bsc pt - cultureal competence in pt practice

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Cultural Competence in Physiotherapy Practice

A professional development resource for

physiotherapists practising in Aotearoa/New Zealand

Package one

Personal identity Diversity

Applications for practice

Developed by Jarrod Ria Kaitiaki, Tae Ora Tinana

Available to NZSP members May 2009

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Cultural Competence in Physiotherapy Practice

Statement of purpose

Kia ora koutou

Welcome to the first of a possible three professional development packages on cultural competence.

This first package is based on the principle of cultural awareness, as explained in the NZSP Guidelines for Cultural Competence in Physiotherapy Education and Practice in Aotearoa/New Zealand developed by Tae Ora Tinana. It comprises of self awareness, awareness of the diversity in others and finally a discussion of practicality in clinical practice.

There is material we suggest participants should read before the professional development session, containing information on Maori principles, models and the treaty of Waitangi. However this is not a “How to” guide when treating Ma�ori. This package provides tools that can be implemented for any culture. Remember that we as therapists must treat our clients as individuals. Therefore any specifics, such as not touching someone’s head, may lead to the therapist assuming values that are not important to the client.

This package is about participation and discussion, so please remember no idea or question is stupid. Enjoy the experience!

Jarrod Ria

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Contents of this package Please return to National Office, including the master copy of all handouts: This folder, containing: • Exercise One – Facilitator Instructions • Exercise Two – Facilitator Instructions • Big 8 Sheet • Exercise Three – Facilitator Instructions

• Case Study: Respiratory • Case Study: Respiratory – Suggestions for Facilitator

• Case Study: Community • Case Study: Community – Suggestions for Facilitator

• Case Study: Neurological • Case Study: Neurological – Suggestions for Facilitator

• Case Study: Muskuloskeletal • Case Study: Muskuloskeletal – Suggestions for Facilitator

Preparation by participants We suggest you send the following (by email or post) to each participant.

• D.O.P.E Test Ask participants to complete the test and read the analysis of their behaviour profiles.

• 9 pages beginning “Cultural Competence in Physiotherapy” Ask participants to read before the session.

Handouts You are provided with a hard copy of each handout. Please photocopy the number you require. • Big 8 Diversity Dimensions • Case Study: Respiratory (for participants) • Case Study: Community (for participants) • Case Study: Neurological (for participants) • Case Study: Musculoskeletal (for participants) Evaluation Feedback Form Certificate of Attendance

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Exercise One – Facilitator Instructions Ice Breaker Each participant should have completed the DOPE personality test before the session. Aims:

To create a safe and participating environment. For participants to learn and identify traits about themselves.

Task: Each person in the group states their personality type and whether or not they agree with the quiz. (If the group knows each other well then they can have a light-hearted discussion about whether the personality type is correct or not, as well.) Tally up the different personalities and allow for a small discussion about the similarities and differences of the group.

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Exercise Two – Facilitator Instructions Diversity Equipment needed: Big 8 Diversity Sheet, pens, and large paper. Aim: To learn about the main aspects of diversity.

To identify which aspects participants associate with most and which aspects the group associates with and places importance on.

Task:

1. Place eight single sheets of flip chart paper around the room with a single dimension of diversity on each---the big 8.

2. Indicate to participants that there are papers around the room that symbolise the different dimensions of diversity. Briefly state what the main points are.

3. Instruct the participants to stand by the dimension of diversity that is least important to them as they think of themselves (the core being, what’s important to them, etc.)

4. Once they choose then instruct them to have a 2-minute conversation with the individuals at that dimension in terms of why they chose it, etc. Tell them to record the key points on the flip chart paper.

5. Now instruct them to stand by the dimension of diversity that is most important to them, to who they are, etc.

6. Have a second 2-minute conversation with those at that dimension. Record the key points in a different colour from the group before them.

7. Now instruct them to go to the dimension of diversity where society and/or most people tend to categorise them at least initially.

8. Repeat the discussion portion (2 minutes) and record in a different colour. 9. After the third discussion, read out the comments to the whole group (not repeating

any that are the same) and ask if anyone has any further points to raise. 10. Process the exercise in large group or small groups as best fits the size and

temperament of the group. Plummer 2003

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Big 8 Diversity Dimensions 1. Age

2. Race/Ethnicity/Nationality

3. Gender

4. Sexual Orientation

5. Mental/Physical ability

6. Education

7. Socioeconomic class

8. Religion

O’Loughlin, Et al, 2007

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Exercise Three – Facilitator Instructions Case studies Aim To create discussion about issues which arise in common scenarios and come up with different ideas you can use in practice to improve your patients’ outcomes Task Choose one of the four available case studies. Read the slide and answer the questions below. Feedback Sheets are provided for each case. It is important to remember that these are not the only answers and that there may be several solutions to each issue. Questions for all case studies With each case study, ask participants about their own experience of similar situations. For instance:

• Have you had patients whose backgrounds were so different that you had difficulty relating to them or explaining treatment to them?

• Have any of the issues talked about here arisen in your practice? • How did you deal with such issues? • Did your strategies work? • Why/why not? • Did you identify better strategies? • Does anybody in the group have ideas about what could be tried?

Finally, would your treatment delivery have changed if the client was:

• an elderly Asian man? • a middle-aged Hindu Indian woman? • the New Zealand Prime Minister’s son?

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Case study: Respiratory You are a new graduate physiotherapist, New Zealand Caucasian, female, fit and healthy. You have been referred a three-year-old boy who has had a moderate to severe asthma attack. He is currently recovering well. You have been asked to review his inhaler technique, as this is his fifth time in hospital in the last year. Family/social history He is identified as being Maori. He has two older sisters aged five and eight. He also lives with his mother and father and grandmother. As you enter the room the Mother, Grandmother and children are present. You can smell the smoke from both adults. You notice inhalers by the bed and the spacer still in the box. You find out in the subjective exam that the mother has been taught how to use the inhalers and the spacer but keeps forgetting. You find out that everybody is crowded into a small three-bedroom flat and that all adults smoke inside. Tasks Identify both the physiotherapist’s and the child’s diversity categories. Which of the diversity dimensions do you think may be important in your relationship with the patient and whanau? Identify possible clashes from these different backgrounds. Determine a plan of how the treatment will be implemented for the family. Are there any other possible services available to you that may prevent another return to hospital?

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Case Study: Respiratory – Suggestions for Facilitator Likely Diversity groupings – from information provided

Diversity headings Therapist Patient Age Early 20’s Under 10 Race/ Ethnicity/Nationality Caucasian Maori Gender Female Male Sexual orientation Unknown N/A Mental/Physical ability Fit and healthy Hospitalised Education Tertiary level Low secondary level Socioeconomic class Middle class Poor Religion unknown unknown Possible clashes

• Age differences between therapist and child o Therapist needs to use methods of communication that the child and also the

family can understand • Differences in background: Poor Maori child vs. middle-class Caucasian therapist

o After identifying that because of this child’s background the focus of his wellbeing may not be the same as the therapist’s, it is then easier to identify possible motivations for compliance to treatment

• Difference in family education level and therapist’s o It is likely that technical jargon will not be appropriate for this situation and the

therapist will need to cater her treatment to both the child and family • Differences in priorities between therapist and family

o With the child being one in a large family, time and money may be a bigger issue than the child’s inhalers. The therapist will need to target the person in the family most likely to help the child.

Possible treatment plans Note to facilitator: suggest only if discussion is stuck.

• Written instructions, in family terms • Make the task of using a spacer a game or something fun • Teach as many members of the family as possible • Create a reward system that does not require money • Involve any community services

Likely Services available

• Maori services within the hospital • Maori Primary Health Care Organisations

o Respiratory Nurses o Tamariki care services

• Respiratory groups • Marae health initiatives

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Case study: Neurological You are a 35-year-old Caucasian female physiotherapist. A new stroke patient has been admitted and you have been asked to assess and treat this patient. From the medical notes you obtain the following information: Mr “Bob” is a 63-year-old Methodist minister. He was born in the Pacific Islands and is of Pacific Island descent. He has a wife, five children, 20 grandchildren and two great grandchildren. Most live locally and two daughters and their grandchildren provide him and his wife with various kinds of help and are keen now to assist with some of the ADL’s (Activities of Daily Living). Mr Bob is described as overweight and does have a medical history of high cholesterol, high blood pressure, and type two diabetes. This has been controlled with medication. He has never smoked, and was independent with most activities. He has been diagnosed with a moderate infarct of the Middle cerebral artery (MCA) cerebral vascular accident (CVA), C.T. scan done but yet to be confirmed. He has been under two-hourly neurological observations and has been deemed medically stable. It has been stated that he is easily fatigued but also easily woken. At the time you see Mr Bob it has been roughly 24 hours since his stroke. On initial assessment he has significant sensory and motor deficits on the right side. He attends well to the task at hand and is well motivated. He is responding well in English with only slightly slurred speech. His family are keen to help and they say that they have been by his side catering to his needs. The next day you return for treatment. There are lots of cards, flowers and food in his cubicle along with four of his family members. Treatment today has not gone so well. Mr Bob is tired and seems distracted and is speaking in his native tongue. You don’t get very far with treatment and check the neurological observations, which have not changed. Tasks Identify the diversity classifications for both the patient and the therapist and which ones are relevant for your relationship. Identify possible clashes resulting from the differences. Identify any cultural practices that could be slowing the recovery of Mr Bob. Provide ideas of how to optimise treatment and Mr Bob’s recovery. What other sources may be helpful for Mr Bob’s recovery?

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Case Study: Neurological – Suggestions for Facilitator Diversity categories Diversity headings Therapist Patient Age Mid 30’s Early 60’s Race/ Ethnicity/Nationality Caucasian Pacific island Gender female male Sexual orientation unknown Heterosexual Mental/Physical ability Fit & well Not active but generally well Education Tertiary Tertiary Socioeconomic class Middle class Middle class Religion Unknown Christian Possible clashes

• The difference in age and gender may make it difficult for the patient to respond to the young female therapist. As a Pacific Island minister he has high status within his community and is accustomed to deference.

o It is quite likely that this family is used to specific people for specific roles, and this patient may be used to having things done for him. The therapist may be asking the patient to do activities that he would not normally do and feels it might not be his role to do.

Cultural practices

• With this family, the norm is to have many people around for support and help. Gifts from the local church are also likely to be plentiful. There may be many prayers throughout the day with a gathering of people.

• Having many people around and a highly stimulating environment may tire the patient instead of helping. This is an issue for the whole rehabilitation team.

Treatment Ideas Note to facilitator: suggest only if discussion is stuck.

• The idea is to limit the amount of stimulation to an amount the patient can handle, but also in a way that the family and church can be involved. This means looking wider than the patient himself and communicating with everyone involved to implement an appropriate treatment plan. A family meeting with the whole rehabilitation team and a member of the hospital’s Pacific Island support services is required. An important part of the rehabilitation plan is effectively involving the family in encouraging the patient to do whatever he can for himself.

Possible services

• Pacific hospital services • Local church initiatives • Stroke Foundation

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Case study: Community You are a part of a community multidisciplinary team (MDT). You are a 50-year-old female Caucasian physiotherapist working in a predominantly rural area. Your team has been referred to see a 70-year-old male in the community who has been falling. His name is Ted. You and an occupational therapist go to visit this man. On arrival you find a complex of houses on the property and one of the sons guides you to his father’s home. You both sit down with Ted, his wife Mary, and daughter Jane. Subjective assessment: Ted has been making light of the issue saying he has been doing ok and didn’t know what a physiotherapist or an occupational therapist were. However his wife and daughter explained that he has been falling occasionally at night but also on outings. He is the local Kaumatua and is kept very busy throughout the week. The wife’s main concerns are that he tires more quickly and is unsteady with his walking stick. The wife and daughter do the housework, and one of the grandchildren helps Ted with the events that he needs to attend. Medical history: Mild Chronic congestive heart failure (CHF), right total knee joint replacement, high blood pressure and high cholesterol. Objectively you find he is of frail stature. He has independent mobility inside the house but does need supervision on uneven ground outside. He has decreased balance and lower limb strength. On walking you notice shortness of breath (SOB) after five metres of walking and Ted needs to rest after 20m. Tasks Identify the diversity categories for the patient and the therapist and which ones are relevant to your relationship. Identify possible differences that may make this relationship difficult. Set short-term and long-term goals for Ted with a treatment plan also. Identify possible people and/or groups that may help maintain compliance to treatment.

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Case Study: Community – Suggestions for Facilitator Diversity categories Diversity headings Therapist Patient Age 50 70 Race/ Ethnicity/Nationality Caucasian Maori Gender Female Male Sexual orientation Unknown Heterosexual Mental/Physical ability Fit and healthy Active but limited Education Tertiary Maybe secondary Socioeconomic class Middle class Poor to middle class religion Unknown Unknown. Tikanga Maori Possible clashes

• Understanding level of the patient • Pride of the patient with denying that there are any issues

Goals and treatment plan Short-term

• To be able to continue to participate in current Kaumatua duties o Needs to stand and present speeches o To have the stamina for powhiri and tangi processes o To be able to walk about 20m at a time

Long-term • To be able to walk with a stick 100m with no rests • To be able to walk independently on uneven ground • To not fall in the next 6 months

Treatment

• A lot of discussion will be involved on how to preserve his dignity as a kaumatua • May need aids e.g. walking frame – discuss patient’s concerns (if any) about use • Involve the whanau to assist patient with Kaumatua duties • Ideas to minimise falls – possible referral to exercise or falls prevention programme –

may be an opportunity to introduce to this housing complex. • OT may assess cognition, and home surroundings with a view to reducing falls

Community groups

• Marae • Cardiac and respiratory groups • PHOs

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Case study: Musculoskeletal You are a 30-year-old Maori male physiotherapist. You work in an outpatients setting. Mr Pomare is one of your patients today. He has been referred to you from the ward physiotherapist, to progress activity after a right total knee joint replacement. On arrival introductions are done and the initial assessment begins. Mr Pomare is 65 years old, Maori, a retired teacher. Subjective Mr Pomare is six weeks post right total knee joint replacement (TKJR). He is walking around without any crutches, independently. Around the house he expresses no issues, but is struggling to walk to town and back. Main concern for him is that he still limps and the knee stiffens up after activity. He is very keen to get back to the golf course. Objective Some swelling noted around the knee. Walking independently with no aids and trendelenburg gait to the right side. Almost full knee extension, 70 degrees knee flexion. No pain in the knee just fell tight. After treatment you get an increase in knee flexion to 80 degrees. Mr Pomare seems happy with results, and an appointment is made for next week. Mr Pomare does not turn up for his next scheduled treatment. Almost a month later Mr Pomare has rebooked and is here to meet you. He apologises for not turning up to the last treatment, and states family issues. Mr Pomare mentions that he will come when he can but it may not be regular. Tasks Identify the diversity categories for the patient and the therapist, and which are relevant to your relationship. Identify possible differences that may make this relationship difficult. How can you still achieve results with irregular treatment times? Design a plan of treatment for this person and explain how compliance can be maintained.

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Case Study: Musculoskeletal – Suggestions for Facilitator Diversity categories Diversity headings Therapist Patient Age 30 65 Race/ Ethnicity/Nationality Maori Maori Gender Male Male Sexual orientation Unknown Unknown Mental/Physical ability Fit and healthy Reasonably fit and healthy Education Tertiary Tertiary Socioeconomic class Middle Class Middle Class religion Unknown Unknown Possible clashes

• Main issue is compliance. In this case the priorities of the patient are likely to be different from the therapist’s:

o Patient has family commitments o Patient may not be aware of the importance of timely rehab o Patient may have unrealistic expectations of post operative results

Compliance

• Firstly, can you provide the patient with a home exercise programme that fits with his lifestyle and family commitments, and motivate him to keep up with it?

• Secondly, explain the importance of your reviewing his progress every few weeks. Can you work out a way to be flexible with your appointment times?

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Evaluation Feedback Form 1. This package was designed to facilitate in understanding the concept of cultural

awareness. Please rate how well this was achieved.

Excellent Good OK Poor Very Poor 5 4 3 2 1

Comments:

2. This package was designed to help you identify cultural issues in your practice. Please rate how well this was achieved.

Excellent Good OK Poor Very Poor 5 4 3 2 1

Comments:

3. Please rate the time taken to finish the package.

Just Right A Bit Long A Bit Short Too Long Too Short 5 4 3 2 1

Comments:

4. Are you likely to be able to apply this concept of cultural awareness to your practice?

Never Occasionally Mostly All the time Don’t know

Comments:

5. Was there enough information provided for an individual to work through this package alone?

Yes No

Comments:

6. Any further comments:

Feedback from the facilitator Please comment on the package from your point of view as the facilitator. (For example: Did you find the package easy to follow? Did the handouts help guide discussion? How could we improve the package?)

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Cultural competence in physiotherapy Definitions:

Biculturalism

-Aotearoa is the only country which New Zealand Maori affiliate to as turangawaewae. As the indigenous people, Maori have a unique place in New Zealand.

-Aotearoa was colonised by European nations.

- The concept of biculturalism is designed to represent the relationship between Maori and others, especially the Crown, honouring the cultural differences.

Culture

- is created, dynamic, lived experience that happens between people.

- is always in process.

- is always viewed from a particular perspective

- Thus it is essential to begin understanding culture and context by interrogating our own perspective.

- includes, but is not restricted to, age or generation, gender, sexual orientation, occupation and socioeconomic status, ethnic origin or migrant experience, religious or spiritual belief, disability.

Cultural Competence

Describes skills, knowledge and attitudes required to safely and satisfactorily deliver health care that is culturally sensitive, and culturally appropriate.

Cultural Safety

- is defined by those who receive the service.

- acknowledges that we are all bearers of culture

- draws our attention to the social, economic, and political position of certain groups within society

- makes us challenge unequal power relations at levels of individual, family, community, and society.

-makes us reflect on our own cultural identity

-helps us understand how this creates/influences our world view, perspectives, values, communication

-helps us understand how different people’s perspectives can influence their world views and that we must respect this in order to communicate effectively.

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-"The effective delivery of physiotherapy services to a person or family from another culture, is determined by that person or family.

The physiotherapist delivering the physiotherapy service will have undertaken a process of reflection on his or her own cultural identity and will recognise the impact his or her personal culture has on his or her professional practice."

Cultural Safety is about absence of discrimination and about behaviour that ensures that staff and patients are valued and respected and being included in decision making. Unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and wellbeing of the individual."

(New Zealand Society of Physiotherapists Inc., 2004.p.9)

"Cultural Safety education is focused on the knowledge and understanding of the individual physiotherapist, rather than on attempts to learn accessible aspects of different groups. A physiotherapist who can understand his or her own culture and the theory of power relations can be culturally safe in any context."

(Guidelines for Cultural Competence in Physiotherapy Education and Practice in Aotearoa New Zealand, 2004)

(Guidelines for Cultural Competence In Physiotherapy Education and Practice in Aotearoa/New Zealand, Taeora Tinana, May 2004)

Cultural Sensitivity

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- involves the recognition that the lived experiences of all people include aspects similar and different to our own .

- acknowledges that our actions affect other people.

- acknowledges that difference is important and must be respected.

Diversity Training

Educational sessions to increase ability of workers to serve people from different cultural groups. In health care the goal is to assist health care providers to deliver culturally sensitive care. Many times, however, diversity training is based on a limited view of culture as a list of behaviours and practices associated with different groups. Such a view does not help providers to see themselves as bearers of culture, nor does it address the power relations between them and their patients or the effects of racism.

Marginalisation

The process of establishing and maintaining a social division of people where the dominant group is considered the norm, and non-dominant individuals or groups are considered to exist outside the norm, at the margins. Those who exist at the social, political, and economic edges of society do not have the same access to life opportunities that members of the dominant group have.

Privilege

A system of unearned freedoms, rights, benefits, advantages, and access afforded members of the dominant group of society. This is usually taken for granted by individuals as they are taught not to see it.

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Treaty of Waitangi 1840 Differences in the meaning of the 2 texts. (kawangatanga= governance

sovereignty= rangatiratanga)

Preamble

Article 1: The right of the Crown to govern, in return for,

Article 2: The right of the tribal nations of Aotearoa to exercise full authority in respect of their own affairs, lands and taonga.

Article 3: The right of all people to equality and equity. Share same rights and privileges as British citizens.

How does this relate to physiotherapy?

Extracting the principles in order to apply them to contemporary health situations has its limitations but has become popular to assist people to translate treaty guarantees into possibilities for action.

Partnership

Participation

Protection

"Physiotherapists have an obligation to honour the principles of the Treaty while undertaking physiotherapy practice in the delivery of health services to and with Maori consumers." 3.

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Maori Health

Decline in Maori health since European contact and health disparities continue to exist.

European Contact (1769-1890) -Introduced diseases, influenza, dysentery, TB, whooping cough

-War

-Poverty

-Population from~200,000- 42,000

Lifestyle diseases -Diabetes

-Smoking related diseases, asthma, SIDS

-obesity

-Treatable diseases e.g. rheumatic and hypertensive heart disease.

-coronary heart disease, cervical cancer in women

-injuries

Other Issues -Accessibility

-Targeting

-Education

-Self determination

-Maori Healthcare Providers

-Biculturalism

-Politics

-Urbanisation

-Te Reo/Language

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TRADITIONAL MAORI HEALTH MODEL

4 Cornerstones Te Whare Tapawha

Te Taha Wairua (Spiritual) Te Taha Tinana (Physical)

Te Taha Hinengaro (Mental) Te Taha Whanau (Support)

Wairua- spiritual well being. The values and beliefs determine the way people live and the search for meaning and purpose in their lives. Intrinsic elements of spiritual well being represents identity, beliefs and values.

Hinengaro-Cognitive and emotional well being which determines or shapes how people perceive themselves i.e., self esteem and self confidence. It also relates to our ability to think clearly, acknowledge and express thoughts and feelings and respond constructively. Whatumanawa= open and healthy expression of emotions.

Tinana- physical element of health that reflects that of your environment and lifestyle. Includes growth and development, ability to move and care for our physical selves.

Whanau- Our social well being, based on our relations with family, friends and support systems. Whanau is about a sense of belonging, connectedness, compassion, caring and social support which allows us to draw strength from these groups.

Other Maori health models include

Te Wheke

Te Pae Mahutonga

You can find these models in depth on the Ministry of Health website under Maori health.

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Traditional Maori Concepts:

MAURI

Vital Life force. Agent that binds Wairua, Hinengaro and Tinana to produce Mauri Ora (Well being). Mauri Ora occurs when all three are synchronised. When this takes place the mauri becomes active and is driven to find avenues of expression.

MANA

Is the product of Mauri. Mauri + Wairua= Mana.

The desired outcome of the wairua, compelled to make its presence known, is to produce evidence of its existence or mana. Mana can be measured by the levels of energy present in the mauri, distinguished by the terms ihi, wehi, wana.

Ihi- energy that captures our attention and incites our spirit, grabs hold of our senses and makes us want to be part of the unfolding magic.

Wehi- when we can't contain the provocative and charismatic nature of ihi, we are driven to be actively involved.

Wana- energies stirred remembering the magic and excitement of the moment.

MANAKITANGA

-urging forward our mana so that it is visible, influential and far reaching.

-purpose was to increase and extend one's mana so that it would nurture and sustain the divine nature of being human.

TIKANGA- customs

KAWA- protocol

"Physiotherapy has a responsibility to respond to Maori health issues by improving the delivery of physiotherapy services to Maori to ensure that they are responsive to, and acknowledge and respect the diversity of world views that may exist between Maori consumers of health services." 3.

Physiotherapists must actively work towards reducing health inequalities for Maori.

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Health Practitioners Competence Assurance (HPCA ) Act Requirements.

As stated in the Act on page 21 of the Act. Clause 114 sets out the functions of authorities (Physiotherapy Board).

Setting standards of clinical competence, cultural competence, and ethical conduct.

Currently Physiotherapists are required to write a reflective statement as proof of their cultural competence development.

The key requirements for a reflective statement are:

1. What did you do? 2. What did you learn? 3. How did this activity affirm or influence your practice?

An example “The Guideline “Maori Cultural Competencies For Providers” was published by ACC and it was sent to our clinic. Our practice has clients from many ethnic backgrounds including Maori. Therefore it made sense to take time to read this publication and obtain an understanding of the Maori perspective on health. I found the tips presented very useful and I have been able to put these into practice with most Maori clients e.g. If I am unsure of their name then I get them to pronounce it, I take care with hand gestures and eye contact. All-in-all I am being far more sensitive to their cultural differences. I have always been careful with touching the heads of Maori clients and I have never had a problem as I have clearly explained my treatments and sought informed consent. Thinking through these cultural differences has made me aware of how culture impacts on health.”

(DEVELOPING REFLECTIVE STATEMENTS,www.physioboard.org.nz)

http://www.physioboard.org.nz

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Helpful readings NZSP Towards cultural competence NZSP Guidelines for cultural competence in physiotherapy education and practice in Aotearoa New Zealand

www.maorihealth.govt.nz Tatau Kahukura, Maori health chart book. (Ministry of Health website) http://www.treatyofwaitangi.net.nz

References

1.MainC. McCallin A, Smith N (2006): Cultural Safety and competence: What does this mean for Physiotherapists? New Zealand Journal of Physiotherapy 34(3): 160-166.

2.Ministry of Health: Maori Health Statistics. Retrieved May 30, 2007, from http//www.maorihealth.govt.nz/

3.New Zealand Society of Physiotherapists Inc, Taeora Tinana(2004). Guidelines for Cultural Competence in Physiotherapy Education and Practice in Aotearoa/New Zealand. New Zealand Society of Physiotherapists Inc. Wellington.

4.New Zealand Society of Physiotherapists Inc. (2006): Standards of Physiotherapy Practice. 3rd Edition. New Zealand Society of Physiotherapists Inc. Wellington.

5.Ramsden I (2002). Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu. Wellington: Victoria University of Wellington.

6.Ratima M, Waetford C, Wikaire E (2006): Cultural Competence of Physiotherapists: Reducing Inequalities in Health Between Maori and Non-Maori. New Zealand Journal of Physiotherapy 34(3): 153-159

7.State Services Commission, Te Komihana O Nga Tari Kawanatanga(2005) The Story of the Treaty-Part 1. State Services Commission, Wellington.

8.Te Puni Kokiri, Ministry of Maori Development (2000) Tikanga Oranga Hauora. Retrieved May 30, 2007, from http://www.tpk.govt.nz/maori/health/default.asp

http://www.maorihealth.govt.nz

http://www.treatyofwaitangi.net.nz

http://www.maorihealth.govt.nz/

http://www.tpk.govt.nz/maori/health/default.asp

bsc pt - cultureal competence in pt practice

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