Tikanga Best Practice Guidelines

This guideline describes ways to incorporate Māori principles, beliefs and values into the delivery of primary health care services to ensure they are responsive to Māori. It aims to uphold the wairua (spiritual), hinengaro (psychological) and tinana (physical) well-being of patients and whānau.
While the guideline reflects Māori concepts, Tikanga Best Practice includes best practice standards of care for everyone, regardless of ethnicity.

Information and Support

Healthcare should be provided in an environment that is culturally sensitive to those using it. This is done out of respect for different cultural perspectives and needs, and also to support the total health of the patient.

Staff Action

The initial welcome and engagement with the patient and  whānau is an important part of a successful interaction within the practice. It is important they feel welcomed, accepted and valued.
Make sure the patient and whānau fully understand what is happening and what resources and support are available to them.
Support this by:

  • Greeting patients and whānau with “Kia Ora”.
  • Taking time for introductions in order to make a connection  with the patient and whānau.
  • Clearly introducing yourself and your role or service.
  • Ensuring names are pronounced correctly and asking when unsure.
  • Understanding that for Māori the concept of “next-of-kin” may be broadly interpreted.
  • Checking that ethnicity data is correctly recorded.
  •  Ensuring that all information is delivered clearly and is fully understood by the patient and whānau.
  • Asking the patient and whānau if they have any special cultural, spiritual, language or other needs you can assist them with.
  • Offering an interpreter wherever appropriate.
  • Informing patients and whānau of how to access the Health and Disability Consumer Advocacy Service and assisting with referral if necessary.
  • Keeping a current list of available resources (eg interpreter services, advocacy services, Māori Health Providers and other support).

Whānau Support

Whānau are of fundamental importance to Māori and are crucial to the patient’s well-being. The concept of whānau extends beyond the nuclear or biological family.

Staff Action

The whānau should be actively encouraged, supported and included in all aspects of care and decision-making.
Support this by:

  • Being mindful that the term “whānau” can be more extensive than just blood ties - it is an inclusive term to embrace others as part of the support unit.
  • Ensuring patients and whānau are actively encouraged, included and supported to be involved in all aspects of care and decision-making.
  • Finding appropriate space where the whānau can wait when they are not with the patient.
  • Being aware that the patient and whānau may wish to nominate a designated person to speak on their behalf.

Te Reo Māori

Te Reo Māori is an official language of New Zealand and many Māori words are becoming part of common New Zealand language. Learning to correctly pronounce Māori names and words shows respect and enables you to communicate in a way familiar to Māori patients and their whānau.

Staff Action

Include Te Reo Māori as part of the everyday language used within the practice.
Support this by:

  • Greeting patients and whānau with “Kia Ora”.
  • Learning to correctly pronounce Māori names.
  • Learning, practicing and using Māori words and phrases.
  • Including Māori signage around the practice.
  • Having Māori images, magazines and books in the waiting area.
  • Watching and listening to Māori TV, Radio and music.

Karakia

For many Māori, karakia (blessings, prayers) are essential in protecting and maintaining their spiritual, mental, emotional and physical health particularly in a healthcare setting.

Staff Action

Be open to the offering of karakia before, during or at the end of a consultation.
Support this by:

  • Allowing time for karakia, especially at times of  particular importance such as before a procedure or delivery of bad news.
  • Not interrupting karakia unless the physical care of the patient is compromised.

Tapu and Noa

Tapu and noa are key concepts that underpin many practices. It is important to keep things that are tapu (restricted) separate from things that are noa (unrestricted). In many cases, these concepts align with good health and safety practice.

Staff Action

Become familiar with the basic principles of tapu and noa, and the practical ways of respecting these concepts.
Support this by:

  • Clearly explaining the reason why and obtaining consent from a patient before touching them anywhere on the body, especially on the head.
  • Clearly identifying fridges/freezers used to store food or medication for human consumption and not using these for any other purpose.
  • Clearly identifying microwaves used for heating food and not using them for heating anything that has come into contact with the body.
  • Never passing food over the head.
  • Keeping food separate from anything that comes into contact with the body or bodily substances.
  • Keeping drinking containers specifically for that purpose.
  • Not sitting on tables or workbenches, and particularly on surfaces used for food or medication.
  • Having different linen and pillows for the head and for other parts of the body (eg white pillows for the head and coloured pillows for other parts of the body).

Taonga

Taonga (often worn around the neck) are extremely important to Māori and have much more significance than just sentimental value.

Staff Action

Be aware and respectful of taonga and, where possible, discuss any need to handle the taonga with the patient and whānau.
Support this by:

  • Only removing taonga if leaving them on the patient places them at risk.
  • Where possible, securely tape the taonga to the patient rather than removing it.
  • If risk is involved, clearly explain why the taonga needs to be removed and obtain consent from the patient before removing it.
  • The patient and whānau should have the first option of removing and caring for the taonga.

This is a printable version of this document should you wish to print and display it.

Tikanga Best Practice Guideline