The Whare Tapa Whā model compared health to the four walls of a house, all four being necessary to ensure strength and symmetry, through each representing a different dimension; taha wairua (the spiritual side), taha hinengaro (thoughts and feelings), taha tinana (the physical side), taha whānau (family)… The four dimensions of health were originally portrayed as a set of interacting variables, not dissimilar from a holistic view, nor for that matter from the World Health Organization definition 1947 but, unlike them, firmly anchored on a spiritual rather than a somatic basis. (Durie, 2006)
We explored family and whānau carer perspectives of the care an older family member received from a hospital, hospice, residential care facility or while at home before and during their death. We used the Whare Tapa Whā framework to discuss examples of good – and less good – health care across the four care domains. A key finding was that all bereaved participants highlighted the holistic care needed by the older person prior to death. Interestingly we found that there was no difference between Māori and non-Māori with respect to the need for holistic care across the domains of Whānau (social – family/whānau health care), Hinengaro (emotional/mental health care), Wairua (spiritual health care) and Tinana (physical health care).
When poor health care was perceived within one care domain, its impact was experienced across all four domains. For example, a perceived breach of care in the tinana/physical domain, such as not keeping the older person pain and symptom free, had consequences for the older person and their family on the whānau/social, hinengaro/emotional and wairua/spiritual health domains. Other examples included health service failure to honor end-of-life wishes (“do not resuscitate” orders), failure to inform families that death was imminent (resulting in the inability of family to carry out their cultural and spiritual death care customs), and failure to provide adequate bereavement support to family.
We concluded that culture is a useful framework to understand peoples’ unique needs and is particularly relevant for those nearing death. Paying attention to the older person’s culture, cultural identity, spiritual needs and end of life aspirations across each health domain helps to strengthen the older person, particularly at time of death.
Our research found positive experiences of holistic end of life care, within settings otherwise dominated by a biomedical model of care. However, this seemed to be left up to individual health professionals to administer as an addendum to their usual work tasks. We believe holistic end of life care should be “business as usual” and align with the needs of each family, inclusive of their familial, social, physical, emotional, spiritual and cultural care preferences, particularly at time of death.
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