WH EXAM

Question 1

Provide introductory information regarding cultural safety

Answer 1

The Health Practitioners Competence Assurance Act 2003 allows the NCNZ to govern the practice of nurses by monitoring standards and competencies for registration, to ensure health consumers receive safe and competent care. The effective nursing practice of a person or whānau from another culture, as detailed in the Code of Health and Disability Services Consumer Rights (2009) is determined by that person or family. Nurses therefore, must incorporate the principles of Cultural Safety into their nursing practice.

Question 2

Cultural safety / PRINCIPLE ONE

Answer 2

Cultural safety aims to improve the health status of New Zealanders and applies to all relationships through: nurses acknowledging the beliefs and practices of those who differ from them.

Question 3

Cultural safety / PRINCIPLE ONE / INDICATOR…..

Answer 3

INDICATOR 1.2 For example, this may be by: • age or generation • gender • sexual orientation • occupation and socioeconomic status • ethnic origin or migrant experience • religious or spiritual belief • disability.

Question 4

Cultural safety / PRINCIPLE ONE / meihana model…

Answer 4

MEIHANA MODEL – This can be applied to the component [Patient - Identifies as Māori] in the Meihana model

Question 5

Cultural safety / PRINCIPLE ONE / EXAMPLE

Answer 5

I displayed this in clinical by ensuring I had asked each patient I worked with if they identify as Maori. This would be in line with the above indicator, and I would ask this question regardess of age, gender, sexual orientation etc. This is to avoid actions that diminish, demean or disempowers the cultural identity and wellbeing of tūroro/patient and whanau. At the same time if they did identify as Maori, I’d follow the Hui process during our interaction in order to gain as much information around the cultural beliefs and stance in order to work together towards positive health outcomes for the patient. I would then review this over time to display cultural competence and safety

Question 6

Cultural safety / PRINCIPLE TWO

Answer 6

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

Question 7

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

Answer 7

INDICATOR 2.1 identifying the power relationship between the service provider and the people who use the service. The nurse accepts and works alongside others after undergoing a careful process of institutional and personal analysis of power relationships

Question 8

Cultural safety / PRINCIPLE TWO / indicator 2.1 / MEIHANA MODEL –

Answer 8

This can be applied to the component [Iwi Katoa – Services and system that provide support for patients whanau within the health environment] in the Meihana model

Question 9

Cultural safety / PRINCIPLE TWO / indicator 2.1 / MEIHANA MODEL / EXAMPLE

Answer 9

I displayed this in clinical with Mr XY, he had just been placed under the act and felt this was unjust. He was elevated at the time and no one had yet sat down with him to explain his rights. To develop the relationship to engender trust and respect I had sat with him to go over these rights. We discussed the betrayal he felt from the health system, he felt as if the MDT had judged his presentation by the notes from Doctors and nurses without talking to him how he felt and his experience had been. We discussed his last admission here and how he would not have had to be placed under the MHA if he had more involvement with MH services like a community nurse or his GP. He felt as though the health system failed him. I was able to discuss these concerns with his social worker and the nurses and pass it on to the MDT. I also communicated his concerns to his family on his behalf and asked the district officer to attend and formally go over the rights with Mr XY. Going through this process I was able to identify the barriers and enablers for Mr XY to accessing services so that the MDT are able to tailor a a more appropriate approach for him.

Question 10

Cultural safety / PRINCIPLE THREE

Answer 10

Cultural safety is broad in its application:

Question 11

Cultural safety / PRINCIPLE THREE / INDICATOR …

Answer 11

INDICATOR 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 / maybe talk about crowded housing being a determinant for helath for maori, ensuring that I ask questions around environemtn and lifestyle

Question 12

Cultural safety / PRINCIPLE THREE / INDICATOR 3.1 / MEIHANA MODEL

Answer 12

This can be applied to the component [Taiao – Physical environment of the patient/whanau ] in the Meihana model

Question 13

Cultural safety / PRINCIPLE THREE / INDICATOR 3.1 / MEIHANA MODEL / EXAMPLE

Answer 13

I displayed the application of this in clinical by asking other questions that are not in the health check to patients who identify as Maori that can contribute to a more thorough assessment. Housing has always been a historical determinant of health for Maori people, this has contributed to respiratory diseases. When doing the health check with the patient, apart from smoking being an obvious question, I ask about their housing situation/environment, how many people live in the house, if people smoke in the house and the conditions of the home itself. When asking these questions it also opens doors to other parts of conversation that can help inform health professionals more about the person. E.g When asking these questions to Mr XY he advised that his parents are often at work and out of the house, he is responsible in looking after the kids during the day. This shows that he has limited supports with his mental diagnoses and needs more support from MH services to be compliant and educated on his medication.

Question 14

Cultural safety / PRINCIPLE FOUR

Answer 14

Cultural safety has a close focus on:

Question 15

Cultural safety / PRINCIPLE FOUR / INDICATOR ..

Answer 15

INDICATOR 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 16

Cultural safety / PRINCIPLE FOUR / INDICATOR 4.1 / MEIHANA MODEL

Answer 16

MEIHANA MODEL – This can be applied to the component [Whanau – Support networks of the patient] in the Meihana model

Question 17

Cultural safety / PRINCIPLE FOUR / INDICATOR 4.1 / EXAMPLE

Answer 17

EXAMPLE – I displayed this in clinical by ensuring I had a connection and relationship not only with the person but their whanau. Ensuring I am understanding of their cultural processes and view of the health system and what they’re goals are for the patient. I worked alongside Mr XY’s brother and mother regularly during his time in the ward. We established what their concerns were and I would pass this on to the necessary people. When working with Mr XY and his family I regularly asked for feedback on their health plan and what they were struggling with. I provided them pamhplets that had information on the medication Mr XY was taking so that they were informed. In order to provide best health practice, any of my personal views or experiences were voided, ass they are with each patient to ensure I can fully grasp what is important to the patient themselves and whanu, whilst working together towards positive health gain.

Question 18

INTRODUCTORY statement for TOW

Answer 18

The TOW is NZ’s founding document. The government affirms Maori as tangata whenua that hold a unique place in Aotearoa. District health boards are required to demonstrate a commitment to be responsive to maori health and ensure positive health outcomes. As Crown Agents nurses must incorporate and demonstrate the principles, tino rangatiratanga, partnership, protection and participation in their nursing practice.

Question 19

TREATY OF WAITANGI / PRINCIPLE ONE

Answer 19

PRINCIPLE ONE Tino rangatiratanga enables Maori self-determination over health, recognises the right to manage Maori interests, and affirms the right to development, by:

Question 20

TREATY OF WAITANGI / PRINCIPLE ONE / INDICATOR

Answer 20

INDICATOR 1.1 enabling Maori autonomy and authority over health

Question 21

TREATY OF WAITANGI / PRINCIPLE ONE / INDICATOR 1.1 / HUI PROCESS / EXAMPLE

Answer 21

Whakawhanaungatanga [making a connection]

Question 22

TREATY OF WAITANGI / PRINCIPLE ONE / INDICATOR 1.1 / HUI PROCESS / EXAMPLE

Answer 22

EXAMPLE – I demonstrated the application by ensuring that I provide a safe space for Mr XY and his whanau to discuss their concerns, values and beliefs. I ask what their goal is and draw on the experiences they have had in the past and what changes they want to see in future. This is established during and throughout the interaction. Mr XY is a young male and often finds humour in a lot of things, I use this as a ice breaker and use humour as well as language that is not complicated to eliminate any stigma that he and his whanau have experienced in the past when accessing health services.

Question 23

TREATY OF WAITANGI / PRINCIPLE TWO

Answer 23

PRINCIPLE TWO Partnership involves nurses working together with Maori with the mutual aim of improving health outcomes for Maori by:

Question 24

TREATY OF WAITANGI / PRINCIPLE TWO / INDICATOR

Answer 24

INDICATOR 2.2 working together with an agreed common purpose, interest and cooperation to achieve positive health outcomes

Question 25

TREATY OF WAITANGI / PRINCIPLE TWO / INDICATOR 2.2 / HUI PROCESS

Answer 25

HUI PROCESS – KAUPAPA [attending to the purpose of the encounter]

Question 26

TREATY OF WAITANGI / PRINCIPLE TWO / INDICATOR 2.2 / HUI PROCESS /EXAMPLE

Answer 26

EXAMPLE – I demonstrated the application by ensuring I have performed a thorough assessment through the Meihana Model framework. I ask for consent to go through with the Meihana model and work collaboratively with the patient and whanau to have a broader understanding of the patients presentation and health experiences and then pass this on to the MDT to follow up on. To work towards positive health outcomes the whanau and patient are encouraged to talk more broadly about their situation so that we’re able to assist. When performing the Meihana model it provided the patient a sense of belonging and trust in our student nurse – patient relationship, further encouraged a shared power with the ultimate goal being a positive health outcome for both patient and whanau.

Question 27

TREATY OF WAITANGI /

PRINCIPLE THREE

Answer 27

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

Question 28

TREATY OF WAITANGI /

PRINCIPLE THREE / INDICATOR

Answer 28

INDICATOR 3.4 promoting a responsive and supportive environment.

Question 29

TREATY OF WAITANGI /

PRINCIPLE THREE / INDICATOR 3.4 / HUI PROCESS

Answer 29

HUI PROCESS – Mihi [initial greeting and engagement]

Question 30

TREATY OF WAITANGI /

PRINCIPLE THREE / INDICATOR 3.4 / HUI PROCESS / EXAMPLE

Answer 30

EXAMPLE – I demonstrated the application by ensuring Mr XY and his whanau knew the roles of the MDT before facilitating a review. During one day the MDT had done a lot of reviews, Mr XY was the last one to have his. At the beginning of the review the psychiatrist asked how Mr XY had been feeling in the last week. He mentioned the interactions we both had. I mentioned that it may be good if we could introduce everyone and their roles as Mr XY’s brother had also attended and it was his first time being in a setting like this. After we introduced everyone and our roles the whanau were able to be more at ease. After the review MR XY’s brother had thanked me for doing that as he wasn’t aware there was so many people involved in Mr XY’s stay in the ward.

Question 31

TREATY OF WAITANGI /

PRINCIPLE FOUR

Answer 31

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

Question 32

TREATY OF WAITANGI /

PRINCIPLE FOUR / INDICATOR

Answer 32

4.1 facilitating the same access and opportunities for Maori as there are for non-MaoRI

Question 33

TREATY OF WAITANGI /

PRINCIPLE FOUR / INDICATOR 4.1 / HUI PROCESS

Answer 33

HUI PROCESS – Poroporoaki [concluding the encounter]

Question 34

TREATY OF WAITANGI /

PRINCIPLE FOUR / INDICATOR 4.1 / HUI PROCESS / EXAMPLE

Answer 34

EXAMPLE – I demonstrated the application with Mr XY by ensuring that we have consistently established understanding in our interactions of what the aim, goal and next steps are. This is including his whanau - if they are not present, we call to update them over the phone. At times Mr XY’s family has not been present at reviews, in order to ensure that the whanau is actively involved and encouraged to participate I offer to facilitate a zoom session instead which we have done, otherwise we encourage that maybe another person in the whanau can attend instead, i.e Mr XY’s brother. This is so that Mr XY feels supported and comfortable when in reviews.