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Limitations: What the Arts can Teach us

Written by Heather Johnson, RN
Resource Nurse, Empira

“I don’t know how to do that and I will never be able to learn.”

“That takes too much time.”

“The way things are now is just fine.”

“No one will listen to me, anyway.”

This way of limited thinking squashes creativity. Some people look at their limitations as a challenge and reason to push forward. I am challenging you to think of limitations in a way that inspires you, motives you, and allows you to think outside of the box and to be creative.

My daughter, Erika, is an artist and she loves to work with different mediums and textures in the pieces that she creates. She loves to learn, and, she thrives when she can mix her textbook learning with the art platform as part of her Arts Magnets program. By connecting the right-sided artistic part of her brain with her left side, she has mastered working with watercolors, chalk, charcoal, clay, and water-soluble paints. Most recently she has started to work with oils in her paintings. To do so, she has had to move outside of her comfort zone and risk some failure. She has had learn the qualities of oils, and the varied types of oils. She has needed to work to understand how the oils react under the stroke of her brushes, and she has needed to be observant, disciplined, and maintain perseverance in her commitment to mastering this new art form.

Portrait painted by Erika Johnson

Limitation is the catalyst for creativity!

Oils, like any other medium, have their limitations, and the artist must learn what those limitations are if they aspire to create a masterpiece of their own. Oils can be challenging and less forgiving than other art mediums, yet, oils can provide some of the most interesting and unique landscapes and portraits one could ever imagine. The brilliant textures and colors of oils bring a piece to life. I like to think that Erika grows stronger in her artistic journey, and in her life journey, each time she attempts to acquire a new skill.

One lesson that I am learning from my daughter, the artist is that limitation is the catalyst for creativity! I will say it again………… Limitation is the catalyst for creativity!

The artist works within the limitations of space, medium, and present skills and knowledge, to create something beautiful and unique. The successful artist challenges themselves to grow and explore. When we acknowledge our limits or limitations, and yet press on, it thrusts us into a new way of thinking creatively. Like an artist that has been provided with a 16 x 20-inch canvas and who is challenged to work with a medium within the parameters of that canvas, we can be inspired to work creatively within any limitations or parameters given to us.

In long term care we have limitations in the form of regulations that must be followed, and with reason. We are likely to also experience limitations in forms of resources, time, skill, and now COVID restrictions and response. Don’t allow those limitations to stifle your creativity in providing excellent care and opportunities for those you care for. Instead, think of those limitations as the catalyst to spark your creativity. Recall, limitation is the catalyst for creativity.
Think of some ways to accomplish your mission and develop them within in your teams.

Ask yourself and team the following questions:

What is our goal?
What can we do different to achieve the outcome(s) we want?
Who are the activators on your team?
What if we fail?
How will/do we push through potential barriers?

Don’t let your limitations stop you

In closing, and on a lovingly personal level, I enjoy sharing a particular story of my grandmother who prided herself on her many talents and who also worked to develop those things she considered to be her limitations. In her later years she chose to work on her creative side by taking a painting class. You could say learner was in her top 5 strengths (referring to StrengthFinders). The class syllabus required the student artist to complete one type of subject and/or medium before being able to move on to the next one. She progressed through chalks, watercolors, acrylics, still life, landscapes, and even portraits. Then came the challenge of painting animals.

My grandmother believed she had reached her limit, and told the instructor that she just was not capable of doing animals. That was met with strict opposition from the instructor. No animals, no progression. I can just imagine the lightbulb going off in my grandmother’s head, and, in true adherence to the premise that limitation is the catalyst for creativity, my grandmother set to work and at the next class she proudly turned in her accomplished assignment to paint animals.

The teacher was understandably puzzled when she saw what appeared to be a painting of a forest. When she asked about the animals, my grandmother clearly pointed out the squirrel tail showing from under a bush, the deer antler protruding from behind a tree trunk, the snout of a turtle emerging from the edge of the pond, and the beaks of some tiny hatchlings poking up out of a nest.

Recognize, respect, and then stretch your limitations. You may surprise yourself and others. Let’s all take a lesson from an artist.

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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.

Better Health Channel. (2020). 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.

Cirillo, A. (2019, June 24). Nursing homes and assisted living activities. In Nursing Homes.

Empira. (2020). Our signature approaches.

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

Harvard Health Blog. Retrieved from

MacMillan, A. (2017, August 16). People age better if they have a purpose in life. In Time.

Sun Health Communities. (2016, July 7). 7 exercises for older adults.

World Health Organization. (2020). Physical activity and older adults. In Global Strategy on Diet, Physical Activity, and Health.

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Shoot It To Me Straight Doc…

Written by Kelly Klund
Clinical Educator & Program Specialist

My Uncle Harry is more than an uncle to me. As I grew up fatherless and lived with my grandparents, Harry has been an uncle, a brother, a father figure, and most importantly, my friend.

Early this fall, as Harry planned an upcoming fishing trip, he wasn’t feeling quite up to par. Believing he was in fairly good health, he was admitted into the hospital for what was supposed to be a routine gall bladder removal. Unfortunately, the surgery did not end up being routine as expected. During the surgery, the doctor saw the need to biopsy his liver. The result was a diagnosis of end stage liver cancer. Harry was given a prognosis of two months to live without treatment and “maybe double that” if he chose palliative chemotherapy. Receiving this shockingly straight forward prognosis felt like a semi-truck had smashed straight into the heart of our family.

Coincidently, I was preparing for Empira’s next grant: ResoLute (Resident empowered solutions on Living until the end). One of the cornerstones of ResoLute is truthful prognostication. As my professional and personal lives collided, I summoned the courage to ask my Uncle Harry if I could interview him, asking some tough questions about how he felt knowing he was facing the end of his life.

During our interview, Harry said it was most important he knew the truth about his prognosis. He told me he looked at the doctor and said “Shoot it to me straight doc”. The prognosis was devastating, but the physician’s honesty gave him a sense of urgency around the work that was left to do, the relationships he had to heal, the affairs he had to get in order, and the things he had left to say.

Karen Hancock did a review on discussing prognosis in advanced life-limiting illnesses and stated “many health professionals express discomfort at having to broach the topic of prognosis, including limited life expectancy, and may withhold information or not disclose prognosis. Reasons include perceived lack of training, stress, no time to attend to the patient’s emotional needs, fear of a negative impact on the patient, uncertainty about prognostication, requests from family members to withhold information and a feeling of inadequacy or hopelessness regarding the unavailability of further curative treatment”, (Karen Hancock et al., 2007).

Another supporting journal publication by Fallowfield, Jenkins, and Beveridge discuss how deceit hurts even more than a painful truth could hurt. They state, “Ambiguous or deliberately misleading information may afford short-term benefits while things continue to go well, but denies individuals and their families opportunities to reorganize and adapt their lives towards the attainment of more achievable goals, realistic hopes and aspirations” (Fallowfield, Jenkins, & Beveridge, 2002).

In his book “Being Mortal” Atul Gawande says, “The chance to shape one’s story is essential to sustaining meaning in life” (Gawande, 2014). For our family, truthful prognostication has given Harry the opportunity to shape to his story. We are thankful for the time to do the undone, and for knowing the time to plan the next fishing trip is NOW.

If you or a loved one had a life limiting illness would you value truthful prognostication or in the words of Scarlett O’Hara subscribe to the belief that “I can’t think about that right now. If I do, I’ll go crazy. I’ll think about that tomorrow.”?





Fallowfield, L. J., Jenkins, V. A., & Beveridge, H. A. (2002). Truth may hurt but deceit hurts more: communication in palliative care. Palliative Medicine, 16(4), 297-303. doi:10.1191/0269216302pm575oa

Gawande, A. (2017). Being mortal: Medicine and what matters in the end. New York, NY: Metropolitan Books, Henry Holt and Company.

Hancock, K., Clayton, J. M., Parker, S. M., Wal der, S., Butow, P. N., Carrick, S., … Tattersall, M. H. (2007). Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review. Palliative Medicine, 21(6), 507-517. doi:10.1177/0269216307080823