Highlights from the Maple Syrup March Newsletter

keywords:  community news, research papers, community discussion resources, newsletter

“Often when you’re at the edge of something, you’re at the beginning of something else.” Fred Rogers

Tidbits from the March 2019 newsletter
March:  The Maple Sap is Rising
It is early spring.  The sap is rising; the season for growth and movement.
What are you noticing about the spring energy of growth and movement?  Uncomfortable? Blocked?  Perfect weather?  More than ready to jump into summer after a long winter?

Short Topic Summary for This Newsletter

• Getting Your Foot in the Door of Hospital Practice: First Steps document
• Did you respond to the feedback form?
• Looking for sponsors to support the “Paths to Practice” interview series
• Self Care:  The Practice of Self-Reflection
• Community Discussion topics:  acupuncture post-surgery models and the "bundle" model for joint replacement
• National News:  The HHS call out--read the NCCAOM response

HH Project News

• Free Download from the Project
• Have you downloaded our free document, Getting Your Foot in the Door of Hospital Practice: First Steps…, yet? 
• Please take the quiz to help me improve future products. 
• All products help support the Project with the goal of making this community work sustainable. 
• Next product available soon:  the workbook for the Getting Your Foot in the Door pdf.  The workbook has been going through edits and beta readers this past month.
• Looking for sponsor(s) to help cover the cost of video edits for the latest in the “Paths to Practice” interview series. 
• In the “Paths to Practice” interview series, I interview a colleague about their path into hospital-based practice. 
• There are options for full sponsorship and partial sponsorship. 
• Please contact me if you or your business or organization is interested.  Thank you for supporting this work.  
• Did you know we have an online short course available?
• You can purchase access to this short course, “How to use a validated pain scale in your chart note” All proceeds go toward supporting the Project.
• Thank you for supporting this work!  

www.thehospitalhandbook.com

March Discussion Topics in the Community

• Acupuncture for post-surgical pain
• Share-able related published articles:
• “Acupuncture Provides Short-term Pain Relief for Patients in a Total Joint Replacement Program”
• Crespin DJ, Griffin KH, Johnson JR, et al.  Acupuncture provides short-term pain relief for patients in a total joint replacement program.  Pain Med. 2015;16(6): 1195-1203.  doi: 10.1111/pme.12685
• Knee/joint replacement integrative care models:  The Bree Collaborative’s bundled payment model 
• On knee/joint replacement care, let's take a step back and look at models of care for the patient's care process from pre-surgery to recovery.  The Bree Collaborative of Washington state finished the total knee replacement bundled payment model standard last year (2018).  This is a one-to-watch for your medical centers. 
• The Bree Collaborative is a standard-setter in value-based model care with patient-centered outcomes.  It sets standards for WA state health care policy. These models they discuss work best in “centers of healthcare excellence (COHE or COE)” where patients can have access to all services in the bundle in one system and in a timely manner.  From assessment of surgery to surgery to inpatient stay to post-operative care to rehabilitation care.  
• share-able published articles on this topic: 
• "Improving Care by Redesigning Payment", an NEJM catalyst article
• Bree Collaborative 2018 end of year report
• Bree Collaborative, the landing page for the "total knee and hip replacement bundle and warranty" standard as well as other accountable payment model standards they have published.   

Recommended reading this month (book and article recommendations)

• Models of integrative health in hospitals and medical centers
• The JACM special edition, March 2019, volume 25, issue S1, Special Focus Issue on Multimodal Approaches in Integrative Health: Whole Persons, Whole Practices, Whole Systems
• When Clinical Research Impacts Health Policy
• “Acupuncture for Chronic Pain in the Vermont Medicaid Population: Interview with Robert Davis, LAc” by Jennifer A.M. Stone, LAc.  Meridians: JAOM, winter 2019, p. 35 -36, 45. 
• Excerpt: (paraphrase) After receiving acupuncture treatment in the study:
• 57% of patients used less non-opioid pain relief medications
• 32% of patients using opioid meds reported reductions in use
• 74% of employed patients reported improved capacity to work
• 96% said they would recommend acupuncture to others with chronic pain
• 91% reported qualitative improvements (physical, functional/behavioral, and psycho-emotional)
• Davis RT, Badger G, Valentine K, Cavert A, Coeytaux RR.  Acupuncture for chronic pain in the Vermont Medicaid population:  A prospective, pragmatic intervention trial.  Glob Adv Health Med. 2018; 7:2164956118769557. Published 2018 Apr 10. 
• Research
• On writing a scientific paper—this article is a good review with specifics to the practice of acupuncture and east Asian medicine. 
• “Writing a Solid Scientific Paper That Will Sail Through the Peer Review Process:  Valuable tricks from the experts” by Jennifer A.M. Stone, LAc, pages 30-35 of Meridians: The Journal of Acupuncture and Oriental Medicine, spring 2018. 

National News

• The U.S. Health and Human Services (HHS) call for information on pain management best practices, identify gaps in care, etc., to help curb the opioid crisis ends April 1^st, 2019.
• Read the NCCAOM white paper submission to HHS here.

More on research this past month--Basics and Bodywork-focused

• The Massage Therapy Foundation (research) and the NCBTMB (massage therapy and bodywork) have collaborated to create a webinar series on the basics of research in 2019.  The first webinar aired in February 2019, with the episode, "Why Research?"
• Go to their landing page to learn more about it.  
• Recording of the February 2019 webinar, "Why Research?" or go to the NCBTMB channel. 
• For the continuing education credit offered by Massage Therapy Foundation for watching this webinar, go to their website.

Support the Project
You can support this work anytime:

1. Share blog posts 
2. Sponsor a newsletter or pitch in to offset daily operating costs at a cup of coffee or lunch. ☕️
3. Take our first metrics course

Thank you for your support!
Happy early spring!
Megan


Here's the link to the full March newsletter if you missed it.  Sign up on our email list to get future newsletters.  

You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

www.thehospitalhandbook.com

March Leadership and Workplace Mondays Summary

keywords:  leadership, workplace, workplace culture, being an employee

Inspiration for Employees and their Leaders 

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

• The Duke University Leadership Program white papers on leading change in health care:
• The Pebble in the Pond:  How Integrative Leadership Can Bring About Transformation by Adam Perlman, Bonnie Horrigan, Elizabeth Goldblatt, Victoria Maizes, and Ben Kliger.
• Informed Mindfulness:  The Power of Awareness and Choice in Effective Leadership by Micahel Aquilino, Bonnie Horrigan, and Adam Perlman.

• "The Surprising Power of Simply Asking Coworkers How They're Doing" from the Harvard Business Review.
• Hints to improve happiness at your workplace, advice from BlueZones.com
• Ideas for Getting Through the Afternoon Slump from Mindful.org.

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

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

More posts on Leadership

• Lunchtime Listens (audiovisual resource recommendations)
• February 2019 Leadership and Workplace Mondays roundup
• January 2019 Leadership and Workplace Mondays roundup
• December Leadership and Workplace Mondays roundup
• November Leadership and Workplace Mondays Roundup
• A leader that practices mindfulness and self-awareness is a positive force in his/her organization
• Making Space for Innovation
• National Academy of Medicine's Clinician Well-being Series--audiovisual resource
• The Mind of a Leader

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.

You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

www.thehospitalhandbook.com

Research Thursdays Summary for March 2019

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

Do you want a pdf copy of this article? 
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. 

The March 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.

Recommended Research Reads this Month

• Acupuncture for post-surgical pain.  “Acupuncture Provides Short-term Pain Relief for Patients in a Total Joint Replacement Program” Crespin DJ, Griffin KH, Johnson JR, et al.  Acupuncture provides short-term pain relief for patients in a total joint replacement program.  Pain Med. 2015;16(6): 1195-1203.  doi: 10.1111/pme.12685
• Models of integrative health in hospitals and medical centers.  An entire special issue focused on this topic in the March 2019 JACM.  volume 25, issue S1.  Special Focus Issue on Multimodal Approaches in Integrative Health: Whole Persons, Whole Practices, Whole Systems
• When Clinical Research Impacts Health Policy
• “Acupuncture for Chronic Pain in the Vermont Medicaid Population: Interview with Robert Davis, LAc” by Jennifer A.M. Stone, LAc.  Meridians: JAOM, winter 2019, p. 35 -36, 45. 
• Excerpt: (paraphrase) After receiving acupuncture treatment in the study:
• 57% of patients used less non-opioid pain relief medications
• 32% of patients using opioid meds reported reductions in use
• 74% of employed patients reported improved capacity to work
• 96% said they would recommend acupuncture to others with chronic pain
• 91% reported qualitative improvements (physical, functional/behavioral, and psycho-emotional)
• Davis RT, Badger G, Valentine K, Cavert A, Coeytaux RR.  Acupuncture for chronic pain in the Vermont Medicaid population:  A prospective, pragmatic intervention trial.  Glob Adv Health Med. 2018; 7:2164956118769557. Published 2018 Apr 10. 

Reviewing the Basics

• On writing a scientific paper—this article is a good review with specifics to the practice of acupuncture and east Asian medicine. 
• “Writing a Solid Scientific Paper That Will Sail Through the Peer Review Process:  Valuable tricks from the experts” by Jennifer A.M. Stone, LAc, pages 30-35 of Meridians: The Journal of Acupuncture and Oriental Medicine, spring 2018. 

Bodywork/Massage Therapy

• The Massage Therapy Foundation is hosting a free webinar series on the basics of research on select days in 2019.  The first one was in February 2019, "Why Research?".  Go here for the recording.   They also offere a continuing education credit for watching the episode, just go to their website.  
• Research Perch podcast episode: "Massage Therapy in Outpatient Cancer Care part 1"  
• Research Perch podcast episode follow up, "Massage Therapy in Outpatient Cancer Care part 2".  
• But, this episode dives into translational research...how research can inform clinical practice.  Asking questions like:  where did this come from?  why do we do that?  Just because something is common doesn't mean it is right.  What is the therapeutic benefit for the patient?  Is that model a business model or a model based on patient-centered care and therapeutic benefit?  Treatment frequency, time in treatment, therapy used, tracking functional measures, etc.  This is a good listen for any clinician in the field of integrative health.

Humanism in Healthcare and Clinician Resilience

• The January edition of the Jeffrey Silver Humanism in Healthcare Research Roundup includes 5 different analyses related to burnout and resiliency across various groups of healthcare professionals.  
• More about building resilience through regular self-care at our HH Project post.  
• More about the research behind clinician well-being and improved clinical outcomes for patients, you can peruse the National Academy of Medicine's 2018 "Clinician Well-being" series.  

Research Conferences

• The 2019 International Massage Therapy Research Conference will be May 9-10, 2019 in Alexandria, VA.  "IMTRC 2019 will feature keynote speaker Helene Langevin, MD, Director of the National Center for Complementary and Integrative Health (NCCIH), and panel sessions on pain management and addressing the opioid epidemic with massage therapy.  Education sessions will explore the use of therapeutic massage for arthritis, breast cancer, low back pain, and anxiety."  

Funding Announcements

• The Society of Acupuncture Research (SAR) posted an easy-to-read blogpost on all the current NIH acupuncture research funding announcements.
• Massage Therapy Foundation Community Service Grants for 2019--apply before April 1st, 2019.  

For more on the topic of research

• follow the tag/label in this blog for "research literacy"

Other monthly research summary blogposts

• February Research Roundup
• January Research Roundup
• December Research Roundup

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You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com

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

Background

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:

The Artists’ Journey: The Wake of the Hero’s Journey and the Lifelong Pursuit of Meaning (2018) 

The War of Art: break through the blocks and win your inner creative battles 

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.

Mindfulness

• Mindfulness for Beginners:  Reclaiming the Present Moment and Your Life by Jon Kabat-Zinn  
• Letting Everything Become Your Teacher:  100 Lessons in Mindfulness  
• Mindfulness Meditation for Pain Relief: Guided Practices for Reclaiming Your Body and Your Life (audio CD)  
• Sitting Still Like a Frog:  Mindfulness Exercises for Kids (and their parents) by Eline Snel 
• Good Night Yoga: A Pose-by-Pose Bedtime Story and Good Morning Yoga: A Pose-by-Pose Wake Up Story  
• Breathe Like a Bear: 30 Mindful Moments for Kids to Feel Calm and Focused Anytime  (book) by Kira Willey, based on her music.    
• A Handful of Quiet: Happiness in 4 Pebbles by Thich Nhat Hanh  

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

Related blogposts and websites

• Adults learning about mindfulness.
• Health and well-being practices with children
• Gaia.com has instructional videos on yoga for health and mindfulness exercises and a small number of tai chi and qi gong instructional videos.
• Mindful.org has many articles about mindfulness practices for health, for improved leadership skills, and mindful education (classroom) resources.

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

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.  

• For more about the research and health benefits of journaling:  
• Opening Up by Writing It Down, 3rd edition:  How Expressive Writing Improves Health and Eases Emotional Pain (July 2016) by James W. Pennebaker and Joshua M. Smyth. 
• For practice exercises on how to journal in this way, the following books are noted as more useful:
• Expressive Writing:  Words that Heal (2014) by James Pennebaker and John Evans.
• Dr. Wayne Jonas on journaling
• The article, “15 Journaling Exercises to Help You Heal, Grow, and Thrive” 
• and related video.

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.
• Centering prayer books:  Thomas Keating, founder of the modern centering prayer practice
• Intimacy with God:an introduction to centering prayer (2009) by Thomas Keating 
• The Path of Centering Prayer:  Deepening Your Experience of God by David Frenette (forward by Father Thomas Keating)
• Open Mind Open Heart by Father Thomas Keating 
• Too Deep for Words: Rediscovering Lectio Divina with Thelma Hall  

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.  

www.thehospitalhandbook.com