Whole Health in Your Practice Day 2/3 Morning

Whole Health in Your
Practice
Advancing Skills in the Delivery of
Personalized, Proactive, and
Patient-Driven Care
Welcome Back!

Pulse Checks
Image: Keepcalm-o-matic.co.uk

Where We’ve Been
• The Big Picture
• Mission, Aspirations, Purpose
• The Power of You
• Mindful Awareness
• Resilience and Clinician Self-Care

For the rest of the course
• Today: Self-Care and Professional Care
• Tomorrow: Community and
Implementation – for you, your patients,
your team, your facility, and beyond
The
System

Whole Health in Your Practice
7. Self-Care, Part I

Group Exercise:
Getting to Know the Self-Care Circles
1. Count off from 1 to 8
2. Your number will be your self-care topic
assignment
3. Meet with your group (we will show you
where in a moment) – take your Passport!
4. As a group, learn all you can about your topic
from the passport for 15 minutes
5. Be ready to share what you learn!

Your Mission
1. Use the Passport chapters to guide you
2. Pick a spokesperson
3. Be ready to share for <5 minutes
Key Question: What are options related to your
topic that could be put into a Personal Health Plan?
You will share when 2 different slides come up:
1. Subtopic Circles: You take the group through what
those topics are, giving a few interesting facts you
learned for each one
2. For “Make One Small Change” share some of the
group’s favorite options

Example: Surroundings
Surroundings
Physical & Emotional
Improve
Where You
Live
Get More
Organized
Improve
Where You
Work
Improve
Emotional
Surroundings
Create
Healing
Environments
Reduce
Toxins
Spend Time
in Nature
Make One
Small
Change
There is a clinical
tools that
suggests a few
things to reduce
toxins...
There was a study
that showed time
in green spaces
helped with...
Some ideas for ways that
people can improve their
work environments
include...
The Passport had this to
say about hoarding...
1

Example: Surroundings
Make One Small Change
• Appeal to the senses
• Get organized
• Change you workplace
• Improve emotional
surroundings
• Create a healing space
• Remove/heal from
toxins
• Get nature time
• Plant a tree
• Paint a wall
• Put a plant on your desk
• Take a media break
• Clean up the roadside
• De-clutter
• Add art
• Get a carbon monoxide
detector
1. Our favorite
options are...
2. Other options
could include...
2

Go to the part of the room with your #
SCREEN
2.
Working Your
Body (Ch 5)
1.
Surroundings
(Ch. 6)
7.
Personal
Development
(Ch 7)
3.
Food & Drink
(Ch 8)
4.
Recharge
(Ch 9)
6.
Spirit & Soul
(Ch 11)
5.
Family, Friends
& Coworkers
(Ch 10)
8.
Power of the
Mind
(Ch 12)
FrontBackMiddle

Photo:Samhealth.org
1. Surroundings
Physical and Emotional

Zeroing in on Options
Surroundings
Physical & Emotional
Improve
Where You
Live
Get More
Organized
Improve
Where You
Work
Improve
Emotional
Surroundings
Create Healing
Environments
Reduce
Toxins
Spend Time
in Nature
Make One
Small
Change
GROUP 1 –
PLEASE
REVIEW
THESE FOR
THE GROUP

Surroundings and Healing
42
Photo: activerain.comPhoto: pinterest.com
What would your rather see from your hospital bed?

Mindful Awareness-
Your Healing Place...
• You are welcome to choose to do this or not
• It should feel safe and relaxing
• You will be visualizing a place that is healing
for you
• What makes it healing?
• You can stop anytime you wish
Photo: videoblocks.com

Partner Discussion:
What Makes for Good Surroundings?
• Take a few minutes each to talk about the
place that came up for you.
• Why do you like that place?
• What is one thing you could do to make other
places where you spend time more like this
place?
Photo: thewordofward.co.uk

Surroundings
• Appeal to the senses
• Get organized
• Change work
• Improve emotional
surroundings
• Create a healing space
• Remove/heal from
toxins
• Get nature time
• Plant a tree
• Paint a wall
• Put a plant on your desk
• Take a media break
• Clean up the roadside
• De-clutter
• Add art
• Get a carbon monoxide
detector
Photo: Adam Rindfleisch
Group 1: Please Share Your Suggestions!

2. Working Your Body
Energy and Flexibility
Photo: npr.org

Working
Your Body
Energy & Flexibility
Work with
an Expert
Make One
Small Change
Create a
Personalized
Activity Plan
Mindful
Movement
Track Your
Progress
Take a Class
GROUP 2 –
PLEASE
REVIEW
THESE FOR
THE GROUP

Working Your Body
58
What if there was
one prescription
that could
prevent and treat
dozens of diseases,
such as diabetes,
hypertension
and obesity?
-Robert E. Sallis, M.D., M.P.H., FACSM,
Exercise is Medicine™ Task Force Chairman

Mindful Movement:
Yoga and Tai Chi
1. All VA’s will be offering them in some way
starting in 2018
2. We know they help your health
– They help prevent heart attacks, improve mood,
build balance, and more
3. Can recommend a class – see what your VA
has to offer
4. We’ll cover these in the CIH module this
afternoon

Working Your Body
All the topics so far
can guide you
• Personal activity plan
(FITT)
• Mindful movement
• App’s and devices
• Classes
• Professional help
Or set a different
small goal
• Walk with a buddy 3
times a week
• Park farther away
• Get a standing work
station
• Use the stairs as able
Photo: Military.com

Movement Practice
Photo: Miybestruns.com

3. Food & Drink
Nourishing and Fueling
Photo: modernfarmer.com

Food & Drink
Nourishing & Fueling
Work with a
Dietitian
Make One
Small
Change
Create Your
Own Food &
Drink Plan
Learn More
About
Preparing
Meals
Eat
Mindfully
Tailor Your
Eating to
Your Health
Needs
GROUP 3 –
PLEASE
REVIEW
THESE FOR
THE GROUP

Food & Drink:
Important Reminders
• This can be complex – good to get
support (dietitians)
• Pay attention to habits – alcohol, binge
eating, eating disorders
• Get your nutrients
• Be cautious if you have health issues,
especially things like diabetes, liver or
kidney problems, stomach problems

Personal Food & Drink Plans:
Some “Food for Thought”
1. Don’t just think in
terms of “diet”
2. People don’t follow
through if it feels like
a punishment
3. Not all calories are
created equal
4. Careful about ‘good
and bad’ labels
5. Consider your budget
and what you have
access to
Photo: newkidcenter.com

Personal Food & Drink Plans:
More Food for Thought
Different Options
1. Add (increase)
something
2. Remove (decrease)
something
3. Change a habit
Photo: myprotein.com

Mindful Awareness-
An Eating Meditation...
• Eating slowly and intentionally is not usually
part of life in the military!
• This next activity might seem strange, but you
might be surprised what you can learn
• You might notice more about what goes on in
your mind (or does not) as you eat
• You will tune into your senses and, if you wish,
your emotions related to food
Photo: total-yoga.org

Reflections on Mindful Eating
• What did you notice?
-Thoughts
-Sensations
-Emotions
• How does this compare to the way you normally
eat?
• How can you use this experience in your daily
life?
• How can you use Mindful Eating with Veterans?

NFS Nutrition Professionals…
Experts in Action!
• Pay close attention to the
research
• Are an important part of
the team
• Follow a specific care
process
– Gather info
– Help figure out what is going
on
– Come up with nutrition plans
• Teaching
• Counseling and support

can guide you
• Personal Food and Drink
Plans
• Meal prep, classes,
teaching kitchens
• Mindful eating
• Tailoring your eating to
your health needs
• Seeing a dietitian
All kinds of goals are
possible
• Add or subtract a food
• Change a pattern
• Time meals in new ways
• Only eat when hungry
• Cook with loved ones
• Try a new food
• Go to a farmers’ market
• Other ideas?
Photo: chron.com

4. Recharge
Sleep & Refresh
Photo: wideopenpets.com

Why Recharging Matters
• Promotes resilience,
prevents burnout
• Increases safety (24 hours
of no sleep is like a blood
alcohol of 100)
• Allows time to reflect
• Gives you time to think
about what really matters
• Gives you energy to pursue
what really matters, too
Photo: Bearlakecamp.com

Sleeping: Why Bother?
7-8 hours a night versus less
than 5:
• 40% less obesity
• 40% less diabetes
• 40% less risk of cholesterol
problems
• 60% lower risk of stroke
• 150% lower risk of heart attack
• Fewer mental health problems
People who regularly get a good
night’s sleep have a 4 times better
survival rate Photo: babygaga.com
Passport to Whole Health, Chapter 9

Other Types of Breaks: Why?
• Low physical activity level (sedentary
time) is tied to more health concerns
• Workaholism also causes problems
• Vacations can be beneficial
• Taking time for you matters
Photo: thefix.com

Recharge
Sleep & Refresh
Work with
an Expert
Make One
Small
Change
Sleep Better
Take Breaks
Boost Your
Energy
Take Time
Just for You
GROUP 4 –
PLEASE
REVIEW
THESE FOR
THE GROUP

Where does your energy go?
Example: Joe

What charges you back up?
Example: Joe

What did you notice?
Photo: medicaleconomics.com

Recharge: One Small Change
All the topics we have
talked about can guide you
• Improve sleep
• Take breaks
• Take a vacation
• Add what energizes you
• Remove things that tap
your energy too much
• Take some “me time”
• Work with a sleep
expert
There are many small changes
you can make. Examples:
• Take one sleep hygiene step
– e.g., ear plugs
• Set aside a few minutes
each day to pause
• Set an alarm to remind you
to take breaks
• See how exercise and
activity affect your energy
Photo: whatsnext.nuance.com

Whole Health in Your Practice
8. Self-Care, Part II

5. Family, Friends & Coworkers
Relationships
Photo: https://www.va.gov/vetdata/veteran_population.asp

Social Workers and Others can…
Experts in Action!• Suggest community resources
• Link people with support groups
• Help with intimate partner
violence
• Assist with benefits and services
• Share couples and family
counseling options (or offer the
counseling themselves)
• Teach communication skills
Photo: socialwork.va.gov

Family, Friends & Coworkers
• Build a relationship
• Make a friend
• Join a group
• Work on communication
• Get expert help
• Practice compassion
There are many small changes
you can make. Examples:
• Go to a Veteran event
• Be active in your community –
the arts, sporting events, local
courses
• Set aside time each week to
call/contact someone you
haven’t see for a while
• Use social media (wisely)
Photo: herbhand.wordpress.com

6. Spirit & Soul
Growing & Connecting
Photo: cbsnews.com

Ground Rules
• Listen to everyone’s views
• Share your views, too
• Do NOT try to impose your beliefs on
others
• Respect that everyone has a unique point
of view
The Spectrum of Spirituality
I don’t
believe
in...
I do
believe
in...
I don’t
know
for
sure

Spirit and Soul may include:
• Meaning and purpose, what we value
• Seeking well-being, inner freedom, and inner peace
• Living, flourishing, and being resilient when
challenges come
• Connecting with others, or with something beyond
us. Belonging
• Being in the present moment (mindful awareness)
Photo: harvestinghappinesstalkradio.com

Spirit & Soul
Growing & Connecting
Work with
an Expert
Make One
Small
Change
Explore
Values,
Meaning
and Purpose
Consider if
Spiritual
Practices are
for you
Work with
Grief, Moral
Injury, and
Recovery
Explore
Forgiveness
GROUP 6 –
PLEASE
REVIEW
THESE FOR
THE GROUP

An important part of self-care is
self-awareness

Six Aspects of Spirituality
Religious
Humanistic
Nature
Experiential
Cosmos
Mystery
You might find that
more than one of these
apply to you. Also, you
might be drawn to
others besides these.

1. Religious
Closeness and connection to
the sacred as described by a
specific religion. Sense of
closeness to a particular Higher
Power
• 83% of US adults belong to a
religious group
• 91% believe in God or a
universal spirit
Photo credit: Lel4nd via Foter.com

2. Humanistic Spirituality
Closeness and
connection to
humankind.
May involve
feelings of love,
reflection, service,
and altruism.
Photo: WND.com

3. Nature Spirituality
Closeness and connection to
nature or the environment.
Like the wonder you feel
walking in the woods or
watching a sunrise.
An important focus for many
traditional healing approaches.
Photo credit: WherezJeff via Foter.com

4. Experiential Spirituality
• Shaped by personal life
events
• Influenced by our individual
stories
• Informed by what we love
to do and be
• Experience in war
influences Veterans
profoundly
Photo: dav.org
Photo: KZTV10.com
Photo: mae.kmi.com
Photo dailymail.co.uk

5. Cosmos Spirituality
• Feeling connected to all of
creation.
• Can come up when you
think about just how big it
all is...
• ...like when you look up at
the stars or down at a
handful of grains of sand
Photo: Sweetie187 via Foter.com
Photo: flickr.com

6. Mystery
• There is much that we
simply cannot know or
understand
• Perhaps it is not
possible to fully grasp
or know, and that is
okay.
Photo credit: _Hadock_ via Foter.com

Partner Exercise-
Your Spiritual Perspective
Consider the six different
aspects of spirituality (and
others you may think of)
1) Religious
2) Humanistic
3) Nature
4) Experiential
5) Cosmos
6) Mystery
• Which ones resonate
with you the most, and
why?
• How might your views
influence how you take
care of yourself?

Spirit and Soul: Experts
• Chaplains
– Can help people from many religions and
traditions
– VA has a strong chaplaincy presence
– They an cover many topics
• Death and dying
• Meaning of illness and suffering: “Why is this
happening?”
• Feelings of spiritual anxiety, guilt, anger, loss,
and despair
• Psychologists and others (clergy, pastors,
ministers, rabbis, etc.) can help with grief,
forgiveness, recovery, and moral injury too
Photo: atlanta.va.gov

Spirit & Soul: One Small Change
• Clarify your beliefs and
values
• Decide if you want to
start a practice
• Work with grief, moral
injury, and/or recovery
• Forgive
• Talk to a chaplain or
other professional
There are many small
changes you can make.
Examples:
• Carry a photo of someone
important to you
• Read something
inspirational
• Offer gratitude
• Do a random act of
kindness each day
Photo: thepet.info

7. Personal Development
Personal Life and Work Life
http://ewddlacity.com/index.php/

Personal Development
How do you learn/grow/live more fully?
• Abilities - talents and skills
• Gratitude
• Learning and education
• Creativity, hobbies
• Service and volunteering
• Healthy mood, humor
• Hope and optimism
• Balance
• Achieving dreams and goals
• Building resilience
• Wonder and amazement
Photo: dailyherald.com

Personal
Development
Personal Life &
Work Life
Build Hope
and
Optimism
Find
Balance
Create and
Learn
Give
Be Grateful
(Count Your
Blessings)
Increase
Humor
Be More
Resilient
Make One
Small
Change
GROUP 7 –
PLEASE
REVIEW
THESE FOR
THE GROUP

Personal Development
can guide you
• Hope and optimism
• Balance
• Create and Learn
• Give and Volunteer
• Be grateful
• Humor
• Resilience
Or set a different
small goal
• Develop self-compassion
• Increase happiness
• Work on your finances
• Set a new goal
• List your strengths
• Do a simple kindness for
someone
Photo: brandvox.com

8. Power of the Mind
Relaxing & Healing
Photo: wjcatv.com

Power of
the Mind
Relaxing & Healing
Work with
an Expert
Make One
Small
Change
Relax!
Work with
Stress
Try a Mind-
Body
Approach
Improve
Emotional
Health
Work with
Habits
GROUP 8 –
PLEASE
REVIEW
THESE FOR
THE GROUP

A Spectrum of Techniques
• Biofeedback*
• Meditation*
• Guided imagery*
• Clinical hypnosis*
• Psychotherapies
• Art and music therapy
• Breathing exercises
• Eye movement
desensitization and
reprocessing
• Therapeutic disclosure
• Progressive muscle relaxation
…and many others
Photo credit: grimeshome via Foter.com
The ones with a * are covered by all
VA’s in some form. Many
psychotherapies are already covered.
Many others are also offered already,
but it depends on which VA.
Passport, Chapter 12

Relaxation Response:
A Common Denominator
• Term coined by Herbert Benson,
MD, a cardiologist
• The autonomic nervous system
has 2 branches
– Sympathetic (fight/flight)
– Parasympathetic (feed/breed)
*Most mind-body exercises have the
parasympathetic activation and other
physiological changes as a common
endpoint
The key is, which approach will best
fit any given individual? Photo: jurist.org

Mindful Awareness-
A Breathing Practice...
• Can change heart rate variability
• Can help you notice more about what is going
on with your body
• Changes your state of mind and body away from
fight or flight
• Can be stopped any time, if you need a break
*If you note discomfort, try to simply watch it without getting
caught up in it. Use caution if you have breathing problems
Photo: tgo-4-health.com

Your Turn:
Teaching a
Mind-Body Skill

1:2 ratio breath
6 breaths per minute
In
3-4
counts
Out
6-8
counts

Now, Practice Teaching Your Partner
• Introduce a breathing exercise
• 1:2 ratio breath
• Centering Breath with hand on heart/belly
• Model it for them
• Get centered and grounded
• Guide them through it
• Ask for feedback from your partner
• Switch

Power of the Mind
All the topics we’ve covered so far
can guide you
• Focus on a way to relax
• Do a mind-body exercise
– Breathing
– Meditation
– Biofeedback
– Imagery
– Hypnosis
– Others
• Work on emotions
• Work on habits
• Seek professional help
There are many small changes you can
make. Examples:
• Take a meditation class
• Practice counting to 3 before
reacting to a challenging situation
• Remove something stressful
• Schedule in time to relax each day
• Talk to someone
• Do something that makes you
happier
• Decrease _____ (smoking,
gambling, etc.)
Photo: rivengear.com

• Find a partner
• Ask them about the green circles
– Areas of strength?
– Areas where they want to improve something
• Practice asking some of the questions on
page 17 of your manual.
• No need to set goals or anything like that
yet – we will practice that tomorrow.
Partner Exercise: Assessing Self-Care

Whole Health in Your Practice Day 2/3 Morning

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