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Top Ten Sleep Disturbances – #6 Incontinence

Adult man in a toilet at home

#6 Incontience

Heather Johnson, RN and Resource Nurse

Did you know that more than 1/3 of adults awaken during the course of the night to go to the bathroom at least twice? This is identified as Nocturia; the need to awaken during the night to urinate, and leads to fragmented sleep and opens the door to additional related complications.

While Nocturia occurs at any age, for those over the age of 60, it becomes much more common, especially for those with a diagnosis of diabetes, hypertension, and/or heart disease. Also contributing to this night-time urgency are: urinary tract infections (UTI), small bladder, kidney disease, enlarged prostate gland, prostate or bladder cancer, neurological disorders, stress, anxiety, fear, psychological issues, sleep apnea, an imbalance of antidiuretic hormone (ADH) or pelvic prolapse in women. Medications are also known to increase nighttime incontinence. Side-effects from hypnotics, insomnia medications and psychiatric medications can also increase your risk of incontinence.

Some people may fail to make it to the bathroom in a timely manner and so live with incontinence. Approximately one to two adults in every 100 live with adult nocturnal enuresis, where they are incontinent of urine while sleeping. If you are among this population, you are not alone.

Identifying the cause of the nighttime incontinence should include a consultation with your medical provider. This may help to direct the treatment if there is a solution, and offer direction to help manage the incontinence.

Toilet paper, capsules and alarm clock on black background

Strategies to help you with nighttime incontinence from the National Association for Continence and Mayo Clinic include the following:

  • Limit your fluid intake later in the day, with dinner, and prior to bed.
  • Reduce your intake of caffeine and alcohol (both are known bladder irritants, especially if consumed later in the day).
  • Avoid acid foods (known bladder irritant).
  • Elevate your lower legs later in the afternoon. This will assist in stimulating the flow of fluid to your kidneys and eventually the ability for your body to rid itself of the fluids.
  • Void the bladder before bedtime, even if you do not feel the need to void.
  • Wear absorbent briefs during the night; ensure proper fitting and absorbency to match the needs.
  • Quit smoking(known bladder irritant).
  • Eat more fiber to help prevent constipation.
  • Maintain a health weight.
  • Practice pelvic floor exercises.

Again, consider the listed strategies, consult with your medical provider to determine the cause(s), and a proper assessment can lead to treatment options to solve the problem or offer ways to manage the condition. Take these steps to minimize sleep disturbances and to increase your access to restorative sleep.

National Association for Continence (NAFC), Incontinence causes and about adult bedwetting: Retrieved from: on October, 26, 2018.
Mayo Clinic, Urinary incontinence: Retrieved from: on October 28, 2018.

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Top Ten Sleep Disturbances – #5 Medications

#5 Medications

Heather Johnson, RN, Resource Nurse

Can Medications Interfere With Restorative Sleep?

The answer is simply, “YES! “ A host of medications can contribute to insomnia (Sleep Foundation, 2018).  Conversely, a number of medications can cause and contribute to day-time drowsiness and napping.  Recall from the last blog that napping can interfere with restorative sleep.   Couple that with some standard medication administration times and practices in long-term care and we have a recipe for anything BUT restorative sleep.

 The Sleep Foundation highlights the following medication list that can affect sleep:

  • Anti-arrhythmic medications
  • Beta blockers
  • Clonidine
  • Corticosteroids
  • Diuretics
  • Cough, cold, and flu medications that contain alcohol
  • Headache and pain medications that contain caffeine
  • Nicotine replacement products (patches, lozenges, gum)
  • Sedating Antihistamines
  • SSRI’s
  • Medications to treat ADD and ADHD
  • Theophylline used to treat asthma
  • Thyroid hormone replacements
  • Herbal replacements

These medications can disrupt restorative sleep and your normal circadian rhythm.  Don’t lose sleep over the side-effects.

What can you do about it? Talk with your Medical Provider, Nurse Practitioner, and Pharmacist and ask if your medications could be contributing to your poor sleep.  There may be other medications, non-pharmacologic interventions, possible recommendations on changing of the time of day in which you take the medications and dosing changes that can possibly be made. Restorative sleep is foundational to our overall health and well-being.  Do seek medical advice from the experts to aid to in aligning your medication to best support you and that offers you the best opportunity for restorative sleep. 

A “perfect prescription” for a good night’s sleep just may be a change in your medication.



Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010.  Retrieved from:

National Sleep Foundation: What is sleep hygiene?  Retrieved from:  https on October 3, 2018.


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Top Ten Sleep Disturbances – #4 Napping

Astronaut Sleeping on Moon

#4 Napping

Heather Johnson, RN, Resource Nurse

The Good, the Bad, and the Ugly of Day time Napping

Have you taken a midday nap, only to awaken feeling more un-energized than before your nap? Have you said to yourself “Self, you should have never taken (said) nap” as you are now feeling much more tired than you had prior to the nap? If so, you are not alone. Why does this happen? According to the National Sleep Foundation, our body starts to naturally feel unfocused and tired in the middle of the afternoon (typically between 1 p.m. and 3 p.m.) and results in us feeling sleepy as most people’s circadian rhythm takes a natural dip.


What we do know from research and epidemiological studies, is that a nap lasting longer than 30 minutes “robs” our sleep bank at night and, in fact, leads to long-term ill-health effects, including higher morbidity and mortality, especially among the elderly. Healthy adults require 7 to 9 hours of uninterrupted sleep, preferably at night, to function optimally. People often will nap out of habit, boredom, or in an attempt to compensate for sleep-deprivation caused by a disruption of sleep, sleep fragmentation, a sleep disorder, or work schedules. Daytime naps can cause what is known as sleep inertia, where your body feels groggy and disoriented after waking up from a nap. This may happen as the result of being woken (by others or an alarm) after your body has entered a deeper stage of sleep. Daytime naps may also cause insomnia and poor sleep quality at night.


When done properly, the Mayo Clinic has found that daytime napping can have its benefits. Napping can offer an opportunity for relaxation, provide an opportunity for a rejuvenating “mini-vacation”, improve mood, reduce fatigue, increase alertness, assist with memory, and improve performance and reaction time. Some refer to these short-measured opportunities as a “power nap.” A recent NASA study found that military pilots and astronauts improved their performance by 34% and alertness by 100% when given the opportunity for a 26 minute nap.

26 minutes? Not 25 or 27? No, exactly 26 minutes is what NASA research found. Napping longer than the 26 minutes is when our body starts to enter into a deeper sleep stage and leaves a person feeling less energized, groggy, and at times, unpleasant to be around. This post-nap period, lasting often 10-20 minutes after awakening, can leave a person feeling disorientated and can have detrimental impacts for those who must perform after waking from a lengthy nap. Post-nap impairment (sleep inertia) can last longer for people who are sleep deprived or those who are not receiving consolidated and restorative sleep at night.


• If you have to nap during the day, keep it limited to one per day, making it no longer than 30 minutes (Remember NASA says 26 minutes) 
• Take the nap in the afternoon (Preferably between the hours of 1pm and 3pm), taking a nap later than this may affect your ability to sleep later that night
• Create a restful environment that is quiet, dark and at a comfortable temperature with few distractions
• If the need for the nap is related to poor quality sleep at night, identify ways that you can have a better night’s sleep

Is there an “ugly” to daytime napping? Yes, when you don’t adhere to the recommended guidelines and research, you will likely have adverse emotional and physical health effects.
The bottom line…. When your body is getting 7-9 hours of restorative sleep at night, on a routine basis, you are putting your body in the best condition to function at its optimal level.

Who doesn’t want that?

Dhand, Sohal (2006), Current Opinion in Pulmonary Medicine. 12(6):379-382, Nov 2006. Doi: 10.1097/01.mcp.0000245703.92311.d0
Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010. Retrieved from:
Mayo Clinic: Healthy Lifestyle Adult Health. Napping: DO’s and don’ts for healthy adults. Retrieved from: on Sept 3, 2018.
National Sleep Foundation: What is sleep hygiene? Retrieved from: https on Sept 3, 2018.



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Top Ten Sleep Disturbances – #3 Sleeping Environment

Sleeping on cloud.jpeg

#3 Sleeping Environment

Heather Johnson, RN, Resource Nurse

Have you ever thought about how your environment (what you are wearing, the mattress or surface you are sleeping on, the pillow and blankets that you use) can affect your sleep?

It can contribute to either a great night’s sleep, or one that falls very short and is far less restorative than you would like to think.  When it comes to creating the right environment to put our bodies into the best restorative sleep possible, there are a number of practices and suggestions that we can adopt, no matter our age.

The Sleep Health Foundation, The Better Sleep Council, and National Sleep Foundation offer great advice and suggestions.  Here are some of the following that have been found to be successful:

  • As much as possible, keep the bedroom set up and environment as familiar to the individual as possible. Muscle memory and feelings of familiarity and security are important when thinking about creating an environment that is relaxing.
  • A warm bed and a cooler room are best. The Better Sleep Council suggests that 65 degrees Fahrenheit is ideal.
  • Having a comfortable mattress and surface to sleep on is important. Check the manufacturer’s guide for life expectancy of the mattress. Check to see if it should be flipped and how often.
  • Find the right pillow for you.  Soft?  Medium? Firm?  If you are not at home, bring your own.
  • Create a relaxing environment.  Use essential oils that promote relaxation and rest such as lavender and bergamot.  Use a diffuser, or in a spray to diffuse on a pillow or blanket.
  • Provide a warm blanket that has been sprayed with a relaxing and calming oil.
  • Get rid of clutter in the bedroom. Think of your bedroom as your sanctuary; where you can escape the business of the day that is inviting and comfortable.
  • Get rid of blankets and bedding that are scratchy and uncomfortable against your skin.  If you are hanging onto the old wool blanket that your great aunt passed down, maybe use it another way instead of having it on your bed.
  • Choose a calming color for the walls. Neutral colors, muted tones, and pastels can help you to wind down at the end of the day and make any space feel calmer.
  • Think about the quality of your bedding; thread count and what appeals to you in the softness of the fabric.  Try different bedding, and remember that the functionality of the bedding should outweigh the looks and style.
  • Sleep in pajamas that are comfortable and fitting for you.
  • Always, always ensure that your path to the bathroom in unobstructed and clear, and if using a night light consider an amber colored bulb.

The sleep environment is simply the space in which you attempt to sleep. In most cases, this means your bedroom.  Make your bedroom and your bed, an inviting place to be; dress appropriately for the part.

“Sleep is an investment in the energy you need to be effective tomorrow.” ~ Tom Rath



Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study.  The Center for Health Design Research Coalition.  Harvard Medical School, 2010.  Retrieved from:

The Better Sleep Council: BedTimes Magazine 2018/04. Retrieved from on July 27, 2018.

The Sleep Health Foundation: Retrieved from on July 26, 2018.

National Sleep Foundation: What is sleep hygiene?  Retrieved from:  https on July 27, 2018.

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Top 10 Sleep Disturbances – #2 Light

Donna stanca a letto al mattino

#2 Light

“Let There Be Light”

Heather Johnson, RN, Resource Nurse

Light exposure does play a significant role as it helps this internal clock regulate our sleep and waking schedules
Have you ever wondered why light exposure plays such a significant role in setting our internal clock?
With the invention of the electric light bulb in the late 19th century, our bodies started to be exposed to more light than humans had ever been exposed to before. Because of this, our patterns of sleep are negatively impacted.
Most living creatures, including humans, have a similar internal clock, also known as the circadian rhythm. Humans, as diurnal creatures, have evolved to sleep at night and active during the day light hours. Deep within our brain there is an area called the hypothalamus which regulates the functions of our body, including sleep, energy, and hunger. Without the right amount of light exposure our bodies would have a very difficult time, at best, to regulate our sleep and wake cycles.
The natural way our circadian rhythm works is that rays of sunlight hit the cells in the retina of our eyes, the light triggers the release of the hormone serotonin (the “happy-feel good” hormone). Serotonin, which is mostly stored in our gut, is released. As the sunlight goes down in the evening and exposure to sunlight and environmental light decreases, our bodies are cued to start producing Melatonin. The hormone Melatonin “drives” our bodies for sleep at night. Since the invention of the light bulb our prolonged exposure to light late in the evening delays our body’s ability to sleep and messes up our internal clock.
In our work during the Restorative Sleep and Vitality Program (R.S.V.P) we identified that residents in long term care communities were not receiving enough white/blue light (sunlight) exposure during the day time hours and were being exposed to too much light in the evening and overnight. Exposure to overhead lighting during night-time rounding practices makes it difficult for residents to fall back to sleep as their Melatonin levels have decreased. The effects of even a brief amount of light exposure at night are long-lasting. Some studies even site that it takes our bodies up to 45 minutes for our Melatonin levels to return to the same levels they were prior to the exposure of light.
Studies show that white/blue light exposure is stimulating to our brains and more appropriate during waking hours, while exposure to red or amber colored light does not stimulate the brain as much, thus making it a better choice for late in the day and over-night. With this added knowledge, our collaborative moved away from old practices of turning on overhead lights in resident rooms during the night. Instead, if need be, staff now wear hug lights (flashlight that wraps around the neck) with amber colored lights. We use amber colored bulbs in bedside lamps that do not interfere with Melatonin production and levels. Hallway lights and lights in common areas have been outfitted with timers to have them on at 8 am and down or off at 8 pm.

Light Tips for everyone:
• Increase sunlight exposure especially early in the day (sunlight is the best light).
• Reduce white/blue light exposure in the evening and late in the day (install an app such as f.lux to block blue light on computers, change the light setting on phones to a more amber back light, shut off the television a few hours prior to bed).
• Use amber colored bulbs in lamps.
• Use an amber colored flashlights or nightlights to navigate walking at night.
• When able, take time to get outdoors or do activities within a few feet from windows.
• Use room darkening blinds in bedrooms.
• Keep the bedroom dark at night.

When light exposure is managed well during day time and night time hours, it can be used to boost performance, improve sleep, improve alertness and increase energy.

Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010. Retrieved from:
Nation Sleep Foundation: What is sleep hygiene? Retrieved from: https on July 10, 2018.

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Top 10 Sleep Disturbances – #1 Noise

You may remember in our last post was our very own Heather Johnson’s podcast debut where she discussed the top 10 sleep disturbances. Now we would like to go into each disturbance with a little more detail.

#1  Noise
By Heather Johnson, RN, Resource Nurse

Have you ever just fallen into a deep sleep, only to be awakened suddenly from the obnoxious noise of your furnace kicking on, or a dog barking in middle of the night? You are not alone.

In 2011, Empira started a 3 year restorative sleep quality improvement (PIPP) grant through the MN Department of Human Services. In the research for the grant, noise was identified as the number one sleep disturbance. Most of the research was conducted in congregate living situations (hospitals and long-term care communities) but there remains additional value in learning about how noise can disrupt anyone’s restorative sleep. In a 2012 National Sleep Foundation bedroom poll, 74% of Americans report that a quiet room as very important to getting a good night’s sleep.

The Cambridge Dictionary defines noise as the “Unnecessary information or activity, especially when it is unwanted, unpleasant, or loud.” The origin is from the word nausea and synonyms include: clamor, racket, uproar, commotion, pandemonium, and babble. By definition noise is not a pleasant word.

How does noise impact our sleep?

After sleeping 7-9 hours at night, have you awoken only to feel groggy and unrested? Noise may have played a factor. Sounds during the night have the ability to awaken and alert our brains, causing small night-time awakenings; ones that we may not recall, but that certainly impact the sleep quality we receive. Our brains continue to process sounds, even well into our sleep cycles and stages. Noise, especially when above 30-40 dBs, can cause us to experience wakefulness, to move and shift in bed, and to increase or change our heart rate and blood pressure. These small awakenings from noise may not even be something that you remember when you wake, but they definitely “rob” from your sleep quality (National Sleep, 2018).

We each have the ability to determine whether or not a certain sound is bothersome in our sleep and one that will wake you, based upon whether that particular sound has personal meaning to you. We awaken, and at times ever so slightly, to sound when it is relevant to us and if there is emotion tied to the sound. For example, you may sleep soundly through the noise of a toilet flushing, or the snoring of your bedmate. Yet, if your child is making a noise (moving in their crib or crying), you are more apt to waken because of the emotions you have tied to that particular noise.

In long-term care settings, we identified that noise from personal alarms and noise from staff conversations, especially during shift changes, were the most bothersome to the residents in our communities. As a result, we continued to encourage our communities to become alarm free and how best to tackle the noise coming from staff conversations. At this writing, all of our communities are alarm free.

To address staff conversations levels, we audited our communities using sound-bar readings that recorded the dB readings. This allowed us to report the findings to the members of the team that had worked to help identify the contributing causes. Once we determined the cause, the solutions became apparent.

What can you do about noise?

  • Be mindful of the need for a quiet environment to accommodate restorative sleep and encourage others to do the same. Be respectful of designated “quiet times.”
  • Identify and be aware of high noise times by asking residents and team members. Ask residents “Are there noises that are bothersome or awaken you during the night?” Begin auditing.
  • Use a white noise machine to help block unwanted noise such as sounds from others that are still awake, the occasional sounds of the furnace kicking on or off, the neighbor’s dog, or the sounds of a roommate).
  • Use ear plugs during sleep to help block out the sound of heavy traffic or passing trains.

Additionally, the National Sleep Foundation recognizes that sounds that we are hearing as we fall asleep are ones that should stay with you until you wake in the morning.  What does this mean? If you are a person who needs to fall asleep to noise, the hum of a fan, or white noise are well preferred over the sounds of a television or radio. The fan and white noise machine offer a constant and continual sound that buffers and masks unwanted noise. White noise will not interfere with alerting the brain, whereas the sound coming from television or the voices and music for your radio offer various levels of noise, tone and volume.

Recent studies suggest that exposure to disruptive noise during the night, not only impacts our overall sleep quality, but exposure to night-time noise is likely associated with cardiovascular disease and stroke in the elderly (Hume, Kl, 2012). The World Health Organization stresses the importance of creating a noise free environment to promote restorative sleep at night, noting that there is an identifiable link to noise and personal overall health and well-being.



Cambridge English Dictionary. Retrieved from: on June 18,2018.

Evidence-Based Design Meets Evidence-Based Medicine: The sound sleep study. The Center for Health Design Research Coalition. Harvard Medical School, 2010.  Retrieved from:

Hume, KL. (2012). Effects of environmental noise on sleep. Noise Health. Nov.-Dec; 14(61):297-302. Doi:10.4103/1463-1741.104897.

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Sleep is the Best Medicine

The Dalai Lama once stated, “Sleep is the best medicine”. This concept is something that we, at Empira, have discovered as well. Although not our first quality improvement program, Restorative Sleep, has become the foundation for success throughout all of our programs. Poor sleep can have detrimental impacts on our health and finding the root cause is the first step.

A study completed by Harvard Medical School in 2010, identified the top ten sleep disturbances contributing to poor sleep in nursing homes and other in-patient settings. Listen to Heather Johnson discuss the top 10 sleep disturbances on the “Peace with Dementia” Podcast hosted by Matt Estrade, MA, MBA.

Stay tuned for our weekly series where we will discuss each sleep disturbance and how to combat it.  

 Click Here To Listen


Evidence-Based Design Meets Evidence-Based Medicine: The Sound Sleep Study. The Center for Health Design Research Coalition, Harvard Medical School, 2010.

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Facing the “Work of Aging” with ResoLute

Video By: Malori Weigel, Communication Specialist
Written By: Sarah Brown, Executive Director

Empira, a consortium of 25 nursing homes in metro and rural Minnesota are helping residents and their loved ones bravely face the “Work of Aging” with ResoLute.

What is the “Work of Aging”?
Empira has coined the phrase “Work of Aging” to describe conversations or actions that support finding hope and peace while facing mortality.

The Work of Aging begins when people start to reflect on the following questions.  This reflection is often prompted because of advanced age or terminal illness… (however wisdom may lead some do this “work” sooner and more frequently…)

  • Did my life have meaning?
  • How long will I live?
  • What matters most to me now?
  • How do I want to live the rest of my life?
  • Will my loved one be okay when I am gone?
  • How will I be remembered?

We know this work is not easy, and that is why have created the ResoLute program which stands for “Resident Empowered Solutions on Living Until the End”. In this program, we are facilitating conversations that support the resident and their loved ones explore these questions to discover fears, hopes, and priorities. Thus creating the opportunity for living with integrity centered around what matters most all the way to end.

Are you ready to support the “Work of Aging” for yourself or your loved ones? I urge you to listen to the cues of your loved ones who may need your support as they bravely face these questions.  Death on this earth is guaranteed for all of us. Instead following your gut reaction to provide false comfort, offer some time to those who want to talk about the “work of aging”.


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Hats & Halos – My Grandmothers Purpose

Hats & Halos Image

By: Heather Johnson RN,

Clinical Educator and Program Specialist

Watching someone you love; someone who holds such a piece of your heart, go through the trials and depths of dementia can often is difficult and sometimes just darn right unfair. Growing up I spent a great deal of my time with my grandparents. Both of whom shared their love with me, my siblings, and my cousins. Our extended family is large, yet somehow my grandparents ensured that we each had individual opportunities to have some special time with them. They took us, two-by-two, on road trips across the United States. My Grandfather was at the wheel of their Lincoln Town Car and my beautiful Grandmother sat as his co-pilot with and her trusty highlighted Rand McNally Road Atlas on her lap. Packed and ready, with one last trip to the bathroom, we set out on trips ear-marked by great stories, laughter, history lessons, singing from a wine-list, and learning how to tip when given great service. All experiences are forever engrained in my memory and in my heart.

My grandparents taught us to have a “Servant’s Heart” and to take an active part in your community. My grandfather served as the mayor of his small hometown of Clarks Grove up until the time of his death. He was on the local volunteer fire department, served on councils in the area, and was also active in the Benevolent Order of the Elks, working his way up to the Minnesota State President.

My grandmother served as a 4-H leader, scout leader, church leader, and a founding force of the Clarks Grove Heritage Society. As she aged, she shifted her talents to knitting and, one of her legacy gifts to her community in Albert Lea was knitting thousands of baby caps for the local hospital which were then presented to each newborn baby. Later, when she made the move north to Maple Plain, MN to an Assisted Living she continued to knit. She knit beautiful pastel baby hats and added what became her signature golden thread halo to the crown. Beautiful. Grandma assigned me a new role and duty and that was to assist her in counting those hats and then deliver them to the Allina Buffalo Hospital where her gifting tradition continued. Grandma had a little notebook that she kept near her knitting chair and basket, and in the notebook we would write the date and number of caps that I was delivering. She would point out specifics with each little hat and asked me to critique her work. Each hat, each stitch, was completed with amazing precision and done with love, and I would praise her for her talent and her contribution. When I would visit her following the deliveries of the hats, I would relay the “thank you” from the hospital staff and she would smile and in her eyes I could see she was pleased.

My grandmother had a form of dementia that affected her speech, ultimately taking her ability to verbally communicate. Her difficulty in talking did not slow down her knitting or detract from the number of babies who felt Grandma’s love.  Sometimes we wondered if she could make those hats with her eyes closed! Months and months would go by and we had our same “game plan.” She would knit hats, I would stop by and she would share them with me, we would count them and, of course tally them. I would deliver them and later tell her of how they were received. As time progressed, I noticed a difference in her work. The stitches were not as tight and uniform. The hat sizes were different from one another and her signature halos had become a little crooked. It occurred to me as her disease was progressing, the hats were telling her story. There came a time that the hats were no longer ones that someone else might identify as beautiful, and I didn’t deliver them to the hospital as I had promised my grandmother. I saved them, shared them with my siblings and cousins who had been such a meaningful part of Grandma’s life, and kept a number of those prized hats for myself; tucked carefully away in my cedar chest.

“Maintaining a sense of purpose through meaningful activities has a direct effect on dignity and selfhood for people living with a diagnosis of dementia” (Roach & Drummond, 2014). My grandmother lived the age of 90, outliving my grandfather, the love of her life, for 18 years. For my grandmother, her ability to contribute, to have a purpose and be of value came in the form of knitting those hats.  I can’t help thinking about what is my purpose today, and what will my purpose and value bring?




Roach, P., & Drummond, N. (2014). It’s nice to have something to do; early-onset dementia and maintaining purposeful activity. Journal of Psychiatric & Mental Health Nursing. 21 (10). Pp889-895. doi:10.1111/jpm.12154

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ResoLute Resolutions


Written by:  Cathleen Lindgren, RN ~ Clinical Educator & Program Specialist

          Several years before Grandma Jean died, she and her husband, Grandpa Gene, prepaid for their funeral expenses.  As they aged, they talked about selling their house at some point and when Grandma became more forgetful, they talked about it with a bit more urgency.  Grandpa had worked well past the age of normal retirement but a few years back stopped working outside of their home so that he could spend his days with Grandma and ultimately, Grandpa became her caregiver.  In the last years of her life, their children and grandchildren became more involved in her care.  Their family included the knowledge of a Geriatric Nurse Practitioner, a few Registered Nurses, and a couple with general healthcare experience.  While this provided much comfort, the last years of her life remained an incredibly stressful time filled with concerns, “what if’s”, and unforeseen moments.

In the months that have passed since her death, I have reflected on our families experience during her last few years of life.  I have great confidence in where our hearts and intentions were as Grandma aged, but many regrets regarding the quality of life she had during those same moments.  I had my own “Ah-ha!” moment like many have had before me and realized there was a sizable gap existing throughout the last few years of life.  There was a lack of resources, education, and focus on this span of time – the period upstream from hospice.  And, without a doubt, a vast need of admirable, purposeful, determined, and unwavering support for the millions of nursing home residents who continue to live throughout these golden years.  Thus, due to the work of Empira, ResoLute was born.

This upcoming new year has inspired our team at Empira as we begin working within our new program, ResoLute (Resident Empowered Solutions on Living Until The End).  ResoLute is a MN Department of Human Services Performance Improvement Grant (PIPP Grant) with a goal of helping residents and their loved ones bravely face the work of aging.  2018 will be filled with improvements as we focus on the cornerstones of the ResoLute program.  These cornerstones are quality resolutions for us all to uphold:

Resolute Resolution #1:   Each residents care team will create a foundation upon which the work of aging can be built.  This is done biologically, psychologically, and socially.

ResoLute Resolution #2:  We will provide information to a resident about their prognosis in a timely and truthful manner.

ResoLute Resolution #3: With the help of our ResoLute teams, our resident’s priorities, fears, life reflections, and wishes regarding their legacy will be explored.

ResoLute Resolution #4: We will truly know our residents, not just know of them.  This means we will care for them holistically.  They are not just a body/diagnosis.  They are a person with unique spirituality, a social history, great achievements, and so much more and they happen to be experiencing symptoms of one or more disease processes.

ResoLute Resolution #5:  We will work together as a team.  Communication between everyone on the residents care team is important when developing a whole-person/holistic care plan.

ResoLute Resolution #6:  We will continue to know better and do better ourselves as we encourage others to do the same!

Wishing you the happiest of New Years!


            Sarah, Kelly, Heather, Malori, & Cathy