Guest Bloggers addressing different topics of Self-Care

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Importance of Sleep Quality for Hospitalized Individuals

Sharla Keough, University of Pennsylvania School of Nursing

We all understand how important a good night’s sleep is for our health. We try to incorporate practices into our daily routine in order to help us achieve a high-quality rest to prepare for the next day’s challenges. There is no doubt that restful sleep is a self-care practice, but this seems to be forgotten as a person is admitted into the hospital. Why is it that when a person becomes a patient, all regards for their tranquil night seems to be thrown out the window?

 The activity of sleeping and its effects on the body are not well understood by scientists. However, there are many benefits to sleep that have been solidified by many research studies. These benefits include macromolecule biosynthesis, prophylactic cellular maintenance, removal of toxic substances, reduced stress levels, and decreased inflammation (Vyazovskiy, 2015). These processes are important for any individual, which is why the recommended amount of sleep of seven to nine hours a night should be obtained to receive the full benefits. In our society, there are constant advertisements about improving one’s sleep health, whether that be through a new mattress, aromatherapy, weighted blankets, or some type of natural supplement. As a group, we are consistently trying to improve our sleep health knowing the benefits of this practice. However, in the hospital there is not a clear effort to encourage high-quality sleep for patients. A hospital room can be a sterile and unfamiliar place for patients, which can prevent them from becoming comfortable enough to fall into a deep sleep. Anyone who has to be admitted for a hospital stay will naturally be anxious and fearful, further impeding deep sleep. Furthermore, there are constant flashes of light, loud beeping noises, and constant conversations with healthcare providers in the hallway. If the patient has a roommate, this can be a further stressor to prevent sleep if that patient needs more attention. In addition to these environmental factors, the patient may be repeatedly awoken throughout the night for vital sign values and blood draws. These disturbances for patients can lead to adverse effects, such as alterations in glucose metabolism and decreased cellular immunity (Growdon & Inouye, 2018). These barriers to sleep are especially upsetting considering that this population requires high-quality sleep to regain strength and be discharged.

 Knowing the challenges that patients face in their quest for a good night’s sleep is daunting, but studies have shown that providing interventions for this population is essential in order to improve quality of sleep. In one study, it was found that antepartum patients who received a hospital kit with sleep-improving objects had decreased sleep disturbances and fewer symptoms compared with patients who did not receive this kit (Lee & Gay, 2017). It is important that healthcare workers recognize the hurdles patients face during the nighttime hours and provide interventions that help patients rest more easily. These interventions can include decreased lighting at night, staff training to minimize disruptions, providing ear plugs and sleeping masks, and educating patients about the benefits of sleep (Growdon & Inouye, 2018). Certainly, some medical procedures cannot wait until the morning and must be performed at night, but all non-essential procedures should take place in the morning.

 The first step to combatting interrupted sleep in the hospital is to recognize that it is a prevalent issue and that measures can be taken to decrease these disruptions. If patients are provided with resources to encourage good sleep hygiene, then they will be more aware of the benefits of a good night’s sleep. Sleep is a self-care practice that is overlooked when a person becomes a patient in a hospital, but it is a human need that must be protected in order for patients to heal and achieve an optimum level of health.

References

Growdon, M., Inouye, S. (2018). Minimizing sleep disruption for hospitalized patients: A wake-up call. Journal of the American Medical Association, 178(9): 1208-1209. doi: 10.1001/jamainternmed.2018.2679

Lee, K., Gay, C. (2017). Improving sleep for hospitalized antepartum patients: A non-randomized controlled pilot study. Journal of Clinical Sleep Medicine, 13(12): 1445–1453. Doi: 10.5664/jcsm.6846

Vyazovskiy, V. (2015). Sleep, recovery, and metaregulation: Explaining the benefits of sleep. Nature and Science of Sleep, (7): 171-184. Doi: 10.2147/NSS.S54036

Plant-Based, Whole Food Diet as a Self-Care Regimen

Broke Engelbrektsson, University of Pennsylvania School of Nursing

A trend rising in popularity in the United States and around the world has the animals, environment, and healthcare providers shouting for joy. This trend? Plant-based eating, or veganism for short. In only three years, the number of U.S. consumers identifying as vegan increased 600% (Forgrieve, 2018). As a result, the food industry has been forced to meet the growing demand for plant-based alternatives to animal-based foods. And while food trends such as the South Beach Diet and the Atkins Diet have come and gone, there is a long list of reasons why I hope the plant-based diet is here to stay.

People primarily switch to a plant-based diet for one of three reasons: the animals, personal health, or the environment (Forgrieve, 2018). I wish to discuss the value of eating a plant-based diet for ones personal health, approaching it as a form of self-care for people with or at risk for chronic disease.

When you think of food as a form of self care, you may think of indulgence in sugary or fried foods after an emotional break up or a bad day at work. We’ve all been there before: popping in a McDonalds and picking up a juicy hamburger, milkshake, and fries. Consuming these fatty, sugary foods are an instant and cheap coping mechanism that makes us feel satiated and comforted.

But for a person with chronic disease, utilizing nutrition as a form of self-care looks different from the aforementioned run to McDonalds. The self-care that I am referring to is “the process of maintaining health through health promoting practices and managing illness” (Riegel & Stromberg, 2012). A burger and shake would not be ‘health-promoting’ in any way to a patient with Coronary Artery Disease. What would be health-promoting, however, is adopting a plant-based, whole food (PBWF) diet. There is a growing body of evidence connecting a PBWF diet with prevention, management, and treatment of chronic disease (Debret, 2019). Prescribing patients this diet, as opposed to continuously handing out antihypertensives and statins prescriptions, may be the solution to the United States’ growing incidence of chronic disease and the best form of self-care for these patients.

Top clinicians, researchers, and politicians have admitted that today’s model of healthcare in the United States should be more appropriately named “sick care” (Marvasti & Stafford, 2012).  Although we spend more than any other country in the world on medical care, our country experiences worsening health outcomes and a decreasing life expectancy (Marvasti, Stafford). Cardiovascular disease, cancer, and diabetes account for the majority of deaths and health expenditures. While certain genes can put an individual more at risk for these diseases, diet and behavior, specifically the Standard American Diet and sedentary American lifestyle, hold the most weight in determining if someone will actually develop the disease (Marvasti & Stafford, 2012). The effects aren’t seen only in the adult population; chronic disease risk factors, such as hypertension and hypercholesterolemia, are increasingly seen in younger age groups (HHS Office, & Council on Sports, 2017).

Nurses are constantly encouraging their patients to take an active role in the treatment and management of their diseases. With the growing body of evidence supporting PBWF diet, I can confidently say that this encouragement can and should go far beyond medication adherence.  

Eating whole, nutrient dense foods takes a proactive stance against disease. There are always going to be instances in which patients will need to stay on medication no matter what diet they follow. Type 1 Diabetics, for example, will always need to take insulin. However, I truly believe that if more people adopt PBWF diets, we could slash the amount of money spent on reactive procedures and medications, as well as reduce the number of children and adults diagnosed with chronic diseases.

Some may argue that vegan diets aren’t inherently healthy. All it takes is one look at the packaging of an Impossible Burger or Oreos to see that vegan foods can still be packed full of artificial ingredients, unhealthy fats, and innutritious calories. That is why I specifically advocate for people with or at risk for chronic disease to follow a WFPB diet, which does not include processed ingredients that are found in many vegan alternatives.

The link between diet and chronic disease is undeniable, yet nutrition is a vastly underused treatment in our country. Following a WFPB diet is the epitome of a proper self-care regimen, because it has the power to give patients suffering from a chronic disease the opportunity to take back their own health.

References 

Debret, C. (2019, June 17). How to Practice Self-Care Through Nutrition. Retrieved from https://www.onegreenplanet.org/natural-health/practice-self-care-through-nutrition/

Forgrieve, J. (2018, November 2). The Growing Acceptance Of Veganism. Retrieved from https://www.forbes.com/sites/janetforgrieve/2018/11/02/picturing-a-kindler-gentler-world-vegan-month/#5bdfa88a2f2b

HHS Office, & Council on Sports. (2017, January 26). Importance of Good Nutrition. Retrieved from https://www.hhs.gov/fitness/eat-healthy/importance-of-good-nutrition/index.html

Marvasti, F. F., & Stafford, R. S. (2012). From Sick Care to Health Care — Reengineering Prevention into the U.S. System. New England Journal of Medicine367(10), 889–891. doi: 10.1056/nejmp1206230

Riegel, B., Jaarsma, T., & Strömberg, A. (2012). A Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science35(3), 194–204. doi: 10.1097/ans.0b013e318261b1ba

Urban Greenspace and Mental Health – Lack of Preservation May Negatively Impact Penn Community

Lisbette Hernandez, University of Pennsylvania School of Nursing

 Since its founding year, the University of Pennsylvania has expanded its borders so that its reach pans out much more than its central campus. For new and incoming students unfamiliar with the city of Philadelphia, Penn’s campus is a breath of fresh air. The trees that line Locust Walk, as well as select campus green spaces such as College Green and High Rise Field are a nice respite from the big skyscrapers of center city and the bustling streets throughout. I remember being a baby Quaker myself, and being excited to see so many students lounging around the communal green spaces. There were volleyball games, hammocks, picnics and study sessions. I even caught a couple glimpses of Penn’s Quidditch team running drills on their “brooms.”

 Since starting at this university, I have noticed that students spend far too much time in lecture halls, dormitories, and libraries. Most of our time is spent indoors attending classes, studying, working, and juggling far too many leadership positions and extracurriculars. Although overused, there is inherent truth to this phrase: College is stressful. Being away from the familial support structure, exploring issues of identity and self, struggling with independence, and trying to balance good grades with at least the semblance of a social life. At a high-achieving, competitive school like Penn, these factors seem heightened. By nature of being a Penn student, we place a high value on education, are extremely self-motivated, and strive for academic, social, and monetary success. It should come as little surprise that mental health at this university is both a taboo and a prevalent concern. Since 2013, there have been over a dozen student deaths that have affected the Penn community. Just a week ago, came the tragic and shocking passing of the director of CAPS at Penn. The reality is that whether student or staff, we are immersed in a high-stress environment that makes it difficult to stay afloat without a myriad of support systems and tools that promote to self-care.

Last spring, it was announced that the construction of a new dormitory was in the works, immediately inciting student concern over the elimination of one of Penn’s largest, popular greenspaces. Studies have shown that living in proximity to a natural living environment reduces the risk of health concerns such as cardiovascular disease, musculoskeletal disorders, respiratory diseases, and – as is the focus of this piece – mental illness. Studies support that being in (or even just within view of) green spaces can increase a person’s capacity for better mental health, increase optimism, and enhance recovery from periods of psychosocial stress. Perceived mental health is better when communities have access to green space. Self-care maintenance behaviors related to being in nature and physical activity (Ex: yoga, walking, sports) happen much less when green space is taken away.

 Since children and those living in a lower socioeconomic status are disproportionately affected by lack of urban green space, I would be remiss to only focus on Penn students and staff. Elimination of urban green space affects the Philadelphia community at large. Because of its distance for central campus buildings and its location near the Free Library of Philadelphia, this was one of the few Penn fields open to the community. Kids and teens would spend time there; playing catch or just running around trying to tag each other. During the warm months, radio stations and community organizations could host events. It wasn’t until all this was compromised that I realized just how much need there is for such spaces in West Philadelphia. For many of the area’s residents, this little acre of grass on a college campus was the closest thing to a park.

 Depression and anxiety are two of the most common mental health concerns that Penn students are faced with during their time here. Green space around Penn’s campus will not resolve any individual’s struggle with depression and/or anxiety. It would be unreasonable to expect the University of Pennsylvania to control for all the factors that negatively impact mental health, but there needs to be a greater sense of responsibility to preserving spaces where students, staff, and community members can de-stress and partake in self-care behaviors.  Prioritization and conservation of green spaces on Penn’s campus is a way to support and promote community mental health.

References 

Braubach M., Egorov A., Mudu P., Wolf T., Ward Thompson C., Martuzzi M. (2017) Effects of Urban Green Space on Environmental Health, Equity and Resilience. In: Kabisch N., Korn H., Stadler J., Bonn A. (eds) Nature-Based Solutions to Climate Change Adaptation in Urban Areas. Theory and Practice of Urban Sustainability Transitions. Springer, Cham

Maas, J. et al. Physical activity as a possible mechanism behind the relationship between green space and health: A multilevel analysis. BMC Public Health, Vol. 8, June 10, 2008, p. 206.

van den Berg, A. E. Green space as a buffer between stressful life events and health. Social Science & Medicine, Vol. 70, April 2010, pp. 1203-10.

https://www.who.int/sustainable-development/cities/health-risks/urban-green-space/en/
https://www.healio.com/psychiatry/practice-management/news/online/%7Ba912e0a6-c1b9-49ba-8632-bcc3b3d14c29%7D/urban-green-spaces-appear-to-offer-mental-health-benefits
https://www.nbcnews.com/news/us-news/head-mental-health-services-university-pennsylvania-dies-suicide-n1052156

Maslow Before Bloom: An Overdue Movement

Carly Welsh, University of Pennsylvania School of Nursing

Theodore Roosevelt once said, “People don’t care how much you know until they know how much you care”. School is a central component of our society, and its place in the community is changing- or at least it’s trying to. The days of telling parents to “get their homes in order” and only focusing on intellectual pursuits within classroom walls need to be over. A teacher presenting multiplication to a classroom of children with no concern for their empty bellies, or fear of school shootings, or social isolation can’t motivate their students to learn or thrive in any meaningful way. Many children have barriers to meeting their intellectual needs that are too big to ignore and trying to address their educational needs before their human needs doesn’t work.

 Recently, a call has been booming through the education world and gaining more traction- this is the idea that children must Maslow before they Bloom. Maslow’s hierarchy of needs is a motivational theory of psychological developed by Abraham Maslow which orders human needs in pyramid form to show that the most basic needs must be meet in order for the individual to have motivation to attend to the higher needs on the pyramid. Maslow’s hierarchy places human needs in the following order: Physiological, Safety, Love/Belonging, Esteem, Self- Actualization. Alternatively, Bloom’s taxonomy of education objectives, which shape much of the traditional classroom and curriculum in America, are a set of learning objectives that appeal to the cognitive domain, the affective domain, and the psychomotor domain.

 This movement urges educators to consider that Bloom’s Taxonomy, when considered within Maslow’s hierarchy of needs, falls under the self-actualization category at the very top of the pyramid. This means that we as a society must consider what basic (physiological and safety) and phycological (love/belonging and esteem) need to be met for children before they can be successful in engaging in learning. This movement is primarily being presented in the academic world; however, it is absolutely a public health issue as well. Education is a fundamental social determinant of health, and education outcomes effect the health of our population. While schools can fight to make sure children are fed, have full-time school nurses, feel safe, feel like they belong, feel supported in their accomplishments, and do their best to allow them to thrive in school—children ultimately return to communities with structural barriers to meeting their basic needs which schools alone cannot overcome.

 We know that dropout rates are higher among children from lower-income families. For example, in 2000, young adults whose families were in the lowest 20% of all family incomes were six times more likely to drop out of school then their peers whose families were in the top 20% (Kee-Smith 2006). We also know that feeling safe at school improves relationships at school, which then improves esteem at school, which then allows children to be motivated to excel at school- it’s Maslow’s hierarchy in its most basic form.

 Knowing that continuation of school and success in school have major implications on population health outcomes, we must act to make this possible for all children. Although Maslow’s hierarchy includes self-actualization, not all people meet the basic and psychological needs required to be able to begin the journey to self-actualization. We need to focus on providing children with the tools they need to meet their basic and psychological needs, so that school can be a place where they can focus on learning, growing, and thriving. There are many structural barriers that exist for children, especially children with families with lower incomes, and there is no simple solution to erase these barriers. What we must do; however, is recognize the poor chance we are giving children if we don’t fight to meet these needs. Attention must be turned to helping children have their most basic needs met, so that they can move forward into self-actualization, and “Bloom”.

Cause I Ain’t Got a Pencil By Joshua T. Dickerson

I woke myself up

Because we ain’t got an alarm clock

Dug in the dirty clothes basket,

Cause ain’t nobody washed my uniform

Brushed my hair and teeth in the dark,

Cause the lights ain’t on

Even got my baby sister ready,

Cause my mama wasn’t home.

Got us both to school on time,

To eat us a good breakfast.

Then when I got to class the teacher fussed

Cause I ain’t got no pencil

References

ADDRESSING OUR NEEDS: MASLOW COMES TO LIFE FOR EDUCATORS AND STUDENTS. (2014, February 6). States News Service. Retrieved from https://link-gale-com.proxy.library.upenn.edu/apps/doc/A357891622/AONE?u=upenn_main&sid=AONE&xid=d07d7e34

DeMarco, M. L., & Tilson, E. R. (1998). Maslow in the classroom and the clinic. Radiologic Technology, 70(1), 91+. Retrieved from https://link-gale-com.proxy.library.upenn.edu/apps/doc/A21204686/AONE?u=upenn_main&sid=AONE&xid=ede26b52

Kee-Smith, R. D. (2006). Perceptions of student engagement in relation to school resources: An application of the theory of Maslow’s Hierarchy of Needs. Retrieved October 1, 2019, from https://proxy.library.upenn.edu/login?url=https://search-proquest-com.proxy.library.upenn.edu/docview/304911230?accountid.

Richman, T. (2019, July 30). Viral poem, ‘Cause I Ain’t Got a Pencil,’ was not written by a Baltimore student. Retrieved from http://www.baltimoresun.com/news/breaking/bs-md-ci-cause-i-aint-got-a-pencil-20180213-story.html.

Tikkanen, I. (2009). Maslows hierarchy and pupils’ suggestions for developing school meals. Nutrition & Food Science, 39(5), 534–543. doi: 10.1108/0034665091099219