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Self Care~ Sleeping For Success


Your long and short term success  is impacted by your sleep.  Getting adequate sleep is an essential self care activity that optimizes your potential by detoxing your brain and healing body organs and systems such as your heart and blood vessels.  Let’s look at the new information about how and why getting enough sleep influences your body, mind and emotions. With this information about your precious brain, you may no longer believe and behave as if sleep is negotiable.

Physiology of the Glymphatic System 

Your glymphatic system, similar to the body’s lymph system, removes toxins and metabolites from the brain, while you sleepResearchers have observed that noradrenaline a fight-or-flight hormone is released in bursts when brain needs to become alert. Awake, your brain cells are busy processing information which creates waste products. The cells swell and are consequently closer together. And then, while you sleep there is an increase in cerebrospinal fluid (CSF) to your brain. Your brain’s glia cells, part of the glymphatic system, helps control the flow by shrinking the cells in your brain by 60% during sleep, thereby creating more space between the cells. Your CSF can wash through the brain tissue with greater ease,washing away harmful waste proteins  like beta amyloid and tau proteins, and other molecules that build up between brain cells during waking hours. The glymphatic system carries the waste to the brain’s blood stream, which then transports them into the larger circulatory system to be removed through the liver and kidneys. Upon waking beta amyloid concentrations are decreased. Maybe it is no wonder that when we say “let me sleep on it”, we have a clearer mind to work with upon waking.

Effects of Sleep Deprivation on You Physical, Emotional and Mental Abilities


When you don’t get enough sleep your reflexes are slower, you are at risk for high blood pressure, a weakened immune system, diabetes, low sex drive, heart disease, poor balance and weight gain. Here’s a fun fact: Dr. Helene Benveniste and her colleagues at Stony Brook University School of Medicine discovered that side lying is the best position for ridding the body of metabolic waste.



When you are tired, not getting enough sleep, you are emotionally off balance and your decision making becomes poor. You may experience pessimism, anger, sadness, depression and grumpiness. Sleep deprivation does not feel good and you may find yourself eating for emotional reasons because the chemicals that make you hungry are in excess and chemicals for a healthy appetite are at low levels. Remember, sleep deprivation, taken to extreme, is a form of torture.


You may experience a mental fog if you are not getting enough sleep to detoxing your brain.  Lack of sleep affects both your long and short term memories, which shows up as  forgetfulness. Concentration, creativity and problem solving skills are dulled. Your decision making becomes poor. This is when accidents such as med errors and car accidents are likely to happen.


Ignorant about the importance of sleep, and mistakenly  believing that multitasking was something to be proud of, I once was grazed by a car while working 3rd shift-not paying attention to the lights. Another time,  I called the police because I forgot my daughter was at a class. We all got a good laugh later, but at the time, it was not funny. I was exhausted from not sleeping.  I make better food choices and my dietary habits are healthier when I get enough sleep. In fact in 12 step programs,tiredness can be  a trigger for addictive behavior as indicated by the term HALT ( hungry, angry , lonely and tired). So dear sister or brother nurse, I ask you honestly,  “are you getting enough sleep?”

Getting enough sleep, essential to self care is a helpful tool in both a burnout prevention and burnout healing toolbox. And whether or not you sleep alone, healing happens best in a  community who support you in your self care efforts to develop strong habits that maximize your potential. The next Vitality in Progress- Healing and Preventing Burnout for Nurses Program ( VIP program) starts May 6, 2018. Give yourself the gift of a supportive community and personalized mentoring as you develop a keystone practice that supports your happiness and well-being. Good nurses become great nurses when they take great care of themselves.

Sending blessings to you for deep sleep and sweet dreams~~ waking refreshed, ready to start your day with enthusiasm, creativity and ease.

With love, Padma



Empower Your Self by Addressing Your Eating Issues

For some of us Self care around food and eating creates a conundrum. Competent and successful in most  areas of life, if you cannot stop eating when you are full… or despite knowing a lot about nutrition, you are unable to apply that information, you may have an eating disorder and you are not alone. According to the ANA Healthy Nurse, Healthy Nation website, there are 3.6 million nurses, and we “are less healthy than the average American. Research shows that nurses are more likely to be overweight, have higher levels of stress, and get less sleep.”  Self care supports your ability to respond rather than react to the circumstances of your life. It enhances your sense of integrity with yourself, nourishes your sense of well being and may be reflected in positive self-esteem, having energy, and feeling connected to others. Is self care around the topic of nutrition a huge challenge for you?  If you experience discouragement, shame, confusion and depression related to your weight, if you cannot eat like “normal people” and your weight is unhealthy for you, you may have an eating disorder, and you are not alone.

Eating disorders are now recognized to be both medical and psychiatric and serious health issues. Eating disorders affect men and women, can occur at any time in the life span and the symptoms can be quite varied. It is beyond the scope of this blog to go into the details of the various manifestations eating disorders other than to say Eating Disorder Not Otherwise Specified (EDNOS), has been revised and refined in the DSMV to Other Specified Feeding and Eating Disorder (OSFED). It is applied when an individual’s symptoms cause significant distress but do not fit neatly within the strict criteria for anorexia, bulimia, ARFID , Binge Eating Disorders (BED) or Compulsive Overeating. For most people, admitting to having an eating disorder is difficult and emotionally painful. For some, their eating disorders may be or will become addictions. However, knowing that it is not just a matter of willpower, self control or a moral issue can remove some of the stigma. You have a treatable disease and you are not alone. With support in living with the disease of an eating disorder, you can get help in applying all of the accumulated information you have about healthy eating. You can recover. Your recovery is Self care.

I remember sneaking back to the break room to get more of whatever was in there. I remember staff gatherings where I was paying more attention to the food on the table than to my interesting and caring colleagues who brought in their favorite specialties.  I sensed something was wrong with me because I could not stop eating once I started. I tried many diets and eating behaviors to try to gain control of my intake. Puzzled by this, I eventually began to experience shame as I could no longer manage not only my eating but the weight. Years later, I came to understand that I had an eating disorder.

Here are some of the symptoms of Compulsive Over Eating, BED and OSFED:

  • Regularly eating large amounts of food and unable to stop when you feel full- experiencing a lack of control.
  • A constant concern about food and weight, restricting food and obsessing about caloric intake.
  • Do you meet the diagnostic criteria for anorexia nervosa, but your weight is in the normal range?
  • Meet the diagnostic criteria for anorexia nervosa, but still having your period.
  • Chewing food and then spitting it out, or vomiting to maintain a normal body weight.
  • Eating normally with others and then eat more when you are alone.
  • Sneak eating.
  • Eating quickly so that you can eat more before feeling full.
  • Experiencing embarrassment, guilt, disgust, depression and/or shame over your inability to control your eating after an episode of over eating.
  • Obese and at risk for the consequent health issues of heart disease, diabetes type II, joint and muscle pain, cancer, osteoarthritis etc. and unable to get a handle on getting to a normal weight.
  • Feeling like you are alone with your eating issue.


If you think you might have an eating disorder, you have a number of options. You can discuss this with your primary care provider.  You can check out Over Eaters Anonymous which despite the name, welcomes all who have issues with food by working a 12 Step Program which is “a spiritual solution to a physical problem”, you can do nothing about the issue and of course you will continue to explore the issue until you find a solution that works for you.

 Vitality in Progress: Healing and Preventing Burnout for Nurses is a 9 week program that supports nurses in developing their personalized Self care plan. Some participants have chosen to address their eating patterns in the program. With successful completion of the program, you also receive 39 CNE’s! Check us out, as the next series starts in January 2018 and there is an early bird discount.


In the meantime, Join our  Free Virtual Connecting Weekly Call-in for Nurses

Self Care for Vitality

Phone 712-432-3066                Pin 177444
There is a guided relaxation, followed by a short time for silence in community and optional sharing. We present tips and strategies for Self care on a variety of topics such as:
Setting boundaries, balance, healing, self love, vulnerability, and other topics as they arise.
You can join in with a share or just listen in.           Wednesdays 6:30-7:00 pm EST

Please share with us your experiences of your challenges with healthy eating and the solutions you have found.


Have a beautiful week taking good care of your precious Self by eating healthy foods in moderation.

With love, Padma

Other Resources:

Nurses and Addictions: https://www.drugrehab.com/addiction/nurses/

A Nurse’s Guide to Eating Disorders  http://onlinedegrees.bradley.edu/nursing/dnp/a-nurses-guide-to-eating-disorders/



Facing Your Biases For Better Nursing and Self Care

The nurse role offers you a wonderful way of deepening your experience with others and yourself as you meet your self care needs. “Back in the 1980s, Salman Rushdie wrote that the defining figure of the 20th century was the migrant.” A few month’s ago the institution I work for offered a diversity training which began my awakening to my own unconscious biases. Recently combining HeartMath and a 21 day challenge to increase my experience and understanding of inclusion sponsored by Kindspring.com , I discovered that inclusion involves an intimacy with my own biases.  

Surprised to discover subtle prejudices despite having worked over 40 years with people of many cultures and abilities, I was uncomfortable and also realized that moving out of my comfort zone meant growth. Self care includes the usual physical options such as improving diet, sleep, and exercise, and taking care of emotional and mental education and well-being. More aware of personal biases, I now listen to the news differently and relate to my colleagues and patients with greater sensitivity, showing up with greater authenticity and kindness as a result.

As a nurse you are responsible for knowing, meeting and advocating for your needs. This means dealing with your fears, concerns and biases which can show up as emotional and mental attitudes that reduce the quality of your patient care. The intellectual knowledge that you are helping, can obscure subtle biases, but these times require us to provide optimum care to everyone. We all have biases, and often they are unconscious. There is evidence that when health care providers are not aware of  their biases,  they actually decrease the quality of the care provided. Hospitals and other health care organizations are now required to offer diversity training. The vision of the CMS OMH (Centers for Medicare & Medicaid Services Office of Minority Health) is to eliminate disparities in health care quality and access through the development, implementation and evaluation of programs and policies that incorporate the needs and voices of the populations they serve.  I encourage you to participate in diversity trainings that are offered because they can be illuminating though perhaps initially uncomfortable.

If you don’t have access to diversity trainings, you can discover some biases by honestly exploring your own thoughts and behaviors as you answer the following questions:

Do you speak about people/patients who are not like you, differently when you are in their presence as opposed to outside their hearing?

What are your feelings about a wall between the US and Mexico?

Do you offer your nursing care with an open heart?  What does being open hearted mean for you?

What are your feelings about the LGBTQ people?

What are your feelings about transgender people serving in the military?

What are your feelings about Deferred Action for Childhood Arrivals?

Are you educated about institutional and systemic racism, oppression and white supremacy?

How comfortable are you talking about these issues with others?

You can also learn more about these topics by checking out the following on line sites:

As a nurse you protect those you care for from all forms of harm as if they are a members of your family. Remember, your inner state, your core beliefs make a difference in how you relate to the world and your work. We all act out our unconscious inclusion issues.  Nowadays, in this global community, we in fact are one human family.

If you are experiencing any discomfort, please take time to be kind to yourself and work with it. I invite you to join me in taking the 7 day Bias Cleanse in the next week.

You are welcome to join our Wednesdays
6:30-7:00 pm EST
Free Virtual Connecting Weekly Call-in for Nurses

                   Self Care for Vitality
Phone 712-432-3066          Pin 177444
On this weekly phone call there is a short guided relaxation, followed by a short time for silence
in community and optional sharing
 We present tips and strategies for Self care on a variety of topics such as:
Setting boundaries, balance, healing, self love, vulnerability, and other topics as they arise.
It’s free to all and you can join in with a share or just listen in.

Take good care of your beautiful self this week and always.
With love, Padma

Jump Start Your Life With the Keystone Habit of Journaling

You can transform your life with a keystone habit. A keystone habit is one that influences other aspects of your life. Journaling, a keystone habit, gives you access to your authentic voice. It can be a centering practice and a source of guidance. Stumped for this week’s blog, I am happy to share with you that using one of my keystone habits, journaling, the topic was revealed. Over the years, I have developed a passion for journaling because it helps me in every area of my life. For example,journaling through a divorce and single parenting I maintained a steadiness and clarity that would not have otherwise happened.

Journal and journey have the same root. A deeply personal experience, journaling gives you a chance to relate to the parts of yourself that are clamoring to be heard. By putting your thoughts onto paper- journaling becomes a tool of discovery which can be fun, interesting and informative. It can broaden your understanding of unfolding events, clarifying health, relationship, career issues and whatever else is on your heart/mind. Even 5 or 10 minutes a day of time spent journaling may bring to light surprising options.

Depending upon your intentions, the circumstances of your life and your proclivities, different styles are useful: reflective/contemplative, lists, work notes/accomplishments, observations, gratitude journals, responses to events, letters to a higher power just to name a few. If you don’t like or can’t read your handwriting ~~ no excuse, you don’t have to write! You can use online options. AND/OR, you can use colored pens, pencils, pictures and collage with paper.   

To  start, consider why, how and when you want to journal.  Mornings can be good to set the tone for the day and before going to bed can be a great time for tying up loose ends of the day for a great night’s sleep. If you have concerns about privacy, there are many on line options to choose from. I prefer paper because doodling and glue help me to get to feelings and concepts that are illusive.  You will discover what works for you when you engage this private time with yourself. 

Additionally, you can journal with others.  In 2016 I gave the workshop Wisdom Journaling: Journaling for Clarity and Connection  at the AHNA Convention.  Participants enhanced their personal discoveries by sharing with the group and having others listen without judgement to their journaling discoveries and process. My children and I had fun journaling together and they both use journaling today, 20+ years later.

If you need more convincing to begin your journaling practice, Judy Willis MD, a neurologist, and former classroom teacher explains, “The practice of writing can enhance the brain’s intake, processing, retaining, and retrieving of information… it promotes the brain’s attentive focus … boosts long-term memory, illuminates patterns, gives the brain time for reflection, and when well-guided, is a source of conceptual development and stimulus of the brain’s highest cognition.”

Maybe you are already journaling. Please share with us how you journal. What mediums you use and why? What do you enjoy about journaling?  What are the benefits? How do you work with your need for privacy?

The Vitality in Progress: Healing and Preventing Burnout for Nurses, the 90 day program supports nurses in establishing 3 keystone habits.  Journaling is often chosen as one of the practices in addition to being one of the tools used in the program. The early bird discount has been extended, so if you sign up in the next week, you will be able to not only get the discount, but get support in building 3 keystone habits for your life.

In the meantime, you might want to journal after participating in the 

Self Care for Vitality 

Free Virtual Connecting Weekly Call-in for Nurses           Phone 712-432-3066       Pin 177444

Wednesdays 6:30-7:00 pm EST

There is a short guided relaxation, followed by a short time for silence
in community and optional sharing
We present tips and strategies for Self care on a variety of topics such as:
Setting boundaries, balance, healing, self love, vulnerability, and other topics as they arise.
It’s free to all and you can join in with a share or just listen in.
May your week be filled with clarity, beauty and inspiration.
With love, Padma

If you want to jump start yourself with a challenge:







Savor & Celebrate Each Step Of The Way

As a nurse, you acknowledge and celebrate the successes of others as they learn new skills, improve their healthy behaviors, or do well after a surgery. You may be getting kids to their games, classes or practices and showing up at your partner’s business functions, in addition to preparing meals. You get to work on time or maybe even early. You put in a full day of work possibly receiving accolades for your good work from colleagues and management and then go on to the next activity.

You show up for people and activities that depend upon you, but how are you showing up for yourself?  Are you putting your own needs onto a “back burner”? A word of caution: what’s on your back burner can, over time, cause you to feel frustrated, ashamed, disappointment and become yet another stressor by being an energy drain.

Some time ago, I had a file of cards, letters and pictures that I wanted to put into a book. I had been collecting these mementos for years, and eventually it became a daunting, overwhelming task to even consider addressing. I could feel my energy drain and my spirits drop, when ever I thought of it, so I’d put it back on the back burner. The same would happen when I thought about my living will.

The 4 stage process below is what I used to create my living will and to create a book designed to prevent such a pile up again. With those energy drains gone I began to feel so free. Savoring and celebrating every incremental step in this 4 stage process is the key to successfully decreasing, eventually eliminating your energy drains. You end up not only feeling better and having more energy but your perspective changes as a result of taking better care of yourself.  You actually change your brain, becoming more open to experiencing happiness. I can honestly say I don’t have any Back Burner Energy Drains at this time!

Rick Hanson,  neuropsychologist, author of Buddha’s Brain and teacher reports that our brains can be sculpted. You begin to rebuild the micro-circuitry to gradually shift the emotional shadings of your interior landscape by making positive experiences last by staying with them for 5, 10, even 20 seconds. This is the savoring process. Having a sense of happiness for your accomplishment is a form of celebration which you can do with or without others, enhancing your internal strength.

Savor and Celebrate Each Step as You Eliminate Your Back Burner Energy Drains

  1. Identify your Back Burner Energy Drains: Possibly inadequate sleep, no reflection/down time, poor exercise habits, unhealthy nutrition, a needed education or career move or even attention to your financial future, organizing your mementos, creating your living will…check inside yourself for any others.
  2. Discern which one to begin working on.
  3. Create an action plan of Specific, Small and Scheduled steps to address  that one Back Burner Energy Drain.
  4. Create an accountability process- partner or partners with whom you report, share, celebrate your process.

Delores, was describing her chaotic and hectic day as a prison counselor, where she has worked for over 20 years. She has been developing better ways of caring for herself at work including better food choices and not getting flustered so often. In the middle of her story she mentioned that she went into a safe room, sat down, closed her eyes, withdrew her attention from the concerns and chaos of the work scene and took a 2 minute meditation break. (This was a new behavior for her.) She also spoke with a trusted colleague about what she did.  At the end of the story before going on to the next topic, we spent time unpacking the experience of the new behavior. In that process she was able to more fully appreciate and savor the good feeling and empowerment it engendered.  The new behavior was a win.

Taking time to remember and re-experience it deepened the new neural pathways she is developing as she creates new Self care habits.  Identifying her Back Burner Energy Drain of not caring for herself at work, she started with a small step, acted on it and celebrated by sharing it with people on her accountability team making her stronger for herself and even possibly setting a different and healthy example for her colleagues. Giving yourself credit for your courageous decision to identify your Back Burner Energy Drains is empowering.

*** Savor and Celebrate***
Beginning to address Back Burner Energy Drains
increases your sense of self integrity.

  *** Savor and Celebrate***
Creating  the action plan is a success in its own right
because it is a start.

*** Savor and Celebrate***
Sharing with your accountability partner(s) enhances positive feelings,
the power of your accomplishments, decreases shame and inspires moving forward.

Each step of the way, acknowledging, and celebrating your successes and savoring the feelings makes the positive experiences last longer, changing your neural wiring . In the end your energy is improved from not only reducing the stress of your Back Burner Energy Drains as you eliminate them, but you experience an increased sense of happiness and well being.

The Vitality in Progress: Healing and Preventing Burnout in Nurses has an accountability process built into it and support for your personal celebration as you empower yourself with healthy habits and improved self esteem. Additionally, nurses receive 39 CNE’s upon successful completion along with 3 new healthy Self care habits.

What are your Back Burner Energy Drains? Please share with us your strategies for eliminating them and restoring your vitality.

Have a wonderful week making your positive experiences last longer, celebrating your successes and increasing your happiness and sense of well being.

With love, Padma

By the way, please join us on our weekly phone call.    Self Care for Vitality 

Free Virtual Connecting Weekly Call-in for Nurses   Phone 712-432-3066    Pin 177444
Wednesdays 6:30-7:00 pm EST
There is a short guided relaxation, followed by a short time for silence  in community and optional sharing. We present tips and strategies for Self care on a variety of topics such as: setting boundaries, balance, healing, self love, vulnerability, and other topics as they arise.



The Potency of Self Care Retreats

When was the last time you refreshed yourself with a retreat? Recently I returned to work from a 4 day retreat with a sense of optimism, contentment and emotional fullness as a result of engaging with the nourishing processes that supported my inner wisdom. Retreats and vacations are similar in that you take time away from your normal responsibilities. Both can be uplifting and renewing.  However, whether you take a “staycation” (not going away) or a vacation, the focus is usually outward- new people, places and, new experiences or working on projects in your home environment. The vacation may or may not be structured, and upon return you resume the schedule you left. With a retreat on the other hand,  your focus is inward using contemplation, reflection, meditation, Self or other inquiry, and possibly prayer. Often there is a structure to help you experience parts of yourself that are often not given time to be seen, heard or felt. After connecting more deeply with your Self, you return to your normal work and other responsibilities with greater insight, contentment and a sense of peace. The processes you practice on retreat often continue to nurture and fuel you into the future.

The goal of a retreat is to experience a sense of calm, a sense of oneness with what is, and a deeper experience of love and your inner wisdom.

When are you going to nurture your Self with a retreat?

There are so many kinds to choose from:

healing retreats

mindfulness retreats

nature retreats

retreats with a spiritual teacher

yoga retreats

silent retreats

12 Step Recovery retreats

what will nurture you?

If you don’t feel you can go somewhere and there is nothing locally available,
you can design a beautiful retreat for yourself.

The following are 6 suggestions and examples:

  1. When I had a limited income and my children still lived with me, they went to friends’ houses for a weekend, and I designed a 2 day retreat that included meditation, silence, reading, gardening, walking, journaling and plenty of sleep. I prepared by cleaning and preparing food before the kids left to optimize my inward focus time.  I told friends  I was unplugging- that I’d be in silence and available only for emergencies. This was not a “staycation”. Telling others of my intention was a way of creating accountability. Choosing to detach from all your electronic devices for a day or more can be very challenging, AND a totally nourishing experience after you go through the feelings of withdrawal- the compulsive reaching for your phone, the obsessive chatter in your mind and random feelings of FOMO- “fear of missing out,” which refers to the blend of anxiety, inadequacy and irritation.  Sticking to the intention of being on retreat at the end, was refreshing, wholesome and empowering.
  2. Our local holistic nurses association chapter offers an annual Self care one day retreat in September. It is a day designed for nurses to focus in community on ourselves. Catered and held in a beautiful setting, we meditate, engage in activities such as journaling, coloring and walking a labyrinth with the goal of nurturing the caregiver in us. There are opportunities for us to give and receive healing modalities such as Reiki, Healing Touch, massage and Therapeutic Touch which encourage discovery of joy, beauty and healing inside and outside of ourselves.
  3.  A few years ago a friend and I decided we wanted to share a retreat and to deepen our friendship. We designed a schedule of meditation, walking, and listening to a series of talks by a healer we had heard of. We tent camped in a state park, in silence for a weekend. It rained the full weekend, and except for laughter, we maintained our noble silence and had a memorable, enriching and powerful shared experience of a deeper friendship.
  4. A daily commitment to unplugging from technology for a given amount of time can be a mini retreat with yourself . “A retreat allows the mind to flow freely, to appreciate information and beauty instead of trying to process it. A quiet 15 minutes among nature can act as a personal daily spiritual retreat for some.” Done on a regular basis you can support your inner wisdom, especially if you combine it with journaling.
  5. Join us on our weekly phone call.    Self Care for Vitality
    Free Virtual Connecting Weekly Call-in for Nurses   Phone 712-432-3066    Pin 177444
    Wednesdays 6:30-7:00 pm EST
    There is a short guided relaxation, followed by a short time for silence  in community and optional sharing. We present tips and strategies for Self care on a variety of topics such as: setting boundaries, balance, healing, self love, vulnerability, and other topics as they arise.
    If you have not had a retreat in a while, maybe you want to consider the following:

 6.  Vitality in Progress is a structured, 12 week creative and healing home retreat to focus on your inner being. With our support you create your own Self care plan that invites you to tap into your inner wisdom as you explore the topics of commitment, habits, vulnerability, setting boundaries,  Self love, compassion, kindness and more. The next start date is August 27th, and there is an early registration discount going on now.

How often do you give yourself the gift of a retreat? Do you have a daily practice that feels like a mini retreat for you? Please share with us other types of retreats  you have used and use to nurture yourself.

Please take good care of you. Not only do you need to do so for your own sanity and well being, but your family, friends  and the world we live in wants and needs you to share your gifts and light. You can do this with greater ease by caring for your beautiful Self.

With love, Padma







Four Rivers Endings and Beginnings

We know the quality of one’s nursing practice, the presence and authenticity one brings to those in our care is influenced by our understanding of the events that happen in our lives. How you end your day is as important as how you start your day. You can affect the start of your next day and even your next 24 hours, by your preparation for restoration and sleep.

I am excited to share with you a beautiful new practice I am using that is a nourishing way to end the day. It extends the positives from the day, ties up loose ends so that the next day is truly fresh. Rick Hanson reminds us, that it is as if our brains are Teflon for the positive and Velcro for the negative. If you want to increase the neural networks for the positive, it is important to extend the time you spend with positive and beneficial experiences. You may be doing this during the day as you experience gratitude or moments where you refocus upon your breath, coming back to your center. However, how often do you brush your teeth, plop into bed, fall asleep as your head is hitting the pillow and wake up with an alarm, feet barely touching the ground, as you dash off into the day? I have changed my nighttime routine. I now answer the following 4 questions from Angeles Arien, cultural anthropologist, educator, and award winning author. She speaks of the Four Rivers of life that nourish us and help us to grow.

1. River of Inspiration. What and/or who inspired you today? In what way or how?
2. River of Challenge. What challenged you to leave your comfort zone? Did you accept the challenge?
3. River of Surprise. What “came out of the blue” today for you?
Staying aware of these mysteries of life can help you move in new directions.
4.  River of Love. How or in what ways did love touch you today?

These questions encourage your reflections on the mystery of being alive, discerning what is important and guiding you to explore your own depths. In the process of answering these  questions regularly, you develop a new intimacy with your Self. Angeles Arien says,  “Intimacy  is, ‘Into Me See’ “.

This practice has added focus to my nursing practice and added a new dimension of closeness with my husband as we share our experiences of the Four Rivers. I also discovered one of my biggest challenges is my shyness around “putting myself out there” in the social media world. And, here I am doing it!

By ending your day in this nourishing way, you too may experience good sleep and a rich next day with focus and clarity. It benefits not only you, but your clients, students, colleagues, patients, family and friends. Perhaps you will enjoy your life and daily experiences even more as you open to your Four Rivers- Love, Surprise, Challenge and Inspiration.

Please share with us what comes up for you as you explore the Four Rivers of Love, Surprise, Challenge and Inspiration. How does this exploration affect your nursing practice and your personal life? What does the practice feel like for you?

We support your Four Rivers exploration here:

With love, Padma

Practicing Gratitude is Self Care

Gratitude is a form of Self care that benefits yourself and can be shared. My 22 year old client PS was pouting, sulking and complaining because something he wanted did not arrive in the mail. He was sharp in his responses to his parents who did everything they could think of to cheer him up to no avail. Mindful of what I was experiencing physically, emotionally and mentally as I completed my usual nursing tasks- med administration, trach care, bath, and whatever else was needed, I was acutely aware that this was an emotionally painful situation for everyone.

What a surprise at the end of that day for us all when I asked PS to tell us something for which he was grateful.
PS did not know what I was talking about as he and his parents focus on him, his needs, wishes, wants and health. I defined gratitude and shared mine setting the stage for everyone to share. His parents shyly participated.  PS could not find anything he was grateful for. After a few visits, PS was willing to agree with a gratitude his mom suggested. Over time, he has become willing to think of something he is grateful for at the end of each visit. PS’s physical health has not changed as gratitude does not reverse chronic debilitating, genetic conditions. It can however, influence how he handles the challenges he faces. PS is learning to focus on what is working and to nurture himself a little with the experience of gratitude. Practicing gratitude on the days I am there, seems to bring some emotional balance to the ongoing trials they face individually and as a family.

There is no way to measure what has happened in this home, but it’s my felt sense that there is enjoyment in the sharing. There is an increased sense of intimacy among the family members and myself, and they now have a tool to shift a negative emotional spiral. The Self care tool of gratitude opened the door for more information about the brain and the neuroscience of gratitude, which they seem interested in. I have no idea where this will lead the family over time. In retrospect, for me, it was a matter of Self care to bring it up initially- shifting the focus to something positive.

The topic of self-care is now something that we talk about. The parents still have not changed any of their self-destructive patterns to date. However, they are working on the more subtle dimensions of growth and healing as they deepen and support the neural pathways for happiness in their brains by developing a gratitude practice. Healing happens in its own way, in its own time and sometimes is so subtle it is not measurable.

Please share with us about your gratitude practice. Have you brought it to the bedside? Maybe you practice with your family. Maybe you have been considering developing such a practice.  It is a great way to boost your spirits and move to seeing a half full glass rather than a half empty one. It is an integral aspect of our Vitality in Progress: Healing and Preventing Burnout for Nurses program which begins on May 7, 2017.

It is also a practice we use in the Self Care for Vitality  Free Virtual Connecting Weekly Call-in for Nurses   Join us on our weekly phone call. There is a short guided relaxation, followed by a short time for silence in community and optional sharing. Phone 712-432-3066     Pin 177444

With Love,


Vital Exhaustion

When I heard Roshi Joan Halifax use the term Vital exhaustion I had a visceral experience of recognition. A profound part of me resonated with those two descriptor words which are also a metaphor. Experimenting with the term, trying it on so to speak for the last few months, I am sharing it with you to help you nuance your understanding of where you may be at in terms of Self care, burnout, compassion fatigue and compassion satisfaction. Next week’s blog will address the last 3 experiences and working with assessments of these experiences to begin addressing the symptoms and underlying causes. The term is not new and it has an interesting history, let’s take a peek.

Vital Exhaustion

Metaphors help us articulate and understand our experiences as sentient beings. Merriam-Webster defines vital as, “concerned with or necessary to the maintenance of life”. The term Vital exhaustion touches all of our interpenetrating fields: physical, emotional, mental and spiritual- and maybe especially the last. When I heard the term Vital exhaustion it was as if the spiritual part of me felt heard too.

In the early 1990’s the concept of Vital exhaustion was explored by cardiologists Appel and his associates. They reported three defining characteristics: (1) feelings of excessive fatigue and lack of energy, (2) increasing irritability, and (3) feelings of demoralization that precedes myocardial infarction and sudden cardiac death. “Therefore, it was suggested that Vital exhaustion is a mental state at which people arrive when their resources for adapting to stress break down.” (my italics)

In 2010 it was reported that European psychiatrists have been using the term Vital Exhaustion as a possible way of defining a  nervous breakdown “which is defined by its temporary nature, and often closely tied to psychological burnout, severe overwork, sleep deprivation, and similar stressors, which may combine to temporarily overwhelm an individual with otherwise sound mental functions.”

Research in Heart Math, in “the past two decades has shown that the heart is an information processing center that can learn, remember, and act independently of the cranial brain and actually connect and send signals to key brain areas such as the amygdala, thalamus, and hypothalamus, which regulate our perceptions and emotions.” Though we don’t know where Spirit lives, it is based in a unitive experience and sages refer to the wisdom of the heart. Vital exhaustion seems to relate to the organ of the heart, and to other fields of human experience. Maintaining Vital energy needs to be ongoing and planned. By putting  Self care into my calendar daily it has become a habit. Otherwise, it is easy to act on automatic pilot focusing on lengthy “to do lists” moving to exhaustion and becoming drained of Vital energy.

When you contemplate the term Vital exhaustion, what is your experience? What part of you responds- your mind, body, emotions and/or spirit? Over time you may notice that it takes on different meanings depending upon different stressors in your life and your ability to tune in and care for your Self.

Next week we will contrast Vital exhaustion with burnout, compassion fatigue and compassion satisfaction and look at measuring them. In the meantime, notice your experience of your Vital energy. Can you give it words? What strategies and tools do you employ to manage the stress in your life? What do you do to maintain your Vital energy? Do you take time in nature? Maybe you meditate, pray, journal, spend time with pets… Share with us what do you do to nourish your beautiful, kind, generous, courageous Self?

Some find our   Self Care for Vitality a free Virtual Connecting Weekly Call-in for Nurses a form of nourishing Self care.  There is a short guided relaxation, followed by a short time for silence in community and optional sharing.

Wednesdays 6:30-7:00 pm EST   Phone 712-432-3066 Pin 177444  You are welcome to join us.


Vital Exhaustion, pp 2032-2033, ©2013, Douglas Carroll
, http://link.springer.com/book/10.1007/978-1-4419-1005-9

Benedict Carey, http://www.nytimes.com/2010/06/01/health/01mind.html

Awareness Begins in the Heart, Not the Brain, http://www.mindfulmuscle.com/heart-has-consciousness-knows-before-brain/


Healthcare: A Right or A Privilege

Yes or No: Do you agree with Dr. Martin Luther King, Jr. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

In 1948 the Universal Declaration of Human Rights was created. Article 25 states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”  Wikipedia https://en.wikipedia.org/wiki/Right_to_health

The 115 Congress and President-elect Trump speak of removing the Affordable Care Act (ACA) and privatizing Medicare and Medicaid. As a citizen and a nurse, you are called to consider: is health care a right or is health care a privilege? As a nurse in North Carolina, I see the inequities and feel the pain of the injustice as the state legislature refused to accept the Medicaid expansion funding that came with the ACA. (There are now 1/2 million without health care because of this.) The ripple effect touches every aspect of life in this state. The economy has fewer jobs, an increase of more than 24% of children under 18 living below the poverty level in the last 5 years. There are fewer health care providers and consequently, there is less care provided with the already worn caregivers shouldering more responsibilities. Perhaps most especially nurses…

The National, Economic, Social Rights Initiative writes:

  • The human right to health guarantees a system of health protection for all.
  • Everyone has the right to the health care they need, and to living conditions that enable us to be healthy, such as adequate food, housing, and a healthy environment.
  • Health care must be provided as a public good for all, financed publicly and equitably.

Take a minute and breathe. Contemplate privatizing health care. What are your thoughts and feelings about this? Is there a difference between health care and insurance care? What are the physical, emotional, mental and spiritual costs and benefits of each for our families, friends, our neighbors and the public in general? How does it impact your work?

Dr. Don McCanne

writes a daily health policy update, taking an excerpt or quote from a health care news story or analysis on the Internet and comments on its significance to the single-payer health care reform movement. On January 10, 2017 he commented on an interview of President Barack Obama by Ezra Klein and Sarah Kliff of Vox Video.

He writes:

Virtually everyone wants affordable access to health care, for themselves at least. Most want a better system than what we have under the Affordable Care Act. But the nation is divided as to whether ACA needs to be repealed prior to improving the functioning of our health care financing system.

So the point is that there is broad agreement that we want the system improved, but the Republicans, who are in control, are hamstrung by their anti-government ideology which prevents them from offering the government solutions that we would need that would actually be effective in improving the system.

Repealing ACA would further impair the functioning of our system, so the Republicans would have to introduce effective policies that would more than compensate for the deficiencies that would be created by repeal. Almost any piecemeal solution would require greater regulation and more government spending, anathema to the Republicans. Suggestions to date coming from their camp would leave us worse off than what we currently have. It is no wonder that they refuse to tell us what their replacement proposal would be.

If they really do want to improve the system, and they say they do, then they have two choices. Either provide beneficial tweaks to the current system, which will cost more and require greater regulation, yet fall far short of reform goals, or replace the current system with a single payer national health program – an improved Medicare for all. The latter would greatly improve the financing of health care, ensuring true universality, improved access, greater choice in care, and affordability for each and every individual. And we could do that without increasing spending above our current level.

The Republicans have an opportunity to provide us with a replacement program that would be vastly superior to building on our current dysfunctional system. Both President Obama and President-elect Trump have acknowledged the clear superiority of a single payer system. Most progressives, a majority of moderates and a plurality of conservatives agree. Now all the Republicans need to do is show us.

Engaging in these conversations is not easy. I work with nurses who say, “I‘m not political.”  However,  health care is not a spectator sport. It is about people’s lives- the quality, the safety, and the sanctity of life. If you believe that healthcare is a right, then figuring out how to make it affordable and accessible is a priority and you need to be at least informed and when you are moved by your conscience become active.

Medicare is not perfect, but it has made health care accessible to many of our loved ones. Why not expand it so our full society benefits? The slogan, “Medicare from womb to tomb” gives me hope.

Video: https://www.whitehouse.gov/videos/2017/January/20170106_President_Obama_Interview_with_Ezra_Klein_HD.mp4

Transcript:  https://www.whitehouse.gov/the-press-office/2017/01/06/remarks-president-vox-live-interview

With love,


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