Conceptualising Kawa Whakaruruhau as a Nursing Praxis: Learnings from Māori Nurses

Abstract

This thesis presents the findings of a Kaupapa Māori research project aimed at conceptualising Kawa Whakaruruhau as a nursing practice. Kawa Whakaruruhau is a Kaupapa Māori (Indigenous people of Aotearoa New Zealand) nursing theoretical framework that was gifted to nursing in Aotearoa New Zealand by tangata whenua (people of the land). Kawa Whakaruruhau was intended to be integrated into nursing practice in Aotearoa New Zealand to underpin the nursing care of whānau Māori (Māori family units) accessing health services. However, since its implementation into the nursing education curriculum in 1992, no formal evaluation of Kawa Whakaruruhau has been undertaken. Moreover, due to public and political pressure, a redefinition period resulted in Kawa Whakaruruhau, a Māori-centric theoretical framework, becoming ‘cultural safety’ for everyone, reflecting multiculturalism. This thesis reports the impact of Kawa Whakaruruhau on Māori nurses. Informed by Māori nurses’ kōrero, this thesis further conceptualises Kawa Whakaruruhau as a Kaupapa Māori nursing praxis. Utilising a Kaupapa Māori methodology and methods, with a decolonising approach, this thesis aimed to answer the following research questions: 1. How do Māori nurses define Kawa Whakaruruhau? 2. How has Kawa Whakaruruhau impacted Māori nurses and their practice? Twenty-one Māori registered nurses, with 2 or more years of nursing experience, participated in the research. Kanohi ki te kanohi (face to face) and online individual interviews were conducted over 8 months, utilising pūrākau as a Kaupapa Māori form of narrative inquiry. Analysis of the pūrākau was conducted using Te āta‐tu Pūrākau framework. The rigour of the thesis was established using the Veracity of a Kaupapa Māori Project framework, which challenges the researcher to engage in reflexive practices to ensure that there are tangible benefits for Māori arising from the project. The participants described Kawa Whakaruruhau as a Kaupapa Māori nursing praxis. It involves ethical and moral decision-making practices, guided by Te Tiriti o Waitangi, tikanga Māori and professional nursing knowledge that are fundamentally underpinned by Māori nurses’ desire to uphold the mana of the tangata and/or whānau accessing healthcare. The foundation of Kawa Whakaruruhau, as a praxis, is whakawhanaungatanga, which Māori nurses prioritise, allowing time and space for this process. Spaces and practices they perceived to enact Kawa Whakaruruhau had a positive impact on Māori nurses. Participants reported that spaces that enact Kawa Whakaruruhau provided an increase in their confidence and practice development, including the refinement of their dual competencies. Notably, consolidation of their soft nursing skills, such as health consumer advocacy and communication techniques, was solidified. This thesis contributes to the conceptualisation of Kawa Whakaruruhau as a Kaupapa Māori nursing praxis. Firstly, the thesis explores Kaupapa Māori nursing practices, skills, and knowledge that constitute high-quality professional nursing practice being delivered to whānau Māori every day. Given the lack of formal evaluation of Kawa Whakaruruhau and cultural safety in nursing in Aotearoa New Zealand, this thesis provides insight into the impact it has had since its implementation into nursing education in 1992. Moreover, culturally unsafe spaces and practices have been highlighted to challenge the wider nursing workforce on current cultural safety education and practices contributing to the well-documented ongoing Māori health inequities (MOH, 2024).