Welcome to an American Association of Nurse Anesthesiology presentation on the pillars of health and wellness, the state of our bodies and the state of our being. The goal today will be to provide information and strategies for supporting optimal health and wellness. I hope you find this informative for your life. Hello, everyone. My name is Katherine Horvath. I am a CRNA in Washington, D.C., although I have practiced in both Boston and Chicago in the past. I have been a provider of anesthesia services since 1992, over 32 years. For the last 16 years, I've also been a nurse anesthesiology educator. I have truly loved my career as a CRNA. Since the beginning, I've had a special interest in how students and CRNAs keep themselves healthy to be able to effectively perform their jobs. Unfortunately, this was an interest born out of seeing colleagues that struggled with their mental and physical health or some who ultimately died from substance misuse or suicide. I told you, and you can see by my white hair, I have had a long career. I imagine I am like many of you listening to this presentation in that I have had my ups and downs in life. I've had happiness and sadness. I've had good days and bad days. I've had health and illness. I've had good coping mechanisms and bad habits. I've had achievements but failures, too. I've had pride and shame. I've had confidence but also fear. Navigating life is interesting, to say the least. To try to help the profession I love and the people who go out every day and care for others giving anesthesia services, I served as a member of the AANA Health and Wellness Committee and then had the honor to serve as chair of that committee for three years. In that role, I was able to publish, to speak formally, participate in podcasts, and serve as an expert on the topic of health and wellness. At the end of this presentation, I personally hope that you have a renewed commitment to your personal health and wellness for your sake, for the sake of your families, for the sake of people who care for you, and for the sake of your patients. I hope you enjoy this presentation. Before I commence on the formal part of this presentation, please remember that your professional member organization, the AANA, is dedicated to keeping its workforce well. The AANA made its first formal commitment to its members, health and wellness, in 1983 when the AANA Committee on Chemical Dependency was formed. However, this was recognized to be not enough when in 2002, past AANA president Jan Stewart accidentally overdosed on sufetinil. So the AANA mobilized again and the AANA wellness initiative started. The official AANA wellness program launched in 2004 with the objectives of developing and implementing functional strategies for its members, encompassing health promotion and the elements of wellness, balance, and self-care. Today, the AANA offers a wealth of health and wellness resources to help CRNAs and nurse anesthesiologists and students achieve holistic wellness to achieve balance and a fulfilling personal and professional life. These include resources on substance use disorder, stress, depression, care fatigue, adverse events, student wellness, and workplace wellness. As part of this initiative, the AANA Health and Wellness Committee was born, which designs, implements, and monitors the wellness program. In this presentation, health and wellness will be first defined, along with describing a balanced approach to integrating the identified key pillars of health and wellness. Let's start our discussion with looking at Tara, a 29-year-old student, five months from graduation. The program faculty and administrators and staff are very excited for Tara, knowing she is about to start a satisfying career. But over the last 36 months, she has worked hard to complete 84 academic credit hours, 2,600 clinical hours, 750 surgical cases, 30 overnight call shifts, driven over 6,000 miles to clinical sites, all the while caring for family as best she can. She is the picture of many residents in nurse anesthesiology programs who did not find the time to dedicate to her health and wellness during her program. Should we worry about her as she begins a demanding career? Let's define what we mean by the terms health and wellness. Today, there are three types of definition for health that seem to be possible and are used. The first is that health is just the absence of any disease or impairment. The second is that health is a state that allows the individual to adequately cope with all the demands of daily life, which also implies the absence of disease and impairment. The third definition states that health is a state of balance, an equilibrium that an individual has established within himself or herself and between himself and his social and physical environment. On the other hand, wellness is an act. It's an activity or active pursuit of practicing healthy habits on a daily basis to attain better physical and mental health outcomes so that instead of just surviving, you're thriving. Again, it's the active pursuit of activities, choices, and lifestyles that lead to a state of wellness. The bottom line of well-being is that being healthy and well is not created by only one thing we do. Balanced living includes all aspects of health and wellness rather than focusing on one area in isolation. The purpose of this presentation is to educate, inspire, and empower resident registered practitioners to adopt a holistic approach to their well-being. Professional self-care is a responsibility of the individual and is influenced by the ability of a practitioner to manage their lifestyles and happiness through personal choices and behaviors. A provider's well-being in professional settings improves productivity and the satisfaction you have in your job. CRNAs and residents have the responsibility, the accountability, and competence to make positive choices and improve their physical wellness, mental health, and their well-being. One way to think about elements of health and wellness are to imagine all the pillars that are needed to hold up the roof of our health and wellness. In this presentation, we are going to talk about the pillars of nutrition, movement, light, sleep, mental health, purpose and meeting, and social connection. The roof is dependent on each of the pillars. While it is possible to remove a pillar without the roof falling down, removing one puts additional stress on the others and the other pillars may crack and become damaged from the additional burden. And you can imagine that if more than one pillar is failing to do its job, it is more likely that the whole roof will fail. So let's take a look at some of the fundamental aspects of health and wellness. I hope to offer you actionable advice and strategies that you can use to easily integrate into your daily routine. The first pillar is nutrition. A healthy diet is important for good health and nutrition. I think all of you listening to this presentation are aware of that. A healthy diet helps you feel your best and provides you with the energy and nutrients for your body to work efficiently and well for you to stay active throughout your day. A healthy diet helps you prevent disease processes such as heart disease and diabetes, cancer, strokes. It improves your immune system so you don't get sick as often. It improves your mood, your memory, your brain health, and it also helps you maintain a healthy weight. Key components of a healthy diet are fruits, vegetables, whole grains, lean proteins, and healthy fats. We all know this, but it's hard to do. So let's talk about a few strategies that may help. Strategies are a balanced diet. So again, I mentioned that this includes a variety of fruits, vegetables, whole grains, lean proteins, and dairy in your meals. Opting for lean proteins like chicken, fish, beans, and nuts helps with decreasing that fat intake. How I introduced more of this into my diet was just starting to bring a piece of fruit to work with me tucked in my lunch, or even if I was going to purchase lunch, I would have it with me so that I would eat that first, know it was good for me, full of nutrients, and then it ended up that I didn't eat as many other bad things for me like that bag of chips or maybe something else that was not as healthy for me. So that was just one small way I helped maintain a more balanced diet. Portion control is another thing. To use smaller plates and bowls can help us control the portion sizes. Be mindful of portion sizes when you go out, and I felt like I could at least initially eat a smaller portion and tell myself I would go back for seconds, and many times I found that I wasn't going back for seconds because I was fine with the smaller portion to begin with. Healthy snacking. Choose healthy snacks, again, like fruits and vegetables, nuts, instead of more processed snacks, and then prepare those snacks before going out or for your, you know, going to work, having some snacks so that if you do get hungry in between meals, you can reach for those rather than reaching for those unhealthy options that might be in the vending machines or at the snack shop. Lastly, just hydration, right? Drink plenty of water throughout the day. Drinking a lot of water helps you limit those sugary drinks because you've, you know, taken in enough hydration and you don't crave getting something else to drink. Infusing your water with some citrus, you know, sometimes makes you feel like you've gotten some flavoring if you're craving some different flavoring, and I'll also include that in this section, just you need to limit the amount of alcohol for your general health, and sometimes just by hydrating, that helps. The second pillar highlights the importance of movement, moving your body, and that can be a regular exercise routine, but it also is about less sitting, more stretching, walking, moving, just moving your body. Physical activity invigorates your mind. It boosts learning. It also enhances your cardiovascular health. It aids in weight management. It boosts the immune system. It even increases your lifespan. It does this by making your muscles stronger, better flexible. It increases your bone density. It actually decreases your risk of falling and improves your balance. It gives you more energy. It makes you sleep more soundly and deeply. So again, many, many benefits to moving and maybe regularly exercising. So regularly exercising is something that is recommended for optimal health. Engaging in at least 150 minutes of aerobic activity or 75 minutes of something intense activity per week and incorporating some strength training in there is a wonderful way to get a regular, real exercise routine that helps your cardiovascular health. This can include some flexibility training and some balance exercises like yoga, tai chi. It's really important to have a consistent type of routine. Again, that's not just for regular exercise, but even movement. If you go out for a walk, if you do your stretching, doing that consistently can really help you establish movement in your life. Using apps or some kind of fitness tracker can help you stay motivated and can help you monitor your progress. Doing a variety of activities keeps people interested in maintaining movement in their lives. Trying new activities like dance classes, going for hikes periodically, anything that will help you prevent boredom and kind of help you start targeting different aspects of your muscle groups and your flexibility. Just having, in general, an active lifestyle helps you maintain good health. Reducing time sitting or lying down or breaking up long periods of sitting or lying down helps you with a more active lifestyle. Light is an interesting as a pillar of health and wellness. Light plays a crucial role at regulating various aspects of health and wellness. Exposure to natural light, particularly sunlight, has significant effects on our physical, mental, and emotional well-being. It can regulate our biological clock. Light is a primary cue for regulating our circadian rhythms, which help control our wake-sleep cycle. Exposure to natural light can kind of help synchronize that, which promotes alertness during the day and better sleep at night. Light exposure helps with melatonin production, again, which maintains a healthy sleep pattern. Sunlight exposure helps with vitamin D synthesis, which helps maintain calcium and phosphorus levels in our blood, which helps support healthy bones and teeth. It also helps with our mood and mental health with things like seasonal affective disorder, which has been shown to happen more often with a lack of sunlight, especially in the winter months. So again, our general well-being, natural light exposure helps us feel better. It makes us feel happier and helps with our general health. So strategies to optimize light exposure is to maximize our natural light exposure. So spend as much time outdoors daily as you can. So maybe going outside on your lunch breaks, going outside and spending some time outside after work when the sun is still out and you can get natural light. Even sitting by a large window with the light coming in, the sunlight coming in, helps strategically place, you know, sitting near things that reflect light onto you, helps use artificial light wisely. So kind of that, you know, bright blue and rich light during the day can mimic kind of natural sunlight and enhance your alertness. So having light on, not working in dim, dimly lit settings. And then the evening switch to a warmer, dimmer lighting to help prepare your body for sleep and kind of adjust your light settings. During the day, especially if you're in a climate that or in a season that has limited light and maybe you're going to work and coming home for more when the sunlight is already gone, sometimes help light therapy can help. Reducing your blue light exposure. So your screen time at night before bed helps manage your sleep. So preventing that, reducing your screen time and managing it in the evening. And then we'll talk a little bit about sleep strategies and kind of making us more sleep friendly environment by making your rooms dark. So again, there's this balance between light during the day to improve your mood, help with your health, but then also to start to dim it naturally as you get ready for a good solid sleep. The next pillar is sleep. Getting enough sleep is not a luxury. It's needed for good health. So it's one of the pillars. Why is getting enough sleep important? It can help you get sick less often, stay at a healthy weight, lower your risk for serious health problems like diabetes, hypertension, and heart disease. It reduces stress and improves your overall mood. It makes you think more clearly and do better at work. It makes you get along with people better. It helps you make good decisions and avoid injuries. We need sleep for repair too. People often think that sleep is just downtime when a tired brain gets to rest, but that's wrong. While you sleep, your brain is working to remove toxins and this helps you prepare your brain to learn, remember, and create. So how much sleep do I need? The amount of sleep you need changes as you ages, but for adults, seven or more hours a night, according to the American Academy of Sleep Medicine and the Sleep Research Society. But the quality of sleep is just as important as quantity. We need deep, uninterrupted sleep, which is crucial for restorative rest in our lives. I'm sure you all can recognize the signs of insufficient sleep, where we have difficulty waking up, we feel sleepy or tired even after getting enough sleep, we repeatedly wake up during the night, we're irritable during the day, we have difficulty concentrating. All of these are signs of when we don't get enough sleep in our lives. So how do we get to have good sleep habits and good quality sleep for health and wellness in our lives? One thing is to establish a consistent sleep schedule. And that's probably one of the biggest things, is to go to bed and wake up approximately the same time every day, even on the weekends or even on the days you're not working. The routine will signal to your body that it's time to sleep when you get to the certain part of the day. The other part is to create restful environments to sleep in. The best is to keep your room cool, dark and quiet. Also investing in a comfortable mattress and pillows helps too. Limit the amount of screen time you have, avoid the screens of your phone, the computer, TV for at least an hour before bed to reduce that blue light exposure that's coming off of the screens that can known to interfere with sleep. If you need to or find it comforting to use any of these devices, at least use a blue light filter on the electronic devices to help decrease the amount of exposure as you're trying to get yourself ready for sleep. Do something relaxing before bed. Engage in a calming activity like reading, taking a warm bath, listening to quiet music or just practicing some relaxation exercise. Avoid ingesting stimulants like caffeine and nicotine, especially in the hours leading up to bedtime. Watching your diet, like avoiding heavy or large meals close to bedtime. I know I sometimes have reflux if I do. Instead, if you're hungry, have a really light snack. And then just in general, getting exercise, being physically active during the day and moving your body can really help you fall asleep easily, more easily at night. All of us at different times are recovering from sleep debt, meaning we've gotten behind on how much sleep we needed. If each of you were to take that seven hours that's required, you know, at least seven hours a night and here and there, we're missing a few hours and you need to kind of recover from the fact that you've lost some sleep. It is recommended that you can take brief naps to help this, it may help you feel more refreshed and increase your working memory and mental acuity for a few hours. So a brief, like even 10 to 15 minute nap can help you feel refreshed. The thing is, you know, if you are recovering from sleep debt or you feel like you need more sleep, give it time. Research has shown that it may take, you know, four days up to a week to recover even one hour of lost sleep and, you know, it can take, you know, days to eliminate that sleep debt. And so by really understanding and respecting your body's need for sleep, you can improve your overall health, your cognitive function and your emotional wellbeing. Mental health is a person's overall emotional, psychological and social wellbeing. And it's a vital part of the quality of our life. It affects how we think, feel, act, and it helps us handle stress, relate to others and make healthy choices. Mental health is an integral component of health and wellbeing that underpins an individual's and our collective abilities to make decisions, to build relationships and shape the world we live in. If you have good mental health, you might feel happy, confident and generally satisfied with your life. You're likely to feel connected to other people and be good at making a contribution to society. You might also have a sense of meaning and purpose and a feeling of being at peace. Research has found a link between an upbeat mental state and improved health, including lower blood pressure, reduced risk for heart disease, a healthier weight, better blood sugar levels and a longer life. So how do we maintain our mental health? Paying more attention to the present moment can improve our mental wellbeing. This includes being present in our thoughts and feelings around our body and how the world around you is working. Some people call this awareness or mindfulness. Mindfulness can help you enjoy life more and understand yourself better. Some strategies for mental health are stress management. So practicing mindfulness and meditation regularly. You can even use something simple like deep breathing exercises in and out to help relieve stress, having a healthy mindset, cultivating that positive outlook, positive affirmation, gratitude, and kind of challenging negative thoughts. Why are they there? Trying to replace them with more positive ones. Leisure activities, engaging in hobbies and activities that bring you joy and relaxation, and spending time in nature, and taking breaks to unwind can help. And then therapy and counseling, seeking professional help if needed to deal with stress, anxiety, or depression, support groups. You can be given recommendation for support groups so that you can share your experience and get advice from others who are going through similar challenges are sometimes helpful, especially in times of challenges in your life. Our purpose is expressed in our thoughts, decisions, feelings, and actions. A greater sense of purpose shapes us in our lives, meaning we are better able to make an impact. Purpose matters in many ways. For example, a study found that when people have a greater sense of purpose, they have less incidence of cardiovascular disease and lower mortality. In addition, a recent study found that when people have a greater sense of purpose, they experience less loneliness and they make better lifestyle choices to protect their health. And you can just see as we're going through these slides how all these pillars are almost intertwined. They're not separated. They're not these standalone foundations. They're really almost wound together as vines. To put it simply, purpose can mean a feeling that the things in your life you are doing are worthwhile. When you have a sense of purpose, you feel that you've made a deliberate choice to act in accordance to your values and your goals and that things are worthwhile. Your purpose does not need to be grandiose. It only needs to be something that is meaningful to you. It could be work. It could be a hobby that you love. It could be a devotion to someone you care about, a creative expression. It could be travel. It could be treating everyone you meet with kindness, keeping up your house and all the chores around it. It could be writing a book or creating some video. It could be starting or expanding a business. It could be connecting with friends or colleagues or grandchildren. Whatever your purpose, you can reap the harvest of its benefits. Purpose and meaning can lead to happiness, healthy habits, stronger personal connections, wealth, health, specifically better heart health and reduced risk of Alzheimer's and also longevity in our lives. It can lead to actually better sleep and better mental health. So again, everything is intertwined. So how can we find better purpose and meaning in our lives? First, you need to self-reflect on your values, your passions, your strengths to identify what you feel your purpose is and then set meaningful goals that align with your sense of purpose. Some people find it in volunteering and engaging in work that aligns with your values and interests. Helping others really many times helps us find a sense of fulfillment in our lives. And then just pursue hobbies and interests that challenge and inspire you and seek opportunities for self-improvement and challenge and learning. Many people find purpose and meaning in their work. Finding meaning in your work is by focusing on how it contributes to a larger good and how you've, you know, it really, being a CRNA has a lot of purpose and meaning and just sometimes reflecting on that and understanding that you're really, you know, you really have a true purpose in your life and you're contributing to a larger good. And then, you know, if you've found other pursuits, you know, having those aligned with your purpose and values really helps you with that personal growth. Pillar number seven is social connections. We as humans are wired to connect and this connection can affect our health. Humans are inherently social creatures. As far back as we can trace, people have traveled, hunted, and thrived in social groups. These social groups provide us with an important part of our identity. And more than that, it teaches us a set of skills that help us prosper in a very complex environment. Feeling socially connected, especially in an increasingly isolated world is far more important than ever. People who feel connected to others have lower levels of anxiety and depression. They also, studies have also shown that if you have good quality social connections, you have higher self-esteem and greater empathy for others. You are more trusting and cooperative. And as a consequent, others are more trusting and cooperative with you. In other words, social connectiveness generates a positive feedback loop of social, emotional, and physical wellbeing for us all. Other positive effects from social connections are it improves our quality of life, it boosts our mental health, it helps us live longer, and it decreases our risk of suicide. So building good social connections takes time. So scheduling regular time with family and friends or others in our community that we would like to make connections with, engage in activities that you enjoy together, join clubs, groups, or classes that interest you. Not only does it give you purpose and meaning, but it also helps you interact with others. Again, volunteer work can help you meet new people, cultivate networks of supportive friends and families, and then remember that reaching out for help or offering support to others when needed is needed for these social connections. Fostering a sense of community by engaging with others in our community by encouraging discussions around our shared goals can help our health and wellness, and it promotes the idea of building supportive networks to help maintain our wellness practices. Now, remember Tara, who we saw at the beginning of this presentation, who was just starting her career? She is at the end of her career, thinking about retirement and what new paths she will take. Despite her exhaustion at the end of her educational program, Tara has thrived in her career and in her life and expects retirement to be fulfilling. She has figured out, with the help of resources and her social connections, that she needed to take care of herself and her family, to do her job, and to stay healthy. She needed the seven pillars. She needed good nutrition. She needed to stay moving. She needed light, good sleep, social connections, purpose and meaning, stress management, all of this to anchor her lifelong health and wellness. Remember that the AANA is here for you, and you can find a multitude of resources to help you on your path of staying well. And in times of crisis, there is a helpline that is always there for you and others if needed, both for crisis around drug misuse, but also for any other emergency crisis that happens in your life. Also remember, as if things seem to be too much for you, there is a National Suicide and Crisis Lifeline, 988, that you can call at any time. I wanna thank you so much for listening to this presentation, and I hope that you can find small ways to improve your health and wellness today and the coming weeks and months, and that you have a joyful and fulfilling life.

Katherine Horvath

CRNA

health and wellness

AANA

seven pillars

mental health

nutrition

self-care