2. 2 Kia Ora Ni Sa Bula Vinaka Talofa lava Kia Orana Malo E Lelei Fakalofa Lahi Atu Taloha Ni Talofa

4. Levuka, FijiFiji School of NursingLevuka Hospital Lakeba Hospital Oneata Nursing Station LEVUKA

8. Background of Pacific population in New Zealand Where they are from Population statistics Geographical distribution Characteristics Nursing workforce Number of nurses Work type and settings Specialty (Oncology) Workforce issues Strategies and recommendations Leadership

9. To highlight the low number of Pacific Nurses choosing Oncology as a specialty To highlight the increasing number of Pacific people utilising Oncology services (within NZ and from Pacific Islands, Countries and Territories) To describe workforce issues facing Pacific Oncology Nurses To discuss Leadership in the context of Nursing Care and Service

12. People from the Pacific Islands have been in NZ for over a hundred years. In 1991 there were 167,000(4.9%) Pacific people in NZ & in 2001 more than 231,802(6.5%) were living in the country. In 2006,it had risen to just under 266,000 people and increase of 15% since 2001. In comparison to the total NZ population, Pacific peoples constitute a predominantly youthful population. Adverse socioeconomic circumstances & poor access to health care services put Pacific peoples among groups in NZ with the highest health needs.

13. Like Maori, Pacific peoples regard health in a holistic socio-ecological framework (is a comprehensive public health approach that not only addresses an individual’s risk factors, but also the norms, beliefs, and social and economic systems ). Ill health is thought to be the result of disharmony between humans & their environment. The patient may be seen as the victim of family wrongdoing Mental illness is often thought of as possession by evil spirits Pacific peoples are very religious & some observers have attributed their apparent apathy to fatalism, which is part of these beliefs. Christian doctrine dominates many customs and traditions, including those surrounding death & dying. (Tukuitonga C & Finau S. (Eds) Pacific Peoples in NZ, Pacific Health Dialog 1997: Vol 4 No. 2 ) (Tukuitonga C & Finau S. (Eds) Pacific Peoples in NZ, Pacific Health Dialog 1997: Vol 4 No. 2 )

14. 2001 Census Total = 3,737,322 Pacific people=200,262 2006 Census Total = 4,027,944 Pacific people=226,302

16. 20062010

17. Pacific Culture GroupsADHB% Samoan21,79840.0% Tongan14,86827.3% Cook Islands Maori8,46015.5% Niuean5,94610.9% Fijian1,9713.6% Other Pacific1,1192.1% Tokelauan3780.7% Total Respondents54,540100.0%

21. PAMTotal%Pacific% Ischaemic heart disease CVD60321.1%11821.2% Malig neoplasm trachea, bronchus, lung30510.7%519.2% Suicide2227.8%519.2% Breast cancer1966.9%285.0% Colo-rectal cancer1966.9%-- Chronic bronchitis and emphysema1665.8%254.5% Diabetes1595.6%6812.2% Intracerebral haemorrhage or occlusion CVA1575.5%397.0% Motor vehicle crashes993.5%183.2% Stomach cancer732.6%162.9%

22. Ethnicity Group20112012 Asian1,5641,770 European10,54210,761 Māori1,2061,483 Middle Eastern/Latin American/African184132 Not Stated/Unknown167214 Other 17 Pacific Peoples1,4131,509 Grand Total15,07615,886

23. 48,563 Total Nursing workforce: 48,563 Total Pacific Nursing workforce: 4,951 (10%)

24. Pacific Nurses Employment Setting Majority of Pacific Nurses work in District Health Boards (Acute)1906/4951(38%)

25. Pacific Nurses by Geographic Region Majority of Pacific Nurses work in Auckland1634/4951(33%)

26. EthnicityNo.% NZ European 3163 English612 Other European 48 Asian48 African24 Pacific24 TOTAL49100%

27. EthnicityNo.% NZ European 1547 English39 Other European 413 Indian516 Filipino39 Pacific26 TOTAL32100%

28. Shortage of Pacific Nurses Shortage of Pacific Nurses Informal survey was done in which nurses were randomly picked from the 3 different areas i.e. Day Stay Outpatient, Radiotherapy and the Oncology Ward). Informal survey was done in which nurses were randomly picked from the 3 different areas i.e. Day Stay Outpatient, Radiotherapy and the Oncology Ward). Lack of knowledge and awareness among non- Pacific Health workforce Lack of knowledge and awareness among non- Pacific Health workforce regarding the Pacific Cultural Competencies and the Pacific Concept of Service regarding the Pacific Cultural Competencies and the Pacific Concept of Service regarding the role of Pacific providers available resulting in under-utilization of these important stakeholders in time of needs. regarding the role of Pacific providers available resulting in under-utilization of these important stakeholders in time of needs.

29. Late presentation Data shows ( MOH NZ Suspected Cancer in Primary Care 2009) that Pacific people often present with cancer at a later disease stage. WHY? Shyness, fear, denial, anger, lack of trust and most importantly culture & language Insufficient Information Evidence suggests that in many areas of health, Pacific peoples do not have good information (MOH 2008b). This means that our Pacific patients cannot make fully informed decisions about their health or that of family members

30. Financial barriers to accessing health care Spending on health care is a lower priority for Pacific peoples resulting in Pacific patients not attending (DNA) Doctor’s Clinic and not having or delayed treatment (H Lewis, personal communication, Oct 2010)

31. Daily nursing intervention with Pacific Patients who utilizes the service by assessing the problem and referral for further management. Pasifika Week 2012. Inclusion of Pacific Family Support Involvement of Community Cancer Navigators (Health West) y Cancer Society referral if Pacific patients preferred the service provided. Other Health Specialist referral within the Hospital and Community based. Pastoral Care

32. Raising the profile of Nursing as a profession in which Pacific Nurses are used for recruitment into Secondary schools and Universities to showcase Oncology Nursing. Oncology focus Oncology focus during Nursing degree and nurse transition from final year to new grad. logy Education about Oncology and offer work experiences in the department to see what a wonderful area Oncology is to work in.

33. Making Oncology “Pacific Friendly”- Have a Pacific Day more than once a year! Pacific Nurses sharing information with other nurses regarding Culture and health perspectives. e Encouraging own staffs to attend Pacific Best Practice In Service coordinated by Pacific Team ADHB. Pacific Cultural Competencies are crucial to better health outcomes for Pacific peoples, it reminds us that health is more than simply the provision of health services, it recognises, healthy cultures, healthy environments, healthy lifestyles and healthy participation in the wider society. (MOH NZ 2009c)

34. Increasing the Pacific Workforce The Health Workforce Advisory Committee recommended that increasing the proportion of Pacific peoples in the health workforce to more closely match the population should be a priority, (MOH NZ, 2006a). Developing the Pacific health workforce will make a significant contribution to improving health outcomes. We bring connections with Pacific communities, personal understanding of Pacific issues and Pacific cultural and language skills (MOH NZ & Minister of Pacific Island Affairs, 2010).

35. “Anyone who is looked to as an authority (e.g., a nurse taking care of a patient ) or who is responsible for giving assistance to others is considered a leader” (Mahoney, 2001) “Leadership is not merely a series of skills or tasks, rather, it is an attitude that informs behavior” ( Cook 2001) Good Leadership is consistent superior performance with long term benefit to all involved. “Leaders are not merely those who control others, but they act as visionaries who help employees to plan, lead, control and organize activities” ( Jooste, 2004)

36. "Whatever work you do, do your best, because you are going to the grave, where there is no working, no planning, no knowledge, and no wisdom” [Ecclesiastes 9:10]

37. ANY QUESTIONS?