The practice of meditation is used in many cultures to reduce stress and anxiety and to maintain optimal psychological and spiritual well-being. Meditation has been extensively studied as a treatment for not only improving cardiovascular health, but also anxiety disorders as well. Since burnout and anxiety are common conditions plaguing health care professionals around the world, nurses must understand the healing power that meditation has in assisting them maintain physical, mental, and emotional balance. By learning how to incorporate the complementary practice of meditation and mindfulness into their lives, nurses have the ability to learn advantageous coping skills to handle potentially stressful situations.
The Art of Meditation and Mindfulness
The ancient art of meditation and mindfulness was derived from ancient Buddhist and yoga practices around 1500 BCE. Mindfulness refers to a process that guides individuals in maintaining a mental state characterized by nonjudgmental awareness of the present moment. The basic premise underlying meditation and mindfulness centers on how experiencing the present moment nonjudgmentally and openly can effectively counter the effects of stressors, because excessive orientation toward the past or future can be related to feelings of depression and anxiety. It is further believed that by teaching nurses to respond to stressful situations more reflectively rather than reflexively, meditation can effectively counter experiential avoidance strategies, which are attempts to alter the intensity or frequency of unwanted internal experiences from the outside realm.
Mindfulness-Based Stress Reduction
Due to the incredible health benefits that meditation and mindfulness possesses, Kabat-Zinn conceptualized a highly effective and integrative approach for reducing the physical, emotional, and mental consequences of chronic stress and anxiety. Mindfulness-based stress reduction (MBSR) is an innovative therapy that blends various elements of different Eastern meditation practices with western psychology. MBSR is a formal eight-week evidence-based program that challenges the patient to cultivate a greater awareness of the unity of the mind and body as well as the unconscious thoughts, feelings, and behaviors that can influence their overall health. During MBSR therapy, the individual learns various coping skills and techniques aimed to reduce the physiological effects of stress, pain, or illness by participating in experiential exploration of stress and distress to develop less emotional reactivity.
Since the mind is known to play an influential role in stress and stress-related disorders, MBSR has been shown to positively affect a range of autonomic physiological processes, such as lowering blood pressure and reducing parasympathetic arousal and emotional reactivity. In addition to mindfulness practices, MBSR also utilizes yoga to help promote wholesome physical activity and prevent unhealthy complications associated with living a sedentary lifestyle.
Due to the many health benefits it possesses, MBSR has been shown to relieve pain and improve psychological well-being across the health care spectrum. Because of this realization, nurses should make a more concerted effort in incorporating mindfulness meditation practices into their daily lives to not only improve their own stress reactivity, but also imbue resiliency to stressful and arduous psychological challenges associated with working in the health care setting.
With the recent groundswell of the MeToo movement concerning sexual harassment and power inequity, it’s no surprise that industries across the board are reevaluating their working cultures. Health care is no exception and the recent Time’s Up Healthcare movement is gaining attention.
The movement began as a response to the Time’s Up Foundation’s widespread success at promoting safe and healthy work environments and calling attention to how power plays a role in harassment people experience in the workplace.
Time’s Up Healthcare’s website states a mission “to unify national efforts to bring safety, equity, and dignity to our healthcare workplace.” The organization, in partnership with organizations such as the American Nurses Association, American College of Physicians, and the Council of Medical Specialty Societies aims to call attention to the disparities in health care workplaces and the undue burden that kind of culture can carry.
When nurses work in an environment where they are concerned about their own safety or that of their colleagues, the quality of care they can give to patients can be disrupted. The distractions caused by an environment where sexual harassment is either accepted or present but expected to be ignored are enormous. Health care workers in those situations can feel the implications of that stress physically, mentally, and socially.
Instead of being able to concentrate on giving the best care possible, health care workers must constantly weigh the risks. They are required to take the temperature of their workplace and wonder what kind of retribution might happen if they speak up. The cost of speaking up could mean losing their job or even enduring additional threats.
Workplaces like this are entirely unacceptable. Time’s Up Healthcare is shining a spotlight on what’s happening and why it needs to change. The movement is hoping to also build a support network where people who are impacted by harassment at work can go for resources and direction. They also hope to promote an awareness around the issue and exactly the kinds of situations or scenarios that might fall under this kind of problem.
With that aim, the organization hopes to help eliminate this problem. Through education and trainings, harassment and power inequity can be challenged, examined, and eliminated.
Harassment is not okay. Nurses and other healthcare workers deserve better. Their patients deserve better. Time’s Up Healthcare is taking that big leap.
Are you like most nurses, filling your days with taking care of everyone else but yourself? That may seem heroic, but putting yourself last ultimately leads to a dip in on-the-job productivity and career burnout. But when you take care of your own needs first, not only do you benefit, and so do your coworkers and patients.
Is there a secret formula to boosting your health and happiness? Fortunately, there is no secret. It’s simple, though not easy, to make yourself a priority in your own life.
By attending to your own self-care, you’re more likely to head off the symptoms of overload which can cut your nursing career short. But where do you start, when there are so many components of a happy, healthy life?
Self-care is easier to establish if you know what’s most important to you at this particular point in time. You may want to focus on a major life activity—eating, exercise, sleep, or relationships—because they seem like obvious drivers of well-being. Improvements in any of those important areas can certainly yield major benefits, but they’re usually tough to crack.
Even if you highly prioritize self-care, it’s difficult to say “No” to that big slice of cheesecake, fit in workouts, or turn in for bed on-time. Especially when your schedule is already jam-packed, your shifts are long, or you work nights.
Why not try another tactic? Consider setting a self-care habit in motion by starting with baby steps toward your ultimate goals. Improvements don’t have to start in your “hot zones” either. Like dominoes, a shift in one habit or routine will cascade down to every other area of your life.
Here are two powerful ideas to spark your thinking:
1. You Need a Budget.
Who even uses a budget anymore? It sounds so old-school, like playing music on 8-track tapes and paying with paper checks at the supermarket. But sitting down to crunch the numbers, and getting a grip on your income and outgo, can be an effective stress-reliever. Your financial situation may remain the same, but seeing the actual facts can stop the free-floating anxiety that’s fueled by imagination.
Your budgeting system doesn’t have to be fancy, either—just use a notebook and pencil to note and track your household expenses and income. Some people like to allocate cash to specific purchases, using an envelope system popularized by Dave Ramsey. One envelope for cafeteria lunch money, another for…
And don’t forget to plan for seasonal outlays (holiday gifts or taxes) and emergencies. That way if you need to replace a dental crown, you’ll have a buffer fund to cover it, and won’t panic as much.
There are also many apps out there for budgeting, including the grand-daddy, You Need a Budget (YNAB).
2. Do a Digital Detox.
Are you always texting, Skyping, Tweeting, Facebooking, or otherwise deep in your digital stream? That’s the case for many “social media natives” and even for their oldest colleagues.
Even if you’re following social media guidelines for nurses in your workplace, you may find that digital is a distraction, always in the back of your mind, ringing, buzzing, or vibrating to get your attention. You could get relief from all sorts of social media ills, from text neck to FOMO, by choosing a set time to disable it, for hours or days.
Some people like to set aside long weekends to go away on formal retreats, like the ones offered by Digital Detox while others simply reduce everyday use. Digital refers to all smartphones and computers (sometimes TV’s too), so resolving to stay away from electronics and screens after 8:00pm could be enough to calm your down, and make it easier to get to sleep at a decent hour.
Oh, but wait, what if you ditched your alarm clock? There are all kinds of new devices for improving your sleep hygiene that you may want to check out. One example is the Philips Wake-Up Light Alarm Clock with Sunrise Simulation, which costs less than $50. The light on this clock slowly gets brighter over a 30-minute span, to gently awaken and welcome you to the new day.
It’s important for you (and your patients) that you engage in self-care every single day. So resolve to take a baby step toward making yourself a priority in your own life.
Why not start today?
Plant-based diets, that is, those that relay mostly on plants for nourishment with small amounts of animal products, are by far the healthiest for ourselves and the planet. Over consumption of animal products are correlated with the development of chronic diseases such as heart disease, diabetes, autoimmune disorders and cancer. However, not all plant-based diets are made equal.
A 2017 study done in the Journal of the American College of Cardiology demonstrates that some plant-based diets can be a larger factor in developing heart disease. The study was done using two groups of people. One group ate plant-based diets that were primarily composed of processed grains which also inevitably had added sugar. These included things like corn chips, potatoes, cookies, cakes, pies, bread, etc. This group had very low consumption of whole grains and whole vegetables.
The second group’s diet had more whole foods meaning meals consisting of vegetables and grains that had very little processing.
The group eating plant-based processed foods developed increased cardiac risk markers even though they were eating a vegetarian based diet.
The take home message is that eating plant-based diets that are healthy requires a little bit of research, intention and time to implement to reap the benefits. Switching from relaying on animal products as your main source of protein, and going vegetarian can be very healthy and energizing, or it can be depleting and lead to greater health risks.
Here’s some healthful and helpful steps in starting on a plant-based diet:
Start slow. Take a look at what you are eating already. Figure out a day or two per week that you can reduce animal products and replace them with nutritious plant-based foods.
Learn to prepare and use legumes and beans. These will be the foundation for your plant-based protein replacements. Chilis, soups, salads and stir fry can use beans and legumes as primary protein.
Include vegetables and fruits that contain a good source of Vitamin B12 and Iron. Some of these foods include apricots, seaweed, kale, collard greens, blackstrap molasses and spinach. These two nutrients are the most common ones that can be deficient in plant based diets.
Supplement initially with Vitamin B12 and potentially Iron.
Slowly introduce desserts that satisfy your sweet tooth but don’t contain a lot of added sugar. There’s plenty of ‘vegetarian desserts’, so be careful. Seasonal fruit, especially when ripe, can be very satisfying. Try to avoid the number of ‘whole food’ desserts which contain processed grains and sugar as well.
Check out a good cook book or follow people or groups on social media that post new and easy recipes.
Preparing nutritious plant-based meals that are tasty do not have to involve a great deal of time and effort. It just takes some getting used to. After that it’s a breeze! Eat well and feel great!
February is universally known as a month devoted to heart health. And while many people know the basics of keeping a healthy heart, there are a few under-the-radar health issues that can have a surprising impact on your heart health.
People who don’t get enough sleep are at a higher risk for heart disease including things like high blood pressure or even a heart attack or stroke. Lack of good-quality sleep raises your levels of cortisol and can increase general, low-lying inflammation throughout your body.
A recent report by the American Stoke Association showed a 71 percent higher stroke rate among people who use e-cigarettes (that’s double those who smoke cigarettes). Although some see vaping as less dangerous than the nicotine in regular cigarettes or even as a way to help quit smoking, these products have their own health hazards. If you are trying to quit smoking, investigate other ways that might be as effective but without the added significant health risk.
Having a diet soda every now and then isn’t a big deal, but if you routinely drink them throughout the day, you could be setting yourself up for heart troubles. A recent study published in the American Heart Association’s journal Stroke linked drinking two or more diet sodas a day with increased risk of stroke. The study focused on a cohort of postmenopausal women, but raises questions for the larger population’s heart health.
There’s not much you can do about going through a natural physical change. It helps to be aware that menopause reduces estrogen which has heart-protective benefits. Women who are approaching, going through, or finished with menopause should pay extra attention to their heart health. Focus on strength training, stress reduction, sleep, diet, and exercise to keep a healthy heart.
Conditions like depression and anxiety can do a number on your heart health. If you are feeling any of the symptoms of depression or anxiety, seek treatment to get help. Medication and/or talk therapy can have a profound effect on your daily life and that helps your long-term heart health.
Gum disease (symptoms include inflamed gums or bleeding when you brush or floss) can indicate systemic inflammation, one of the known risk factors of heart disease. Dental checkups are easy to let slide, so make sure you make it a priority. Even if you take excellent care of your mouth, a dentist can help stop trouble before it becomes a major problem.
The 57-year-old woman is standing in the hall outside of the exam room. She is agitated. “I’m waiting for the doctor. I’m freezing! My back is killing me!” I note she is pale, unable to stand still, and has a sheen of perspiration on her forehead. She is in withdrawal. I get her a blanket and ask her to wait in her room. The pain clinic nurse is downstairs at the pharmacy getting the patient’s prescription for Suboxone for induction. Induction is the process of starting the patient on medication and finetuning the dose.
An hour later the patient is back in the hall calling me, “Thanks for the blanket!” She is smiling. Her color is back. She is clear eyed, calm, and collected. What happened? Suboxone. Suboxone is a combination of buprenorphine and naloxone that is used to treat opioid addiction. Buprenorphine is a partial agonist of the μ-opioid receptor with a high affinity and low rate of dissociation from the receptor. In English, the buprenorphine molecule sticks to the opioid receptor in the brain, but only partially activates it. Then it stays there for a long time, blocking it from opioids, before dissociating. What this means for the addict is that they get enough opioid receptor activation that they don’t get sick from withdrawal. They can function normally with less of the problematic effects of a full agonist like morphine or heroine.
The addition of naloxone, a full opioid antagonist (blocker), keeps the Suboxone pills from being crushed and injected. Though naloxone has a strong effect when given parenterally (by injection), its effect when given by mouth is negligible because it is poorly absorbed sublingually. Suboxone disintegrating tablets are given under the tongue.
So, what is this wonder drug all about? In 2000, federal legislation (Drug Addiction Treatment Act of 2000) made office-based treatment of narcotic addiction with schedule III-V drugs legal. Until then, the only option for addicts was abstinence-based treatment or methadone clinics. The ever-increasing rates of drug overdose deaths in the United States showed this was not working. At first, only MDs specially approved by the Department of Health and Human Services could prescribe medications to treat addiction. In 2016, President Obama signed the Comprehensive Addiction and Recovery Act allowing nurse practitioners and physicians assistants to prescribe schedule III-V drugs for the treatment of addiction. Previously, they could prescribe these medications to treat pain but not to treat addiction.
What does this mean for the addict? For starters, Suboxone and similar drugs are now more widely available. Until recently, the only way for a heroin addict to keep from getting withdrawal sickness was to use more heroine. These patients were considered toxic to regular doctors because their disease lead to ever-increasing doses, seeking medications from multiple providers, decreasing levels of health, and ultimately death. Now that there is an option other than going cold turkey, the addict without some kind of pain diagnosis can get access to health care whereas before they would avoid it because of the stigma of being an addict. Because Suboxone is a partial agonist with high affinity to the μ-opioid receptor, it decreases the ‘high’ if the patient continues to use narcotics causing the patient to lose interest. It offers the benefit of allowing the addict to function in life, decreases the likelihood of death from respiratory depression, and increases the quality of life because there is no need for the addict to ride the wheel of withdrawal—drug seeking, using, running out, and then seeking again to the exclusion of every joy of life.
What happens when a person starts buprenorphine? After a largish battery of tests, the prospective recovering addict will be asked to abstain from narcotics before induction to Suboxone. How long before the first dose the addict has to abstain depends on the person’s addiction. Longer acting drugs like methadone could be 24 hours. Shorter acting drugs like morphine could be as little as six hours. The person should be in the early stages of withdrawal. The reason for this is the “partial” part of partial agonist. The buprenorphine molecule will muscle other narcotics off the receptor site where it was fully activating the receptor. Now, the higher affinity buprenorphine is sitting there doing half the work that the heroine was doing and this leads to symptoms of withdrawal. Giving a person a drug that puts them immediately into withdrawal will turn them off to it completely. You won’t see that person again. Higher success rates are tied with higher levels of symptoms of withdrawal before induction. Now instead of precipitated withdrawal, the person has relief from symptoms of withdrawal even if they are not getting high.
A person who has been successfully inducted to Suboxone therapy will find almost immediate relief. The terrible body aches, muscle pain, abdominal pain, depression, diarrhea, and cravings evaporate. Our patient might just have found a new way to live, free from the constant need to find more narcotics. She can focus on her life instead of her disease. Most of the clinic patients have jobs. They want desperately to be productive members of society for themselves and for their families. Buprenorphine therapy coupled with lifestyle interventions provided by mental health professionals, self-help groups like Narcotics Anonymous, and patient-initiated interventions (like taking a class or going back to school) are part of the success story of a growing number of recovering addicts.
What’s it like to come off Suboxone? Eh, probably a lot like getting off heroine. Same withdrawal profile or pretty close. Patients wanting to get off all narcotics, including Suboxone, can be weaned off gradually depending on their desired treatment goals. Someone facing a jail sentence or travel overseas that needs to detox from opioids quickly may be on a tapered dose of Suboxone for just a few days or weeks. Other people may decide that the burden of staying on Suboxone is worth not having to go through withdrawal and choose to stay on a maintenance dose for the rest of their life. The addiction specialist will help guide the patient through the decision process. Many patients decide to stay on the medication as a hedge against relapse since buprenorphine has a higher affinity for opioid receptors than street drugs. This coupled with the very slow rate of dissociation means that a person would have to stop the buprenorphine well in advance of restarting heroine or other opioid in order to get high.
What does this mean for health care? For one, at least some addicts who eschewed health care in the past can now get treatment for this disease. At some point, most addicts will desire to get off narcotics. Having a real treatment option available instead of a far-away methadone clinic or withdrawal will work to drive these patients into recovery. Another thing is that it’s possible that some of the stigma of addiction will be lifted, at least slowly, as treatment becomes available and success stories become commonplace. As the DEA and FDA work to get a handle on the 70,000 overdose deaths per year by educating doctors and enforcing distribution laws, these drugs will become harder to get. During the 12 months prior to July 2017, overdose deaths fell in 14 states for the first time during the opioid epidemic, according to the Centers for Disease Control and Prevention. In the rest of the nation, at least the numbers have leveled off. Greater access to Narcan (brand name of naloxone, one of the drugs in Suboxone), and more treatment options for addicts will hopefully drive these numbers lower over time. It’s not time to celebrate, but at least there is a glimmer of hope. The priority is to keep addicts alive until they can (or they are ready to) get treatment for their disease.