Monday, March 18, 2019

Self Care: Self-Reflection for the Lenten/Early Spring Season

key words:  self-care, self-reflection, mindfulness, poetry, qi gong / nei gong, tai chi, finding your current calling, clearing physical clutter and Marie Kondo's books, journaling with James Pennabaker's books or journal prompts from Wayne Jonas, MD and the Samueli Institute, and a couple self-reflection prayerwork traditions

Self-Care:  Practicing Self-reflection

If you could use an opportunity to renew your self-care, whether it is your new year resolution or just the spring-cleaning vibe, the Lenten season is as good a time as any.  Lent is 40 days before Easter from Ash Wednesday to Good Friday.  It coincides with the turning of the season from late winter to spring. 
The Christian observance of Lent focuses on self-reflection and discerning your path to your best self—to discerning your path/your calling.  It is about clearing out the (internal) debris and clutter between you and God and turning your path back toward the Light.

You don’t have to be Christian for these timeless ideas to sound familiar.

So, in your self-care practice, pick what is true to you and your path.  This blogpost is only my ideas from my limited experience.  If some of this is helpful, great!  If it’s not for you, that is okay; just let it go.

Where Self-Reflection Fits Into Self-Care Habits
So, in self-care practice, you should have some element of self-reflection.  I discussed this briefly in an earlier blogpost about different categories of self-care to include movement, self-reflection/mindset/inspiration, nutrition/food, spending time outdoors, breathwork, and recreation/socializing and connecting to your community.

How to Start Your Self-Reflection Habit
As we move from winter to spring, take quiet time to be with your heart.  Quiet, heart-listening time.
What comes up for you?  Peace or restlessness?
If it is restlessness or discontent, can you identify where this is coming from?
The energy of spring is about forward movement and new growth.

Is there a change you need to make in your life?  In self-reflection, slowly work to discern, what this discontent or restlessness is connected to.
Is this leading you forward on your life path toward the best-version-of-yourself?  Or is something in your current life or your lifestyle that has you stuck in a rut or leading you to something you do not want to be?

What do you need to do to be closer to the best-version-of-yourself?  Journal about it.  Find mentors who can help you on your path.  Keep working on it.  5 minutes/day minimum is better than no time at all.
Identify (to yourself) the clutter you are clearing out to make space and peace in your heart and in your life.

There are so many ways this can manifest, as many ways as there are individuals.  And, as an individual, you may find one pattern of clearing/de-cluttering/cleaning that works best for you.  And you may notice you have familiar ruts you get stuck in.
You may need to change up how you do your clearing/de-cluttering/cleaning when you “best way” is no longer working as well as it used to.

Change is uncomfortable.  And, change is constant.
“Often when you’re at the edge of something, you’re at the beginning of something else.” -Fred Rogers
Nobody else can live the life you live.  And even though no human being is perfect, we always have the chance to bring what’s unique about us to live in a redeeming way.”       -Fred Rogers
“Our lives change when our habits change.” –Matthew Kelly

Self-reflection—discerning your current calling
Sister Joan Chittister, in her book Following the Path: the search for a life of passion, purpose, and joy, says an individual rarely has just one calling in life.  In fact, we are called to different things throughout our lives.  But we must practice self-reflection and discernment to hear those calls and recognize what they are.  And, have the courage to follow them.  Saint Mother Teresa of Calcutta had a calling-within-a-calling. 

Steven Pressfield and Tim Grahl talk about “shadow
careers”.  That we are following what we feel is “best fit” and “right at the time” careers that help us develop the skills we need for our “true calling”.  But that everything eventually becomes a shadow of what your next calling is. 

Links to Stephen Pressfield’s books:

Concluding Message
We should be always listening to our hearts, discerning in our self-reflection practices, and taking stock of where we are in our path toward what we are called to be, the best-version-of-ourselves, and what that looks like, in that time and space.

Ideas and resources
If you are looking for ideas to renew or start your self-reflection practice, here are some resources to learn more about mindfulness, clearing physical clutter, journaling, tai chi and qi gong, prayerwork, and poetry.


Informed Mindfulness:  The Power of Awareness and Choice in Effective Leadership by Michael Aquilino, Bonnie Horrigan, and Adam Perlman

Related blogposts and websites

Clearing the Physical Clutter
Clearing the clutter.  For clearing out the physical space to help make room in your internal (mental, emotional, spiritual) space, I recommend the book by Marie Kondo, The Life-Changing Magic of Tidying Up.  She also has a follow up book, Spark Joy: An Illustrated Master Class on the Art of Organizing and Tidying Up 

Journaling, proven by James Pennebaker and colleagues (published in peer-reviewed scientific journals) to be useful in processing emotions and ideas in a healthy way.  Journaling helps process experiences to find clarity.  Journaling has proven health benefits.  

Tai Chi and Qi Gong
Work with your local certified instructor or NCCAOM board-certified acupuncturist.   

If you are also interested in a book about these practices for self-care, look up Dr. Roger Janke’s The Healer Within: Using Traditional Chinese Techniques to Release Your Body’s Own Medicine ,Movement, Massage, Meditation, Breathing 

Prayer work

  • Work with a spiritual director in your faith.  The oldest Christian monastic order, the Benedictines, have a tradition of outreach to community in spiritual direction from one-on-one sessions, group sessions, and retreats that are non-denominational or Catholic. 
    • For example, see the St. Placid Priority programs in Olympia, WA, at the Priory Spirituality Center 2019 programs include art (felting, enneagram), music-facilitated imagery for the soul, and seasonal programs (Lenten retreat). 
  • Or maybe other monastic traditions in your area may offer some form of spiritual direction.
  • If you enjoy mindfulness practices and quiet contemplation, you may be interested in learning centering prayer.  The old tradition of lectio divina that leads to the practice of centering prayer is both peaceful and healing but requires a mentor due to its complexity and depths.

Poetry and Poetry-Prose
Tao De Ching
(on the Reflective Reads post)

  • Ideas for inspiration at the Reflective Reads blogpost include the following authors: John Muir, Lao-Tzu, Mary Oliver, Benjamin Franklin, William Butler Yeats, and John O’Donohue

poetry is a useful vehicle for self-reflection

If this post on self-care was helpful to you, please support this work via our website and share with a friend.  Peace to you in your self-reflection practice.  

Thursday, February 28, 2019

February Research Thursdays Summary

key words:  research literacy, funding and grants, sharing related research in the field, research in integrative health

The February Research Roundup

Review of the "Research and Metrics Thursdays" theme from the public Facebook Page and newsletter

At the Hospital-practice Handbook Project, we encourage practitioners to cultivate mentor-relationships and practice research literacy.

  • Resource: The PCORI ambassador program supports the forward movement of patient-centered care metrics.  Did you know they have an Ambassador program you can connect to?  According to their website:  
    • "PCORI Ambassadors represent the entire healthcare stakeholder community and the program is open to anyone interested in advancing patient-centered outcomes research (PCOR).  Get connected to PCORI Ambassadors and learn more about them."  
  • Do you know where your nearest Teaching Kitchen or Community Health Kitchen is located?  Learn more about this resource and the research being presented at past Teaching Kitchen conferences, the Healthy Kitchens Healthy Lives annual conference. 
  • The 2018 National Academy of Medicine (NAM) "Non-Pharm Pain" Conference recordings are available.  These are a recommended lunchtime listen and there is more information on the Lunchtime Listen page.  Or you can go directly to the YouTube playlist. 
  • The U.S. Center for Medicare and Medicaid Services (CMS) call for research papers on acupuncture for low back pain and on the training and education of acupuncturists ended February 14th, 2019.  See the related blogpost for more information on it.  Several national and international organizations submitted white papers to CMS and will be publishing their white papers on their websites by spring, including the American Society of Acupuncturists and the Acupuncture Now Foundation.  I will add those links, when they are available, to the CMS blogpost.  The CMS call reference the AHRQ paper published in summer 2018.  The link to this paper is also in the CMS blogpost.
  • Latest update in the FDA Roadmap Series by the National Health Council published late February 2019.  See this post for the link to the video.  (audiovisual presentation on patient-centered metrics)
  • The Massage Therapy Foundation is hosting a free webinar series on the basics of research on select days in 2019.
  • The winter issue of Meridians: Journal of Acupuncture and Oriental Medicine is out.  If you have membership with your state professional acupuncture organization, you have free access to the full electronic edition.  Or you can buy access to a specific issue or a subscription through their website.  Send me a message through The Hospital Handbook Project website contact page or write in the comments below your favorite article of this issue or another issue!
  • NCCIH and the National Cancer Institute hosted a workshop on "translating the fundamental science of acupuncture into clinical practice" earlier this month (February 2019).  

Funding Announcements

Recommended Study to Read this Month 

For more on the topic of research
  • follow the tag/label in this blog for "research literacy"

Other monthly research summary blogposts

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February Leadership and Workplace Mondays Roundup

keywords:  leadership, workplace, workplace culture, being an employee, teamwork and team communication

Inspiration for Employees and their Leaders 

Review of the "Leadership and Workplace Mondays" theme from the public HHP Facebook Page, February 2019

"To scale daring leadership and build courage in teams and organizations we have to cultivate a culture in which brave work, tough conversations, and whole hearts are the expectation.  And, probably more importantly, armor is not necessary or rewarded." 
"If we want people to fully show up, to bring their whole selves, including their unarmored whole hearts, so that we can innovate, solve problems, and serve people, we have to be vigilant about creating a culture in which people feel safe, seen, heard and respected." 
"Daring leaders must care for and be connected to the people they lead. Care and connection are irreducible requirements for whole-hearted, productive relationships between leaders and team members."  
-Brene Brown, Dare to Lead: Brave Work. Tough Conversations. Whole Hearts.  quoted from the audiobook.  chapter 9.

How to build a dream team in 5 steps--an interesting read on building a dream team with links to a free access lecture on the topic from LinkedIn learning.

How to have a productive conversation--how to talk with your manager/hospital admin about additional training, expanding a program, funding, or time.  The LinkedIn Learning article and video give 5 steps for a productive conversation:
  1. present your case and state your goal
  2. offer supporting evidence
  3. check in
  4. show you heard the feedback
  5. restate or refine your request
See the open (free) video "making your case", within the larger course, Having an Honest Career Conversation With Your Boss.  

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For more recommended reading (books and audiobooks) on leadership, see our Reflecting on Leadership post. 

More posts on Leadership

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Wednesday, February 27, 2019

February Self Care Saturday summary: ideas for your home self-care practices

key words:  self-care, practitioner resilience, wellness, mindfulness practices, movement (walking, tai chi, qi gong), spending time outdoors, nutrition for health, the quadruple aim research paper

The February Self-Care Roundup

Some inspiration from the Self-Care Saturdays theme over at our public Facebook Page

Taking time for self-care in your day and week, from a few minutes here to 30 minutes to several hours at a time, are drops of water into your resilience bucket.  A full resilience bucket makes it easier to weather the storms of life and work.  A half-full or empty bucket provide little defense or support when the storms hit and make it easy to get swept away or feel like you are drowning.  Fill your bucket, minutes or seconds at a time. Make regular drops or cups of self-care into your bucket part of your daily and weekly routine (habits) to keep it closer to full.  Consider the following categories of self-care when you are filling your bucket:

  • Movement:  any movement from walking, hiking, dancing, tai chi, bicycling, swimming, or other forms of active movement and exercise
  • Mindset/inspiration and reflective reading:  any activity that encourages you to slow down and self-reflect.  Forms this may take:  journaling, qi gong/nei gong (inner-work qi gong), several types of mindfulness practice, reading poetry, some forms of prayer.  
  • Spending time outdoors in nature:  going outside into fresh air and "green space" whether it is your backyard lawn, working in the garden, the local town park, pond, or creek, time at the beach, the botanic garden/arboretum/conservatory, doing chores at your friend's farm, or a trip to a state park or national park/federal lands.
  • Breathwork:  practice basic diaphragmatic breathing.  Can be a simple breathing exercise, like the one below. Or maybe your breathwork self-care practice takes the form of any of the following:  yoga, mindfulness meditation, qi gong, or tai chi
  • Nutrition/Food as fuel:  everything in moderation.  talk with your health care provider before making any major changes to your food intake (diet), especially if your have a chronic health care condition.
  • Time "having fun", socializing, connecting to your community.

Self-care practice could include more than one of these categories in just one activity

  • Depending on what you do for your self-care, it likely fits into more than just one of these categories, or it could.  For example, practicing Tai chi outdoors is "movement", "outdoor", and "breathwork".  Stretching exercises at your desk could be "movement".  Or, if you add a breathwork exercise to it, could be both "movement" and "breathwork".  

Ideas from the Self-Care Saturdays theme on the public Facebook Page from February

  • The Research--the Quadruple Aim study
    • "quadruple aim" added a 4th component to the well-known "triple aim".  What is the 4th component?  clinician well-being and resilience.  The triple aim doesn't work when the system is burning out clinicians.  Adding the 4th aim, focus on healthy workplace environment for clinicians, provides a compass for implementing the ideals of triple aim.  Read more in the research paper.
  • Nourishment/Food

    • Breathwork exercise, "belly breathing"
      • Breathwork is the conscious control of your breath.  "Belly breathing" is practicing diaphragmatic breathing.  This type of breathing induces the "rest and digest" phases of our nervous system, the parasympathetic response.  This is an important practice because, in our modern world, we are often going about our day rushing, in a full or partial sympathetic (fight or flight) state.
      • Practice (self-care):
        • Take a few moments to check in our breathing.  One hand over your heart, one over your belly.  Practice belly breathing (where your belly hand moves more with each breath than your heart hand does). 
        • Breathe in for a count of 5 and out for a count of 7.  Repeat 20 times.
      • If you want, you can watch one of these videos while you practice:

    • May you have some peace in your day.  Remember you can come back to this breath-centering practice any time.

    Mindset/inspiration and reflective reading
    Outdoors/Time in Nature
    • You can read more about the health benefits of spending time outdoors in the book, Nature Fix. You can follow the link to the Amazon store for this book in paperback or audiobook at our gift ideas page under "outdoor fun and health benefits of nature".   It is packed with scientific study references!

    Related blog posts

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    Friday, February 1, 2019

    January Self-Care Saturdays: inspiration for your home self-care practices

    key words:  self-care, practitioner resilience, wellness, mindfulness practices, movement (walking, tai chi, qi gong), spending time outdoors, nutrition for health

    The January Self-Care Roundup

    Some inspiration from the Self-Care Saturdays theme over at our public Facebook Page

    Breathwork, the basics of breathing for self-care
    • As an east Asian medicine practitioner (acupuncturist) I have been teaching my patients diaphragmatic breathing on day one and reinforced practice throughout treatment course with related self-care homework. This breathing practice often also called "belly breathing" has been known for a long time to help us consciously switch our breathing state into the parasympathetic state (rest and digest). Because, in our modern world, most people go about their day in sympathetic state of breathing (fight or flight). Breathwork, the conscious control of your breath, is the foundation of qi gong and mindfulness practices.  More recently, research has been conducted to test these age-old practices, such as this article available on PubMed.      --Megan
    • Now, practice (self-care):
      • Take a few moments to breathe. Check in on your breathing. One hand over heart, one over your belly. Practice belly breathing. Breathe in for a count of 5 and out for a count of 7. Repeat several times.
      • If you want, you can watch this 1 minute video of a sunrise over a bay of the Salish sea while you practice.   
      • Have a wonderful day! Remember you can come back to this breath-centering any time.

    Food as Fuel, everything in moderation

    • Everything in moderation.  Coffee is more than just caffeine.  There is wisdom to consuming foods in the traditional way.
      • For example, a cup of warm black coffee (traditional) vs. iced, extra sugar, etc (modern).
      • Water is the best liquid to drink. If you drink caffeinated beverages, you need to be drinking more water than coffee. Drink less coffee than water. Stay hydrated. See your licensed and board-certified acupuncturist for more specific advice.
    • Note on coffee research from NIH:
      • “Two substances from coffee, acting together, may protect against nerve cell damage and improve behavior in animal models of Parkinson’s disease and a related disease called dementia with Lewy bodies (DLB). This is according to a new study funded by NCCIH and conducted at the Rutgers Robert Wood Johnson Medical School.
      • "The two coffee components, eicosanoyl-5-hydroxytryptamide (EHT) and caffeine, were evaluated separately and together in mouse models of the two diseases. Both diseases are associated with abnormal deposits of a protein called alpha-synuclein in the brain. The two substances administered together for 6 months, decreased the buildup of alpha-synuclein and led to better nerve cell function, less nerve inflammation, and closer-to-normal behavior.
      • "These findings may help to explain the link between coffee consumption and reduced risk of Parkinson’s disease; however, other components of coffee—a complex mixture of more than a thousand different substances—may also be involved."
    • You can read more about nutrition for health at our Nutrition Learning with Your Family post.

    Mindset/inspiration and reflective reading
    • Setting your new year resolutions--know your "why"
    "Why? It’s a small word, but a mighty question, especially when it comes to setting a New Year’s resolution.... When you get right down to it, your why is about authenticity. And authenticity falls in lockstep with trusting yourself. What do you need this year and why?" Go to the article.
    • Poetry
    "Snow was falling,
    so much like stars
    filling the dark trees
    that one could easily imagine
    its reason for being was nothing more
    than prettiness."
    -Mary Oliver

    Movement:  Tai Chi

    • The health benefits of regular movement practice, particularly practicing Tai Chi, includes improved balance and strength.  More at the NY Times article, "Using Tai Chi to Build Strength".

    Outdoors/Time in Nature

    • You can read more about the health benefits of spending time outdoors in the book, Nature Fix. You can follow the link to the Amazon store for this book in paperback or audiobook at our gift ideas page under "outdoor fun and health benefits of nature".  I have been listening to the Nature Fix as a audiobook throughout January.  It is packed with scientific study references!


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    Thursday, January 31, 2019

    January Leadership and Workplace Mondays roundup

    keywords:  leadership, workplace, workplace culture, being an employee, mentorship and mentor relationships, mindfulness and leadership

    Inspiration for Employees and their Leaders 

    Review of the "Leadership and Workplace Mondays" theme from the public HHP Facebook Page, January 2019

    If you enjoyed this, check out our public Facebook Page and subscribe to our email list. 

    Related blogposts on Leadership

    If this was useful, please support this community work.  
    You can buy me a coffee, sponsor a newsletter, or sponsor a project via the website.

    CMS public comment call out for coverage of acupuncture for low back pain

    Medicare, Medicaid, insurance coverage, major hospital insurance entities, federal health care coverage policy, health care policy

    CMS and acupuncture coverage for LBP
    The U.S. Center for Medicare and Medicaid Services (CMS), whose coverage policies are intertwined in hospital and medical center systems, has announced a call for public comment on the topic:  “acupuncture coverage for low back pain”.

    To my knowledge, this is the first time in history the CMS has ever announced a public comment call for anything related to coverage of acupuncture services.  Tell your hospital sponsors and advocates.  If CMS reimbursed for acupuncture and other integrative health therapies, that would be a major milestone.

    CMS is under the U.S. Department of Health and Human Services (HHS).  HHS is an enormous department that also contains the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ)

    In the announcement, they state, 
    “In response to the U.S. opioid crisis, HHS is focused on preventing opioid use disorder and providing more evidence-based non-pharmacologic treatment options for chronic pain. The [AHRQ, CMS, and NIH] are collaborating in this effort.”  In June 2018, AHRQ “published a systematic review of noninvasive, nonpharmacological treatment for chronic pain.”  “This review included assessment of several nonpharmacological interventions, including exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation for [chronic low back pain] CLBP. “

    Then, the CMS announcement says:
    “The NIH recently issued a Funding Opportunity Announcement for interested parties to apply to conduct an efficient, large-scale pragmatic trial to evaluate the impact of, and strategies to best implement, acupuncture treatment of older adults (65 years and older) with chronic low back pain.”

    “CMS is opening this national coverage analysis (NCA) to complete a thorough review of the evidence to determine if acupuncture for CLBP is reasonable and necessary under the Medicare program.  CMS is soliciting public comment on this topic.  We are particularly interested in comments that include scientific evidence and discuss appropriate clinicians and training requirements to provide acupuncture that improves health outcomes.  In addition, for commenters recommending Coverage with Evidence Development, we are interested in comments related to appropriate outcomes and study designs.  While CMS has conducted previous national coverage analyses on acupuncture, the scope of this current review is limited to acupuncture for chronic low back pain.”

    Public comment period ends 2.14.2019