KV Healthcare

Your Home for Health

KVH News

Home Again: The old Cle Elum Hospital operating lamp’s journey back to Upper County

· ·

On September 27, 2022, a large crate with the words, “FRAGILE” imprinted on the side arrived at the KVH loading dock. So large that it had people guessing what could be inside. An item of this size wasn’t expected to arrive. Affixed to the outside of the pallet was a small 4×6 photograph of the contents…a large operating lamp from the old Cle Elum Hospital. As it was carefully opened, there was a handwritten note inside with such penmanship as was hard to distinguish every letter. It read, “Our family is so pleased to donate this piece of Cle Elum history to your hospital. The Fassero family were pioneers in Cle Elum…Peter Fassero was born there in 1905. After raising a family with his wife, Mary (children Delona & Donn) Peter retired and sold his Economy Grocery Store and Wrote weekly columns in the Tribune.”  The lamp had been a gift to the family upon Peter’s retirement. After his passing, the family felt it was only right to donate it back to its home. As layers of bubble wrap, shrink wrap, and many, many layers of tape were moved aside, a beautiful operating lamp from the 1930s was discovered.

The lamp was long and slender with a bulbous counterbalance on one end. This was to help keep the lamp steady during procedures as it was hung from the ceiling. Along the slender metal body, were found two switches protruding from metal casing looking every bit of their nearly 100-year-old age. At the base of the long, slender portion, it began to branch out, almost like tree branches but looking more alien as the moments went along. A large lamp surrounded by what looked like a metal colander was the centerpiece. On either end of this lamp was a framework that supported three individual mirrors angled just so, making six mirrors in all. Inside the center lamp was an intricate series of small mirrors that seem to be angled to refract the most amount of light from a single light bulb as possible. One can imagine it hanging in place and providing enough refracted light for the surgeon to see even the tiniest detail while miners, loggers, and farmers were lying on the table as families hoped everything was going to be alright.

The lid was carefully closed, and the crate was moved to storage, tucked away for safekeeping. Kittitas Valley Healthcare had a large, cast iron, vintage operating lamp with no immediate plan.

In 2024, the KVH Family Medicine – Cle Elum decided to revamp its lobby. This plan involved updating the wall hangings and removing the too-faded photographs that had become hard to distinguish, to hang posters that share the KVH values reminding patients and visitors that we all have a unified goal across all clinics, and to make it feel warm and inviting once more. With the posters hung, and old faded photographs from the area removed, the clinic was missing something. It was missing the people. It was missing the people and places that brought life to the Upper County in the first place. Turning our attention towards bringing the history back to the walls, the Central Washington University Archive was contacted. They supplied hundreds of images from all of Upper County. Combing through these images was like being transported back to a time when people worked hard out in the elements every day, where large parades celebrated culture and holidays, where boys and girls basketball teams played after school, where new inventions were tried out, and where the culture of the Upper County began.

Two large frames were secured to the walls with many photographs from that time, courtesy of the CWU Archive. They are like stepping back in time and reconnecting to the life that is rooted in that place. But something was still missing, the operating lamp. With careful planning and approval, the lamp made its way back to Cle Elum where it oversaw so many medical moments in the history of Upper County. It was headed back to where it belonged. On July 24, 2024, the lamp made its journey to its destination. After some unique engineering, it was suspended from the wall right next to the archive photos of people who may have seen it long ago. It points towards every patient who walks into the clinic doors welcoming them to take a step back in time. To the Fassero family, we thank you. We will be good stewards of this donation. To the community, our clinic is feeling just a little more complete today. The lamp has made its way home at Your Home for Health. 

Kristl Densley, Marketing Coordinator
Kittitas Valley Healthcare

AHA Podcast: How a Rural Health System Continues to Provide Essential Obstetric Services

· ·

Prior to 2022, Kittitas Valley Healthcare (KVH) was delivering 300 – 350 babies each year, offering the region’s only comprehensive OB/GYN services. But when its three full-time OB/GYNs left, KVH was suddenly faced with a huge problem. In this conversation, Julie Petersen, CEO of Kittitas Valley Healthcare, discusses how her organization kept its promise to preserve essential obstetric services for women of all ages.

How to Have a Good Family Road Trip

· ·

Contributor Dr. Elise Herman

If you have a family road trip coming up this summer, you may be dreading the challenge of being together in the car for hours (or days). But with a little planning, you can employ some strategies to make this go more smoothly. Consider starting out when kids will sleep through the first part of the trip- either in the wee hours of the morning or at bedtime and remember to take any ‘loveys’ (favorite blanket or stuffed animal) along for the ride.

Plan on stopping about every 2 hours for younger kids (though we all need breaks from the car) and pick places like a park or playground so kids can get some fresh air and exercise. Have lots of healthy snacks on hand when you get out of the car; young kids should not eat in their car seat due to choking concerns. Avoid processed snacks with high sugar content which can spike the blood sugar and affect your child’s mood. Water is fine but sticky liquids like juice can be a big mess in the car. If anyone has symptoms of carsickness (queasiness, nausea), open the windows a bit and make a quick stop if you can. A bland snack like crackers can help.

Have everything you need for your child in a separate bag in the front, so it is easy to find things quickly. Bring lots of books, toys, puzzles (with big pieces that are less likely to get lost), crayons and paper, etc. Etch A Sketch and magnetic drawing boards work well for a variety of ages. Kids are more entertained by new things—or at least new to them; see if you can borrow from a friend as opposed to buying lots of new stuff.

Depending on the age of your child, classic activities such as “I Spy with My Little Eye” and license plate bingo work well; there are lots of variations found online. Singing songs together is a perennial favorite, as are word games such as GHOST (each person adds a letter with the goal being not to end the word). Kids’ podcasts (for example, NPRs “But Why?”) and kids’ music playlists and audiobooks can help pass the time.

Older kids can help navigate and point out interesting places along the way. Give them a paper map (remember those?!) and ask them to give input on routes, provide updates on location, and how much distance has been covered and how much lies ahead.

Screen activities can have a place in your road trip, but much better to use judiciously than have everyone with their head down on their own device the whole time. Try to save this till later in the trip when you ‘really need it’. If there is whining for devices, don’t give in—these are a privilege and are ‘awarded’ for good behavior.

Family road trips can be exciting and lots of fun, but it is realistic to expect there may also be crabbiness and bickering. Acknowledge to your child that it may be challenging but that you are on your way to somewhere special. Remember this is also a time for kids to learn patience, kindness, and compromise. With planning and preparation, you can all have a pretty good (and memorable) time on your adventure.

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Can Rural Healthcare Deliver?

· ·

Written by: Tricia Sinek, Strategic Projects Coordinator

In the US today, 55% of rural hospitals have closed their maternity units. Women in these communities must travel long distances to deliver their babies. Traveling during active labor increases the risks of complications for both mother and baby. Why is this happening? A perfect storm of conditions is leading to this trend.

The amount hospitals are paid to deliver babies is often lower than the cost of providing this care. To deliver babies safely in a rural setting requires several specialized team members, including maternity-trained RNs available 24/7/365 days a year, physicians available to deliver babies 24/7/365, anesthesiologists 24/7/365, and surgeons for OB emergencies 24/7/365. Additionally, you need specialists who can perform newborn resuscitation if needed. The cost of providing this expert care is huge. At KVH, this cost is over 7.5 million dollars a year. The reimbursement for delivering this care at KVH does not cover the cost of staffing. Because of this shortfall in reimbursement, KVH must make up for these losses with other services they provide. Hospitals that are losing money in their operations cannot pay for the high cost of maternity care. 

The second major force leading to the loss of maternity care in rural communities is the inability to recruit and retain OB/GYNs. Historically, OB/GYNs have worked in both the clinic setting and the hospital – frequently being called away from the clinic to deliver babies. This is a disruptive way to live and disruptive for women getting their in-clinic care. In a rural setting, typically three doctors would share the responsibility for 365 days a year of OB coverage plus see clinic patients Monday through Friday. Each doctor is on-call 24 hours straight to deliver babies, but they also have a full schedule of patients in the clinic Monday through Friday. Typically, an OB/GYN could work all day in the clinic seeing patients, cover OB deliveries all night, and then return to the clinic for another full day of appointments. Rural OB/GYNs working this schedule can conceivably work two to three 33-hour shifts per week, plus additional clinic days. A cultural shift in healthcare has led to providers seeking a better work-life balance, so hospitals are unable to recruit new Doctors for this type of schedule. It is incumbent upon healthcare systems that wish to continue delivering babies to find new staffing options.

KVH remains fully committed to being able to deliver the babies of Kittitas County. This requires us to do two things: first, find a model that works in the rural setting, and second, make enough money with the other services we provide to cover the unfunded costs of delivering babies. We have taken steps starting in 2023 to work with an expert partner in OB/GYN care to provide consistent OB/GYN coverage and separate clinic care from OB Call coverage. This will increase our capacity to serve individuals for all their women’s healthcare needs without interruption. It will also lead to a greatly improved work-life balance for our current and new providers. We believe this to be a win-win for KVH, our staff, and most importantly – our community. Bring on the babies! In the US today, 55% of rural hospitals have closed their maternity units. Women in these communities must travel long distances to deliver their babies. Traveling during active labor increases the risks of complications for both mother and baby. Why is this happening? A perfect storm of conditions is leading to this trend.

‘Phubbing’ and Its Effects on Children

· ·

Contributor Dr. Elise Herman

Smartphones are a mixed blessing. As amazing as they are, they take our attention away from what is right in front of us—and that can include our children. The term ‘phubbing’ describes snubbing someone we are with by paying attention to a smartphone, and ‘parental phubbing’ means interacting with a phone instead of one’s child. For kids over age 2, we do not have to be interacting with them constantly, but we do need to be emotionally available if they have a question or need us in some way, and being tethered to the phone impairs this.

When a parent chooses looking at their phone over paying attention to their child, the interaction between them suffers- the parent is less engaged with their child who may at first ask for more attention, but then soon give up. The child may become frustrated and sad and act out. Over time, this pattern of phubbing can lead to poor self-esteem and less confidence with other social interactions. Parental phubbing is also related to increased anxiety and depression in children and adolescents.

Research has shown the negative impact of parental phone use on babies, too, who may become more irritable and behave negatively when their parent ignores them to be on their phone. Studies of maternal phubbing revealed babies showing signs of stress (such as increased heart rate and emotional distress) and less effective learning. We know that simple eye contact between an infant and their parent builds brain development, so it is not surprising that taking this vital connection away can have a negative consequence for the child.

While most parents acknowledge that their cell phone usage gets in the way with interacting with their child, they may feel they ‘need it’ to be in touch with others, to keep track of their calendar, take photos, etc.  The more a parent uses their phone and especially ‘phubs’ their older child, the more that tween or teen will use their own phone similarly. Kids learn that it is OK to not be available and connected to those around them and miss out on how to relate to others emotionally.

So how to avoid parental phubbing? It takes real effort to break this habit, and both parents (and other adults in the child’s world) need to be invested in changing. Some suggestions include:

  • Have phone-free times for the whole family- at meals, at the park, while playing games, when out in nature, etc.
  • Have phone-free zones in the house such as the dining area, your child’s bedroom, and the playroom. If you have something urgent to take care of on your phone, explain this to your child and use it as quickly as possible
  • Disable notifications and put your phone on silent or ‘Do Not Disturb’ if you have it with you when you are with your child. If you forget to do this and hear a ‘ping’, ignore it (and then put it on silent mode)
  • Encourage mindfulness; pay attention and really notice what is in front of you. Even when not directly interacting with your child, make pulling out your phone intentional, ask yourself, “Do I really need to use my phone now?”
  • Work on dealing with boredom or ‘empty time’ (such as waiting in line) without reaching for your phone; you will be less likely to do this as a habit when you are with your child
  • Have a ‘code word’ for your child to let you know if they are feeling ignored by your being on your phone; this can be done in a playful manner and will encourage your child to speak up about phubbing

It is not easy to change our habits with technology, but our time with our kids is fleeting and vital to their social and emotional well-being. Being truly present with our children is one of the most important things we can do as parents. In addition, your child is watching, and you have an opportunity to be a good role model in how you handle your smartphone.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Celebrating Public Hospital Districts during Hospital Week

· ·

Written by: Michele Wurl, Chief Public Relations Officer at Kittitas Valley Healthcare

Your access to high quality healthcare should not depend on where you choose to live. In the last decade, more than 100 rural hospitals in the U.S. have closed.  Another 700, 30% of remaining rural hospitals, are at risk of closure.  Many, many more have been acquired by multistate hospital systems, private equity firms, or other for-profit companies.  Rural communities that lose their hospitals not only lose access to care, but they forfeit the economic vitality and many family-wage jobs. Rural communities that lose control of their local hospital find that governance, the ability to determine which services will be available, and how earnings will be reinvested are outsourced to national headquarters. 

Washington state is unique for the number of independent, community hospitals that continue to serve rural residents.  That’s because fifty-six communities in Washington State take advantage of a WWII-era statute that allows for the creation of Public Hospital Districts (PHDs).  These communities made a choice and investment to keep quality care local. Residents of Ellensburg made that choice in 1960 when they voted to form Kittitas County Public Hospital District 1, now operating at Kittitas Valley Healthcare (KVH). In 1969, Upper County voted to form Kittitas County Public Hospital District 2. For sixty years, KVH has been on the forefront of protecting Kittitas County’s community health.  As the only hospital in Kittitas County, KVH is responsible for the well-being of over 44,000 residents who call this valley home and for the millions of visitors who pass through.  Hospital District 2 operates the Medic One ambulance service, providing the only licensed advanced life support paramedics to all Upper Kittitas County, from Snoqualmie Pass to Elk Heights.

Back in 1960, the hospital was the hospital, and primary care was provided by small, private practices scattered around the hospital and throughout the community. Today most physicians choose to become employees of hospitals, health systems, or large groups, and Kittitas County is no different.  Like the rest of the country, we grapple with healthcare access.  This shortage is worse in rural areas and undermines the well-being of rural residents. Public hospital districts stand as unique champions for community-centric healthcare and prioritize accessibility and inclusivity. As nonprofit organizations, every dollar earned goes to answer the needs of the community. By pooling resources and leveraging community partnerships, these districts bridge healthcare gaps, ensuring that essential services are within reach for all residents. Moreover, they foster a sense of ownership and accountability, empowering communities to shape their healthcare futures.

The governing board of a public hospital district is elected by the district’s residents.  These elected board members are responsible for the oversight of the operations of PHDs.  The board is responsible for strategic direction, setting policies, approving budgets, and representing the interests of the community in healthcare matters.  Board members uphold the principles of accountability and stewardship.  Throughout this process, transparency, public participation, and adherence to legal requirements are crucial to ensuring the effectiveness of the publicly elected board.

Public hospital districts make a tangible contribution to the community’s health and economic vitality. PHDs tailor programs and services to address the unique healthcare needs of the residents, from preventive care to specialized treatments. By fostering partnerships with local providers and organizations, the district can create a robust healthcare ecosystem that fosters wellness and resilience.

The benefits of a public hospital district extend far beyond the realm of healthcare. By bolstering the local economy and attracting skilled healthcare professionals, it spurs economic growth and job creation, laying the groundwork for a thriving community.

From May 12 to 18, communities around the country are celebrating Hospital Week, when we honor and recognize the invaluable contributions of hospitals and healthcare workers to their communities.  This is an opportunity to express gratitude and appreciation for the dedication, compassion, and hard work of healthcare professionals. These individuals, including doctors, nurses, technicians, administrators, and support staff, play a vital role in delivering quality care and saving lives every day.

Hospital Week is also a time to thank our community for creating Kittitas County’s two hospital districts.  On behalf of the healthcare professionals and staff, I extend heartfelt gratitude for your unwavering support. We recognize and appreciate the trust you have placed in us as we work towards the shared goal of enhancing healthcare delivery and promoting wellness for all.  As we move forward, we remain dedicated to fostering transparency, accountability, and inclusivity. Together, we will continue to build a brighter future for the people of Kittitas County.

Helping Kids Deal with Climate Change

· ·

Contributor Dr. Elise Herman

We are hearing and reading a lot about climate change and our kids are getting lots of exposure to this topic, too. The terms “eco-anxiety” and “climate change grief” refer to the psychological effects- feelings of worry, fear, despair, and hopelessness- that can develop with awareness of the realities of climate change including more extreme weather, increased heat, wildfires, and loss of biodiversity. There are steps we can take to help our kids be more resilient in the face of climate change and help ourselves cope at the same time.

Decreasing your own and your children’s exposure to media, especially media that is sensationalistic, is very important. There is a fine line between being informed and being overwhelmed—our kids feel it, too. Don’t have the news on (radio or TV) a lot, and don’t constantly refresh your online news source. There are media sites such as Earth Rangers which can give information that is more positive, such as what steps are being taken to combat climate change. The National Geographic Kids website explains this issue in a developmentally appropriate way while offering steps kids and parents can take together to help, even in small ways. The documentary show “An Optimist’s Guide to the Planet” on Apple Plus explores people, traditions, and ideas which foster optimism in the face of climate change. Look for books that explain climate change in age-appropriate ways and offer a hopeful outlook. Books that show kids as the ones coming up with some solutions and creating positive change are particularly empowering.

When discussing climate change, ask your child what they have heard and believe. Ask open-ended questions to encourage a conversation. What do their friends think? How are their teachers approaching climate change education? Don’t be afraid to discuss negative environmental stories (wildfires, etc.) and how they are feeling while reassuring them that they are safe. Validate your child’s emotions and response and share some of your own. You may be able to dispel some alarming misconceptions right up front. The bleak and scary possibilities may not come to pass; it is important to leave room for hope and to discuss what positive steps are being taken. Point out some ‘climate victories’ such as more electric vehicles and increasing use of solar and wind power. Knowing that scientists, governments, and environmental organizations are working together to combat climate change can be reassuring.

Encourage a positive mindset and take positive actions. When your child sees you driving less, being mindful with water use, and aiming to conserve energy, you are being a good role model. Find things you can do together—buy less, especially things encased in single-use plastic; consider a more plant-based diet; try to walk and bike instead of driving if possible, at times. Your child may be able to work with their school to help it be more eco-friendly perhaps by decreasing unused food waste, eliminating plastic straw use, or recycling, for example. You can become active with an environmental group or even help your child start one at school. Earth rangers.com has a free club portion geared towards kids with great ideas for your child to take action. Older kids may enjoy sites such as earth.org which highlight young adults making a difference through climate change activism.

Both parents and kids benefit from time in nature, which is known to improve mental and physical health. Getting outside regularly builds connection and a sense of responsibility to nature, as does showing gratitude, especially for the beauty here in Eastern Washington. Do things that help our local environment-plant trees, have a garden, scatter native wildflower seeds. These actions inspire hope and increase a sense of stewardship for the planet. Kids can feel powerless but listening to them and taking action together, even in seemingly small ways, can give them (and us!) a sense of optimism and control. Do consider talking with your child’s healthcare provider or counselor if you note persistent or severe feelings of anxiety or depression related to climate change.

Resources

http://www.earthrangers.com

http://www.natgeokids.com/uk/parents/eco-anxiety-guide-for-parents/

10 Young Climate Activists Leading the Way on Global Climate Action

    more about The contributor

    Dr. Elise Herman

    Blog Posts
    Profile

    Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

    Meeting Essential Health Services And Reimagining Obstetrics In A Rural Community

    · ·

    Case Study via AHA.org (American Hospital Association), Meeting Essential Health Services And Reimagining Obstetrics In A Rural Community (pdf), highlights women’s challenges in accessing healthcare services in rural areas like Kittitas County. It discusses the efforts made by KVH, a healthcare provider in the county, to improve women’s health services despite difficulties. The article emphasizes the importance of community support in providing quality healthcare to women in the region. It also encourages readers to join KVH in their efforts to support women’s health services in the community. The article calls for a collaborative effort to provide accessible and equitable healthcare services to women, particularly in rural areas.

    Building a Workforce

    · ·

    Kittitas Valley Healthcare (KVH) is leading the way to increase healthcare providers in Kittitas County.

    The healthcare workforce shortage is not a new concern, but one that is on top of mind for our industry. Long before the COVID-19 pandemic, the expected number of nursing school graduates did not expect to exceed the number retiring. Add the stress of the pandemic and the emergency staffing needs for hospitals across the nation, and the problem has only been exasperated. Healthcare workers now have many options as healthcare systems across the country are desperate to fill staffing gaps. It is increasingly competitive to find and retain workers. KVH has worked hard on retention efforts for staff- offering free fitness and art classes, career development programs, decreasing benefits costs, and most recently implementing an $18 organizational minimum wage.

    But is it enough to attract new healthcare professionals? In a rural community with limited education programs to develop healthcare workers, you aren’t just recruiting to your organization, you are recruiting to a new community or hoping people are willing to commute. This is why KVH took a different approach. Instead of waiting for applicants to happen to find us for opportunities, we are building our own workforce. This not only helps us recruit new staff but helps us develop and retain our own.

    KVH now offers three apprentice programs with paid on the job training. The Medical Assistant program, which trains students to provide direct medical care in an outpatient clinic setting, is a year-long program where students work with a preceptor to provide supervised patient care with independent coursework. This has been a highly successful program that takes approximately one year to complete.  To date, 50 students have completed the program and are employed at KVH. The pharmacy tech program is a 520-hour clinical rotation. Actual completion time is dependent on the pace of the individual. And, most recently, KVH just got approved to be a training site for a Certified Nursing Assistant (CNA). KVH will be offering paid training for this six-week course to prepare trainees to apply for Patient Care Technician positions in our inpatient hospital units and Home Health.

    We aren’t waiting. We are building our workforce, one employee at a time. Our patients need quality, trained healthcare professionals and our employees need an employer invested in their future.

    Manda Scott, SPHR, MAOL, joined KVH in December 2019 as the Chief Human Resources Officer. With a background in healthcare and nonprofit, Manda’s focus at KVH includes communication, culture, and talent development. She oversees all HR functions for KVH staff, including recruiting and employment, benefits, wellness, labor negotiations, and staff development.

    ​

    The Daisy Award

    · ·

    The DAISY Foundation was established in 1999 by the family of J. Patrick Barnes, who died of complications of the auto-immune disease Idiopathic Thrombocytopenia Purpura (ITP) at the age of 33.

    During Pat’s eight-week hospitalization, his family was amazed by the care and compassion his nurses provided to Pat and everyone in his family. So one of the goals they set in creating a Foundation in Pat’s memory was to recognize extraordinary nurses everywhere who make an enormous difference in the lives of so many people through the super-human work they do every day.

    To learn more about the program and its growing list of partners, visit www.daisyfoundation.org.

    What is The DAISY Award?

    The DAISY Award is an international program that rewards and celebrates nurses’ extraordinary clinical skills and compassionate care every day. Kittitas Valley Healthcare is proud to be a DAISY Award Partner, recognizing one of our nurses with this special honor bi-annually. DAISY = Diseases Attacking the Immune SYstem

    DAISY Award

    Nominee

    Tamara Lewis, RN, Medical/Surgical Unit

    Reason for Nomination

    Developing a trusting relationship with a patient that aided in identifying a severe wound infection that required a higher level of care.

    Nominator

    Beth Isbell, RN, House Supervisor, House Supervisor Department

    Event

    Tamara was taking care of a patient on Med/Surg, preparing her for discharge after the patient had been admitted four days prior. Through a comprehensive assessment performed by Tamara, she became aware of a severe wound infection in this patient and alerted the provider. This wound infection had gone unnoticed by Nursing as the patient was extremely modest. Tamara’s ability to convey trust and compassion to this patient allowed this patient to feel comfortable enough to be examined and share with Tamara the wound she had kept hidden and confide in her the pain she was experiencing. Tamara is an excellent nurse and took time with this patient to get to the source of some significant findings. The decision was made to transfer this patient to a higher level of care. Tamara’s nursing care and promptness in alerting the provider to her clinical assessment indeed aided in an optimal healthcare experience and recovery.