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Caring respectfully for the dying

By UCOL on Friday, 25 May 2018

A photograph of UCOL Nursing Graduate Diane Noble

This article was written by Kathy Stodart of New Zealand Nurses Organisation for the monthly members' magazine, Kai Tiaki Nursing New Zealand. It featured in Volume 24, number 4 released in May 2018.

Diane Noble never considered becoming a nurse until her late 20s – growing up she didn’t even like the sight of blood. However, she was inspired to gain further education by seeing her father receive a BA from Massey University as a mature student. “I wanted to show my kids they could go to university too.”

Aged 28 then, Noble was a mother of two primary school children and a part-time manager at a McDonalds in Palmerston North. After talking to whānau, and going to an information evening at the Universal College of Learning, she decided to take a nursing degree. “From my first class, I knew – this is me. And I’ve loved the whole journey.”

Noble is of Waikato, Ngāti Koroki and Taranaki descent. Her father is Māori, while her mother’s great grandparents came to New Zealand from Wales. She strongly identifies as Māori, but has also visited Wales and felt connections there too.

Running nursing clinics
Her first job was with Best Care Whakapai Hauora, an iwi provider in Palmerston North which provides wrap-around social and health services. For four years she worked as a community/long-term conditions/whânau ora nurse. Her job involved running free nursing clinics in outlying Manawatu towns such as Shannon and Foxton. She saw people in local community rooms or in their homes – “places they felt they could come to on their own terms”. Many were Māori whānau who hadn’t been to a GP in years or who didn’t show up to appointments. She was able to talk to them about their health needs and encourage them to contact a practice and take charge of their own health.

She then heard about a Donny Trust scholarship, offered in association with Palmerston North’s Arohanui Hospice, for a two-year training programme in specialist palliative care for a nurse who identified as Māori. Noble successfully applied and began in July 2016 and will  finish in July this year. She now has a permanent position at the hospice.

She said Māori did not tend to access palliative care as much as non-Māori, and the hospice was particularly keen to improve its services for Māori by increasing its Māori staff. “I know there are not a lot of Māori palliative care nurses – I’m the only one in our region.”

The course has involved four six-month placements, at Arohanui’s inpatient service, its community service, with the Palmerston North Hospital palliative care team, then back at Arohanui inpatients, where she is now.

“Palliative care feels very special to me,” Noble says. “When I walk into the hospice, I feel a sense that I am where I should be.” Mason Durie is the hospice’s patron, and his Te Whare Tapa Whā model of health care guides the provision of an holistic service, which cares not just for the patient’s body, but their spirit and their whānau – what is important to them.

Good palliative care is not just about relieving physical pain, but also supporting people in their spiritual pain – some people go through an existential crisis as they die. “When you are looking after people who are nearing death, and they know that no further treatment is possible, it is important to acknowledge every aspect of them. I like to find out from my patients what’s important to them, and let them lead.”

Embracing tikanga Māori
Noble cares for some, but not all, of the Māori patients at Arohanui. She praises her nursing colleagues at the hospice for their respectful care of Māori. An example of efforts made by hospice staff to embrace tikanga Māori is the provision of a bowl of water outside the room of a patient who has died, so whānau can cleanse their hands as they leave. “We give respectful care, asking whānau what is important to them.” The hospice also has a Māori adviser to support whānau.

She says many people associate hospices solely with cancer, but hospices were caring for an increasing number of people with life-limiting conditions, such as end-stage renal and liver disease and heart failure, for which Māori had a higher risk. Many Māori want to die at home, and the hospice supports them to do so via its community service.

Palliative care does take an emotional toll, so she makes time for professional reflection, debriefing and supervision. She also has a very supportive family, and has other interests in her life, including swimming and reading, and is president of the No Ngā Hau e Whā branch of the Māori Women’s Welfare League.

Taking a course in te reo Māori is another way she is enriching her life; it is another way her father, who died suddenly last year, has inspired her. “When he died, he was finishing Māori classes – he spoke very good Māori but wanted to get better.”