1. Cheryl Atherfold and Chris Baker Professional Development Unit

2. Overview Use David’s story to discuss what living with chronic illness means for him and his wife Lyn Consider how culture, values and beliefs influences understanding of health issues and inequities Profile Maori living with chronic illness Identify models and approaches to care Discuss care considerations for Maori Te Whare Tapa Wha as a reflective practice model Empowering patient and family/whanau to manage their chronic illness

3. David’s Story In small groups discuss David’s story under the following headings: (10 minutes) Who is David?Taumarunui Social contextTe Kuiti Medical historyTokoroa Day to day living with chronic illnessThames Challenges when unwell and hospital admissions Waikato Feedback to whole group

4. Key messages from David’s story Build trust and rapport Treat with respect Listen to the patient Provide information so patient understands the importance of following treatment and taking medication Acknowledge patient’s knowledge and experience of their health condition and needs Nurses need to understand how complex the patient’s condition is Understand that patients would rather be treated at home

5. Person centred care Definition: Focusing care on the needs of the person rather than the needs of the service. A way of thinking and doing things that sees people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs

6. Considerations for person centred care A person’s culture, values, background and experiences influence how they understand health and illness, access services and respond to health care interventions. Spirituality Mental and emotional wellbeing Social and family Barriers to, and through, the health system for indigenous people and people in minority ethnic groups produce and perpetuate significant health inequalities.

7. People living with chronic illness Within the Waikato region: Aging population Rural population Maori Pacific

8. Maori living with chronic illness South Waikato and Hauraki health profile 2015 Maori aged 45-64 years have 3-12 times higher rates for heart failure than non-Maori Maori aged 45-64 have 3-5 times higher rates of Type 2 diabetes and COPD hospitalisations Maori aged 45-64 have up to 5 times higher rates of COPD than non-Maori

9. Other models of care / care approaches Holistic approach- a system of comprehensive or total patient care that considers the physical, emotional, social, economic and spiritual needs of the person; his or her response to illness; and effect of the illness on ability to meet self-care needs Strengths based approach- concentrates on the inherent strengths of individuals and families. It is client-led, with a focus on future outcomes and strengths that people bring to a problem or crisis Wagner’ chronic care model- is a widely recognised, applied and evaluated model for chronic care. It is a versatile framework for systems reorientation with six essential components: health system culture changes, community engagement, support for self-management, delivery systems (re)design, decision support and clinical information systems. Te whare tapa wha- is a Maori model of health and wellbeing that encompasses physical, whanau/social, spiritual and emotional wellbeing.

11. Te Whare Tapa Wha

12. Care considerations for Maori with chronic illness (Group work) DimensionCare considerations Whanau /family /social Wairua / Spirituality Hinengaro / mental and emotional wellbeing Tinana / physical

13. Te whare tapa wha as a reflective model DimensionReflection on practice Whanau /family /social How did you engage and connect with patient and whanau in a culturally appropriate manner? How did this build trust and rapport? What other resources did you access to meet cultural and holistic needs? How did you include patient and whanau in decision making, planning care? Were there any challenges that you needed to work through with whanau? If so how did you do this? Wairua / Spirituality How were spiritual needs identified and included in plan of care? How did you integrate cultural practices/tikanga into practice and care? What resources / support did you access to meet spiritual neeeds? How do your own spiritual beliefs impact on your practice as a nurse? Hinengaro / mental and emotional wellbeing How did you determine emotional needs and plan care to meet needs? How did you determine that care was provided in a culturally safe manner? How did issues related to mental and emotional wellbeing impact on other dimensions of health? Tinana / physical What did the patient identify as their physical needs? As nurse how did you meet patients’ physical needs?

14. Empowering person to manage their chronic illness Listen to patient Good communication strategies Therapeutic relationship Health literacy How information is provided and understood- think about how you provide information Equipping to self manage

15. What are people with chronic illness saying? Want more time with doctors Better explanations about their condition Better communication with health providers Need to involve family/whanau in health care Someone to assist them with accessing and co-ordinating services Difficulties with costs of health care and associated costs for their life and that of family/whanau Wanted their life and culture to be recognised and asked for links between mental and physical health to be acknowledged National Health committee. (2007). Meeting the needs of people with chronic illness. National Advisory Committee on Health and Disability: Wellington.

16. Conclusion Nurses play a key role in: Improving health literacy Empowering and equipping patients and whanau to manage their chronic illness Assisting patients and whanau to navigate health services Linking patients and whanau into relevant support Enabling people to live well with their chronic illness Improving health outcomes and reducing progression of co-morbidities