Person-centred care: Being culturally appropriate

Our team was supporting a Māori kāumatua (elder) called Eru. 

Many of my colleagues thought he was physically aggressive and threatening, especially when he waved his walking stick at all the people in the lounge room. 

I was able to reassure them that the lounge was like the Wharenui, the main meeting house on a marae. He was using his stick as a tokotoko to give weight to his words. 

We now ask him to say a karakia before meals and give him a moment of respect when he comes into the lounge in case he has something to say to us all. 

Everyone is much more relaxed now, including Eru!

• Ngaire recognised that for Eru aspects of Māori culture such as mihi (the process of greeting and introducing ourselves), karakia (prayers and rituals), kai (food), te reo (language) and waiata (songs) could be important ways to enhance mana. Ngaire recognised the cultural importance of showing Eru that he was respected. She found ways in the activities and interactions to honour Eru’s identity as an older Maori (Dudley et al., 2019). 
• We interpret the world with reference to our own culture and world view. Ngaire was able to recognise that while the waving of a stick in her culture was interpreted as threatening, for Eru it had a different meaning in his culture.
• We hear a lot about the negative side of belonging to non-Pakeha cultural groups in the statistics. Ngaire and Eru remind us that culture and language are a precious resource that can help strengthen our sense of self, our sense of belonging to something bigger than ourselves, and our well-being.
• We can see the value of having someone who is comfortable within Te Ao Māori (the Maori world). When kaupapa Māori services or Māori care workers are available, we should always start by offering these sevices to tangata whenua we are working with, even if they decide not to use them. 
• Ngaire’s team was open to learning more and adapting their care, and Ngaire was confident in helping her team do things differently. To those of you who are tangata whenua, thank you for your generosity in helping those around you to continue to learn. For those who are seeking to learn more to support kaumatua, do seek out and build relationships with local cultural advisors (Dudley et al., 2019). 

• We often talk about cultural sensitivity and cultural competence. Another approach you may not have heard of is called “cultural humility” (Tervalon & Murray-Garcia, 1998; Hook et al., 2013; Waters & Asbil, 2013). Cultural humility is the ability to work with others in a way that is person-centred in relation to aspects of culture that are most important to the person. 
• Cultural humility isn’t about a one-off tick in the box, it’s a commitment to ongoing learning and self-reflection.
•  We are all influenced by culture. Part of cultural humility is to keep reflecting on our own cultural perspectives. This helps us move away from a hidden assumption that our way of looking at the world is “normal”.  
• Being aware of our own biases helps us to come into each care interaction in a way that is genuinely open, and to try to see the world from the perspective of the person living with dementia.
• We see ourselves as lifelong learners about culture and we welcome the opportunity to learn from our clients.
• We look for ways to express and put into action our valuing of culture in our day to day interactions with the person living with dementia.
• Cultural humility also involves looking at the big picture beyond ourselves: being aware of the power imbalances and holding our organisations accountable.

• Makarena Dudley, Oliver Menzies, and their colleagues (2019, 2021) have described a kaupapa Māori understanding of mate wareware and an approach to mainstream services supporting people living with mate wareware called the Tūhononga Whaiaro model.  This approach emphasises how important it is that we support tūhononga (connections / connectedness) for older Māori living with mate wareware to:
  • wāhi - place
  • tūpuna / tipuna - ancestors
  • whānau - extended family
  • whanaungatanga - the wider social network
• Mate wareware is a process that highlights how much of a person’s identity is actually tied up in these connections: to their roots in the land they belong to, their tūpuna (ancestors), their whānau (family and wider connections), their wairua (spiritual life and faith), and their access to being respected and loved – having a tūrangawaewae, a place they can truly stand with their mana intact. 
• Connections are important for all human beings but the connectivity that is described in this approach is uniquely Māori (Dudley, 2019).
• Sometimes we can be fooled into thinking that a person’s identity is entirely carried in their own head, so that mate wareware can somehow completely take away who they are. Instead we can think of the metaphor of being held within a net, with all these connections being knots in the net that collectively hold the kaumātua living with mate wareware to who they are and their place in the world (Perkins). 

• Person-centred care is about getting to know and support the whole person. When we are supporting kaumātua, the Tūhononga Whaiora model reminds us that this nestles within a kaupapa Māori approach that supports a person's whaiaro (sense of self / personhood) by enhancing:
  o    wairua and wāhi ngaro - the spirit and spiritual well-being
  o    hinengaro - the mind / mental well-being
  o    tinana - the body / physical well-being
  o    tuakiri - identity and role (Menzies et al., 2021)

• Cultural humility reminds us that person-centred care is about the aspects of culture that are important to the person.  Just because a person identifies themselves as belonging to a certain ethnic group doesn’t mean they sign up to a particular way of doing things. There isn’t one way to be Māori. Each person is unique and complex.

•  You can read the work of Makarena Dudley and Oliver Menzies and their colleagues about understanding mate wareware from a Māori perspective here.
•  You can read the abstract to the Tūhononga Whaiora model here.
•  You can watch a video by Melanie Tervalon and Jann Murray-Garcia who developed the idea of cultural humility here
•  You can find more resources about supporting Māori living with mate wareware on this page on our website here.
• You can find more resources about supporting people living with mate wareware who come from linguistically and ethnically diverse backgrounds on this page on our website here. 
• You might want to take a Te Reo course such as this one here.