Background: Goal setting is an integral part of person-centred rehabilitation. It can promote engagement and align the expectations of the patient, whanau (extended family), and rehabilitation team.
For Maori the goal setting process needs to be guided by Tikanga (process), particularly Whakawhanaungatanga (building connections and trust), and needs to be a collaborative, collective experience. The patient is rarely considered in isolation, they are part of a whanau unit. We set out to design a process that meets these needs.
Aims: To create a goal setting process that is meaningful, collaborative and culturally safe for Maori and their whanau, on a comprehensive stroke unit.
Methods: A working group, including Maori clinicians, reviewed the current goal setting process, relevant literature and current best practice guidelines. In consultation with Maori health leads we developed new documentation, incorporating familiar cultural terms and used PDSA (Plan, Do, Study, Act) cycles to test this and new processes with both Maori and non-Maori.
Results: Our review revealed a very euro centric process, with no Tikanga to make this meaningful for Maori. Patient and whanau had limited involvement.
Goals were often set by clinicians with the patient, with minimal discussion between the rest of the team. Staff needed training to implement a new goal setting process, especially introducing the foundation of the process, a Maori health model - Te Whare Tapa Wha (Durie, 1982).
A new process encouraging whakawhanaungatanga with patient/whanau and then IDT meetings, lead to a collaborative, culturally safe experience for patients and whanau. New paperwork, informed by the Te Whare Tapa Wha model was used during these discussions.
Staff needed training to use the Te Whare Tapa Wha model, as conversations regarding spiritual health and mental well-being was new for them.
Conclusion: The new process is integrated and continues to be refined and feedback continues to be collected.