Preserving Kawa Whakaruruhau--what is Kai Tiaki's role? Assuming a Maori word for its title would suggest Kai Tiaki Nursing New Zealand has an obligation to be a guardian of nursing knowledge, including the philosophy of cultural safety.

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A guardian. A protector. A watcher. A custodian. An advocate for the vulnerable. A teacher; mentor; nurturer and nurse. A kaitiaki.

Kai Tiaki Nursing New Zealand has carried the name of this ancient Polynesian system of guardianship for 100 years. At the time of the journal's inception, its founding editor Hester Maclean sought a distinctive title, indicative of the journal's country of origin. A Government interpreter responded to her request with the suggestion "kai tiaki", as there was no literal translation for "nurse" in te reo.

Maclean's idea was to find a word that conveyed the idea of caring for the sick. Choosing a Maori name was a brave and pioneering decision at that time, especially for someone who had not grown up in this country--she was an Australian after all! Over the years, the meaning of the term has deepened, along with our understanding. It is doubtful Maclean understood the other layers of meaning this word contains, that of "guardianship" and "protection" One could argue that by assuming a Maori name and concept, the journal and the nursing world it represented undertook an obligation to honour the term and to act as guardians, through the printed word, of the taonga of nursing. That taonga includes Maori nursing and the theory of kawa whakaruruhau/cultural safety which is now an intrinsic part of nursing education.

Being a kaitiaki--someone who takes care or protects--carries a sense of responsibility. A kaitiaki is in a position of power and, at the same time, obligation. There is a degree of teaching involved--to encourage questioning, pushing the boundaries, learning more and expanding horizons. The concept easily translates into nursing and midwifery. But it is just as applicable to the journal itself. Does the journal, which bears the name and concept of kaitiaki, meet the obligations it implies?

The philosophy of kawa whakaruruhau was designed and gifted to the nurses of this country--and to nurses internationally--by nursing leader Irihapeti Ramsden. The Nursing Council introduced it into nursing and midwifery curriculum assessment processes in 1990, but the theory applies in a variety of realms. As Ramsden says in the abstract to her doctoral thesis Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu: "The story of cultural safety is a personal story, but also a very public one. It is set in neo-colonial New Zealand, but has implications for indigenous people throughout the world. It is about human samenesses and human differences, but is also a story about all interactions between nurses and patients because all are power laden. Finally, although it is about nursing, it is also relevant to all encounters, all exchanges between health care workers and patients." (1)

She expands on these points later in the thesis: "Cultural safety ... investigates setting up systems which enable the less powerful to genuinely monitor the attitudes and services of the powerful to comment with safety, and ultimately, to create useful and positive change, which can only be of benefit to nursing, and to all the people whom nurses and midwives serve." (1)

Ramsden died in 2003 without completing the text book she wanted as a teaching tool for students and tutors. However, the history, evolution and controversy of kawa whakaruruhau are well documented, much of it recorded within the pages of Kai Tiaki. Ramsden was also the co-editors' adviser and guide in the preparation of a special issue of Kai Tiaki on cultural safety in February 2001. The painting of Ramsden reproduced on p38 formed the cover of that significant issue.

Cultural safety's declining profile

It concerns us, however, that since Ramsden's death, kawa whakaruruhau's profile has steadily declined. We need to remember and honour the fact that Ramsden changed the face of nursing in this country. Sadly, the term kawa whakaruruhau is not in as much use as when Ramsden was alive. Do nurses, midwives, students and tutors still believe in the philosophy? And what rote can Kai Tiaki, the journal, play in protecting kawa whakaruruhau, if it is vulnerable? If the theory has lost its momentum, how will it be revitalised? Or if it is continuing, is it being diluted? Is it devolving into "cultural awareness" or" cultural sensitivity"? Who is monitoring this? These are important questions the journal could usefully attempt to answer. Much like the interpretations of kaitiaki, the concepts of kawa whakaruruhau/cultural safety are broad and therefore flexible. They are not, and should not be applied exclusively to nursing and midwifery. They are human concepts, not professional ones. However if they are left dust-covered, they are of no use to anyone. Te Roopu Kawa Whakaruruhau at the Christchurch Polytechnic Institute of Technology has recently been accused by students of diluting cultural safety. Rather than being taught through one paper per year and a Maori health week, from 2008 it will be disseminated through all papers, with an obligation on every tutor to incorporate it into her/his course material. Te Roopu's objectives are to see cultural safety kept alive and integral to all nursing and midwifery papers. Rather than the teaching of cultural safety being a burden on one Maori tutor--a lonely journey indeed--all tutors will now need to take responsibility for it. With practice, cultural safety learnings will meld naturally into clinical learnings.

New graduate programmes

In previous years, many new graduates would drop cultural safety at the door of their new workplaces, so it is gratifying to see kawa whakaruruhau being incorporated into the recently introduced new graduate programmes.

However, the challenge remains to get older nurses, those who were educated in an earlier era, on board with the concept. Another hopeful sign is the interest overseas-trained nurses are showing in Maori health issues, te Tiriti o Waitangi and cultural safety. They are hungry for knowledge about this country and thus inspiring many New Zealand-trained nurses to upskill themselves in these areas.

The invisibility of nurses and their views and knowledge is widely acknowledged. Even more invisible are the views of Maori nurses. We need to hear a strong Maori nursing voice and Kai Tiaki is a natural vehicle to convey that voice and bear our stories. But do we see many Maori writing in the journal? Are we feeling safe enough to write publicly? Great strides have been made in recent years and we congratulate Kai Tiaki for its regular Te Runanga page and for publishing a variety of stories about Maori nurses and their practice.

However, while numbers of Maori nurses in the workforce remain small (below ten percent), the expectations on those few are high, both inside and outside nursing. We would like to see more Maori nurses taking the time to write but we also know from harsh experience that, despite having some great support from our colleagues, we do receive a tot of criticism from fellow nurses and members of the public about cultural safety and Te Tiriti issues. It is understandable that many Maori nurses often prefer to remain out of the debate, choosing instead to work kanohi kite kanohi (face to face) and hands on with their turoro rather than writing letters to editors or submitting journal articles. So it is clear why many choose not to engage on paper around debates on cultural safety. We have seen and, at times, borne the brunt ourselves, of the attitudes of the powerful who comment with safety about their disagreements with kawa whakaruruhau. We all need to choose where our energies are best spent "creating useful and positive change".

Ramsden understood this tension: "In order to grow in their ability to care, nurses need to be able to discuss their practice, consult their peers and expert practitioners and to have the confidence that their experience and views will be respected. This is often very difficult for nurses who differ philosophically and politically from their colleagues." (1) It is one of Kai Tiaki's roles to reflect diversity and to provide a forum for the wide range of philosophical and political views within the profession.

If NZNO continues its strong, clear leadership and commitment to Maori, as demonstrated in its ongoing journey towards organising its governance on a partnership model, Kai Tiaki will continue on its own journey of guardianship and protection. Debates, columns, articles and questions need to continue, for cultural safety's survival ties in development; its death in rigidity.

Kawa whakaruruhau is concerned with the individual, with examining self, before examining others. As Kai Tiaki celebrates its centennial, looking back on past achievements and examining its future role, now might be a good time for all of us to ask ourselves, "Does cultural safety have a place in my future?" We leave the last words to Irihapeti Ramsden: "What we have learned is that we cannot revisit the subjective experience of being deprived of precious things but rather we should learn from the experiences of the past to correct the understanding of the present and create a future which can be justly shared." (1)

Reference

(1) Ramsden, I.M. (2002) Cultural Safety and Nursing Education in Aotearoa and Te Waipounornu. Doctoral thesis submitted to Victoria University of Wellington.

Elizabeth Cunningham, no Ngai Tahu, Ngati Mutunga, is chair of Te Roopu Kawa Whakaruruhau at the Christchurch Polytechnic Institute of Technology, and research manager, Maori, at the University of Otago's Christchurch School of Medicine.

Annette Finlay, RN, BHSc, no Tainui, Te Arawa, Ngati Haua, Ngati Pikiao, is quality and risk co-ordinator with community services at the Nurse Maude Association in Christchurch.

* With further research by co-editor Anne Manchester