Improving Your Work-Life Balance – Make it a Goal

By Misty Kevech, HHQI RN Project Coordinator

stressed nurseAre you asking yourself the question, “Where did the summer go?” It seems like just yesterday when you were making plans for this summer to relax and get some quality downtime. I know, I made plans to eat lunch away from my computer four days a week (being practical), but soon realized that I continually needed to reduce that goal all summer. I think I can confidently say that I did take lunch away from my computer and eat outside four times, okay, not per week, but four times throughout the whole summer. Geez!

If you have kids, you are probably getting them ready for school. That can bring on additional stress for the next nine months – lunches, homework, and extracurricular activities. Whatever your stressful time of the year may be, many of us think we will do better the next season. A little more “me time” and a little less work, family, and everyone else time. If you are like me, that just does not seem to happen.

Does it really matter? The answer is, yes! According to the Mental Health America, 25 percent of Americans describe themselves as “super stressed.” Literature shows that the more we try to do, the less productive we really are. I am a super multitasker, are you? I juggle many projects constantly and it takes time and effort to keep the balls moving. But when I designate time to work on one project (as the self-help tips recommend), I actually do find that I am more effective and efficient.

But who has time to stop and work on one project? I am a Type A personality and thrive under stress and deadlines, but is that good for me? A certain amount of stress is good to motivate and improve performance. Too much or a constant level of stress, especially over time, can weaken our immune systems and predispose us to everything from a cold to the risk of a heart attack. We have to learn how to manage stress and balance our work life.

I often teach clinicians about “motivational interviewing” and “teach-back” skills. I explain that it is hard to do and it takes a lot of practice to hone in on those skills. Stress reduction and work-life balance is also hard, takes a lot of practice, and requires a continuous conscious effort.

Mental Health America provides the following simple tips:

  • At Work
    • Set manageable goals each day
      • Prioritize
      • Feel good about progress (I love to check off items)
      • Be realistic
      • Be efficient with your time at work
      • Don’t procrastinate (I find picking the hardest of the tasks first makes my day go better)
      • Divide big projects into smaller pieces
      • Reward yourself with completions (break, coffee, walk outside for 5 minutes)
      • Turn off e-mails for work time
    • Ask for flexibility
      • Ask if telecommuting is possible, even if it is to work on a big project
      • Flex your days to work on an off-peak day or hours if you want uninterrupted time or to facilitate family commitments
    • Take five
      • Use small breaks to clear your head and refocus
      • Spend a few minutes doing visualization (imagining yourself on the beach or at your favorite place)
    • Tune in
      • Listen to your favorite music to relax you and increase your creativity (be sensitive to others and wear a headset)
    • Communicate effectively
      • Speak up if your are feeling overwhelmed with workload and offer some possible solutions
      • Look at stressful or conflicting situations from the other person’s view, rethink your strategy or stand your ground calmly and rationally.  Look for ways to compromise.  Retreat if needed to regroup and determine better strategy to address conflict.
    • Give yourself a break
      • Remember you are not perfect
  • At Home
    • Unplug
      • Reduce availability for work for after hours, if possible
      • Decrease amount of time on electronics
    • Divide and conquer
      • Distribute home responsibilities with others
      • Communicate clearly
    • Don’t over commit
      • Learn to say no
      • Get support
      • Talk with friends or family about how you feel
    • Take advantage of your company’s Employee Assistance Program (EAP)
      • Check if your organization offers this assistance
      • Stay active
    • Exercise regularly – this reduces stress, depression, and anxiety
      • Boosts immune system
    • Treat your body right
      • Eat right, exercise regularly, and get enough sleep
      • Don’t rely on caffeine and tobacco for coping
    • Get help if you need it
      • Ask for assistance or seek help

I personally use some of these tips, but as I said before, it does take practice. Please join me in committing to setting a goal to improve your work-life balance over the next few months. Pick one or two of the above tips to try (don’t implement them all – that would cause stress overload). Find what works, add another one along the way, and hopefully we will all begin to see a better work-life balance!

Additional Resources:

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Score a Vaccination Touchdown with Pneumococcal Vaccines

by Crystal Welch, MSN, HHQI RN Project Coordinator

quarterback-73614_960_720We may be a few weeks away from the kickoff of football season, but now is the time to get your vaccination game started since August is National Immunization Awareness Month (NIAM). The Centers for Disease Control and Prevention (CDC) reports pneumococcal disease kills thousands of adults annually, including 18,000 adults aged 65 and older.

  • Pneumococcal pneumonia (lungs) kills about 1 out of 20 who contracts the disease.
  • Pneumococcal bacteremia (bloodstream) kills about 1 out of 6 who contracts the disease.
  • Pneumococcal meningitis (lining of the brain and spinal cord) kills about 1 out of 6 who contracts the disease.

There are two types of pneumococcal vaccines currently available which are PCV13 (brand name Prevnar 13®) and PPSV23 (brand name Pneumovax 23®). PCV13 is recommended for all adults age 65 and older, adults age 19 and older with certain health conditions, and adults 19 and over who are taking medicine that lowers resistance to infection. PPSV23 is recommended for all adults age 65 and older, adults with certain health conditions or who smoke, and adults 19 or older who have a lower resistance to fight infection. All adults aged 65 years and older should receive both PCV13 and PPSV23 as long as they have no contraindication for vaccination. The vaccinations need to be separated into two separate visits according to the vaccine schedule. If a person has not received any pneumococcal vaccines, then they should first receive PCV13 followed by PPSV23 at least one year later. If a person has already received PPSV23, the dose of PCV13 should be given at least one year after they got their most recent dose of PPSV23.

72969667The CDC recommends that everyone at this age, as well as those in a high risk group, get vaccinated against pneumonia twice in their lives. Because having the flu increases your chances of getting pneumococcal disease, it is important to get the influenza (flu) vaccine each flu season.

So how can we as homecare providers play a key role in increasing pneumococcal vaccination? Check out the HHQI Resources listed below for tools and resources:

Additional Resources:

Remember, if you or a loved one is age 65 or older, getting vaccinated against pneumococcal disease is the best defense for your game!

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Stop the Cavities! Tips to Improved Oral Health for Seniors

Guest post by Maria Eliopoulos, DMD, private practice family dentist

toothbrush-592102_960_720“Oh my, Dr. Maria, I haven’t had a cavity in 30 years, but now I have at least two or three every cleaning appointment. Why is this happening?”

I hear this question at least once a week from many of my older patients. These patients have good hygiene, watch their sugar intake and maintain regular cleanings and exams. So why now? Why do they seem to be prone to so many cavities along their gum lines?

The major culprit is dry mouth. The aging process alone doesn’t cause dry mouth, but common senior issues exasperate the dryness. One in three older adults suffer from xerostomia. This lack of saliva leads to many problems in the mouth. Without the wetness of saliva, food and plaque cannot be properly washed away along the gum line. So, bacteria can have a feast on the dry areas of the teeth, thus causing root caries. Also, due to the dryness of the root surface, teeth are unable to absorb minerals such as calcium and fluoride. Eventually, this causes significant tooth decay which can lead to tooth loss. Many patients experience cracks on their tongues, which can be very painful. It can also cause systemic problems such as infection and poor digestive health.

Many common medications frequently have this undesirable side effect. Common prescription drugs used to treat high blood pressure, depression, allergies and pain can increase dryness. Popular pills including Lisinopril and Norvasc (high blood pressure), Zocor (cholesterol), Metformin (diabetes), Xanax and Zoloft (depression), and Vicodin and Lorcet (pain) are all medications we are familiar with. I know my own parents take a number of these.

As if taking prescriptions are bad enough, even over the counter products can cause problems. Antihistamines, decongestants and some vitamins can dry our mouths. Always read the directions, before taking these seemingly innocent products.

Other factors include diseases such as diabetes, autoimmune diseases, nerve damage and cancer treatments. Snoring and tobacco use are also culprits.

So, what can we do?

As in all good medical care, the most important person is YOU! If you are waking up with “cotton mouth,” if you have thick and sticky saliva, if you have bad breath, trouble swallowing or mouth sores more than usual, please tell your doctor and your dentist. Don’t just assume that it’s another sign of our bodies getting old! This is a condition we can actually alleviate.

Medically, your physician might be able to adjust your prescriptions. He can review your medical history and diagnose underlying conditions. Medications, such as Salagen, can be prescribed to increase how much saliva is formed and how easily it flows in your mouth.

So, what can I, as your dentist, do? Most importantly, I can see the effects of dry mouth by a simple exam. I’m looking for root caries, red dry patches on your gums and cracked lip corners. I can treat decay while it is small, causing less damage to your teeth and your pocketbook. I can also give in-office fluoride treatments, and sometimes, prescribe a home fluoride therapy. But, once again, the most important item is a conversation about the symptoms you might have.

What can you do at home? Maintain good brushing and flossing habits. Use a mouthwash that contains fluoride but make sure the mouthwash rinse has no alcohol in it because that exasperates dryness. Drink plenty of water every day and avoid soft drinks and sugar drinks. Chew sugar-free gum (I bet you didn’t think a dentist would tell you to chew gum) and suck on sugar-free candy. Chewing gum will stimulate saliva flow. Use a humidifier at night. Try to avoid smoking, caffeine and tobacco. Limit sugary foods. I know, I might sound like a killjoy but you just need to try and curb the cookies and gummy bears in your diet, you don’t need to totally eliminate them.

Hopefully by working together we can diminish the amount of cavities that senior patients often experience. Knowing the causes of dry mouth, it becomes easier to counteract the negative effects. I would much rather hear about your grandchildren, your travels and how much better your garden is doing than mine than telling you that we have to restore five cavities!

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Thriving After Emergency Bypass Surgery Using Evidence to Strengthen My Body – A Patient Perspective

Guest post by Larry Wagner

Larry Wagner_7.8.16When I had my emergency triple by-pass surgery 10 years ago I had just 1 percent blood flow in my two main coronary arteries, plus 80 percent blockage of the third coronary main, the circumflex, and two dozen other blockages and aneurysms throughout the artery branches. Thankfully, I survived. Nursing and OR staff wondered if I would survive. Three weeks before my surgery I was an active 53 year old working in an office setting. I had a few minor incidents the prior three years but was well recovered and I had no warning of what was about to happen.

I was very active, using a rowing machine 2-3 times a week, did weight training, swam occasionally, and played a little basketball. Two weeks after my surgery I could barely walk across a room every few hours. After another two weeks, I could walk slowly on a treadmill for five minutes with my heart rate barely over 100. To try more was too tiring. Elderly people with walkers could walk faster and farther than me.

I immersed myself in research to find information about my condition and how to improve my hope to survive. I found excellent research articles on the National Institute of Health’s (NIH) website on important functional foods for my diet, exercise methods to improve recovery from heart disease, and other articles to guide and monitor my physical recovery. There were thousands of articles from dozens of research journals from all over the world, but I focused on valid, but lesser known information that could make a bigger difference. I came across the Finnish manufacturer SUUNTO which produced a fitness computer/heart rate monitor that could guide my progress and identify the intensity and recovery period of every workout.

My doctor keeps me up-to-date on my cholesterol numbers. The first few years it was checked every six months, then later it was done just once a year. I checked my blood pressure daily for a while. I became accustomed to my energy as a function of my blood pressure. If I had too much energy, I knew my blood pressure was high. If I was drowsy, I knew my blood pressure was too low. Long-term improvements in blood pressure allowed my doctors to reduce my medications which eventually led to me taking one sixth of the original dose.

I worked on increasing my strength and endurance. My diet was modified to include minimal salt, no dairy, no beef, no fat, and no fried foods. I created a consistent diet included healthy proteins (no red meats), no dairy, whole grains, and lots of fruits and veggies. I was able to keep to my healthy diet even at my work cafeteria. My consistent health diet instigated many conversations that influenced other employees. Many foods became flat tasting due to these dietary restrictions so I began to use more spices and started to eat tart/bitter foods, such as very intense dark chocolate and tart cherries. To help you understand how tart, after I sharing some of my treats with a co-worker he commented, “How do you eat that stuff?” I told him that it has become my new candy and what makes it even better is that it is good for me. Strong flavors make it wonderful.
I have not lost any weight on my new diet but am maintaining it since I was already at my ideal weight. I also learned how to use foods that were high in antioxidants, niacin, thiamine to boost my endothelial progenitor cell and HDL levels that leads to reducing coronary artery blockage.

I feel better, have more energy, and have more strength for everyday living now than I did before my heart attack. I exercise 5-7 times a week for 45 minutes or more with parts at high intensity, yet well tolerated, and no shortness of breath or fatigue. I tolerate a heart rate with intense exercise as if I was 40 years old, or younger. Other athletes think I am 10 or 15 younger because of my energy level. It is all due to the purposeful changes that I have made in my life that make this possible. Incidents of angina or shortness of breath are rare and minor.

After five years of sharing what I was learning with others, including the WebMD website forum on heart disease, WebMD profiled me in a 2012 WebMD magazine on my amazing story of cardiac recovery.

Today, I row 3 to 4 times a week, for 30 to 90 minutes. Sculling, really, as on a rowing machine. My boat is 17 feet long, 45 inches wide, with two sculling position. It is much heavier to row than most sculling shells, however that suits me just fine as I stay strong at age 63 and plan to stay that way for many years to come.

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Providing Patients with ISMP Consumer Leaflets Can Help Prevent Hospital Readmissions

Guest post by Ann Shastay, MSN, RN, AOCN, Managing Editor, Institute for Safe Medication Practices (ISMP)

Amy Shastay_6.24.16The stakes have never been higher for hospitals to prevent patient readmissions within 30 days. While the ability to predict which patients are at high risk for readmission is not an exact science, numerous studies have identified that adverse medication events are at the very core of the readmission problem.1-3 This includes patient non-adherence to prescribed drug therapy, which by itself leads to treatment failures and wasted resources costing $150 billion annually.4 A study by Budnitz et al. identified the drugs involved in 88.3% of emergency hospital readmissions of older adults caused by adverse drug events: hematologic, endocrine, cardiovascular, central nervous system, and anti-infective agents.3 Nearly two-thirds of the hospitalizations were due to unintentional drug overdoses. Just four types of medications—warfarin, insulins, oral antiplatelet agents, and oral hypoglycemic agents—together accounted for 7 in 10 of the emergency hospitalizations. A review of 55 observational studies found that information related to medications was missing from hospital discharge summaries up to 40% of the time.5 Another study found that patients with medication discrepancies had a 30-day hospital readmission rate of 14.3% compared with 6.1% for patients without a medication discrepancy.6

 Because patient education has been shown to improve health outcomes and reduce the risk of preventable adverse drug events,7 nurses and pharmacists can play a central role in reducing hospital readmissions by teaching patients and their families about the medications that have been prescribed upon discharge. Particular attention should be paid to teaching patients about the risks associated with taking any medications identified in the Budnitz et al. study and those on ISMP’s list of high-alert medications dispensed in the outpatient setting.

resources - reportsTo assist with patient education, ISMP has developed and tested more than a dozen consumer leaflets that offer important safety tips for taking high-alert medications. Included are leaflets for warfarin, enoxaparin, fentaNYL patches, oxyCODONE with acetaminophen, HYDROcodone with acetaminophen, oral methotrexate, and various insulins. These leaflets are readily available on the ISMP website at no charge to use in your organization to educate patients. (We have recently made them available in Spanish as well.) The “Top 10 List of Safety Tips” on the front of each leaflet is intended to help patients detect and prevent medication errors and other adverse drug events. The safety tips were derived from reports of actual adverse events with these medications submitted to various national and state reporting programs. For example, one safety tip in the warfarin leaflet advises patients who have been told to stop taking warfarin until their next lab test to call their doctor if they don’t hear anything within 24 hours of the test to find out the next steps. This tip is included because there have been numerous reports involving patients who developed a thrombus because they never resumed taking warfarin after it was on hold until the next International Normalised Ratio (INR).

Through a grant from the Agency for Healthcare Research and Quality (AHRQ), ISMP tested the readability, usability, and perceived value of the leaflets. Ninety-four percent of patients felt the leaflets provided great information or good information to know after receiving it when picking up a prescription at their community pharmacy. Ninety-seven percent felt the information in the leaflets was provided in a way they could understand. Eighty-two percent of patients taking the drug for the first time learned something new after reading the leaflet, and almost half (48%) of the patients who had previously taken the medication reported learning something new. Overall, 85% of the patients felt they were less likely to make a mistake with the medication because they had read the leaflet. Pharmacists who handed out the leaflets also reported that they were highly useful in guiding the educational sessions with patients. Given the very favorable response to the leaflets during the study, ISMP hopes that any healthcare professional caring for patients taking one of these high-alert medications will download the leaflets from our website, use them as a resource when educating patients about the medications, and provide them to patients to read and refer back to as needed.

Oral MedsISMP believes that professionals should focus patient education on those issues that cause the most harm and are likely to result in a readmission. No patient discharged with a prescription for a fentaNYL patch should be sent home without being specifically informed to remove the old patch before applying a new one. No patient being discharged on methotrexate for arthritis or psoriasis should be sent home without warnings regarding the risks associated with taking the medication daily instead of weekly. No patient who takes a combination opioid analgesic upon discharge should go home not knowing the daily acetaminophen limit and to avoid taking other common over-the-counter products that contain acetaminophen while taking this product. No patient with a prescription for enoxaparin should be sent home without knowing how to dispose of the used syringes safely. No patient discharged with a prescription for an insulin pen should arrive home without knowing that it should never be shaken prior to use. Given that discharged patients may remember little of what has been discussed in the hospital, the leaflets are a great way to ensure that patients are armed with information they need to avoid a medication mishap once they go home.


  1. Forster AJ, Murff HJ, Peterson JF, et al. Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2006;20(4):317-23.
  2. Davies EC, Green CF, Mottram DR, et al. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. Br J Clin Pharmacol. 2010;70(5):749-55.
  3. Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365:2002-12.
  4. Erickson J. The cost of medication noncompliance. J Am Assoc Preferred Provider Organ. 1993;(2):33-4,38-40.
  5. Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. 2007;297(8):831-41.
  6. Coleman EA, Smith JD, Raha D, et al. Post-hospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165:1842-47.
  7. Guirguis LM, Chewning BA. Role theory: literature review and implications for patient-pharmacist interactions. Res Social Adm Pharmacy. 2005;1:483-507.


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June is Alzheimer’s and Brain Awareness Month

Guest post by Bethany Knowles Hall, Executive Director at Alzheimer’s Association, West Virginia Chapter

Bethany Knowles HallIt is common knowledge that Alzheimer’s disease robs people of their ability to remember, but many people are unaware that Alzheimer’s disease is fatal, its symptoms extend much further than memory loss and early detection does make a difference. These are the “truths” about Alzheimer’s disease that the Alzheimer’s Association, WV Chapter is trying to spread throughout the month of June.

To improve the public’s understanding of the disease and to reiterate the imperative need for swift action, the Alzheimer’s Association is highlighting essential truths aimed at curbing common misconceptions about the disease.

  • 4 million Americans are living with Alzheimer’s disease and close to 15 million Americans are caregivers.
  • Here, in West Virginia, we have 37,000 West Virginians with the disease and 108,000 caregivers.
  • Being the sixth leading cause of death in the United States, Alzheimer’s kills more than breast and prostate cancer combined.
  • Alzheimer’s is not normal aging. It is a fatal and progressive disease that attacks the brain, killing nerve cells and tissue which affects an individual’s ability to remember, think and plan. Although age is the greatest risk factor, Alzheimer’s is not a normal part of aging.
  • Alzheimer’s is more than memory loss. It doesn’t only manifest itself through memory loss, it may appear through other signs and symptoms. Check out the 10 key warning signs to recognize in yourself or others.
  • Alzheimer’s risks are higher among women, African Americans and Hispanics. African Americans are almost twice as likely to have Alzheimer’s disease or another dementia. Hispanics are about one-half times as likely. And shockingly, more than two-thirds of Americans with Alzheimer’s disease are women. Women are also more likely to become a care partner or giver for a person with Alzheimer’s.
  • Alzheimer’s cannot be prevented, slowed or cured. However, adopting healthy habits can reduce your risk of cognitive decline and help contribute to brain health. Learn the 10 Ways to Love Your Brain.

Show your support for those living with the disease this June by:

  • Participating in The Longest Day on June 20th which honors those facing the disease with strength, heart and endurance, or sign up to start a Walk to End Alzheimer’s event. These special Walks are held in the fall all throughout the country and are a great way to honor your loved ones.
  • Join the Alzheimer’s Association in wearing purple throughout the month, but especially on June 20th. Share photos via social media with #ENDALZ.
  • Visit the Alzheimer’s Association website to uncover more truths about Alzheimer’s and why they matter.

Also, this past week brought an extraordinary amount of good news from Capitol Hill for those living with Alzheimer’s disease and their families. The Senate Appropriations Committee approved a $400 million increase in Alzheimer’s research funding and included the Health Outcomes, Planning and Education (HOPE) for Alzheimer’s Act (S. 857) in its funding bill. The HOPE for Alzheimer’s Act would increase access to information on care and support for newly diagnosed individuals and their families – providing essential support for those facing this devastating, debilitating disease. It would also ensure that an Alzheimer’s or dementia diagnosis is documented in the individual’s medical record.

If you or someone you know needs some direction about care, support, research or resources, please visit or call the Alzheimer’s Association 24/7 Helpline at 1.800.272.3900 where you can you speak to a dementia care specialist day or night. The Alzheimer’s Association, no matter where you live, provides support groups, care consultations, early stage programs, educational workshops and resources to cope with caregiver stress.

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May is Stroke Awareness Month

by Crystal Welch, MSN, HHQI RN Project Coordinator

exclamation pointA stroke is serious, just like a heart attack. According to NIH Senior Health, stoke occurs in all age groups but nearly three-quarter of all strokes occur in people over the age of 65. Each year in the United States, approximately 795,000 people have a stroke. About 610,000 of these are first or new strokes. On average, one American dies from stroke every four minutes. Stroke is the fourth leading cause of death in the United States, and causes more serious long-term disabilities than any other disease.

Stoke can be preventable and early recognition of the signs of stroke can save lives. The FAST Test is an easy way to remember the symptoms of a stroke and what to do about it.

  • F (Face): Ask the person to smile. Does one side of the face droop?
  • A (Arms): Ask the person to raise both arms. Does one arm drift downward?
  • S (Speech): Ask the person to repeat a simple phrase. Is their speech slurred?
  • T (Time): If you observe any of these signs, call 9-1-1 immediately.

ABCs of Heart HealthHypertension, or high blood pressure, is a wide spread, chronic disease that can damage arteries throughout the body. Weakened arteries in the brain put you at a much higher risk for stroke. The national Million Hearts® initiative has set its sights on preventing 1 million heart attacks and strokes by 2017. At the cornerstone of the initiative is ABCS. ABCS represents the pillars of preventive cardiovascular care — Aspirin as Appropriate, Blood Pressure Control, Cholesterol Management, and Smoking Cessation. By developing resources, tools and partnerships that focus on improvements in these four areas, the national Million Hearts® initiative has already made great strides in dramatically reducing heart disease in this country.

Home health professionals are an integral part of many of their patients’ lives – sometimes seeing them daily – and often develop an exceptional level of trust with their patients. This puts home health agencies in a unique position to make a big impact on our nation’s cardiovascular health. For more information and resources on patient self-management for stroke, take a look at HHQI’s Best Practice Intervention Packages (BPIP’s):

HHQI developed a patient video titled “Are You at Risk for a Heart Attack or Stoke?” Watch the video on YouTube and make sure to check out the My Healthy Heart Workbook for patients – also available in Spanish.

Other free resources include fact sheets addressing health disparities (African Americans and High Blood Pressure and Hispanics and High Blood Pressure).

Don’t Forget: World No Tobacco Day is May 31 – The World Health Organization (WHO) and partners promote World No Tobacco Day (WNTD) every year on May 31, highlighting the health risks associated with tobacco use and advocating for effective policies to reduce tobacco consumption. Click here for more information.

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