+ General Country Information
+ History
+ Concept of Time
+ Family and friends
+ Gender
+ I or We Attitudes
+ Manners and Taboos
+ Spiritual care
+ Communication Style
+ Greetings
+ Language and Communication
+ Non-verbal Communication - Eye contact
+ Non-verbal Communication - Gestures
+ Non-verbal Communication - Personal Space
+ Attitudes and understanding of dementia and other health issues
+ Attitudes to end of life care
+ Attitudes to pain
+ Attitudes to residential care
+ Care information
+ Cultural Activities
+ Cultural Traits
+ Food and Diet
+ Music
+ Special Days - Christmas
+ Special Days - Easter
+ Special Days - New Year
+ Special Days - Other
+ Superstitions

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Aboriginal and Torres Strait Islander

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Indian

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Maori

Nepalese

New Zealander

Polish

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Ukrainian

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Generalist

  • New Zealand is located in the continent of Oceania.
  • It has four maritime boundaries; Australia, Fiji, Tonga and Norfolk Island.  
  • It comprises of two main islands, named the North Island and the South Island. These islands are separated by the Cook Strait.
  • The North Island is renowned for its diverse cities, volcanic activity and national parks and the South Island is renowned for its mountains, lakes and glaciers.
  • New Zealand also consists of; Stewart Island (the third largest island that lies south of the south island), hundreds of coastal islands and many regional islands.
  • Three quarters of the population lives in the North Island and Waiheke Island has the largest population of the smaller islands.
  • In the 2013 census, 598,605 people identified with the Māori ethnic group and 668,724 people were a descendent of a person of the Māori race of New Zealand (New Zealand Government).
  • New Zealand has a low population density, with a population of approximately 4,474,549 people (Central Intelligence Agency, 2016).
  • New Zealand has a total area of 268,838 square kilometres and ranks as the 76th largest country (Central Intelligence Agency, 2013).
  • People from New Zealand are often given a “nickname” (informally referred to as) “a kiwi” or  a “Maussie” (short for Māori Aussies).
  • Census data indicate major ethnic groups are; European 71.2%, Māori 14.1%, Asian 11.3%, Pacific Islanders 7.6%, Middle Eastern, Latin American, African 1.1% as well as others (Central Intelligence Agency, 2013).
  • The climate is; subtropical in the far north in summer, snow in the mountain areas in winter, and mild weather in most of the country.

Tips

  • Understand that a person’s country of birth does not define their culture. Whilst we are “born into culture” we are not “born with culture”. A person’s “culture” is something that is learnt from our environment and by our individual experiences. It continuously adapts to our changing circumstances throughout our lives.
  • Determine what culture or cultures your care recipient identifies with.
  • Keep in mind that the culture in metropolitan areas varies with culture in rural areas and that culture in different regions within a country may also vary significantly.
  • Learn about your care recipient’s life history, and who they identify with, to determine their individual cultural traits. Document any significant details.
  • Understand how your care recipient’s culture informs their values, behaviours, beliefs assumptions, likes, dislikes and sensitivities.

Resources

Generalist

History of Migration to Australia

  • It is reported that by 1842 the Māori language could be spoken by some workers on Sydney docks, and that Māori people were also in the gold fields of Australia in the 1850s.
  • All New Zealanders, including Māori, had easy access to Australia, however, very few migrated until the 1960s.
  • The downturn in the New Zealand economy saw a surge in Māori migration in the 1970s and 19780s.
  • Many Maori worked shearing sheep or in the mines in the Australian outback.
  • New Zealanders of Māori descent make up about 12% of the New Zealand-born population in Australia and it is estimated that in 2011 there were about 128,434 Māori people living in Australia (Australian Bureau of Statistics, 2011)

History of New Zealand

  • Refer to History Resources

 

Tips

  • Determine exactly where your care recipient was born and where they lived. For example; was your care recipient born in Australia, or did they migrate to Australia? If they migrated, how and why did your care recipient migrate to Australia? What experiences and associations do they have of their home country? If they have lived in other countries; where have they lived? How long did they spend in other countries and what did they do whilst they were there?
  • Be aware and sensitive to any stress that may have been experienced as a result of their history (this may include; family separation, homesickness, conflict, depression and isolation).
  • The knowledge of a person’s history may assist with a better understanding of the care recipient as well as any associated psychological issues resulting from their past.
  • Understand how your care recipient’s culture informs their values, behaviours, beliefs assumptions, likes, dislikes and sensitivities and document any significant details.

Resources

Generalist

  • Māori are considered collectivistic people.
  • The Māori society is based on the social units (or whakapapa): iwi (tribe), hapu (sub-tribe) and whanau (family - including immediate and extended family).
  • Identity is based on a combination of all units.
  • Collective identity is a lived experience that is based on deeply held values. These are reflected in the attitudes, behaviours and lifestyles of many Māori people.

Tips

  • Identify and document if your care recipient is an “individualist” with an “I” attitude of self and immediate family, or a “collectivist” with a “we” or group attitude, or if they have both “collectivist” and “individualist” traits.
  • Allow for a “collectivist” person to feel the comfort of doing most things in a group setting and for an “individualist” person to have more opportunities for themselves.

Resources

Generalist

In New Zealand

  • The major religious affiliations in New Zealand include:  Religions: Christian 44.3% (which includes Catholic 11.6%, Anglican 10.8%, Presbyterian and Congregational 7.8%, Methodist, 2.4%, Pentecostal 1.8%, other 9.9%), Hindu 2.1%, Buddhist 1.4%, Māori Christian 1.3%, Islam 1.1%, and other religions 1.4% (includes Judaism, Spiritualism and New Age religions, Baha'i, Asian religions other than Buddhism).
  • A large proportion of New Zealanders (38.5%) also reported having no religious affiliations religion. Smaller proportions did not identify any religion or refused to answer (Central Intelligence Agency, 2013).

In Australia

  • New Zealand-born people living in Australia are predominantly Anglican, Catholic, Presbyterian or Reformed Christians (Australian Bureau of Statistics, 2011).

Māori spiritual beliefs

  • Creation started with the gods (or atua): Te Kore (the void), Te Pō (the night) and Te Ao Mārama (the world of light).
  • The gods Papatūānuku (earth mother) and Ranginui (sky father) had children including: Tāne (forest God), Tangaroa (sea God), Rongo (cultivated food God), and Tūmatauenga (God of war).
  • Human beings are believed to be descendants from Tāne and the first women he created.
  • Tohunga were the experts or priests. It is believed that Gods (atua) and spirits communicated through a tohunga.
  • It is believed that power (mana) came to people from their ancestors, and more mana came to those that were born first in the family.
  • Today, many Māori are Christian (primarily Anglican, Presbyterian, and Roman Catholic).
  • Generally, Māori public gatherings include a Christian prayer in the beginning and the end.
  • Māori people may begin and end their day with a prayer and bless their food before eating.

General

  • Different cultures and religions have different expectations of care in regards to toileting, dressing and feeding.
  • Every culture and religion vary greatly in spiritual needs and this may impact on the acceptability of certain treatments and medications. Therefore, it is paramount to identify the care recipient’s religion and cultural background to appropriately address the supports and services required.
  • For further information, refer to Spiritual care resources.

Tips

  • Accept and respect that customs, religious and spiritual beliefs vary from one culture to another and that the beliefs of your care recipient may significantly differ to your own beliefs.
  • Utilise resources and attend training sessions to increase your own knowledge about different religious and spiritual beliefs.
  • It is useful to ask care recipients a range of questions such as; ‘what helps you cope in difficult times’ and ‘what is important to you’ to determine ways to enhance their care.
  • Be aware of the significance of spiritual needs to your care recipient. Identify and document their religious beliefs and spiritual needs such as; any special requirements regarding food, personal care, linguistic needs or religious impacts towards treatments and/or medication.
  • Identify and provide access to relevant religious literature, radio, TV, live stream services, DVDs and CDs.
  • Support care recipients to maintain religious networks and religious representation and facilitate outings to places of worship.
  • Acknowledge and observe days of religious significance to your care recipients in a culturally appropriate manner.

Resources

Generalist

  • The extended family (whänau) is important to Māori people.
  • To Māoris, whänau relates to direct family and well as a wider kinship group that share a common ancestor.
  • The whänau is the basic social unit of Māori society, and the wellbeing of one member is of concern to all.
  • Māori people tend to live in close proximity with their extended family, either within mixed households or as neighbours.
  • Whänau helps to define one’s role within the family and it also brings with it a system of interrelated obligations, responsibilities and benefits.
  • Māori people share their achievements with their whänau and may also make decisions for a member, usually in consultation with the person concerned.
  • Māori people are familiar with ancestral connections and display these at formal occasions.
  • Sharing a bit of your own background, and allowing Māori people to do the same, can make it easier to establish rapport.

Tips

  • Be aware and sensitive to the fact that some people may have become separated from family for a range of reasons including; Stolen Generations, war, conflict, disaster or migration.
  • Families and friends from different cultures will have a different understanding of dementia and their expectation of care for their loved one may vary significantly.
  • Provide communication and information in accordance with their language and literacy level and facilitate all achievable care expectations.
  • Gain an understanding of the dynamics of your care recipient’s family and friends and engage with them whenever required/needed.
  • Ensure that roles in decision-making about care of the person with dementia have been clearly established and documented.
  • Research indicates that carers of people living with dementia experience greater strain and distress than carers of other people.
  • It is important to be sensitive to the feelings of shame and guilt that family members and friends may be experiencing.  

“Family and friends” resources

  • A range of information to help support family and friends is available in the “Family and friends, resources” section below.

Resources

Generalist

In Australia

  • The main languages spoken by New Zealand-born people in Australia are; English, Samoan and Māori (Australian Bureau of Statistics, 2011).
  • The majority of Māori people can speak English and it is common for Māori to use informal, shortening words or adding endings to words (such as ‘o’ or ‘e’).

In New Zealand

  • English, Māori and New Zealand Sign Language are the official languages of New Zealand (New Zealand Government).
  • Other languages include; Samoan (2%), Hindi (1.6%), Northern Chinese (1.2%) and Yue (1%) (Central Intelligence Agency, 2013).

Tips

  • Being able to communicate effectively is crucial to the physical and emotional well-being of the care recipient.
  • Be careful not to underestimate or assume the communication capacity of a person with dementia.
  • Ensure that the care recipient has participation in decisions that affect them.
  • The words you use when speaking to, and about, a person with dementia matters. It is important to always use positive and enabling language and to not use words that may cause offense.
  • Ensure the health care and personal care plans and reviews identify and support the linguistic needs of your care recipient and their family.  Be mindful that linguistic considerations should include the care recipients’ menu choices, food services, their religious and spiritual needs, and their ability to participate in activities. Determine what language(s) they are able to speak, read and write. Communicate with them and provide information according to their language preference and literacy level.
  • Identify and record and health issues such as poor hearing, poor eyesight, dehydration or problems with dentures to ensure there is no miscommunication with your care recipient.
  • Be aware that most people with dementia will revert back to their native tongue and/or other languages they have learnt.
  • Care recipients should always be given the choice to use professional translators and interpreters. Provide professional translators and interpreters to your care recipients and/or to their family whenever they request the need, when the care plan is developed, when the care plan is reviewed and at any time when “informed consent” is required.
  • Care recipients often prefer to communicate with a care worker from their own cultural background therefore the use of bilingual staff or volunteers should be always be considered and provided whenever possible. The care recipient should however be given this choice rather than it be assumed that this is their preference.
  • Provide visual aids, use gestures and physical prompts, and learn and use key words in the person’s own language to improve communication during routine care and other simple service interventions.
  • Ensure that communication is adapted to the care recipient’s level of dementia and understand the importance of allowing more time for those in later stages to understand and respond to you.
  • Support your care recipients' individual choices by providing access to media such as radio, TV, live stream services, DVDs, CDs and books in their preferred language.
  • All staff and volunteers should undertake training in cultural awareness, appropriate communication and the correct use of telephone and on-site interpreting services.

Language and Communication resources

  • Refer to the “Language and Communication, Resources” section below for a wide range of information (including communication cards, signage, health information in community languages, etc.)
  • Translating and Interpreter contact details and other relevant information is available in the "Links, Translating and Interpreting" section. 

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Language is a foundation of the Māori culture and it is believed to be a gift from their ancestors. Words are seen as links to the past, present and future.
  • Traditional greetings in Māori culture include people touching or lightly rubbing their noses together (known as Hongi). This type of greeting is mainly used at formal Māori events.
  • Pronunciation is important and considered a sign of respect. It is therefore best to admit difficulty with pronunciation and seek guidance first, rather than attempting to pronounce a Māori name you are unsure of how to say.
  • Māori people like to know the name of their carer and often wish to learn about the people that are involved in their care (as Māori culture relies on interpersonal relationships).

Tips

  • Start building trust and rapport from the first time you meet your care recipient. Ensure you correctly pronounce their name. Smile and speak clearly. Be respectful and make sure the care recipient understands you.
  • Establish and document how your care recipient prefers to be greeted. Take into account; formality, titles, preferred name(s), any different greeting expectations from different genders or from people from a different generation, and the way(s) they like and dislike to be greeted. 
  • Understand that a person with severe dementia will think that each time they see you during the day is for the first time. Therefore ensure that you greet them in an appropriate, friendly and caring manner each time you meet.

Language and Communication resources

  • Translating and Interpreter contact details and other relevant information is available in the "Links, Translating and Interpreting" section. 

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • It is common for Māori’s to use an indirect style of communication.
  • The values of harmony and respect are of great importance, therefore Māori’s naturally avoid disagreements and try to seek consensus, even if they do not agree with what you are saying.
  • Silence may also indicate disagreement.
  • A good approach to gauge the level of understanding and acceptance of information provided to a Māori is to ask them open ended questions. For example; “Please tell me what you think will happen to you from what I have explained to you”.
  • Māori culture values expressiveness when it comes to communication, so hurrying or interrupting another person in conversation is regarded as rude and disrespectful.
  • Māori people may be reluctant to engage in conversation if they know they will be rushed.
  • Good rapport can be built by spending extra time during an initial meeting and identifying mutual friends, discussing shared hobbies, or learning the names.
  • It may be useful to include whanau (extended family) when providing health care information to Māori patients, so that they are able to ensure that sufficient information has been given and any disagreements can be identified.
  • Māori people often have a preference to speak face-to-face (known in Māori as ‘kanohi kitea’). This should be considered when providing services and information to Māori people.

Tips

Care recipient

  • Identify the communication style of your care recipient.
  • Be aware that communication styles vary from one culture to another.
  • Realise that physical, sensory, psychological and social issues can impact on the ability to communicate effectively. Make a note of any that are relevant to your care recipient.

Care worker

  • To ensure that the care recipient can understand you avoid speaking too quickly or using slang, acronyms or jargon. Also try not to give too much information at one time.
  • Be aware not to use patronising speech or a demeaning tone as this can lead to a communication breakdown.
  • Remember than non-verbal communication such as body language is just as important as verbal communication. Ensure that your tone matches your body language to avoid miscommunication.
  • Be kind and caring in your communication with the care recipient. Remember the person with dementia has a lifetime of experiences and is a person with feelings, even though may have lost the capacity to think or behave like they used to.

Language and Communication resources

  • Translating and Interpreter contact details and other relevant information is available in the "Links, Translating and Interpreting" section. 

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Indirect eye contact is preferred by Māori’s.
  • The use of direct eye contact may be considered as confrontational, a sign of conflict, or as being rude.
  • Even though Māori people generally have a preference for verbal communication, this is not a request for direct eye contact.
  • A common Māori’s saying is “we listen with our ears, not our eyes”.
  • Māori people often look at a neutral spot during conversation, to better listen to how something is said, instead of being influenced by the appearance of the person speaking.
  • As with any other care recipient, indirect eye contact may also be due to anger, anxiety, boredom, or fear, and therefore other signals from the care recipient should always be taken into consideration.
  •  Observing interactions between a Māori person and others can be a gauge on preference of use of eye contact, however, if you are unsure of any non-verbal signal, it is best to ask.

Tips

  • Determine and document if the care recipient prefers direct or indirect eye contact and if there are any different expectations from different genders or from people from a different generation.

Resources

Generalist

  • The head is the most sacred (or tapu) part of the body in Māori culture so consent should be sought and casual touching should be avoided.

Tips

  • Any gestures you use need to be respectful to the person with dementia.
  • Body language can provide important clues and increased understanding for both the carer and the care recipient. However many gestures have different meanings in different cultures therefore take care to ensure there is no miscommunication.
  • Document any gestures that the care recipient prefers to use or any gestures they find offensive.
  • Determine if the care recipient has expectations from different genders or from people from a different generation in relation to the use of touch. For example; if they find it appropriate/comforting for someone to hold their hand when they are upset or in pain.

Resources

Generalist

  • Personal space is important in Māori culture.
  • Physical distance between non-Māori and Māori is particularly important until a closer relationship has been established.
  • Traditional Māori welcoming ceremonies (known as a powhiri), require physical distance to be maintained between visitors and hosts until greeting rituals are completed. This then indicates the basis of a closer relationship has been established, and allows closer physical distance.
  • Awareness and respect for physical distance is appreciated, and can be shown in the care setting. For example; if the care setting is very small a care worker could say “I’m sorry that this office is so small. Please excuse me for having to sit so close”.
  • Care workers should also be aware that an unfamiliar person walking into the room of a person with Māori descent, and instantly exceeding their personal distance to examine them, can cause the Māori person great discomfort. Best practice is for introductions to be made and rapport to be established first.

Tips

  • Determine and document how the care recipient feels about their personal space and if there are any different expectations from different genders or from people from a different generation.
  • Allow for a “collectivist” person (with a “we” or group attitude) to feel the comfort of doing most things in the space with others (group settings) and for an “individualist” person (with an “I” attitude of self and immediate family) to have opportunities to have personal space for themselves.

Resources

Generalist

  • Māori people are generally not punctual.
  • Many are driven by their Wairu (“spirit”) rather than time imposed by wider society.
  • Māori prefer to measure and indicate time in terms of events (natural or man-made) rather than at a pre-arranged clock time. This allows them to place priority on Māori values.
  • “Māori time”, commonly used by New Zealanders of European descent, refers to being late or past the appointed time.
  • Māori’s generally like to “take their time”. Their pace is usually slow and calm rather than rushed and fast paced.

Tips

  • Determine and document how the care recipient and the family view “the concept of time”. For example; do they like to be punctual? Do they expect others to be punctual?
  • Ensure the care recipient's concept of time does not adversely impact on meal times, activities and other scheduled events.
  • Be mindful that shaming and blaming someone for being late can cause feelings of guilt and low self-esteem. Instead, use positive communication. For example; you might ask “Would a different time would be more suitable”?

Resources

Generalist

  • Māori culture is guided by the principle of balance, and men and women play complementary roles.
  • When caring for Māori people it is important not to assume that a male is the head of the family.
  • Women hold as much authority (or ‘mana’) as their male counterpart in traditional Māori society.
  • Within Māori creation beliefs, there are key female figures, which highlight the importance and power of women. For example; “Papatuanuku” (Earth Mother) and “Hineahuone” (first human formed from the earth – a female).
  • Māori language is gender neutral. For example; there is no equivalent word for “he” or “she”.

2016 Global Gender Gap Index  rankings

  • New Zealand ranked 9th out of 144 countries for gender equality in 2016.
  • Countries are assigned a score where 0.00 = inequality and 1.00 = equality. New Zealand received a score of 0.782 (World Economic Forum, 2016).

Marriage

  • Traditionally, Māori society was shaped by family and tribal links and partners were chosen within the "hapū" (a division of people) or "iwi" (tribe).
  • Māori chiefs often had more than one wife.
  • Many marriages were arranged but people sometimes found their own partners, and then asked for agreement from family members.
  • Since 1909, a minister of religion (recognised by the Marriage Act) has been required to perform a marriage ceremony.
  • In 1951, the Māori Purposes Act was implemented, removing the any legal recognition of traditional Māori marriage.

Same-sex relationships

  • Historians have evidence such as early wood carvings, (including a Māori “treasure box” from the late eighteenth century that includes stylised sex between two males) indicating homosexuality existed and was accepted in pre-colonial Māori society.
  • It was only after the arrival of the missionaries, that bought with them views that homosexuality was sinful, that there were challenges of the acceptance non heterosexual relationships by Māoris.
  • In Māori language, “Takatāpui“(also spelled takataapui), means “a devoted same-sex partner”. In modern terminology, Takatāpui” refers to anyone that is not a heterosexual partner (including; bisexual, gay, lesbian,  transgender, transsexual or queer).
  • Same sex marriage has been legal in New Zealand since 19 August 2013 (Equaldex).

Tips

  • For many people with dementia the gender of the care workers is important, particularly in sensitive situations. Determine and document if they have any preferences, concerns or expectations regarding care provided by someone of a different gender.
  • Accept and respect that male-female roles in families may vary significantly among different cultures.

Lesbian, gay, bisexual, transgender or intersexed (LGBTI) people with dementia

  • Don’t assume the gender preference of the person with dementia.
  • Recognise that even those that have children may not be completely heterosexual and understand that it could take some time for a care recipient to gain enough trust to share personal information about their gender preference.
  • Begin by evaluating yourself and any assumptions, phobias, biases or beliefs that you might hold internally.
  • Utilise resources and attend training sessions to increase your own knowledge about LGBTI people.
  • Understand the importance of your first and immediate reaction or response. Be aware of your own reactions - not only what you think, but also be aware of what you say and what body language you use.
  • Most LGBTI people have experienced rejection, stigma, discrimination and abuse and therefore have a fear of receiving inadequate treatment, being denied services or facing further discrimination or prejudice. It is vitally important to create a non-judgmental open and caring atmosphere free from discrimination. Confidentiality is also a vital aspect of care for LGBTI care recipients.
  • Be careful with the terminology you use to the care recipient and their partners.
  • Provide partners of LGBTI care recipients with the same respect and privileges that you would give to a spouse or relative.      

Resources

Generalist

World Alzheimer’s Day

  • Each year on 21 September, Alzheimer associations around the world unite to acknowledge and recognise World Alzheimer’s Day. The aim of the day is to make a difference for people with dementia, their families and carers worldwide.

Illness beliefs

  • Some Māori may believe that illness is the consequence of wrongdoing, or breaking “tapu” (a tribal law).
  • Illness caused by wrong doing is known as “mate Māori”.
  • Māori patients (as with patients of other cultural backgrounds) should be asked about their views on the cause of their illness.
  • If appropriate, care workers could suggest that a “tohunga” (expert advisor) or minister helps to address the spiritual aspects of the Māori patient’s condition.

Tips

  • The amount of understanding and acceptance of dementia may vary significantly among different cultures, families and individuals. Determine the understanding of dementia of the care recipient and their family, if they accept dementia and if stigma is associated.
  • Provide information to the care recipient and their family according to their language preference and literacy level.
  • Ensure that people with dementia and their families are aware of dementia information and of support services available.

Dementia resources

  • A wide range of information is available in the Attitudes and understanding of dementia disability and illness, resources section below.
  • Contact details for Alzheimer’s Australia offices are available in the “Links, Alzheimer’s Australia offices” section of this app.

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Māori people often consider hospitals as “places where people die” and therefore may be reluctant to be admitted.
  • Māoris may also be concerned or feel discomfort, because non-Māori hospitals do not consider the death tapu (sacred) way of doing things such as cleansing hospital rooms and beds in line with Māori standards.
  • Hospital restrictions on the number of visitors and the hours in which visitors are permitted can also be problematic, as Māori people are accustomed to having friends and relations around especially when they are unwell. If limitations are necessary, it is important to discuss the rationale with the person with dementia and their family and to try and establish the best possible compromise.

Tips

  • The meaning or value of residential or community care may vary greatly among cultures.
  • Be aware that many people will not want to hear about or talk about residential care until crisis point.
  • Understand that families and friends from different cultures will have different expectations for the care of people, particularly in regards to toileting, dressing, feeding and other self-help skills.
  • Allow the care recipient and their family to make choices to suit the individual’s care needs.
  • Ask care recipients questions about what can be done to achieve quality of life and help them have meaningful lives that enable them to pursue their cultural interests and passions in accordance with any frailty, disability or cognitive impairment.
  • Understand and facilitate all achievable care expectations of the care recipient and their family.

Resources

Generalist

  • Māori people, especially those that are older, may seek advice from a tohunga instead of seeking assistance from a western doctor.
  • Tohunga are often older relatives that look after the wellbeing of the family, and have knowledge on human nature, psychology as well as expertise in Māori laws.
  • Pain behaviour studies suggest there is a need to be cautious of ethnic or cultural stereotypes. Therefore, even though there are findings of general cultural differences it is considered very important to evaluate the pain of each person individually.
  • Clinical recommendations regarding pain treatment are available in the “Attitudes to pain Resources” section of this app.

Tips

  • Research indicates that pain and discomfort are frequently under reported and under treated amongst people with dementia.
  • Ensure care recipients and their family understand pain relief medication and treatment options by providing information in their preferred language and in accordance with their language ability.
  • Religion and culture may influence your care recipients pain experience including; their pain expression, pain language, remedies for pain, social roles and expectations and perceptions of the medical care system.
  • Understand that for some religious or spiritual beliefs, fate and/or karma may mean that your care recipient also believes their illness and pain are caused by a higher power.
  • Care recipients may feel it is important to accept their pain in order to demonstrate their religious / spiritual faith. This may also impact their request for pain medication and treatment.
  • Identify and support the cultural and religious impact on the acceptability of certain treatments and medications.
  • Identify, respect and document how your care recipient and their family view and express pain.
  • Pay particular attention to verbal expressions of pain during later stages of dementia and ensure adequate treatment is provided.

Resources

Generalist

  • Most Māori people (even those that are generally relatively unobservant of traditional practices) will follow traditional practices when they themselves, or one of their loved ones, are nearing death.
  • The communal aspect of Māori culture is extremely important during this time and the extended family members will hurry to visit and stay with the patient when passing is imminent.
  • Arrival at this late stage to be with the patient should not be misinterpreted as a lack of caring, or a misunderstanding of the severity of the condition.
  • It can be helpful for Māori to have familiar and trusted medical support from those they rely on most which for many, is their local doctor.
  • Māoris have a different understanding of the past and the future, which influences how they grieve. Specifically, the past is believed to be ‘in front’ because it is known about and understood, and current actions are based upon it. The future however, cannot be seen and is therefore considered to be ‘behind’ us.
  • The deceased is considered an important part of current life, as they are the foundation of one’s existence in the present.
  • Māori people often prefer to have their terminally ill family members die at home rather than in hospital.

Māori mourning and funeral rites (tangihanga)

  • Mourning and funeral rites are important and complex to Māoris.
  • Māoris believe that the spirit (wairua) remains within the body (tüpäpaku) for a period of time after the person as passed. Because of this, extended family will usually wish to be present with their relative when they pass, and remain with them after they have died. They may also wish to wash and dress the body themselves.
  • Adequate time should be provided to allow the extended family members to grieve before moving the body.
  • It is important to remember that no food or drink should be taken into the room. For example, bringing cups of tea, whilst well-meaning, would be culturally offensive.
  • Also, according to Māori beliefs, everyday linen should not be used to wrap the body of the deceased, and there are culturally appropriate ways in which the body should be moved. It is best to seek guidance from family members regarding the appropriate practices.
  • After the body has been removed from the room Māori prayers (known as karakia) are usually performed. It is only after this has taken place that the room should be physically cleaned.

Death and the Afterlife

  • Māori funerals are known as “tangi” and include a mixture of festivity and grief.
  • Māori people often believe that ancestors dwell after death in the ancestral lands and are used as a reference point amongst the living.
  • Similar to most other cultures, Māori people will expect a complete and accurate explanation if a post mortem is required. Māori people should be consulted regarding the return, retention or disposal of any tissue, body parts or fluids taken during autopsy.
  • Māori people may wish to be present during autopsies and the body should be released to the family as soon as possible after the procedure.

Tips

  • Understand that attitudes to end of life care, death and dying are diverse and may include a range of factors such as cultural and religious beliefs.
  • Be aware that the acceptance of certain treatments and medications are likely to be impacted upon by cultural and religious factors.
  • Identify and support “end of life choices” of care recipients and their family. Note: these are formally known as “Advanced Care Directives” or “Advanced Care Planning” depending on the state or territory in Australia that you are in. Ensure their choices are documented and strictly followed.
  • Ensure the linguistic needs of care recipients are addressed in end of life religious and spiritual support.
  • Ensure family members have access to appropriate resources and support in their preferred language and in accordance with their language ability.

Resources

Generalist

  • In Māori culture, something sacred, special or restricted is known as ‘tapu’ and tapu/noa (food) separation is important.

Some specific actions that are considered tapu include:

  • Sitting on a table
  • Placing a hat on the table
  • Eating or drinking inside a “wharenui” (meeting house)
  • Touching someone’s head without asking for direct permission beforehand
  • Passing something over the top of someone’s head.
  • Wearing shoes when entering a Māori home
  • Passing food or food trays, over a person’s head.
  • Death and elements surrounding death are also considered tapu.
  • As part of the tapu belief, items that come into contact with the body (or bodily substances) should also be kept separate from food, as well as items that are associated with food, including tea towels and dishes.
  • Māori people may be sensitive to the use of linens that are used for the head and the body. For example; Māori’s may consider it a violation of their “tapu”, if the pillow beneath their head is then used for the leg (or vice versa). It can be helpful to use pillowcases of different colours to keep those for the head and the rest of the body separately. Similarly flannels used for the head and the rest of the body should be kept separate.

Tips

  • “Manners” and “taboo” expectations and beliefs may vary greatly among cultures resulting in differing emotions and behaviours in your care recipient.
  • Be aware of your own beliefs and expectations of “manners” and “taboo” beliefs and how these may differ to those of your care recipient.
  • Be aware of judging other people's behaviour, expectations and beliefs according to the standards of your own culture.
  • Be aware that the care recipient may judge your behaviour according to the standard of their own culture.
  • It is important to recognise, accept and document individual interpretations of “manners” and “taboo” expectations and beliefs of your care recipient and their family.

Resources

Generalist

  • It is a Māori belief that the spirit (or Wairu) is connected to health.
  • Māori culture regards karakia (or blessings or prayers) as crucial actions to protect and maintain spiritual, physical and mental health.

Tips

  • Superstitions may be considered as old wives’ tales, family traditions or have a significant meaning and be taken seriously.
  • Be aware of your own beliefs and how these may differ to those of your care recipient.
  • Be aware of judging other people's superstitious beliefs according to the standards of your own culture.
  • Be aware that the care recipient may judge your beliefs according to the standard of their own culture.
  • It is important to recognise, accept and document individual interpretations of superstitious beliefs.

Resources

Generalist

Traditional Māori food (Kai)

  • Māori people were hunters and gatherers and crop farmers. Food was harvested from the forest, river, sea and the garden.
  • The traditional diet was based on birds and fish and accompanied with wild herbs and roots.
  • Tribal gardens included; root crops such as potato and sweet potato.
  • Māori potatoes known as ‘taewa tutaekuri’ are deep purple in colour.
  • Māori bread is called ‘rewena pararoa’ and is made from potatoes. It is still available in some markets and specialty shops.
  • Many Māori bless their food prior to eating.

Māori people have specific beliefs regarding food and the body. Due to cultural beliefs, the two are kept separate, and the following practices may be observed:

  • Microwaves are used solely for food and not for heating anything that has come into contact with the body such as a heat pack.
  • Tea towels are used specifically to dry dishes, nothing else.
  • Containers used for drinking water will be restricted to liquids.
  • Food should never be passed over the head (as the head is sacred to Māoris).
  • Vaccinations should not be stored in the same fridge as food.
  • Fridges should be kept specifically for food storage.
  • Anything that comes into contact with the body or substances should be kept separate from food.

Māori Dining Etiquette

  • A ritual ceremony known as ‘Powhiri’ is held first and then visitors are asked to the dining room.
  • Food is blessed or acknowledged by an elder of the home before anyone eats.
  • It is polite for visitors to speak with the members of the household whilst eating.
  • Visitors should thank those who served them and prepared the meal.
  • Visitors may be asked to sing a song from their home country to show respect and thanks.

Tips

  • Food is an important aspect of cultural identity, therefore it is important to identify food preferences, likes and dislikes including eating habits, meal times, preferred setting, preferred eating utensils etc.
  • Identify and facilitate cultural food when possible and ensure the impact of religion on food services is documented, adhered to and regularly reviewed.
  • Provide menu choices and food services information in the preferred language of care recipients, or with pictures if the person has difficulty reading. 
  • Consider alternative ways to facilitate culturally appropriate food such as; obtaining recipes from family/friends, specific meal delivery services, community groups, seniors’ clubs, or and/or other clubs.
  • Ensure that the care recipient is given food choices throughout all stages of dementia.

Food and diet resources

  • A wide range of information (including religious food requirements, nutrition information and recipes) is available in the “Food and diet resources” section below.

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Many people with dementia want to remain independent for as long as possible and rely on the community care system to help them achieve this.

The Māori view of health is holistic and includes four major dimensions:

  • spiritual (te taha wairua)
  • mental (te taha hinengaro),
  • physical (te taha tinana) and;
  • family (te taha whänau).
  • Māori people may be less likely to question treatment plans or ask general questions of health professionals.
  • Shyness or silence does not indicate that they understand or agree.
  • It is important that explanations are provided by care professionals about what is being done, including any medications prescribed, how they should be taken and why treatment is necessary (including any benefits or risks).
  • Permission should always be asked before examining a Māori.
  • In some instances, family may wish to remain with the patient during the examination.
  • Valuables or heirlooms (known as taonga) are often worn by Māori people. In the event that these need to be removed, it should clearly be explained why. It is also best to ask if the patient permits you to remove them, or they prefer to do this themselves.
  • Māori culture includes; family and community ties, acknowledges the wisdom of the past, has connections to the present and to the physical world. This influences patient’s behaviours, for example; bringing family members to medical visits, expecting meetings will be handled at an unhurried pace until a relationship is established, consulting with family before approving treatment and a preference for face-to-face interactions.

Traditional medicine

  • Tohungas (including expert priests, healers, navigators, carvers, builders, teachers and advisors) practice traditional medicine and may be sought by Māori people.
  • Traditional Māori medicine is known as ‘ronga’ and includes; techniques such as massage and spiritual healing as well the use of native plants and/or herbs.
  • Health professionals should be aware that traditional medicines may be used by some Māori people.

Anaesthesia

  • Māori people may have spiritual concerns with the use of anaesthesia. Specifically, the status of their spirit (or wairua) and how their body is protected and preserved during anaesthetic.
  • Māoris may prefer to have a family member present during anaesthesia, or for prayers to be said, to help ensure that their spiritual and physical welfare is upheld.

Tips

  • Identify and document the care needs of your care recipient and continuously re-evaluate how their dementia progression affects their care needs.
  • Make every effort to understand a dementia behaviour before attempting to manage it, as you will often discover that what lies behind it is a genuine attempt to communicate an unmet need.  

Care information resources

  • A wide range of information is available (e.g. personal hygiene, sleeping, incontinence etc.) in the “Care information, resources” below.
  • Advice and Support - Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.
  • Employee/employer resources - A range of information is available under “Links – Other useful weblinks”.

Resources

Generalist

  • Key cultural aspects to Māori culture include that understanding and being connected to the past is vital for the present as well as for the future.
  • Māori values (also known as ‘tikanga’) can be thought of as the rules for living, which include the Māori social system as well as reflect Māori knowledge and traditions.

Key concepts of Māori culture include:

  • Tapu - often used to describe a state of sacredness, but can also have the general meaning of being special or restricted.
  • Noa (the complimentary state to Tapu) - the absence of tapu and means being normal or ordinary or safe.
  • Mana - the importance of respecting individuals and their right to dignity.
  • Wairu - the spiritual force within people.
  • Whänaungatanga - the significance of interpersonal relationships to well-being.

Māori demeanour

  • Māori people are generally friendly and reserved and tend to place emphasis on hospitality.
  • Māori people may offer hospitality to the point that it may inconvenience themselves although they will hide it.
  • Song is an important part of Māori culture, and it is not uncommon for Māori people to spontaneously break into speech and song. Visitors may be expected to return with a song from their country.

Tips

  • Everyone has “culture”. This includes a number of factors such as ethnicity, identity, age, gender, education, sexual orientation, ability/disability, values, beliefs, attitudes etc.
  • Recognise your own cultural traits and influences and be mindful not to judge other people’s behaviour and beliefs according to the standard of your own culture.
  • Be aware that your care recipient may judge your behaviour and beliefs according to the standard of their own culture.
  • Your care recipient may be “similar to others” but “no two people are the same” so take care not to generalise or make assumptions about them. Gain general cultural information from resources to assist with conversations to allow you to identify your care recipient’s individual cultural traits.
  • Understand and document how your care recipient’s individual cultural traits impact their care needs.
  • Increase your knowledge about different cultural practices and issues through resources, cultural background information sessions and/or cultural awareness training.

Cultural Traits resources

  • Find information (such as guides and cultural profiles created by other organisations) in the “Cultural Traits, resources” section below.
  • You will also find information including; links to community contacts, cultural profiles, useful weblinks etc. in the “Links” section of the app.

Resources

Generalist

  • Easter is celebrated by Maoris.
  • The date Easter is celebrated depends on the ecclesiastical approximation of the March equinox.
  • Māori people with Christian religious affiliation celebrate Easter.

Tips

  • Understand the importance of Easter to your care recipient and accept and respect that customs and beliefs about Easter are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • Christmas is celebrated by Maoris on 25th December.
  • The colours red, white and green have a traditional meaning in New Zealand. Specifically, red stands for the Christmas tree, green represents the vegetation around the country, and white represents the golden sands on various beaches in the country.
  • Christmas is a relaxed festivity where little is done or spent.
  • The Christmas tree (known as pohutukawa) is decorated with scarlet flowers and ornaments every year.
  • Christmas dinner is traditionally a ‘Hangi’, which is cooked in a pit underground. The Hangi usually includes; sweet potato, pumpkin, pork, chicken, vegetables, stuffing and potatoes. Food is cooked in this way as it not only tastes delicious, but the earthy cooking style also reminds people of their ‘roots’ and to stay ‘grounded’.
  • After the Hangi, people usually sit around a bonfire and sing Christmas carols.
  • ‘Meri Kirihimete’ is Māori for Happy/Merry Christmas.

Tips

  • Understand the importance of Christmas to your care recipient and accept and respect that customs and beliefs about Christmas are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • New Year’s Day is celebrated by Maoris on 1 January and on the first new moon after the rise of Matariki star constellation, usually in early June
  • New Zealand is located close to the International Date Line, which means that they are one of the first countries to celebrate New Year, on the 1st January.
  • New Year’s Day and the day after the New Year are public holidays throughout New Zealand.
  • Matariki is the Māori term for the cluster of stars known as the Pleiades star cluster. The word ‘Mata Riki’ means ‘tiny eyes’ and ‘Mata Ariki’ means ‘eyes of God.’ Some people may also think of Matariki as a mother with six daughters or may refer to it as the seven sisters.
  • Matariki can be seen in the eastern sky around the shortest day of the year. It is believed to indicate the success of the upcoming harvest season and it is thought that the brighter the stars are, the more productive the crop will be.
  • Matariki rises in the last few days of May. Celebrations may begin when the stars are first seen, however the first new moon after Matariki is the official beginning of the Māori New Year. Some people celebrate New Year the day that the moon rises, whilst others begin celebrations (that may last for up to three days) the day after the new moon.

Tips

  • Understand the importance of New Year to your care recipient and accept and respect that customs and beliefs about New Year are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • The Māori word for food is ‘kai.’ Māori kai festivals are popular events in New Zealand.
  • The Kāwhia Kai Festival (held in February) is a celebration of traditional Māori food from the land and the sea.
  • 6th of February – Waitangi Day is a day when Māori people reflect on the signing of the Treaty of Waitangi as well as the influence it has had on the current day. For many, controversy surrounds the way in which the Treaty has been and continues to be carried out.

 

Tips

  • Understand the importance of any significant days to your care recipient and accept and respect that customs and beliefs about special days are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • Types of activities Māori seniors usually like to participate in include; walking, gardening, swimming, golf and dancing.
  • Many older Māori men and women are important mentors and leaders within their iwi (tribe) and hapū  (community).

Reminiscence                                      

  • Smell or taste - Using smell kits, different cultural foods. Suggestions include; lamb, kiwi fruit, vanilla, honeycomb, golden syrup, Piri Piri, Kawa Kawa, Korengo and Harakeke.
  • Sight - Cultural photographs, slides, films, painting pictures, looking at objects. (Refer to the “Cultural activities resource” section for some visual ideas).
  • Touch - Touching cultural objects, feeling textures, painting and pottery. Pampering, massage hands, etc. if it is considered culturally appropriate by the care recipient, and they trust you to do this without being intrusive.   
  • Sound - Personalised playlists, listening to familiar tunes from the radio, C.D's, YouTube, listening to cultural performances, or making music using various instruments. (Refer to the “Music resources” section for some music ideas).

Tips

  • It is important to understand your care recipient’s activity likes and dislikes and their personal history to plan appropriate activities for them.
  • Your care recipient should be provided with a choice of activities to participate in.
  • Participating in suitable activities can help a person with dementia to achieve purpose and pleasure, help to improve their mood, responses, memory function, increase social interaction, sleep, improve verbal and non-verbal communication and restore a sense of identity. Activities also play a significant part in increasing the person’s wellbeing and confidence which will decrease responsive behaviours or ill-being.
  • It is important that activities are suitable to the level of ability of the person with dementia. People with dementia should be encouraged to participate as independently as possible and be given the choice to participate or to watch others.
  •  Always talk to the person’s doctor before starting them on a new exercise program and ensure the program designed for them takes into account their current health and ability.
  • Alzheimer’s Australia SA, local council libraries or community organisations may be able to loan suitable cultural activities such as music, games, videos etc.

Cultural activity resources

  • For cultural activity information and ideas refer to the “Cultural activities, resources” section below.
  • For local community contact details refer to the “Links, Community Contacts” section of this app.

Resources

Generalist

  • Music is an integral part of traditional Māori life and accompanies almost most all activities.
  • There are several different types of Māori music, including; waitata, karanga, karakia and haka.

Waiata

  • Waiata is the term for songs.
  • Waiata were traditionally sung in public as a way to express emotions and convey messages, including passing down history, knowledge and stories to the present generations.

Karanga

  • Karanga is a wailing call of welcome. They are usually sung by women to mark the beginning of a social gathering (hui).
  • They are usually short poetic statements by callers in fluent Māori language.
  • Farewell karanga are used as an esteemed means of honouring the deceased and their family.

Karakia

  • Karakia are prayers to ‘atua’ or gods.
  • Karakia may be made to specific gods responsible to particular areas, such as welcoming a new dawn, a newborn child or opening a new meeting house.

Haka

  • Haka is a famous Māori posture-dance which includes; shouted vocal chanting, body actions (including hand actions and foot stomping) and facial expressions.
  • The Haka is commonly associated with men and war, however there are also other types of haka that are performed by women and children.
  • Haka can also be used for a range of occasions such as; welcoming visitors to meeting grounds, meetings, weddings, and to honour the dead. The Haka is also commonly used for significant cultural occasions.

Māori musical instruments

  • Traditional Māori instruments are those that can be blown (such as flutes, whistles and trumpets) or stuck (including the gong).

Flutes

  • Flutes are of particular significance to Māori people.
  • Flutes often featured in traditional Māori tales, such as the legend of Hinemoa and Tūtānekai.

Trumpets

  • Trumpets were used to mark the arrival of visitors to a village, and during the war, to signal when an enemy was sighted and to alert people of a possible attack.

Gongs

  • Gongs or ‘pahū’ were constructed from wooden slabs and then hollowed in the centre.
  • Gongs were often mounted on watch towers and struck with a mallet to signal when the enemy was sighted during war. The sound could be heard over long distances such as many kilometres.

Tips

  • Music is the most powerful universal language.
  • Music provides an external rhythm and can restore a person back to themselves, and to others, at least for a while.
  • People tend to remain contactable as musical beings on some level right up to the very end of life.
  • It is important to understand your care recipient’s music likes and dislikes and to provide them with their choice of music to listen to.
  • Create a personalised music playlist for your care recipient for their maximum benefit and enjoyment.
  • Provide opportunities for the person with dementia to watch live music performances.
  • Providing music a person relates to can have a wide range of benefits to the care recipient. Benefits may include; helping to improve their mood, responses, memory function, increase social interaction, improve verbal and non-verbal communication and restore a sense of identity.

Resources