Jan
27

The Holistic Nurse: Nutrition and Health

Photo by Andrea Hubbell Photography

Today’s Holistic Nurse words of wisdom come from Kath Younger, a registered dietitian (RD) and popular food blogger at Kath Eats Real Food. Fun fact: Kath and I are both part of a large Davidson College family – we graduated two years apart! Today she lives in Charlottesville, Virginia where she owns Great Harvest Bread Co. with her husband Matt Monson. I asked Kath to share her thoughts on the relationship between health and nutrition and she graciously took time out of her very busy holiday schedule to contribute. Thank you Kath!

What does it mean to be healthy, in your professional (and personal) opinion?

To mean healthy means that decisions that impact your health in a good way out number decisions that might be detrimental to your health. I think it’s more about effort than a number on a scale and more about what you put in your body than what you don’t. Health to me means choosing to be educated on which food, exercise, environmental, stress, sleep, etc. factors make you feel good and lead to a long happy life.

What inspired you to become an RD?

After graduating from college, I lost 30 pounds through calorie counting, exercise and a focus on eating real food. To be honest, the weight melted off of me. Once I set my mind to it, losing weight was so easy. I reached my goals in about 15 months and learned so much about myself and healthy living along the way. Despite how easy I found weight loss, so many people struggle with their weight. So many yo-yo diet and starve on sugary granola bars and iceberg lettuce. When I set out to become an RD, my goal was to someday open a business where I could show people how easy weight loss can be – and how delicious real food is. Little did I know then that my practice wouldn’t take shape in a office building, but online through creative photography and cooking!

What kind of educational process did you go through to become RD? What kind of continuing education do you need?

Although I had a bachelor’s degree, which was good, I had nothing else needed for the RD requirements, so I had to start from scratch in my program. This mean taking Chemistry 101 – the periodic table, acids and bases – all the boring stuff I learned in high school. But at the same time, I started on my nutrition track and loved the curriculum so much that the sciences were less painful. My 2 years of studies went by SO fast (including a whole summer of summer school). I really enjoyed being a student again, although I’ll admit I had it easier than a few of my classmates who had children or full-time jobs. My internship was most definitely the most challenging part of my degree. It was 6 months, full-time with no vacation days. It was extremely intense, especially since at this point I knew when I finished I would be working for myself as a blogger and opening a bakery with my husband in a different state. But I charged through and am very glad I completed the internship and passed the RD exam!

How can the foods we put in our body affect our health? 

Nutrition is such a young science. Scientists have only touched the tip of the iceberg of all there is to know about the relationship between food and health. There are many epidemiological studies that link whole foods to good health (I did an entire research project on real food while in school!). Yet scientists have trouble isolating nutrients and getting the same effect. I believe that there are hundreds – maybe millions – of nutrients that we have yet to discover, and moreover, processes and interactions between them that work in magical ways. Since we don’t have the answers yet, the best thing we can do for our health is to eat food in the state nature grew it.

What are your short- and long-term goals as an RD?

In the short term I’m hoping to continue writing my blog, which serves as an example of how I fit healthy eating into a busy life and provides recipes made with real food. I’ve written a few science-based articles on nutrition since becoming an RD, and I’d love to find ways to do more of that. Long term, I’m dreaming big with a TV show on healthy living – perhaps a collaborative effort with some of my co-bloggers dedicated to fitness and food. And maybe one day if the blog dries up I’ll open that brick and mortar private practice – or open up on online weight loss consulting business. As of now, though, the blog and bakery eat up most of my time.

Where can people get more information about becoming an RD or about the relationship between food and health? 

Other than Katheats.com you mean!? :) I actually do have a whole post dedicated to becoming an RD and it includes a list of a bunch of other RDs online at the bottom. Eatright.org is the American Dietetics Association’s (soon to be renamed the Academy of Nutrition and Dietetics! ) main site and there a lot of information hidden inside. From Q&As about becoming an RD to research blurbs and position statements on topics, you can find a lot of information inside.

Jan
21

A Year Later

My first annual evaluation at work took place this past week. It was an incredibly affirming, positive experience. My supervisor expressed concern that I would be “snatched away” the minute I got my master’s degree.

After all of the emotion, frustration and questions from the past year, I walked away from the eval with a surprising realization.

I am exactly where I am supposed to be.

My instinct on Day 1 was that I was going to love this work. I’m actually good at this, and my contributions do not go unappreciated. But somewhere along the way, I started feeling like I wasn’t being a nurse. And I started to struggle, holding up my job description to the popular image of nursing, and feeling inadequate.

I am notorious for getting ahead of myself. S calls it “borrowing trouble”. Before I even entered nursing school, I had my heart set on peds oncology. And I pursued this goal ruthlessly. When a job in peds hem/onc didn’t happen for me, I took any acute care position I could find, vowing that if I couldn’t work with kiddos, maybe I could at least find my way onto an oncology unit.

But that hasn’t happened either. And I find myself uniquely suited for the job I stumbled into. It is a great fit for the trouble-shooting, boat-rocking, advocating, relationship-centered type of nursing I have always wanted to do. The type of nursing I couldn’t find in an acute care setting. The type of nursing I probably won’t ever find in acute care.

I have realized that working as part of a multidisciplinary collaborative team is important to me. As are autonomy and creativity.

I confess that despite claiming to be open-minded about my future, I have been setting up informational interviews. I confess that my brain wants to be 100 steps ahead of reality, and that can sometimes be to my detriment. I wax philosophical about being present with my clients when I’m terrible at being present with myself. I’m terrible at being okay in the moment. I am always looking for the next better chance, the opportunity to move up or at least move on.

I’m not claiming goals are a bad thing. It’s wonderful to have your sights set on the future, to keep you going when the going gets tough. The past four years have been a testament to keeping my eyes on the prize.

But they have also been a testament to the value of flexibility and open-mindedness. Rather than resign myself to the job I have now (a job I happen to love), why not embrace the opportunity presented to me and live the fullest life possible? Rather than blame the work I do for becoming jaded, why not look inside and make a shift in my own thinking? What happened to my internal locus of control?

Why keep trying so hard to fit myself into an image of nursing that clearly doesn’t fit me? Why not use the nursing process and nursing skills I’ve attained and fit them to who I am instead? Who says there only has to be one way?

I’ve spent the better part of 31 years feeling unsettled. Untethered. And I think in the midst of becoming a nurse, that discomfort and lack of acceptance has fostered the negativity I am trying so hard to avoid.

So as part of getting over it, here’s my plan: Do what I love. And what I love is empowering, educating and supporting. Wherever I can do that, I will. However I can put these concepts at the center of my nursing practice, I shall.

It’s time to get out of my head and into my life

Jan
17

Naysayer Nurse

One of the unfortunate side effects of four consecutive years in nursing school has been a palpable increase in my own negativity. I’ve always been a – shall we say – passionate person, but the stress and challenges have brought out a whole new side of me. A side I don’t particularly like.

I’m ashamed to admit that this experience got the better of me. I’m not a bad person, but I know what a grouchy, road rage-y, emotional wreck I’ve been more often than not. It hasn’t been pretty. Sometimes I honestly wonder how S deals with it. I’d be done with me times a million if I were him. (Did that sentence even make sense???)

But the light at the end of the tunnel is shining so bright I can actually feel its warmth. Nevermind that it’s snowing outside, I’m basking in the glow of one last semester and a little more than 100 days to go before graduation. And in honor of this momentous occasion, I’m making one more resolution:

Get over it.

I lived by the mantra “It is what it is” during nursing school. And while that helped me accept the things I had no power to change, it also made me rather pessimistic. If this is a year of no excuses, I have to stop making excuses for my own behavior as well.

It won’t be easy. As much as I love my profession, there is a cultural tendency in nursing to behave badly (I don’t get it but it is pervasive)…

(Source)

I met with my advisor this morning. I haven’t really gotten to know her up to this point (we changed advisors when we started our MSN coursework), but we were discussing the difficulties my cohort has had. And she reminded me of something I had previously tried to live by: You can only control your own behavior.

Touché, Professor.

So I pledge to get over it this year. I pledge to remember that many things may be out of my control. But my own response to these things is within my control. And I need to stop self-destructing and start being thankful.

I can’t promise perfection. But I can promise to try harder. :-)

(Source)

Jan
16

The Home Stretch

My final term begins today. And while I’m still trying to figure out what’s next, I am ready to take this semester on.

The good news is we only have two classes this spring, totaling 7 credits. The bad news is one of the classes alone is worth 6 credits (but I guess on the flip side, the other is worth only 1 :-) ) Here’s a rundown of the last two hurdles:

  • CNL Residency – This is the 6-credit behemoth. We have to complete 300 clinical hours (on top of our regular jobs). I accumulated about 20 before the semester began by prepping for my quality improvement project. My goal is to have a big chunk of hours done by mid-March, so that I can focus on data analysis and putting everything together the last month of school. We’ll also be preparing for the CNL certification exam and meeting with advisory committees to ensure that we have met all the CNL competencies. The semester will culminate with a humongous paper and a professional presentation.
  • Integrative Health Leadership – The final in a 3-course series, we’ll be putting everything together. The big assignment of the term will be writing a proposal to incorporate an integrative health modality into our clinical site (we don’t actually have to implement it – just propose the idea).

I’m sure it will be a little rough around the edges. We will all be short on time and energy. But we are so close!

Jan
15

On the Horizon

Monday is the first day of spring term. It’s my LAST first day of the semester! We’re just about to the 100-day mark and I couldn’t be more ready.

Perusing our syllabi, I noticed that we will be doing a lot of preparation for the Clinical Nurse Leader (CNL) certification exam. Which brings me (and many people I know) to the inevitable question: What am I going to do with this degree and this credential?

To be honest, your guess is as good as mine. ;-)

The beauty and the curse about the CNL role is that you graduate equipped with a skill set rather than an advanced practice license. The CNL competencies include such abilities as systems analyst/risk anticipator, clinician, advocate, team and information manager, educator and outcomes manager (see my literature review for more details). The beauty is that you can take this skill set anywhere and theoretically be able to apply what you have learned in a variety of roles. The curse is that because the role can be so broadly applied, there are not many jobs out there specifically for “CNLs”.

Since it’s still a relatively new role in nursing, there is also a lot of confusion and misinformation. Most health care professionals at least generally understand where Nurse Practitioners and Clinical Nurse Specialists fit into the picture. Not so much with CNLs. A lot of people assume we are on track to be managers or health care administrators but in actuality we are supposed to be in the trenches/at the bedside. Very few health care systems have figured out where we fit in at the microsystem level. The VA has embraced the role but different facilities are implementing it at different rates. Virginia Mason Medical Center in Seattle (which is on the cutting edge of pretty much everything) has also successfully integrated CNLs into its workforce.

So for the most part we are paving our own way. Many previous graduates have taken jobs as care coordinators/case managers, unit educators, professional practice leaders, or unit managers. Others are applying the CNL skill set where they were working before they graduated, without a title (or promotion/pay raise) to accompany the skill level. And then there those who have been hired as CNLs where the positions are available.

So the world is apparently my oyster. But the thing about oysters is you have to shuck them to get to the good stuff. In other words, it will take a lot of energy and effort to demonstrate what we can offer to the health care workforce.

Where does that leave me after May 5? I’m taking an optimistic “wait and see” approach…

Jan
14

Write Here

If you love writing as much as I do, I hope you will give some thought to this incredible opportunity. Creative Nonfiction is putting together an anthology exclusively by and about nurses, and they are looking for submissions!

Check out more details here. The deadline is January 31 so get those wheels turning!

Jan
13

The Holistic Nurse: Oriental Medicine

I am absolutely thrilled to be launching The Holistic Nurse with a look at Oriental Medicine. Our guest post is by Kristien Boyle, a practitioner at the Holistic Wellness Center of Charlotte in North Carolina. Kristien is a Diplomat in Oriental Medicine, Chinese herbology and acupuncture. He also keeps a blog, which you can check out here.

What is Oriental Medicine, compared/contrasted with “conventional”/Western medicine?

Oriental medicine is a systematic approach that looks at the  body as a integrated set of systems. We utilize treatment methods such as acupuncture, herbology, nutritional therapy, cupping, and moxabustion to assist our patients. Just like western medicine, the field contains various theoretical ways to look at the body.

Patients regularly come in for the following reasons:

  • Adrenal Disorders
  • Amenorrhea
  • Anxiety
  • Arthritis
  • Auto-Immune disorders
  • Chronic and acute pain
  • Chronic Fatigue Syndrome
  • Depression
  • Digestive disorders
  • Fibromyalgia
  • Hashimoto’s
  • Headaches
  • Hypothyroidism
  • Infertility
  • Insomnia
  • Male and Female disorders
  • Migraines

What kind of educational process did you go through to become an Oriental medicine provider? How can people recognize a credible provider?

I completed a four year masters program and then passed four national  board exams in oriental medicine, acupuncture, herbology and western  biomedical sciences. To find a credible provider go to nccaom.org and look for someone who has completed all four national boards.

How much do your visits cost? Does insurance cover your care?

Insurance does cover care in our field, depending on what state you live in. At my clinic, first visits are $120 and all subsequent visits are $75. I spend 90 minutes with new patients and 60 minutes with returning patients.

 How/when do you collaborate with Western medical providers?

At our clinic, we are in regular contact with all of our patients’ other physicians when necessary. This is especially important if our patients are on an array of pharmaceutical drugs.  We also coordinate lab work with our patients’ other physicians.

Have you ever seen a patient whose needs were outside your scope? What did you do about it?

Sometimes patients come in and after the initial visit, I have declared their concerns are out of my scope of practice, then I refer out to the appropriate specialist.   We offer our patients a list of recommendations for physicians in the area who are open to an integrated approach to medicine.

What kind of evidence is available to support the efficacy of Oriental medicine?

The World Health Organization regularly cites researched publications on oriental medicine and its efficacy. There are countless articles available in research journals, and thousands of years of clinical evidence in China and Eastern Asia.

Where can people get more information? 

Patients can read more about what we do at HolisticCharlotte.com

Jan
11

Sleep? Who Needs Sleep?

Oh, the irony. I go on and on about self-care and then comes my final semester…

I have propelled myself through nursing school with the mantra that “I can survive this…it’s only temporary”. (Not to mention repeatedly chanting “It is what it is.”) But I am a mere 48 hours into my new schedule and have already started questioning my sanity. Requiring 300 clinical hours by mid-April is no joke.

This is what my days will look like for the next few months:

  1. 4:30 am. Alarm clock rudely interrupts whatever I am dreaming about. I drag myself into the shower, throw on the clothes I have set out the night before and kiss a sleeping husband.
  2. 5:30 am-6:30ish. Into my clinical site for morning report. Since my quality improvement project will center around clinical handovers (more on that soon), I have to collect data before we implement the project. Which means being there to catch as many staff as possible at change of shift. After finishing data collection, it will mean being there at change of shift to help the staff adjust to the new process.
  3. Run home, refill my coffee mug and kiss a groggy husband.
  4. 8 am. Report for work. Attempt to make it through the day.
  5. 1 pm – 3 pm (4 out of the next 6 weeks). Slip away to my clinical site for the second change of shift.
  6. 5 pm. Close out my work day and change into gym clothes. If this doesn’t happen at work, it won’t happen at all.
  7. Drive to the gym. Motivate myself on the way with Zumba music.
  8. Power through a class or two.
  9. 8 pm. Return home, kiss a cooking husband, shower and change into scrubs. Eat a delicious dinner on the run.
  10. 9:30 pm – 11 pm. Back to clinical to catch outgoing evening shift/incoming night shift staff.
  11. 11:30 pm. Set out my work clothes and gym clothes for tomorrow. Crawl into bed and curse my alarm clock.

Add to this a monster education project in February that will feature additional evening and weekend hours. And several full days at clinical on my Fridays off. And two (maybe three) conferences between now and the end of April.

Don’t even bother asking about homework…I don’t want to talk about it.

It’s only temporary, right?

Ah, well, it is what it is.

Jan
10

Thank Uncle Sam

The Health Resources and Services Administration (HRSA) recently opened their application window for the Nursing Education Loan Repayment Program (NELRP). This is an incredible loan repayment option, especially for nurses working in critical shortage areas (critical access/disproportionate share hospitals, clinics, government agencies, etc.) and nurse faculty.

This federal program repays you 60% of your nursing student loan balance in return for your commitment to work two years in a critical shortage area or teach at an accredited school of nursing. If you sign on for an optional third year, you get an additional 25% of your loans paid back.

The application cycle for this year ends on February 15. You are notified in late summer/early fall and loan repayment begins soon afterward. Click here for more information and to learn about the application process.

Special Note for Alternate Entry/Graduate Entry nursing students: You must have your nursing degree in hand at the time you apply for this program. That means if you are graduating in 2012 after February 15, you are not eligible. It also means that if you have received your RN license through an agreement between your school and state board of nursing but you do not yet have an academic degree in nursing, you are not eligible either. I learned this the hard way when I applied last year. Save yourself the trouble and wait for that degree.

Jan
09

Mandatory Reporter

The recent child sex abuse scandals involving Penn State and Syracuse University have raised awareness about the importance of reporting. I have recently seen billboards pop up in my city reinforcing the message that “It’s okay to tell”. And one of the repercussions of these scandals has been an energized campaign to pass legislation requiring every adult to be a mandatory reporter of child abuse. A bill about this very issue is currently being debated in the U.S. Senate. Individual states are also highlighting Penn State in efforts to make reporting child abuse mandatory within their own borders.

It’s a difficult, emotional issue, to be sure.

As a health care professional, I am already a mandatory reporter. This means that if I see or suspect abuse or neglect of a child or vulnerable adult (meaning an older adult or someone with disabilities), I am required to report it to my local protective services agency. In my job as a community health nurse, I am often called upon by protective service workers to do home visits and help assess the health status of reported abuse/neglect/self-neglect victims.

But I must say I have mixed feelings about this universal reporting requirement. Had mandatory reporting laws been in place, maybe Mike McCreary would have spoken louder and more vehemently. Maybe Joe Paterno would have pushed harder. Maybe other witnesses of other horrific abuses would have called and reported what they saw if they feared the legal consequences of not doing so.

Or maybe not. The issue of abuse and neglect is not as cut and dry as one might think, nor are the consequences of making such a report. Investigations can be traumatic for the alleged victim. False allegations, even those made with honest intentions, can ruin lives and relationships. And reporting suspicions of abuse or neglect is not clear-cut, either. Some individuals may be quick to report “gut feelings”, while others may want more proof before they refer to an investigative agency. What level of suspicion would be needed to legally require making a report?

I’m not saying Sandusky didn’t abuse those boys – that is a legal matter outside of my scope. If he did commit sexual abuse, I am as appalled and disgusted as everyone else. Let me be perfectly clear: sexual acts performed on an underage child by an adult are not okay. Laying hands on a child is and should be criminal. And those brave individuals who have spoken out about their horrific experiences are testament to the emotional and physical trauma of childhood abuse. The folks I have assessed over the past year, the ones who were hurt so brutally by caregivers and family members they trusted, stay with me today. I can vividly see their faces and recall their stories.

But the act of making an accusation is powerful. And the act of investigating a report is difficult for everyone involved. If every adult in this country was legally bound to report a suspicion, would that not flood the already overwhelmed protective services agencies with referrals and compromise the time and energy they have to investigate true allegations? Would it not delay investigations unnecessarily? The protective service workers I know are already stretched, and every year we hear threats of budget cuts. Can an overworked system handle the influx that would likely result from this legislation? Will lawmakers put their money where their mouth is and fund the agencies adequately to keep up with the demand?

Some people might disagree with my concerns, and point to Penn State and the Catholic Church as prime examples. But the states that already do mandate that all adults report child abuse have had mixed results. Would a national policy really improve this tragic situation?

I honestly don’t know.

What do you think? Have you ever had to report abuse or neglect? Did you base your report on suspicion or did you look for more evidence before making the call? If you want to share your own story, please remember to respect privacy and confidentiality.

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