Indigenous nurses in New Zealand deliver innovative project

In New Zealand we are celebrating a continuing decline in smoking rates, however inequalities persist in prevalence among population groups. Maori adults (indigenous population) maintain the highest smoking rates at 36% compared with 15.5% in the general population (Ministry of Health, 2013).

A similar disparity exists between Maori nurses and their non-Maori colleagues. Although the rate of smoking for Maori nurses remains lower than Maori overall, nurses’ own smoking is a significant barrier in their ability to deliver smoking cessation interventions in their nursing practice.

This has implications for the role Maori nurses can play in reducing smoking among Maori. As role models for their clients, nurses who are themselves addicted to tobacco can experience feelings of shame, guilt and hypocrisy (Radsma & Bortloff, 2009). This conflict is compounded for Maori nurses who are seen not only as examples for their own people but the expectation is that a strong Maori health workforce is at the heart of improving the health status of Maori as a population. “Walking the talk” is fraught with dilemma, stigmatisation and vulnerability for nurses who smoke.

In 2011 Maori nurses themselves (Te Runanga o Aotearoa of the Nurses Organisation of New Zealand) initiated a collaborative project exploring the context of smoking among Maori nurses. Findings suggest that current smoking cessation services are not effective and add to feelings of stigmatisation and persecution (Gifford, Walker, Clendon, Wilson & Boulton, 2013).

In this study smokers and non-smokers alike suggested the need for more culturally-specific cessation approaches based on establishing supportive environments, positive messages and incentives. Such an approach is the focus of a study to assess the efficacy of financial incentives as a method to achieve smoking cessation among a cohort of Maori nursing students and their whanau members. This research is about to be undertaken and is funded by New Zealand’s Tobacco Control Research Turanga .

Using a Kaupapa Maori methodology, the study will take place in a school of nursing and will sit in an existing programme of cultural and pastoral support for Maori nursing students. A scholarship will be offered to students who with a whanau member remain quit at certain intervals over a six month period. The programme will offer a range of cessation support options including access to subsidised NRT in the first instance, but a critical part of the programme is that students and their whanau decide what may suit them. Behavioural support in the form of regular follow-up individually, in pairs or as a group will be emphasised as a significant factor in staying quit.

Including a whanau member reflects what is known about smoking within the whanau. For example, when both partners smoke, efforts to quit are compromised if one partner continues smoking. The opportunity for a “quit mate” in the whanau provides additional motivation and encourages other whanau members to also quit. It will also create a whanau-inclusive approach in the nursing school which may further enhance the successful completion of the students’ nursing programmes.

In the initial events of colonisation, Maori died in the thousands from introduced diseases. They now die from introduced products such as tobacco. There is much we can do to provide better support for Maori to eliminate tobacco from their lives. There is much more we need to do to eliminate tobacco from our world.

  1. Gifford, H., Walker, L., Clendon, J., Wilson, D., & Boulton, A. (2013). Maori nurses and smoking: Conflicted identities and motivations for smoking cessation. Kai Tiaki Nursing Research, 4(1), 33-38.
  2. Ministry of Health. (2013). New Zealand Health Survey: Annual update of key findings 2012/13. Wellington: Ministry of Health.
  3. Radsma, J., and Bortloff, J. (2009). Counteracting ambivalence: Nurses who smoke and their health promotion role with patients who smoke. Research in Nursing & Health, 32(4), 443-52.