Cultural responsiveness and the family partnership model

Abstract

IntroductionCultural responsiveness is contingent on the relationships developed between nurses and clients, and is necessary for the clients' and whanau (extended family) cultural needs to be incorporated into care delivery. The health and wellbeing of Maori children and their whanau is an ongoing concern for the delivery of health and social services in New Zealand. The Royal New Zealand Plunket Society (known as Plunket) provides well child services to 90% of children and their families nationwide, and to 65% of Maori children born in 2010 (Royal New Zealand Plunket Society, 2012). Plunket is committed to the Family Partnership Model, developed in the United Kingdom (Davis, Day, & Bidmead, 2002). The Family Partnership Model is based on establishing relationships and communication for working with others, and informs a programme to develop knowledge, skills and techniques for those working with children and their families. Plunket nurses undertake a 10-session Family Partnership Model training that aims to enhance their communication and ability to establish partnerships with families. However, it is not clear if the Family Partnership Model supports culturally responsive nursing practice. In this article we report the findings of a study investigating whether the Family Partnership Model influenced culturally responsive practice for nurses working with Maori whanau.BackgroundMaori, indigenous peoples of New Zealand, experience persistent inequities in health status and outcomes, similar to other Indigenous peoples who have histories of colonisation. They comprise 14.9% of the New Zealand population (Statistics New Zealand, 2013). Ninety percent of Maori live in households with other family members, and of these, 42.9% are couples with children, 26.5% are single adults with children and 11.5% in multi-family households (Te Puni Kokiri, 2011). Many Maori women have children at a younger age than other women living in New Zealand, are disconnected from their iwi and lack wider whanau support (Ritchie, 2007). Consequently, Maori whanau and children are often deemed at risk and vulnerable. For example, Maori children suffer health disparities and inequities at higher rates than other children living in New Zealand (Ministry of Health, 2012a, 2012b).Health inequities occur within a complex context that includes being indigenous; experiencing discrimination, poverty and unemployment; and having low levels of education. Many Maori children live in areas of high deprivation, with 41% of Maori whanau living in neighbourhoods with high deprivation (NZDep 2006 deciles 9 and 10) compared with 15% of non-Maori, while 73% of Maori live in deciles 6 to 10 neighbourhoods compared with 44% of non-Maori (Ministry of Health, 2010). There is a high likelihood that Maori children will live in poverty, an adverse experience that impacts lifelong health and social outcomes (Marie, Fergusson, & Boden, 2008; Poulton et al., 2002). The health system has a role to manage improvement in the poor health status of children (Tipene-Leach, 2012). Yet, despite Maori reporting good health in the 2012/13 New Zealand Health Survey, ongoing health inequities for parents and their children are evident, such as unmet health needs (Ministry of Health, 2012b).Providing culturally safe and responsive care is crucial for reducing health disparities and inequities for Maori (Robson & Harris, 2007; Wilson & Barton, 2012). Cultural responsiveness is grounded in worldviews, relationships, cultural contexts, and connecting in 'culturally-normed' ways of functioning (WerkmeisterRozas & Klein, 2009). Werkmeister-Rozas and Klein go further, stating cultural responsiveness is a "cocreated reality between worker and client" (p.6). This concept defies the adoption of universal or one-size-fits-all approaches. In addition to practitioners' awareness of their own cultural positions, cultural responsiveness is informed by a critical analysis of Maori whanau realities in terms of equity, social justice, rights, intersectionality, and complex interactions that impact their daily lives (Anderson et al. …