Saturday July 15

FREEDOM, well sort of

Today we got to experience a bit more laid back environment and see things. We were even able to sleep in, SCORE! During my week here at Cherokee I experienced generosity from others more times than I can count. Be in the "Southern Hospitality" way of living, or just the nature of the Cherokee, it was like anything back home. When our teacher was waiting in line to put air in the tire, the women ahead pulled forward and offered to help her. Not sure if she read the plate and could tell we weren't from around there, or just noticed how confused out teacher seemed, but I have never been offered help airing up my tires back home.
One thing I got to do to improve the health of others was bringing the donations to the church. Though I was only able to go to one of the two churches wee donated to, I still felt that this had such an impact. Getting to see the children's faces light up when they were told they were getting paper and pencil cases for the school year was amazing. This is why I got into nursing, to be there to help others in all situations, to the best of my abilities.
The most obvious way this culture is able to keep their heritage for future generations is by having their set school that only teaches in their language. That will help to keep the culture alive! A way that they are able to get healthier would be to continue to get educated, especially on your own conditions but also on compliance. If you know what you should be doing to take care of yourself but you don't, nothing will change. I love how the hospital has complementary therapies offered, since Native Americans are not know for their acceptance to modern medicine, as many prefer natural remedies passed on from ancestors. This is so important because their culture is unique, and it should be kept alive to keep their ancestors alive in thought and memory. Kituwah Academy, a school opened up dedicated to teaching the Cherokee native language for Pre-K through 5th grade students. I 2004, only 420 elders fluently spoke the native language, and the need for an immersion program was created (New Cherokee. n.d.)
Something I did outside my own comfort zone this week was to just observe. Being that it is my second nature to help others, but knowing this was an observation only clinical, I found it stressing that when a patient's family asked to receive help getting their mother back into her bed from her chair, I was forced to locate a Certified Nursing Assistant to assist her, as I was legally not able to do so. This just tore my heart to pieces, as I wanted nothing more than to help. But learning their culture was important, and knowing nothing of the patient I could have caused harm or offense by not knowing how to take care of this patient.
Compared to my first day here, I feel that I have grown not only as a person but with my classmates. We all grew closer (and survived an entire week together!) I was able to learn more about a population that had only be barely touched on in my Populations lecture rotation. Getting to see first hand that not all Native American avoid eye contact, but elders definitely do, showed me not to just assume. Thinking all the way back to the beginning of my nursing clinicals, it is important to ask patients if there is anything that I may need to know about them or their religion, beliefs, or culture to be able to provide them with the greatest care possible.

Reference

New Cherokee School Opens. (n.d.). Retrieved July 16, 2017, from https://www.culturalsurvival.org/news/new-cherokee-school-opens

Friday July 14

Another Day of Observations

Today I was able to witness the life in the Emergency Department and see just how their setup is in comparison to the Emergency room I work in back home. As with most things I've noticed here, they have a very detailed set up. Nurses are assigned to specific rooms, and each room is generally used for different ailments. There is trauma rooms, forensic rooms (for assault cases), orthopedic rooms, and so on. They even have a set Code Blue team where each person is given a role at the beginning of the day, so that in the event of an emergency the team already knows what to do and who's in charge of what. Back home it's more of a free for all when the event arises and one must be prepared to jump into any role.

Some of the most critical issues this culture faces on a daily basis would be diabetes, drugs, and compliance. Diabetes is a rising factor across the nation, as is drug usage, more and more strains of drugs are being produced causing more and more people to become addicted. "The rates of obesity and Type 2 diabetes among the Eastern Band of Cherokee Indians exceeds the rates of the United States and North Carolina's general population" (Bachar. Lefler. Reed. McCoy. Bailey. Bell. 2006.) When talking with the natives, they noted that their bodies, our bodies, are not meant to eat such foods, and this is a reason for the increase. I feel that these issues are related more to deficient knowledge of proper foods to eat and how to exercise appropriately. I do also think that the culture plays a huge role as well. Prior to the increase in fast food restaurants, more families ate at home, likely eating more traditional dishes with less sugar and carbohydrates.  As nurses, it is important to educate families on the importance of healthy lifestyles including foods and exercise. It would also be important for nurses to touch on drug usage as well, since that is on the rise it needs to be addressed.
The center of the healthcare system in Cherokee, in my opinion, is the enrolled members and the board of the hospital. Since the tribe bought their hospital, and it is no longer using governmental funds, they have a lot of say on what goes on in the health care realm. I think this is very different to what we are used to back home, as the government plays a large role in the care we receive and are offered based on our abilities to pay.

Reference

Bachar, J. J., Lefler, L. J., Reed, L., McCoy, T., Bailey, R., & Bell, R. (2006, June 15). Cherokee Choices: A Diabetes Prevention Program for American Indians. Retrieved July 16, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1637791/

Thursday July 13

Few days late from all the craziness!

The Mission Hospital was amazing! It was very much designed for children in every way. They even used input from families that had stayed there about what they would like. The walls were painted by a local artist and each hallway had a street name. There were also two toy rooms for the children, one at either end of the unit. Each nurse is only assigned 4-5 patients in the PICU and 1-3 in the NICU all depending on the acuity of the patients. Hospitalization in children can be very difficult as it can cause them to regress in function. "Managing regression in a hospital is resource intensive and can prolong hospital stays" (Lokko. Stern. 2015) prevention is key.  The Mission hospital took this into consideration when creating their floor. They created a separate room for procedures so that children would never associate their own room with negative thoughts.
The hospital took into great consideration the convenience for their patients and their families. Each room has a couch that converts into a bed so the children do not have to stay alone, as well as televisions, and a nourishment area that has healthy drinks and snacks, like fruit.
When in Asheville, North Carolina everything was more modern, from having a Starbucks to the structures of the buildings. Cherokee prides itself on culture and traditions, they even pull nature into their hospital facility.
Of everything we did today, what stood out the most was how different the set ups are from out own and from each other. We do things one way, Cherokee does things another, and Mission Hospital does things a completely different way. Although there were similarities, the overall vision of each facility is vastly different. For instance, Unity Point is "FOCUS" and Cherokee has "The Right Way."

We were also fortunate to tour the Biltmore Estates in the afternoon. This place was amazing! There is no way I could explain the beautiful craftsmanship and artwork that went into this home. Following the roped off guided tour, I still felt loss among the endless halls.

Reference

Lokko, H., & Stern, T. (2015, May 14). Regression: Diagnosis, Evaluation, and Management. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578899/ 

Wednesday July 12

Another day at the Cherokee Indian Hospital! 

Actually, my portion of clinical observation today consisted of shadowing the nurse and nurse practitioners at the Indian Care Clinic. Which is a prompt care office that only serves Cherokee Indians! Though it was not real busy this morning, I was able to get to know more about the area that makes up the reservation, and how there are 7 counties within the Qualla Boundary and only 3 clinics where the Indians can be seen (Qualla. 2017.)
Children in this culture are typically raised by their grandparents. It is tradition and seen as the normal way. The elders in the community are seen as those with authority and deserving of the highest degree of respect. Elders are thought to have great wisdom to pass down, and are the ones that gave you life. I have been able to observe several family structures. Some have included several generations in one room and others have included just the grandmother and her grandchildren. Though in all scenarios I have witnessed the respect younger generations have for the elders. As far as support systems in the community, the entire tribe serves as a support system for each other.  There are also several churches to attend and community activities to get involved in to create connections with others to have a larger support system. They even have places for addict to go for support specially designed for them.
Resilience is the ability to bounce back. Children of the Cherokee tribe have great resilience. Especially when looking back through history to when children would attend boarding schools and be lined up and forced to drink medications and be given shots. As adults looking back these memories are all to familiar. However, due to all the positive changes that have been made, more adults are taking to the concept of health care today and treatments. Most of the families whom have resilience today have optimism.  As the Cherokee Indian Hospital says "The Right Way" is to
After getting to watch the drama "Unto These Hills" last night, it was clear how the white man treated the Indians so poorly, yet they have been the most welcoming and accepting people in my entire nursing student career. Everyone seems so accepting and genuinely wants to help teach us about their culture and how their nurses perform their cares.

Service Project

My school's instructor was placed into contact with a local church in the Cherokee area that had several children in need where we were able to donate several boxes of clothing for the gender and sizes that required as well as school supplies and some toys. We were also donated several glucose monitors (some even had Bluetooth capabilities) half of which we have donated to the Family Care Clinic (which is like a doctors office that serves non Indians) and Indian Care Clinic as well since they are connected. This will allow them to dispense these to diabetics in need who may not be able to afford their own supplies.

Reference

Qualla Boundary. (2017, July 07). Retrieved July 12, 2017, from https://en.wikipedia.org/wiki/Qualla_Boundary 

Tuesday July 11

Day two is quite the long one!

When it comes to the healthcare system within the Cherokee community, it is operated by the tribe. Casey Cooper is the Chief Executive Officer of Cherokee Indian Hospital. The hospital itself is run by those selected to represent from each of the 7 clans of the Eastern Band of the Cherokee Indians.

The members of the healthcare teams consist of doctors, nurses, aides, nutritionist, pharmacist, dental, eye doctors, and even behavioral health staff. Essentially their way of operating around health is quite amazing. EVERYONE WORKS TOGETHER. You read that right! On the inpatient unit all the doctors, nurses, aides, pharmacy and anyone else taking care of the patient make their grand rounds.  This ensures that everyone is on the same page for the patients health. This is done for each patient! There is less miscommunications and a better sense of patient centered care.  I was able to witness this process during my shadowing of inpatient and outpatient today and was simply amazed. When the case manager had a phone call, the doctor was sitting right there and was able to hear everything, any questions could be asked without having to disconnect and call back. Questions about medications or dosing? There's a pharmacist sitting right there as well. The patient is really put first with this type of healthcare. One major difference is just that. When a patient presents with a need, the staff are able to fill that need, or find the means to do so.  If they are losing weight from not eating properly due to an upset stomach from a new medication, the doctor can have the pharmacist step in with the patient, during the same appointment, and educate them about how taking medications with meals can decrease upset stomach.In our society it can be harder to get patients to be compliant because so much time and effort is spent going from one location to another for visits to be seen for one ailment, not to mention a person having more than one (which is very common.)
In our healthcare system, doctors do not take the time to collaborate and work together on a patients care. The cardiologist may never speak to the urologist regarding a patients care plan.  This could (and does) lead to different desired goals as the patient is expected to meet these, but their medications may not be compatible with one another, adding more ailments to the seemingly never ending list.

There are a few alternative practices that they incorporate into their health care. These include acupuncture, massage therapy, and even chiropractors all within the hospital building. In modern medicine, these methods are not always incorporated or practiced among our culture. Chiropractors are becoming more popular, though some still have the stigma of these being "a bologna practice."

We are working on our service project down here as well. So here's a hint:

Currently in foster care, children under age 3 in each county are as follows: Swain County , 19; Jackson County, 28; Graham County, 12 (Eastern. 2017)

Reference:
Eastern Band of Cherokee Indians, The Cherokee Safe Babies Program, Cherokee, North Carolina. (2017). Retrieved July 12, 2017, from http://www.qicct.org/eastern

Monday July 10

First day out on the town=SUCCESS! 

Upon my first glance I noticed the housing is very modest. Several homes appeared to house low income families. I also noticed there were several apartment style buildings with rooms for rent, which I learned only those that belong to the Cherokee Qualla can own the land, but they are able to lease it out to others. When we got to the hospital I was almost in shock at how amazing their landscaping was. The first thing you notice when you turn in is a beautiful waterfall. The Cherokee people brought nature into their hospital as they place great importance on it.
We visited the Museum of Cherokee Indians, upon entering the facility we were greeted by Jerry Wolfe, whom told us through an interactive video in the next room about how Earth was created. The water beetle swam to the bottom of the water until it found mud, then it dug into the mud and carried it to the surface and created land. A tree caught fire and the animals wanted it, so after the raven and the owl failed to get it, the spider spun a bowl out of thread from its own body and crawled into the tree and placed an ember in it's bowl and brought fire. To me this was very interesting because growing up in church we were always taught a much different story. The Native Americans place a great amount of value into nature and animals, where as I do believe in making attempts to preserve, most things that crawl (like spiders and beetles) give me the creeps.
There is a school that the parents can send their children to where they sign off to only have the children taught in their native language to keep their culture from dying out. This is amazing to me because the importance they place on keeping their heritage and culture alive is great! It's so sad to see cultural practices die out in our modern world.
Some of the common things I have noticed within this community and my own is the love for people watching! After the elders get their blood work done they go upstairs and sit down and people watch.We also have a Head Start program that the Qualla Boundary offers! This program helps children get ready for entering school, the teachers work along side of the parents to help them. The children receive education on things like nutrition, social and emotional services, and developmental screenings. The parents are educated in fire safety, nutrition, child abuse/neglect, health, how to budget, dental health care, how to discipline young children, and how to obtain legal services. This is great, and something I wish we utilized more in our own community, because it really empowers the youth and makes you realize they are our future and we need to guide them in the right directions.

Reference

Qualla Boundary Head Start and Early Head Start. (2017). Retrieved July 10, 2017, from http://www.cherokee-hmd.com/head-start/index.html 

Sunday July 9th

Today was full of travel!

Going forward with the week I am looking forward to indulging in a new culture and learning about the ways of the Indians.  I am also excited to be able to not only compare their ways with ours back home, but with the way Mission Hospital operates. I am nervous of traveling through the hills, as my stomach is weak and the hills always get to me. Outside of the travel I am most nervous of potentially offending someone. One thing the children of the area receive is the Juvenile Services Program. This program helps hold the juvenile offenders accountable for their actions to their victims and the community. There is also a Project Challenge which helps "shape" the youth into respectable members of society using their talents through the use of challenging recreational activities (Juvenile. 2017.) My boyfriend and his mother's side of the family are actually Alaskan Native American's so I have been immersed in some of their cultural ways. I also follow some Native American pages on social media because the topic is very interesting to me of how they do things. I believe we all have stereotypes and prejudices weather we notice it or not. Personally I have a strong connection with animals, I am a die hard animal lover and I do rescue work so I have very strong beliefs on how animals should be raised and kept. We may not see their pets, if any, but if I hear stories I'll have to set it aside in my mind and accept it as a different way of life. I also feel like there's a certain way to treat elders in the community, not just your family. I always find it hard to watch someone harass or poorly treat an older family member. These people should be seen as wise and a solid source of wisdom for the youth. 

Looking forward to a new day tomorrow of orientation and getting to see the village!

Reference

Juvenile Services Program. (2017). Retrieved July 09, 2017, from http://www.cherokee-hmd.com/juvenile-services/index.html

 Juvenile Services Program. (2017). Retrieved July 09, 2017, from http://www.cherokee-hmd.com/juvenile-services/index.html

Juvenile Services Program. (2017). Retrieved July 09, 2017, from http://www.cherokee-hmd.com/juvenile-services/index.html

Juvenile Services Program. (2017). Retrieved July 09, 2017, from http://www.cherokee-hmd.com/juvenile-services/index.html