It is already day five of this amazing new journey the eleven of us ladies have ventured on and today has been no exception to the wonderful learning opportunities I have come across. We started our day off at the Mission Children’s Hospital in Ashville, North Carolina. We first met with the nurse coordinator Karen who introduced us to their Pediatric Nurse Educator Ashley. Ashley oversees both the general pediatric floor and pediatric intensive care unit; that means she supervises over 130 inpatient beds between the two floors. Ashley taught us a great deal about their pediatric system. One of the first things I noticed that I loved about this hospital was the large support system they had for their pediatric and neonatal units. The pediatric and neonatal intensive care units are all given designated healthcare team members specifically for their units. For example, when there is a rapid response call for any of the three floors, there is a pediatric physician, nurse, and respiratory therapist that responds to this call and they are hired specifically for those patients. This contrasts a great deal with the typical pediatric and neonatal floors I have been exposed to back home. Most pediatric floors I have come across do not have specified rapid response team members for those patients and there is no sense of “unity” among the three floors; that is general peds, intensive peds, and neonatal intensive care. Another difference I noted was their phenomenal orientation program. When a new graduate nurse is hired at this hospital, they are placed on a six to twelve month “learning plan” where the employee is able to move throughout the floors and see where they best fit and feel comfortable nursing. The administrative staff meet with the new nurses often to discuss their feelings, concerns, and goals in order to see where the best placement is for the new nurse. I have never heard of another facility implementing such a program and I believe it is a very thorough means to ensure quality nursing care and decrease employee turnover rates.

As we progressed throughout our tour we met our new tour guide named Whitney and entered the neonatal intensive care unit. I was beyond excited to have the opportunity to step onto this floor as I hope to someday work as a NICU nurse. I learned a great deal from the NICU about how families and their children were affected by hospitalization. It is not a surprise that the majority of babies in the NICU have been hospitalized since their birth. Whitney discussed with us that while their facility promotes and encourages parents to be present in order to feel comfortable and provide care to the child, this cannot always be done. Mission Children’s Hospital provides care to patients from over seventeen counties; some of them being over two hours away. She informed us that many times parents have other children, they have work that they cannot take off, or they live to far away to be at the NICU 24/7. Do to this, parents often miss out on what is called “multidisciplinary rounding”. The NICU at this hospital has implemented a rounding program where every morning the physician or nurse practitioner, nurse, and other applicable health team members to the child’s care, meet with the parents to discuss what the treatment plan is for that specific day. This is a critical meeting for parent’s to be at as it allows them to be included in their child’s care, keeps them up to date, and gives them a greater sense of control often in circumstances where parents already feeling helpless. One of the ways to combat this issue and continue to provide family-centered care is by using the “transition” area of the NICU. The transition section of the NICU is used when the patient has been deemed stable and is planned to be discharged soon. The patient and family are in a private room where the parents are given education about specialty cares for their child, taught typical parenting skills, and essentially begin to take on the role as the sole primary caregiver to the child. Elements that also instill family centered care of the NICU are the sleeping accommodations in the transition rooms. The NICU itself does not have an area for parents or family to stay the night and so the hospital will rent what is called a “Ronald McDonald” room to the parents if they meet certain criteria. However the transition rooms have pull out beds that encourage parents to stay and become involved in providing care to the child. While I learned much more from out time at the NICU, these were a few of the differences from other health care systems that I felt were critical to promoting holistic and family-centered care. 

After touring the hospital we visited the outpatient Mission Children’s clinic. This is a clinic dedicated solely to pediatric patients and has a vast variety of different types of care they can provide. This facility has pediatric endocrine, pulmonary, neurology, physical therapy, MRI, orthopedics and many other types of units. This clinic was much similar to the Cherokee Indian Hospital we have been observing this week. Its focus is centered on the patient and providing nearly all of the different treatments a pediatric patient may be in need of in one building.

After having learned a great deal from both facilities today I have found myself comparing and contrasting their systems to that of the Cherokee Indian Hospital. As stated previously, the outpatient clinic was similar to Cherokee in that it provides a more holistic treatment facility than most. However I do believe there were more differences to be noted. The Mission Children’s hospital functions more like a western healthcare system. Their hospital is designed as an acute care setting that does not incorporate a multitude of interdisciplinary departments. They also are not as family or culturally oriented as the Cherokee. When discussing with Ashley how they would accommodate a large family in the PICU, she stated that there are strict rules about limiting visitors in the PICU. This is done because they believe that allowing a large influx of visitors comprises both patient safety and healing. Do to this, their patient rooms are not as large as the Cherokee and though they would try to accommodate the families cultural beliefs about visiting, ultimately the policies and rules take priority. This philosophy was the same for the NICU but at an even stricter level. Whitney informed us that the family must create a list of acceptable visitors and once that list is written, it can never be changed. Anyone who is not the parents or grandparents has to be accompanied by the parents in order to visit a patient in the NICU. Additionally, siblings of a patient in the NICU must be vaccinated in order to visit. Whitney explained that the vaccination policy is related to the compromised health status of NICU babies and the recent increases we are seeing in preventable diseases. I believe both health care systems have their advantages and disadvantages.  I am curious and have found myself contemplating if you could realistically incorporate attributes of both healthcare systems, and ultimately what that would look like. For example, could we incorporate the holistic and culturally sensitive aspect of the Cherokee health care system with the progressive and regulated aspects of the Mission Children’s health care system? I am unsure of the answer but after seeing all that I have today, I am confident that health care is an every changing system that will always have its achievements and setbacks. The key is to be a professional that can adapt to the necessary changes needed in order to provide our patients with the best care we whole heartedly know they deserve. 

A side-note to this post is about the last place we visited today, the Biltmore Estate. This estate was built by the Vanderbilt’s in the late 1800s. This was a gorgeous and beyond imaginably large estate with a mansion, multiple gardens, farms, and a winery where the public are invited to come spend the day and relax. Below are a few pictures of the fun time we spent at Biltmore! 

 The NICU:
Stories of  little ones who have overcome greater obstacles than most can imagine.

 Mission Children's Outpatient Clinic: The entire building is designed with bright colors, animals, and fun patterns that help the pediatric patient to feel comfortable and excited about their treatment!

The Biltmore Estate: The picture to the right is a small view of a huge mansion with over 250 rooms. The picture to the right is me relaxing in one of the many Biltmore gardens!