Canterbury DHB

Cultural Considerations for Nutrition Support

Approximately 10–20 patients per year will receive an Allogeneic Stem Cell Transplant (Allo SCT) in Christchurch Hospital’s Bone Marrow Transplant Unit (B6). Data from the last ten years shows six percent of transplant patients identify as Māori.

Types of nutrition support currently provided during the transplant admission include enteral nutrition (EN) and parenteral nutrition (PN).

Due to traditional Māori values and beliefs these two forms of nutritional support may cause additional distress for Māori tūroro (patients) and their whānau (family), which may in turn affect their health outcomes.

• Firstly, it is important to identify the ethnicity of a tūroro rather than assume which ethnic group they identify with. Māori have a diverse culture and each person may have differing beliefs and values.
• Secondly, the development of a relationship based on trust and respect is crucial so a tūroro feels their cultural beliefs will be valued and respected. In te reo Māori, the term for this relationship building is whakawhanaungatanga. By listening to the tūroro and taking into account their values and beliefs we may establish a nutrition care plan that is culturally responsive and an act of manaakitanga (the process of showing respect, generosity and care for others).
• The Māori Haematology Nurse or Māori Health Team are available for support if needed.
• The CDHB Tikanga Māori policy also provides further information.

Two aspects of traditional Māori beliefs that may be challenged by a enteral or parenteral nutrition are:

1. The head is tapu (sacred, to be protected), and as such should not be touched by another person

   Key practice points:

   • Before starting any procedure (e.g. tube insertion or adjustment of nose/face plasters) ask for permission to touch their head.
   • When a tūroro is pump feeding, always have the pump positioned to the side of the tūroro, not directly above or behind them.
   • Food (kai), drink or feed should never be passed over the head (or the feet) of the tūroro (whether on a tray or not).
   • Explain to the tūroro and whānau what their new version of kai is, and that it will continue to sustain life, just like whole food.
2. When whānau bring kai it is an act of manaakitanga which is crucial for the wairua (the spirit or soul of a person) of both tūroro and whānau.

   Key practice points:

   • When a Māori tūroro cannot eat, it affects both the tūroro and their whānau . There is a sense of disempowerment when the tūroro is not able to consume the kai that their whānau has prepared, as a means of showing aroha (love).
   • It is important to explain to the tūroro and their whānau the reasons why it is recommended that the tūroro does not eat or drink orally, including time frames of nil by mouth and alternative means of hydration/fluids and medications.

Translations

Topic Code: 578281