Foreword | Kupu whakataki (Frailty care guides 2023)
Frailty is a recognised clinical syndrome that requires specialised assessment and interventions to promote resilience in people who are ageing and/or those with multiple co-morbidities.
This 2023 edition of Frailty care guides | Ngā aratohu maimoa hauwarea (FCGs), the development of which has been led by Julie Daltrey and Patumahoe Leaf-Wright on behalf of Te Tāhū Hauora Health Quality & Safety Commission, includes mātauranga Māori (Māori knowledge) and cultural concepts that are important when manaaki (caring for) kaumātua (Māori elder/s) as well as evidence updates. As with all practice guides, the FCGs do not replace clinical judgement and/or individualised resident goals of care. Rather, they continue to promote early intervention and communication with the older person’s multidisciplinary team, particularly their lead primary care provider.
The FCGs have an aged residential care (ARC) focus and may be applied to other settings providing care for people living with frailty.
The whakapapa (history/genealogy) of these guides reaches back to 2007 where, under the leadership of Dr Michal Boyd, the Residential Aged Care Integration Programme developed a set of guides for registered nurses working in ARC in the Waitematā region. This 2023 update has been a collaborative effort incorporating feedback from diverse stakeholders. These include the original authors, Te Whatu Ora Gerontology Nursing Service, Waitematā, as well as ARC providers, the wider ARC community and experts in clinical content and mātauranga Māori.
The FCGs explain mātauranga Māori in a practical and pragmatic way and are designed to support health professionals to enhance the experience of kaumātua and their whānau/family in their care. The inclusion of cultural concepts applicable to caring for kaumātua aims to create a resource that encourages health professionals to fully explore the holistic needs of kaumātua and their whānau/family and to increase awareness and sensitivity to cultural needs. The inclusion of mātauranga Māori in the FCGs required drawing from deep wells of lived experience and innate understanding of te ao Māori (Māori world view). This was followed by consultation with Māori experts within the sector. We hope we have created a conversation starter while honouring the mana (dignity, prestige), tapu (sacredness) and mauri (life force, vitality) of the mātauranga (knowledge) contained within these guides.
Te Tāhū Hauora is pleased to publish the FCGs, recognising their value as a resource to support education and promote quality improvement initiatives within the ARC sector. If organisations choose to incorporate the guides into standard operating procedures, we highly recommend they become part of governance structures.
The FCGs are a starting point. We believe they will help providers and health professionals to reflect on and recognise where cultural competency training would enhance service delivery and professional practice.
Cultural competency training comes in many forms, from formal courses, through the establishment of dedicated cultural positions, to role-modelling from people with cultural expertise. Using cultural experts (kaumātua residents, community members, staff with other roles) fosters a supportive learning environment and helps to embed cultural competency throughout an organisation.
Creating this environment and providing care in this way aligns with health care’s obligations under Te Tiriti o Waitangi (Treaty of Waitangi) through ensuring mana motuhake (unique Indigenous status) and active protection of Māori taonga (treasures), such as health, cultural concepts, language and identity. It also enables equity by providing care that is specifically designed to meet the unique needs of kaumātua while upholding their tino rangatiratanga (self-determination and autonomy) and providing options.
We hope this is a valuable resource for those caring for older people requiring specialised frailty support. Thank you for your ongoing efforts and dedication to ensuring the wellbeing and quality of care for those in your facility.
Professional Teaching Fellow and nurse practitioner, University of Auckland, School of Nursing
Clinical lead, aged residential care programme, Te Tāhū Hauora
Nurse Educator Cultural Support, Te Whatu Ora Waikato
Clinical Academic, University of Waikato
Cultural Consultant, Te Tāhū Hauora
Acknowledgements | He mihi
We would like to express our appreciation to the numerous individuals who have contributed to the development of the FCGs. We extend our gratitude to the leaders and clinicians who provided valuable feedback throughout the review process. Their insights and expertise have greatly enhanced the quality and relevance of the guides.
The many people who have contributed to the development of the FCGs are acknowledged below. We also acknowledge that the reviews of these guides were team efforts in many instances.
We extend our thanks to the wider groups involved, whose collective efforts have contributed to the final suite of guides.
- Dianna McGregor, Te Whatu Ora Waitematā
- Donna Foxall, University of Waikato, Te Huataki Waiora School of Health
- Doug Edwards, Te Tāhū Hauora
- Fiona Morgan, Kimihia Home and Hospital Trust
- Gerontology Nursing Service, Waitematā, Te Whatu Ora Waitematā (original authors)
- Gerry Fennelly, CHT Healthcare Trust
- Glenda Dagger, Te Whatu Ora Waitematā
- Irihapeti Bullmore, Ryman Healthcare
- Joanna Hikaka, University of Auckland
- Kristen Lassey, HealthCERT
- Mandy Pagan, Te Whatu Ora Southern
- Maria Schollum, Te Whatu Ora Waikato
- Rangimahora Reddy, Rauawaawa Kaumātua Charitable Trust
- Rebecca Aburn, Te Whatu Ora Southern
- Ruth Barratt, Te Tāhū Hauora
- Sarita Walker, Arvida – The Wood retirement community
- Sasha Drennan, Te Whatu Ora Waitematā
- Stephanie Turner, Te Tāhū Hauora
ARC quality leads forum members
- Ana Gluyas, Sam Powell, Diane Taylor and Cheyne Chalmers, Ryman Healthcare
- Anna Carey and Lynda Irvine, Summerset
- Clare Tullet and Rosie Dwyer, Radius Care
- Katherine Foulkes, Health and Disability Commissioner
- Lyn Wardlaw, The Selwyn Foundation
- Michal Boyd, University of Auckland
- Mikaela Shannon, Presbyterian Support Central
- Nerupamal Fernando and Sandy Turnwald, Bupa
- Nikki Close, Ultimate Care Group
- Pam Walker, Heritage Lifecare
- Sharmila Devaraj, CHT Healthcare Trust
- Shirley Ross and Jane Watson, Oceania Healthcare
- Susan Shaw and Kim Brown, Arvida
- Tanya Bish and Lucia Zidich, Metlifecare
- Trish Fleming, Hospice New Zealand