By Jack Tyrell, VGH Volunteer

What happens when we experience a loss?

Loss is what we experience when something is taken from us.  Relatively common losses include the loss of a job, a pet, a pregnancy, a relationship, a loved one, good health, or even the loss of a dream. If we lose something that we value, the natural responses can include disbelief, anger, and great sadness.

Experiencing any form of loss can impact our mental well-being. Because of this, it is important to reach out to those who are experiencing a loss to show our support and make sure they know they are not alone. Helping someone through a loss can be a challenging assignment, but it is also an act of humanity that makes a huge difference; actions like this make the world a better place.  It can be very intimidating to know what to say or do when someone has experienced a profound loss, but with this list of Do’s and Don’ts you should be well prepared.

Things to Do:

• Reach out.
• Ask if they want to talk and accept their response.
• Check in often.
• Be empathetic and supportive.
• Understand that everyone grieves differently and for different amounts of time.
• Understand that you may not understand exactly what they are going through.
• Be willing to sit in silence; sometimes they just need to know someone is there.
• Acknowledge their feelings.
• Acknowledge the situation.
• Offer help in practical ways.
  • Drop off food.
  • Offer to help with errands and chores.
• Show continued support.
• Watch for symptoms of depression and voice your concerns if you see anything.  Be prepared to provide recommendations to mental health supports such as Winnipeg’s Mobile Crisis Line (204-940-1781), or Canada’s Suicide Prevention Service (833-456-4566; SMS 741741).

Things Not to Do:

• Don’t let your anxieties stop you from reaching out. Unless people reach out, the grieving person can feel abandoned in addition to their grief.
• Don’t force them into a conversation if they are not up for it but do let them know you are there when they are ready to talk.
• Don’t try to fix everything.
• Don’t try to compare your experience to theirs.
• Don’t force them to see silver-linings.
• Don’t diminish their feelings or the situation.

Remember, you don’t have to be perfect.  Be patient with yourself if you feel inadequate.  Chances are your efforts will still make a big difference in the life of someone who is suffering with their grief.

References

Baker, M. (2020). How To Support A Loved One with Depression. Retrieved from
https://thedepressionproject.com/school/books/how-to-support-a-loved-one-with-depression

Psoriatic-athritis.com Editorial Team (2018, March 30). How Can I Help? Tips (and Resources!) for Supporting Someone with PsA. Retrieved from https://psoriatic-arthritis.com/living/tips-resources-support-relationships/

Hoggart, A. (2018, January 26). 21 Ways to Help Someone You Love Through Grief. Retrieved from https:// time.com/5118994/advice-for-helping-grieving-friend/

How to Support a Partner with Depression. (2020, May 08). Retrieved from https://www.raq.org.au/blog/how-support-partner-depression

Melinda. (2020, September). Helping Someone Who’s Grieving. Retrieved from https://www.helpguide.org/articles/grief/helping-someone-who-is-grieving.htm

By Brenda Catchpole with research from Antonio Pellegrino

Imagine five years from now, when you look back on the 2020 COVID holiday season.  You will easily remember it because it is going to be different than every other year.  But will it be a good memory, or a bad one?  To some extent that is up to us, and how we choose to handle this opportunity.  It will take a little effort, but here is a three-step strategy for creating the very best holiday season possible.

1. What Is Important?

How you develop your holiday plan depends upon your priorities.  What do you love most about the holidays?  Is it the family time? The food? The gifts? Parties with friends?  Outdoor activities? Perhaps you like the quiet time, or maybe the religious significance speaks most to you.  Pick two or three areas you would like to focus on.  (Don’t try to do them all; that would be too much stress!)  For each area you’ve chosen either:

• develop plans for a COVID-style replacement, or
• pick a brand-new tradition that satisfies you in a new way! 
  
  

2.  Get Planning! 

Once you’ve chosen your 2 or 3 priority areas, get creative and choose your strategies:

• If a big turkey dinner is the highlight of your holiday, maybe you can cook your traditional feast and drop off meals for friends who will be alone.  Or, with a little more time on your hands, maybe try some challenging new recipes (how about a buttermilk-brined turkey breast, garlic thyme fondant potatoes and a classic French croquembouche?) Maybe you’ll choose a menu based on your ancestry, or a country you hope to visit when travel resumes?
• If your joy comes from buying perfect gifts for everyone on your list, why not make some gifts? Or, challenge yourself to only buy local.  If you can’t buy the perfect gift now, create stunning homemade gift certificates that promise gift delivery later.  Or, write a personal letter with the promise of doing a specific post-COVID activity together (like a trip to the spa or the movies).
• If your highlight is the candlelight Christmas Eve service, check out on-line services offered by religious organizations in Winnipeg and around the world. How about mass at Westminster Cathedral? Take time to create your own candlelight “watch party” to make it extra special. 
• It is hard to replicate a houseful of family or friends if that is your favourite part of the holidays.  However, with time you can figure out how to connect everyone on-line.  Lots of seniors never imagined using technology but they have suddenly learned how to videoconference.  Provide a program to keep things on track – include opening presents, telling jokes, playing games, singing traditional songs, etc.  Make sure everyone has a chance to share what they are grateful for.
• Many outdoor activities can be modified to be COVID-friendly.  Masking up and going for a walk at the zoo could be the start of a new tradition.  Try a short hike, or if the public health orders allow, maybe a bonfire?  How about a caravan of cars (one per household) to see the Christmas lights followed by virtual hot chocolate to compare favourites?
• If you love the frenzy of the season, intentionally create a calendar for yourself that is jam-packed with activities.  A little research will uncover on-line concerts and holiday movies. Schedule yourself to do some holiday baking, a jigsaw puzzle, read a novel, and create a holiday ornament to commemorate this strange year.  Make a list of all the friends you would normally see over the holidays and schedule a call with someone different each day.

3. Care for Yourself.

Increased stress levels are a normal response to the pandemic.  And as much as we love the holidays, the preparations and changes in routine can also increase your stress level.  Here are a few reminders of ways to manage that stress and care for yourself:

• First, recognize that you do need to care for yourself, and make a point of doing it.
• This is the perfect time to use the strategies you already know:  get moderate exercise, get regular sleep, practice mindfulness or meditation, eat nutritious food, stay hydrated, spend time outdoors, and connect with other humans.  Practice gratitude daily.
• Remain informed through reputable news sources, but limit exposure to the news to once or twice a day.  Continuous exposure can contribute to anxiety.
• Practice moderation.  The holidays can lead to overindulgence in food and alcohol, but you can find balance. Avoid using alcohol or drugs to cope with anxiety or fear, as they often worsen outcomes.
• Do not strive for perfection.  You do not live in a Hallmark Christmas movie.  Expect some burnt food, dropped calls, and gifts that don’t fit.  You will forget to do something important.  It is 2020.  Accept that anything can and will happen.
• Maintain a routine, with regular bedtimes and mealtimes, time for work and rest, and consistent personal hygiene.  Identify a limit for screen time and stick to it.
• If you need help, ask for it.  It might be something small, like asking a family member to set the table, or it might be more significant like reaching out to a crisis line.  This isn’t the year to tackle everything by yourself.  Identify what you need and simply ask.

The best thing about this holiday season is that we get to decide how we are going to respond to it.  Whether you fill every day with connections and activities, or whether you take the glorious opportunity to unwind and enjoy quiet moments, we wish you a beautiful and joyous time. Make it memorable, and something that still warms your heart five years from now.

References:

Bible, L. J., Casper, K. A., Seifer, J. L., & Porter, K. A. (2017). Assessment of self-care and medication adherence in individuals with mental health conditions. Journal of American Pharmacists Association. 57, 3. https://doi.org/10.1016/j.japh.2017.02.023

WHO. (2020). Healthy at Home – Mental Health. World Health Organization. https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome—mental-health?gclid=EAIaIQobChMI-PGQtu-R7QIVqj6tBh0ZUgxVEAAYAiAAEgJRgvD_BwE

Griffin E., Dillon C. B., O’Regan G., Corcoran P., Perry I. J., & Arensman E. (2017). The paradox of public holidays: Hospital-treated self-harm and associated factors. Journal of Affective Disorders. 218. 30-34

Ronalyn Rollon and Jack Tyrrell  
VGH Volunteers

The lockdowns and physical distancing requirements created by COVID-19 are very challenging.  How can we keep our distance without being lonely?  How do we prevent boredom, frustration, anxiety, and depression?  We’ve collected some ideas designed to help.

First, connect with yourself:

Checking in with yourself is a great place to start.

1. Assess your current mindset

Check in with yourself to see how you are feeling.  Are you feeling irritable, tired, or angry? It is OK not to be OK.  Honestly assessing your feelings will help you choose your best coping strategies and it alerts you if it is time to reach out for mental health assistance.    

• Limit news consumption

It is important to stay informed, but constant exposure to the news can cause a negative impact on your mental health.  “Seek information from reliable news sources only. Limit checking the latest news to short, defined periods, and refrain from setting news-related push notifications on your electronic devices. Appropriate information consumption may be calming and can lessen the sense of danger.”(Mental Health Resources to Support During COVID-19, 2020) 

• Set a regular routine

An organized schedule can create a sense of order and control. Try to plan out your day with regular wake up times, daily activities such as work, meals, exercise, and enjoyable distractions, followed by a regular bedtime.

• Maintain a healthy lifestyle 

Staying at home may have caused you to slip into unhealthy activities including extra eating and a sedentary lifestyle. A high-quality diet is good for your physical and mental health.  Scientists have proven that physical activity is linked to improved mental health and cognitive function.

Second, stay socially connected

Experts say that “being socially connected can have enormous positive effects on mental health and physical health. Social connection can reduce stress and give one a sense of meaning, purpose and belonging.” Living with pandemic restrictions, we need to be very deliberate about our social connections.

1. Build your circle:

Keep in touch with friends and family. Strengthen your relationships by talking more or sending messages by text or email. If you have a limited circle of friends maybe it’s time to make new ones. Consider joining virtual groups based on something that interests you.

Here are some creative ideas on how to stay connected online:

• Keep communicating online by sharing posts, interesting stories, photos, gifs, and memes
  • Get together over a video call.  Try having a virtual meal together or ask grandparents to read the kids a bedtime story over a video call.  Consider starting a chat group with friends you haven’t seen in a while. Popular video calling apps include FaceTime, Google Duo, Whatsapp, Houseparty, Skype and Zoom; on-line tutorials will show teach you how to use each program.
  • Netflix Party and Facebook’s “Watch Party” allow you to watch movies or other content with people in another location at the same time. 
  • Join a virtual Book club
  • Try an on-line organization centered on a common interest – it could be as simple as a Facebook page for your neighbourhood, or an interest group associated with your favourite political party.  Interested in French cooking? There’s a Facebook group for that. No matter your interest, there is probably a group for you!
  • Attend an on-line worship service.  There are many run by religious organizations in our city, and some have virtual “coffee hours” afterwards
  • Try taking an on-line course – either furthering your formal education or just taking a class for fun – maybe another language, a photography or cooking course
  • Many of the world’s great destinations are offering virtual tours; connect with a friend and take a virtual tour together. 
  • Exercise with an on-line fitness programs, and have an accountability buddy

Here are other ways to keep connected without your computer:

• Get out some stationery and write some old-fashioned letters
  • Go old school with a long telephone call over a cup of coffee
  • Arrange for a treat to be delivered to someone with a lovely note attached (maybe flowers or a desert from a local bakery?)
  • Use your creativity and talent to make gifts for others.  It could be as simple as a homemade card, or perhaps baking, or a more elaborate handmade present.
  • If you are in lockdown with others, enjoy their company.  Have a game night or take time to teach life skills like cooking to younger members of your household.

• Acts of kindness:

A strong component of staying connected is being involved with your community. Go beyond your circle to help others in need. Extending a hand to our vulnerable populations can help them get through the pandemic.  

How to help:

• Donate to shelters or food banks
• Offer to run errands or grocery trips for elderly or at-risk friends and family.
• Volunteer where you safely can. Many organizations need people to continue with operations. Call your local agencies or check out: https://helpnextdoormb.ca/

• Reach out when in need:

If you are feeling heightened anxiety and depression, feelings of social isolation or despair, it’s time to talk to your physician or use one of the many online or telephone resources.  Here are a few:

AbilitiCBT: free and confidential online mental health virtual therapy

https://manitoba.abiliticbt.com/home

Mental Health Crisis and Non-Crisis Regional Contacts

https://www.gov.mb.ca/health/mh/crisis.html

Wellness Together Canada

https://ca.portal.gs/

Canadian Mental Health Association

Good luck!

We aren’t sure how long we’ll need to stay physically apart, but we hope you’ll be able to try out some of these ideas to pass the time in the best way possible. We are apart but not alone.  

References:

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395(10227), 912–920. https://doi.org/10.1016/s0140-6736(20)30460-8

Cohen, S. (2004). Social Relationships and Health. American Psychologist, 59(8), 676–684. https://doi.org/10.1037/0003-066X.59.8.676

Mental Health Resources to Support During COVID-19. (2020). Https://Cmhamiddlesex.Ca/. https://cmhamiddlesex.ca/mental-health-resources-to-support-during-covid-19/

Reid, A. (2020, May 16). Worry, Gratitude & Boredom: As COVID-19 affects mental, financial health, who fares better; who is worse? Angus Reid Institute. http://angusreid.org/covid19-mental-health/

Collie, M. (2020, April 11). More than half of Canadians feel lonely, isolated during coronavirus pandemic: Ipsos poll. Retrieved November 9, 2020, from https://globalnews.ca/news/6793214/coronavirus-canada- lonely/

Sliwa, J. (2017, August 5). So Lonely I Could Die. Retrieved November 9, 2020, from https://www.apa.org/ news/press/releases/2017/08/lonely-die

Rev. Dr. Paul Peters Derry
Clinical Service Lead, Spiritual Health

Dr. Susy Santos
Director of Health Innovation

Remember that commercial where a young father points to his newborn child as his reason for quitting smoking?  The commercial ends with the tagline: “Every why needs a how…”   It’s a great line: the baby is the why, the smoking cessation product is the how. 

The reverse is also true.  Every how needs a why.  Actions are most successful when we know and understand why we are doing them and what we hope to achieve.  As we seek hope, meaning, and purpose during COVID-19, it’s helpful to think about why we need hope, what we expect from it, and even what we are hoping for.

We can agree that hope is “a feeling of expectation” and a “desire for a certain thing to happen.” Why do we go in search of hope?  It provides motivation for facing the variety of challenges we are encounter.  We look for hope to support us as we deal with threats of economic instability, social isolation, reduced access to services, and other challenging impacts on our lives.  Hope is “an optimistic state of mind”, but amid a global pandemic, hope can be an increasingly scarce resource. 

 Life will not soon return to normal – whatever that means – or the way things used to be, at least not anytime soon  The COVID-19 virus will not, as some might proclaim, “simply disappear.”  A vaccine is not on the immediate horizon.  Perhaps grudgingly, we accepted visiting restrictions, the need for physical distancing and personal protective equipment (PPE) as temporary measures.  Thinking about incorporating those things into our lives for a prolonged period is unwelcome news and can lead to feelings of hopelessness. 

Perhaps we might look for it along other pathways. 

During the SARS outbreak, patients, family members and health professionals were interviewed as part of a research project examining their experience of persevering through such a difficult time.  Bearing witness to suffering was a common element.  There was what one described as a feeling of “smothering connectedness.”  A healthcare worker reported “feeling relieved, optimistic and free when precautions relaxed.”  A family member referenced “welcoming kindness, patience and humor.”   A patient expressed appreciation for “the compassion of doctors, nurses and technicians.”

Even amid the worst and most difficult, kindness and optimism took root, and grew.

Several months back, with a patient asking for “Last Rites,” visiting restrictions meant that since the individual was not “imminently dying,” this request could not be accommodated. Instead, arrangements were made for the priest to offer a ritual during a “virtual” visit.  With the right technology, out-of-province family members joined in the experience, deepening the meaning of the intervention. From disappointment, even of despair, came an unexpected but sacred experience. 

COVID-19 has shattered assumed notions of safety and security.  It also offers new possibilities as we take time to listen to each other’s stories, experiences, and frustrations.  This kind of compassion-filled intervention helps restore a sense of balance for care-receivers as well as caregivers.  Caring for each other during these trialing times replenishes reservoirs of hope.

In our search for hope, it is worthwhile taking time to understand why we are looking for it.  When contemplating how we are going to find it, be open to find discovering it in unexpected places.  Especially at a healthcare facility whose tagline is “Small Hospital.  Big Heart.  Clear Vision.”

Susy Santos, Ph.D., M.A.,
Director of Health Innovation

Although people typically associate dementia with memory loss such as forgetfulness, dementia is actually a term used to describe symptoms of diminished memory, communication and thinking which impacts daily life.  Dementia is caused by several diseases and is not a normal result of aging even though older people are most afflicted.  In Canadian adults aged 85 and over, 25% will be diagnosed with dementia and it is more prominent among women than men.

Dementia occurs because of brain cells dying; neurodegenerative disease, which causes brain cell death over time, causes most cases of dementia.  What is not known is whether brain cell death causes dementia or if this cell death is caused by dementia.  Strokes, damage from repetitive head injuries, brain tumors, prion disease, HIV infection and reversible factors such as depression or vitamin deficiency can all cause dementia. 

Here are five of the most common types of dementia:

• Alzheimer’s Disease causes neurons in the brain to die and accounts for 60% of all dementia.
• Vascular Dementia is the second most common cause of dementia and is caused by damage to the vessels carrying blood to the brain and the blood brain barrier, leading to neuronal death.  Most often there is a history of strokes, head injuries, diabetes, hypertension or smoking.
• Lewy Body Dementia is a progressive disease characterized by clumps of abnormal protein in the brain called Lewy bodies.
• Frontotemporal dementia is a group of diseases that cause the deterioration of nerve cells in the temporal and frontal brain lobes.
• Mixed Dementia is when two or more types of dementia occur at the same time.

Dementia can be caused by other disorders.  Here are three of the most common conditions related to dementia:

• Parkinson’s Disease is also characterized by Lewy bodies being present in the brain and many people with Parkinson’s develop dementia.
• Creutzfeldt-Jakob disease is a rare condition in which the brain begins to break down and may be caused by abnormal proteins called prions.
• Huntington’s disease is caused by a mutation in chromosome 4 that causes changes in the brain and spinal cord.

Dementia can be imperfectly divided into four different stages.  The first stage is mild cognitive impairment which is exemplified by forgetfulness.  The second stage is mild dementia, in which cognitive impairments begin to occur.  This can include confusion, changes in personality, loss of memory, and challenges with directions.  During moderate dementia, the third stage, individuals require additional help as day to day life becomes more difficult.  Although symptoms are similar to those seen during mild dementia, they are increased, quality of sleep decreases and significant personality changes occur.  In the fourth stage, severe dementia, individuals may no longer be able to communicate and will require full time care.

Recognizing the symptoms of dementia is important in order to determine whether they are due to treatable conditions (such as infections, nutritional deficiencies, or medication side effects) or other underlying conditions.  Some early signs are memory loss, confusion, disorientation, changes in mood and in short term memory, difficulty with communication, difficulty in accomplishing daily tasks and trouble with problem solving or accomplishing complex tasks.  Other psychological changes might be anxiety, depression, agitation, inappropriate behaviour, and paranoia.

There are a multitude of risk factors that can lead to dementia.  The risk factors that cannot be changed are age, family history and Down syndrome.  Risk factors that can be controlled are diet and exercise, heavy alcohol use, cardiovascular health, depression, diabetes, smoking, sleep apnea, and deficiencies in vitamins and nutrition. 

What can you do for your cognitive health?

Although there is no definitive way to prevent dementia, there are things that you can do to reduce your risk.  Stimulate your mind with puzzles, reading or memory training.  Be active which means increased exercise but also increased social interaction.  Quit smoking and reduce alcohol intake.  Make sure to maintain a healthy diet rich in fruits, vegetables and omega-3 fatty acids as well as plenty of vitamin D, B, and C.  Treat any cardiovascular risks such as high blood pressure as well as any other health conditions such as anxiety or depression.  Quality sleep is also essential.

The more preventative steps that you take during your 40s and 50s, the more likely you’ll lower the risk of developing dementia.

References

1. Canadian Institute for Health Information. Dementia in Canada. Ottawa, ON: CIHI; 2018.
2. Dementia. Mayo Clinic. Accessed August 2020 https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013
3. Grossman M. An introduction to different types of dementia. Accessed August 2020 https://www.kindlycare.com/types-of-dementia/
4. MacGill M. Dementia: Symptoms, stages and types. Medical News Today; 2017.

The Winnipeg Health Region’s Clinical Consolidation plans (implemented over the past few years) significantly changed the way French-language services are provided within Winnipeg hospitals.

Before Clinical Consolidation, services in French were primarily offered by St. Boniface Hospital (SBH). However, the reorganization of services shifted the designated bilingual (French/English) Geriatric Rehabilitation and lower acuity units from SBH to The Vic along with the Centre de Santé Saint-Boniface (CDS) bilingual family medicine physicians’ group and their admitting privileges. The designated bilingual services now found at The Vic are: Urgent Care, Patient/Client Relations, and inpatient beds on the Geriatric Mental Health unit, the Geriatric Rehabilitation unit, and one Family Medicine unit.

These changes were necessary to provide a wide range of health care services to the Francophone population. Bilingual primary care services can still be found at CDS, while urgent care is available at The Vic, and emergency services at SBH. Having The Vic provide bilingual services works especially well because our catchment area includes major portions of the designated bilingual communities of St. Boniface, St. Vital and St. Norbert.

As Victoria General Hospital now has a bilingual mandate for specific units and services, building bilingual capacity to offer the best French service possible is a priority for the next several years. The WRHA, the French Language Services (FLS) department and the leadership at The Vic are striving to create an inclusive and comprehensive environment that fosters French language services.

The bilingual commitment within The Vic’s leadership team begins with Rachel Ferguson (née Manaigre), Chief Operating Officer. In September 2019 Rachel was chosen to be the new WRHA French Language Services Executive Lead. Rachel is fully bilingual, understands the needs of the Francophone community and is devoted to developing a bilingual workforce.

Another example of the bilingual commitment at The Vic is demonstrated by the partnership between the hospital and the Centre de Santé Saint-Boniface (CDS) bilingual family medicine physicians’ group. As of January 2020, these physicians resumed inpatient work at The Vic after a brief interruption. Additionally, the hospital identified three other site physicians with bilingual capacity willing to care for Francophone patients. The data shows we have an average of four identified French-speaking patients per day on the designated bilingual family medicine unit (5 South). With the help of these physicians, our family medicine inpatients can be usually be cared for in their preferred language.

Bilingual services at The Vic is a work in progress and we recognize that it will take time to build bilingual capacity. We are approaching this challenge by two ways: by actively recruiting bilingual candidates, and by identifying and building further bilingual capacity with existing staff. As of March 31, 2020, The Vic had filled 25 designated bilingual positions of various classifications (Nurses, Unit Clerks, Health Care Aides, etc.). We have also identified several employees with bilingual capacity, including Tricia Coulter, Manager of Patient Care on Unit 5 South. Tricia is a dedicated manager that strives to implement best practices regarding French-language services to the patients on her unit.

Identifying Francophone patients is another key to achieving a successful French Language program at The Vic. To better identify and serve Francophone patients, an “Active Offer” is made as patients are being triaged in Urgent Care. The active offer concept means that the service providers publicize the availability of services in both official languages and create an environment where the public is completely at ease in either English or French. Regionally, efforts are made city-wide to track and transfer French-speaking patients to The Vic if we can meet their care needs.

Another initiative underway is to focus on bilingual communications and the translation of patient material into French. This can be demonstrated by the upcoming launch of the hospital’s bilingual website and social media posts. All patient material such as forms, patient information, signage, etc. will eventually be available in both Official Languages.

The Vic is not yet a fully bilingual site, and significant work remains to achieve that goal. However, we are committed to doing all we can to serve the public in both Official Languages. We believe that the implementation of designated bilingual units and the further bilingualism efforts will eventually address the needs of the Francophone community of Manitoba and ensure that we offer the best quality service and safest care possible.

Many thanks to Joel LaFond, Regional Manager, French Language Services, WRHA

A Wealth of Benefits

Ashley Dercach, CTRS, BRLS, BHSc
Recreation Coordinator

People experiencing mental health concerns can experience many different symptoms; their physical, social, emotional, spiritual and cognitive health can all be negatively impacted. Fortunately, nature-based therapies can have a positive impact on all these symptoms. At Victoria General Hospital we’ve taken a very practical approach to nature-based treatment by introducing a gardening program, and we are finding that the effect on patients is very positive.

Researchers have found that nature-based therapies improve depression, anxiety, stress, and even schizophrenia. Offering people a chance to spend time doing an enjoyable activity, potentially evoking positive memories of past experiences, and creating new positive memories are all important ways to help them cope with adversity during stressful times. Researchers have also found spiritual benefits from connecting with nature and creating life.

Social isolation is a common attribute of having a mental illness, but nature-based therapies can increase socialization. Participants can build social skills and learn how to work as a team. The development of these skills can lead to better employment options, increased self-worth, self-esteem, motivation and a sense of purpose. Nature-based activity can help participants process and reflect on life stressors which reduces overthinking.  Finally, there are physiological benefits of sunshine and increases in energy that come from nature.

Our gardening program at The Vic looks different throughout the year. In spring, patients prepare the garden and plant seeds. They develop new skills reading seed packets and learning about companion planting. Throughout the growing season, they water, prune, fertilizer and weed. Many patients find therapeutic benefits from the repetitive nature of weeding, and the sense of accomplishment it provides. Towards the end of season, patients harvest the plants, (at least what’s left after the animals have eaten their share!). The produce is then used for cooking group which furthers the connection between food and nature. Patients enjoy the chance to socialize in a relaxed environment.

For some, this is their first exposure to gardening. They can be nervous about trying something new, or about failure. The chance to try a new experience in a safe, supportive environment can be therapeutic. In addition to gardening skills, the program teaches our patients about emotional regulation, healthy coping, and the importance of having both positive experiences and a sense of purpose.

Because nature can be a very sensory experience, patients can practice mindfulness through the gardening program. They can feel the velvety leaves of the lamb’s ear plant, smell the thyme, breathe the fresh air, identify and taste the vegetables. Getting their hands dirty and feeling the earth is generally a positive experience. Patients always seem to be surprised after connecting with nature this way and often ask to keep a piece of nature they connected with.

When our Recreation Therapy staff see a patient experiencing greater relaxation or an improved mood, they help the patient identify the connection with nature, and encourage the patient to pursue nature-based activities at discharge. The staff will provide patients with suggestions on ways to increase exposure to nature in the community in hopes that they will make healthy choices as part of their plans for self-care.  

The gardening therapy program at The Vic is just one example of using information from research to guide our treatment program in a very practical way. We enjoy being able to offer the benefits of nature to our patients, and we are hopeful that this opportunity will provide the spark for them to pursue a future full of positive experiences.

References

Adevi, A., & Mårtensson, F. (2013). Stress rehabilitation through garden therapy: The garden as a place in the recovery from stress. Urban Forestry & Urban Greening, 12(2), 230–237. https://doi.org/10.1016/j.ufug.2013.01.007  

Cipriani, J., Georgia, J., Mcchesney, M., Swanson, J., Zigon, J., & Stabler, M. (2018).  Uncovering the Value and Meaning of a Horticulture Therapy Program for Clients at a Long-Term Adult Inpatient Psychiatric Facility. Occupational Therapy in Mental Health, 34(3), 242–257. https://doi.org/10.1080/0164212X.2017.1416323

Gonzales, M.T., Hartig, T., Patil, G.G., Martinsen, E.W., & Kirkevld, M. (2011). A Prospective Study on group cohesiveness in therapeutic horticulture for clinical depression. International Journal of Mental Health Nursing, 20, 119-129. https://doi.org/10.1111/j.1447-0349.2010.00689.x

Howarth, M., Mcquarrie, C., Withnell, N., & Smith, E. (2016). The influence of therapeutic horticulture on social integration. Journal of Public Mental Health, 15(3), 136–140. https://doi.org/10.1108/JPMH-12-2015-0050    

Oh, Y., Park, S., & Ahn, B. (2018). Assessment of the psychopathological effects of a horticultural therapy program in patients with schizophrenia. Complementary Therapies in Medicine, 36, 54–58. https://doi.org/10.1016/j.ctim.2017.11.019

Parkinson, S., Lowe, C., & Vecsey, T. (2011). The therapeutic benefits of horticulture in a mental health service. The British Journal of Occupational Therapy, 74(11), 525–534. https://doi.org/10.4276/030802211X13204135680901

Sleep: Why, When and How?

July 15, 2020

Sleep is not just the time that our bodies and minds shut down; it is also the time when processing, restoration and strengthening takes place. Scientists continue to study how and why this happens, but they have learned a lot already. One role of sleep is to move information and your experiences from your short-term memory into long-term memory. Studies have shown that after sleep, people execute memory tasks better and have better information recall. Not only is sleep important for brain function, but our bodies also require sleep to help grow, heal and create hormones. Research shows that sleep even allows your body to remove toxins from your brain. Not getting enough sleep on a regular basis can increase the risk of various disorders such as diabetes, cardiovascular disease, high blood pressure, depression, and obesity.

Sleep is essential for all ages, but how much sleep is enough? Children require more sleep than adults, probably because they acquire a huge amount of information, skills and growth compared to that of an adult. Children under one year of age typically require 11 to 14 hours of sleep, while school aged children require 9 to 11 hours. Teenagers need 8 to 10 hours of sleep, and adults only require 7 to 9 hours per day.

There are two main types of sleep: Rapid eye movement (REM) sleep and non-REM sleep. During REM, your eyes move rapidly, brain wave activity occurs, breathing increases, and heart rate and blood pressure are increased. During non-REM sleep your eyes don’t move, and your heartbeat and respirations are more relaxed. Dreaming mostly occurs during REM sleep, but you cycle between the two types and it seems that consolidation of memories requires both types of sleep.

If sleep is so important, how do you make sure you are getting enough? Here are some tips for getting a good night sleep:

• set a schedule so that sleeping and waking occur at the same time everyday;
• make sure exercise occurs during the day, at least a few hours before bedtime;
• avoid alcohol and stimulants such as caffeine and nicotine for a few hours before bed;
• relax before bed;
• create a sleep space where loud sounds and watching TV or other devices are limited;
• if you can’t sleep, distract yourself with music or reading until you are tired

Interested in learning more? We’ve summarized some of the information in these two articles, but there are even more facts if you follow the links:

1. Why do we need sleep? National Sleep Foundation. https://www.sleepfoundation.org/articles/why-do-we-need-sleep
2. Brain Basics: Understanding sleep. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

June 11, 2020

During this challenging time, engulfed with change and complicated by restrictions, there is a tendency to reach out for what feels right and what offers us comfort. From our earliest memories, food and beverages have been our “go to” when we needed to be energized, when we wanted a sense of wellbeing, and when we looked for reassurance or security. The challenges of the pandemic may explain why you are having “snack attacks”, craving high energy food more often than usual, eating more, or perhaps finding your weight creeping up.

Our Registered Dietitians, like Phyllis Marsch R.D., offer nutrition consultations to patients for various medical reasons. Most recently, due to COVID-19 guidelines, Marsch reports that our patients are frustrated with their lack of self-control on food and beverage choices, volumes and frequency of eating throughout the day and in some cases into the night. Combined with a reduced level of activity the eventual outcome can be weight gain. If this is your experience, be reassured that you are not unique in this dilemma … it is an epidemic in this pandemic era!

If you are ready to consider some nutrition education, or if you are looking to boost your immune system as a response to the pandemic, you will find that there are a multitude of sources willing to advise you. Especially when the going gets tough and feelings of defeat or disappointment set in, the choices can be overwhelming. If you are looking for a safe journey to healthy eating please review your options with caution because some alternatives will be more beneficial than others and some can even be dangerous. Marsch points us to the following list of tips, shared by Dietitians of Canada, which offers key points on how to spot misinformation:

• If the information sounds too good to be true, then it likely is. Be wary of quick fixes and miracle cures.
• Be concerned if an organization is trying to sell you products such as supplements rather than educating you on how to make healthier food choices.
• Nutrition advice should be based on the best evidence-based information and scientific research. Do not rely upon information based on personal stories even though they are very compelling.
• Is the claim based on a single study or a few research studies? Were the studies conducted with cells in test tubes or Petri dishes, in animals or in humans? The stronger the study design and the more studies available that draw the same conclusions, the stronger the evidence that something is reliable.
• Who is providing the nutrition advice? Get the credentials so you know the person’s qualifications and ask – are they associated with a university or a licensed registered practitioner. Note that health professionals’ titles are protected by law.Choosing the right foods is certainly one of the keys to creating an overall sense of wellbeing. This connection is more important than ever during challenging times like these. If you need guidance to make nutritional changes be sure to choose your advisors carefully.