The following academic paper highlights the up-to-date issues and questions of Fonofale Model. This sample provides just some ideas on how this topic can be analyzed and discussed.
Pacific Islanders health and wellbeing has a holistic approach involving spirituality and environment. As a result of these and other differences, pacific models have been developed. The Pacific people in New Zealand are represented by seven different countries which are Samoa, Cook Island, Tonga, Niue, Tokelau, Fiji and Tuvalu. This essay will describe one of the pacific health models, the Fonofale model, and will also discuss how this model can enhance nursing practice. Moreover, it will attempt to demonstrate the application of the Fonofale model to holistically assess the cultural and clinical needs of a Pacific client.
Finally this essay will address the client’s health concerns and resilient factors and one concern will be discussed in more detail, reflecting on how the client’s cultural beliefs and practices impact on their current health status (Ministry of Health, 2009). The Fonofale model of health is a Samoan model that was created by a psychiatric nurse called Fuimaono Karl Pulotu Endemann. The model is a holistic concept and was developed to explain key features that Paci? c peoples consider important for maintaining good health which included family, culture and spirituality.
The model arose after the Dawn raids of the 1970’s in where the Pacific community was a target and over stayers were sent back to the Islands (Manukau Institute of Technology, 2013). The concept of the Samoan fale or meeting house was a way to incorporate and portray a Pacific way of what was important to the cultural groups. In the Fonofale model, cultural values and beliefs are seen as a shelter (the roof) – this may include traditional methods of healing and western treatments. Family forms the foundation or the floor of the fale. This may be the nuclear and/or the extended family and is significant to one’s health.
Connecting culture and family are the four pou or posts. ‘Spirituality’ includes christianity, religion or traditional spirituality. The ‘Physical’ pou relates to the physical and biological well being of the person. ‘Mental’ relates to the health of the mind which involves thinking, emotions and expressed behaviours. The fourth pou ‘Other’ refers to factors that can directly or indirectly affect health, such as gender, age, social class, employment, education and sexual orientation. Surrounding the outside of the fale is environment, time and context.
Environment addresses the relationships and uniqueness of Pacific people to their physical environment. Time relates to the actual or specific time in history that impacts on Pacific people and context relates to the meaning of health for that particular person (Manukau Institute of Technology, 2013). Pacific models like the Fonofale model is important to consider when providing nursing care to Pacific people to establish empathy and rapport between the client and nurse. It also helps to acknowledge cultural differences and to demonstrate respect and appreciation.
By acknowledging the different components of the Fonofale model this will provide nurses the tools that are culturally appropriate and effective for Pacific peoples in order to improve and maintain their holistic health and well being (Ministry of Health, 2008). The Popao is a canoe that Pacific elders use for fishing and travelling – the Popao model is portrayed by the concept of relationship, connectedness and working together as a unity in which is fundamental to the health and well being of the Pacific people. Auckland has the largest Pacific population in the world. There is diversity within the Pacific Population living in Aotearoa.
Each Paci? c nation has its own set of cultural beliefs, customs, languages, values and traditions. However, there are also differences within each Pacific community Therefore it is of great significance to understand the Pacific models as it can enhance nursing care (Ellis, 2007). As clinicians, an awareness of the context of where Pacific People have come from gives nurses advantage of how to approach nursing care for clients. By understanding the complexities of the Pacific population in this country, helps gives nurses a wider context in which Pacific worldview is applied and its influences.
With these models, nurses’ practice will be enhanced by practicing in a culturally safe manner and cultural competency. Nurses should also carry out important values such as alofa (love), faaloalo (respect – foundation for good relationships), usita’i (obedience), and faamaualalo (humility – not putting yourself above others) to name a few. The ‘Va’ is a term defining space between. All relationships especially the one between the client and nurse are sacred. One can violate that ‘Va’ (relationship) by practicing in a manner that is not client focussed.
As nurses it is our duty to be culturally aware and sensitive in order to enhance nursing practice (Manukau Institute of Technology, 2013). The Fonofale model was used as an assessment tool to assess the chosen client nam ed Ana (pseudonym). With the permission of the preceptor accessing Ana’s notes was critical to gain insight to her scenario. Bridging the ‘Va’ and creating a meaningful relationship with Ana was important. This was carried out by visiting Ana three times prior to asking for consent to interview her, greeting Ana in her language (Tongan) and speaking some Tongan phrases.
Active listening was also used and being non-judgemental. Therapeutic relationship was built with Ana by developing a sense of trust and rapport from her. Rapport is often increased by the use of humour, informality and simple language. In the beginning of the interview a prayer was said to sanctify and set apart the conversation that was about to be made. Also prior to assessing Ana, I also shared some information about myself and some significant events in my life which also contributed to bridging the ‘Va’ between Ana and me (Culbertson, 2007).
Ana is a 26 year old Tongan lady who was born in New Zealand and lives with her parents. Her parents migrated from Tonga in the 1980s to New Zealand for economic reasons and hoping to raise their children with better education. Ana has no other siblings but her extended family are very much involved in her life. Ana attended church but was not involved in church activities. She also had successfully completed one year in business studies and had started her second year of study. According to Ana’s clinical notes she was physically in good health, having no medical problems of any type.
The Tongan culture including beliefs, values and traditions play an important part of Ana’s health and wellbeing. Ofa (Love), toka’i (respect), talangofua (obedience) and fakatokilalo (humility) which is making one’s self lower than others, are some of the values that are significant in the Tongan culture ( Toafa & Moata’ane, 2001). Ana’s first presentation of mental illness was in March 2011. Ana’s family noted deterioration in her mental state over the past ten days. They stated that Ana paced herself around the house, became paranoid that someone was out to get her, talked to herself, was agitated and even isolated herself.
She also attempted to leave the house in which it took six family members to restraint her. Ana claimed to see devils and felt that God was working through her and had a mission to save the world. She also stated that her brothers were Prince William and Prince Harry. Ana’s cousin contacted the mental health line and she was then referred to a community mental health service. Ana had a psychotic episode which resolved quickly with medication.
She was diagnosed with Schizo affective disorder with elevated mood and the initial plan was to continue taking medication with a iew to slowly decrease it and to continue her normal routine (Herrmann, 2005). Medications that have been prescribed for Ana was olanzapine 10mg daily which is an antipsychotic drug that is used to relieve psychotic symptoms. Some of olanzapine’s side effects include weight gain and sedation causing one to feel calm and often sleepy. Epilim 500mg (daily) was also prescribed for her, which is a mood stabilizer. Ana appeared to have an elevated mood so Epilim helped her to feel a more relaxed feeling, have less racing thoughts, and a big decrease in impulsiveness.
Some of Epilim’s side effects include increase in appetite, temporary hair loss and diarrhoea (Elder, Evans & Nizette, 2005). At the time of assessment Ana was pleasant, polite and cooperative in interactions. She was reasonably groomed and dressed appropriately. Her mood appeared to be euthymic with a pleasant and reactive affect. Ana denied any hallucinations, paranoia and denied hearing any voices. She appeared to be alert and orientated to time, place and person. Her memory appeared intact, but however had little insight to her illness.
Her speech was relevant to the topic of discussion. Ana was not attending course anymore, was currently unemployed and on the sickness benefit (Manukau Institute of Technology, 2013). Concerns that are leading to Ana’s slow recovery in her mental illness include non-compliance. Ana has had three relapses in the past three years and had again deteriorated in her mental state all because she was reluctant to take her medication because it caused her to increase in weight. This relapse caused Ana to shoplift at the shops nearby, which may very well be part of her disorganized thought process.
A major concern with increase in weight is that Ana is more prone to other health diseases such as diabetes, cardiovascular diseases, obesity and high cholesterol. Therefore it is crucial to have ongoing assessment to monitor and prevent any major health problems. The doctor then decided to stop the olanzapine in July 2012 and prescribed risperidone 3mg (daily) which is another antipsychotic for a week then have intramuscular injections of risperdal consta 37. 5mg (fortnightly). One of Ana’s goals was to try and lose 20kg by the end of the year.
Losing the weight will help to boost her self esteem and self image (Elder et al. 2005). Stigma is another concern and is defined by a mark of shame, guilt and inferiority that a person may carry from having mental illness and negative views from others, otherwise known as prejudice. Most Tongans have negative attitudes towards people with mental illness such as thinking they are fakasesele (crazy), broke a taboo (something sacred) or are possessed by the devil. Tongan families often attempt to conceal members who may be afflicted. Ana is the only child in the family and being a female her worth is of great value.
In the Tongan culture, women are ranked higher than males. Ana’s parents stated that she is “the pearl of the family”. For Tongans including her parents, they prefer Tongan Healers and believe that taking medications and going to the hospital is the last resort. The lack of insight and support from Ana’s family contributed to her relapses (Peterson, Barnes & Duncan, 2008). Ana and her parents have certain disagreements in regards to health because Ana was born and raised in New Zealand (an environment where almost everything is westernized), compared to her parents who were from the Tonga.
The family denied that Ana had mental illness they sought help from Traditional Healers. Her parents believed that it is ‘avanga or spirit possessed. So the Traditional Healers put green leaves in her eyes and throat. This treatment was carried out four times until Ana refused it completely; she said that “it burnt” and preferred the medications. Pacific cultures do not have words that translate easily into ‘mental illness’. It is considered to be conjoined from the overall wellbeing of the body, soul and spirit.
The traditional Paci? belief related to mental health is that disturbed behaviour is a manifestation of an external spiritual force, especially ancestral spirits who have taken possession of the person because the person or the person’s family have broken a certain custom or offended the spirits in some way (Toafa & Moata’ane, 2001). The more relapses Ana has, the more difficult it is to help her in her recovery process. The plan is for the nurse to carry out psycho education continuously for Ana and her family about her illness and educate them on the medication that she is taking, its side effects and why she needs it.
The Tongan peer support service (PSS) will also be involved. This is a person who has experienced mental illness and is able to help clients like Ana to break the stigma and walk alongside Ana’s journey with mental illness. Psycho education and involving Ana’s family is extremely crucial to Ana’s recovery process. The expected goal is for Ana and her family to have a good understanding of her illness that is Schizo affective disorder and to be accepting and supportive in Ana’s recovery process (Ross, 2009).