1. Reflexivity in Practice
16th South Pacific Nurses Forum-Melbourne Australia 2012
Reflexivity in Practice
A cultural journey of nurturing the growth of Indigenous Māori Registered Nurses
Presented by Denise Rangitewhakaipo Riini

2. Mihi Pepeha- A Greeting
“The illustration depicts key elements of my ancestral ties to a the land, the water and tribal affiliations.”
Beginning
Taku mihi tuatahi ki te tangata whenua.
Taku mihi tuarua ki a koutou nga tangata o te moana nui a kiwa
Tena Koutou Tena Koutou Tena tatou katoa
Ko Mataatua te waka, Ko Putauaki te Maunga, Ko Whakatane me Rangitaiki nga awa, Ko Ngati awa te iwi, Ko Ngati Hokopu me Pahipoto nga hapu, No Aotearoa ahau. Ko Denise Riini ahau. No reira tena koutou katoa
Let me translate.
I greet the first nation’s people of this land. I greet the people of the Pacific. Greetings to you all.
I acknowledge these key elements of my Maori ancestry Canoe Mataatua, Mountain Putauaki, The Rivers Whakatane and Rangitaiki, My Tribal affiliation is Ngati Awa, My sub tribe affiliations are Ngati Hokopu and Pahipoto, I am from the land of the long white cloud (New Zealand). My name is Denise Riini , I greet you all once again.
This presentation is based on an auto-ethnological study.
16th South Pacific Nurses Forum-Melbourne Australia 2012

3. Background Māori ( Indigenous person of Aotearoa (New Zealand)
Te Ao Māori (A Māori world view)
Whanau ( consisting of a group of people who have a common ancestor or can be a group of people with a common goal- number 2 to 1000’s of people)
A cultural journey of discovery through reflexivity
Background
Let me provide you with some background to why I decided to reflect on my practice context.
When I entered into a nurse education role I was excited about the challenge of a different scope of practice. I was primarily a surgical/orthopaedic Registered nurse and my clinical colleagues would have considered me as a senior in the ward. I had limited professional involvement with a Maori world view and during the 15 years I worked in a secondary health service neither did the hospital I worked in. I was like many nurses, busy raising families and paying the mortgage, while my cultural roots were being consumed by the influence of the demands of a monocultural view.
I was thrust into an education role that demanded that I have a closer relationship with my ancestral origins. I was continually challenged with questions on my obvious (looks Pukana) ethnicity and I discovered that my ignorance was constricting my relationship with Te Ao Maori. I was totally out of my comfort zone and I was being pushed by non-Maori managers, at the time, into an arena that required that I justify who I am. There seemed to be an assumption that because I was Maori, I should know about all things Maori.
It’s a little like when you enter nursing and then all of a sudden your family see you as the expert on all things health related.
I remember Rangitamata Kinita a Maori Nurse Educator saying to me ‘Denise you need to read’. I thought to myself ‘I hate reading’ as if she had read my mind she said ‘you have too’
With an extensive amount of emotional stress I survived my first two years of lecturing. It was challenge to say the least ---however I survived and then began to realise the impact that I could have on the health of Maori through supporting Maori nursing students to succeed through the Bachelor of Nursing programme and to become Registered Nurses who would work with and for Maori.
So my cultural journey of exploration began.
16th South Pacific Nurses Forum-Melbourne Australia 2012

4. A Māori Worldview-Te Ao Maori
Reflexivity
A Nursing World View
A Māori Worldview-Te Ao Maori
Past
Present
Future
Whakapapa (genelogy)
Kaipurakau (Story telling)
Moteatea (lamenting song)
Tukutuku (weaving)
Whakairo (carving)
Waiata (Song)
Reflexivity
I considered a framework that would aid me in reflecting about my role context. I discovered that there were 2 distinct world views that had contributed to my understanding of reflective practice;
A Nursing world view;
A Maori world view;
Click -A NURSING WORLD VIEW:
Reflexivity is not new to nursing practice however; the models that guide our reflective practice are. And they are continually evolving.
Historically nurses used a range of practices to reflect on their role;
Florence Nightingale wrote her thoughts and her observations in a journal; (not too distant from today’s reflective practice).
Other practices include:
Handover between shifts provided a platform to reflect on practice;
Having experienced living in the nurses home at Waikato Hospital in the early 80’s (Hamilton NZ) this environment provided nurses with the opportunity to discuss challenges and triumphs of the day.
Some of these past practices, valuable at the time for some nurses, are viewed today by some as having being unprofessional and unproductive.
The models for reflective practice today, provide nurses with an opportunity to critique their professional practice.
Initially constricted to the art of academic writing health professionals are expanding reflexivity into other art fields.
The challenge nowadays and into the future is inspiring nurses to undertake this form of professional practice.
CLICK- FROM A MAORI WORLD VIEW it is my perspective that reflexivity has been practiced since the beginning of time. The process of Whakapapa (geneology) provides a laying effect as each generation reflects on the past, present and future Kaipurakau (storytelling) presents the details embedded within the layers and from this comes mōteatea (lamenting song), tukutuku (weaving), whakairo (carving) and waiata (song),
He moemoea, He wawata, He wero
The challenge for Maori past and present is that these ways of knowing have been devalued by another culture and for some Maori they have assimilated to this belief.
16th South Pacific Nurses Forum- Melbourne Australia 2012

5. Whai Whakaaro- Reflect
“The illustration depicts a reflection of a Poutama. A Poutama is literately a stairway. The significance of the stairway is in the journey one takes in their life .
Reflection requires:
Integrity and honesty
An open mind and transparent focus
The ability to consider the connectedness of the information the controversies and contrasts
Value the learning from the reflective process and visualise the potential outcomes
In considering a Maori and a Nursing World View – There are some key elements that are essential to Reflexivity- I use the analogy of the kaleidoscope ‘a favourite toy of mine as a child’.
These elements include- Firstly the operator –that’s me -self as the observer and than the next step requires that
I reflect with the ability to analyse and interpret the visual stage with Integrity and honesty- so that may means I need to look closer, let more light into the scope to explore and clarify.
I need to than have an Open-mind approach to the process and ensure a transparent focus is maintained- I may not like what is being reflected back at me,
So how do I deal with that?
I need to examine the interconnectedness of the information and the contrasts and controversies- Looking through a Kaleidoscope the hues don’t always blend with each other
Finally, I need to consider potential outcomes of the reflective process – Is there meaning in the task- what learning do I take from my reflection.
In using reflection on my practice context I discovered that understanding my entire life’s journey was essential to understanding how it has affected my nursing practice today, and consequently into my future.
16th South Pacific Nurses Forum- Melbourne Australia 2012

6. A Māori World view-Te Ao Māori
Inclusive within the constructs of the whanau
Opportunity to engage in Matauranga (knowledge/education) Māori
Whakapapa encased in values and beliefs
Connection to resources
There were two distinct worlds that influenced who I am today - A Maori Worldview and a Non Maori View.
Through reflection I was able to highlight the areas in my life I had been exposed to a Maori world view. I concluded by realising that the experiences I had living a Maori way of life and engaging in Maori ways of knowing was hugely positive influence in my life.
As I was:
Surrounded by the extended whanau- that meant being included and valued in the whanau for who I am
Stories of Acknowledgement of ones whakapapa/Genealogy and the deeds of my ancestors (These stories weren’t all rosy!)
Learning to value and respect elders and those who have knowledge.
You learnt not to challenge as you trusted that your elders would guide and support you in your life’s journey and you could rely on that judgement.
The connectedness to the land/whenua and the marae provided a sense of belonging
I had the opportunity to learn Te Reo and Maori Pedigogy such as– waiata
He moemoea, He wawata, He wero
I was exposed too much of what Dr Mason Durie describes as a secure Maori identity
So I wondered why I had assimilated my thinking towards a negative view of things Maori in my later life
The picture is of Rongomaipapa Marae (community complex connected by a common ancestor with ties to the land). This is where I had the fortune of experiencing a positive view of being Maori.
16th South Pacific Nurses Conference-Melbourne Australia 2012

7. Reflexivity Non Māori World View
“Justice system overwhelmed with Māori”
Māori Protest - Wanting land returned”
Non Māori World View
“Māori teenage pregnancies on the increase”
Restrictions because of my ethnic ties
Negativity of things Māori
Stereotypical views
Monocultural views
Assimilation to the main view
“Police are seeking Māori man in relation to a crime”
In reflection there were key areas in my upbringing that influenced my thinking in a Non Maori World view:
I went to a Catholic middle class secondary school where my ethnic culture was second to Catholicism
When I ventured out into the world looking for employment within a pre-dominantly non Māori workforce It was fair to say it was near impossible to secure employment that would be meaningful
Working within a health system were culture other the main viewpoint was ignored
Consistently exposed to a variety of media platforms that depicted the negative activities of Maori individuals or groups (Click to reveal post its)
Exposed to Maori and non-Maori managers who believed the propaganda and the stereotypes related to Maori
It didn’t take me long to assimilate to the main view that Maori (that’s me) was of no benefit too this world. This was my reality.
It was certainly an illuminating experience. Remember reflection should never be about blame- In my view it needs to be about the potential. I certainly had discovered my biases towards being Maori and for me in my role as a lecturer and nurse it was important to have that knowledge to ensure that how I delivered in my teaching practice and pastoral role –I would be regardful of those who are on their own individual life journey.
“Death rates for Māori on the increase”
“Unemployment
for Māori on the rise”
16th South Pacific Nurses Conference-Melbourne Australia 2012

8. Māori Nurse Educators role
“The Ilustration depicts two worlds a curved frond (koru) embedded within another representing a dual practice reality”
Conventional lecturing role
Cultural role
Although the pastoral role is embedded into the conventional lecturing role there are aspects of the pastoral care relationship which require a cultural perspective
As my pathway within nursing education continued there were many challenges I encountered
I had the conventional lecturing role,
marking, covering students on clinical/practicum, developing course outlines, lessons both up front teaching and online, supervising students with projects, developing assessments, pastoral care, contributing to the team through various committees and my studies towards a Masters
Cultural Role
There were some key areas that because I was Maori. It appeared to me that I represented Maori in a tokenistic view on committees or as consultant on things Maori, interview panels
Teaching of Te Tiriti o Waitangi/The Treaty of Waitangi (The founding document of New Zealand) Cultural Safety.
organising National Conference (Hui) attendance of staff and students and setting up Maori student cultural gatherings (noho),
pastoral care of year 1 Maori students
I reflected on the Pastoral care role as that too me appeared to have the potential to nurture the development of Maori Registered nurses. Fundamentally as nurses our vocation foci is supporting, guiding and caring for those who are within our nursing practice. The pastoral care role for me embraces these concepts. I do not proclaim to be an expert on the learning experience of the Māori nursing students, only that my lived experience provides the backdrop to my discussion.
16th South Pacific Nurses Forum – Melbourne Australia 2012

9. Aim of the Pastoral Relationship: Tino Rangatiratanga –Self determination
Nga Matatini Māori
Whakakotahi
Mana Motuhake Māori
Acknowledges that Māori come from diverse backgrounds
“Support regardful of unique world view”
Principle of Maori unity and belonging with a common goal
“Walking alongside students in their journey”
Maori autonomy through controlling own pathway
“ Providing the tools to strengthen students self determination”
So I was ready to engage in the pastoral relationship having reflected on my own experiences. I considered a few models to assist me in delivering an effective relationship that would have meaning for Maori student nurses. My goal for an effective pastoral relationship was the focus of Tino Rangatiratanga (self-determination) a concept that Dr Mason Durie explores.
Click- Nga Matatini Maori
Maori come from diverse realities so in the pastoral relationship an acknowledgement of that unique world view is essential.
Click- Whakakotahi
So the unity and collective approach to the student journey is imperative and its about walking with the student and guiding and supporting.
The concept of the whanau group provides students with a
Click- Mana Motuhake Maori
Students are valued within the pastoral relationship; they maintain ownership and set the direction of the relationship. Nurse Educators provide tools within the relationship towards autonomy e.g. knowledge
My goal is Tina Rangatiratanga, I thought how could I achieve this goal- I looked at another model to assist me -The underpinning philosophy of the BN programme at Waiariki Institute of Technology- Te Wheke
Durie, M. (1995) Tino Rangatiratanga: Maori Self Determination, He Pukenga Korero, A Journal of Maori Studies. 1(1), 44-53
16th South Pacific Nurses Forum-Melbourne Australia 2012

10. Holistic view of the Pastoral care relationship
Te Wheke
Based on the Octopus and its synergistic being as it flows through the water
Each of the eight tentacles are representative of a fundamental human need to achieve wellbeing
Through using components of Dr Rangimarie Tururiki Pere’s (1995) Te Wheke’ a philosophical concept based on an Octopus ‘ and its synergistic seamless capacity to move smoothly through water. Each of the Eight tentacles represent a fundamental human need to achieve wellbeing.
The following slides provide the direction of the pastoral relationship within the 8 areas of wellbeing, as I will talk about the challenge’s that some Maori nursing students encounter in their lives while studying towards their goal.
Pere, R. T. (1997). Te Wheke: A celebration of infinite wisdom. Gisborne: Ako Ako Global Learning New Zealand Ltd.
16th South Pacific Nurses Forum-Melbourne Australia 2012

11. Holistic view of the Pastoral care relationship
Te taha Whanau-social wellbeing
Holistic view of the Pastoral care relationship
Providing advocacy for Maori students unique world view
Provision of an environment that endorses Whanangatanga/collectiveness
Endorsement of the pastoral care relationship
Establish and maintain the therapeutic relationship
On-going support and guidance
Click-Te Taha Whanau
The reality of the whānau experience for many Maori students is that:
There are expectations by whānau, iwi and hapu for these students to succeed
There home lives are often consumed by generational expectations e.g. looking after not only their own children but also grandchildren; elderly grandparents, sometimes parents and sometimes nieces and nephews
There role of mother changes to becoming a student and whānau often have trouble grasping the role change.
A reduction on a relatively meagre income places pressures on all members of the whanau to make sacrifices.
Social networks alter as they develop relationships with likeminded people and whanau feel excluded
Maori students and staff who attended National conference in 2010, Christchurch NZ.
16th South Pacific Nurses Forum-Melbourne Australia 2012

12. Holistic view of the Pastoral care relationship
Te taha Tinana-physical wellbeing
Te taha Hinengaro- intellectual wellbeing
Supporting students physical wellbeing
Support with reducing smoking
Education and support with pregnancy
Education Support with menopause
Guiding students with academic development
Encouraging students to seek specialist interventions
Provide a forum that allow s for Maori students to discuss academic challenges
Translate curriculum requirements into a language understood.
Click-Te Taha Tinana
About 50% of Māori nursing students indulge in risk taking behaviour e.g smoking, alcohol consumption
Physical health will be challenged; nutritional deficits, weight management, increased stress
2% will become pregnant during the course
1% will experience menopause
Click- Te Taha Hinengaro
Many Maori nursing students will enter the program as 2nd chance learners, Most would have had challenging educational journeys up to the time they enter the program. And haven’t leant the art of assertiveness with diplomacy. So they often don’t question.
Definitely within the first year, they struggle to grasp the academic processes.
16th South Pacific Nurses Forum-Melbourne Australia 2012

13. Holistic view of the Pastoral care relationship
Te taha Wairua- spiritual wellbeing
Te taha Whatumanawa-emotional wellbeing
Providing a forum for spiritual wellbeing-marae
Encouraging students to realise their potential
Advocacy
Caring for students wellbeing
Referral to appropriate services e.g. counselling, social welfare
Ensure students values and beliefs are upheld
Provision of an environment that nurtures a whanau perspective-a dedicated space
Click- Te Taha whatumanawa
Financial constraints, and coping with whanau needs e.g. teenagers, dependent children, partners, and extended family needs and cultural needs ---along with meeting study requirements increases the students:
Stress , Anxiety And Guilt levels
Click- Te Taha Wairua
Students try to maintain their dream, they often make sacrifices for their whānau and the consequences are their study suffers. They try to balance the needs of themselves and those of the whānau and the end result for some is that their Wairua becomes depleted.
16th South Pacific Nurses Forum-Melbourne Australia 2012

14. Holistic view of the Pastoral care relationship
Te Mauri-life force that sustains energy
Te Mana-diverse worldview
Develop a supportive therapeutic relationship that enables Māori nursing students to engage in a positive relationship with others
Role model the potential
Encourage things Māori
Encourage self development
Celebrate success
Provide a forum that supports students unique te Ao Māori viewpoint
Being Genuine
Maintain each persons mana
Click- Te Mauri
Sustaining the energy to succeed and some don’t succeed but most will have a tenacious attitude and see a future for their whānau and realise their dreams and potential
Click- Te Mana
The unique diversity of the Maori nursing student world is challenged within a conventional educational systems. Maintaining their mana is a priority within the pastoral relationship. If they succeed they will make a huge difference in their lives and the lives of the whanau.
If they fail they become another statistic.
16th South Pacific Nurses Forum-Melbourne Australia 2012

15. Reflexivity
Does an effective pastoral care relationship nurture the development of Māori Registered Nurses?
The relationship creates a supportive partnership throughout the Māori student nurse journey- Nga Matatini Māori
The Māori student nurse duplicates the relationship with subsequent intakes of Māori nursing students-Whakakotahi
Year 3 Māori student nurses become independent and less reliant on the pastoral relationship -Mana Motuhake
The role modelling of the pastoral care relationship evolves as students become Māori Registered Nurses who engage in a similar relationship within their practice context.
They graduate with a holistic wellbeing that has experienced growth.
Does an effective pastoral care relationship nurture the development of Maori Registered Nurses? I say YES
There are several Maori nursing students I have had the pleasure in walking beside during their journey in becoming Maori Registered Nurses.
They graduate and work as Registered nurses within a variety of health services.
AND they nurture Maori nursing students who come into their practice context.
16th South Pacific Nurses Forum-Melbourne Australia 2012

16. Reflexivity
Does growing Indigenous Māori registered nurses contribute to health outcomes for Māori?
Māori Registered Nurses become health educator s and health resource people for the whanau, hapu and iwi
They advocate for the Māori consumer of health services
They become consultants to Health policy development
They inspire their whanau to take up the challenge of nursing or other tertiary study.
They become nurse leaders of the future for Māori
Does growing indigenous Maori registered nurses contribute to health outcomes for Maori?
I say YES
Through supporting the training of Maori to become Registered Nurses this will improve health outcomes for Maori in terms of
becoming the educator on health within their own whanau hapu and iwi,
advocacy for Maori as consumers of health services,
Health policy developers
First generation health professionals who inspire
16th South Pacific Nurses Forum-Melbourne Australia 2012

17. Conclusion
Reflexivity is simply a tool if used with integrity the experience can enlighten and empower ones practice context.
A Māori Nurse Educators role is sometimes a solitary journey and requires a selfless attitude.
The role is demanding and challenging from a conventional and cultural context
The role is integral to the success of Māori taking up the challenge of becoming Registered Nurses.
This role does impact on health outcomes for Māori.
The role is humbling and I am privileged to be part of a journey that supports the development of Indigenous Māori Registered Nurses.
Conclusion
Reflexivity is simply a tool if used with integrity the experience can enlighten and empower ones practice context.
A Maori Nurse Educators role is sometimes a solitary journey and requires at times a selfless attitude.
The role is demanding and challenging from a conventional and cultural context
The role is integral to the success of Maori taking up the challenge of becoming Registered Nurses.
This role does impact on health outcomes for Maori.
The role is humbling and I am privileged to be part of a journey that supports the development of Indigenous Maori Registered Nurses.
16th South Pacific Nurses Forum-Melbourne Australia 2012

18. Waiata
He moemoea, he wawata, he wero A dream a vision, a challenge He hikoi, he tiaki I etahi atu, A journey, to care for others He akiaki, he tautoko Encouragement and support, Aroha me te arotau Love and understanding Nga whanau, hoa, tipuna me Ihowa Family, friends, ancestors and god He moemoea he wawata he wero
He moemoea, he wawata, he wero
A dream a vision, A Challenge
He hikoi, he tiaki I etahi atu,
A journey, to care for others
He akiaki, he tautoko
Encouragement and support,
Aroha me te arotau
Love and understanding
Nga whanau, hoa, tipuna me Ihowa Nga whanau
family, friends, ancestors and god
He moemoea he wawata he wero
16th South Pacific Nurses Forum-Melbourne Australia 2012

19. Acknowledgements
Year 2008,2009, 2010 and 2011 Māori Registered Nurse Graduates of Waiariki Institute of Technology
The whanau at Rongomai papa Marae
My own whanau and my children for creating the illustrations
Veronica Tawera RN driving force behind the waiata-class of
Māori Nurse Educator Colleagues who have supported me in my Poutama within nursing education
Dr Rose McEldowney who was my supervisor during my studies
Waiariki Institute of Technology for supporting me financially to present at the 16th South Pacific Nursing Conference.
16th South Pacific Nurses Forum-Melbourne Australia 2012

20. References
Durie, M. (2003). Nga Kahui Pou: Launching Maori Futures. Huia Publishers: Wellington. Durie, M. (2001). Mauri Ora: The dynamics of Maori health. Oxford University Press: Melbourne. Durie, M. (1999). Whaiora: Maori Health Development (2nd ed.). Oxford University Press: Melbourne. Durie, M. (1995) Tino Rangatiratanga: Maori Self Determination, He Pukenga Korero, A Journal of Maori Studies. 1(1), Mead, H.,M. (2003). Tikanga Maori: Living by Maori Values. Huia Publishers. Wellington. Munford, R., & Walsk-Tapiata, W. (1999). Strategies for Change: Community development in Aotearoa/New Zealand. School of Social Policy and Social Work. Pere, R. T. (1997). Te Wheke: A celebration of infinite wisdom. Gisborne: Ako Ako Global Learning New Zealand Ltd.
16th South Pacific Nurses Forum-Melbourne Australia 2012