Taonga gifted recognising staff cultural care in ICU
Thomas Mitai is lucky to be alive and
he’s grateful.
In February the prominent and talented singer, kapa haka
performer, film maker, member of Ringatū church and man-
ager of Te Whare Wānanga o Awanuiārangi Tech Pā Studio
was on his way to work when he had a head on car crash.
The crash happened on a SH2 Wainui road between
Ōpōtiki and Whakatāne. Thomas suffered multiple injuries
including eight fractured ribs, punctured lungs, a lacerated
spleen, hematoma on his liver, a broken leg and several
cuts.
“I just came around the corner and the other car was on
the wrong side of the road. They were tourists, they were
lucky, they weren’t badly injured.
“I managed to stay conscious, but I was in a bad way. I
couldn’t breathe and I lost a lot of blood,” says Thomas.
He was taken to Whakatāne Hospital and transferred to
the Intensive Care Unit (ICU) at Tauranga Hospital. “I had a
nasal oxygen tube to help me breathe and at some stage I
had two blood transfusions.”
The crash happened just weeks out from Te Matatini Kapa
Haka Festival; New Zealand’s bi-annual kapa haka show-
case. When word got round that Thomas, a key talent in
the Ōpōtiki Mai Tawhiti group and well known in the wider
Thomas Mitai with Tauranga Hospital ICU Clinical Nurse Manager
Chris Southerwood and Health Care Assistant Tracy Penwarden.
kapa haka movement had been in a major car crash, people
came from all over the country to see him.
“I have huge respect for those who treated and cared
for me in hospital. They accepted and acknowledged my
Māoritanga, Ringatū faith and whanaungatanga. Having my
whānau and friends at my bedside gave me strength. For
me, that was everything and a key part of my recovery.”
Every evening Thomas was in hospital, his Dad, Richard,
a Tohunga of Ringatū would hold a karakia at his bedside.
Staff and patients would gather around as well.
There was waiata too. Blessed with a baritone voice,
Thomas is no stranger to performing solo or as a duet at
major sporting and cultural events across the country.
“I’d crumble if I couldn’t sing, it’s who I am. Their presence
and hearing them sing while I rested really lifted my spirit.”
Recently Thomas returned to the hospital bringing morn-
ing tea for staff and gifting a waka hoe (paddle) to ICU as a
symbol of his gratitude for the care he’d received.
Thomas says the message inscribed on the waka hoe is
one for all.
“Kia mau ki tō hoe. E hoe tō waka. Hold on to your paddle.
Continue your journey.”
Thomas is having physiotherapy as he continues his jour-
ney to recovery. The crash has also made him think about
other things he can do to improve his health.
“I’m more mindful about exercise and eating well. I’ve
stopped drinking so many fizzy drinks and since the crash
I’ve lost about 30 kilos.”
Ehara taku toa, he takitahi, he toa takitini.
My success should not be bestowed onto me alone, as it
was not individual success but success of a collective.
Kaupapa Māori approach to patient safety
This article was first published in the New
Zealand Medical Journal Digest by the
Health Quality and Safety Commission.
Patients and whānau often say ‘something just
doesn’t feel right’ and they are often correct,
recognising subtle signs of patient deterioration in
hospital, even when vital signs are normal. Failures to
adequately respond to concerns raised by patients and
whānau are commonly highlighted in adverse events
reported to the Health Quality & Safety Commission.
One US study reviewed patient and family escalation
data over a two-year period, concluding that the patient
and whānau escalation system saved lives, without an
overload of false positive calls.
Dr Alex Psirides, the Commission’s clinical lead on
patient deterioration, says it is important that patients
and whānau feel comfortable escalating care and have
a way to do this that suits their needs.
To achieve this, Dr Psirides says a co-design
approach to quality improvement can bring about
positive changes in the delivery of health care in
particular settings. Co-design is at the heart of the
Commission’s patient deterioration programme Kōrero
Mai | Talk to Me.
‘Involving patients in the design of the escalation
process is important because they have unique
experiences and insights to share alongside the staff
delivering care.’
To gain a better understanding of the cultural aspects
of whānau escalation, Kōrero Mai is supporting a
co-design project at the Bay of Plenty District Health
Board’s kaupapa Māori ward. Part of this involves
patient experience data collection.
Patients and whānau showed high levels of
connection to nurses. One patient reported ‘because
there is more of a whānau feel in this ward, and the
nurses make you feel very comfortable, it is easier to
tell them if you have a concern.’
Another patient said ‘I asked the doctor to write down
what was my illness and why I am in hospital. The
doctor left a hand-written note. This was great, I then
felt as if I knew what I needed to know.’
‘These positive relationships with staff appear to
encourage patients to use the call button and raise
concerns immediately when needed. The data and
analysis has shown that tikanga Māori concepts such
as whanaungatanga and manaakitanga are critical
in delivering safe and effective care for patients and
whānau,’ says Dr Psirides.
Whanaungatanga (building a relationship connection
with others) can be characterised by staff introducing
themselves to patients, explaining why they are there,
and treating the patient with familiarity and warmth.
Manaakitanga (care, hospitality) between clinicians
and patients is also important. Manaakitanga can be
characterised by clinicians taking the time to explain
medical matters to patients and whānau, being gentle
and caring, not rushing, and ensuring the patient
feels safe.
The project also highlighted that consulting doctors
and house officers don’t tend to introduce themselves
to the patient and their whānau.
‘The simple action of doctors introducing themselves
can help to build connection and break down barriers.
This helps patients and whānau feel more comfortable
about escalating concerns if needed.
‘Another reason that was highlighted for delayed
escalation is due to patients not wanting to be hōhā (a
nuisance). Identifying this is useful for understanding
some of the barriers patients face,’ says Dr Psirides.
Ria Earp, the chair of the Commission’s Te Rōpū Māori
(Māori advisory group) says ‘the approach to patient
safety used in the kaupapa Māori ward could benefit
far more patients, both Māori and non-Māori, if it was
introduced into the wards we call ‘mainstream’.
‘When bringing these successful elements into health
care it is important to have high-level management
support the application of tikanga Māori principles in
wards, and staff who are familiar with demonstrating
regional tikanga Māori principles,’ she says.
The Kaupapa Māori ward team at Tauranga Hospital.