Cultural Flashcards
Psychometrics (cultural norms) 3
SUDS - Leeds Dependency Questionnaire (normed NZ)
Trauma - Impact of Events Scale (chinese version)
Criminology - VRS-SO (sexual offending), ASRS-R, ROC*ROI (NZ normed)
3 P’s of treaty
The Treaty of Waitangi
* Protection – Recognising that Maori health is worthy of improving. Ensuring that services are appropriate to individuals and their families. Acknowledging beliefs and practices held by Maori.
- Participation – Providing the same intervention and opportunities for Maori as non-Maori.
- Partnership – Working together with Maori to agree on a common goal of treatment. Collaborative practice
Ethical issues to consider:
- Identify own limits and competencies
- Seek cultural supervision/Pukenga Atawhai.
- Pukenga Atawhai does cultural assessment relating to connection with culture.
- Be even more aware of power & control in the assessment process. Give them the power & control.
- Reflect on own culture and influence
- Convey the fact that I consider cultural variables important and relevant.
- Easy for Maori to “dull down” their culture when not in a Maori context. Find a way to create a sense of cultural safety.
- Maori norms for psychometrics?
- Allow for whanau to be involved. Confidentiality – who is given disclosure?
- Does client consider Maori cultural issues as part of their difficulties?
- Whakama – shame, self-doubt, feel inferior
- Mate Maori – hearing voices of ancestors.
Hui Process (4)
Mihi: initial greeting and engagement.
* Clearly introduce themselves and describe their role and the specific purpose of the consultation and should also confirm that the patient identifies as Māori.
Whakawhānaungatanga: making a connection.
* Connecting at a personal level with the patient and any whānau present.
* clinicians to draw on their understanding of Te Ao Māori - patient’s whenua (land) connections, whānau involvements, use of te reo (Māori language).
* self-disclosure of the student / doctor about their own experience of these aspects.
Kaupapa: attending to the main purpose of the encounter.
* Draw upon meihana Model,
Poroporoaki: concluding the encounter.
* Ensure that you have understood what the patient has said, they understands what you have said, and, patient is clear about the next steps
The Meihana Model
Predisposing factors
Ngā Hau e Whā (representing the four winds)
- Wind - work against
Colonisation
- loss of connection to land and family
- consequences: SES, employment, housing
Racism
- institutional [differential access], interpersonal [beliefs, attitudes, and actions of individuals] , and internalised racism [the acceptance of negative messages (“I’m not into that Māori stuff”]
Migration
- Internal migration of Māori from traditional iwi land, to other regions in NZ; leading to loss of whanau support
Marginalisation
- Māori health status, health disparities and health gains. Māori incidence, prevalence, morbidity and mortality rates (of a specific illness).
The Waka Hourua (double-hulled canoe)
- Relationship between client and Whānau AND the impact of the 5 on not just client but whānau too (WITTH acconym)
tinana = physical body – exercise, diet, substance use
hinengaro = psychological/emotional patient’s concept and perception of their condition
ratonga hauora = Services and systems that provide support access to quality health services
wairua = connectedness and spirituality - about spiritual-religious beliefs and attachments to people, places and taonga
taiao = physical environments - home environment, neighbourhood and workplace health and safety. spaces promote privacy and dignity
- ALSO THINK Barriers: Are there potential barriers to access the service like car parking, Māori friendly environment?
Protective factors
Ngā Roma Moana (representing the four ocean currents) PUSHING the WAKA – HELPING THEM
āhua - Personalised indicators of maori language – speaking te reo, wearing clothing with te reo, maori name
tikanga - Māori cultural principles
whānau - Relationships, role and responsibilities of the patient
whenua - specific genealogical or spiritual connection between client and/or whānau and land
Whakatere (navigation)
- challenges and supports clinicians to acknowledge and mitigate personal and institutional biases within assessment, formulation and treatment
- draws together the relevant information from the model and integrates this information.
The Fonofale model
The Fonofale model incorporates the values and beliefs
Foundation = Family
- Nuclear family + extended family + fundamental basis of Pacific Island social organisation.
Roof = cultural values and beliefs that is the shelter for life.
- These can include beliefs in traditional methods of healing as well as western methods.
Four Posts (pou)= Connect the culture and the family + continuous and interactive with each other.
- Spiritual – wellbeing which stems from a belief system - Christianity or spirituality relating to nature, or a combination of both.
- Physical –biological or physical wellbeing. Physical substances such as food, water, air, and medications that can have either positive or negative impacts on the physical wellbeing.
- Mental – Health of the mind, thinking and emotion as well as behaviours expressed.
- Other – Variables that can directly or indirectly affect health such as, but not limited to, gender, sexual orientation, age, social class, employment and educational status.
The fale is encapsulated in a cocoon whose dimensions have direct or indirect influence on one another. These dimensions are:
- Environment – Relationships to physical environment (may be a rural or an urban)
- Time – Actual or specific time in history that impacts on Pacific people.
- Context – where/how/what and the meaning it has for that particular person or people. The context can be in relation to Pacific Island-reared people or New Zealand-reared people. Other contexts include politics and socio-economics.
TE WHARE TAPA WHA
The Maori model of health viewed as a product of:
Te Taha Wairua (spiritual): Related to individual and whanau perceptions of wairuatanga. Considers aspects of wellness that are often nondescript and intangible.
Four dimensions to measure outcome: dignity and respect / cultural identity / personal contentment / spirituality (non-physical presence). Think about: church, matakite (psychic), identity issues, visions, place in the universe, what makes you feel connected
Te Taha Hinengaro (psychological): Related to thoughts, feelings and subsequent behaviours.
Four dimensions to measure outcome: motivation / cognition and behaviour / management of emotions and thinking / understanding. Think about emotions, confidence, thoughts about self, future, world, identity.
Te Taha Tinana (physical dimension: It is inconsistent to isolate mental well-being from physical well-being, or to deliver psychological therapies without considering physical health.
Four dimensions to measure outcome: mobility and pain / opportunity for enhanced health / mind and body links / physical health status. Think about: alcohol & drugs use, diet, exercise, sleep, energy levels, GMC.
Te Taha Whanau (family): Measures the quality of the relationship between the client and whānau across
four dimensions: communication / relationships / mutuality / social participation. Think about: origin, networks, people that make them feel good/bad.
With 4 walls, the wharenui (meeting house) is a symbol of these 4 dimensions. The wharenui’s connection with the whenua (land) forms the foundation for the other 4 dimensions. By nurturing and strengthening all 5 dimensions, you support your health and wellbeing, as well as the health and wellbeing of your whānau.If something in your life is challenging the wellbeing of one wall or dimension, you can draw on the foundation and other walls until you can strengthen that wall again.
Rainbow model / ethinic
Minority stress chronically high levels of stress faced by members of stigmatized minority groups
Due to:
- poor social support
- low socioeconomic status
- interpersonal prejudice ( “feeling, favourable or unfavourable, toward a person or thing, prior to, or not based on, actual experience” feeling towards a person based on their perceived group membership) and discrimination (unjustified distinctions between people based on the groups)
o when minority individuals experience a high degree of prejudice, this can cause stress responses (e.g., high blood pressure, anxiety) that accrue over time, eventually leading to poor mental and physical health.
- difficult social situations lead to chronic stress and poor health among minority individuals.
Other cultural considerations
Other Cultural Considerations eg
- Waiting room and session rooms welcoming environment (diversity in signs, books, etc)
- Checking pronunciation of names
- Consider first language not English (eg reading resources)
- Be aware of age (e.g. different histories, values, what homework give eg apps)
- Different presentation of symptoms across cultures (eg more physical Asian cultures)
- Hesitancy sharing difficulties due to stigma (eg older male stoic attitudes, NZ culture ‘toughen up’)
