The Midlands Health Network has developed a model of school-based health care that reflects Māori values, adapting the usual provision of nursing services to a whānau-centric way of life.
The Midlands Health Network serves the Waikato region, which has ten Māori immersion wharekura (schools), seven of which are Decile 1 or 2. The wharekura differ from most mainstream schools in their structure, as well as their language and culture.
Nicki Spring, who has a background in Māori medium education, is the coordinator for Waikato school clinics. When she took up the role, she realised that the existing model of health care service wasn’t meeting the needs of wharekura.
Schools qualify for one full-time nurse for every 750 pupils. Wharekura usually have a smaller roll than mainstream schools. Five of Waikato’s seven decile 1 or 2 wharekura are in rural areas, where there is a high level of socioeconomic deprivation and disengagement from health care services. Health needs are high in the populations the wharekura serve, but most wharekura qualify for only about an hour of nursing services per week.
In addition, current funding arrangements mean that nursing services for wharekura are fragmented. Most wharekura take pupils from Year 0 to Year 13. Public health nurses care for pupils in Years 0 to 6, while school nurses care for those in Years 7 to 13. This arrangement doesn’t work well with the whānau-centric values of wharekura. A nurse accepted into a wharekura community is expected to care for the whole whānau, and take a holistic approach to improving health outcomes.
In 2013, funding became available under the Youth Mental Health Project, and Nicki began working with wharekura to build a model of care that would better serve their needs.
One wharekura, Te Wharekura o Manaia, was chosen to host the pilot model. Nicki secured nine school nurse hours per week for the wharekura, and the school nurse service was extended to include pupils from Years 0 to 6.
The partnership between the school nurse service and the wharekura ensured that the model addressed the issues that were important to the wharekura. One issue was the need to find the right nurse. Clinical competency was crucial, but the nurse also had to have knowledge of Māori language and culture. Together, Nicki and Te Wharekura o Manaia tumuaki (principal) Martin Mikaere recruited Riana Manuel, a nurse who was fluent in Te Reo Māori.
Riana helped to develop a range of services for the new model. The pilot introduced kaupapa Māori sexual health education to Te Wharekura o Manaia’s curriculum, and created opportunities for one-on-one consultations between the nurse and young people. The team monitored these consultations to collect data for a six-month review, which would inform future development.
For Te Wharekura o Manaia, the new model provided school nursing care that fit with their inclusive whānau-centric values. It enabled the school nurse to become a genuine part of the wharekura community, able to care for the entire whānau.