Last Day

            The amount of generosity we have received this week is unable to be described.  Cherokee Indian Hospital (CIH) staff greeted us with open arms among all members of their interdisciplinary team.  Physicians were open to allowing us students to ask questions and observe procedures.  The nurses were more than willing to talk to us about previous personal experiences, the Cherokee culture, and advice for our future as a nurse.  All members of the interdisciplinary staff were open to allowing us to observe, ask questions, and express emotional concerns throughout the week. Saying thank you would not be enough to thank them for all they have done for us this week. 

            There were several experiences this week that allowed me to gain knowledge to benefit my future career.  Some of these experiences allowed me to grow inside and realize the importance I can serve in the future.  Others allowed me to gain new skills and communication styles with my future clients.  A combination of caring, gaining confidence, and gaining new skills will allow me to better myself as I prepare for my last three semesters of nursing school. 

            The CIH provides a one-stop shop for all their clients.  The only resources the hospital is unable to provide are surgery and intensive care.  However, the hospital does have a life-flight that is able to transport them to any other nearby hospitals within a short amount of time.  I feel the Cherokee culture will better their health with upcoming programs established by the hospital.  Several issues mentioned by the staff included the client’s behavioral health.  The hospital has a new project that involves treating the client’s behavioral health and helping them gain independence with their care. This program has a goal to prevent members of the tribe abusing opiates from recurrent use and find other ways to cope.

            It is important for the Cherokee to keep their health and traditions alive since they are both very highly valued.  This culture could teach others the importance of family values and how to better themselves without the use of prescriptive medications.  This week emphasized the importance on mind, body, and spirit.  I hope to provide the content learned this week into my future career.  I found areas that I felt I needed to work on as an individual.  The experiences this week allowed me to dig deep and find reassurance in myself. 

            Several experiences this week forced me to step outside my comfort zone.  However, each time I stepped out of my comfort zone I gained a comfort.  I faced the death of a client for the first time in the beginning of the week, and then again at the end.  This was emotional for me, however I felt more composed during the second exposure.  Each experience outside my comfort zone benefited me in several ways that I cannot take for granted.  

             I have gained so much confidence, faith, and hope this past week I cannot describe. I am thankful for the people that put this trip together and made it possible; I cannot thank them enough for the experience I gained from it.  I was able to complete two of my five goals established at the beginning of the course.  I was not able to see an infant be assessed, but I have gained new assessment skills projecting towards asking a client questions regarding their culture.  Prior to this experience I was timid and afraid to ask clients questions regarding their culture.  I was worried I would offend them or upset them, causing a barrier to form between our relationship.  This past week allowed me to gain confidence and new skills towards addressing a client, their culture, and health care needs. 

Photos

Nursing student by morning, tourist by afternoon

            Mission Children’s Hospital located in Ashville, North Carolina, is a children’s hospital that holds 130 beds (approximately 3,000 children) (Mission Children's Hospital, 2016).  Our tour included visiting the Newborn Intensive Care Unit (NICU), Pediatric Intensive Care Unit (PICU), and the Pediatric General Floor.  Mission Children's Hospital also has an outpatient pediatric center that provides all outpatient procedures for all body systems. This outpatient center has features that treat endocrine, respiratory, orthopedic, and many more injuries presented. The outpatient center allows the family and the pediatric client to receive all care within one visit.  

            There were several actions or interventions the Mission hospital staff provided for the families that struck me.  One intervention is the Mission staff providing a pull out couch for two parents of the child to sleep on and stay overnight in the child’s room.  This helps promote comfort and a calming sense for both the parents and the child.  A child admitted to the hospital forces the nurses to treat them, but also take care of the parents.  Parents are forced to create time in their lives that allow them to visit and comfort their hospitalized child.  This may force them to skip work and not earn the financial income needed. 

Another stressful event that may occur in the hospital setting is regression of the child’s milestones.  A toddler may begin using “baby-talk” after being able to speak two to three word sentences clearly.  The sense of insecurity found within the hospital setting causes the child to feel unsafe and regress back to previous milestones.  To help prevent this, it is recommended to not perform any procedures on the child’s bed.  The bed is commonly referred to as the child’s “safe zone” at school. At Methodist Hospital in Peoria, Illinois, I have only observed staff members prepare oral medications for the children. However, the nurse I observed did inform me and give me suggestions on how to prepare equipment such as urinary catheter or IV site. Mission Children’s Hospital had a designated room entitled “Treatment Room” where all treatments (IV insertion, shots) are performed to ensure the child’s security and sense of safety.  The treatment room can also promote trust and loyalty within the nurse-client relationship among the child and their family.Unfortuantely, Methodist does not have a treatment room, the nurse I observed gave me ideas on preparing equipment that may often be seen as frightening to children.  She suggested preparing them outside the room, or having your back turned towards the client so they cannot see the equipment.

            A pediatric nurse is not only responsible for the pediatric clients, they are also responsible for educating the parents and demonstrating treatment interventions if needed.  Rounding is often described as the process of the residents, physician, nurse, and client giving a report at bedside or within a common gathering area.  Mission Children’s Hospital allows the parents to sit in on rounding with the physician, nurse, dietician, resident, and nurse manager.  This allows the parents to receive feedback regarding their child’s prognosis as well as share their concerns regarding treatment.  Miscommunication can be found within healthcare as many health care team members have more than one client to care for.  These rounding sessions help apply family-centered client care to ensure the parents understand the child’s condition, as well as being competent enough to care for the child once discharged.

            Mission Children’s Hospital is located in Ashville, which means it is not on the Cherokee Qualla Boundary.  This allows the hospital to have different policies or regulations than the Cherokee Indian Hospital.  One difference between the two is the presence of an ethics committee, used if needed.  Both hospitals provided family-centered care and allowed the clients to have nature-themed rooms.  The rooms have one wall full of windows that outlook the mountains and a gorgeous view.  Both staffs have interdisciplinary report that prevents miscommunication or confusion regarding the client’s treatment program.  The use of the interdisciplinary report (witnessed at Cherokee Indian Hospital) is one observation that has stuck with me this entire week.  I hope our hospital systems are able to inquire this type of report session in the near future. 

About us. (2016).  Mission children’s hospital. Retrieved from http://www.missionchildrens.org/about-mission-childrens.php

"The eyes are the mirror to the soul."

          Tuesday was an overwhelming, emotional, but educational day at Cherokee Indian Hospital (CIH), while Wednesday was a day to recover and spend time in the Cherokee village.  Tuesday morning consisted of several experiences that have left a strong impact on my thoughts of becoming a future nurse.  These complex experiences have left a mark in my heart in that I hope to become a better person to treat my future clients.  I realize the importance of intervening with the family while providing care for their pediatric patient.  There are several times in life where we, or I, have a rough patch and think the world is coming to an end.  The two experiences I witnessed at CIH struck me with emotions that made me realize those bad moments are just a moment in time, not lifelong. 

            The CIH has several departments that help the clients promote adherence to their treatment regimen and simply have a “one-stop” shop for all their needs.  Tuesday afternoon I was able to witness two clients within the prenatal clinic perform periodic pregnancy testing.  The prenatal appointments were very similar to our culture; they consisted of vitals, belly measurement, questions regarding health care behaviors, and risky behaviors.  One element of the prenatal appointment that was different than our culture was questions regarding the use of Complementary Alternative Medicines (CAM).  CAMs can easily interfere with prescriptive medications if not used with caution.  I have found through observation with a few clients is the Cherokee tribe members do not share what CAMs they use.  One nurse explained clients will have a “leather pouch” with their medication herbal mixture, but may not be open to sharing what herbals are mixed within the pouch. This could be a risk if the physician were to prescribe the client medications; however, as a nurse caring for a client using CAMs it is important to educate about side effects that may occur with common CAMs.

            In my previous post I mentioned the Cherokee tribe is concerned with losing their language.  After seeing a reenactment of the Trail of Tears, I have found that tribal members have trouble with resilience and bouncing back from their traumatic past of attending boarding schools.  The tribe members that attended boarding school were not shown the guidance and love necessary to provide for a family.  These members continue to pass down these habits generation to generation, causing a whirling wind of ineffective coping and guidance.  Family is a value that the Cherokee strongly believe in and practice. The long strain of lacking guidance does not provide a structural environment children need while growing up and learning life values. In the Cherokee culture, the woman is commonly the verbal decision maker of the family.  Children may need to gain independence sooner than our culture due to the need to take care of their elderly and family.  This can create issues if the woman was to pass away or become ill, the father will need to learn how to consider the values and beliefs in order to pursue the tribe's beliefs.

CIH is in the process of starting a new program that allows clients who are abusing opiates long term to learn how to take care of themselves in a holistic perspective.  This includes mind, body, spirit, and physical assessment.  One struggle commonly found within this culture is the healing of mind, body, and spirit.  This new program will allow the clients to attend classes for four weeks and wean off the opiates while using healing and touch to better their health.  Healing and touch are examples of CAMs, as well as guided imagery, relaxation, and acupuncture.  These alternatives may help the Cherokee take care of themselves and gain independence without interfering with cultural beliefs against Western medicine.

This trip has allowed me to gain confidence in asking clients questions regarding their culture.  Prior to this trip I felt uncomfortable asking my clients questions regarding their culture; I was always afraid they would be offended.  Each person I have asked questions to regarding the Cherokee culture has been open and willing to share endless stories with me.  This has allowed me to gain confidence and gain reassurance that I have found a career where I belong.