Tikanga Māori in the Context of Inpatient Whakatahe (Miscarriage): A Quality Improvement Project

Abstract

In Aotearoa New Zealand, it is estimated that one in four women experience a pregnancy that ends in whakatahe (miscarriage). A surgical procedure and hospital inpatient stay is sometimes required. In this highly medicalised context, the cultural needs of wāhine (women) Māori are often overlooked. Due to the lack of awareness of tikanga Māori (traditional cultural practices) amongst nursing staff, a quality improvement project was initiated in 2023 in a ward setting of a tertiary hospital. The aim was to incorporate tikanga principles into clinical practice for the management of miscarriage of pregnancy less than 21 weeks’ gestation. A kaupapa Māori approach informed the project design. Data collected during the project included a review of hospital policies and guidelines, a review of literature and other publications that addressed tikanga Māori principles during birthing and miscarriage, and consultation with Māori midwives. Using Te Whare Tapa Whā as a framework, the findings from these sources applied relevant tikanga principles to the clinical context of nurses caring for wāhine Māori and their whānau (extended family). A subsequent study day for nurses has increased their knowledge and confidence to incorporate tikanga Māori into their everyday practice, leading to observable changes. This outcome points to the need to invest in the education, knowledge and confidence of nurses in the use of tikanga Māori in ways that support wāhine Māori and whānau during a time of loss and grief. When nurses understand and know how to apply Te Whare Tapa Whā to their practice, it is possible to improve the experience of health services for wāhine Māori. Te Reo Māori Translation Ko ngā tikanga Māori ka pā mō te whakatahe ohorere o te tūroro: He kōkiri Whakapiki Kounga Ngā Ariā Matua E whakapaetia ana, kotahi wahine i roto i te whā i Aotearoa ka rongo i te pōuri o te whakatahe e mutu ai tētahi o ōna hapūtanga (miscarriage). Mō ētahi me haere tētahi mahi poka tinana, me noho hoki hei tūroro i te hōhipera mō tētahi wā. I roto i tēnei horopaki hōhipera nei, he rite tonu te wareware o ngā hiahia ahurea o te wāhine Māori. Nā te kore hoki o ngā tapuhi e mārama ki ngā tikanga Māori, i whakarewaina tētahi kōkiri whakapiki kounga i te tau 2023 i tētahi mātūtū (ward) o tētahi hōhipera taurima matatini. Ko te whāinga ia kia whakaurua ngā mātāpono i takea mai i ngā tikanga Māori ki roto i ngā mahi tiaki tūroro ki ngā mahi āwhina i te wahine mō ngā whakatahe hapū, i ngā wiki i mua i te wiki 21. I riro nā tētahi ara kaupapa Māori i ārahi te hoahoa kōkiri. Ko ngā raraunga i kohia i roto i te kōkiri ko tētahi arotake o ngā kaupapahere me ngā aratohu hōhipera, he arotakenga o ngā tuhinga me ērā atu pukapuka mō ngā mātāpono i takea mai i ngā tikanga Māori i roto i te whakawhānau me te whakatahe, me te torotoro i ngā whakaaro o ngā kaiwhakawhānau Māori. I whakamahia Te Whare Tapa Whā hei anga, ā, i hoatu ngā mātāpono tikanga hāngai ki te horopaki tiaki tūroro o ngā tapuhi e tautiaki nei i ngā wāhine Māori me ō rātou whānau. Nā tētahi rā wānanga i muri mai i piki ake ai te mōhiotanga me te māia o ngā tapuhi mō te kawe i ngā tikanga Māori ki roto i ā rātou mahi o ia rā, me te piki anō o ngā rerekētanga ka taea te kite. Ka puta i konei te whakaaro me tāpae rawa ki te akoranga, ki te mōhiotanga me te māia ki ngā tikanga Māori, i runga anō i te kimi tikanga tautoko wāhine Māori me ō rātou whānau i te wā o te mate me te pōuri nui. Ina mātau ngā tapuhi ki te hoatutanga o Te Whare Tapa Whā i roto i ā rātou mahi, ka taea te whakapiki ngā wheako o ngā wāhine Māori i roto i ngā ratonga hauora. Ngā kupu matua Tikanga; Māori; whakatahe; whakapiki kounga; mahi tapuhi; hōhipera; haumaru ahurea