NZREX Cultural Safety & Māori Health — Questions and Answers
Question 1: Who developed the concept of cultural safety (kawa whakaruruhau) in New Zealand nursing?
- Irihapeti Ramsden (Correct answer)
- Mason Durie
- Sir Tipene O'Regan
- Rangi Matamua
Correct answer: Irihapeti Ramsden
Irihapeti Ramsden (Māori nurse and academic) developed the concept of kawa whakaruruhau (cultural safety) in the 1980s–90s in NZ, emphasising that safety is defined by the patient, not the provider, and that power imbalances in healthcare must be examined.
Question 2: Which of the following best defines 'cultural safety' in the NZ health context?
- An environment where patients feel respected and safe to share their culture, as determined by the patient (Correct answer)
- The same as cultural competence — knowing facts about different cultures
- Providing culturally themed decorations in clinical settings
- Asking every patient about their ethnicity at triage
Correct answer: An environment where patients feel respected and safe to share their culture, as determined by the patient
Cultural safety is about the patient's experience of feeling safe. It requires health professionals to reflect on their own identity, attitudes, and biases. Safety is assessed by the recipient of care — not the provider. This distinguishes it from cultural awareness or competence.
Question 3: What does the concept of 'whanaungatanga' mean and how is it relevant to clinical care?
- Relationships and kinship — relevant because Māori patients often prefer whānau involvement in health decisions (Correct answer)
- A traditional Māori healing ceremony
- A Māori health assessment tool
- The concept of spiritual wellbeing in Māori health
Correct answer: Relationships and kinship — relevant because Māori patients often prefer whānau involvement in health decisions
Whanaungatanga refers to relationships, kinship, and a sense of connection. In clinical care, it means recognising the central role of whānau in Māori patients' wellbeing and decision-making, and actively facilitating whānau involvement.
Question 4: A Māori patient is dying in hospital. The whānau requests that the patient not be left alone and that karakia (prayer/incantation) be performed. What is the most appropriate response?
- Accommodate these requests as much as possible and involve the Māori health team or kaiāwhina (Correct answer)
- Explain that hospital rules prevent this
- Allow only one visitor at a time as per standard policy
- Decline as it may upset other patients
Correct answer: Accommodate these requests as much as possible and involve the Māori health team or kaiāwhina
Cultural safety requires accommodating the spiritual and cultural practices of dying patients and their whānau. Karakia and the need for whānau presence are important tikanga practices around death (mate). Flexible visiting and spiritual support are expected in culturally safe hospitals.
Question 5: Which of the following health disparities is most accurately documented for Māori compared to non-Māori in New Zealand?
- Māori have significantly lower life expectancy, higher rates of chronic disease, and poorer access to primary care (Correct answer)
- Māori have better mental health outcomes but worse cardiovascular outcomes only
- Health outcomes for Māori are now equivalent to non-Māori
- Māori have higher vaccination rates than non-Māori
Correct answer: Māori have significantly lower life expectancy, higher rates of chronic disease, and poorer access to primary care
Persistent and significant health inequities exist for Māori across most indicators: lower life expectancy (~7 years), higher rates of diabetes, CVD, respiratory disease, cancer, and mental illness, and reduced access to timely primary care.
Question 6: When documenting ethnicity in a NZ clinical consultation, which approach is recommended?
- Ask the patient to self-identify their ethnicity using the Statistics NZ priority coding — do not assume (Correct answer)
- Record ethnicity based on the clinician's observation of appearance
- Leave the field blank if unsure
- Only document ethnicity for Māori and Pacific patients
Correct answer: Ask the patient to self-identify their ethnicity using the Statistics NZ priority coding — do not assume
Self-identified ethnicity (using Statistics NZ categories) is the standard for NZ health data. Ethnicity should be asked directly and sensitively, not assumed by appearance. Accurate data is essential for monitoring health equity and allocating services.
NZREX Cultural Safety & Māori Health
Who developed the concept of cultural safety (kawa whakaruruhau) in New Zealand nursing?