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Much attention has been focused on health risks associated with Canadian diets for many years and after a heightened attention about sodium and salt intake, the next bandwagon coming to the forefront appears to be sugar.

Why is sugar becoming the next ‘naughty’ ingredient? The fact is that we Canadians have a love for the sweet taste and pleasure derived from both the natural (fruit sugar in fruit juices) and added sugars (found abundantly in many products to enhance the flavour) in our favourite foods. Increasing obesity rates (particularly in young children), higher incidences of diabetes and heart disease, emerging diet trends focusing on sugar elimination like Keto, and an increased attention to ingredients and food sources has raised the attention to this potential big bad category!

The question is, do we consume too much sugar? Well, many health experts will say yes, but believe it or not, there are some interesting trends that demonstrate we are actually consuming less sugar than we used to:

• The overall amount of added sugar consumption in Canada has declined in the last 20 years. Food preferences and intakes have changed, while ingredients and formularies of ingredients that contain sugar have also undergone small reductions.  The proliferation of sugar substitutes has greatly increased as had variety of low-calorie products (sugar free soft drinks in particular), as consumers looks for lower calorie options with the same sweet sensation.

• Canadians consume an average 30% less sugar than our American counterparts. It is predominantly due to the lower amount of regular soft drink consumption.  Is it because of fewer choices or a higher proliferation of low-calorie carbonated beverages? The answer is no. Canadians simply reach for water or unsweetened beverages more often (and remember water and sparkling water consumption continues to climb!).

In recent years, some provinces have tried to regulate consumption of sugar through health programs such as school food guidelines and standards. These regulations impacted our industries ability to offer traditional choices that were available through vending and self-serve areas. For the most part, Canada currently does not have any nutritional guidelines related to the quantify of sugar Canadians should or should not consume, however Health Canada suggests choosing foods with little or no added sugars.

So how will this impact our business going forward? Health Canada’s new nutrition labelling requirements which have been worked on for years, are scheduled to be completely implemented by December 31, 2021. In addition to sugar being a mandatory item on the nutrition label, packaging requirements will also change under this new legislation as symbols indicating a product is high in sugar will have to be identified. Stay tuned!

How do we ensure our business thrives even given these potential bumps in the road? Here are a few things to pay attention to:

• Choice & Selection. Offering residents choice and selection in all categories ensures that you are providing a variety of options without added or natural sugar; both impulse purchases and regular frequent offerings can help you demonstrate your commitment to healthy choices. Some residents may look for more natural sources of sugar (i.e. honey) as a preference. Remember to display a mix of both sweet and salty snack options in your impulse section of micro markets, feature areas, as well as in any combo packages you offer.

• Sugar Free Options: This trend is growing, we recommend that 20% of your beverage offerings are free of sugar (e.g. water, sparking water beverages such as Bubly) or low-calorie offerings. It may seem like a lot, however over your entire portfolio is it quite simple to do

• Say Tea! There is an opportunity to focus on tea as it is currently a growth category. Hot and cold tea consumption continues to climb and provides strong revenue opportunities while offering choices with health benefits (and interesting exotic flavours)

Whether your residents have a sweet or salty tooth, staying on top of trends is critical. It can help to keep your residents interested, demonstrate that your services reflect the current marketplace drivers, and provide your business with a competitive edge.


About the Author:
Brian Emmerton is a Registered Dietitian and the Vice President and General Manager of Complete Purchasing Services Inc, a leading supply chain solutions provider for non-commercial clients and hospitality organizations across Canada. Brian has worked and researched consumer behaviors for over 30 years to assist clients in following trends and practices that can drive revenue and growth opportunities.

Darlene Legree Co-owner, Company Principal, Silver Meridian

The past 18 months represents the most stressful time in most nurses’ careers. Nurses working in long term care have confronted the COVID-19 pandemic with determination, courage, and compassion. Now, nurses are encountering another more personal challenge…burnout and moral distress. By prioritizing self-care and workplace wellness strategies nurses can proactively protect their personal well-being.

Nurse Well-Being and Implications for Long-Term Care

Prior to the pandemic crisis nursing in long term care was already a stressful job with high levels of clinical and leadership responsibilities that required the balancing of effective and compassionate resident care with sector limitations (underfunding, staffing shortages, limited resources, legislative standards, inspection requirements etc.) The COVID-19 pandemic has compounded these issues and this prolonged physical and mental strain has resulted in many nurses experiencing fatigue, potentially leading to burnout and moral distress, and impacting the sustainability of the nursing workforce.

Nurses recognize they must now prioritize their personal well-being. Taking care of themselves protects their own mental and physical health and improves their job satisfaction, workplace engagement, and performance.

Given the significant importance of nurses’ contribution to quality and safety, both for the people who work in, and the residents that live in, long term care, it is essential that all stakeholders truly understand and support nurses as they seek to protect their well-being in the face of burnout and moral distress.

Burnout

Even the most resilient nurse could experience feelings of being overwhelmed and not coping well as the pandemic progressed. The communication overload was enough to make anyone feel frustrated and anxious. These feelings, plus the grief associated with the loss of life and the heightened fear that if not already, it could happen here, or the risk of exposing family members, left many feeling emotionally or physically drained. And now as we move into the 4th wave nurses must brace themselves once again and draw on their inner strength to lead their team through this recurring pandemic. As a result of these difficult conditions, nurses are at a high risk for burnout (Sriharan et al. 2021). Burnout is in response to chronic workplace stressors, which of course the pandemic crisis has now become.

Over and above feeling completely exhausted (emotionally and physically), the nurse may have a sense that they are no longer effective, experience little to no job satisfaction, have headaches and irritability, with increasing cynicism and detachment. When dealing with these symptoms the nurse may initially begin to miss work deadlines, procrastinate, be late for work, complain of feeling persistent tiredness or have physical illness. As the symptoms intensify there is increased absenteeism escalating to sick leave and ultimately the nurse quitting their job and leaving a profession they had once loved and were committed to. We need to support, not stigmatize nurses, if they do experience burnout. It is not a sign of being an ineffective nurse or of not being able to cope. Instead, we all share responsibility in preventing burnout and to work on personal and professional solutions.

Moral Distress

Doing the right thing for both the resident and the staff ensures that nurses maintain their professional integrity and ethics. During the pandemic difficult and complex decisions were made that were often outside of nurses’ control. In fact, the nurse may have felt a different action was the “right” thing to do in the best interest of the residents. Often external constraints made it nearly impossible to take what the nurse felt was the right course of action. A common example was isolating residents even though the nurse felt it was causing increased anxiety, agitation, and confusion for the majority of the residents. Not being able to act accordingly resulted in nurses feeling powerless, guilty, and experiencing moral distress. Other causes of moral distress may be working with inadequate resources (supplies or staff shortages), being pushed to function outside their usual scope of practice, lack of collaborative decision-making and juggling the need for efficiency with the needs of residents. All of these conditions and actions contribute to a decline in quality care and can be a source of moral distress (Pijl-Zieber et al. 2008).

Moral distress results in negative emotions such as anxiety, anger, resentment, and frustration as well as physical symptoms such as insomnia, bouts of crying and headaches. Moral distress is closely aligned with burnout and both impact quality care, staffing shortages and lack of job satisfaction (Sriharan et al. 2021). It becomes a vicious cycle where nurses feel stressed and overwhelmed, experience burnout, leave their jobs, resulting in staff shortages which then fosters conditions for nurses to experience moral distress, which then accelerates further staff turnover. Again, proactive strategies are required to limit conditions that contribute to the moral distress experienced by nurses, and to support nurses as they grow to understand the meaning of moral distress and determine preventative strategies.

Personal Protection Strategies

My Plan, My Way

We have all read or heard the messages about the importance of self-care. The abundance of advice can seem overwhelming and result in feelings of guilt and anxiety. How can I possibility fit self-care into my life when I have so many other higher priority commitments and responsibilities? If by the end of the day you are feeling exhausted, it can be difficult to find the energy and motivation to focus on self-care activities when all you really want to do is watch a mindless TV show.

But wait a minute, is this really a problem? We know that we look at the resident from a holistic perspective, considering their physical, emotional, social, mental, and spiritual needs. Isn’t this the same philosophy we should apply to self-care? We understand that each of us is a unique “whole” person and recognize the interdependence between our biological, social, psychological, and spiritual selves. Therefore, isn’t it reasonable to suggest that the focus of self-care should be on you, and as such only you can determine what approaches will work best to replenish and revitalize your body, mind, and spirit.

To shift your thinking away from the litany of recommended self-care activities that you feel obliged to try, reflect on things you do that relax or energize you. For example, getting together with a friend. Does this leave you feeling calm and happy or drained and upset? What about taking a walk? Do you return feeling positive and optimistic or negative and tired? Monitor your feelings and do the things that make you feel good and limit the things that make you feel bad! So go ahead, take control. Protect your personal well-being by creating a self-care plan, based on your terms and needs. And, if at the end of viewing a mindless TV show you reflect and think that was relaxing and enjoyable, add it to your self-care plan. If you feel frustrated and irritated, it would be a good idea to remove it from your plan. After all, it’s your plan, your way!

Attitudes That Impede Self-Care

All or Nothing

A hindrance to self-care is the attitude that either you fully commit to self-care, or there is no point to doing anything. Realistic self-care is a step-by-step process. You try one achievable activity, monitor how it makes you feel, and if it works, add it to your self-care plan. Success is realized when you make small changes over time, as you continue to grow your personal self-care plan.

Some have said that self-care seems selfish, even self-indulgent. This is simply not true. Being selfish focuses on “me” and doing only for oneself and not giving to others. Conversely, self-care benefits you and everyone else. It ensures that you don’t deplete all your personal energy, enabling you to effectively take care of others.

Silo Thinking

Another self-care attitude negatively impacting success is when self-care is considered so personal that it cannot be integrated into other aspects of one’s life. However, self-care plans work best when integrated with your personal and professional life. For example, if exercise through walking provides relief and a sense of accomplishment, wearing a step counter and monitoring steps at work and away from work overcomes one silo in your life.

Put It Behind You

It is easy to criticize yourself and hard to practice self-forgiveness. When you hear your internal voice chastising you for slippage from your self-care plan, as difficult as it can be, let it go.  By practicing self-forgiveness, you reduce your anxiety and stress, boost your positivity, and set the stage to reflect and learn from your experience. You are doing the best you can right now. Remember to apply this same principle to others as they too are doing the best they can. “If you are more accepting of others, then you inevitably become more gentle with yourself” (Brene Brown, 2017).

Workplace Protection Strategies

Given the urgency of nurse shortages in LTC it is imperative that organizations look to strengthen well-being protection strategies to retain current employed nurses and recruit others. By integrating employee well-being into the values of the Home, it will hold everyone accountable to advocate and support workplace well-being strategies.

Communicate and then Repeat and Repeat Again

During this COVID-19 crisis communication remains a key success strategy. Between frequent meetings, team huddles, emails, and printed messages, effective communication is fundamental in sharing new and updated information. Communication needs to timely and transparent, and leaders need to listen and acknowledge concerns. It is important to keep these communication techniques open, post-pandemic, to avoid information gaps and to support nurses in their leadership and clinical practice. On the other hand, poor communication practices will serve to increase frustration and stress.

Engage and Empower

During the pandemic nurses have demonstrated their critical thinking skills and determined innovative solutions that not only impacted the nursing department, but the organizational level as well.  Managers need to continue to harness this potential, so nurses feel recognized and empowered.

Continuing to engage nurses in decision-making and seeking their input and feedback also fosters this sense of empowerment, builds healthy work relationships, and creates a positive work environment.

Working Together

Well-being involves a broad range of feelings, attitudes, and both internal and external experiences and conditions. It is subjective and includes physical and mental dimensions. Strategies are not a “one size fits all” making it more challenging for workplaces to support nurses’ well-being. Managers and nurses should work together to determine wellness initiatives that encourage active participation. This collaborative approach will ensure that the voices of nurses are heard, and that what is important to them is reflected in the program. Utilize available tools to assess employee wellness, or the organization can create their own assessment tool.

Well-Being Support

Nurses should know their well-being is vital to the success of their Home and be encouraged to share when and why they are feeling stressed. Their managers should reinforce that feeling stressed is not a sign of weakness, but is in fact normal, and invite the person to a private or group meeting or have an informal conversation to discuss their feelings and conditions contributing to their stress. However, managers should not wait for the nurse to report feelings of anxiety and stress, but instead check-in regularly and be alert to signs of burnout and moral distress.

Managers should also make sure that there is a safe place for nurses to gather and reflect on the pandemic experience. Reflection allows nurses to hear others’ perspectives, share emotions, and to find a sense of meaning from the pandemic experience. This process is an important step in restoring confidence and re-vitalizing commitment to the Home.

Summary

Nurses working in long term care have demonstrated extreme resilience throughout the COVID-19 pandemic. They have been able to adapt quickly and successfully navigate through this complex and rapidly changing work environment. There has been a substantial amount of professional growth and a deep sense of accomplishment. They have been steadfast in providing compassion and support to colleagues, staff, residents, and families.

Now is the time for nurses to pause and reflect on their personal well-being. They should consider how the pandemic has impacted their mental and physical health and commit to self-care actions that will protect them from burnout and moral distress. Long Term Care organizations should also prioritize initiatives that support the well-being of their nurses to ensure they have the energy and positive approach to guide their teams and residents through upcoming uncertainties and towards the new reality of long-term care.


About the Author
Darlene Legree is the Co-owner of Silver Meridian. For over 20 years, Silver Meridian has provided leadership training and support to staff working in the long term care sector (English only). Go to Silver Meridian (https://silvermeridian.com/) for more details. For a free copy of "8 Steps to Positively Connect with Others' click on the following link: https://silvermeridian.com/8-steps-to-positively-connecting-with-others/

References

-Blake N (2021) Building a new, better normal after COVID-19. Nursing Management; 52:6,20-23.

Brown D (2017) Brene Brown on the 1 question you need to ask about people you truly dislike. Inc Newsletter [online}; Available at: https://www.inc.com/damon-brown/brene-brown-on-the-one-question-you-need-to-ask-about-people-you-despise.html. Accessed September 2021.

-McLean C, Kamkar K (2020) Helping health care workers cope with COVID-19 related trauma. Anxiety Canada [online]; Available at: https://www.anxietycanada.com/articles/helping-health-care-workers-cope-with-covid-19-related-trauma/. Accessed August 2021.

-Moore C (2020) Nurse leadership during a crisis: ideas to support you and team. Nursing Times; 116:12, 34-37.

-Pijl-Zeiber E et al (2008) Moral distress: an emerging problem for nurses in long-term care. Quality in Aging; 9:2, 39-48.

-Prestia A S (2020) The moral obligation of Nurse Leaders: COVID-19. Nurse Leader [online]; Available at: https://pubmed.ncbi.nlm.nih.gov/32313516/. Accessed August 2021.

-Sriharan A et al (2021) COVID-19 related occupational burnout and moral distress among nurses: a rapid scoping review. Nursing Leadership; 34:1, 8-19.

-Su A J (2017) 6 ways to weave self-care into your workday. Harvard Business Review[online]; Available at: https://hbr.org/2017/06/6-ways-to-weave-self-care-into-your-workday. Accessed August 2021.

-Westring A F (2021) There’s no “right” way to do self-care. Harvard Business Review[online]; Available at: https://hbr.org/2021/04/theres-no-right-way-to-do-self-care. Accessed August 2021.

What do blueberries, carrots, raspberries, and broccoli have in common? They’re colourful fruits and vegetables that are packed full of important antioxidants such as, vitamin A, C, E and polyphenols. Antioxidants are naturally occurring components in food that may help prevent and/or delay cellular damage caused by aging, environmental pollutants and certain behaviour patterns including smoking, and excessive alcohol consumption. While aging is natural, it can be associated with significant changes to both the body and the brain that can occur slowly or quickly over time.

According to the Alzheimer’s Society of Canada, “1.1 million Canadians are affected by dementia.”[1] Dementia is typically seen in older adults over age 65, and older women tend to be affected more so than men.[2] However, younger individuals can develop Alzheimer’s, too. To help raise public awareness about this condition, September has been deemed World Alzheimer’s month.

Preventing Alzheimer’s
So, what’s the connection between food and brain health? Although genetics and aging can play a role in increasing dementia risk, evidence reveals that lifestyle factors, including diet may help to reduce one’s risk level.[3]

When it comes to diet, a systematic review reveals that the Mediterranean, Dietary Approaches to Stopping Hypertension (DASH) and the Mediterranean-DASH Intervention for Neurodegenerative Delay or MIND diet are all associated with reduced dementia risk; however, in this review, the MIND diet was more strongly associated with less cognitive decline and a lower risk of AD.[4]

MIND Diet & Brain Health
The MIND diet combines elements of the Mediterranean and DASH diets and emphasizes the importance of including fresh, whole and minimally processed foods that include the following:

• Fruits and vegetables, particularly berries and green leafy veggies
• Legumes (lentils, chickpeas, fava beans, kidney beans)
• Fatty fish (trout, herring, salmon, sardines)
• Whole grains (oats, barley, quinoa, whole grain breads/cereals)
• Lower fat dairy (1 or 2% yogurt or milk)

While the MIND diet is not a vegetarian diet, emphasis is placed on plants and plant/fish proteins with less attention given to animal foods (meat, poultry, high fat cheeses).

Brain-Heart Connection
Research shows that what’s good for the heart, is good for the brain when it comes to preventing and delaying Alzheimer’s disease. The high antioxidant and polyphenol content found naturally in plants along with the omega-3 fats present in fatty fish have anti-inflammatory effects on the cells and tissues that may help protect both heart and brain health[5].

Key Diet Principles
To help lower your risk of Alzheimer’s disease, keep the following diet principles in mind when making food choices and planning meals and snacks.

- Eat plants: research consistently shows that people who include more plants and who follow a vegetarian diet are less likely to develop heart disease, diabetes and certain cancers[6]. Additionally, eating more plants is associated with protecting the brain from cognitive decline[7].

Nutrition Tip: Aim to include a fruit or vegetable at every meal. Have 3 meals a day so you can be sure to get an adequate amount of fruit and vegetables in your diet. Choose fresh, frozen or unsweetened canned options.

- Go for colour: vibrant colourful foods indicate high antioxidant and polyphenol content that protect against oxidative stress and inflammation that can lead to disease progression[8].

Nutrition Tip: Add colour to your meals by selecting foods that are blue, red, orange, purple and green so you can benefit from their healthful properties. Try adding blueberries to oatmeal, include a kale salad with lunch, snack on carrots and incorporate another green leafy vegetable at dinner.

- Include fish: aim to include fish at least twice a week and benefit from the healthful effects of omega 3 fats. The World Health Organization (WHO) Dementia Guidelines report that higher intakes of fish, fruit and vegetables are consistently associated with a reduced risk of dementia[9], and many studies showed how fish in particular is correlated with less memory decline in healthy subjects⁹.

Nutrition Tip: Think of ways to include fresh, frozen or canned fish. For example, have canned sardines on toast or add canned tuna or salmon to a green salad. Baked, grilled or pan-fried trout are quick and easy ways to prepare fish.

Whenever possible, choose fresh, whole, minimally processed foods to maximize your fibre and nutrient intake. Additionally, nutritional supplements are not a replacement for food. A systematic review by Butler et al revealed how supplements did not contribute to preventing or delaying cognitive decline or dementia in older adults[10]. Diet is only one way to lower your risk of Alzheimer’s. Remember to focus on a variety of colourful fruits and vegetable and include plant and fish protein sources more often.


About the Author:
Maria Ricupero is a Registered Dietitian and Certified Diabetes Educator with a nutrition consulting practice in downtown Toronto, Canada. She has taught at two Ontario universities, is published in peer reviewed journals and is frequently invited to present at professional conferences both nationally and internationally.