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MAORI HEALTH ESSAY
Maori are not a homogeneous group; they are diverse with no single or typical Maori identity (Durie, 2001). Maori is recognized as an ethnic population group and they experience a holistic view of health. To promote whanau ora for Maori, Te Whare Tapa Wha is the most common Maori health model used by doctors, nurses and other health professionals. This approach compares health to the four walls of a house, where all four walls are necessary to ensure strength and symmetry (Durie, 2004).According to Nadia Glavish (personal communications, February 25, 2008), a Maori patient in bed is a part of whanau, hapu and iwi. To promote whanau ora in practice, she explained the Te Whare Tapa Wha Maori model of health which includes taha whanau (family), taha tinana(physical), taha wairua(spiritual body) and taha hinengaro(mental and emotional) dimensions to the patient. The multidisciplinary team provide care for the patient s tinana, whereas as nurses, it is our duty to facilitate the whanau and the Maori Health Service team for the Wairau and the hinengaro of a patient. This essay is focused on the exploration of whanau ora, introduction of He Korowai Oranga and its directions for Maori health development, and is related to the panel discussion. Furthermore, this essay will analyse diabetes as a social political factor that impact on whanau ora and the factors that act as barriers and access to health care. Finally there is a discussion of how nurses implement tikanga best practice into the nursing practice to facilitate whanau ora to promote access and receipt of health care.
Whanau is the foundation of the Maori society. Whanau is a principle source of strength, support, security and identity for Maori and it plays a major role in the wellbeing of Maori individually and collectively (He Korowai Oranga, 2002). Whanau ora is a strategic tool for the health and disability sector, as well as for other government sectors, to assist them to work together with Iwi, Maori providers and Maori communities and whanau to increase the life span of Maori, improve their health and quality of life, and reduce disparities with other New Zealanders (He Korowai Oranga, pg-2, 2002).
The establishment of Local Diabetes Team also contribute to the monitoring and reports on diabetes care in the various regions (Health Funding Authority. They are working across sectors. It is about three to five times more common in Maori people when compared to other New Zealanders. Diabetes is a major socio-political factor that impact on the whanau ora. 2000). The mortality rate in the Maori (40-65 years age range) is nearly ten times higher than for other NZ s (Health Funding Authority. According to Jane Grant (personal communication February 25. 2002). effective service delivery. Maori participation and Whanau. cardiovascular problems and other disease. The MOH plays a major role in addressing this sociopolitical problem and has developed a diabetes implementation plan to promote increased and more comprehensive health promotion through diabetes education and support. 2008) the four pathways are the essence of nursing practice. It has two broad directions based on Maori and Crown aspirations and contributions and within these there are three key threads called rangitiratanga. diabetes. kidney failure and death (Capital and Coast District Health Board. stroke. It is a chronic condition that can lead to blindness. Diabetes is a Maori health gain priority area and it potentially affects all New Zealanders (Health Funding Authority. there are four pathways to achieve whanau ora. She also stated that they work in partnership together with the participation of mainstream providers and whanau to protect the health of whanau. It is all about doing what is right with integrity and compassion. 2001). iwi community development (He korowai Oranga. . 2000). heart disease. 2000). which are explained throughout the strategy (He Korowai Oranga. 2002). The basis of whanau ora is to know the family and recognising the values of whanau. Furthermore. it is about the family and what else is going on with them. hapu. building on gains and reducing inequalities. lower limb amputation. free annual reviews in primary care (Health Funding Authority. she explained that whanau ora is not about looking at the presenting problems. They provide effective service delivery through mobile nurses to work with people with asthma.ID NO: 0643573 Jayanthi Mathew The government introduced He Korowai Oranga as a Maori health strategy for mainstream health provider s inorder to achieve whanau ora. 2000). Further more. more eye screening.
d. poor access to services in the community and lack of choices. This concluded that the strategies for prevention of diabetes among Maori must include more marae based education and more visits by health professionals. Increase in funding targets on reducing barriers like cost. how to access health information and failure to provide information and service that are appropriate and acceptable for use in the Maori communities act as barriers to health care in Maori people (Baxter. individual empowerment and message dissemination among Maori(Win. lack of knowledge. 2000). including the Local Diabetes Team and Maori health . 2002). especially Maori staff (Baxter. According to Win. March 2000..n. According to a study conducted in a rural Maori community over the age of 45 to assess the community awareness and knowledge of diabetes among those without diabetes. dieticians and podiatrists in primary care and Maori health provider organisations to maintain active diabetes registers and present the information to Local Diabetes Team (Health Funding Authority. n. for the effectiveness of health messages targeted on Maori audience. screening programmes. The aim was to identify whether the rural kaumatua(grandfather) and kuia (grandmother) were aware of the importance of the diabetes and the researchers concluded that they consider diabetes as a serious health issue but the community level awareness of specific symptoms and complications was low. Strategies for increasing awareness of diabetes are community interventions by training community leaders to enable access to health care for Maori because they support the concept of whanaungatanga(extended family and group dynamics) and it is an effective strategy for community development. MOH also encourages involvement of patients and clinicians in diabetes team to monitor the diabetes services in their areas and recommend improvements. They also aim to increase nurse educators.d. Lack of knowledge of diabetes as a serious health issue. government has increased diabetes funding by $5 million annually per year and there is a need for further increase over the next two years.ID NO: 0643573 Jayanthi Mathew According to the Health Funding Authority. 2002).). multidisciplinary team. they identified that the lack of knowledge of when and where to access help for diabetes is a potential individual barrier to health care for diabetes.
The Community Service Card (CSC) targets to reduce the impact of cost as a barrier and it act as access to health care for people with low income. For example.ID NO: 0643573 Jayanthi Mathew providers need to include culturally specific characteristics like languae. Give them a thought by Department of Health. the costs of the scripts for insulin stops insulin therapy and 33% reported the cost of insulin stops regular insulin therapy (Baxter. 2002). To reduce barriers associated with low income and vulnerable population and to promote access to health care. the nutrition education videos like Let s Stop Diabetes Now (Maori version). CSC involves targeting of health subsidies to individuals and families in need. These economic barriers results in the poor health outcome among Maori. These video presentations include music. Financial barriers also hinder the access of Maori communities to health care. n.). 44% reported costs of scripts stops regular self medication. 41% reported that costs stopped regular BSL monitoring. non-profit making health care services are the primary components (Baxter. . using low fat cooking methods. MOH has started a reconfiguration of Primary Care Strategy. Keeping Well with Diabetes. to study the impact of cost on access to monitoring and treatment among Maori. 27% reported. choosing low fat diary products. The Local Diabetes Team also contributes to the implementation and integration of diabetes services in the district. 2002). They can modify their diet by trimming the fat off meat.d.). According to a research conducted in the South Auckland. Sugar and Salt. tikanga Maori and audiovisual media. in which reduction in cost to patients.d. increasing fibre intake and reducing overconsumption of food. Te Reo Maori and overall a whanau approach for the effectiveness of their mission targeted on Maori population (Win. which is a potentially effective education strategy with the Maori population. n. A key and Simon s story by MOH for the diabetes prevention in Maori include the need for increase in physical activity and change in their dietary style by decreasing fat intake (Win. They provide free annual check to screen for risk factors and complications of diabetes and to promote early detection and intervention (Baxter. 2002).
It involves establishing whakapapa(genealogical) links with patients. 2003). 2008). 25. As nurses it is our responsibility to respect their cultural beliefs and to treat them with dignity (Tikanga Recommended Best Practice. According to Linda Thompson (personal communications. . Tikanga Recommended Best Practice Guideline helps nurses and other health professionals to ensure the overall wellbeing of Maori patients and their whanau. with participation from both sides to protect the health of whanau. In short. As health professionals.ID NO: 0643573 Jayanthi Mathew Nurses play a major role in improving Maori health outcomes. it is the right of all her whanau to know what is wrong with her. Nurse support Maori to achieve the maximum wellbeing. The day after her angiogram. nurses work in partnership together. the concept of whakawhanaungatanga is highly recommended. and they appreciated it. Her whanau also gave her support and courage. There was a Maori patient in my ward after the Per Cutaneous Intervention and she was offered the choice of having karakia(prayer) before her angiogram by the nurse who was looking after her. me and my buddy nurse introduced ourselves and explained to her what we were going to do. it is our responsibility to communicate with all whanau members who asked for information. February. This helps to engage in conversations. Whakawhanaungatanga ensures that the practice is culturally safe and the needs and aspirations of Maori were addressed. what is her treatment and all the facts related to her health. to make rapport and to respect patients. they came to the hospital after the visiting time but the nurse who was coordinating allowed them to see the patient. If an individual became ill. to gather data. for caring a Maori patient. in accordance with Treaty of Waitangi. Nursing staff always tried to support the need for karakia at all times during her care. When we went to take her vital signs for the first time.
He Korowai Oranga.). Diabetes2000. 2008 from http://www. Retrieved March 11. Maori Health.kci.org. New Zealand. Auckland. Health Funding Authority (2000).org. Wellington: Health Funding Authority. . from http://www. 2001.nz Capital and Coast District Health Board (2001). A Needs Assessment for a Diabetes Prevention Video for Maori in Christchurch.ID NO: 0643573 Jayanthi Mathew References Auckland District Health Board (2003). C (n. Retrieved March 3.govt. M (2001).nz Win. Baxter. Maori Health Strategy Discussion Document.moh. Retrieved March 11. 2008.d. Ministry of Health (2002). He kamaka Oranga. Health Needs Assessment. Mauri Ora: The dynamics of Maori Health. Barriers to Health Care for Maori with Known Diabetes . J (2002). Auckland: Oxford University Press.nz Durie. Wellington: Capital and Coast District Health Board. from http://www. Wellington : Ministry of Health. 2008.Tikanga Recommended Best Practice Policy.nzgg.
ac.ID NO: 0643573 Jayanthi Mathew Christchurch. from http://www. Retrieved March 11. 2008.nz/humannutrition/dietetics .otago.
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