Exam

Question 1

What is cultural safety?

Answer 1

The experience of the recipient of nursing service that extends beyond cultural awareness and sensitivity

Question 2

Cultural safety is underpinned by?

Answer 2

Communication, recognition of the diversity in world-views, and the impact of colonisation processes on minority groups.

Question 3

What is cultural safety, principle 1?

Answer 3

Cultural safety aims to improve the health status of New Zealanders and applies to all relationships through:

1. 1: an emphasis on health gains + positive health outcomes
2. 2: Nurses acknowledging the beliefs and practices of those who differ from them
   example: Age, gender, sexual orientation, occupation and socioeconomic status, ethnic origin, migrant experience, religious or spiritual belief, and disability

Question 4

What is cultural safety principle 2, indicator 1?

Answer 4

Cultural safety aims to enhance the delivery of health and disability services through a culturally safe nursing workforce by:

2.1: Identifying the power relationship (PR) between provider and patient/customer/client. The nurse accepts and works alongside others after undergoing a careful process of institutional and personal analysis of the PR.

Question 5

What is cultural safety principle 2, indicator 2?

Answer 5

Cultural safety aims to enhance the delivery of health and disability services through a culturally safe nursing workforce by:

2.2: Empowering the users of the service. People should be able to express degrees of perceived risk or safety. For example, someone who feels unsafe may not be able to take full advantage of a primary health care service offered and may subsequently require expensive and possibly dramatic secondary or tertiary intervention.

Question 6

What is cultural safety principle 2, indicator 3?

Answer 6

Cultural safety aims to enhance the delivery of health and disability services through a culturally safe nursing workforce by:

2.3: Preparing nurses to understand the diversity within their own cultural reality and the impact of that on any person who differs in any way from themselves

Question 7

What is cultural safety principle 2, indicator 4?

Answer 7

Cultural safety aims to enhance the delivery of health and disability services through a culturally safe nursing workforce by:

2.4: Applying social science concepts that underpin the art of nursing practice. Nursing practice is more than carrying out tasks. It is about relating and responding effectively to people with diverse needs in a way that the people who use the service can define as safe.

Question 8

What is cultural safety principle 3, indicator 1?

Answer 8

Cultural safety is broad in its application:

3.1: recognising inequalities within health care interactions that represent the
microcosm of inequalities in health that have prevailed throughout history and
within our nation more generally.

Question 9

What is cultural safety principle 3, indicator 2?

Answer 9

Cultural safety is broad in its application:

3.4: addressing the cause and effect relationship of history, political, social, and
employment status, housing, education, gender and personal experience upon
people who use nursing services

Question 10

What is cultural safety principle 3, indicator 3.3?

Answer 10

Cultural safety is broad in its application:

3.3: accepting the legitimacy of difference and diversity in human behaviour and social structure

Question 11

What is cultural safety principle 3, indicator 3.4?

Answer 11

Cultural safety is broad in its application :

3.4: accepting that the attitudes and beliefs, policies and practices of health and disability service providers can act as barriers to service access

Question 12

What is cultural safety principle 3, indicator 3.5?

Answer 12

Cultural safety is broad in its application:

3.5: concerning quality improvement in service delivery and consumer rights.

Question 13

What is cultural safety principle 4, indicator 1?

Answer 13

Cultural safety has a close focus on:

4.1: understanding the impact of the nurse as a bearer of his/her own culture, history, attitudes and life experiences and the response other people make to these factors

Question 14

What is cultural safety principle 4, indicator 2?

Answer 14

Cultural safety has a close focus on:

4.2: challenging nurses to examine their practice carefully, recognising the power relationship in nursing is biased toward the provider of the health and disability service

Question 15

What is cultural safety principle 4, indicator 3?

Answer 15

Cultural safety has a close focus on:

4.3: balancing the power relationships in the practice of nursing so that every
consumer receives an effective service

Question 16

What is cultural safety principle 4, indicator 4?

Answer 16

Cultural safety has a close focus on:

4.4: preparing nurses to resolve any tension between the cultures of nursing and the people using the service

Question 17

What are the different components of the meihana model?

Answer 17

Patient/Whanau, Tinana, Hinengaro, Wairua, Taiao, and Iwi katoa

Question 18

Define the patient/whanau component of the meihana model.

Answer 18

The support networks for the patient.

Question 19

Define the Tinana component of the meihana model.

Answer 19

The physical health and functioning of the patient.

Question 20

Define the hinengaro component of the meihana model.

Answer 20

Psychological and emotional well-being.

Question 21

Define the Wairua component of the meihana model.

Answer 21

The levels of attachment and engagement of spiritual beliefs.

Question 22

Define the Taiao component of the meihana model.

Answer 22

The external physical environment

Question 23

Define the iwi-katoa component of the meihana model.

Answer 23

The societal impact on the client/whanau.

Question 24

What are the two hiwi (hulls) of the waka represent - in the meihana model?

Answer 24

Patient and Whanau

Question 25

What do the Aku (crossbeams) of the waka in the meihana model represent?

Answer 25

Tinana, Hinengaro, ratonga hauora (iwi katoa), wairua, and taiao.

Question 26

What do the Nga hau e Wha - the four winds represent in the meihana model?

Answer 26

Racism, Colonisation, Marginalisation, and Migration.

Question 27

How can we apply the patient component of the meihana model to practice?

Answer 27

Checking if the patient identifies as Maori.
Making it culturally safe for the patient to ‘enrich mana’ i.e express Identity.
Not assuming someone if maori or not maori based of appearance.
Not assuming someone is not maori based of an initial question form they may fill out.

Question 28

How can we apply the Whanau component of the meihana model to practice?

Answer 28

Discuss with the patient who they are living with and who are their supports.
Ask where their whanau are from - migration ect?
Ask what side of the whanau is Maori - paternal/maternal
Could create a small family tree of who is in their Whanau
Include the Whanau in the psychiatric assessment process (i.e offer a chance to talk to the Whanau without the patient being present.

Question 29

How can we apply the Tinana component of the meihana model to practice?

Answer 29

Ask in the patients assessment about their physical health (both themselves and family).
Ask questions about diet and exercise.
Ask questions about alcohol and drug use “If we went to the supermarket and you were down the alcohol isle, what would you put in your trolly”.
Give information regarding medications and side effects
Do an intrusive examination regarding their birth.

Question 30

How can we apply the Hinengaro component of the meihana model to practice?

Answer 30

Assess mood and anxiety.
Capture the ‘now’ and moving forward.
Assess the difference between spiritual/cultural practice and their mental illness - such as in psychosis ( talking to/calling on their ancestors).
Face and understand the stigma around mental illness.
Assessment of their perception and understanding of their condition and the impact this has on their well-being.

Question 31

How can we apply the Ratonga Hauora (iwi katoa) component of the meihana model to practice?

Answer 31

These are systems and services that provide support for patients and whanau therefore we can:
Get in contact with NGOs, plunket and kaupapa maori groups.
Refer to other services.
Understand and investigate positive and negative family experiences with services - racism ect
Learn what barriers a whanau will face within services
Make your service a welcoming service to patients through the use of te reo, tikanga, te reo signage, clear communication, providing hot drinks, and karakia.
Acknowledge the ongoing effects of colonisation and marginalisation for maori in our services.

Question 32

How can we apply the Wairua component of the meihana model to practice?

Answer 32

Ask using questions such as “Where do you feel grounded/go to feel grounded” OR “is spirituality important to you”.
Ask regarding connectedness, i.e “Do you feel connected to your community”.
Build rapport with client, be vulnerable i.e use self disclosure.

Question 33

How can we apply the Taiao component of the meihana model to practice?

Answer 33

Identify the environment of the patient and whanau.
Critiquing and the service or clinical environment that the client and whanau are interacting with. I.e are there enough chairs for my patients whanau, or is there room for my patients whanau to stay in ect.

Question 34

What are the 4 principles of te Tiriti o Waitangi/ treaty of Waitangi.

Answer 34

Tino rangatiratanga, partnership, protection, and participation.

Question 35

Discuss and explain the principle: Tino Rangatiratanga.

Answer 35

Tino rangatiratanga enables maori self-determination over health, recognised the right to manage Maori intrests, and affirms the right to development by:

1. Enabling maori autonomy and authority over health
2. Accepting maori ownership and control over language, knowledge, and customs and recognise these as Taonga
3. Facilitate maori to define knowledge and world views and transmit these in their own ways
   And 4. Facilitate Maori independence over thoughts and action, policy and delivery, and content and outcome as essential activity’s for self-management and self-control.

Question 36

Discuss and explain the principle: Partnership

Answer 36

Partnerships involves nurses working together with Maori with the mutual aim of improving health outcomes for maori by:

1. Acting in good faith as treaty of Waitangi partners
2. Working together with an agreed common purpose, interest, and cooperation to achieve positive health outcomes.
3. Not acting in isolation or unilaterally in the assessment, decision making, and planning of services and service delivery.
4. Ensuring the integrity and wellbeing of both partners is preserved.

Question 37

Discuss and explain the principle protection.

Answer 37

The nursing workforce recognises that health is a taonga and acts to protect it by:

1. Recognising that health for maori is worthy of protection in order to achieve positive health outcomes and improvement in health status
2. Ensuring that health services and delivery are appropriate and acceptable to individuals and their families and are under pinned by the recognition that Maori are a diverse population.
3. Facilitating wellbeing by acknowledging beliefs and practices held by maori.
4. Promoting a responsive and supportive environment.

Question 38

Discuss and describe the principle: Participation.

Answer 38

The nursing workforce recognises the citizen rights of maori and the right to equitable access and participation in health services and delivery at all levels through:

1. Facilitating the same access and opportunities for Maori as there as for non-Maori.
2. Pursuing equality in health outcomes.

Question 39

What is the hui process?

Answer 39

A framework for working effectively with Maori. It applies traditional principles of greeting, introducing, starting a relationship and closure of an encounter to the medical setting.

Question 40

What are the key elements of the hui process?

Answer 40

Mihi, Whakawhanaungatanga, Kaupapa, and Poroporoaki.

Question 41

What is a brief description of the element: Mihi?

Answer 41

The Initial meeting and engagement. The main focus of this first stage is to clearly introduce and describe their role and the specific purpose of the consultation to the Maori patient and whanau. This is also when we should confirm if the patient identifys as Maori.

Question 42

What is a brief description of the element: Whakawhanaungatanga

Answer 42

Making a connection. The primary focus of this stage is to connect with the patient and whanau on a personal level. This is often mistaken as ‘building rapport’. However we need to take a further step than rapport. This requires clinicians to draw on their own understanding of Te Ao Maori and relevant Maori beliefs, values and experiences. Example: relating to patients whenua (land) connections, whanau involvements, use of te reo (maori language). This enchourages self-disclosure from the clinician. It is emphasises that Whakawhanaungatanga is not a one off event and there is a need to attend to this throughout the consultation.

Question 43

Give a brief description regarding the element: Kaupapa

Answer 43

Attending to the main purpose of the encounter. This is identified as the point at which the focus moves to history taking or the clinical task at hand. We can use the meihana model here to extend the standard history taking process for Maori. This allows for a broader focus in understanding patients presenting complaints as well as facilitating ongoing Whakawhanaungatanga.

Question 44

Give a brief description of the element: Poroporoaki

Answer 44

Concluding the enchounter. This reminds clinicians of the need to clearly identify both the finishing point of the consultation and to ensure clarity about the next steps for the patient and whanau. The three tasks as as follows: Ensure you have understood what the patient has said, ensure the patient has understood what you have said, and ensure the patient is clear about the next steps (eg dates for follow up appointments, medication regimes). The poroporoaki only occurs if a relationship has been effectively developed.

Question 45

What is taonga?

Answer 45

An object or natural resource that is highly prized

Question 46

What is tikanga?

Answer 46

Customary practices or behaviours

Question 47

How can we develop and maintain partnership appropriately with clients and their whanau?

Answer 47

Working alongside the patient and whanau for positive health outcomes
Making sure the patient fully understands treatment plans ect
Enables autonomy over treatment plan

Question 48

What is the impact of the treaty of Waitangi/ te Tiriti o Waitangi in my practice?

Answer 48

I understand the impact of colonisation and treaty non-compliance for Maori, therefore, understand the different health and socioeconomic status of Maori compared to non-maori. As maori as disadvantaged and are more likely to receive poorer health outcomes. Therefore, in my practice I will enable maori service users (patients) to enrich their mana (honour and respect) by reflecting on my own cultural beliefs and supporting the identity and culture of the patients. This will enable patient recovery and influence positive health outcomes for Maori.