Author: Joseph Gerard

How Small Clinics Streamline Vendor Payments

Posted on by Joseph Gerard

Please also review AIHCP's Healthcare Case Management Certification and see if it meets your academic and professional goals

Written by Sarah Jenkins,

In the intensity of small clinic operations, it’s typical to see focus placed on providing the best outcome for service users, which inevitably means making compromises in other areas due to a lack of adequate people power. Such a strategy might make sense from moment to moment, but the big-picture perspective provides clear evidence that if important pieces of admin are sidelined, the knock-on effects can be catastrophic. Imperfect vendor payment management is a prime example, as missteps here can leave dents in your medical supplies and even have a deleterious impact on facility upkeep.

All of this sounds daunting. But the reality is that making the most of modern tools and tactics can iron out all manner of issues with paying vendors promptly.

If you’re still on the fence about whether it’s actually necessary to take action, consider the fact that processing an automated invoice takes 3.3 days, compared to 2 weeks for manual systems, according to the CAQH Index Report. Such a dramatic reduction in time, as well as the shift away from manual processes which would otherwise monopolize the working day of at least one team member, allows office managers to focus on patient coordination rather than tracking down lost paper trails or managing disgruntled contractors waiting on late payments.

Building The Foundation Of A Reliable Intake System

The efficiency of a vendor payment workflow is like medical billing, in that it’s determined early on, long before a check is cut or an ACH transfer is initiated. It begins during the vendor onboarding phase, where legal and financial expectations are set. Many clinics fail because they treat onboarding as an afterthought, leading to frantic requests for W-9 forms during tax season or payment delays when insurance certificates expire.

Standardizing the intake process ensures that every service provider, whether they are a recurring medical waste disposal company or a one-time flooring contractor, meets the clinic’s compliance standards. Collecting a Form W-9 before the first invoice is processed is a non-negotiable step that prevents backup withholding penalties from the IRS. Without this document, the clinic remains at risk for significant fines during an audit.

For specialized facility repairs, such as HVAC or plumbing, the documentation becomes even more granular. Administrators need to verify that contractors carry the appropriate liability insurance and workers’ compensation coverage to protect the practice from litigation. A centralized digital repository for these documents ensures that payments are never issued to non-compliant vendors, creating a natural gatekeeper for the clinic’s funds.

Small clinics often find success by adopting digital tools that mimic the transparency found in professional service industries. When a clinic works with tradespeople, they often encounter a contractor estimate app like Joist which provides clear, professional breakdowns of labor and materials. This level of detail helps administrators understand exactly what they are paying for, allowing for faster internal approvals and reducing the back-and-forth communication that typically slows down the accounts payable cycle.

Establishing clear communication regarding payment terms is the final piece of the intake puzzle. Most vendors default to Net 30 terms, but clinics can often negotiate better rates or prioritized service by offering shorter windows, such as Net 15, in exchange for a small early payment discount.

Streamlining Approval Tiers And Purchase Orders

Once a vendor is onboarded, daily invoice management requires a structured hierarchy to prevent unauthorized spending and ensure accuracy. The use of Purchase Orders (POs) is a gold standard in healthcare because it creates a pre-approved spending limit for specific services. When an invoice arrives, it is matched against the PO and the packing slip, a process known as three-way matching.

Approval tiers add a necessary layer of security, especially in clinics with multiple departments or locations. For example, a department head might have the authority to approve medical supply orders up to $500, while any facility repair exceeding $2,000 might require the signature of the practice manager or the physician-owner. This prevents “maverick spending” and ensures that the clinic stays within its monthly operational budget.

To maintain a smooth workflow, clinics should follow these specific steps:

  • Digital capture of all incoming invoices through a dedicated email address
  • Automatic routing to the designated department head for initial verification
  • Final authorization by the practice manager before the payment is queued

Moving away from physical sign-offs is essential for clinics that want to remain agile. Paper-based approvals are notorious for getting buried under patient charts or lost in inter-office mail. A digital approval workflow provides a time-stamped audit trail that shows exactly who approved a payment and when, which is invaluable during year-end financial reviews.

Emergency repairs often bypass the standard PO process, leading to chaos in the general ledger. To mitigate this, clinics should establish “emergency spending caps” for trusted vendors. If an HVAC unit fails during a summer heatwave, the facility manager should have pre-authorized approval to approve the repair up to a certain dollar amount without waiting for a board meeting.

Transitioning To Secure Digital Payment Methods

The final stage of the workflow is the actual disbursement of funds. While paper checks were once the backbone of small business commerce, they are increasingly viewed as a liability in 2026. Data shows that paper checks remain the primary target for fraud, accounting for 63% of payment security breaches.

ACH transfers and virtual cards have emerged as the superior alternatives for small clinics. ACH is cost-effective and integrates directly with most accounting platforms, reducing the manual labor required for reconciliation.

Virtual cards go a step further by offering “single-use” credit card numbers for specific transactions. This is particularly useful for one-time vendors or emergency contractors, as it allows the clinic to set a strict limit on the card that expires immediately after use.

Virtual cards also provide automated reconciliation. Because each card is tied to a specific vendor or project, the accounting software can automatically categorize the expense, saving the bookkeeper hours of manual data entry. This level of precision ensures that the clinic’s financial statements are always up to date and accurate.

Managing change orders in construction or facility maintenance is another area where digital payments shine. When a roofing contractor discovers unforeseen damage during a repair, the budget can shift instantly. Having a digital system that allows immediate adjustment of a virtual card limit or rapid approval of a revised estimate prevents project delays and keeps the vendor-client relationship healthy.

Ensuring Audit Ready Records And Compliance

The ultimate goal of a streamlined vendor payment process is to produce records that can withstand the scrutiny of an audit. Whether it is a routine tax audit or a more rigorous healthcare compliance review, the clinic must be able to prove that every dollar spent was authorized, documented, and paid to a legitimate entity.

A centralized document management system links the original estimate, the approved PO, the final invoice, and the payment confirmation. This “golden thread” of information prevents double payments or fraudulent invoices from slipping through the cracks. In a high-stakes environment like healthcare, this transparency is the best defense against financial mismanagement.

Standardizing these processes also simplifies the transition in the event of turnover among administrative staff. When the workflow is documented and digital, a new office manager can quickly understand the status of every pending invoice without having to dig through filing cabinets. It creates institutional knowledge that protects the clinic’s operational continuity.

For more insights on optimizing the administrative side of your healthcare practice, we recommend exploring our internal blog resources on medical billing efficiency and practice management strategies.

Integrating Service Professionals For Smooth Facility Management

Facility maintenance often presents the most volatile variable in a clinic’s budget due to the unpredictable nature of structural repairs. The majority of plumbing calls qualify as emergency dispatches, meaning a clinic’s payment workflow must be agile enough to handle immediate billing without compromising oversight. When a pipe bursts or the HVAC fails, the administrative team cannot afford to spend three days debating internal approvals while the lobby floods.

Modern medical administrators are increasingly looking toward the service industry for cues on how to handle these rapid-fire transactions. Many elite tradespeople provide transparent, line-item quotes that can be approved via a smartphone in seconds. By demanding this level of professional digital documentation from your HVAC or electrical partners, you eliminate the guesswork from facility overhead.

The goal is to create a symbiotic relationship in which the vendor is paid instantly for their expertise, and the clinic retains a clean, audit-ready record of the work performed. This prevents the common trap of verbal agreements that lead to billing disputes six months later during a financial review. A structured payment path for these external pros ensures the physical environment remains as healthy as the patients being treated inside it.

Modernizing The Clinical Back Office

Implementing these changes requires an initial investment of time and a shift in mindset, but the long-term rewards are undeniable. By moving toward a digital-first approach to vendor payments, small clinics can reduce their overhead costs, strengthen their relationships with essential service providers, and protect themselves from the growing threat of financial fraud.

The transition from manual chaos to automated precision allows the clinic’s leadership to focus on what matters most: providing exceptional patient care. When the lights stay on, the supplies are stocked, and the contractors are paid on time, the entire ecosystem functions at its highest potential.

Author Biography

Sarah Jenkins, MHA

Sarah is a veteran practice management consultant with over 15 years of experience helping small and mid-sized healthcare facilities optimize their operational workflows. She holds a Master of Health Administration and is a certified Healthcare Financial Professional. Sarah specializes in the intersection of clinical excellence and administrative efficiency, focusing on how digital transformation can reduce burnout in the medical office.

 

References

Internal Revenue Service. (2025). About Form W-9, Request for Taxpayer Identification Number and Certification. https://www.irs.gov/forms-pubs/about-form-w-9

AFP. (2025). 2025 AFP Payments Fraud and Control Survey. https://www.financialprofessionals.org/training-resources/resources/articles/Details/companies-stick-with-check-payments-despite-fraud-risk

CAQH. (2025). The 2025 CAQH Index 

https://www.caqh.org/insights/index-report

 

 

 

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

Vision and Vestibular Rehab After Concussion Explained

Posted on by Joseph Gerard

Brain Injury word cloud on a white background.Written by Dr. Elias Thorne,

Concussions are incredibly common, and while more is being done to raise awareness about the dangers they pose to long-term health, there’s still much more that the healthcare sector must do to educate people about possible outcomes of head injuries, while also ensuring clinical staff are up to speed with the symptoms and rehabilitation options available to patients already in the system. Symptoms of persistent dizziness and visual issues are especially common in the aftermath of a concussion, although it’s reasonable to claim that such side effects used to be dismissed as minor, resulting in little to no direct treatment. With time and research into concussions, it’s become apparent that recommending a patient sit passively in a dark room simply isn’t sufficient.

The known impact of mild traumatic brain injuries (mTBI) on the overlapping systems governing sight and balance comes from patient self-reporting. Here, the problem is that clinicians have to rely on what they’re told about the symptoms, rather than being able to fire up the CT scanner and use it to pull up unambiguous evidence of the damage that’s been done. The vestibular and ocular systems have a fragile symbiosis that seems easily sent off-kilter by mTBIs, and as we expand our understanding of this relationship and how it can be disrupted, we’re also developing improved frameworks and techniques for rehab.

The top-level goal of visitation and vestibular rehab is to bring these systems back into alignment, essentially righting them after the disruption of a concussion, so it’s not necessarily a swift or linear process. Even so, understanding what’s involved helps elucidate the inner workings of clinical steps and decisions in this context.

The Mechanism of Post-Concussive Sensory Mismatch

The primary purpose of the vestibular system is to give the body a real-time sense of where the head is in three-dimensional space, with a complex configuration of semicircular canals and otolith organs in the inner ear delivering the necessary data for the brain to interpret this status. The interaction with vision occurs in the provision of secondary confirmation of what the vestibular system tells us, which is why confusion can occur in a moving vehicle. If our ears tell us our head is stationary, but our eyes tell us it’s moving rapidly, the result is dizziness and nausea, at least for some people.

Similarly, a concussion intervenes between what our eyes and ears tell us, resulting in a range of symptoms, including a sense that the world is lagging, a little like a video game, or that we’re on unstable ground, perhaps mimicking the feeling of being on a boat. This is often the result of a faulty Vestibulo-Ocular Reflex (VOR), which is the mechanism that keeps your vision stable while your head is moving.

If the VOR is impaired, the brain has to work overtime to make sense of the conflicting data. This leads to the profound cognitive fatigue that characterizes the post-concussive state. It is not just that the eyes are tired; it is that the processor is overheating as it tries to reconcile the mismatched inputs.

Comparing Vestibular Therapy and Clinic-Based Vision Rehab

While they are often grouped together, vestibular therapy and vision rehabilitation target different components of the recovery puzzle. Vestibular therapy focuses on habituation, gaze stabilization, and balance training. It is about teaching the brain to ignore “false” signals and rely on the accurate ones.

Vision rehabilitation, specifically Neuro-Optometric Rehabilitation, addresses the motor aspects of how the eyes move and work together. This includes addressing issues such as Convergence Insufficiency (CI), where the eyes struggle to converge to focus on near objects, and saccadic dysfunction, where the eyes jump and skip during reading.

Clinicians are increasingly using computer-guided protocols to provide high-resolution feedback during these sessions. These tools allow for the precise measurement of reaction times and accuracy that the human eye simply cannot track. You can view this concussion clinic to see how these specialized assessments are integrated into a cohesive recovery plan for patients struggling with these specific deficits.

Research has shown that early office-based vergence and accommodative therapy significantly improves symptoms compared to a “wait and see” approach. The shift toward active intervention within the first two weeks of injury is perhaps the most significant change in concussion management in the last decade.

Computer-Guided Protocols and Evidence-Based Interventions

The digital evolution of rehab has changed the way we quantify progress. In 2026, we are no longer relying solely on a patient saying they “feel better.” We are looking at objective data from force plates and eye-tracking software.

These computer-guided systems provide a level of consistency that manual testing lacks. For instance, a patient might perform a gaze stabilization exercise while a sensor tracks their head velocity. If they can maintain focus at 120 degrees per second but lose it at 150 degrees per second, the clinician has a specific, measurable target for the next session.

Current clinical protocols suggest a specific hierarchy of intervention for maximum efficacy:

  • Address acute BPPV or mechanical inner ear issues first to clear the signal
  • Implement gaze stabilization exercises to reinforce the connection between the inner ear and eye movement
  • Progress to dynamic balance tasks that incorporate cognitive load to simulate real-world environments

This progression ensures the patient is not overwhelmed too early. If you try to do complex vision therapy while the vestibular system is still sending “spinning” signals, you will likely induce a symptom spike that sets the patient back several days.

Clinical Training Pathways For The 2026 Landscape

For healthcare providers looking to bridge the gap into specialized concussion care, the requirements are becoming more rigorous. It is no longer enough to be a generalist physical therapist or optometrist. The complexity of the 2026 patient requires a multidisciplinary understanding of neurology.

Advanced courses now focus heavily on central causes of dizziness and cervical integration, acknowledging that the neck often plays a massive role in “dizzy” presentations. Proprioceptive sensors in the upper cervical spine are frequently damaged in the same whip-lash motion that causes a concussion.

If the neck tells the brain the head is turned five degrees to the left, while the eyes and ears say it is centered, the result is dizziness. Training pathways now emphasize this “Cervicogenic” component, requiring clinicians to be as proficient in manual therapy as they are in vestibular habituation.

Outcome Measures And The Role Of Patient Education

Success in rehab is defined by the patient’s ability to return to their life. While objective metrics are vital for the clinician, the patient cares about whether they can look at a computer screen for an hour without a migraine.

We use the Dizziness Handicap Inventory (DHI) and the Post-Concussion Symptom Scale (PCSS) to track the subjective experience. However, patient education remains the most powerful tool in the shed. When a patient understands that their dizziness is a “data mismatch” rather than permanent brain damage, their anxiety levels drop.

Lower anxiety leads to better autonomic regulation, which in turn speeds up the healing process. It is a virtuous cycle. We must teach patients how to “pace and space” their activities, ensuring they are pushing into their symptoms enough to provoke adaptation, but not so much that they crash.

Multimodal Integration Of Sensory Systems

The most effective treatment plans are rarely monochromatic. They are a blend of physical therapy, neuro-optometry, and, sometimes, occupational therapy for environmental modifications. The goal is to create a controlled, “sensory-rich” environment.

In a 2026 clinical setting, this might look like a patient performing balance tasks on an unstable surface while wearing strobe glasses that limit visual input. This forces the brain to up-weight the vestibular and somatosensory systems. By stripping away one sense, we strengthen the others.

This interprofessional approach ensures that no stone is left unturned. If a patient is plateauing in vestibular rehab, the neuro-optometrist might find a latent vertical heterophoria (a slight vertical misalignment of the eyes) that was sabotaging the balance work all along.

Visual Strain And The Mechanism of Post-Concussive Dizziness

There are over 400 patients seeking specialized neuro-rehab every day because their eyes and ears no longer speak the same language. This sensory mismatch is the primary engine behind the chronic nausea and “spatial anxiety” that keeps high-performing professionals away from their desks. When the vestibulo-ocular reflex is disrupted, the brain cannot differentiate between the world moving and the head moving.

Visual strain in these cases is rarely due to eyesight quality or basic refraction. It is a functional deficit in the brain’s integration of focal and peripheral data streams. If your peripheral vision is “too loud,” every movement in your environment feels like a personal threat to your balance.

Clinical research confirms that 82 percent of post-concussion patients suffer from specific oculomotor issues that cannot be resolved through rest alone. These patients require a deliberate recalibration of the neural pathways that govern gaze stability.

Measuring Success Through Integrated Symptom Tracking

We no longer rely on a patient simply saying they feel better, as subjective reporting is notoriously unreliable during neurological recovery. Modern clinics use force plates and infrared eye-tracking to provide a digital “scorecard” of progress. This allows us to adjust the difficulty of rehab exercises in real time, ensuring the patient is always in the “Goldilocks zone” of neuroplastic change.

Success is defined by the ability to handle increased cognitive and physical loads without a symptom “crash.” By tracking these metrics weekly, we can provide patients with a concrete timeline for their return to life, significantly reducing the psychological burden of the injury.

Precision Medicine In Neurological Recovery

The future of concussion care is moving toward precision medicine. We are getting better at identifying “phenotypes” or clinical trajectories early on. Some patients are primarily “vestibular-ocular,” while others are “autonomic/exertional” or “migraine-associated.”

Identifying these subtypes in the first week allows us to skip the trial-and-error phase. A patient with a clear vestibular-ocular profile should be in specialized rehab by day ten, not month three. The evidence is clear: the longer these systems remain uncalibrated, the more the brain “hard-wires” the maladaptive patterns, making them much harder to break later on.

About The Author

Dr. Elias Thorne is a clinical neurologist specializing in traumatic brain injury and vestibular disorders with over a decade of experience in multidisciplinary rehabilitative settings. He has consulted for professional athletic organizations and currently contributes to the development of integrated sensory-motor protocols for post-concussion recovery. His work focuses on the intersection of neuroplasticity and digital health interventions.

References

Melissa Biscardi, Zane Grossinger, Angela Colantonio, Mark Bayley, Tatyana Mollayeva (2024).  Efficacy of restitutive interventions for oculomotor deficits in adults with mild traumatic brain injury: a systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/38433498/

Traumatic Brain Injury Center of Excellence. (2026). Assessment and Management of Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager. https://health.mil/Reference-Center/Publications/2026/02/04/Assessment-and-Management-of-Dizziness-and-Visual-Disturbances-Following-Concussion-Mild-Traumatic-Brain-Injury 

Tara L Alvarez, Mitchell Scheiman, et al (2026). CONCUSS randomised clinical trial of vergence/accommodative therapy for concussion-related symptomatic convergence insufficiency. British Journal of Sports Medicine, Volume 60, Issue 5 https://bjsm.bmj.com/content/60/5/340

 

 

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

Managing Complex Needs in a Home Environment

Posted on by Joseph Gerard

Nurse Discussing Records With Senior Female Patient During Home Visit Sitting On Sofa ReassuringWritten by Lucy Peters,

 Home is more than just a roof over our head. It represents familiarity, routine, autonomy and emotional security. That is one reason healthcare systems in many countries increasingly recognize the value of supporting people in their own homes for as long as safely possible. Ageing populations, rising hospital pressures and the preference many patients express for independent living have all accelerated interest in home-based care models.

 At the same time, the phrase care at home can sometimes be misunderstood. To outsiders, it may sound limited to companionship or help with daily tasks. In reality, modern home care often involves the management of highly complex physical, emotional and clinical needs that once would have been associated primarily with hospitals or residential facilities.

 This shift raises an important conversation for clinicians, care managers and families. How can compassionate companionship be integrated with structured healthcare support in the home environment?

 Companionship has clinical value

 Companionship is sometimes framed as separate from healthcare, but the two are closely connected. Loneliness and social isolation have been associated with poorer physical and mental health outcomes, prompting the US Surgeon General to describe social disconnection as a significant public health concern. For older adults or individuals living with chronic illness, regular human contact can support wellbeing in several ways:

 Improved mood and emotional resilience

  • Greater motivation to eat, hydrate, and move
  • Better adherence to medication routines
  • Earlier recognition of changes in health status
  • Reduced anxiety during recovery periods
  • Continuity and reassurance for families

 A trusted caregiver who notices subtle changes in appetite, cognition, mobility or mood may become an important early warning system. In that sense, companionship goes beyond mere social comfort. It can contribute directly to clinical stability.

 Choosing the right model of home care

The needs being managed at home today are often substantial. Individuals may be living with combinations of dementia, frailty, diabetes, cardiovascular disease, mobility impairment and anxiety to give just a few examples. Supporting such individuals safely requires more than kindness alone. It calls for communication skills, observation, safeguarding awareness, escalation protocols and coordination with medical professionals. In other words, home care has evolved into a multidisciplinary environment where personal support and clinical oversight frequently intersect.

One of the most important practical decisions is selecting the right level of support. Some people benefit from scheduled visits throughout the week, while others need continuous presence, overnight reassurance or immediate help with mobility and personal care. Families comparing options often ask whether hourly support or round-the-clock care is more appropriate. The correct answer depends on a host of factors, including clinical risk, cognitive status, social support, home layout and patient preference. Cost is also an inevitable consideration.

 The home as a care setting

Environment shapes outcomes. Hospitals are designed for treatment efficiency, but they can also disrupt sleep, reduce orientation and increase stress. This is particularly so for older adults or those with dementia. Home settings often preserve routines and components that matter including the following:

  •  Familiar bathrooms and bedrooms
  • Known meal patterns
  • Preferred sleep schedules
  • Access to pets or gardens
  • Emotional comfort from personal possessions
  • Easier contact with neighbours or family

These factors may seem small, yet in combination, they can significantly affect mood, cooperation and confidence. For example, a patient recovering from illness may mobilize better in familiar surroundings than in an institutional setting. Someone with cognitive decline may remain calmer when not repeatedly exposed to unfamiliar environments.

One of the biggest advances in home care is the ability to deliver structured monitoring without creating a medicalised atmosphere. Blood pressure checks, glucose monitoring, medication prompts, hydration tracking, falls prevention strategies, wound observation and symptom escalation pathways can all be incorporated into everyday living. It doesn’t mean turning the home into a hospital. The goal is to embed sensible clinical vigilance within normal life. That distinction matters psychologically, as many people accept support more readily when it feels enabling rather than institutional.

Communication and preventing escalation

Families often focus on tasks such as bathing, medication, mobility or meals. Yet communication may be the most important intervention of all. A skilled caregiver knows how to reduce agitation through calm tone and pacing, to preserve dignity during intimate care, to encourage cooperation without confrontation and to reassure anxious relatives or pass on accurate updates to nurses or physicians. It is easy to dismiss these skills as secondary, but they can be the factor that determines whether or not a care plan succeeds. Poor communication may lead to resistance, distress, missed medication or avoidable hospital admission.

One underappreciated benefit of effective home support is the prevention of deterioration. A caregiver who notices swelling, confusion, reduced appetite, increasing breathlessness or repeated near-falls may prompt earlier intervention before a crisis develops. Likewise, consistent routines around hydration, movement, toileting and medication can reduce complications that commonly trigger emergency care. For health systems under pressure, this preventative value is significant, and for families, it can prove absolutely priceless.

 Supporting the family unit

This brings us on to an important but often overlooked consideration. Complex needs affect more than the patient. Spouses may become exhausted. Adult children may juggle work and caregiving. Family relationships can become strained when everyone feels responsible but no one feels equipped. Professional home support can restore balance in a number of ways, from the purely practical such as sharing practical workload to improving confidence in safety and offering clearer communication channels. This emotional stabilization of the family system can indirectly improve patient outcomes as well. When advising families, healthcare professionals should look beyond diagnosis alone. Questions may include the following:

  • Can the person transfer safely?
  • Are medications managed reliably?
  • Is there nighttime wandering or falls risk?
  • How much family support is realistically available?
  • Is nutrition declining?
  • Are loneliness or anxiety worsening symptoms?
  • Would continuous presence reduce avoidable risk?

These are functional questions, but they often matter as much as purely medical ones.

The future of home-based care

As populations age and healthcare resources remain stretched, more sophisticated care will continue moving into domestic settings. Technology will help through remote monitoring, telehealth, medication systems and digital care coordination. But technology alone cannot replace human presence.

Companionship, reassurance, observation, patience and trust remain deeply human forms of care. That is why the future of home healthcare is likely to be hybrid: clinically informed, professionally coordinated and relational at its core. Companionship should not be dismissed as a soft extra in healthcare. In many home environments, it forms part of the clinical foundation that keeps vulnerable people stable, safe and emotionally supported. Managing complex needs at home calls for thoughtful assessment, appropriate care models, communication skill and close attention to changing risks.

 Author bio

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

 

Please also review AIHCP’s 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

How to Coach Home Exercise Patients Over Video

Posted on by Joseph Gerard

The future of telehealth and its role in case management will continue to grow

Written by Angela Rivera,

Home exercise programs (HEPs) are essential for physical therapy success, yet adherence to HEPs remains a persistent challenge in rehabilitation. Even when patients understand their plan and express initial commitment, follow-through is rather abysmal. Some studies estimate non-adherence can go as high as 70%.

Telehealth has only complicated things for physical therapy. When there’s no physical presence, you have to rely entirely on observation, instruction, and patient self-report to guide performance. All flawed or incomplete data.

Still, there’s no doubt that telehealth offers advantages to both therapists and patients. You gain direct insight into the patient’s home environment (where adherence either succeeds or fails), and the patient enjoys greater comfort and convenience. Considering these advantages, why is adherence to HEPs so low?

Most breakdowns can be traced to two factors: patient-specific barriers (personal reasons) and program design flaws or limitations. While you cannot eliminate every personal constraint, you can significantly improve outcomes by refining how you design, teach, and monitor HEPs over video. Below, we outline structured, telehealth-ready approaches to help you do exactly that.

Video Coaching Changes How HEP Actually Works

Before we get to the practical coaching advice, let’s cover the basics first: how does video actually change HEP in practice? Setting aside, obviously.

Perhaps the most important change comes from your own clinical reasoning. Namely, video forces you to rely on observation and communication (instead of tactile cues) as your primary means of intervention. That means that any subtle compensations that you might correct instinctively in person now have to be noticed earlier and described clearly (and briefly enough that the patient can act on them).

Having said that, with video, you gain insight into something that rarely exists in clinic-based care: a patient’s home environment and therefore context you can trust. When you see the patient’s environment (the chair they always use, the limited space in a hallway, the distractions that compete for their attention, etc.), you’ll be able to quickly tell whether they’ll be able to adhere to the program or not. And that information will allow you to adjust it so it fits into the patient’s day instead of competing with it.

In other words, video coaching forces greater precision. Here, you can’t just prescribe exercises as you would in-person; you have to prescribe exercises while keeping in mind they will be carried out when you’re not there. So, small decisions like the camera angle, wording of a cue, or how many exercises you assign carry more weight than they might in person.

What “High-Quality” Means in a Home Exercise Program

Most adherence problems don’t start with patient motivation but with vague or impractical programs. If the HEP isn’t specific, adaptable, and easy to interpret without you there present, patients are bound to improvise or simply disengage.

The cure is a clear, high-quality HEP, one that tells the patient exactly what to do, how to do it, and what to expect when they do it correctly (and incorrectly).

At a minimum, your HEP should include:

  • Clearly defined exercises with dosage (sets, reps, tempo, rest)
  • A stated purpose (what impairment or function you’re targeting)
  • Symptom boundaries (what level of discomfort is acceptable)
  • Progression criteria tied to observable changes
  • A schedule that fits into the patient’s existing routine

But structure alone isn’t enough. The program also needs to anticipate friction. What happens if pain increases? What if the patient misses a day? What if they’re unsure whether they’re doing it correctly?

These questions cannot go unanswered if the goal is adherence. For a deeper look at how to build and refine these elements, including practical examples, you can refer to this guide on physical therapy home exercise programs, which expands on progression strategies and patient education in more detail.

Think of what we outlined here as your baseline. Everything that follows builds on how well this foundation holds up when you’re not physically present.

Screen for Risk and Constraints Before the Session Starts

To start, you want to make sure there are no surprises, so have a brief pre-visit screen that covers clinical risk and environmental constraints.

avoid any potential surprises and problems.

Before the session, screen for:

  • Cardiovascular or neurological red flags
  • Fall risk (especially for balance or gait tasks)
  • Pain irritability levels
  • Equipment availability

Ask direct questions: Where will you be doing the exercises? How much space do you have? What surface are you standing on? Do you have a stable chair or support within arm’s reach? These details determine whether your plan is feasible, not just appropriate on paper.

Also, during the session, confirm the patient’s physical location and an emergency contact protocol. If a patient becomes symptomatic (dizziness, acute pain, loss of balance, etc.), you need a clear plan for what happens next. Telehealth guidelines emphasize location verification and contingency planning as part of safe remote care, so this step is non-negotiable.

Set Up the Camera Like It’s a Clinical Tool

Poor camera positioning can undermine your assessment because you can’t correct what you can’t see clearly.

Ask the patient to:

  • Position the camera at joint level when possible
  • Use landscape orientation for full-body movements
  • Ensure adequate lighting from the front (not behind)
  • Keep enough distance to capture full movement arcs

And test it by spending the first few minutes adjusting angles. It takes a few moments only, but pays off later when you’re cueing subtle movement errors.

Demonstration Still Matters But It Needs Structure

Demonstrations are important, but they should be concise and purposeful. Long, uninterrupted explanations are actually counterproductive.

So, break it into steps:

  1. Show the full movement once at normal speed
  2. Repeat at a slower pace with key cues
  3. Highlight common errors (and how to fix them)

Then switch quickly to patient performance. The longer you talk, the less time they practice.

And consider your positioning because some patients struggle to repeat the exercise when switching from your orientation to theirs. You can help this by demonstrating from the same orientation they will use. Or, by explicitly stating left/right to avoid confusion.

Refine Your Cueing Strategy

Without tactile input, your words carry the intervention so they need to be clear and impactful.

Use:

  • External cues (“push the floor away”) rather than internal ones (“activate your glutes”)
  • Short phrases, not paragraphs
  • One correction at a time (cue after cue overwhelms patients)

And ask for feedback. A simple question like “What did that feel like?” often reveals whether your cue worked.

Of course, mirror neurons still play a role in video learning, but clarity matters more. Usually, patients don’t need more information, but the right information at the right moment.

Build in Adherence Tactics from the Start

Research shows that tailored programs and regular follow-up improve adherence significantly. So one of your main goals should be customization of the program so it’s tailored to your patient’s life.

The best way to do this is to tie exercises to your patient’s existing routines. So, instead of asking patients to “find time” for the HEP, attach exercises to their existing routines like morning coffee or evening TV.

For example, you can ask a patient with knee osteoarthritis to perform sit-to-stand repetitions immediately before meals, using the same kitchen chair each time. Or schedule thoracic mobility or cervical exercises directly after computer work sessions, when symptoms are typically most noticeable.

And use simple tracking tools:

  • Paper logs (still effective)
  • Mobile apps with reminders
  • Brief check-ins between sessions

Documentation and Tracking Outcomes

Telehealth documentation requires the same rigor as in-person care. In fact, it requires a few extra steps.

Include:

  • Patient location and consent
  • Technology used (platform, any issues)
  • Objective findings based on visual assessment
  • Patient-reported outcomes
  • HEP details and progression criteria

And if you’re tracking continuing education (CE) or competency logs, make sure your documentation aligns with measurable outcomes. It’s key to making your records actually usable for both clinical and professional development purposes.

Speaking of tracking outcomes, make sure you track those that actually matter, not every single detail. This includes pain levels (standardized scales), functional measures (like sit-to-stand reps, timed walks, etc.), patient-reported confidence or perceived effort, and finally, adherence.

And review these metrics with the patient. When they see progress, adherence improves.

Another thing outcome tracking helps with: your own progression decisions. With real, usable data, you can move from guesswork to data-driven adjustments.

Adapt for Different Abilities and Access Levels

Since not every patient will have the same technology, space, or physical capacity, you need to adapt your plan to each individual.

You can do this by planning for:

  • Low-bandwidth options (audio-only backup, simplified visuals)
  • Limited equipment (bodyweight alternatives)
  • Cognitive or language barriers (simpler instructions, visual aids)

And consider equity. Patients in rural or underserved areas may rely heavily on telehealth. Your ability to adapt directly affects their access to care. Digital literacy also varies, so spend time early on teaching patients how to use the platform.

Use Asynchronous Support Between Sessions

Video sessions don’t have to carry the full burden.

Between visits, you can:

  • Send short instructional videos
  • Provide written summaries of the HEP
  • Offer quick feedback on recorded patient performance

If your goal is better continuity, take this hybrid approach. With it, patients won’t feel “on their own” between sessions, which supports adherence.

Anticipate Common Failure Points

Some issues repeat across patients.

Expect:

  • Overload
  • Unclear instructions
  • Pain flare-ups without guidance
  • Scheduling conflicts

Address these proactively by limiting the number of exercises, clarifying stop rules, and offering flexible scheduling options (if possible).

Treat Video Coaching as a Skill

With video coaching, you don’t get the same tools as in-person care. That’s obvious. But you gain others, including direct visibility into the patient’s daily environment and a clearer sense of what will realistically happen once the session ends.

So approach video coaching as its own clinical skill set. The quality of your cueing, exercise selection, follow-up, and progression planning carries more weight when the patient performs most of the work independently.

In many cases, telehealth exposes weaknesses in HEP design faster than in-person care because patients cannot rely on constant correction or supervision. So it forces you to build programs that patients can actually understand, repeat, and sustain without you in the room. And ultimately, that is the real test of whether a home exercise program works.

References:

American Physical Therapy Association. (2020). Telehealth in physical therapy in light of COVID-19. 

Cottrell, M. A., Galea, O. A., O’Leary, S. P., Hill, A. J., & Russell, T. G. (2017). Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: A systematic review and meta-analysis. Clinical Rehabilitation

Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Manual Therapy

Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence. BMC Public Health

National Consortium of Telehealth Resource Centers. (2025). The telehealth policy cliff: Preparing for October 1, 2025. 

Author:

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

 

 

Please also review AIHCP’s Life Coach Certification program and Life Coach 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 to Prepare for a Malpractice Deposition

Posted on by Joseph Gerard

No matter how good a healthcare provider you are, most physicians eventually face a lawsuit case. Please also review AIHCP's Legal Nurse Consulting Program and see if it meets your professional goals

Written by Vivian Kane

There are thousands of medical malpractice cases filed every year, but only 7% go to trial, according to the U.S. Justice Department. Depositions become crucial, as they assess your credibility, clinical judgment, and professional composure in a high-stakes setting.

Approaching a deposition requires a shift in mindset from clinical collaboration to defensive precision. While your natural instinct is to explain and heal, the legal arena demands that you provide the narrowest accurate testimony possible to protect the defensibility of your care.

The blog post below will help you learn how to be well prepared, both factually and confidently, for a malpractice deposition.

Understand Why Clinicians Are Deposed

Depositions allow attorneys to gather evidence and evaluate a witness’s credibility through questioning. The testimony influences settlement offers and trial strategies, and everything stated is documented.

As a treating physician, you are deposed as either a fact witness or an expert witness. There are specific duties for each role. Understanding your function will help you realize how much or how little information to reveal and avoid expressing an inappropriate opinion.

Distinguish Between Fact and Expert Testimony

You will need to articulate your actions as well as your observations while treating the patient, but stick to what you know. Do not guess or speculate. Use language that aligns with the opposing lawyer, as they will compare your oral communication with official documentation.

Expert witnesses must give an opinion based upon their training and the standards of their profession. As an expert, you are required to articulate your reasoning and the materials upon which it is based. Combining the two duties without definition leads to a loss of credibility.

Review Medical Record Thoroughly

A thorough review of the patient’s chart needs to be conducted. Every section from nursing notes, labs, and all forms of communication should be thoroughly read. 

The record should be assessed for discrepancies in the timeline as well as those that can be exploited. Do not rely on your memory alone.

Your notes should be taken in such a way that you will be able to cite an entry as and when you need it. Critical information, such as the dates and times of certain events, must be clear. Preparing yourself will allow for accurate responses during the examination.

Build a Clear Timeline

Create a chronology of the treatment events. All aspects of the event must be captured and included, such as presentation, assessment, treatments, and follow-up care. A clean timeline will prevent unnecessary confusion.

Your timeline must align with the written record. You must be ready to explain a lapse in memory in a convincing manner.

Meet With Your Attorney Early

Your attorney will outline the theory of the case, potential questions, and your rights during the process. The initial interview is for you to gain an understanding of what to expect and where the dangers might lie. It’s not about being coached.

You must clarify your specific role in the case, fact, or expert witness during your meeting with the attorney. Together as a group, both attorney and clinician can thoroughly study critical areas and ensure wording is clear and concise.

Denver is a prime real world illustration to demonstrate the nature and treatment of malpractice cases during litigation. Competent medical negligence lawyers in Denver can collaborate with experts on medical record disclosures, claim valuations, and preparing testimonies.

Lawyers also prepare medical experts for testimony, which is crucial in influencing case outcomes. A thorough examination of the facts is essential for both the legal team and affected individuals to effectively navigate the litigation process and advocate for justice.

Learn the Deposition Process and Rules

A deposition is a pre-trial questioning process where the witness is questioned under oath, and the proceeding is recorded. Attorneys will pose the questions.

A court reporter will record every utterance. An attorney may object. Listen carefully to the entire question before responding.

You can ask for a question to be repeated. You have the right to take a break at any time unless there is a pending question. Knowing your rights allows you to maintain control and prevent mistakes.

Know Common Question Types

Attorneys frequently use leading questions or compound questions to ascertain where the response is derived from. The question also aims to ensure your testimony aligns with the chart. The goal is to know what you are to give your opinion on.

Identify the question patterns before answering. You should request that the questioner repeat the question, kindly. Do not answer a question if you are not prepared, if you do not have sufficient knowledge of the question.

Quick Preparation Checklist:

  • Confirm your role and scope of testimony
  • Review all relevant records and communications
  • Prepare a clear timeline of care
  • Meet your attorney to discuss strategy
  • Identify areas that require careful wording

Answer Questions Clearly and Concisely

The short answers limit the potential for error, so answer only the exact question that is posed and then stop. Give long answers only when your attorney has instructed you to provide background information.

Your answers should be kept in simple language that any layperson can understand and free of jargon or unnecessary complexity. Define any necessary technical terms briefly, it helps keep the record clear and reduce confusion during subsequent proceedings.

Be Careful with Trick Questions

Some questions aim for speculative or definitive answers. Avoid generalizations with words like “always” or “never.” Stick to the facts in the record and respond within the bounds of what is knowable and unknowable.

Say when you don’t know the answer and if appropriate, ask for the documentation you need to refer to, to give the correct answer. You are not going to be rewarded with speedy, but incorrect, answers.

Use Controlled Language

Answer cautiously with words such as “appears” or “to the best of your knowledge” when appropriate. Technical contexts are most suitable with language that indicates that the answer is being formed on the basis of the record and to a reasonable degree of medical certainty.

Using a cautious language helps structure your thoughts, leading to clear and organized responses. It prevents lengthy, unfocused replies and promotes professionalism, especially in discussions of complex subjects.

Respect Privacy and HIPAA Boundaries

You cannot share anything except facts and information specific to the case that you are legally allowed to disclose. Do not mention details about other patients or unrelated medical information. You must keep confidentiality at all times.

Professionals should stop all work when a particular situation demands that they protect information that would jeopardize the case if shared with unauthorized individuals. HIPAA is critical throughout the deposition process. Essential conduct reminders for the room include:

  • Answer truthfully without volunteering extra information
  • Remain strictly within the limits of your defined expertise
  • Pause for three seconds before answering any complicated questions

Prepare for Questions on Standards of Care

You will need to explain how other doctors in a similar situation should have handled a specific case. The explanation should be based upon your knowledge of the literature, your training and experience, and authoritative medical literature.

You must not develop expectations of other doctors based upon your personal preferences. Both the minimal required elements and at least one possible valid method that fulfills those requirements should be established.

Reference Reliable Sources

It is essential that you are prepared to reference specific policies or medical literature that informed your opinion. While you won’t need to provide citations for every single source, a thorough understanding of the details underlying your testimony is crucial.

Your testimony should clearly connect your opinion to at least two relevant medical standards or scholarly sources. Be ready to explain how specific protocols or studies support your findings, demonstrating a solid basis for your assertions.

Engage in Mock Deposition Practice

Through pre-deposition training, people learn to recognize that they tend to give too much information and that their answers are more often speculative or not precise enough. If possible, the practice session should be recorded so it may be reviewed for assessment.

In a mock deposition, you will be assessed on your speaking ability and how well you respond to questions. Repeating the process will increase your comfort level and reduce anxiety for your deposition date.

Learn from Jurisdiction Specific Examples

Each jurisdiction has particular protocols to follow when attempting to submit a specialized expert to a court.

Colorado Malpractice Overview

Medical malpractice claims in Colorado are process driven, with strict requirements for filing, expert designation, and damages. Understanding the framework helps clinicians see how their testimony fits into a malpractice suit, as specific rules guide the case from claim to conclusion.

In Colorado, the plaintiff must state a claim within the limits of the statute of limitations, typically two years from when they knew or should have known about their injury. The claim also must be brought within three years of the allegedly wrongful act, although exceptions do apply.

Further, a certificate of review must be submitted. The certificate indicates a qualified medical professional has reviewed the case and found it to have merit. If no such certificate is produced, the suit is often thrown out of court at the beginning of litigation.

Delivering Accurate and Credible Testimony

Being prepared for the deposition will turn a stressful task into a professional procedure. When the time comes, respond to questions by understanding your role, researching the record, and practicing concise answers.

Everything should be conducted within the boundaries of the legal limitations and confidentiality obligations set forth for the entire procedure. You will be providing the most accurate and consistent testimony to maintain credibility with your meticulous preparation.

 

Author Bio

Vivian Kane is a health writer with a passion for improving care for the elderly. With over a decade of experience in healthcare policy and senior care, she focuses on educating the public about innovative trends and best practices in eldercare. Vivian has contributed to various healthcare journals and blogs. Her work aims to bridge the gap between healthcare professionals and caregivers, ensuring that the latest trends in eldercare education are accessible to everyone. When she’s not writing, Vivian volunteers at local senior care centers and advocates for better care standards for aging populations.

 

 

Please also review AIHCP’s Legal Nurse Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Developing Skills in Chinese Meridian Therapies for Healthcare Professionals

Posted on by Joseph Gerard

Chakra Clearing Tapping Technique, Triple Burner Meridian, EFT or Emotional Freedom Technique.Written by Lucy Peters

As integrative and complementary approaches continue to gain traction in modern healthcare, many professionals are exploring modalities that extend beyond conventional Western frameworks. Among these, Chinese meridian therapies offer a distinct perspective on health, balance and physiological function.

For healthcare practitioners, developing skills in this area can provide additional tools for addressing complex, multifactorial conditions, in particular those involving chronic pain, stress or functional imbalances.

 

Understanding the meridian system

At the core of Chinese meridian therapies is the concept of energy pathways, or meridians, through which vital energy is believed to flow. These pathways are associated with specific organs and physiological functions, forming an interconnected network that reflects the body’s overall state of balance.

While the meridian system does not map directly onto Western anatomical structures, parallels are often drawn with the nervous system, fascial networks and circulatory pathways. Increasingly, healthcare professionals are approaching these concepts. The idea is not to replace biomedical models, but to use them as complementary frameworks that can enhance patient assessment and care.

This shift reflects a broader movement within healthcare toward systems thinking. Rather than viewing the body as a collection of isolated parts, practitioners are recognizing the importance of interactions between different systems. Meridian-based approaches fit naturally within this perspective, offering a way to consider how seemingly unrelated symptoms may be connected through underlying patterns of imbalance.

 

Clinical applications in modern practice

Chinese meridian therapies encompass a range of techniques. These include acupressure, acupuncture, meridian-based muscle testing and energy balancing techniques. In clinical settings, these approaches can be used to address a range of conditions including the following:

For practitioners trained in conventional medicine, these therapies can offer additional insight into patterns that may not be fully explained by structural diagnosis alone. One area where meridian theory has found particular relevance is in applied kinesiology.

Kinesiology-based assessments often incorporate meridian concepts to evaluate how different organ systems and energy pathways may be influencing muscle function and overall health. Through muscle testing and functional analysis, practitioners aim to identify imbalances that could be contributing to a patient’s symptoms.

This integrative approach reflects the broader healthcare trend of combining structural, biochemical and energetic perspectives to form a more comprehensive understanding of patient health. Some practitioners exemplify this multidisciplinary approach. For example, Zibo Gao incorporates Chinese meridian therapies alongside chiropractic care, sports medicine and nutritional counselling. This type of practice illustrates how Eastern and Western methodologies can be combined in a clinical setting.

 

The role of assessment and patient-centered care

An important aspect of developing skill in meridian therapies is learning how to assess patients in a more holistic and individualized way.

Rather than focusing solely on symptoms, practitioners are encouraged to look at patterns over time. This may include considering lifestyle factors, stress levels, movement habits and even emotional wellbeing. Meridian-based assessments can help identify subtle imbalances that may not yet have developed into diagnosable conditions but are still affecting overall health.

This patient-centered approach aligns closely with modern healthcare priorities, particularly in preventative care. By identifying early signs of imbalance, practitioners may be able to intervene sooner, potentially reducing the risk of more serious or chronic conditions developing later.

It also encourages greater patient engagement. When individuals feel that their health is being considered more holistically, they are often more motivated to take an active role in their own care, which can improve long-term outcomes.

 

Developing competency as a healthcare professional

For healthcare professionals interested in expanding their skill set, training in Chinese meridian therapies typically involves both theoretical and practical components including meridian pathways and their associated organ systems, principles of energy flow, application of acupressure and a range of diagnostic techniques, including palpation and observation.

In addition, practitioners often benefit from training that bridges Eastern and Western perspectives, helping them translate traditional concepts into clinically relevant insights. Education programs and workshops can provide structured pathways for developing these competencies. Importantly, training should emphasize both safety and scope of practice, ensuring that therapies are applied appropriately within a practitioner’s professional framework.

Hands-on experience is particularly important. Developing sensitivity to touch, understanding subtle changes in tissue response and learning how to apply techniques effectively all require practice over time. Mentorship and supervised clinical experience can also play a valuable role in building confidence and competence.

 

Benefits and considerations

The integration of Chinese meridian therapies into healthcare practice offers several potential benefits:

  • A more holistic view of patient health
  • Additional tools for managing chronic or functional conditions
  • Opportunities to address stress and emotional factors alongside physical symptoms
  • Enhanced patient engagement through personalized care approaches

However, it is equally important to recognize the limitations. Scientific evidence supporting some aspects of meridian theory and related therapies remains variable, and ongoing research is needed to better understand their mechanisms and efficacy. As such, these approaches are best positioned as complementary to, rather than replacements for, evidence-based medical care.

At the same time, interest in integrative approaches continues to grow, both among practitioners and patients. As healthcare systems increasingly recognize the value of personalized and preventative care, therapies that consider the whole person instead of isolated symptoms are likely to play a more prominent role.

 

A broader perspective

Developing skills in Chinese meridian therapies offers healthcare professionals an opportunity to broaden their clinical perspective and enhance patient care. By integrating traditional concepts with modern medical knowledge, practitioners can adopt a more comprehensive approach to health. This is one that acknowledges the complexity of the human body and the many factors that influence wellbeing.

While continued research is essential, the practical value of these approaches in supporting holistic, patient-centred care makes them a worthwhile area of exploration for many healthcare professionals.

 

Author bio

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

 

Please also review AIHCP’s Meditation Emotional Freedom Technique & Meridian Energy Health Tapping Certification and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

The 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:           Http://www.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://doi.org/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://doi.org/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. https://doi.org/10.1097/NAN.0000000000000532

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. https://doi.org/10.1539/joh.15-0275-RA

 

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