Behavioral Health Care Certifications: What is the DSM?

Posted on by Mark Moran

This blog looks to give a short description and analysis of the DSM and its purposes and ways of classifying mental illness.  The Diagnostical Statistics Manuel of Mental Disorders or DSM is a series of editions that looks to help mental health professionals diagnose mental pathology.  It lists numerous types of psychopathologies and looks to classify and aid mental health professionals through the diagnostic process.  It is meant as an aid not necessarily a replacement of one’s professional acumen.

Please also review AIHCP’s mental and behavioral health certifications for clinical as well as non clinical professionals.

DSM

The DSM-V-TR is a helpful tool in diagnosing mental illness. Please also review AIHCP’s Healthcare Certifications

The first edition of the DSM appeared in 1952 (DSM-V-TR, 2022).  Since then there have been five editions with the most recent appearing in 2022.  This edition is the revised text of the fifth edition which appeared in 2013.  In 1999, the American Psychiatric Association (APA) launched an extensive evaluation of strengths and weaknesses of the previous DSMs.   In efforts with the World Health Organization (WHO), as well as the National Institute of a Mental Health (NIMH), the revision began to correlate closer with the International Classification of Diseases (ICD).  This led to sharing the same codes with ICD-11 instead of separate coding for mental health and diseases (DSM-V-TR, 2022).   This led a better harmonization with the ICD and a regrouping of mental disorders to correlate with developmental and life span considerations of mental disorders (DSM-V-TR, 2022).  The DSM-V also removed its previous multiaxial system of diagnosis which involved assessment on various axes which referred to different domains.  Axis I was previously clinical disorders, Axis II included personality disorders and intellectual development disorders, Axis III included other medical disorders, and Axis IV included psychosocial factors.(DSM-V-TR, 2022).   These axis are no replaced in the DSM-V with diagnosis and conditions correlated with the ICD z coding.  The final axis V which included Global Assessment and Functioning was replaced by the WHO Disability Assessment Schedule (DSM-V-TR, 2022) (McRay, B., et al., 2016).

Emphasis is also placed within the new revision of cultural and social norms and the danger of abnormality being measured universally without proper context of different cultures and expression.  In addition, the new revision calls for a greater focus on mental issues caused by biases and prejudices caused by race, gender, sexual orientation and culture.

The new edition also defines key terms regarding diagnosis.  This includes the differences between a primary diagnosis and provisional diagnosis.  Within a primary diagnosis, the diagnosis deals with the presenting issue or reason for visit.  This diagnosis is based on the inpatient setting and the available information.  A provisional diagnosis occurs when current information is insufficient at the time to make an official diagnosis based on needing more records or more time to unfold according to the DSM for a particular disorder to manifest (DSM-V-TR, 2022).

Important terminology for diagnosis also explains the etiology or origin of the disorder.  In some cases, it will be attributed to substance abuse or medical disorders and in other cases independent mental disorder.  Instead of past diagnosis with labeled disorders as organic or physical versus nonorganic or purely of the mind, current systems utilize these labels to help understand the etiology of the disorder (DSM-V-TR, 2022).

If a clinician were to review a patient’s symptoms and cross reference it with the DSM-V-TR, they would discover various headings to help one further a diagnosis.  First, the Diagnostic Criteria heading lists the various symptoms that must manifest and how many the patient must possess.  Second, Diagnostic Features, as well as Associated Features, Development and Course, and Risk and Prognostic Factors all provide more insight and information for the clinician to review and refresh upon.  In addition to the primary diagnosis, the manual also has headings for Comorbidity and Differential Diagnosis which illustrates other possible disorders to review that are related to the patient as well as possible concurrent disorders that can co-exist with the primary disorder (DSM-V-TR, 2022).

Classification and Etiology

Diagnosis of mental pathology is a complex and multi-faceted process.

Many modern psychopathologies are classified according to different schools of thought but ultimately, psychopathology is a complex system.  Nosology refers to the scientific process of categorizing phenomena (McRay, B., et al., 2016).  Three approaches to classification involve the monothetic approach, the polythetic approach and the dimensional approach.  The monothetic diagnosis is based on a “yes” or “no” classification if the agent meets the model of criteria for something or not.  The polythetic which is more attuned to the true nature of psychopathology permits for a broader criteria of prototype for membership of a particular class or disorder.  Criteria is more than merely pathognomonic but due to correlation, can fit some of the criteria to be included and hence creating a more heterogeneity class membership (McRay, B., et al., 2016).  Dimensional models are also more diverse because they do not merely focus on qualitative distinctions between normal and abnormal but more so on a continuum of health that reviews extremes of traits (McRay, B., et al., 2016).

Most theoretical classifications fall under various schools of thought.  Ultimately a multidimensional approach is critical and is what the DSM utilizes.  Among theoretical perspectives there are biophysical theories which emphasize physiological factors that determine psychopathology.  Included also are intrapsychic which primarily assume psychological factors, phenomenological factors which stress experience and perception, and behavioral theories which focus on how a person’s learning and personality was determined by reinforcement (McRay, B. et al., 2016).

The primary foundations for all mental illness finds itself in four broad models of psychopathology: Biological, psychosocial, socio-cultural, and spiritual. Biologically, mental maladies can be due to genetics and physiological factors.  Psychosocial reviews the formation of psychopathy from the numerous branches of psychology.  Whether from a psychoanalytic perspective, or a behavioral perspective, or even a humanistic perspective, psychopathology and illness is an expression of underlying personality dynamics, environmental factors, internal thinking processes or learned habits that create pathology (McRay, B., et al, 2016).   The socio-cultural pinpoints where some psychopathologies can emerge due to cultural and family aspects of development and how they play  a role in a person’s mental health.  This includes the role of social labels and roles, as well as social connections and support play in the development of one’s mental health.  Finally, spiritual models look at the power of identity, meaning and existential realities and how these spiritual practices help or hinder a person’s mental health (McRay, B., et al, 2016).

Caution when Utilizing any Diagnosis

The DSM-V-TR when used by untrained professionals can be dangerous.  Also, even for trained individuals, it is important to understand that the DSM-V-TR despite based on a wealth of knowledge, empirical research, as well as multiple health organizations is still limited in diagnosis.   According to McCray, DSM V categories are more descriptive than explanatory.  He also points out that diagnostic labeling needs to be done with sensitivity and care to avoid damaging the self worth of an individual (2016). Ultimately, the field of psychotherapy is not an exact science and false diagnosis can occur.  While the most current DSM is the premiere resource, it is only as reliable as the trained user utilizing and applying it.  Humility and thoroughness in assessment and diagnosis is key, as well as a Rogerian sensitivity in discussing an mental disorder.  A person should not be a seen as “this” or “that” but a person exhibiting traits of “this” or “that” or suffering from “this” or “that”.  This prevents labeling, mental stigma, and including the identify of the person with the disorder itself.

Conclusion

Please also review AIHCP’s Healthcare Certification Programs

The DSM-V-TR is the most current edition of the DSM at the time of this blog.  As science and the medical field discovers more, new editions will emerge.  As new strategies and ways of viewing mental illness emerge, new editions will incorporate them as well.  In the meantime, those in behavioral health and the clinical side must adhere to the best and most current ways of understanding, diagnosing and treating mental health.

It is important to remember that non-clinical members of AIHCP who may be certified are not entitled to diagnosis and treatment.  Individuals in grief counseling who are not licensed need to refer clients to the appropriate professionals. Please also review AIHCP’s healthcare certifications for both clinical and non-clinical counseling in grief, stress, anger, crisis, trauma informed care, spiritual and Christian counseling programs.

References

McRay, B., Yarhouse, M., & Butman, R. (2016). Modern psychotherapies: A comprehensive Christian appraisal (2nd Ed). IVP Academic

DSM-V-TR.  Access here

Additional AIHCP Blogs

Diagnosing Psychopathology.  Access here

Additional Resources

DSM-5.  Cleveland Clinic. Access here

First, M., et al. (2022). DSM‐5‐TR: “Overview of what’s new and what’s changed”. World Psychiatry. May 7;21(2):218–219.

doi: 10.1002/wps.20989

Fritscher, L. (2026). Advantages and Disadvantages of the Diagnostic Statistical Manual. VeryWellMind.  Access here

APA. DSM-5-TR Online Assessment Measures. Access here

 

 

 

 

How Holistic Nursing Improves Outcomes in Acute Care Settings

Posted on by Joseph Gerard

Nurse visiting an elderly patient in need of acute care.

Written by Zainab Shakil,

As a nurse, you know how busy acute care gets. Patients come in sick or injured, and you do your best to save their lives. 

You fix broken bones, treat heart attacks, and try to contain infections. But sometimes, in the middle of all that rush, the human side gets lost. You might focus so much on the disease that you forget about the person lying on the bed.

But more and more, we are seeing that treating the symptoms isn’t enough to improve patient outcomes. 

Leaning into holistic nursing, which involves caring for the whole person (body, mind, emotions, spirit, and even their family and social world), can make your job more fulfilling while improving results. How? We will discuss that here. 

Why Acute Care Needs Holistic Approaches

Acute care settings are intense. Patients arrive with sudden illnesses, surgeries, or exacerbations of chronic conditions. 

Traditional models focus heavily on physical symptoms and quick stabilization, which is crucial, of course. But they often overlook stress, fear, isolation, poor sleep, or lack of family support that can slow healing or spark complications.

No wonder readmission rates stay high for many conditions. Medicare data shows that about 20% of patients are readmitted within 30 days. Stress slows healing. Poor sleep in the hospital raises infection risks. People leave without knowing how to manage at home.

Holistic nursing changes that. It treats the patient as a whole. You check their emotions, family support, spiritual needs, and daily habits. 

A holistic approach teams up doctors, nurses, therapists, and families. Recent research published on ResearchGate points out that holistic methods help in busy settings by building better teamwork and catching problems early.

How Nurses Can Get into Holistic Practice

If you’re a licensed nurse and like what you’re reading about holistic practice, how do you get into it? Surprisingly, it’s very simple. You can get started by doing a continuing education program through the American Institute of Health Care Professionals (AIHCP). Holistic nursing certifications offered by AIHCP incorporate the latest findings and techniques required to provide well-rounded treatment to patients from day one.  

How Holistic Nursing Improves Outcomes in Acute Care Settings

Here is a closer look at how holistic nursing improves outcomes in acute care settings.

1. Improved Patient Outcome

Holistic nursing leads to better overall results. Patients feel less pain, have stronger spirits, and heal better.

In a 2025 cohort study from China, ICU patients with holistic integrated nursing had a much better quality of life three months later. They scored higher on all parts, physical function, energy, mental health, you name it,  of the SF-36 survey. 

Why? Nurses addressed anxiety with conversation and relaxation. They got families involved early. Patients ate better, moved more, and slept more easily. This reduces complications like pressure sores or confusion.

Rockhurst University notes that the NUA 5020 of the acute care nurse practitioner program teaches nurses ways to overcome current healthcare challenges to give patients better, safer care. 

Even nurses who opt for an online acute care nurse practitioner program study current healthcare challenges to find ways to make care safer and improve patient outcomes. Flexibility to study while working allows them to pursue career advancement without abandoning the understaffed healthcare workforce.

Holistic approaches also reduce complications like hospital-acquired infections or delirium. Patients report higher satisfaction, which often translates to better adherence to treatments.

2. Faster Recovery and Shorter Hospital Stays

Holistic nursing helps patients bounce back quicker by tackling barriers beyond the physical. 

Nurses get families involved early. Holistic care gets patients moving gently sooner, eating right, and managing stress. Less stress means less inflammation. Better sleep helps repair the body. Simple things like guided imagery or hand massages reduce anxiety, so patients recover more quickly.

Data from PMC shows that holistic models in the ICU cut the length of stay. Patients recovered more quickly with integrated medical-nursing care. Complications dropped, so no extra days for treating new issues. 

This matters big time. Medicare and insurers watch the length of stay closely. Holistic nursing fits with Enhanced Recovery After Surgery (ERAS) protocols, which involve early mobility, nutrition talks, and emotional support. Nurses lead a lot of this.

Shorter stays also help combat burnout, which currently affects around 35.3% in the U.S. When patients recover well, you see progress instead of constant crises. Plus, hospitals save money. Fewer bed-days mean better resource use, which can translate to better staffing or equipment down the line.

3. Reduced Complications and Readmissions

No nurse wants their patients to return soon. Readmissions are costly and stressful for patients and teams.  

Research published in PMC reveals that readmission rates vary depending on the illness. For general patients, it ranged from 3.7% to nearly 31%. Heart failure saw the highest return rates (up to 31.9%), followed by heart attacks (up to 23%), and strokes (up to 13.7%).

When patients are sent home, they are often confused. They have a huge stack of complex discharge papers. They have brand new pills to take every day. 

If they do not understand the doctor’s instructions, they mess up. They might take the completely wrong dose of medicine. They might eat the wrong foods. Very soon, they end up right back in the emergency room.

Holistic nursing is one of the best tools to stop both complications and readmissions. Nurses prevent readmissions by using transitional care. This simply means they bridge the gap between the hospital and the home. 

In practicality, that means you sit down with the patient and their family members. You explain everything in plain, simple English, making sure the family knows exactly what to do. You might also follow up with the patient a few days after they go home. 

FAQs

1: What is holistic nursing in acute care?

Holistic nursing treats the whole person, not just the disease. It reduces stress and improves healing in fast-paced hospital settings.  

2: How does holistic care reduce hospital readmissions?

It improves discharge education, involves families, addresses emotional needs, and ensures better understanding of medications and home care, lowering confusion and complications after discharge.  

3. Can holistic nursing help alleviate nurse burnout?

Yes. By fostering better patient outcomes, earlier recoveries, and effective teamwork, nurses experience a more fulfilling work environment. 

Key Statistics

30-day hospital readmission rate ~20%
Nurse burnout rate (U.S.) 35.30%
General patient readmission rate 3.7% – 31%
Heart failure readmission rate Up to 31.9%

 

You Are the True Heart of Healing

Hospitals can be cold and scary places, but holistic nurses bring much-needed warmth and humanity back to medicine. They prove every single day that looking at the whole person is the best way to heal the human body.

By treating the mind, body, and spirit together, these nurses deeply improve patient outcomes. They help people recover faster and get back to their own cozy beds much sooner. Most importantly, they make sure patients stay healthy once they go home, avoiding stressful return trips to the hospital.

You already do pieces of this. Add a little more listening, a relaxation tip, or a family huddle, and you can help people truly heal. 

References:

Cao, F. (2025). Cohort study on Medical-Integrated holistic nursing’s impact on intensive care unit patients’ outcomes, complications, and comprehensive health care. Scientific Reports, 15, 21474. https://www.nature.com/articles/s41598-025-04794-8. 

Liang, Y., Peng, H., Luo, X., Wang, M., Zhang, Y., Huang, H., Zhu, J., Chen, M., Tian, W., Mo, J., Nong, Y., Wang, Y., Huang, Y., Tan, S., Jiang, L., Pan, W., & Ning, C. (2025). The impact of health emergencies on nurses’ burnout: A systematic review and meta-analysis. BMC Public Health, 25, 12366180. https://pmc.ncbi.nlm.nih.gov/articles/PMC12366180/. 

Rockhurst University. (n.d.). Online AGACNP program. https://onlinedegrees.rockhurst.edu/programs/online-agacnp-degree

Liang, Y., Peng, H., Luo, X., Wang, M., Zhang, Y., Huang, H., Zhu, J., Chen, M., Tian, W., Mo, J., Nong, Y., Wang, Y., Huang, Y., Tan, S., Jiang, L., Pan, W., & Ning, C. (2025). The impact of health emergencies on nurses’ burnout: A systematic review and meta-analysis. BMC Public Health, 25, 12366180. https://pmc.ncbi.nlm.nih.gov/articles/PMC12366180/. 

Song, J. H., & Kim, M. (2024). Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review. The Ewha Medical Journal, 47(4), e69. https://doi.org/10.12771/emj.2024.e69 

Bustamente Quiroz, U. (2026). Holistic patient care: A systematic review of recent evidence (2022–2025). Architecture Image Studies, 7(1), 827–832. https://www.researchgate.net/publication/399764837_Holistic_Patient_Care_A_Systematic_Review_of_Recent_Evidence_2022-2025

 

Author’s Bio: 

Zainab Shakil is a writer with over six years of experience in fields like tech, health, and finance. She is great at creating content that helps businesses reach more people. Currently, she works as a freelancer, helping SaaS, e-commerce, and lifestyle businesses grow their online presence.

 

Essential Role of Support Systems in Healthcare

Posted on by Joseph Gerard

Black nurse listens to a patient

Written by Agwalogu Bob

For many people, getting better just means walking into the hospital and seeing a doctor. But if you’ve ever spent time working on a hospital floor, you know that it’s not that white and black.

Many patients come in with physical symptoms. But they also come with the fear of the unknown, anxiety about treatment, and maybe worst of all, uncertainty about meeting the hospital bills.

A recent KFF research actually found that up to 36% of U.S. adults couldn’t afford healthcare in the past year. Not knowing how to meet the out-of-pocket costs is enough to make anyone get sicker.

That’s exactly why healthcare support systems are essential. In fact, proper support can be the difference between a patient who goes home completely better and one who returns to the hospital within weeks. 

The good news? Many healthcare systems have it in place, and many others are working on it.

What Healthcare Support Systems Actually Mean?

Let’s start by clarifying what healthcare support systems are.

These are the systems that supplement medical treatment. They basically provide the support patients need to ensure that nothing disturbs their full and total recovery.

This includes:

  • Emotional support
  • Social support
  • Financial guidance
  • Care coordination
  • Mental health services

All these support systems hold the patient journey together. Imagine a middle-aged woman gets discharged after heart surgery. 

Her discharge papers say she is to follow up with cardiology in two weeks. But there are problems. For one thing, she can’t afford the Uber. She also doesn’t fully understand what’s written in the discharge papers. All that anxiety makes her think the surgery wasn’t successful.

Now, guess what? There are millions of people in that exact situation. 

These people have what experts call unmet health-related social needs (HRSNs), and this puts them at a higher risk of emergency hospitalizations and hospital readmission. 

What healthcare support systems do is focus on those “unmet needs”.

Why Patients Need Support Beyond Treatment

As much as core medical teams wish it were possible, medical treatment alone cannot bring about full recovery and overall well-being. That’s the honest truth.

A surgeon can perform a flawless operation. But if the patient goes back home to an empty house, where there’s not even one person who’ll help, that surgery can quickly become a failure. That’s why support beyond treatment matters.

It matters because a lot of patients’ faces:

  • The crushing, daily weight of long-term illness stress
  • A total lack of understanding about treatment plans once they leave our care
  • Deep burnout of informal caregivers

But when we actively address these emotional and social needs, clinical outcomes improve. Even experts who have been in the industry for years think so, too.

I have been a Doctor of Medicine for 42 years, and an ophthalmologist for 34 years. I can say with conviction that 90% of the cure is psychological. — H.E. Dr. Edna Joyce (Fatima) Santos on LinkedIn.

The Role of Social Workers Within Healthcare Support Systems

One of the most underrated support systems in healthcare is social workers.

These are the people whose work straddles medicine and real life. They typically help patients:

  • Understand what their diagnosis is in plain language
  • Navigate the world of financial aid and insurance
  • Access community or government support
  • Plan for discharge and long-term care
  • Handle emotional stress and family dynamics

Remember the example we gave earlier of the middle-aged woman who got discharged after heart surgery? This type of situation is where a social worker comes in. 

Their intervention can go a long way in reducing the risk of readmission.

Social work is such an interesting and impactful field that many people are pivoting their careers into it. In fact, according to the U.S. Bureau of Labor Statistics, there were more than 810,000 social workers in the country in 2024. 

There will also be yearly openings for roughly 74,000 workers in the country until 2034, a clear sign of how important this field is to healthcare.

Many of the people who enter this profession come from many different educational backgrounds via online MSW programs.

According to Saint Leo University, the coursework for some of these programs are 100% online. If you’re thinking about a career as a social worker, you don’t even need to quit your day job to train for it.

Of course, social work isn’t the whole support system. But it’s a critical piece of it.

Other Key Support Systems That Improve Patient Care

As we’ve already established, social work isn’t the only support system in healthcare. It’s an ecosystem of different roles that work together to make sure that people who come to the hospital leave better and remain better.

This includes:

  • Nurses who track daily progress and patient needs
  • Patient navigators who guide individuals through complex treatment paths
  • Mental health counselors support emotional stability
  • Case managers who coordinate care between departments
  • Community health programs that provide care beyond hospitals

All these systems together make the technical aspect of medicine work more effectively.

How effectively? It can significantly reduce the 30-day post-discharge hospital readmissions, according to a February 2026 study published in PubMed.

How Support Systems Improve Patient Outcomes

As you can see, healthcare support systems absolutely play a key role in patient outcomes. Let’s connect the dots.

Good support systems lead to:

  • Better recovery rates
  • Improved treatment adherence
  • Fewer hospital readmissions
  • Higher patient satisfaction

But beyond that, healthcare support systems also help patients feel the human, non-technical side of medicine. Patients who thought that they were just an item on a chart know that there’s someone somewhere to call when they’re scared. 

That alone can put them in the proper mental frame for full physical recovery.

FAQs

What are healthcare support systems?

These are the people and processes that support and supplement medical care. People here include social workers, patient navigators, mental health counselors, case managers, and community health programs.

Why are support systems important in hospitals?

Support systems are important because without them, certain non-medical issues can slow down recovery. Examples include financial stress, emotional strain, family pressure, and confusion about treatment. Without support for these issues, patients might not get better on time or recover fully.

What do social workers do in healthcare?

Social workers are the ultimate unsung heroes in healthcare. They work with patients, understand their situation, and connect them to the help and resources they need. In many cases, full and permanent recovery is not possible without social workers.

Key Statistics at a Glance

Figure Details Source
36% U.S. adults who couldn’t afford healthcare in the past year KFF
810,000+ Social workers employed in the U.S. in 2024 U.S. Bureau of Labor Statistics
74,000+ New social worker job openings per year until 2034 U.S. Bureau of Labor Statistics
30-day Post-discharge readmission window PubMed study, February 2026

Final Thoughts

Healthcare is more than what happens in the doctor’s office or OR. It’s everything that happens to a patient before, during, and after treatment. This means the medical care, the emotional support, the social care, and the coordination between many different people just to make sure one person gets better and stays better.

If there’s anything to take from this guide, it’s that the people who provide support are no less than the doctors and nurses who provide medical care. More importantly, if you feel the pull towards the support side of healthcare, it’s totally okay to make the switch.

References:

  • Grace Sparks, Lunna Lopes, Alex Montero, Marley Presiado, and Liz Hamel (2026). Americans’ Challenges with Health Care Costs. Retrieved from the KFF website.
  • Rebecca Williams, Maria Tsantani, Lina Lloyd, Martin Wood, Charlotte Bessant, Helena Takala (2026). Unmet Needs, Unplanned Admissions The critical link between social care and hospitalisations in later life. National Centre for Social Research. Retrieved from NCSR website.
  • U.S. Bureau of Labor Statistics. (2025). Social Workers. U.S. Bureau of Labor Statistics. Retrieved from the U.S. BLS website.
  • Hamadi H, Haley DR, Park S, Tafili A, Zhao M, Spaulding A. Social determinants of health data reporting and hospitals’ 30-day readmissions (2026). Social determinants of health data reporting and hospitals’ 30-day readmissions. Health Care Manage Rev. Retrieved from PubMed Central.

 

Author Bio

Agwalogu Bob believes great content doesn’t just inform, it resonates, and then sticks. For over eight years, he’s been helping agencies across four continents craft just that kind of content: sharp, engaging cut-through-the-noise copy across SaaS, finance, tech, health, and lifestyle.

When he’s not putting pen to paper, you’ll likely find him scouring the internet for funny memes.

Connect with him on LinkedIn or Medium.

 

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

Why the ‘Strong One’ Often Burns Out in Healthcare 

Posted on by Joseph Gerard

Headache, anxiety or sad surgeon in meeting with doctors with burnout, stress or fatigue with medical emergency. Migraine, tired black woman or depressed nurse with depression or loss in hospital.Written by Deepika,

Who doesn’t want to thrive at their workplace, right? This process of ‘thriving’ is generally understood as a psychological state characterized by learning and vitality. 

In other words, your workplace is not about survival of the fittest, especially in the healthcare industry. Naturally, strength is one of the most valued qualities in this field. The word in itself is quite broad and may be loosely thrown around. What exactly does strength refer to in healthcare?

In an environment where people are constantly exposed to grief, uncertainty, and emotional pressures, it could simply mean the ability to remain calm and composed. However, there is a thin line, one that many do not notice. As a healthcare worker, you must stay emotionally composed, but not numb or hardened. 

A little too much to the left or the right can lead to dreadful burnout. As per recent research, burnout scores among healthcare professionals ranged from 16% to 86%, with a mean overall score of 57.4%. The same study revealed that burnout affects clinical decision-making and the ability to cope with work pressures. 

So, while being strong is a necessity, making that your entire identity is like walking on thin ice. Before it breaks, let’s understand the importance of emotional sustainability. This article will explore that by revealing why the ‘strong one’ in healthcare is particularly vulnerable to burnout. 

 

The Emotional Labor That Lives in the Shadows 

In healthcare or otherwise, emotions are shaky ground. That’s because much of the attention goes to competence, technical skills, and sound decision-making. With these covering the surface, what goes unseen is the emotional role many healthcare workers must play. 

Being on the frontline involves holding space for complex emotions like grief, fear, and even anger, both for patients and their families. It’s only a matter of time before such a role no longer remains merely empathetic. It’s commonplace to find healthcare workers who gradually become emotional fulcrums in the teeth of human suffering. 

That explains why higher-level learning routes, such as a Master’s of Science in Nursing (MSN), focus on specialized roles that require deeper emotional and psychological engagement. For instance, those pursuing psychiatric nursing tracks are trained to support patients dealing with trauma and emotional dysregulation. 

Modern online MSN programs have made this type of advanced training more accessible for working professionals already navigating complex healthcare settings. The online format ensures nurses learn counseling frameworks and care principles even as they encounter emotionally taxing situations in real time. 

As Felician University explains, the online MSN track is designed for licensed registered nurses who wish to step into an advanced practice role. As such, formal training makes nurses more competent, and it also places them in a unique position where emotional exposure is continuous. 

It is usually in the space between training and real-world experiences where emotional labor can be found. A recent meta-analytic review confirmed that higher emotional labor is associated with increased levels of burnout in healthcare. Another finding in that study was how emotional intelligence can soften this impact by improving emotional regulation. 

However, why does this emotional labor we speak of live in the shadows? Here are the main reasons:

  • In most cases, it remains unrecognized as a part of healthcare job descriptions. 
  • The industry still seems to prioritize measurable clinical outcomes over abstract emotional effort. 
  • Some form of pressure, no matter how subtle, is always there to appear emotionally composed. 
  • There is limited time and space to process emotional experiences during or after shifts. 
  • At some point, repeated exposure to distress gets normalized, making emotional strain harder to identify. 

 

The Exhaustion of Maintaining Constant Emotional Composure 

Have you ever paused to wonder whether it is humanly possible to maintain perfect emotional composure without any psychological costs? Well, that doesn’t seem to be a realistic feat, nor should it be. After all, healthcare is a people’s industry, and what could be more human than expressing emotions in a healthy way? 

According to a 2025 systematic review involving 2,425 healthcare professionals, there is a significant link between moral distress and emotional exhaustion. Although the expectation to remain strong at all times sounds noble, it is also unrealistic. Let’s look closely at how compassion fatigue and emotional suppression gradually lead to burnout. 

The Mental Strain of Keeping Emotions on Lock And Key 

Healthcare workers must witness grief, trauma, and loss, but amid it all, they cannot lose their composure. This makes many people accustomed to keeping difficult emotions on lock and key so they can continue functioning effectively. Now, this strategy works, but constant withholding of emotions is a disaster in the making. 

A 2024 study revealed that more than 20% of surveyed healthcare professionals displayed severe symptoms of stress, anxiety, and depression. Only 10.7% of the participants showed no signs of burnout. Well, that’s primarily because suppressing emotions does not make them disappear. 

The Compounding Effect of Compassion Fatigue 

Even if one is not experiencing pain, grief, or emotional vulnerability directly, repeated exposure to suffering can take a toll over time. This condition is often described as compassion fatigue, and it has a compounding effect. In other words, time will wear down a caregiver’s psychological reserves. 

At the same time, detachment is not an option. In a 2025 discussion on compassion fatigue among clinicians, oncologist Eric Singhi said, “Compassion and being able to empathize are so important; it’s how you gain trust.” This is where the emotional tension comes in, as the same empathy that comforts patients can become emotionally taxing for the healthcare professional. 

The Struggle to Ask for Help 

This part usually gets pushed under the rug, but many healthcare professionals find it difficult to ask for help. After all, the pressure to appear fine at all times can be intense. When being strong has become one’s identity, vulnerability can feel uncomfortable, daunting even. 

Is this pressure generated by the healthcare culture itself? Perhaps, since emotional endurance and resilience are almost always rewarded in clinical settings, acknowledging one’s struggle may be seen as a lack of professionalism. 

 

When it’s Time to Care for the Caregiver 

Burnout among the ‘strong’ healthcare workers should not only be recognized, but also addressed using meaningful support. Let’s see three effective ways this may happen:

Creating an Environment Where Vulnerability is Welcomed 

Fear of judgment and professional consequences can keep the best of healthcare workers silent about their struggles. A safe place need not come at the cost of unscrupulous emotional expression, for it to be effective. What truly matters is to ensure everybody feels safe to admit they are struggling. 

In a 2025 study conducted on 322 surgical nurses, those with higher levels of emotional exhaustion were less likely to seek professional help. Moreover, such nurses displayed more stigmatized attitudes towards mental health support. Doesn’t that sound like hurt people hurt people? Everyone needs an environment where they can voice their concerns without fear. 

Encouraging Rest Before Burnout Reaches a Saturation Point 

Rest is a lot like food; simply having it isn’t enough; the timing also matters. Hustle and resilience cultures have made rest a privilege only a few can enjoy. When something necessary to sustain emotional stability becomes a badge of honor, the results can be disastrous. 

A somber survey conducted among physicians in 2025 discovered that one in three experienced fatigue severe enough to interfere with their ability to treat patients. At least one thing is clear: fatigue can quickly cross the threshold into impaired functioning in the absence of sufficient rest. 

Implementing Burnout Prevention Methods 

It is important to be on the lookout for the early signs of burnout so it doesn’t get worse. At the same time, certain interventions should be in place to prevent burnout as far as possible. Such methods may include regular wellness screenings, confidential self-reporting tools, and other institutional channels that allow healthcare workers to report emotional burden. 

A recent review published in the Frontiers of Psychology highlighted that burnout prevention strategies were more effective when implemented at early stages, when the signs appear. Once full-blown emotional numbness has set in, it’s usually a tedious journey to recovery. Hence, early recognition of warning signs is a crucial factor in preventing progression. 

 

FAQs 

Why are healthcare workers often expected to be the strong ones?

The main reason why healthcare workers are often expected to be the strong ones has to do with how their roles place them in contact with human suffering and uncertainty. In such scenarios, being calm and composed is almost a necessity to ensure effective patient care. While emotional strength is admirable, it may create pressure to suppress vulnerability, preventing healthcare workers from seeking support. 

What is emotional labor in healthcare?

In the healthcare context, emotional labor refers to the exertion needed to manage personal emotions while responding to others’ emotional needs. This may involve maintaining composure during negative situations or regulating one’s emotional responses during work hours. Prolonged emotional labor is tied to burnout, especially when the same goes unacknowledged. 

How can healthcare workers recognize early signs of burnout?

In one’s own self, early signs of burnout often include unexplained fatigue, reduced empathy, and a feeling of detachment from work. In colleagues, the same may manifest itself as withdrawal, lower emotional engagement, or reduced communication. Early recognition of such signs allows timely support in the form of rest, open conversations, and workload changes. 

 

Recent Data on Burnout in Healthcare 

Burnout score range and mean overall among healthcare professionals, respectively  16%-86%, 57.4%
Meta-analytic review on the link between emotional labor and burnout  Directly proportional, with emotional intelligence able to reduce the impact through better regulation of emotions 
2025 systematic review involving 2,425 healthcare professionals on the link between moral distress and emotional exhaustion  Directly proportional 
Healthcare professionals displaying severe symptoms of stress, anxiety, and depression in a 2024 study  >20%, with only 10.7% showing no signs of burnout 
2025 study involving 322 surgical surgeons on the connection between emotional exhaustion and seeking professional help  Those with higher levels of emotional exhaustion were less likely to seek professional help 
Physicians experiencing fatigue severe enough to interfere with their ability to treat patients in a 2025 study  One in three 
Recent review on burnout prevention strategies Such strategies are effective when implemented at early stages, when the first signs appear

 

So, are you the ‘strong one’ at your workplace? If so, has that identity started to feel less like a role and more like a burden you must carry every day?

While strength is praiseworthy, it also deserves to be questioned, even if we’re the first ones to do so. Discretion in this area is all about knowing when to try harder and when to let go and seek help. 

Do not take even the small signs, like unexplained fatigue or constant irritability, lightly, either in yourself or a colleague. Seeking help early or checking in with a colleague are forms of care that protect both the caregiver and the quality of care they deliver. Being the strong one only makes sense when that strength is sustainable and not tied to one’s identity. 

Author Bio

Deepika has over six years of experience as a writer and editor. Passionate about words and learning, she takes an interest in a variety of niches. Her knack for turning complex ideas into relatable narratives allows her to resonate with the reader. 

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

References:

  1. Batanda Ian. 2024. Prevalence of burnout among healthcare professionals: a survey at Fort Portal regional referral hospital. Npj Mental Health Research, 3, 61.

https://www.nature.com/articles/s44184-024-00061-2

  1. Chen Yin-Che, Huang Zhi-Ling, et al. 2024. Relationships between emotional labor, job burnout, and emotional intelligence: an analysis combining meta-analysis and structural equation modeling. Springer Nature Link, Volume 12, 672. 

https://pmc.ncbi.nlm.nih.gov/articles/PMC11575177/

  1. Orgambidez Alejandro, et al. 2025. Moral distress and emotional exhaustion in healthcare professionals: a systematic review and meta-analysis. PubMed. 

https://pubmed.ncbi.nlm.nih.gov/39997268/

  1. Major Jutta, Palfi Krisztina, et al. 2024. Adaptive emotion regulation might prevent burnout in emergency healthcare professionals: an exploratory study. Springer Nature Link, Volume 24, 3136. 

https://link.springer.com/article/10.1186/s12889-024-20547-0

  1. Coffey Donavyn. 2025. Compassion fatigue: how oncologists can recognize the signs. Medscape. 

https://www.medscape.com/viewarticle/compassion-fatigue-how-oncologists-can-recognize-signs-2025a100021r

  1. Smajlovic Aljana, Budler Cilar Leona, et al. 2025. Burnout and the stigma of help-seeking in nurses: a cross-sectional study. ScienceDirect. 

https://www.sciencedirect.com/science/article/pii/S0001691825011059

  1. Gregory Andrew. 2025. One in three NHS doctors so tired their ability to treat patients is affected, survey finds. The Guardian.

https://www.theguardian.com/society/2025/mar/03/one-in-three-nhs-doctors-so-tired-their-ability-to-treat-patients-is-affected-survey-finds

  1. Alhassan Abdulrahman Shaden, Alhassan A. Mohammed, et al. 2025. Prevalence of burnout and its risk and protective factors among healthcare workers in the Middle East, North Africa, and Turkey: a systematic review and meta-analysis. Frontiers in Psychology. Volume 16. 

https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2025.1539105/full

 

 

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

Christian Spiritual Direction and Counseling: Analysis on Ignatian Discernment of Spirits and Election

Posted on by Mark Moran

This is a short blog that will analyze and clarify St. Ignatius’ concept and semantics regarding desolation and consolation and their use in discernment of spirits and election or choice.  This is a general blog for any interested reader as well as a synopsis for those in AIHCP’s Christian Counseling or Spiritual Direction courses, as well as those enrolled in Ignatian Spirituality.

Please also review AIHCP’s Christian Counseling Certification.

Introduction

Desolation and Consolation are spiritual phases and states that come and go throughout the spiritual life. Please also review AIHCP’s Spiritual Direction Certification

For those in the Spiritual Direction Program, consolation and desolation are universal Christian terms but primarily stemming from the Catholic tradition.  So for those who are Protestant or from non-denominational faith traditions, do not feel intimidated.  These concepts can be applied and should be applied in spiritual direction regardless of Christian denomination.  None of these concepts deal with any dogmatic dispute between denominations of Christianity and can be universally applied to Catholic/Orthodox and Protestant traditions.  These concepts are extremely helpful in guiding souls as well as helping alleviate spiritual times of suffering.

I would like to point out that the terms desolation as well as consolation can be utilized more generic in sense regarding mood of the soul.  St Ignatius points out that in consolation, the soul’s interior is aroused with spiritual sweetness from the Creator and inclined to the will of God via this good spirit.  In contrast, he states that desolation is a time of inner turmoil and restlessness of the soul when it is inclined away from God and influenced by a false spirit.

This may seem confusing when we hear the term consolation and desolation its pure emotional semantic meaning.  In cases of other mystics, such as St Teresa of Avila, consolations are times when the soul feels God’s presence and desolations are when the soul does not feel God’s presence.  I myself in a video reference the term in this more simple format.   Ignatius would refer to desolation in this sense as difficult consolation because the soul is still inclined towards God and pushing forward while in Ignatius’ concept of true desolation, the soul is falling away from God, albeit not necessarily in a state of sin but one of spiritual apathy.   St Teresa of Avila refers to simple desolation as more spiritual aridity, while Ignatius seems to refer to it more as spiritual apathy.  These are big differences but I wanted to notate this when reading the Ignatian texts.  Again for Avila, it is a simple emotional state, for Ignatius it is more than just mood but also a disposition of the soul that comes and goes in different phases and periods of times.  So there is a distinction between Avila and Ignatius between an emotional state and a spiritual state in regards to the word.  Again, desolation is not in itself sinful but it can lead to sin and bad habits because it is guided by false spirits and interior dispositions.

What are Consolations and Desolations?

Consolation

A soul in consolation is in sync with God. While some saints use the word semantically to explain emotional states, Ignatius broadens it to also mean states of being.

A consolation can be considered an emotional state of intense union with God but also a spiritual state of union with God that is in sync with God’s will and laws.  According to Thibodeaux, it can be dramatic as well as placid in nature (2020). In a dramatic state, the soul experiences a moment with God that is overwhelming and exciting to the soul and the body’s senses.  It is uplifting and warm.  One in a state of placid consolation is not a in a current state of intense excitement but a consistent balance.  In comparison, consider dopamine and serotonin.  Dopamine as a neurotransmitter produces an intense edge, while serotonin as a neurotransmitter produces stability of mood.  I think this best explains this balance between dramatic and placid consolation.

It is important to remember that consolation itself is gift.  It cannot be earned by praying a certain way or meditating but is a gift from God.  He grants it to whoever He desires.  We should then be grateful and thankful to God when He chooses to gift the soul with more intense presences.   St Teresa of Avila expresses different states of reward in prayer, namely the Prayer of the Quiet when God reveals Himself without effort on the part of the person, as well as Prayer of the Union, when the soul also receives an unexpected and unearned gift of a deep unitive gift with the Divine.  These are all greater examples of consolations.  Ignatius also speaks of unexpected and memorable spiritual experiences and refers to them as Consolations without Previous Cause (Thibodeaux, M., 2020).   This is similar to extraordinary spiritual experiences that the soul is granted by God.

Strangely enough, even during consolation, the soul can feel what St Teresa of Avila would refer to aridity.  St. Ignatius does not refer to this state of aridity as a desolation but a Difficult Consolation (Thibodeaux, M., 2020).  In this, Ignatius points out that the soul is still directed toward God and is not facing a desolation that puts the soul out of sync with God.  Instead, while still experiencing aridity, the soul still is orientated toward God.

Desolation

In contrast, desolations, according to St. Ignatius, are darker moments of the soul’s spiritual phases.  It is time associated with anxiety, depression, and inclination towards false spirits and bad habits.  The soul is not in sync with God.  These false spirits can but are not necessarily even demonic in nature but more natural inclinations of humanity’s fallen nature.  Energies or inclinations towards the world, or particular vices that bring the soul downward away from God towards other sources of “completeness”.   This state does not designate sin in itself but can lead to sinful situations and sinful aspirations.

Like consolations, the desolation can be dramatic or placid in nature.  They can be an intense anxiety or merely a tiresome and gradual decay of the soul’s spiritual life with God.  In other cases, there can be False Consolations, where the soul feels it is following God’s calling but in reality is fulfilling one’s own desires and needs (Thibodeaux, M., 2020).

The Spiritual Life: A Spiritual Rollercoaster

Spiritual life is filled with waves of consolation and desolation, as well as emotional “consolation” and “desolation”.  Life happens and things can occur that make us very happy or very sad or angry.  These life events can steer us closer or away from God through certain phases of life.  The loss of a child, or a parent, or any loved one can lead some individuals into a desolation against God which includes anger and resentment.  Likewise, individuals can go through numerous loses and pains in life, but still remain in sync with God, but feel truly empty and sad over such losses.  These are natural bio-rhythms.  Like the body, the soul also goes through natural ups and downs.  What is important is to orientate one’s self to never lose sight of God even in the rough times, even in times we do not feel His presence.

It is also crucial to understand the psychological components of desolation as well as consolation.  Psychotherapy tends to separate soul care and mental health but both are uniquely tied together.  This does not mean clinical depression should only receive spiritual advice but it does mean within all melancholy, there is also a saddening of the soul.  States of depression can distort thinking and value of self as well as one’s relationship with God.  Desolation can make one doubt one’s love from God, as well, as to hate oneself for past sins and feel a lack of forgiveness.  These deeper states of desolation leave the soul out of sync with the Divine and can lead it to other maladaptive practices to find solutions from the pain.  So, spiritual desolation itself can be a dark time, but it is even darker when tied to mental health issues.  Spiritual Directors, while understanding the union between soul and mind, but also understand the need to refer individuals for psychological help when signs and symptoms of clinical depression emerge.

Guiding others through Spiritual States

The Spiritual Director is trained to help souls through consolation and desolation and also in helping them in discernment

Thibodeaux discusses multiple applications of spiritual direction through different states of consolation and desolation.

In consolation, he lists numerous points but importantly, one needs to remember to encourage humility and thankfulness in these states, but also to prepare one for future desolation.  In times of consolation, he recommends that individuals journal the good times so when tougher times arrive, they can fall back on these emotions and feelings as a spiritual anchor.  He also points out that it is during these times that one has the most clear head to make elections or decisions (2022).  Ignatius believed during consolation, the soul is able to understand God most and be able to make decisions.  Decision making is difficult enough.  Life decisions are not easy mathematical equations but require our whole being partaking in it.  When one’s conscious and subconscious –mind and soul–find God’s presence and can hear His voice, then elections can be made.   However, like any dopamine affect, it is important to reflect also on these decisions which are indeed well-founded, but once a more stable mood is restored, one can reflect on the extraordinary insight God has given.   This is why Ignatius, while dictating the validity of election in this state, does think it is wise for immediate action on it until it is reflected upon.  Ignatius teaches that discernment also involves feeling the spirits of the movement.  In consolation, these are genuine, but one must be certain of the genuine experience.   This is especially true if one experiences an extraordinary spiritual state, as as Ignatius would refer “Consolation Without Previous Cause”.  In this state, the soul, as well as the body feeling in the intake of dopamine and happiness, should wait a short period to stabilize mood wise.  In this way, the intellect can share in the evaluation of the message before acting in  haste (Thibodeaux, M., 2022).  Spiritual Director help souls recognize true consolation over false consolation and also help souls discern the messages and movements of the soul during them.  They help the soul understand when it is good to make a choice or election when sound mind exists that correlates with the valid message of a consolation.

In regards to desolation, it is a time for even more renewed prayer and  to remind the directee that acting on any impulses or changes during this time is dangerous.  A soul in desolation, even in troubled consolation, should not act due to the variety of emotional blinders.  Until the blinders are removed, the soul could be influenced to poor decisions.  For instance, many depressed individuals turn to maladaptive coping or choices for a quick fix.  They will try to feel good by merely making a move in life to alleviate the desolation.  Spiritual Directors must utilize empathy, patience, and unconditional positive regard to these souls.  They need to help them cognitively reframe false assumptions or low images of self that have influenced them via the false spirit.  Psychology gives many tools to help people rethink about themselves.  Cognitive Behavioral Therapy teaches individuals that bad thoughts create bad self image and behaviors associated with those thoughts.  It is important to reframe these thoughts or images and help the directee re-evaluate in a different light.

Another important thing to consider in desolation is the movement of the enemy within the soul.  A soul that begins to change itself will be met with loud noise and anger from the enemy.  Those looking to re-orientate themselves will face stiff resistance that can produce anxiety and depression.   It is not only a spiritual battle, but also a psychological rewiring of neuropathways that are tied to bad habits of the past.  Likewise, the soul who is muddied and stuck in desolation quietly acquiring bad habits of spiritual sloth, or any other vice, will form habits but the approach of the enemy will be far more quiet and less disturbing.  Only till the soul pulls away, will the enemy become loud again with persistence in pushing bad habit and vice.

It is of no wonder then that Ignatius emphasizes the danger of making an election or drastic decision in this state of being.  Only until balance or equilibrium is restored with God can the soul regain composure to make healthy and good decisions that are aligned with God.  Spiritual Directors who work with souls in deep and acute desolation need to help the soul again find balance and then exhibit extreme patience with the individual as he or she again looks to hear God and answer Him.

Desolation is obviously a natural part of life.  It can be caused by life itself and the sorrows of this world.  It can be deep and disorientating but it does not necessarily mean the soul needs to lose sight of God.  Those in desolation, or even simple aridity, are called even more so to daily prayer, even if there is no warmth or sense of happiness.  Eventually, the soul will come out of desolation, but again, those with psychological issues, with also require professional mental health providers to help them.

Why would God permit this?  First, it is the natural state of humanity.  In regards to abandonment, Christ Himself felt alone or desolate, albeit, never out of align or not in sync with God, since He is God incarnate, but this does not mean He did not sense or feel within His human nature, the fear, anxiety and angst of life.  In the Garden, He wept blood, and on the cross, He felt forsaken.  So, whether in desolation, aridity, or troubled consolation, the emotions and feelings associated with it are part of the natural world.  Jesus teaches us how to fight them.

God also uses these moments as teaching moments to train the soul on its dependence on God.  St. Ignatius points out that the soul can become proudful of its own accomplishments in false consolations, or may feel consolations of intense proportion are earned or deserved.  A soul that continues to fight, sees its own humility and dependence upon God can learn much through desolation and aridity.

Conclusion

Please also review AIHCP’s Christian Counseling as well as Spiritual Direction Certifications

I hope this clarifies some of the semantics regarding desolation and consolation that we hear in spiritual states of life.  Obviously this is more so focusing on St. Ignatius and the Thibodeaux text in understanding consolation and desolations in Spiritual Direction and how to guide souls through these states to make better choices.

Please also review AIHCP’s Spiritual Direction Program as well as its Christian Counseling Program

Reference

Thibodeaux, M, SJ. (2022). Ignatian Discernment of Spirits for Spiritual Direction and Pastoral Care: Going Deeper. Loyola Press.

Additional AIHCP Blogs

Vocation and Discernment: Access here

Desolation and Affliction.  Access here

Additional Resources

Peoples, I. (2022). “Jesuit 101: Consolation and Desolation”.  The Jesuit Post.  Access here

“Consolation and Desolation”. Ignatian Discernment Institute.  Access here

“Discernment: Consolation and Desolation”. Loyola Press.  Access here

 

 

How to Address the Challenges of Relocating Your Nursing Practice

Posted on by Joseph Gerard

A female Case Manager taking notes.Written by Deboshree Bhattacharjee,

Nursing, despite its many professional and personal rewards, also has several challenges. The American Nurses Association acknowledges that nurses experience high levels of stress. Among younger nurses, around 69% report burnout. 

Part of this is due to work overload and being inundated by administrative tasks. Interacting closely with patients suffering from chronic illnesses may take a toll on nurses’ mental wellness. Professionals in emergency units also report feeling vulnerable and experiencing despair after long, relentless shifts.

Many nursing practitioners decide to switch to another profession to achieve a higher work-life balance. Others relocate to be associated with a healthcare facility that promises more flexibility. Alternatively, they may wish to relocate to a neighborhood that offers a greater opportunity to connect with a diverse patient community.

Let’s address the challenges associated with such a move to help you be prepared.

Stay Updated With Licensure Requirements

A practical obstacle to relocating may lie in your licensure as a registered nurse. In the US, the RN requirements by state can differ vastly. Although the Nurse Licensure Compact (NLC) permits nurses to practice in multiple states, some states are not yet part of this agreement. 

For example, suppose you wish to relocate from Alabama to Alaska. While the former is an NLC state, the latter is not. This can affect the possibility and ease of practicing unless you manage to obtain an individual license for that state. It is an important consideration to heed before you decide to move for financial or personal reasons.

The good news is that one can hope for smoother licensing arrangements for nurses in the near future. According to Keypath Education, this approach benefits both nurses and patients. The former don’t have to apply for a separate license in each state, and the latter can access more care providers.

Recently, Illinois hit a roadblock in this regard, as the decision on allowing nurses to practice across state lines could not be finalized. Even so, active advocacy is ongoing as more people realize the favorable impact on patient outcomes.

“It really affects not just the younger people that need to have that medication management, but it also affects students that are growing up with an IEP or ADHD that need to continue their therapeutic relationship for their medication management.” – Kyle Maichle, President, Americans for Autism Advocacy.

 

Assess Local Health Problems and Priorities 

Another challenge you will likely encounter is linked to a different demographic with unique health problems. 

These could be related to an aging population, wherein many older adults face mental health issues due to social isolation. A 2024 Frontiers in Public Health research observes that migrant populations may be affected by occupational risks and socioeconomic differences. Both these factors can impact their health, mandating data-driven frameworks for their management. 

You may not have experience handling such conditions, which can take a hit on your confidence and professional well-being. 

To address this challenge, you must assess local sociocultural factors that may be impacting the health of the community you will be supporting. It can be helpful to discuss the unique health aspects of the region with associates and connections from the new facility.

Another idea is to conduct local community visits focused on observation and interaction. The American Association of Colleges of Nursing explains that a windshield survey can help practitioners get a clear understanding of a community’s people and the services they require.

Use Tech To Maintain and Build Connections 

As you attempt to adapt to a new location and workplace, turning to old connections for support can be both helpful and reassuring. With technology now facilitating collaboration at every level, this has become much simpler.

Your former colleagues can:

  • Help you build on your strengths to excel in a new location.
  • Offer you practical advice on working in a facility they may have visited before, such as transport and management priorities.
  • Connect you to peers and mentors from their networks.

A McKinsey feature on building healthy teams highlights that psychological safety and collaboration are crucial for an organization’s effective functioning. In healthcare, cross-functional initiatives are often key to patient health outcomes. 

For instance, nurses may need to work with physiotherapists and mental health professionals to ensure holistic care for a patient. Ideally, a collaborative ecosystem demands leadership input. However, maintaining connections with peers and forging new, productive work relationships is also an individual endeavor. 

Sharpening Tech Skills as a Nurse

If you are tech-averse, it is advisable to hone the required skills for connecting and learning from other professionals digitally. Attending in-person industry events or workshops can be difficult when you are trying to adapt to the logistics of a new place. Webinars and podcasts can be your aid. 

Tech skills you pick up along the way will also help you strengthen your competency in working with digital medical devices, such as fitness monitors, and AI-based tools for nursing decision support. 

An insightful Cureus study on the implications of AI in nursing recommends that AI literacy be included in professional training. The scholars assert that this will support practitioners in applying technology as a transformative partner in high-risk settings, such as intensive care. 

This mental orientation can be helpful when you shift your practice. You will know that technology will support you in maintaining consistency and seamlessness.

FAQs

1. What are the main challenges nurses can face when relocating their practice?

Relocating your nursing practice can involve numerous challenges, like adjusting to new licensure requirements and adapting to different patient demographics. Building professional relationships in a new workplace can also be difficult. As a nurse, you may face emotional stress while balancing personal transitions with demanding work responsibilities.

2. How can the Nurse Licensure Compact (NLC) help relocating nurses?

The Nurse Licensure Compact (NLC) permits registered nurses to practice in all the participating states. All these states are under a single multistate license. The NLC simplifies the relocation process and bolsters access to healthcare services for everyone.

3. Why are technology skills crucial for nurses relocating to a new workplace?

Technology skills can help nurses stay connected with peers and attend virtual training sessions. They simplify the process of adapting to digital healthcare systems in a new facility. When you are familiar with AI tools and digital medical devices, you can also support better patient care outcomes.

Nursing Practice Relocation Challenges

 

Nurse burnout among younger professionals Around 69% of younger nurses report burnout
NLC participation differences Some US states participate in the NLC, while others require separate licensure
Impact of demographic changes Migrant and aging populations may experience increased health risks tied to social and economic disparities
Importance of collaboration in healthcare Psychological safety and collaboration are considered essential for effective healthcare teams

 

Committing to Patient Care, Across Locations

Empathy and dedication to service are underlying tenets of the nursing profession. They remain true, irrespective of where you are. The stress of moving your practice can cause you to question your competencies and motivations. However, if you feel the decision will help you personally and in your career, you should not hesitate to make it.

Remembering what drew you to this vocation and taking proactive steps to address relocation challenges will help you stay true to yourself and your vital role in public health. 

 

References:

American Nurses Enterprise (2024). What is Nurse Burnout? How to Prevent It. Retrieved from the ANA website.

Keypath Education (2024). RN Licensure Requirements by State. Retrieved from the Keypath Education website.

Alex Whitney (2026). Healthcare advocates split on bill to allow nurses to practice across state lines. Retrieved from the Nexstar Media Inc. website.

Shen Y, Wang J, Ma L and Yan H (2024). Novel concept for the healthy population influencing factors. Frontiers in Public Health. Retrieved from Frontiers.

Meagan Rogers (2025). Windshield Survey of the Community. Retrieved from American Association of Colleges of Nursing.

Aaron De Smet, Gemma D’Auria, Liesje Meijknecht, Maitham Albaharna, Anaïs Fifer and Kim Rubenstein (2024). Go, teams: When teams get healthier, the whole organization benefits. Retrieved from McKinsey.

Sumangal Bose, Avinash Prakash, Avijit Kumar Prusty, Rashmi Verma, Karthika Padmavathy, Venugopal Reddy Iragamreddy (2026). Artificial Intelligence (AI) Supported Decision-Making in Intensive Care Units: Implications for Nursing and Medical Practice. Retrieved from Springer Nature.

Author Bio:

Deboshree Bhattacharjee likes to tell stories that delight and engage. Her focus areas include lifestyle, parenting, health & wellness, and technology. Besides writing, she also edits and strategizes content. Every morning, she wakes up with the northern lights in her eyes and chalks out travel plans.

 

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

Practical Ways to Use Genomics in Nursing for Better Health Outcomes

Posted on by Joseph Gerard

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

Written by Deboshree Bhattacharjee

The pace of evolution in healthcare is impressive. We have moved on from standard treatments for everyone to precise care that perseveres to reach the root of the problem. In nursing, new models of care have emerged to improve patient health over their lifespan. Genomics is one of these advanced techniques: it may sound complex, but it has actually started delivering excellent results.

Essentially, this methodology of diagnosis and care takes the genetic makeup into close consideration. After all, diverse populations may respond to similar care strategies differently based on multiple factors, including lifestyle and sociocultural parameters. Genes, which affect many underlying bodily aspects, occupy a prominent space among these factors.

The Human Genome Project has been one of the most significant biomedical research projects of our time. As early as 2003, this project produced a genome sequence that covered 90 percent of the human genome. Since then, genomic data has proved immensely helpful in biomedical advancements and healthcare. 

As a nursing practitioner, integrating genomic insights into your care models can be transformational.

 

Assess The Possibility of Hereditary Conditions

We live in such challenging times, so fraught with risks of microbial contamination and lifestyle-induced sickness, that hereditary possibilities don’t seem as likely. Many professionals restrict this category of diseases to relatively rare concerns like cystic fibrosis and sickle cell anemia. 

However, several recent studies have indicated that seemingly “regular” cardiac and blood pressure problems could also be affected by genetic makeup. Sidestepping this aspect in diagnosis and treatment can lead to suboptimal outcomes.

In 2025, a research study published in Nature Communications showed that cardiovascular diseases often co-occur with genetic correlations. Many of these complex conditions have a shared genetic basis. Studying and applying the underlying biological mechanisms behind clinically defined cardiovascular diseases can ensure that patient care is focused and informed.

As a nurse, you are uniquely positioned to identify such possibilities because you have an ongoing relationship with the patient. Your interactions focus on communication and active listening, which makes it likely that you can pick up on cues like:

  • Breast cancer incidence in the family
  • A history of cardiac troubles and unhealthy eating habits
  • Recommended genetic testing for another condition, which the patient may not find relevant to disclose to a physician or in an intake form

Based on your observations, you can recommend earlier screenings and lifestyle interventions. These can potentially be life-altering for patients with genetic risks. You will also be a reliable source of actionable steps people can take, which has become imperative in this age of mistrust.

“We find ourselves in a time where fake news, lies, conspiracy theories, misinformation and disinformation are rampant.” – Dr Tedros, WHO Director-General

 

Monitor and Advise on Drug Dosage Based on Genetic Metabolism

Helping patients understand and follow their medication regimen has always been a core nursing responsibility. 

Medication adherence can be particularly tricky in older adults, who may display inappropriate use or struggle to follow multiple pharmacological regimens. Some patients discontinue their dosage if they don’t perceive significant benefits. This can be alarming for chronic conditions that demand continued medication. 

A 2024 Cureus study on medication adherence in the Middle East showed that asthma patients had only 41% rate of adherence. They also had higher levels of severe depression. Patients with schizophrenia are also known to show poor adherence, partly due to side effects and because they feel uncomfortable with the treatment.  

What if the reason behind a medication’s apparent inefficacy or a patient’s adverse reaction to it lies in genomic data?

The American Council on Science and Health explains that genetic testing can reduce side effects for patients who need psychiatric and cardiovascular drugs. This is because drug metabolism can be affected by our genetic makeup. 

No wonder more healthcare firms are investing in using advanced technologies to fine-tune drug dosage. Pharmacogenomics promises to usher in groundbreaking changes in how nurses can support patients with their drug regimens. 

 

Equip Yourself With an Advanced Academic Foundation

With genomics now accessible to healthcare organizations, nursing professionals are learning to apply these insights. 

Incorporating deeper, more personalized learning into everyday practice can support patients like never before. Not only do they benefit from prescribed drugs with lower side effects, but they also adopt a more considered lifestyle. Early cancer screenings or lipid profile testing become standard for those at risk, possibly averting a chronic disease that could have been.

As a working nurse, pursuing an FNP degree online can be a smart way to equip yourself with advanced health assessment competencies. It can train you to integrate genomics and apply biopsychosocial principles in your practice.

It also accrues considerable career advantages, including higher salaries for more advanced responsibilities. You may also find opportunities to be part of multi-specialty patient care teams for serious illnesses such as cancer.

While selecting a further education path, ensure it aligns with your current work and personal routines. American International College recommends seeking accreditation with CCNE, the Commission on Collegiate Nursing Education, and a flexible delivery format.

With these skills to guide you, your patients will benefit from personalized and more accurate medication. You can also use genomic insights to complement prescription digital therapeutics. Some practitioners are trying out this comprehensive approach as part of biopsychosocial treatment for schizophrenia (and other conditions).

 

FAQs

1. How is genomics used in contemporary nursing practice?

Genomics can help nurses understand a patient’s genetic makeup and how it influences their disease risk and treatment response. Nurses can use these insights to recommend earlier screenings and personalized care plans. On the whole, it facilitates better patient education for serious conditions such as cancer and mental health disorders.

2. Should nurses learn about pharmacogenomics?

Yes. Pharmacogenomics can help nursing professionals understand how genes affect a patient’s response to medicines. These insights can help nurses monitor side effects and streamline treatment routines. This way, they can contribute to more personalized treatment plans that enhance patient results.

3. How can an online FNP degree help nurses acquire genomics competencies?

An online FNP degree can help nurses build advanced assessment, diagnostic, and patient care skills. Such programs may introduce students to evidence-based practices, including genomics and personalized healthcare. The online format supports flexible scheduling for working professionals.

 

Patient Health and Genomics By The Numbers

 

90% of the human genome sequenced by 2003 Opened the door for precision medicine and genomic-based healthcare
41% medication adherence among asthma patients Highlights the need for personalized medication strategies and stronger nursing support
44% lower coronary heart disease risk Demonstrates that lifestyle interventions can still greatly improve outcomes despite genetic predisposition.

 

Genomics Can Enable More Informed Patient Care

Amid all the mad rush for the next AI application that creates simulated worlds and volatile social media trends, it is heartening to see healthcare advancements progressing well. They may not always make front-page news, but the changes that tailored care is bringing are meaningful and enduring.

For nurses, learning about genomics and finding the confidence to go the extra mile in their practice can be a huge career step. Imagine the difference one could make by employing individual data to develop more effective medication and preventive techniques. 

Moreover, you will ensure that people do their part in following instructions, all through nursing superpowers of understanding and assistance.

 

References:

Human Genome Project (2026). Retrieved from the National Human Genome Research Institute website.

Qiao, J., Jiang, L., Cai, L. et al. (2025). Shared genetic architecture contributes to risk of major cardiovascular diseases. Retrieved from Nature Communications. 

WHO looks back at 2024 (2024). Retrieved from the WHO website.

Cardona D, Santacruz-Restrepo V, Rendón-Montoya A, Madrigal-Cadavid J, Segura-Cardona A and Estrada-Acevedo JI (2025). Medication adherence in the elderly population with chronic diseases: a factor analysis. Retrieved from Frontiers.

Alomar A O, Khushaim R H, Al-Ghanem S K, et al. (2024). Relationship Between Depression and Medication Adherence Among Chronic Disease Patients in the Middle East. Retrieved from Springer Nature.

Henry I. Miller (2025). How Genetic Testing Could Prevent Dangerous Drug Reactions and Reduce Healthcare Costs. Retrieved from American Council on Science and Health.

American International College (2026). Online MSN – Family Nurse Practitioner (MSN-FNP). Retrieved from the American International College website.

Rimal B. Bera, MD, Ryan Haumschild, PharmD, MS, MBA, CPEL (2025). The Potential of Prescription Drug Therapeutics (PDTs) in Schizophrenia. Retrieved from AJMC.

 

Author Bio:

Deboshree Bhattacharjee likes telling stories that delight and engage. Her focus areas include lifestyle, parenting, health & wellness, and technology. Besides writing, she also edits and strategizes content. Every morning, she wakes up with the northern lights in her eyes and chalks out travel plans.

 

 

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

Diagnosing Psychopathology

Posted on by Mark Moran

Psychopathology refers to mental disorder or illness.  It maintains that mental disorders are not merely things in someone’s head but a true reality that is usually more complex than merely one explanation.  Etiology for psychopathology has many multidimensional facets which professional must consider and review before giving an official diagnosis.  Like any physical disease, mental disease and disorder is very broad and can cause a variety of ailments and dysfunctions.  Nosology is the classification of phenomena especially in mental health and psychopathology (McRay, B.,et. al, 2026).  Categorizing psychopathology, however, is not a simple process and like psychology itself has many differing opinions on what causes an issue or how differing conditions should be classified.  In this blog we will take a closer look at classification of psychopathology, as well as classification and diagnosis.

Psychopathology and diagnosis is a multi tiered and multi disciplined approach usually without one clear answer

Please also review AIHCP’s Behavioral Health and Healthcare Certification Programs.

Pathology, Assessment and Diagnosis

The American Psychological Association (APA) defines psychopathology as understanding the nature of pathologies of the mind, mood and behavior (McRay, B. , et. al,, 2016).  Pathologies also share four common features or the “four Ds”.  The pathology deviates from the norm, causes distress to the person, imposes some type of dysfunction to the person, and presents a clear danger to the person or others (McRay, B., et al., 2016).   Differing schools of thought look to classify pathologies into different categories and emphasize one over others, but the reality is pathology has very complex origins in mental health.  The DSM-5-TR, proceeds just etiology but looks to diagnose according a symptom based approach.  This empirical approach looks at the manifestations of certain symptoms of individuals based off of case studies and empirical data.  Mental Health Care professionals can then properly identify symptoms based on severity and frequency to determine a prognosis.

Mental Healthcare professionals utilize the clinical interview and a broad range of assessments to come to diagnostic conclusions paired with the DSM-5-TR.  These assessments involve personality tests that act more as a wide reaching net or funnel that proceeds from more general to more individual questions as the presenting problem becomes more evident in the search (Barlow, D., et. al,  2023).  These assessments include wide ranger personality tests, as well as more narrowing assessments on a particular type of issue.  Including also are usually physical exams by the primary health provider to rule out mental disorders with origins due to physical conditions, such as thyroid, cancer, or other physical illness that portray mental symptoms.  Cat scans and MRI’s are also utilized to give the provider the necessary biological information about the brain and how it is functioning (Barlow, D. et. al. 2023).  The DSM-5-Tr discusses in particular the wide range cross cutting symptom measure and its broad range of questions.  Also frequently used is the Minnesota Multiphasic Personal Inventory test.

Please also review AIHCP’s blog on Clinical Interviewing and Assessments.  Click here.

Classifying and Etiology of Mental Disorders

Since mental health is so complex, the root cause of a particular disorder is a complex thing to understand.  There are biological, psychological, spiritual and sociocultural models to consider in mental health (McRay, B. , et. al,, 2016). Biological factors include the brain, neurotransmitters, the nervous system and genetics itself.  When parts of the brain are not operating properly, or due to injury, or not not properly formed or developed, then psychopathologies can occur in how the person sees and reacts with the world.  When neurotransmitters such as dopamine, serotonin, glutamate, norepinephrine or GABBA are not properly transferring or in lack of proper doses and balances then an array of symptoms and cases of anxiety and depression can occur (Barlow, D., et. al,  2023).  The nervous system as well, especially within the autonomic branch which encompasses both the sympathetic and parasympathetic can play key roles in how a person emotionally and mentally reacts to problems.  Trauma and PTSD is closely tied to the activation to these systems.  In addition, certain genes can carry powerful predispositions to certain behavioral traits and some can become activated in life.  Sometimes a combination of these biological issues tied to other elements lead to an overflow to the system.  The diathesis-stress model points how genetic vulnerability tied to life events and stressors can be the causing and tipping point in when a person develops the disorder and it manifest (Barlow, D., et. al,  2023).

In addition to biological, psychological issues look to the multidimensional history of psychotherapy and its numerous founders of different schools to explain pathology.  Psychoanalytic identifies pathology as unresolved subconscious issues that can re-emerge in life.  Behaviorism looks at conditioned and unconditioned response and how one thinks, and feels in regard to behavior itself.  Human Centered approaches applies lack of self actualization as a big component leading to various pathologies.  Emotion, behavior, and the subconscious play key roles, but especially when tied to biological factors.  Fortunately, towards the later part of the 20th Century, psychology turned to utilizing many pharmacological medications based in the school of biological factors to supplement care beyond mere therapy and talk.

Spiritual issues can also cause psychological issues.  The spirituality of a person is at the center core of a person and goes beyond mere biological and psychological processes.  Spirituality grants one meaning in life.  Spirituality is tied to healthy coping but maladaptive spiritual practices can also lead to poor mental health.  Spirituality can also grant for some a true etiology for disease and illness.  Within Christianity, sin is seen as the source for humanity’s fall and pain.  It also does not dismiss the factor of vice and evil that can play a role in mental health and the effects bad habits and actions can have on a person’s wellbeing.  Many secular therapists dismiss right and wrong in psychotherapy.  While one cannot expect to diagnose and treat mental illness from a spiritual standpoint void of empirical data, it can help individuals understand in their view the origin and purpose of mental illness and bad things in the world.  It can grant an order to things.  Those without order and understanding of their existential reality can have harder times coping with life’s problems.  However, when religion and spirituality is misused it can lead to superstition, as well as dangerous views about life and reality that can harm the individuals self concept.

Sociocultural elements of a person’s family life, as well as culture and ethnic make up play key roles in how one behaves and feel mentally.  Family and social support, as well as a healthy self image lead to healthier outcomes as opposed to individuals who face poverty, discrimination, and poor diet.  Relationships and support are critical elements in completely understanding the origin and causes of various pathologies.  The sociocultural model also expresses the importance of healthy communication and conflict management (McRay, B. , et. al,, 2016).

The DSM-5-TR

The DSM-5 -TR lists numerous criteria and symptoms to classify pathology. Please also review AIHCP’s Behavioral Healthcare Certification Programs

The DSM-5-TR looks to diagnose based on the most empirical evidence available and understands the multidimensional models associated with the etiology of pathology.  While it strives to give the most empirical approach possible, bias can still exist in what is considered normal and abnormal according to spiritual and cultural status of a person.  It is hence important to be culturally aware.  For instance, individuals who believe in demons may associate an issue with the demonic.  This would not constitute psychosis for these types of individuals who may think something could be demonic in nature and not natural.  Whether real or not, it is not a psychosis for a believer to rationally think of such possibilities.   So what would constitute an insane possible explanation to an atheist may not be a pathological expression in a believer.  It is also important to understand the negative consequences of diagnosis when tied to labeling.  Mental health already has a severe stigma tied to it and it is important to differentiate the diagnosis from the person’s self identity.

In the diagnosis process, mental health care providers follow a standardized and empirical process of diagnosing a certain ailment.  The DSM-V-TR lists diagnostic criteria for any mental ailment and also has codes tied to the International Classification of Diseases (ICD) which was developed by the World Health Organization.  This is seen in its coding procedures that correlate with the ICD.  This helps tie the named mental disorder with the ICD code for purposes of consistency and also medical billing.   The DSM replaced the concept of mental disorder vs physical disorder to mental disorder vs general medical condition and how they can interact (DSM-5-RT).  A person will then receive in diagnosis the proper code.  The first day of diagnosis deals with the presenting problem and can be seen as the principle diagnosis with a possible provisional diagnosis if current information is insignificant.   The DSM-V-TR provides a section on diagnostic criteria, diagnostic features, associated features, development and course, risk and prognostic factors, differential diagnosis and comorbidity factors with each diagnosis.

With mental disorders, the diagnosis includes a broad range of issues that is ranked according to intensity and frequency much like other mental disorders found in the DSM-5-TR.  The DSM-5 lists a variety of domain names starting with domain 1 as depression, followed by anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts or behaviors, dissociation, personality function and substance abuse.  The threshold guide  of symptoms is between mild to greater but has full range from none, slight, mild, moderate, severe and highest.

Personality disorders include key questions regarding identity, self-direction, empathy and intimacy.  In regards to identity, does the person have a strong sense of self or a weak and distorted sense of self?  In regards to self-direction does the person have good goals and reachable aims or does the person have limited ability to function and meet goals and assess healthy vs unhealthy ones?  In regards to empathy, does the person have the ability to feel for others, or is that reduced, or limited or non-existent?  In regards to intimacy, is the personable to maintain and keep healthy relationships, or does the person fail to keep healthy relationships with others? These symptoms in personal life also fall under the level of personal functionality and differences vary according to the disorder as well as its severity

Personality disorders also possess certain domains based on severity as well as manifestation within certain disorders.

Negative Affectivity vs Emotional Stability looks at a persons’ negative range of emotions such as guilt, worry, shame, anger, as well as  emotional liability, anxiousness, separation insecurity, submissiveness, hostility, perseveration, depressivity, and suspiciousness.

Detachment vs extraversion looks at issues of avoidance, lack of interpersonal activities, withdrawl, intimacy avoidance, anhedonia, depressivity and suspiciousness.

Antagonism vs Agreeableness includes behaviors that are at odds with other people, manipulation, deceitfulness, grandiosity, attention seeking, hostility,  and callousness or lack of empathy

Disinhibition vs Conscientiousness lists irresponsibility, impulsivity, distractibility, risk taking and rigid perfectionism.

Finally, Psychoticism vs Lucidity includes  incongruent, odd or eccentric behaviors or cognitions, unusual beliefs or experiences, eccentricity, and cognitive and perceptual dysregulation.

Conclusion

Please also review AIHCP’s Healthcare certification programs and see if they match your academic and professional goals

Diagnosis regarding mental health is a tiered process with numerous multidimensional factors that need to be considered before diagnosis.  The DSM-5-TR supplies an empirical based catalogue based on symptoms to better narrow down a condition.  It is important to follow the interviews, assessments, and possible other physiological conditions before ruling on anything.  It is also important to understand the detrimental aspect of labeling someone and the care that needs to be done when helping someone with a condition as not to tie that individual’s identity with the pathology.

Remember as well, that only licensed mental health professionals can diagnose.  While many AIHCP members may have certifications in certain behavioral health domains, this does not constitute licensure.  Only certified members with AIHCP who are ALSO licensed can diagnose issues in grief, stress, and crisis.

Please also review AIHCP’s Behavioral Healthcare Certification which include grief counseling, crisis intervention, anger management, trauma informed care, stress management, and spiritual and Christian counseling programs.

References

Barlow, D, Durand, V.M., & Hofmann, S. (2023).  Psychopathology: An integrative approach to mental health (9th Ed). Cengage

DSM-5-TR. APA (2022).

McRay, B., Yarhouse, M., & Butman, E. (2016). Modern Psychopathologies: A comprehensive Christian appraisal (2nd, Ed). Intervarsity Press.

Additional Resources

DSM-5.  Cleveland Clinic. Access here

Casali, B. (2025). “How Mental Disorders are Assessed and Diagnosed”. MentalHealth.com.  Access here

7 Core Pathological Personality Traits. (2020). Psychology Today. Access here

What Is Considered Pathology in Psychology? (2025). BiologyInsights.com.  Access here

 

The Unspoken Nursing Skills of End-of-Life Conversations 

Posted on by Joseph Gerard

health care worker comforting a patientWritten by Marchelle Abrahams.

Some conversations are hard to have. And nothing can prepare you. Not a textbook. Not an online tutorial. Not a deep breath before delivering the bad news.

Once you have taken the Nurses’ Pledge of Service, talking to a patient about the end of their life is part of the package. Maybe you were warned how difficult it would be. Maybe you thought you’d cross that bridge when you got there.

The truth is that it doesn’t get easier. Sometimes the opposite. As long as you treat your patient and their family with dignity, the right words will form. Also, there are certain skills nobody has taught you until now.

Words Have Gravity

To you, words are something you speak to share information. An individual who doesn’t have the luxury of time can find comfort or hurt in them.

The journal Federal Practitioner published a paper titled The Meaning of Words and Why They Matter During End-of-Life Conversations several years ago. The advice still holds.

Author Grace Cullen goes into extensive detail on how essential effective communication is in healthcare delivery. However, misinterpretation can influence the quality of the care. 

The former palliative care nurse practitioner (NP) says that discussions must be handled with accuracy and precision. They must be conducted in a timely fashion and require skills that take practice to sharpen.

So, what are those skills?

With her years of experience, Cullen has learned that nurses don’t control how the conversation flows. 

“We approach patients with a blank canvas, open to receive messages that will be shared and reacted to accordingly.” – Grace Cullen, DNP, FNP-BC, ACHPN, AOCNP, RN-BC.

That’s why end-of-life (EOL) talks require compassion, an inherent human trait that isn’t taught in textbooks. Instead, it’s cultivated with training and application, advises Cullen.

Suggested Communication Phrases

Do not use medical terms. Talk in simple language and repeat the information. The truth should be gradually introduced to the patient.

Don’t leave families to their own devices. Offer administrative help, such as suggestions for hospice or palliative care. (Flugelman MY. How to talk with the family of a dying patient. BMJ Supportive & Palliative Care 2021;11:418-421.)

When speaking about advanced planning, Healthier Washington Collaboration Portal suggests the following:

  • What’s your understanding of your current situation?
  • If there ever came a time when you couldn’t make decisions for yourself, who would you trust to do that for you?
  • When you think about dying, have you thought about what the end would be like or how you would like it to be? 

Look to Mentors for Advice

You’ll probably get the best advice from your mentors. And yet, they’ll admit that no matter how many times you have the conversation, it still stings.

That’s why it’s important when finding a preceptor for a nurse practitioner to latch onto someone with years of experience in the EOL field. They can guide you on the best practices and share their wisdom on what works and what doesn’t.

In most cases, a nurse practitioner (NP) preceptor is a proficient clinician. They bridge the gap between classroom theory and real-world practice. In other words, you’re in good company.

ClickClinicals advises using professional NP preceptor matching services to ensure you’re matched with a preceptor aligned with your goals. They’re a sound option for nurse practitioner clinical placement help, and they’ll find you an NP preceptor fast.

Missed Opportunities for EOL Care Discussions

Timing is everything. Having the conversation too late can do more harm than good. A qualitative study published in the JAMA Network revealed a few insights. 

About 140 oncology patients were surveyed. Only 21 (5%) of encounters included EOL discussions. The study found that early EOL care preferences improve clinical outcomes. Unfortunately, most talks occur a month before death, despite most patients wanting information earlier.

Discussions about end-of-life care shouldn’t wait until a patient needs hospice, psychiatrist Natalie Jacobowski tells the Cleveland Clinic. She views it as counterintuitive.

Ask for permission to speak about the “what ifs” when starting treatment to prolong a patient’s life, advises Dr Jacobowski.

Create a Safe Space

Talking about someone’s imminent death is taboo, to say the least. It’s also uncomfortable and morbid.

A patient might not want to broach the topic, as it may appear weak or negative. Dr Jacobowski suggests taking your cue from them. Watch their body language. Acknowledge their fears. 

Take this as a step in the right direction. 

Frame the conversation as: “I imagine there are a lot of thoughts and worries. Is there anything that’s standing out to you that’s worrying you the most?”

That way, the patient will know you’ve created a safe space for them to voice their concerns.

Validate and Respond

Not every conversation goes according to script. Emotions are fraught. Anger. Sadness. Frustration. Grief. Patients are feeling them all at once.

Don’t gloss over their response and carry on like normal. Recognize their emotion and name it. For example: “I can see that this is incredibly difficult and upsetting to hear.”

Always lead the conversation, but also prioritize open-ended questions, because they’ll have many.

Validate their feelings. No judgment needed. Allow for silence. Remember, they’re only just processing the news. It takes time.

 

FAQs: End-of-Life Conversations in Clinical Practice 

  1. Why are end-of-life conversations delayed in healthcare settings?
    Many clinicians hesitate due to discomfort, fear of removing hope, or uncertainty about timing. 
  2. What is the most important communication skill during end-of-life discussions?
    Clarity paired with compassion. Using simple, non-medical language helps patients and families better understand and process the situation.
  3. How can clinicians create a safe space for these conversations?
    By asking open-ended questions, observing body language, and validating emotions without judgment.
  4. How do preceptors help nurse practitioners improve in end-of-life care?
    Experienced preceptors provide real-world exposure, model difficult conversations, and offer feedback that helps refine communication skills.

Key Statistics at a Glance 

Topic Finding Insight
EOL Discussions in Oncology Encounters  5% (21 out of 140 patients)  Very few clinical encounters include EOL discussions.
Timing of EOL Conversations  Often, within one month before death  Conversations are happening too late, limiting patient autonomy and preparedness. 
Patient Preferences  The majority prefer earlier discussions  Patients want transparency sooner, not at critical decline stages. 
Communication Risks  Misinterpretation affects care quality  Poor wording or unclear messaging can negatively influence patient understanding and care decisions. 

 

Parting Words

You chose to become an NP for a reason. And that reason is to care for and help people heal. Keep that in mind whenever sensitive patient discussions arise.

Lectures and textbooks can only teach so much. The rest is up to you. 

Whether you’re at the start or in the middle of this big, bold, beautiful journey called nursing, never forget why you are here.

References:

 

Author bio

Marchelle Abrahams is an award-winning writer (RDMA Awards 2019) who found her voice after carving a niche as a features writer for Independent Media. Currently, she freelances for various print and online publications, while ghost-writing blogs for several clients. 

 

 

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

When Should You Refer a Patient for DBS?

Posted on by Joseph Gerard

human brain illustrationWritten by Jameson Thorne,

Patients with serious neurological conditions are among the most vulnerable any healthcare team can encounter, and the outcomes of decision-making throughout their treatment balance on the thinnest margins because there’s so much at stake. And with Parkinson’s disease impacting more than a million people nationally, tens of thousands of major turning points in these cases crop up each year. As a result, medical professionals must be prepared to choose the right route forward, especially when that means moving from a medical management approach to one involving direct neurosurgical intervention.

Deep Brain Stimulation (DBS) is one option in this context, and because the conditions it addresses are time-sensitive, there’s an imperative to make the decision on intervention at a moment when the treatment will have the desired impact without the associated downsides outweighing the positives. Patient referrals for DBS treatment hinge on a number of symptoms and must also be made in light of a holistic picture of the individual’s health. Clinical teams currently in the dark about the correct approach need to stick around as we address this issue head-on and establish a framework for appropriate next steps.

Clinical Triggers In Parkinson’s Disease Management

In the first instance, clinicians seeking to determine whether a DBS referral is the right next step must keep the indicator of motor complications that aren’t responding to levodopa dosage and/or frequency changes front and center in mind. While this medication might prove efficacious for a protracted period, it’s still possible for dyskinesia to emerge, or for patients to experience periods of diminished responsiveness, in which case there’s a greater likelihood of additional interventions being required sooner rather than later. The good news is that the 5-2-1 rule for advanced Parkinson’s identification gives clinicians an unambiguous way to choose what to do next, as five doses of levodopa per day, two hours of off time, or one hour of dyskinesia should trigger an immediate evaluation.

Similarly, patients may have an appropriate ongoing response to levodopa that leads to positive outcomes, but suffer side effects that are less than desirable, to the point of being deleterious in other ways. Here, the decision to move on with a DBS referral is even simpler, as outcomes from this treatment will align with an individual’s optimal levodopa response, even if other symptoms remain unaffected. Problems with physical frailty, specifically regarding unsteadiness of gait, along with a marked decline in mental faculties, may not be alleviated, for instance.

Refractory tremor is the notable exception to the levodopa response rule. Many patients experience a persistent, high-amplitude tremor that remains socially or functionally debilitating despite optimal medical therapy. In these cases, DBS of the subthalamic nucleus (STN) or internal globus pallidus (GPi) can offer profound relief even when medication fails to suppress the involuntary movement.

Assessing Essential Tremor And Dystonia Benchmarks

Essential tremor (ET) often follows a different referral trajectory than Parkinson’s disease. Because ET is primarily a monosymptomatic disorder, the referral trigger is usually a self-reported loss of independence in activities of daily living, such as feeding, writing, or grooming. When a patient has failed at least two trials of first-line medications like propranolol or primidone, the conversation should shift toward surgical options.

Dystonia presents a more complex set of variables, particularly regarding the timing of intervention. For many forms of primary dystonia, earlier surgery is associated with superior long-term outcomes in neck and limb mobility compared to delaying intervention until fixed contractures develop. Because the brain’s neuroplasticity plays a role in its adaptation to stimulation, referring patients before their dystonic postures become permanent is vital for functional recovery.

  • A documented history of medication non-responsiveness or intolerable side effects
  • A clear impact on the patient’s ability to maintain employment or social engagement
  • The absence of significant cognitive impairment or untreated psychiatric instability

Comprehensive programs like the center for deep brain stimulation in Denver offer a streamlined intake process that integrates these clinical benchmarks into their initial screening. By utilizing a multidisciplinary team, these centers can quickly determine if the patient’s specific phenotype aligns with the known benefits of STN, GPi, or VIM nucleus stimulation.

The Role Of Neuropsychological Screening In Patient Safety

A successful DBS outcome is defined by more than just the reduction of a tremor. It requires preserving the patient’s cognitive and emotional well-being. This is why neuropsychological testing is a non-negotiable component of the pre-surgical workup. Patients with significant pre-existing dementia or severe, untreated depression are at a higher risk for poor postoperative outcomes and may experience a worsening of their cognitive status following electrode implantation.

Clinicians must look for red flags such as rapid cognitive decline, hallucinations that are not related to medication, or significant executive dysfunction. While mild cognitive impairment is not always an absolute contraindication, it does require a more cautious approach and a different target selection, such as prioritizing the GPi over the STN to minimize cognitive side effects.

Shared decision-making hinges on setting realistic expectations regarding what DBS can and cannot do. It is essential to communicate to the patient and their family that while DBS is transformative for motor symptoms, it is not a cure for the underlying neurodegenerative process. The goal is to “turn back the clock” on motor function, providing a period of improved stability and reduced medication burden.

Insurance Considerations And Collaborative Care Workflows

Navigating the logistical hurdles of a DBS referral requires a clear understanding of the documentation needed for insurance approval. Most payers, including Medicare, require documented evidence that the patient has tried and failed appropriate medical therapies. Clear charting that details the specific “off” time, the frequency of dyskinesia, and the functional limitations caused by the tremor will significantly expedite the prior authorization process.

The relationship between the referring neurologist and the neurosurgical team should be collaborative rather than transactional. A transparent communication loop ensures that the patient’s long-term programming and medication adjustments are managed cohesively. Many high-volume centers give the referring physician detailed intraoperative data and postoperative programming parameters to ensure continuity of care.

Referrals should ideally happen when the patient is still in a relatively stable phase of their disease. Referring too late can mean that the patient has developed “red flag” symptoms like significant dysphagia, frequent falls that are non-responsive to medication, or severe postural instability. These symptoms are rarely improved by DBS and can sometimes be exacerbated by the procedure if not managed carefully.

Implementing A Referral Checklist For Clinical Teams

To ensure no patient misses their window of opportunity, clinical teams should adopt a standardized screening tool. This prevents the “wait and see” approach that often leads to suboptimal outcomes. A quick review of the patient’s medication log and a brief discussion about their quality of life can often reveal hidden motor fluctuations that the patient may have adapted to or failed to report.

When discussing the referral with the patient, emphasize that an evaluation is not a commitment to surgery. It is a consultation to gather data and explore options. Many patients harbor outdated fears about “brain surgery” and may be relieved to learn about the minimally invasive nature of modern stereotactic techniques and the availability of rechargeable or remote programming options.

The inclusion of the family in these discussions is paramount. Since the patient may not always be the best judge of their own “off” periods or cognitive shifts, the observations of a spouse or caregiver give important context for the surgical team. This holistic view ensures that the surgical plan is tailored to the patient’s actual lived experience rather than just their clinical presentation during a brief office visit.

Navigating The Postoperative Integration Period

Once the hardware is implanted, the focus shifts to the programming phase. This is an iterative process that requires patience from both the clinician and the patient.

During the first few months, medication doses are typically tapered as the stimulation is optimized. This “washout” period can be challenging as the brain adapts to the new electrical environment, but it is necessary to find the most efficient stimulation parameters.

The referring neurologist often remains the primary point of contact for the patient’s overall neurological health. Understanding how to troubleshoot basic issues, such as identifying when a battery is low or recognizing signs of infection at the pulse generator site, enables the local care team to offer higher-level support. This integrated approach reduces the patient’s burden of traveling back and forth to the surgical center for minor concerns.

Ongoing education for the clinical staff on the latest advancements in directional leads and sensing technology (such as BrainSense) is also beneficial. These newer technologies enable more precise steering of the electrical field, which can help mitigate side effects such as speech or gait disturbances that were more common with older, omnidirectional electrodes.

Future Directions In Neuromodulation Referral Patterns

As our understanding of brain circuitry expands, the indications for DBS are likely to grow. We are already seeing increased interest in using DBS for refractory obsessive-compulsive disorder and certain types of epilepsy. For the movement disorder specialist, this means staying abreast of the evolving practice advisories from the American Academy of Neurology regarding new targets and patient populations.

The trend is clearly moving toward earlier intervention. Waiting for total disability is no longer the standard of care. By shifting the paradigm toward proactive neuromodulation, we can offer patients a significantly higher quality of life during their most active years. This requires a vigilant, informed, and courageous approach to patient advocacy from every member of the healthcare team.

If you are interested in exploring more about the practical applications of neurotechnology in clinical practice, I recommend reviewing clinical briefs on advanced programming techniques and patient selection for spinal cord stimulation.

Author Bio

Jameson Thorne is a clinical consultant and senior medical writer with over fifteen years of experience in the neurosurgical and neuromodulation space. He specializes in bridging the communication gap between specialized surgical centers and primary care networks to improve patient access to advanced therapies.

References

American Academy of Neurology. (2020). Guideline for Treatment of Early Parkinson’s Disease. https://www.aan.com/PressRoom/Home/PressRelease/4936  

Patricia Krause MD, Philipp Mahlknecht MD, PhD, et al (2025). Long-Term Outcomes on Pallidal Neurostimulation for Dystonia: A Controlled, Prospective 10-Year Follow-Up. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.30130

Santos-García, T. de Deus Fonticoba, E. Suárez Castro, A. Aneiros Díaz, D. McAfee, (2020) 5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson’s Treatment. https://onlinelibrary.wiley.com/doi/10.1155/2020/7537924

 

 

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