Legal Nurse Certification: Crafting and Writing Expert Opinions

Posted on by Dominick Flarey

In a world where the complexities of healthcare intersect with the intricacies of law, the role of a professional with a legal nurse certification becomes indispensable. This unique blend of nursing expertise and legal acumen allows for the translation of medical jargon into comprehensible, court-admissible documentation and expert opinions, particularly in cases of medical malpractice. The importance of such a role cannot be overstated, as it not only bridges two highly specialized domains but also contributes significantly to the administration of justice in healthcare-related legal disputes.

Legal Nurses are required to not only testify sometimes as an expert witness but to also prepare and draft reports on the case

Writing an expert witness opinion in legal nursing is a critical task that can significantly influence the outcomes of legal proceedings. Nursing expert witnesses play a vital role in interpreting medical facts, establishing standards of care, and providing unbiased opinions that assist the court in making informed decisions. This article will delve into the various aspects of writing an expert witness opinion in legal nursing, from understanding the role and qualifications of a nursing expert witness to the impact of their testimony on legal outcomes. Further, it will dissect the practicalities of stepping into the shoes of a legal nurse consultant, navigating through the challenges and rewards inherent to the profession, and ultimately how one can build a robust career within this domain.

Key Takeaways

  • Nursing expert witnesses must have the appropriate nursing education and clinical experience to provide credible testimony.
  • Expert witness reports should be clear, concise, and well-structured to effectively communicate the expert’s opinions.
  • Understanding the legal framework, including Rule 702, is essential for nursing expert witnesses to ensure their testimony is admissible.
  • Maintaining impartiality and adhering to ethical standards are crucial for the credibility of nursing expert witnesses.
  • Continuous education and professional development are vital for nursing expert witnesses to stay updated with legal and medical advancement

Exploring the Realm of Legal Nurse Consulting

Definition and Role

Legal nurse consultants are registered nurses who possess specialized training and knowledge, enabling them to provide expert consultation and analysis on medical issues within a legal context. They serve as vital liaisons between healthcare providers and legal professionals, assisting attorneys to navigate complex medical records, understand intricate medical procedures, and evaluate the merits of claims. These consultants review medical records, decipher medical terminologies, and analyze the chronology of events to identify potential deviations from accepted standards of care, thereby equipping attorneys with the necessary information to build strong cases.

Fields of Specialization

Legal nurse consultants can specialize in various fields such as medical malpractice, personal injury, workers’ compensation, and more. Each specialization demands a deep understanding of specific medical guidelines and practices. For instance, those specializing in medical malpractice focus on identifying negligence or substandard care by reviewing medical records. Similarly, consultants working on personal injury cases provide insights into the medical aspects of injuries caused by accidents or negligence. Their expertise is crucial in assessing the standard of care provided and determining whether there has been a deviation from this standard.

The Intersection of Healthcare and Law

Legal nurse consultants play an integral role at the intersection of medicine and law, providing attorneys with invaluable expertise that can significantly impact the outcome of a case. Their ability to dissect medical records, identify deviations from accepted standards of care, and effectively communicate complex medical concepts makes them essential assets in medical-related litigation. By collaborating with legal nurse consultants, attorneys can navigate the intricacies of medical issues and enhance their chances of achieving favorable claims outcomes. Moreover, these consultants stay updated with the latest advancements in both medicine and law to ensure they provide the most current and relevant advice.

The Art of Drafting Legal Nurse Consultant Reports

Defining the Nursing Expert Witness

An expert witness is someone who, because of their education, experience, or a combination of both, has knowledge that can inform decision-makers about nursing practice standards. The most common use of expert testimony in a nursing or medical negligence case is to establish what the reasonable standards are in the circumstances and whether the nursing care provided met those standards. Mastering the art of effective communication is paramount for an expert witness.

An expert witness must have some form of specialized knowledge and experience beyond that of the court in order to assist the court in coming to a proper understanding of the evidence. Nurses’ and doctors’ professional training, skill, and experience make them ideal expert witnesses to assist in applying the art and science of their practice to the facts the court must decide. Most jurors have a limited understanding of both areas.

An expert witness may come from a nurse defendant’s own state or may come from another jurisdiction. Generally, an expert witness is an individual who by training, education, and/or experience is determined to be qualified by a court as able to assist the jury in understanding health care and the role of health care providers, and are from the same profession (e.g., nursing).

Federal Rule 702 is a cornerstone in the legal framework governing expert witness testimony. This rule mandates that the expert witness’ scientific and specialized knowledge must assist the trier of fact in understanding the evidence or determining a fact in issue. Furthermore, the testimony must be based on sufficient facts and data, and it must reflect a proper application of reliable principles and methods.

Writing the Report

Reports are a key part of the process of legal nurse consulting. Writing concise and accurate reports for a client are sometimes the only required job for a particular case

 

When drafting legal nurse consultant reports, it is imperative to recognize the dual audience that the report will address: the client (typically an attorney) and potentially their client as well. This awareness shapes the content and tone of the report, ensuring that information is delivered with clarity and professionalism. Legal nurse consultants must tailor their reports to meet the specific needs of these audiences, which may vary significantly based on the legal context and the medical specifics of the case. For instance, younger attorneys or those in smaller law firms might require more detailed explanations due to their limited access to medical expertise.

The effective legal nurse consultant report balances hard facts with a necessary degree of empathy. Empathy enhances the readability and relatability of the report, making complex medical information more accessible. However, too much empathy might risk the objectivity required in legal proceedings. Therefore, it is crucial to maintain professional boundaries and ensure that empathy does not overshadow factual accuracy and relevance. The use of empathetic language should aim to clarify rather than confuse, assisting attorneys in understanding the patient’s perspective without compromising the report’s objective integrity.

After reviewing the case materials, the next step is to formulate your expert opinion. This involves analyzing the evidence and identifying key points that support your conclusions. Your opinion should be based on a thorough understanding of the medical facts and the applicable standards of care. It is important to present your findings clearly and convincingly, as they will be scrutinized during deposition and trial testimony.

A comprehensive nursing expert witness report begins with a detailed review of all relevant documents. This includes medical records, depositions, and any other pertinent materials. Listing these documents is crucial as it provides a foundation for the expert’s opinions and ensures transparency in the review process.

The next step involves summarizing the medical events in a clear and concise manner. This summary should include the sequence of events, treatments provided, and any deviations from standard procedures. A well-structured summary helps in presenting a coherent narrative of the case.

In this section, the expert witness must explain the applicable standards of care. This involves detailing what a reasonably prudent nurse would have done under similar circumstances. The explanation should be based on established guidelines and practices within the nursing profession.

A well-structured report is crucial for effectively presenting facts and opinions. Establish the key points early, and then return to them as you elaborate. It is easier for people to follow your structure if they know in advance what you plan to discuss. Follow a logical format for presenting the key points. Consistently refer back to and develop the points you have told the reader you’ll be sharing with them.

When presenting your expert opinion, it is essential to balance objectivity and advocacy. You are tasked with providing unbiased opinions based on the facts of the case and your professional expertise, rather than personal biases or opinions. This balance ensures that your testimony is credible and reliable.  Anticipating and addressing potential counterarguments strengthens your report. By acknowledging and refuting opposing viewpoints, you demonstrate thoroughness and enhance the persuasiveness of your testimony. This approach not only prepares you for cross-examination but also reinforces the validity of your conclusions.

Delivering bad news in legal nurse consultant reports requires a sophisticated blend of honesty and tact. Reports should be straightforward yet considerate, acknowledging the potential impact of the news on the recipient. Techniques such as using softening phrases, expressing understanding, and anticipating defense positions can help mitigate the harshness of unfavorable findings. Moreover, legal nurse consultants should employ clear communication strategies, avoiding medical jargon and ensuring that the report is understandable to non-medical professionals. Structured frameworks and evidence-based practices should guide the assessment and reporting processes, ensuring that each conclusion is well-supported and justifiable.

In crafting these reports, the consultant’s role extends beyond mere information transmission; they facilitate a deeper understanding between the legal and healthcare domains, ensuring that each report contributes effectively to the resolution of the case.

Common Challenges Faced by Nursing Expert Witnesses

There are a variety of challenges a legal nurse can meet during a case

Dealing with Cross-Examination

One of the most intellectually stimulating yet daunting aspects of being a nursing expert witness is facing cross-examination. During this phase, the opposing counsel will scrutinize your qualifications, experience, and the basis of your opinions. The goal is to find inconsistencies or weaknesses in your testimony. To navigate this effectively, it is crucial to remain calm, composed, and confident in your expertise.

Maintaining Professional Credibility

Professional credibility is paramount for a nursing expert witness. Any hint of bias or lack of impartiality can severely undermine your testimony. It is essential to present your findings and opinions based on objective analysis and evidence. Consistently updating your knowledge and skills through continuing education can also help maintain your credibility.

Handling Ethical Dilemmas

Nursing expert witnesses often encounter ethical dilemmas, such as conflicts of interest or issues related to confidentiality. It is vital to adhere to ethical guidelines and standards to navigate these challenges effectively. Always disclose any potential conflicts of interest and ensure that patient confidentiality is maintained throughout the legal process.

The role of a nursing expert witness is both challenging and rewarding, requiring a balance of professional expertise and ethical integrity.

The Importance of Clear and Concise Communication

Clear and concise communication is paramount for a nursing expert witness. Effective communication ensures that complex medical concepts are accessible to attorneys, judges, and juries who may have limited medical knowledge. This not only aids in understanding but also enhances the credibility of the testimony.

Writing in Plain Language

When drafting reports or providing testimony, it is essential to use plain language. Avoiding medical jargon and technical terms helps in making the information more digestible. This approach ensures that the key points are understood by all parties involved, regardless of their medical background.

Avoiding Jargon and Technical Terms

To effectively and succinctly present their conclusions, nursing expert witnesses should steer clear of jargon and technical terms. Instead, they should focus on explaining medical concepts in a way that is easy to understand. This practice is crucial for maintaining clarity and ensuring that the testimony is comprehensible.

Ensuring Consistency and Clarity

Consistency and clarity are vital in both written and oral communications. Establishing key points early and revisiting them throughout the testimony helps in maintaining a logical flow. This method not only aids in comprehension but also reinforces the main arguments, making the testimony more persuasive.

Clear and concise communication is not just about simplifying language; it is about making complex information accessible and understandable to those without specialized knowledge.

Ethical Considerations for Nursing Expert Witnesses

Maintaining Impartiality

As a nursing expert witness, it is crucial to maintain impartiality throughout the legal process. Bias can undermine the credibility of your testimony and potentially affect the outcome of the case. It is essential to provide an objective analysis based on the facts and standards of care, without letting personal opinions or external pressures influence your judgment.

Confidentiality and Privacy Concerns

Nursing expert witnesses must adhere to strict confidentiality and privacy standards. This includes safeguarding patient information and ensuring that any sensitive data reviewed during the case is handled with the utmost care. Breaching confidentiality can have serious legal and ethical repercussions.

Conflict of Interest

Avoiding conflicts of interest is paramount for maintaining professional integrity. Before accepting a case, thoroughly evaluate any potential conflicts that may arise from your professional relationships or personal interests. Navigating ethical considerations effectively ensures that your testimony remains credible and unbiased.

Ethical considerations are fundamental to the role of a nursing expert witness, as they uphold the integrity and trustworthiness of the legal process.

Stepping into the Shoes of a Legal Nurse Consultant

A Day in the Life

Legal nurse consultants begin their day by reviewing medical records and preparing for consultations with attorneys. They analyze these documents to identify discrepancies and summarize key information for legal teams. Throughout the day, legal nurse consultants may engage in various tasks such as conducting client interviews, preparing testimony, and attending medical examinations. Their role requires them to communicate effectively with both legal and healthcare professionals, ensuring that all parties have a clear understanding of the medical aspects involved in a case.

Case Studies: Successes and Challenges

Legal nurse consultants often reflect on memorable cases that highlight both their successes and the challenges they face. For instance, one consultant discussed leveraging their nursing experience to educate an attorney on the merits of a case, which played a crucial role in achieving a favorable outcome. These case studies exemplify how legal nurse consultants apply their expertise to bridge the gap between healthcare and law, providing critical insights that influence the direction and results of legal proceedings.

Successful Nursing Expert Witness Reports

In a personal injury case, a legal nurse consultant was instrumental in evaluating the extent of the plaintiff’s injuries. Through a comprehensive review of medical records, the consultant identified additional underlying conditions that exacerbated the plaintiff’s injuries. This information allowed the legal team to pursue additional claims for damages, resulting in a significantly higher settlement for the client.

Lessons Learned from Courtroom Testimonies

One notable lesson from courtroom testimonies is the importance of clear and concise communication. Nursing expert witnesses must present their findings in a manner that is easily understood by the jury. This involves avoiding medical jargon and explaining complex medical terms in plain language. Additionally, maintaining professional credibility is crucial, as any perceived bias can undermine the expert’s testimony.

Analyzing Notable Cases

A notable expert witness case study involved a dispute concerning cattle slaughter, which occurred in the early 1990s on Victorian land. The nursing expert witness provided critical insights into the standard of care and the medical implications of the case, which were pivotal in reaching a resolution. This case highlights the diverse range of scenarios where nursing expert witnesses can provide valuable testimony.

The role of a nursing expert witness is not limited to medical malpractice cases; their expertise can be crucial in a variety of legal contexts, from personal injury to product liability cases.

Continuing Education and Professional Development

Transitioning from Clinical Nursing

The transition from clinical nursing to legal nurse consulting involves acquiring specialized knowledge and skills. Legal nurse consultants must understand legal principles and processes, which requires comprehensive training in legal research, case analysis, and medical-legal ethics. This transition also demands a shift in perspective from direct patient care to analyzing broader healthcare practices and outcomes as they relate to legal standards and claims.

In sum, stepping into the shoes of a legal nurse consultant involves a dynamic and challenging blend of medical and legal expertise. These professionals play a pivotal role in the legal system by providing essential insights into medical practices and patient care, which are critical to resolving complex legal cases.

Building Your Career as a Legal Nurse Consultant

Essential Skills and Qualifications

Legal nurse consultants are integral to bridging the gap between healthcare and law, utilizing their deep understanding of medical procedures and legal expertise to assist in litigation. To excel in this role, one must have a comprehensive knowledge of medical terminology and standards of care, coupled with the ability to perform detailed case analysis and communicate complex medical concepts clearly to non-medical professionals. A strong foundation in nursing, typically supported by a Bachelor of Science in Nursing (BSN) degree, is crucial, although not strictly necessary for all positions. Importantly, licensure as a Registered Nurse is required, and additional certification in legal nurse consulting can significantly enhance credibility and marketability in this competitive field.

Training and Certification Programs

Aspiring legal nurse consultants can gain the necessary skills through specialized training programs that cover a range of relevant topics. These programs typically include medical record analysis, legal terminology, and an understanding of healthcare laws and regulations, all crucial for effective practice in the field. The quality of these programs is often reflected in their ability to provide real-world case studies and comprehensive contact hours, which prepare students for practical application of their knowledge. Certification, while not mandatory, is highly recommended as it validates expertise and dedication to the profession. It also requires ongoing education to stay current with the latest developments in both healthcare and legal fields.

Marketing Your Services and Growing Your Network

Effective marketing is essential for legal nurse consultants to establish and grow their practice. This includes understanding that you’re not just offering a service but also marketing your expertise every time you interact with potential or existing clients. Successful consultants use various marketing strategies, such as networking, maintaining a strong online presence, and leveraging social media platforms like LinkedIn to connect with the legal community. Regularly updating profiles and engaging with content on these platforms can significantly enhance visibility and attract new clients. Additionally, it’s important to focus on building relationships with attorney-clients, as referrals and repeat business are crucial for long-term success in the field.

Conclusion

Please also review AIHCP’s Legal Nurse Consulting Program and see if it meets your academic and professional goals

Throughout this exploration of the legal nurse consulting field, we’ve journeyed from the foundational pillars that define its necessity within the legal and healthcare sectors to the intricate details of building a successful career in this niche. The union of medical insight and legal acumen positions legal nurse consultants as invaluable assets in navigating the complexities of healthcare-related legal cases. Their expertise not only fortifies the legal process but also ensures that justice is served with an understanding of the nuances of patient care and medical standards.

Looking ahead, the significance of legal nurse consultants continues to grow as the healthcare industry evolves and legal disputes become more intricate. The capacity of these professionals to bridge the gap between two distinctly specialized fields underscores a broader implication for the legal system and patient advocacy alike. By fostering a deeper comprehension of medical facts within a legal framework, legal nurse consultants not only aid in the resolution of current cases but also pave the way for a future where the synthesis of healthcare knowledge and legal practice is seamlessly integrated.

Please also review AIHCP and the American College of Legal Nurse Consulting’s, Legal Nurse Consulting Certification and see if it meets your academic and professional goals. The program is online and independent study and open to qualified nurses looking to enter into the field of Legal Nursing.

FAQs

What distinguishes a CLNC from an LNCC?

The Certified Legal Nurse Consultant (CLNC) and the Legal Nurse Consultant Certified (LNCC) differ primarily in accreditation and recognition. The LNCC is the only certification recognized by the American Association of Legal Nurse Consultants (AALNC) and is also the only designation nationally accredited by the American Board of Nursing Specialists.

What are the benefits of becoming a legal nurse consultant?

Becoming a legal nurse consultant offers several advantages, particularly for nurses looking to manage their own business. Most legal nurse consultants (LNCs) operate as independent contractors, which allows them the flexibility to set their own schedules and select their clientele. Additionally, many newer and mid-career LNCs often find opportunities working as subcontractors for larger firms or agencies.

Can you share an interesting fact about the role of a legal nurse consultant?

Legal nurse consultants play a crucial role in the legal field by performing several key responsibilities. These include reviewing and analyzing medical records, providing professional judgments on medical cases, advising attorneys on healthcare-related cases, educating legal professionals on nursing standards of care, and serving as expert witnesses during trials.

How does a nurse paralegal differ from a legal nurse consultant?

Nurse paralegals and legal nurse consultants both work within the legal sector but in slightly different capacities. Nurse paralegals typically work for law firms that specialize in malpractice or for general counsel offices within healthcare institutions. In contrast, legal nurse consultants may offer advice, serve as witnesses, and even speak in court on a variety of legal medical matters.

What is the role of a nursing expert witness?

A nursing expert witness provides an opinion on nursing care standards and practices in legal cases. They testify on whether the care provided met the accepted standards.

How should a nursing expert witness report be structured?

A nursing expert witness report should include a list of reviewed documents, a summary of medical events, an explanation of the standard of care, and a summary of opinions.

A nursing expert witness must provide truthful, unbiased testimony, maintain confidentiality, and adhere to legal standards such as Rule 702 governing expert witness testimony.

How can a nursing expert witness prepare for a case?

Preparation involves initial considerations and retainer agreements, reviewing case materials thoroughly, and formulating expert opinions based on the evidence.

What challenges might a nursing expert witness face?

Common challenges include dealing with cross-examination, maintaining professional credibility, and handling ethical dilemmas.

Why is clear and concise communication important for nursing expert witnesses?

Clear and concise communication ensures that complex medical information is understandable to non-medical professionals, including judges and juries, which is crucial for effective testimony.

What ethical considerations must nursing expert witnesses keep in mind?

 

Additional Resources

Jibril, F. (2022). “The Medical Expert Witness Litigation Guide”. Expert Institute.  Access here

Evans, J. (2017). “Drafting Expert Witness Reports: Pitfalls and Best Practices”. Expert Institute.  Access here

Mangraviti, J. et. al. (2014). “HOW TO DRAFT A POWERFUL, PERSUASIVE, AND UNDERSTANDABLE EXPERT WITNESS REPORT”. Access here 

 

Multicultural Competence in Counseling

Posted on by Dominick Flarey

A driving force in recent years is a more counselor awareness of multicultural differences between people.  As the world becomes smaller and more and more different ethnic and religious communities interact, the reality that individuals with very different views is becoming more and more common.  Simply through social media, the interaction between different individuals with diverse backgrounds has increased over the years.  Counselors also are coming into more contact with others of different beliefs and cultures and it is important for counselors to understand cultural issues within a client and how that affects the counseling process.  How a particular person from one culture versus another culture can vary greatly how various emotions such as grief are displayed, or how certain emotions are seen as positive and negative.  When working with a client, a counselor needs to be able to understand these differences.  The counselor will also need to understand other sensitive issues that exist for a particular client that is tied to his/her culture or background.  This involves many investigative and interviewing steps to have a full grasp of the client.

Multicultural Competence

When counseling, counselors need to be aware of cultural differences between themselves and clients

Many are sometimes rigid to ideas of multicultural issues and may see it as merely another “woke” agenda but this is farther from the truth.  Multicultural competence is imperative to social skills, especially for counselors.  It helps counselors better understand different clients to maximize helping and minimize harm.  According to Ivey, it is ethically imperative that counselors become more multicultural competent in their care of clients (2018, p. 51).   Hence any hesitancy by counselors to remain close minded to cultural realities is something contrary to the very nature of helping others.  There are extremely important things to consider when helping others with different backgrounds and they play key roles in the therapeutic process.

Ivey lists the “RESPECTFUL” model which highlights key dimensions within a human person.  Each letter of respectful correlates with something unique about ourselves as well as others.  When looking at the counselor and client, it is important to identify not only the client within this model, but also the counselor and how the differences between the two could possibly manifest and side track the counseling process.  We will briefly look at this model.

 

 

R= Religious or spiritual background.  Obviously someone who is Christian would differ greatly from someone who is Hindu, or someone who is religious versus someone who is secular.

E= Economic and social background.  A more wealthy counselor may have issues identifying with an individual with far less income and wealth.

S= Sexual Identity.  Individuals who are heterosexual or homosexual have very different stories to tell in regards of acceptance within society

P= Personal Style and Education.  Different levels of education can cause differences in how well communication and conversation is achieved.

E= Ethnic and Racial Identity.  Different cultures and races have different experiences with situations. Sometimes counselor and client are two differently culturally and racial people

C= Chronological/Life Span.  Depending on one’s age, the outlook on a particular situation can differ greatly.

T= Trauma.  An individual based on their situation or culture may inherit various different levels of inherent trauma

F= Family background and History.  A person’s upbringing can play a key role in his/her development.  A person raised in a two parent home versus a one parent home

U= Unique Physical Characteristics.  A person with various disabilities has a unique set of challenges.

L=Location and Language.  A person’s land or origin, or where a person resides or the language a person speaks can all create unique difficulties

(Ivey, 2018, p. 33)

These types of differences all point to unique challenges a counselor may encounter with a particular client.   When counseling, different cultural expressions can emerge in how one expresses or speaks or means a certain phrase.  Hence it is important to be aware of the RESPECTFUL model and see how each element can possibly apply to a client

Soul Wounds

Different races, cultures and people face historical traumas and what is referred to as “soul wounds”

 

Different cultures experience different griefs or collective wounds that an individual has inherited.  This can be referred to as social grief, but also according to Ivey, as “soul wounds” (2018., p.52),  Historical trauma can play a key role in how an individual living in the present experiences the world and interacts with it.  African American clients can experience quite a different situation from day to day interaction with others than White Americans.  A simple traffic stop can have a greater traumatic effect due to racial profiling, police brutality, and social injustice.  In addition, African Americans suffer the tragic legacy of slavery within their history.  Following slavery, unjust and unequal economic restrictions prevented many African Americans from accumulating wealth leading to current poverty levels for many of them.  These types of issues and a host of other microaggressions greatly affect African American clients.

Simple prejudice can also exist at the microlevel that many individuals do not notice.  Microaggressions based on mere differences of culture and skin color exist within the world.  Whether unintended or intended, these aggressions add up over time.  Individuals face prejudices, looks, stares, or unkind words or opinions that can build up within them over time (Ivey, 2018, p. 52).  In most cases, although, microaggressions are not intended to be harmful, they still can cause great harm and trigger the other party.

So whether it is the African American community, or the Native American community, or the LGBTQ community, various slights and soul wounds exist within their communities that affect them.  Understanding these wounds and the importance of recognizing this diversity is critical in any type of counseling.

Counselor World View 

Believe it or not, the counselor brings with him/herself a variety of inherent bias and world views that he/she must be aware of and attempt to filter out when counseling.  Awareness  of one’s own background is as key as awareness of the client’s background (Ivey, 2018, p. 52).  Within this, a counselor of a particular background must be aware of his/her own beliefs and background but also how he/she appears before the client.  A white male counselor may initially cause some distance between a black female client.  The issue of creating trust and understanding may take longer. In this case, privilege and image play a key role.  A young counselor may find struggles counseling an older client, so minimizing the status of oneself or the privileges associated with oneself can play a key role in a healthy counselor/client relationship.  Unfortunately, sometimes, counselors and clients do not match, and through no fault of either, another fit may be best.  Do not feel horrible if this is the case because in many cases the perception of the client regarding the counselor is key.

The client hence needs to show cultural sensitivity to race, religion, age, gender, sexuality or culture of the individual.  This involves using political correct terminology (Ivey, 2018, p. 52).  The counseling session should not include language that is non-inclusive that already exists in the  outside world and causes distress to the client.  The counseling should be professional and void of damaging language.  In addition, the counselor must be extra careful in how he/she presents himself to different individuals with different backgrounds that may cause distress, either through posture, facial expressions, or words.  The counselor also needs to be mindful of his/her own beliefs and maintain a neutral setting with those of extremely different views.  The counselor should do his/her very best to be inclusive and open minded in listening and discussing issues that are different than his/her own religious or even moral beliefs.   If bias exists, then it needs to be dismissed.  A client can never be dismissed or set to the side due to cultural or moral differences.  This goes against all ethical standards of counseling.  If cultural differences are so great and there is no benefit in the counseling, usually the client will sense it, but if not, a counselor can help the client find a counselor that better matches the client’s needs, but again, this must be done with sensitivity, care and mutual agreement.

Conclusion

Ultimately it is the counselors job to be multicultural competent.  Some counselors may be less open to this type of training but to better serve the client and cause no harm it is absolutely essential that counselors become multicultural competent.

Please also review AIHCP’s Grief Counseling and Christian Counseling certification programs and see if they meet your academic and professional goals

Counselors need to be aware of different backgrounds through the RESPECTFUL MODEL, be aware of soul wounds of a particular culture and also be aware of their own beliefs and values.  The counselor needs to remain neutral but educated on different backgrounds.  This is not only important ethically but it also permits the counselor to better understand how different people experience the world and how they communicate it.  In addition, a counselor needs to be aware of his/her own values and appearance and how that translates to a potential client.

Please also review AIHCP’s Grief Counseling Certification, as well as its Christian Counseling Certification.  AIHCP also offers a host of other mental health certifications for clergy, pastoral and clinical counselors, social workers and any individuals within the Human Service fields in Crisis Intervention, Stress Management and also Anger Management.  All of the programs are online and independent study and open to qualified professionals seeking a four year certification.

Also for members of AIHCP with existing Grief Counseling Certifications, please review AIHCP’s Grief Diversity Counseling Program which focuses on such issues of grief and diversity within different cultural groups.

 

Reference

Ivey, A. et. al. (2018). “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society” (9th Ed.) Cengage

Additional Resources

Seales, J., (2022). “Cultural Competence in Therapy: What It Is and How to Find It”. PsychCentral.  Access here

Farook, M. “The State of Multicultural Counseling Competencies Research”.  Society for the Advancement of Psychotherapy. Access here

Gillson, S. & Ross, A. (2019). “From Generation to Generation: Rethinking “Soul Wounds” and Historical Trauma”. Biol Psychiatry. 2019 Oct 1; 86(7): e19–e20. National Library of Medicine. Acces here

Berns-Zare, I. (2021). “6 Ways to Build Multicultural Competence and Combat Racism”. Psychology Today.  Access here

Dissociation Video

Posted on by Dominick Flarey

Dissociation is a serious condition resulting from PTSD.  When triggers of past trauma arise, the mind tries to shut the body down through dissociation.  Sometimes it is through a flashback, or a disconnect from reality.  These situations while in public or driving can cause injury to the person. So it is important to understand what triggers it and how to ground oneself when dissociation occurs.

Please also review AIHCP’s numerous mental health certifications which include grief counseling, crisis intervention, spiritual and Christian spiritual counseling, stress management and anger management programs.  The programs are online and independent study and open to qualified professionals seeking a four year certification.

Responding Skills in Counseling

Posted on by Dominick Flarey

In the previous blog, we discussed listening skills and observing skills of the client.  Good listening and observation set the stage for proper responses.  In this blog, we will shortly review core concepts in turning listening into positive and productive  counselor responses that help the client through the counseling process.  Attending skills are essential in any type of counseling, especially grief counseling.  When these basic skills are absent, the client can feel neglected or misunderstood.  Good grief counselors, whether licensed clinical counselors or non-clinical counselors, are able to incorporate these skills to enhance the therapeutic nature of counseling and keep the client as an active and on going participant in his/her mental health.  Bear in mind, good responses are not necessarily saying the most profound or theory correct statement, but the particular response that is best for the particular stage of counseling and needed comment.  Sometimes the responses may be short or longer, statements or questions, informative or probing, but they all have a particular reason and are the tools of the trade in discovering issues and helping clients find better outcomes.

Identifying Emotions in Counseling

Grief Counselors need to identify emotions when preparing a response or prompt to help the client’s story proceed smoothly

In the last blog, we spoke about the vital importance of observation and how a grief counselor needs to identify verbal but as well as non-verbal cues in a client that can illustrate a particular issue or feeling.  In formulating therapeutic responses, grief counselors and other counselors need to identify the particular emotion of an attending client.  This involves identifying the words associated with the emotion, implicit and unspoken emotions, and any non-verbal cues of the emotion expressed (Ivey, 2018, p., 170).   Based from the core universal feelings across cultures, a counselor should watch for sad, mad, glad and scared (Ivey, 2018. p., 171).   These are root words for all emotions and a grief counselor can build from these words to more complex emotions.

It is crucial to employ empathetic responses.  Like the previous blog, which emphasized empathetic listening, again, the word empathy appears in counseling.  The grave importance of empathy allows the counselor to become involved in the client’s state of being in a true and understanding way that helps the counselor produce productive and positive change.  Empathetic responses help the client feel understood and not judged, or admonished.  Hence, responses to emotions need to be empathetic and caring in nature.   Egan reports three important types of empathy in responding from the work of Arthur Clark.  He first lists subjective empathy, which puts the counselor literally in the client’s life and helps the counselor understand the emotional state of the client.  Second, he lists the term objective empathy which ties to the studies of the counselor and the counselor’s own personal experience in counseling.  Tying these together is a third type of empathy referred to as interpersonal empathy, which ties together the client’s feelings and the way the counselor is able to communicate it as well as any needed information (Egan, 2019, p. 132-133).

Interpersonal empathy involves the ability to perceive the issues, the know how to state it and the assertiveness when to input it (Egan, 2019, p. 134-137).  Grief Counselors need to perceive the emotion on display, the ability to articulate it and the assertiveness to sometimes address it when uncomfortable.  It is important to report what is said back with empathetic accuracy (Egan, 2019., p. 137).  Ivey also emphasizes the importance of accuracy in naming particular emotions.  He points out that counselors should use the words to describe the emotion by the client and also attempt to articulate the emotion with name and when only seen non-verbally as close as possible to what the client is experiencing (2018, p. 171).  Egan continues that is important when naming emotions to remain sensitive when naming them, as well as to not over-emphasize or under emphasize them.  He also encourages counselors to be aware of cultural sensitivities as well when naming particular emotions (2019, p. 139-142).

 

Prompts in Counseling

Some clients may speak openly about issues of loss, trauma or everyday issues.  They are a flood of information.  Other clients may be more shy, untrusting, or quiet in how they detail their issues.  Obviously, building trust is key within the therapeutic relationship and plays a large role in receiving vital information during the listening phases. However, sometimes it takes various prompts, nudges, or encouragements to help a client discuss difficult issues.  The art of counseling involves keeping a steady dialogue and flow between client and counselor and this falls upon the counselor’s shoulders to ensure this productive process.  According to Egan, probes are extremely beneficial in helping clients engage more fully, especially with more reluctant clients, in identifying experiences, feelings and behaviors.  They further help clients open to other areas of discussion and engage in conversation with more clarity and specifics.  They can also help clients remain on target and on important issues (2019, p. 177).

There are a variety of ways to help a client continue the story through prompts such as paraphrasing, summarizing, or open ended questioning

Some encouragers can be as simple as “uh huh” or a simple phrase of understanding which serves as a bridge for the client to continue speaking (Ivey, 2018, p. 148).  Sometimes, as simple, as saying “I see” or “okay” or “please continue” are strong enough phrases to encourage the client to continue the story. Sometimes the counselor can merely restate the emotion in a particular tone expressed by a client which further facilitates further discussion.  These simple prods can break silence and encourage the client to continue with the story.  Others can be simple non verbal movements, as a nod of the head, a particular look or leaning forward (Egan, 2019, p.161).  Prompts, probes or nudges can also take the form in longer responses.  Counselors can make statements, requests, or ask particular types of questions to better understand the story and also to properly push it forward.

Questions in particular have high value in counseling.  They help the counselor not only understand and clarify points, but they also show the client a sincere interest on the part of the counselor and sometimes can push the client to delve deeper into an issue and find more self discovery.  Questioning, however, for the pure purpose of questioning can be counter-productive and make the client feel they are being interrogated, so questions need to be utilized sparingly and effectively (Egan, 2019, p. 163).   Ivey points out that there are types of questions that are open and closed (2018, p. 124).  Both have their purpose and time but need to be utilized properly in order for the question to be effective.   Open ended questions, as a rule, should be utilized most.  These types of questions do not end with a simple response of “yes” or “no” by the client but look to abstract more information and input from the client.  According to Ivey, most open questions begin with the words “how”, “what”, “where”, “when” or “could” (2018, p. 124). Close ended questions look for a particular concise answer and have value but usually are used when the counselor is looking for a particular answer while the counselor is primarily talking during the session.   Another great question is the “what else question”.  This question looks for any additive elements to the story or if the counselor is missing anything (Ivey, 2018, p. 125).  Remember, if the counselor does not understand something, then questions or statement looking for greater clarity are better than pretending to understand.

Another important prompt involves paraphrasing.  Paraphrasing is a useful tool utilized in responses by counselors to help keep the conversation going or to help the client hear reflectively what the client has stated.  Sometimes the mere power of hearing something back has immense value.  When a counselor paraphrases, the counselor usually states the emotion in a sentence and then concludes with a “because” phrase.  For instance, a counselor may paraphrase to a depressed client by stating, “you are depressed because you no longer feel any energy”.  This paraphrase can illicit additional information or continue the conversation, much in the same fashion as a simple nod, or phrase.  Ivey points out that paraphrasing is not repetition but also adding some of the counselor’s own words (2018,p. 148).  It is important to note that when paraphrasing, if something is worded incorrectly, the counselor should apologize and ask for deeper clarification.  Sometimes, hearing certain things back can trigger an individual, or if worded differently, and the client is not ready to hear the interpretation, the client may respond quickly, or begin to close up.  Cultural issues can sometimes play a key in this.

Finally, Summaries are a critical promoting tool in responding to a client. Summaries are more detailed paraphrases that adds more depth to the conversation.  They are usually utilized to begin an interview to help bridge the previous meeting, or to conclude a meeting, but they have other purposes as well during the session (Ivey, 2018, p. 148).  Egan points out that sometimes a more detailed summary can help during a session when the discussion is not going anywhere.  They can also be utilized to help the client see a new perspective (2019, p. 178-179).   A counselor utilizing a summary for purposes of illustrating a new perspective can state “I’d like to get the bigger picture… or “I’d like to put a few things together” (Egan, 2019, p. 179).   According to Egan, it is also important to help clients create summaries.  The counselor can ask the client to put together the major points or concerns of the issue and to articulate them Egan, 2019, p. 180).

Carl Rogers saw the importance of these ways to respond.  In this Basic Listening Sequence BLS, he saw the skills of the counselor in how he/she responds to be most crucial.  The utilization of open/closed questions, encouraging, reflecting feelings, paraphrasing and summarizing were all critical elements in the empathetic relationship and understanding the story (Ivey, 2019,p.194).

Pitfalls to Avoid When Responding

Responses while helpful can also be detrimental when not properly utilized by the counselor during a session.  A counselor needs to avoid certain responses that derail the process or make the client uncomfortable.  Not responding or asking too many questions are two extremes to avoid.  Not responding can remove merit from a statement or display disinterest to the conversation.  While sometimes silence can be powerful, not saying anything or responding is usually non productive to the counseling session (Egan, 2019.p. 155).  It is also a dis-service merely to respond for the sole purpose of it.  Counselors should avoid parroting or repeating without context  Parroting dismisses any empathetic response (Egan, 2019, P. 156)

Counselors need to avoid distracting questions when working with clients

In addition to not responding, some counselors misuse questioning.  They can either over utilize it and make the session appear as an interrogation, or ask distracting questions that inflame rather than heal.  For instance, instead of responding with empathy, some counselors can ask inflaming and distracting questions that upset the client.  Instead of focusing on the client’s feelings, the question looks at how the client may have responded. “Did you confront him” or ” Did you do anything at all” or “Are you positive you cannot resolve this” (Egan, 2019., p. 155).  These questions again distract from the story and the emotion and can cause irritation in the client as he/she focuses on a personal injustice or slight.

Cliches are another responses that should be avoided.  In grief counseling,  cliches are counter-productive.  In general counseling, they are also counter-productive.  Cliches can minimize the conversation and cheapen it.  They attempt to replace understanding and empathy with a more generic and impersonal response (Egan, 2019, p. 155).  Clients can hear cliches from the next door neighbor, they do not need to hear them from trained professionals that are their to help assist them in resolving issues.

Another pitfall is how counselors advise clients.  In the counselor-client model, most people expect advise from a counselor.  Other cultures may demand it.  However, in counseling, the counselor does not exist to advice a course of action, but presents a host of options for the client to choose. The client is in control and the counseling relationship is one of teamwork and collaboration.  When the client is told what to do, then the counseling relationship strips the client of self discovery and self healing.  The client is not looking for a family member to give un-wanted advice, but a set of options.  Instead of saying what to do, instead utilize “if I was in your situation, here are a few options that I might look into” (Egan, 2019, 156).

Interpretations based on theories and models are also tempting responses that have a time and place but usually not in responses.  A counselor may have a wealth of knowledge to share, but when interpretations and labeling of an client’s state of mind overtake empathetic responses, then the process of counseling can become derailed.  Instead of giving a moralistic interpretation based on past study, respond to the client’s feelings (Egan, 2019. p. 155).

Counselors need to be also honest in their responses to a client.  Pretending to respond with ingenuine “Uh huh” or “Ok” can lead to later issues when the counselor is expected to remember or understand something previously stated by the client.  Hence if, one loses sight, or track of a story, it is far better not to pretend to understand but to ask for clarification.  This is not only polite and professional but it also shows genuine interest and also pushes the client to better explain the issue which alone may be beneficial (Egan, 2019, p. 157).

Finally, a counselor’s response should not be sympathetic and agreeing for the sake of being so.  Empathy is far different than sympathy.  Many times sympathy can drown logic and allow one to lose focus on the facts.  An empathetic counselor while caring remains grounded.  The counselor response is not overtly sympathetic or judgmental but one that addresses emotion and the issue in a caring way.  The client is looking for help beyond a shoulder to cry on (Egan, 2019, p. 157).

Conclusion

A grief counselor’s response to a client is key in helping the client tell the story.  The response is tied to good observation of the client’s emotions.   Good responses are helpful in transitioning the story, moving it forward, but also in in proper feedback about the story.  Empathy is the guiding force in responding.  Grief Counselors can utilize nudges or prompts with verbal and non-verbal responses. Some verbal responses can be one word or a phrase, while some may include paraphrasing or summaries.  Good counselors utilize responses like an artist and interweave them throughout the counseling process.

Please review AIHCP’s multiple mental health certifications including Grief Counseling and Christian Counseling

Please also review AIHCP’s numerous mental health certifications that involve counseling skills.  AIHCP offers a Grief Counseling Certification, as well as a Christian Counseling Certification.  Other topics include crisis counseling, stress management and anger management.  All of the programs are online and independent study and open to qualified professionals seeking a four year certification.

 

 

 

 

 

 

References

Egan, G & Reese. R. (2019). “The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping” (11th Ed). Cengage

Ivey, A. et, al. (2019). “Intentional Interviewing and Counseling: Facilitating Client Development6 in a Multicultural Society” (9th Ed.) Cengage

 

 

 

 

Additional Resources

Bennett, T. “Empathic responding (or active listening) in counseling: A basic, yet essential response for counselors to master in their practice”. Thriveworks.  Access here

Sutton, J. (2022). “Communication Skills in Counseling & Therapy: 17 Techniques”. Positive Psychology. Access here

“ENCOURAGERS, PARAPHRASING AND SUMMARISING”. Counseling Connection.  Access here

“What Are The Benefits Of Paraphrasing In Counseling”. Processing Therapy.  Access here

 

 

 

The Problem Management Helping Model in Grief and Counseling

Posted on by Dominick Flarey

Helping individuals from one point of need to the final point of self resilience and healing is the process of counseling itself, however, many times counselors helping others with grief, issues of loss, or problems in life become loss in the process.  Maintaining a sense of direction when helping is key.  While there is a partnership in the counseling relationship, the counselor still nonetheless is the guider within the partnership.  The counselor directs the process and guides it to its eventual end point.   Whatever counseling philosophy or model one incorporates, it is still essential to have a template of how to help resolve a particular issue.  Problem Management is a key arrow and guiding modality to help counselors and clients stay on track and have a sense of direction.  It is essentially the compass or navigation control in the counseling session.  Good counselors understand its use and properly utilize it during counseling.  In this short blog, we will review its essential nature in counseling and how to properly incorporate it with a client.

We will also note how Problem Management lays the foundation and structure for a counseling session and compare it to the 5 Stage Model of Carl Rogers.

Counselors help clients identify problems, offer solutions, and incorporate goals and ways to achieve them

 

Problem Management: Four Questions

When a client attends counseling, he/she is looking for guidance in a particular struggle.  Whether it is more complex trauma or loss, or instead a simpler issue revolving around a decision to find a job or not, clients are seeking guidance.  While the clients ultimately determine the outcome, they seek guidance with options and how to accomplish a given thing.  Counselors can help guide clients through Problem Management and its four questions.  The process involves the current picture, preferred picture, a way forward and action itself.

First, the counselor will ask questions about the current problem and current picture..  According to Egan, one should ask a client, what his/her issues or concerns pertain to (2019, p. 45)?   Within this first stage of helping the client, the counselor can help the client discover and identify the issue.  The first task involves the story itself.  What is the primary problem and main concerns (Egan, 2019, p. 48)?  When discussing the story, the counselor should help the client possibly see new perspectives to the problem and what may be really going on beyond the client’s initial story.  Finally, the counselor should be able to direct the client to the right story and what  he/she should be working on.  This process leads to first listening, but then helping the client identify beyond his/her perceptions and find the right story and the keys surrounding it (Egan, 2019, p. 48).  For example, a person who is obese may discuss multiple issues revolving around self image and poor diet/health.  Discussing the primary problem and identifying perceptions of self image and directing the person to the core of the problem is important.  Leading the client to the right story and issue sometimes takes time, but is essential.

After helping the client identify the right issue at hand, the counselor needs to help the client look beyond the current picture and propose a preferred picture.  The primary question should include what does a better picture look like? Within this phase, according to Egan, the counselor helps the client determine problem managing outcomes and set goals (2019, p. 48).   What are the possibilities for a better outcome entail?  What goals and outcomes are truly the most critical and important?  Finally, what is the client willing to do to achieve these outcomes (2019, p.48). Ultimately, these better outcomes and preferred pictures involve effort.  In this phase, again the example of the obese client will see a preferred picture of weight loss, better health and higher self esteem.

Following the preferred picture, the counselor looks to guide the client forward.  The counseling sessions look to help the person move forward with a plan.  The client and counselor should brain storm with possible ideas and strategies to resolve a particular issue.  The counselor will help narrow down the best fit strategies for the particular client and then help the client organize a way to accomplish these goals (Egan, 2019, P. 48).  In the case and example of the obese client, the counselor will discuss diet and exercise strategies and then see which particular strategies fit best with the client’s work and life schedule.  The counselor will then help coordinate first steps and possible times to put things into action.

These three phases of identifying problems, seeking better outcomes and making plans all lead to a call to action.  How well will this call to action being implemented depends on many subjective factors within the client.

Clients and Change

Human beings, despite perfect plans, usually fail to accomplish goals the first time. This requires patient and flexibility by the counselor to help facilitate lasting change and resiliency within the client

Counselors can only direct, they cannot force a client to change.  Hence it is important to help facilitate change but not to expect perfection.  Change takes time.  Some clients may be more resilient to let downs, or more focused in accomplishing a task.   It is important to expect a back and forth wavering between stages.  Clients when they finally become aware of a problem enter into various phases to push forward in change.  According to Egan, individuals looking for change after initial awareness of a problem, will still waver, until the awareness leads to a heightened level (2019, p. 56). This leads to preliminary actions and a search for remedies.  Within this, individuals estimate costs and weigh those costs of a change.  They soon turn to more rational decision that is not only rational but tied to emotional change.  This leads to serious action.  However, these actions still require maintenance and the reality that relapse can occur (Egan, 2019, p.57-58).

It is the counselors job to help nurture positive change and guide clients through pitfalls.  Those facing addiction issues, or in our example, one facing weight loss challenges, will wish to change but may sometimes not be emotionally tied to the rational decision enough to take the serious action.  Others may do well for a few months and not be able to maintain what is demanded, or worst, yet relapse into addiction, or fall off their diet.  Counselors are there to help guide in those cases and foster resilience.  This may involve returning to the Problem Management model at an earlier stage to again find grounding and direction.

This is why counselors must ever remain flexible in their approach.  Somethings may work for one client but not another.  Counselors need to constantly “mine” various approaches or counseling philosophies that will help a particular client (Egan, 2019, p. 58).   The counselor then organizes what works best, evaluates it and incorporates it into the various phases of the Problem Management Model (2019, p, 58-59)

Pitfalls to Avoid in Problem Management

When helping clients identify issues, outcomes and plans of action, there are some pitfalls that counselors need to avoid.  Counselors need to avoid a lack of plan in their work.  Some helpers go session by session without a uniform plan set into play.  Others on the contrary attempt to implement to many plans at once.  While there are many good models, not all models fit for a particular person, so each model and stage of helping, needs to be tailored to the individual client.  Avoiding rigidness and being flexible in approach is key with an understanding that one can go back and forth between stages.  It is also important to include the client in the process.  Since counseling is a partnership, then it is essential to share the helping models with the client.  This is an element of psycho-educational healing.  A client who is part of the process understands the points of reference and can better track oneself in the healing and change process (Egan, 2019, p. 60-61).  Finally, while important as it is to utilize flexibility, a good counselor can recognize lack of progress on part of the client and when to help the client push forward (Egan, 2019, p52).

Hence the process while simple in theory is more difficult when people become involved.  People are complex and no one person is the same.  This leads to the need of flexibility, testing and feedback, and trying other things within the parameters of the Problem Management model.  Some clients may process the issue quicker, others may take longer.  Some my engage in a certain stage a different way than another, while others will regress or progress.   This is why counseling while a science is also an art.  The individual talents of a counselor go well beyond the models and theories but also helping others implement what needs to be done through a variety of skills that involve evaluation and guidance.

Problem Management and Carl Roger’s 5 Stage Model

The great Humanist counselor, Carl Rogers, understood the importance of structure in helping clients find direction.  At the source, he also made his care patient based and utilized empathy to help individuals find healing.  In previous blogs, we discuss the Humanistic Approach.

In regards to Carl Rogers, the Problem Management Model shares many similarities with the 5 Stage Model.  Carl Rogers listed 5 important stages within any counseling relationship that are essential in directing an individual towards healing.  The first stage involves an empathetic relationship.  Within this first stage, the counselor looks to build rapport with the client through empathy, trust building and establishing a goals and direction (Ivey, 2018, p. 194).  This stage is so critical because many counselor/client relationships end because of a disconnect.  Whether due to insensitivity or indifference that is purposeful or perceived, the relationship is never able to grow.  The client does not feel the counselor cares or truly invests in the problem.  Furthermore, in our previous blogs, it can be due to multicultural issues that are perceived by the client.  The client may feel a young woman may not understand himself, an older man, or a black woman, feeling a white middle class counselor will not understand her issues of social injustice.

Rogers second stage includes understanding the story. Stage two is labeled Story and Strengths and focuses on the story itself.  Collecting data, drawing out the story and establishing early goals are essential (Ivey, 2018, p., 194).  Of course this stage demands good attending of the client.  It involves active listening and good responding skills that emphasize reflecting feelings, paraphrasing and summarizing as needed to have a full understanding of the story.  It involves empathetic understanding of the client and identifying strengths and weaknesses, truth and discrepancies, and helping to build up with the client.

Stage three involves in identifying and establishing goals that best fit the needs of the client.  It is a collaborative effort where as a team, the counselor and client identify the best goals and options (Ivey, 2019, p. 194).  This stage is very similar to the Problem Management Model, where after feelings are identified, then the client is asked beyond the current picture, what is the preferred picture?  Hence, the similarities show a concrete plan in helping the client from one point to another and helping the counseling sessions move forward with purpose and direction.

Rogers’ stage four continues align with the Problem Management Model in continuing to identify the preferred picture.  Within this stage, the Restory stage, the client is asked to identify alternative goals, confront issues and rewrite the narrative (Ivey, 2018, p. 194).  It is the completion of the preferred picture and implementation of a plan.

Finally, the final stage, looks at action and how to achieve it and also deal with set backs (Ivey, 2018, p. 194).  Hence one can see the similarities but also see a common art and science that should guide a counselor in helping individuals through problems.  There is a common theme and way to do things.  There is a general current that one should allow counseling sessions to flow.  The flow may be different at certain times, but the general direction is essential.

 

 

Conclusion

It is essential to have a plan.  Counseling is structured while also flexible.  It has a purpose and a plan to reach a goal.  The flexibility is how to reach that goal not the goal itself.  Problem Management helps the counseling relationship stay structured in regards to the issue.  It helps identify the issue, state the better outcome and help give the tools and plans to accomplish it.  Counselors need to work their clients to the desired change but while doing so understand the nature of change within the human person and the need to keep trying when results do not appear.  The counselor not only guides the client to facilitate positive change but also helps the client get up when the client falls.

Please also review AIHCP’s numerous mental health programs, including its Grief Counseling and Christian Counseling Certification Programs

 

Please also review AIHCP’s Grief Counseling Certification as well as its Christian Counseling Program.  AIHCP also offers Spiritual Counseling, Stress Management, Crisis Intervention and Anger Management programs to help train professionals in facilitating positive changes in clients.  Utilization of a Problem Management paradigm is essential in all of these models.  AIHCP’s programs are all independent study and online.

Reference

Egan, G & Reese, R. (2019). “The Skilled Helper: A Problem Management and Opportunity-Development Approach to Helping” (11th Ed.) Cengage.

Additional Resources

“Problem-Solving Models: What They Are and How To Use Them”. (2023). Indeed Editorial Staff. Indeed.  Access here

Cuncic, A. (2024). “What Is Problem-Solving Therapy?”. Very Well Mind.  Access here

Antonatos, L. (2023). “Problem-Solving Therapy: How It Works & What to Expect”. Choosing Therapy.  Access here

 

 

 

 

 

Case Management and Wound Management of Patients

Posted on by Dominick Flarey
The management of wounds is a critical aspect of healthcare that requires a comprehensive approach involving multiple disciplines and the latest in care techniques. This article explores the various dimensions of wound care management, from the basics of treatment to the collaborative efforts needed to optimize healing and patient involvement.

Key Takeaways

Case Managers play a big role in wound management and ensuring the patient receives the proper follow up and care

 

Case Managers can help coordinate healthcare teams and ensure proper upkeep and follow up care is given to the patient’s wound.

  • Understanding the fundamentals of wound care is essential for effective management and resource optimization.
  • Interdisciplinary collaboration and the use of cutting-edge technology are key to improving healing rates and patient quality of life.
  • Regular training and the establishment of best practices are crucial for ensuring high-quality wound care.
  • Patient involvement and education in wound care can significantly enhance treatment outcomes and prevent complications.
  • Advancements in wound care research and technology continue to evolve, offering new opportunities for more effective treatments.

Overview of Basic Wound Care Management

Understanding the Fundamentals

Basic wound care management is essential for effective patient recovery and prevention of complications. Proper understanding of wound healing processes—such as hemostasis, inflammation, and epithelialization—is crucial. This knowledge ensures that healthcare providers can apply the most appropriate and effective treatments.

Resource Utilization

Effective wound care management requires significant resources. It involves not only the direct care of wounds but also the strategic use of materials and personnel to optimize healing and minimize resource waste. Strategies include streamlining the supply chain for dressing materials and educating staff on the latest wound care techniques.

Improving Healing Rates

To enhance the healing rates of wounds, it is imperative to implement evidence-based practices. These include maintaining a clean and moist wound environment, using advanced dressings, and employing modern therapeutic techniques. Regular monitoring and timely interventions can significantly improve outcomes and reduce the duration of patient recovery.

Collaborative Approaches in Wound Management

Case Managers help coordinate healthcare teams in providing the best care for the wound of the patient.

Interdisciplinary Team Roles

In effective wound management, the collaboration between various healthcare professionals is crucial. The nursing team, treating medical team, and specialists such as stomal therapists and plastic surgeons play pivotal roles. Each member contributes uniquely to the management and dressing selection, optimizing the healing process.

Referral Processes

Referrals are essential for specialized wound care. They should be streamlined through an Electronic Medical Record (EMR) system to ensure timely and appropriate management. This process involves multiple healthcare departments, including Specialist Clinics and Allied Health teams.

Optimizing Dressing Selection

Selecting the right dressing is a critical decision that affects wound healing. It requires a thorough understanding of wound types and the available dressing technologies. The choice of dressing can significantly influence the healing rate and should be made collaboratively by the interdisciplinary team.

Healing Mechanisms in Wound Care

Primary Intention

Wound healing through primary intention involves the direct closure of the wound, typically through surgical means such as suturing or stapling. This method is most effective for clean, uninfected wounds with well-defined edges. The goal is to minimize scarring and reduce the risk of infection, promoting a quicker recovery.

Monitoring Progress

Effective wound management requires diligent monitoring to assess the healing process. Key indicators include the reduction of redness and swelling, the absence of infection, and the progression of tissue regeneration. Regular assessments help in adapting the treatment plan to enhance healing outcomes.

Adapting Care Plans

Adapting care plans to individual needs is crucial for optimal healing. Factors such as the patient’s nutritional status, underlying health conditions, and mobility affect wound healing. Tailored interventions, considering these intrinsic and systemic factors, are essential for effective wound management.

Implementing Wound Assessment Technology

Role in Pediatric Care

The implementation of wound assessment technology plays a crucial role in pediatric care, enhancing the accuracy and efficiency of treatments. These technologies, particularly portable imaging devices, allow for precise measurements and monitoring of wound healing, which is vital in the sensitive and varying physiology of children.

Guidelines and Aims

Wound assessment technology aims to standardize the evaluation process across different healthcare settings. Guidelines focus on ensuring consistent and accurate measurements, which are critical for effective treatment planning and outcome prediction.

Multidisciplinary Assessment

Incorporating technology into wound care facilitates a multidisciplinary approach, involving various healthcare professionals. This integration ensures comprehensive care, from initial assessment to the final stages of healing, leveraging the expertise of each team member.

Defining Key Terms in Wound Care

Common Definitions

In the realm of wound care, understanding the terminology is crucial for effective communication and treatment planning. Key terms include ‘acute wound’, ‘chronic wound’, ‘debridement’, and ‘exudate’ among others. These terms help in categorizing and treating wounds based on their nature and severity.

Impact of Comorbidities

Comorbidities significantly affect wound healing processes. Conditions such as diabetes and vascular diseases can impede blood flow, thus delaying wound healing. It’s essential to consider these factors when planning treatment to ensure optimal care.

Preventive Measures

Preventive strategies in wound care are vital to reduce the incidence of wounds, especially in at-risk populations. These include regular inspections, maintaining skin moisture, and proper nutrition. Implementing these measures can significantly decrease the risk of wound development and complications.

Assessing Causes of Wounds

Identifying Damage

Identifying the cause and extent of damage is crucial for effective wound management. Early and accurate assessment helps in tailoring the treatment to the specific needs of the wound, thereby enhancing the healing process. Factors to consider include the size, depth, and the presence of any foreign bodies or underlying tissue damage.

Control Measures

Control measures are essential to prevent the exacerbation of the wound. These include maintaining a stable temperature and moisture balance, ensuring adequate oxygenation, and managing any infection present. It is also important to address any intrinsic factors such as nutrition and underlying chronic diseases that may affect wound healing.

Predicting Treatment Outcomes

Predicting treatment outcomes involves understanding the complexities of wound healing and the patient’s overall health status. This includes monitoring the wound’s response to treatment and making necessary adjustments to care plans. Effective prediction helps in setting realistic expectations and improving patient outcomes.

Note: Effective wound assessment and management require a comprehensive understanding of both the wound and the patient’s overall health condition.

Establishing Best Practices Internally

Training Staff

Ensuring that all healthcare providers are well-trained in the latest wound care techniques is crucial. Comprehensive education programs should be established, focusing on both theoretical knowledge and practical skills. Workshops and continuous training sessions can help in maintaining high standards of care.

Partnering with Specialists

Collaboration with specialists in wound care enhances the overall quality of care provided to patients. Establishing partnerships with experts can bring in advanced insights and techniques, thus improving patient outcomes.

Ensuring Proper Techniques

Adopting and adhering to evidence-based practices is essential for consistent patient care. Regular audits and feedback mechanisms should be implemented to ensure that the care provided meets the highest standards. The use of innovative technologies, such as portable wound assessment devices, can aid in early detection and management of wound conditions, thus enhancing the effectiveness of treatments.

Role of Post-Acute Professionals

Case Managers work with other teams to ensure proper wound management is applied to patients

Case Management plays a key role in record keeping and assessment of healing.

Improving Patient Quality of Life

Post-acute professionals are pivotal in enhancing patient outcomes by teaching management skills that foster independence and self-care. Their role extends to ensuring that patients are well-equipped with the necessary knowledge and tools to manage their conditions effectively, which significantly contributes to improved quality of life and reduced complications.

Teaching Management Skills

The education imparted by these professionals is crucial for patient empowerment. By providing comprehensive training and resources, they help patients understand their treatment protocols, which aids in faster recovery and minimizes the risk of rehospitalization.

Recognizing Complications Early

Early detection of complications is vital in post-acute care. Through regular monitoring and assessments, post-acute professionals can swiftly intervene, preventing the escalation of potential issues. This proactive approach not only saves costs but also enhances the overall healing process.

Challenges in Wound Care Management

Dealing with Complications

In the realm of wound care, complications can arise from a variety of sources, including infections, delayed healing, and reactions to treatment methods. Effective management of these complications is crucial to prevent prolonged recovery times and increased healthcare costs. Strategies to address these issues include rigorous monitoring, timely intervention, and personalized care plans based on individual patient needs.

Generalized Treatment Risks

The application of generalized treatment protocols to all patients can lead to suboptimal outcomes. Each wound and patient is unique, and treatments must be tailored to address specific conditions and comorbidities. This approach helps in minimizing risks associated with inappropriate treatment applications and enhances the overall effectiveness of wound care strategies.

Implementing New Methods

Introducing new wound care techniques and products into clinical practice involves challenges related to acceptance, training, and evaluation of effectiveness. It is essential to ensure that these new methods are implemented with careful oversight to avoid potential setbacks. Continuous education and training for healthcare providers are vital to keep up with advancements and to ensure the safe integration of innovative treatments into standard care practices.

Advancements in Wound Care Techniques

Research and Development

The field of wound care is rapidly evolving with significant investments in research and development. Innovations such as xenogeneic tissue scaffolds and recombinant growth factors are transforming patient outcomes. These advancements are crucial for enhancing the efficacy of wound treatments and reducing recovery times.

Updating Clinical Practices

As new technologies and treatments emerge, updating clinical practices is essential. This includes integrating novel methods like endoscopic subfascial ligation and endovascular arterial repair techniques into standard care protocols to ensure that all healthcare providers are up-to-date with the latest in wound care management.

Cooperation with Specialized Facilities

To maximize the benefits of new wound care technologies, cooperation with specialized facilities is vital. These collaborations help in refining techniques such as negative pressure wound therapy and optimizing the use of advanced dressings and devices. By working together, healthcare providers can leverage collective expertise to improve patient care and outcomes.

Patient Involvement in Wound Care

Nurse-Patient educators can play a key role in helping patients take a big step in self care of their wounds

Self-Management Education

Empowering patients through education is crucial for effective wound care management. Providing patients with the knowledge and skills to manage their wounds can lead to improved outcomes and a greater sense of control over their health. Educational sessions should cover topics such as proper wound cleaning, the importance of maintaining a clean environment, and recognizing signs of infection.

Tools for Effective Care

To support patients in their self-management, various tools and resources should be made available. These include instructional guides, videos, and wound care kits. Ensuring that patients and caregivers know the correct technique to use, these materials should be made available as options. Regular updates and easy access to these resources can significantly enhance patient autonomy and treatment effectiveness.

Benefits of Active Participation

Active participation in wound care not only improves healing rates but also enhances the patient’s quality of life. When patients are involved in their care, they are more likely to adhere to treatment plans and engage in preventive measures. This involvement can also lead to quicker recognition of complications, which is crucial for timely intervention and improved outcomes.

Resource Management in Wound Care

Reducing Hospital Stays

Effective resource management in wound care is crucial for reducing hospital stays. By optimizing wound care protocols and streamlining processes, healthcare facilities can minimize the duration of inpatient care required for wound management. This not only frees up hospital resources but also enhances patient comfort and recovery speed.

Preventing Infections

Preventing infections is a pivotal aspect of resource management in wound care. Implementing stringent sterilization and hygiene practices can significantly reduce the incidence of wound-related infections, thereby conserving resources and improving patient outcomes.

Cost-Effective Strategies

To ensure sustainability in wound care, adopting cost-effective strategies is essential. This involves evaluating and selecting appropriate wound care products and technologies that offer the best value for money. Additionally, training healthcare providers on efficient resource utilization can lead to substantial cost savings and improved care quality.

By focusing on efficient resource management, healthcare facilities can enhance the overall effectiveness of wound care, leading to better patient outcomes and reduced costs.

Conclusion

Please review AIHCP’s Case Management Program as well as its Nurse Patient Educator Program and see if they meet your academic and professional goals

In conclusion, effective case and wound management of patients is a multifaceted endeavor that requires a collaborative and systematic approach. It is essential to integrate the latest research, technology, and best practices to optimize wound healing and patient outcomes. By fostering cooperation among healthcare professionals and ensuring they are well-informed and equipped, we can enhance the quality of care provided to patients. Additionally, involving patients in their own care and educating them on proper wound management techniques can significantly reduce complications and improve healing rates. Ultimately, a comprehensive and evidence-based approach to wound care management not only benefits individual patient health but also contributes to the overall efficiency and effectiveness of healthcare facilities.

Please also review AIHCP’s Case Management Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a Case Management Certification

To learn more about AIHCP’s Nurse Patient Educator Certification then please also review the program and see if it meets your academic and professional goals.

 

Frequently Asked Questions

What is primary intention in wound healing?

Primary intention refers to a method of wound healing where the wound edges can be pulled together, such as in a surgical incision, using sutures, staples, or steristrips.

How can resource utilization improve basic wound care management?

Effective resource utilization in wound care can reduce follow-up visits and lengthy hospital stays due to infections, optimizing the overall healthcare facility’s operations.

What role do post-acute professionals play in wound care?

Post-acute professionals improve patient quality of life by teaching proper wound care management skills, helping in quicker recognition of complications, and enhancing treatment outcomes.

What is the aim of implementing wound assessment technology in pediatric care?

The aim is to provide guidelines for assessing and managing wounds in pediatric patients, ensuring optimal healing through ongoing multidisciplinary assessments and interventions.

How does understanding comorbidities impact wound care management?

Knowing the impact of comorbidities, such as diabetes, on wound healing helps providers avoid complications and improve healing speeds by tailoring treatments to individual needs.

What are the risks associated with generalized wound care treatment?

Generalized treatment can lead to assumptions and risks, necessitating careful implementation of new methods and oversight to avoid complications.

How does assessing the cause of wounds aid in management?

By identifying the cause and extent of damage, providers can apply targeted control measures and predict treatment outcomes more accurately.

What are the benefits of involving patients in wound care?

Involving patients in their wound care through education and tools empowers them, leading to active participation and potentially better healing outcomes.

Additional Resources

Hogan, T. (1997).  “Case management in a wound care program”.  1997 Jan-Feb;2(1):2-13; quiz 14-5. National Library of Medicine.  Access here

Bowers, S & Franco, E. (2020). “Chronic Wounds: Evaluation and Management”. Am Fam Physician. 2020;101(3):159-166. American Family Physician.  Access here

“Creating a Plan of Care for Wound Management” (2022). Wound Source.  Access here

Annesley, S. (2019). “Current thinking on caring for patients with a wound: a practical approach”. British Journal of Nursing.  Access here

Stages of Addiction Video

Posted on by Dominick Flarey

Addiction does not happen overnight.  One who becomes addicted goes through a variety of phases that usually begins due to poor coping via escapism or through experimentation.  Some individuals may not become addicted, others may have genetic predisposition.  Others may be chemically addicted while others may be behaviorally addicted.  There are many different aspects.  This video looks at the most common stages of addiction and how to fight it.

Addiction has numerous stages. Please also review AIHCP’s Substance Abuse Practitioner Program

Please also review AIHCP’s Substance Abuse Practitioner 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

 

 

 

 

 

 

 

 

 

Please review the video below

Attending Skills in Counseling: Listening and Observing

Posted on by Dominick Flarey

Attending skills and attending the client are the initial phases of patient interaction with a counselor.  It involves how well the counselor attends the client through listening, observing and feedback skills.  These basic skills set the table for productive counseling.

Attending to the client involves listening and observing skills that lead to better feedback. Please also review AIHCP’s Grief Counseling Certification as well as its Christian Counseling Certification

The fundamental foundation in conversation and communication is listening.  When others try to interrupt or speak over each other, the purpose of communication is crippled.  Listening is a key communication skill that helps one understand the other half of the conversation.  It allows one to learn about the other person and be able to make productive comments to the process of the conversation.  When listening fails, communication fails.  No wonder then, counselors, whether clinical or pastoral, whether in grief, spiritual or general counseling fields need to develop this skill in counseling.

When working with someone, whether in basic clinical interviewing where information is collected, or in counseling itself, where one hopes to help someone find healing or progress in life, listening is a key ingredient.  When counselors fail to listen properly, the counseling process itself fails.  Clients sense when their issues are addressed or if the counselor cares about what they are telling them.  Hence, listening and giving good feedback is key not only for providing help but also creating a relationship between counselor and client.  A counselor who listens is not only better able to help the client but is also better able to give the client a sense of meaning.  Through listening, the client feels someone cares about his/her problem and is willing to listen and offer productive advice and guidance in the process.

 

 

 

 

The Counselor and Client Relationship

The counselor and client relationship is key.  When the counselor makes him/herself available to the client, he/she invites the client into a professional and therapeutic relationship. Through this communication, a team evolves that works together for the benefit of the client.  In essence it becomes an alliance (Egan, 2019, p. 67).  Any good alliance is built upon good communication and listening.  The counselor builds the relationship first via listening.  Through listening, communication begins, through communication, trust emerges, and through trust, a relationship that can heal begins.

The Art of Attending

Attending a client involves both listening and also observing.  When attending to a client, the counselor reduces talk time and provides clients with the timeframe to speak (Ivey, 2018, p. 75).   Conducive to this is how a counselor attends to the client from four physical aspects.  These attending aspects include visual contact, vocal qualities, verbal tracking and body/facial expressions (Ivey, 2018, p. 75).  In regards to eye contact, when someone looks away, it denotes for many, a sign of disrespect or lack of interest.  Hence good visual contact involves eye contact.  This does not necessarily mean awkward staring, but it does denote eye contact during conversation.  This promotes the sense that one is genuinely interested in the story of the client and promotes the process of counseling itself.  Vocal qualities also play a key role in the attending art.  Tones and speech rate can be interpreted by the client as positive or negative based on the counselor’s speech.  A counselor who seems upset via a tone, can quickly scare away a client or embarrass a client from further discussion.  A calm and sensitive tone is essential to provide security to the client while his/her story is being told.  While listening it is also essential to track the conversation.  It is important to keep the client tied to the initiated topic (Ivey, 2018, p. 75).   Good listening helps keep the conversation in a good and purposeful direction.  Finally, one’s body language and facial expressions can play a key role in attending.  An awkward or angry face, or turning away from a person can have the same negative effects as the tone of one’s voice.   Egan recommends facing the person squarely, adopting an open posture and sometimes leaning forward as needed during the conversation (2018, p. 101).   Instead of folding one’s arms, or shifting and moving, one can create a safe sense of being for the client during the narrative.  Bear in mind also cultural aspects.  Some individuals may be from a different and diverse culture that utilizes different ways of expressing certain emotions.  This can lead to different postures or emotional ways of expression.  It is important to be aware of other cultures and their views and to also be aware of oneself and how one’s own appearance, race, faith or culture can affect the client one is attending and trying to help.

Dialogue and Listening

Empathetic listening is an important skill that lets the client know his/her story matters

A good conversation involves taking turns during it.  It involves connecting and mutually influencing each other (Egan, 2018, p. 100).  It not only a monologue but a shared story that each party invests in.  Good listening skills help the counselor make the most of the narrative but some types of listening miss the point.  Egan points out that partial listening is one type of listening that counselors need to avoid.  When counselors only partially listen, they only skim the surface.  They pick up parts of the conversation and miss others.  When questioned by the client, their response is less complete and can cause problems with the client (2018, p. 107).  Another poor listening skill, according to Egan, is an audio-recording style of listening, where the counselor simply parrots what the client has expressed.  In this case, the paraphrase adds no insight or questioning but merely repeats.  Sometimes, repeating something has power and can be utilized but if paraphrasing is utilized in parrot form consistently, then it only mirrors and gives no true insight.  Counselors need to listen to the client’s experiences, thoughts, behaviors and feelings and better respond to those things with insight (Egan, 2018, p. 108).  This insight should not be judgmental, but should be slowly integrated into the responses.  The response then should not merely always paraphrase or repeat, but the listening should produce a paraphrase that not only restates but also probes deeper, but without judgment or necessarily value based accusations.  The key is to help the client find the answer because ultimately the client is in the driver seat.  Finally, Egan points out that another form of bad listening involves rehearsing.  Many novice counselors are looking for the perfect answer or solution, or even the proper response.  During this, counselors can become dominated during listening as to what their response will be instead of what the client is discussing (2018, p. 107). Effective helpers  do not stop listening to derive a solution but continue to listen instead of preparing what they will say next.

Other Distortions in Listening

Egan points out a few other ways distortions to listening that can occur even to counselors who are fully paying attention.  Egan states that it near impossible to listen to someone in a completely unbiased way but counselors need to try their very best to filter these assumptions (2018, p. 125).  A counselor who is a white male may use filters from his own life that could distort cultural differences from a black female.  This bias could side track both parties.  Hence it is critical to remove types of subconscious bias when listening to the narrative of a person from a different race, culture, or faith.   In addition, during listening, it is important to avoid evaluative listening.  Egan defines evaluative listening as judgmental listening.  It involves seeing statements as good or bad, or right or wrong or acceptable or unacceptable (2018, p. 126).  Clients need to be first understood before productive change is introduced.   Another type of distortion involves stereotyping a client based on diagnosis.  This type of listening involves labeling the individual.  While diagnosis is important, when focusing solely on diagnosis of the individual, the counselor puts the client in a box.   Egan states the counselor can be correct in diagnosis but still lose the person (2018, p. 127).   Finally, it is important for counselors not to fall victim to sympathetic listening, where they become solely captivated and emotional about the client’s situation while missing the objective facts.  Sometimes too much sympathy can limit effective helping (Egan, 2018, p. 127).

Importance of Empathy and Finding Missing Cues

Counselors can discover various insights into a client through various physical cues

Empathy is crucial in human relationships. An empathetic person is able to understand the other person emotionally and feel what it may be like to experience certain things.  Empathetic listening allows the counselor to take a sincere and honest interest in the client but still remain objective. Carl Rogers, author of the Humanistic Approach in counseling, emphasized the importance of acute empathy and the utilization of it throughout the discussion.  Empathetic listening according to Ivey can be subtractive, basic or additive.   When subtractive, the counselor gives less back in response and the response is sometimes distortive and hence ineffective.  When the empathy is basic, it is an accurate feedback.  One needs to avoid completely audio-repeating but it sufficient to help the client.  Additive empathy is the best because it reframes but also may include past statements or include additional information to produce positive change (Ivey, 2018. p. 67).  Again, these rephrases, summaries or reflections are not meant to be commands but are used to guide.  They are not meant to impose judgment or value either, but awaken the client to other views or self actualizations.

Counselors have a wide variety of ways to respond through their listening and observing skills, some may include generalizing or summarizing, paraphrasing or reflecting on various issues.  Regardless, they need to be at least additive or basic in empathy.  Summarizing is a broad basic account of the dialogue.  Paraphrasing is more acute but it can be basic or additive.  Reflective is very additive in nature but connects the dialogue to self and offers insight and questions on the statement.

Empathetic listening is key in helping clients and is the basis for a client-based therapy (Egan, 2018, p. 67).  Through empathetic listening, one can become more attune to verbal and non-verbal cues that can reveal issues surrounding the story.   Counselors should watch for tone of voice in responses, facial expressions or body movements during the conversation.  How a client speaks or responds to a question can be a key clue (Egan, 2018, p.116).  Ivey recommends mirroring sometimes the client.  When movements do not clearly match and shifts and jerks within the client appear, then this could be a sign of an issue (2018. p. 99).

As noted, counselors need to watch for changes in tone of speech or physical movements.  Good observing skills, in addition to good listening can help counselors discover other missing pieces of the puzzle. In regards to some verbal behaviors, Ivey emphasizes that counselors should carefully watch “I” statements or “other” statements.  Are these statements positive or negative regarding “I” or “other” (2018, p. 93).  Ivey also recommends looking for words such as “can” and “can’t”.  Some clients as well are more concrete in their speech, while others are more abstract.  During listening and observation, a counselor needs to identify this.  Abstract clients are excellent at self analysis and reflecting on an issue, but may struggle with concrete issues.  More concrete clients may be able to provide specifics, but be less able to see the point of views of others.  Both types have their strengths, but it is important for a counselor to identify which type of speech one is listening and observing (Ivey, 2018, p. 91).  During interviewing or counseling, a counselor may be able to find cues to the issue through various discrepancies throughout the clients story.  Ivey points out that contradictions may occur between statements, or between words and actions, or regarding goals. It is important for the counselor to identify these discrepancies and in a non-confrontational way expose them to the client (Ivey, 2018, p. 99).

In listening empathetically and avoiding bad and distortions of listening , one can better hear the client’s experiences, thoughts, behaviors and feelings and not miss various cues of other issues.

 

Conclusion

Proper attending of the client is key for good counseling. Please also review AIHCP’s Grief Counseling Certification

Attending a client involves good listening and observing with feedback that reflects this.  Counselors need to develop good listening skills for the betterment of their clients.  Listening forms the foundation for any relationship and it is important to avoid bad listening habits.  Counselors can better attend their clients through a patient-centered model that is empathetic and humanistic.   Neuro-science studies portray that when clients are properly listened to and given feedback that show thought and reflection corresponding with listening, then certain parts of the brain light up in positive ways (Ivey, 2018, p. 77).  Listening plays a key role in making a positive effect on one’s client.  It lets the client realize someone actually is listening and cares and is providing feedback to produce positive change.

 

If you would like to learn more about helping other people or would like to become certified in Grief Counseling or Christian Counseling, then please review AIHCP’s certifications in these fields.  The programs are open to both clinical and non-clinical counselors who would like to earn a certification in these fields and add to their existing practice.  The Grief Counseling and Christian Counseling programs are online and independent study and lead to a four year certification.

References and Additional Resources

Egan, G & Reese, R. (2018). “The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping (11th)”. Cengage.

Ivey, A. et, al. (2018). “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society (9th)” Cengage.

Sutton, J. (2021). “Defining the Counseling Process and Its Stages”. Positive Psychology.  Access here

“Reflecting Skills”. Counseling Education.  Access here

“7 Attending Skills”. Optimist Minds.  Access here

EFT AND MERIDIAN POINTS

Posted on by Dominick Flarey

Holistic Nursing and Managing Sugar and Diabetes I/II

Posted on by Dominick Flarey

Holistic Nursing and Natural and Holistic Ways to manage high sugar

Managing sugar is a life style choice. Holistic Nurses and other healthcare professionals can help guide you through the process for better health with sugar related issues

Holistic nursing integrates various natural and holistic methods to manage high blood sugar effectively in diabetes management. It emphasizes the importance of treating the whole person by incorporating physical, mental, and emotional wellness into care strategies. This article explores how holistic nursing and natural remedies can be used to optimize blood sugar control and enhance overall health outcomes for individuals with diabetes. Please also review AIHCP’s Holistic Nursing Program

 

Key Takeaways

  • Holistic nursing addresses the root causes of diabetes by focusing on comprehensive lifestyle changes.
  • Natural remedies like herbs, dietary adjustments, and lifestyle interventions play a crucial role in blood sugar management.
  • Incorporating berberine with dietary and lifestyle changes can significantly improve blood sugar levels and overall diabetic health.
  • Regular exercise and stress management are essential for enhancing insulin sensitivity and controlling blood sugar.
  • Holistic approaches not only manage high blood sugar but also improve cardiovascular health, reduce inflammation, and enhance overall quality of life.

Understanding Holistic Nursing in Diabetes Management

Certified Holistic Nurses can help patients better control or prevent diabetes from taking over their lives. Please also review AIHCP’s Holistic and Integrative Health Care Specialist Program

Defining Holistic Nursing

Holistic nursing is an approach that integrates the whole person in the care process, including physical, mental, emotional, and spiritual well-being. This method is particularly effective in managing chronic conditions like diabetes, where multiple factors influence health outcomes.

The Role of Nurses in Holistic Care

Nurses play a crucial role in implementing holistic care strategies. They assess all aspects of a patient’s life and coordinate care plans that address both the medical and lifestyle needs of individuals with diabetes. Nurses are pivotal in educating patients about the importance of lifestyle changes alongside medication.

Benefits of a Holistic Approach

A holistic approach to diabetes management not only focuses on controlling blood sugar levels but also emphasizes improving overall health. This includes cardiovascular health, reducing inflammation, and enhancing the quality of life. By addressing the root causes and not just the symptoms, holistic care promotes long-term health benefits.

Natural Remedies for Blood Sugar Control

Herbs and Spices

Incorporating certain herbs and spices into the diet can be a potent way to manage blood sugar levels naturally. Some of the most effective include cinnamon, fenugreek, and ginseng. These herbs have been shown to improve insulin sensitivity and reduce blood glucose levels. For instance, cinnamon can mimic insulin and increase glucose transport into cells, while fenugreek seeds contain fibers and chemicals that slow down the digestion of carbohydrates and sugar.

Dietary Adjustments

Making dietary adjustments is crucial for controlling blood sugar. A focus on low-glycemic foods that do not spike blood sugar levels is beneficial. Incorporating a balanced diet rich in fiber, such as whole grains, fruits, and vegetables, helps in the slow release of glucose into the bloodstream, thereby maintaining steady blood sugar levels. Additionally, reducing intake of refined sugars and carbohydrates is advised.

Lifestyle Interventions

Adopting a healthy lifestyle is essential for effective blood sugar management. Regular physical activity helps increase insulin sensitivity and glucose uptake by the muscles. It is also important to maintain hydration and limit sedentary behavior by incorporating light activities throughout the day. Stress management through techniques like yoga and meditation can also play a significant role in controlling blood sugar levels.

The Impact of Berberine on Type 2 Diabetes

Berberine can play a key role in reducing sugar levels in the blood if taken regularly.

Berberine, a natural plant alkaloid, has garnered attention for its potential in managing type 2 diabetes, a prevalent chronic metabolic disorder. This section explores the multifaceted role of berberine in diabetes management, highlighting its mechanisms, clinical efficacy, and integration with lifestyle modifications.

Mechanisms of Action

Berberine’s ability to regulate blood sugar levels is primarily attributed to its glucose-dependent insulinotropic effect. This means it helps maintain blood glucose levels without significantly increasing the risk of hypoglycemia. Berberine might lower blood sugar levels, which is crucial for managing diabetes effectively. Additionally, its anti-inflammatory and antioxidant properties contribute to its overall health benefits, making it a comprehensive treatment option.

Clinical Studies and Results

Recent studies have demonstrated berberine’s effectiveness in improving glycemic control among individuals with type 2 diabetes. Here are some key findings:

  • Significant reduction in fasting blood sugar and postprandial blood sugar levels
  • Improvement in insulin sensitivity
  • Reduction in HbA1c levels, indicating better long-term glucose control

These results underscore berberine’s potential as a valuable addition to diabetes management strategies.

Integrating Berberine with Lifestyle Changes

Incorporating berberine into a holistic diabetes management plan involves more than just supplementation. It requires a coordinated approach that includes dietary adjustments, regular physical activity, and stress management. By integrating berberine with these lifestyle changes, individuals can enhance their overall health and better manage their diabetes.

Note: Always consult with a healthcare provider before starting any new treatment, especially when combining supplements with other medications.

Exercise as a Pillar of Diabetes Management

Types of Beneficial Physical Activities

To control sugar or diabetes, one needs to develop a healthy life style that not only involves diet but also consistent exercise. Please also review AIHCP’s Holistic Nursing Program

Exercise is crucial in managing diabetes, particularly through aerobic activities like walking, bicycling, and dancing. Strength training also plays a significant role, as it helps improve insulin sensitivity and enhances blood sugar management. Activities such as push-ups, squats, and lunges are especially beneficial.

How Exercise Affects Blood Sugar

Exercise can immediately reduce blood sugar levels in people with type 2 diabetes by increasing insulin sensitivity and the body’s ability to use glucose as energy. It is generally recommended to exercise about 30 minutes after a meal to maintain optimal blood sugar control.

Creating a Sustainable Exercise Routine

To create a sustainable exercise routine, it is essential to monitor blood sugar levels closely, especially since physical activity can cause these levels to drop. Incorporating a variety of exercises and gradually increasing the intensity can help maintain interest and effectiveness. Breaking up long periods of inactivity, like sitting at a computer, can also aid in blood sugar control.

Dietary Strategies for Managing High Blood Sugar

Foods to Include

Incorporating a variety of nutrient-dense foods is crucial for managing high blood sugar. Focus on including high-fiber foods, such as whole grains, legumes, vegetables, and fruits, which can help regulate blood sugar levels. Additionally, foods rich in magnesium and low-glycemic index fruits are beneficial. For instance, leafy greens and nuts are excellent sources of magnesium, which aids in blood sugar control.

  • Whole grains (e.g., oats, barley)
  • Legumes (e.g., beans, lentils)
  • Low-GI fruits (e.g., berries, apples)
  • Leafy greens (e.g., spinach, kale)

Foods to Avoid

To prevent blood sugar spikes, it is essential to limit foods that are high in refined sugars and carbohydrates. Avoid sugary beverages, processed snacks, and high-GI foods that can rapidly increase blood sugar levels. Instead, opt for water and healthy snacks that contribute to overall health and help maintain stable blood sugar levels.

  • Sugary drinks (e.g., soda, fruit juices)
  • Processed foods (e.g., cookies, cakes)
  • High-GI foods (e.g., white bread, potatoes)

Balancing Macronutrients

Balancing the intake of carbohydrates, proteins, and fats is key to managing diabetes effectively. A balanced diet helps in stabilizing blood sugar levels and preventing long-term complications. Carbohydrates should be consumed in moderation and paired with proteins or healthy fats to minimize blood sugar spikes.

Balanced diet tip: Always pair carbohydrates with protein or fat to stabilize blood sugar levels.

Stress Management Techniques for Better Blood Sugar Control

Stress and higher sugar are related problems

Stress can significantly impact blood sugar levels by affecting insulin production and increasing the release of glucose from the liver. Managing stress is crucial for maintaining stable blood sugar levels and overall health in individuals with diabetes.

Effective Stress Reduction Methods

Incorporating stress reduction techniques into daily life can help manage blood sugar effectively. Practices such as meditation, deep breathing exercises, and engaging in hobbies are beneficial. Additionally, regular physical activities like yoga can also reduce stress and improve insulin sensitivity.

Case Studies on Stress Management

Several studies highlight the effectiveness of stress management in controlling blood sugar. A notable study involving nursing students showed that a combination of yoga and meditation significantly reduced stress levels and lowered blood glucose after 12 weeks.

The Role of Sleep in Blood Sugar Regulation

Sleep Patterns and Glucose Metabolism

Sleep is a critical factor in regulating glucose metabolism. Poor or limited sleep affects body chemistry, leading to increased blood sugar levels. A study highlighted that healthy volunteers who slept only four hours for three consecutive nights exhibited a significant reduction in insulin’s ability to regulate blood sugar, by approximately 23 percent.

Improving Sleep Quality

Improving sleep quality can directly benefit blood sugar control. Strategies to enhance sleep include maintaining a regular sleep schedule, creating a restful environment, and avoiding stimulants close to bedtime. These steps help in stabilizing blood sugar levels and improving overall health.

The Consequences of Sleep Deprivation

The consequences of sleep deprivation extend beyond poor blood sugar control; it is also linked with obesity, heart disease, and stroke. Ensuring adequate sleep is therefore not only vital for managing diabetes but also for overall health maintenance.

Holistic Approaches to Cardiovascular Health in Diabetics

Heart Disease and Diabetes

Heart disease remains a leading cause of morbidity and mortality among individuals with diabetes. A holistic approach to cardiovascular health focuses on more than just managing blood sugar; it includes lifestyle modifications, dietary adjustments, and stress management to improve overall heart health. Regular monitoring and proactive management of cardiovascular risk factors can significantly reduce the incidence of heart-related complications in diabetics.

Natural Ways to Improve Heart Health

Incorporating natural remedies and practices can play a crucial role in supporting cardiovascular health. Herbs such as garlic, turmeric, and ginger are known for their anti-inflammatory and cholesterol-lowering properties. Additionally, omega-3 fatty acids, found in fish oil and flaxseeds, are beneficial for heart health due to their ability to improve lipid profiles and reduce inflammation.

Monitoring Cardiovascular Health

Regular check-ups and cardiovascular screenings are essential for detecting potential heart issues early. Diabetics should have their blood pressure, cholesterol levels, and other cardiovascular markers routinely monitored. This proactive approach allows for timely interventions and adjustments in their holistic health plan, ensuring optimal heart health and reducing the risk of severe complications.

Understanding and Managing Inflammation in Diabetes

Causes of Inflammation in Diabetics

Inflammation is a critical factor in the progression of diabetes and its complications. Chronic inflammation can be triggered by obesity, poor diet, and sedentary lifestyle, all of which are prevalent in individuals with type 2 diabetes. Addressing these root causes through lifestyle changes is essential for managing inflammation effectively.

Natural Anti-inflammatory Strategies

Several natural strategies can help reduce inflammation in diabetic patients. These include:

  • Incorporating anti-inflammatory foods like turmeric, ginger, and omega-3 fatty acids.
  • Regular physical activity to enhance insulin sensitivity and reduce inflammatory markers.
  • Adequate hydration to help flush out toxins that may contribute to inflammation.

The Impact of Inflammation on Blood Sugar Levels

Inflammation directly affects blood sugar control by impairing insulin action and secretion. Reducing inflammation can therefore improve glycemic control, which is a key goal in diabetes management. This connection highlights the importance of a holistic approach to diabetes care that includes managing inflammation.

Improving Lipid Profiles through Holistic Methods

The Importance of Lipid Management

Managing lipid profiles is crucial for diabetic patients as it directly impacts their risk for cardiovascular diseases. Holistic methods focus on natural remedies and lifestyle changes to improve lipid balance and overall health. Incorporating plant sterols has been shown to cause a modest reduction in LDL-C and total cholesterol, which are key components of lipid management.

Natural Remedies for Lipid Balance

A variety of natural products can be utilized to manage lipid levels effectively. These include:

  • Omega-3 fatty acids from fish oil or flaxseeds
  • Niacin (Vitamin B3)
  • Soluble fiber from oats, barley, and fruits
  • Garlic and soy products

Diet and Exercise for Lipid Health

Diet and exercise remain the cornerstone of any holistic approach to health. For lipid management, a diet low in saturated fats and high in fruits, vegetables, and whole grains is recommended. Regular physical activity, particularly aerobic exercises, can also significantly improve lipid profiles and enhance insulin sensitivity.

Blockquote: Emphasizing a balanced diet and consistent exercise can lead to substantial improvements in lipid profiles and overall well-being.

Enhancing Quality of Life for Diabetic Patients

Holistic Strategies for Well-being

Holistic strategies emphasize a comprehensive approach to managing diabetes, focusing on both physical and mental health. Incorporating a balanced diet, regular physical activity, and stress management techniques can significantly enhance the quality of life for diabetic patients. These methods help in maintaining stable blood sugar levels and reducing the risk of complications.

Patient Success Stories

Many patients have reported improvements in their daily lives after adopting holistic practices. Success stories often highlight increased energy levels, better control of blood sugar, and a more positive outlook on life. These narratives serve as powerful testimonials to the efficacy of holistic approaches in diabetes management.

Long-term Benefits of Holistic Care

The long-term benefits of holistic care for diabetic patients include improved overall health, reduced need for medications, and a lower risk of diabetes-related complications. Emphasizing preventive care and lifestyle modifications can lead to a sustained improvement in life quality and longevity.

Integrating Holistic Practices with Conventional Diabetes Treatment

When to Combine Treatments

Integrating holistic practices with conventional diabetes treatment should be considered when patients are not achieving their health goals through standard medical approaches alone. Holistic practices can complement medical treatments by addressing lifestyle factors and mental health, which are often overlooked in conventional care.

Safety and Efficacy

It is crucial to evaluate the safety and efficacy of combining holistic and conventional treatments. Patients should consult healthcare professionals to tailor a plan that includes both approaches, ensuring that they are compatible and beneficial.

Patient and Practitioner Perspectives

Understanding both patient and practitioner perspectives on integrating holistic practices is essential for a successful treatment plan. This collaboration fosters a more comprehensive approach to diabetes management, enhancing patient satisfaction and health outcomes.

Conclusion

Holistic Nurses and specialists can help one manage sugar or diabetes with a healthier life style and supplements to existing medication

In conclusion, adopting a holistic approach to managing high blood sugar and type 2 diabetes involves a comprehensive consideration of the individual’s entire well-being. This includes dietary changes, regular physical activity, stress management, and the potential integration of natural supplements like berberine. Each element plays a crucial role in optimizing blood sugar control and enhancing overall health. By addressing the interconnected factors that influence diabetes, individuals can achieve more sustainable health outcomes. It is essential, however, to consult healthcare professionals when incorporating new treatments or supplements to ensure safety and efficacy.

Please also review AIHCP’s Holistic and Integrative Health Care Specialist Certification 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.  Holistic Nurses are excellent guides to helping individuals manage sugar and also diabetes 1 or 2.  Through alternative herbs, diet and exercise, sugar can be lowered.  Whether trying to avoid diabetes and manage sugar, or if already afflicted with diabetes 1 or 2, holistic nurses can help guide individuals into better life choices and supplements that can make a large difference in overall health and life style.

Frequently Asked Questions

What is holistic nursing and how does it relate to diabetes management?

Holistic nursing focuses on healing the whole person by considering their physical, mental, and emotional well-being. In diabetes management, this approach involves integrating dietary, lifestyle, and possibly natural supplements like berberine to optimize blood sugar control and overall health.

Can diabetes be reversed naturally?

Type 2 diabetes can be managed effectively through dietary and lifestyle changes such as increased physical activity, fiber intake, and careful management of sugar intake. While not reversible for everyone, these changes can significantly improve blood sugar levels and reduce dependency on medications.

What herbs are known to help with diabetes?

Several herbs are known to help manage blood sugar levels, including cinnamon, fenugreek, and berberine. These herbs have been shown to have glucose-lowering properties, making them useful in a holistic approach to diabetes management.

How does exercise impact blood sugar control?

Regular physical activity helps muscles use glucose for energy and improves insulin sensitivity. This can lead to lower blood sugar levels and is a crucial component of a holistic diabetes management plan.

What are the benefits of integrating berberine in a diabetes management plan?

Berberine has been shown to improve glucose metabolism, enhance insulin sensitivity, and reduce blood sugar levels. Integrating berberine with dietary and lifestyle changes can enhance the effectiveness of diabetes management from a holistic perspective.

How important is sleep in managing diabetes?

Adequate sleep is critical for maintaining hormonal balance and glucose metabolism. Poor sleep can lead to increased insulin resistance and higher blood sugar levels, making sleep an essential component of holistic diabetes management.

A diet rich in whole foods, fiber, and healthy fats, along with reduced intake of processed foods and sugars, is recommended for managing high blood sugar. Balancing macronutrients and careful meal planning can significantly improve blood sugar control.

Can stress affect blood sugar levels?

Yes, stress can significantly impact blood sugar levels. Stress management techniques like meditation, deep breathing exercises, and engaging in hobbies can help regulate stress hormones and support overall well-being in managing diabetes.

Additional Resources

“Diabetes management: How lifestyle, daily routine affect blood sugar”. Mayo Clinic Staff.  Mayo Clinic.  Access here

“Living with Diabetes”. Centers for Disease Control and Prevention. CDC. Access here

Juanamasta, G. et, al. (2021). “Holistic Care Management of Diabetes Mellitus: An Integrative Review”. Int J Prev Med. 2021; 12: 69. National Library of Medicine.  Access here

“What To Know About Berberine: Benefits, Uses and Side Effects”. Cleveland Clinic Essentials. Cleveland Clinic.  Access here