Day 6: Observation Clinical

Now that you have had 3 days in the Cherokee Health Care System, what are some of the most critical issues this culture encounters daily? 

          To me, it seems that a critical issue is patients not showing up for appointments. During my two clinic shadows, there were many patients that did not come to their appointments. I was told that there is no penalty to patients that have no-call/no-shows. Back up north, there are charges to patients who do this and the risk of being refused making appointments because of inconsistency. We are given cards with appointment times, and most patients put the appointment in their phone calendar. I have also seen an uprising in text alerts for appointments. Going to appointments is important in order to ensure health and prevent delays in necessary care.

Are there any prevalent conditions that you have noted? If so, are they related to genetics, culture, or deficient knowledge/health maintenance?

          The only condition that I have seen in high prevalence is that of detoxing. On one clinical day, there were many patients that were in the process of detoxing. This was a community issue, though we have been told that this is prevalent everywhere and the small area makes it seem as though it is high. I did not see another condition in excess with the people coming to the hospital for care.

What is the nurse’s role in health promotion and health maintenance?

          The nurse should be providing education to the patient and their family on necessary topics to ensure that health maintenance will be continued at home. The nurse should ensure that the teaching was effective and the nurse should be confident that the measures taken will ensure that the patient and the family can maintain the health measures at home. The nurse should also be looking at the community to see the prevalence of certain health conditions to educate future patients on, even if it is not exactly why they are receiving care. According to Kemppainen, V., Tossavainen, K., & Turunen, H. (2012) , “nurses can be considered general health promoters, with their health promotion activities based on sound knowledge and giving information to patients (p 499).”

In your opinion and observation, who is at the center of the health care system? Is this similar or different than your previous experiences in health care outside of Cherokee? Why or why not?

          The center of the health care system are the patients, in other words, the community. Without a community to care for, the hospital team would have nothing to work from. The care provided and measures taken depends on the status of the community involved and what their needs are. I believe that this is the philosophy everywhere throughout every field in healthcare. Patient-centered care is the main focus of the medical team and we are slowly expanding our focus to the family as well as the population.

Reference

Kemppainen, V., Tossavainen, K., & Turunen, H. (2012). Nurses’ roles in health promotion practice: An integrative review. Health Promotion International, 28(4), 490-501.

Day 5: Mission Children's Hospital & Biltmore Estates

How did the 130-bed, only children’s hospital in Western North Carolina compare to your previous experiences in health care?

          Mission Children’s Hospital did not compare to any of my previous experiences in health care. It surpassed any expectation I could have had. I did not know it was a children’s hospital when we arrived. From the outside, the hospital did not look like it was focused for children, nor did it when we entered. Once we took the elevators to the general pediatrics floor, it was evident that this organization took a substantial amount of effort to ensure the welcoming atmosphere for children. Every inch of the hallways and patient rooms to thought out to intrigue children of all ages to be engaged in play and fun instead of feeling down and scared to be there. I did not feel this way in my other hospital experiences.

 Consider how hospitalization effects children and their families.  How does this organization apply family-centered care?

          As stated in a study by Bsiri-Moghaddam, K., Basiri-Moghaddam, M., Sadeghmoghaddam, L., & Ahmadi, F. (2011), “hospitalization of children can bring about negative changes and mental and spiritual pressure on children and their parents, and can endanger their health.” I have seen this to be true for children that are scared of where they are, knowing it is a hospital, and parents being stressed over accommodating their lives to care for their child in need. The pediatric floors are painted and decorated in interesting ways to attract the children’s attention as well as teach them about the medical field. One way in particular was the x-ray light in the playroom where children can look at pictures and find objects in stuffed animals. They can also play pretend to insert NG tubes and give the doll an IV with its own IV pole and med bag. This is beneficial for the child to be more comfortable if they have to have these procedures done on themselves. This puts parents’ minds at ease to see that the nurses have thought of everything like this to show how dedicated they are. If parents trust the staff caring for their child, the less stressed the parents may be.

How does the environment in Asheville, NC compare or contrast to Cherokee, NC? What stood out to you the most today?

          Both of the hospitals are in great condition with an attention to detail pertaining to the community that stay in the establishment. For Mission, the focus is on children’s comfort, so walls are painted in murals and there are “street names” instead of regular room numbers to allow children to be engaged with the environment. At Cherokee, the focus is around the culture’s passion for nature. They involved this concept at their new hospital by having large, open windows to view the fields, trees, and mountains that their land offers them. This is important for the healing of their patients by using sunlight and nature views as a healing technique. What stood out to me most today was the NICU at Mission Children’s Hospital. As I have in interest in OB, Women & Children’s Health, and a love of babies, I knew that visiting the NICU would be a special experience for me. I was able to see and learn more than I could have expected from a nurse with a genuine passion for her career. Seeing a nurse with this love for what she does makes me strive to have that kind of hope and drive as a nurse one day. If I land in NICU, I can only hope I can be as much of a nurse as she is. If my heart brings me to another field, I will work to show my passion every day on the floor, as well as to those who encounter me.

Reference

Bsiri-Moghaddam, K., Basiri-Moghaddam, M., Sadeghmoghaddam, L., & Ahmadi, F. (June 2011). The concept of hospitalization of children from the view point of parents and children. Iranian Journal of Pediatrics, 21 (2), 201-208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446164/. 

Day 4: Observation Clinical & Donation Delivery

What have you learned about childrearing practices in this culture?

          I learned that caring for the child is done so within the family. Part of the culture is that the parents take care of their children as well as care for their children’s children. When parents marry, each of their genetic codes determine what the child will be. If parents marry outside of their specific tribe or to someone not of Indian descent, it reduces the child’s “Indian quantum.” The lower the quantum, the less benefits they receive. The child must be at least 1/16 to become a member of the tribe, which will then be able to receive their services. If they do not meet this, then the child would need health insurance. If they needed to go to the hospital, they could use ER services. For any other service, they would need to transfer to another hospital for care.

Which individuals have much respect and authority and why?

          Though I have not been told specifically whom holds highest respect and authority, it seems that those that are full-blooded Cherokee (which is said to be a half-dozen people) would be thought of highly seeing as their family line has been so well preserved. These individuals would also most likely have great stories that have been passed down the generations to be shared today about history that can be learned to those with open minds. We were also told that individuals will be highly respected if they show the highest respect back, which I believe is a great life philosophy.

What type of family structures or family types did you observe?

          I have not seen much family structures in place thus far. However, there was a patient on a unit today whom was being cared for. There were three family members who came in to visit at different times throughout their stay in this unit, which was within the first hour of my being there. This was already touching, seeing the love that they had for this patient. I can only imagine that after their transfer to the new unit that they would have even more family and friends to visit. Family is important to me, so seeing the care these members provided, it only makes me hope that this would happen for me as well.        

Who are the support systems in the community?

          There are many support systems for the Cherokee community. From speaking with the hospital personnel, there is always someone available to aid for a patient that is in need. With the placement of in-house specialists, this allows patients to receive the care they need when they need it, instead of waiting for the specialist to be called and waiting until they arrive to the hospital. This is beneficial in giving the care needed right then and there for that patient. Currently, the ER is the mental health unit, with three rooms for those needing these accommodations. However, the hospital already had plans to convert the old hospital into a behavioral health unit. This is the definition of patient advocacy, seeing as they are using their resources to provide patient care pertinent to that point in time. With the prevalence in the whole US of mental health care needs, including substance abuse, this will provide CIH with an even more broad-spectrum ability to provide support systems for their community.

 Consider the word resilience as it would relate to a child and/or family; “the ability to bounce back” from stress, challenges and vulnerabilities.  What do most children & families who are resilient have? 

          Resilient children and families all come with the ability to become stronger from those things that try to bring them down. I have met the friendliest group of people here of the Cherokee culture that have not discriminated against me, which is one thing I may have been expecting when coming here. Instead, they have been more insisting on teaching us the history of the culture as well as an everlasting interest in answering our questions about the culture so we can be as competent as we can learn to be in this week. Most importantly, I believe that this experience with this resilient group of individuals does not end here; learning to be culturally competent for the Cherokee Indian culture will continue at home by doing our own research and advocacy for them.

            After researching, I have come across and will post this Resiliency Quiz. It lists many factors as to what makes someone more resilient and able to keep moving forward after facing trauma. As someone who has dealt with their own amount of hardships in life, I believe that this quiz made me more confident in myself to keep my head held high. I hope that it allows others to be driven in their certainty to succeed in life no matter their history.

Reference

Resilience Quiz Link:

Henderson, Nan. (2014). The resiliency quiz. Resiliency in Action. Accessed on 12 July 2017. Retrieved from https://www.resiliency.com/free-articles-resources/the-resiliency-quiz/. 

Day 3: Observation Clinical & Mountainside Theatre

Who runs the health care system in this community?

            According to the Cherokee Hospital organization site, “The Cherokee Indian Hospital is governed by the [Eastern Band of Cherokee Indians] EBCI Tribal Council appointed board which consists of community leaders, tribal member health care professionals, and other professionals (n.d.).” Seeing as the tribe owns the hospital, they are the best to care for the individuals of their tribe by the tribe.

Who are the members of the health care team?

          At this hospital, there are many members of the healthcare team to keep it running smoothly. They have many in-house specialists in addition to the generalized employees: CMAs, LPNs, CNAs, RNs, physicians, respiratory, chiropractors, massage therapists, acupuncture, dentists, radiology, imaging, and the list goes on.

When someone comes in with a need how is it handled?

          If they are part of the tribe, they will receive care at the Cherokee Indian Hospital. If their care is advanced (ex. Cardiac issues), they will be transported to another hospital. If they are having a baby, they will be transported to another hospital. If the person is not a member of the tribe, they may receive care in the ER until stabilized, otherwise they will be transported to another hospital.

What are the similarities and differences that you observed with the organization?

            Back at home, the hospital is focused on getting patients out of the hospital as soon as it is possible for their health ability. At CIH, according to the floor supervisor of the In-Patient Unit, as well as what I could tell from my time during observation, they are focused on family-centered care. With the rooms, they are updated to look like home that make the patients feel more comfortable and like they are at home. The large rooms, also, allow family members and friends in large numbers to be able to come in to pay condolences to the ill member. The hospice rooms also have an additional room connected specifically as a living area to be able to stay with the member comfortably. Our hospital is still a little outdated, even with the construction going on, where the rooms still look like hospital rooms with the view of other buildings and a highway. Though this cannot be changed, the CIH went leaps and bounds to thoroughly think out where to place the new hospital to bring nature in.

Are there any complementary and alternative medicines commonly practiced in this culture?

            I had not seen any complementary or alternative medicines today. I hope that this week I will be able to learn or see from those in the hospital these complementary or alternative medicines.

Reference

Cherokee Indian Hospital Authority. (n.d.). About us. Accessed 11 July 2017. Retrieved from http://cherokeehospital.org/page?title=About-Us. 

Day 2: CIHA, Museum of Cherokee Indians, & Ocanaluftee Indian Village

Now that you are here, what is your first impression of the environment in Cherokee? 

          I was thinking that it would look worse than it did. I am not sure if we have gone through the area that is more run down. I was in awe as we drove through the city seeing the cute local shops and cafes. I felt that this area is more entertaining than Peoria because there was more to do. It was cool to be able to just drive up the road and be able to go tubing. That’s already more than what we can do in Peoria.

What did you find most interesting about this culture’s history? 

            The most interesting things to me were the stories of the water beetle, water spider, and the raven. These beliefs in how the world was created is different than mine. Their beliefs seem to always revolve around nature and I think that this makes it interesting in the fact that it is said that these stories were passed down through many generations. While their beliefs are different than mine, it was intriguing to hear such a thought out and different way of looking at how the world was made.

Are there values and beliefs that are similar and or different to your own?  

            The value that I share with the Cherokee is the importance of family. I would not be where I am today without the help of my family, and seeing what the Cherokee do for each other as a whole makes me happy to see another group even more close-knit than my own family.

How is this culture’s heritage integrated into the children in the community? 

            We have passed a school for the children in the community in which they are sent to and learn the native language of the Cherokee. This is an important thing to do so that the heritage can continue down generations. With the percentage of Cherokee in each child getting lower, this is an important way to keep the children in their roots and to keep the culture living on. Another way this is done is to tell the stories shared with them by their ancestors and spread them to those that will listen, which is likely to happen when they grow up and have children of their own, and so on.

Are there other influences? What are some common threads in this community that is similar to your community?

            I would say that hospitality is similar in the Cherokee community as it is to my community.  The Cherokee seem very welcoming to outside visitors as these visitors are here to learn about them and their culture. With my community, it can act as the same concept as we have a group that opens their doors to others. It is also kind of a custom that if we have visitors we offer them drinks and meals if they desire them. As stated by J.P. Evans in 1835 (2017),

“Hospitality is a prominent feature in Cherokee character and that instinctive impulse to ‘eat when you are hungry’ is scrupulously complied with by them when among their own people and anything can be found acceptable to a hungry stomach. To such a height is this custom carried, that in many towns an invitation is not a necessary preliminary to eating; whether the person be a stranger or a relative; and from a native, no compensation is required for eating, lodging, and provender for beasts.”

Reference

Cherokee Nation. (2017). Cherokee hospitality. Accessed on 10 July 2017. Retrieved from https://owl.english.purdue.edu/owl/resource/560/07/. 

Day 1: Departure

What are you most excited about in the days to come? 

           I am eager to learn about a different culture than my own. This has been one of the biggest reasons that I wanted to take this course. I feel that I need to open my mind to different cultures, so being able to take a course specific to a culture that I have genuine interest in is exciting to me.

What are your apprehensions? 

            One major setback for me was the van ride to North Carolina. I knew it would be a tight squeeze, but once getting in the van and everyone being settled in, I knew that it would be a rough ride. It was not the most comfortable, but from what I have been told, this is an upgrade from the previous group, so I cannot complain too much.

Considering the social/cultural and environmental influences on children, what have you explored in the counties and boundaries in which we will be learning?  

          We have been taught thus far that the Indian Cherokee community is close-knit. Members of their community care for each other and may be reluctant to accept outside civilians. For children, depending on their family situations, it can put them in turmoil, such as not being full-blood Cherokee or being given up for adoption. Being outcasted can cause social, cultural, and environmental issues for them.

What are your thoughts about Native American peoples? 

          I’m not certain that I have an exact thought about the Native American people, as that would mean I am making assumptions without having full knowledge. I feel that I can make an educated comment on this question once I learn and interact more.

Do you think you may have any cultural biases/ prejudices/ pride/stereotyping that you may need to set aside to have better understanding about this culture? Why or why not?

            Related to the previous question, I do not think I have any biases or stereotypes directed towards the Native American peoples. I do know that if I did that it would have to be set aside as I am here to learn and educate myself about them and to not present any prejudices. They have welcomed us to their home, therefore I must respect that.