Day 8: Reflection about Cherokee

The first way that we experienced generosity this week was by having a grant gifted to us for the trip. This helped so much with the overall cost and for us to save money while traveling as well. When we arrived at Cherokee hospital, everyone was very welcoming. Ashley who was Kayla’s assistant, gifted us free tickets which was very generous of them. As for Kayla, Kim and Victoria, they are very busy with their jobs. They have staff to look over as well as many meetings, but they took the time out of their week to spend time and talk to us and to make sure that we had the best experience possible. The nurses at the hospital explained so much to us and wanted to help us learn. I think that this culture is able to get healthier by having their effective healthcare system that is put into place for them. The challenge now is educating them on the importance of using those resources. For future generations, they can keep their heritage by continuing to teach the ways of their past. They teach the arts and crafts in school and they have their language school. This is important because their culture is sacred, and they were the first people in this country and their story should always be shared and protected. This is a culture that I have gained so much respect for and I think that we can all learn so much from everything that has happened in history. This week, I was out of my comfort zone because I felt very vulnerable. There were some sad stories shared and that I experienced that I will always hold with me. I also heard some happy stories and learned so much about the Appalachia area and the people who live here. I have been impacted from this experience because it made me fall in love with nursing in a whole new way. I also was able to see other areas of nursing that I had not been exposed too yet and I am excited to have the experience soon of starting to apply for jobs and to see where I end up in my career. I was also reminded that everyone has a story and that it is important to always listen to those stories and that in order to be a strong team of co-workers, it is important to know how they work and what they do best at so that you can provide the best care possible. I think that sometimes in nursing it is very easy to become jaded. It is frustrating to watch someone continually drink or use drugs and put themselves in those bad situations. However, I know that addiction is very hard to overcome, and they have turned to these things because they have other problems, and this is a way that they are getting covered up. I need to remember that, and I also need to remember that I will never understand why or how someone could put a child in harm. I realized that is not my job to understand but what is my job is to take care of the children and make sure that resources and policies are available to prevent this from continuing to happen. This week, I was very touched by Kayla. I think that she is a very strong person and I was touched by her stories that she shared with us. I also plan to use her corrections to update my cover letter and am thankful that she took the time to help us edit those. I am very thankful for this opportunity that I had this week to travel and I will forever hold the memories close to my heart. I also made new friends and I am thankful for that as well.

Day 7: Last day at the Hospital

The first most critical issue this culture encounters daily is drug and alcohol abuse. It was eye opening to me to actually learn that they have this problem due to previous broken generations. When this happens, it is very hard to break the cycle. Another critical issue that they encounter is that great grandparents are raising their grandchildren as they have been taken away from the parents. This is hard on the children and on the grandparents as it is a lot of responsibility and hard work that they might not have the resources for. The prevalent conditions that I have noted are that they are not using their dental facility. I learned this today when they told us how they previously treated them with their dental care and now they have a fear of getting teeth pulled or getting cleanings. This is something that through education, they will eventually learn to use and work on. The nurse’s role in health promotion and health maintenance is by education and treatment. For example, when the patients are coming in time after time for addiction, I think that after detoxing, a seriously conversation needs to happen. They have resources to help them overcome that, so it is important to be educating about those things. When the children are taken away from the parents, they need to make out plans regarding care and that parenting classes should be taught. I also think that they should teach the importance of maintaining medications and follow up appointments as I noticed that many were skipping their appointments due to per-cap. Money management would be an effective teaching point as well as most of them spend it all and with proper investments and savings, that could really help them out with their resources. In my opinion and observation, their healthcare system was driven on what they wanted as well as systems that provide patient centered care. They also have trainings for all of their employees, and everyone is on the same page. When the employees want to be there, they also provide better care for the patients verses systems that are driven around money. This is different that my previous experiences in healthcare outside of Cherokee because where I work, it is a large corporation and it is not as close nit as Cherokee. However, I think that Unity Point does care about their patients and their care. I just think that there are things that could be improved. I like how the employees get to know each other at Cherokee and how they try their best to work well together. These are things that we can take back with us though and by meeting with our nurse educators and having meetings, things can change, and we can advocate for our patients.

Day 6: Traveling to Asheville

The 130 bed children’s hospital in western North Carolina had a very effective system. In other hospitals, I have never seen patient satisfaction surveys and other data displayed on the wall. I thought that it is an effective system to have and I think that is shows that you are providing good care across the board. I also liked how they had CHG and Foley signs on the door with when the care needs to be provided. It also lets the patients know that this needs to be done and then they can ask about it. Hospitalization affects families because it is very hard to have a loved one in the hospital. It is also hard to find coverage for work or take care of other children. It is also mentally stressful and when you also have other children at home, it can make it difficult to find others to watch the children. This organization applies family centered care by considering the patient’s needs first. I heard the nurse at the primary clinic say that the doctors have changed some of their procedures to make them better for the patients but in return, they are receiving less money overall. For someone to put money aside in a job, that says a lot for a person. They also have a very good child life team to help the parents and families. One thing that I really liked about the hospital was their projects that they are doing. In the NICU, I saw the sleep safe display. They also had an area where they have families wipe off their cell phones and put them in a bag and they can still use them, but this is keeping germs out of the NICU which in return they found that it is reducing MRSA infections in the hospital. I also saw a poster board on diaper dermatitis and learned that breast milk (0.5 mL) helps as well and that was fascinating to me. Another way that they provide family centered care by having an office that has everything in it at once. For example, they have endocrine, neuro, orthopedics etc. in one building. This is very convenient for parents because a lot of them have children with other problems and then they don’t have to drive to multiple offices. The environment in Asheville compares to Cherokee because they both have really good healthcare systems. They consider people’s culture, finances and what is going to be best for the patients. They have definitely looked at what the patients need and have provided that for them. What was different was the types of patients that they are taking care of. Cherokee doesn’t deliver babies and they do not have a peds unit. They do have primary care for peds but that is different. The children’s hospital covers 18 counties and that is a huge amount of coverage. The Cherokee hospital will see anyone in their ER but only admit Cherokee patients and if they couldn’t provide the care for the patient, they would transfer them to someone like Mission. However, Mission wouldn’t have to transfer anyone out. What stood out to me the most today was the child abuse room. I was shocked to see the number of hand prints on those walls and that they are running out of room. My heart breaks for each of those children. However, I am glad to know that they are getting help and that they offer those services to them. I hope that the children go to good foster homes and that if they have children of their own, that they will be the change. I thought that today was a very good experience of seeing another hospital and learning about how they care for their patients and that is a type of hospital that I would love to work at.

Day 5- Wednesday

The childbearing practices are different in this culture due to their high levels of drug and alcohol abuse. Only Cherokee adopts Cherokee and many times, the grandparents or even great grandparents are raising their grandchildren, or the children have been removed from the parents by their childcare system. They also have a boys and girls home which is like the youth farm back home. In the Cherokee culture, the elders have the most respect. However, I feel that everyone is respected in their culture because they are all very close to each other and they do not disrespect their children. Kayla also told us that the elder Cherokees will not look us in the eye and that is apart of their culture and to not take offense to that. She said it is because they know that we are taking care of them and they see us to be above them and that makes me feel bad because I don’t ever want someone to feel that I would be over powering them or that I thought that I was better than them or something. I have a lot of respect for them because of the way that they do treat their healthcare providers though. At home, we have signs at our hospital saying that you shouldn’t abuse your healthcare workers and here you don’t see that. The family structures that I observed was when I was in the primary care setting and I observed mothers brining in their children for a well child visit but other than that, I haven’t seen any families. The support systems in the community are the public and their culture. I think that through the spread of things like the play and museums, they are spreading awareness for respect of this culture. I think that people realize that this group has been through so much and that they need help. That is why people from the general public are working at their facilities and they love their jobs so much. Their culture supports each other because they have been working together to improve their health and expand in ways to meet their needs. For example, they lead their own healthcare and they are editing their current mental health system to prevent further relapses for the people going through the program. Most children and families who are resilient have a strong support system. They also have good health care to support them through their changes. “Bouncing back” from stress and other problems is very hard to do. It often takes many tries and hardships to be able to get themselves there. Today at church we saw the family dynamics firsthand and I enjoyed seeing how the families are fostering these children and I know that they will grow up loved. Overall, even though these people face many hardships, they have a lot of support. I hope that this drug and alcohol addiction is one day broken and that they learn how to love and grow properly again. I think that with the way that their systems are developing, that they have a high chance of getting that back.

First Clinical Day ER, Primary Care and In Patient

In this health system, the people run it. I learned that a lot of their funding comes from their casino and that is also where their per capita check comes from as well. The members of their health care system are members like the physicians, case managers, nurses etc. but we were taught how involved the family is within their care. In their hospital rooms, they had a separate section for the family to be in and when the family comes, they normally don’t leave. Kayla said that her job has taught her to be more present with her family. She said that she normally would just let someone else watch her kids if they were sick, but she said that there might be a day when she isn’t able to rock her baby anymore and that hit me. When someone comes in the hospital with a need, it is handled based on their level of Cherokee. That is the only way that they are able to be admitted to the hospital. However, by law the emergency department has to see anyone who comes through the door. The similarities are their protocols that they follow. For example, they had the same measure system that we do for pediatric emergencies and similar protocols for treating patients. Something that was different that I noticed in the emergency department was that they don’t have computers in the rooms and their charting system was completely different. Their in-patient floor was so quiet, and it was weird to be on a hospital floor where everything wasn’t beeping, and call lights weren’t going off all of the time. For the primary care, they had a lot of no shows which is similar to what we have but back home, either you get charged for that or the physician can refuse to see you after so many no-show appointments. With this system, you can no show as much as you want, and you will always get into a provider. I personally didn’t see any complementary or alternative medicines used in practice but I did have a patient who had a necklace on, and he said that the medicine man gave it to him and he said that it has healing powers so I thought that was neat. They said that they keep their herbal recipes private, but I would love to learn more about it. Overall, I had a really good experience today. In the ER, we had one asthma patient, but we discussed overdoses a lot and the nurse shared ways that he handles coping with that. In primary care, I was able to shadow the nurse with a well child visit and her mom was filling in the paperwork to be able to fill out the paperwork to start foster care and I thought that was amazing. She has such a passion for that. In in patient, I spoke with a patient who had been through so much. From diabetes to multiple wounds, to traumatic accidents etc, he had been though so much. However, he still had so much passion for life and to keep pushing forward. Besides the patient care aspect of today, lunch was my favorite part. Kayla’s story was absolutely amazing. I just have so much respect for her. Her story is amazing. I could listen to her talk all day because every time she talks, I feel like I am learning so much from her and I am truly thankful for this experience and for everything that she has done for the group.

First day at the Hospital

My first impression of the environment in Cherokee is that the hospital was beautiful. I loved how holistic the environment was and I think that it has many healing properties for the patients. What I found most interesting about this culture’s history is that they are preserving their past and I was fascinated on how they made things. For example, they used every part of the animal. They even used yellow locust to make some of their items. Everything they did was through trial and error. They used the land to their fullest potential. I would say that some of my values and beliefs are similar and some are different. They believe that the earth has so many natural properties and that they are very healing. Native Americans have discovered many natural properties and they use them in almost everything that they do. I do not believe that the earth was created by a beetle, but they have incorporated Christian beliefs and that is more of my belief system. I also believe highly in respecting elders and that they can teach us so much and it is important to listen to what they have to say. I also like how they have stories that teach valuable life lessons. For example, I read a story today about a rabbit and a turtle and how even though the turtle was slow, he was persistent and tried his hardest and he was the one who ended up winning the race over the rabbit who used up all of his energy in the beginning. The culture heritage is integrated into the children in the community by having classes set up in their schools. The girl said today that their school had a mentor program and she did some art classes and pottery classes. They also have a language school which is keeping the language in their community. I think other influences is that they have a lot of tourist attractions and that brings in money to their community so if they teach about their culture, they are influencing the children and they can help out at events. A common thread that is similar to my community is that I am from a smaller town where everyone knows everyone and that is how it is here. I think we also all try to take care of each other, and we have always helped people out in our community when needed and they do the same thing. People in my hometown have respect for elders and at my old job, we would help anyone out with their groceries and help them with shopping needs and the same would be done for their elders as well. Overall, it was said in clinical today that even though we might be of a different culture, we are all human and just want to be accepted and loved and that couldn’t be truer. No matter where you are from, humans can always connect together.

Day 2: Museum of Appalachia and Traveling to the Cabin

Today we went to the museum of Appalachia. After that, we had a very good lunch at the restaurant in the museum. I had a pork loin with sweet potato casserole, mandarin orange salad and corn bread. For dessert, we had wedding cake! My perception of the Appalachia was that it would be a mountain area town that would be in a rural area with not a lot of resources. Previously, I didn’t have a lot of knowledge of Appalachia. What stood out to me at the Appalachia Museum was all of the log cabins that we were able to tour through and all of the artifacts that we were able to see. We saw jail cells, churches, schoolhouses, animals, arrow heads, coffin examples of what they used to be like, examples of what they used to wear to funerals, a hearse, and so much more. What makes this culture unique is how well they treated each other. In order to make everything work, they all had to work well together and be apart of a team. They also had to work very hard for everything that they had. For example, in the General Bunch House, he talked about how they had twelve children and they only had two rooms to raise them in. They would walk twelve miles just for a bag of salt. I couldn’t imagine walking that far just for salt as that would take so long. My highlight that I would take away from this experience is learning about how they made everything work for them. I think that it would have taken a lot of time to figure out the best way to preserve food and raise children and care for the animals etc when they didn’t have all the easy access to things that we have today. They also dealt with the harsh winters that come about in the mountains and they can have other problems like rockfall as well. However, they made it work and they seemed to enjoy the life that they lived, and it is a very close community that they all shared together.