Turning perception into practice: Advocating for cultural safety in health care

May 17, 2023

The journey to complete a master of nursing has served to further ignite Tania Bailey’s passion for reducing health inequities for Māori.

The 54-year-old graduated in Manawatū this month and says while challenging, the hard work was worth it.

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“As a single māmā of three boys, it meant finding ways to navigate and balance life, whānau and mahi all whilst studying. There were further complications when I had to put my study on hold because of an injury, but I was able to negotiate with ACC to incorporate it into my treatment plan, one paper at a time. This was the best rehabilitation and perseverance pays off!”

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Bailey (Te Āti Haunui-a-Pāpārangi, Ngāti Rangi, Te Ātiawa, Ngāti Mutunga) began her nursing journey when she was 18, working as an enrolled nurse before completing a nursing degree at Waikato Institute of Technology to become a comprehensive registered nurse (RN) in the early ’90s.

Throughout her career, Bailey has remained in a clinical role and worked across the health spectrum in both primary and secondary care while attaining an expert nursing professional portfolio and becoming an RN prescriber.

She started her postgraduate journey at Eastern Institute of Technology, before transferring to Te Kunenga ki Pūrehuroa Massey University after moving to Palmerston North. Tania says her journey with Massey has been special.

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“I’ve learned that I love research! It’s been a privilege to conduct research with neehi rangatira [Māori advanced practice nurses], to be part of Te Rau PuawaiTe Pūtahi a Toi – School of Māori Knowledge, and have the opportunity to complete this tohu [postgraduate degree] alongside my supervisors.

“As a tauira Māori, you do not have to feel isolated – there is tautoko [support] and manaakitanga [hospitality, kindness, generosity] from various rōpū Māori [Māori groups] at Massey. Whanaungatanga is everything!”

‘Māori advanced practice nurses hold vital resources to inform Te Aka Whai Ora – the Māori Health Authority.’

Her research project involved asking seven Māori advanced practice nurses (APNs) around Aotearoa New Zealand the question: “Are we culturally safe yet?” The research explored the current views of kawa whakaruruhau (cultural safety) at individual, organisational and systemic levels.

Bailey said the purpose of this question was to understand more profoundly what the barriers and enablers are to implementing cultural safety.

“This research follows on from the formal programme initiated by Dr Irihapeti Ramsden over 30 years ago. The findings have provided valuable information about the support needed for career progression and growth for Māori APNs to work to their full potential.”

‘This shift to a more authentic enactment of cultural safety will result in improved outcomes for Māori whānau, health-care practitioners and the system as a whole.’

Noteworthy findings in the study include highlighting the different and unique pūkenga (skill sets) of Māori APNs, which Bailey says positions them as key players in addressing inequalities within the profession and system.

“Māori APNs hold vital resources to inform Te Aka Whai Ora – the Māori Health Authority. One of the biggest challenges faced is how to move beyond simply having knowledge or awareness of cultural safety into operationalising cultural safety.

“This shift to a more authentic enactment of cultural safety will result in improved outcomes for Māori whānau, health-care practitioners and the system as a whole.”

Cultural safety pioneer and nurse, the late Irihapeti Ramsden.

“This research is dedicated to all neehi Māori o Aotearoa to acknowledge their mana and strength to continue to drive for transformative changes in health for our whānau, ngā iwi Māori,” Bailey said.

She is now working on publishing her research report which has implications for further research to guide policy and strategies for cultural safety in nursing and other health professions. Bailey is also considering a PhD pathway to continue her lifelong study and says she hopes to both see and help implement real change.

“I hope to see a full critical review of the nursing system in Aotearoa, with strategies to grow and strengthen the Māori nursing workforce. We need to grow and support our own nurses as an over-reliance on overseas nurses is unsustainable.”

Bailey has recently switched from clinical practice as an RN at He Puna Hauora to a research assistant role for a kaupapa Māori organisation. She is also now a pou a rongo (mentor) for Te Rau Puawai, having been a recipient of a Te Rau Puawai scholarship herself.

‘As a single māmā of three boys, it meant finding ways to navigate and balance life, whānau and mahi all whilst studying.’

She says support is everything when it comes to undertaking study.

“I’m extremely grateful for the tautoko, not only in the financial sense but being able to study with and draw support from other Māori health professionals and academics – being Māori with other Māori.”

She encourages current and future Māori tauira to ensure they seek similar foundations.

“Study is a commitment, but know there is support at Massey. Do your due diligence and plan your pathway, kōrero with someone who has or is studying the same course, kōrero to tutors and find out if any scholarship programmes would suit you. Find other Māori – there is a whole new whānau waiting there to tautoko you!”

Bailey says she’s incredibly thankful for her own support system.

“It’s been a privilege to work with my supervisors, Distinguished Professor Graham Hingangaroa Smith, Dr Kerri-Ann Hughes and Dr Jeremy Hapeta. Ngā mihi nui koutou katoa for your tautoko, guidance and belief in me. To my whānau whanui, aku tama tane: Weraroa, Raniera and Wiari – thank you for keeping the home fires burning.

“To my hoamahi [workmates] at He Puna Hauora and ‘Team Tania’: Janice Harrington, Matt Ward, Charlotte Bruce and Nici Scott-Savage, thank you for holding this space for me as I made my way back to Te Ao Marama. Thank you Te Ropū Ohu Rangahau.

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“I’d also like to express my immense gratitude and admiration to the seven rangatira Māori APN who shared their pūrākau [story], their mamae [pain] and their aroha with me.”

— Written by Massey University communications coordinator Holly Ann Taylor and reproduced with permission from Massey News.