1. Tatau p Equality and Talanoa Tongan Oral Culture Tatau pē Equality and Talanoa Tongan Oral Culture Dr Amelia Afuha’amngoTuipulotu Supervisors: A/Professor Maureen Boughton Professor Jill White The University of Sydney

2. 1.Background 2.Global and Tongan Contexts 3.The Research Approach 4.Research in Process 5.3 Foundational Elements for Nursing Practice: Challenges and Enablers 6.Tatau pē Equality and Talanoa Tongan Oral Culture 7.The Future of Nursing and Midwifery Practice- Where to from here? Kano’i Lea Content Overview

3. 1.Personal Philosophical Stance Socrates Philosophy “I only know that I know Nothing” I know Nothing” Holomui ki mu’a Background 2. a. Contrasting Nursing Experiences b. Externally driven Projects

4. Holomui ki mu’a Background Purpose of the Study To explore and identify collaboratively with Tongan nurses the foundational elements that will underpin the implementation of standards for nursing practice in Tonga

5. Holomui ki mu’a Background Significance of the Study 1.Gaining insights and understanding: enablers and challenges 2.Identification of Context-specific foundational elements for standards: to inform future development of standards 3.“Bottom up” Approach

6. Competency Standards in the Global Context Western World a.Challenges b.Why competency standards (CS) emerged? c.Other Conceptualisations surrounding CS d.Analysis of Professional CS e.Critiques of CS f.Gaps in the Literature

7. The Tongan Context The Four Strands for Development: The Kafa Pekepeka a.Cultural Influences b.Economic situation c.Political Influence d.Geographical Influence

9. The Research Approach a.Constructivism Paradigm: multiples, constructed, context-specific b.Influences from Action Research Perspective: participation, collaboration, reflection, investigation, reflective cycles c.Data Analysis Frameworks: Thorne (1997), Sandelowski (2000)-Braun & Clarke (2006): 6 Phases-1.familiarizing, 2.coding, 3.searching for themes, 4.reviewing themes, 5.defining themes, 6.reporting

10. Research Process Community Clinical Group meeting 1 Group meeting 2 Group meeting 3 Group meeting 4 Community Clinical Community Clinical Focus Group (10 co-researchers) Focus Group (10 co-researchers) Final meeting with group of co- researchers Nursing Profession 4 focus groups with all 10 co- researchers 10 co-researchers divided into two groups 6 focus groups with 5 co- researchers in each Nursing leaders Community nurses School of Nursing Clinical nurses Retired nurses Nurses in the outer islands List of Broad Themes Emerged Endorsement Cycles

11. 3 Foundational Elements: Challenges and Enablers 3 Ike wooden mallet 1.Patient Care Management 2.Professional Comportment and Development 3.Resource Management

12. a. Communication: Patients, Leaders, Doctors b. Quality and Safety: Practice, Workforce adequacy, Supervision, Competence Assessment 1. Tokangaekina ‘a e Mo’ui ‘a e Kakai Patient Care Management 1.Nurses’ Level of Knowledge 2.Attitudes of all 3.Work overload 4.Supervision of Practice

13. 1‘UlungaangaAttitudes2 Ngaahi Vaa Relationships3 Tupulekina Professional Development 2. ‘Ulungaanga moe Tupulekina Fakapolofesinale Professional Comportment and Development 1.Nurses’ Level of Knowledge 2.Nurses’ willingness to listen and show restrain 3.Lack of ongoing development, supervision, structure 4.Attitudes of all

14. 3. Tokangaekina ‘o e Ngaahi Naunau Fakangaue Resource Management 1. Understanding Scarcity of basic Resources – a Reality 2. Fakapotopoto mo Fakama’opo’opo –Tongan economic strategy economic strategy 3. Fetokoni’aki mo Fevahevahe’aki –Tongan Communal sharing 1.Lack of understanding 2.Nurses’ level of knowledge 3.Lack of maintenance 4.Attitudes of all

15. Ngaahi Poupou Enablers for Nursing Practice 1. Encouraging Talanoa Tongan oral culture 2. Ongoing development 3. Embracing good attitudes 4. Building Va Relationships 5. Empowering one another 6. Structures in Place 7. Safe Nurse-Patient Workload 8. Ensuring Basic Resources are Place 9. Kau Katoa Everyone Caring for Resources

16. Tatau pe Equality & Talanoa Tongan Oral Culture: The two Strands

17. Patients Nurses Leaders Respect Inclusiveness Recognition Empowerment Equal treatment Tatau pē Equality All stakeholders; patients, nurses and leaders are equal in relation to respect, inclusiveness, recognition, empowerment and treatment despite their individual status within the Tongan hierarchical society. Tongan Hierarchical Society

18. Talanoa Tongan Oral Culture AB Increasing Talanoa Patients Leaders Nurses Patients Nurses Leaders Increasing Talanoa from A to B will lead to stakeholders coming closer together

19. Koe Luva atu Our Me’a’ofa Gift

20. Siueli ‘o Tonga Motu’a Tongan Concepts 1.Pukepuke ‘a Fufula Nurturing the Priceless 2.Hoko e Fau moe Fau Excellence woven into Excellence 3.Alai-sia-alai-Kolonga Ambidextrousness of Talent and Performance

21. The Future of Nursing and Midwifery- where are we heading? 1.Leadership 2.Regulation (and Accreditation) 3.Workforce Development 4.Innovation/ Relevance in Education and Practice 5.Working Together: The Responsibility of All-Local, Regional and Global Contexts

22. Sosaieti ma’ui’ui matala ‘alaha ‘i Onopooni A fertile society blossoming into the Modern World

24. First International Conference for Tongan Nurses, 2010

25. Leveleva e Malanga Tu’a ‘Ofa atu