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This is the second part to a series of posts, titled ‘Improved’, aimed to improve the life and work of Respiratory Therapist and other healthcare providers.

I share recommendations and advice from a friend who is a health professional with educational and work experience as a nutritionist.  In my short conversation with her, I asked for any recommendations for clinicians who either work long 12 hours long day/night shifts/ acute care, and/or to those who work sedentary 9 hours shifts/diagnostic/patient education.  I have added relevant resources to some of the suggestions so I recommend that you check out the reference section for additional information.

Regardless of the work-setting, clinicians get heavily involved with their responsibilities and may loose track of time and their food intake.  Nutrition can directly impact cognition, concentration and decision making (1).  My source, the nutritionist, suggests: stay hydrated, eat healthier, plan your meals, have healthier snacks, and give yourself time to adjust to healthy eating habits.

Stay Hydrated. Don’t ignore thirst. Drink water. Carry a container of water with you (at your desk/RT department). If you choose to drink other fluids, check out the 2014 guideline by Dietitian of Canada (2). This guideline suggests a daily water intake of  2.2 L for women and 3 L for men (19 years and older).

 Eat Healthier.  Eat more vegetables and fruits.  It also adds more fiber to your diet (just remember to increase your water intake with it).  Limit foods that are high in  calories, fat and salt.  Consider lean meat or alternatives. Check out Canada’s Food Guide for more details.

Meal Preparation. A main obstacle in healthy eating at work is preparation.  Prepare food in advance:  Purchase, prepare and cut your veggies before it is time to cook.  Use slow cookers or pressure cookers to better fit your schedule.  Cook higher quantity of food than needed and freeze it for later consumption (reference 5).  If you don’t have time to prepare a meal and have to purchase a one at work, cut up some veggies and fruits to take with you.

Snacks. No matter how busy you may get, take the time to eat something, e.g. instead of having cookies and chips, cut up some bell peppers and celery sticks. Pair it with protein such as almonds and walnuts. It is better than working on an empty stomach (impacting concentration and overall performance at work). (3 and 5 ).  Also when it comes to shakes, it is better to eat food than to drink it (chewing food improves the transmission of satiety signals).

Habits. Keep in mind that any behavioural change, including improving dietary intake, requires time and practice. Set SMART goals (Specific, Measurable, Attainable, Rewarding, and Timely) .  Take small steps, keep motivated and enjoy!

Thank you to my nutritionist source (anonymous, so her opinions would not reflective of her employer(s) ) .  Also, a thank you to my followers for allowing me to be part of your  personal or professional development and growth.

Resources and references:

1. Friedman, Ron. What you eat affect your productivity. October 17, 2014. Harvard Business Review. https://hbr.org/2014/10/what-you-eat-affects-your-productivity
2. Guidelines for Drinking Fluids To Stay Hydrated. Nov 27, 2014. Dietitians of Canada. https://www.dietitians.ca/Your-Health/Nutrition-A-Z/Water/Why-is-water-so-important-for-my-body—Know-when-.aspx
3. 10 Nutrition Tips for Shift Workers. Dietitians of Canada. 2013 http://www.dietitians.ca/Downloads/Factsheets/10-Nutrition-Tips-for-Shift-Workers.aspx
4. Miller, Carla. Changing Your Habits for Better Health. June 2013. NIDDK (NIH).  https://www.niddk.nih.gov/health-information/health-topics/diet/changing-habits/Pages/changing-your-habits.aspx
5. Canada’s Food Guide: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
   Limit these: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/maintain-adopt/limit-eng.php
   Fruits/Vegies  http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/fruit/tips-trucs-eng.php
   Fast and Easy Meal Ideas: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/fruit/tips-trucs-eng.php
   Planning Tips: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/using-utiliser/plan-eng.php
6. Getting Started: Setting SMART goals.  Alberta Health Services. Mar 2012. http://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-getting-started.pdf
7. Image credit. Freepik. http://www.freepik.com/free-photo/table-with-vegetables_889630.htm

[End] [Farzad ‘Raffi’ Refahi HBSc/RRT/CRE. FarzadRefahi.com April 02, 2017]

Working on my presentation for the upcoming CSRT Conference in Halifax. Thursday May 11, 2017. 10:45 am. Leadership Forum. 

Working with Multi-Generations in Health Care.

See you there! 

Farzad Refahi Feb 17, 2017

“The first experience of intubation on a manikin was so fun!”

These were my initial thoughts after trying intubation on a manikin for the first time on Feb 13, 2012 at The Michener Institute. My first intubation in a simulation setting. “So Fun”.  Reaching for the laryngoscope with the left hand, sliding the tongue to the left.  Recalling to lift up and NOT to bend the wrist. To pass the tube through the cords.  To establish an airway. To intubate.  A palpable excitement in the clinical laboratory as my classmates took turns to attempt this skill.    Somehow it made us feel powerful, and closer to becoming a Respiratory Therapist, an RT.

This post is a self-reflection, a personal opinion, and does not represent the thoughts and the beliefs of my employers.  I will make references to intubation as a unique RT skill, without suggesting that it is the ultimate required intervention.  Also, I will draw on my experiences and insights as a lifeguard and a respiratory therapist, without any attempts to fully describing the responsibilities of each job.

When I read my Facebook post from 5 years ago, I started to think about my role as an RT.   I realized that my views and thoughts have shifted, or expanded to be more accurate.    I had gone through the same realization some years ago about a similar case.  I started recalling my training and work as a lifeguard.

To be a lifeguard.  To recognize the signs of struggle, to make that dive, and to save someone.  Many swimming classes and training sessions prepares one to become a lifeguard.  The idea of being able to save someone is a strong motivation to jump through all the hurdles and requirements.   However, when you complete the training sessions and start working as a lifeguard, you realize that the ability to ‘dive in and save’ , is only a very small part of your actual shift.  Does that take away from the skills and abilities of a lifeguard? Absolutely not.  But one quickly learns that there are many more processes in place to make someone a quality lifeguard.  The meaning of ‘saving’ someone shifts and expands.   Once trained, lifeguards are equipped with many skills to approach and intervene with the situation at hand.  However, most of the shift is spent on preparation and monitoring.  Yes.  Lifeguards spend most of their time preventing the opportunity to do the glamorous ‘dive and save’.   Time is spent to scan the swimming pools before the beginning of the shift: scanning for any loose bricks, sharp corners, water quality and levels.  During the shift, they monitor any risky behaviour by the patrons. They move around to have a clear view of those in the water.  Lifeguards have learned to expect and predicts certain patterns.  In case of emergency, they use the skills and routines that they have spent hours practicing.  Once the incident is dealt with, they spend time documenting and communicating with appropriate staff.  The incidents are monitored to recognize any patterns.

I had a very similar insight when it came to practicing respiratory therapy. After finishing my undergraduate studies and then few years of respiratory therapy program, I became an RRT.  I learned that if intubation is the required intervention then RTs are willing and ready to perform the task.  However, just like my lifeguarding experience, a lot of effort is spent on recognition, monitoring and prevention. After performing any required intervention, RTs educate and follow-up to prevent the repeat of this incident.    With additional knowledge and experience, one stops thinking about one specific event and start thinking about the bigger spectrum of care.
Let’s imagine that you are an RT responding to a page for intubation of an Asthma exacerbation.  The initial nebulizer and oxygen therapy treatment has failed, and deterioration has continued; Intubation has been selected as the next intervention.   You intubate and ventilate, and the team uses the appropriate pharmaceutical therapy to help the patient.   Your job as an RT may have been done for that instance, but you soon realize that there is a whole system in place that will continue to take care of this patient.   Your colleague may be called in during discharge to review an Asthma Action Plan with the patient.  This patient goes home and returns to his/her daily life.      He/she books an appointment with an RT, a certified respiratory educator, to discuss the recent events.  During the session, spirometry is done to compare the current values with his/her baseline.  A review of the current puffers is done.  Puffer techniques are assessed, corrected and/or reviewed.  The action plan is reviewed and modified as needed.  A list of triggers is updated, and plans to prevent these triggers are discussed.    Our patient is monitored by a team of RTs/CRE/Respirologist/MDs/nurses/Pharmacists who look after him/her.  If all of the above fails, then we know there is a team of healthcare providers waiting in the emergency departments and ICUs to assist and treat such exacerbations.  Preparation, monitoring, interventions, and follow ups.

Through my short RT career so far, I have worked in acute care, pulmonary function testing and sleep apnea education/CPAP. I have had the opportunity to view our role from a wide spectrum.  It is comforting to know that this system of prevention, treatment, and follow up is active in all the settings.   While this system is not perfect, there are caring people who are trying to make improvements.  By thinking about the bigger image, and staying humble, we can be a better member of this spectrum of care.

In hindsight, the thought of diving in and rescuing someone via intubation seems glamorous and ‘fun’, however, it is but one aspect of being an RT. Respiratory Therapy field is expanding and we are the driving force behind it.

[End]

 We said farewell to 2016 and welcomed 2017.  After few days of celebration we returned to our regular schedule.  Having a new year’s resolution is common and well established for many individuals.  Creating a new year resolution is not a new concept, and can be linked back to 4000 years ago, in the ancient Babylon (1).  We can all recall the elements of an effective goal setting/plan. SMART. Specific, Measurable, Attainable, Realistic and Timely. We have been exposed to effective planning throughout our academic and clinical training.  However, I would like to remind you of an important step that will benefit both us and our patients.  Planning for possible and upcoming obstacles will be the focus of this post.  During my undergraduate studies, Kinesiology with a minor in Psychology, students were encouraged to explore possible obstacles that may hinder the performance and recovery of their patients.  Let’s look at one scenario.
 The client  works in an administrative setting where the stress of producing end of month reports elevates his or her stress level.  This anxiety may lead to an increased urge or temptation to variety of thoughts, actions, feelings and behaviours.  Our client may end up working longer hours in the final days of the month, and resort to take-out and unhealthy eating habits.  Also, in order to meet his/her deadlines, he/she skips the dedicated exercise time.  If our patient is trying to quit smoking or recently has stopped smoking, stress may trigger an automatic impulse to reach for a cigarette.  Also, if others in the office react and behave in the same unhealthy manner when faced with stress, there will be an added external confirmation and enabling.  Now, if we sit down with the client and identify this monthly obstacle or challenge, we can better plan for it.  

Meals:  Packing healthy snacks and lunch/dinner so it is readily available.  Benefits include saving money, one less thing to possibly to worry about, and providing the body with a well balanced energy and nutrients.

Exercise: Exercise helps to lower stress and improve mood, which allows individuals to remain calm and better focus on task on hand (2).  Consider taking 30-minutes walk breaks, without the distraction of listening to the news, reading/replying to emails, talking on the phone, or watching a TV show/Netflix.

Smoking Cessation: By preventing or managing stress triggers when overwhelmed, individuals can better handle their cravings. Avoid accompanying colleagues who are going outside to smoke. (For other list of available resources check out: http://www.smoke-free.ca/pdf_1/smoking_guide_en.pdf )

 When people become stressed, the fight or flight conditioning kicks in, their focus becomes narrowed, and they are more inclined to repeat what they have trained themselves to do.  We can adopt the lessons from this case study and apply it to our lives. Take the time to analyse and identify the obstacles in our plans.  Write them down.  It may feel weird or silly to do this exercise but you will thank yourself in the long run.   Create a list. (If X happens, then I can do   A, B or C). Keep it simple.  Break down each step into smaller parts.  Keep track of your progress.  Celebrate every small achievement in your path.  Keep at it!

Farzad ‘Raffi’ Refahi        

1. Bennett, Howard. Why do we make new year’s resolutions? Washington Post (online). Posted:  December 31, 2015
https://www.washingtonpost.com/lifestyle/kidspost/why-do-we-make-new-years-resolutions/2012/12/21/08b56a2a-381e-11e2-b01f-5f55b193f58f_story.html?utm_term=.dfd45acd2199

2. Exercise and stress: Get moving to manage stress. Mayo-Clinic (Online). Posted: April 16, 2015
http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469