June 9

Today was yet another amazing learning experience. We got to take a tour of Mission Children’s Hospital and Reuter which is an outpatient center for children as well in Ashville. When walking in you think it’s just an ordinary hospital-honestly that’s what I thought-but after taking a tour and meeting with a few of the nurses, it wasn’t anything like I expected. I was literally blown away with what this hospital does for children and their families. This hospital completely focuses on the child and their family. I mean it should since it is a children’s hospital but they prove it. Just seeing what they do first hand is amazing work. They have specified areas for peds ie pharmacist, dietician, case manager, flight nurse, respiratory therapist, neurologist, and specially trained nurses to name a few. I thought that was neat since children are a different complexity than adults it only makes sense that they have their own healthcare team basically.

What I found interesting is yes they center on the child but also include the family greatly. We do back home but it doesn’t seem to be emphasized as much as here at Mission. When they have change of shift to report off, they do it at the bedside to include the parents in on what is going on. That way the parents know what is being communicated between the staff and if there are any issues/concerns/questions, that parents are encouraged to comment to speak up. When there are meetings with the doctors or anyone else on the healthcare team that is on the child’s case, the parent is completely involved in the communication as well. They have found this to be very beneficial because the parent is the only people who know the child better than the healthcare team. I thought that was interesting and it makes sense. It should be encouraged more so the family feels more involved and knows what is going on when the case is being discussed right then and there. The hospital even has a sign posted encouraging parents to speak up when there are questions or concerns or care in general for the child. Mission also has a transition room for babies about to go home which I thought was interesting too. This allows the parents to step up and actually do all the work with caring for a child. If the parent hadn’t stepped up yet in feedings or changings or whatever the case may be, this was their time to be caring for the child since they were about to be discharged. This also gives the family time to ask questions and make sure they are ready for baby to come home. What the nurse emphasized about was it’s not just the child you are caring for, its also the family and I completely agree with that. It’s not easy to have a child in the hospital ever so care essentially is for the whole family. While touring the NICU, I like how the family has to show proof of immunizations-specifically children. I think that is a very good concept to have in a high risk area like that. In today’s day in age, there are so many parents against vaccines but this is a way to help keep diseases at bay and help the baby strive so they can go home and have a future. I thought it was very odd though while being in the NICU there weren’t a lot of parents with the children. I don’t know if that’s just a thing down here but when I had a family member in the NICU back home, it was packed with parents or grandparents. I was really surprised especially since the hospital is so family focused.  Another thing I really liked about this hospital since they are family focused is the accommodations they will make for a family. If your child is in the hospital and you have a big family, they will get the child a big room. They also have other rooms available for family to relax if needed. Culture was brought up and since we have just learned about how the Cherokee care for their families, we asked what they would do for them. The hospital is accommodating but only so much due to if they do it for one family like having 80 members show up, then they have to do it for everyone. There are also certain situations like palliative care where accommodations are made as well and I like that. They are caring for this child but willing to make the necessary changes if needed to help both the child and the family. A child needs that support system to be around and it helps them get better. With all the care and accommodating this hospital does for the child & families, it has to be very difficult. I like how like I have mentioned how accommodating they are by providing a bigger room for the child for family needs, other rooms for family, they have family counseling if needed, they have a great pediatric chaplain if needed. One of the things that Mission does is primary care nurse. This means that a nurse that has consistently taken care of a child and knows the child’s case can be requested by the parents to be the nurse to care for them all the time. That way it’s consistency of care and that nurse(s) know everything that is going on with care. The parents also feel more comfortable with this because they have seen this nurse multiple times caring for their child. I like that method and see the benefits of using it. It’s both comforting for the parents and the child to have that consistency since the child is not at a place where they want to be.

After visiting Cherokee Hospital and then Mission Hospital, it’s neat to see what differences or similarities they have even though they are doing the same thing essentially. Cherokee isn’t specific to children needs as in if there was an urgency for care or some kind of specialist needed, they couldn’t do it. I like though that even when the Cherokee is run by the Tribal Council and Mission has their own committees, they focus on the same concepts like including the family on everything and accommodating for them. The hospital if there is an issue has to go to the ethics committee for answers whereas Cherokee answers to the Tribal Council and that is something that is hard for me to wrap my head around on certain cases. I also like that they both have almost all around care in one spot. It makes it easier for the child and families or pts being seen who have multiple needs. What I mean by this is Cherokee has an outpatient center, dental place, imaging, emergency, nurse visits to just name a few right in one place. Mission is the same way in that it has specific health care teams for the children to better their care and be on the same page about the case. Reuter, the outpatient clinic we visited, has quite a few specialties for children as well like orthopedics, disability programs, family counseling, imaging, dental to just name a few. It makes it easy and convenient for everyone involved and should be implemented more back home.