June 8th

June 8^th

             I have experienced nothing but generosity this week, from visiting the hospitals, going to the museums, theater and the gifts we have received. All the people we have encountered have been kind, willing to teach us, and welcomed us with open arms. While we were here we brought donations to give to the church and the hospital. I have learned many things while being here that I can take back with me and implement in my nursing career. From health promotion and health maintenance we have learned several tools to help take care of people holistically. With the healthcare system they have here and the growing of their services this culture will be able to get the care they need and hopefully start moving in a better direction. They have several programs they are looking to expand such as their addiction recovery program; their primary care program and hopefully their inpatient services can grow as well. With the services they are offering they can educate the population so that the outlook on healthcare can move in a positive direction that they can pass on from generation to generation. The hospital has in cooperated nature into their design because this is important to there culture. I found this important because if they feel comfortable going to a place then they will be more likely to go there. Since this culture has had bad experience in the past with healthcare some people still have a negative outlook. Hopefully with the care they are implementing and the facilities they have this change the outlook and help improve health and move it in the right direction. This is important because if the population isn’t healthy then there children and future generations will continue to have these feelings and pass on the unhealthy habits. This week I was able to learn about a new culture from where they got their beliefs from, to why they have the outlooks they do and the problems they have. When you are learning something new it can be uncomfortable but it has been an amazing experience. I have learned so much from being here from learning about a new culture to a different view of healthcare. I think from this I have grown as a person, learned ways to be a better nurse and how healthcare could be. I want to be able to give my patients the best care they can have and I have learned so much from this trip.

June 7th

June 7^th

            Some of the critical issues that I have noticed are diabetes, drugs, wounds and stress.  They have high obesity rates, which relates to the diabetes, the wounds and so do drugs and alcohol.  The issues they do have with alcohol and drug abuse they end up having great grandparents raise small infants, this adds to stress that impacts all aspects of health. The prevalent issues I noticed are the same as the critical issues these issues impact all aspects of health. Another aspect that is very prevalent is mental health. These issues are a main focus here because with out fixing the mental health issue we cannot fix any other issues. This is influenced by genetics, environment, and knowledge. This culture as had some negative experiences with healthcare previously and some of these stories and view points have been passed on so they don’t always come in to see the doctor or understand what that we are here to help them. Over the years this has gotten better but living in poverty they cant always eat the best or take care of themselves in the best way possible. The nurse’s role in health maintenance and promotion is to do what they name says. Promote health behaviors and give people the knowledge they need to live a healthy life and manage the diseases and illness they have. Along with this comes empowering patients to take control of there health and become the best the can be healthy. In order to do this we need to look at the things that are important and some of the things I have noticed here is the stress on mental health. I feel that once we get people in the mindset and take care of those deeply rooted issues along with getting people in a healthy mindset will help with all of these other issues I mentioned above.  The patients and there family is at the center of this health model. This makes a big difference in the care they are given and the differences they can make for the patient. With this model and the patients being at the center you can really impact their lives and health. In my previous experiences patients have always been important but not at the center.  It has been refreshing to see that the patient and there family is at the center and not the hospitals appearance or how much money they will make. When creating this health system patient centered care was there goal and they are exceeding. I feel other places I have been have presented themselves as why their hospital is great but haven’t focused on the patients themselves. Every place we have toured really puts the patients at the center and seems to really care about their staff. I have been impressed and inspired by the places and people we have meant and have learned something everyday that has impacted me and will influence the care I give my patients in the future.

June 6th

June 6^th

            Today’s hospital was amazing and really had the children at mind. They have several playrooms; toys that can help them get out of their rooms and get moving. They also had every room ready for emergencies because as we know when kids go downhill they go down quick.  They also had nice fun white board communication boards in the room to help keep the families updated. Not only did they have this but they had cheat sheets in the room to help the families understand things they might not. One thing that stood out to me was there was a sheet the family could look at that had common medications they might be given and what they are used for and common side effects. This can really help educate families because they might not always remember everything that is going on. I also really liked that everything was based on the child’s comfort and the comfort of the family. Since this hospital serves 18 counties and is really the only hospital the children can go to this can impact families in a number of ways. Parents might have to drive several hours to visit their kids and if they have other children at home or jobs they might not be able to do this everyday. This can really cause some issues with being there for the ill child and for your other family. Not only that but gas, food, and a number of things can cost money, not only the stress of the location but the fact that you have an ill child that is hospitalized creates a new stress that not everyone experiences.  This hospital and the Ashville Reuter Clinics all have a family center model. This means that they are concerned about how family and the children are being taken care of, how they are involved in the child’s care. They have places for the family to stay at the hospital, they have changed there rounding with all of the medical team to where it works best for the family and is not overwhelming. They also have a continuity of care, where they keep them in the same group, or can get all of there needs meet in one building. The environment in Ashville is not in a rural area like Cherokee, they have more equipment and resources available to take on critical patients. Not only that but they can take all people of all different cultures. They hospital looks more like a hospital and has not been designed around the cultural of the Cherokee. The thing that stood out to me was that each facility that we have been to really has the patient and family at mind and really tries to make the best working environment for the staff. They also had a continuity of care that not many places have and can take all forms of insurances. I have been impressed in all aspects of the facilities we have toured and this has really opened my eyes to what health care can be like and where some things can be improved back home.

June 5th

June 5^th

            Some of the childrearing practices that I have observed are that the family is a huge part of the family. It is hard to get to hospitals to even have babies and as soon as they find out they are pregnant they start planning for them to go to another hospital which are an hour or more away. They struggle with getting prenatal care because of the remote location with not a lot of areas that offer prenatal care. Since there is a lot of people are addicted to drugs and alcohol you find grandparents and even great grandparents raising babies. The members who have the most respect and authority are the elders, which are members that are 62 and half. They also have members that are noticed as beloved, which are members that love to teach and are very friendly and known by everyone. The family structure is very different a lot of parents are not involved or only see them some of the time. Grandparents raise a lot of children, many foster families, and families that everyone is involved and lives together. It is known that the Cherokee take care of there own, I have heard this many of times and through my experiences thus far I have seen this multiple times. Every one is the support system here but mainly the elders support the rest of the family. Through all the hard times these children have been through they still seem happy, they go to school, and they try to maintain healthy lives. I have seen people addicted to drugs my whole life through family and watching what there kids have been I can only imagine the endless cycle these families have been through. Every time we have encountered Cherokee Indians they have been receptive and welling to teach us about their culture. It is truly amazing what a person is capable of when you have support. Resilience comes from support and willpower to overcome.

June 4th

June 4^th

            The Cherokee run the healthcare in the community. They decided how they wanted their healthcare system to be run. They have CMA, LPNS, RNS, Case manager, PA’s, Nurse Practitioners, and physicians. They have the same medical team members that we utilize but when in the primary care setting they all sit next to each other and have easy access to each other to communicate which I thought was efficient and worked really well. When patients come in they are triaged, they then base there needs off of what they learn. They can only be admitted if their tribe is federally recognized. They can be treated in the ER if they are not able to stay there then they will be transferred to another hospital if they need to be admitted. Differences are they don’t do all of the things that I’m use to hospitals doing such as surgeries, major trauma, no cardiac monitors, and no OB areas.  Similarities would be the care they receive, they same charting systems, equipment and process of doing things.  There are a lot of herbal medications and plant based healing properties. They use heat, cold repositioning and sensory tools just like we learn to help their patients as well.