Senior Nurses' Perspectives on Kawa Whakaruruhau and Cultural Safety for Māori Accessing Adult Mental Health Services in Aotearoa-New Zealand.

Māori, the indigenous people of Aotearoa New Zealand have poorer outcomes and experiences when accessing adult mental health services (MHS), including higher rates of seclusion and compulsory treatment. These inequities for Māori represent a breach of Te Tiriti o Waitangi, the constitutional foundation of Aotearoa New Zealand, and stem from over a 100 years of European colonisation involving massive confiscation of Māori land, population decline, and suppression of Māori identity and culture. The recent New Zealand mental health Inquiry, He Ara Oranga, emphasised the need to transform the cultural responsiveness of mental health services for Māori. Similar issues were highlighted by Dr. Irihapeti Ramsden who pioneered the concept of cultural safety for Māori in nursing practice, which when applied to Māori consumers is referred to as 'Kawa Whakaruruhau'. This qualitative study explored 10 Māori and non-Māori senior nursing leaders' perspectives on the status of Kawa Whakaruruhau and Cultural Safety for Māori consumers (tāngata whaiora) and their family (whānau) accessing adult MHS in Aotearoa-New Zealand. The participants came from four health regions and a national mental health nursing organisation. Key themes focussed on Kawa Whakaruruhau and Cultural Safety as either cultural competence or power relationships between nurses and Māori, and there were many opportunities for improving Kawa Whakaruruhau in services. The results suggested that from a nursing perspective, the status of Kawa Whakaruruhau and Cultural Safety in adult mental health services for tāngata whaiora Māori and their whānau is highly problematic. This report is adherent with the COREQ checklist.