‘The wairua first brings you together’: Māori experiences of meaningful connection in neurorehabilitation

Abstract

Background and Aims: Therapeutic connections enhance patient experience and outcomes after neurological injury or illness. While we have some understanding of the components necessary to optimise therapeutic connections, these have developed from western-centric ideals. This study sought to explore the perspectives of Māori brain injury survivors, and their whānau (wider family and community), to develop more culturally informed understandings of what matters most for Māori in the development and experience of therapeutic connection. Design and Methods: A bicultural approach underpinned by principles of Kaupapa Māori Research was used. Whānau views and experiences were gathered through wānanga (focus groups). These perspectives were analysed drawing on Māori methods of noho puku (self-reflection), whanaungatanga (relational linkage) and kaitiakitanga (guardianship). Findings: Three wānanga were held with 16 people – 5 brain injury survivors and 11 whānau members. The phrase ‘therapeutic connection’ did not resonate; instead, people spoke of meaningful connections. For rehabilitation encounters to be meaningful, three layers of connection were acknowledged. The elemental layer features wairua (spirit) and hononga (connection) which both underpinned and surrounded interactions. The relational layer reflects the importance of whānau identity and collectivism, of being valued, known, and interactively spoken with. Finally, the experiential layer consists of relational aspects important within the experience: relationships of reciprocity that are mana-enhancing and grounded in trust. These layers are interwoven, and together serve as a framework for meaningful connections. Conclusions: Meaningful connections in neurorehabilitation are underpinned by wairua and hononga; are multi-layered; are enabled through interactions with people, practice, process and place; are inclusive of whānau and resonate with Māori worldviews. The primacy of wairua and whānau within an interconnected view of health, challenges individualistic notions inherent in western health models and deepens existing understandings of meaningful connections in neurorehabilitation which can guide future rehabilitation research, teaching and practice.

Wairua: Te ātaahua kaiwhatu = The beautiful weaver: Incorporating wairua into tertiary education

“…As participants understanding of wairua developed, so too did their recognition of wairua within the less tangible or tacit, such as feeling and seeing ancestors, and gut feelings. This aligns with the description of wairua from Wilson et al (2021) where they describe wairua as "a deep sense, energy" and can include an element of intuition (p. 13). As participants expressed their growing understanding of wairua, there was alignment noted with the dimension of being from the Occupational Perspective of Health (Hitch et al, 2014;Hitch & Pepin, 2021).…”

“…One potential reason wairua is not regularly included in tertiary education is the lack of a singular definition. Defining wairua is considered near impossible due to its encompassing, interconnected, and subjective nature (Valentine et al, 2017, Wilson et al, 2021. Therefore, it may be appropriate to explore personal experiences of wairua to better understand wairua and its significance.…”

“…Ripikoi (2015) states that wairua creates connection to all that is significant within te ao Māori. Wilson et al (2021) describe wairua as "a deep sense, energy" and believe wairua is an integral part of working with Māori and whānau and can include an element of intuition (p. 13).…”

“…The literature review was the catalyst for developing understanding of this concept and the current study strengthened this knowledge from a tauira perspective. From the outset of this discussion, it is important to understand that wairua is essential and fundamental in the lived realty of Māori (Durie, 2001b;Valentine et al, 2017;Wilson et al, 2021). Participants resonated with this fundamental aspect within their own lives, sharing their connection to wairua and their growing appreciation and awareness of wairua as the research journey progressed.…”

Reflecting on challenges and opportunities for the practice of person-centred rehabilitation

“…Several tools and practices have been developed to support person-centred ways of working in rehabilitation. For example, there is extensive research aiming to optimise person-centred approaches to goal planning, [41][42][43][44][45] engagement, [46][47][48][49] therapeutic relationship, [50][51][52][53][54][55][56][57][58][59][60] communication, [61][62][63][64] education, 65,66 interdisciplinary teamwork 15 and selfmanagement [67][68][69] all aiming to support the practice of person-centred rehabilitation through a focus on transdisciplinary rehabilitation processes.…”