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  1. Self-Care “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” This is truly the time when I (we) need to cling to that message so I (we) don’t collectively lose it. My career is based on helping people with self-care to achieve optimal health and wellness so I know what I need to do to keep myself grounded and in balance. After all, the foundational principle of wellness is “Self Responsibility”. So what did I do for myself to that end? I attended a self-care retreat online to bring back a feeling of calm and even at one point – serenity. There are so many tools we can draw from in times like these to take care of ourselves and my message to you is to find them and embrace them, now more than ever. Currently, I am doubling up on the stress management tools I use daily because I need it for balance. Stress Management Tools / Strategies Now I want to share how attending this healing retreat flowed for me so it might give you some ideas as well as tools you can use. Here are some highlights of the four strategies that we experienced under the wise guidance of our facilitator Barbara Badolati. Conversation centered around “I hear you” Now more than ever we need safe spaces to talk about our feelings. We were given that opportunity in small breakout rooms in Zoom with a skilled facilitator to initiate a question and time for each to respond. I believe this was my most important takeaway and subsequently, I have been engaged in more conversations at this level with other groups I am in. We need to pull back the curtain and explore the deep underbelly of why we are feeling the way we are right now. Kundalini Yoga Kundalini means "coiled like a serpent" in Sanskrit. Kundalini energy refers to the coiled up energy that lies at the base of the spine. When released, this energy moves from the base of the spine through the seven chakras (or energy centers) in the spine. Specific meditation and breathing techniques were used to tap the kundalini energy, and these practices were known as Laya yoga. This school of yoga was founded by Sage Gorakshnatha, a sage from Nepal. This was not the traditional yoga I expected but was very energizing. However, I was reminded that my yoga endurance was sorely lacking and found myself taking several short breaks to “catch my breath”. When finished, however, I felt the flow of energy in my body and was certainly more relaxed. Note to self: ease into yoga gradually so you can work up to more endurance. Sound Bath with Kathy Murphy Sound helps to facilitate shifts in our brainwave state by using entrainment. Entrainment synchronizes our fluctuating brainwaves by providing a stable frequency which the brainwave can attune to. By using rhythm and frequency, we can entrain our brainwaves and it then becomes possible to down-shift our normal beta state (normal waking consciousness) to alpha (relaxed consciousness), and even reach theta (meditative state) and delta (sleep; where internal healing can occur). What You Need to Know About Sound Healing This was a body, mind and soul bath in a symphony of the highest quality therapeutic sound and vibration. A Planetary Gong, Nepalese Singing Bowls and a Crystal Lyre all came together to bring us into complete alignment with the goal of lasting healing. Did it do the job? Yes! My body became so relaxed that I almost fell asleep. Yes, I reached Delta. Priceless! Regenerating Images in Memory Macy Matarazzo RIM ® (Regenerating Images in Memory) is a body-centered, transformational technique that frees you of negative thoughts, feelings, and memories, so you are empowered to live your best life. The RIM ® process allows you to re-generate your neurologically grounded sense of self in a profound way. Through her guided memory experience, I discovered what my spiritual grounding-guide might look like. What came to mind for me was a very large maple tree I had discovered right on my property while I was clearing away a lot of dead brush and burning it. I had never noticed this tree before because the area was all overgrown and had been ignored for years. But once I “uncovered” it and appreciated it’s size and majesty, it occurred to me that I had planted it as a foot high sapling 40 years ago and it became a visual representation of who I am today. Thriving in nature, grounded, healthy, strong, flourishing, reaching upward with continuous growth, and surviving around other trees that were not as hearty and even had died off. This tree had become a beacon of light for me, a spirit guide from nature. A perfect reminder of who I am and who I can rely on when it seems like the world is falling apart. And, it has been with me all this time but needed to have the clutter around it removed so I could see and appreciate its presence to help me stay grounded. What a gift I received from that meditation. At the conclusion of the retreat, I can say without hesitation that I had released all the pent-up stress and felt a great sense of calm, relaxation and felt the flow of balanced energy in my body. I was numb – in a very good way. So what steps can you take to “change the things you can” and bring balance back into your being. Remember, you are the only one who can change YOU, and trying to change others or situations is not your work.
  2. Take Care of Your Body It’s easy to lay around and not get moving, but during this time, it’s important that you take care of your body. Don’t stress out feeling like you have to do intense work outs daily, but get a routine going in which you take a walk, do some dancing or stretch with the help of a Youtube video. By all means, please take time to get proper rest. The stress and energy, both mentally and physically, working on the frontlines earns you the right to rest. If you need two days to sleep and lounge around, do that. Just make sure you’re being conscious in showing your body some extra TLC. More importantly, take care of your body from the inside. Vitamins and immune boosters are necessary especially now during these times of COVID-19. I suggest that everyone takes a multivitamin as well as B complex and Vitamin D. Taking in extra vitamin C through foods and supplements are a sure way to boost your immunity as well. As nurses working on the frontlines, you have to care for your body from the inside. Give yourself the upper hand and take your vitamins. Life as we know it has changed! As you know, most people are deficient in vitamin D which we get through the sun. Now that we have to stay inside, we are getting even less vitamin D than we did before. One of the most important roles of vitamin D is immunity. It also helps with maintaining healthy bones and teeth, disease prevention and mood and brain function. So, if you haven’t yet, get some vitamins! Cut Out the Extra Noise There have been times recently where I had to take a social media break. Seeing my whole newsfeed with people getting infected, dying and loosing loved ones became too much! That, paired with the fact my husband loves to watch the news all day, sent me in a downward spiral. You have to stay informed so I’m not saying cut out all information sources, but if you find yourself headed down the spiral like I did, cut it out. Fill your mind with more positive than negative to keep your spirits up. Take Breaks I don’t know how many nurses I’ve heard tell me they can’t take breaks at work. That’s insane! I understand that some employers try to work their nurses to death, but it’s up to you to take a stand and know your rights. If they continue to refuse breaks after bringing it up to management, it might be time to find a new job. I always find it best to take breaks outside the department. If you’ve never taken a small break at work to walk outside and feel the sunshine or cool air hit your face, you’re missing out. When you start your shift, let your relief know that you plan to take a break at 10am, 1pm and 5pm (for example). This way, you have a break to look forward to which can relieve some stress when work gets busy and at times unbearable. Maintain Relationships Check in with your friends and family during this time. Talking about my feelings with those closest to me not only gives me a sense of relief (from stress, uncertainty of life after COVID and how to entertain myself during this time), but often times I find out that I’m not alone in how I feel. When you know that other people are experiencing the same thoughts and feeling as you, it gives you a sense of normalcy. Apps like zoom, facetime and facebook messenger allow you to video chat with family and friends. Having a virtual happy hour or afternoon virtual tea (both of which I have participated in) are extremely fun! Although I can’t wait to get back to brunch and happy hours, these interim activities remind me that my relationships can withstand hardships and keeps me motivated to remember life as we once knew it, although different, will return. Learn Something New This has to be my favorite activity to do during quarantine. Many business owners are offering free classes and courses to help others during this time. Information is abundant on the internet. I’ve taken free cooking classes, business courses and design classes. Beauty experts are teaching how to do certain hair styles as well as makeup! Use this time to learn something fun! Think about what excites you or interest that you have and research to see if someone is teaching a class on it. You never know, investing time into a hobby now, can set you up for a possible side business in the future.
  3. Since the spread of this Corona Virus and new protocols, lockdowns, school closures, etc, The ICU where I work has had a weird vibe. Then we got our first Covid-19 patient. All of the sudden, behavior has been concerning. People refusing to care for "that patient", nurses stating their cases and co-morbidities, nurses demanding masks when they are already in short supply, and the general vibe of the unit has been off and very concerning. Emotion and mental health for nurses is important but somehow we are missing this element in our unit. Add to that, many of our husbands have lost their jobs and home stress. I'd like to hear from some of you who may have experienced similar issues. Is there any units out there who have successfully maintained a positive work environment? In the midst of fear, how do you deal with co-workers who are spinning out? Do you all have a zen room or a place to debrief? Do baked goods or ice cream work? Any ideas how to bring a team together and debunk fear? Any ideas on how to cultivate that this is going to be a great day because we are all going to do what we do everyday and be here for one another? Thank You, Stephanie BSN, RN, CCRN-CMC-CSC
  4. Maureen Bonatch MSN

    Stop Putting Your Life on Hold

    Maybe I’ll do that tomorrow, or next month, or next year, or … Maybe never. Nurses are busy. As caregivers, we tend to put other’s needs in front of our own. We strive to do as much as we can, for as many people as possible, in the least amount of time. This can lead to missing breaks, staying for a second shift, or not taking that class we were thinking about. We might feel like we don’t have time to add one more thing, or we’re too tired to spend our personal time the way we’d planned. After a while, the tendency to put things important to us off until another day may become reflexive, and this behavior can leak into our personal life. When we keep putting our life on hold it could eventually affect our physical and mental health if we deprive ourselves of meeting our needs. Why Not Me, Why Not Now? I’ll Be Happy When… Why do we wait for happiness? Sometimes we associate a new job, finishing a class, losing weight, or a specific day of the week, as what’s standing in the way of happiness. But often once we reach that desired destination, we realize that it wasn’t the barrier. Or we discover that there’s something else we believe we should accomplish first before we can be happy. If we continue with this pattern of putting our happiness on hold, dissatisfaction may become our default emotion. I’ll Do That When I Have Time to… So far no one has had any more luck coercing Father Time to slow down than they have had in fooling Mother Nature. As much as we try, we all have the same 24 hours each day. The key is dividing up and prioritizing how we want to spend this time. If we feel as if we have no time to do what we want, or what we enjoy, it can take an emotional toll. Make living life now a priority, instead of waiting to enjoy life. They’ll Be Upset If I Don’t… Sometimes it’s difficult to say no when helping others can feel satisfying. It can provide us with a sense of pride and purpose. But if we spend too much time giving to others and neglecting ourselves it can build resentment. We can still be helpful to others, although if we always say, yes, and never say, no, we might never have any space on our calendar for ourselves. Time to Let It Go We’re allowed to change. What worked at one stage of our life might not bring us joy in another. There are many things that occur in our lives that can cause us to shift our schedule, or our priorities, or to put goals on hold. They could be related to different stages of our career, our life, or those of our family, that require our attention. Although the years may pass, and things may change, sometimes we’re left with the mindset from a different time of our life. It might be time to let go of obligations that don’t fit what we want out of our life now. If we do a self-assessment, we might determine that we might be compromising aspects of our self-care. This could result in us pushing our bodies harder than we should to meet what we feel are our obligations day after day. We should be able to shift our perspective to feel joy, instead of guilt, when we reach for what we want instead of putting our needs on hold. Self-Care Isn’t Selfish It might feel as if we’re being selfish in making ourselves, and our lives, a priority. As nurses, we educate our clients about taking care of themselves with proper sleep and nutrition for better overall health and well-being, but we don’t always listen to our own advice. We know that listening to our body can help more than just us. When we work to meet our needs first, and our goals, we shouldn’t think of it as being selfish. It can help us be more productive, to be able to give more to others, and care for our patients easier. Self-care should extend to examining the goals we’ve put on hold for our personal and professional life. Even starting with small steps toward bigger goals and dreams can help refresh our mindset and help us remember what’s important. Gain a Positive Return on Investing in Yourself Don’t put your personal wellbeing on the back burner by always saying yes to things you don’t want to do, or that don’t serve you purposefully, or that take time away from meeting your goals. You might find a much more positive return on investing in yourself. What Have You Put on Hold in Your Life?
  5. Dr Georgianna Donadio

    Personal and Professional Benefits of Self Care

    As trusted health professionals it is our responsibility, and our calling as nurses, to provide compassionate, competent care, as well as to educate our patients and clients on an important topic in today’s health and wellness landscape, which is the growing need for and a demystified presentation of what is referred to as “self-care.” Self-Care: The Foundation for Healthy Living Self-care has been misinterpreted by some as potentially unrealistic because it is believed that lay people do not have the knowledge required to make the best decisions for their health. However, research studies are revealing that “self-care” is the foundation for leading a happy, healthy, and purposeful life, not only for ourselves but for our families and communities and does not have to be complicated, hard to understand or require special knowledge to integrate into our lifestyle. While there remains an emphasis in our culture on putting the needs of others before ourselves – whether it be at home, work, worship, etc. – this practiced selflessness at the expense of our well being can lead to chronic illnesses, depression, and a host of other maladies. We especially see this in what has been referred to as the “sandwich” generation which finds adults caring for their children, as well as their aging parents. Without self-care, these caregivers burn out or become ill within a relatively short space of time. A common message during air travel is “in the event of an emergency, put on your oxygen mask first before trying to assist anyone else.” The same is true with serving others as a nurse, as a family member or community member. If we cannot take care of ourselves in a way that supports our own well-being, we are less effective in assisting or caring for others. In the patient health education program I work at, we teach that a person’s whole health is contingent upon multiple factors in their lives – such as the physical, emotional, environmental, nutritional, and spirituality/world-view. If there is an imbalance in any or even some of these areas due to neglect or stress, it can lead to a whole array of health concerns, affecting not only us but our immediate family and social networks. Taking the time for proper self-care is all the more important given the competitive, stress inducing nature of our culture today. An article published this past April in The New York Times reported that, according to an annual Gallop poll of more than 150,000 global participants, those Americans polled “reported feeling stress, anger, and worry at the highest levels in a decade”. (1) When asked how much stress they’d experienced the day before being polled, 55% of Americans felt “a lot” of stress, versus 35% of the world population. When it came to worrying, 45% of Americans said they worried “a lot”, versus 39% of the rest of the world. 22% of Americans also felt “a lot” of anger, in line with the global average. Furthermore, American participants cited a rise in the number of negative experiences they had. While there are a wide range of factors that can account for this rise in stress and worry, it is well documented from years of study and research the toll which chronic stress, worry, and anger can take on physical and mental health, individually and collectively. Though the polling data cited in the article is alarming, we thankfully live in a time of unparalleled access to information to educate ourselves with regarding the myriad benefits of self-care. Knowledge is power as we know and with everything that medical research has revealed it is perhaps easier than ever to make informed, evidence based decisions for our health and well-being. In a blog post for Psychology Today, Tchiki Davis and Brad Krause identify 12 easy to implement steps for creating a sustainable self-care plan. (2) Among them are: What are Some of the Steps for Sustainable Self-Care? Get enough sleep As Davis and Krause write, “Sleep can have a huge effect on how you feel both emotionally and physically. Not getting enough can even cause major health issues. But stress and other distractions can wreak havoc on our sleep.” Exercise regularly “Daily exercise can help you both physically and mentally, boosting your mood and reducing stress and anxiety, not to mention helping you shed extra weight.” Proper nutrition “The food we eat has the potential to either keep us healthy or contribute to weight gain or diseases such as diabetes, but it can also keep our minds working and alert.” Learn that it’s ok to say “no” “It may take a little practice, but once you learn how to politely say no, you'll start to feel more empowered, and you'll have more time for your self-care.” Spend time in Nature “Spending time outside can help you reduce stress, lower your blood pressure, and be more mindful. Studies have even shown that getting outside can help reduce fatigue, making it a great way to overcome symptoms of depression or burnout.” These are just a few of the ways we can cultivate a consistent and centering practice of self-care for optimal health and well-being. Prevention is a major focus in medical health care today and there is no better way to prevent disease than to develop these simple, easy to implement steps to better health and longevity. What are some steps to healthy living that you have implemented?
  6. Maureen Bonatch MSN

    Make a Not to Do List

    Many of us spend the day counting the hours until our shift is done, or until we have a day off to focus on our personal To-Do List. But once this long-awaited time arrives, often it’s never enough. We may spend most of our spare time crossing off the things that we need to do, leaving little time for what we want to do. Often there’s no better feeling than accomplishing everything on your To Do List, although sometimes that list seems never-ending. What if that list was shorter, making it easier to reach those goals? What if we narrowed down our To Do List by focusing on what not to do? Then perhaps instead of being controlled by what we feel we have to do, we can spend more of our free time doing what we want to do. Reevaluate Your To Do List There’s no doubt that there are many tedious tasks that we have to do each day, but often many that populate our list, or our minds, are things that may not merit the guilt accompanying them. What might have been good a few years ago, might not meet your needs today. We may spend so much time doing what we feel we have to do that we no longer know what we want to do. The life you live today isn’t the same as the one you lived a few years ago, or even last year. Our needs and wants evolve with the passing of time, but often we don’t reevaluate if there are things we can remove from our homes, or our thoughts. Minimizing, decluttering, and organizing our material possessions has gotten a lot of focus lately. Some even say that decreasing the things in our physical space can help us find more happiness and peace in our thoughts. Make a Not To Do List There are tasks that take up our time, energy, and finances, that may begin to feel more tedious and not worthy of our time and energy. Focus on one or two tasks, or items at a time and consider, how much do I care about this? Prioritize your time for what’s important to do today, what can wait until later, and eliminate those things that may not be worth your time. I’m Not Going to ... Keep that subscription to that magazine or blog I no longer read, or pay the membership fee for an organization I no longer have the time, or the desire, to participate in. Purge your home and the guilt of things that are no longer important to your life today. Move those clothes around that I keep thinking will come back in style, or that I’ll lose 10 pounds so they’ll fit better. Reduce the time spent sorting through your closet and make it easier to find the items you love to wear. Stare at the overflowing inbox and instead start deleting or unsubscribing the unnecessary, or endless, emails vying for your attention. If you don’t want to unsubscribe, many offer the option of reducing the frequency. Check my email every five minutes. Plan certain times during the day for email and social media so it doesn’t overtake your day. Set your phone down so you can be fully present. Be distracted or annoyed by spam phone calls, or feel the need to respond immediately to texts and social media. Instead block spam numbers, let them leave a message, or change the settings for times you don’t want disturbed. Say yes to get-togethers, meetings, and clubs that I really don’t have the time, or desire to participate in. Decline early, and politely, so guilt doesn’t weigh on you or result in you backing out at the last minute. Neglect to ask for help. Someone in your family, or professional life, might be willing to assist with, or do some tasks more efficiently. The Gift of Time Most nurses realize the value of each minute. Whether we’ve learned that from the demands on our time, or our patients who say they wish they’d spent their time in a different way. Make the space and time for what’s most important in life. Don’t let the tedious tasks on your To Do List take up all your time and prevent you from getting to the things you really want to do because there’s too much you have to do. What we don’t do might just provide more time for what we want to do.
  7. Mass casualties, shootings, horrific motor vehicle accidents, untimely deaths, abuse, lingering deaths that are not peaceful, medication errors, neglect—the list of causes of trauma in nurses is long and impossible to enumerate completely. We all know what it is: these are the events that keep us awake at night, even though we are bone-tired, worn out in body and soul. Try as we might, we can’t forget that haunting look, the moment of discovery, the pain, the guilt the utter tragedy of traumatic events. A recent article about the killings in El Paso states, “The story of their lifesaving labors at the El Paso hospital, the only one in a 270-miles radius prepared to treat complex trauma patients, is one of heroics in the face of violence, and of the doctors and nurses, who, once the adrenaline rush died down, struggled to live with the horror of what they had experienced." (Surgeons Labored to Save the Wounded in El Paso Mass Shooting) Oddly, in order to result in lingering mental health side-effects, these tragedies don’t have to happen to us, necessarily. We can experience trauma even after events that have happened to our loved ones or to someone we know or to someone we heard about on the news. Traumatic events are universal: most of us suffer through some in our lifetime. But the residual effects of trauma and the associated losses can be debilitating at times. What is PTSD? Post traumatic stress disorder (PTSD) is most commonly associated with veterans and refers to their emotional, physical and psychological difficulties after single event trauma or after multiple events accumulate. We read about their nightmares, their anger, their difficulty sleeping and their problems with everyday life. “PTSD is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.” (PTSD: National Center for PTSD). PTSD can be short term or a more persistent condition that hampers the person’s ability to live well and fully. The Trauma Healing Institute identifies several characteristics of trauma and emphasizes the importance of addressing all aspects of trauma so that true healing can take place: Trauma overwhelms normal coping Trauma is difficult to put into words Trauma shatters dignity Trauma destroys choice Nurses can also experience symptoms of PTSD related to their work in highly charged emergency situations. Most recently, the shootings in Kentucky and Texas have brought to the fore the need for nurses and other medical professionals to care for their minds and spirits after the horror of caring for the victims of shootings, especially those that involve high numbers of mass casualties where lives depend on nurses and other medical professionals to work with efficiency and to cope with multiple needs at one time. But even on routine days, nurses can experience the trauma of caring for victims of accidents or crimes. We can be traumatized by procedures we are a part of that don’t go well, by patients that die on our watch, by places where we feel we didn’t do all we could have done. How do we carry on when these events keep coming up and clouding our thinking? How can nurses practice good self-care in the face of tragedy and its residual effects? 1 - Be alert for signs that you are struggling and get help if needed If you are normally calm and can deal with adversity or failure well, but then all of the sudden, you are flying off the handle and fussing about things that didn’t disturb you before, it may be time to look deeper and to ask yourself if you may need to get help. It is not unusual to have problems with anger, sleep, attention for a few days or weeks, but if the problem persists, get help with a counselor or other mental health professional. Getting help is important and necessary if the aftereffects of trauma persist. 2 - Sleep While this bit of advice only applies after the initial episode of trauma, it seems that some recent studies show that sleeping after a traumatic event can help to lessen its after-effects and shorten the length of time that the episode causes distress (Sleep helps process traumatic experiences). While this theory is still being studied, it appears to support what we may feel instinctively—a good night’s sleep helps. The common adage, “Sleep on it,” reminds us that sleep will help restore some order to our confused and disturbed thoughts after trauma. 3 - Connect After trauma, it is often helpful to spend time with others, to talk about what happened (if that is possible), to join a support group, to let friends and family nurture you if they offer. While traumatic events and PTSD symptoms may lead the sufferer to want to withdraw from others, the healing happens in community and communication. Nursing can be full of traumatic episodes. As professional nurses, we must continually work to stay healthy in mind, body and spirit so that we can, in turn, help others.
  8. Nurse Beth

    What to Say When Your Patient Dies

    Before Ashley could begin to regroup, she glanced down the hallway towards the elevators. Stepping off the elevator was George’s elderly wife, Elaine. George and Elaine had been married 46 years. Ashley felt trapped and panicky. She was the nurse, but what was she supposed to say? This had certainly never been on any test in school. Ashley knew how to fix plenty of things - a beeping infusion pump, a low serum magnesium level- but Elaine’s crumpled face? She couldn’t fix this. She couldn’t get busy and make her patient comfortable. She had never felt so unprepared and didn't even know what to do with her hands as Elaine walked towards her. Provide Comfort It’s always OK to say a simple, heartfelt “I’m so sorry”. Don’t worry as long as you are genuine. Common phrases like "I'm so sorry for your loss" carry more weight and meaning in these situations, and are comforting. At the same time, be comfortable with not saying anything. Be present and follow the family’s lead. Practical Help Nurses are good at providing material comfort. Offer Kleenex if needed, or a glass of water. “What can I get for you?” “Is there anyone I can call for you?” “Would you like some time alone?” “ I can get some more chairs in here for you”. Ask permission to give a hug if you are comfortable with hugging. Offer to contact their pastor or the hospital's pastor. A blanket from the warmer placed around the shoulders can also be a comfort. Acknowledge their feelings “I know how much you loved him” (if you know this to be true) “I can’t imagine what this must be like for you”. Manage Your Feelings At some point you may feel like crying. Nurses who are empathetic will feel the grief along with the family. It’s Ok to shed a tear, but it’s important to manage your emotions. Out and out crying is not OK, because then it becomes about you. To keep yourself from crying when you don’t want to, bite your lip, or do a quick math problem in your head. Help Them Move Forward At some point you may need to move the process along without rushing the family. Your other patients and duties are still there, and the bed may well be needed for another patient. The key here is to gently move the family from the emotional realm to the cognitive realm. How do you this? When someone is in crisis and in an emotional state, you can refocus them by asking a question. “George said he loved being a coach. Was it basketball that he coached?” or “He was a golfer, right? Did he play much?” The person will immediately switch to the cognitive side of their brain and answer you. It's insensitive to switch gears on someone who is in an emotional state, but once they are in a cognitive state, you can begin to bring closure. They are now in the realm of dates and facts. Ask them if they have chosen a mortuary, or whatever else you need to do, such as gather belongings. Find out if they are waiting on any other family members. Self-Care: Debrief and Process It’s traumatic to watch another human being die, and it can be a loss if you cared for them or became attached. When you’re at work, you need to put your feelings on hold in order to function and remain professional. It’s OK to compartmentalize your feelings as a coping mechanism, but be careful. Putting the experience aside doesn’t mean it’s been dealt with. Emotions have a way of coming out one way or another. You might burst out crying at a Hallmark movie, or over react in some other situation. But eventually the experience needs to be processed. You owe it to yourself to debrief as soon as you are able. Processing usually means talking about it to a supportive person. Putting your feelings into spoken words helps you name what happened and begin to heal from the trauma. Practical tip- when you get home after your shift, take a shower. Stripping off your scrubs and letting water run over you symbolically cleanses and refreshes. Note: If you have unresolved grief issues of your own, get help so you can better help others without your needs taking precedence. Nurses are often the first person a family member turns to at point of loss. It’s a privilege to bear witness at the time of death, and it's an honor to comfort and help the family. What have you learned to say or do when your patient dies? Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!
  9. Melissa Mills

    8 Best Apps for Patient Self-Care

    According to a New York University School of Medicine study of 1,604 mobile phone users in the U.S., over half (58%) downloaded at least one health-related mobile phone app. The most popular categories of apps were fitness and nutrition, with users accessing these apps daily for self-care management. What does this mean for your nursing practice? Nurses must be aware of this trend. Your job hinges upon educating patients about important self-care behaviors that will keep them healthy and out of the hospital. An article in Nurse Journal reports that patient education must be comprehensive and easily understood because more than 50% of Americans are health care illiterate, meaning they don’t understand the health care information given to them or what to do with it. This is where the mobile phone app trend can help you and your patients. When you are no longer there to educate, these apps can help your patients remember, search, track, and learn about their illness to better manage at home. Glucose Buddy for Diabetics This app has been ranked the #1 diabetes app for over 9 years and allows the user to track blood sugar, medication management, and Hemoglobin A1C results. Glucose Buddy can also track carb intake through the food database, weight, insulin, blood pressure, and provides daily and long-term trends. It integrates with the Apple Health App and has the option of purchasing premium features. Clinical Trial Seek for Cancer Research Studies If you have a cancer patient seeking to enroll in a clinical trial in the U.S. for their cancer care, Clinical Trial Seek is just the app. It allows them to search by location to find studies in their area and by cancer type, clinical trial phase, study sponsor, and inclusion criteria to see the trial that is right for them. CDC App for Flu Season The Centers for Disease Control and Prevention has several apps that can help just about any patient with self-care activities. A popular one for this time of year is the FluView Interactive app gives the latest flu outbreak data to keep your patients safe during the flu season. Click here for a full list of general public CDC health apps available on iOS and Android. WebMD App for Overall Wellness Just about every patient uses WebMD to check symptoms. But, did you know that you can point your patients in the direction of the WebMD app to help with healthy living including a physician directory, pill identifier, medication reminder, and the ever-popular symptom checker for when they’re on-the-go? This app is highly rated by users and available in the Apple Store, Google Play Store, and on Amazon. What to Expect Pregnancy and Baby Tracker for Future Moms Just like the book, the “What to Expect When You’re Expecting” app is chock full of details about exactly where your patient is in their pregnancy and offers week-by-week videos showing the development of their baby. It also has loads of general pregnancy information including tips for nutrition, exercise, and how to prepare for labor. Mango App for Tracking Self-Care Habits If you’re looking for a general health app to help patients with medication management and creation of health habits, check out Mango Health. Patients can track their weight, medication compliance, and even get regular reminders to help with self-care behaviors. SmartBP App for Healthy Hearts Many patients could benefit from an app that helps with blood pressure management and tracks progress towards healthy heart goals. SmartBP uses an iPhone, iPod Touch, or iPad to record, track, analyze, and share blood pressure readings. It connects with Apple Health to keep all health information at the patient’s fingertips. Saebo VR for Stroke Recovery Many stroke patients need assistance with activities of daily living after having a stroke. The SaeboVR app was designed to engage patients in physical and cognitive rehab to simulate everyday tasks. It uses a virtual assistant to offer guidance when performing self-care activities with the affected extremity like picking up transferring, or picking up and manipulating objects. Sample activities include grocery shopping, preparing breakfast, and putting away clothes. Do you have a go-to patient app that you recommend? Comment below and let us know the name of the app, the population of patients you use the app for, and why you like it.
  10. SafetyNurse1968

    I think I'm Alone Now: The Benefits of Solitude

    "I took a walk in the woods and came out taller than the trees" - Henry David Thoreau SELF-CARE How many times have you heard that nurses are bad at self-care? We don't go to the bathroom enough, we don't take lunch breaks, we don't exercise, we smoke cigarettes, we don't sleep enough, we eat our young...the list is seemingly endless. I'm going to add another one: we don't get enough alone time. In between 13-hour shifts and family/bank/school/grocery store, when do we have time? When was the last time you were actually alone? I'm going to guess: you were in your car driving to work, or running an errand. Am I right? When was the last time you were in nature? You know, with the tall green things and that bright, shiny orb in the sky? When was the last time you were alone in nature? As nurses, we are at risk for compassion fatigue, burnout, exposure to infectious diseases, and violence in the workplace. We deserve a break...we need a break. Keep reading to learn some of the mental and physical benefits of being alone in nature, and why solitude should be on our self-care list. ADVENTURE IS OUT THERE I've done plenty of adventurous things, like traveling to Haiti for a medical mission trip, a mountain bike adventure race that lasted 16 hours, jumping out of an airplane, having children. I moved across the country to take up kayaking, and I bought my first house on my own. I went back to school to be a nurse when I was 36, quitting a good full-time job with benefits. I'm not afraid of much. I like to test myself, but lately, the most adventurous thing I've done is binge watch Stranger Things. Something about turning fifty, and being a (mostly) stay at home mom to four kids has slowed me down lately. I've been feeling antsy, less alive. I needed some adventure. My mom did four nights on the Appalachian Trail when she was 50, so perhaps I got the idea, and the courage from her, but I could never seem to get a plan in place for my own adventure. Finally, my success with daily journaling inspired me to set myself a deadline. When I had completed 60 days, I would head out into the woods with my journal, read through the pages, take notes of anything useful or important, and then burn the rest. I planned a ceremony of sorts. I planned to release the inner demons that were trapped on my journal pages. I was hoping for some transformation, and I was looking forward to the hike - I love being in the woods. I was less excited about the sleeping alone part, but there's that pesky need to test myself...it's like an itch I just have to scratch once in a while. THE OVERNIGHT With a 20 mile round trip mapped out, I got underway. The day was gorgeous. I only saw one or two people, but no one tried to chat (whew!). I had a perfect moment where I laid on my back in the middle of the trail and just looked up at the sunlight streaming through the leaves of the Beech tree canopy. It was glorious. I was alone. I didn't get scared until I had settled into my hammock around 10 pm. That was when I started worrying about bears and the meth heads who've set up camp in our forest. I decided there was nothing I could do about it, said a prayer, and fell asleep... for nine hours! In retrospect, I would do it all again with a few changes. I think burning my journal was a good idea in theory, but not the transformation I was hoping for, and I will definitely not take another burrito, which did transform into a soggy mess by dinnertime. While I was hiking I had some thoughts about this article. I am Safety Nurse after all, so I feel compelled to discuss whether what I did was actually safe. I also want to talk about the benefits of solitude, and if they outweigh the risks of a solo venture. BEARS So what about bears? Just how dangerous are they? Here in Western North Carolina (WNC) they are as common as stray dogs. They wander into yards, open car doors, and even break into houses. Despite their prevalence, there are, on average, only three fatal attacks per year nationwide, though some years there are as few as zero1. Here is where "death by bear" falls on the CDC list for 2005.2 Cause of death # dead Cardiovascular disease 856,030 Transportation accidents 48,441 Drowning 3,582 Hypothermia 699 West Nile virus 119 Hornet/bee/wasp stings 48.5 Snake bites 5.2 Bear attacks 2 So worrying about being killed by a bear seems a little far fetched, but what about getting injured? It turns out that in the outdoors, the primary way you get injured is the same as everywhere else-slips, trips and falls. Mainly, I need to watch out for roots and stray rocks. While bear attacks are relatively rare occurrences, if you ever make contact with a bear, you can either play dead or fight back. "If a bear is acting defensive, especially brown bears, it's a good idea to just play dead," according to the Alaska Department of Fish and Game (ADF&G). When a bear perceives a human as food, the department says to fight back, "Concentrate on the bear's face or muzzle with anything you have on hand." The department warns people against running away from bears. "They will chase fleeing animals," according to ADF&G. "A charging bear might come within a few feet, before running off. It's important to stand your ground." So that covers that problem - being eaten by a bear is not likely to happen, and given the number of bears that are now entering human habitations4- just as likely to happen in your living room if you live in WNC. WHAT ABOUT PEOPLE? While 1 out of 5 people fears the possibility of being murdered, the odds that a person will be murdered in any given year are about 1 in 18,690.5 Safety is even higher if you are a woman. Teenaged black males are most likely to be victimized, whereas elderly white females (me) have the lowest chance of being a victim.6 Location is the biggest risk factor for a solo hike. The US had 17,250 homicides in 2016, which equals a rate of 5.35 deaths per 100,000 inhabitants. Though we are at a 30-year low for homicides in the US, I would rather go hiking in Monaco or Andorra where the homicide rate is 0.7 ALONE TIME There are risks involved in a solo hike. While meeting a hungry bear, or a psychopath are not likely, they can still happen. Do the risks outweigh the benefits of being alone in the woods? Let's define the terms. When I talk about being alone, I'm not talking about social isolation, which is associated with alcohol and drug abuse, anxiety, depression, self-harm and suicide. Social isolation, an increasing problem in our society, is a state of complete, or near complete lack of contact between an individual and society, and can be caused by depression, illness, age or any number of factors over which people have little control.8Solitude is voluntary. Psychology Today defines solitude as a state of being alone without being lonely, and can lead to self-awareness.9Loneliness is a negative state, marked by a sense of isolation, a sense that something is missing. Solitude is a positive, constructive state of engagement with oneself. WHY SPEND TIME ALONE? Though western culture tends to equate a desire for alone time with people who are lonely, sad or "antisocial", seeking solitude can actually be quite healthy.10 Some benefits of being alone: Rebooting your brain and unwinding - having time to think deeply can spark creativity Improved concentration and increased productivity - oh the thoughts you'll think when there's no TV! The opportunity to discover yourself and your voice - who are you when your friends and family aren't around? Working through problems more effectively - being alone can lead to solutions you didn't expect to find. Enhanced quality of relationships with others - solitude can increase empathy and compassion Building mental strength- your ability to tolerate alone time can increase your happiness Reduced behavior problems in kids - one study suggests that kids who learn to be by themselves are better behaved than other children. HOW TO BE ALONE An article I read from Psychology Today has five recommendations for getting some alone time11: Disconnect - set aside time each day to unplug. I'm now limiting myself to checking my email at 10 a.m. and 4 p.m. I'm so pleased with how free I feel in between. Also, I removed Facebook from my phone. Get up early - I try to get up 30 minutes before my kids do, but sometimes I hit the snooze button. I will continue to try to make it a habit. When I do get up and journal alone on the back porch with some meditation music and coffee, I feel better able to face the day, and back-to-school tantrums. Close your door - since I work at home this isn't as much of a problem for me - when my kids are at school, I'm in heaven. When I used to work at a college of nursing, I would put a sign on my door for two hours each day: "Working on an important project, please only knock if you really need to interrupt." Use your lunchtime - what lunchtime? Does anyone eat lunch any more? And if you do eat lunch, aren't you doing it while doing three other things? Seriously though, try having a lunch date with YOU. Schedule solitude - again, since I work from home, I have had to be creative here. I am trying to put a regular "solitude date" on my calendar so I will actually do it. The problem? It's so easy to move the appointment. I'd love to hear your suggestions. BEING ALONE IN NATURE This article isn't just about solitude, it's about being alone in nature. In a literature review of the topic, Thomsen, Powell and Monz (2018) report that exposure to and engagement with natural environments can provide significant health benefits. Research supports that being in nature leads to higher rates of physical activity, reduced blood pressure, reduced risk of cardiovascular disease and diabetes, as well as improved BMI. In addition, being in nature can give you an improved ability to cope with stress, improved mood and self-esteem, reduced anxiety and depression and increased attention levels.12 TO BE ALONE, OR NOT TO BE ALONE? I've argued that being alone in the woods isn't any more dangerous than sitting on your couch eating a pizza. I've provided some evidence that women can safely be alone in the woods.13 I've even suggested that going out into the woods might improve your health. Ultimately, however, it's up to you. Schedule yourself for some alone time. Take a walk on that trail near your house after work today, get up early and sit on your back porch and listen to the world come alive. Your body and mind will thank you. "I can't believe you are going to sleep outside in the woods by yourself, aren't you scared?" Said my good friend, Anna. "Well yes, of course, I'm afraid, but I am more afraid not to go." REFERENCES 1. Bear Attacks - Killer Statistic That May Surprise You - The Alaska Life 2. FastStats - Deaths and Mortality 3. Bear Attacks - Killer Statistic That May Surprise You - The Alaska Life 4. 2 bears break through window while family inside home | CBC News 5. Dicing with death - The odds of being murdered 6. https://www.bjs.gov/content/pub/pdf/VIOCRM.PDF 7. List of countries by intentional homicide rate - Wikipedia 8. Social isolation - Wikipedia 9. What Is Solitude? | Psychology Today 10. https://www.forbes.com/sites/amymorin/2017/08/05/7-science-backed-reasons-you-should-spend-more-time-alone/#7291cbfb1b7e 11. https://www.psychologytoday.com/us/blog/high-octane-women/201201/6-reasons-you-should-spend-more-time-alone 12. Thomsen, J. M., Powell, R. B. & Monz, C. 2018. A systematic review of the physical and mental health benefits of wildland recreation. Journal of Park and Recreation Administration, 36. 123-148. 13. https://www.adventuresportsnetwork.com/lifestyle/culture/is-it-smart-or-safe-for-women-to-go-hiking-alone/ VIOCRM.PDF
  11. Carol Ebert

    Can Stress Make You Fat?

    Let's begin with the basics to get a handle on this. As you know there are two kinds of stress. Short term like long lines and bad traffic. This is where your fight or flight response kicks in and hormones are released. Adrenal glands secrete epinephrine and norepinephrine Heart rate and blood pressure increase Fat and carbohydrates in your system are broken down faster Your metabolism changes to fuel this heightened state to be ready to fight or run away. Once the threat is eliminated your body settles down and you relax (hopefully). The other kind of stress is long term when the big or even little things in life keep piling up over and over and your body stays in that heightened state without settling down. You are in an ongoing battle against stressors that are repetitive, continuous and feel insurmountable - like debt or facing a job you hate every day. At this point, your stressors may not only be real, but you may just perceive them as a risk when they aren't after all - like worrying about something that could happen even tho it hasn't happened and may not even happen. With long-term stress there is also a hormone release. Adrenal glands secrete CORTISOL, your primary stress hormone Elevated levels remain for prolonged periods of time Your body adjusts to these levels and establishes a baseline of tolerance while the secretions of cortisol continue to increase. Seems like the signs of dependence and addiction, doesn't it? When stress becomes so normal to you that you don't even know you're stressed, you think you are doing OK. (This happened to me at one point and until I learned stress management techniques, I had no idea my body was in a stressed state!) And now the stage is set for the long-term effects of high levels of cortisol on your weight. Here are some considerations. Carb and Sugar Cravings If high levels remain, cortisol secretions continue to increase which in turn: Stimulates appetite Stimulates a rise in insulin Causes blood sugar to drop Creates cravings for high sugar foods Comfort Foods If you have stress without relief - you may reach for "comfort foods" They provide lots of energy in the form of refined sugar They are rich in fat They calm the brain Your body's response positively reinforces frequent consumption of comfort foods when you are under stress and are hungry Stress and Middle Fat CORTISOL activates LPL (lipoprotein lipase) LPL is an enzyme that deposits and stores fat Study results Women's study: High cortisol levels from long-term stress can lead to greater central fat accumulation Mouse study: Mice not on a high-fat diet under prolonged stress had gut microbiome changes that resembled mice eating a high-fat diet Sleep Deprivation When you are sleep deprived your body is stressed and releases even more hormones that affect your weight. Being awake in the night increases the odds that you will engage in late night snacking and have cravings for high sugar and carb snacks. Because you aren't "thinking straight" you might have decreased portion control so you eat bigger portions. Cortisol increases -fat storage hormone to prepare you for possible emergency (ex: famine) Gherlin increases -hormone that stimulates appetite Leptin decreases -hormone that suppresses appetite Insulin increases -hormone that stores fat when it can't transport all the excess sugar to the cells for energy So how do we tamp down this physiological response? Do you just cope and scrape by during each episode of stress? Or do you manage the situation by planning ahead and building systems of support before stressors become overwhelming? I have tried both and the coping part only lasts so long until you can't manage the pain any longer. So here are some strategies to help you move forward with your weight loss goals. Create a Support System Identify friends or family you can count on and write down their contact info so you can reach out in a hurry. Let's just start with one key person in your life. Name_____________________________________Phone__________________ Block out alone time on your calendar One hour block or a few shorter ones where you will be free from distractions and visitors. List one activity you can use to recharge your batteries Activity___________________________Day________________Time_________ Prioritize your tasks Make a to-do list and do harder or more challenging ones first. Use the "easier" tasks which take less time as a reward for completing the big stuff first. Check off each when done to create a feeling of accomplishment which helps your body relax. Task__________________________________________________Challenging_____Easy____ Make time for Self-Care This is not a luxury, it is crucial for health! Eat balanced, low-glycemic meals and snacks to keep your blood sugar in balance so it doesn't set off the cortisol response - bring healthy food to work from home so you can control what you eat Get 7-8 hours of restful sleep to prevent sleep deprivation which sets off that cascade of hormones - wind down in the evening, turn off electronics, ease into a sleep mode, don't eat or exercise right before bed Exercise daily - to lower cortisol levels and boost endorphins. Choose an activity you enjoy, put it on your calendar, rejoice that exercise is a 2-for-1 deal: helps with weight management AND stress management. Engage in relaxation techniques - select those you like: meditation, visualization, Tai Chi, Chi Machine, EFT Tapping, progressive relaxation; the choices out there are endless it seems. So what do you think? Does getting a handle on stress become THE missing link for weight loss? What are your thoughts? Resources Bridgewater LC, et al. Gender-based differences in host behavior and gut microbiota composition in response to high-fat diet and stress in a mouse model. Nature Scientific Reports. 2017; 7(1):10776. Epel ES, et al. Stress and body shape: Stress-induced cortisol secretion is consistently greater among women with central fat. Psychosomatic Medicine. 2000;(62):623-32. Maglione-Garves, CA et al. Cortisol Connection: Tips on Managing Stress and Weight. ACSM'S Health & Fitness Journal. 2005; 9(5):20-23. Montes M and Kravitz L. Unraveling the Stress-Eating-Obesity Knot: Exercise can significantly mitigate the effects of stress and weight gain. IDEA Fitness Journal. 2011; 8(2):44-50. Exercise for Stress and Anxiety | Anxiety and Depression Association of America, ADAA http://www.apa.org/helpcenter/manage-stress.aspx Stress might be just as unhealthy as junk food to digestive system: Study with mice shows stress causes digestive microorganisms to behave similar to how they act with high-fat diet -- ScienceDaily
  12. Tenebrae

    Importance of self care in nursing

    Reflection Before I progress in this reflection I need to acknowledge that I made a medication error by giving medication that impacts on a patient's cardiac rate control to a patient who had no clinical need for it. This had the potential to have a disastrous outcome for the patient including postural hypotension and fatal bradycardia. This incident has got me thinking about the role of grief and stress and how it impacts on our ability to function safely and effectively as registered nurses. Over the last several years I have been dealing with the impact of two terminal illness diagnosis of close family members, my mother (who had small cell lung cancer) and my brother in law (who had pancreatic cancer). Working in primary health and elder care I have had the opportunity to see how a terminal illness impacts on members of the family, however it was not until my mum and brother in law were diagnosed that I fully began to experience the stress that causes. Despite the terminal diagnosis, life still continues on, other family members still have to continue working at jobs as well as supporting the family member through palliative treatment and care. My brother in law died 15th January 2018. At the same time my mother was dramatically deteriorating as well, the cancer was slowly robbing her of physical function and taking large portions of her personality. Living with her up until four weeks before she died, affected me a lot. After working a full day I found I was coming home and having to be on constant alert in case she fell and hurt herself, trying to find foods to encourage her to eat and ensure that her symptoms were being adequately managed. When mum died I expected to feel primarily relieved. I under estimated the impact of grief and how it impacts a person's ability to function in a day to day context and within the work environment. As nurses we tell our patients and their families about the importance of self-care and how it is critical that they 'look after themselves'. Yet often we fail to take our own advice. I felt that by getting back into work it would help me get back to normality and start the process of moving on from the death of my mum and my brother in law. I now realise that I would have been better to take some more time and to get my health issues under control before coming back to work. This medication error has really bought home to me several things. How if a nurse fails to look after themselves it can bring their stress into the work place. Which in turn can impact on how the nurse does their job and could result in errors that may result in serious harm to the patient. Also grief at the loss of a family member or in my case several family members whether expected or whether the end to a long illness also has the potential for the nurse to bring more stress into the work place which in turn can result in an error such as the one I committed where medications that could have had a huge impact on the patients well being were given to the wrong patient. As a result of this error I realised my grief wasn't as dealt with or wrapped up in a nice package as I hoped. To ensure my grief did not impact on my work or put another patient at risk at the recommendation of the palliative clinical nurse specialist I decided to take a few days off as I was not up to working and to try and get my head on straight to ensure another mistake like the one concerning Mr X did not occur again.
  13. tnbutterfly - Mary

    Self-Care for Nurses During the Holidays

    Nurses face challenges year round, but we all know the extra stresses that the holidays bring with all the special preparations and activities. With many nurses working stressful jobs having to deal with the health challenges of others as well as their own personal stresses and hectic schedules, the added demands of the holidays can lead to emotional and physical exhaustion. The workplace usually feels more festive this time of year with added holiday decorations, Christmas cards, parties, etc. However, nurses often feel torn between their responsibilities at work and holiday preparations at home. Many of us feel stretched almost to the limit as the demands on our energy, time, and attention increases. We spend several weeks and months of intense preparation for Christmas day. We get caught up in the flurry of decoration, shopping, cooking, and entertainment. But, for other people, feelings of anxiety, depression, and loneliness stand in sharp contrast to the excitement of parties, gift-giving, and family gatherings. What are some steps we can take to control our stressors. As nurses, how can we take care of ourselves during the holiday season? The causes of holiday stress are as varied as the people who experience it. The stresses of trying to cram shopping, social events, and family get-togethers into a schedule already full of day-to-day obligations can leave a person exhausted and overwhelmed. But wait a minute..... Take a deep breath, and think....... What is it that all these holiday obligations have in common? The majority of them are self-imposed, and once you learn to identify what stressors are self-imposed you can begin to control the stress. Many of these self-imposed obligations are based on expectations that we may have of what holidays are supposed to be like. Sit back, close your eyes, and be still for a few minutes. Let your thoughts return to Christmas past. Let your mind go back to the earliest Christmas you can remember. Childhood memories of holidays are some of the strongest memories we retain. We all have Christmas memories, and these memories are the basis for all future Christmas expectations. Some of us want to recapture past holiday moments. We hope to re-create that experience we had with a special person at a memorable place. For others, past Christmases never quite had the joy, intimacy, and spirituality they desired. Their expectations of Christmas are the result of hoping to create a wonderful Christmas memory for the first time. All of these memories are standards and expectations we bring with us to the holiday season, and if we can identify them as such, we can modify them. But how do we do that? Only the individual can make the determination if the stress is really worth it. Everyone has the right to say no to social events of other obligations. Sometimes changes in our lives (loss of a family member through death or divorce, changes in health, marriage, addition to the family, etc.) may necessitate establishing some new Christmas traditions. Traditions offer us comfort, and that is part of the anticipation that we all have for the holidays. Knowing that you are going into a holiday with none of your traditions can be very uncomfortable, and you sometimes have to establish new ones that you can look forward to. Being realistic about expectations of ourselves and others is important and challenging. This allows us to enjoy the holiday season rather than simple endure it. realistic expectations allow for human limitations. No one can go non-stop on a daily basis from November 24 to December 25 or January 1 without having some sort of emotional or physical breakdown. Allow time for holiday activities, but also allow time for self and recuperation. Use a calendar. Begin planning a few months before Christmas. Brainstorm about what you would like to do during the holidays. Prioritize these ideas before placing them on the calendar. For those of you who will be spending time with family, get input from family members as to what is important to them. You might be surprised by their answers. You might find that you can actually cross off some of the things you were planning to do for them. Check for overload by scanning the calendar for back-to-back events. When overload or overlap is identified, adjust your calendar accordingly. Remember, you cannot be two places at the same time. Equally important......you do not have to do and be everywhere. REST..... The holiday season can be very tiring. Your body can't tell the difference between good and bad stress. All it knows is that energy was spent. Take a bold red marker and write REST on specific days and evenings in December. This will ensure a more restful and enjoyable holiday season. Remember that you are one person and you cannot do it all. Ask for help from others. Delegate responsibilities as much as possible. Most importantly, focus on the real reason for the season. Giving of yourself is more valuable than anything you can by. Time spent with others making wonderful memories will be something cherished for years to come. Focus on the spiritual aspects of the holidays versus the commercial ones. What do you want the holidays to mean? For me, it is very important to remember to focus on the gift of Jesus Christ and share that wonderful gift with others. There will never be a perfect celebration......but there will always be the perfect gift of love that was given to all of us. My wish is that each of you has a wonderful Christmas. And remember to take care of yourself as you create some wonderful holiday memories. You might like to read I am Afraid. Please Pray for Me; Munchausen by Internet: The Lying Disease that Preys on the Heart, and other articles in my blog] Body, Mind, and Soul
  14. Virginia PMH-NP

    Nurses Must Learn to Take Care of Themselves

    Women's' sense of self is often one of caretaker and nurturer. Nurturing and caretaking have long been associated with women in general, and nurses and social workers in particular. Empathy is a mainstay of the helping professions, particularly the "women's professions" such as nursing and social work. Nurturing has historically been intertwined with, and seen as a major function of nursing. Nursing has been called the "practice of professional nurturing". We often ask ourselves the question "Who comes first you or me"? When a woman must choose between caring for herself and caring for another, social pressure fosters the choice of nurturing of others. Women often experience conflict when faced with what may seem like the endless choices about who comes first, that is; do I care for me or you first? Women often have difficulty saying no or setting limits. They often wind up doing more than they really want to. Women may nurture everyone but themselves. This will cause them to end up feeling conflicted, unappreciated, resentful, and burned out. These issues can be much worse for those in the professional role of nurse and nurturer. Some hints for self-nurturing for nurses and all women Take care of yourself, it allows you to better take care of others Use your empathy and nurturing for yourself. Care for and understand yourself with the same expertise you give your patients. Say no when you want to. if you have a hard time saying no, offer alternatives (i can't do that but I can do this). avoiding situations where you will be asked to do too much is really OK. Increase your self-awareness Unwind after work before you jump into your responsibilities at home. (do not use alcohol to unwind) Do not base all your self-worth on your profession or your nurturing abilities. Develop outside interests, if you volunteer choose opportunities that have nothing to do with helping others! Don't identify with patients too much. Identify your feeling and accept and allow them. this does not mean you have to act on them! Friendships, where you can talk about your feelings, are critical. Practice stress reduction techniques (exercise, relaxation, meditation, distraction) Plan for regular breaks, days off, conferences, and vacations. Talk with colleagues to make plans for burnout prevention, take charge where you can. avoid chronic complainers Know when to say "enough", consider a transfer or a different area of practice if necessary. Helping others can be a rewarding career it is meant to be. Burnout and compassion fatigue can be prevented. recognition of your own level of stress and needs for self-care are the first steps to stress reduction and burnout prevention. You must make self-care a priority. Ironically, beginning signs of burnout can have an unexpected positive influence in your life; if you don't let it go on too long! these signs can act as a catalyst for you to make a much-needed change. they can be the impetus to move on to different areas of your profession or even more rewarding careers. Nurses in search of something more have become entrepreneurs (the writer included). They have discovered other ways of helping others that allow them more satisfaction and financial and personal reward both, and more control over their careers and their lives. Caretaker take care of yourself!
  15. There is no denying grad school can be stressful. Listening to lecture, working on homework assignments, being active on discussion boards, and attempting to finish all reading material can take more than forty hours a week to complete. Then add on family obligations, bills and work, there isn't much time left for self-care. However, if one is to succeed in graduate school, self-care must be a priority. This week, as I drowned further into my studies, I began to go stir crazy. Luckily my cousin threw me a lifeline and convinced me to get my head out of the books and me out of the house. In this episode, I indulge in some much-needed self-care and go over what happened in class this week. Some highlights include Self-care is an important factor to graduate school success. While you're taking care of everything and everyone else, don't neglect yourself. Take time for self-care. A few moments away from the books helped me to re-charge and able to tackle this week's workload. It's important when providing recommendations to your patients that it's from evidence-based research, and not from popular press articles. Popular press tends to be less rigorous and more biased. Your patients depend on you as a provider to help decipher medical fact from fiction. I hope you enjoy Follow Me Through Grad School Episode 103: Going Stir Crazy. Let me know below, what do you do for self-care? Don't miss the first 2 episodes: Follow Me Through Grad School Episode 1 - Journey Before the Storm Follow Me Through Grad School Episode 2 - First Week of Classes
  16. ElizabethScala1

    6 Resiliency Tips for Your Nursing Staff

    Resiliency keeps your nursing staff on the job. It staves off stress, illness, and burnout. A resilient nursing staff builds strong teams able to respond to the demands of this noble profession through long hours, patient and family needs, and... aching backs! Check out these tips to share with your nursing staff to keep them resilient and strong: Nurture with Nature On those shifts where breaks are few or nonexistent, taking 30 seconds to get some fresh air, even if it's just sticking your head out the door to remind yourself that there is a "world out there" and breathing in some fresh air, can reset your mood and lower the stress response -- meaning lowering your heart rate, blood pressure, and cortisol levels. Pack Your Lunch With Quick Snacks If you are able to take a full lunch break - GREAT! But have a snack-type lunch on hand just in case. A few grapes, apple slices or a banana, an organic juice box, crackers, cheese, and nuts allow you to eat quickly and nutritiously as well, in order to get you through your shift. Also pack your locker with quick snacks just in case you do not have time to pack a lunch -- a small jar of a nut butter, crackers, nuts, dried fruit, juice boxes, and granola bars can get you through a shift easily enough. Just don't forget to restock your stash! Focus on the Patient in Front of You This is a case of easier said than done, unfortunately. Nurses often have overwhelming patient loads, but only one patient can be tended to at a time. Focusing all your energy on the patient in front of you prevents mistakes and often helps you catch things that you might miss if your mind is on your other patient(s), rather than the one in front of you. Mistakes are costly to nurses not only in their self-confidence in their ability to do the job, but also in their co-workers' confidence to be a strong and trustworthy team member. Give yourself the benefit of full focus. The next patient will still be there when you are finished with the one in front of you. Keep a Reminder of Joy in Your Pocket or Locker Some nurses decorate their lockers with pictures of their children or pets. One nurse I knew kept a small seashell in her pocket that her young son had picked up on their last vacation. Another sometimes brought her lunch in a Barbie lunchbox because her daughter packed it for her. A small touchstone of a reminder of the joy in your life can alleviate stress and bring a smile to your face and heart to power your through some tough shift hours. As a Nurse Manager, you can..... Plan Some Fun Outings Great teams do not limit bonding to work alone. Great teams can bond over dinner and a movie, ice skating, hiking, the beach, and all sorts of other activities. You get to see your co-workers in a whole new light and some regular clothes. How many times have you run into a co-worker outside of work and almost not recognized them without their scrubs on? One guideline to follow during the outing: keep the shop talk to a minimum. We are never not nurses, but reserve the outing time as bonding and fun time. After all, you're not clocked in for work. Educate New Nurses on Self-care Strategies New nurses may believe that in order to be a good nurse they must give 110% of themselves at all times and forget that nursing is not a perfect profession. New nurses may be at greater risk for making mistakes if they feel stressed and are not taking care of their needs while also caring for patients. Although the media sometimes portrays nurses as SUPERHEROES (but of course!), we are human with human needs of rest, relaxation, and forgiveness of ourselves when we make a mistake. And one of the best self-care strategy tools a new nurse can have is not holding herself/himself to an impossible standard of perfection. I hope you have enjoyed these tips and can put some of them to use on your nursing unit. What other tips have you employed that have been successful with your nursing team?
  17. ElizabethScala1

    Finding the Time for Self-Care

    "You cannot serve from an empty vessel." -Eleanor Brown As nurses and healthcare providers, time for ourselves often comes in scant quantities. Patients and our own family's needs frequently take center stage because we are so good at putting others and their needs first that our needs simply get lost in the shuffle of our lives. But there's a cost to pay for this perpetual dysfunction. In caring for our patients, our homes and families -- with the endless cleaning, cooking, errands, etc., -- attending classes and training, and preparing mentally for our next shift, it feels like we're constantly at work. Without "filling up our vessel" as the above quote states, we risk our health, happiness, feelings of self-worth and self-esteem and unwittingly prime the pump for nurse burnout. We need time to decompress and facilitate our own healing, if we are going to give adequate care to anyone else. Taking care of ourselves makes us better caregivers for others, and quite simply, we'll be happier and experience more satisfaction in our careers and personal lives when we put self-care practices into place. Here are some strategies for getting those moments of self-care into your life as a busy nurse: Advocate for Yourself Nurses are natural advocates for their patients, so turn that service towards yourself. Figure out what your needs are for better self-care and prescribe them for yourself. What favorite activities do you LOVE to do, but haven't done in a while? Look through the newspaper for activities or events that you would like to attend, but haven't in awhile. Make a list of all the places you've wanted to see or activities you'd want to do if you had a three-day weekend. Your list is your starting point for the self-care appointments you will place on your calendar. Follow the 1:1:1 Rule One thing a day. One thing a week. One thing a month. Look at your week and plan your self-care rituals. Set them as appointments on your calendar. The daily rituals can be short 10-15 minutes or whatever you can work in. Some days are busier than others. For a weekly ritual, set aside a longer period of time. The same with the monthly appointment, and look at doing something really big once a year. Plan out self-care rituals for a month and then take a look at the calendar. Look at all the time you've made yourself a priority! Feels kind of good, doesn't it? Now the trick will be to keep your appointments! Remember Self-care Doesn't Have to Mean Self-Only Care Many people, not just nurses, think self-care rituals need to have a selfish benefit of only yourself benefiting from the ritual. A self-care ritual can bring peace of mind and reduce stress. I have a friend that detests unorganized closets and to her, even though she is not the only person in her house that benefits from an organized closet, it certainly decreases her stress when she can reach for something in the closet and not have 10 things fall down on top of her. Closet organizing is a favorite self-care ritual that she also sees as an indulgence, because she gets to do it alone with her favorite music blaring away and no one interrupts her or they know they'll be forced to help (not really, but it's that little threat that ensures she has all that time to herself). Another nurse I know likes to take Sunday afternoons to make a breakfast baked good and a few family meals for the week ahead, so she doesn't have to think about dinner or breakfast during her work week. "At least I know we're eating healthy most of the time and that I won't be tempted to order a pizza on the way home or stop at McDonald's for breakfast because I'm pinched for time. Peace of mind is what I get, and I'll take that any day." Know That Little Things Count if They Matter to You If it's tough planning the everyday self-care rituals, know that even giving into a pet peeve counts as self-care if it lowers your stress level. A nurse friend of mine detests when her nail polish is chipped. She can wear her hair up in a messy bun or leave the house happily without makeup, but chipped nail polish aggravates her. "It just reminds me of all those girls in high school that would run around with chipped polish for days and weeks or they'd sit in class and pick half of it off and then wear it half picked off for days. Just don't wear it if you can't keep it up." To her, taking a couple minutes to take off old chippy nail polish is a stress reliever and one of her easy methods of self-care. For others, it may be not to leave one dirty dish in the sink before retiring for the night, setting the timer on the coffeemaker, packing a lunch the night before. The little daily rituals are self-care that don't even have to be scheduled. They just have to be noted and appreciated as filling up the vessel in order to care for others too. I'd love to hear from you! What self-care rituals do you use to "fill up your vessel"? How do you unwind and recharge? Leave a comment below on how you carve out time for yourself to promote the 'life' portion of work-life balance!
  18. diannecabelus

    Self-Care or Bust

    My thoughts start racing as I realize that I am supposed to be at my next patient's home already. I have so much charting to do, I think to myself. "Oh my god I am drowning," I mumble so no one can hear as my eyes start to well up with tears all while still trying to appear professional and smile. I look at my patient just sitting and rocking, quietly in her giant, green chair that appears as though it is swallowing her. I glance over then at the daughter whose lips have not stopped moving for what seems like an eternity and nod again. She incessantly taps the pen she is holding on the notebook in her lap. I start to spiral and envision myself ripping the notebook and pen from her hands (why do they all have a notebook?) and writing in giant letters, "I am not here to correct your childhood, fix your divorce, or change the fact that your dog is dying! I'm the nurse!" And then envision myself throwing it across the room and walking out the door. I have to change my patients dressing and perform an assessment and go. Somebody help me.... I look at the clock again and then decide to just start my tasks as she keeps talking. Right leg arterial ulcer dressing changed. Vital signs done. I interrupt the daughter who is now talking about some type of competition her son is in, and begin asking questions to my patient. "Any pain? Bowels ok? Urinary issues?" All no's. I look over at the daughter and tell her kindly that we will address her issues regarding her mom throughout the episode of care and assure her as a team we will take good care of her. I ignore all of what else she said that is not in regards her mom, my patient. She shakes her head annoyingly and puts her notebook down. "That's it?" She says. Can't solve all of your life's problems in a day, I think. "I will be back on Wednesday," I say and smile while saying my good byes. I walk out the door down the stairs and jump into my car. I look over and the daughter is standing on the porch just staring at me. I wave and smile and race to my next patient.   My day doesn't get much better from here. Many days are like this one as a visiting nurse or any nurse for that matter. Racing to patients, the phone is ringing incessantly, emails are piling up, and charting, oh my god, the charting. We are all drowning. I think the number of patients that we are expected to care for in one day and let's not forget, chart on them, although we would like to; The ratio may be actually 5 minutes with your patient and 45 minutes to document the 5 minutes that you spent with them to complete your day in 8hrs with no overtime. I would love to say that I am exaggerating ,and I may be slightly off, but not by much. I arrive home after my last patient and a fender bender later. I wasn't paying attention as my phone was ringing and vibrating incessantly which caused it to fall down in between my seat and the console. Love when that happens! I looked down for a brief moment and tapped the car in front of me who was stopped at a stop sign. Best day ever. Now home and time to make dinner and help with homework. My son asks why I am so cranky as my husband and he both look at each other and shrug their shoulders when I don't respond. I am looking for a pot in the cabinet and moving things around with a little more force than necessary mumbling to myself trying to refrain from snapping at them. If I am really honest at that moment I would have liked to throw a pot across the room but I some how managed to practice self-control. I envision myself being hauled off to the psych ward if I had acted on any of my impulses of the day and this manages to keep me restrained. I use this tactic often. After dinner, homework, three arguments about homework and then a temper tantrum, thank heavens, it's bed time. I open my computer and stare at the screen realizing that I have about two hours of charting left to do and a never ending column of new emails to look at. My head hurts again and I start to cry. This is just too much... I know that I did not become a nurse for days like this. I do not think that any of us did. While this day is in fact fictional it is all to familiar. I have spent many days like this. Too many. We became nurses to provide excellent care to our patients and never want to feel we are rushing them, not to them and not caring. Our job is to care and that is what a patient expects from us. I think, however, that they sometimes expect a little too much or maybe we as caregivers, or the medias portrayal of us, mislead them in to thinking we can provide much more than we can. We cannot solve all of your problems. We are not sponges that are going to absorb all of your issues while smiling compassionately and mastering a grand plan to make it all better. I feel like as a nurse and a woman, that is what not only what my patients sometimes expect, but my own family I feel thinks my very existence is for at times. This is why it is vital in this profession to have a consistent plan for self-care and to practice it. We need to think of ourselves as priority number one so that we can be all of these things to our patients and families to a certain degree while being our own best friend also. I know that so many days I feel like I am just mediocre in all of my life's roles as I have so many of them. Don't we all? How do you thrive in all of them? It seems impossible, and I feel like I am drowning and want to give up far too often. I know that this feeling worsens especially when I have too little sleep, am not eating right or not getting any exercise... All of the things that I need to do for me to stay on top of my game. A self-care plan is something therapists have been using for years with patients to help them achieve a better and more balanced, rewarding life. Many good self-care plans have a variety of components in them that are important in our everyday lives for balance. These can include workplace, spiritual, relationship, psychological and physical categories. But you can create a custom plan for your specific needs making it as small or large as you see fit. For example; the workplace component could include setting up boundaries and attending professional development groups. In the physical component, it may be important for you to have to go for a walk at lunch time and to remember to use your vacation time. The emotional piece may be something like writing down 3 things that you are grateful for each night. There are many options and no limits. Also, there are so many places online to get ideas from. Taking the time to sit down and create your own care plan is the first step. You do it every day for others. It's your turn You are worth it and you will be better in all that you do for it.
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