Midlife Survival Tips

I have compiled suggestions from authors, experts, theorists, spiritual writers, and self-help gurus and websites.

1.  Accept the gift of change. Sometimes we are living in the in-between times: when we’re no longer who we used to be, but we haven’t yet arrived at our next stage either (Williamson,2004). This is often called the “in-between times”. Williamson pointed out that the middle zone is where real change happens. We are always on the road to the next stage whether we are days old or decades old. Williamson summoned us to think of age in the spiritual context rather than the material – the spirit of life is not diminished by time. This is time to deal with issues that we have shelved and pushed back. This is a time for us to make a radical break from our weaker selves, devoting each day to the total elimination of whatever ego energies remain attached to our psyches to ruin our lives (Williamson, 2004).

2.  Prepare yourself for the facts of life. When an individual prepares of normal life events (birth, empty nest, retirement, death) he can often prevent the development of crisis (Schuster & Ashburn, 1992). Francis of Assisi offered this advice to his brothers: “First do what is necessary, then what is possible, and before long you will be doing the impossible.”

3.  Connect with the social convoy. Get connected with your generation cohorts especially members of your clan or extended family. Berger defined social convoy as a group of people who form relationships with an individual through which they guide that person as he/she moves through life.

4.  Protect your free time. Don’t feel guilty of your free time on hand. You need it and you can’t buy it. Use it to reenergize your senses and passions. Give rest and play a purpose and dignity. The major part of music is also silence that is called “rest”. It is a major part of the rhythm and the beauty of life.

5.  Record your soul’s journey. Writing is a way of thinking and rediscovering ourselves in words and meanings as expressions of our deepest emotions. Journaling is healing and helps us work through our negative feelings and letting them go. It makes us see our perspectives in life, a journey of understanding our thoughts especially in difficult moments. Our journals are a vote for our future, a visible sign that what we think and do today really matters, both for now and for posterity (Bellah, 2004).

6.  Find your rhythm. We must find the rhythm that connects us with the rest of creation, the rhythm that allows us to find that sacred balance that gives strength, courage and confidence to be ourselves (Kelly, 1999). Find wisdom from the words of the great Aristotle, “Drink deeply from life’s experiences but know when to quit.”

Overall, aging should be viewed as a normal process marked by changes and new boundaries in which the goal is to maximize all domains, as emphasized by Schuster and Ashman. They further discussed that if a person is well adjusted in younger years, middle age is only a continuation of the “identity search”. These years can be a time of crisis but can also be of reversal and stability (Schuster & Ashburn, 1992). As we reevaluates relationships, lifestyle, career, goals, and personal interests, we discover new energy, insightfulness, attitudes, approaches, and even self appreciation (Schuster & Ashburn,1992). The goal is to view life as a continuum, rather than a last chance. More importantly is to find the rhythm that can lead to self actualization. And that the real fear is of stagnation rather than development. The new adult ideal is an ever-evolving but unified and integrated self, one who keeps alive the energy and adaptability of youth while cultivating the wisdom of age (Schuster & Ashburn, 1992). Midlife is indeed the “old age of youth and the youth of old age.”

Midlife: What is it?

Midlife is referred to by many writers and theorists as middle adulthood, middlescent, middle age, sandwich generation, autumn years, transition age, and middle zone. Berger stated that this development stage occurs between the ages of 35 and 64. It is a time when adults feel healthier, smarter, and more pleased with themselves and their lives during these three decades than they ever did (Berger, 2005). In fact the first astronauts to work with space programs were middle aged scientists between the ages 38 to 45. It was believed that at that stage, they were mentally alert, physically sound, and emotionally stable.

The philosopher Aristotle wrote about midlife (about 50) as the ideal age, the time in life when one is most balanced between the excesses of youth and age. Aristotle called this equilibrium the “golden mean” of life.

Berger described three major aspects of development in middle adulthood: Biosocial, Cognitive, and Psychosocial. Physical changes start to show at this stage especially skin, body shape, hair, and visual acuity. These changes pose challenges in the middle age adults and are usually well compensated. The sexual and reproductive system takes a turn on this stage between late 40’s and 50’s when women experience hormonal changes and menopause sets in. Some intellectual abilities improve with age while others decline (Berger, 2005). According to Berger, each adult become expert at tasks that were once difficult and mysterious. Though, work can be a source of stress and status in the middle age.

Berger said that middle age is characterized by more stability than change in personality. He further discussed that the big five traits: neuroticism, extroversion, openness, agreeableness, and conscientiousness remain stable in middle adulthood, although people tend to become less neurotic and more open.

Family relationships in middle age are more complex. As Freiberg mentioned, these middle age people are often sandwiched between two generations – the aging parents and their adult children. On the contrary, Berger said that middle aged are neither squeezed nor sandwiched but instead are the link that keeps the family connected. Middle age is also between the years of parenthood, personal and career development, and retirement and old age.

Another interesting characteristic of middle age according to Berger is the loosening up of gender restrictions. Sexes become more similar as men and women explore feelings reserved for the other sex which leads to “gender convergence” or even “gender crossover” which is an actual switching of roles.

Some studies support Erik Erikson’s view of increasing generativity during the middle years wherein the middle aged are more involved as coaches, mentors, advisors, teachers, and preachers. Daniel Levinson’s theory suggests that adults experience alternating periods of relative stability and crisis or change (Feldman, 2003).

Fighting the Nursing Shortage

The nursing shortage is multi-dimensional in nature and therefore requires  multi-dimensional solutions.  Huber defines nursing shortage as a disparity between supply and demand of nurses.  In the same token, Huber also organized his solutions in view of increasing the supply and decreasing the demand in order to arrest the imbalance.  It seems like a very simple mathematical equation, but there is more to it than meets the eye.  Huber also discussed the history of nursing shortage and describes it as cyclical reaching its worst bottom in the present era owing to RN’s nearing retirement coupled with the aging population of the Americans (2010).  Yoder and Wise (2007) refers to this as the perfect storm – “A perfect storm exists when conditions come together simultaneously to create an effect with greater impact than any single condition would have alone” (as mentioned by Huber, 2010, p. 701).

What is the main reason for the nursing shortage?  I don’t know if there is one major root of the problem.  I believe that this shortage is a product of previous policies and strategies that successfully solved then problems but failed to look into strategic implications of policies and directions.   It could also be product of trial and error or last ditch efforts in the past.  This is a classic example of good management with bad leadership.  Good management because the country’s healthcare was able to survive with scarcity of resources (managed well enough), but leadership fiasco because of the failure to look into the far future (like the now).

I did a little literature search on this impending shortage and found one very interesting study from the United Kingdom.  On Buchan’s and Aiken’s article, they argued that the international shortage of nurses is not in terms of qualifications but in terms of willingness to work in the present conditions (2008).  In their article entitled Solving nursing shortages: a common priority, they concluded that the main challenge of policy makers is to develop policies that have long term and sustainable solution (Buchan & Aiken, 2008).  Lastly, since healthcare is for the common good, it therefore requires government intervention.

Sources:
Buchan, J., & Aiken, L. (2008). Solving nursing shortages: a common priority. Journal of Clinical Nursing, 17(24), 3262-3268. Retrieved from CINAHL Plus with Full Text database.

Huber, D. L. (2010). Leadership and nursing care management (4th Ed.). Philadelphia: Saunders Elsevier.

Justice and Care

It is hard to separate the concepts of justice and care.  The values of care and justice are the centerpoint of nursing in the Christian perspective.   The roots of nursing trace itself to Christian women who were selflessness enough to devote their time and energy in taking care of the sick.  Care and justice are inherent values we have seen in Jesus – caring for the sick and oppressed while rebuking those who were not in the right track.  Our God is a God of love and mercy.  We are called not only to care but to act with justice to those we provide care and are affected by it.

To find substance in our moral experiences, we need the concepts of care and justice (Doornbos, Groenhout, & Hotz, 2005).  The same authors further wrote that: “We need both concepts to have an accurate sense of who God is and of how to structure our own lives, and if we loose sight of either we end up with distortions in our thinking (p.97).

In view of the current nursing shortage and the changing landscape of the health care, nurses providing care at the bedside are experiencing ‘moral distress’.  We feel that we are not able to take care of our patients adequately because of the nursing shortage (increasing nurse to patient ratio).  “The situation cannot be solved by working harder or more efficiently, so the nurses feel they have no solution” (Doornbos, Groenhout, & Hotz, 2005, p.95).  As Christian nurses, we cannot separate our personal values from our work values, that is why we have to dig deeper into our value system and define it.

Let us go forth and continue to serve…

Change: Be open to it

Change is a big word.  I searched for synonyms of change and found: alter, modify, adjust, amend, vary or even die. My favorite ones were transform or revolutionize.   Pearson et al. talks about change as “the process that brings about alteration in behaviour or substitutes one way of behaviour for another” (2003, p.233).  One very important term that is used in their definition is “substitutes” – a change from one model to another which can be temporary or permanent. Pearson et al. emphasizes the importance of planned change which is easier to manage (2003).

Change is inevitable and constant.  Change happens whether we are ready for it or not.  People change, work change, we change, environments change, roles change, and so do meanings change.  Change is the essence of life.  That is why openness to change is important.  In his book (allegory) Who Moved my Cheese, author Spencer Johnson (1998) simplified the ideal attitude towards change.  Johnson (1998) listed the following:  Anticipate change, monitor change, change with change as quickly, enjoy change, and be ready to change again and again.  Johnson (1998) compared change to cheese when he wrote: “Smell the cheese often so you know when it is getting old.” This to me means constant reflection which leads to understanding and wisdom.  We reflect upon ourselves, upon our environments and relationships and how we affect and are affected by them.  Though, we do not stop there.  We move forward to respond to the changes to make meaningful experiences, and be able to change again.

Openness to change requires unlearning the things we have already learned, learning new ways of doing things, relearning, and applying it in our lives.  If we are able to anticipate change, then change itself is not anymore new to us.  Just like an expected guest, we are prepared for it.

I would like to end this post with a quote from my favorite author, Marianne Williamson (2004), The Gift of Change, and it goes: “Sometimes we are living in the in-between times: when we’re no longer who we used to be, but yet haven’t arrived at our next stage either” (p. 238).

Critiquing theoretical work: Not easy to pursue

Nurses do not pursue critiquing of nursing models for many reasons than one.  Let me mention a few: there is no bottom line, it is just an exchange of scholarly/non-scholarly informed thinking process, no moderator or expert on how to process critiques, very involving in terms of effort ,thinking, and manpower.  Furthermore, there are no tangible outcomes – outcomes are cumulative in nature therefore there is no concrete product.  Critiquing is not pursued by those who are not familiar with the discipline; nurses need education and training, background on concepts and paradigms, an open mind and a systematic approach to simplify the critique process.  Nurses also need clear goals and “buy in” of what and why we critique.  I think most nurses (or people) are afraid of change or indifferent to change, after all, it is an investment of the self.

Nursing is too complicated to reduce into simplistic terms for the purpose of critiquing.  Pearson et al pointed out that “Given the complexity of nursing, it follows that a well-developed model will reflect this and it will be sufficiently rich to encompass the richness of nursing” (2003, p. 228).  Is there any model that fits this criterion? It depends on what nurses and institutions are looking for, or it depends on the direction the nursing team wants to take.  At this point, I am tempted to ask whether nurses take a conscious effort in choosing a model for practice.  Is the workplace culture rich enough to offer different kinds of nursing models that we can choose from?  Is a nursing model pre-chosen by the institution so that nurses just fit themselves into the roles?

Since critiquing is a conscious effort, what is in it for them?  Pearson et al. brought up that as we evaluate these models using a set of criteria, we throw our “own intuitive judgments about their relative values” (2003. p. 225).  However, before we can choose a particular model, we need to investigate and explore our options (Pearson et al., 2003, p.230).  The same authors further cited that before choosing a model “discussion and education” are prerequisites especially before implementing change (Pearson, 2003).

Reference:

Pearson, A, Vaughan, B., & FitzGerald, M. (2003).  Nursing models for practice. (3^rdEd.). St. Louis: Butterworth Heinemann.

Biomedical Model: My views

The biomedical model values knowledge of physical sciences, performance of treatment activities and “cure-directed” actions, healthcare technology, and specialization of functions of healthcare workers. Pearson et al (2005) noted that the biomedical model has influenced the emphasis of nursing on “technical, medically related aspects of the nursing role and to a resulting devaluation of acts related to how individuals experience their own illness…” (p. 52).

Since the biomedical model is traditional and a well developed one, it has paved the way in the development of newer models. Pearson et al (2005) emphasized that this  model is “instrumental” in the development of healthcare workers from being unskilled and uneducated to highly efficient ones; it values objectivity and efficacy (p. 53).   The text, however, noted the restrictive nature of the biomedical model in terms of nursing practice.

My views. My take on the role of biomedical model in contemporary nursing is one of practical application of the model. In my very limited experience in floor nursing, we can’t help but cling to the biomedical model due to the lack of personnel/help and not mention the lack of time. We are driven by things to do or accomplish in our shifts that we could hardly find time to sit and visit with our patients and their families. I think that we are driven not by choice to use this traditional model but because of restrictions and realities that confront us in the real hospital setting, hence, the popularity of this model. Time does not permit us to do actual bedside care (not the skills of meds and dressing change) and we leave it to our nursing assistants who barely have time in their hands. Sometimes we are inclined to believe that the best nurses are those that don’t leave their nursing activities to the next shift, because we too have our own list or priorities unique to our shifts.

This is an interesting age of radical changes in almost all aspects of healthcare. New models challenging traditional ones, technological development, rising cost of healthcare, and new schools of thought among others, will forge the construction of newer nursing models that reflect our time. We are only a part of the whole continuum, and how we act upon our contemporary issues will affect the future of nursing.

Reference:

Pearson, A, Vaughan, B., & FitzGerald, M. (2003).  Nursing models for practice. (3^rdEd.). St. Louis: Butterworth Heinemann.

What is the Future of Nursing Informatics?

What is the future of nursing informatics?  Like my Informatics teacher, Ms. Terri, I am a big fan of dreaming big.  Who isn’t?  So, calling all inventors and investors out there!  Here out some wild suggestions.  In the near future, I would like to see myself being able to use advanced nursing gadgets like handheld medicine scanning system imbedded in a handheld computer (I saw a prototype of this one in COX Hospital), to walk around the floor taking care of my patients with blue-tooth-like (hands-free) equipment on my ear so I don’t have to answer the hand held phone while doing dressing changes.  How about being able to see my patient’s face ( and vice versa) on the computer screen when he/she pushes the call button?   It would be nice if there is an alert to my phone or the nurse’s assistant phone if my patient pushes the call button.  How about eye scanners instead of ID badge swipes?  I can imagine myself doing patient teaching in the patient’s room using multi-media, and for the doctors too.  Most of the time the doctors use the white board or scratch paper to explain surgical procedures done to patients.  It would be nice to get patient assignment summaries like electronic SBAR types that would give us complete, accurate and relevant data about our patient assignments, that is on top of verbal reports.

After all my dreaming, the authors McGonigle and Mastrian remind us that the work of nurses is centered on data, knowledge, information, and wisdom (2009).  They also mentioned that the essence of informatics is the manipulation of data, information, and knowledge in helping us make sound decisions.  The centerpiece is in improving technology to be able to deliver the right care at the right time to the right patients, and not to forget – at the lowest possible cost.

Source:
McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of

knowledge. Sudbury, MA: Jones & Bartlett.

Antiaging: A Webliography

Aging is one of the most researched topics of all time.  For thousands of years, people have searched for ways to reverse, slow, or even stop the aging process.  The truth is that we start aging the moment we are born.  Many ways to slow down or combat the aging process were published i.e. the role of antioxidants, skin care products, exercise, meditation, sleep, less stress, and even surgical approaches.  So what draws everyone to this very elusive work of nature?  Why are investors attracted to this inevitable phenomenon? Can aging be really slowed down, reversed, or even stopped?

I chose this topic because it is one of the most amazing works of nature.  We live to age, and we age to live.  It is quite ironic but true.  Having been raised as an Asian, I have heard of and seen so many antiaging tips.  My grandmother used to rub her skin with pure lemon for rejuvenation, my aunt washes her face with tea (using used tea bags like recycling tea bags), one of my aunts uses coconut milk for soap and shampoo.  I also heard of ladies bathing in ashes and mud.  My best friend’s mom baths in milk (she is very rich to afford this).  My mom’s hair dresser makes faces in the mirror every morning upon rising.  He said that the longer we can stick our tongue out of our mouth, the better antiaging effect.  But I found out that this is not all true.  The trick is to make as many facial expressions as we can because if we just smile, it will create the same lines and eventually turn into permanent indentions or wrinkle-like lines on our faces.  Smoking can also create permanent lines in our faces.  There are many more enlightenment that I actually found with this antiaging research that I ventured into.  I am very glad to share the links with you.

This webliography features websites and databases that help us choose the best ways to take care of our aging process amidst the wide range of talks, articles, and products that are available for antiaging.  These resources that I have chosen reveal valuable data and information about (but not limited to) the aging process, how to make an antiaging plan, skin care products and reviews, predictors of longevity, and antiaging tips and product scams.   One of the links talks about centenarians and how they live their lives to reach 100 years or more.   So can we really turn back the hands of time?  Go as far as you can, and when you get there, you will see farther.  You will see.

These websites are worth visiting for further information:

National Institute on Aging (NIA)
Can we Prevent Aging?

http://www.nia.nih.gov/HealthInformation/Publications/preventaging.htm

 

Tips from NIA on aging.  This article provides an overview of hormones and hormone supplements.  The NIA is urging the public to be skeptical of antiaging approaches but instead to focus on healthy diet and physical activity.  The NIA leads the federal effort on aging research and is one of the 27 institutes of the National Institutes of Health (NIH) which is a part of the U.S. Department of Health and Human Services.

National Institute on Aging (NIA)
Beware of Health Scams
http://www.nia.nih.gov/HealthInformation/Publications/quackery.htm

Features tips on how we can prevent ourselves from health scams and outlines redflags on how to spot fake promotions and products.  Also offers links to Federal and Non-federal resources on product scam information.

Wikipedia
Ageing or Aging
http://en.wikipedia.org/wiki/Ageing

This article features human aging, cultural variations, impact of aging in the society, theories on aging, and prevention and reversal of the aging process.  Wikipedia is a collaborative multilingual encyclopedia that features more than 12 million articles written by volunteers worldwide.  This is a good jumpstart for researching broad topics.  Various links and references are cited in Wikipedia which helps the reader to navigate to more specific and authoritative links, articles, documentaries, and journals.

Documentary
How to Live Forever
http://www.liveforevermovie.com/

Documentary by film maker Mark S. Wexler featuring interviews with centenarians and world’s oldest people.  This site provides links to other longevity websites including the Life Expectancy Calculator.

Society of Actuaries
Living to 100 and Beyond: Search for Predictors of Exceptional Human Longevity
http://www.soa.org/files/pdf/Gavrilova-Report-October-2005-Final.pdf

An article that explores possible predictors of exceptional human longevity such as familial factors, early–life living conditions, month-of-birth, and birth order.  Is life expectancy really predictable at all?

MedlinePlus
MedlinePlus: Antioxidants
http://www.nlm.nih.gov/medlineplus/antioxidants.html

Compilation of links to information and news on these substances that have been studied and tested for their possible health benefits, such as cancer prevention and anti-aging properties.  Includes information about studies of antioxidants in wine, fruits, and vegetables.  Also provides information on supplements, vitamins, minerals, and significant sources.

American Academy of Dermatology
Guides on Choosing Anti-aging products

http://www.aad.org/public/SkinCareonaBudget.html

The largest association of dermatologists with memberships of more than 16,000 physicians.  It represents all practicing dermatologists in the United States and Canada.  This article features top tips on choosing skin care products and anti-aging products.  This website allows extensive topic searches on subjects pertaining to skin care and more.

The U.S. Government Web
FTC Targets Bogus Anti-Aging Claims for Pills and Sprays

This article features the  largest monetary judgment ever obtained in an FTC health fraud case – to settle charges that they deceptively claimed that their pills and sprays would increase consumers’ human growth hormone (HGH) levels and provide anti-aging benefits, including weight loss and increased cognitive function.  Also contains FTC’s position on alleged hype on Human Growth Hormone uses.

What it Means to Know

I learned so many things in my first week of Health Care Informatics class.  First of all I learned to open my Twitter and WordPress accounts.  For the not-so-computer-savvy people like me, this is a huge milestone.  Navigating in these online social media channels is not easy.  I am not ashamed to tell you that I belong to the old school.  I can still remember how our teachers used to show us everything we needed to learn in the classroom setting.  We were physically present in the class, eye to eye.  Goodbye to blackboards and chalk, or whiteboards and markers.  Hello to discussion boards, online exams, virtual classes, Elluminate, Twitter, and blogs.

In this class, I also learned about Clinical Information System (CIS) and Electronic Health Records (EHR).  CIS, as mentioned in our text by McGonigle and Mastrian, is an electronic-based system that embodies a collection of all information about the patient’s medical history, present condition and treatment options.  This tool is not foreign to most leading hospitals and integrated health systems in the country.  Interestingly, I learned that most health organizations today are expanding the use and scope of CIS to include staff training and development i.e. prompts and information in the nursing documentation application.

When I was reading the early chapters that talked about knowledge on page 55 of the text, one phrase struck me the most: “…what it means to know.”  What does it really mean to know in this age of too much information and technology?  The only 2 things that put humans above animals (and I guess computers) are reason and intuition.  The text offers interesting quotes on their meanings.  I think the quote on intuition is worth mentioning here.  Intuition, according to Aristotle as mentioned by McGonigle and Mastrian quoting Shallcross & Sisk is, “The leap of understanding, a grasping of a larger concept, unreachable by intellectual means, yet fundamentally an intellectual process.”  After all, we are still above our computers no matter how intelligent (artificial) they are.

EHR is the comprehensive record of patient encounter history, demographics, problems, and all related care-interventions including outcome reports.  On the question of who owns the EHR?  In my opinion, the patient is the legitimate owner of the EHR.  Why not?  This is all about the patient anyway.  The healthcare institution and the vendor who maintain the system are record keepers.  It is just like how we own our money that we deposit in our bank, and how the bank safeguards our money.  They are co-owners but are limited in access to many extents.  The third-party co-owners are those that need the patient’s information for purposes of finances, medical intervention decisions, public protection, and those who the patients would deem authorized to their information.  There is more to ownership of information and liability than meets the eye in this day and age.

Thanks to my teacher Ms. Terri, who has opened new avenues online.

My sources:

McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of

knowledge. Sudbury, MA: Jones & Bartlett.

Understanding health information privacy. (n.d.) Retrieved March 3, 2010, from

http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html