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Bicultural Essays 005 Final Copy

By mandycallon Apr 22, 2015 2069 Words
In New Zealand the term biculturalism came to represent the relationship between Maori and others, particularly the crown (Wepa, 2012). Accordingly, we recognise that we are living in a bicultural society with the two main cultures being Maori and Non-Maori. It is understood that culture not only relates to ethnicity, but can also be defined as beliefs, language, dress, practice and customs (Hardings, Sibley & Robertson, 2011). The nursing role of caring in a bicultural society involves implementing Te Tiriti o Waitangi into practice to form a basis for understanding the partnership, participation and protection principles of nursing (Nursing Council New Zealand [NCNZ], 2011). Cultural safety is a vital concept in nursing and refers to the effective nursing of patients from other cultures by nurses who have undertaken a process of reflection on their own cultural identity and recognize the effect of their culture on their nursing practice (NCNZ, 2011). The student nurse will apply the nursing concept of cultural safety into contemporary nursing practice in a bicultural mental health setting. Cultural safety implies more than sensitivity to otherwise marginalised cultures or ethnic groups in healthcare practice (Woods, 2010). The concept of cultural safety arose from the colonial context of New Zealand society in response to the poor health status of Maori, the indigenous people of New Zealand, and their insistence that service delivery change profoundly (Woods,2010). During placement, the student nurse noticed that Maori have a higher emphasis on Whanau and community whereas European or non- Maori have a higher emphasis on western medicine when it comes to health. Maori beliefs regard health as being influenced by four domains called Te Whare Tapa Wha, which consist of spirituality, family, mind and the physical world (Ministry of Health, 2014). As a Fijian student nurse, when caring for European patients in the mental health setting as in practice the decisions about mental healthcare and treatment for a person with an independent mind-set is decided by an individual and not by the extended family as it is done in Maori culture, which is similar to the student nurse’s culture. The health status of indigenous people varies according to their unique historical, political and social circumstances. Disparities between Maori and non-Maori have been evident for all of colonial history in New Zealand; these differences involve factors such as lifestyle, socioeconomics, availability of healthcare and discrimination (Theunissen, 2011). The student nurse has noticed these cultural differences in the mental health setting when caring for Maori and non-Maori. During a previous clinical placement in the mental health ward, the student nurse encountered "Mel", a European woman in her mid-thirties. Mel was admitted to the ward voluntarily as she had been feeling deeply depressed and was expressing suicidal ideations. Mel came into the hospital alone and did not want her family involved in her care as she stated they are not a close family. This was evident as Mel was the first person to notice her decline in mental health and was very vulnerable. Mel chose to have her meeting with the healthcare team alone and did not want to involve her family as she did not want to inconvenience them or have them feel ashamed of her for suffering from a mental illness. In that same clinical week the student nurse also encountered "Tina" a Maori woman who is also in her mid-thirties. Tina's admission to the mental health ward was a stark contrast to Mel's. Tina was brought in to the emergency department by her parents and partner as they had noticed her decline in mental health and had been concerned for her safety for some time. Tina has a diagnosis of schizo-affective disorder and had been displaying very odd behaviour such as doing the Haka whenever she was distressed or being sexually disinhibited with strangers. Tina is from a very close Maori family and this is evident as her family were the first to notice her decline in mental health and were the ones to bring her into the emergency department for help. Tina was adamant about having her family attend all her meetings with the healthcare team and having them fully involved in every aspect of her care. These differences in the approach to health care between a Maori woman and a European woman of the same age are evident as cultural differences. The student nurse recognised Tina's culture as Maori with strong cultural beliefs, female and of a low socioeconomic demographic whereas Mel; who is a European, working class, single female. The student nurse was welcome at both patients’ admissions meetings with the healthcare team after asking permission and gaining consent from patients and preceptor (Nursing Council of New Zealand [NCNZ], 2009b). The student nurse noticed that Mel was confidently asking many question pertaining to her admission on the ward whereas Tina and her whanau remained very quiet and allowed the healthcare team to explain what would occur during Tina's admission. Maori are less likely to challenge treatment plans or ask questions than many non-Maori are but their silence does not necessarily imply understanding or agreement on their part, so it is important for the healthcare team to fully explain what they are doing and why (Davis, Lay-Yee, Dyall & Brian, 2010). Upon caring for Mel and Tina in the mental health ward, the student nurse was mindful to apply the cultural safety principle of Tikanga to both women. Tikanga relates to values, principles and spirituality and is a process as well as a fixed attitude or knowledge (Taranaki District Health Board [TDHB], 2011). Tikanga must be applied to all patients regardless of their culture and ethnicity. As it is Tina’s culture, the student nurse applied the concept of tapu and noa, which were essential for Tina’s nursing care. Bodily substances are tapu and food is noa, so when caring for Tina the student nurse ensured that she refrained from passing food over her head, gave her separate wash clothes for her face and body and did not place her medications or food tray on her bed or any place that would be used for seating. The cultural aspects of caring for Mel were similar to caring for Tina; the student nurse still applied the cultural safety principle of Tikanga and the concept of tapu and noa to Mel's nursing care. While caring for Mel, the student nurse noticed the cultural differences between the two patients. In caring for Mel, there was a minimal interaction, and Mel was independent and did not want to be assisted whereas working with Tina, the student nurse found she was more confident. This may be because the student nurse related to Tina’s culture as it is similar to her own which made the student nurse feel more confident in the cultural aspects of her nursing care. By adopting patient’s cultures in nursing praxis, the student nurse ensured that she would not offend patients’ and whanau in any way and would remain culturally safe. In considering Mel’s culture, it has allowed the student nurse to understand a great deal about European culture, so that the student nurse could gain a better understanding of how culturally diverse New Zealanders are. While working with Tina, the student nurse gathered that Tina's Whanau could not attend every one of her meetings with the healthcare team, therefore the student nurse’s preceptor and the healthcare team assisted her to gain appropriate support and representation from those who understand her culture and needs (NCNZ, 2011). The services of a Kaimahi Hauora were offered to Tina, Kaimahi Hauora work in the hospital and assist in the care of patients identifying as Maori. The healthcare team worked together with Tina and the Kaimahi Hauora with an agreed common purpose to achieve the outcome of Tina getting well again. Tina and the Kaimahi Hauora always performed a Karakia (prayer) during the meetings, as this appeared to calm Tina down when she was feeling distressed. The patient and whānau are offered karakia during care processes, particularly in distressing situations (TDHB, 2011). Tina was also under the care of the Tui Ora organisation for her mental health issues, Tui Ora provides a range of health and social services across Taranaki, with a focus on supporting Maori and people with high needs to access the care they want, when and where they need it (Ministry of Health, 2014). While working with Mel and Tina, the student nurse continued to notice more cultural differences. In Mel's culture, family do not hold as much importance as Tina's. Mel made the decision to attend her meetings with the healthcare team alone and to keep her mental health issues a private matter. The healthcare team respected Mel's wishes as every consumer has the right to have their privacy respected (Health and Disability Commissioner, 1996). The healthcare team suggested respite care to Mel or access to a service such as the acute home base team to follow up on her progress after discharge. These were the same services that Tina was offered upon her discharge as it is the responsibility of the healthcare team to facilitate the same access and opportunities for Maori as there are for Non-Maori (NCNZ, 2011). Mel made the decision to go into respite care for five days until she was well enough to return to work as she wanted her independence back. Tina, however, decided to stay in the mental health ward and be cared for by the healthcare team. A therapeutic level of communication is important with all patients especially those suffering from a mental health illness. In the mental health ward the student nurse noticed that when speaking to patients you must allow adequate time for listening so that you can better understand where the patients are coming from and how they perceive their illness. The model of communication most effective when interacting with a patient in the mental health ward is the transactional model. The transactional model shows that the elements in communication are interdependent. Each person in the communication act is both a speaker and a listener, and can be simultaneously sending and receiving messages; the transactional model of communication reacts depending on factors such as background, prior experiences, attitudes, cultural beliefs and self-esteem (DeFleur, Kearney & Plax, 2009). There are many barriers to effective communication in the mental health setting, many of the patients in the ward have a distorted view of reality and can suffer from delusions, hallucinations and paranoia. For a schizo-affective patient like Tina, she knows very well that other people have minds but she has lost the ability to infer the contents of these minds, she has lost the ability to reflect the contents of her own mind but will still have some ritual and behavioural routines for interacting with people (Hills, 2013). Mel's mind however is cognitively intact and she had a very bleak yet rational way of thinking. Mel expressed suicidal ideations but without intent to act upon these thoughts, the student nurse was mindful to stay away from topics that may upset Mel such as her family, money and relationship issues. The student nurse would just sit with Mel and let her direct the conversation into any topic she chose. By just sitting and taking the time to listen to someone experiencing a mental health illness such as depression or schizo-affective disorder, you will gain their trust. By allowing the patient to tell their story will help them to break the distress of their illness (Hills, 2013). The student nurse found herself doing a lot of listening and not much talking in the mental health setting as the care is more patient focused which means the needs and expectations of patients are placed at the heart of communication and their voice in decision making is heard and heeded. Mel and Tina were two examples of biculturalism in New Zealand. There are many other cultures we will come across as nurses and it is important to practice in a way that respects each health consumer's identity and right to hold personal beliefs, values and goals (Nyrhinen, Hietala, Puukka & Leino-kilpi, 2009). It is difficult to understand someone from another culture if we have not taken the time to listen to what they believe. Learning about other cultures; helps us to live together and respect each other's way of life, without misunderstanding or hurting each other.

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