Guide for health professionals caring for kaumātua | Kupu arataki mō te manaaki kaumātua (Frailty care guides 2023)

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Contents

• Introduction
• Definition
• Why this is important
• Cultural concepts that can help with assessments, and planning and providing care
• Other important Māori cultural concepts
• Kupu Māori used in the frailty care guides
• References | Ngā tohutoro

Introduction

This guide presents cultural concepts that define the cultural identity of being Māori both as an individual and as a collective (‘it’s part of the cultural DNA’). It aims to do so in a way that honours the mana (dignity, prestige), tapu (sacredness) and mauri (life force, vitality) of these concepts while also making sense of each concept in a practical way for health care.

Achieving both of these aims requires a delicate balance. In adding cultural concepts to the Frailty care guides | Ngā aratohu maimoa hauwarea for the first time, we have no doubt future updates will make improvements.

Oral traditions have been the main way of preserving many of the concepts introduced in this guide, as written records are rare. To develop this guide, we needed to draw from deep wells of lived experience, an innate understanding of te ao Māori (Māori world view) and applied nursing knowledge. The cultural knowledge shared herein is a taonga (treasure) and we ask that you respect it as such.

This guide explains mātauranga Māori in a simple and pragmatic way. It is designed to support health professionals to enhance the experience of kaumātua and whānau/family in their care. In particular, it:

• offers a conversation starter, encouraging health professionals to fully explore the individual cultural needs of kaumātua and their whānau/family
• shares cultural concepts that are relevant to caring for kaumātua and so increases awareness of and sensitivity to cultural needs.

Definition

Māori are the indigenous people of Aotearoa New Zealand. All people who whakapapa Māori (have Māori genealogy) have the right to identify as Māori.

Key points

• Identifying as Māori is self-determined (Te Huia 2015). Not everyone with Māori genealogy chooses to identify as Māori for complex reasons related to colonisation and historical intergenerational trauma (Hokowhitu et al 2020).

• Māori peoples and culture are not all the same. Different hapū (sub-tribes), iwi (tribes) and rohe (regions) have different customs, traditions and dialects.

• Not all Māori have been raised in te ao Māori. For this reason, individuals may vary greatly in their level of connection with their cultural identity, language and tikanga. Colonisation resulted in the desecration of Māori culture, land, language and customs, including tikanga and mātauranga Māori. Each new generation continues to feel the experience and impact of cultural disconnection (called ‘historical intergenerational trauma’) (Curtis et al 2019; Waitangi Tribunal 2019; Wirihana and Smith 2019).
• It is critical that users of this guide remain mindful that individuals and whānau/family have had varied experiences of intergenerational trauma, and it has affected them in different ways.

For the purpose of these frailty care guides, we use the term ‘kaumātua’ to mean any elder who identifies as Māori.* This use is a broad, modern interpretation of the term. Traditionally, ‘kaumātua’ meant particular Māori elders with a specific role as a figurehead or leader. We acknowledge the mana of kaumātua who hold this traditional title and role within their whānau/family, hapū and iwi.

Kaumātua are considered the keepers of knowledge, guardians of traditions and nurturers of the young (Higgins and Meredith 2011). Their roles and responsibilities increase with age due to their life experience, knowledge and wisdom (Dyall et al 2014). For these qualities, they are held in high esteem.

*You may also hear the term kuia or kui to refer to female elders and koroua or koro for male elders. 

Key points

• From a Māori world view, ageing adds mana (see below). Kaumātua are valued for what they add to society. This can be at odds with health care assessments that focus on deficits (what people cannot do) rather than strengths (what people can do).
• Focusing on strengths helps align assessment and care planning with a Māori world view. (For an example of this approach in practice, see the Falls | Ngā hinga guide.)
• Incorporating cultural concepts into everyday practice with kaumātua upholds their mana and enables them to thrive. It also reassures whānau/family that they can entrust you with the care of their loved one.

Why this is important

Kaumātua are the people who carry mātauranga Māori (ancestral knowledge of how Māori view, understand and navigate the world, including creativity and cultural practices) and tikanga (customs and traditions). For this reason, they are cherished and venerated (Hikuroa 2016).

• Mātauranga Māori and tikanga cannot be understood without each other (Mead 2016).
• Mātauranga is the knowledge held in the mind. Tikanga is the embodiment of that knowledge – that is, it is knowledge that we can see, do and feel (Duncan and Rewi 2018; Royal 2012).

Important: Due to the impact of colonisation, some kaumātua and whānau/family do not have either the knowledge of these concepts or the ability to articulate them. If you presume kaumātua and whānau/family have such knowledge, it can cause whakamā (shame, embarrassment). So be curious, be open to conversations and seek to understand, but allow whānau/family to lead.

Cultural concepts that can help with assessments and planning and providing care

The concepts we discuss here are only some of the many that underpin te ao Māori. Having a background knowledge of these cultural concepts* may be useful when assessing kaumātua, and planning and providing their care.

Although we discuss the following concepts separately, please keep in mind that they are all closely related and interconnected. For this reason, we group some concepts in the same section to show particularly close connections.

*This guide is not a comprehensive culture resource. 

Mātauranga Māori and tikanga Māori

Mātauranga Māori

Mātauranga Māori is the body of knowledge that is innately Māori and based on ancestral sources of knowledge. It consists of both traditional and contemporary knowledge and includes cultural practices, creativity and world view.

Tikanga Māori (‘tika’ meaning correct + ‘nga’ meaning more than one = correct ways)

Tikanga Māori represent the ethical values that keep us safe in interactions and relationships. Tikanga are tangible – they are present in Māori actions and behaviours and are how Māori live out being Māori.

Tikanga are more than customary values and practices: they enact mātauranga Māori in daily life (Mead 2016). On a day-to-day basis they provide a guide for living and interactions; they maintain social and spiritual balance. Traditionally, a breach of tikanga incurs the wrath of the atua (gods), so it is easy to imagine why even an unintentional breach of tikanga can have a significant spiritual impact on kaumātua.

In practice, whānau/family may be referring to a breach of tikanga when they make comments such as:

• ‘It’s just not how we or (kaumātua name) would normally do it’
• 'We are not sure you are looking after (kaumātua name) the right way’.

Such comments present an opportunity to explore cultural needs and care preferences. Of course, not all feedback is about tikanga – it is important to check rather than assume it is.

Manaakitanga and whanaungatanga

Some aspects of tikanga are universal. In the frailty care guides, two areas of tikanga that are particularly important to care are manaakitanga and whanaungatanga.

Manaakitanga (‘mana’ meaning dignity or prestige + ‘aki’ meaning to enhance + ‘tanga’ meaning action = acts that uphold mana of others).

Manaakitanga is about ‘nurturing relationships, looking after people, and being careful about how others are treated’ (Mead 2016). A common translation is hospitality, reciprocity, kindness and generosity. On a deeper level, however, manaakitanga is about the behaviours and actions that honour and uphold the mana of others. (For more on mana, see the next section.) Manaakitanga is reciprocal: by honouring the mana of others, you in turn uphold your own mana.

Practical examples of how you can support manaakitanga include:

• enabling kaumātua to show manaakitanga by providing whānau/family or manuhiri (guests) with hospitality, such as a cup of tea

• enabling kaumātua to contribute to the facility community, for example, by participating in committees, leading welcomes for new staff or residents and blessing food
• having a welcoming space for whānau/family when they visit.

For other examples, see the guides on Frailty | Te wairuhi and Communicating effectively with older people and their whānau/family | Kia kōrerorero pai ki ngā kaumātua me ō rātou whānau.

Whanaungatanga and whānau/family

Whanaungatanga means relationships or a sense of connection or belonging. Whakawhanaungatanga is the process of establishing relationships and relating to others through whānau/family, shared experience or other things people have in common. It requires both parties to share reciprocally about themselves and provides a sense of belonging (Lacey et al 2011).

This connection can occur between aged residential care (ARC) staff and kaumātua, with the result that staff become ‘facility whānau/family’. It is a great honour to be thought of in this way and recognises the contribution staff make to the lives of kaumātua and their whānau/family.

Māori have ideals that are strongly centred on whānau/family. Traditionally, several generations of whānau/family members lived together, and younger whānau/family members helped manaaki (care for) and tiaki (look after) the older generation. In modern times, whānau/ family care of kaumātua remains grounded in cultural norms. While kaumātua generally welcome this care, they may be reluctant or whakamā about accepting whānau/family help because of the demands of modern lifestyles. Whānau/family may also experience whakamā where they feel guilty about being unable to fulfil the traditional caring role.

When kaumātua live in ARC, whānau/family continue to have an integral role in contributing to their holistic health and wellbeing. In particular, they connect the kaumātua to and validate their cultural identity and are vital in maintaining the oranga wairua (spiritual wellbeing) of kaumātua. The contribution of whānau/family to kaumātua wellbeing cannot be overestimated.

Mana, mauri and tapu (and noa)

Mauri, tapu and mana are interconnected in te ao Māori. This interconnection is reflected in the way that an action impacting on one of these concepts affects them all.

Mana

Understanding the concept of mana is fundamental when planning care. Delivering care that upholds dignity and mana at all times is vital to hauorangatanga (health and wellbeing) of kaumātua. By upholding the mana of kaumātua in your care, you in turn honour the mana of their whānau/family, as well as your own.

Mana refers to dignity, prestige, esteem and status (as viewed by self and others), and with this status comes power and pride. Mana can be a difficult concept to translate but is represented in the social standing of an individual and the respect, reputation, credibility and responsibility that comes with it. Mana cannot be self-appointed as it exists outside the control of the individual (Reweti et al 2022). With older age, mana often grows in recognition of the wisdom, experience and knowledge that elders have.

Mana is considered a sacred force that the atua pass down, endowing a person with pride, dignity, integrity, self-esteem and spiritual vitality. After receiving it at birth, a person can gain more mana over their lifetime through their personal achievements. It is the source of identity, strength and pride for both the individual and the collective: personal achievements uplift the mana of the whole group (whānau/family, hapū, iwi) (Mead 2016). This is about how the individual has obligations to things beyond themselves (other people, relationships, the environment), which is why manaakitanga is so important.

The risk for kaumātua moving into ARC is that their feeling of mana may be diminished. This is due to them being removed from cultural contexts and environments that maintain their mana through customs, whānau/family interactions, tuakana–teina (older–younger person) interactions and ‘giving back’.

Mana is closely tied to both mauri and tapu and as mana increases, so does tapu (Mead 2016). (See ‘mauri’ and ‘tapu’ below for more information.) Examples of how an impact on one of these concepts can affect them all are where:

• breaches of tapu cause damage to mana
• actions that diminish or uplift mana affect the mauri of the person, which impacts on their wellbeing
• mishandling of mana becomes a source of whakamā (shame, embarrassment).

Mauri

Mauri is the life spark, life force or essence in all living things. Mauri is also the source of emotions and connects people to the environment and to the atua (Reweti et al 2022).

Mauri is not a fixed state. Instead it moves through states of:

• mauri noho (languishing)
• mauri rere (unsettled)
• mauri oho (awakening)
• mauri tau (settled or in balance)
• mauri ora (flourishing) (Reweti et al 2022).

These different states of mauri help to explain levels of wellbeing and can be perceived or observed in those who are experiencing an imbalance in their hauora (holistic wellbeing).

Mauri can change due to actions that impact on the mana of the person, but it can also be a sign that the person is unwell (Mead 2016). At times, these changes in mauri may be observed as changes in consciousness, and it is understood that when a person dies, their mauri vanishes (Mead 2016). This means that paying close attention to mauri is important because it helps in recognising changes in the health and wellbeing status of kaumātua.

Tapu and noa (‘tapu’ restricted; ‘noa’ unrestricted: a process of separation and balance)

In simple terms, tapu refers to prohibitions or restrictions and noa means ordinary, unrestricted or free of tapu. Tapu is used to protect the sacredness of places, certain objects and people (Duncan and Rewi 2018).

Personal tapu or the sacredness of the person is considered an individual’s most important spiritual attribute. It is understood that the atua pass down tapu, bestowing it at birth. In providing care, you need to be aware that:

• the head and the sexual organs are most tapu
• an individual’s personal space is tapu
• items that make physical contact with a person absorb their tapu.

Tapu and noa are almost opposing or balancing concepts and are a complex feature of tikanga Māori. Tapu and noa must remain separated and balanced. This is one of the areas where it is easy for health staff to unknowingly breach tikanga. Here are a few practical examples of how to avoid doing so.

• Do not pass anything over a person’s head.
• Do not take food into the room of a tūpāpaku (deceased person’s body).
• Do not put items that have touched the head or body on surfaces meant for food, drink or medications.
• Do not put items that have touched the head (eg, pillows, hats, hairbrushes) on chairs or anywhere other than the head of the bed. These items should be kept off surfaces and equipment used for the rest of the body.

It is common practice after the burial of tūpāpaku to lift the tapu from the room or area where the deceased was lying, as well as from their home and possessions, through a ceremony called ‘takahi whare’.

Food and water (except holy or sacred water) are considered noa. Water is used as part of some ceremonies to lift or remove tapu.

There may be instances where things go wrong and a breach of tapu occurs, or mana is not upheld. This may result in whakamā.

Whakamā (shame, embarrassment or shyness)

The concept of whakamā is grounded in Māori social context. It is considered a complex and holistic experience (Knight 2019).

The experience of whakamā is closely linked to mana. Damage to an individual’s mana may result in whakamā (Knight 2019). (See an example of how mana, mauri, tapu and whakamā are interconnected under ‘Mana’ above.)

Whakamā may also occur when a kaumātua:

• senses a loss of rangatiratanga (autonomy and self-sufficiency), such as when their mobility, continence or cognition changes
• experiences a loss or breach of privacy. Take a delicate approach when the kaumātua needs to share intimate personal details or information and, where possible, allow the kaumātua to direct this process.

When kaumātua experience whakamā, they may respond with withdrawal behaviours and it may impact on their holistic wellbeing. (For examples of such situations, see the wound-related care guides as well as the Acute deterioration | Te tipuheke tārū, Constipation | Kōroke, Falls | Ngā hinga, Scabies | Mate māngeongeo riha and Urinary incontinence | Te turuturu o te mimi guides.)

Other important Māori cultural concepts

From a Māori perspective, wellbeing is holistic, so the following concepts that impact on health and wellbeing are interconnected. Keep in mind that, although we discuss them separately, the concepts flow into each other.

Wai (water)

From the perspective of te ao Māori, wai sustains life both physically and spiritually. The understanding that people are made up of water is reflected in the word wairua (spirit). It literally means two waters, referring to both the physical and metaphysical aspects of being.

This perspective is reflected in the question, ‘Who are you?’ in te reo Māori: ‘Ko wai koe?’. In essence, this is asking, ‘Of what water are you?’. The question acknowledges the person’s whakapapa connection to Ranginui (sky father) and Papatūānuku (earth mother), through the waters that flow from the atua to form Māori people.

It is believed that where a person’s internal waters shift either up or down from their usual balance, it can reflect a change in the person’s state of wellbeing. Shifting up can be due to mental distress and elevated mental state. Downward shifts are often associated with depression and/or anxiety. This is why water is used as a medium to heal.

Oranga wairua (spiritual wellbeing)

From a Māori perspective, oranga wairua is fundamental to human existence. It has important implications for staff providing health care.

• Spiritual disturbances or wairua unrest can occur when kaumātua experience an imbalance in holistic health such as during times of illness or acute deterioration (bpac^nz 2010; Lindsay et al 2022; Valentine et al 2017). (For examples, see the Delirium | Mate kuawa, Diabetes | Mate huka, Responsive and reactive behaviour | Ngā momo whanonga kātoitoi, tauhohe hoki and Urinary tract infections | Te pokenga pūaha mimi guides.)
• Because of their holistic view of health and wellbeing, during times of wairua unrest, Māori may see addressing a person’s spiritual needs as equally important to meeting their physical needs. It is important to support kaumātua and whānau/family to do this and to include culturally relevant, holistic interventions in care planning and treatment.
• Wairua disturbances can manifest in many ways. To understand them accurately, you need careful interpretation from a Māori world view. Listening to kaumātua, whānau/ family and other sources of cultural knowledge will be vital.

Whenua

Another aspect of oranga wairua acknowledges the close connection that tangata whenua (people of the land) have to the whenua (land). From a Māori world view, the health and wellbeing of people are interconnected with the health and wellbeing of the land. Through this connection, the nourishment, healing and protection between people and the land are reciprocal (Reweti et al 2022). Many traditional Māori healing principles and practices focus on connecting with te taiao (the natural environment).

Kaumātua living in ARC may gain some benefit from spending time outside. This can be a way to promote oranga wairua by supporting them to connect with te taiao. A meaningful experience with nature may be as simple as going barefoot on soil or grass, feeling the wind on their face or hearing the sounds of birds and insects.

Kupu Māori used in the frailty care guides

• Aroha — Love, compassion, kindness, empathy 
• Atua  —  God(s), primordial being(s) 
• Hauora —  Health, wellbeing
• Kai —  Food 
• Kanohi ki te kanohi —  Face to face, in person
• Karakia —  Prayer, incantation
• Kaumātua —  Māori elder(s), older adult(s) (see ‘Definition’ section for further information)
• Koroua —  Male elder(s)
• Kuia —  Female elder(s)
• Mana —  Prestige, authority, control, power, influence, status, spiritual power, charisma (see ‘Mana’ section)
• Manaaki  —  Host, care for, look after, support 
• Manaakitanga —  Hospitality, kindness, reciprocity, generosity 
• Manuhiri —  Visitor(s), guest(s)
• Mātauranga  Māori  —  Māori sources of knowledge, Māori ways of knowing. It covers both traditional and contemporary forms of knowledge, including waiata, maramataka, pūrākau (see ‘Mātauranga Māori’ section)
• Mauri — Life force, life essence, vitality
• Noa — Neutral, ordinary, unrestricted (see ‘Tapu and noa’ section) 
• Oranga  —  Health
• Pūrākau —  Traditional cultural stories or mythology, including Māori creation stories
• Pure  —  Traditional cleansing ritual or ceremony to remove tapu, usually including karakia and often water
• Rongoā —  Medicine
• Rongoā  Māori —  Traditional Māori medicine 
• Takahi —  Trample; can be used to describe damage to (‘trampling on’) a person’s mana or to describe the custom of ‘takahi whare’ where a house/place of residence is blessed to lift the tapu after the burial of a deceased person (See example in the Care during the last days of life | Pairuri (palliative care) guide) 
• Taiao  —  Nature, environment 
• Tangata  whenua  —  People of the land; used to refer to the indigenous people
• Tapu —  Sacred, prohibited, restricted (See ‘Tapu and noa’ section)
• Te  ao  Māori —  The Māori world – a Māori world view or perspective
• Te  reo  Māori  —  The Māori language 
• Tiaki —  Look after, take care of 
• Tikanga — Cultural customs and traditions; literally means the ‘correct, right way(s)’ 
• Tuakana–teina  — Term describing the relationship between a tuakana (person who is older) and a teina (someone who is younger), where the teaching and learning are reciprocal 
• Tūpāpaku — Deceased person 
• Wā  — Time 
• Wai — Water
• Wairua  — Spirit
• Whakamā — Shame, ashamed, embarrassed, embarrassment, shy, bashful
• Whakapapa — Genealogy
• Whakawhanaungatanga — The process of establishing connections or relationships and relating to others
• Whānau  — Family, extended family or familiar group of people. Can include friends or others who may or may not be connected through kinship ties
• Whenua — Land

References | Ngā tohutoro

bpac^nz. 2010. Recognising and managing mental health problems in Māori. Best Practice Journal 28: 8–17. 

Curtis E, Jones R, Tipene-Leach D, et al. 2019. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal for Equity in Health 18(174): 1–17. DOI: 10.1186/s12939-019-1082-3. 

Duncan S, Rewi P. 2018. Tikanga: how not to get told off! In M Reilly, S Duncan, G Leoni, et al (eds), Te Kōparapara: An introduction to the Māori world (pp 30–47). Auckland: Auckland University Press. 

Dyall L, Kēpa M, Teh R, et al. 2014. Cultural and social factors and quality of life of Māori in advanced age. Te puawaitanga o ngā tapuwae kia ora tonu – Life and living in advanced age: a cohort study in New Zealand (LiLACS NZ). New Zealand Medical Journal 127(1393): 1–18. URL: journal.nzma.org.nz/journal-articles/cultural-and-social-factors-and-quality-of-life-of-maori-in-advanced-age-te-puawaitanga-o-nga-tapuwae-kia-ora-tonu-life-and-living-in-advanced-age-a-cohort-study-in-new-zealand-lilacs-nz. 

Higgins R, Meredith P. 2011. Kaumātua – Māori elders. Kaumātua and their role. Te Ara – Encyclopedia of New Zealand. 

Hikuroa D. 2016. Mātauranga Māori – the ūkaipō of knowledge in New Zealand. Journal of the Royal Society of New Zealand 47(1): 5–10. DOI: 10.1080/03036758.2016.1252407. 

Hokowhitu B, Oetzel JG, Simpson ML, et al. 2020. Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders. BMC Geriatrics 20(377). DOI: 10.1186/s12877-020-01740-3. 

Knight K. 2019. From whakamā to whakamana: he aha tēnei? Psychology Aotearoa 11(2): 134–7. 

Lacey C, Huria T, Beckert L, et al. 2011. The hui process: a framework to enhance the doctor-patient relationship with Māori. New Zealand Medical Journal 124(1347): 72–8. 

Lindsay N, Haami D, Tassell-Matamua N, et al. 2022. The spiritual experiences of contemporary Māori in Aotearoa New Zealand: a qualitative analysis. Journal of Spirituality in Mental Health 24(1): 74–94. DOI: 10.1080/19349637.2020.1825152. 

Mead HM. 2016. Tikanga Māori: Living by Māori values. Wellington: Huia. 

Reweti A, Ware F, Moriarty H. 2022. A tangata whenua (people of the land) approach to conceptualising Māori health and wellbeing. Global Health Promotion. DOI: 10.1177/17579759221130948. 

Royal TC. 2012. Politics and knowledge: kaupapa Māori and mātauranga Māori. New Zealand Journal of Educational Studies 47(2): 30–7. DOI: 10.3316/INFORMIT.446746674901479. 

Te Huia A. 2015. Perspectives towards Maori identity by Maori heritage language learners. New Zealand Journal of Psychology 44(3). 

Valentine H, Tassell-Matamua N, Flett R. 2017. Whakairia ki runga: the many dimensions of wairua. New Zealand Journal of Psychology 46(3): 64–71. URL: www.psychology.org.nz/journal-archive/Whakairia-ki-runga-private-2.pdf. 

Waitangi Tribunal. 2019. Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry. WAI 2575. Wellington: Waitangi Tribunal. 

Wirihana R, Smith C. 2019. Historical trauma, healing and well-being in Māori communities. In C Smith, R Tinirau (eds), He Rau Murimuri Aroha: Wāhine Māori insights into historical trauma and healing (pp 3–14). Whanganui: Te Atawhai o Te Ao. 

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