Multicultural counseling proficiencies are essential to good counseling. Since Western counseling initially emerged from Europe it is culturally immersed with European culture values. European culture is very individualistic, self-centered and free of many forms of oppression due to the fact Europe was the colonizing force between the 16th and 19th Centuries. Furthermore, while Europe’s secular awakening drove a wedge between its Christian culture and itself, Christianity still plays a key part of life in millions of individuals of European descent, as well as a driving force behind the intent of nations to colonize. With these things in mind, the classic male European descent counselor must be aware of his cultural identity and how that same identity translates his world views, as well as how others of different cultures perceive him as a person when counseling. Within melting pots nations, such as the United States or Canada, many minority cultures can look upon counseling itself with suspicion as a Western custom created by white men.
Grief and loss is also cultural and is expressed differently. This type of difference that inherently exists within different grieving cultures needs to be understood and respected within the grief counseling session itself. Kastenbaum points out that many from a different culture can misinterpret expressions of grief or rituals within another culture (2018, p.372). Please also review AIHCP’s Grief Counseling Certification, as well as its Grief Diversity Counseling Certification to learn more about responding better to other cultures during times of grief.
The African American Experience and Counseling
It is important to have a strong understanding of African American heritage but also African American oppression to fully help individual blacks in counseling
African American culture has an intense pride in its African heritage and its rich spiritual and cultural beliefs and rituals. While many in America have been culturally separated from the home continent and completely interwoven into a unique African American culture with its own history and adaptations, there still remains a strong echo of the past for many who look to rediscover their roots. African consciousness possesses ancestral wisdom, naturalistic attitudes, rhythm, and creativity (Pedersen, 2018, p. 147), These images help many African Americans tie to a greater power and consciousness to face the oppression they have faced for centuries. This consciousness helps blacks create a stronger self concept, self esteem and self image about themselves that was stolen so many centuries ago (Pedersen, 2018, p.147)
Due to imperialism, oppression and the slave trade, many African Americans cannot trace their lineage and families as European Americans. Many tribes of the Congo, Yoruba, Wolof and Ibo were targeted for the salve trade (Pederson, 2018. p. 145). Many of the records and identities of abducted human beings into the slave trade were erased from history and replaced with new roles and titles on various American plantations. In many cases, these individuals took upon the name of the slave owner or when emancipation occurred chose a simple American name. Hence some African Americans have a yearning to reconnect to their cultural heritage that was stolen from them.
When counseling with African Americans, there is large diversity to consider. Many marginalized blacks in America have been robbed of economic stability for generations. This has led to a succession of poverty, less education and less opportunity. Some blacks have been able to bridge the gap and are successful and resent the idea that they are marginalized and find pride in their work ethic and success. Some black communities are very religious and hold strong to the Christian faith, especially in Baptist congregations. Immigrant Africans hold stronger to the older ways of tribalism, honor, family, ancestors and have a far more spiritualistic religion than many Christian blacks. Some African immigrants share a combined spiritualism and Christian belief system as well.
Yet, within all the diversity, their exists the soul wound of imperialism and slave trade that forever scarred the continent of Africa. Whether from Africa and enduring genocide and civil wars due to European imperialism of the 18th and 19th Centuries, or from the United States and scarred from the history of slavery, segregation, economic theft, and racism, both African groups have historically faced collective wounds that have been transmitted from one generation to the next. This type of historical disadvantage has created numerous imbalanced economic opportunities. In addition, overt racism or systematic racism that exists within the system, has made the African American experience a far different experience than the European experience. Racial profiling, job discrimination and prejudices continue to haunt the black community. These incidents make even a random police stop into an entirely different ordeal for an African American than a white person. Hence when counseling a black client, one must realize racism and oppression have shaped the development and experiences of black people worldwide (Pedersen, 2018, p. 145).
It is important also when counseling African Americans to understand the value of family and groups within their grieving processes as well as life issues. Many African Americans turn to family and support and church before they look for mental health care. Group therapy and community interventions are more relatable to these social structures and can be beneficial for many African Americans (Pedersen, 2018, p.154). African Americans in general also prefer more naturalistic healing interventions, and prefer more so to face personal issues with action (Pedersen, 2018, p. 155). Again, these are collective statistics and each individual is different. When counseling across culture, it is important to remember the dictum of Kluckhohn and Murray (1949) that “each person is like all other persons, like some other persons and like no other person (Pedersen, 2016. p.42)”.
When helping African Americans who are grieving it is important to understand the numerous social issues that apply daily anxiety and sadness to the unique black experience in America. In addition, utilizing African American spirituality, family and church structures as well as modeling coping strategies after African American strengths can all play a key role in helping African Americans grieve in a more healthy way.
Counseling Mistakes with African Americans
Like many minorities, there can exist a mistrust for white mental health counselors. Even though African Americans make up the second largest non-white group in America, they still only represent 12 percent of the population (Pedersen, 2018, p. 144). With this in mind, counselors need to understand that blacks may not always be comfortable with a white counselor or someone from a different socio-economic background. Many blacks do not feel that the suburban American truly understands their concerns or fears.
It is important to understand the role of oppression, slavery, racism and discrimination when counseling African Americans.
White counselors need to understand the importance to acknowledge the concept of “White Privilege”. This refers to the unearned societal awards that are given to the white culture based on color of skin (Pedersen, 2018, p. 146). While liberals sometimes have taken the notion to far as to dismiss personal achievement and ignore poor life choices of others, one must conclude due to the centuries of oppression as well as economic imbalance given to the black community that better life opportunities have been granted overall to more whites than blacks in the present day. It is important to acknowledge this in counseling as well as publicly. It helps heal past soul wounds and helps generate awareness to possible past thefts against the black community and present day attempts to rectify those injustices. Again, this does not justify a black person to live a life of crime but it does suggest a better understanding of why so many blacks fall victim to a life of crime due to inherited poverty due to past injustices against their community. Hence in counseling, it is important for a white counselor to check him/herself and understand the role their color and experiences brings to the counseling room (Pedersen, 2018, p. 146).
In addition, Pedersen points out that ignoring race in counseling can also be negative. He refers to this concept as “Color Blindness” (2018, p. 146). When one attempts to ignore the role of color and race in a client’s life struggles and problems, then the counselor can miss the importance that oppression and soul wounds can play on a particular group’s mental health. The APA suggests that counselors always consider how racism and discrimination can be sources of distress for black populations (Pedersen, 2018, p. 146). In addition, conversely, imagining no color exists between counselor and client can also play a negative role in the counselor understanding his/her color as a factor in the counseling process.
Another mistake to avoid is the historically and inherently prejudice studies on black populations. Assumptions on African American attitudes and reactions to life have in the past resulted in an over diagnosis of schizophrenia and an under diagnosis of depression and anxiety (Pedersen, 2018, p. 152). While African American communities have historically suffered less from suicide due to family and church connections, studies also show like anyone, if an African American suffers from depression or substance abuse, his or her chance of suicide rises like anyone else. Also, it is important to note that when working with African Americans, there is a far higher chance of the clients exposure to violence or PSTD (Pedersen, 2018. p. 153). This greatly leads to a higher trajectory of African Americans who suffer from depression, grief, loss and anxiety.
Conclusion
Helping African Americans through grief by utilizing the deep spirituality within the heritage can be useful for healing. Please also review AIHCP’s Grief Counseling Certification
African American heritage is rich and beautiful with family, heritage, ritual, and spiritual life. Tapping into these elements give blacks a higher appreciation of self and worth and tie them to a greater story. Unfortunately, slavery and oppression stole this identity centuries ago and many African Americans in the United States suffer intense soul wounds associated with the history of slavery, oppression, racism and discrimination. These things cannot be ignored but must be understood in factors leading to many modern day issues African Americans face. Counselors need to be aware of these issues as well as their own color and race when working interracially with a black person. White persons must understand that differences exist and sometimes need addressed to help promote healing. Also, like in all multi cultural issues, counselors must be alert not to over generalize or under generalize a person. Each person is unique but at the same time within a particular race or culture usually shares some common issues or problems.
Please also review AIHCP’s Grief Counseling Certification. The program is online and independent study with mentorship. For those who are already a Certified Grief Counselor, then please also review AIHCP’s Grief Diversity Counseling Certification and see if it meets your academic and professional goals in working with diverse populations.
Reference
Pedersen, P. et. al (2018). “Counseling Across Cultures”. (7th). Sage
Additional Resources
Williams, M. (2011). “Why African Americans Avoid Psychotherapy”. Psychology Today. Access here
Watkins, S. & Andrews, A. (2021). “Creating & Maintaining Safe Therapeutic Spaces for Black Clients”. Advances in Addition Recovery (Winter 2021). Access here
Alang, S. (2019). “Mental health care among blacks in America: Confronting racism and constructing solutions”. Health Serv Res. 2019 Apr; 54(2): 346–355. Published online 2019 Jan 27. doi: 10.1111/1475-6773.13115. National Library of Medicine. Access here
Carrouthers, Z. (2014). “Yes, There’s a Stigma with Counseling in the African-American Community”. ThriveWorks. Access here
The concept of autonomy stands as a cornerstone in healthcare ethics, shaping the way medical professionals interact with patients and make critical decisions. This principle, deeply rooted in ethical standards and codes, emphasizes the right of individuals to make informed choices about their own health and well-being. As healthcare continues to evolve, the importance of autonomy has grown, influencing everything from daily patient care to complex end-of-life decisions.
Exploring autonomy in healthcare involves examining several key areas. These include the foundations of informed consent, the balance between patient rights and other ethical principles, and the role of cultural considerations in decision-making. Additionally, the application of autonomy to special populations, the use of advance directives, and the responsibilities of healthcare providers in promoting patient self-determination are crucial aspects to consider. By delving into these topics, we can gain a deeper understanding of how autonomy shapes modern healthcare practices and ethics.
Autonomy is crucial for patient care and patient rights. Please also review AIHCP’s Health Care Ethics Program
Definition of Autonomy
Autonomy in healthcare refers to the right of patients with decision-making capacity to make choices regarding their care, even when these decisions contradict their clinicians’ recommendations. This concept encompasses two essential components: liberty, which involves independence from controlling influences, and agency, which refers to the capacity for intentional action. The principle of autonomy emphasizes the importance of patients’ self-governance and their ability to make independent decisions based on their own assessment of the reasons for pursuing different outcomes. Autonomy is an important concept for any healthcare ethics consultant to understand.
Historical Context
The concept of autonomy in healthcare has its roots in the aftermath of World War II, particularly following the revelations of the Nuremberg trials. These events led to the development of the ideal of “informed consent,” which became a hallmark of Western medical ethics. In 1972, the legal case of Canterbury v. Spence codified informed consent into American law, further solidifying its importance in medical practice. This historical context highlights the shift towards prioritizing patient autonomy and protecting individuals from potential exploitation or coercion in medical settings.
Importance in Medical Ethics
Autonomy has become a cornerstone of medical ethics, often considered the highest priority in American bioethics. Its significance is reflected in several key aspects of healthcare:
Informed Consent: This principle requires physicians to respect patients’ autonomy by providing them with the necessary information to understand the risks and benefits of proposed interventions, as well as reasonable alternatives. This process enables patients to make independent decisions about their care.
Patient Rights: Respecting autonomy means acknowledging patients’ right to make decisions about their care, even when these choices may not align with medical recommendations or what others perceive as their best interests.
Family Involvement: While autonomy emphasizes individual decision-making, it also includes respecting how patients wish to make decisions. This may involve taking family members’ opinions into account, as patients often do in other important life decisions.
Ethical Foundation: Autonomy has been described as the ‘ultimate moral foundation’ of informed consent, underscoring its central role in shaping ethical medical practice.
Protection from Coercion: The emphasis on autonomy in healthcare serves to protect patients from potential coercion, manipulation, or undue influence, particularly from medical professionals.
Self-Governance: Autonomy facilitates patients’ self-governance by giving them the power to make their own treatment decisions based on their values and preferences.
The concept of autonomy in healthcare reflects the broader societal value placed on individuals’ right to shape their own lives and make decisions about their well-being. It acknowledges that even if a patient’s choices may not be considered optimal by third-party standards, the act of making these decisions independently holds intrinsic value. This principle continues to guide ethical considerations in medical practice, shaping the relationship between healthcare providers and patients, and influencing the development of healthcare policies and procedures.
Informed Consent and Patient Rights
Informed consent serves as a cornerstone of patient rights in healthcare, embodying the ethical principle of respect for persons. This process involves more than just obtaining a signature on a form; it represents a thorough communication between healthcare providers and patients. The concept has evolved to protect patients’ autonomy and ensure their active participation in medical decision-making. Healthcare Ethic Consultants need to ensure patient rights are protected.
Elements of Informed Consent
Informed consent comprises three key features:
Disclosure of information: Healthcare providers must present patients with all necessary details to make an informed decision.
Facilitation of understanding: Ensuring that patients comprehend the disclosed information.
Promotion of voluntariness: Safeguarding the patient’s right to make decisions without coercion or undue influence.
The process should provide patients with sufficient opportunity to consider their options and minimize any possibility of coercion. Healthcare providers must present information fairly, clearly, accurately, and compassionately, avoiding exaggeration of potential benefits or making unrealistic promises.
Legal Foundations
The legal basis for informed consent varies by state, with three primary standards:
Subjective standard: Focuses on what this specific patient needs to know.
Reasonable patient standard: Considers what an average patient would need to know.
Reasonable physician standard: Based on what a typical physician would disclose.
Many states adopt the “reasonable patient standard,” emphasizing the information a typical patient would require to make an informed decision. However, it remains the provider’s responsibility to determine the appropriate approach for each situation.
Legal exceptions to informed consent include:
Patient incapacitation
Life-threatening emergencies with insufficient time for consent
Voluntary waiver of consent by the patient
In cases involving minors, parents typically provide “informed permission” rather than consent, except for legally emancipated minors who can consent for themselves.
Challenges in Practice
Implementing informed consent in healthcare settings presents several challenges:
Time constraints: Emergency departments often face pressure to make quick decisions, limiting the time available for thorough discussions.
Patient capacity: Some patients may be unable or unwilling to engage in decision-making processes.
Provider perceptions: Healthcare providers may have varying views on how informed consent affects their medico-legal protection.
Institutional limitations: Facilities may lack validated risk prediction tools to guide decision-making.
To address these challenges, healthcare institutions have developed various strategies. These include using worksheets to help patients weigh choices and employing the “teach-back” method, where patients repeat their understanding of the information provided. Some institutions have implemented policies to give patients consent forms at least one day prior to elective procedures, ensuring ample time for consideration.
The complexity of informed consent increases in teaching hospitals and medical schools, where trainees often observe and participate in treatments. Institutions must disclose trainee involvement in their consent processes, addressing both accreditation requirements and liability concerns.
Ultimately, the art of obtaining informed consent lies in a healthcare provider’s ability to perceive the level of detail a patient desires, recognize their personal values and goals, and meet legal requirements simultaneously. This patient-centered approach to informed consent reflects the broader shift in medical education towards more robust curricula related to ethics and effective communication with diverse individuals.
Balancing Autonomy with Other Ethical Principles
All ethical standards need to be enforced by healthcare management and healthcare ethic consultants
While autonomy stands as a cornerstone in healthcare ethics, it does not exist in isolation. Healthcare providers must carefully balance respect for patient autonomy with other fundamental ethical principles. This balance ensures comprehensive, ethical care that considers the multifaceted nature of medical decision-making. Three key principles that often interact with autonomy are beneficence, non-maleficence, and justice.
Beneficence
Beneficence refers to the obligation of healthcare providers to act for the benefit of the patient. This principle supports a range of moral rules designed to protect and defend the rights of others, prevent harm, remove conditions that may cause harm, help individuals with disabilities, and rescue those in danger. Unlike non-maleficence, beneficence involves positive requirements, calling for actions that not only avoid harm but also actively benefit patients and promote their welfare.
In practice, beneficence may sometimes conflict with autonomy. For instance, a patient might make a decision that a healthcare provider believes is not in their best interest. In such cases, the provider must navigate the delicate balance between respecting the patient’s autonomy and fulfilling their professional obligation to act in the patient’s best interest.
Non-maleficence
Non-maleficence embodies the principle of “first, do no harm.” It obligates healthcare providers to avoid causing harm to their patients. This principle underpins several moral rules, including prohibitions against killing, causing pain or suffering, incapacitating, causing offense, and depriving others of life’s goods.
The practical application of non-maleficence involves carefully weighing the benefits against the burdens of all interventions and treatments. Healthcare providers must avoid treatments that are inappropriately burdensome and choose the best course of action for the patient. This principle often aligns with respect for autonomy, as patients generally do not wish to be harmed. However, conflicts can arise when a patient’s autonomous decision might lead to harm, requiring careful ethical consideration.
Justice
Justice in healthcare ethics generally refers to fair, equitable, and appropriate treatment of persons. In the context of clinical ethics, distributive justice is particularly relevant. This concept addresses the fair, equitable, and appropriate distribution of healthcare resources, determined by justified norms that structure the terms of social cooperation.
Implementing distributive justice in healthcare is complex, as there are several valid principles to consider:
Equal share distribution
Distribution according to need
Distribution based on effort
Distribution according to contribution
Distribution based on merit
Distribution through free-market exchanges
These principles are not mutually exclusive and are often combined in practice. The challenge lies in choosing, balancing, and refining these principles to create a coherent and workable solution for distributing medical resources.
Balancing justice with autonomy can be particularly challenging. For example, a patient’s autonomous decision might conflict with the fair distribution of limited healthcare resources. In such cases, healthcare providers and institutions must navigate the tension between respecting individual autonomy and ensuring equitable access to care for all patients.
In conclusion, while respect for patient autonomy is crucial in healthcare ethics, it must be balanced with other ethical principles. Healthcare providers must navigate the complex interplay between autonomy, beneficence, non-maleficence, and justice to provide ethical, comprehensive care. This balancing act requires careful consideration of individual patient needs, societal obligations, and the equitable distribution of healthcare resources. By thoughtfully weighing these principles, healthcare providers can make ethical decisions that respect patient autonomy while also fulfilling their broader professional and societal responsibilities.
Cultural Considerations in Patient Autonomy
Cultural competence in healthcare involves delivering effective, quality care to patients with diverse beliefs, attitudes, values, and backgrounds. This practice requires systems that can personalize healthcare according to cultural and linguistic differences, understanding the potential impact these differences can have on healthcare delivery.
Western vs. non-Western perspectives
In Western medical culture, particularly in the United States, individual autonomy is highly valued. However, this perspective is not universal. A review of medical practices worldwide reveals that in many parts of Asia, Central and South America, the Middle East, Eastern Europe, and some areas of Western Europe, the traditional practice has been for physicians not to directly inform patients of serious illnesses.
These differing practices reflect culturally shaped views of patient autonomy, the role of family, and the doctor-patient relationship. In many non-Western cultures, respecting autonomy may involve prioritizing other ethical values, such as fidelity and connection to family and community, over individual decision-making.
Religious and family influences
Religion and family play significant roles in shaping patients’ perspectives on autonomy and healthcare decision-making. In many cultures, the family, rather than the individual, is traditionally the primary locus of decision-making. Family members are expected to protect and care for each other, particularly those seen as most vulnerable. This expectation often leads to family involvement in key decisions affecting the patient, including discussions with doctors about if, when, and how to share information with the patient.
Religious beliefs can also profoundly influence patients’ healthcare decisions. For instance, some patients may refuse certain treatments or procedures based on their religious convictions. Healthcare providers need to be aware of these influences and approach them with sensitivity and respect.
Adapting care to cultural contexts
To provide culturally competent care, healthcare providers must adapt their approaches to accommodate diverse cultural perspectives. This adaptation involves several key strategies:
Cultivating cultural humility: Healthcare professionals should recognize the limits of their knowledge about others’ cultures and engage in ongoing self-evaluation to improve awareness of implicit biases.
Improving cross-cultural communication: Building teams with healthcare professionals who reflect the diversity of the patient populations served can enhance cross-cultural communication.
Engaging in open dialog: Healthcare providers should engage patients, their families, and trusted community members in discussions about cultural preferences and needs related to healthcare.
Providing language support: Securing interpreters for patients with limited English proficiency is crucial for effective communication and informed decision-making.
Avoiding assumptions: While knowledge of diverse cultural beliefs and practices can be helpful, it’s critical that clinicians do not make assumptions about individual patients based solely on their ethnicity, race, or religion.
Recognizing acculturation factors: Culture and religion are mediated by various factors, including level of acculturation, socioeconomic status, gender, and age. Individuals and families can fall along a spectrum of beliefs and practices.
Balancing cultural sensitivity with ethical obligations: Healthcare providers must navigate the delicate balance between respecting cultural preferences and fulfilling their professional and ethical obligations to provide the best possible care.
By implementing these strategies, healthcare providers can create a more inclusive and respectful environment that acknowledges the diverse cultural perspectives on patient autonomy. This approach not only enhances the quality of care but also fosters trust and understanding between healthcare providers and patients from various cultural backgrounds.
Autonomy in Special Populations
The principle of autonomy in healthcare takes on unique dimensions when applied to special populations, such as pediatric patients, the elderly, and individuals with mental illness. These groups often face distinct challenges in exercising their autonomy, requiring healthcare providers to navigate complex ethical considerations. Health Care Ethic Consultants need to ensure special populations are protected.
Pediatric Patients
In pediatric healthcare, the concept of autonomy involves a delicate balance between parental authority and the developing decision-making capacity of the child. Parents have the legal responsibility to make medical decisions in the best interests of their minor children who lack decision-making capacity. However, they also have an ethical duty to foster their children’s autonomy and moral growth, a responsibility shared by clinicians.
The American Medical Association (AMA) has recently adopted an ethics policy recommending ways physicians should support parents in helping children become independent decision-makers. This approach involves:
Providing information in a developmentally appropriate manner that respects the minor patient’s cognitive ability.
Engaging the child in decision-making to the extent possible.
Seeking the child’s assent to proposed interventions.
As children mature, their ability to understand the risks and benefits of proposed treatments increases. Physicians should tailor their disclosure accordingly, recognizing that the more mature a minor patient is, the stronger the ethical obligation to seek their assent to treatment. Except in cases where immediate intervention is essential to preserve life or avert serious, irreversible harm, physicians and parents should respect a child’s refusal to assent and explore the reasons for dissent when circumstances permit.
Elderly Patients
Autonomy for elderly patients often involves complex considerations regarding independence and safety. Physicians face the challenge of respecting their patients’ autonomy while addressing potential safety concerns, particularly when independence and the ability to continue living at home are essential for most older patients’ quality of life.
Certain target populations and patients require different types of care
Clinic visits provide an optimal opportunity to discuss with elderly patients and their families important social issues, as well as patients’ values and care preferences. These discussions should include topics such as advanced directives, living wills, and resuscitation status. Physicians must navigate the fine line between their responsibilities and society’s obligations to respect the autonomy and preserve the quality of life of elderly patients.
As social situations play an increasingly significant role in the successful management of an elderly patient’s medical problems, physicians must learn how to preserve quality of life even as they prolong it. They often serve as the ultimate advocates for their patients’ autonomy, working to optimize social situations that may inhibit or allow for successful medical care.
Patients with Mental Illness
For individuals living with severe mental illness (SMI), protecting autonomy presents unique challenges. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) commits countries to recognizing that people with mental health conditions enjoy legal capacity on an equal basis with everyone else. However, in practice, people experiencing mental health conditions often lose their rights to informed consent, confidentiality, privacy, and communication with family members through substitute decision-making.
Psychiatric Advance Directives (PADs) have emerged as a tool to protect the autonomy of those living with SMI and improve their treatment outcomes. To promote optimal mental health outcomes while protecting patient autonomy, a peer-support model has been proposed. This approach involves shifting the burden of PAD facilitation from providers to peer-support specialists who have lived experiences that strongly parallel others with SMI.
The concept of relational autonomy recognizes that individuals are embedded in social relations and that conceptions of autonomy should not neglect emotions, communal life, social context, interdependence, and reciprocity. Within this framework, peer-support specialists can guide service users through their struggles with SMI, allowing them to act intentionally, with understanding, and without external influences.
Establishing peer-support facilitator networks could increase the uptake of PADs and motivate continued engagement in treatment, which is crucial for patients with SMI. Policymakers and mental health organizations are encouraged to devote resources toward establishing these networks to mitigate the inequities faced by those with SMI and protect their autonomy in accordance with the principle of beneficence.
Advance Directives and End-of-Life Decision Making
Advance directives play a crucial role in preserving patient autonomy during periods of incapacity or at the end of life. These legal documents allow individuals to outline their healthcare preferences and designate decision-makers when they are unable to communicate their wishes. The concept of advance directives is deeply rooted in the ethical principle of patient autonomy, enabling individuals to maintain control over their medical care even in challenging circumstances.
Types of Advance Directives
Several types of advance directive documents exist, often with overlapping scopes and activation points. The most common forms include:
Living Will: This document outlines an individual’s end-of-life care preferences, specifying desired medical treatments, procedures, and interventions.
Durable Power of Attorney for Health Care: This legal instrument allows individuals to appoint a healthcare agent, also known as a proxy or surrogate, to make medical decisions on their behalf when they are incapacitated.
Psychiatric Advance Directives (PAD): These documents, also called advance directives for mental healthcare, enable individuals to detail their preferences for future mental health treatment.
Physician Orders for Life-Sustaining Treatment (POLST): This form, completed jointly by a patient and their doctor, provides specific instructions for end-of-life care, including preferences for CPR and feeding tubes.
Do Not Resuscitate (DNR) Order: This document, signed by a doctor at a patient’s request, indicates the patient’s wish not to receive CPR.
Many individuals choose to combine a living will with a durable power of attorney for health care, creating a comprehensive advance healthcare directive that addresses both specific treatment preferences and designates a trusted decision-maker.
Legal and Ethical Implications
Advance directives are legally recognized documents, but they are not always legally binding. Healthcare providers and proxies are expected to make their best efforts to respect these directives, but complex medical situations may arise where exact adherence is challenging. The legal status of advance directives varies by state, and physicians need to be familiar with the applicable laws in their area.
Ethically, advance directives serve to uphold the principle of patient autonomy. They allow individuals to express their values, beliefs, and care preferences, ensuring that their wishes are considered even when they cannot communicate directly. Healthcare providers have an ethical obligation to honor these preferences to the best of their ability, balancing respect for patient autonomy with other ethical principles such as beneficence and non-maleficence.
Challenges in Implementation
Despite the importance of advance directives, their implementation faces several challenges:
Low Completion Rates: Recent Medicare data shows that only 2.8% of patients have advance care planning conversations with their physicians.
Role Clarity: There is often confusion about who should initiate discussions about advance directives and when these conversations should occur.
Time Constraints: The time-intensive nature of creating advance directives can be a barrier in busy clinical settings.
Knowledge Gaps: Physicians may lack confidence or knowledge about legal considerations, documentation processes, and patient competence assessment.
Accessibility: Advance directives may not be readily available when needed, especially during transfers between care settings.
Language and Specificity: The language used in advance directives can be vague or open to interpretation, making implementation challenging.
To address these challenges, healthcare systems are exploring various strategies. These include involving trained facilitators, implementing structured patient-centered discussions, and utilizing external partners to manage the advance care planning process. Additionally, efforts are being made to create centralized registries for advance directives, improving accessibility and ensuring that patients’ current wishes are accurately recorded and easily retrievable when needed.
By addressing these challenges and promoting comprehensive advance care planning, healthcare providers can better honor patients’ autonomy and ensure that end-of-life care aligns with individuals’ values and preferences.
The Role of Healthcare Providers in Promoting Autonomy
Promoting autonomy is key in healthcare ethics
Healthcare providers and health care ethic consultants play a crucial role in promoting patient autonomy through effective communication, shared decision-making, and addressing power imbalances. These practices are essential for fostering trust, respect, and collaboration between healthcare professionals and patients, ultimately leading to improved health outcomes and patient satisfaction. Those involved in healthcare ethic consulting need to ensure the promotion of autonomy.
Communication Strategies
Effective communication serves as the foundation for promoting patient autonomy. Healthcare providers should employ various strategies to ensure clear and empathetic communication with patients:
Active Listening: Providers should give patients their full attention, avoiding multitasking or distractions. Nonverbal cues such as eye contact, nodding, and appropriate facial expressions demonstrate engagement and concern.
Open-Ended Questions: Beginning patient interviews with open-ended questions like “How can I help you today?” encourages patients to express their concerns fully.
Reflective Statements: Acknowledging patients’ emotional states through reflective statements shows empathy and understanding.
Clear Explanations: Providers should explain diagnoses, treatment recommendations, and follow-up plans clearly, using language that patients can understand. Writing down key information can help ensure patient comprehension.
Teach-Back Method: This technique involves asking patients to repeat information in their own words, helping providers confirm understanding and address any misunderstandings.
Shared Decision-Making
Shared decision-making is a collaborative process that respects patient autonomy by involving patients in their healthcare decisions. This approach includes:
Eliciting Patient Preferences: Providers should actively seek out patients’ values, goals, and preferences regarding their care.
Providing Evidence-Based Information: Communicating relevant and understandable information about treatment options is crucial for informed decision-making.
Discussing Risks and Benefits: Providers should clearly explain the potential outcomes and side effects of various treatment options.
Encouraging Patient Participation: Creating an environment where patients feel comfortable asking questions and expressing concerns is essential for shared decision-making.
Addressing Power Imbalances
Power imbalances in healthcare settings can significantly impact patient autonomy, particularly for diverse and marginalized populations. Healthcare providers can address these imbalances by:
Recognizing Hierarchy Differences: Providers should be aware of how hierarchical structures within healthcare can inhibit open communication and patient participation.
Creating a Safe Environment: Fostering an atmosphere of trust and respect encourages patients to speak up about their concerns and preferences.
Using Standardized Communication Tools: Techniques like SBAR (Situation-Background-Assessment-Recommendation) can help bridge communication gaps and ensure clear information transfer.
Practicing Cultural Competence: Providers should be sensitive to how patients’ social relationships and cultural backgrounds may influence their healthcare decisions and preferences.
Promoting Relational Autonomy: Recognizing that patients’ identities and values are shaped by their social relationships and circumstances can help providers tailor their approach to enhancing patient autonomy.
By implementing these strategies, healthcare providers can significantly contribute to promoting patient autonomy. This approach not only respects patients’ right to self-determination but also leads to more effective, patient-centered care and improved health outcomes.
Conclusion
The exploration of autonomy in healthcare reveals its profound impact on medical ethics and practice. From informed consent to end-of-life decisions, respecting patient autonomy has a significant influence on how healthcare providers interact with patients and make critical choices. Balancing this principle with other ethical considerations, such as beneficence and justice, creates a complex landscape for healthcare professionals to navigate. Cultural differences and special populations add further layers of complexity, requiring healthcare providers to adapt their approaches to ensure patient-centered care.
Please also review AIHCP’s Health Care Ethic Consultant Certification Program and see if it meets your academic and professional goals
To promote autonomy effectively, healthcare providers must hone their communication skills and embrace shared decision-making. This approach helps to address power imbalances and fosters an environment where patients feel empowered to participate in their healthcare decisions. By implementing strategies to enhance patient autonomy, healthcare systems can improve patient satisfaction and health outcomes. As the healthcare landscape continues to evolve, the commitment to respecting and promoting patient autonomy remains a cornerstone of ethical and effective medical practice.
Please also review AIHCP’s Health Care Ethic Consulting Program. The program prepares healthcare professionals in the ethical standards of healthcare. The Health Care Ethic Consulting Program is online and independent study with mentorship as needed. Please review the program and see if it meets your academic and professional goals.
FAQs
What does the ethical principle of autonomy entail in healthcare?
The ethical principle of autonomy in healthcare requires healthcare providers to share all necessary medical information and treatment options with patients. This enables patients to make informed decisions, ensuring self-determination. It is foundational for informed consent, truth-telling, and maintaining confidentiality.
What are the four main ethical principles in nursing regarding patient autonomy?
In nursing, patient autonomy is one of four central ethical principles, alongside beneficence, justice, and non-maleficence. Autonomy allows patients to make decisions about their healthcare based on their personal beliefs and values, with nurses serving as advocates to support these decisions.
How is the principle of autonomy defined in professional ethics?
In professional ethics, autonomy involves making decisions based on one’s moral reasoning. A person is considered autonomous if their choices align with the dictates of correct moral reasoning. Conversely, incorrect decisions indicate a deviation from this principle.
How is autonomy implemented in healthcare practices?
In healthcare, autonomy is primarily upheld by respecting the rights of competent adults to make informed decisions regarding their own medical care. This principle necessitates obtaining a patient’s consent or informed agreement prior to conducting any medical investigation or treatment.
Multicultural proficiency exists not only in race, age, gender and culture, but also within the confines of religion and spirituality. Counselors working in grief or merely spirituality need to be well versed in the multitude of spiritual beliefs that may exist within a particular person or target population. In many cases, religion and spirituality can play a key role in the grieving process, as well as emotional and mental outlooks. Many individuals tied to some world view are better able to find meaning in loss and religion and spirituality can be a great tool in helping clients find resolution and peace. Religion and spirituality can also sometimes be a double-edged sword and also cause conflict and stress with outcomes and faith. Regardless, counselors need to be able to understand the importance of faith, religion and spirituality in a client’s life because whether a counselor has a particular belief or any belief at all does not matter when it comes to helping a person who may.
Role of Faith
Clients are diverse in spirituality and faith and these aspects play key roles in multicultural counseling
Many secular counselors trained solely within the confines of modern psychology and behavioral studies especially from numerous schools of Freud may be hostile to faith and see faith as a neurosis to the mind (Pedersen, 2018, p. 480). Despite this, the value of the religious experience, whether believed by the counselor or not, is an important aspect of the wholeness of the person and the person’s emotional well being. Even William James understood the importance of the religious experience within the mind, and other prominent humanist psychologists such as Carl Rogers and Victor Frankl understood the value of spirituality for a person (Pedersen, 2018. p. 480). Modern counseling demands a counselor’s proficiency with multicultural issues such as spirituality, faith or religion.
Faith is a universal human experience that spans across all of humanity. Spiritual and religious beliefs play a key role in all cultures in every aspect of health, life and death (Pedersen, 2018, p. 478). While within the United States there has been a drop in religious and church attendance, this decline is supplemented in other areas with individual spiritual practices. Even said, the dominant culture within the United States still holds true to a Judeo-Christian background that reflects itself in cultural norms even for some of the most anti-religious people. In the United States alone, a 2007 Gallup poll listed that 86 percent of Americans believe in God and another 55 percent still pointed out that religion is still important to them (Pedersen, 2018, p.478). Hence it is important not to dismiss the importance of faith and religion in counseling.
Yet even within this innate spiritual pursuit, there still remains a high level of diversity within religious individuals. The United States exists in itself as a melting pot of creeds. Christianity is far from monolithic but a diverse population of Catholics, Orthodox and various Protestant denominations which can range from very structured to very charismatic and individual. Beyond Christianity, exists numerous faiths not from the dominant culture, including Judaism, Islam, Hinduism, Buddhism and various smaller religious sects, as well as pantheistic creeds. If one then also considers some individuals are more spiritual than religious and follow a myriad of concepts, then one can find almost any combination of spirituality that may exist within a client. Some may be more dogmatic and religious, while others may be more spiritual and less defining, or one may be a combination of the two.
Within this diversity of faith also comes various different paths of thought. Spirituality, according to Pedersen, is a commitment to choose a context to understand and act within one’s relationships with all that is, whether within confines of person and creator, or between community, or nature itself. It is an awareness of something more in this world. It includes values that guide one’s meaning of life, sense of mission and how to help others for a better world (Pederson, 2018, p. 480). Many individuals share these similar views but express them in multiple different ways. In addition, religion, the social and dogmatic mechanism of the person provides the means and methods within the religious group (Pedersen, 2018. p. 480). In this day and age, one constantly hears the term “I am spiritual but not religious”. This points to this less dogmatic binding life style. Within these differences alone exist a multitude of different spiritual as well as religious ideals about God as a being, a source of being, or an infusion and connection within all humanity. A transcendent God reflects to a person a very ordered moral code of not only obedience but also justice. In more immanence theology, God exists literally within all and plays a part in all. This does not dismiss a moral code but it is far less dogmatic and refers more to a balance of life. These different theological concepts of God as one, many, transcendent or immanent, all play key roles in how a person morally acts and responds to many issues in life.
Spirituality in Counseling
In settings where Spiritual Counseling or Christian Counseling, or Spiritual Direction is not expected, such as within pastoral settings, one may seem from a professional or secular view anxious about discussing faith and religion. In the secular and professional world, religion is a question that is usually best left avoided. When asked to discuss religion or spirituality, many feel as if they may offend others, or be judged, or that faith is personal, or that one seems less academic (Pedersen, 2018, p. 478). The reality is faith plays a key role in a person’s life and hence plays a key role in healing, coping, finding meaning in loss, and facing adversity. Counselors, whether religious, atheistic or agnostic, should not dismiss the valuable part of the client to help one find healing. In fact counselors, like in all multicultural proficiencies, should take into account their own religious background and potential biases before helping someone of a different spiritual or religious background.
In addition, the counselor should attempt to help guide the client by understanding the client’s religious and spiritual background. Within the first interview, spiritual questions should be an important element of understanding the client. A spiritual genogram should be conducted which looks to examine religious and spiritual family history to analyze any cross section impacts upon the mind of the person (Pedersen, 2018, p,489). In addition, the client should be asked about questions regarding identification with religious groups, one’s perception of God, or special spiritual and religious beliefs one may hold. In addition, the counselor should attempt to discover if any life styles or actions may contradict one’s moral code and way of operating. Counselors can also ask what gives life meaning, the importance of one’s faith in life and healing, as well how the religious community can be helpful in one’s healing. Finally, counselors should ask if clients wish to address these spiritual issues moving forward (Pedersen, 2018, p. 488).
Understanding how spirituality plays a role in a client’s emotional health is critical in spiritual counseling
Counselors working with particular religious groups, especially those of a smaller religious community, such as Native Americans, or Asian Americans, may find the need to address healing and spirituality from the client’s perspective by working with local religious authorities within that group. If the client wishes, a joint healing model can be placed into action with conjunction with the client’s spiritual community.
Sometimes, religion can be a powerful anchor of meaning for the individual but sometimes, faith can also cause issues within a person’s life. When tragedy strikes, individuals may question their faith and lash out against God. They will doubt their faith and question meaning itself. Some may reject faith, others will turn to it more. Some may see their faith as a contract if left unfulfilled by God, they may terminate, while others may find God as a source of strength and covenant in suffering. Others within other dogmatic and strict denominations, may see faith as a block to their expression and look to free oneself from the morality the faith of one’s parents taught oneself. Others on the other hand, may feel extreme guilt if their moral actions contradict the morality of faith and the teachings of it. Many LGBTQ individuals who are spiritual and wish to hold to their faith can find one of these two reactions within Christianity, where their faith either torments and guilts them regarding life style or pushes them into total rejection of it or at least adjustment of their personal moral paradigm. Fukuyama in the Pederson text rightfully points out that religion and spirituality can be functional or dysfunctional when it comes finding solutions (2018, P. 489). This is very important for the counselor to identify when helping someone through moral issues, suicide, or other social issues that affect religious individuals. Is the spirituality properly function to help the person find meaning, or is it instead a sick faith that is tormenting and guilting the individual to a point of pathology? Spiritual Directors work with others in a pastoral capacity and help use healthy spirituality to guide those who seek guidance, but sometimes, they even need to identify spiritual pathology that corrupts. Scruples, guilt, torment, anger towards God, or unhealthy compliance to the Will of God as a way to escape the situation, are all examples of when spirituality can become dysfunctional. Unlike spiritual directors, counselors however are called not to give moral direction or dictate what moral code is right but instead to determine if spirituality is healthy or unhealthy in a particular situation and help the client heal.
Conclusion
Spirituality and religion are not opiates of the people. They are important elements of what it means to be human. When properly in tune, spirituality and religion can play key roles in helping individuals find meaning and guidance. However, when spirituality becomes dysfunctional it can also become a problem for the person’s ability to cope or heal. Since spirituality and religion is important, counselors need to be culturally aware of faith and religion and the target population they are working with. Regardless of the counselors own beliefs or lack thereof, counselors need to respect spirituality and discuss it in a healthy and non biased way. Spirituality and faith are a key aspect of understanding the client and is a key element of multicultural counseling. Utilizing it properly in counseling can be a great benefit, but one must like in all cultural aspects understand that diversity exists within spiritual and religious persons and not every treatment or intervention serves one best over the other. Individuals may be spiritual but not religious, or a combination, or have a myriad of different religious beliefs within their family history. These all play unique roles in forming the person before the counselor. These religious and spiritual beliefs will also play a key role in how many clients see the world, react to it and heal from it.
Please also review AIHCP’s Spiritual Counseling Certification and see if it meets your academic and professional goals
Please also review AIHCP’s Spiritual Counseling Certification as well as AIHCP’s Christian Counseling Certification. The Spiritual Counseling Certification represents a more broad spirituality that encompasses human experience with spirituality without any one dominant religious paradigm, while the Christian Counseling Certification presents a biblical and Christian perspective from multiple Christian communities. Both programs are integrative in nature and present spirituality with psychology. The programs are online and independent study and open to qualified professionals seeking a four year certification in Spiritual or Christian Counseling. The programs accept Human Service professionals, those in ministry, licensed counselors, as well as pastoral counselors, and those who work in healthcare.
Reference
Pedersen, P. et. al (2018). “Counseling Across Cultures”. (7th). Sage
Additional Resources
Bartley, J. & Cashwell, C. (2014). “Integrating Religion and Spirituality into Counseling”. Access here
Hull. C. et al. (2016). “Developing Spiritual Competencies in Counseling: A Guide for Supervisors”. Wiley. Online Library. Access here
Aten, J. (2020). “The Importance of Spirituality in Therapy”. Psychology Today. Access here
Richards, P. S., & Barkham, M. (2022). Enhancing the evidence base for spiritually integrated psychotherapies: Progressing the paradigm of practice-based evidence.Psychotherapy, 59(3), 303–306. Access here
Cognitive Behavioral Therapy helps individuals alter bad behaviors through reframing. In depression and grief, reframing can help build new perspectives and to approach life differently. Reframing and labeling something in a positive light can help an individual understand life differently and move forward with healthier behaviors. In grief and loss meaning reconstruction and reframing is especially important in understand loss but also understanding one’s reaction to loss.
Reframing is key to recovering from grief and loss. Please also review AIHCP’s Grief Counseling Program
Please also review AIHCP’s Grief Counseling Certification program and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Grief Counseling.. The program is for both clinical professional counselors as well as pastoral counselors. Please also review the video below on reframing and meaning reconstruction
Multicultural counseling proficiencies are essential to good counseling. Since Western counseling initially emerged from Europe it is culturally immersed with European culture values. European culture is very individualistic, self-centered and free of many forms of oppression due to the fact Europe was the colonizing force between the 16th and 19th Centuries. Furthermore, while Europe’s secular awakening drove a wedge between its Christian culture and itself, Christianity still plays a key part of life in millions of individuals of European descent, as well as a driving force behind the intent of nations to colonize. With these things in mind, the classic male European descent counselor must be aware of his cultural identity and how that same identity translates his world views, as well as how others of different cultures perceive him as a person when counseling. Within melting pots nations, such as the United States or Canada, many minority cultures can look upon counseling itself with suspicion as a Western custom created by white men.
Native Americans have unique ways of expressing grief. Please also review AIHCP’s Grief Counseling Certification
Grief and loss is also cultural and is expressed differently. This type of difference that inherently exists within different grieving cultures needs to be understood and respected within the grief counseling session itself. Kastenbaum points out that many from a different culture can misinterpret expressions of grief or rituals within another culture (2018, p.372). Please also review AIHCP’s Grief Counseling Certification, as well as its Grief Diversity Counseling Certification to learn more about responding better to other cultures during times of grief.
Basic Understandings When Helping Others
There is strong scientific documentation that minority cultures mistrust counseling services (Pedersen, 2016. p.14). Also from a human perspective and counseling perspective, when similarities become less and differences rise between groups one can see a correlated sharp rise in disinterest. Grief Counselors need to be aware of these realities and be able to utilize inclusive cultural empathy to increase awareness against false assumptions, increase knowledge to better comprehend and improves skill for proper calls to action (Pedersen, 2016, p.28).
Different Native American populations experience different levels of integration. Please also review AIHCP’s Grief Diversity Counseling Certification
While employing multiculturalism on grief counseling or any counseling is critical, it is still important to identify a few clear points when working with a group outside one’s cultural circle. Leong cautions against homogeneity to all clients from a particular group (Pedersen, 2016,. p. 44). This simply means, one should not assume certain individuals exist a stereotypes of their particular culture. If working with a culturally distinct client, the grief counselor or counselor should not assume the problem of this individual automatically correlates with the problem of the race or population itself. Different individuals will have different levels and ties to their cultural heritage, creed, race or forms of expression. It is important to realize different persons exist at different facets and are unique hence requiring individual focus, or in some cases universal focus. When counseling across culture, it is important to remember the dictum of Kluckhohn and Murray (1949) that “each person is like all other persons, like some other persons and like no other person (Pedersen, 2016. p.42)”.
This ideal of personhood is key. Many within populations have varying degrees of cultural awareness. Some are aware of microaggressions even against themselves, while others may be very naive to not only differences but also microaggressions. Many individuals within diverse populations exist at an integrated level where they maintain their culture of origin but adopt the culture of the majority. They exist at a dual level. Others my completely assimilate and function and exist within the majority culture. Still others may separate from the majority culture and exist primarily within their culture of origin, or oppositely exist within marginalization that adopts the majority culture (Pedersen, 2018. p. 103).
In any of these four cases, this presents a diverse reaction from ethnic individuals who may appear a certain way but may personally very different. In grief counseling, it is important to understand the individual and not hold that individual to a particular paradigm of how to grieve.
Multicultural Issues and Grief within Native Populations
Within Native American populations and other indigenous people worldwide, European contact has left extreme historical trauma due to centuries of war, massacres, exploitation, relocations, betrayals and disease (Pedersen, 2016, p. 103). This concept of past wrongs that leave a history of cultural trauma is referred to as soul wounds. These wounds shape the culture because the history of it not only shaped the present but also the community living in the present. Present conditions due to massive trauma to ancestors greatly affect present day living conditions and economic wealth due to past exploitation and theft from previous generations. Many tribes were stripped of identity when children were cruelly separated from their families and culturally indoctrinated into European culture. Hence, these type of soul wounds are essentially an intergenerational transmission of trauma from one generation to the next (Ivey, 2018.p. 33). Native Americans hence have a unique collective grief of past historical wrongs against their tribes at the hands of European aggression. These past wrongs has been transmitted into a strong and heavy mistrust of indigenous communities with Western forms of counseling (Pedersen, 2018, p.103).
Native American populations due to these wrongs look to reassert cultural identity and pursue more traditional forms of treatment as well ritual. Numerous cultural recovery programs exist within the country that looks to help these groups rediscover their culture (Pedersen, 2018, p. 105). This strive for identity has at times also put native populations at odds with European and conventional forms of counseling with suspicion.
Counselors must be multicultural proficient to understand the different ways native communities communicate
Grief counselors who work with native populations need to be self aware of their own ethnic background and how this is perceived by native populations. Pedersen notes that counselors cannot blindly pretend a cultural difference does not exist between a client and counselor, especially with native populations (2018, p. 105). In some cases, counselors can also sometimes question the efficacy of conventional methods of treatment for depression or other mental disorders when working with a mistrusting client. Of course, all persons are still persons and genuine empathy, warmth and respect are critical for any person much less one of a different culture (Pedersen, 2018, p. 106).
Many Native Americans are essentially spiritual in healing and those spiritual traditions are important to their identity. Hence counselors working in indigenous populations should work with healers within the community. Counselors should seek the advice of healers and when clients request it, form a care team that best meets the overall needs of the client. Presenting a ethnocentric therapeutic approach to a population with distrust can be disastrous and lead to no healing. Pederson recommends a healing combination of both Western and Native modalities that link the community and spiritual nature of native populations (2018, p. 110).
In addition, Pedersen points out that counselors need to become comfortable with ways natives express themselves, not only in grief but also in communication. Within Native American populations, clients are usually more comfortable with silence and long pauses and responses (2018, p. 107). If a counselor is ignorant of these types of responses or pauses, then the counselor may perceive it as a form of pathological grieving, or denial, or lack of intelligence. Grief counselors need to properly understand the social patterns of interaction within natives to better understand their grieving process. Obviously, grieving and ritual within these populations is also more communal in nature and the community plays a key role in helping others grieve. When natives are isolated or stripped from this population then it can negatively affect their ability to grieve in a healthy way.
In conclusion, Herring points out that counselors should discuss differences instead of pretending one does not exist between client and counselor, secondly, schedule appoints that are flexible and even open to family if requested, third, the allowance for natural trust to grow, fourth, the respect of silence and pause, fifth, a strong respect and honor for the client’s culture and application when necessary of it, and finally, the universal ideal of all counseling, confidentiality (Pedersen, 2018, p. 114).
Conclusion
Counseling across multicultural scopes is difficult. This is especially true when one is a counselor of European descent. With that ancestry carries a history of incidents, that through no fault of oneself. can lead to mistrust between client and counselor. It is important to be self aware of these differences and to be able to show empathy and respect cross cultural lines to the client if one truly hopes to help the client. This involves adaption and flexibility in how one approaches certain clients. This is especially true of Native Americans who have their own unique views on counseling and healing and how they express and communicate grief. It is also important to have a true understanding the of the nature of soul wounds that exist within the Native American population and how this not only affects grief but also present day economic and social life. While it is still critical to acknowledge this, a counselor still cannot assume each Native American is cultural. Every person is diverse and only through communication and genuineness can one truly understand the subjective nature of the individual.
Please also review AIHCP’s Grief Counseling Certification. The program is online and independent study and open to qualified professionals seeking a grief counseling certification. In addition to AIHCP’s Grief Counseling Certification, AIHCP also offers for Grief Certified Counselors a specialty program in Grief Diversity that covers in greater detail many multicultural aspects of grief and diverse populations.
References
Ivey, A. et, al (2018). “International Interviewing and Counseling” (9th). Cengage.
Kastenbaum, R & Moreman, C. (2018). “Death, Dying and Human Experience” (12th). Routledge
Pedersen, P. et. al. (2018). “Counseling Across Cultures” (7th). Cengage
Additional Resources
“Healing Trauma, Attending To Grief – Native Wellness Institute & Jillene Joseph” Click here
Lovering, C. (2022). “Mental Health in Native American and Indigenous Communities”. PsychCentral. Click here
Franco, M. (2020). “Culture Impacts How We Grieve”. Psychology Today. Click here
Stringer, H. (2022). “The healing power of Native American culture is inspiring psychologists to embrace cultural humility”. APA. Click here
A key part of counseling involves helping the client identify the problem, propose solutions and execute those plans into action with assessment of progress. This is the core of the Problem Management Model in counseling and is key in helping track a client’s progress.
Counselors can help clients learn to find solutions for their issues through the Problem Management Model
Please also review AIHCP’s multiple behavioral health certifications ranging from Grief Counseling and Christian Counseling to Crisis, Stress, Life Coaching and Anger Management Programs. The programs are online and independent study and open to qualified professionals in both the behavioral health and health field areas.
The allure of the world in the fallen and temporal reality that humanity exists is an illusion or mirage in the desert. As pilgrims in this fallen world, our senses are dulled, our will distracted, and our eyes sometimes blinded towards truth and beauty. The inherited broken nature from Adam hinders our ability to sometimes distinguish right from wrong. According to St. Thomas Aquinas, the concupiscible appetite of humanity’s fallen nature is associated with initial desires of the senses. Unlike Adam prior, humanity lost perfect control of the passions after Adam’s fall. The end result is humanity’s appeal to these senses which can in some cases be good but in other cases bad. Hence illusionary goods that are immorally distasteful but physically pleasing can blind humanity. In addition, the broken human nature not only sees illusion in the near and present but also abstract and secondary goods. Greed, power, status and worship become end goals leading multiple individuals down a dark path.
Filtering out the noise and finding peace in prayer leads to ultimate happiness.
The conscience always seeks good. In that our human nature is not totally devastated but the conscience while perceiving a goal as good does not always objectively choose correctly. Hence the illusion that can exist even within those with good intentions. Individuals can become so distracted by the noises of the world that they can lose sight of the truth and reality. Before Christ and His ultimate sacrifice on the cross, our broken natures were left without grace, but through the cross, Christ grants grace and guidance to His creation. This can help humanity see the noise, uncover the illusions, and focus more solely on truth. Christian Counselors, ministers, priests, clergy, and other ministry based vocations can help individuals see truth. Like Paul, we sometimes need the scales removed from our eyes to see before we can truly flourish.
The Noises of the World
St Teresa of Avila in her masterpiece “The Interior Castle” guides the soul through the world to deeper connections or castles with God. The first castles are very much consumed by the world. Outside of the castle exists the world and those who are flooded with false illusions. Once one understands the inherent malfunction of this world and understands the need of God, one is able to enter into the first castle, the entry room with God. This exist from the world of illusion into the world of reality though is nevertheless filled with noise that exists outside. The noises can pull one back and forth from truth and reality to untruth and illusion. The broken conscience and will seek the world but the intellect and mind through the grace of the Holy Spirit invite it to truth. This tug of war between the the world and God exists according to St Teresa throughout the first three mansions before the soul can become more stable. Christian Counselors primarily work with individuals in these sincere but still incomplete relationships with God. Where vice and virtue, right and wrong and truth and illusion pull at clients or spiritual children.
While the world, while marred by Original Sin, is broken, it is still beautiful. Unlike Manichean views that draw a dichotomy between the world/evil with the spiritual/good, Christian theology still sees the temporal world as still retaining goodness since it was created by God. Even our fallen human nature, still retains beauty for it is not totally corrupted. Christ became human, lived among humanity, existed within the temporal world, highlighted its beauty but also pointed out its noises and imperfections. So, while broken, nothing is totally destroyed. Not all noises of the world are evil. In Christian Counseling, it is hence important to help guide individuals through these noises, labeling them and better understanding them.
In creating a hierarch to judge the noises of the world as good, bad, or neutral, one needs two fundamental measurements. First, and foremost, do noises distract from the ultimate purpose of existence to know, love and serve God? Our primary goal in life is always spiritual. The ultimate end is always God. Things that lead to another end are noises within the world that are not good but inherently evil. Do the noises or actions from those noises correlate with God’s Law or violate it? Do they even if neutral seem to distract one from God? Secondly, some noises of the world can be more difficult to discern. Discernment involves deep spiritual prayer and reflection upon choices. What are the fruits of certain actions? Are they, as St. Ignatius Loyola point out, lead to the banner of Satan and the world, or under the banner of Christ? So noises can be difficult sometimes to discern and it is important to be able to discern what ultimately leads to God and not away from Him. So, noises within the world can be good, neutral or bad. So, we will look at some of these noises and try to better understand their role in our existence. As temporal beings, these noises although not always tied to our ultimate end are still nonetheless sometime very important. In addition, as we will see, some noises are also completely un-necessary but allow them to enter and destroy our peace.
Good Noises
As physical beings, we have physical needs and the good noises of the world meets those needs. Pieces of heaven pierce through the veil that separates and gives sunshine to the broken nature of things in temporal reality. Things that are physical but also connected to higher values such as love will exist here and in the next world. A beloved family member, friend, or even pet, is more than a temporal bond but a bond that is beautiful on earth and heaven. The noises of the world that call one to serve one’s fellow brother or sister are good noises. Seeing Christ in other human beings and being called to the temporal needs of others in this world are good noises. They do not distract but are means to the end. Unfortunately because we exist in a fallen world, happiness associated with our loved ones ultimately ends in suffering because of death and loss but these connections are re-made again with God in the eschatological reality which is perfect and true. So the noises of this world that call us to special bonds and helping our neighbor are good noises that build our union with others and God.
If we offer our day to God, then all the daily duties are spiritualized as a living prayer and not a distraction from God. Please also review AIHCP’s Christian Counseling Certification
Some good noises are less binding to the next world and exist only in this world. They are good when in balance with our spiritual needs and understood within their proper context. Jesus who existed on earth lived as a human being and understood that existence requires not only spirituality but also physical dependence to survive. So many noises direct oneself to temporal needs because one cannot always focus on the spiritual end. These noises include the joys of a good meal, exercise, health, career and income which make survival possible. Jesus within His first thirty years of life followed in His foster father’s footsteps and worked as a carpenter. He worked, he collected income for Himself and His mother, and existed. Jesus also as a human person experienced joy with social communal meetings. He ate with friends, attended parties and weddings, and experienced the goodness that exists in this dark world.
In many ways, good noises are healthy. We have duties and obligations. We cannot always contemplate the mysteries of God but must make a living, or prepare a meal, or sweep the house, or attend a friend’s wedding, or enjoy a song or movie, or go on a vacation! Jesus understands this because He is also one of us. The good noise does not take away from God but focuses one on the daily duty ahead that is required in this important phase of our existence. What Jesus did not do though is turn these good noises into distractions to primary duty. When secondary duties consume, or events take away from God, that are not inherently bad, but in some cases good or neutral, then they can become corrupted. When one allows temporal activities to become an obsession over duty to God, then they can become detrimental. Jesus never put prayer second to anything. He also corrected Martha, when Mary focused on worship, while Martha was more concerned about preparing the house or serving the guests. Martha was not distracted by a bad thing to do, but it was her timing that Jesus corrected in regards to duty to first Himself as God, and then later temporal duties. This is why good noises must always be tied to God. One cannot focus on God every minute, but one can in the morning offer all duties and obligations to God as prayer. St Theresa the Little Flower would turn a simple action as sweeping the convent floor into an act of love by giving her daily duty to God. In this way, one can spiritualize the temporal duties and vocations one may have at home, work, or school and turn them into living prayers.
Now obviously, some urges are neutral noises. Hunger, fatigue, even sickness, can distract one from God, but again God understands when hunger or fatigue affects prayer. He understands when basic human needs push one to focus on those needs. Jesus endured all the basic human needs we do but as God was also able to teach us how to offer up those needs when suffering or upset or hungry. These minor neutral and natural distractions are noises that can distract from prayer but when offered up can become powerful tools for growth in grace. Our most beautiful prayer may be our least focused due to pain or hunger, but the effort to still say it, is most pleasing to God.
Bad Noises
Bad noises in the world are inherently evil noises of the world or neutral or initially good noises that are imbalanced or lead to distraction from the spiritual. If someone is working for his or her family with long hours or attending events with family and friends, this is good or neutral within itself, but if this causes neglect of prayer life or leads one to miss spiritual obligations then it becomes a distraction. If a sporting events prevents spiritual obligations that are due to God to become unmet, then the sporting event, while good or neutral, becomes in this particular case a bad and distracting noise. When one creates an imbalance on earthly duties or leisure events at the expense of God then God is put second and the this particular noise steals from God and distracts one from one’s duty to the ultimate end. It is important to have a hierarchy of needs within one’s life. Spiritual needs should always exist on the top of the list. When spiritual needs are neglected, these noises create spiritual sloth. This in turn creates laziness and imbalance. Imagine if one neglected teeth hygiene but over focused on skin hygiene. Hence we need to balance and meet all human needs from mind, body and soul. Obviously the soul should be at the top of the list, but when other things take away from the soul, then the soul suffers. This type of neglect or spiritual sloth occurs because of outside noises that are inherently good or neutral but distort balance and lead to spiritual sloth. One must identify what is most important and also find balance to ensure the ultimate end is not neglected.
Of course, some noises are inherently bad. Sins and vice not only distract one from God, but also call us away from God and harm the soul. They damage the soul and replace virtue and good habit with vice and bad habit. They become the illusions that present themselves as good options and look to replace God as our new idol. These bad noises pull and drag us from the first mansion of union with God and dump us again in the cold barren world. The bad noises of the world are very loud. They fall under the banner of the world and Satan and make false promises. They are cheap thrills and pleasures that ultimately lead to no long term happiness but only brokenness. Like the Sirens of ancient Greek mythology, they lure wayward sailors to impending doom.
It is important to discern the bad noises from the good noises and fight temptations that lead to the wrong path of life. These noises not only distract but lead to alienation from God and entrap the soul into the follies of the world. As Christian Counselors, we must try to help individuals escape the mire and mud of the bad noises that sometimes refuse to release. That involves identifying the true nature of these noises but also ways to help form new and better habits. As Christians, we can at any moment make a poor decision. We can not only become distracted by inherently neutral or good things but also fall victim to a bad noise. When this happens, we will feel guilt and sorrow, however, we are not perfect, nor claim it, but acknowledge our broken nature and dependence upon Christ and the grace of the Holy Spirit to seek forgiveness. So, while some may be entrapped by bad noises constantly, Christian Counselors, pastors, priests, as well as anyone in ministry should be aware that there are many who slip on the trail from time to time and need an encouraging word to get back up. Within Catholicism, confession exists, but for those within other denominations of Christianity, counseling and words of love can be very helpful. Ultimately God forgives everyone who slips. The Church is comprised of sinners. We cannot escape it, so if distracted, we must sometimes acknowledge our brokenness with humility and seek forgiveness and refocus on becoming closer to God.
Helping Christians Through Un-necessary Noises
Understanding what noises are both good and bad is an important first step but there is more sometimes in finding true balance in life. The first point is to be spiritual first. This involves the moment one wakes up, offering the entire day to God. Spiritualizing the daily duty and offering to God through Christ sets the tone for the day. Furthermore, the evening and night should end with thanksgiving.
So much anxiety and lack of peace comes from un-necessary noise. This not only distracts from God but also causes inner turmoil
As spiritual beings, it is important that the spiritual end with God comes first in life. Hence, even good noises, need to find placement second to spiritual obligations throughout the week. There is an abundance of opportunities throughout churches not to forgo spiritual obligation for secular event. God asks for one hour a week.
Christian Counselors can help individuals better plan times and find better management for spiritual hygiene. Clergy can help people understand the best ways to implement prayer on the go during busy schedules. One can fulfill daily temporal duties and still worship God and find time for God. This may involve also properly balancing time. Idle time on chat, social media, or tv can be moderated if in excess. When these simple neutral noises become so loud that they dominate a larger part of the day at the expense of daily duty as well as spiritual duty, then one needs to step aside and re-evaluate priorities and possible addictions. Christian Counselors, pastors, and clergy can help individuals better time manage and also balance life in regards to social distractions not in moderation.
The peace that comes with time with God can better adjust attitudes and emotions that are soiled by the constant useless idle addiction to the world. The irritations of the world cannot only make one bitter but they can also distract one from God, while focusing on useless and meaningless trivial issues on social media, or what someone is doing or not doing. Prayer refocuses and filters out the unnecessary noises. I think that is another good adjective for noise beyond good, neutral and bad. The temporal world thrusts many necessary but also many un-necessary noises on individuals that dominate their day and distract them from what is important not only spiritually but also temporarily. These distractions cause frustrations at the emotional level causing unneeded stress and bitterness for many things that do no even involve a person. The news, politics, or what someone said on a social media outlet that you will never meet can all cause unneeded anger and frustration that un-necessarily dominates the day and most negatively steals peace for oneself and prayer towards God. So, it is important to take inventory of time management on fruitless endeavors and meaningless and un-necessary noise that steals peace but also distracts one from God.
Conclusion
Give everything to Christ and not worry. Please also review AIHCP’s Christian Counseling Certification
We are pilgrims in a fallen world. We ourselves are broken through Original Sin but through the graces obtained by Christ on the cross and administered by the Holy Spirit, we can walk through this temporal world. While broken, the world itself is not completed corrupted and through the example of Christ, we can see the importance of merely existing in it and offering everything to God. It is important however for us while existing to understand the ultimate end which is God. Through a morning offering, we can spiritualize our daily lives and instead of them becoming distractions allow them to become living prayers. Yet, we can sometimes be tugged by distractions and noises of the world and must find balance and priority with God. There are many good or neutral noises that are necessary but when they become first over God then they become big issues. Of course there are also bad noises that are inherently evil within themselves and we must try as hard as we can to limit these mistakes in life. Our goal is to live in this world, as Christ did, but to also to focus on the next. Christ is out ultimate example as both God and Man to filter through the noises of the world, discern them and offer them to God, while existing here but also hoping for there.
AIHCP offers a Christian Counseling Certification for behavioral health or human service professionals or those in ministry who wish to help counsel others to Christ. The program is online and independent study and helps equip the student with the necessary knowledge and abilities to help individuals find God. Please review the program and see if it meets your academic and professional goals.
Additional Resources
“Understanding ‘The Interior Castle’ by St. Teresa of Ávila”. Root Classics. Access here
“Ignatian Discernment”. Office of Ignatian Spirituality”. Access here
Blevins, K. (2020). “What Is the Sin of Sloth and Why Is it Worse than Laziness?”. Crosswalk. Access here
Vannoy, C. (2021). “How to Stay Spiritually Focused in a Distracted World”. Life Way Voices. Access here
In the area of grief and loss, anxiety, trauma, or in special needs, individuals are or can become more closed off from other human beings. Many are unable to express emotions properly, communicate with others, or feel independent to do things or interact with others. Individuals can become closed off to the world and unable to communicate with it. Counselors can utilize a variety of the therapies to help individuals cope better with emotions and also open back up with the world, but sometimes, especially in the case of those with mental defect, individuals need other ways to communicate and express emotion.
Animals and pets can help individuals suffering from anxiety and depression find healing. Please also review AIHCP’s Grief Counseling Certification
Animals and pets are an excellent source of love and way to heal. Animals can bring out the best in people and their presence can reduce stress and depression. Animals hence can play a key role in helping individuals who are grieving or dealing with anxiety.
Animal Therapy for Grief, Depression and Anxiety
Animal Therapy is broad spectrum approach to healing and helping those with autism express themselves, but also those who have experienced trauma, or even those who have anxiety or depression issues. Animals help individuals in a broad variety of ways to rediscover self, heal and move forward. While those who face life long mental issues can gradually improve through animal therapy, those with trauma or temporary issues can also benefit greatly with the company of an animal.
Animal Therapy has a long history, back to even Sigmund Freud, and with the advances of the its modern father, Boris Levinson. The idea of the comforting nature of an animal or pet and his/her presence has a calming effect on human beings. The company of animals can increase serotonin and dopamine, as well as lower cortisol levels by awakening the para sympathetic system. The presence releases tension and allows the person to find healing.
There is no limit to the types of animals that can be utilized. Horses, dogs, cats, rabbits, ferrets and other small mammals, birds, fish and even lizards can all be utilized. Different species have different end goals that can help individuals with particular needs. Dogs play a key role providing comfort and unconditional love, while cats help with individuals who are more awkward with initial touch and need. Horses and equine therapy play a large role in animal therapy and are provided at various locations for those who need to form better connections, trust, and responsibility. Even birds or fish can play a role in helping individuals find connection but also responsibility.
Benefits of Animal Therapy
Animal Therapy helps those with a wide variety of mental issues, but also those dealing with stress, anxiety, loss and depression. Physically, animal therapy, reduces stress and lowers blood pressure and increases dopamine and serotonin. It reduces cortisol and helps the person find comfort and calm. Emotionally, animal therapy, helps individuals find love and support. The unconditional love an animal can supply, or the fact, the animal needs the person, can help the individual feel love when sometimes love is absent in the person’s world.
Psychologically, animals help individual feel love and from that love individuals can find stronger self esteem to feel loved but also to express love to a fellow creature. The need and dependency of the animal upon the person helps build the person’s purpose. In addition, this purpose gives the person duty and responsibility. During therapy, the person is called to care for the animal, supply food and water, or provide basic care such as grooming or walking. Even the smallest duty of having to feed a fish and supplying a need to another creature can have huge therapeutic effects on the person. This sense of purpose also increases self esteem especially with the depressed.
Animals can help the bereaved form new bonds, feel loved and find purpose again
In addition, training and teaching an animal helps individuals improve communication skills, social interaction, and independence to push forward in an endeavor or task. Individuals plagued with depression or other psychological maladies may be less receptive to enter the social arena of human interaction, but through animals, they can find it easier to communicate, wake up and do tasks, and exercise. This also increases one’s sense of trust between another being. Horse riding, or walking form bonds of trust which may be difficult with another person. This trust permits the person to feel more safe in social settings and to put oneself into the hands of another while also giving purpose to care for the other. Individuals experiencing loss may need to form new bonds and the bonds of love and trust and the social skills that are re-introduced through animals can be physically, emotionally and mentally rewarding.
Overall, animal therapy helps form new bonds, increases social interaction, improves communication skills, teaches trust and responsibility and reduces the physical manifestations of stress and anxiety. It gives the person purpose and responsibility again and helps the person re-enter the social world of other human beings or at least better skills to reintegrate oneself into society after trauma or loss, or if dealing with a mental issue. Animal Therapy can help with emotional release, talk therapy, and relief of various negative symptoms.
Obviously animal therapy is not for everyone. Some individuals may have issues that may endanger the animal, or others may be allergic to certain animals. Like all therapies, it depends upon the person but overall animal therapy is a very successful therapy when applied. One can find animal therapy through the referral of a therapist. Many are offered through campuses, hospitals and special programs at rehab centers or correctional facilities.
Conclusion
Animal Therapy can be supplemental with other therapies or a sole therapy. Ultimately, those with deeper issues such as Autism or permanent conditions can benefit greatly from animal therapy. Animals have the ability to help individuals form new bonds, express feelings and explore new skills necessary in social settings. Animals have the ability to bring out physical and emotional wellness by reducing stress and anxiety. Those who experience grief and loss can also form new bonds and find new purpose through animal care and the reciprocity of love that is shared between a person and animal. While animal therapy may not be the answer for everyone, it is highly successful for those suffering from various mental ailments and temporary issues with anxiety or depression.
Horses can play a large role in animal therapy. Please also review AIHCP’s Grief and Stress Management programs
Please also review AIHCP’s mental and behavioral health certifications, as well as in particular, it’s Grief Counseling Certification as well as its Stress Management Certification. The programs are online and independent study with mentorship as needed and is open to qualified professionals in the Healthcare, Human Service and Ministry fields. Please review and see if the programs meet your academic and professional goals.
Additional Resources
Baer, B. (2024). “Animal-assisted therapy (AAT) and emotional support animals”. Therapist.com. Access here
Jelinek, J. (2022). “All About Animal-Assisted Therapy”. PsychCentral. Access here
“Emotional Support/Therapy Animals”. (2017). Good Therapy. Access here
Olivine, A. (2024). “What Is Animal Therapy?” Very Well Health. Access here
“Animal-Assisted Therapy” (2022). Psychology Today Staff. Psychology Today. Access here
Healthcare Management: Key Leadership Qualities for Success
Healthcare management plays a crucial role in shaping the delivery of medical services and ensuring the well-being of populations. As healthcare systems become increasingly complex, the demand for skilled healthcare administrators continues to grow. These professionals are responsible for overseeing various aspects of healthcare organizations, from strategic planning to day-to-day operations. The field of healthcare management requires a unique blend of leadership qualities, medical knowledge, and business acumen to navigate the challenges of the modern healthcare landscape.
Leadership is key in healthcare management. Please also review AIHCP’s Health Care Management Certification
Effective leadership in healthcare management has a significant impact on patient outcomes, staff satisfaction, and organizational success. Healthcare managers and their leadership skills play a key role in this. This article explores the key leadership qualities essential for success in healthcare management. It examines the development of a leadership mindset, the building of high-performance teams, and the importance of strategic planning. Additionally, it discusses quality and safety management, technology integration, policy and compliance, and community engagement. By understanding and cultivating these qualities, healthcare professionals can enhance their ability to lead and make a positive difference in the healthcare industry.
Effective leadership in healthcare management requires more than just managing a team. It involves identifying challenges in the system and finding solutions to those problems. To develop a strong leadership mindset, healthcare administrators and healthcare managers should focus on three key areas: self-reflection, cultivating a growth mindset, and building resilience.
Self-reflection
Self-reflection has a significant impact on leadership development. It involves critically assessing one’s thoughts, feelings, actions, and experiences. For healthcare leaders, this process includes evaluating their leadership practices, decisions, and interactions. By engaging in self-reflection, healthcare managers and leaders can:
Gain a clearer understanding of their leadership style
Identify areas for improvement
Develop new skills and competencies
Approach problems with a more open mind
Increase empathy and compassion
To practice self-reflection effectively, healthcare leaders can:
Set aside dedicated time for introspection
Maintain a leadership journal
Regularly assess their performance
Be honest about their strengths and weaknesses
Growth Mindset
A growth mindset, coined by psychologist Carol Dweck, refers to the belief that a person’s abilities and intelligence can be developed through dedication, hard work, and continued learning. This mindset has significant implications for healthcare leadership. Leaders with a growth mindset:
View challenges as opportunities for learning and growth
Actively seek knowledge about health conditions and management practices
Embrace necessary changes in the healthcare landscape
Set realistic and step-by-step targets
Celebrate small victories and learn from setbacks
To foster a growth mindset in healthcare leadership:
Seek opportunities to expand knowledge and skills through training and mentorship
Encourage team members to pursue professional development
View failures as learning experiences rather than signs of incompetence
Focus on the learning process rather than just the end results
Create an environment that fosters learning and development
Resilience
Resilience, defined as positive adaptation in the face of risk or adversity, has a crucial role in healthcare leadership. It affects not only the healthcare manager or leaders’ well-being but also the health and efficiency of their workforce. Resilient healthcare leaders and healthcare managers:
Promote well-being, joy, and satisfaction at work
Reduce intentions to change jobs among staff
Act as role models for their teams
Cope effectively with crises and challenges
To build personal resilience and foster it in others, healthcare leaders can:
Recognize factors that contribute to burnout and stress
Dedicate time and energy to building their own resilience
Practice compassionate leadership
Address individual “storms” among staff with empathy and support
Challenge personal, team, and organizational biases
By focusing on these three key areas – self-reflection, growth mindset, and resilience – healthcare leaders and healthcare managers can develop a strong leadership mindset. This mindset enables them to navigate the complex healthcare landscape more effectively, inspire their teams, and ultimately improve patient outcomes. As the healthcare industry continues to evolve, leaders who embrace these qualities will be better equipped to address challenges, drive innovation, and create a positive impact on their organizations and communities.
Building a High-Performance Team
Team building is key to successful leadership in healthcare
In healthcare management, building a high-performance team has a significant impact on patient outcomes, staff satisfaction, and organizational success. To achieve this, healthcare leaders must focus on three key areas: hiring the right talent, creating a positive work culture, and implementing effective performance management strategies.
Hiring the Right Talent
The process of finding skilled candidates for healthcare jobs has become increasingly challenging. With a predicted 1.9 million job openings annually in the U.S. healthcare sector until 2031, healthcare organizations face a talent shortage due to fewer people opting for careers in healthcare and an aging population. To address this challenge, healthcare managers should:
Craft comprehensive job descriptions that go beyond standard responsibilities
Offer flexible work arrangements, including internships and part-time positions
Utilize technology and AI-powered tools to streamline the recruitment process
Leverage social media and professional networking platforms to reach potential candidates
Participate in industry-specific events and job fairs to connect with talented professionals
Creating a Positive Work Culture
A positive workplace culture has a significant impact on employee well-being, job satisfaction, and loyalty. Healthcare leaders in healthcare management should focus on:
Promoting open communication and encouraging feedback
Fostering teamwork and collaboration among employees
Providing opportunities for professional growth and development
Recognizing and rewarding employee contributions
Ensuring a safe and supportive work environment
Healthcare managers can implement various strategies to enhance workplace culture, such as:
Organizing team-building activities and social events
Establishing mentorship programs
Encouraging work-life balance through flexible scheduling
Promoting diversity and inclusion initiatives
Performance Management
Effective performance management has a crucial role in optimizing individual and organizational performance in healthcare settings. It involves:
Setting clear performance expectations
Providing regular feedback
Conducting performance evaluations
Identifying areas for improvement
Offering training and development opportunities
To implement a successful performance management system, healthcare leaders and healthcare managers should:
Align performance goals with organizational objectives
Use key performance indicators (KPIs) to measure progress
Implement a continuous feedback culture
Utilize data-driven insights to inform decision-making
By focusing on these three key areas, healthcare managers can build high-performance teams that deliver exceptional patient care, drive innovation, and contribute to the overall success of their organizations. As the healthcare landscape continues to evolve, leaders who prioritize talent acquisition, positive work culture, and effective performance management will be better equipped to navigate challenges and achieve long-term success.
Strategic Planning
Planning is key in healthcare management
Strategic planning has a significant impact on the success of healthcare organizations. It involves a systematic approach to setting goals, analyzing the current situation, and developing strategies to achieve desired outcomes. Healthcare managers must focus on three key areas to ensure effective strategic planning: SWOT analysis, goal setting, and implementation strategies.
SWOT Analysis
SWOT analysis is a strategic planning framework that helps healthcare organizations analyze their businesses. It originated from a Stanford University research project in the 1960s-70s and has been widely adopted in the healthcare industry due to its effectiveness and straightforward methods. The SWOT framework examines four key elements:
Strengths: Internal factors that give the organization an advantage
Weaknesses: Internal factors that put the organization at a disadvantage
Opportunities: External factors that the organization could exploit to its advantage
Threats: External factors that could cause trouble for the organization
To conduct a SWOT analysis in healthcare, managers should:
Collect and assess important data, focusing on key metrics related to strategy
Organize the data into the four SWOT categories
Develop a four-box SWOT matrix for each business unit (if applicable)
Analyze the information to gain insights that inform strategic planning
By performing a SWOT analysis, healthcare organizations can identify areas for improvement and highlight their strengths, providing a clear overview of critical metrics key to their performance and overall success.
Goal Setting
Goal setting has a crucial role in strategic planning for healthcare organizations. It ensures that all employees understand their roles, expectations, and importance to organizational success. Best practice goal setting provides:
Clarity of purpose
Alignment with organizational objectives
Measurable outcomes
A framework for performance management
To implement effective goal setting, healthcare managers should follow these steps:
Align healthcare goals with employee expectations
Clearly outline competencies for each role
Establish an ongoing performance management system
Ensure employees understand the importance of their work and the quality of their performance
By setting goals in the right way, healthcare organizations create a map that leads to the exact performance outcomes desired, regardless of potential distractions encountered along the way.
Implementation Strategies
Implementation strategies are methods or techniques used to improve adoption, implementation, sustainment, and scale-up of interventions in healthcare settings. These strategies can vary in complexity, from discrete or single-component strategies to multifaceted approaches that combine two or more discrete strategies.
Key aspects of implementation strategies include:
Targeting a range of stakeholders and multilevel contextual factors
Addressing patient, provider, organizational, community, policy, and financing factors
Utilizing taxonomies to describe and organize types of strategies available
While multifaceted and tailored implementation strategies are intuitive, evidence regarding their superiority to single-component strategies has been mixed. Healthcare managers should consider the following when developing implementation strategies:
Select components thoughtfully to address identified determinants
Use theoretically or empirically-derived change mechanisms
Avoid a “kitchen sink” approach to strategy selection
Recognize that definitions of discrete and multifaceted strategies can be problematic
By focusing on these three key areas – SWOT analysis, goal setting, and implementation strategies – healthcare managers can develop effective strategic plans that drive organizational success. These approaches provide a structured framework for analyzing the current situation, setting clear objectives, and implementing strategies to achieve desired outcomes in the complex healthcare landscape.
Quality and Safety Management
Team work together with healthcare managers to ensure safety compliances
Quality and safety management has a significant impact on healthcare organizations, as it directly affects patient outcomes, organizational efficiency, and overall performance. Healthcare managers must focus on implementing best practices, managing risks, and fostering a culture of continuous improvement to ensure the delivery of high-quality care.
Implementing Best Practices
Implementing best practices in healthcare quality and safety management involves adopting evidence-based approaches and standardized processes. Healthcare organizations should:
Establish clear quality metrics aligned with organizational goals
Develop a robust reporting culture that encourages transparency
Engage all stakeholders, including patients and families, in quality improvement activities
Utilize formal models for continuous and quality improvement, such as Lean or IHI
To effectively implement best practices, healthcare managers should ensure that all staff members understand the established metrics and their role in achieving quality outcomes. This approach helps create a shared vision of transformed healthcare environments and aligns improvement efforts with the organization’s mission.
Risk Management
Risk management in healthcare encompasses the clinical and administrative systems, processes, and reports employed to detect, monitor, assess, mitigate, and prevent risks. An effective risk management strategy should:
Proactively identify and prioritize risks
Develop response plans for potential adverse events
Investigate and report sentinel events
Capture and learn from near misses and good catches
Analyze latent failures using proven models such as FMEA or Root Cause Analysis
Healthcare organizations should invest in robust Risk Management Information Systems (RMIS) to enhance their ability to document incidents, track risks, and generate reports on trends and benchmarks. These systems can significantly improve risk management performance and reduce costs by automating routine tasks.
Continuous Improvement
Continuous improvement is a systematic, sustainable approach to enhancing the quality of care and outcomes for patients. It requires a long-term commitment and involves:
Building a culture of improvement driven by frontline staff
Empowering employees to identify root causes of problems and develop solutions
Providing ongoing training and support to reinforce new behaviors
Celebrating early successes to engage staff and build momentum
Healthcare managers should focus on creating a learning organization that encourages blame-free reporting of system and process failures. This approach fosters an environment where employees constantly ask, “How are we doing?” “Can we do it better?” and “How can we do this more efficiently?”
To implement an effective continuous improvement strategy, healthcare organizations should:
Align improvement efforts with the organization’s “True North” metrics
Prioritize a smaller set of improvement initiatives to deliver breakthrough change
Engage frontline managers as the primary recipients of coaching and support
Utilize technology to support improvement efforts, but only after addressing underlying cultural and management issues
By focusing on these three key areas – implementing best practices, risk management, and continuous improvement – healthcare managers can create a robust quality and safety management system. This approach not only enhances patient care but also improves organizational performance, reduces costs, and fosters a culture of excellence throughout the healthcare system.
Technology Integration
Technology integration has a significant impact on healthcare management, revolutionizing the industry and shaping its future. Healthcare organizations rely on technology to streamline workflows, provide proactive patient care, and improve overall efficiency. This section explores three key areas of technology integration in healthcare management: digital transformation, data analytics, and cybersecurity.
Digital Transformation
Digital transformation in healthcare refers to the comprehensive integration of digital technologies, data analytics, and innovative processes to enhance the delivery of healthcare services. It involves changes related to the internet, digital technologies, and their relation to new therapies and best practices for better health management procedures. Some key components of digital transformation in healthcare include:
Telemedicine
Electronic health records (EHR)
Wearable devices
Artificial intelligence
Digital transformation has the potential to create opportunities in the health sector, provided the necessary infrastructure and training are available. It facilitates patient participation in the healthcare process and shapes the industry based on the needs and expectations of the new “consumer of health services.” This transformation requires personalization, comfort, speed, and immediacy in service provision.
Benefits of digital transformation in healthcare include:
Increased employee productivity
Improved efficiency and effectiveness of health unit operations
Reduced operating costs
However, it is important to note that digital transformation is an ongoing process that requires systemic changes in healthcare finances, staff education, and infrastructure.
Data Analytics
Data analytics has become a crucial component of healthcare management, allowing organizations to improve patient care, make faster and more accurate diagnoses, and support decision-making at both the patient and business levels. Health care data analytics involves examining raw datasets to find trends, draw conclusions, and identify potential areas for improvement.
Key applications of data analytics in healthcare include:
Predictive modeling: Analyzing current and historical data to predict future outcomes, such as potential risks for chronic illnesses or self-harm.
Population health management: Using data to predict outbreaks and implement preventive measures.
The use of big data tools has played an increasingly significant role in healthcare decision-making, especially during the COVID-19 pandemic. The collection and analysis of health data have become more streamlined, allowing for better tracking of trends and making predictions based on both historical and current information.
Healthcare organizations can benefit from employing skilled data analysts who can perform tasks such as:
Data acquisition
Analysis
Predictive modeling
Report automation
These professionals play a crucial role in various healthcare-related industries, including hospitals, large medical practices, diagnostic centers, and health IT vendors.
Cybersecurity
As healthcare organizations increasingly rely on technology, the risk of cyberattacks and potential compromise of patient health information also grows. Implementing robust cybersecurity measures has become essential for protecting sensitive data from cybercriminals.
Key cybersecurity measures for healthcare organizations include:
Strong passwords and multifactor authentication (MFA)
Regular employee cybersecurity training
Encryption technology for safeguarding patient health information
Regular security audits to identify vulnerabilities
Access controls for connected medical devices
Secure connections for accessing patient health information
Continuous monitoring of networks and devices
Healthcare providers can benefit from collaborating with cybersecurity experts, such as Managed Security Service Providers (MSSPs), to assess current security measures and implement effective cybersecurity practices. Additionally, compliance with industry regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), is essential for protecting patient data and avoiding potential penalties.
Creating a culture of cybersecurity awareness is vital for the long-term protection of patient data. Healthcare providers should promote a culture where every employee recognizes the importance of cybersecurity and understands their role in maintaining the security of patient information.
By focusing on these three key areas of technology integration – digital transformation, data analytics, and cybersecurity – healthcare managers can leverage technology to improve patient care, streamline operations, and protect sensitive information in an increasingly digital healthcare landscape.
Policy and Compliance
Healthcare managers need to have a strong understanding for rules, regulations and law and ensure their department complies
Understanding Healthcare Laws
Healthcare regulations encompass a set of rules and laws that govern healthcare professionals, entities, and providers. These regulations serve to protect patients and ensure the delivery of high-quality medical care while safeguarding the interests of healthcare professionals and organizations. The regulatory landscape in healthcare is complex and constantly evolving, requiring healthcare leaders to stay informed about changes in legal and regulatory issues.
Key healthcare laws and regulations include:
Health Insurance Portability and Accountability Act (HIPAA): This act safeguards protected health information (PHI) and sets standards for data privacy and security.
Affordable Care Act (ACA): This legislation has introduced significant changes to the U.S. healthcare system, affecting both providers and patients.
Medicare Access and CHIP Reauthorization Act (MACRA): This act has implemented new quality and reimbursement measures for healthcare providers.
Clinical Trial Regulations: These ensure the safety and efficacy of new drugs before they are made available to patients.
Ensuring Regulatory Compliance
Compliance with healthcare regulations has numerous benefits, including enhancing patient safety, maintaining quality healthcare standards, safeguarding data security, providing legal protection, and fostering public trust. To ensure regulatory compliance, healthcare organizations should implement the following strategies:
Establish a compliance program: Develop a comprehensive plan that aligns business practices with existing regulatory compliance standards.
Designate a compliance team: Appoint a chief compliance officer and a team with specific roles to oversee the implementation of the compliance program.
Conduct regular risk assessments: Identify and mitigate potential vulnerabilities in the organization’s compliance efforts.
Implement staff training and education: Develop programs to keep employees updated on current regulatory standards and expand their knowledge base.
Create effective communication systems: Establish channels for reporting compliance concerns anonymously and develop action plans to address potential breaches.
Perform internal audits: Regularly assess compliance processes and procedures to identify and rectify issues promptly.
Leverage technology: Utilize compliance tracking software and other technological solutions to streamline compliance management and monitoring.
Developing Organizational Policies
To effectively manage compliance and ensure adherence to healthcare regulations, organizations must develop and maintain comprehensive policies. These policies serve as a framework for employees, outlining expected standards for day-to-day operations and helping facilities meet health, safety, and legal regulatory requirements.
Key elements in developing organizational policies include:
Create a “policy on policies”: Establish an overarching document that sets standards for creating, implementing, and reviewing all future policies.
Form a policy management committee: Designate a group of individuals representing different departments to oversee the policy creation and approval process.
Develop clear and concise protocols: Outline objectives, procedures, and conduct for various aspects of healthcare operations, including clinical trials, data privacy, and security measures.
Implement a robust document management system: Maintain both current and historical versions of policies to track changes over time and ensure accessibility.
Establish review and update procedures: Regularly review and update policies to reflect changes in regulations and best practices.
Ensure accessibility: Make active policies easily accessible to all employees through a centralized system.
By focusing on understanding healthcare laws, ensuring regulatory compliance, and developing comprehensive organizational policies, healthcare leaders can navigate the complex regulatory landscape effectively. This approach not only mitigates risks but also contributes to the delivery of high-quality patient care and the overall success of healthcare organizations.
Community Engagement
Community engagement has a significant impact on healthcare management, fostering partnerships between healthcare organizations and the communities they serve. This approach enhances the overall health and well-being of populations while addressing specific community needs and priorities. Healthcare leaders must focus on building partnerships, implementing corporate social responsibility initiatives, and supporting public health efforts to create a culture of health and reduce health disparities.
Involving the community is key in healthcare management leadership
Building Partnerships
Effective and sustainable hospital-community partnerships are critical to building a Culture of Health, which aims to provide all individuals with an equal opportunity to live the healthiest life possible, regardless of their circumstances. To develop these partnerships, healthcare organizations should:
Identify community health needs and reach consensus on priorities
Seek out potential partners from diverse sectors
Create sustainable partnership structures
Overcome obstacles through collaboration
Assess interventions and partnerships regularly
Healthcare entities can benefit from partnering with community members, especially when addressing the needs of patients with complex health and social needs. By incorporating community voices, organizations can better inform program and policy design, leading to more effective interventions. However, obtaining and incorporating community perspectives in a sustainable and authentic manner can be challenging.
To build effective partnerships, healthcare organizations should consider:
Establishing clear communication channels with community members
Providing opportunities for community input in decision-making processes
Developing trust through transparency and accountability
Recognizing and valuing the expertise of community members
Addressing power imbalances between healthcare organizations and community partners
Corporate Social Responsibility
Corporate social responsibility (CSR) has evolved to encompass a growing range of social obligations for healthcare organizations. This concept suggests a new paradigm in hospital management, emphasizing the interconnections between healthcare providers and the communities they serve. CSR in healthcare includes:
Ethical considerations in service delivery
Environmental stewardship
Community support and engagement
Transparency and accountability
Healthcare organizations, including non-private hospitals, should adopt CSR principles to improve their overall performance and impact on society. This approach can have individual, global, and systemic effects on the community and society at large. Key aspects of CSR in healthcare include:
Raising awareness about diseases and prevention methods
Integrating civil society through the creation of supportive associations
Collaborating with other healthcare providers to address community needs
Advocating for increased healthcare funding and resource allocation
Public Health Initiatives
Public health initiatives play a crucial role in community engagement and improving overall population health. Healthcare organizations can support and participate in various programs aimed at addressing specific health concerns and reducing disparities. Some examples of successful public health initiatives include:
Steps to a HealthierUS (now Healthy Communities program): This Centers for Disease Control and Prevention (CDC) initiative provides funding to communities to improve policies and environmental factors influencing health, focusing on reducing obesity and chronic diseases.
Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.): This CDC-funded program aims to eliminate racial and ethnic health disparities in the United States.
Community-based prevention programs: These initiatives focus on specific health issues, such as immunization, diabetes management, HIV prevention, and cardiovascular health.
Environmental change interventions: Programs like Shape Up Somerville focus on creating energy balance for children through before-, during-, and after-school interventions.
To effectively engage in public health initiatives, healthcare organizations should:
Collaborate with local government agencies and community organizations
Participate in health fairs and community events
Offer targeted assistance to vulnerable populations, such as older adults
Support initiatives that address social determinants of health
Promote health equity and access to resources across all demographics
By focusing on building partnerships, implementing corporate social responsibility initiatives, and supporting public health efforts, healthcare organizations can create meaningful connections with their communities. This approach not only improves population health outcomes but also fosters trust, enhances the organization’s reputation, and contributes to the overall well-being of the society they serve.
Conclusion
The field of healthcare management requires a unique blend of leadership qualities, medical knowledge, and business acumen to navigate the challenges of the modern healthcare landscape. Successful healthcare leaders focus on developing a strong leadership mindset, building high-performance teams, and implementing strategic planning. They also prioritize quality and safety management, technology integration, policy and compliance, and community engagement. These key areas have a significant influence on patient outcomes, staff satisfaction, and organizational success.
Please also review AIHCP’s Healthcare Case Management Certification and see if it matches your academic and professional goals
To wrap up, healthcare managers who excel in these areas are better equipped to address challenges, drive innovation, and create a positive impact on their organizations and communities. By understanding and cultivating these essential qualities, healthcare professionals can enhance their ability to lead and make a real difference in the healthcare industry. As the healthcare landscape continues to evolve, leaders who embrace these principles will be well-positioned to shape the future of healthcare delivery and improve the well-being of populations.
Please also review AIHCP’s Healthcare Management Certification and see if it meets your academic and professional goals. The healthcare management program is online and independent study and open to qualified healthcare professionals looking to manage healthcare facilities or departments.
FAQs
What key characteristics define effective leadership in healthcare? Effective leadership in healthcare is characterized by the ability to embrace diverse perspectives and adapt to evolving knowledge. Leaders in this field must exhibit humility, which includes empathetic communication with patients and a readiness to shift strategies as needed.
What are the essential skills for leaders in healthcare? The essential skills for effective healthcare leadership include six core competencies:
Medical Knowledge
Patient Care
Interpersonal and Communication Skills
Professionalism
Practice-Based Learning and Improvement
Systems-Based Practice
Which leadership qualities contribute to the success of healthcare leaders and foster positive stakeholder relationships? Successful healthcare leaders are distinguished by their adherence to core values, which builds trustworthiness. Key qualities include technological adeptness, strong communication skills, effective time management, focus, and integrity. These traits are particularly valued by contemporary stakeholders.
What is the most effective leadership style for managing healthcare organizations? The transformational leadership style is highly effective in healthcare management. Transformational leaders are visionaries who inspire significant change and set ambitious goals. They excel in motivating teams and designing achievable, yet challenging plans that require collective effort
Additional Resources
Boyles, M. (2024). “Healthcare Leadership: What Is It and Why Is It Important?” Northeastern University Graduate Programs. Access here
Kark, L., et. al. (2023). “Management and Leadership Development in Healthcare Professionals”. JNMA J Nepal Med Assoc. 2023 Mar; 61(259): 294–296. Published online 2023 Mar 31. doi: 10.31729/jnma.8100. National Library of Medicine. Access here
Kupietzky, K. (2023). “Why Strong Leadership Is Critical In Healthcare”. Forbes. Access here
Al Sawai, A. (2013). “Leadership of Healthcare Professionals: Where Do We Stand?”. Oman Med J. 2013 Jul; 28(4): 285–287. doi: 10.5001/omj.2013.79. National Library of Medicine. Access here
Kumar, R. (2022). “Leadership in healthcare”. Clinics in Integrated Care Volume 10, January 2022, 100080. Science Direct. Access here
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. IHI White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2013. (Available at ihi.org) Access here
This video discusses confronting and challenging clients to transform and find change. Counselors many times have to help push clients see the truth when the client’s own view is distorted. This involves careful and empathetic ways of challenging and confronting. Empathetic confrontation is a key concept within this video. Sometimes to help transformation, clients need have their view and story challenged or emotions confronted.
In some cases, counselors need to empathetically confront and challenge clients
Please also review AIHCP’s mental health certifications, including Grief Counseling. The certification programs are online and independent study with mentorship as needed. The programs are designed for pastoral as well as clinical counselors in behavioral health, human service and ministry. Please review and see if the programs meet your academic and professional goals
