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4th of July Traditions

Written by Birttni Peterson, RN
Resource Nurse, Empira

There is no doubt, that for many people, Independence Day is one of the most looked forward to days of the summer. What’s not to love? Time spent with family and friends, fireworks, tasty food, bonfires, and if we are lucky, as Minnesotans, nice weather. I’m pretty sure that most people understand the symbolism of the fireworks, like it says in the Star-Spangled Banner: And the rocket’s red glare, the bombs bursting in air. But for many people the 4th of July is like many other holidays; a perfect reason to get together and celebrate with family. Many of those families have traditions and unfortunately with this COVID virus right now most will not be able to celebrate as they would like.

Vintage American Flag With Sparklers And Smoke On Rustic Wooden Background - Independence Day Celebration ConceptWhat is the reason we celebrate with fireworks, parades, and red white and blue on the 4th day of July? Well, here’s a brief history on it.

The Revolutionary War began in 1775 and ended in 1783. The cause of this war was due to growing tension between Great Britain’s 13 colonies and the Colonial Government. On July 2nd of 1776, there was a vote to gain their Independence, it wasn’t until two days later that representatives from the 13 colonies and Continental Congress officially adopted the Declaration of Independence.

“Fun fact, John Adams thought that July 2nd would be the date that Americans would celebrate their independence.”

Now, I’m not much of a history buff… but do you know who is? Our good friend Andy Griffith.

A family tradition of mine is adventuring to my Grandparent’s house in Deerwood Minnesota. We would attend the Crosby-Ironton parade during the day. Our parade spot was right across from a Dairy Queen, so of course we always bought a treat before the parade started… even if it was only 10 o’clock in the morning. The parades have been getting shorter and shorter each year, but average to be a little over an hour. Which for a kid looking to fill her bag with candy, it wasn’t long enough. We would then make the drive home to grill hamburgers and hot dogs for lunch and if my parents were lucky, us kids would let them take a nap before our evening festivities. We would finish our 4th of July day off by being mesmerized by fireworks in the evening. What are your family traditions for Independence Day?

Like I said earlier, the 4th of July, 2020, for most Americans, is going to be celebrated differently this year. Those most affected are the residents of long term care facilities. A lack of togetherness with their families will only be amplified during this holiday. Although recently the MN Department of Health has put out guidance for long term care facilities to have outdoor visitations, it just won’t be the same.

But there are a few other ways that you can celebrate with your loved ones this 4th of July.

Bring the tradition to them. Since visitors are not allowed in nursing communities and we don’t know how the outdoor visitations will work, bringing the tradition to them may be a bit more difficult this year. A way you can still celebrate with your loved one is by decorating the outside of their window with an American Flag, window decals, and/or flowers.

Cute American Kids watching Fourth of July ParadeCall and Reminisce. If you aren’t able to carry out your normal family traditions, call and reminisce about what you have done in the years past. Take it one step further by writing down your 4th of July memories and make it into a keepsake for you and your loved one(s).

Just remember that the biggest thing for people facing tough times, especially around holidays, is that they know you are here for them and that they are cared for.

Firework and bokeh lights at night in the colors of the flag from the united states of america (blue, white and red)Resources
https://www.history.com/topics/american-revolution/american-revolution-history
https://www.timeanddate.com/holidays/us/independence-day

Click to access ltcoutdoor.pdf

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Memorial Day – Remember to Remember

Written By Heather Johnson, RN
Resource Nurse, Empira

Think about what Memorial Day means to you.

Does it bring up childhood memories of a long weekend with family and friends?

Memorial Day is known to many of us as the unofficial start to summer. You may also know it as:

  • Ear-marking the final days of the school year
  • The start of the camping season and warmer weather
  • The first bonfires of the year
  • Celebrations at the lake
  • Mattress sales
  • Picnics galore
  • Large BBQs
  • Well attended parades
  • A paid day off of work
  • Brilliant fireworks
  • Family traditions, reunions and celebrations

Do any of your memories and plans include decorating gravesites and paying respect?

Do you know the history of Memorial Day and the significance in our American history?

Memorial Day is so much more than an extended weekend.

Here is a little bit of history.

By the late 1860’s and with death tolls rising from the American Civil War, Americans began holding springtime tributes to the fallen military heroes by decorating the soldiers’ graves with flowers and memorabilia and reciting poems and prayers. The first such memorial is believed to have originated in Charleston, South Carolina, and was coordinated by freed slaves.

Decoration Day, now known to us as Memorial Day, was first proclaimed by General John Logan on May 5th, 1868. A solemn day of reflection and respect. He recognized the need to honor the more than 620,000 soldiers who died during the American Civil War. He chose May 30th as the declared day because it was not an anniversary date to any particular battle. Some historians believe the date was selected to ensure that flowers across the country would be in full bloom.

Arlington National Cemetery

The Proclamation reads:

“The 30th day of May, 1868, is designated for the purpose of strewing with flowers or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village, and hamlet churchyard in the land. In this observance no form or ceremony is prescribed, but posts and comrades will in their own way arrange such fitting services and testimonials of respect as circumstances may permit.”

General Order No. 11

For more than 50 years, the holiday was used to commemorate those killed just in the Civil War, not in any other American conflict. It wasn’t until America’s entry into World War I that the tradition was expanded to include those killed in all wars.

Memorial Day was not even officially recognized nationwide until the 1970s

In 1968, Congress passed the Uniform Monday Holiday Act which moved Memorial Day from May 30th to the last Monday of May. Making it a three-day weekend for federal employees and in this same law also declared Memorial Day a federal holiday which went into effect in 1971. Many argue that in making Memorial Day a three-day weekend, it commercialized the day and made it less significant and easier for Americans to treat the weekend as more of a celebration and in return losing its significance.

Now, I don’t believe there is anything wrong with this type of celebration. To be honest almost everyone likes a good time. Remember our freedom does bring us life, liberty and the pursuit of happiness. But for those who were forged into adults on the anvil of war or those who lost dear friends and faithful comrades or those who have a personal connection we can’t help but to having a slightly more respectful attitude about the sacrifices that produce our safety and liberty. Being able to live in freedom is an incredible stroke of good fortune, but the freedom itself exists only because hundreds of thousands of our service members perished for it.

So while none of us should ever dodge a chance to take a break, spend some time with family and overeat a bit, we should also remember why we have the freedom to do it, even if it’s just on this single day at the end of May.

So what can we all do for those we serve in our communities?

Start by reflecting on the history of Decoration Day/Memorial Day and how that history affects those who serve, and have served our country. Here are some other ideas:

  • Share the history with the younger generation.
  • Take time on this day to honor the men and women who gave their lives in service to our country.
  • Reflect on how the memories of the fallen impact those in our communities.
  • Find meaningful ways to bring that history, honor, and respect into your communities.
  • Reach out to your local Veteran’s groups.
  • Personally, take part in Memorial Day.
  • Pause and pay your respects.

Show the world that this day has not lost its reverent meaning.

A simple gesture is to wear a red poppy, a tradition that began with a World War I poem written in 1915 in which the author gave voice to the soldiers who had been killed in battle and lay buried beneath the poppy-covered fields.

Red Poppies in Flanders Fields

“In Flanders Fields” by John McCrae

In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.
We are the Dead. Short days ago,
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.
Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

In memory, with reflection, of my Great Uncle Pfc. Henry Mattson

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I’ll Do It Anyway

Written By Adrienne Duncan, RN, BSN
Resource Nurse, Empira

The year of the nurse is here!

2020

Although this year has been rough so far, it has cast the light on the profession of my choice and on the millions of other nurses around the world. Caring for those with illnesses can be scary, but we do it anyway.

Although even more attention is on the profession during this pandemic, the truth is nurses have been highly regarded by the public for a long time. Actually, according to a yearly poll done by Gallup, nurses were rated by Americans as the #1 most trusted profession. This has been the case for an impressive 18 year streak! 85% of Americans rated nurses’ honesty and ethical standards as high or very high. This honor is crazy impressive considering the poll included other medical professionals like physicians, dentists, and pharmacists. 85% is also impressive given next most honest profession was engineering coming in at 66%.

Nurses are seen as compassionate, dedicated, educated, advocates who will do right by their patients and uphold high standards. People come in contact with nurses during some of the most vulnerable times of their lives. During this vulnerability, trust is surrendered to those caring people who are caring for you and that can be scary. But as nurses we meet these challenges almost daily and still rise to the calling and do it anyway.

If you take a look back at history to one of the first nursing pioneers in the field, you will find an amazing woman named Florence Nightingale. You may have heard of her before but you probably don’t know how much she actually influenced healthcare and social reform.

Portrait of Florence Nightingale

She was a world traveler who grew up in an affluent, proper family with two homes. She defied her family’s plan for her to become a socialite in the upper class to pursue a nursing career. She was deeply religious and was answering a call from God to be of service. In that era, nurses made little money and were not as respected as they are today. Florence did it anyway.

Her influence is world-renowned, from her work with soldiers during the Crimean war, to opening one of the first nursing schools in England. (I know what you are thinking: Crimean war??? I didn’t know what it was either, it was a military conflict fought from 1853 to 1856. Russia was there, so was the Ottoman Empire, France, United Kingdom and Sardinia. Feel free to look it up if you want to know more.) Ok, back on topic.

Florence realized the impact of the environment on the overall well-being and outcomes for her patients. She promoted nutritious food, clean linens and clothing, fresh air and ventilation, and sanitization. She and her team of nurses were able to significantly reduce the mortality rate of soldiers in military hospitals, from as high as 40% to nearly 2%. Thank goodness for people like Florence, who do it anyway.

And the world needs more. More individuals to answer the call of service to the nursing field. According to the American Association of Colleges of Nursing, the U.S. is projected to have a shortage of nurses that will only increase as Baby Boomers age and nursing schools are also having a hard time increasing their capacity to meet the demand.
According to Purdue Global, here are the top 10 Reasons to become a nurse:

  1. Nursing is an opportunity to make a real difference in people’s lives
  2. There are ample job opportunities
  3. Nursing is a trusted and respected profession
  4. There’s significant opportunity for inter-professional collaboration among a variety of health care disciplines
  5. Nursing offers a high degree of job satisfaction
  6. Employment choices are wide and varied
  7. Work full time, part time, varying shifts
  8. Nurses receive excellent benefits
  9. Nurses can travel the world
  10. Nurture a love of learning

Nursing is beautiful and it can be very hard, but it’s worth it. I would never take back the times I decided to do it anyway. When I was told I was too young to be taken seriously, I did it anyway. When my residents with Alzheimer’s didn’t know who I was, I smiled and loved them anyway. When I was really busy at work and I thought I didn’t have the time to sit at the piano at 10pm on Christmas Eve and sing with Edith, I did it anyway.

When I decided education was my best way to use my strengths and support other nurses, I was filled with both nerves and excitement and I did it anyway. Here’s to a profession that gives, and takes, but mostly gives.

“To do what nobody else will do, in a way that nobody else can do, in spite of all we go through…that is what it is to be a nurse.”

Rawsi Williams

No matter what, we’ll always take care of you!

References:
https://nurse.org/articles/nursing-ranked-most-honest-profession/
https://www.purdueglobal.edu/blog/nursing/10-reasons-become-nurse/
https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx
https://nurseslabs.com/8-florence-nightingale-facts-probably-didnt-know/
https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage

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Why I Don’t Hate COVID 19

Written By Kelly Klund, LPN
Resource Nurse, Empira

Now that I have your attention let me explain.


I do hate that people are dying. I do hate that people are sick. I do hate that people are separated from their families. I do hate that people are losing their jobs. I do hate that our economy is crashing. I do hate that we don’t have a perfect health care infrastructure. I do hate that small businesses are suffering and some may not survive, and I do hate that our children’s education has been disrupted.

Where there is tragedy there is also triumph, and somewhere on the other end of this unprecedented time we will see that there may be things that are better because of what we have been through.

I think about the poem “I miss September 12th” by Elizabeth Gray.

I miss September 12, 2001. I would never want another 9/11, but I miss the America of 9/12. Stores ran out of flags to sell because they were being flown everywhere. People were Americans before they were upper or lower class, Jewish or Christian, Republican or Democrat. We hugged people without caring if they ate at Chick-fil-A or wore Nikes. On 9/12 what mattered more was what was uniting us than what divided us.

Elizabeth S. Gray

In a study completed in 2015 Pollak and Wilson found Advance Care Planning (ACP) conversations to be uncommon. The category of frail elderly patients was identified as a population with limited or no meaningful engagement in ACP. COVID 19 is forcing all of us to have hard, but necessary conversations about our health care wishes. This is a positive that has come from COVID19.

In 2017 Walmsley and McCormack published a study that showed the difficulty that family members encounter when trying to stay engaged. We all know of someone who visits their loved one in a nursing home every Sunday because it is the right thing to do, but they often don’t know what to talk about. With the strict visitor restrictions aging services has appropriately imposed many of those families have had to embrace technology as a way to stay connected. My hope is that when this is over those families continue with their meaningful good night or good morning video chats, as opposed to their weekly obligatory visits. That would be a positive that came from COVID 19.

I have a friend who hosts daily what’s for supper video chats with her girlfriends who struggle in the kitchen. Whether eating curbside pick-up or home cooked meals, people are congregating around the dinner table. This is a positive from COVID19.

I live in a small town in Wisconsin and our main street cafe posted on their Facebook page that they have had some of their busiest days ever. People are pulling together to support local businesses differently than before. This is a positive from COVID 19.
I don’t hate that COVID 19 cancelled my large family Easter celebration. Instead of the hustle and bustle of a house full of people, my husband, college aged daughter, adult son and I had a lovely family dinner at home. The belly laughs were abundant and the memories are priceless. This is a positive from COVID 19.

In the article “Forget Happiness, find Meaning” the author, Kaufmann, says that we should focus on empathy, compassion and gratitude when faced with challenges. There is meaning in COVID 19 for all of us, the challenge is for us to embrace that meaning and grow from it.
I am finding meaning in community, family and appreciation and that is why I don’t hate COVID 19, it is about perspective. I wouldn’t want this new way of life to last forever, but I can find the gifts.

In this time when everyone’s world has been upended where can you find opportunities for empathy, compassion and gratitude? I challenge you to find the September 12th moments in your life.

Kristian Pollock, Eleanor Wilson. Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life. Health Services and Delivery Research. 2015;(31). doi:10.3310/hsdr03310.
Kaufman SB. Forget Happiness, Find Meaning. Scientific American Mind. 2019;30(6):21. https://search-ebscohost-com.ezproxy.umuc.edu/login.aspx?direct=true&db=f5h&AN=139129444&site=eds-live&scope=site. Accessed April 13, 2020.
Walmsley B, McCormack L. Severe dementia: relational social engagement (RSE) during family visits. Aging & Mental Health. 2017;21(12):1262-1271. doi:10.1080/13607863.2016.1220923.

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Social Distancing & Emotional Health

Written by Heather Johnson, RN
Resource Nurse, Empira

How are you doing? Stressed? Anxious? Worried? Fearful?

It’s natural to feel this way under the current circumstances. The pandemic of COVID-19 is being broadcast everywhere on everything. As humans we also need to recognize and accept that everyone reacts differently. These reactions are based on your current circumstances, your mental health and your own feelings. Just know you are not alone. Or are you?

In a previous post I wrote about the need for social connectedness. This undeniable need for social connection is scribed into our DNA, it’s an innate part of our human existence. We need one another, and yet we are living in a time where social distancing is our new norm. This all seems counterintuitive to our nature.

So how do we balance the need for social distancing while preserving and supporting emotional health and our need for human connectedness at the same time?

The reality of it is, for most of us this is uncharted territory and we are unsure.

Emotional connectedness is subjective and is created when two or more people come together and create a bond over similar emotions. It’s a tie with someone who you share a particular set of emotions even if those emotions and feelings are anger, sadness, sorrow, joy, love or a thousand or more emotions that humans experience. The sharing of our emotions with one another provides us with the opportunity to create relationships. It allows us to bond over and to process what is happening while creating an understanding that we are not alone.

As a society we are bombarded with information about precautionary hygiene practices and social distancing, and as a nurse, I can fully embrace the heightened awareness and education to support physical health. As a late life care nurse, a mother, a daughter, a wife, a sister, a niece, a community member, and a friend, I also think about the added need for individuals to understand just how important our emotional health is. It is crucial in maintaining our physical health. Our physical and emotional health are intertwined and you need to take care of both to be healthy.

How then do we move forward in the coming days and weeks following social distancing guidelines without compromising emotional connectedness?

Here are a few strategies to support emotional connectedness while keeping your distance.
• Make and maintain eye contact with those around you.
• Use a hand wave to say hello or goodbye.
• Nod your head as you walk by one another.
• Listen to what others are sharing, and pay attention to their emotion.
• Put yourself in their shoes, empathize with what they may be feeling.
• Have genuine conversations. Make a phone or video call to a friend or family member. (Your grandparents need you now more than ever!)
• Email or write a letter.
• Share a simple smile with someone. (Did you know that the more you smile, the more intelligent (and better looking) the other person will perceive you as? And, chances are they will smile back!)

Remember: Emotional connections are the one thing that connects us all!

Please be safe and stay healthy!

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Spiritual Pain

Written by Kelly Klund
Resource Nurse, Empira

I’ve had natural childbirth……. twice. I’ve had my appendix rupture and I suffer from migraine headaches.

For these types of pain there is a “plan”. You hold your child in your arms and forget the pain. You have surgery to remove an inflamed appendix. You take your medications and stay in a dark room to cope with a migraine.

We all recognize times when we have had physical pain, but what is spiritual pain? How do we recognize it and how do we respond to it?

The Marie Curie Organization defines spiritual pain as the distress or anxiety you feel related to a loss of meaning or purpose. This can include loss of identity, worth or esteem and includes dealing with regrets or unresolved issues. Spiritual pain challenges your core values and beliefs about how things are supposed to be.

There is no surgery for a challenge to your core beliefs. There is no take two and call me in the morning for a pain that comes from our soul and not our cells.

The Sacred Art of Living Center teaches that there are 7 elements to spirituality for all of us.

  1. Awareness of “the other”. What is valued or sacred to me?
  2. Sense of responsibility. How am I responsible to the world around me?
  3. Sense of vocation. What is my reason for being?
  4. Sense of community. Am I being cared for by and giving care to others?
  5. Sense of repentance. What is my capacity for forgiveness with myself and others?
  6. Ability to be present. Is my focus on the past, present or future?
  7. Faith. What is the relationship between my personal story and the greater story?

We have all had, or will have things that cause spiritual pain.

When I got divorced my world shattered as I acknowledged that my family was not going to be defined how I’d always dreamed it would be.

When my daughter was diagnosed with leukemia my faith was challenged and I was upset with God.

When my adult son struggled with the pressures of life I battled with my sense of responsibility on a daily basis.

The cure for pain is in the pain.

In preparation for this blog I came across an amazing quote by the 13th century poet Rumi. He said “The cure for pain is in the pain”. Thinking about this statement has been profound for me.

The cure for pain is in the pain – ancient Persian poet and philosopher Rumi quote printed on grunge vintage cardboard

When we have spiritual pain we can’t ignore it, there isn’t a rug big enough to hide it under and there are no Band-Aids that can help make it better. We have to go into the pain to truly address it.

In my divorce I had to acknowledge a sense of failure to set a course for a new life.
I had to accept that my daughter could die from her illness in order to appreciate every moment of her future.
I have to, at times; feel the pain of allowing my son to struggle in order to see him succeed.

If we ignore it…… it doesn’t go away. In contrast, it pours out of us and on to everything in our path. In the journal Spiritual Distress: Integrative Review of Literature it is stated that “…. concepts of spiritual distress presented common and related elements to the human being subjective and individual response to life experiences, which harms the human spiritual dimension.”

I challenge you to examine how The Sacred Art of Living’s 7 elements of spiritual pain play a part in your life and to lean into your spiritual pain to find your cure.

Sources

https://www.mariecurie.org.uk/help/support/terminal-illness/wellbeing/emotional-spiritual-pain https://sacredartofliving.org/ https://www.researchgate.net/publication/41619584_Spiritual_distress_Integrative_review_of_literature https://doi.org/10.5935/1676-4285.20081551

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Physical and Mental Well-being for Older Adults

Written by Brittni Peterson, RN
Resource Nurse, Empira

When it comes to setting goals, never say never. With an outstanding time of just under four hours, Harriette Thompson became the oldest woman to run a half marathon in 2017. Can you guess her age when she crossed over that finish line? 94. People tend to believe the older we become, the more fragile our body becomes… but that doesn’t have to be the case.

Exercise for older adults is just as important as exercise is for children, adolescents, teens and adults. There is no doubt that the older we get the more our body starts to have aches and pains, which may make it more difficult to get up and get moving. However, according to the Better Health Channel, regular exercise may help decrease some of those aches and pains by strengthening the bones and muscles in our body. Individuals over the age of 65-years-old should spend approximately 20 minutes/day on aerobic exercise or 10 minutes/day anaerobic exercises.

Aerobic vs. anaerobic

The word aerobic means “with oxygen”. The amount of oxygen intake, while performing an aerobic exercise is adequate enough to fuel the physical activity. Running, brisk walking, cycling, or swimming are all examples of aerobic exercise. Your body is burning the carbohydrates and fats that are stored in your body to fuel your muscles while increasing your heart rate and breathing. Since your body is slowly burning the carbs and fats, aerobic can be done for a long time (like a marathon) because energy is slowly being released and the demand for oxygen is not high.

The word anaerobic means “without oxygen”. For this type of exercise, regular oxygen supply is not adequate enough to fuel the activity, so the body needs to rely on other means of fuel like carbohydrates, amino acids and lactate. Anaerobic exercise cannot be done for a long time because of the limited supply of energy. Some examples of anaerobic exercise are weight lifting, sprints and box jumps.

Benefits of physical exercise for aging adults

According to the Centers for Disease Control and Prevention in 2017, approximately 3 million older adults were seen in the emergency department due to injuries that were sustained from a fall and more than 95% of hip fractures are caused by falling. When we become older, our bone density decreases, as well as, our muscle mass. How can we change that? Simple. Exercise.

Weight bearing exercises, like walking or lifting weights, helps to improve balance by strengthen your bones and increasing your muscle mass. This will help decrease falls and bone fractures by providing your body with strength and stability. Exercise will also benefit your joints by keeping them in regular use. Physical activity can also help improve the function of your heart and lungs. Aerobic exercises help to strengthen your heart which will help decrease your risk for illnesses like heart disease, hypertension and diabetes.

Let’s do an overview on the benefits of exercise.

  • Improves our mood and sleep while reducing stress and anxiety by releasing those feel good chemicals.
  • Increases stability and balance by strengthening our bones and increasing muscle mass.
  • Improves our health and lowers our risk for diseases like hypertension, heart disease and diabetes by strengthening our heart and lowering bad cholesterol.
  • Decreases joint pain by regularly moving and keeping them from stiffening
  • Improves brain function by reducing inflammation and extending the existence of new brain cells.

Is physical activity the only type of activity we need?

When we think of exercise we typically only think about how it helps our bones, muscle, heart, and lungs… but what about our most essential muscle, the brain? Just like any muscle in our body, the brain can lose its muscle tone, making it more susceptible to memory loss and decreased cognitive function. This may make it difficult to independently perform activities of daily living that mean that most to you, upholding conversations and can even make it more difficult to learn new skills.

Author Heidi Godman, writes that exercise helps the brain directly by reducing inflammation and promoting growth of new brain cells, blood vessels in the brain and extending the survival of new brain cells. Exercise helps the brain indirectly by improving mood, sleep and by decreasing episodes of anxiety and stress. When we get our body moving and increase our heart rate, our brain releases good chemicals known as endorphins and serotonin.

Here are some inexpensive ways to exercise your brain:

  • Word games help improve word association and memory recall.
  • Board games integrate problem solving skills and create opportunities for socialization.
  • Jigsaw puzzles incorporate fine motor skills.
  • Crafts promote autonomy for creativeness while combining fine motor skills.
  • Cooking utilizes critical thinking and helps improve memory (recipes) while encouraging creativeness.
  • Gardening stimulates the brain with planning and provides sun exposure, a great source of vitamin D.

Integrating meaningful activities in nursing communities

An F-number, called a tag number (F-tag), corresponds to a specific regulation within the Code of Federal Regulations that governs long term care facilities. F-tag 248 states that ”the facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psycho-social well-being of each resident.” This F-tag is overseen by federal regulations with the hope of providing residents with activities that fit their individualized interest to provide them with purpose and increase their overall well-being. There is even a federal regulation that emphasizes the importance of both physical and mental activities for residents.

How do we know which activities will spark interest in residents? I’m glad you asked. Empira’s fourth signature program, ResoLute, helps by supporting “residents and loved ones as they embrace the process of aging with purpose, determination and an unwavering commitment to uphold what matters most in the late stages of life.” Supporting the resident is done with meaningful conversations to determine what matters most to them. By asking those important questions, we can begin to plan focused activities around their personal goals. Purposeful living has already been linked to other aspects of well-being, like a longer life, lower risk of disease, better sleep and healthier behavior.

I’m not saying everyone has to be like Harriette and run a marathon to live a purposeful life, but if you can find what sparks your resident’s joy, you will make their world a better place to be.

References:
Better Health Channel. (2020). Physical activity for seniors. https://www.betterhealth.vic.gov.au/health/HealthyLiving/physical-activity-for-seniors

Boren, C. (2017, June 4). At 94, Harriette Thompson becomes the oldest woman to run a half-marathon.

In The Washington Post. https://www.washingtonpost.com/news/early-lead/wp/2017/06/04/now-94-harriette-thompson-is-trying-to-become-the-oldest-woman-to-run-a-half-marathon/

Cirillo, A. (2019, June 24). Nursing homes and assisted living activities. In Nursing Homes. https://www.verywellhealth.com/nursing-home-and-assisted-living-activities-197763

Empira. (2020). Our signature approaches. http://empira.org/programs/our-programs

Godman, H. (2018, April 5). Regular exercise changes the brain to improve memory, thinking skills. In

Harvard Health Blog. Retrieved from https://www.health.harvard.edu/blog/regular-exercise-changes-brain-improve-memory-thinking-skills-201404097110

MacMillan, A. (2017, August 16). People age better if they have a purpose in life. In Time. https://time.com/4903166/purpose-in-life-aging/

Sun Health Communities. (2016, July 7). 7 exercises for older adults.
https://www.sunhealthcommunities.org/resource-center/articles/7-brain-exercises-older-adults/

World Health Organization. (2020). Physical activity and older adults. In Global Strategy on Diet, Physical Activity, and Health. https://www.who.int/dietphysicalactivity/factsheet_olderadults/en/

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Moai: It’s written into our DNA!

Written by Heather Johnson, RN
Resource Nurse, Empira

Would you agree that we live in a world consumed by convenience and technology?

With a global population nearing 7.7 billion people, one would like to think that there would be no loneliness, no lack of human contact and certainly plenty of opportunities for social connectedness in our world. Yet, social isolation, loneliness and lack of social connections are the stark reality for many, especially older adults in the United States.

Recently, in an article that I read, an 80-year-old woman refers to herself and those in her age group, as glass people. She explains that she feels invisible even though she resides in a senior apartment building and is constantly surrounded by others. She shared that, even in a complex that brings people in close proximities to each other, there is a lack of social connection, a nonexistent sense of community and a stigma about productivity in elders. She’s not alone in her thinking.

Social connectedness is defined as the feeling that you belong to a group and generally feeling very close to other people. In fact, scientific evidence strongly suggests that social connectedness is a core psychological need, which is essential to feeling satisfied with your life. As humans, we have a drive to connect with others, it’s embedded within our DNA and it begins at birth with our connection to those who cared for us. This same relationship exists throughout our lifespan. Studies often conclude that when a person is well cared for as a child they are more likely to have healthy and happy relationships as they get older.

In recent months, I have been researching more and more about the multiple blue zones that exist across the globe. Blue zones are areas identified by experts as having environments and traditions that support one in living a much longer and happier life. Five such zones are identified and they include:

  • Okinawa (Japan)
  • Sardinia (Greece)
  • Nicoya (Costa Rica)
  • Icaria (Greece)
  • Loma Linda, California (USA)

Teams of experts have found nine common denominators, often referred to as the power of nine, among blue zones and they include the following:

  • Move naturally: People live in environments that nudge them to move
  • Purpose: In Japan it’s known as “Ikigai” which translates to why I wake up in the morning
  • Down shift: Taking time each day to slow down (praying, meditating, resting)
  • 80% rule: In Japan this is known as “hara hachi bu” which means to stop eating when you feel your stomach is 80% full
  • Plant slant: Beans and plant sources are the cornerstone of your daily diet
  • Wine at 5pm: Drinking 1-2 glasses per day with friends and/or with food
  • Belong: Be a part of a faith-based community or organization
  • Loved ones first: Families are put first and a priority in one’s life, invest time with your partner and time with children
  • Right tribe: Being part of a group of 5 or more people that are committed to one another for life, cultivating a strong social network, this group is known a your moai

Do you notice that four of the nine definitely involve social connectedness?

Elders in Okinawa, Japan, one of the original blue zones longevity hotspots, live extraordinarily better and longer lives than almost anyone else in the world. Moai, one of their longevity traditions are social support groups that start in childhood and extend into the 100s. This term originated hundreds of years ago as a means of a village’s financial support system. Originally, moais were formed to pool the resources of an entire village for projects or public works. If an individual needed financial resources to buy land or take care of an emergency, the only way was to pool money locally. Traditionally, these groups of five or more children were brought together with the expectation that they would be committed to one another for life. Today this idea has expanded to become more of a social support network, a cultural tradition for built-in companionship and is often known as one’s “second family.”

Half of the Okinawans population still participates in the moai traditions and some belong to more than one. Statistics show that when people share similar values, healthy habits and life goals, they are much more likely to experience less stress, are happier and live longer. The average life expectancy in Japan is 86.3 years of age, while here in the United States; average life expectancy is 78.9 years of age.

What can we learn from Japan?

Research and life stories confirm the value of being socially connected. Take inventory of your life for social connectedness. Take notice of the social connectedness of those you care for and about, no matter what age. Understand and appreciate that a person can still feel lonely, useless and like a glass person in a crowd. Then take measures to enhance those lives by helping to find meaningful ways to really connect.

Resources:
Blue Zones: retrieved from bluezones.com on January 4, 2020
Buettner, D.B., (2012). The blue zones (2nd edition): 9 lessons for living longer from the people who’ve lived the longest. National Geographic Partners LLS.
Weil, A., (2005). Healthy aging: A lifelong guide to your physical and spiritual well-being. Knopf.

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You Ain’t Cool Unless You Pee Your Pants

Written by Sarah Brown, BS, RN, LNHA
Executive Director, Empira

“You ain’t cool unless you pee your pants!” – Billy Madison

Some of you may remember this classic line from the 1995 comedy movie, Billy Madison. Adam Sandler plays the role of an adult, Billy Madison, who has to complete all of grade school over starting with Kindergarten. While on a school field trip in 3rd grade, Billy notices his classmate had an “accident”. Sensing his classmate’s embarrassment, Billy pretends to pee his pants too to save the boy from embarrassment. Because the rest of the class looks up to Billy as an older cool kid they accept his claims and the boy is saved from embarrassment. Part of this scene includes a cut to an elderly woman who says, “If peeing your pants is cool… consider me Miles Davis.” Fun Fact (Miles Davis was influential Jazz musician with a record titled Birth of the Cool in 1957.)

Although incontinence is common, it is not a normal part of aging.

With stereotypes like the one in the movie and daily exposure to the widespread prevalence of incontinence observed in care centers, it is very easy to normalize and expect incontinence with aging. In the United States, incontinence is common for older adults and according to the National Association for Contienence (NAFC), incontinence is second, only to falls, as the reason for nursing home placement.

Incontinence affects on average 70% of residents in the Empira consortium. We have learned through the Empira Falls Prevention & Reduction program that incontinence is a common contributing cause of falls and toileting schedules also have a major influence on several other nursing home care plan areas including sleep, nutrition, hydration, skin integrity and mobility.

One thing the movie portrayed accurately is the social impact of incontinence. Through conversations with residents Empira became increasing aware of the impact it has on quality of life in our care centers. We have learned that resident don’t feel like Miles Davis, the king of cool. Residents have shared the following statements about what it is like. As you read the comments you will see they feel more like the embarrassed school mate:

  • “Because I have so many accidents I prefer not to go to my social engagements.”
  • “I buy two of every outfit because I got tired of explaining to my friends why I changed clothes.”
  • “I am limited in my ability to venture too far from bathrooms for fear of accident and embarrassment.”
  • “Going to the bathroom becomes all consuming and takes over my whole day’s schedule.”
  • “I was surprised how quickly incontinence products were suggested and it was presented as my only option.”
  • “I was living at home until I began to have incontinence issues. It was the reason I had to move to a nursing home”
  • “I don’t attend family events outside of the nursing home because my bathroom needs are more trouble than it is worth.”
  • “Bathroom routines are embarrassing and distract from living life.”

I am not saying we should all start peeing our pants.

We as aging service providers need to acknowledge that we are not helping older adults feel cool or understood as Billy Madison did with his empathetic gesture. I am not saying we should all start peeing our pants but I am saying we should all start with empathy and understanding of the impact incontinence issues has on those we care for. Our current status quo of continence care in nursing homes has normalized incontinence to the point where we don’t even see it as a problem that deserves investigating. The resident comments above convey that our actions say, this is normal, there is nothing more we can do other than offer incontinence products and a 2 hour toileting schedule.

We need more thorough understanding and more options for treatment and management besides the house special standard incontinence product. I want to encourage us as aging service providers to keep learning and to create new standards that give incontinence the time it deserves. This will allow for discovering root causes, preventative measures and alternative options for residents.

Starting January 2020, the Empira collaborative has created and deployed a new approach to incontinence titled STREAM (Strategies Targeting Resident Elimination and Assessment Management). This program will be in 25 skilled nursing homes in metro and rural Minnesota.
STREAM was made possible by PIPP funding through the MN Department of Human Services.

STREAM was developed after listening to residents share the negative impact toileting and incontinence has on their everyday life. This program will challenge current assessment practices that do not accurately reflect the resident’s condition and replace it with technology-based assessments to improve accuracy and efficiency. STREAM funding provides each community with a Clinical Informatics Specialist (CIS) who will utilize the technology based assessments and data to strengthen resident care plans for a holistic approach to individualized care.
We believe improved understanding of the root cause will lead to better options for prevention, treatment, and management and ultimately resulting in higher quality of care.

Stay tuned to follow the STREAM journey. If you are interested in learning more about continence and emerging best practices visit http://www.nafc.org/