Today we had the opportunity to get a tour of Mission Children’s Hospital in Asheville, North Carolina. We also were able to tour the Mission Children's Hospital Reuter Outpatient Center. It was interesting to see another hospital and how their pediatrics unit operates. My only health care experience to a pediatrics or neonatal unit was in clinical at Unity Point. Unity Point is a level 2 neonatal unit and they transfer all babies requiring ventilation to another facility better equip to handle and care for the baby. Mission has a unique setup in their NICU that helps keep their babies within the unit. The unit includes RN’s, CNA’s, hospitalists, nutrition, social worker, respiratory therapist, x-ray capabilities. They try to do as many procedures and tests on the unit to limit the neonates exposure to germs. Another unique feature is the rounding that is completed with a member from every discipline and the parents are invited and encourage to attend these meetings so they know and understand the status of their baby.  This allows for consistent care for the baby. The nurses also have the opportunity to advocate for their patient and make suggestions for their care.  

The rounding that is done at Mission on all floors tries to make accommodations for the family to help make the child’s stay less stressful.  One unique feature on the pediatric floor at Mission was a procedure room that is used for all procedures done that will hurt or agitate the child. The room is meant to be a safe place so nothing is done is done that will make the child uncomfortable. Also the toy room is a hands off room for the nurse, meaning they are not allowed to go in there to give medications while the child is playing. These ‘safe places’ for the children in the hospital help them maintain a sense of normalcy within the hospital and allow the child to rest and know nothing ‘bad’ will happen to them in their room or in an area that is meant for play. Depending on the floor visitors maybe limited on the general pediatrics floor the patient is allowed multiple visitors, on Pediatric ICU there are only 2 visitors allowed at a time and a parent can spend the night. In the NICU it is a little different, the parents are able to list up to 4 people that can be with the child and then other people that can visit the child with a parent. This list cannot be changed at any time during the child’s stay.

Another unique feature is the transition rooms that allow the parents to stay with the baby that is still on the monitor to prepare for taking the baby home. This allows the parents to get accustom to taking care of the babies needs rather than relying on support from the nurses. It better prepares the parents and builds their confidence to take care of the baby at home. It also allows them to understand how any monitors sent home work and how to handle adverse situations. Also, once a child is admitted the parents can pick a primary nurse that will care for their baby anytime the nurse is on shift. This provides comfort for the parents and continuity of care for the baby. Mission takes many steps to apply family-centered care.

At Unity Point and Mission they use Child Life Skills workers that advocate for the patient to keep them comfortable and help relieve stress. Child Life Skills also educate the child about procedures they will receive using play or toys to demonstrate the procedures to help relieve anxiety and fear. 

At Reuter Outpatient Center they had a room setup with a child size MRI machine and doll. It looked very similar to the real thing but it gave the chance for the child to play with it and understand what to expect before the procedure. Also, within the MRI machine they have 3D goggles that allow the children to watch movies. This helps them stay still and relaxed during the lengthy MRI.

Previously, this week we were at Cherokee Indian Hospital which is a 22 bed facility so there is no comparison to the volume or acuity at Mission Children’s Hospital. The Cherokee Indian Hospital actually transfers many moms and babies to Mission for care. One major difference between the two areas is the Cherokee has a small town atmosphere where as Mission is in a major city and the hospital gigantic is compared to Cherokee. I cannot imagine how stressful and intimidating it must be for the Cherokee to go to Mission for care. At Cherokee the culture and practices are encompassed in the care whereas Mission treats patients from the Eastern side of North Carolina.

It was beneficial to go see the Mission Children’s Hospital today because many of the Cherokee Hospitals refer to it but I have never seen. I understand more why some Cherokee will not go to Mission for care. It must feel like they are going to a different world that is very busy, fast paced. This is a challenge for health care workers at Cherokee because they have to convince them that it is necessary to go there for further care.

One thing that stood out to me at Mission Children’s Hospital was the nurses and the genuine care and love for the children they take care of. One of the nurses gave us some very good advice. She explained that working in the NICU is tough and emotional. She said she cries at times in her car or in the shower after her day has finished. She said the day you stop crying is the day you need to start looking for something else to do in nursing. She said you have to care and be invested in your patients. Be ready for emergencies but allow yourself let your emotions out at the end of the day. I will take that advice with me as I move through my nursing career.