Māori end-of-life care in the intensive care unit
Although the goals of care for intensive care patients are typically focused on restoration of health, people die in the intensive care unit (ICU). Early recognition of the need for end-of-life care is vital to identify and support the wishes of the patient and needs of their family. In Aotearoa, New Zealand, Māori are over-represented in admissions to ICUs. Enabling nursing staff to provide culturally-responsive care to Māori patients and whānau (family, including extended family, kin) is critical. A qualitative study by Bachelor of Nursing Honours graduate Ellie Taylor and supervised by Dr Natalie Anderson and Dr Tess Moeke-Maxwell explores the experiences of both Māori and non-Māori intensive care nurses, in providing end-of-life care for Māori patients and their whānau.
Four Māori and five non-Māori ICU nurses with varying years of experience were interviewed.
Whanangatanga and partnership was a central theme of culturally responsive care . Whanaungatanga does not easily translate to English, but it is about relationships, kinship, family connection, and a sense of belonging. In this context, it refers to the relationships and connections, rapport and trust between the nurses, doctors, whānau, and kaumātua (older men and women), each bringing invaluable knowledge.
“The aftercare was quite beautiful for the family and just getting them involved in that sort of stuff is important for them for their hinengaro (mind and emotions)”
Another key finding was the need for education around culturally-responsive care at the end of life. A large number of internationally qualified nurses staff ICUs across New Zealand. One participant conceded they had little familiarity with Māori worldviews.
“You feel uncomfortable in a lot of death and dying situations anyway - that you could do something wrong - but even more so if it’s unfamiliar … not growing up in New Zealand and not being exposed to Māori culture.”
Non-Māori participants found it helpful to have Māori colleagues to ask for support. However, Māori participants noted this extra cultural loading can contribute to burn out.
This research was recently published open access (free to all) in Australian Critical Care: