A Story of True Courage - 4 Ways to overcome challenges in the boxing ring of life...

Good Morning,

I wanted to share a story with you today of true courage that I'm sure will resonate with many of you who have experienced challenges and adversity in your lives.  For the past ten years the woman in this photo has been battling a non-malignant brain tumor that has taken her to various providers, through many surgeries, bouts of treatment, and has taken part of her physically.  During these difficulties she has remained a picture of strength, showed kindness for others, and looked for ways to reach out to inspire people in their own personal battles.

This beautiful lady (my wife) has shown me how to be a true fighter, and to learn how to break through barriers in our lives.  This journey has been difficult, but has provided the opportunity to grow by clarifying what matters in life.  

4 ways that I've learned from her to break through the barriers in the boxing ring of  life

Be Agile - When life is throwing punches your direction you have to know how to bob and weave, duck, and move around the ring.  Having the ability to change with the various challenges is vital to surviving.  Throughout the years I've seen my wife deal gracefully with being treated poorly at times, staying positive when answers were no where to be found, and continue standing after being hit by a sucker punch that her tumor was back with a vengeance.  Agility is a key component of overcoming the challenges faced when you've stepped into life's boxing ring.

Be Positive - Obstacles will enter into our lives without warning, and we must look at the situation with a hopeful perspective.  It's not an easy task, but holding firm to thoughts that there is the possibility things can change for the better will prevent a defeatist attitude.  During tough times make a list of the positive things in your life, and reflect on how great it is to have these passions, people, and purposes in your life.  When you look through a positive prism it quickly diminishes the size of the obstacle your facing, and you can get off the stool in the corner of the ring and continue fighting.

Be Generous - Meeting the needs of others is an effective way to minimize the negative introspection that can occur when facing difficulties in life that seem overwhelming.  By looking for opportunities to brighten another's day you can gain more than you give.  Generosity will mitigate feelings of sadness, and help to build your confidence that you still have something meaningful to contribute others.  What you have to give may be your talents, a trinket, or your time can create that fan base necessary you need to be successful in the challenges faced in the boxing ring of life.  By putting these valuable resources to use for others you'll be able to go the distance in the prize fight of your life.

Be Victorious - It's the final round, and you must come out swinging to win the fight.  Thinking like a winner will provide the energy necessary to throw the blows needed to knock out the challenges you're facing.  Having the right mindset is essential for becoming a victor.  The next time you face that difficult opponent (challenge) in your life you have to remember the strengths you bring into the Ring of Life.  If someone asked you about yourself could you tell them what makes you special?  To be a victor you have to know with confidence that you're a special person with something to offer this world.  When you step into the ring and can duck when needed, remember the past fights you've won, and believe in the strength you possess then you'll overcome the challenges facing you in boxing ring of life.

“Promise Yourself

To be so strong that nothing
can disturb your peace of mind.
To talk health, happiness, and prosperity
to every person you meet.

To make all your friends feel
that there is something in them
To look at the sunny side of everything
and make your optimism come true.

To think only the best, to work only for the best,
and to expect only the best.
To be just as enthusiastic about the success of others
as you are about your own.

To forget the mistakes of the past
and press on to the greater achievements of the future.
To wear a cheerful countenance at all times
and give every living creature you meet a smile.

To give so much time to the improvement of yourself
that you have no time to criticize others.
To be too large for worry, too noble for anger, too strong for fear,
and too happy to permit the presence of trouble.

To think well of yourself and to proclaim this fact to the world,
not in loud words but great deeds.
To live in faith that the whole world is on your side
so long as you are true to the best that is in you.” 
― Christian D. Larson, Your Forces and How to Use Them

Being Grateful - One of the Keys to Moving Forward in Life...

Gratitude - feeling or being grateful

How often do you stop throughout your day, and think about the good things in your life?  Completing that process is called being grateful.  One definition is “Having a sincere appreciation for both the people and possessions in your life”.  This feeling or emotion is often praised as the "father of all emotion".  I personally believe that most likely stems from the fact that every known major religion has an aspect of gratefulness in their practices.  Believers are exhorted to give thanks for the good in their lives, and in some faiths even in tough challenges.

Why does giving thanks matter?  That may seem like a silly question or not depending on your personal view of this emotion.  Either way, an attitude of gratitude has been proven to be a very beneficial component in the lives of people who remind themselves of the good in their lives.  There are a number of studies that support this concept, and have shown results that include improved health, mood, and better sleep all by saying thank you more often.

Wow!  So, how does someone start to increase the frequency of giving thanks?  I would imagine that each and every person reading this is thankful for many things in their lives, but may not verbalize that gratitude.  Taking the time to focus your mind, and really think about the good in your life is how outcomes improve according to these studies. ( http://www.socialemotions.org/page5/files/Bartlett.DeSteno.2006.pdf )

There are a couple of ways that you can experience the benefits of gratitude:

• Every morning when you wake up say one thing you're grateful for in your life.

• You can split up and say 5 things on one day as well.

• When you return home at the end of the day write down how grateful you are for the events that occurred during you day.

Start small, and see how you feel.  Try doing it every day for one week.  Let me know how it goes.  The nice thing about gratitude or being thankful is it can be a two way street.  You can give and receive, and enjoy the benefits no matter what direction you’re traveling.  Take care.

Dave

Am I losing my mind? - A new breakthrough for many...

Am I losing my mind?  Sadly this often is a question that may be fearfully muttered under the breath of many people.  Maybe its' following a stroke, a traumatic brain injury, a debilitating neurological causing havoc, or the effects that occur after brain surgery.

For years I have had the experience of both personally and professionally dealing with the effects caused by changes that occur when the brain experiences changes in it's function.  It's a difficult thing for any of us to see that person we love slip away, and feel helpless to intervene.  Currently the incidence of both Alzheimer's and Dementia continue to grow each day with our ever-increasing aging population.  In my work with hospice I see and help people that have come to the end of this journey after trying numerous ineffective treatments.  Many of us that have a had a personal experience may ask why or how this happens?  Understanding a challenge is the first step in trying to create a plan to achieve success over the struggle you face.

Brain 101 - A layman's approach to understanding how our brain works

Therefore, how does the brain function and what happens to create the pathway for the onset of both Dementia and Alzheimer's?  First, let's look at what are the parts of our brain and their importance to our cognition and function.

• The cerebrum is the major portion of your brain.  It provides the resource to help with memory, problem solving, thinking, feeling, and controls the body's movement.

• The cerebellum is at the back of your brain under the cerebrum and helps you stand steady while you perform physical actions.

• The brain stem is below you cerebrum and in front of your cerebellum, and connects the brain to the spinal cord.  It is the source of life because it controls our automatic functions that allow us to breath, have a beating heart,  and aids in digestion.

• The brain functions as a result of being nourished with a network of blood vessels that include capillaries, veins, and arteries.  Without the oxygen rich blood the brain cannot exist.

• Next is the squiggly grey matter we see called the cortex.  It is the outermost portion of the cerebrum and is responsible for:

• Sensations - sight, sound, and smell

• Is the problem solving resource 

• Creates and stores memories

• Controls voluntary movement

• Our brains are also divided into two parts called hemispheres - The right and left - the control the opposing side of the body - the left brain is where the conversation truly begins.

• The next portion of the brain is the pathway to action and thought.  Our brains contain billions of little nerve cells called neurons.  These are responsible for transferring information that results in action.  It is this selected pathway that is attacked when a person has Alzheimer's. These cells are joined together, and go into action when an electrical charge is received that releases a chemical.  These chemicals are called neurotransmitters and are the brains messages to create responses in the body. These responses are recorded at the cellular level, and store our memories and thoughts.

  

A Thief in the Night

Alzheimer's is that robber that steals our mind by causing the destruction of those small nerve cells.  As the disease progresses the brain actually reduces in size, and inhibits most every function of the brain.  In the Alzheimer's brain:

• The cortex will shrivel up causing damage to the areas that involve thinking, planning, and memory.
• The shrinkage occurs mainly in the hippo-campus which is the most significant center for memory in the brain.
• Finally, the ventricles in the brain grow larger.

As a result:

• The tissue of a brain with Alzheimer's has fewer nerve cells than a healthy brain.
• Plaque and clusters of protein fragments build up more rapidly between cells blocking the pathways
• The dead and dying cells create structures called tangles that inhibit brain function.

Scientists don't have a specific cause yet for why this occurs in the brains of people with Alzheimer's, but the tangles and plaques are the possible suspects.  Once a person is diagnosed with Alzheimer's the course of the disease is thought to last from 8 to 20 years.  Much like other diseases there is a progression in the severity and symptoms:

• Early stage disease causes effects to occur generally 20 years before it may even be officially diagnosed.  In this phase people experience changes in their memory and problem solving abilities.

• In mild to moderate stages, which lasts 2 to 10 years, the impacts continue creating social challenges because of their increasing confusion.

• The final stage of Alzheimer's may last from 1 to 5 years and causes the brain to shrink which creates the inability to communicate, and most often these people can no longer recognize their own family.

Alzheimer's truly acts as that thief in the night that sneaks into your life, and robs you of your life without much warning.  With such a tragic and stealthy disease it's imperative to do whatever we can as people to protect against losing our mind.  Thankfully, there is some hope on the horizon. 

 

The Key to Unlocking a Better Tomorrow

Currently there are many drugs out there that are being used to help manage the diseaseprocess, but they often are the culprit of causing side effects without much of a result. Thankfully there is something on the horizon that is fast approaching.  

Take a peek at how it works...

The regeneration of our mind

Now think about a world where people wouldn't have to be fearful of aging, and quietly questioning if there losing their mind.  It's time to tackle these degenerative diseases that are causing havoc on so many lives.  Let's take control today.  Join me in preventing that next family from suffering the affects of their loved one's loss in cognition.  

Contact me today to get involved.  Take care, Dave.

Holding the Hourglass – 3 Steps Nurses Can Take to Support End of Life Discussions

Not very many people have an hourglass in their home any more, but for some people as children it represented a fascinating object they watched as the granules drained out into the other side.  Life is similar to that hourglass because the moments of our lives continually drain like the sand, and eventually result in our passing.  Death has become more of a challenging subject to discuss in our culture throughout the decades, and now is often treated like the elephant in the room.  For those of us who call ourselves nurses, it can be something we encounter often in our careers.  Some nurses struggle with the topic of death, and experience angst at having to care for a patient at the end of life.  In order to provide empathetic patient-centered care, nurses need to be comfortable participating in conversations with patients who have end of life needs.  Therefore, it’s imperative that nurses take these 3 steps that will help to initiate end of life discussions with the patients in their care.

1. Seeing the picture – Developing Awareness and Advocacy

What do you see?  In this picture there is an old lady and a young lady.  Just like looking at this picture we can see different things in the patients that are entrusted to our care.  The first step in being successful at approaching end of life discussions is being aware the need exists. 

She was an 89 year old little lady who came in through the Emergency department complaining of back pain, and feeling like she couldn’t catch her breath.  As the team started the work her up for chest pain, she received all the customary evidence-based interventions.  Baby aspirin, IV, EKG, oxygen, and lab work.  When the results came back it was conclusive that she had experienced a cardiac arrest precipitated by a blocked artery.  After speaking with her and her family the decision was made by the surgeon to do bypass surgery.  She was stabilized with medications through the night, and was the first case in the morning.  After she and her family said their tearful goodbyes she was whisked off to surgery.  An hour later the surgeon came out to the waiting room hesitantly, and began to share the news that their mother (“the patient”) had a massive stroke during surgery.  She was now on life support, and sent to the ICU.  Her family was now confronted with the challenging decision about removing her life support or watching and waiting.  Not long after she returned to the ICU her family made the choice to stop the lifesaving interventions, and allowed her to pass away naturally.

This picture is one that many of us have seen all too often.  Chronically ill patients like this come through the hospital doors without truly being offered the care they need or what is appropriate for their condition.  As the nurse caring for these patients, you need to be able to identify these patients in your care.  That means being aware of the trajectory of their disease progression, and the realities of what can actually be done for the patient.  You may not be the one to initiate that conversation or provide the news concerning the prognosis, but as a nurse you must understand the process to be prepared to have end of life discussions with your patients.  Was there another alternative in this case?  Is this what the patient and family wanted?

2. Understanding their Story – Listening to their heart

At the bedside or in any discussion with a patient, nurses must listen to what patients are saying.  It is no different dealing with patients that have a terminal prognosis.  It is important at these times to be acutely aware and tuned in to hear what their heart is saying.  All people have the issue of death in common, and it is often a theme that is natural for people to ponder.  Thoughts that make people think about how it will happen, who will be there when it occurs, or how will it feel?  These are a normal progression of thoughts for people facing mortality.  As nurses we have to be ready for these conversations, and approach them with an empathetic ear.  We have to be willing to put aside our own personal judgments and feelings, so we can be with them in the moment as they start processing their emotions about their death.

A process where they are learning to cope with the challenge they face.  This process was first famously outlined by Swiss Psychiatrist Elisabeth Kübler-Ross in her 1969 book, On Death and Dying, and was inspired by her work with terminally ill patients.  Motivated by the lack of curriculum in medical schools on the subject of death and dying, Kübler-Ross examined death and those faced with it at the University of Chicago's medical school. Kübler-Ross' project evolved into a series of seminars which, along with patient interviews and previous research, became the foundation for her book… The stages, popularly known by the acronym DABDA, include:

1. Denial — One of the first reactions is Denial, wherein the survivor imagines a false, preferable reality.
2. Anger — When the individual recognizes that denial cannot continue, it becomes frustrated, especially at proximate individuals. Certain psychological responses of a person undergoing this phase would be: "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"; "Why would God let this happen?".
3. Bargaining — The third stage involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Other times, they will use anything valuable against another human agency to extend or prolong the life. People facing less serious trauma can bargain or seek compromise.
4. Depression — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point?"; "I miss my loved one, why go on?"
   During the fourth stage, the individual becomes saddened by the certainty of death. In this state, the individual may become silent, refuse visitors and spend much of the time mournful and sullen.
5. Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it."
   In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or other tragic event. People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the individual, and a stable condition of emotions. http://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model

Working effectively with people at the end of life requires an understanding of this process, and being able to listen for the cues to where the person is in their journey.  By knowing the stages you can recognize the emotions the person is displaying, and use that information to initiate a conversation that matches their readiness.  After establishing a trusting dialogue you can be the supportive caregiver that encourages them to make their wishes known to those involved in their care.  Having access to this information is necessary for introducing resources to the patient and family that will support achieving their goals of care by utilizing a patient-centered approach.

Delivering Hope - How an explanation creates a comfortable journey

Patient-centered care according to the IOM (Institute of Medicine) is “Care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions."  Not only must nurses understand their patient’s end of life needs, but they must be knowledgeable concerning the resources available to support their care.  Nurses can explain how resources are available that can address their physical, emotional, and psychological needs. 

Whether you’re in the hospital at the bedside or in the community a nurse’s main role is to provide information to support the understanding of the people they serve.  The end of life journey is difficult for any family because of the realization they experience when they consider the loss of the person they love.  As nurses we can support them in this struggle by painting the picture of the journey.  What will the progression of the disease look like, how will they feel, and what can be done to keep them comfortable?  Explaining that when they hold their loved one’s hand in may be cold or the color may change, they may sound differently when they breathe, or they may say things that don’t make sense.  It’s important for the nurse to normalize the process, and to encourage those involved in their care to express their feelings to the patient. 

Dealing with patients at the end of life can test our personal strength as individuals, but being there to support patients and families at such a fragile time in life is an honor.  Therefore, don’t shy away from having discussions with patients at the end of life.  As their nurse see their need, listen to their story, and deliver the hope they need by being that caring presence that ensures they have a comfortable journey. 

 This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at

This Nurse Wonders. Find out how to participate.

Click here to visit Living Sublime Wellness.

What is the Role that Could Heal Healthcare??? 5 Ways Nurses can be the Answer to Reform

Nurses have a long legacy of caring for our fellow citizens.  From the originator of our profession (Florence Nightingale) to modern day men like me, nurses everywhere hold this privilege to care for the needs of others as what defines us.  The role of the nurse has expanded greatly over the years as our influence has impacted almost every aspect of medicine.  Nurses have become versatile professionals that can be the answer to healing our current system.

Here are 5 ways that nurses could make an impact in changing the face of health care:

We are the Advocates - Currently there is much discussion in health care about empathy and patient centered care, but nurses have been providing a holistic approach that focuses on delivering care to the individual since the Crimean War.  We know what it is to provide dignity in undignified moments, and to care for that patient as your own family.  With this knowledge and experience we serve as the best advocates for knowing what patients and their families need when they're in our care.

We are the Balance - Our schooling requires that we grasp the concepts of what makes a body healthy and sick, but we also come to understand that sometimes the answers may be elusive unless you stop to listen to the patient.  Many of us have learned over the years that patients are the best diagnosticians, and believe that trusting what patients and families tell you versus what may be in a published study or book.  As nurses we provide the balance necessary to humanize medical science, so people are able to receive competent compassionate care.

We are the Continual Presence - Very few other health care professions interact with patients and families like nurses.  We are found in every aspect throughout the continuum, which leads to our thorough understanding of what is necessary to create positive outcomes for those in our care.  We are found at every stop along the path because we care for both those being born and those leaving this world. 

We are the Foundation - Our long and proud history has caused us to be the only discipline who is asked to function in multiple capacities.  At times we may be the social advocate figuring out how to keep the lights on for those we serve, or may be the spiritual presence as we hold the hand of one who's life is moving on.  As the foundational role in medicine we represent the largest number of any health care profession.  Therefore, we need to use our voice to build the foundation of a system that will meet the needs of all we serve.

We are the Answer - Nurses are continually put in autonomous roles where they have to think and lead quickly to save lives and resources.  Most of us are comfortable in these situations, and have used this ability to move into greater roles of responsibility.  Now is the time for nurses to take a more important role in changing health care by becoming the leaders of tomorrow.  We need to provide our expertise in caring for patients, our understanding of what is necessary to give staff the tools to effectively deliver care, and our perspective of what the answers are to creating a system of both quality and satisfaction for those we serve.

It is my duty
Dawn Butler, RN
(Pennsylvania)
I walk through those doors with pride,
Who's life will i save tonight?
Someone is waiting for me,
Someone is alive today because of my duty.
Sometimes we cry cause we can't save them all,
God sometimes won't let us interfere when he calls.
A baby's first breath when he looks at me,
The joy of my first delivery.
The tear i wipe a way with my own hands,
The life ending of a gentle old man.
The night seems so dark and the morning so bright.
Being a nurse you see life in a different light.
Who will i save tonight?
Who will hold my hand during their last breath with no fright?
Who will enter this world on my shift?
How many mothers will greet their babies with a kiss?
I don't know who these special people are
but i will meet them with every call
I will hold them tight and help the pain
I will hold them up when they feel faint.
I will be strong when i am needed
That is my job, I am a nurse..that is my duty. 

My hope is that those who read this believe as I do that nurses can be the positive force to drive change in America's health care system.  I would encourage my fellow nursing professionals that each of us look for new and innovative ways to create a greater impact in our spheres of influence, and step up to the plate if you really want to see things change.  

Take care.   Dave

Thoughts for the Day - An Attitude of Gratitude

An Attitude of Gratitude - How to put things in perspective by being thankful.

​“Acknowledging the good that you already have in your life is the foundation for all abundance.”
Eckhart Tolle


“We must find time to stop and thank the people who make a difference in our lives.”
John F. Kennedy


“Some people grumble that roses have thorns; I am grateful that thorns have roses.”
Alphonse Karr


“Gratitude is not only the greatest of virtues, but the parent of all others.”
Marcus Tullius Cicero


“We should certainly count our blessings, but we should also make our blessings count.”
Neal A. Maxwell

Breaking Addiction to Missiles to Improve Healthcare

“During the Korean War, the Navy kill ratio was twelve-to-one. We shot down twelve of their jets for every one of ours. In Vietnam, this ratio fell to three-to-one. Our pilots depended on missiles. They lost their ‘dog-fighting’ skills.”*

~ Jester, Top Gun, 1986

I remember seeing the movie Top Gun in the mid-1980’s and how this quote struck me … and believe it or not … it has informed much of my work in healthcare.

Fifty-one years ago (1964) the Hippocratic Oath was rewritten by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, to include (excerpts):

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.

… may I long experience the joy of healing those who seek my help.

With this is mind, and in the blog post How a lack of empathy affects our healthcare I made note …

“Thirty years ago, medical schools taught that the most important component of a mental health healing encounter is empathy, human connection, and authentic relationship between a physician and patient.” 

And yet more recently we healthcare leaders have evolved the healthcare delivery system to include:

·         Clinicians triple booked every 15 minutes

·         8 to 12 minute office visits

·         The I-Patient (to borrow from Dr. Abraham Verghese) replacing the actual patient

 

·         Patients being dehumanized and becoming a diagnosis rather than a whole person

·         Clinician focus turning away from the human being before them and toward electronic health records, target organs and test results

·         Technology becoming the solution focus rather than a tool

·         Care teams held to the same productivity standards as clinicians (as noted above) and yet providing less continuity for a patient with “their” clinician

·         A model which rewards excessive tests and invasive procedures

·         Physicians and nurses burningout and worse

We have switched from “dog fighting” i.e. avoiding overtreatment, establishing and ensuring human connection and authentic relationship, and finding joy in healing to “missile dependency” i.e., the “evolved” model described above.

In our effort to make things better we have forgotten why we are here in the first place.  We have sought “missiles” to improve the broken system. We have lost our way. And we are harming those we are honored to serve.

If we truly want to improve the health of our patients, families and communities, it is time to break our addiction to missiles and reconnect with the Hippocratic Oath, what was taught in medical schools thirty years ago, and to our patients, families and communities. 

For only then will we truly innovate healthcare.

It’s not too late and yet long overdue. 

 

 

* As both an animal lover and someone who desires peace this analogy was challenging and yet hopefully lends itself to creating a compelling argument for the need for dramatic change and improvement to our healthcare delivery system.