Author: Joseph Gerard

The Myths That Silence the Most Important Question in Healthcare

Posted on by Joseph Gerard

healthcare power of attorney advance directive papers with on a table with a pen near itWritten by Dr. Erin Jenkins

As healthcare professionals, many of us will never forget 2020. During a global pandemic, millions of people died, and families were forced to grieve losses they never imagined they would face. Loved ones were taken by a virus that moved quickly and unpredictably, leaving little time to prepare emotionally or practically. During this period, I was working in hospital based palliative medicine. In more typical times, our work focused on supporting people living with chronic illness, managing symptoms, and helping patients clarify how they wanted to live while navigating conditions such as COPD, CHF, and cancer.

During the pandemic, that work shifted dramatically. Patients who had long been managing chronic disease were suddenly confronted with a virus that disproportionately affected those same conditions. Regardless of diagnosis, one reality remained constant: COVID significantly increased the risk of death for patients with chronic illness.

End of life conversations became part of our daily work. We spoke with patients struggling to breathe, many dependent on oxygen or ventilatory support, including individuals with no prior respiratory disease. Yet, when asked about their wishes, most patients did not have clear answers. Families often struggled to accept that their loved one might die. Hope persisted, as it always does in medicine, but it became increasingly apparent that many patients and families were completely unprepared to make these decisions. Some waited until it was too late.

It was during this time that I began to fully grasp how many Americans lack end of life plans, even those who regularly interact with the healthcare system. Research suggests that fewer than one third of U.S. adults have completed an advance directive to guide care during times of crisis (Auriemma, Halpern, Asch, Van Der Tuyn, & Asch, 2020). These rates vary based on age, education, and other social determinants. Together, these findings highlight the gap between clinical recommendation and real-world readiness. It suggests a broader disconnect between patients and providers, as well as between patients and their families, leaving many unprepared to make critical decisions under duress. The question is, why?

One persistent myth in healthcare is that end of life planning is only for the elderly or those with terminal illness. This belief delays conversations that are both necessary and appropriate for all. End of life planning is for everyone and involves more than signing a document. It is a process designed to align care with what matters most to patients and their families. While these discussions can feel uncomfortable, proactive conversations lead to better alignment of care, reduced moral distress, and support clearer decision-making during times of crisis. These discussions include preferences regarding CPR versus DNR status, surrogate decision makers, mechanical ventilation, artificial nutrition, and post death wishes. While formal documentation is important, the most critical step is initiating the conversation. Without clarity, families are left to make life altering decisions under intense emotional strain, and clinicians are placed in ethically challenging positions.

Another common myth is that discussing end of life planning takes away hope. During the pandemic, many clinical teams hesitated to initiate these conversations out of concern that they might cause anxiety or signal that death was imminent. But our experience in palliative care showed the opposite. Even when the focus of conversation is a difficult topic, patients often felt less anxious and more supported. Additionally, research shows that advance care planning improves proximal outcomes, including communication quality, decisional confidence, and patient-surrogate congruence (Malhotra et al., 2022).Trust between patients and their care teams also increases. These discussions are not about removing hope. They are about preserving dignity, honoring autonomy, and reducing unnecessary suffering.

There is also a common misconception that patients will bring up these conversations “when they are ready”. In reality, no one ever feels ready for these discussions. Patients cannot ask for guidance around decisions they do not yet understand or know need to happen. That is where we come in. As healthcare professionals, part of our role is to guide patients through complex medical decisions, including those related to end-of-life care. Many clinicians who consulted our palliative care team in 2020 did so because they were unsure how to begin these conversations. Some were waiting for patients to say they were ready, while others felt that they were not equipped to lead the discussions themselves. While palliative and hospice teams are often seen as the experts in end-of-life discussions, the responsibility for these discussions is shared. At their core, these are conversations about goals and values. When framed that way, they become more approachable for both patients and clinicians.

Another misconception is that there simply is not enough time during a visit to address end of life planning. Anyone who has worked in primary care understands the challenge of limited time within the appointment. But these conversations do not need to be lengthy. They also do not need to occur in a single visit. Clinicians can begin with a simple question: “I was hoping we could talk a little about your goals in case there came a time when you could not make decisions for yourself.” From there, some foundational questions can be explored: who would serve as a surrogate decision-maker, what types of interventions the patient would or would not want, and how they wish their body to be cared for after death, including organ donation. These discussions frequently can unfold over two or three brief visits. What matters most is our willingness to normalize and prioritize them.

Despite the documented benefits of advance care planning and strengthened communication between patient and clinician, barriers remain. Many clinicians report lack of training or confidence in initiating end-of-life discussions, time constraints that reduce opportunities for discussion, and concerns about disrupting the clinician-patient relationship. Yet, when these conversations occur, they contribute to greater alignment of care with patient values and help prevent crisis-driven decision-making that may not reflect what patients would choose.

So, the question becomes this: have you had these conversations with your patients? And if not, what are you waiting for?

Author Biography:

Dr. Erin Jenkins is a certified Family and Psychiatric Nurse Practitioner with 23 years of experience in critical care, family medicine, neurosurgery, and palliative medicine. She owns Your Full Potential Psychiatry & Wellness in Southern Nevada, where she helps people improve their overall wellbeing using integrative medicine. Dr. Jenkins also serves as an Advanced Practice Registered Nurse in the U.S. Air Force Reserve, working in base operational medicine and focusing on military psychiatry. Learn more at https://www.yfpwellness.com and connect with her on LinkedIn at https://www.linkedin.com/in/erinjenkinshealth .

References:

Auriemma, C. L., Halpern, S. D., Asch, D. A., Van Der Tuyn, M., & Asch, J. M. (2020). Completion of advance directives and documented care preferences during the Coronavirus Disease 2019 (COVID-19) pandemic. JAMA Network Open, 3(7).  Access link here

Malhotra, C., et al. (2022). What is the evidence for efficacy of advance care planning … BMJ Open, 12(7). Access link here

 

 

 

.

Please also review AIHCP’s Grief Counseling Certification program and Grief Counseling CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

What Happens to Clinical Accuracy When Patients Know You Report

Posted on by Joseph Gerard

Target case management works with particular needs such as children or the elderly

Written by Dede Stratton

I. Introduction: When Patients Read What Was Once Hidden

Once upon a time, medical reporting used to sit in a closed space. Health care clinicians wrote for health care clinicians. Patients trusted the process without (over)seeing every step. That model no longer holds. Today, patients log in, scroll, and read. They study their records as if they were part of the team. This change has affected how care feels, how truth lands, how responsibility moves across the page. Our question is direct and serious: what happens to clinical accuracy when patients know you report?

The answer lies in how fear, trust, and clarity meet on a screen. When records become shared, the page becomes a public space. That space needs both precision and restraint. It needs honesty without coldness; care without confusion.

This article explores how transparency shapes medical writing. It will examine how tone, pressure, and uncertainty affect what ends up in the record. It will also look at how clinicians can protect the truth while respecting the patient who reads it.

A. Boundaries That Support Safe and Honest Reporting

Boundaries matter in care, as they define roles and protect focus. They keep the work grounded. A clinician brings training and responsibility. A patient brings lived experience and personal meaning. Each of the roles is strong. Each role also needs structure. Without boundaries, both sides might drift.

In care involving addiction, boundaries protect both the patient and the clinician. A medical note must stay honest. It must also stay grounded in fact. When a doctor feels pressure to soften the reality of substance use or avoid naming risk, the record loses strength. This is where, if you’re a doctor, protecting yourself while offering care becomes essential. A physician who can hold their role with clarity can document without fear or avoidance. The boundary keeps the work firm. It keeps the truth intact even when the patient is emotionally close to the issue.

A clear boundary also reduces emotional strain. It allows the clinician to care deeply without losing distance. That distance doesn’t block compassion. It supports it. A strong record grows from a calm and grounded writer.

B. Writing for a Reader Who Is Also the Subject

The medical record now has two readers. One is the clinical team. The other is the patient. This changes everything. The note is no longer a private exchange between professionals. It’s now a shared document.

That shared space shapes tone. A sentence that once felt neutral can now feel sharp. A word that once felt precise can now feel heavy. The clinician has to think about meaning and impact at the same time. This isn’t synonymous with hiding facts. It just means choosing words that explain instead of confusing.

C. How Transparency Alters the Clinical Environment

Transparency doesn’t only affect writing. It affects the entire clinical environment. Patients arrive with notes open on their phones. They ask about phrasing or point to words. They question conclusions.

This changes the rhythm of care. Visits become more focused. They also become more demanding. The clinician now answers not only for decisions but for documentation. The page becomes part of the conversation.

This new dynamic carries value. It can build trust. It can also create strain. The challenge is to let the page support care rather than compete with it.

II. Uncertainty, Pressure, and the Open Record

The open record brings light into spaces that once stayed private. Light shows strengths. It also shows gaps. When patients read every word, the writer feels watched. That feeling shapes behavior. It shapes the tone. It shapes how doubt appears on the page.

Medical work includes uncertainty. Diagnosis often starts with questions. Treatment begins with probability. The record must reflect this reality without creating fear or confusion. That task requires a bit of skill.

A. How Transparency Increases Emotional Weight

A medical note now carries emotional weight for the patient. A short phrase can change how a person sees their health. A lab value without context can sound final. A clinical term without explanation can sound threatening.

The writer must now consider both fact and feeling. This doesn’t mean turning the record into a story. It means shaping the information so the reader understands it without misreading it.

The record becomes a guide. It should reduce panic, not raise it. Clear structure and direct language help achieve that goal.

B. When Discomfort With Uncertainty Alters Communication

Some research studies suggest a pattern. When clinicians feel uneasy about diagnostic uncertainty, their communication changes, and their writing can sound firm when it should sound open. Their tone can feel closed when it should feel careful.

Patients can read this as a dismissal of their symptoms. The clinician may mean to stay precise. The patient may feel unheard. This gap forms when fear of error meets pressure to appear confident.

C. The Page as a Public Space

Even when the room is private, the page is public. This awareness changes how clinicians write. They may avoid strong language. They may hedge. They may add long explanations to protect tone.

Each choice has a cost. Too much hedging weakens meaning. Too little context sharpens fear. The aim is to keep the page clear and calm at the same time.

D. How Systems Shape Documentation Behavior

Documentation systems guide behavior. Templates shape sentence flow. Prompts shape word choice. Time limits shape depth. If the system values speed over clarity, notes shrink. If it values structure without flexibility, meaning it flattens. The best systems support direct language with room for brief explanation.

III. Meaning, Trust, and the Middle Ground

Patients don’t read records as data. They read them as stories about their bodies. They search for meaning in every line, looking for reassurance, or danger, or hope. The writer must remember this.

A. How Patients Interpret What They Read

A patient sees a phrase and asks: What does this mean for me? A number becomes a future. A comment becomes a judgment.

If the note is vague, the patient fills the gaps. Anxiety grows. If the note is clear, the patient stays grounded. The page either stabilizes or unsettles.

The goal is not to simplify the truth. It’s to present it in a way that holds meaning without distortion.

B. Precision Without Emotional Distance

This is where clinical accuracy meets human understanding. Clinical accuracy isn’t cold, but focused, giving facts without noise.

A strong note states what is known. It names what’s not known. It avoids drama. It avoids empty comfort. It stays honest in clean language.

Precision builds trust when it’s paired with clarity.

IV. Training, Time, and Team Culture

Good documentation doesn’t happen by accident. It grows from skill and support. It grows from culture.

A. Learning How to Write for Shared Understanding

Clinicians are trained to diagnose and treat. They are often not trained to write for patients. This skill must be taught. Writing for shared records requires short sentences. Direct structure. Clear flow. Each idea should move forward.

Practice builds this skill. Feedback refines it. Reading one’s own notes as a patient strengthens it.

B. Why Time Shapes the Quality of Records

Time is a tool. Without it, quality falls. Rushed notes carry gaps. They drop links between ideas. They sound harsh without meaning to.

A slower pace allows for better structure. It allows for tone control. It allows for fact-checking. Good records require space to think.

C. Culture as the Hidden Force Behind Documentation

Culture guides behavior. In a team that values clarity, notes improve. In a team that values speed only, notes shrink.

Leaders set the tone. They show what matters by what they read and comment on. If they care about voice and truth, the team follows.

Culture is what turns standards into habits.

V. Conclusion: Accuracy Under Open Eyes

Patients now read what once stayed hidden, and this has changed how medical work feels on both sides of the desk. The setting is new, but the duty is not. The duty remains simple: tell the truth with care, even when the truth feels close, sensitive, or difficult to hold.

A. Truth and Respect on the Page

The medical record must carry facts and respect at the same time. It should explain what’s known, what’s uncertain, and what comes next without hiding behind vague language. A clear page supports trust. A blurred one weakens it. The goal is not perfect wording. The goal is honest meaning in plain structure.

B. Support That Makes Accuracy Possible

For this to happen, clinicians need space to think, time to write, and training that treats documentation as a clinical skill, not just a task. The record is more than a technical tool. It’s a bridge between minds. It carries data, tone, and responsibility together. When written with care and precision, it protects both the patient and the clinician. And when patients know they will read what’s written, clinical accuracy doesn’t fall. It rises to meet the moment.

 

Author’s bio: Dede Stratton is the CEO, LCSW, LCADC over at Altruism Counseling Services. When she’s not ensuring her center runs smoothly, she spends her time writing about insights drawn from her extensive career.

 

References:

Contributor, G. (2023, September 1). When patients understand their medical record. AAPC Knowledge Center. https://www.aapc.com/blog/88743-when-patients-understand-their-medical-record/

NovoPath. (2025, August). Lab reporting accuracy: How miscommunication risks patient care. https://www.novopath.com/blog/laboratory-information-systems/lab-reporting-accuracy/

World Insurance Associates. (n.d.). The importance of accuracy in medical records. https://www.worldinsurance.com/blog/the-importance-of-accuracy-in-medical-records

 

Please also review AIHCP’s Case Management Courses and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

The Evolution of Trauma-Informed Mindfulness: Neurobiology, Adverse Effects, and What You Need To Do

Posted on by Joseph Gerard

Trauma as a complex subject, related to important topics. Pictured as a puzzle and a word cloud made of most important ideas and phrases related to trauma.

Written by Shebna N. Osanmoh I, PMHNP-BC

Over the past ten years, ideas about meditation have changed a lot. People used to treat mindfulness as a one-size-fits-all fix for mental health problems. The common advice was simple: if you feel anxious, sit quietly; if you feel stressed, pay attention to your breathing.

However, as we move through 2026, emerging clinical evidence and longitudinal neurobiological research have revealed a more complex reality. For a significant portion of the population—particularly those with histories of complex trauma, Adverse Childhood Experiences (ACEs), or Post-Traumatic Stress Disorder (PTSD)—standard meditative practices can inadvertently worsen symptoms of traumatic stress.

This is not a failure of the student, but a failure of the framework.

Trauma-Informed Mindfulness (TIM), sometimes called Trauma-Sensitive Mindfulness (TSM), represents a systemic and essential “upgrade” to contemporary mindfulness-based programs. It integrates a sophisticated understanding of the human nervous system, the physiology of trauma, and the fundamental necessity of individual agency.

This thorough guide will explore the neurobiology of why traditional mindfulness fails for trauma survivors, the specific “adverse effects” to watch for, and the practical, evidence-based adaptations you can use to build a safe, healing practice.

The Paradox – Why Traditional Mindfulness Can Bring Up Difficult Feelings

To understand why a practice meant for peace can cause panic, we must look at the brain. Traditional mindfulness interventions often rely heavily on interoception—the practice of paying close attention to internal bodily sensations (e.g., “scan your body,” “feel your heartbeat,” “watch your breath”).

The Double-Edged Sword of Mindful Attention

Research published in Frontiers in Psychology (2025) highlights a phenomenon known as the “Mindful Observing Paradox.” For the general population, observing internal sensations promotes regulation. However, for trauma-exposed populations, the act of “observing” can blur with a hypervigilant state focused on detecting threats.

  • Internal Observing & Anxiety – High levels of internal observing are linked to increased anxiety sensitivity. When a trauma survivor is asked to “turn inward,” they may encounter stored somatic memories of abuse or pain without the “brakes” to slow the experience down.
  • The U-Shaped Curve – Researchers now discuss a “U-shaped curve” of mindfulness, where moderate practice is beneficial, but “too much” mindfulness (excessive amygdala downregulation) can lead to functional impairment, such as emotional numbing or dissociation.

The Neurobiology of Freeze

Trauma is often stored in the nervous system as incomplete survival responses. When we remove all external stimuli and force the body into stillness, we may inadvertently simulate a “Freeze” response (immobility). For a survivor, being unable to move while feeling intense internal sensations can replicate the physiological experience of entrapment, triggering a cascade of stress hormones even as they sit “peacefully” on a cushion.

The Data on Adverse Effects – It’s More Common Than You Think

One of the most critical developments in the field (2024–2026) is the quantitative data regarding Meditation-Related Adverse Effects (MRAEs). Pioneering research by Dr. Willoughby Britton at Brown University and the Cheetah House organization has challenged the “no pain, no gain” mentality of meditation.

Key Findings from 2025 Research

Dr. Britton’s team identified 59 categories of meditation-related experiences that can be distressing or associated with impairment in functioning. The statistics are sobering and essential for any instructor to know:

  • High Prevalence: In studied cohorts, up to 83% of participants experienced at least one unintended effect during meditation.
  • Negative Valence: Approximately 58% of these side effects involved unpleasant or distressing emotions, refuting the myth that meditation is always relaxing.
  • Functional Impairment: Crucially, 9% of participants reported effects that impaired their ability to function in daily life.

Distinguishing Hyperarousal from Hypoarousal

Trauma responses in meditation generally fall into two categories. While most teachers recognize the “loud” symptoms of trauma, the “quiet” symptoms are often missed.

a) Hyperarousal (The “Gas Pedal”)

  • Signs: Panic attacks, racing heart, intrusive thoughts, traumatic re-experiencing, agitation, insomnia.
  • Teacher Noticeability: High. These students often open their eyes, fidget, or leave the room.

b) Hypoarousal (The “Brake”)

  • Signs: Dissociation, emotional blunting, feeling “floaty,” numbness, checking out.
  • Teacher Noticeability: Low. A student in a hypoaroused state may look like the “perfect meditator”—still, silent, and compliant—while internally they are completely disconnected from reality. Dr. Britton notes that while students may not report dissociation as “negative” because it numbs the pain, it is a significant predictor of lasting functional impairment.

Trauma-Informed Mindfulness: What to Avoid

Based on the “Procedural Modifications Checklist” developed for 2026 clinical applications, specific traditional instructions are now flagged as potentially contraindicated for trauma survivors.

Forced Stillness

  • The Trap: Instructing a class to “sit perfectly still without moving.” 
  • The Risk: For survivors of physical or sexual trauma, forced immobility can trigger somatic memories of being held down or trapped. It removes the primary mechanism (movement) the nervous system uses to discharge stress energy.

The “Breath-Only” Anchor

  • The Trap: “Focus exclusively on the breath at the tip of the nose.” 
  • The Risk: The breath is often a carrier of anxiety. Respiratory focus can trigger hyperventilation or memories of suffocation. For many, the breath is not a neutral anchor; it is a source of distress.

Closed Eyes (Mandatory)

  • The Trap: “Now, close your eyes.” 
  • The Risk: Closing the eyes removes visual safety cues. For a person with PTSD, being unable to see their environment can induce immediate paranoia or flashbacks. It forces the brain to rely solely on internal (often unsafe) input.

 Authoritative/Command Language

  • The Trap: “You must…” “Don’t think…” “Stay with the pain.” 
  • The Risk: Command-based language mimics the dynamic of the perpetrator-victim relationship, stripping the participant of agency. This can cause “flooding”—an overwhelming surge of emotion that pushes the student outside their window of tolerance.

What to Do Instead – The N.I.A. Language Model & Safe Anchoring

The goal of trauma-informed mindfulness is not the mastery of stillness, but the cultivation of safety, choice, and self-regulation. To achieve this, we employ specific frameworks like the N.I.A. Language Model.

The N.I.A. Language Model

Developed to empower participants, this model shifts the power dynamic from the teacher to the student.

N – Non-Directive:

  • Instead of “Close your eyes,” try: “You might choose to lower your gaze to the floor, or close your eyes if that feels comfortable”.
  • Why: It guides gently without demanding compliance.

I – Invitational:

  • Instead of “Focus on your breath,” try: “I invite you to notice the rhythm of your breathing, or perhaps simply notice the sensation of your feet on the ground”.
  • Why: It reinforces that the student is in control of their own attention.

A – Adaptive:

  • Instead of “Do not move,” try: “Feel free to shift your posture, stretch, or open your eyes at any time to make yourself more comfortable”.
  • Why: It encourages autonomy and self-care over rigid adherence to rules.

Prioritizing External Anchors (Exteroception)

When internal focus (interoception) becomes unsafe, we must offer external anchors. This engages exteroception—processing stimuli from outside the body—which helps re-orient the brain to the safety of the present moment.

  • Sound: Listen to the hum of the air conditioner or the birds outside.
  • Sight: Let your eyes rest on a color in the room, or a specific object like a plant.
  • Touch: Feel the texture of your jeans or the weight of your body in the chair.

Research confirms that external observing is more grounding for trauma-exposed populations and prevents the brain from being consumed by internal traumatic stimuli.

Procedural Adaptations – Building a Safe Practice

Beyond language, the structure of the practice itself must be adapted. The MINDS-V Study (Australian Veterans, 2025) demonstrated that tailored interventions led to significant reductions in PTSD symptoms even without increasing “mindfulness states,” proving that regulation is more valuable than “depth” for this population.

1. Titration and Micro-Practices

Trauma survivors often have a narrowed Window of Tolerance. Long sessions can push them into hyper- or hypoarousal.

  • Do This: Start with Micro-Practices lasting 30 seconds to 3 minutes.
  • Why: This builds “confidence and self-trust without overwhelming the system”. It allows the student to dip their toe in the water without drowning.

2. Mindful Movement (Dynamic Mindfulness)

For many survivors, movement is a clinical necessity.

  • Do This: Incorporate rhythmic swaying, walking meditation, or gentle stretching before or instead of sitting.
  • Why: Practices like “shaking” or Dynamic Mindfulness (DMind) allow the nervous system to discharge tension and remain within the window of tolerance. It signals to the body that it is not trapped.

3. Pre-Orientation and Predictability

PTSD symptoms thrive on unpredictability.

  • Do This: Inform participants beforehand about potential triggers and exactly what will happen in the session.
  • Why: This provides informed consent. For example, saying “We will try this for two minutes, and then we will stop” reduces the anxiety of the unknown.

To move beyond theory, we must look at the data. One of the most significant recent contributions to the field is the 2025 MINDS-V Study, which evaluated a tailored Trauma-Informed Mindfulness-Based Stress Reduction (TI-MBSR) program for Australian veterans.

This study is critical because it challenges the assumption that “more mindfulness is better.” The intervention was culturally adapted to mirror military training routines, emphasizing discipline and perseverance, but with strict trauma modifications.

The “Mindfulness Paradox” Finding. The study yielded a fascinating result:

  • Symptom Improvement: Participants showed significant reductions in PTSD symptoms, including re-experiencing, avoidance, and hyper-arousal.
  • The Surprise: Interestingly, while symptoms decreased, participants did not show a statistically significant increase in their actual “mindfulness state” (momentary awareness).

This suggests that the benefits of trauma-informed mindfulness may not come from achieving a deep, Zen-like state of awareness. Instead, the benefits likely stem from improved emotional regulation and the interruption of ruminative thought patterns.

For the practitioner, this is a liberating finding. It means you do not need to “clear your mind” or achieve perfect focus to heal. The simple act of practicing regulation—stopping the cycle of panic and returning to safety—is where the healing lies, regardless of how “mindful” you feel in the moment.

Systemic Implementation – Beyond the Individual

Trauma-informed mindfulness is not just for the meditation cushion; it is a framework for schools, healthcare, and justice systems.

  • In Schools (TR Schools)

Toolkits like the “Resilient Gwinnett Toolkit” emphasize shifting the mindset from “What’s wrong with you?” to “What happened to you?” Strategies include creating “calming corners” and focusing on peer support rather than punitive discipline.

  • In Healthcare

Audit checklists now recommend reviewing waiting rooms and exam procedures to ensure “welcoming spaces” and “transparency,” ensuring patients know exactly what to expect during a visit.

  • In Youth Services

Organizations like the Justice Resource Institute (JRI) train providers in de-escalation and vicarious trauma planning, recognizing that the “well-regulated facilitator” is the most important tool in the room.

Conclusion

The evolution of mindfulness toward a trauma-informed framework is not a rejection of tradition, but a maturation of it. We are moving away from a passive, potentially dangerous state of stillness toward a dynamic, active state of safety.

As we look toward the future of 2026, the goal is clear: theoretical and conceptual clarity. We must stop asking – Does mindfulness work? and start asking – Which type of mindfulness works for whom?

By integrating the N.I.A. Language Model, prioritizing external anchors, and respecting the Window of Tolerance, we can ensure that mindfulness remains a transformative tool for healing rather than a source of harm. The most important intervention is not the technique, but the genuine, attuned relationship between the teacher and the student—one that honors their survival and empowers their recovery.

 

Shebna N. Osanmoh I, PMHNP-BC

Author Bio: 

Shebna N. Osanmoh I, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner associated with Savant Care, CA, mental health clinic. He has extensive experience and a Master’s from Walden University. He provides compassionate, holistic care for diverse mental health conditions.

 

 

 

 

Please also review AIHCP’s Trauma Informed Care Specialist Certification programs and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Which Entities Are Accountable for Human Research Compliance?

Posted on by Joseph Gerard

Medicine doctor hand working with modern computer interface as medical concept

Written by Elissa Capelle Vaughn,

What’s the origin story of a life-changing consumer medical product or surgical advancement? 

The road toward a medical breakthrough isn’t possible without human research and clinical trials. Studies are where the big ideas are born and tested. Research brings invested parties together across industries, from doctors to legal teams, to gather valuable insights for product development and medical procedures.

Clinical trials are more than a necessary step. They’re a powerful signal of trust to patients and over-the-counter consumers. As Google puts it, the topic of health falls under “your money, your life.” The stakes are high from every angle, whether you’re leading or sponsoring a study, making compliance essential at every level of a research study.    

Learn more about the accountable parties behind human research compliance. 

 

Who Leads the Study?

Behind every clinical research study is a large team of industry professionals with wide-ranging expertise. These teams develop and manage the human research end, or human subject research (HSR), of the clinical trial. 

Every team member has a duty to uphold all compliance measures relating to this type of work. The job of compliance doesn’t rest with just one person; however, some individuals have more compliance-related duties. 

For example, the principal investigator (PI) is the head researcher who leads the human research study and works with study participants. They’re the “face” of the study for clinical trial participants and must exemplify the highest standards of clinical trial compliance. 

It’s not uncommon for PIs to delegate study workloads to lower-level investigators or research coordinators, especially if the study is large. However, despite delegation, the lead PI is still the primary party responsible for ethical breaches. For example, if a PI delegates a portion of the study to another researcher, and that researcher violates compliance regulations, the PI is also held responsible for noncompliance. 

It’s important to understand that human research PIs interact directly with voluntary trial participants. Compliance ensures the integrity of the study and data. 

 

Participant Safety Oversight

Since the PI leads the human research study, they’re in charge of overseeing patient safety. Therefore, this role requires frequent communication with doctors and relevant external parties, like clinical trials lawyers who ensure medical product testing is legal and compliant with industry and state regulations. 

The study’s principal investigator is expected to immediately report any serious adverse events (SAEs) and unexpected adverse events (AEs) to both the study sponsor and the Institutional Review Board. IRBs also work directly with clinical trial lawyers. 

PIs are responsible when a study participant is injured. Therefore, they must develop an injury care protocol before launching the study, ensuring that medical care is quickly administered. 

 

ALCOA Compliance 

FDA approval is crucial in medical product development, whether you’re developing a new prescription drug or a bandage. PIs must strictly follow the ALCOA data documentation framework to ensure a smooth path to FDA approval. ALCOA stands for: 

  • Attributable
  • Legible
  • Contemporaneous
  • Original
  • Accurate

Research study data must be attributed to the lead researcher who produced (and modified) the report. 

Data must be legible, which means it must be presented in a clear manner. 

All study data must be recorded at the very time it was generated, ensuring that reports are contemporaneous. 

Reports must be original; PIs are required to show the original copy of the data report.   

Lastly, PIs must ensure that all reported research data is accurate and reliable. Research reports should also be free of errors before submitting to an approval body. All case report forms (CRFs) must align with any medical records or lab results from the study. 

 

HIPAA and Policy Compliance 

Human research studies are subject to both health and research-based laws. The Health Insurance Portability and Accountability Act (HIPAA) is widely recognized, also by patients and study participants. HIPAA protects clinical study participants from the unauthorized release of patient health information (PHI).  

The Family Educational Rights and Privacy Act, or FERPA, may receive less attention in conversations about research, but it’s just as important. This act protects student records, which include academic performance and behavioral data. 

Research studies cannot deviate from clinical trial agreements (CTAs), which also include compensation and injury coverage for study participants. Informed consent forms (ICFs) for study participants must align with the CTA. 

It’s the responsibility of human research PIs to enforce these data privacy protocols. 

 

Who Sponsors Human Research Studies?

This question will lead you to a range of corporate and academic entities, from major pharma companies to research institutions. While PIs are the “face” of the study for participants, sponsors are the “face” of the study itself. 

Sponsors both initiate and finance medical research studies. Broadly, they’re accountable for a clinical study’s global impact, which could encompass multiple countries. 

 

Study Quality Monitoring

Sponsors are responsible for selecting and monitoring a study PI’s overall performance. PIs legally commit to this role via Form FDA 1572, which is the official Statement of the Investigator. 

PIs work with clinical trial participants directly. Study sponsors, on the other hand, are responsible for the quality of the study at large. 

Study sponsors must form teams of experts to build and oversee quality assurance (QA) and quality control processes. Sponsors are expected to audit research labs and data to ensure all quality measures are followed. 

If an audit reveals a compliance breach at a research site, the sponsor is expected to take immediate corrective action, which can include termination of the site.  

 

Safety Reporting Duties of Sponsors

While PIs must report to IRBs, sponsors must also submit safety reports to government agencies. They must evaluate study data from all research sites to determine if trial products resulted in injuries. Life-threatening injuries must be reported to government regulatory agencies within 15 days.   

 

What Are Contract Research Organizations?

Also known as CROs, contract research organizations are outsourced parties that work on clinical trials. Studies of this scope require a lot of work across various fields, prompting sponsors to outsource certain roles. 

A sponsor may outsource all clinical trial management to a CRO. Once the Transfer of Regulatory Obligations (TORO) is complete, the CRO will select the PIs, oversee resource allocation, and so forth. CROs are accountable for specific duties outlined in their contract, which may also include data management, research site monitoring, or safety reporting.   

Even with a TORO in place, study sponsors still retain primary legal liability for the medical product being studied. CROs are responsible for the operations they manage.  

 

What Is the Role of an Institutional Review Board?

Conflicts of interest can tarnish the integrity and contaminate the data of a research study. Clinical trials require independent oversight solutions like institutional review boards (IRBs) to hold appropriate parties accountable. 

The IRB for a study protects the rights and well-being of human research subjects. Clinical studies must be reviewed for acceptable risk-benefit before they can proceed. IRBs also review informed consent forms for clarity before they’re distributed to study participants. 

 

The Data Safety Monitoring Board

While the IRB assesses the accountability of sponsors, CROs, and PIs, the data safety monitoring board (DSMB) monitors data for compliance. 

For example, if a study’s data reveals an unexpected level of harm, this would be cause to cease a study. On the other hand, if the DSMB discovers benefits well above expectations, the DSMB would recommend ceasing the placebo control group so that these participants could benefit as well. 

 

Hospital Compliance

Studies that are conducted within the hospital system are also reviewed by healthcare compliance teams. These teams focus on the hospital’s institutional risk and legal obligations. 

Research billing is typically handled by hospital compliance teams. To avoid large fines under the False Claims Act, clinical trial drugs must be billed to the study, not Medicare. These teams also manage conflicts of interest that could arise between healthcare institutions (or pharmaceutical companies) and researchers.   

 

Compliance Training and Education

You can’t have proper accountability without competency. Updated and ongoing compliance training is absolutely crucial to research integrity. To ensure all research staff are prepared, sponsors, CROs, and hospitals should mandate certified compliance training.

For example, training from the Collaborative Institutional Training Initiative, or CITI, is industry-standard for medical research professionals. A CRO may require that all study researchers have CITI training.

Human Subjects Protection (HSP) training is available through the Office for Human Research Protections under the U.S. Department of Health and Human Services. Good Clinical Practice (GCP) training, along with HSP, is also offered through the CITI program.    

Research institutions and healthcare organizations can also foster a culture of compliance by promoting continuing education (CE) beyond industry-standard training. Including interactive compliance material in the research staff onboarding, like presentations and quizzes, can promote critical compliance principles from day one. 

 

Conduct Compliance-First Research Studies

Designing a human research study with compliance in mind provides an extra layer of protection for all parties. Use this guide to develop a knowledge base of roles, responsibilities, accountable entities, and legal guidelines. Promote a culture of compliance to inspire medical breakthroughs built on ethics and good data.

 

Author Bio: Elissa Capelle Vaughn is a New York-based content writer who covers trending topics in health and wellness. She also brings a diverse background in sales and marketing to her work when discussing communication strategies in the health field.

Please also review AIHCP’s Health Care Management Certification program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Integrating Recognition into Healthcare Retention Strategies for High-Turnover Clinical Roles

Posted on by Joseph Gerard

Doctors standing together

Written by Angela Rivera,

If you manage clinical teams, you already know how hard it is to not only attract the right talent but, perhaps more importantly, how hard it is to keep the great ones. This is a problem for two reasons, both of which you’re also likely familiar with, but it bears repeating: turnover is both expensive and bad for team morale.

So the question is, what, if anything, can be done to retain healthcare workers, especially in high-turnover clinical roles? The good news is, there is plenty you can do, and we’ll give you several recognition strategies for employee retention, but before you apply any, it’s crucial to understand why this happens in the first place.

Next, you need a solid, science-backed retention model that actually fits the realities of modern healthcare work. We give you both in this article: the theory, yes, because it helps to know the statistics and research, but also concrete retention tactics.

Why Retention in Healthcare Is Essential

Retention is obviously a big budget issue. Losing an employee, even one with moderate tenure, means the organization has to pay first for recruiting costs and then for onboarding time. But that’s only a part of the financial problem; the organization typically also needs to pay extra overtime for colleagues who have to step in until the new employee is ready. And that time until the employee is actually ready also means there is a drop in Another thing that matters but is often ignored is the drop in quality of service; over-worked employees cannot give their best, naturally.

According to industry analyses, a single RN resignation can cost an organization tens of thousands of dollars (up to $61,000 according to the linked report)  in replacement and productivity loss. That is a lot, and only for one employee. When that keeps happening over and over again, the financial impact is often so big, it can devastate an organization. Clinical support roles do cost less per departure but since they churn far more frequently, their cumulative impact is enormous as well.

However, the extra costs, enormous as they can be (depending on how bad the turnover is_, are only a part of the problem when you look at it from a bird’s perspective. Staff who stay longer build not only better clinical intuition and the ability to remain calm under pressure, but they also build familiarity with patients. This combination allows them to become true experts in their fields, and both patients and their colleagues benefit from this.

Why Retention Is So Hard in High-Turnover Clinical Roles

Burnout is notoriously high in the healthcare sector, and while that is not news to anyone in the field, what may be is the sharp jump in recent years. Since COVID, the annual rates have climbed into the 30% range, even nearing 40% range.

Those are alarming numbers. While the dissatisfaction and overwhelmingness are sometimes the fault of organizations (poor management, poor relationships, etc.), there’s no denying that even well-run institutions struggle to retain staff. Why is that? There are several reasons, with the most common being:

1. High emotional strain without adequate recovery

Nursing assistants and behavioral-health technicians often have intense emotional interactions daily and while many can detach (as best as they can), it’s not possible to not absorb any of that emotional content and that takes a toll. Over time, many describe a sense of emotional depletion not only at work, but even when they leave. When that becomes routine, the exit often becomes inevitable.

2. Fragmented work and nonstop task switching

Going from one micro-task to another (vital signs, transport, stocking, discharges, etc.) is an everyday work for support roles. But this kind of work, while necessary and unavoidable to a degree, also takes a mental toll on a person. None of these tasks is overwhelming individually, but when combined, they create nonstop cognitive fragmentation, and as a result, exhaustion.

3. Little to no voice in decisions

Healthcare workers across all roles, including support, want at least some input in decisions that affect their daily work, be it workflow changes, assignments, or equipment choices. When changes arrive without explanation or, equally bad, without any opportunity for feedback, employees tend to feel invisible. This is a recipe for disengagement and is exactly the opposite of what you want if the goal is job embeddedness.

4. Schedules that leave little time for life outside work

Unpredictability is a part of the healthcare work package and your employees are aware of that. However, while some unpredictable shifts are unavoidable, frequent last-minute changes or too rigid scheduling structures are not. And they can push people out faster than pay alone. For staff who have children or are caring for aging family members, in particular, stability and flexibility often matter more than incremental wage increases.

5. Recognition is sporadic or absent

Most employees don’t expect to be constantly praised, but when they give it their best, everyone should be recognized and praised. It’s the key to job satisfaction. On the flip side of this, when effort goes unnoticed most of the time, job embeddedness weakens. The same thing tends to happen when recognition is too generic; there are effective ways to do this (more on this below).

Understanding the Problem Through Job Embeddedness and Retention Economics

With common reasons for high turnover out of the way, let’s look at the reasons why employees choose to stay at organizations. For this, we’ll use job embeddedness theory, which highlights three clusters:

  • Fit: This element asks whether the role actually aligns with the employee’s identity and their vision of their future. In other words, do they see themselves here long-term (ideally, fulfilled).
  • Links: This reflects relationships at work, including with coworkers, supervisors and patients. It includes routines, too. Who relies on the employee, and who do they have to rely on?
  • Sacrifice: Finally, sacrifice refers to what an employee would lose by leaving. When schedules are too chaotic or alternatively, too rigid, or recognition is absent or inconsistent, or there is little to no opportunity for advancement, the perceived sacrifice stays low.

Note that for clinical support roles, “fit” is often underdeveloped not just because of the nature of work (demanding, low pay) but also because many see the role as a stepping stone. “Links” can vary quite dramatically depending on unit culture, and how managers communicate, and shifts play a big role, too. The “sacrifice” element is self-explanatory: it’s weak if schedules are always chaotic or relationships feel purely transactional, but high if there’s stability and flexibility and relationships feel more authentic.

Retention Tactics That Reflect Real Human Experience

Turnover among CNAs, MAs, home health aides, and behavioral health technicians differs from RN or physician turnover in several important ways, the most important ones being:

  • Emotional labor tends to be higher but formal recognition low,
  • Compensation and benefits are often modest,
  • Staffing shortages are common, which creates a sense of constant urgency,
  • There is limited career advancement.

How do you fix all of these (or at least most)? With retention strategies that reflect both evidence and the daily reality of clinical work.

1. Consistent, Authentic Recognition

Generic praise does very little. If the goal is to increase the “fit” and “link” elements, it needs to be more targeted and authentic. So, instead of a general “good job today,” it’s better to say something concrete and tied to their real effort to show you’re truly seen them.

Some teams respond well when recognition includes something small and tangible, especially when it’s paired with a personal note that explains why their contribution mattered. As long as the gift is ethical and simple, it can mean a lot and increase job satisfaction. If you don’t know what to give a remarkable employee, check out companies like Successories that curate thoughtful employee gifts for staff. 

There are plenty of options but it’s best to get something you know (or at least have a hunch) the employee likes or could use.

2. Achievable micro-career pathways

Like any other role, support staff want attainable career progression, not a distant career ladder that requires two degrees they can’t pursue right now to climb. Short, stackable credentials tied to clear pay steps and defined competencies are ideal for this.

In short, you want to provide opportunities for small wins. These are what help build confidence, engagement, and loyalty. They also increase job embeddedness.

3. Scheduling that respects life outside work

Schedules should be fair and as predictable as possible, and designed protect sleep and family obligations. Even something simple like rotating holidays fairly or offering core hours, shows respect for employees. Flexible schedules (where possible, of course) tend to reduce turnover rates as they allow for more time for personal life.

Staff tend to be candid about this: “If I can plan my life, I’ll stay longer.” Maybe not to leaders directly, but this is absolutely what they think and often talk about to each other.

4. Emotional support embedded into culture

Occasional perks help, but burnout cannot be solved by them alone. To truly ease:

  •         Staff should routinely get debrief time after critical incidents,
  • Leaders need to openly talk about their own stress and coping mechanisms,
  • Mental health resources should be easy to access without stigma,
  • And units should normalize checking in on each other.

5. Relational management and high-visibility leadership

Regardless of profession, employees tend to feel more valued when they feel their superiors, especially managers, know them; it’s simple human psychology. This goes even for companies that pay higher-than-average salaries, but is even more important for the healthcare sector, where pay tends to be lower and expectations higher.

But knowing your staff should go beyond the superficial way in order to count for retention. No, you don’t need to become best friends with everyone, but your relationship should show that you see their strengths and pressures. And, equally important, that you appreciate them for it. Again, words of encouragement, some work flexibility (so they have more time for their personal life where possible) and even modest gifts from time to time can go a long way here.

6. Peer recognition systems that give everyone a voice

Peer-nominated micro-awards can also make the workplace more positive and therefore increase job satisfaction. These should highlight contributions leaders may never witness.

This is particularly important for night-shift teams who usually receive the least direct visibility.

Measuring Retention Impact

When you apply some of these suggestions, you want to take time to actually measure their impact. Organizations are different and so are units, so what works great for one may prove to be inefficient for another.

So, after some time (ideally several months up to a year but not sooner than that), use both quantitative and qualitative indicators to measure things like:

  • Turnover rates,
  • Orientation completion rates,
  • Overtime usage,
  • Patient experience scores,
  • Pulse survey items on trust, recognition, and intent to stay,
  • And sentiment trends in open-text survey responses.

The qualitative feedback often contains your best insights. When you start getting feedback like “feeling appreciated,” “feeling safe and supported,” or “experiencing better teamwork,” retention improvements usually follow.

References

Becker’s Hospital Review. (2025, May 28). The cost of nurse turnover: 5 things ASCs need to know. Becker’s ASC.

Mohr, D. C., Elnahal, S., Marks, M. L., Derickson, R., & Osatuke, K. (2025). Burnout trends among US health care workers. JAMA Network Open, 8(4), e255954.

NSI Nursing Solutions. (2025). 2025 NSI National Health Care Retention & RN Staffing Report – Quick Reference Guide. NSI.

Psychology Today. (2024, June 6). Why appreciation from management matters.

TrustedHealth Works. (2023). Understanding and addressing nurse turnover.

 

Author Bio

Angela Rivera is a health writer who specializes in addiction care, telehealth, and behavioral science. With a background in patient education and evidence based communication, they focus on making complex clinical topics clear and approachable. Their work highlights practical strategies people can use to navigate recovery with confidence and support.

 

 

Please also review AIHCP’s Health Care Management Certification program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

How Clinicians Assess Plantar Heel Pain Efficiently

Posted on by Joseph Gerard

Shot of confident young female doctor reviewing the patient's medical history on her digital tablet while standing in the consultation.Written by Harry Wolf,

Plantar heel pain… When clinicians evaluate this, they rely on structured assessment methods to identify symptom patterns, determine underlying causes, and guide effective treatment. 

By combining patient history, physical examination, functional testing, and selective imaging, practitioners can accurately differentiate plantar fasciopathy from other conditions – and develop targeted management strategies.

Clinical Interviews and Patient History

A thorough clinical interview is one of the most efficient ways in which clinicians begin evaluating a patient’s plantar pain. It is foundational to building a clear diagnostic pathway. 

This step allows clinicians to collect information that reveals:

  • Symptom characteristics.
  • Functional limitations.
  • Potential contributing factors. 

In settings that prioritize accuracy and efficiency, gathering patient history early on ensures that later assessments are targeted and relevant. Thus, the need for unnecessary testing or redundant procedures is reduced.

Asking Questions

Clinicians typically begin by having the patient describe the onset and progression of their heel pain. 

(As you may know: plantar fasciopathy commonly develops gradually.) 

Many patients report that their symptoms began after an increase in:

  • Standing time.
  • Walking distance.
  • Repetitive impact activities. 

Understanding whether the symptoms emerged suddenly or progressively helps clinicians distinguish between soft tissue irritation, structural injury, and conditions that may have systemic origins. 

And patients are often asked to describe specific behaviors of their symptoms throughout the day. 

The classic morning pain pattern associated with plantar fasciopathy is an important diagnostic clue. And identifying whether symptoms improve with initial movement offers additional clinical value.

Another key line of questioning focuses on occupational and lifestyle factors. 

Individuals who stand on hard surfaces for extended periods – such as food service workers or manufacturing employees – tend to experience increased mechanical stress on the plantar fascia. 

Similarly, athletes who abruptly change their training volume – or footwear – may develop symptoms that are related to overload. 

By clarifying such details, clinicians can determine whether daily load patterns are consistent with typical presentations of plantar heel pain.

Looking at Medical History

Clinicians also review the patient’s medical history – to assess whether underlying health conditions could contribute to symptom development or delayed tissue healing. 

Conditions such as diabetes, rheumatoid arthritis, thyroid dysfunction, or chronic obesity can influence how tissues respond to mechanical stress. 

Patients may also have a history of lower extremity injuries, gait alterations, or previous foot conditions that lead to compensatory movement patterns.

Noticing Red Flags

In addition to individual factors, clinicians look for red flags that require further evaluation. 

These include:

  • Progressive neurologic symptoms.
  • Night pain that is unrelated to activity.
  • Unexplained swelling.
  • Bilateral symptoms without clear mechanical triggers. 

Identifying such findings early on plays an important role in determining whether referral or additional testing is necessary.

The clinical interview gives clinicians a solid foundation to guide physical examination, functional testing, and imaging decisions.

Physical Examination and Palpation Findings

Physical examination… It is a critical step in diagnosing plantar heel pain, as it provides objective data that directly confirms or challenges the initial impressions formed during the interview. 

Efficient assessments typically begin with:

  • Palpation.
  • Range of motion testing.
  • Observation of basic functional movements. 

Each of these components helps clinicians identify whether symptoms align with plantar fasciopathy or another condition.

Palpation of the proximal plantar fascia at the medial calcaneal tubercle is one of the most widely recognized and reliable diagnostic indicators. Patients with plantar fasciopathy typically experience sharp, localized tenderness at this point. 

The study entitled “Medical imaging for plantar heel pain: a systematic review and meta-analysis,” published by the National Library of Medicine, describes this specific palpation finding as one of the most reproducible markers for diagnosing plantar heel pain. 

By confirming localized tenderness, it becomes easy to differentiate plantar fascia involvement from nerve entrapment, fat pad disorders, or bone-related conditions.

As well as focal tenderness, clinicians evaluate soft tissue texture. They note any thickening, swelling, or irregularities along the fascia. 

These tissue changes often indicate adaptive responses to repeated mechanical stress. 

And palpation along the arch and into the midfoot can reveal whether symptoms are isolated or part of a broader mechanical pattern.

Range of motion assessment complements palpation findings and helps clinicians determine whether mechanical restrictions contribute to the patient’s symptoms. 

Visual inspection of foot posture during standing may also reveal pes planus or pes cavus tendencies – both of which influence plantar fascia loading.

In some cases, clinicians also evaluate whether patients are using external devices to support the foot. 

This may include footwear modifications or the use of medical-grade Plantar Fasciitis orthotics, which not only cushion the heel but also correct the strain on the plantar fascia band.

Medical-grade insoles address the specific biomechanical issues that cause an individual’s plantar fasciitis.

Functional Tests and Mechanical Loading Response

Functional testing provides real-time insight into how the plantar fascia responds to mechanical stress – making these tests highly valuable in an efficient diagnostic process. 

Clinicians use functional movements to determine whether symptoms are consistent with plantar fasciopathy and to assess the overall lower extremity performance. 

Functional tests not only help confirm a diagnosis. They also guide treatment planning by revealing strength deficits, mobility limitations, or altered movement patterns.

The Windlass Test

You may be aware of the windlass test. It is one of the most important and commonly used functional assessments for plantar heel pain. 

By dorsiflexing the great toe and tensioning the plantar fascia, clinicians can provoke symptoms in individuals with plantar fasciopathy. 

A positive windlass test supports the diagnosis, especially when combined with the focal tenderness identified during palpation. 

The windlass test is particularly useful when symptom reproduction is immediate and localized.

Heel Squeeze Testing

Clinicians use the heel squeeze test to rule out calcaneal stress fractures.

This involves compressing the heel medially and laterally to assess for deep bone pain. 

Stress fractures, unlike plantar fasciopathy, typically produce a sharp, deep ache when this test is performed. 

A negative heel squeeze test supports a soft tissue origin of symptoms – whilst a positive test helps clinicians determine whether imaging may be necessary.

Activity-Based Provocation Tests

Activity-based tests include heel raises, single-leg balance, and step-down movements. Each of those tests challenges the plantar fascia differently. 

Clinicians observe how the patient performs these tasks – looking for abnormal weight shifting, pain triggers, or endurance deficits. These assessments help identify whether the plantar fascia can tolerate functional loading – or whether certain movements consistently reproduce pain.

Also, clinicians often assess whether repetitive loading worsens symptoms over time. For example, performing several consecutive heel raises can reveal fatigue or compensatory mechanics that do not appear during isolated movements. 

This process helps clinicians identify whether strengthening, flexibility, or movement retraining should be prioritized when creating a treatment plan.

Integrating Functional Testing Into Diagnostic Reasoning

Functional testing enables clinicians to compare the involved foot with the contralateral limb. Differences in balance, strength, or movement quality often highlight biomechanical contributors – that are not visible during static assessments. 

These insights help determine whether plantar fasciopathy is linked to broader kinetic chain dysfunctions, such as:

  • Weak hip stabilizers.
  • Limited leg flexibility. 

Functional tests, therefore, enhance both diagnostic accuracy and treatment efficiency.

Imaging and Evidence-Based Diagnostics

Although plantar fasciopathy is typically diagnosed through clinical examination, imaging plays an important role – when symptoms do not improve as expected or when the diagnosis remains uncertain, that is. 

Clinicians use imaging selectively to:

  • Confirm soft tissue changes.
  • Identify structural abnormalities.
  • Rule out alternative conditions.

Ultrasound is often the first imaging choice – due to its convenience, affordability, and ability to visualize soft tissue structures. 

Clinicians can measure plantar fascia thickness, identify hypoechoic regions, and assess the presence of perifascial fluid. 

According to a study published by the National Library of Medicine, ultrasound findings closely correlate with symptomatic presentations, making it a useful tool in confirming the diagnosis.

And radiographs can help clinicians rule out bone abnormalities. 

MRI is reserved for chronic, persistent, or complex cases that require detailed visualization of both soft tissue and bone. MRI can identify: partial tears, chronic degeneration, or bone marrow edema. 

So, these steps should be taken:

  • Ultrasound.
  • Radiographs.
  • MRI.

Even when imaging is used, efficient clinicians rely primarily on physical examination and patient interviews to drive diagnostic decisions.

Differential Diagnosis and Condition Classification

Differential diagnosis is essential for efficiently identifying plantar fasciopathy – among the many conditions that can cause heel pain. 

Because several disorders share overlapping symptoms, clinicians systematically compare findings from the interview, physical examination, and functional testing – to distinguish between them.

Neuropathic conditions, such as Baxter’s nerve entrapment, often produce burning sensations or radiating pain that is not typical of plantar fasciopathy. 

Clinicians test for nerve tension, sensory changes, and symptom patterns unrelated to mechanical load to identify these presentations.

Mechanical conditions (such as fat pad atrophy) create diffuse heel pain that worsens on hard surfaces, contrasting with the localized tenderness characteristic of plantar fasciopathy. 

Gait observation and palpation help differentiate these conditions effectively.

Inflammatory or systemic conditions may require laboratory testing when patients have issues like bilateral heel pain or prolonged morning stiffness – or symptoms that extend beyond typical mechanical patterns. Identifying these cases early on ensures appropriate referral.

Condition Classification

Clinicians often classify plantar heel pain into phases such as:

  • Acute.
  • Subacute.
  • Chronic. 

This classification helps guide treatment intensity and expectations for recovery. 

Acute symptoms may require load reduction and symptom management, while chronic symptoms typically benefit from progressive loading, movement retraining, or supportive strategies that address long-term biomechanical patterns.

Evidence-Supported Approaches

Research published by MDPI highlights this: clinicians using structured classification systems demonstrate greater efficiency and diagnostic confidence. 

By integrating classification into differential diagnosis, practitioners can streamline both evaluation and the planning of treatment.

The Bottom Line

Clinicians assess plantar heel pain efficiently by combining:

  • Thorough patient interviews.
  • Targeted palpation.
  • Functional testing.
  • Selective imaging. 

These strategies allow practitioners to differentiate plantar fasciopathy from other conditions, classify symptom stages, and guide evidence-based interventions. 

Author bio: Harry Wolf is a freelance writer. For almost a decade, he has written on topics ranging from healthcare to business leadership for multiple high-profile websites and online magazines.

References

  • Mayo Clinic Staff, Plantar fasciitis, Mayo Clinic, 2023.

https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846

  • Rodseth, Merinda, Bell, Jess, Jackson, Kim, Jaraczewska, Ewa, Ogunleye, Olajumoke, Saban, Bernice, Assessment of Plantar Heel Pain – A Literature Review, Physiopedia.

https://www.physio-pedia.com/Assessment_of_Plantar_Heel_Pain_-_A_Literature_Review

  • Unauthored, How should I assess a person with suspected plantar fasciitis?, National Institute for Health and Care Excellence, 2024.

https://cks.nice.org.uk/topics/plantar-fasciitis/diagnosis/assessment/

  • Nweke, Tonyclinton C., Comprehensive Review and Evidence-Based Treatment Framework for Optimizing Plantar Fasciitis Diagnosis and Management, National Library of Medicine, 2025.

https://pubmed.ncbi.nlm.nih.gov/40717873/

  • Drake, Chris, Whittaker, Glen A., Kaminski, Michelle R., Chen, John, Keenan, Anne-Maree, Rathleff, Michael S., Robinson, Philip, Landorf, Karl B., Medical imaging for plantar heel pain: a systematic review and meta-analysis, National Library of Medicine, 2022.

https://pubmed.ncbi.nlm.nih.gov/35065676/

  • Alnefaie, Abdulmajeed Muhaysin, Alzahrani, Hosam, Alshehri, Mansour Abdullah, Physiotherapy Management of Plantar Fasciitis: A National Cross-Sectional Survey in Saudi Arabia, MDPI, 2025.

https://www.mdpi.com/2077-0383/14/13/4584

  • Akhtar, Amir, Baxter’s Nerve Entrapment, My MSK Clinic.

https://mymskclinic.co.uk/baxters-nerve-entrapment/

 

Please also review AIHCP’s Health Care Manager Certification program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Psychological Factors Influencing Patient Adherence to Contact Lens Care Regimens

Posted on by Joseph Gerard

Nurse Patient Educators also understand the individual needs of their patients

Written by Michael Austin,

Patient compliance remains a challenge in many areas of healthcare, including eye care. Even when patients understand the advice given and the possible risks, not everyone follows the steps needed to protect their eye health, especially when using contact lenses. Poor compliance with contact lens care can increase the risk of eye infections and inflammation.

Because of this, a behavioral or mental health approach can be helpful in explaining why some patients follow care guidelines while others do not. Understanding these differences can support better strategies to improve compliance and reduce complications.

Why Is Contact Lens Nonadherence So Common?

Nonadherence to contact lens care is rarely caused by a lack of intelligence or concern. Instead, it often stems from how patients perceive risk, routine, and personal relevance.

Many patients underestimate the consequences of poor lens hygiene because complications are not always immediate. When negative outcomes are delayed, motivation weakens. Others view lens care as an inconvenience that competes with daily responsibilities, leading to shortcuts that become habits over time.

Psychological distancing also plays a role. Patients may cognitively separate contact lens care from other health behaviors, seeing it as optional rather than preventive. This mindset increases the likelihood of inconsistent practices, especially during periods of stress or fatigue.

How Do Risk Perception and Optimism Bias Affect Care Behaviors?

Risk perception influences patient adherence to health advice, particularly regarding contact lens care. Humans tend to remain optimistic and believe that unfortunate incidents occur to someone else and not to them. 

Their past experiences also work towards this end. Those individuals who reuse solution or sleep while wearing contact lenses but experience no immediate negative consequences tend to consider it safe.

Healthcare providers can help by explaining risk in a way that is easy to understand and not just through numbers.  They can show how little mistakes add up over time and raise the risk, which lets patients rethink their assumptions.

What Role Does Habit Formation Play in Adherence?

A habit is a routine so thoroughly embedded in a person’s life that it can be performed with very little conscious thought. Routines can be great facilitators of adherence or, conversely, of nonadherence.

Patients can maintain consistency if they incorporate the care of their lenses into daily routines, like the evening ritual, while those without routines might forget or deliberately omit when tired or distracted.

Research on human behavior finds that when actions are straightforward, predictable, and directly associated with an existing behavior, habits can develop more readily. Nurses and educators can assist patients in following a treatment plan by helping patients recognize what specific stimuli will trigger them to follow proper lens hygiene practices.

How Do Motivation and Personal Identity Influence Compliance?

Motivation is rarely static. It fluctuates based on lifestyle changes, emotional state, and perceived value. Some patients are highly motivated during initial lens fitting but gradually disengage as novelty fades.

Personal identity also matters. Patients who see themselves as health-conscious or detail-oriented are more likely to follow care guidelines. Conversely, those who prioritize convenience or aesthetics may be more prone to cutting corners.

This is especially relevant for patients using specialty lenses, including colored contact lenses, where motivation may be tied more to appearance than health. In such cases, reinforcing the connection between proper care and long-term eye safety is critical to sustaining adherence.

How Does Cognitive Load Interfere With Contact Lens Care?

Cognitive load represents mental effort when dealing with a large number of tasks. Patients dealing with a heavy cognitive load resulting from work, family care-giving responsibilities, and psychological problems are likely to postpone disease prevention.

Looking after contact lenses requires several procedures: cleaning the lenses, storing them properly, and changing them periodically. People who have restricted cognitive resources may perform the procedures improperly or simplify the routine with deleterious consequences on safety.

Healthcare practitioners may help by indicating appropriate simple care strategies when possible and emphasizing the need for consistency over perfection. Simple instructions reduce the mental cost of thinking and make it easier for people to comply.

What Emotional Factors Impact Adherence Over Time?

Conditions such as anxiety, depression, and burnout can influence self-care practices. Patients with mental health issues would have difficulty with routines requiring constant focus or following things that entail waiting for rewards.

Fear can also function in a double manner. While some patients will actually follow treatment instructions in fear of complications, others will avoid all information to alleviate fear. This can cause them to tune out instructions for care.

Awareness of emotional barriers can help healthcare staff adjust their communication style accordingly. A patient support approach is better than fear messaging for most people.

How Can Healthcare Professionals Improve Patient Adherence?

Improving adherence requires more than repeating instructions. It involves understanding the patient’s mindset, lifestyle, and emotional context.

Effective strategies include:

  • Using open-ended questions to assess beliefs and concerns
  • Normalizing common challenges without validating unsafe behavior
  • Reinforcing positive habits rather than focusing only on mistakes
  • Providing written and verbal guidance in plain language
  • Encouraging follow-up conversations rather than one-time education

Nurses, in particular, play a vital role due to their frequent patient contact and trusted position. Brief, consistent reinforcement during routine interactions can significantly influence long-term behavior.

Why Is a Psychological Approach Essential in Contact Lens Education?

A purely technical approach assumes that information alone drives behavior. Decades of healthcare research show this is rarely true. Psychological factors shape how information is received, interpreted, and acted upon.

When contact lens education incorporates behavioral insight, it becomes more patient-centered and effective. Addressing motivation, habits, and emotional barriers helps transform instructions into sustainable practices.

This approach aligns with broader trends in healthcare that emphasize holistic care, patient engagement, and preventive strategies rooted in behavioral science.

Final Words

Adherence of patients to care regimens of contact lenses is affected by intricate dynamics of psychological, emotional, and behavioral issues. By understanding these issues, healthcare professionals can go beyond instruction-based education toward more effective, patient-centered support.

Through recognizing the dynamics behind the formation of habits, the perception of risk, or the role of emotional state in the process of taking care of oneself, nurses and clinicians would be able to guide patients more effectively towards good habits regarding contact lenses. In the end, using psychological insights in lens care education helps both eye health and the broader goals of preventive healthcare.

 

Author’s Bio

Michael Austin is a lifestyle blogger with a strong interest in fashion, personal style, and intentional living. He enjoys planning and organizing every aspect of life—from curating a functional wardrobe and making smart purchasing decisions to managing finances and long-term goals. This blend of style, practicality, and structure comes through in the informative articles he shares on his personal website, awebtoknow.com.

 

Please also review AIHCP’s Nurse Patient Education Certification program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Living With Perimenopause: Practical Support for Changing Body and Emotions

Posted on by Joseph Gerard

Nurse, portrait or laptop with medical student books, research education studying or hospital learning university. Smile, happy or healthcare woman with technology in scholarship medicine internship.Written by Dr. Sci. Jelena Veličković,

Every year millions of women experience perimenopause as a major biological transition; however, this time is often misinterpreted or regarded with low importance by society and healthcare providers. The cyclical change in estrogen and progesterone levels experienced during this time influences almost all of the major systems in the body, such as temperature regulation, cognition, sleep, and mood changes, and some aspects of cardiovascular and lipid metabolism (Santoro, 2016). Perimenopause is even more unpredictable since body changes occur in varying levels of severity from one month to another. This is a natural biological event, but it is not necessarily an easy or insignificant one since it tends to influence daily living for many women. Taking women’s experiences seriously can make the difference between care that helps and care that dismisses what they are going through.

What is Perimenopause?

Perimenopause is the transitional phase leading up to menopause, experienced between the ages of 40 and 50. However, it can begin earlier or later for some women. During the phase, there is more variability in the levels of estrogen, progesterone, FSH, and LH. This is far more unpredictable than the pre-reproductive phases of estrogen or the phases of estrogen that occur after menopause (Talaulikar, 2022).

Menopause is diagnosed retrospectively after 12 months of amenorrhea, whereas perimenopause is a dynamic process that takes longer between four to ten years with more variability in the pattern of menstruation as well as hormone secretion patterns (Harlow et al., 2012). A Staging of Reproductive Aging Workshop (STAW +10) proposes markers for early or late perimenopause through variations of menstruation pattern length or endocrine features, allowing practitioners to classify women for stages of reproductive aging. This is all related to the physical discomfort that women may go through as their ovaries become less active with the onset of perimenopause. These endocrine changes affect thermoregulation, neurotransmitter activity, circadian rhythms, cardiovascular function, and lipid metabolism.

Physical Symptoms of Perimenopause

Even though every woman’s experience is different, some of the physical symptoms occur at such a high rate that they are clearly documented by research studies. This is what causes the differences in the transition of the perimenopausal woman.

1. Vasomotor Symptoms (Hot Flashes and Night Sweats)

They are frequently listed as the most common symptoms of perimenopause. Women can have them in various ways like getting sudden hot sensations, turning red in the face, experiencing heart palpitations, or having a feeling of warmth radiating over the body. Night sweats could also interfere with the woman’s sleep. This could then result in other issues such as fatigue, irritation, or mood swings, which would then impair one’s work performance since one could feel self-conscious in their work or social setting (Thurston, 2018).

2. Irregular Menstrual Cycles

Changes in the menstrual cycle can be an early sign of perimenopause. Some women experience shorter cycles, more menses, or periods of amenorrhea, whereas some women experience longer cycles or spotting. In later stages, breaks between periods grow, often 60 days or more without a bleed. That shift points to shifting estrogen levels from the ovaries, tied closely to what’s called STRAW+10 (Harlow et al., 2012).

3. Interruption of Restorative Sleep

Most women experience disruption to their natural sleeping patterns; during perimenopause, sleep disruptions occur between 50-60% of the time. It has been found that these sleep disturbances may exacerbate anxiety and contribute to increased levels of mood fluctuation. Contributing factors to these sleep disturbances include: hot flashes, night sweats, body rhythm changes, anxiety, and disturbed sleeping patterns (Kravitz & Joffe, 2021). The poor sleep quality associated with these factors increases irritability, difficulty with cognitive function, and stress reaction, and can create additional challenges for women who were already vulnerable to poor quality sleeping patterns before menopause occurred.

4. Musculoskeletal Pain

Muscle and joint issues, like tightness, soreness, or general aches, are often linked to perimenopause today. Studies found about 7 out of 10 women go through this (Lu et al., 2020). Newer findings point to what’s called a “menopause-related musculoskeletal pattern,” involving weaker muscles, thinner bones, plus greater chances of developing joint wear (Wright et al., 2024).

5. Urogenital and Sexual Changes

A drop in the levels of estrogen causes related signs and symptoms that affect the tissues of the vagina, vulva, bladder, or urethra. Some of the signs include dryness, irritation, painful sexual intercourse, or more frequent urination. These signs are related to low levels of estrogen in the area; collectively, they are referred to as the genitourinary syndrome of menopause (GSM). These signs affect sexual health, self-confidence, and daily functioning (The North American Menopause Society, 2020). Some of the signs may also be linked with other gynecologic conditions, such as uterine fibroids, painful or irregular bleeding or pressure in the pelvis.

These somatic complaints indicate real physiological phenomena, as opposed to psychological attribution, which further verifies the need for experience verification of women in such a transition.

Cognitive and Emotional Changes During Perimenopause

The hormonal changes in perimenopause affect memory, mood, and stress responses. These cognitive and emotional changes often come out of the blue and may fluctuate from month to month.

1. Cognitive Fog and Attention Difficulties

Women frequently face “brain fog” symptoms during the peri-menopause phase. These issues can include poor focus or inability to concentrate, difficulty organizing their ideas, and a feeling of having too many simultaneous thoughts; problems with effective communication, notable barrier to completing multiple tasks simultaneously, and inability to easily find or recall appropriate words when talking about something to a third party. Current research indicates that women’s cognitive difficulties during this stage of their lives are due to small disruptions in both attention and short-term memory rather than an actual cognitive disability of the brain (Greendale et al., 2009). Consequently, when women’s cognitive difficulties interfere with appropriate functioning in their daily activities or with the demands of their job, women may develop feelings of anxiety and doubt about their cognitive abilities.

2. Mood Swings

Estradiol influences neurotransmitters such as serotonin, dopamine, and norepinephrine which play a part in how we feel emotionally about ourselves. When estrogen levels fluctuate, mood may fluctuate, which can lead to increased feelings of agitation, depression and anxiousness or intensity of response to external pressure. Also, some women that had previously been able to cope with their emotions may experience rapid changes in their mood that do not coincide with their current situation (Han et al., 2023).

3. Anxiety and Emotional Reactivity

Alteration in the HPA (hypothalamic-pituitary-adrenal) axis may cause worsening of anxiety symptoms by increasing the recognition of agitation, anxiety and emotional reactivity. For example, an increase in these feelings may develop in women that had previously never experienced the feelings of anxiety prior to going through the menopause transition. The likelihood of developing these vulnerabilities can also be exacerbated by both poor sleep quality and the added stress of day-to-day living (Han et al., 2023).

4. Increased Vulnerability to Stress

Life’s hectic years sometimes line up with perimenopause. Many women balance jobs, kids’ needs, helping older relatives, or dealing with personal health stuff. Hormone shifts during this phase can amplify tension – making it tougher to cope, no matter how steady daily pressures stay. Knowing these reactions come from physical changes helps ease guilt. It opens space for gentler, kinder choices when tending to your well-being.

These mood and cognitive shifts are real and biologically based. They demonstrate the importance of support in all contexts – at home, at work, and in healthcare facilities.

How Perimenopause Affects Daily Life and Relationships

Women can face mood swings and exhaustion during perimenopause despite being responsible for work, family, and other obligations. With fluctuating symptoms, simple activities become hard to cope with. While a woman may have phases where she feels competent to deal with her responsibilities, she may experience phases of feeling emotionally or physically overwhelmed, which can influence her self-confidence. Poor sleep and sudden hot flashes can worsen her level of concentration and patience. A study among middle-aged women portrays a picture where women dealing with severe vasomotor symptoms or anxiety often experience greater difficulty with daily activities and social interactions as well as social encounters. At work, some women may become distant or less engaged in activities because she remains uncertain if others will see her as inconsistent in her roles. With her relationships, a woman with perimenopause symptoms can be perceived as impatient or distant emotionally rather than being exhausted because of hormones, which can become a common issue if misunderstood. Research suggests doctors and nurses can help with such relationships by making emotions sound more common, describing symptoms, or admitting reactions to stressful situations. Speaking freely without shame and developing methods to cope with stressful situations can make a huge impact in making coping with symptoms a less complicated situation without disturbing emotions and everyday life skills (Avis et al., 2009).

Barriers to Seeking Support

Even though many of women go through perimenopause signs, plenty wait before getting help. They often link those changes to pressure, getting older, or feeling like they’re not doing enough, instead of seeing them as part of shifting hormones, which means care might come late. Shame about growing older, fear doctors won’t take them seriously, and habits that tell women to tough it out can make things harder to talk about. If someone’s working full-time or looking after others, admitting struggle might feel risky, as if it shows they can’t handle their duties. These hurdles might leave women feeling alone during perimenopause, despite how widespread and medically acknowledged the signs are. More awareness, open conversations, and supportive healthcare can make women feel safe to seek help sooner.

How to Provide Support to Women During Perimenopause

Supporting someone through perimenopause means listening carefully, remaining patient, and exploring how physical changes may correlate with changes in emotional state, relationships or stress levels. Many women who are experiencing this phase of life may also be working and taking care of others or attempting to live up to their own expectations; the combination of these factors increases the likelihood of experiencing greater symptoms. The support provided can be of tremendous value when life becomes overwhelming.

1. Listen Without Minimizing

Women often say they’re brushed off when talking about perimenopause. Comments like “we all go through this” or “that’s just getting older” might downplay real struggles. But paying close attention, repeating what you hear, and treating their feelings as valid builds trust. When people feel heard, it lessens guilt and makes them more likely to share openly.

2. Encourage Symptom Tracking

Tracking symptoms can give a greater sense of control and clarity. Using a symptom diary or a mobile app enables the user to identify potential triggers for these symptoms and track any cyclical patterns associated with them and, consequently, help the user effectively communicate with their doctor about their concerns. The act of tracking symptoms also assists women in becoming more aware of their own bodies and help them collaboratively make decisions together with their healthcare providers.

3. Support Sleep Hygiene

Sleep disruption is one of the most challenging aspects of perimenopause, affecting emotional stability, concentration, and overall functioning. Supportive measures that can improve sleep quality include:

  • maintaining a consistent bedtime and wake time
  • practicing relaxation strategies before bed
  • minimizing caffeine and alcohol in the evening
  • reducing screen exposure before sleep
  • keeping the bedroom cool to offset night sweats
  • choosing breathable fabrics or menopause friendly bedding

Sticking to a regular schedule, cutting back on things that keep you up, or tweaking your bedroom setup often helps. Once rest gets better, lots of women notice sharper focus, feeling more even-keeled, and handling everyday challenges with less struggle.

4. Foster Healthy Lifestyle Habits

Lifestyle changes can ease symptoms and enhance overall well-being. Staying active helps control body temperature, lifts mood, also keeps muscles and joints strong. Practices like yoga or tai chi, along with meditation and slow breathing,  can reduce stress and support better emotional balance. Eating whole foods, drinking enough water, eating at steady times can also help balance energy levels and reduce physical discomfort. Even though daily habits won’t eliminate symptoms completely, studies show that they can bring noticeable improvements for many women (Innes et al., 2010; Nguyen et al., 2020; Khan et al., 2023).

5. Promote Shared Understanding in Relationships

Spouses, kids, or relatives might see mood shifts or low stamina as personal issues instead of signs tied to hormonal changes. Getting loved ones informed about perimenopause can reduce blame, improve communication, and create a more supportive home. Once they understand the hormonal cause they are more like to respond with patience and empathy instead of frustration.

6. Encourage Medical Evaluation When Needed

Even though perimenopause is a natural life stage, certain symptoms require medical evaluation:

  • heavy or prolonged bleeding
  • significant mood changes
  • persistent pain
  • functional impairment

To find out what else might be wrong, a medical professional may perform blood tests, such as checking thyroid, estradiol, FSH, LH, or metabolism.

When to Refer for Clinical Care or Specialized Support

Healthcare professionals should encourage referral when:

  • Symptoms seriously interfere with day-to-day functioning
  • Bleeding patterns point to endometrial pathology
  • Mood symptoms point to depression or anxiety
  • Cognitive changes are severe or progressive
  • Vasomotor symptoms disrupt sleep and quality of life

Evidence-based interventions include menopausal hormone therapy, cognitive-behavioral therapies for menopausal symptoms, non-hormonal medications, lifestyle strategies, and integrative health approaches (The North American Menopause Society, 2023).

Improving Quality of Life for Women Living with Perimenopause

Since hormone fluctuations vary from person to person perimenopause hits each woman differently. Daily routines, stress, and environment also influence how symptoms show up. Understanding what’s happening in the body helps, but noticing changes in focus, mood, or energy is just as important. Support from loved ones works best when it comes from listening rather than assumptions.

This phase is about more than hormones alone. It affects the body, emotions, and mental well-being, shaping daily life and relationships. When guidance is based on reliable information instead of myths, women can manage symptoms more confidently. Feeling heard, respected, and gently supported plays a key role in maintaining quality of life.

Author Bio

Dr. Sci. Jelena Veličković is a molecular biologist and geneticist specializing in medical and forensic genetics. With over ten years of experience in clinical diagnostics and academic research, she has authored peer-reviewed studies in prenatal genetics, thrombophilia, oncogenetics, and molecular biology. Her work spans international research centers and clinical laboratories, where she has advanced molecular diagnostic methods including PCR microbiology, liquid biopsy, and NGS analysis. She is committed to applying evidence-based genetic insights to enhance diagnostic accuracy and support clinical decision-making.

 

References:

Avis, N. E., Colvin, A., Bromberger, J. T., Hess, R., Matthews, K. A., Ory, M., & Schocken, M. (2009).
Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: The Study of Women’s Health Across the Nation. Menopause, 16(5), 860–869.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2743857/

Greendale, G. A., Huang, M. H., Wight, R. G., Seeman, T., Luetters, C., Avis, N. E., & Karlamangla, A. S. (2009).
Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 75(21), 1888–1896.

https://pubmed.ncbi.nlm.nih.gov/19470968/

Han, Y., Zhang, Y., Li, X., & Wang, L. (2023).
Neuroendocrine pathogenesis of perimenopausal depression. Frontiers in Psychiatry, 14, 1162501.

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1162501/full

Harlow, S. D., Gass, M., Hall, J. E., Lobo, R. A., Maki, P., Rebar, R. W., … & the STRAW+10 Collaborative Group. (2012).
Executive summary of the Stages of Reproductive Aging Workshop +10: Addressing the unfinished agenda of staging reproductive aging. Menopause, 19(4), 387–395.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3340903/

Innes, K. E., Selfe, T. K., & Vishnu, A. (2010).
Mind–body therapies for menopausal symptoms: A systematic review. Maturitas, 66(2), 135–149.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3031101/

Khan, S. J., Kapoor, E., Faubion, S. S., & Kling, J. M. (2023).
Vasomotor symptoms during menopause: A practical guide on current treatments and future perspectives. International Journal of Women’s Health, 15, 273–287.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9938702/

Kravitz, H. M., & Joffe, H. (2011).
Sleep during the perimenopause: A SWAN story. Obstetrics and Gynecology Clinics of North America, 38(3), 567–578.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3185248/

Lu, C., Liu, P., Zhou, Y., Meng, F., Qiao, T., Yang, X., Li, X., Xue, Q., Xu, H., Liu, Y., Han, Y., & Zhang, Y. (2020).
Musculoskeletal pain during the menopausal transition: A systematic review and meta-analysis. Neural Plasticity, 2020, Article 8842110.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7710408/

Nguyen, T. M., Do, T. T. T., Tran, T. N., & Kim, J. H. (2020).
Exercise and quality of life in women with menopausal symptoms: A systematic review and meta-analysis of randomized controlled trials. International Journal of Environmental Research and Public Health, 17(19), 7049.

https://www.mdpi.com/1660-4601/17/19/7049

Santoro, N. (2016).
Perimenopause: From research to practice. Journal of Women’s Health, 25(4), 332–339.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4834516/

Talaulikar, V. S. (2022).
Menopause transition: Physiology and symptoms. Best Practice & Research Clinical Obstetrics & Gynaecology, 81, 22–36.

https://pubmed.ncbi.nlm.nih.gov/35382992/

The North American Menopause Society. (2020).
The 2020 genitourinary syndrome of menopause position statement. Menopause, 27(9), 976–992.

https://pubmed.ncbi.nlm.nih.gov/32852449/

The North American Menopause Society. (2023).
The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573–590.

https://pubmed.ncbi.nlm.nih.gov/32852449/

Thurston, R. C., & Joffe, H. (2018).
Vasomotor symptoms and menopause: Findings from the Study of Women’s Health Across the Nation. Obstetrics and Gynecology Clinics of North America, 45(4), 535–552.

https://pubmed.ncbi.nlm.nih.gov/29390899/

Williams, R. E., Kalilani, L., DiBenedetti, D. B., Zhou, X., & Fehnel, S. E. (2009).
Health-related quality of life and menopausal transition: Observations from the WOMAN study. Maturitas, 62(2), 153–159.

https://pubmed.ncbi.nlm.nih.gov/19157732/

Additional References

Cleveland Clinic. Perimenopause Overview. Access here

Healthline. Perimenopause: Feeling Like “I’m Dying”? Access here

Ohio State University Wexner Medical Center. Why Perimenopause Affects Your Mood. Access here

American Society for Reproductive Medicine. Menopausal Transition: What Is It? Access here

 

 

Please also review AIHCP’s Health Care Manager Certification program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

From Occupational Hazards to Smart Strategies: Weight Loss for Healthcare Professionals

Posted on by Joseph Gerard

Weight Loss and Herbs can work if used properly and under guidance. Please also review AIHCPs' Holistic Integrative Specialist Program

Written by Lucy Wyndham,

Many may assume that healthcare professionals lead healthier lives than most, though this isn’t typically the truth. Over half of registered nurses were noted to be “overweight or obese,” at 34.1% and 23.4% respectively, according to survey results highlighted in a 2018 article published by the Journal of Nursing Management titled ‘Nurses and Health-Promoting Self-Care: Do We Practice What We Preach?’ The article further points out that a significant number of RNs were reportedly sedentary at 80.1%, further underlining the fact that working in a healthcare profession doesn’t necessarily align with leading a healthy lifestyle. For healthcare professionals that aim to lose weight, there are a variety of healthy choices and changes that can make a long-term difference. From the unique ways that the job can affect physical wellness to the beneficial strategies that can help, healthcare professionals can make small yet mighty changes that lead to a healthier weight.

 

The overlooked impact of working in healthcare

In the United States, careers in the healthcare industry can leave many under the impression that employees abide by the standards that they hold their patients to. However, a 2017 article from Safety + Health Magazine showcases the findings of a study from the University of Texas School of Public Health, which, while it excluded physicians, unveiled that a significant number of those that work in hospitals are “overweight or obese.” Findings also include the fact that many workers were sedentary, with 65% reporting experiencing “zero days of vigorous physical activity.” A 2012 ABC News article presents even more evidence of the concern, highlighting research from the University of Maryland School of Nursing where similar findings were discovered by researchers. The study in question, which surveyed female nurses, found that 55% happened to be obese, underlining the fact that the matter has been a longstanding concern. The article further states that the findings stem from causes such as improper sleep and stress due to the job and its nature, which can undoubtedly take their toll over time.

 

Unique occupational hazards can further lead healthcare professionals to overlook their own health:

  • Long work hours or irregularity in the work schedule. This can throw off a healthy sleep schedule, especially for those who work a shift work schedule. This can subsequently lead to a disruption in a healthcare worker’s circadian rhythm.
  • Unhealthy dietary choices, which may be made out of convenience while on the job.
  • A lack of dedicated exercise routine. For some, this may be a result of long hours at work, which can lead to an unhealthy work-life balance.

Additional context can be found in the lifestyles that many in the healthcare industry lead. An article from the American Nurse Journal notes that several aspects of nurses’ lifestyles are often “far from ideal,” particularly in key areas like diet, physical activity, and sleep habits. All of these elements are crucial to a healthy and effective weight loss plan. Diet and exercise, for instance, have long been touted as major factors to successful weight loss. An article from the American Heart Association confirms this, stating that of those who have “successfully maintained weight loss,” 98% had changed the way they eat. It’s further noted that 94% introduced more physical activity, a statistic that only backs up the importance of a lifestyle that is healthier overall.

 

Starting small through daily changes

Rather than focusing on a major end goal that will take time to reach, setting smaller, more realistic goals can help kick off a weight loss journey in a way that feels more achievable. One of the best ways for healthcare workers to work towards a weight loss goal is through the seamless integration of small lifestyle changes in order to work towards weight loss goals in a healthy way. Positive and balanced dietary changes can be the perfect way to start working towards realistic wellness goals as a healthcare professional, and can help avoid unsafe and dangerous weight loss techniques like starvation diets. While there are a plethora of healthy choices out there, healthcare professionals may opt to first switch out old unhealthy habits for those that promote healthier dietary choices throughout the day, like:

  • Exchanging greasy fast food options for balanced meal prep choices. While fast food can make for a quick lunch between shifts at the hospital, setting aside a day off to meal prep can pay off in the long run with a nutritious and convenient lunch that is ready to eat. This can be particularly beneficial for those that have a busy or demanding schedule throughout the week with minimal downtime.
  • Packing yogurt, fresh fruits, or vegetables for a snack while on the job, instead of heading to the vending machine for a candy bar or bag of chips. In an AIHCP article discussing common weight loss difficulties, Dominick Flarey writes that when dressed up with “natural spices and condiments” boring choices can become more appealing. Apart from salt, this may include a bit of garlic powder or red pepper flakes, for a kick of flavor, while peanut butter or yogurt dip can dress up fruit to match personal preferences.
  • If your morning coffee contains an ungodly amount of sugar and artificially flavored syrups, exploring healthier options can be a small way to make a change before the workday officially begins. Honey is just one choice for those in search of a natural sweetener.

Eating well-balanced meals and choosing healthier snacks are great ways to work towards a weight loss goal, though it’s crucial to remember that diet is only part of the foundation for successful weight loss. Along with a solid sleep routine, the integration of exercise can help achieve and maintain an optimal weight even after shedding the desired pounds. For many in healthcare, the thought of hitting the gym at the end of a long shift at the hospital can sound impossible, though it’s not a necessity. In fact, there are a plethora of ways that healthcare workers can make small yet impactful changes to their daily routines without a dedicated gym routine. For example:

  • Walking the dog before work can be a great way to start the day with a light activity.
  • Opting for the stairs at the workplace, rather than relying on the elevator each time.
  • Choosing to bike or walk to work, if possible.
  • Making a goal to get active after a shift at the hospital. Even if it’s not every day, the choice to go for a walk or run after work can be an ideal way to burn off steam and stay active.

 

Mental health and motivation remain essential 

Professionals who often find themselves overextended at work can easily fall victim to excessive stress, depression, and other mental health concerns, all of which can result in the neglect of any personal physical health goals. Burnout is just one significant issue in the healthcare field, which can affect both the body and the mind. A 2023 article from the American Nurses Association or ANA cites a nationwide study, which revealed that 55%, or over half of those who work in health care “feel burned out.” Due to the fact that mental health correlates with physical wellness, it’s crucial to care for both the body and the mind. However, this can often feel unattainable when the goal is to achieve the perfect work-life balance, nevermind one that caters to weight loss.

Exercise and a healthier diet can often be considered self-care and while these small lifestyle changes can work more seamlessly into a busy work schedule, maintaining mental wellbeing must extend beyond the workday. In addition to making time for dedicated self-care tasks like relaxation and hobbies, discovering motivation for weight loss goals can often coincide with actions that can benefit mental health. This may include taking the time to reflect and acknowledge progress and milestones, or switching up workouts to try something new or more exciting. In some cases, discussing options with a healthcare provider can help explore paths like weight loss injections. Depending on personal needs and goals, this could present a newfound avenue in certain circumstances, such as for those who have faced challenges with weight loss even after making lifestyle adjustments.

 Seeking social support is a fantastic way to help spark motivation on a weight loss journey while prioritizing mental health, whether it be with friends, coworkers, or family members. This can be an ideal way to stay active, especially for those who may have trouble sticking to a workout routine or meeting personal goals. An article from the Mayo Clinic on weight loss points out that while one can technically lose weight without exercise, it is more of a challenge. “Regular physical activity helps burn off extra calories,” the article states, going on to note that exercise itself can be a mood lifter. When getting active with others, healthcare professionals can find additional benefits — such as being held accountable to show up for friends or loved ones. Biking to work together, weekend hikes, or evening walks are all great ways to stay active, and can often become more enjoyable with company.

Despite the nature of the industry, healthcare professionals face a variety of challenges that often prevent optimal health and wellness. For those that wish to lose weight in a healthy and effective way, prioritizing diet, exercise, and sleep in conjunction with smart strategies can help achieve goals in a way that aligns with a busy work schedule.

 

Author bio

Lucy Wyndham is a freelance writer who enjoys contributing to a range of publications, both in print and online. She spent almost a decade working in the care sector with vulnerable people before taking a step back to start a family and now focuses on her first love of writing.

 

 

Please also review AIHCP’s Health Care Manager Certification program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Why Patients Ghost Medical Bills and What Actually Fixes It

Posted on by Joseph Gerard

Health care management professional working on a tablet

Written by Mark San Juan

You may have already forgotten about your appointment, and then, weeks later, the medical bill shows up.

You glance at the total and tell yourself you’ll deal with it later because your day is stressful enough as it is. ‘Later’ turns into next week, then next month, and, at some point, there’s nothing but silence on your end.

And that’s how people ghost their medical bills. 

It’s not like someone deliberately chose to ignore their responsibility, but life is stressful, and they hope the bill will just take care of itself… Somehow. 

Medical debt isn’t like other bills because it’s tied to vulnerability and health. There are numbers that don’t make total sense, and the fine print from the insurance you need to deal with, so all in all, it’s a lot. And remember that you still have your everyday expenses to take care of, so avoiding medical expenses seems almost automatic. 

It’s not even just about the money. It’s about trust and about the fear of being trapped in a conversation you can’t control. 

This type of behavior follows predictable patterns, and once you know about it, you can see what brings patients back instead of pushing them away. 

Why Patients Delay or Avoid Medical Bills

Stressing over money changes how your brain works.

  • Financial strain can negatively affect cognitive bandwidth, which results in people being less likely to take on financial tasks. – Princeton University
  • High stress was shown to impair decision-making, and it makes people less likely to do tasks that feel threatening/complex. – National Institute of Mental Health (NIH)

When a medical bill feels too big or too unclear, the natural response is usually to avoid it.

That’s not being lazy, it’s simply a reaction to stress. 

When the nervous system feels overloaded, it looks for the fastest way to reduce pressure, and the quickest relief comes from not engaging with what’s stressing you out. Opening the bill is stressful, as is logging into the portal or calling the office. Best to just deal with it ‘some other time’.

As previously mentioned, medical debt doesn’t feel the same as a utility bill, so that’s another thing to think about.

The most common type of debt in collections in the U.S. is medical bills. – Consumer Financial Protection Bureau

A phone plan is tied to service, but a medical bill? That’s about health and fear. 

It comes from a moment where you already had little to no control, and even patients who can afford to pay the bill right away feel unsettled when they’re looking at a charge connected to their body and diagnosis. 

Embarrassment is another factor. 

A lot of people don’t want to admit that they’re confused by the bill or unable to pay it immediately, which is perfectly understandable. The figure, if they ask for help, they have failed, regardless of how common their situation is. So they don’t reach out because it feels safer to stay away from the whole thing. 

Then there’s decision overload, which is something everyone can relate to. 

Large numbers here, unclear insurance coverage there, and a bunch of unfamiliar terms are a lot to take in. If it feels complicated to move forward, doing nothing is the default choice.

In the short term, you calm your anxiety when you ignore the bill. In the long term, though, avoiding it means that the stress is always somewhere in the background. 

Where Billing Communication Breaks Down

Usually, billing communication goes on the fritz long before a bill is overdue. 

Most patients don’t ignore their balance because they’re trying to avoid responsibility, but because they don’t quite realize what’s happening.

In the U.S., the most common reason for delayed/avoided payments of medical bills is that patients frequently misunderstand them and/or the insurance terminology. – Yale School of Medicine

Medical codes and insurance terms are insanely confusing (some would go as far as to say this is done on purpose), and anyone outside these systems has a hard time understanding even the basics, let alone something more complicated. When you’re faced with terms that don’t clearly explain what you’re being charged for, it’s only normal to feel reluctant to pay. 

Timing makes matters worse.

Sometimes, it could be months between the treatment and the first bill, so by the time the bill arrives, the patient hardly remembers the details of their appointment. There’s no real connection between the care they received and the cost of it, so it all feels sudden and awkward when the bill gets to their address.

Medical bills that come delayed or are unexpected increase mistrust, lowering the likelihood of a timely payment from the patient. – Institute for Healthcare Policy & Innovation, University of Michigan

This makes patients suspicious and hesitant.

And on top of all that, it’s not uncommon for the patients to receive mixed messages. 

The insurer says one thing, the clinic’s billing office says something else. One document clearly states that part of the cost is covered, the other suggests it’s not. 

How can you not be doubtful with this kind of inconsistency? People start to question if the amount is correct, and once that doubt creeps in, a lot of them choose to wait rather than act. And it makes sense. 

Some clinics use structured digital billing systems to keep communicating with the patient instead of doing that through statements, portals, reminders, and tools like medical billing merchant account solutions, which are systems designed to stabilize the entire payment flow, which helps reduce delays caused by unclear/delayed charges and/or slow confirmation steps.

But even with helpful systems in place, communication still depends on whether patients get clear answers when they ask questions. 

Issues Within the System That Increase Avoidance

Some patients pull away out of fear or confusion, but others do it because the system makes them. Even if you fully intend to pay the bill, the billing process can be long and frustrating. 

Here’s how the system makes this harder on the patients. 

Insurance Not Covering as Much as Expected

Insurance is supposed to cover most of the cost, or at least that’s what people think. 

Then the bill arrives and says otherwise. Deductibles, co-insurance, and services that aren’t fully covered leave patients owing way more than they expected. And it’s not just the amount that makes this hard, but the surprise, as well. 

Imagine a person thinking they did everything right, and they still get hit with a huge balance. It feels unfair, even if the charge is technically correct. 

Multiple Providers and Separated Billing

One visit doesn’t always mean one bill, which adds to the confusion even more.

In the U.S., a major source of patient confusion and billing disputes is fragmented billing. – Centers for Medicare & Medicaid Services

Let’s say you went for a routine appointment. 

That one appointment can mean one charge from the clinic, one from the lab, one from imaging, and one from the specialist. The bills all arrive at different times and look nothing alike, and sometimes they even have unfamiliar names. 

So instead of dealing with one situation that’s relatively clear, you’re left with several bills all looking and sounding off. You can hardly keep track of what you paid and what’s still open. 

It’s all so scattered that it’s easier to avoid the whole thing altogether. 

Income Timing and Competing Expenses

Since people (usually) earn a fixed amount each month, they usually tend to know how much money they have to work with in terms of spending/saving. When it comes to spending, it’s all about priorities (e.g., utility bills, food, rent, childcare, etc.). On this list of priorities, medical bills don’t rank as high.

Sure, people will want to pay them, but if they don’t have enough money that month, it’ll have to wait.  Besides, they may show up late, like after the rent has already been paid, and money is tight. 

When that happens, people push the bill aside, and they think they’ll handle it ‘later’, which means that there’s no clear timeline or plan.

What happens is that the bill just sits there. Unpaid. Waiting. Stressing everyone out. 

Technical Barriers to Online Billing

Lots of online tasks (billing included) tend to get abandoned due to issues with login, layouts, and/or portal errors. – Pew Research

You expect to manage your bills online, but that’s not always simple.

Problems with logging in, confusing layouts, missing information, error messages popping all over the place… 

If you’re already stressed with the bill itself, this seems like a dead end. Instead of calling for help, you click out and, you guessed it, decide to deal with it ‘later’. 

How to Help Patients Deal with Unpaid Bills

The biggest difference can be made before the bill is even sent. 

If a patient has a clear idea of what they’ll have to pay upfront, they’re a lot less likely to shut down later. The number doesn’t necessarily have to be small; it just shouldn’t take patients by surprise, and they’ll already react to it better. When they know what to expect, they have a sense of control over the situation, which is a huge deal. 

Also, talking about costs early changes how people react when they receive the bill. 

Money should (in an ideal world) be treated as a normal part of the conversation, not something awkward that everyone tries to avoid. That way, it loses a big chunk of its emotional charge and causes patients not to panic as much.

Another thing that helps a lot is a predictable payment schedule.

A clear plan turns an intimidating amount into something that’s doable, and that alone can lower resistance and make patients more willing to stay in contact. 

Of course, you can’t forget about the importance of the way the staff communicates with the patients. A calm, respectful tone is always a must because, apart from other things, it makes everyone want to cooperate. 

A rush, dismissive tone does the opposite. Patients should never feel judged or pressured, and when they do, they start ignoring their responsibilities. Make them feel understood, and they’ll respond properly. 

Then there’s the follow-up. 

How you frame it makes all the difference, so what you want to do is send messages that sound supportive, not something that feels like a demand. A reminder that offers help or answers questions can do a lot.

Conclusion

It’s rare that a person ghosts their medical bill because they’re careless and irresponsible like that.

But the stress over it is very loud, and when you add confusion to that, it becomes exhausting, so silence is the easiest exit. For a while, at least. 

What usually changes this story is how you approach it. Endless reminders and notices won’t do anyone any good because all they do is stress people out more. Clarity is what cuts through all the fog and anxiety, so focus on that. 

Treat every patient like a real person instead of an account number. Give them clear information from the get-go.

Author’s Bio

Mark San Juan is a distinguished author and health care professional with a passion for transforming health care delivery through innovative approaches. With over two decades of experience in the field, Mark has established himself as a leading voice in health care reform and patient-centered care.

 

Please also review AIHCP’s Health Care Management Certification program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification