Kierkegaard said, “Once you label me, you negate me.” And, so it goes for the many labels we unwittingly assign people in our health care interactions. Those affected by homelessness, who are often labeled as “the homeless,” are no different. People are not their circumstances and as nurses we want to support a forward momentum out of unhealthy situations. Here are 10 ways you can help.
1. Change the language.
Anchoring someone down under a label creates the risk of someone officially taking on that label and identity permanently. It’s time to change the language so that those affected by a circumstance or condition are upheld in the energy of transitioning into a better outcome.
2. Offer frost bite checks in the streets and the shelters.
When I was a city hospital war horse, I took care of more post-operative amputations than seemed reasonable. Many were individuals who experienced one bad night out there on the streets. Frost bite is a killer of digits, ear lobes, and limbs. As we know, prevention is best and early treatment is second best. It can be a slower row to hoe toward amputation from peripheral vascular disease, diabetes, and wound infection.
3. Offer foot gear.
Start a boot and shoe brigade. Foot gear needs to be protective. The average person affected by homelessness walks five miles per day. Even those who stay overnight in shelters cannot stay there during the day. It’s out into the elements in the morning. Try doing that in lousy shoes or boots and paper thin socks. Offer shoes and boots at the shelters and neighborhoods that have been identified as areas of need. Enroll some shoe outlets and podiatrists to set up a “give away” table in neighborhoods of high need, announce a foot gear day at the local church or community center. Shoes don’t have to be new; however, be kind and do not donate anything you would not wear yourself. Dignity needs to be a part of the equation.
4. Offer foot care clinics at shelters or request to use space at a church or community center.
This can be a great monthly event among nurse friends. You can check for peripheral vascular symptoms, diabetic ulcers, the need for nail trimmings, wash feet, moisturize, offer clean socks, and recommend appropriate medical follow-up. Folks are having it hard enough without adding a missing limb to the mix. I became a WOCN board Certified Foot Care Nurse (CFCN) and travel with my nail trimming tools as part of my amputation prevention initiative.
5. Provide socks.
In the winter, wool cotton socks go a long way at preventing frost bite. The wool cotton hikers found in multi-packs at Sam’s Club or BJ’s have been a great resource for my work. While you’re at it, throw in some winter hats, gloves, and scarves. In the summer, give them cotton blend, moisture-wicking socks with comfort cushion. Remember, there is a lot of walking within this population. Throw in some fabric band-aids for blisters.
6. Give them coffee shop cards.
This will get someone out of the elements and into a place where they are a paying customer. Whether it’s the heat of the summer or cold of the winter, imagine being outside and just wanting to sit somewhere out of the extremes. In New England, we use Dunkin Donuts. Five dollar increments prevent folks from mugging each other for a higher value item. Bear in mind, it can be like Mad Max and the Thunderdome on the streets.
7. Donate feminine hygiene products.
Women affected by homelessness get menstrual cycles. It’s tough going enough without dealing with the need for pads, tampons, and wipes. Donate feminine hygiene products to shelters, offer feminine hygiene products in “benevolent baggies” (see #9). Offer neighborhood pharmacy cards so a woman can choose her own products.
8. No judgement, just help.
Do conscious inner work to extinguish the urge to judge what brings a person to be without a permanent residence. There are married couples who both work full time but still cannot afford to pay rent; there are those who served to protect your freedoms in the military who are now affected by PTSD and cannot support themselves; there are children born into extenuating situations; and there are those who find it safer to be on the streets instead of shelters, and if you knew more, you would understand why. There are those with mental health and addiction issues. While I was offering foot care at a shelter, I learned of a fellow nurse staying there. He was in a terrible car accident, had spinal fractures, could not work, and lost his apartment due to an inability to keep up with the rent. The circumstances are as individual as the person. Take time to listen; everyone wants to be known. When we care for others within compassion, we care for ourselves.
9. Offer “benevolent baggies.”
If you see someone panhandling and you don’t want to offer cash, benevolent baggies (as I call them) are a way to go. You can include whatever you personally would appreciate if you were humbled to having to stand on the street and ask for immediate help. Use a small or large freezer weight Ziploc bag, which works better for those on the street. You can include a coffee shop card, neighborhood pharmacy card, snack bar, water, socks, underwear, feminine hygiene products, a quote you find inspiring that may encourage someone else. I keep a small stack of $5 Dunkin Donuts coffee shop cards in the center console of my car. I know many feel uneasy about giving to panhandlers. I hope this will put it in perspective for you: A woman once said, “I would rather panhandle than sell my body or steal.” Let’s all work toward a healthy society where people do not have to make these types of decisions.
10. Work for social change.
Pick any piece of this huge puzzle and go for it. Ask yourself the bigger questions about this issue. Jump on an initiative with some integrity or start your own. You are smart, caring, and a creative problem solver. You’re a nurse who can facilitate healing far reaching into the community. You don’t need any formal permission to bring that to the world.
When it comes to the current political and social terrain, everyone agrees it’s like a bad case of vertigo. At some point, you’ll discover the Breaking News hang over. You’ll declare it’s time to engage some form of ballast to prevent yourself from getting swept away with every tsunami. It feels like we aren’t allowed to recover from a previous informational shockwave and we are getting hit with the next “almost unbelievable” revelation. At present, we are getting layered with daily compounding stress and trauma. Everything from human rights marches, water protecting, presidential satires, immigration contentions to unveiled conspiracy and corruption. Now add a second helping of Fukashima Cesium 137 radiation and we have the cherry on top of the daily disasters. Before you become the next piece of collateral damage from the daily barrage on your mental, emotional, and spiritual well-being…STOP!
1. Stay centered
Reserve time to reflect on your personal social and political values. If you find yourself needing to change your personal position on something; do it. You’re allowed to change your mind at any time. Knowing that there are some politicians out there that change their views on the daily should release you from any anxiety from taking a firm stance from your personal philosophy. You’ll want to have some certainty about your core beliefs before jumping back into the tempest to get tossed around by a rogue wave between views.
2. Know that there is empowerment with action
Work toward a solution within your own community. Do some research on what initiatives are underway that match your values. No matter how small an action, know many small actions amount to big change. Take a small piece to the very large puzzle. This is a great way to engage and contribute without getting overwhelmed and burnt out. Many hands make work light. Determine what you are most passionate about and seek out the like-minded folks focused on solutions. You may be inspired to start your own initiative toward a better world.
3. Periodically disengage
Give yourself a time limit to keep informed, for instance, 30 minutes in the morning and 30 minutes in the evening. If you’re the type to get glued to media for hours, set a timer and adhere to it. Be kind to yourself and don’t engage in the information mayhem before bed. You clearly want to prevent your mind from reeling and creating a perfect trifecta: fear, anger, and sleep deprivation. Keep a lid on high intensity topics at work and out socially unless it is within the context of a solutions think tank. The days of singing “Isn’t it awful” are over so commit to discarding any notion of an arcane construct that contributes to being stuck in the current state. Giving yourself some breathing room on topics will support a rational perspective.
4. Have a daily stress management practice
Walk/exercise, meditate/pray, laugh, and spend time face to face with friends…whatever gets you to higher ground. We are not made of steel and we are not meant to absorb this much information and vicarious distress. A balanced self-care practice can offset what you’re being exposed to.
5. Remind yourself that we are all part of one global humanity
As nurses, we know we are facilitators of healing, protectors, and advocates. We also know that anyone who has passed the NCLEX is capable of remarkable critical thinking. This is what needs to be elevated to the forefront now. Realize that we are being presented with another vitally important opportunity to put our extraordinary presence to practice for the betterment of all.
It’s a new year and like most folks, you’re probably embarking on an inclined treadmill like the ramp to the SS Fabulous Me. Along with the New Year party favors, gym memberships have been exploding in full spandex regalia.
Before you beat yourself up for …well, just about everything not perfect with your body, read on. Some new information may be just the thing that turns it around for you.
Everyone agrees that it’s a lot easier to maintain health than to chase after it once things go rogue. But, if you’re not in tip top shape and find yourself staring in the mirror vowing swift and definitive action, know that you’re in good company.
Science shows that there is no one nutritional and movement approach that will work for everyone. Why? Hormones, metabolism, and what is consumed matters and can vary greatly between individuals. Determining where your endocrine system is on the spectrum of its complex symphony plays a huge role in how effective your efforts will be. Higher than normal insulin levels from insulin resistance (pre-diabetes or Type II diabetes) tell your body to store fat. High cortisol levels from stress also tell your body to store fat. Sugars go on to be stored as fat. So, the outdated mantra of calories in and calories out will not apply when hormones are not balanced. Those same calories behave differently in a metabolically broken individual than they do in a metabolically sound person.
Everyone agrees across the board that refined sugar is detrimental to all health efforts. Almost 80% of all processed foods in the grocery store have some form of sugar added to it, whether hidden under a stealthy proper noun or announced with a brazen neon label. You must become an informed consumer and your own best health advocate. Consider taking refined sugar out of your diet entirely while you are working on your newest health goals. I know…a herculean undertaking. But, considering you want health rewards, it will be tough to do it with a hijacked brain. If you decide to go the no refined sugar route, you are urged to stay away from artificial sweeteners, which come with a whole other set of problems. Although sugar substitutes are low on the glycemic index, they will still spike insulin.
It may help you to know that different types of sugars are metabolized differently in the body. So, it pays to become acquainted with a bit of biochemistry at the outset. In a healthy, metabolically stable person 120 calories of glucose hums through the system wreaking little to no havoc. On the other hand, 120 calories of fructose (as in high fructose corn syrup) is metabolized very differently than glucose and exactly like ethanol. Because the liver doesn’t like fructose any more than it likes a six-pack of beer, it’s showing up as non-alcoholic fatty liver disease. This is very different from eating a piece of fruit which accompanies its own fiber. Suffice to say, there’s a whole world of biochemical reactions that the average person is not privy to unless you’re sifting through reams of empirical data and reading research journals. Still, these details are important to know as part of the informed decisions you will make about food, movement, and treatment if you find yourself within metabolic disease.
Consider viewing this lecture about sugar by Dr. Robert H. Lustig:
It covers everything you absolutely need to know about sugar. As a big plus, some parts of the biochemistry will exercise your gray matter the way you want to challenge your glutes.
The real skinny according to Dr. Lustig:
Exercise works because it improves skeletal muscle insulin sensitivity.
Exercise works because it reduces stress and the resultant cortisol release.
The TCA cycle runs faster and detoxifies fructose, which improves hepatic insulin sensitivity.
Since it is estimated that one third of Americans will become insulin resistant and may not even be aware of it, they will go on to develop metabolic illness and Type II diabetes. It’s time to know more to help ourselves, our patients, and our families.
Dr. Jason Fung, a nephrologist from Toronto, Canada, has taken a deep and concerning look into the current treatments for insulin resistance and Type II diabetes. He finds that current treatments for Type II diabetes are ineffective at restoring health. He also publishes that Type II diabetes needs to be treated differently than Type I diabetes as they simply are not the same illness. His findings and recommendations have garnered international attention and can be found in his book, The Obesity Code.
If you’re not feeling compelled to read Dr. Fung’s book, you can watch this informative interview that Dr. Mercola held with him about healing your body through fasting:
As you move toward new year health goals, take the following steps:
1. Determine at your starting point if your metabolism is functioning properly or if you are dealing with other considerations. A metabolic or hormonal dysregulation such as insulin resistance, metabolic syndrome, Type II diabetes, and adrenal fatigue will impact the normal processing of energy and fat storage/release.
2. Conduct some personal research, such as the links suggested here and get support from reliable specialists that can help you land on what the best approach is for you.
3. Proceed with online support groups. They go a long way with not having to go it alone and re-invent the stationary bike wheel. The connection to others sailing on the same boat is exceedingly valuable.
Much attention is currently being given to redefining and elevating relationships between coworkers. From the ‘Building Better Communication’ meeting to anti-bullying campaigns; we’re always seeking to identify and evolve into a better way of being. One way we can reign in the good feelings and bring it on into home base is by celebrating others, especially when they are sharing their good news. It boosts morale, it shows appreciation for our coworkers, and it brings some humanity back into our daily lives. If you are wondering how far we have gone astray from the basics, you can take a look-see at the American Nurses Association’s position statement on Incivility, Bullying, and Workplace Violence.
Since the ANA has spoken, I’ve had my radar running on the lookout for ways that nurses can retreat from the dark side and come back to Kumbaya. Recently, I picked up a signal that I’d like to transmit back to the masses. I’ve become aware of a construct created by Shelly Gable, a psychologist and professor at UC Santa Barbara. She is an expert on what makes a good relationship within positive disclosures.
As part of our everyday life, we can have positive life events that we want to share with others: positive disclosures. It’s part of being in a balanced community and creates affirmative bonds. According to Shelly Gable’s construct, there are four ways in which a person can respond when someone shares their good news. One is relationship building; the other three get the big gong of disapproval because they are relationship destroying.
So, follow along with me and my enthusiasm, because today you’ll walk away with a golden nugget in your pocket. It will be an easy, simple skill you can add to your repertoire for being a relationship-upholding individual and someone who coworkers appreciate being around. Hooray for improved relationships with coworkers across the board. Now that’s something to celebrate!
Many people have a natural knack and charisma for positive interactions while others struggle and need the Betty Crocker cookbook type of how-to instruction. Either way, the goal is to be the best version of ourselves for each other, our coworkers, and the people we serve. Taking advantage of what works and feels good makes absolute sense. Moreover, this accessible skill will make you a better friend and family member. So, don’t think twice about spreading the good vibe outside of the work environment, which will only serve to extend the sunshine even further.
In Positive Psychology, there is a handy four quadrant map that indicates where you are with hitting the right mark for being a good citizen in the workplace. On this quadrangle, the goal is to reach for the upper left quadrant: Active Construction.
To elucidate further, here are examples of each communication response type. You’ll want to take some time to practice various scenarios and how you would respond. This will help you in recognizing where you need to make some adjustments in communication response style. Some folks may find that they have already been innately employing Active Construction. Others may realize they are at ground zero and need to learn how to develop more empathy and sincerity. And lastly, there are those that will discover that they need to do some deep inner work to unravel why they cannot be happy for someone else and achieve a genuine Active Construction stance.
Active Construction offers a sincere and enthusiastic response, full of support, eye contact, and a request for elaboration. One gets the sense that they are authentically being celebrated with.
Nurse to coworker: “I just received word that I landed the promotion I was going for.”
Response: “That’s so exciting! I think you are the perfect choice. It was only a matter of time before you were recognized for all your hard work. I’m looking forward to hearing all about it. Let’s celebrate at lunch today.”
Passive Construction carries a low-energy quality in its response. The response can be delayed or quiet. Apathy and insincerity are destructive to relationships, especially in the face of positive life event sharing. One gets the sense that their balloon has just been deflated.
Nurse to coworker: “I just received word that I landed that promotion I was going for.”
Response: “That’s nice. I’m glad for you.” (Coworker makes no eye contact and continues to work on the computer.)
Active Destruction will stifle or extinguish enthusiasm. It can be outright dismissive and demeaning. This can leave a person feeling embarrassed for sharing their news.
Nurse to coworker: “I just received word that I landed that promotion I was going for.”
Response: “Well, that’s just sweet. You realize that’s going to leave us one person short on the unit. Are you sure you’re up for all the extra responsibility since you’ve been so tired lately? Maybe you should re-think this big change.”
Passive Destruction turns the conversation away from the enthusiasm. It can go as far as completely changing the subject without acknowledgment. It has an ignoring and avoidant quality.
Nurse to coworker: “I just received word that I landed that promotion I was going for.”
Response: “That’s right. I remember you telling me you were going for that. Hey, I ended up booking my cruise last night. I’ll be gone for two whole glorious weeks!”
For those who are more visual learners, check out the video below. This is a great way to see this skill in action.
There are many ways we can up our game where social decorum is concerned. It can roll out the red carpet toward a better work environment. Making the conscious effort in the direction of healthy peer bonds and bridging relational gaps will always need our attention. Now you know that when it comes to celebrating others and when someone is sharing good news, always shoot for the upper left quadrant: Active Construction.
Have you ever noticed how many altruistic nurses there are out there in the world or even just in your own community? I’ll bet you dollars to stale breakroom donuts that you’re one of them. It seems as though it’s an inseparable quality inherent in most health care providers. Altruism is a great personality trait to have in many instances. It keeps the compassion in our work evident. It fearlessly upholds our love for our fellow beings and gives us every day heroes to keep our hope in humanity strong. It was likely a driving force that helped move you and many others toward a career in nursing. But once there, have you also noticed how it can be the very detriment to the longevity of it?
By the very selflessness of altruism, one begins to see how it fosters an acceptance of self-neglect and can ultimately wear a nurse down. Don’t let the best of you end up ushering you out of your hard-earned career. After all, if we wish to give our patients and colleagues the best of us, we cannot give from an empty medicine cup. The daily energy depletion from all forms of stress in nursing adds up quickly. You need to be on your toes for yourself, just as you are with your patients or administrative duties. The environments most nurses work in do not support self-care by the very nature of the total demands, so you will have to come forward and be a champion for yourself in all of this.
The good news is that pendulum can come back to center with an empowering consciousness shift. Nurses can certainly thrive while honoring their own needs within their career. Let me show you how by offering a few strategies that will go a long way in keeping you healthy in mind, body, and spirit within your exceedingly high stress career.
Start with the Basics
What follows here serves as a caring reminder, because, let’s face it, we could write the book on this stuff. But there’s something about those whirlwind work hours that somehow make us forget ourselves. Think of me as your best friend reminding you of how important you are.
1. Make time to stay hydrated and make time for the restroom.
Drink plenty of water prior, during, and after your shift. Find a water bottle that makes you tickled in your favorite color or whimsical design. Sponge Bob Square Pants themed? Go for it! The days of nurses holding their bladders for 8-12 hours needs to stop, seriously, today! Check in with yourself hourly and take the 2-3 minutes to visit the porcelain sanctuary when needed. Your bladder matters, you matter.
2. Meal plan in advance of your work week so there is no repeated wasted energy with what and when to eat.
Try not to tell yourself “you’ll figure it out as you go along.” This tends to put yourself last once again and you may not ever come up in queue. Choose high quality foods that are portable and nutrient dense; you are a powerhouse during your shifts and your food choices need to support that. Nix the sugar; it will unplug you faster than anything else. And for the love of all things healing, don’t resort to mutterings when a coworker makes a decision toward self-care. This is not a luxury. Learn sooner than later, that basic self-care in nursing is a priority and a necessity. Being part of an amazing team is great and part of that is respecting individual sovereignty and decisions made for self-preservation within the context of the demands. Support each other always and bring back the normalization of taking a break and having a meal during a work shift. If you are in a position where basic needs are not being honored; it isn’t the right place for you or any human being. Make moves to move on.
3. Lastly, blissful sleep.
So important as you know, but elusive to 50% of Americans. Many nurses have a difficult time forgetting what goes on during their shifts and with the unrelenting demands, many nurses leave fearing they haven’t covered all the bases and the mental list goes on and on until the rooster starts to crow. Add into the mix pre-shift anxiety with nonstop adrenaline surges and you’re dealing with a perfect storm.
Despite all of the bombardment, you’ll need to navigate your way to serenity shores in order to get an optimal eight hours. Being fully functional and keeping your immune system in tip-top shape is non-negotiable. Therefore, quality sleep is an unbreakable deal you need to make with yourself. Commit to remove your mind from the work environment the minute you physically walk out of the door at the end of your shift. Instead, consider taking a walk out in nature; watch a great comedy movie; enjoy being with family, a friend, or pet; express your creative flair with adult coloring books, engage in hobbies; or develop new ones including cooking, photography, knitting, or reading. You get the idea. Just know that if work thoughts start to invade your off time space, kick it down the yard lines like an NFL player, take a deep cleansing breath, and refocus on those things that you love and make life enjoyable. Unwind with healthy options that do not affect sleep quality, such as alcohol or caffeinated beverages. One hour before turning in, disengage from all electronics. Lower lights can ease you into a pre-bed ritual, which can include a bath to help you ramp down. Try augmenting the water with non-toxic bath salts with a couple of drops of an essential oil to the water. Explore unwinding scents such as Lavender, Ylang Ylang, and Bergamot for yourself. Perhaps some light and relevant reading? I recommend A Good Night’s Sleep written by Dr. Brian Luke Seaward.
Relaxation, Breathing, and Movement Will Save You
It’s true, you’ve certainly learned it in nursing school: the ABC’s every living creature needs. When the body, mind, and spirit are in a relaxed state, fully circulating with unrestricted movement, healing and restoration occurs. Instead of bolting out of bed like you’ve been released from the gate at the Kentucky Derby, allow for some time upon awakening to ease into your day. If you arrive to your post amped up on stress you are less likely to be able to easily handle the ensuing compounding stress. Begin and end your day with a variety of options that include meditation/prayer, positive affirmations, guided imagery, and some gentle stretching. Take a couple of initial deep breaths and remember that you are a living, sentient being in need of oxygen. Remind yourself throughout the day to take some deep breaths and shake off all of that shallow breathing.
Import a few yoga moves before getting out of bed, after a shift, and before sleep. These are easy peasy and can be done by almost any exhausted nurse in need of recharging:
Before leaving your bed, try Supine Bound Angle Pose (Supta Baddha Konasana) and Supine Spinal Twist Pose (Supta Matsyendrasana).
Need to silence your barking dogs after a harrowing shift? Move to a modified Waterfall Pose (Viparita Karani). It really is enough to lie flat on your back with your legs resting up on a wall.
Before heading into your next shift, which we all know is like going into battle, take a moment to engage in the Warrior Pose (Virabhadrasana), which will leave your battery juiced up and grounded.
Check out Google Images or Youtube.com for visuals of these elementary and manageable moves. At the very least, you’ll have fun with the names of the yoga poses rolling off of your tongue.
Guided Imagery is Your New Friend
Guided imagery needs to be in every nurses’ stress management repertoire. By going within using custom scripts for relaxation, we can develop a healthy baseline with more resiliency moving through stress and aid in resetting cortisol and adrenaline. This is not only a useful tool for ourselves but can be used in coaching patients through pain, fear, and anxiety. It’s a great way to be there for yourself and your patients in a meaningful way. I recommend anything offered by the forerunner in guided imagery, Belleruth Naparstek. Visit www.healthjourneys.com to learn more.
There are numerous ways that nurses can avoid becoming collateral damage from the stress in their professional environments. Nurses need to explore what pieces of this puzzle work for them personally. Small positive incremental changes add up to create life-affirming routines that navigate away from career-crushing burnout. I’ve provided a starting point. Keeping with internal and didactic wisdom can be there as daily reminders. Sticky notes on your bathroom mirror help as well. Namaste.