Author: Joseph Gerard

The Creative Grief Cycle: Stage 1 – Creation

Posted on by Joseph Gerard

Where Grief First Finds Language

Written by Daniel Stern

A Conceptual Model Emerging from Lived Experience

The Creative Grief Cycle is a conceptual framework that emerged from my own experience of grief and the process of writing through it. In the time following loss, I found that writing did not begin as expression or communication, but as something more immediate—an attempt to give form to experience before it could be fully understood. What I describe here reflects that process. It is not a formal clinical model, but an effort to articulate a pattern that became visible through lived experience, considered alongside existing research in expressive writing, narrative psychology, and grief theory.

In a previous article, I introduced what I call The Creative Grief Cycle—a way of understanding how grief moves through creative expression. In that earlier piece, I described how grief often begins in silence; this stage begins at the point where that silence first breaks into language. This article focuses on that transition: the moment when experience first enters language.

The cycle has three stages:

  • Creation — where grief first takes form in language
  • Communication — where that expression connects with others
  • Rediscovery — where the work can be revisited over time, allowing meaning to evolve

Here, I want to focus on the first stage: Creation.

Research in expressive writing and grief has shown that writing about emotional experience can improve psychological and physical well-being (Pennebaker & Chung, 2011). This aligns with work in expressive and therapeutic writing (Mazza, 2017; Stepakoff, 2009), and with research emphasizing the role of narrative in helping individuals organize and make sense of loss (Neimeyer, 2001; McAdams, 2001). What receives less explicit attention, though, is an earlier phase—the point before writing becomes expressive or communicative, when pre-verbal emotional experience first begins to take form in words. While elements of this transition appear across existing research, they are not typically isolated as a distinct phase in grief writing itself.

 

Writing Begins as Pressure

In my experience, grief did not begin in words. It began as something closer to pressure—diffuse, persistent, and not yet nameable.

This pressure did not feel like a thought or even a clearly defined emotion. It was more constant than that—something ambient, but insistent. It did not organize itself into sentences or ideas. It accumulated.

At times, it felt physical: a weight in the chest, a tightening, a sense of something pressing inward or outward without direction. At other times, it was harder to locate—an internal density, a sense of saturation, as though experience had nowhere to go.

Research in trauma and affective processing suggests that overwhelming emotional experience is often encoded in sensory, bodily, and affective forms before it becomes available to language (van der Kolk, 2014). Putting feelings into words can also change how those experiences are processed (Lieberman et al., 2007). In this sense, what I describe as pressure may reflect a stage where experience is present but not yet organized in language.

What defines this state is not just intensity, but a lack of structure. Something is there—persistently—but it cannot yet be articulated or fully understood.

It is this pressure, rather than intention, that seems to initiate writing.

Writing does not begin here as expression. It begins as a response. Something pushes toward language—not clearly or steadily, but in fragments that appear, recede, and return.

Words surface incompletely: a phrase, an image, a line that will not leave. There is often hesitation, even resistance. The act begins not because there is something clear to say, but because something can no longer remain entirely internal.

In practice, this early movement often appears in small, recurring fragments before anything fully forms. For example:

From “A Picture on the Wall”

A small square of pigment
leaned out of its silence
and took me by the collar.

Or:

From “Between Two Gravities”

Between what demands I shine
and the gravity that pulls me inward…

These lines do not yet explain, resolve, or interpret the experience—they simply hold it in place. What they do is more immediate: they allow something to remain present long enough to be encountered.

At this stage, what appears on the page is not meaning in the usual sense. It is better understood as what I call proto-meaning— the earliest linguistic shape of an experience before it has become explanation, insight, or story.

Experience begins to take shape in language, but it is not yet narrative, explanation, or reflection. What emerges instead are fragments—images, lines, repetitions—that allow experience to exist outside the self for the first time.

This shift is subtle but significant. What was previously diffuse and internal begins, however slightly, to cohere.

Seen this way, fragmented or image-based writing is not a failure of clarity, but the beginning of it.

At this point, writing is not oriented toward communication or interpretation. Its function is more basic. It brings experience into form—giving it just enough structure to be encountered rather than only endured.

This is the first movement of Creation: not clarity, but necessity.

 

When Language Creates Distance

Once experience begins to take form in words, something shifts.

Language introduces structure. Even a single line creates a boundary—this word instead of another, this image held long enough to be seen. What was previously diffuse begins, however slightly, to take shape.

This does not immediately produce understanding. The experience may still feel unclear. But something important changes: distance becomes possible.

Not detachment—but perspective.

The experience is no longer entirely internal. Some part of it now exists outside the self, where it can be returned to. The writer is no longer completely inside the feeling. Something has been set down, even if only partially.

Research on expressive writing shows that, over time, people begin to organize emotional experience into more structured language—connections, causality, and meaning (Pennebaker & Chung, 2011; McAdams, 2001). Before that happens, a more basic shift occurs: experience becomes something that can be held and revisited (Neimeyer, 2001).

Writing begins to do more than respond—it begins to shape.

That shaping is not linear. It circles. It revisits. It approaches the same experience from different angles. But even in fragments, something changes: what was uncontained is now being held, line by line.

 

Why Grief Turns to Metaphor

Even as writing begins to create structure, it rarely does so through direct explanation.

Grief often resists that kind of language. Statements like “I feel empty” or “I am overwhelmed” may be accurate, but they flatten the experience. They fail to capture its movement, its contradictions, and the way it shifts over time.

So the writing moves toward image.

This is not simply stylistic. In early grief writing, metaphor may become necessary because direct language can feel too limited.

In early drafts, grief often appears not as a statement, but as a force. The fragment returns, unchanged:

From “Between Two Gravities”

Between what demands I shine
and the gravity that pulls me inward…

Here, the experience is not named directly. It is approached through something else—gravity, pressure, distance. Not because these are more precise, but because they make the experience possible to hold.

This aligns with work in poetry therapy, which suggests that metaphor provides an accessible structure for experiences that resist direct articulation (Mazza, 2017; Stepakoff, 2009). Cognitive linguistics similarly proposes that metaphor acts as a bridge between emotional and conceptual experience (Lakoff & Johnson, 1980).

In early grief writing, metaphor functions less as ornament and more as a tool.

By mapping internal experience onto something more concrete, metaphor creates a structure capable of holding what would otherwise remain diffuse. It gives shape without requiring full understanding. It allows movement—an image can shift, return, and evolve in ways a direct statement cannot.

Through metaphor, writing does not simply express experience—it begins to uncover it.

 

Writing as Discovery: Aphelion

In my own experience, the first poem I wrote after loss—Aphelion—began without intention. It did not start as an effort to express or explain anything. Instead, it emerged in fragments: isolated lines, images that appeared without context, and a persistent sense of movement that I could not yet name.

The central metaphor developed gradually rather than by design. Aphelion—the point in an orbit where a body is farthest from the center it moves around—became a way of approaching an internal state that resisted direct articulation: a simultaneous sense of distance and attachment, of being pulled away while still held in relation.

An early passage reflects this movement:

Some slip the constellations we hope to trace,
following a hidden geometry,
their own unseen law.

And when they reach aphelion—
that farthest point
where distance feels eternal—
we feel their silence
more sharply than their light.

Early lines did not explain this. They circled it. Images of distance, gravity, and motion appeared before any clear conceptual link was made. The metaphor did not begin as meaning; it functioned first as a container—something stable enough to hold a shifting internal state.

As the poem developed over several weeks, that structure allowed movement. The metaphor could shift, return, and reconfigure in ways that direct language could not. What had been entirely internal began to exist externally—not as a coherent narrative, but as something visible and revisitable.

By the time the poem was complete, the experience itself had not resolved. But it had changed form. What had been diffuse became structured enough to be encountered.

This pattern is not unique to a single piece. Across early grief writing, metaphor often emerges not as stylistic choice, but as necessity—providing the first framework capable of holding experience before it can be interpreted.

At this stage, there is often:

  • no audience
  • no intention to explain
  • no clear endpoint

 

The process itself is the point. Writing is not expressing experience—it is creating the conditions under which experience can be known.

 

The Function of Creation

It is important to be clear about what writing in this stage does—and does not—do.

Writing does not resolve grief.
It does not produce immediate understanding.
It does not yet create stable meaning.

What it does is more foundational.

It transforms experience from something uncontained into something structured enough to be encountered. It brings experience into language—not as explanation, but as form.

What emerges at this stage is not fully developed meaning, but something closer to proto-meaning—the first structures capable of holding experience in language.

This can be understood as a process of linguistic emergence, in which pre-verbal emotional experience begins to take early linguistic form. Through this process, experience becomes something that can be returned to, engaged with, and gradually understood over time.

From this point, the later stages of the Creative Grief Cycle become possible:

  • Communication, where expression becomes relational
  • Rediscovery, where meaning evolves across time

But neither occurs without this first shift.

Before grief can be shared or understood, it must first take form in language.

 

Author’s Bio:

Daniel Stern is a retired engineer turned astronomer and astrophotographer whose poetry explores grief, silence, memory, and renewal. His work lives at the intersection of science and emotion, where observation becomes reflection and language reaches for what cannot be measured. He is the author of Aphelion, his debut book of poetry, and the chapbook The Roar of Silence, a collection born from personal loss and the search for meaning in its wake. In his work as an astronomer, his astrophotography has been recognized numerous times by NASA (APOD). He has discovered deep-sky objects and, in collaboration with others, has been published in peer-reviewed astrophysics journals. Stern lives in Delray Beach, Florida, with his wife, Randie.

Website:           https://theroarofsilence.com/

Email:                dstern@mea-obs.com

 

 

 

References

Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338–346.

Lakoff, G., & Johnson, M. (1980). Metaphors we live by. University of Chicago Press.

Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421–428. https://journals.sagepub.com/doi/10.1111/j.1467-9280.2007.01916.x

Mazza, N. (2017). Poetry therapy: Theory and practice (2nd ed.). Routledge.

McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100–122. https://journals.sagepub.com/doi/10.1037/1089-2680.5.2.100

Neimeyer, R. A. (2001). Meaning reconstruction and the experience of loss. American Psychological Association.

Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. In H. S. Friedman (Ed.), The Oxford handbook of health psychology (pp. 417–437). Oxford University Press.

Stepakoff, S. (2009). From destruction to creation, from silence to speech: Poetry therapy principles and practices for working with suicide grief. The Arts in Psychotherapy, 36(2), 105–113. https://doi.org/10.1016/j.aip.2009.01.007

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

 

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.

What Is Performance Medicine in Clinical Practice?

Posted on by Joseph Gerard

What is the best intensity workout for you? Please also review AIHCP's Healthcare Life Coaching Program

Written by Elissa Capelle Vaughn

When we think of medicine, often the first thing that springs to mind is “illness.” From this perspective, patients visit a doctor when they have a symptom, like a persistent pain or stomach bug. But on the other side of this approach is medicine as a proactive tool, and that’s where performance medicine comes in.   

Performance medicine is an integrative practice that combines sports medicine, functional medicine, and even anti-aging studies to enhance well-being. It also appeals to multiple patients, from athletes who want to achieve peak health to individuals who want targeted care for longevity.

When paired with traditional general healthcare, performance medicine fosters a truly holistic approach to health. Here’s a closer look at core components, comparisons, practices, and case studies of performance medicine.       

 

Performance Medicine vs. Internal Medicine

Let’s start with distinguishing the similarities and differences between performance medicine and internal medicine.

For starters, both practices strictly rely on evidence-based care. Internal medicine treats illnesses and health conditions, but like performance medicine, it also focuses on:

  • Prevention
  • Nutrition
  • Sleep
  • Diagnostics
  • Lifestyle changes

Both practices share the same goal in improving long-term health outcomes and reducing the risk of injury. Performance medicine practitioners and general physicians both conduct comprehensive assessments, including: 

  • Lifestyle evaluations
  • Hormone levels
  • Metabolic health 

Of course, both physicians maintain high levels of trust with patients to foster the best possible outcomes.    

As for key differences, while internal medicine does involve preventative care, it’s also a “reactive” process that must diagnose and treat symptoms quickly. Performance medicine is a “proactive” practice that enhances physical and mental performance, such as:

  • Adaptive capacity
  • Endurance
  • Mental acuity
  • Stamina
  • Longevity

Patient segments also differ, with performance medicine generally targeting individuals with low health risks who want to enhance their health. 

An athlete may seek out a performance medicine practice to boost their endurance or mental grit. Active older adults may also work with a performance medicine doctor to manage the impacts of aging through peptide therapy and weight management. 

Women in general good health may also take a proactive approach and seek a performance medicine clinic for menopause care. While an internal medicine physician can help the same female patient manage menopause symptoms, a performance medicine professional can help balance hormones and promote healthy metabolism.  

 

Performance Medicine vs. Sports Medicine

At first glance, the term “performance medicine” may be confused with sports medicine, but there are distinct differences.

Let’s start with the similarities, with the clearest being strength and endurance, followed by: 

  • Proactive injury prevention
  • Nutrition
  • Health monitoring

For example, a sports medicine doctor will also monitor hormone levels, nutrition, and musculoskeletal health to improve performance and prevent burnout. Monitoring also speaks to the level of individualized care seen in performance medicine, as well. 

One of the clearest differences is “return to play” care. 

Sports medicine is primarily concerned with treating sports injuries and getting professional and collegiate athletes back on the field. Sports medicine doctors often work in teams to answer whether an athlete can jump, throw, and sprint again, and if so, when?

Depending on the severity of a sports injury, a sports medicine team may require surgical or orthopedic treatments.   

As such, sports medicine patients are primarily athletes. Performance medicine targets a wider range of patient profiles, from the high-level executive managing corporate stress to the mother who’s navigating perimenopause while trying to keep up with a busy household.

A valuable takeaway is that sports medicine has a narrower, short-term approach to resilience, while performance medicine focuses on long-term resilience.   

It should also be noted that many performance medicine doctors do train in sports medicine, internal medicine, or physical medicine & Rehabilitation (PM&R) before entering their chosen field. They may pursue performance medicine as a sub-specialization through a sports medicine fellowship, for example.    

 

Performance Medicine vs. Medical Spas

Performance medicine also shares similarities with medical spas (medspas), with notable differences.  

A common similarity is an integrative approach, as seen in the case study of Moonshot Medical and Performance, a medical optimization and physical rehabilitation clinic. Similar to some medspas, this case study integrates the following approaches into weight management programs: 

  • GLP-1 medications
  • Nutrition guidance
  • Dual-Energy X-ray Absorptiometry (DEXA) scans

DEXA scans are comprehensive health reports that compare patient results with appropriate age and sex ranges. Patients see a more accurate view of fat and muscle distribution. DEXA tracking is then used to develop plans and monitor progress. 

It’s important to note that performance medicine clinics apply strict medical scrutiny in practice. This is a key differentiator between performance medicine clinics like the case study and some medspas. 

For instance, a general wellness center may offer massage therapy, but lack the medical oversight to provide GLP-1 plans. Similarly, while many medical spas do offer weight loss management, they may not have an on-site physician to diagnose and prescribe a GLP-1 like Semaglutide. 

Anti-aging treatments are another overlap. 

For example, the performance medicine clinic in the case study provides peptide-based therapy for anti-aging. Peptides are naturally occurring amino acids in the body; therapeutic peptides like GHK-CU mimic natural peptide signals to simulate the collagen synthesis process, promoting skin elasticity and hair growth.   

A medical spa may offer peptide anti-aging therapies with the right medical oversight. However, most spas focus on cosmetic treatments like dermal fillers and skin resurfacing. Performance medicine takes a more rigorous inside-out approach to health and wellness.

Performance medicine clinics may vary when it comes to treatments, with some offering cold plunges to relieve inflammation, while others may focus on HRT treatments for hormone balance. However, the goal of medical optimization remains unchanged. 

 

Blood Panels and Labwork in Performance Medicine  

Similar to internal medicine, performance medicine clinics run bloodwork to get a clearer picture of a patient’s health status. However, performance medicine labwork looks beyond statistical averages based on population data. Instead, it looks at optimal health ranges to set benchmarks. 

Consider this scenario: A patient visits their doctor, a general physician, citing issues with fatigue and longer recovery times from muscle strain. 

The GP runs a blood panel, revealing testosterone levels on the lower end and cortisol levels on the higher end, but these levels are still within the “normal” range, despite the rise and falls. The GP may tell the patient that their levels are normal and likely to balance out. 

The patient decides to see a performance medicine physician. 

The physician looks at the blood panel and sees the subclinical dysfunction in the testosterone and cortisol levels. They create a treatment plan consisting of bioidentical hormone therapy (BHRT) and targeted stress mitigation to restore the patient’s anabolic drive, which should help the body build and repair tissue while controlling hormones. 

Lab-informed decision-making is a core pillar of performance medicine.

Performance medicine physicians order advanced blood panels that test beyond the standard 15 markers used by internal medicine. Advanced panels test over 60 biomarkers, including: 

  • ApoB for cardiovascular health risk
  • Fasting insulin for metabolic health
  • Sex hormone metabolites

Meanwhile, genetics and epigenetics tests offer important insight into genetic predispositions. This allows performance medicine practitioners to customize targeted lifestyle interventions early. 

 

Data Analysis in Performance Medicine

Blood tests provide valuable patient data for treatment plans, but continuous monitoring ensures that data is current and relevant. 

Performance medicine doctors perform objective blood re-testing and DEXA scans every few months to analyze treatment progress. For instance, if lipid levels remain unchanged, they may administer PCSK9 Inhibitors.  

Biometric dashboards are used to monitor the autonomic nervous system (ANS), which regulates involuntary processes, such as: 

  • Resting heart rate (RHR)
  • Heart rate variability (HRV)
  • Respiratory Rate
  • Blood Pressure 
  • Sudomotor Function (Sweat Response)

Patient-reported outcomes (PROMs) are also vital to data analysis in performance medicine. These digital surveys ensure data actually aligns with a patient’s daily life, tracking patterns in sleep quality, mental clarity, and pain impact.

 

Rehabilitation and Recovery in Performance Medicine

In internal medicine, a patient’s physical therapy treatment typically ends once they’re able to perform daily tasks and go to work without pain. If they want to improve their strength beyond their PT sessions, they can see a performance medicine doctor for targeted strength and endurance regimens.  

For instance, a practitioner may use load management techniques to stress the patient’s tissues just enough to improve muscle adaptation. The goal is to strengthen the muscle without re-injuring the area. But the ultimate goal is greater resilience, lowering overall injury risk.

Performance medicine also takes an active, rather than passive, approach to recovery. A doctor may recommend contrast therapy, which combines infrared sauna sessions and cold plunges to: 

  • Promote better vascular health
  • Detoxify the system 
  • Trigger norepinephrine release
  • Reduce overall inflammation

Hyperbaric oxygen therapy (HBOT) is also used in performance medicine to speed up healing and cellular repair in the body, treating the whole person.

All three of these methods help downregulate the nervous system and flush out metabolic waste.

 

Learn More About Performance Medicine

Performance medicine stands out as an integrative practice that considers the whole person, whether it’s a patient who wants to build up strength after physical therapy, a woman entering menopause, or a busy corporate professional trying to reduce toxic stress. 

Research further into its similarities and differences with other practices, clinical tests, data analysis, and recovery. Our blog is packed with information on sectors, career pathways, and innovations in the healthcare community. 

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 Managed Health Care Consultant Certification program and 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

Hospital Consumables and Clinical Outcomes: What Procurement Choices Mean at the Bedside

Posted on by Joseph Gerard

Doctors wearing gloves giving a thumbs upWritten by Kelton Lewis & editorial team at MAP Medical,

Gloves, IV bags, and administration sets sit in every supply room, but their specifications shape infection rates, medication errors, and nurse workload in ways that purchase orders rarely reflect. Barrier failures, incompatible tubing, and inconsistent sizing show up first at the bedside, not in procurement dashboards. Facilities that source wholesale hospital supplies from distributors with documented quality controls give clinical teams something most contracting conversations overlook: consistency from one lot to the next.

Supply variation is not neutral. When a unit’s glove brand changes mid-week, nurses relearn tactile feedback, donning friction shifts, and occupational allergen profiles can move. When IV sets change manufacturers, Y-site port spacing, roller-clamp resistance, and drop factors may differ in ways that raise the cognitive load of high-acuity care. These small mismatches accumulate, which is precisely why value analysis committees staffed by clinicians, rather than contracting staff alone, should drive catalog decisions.

Gloves are the highest-volume consumable in any healthcare facility and a useful case study for these decisions. When a nurse or infection preventionist evaluates medical supplies gloves for formulary inclusion, four characteristics matter more than unit price: barrier integrity under use conditions, allergen profile, chemical resistance for expected tasks, and donning ergonomics. The regulatory baseline for these products is also specific enough to shape contract language.

The regulatory floor for medical gloves

Medical gloves function as primary barriers under OSHA’s Bloodborne Pathogens Standard, 29 CFR 1910.1030, which requires employers to provide appropriate PPE wherever occupational exposure to blood or other potentially infectious materials is reasonably anticipated (Occupational Safety and Health Administration, 1991). Every medical glove sold in the United States is a Class I reserved medical device that requires 510(k) premarket notification. Under 21 CFR 800.20, the Food and Drug Administration applies a minimum acceptable quality level (AQL) of 1.5 to surgical gloves and 2.5 to patient examination gloves, using the ISO 2859 sampling plan and a water-leak test method (U.S. Food and Drug Administration, 2024). A 2.5 AQL means that, statistically, up to 2.5 percent of gloves in a batch may contain pinhole defects and still pass inspection. Many health systems now specify 1.5 or lower for all exam gloves, particularly in oncology, emergency, and critical care units, where barrier reliability is non-negotiable.

Since January 18, 2017, powdered surgeon’s gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon’s glove have been banned under the FDA’s final rule published at 81 FR 91722. The agency found these products to present an unreasonable and substantial risk of severe airway inflammation, hypersensitivity, and peritoneal adhesions, and determined that labeling changes could not mitigate these risks (U.S. Food and Drug Administration, 2016). Procurement specifications should still explicitly require powder-free product, because the ban does not apply to powdered radiographic protection gloves, and cross-border sourcing of non-compliant stock remains a risk.

Material selection in practice

Nitrile

Nitrile has become the clinical default for non-surgical use across most U.S. health systems. It is latex-free, has strong puncture resistance, and performs reliably against common disinfectants. For oncology and pharmacy personnel handling antineoplastic agents, United States Pharmacopeia General Chapter 800 requires gloves tested under ASTM D6978 for chemotherapy drug permeation, along with double-gloving during compounding and administration (United States Pharmacopeial Convention, 2019). Facilities should stock these chemotherapy-rated gloves as a separate line item from standard exam inventory, and pair them with compliant gowns and engineering controls.

Latex

Natural rubber latex still offers the most refined tactile feedback, which is why many surgeons continue to prefer it for procedures that require fine motor control. Its drawback is well documented: occupational IgE-mediated sensitization in healthcare workers, with reported worldwide prevalence averaging around 9.7 percent and rising higher in populations with intense latex exposure prior to the shift toward powder-free and synthetic alternatives (Wu et al., 2016). Facilities that stock latex for surgery should maintain synthetic alternatives for latex-sensitive staff and patients, and a latex-safe protocol for known allergies.

Vinyl

Vinyl gloves are suitable for brief, low-risk tasks such as environmental services, food handling, and certain non-sterile support functions. They are a poor choice for sustained patient contact, venipuncture, or any scenario where barrier integrity must hold under stretch.

IV administration sets and medication safety

Infusion-related errors remain among the most frequent preventable harms in acute care. The 2024 INS Infusion Therapy Standards of Practice, now in its ninth edition and published as a supplement to the Journal of Infusion Nursing, establishes evidence-based expectations for device selection, care, and evaluation across the infusion pathway (Nickel et al., 2024). Several design elements deserve specific attention during procurement.

Free-flow protection

An administration set without integrated anti-free-flow protection can deliver an uncontrolled gravity bolus when tubing is removed from a pump. Free-flow protection should be a baseline specification for any set used with electronic infusion devices, and the clinical team should confirm that the mechanism engages automatically, rather than requiring a separate step by staff.

DEHP-plasticized tubing

Di(2-ethylhexyl) phthalate is a plasticizer historically used in PVC tubing. It can leach from tubing into infusates, with leaching rates highest in lipid-containing solutions. In its 2002 public health notification, the FDA identified male neonates, pregnant women carrying male fetuses, and peripubertal males as populations of concern, particularly during total parenteral nutrition, ECMO, and multi-device procedures in the NICU (U.S. Food and Drug Administration, 2002). DEHP-free tubing is now standard in NICU, PICU, and oncology settings in most U.S. health systems, and should be specified explicitly in purchase contracts for those units.

Drop-factor standardization

Macro-drip sets (typically 10, 15, or 20 gtt/mL) and micro-drip sets (60 gtt/mL) serve different clinical purposes. Mixing drop factors on a single unit invites calculation errors when staff revert to manual rate verification during pump downtime. Facility-wide standardization, supported by written policy and clear labeling, reduces this risk.

Supply chain resilience after 2020

The COVID-19 pandemic exposed the fragility of single-source consumable procurement. Glove shortages, IV fluid allocations, and PPE rationing forced many U.S. hospitals to rebuild sourcing strategies. Dual-source agreements, real-time PAR-level dashboards, and formal substitutability testing for backup SKUs have become the new baseline. Nurses, who see empty bins before they appear in a report, are the most reliable early signal in this process and should be invited into sourcing reviews rather than informed of their outcomes.

The clinical voice in value analysis

Clinical staff surface evidence that contract bids cannot: tear rates on 12-hour shifts, skin reactions that emerge over weeks, tubing kinks in crowded corridors, pump alarms that correlate with a specific set design. Formalizing nurse participation on value analysis committees consistently produces better formulary decisions and stronger staff engagement with supply protocols. The financial case is also direct: a product that reduces one medication error or one catheter-related bloodstream infection pays for significant price differences many times over.

Choosing a wholesale partner

A supplier’s role is not limited to fulfillment. Clinical teams benefit from partners that can produce FDA 510(k) documentation, ASTM test reports, and lot-level quality data on request. MAP Medical is a distributor of medical products for clinics, hospitals, and surgical centers, carrying gloves, IV bags, IV sets, and other daily consumables supplied under the quality standards outlined here.

About the authors

This article was prepared by the editorial team at MAP Medical, a U.S. distributor of medical consumables to clinics, hospitals, and surgical centers, together with Kelton Lewis, Managing Manager. The team draws on direct experience supporting procurement, infection prevention, and nursing leadership across acute-care facilities.

References

Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., Ong, J., Clare, S., & Hagle, M. E. (2024). Infusion therapy standards of practice (9th ed.). Journal of Infusion Nursing, 47(1S Suppl. 1), S1-S285.

Occupational Safety and Health Administration. (1991). Bloodborne pathogens standard, 29 CFR 1910.1030. U.S. Department of Labor.

United States Pharmacopeial Convention. (2019). USP general chapter <800>: Hazardous drugs-handling in healthcare settings. USP Compounding Compendium.

U.S. Food and Drug Administration. (2002). Public health notification: PVC devices containing the plasticizer DEHP. Center for Devices and Radiological Health.

U.S. Food and Drug Administration. (2016). Banned devices: powdered surgeon’s gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon’s glove. Federal Register, 81(243), 91722-91731.

U.S. Food and Drug Administration. (2024). Patient examination gloves and surgeons’ gloves; sample plans and test method for leakage defects; adulteration, 21 CFR 800.20. Code of Federal Regulations.

Wu, M., McIntosh, J., & Liu, J. (2016). Current prevalence rate of latex allergy: Why it remains a problem? Journal of Occupational Health, 58(2), 138-144.

 

Please also review AIHCP’s Health Care Management Certification program and 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

Workplace Violence Prevention in Healthcare: Bridging Clinical Training and Security

Posted on by Joseph Gerard

Vector imagine of doctors and nurses togetherWritten by Harry Wolf

According to the U.S. Government Accountability Office, it is estimated that those wonderful people who work in healthcare facilities sadly experience substantially higher rates of workplace violence – compared to workers in other sectors, that is. So, prevention strategies matter!

Workplace Violence 

Workplace violence… It extends far beyond physical altercations. It includes any act or threat of physical violence, harassment, intimidation, or disruptive behavior from patients, family members, visitors, students, colleagues, or outside individuals. 

Verbal abuse, psychological intimidation, sexual misconduct, and physical assault – they all fall within its scope.

Nurses and frontline clinicians face heightened exposure. Why is that? Because of their close proximity to patients. 

A 2021 Press Ganey survey, highlighted by the American Nurses Association, found that – staggeringly – two nurses per hour are assaulted in acute care settings. Such frequency underscores just how routine aggression can become in high-acuity environments.

Violence also exists on a continuum. Incivility refers to low-intensity, disrespectful behaviors that violate norms of mutual respect. And bullying involves repeated, intentional hostility. Both can erode psychological safety and contribute to distress.

Aggression… It may originate from distressed patients or family members. But internal hostility between colleagues is also documented across healthcare settings. 

Clear definitions matter. Why is that? Quite simply, because underreporting remains common. 

When verbal threats or intimidation are normalized as part of clinical work, patterns remain hidden.

Now, let’s explore how to prevent workplace violence in the healthcare sector.

Conduct a Data-Driven Risk Assessment 

Prevention in healthcare begins with rigorous risk identification. Organizations cannot manage what they do not measure, after all. 

And anecdotal impressions… Well, they often underestimate patterns of escalation.

If it goes unaddressed, workplace violence can create:

  • High employee turnover
  • Recruitment challenges
  • Reputational risk for the healthcare facilities

A comprehensive risk assessment should include:

  • Reviewing historical incidents and near-miss reports 
  • Mapping high-risk locations 
  • Evaluating staffing ratios and wait-time pressures during peak operational hours

Expand Data Sources Beyond Incident Reports

Incident reporting systems… Unfortunately, they capture only a portion of actual events. Yes, underreporting remains common, particularly when staff perceive aggression as part of the job (which they really shouldn’t have to do!).

Leaders should incorporate workers’ compensation data, security logs, patient complaint records, and even exit interview feedback. Patterns often emerge when data sources are cross-referenced.

Align Assessment With Regulatory Guidance

National frameworks offer structure for local programs. The Occupational Safety and Health Administration outlines core elements of an effective workplace violence prevention program, which includes:

  • Management commitment
  • Employee participation
  • Hazard identification
  • Ongoing evaluation

Alignment with federal guidance strengthens compliance posture and supports accreditation readiness. Documented risk assessments also help justify capital investments in staffing, training, and physical infrastructure.

Strengthen De-Escalation and Provide Training

Training serves as a frontline defense against escalation. However, meaningful prevention requires interactive, skill-based education – rather than passive online modules, that is.

The National Institute for Occupational Safety and Health emphasizes that effective prevention combines administrative controls with targeted worker training. For clinicians, preparation influences not only safety outcomes but also therapeutic rapport.

Comprehensive training programs typically include:

  • Simulation-based role play 
  • Education on trauma-informed communication techniques
  • Clear guidance on when and how to activate security or emergency response systems

Standardize Escalation Protocols Across Departments

De-escalation techniques… They must align with clear escalation pathways. Code terminology, alarm activation procedures, and response hierarchies should all remain consistent across departments – to reduce confusion, that is.

Interdisciplinary drills reinforce readiness. Practicing realistic scenarios involving aggressive visitors, psychiatric emergencies, or intoxicated patients improves response coordination – and reduces hesitation, as well.

Implement Controlled Access and Layered Physical Security

Clinical skill mitigates risk but cannot eliminate all threats. Healthcare facilities remain open and dynamic environments. In turn, that unfortunately increases exposure to unpredictable behavior.

Physical security infrastructure… It functions both as a deterrent and a response support. Effective physical security measures often include:

  • Badge-based access control limiting entry to restricted clinical areas
  • Visitor management systems with identity verification and time tracking
  • Clearly identifiable security presence in high-risk departments

Design Environments That Support Safety

Environmental design influences behavior. For instance? Open sightlines reduce concealment opportunities, and secure nursing stations limit direct access to staff.

Also, furniture placement can prevent entrapment and ensure unobstructed exit routes. And exam rooms and triage spaces should allow clinicians to position themselves closer to exits when feasible.

Lighting, signage, and controlled entry points… They all further contribute to perceived and actual safety. Balanced design maintains patient-centered accessibility while reinforcing boundaries.

Partner With Experienced Security Firms

Healthcare organizations frequently collaborate with a trusted security system installer to implement integrated access control, surveillance, and alarm systems. Professional system integration reduces compatibility issues – and enhances reliability, too. 

Layered security measures, when thoughtfully implemented, reinforce clinical efforts –  and that’s without creating a punitive or intimidating environment.

Deploy Real-Time Monitoring and Communication Systems

Video surveillance systems, duress alarms, and centralized monitoring centers… They all enable security personnel to assess unfolding events quickly. And integration with mobile devices ensures that supervisors and administrators remain informed.

Core monitoring components? They frequently include:

  • Discreet panic buttons
  • Centralized video management systems with live-feed capabilities
  • Two-way communication platforms connecting clinical staff and security teams

Integrate Technology Into Clinical Workflow

Technology must remain intuitive and unobtrusive. Alarm systems should be easily accessible yet discreet – to avoid escalating patient agitation, that is.

Clear response expectations reduce uncertainty. Staff members should understand who responds to alerts, anticipated response times, and post-incident documentation requirements.

Leverage Data 

Monitoring systems generate valuable data. Video recordings and alarm logs allow leadership teams to conduct structured root cause analyses – after incidents occur, that is.

Foster a Culture of Reporting 

Organizational culture ultimately determines whether workplace violence prevention efforts succeed. Underreporting undermines risk assessment – and leaves systemic vulnerabilities unaddressed, too.

And for individual clinicians, repeated exposure to workplace violence without institutional support increases burnout risk and may contribute to workforce attrition.

A strong safety culture includes:

  • Anonymous reporting channels
  • Access to counseling, peer-support networks, and post-incident debriefings

Address Psychological Impact 

Exposure to aggression… It can produce anxiety, sleep disturbance, and moral injury. Early psychological support mitigates long-term effects.

Structured debriefings following significant incidents provide emotional processing space. And they encourage feedback on system improvement. 

Establish Measurable Benchmarks

Continuous improvement… It requires measurable goals. Organizations may track:

  • Incident frequency
  • Injury severity
  • Response times

Long-term success depends on:

  • Leadership commitment
  • Adequate funding
  • Ongoing education

So, prevention programs should evolve in response to: demographic shifts, emerging threats, and technological advancements.

Strengthen Policy Infrastructure 

Workplace violence prevention in healthcare cannot rely solely on frontline efforts. Clear policy infrastructure and defined governance structures ensure consistency – across departments, campuses, and affiliated outpatient sites, that is.

Formal governance signals that prevention is an organizational priority rather than a unit-level initiative. When executive leadership, clinical directors, human resources, legal counsel, and security leaders collaborate, policies become more enforceable and sustainable.

Core governance elements? Well, they often include:

  • A multidisciplinary workplace violence prevention committee
  • Written zero-tolerance policies 
  • Standardized documentation and investigation procedures

Clarify Behavioral Definitions and Consequences

Ambiguity… It weakens enforcement. Policies should define (in explicit terms):

  • Verbal threats
  • Intimidation
  • Harassment
  • Physical assault

Progressive response pathways must also be documented. Consequences for visitors, patients, contractors, or staff should align with legal requirements and ethical obligations.

Clear behavioral agreements for high-risk patients may also reduce escalation. In some cases, care plans include behavioral expectations – which are developed collaboratively with the patient and care team.

Integrate Legal and Regulatory Considerations

Of course, healthcare facilities operate within a complex regulatory environment. State laws governing assault on healthcare workers, mandatory reporting requirements, and patient rights statutes must be reflected in policy language.

Legal counsel should review reporting protocols and ensure alignment with:

  • Labor law
  • Privacy standards
  • Accreditation expectations. 

Documentation processes must support potential litigation or regulatory review.

Regular policy audits help identify outdated procedures or inconsistent application – across departments, that is. Governance structures that meet quarterly and review aggregate data promote accountability at the highest level.

Design Workforce Support and Resilience Programs

Preventing workplace violence in healthcare also requires strengthening workforce resilience. Staff who feel supported and psychologically prepared are better equipped to manage volatile encounters.

Violence prevention efforts should, therefore, extend beyond physical safety measures and into professional well-being initiatives. Resilience-building programs reinforce coping strategies and reduce cumulative stress.

Effective workforce support strategies? Well, they may include:

  • Structured resilience training integrated into professional development programs
  • Peer-mentor systems for new clinicians entering high-risk specialties
  • Scheduled wellness check-ins following critical incidents

Address Fatigue and Staffing Pressures

Operational stressors such as long shifts, mandatory overtime, and high patient acuity… They can all potentially amplify vulnerability to violence. And the thing is: fatigue impairs situational awareness and reaction time.

Leaders should evaluate:

  • Scheduling practices
  • Staffing ratios
  • Float pool availability

Strategic staffing adjustments during historically high-risk shifts may prevent escalation before it begins.

Incorporate Prevention Into Academic and Residency Training

Academic medical centers and teaching hospitals play a crucial role in shaping professional norms. Curricula should integrate:

  • Prevention principles
  • Reporting expectations
  • Communication skills training

Early normalization of reporting reduces long-term underreporting trends.

Simulation laboratories can replicate high-risk scenarios in controlled environments. Exposure to structured practice increases confidence and preparedness before trainees encounter real-world volatility.

Workforce resilience initiatives complement physical security and policy infrastructure. Together, they reinforce a comprehensive, prevention-oriented culture.

Advancing Workplace Violence Prevention 

Workplace violence prevention in healthcare. As we have seen, it demands coordinated action across clinical practice, education, security operations, and executive leadership. 

Healthcare organizations that invest in integrated security infrastructure and interdisciplinary collaboration will strengthen both staff well-being and patient care quality.

Was this article helpful? If so, be sure to take a look at our other insightful content. 

 

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:

  • Unauthored, 2016, Workplace Safety and Health: Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence, U.S. Government Accountability Office.

https://www.gao.gov/products/gao-16-11

 

  • Unauthored, 2021, Workplace Violence: Protect Yourselves, Protect Your Patients, American Nurses Association.

https://www.nursingworld.org/practice-policy/work-environment/wpv/

  • Unauthored, 2016, Workplace Violence, Occupational Safety and Health Administration.

https://www.osha.gov/healthcare/workplace-violence

  • Unauthored, 2024, Violence and Work, Centers for Disease Control and Prevention.

https://www.cdc.gov/niosh/violence/about/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fniosh%2Ftopics%2Fviolence%2Fdefault.html

  • Behrens, M., Gube, M., Chaabene, H., Prieske, O., Zenon, A., Broscheid, K.-C., Schega, L., Husmann, F., & Weippert, M., 2022, Fatigue and Human Performance: An Updated Framework, National Library of Medicine.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9807493/

 

 

Please also review AIHCP’s Nursing Management Certification program and 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

Clinical Considerations in the Selection of Oral and Topical Antifungal Therapies for Onychomycosis

Posted on by Joseph Gerard

If you would like to become a certified case manager then please review the program and see how it matches your career needs

Written by Harry Wolf

Onychomycosis affects around 10 to 20 percent of the global population. It also makes up about 50 percent of all nail disorders, according to a 2025 report published by the International Journal of Advanced Biochemistry Research.

Age-related nail changes, reduced peripheral circulation, cumulative environmental exposure, and comorbid disease… They all contribute to the condition’s prevalence. 

Therapeutic decisions are rarely straightforward for clinicians. Efficacy, pathogen identification, comorbidities, drug interaction potential, laboratory monitoring requirements, adherence capacity, and cost… All influence selection between oral and topical antifungal therapies.

A Brief Overview of Onychomycosis

What exactly is onychomycosis? If you are not aware, here is the lowdown: it is a chronic fungal infection involving the nail plate, nail bed, and (in advanced cases) the nail matrix. 

Dermatophytes remain the most common etiologic agents, although non-dermatophyte molds and yeasts are increasingly identified in laboratory-confirmed cases, as detailed in an interesting analysis published by Nature’s Scientific Reports. 

Accurate organism identification has become increasingly important. Why is that? Quite simply, because therapeutic response varies by species.

Clinically, onychomycosis presents in several morphologic patterns. The following patterns influence both severity assessment and treatment selection:

  • Distal lateral subungual disease with progressive onycholysis
  • Superficial white onychomycosis affecting the dorsal nail plate
  • Proximal subungual disease
  • Total dystrophic onychomycosis in advanced and long-standing infections

Chronic fungal colonization can produce subungual hyperkeratosis, nail thickening, discoloration, and friability. Functional consequences include pain, difficulty ambulating, and impaired quality of life. 

In patients with diabetes, neuropathy, or peripheral arterial disease, thickened dystrophic nails may contribute to ulceration risk.

Diagnostic confirmation is recommended before initiating systemic therapy. 

Antifungal Therapies

Antifungal therapies for onychomycosis are categorized as systemic oral agents or topical transungual therapies. Selection should be determined by:

  • Disease severity
  • Nail matrix involvement
  • Organism type
  • Comorbidities
  • Patient preference

Systemic agents achieve therapeutic concentrations in the nail bed via bloodstream distribution. 

An evidence-based review, published by the National Library of Medicine, confirms that terbinafine, itraconazole, and fluconazole demonstrate clinically meaningful efficacy in treating onychomycosis. 

Cure rates? They are generally higher with systemic therapy in moderate-to-severe disease – compared with topical monotherapy.

Topical therapies act directly at the site of infection. A study published by Springer Nature demonstrated superior transungual penetration and antifungal activity of efinaconazole compared with tavaborole, ciclopirox, and several over-the-counter options. 

Penetration capacity is clinically relevant. Why? Because the nail plate presents a dense keratin barrier.

Therapeutic strategies? They may include:

  • Continuous oral dosing regimens lasting 6 to 12 weeks
  • Pulse-dosed oral therapy administered in treatment cycles
  • Daily topical application for 48 weeks or longer
  • Combination systemic and topical approaches in refractory cases

Mechanistically, allylamines such as terbinafine inhibit squalene epoxidase. They can lead to:

  • Ergosterol depletion
  • Fungal cell membrane disruption

Azoles such as itraconazole inhibit lanosterol 14-alpha-demethylase, thus impairing ergosterol synthesis. And oxaboroles such as tavaborole inhibit fungal protein synthesis by targeting leucyl-tRNA synthetase.

Understanding pharmacodynamics supports rational therapeutic selection – particularly in complex or recurrent cases, that is.

Selecting Oral Antifungal Therapies

When multiple nails, matrix involvement, or extensive subungual hyperkeratosis are present, systemic therapy remains a first-line approach. Treatment selection needs a high level of attention. 

It requires careful evaluation of:

  • Efficacy data
  • Safety profile
  • Comorbid disease
  • Drug interaction potential

The Comparative Efficacy of Oral Agents

Multiple comparative trials and meta-analyses demonstrate the following. Continuous oral terbinafine produces higher mycologic and complete cure rates than intermittent itraconazole in dermatophyte toenail onychomycosis.

A double-blind randomized clinical trial, published by the Institute of Tropical Medicine, is worth noting. It compared terbinafine 250 mg daily for 12 weeks with itraconazole 200 mg daily for 12 weeks. 

The study reported significantly higher negative mycology rates at 48-week follow-ups in the terbinafine group – 73% versus  46%, in fact. Plus, there were higher rates of near-total clinical cure as well. 

These findings support continuous terbinafine as a preferred first-line agent in dermatophyte-predominant disease.

Long-term follow-up data published in JAMA Dermatology further demonstrates that terbinafine can achieve significantly higher sustained mycologic and clinical cure rates, compared with itraconazole, that is. There were lower relapses observed over extended observation periods. 

Sustained clearance is clinically meaningful. And that is because? Recurrence contributes to repeated systemic exposure and cumulative cost.

Key comparative considerations? They include:

  • Higher sustained mycologic cure rates with continuous terbinafine
  • Lower relapse rates in long-term follow-up with terbinafine
  • Broader organism coverage with itraconazole
  • Dosing flexibility with pulse itraconazole regimens

Yes, itraconazole remains an effective alternative – particularly when non-dermatophyte molds or yeasts are implicated, that is. However… continuous terbinafine therapy continues to demonstrate superior efficacy outcomes in dermatophyte-associated toenail infection.

Safety Profiles and Monitoring

Oral antifungals… They require attention to hepatic safety and drug interaction potential. A safety-focused review published by the National Library of Medicine confirms that terbinafine and itraconazole are generally well tolerated but associated with rare hepatotoxic events. 

Hepatic injury is uncommon, yes. But it is clinically significant. So, it warrants appropriate screening.

Baseline liver-function testing is widely recommended before initiating systemic therapy. Monitoring intervals vary depending on the:

  • Duration of therapy
  • Patient-specific risk factors

Important safety considerations include:

  • CYP3A4 inhibition and interaction potential with itraconazole
  • Rare hepatotoxicity associated with terbinafine
  • Possible negative inotropic effects with itraconazole
  • Polypharmacy concerns in older adults

Special Populations and Comorbidities

Patients with diabetes… They represent a clinically significant subgroup. Thickened, dystrophic nails may increase pressure points and contribute to ulcer risk. 

Effective fungal eradication may reduce mechanical complications in this population.

Immunocompromised patients may experience atypical or proximal subungual presentations. Broader-spectrum coverage may be considered when non-dermatophyte pathogens are suspected.

Oral therapy may be less suitable in:

  • Active or chronic hepatic disease
  • History of medication-induced hepatotoxicity
  • Inability to adhere to monitoring protocols
  • Patient preference for localized therapy

Selecting Topical Antifungal Therapies

Topical therapy… It plays a central role in mild-to-moderate onychomycosis and in patients who cannot tolerate systemic agents. Localized therapy minimizes systemic exposure. However, it requires sustained adherence and realistic counseling regarding duration.

Indications for Topical Monotherapy

Topical monotherapy is typically reserved for limited nail involvement without matrix infection. Treatment duration often approaches 48 weeks because nail growth is slow and drug penetration through keratin is limited.

Appropriate candidates may include:

  • Involvement of less than 50 percent of a single nail
  • Absence of matrix involvement
  • Contraindications to systemic therapy
  • Preference to avoid systemic adverse effects

Comparative Effectiveness of Topical Agents

Let’s now reference laboratory evidence published by Springer Nature. It demonstrated significantly greater antifungal activity and transungual penetration for efinaconazole compared with tavaborole, ciclopirox, and evaluated over-the-counter products. 

Enhanced penetration may improve mycologic clearance – in carefully selected patients, that is.

Also, the study published by the  International Journal of Advanced Biochemistry Research, which we referenced earlier, emphasizes relapse risk and identifies adherence as a primary determinant of success. 

Prolonged daily application is required. For what reason? To maintain therapeutic drug levels in the nail plate.

Prescription options include:

  • Efinaconazole 
  • Tavaborole 
  • Ciclopirox 

Clinical selection depends on severity, penetration profile, and tolerability – as well as financial accessibility. So, if you are looking for products containing the active ingredient of efinaconazole, such as Jublia, for example, consider all those elements.

Reviewing the cost of Jublia at PricePro Pharmacy could assist patients in aligning their therapy with affordability.

Combination Therapy and Adjunctive Measures

Combination therapy may be considered in recalcitrant cases. Concomitant topical therapy during or after systemic treatment may reduce recurrence risk – by suppressing residual fungal elements, that is.

Adjunctive strategies? They include:

  • Mechanical debridement to reduce nail thickness
  • Regular trimming to decrease fungal burden
  • Treatment of concomitant tinea pedis
  • Environmental hygiene to reduce reinfection

Addressing concomitant skin infection reduces the likelihood of nail reinoculation.

Adherence 

Adherence remains a significant barrier in topical therapy. Daily application for extended periods requires sustained patient engagement.

Clinical reviews highlight:

  • Nearly year-long treatment timelines
  • Gradual cosmetic improvement rather than rapid change
  • Higher relapse rates compared with systemic therapy

Clear communication regarding expected time frames and visible milestones is crucial. Because? It improves persistence and therapeutic satisfaction.

Evolving Dermatophyte Resistance Patterns 

Emerging antifungal resistance is increasingly influencing clinical decision-making in onychomycosis management. Clinically relevant considerations include:

  • Refractory infection despite confirmed adherence
  • Recurrence shortly after completing systemic therapy
  • History of travel to areas with reported resistant strains
  • Prior prolonged or repeated terbinafine exposure

Itraconazole is frequently utilized as an alternative systemic agent when terbinafine resistance is suspected. In documented resistant cases, switching antifungal class has demonstrated clinical improvement. 

Molecular diagnostic tools and susceptibility testing may become increasingly relevant in tertiary-care and academic settings.

Also, antifungal resistance reinforces the importance of avoiding empiric systemic therapy without laboratory confirmation. Confirmed diagnosis prior to initiation minimizes unnecessary exposure. And it may reduce selective pressure that contributes to resistance development.

Recurrence Prevention and Long-Term Management 

Recurrence remains a persistent challenge in onychomycosis management. Even after an apparent clinical cure. 

Data indicates relapse rates of approximately 20 to 25 percent within two years following successful treatment, as summarized in that study published by the International Journal of Advanced Biochemistry Research. 

For clinicians, a durable cure requires attention beyond initial fungal eradication.

According to an article by Infection and Drug Resistance, recurrence may be influenced by:

  • Biofilm formation
  • Untreated concomitant tinea pedis
  • Persistent environmental reservoirs
  • Host factors such as immunosuppression or diabetes

Addressing those elements can improve long-term outcomes. 

Preventive strategies include:

  • Treating coexisting tinea pedis concurrently
  • Encouraging proper foot hygiene and drying practices
  • Disinfecting footwear and nail-care instruments
  • Monitoring high-risk patients periodically after cure

Patients with diabetes, peripheral vascular disease, or immunosuppression may require closer follow-ups. Why is that? Quite simply, it is due to elevated complication risk. 

Maintenance topical therapy following systemic treatment has been explored as a strategy to reduce recurrence, particularly in individuals with repeated relapse.

Environmental reinoculation also plays a role in recurrence. Shared showers, occlusive footwear, and persistent fungal reservoirs in socks or shoes may facilitate reinfection. Counseling patients about these risks will help to improve long-term therapeutic durability.

Recurrence prevention represents a shift from episodic treatment toward longitudinal management. Integrating preventive counseling into routine care:

  • Supports sustained remission
  • Reduces cumulative treatment burden

Applying Clinical Judgment in Onychomycosis Management

Let’s recap. Firstly, effective onychomycosis management requires individualized assessment – rather than protocol-driven uniformity, that is. 

Oral antifungal therapy generally provides higher complete cure rates in moderate-to-severe disease. Topical antifungal therapy offers a valuable alternative for localized infection or when systemic agents are contraindicated.

Diagnostic confirmation, organism identification, safety monitoring, adherence counseling, and financial accessibility… They all influence therapeutic success. 

Hopefully, this article has been helpful. If it has been, take a look at our other relevant content.

 

 

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

  • Unauthored, 2022, Toenail Fungus, Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/11303-toenail-fungus

  • Unauthored, 2024, Toenail fungus (onychomycosis), Harvard Health Publishing.

https://www.health.harvard.edu/a_to_z/toenail-fungus-onychomycosis-a-to-z

  • Bodman, M. A., Syed, H. A., & Krishnamurthy, K., 2025, Onychomycosis, National Library of Medicine.

https://www.ncbi.nlm.nih.gov/books/NBK441853/

  • Sinha, R., Rathaur, H., & Mukhopadhyay, S., 2025, Onychomycosis focus in the elderly: Prevalence, diagnosis and treatment strategies, International Journal of Advanced Biochemistry Research.

https://www.biochemjournal.com/archives/2025/vol9issue6/PartB/9-5-104-852.pdf

  • Mayengo, R., Petra, N. P., Joseph, O., Ogwang, E., Kitunzi, G. M., Onguti, A. G., & Mirembe, S. K., 2025, Onychomycosis prevalence etiology and associated factors in women using nail cosmetics attending Mbarara regional referral hospital dermatology clinic Uganda, Nature.

https://www.nature.com/articles/s41598-025-30250-8

  • De Sa, D. C., Lamas, A. P., & Tosti, A., 2014, Oral therapy for onychomycosis: an evidence-based review, National Library of Medicine.

https://www.ncbi.nlm.nih.gov/books/NBK189719/

  • Elabbasi, A., Kadry, A., Joseph, W., Elewski, B., & Ghannoum, M., 2024, Transungual Penetration and Antifungal Activity of Prescription and Over-the-Counter Topical Antifungals: Ex Vivo Comparison, Springer Nature.

https://link.springer.com/article/10.1007/s13555-024-01237-6

  • De Backer, M., De Keyser, P., De Vroey, C., & Lesaffre, E., 1996, A 12-week treatment for dermatophyte toe onychomycosis: terbinafine 250 mg/day vs. itraconazole 200 mg/day – a double-blind comparative trial, Institute of Tropical Medicine Antwerp.

https://research.itg.be/en/publications/a-12-week-treatment-for-dermatophyte-toe-onychomycosis-terbinafin/

  • Sigurgeirsson, B., Ólafsson, J. H., Steinsson, J. Þ., Paul, C., Billstein, S., & Evans, E. G. V., 2001, Long-term Effectiveness of Treatment With Terbinafine vs Itraconazole in OnychomycosisA 5-Year Blinded Prospective Follow-up Study, JAMA Network.

https://jamanetwork.com/journals/jamadermatology/fullarticle/478735

  • Gupta, A. K., Haas-Neill, S., & Talukder, M., 2023, The safety of oral antifungals for the treatment of onychomycosis, National Library of Medicine.

https://pubmed.ncbi.nlm.nih.gov/37925672/

  • Axler, E., & Lipner, S. R., 2024, Antifungal Selection for the Treatment of Onychomycosis: Patient Considerations and Outcomes, Infection and Drug Resistance.

https://www.tandfonline.com/doi/pdf/10.2147/IDR.S431526

 

Please also review AIHCP’s Managed Health Care Consultant Certification program and 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

3 Actionable Rules for Managing Unexpected Incidents in Care Settings 

Posted on by Joseph Gerard

Healthcare professionals certified in Pastoral Thanatology from AIHCP can better deliver bad news to patients and family with empathy and professionalism

Written by Deepika,

Unexpected incidents in care settings stand at the bittersweet intersection of reality and uncertainty. All seems to be going well until things spiral out of control at lightning speed. 

Now, healthcare professionals are not only trained for such events, but most are even familiar with the pressure points. However, that’s the thing about ‘the unexpected’, right? You never know what the next twist will be like. 

Such incidents may seem minor in isolation, but they add up quickly. This is why your response must be a carefully planned strategy of management, not an impulsive series of decisions. 

This article will outline three actionable rules that govern how unexpected situations in care settings should be managed. They will strengthen care for improved patient outcomes in the future. 

 

Timeliness and Safety Must Run Parallel to Each Other 

What’s the first rule of any healthcare service? It’s to do no harm. Now, unexpected incidents make this trickier as you must do no harm, but also as swiftly as possible. 

The implication here is that your quick response should not be made at the expense of safety. Since unplanned situations are part and parcel of healthcare, staff must be well-prepared. 2024 was a tragic year in the sense that 2.5 million non-fatal workplace injuries and illnesses were reported by private industry employers. 

Even one life lost is one too many, right? Every decision or move you and your team make should focus on preventing further harm to everyone involved. First, figure out what happened and who was affected by the event. Then, earmark any immediate dangers that loom over the affected. 

Equipment failure and heavy bleeding are two common examples of urgent risks. In the process, secure the environment by getting rid of hazards along the way. Basically, this is about anything you must do to make room for safer care.

Often, there may be scenarios where you sense a need for emergency intervention. If that’s the case, put the necessary protocols into action without delay. On that note, here are the essential steps to focus on: 

  • Stabilize the affected individual using relevant clinical measures. 
  • Look for additional support, especially if the situation is unclear or urgent. 
  • Adhere to the established protocols based on the event in question. 
  • Stick to clear communication lines with the rest of the care team. 
  • Provide reassurance to the patient and others involved to alleviate distress.

What you should be concentrating on is a calm and systematic approach. Your entire team can do the same through regular training sessions that facilitate razor-sharp discretion. 

 

Thorough Documentation With Full Context Is a Must 

With unforeseen incidents, you undoubtedly learn to keep accountability at the forefront. Only thorough documentation can enable that; however, it must include the complete context of the event. 

Always start by managing the incident, but follow it up with documentation that’s straightforward, crystal-clear, and factual. The importance of this step comes to light in real-life healthcare scenarios. For instance, in Ohio, around 77,100 workplace injuries and illnesses were reported in 2024. 

Tragically, the healthcare and social assistance sectors took the brunt of the blow. In dynamic care settings, which include cities like Toledo, such incidents are a part of daily operational reality. This is a direct connection to the importance of accurate reporting, one that remains objective to the letter.

If an incident results in harm, it may extend into considerations of accountability. This is where personal injury becomes relevant, especially since many healthcare incidents are later evaluated for medical negligence. 

As Zoll & Kranz, LLC, notes, negligence that leads to injuries makes the affected individual eligible for monetary compensation. Since securing fair compensation is not always a cakewalk, documentation becomes essential. 

Given our example, one may seek help from a Toledo personal injury lawyer to assess how care was delivered and where liability lies. For healthcare professionals, the following actions are of utmost importance: 

  • Work on documentation at the earliest to secure the most accurate details. 
  • Record facts in an objective manner without any assumptions. 
  • Be mindful of the institution’s reporting protocols. 
  • Make the document thorough and clear enough for an external review. 

 

There is No Way Around Steady Improvement 

Is the glass half-empty or full? In the world of healthcare, you cannot afford to hold the first perspective. The only way to keep up with patient needs is to consider each unexpected incident as an opportunity for growth. A recent study found that when hospitals focused on safety, over 300,000 additional patients survived care between April 2024 and March 2025. 

You won’t find any alternatives here, because weaknesses are usually not isolated loopholes. There is often plenty of room for better outcomes, provided you know how to avail of the chance. Consider a hypothetical scenario where a patient is given the wrong dose of medication during a busy shift. 

Fortunately, the error is recognized, and the patient is restored to a stable state. Should not this incident be documented? Well, in most cases, they will be, but that is the bare minimum. 

The example we shared calls for a 360-degree inspection into the matter. It may bring issues to the surface, like the medication labels looking similar or the nurse being interrupted during administration. 

Then, steps for rectification can be taken accordingly. If the former is the issue, careful storage and labeling would do the trick. If the latter, a mandatory cross-checking would suffice. 

There are not  ‘small issues’ in your field, so address them all at the earliest. In general, the following strategies for steady progress should help: 

  • Dig deeper into an incident using methods like root cause analysis. 
  • Look for any cracks in staffing or the environment. 
  • Ensure all procedures are up-to-date. 
  • Keep everyone in the loop, in real time. 
  • Fortify training measures in areas where glaring gaps are revealed. 
  • Discern changes in patient health to decide if the measures worked. 

 

Resist the urge to let panic have its way with your team. You can always take it slow as long as you don’t stall altogether. Keep matters in perspective by emphasizing one rule at a time.

Safety is a good starting point, which can be followed by documentation and analysis. Just stay the course, resisting the urge to skip any of the golden rules discussed here. In 2024, rates of incident reporting increased, reaching around 32.2 reports per 1,000 patient days in hospitals. 

Why such a dramatic change? One definite factor was that of learning from such incidents for a brighter future. Take your time, and the small actions will accumulate for the better. In due course, the unforeseen will have turned the tables for delivering safer care. 

Author Bio 

Passionate about words and learning, Deepika is a budding content creator who takes an interest in a variety of niches. Her knack for turning complex ideas into relatable narratives allows her to resonate with the reader. 

When her pen falls silent, you can find her engrossed in a novel or getting her hands messy with fine arts. By these, Deepika is committed to keeping her curiosity and creativity alive. 

 

 

Please also review AIHCP’s Crisis Intervention Certification program and our 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

How Clinicians Help Families Weigh Home Care Options

Posted on by Joseph Gerard

Please also review AIHCP's Healthcare Case Management Training Program and see if it matches your academic and professional goals

Written by Sofia Vallasciani,

“Is home really the best place?” It’s a question that triggers anxiety for both families and clinicians when care needs intensify. As a loved one ages, you and your whole family may find yourself sorting through a tangle of home care, residential care, and hybrid options. The stakes are high: quality of life, finances, and future well-being may all depend on your choice.

However, in the decision-making process, there is one ally to not overlook: your clinician. Clinicians often know your family and concerns, and may have followed your loved one through their care needs. Consulting them helps you get practical strategies for conversations and step-by-step tools for needs assessment, risk review, and budgeting. All of this can make it easier to navigate what’s ahead with more confidence, less stress, and peace of mind. 

Mapping the Conversation: Start With a Strong Foundation

Noticing that a loved one needs more help than he or she usually requires can be tough for family and friends. You may not be sure where to begin, what options are available, or what level of care may be needed at each stage. Here, clinicians can play a significant role in helping to guide the discussion with clarity and balance.

They will usually start by opening up the conversations and get a better feel of the situation with questions such as, “What matters most to you and your loved one right now?” Answering honestly and openly can help you and your family address immediate concerns and longer-term worries.

During a conversation regarding your loved one’s care, a clinician may use some strategies, including:

  • Clear, jargon-free explanations of home versus facility versus hybrid care.
  • Early identification of priorities (safety, independence, cost, access to medical care).
  • Emotional acknowledgment. They know that families will feel vulnerable, and they will work to normalize those emotions.

It may take patience, but recognizing family emotions upfront is essential to set the foundations of honest dialog later. 

Needs Assessment: Sorting Wants, Needs, and What’s Realistic

A structured needs assessment is the first step, which will support the entire decision-making process, grounding your decisions in facts rather than fear or wishful thinking. Clinicians can guide families through core questions, including:

  • What physical, cognitive, and emotional support does the person need on a daily basis?
  • Which tasks are truly challenging? These may include changes that you have noticed regarding everyday activities or aspects such as medication, bathing, transportation, and meal prep.
  • How available and willing are family members to pitch in, and for how long?

It is important to answer these questions honestly, allowing your clinician to have a full picture of the situation. For a fairer assessment, clinicians may also recommend using checklists, like those provided by AARP Needs Assessment, to clarify and quantify these details. 

Clinicians may also review your loved one’s medical history to identify health issues that may be manageable now but require more intensive care in the future. This way, you can have a clear idea of the steps ahead and what to expect as your loved one ages or their disease progresses. 

Weighing the Costs: Budgets, Value, and What’s Achievable

Cost is usually a key point in care discussions, and families often underestimate both the price and value of in-home support. However, it is important to understand that there are different levels of care, which are differently priced, and financial support options for eligible families. 

Here’s where consulting a healthcare provider can truly pay off. They understand the options available and the strategies you can use to reduce your out-of-pocket costs. During a thorough conversation, they will be able to take you through important aspects, such as:

  • Common home care services (personal care, homemaker assistance, nursing).
  • Typical price ranges by region.
  • What is and isn’t covered by Medicare, Medicaid, or private insurance.

They can help you better understand what are the senior care costs and benefits to expect, providing you with a realistic price forecast and an overview of the services that are typically included.

Managing Your Emotions During Money Conversations

Discussing detailed costs also helps reduce tension over what’s affordable by identifying which options fit within the family’s budget. When everyone sees a clear comparison of services and their prices, it becomes easier to remove emotion from the decision and select practical solutions that don’t cause resentment later. If the budget remains a sticking point, a provider can help the family separate true needs from extras, ensuring the essentials remain non-negotiable. 

As much as it feels cold to assign a value to a loved one’s care, understanding costs is critical for planning support that’s sustainable. If families overextend and run out of resources, gaps in both care and health outcomes can develop. Simply, making careful, well-informed budgeting decisions is an act of love as much as duty.

Assessing Risk: Safety, Function, and Setting

Risk conversations are rarely comfortable. No one wants to discuss the day-to-day needs of a loved one or how their health and care needs may change over time. However, discussing this aspect is vital for family peace of mind. They are also essential for meeting legal and ethical standards, ensuring your loved one is cared for in an efficient, compliant, and dignified way. 

A clinician may use open questions to guide families:

  • “What specific risks worry you most about home care? Are falls, wandering, or emergencies the main concern?”
  • “How likely is a sudden decline, and what backup plan feels realistic?”
  • “Which care setting offers the right level of supervision and structure?”

Assigning risk “tiers” (low, moderate, high) with clear examples can help families remove bias and correctly identify the level of care needed. 

A clinician might say, “If your father only needs help with occasional meal preparation but manages all medications safely, he’s at low risk and could thrive with part-time in-home support.” Or, “If your mother experiences frequent falls and sometimes forgets to turn off the stove, that places her in the high-risk category. In this case, 24-hour supervision at home may be safest.”

Using these kinds of specific scenarios frames the discussion around facts instead of fear, helping families see where their loved one truly fits on the risk spectrum. 

Navigating Family Conflict and Bias

Even with the best prep, conflict can erupt when siblings, spouses, or multiple generations get involved. Clinicians will expect, not fear, strong opinions. They understand that conflicts often start when some family members fixate on worst-case outcomes, issues relating to finances or level of responsibility, or when past grievances resurface as objections about care.

To keep things productive a clinician may:

  • Use scripts: “I can see this is stressful for everyone. Can we focus on what matters most to your loved one?”
  • Encourage the “wisdom of the table” by giving each participant a chance to state their concerns, without interruption.
  • Normalize disagreement as a natural phase of family decision-making.
  • Taking short breaks or moving the conversation to neutral territory (a coffee shop, park, or video call). 

The point isn’t to force agreement: it’s to ensure every family voice is weighed with dignity.

Documentation and Scripts: Tools for Clear, Unbiased Decisions

Accurate documentation supports better care, reduces revisiting old arguments, and ensures wishes are taken into account during the decision-making process. Clinicians can prepare take-home worksheets that include:

  • Date and participants in each meeting.
  • Main concerns and care goals discussed.
  • A brief summary of options, ruled-in and ruled-out.

Sample scripts to aid decisions might use phrasing like:

“Based on what we’ve discussed, here are the options we’ve agreed to consider… Our next step is to revisit these choices in two weeks, unless there’s a significant change in health.”

Sharing copies for everyone (yes, even via group email) avoids miscommunication and showcases that the process is transparent, which may help avoid conflict down the line.

Exploring Hybrids: When Neither Home Nor Facility Feels “Right”

Sometimes the best option isn’t either-or, it’s both. Hybrids, such as adult day services plus in-home help, can bridge gaps for families not ready to commit fully to residential care.

Your clinician may discuss hybrid options, which are often customized around your loved one’s needs. During this conversation, your healthcare provider can bring together support from different providers, providing information such as:

  • What services operate at home, in the community, or virtually.
  • A sample week’s support (e.g., in-home care three mornings, adult day care twice a week).
  • Reviewing transportation, supervision, and transition plans if needs change.

Clinicians may also encourage families to trial a hybrid model for 30–60 days, adjusting as needed, rather than making irreversible decisions after a single stressful meeting. During this time, you may be able to review and assess the level and quality of care, find out what works and what needs improvement, and discuss your thoughts with other family members. This can help you make a more informed decision when the time comes. 

Final Thoughts: Continuing the Family Care Conversation

Choosing between home, facility, or combination care isn’t a one-time event. Needs evolve, finances shift, and family dynamics change. Clinicians can help approach these conversations with humility, transparency, and expert tools that can help families choose with confidence.

For more practical frameworks, scripts, and case studies on family-centered care planning, The American Institute of Health Care Professionals’ internal blog archives offer a wealth of clinician-tested insights. Explore resources for continuing education, downloadable worksheets, and clinician support networks to deepen your understanding and enhance your next care conversation.

 

Writer Bio

Sofia Vallasciani is a health and wellness writer with over five years of experience creating clear, accurate, and accessible medical content. She specializes in translating complex health topics into reader-friendly material, with particular expertise in regenerative medicine, integrative health, and lifestyle medicine. Her work focuses on educating readers and supporting informed health decisions through evidence-based writing.

 

Please also review AIHCP’s Case Management Certification program and Case Management 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

Healthcare Facility Security: Why It Matters

Posted on by Joseph Gerard

A stethoscope over computer keyboard Written by Marchelle Abrahams,

One of the biggest challenges facing healthcare facilities these days is the rising number of security threats. Hospitals all over the world deal with physical threats, the risk of cyberattacks, and even problems with internal safety daily. In fact, the healthcare sector has quietly become one of the most targeted in the world.

The numbers tell the story. In 2024 alone, more than 250 million Americans had their health records compromised. As if that wasn’t bad enough, many nurses have said that they have experienced at least one incident of workplace violence in the past few months.

The message couldn’t be clearer: security is no longer a nice-to-have for healthcare facilities. It’s fundamental. If your facility isn’t protected, everything else is at risk. Patient trust. Staff morale. Daily operations. All of it.

So what does healthcare facility security look like in real life, and more importantly, how can you get it right? Let’s discuss.

What Security Means in Healthcare

When you hear “healthcare security”, you probably picture a guard at the front desk checking IDs. That’s a part of it, but it’s not all there is to it.

True healthcare facility security is multi-layered. As you already know, there will be a physical security guard at the front desk checking for IDs and watching out for trouble. You also have cameras, badge readers, and other forms of biometric security so that only authorized people can access certain areas. 

Then there’s occupational health and safety. This involves providing healthcare personnel with PPE, ventilation systems, as well as your protocols for handling biohazards.

Facilities also need safeguards for patient records, billing systems, and even medical devices. Why? Because a successful breach can cost facilities up to $7.42 million, according to the HIPAA Journal. Healthcare cybersecurity is non-negotiable.

If your facility is located in a rough neighborhood, healthcare safety means having the right legal safeguards and response plans in place.

Bottom line? Healthcare security isn’t just stopping threats. It’s keeping the entire system stable, safe, and running without a hitch.

Key Areas of Protection in Healthcare Facilities

So, what are the key security or protective measures that should be put in place? We already mentioned them briefly earlier. Let’s now go in-depth.

Physical Security

It starts with the physical security. This covers trained security personnel who check IDs and do bag checks. It also involves access control systems and CCTV surveillance that covers high-risk areas like ICUs, operating rooms, and drug storage facilities. 

The idea is that not everyone can go everywhere within the facility. But facilities are also moving beyond traditional bag checks and manual screening. 

Hospitals are now installing metal detectors like those used in airports. This trend has become even more popular since the Carilion Roanoke Memorial Hospital attack. On Christmas Day 2024, a man walked into the hospital’s trauma center with a hatchet and attacked a physician. 

He was able to carry out the attack because there was no system in place to detect the weapon. That’s changing. Systems like the CEIA OPENGATE detector allow people to walk through without stopping or removing personal items, while still detecting weapons like knives or firearms. 

According to GXC Inc., these detectors are fast, reliable, and less intrusive. And honestly, more practical in high-traffic environments.

Occupational Health and Safety

Your staff faces risks that go beyond angry patients. They also deal with exposure to biological hazards, chemicals, and infectious diseases. The COVID-19 pandemic was a real eye-opener. It showed just how vulnerable healthcare workers can be in these environments. 

That’s why healthcare security should also cover protection against these threats.

Let’s also not forget physical injuries from patient handling, as well as ergonomic strain from repetitive tasks. Hospital nurses are the most affected, with one source reporting that up to 83.9% of nurses experience symptoms of musculoskeletal disorders.

As a hospital admin, it’s on you to put clear policies in place. Not just on paper, but in practice. Proper lifting techniques, better equipment, and realistic shift structures can go a long way in reducing these risks.

Data and Asset Protection

We’ve already touched on the cost of healthcare data breaches. But honestly, the financial loss is just one part of the story. Think about the loss of reputation, as well as the legal consequences that will follow when patients’ personal information is stolen. And worse, sold on the black market.

This is a real and growing threat, and healthcare facilities need to take it seriously. At the very least, this means strong EHR security, firewalls, and encryption, and providing regular staff training on cybersecurity. These are non-negotiable basics. 

You may also want to consider taking on a cybersecurity expert. That could be an in-house role or an outsourced partner, depending on what makes sense for your setup. 

The goal is to ensure that patients’ information is safe within your system.

Protection in Conflict Zones

For facilities operating in rough neighborhoods or conflict zones, the stakes are even higher. 

In conflict zones, hospitals and medical facilities might have some leverage, but only just. And that wiggle room can be found in the Geneva Convention, which states that healthcare facilities are not to be attacked as long as they are fulfilling a medical function. 

But the truth is a lot different.

There are always attacks on healthcare facilities in these areas. In fact, health facility attacks intensified in the past couple of years, with more than 900 health workers killed in 2024 alone. 2025 was even worse.

Knowing that there’s a law somewhere protecting your facility is one thing, and it may not be enough. You need to have an actual security plan that reflects the risk to your facility.

The same thing applies if your facility is located in a rough neighborhood.

Why Security Is Critical in Healthcare

Maybe your healthcare facility has been enjoying people and tranquility, and now you’re wondering, “Why bother?” Here are three reasons to care.

  1. Patient and Staff Safety. First, it keeps people alive. Your patients and your staff. A secure facility has fewer injuries, fewer infections, and fewer incidents. People trust you more when they feel safe.
  2. Operational Continuity. Next, it keeps your doors open. A data breach can shut down your facility for weeks. A violent incident? It can also shut you down for weeks while the authorities investigate. Bottom line? Security failures cost money.
  3. Financial and Legal Exposure. According to the American Hospital Association, violence can cost healthcare facilities an estimated $18.27 billion. It might not be that much for your facility, but you get the picture. Without a proper security posture, you’re exposed both financially and legally.
  4. Reputation. Finally, it protects your reputation. It takes little to damage the reputation you’ve spent years building. One bad breach. One viral video of a fight in your waiting room. Suddenly, nobody trusts you anymore. Hospitals run on credibility. Lose that, and you lose everything.

Is Your Healthcare Facility Secure Enough?

Now that you know why security is important in healthcare facilities, ask yourself, is your security system secure enough?

The truth is that when your doctors and nurses feel safe, they provide better care. When patients feel secure, they heal faster. And of course, better patient outcomes speak well for your hospital.

So, investing in hospital security isn’t just an item in your budget. It’s an investment in your people, your patients, and your community.

Just like you wouldn’t run a hospital without electricity, don’t run one without real protection either.

Author Bio:
Marchelle Abrahams

Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks

 

 

Please also review AIHCP’s Health Care Leadership Certification program and 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 Makes Traumatic Grief Different?

Posted on by Joseph Gerard

Grief - human hands holding black silhouette wordWritten by Marko,

The idea of saying goodbye to someone you love forever is heartbreaking. 

But, as hard as it is, it’s a different kind of hurt when you compare it to losing someone out of the blue. It’s sad, but the truth is, being able to say goodbye is a privilege not everyone gets. 

You have time to sit with it, and to hold your loved one’s hand, even if it’s for the last time.

Then there’s the other way, when you’re just living your normal life. And someone knocks on your door and tells you your loved one is just… Gone. Just like that. No last conversations, no warnings. One minute they’re here, the next, they aren’t, and there’s nothing in between that. 

This kind of shock leaves your brain stuck, and that stuck place is called traumatic grief.

In this article, we’ll go over the differences between traumatic grief and what people call normal grief. And if you’re wondering why that difference is important, it’s because you can’t recover unless you know what you’re recovering from.

How Grief Usually Unfolds When Loss Is Expected

Grief always hurts. There’s no way around that. It doesn’t matter if loss is expected; nobody can prepare for it in a way that doesn’t hurt. 

But the hurt usually doesn’t come all at once. Instead, it follows a somewhat steady path. Imagine if a person has a family member who’s terminally ill. They know what’s coming, and the hard moments come little by little. The whole thing feels like this heavy burden they’re carrying around all the time, and when the time comes, and they finally lose their loved one, they already saw it coming.

This all gives the brain some time to prepare.

That doesn’t mean that there’s a way to be actually ready for what’s going to happen, but you can’t help but have a sort of mental rehearsal going on in your head. So, you might cry in your car every few days, or you might imagine what your life is going to look like once that person is no longer here. There’s time, which means there can be closure, and closure is the first step towards healing.

Time also means emotions can adjust. 

By no means does that mean it follows neat little stages that come one after the other. Grief is messy, and some days are better than others. Still, the little things like going to work and making dinner help in keeping you grounded.

And as time heals you, you’ll still have all the memories of the person who’s no longer with you, but it’ll stop hurting (as much, anyway).

If the loss comes without any warning, though, none of this can happen.

What Changes with a Sudden, Traumatic Loss

It’s very frowned upon to say that one kind of grief is harder than another because everyone deals with grief in their own way. 

You can’t know how someone else is feeling, and you can’t be sure that you have it better or worse than they do. With that being said, the grief that accompanies traumatic loss is very different from the grief that happens after an expected loss, and some might say it’s harder. 

And they wouldn’t be wrong.

The hardest part of traumatic grief is that you now have to deal with two things at once. 

Sudden or violent loss measurably increases risk of prolonged grief/trauma (e.g., PTSD-like reactions). – National Institute of Mental Health

You feel the emotional loss, which is heavy enough on its own. But along with that, you’re also in complete and utter shock. And shock and sadness are two different emotions. 

When you’re in shock, it’s basically your brain slamming the brakes even though there was no yield or stop sign in sight.

For the most part, people go numb right after they hear the tragic news. Not in a cold way like they don’t care, but just blank.

Acute stress reactions )e.g., numbness, confusion, dissociation, etc.) are common side-effects of experiencing traumatic events. – Substance Abuse and Mental Health Services Administration

So, they’ll stare at a wall for an hour, or they’ll answer the door and forget they did it a few seconds later. They’ll hire a wrongful death attorney for fatal car crashes in Chicago when they should have hired one in Joliet, where they live. From the outside, this seems absolutely ridiculous, but two things are happening here: one, the brain is trying to protect you. 

And two, that loss made no sense, so it’s pretty much impossible to accept what’s happening. 

The brain keeps searching and searching for a connection between one moment where life was normal, and the next when it fell apart.

On top of all this, there’s also the real-life stuff to handle because there’s no grace period. You have to sign the papers here, make the calls there, decide on funeral arrangements and finances, and yes, hire a lawyer if someone else is to blame for the tragedy. 

It’s not that hard to believe that, because of dealing with all this, a person would forget they opened the door or hired a lawyer in the wrong city, isn’t it?

How Traumatic Grief Feels Different in Daily Life

Normal grief is heavy, but traumatic grief? That’s both heavy and confusing at the same time. 

Here’s what the difference looks like in everyday life.

There’s No Time to Prepare Mentally

If the loss came out of nowhere, the brain didn’t get any of the warning signs. 

No hospital stays, no bad test results, no slow decline, no last conversations… Nothing. As a result of this, the mind will continue acting as if the person is still alive, regardless of the fact that reality is different.

A person who’s grieving could find themselves picking up a phone to call their deceased loved one, or setting an extra plate for dinner. You might say this is pure denial and nothing else, but that’s not the case here. The brain is having a hard time catching up with what’s actually happening because nothing makes sense. 

The worst part is that this can go on for months.

The Body Stays Stressed

Grief consumes both mental and physical health, and with traumatic grief in particular, the body acts as if the danger is still here. You stay in that terrible fight-or-flight mode for a long time. You might notice your heart starts to race at random times, or you’ll jump at small noises.

Your body can stay in a constant state of heightened stress after experiencing trauma; this can negatively affect sleep, heart rate, body regulation, etc. – National Institute of Mental Health

And sleep? Now, that’s a battle every single night. 

You’ll either sleep too much or too little, but either way, you’ll never truly rest.

As crazy as it sounds, all this is normal. This is basically your nervous system doing exactly what it’s designed to do. The problem here is that there’s no ‘real’ threat to handle. Your mind thinks there is a threat, so it reacts accordingly.

Thoughts Keep Going Back to The Dreadful Event

Normal/regular grief revolves around someone’s memories about the person that’s gone (for the most part). These are inside jokes, things you’ll miss (laugh, jokes, routines, etc.) – the good times.

Traumatic grief is different. This type of grief is stuck on death where your mind replays a few moments over and over again. And it’s difficult to get out of that loop.

Core features of trauma-related conditions  are intrusive (negative) memories and repeated mental replay of the trauma. – U.S. Department of Veteran Affairs

The phone call, the news, the moment you found out, rinse and repeat, over and over.

You don’t consciously choose to think this; it simply shows up. The hardest part about this is that the brain is so focused on that tragic event that you can’t hold onto the happy memories.

It’s not that they’ve disappeared, but they’re buried under that replay button that refuses to stop.

It’s Harder to Find Closure

Harder, and even impossible. 

Normal grief gives you an ending. It’s not a happy ending, but it’s an ending nevertheless, where you might even get to hold the person’s hand and tell them you love them. It all makes sense, as painful as it is.

But there’s no ending with traumatic grief, and nothing makes sense anymore. 

Because of the absence of anticipatory coping/closure after experiencing unexpected loss a person can experience prolonged grief. – Harvard Medical School

So, in order to make it all feel sensical, the ‘what ifs’ start to pop up. What if they left 5 minutes earlier? What if someone had been there? 

None of that helps, but it also can’t go away. You know it’s irrational to play those scenarios over and over, but without a proper goodbye, your mind can’t wrap around the fact that this tragedy happened, and it can’t move past it.

Conclusion

None of this has anything to do with how much you loved the person. 

The only thing that matters is how the tragedy happened: was it expected, or was it a shock? And you might say that neither is worse, but truthfully, traumatic grief hits on more levels. Aside from the deep sadness, there’s also shock and pressure, with no soft landing in sight. It’s like your life just attacked you all of a sudden.

Make no mistake; just because you understand the difference doesn’t mean you can fix anything. But it’s useful because it explains why recovery is slower, and why everything feels more unpredictable. 

At the end of the day, if all you can know is that you’re not going insane, that’s still something.

Author Bio 

Marko is an adamant and eager content writer with a decade of experience in various niches,  with healthcare being one of them. With his way of implementing storytelling, comparisons, and examples into hard-to-grasp topics, Marko’s able to make complex things sound interesting and relatable – key ingredients to make something understandable. As a hobby, Marko enjoys offroading, board games, and spending time with his family and his dog Cezar.

 

 

Please also review AIHCP’s Grief Counseling Certification, as well as its Child and Adolescent Grief Counseling Program, Pet Loss Grief Counseling Program, Christian Grief Counseling Program, Grief Diversity Counseling Program, Grief Perinatal Program, Grief Practitioner Program and finally its Grief Support Group Leader Program.

Iatrogenic Addiction: When Treatment Becomes the Trigger

Posted on by Joseph Gerard

Medication management is a critical element of case management and patient recovery and overall health

Written by Stephanie Garner

Reduce suffering. That is the goal most clinicians carry into practice. But sometimes the treatment itself turns into the problem — a patient walks into a clinic with a fracture and walks out, weeks later, unable to stop taking the opioid prescribed for post-surgical pain. Iatrogenic addiction is the clinical term for substance dependence or compulsive behavior that originates directly from medical treatment. Vowles et al. (2015) found wide variation in rates of problematic opioid use in chronic pain studies, largely because studies used different definitions of misuse, abuse, and addiction. Their weighted estimates placed addiction in the 8% to 12% range. Even the lower estimates remain clinically significant because they affect a large number of patients exposed to long-term opioid therapy.

What makes it worse? Many of these cases begin with textbook prescribing. A five-day course of hydrocodone after knee surgery. Lorazepam for acute panic attacks. Nothing reckless. The slide from therapeutic use into dependence happens quietly, and clinicians are often the last ones to notice — partly because medical training has long treated addiction as something that happens to other people’s patients.

The Broader Addiction Spectrum

Treatment-induced dependence does not develop in a vacuum. Genetic factors play a role. So do environmental stressors and psychiatric comorbidity. All of it feeds into whether a given patient crosses the line from use into disorder. The addictions most often seen in people today can be triggered by a variety of factors. A clinician trying to understand where iatrogenic cases fit has to look at the full picture — the most common types of addiction seen in clinical practice range from alcohol and opioid use disorders to behavioral patterns such as gambling and disordered eating.

Here is why that range matters: if you only screen for prior substance misuse, you will miss the patient who has never used recreationally but happens to carry an OPRM1 polymorphism. Variants in genes such as OPRM1 may influence opioid response and addiction vulnerability, but they are not reliable stand-alone predictors of who will develop opioid use disorder (Mistry et al., 2014).

On paper, that patient looks low-risk. In reality, biological vulnerability can complicate that picture. There is also a classification issue. The DSM-5 collapsed “abuse” and “dependence” into one spectrum — substance use disorder, mild through severe. Iatrogenic cases sit awkwardly inside that framework. The patient may meet DSM-5 criteria for substance use disorder, but the origin of that disorder is medical. It matters for treatment planning, for prognosis, and for how the patient sitting across from you processes what went wrong.

High-Risk Medication Classes

Some prescriptions carry far more risk of iatrogenic addiction than others. Knowing which ones is not optional — it is the baseline.

Opioid analgesics are the most studied example. The CDC’s 2022 guideline advises prescribing opioids at the lowest effective dose and for no longer than needed, with a tapering plan when opioids are used around the clock for more than a few days. Many post-surgical patients in some settings go home with enough pills for two weeks because the discharge paperwork was written before anyone stopped to ask whether acetaminophen and a nerve block might have been enough. Hospitals know alternatives exist. Actually rewriting the default order sets is a different story.

Benzodiazepines come next. Alprazolam, lorazepam, diazepam — effective for acute anxiety, but tolerance and physiologic dependence can develop with ongoing use. Withdrawal after prolonged use can mimic the original symptoms, trapping patients in a dose-escalation cycle they didn’t ask for. Some patients do not realize they are dependent until they try to stop.

And then there are gabapentinoids — pregabalin, gabapentin — which got positioned as the safer alternative to opioids around 2015 and never lost that reputation. Prescriptions went through the roof. Emerging data challenges that assumption (Evoy et al., 2021). Z-drugs and stimulants carry their own dependence curves. The common denominator? Neuroadaptation. The brain adjusts, and adjustment is where dependence starts.

Risk Factors and Vulnerable Populations

It would be convenient if prior substance use history were the only red flag. It is not. Not even close.

Depression, PTSD, and generalized anxiety — each one raises the risk substantially. Chronic pain also increases risk, even before prescribing patterns are considered. Imagine a scenario where two people walk out of the same pharmacy holding the same bottle of oxycodone 5 mg. One had an appendectomy last week — healthy, stable, good support at home. The other? Fibromyalgia for eight years. Depression that nobody has treated. No therapist, no psychiatrist, no safety net. Same prescription. Wildly different risk profiles.

Age complicates things further. Benzodiazepine clearance slows down as patients get older — a 78-year-old on lorazepam is not going to process it the way a 45-year-old does, and the sedation piles up in ways that increase fall risk significantly. Teenagers are a different problem entirely. Adolescents prescribed stimulants need careful monitoring because these medications are Schedule II and have misuse potential, but appropriate ADHD treatment does not clearly increase later substance use disorder risk.

And across every demographic, fragmented care makes things worse. Three specialists, no shared chart, nobody coordinating. The orthopedist writes hydrocodone, the psychiatrist writes clonazepam, and the two of them have never spoken. Meanwhile, the patient’s medicine cabinet holds a combination that any pharmacist would flag — if anyone thought to ask.

Screening and Early Detection

Catching iatrogenic addiction early is possible. The tools exist. They are just underused. Tools such as SOAPP-R and CAGE-AID can support screening, but they measure different kinds of risk and should be used as part of a broader clinical assessment. These tools are brief and practical enough for routine clinical use. Yet both get skipped constantly.

Ongoing monitoring matters just as much. Prescription Drug Monitoring Programs operate in all 50 states now, but a 2023 study out of Minnesota found that four in ten opioid prescribers never checked the PDMP before writing a prescription (Sacarny et al., 2023). Four in ten. That is not an individual failing — it’s a systems problem.

The early warning signs are often subtle. A patient asks for a dose increase ahead of schedule, becomes anxious around refill dates, or shows pushback when tapering is discussed. These shifts deserve attention before anyone meets formal diagnostic criteria. Once someone is doctor-shopping or repeatedly presenting to the ED, the best window for early intervention may already have passed.

Prevention and Ethical Prescribing

The conversation about dependence risk needs to happen before the first pill is dispensed. Not in a consent form buried under six other documents — out loud, in plain language. Most patients do not get this conversation. They should.

When you spread pain management across multiple modalities, no single drug carries the full load. Chronic low back pain might respond better to a low-dose NSAID, physical therapy, and nerve blocks than to oxycodone alone. Same logic for anxiety — an SSRI plus psychotherapy is a different risk equation than a benzodiazepine and a six-week follow-up. None of this is new. It is just underutilized — reimbursement still favors pills over sessions.

Tapering deserves its own mention. Abrupt discontinuation of opioids or benzodiazepines can cause significant withdrawal symptoms, and with benzodiazepines in particular, sudden cessation can trigger seizures. Evidence-based deprescribing guidelines outline gradual dose-reduction strategies that are safer and more practical in clinical care (Pottie et al., 2018). Some of this work also has to happen at the institutional level. Systems that require PDMP review when opioids are prescribed, and that audit whether those checks occur, are more likely to catch high-risk prescribing patterns that individual clinicians may miss.

Implications for Healthcare Education

This is where medicine has genuine catching up to do. A scoping review found very limited coverage of opioid use disorder within the broader literature on substance use disorder education in medical schools. Medical schools have often devoted limited curricular time to addiction education, and that gap shows in clinical practice. Students graduate knowing oxycodone’s pharmacokinetics but not how to recognize when a patient is sliding toward dependence on it.

Continuing education has to pick up the slack. Nurses, counselors, case managers, pharmacists — these professionals encounter iatrogenic addiction regularly, sometimes before the prescribing physician does. Certification bodies need to make addiction-risk literacy a requirement. The LCME still does not mandate specific SUD education hours, so each school decides for itself. A handful — Virginia Commonwealth among them — have embedded addiction rotations into clerkships. Most have not.

I realize “add more training” sounds like a platitude at this point. But the ask here is specific: if you can prescribe a Schedule II controlled substance, you should be able to explain — in clinical terms — how that substance produces dependence. If you can’t, the training failed you somewhere.

Conclusion

First, do no harm. Everyone learns that phrase. Iatrogenic addiction is what it looks like when we fail at it — not because anyone acted with bad intent, but because the screening wasn’t done, the training wasn’t there, or the system made it too easy to keep refilling a prescription nobody was monitoring. The prescriber has to look at their own patterns honestly. The institution has to fund PDMP integration and real addiction coursework, not a single noon lecture during orientation week.

The patients who developed dependence through medical treatment did nothing wrong. They followed instructions. They trusted the system. Earning that trust back means doing the structural work — and then doing the harder thing, which is admitting out loud where we got it wrong.

References

Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recommendations and Reports, 71(3), 1–95.

Evoy, K. E., Sadrameli, S., Engel, J., Covvey, J. R., Peckham, A. M., & Morrison, M. D. (2021). Abuse and misuse of pregabalin and gabapentin: A systematic review update. Drugs, 81(1), 125–156. https://doi.org/10.1007/s40265-020-01432-7

Mistry, C. J., Bawor, M., Desai, D., Marsh, D. C., & Samaan, Z. (2014). Genetics of opioid dependence: A review of the genetic contribution to opioid dependence. Current Psychiatry Reviews, 10(2), 156–167. https://doi.org/10.2174/1573400510666140320000928

Muzyk, A., Smothers, Z. P. W., Akrobetu, D., Ruiz Veve, J., MacEachern, M., Tetrault, J. M., & Gruppen, L. (2019). Substance use disorder education in medical schools: A scoping review. Academic Medicine, 94(11), 1825–1834.

Pottie, K., Thompson, W., Davies, S., Grenier, J., Sadowski, C. A., Welch, V., Holbrook, A., Boyd, C., Swenson, R., Ma, A., & Farrell, B. (2018). Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline. Canadian Family Physician, 64(5), 339–351. https://pmc.ncbi.nlm.nih.gov/articles/PMC5951648/

Sacarny, A., Williamson, I., Merrick, W., Avilova, T., & Jacobson, M. (2023). Prescription drug monitoring program use by opioid prescribers: A cross-sectional study. Health Affairs Scholar, 1(6), qxad067.

Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., Ney, J. P., & van der Goes, D. N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain, 156(4), 569–576.

 

Author bio: Stephanie Garner, MS, is the Chief Executive Officer of ARVAC Incorporated in Dardanelle, Arkansas, where she has served since 2013. She holds a Master of Science in College Student Personnel from Arkansas Tech University and a Bachelor of Science in Political Science from the University of the Ozarks.