Allow space for whānau to gather

Health and social care professionals who provide holistic care are caring for the mauri (life force, vital essence) of kaumātua and their whānau. When health professionals demonstrate manaakitanga (hosting, caring) to kaumātua and their families during emotionally challenging times, their aroha can really help whānau to feel cared for.

Kaumātua Ned, his wife Whaea Jane, his sister and brother Rameka described how hospital staff provided their mother and the whānau with good manaakitanga after she had a stroke. Staff were very supportive and extended the rules so that the whānau could spend time with their kuia (older female relative):

Ned: They were so supportive… at times we took it for granted… you know, in the time of emotions you can expect that… you would hope that we are adult enough to recognise how far they were bending the rules just to support it.

Jane: So, they allowed us, to take her out of the stroke unit which has four beds and put her in for a certain time, to be in one of the isolation rooms… And they catered for us because we had the number of whānau there and number of visitors plus our little wee ones were in and out of the ward, so they were good with that. They didn’t harass the little ones by telling us off… So, they, went out of their way and the other thing was that we had those (the head) nurses that were continually with us on, on her journey. They didn’t change… there were three. And we knew them because we met them, those three the very first time that she went in. And because of that, they knew that we, there was a whole lot of us. So… that’s how they catered for us.

Sister: Because at one time they were catering for like 80 people… Yeah, 200 went through that ward…

Rameka: I think you can put it in the category of awhi (to embrace, cherish) … it’s not aroha because it’s not a personal connection, but massive awhi.

The whānau also spoke about how hospital staff provided breakfast, lunch and dinner to the whānau members who were constantly at the hospital caring for their mother:

Sister: The ones that looked after Mum, that were there constantly, they provided food… on a constant basis… You can see that they were well thing [equipped] in that sort of situation, dealing with whānau that are going through that sort of traumatic, you know, time with their loved ones.

The hospital staff also allowed the whānau to access a spare room during the weekend as the kuia had many visitors coming to see her at this time:

Sister: … and they said that they thing [manaaki] that to patients with you know, when their families are going through that sort of thing, and they always give the room over. But they were very impressed with us because we kept that room tip top…

The vital life essence is present until the kaumātua takes their last breath. Once their wairua (spirit) leaves their body they continue to be treated as if their wairua is present. This is because Māori believe the wairua stays close to the body until it is interred. This is why whānau manaaki continue to talk, kiss or care tenderly for kaumātua’s body after their wairua (spirit) has crossed the ārai (veil). Having privacy and space to carry out these cultural processes is essential for whānau manaaki to enact their end of life care customs. Having the support of health professionals can make a huge different to the grieving family.

Whaea S. (health professional) shared her thoughts about the time taken to support whānau. She said that caring for bereaved whanau did not need to take a lot of time. Professionalism should not get in the way of being kind:

I think you always do [tautoko whānau] … any care for whānau, whether it’s end-of-life or, whether there’s a mate, you can give that [tautoko] within a moment… Sometimes it’s just a, it might be just a touch, it might be just a consideration of, ‘How are you? What would you like to happen?’ A question. Or it might just be tidying up around them, so they’ve got more room to sit with their whānau. It’s about being discerning around what is needed in that moment. Sure in 2 hours or 20 minutes we’re going to have you know clear you out and say we’ve got to clean up and do whatever we need to do for the tūpāpaku, but at any moment we can adapt.

We can choose to be kind because that is the best thing to be at that time rather than [not]. And I, I disagree from any angle that my professionalism means I cannot be kind… I think it’s an absolute farce that [people say], ‘I don’t get the time to, to make their bed, I don’t have the time.’ If that’s what [whānau] want you to do, if they want to make the tūpāpaku look good, then make the tūpāpaku look good. Who cares if you’ve got a degree or you’ve got a master’s or… you’re a nurse practitioner? Person first you know. So yeah, I think we lose that because of our professionalism.

Whānau talk appreciatively about the physical space (rooms) that health professionals provide when someone is very ill or dying. This physical space becomes an important site for the kaumātua and their whānau to gather and to say goodbye to each other. It is essential for end of life cultural customs to be enacted and spiritual processes to take place. Whānau are often large and it can be normal to have more than thirty or forty people gather, especially as the kaumātua approaches death. As whānau fulfil their role to help someone pass through the ārai (veil) between this realm and the next, health professionals can fulfil their role to alleviate pain, suffering, and ensure dignity is preserved; their supportive actions will help the whānau to whakamana (uplift the status, authority and prestige) of their kaumātua at the end of life.

Recommendations

For health and palliative care professionals, we recommend:

That when cultural customs are taking place (such as prayers, karanga, speechmaking or singing), being respectful and joining in. It might be more important to the whānau manaaki that you join them and become part of the caring force that is working to bring forward a loving and healing energy as this helps to assist the kaumātua to cross the ārai (veil).

When Pato (health care assistant) visits a whānau and they start karakia, it is good tikanga (practice) to stop her mahi and join the whānau in karakia: