‘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 Maori brain injury survivors, and their whanau (wider family and community), to develop more culturally informed understandings of what matters most for Maori in the development and experience of therapeutic connection.

Design and Methods: A bicultural approach underpinned by principles of Kaupapa Maori Research was used. Whanau views and experiences were gathered through wananga (focus groups). These perspectives were analysed drawing on Maori methods of noho puku (self-reflection), whanaungatanga (relational linkage) and kaitiakitanga (guardianship).

Findings: Three wananga were held with 16 people - 5 brain injury survivors and 11 whanau 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 whanau 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 whanau and resonate with Maori worldviews. The primacy of wairua and whanau 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.