The weekend in Sydney provided some space and time to engage with culture and nature. The weekend newspapers reported the death of Hazel Hawke, a ‘first lady’ of Australia, with extracts from an interview with her grandson and friends. They described her many positive qualities, her experience of dementia and provided details of her final hours. Details, that few outside families, would generally come to know about.
A concert at the Sydney Opera House reminded me that care and dignity are not just applicable to healthcare contexts. Band members and crew of an extraordinaryR & B performer demonstrated sublime sensitivityand care as they supported their lead singer who seemed physically frail who remained more than capable, however, of providing wonderful entertainment.
I arrived in New Zealand on Monday afternoon and have spent the last few days visiting the three Massey University nursing departments at Palmerston North, Wellington and Auckland and two hospitals. I met with staff and students and gave talks on the theme of ‘sustaining ethical practice in challenging times’.
New Zealand, a guidebook informs me, is known by “its people” as “Godzone” (God’s own country). Later on the same page, we are informed, that the indigenous Maori people refer to New Zealand as Aotearoa – the land of the Long White Cloud. We might ponder the point about ‘its people’ and ask if the author meant indigenous and/or non-indigenous inhabitants…
My host in North Palmerston said that one of the reasons he liked New Zealand is that ‘it is a long way from anywhere”.
Common to each encounter here has been an acute cultural sensitivity and an awareness of the importance of family and place. I learnt something of the history of New Zealand (for example, of the Treaty of Waitangi), of the relationship between the Maori and non-indigenous people and of current norms and practices in universities and hospitals that support cultural safety. I learnt also of Maori rituals that welcome new members to the hospital community. A senior nurse who had returned to NZ from the UK, told me of her Maori welcoming ceremony that included her partner and family.
The second year nurse student seminars I observed at Palmerston North reminded me that some ethical challenges in healthcare are universal. They related to: truth-telling (should an elderly patient be told of a poor prognosis against family wishes?); responses to patients who lack capacity (how to manage a patient who wanders and disturbs other patients?); resource allocation (should a nurse intervene on behalf of a family when doctors decide that dialysis is not appropriate?); and nurse involvement when family members decide that an elderly woman should be moved to a nursing home against her wishes.
I was impressed by the sensitivity and creativity of the students as they considered a range of strategies to respond ethically and also by their ability to negotiate a wide range of personal, professional, Maori and legal values.
I also had to negotiate my own ethical challenges outside the academy and hospital…
On the very tiny plane from Wellington to Palmerston North I sat opposite a very large passenger. As one of the pilots walked down the aisle to check that we had fastened our seatbelts, my neighbour put his hand over the fastening and did not disclose that he needed an extension. I was reminded of those car safety adverts where, sans seatbelt, the passenger in the back seat becomes a lethal missile….So did I quietly suggest to my neighbour that he ask for an extension for his seatbelt?
I reasoned that his loss of dignity was likely to outweigh the low likelihood of harm resulting from a head on crash. It seemed much more likely that we would plunge into the sea or that the tiny precarious craft would explode and we would be scattered over the very green land.
So did I do the right thing? What would you have done?
One of the most interesting aspects of Australia and New Zealand has been engagement in discussions about the negotiation of relationships with indigenous peoples. During a lively discussion in Australia, we were challenged to consider our ‘unearned’ privilege or advantage in terms of our colour, class, gender, language and history. The openness to dialogue regarding the responsibilities of individuals and communities has been impressive. There is an opportunity here for us to learn from Kiwi and Australian responses to past wrongs and from journeys towards social justice and non-discriminatory practice.
I have had to also learn this week that computer problems can result in a good deal of unnecessary angst. My lack of blogging has been due to the fact that I have had to prioritise other activities - such as submitting a research proposal by a deadline - and rely on the generosity and goodwill of my hosts here to access a reliable internet connection.
Just two more days in this part of the world…
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