Cultural Safety and Nursing Education in Aotearoa and Te ...

1 Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu Irihapeti Merenia Ramsden A thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing Victoria University of Wellington 2002. Abstract The research on which this thesis is based involves both a private narrative and a public narrative. It traces a personal history in order that the story of Cultural Safety can be told and the history, theory and the future direction can be gathered into one qualitative work. The work is divided into three sections. The first is entitled, Ko Wai Matou? The Private Narrative. This section seeks to explore the historical, social, educational, physical, emotional, political and moral influences and ephiphanies which brought about the personality which introduced Cultural Safety ideas into Nursing and midwifery.

2 Early Nursing practice is investigated and examples from practice are used to illustrate learning and consolidation of the ideas which led to Cultural Safety theory. The second section is entitled He Huarahi Hou: A New Pathway. This section explains the progress of the theory and its relationship to Education pedagogy and to Nursing practice. Comparison between the work of Madeline Leininger and the Transcultural Theory of Nursing and the new zealand concept of Cultural Safety is undertaken. The role and application of the Treaty of Waitangi to the theory of Cultural Safety is explored in this section. The third section, entitled He Whakawhanuitanga: The Public Narrative, looks at the introduction of Cultural Safety into the Nursing Education system and its implementation.

3 The public and media reaction to the inclusion of Cultural Safety in the national examination for Nursing registration and the subsequent parliamentary response are noted. The interviews with Nursing and midwifery leadership, Maori and pakeha key players in the process and consumer views of the ideas are documented and pertinent excerpts have been included. The work concludes with a discussion on the likely future of Cultural Safety as a theory and in practice and outlines several issues which represent a challenge to the viability of the concept in Nursing and midwifery Education . The story of Cultural Safety is a personal story, but also a very public one. It is set in neo-colonial new zealand , but has implications for indigenous people throughout the ii world.

4 It is about human samenesses and human differences, but is also a story about all interactions between nurses and patients because all are power laden. Finally, although it is about Nursing , it is also relevant to all encounters, all exchanges between health care workers and patients. iii Acknowledgements This thesis is dedicated with great love to the memories of Billie Manawatu Te Ra, Freda McKiech, Eric Ramsden, Linda and Frank Lewis, Te Uri o Te Pani Manawatu Te Ra and Hohua Tutengaehe, all of whom died too early and still had much to give. This work could not have been done without the financial support of the Health Research Council of new zealand from whom I received a Training Fellowship.

5 I wish to acknowledge and thank all the participants in the interviews who gave permission for their identities to be used in the study and gave of their time and their knowledge to help this project. Marian Evans who did the filming and helped compile the video archive. Lis Ellison . Loschmann who did everything else including the compilation of the video archive. Looking back over this journey there have been people who have offered love, energy, advice and support all along the way. From our Poua Tom who thought I was much too old to be doing this sort of thing, should be looking after the kids but oh well if that's what she wants to do then we are beside her, to those who slogged along with me helping with editing, culling, reviewing drafts, adding and subtracting from my propensity to include everything I have ever heard about Cultural Safety and then some.

6 I owe my supervisors Moana Jackson and Pamela Wood immeasurable gratitude. Through an extremely difficult and often unpredictable process they stayed with me and demonstrated their belief that the job would eventually be done. If they had their doubting moments they did not let me see them. Neil Pearce has been the mentor whom every student could want. Not only has his shining intelligence helped guide me through the mazes of the PhD experience but his partner Lynette Shum, busy with her own family and academic life, took the time to make me traditional medicinal treatments when I was ill. Lois Grant-Hroch, Naomi Young, and Allison Clark made sense of the typing and formatting. iv Other people have been there always and others for parts of the journey.

7 Their support and love has all been deeply appreciated. Sam Brown, Jim Vandeveer, Aroha Webby, Elizabeth Cunningham, Linda Grennell, Peter Ramsden, Paul Stannard, Arawhetu Peretini, Papaarangi Reid, Dierdre Nehua and Syd Jackson, Patricia Grace, Kathie Irwin, Joy Bickley, David Loeber, Michael King, Hal and Marlene Levine, Rocky and Jeanie Douche, Sue Thompson, Denise Wilson, David Burger, Rod McLeod, Rob McIlroy, Debbie Southgate, Shona Rapira-Davies, Jonathan Dennis, Vera Morgan, Lynn Pomare, Kere Pomare and Eddie Ford, both Eru senior and new Eru, Kahe and Tahuwhenua, the beloved middle child. Every word and gesture of encouragement and support from all these people and many more have been noted and appreciated.

8 Between these people and their children I have been nourished intellectually, emotionally and physically. Last, to my children and their partners my acknowledgement for their love and patience as I wove my distracted way through their lives. Peter and Pip, Pirimia and Ryan, thanks. Nga mihi aroha ki nga hoa me toku whanaunga, tino arohanui, Na o hoa aroha, (me o matua whaea me o taua ano) ko Irihapeti. v Table of Contents Abstract ii Acknowledgements iv Table of Contents vi Volume Two: Supplementary Material ix Table of Contents ix Figures xi Tables xii Chapter One: Introduction 1. Maori Nurse Recruitment and Retention 4. Cultural Safety and Perspectives 5. Ko Wai Matou? The Private Narrative 8.

9 He Huarahi Hou: A New Pathway 8. He Whakawhanuitanga: The Public Narrative 9. SECTION I: KO WAI MATOU? THE PRIVATE NARRATIVE 11. Chapter Two: Early Years, the People and the Places 14. Henrietta Merenia Manawatu Te Ra: 1918 - 1953 15. George Eric Oakes Ramsden: 1898 - 1962 19. Wellington: 1946 2001 21. Irihapeti Merenia Ramsden: 1946- 26. Schools 28. Chapter Three: Nursing 32. New Graduate 35. Team Building? 37. Quality Assurance 38. Expanding Horizons/Epiphanies Etcetera 40. the bone people/The Spiral Collective 43. Chapter Four: Community Health and Nursing 46. Mokai 49. Practice Issues and Ethical Dilemmas 50. Borders and Frontiers 52. Practice Examples 52. Practice Example One: Informed consent on the border 53.

10 Practice Example Two: Doing things differently 56. Practice Example Three: Establishing and maintaining trust 60. Practice Example Four: The power of attitude 62. Practice Example Five: Practice and research 63. Moving On 65. vi SECTION II : HE HUARAHI HOU : A NEW PATHWAY 69. Chapter Five: Towards Cultural Safety 72. Kawa Whakaruruhau: Maori Issues 72. The Treaty of Waitangi 74. Chapter Six: Learning and Teaching: Students as Teachers 78. Practice Examples 84. Practice Example One: Attitudes matter 84. Practice Example Two: Recognising powerlessness and power 86. Practice Example Three: Open-minded, self-aware 87. Appointment to the Department of Education 89. The Hui Waimanawa 92. Origin of the Term Cultural Safety 92.