Ngā whānau Māori wheako ki te tauwhiro pāmamae me te whakaoranga | Whānau Māori experiences of major trauma care and rehabilitation
Pānuihia ki te reo Māori | Read this page in te reo Māori
Pānuihia ki te reo Ingarihi | Read this page in English
Katoa ngā putanga e pā ana ki tēnei kaupapa ka taea te tikiake i raro o tēnei whārangi. Tae atu ki:
- te pūrongo katoa (PDF)
- te whakarāpopototanga (PDF)
- e rua ngā rauemi mā ngā mātanga:
- Whakawhanaungatanga me ngā whānau Māori i wheako ai i te pāmamae (PDF)
- Te tautoko i ngā whānau Māori i wheako ai i te pāmamae (MS Word ka taea e ngā kaiwhakarato hauora te ētita hei tiki atu i te wāhanga e pai ai ki a rātou).
Kei raro nei he kupu whakarāpopoto mō te pūrongo (te reo Ingarihi, reo Māori) me ētahi kupu mō te pā harakeke me tōna kaihoahoa.
I whakaritea tēnei pūrongo, Ngā whānau Māori wheako ki te tauwhiro pāmamae me te whakaoranga - Whānau Māori experiences of major trauma care and rehabilitation e Sharon Pīhema mō te Kupu Taurangi Hauora o Aotearoa me Te Hononga Whētuki ā-Motu. Nā Sharon i whakawhanake i te pūrongo mai i ngā mōhiohio i kohia mai i tētahi kaupapa whakapai kounga mō ngā wheako ā-whānau ki te whakaoranga i te pāmamae tino nui.
Ko tā Sharon kupu whakamārama i tana whakatakinga ki te pūrongo:
He taonga te reo o te whānau. Nāna i arataki hei panoni mahi me ngā mea whakapai e pai ake ai ngā hua hauora me ngā wheako mō ngā whānau Māori. Ko ngā whānau i uiui ai mātou ka hiahia kia kōrero mai ō rātou whakaaro mō tēnei kaupapa kia kore ai ētahi atu tangata e wheakohia pērātia e rātou. Mōhio pū ana rātou ki ngā wero me te whakapuaki ki a mātou i ngā panonitanga me panoni. Kua takoto te mānuka ki a mātou me kawe ake.
Ka hiahia a Kupu Taurangi Hauora o Aotearoa me a Te Hononga Whētuki ā-Motu ki te tuku mihi ki a Sharon mōna i mahi me te whakamihi:
- i nga whānau i uru mai ki tēnei kaupapa me te kōrero mai hei para i te huarahi panoni
- te ringatoi tohu me te kaihoahoa Whareāhuru Gilbert
- ngā kanohi o te rōpū mātanga mō rātou i tautoko mai, i arataki mai huri noa i te kaupapa.
Ngā mihi nui ki a koutou.
Kei te mihi atu a ACC i tēnei pūrongo e tuari ana i ngā whakaaro nui o ngā whānau mō ō rātou wheako tauwhiro whai muri i te pāmamae nui, te whētuki nui. E kaha mahi ana a ACC i ētahi kaupapa hei urupare atu ki ngā tūāhuatanga i tautohua ai. E titiro whakamua ana a ACC kia āta whakaarohia ngā kitenga o te pūrongo me te pēhea e akiaki ai i ngā māhi me ngā ratonga mō āpōpō, ā, haere ake nei.
Ko te pāmamae tino nui te take matua e whara ai te tangata e hauā roa ai. Kua wheakohia e ngāi māori te nui o ngā wharanga engari mō te whai wāhi atu ki ngā ratonga hauora hei tautoko i te mahi whakaoranga, auare ake. He tino raru tēnei hei whakaoti.
Ko te whāinga o tēnei kaupapa kia rongohia ā-taringa i ngā tāngata me ō rātou whānau ō rātou wheako mō te pāmamae tino nui me te whakaoranga. I te hiahia mātou ki mārama ki a rātou wheako mai i te wā i whara ai, tō rātou wheako i te hōhipera, haere ake kia whakamāui ake me te whakaoranga i te wā kua hoki atu ki te kāinga. I te hiahia mātou ki te ako me pēhea ngā wharanga o te pāmamae i pā atu ai ki te hauora katoa o te tangata. I pēhea hoki te tauwhiro pāmamae me te whakaoranga i pā atu ai ki ō rātou hauora hinengaro, te hauora wairua me te oranga o te whānau?
Mā te reo o ngā whānau kua whai wāhi mai hei tohutohu i tētahi nekehanga o te hoahoa me te ratonga kia āwhina ai i ngā wheako (me ngā hua torohū) mō te Māori.I meatia kia arataki mai te whānau i te kōrero kia whakatōmene iho i ngā wheako me ngā tirohanga o te tangata takitahi me ō rātou whānau i a rātou e whakaora ake ana whai muri i tō rātou wharanga me ngā pānga o taua wharanga ia.
Ko ngā take kōrero ko ēnei:
- ko te pūtake o ngā mahi mō ngā wharanga
- te wā i hōhiperatia ai, ā, i te whare whakaora rānei
- te hokinga ki te kāinga• ngā mahi tautoko i muri
- te mahi e āwhina ai, e aukati ai i te whakamāuitanga
- i pēhea ngā ratonga i whakatutuki ai i ngā hiahia ā-ahurea.
Nā te kōrero noa mō tā rātou wheako tauwhiro, kua homai e ngā whānau he mounga kōrero mō ngā wāhi e noho nei ngā tarepa me ngā mea papai; mā konei ka whakapai ake i ngā wheako tauwhiro.
Ka tautohu tēnei pūrongo i ngā mahi ka taea, arā, ina meatia paitia ka whakapai ake i ngā wheako o ngā Māori e whara ana, ka mutu, ka pai ake ngā hua whakaoranga.
1. Ko te whakawhanaungatanga me noho hei whāinga matua mā ngā kaiwhakarato tauwhiro hapori
- Hei mahi: Me whai e ngā ringa tauwhiro pāmamae katoa i te whakawhanaungatanga me ngā tūroro Māori me ngā whānau.
2. Me whai e ngā ringa tauwhiro pāmamae i te tikanga ahurea
- Hei mahi: Ki ngā whare pāmamae nui me noho ngā kaiāwhina hei tino tangata ki ngā rōpū pāmamae.
- Hei mahi: Ina wātea, ina whakaae hoki ngā tūroro, me tuku ngā tūroro Māori pāmamae ki ngā ratonga tautoko Māori o te hōhipera.
- Hei mahi: Me whai wāhi ngā ringa tauwhiro pāmamae katoa o ngā hōhipera kia akona ki ngā tikanga ahurea kia ākina hoki ki te ako i te reo Māori.
3. Me tātari, me aroturuki me te tautoko hoki e ngā kaiwhakarato hauora me ngā kaiwhakarato tauwhiro hapori te oranga ngākau o te tūroro me te whānau
- Hei mahi: Mātai haere ai ngā kaiwhakarato i ngā tūroro Māori pāmamae katoa e kitea ai he mamae (PTSD) he mātengatenga kia whai wāhi mai hoki te whānau mehemea e tika ana.
- Hei mahi: Ina whaihua ana me aromātai ngā kaiwhakarato hauora, kaiwhakarato hapori i te oranga o te tūroro me ngā whānau mā te tauira hauora Māori.
4. Me noho tahi me te tautoko ngā rāngai ki ngā whānau Māori.
- Hei mahi: Ko ngā rāngai katoa e mahi tahi ana ki ngā tūroro pāmamae me ngā whānau, tae atu hoki ki ngā kōtuitui pāmamae ā-rohe me toro atu ki tētahi pae kiritaki/whānau hei whakapai ake i te ratonga.
- Hei mahi: Kia whakawhanakehia e te ACC me Te Hononga Whētuki ā-Motu ngā rauemi mōhiohio mā ngā tūroro me ngā whānau mā te Māori me te kaha tohatoha ki ngā rōpū pāmamae me ngā ratonga e kirimanatia ana.
5. Me mahi tahi me tautoko hoki e ngā rāngai ngā ratonga Māori
- Hei mahi: Mā te ACC me ngā ratonga pāmamae e kawe i ngā kōwhiringa hei tuku i ngā tūroro Māori ki ngā ratonga kaupapa Māori, rongoā Māori rānei.
- Hei mahi: Me whakakaha ake e ACC ngā ara whakawhiti ki ērā atu o ngā rāngai mō ngā take hapori huhua.
- Hei mahi: Me whakarite e ngā ratonga hauora, hapori katoa he akoranga mā ngā kaimahi, tae atu hoki ki ngā kaiwhakahaere kēhi ACC, kaiāwhina Māori i ngā hōhipera kia tika te whakawhiti kōrero ki ngāi rangatahi.
6. Me ine e ngā rāngai ngā kaupapa nui ki te Māori.
- Hei mahi: Kei te whakahou a Kupu Taurangi Hauora o Aotearoa i ngā taputapu tiro whānui mō te wheako o ngā tūroro ki rō hōhipera kia uru mai te pūkenga ahurea o ngā kaiwhakarato.
- Hei mahi: Inea haere ai e Te Hononga Whētuki ā-Motu ngā hua mō ngā tūroro Māori.
Mo te pūrongo katoa kei raro i tēnei whārangi te hononga hei tikiake.
(nā te ringatoi nā te kaihoahoa Whareāhuru Gilbert, nō Rongowhakaata, Kāitahu, Ngāti Tama, Ngāti Toa-Rangatira)
Ko te whakamāramatanga o tēnei mahi toi, he whānau me te tino mahi a te whānau he tiaki, he poipoi i te rito (te tamaiti, te reanga taiohi, whakaraerae) i waenganui.
Kei ōna tahataha, ko ngā mātua, kei ō rāua taha, ko kui rāua ko koro, ā, haere tonu, haere tonu.
Ko tā rātou mahi tahi, he tiaki i te rito kia tipu ora ai, kia tipu kaha ai. Koirā te mahi a te whānau, te pā harakeke.
Ko ngā manaia kei te harakeke he kaitiaki e tohu ana i ngā huānga o te hauora me te oranga. Kua waiho tētahi rau e horehore ana hei tohu i ngā mahi e mahia tonutia ana kāore anō kia oti.
I ētahi wā ko te pīwakawaka he kaiarataki i a koe e uru atu ana ki te waonui o Tāne Mahuta, rērere ai ia mai tērā te taha ki tēnei taha e para ana i tētahi ara hīkoi.
All publications relating to this project are available for download at the bottom of this page. They include:
- the full report (PDF)
- executive summary (PDF)
- two resources for clinicians:
- ‘Whakawhanaungatanga with whānau Māori who experience trauma events’ (PDF)
- ‘Supporting whānau Māori who experience trauma events’ (editable MS Word format so health providers can choose what to use according to their service).
A brief summary of the report is below and some information about the Pā harakeke tohu and its designer.
This report, Ngā whānau Māori wheako ki te tauwhiro pāmamae me te whakaoranga | Whānau Māori experiences of major trauma care and rehabilitation, was prepared by Sharon Pīhema for the Health Quality & Safety Commission and the National Trauma Network. Sharon developed the report from information gathered during a quality improvement project on whānau Māori experiences of rehabilitation from major trauma.
As Sharon explains in her introduction to the report:
The whānau voice is a taonga. It provides direction for making the changes and improvements needed to achieve better health outcomes and experiences for whānau Māori. The whānau we interviewed wanted to give their voice to this kaupapa so others would not have to go through what they went through. They know the challenges first-hand and have expressed to us the changes that need to happen. The wero (challenge) is now with us to make it happen.
The Health Quality & Safety Commission and the National Trauma Network would like to thank Sharon for her work, and acknowledge:
- the whānau who participated in this project and shared stories to create change
- the tohu artist and designer, Whareahuru Gilbert
- the expert advisory group members for their support and guidance throughout the project.
Ngā mihi nui ki a koutou.
ACC welcomes this report which shares valuable insights from whānau about their experiences of care following major trauma. ACC is actively working on a number of initiatives that address several of the action areas identified. ACC look forward to considering the report’s findings in more detail and how they might inform our current and future initiatives and services.
Major trauma is one of the leading causes of injury and long-term disability. Māori experience higher rates of injury yet have less access to, and lower use of, health services that are intended to support rehabilitation. This is an important problem to solve.
The purpose of this project was to hear first-hand from individuals and their whānau about their experience of major trauma care and rehabilitation. We needed to understand their journey from the time they were injured, their experience while they were in hospital and their continued recovery and rehabilitation once they were back at home. We wanted to learn how major trauma injuries impact on every dimension of health. How has their major trauma care and rehabilitation affected their mental health, spiritual health and whānau wellbeing?
The voices of whānau present an opportunity to inform a shift in the design and delivery of services to enhance experiences (and potentially outcomes) for Māori.
We used whānau-led kōrero (conversations) to explore in-depth the experiences and perspectives of individuals and their whānau as they navigated life after their injury and the impacts of that injury.
Topics covered during the kōrero included:
- background to the events surrounding the injuries
- their time in hospital and, if applicable, a rehabilitation centre
- their transition home
- follow-up support
- what helps and hinders recovery
- how services met their cultural needs.
By opening up about their care experiences, whānau have provided a taonga rich in detail about where the deficits and strengths in services lie; this can be used to optimise care experiences.
This report identifies a number of feasible actions that, when implemented effectively, will improve experiences for injured Māori and ultimately lead to improved rehabilitation outcomes.
1. Whakawhanaungatanga must be a priority for all health and social service providers
- Action: All trauma clinicians practise whakawhanaungatanga with Māori patients and whānau.
2. All trauma clinicians must adopt and be accountable for a culturally effective approach
- Action: All large trauma centres make kaiāwhina (assistants) available to be an integral part of trauma teams.
- Action: Where available, and patients agree to it, routinely refer Māori trauma patients to the hospital’s Māori support service.
- Action: All hospital trauma clinicians receive training in cultural competency and are encouraged to learn te reo Māori.
3. Health and social service providers must assess, monitor and support the psychological and emotional wellbeing of the patient and whānau
- Action: Providers routinely screen all Māori major trauma patients for clinical signs of pain, post-traumatic stress disorder (PTSD) and concussion, with whānau engagement and referral as appropriate.
- Action: All health and social service providers, where feasible, assess the wellbeing of the patient and whānau using a hauora Māori (Māori health) model.
4. Agencies must involve and provide supports for whānau Māori
- Action: All agencies working with major trauma patients and whānau, including regional trauma networks, use a consumer/whānau panel to inform service improvement.
- Action: The Accident Compensation Corporation (ACC) and the National Trauma Network develop patient and whānau information resources specifically for Māori and actively distribute them across trauma teams and contracted provider services.
5. Agencies must invest in kaupapa Māori service providers and support their use
- Action: ACC and trauma services facilitate options for routinely referring Māori patients to kaupapa Māori (Māori-themed) or rongoā māori (natural medicine) services.
- Action: ACC strengthens mechanisms to liaise with other agencies on complex social cases through identifying need early.
- Action: All health and social service agencies invest in training staff, including ACC case managers and hospital Māori support service staff, to effectively communicate with rangatahi (youth).
6. Agencies must measure what matters to Māori
- Action: The Health Quality & Safety Commission continues to rework in-hospital patient experience survey tools so they include cultural competence of providers.
- Action: The National Trauma Network routinely measures patient-reported outcomes for Māori.
For more detail, please see the full report, available to download at the bottom of this page.
(in the words of tohu designer and artist Whareahuru Gilbert (Rongowhakaata, Kāitahu, Ngāti Tama, Ngāti Toa-Rangatira))
The meaning behind this art piece is family and the essential role they play in caring and nurturing the rito (child, younger generation, vulnerable) in the centre.
To the side are the parents and to their sides are the grandparents and so on.
Their collective purpose is to protect and care for the child, enabling the child to grow healthy and strong. That is the purpose of whānau, the pā harakeke.
The manaia within the harakeke are guardians and symbolise the different elements required for health and wellbeing. One rau (leaf) has been left bare, to represent that the work is ongoing and not yet complete.