Nevada RNformation - March 2011

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Page 16 • Nevada RNformation March, April, May 2021 The Quest for Warm and Fuzzies in the Age of Physical Distancing 20 ways to release oxytocin, many of which do not require you to be in close proximity to another human. Sherry Stofko, MSN, RN I’m a hugger. A long hugger. Sometimes, an uncomfortably lingering hugger. I like to get close to people and really look into their eyes when they talk. I’m not afraid of the “personal bubble.” I prefer to touch another person’s hand while I listen empathetically to their struggles. I share smiles, laughter, and tears. These needs and preferences made 2020 that much tougher to bear. Aside from the unrelenting feeling of uncertainty, the lack of hugging and close physical contact is, for me, the toughest aspect of this pandemic. Close physical connection such as hugs is the core language of compassion and caring (Psychology Today, 2020). Why do embraces, hand holding, and caresses - both platonic and romantic - feel so yummy? Likely it’s the natural release of the neurochemical oxytocin associated with these activities. Let’s look closer at oxytocin, which you undoubtedly learned about in your neuro, endocrine, or OB studies. Oxytocin is a hormone and neuropeptide produced in the hypothalamus and secreted into the bloodstream through the posterior pituitary gland. This neurochemical works in a positive feedback loop and has immediate effects on the brain. It may be most well-known for its role in female reproduction, causing uterine contractions during childbirth and increasing milk supply during lactation. Oxytocin is also known for eliciting feelings of trust, emotional openness, generosity, relaxation, and pain suppression (Wu, 2020). Studies show promise for oxytocin in treating depression and anxiety (Han et al., 2018). Recent research shows that oxytocin has anti-inflammatory and immunosupportive properties and may even be helpful in treating the cytokine storm associated with COVID-19 infections (Imami, 2020). In addition to being generated naturally in the body during childbirth and breast feeding, oxytocin is also released during sexual orgasm, during close physical contact with loved ones, during activities that stimulate skin, while crying, and when feeling empathy for another (Wu, 2020). The warm and fuzzy feeling we get when cuddling an infant or hugging a friend can be attributed to this amazing hormone. Because of these pleasing effects, oxytocin is often grouped with other feel-good chemicals like dopamine and serotonin and has assumed nicknames such as “the love molecule,” “cuddle chemical,” or the “life hormone.” Primary Stroke Center Sherry generating oxytocin holding Zanya and visiting Mom. Seeking Adventurous, Compassionate Nurses Knee Hip Replacement Replacement Spine Surgery Pain Management Chest Pain Center Leapfrog Award Looking for Exceptional Nurses... Northern Nevada Medical Center offers progressive employee programs including a culture of Service Excellence that honors outstanding employee efforts at every level. We provide a generous benefits/compensation package, 401K and tuition reimbursement. You’ll enjoy the innovative approaches to personalized health care in our 124-bed acute care hospital located on a scenic hillside over looking the Truckee Meadows in Sparks, NV. For more information, please call Leah Webb at 775-356-4085 or visit www.nnmc.com/careers. Patient Safety Award So here we are, in this dreadful pandemic that forces us to limit our physical contact with others, isolate in our homes, and certainly not hug or kiss anyone outside our very small quarantine bubble. During daunting times of fear, uncertainly, grief, and sadness, humans rely on connection, hugging, and human contact to sooth the heartbreak (Levoy, 2020). Over the past twelve months, the lack of platonic physical touch has been taking its toll on us in the way of deteriorating mental health and self-esteem; worsening loneliness, depression, and anxiety; and increasing suicide rates (Jha, 2020). “In the 1950s, the University of Wisconsin psychologist Harry Harlow showed that baby rhesus monkeys raised by surrogate mothers preferred one that was made of soft terrycloth but offered no food to one that had food but was made of wire. Touch was more important than food!” (Levoy, 2020). Jha (2020) reports on a Carnegie Mellon University study that demonstrates hugging and interpersonal touch can boost the immune system. In a recent study, mice demonstrated signs of depression and anxiety after only three-to-five weeks of social separation (Han et al., 2018). Need I remind you how long we have been socially isolating? What can we do about the lack of oxytocin on our systems if we still cannot cuddle or even visit extended family or friends? How can we boost our body’s natural secretion of this delightful and pleasing neurochemical, save for giving birth or renting a breast pump? It’s actually a lot easier than you may think to self-generate oxytocin, even when you’re all alone. Oxytocin release is easily triggered during interpersonal physical touch: embracing, holding hands, sex intimacy - orgasms in particular. But we can also have the same effects while receiving a professional massage or pedicure, snuggling a body pillow, massaging your own scalp, or rubbing your own feet (Levoy, 2020). Stroking and cuddling a pet can stimulate the same effects; in fact, research shows that dogs also receive a bump in oxytocin while being petted (Raypoole, 2020). Spending time with friends can increase oxytocin production. Cooking together, listening empathetically, smiling and laughing all lead to higher levels of this feel-good hormone (Power of Positivity, n.d.; Psychology Today, 2013; Wu, 2020). Opening up emotionally, sharing feelings, encouraging others, and saying statements of affection or gratitude can also bump oxytocin levels (Psychology Today, 2013; Raypoole, 2020). Even if the conversation gets heavy, know that crying also stimulates oxytocin production (Power of Positivity, n.d.) and decreases blood levels of the stress hormone cortisol. Connecting on social media and “liking” others’ posts can also create a feeling of connection with others. Sharing meals with others stimulates bonding as well. When preparing the menu, remember dark chocolate and foods containing tryptophan are known to promote oxytocin (Life Coach Code, 2017). Tryptophan-laden foods include chicken, turkey, beef, pork, eggs, fish, tofu, legumes, milk products, nuts, seeds, and oatmeal (Whitbread, 2021). One author suggests vitamin B complex and magnesium supplements may increase oxytocin release (Life Coach Code, 2017). Physical exercise is another way to increase oxytocin release. Swimming, hiking in nature, and dancing to music were specific activities mentioned as beneficial (Raypoole, 2020). Relaxing activities such as soaking in a hot tub, listening to music, spending quiet time alone, practicing gentle yoga, or engaging in a lovingkindness meditation have also been encouraged as ways to generate oxytocin (Life Coach Code, 2017; Power of Positivity, n.d.; Psychology Today, 2013). Finally, get creative! Spending time doing a hobby like knitting, drawing, or playing an instrument has also been shown to increase oxytocin while releasing other fell-good endorphins… added bonus when you give away these created items (Life Coach Code, 2017; Power of Positivity, n.d.). Trying something new, unique, or scary, especially with someone else, will also generate a feeling of bondedness (Psychology Today, 2013; Raypoole, 2020). Putting all this together, I’ve created an itinerary for a day saturated with the “love molecule.” Don’t have a puppy or a friend like “Sam”? No problem: use the power of imagination or practice some self-love. The ‘Rona has profoundly changed the ways we give and receive affection. Hugs, which make us feel safe and loved, are now taboo. Spending time with friends makes us feel less lonely as we navigate this new world but is generally discouraged. Love, safety, connection, trust… these are much needed feelings these days, so it is crucial we practice alternative methods to generate oxytocin and improve our mental health. I believe you can see boosting natural oxytocin levels is much more accessible than you may have realized. Don’t forget to pass these tips onto your family and patients. References: Han et al. (2018). Long-term isolation elicits depression and anxiety-related behaviors by reducing oxytocin-induced GABAergic transmission in central amygdala. Frontiers on Molecular Science. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC6104450/ Imami, A., et. al (2020). Oxytocin’s anti-inflammatory and proimmune functions in COVID-19: A transcriptomic signature-based approach. https://journals.physiology. org/doi/full/10.1152/physiolgenomics.00095.2020 Levoy, G. (2020). The pandemic and the pain of losing touch. https://www.psychologytoday.com/us/blog/ passion/202003/the-pandemic-and-the-pain-losingtouch Life Coach Code (2017). 29 ways to trick your brain to create oxytocin naturally [the love chemical]. https:// www.lifecoachcode.com/2017/06/30/29-ways-tocreate-oxytocin-naturally/ Power of Positivity (n.d.). 10 ways to increase the oxytocin in your body. https://www.powerofpositivity.com/ increase-oxytocin-levels/ Psychology Today (2013). The top 10 ways to boost good feelings. https://www.psychologytoday.com/us/blog/ the-moral-molecule/201311/the-top-10-ways-boostgood-feelings Raypoole, C. (2020). 12 ways to boost oxytocin. https:// www.healthline.com/health/how-to-increase-oxytocin Whitbread, D. (2021). Top 10 foods highest in tryptophan. https://www.myfooddata.com/articles/hightryptophan-foods.php Wu, J. (2020). Why oxytocin is incredible and how to get more of it. https://www.quickanddirtytips.com/healthfitness/mental-health/oxytocin About the author: Sherry is a hospital clinical educator and the CEO of Capricorn Healthcare Consultants. Her passions are emergency medicine, resiliency development, and education. She teaches CEU classes on gratitude, perfectionism, and self-compassion in healthcare and now offers adventure CEU travel trips to Ecuador. www.CapricornHealthcareConsultants.com 2375 E. Prater Way, Sparks, NV 89434
March, April, May 2021 Nevada RNformation • Page 17 INTERVIEW: Through the Eyes of a Nevada Nurse Submitted and Interviewed by Dr. Bernadette Longo, RNFormation Editorial Team “We have to leave our discipline better than the way we found it.” Nurse’s Name: Timothy Martin, BSN, RN Time in Nursing: 9 yrs Practice Location: North Las Vegas VA Medical Center, V.A. Southern Nevada Health Care System Position/Role: ICU Relief Charge Nurse Clients you serve: Veterans in need of critical care services (COVID-19 ICU & regular ICU) What is your typical day like? “Recently, I have been the lead ICU nurse on the non-COVID unit. I work 12-hr days and arrive 30-45 mins early to check my assignment. I have two to three RNs and additional augment staff. The assignments for nurses have gotten heavier as the epidemic’s surge has hit us. So, typically the ICU nurses are taking two ICU patients and two step-down patients, along with having two augment staff to assist them with tasks. A team nursing model is used. I make sure the assignment is balanced and fair. I make sure they’re not overwhelmed.” “As the lead ICU nurse, I have to make myself available for Rapid Responses and Codes that occur both inpatient, outpatient and on the grounds. This happens about 1.5 times per shift. Most of them are either inappropriate activation of the Rapid Response system or some brief resolving issues. But there are persons who experience code whites (strokes), anaphylaxis, heart rhythm disturbances (afib, v-tact) for example, that occur in different departments at the VA.” What has been the impact of the COVID-19 pandemic on your nursing? “So, COVID-19 has made me a better nurse in a number of ways. At the VA we are very fortunate that typically our patient ratios are very low. COVID has changed all that. COVID has reinvigorated my time management and being able to pass on to our younger nurses – the next generation – just these strategies for time management and planning out your day. So, that has made me stronger.” “We are doing a lot of bedside procedures that we never did (trachs, pegs). We are doing a lot more ultrasounds at the bedside looking for DVTs and those microthrombi. My critical thinking skills have sharpened because of all the sequalae and symptoms that these patients experience. One of the earliest practice things I noticed during COVID-19 was when we were sedating or anesthetizing a patient. We are now using these great tools like BIS monitoring (bispectral monitoring for effects of anesthesia on the brain) and Train of four (assesses nerve function in patients receiving neuromuscular blockers). So, we can tell how deep we have these patients. We need to know this considering the risks for delirium and because we know deep sedation increases many risks for these patients. It is part of the bundle of care and will likely continue for all patients needing intubation (standard of practice) going forward.” “Besides my assessment skills improving, there has been more of trusting my gut. Like, we all have those feelings when the patient is going to go south - a bad feeling we are heading in the wrong direction with the patient. Yet, all the numbers contradict the way you feel. Like, it doesn’t look it. But as a bedside nurse, you can just tell that the patient is going to turn and that definite sense that death is standing in the room with you – that you know they are there. I think those two senses - I have become much more aware of them during COVID.” “I had an interesting conversation the other day with a physician. We got a new patient and he just didn’t look good yet his stats and ABGs were OK, but everything was trending flat. He had been improving, but now flat. I said to myself, ‘I just don’t feel good about this.’ So, I called the doc at home and asked that he make his first stop here. I shared my feelings. In 30 minutes, he was on the floor and the patient had turned. I said, ‘Oh you’re here so soon.’ He replied, ‘I was thinking about it and you had never called me at home before.” In your opinion, what is the future for nursing? “The future for nursing is our continuation of the nursing discipline. As we become novice nurses, we take this oath of providing care and being nurses and doing no harm. We need to remember the oath we took. Part of that oath should be furthering the nursing discipline. We have to leave our discipline better than the way we found it. We have to improve it, to grow it and to nurture it.” Why are you still choosing to be a nurse today? “It’s funny, I choose nursing because being a paramedic didn’t pay enough. Now, nursing has chosen me! I could no more turn my back on it than it could turn it’s back to me. Nursing and I are now married to each other. We are very committed to each other. I could not imagine being married to another career. The ability to learn every day, to teach every day, to impact my patients lives either through direct patient care or indirectly by helping develop my nurses and through leadership. I couldn’t imagine choosing another career! Afterthought: Timothy Martin is an Army veteran who defended our country for 14 years. He served in the Bosnia mission as a combat engineer who cleared land mines and rigged explosives. It inspired him to become a nurse. He described that the best “coolest” job in the military was to serve as Team Leader on the Honor Guard. He was the last voice of the military thanking the spouse for their loved one’s service. Today, his coolest memories as a nurse are helping our veterans heal or transition from this life to the next, along with seeing a veteran’s family take them home. He is currently a DNP student at Orvis School of Nursing (UNR) with the goal of becoming an acute care nurse practitioner. Thank you, Tim, for your past and ongoing service! Greater Inclusion of Nursing Students with Disabilities Alyssa Macleod UNLV Level 3 Nursing Student When life gets hard, you fight back harder. When I was born, my parents were told I would never walk, never talk and I would be in a wheelchair for life. Now I am a Level 3 UNLV nursing student trying to help others in similar roles have their voices heard. I’ve been called a hero, a role modelyou name it, and I am none of those things. I am someone who just wants to make the world a little easier for the children of today. GROWING UP RESILIENT I had a seizure shortly after I was born. I was two months early weighing just over four pounds. I did not take my first steps until I was three years old. It is thanks to a selective dorsal rhizotomy [SDR] (a surgery that involved opening my spine and burning some of the nerves leading to my legs) and countless hours of physiotherapy that I am able to walk today. I was born with Cerebral Palsy (CP), the most common motor disability in childhood, according to the Centers for Disease Control and Prevention. It affects my ability to move and maintain balance. While there are different types of CP, the type I have only affects my legs. With the help of Shriners Hospitals for Children in Montreal, Canada, and with many surgeries and Botox treatments in my legs, I defied the odds, and I am proud to say I now walk unassisted, albeit a little differently than everyone else. I have bad days when it’s hard, and my legs don’t want to work. On my bad days when I’m really stiff and falling over nothing, these thoughts run through my head: “Why am I here?,” “What am I supposed to do?,” “Why is this so hard sometimes”? Then I snap out of it and realize how far I’ve come (which isn’t easy for me to do either). LEARNING TO SUPPORT OTHERS Being a disability advocate started in 2014 when I was crowned Miss Canada International. I chose the platform, “Power of Perseverance” (inspiring people with disabilities to reach their dreams). I travelled all over Canada and the USA doing speaking engagements and attending special events as well as visiting hospitals and nursing homes among many others for 15 months. After I was crowned Miss Canada and CP Ambassador, I was asked to talk to parents and young kids with CP. That’s when I first thought maybe I’m supposed to be the light at the end of the tunnel for others. Maybe I’m meant to show them that CP isn’t the end of the world (although it really does suck some days). I still haven’t found my true purpose yet, but I think I’m close. After spending 20 years as a Shriners patient, I knew I wanted a career in healthcare when I grew up. The nurses and doctors at Shriners took such excellent care of me after all my surgeries and treatments; they became my second family. I loved going to my appointments (no one says that, right?). The hospital staff made such an impact on me, and I knew I wanted to give back to a community that has given me so much. But it didn’t come easy. After my reign as Miss Canada ended, I went to medical school in the Caribbean. There, I felt like I didn’t belong. I later found out the school was changing my passing grades to failing grades and forcing me out because they didn’t like that I was disabled. After fighting a losing battle, I returned home to Canada and decided to apply to nursing. I applied twice and was not accepted. The director of the nursing program told me she did not believe I would be able to perform the required duties because of my CP. That’s when I turned to UNLV. AMPLIFYING MY FOCUS AND INNER STRENGTH I applied to UNLV after reading reviews about how great their nursing program was. I was very transparent about my CP, and I got accepted right away, no questions or discrimination. The SON has been the most supportive and amazing people I’ve met in my education journey, and I mean that wholeheartedly. I’ve been fully accepted here, and it feels amazing to have so many faculty and classmates in my corner. For my Community health class, we had to record a video discussing an issue we would like the Nevada State Board of Nursing to address. I chose the topic of greater inclusion of nursing students with disabilities. Due to my experience of being rejected, I felt like the myths of disabilities needed to be addressed. One myth is that since CP affects the brain, many people also believe that people with the disability are not as intelligent. That video evolved into a National Student Nurses Association resolution on the same topic, asking for greater inclusion. A resolution is a motion that is adopted by a deliberative body and can potentially be written into regulation. In my experience, many people think having CP automatically means you are in a wheelchair and are then labelled by society as being less than even if you are not in a wheelchair. The truth is, I can do what everyone else can do. I may do it a little differently and some things may take me a little longer to accomplish but I will do it; all I need is a chance to show you. In my time doing clinical rotations, I have not seen another physically disabled nurse on the floor. I wrote the resolution to bring attention to how disabilities are perceived and to make progress towards changing it. Nurses with a disability have so much to offer, and we can relate to patients in unique ways due to shared experiences. We deserve a chance. We should not be scared to go after our dreams simply because we are afraid of being rejected or being the first disabled nurse on a unit. BE THE FIRST. CHANGE THE STEREOTYPE. UNLV SON has supported and helped me in more ways I can count. They gave me that chance, and it’s my pleasure to help them gain recognition for all they’ve done. It took me a long time to find my place but I’m so happy I didn’t give up. A disability doesn’t define you; you define the disability!
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