursing education. Perhaps not surprisingly, culture, cultural safety and the context of care featured highly in the presentations and workshops. DESIGN AND METHODS: Discussion paper. RESULTS: A key outcome of the conference proceedings and workshops was the call for nurses and the International Learning Collaborative to work in partnership with indigenous groups to iterate the importance of the Fundamentals of Care framework and evaluate the impact of that on health equity. Other essential messages were to value establishing relationships, to continue to talk about the fundamentals of care, to research and to own them. Nurses were reminded to use their humanity to create a climate and culture in which patients and staff feel valued, safe and trusted. CONCLUSIONS: Future iterations of the Fundamentals of Care framework must incorporate indigenous worldviews, which emphasise the importance of relationships, family and spirituality on wellbeing. Such additions will provide an opportunity for the International Learning Collaborative to optimally respond and direct nursing practice. RELEVANCE TO CLINICAL PRACTICE: International Learning Collaborative members and conference attendees learned, listened and worked on meeting the challenges of consistently implementing and applying the fundamentals of care in practice and its importance to education, research and policy. The takeaway message is, when this does not happen, nurses must speak up.