Integrating Recognition into Healthcare Retention Strategies for High-Turnover Clinical Roles

Posted on by Joseph Gerard

Doctors standing together

Written by Angela Rivera,

If you manage clinical teams, you already know how hard it is to not only attract the right talent but, perhaps more importantly, how hard it is to keep the great ones. This is a problem for two reasons, both of which you’re also likely familiar with, but it bears repeating: turnover is both expensive and bad for team morale.

So the question is, what, if anything, can be done to retain healthcare workers, especially in high-turnover clinical roles? The good news is, there is plenty you can do, and we’ll give you several recognition strategies for employee retention, but before you apply any, it’s crucial to understand why this happens in the first place.

Next, you need a solid, science-backed retention model that actually fits the realities of modern healthcare work. We give you both in this article: the theory, yes, because it helps to know the statistics and research, but also concrete retention tactics.

Why Retention in Healthcare Is Essential

Retention is obviously a big budget issue. Losing an employee, even one with moderate tenure, means the organization has to pay first for recruiting costs and then for onboarding time. But that’s only a part of the financial problem; the organization typically also needs to pay extra overtime for colleagues who have to step in until the new employee is ready. And that time until the employee is actually ready also means there is a drop in Another thing that matters but is often ignored is the drop in quality of service; over-worked employees cannot give their best, naturally.

According to industry analyses, a single RN resignation can cost an organization tens of thousands of dollars (up to $61,000 according to the linked report)  in replacement and productivity loss. That is a lot, and only for one employee. When that keeps happening over and over again, the financial impact is often so big, it can devastate an organization. Clinical support roles do cost less per departure but since they churn far more frequently, their cumulative impact is enormous as well.

However, the extra costs, enormous as they can be (depending on how bad the turnover is_, are only a part of the problem when you look at it from a bird’s perspective. Staff who stay longer build not only better clinical intuition and the ability to remain calm under pressure, but they also build familiarity with patients. This combination allows them to become true experts in their fields, and both patients and their colleagues benefit from this.

Why Retention Is So Hard in High-Turnover Clinical Roles

Burnout is notoriously high in the healthcare sector, and while that is not news to anyone in the field, what may be is the sharp jump in recent years. Since COVID, the annual rates have climbed into the 30% range, even nearing 40% range.

Those are alarming numbers. While the dissatisfaction and overwhelmingness are sometimes the fault of organizations (poor management, poor relationships, etc.), there’s no denying that even well-run institutions struggle to retain staff. Why is that? There are several reasons, with the most common being:

1. High emotional strain without adequate recovery

Nursing assistants and behavioral-health technicians often have intense emotional interactions daily and while many can detach (as best as they can), it’s not possible to not absorb any of that emotional content and that takes a toll. Over time, many describe a sense of emotional depletion not only at work, but even when they leave. When that becomes routine, the exit often becomes inevitable.

2. Fragmented work and nonstop task switching

Going from one micro-task to another (vital signs, transport, stocking, discharges, etc.) is an everyday work for support roles. But this kind of work, while necessary and unavoidable to a degree, also takes a mental toll on a person. None of these tasks is overwhelming individually, but when combined, they create nonstop cognitive fragmentation, and as a result, exhaustion.

3. Little to no voice in decisions

Healthcare workers across all roles, including support, want at least some input in decisions that affect their daily work, be it workflow changes, assignments, or equipment choices. When changes arrive without explanation or, equally bad, without any opportunity for feedback, employees tend to feel invisible. This is a recipe for disengagement and is exactly the opposite of what you want if the goal is job embeddedness.

4. Schedules that leave little time for life outside work

Unpredictability is a part of the healthcare work package and your employees are aware of that. However, while some unpredictable shifts are unavoidable, frequent last-minute changes or too rigid scheduling structures are not. And they can push people out faster than pay alone. For staff who have children or are caring for aging family members, in particular, stability and flexibility often matter more than incremental wage increases.

5. Recognition is sporadic or absent

Most employees don’t expect to be constantly praised, but when they give it their best, everyone should be recognized and praised. It’s the key to job satisfaction. On the flip side of this, when effort goes unnoticed most of the time, job embeddedness weakens. The same thing tends to happen when recognition is too generic; there are effective ways to do this (more on this below).

Understanding the Problem Through Job Embeddedness and Retention Economics

With common reasons for high turnover out of the way, let’s look at the reasons why employees choose to stay at organizations. For this, we’ll use job embeddedness theory, which highlights three clusters:

  • Fit: This element asks whether the role actually aligns with the employee’s identity and their vision of their future. In other words, do they see themselves here long-term (ideally, fulfilled).
  • Links: This reflects relationships at work, including with coworkers, supervisors and patients. It includes routines, too. Who relies on the employee, and who do they have to rely on?
  • Sacrifice: Finally, sacrifice refers to what an employee would lose by leaving. When schedules are too chaotic or alternatively, too rigid, or recognition is absent or inconsistent, or there is little to no opportunity for advancement, the perceived sacrifice stays low.

Note that for clinical support roles, “fit” is often underdeveloped not just because of the nature of work (demanding, low pay) but also because many see the role as a stepping stone. “Links” can vary quite dramatically depending on unit culture, and how managers communicate, and shifts play a big role, too. The “sacrifice” element is self-explanatory: it’s weak if schedules are always chaotic or relationships feel purely transactional, but high if there’s stability and flexibility and relationships feel more authentic.

Retention Tactics That Reflect Real Human Experience

Turnover among CNAs, MAs, home health aides, and behavioral health technicians differs from RN or physician turnover in several important ways, the most important ones being:

  • Emotional labor tends to be higher but formal recognition low,
  • Compensation and benefits are often modest,
  • Staffing shortages are common, which creates a sense of constant urgency,
  • There is limited career advancement.

How do you fix all of these (or at least most)? With retention strategies that reflect both evidence and the daily reality of clinical work.

1. Consistent, Authentic Recognition

Generic praise does very little. If the goal is to increase the “fit” and “link” elements, it needs to be more targeted and authentic. So, instead of a general “good job today,” it’s better to say something concrete and tied to their real effort to show you’re truly seen them.

Some teams respond well when recognition includes something small and tangible, especially when it’s paired with a personal note that explains why their contribution mattered. As long as the gift is ethical and simple, it can mean a lot and increase job satisfaction. If you don’t know what to give a remarkable employee, check out companies like Successories that curate thoughtful employee gifts for staff. 

There are plenty of options but it’s best to get something you know (or at least have a hunch) the employee likes or could use.

2. Achievable micro-career pathways

Like any other role, support staff want attainable career progression, not a distant career ladder that requires two degrees they can’t pursue right now to climb. Short, stackable credentials tied to clear pay steps and defined competencies are ideal for this.

In short, you want to provide opportunities for small wins. These are what help build confidence, engagement, and loyalty. They also increase job embeddedness.

3. Scheduling that respects life outside work

Schedules should be fair and as predictable as possible, and designed protect sleep and family obligations. Even something simple like rotating holidays fairly or offering core hours, shows respect for employees. Flexible schedules (where possible, of course) tend to reduce turnover rates as they allow for more time for personal life.

Staff tend to be candid about this: “If I can plan my life, I’ll stay longer.” Maybe not to leaders directly, but this is absolutely what they think and often talk about to each other.

4. Emotional support embedded into culture

Occasional perks help, but burnout cannot be solved by them alone. To truly ease:

  •         Staff should routinely get debrief time after critical incidents,
  • Leaders need to openly talk about their own stress and coping mechanisms,
  • Mental health resources should be easy to access without stigma,
  • And units should normalize checking in on each other.

5. Relational management and high-visibility leadership

Regardless of profession, employees tend to feel more valued when they feel their superiors, especially managers, know them; it’s simple human psychology. This goes even for companies that pay higher-than-average salaries, but is even more important for the healthcare sector, where pay tends to be lower and expectations higher.

But knowing your staff should go beyond the superficial way in order to count for retention. No, you don’t need to become best friends with everyone, but your relationship should show that you see their strengths and pressures. And, equally important, that you appreciate them for it. Again, words of encouragement, some work flexibility (so they have more time for their personal life where possible) and even modest gifts from time to time can go a long way here.

6. Peer recognition systems that give everyone a voice

Peer-nominated micro-awards can also make the workplace more positive and therefore increase job satisfaction. These should highlight contributions leaders may never witness.

This is particularly important for night-shift teams who usually receive the least direct visibility.

Measuring Retention Impact

When you apply some of these suggestions, you want to take time to actually measure their impact. Organizations are different and so are units, so what works great for one may prove to be inefficient for another.

So, after some time (ideally several months up to a year but not sooner than that), use both quantitative and qualitative indicators to measure things like:

  • Turnover rates,
  • Orientation completion rates,
  • Overtime usage,
  • Patient experience scores,
  • Pulse survey items on trust, recognition, and intent to stay,
  • And sentiment trends in open-text survey responses.

The qualitative feedback often contains your best insights. When you start getting feedback like “feeling appreciated,” “feeling safe and supported,” or “experiencing better teamwork,” retention improvements usually follow.

References

Becker’s Hospital Review. (2025, May 28). The cost of nurse turnover: 5 things ASCs need to know. Becker’s ASC.

Mohr, D. C., Elnahal, S., Marks, M. L., Derickson, R., & Osatuke, K. (2025). Burnout trends among US health care workers. JAMA Network Open, 8(4), e255954.

NSI Nursing Solutions. (2025). 2025 NSI National Health Care Retention & RN Staffing Report – Quick Reference Guide. NSI.

Psychology Today. (2024, June 6). Why appreciation from management matters.

TrustedHealth Works. (2023). Understanding and addressing nurse turnover.

 

Author Bio

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

 

 

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

The Soul of Care: What is Holistic Nursing?

Posted on by Mark Moran

 

I. Introduction

In recent years, the concept of holistic nursing has emerged as a pivotal approach within the healthcare landscape, emphasizing the interconnectedness of body, mind, and spirit in patient care. Holistic nursing transcends traditional medical practices by recognizing patients as complete beings rather than mere recipients of treatments. This comprehensive perspective fosters an environment where emotional and spiritual needs are acknowledged alongside physical ailments, thereby enhancing overall well-being. By integrating holistic principles, nurses can cultivate deeper relationships with their patients, leading to more effective and empathetic care. The practice is not merely a set of techniques; rather, it embodies a philosophy that encompasses compassionate presence, active listening, and individualized care strategies tailored to the unique circumstances of each patient . As such, understanding the essence of holistic nursing is essential for healthcare professionals aiming to provide impactful, person-centered care (2009).

Please also review AIHCP’s program in Holistic Nursing to become a certified Holistic Nurse

Please review AIHCP’s Holistic and Integrated Health Care Certification

 

A. Definition of holistic nursing

Holistic nursing represents an approach to health care that emphasizes the interconnectedness of mind, body, and spirit in the healing process. This philosophy extends beyond traditional medical practices, recognizing that a patient’s emotional, social, and spiritual needs are equally vital to their overall well-being. Holistic nurses advocate for patient-centered care that respects individual values and preferences while promoting health in a comprehensive manner. By integrating various therapeutic modalities, such as art therapy and guided imagery, holistic nursing seeks to empower patients in their journey towards health and wellness. This comprehensive framework not only addresses physical symptoms but also considers lifestyle factors, personal beliefs, and cultural contexts that influence an individual’s health experience. As such, holistic nursing challenges conventional paradigms by urging practitioners to foster deeper connections with their patients, ultimately enriching the practice of care itself (Smith MJ et al., 2015-02-20).

 

B. Importance of holistic approaches in healthcare

In recent years, holistic approaches have gained prominence in healthcare, emphasizing the interconnectedness of the mind, body, and spirit in promoting overall well-being. This comprehensive perspective is crucial, as it recognizes that patients are not merely recipients of care but individuals with unique experiences, emotions, and social contexts that influence their health outcomes. By addressing psychological, emotional, and spiritual needs alongside physical ailments, holistic nursing fosters a more personalized and compassionate care model. Furthermore, such an approach can enhance patient satisfaction, engagement, and adherence to treatment plans, thereby improving recovery rates and fostering long-term health. Studies have shown that holistic practices, including mindfulness, nutrition, and alternative therapies, significantly contribute to the efficacy of traditional medical treatments . This integration of holistic principles into healthcare practice not only facilitates disease management but also nurtures a culture of empathy and respect in the patient-provider relationship (Ross L et al., 2025-05-23).

 

C. Overview of the essay structure

In establishing a comprehensive exploration of holistic nursing within The Soul of Care: What is Holistic Nursing?, a clear and structured essay format is indispensable. The introductory section will lay the groundwork by defining holistic nursing and articulating its significance in contemporary healthcare. Following this, the body will be divided into subsections that delve into the key principles of holistic care, the role of triad leadership in promoting collaborative practices, and the integration of teaching methodologies for healthcare professionals. For instance, (Hill J et al., 2025) highlights how triad leadership cultivates an environment conducive to patient-centered care, thereby enhancing holistic approaches in nursing. Additionally, the examination of educational frameworks aimed at improving teaching skills among medical professionals underscores the necessity of effective communication in holistic practices, as suggested by (Darwin A et al., 2025). Ultimately, the conclusion will synthesize the insights gathered, reaffirming the value of holistic nursing in delivering compassionate care.

 

II. Historical Context of Holistic Nursing

The historical context of holistic nursing reflects a confluence of ancient practices and modern-day healthcare philosophies, emphasizing the significance of treating the patient as a whole rather than merely addressing symptoms. Historically, various cultures, including Indigenous communities, embraced holistic approaches that acknowledged the interconnectedness of mind, body, and spirit in health and healing . The formalization of holistic nursing as a practice began in the late 20th century, spurred by a growing recognition of the limitations of conventional biomedical models in promoting comprehensive patient care. Prominent figures such as Florence Nightingale laid the groundwork by advocating for a healing environment and the importance of the caregiver-patient relationship (Jones & Publishers B). This evolution has led to the integration of holistic principles into nursing curricula and practice, reinforcing the idea that empathetic, patient-centered care is foundational to effective nursing. Such advancements reflect an enduring commitment to nurturing the inherent dignity of each individual.

Holistic Nursing is important in treating the whole person. Please review AIHCP’s Holistic Nursing Certification

 

A. Origins of holistic nursing practices

The origins of holistic nursing practices can be traced back to ancient healing traditions that recognized the interconnectedness of body, mind, and spirit. Early practitioners, such as those in traditional Chinese medicine and Ayurveda, emphasized the importance of treating the whole person rather than merely addressing symptoms. These philosophies laid the groundwork for holistic approaches by fostering an understanding that emotional and spiritual well-being significantly influence physical health. In the 20th century, the emergence of holistic nursing as a formal discipline occurred alongside the evolution of patient-centered care models. Pioneering figures, such as Florence Nightingale, advocated for a more integrative approach to nursing that considered patients environmental, physical, and emotional contexts. This historical foundation has increasingly gained recognition, reflecting a shift in healthcare paradigms towards a more comprehensive and compassionate understanding of patient care (Alligood MR, 2021-07-23).

 

B. Evolution of nursing philosophies

The evolution of nursing philosophies has significantly shaped the practice of holistic nursing, emphasizing the importance of understanding a patients lived experiences beyond mere diagnostic labels. This shift reflects a philosophical commitment to interpretive phenomenology, which seeks to explore the essence of patient care through authentic engagement with their narratives. By recognizing how societal stigmas can limit empathetic care, nurses are encouraged to approach patients with a framework that prioritizes holistic well-being. Moreover, as the profession grapples with the demands of Diversity, Equity, and Inclusion, the introduction of the C.A.R.E. Framework underscores the need for a values-driven approach rooted in advocacy and social justice. By melding these evolving philosophies, nursing practice can transition towards a more comprehensive model, ultimately enhancing patient outcomes and reaffirming the professions dedication to caring as an ethical and human-centered practice (Doucette N et al., 2025), (Campbell S et al., 2025).

 

C. Key figures and movements in holistic nursing

Holistic nursing, an evolving field, has been significantly shaped by key figures and movements that promote a comprehensive framework for patient care. Pioneers such as Florence Nightingale laid the groundwork for holistic principles by emphasizing the importance of the environment and emotional well-being in nursing practice. Further advancements were made in the 1970s and 1980s when the holistic nursing movement began to gain momentum, largely due to the work of nurses like Dr. Jean Watson, who formulated the Theory of Human Caring, highlighting the interconnectedness of mind, body, and spirit in health. The emergence of organizations such as the American Holistic Nurses Association has formalized and expanded the practice, advocating for educational standards and ethical guidelines that address the multifaceted nature of health and wellness (Margaret A Burkhardt et al., 2024-06-07). Through these contributions, holistic nursing has matured into a discipline dedicated to fostering healing relationships that honor the whole person.

 

III. Principles of Holistic Nursing

At the core of holistic nursing lies a set of principles that prioritize the interconnectedness of the body, mind, and spirit in the healing process. Holistic nurses embrace a person-centered approach, recognizing that each patient is a unique individual with diverse experiences, beliefs, and needs that must be addressed in the care plan. This perspective emphasizes the importance of creating a therapeutic relationship, fostering open communication, and practicing empathy to support patients emotional and psychological well-being alongside their physical health. Moreover, holistic nursing incorporates complimentary therapies, such as mindfulness, nutrition, and physical activity, to promote overall wellness and balance within the individual. By understanding the intricate relationships between various aspects of health, holistic nurses strive to empower patients, guiding them toward self-care and resilience while acknowledging the complexities and nuances of their healing journeys (Ruth F Craven et al., 2019-12-26). This comprehensive approach underscores the essence of holistic nursing as the soul of care.

Please also review AIHCP’s Holistic Nursing Certification

 

A. The mind-body-spirit connection

Holistic nursing fundamentally recognizes the profound relationship between the mind, body, and spirit, emphasizing that these components must be in harmony for optimal health and wellness. This integrated approach draws from ancient philosophical teachings, notably within Indian traditions, where practices such as meditation and yoga are instrumental in fostering this connection. Through these practices, individuals often discover that true wellness emanates from a balance among their mental, physical, and spiritual states (Thakur DK, 2025). Furthermore, contemporary research supports the notion that addressing these interconnected facets is crucial for mental health, as holistic interventions have demonstrated statistically significant improvements in patient outcomes compared to traditional methods (Kaushik D et al., 2024). Thus, the mind-body-spirit connection serves not only as a foundational principle of holistic nursing but also as a transformative framework that challenges reductionist views of health care, promoting a more comprehensive understanding of well-being and patient care.

 

B. Patient-centered care and individualized treatment

Patient-centered care (PCC) and individualized treatment are central to holistic nursing. This model addresses the diverse needs of patients and prioritizes their unique preferences and values. The interaction builds deeper engagement between healthcare providers and patients. It creates a space where individuals can openly discuss their health concerns and goals. Research in interventional oncology shows the effectiveness of PCC. It improves patient satisfaction and emotional well-being through custom treatment strategies, clear communication, and shared decisions (Devora L Stone et al., 2025). A sexuality education program for older adults showed major gains in sexual knowledge and self-efficacy. This result proves the value of addressing specific age-related concerns (B S Diggle-Fox et al., 2026). Holistic nursing uses these principles to build a responsive healthcare system. It honors the whole person and supports overall well-being.

 

C. The role of environment in healing

The environment profoundly influences the healing process. This setting is central to holistic nursing practices. A caring environment supports emotional and physical well-being. It helps patients feel safe and protected during their recovery. Elements like natural light, plants, and calm colors create a serene atmosphere. This atmosphere reduces stress and anxiety levels. The result is better health for patients. Sound is another factor. It serves as a tool for healing or a source of irritation. This fact requires mindful attention to the acoustic environment in healthcare settings (Douglas A Wengell et al., 2008). Holistic nursing designs spaces for comfort and peace. This approach meets immediate medical needs. It also supports emotional and spiritual health. A healing environment helps individuals begin their recovery. This practice represents the core principles of holistic care.

 

IV. Holistic Nursing Practices

Holistic nursing practices use a complete method for patient care. This moves beyond standard models and looks at physical, emotional, social, and spiritual health. This view helps providers connect deeply with patients. They see that illness affects the mind and spirit, not just the body. Holistic nurses use active listening, empathy, and kindness. They adjust care to fit the specific needs and wants of each patient (Dossey BM et al., 2015-05-23). These practices often include extra therapies like mindfulness, nutrition, and physical activity. These habits support well-being. The main goal is treating the whole person instead of just symptoms. This improves care quality. It helps patients heal and learn about themselves.

Holistic Nursing is becoming more mainstream as individuals look for multiple modalities for healing yet also need expert guidance

 

A. Integrative therapies and their applications

Holistic nursing pays new attention to integrative therapies. These methods come from ancient healing practices. They focus on the connection between mind, body, and spirit. Daivavyapashraya Chikitsa is a key example of this approach. This Ayurvedic model uses spiritual therapies like mantra chanting and sacred rituals. These practices support mental health and emotional strength. This model treats common mental health problems. It offers a path that works with standard medical treatments (Dr. Pareek A et al., 2025). Digital health technologies also offer new opportunities for holistic nursing. Mobile apps and telehealth services make care more personal and accessible. These new tools help build deeper relationships between patients and nurses. They keep the main goals of integrative care strong even with advanced technology (Swain M et al., 2025). Holistic nursing grows by mixing traditional wisdom with modern tools. This mix meets many patient needs. It also confirms that compassionate care remains the priority.

 

B. Communication techniques in holistic nursing

Holistic nursing requires effective communication techniques to build a compassionate and empathetic environment. These methods involve more than verbal exchanges. They include active listening, nonverbal cues, and attention to patient emotions. Nurses use tools like the NURSE model to improve empathy. This builds rapport and trust with patients and their families. Experiential learning strategies also strengthen these skills in nursing education. Simulation-based scenarios show that emotional intelligence is central to holistic care (Reis TH da Silva, 2025). Collaboration is required as well. Nurses coordinate care across disciplines to meet the many needs of patients. This integration helps patients have a full dialogue about their health. Such conversations assist with chronic pain management and well-being (Alsamti AI¹ et al., 2025). These communication techniques define holistic nursing and support patient-centered care.

 

C. The importance of self-care for nurses

Nursing is a demanding field. Self-care is crucial because it directly affects the quality of care patients receive. Holistic nursing recognizes that nurses must care for their own physical, emotional, and spiritual health first. They do this to support their patients well. Self-care lowers the risk of burnout. It also helps the nurse give compassionate and empathetic care. Research shows that nurses like their jobs more when they look after their own well-being. Patient outcomes improve too. This proves a link between nurse health and patient care. Spiritual care helps build emotional resilience in holistic nursing. It reduces depressive symptoms among caregivers. Putting self-care first fits with Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. These ideas show the strong connection between personal health and professional success (Yeh C-T et al., 2025), (Muhammad T, 2024).

V. Conclusion

Holistic nursing uses a complete approach to healthcare that connects the mind, body, and spirit. This method builds a deeper sense of compassion in caregivers and improves patient well-being. Recent studies show that nursing students, such as those in Indonesia, report good self-care habits. They succeed in emotional and spiritual areas, but they also note a need for better physical self-care techniques (Damayanti MR et al., 2025). Including creative arts in nursing education also helps students understand holistic care. This training encourages spiritual discovery and moral values like mercy and compassion (N/A, 2025). Focusing on these different parts of holistic nursing prepares future nurses to give empathetic care. It also helps them care for themselves, which creates a continuous cycle of wellness in healthcare settings. Building a holistic nursing system is necessary to improve both the practice of nursing and patient results.

Please also review AIHCP’s Holistic Nursing Program
Please also review AIHCP’s Holistic Nursing Certification and see if it meets your academic and professional goals.

 

A. Summary of key points

We finish our review of holistic nursing. Several key points show its nature and value in modern healthcare. This care connects the mind, body, and spirit. It treats patients as whole individuals, and it does not just fix physical problems. This view helps build meaningful relationships between nurses and patients. These bonds improve trust and treatment results. The practice also asks for personal care plans. These plans account for unique experiences, culture, and beliefs. Such factors affect health results (Peate I et al., 2022-07-18). The field also promotes self-care for practitioners. Nurses must watch their own well-being to support others. These steps improve patient satisfaction. They help create a compassionate and empathetic healthcare setting. This confirms that every part of a patient’s life affects their health and healing.

 

B. The future of holistic nursing in healthcare

The healthcare field changes constantly. The future of holistic nursing will integrate comprehensive care models. These models address the many needs of patients. Holistic nursing emphasizes the physical aspect of health. It also includes emotional, spiritual, and social dimensions. This focus reflects a move toward patient-centered practices. Providers prioritize well-being over simple symptom management. Recognition of the limits of traditional biomedical methods drives this change. This is true for chronic disease management. A deep understanding of the patient’s experience is crucial there. Technology also helps. Telehealth and digital health tools allow nurses to provide holistic care remotely. These tools support ongoing connections with patients (Eliopoulos C, 2013-05-24). Holistic nursing gains prominence. It may lead to improved health outcomes and greater patient satisfaction. The practice redefines the nature of care in modern settings.

 

C. Final thoughts on the impact of holistic nursing on patient care

Adding holistic nursing to patient care changes the process. It improves physical and psychological well-being. The InterStellar framework focuses on patient safety. It shows that a holistic quality improvement model greatly reduces mortality rates. It also raises the quality of care in hemodialysis settings (Palencia H et al., 2025). The extended care model for breast cancer patients also proves the value of this method. Holistic nursing lowers anxiety and depression. This helps patients manage themselves and improves their quality of life (Liang W et al., 2025). These findings show that holistic nursing tracks more than just standard medical numbers. It builds a compassionate connection between healthcare providers and patients. Adopting a holistic nursing philosophy leads to complete care. It meets the needs of the whole person. This fulfills the essence of providing care from

Additional Blogs

The Art of Holistic Nursing: Access here

Additional Resources

“How Holistic Medicine Complements Modern Science” (2025). Science News Today.  Access here

Wisner, W. (2025). “Understanding Holistic Health: Types and Benefits”. Health.  Access here

“The Benefits of Holistic Medicine: Supporting Mind, Body, and Spirit”. (2025). AANMC.  Access here

Marks, H. (2025). “What Is Holistic Medicine and How Does It Work?”. WebMed.  Access here

How Clinicians Assess Plantar Heel Pain Efficiently

Posted on by Joseph Gerard

Shot of confident young female doctor reviewing the patient's medical history on her digital tablet while standing in the consultation.Written by Harry Wolf,

Plantar heel pain… When clinicians evaluate this, they rely on structured assessment methods to identify symptom patterns, determine underlying causes, and guide effective treatment. 

By combining patient history, physical examination, functional testing, and selective imaging, practitioners can accurately differentiate plantar fasciopathy from other conditions – and develop targeted management strategies.

Clinical Interviews and Patient History

A thorough clinical interview is one of the most efficient ways in which clinicians begin evaluating a patient’s plantar pain. It is foundational to building a clear diagnostic pathway. 

This step allows clinicians to collect information that reveals:

  • Symptom characteristics.
  • Functional limitations.
  • Potential contributing factors. 

In settings that prioritize accuracy and efficiency, gathering patient history early on ensures that later assessments are targeted and relevant. Thus, the need for unnecessary testing or redundant procedures is reduced.

Asking Questions

Clinicians typically begin by having the patient describe the onset and progression of their heel pain. 

(As you may know: plantar fasciopathy commonly develops gradually.) 

Many patients report that their symptoms began after an increase in:

  • Standing time.
  • Walking distance.
  • Repetitive impact activities. 

Understanding whether the symptoms emerged suddenly or progressively helps clinicians distinguish between soft tissue irritation, structural injury, and conditions that may have systemic origins. 

And patients are often asked to describe specific behaviors of their symptoms throughout the day. 

The classic morning pain pattern associated with plantar fasciopathy is an important diagnostic clue. And identifying whether symptoms improve with initial movement offers additional clinical value.

Another key line of questioning focuses on occupational and lifestyle factors. 

Individuals who stand on hard surfaces for extended periods – such as food service workers or manufacturing employees – tend to experience increased mechanical stress on the plantar fascia. 

Similarly, athletes who abruptly change their training volume – or footwear – may develop symptoms that are related to overload. 

By clarifying such details, clinicians can determine whether daily load patterns are consistent with typical presentations of plantar heel pain.

Looking at Medical History

Clinicians also review the patient’s medical history – to assess whether underlying health conditions could contribute to symptom development or delayed tissue healing. 

Conditions such as diabetes, rheumatoid arthritis, thyroid dysfunction, or chronic obesity can influence how tissues respond to mechanical stress. 

Patients may also have a history of lower extremity injuries, gait alterations, or previous foot conditions that lead to compensatory movement patterns.

Noticing Red Flags

In addition to individual factors, clinicians look for red flags that require further evaluation. 

These include:

  • Progressive neurologic symptoms.
  • Night pain that is unrelated to activity.
  • Unexplained swelling.
  • Bilateral symptoms without clear mechanical triggers. 

Identifying such findings early on plays an important role in determining whether referral or additional testing is necessary.

The clinical interview gives clinicians a solid foundation to guide physical examination, functional testing, and imaging decisions.

Physical Examination and Palpation Findings

Physical examination… It is a critical step in diagnosing plantar heel pain, as it provides objective data that directly confirms or challenges the initial impressions formed during the interview. 

Efficient assessments typically begin with:

  • Palpation.
  • Range of motion testing.
  • Observation of basic functional movements. 

Each of these components helps clinicians identify whether symptoms align with plantar fasciopathy or another condition.

Palpation of the proximal plantar fascia at the medial calcaneal tubercle is one of the most widely recognized and reliable diagnostic indicators. Patients with plantar fasciopathy typically experience sharp, localized tenderness at this point. 

The study entitled “Medical imaging for plantar heel pain: a systematic review and meta-analysis,” published by the National Library of Medicine, describes this specific palpation finding as one of the most reproducible markers for diagnosing plantar heel pain. 

By confirming localized tenderness, it becomes easy to differentiate plantar fascia involvement from nerve entrapment, fat pad disorders, or bone-related conditions.

As well as focal tenderness, clinicians evaluate soft tissue texture. They note any thickening, swelling, or irregularities along the fascia. 

These tissue changes often indicate adaptive responses to repeated mechanical stress. 

And palpation along the arch and into the midfoot can reveal whether symptoms are isolated or part of a broader mechanical pattern.

Range of motion assessment complements palpation findings and helps clinicians determine whether mechanical restrictions contribute to the patient’s symptoms. 

Visual inspection of foot posture during standing may also reveal pes planus or pes cavus tendencies – both of which influence plantar fascia loading.

In some cases, clinicians also evaluate whether patients are using external devices to support the foot. 

This may include footwear modifications or the use of medical-grade Plantar Fasciitis orthotics, which not only cushion the heel but also correct the strain on the plantar fascia band.

Medical-grade insoles address the specific biomechanical issues that cause an individual’s plantar fasciitis.

Functional Tests and Mechanical Loading Response

Functional testing provides real-time insight into how the plantar fascia responds to mechanical stress – making these tests highly valuable in an efficient diagnostic process. 

Clinicians use functional movements to determine whether symptoms are consistent with plantar fasciopathy and to assess the overall lower extremity performance. 

Functional tests not only help confirm a diagnosis. They also guide treatment planning by revealing strength deficits, mobility limitations, or altered movement patterns.

The Windlass Test

You may be aware of the windlass test. It is one of the most important and commonly used functional assessments for plantar heel pain. 

By dorsiflexing the great toe and tensioning the plantar fascia, clinicians can provoke symptoms in individuals with plantar fasciopathy. 

A positive windlass test supports the diagnosis, especially when combined with the focal tenderness identified during palpation. 

The windlass test is particularly useful when symptom reproduction is immediate and localized.

Heel Squeeze Testing

Clinicians use the heel squeeze test to rule out calcaneal stress fractures.

This involves compressing the heel medially and laterally to assess for deep bone pain. 

Stress fractures, unlike plantar fasciopathy, typically produce a sharp, deep ache when this test is performed. 

A negative heel squeeze test supports a soft tissue origin of symptoms – whilst a positive test helps clinicians determine whether imaging may be necessary.

Activity-Based Provocation Tests

Activity-based tests include heel raises, single-leg balance, and step-down movements. Each of those tests challenges the plantar fascia differently. 

Clinicians observe how the patient performs these tasks – looking for abnormal weight shifting, pain triggers, or endurance deficits. These assessments help identify whether the plantar fascia can tolerate functional loading – or whether certain movements consistently reproduce pain.

Also, clinicians often assess whether repetitive loading worsens symptoms over time. For example, performing several consecutive heel raises can reveal fatigue or compensatory mechanics that do not appear during isolated movements. 

This process helps clinicians identify whether strengthening, flexibility, or movement retraining should be prioritized when creating a treatment plan.

Integrating Functional Testing Into Diagnostic Reasoning

Functional testing enables clinicians to compare the involved foot with the contralateral limb. Differences in balance, strength, or movement quality often highlight biomechanical contributors – that are not visible during static assessments. 

These insights help determine whether plantar fasciopathy is linked to broader kinetic chain dysfunctions, such as:

  • Weak hip stabilizers.
  • Limited leg flexibility. 

Functional tests, therefore, enhance both diagnostic accuracy and treatment efficiency.

Imaging and Evidence-Based Diagnostics

Although plantar fasciopathy is typically diagnosed through clinical examination, imaging plays an important role – when symptoms do not improve as expected or when the diagnosis remains uncertain, that is. 

Clinicians use imaging selectively to:

  • Confirm soft tissue changes.
  • Identify structural abnormalities.
  • Rule out alternative conditions.

Ultrasound is often the first imaging choice – due to its convenience, affordability, and ability to visualize soft tissue structures. 

Clinicians can measure plantar fascia thickness, identify hypoechoic regions, and assess the presence of perifascial fluid. 

According to a study published by the National Library of Medicine, ultrasound findings closely correlate with symptomatic presentations, making it a useful tool in confirming the diagnosis.

And radiographs can help clinicians rule out bone abnormalities. 

MRI is reserved for chronic, persistent, or complex cases that require detailed visualization of both soft tissue and bone. MRI can identify: partial tears, chronic degeneration, or bone marrow edema. 

So, these steps should be taken:

  • Ultrasound.
  • Radiographs.
  • MRI.

Even when imaging is used, efficient clinicians rely primarily on physical examination and patient interviews to drive diagnostic decisions.

Differential Diagnosis and Condition Classification

Differential diagnosis is essential for efficiently identifying plantar fasciopathy – among the many conditions that can cause heel pain. 

Because several disorders share overlapping symptoms, clinicians systematically compare findings from the interview, physical examination, and functional testing – to distinguish between them.

Neuropathic conditions, such as Baxter’s nerve entrapment, often produce burning sensations or radiating pain that is not typical of plantar fasciopathy. 

Clinicians test for nerve tension, sensory changes, and symptom patterns unrelated to mechanical load to identify these presentations.

Mechanical conditions (such as fat pad atrophy) create diffuse heel pain that worsens on hard surfaces, contrasting with the localized tenderness characteristic of plantar fasciopathy. 

Gait observation and palpation help differentiate these conditions effectively.

Inflammatory or systemic conditions may require laboratory testing when patients have issues like bilateral heel pain or prolonged morning stiffness – or symptoms that extend beyond typical mechanical patterns. Identifying these cases early on ensures appropriate referral.

Condition Classification

Clinicians often classify plantar heel pain into phases such as:

  • Acute.
  • Subacute.
  • Chronic. 

This classification helps guide treatment intensity and expectations for recovery. 

Acute symptoms may require load reduction and symptom management, while chronic symptoms typically benefit from progressive loading, movement retraining, or supportive strategies that address long-term biomechanical patterns.

Evidence-Supported Approaches

Research published by MDPI highlights this: clinicians using structured classification systems demonstrate greater efficiency and diagnostic confidence. 

By integrating classification into differential diagnosis, practitioners can streamline both evaluation and the planning of treatment.

The Bottom Line

Clinicians assess plantar heel pain efficiently by combining:

  • Thorough patient interviews.
  • Targeted palpation.
  • Functional testing.
  • Selective imaging. 

These strategies allow practitioners to differentiate plantar fasciopathy from other conditions, classify symptom stages, and guide evidence-based interventions. 

Author bio: Harry Wolf is a freelance writer. For almost a decade, he has written on topics ranging from healthcare to business leadership for multiple high-profile websites and online magazines.

References

  • Mayo Clinic Staff, Plantar fasciitis, Mayo Clinic, 2023.

https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846

  • Rodseth, Merinda, Bell, Jess, Jackson, Kim, Jaraczewska, Ewa, Ogunleye, Olajumoke, Saban, Bernice, Assessment of Plantar Heel Pain – A Literature Review, Physiopedia.

https://www.physio-pedia.com/Assessment_of_Plantar_Heel_Pain_-_A_Literature_Review

  • Unauthored, How should I assess a person with suspected plantar fasciitis?, National Institute for Health and Care Excellence, 2024.

https://cks.nice.org.uk/topics/plantar-fasciitis/diagnosis/assessment/

  • Nweke, Tonyclinton C., Comprehensive Review and Evidence-Based Treatment Framework for Optimizing Plantar Fasciitis Diagnosis and Management, National Library of Medicine, 2025.

https://pubmed.ncbi.nlm.nih.gov/40717873/

  • Drake, Chris, Whittaker, Glen A., Kaminski, Michelle R., Chen, John, Keenan, Anne-Maree, Rathleff, Michael S., Robinson, Philip, Landorf, Karl B., Medical imaging for plantar heel pain: a systematic review and meta-analysis, National Library of Medicine, 2022.

https://pubmed.ncbi.nlm.nih.gov/35065676/

  • Alnefaie, Abdulmajeed Muhaysin, Alzahrani, Hosam, Alshehri, Mansour Abdullah, Physiotherapy Management of Plantar Fasciitis: A National Cross-Sectional Survey in Saudi Arabia, MDPI, 2025.

https://www.mdpi.com/2077-0383/14/13/4584

  • Akhtar, Amir, Baxter’s Nerve Entrapment, My MSK Clinic.

https://mymskclinic.co.uk/baxters-nerve-entrapment/

 

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

Christian Counseling: Christmas and the Theology of the Incarnation

Posted on by Mark Moran

Christ is born!  Glorify Him!

In this blog, we are going to see the critical and central importance of the Incarnation to Christian theology and human salvation found in Christmas.   The power of John’s monologue that leads to the famous words “And the Word became Flesh” are central to the faith and are powerful reminders of God’s love for humanity which He never intended to forsake due to the sin of Adam.  In fact, the Incarnation is the most singular act of love ever in history.  Instead of being an absent God from a distant throne, God chose to get into the mud with His creation and save it.

Please also review AIHCP’s Christian Counseling Certification.

What is the  Incarnation?

The Incarnation was necessary but it was also an act of love. Please also review AIHCP’s Christian Counseling Certification

While the Incarnation is the most central aspect of the Christian faith, it is a mystery that is hard to understand or even believe for those outside of the faith.  Whether religious within a different tradition, or secular, it seems almost impossible that a human being can be God.  For many, it screams the same ancient stories of Hercules, half god and half man, or as if gods with more human qualities procreate with women under the guise of regular person.  This crude analogy to the Incarnation of Jesus Christ does not compare or even capture the true meaning of the Incarnation.

Mary said yes at the Annunciation in Luke’s Gospel and with that yes, a miracle occurred. Mary, herself, became the new Ark of the Covenant, a covenant far greater than that of Moses and law, but a new covenant of salvation with Christ.   Mary’s willingness to say yes to God allowed an infinite being to enter into time.  The Holy Spirit miraculously permitted Mary to become a mother yet also retain her virginity by infusing into her womb, the Second Person of the Trinity and the complete personhood of the man, Jesus Christ.  She “knew” not any man but yet had conceived.  Upon her yes, an angel was sent to inform St Joseph,  her betrothed and the foster father of Jesus, that Mary had committed no sin and that but God had granted the world a great miracle and its Messiah. Joseph, like Mary, said yes.   Mary and Joseph both played key roles in the Incarnation and through their obedience and humility, Christ entered into the world.  Jesus would become the new Adam and his mother would become the new Eve.  Where Adam and Eve said no to God,  Jesus and Mary would say yes to God

But beyond the story of Christ’s birth in a stable and the coming of the shepherds and wise men, there is a deep theology which while unable to explain how the impossible can occur due to its mystery, still nonetheless explains what is to be believed and why.  The theology of the Incarnation first speaks about the reason behind the miracle.  There are two primary reasons for the purpose behind the Incarnation.  First, it was necessary.  The fall of Adam and Eve left humanity in the darkness of the world.  Adam entered into a new temporal reality that stripped him of his supernatural gifts of knowledge and control of the passions and instead granted him suffering, hard work and death.  Beyond these physical manifestations, his fall also left humanity without grace and marked with Original Sin.   A grave injustice and imbalance emerged which left humanity severed from God’s grace and parenthood.  Instead, the power of Satan overtook the world and humanity was locked away from grace and divine paternity.   The solution required a sacrifice of penance and reparation for the wrong.  It required a spotless and perfect priest to offer a spotless and perfect victim or sacrifice.  No human was perfect and no sacrifice could ever match the injustice done to God via Adam’s sin.   Hence out of necessity, God became flesh to not only be our priest but to also be our victim of sacrifice.  The second reason behind the Incarnation is theoretical but championed by many theologians, saints and mystics.  It is believed that God always planned to take upon human nature to better connect and love us, but to also elevate His creation of humanity.  It is speculated that this plan of elevated human nature to such status was one of the primary reasons Lucifer rejected God.  Out of pride, Lucifer resented that something so human could ever be made greater than his own angelic self.  Upon this he rebelled, was cast to Hell and forever determined to mock and destroy humanity.

Understanding the Incarnation

As a mystery of faith, the Incarnation cannot be completely explained, nor can rationale or science confirm it, but through philosophical reasoning, an understanding of the fall, and God’s infinite mercy, one can come to coherent system of thought within the narrative of the fall of Adam.  Within this narrative, the necessity of God/man is essential.  The Incarnation answers the challenge of the fall of humanity and gives humanity redemption.  The Incarnation, even without the passion of Christ, would have sufficed for humanity’s salvation.  One simple chill to the new born Christ, or even a cry of hunger to His mother would have been alone suffice to redeem humanity, but the price of sin, the evil side of humanity and the vengeance of Lucifer demanded more. And like Mary and Joseph, Jesus said yes to God.

And the Word Became Flesh

The Incarnation while mysterious is not hard to describe or illustrate.  In essence, the Second Person of the Blessed Trinity, the Word or Son, took upon a human nature.  In this way, God entered into time and the temporal realm as a person.  Due to many ancient heresies regarding the nature of Christ as both God and man, many theories and confusions arose.  Most heresies either combined Christ’s human nature and divine nature into a messy personhood that is truly neither (Monophysitism) or separated the natures to such an extent that Christ appeared as two persons (Nestorianism).  These and other heresies regarding Christ were condemned at early Church councils such as Ephesus or Chalcedon.

So, the Incarnation is not about fusing two natures into one nature, or separating two natures creating two persons, or even the body of Jesus being a shell for the Divine, or the body being a mysterious phantasm, but the Incarnation teaches, as Pope Leo I declared at Chalcedon, two complete natures, one person.

If dissecting this, it means Jesus is both God and man, perfectly complete.  It is not a 50/50 mix but a 100/100 fusion of two complete natures into one person.  At the moment of Christ’s conception in the womb of Mary, Jesus’ human nature was created and at that exact moment, the Word entered into the body of Christ.  There was never a moment that Jesus human nature was without the divine nature.  There was not a preliminary moment for Jesus to accept His divinity for it was always there within His very essence of creation.  Yes, the Divine nature was eternal and existed before time and the human nature was created in temporal time, but the moment the conception occurred, Jesus was both God and man perfectly.  Jesus had a body and yes, even His own soul.  Many Christians some time forget this amazing aspect of the Incarnation.  Jesus had two wills since He had two natures but the wills were perfectly aligned within one person and working in perfect harmony.  Sometimes in Scripture, Jesus says things that are very human, but also at times says things that are very divine.  We can see when Christ’s humanity shines bright and in other cases when His divinity shines bright throughout His life in the Gospels.  As a man, Jesus could suffer, albeit not due to sin, for He was made like us in everything but sin, but He still permitted Himself to be subject to the pains of the temporal world.  But as God, Jesus was able to perform miracles and manifest Himself to the Apostles at the Transfiguration.  So when we study scripture, we find many samples of emphasis on humanity but also many points that direct to His Divinity.  To the untrained eye, this can seem as contradictions, but it is merely the reality of Jesus being both completely God and man.

Conclusion

The Incarnation is a story of love.  The perfect gift of self.  God, through the Second Person, took upon a human nature of Jesus, retaining His divine and sharing in complete possession of the human.  It is because of this that Christ is both God and man.   This is why we worship Jesus Christ because within this singular person is both Jesus and the Second Person, perfectly united as one person.  This is indeed mysterious, but is also the faith!

Please also review AIHCP’s Christian Counseling Certification

Please also review AIHCP’s Christian Counseling Certification

Additional Resources

“What Is the Incarnation?” (2007) Desiring God.  Access here

Moran, M (2024). “Christian Counseling Education: The Incarnation: Divinity on Earth”.  Access here

“The Incarnation of Jesus Christ: Purpose and Meaning for Mankind” (2023). Christianity.com.  Access here

“Incarnation”. Catholic Answers.  Access here

 

 

Trauma and Informed Care and Imminent Danger in Counseling Video Blog

Posted on by Mark Moran

It is a grave and immense responsibility of counselors to protect their clients when imminent harm to themselves, others or abuse is reported.  Confidentiality has its limitations in these cases and a legal obligation to report becomes necessary.  This video looks at signs of imminent harm as well as how to help clients understand the need to submit to the safest decisions that may include temporary mental ward observation or reporting an abuser.

Please also review AIHCP’s Healthcare Certifications as well as AIHCP’s Trauma Informed Care Certification

Trauma Informed Care: Understanding Dissociation

Posted on by Mark Moran

The most common trait we think of when discussing PTSD is dissociation.  Whether through flashbacks, or disconnections from the present, dissociation primarily seen as a pathological left over from a traumatic event, most seen with combat veterans.  Within this imagery, one sees a firecracker or backfire from a car that sends a military veteran into a flashback of a past war scene.  While this is accurately captures PTSD, this is only one minor aspect of dissociation and only illustrates its pathological symptoms instead of its overall necessity within the protective and defense mechanisms of the human body against extrema trauma.  It is important to remember according to Contreras, that some dissociative behaviors are also part of the human experience and not necessarily pathological symptoms (2024, P, 181).   In this blog, we will shortly look at dissociation in a broader scope and see how it exists not only during the trauma, but after the trauma as well, and how it manifests in multiple different ways.

Dissociation while a natural mechanism for some during the actual trauma becomes pathological if it becomes chronic and persistent after the actual trauma event

Please also review AIHCP’s Healthcare certifications, especially AIHCP’s Trauma Informed Care and Spiritual Trauma Informed Care programs.

Peritraumatic Dissociation

During extreme stress or trauma, or life or death situations, the body’s autonomic nervous system responds through its sympathetic or parasympathetic branches.  As discussed in previous blogs, this can lead to fight, flight, freeze, fawn, or even fade.  Since dissociation deals with fade or immobility, it is part of the parasympathetic response during a traumatic event.  In its peritraumatic state, the survival mechanism is natural and looks to help the person disconnect, detach, or compartmentalize the event.  This is shutdown is is to spare the mind the horrible nature of the event and other emotional and mental damages, albeit, it also shuts the person’s physical abilities to continue resistance.  During this moment of detachment, the Prefrontal Cortex’s emotional processing is inhibited and the sympathetic activity is reduced.  In turn, the parasympathetic response increases and the activity of the cortico limbic brain creates algesics to skip the process of storing memories, or recalling memories, especially painful ones.  In addition, analgesics are produced to reduce pain and numb the body from the event (Contreras, 2024, p. 176-177).   This process can leave gaps in memory as well as other cognitive and emotional related issues.  The more traumatic event, the more traumatic the dissociation and due to this the  higher possibility to dissociate later (Contreras, 2024, p. 173).

What to remember is this natural defense and survival response is normal in its hope of protecting the mind and body.

Posttraumatic Dissociation

Dissociation becomes pathological when it continues to haunt the mind after the actual event.  The mind can be easily triggered due to similar scents, surroundings or signs that evoke the survival response.  For many, they are already existing in a constant survival strategy mode, keeping systems on red alert.  Within dissociation, individuals may experience psychological and functional alterations of memory and identity.  Others may sense physiological symptoms such as temperature loss in the limbs, or a lowered heart rate.  Others may sense a detachment from surroundings or disconnect from bodily sensations.  Others may experience less pathological experiences with temporary states of day dreaming or disengagement with life (Contreras, 2024, p. 174).   Various aspects are also affected by dissociation such as loss of time, disconnect from body, disconnect from identity of self, lack of motivation, amnesia and memory loss, or loss of capacity to recognize emotions and their affect, meaning and range (Contreras, 2024, p. 175).  All of these issues represent true significant issues for a person who has not returned to homostatis or baseline due to the traumatic event.  Since the body remains in a state of survival mode, mechanisms that are meant to be temporary instead are becoming permanent states of being for the individual.

Dissociation can become especially dangerous when in its extreme form it can cause individuals to become invert and thoughtless to their surroundings or what is happening.  When amnesia is present, it can disconnect a person from their true self which forces the person to create new schemas or behaviors that are extreme in nature (Contreras, 2024, p, 182).

Dissociation according to the DSM-5 can also be experienced as a DPDR disorder (Depersonalization-Derealization disorder), as a Dissociative Identity disorder (multiple personality) or a amnesia based disorder.  Due to these more extreme cases, it is critical to find help if these issues grow worst or persist.  With personalization, the person feels detached, or even as an outside observer of one’s mental processes.  With derealization where one experiences a type of unreality about one’s surroundings, as if dreamlike, distant or distorted (Contreras, 2024, p,. 319).

Finding Help

Therapists, especially those trained in trauma informed care, are especially equipped to help a person again find baseline or homostasis.  They can help the individual again deactivate the autonomous nervous system and turn off survival mechanisms that have hijacked the overall person’s life.  This involves not only learning to regulate emotions, but also instructing others in grounding techniques that can limit the dissociation.   In many cases, exposure therapy and reframing is necessary to help the person move beyond the traumatic event.  It involves helping the brain properly store the memory and process it.   In doing so, the brain can eventually reset without being alerted to non threats.

Please also review AIHCP’s blog on grounding techniques for those suffering from PTSD.  Click here

Conclusion

Please also review AIHCP’s healthcare certifications as well as its Trauma Informed Care program

Dissociation is a natural response of the parasympathetic nervous system that involves detachment during a traumatic event.  It shuts down many centers of the brain for memory by effecting encoding , storage and retrieval.   Instead the memory becomes emotional and tied to the amygdala.  Additionally, the hippocampus  has a difficult time differentiating the past memory and event with the present moment and associates everything as imminent.  This in turn leads to triggers and continued detachment from non existent threats.   Since the body remains in a state of red alert, dissociation as a survival mechanism instead becomes a survival strategy that persists until the person is finally able to resolve the past trauma.

Please also review AIHCP’s healthcare certifications as well as its Trauma Informed Care and Spiritual Trauma Informed Care programs.

Resource

Contreras, A (2024). “Traumatization and Its Aftermath: A Sympathetic Approach to Understanding and Treating Trauma Disorders”

Additional Resources

Tull, M. (2025). “What Is Dissociation?.  Very Well Mind.  Access here

“Dissociation”. Psychology Today.  Access here

“Dissociative Disorders”. Mayo Clinic.  Access here

Guy Evans, O. (2025). “What Is Dissociation? Types, Causes, Symptoms & Treatment”. Simply Psychology. Access here

Psychological Factors Influencing Patient Adherence to Contact Lens Care Regimens

Posted on by Joseph Gerard

Nurse Patient Educators also understand the individual needs of their patients

Written by Michael Austin,

Patient compliance remains a challenge in many areas of healthcare, including eye care. Even when patients understand the advice given and the possible risks, not everyone follows the steps needed to protect their eye health, especially when using contact lenses. Poor compliance with contact lens care can increase the risk of eye infections and inflammation.

Because of this, a behavioral or mental health approach can be helpful in explaining why some patients follow care guidelines while others do not. Understanding these differences can support better strategies to improve compliance and reduce complications.

Why Is Contact Lens Nonadherence So Common?

Nonadherence to contact lens care is rarely caused by a lack of intelligence or concern. Instead, it often stems from how patients perceive risk, routine, and personal relevance.

Many patients underestimate the consequences of poor lens hygiene because complications are not always immediate. When negative outcomes are delayed, motivation weakens. Others view lens care as an inconvenience that competes with daily responsibilities, leading to shortcuts that become habits over time.

Psychological distancing also plays a role. Patients may cognitively separate contact lens care from other health behaviors, seeing it as optional rather than preventive. This mindset increases the likelihood of inconsistent practices, especially during periods of stress or fatigue.

How Do Risk Perception and Optimism Bias Affect Care Behaviors?

Risk perception influences patient adherence to health advice, particularly regarding contact lens care. Humans tend to remain optimistic and believe that unfortunate incidents occur to someone else and not to them. 

Their past experiences also work towards this end. Those individuals who reuse solution or sleep while wearing contact lenses but experience no immediate negative consequences tend to consider it safe.

Healthcare providers can help by explaining risk in a way that is easy to understand and not just through numbers.  They can show how little mistakes add up over time and raise the risk, which lets patients rethink their assumptions.

What Role Does Habit Formation Play in Adherence?

A habit is a routine so thoroughly embedded in a person’s life that it can be performed with very little conscious thought. Routines can be great facilitators of adherence or, conversely, of nonadherence.

Patients can maintain consistency if they incorporate the care of their lenses into daily routines, like the evening ritual, while those without routines might forget or deliberately omit when tired or distracted.

Research on human behavior finds that when actions are straightforward, predictable, and directly associated with an existing behavior, habits can develop more readily. Nurses and educators can assist patients in following a treatment plan by helping patients recognize what specific stimuli will trigger them to follow proper lens hygiene practices.

How Do Motivation and Personal Identity Influence Compliance?

Motivation is rarely static. It fluctuates based on lifestyle changes, emotional state, and perceived value. Some patients are highly motivated during initial lens fitting but gradually disengage as novelty fades.

Personal identity also matters. Patients who see themselves as health-conscious or detail-oriented are more likely to follow care guidelines. Conversely, those who prioritize convenience or aesthetics may be more prone to cutting corners.

This is especially relevant for patients using specialty lenses, including colored contact lenses, where motivation may be tied more to appearance than health. In such cases, reinforcing the connection between proper care and long-term eye safety is critical to sustaining adherence.

How Does Cognitive Load Interfere With Contact Lens Care?

Cognitive load represents mental effort when dealing with a large number of tasks. Patients dealing with a heavy cognitive load resulting from work, family care-giving responsibilities, and psychological problems are likely to postpone disease prevention.

Looking after contact lenses requires several procedures: cleaning the lenses, storing them properly, and changing them periodically. People who have restricted cognitive resources may perform the procedures improperly or simplify the routine with deleterious consequences on safety.

Healthcare practitioners may help by indicating appropriate simple care strategies when possible and emphasizing the need for consistency over perfection. Simple instructions reduce the mental cost of thinking and make it easier for people to comply.

What Emotional Factors Impact Adherence Over Time?

Conditions such as anxiety, depression, and burnout can influence self-care practices. Patients with mental health issues would have difficulty with routines requiring constant focus or following things that entail waiting for rewards.

Fear can also function in a double manner. While some patients will actually follow treatment instructions in fear of complications, others will avoid all information to alleviate fear. This can cause them to tune out instructions for care.

Awareness of emotional barriers can help healthcare staff adjust their communication style accordingly. A patient support approach is better than fear messaging for most people.

How Can Healthcare Professionals Improve Patient Adherence?

Improving adherence requires more than repeating instructions. It involves understanding the patient’s mindset, lifestyle, and emotional context.

Effective strategies include:

  • Using open-ended questions to assess beliefs and concerns
  • Normalizing common challenges without validating unsafe behavior
  • Reinforcing positive habits rather than focusing only on mistakes
  • Providing written and verbal guidance in plain language
  • Encouraging follow-up conversations rather than one-time education

Nurses, in particular, play a vital role due to their frequent patient contact and trusted position. Brief, consistent reinforcement during routine interactions can significantly influence long-term behavior.

Why Is a Psychological Approach Essential in Contact Lens Education?

A purely technical approach assumes that information alone drives behavior. Decades of healthcare research show this is rarely true. Psychological factors shape how information is received, interpreted, and acted upon.

When contact lens education incorporates behavioral insight, it becomes more patient-centered and effective. Addressing motivation, habits, and emotional barriers helps transform instructions into sustainable practices.

This approach aligns with broader trends in healthcare that emphasize holistic care, patient engagement, and preventive strategies rooted in behavioral science.

Final Words

Adherence of patients to care regimens of contact lenses is affected by intricate dynamics of psychological, emotional, and behavioral issues. By understanding these issues, healthcare professionals can go beyond instruction-based education toward more effective, patient-centered support.

Through recognizing the dynamics behind the formation of habits, the perception of risk, or the role of emotional state in the process of taking care of oneself, nurses and clinicians would be able to guide patients more effectively towards good habits regarding contact lenses. In the end, using psychological insights in lens care education helps both eye health and the broader goals of preventive healthcare.

 

Author’s Bio

Michael Austin is a lifestyle blogger with a strong interest in fashion, personal style, and intentional living. He enjoys planning and organizing every aspect of life—from curating a functional wardrobe and making smart purchasing decisions to managing finances and long-term goals. This blend of style, practicality, and structure comes through in the informative articles he shares on his personal website, awebtoknow.com.

 

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

Living With Perimenopause: Practical Support for Changing Body and Emotions

Posted on by Joseph Gerard

Nurse, portrait or laptop with medical student books, research education studying or hospital learning university. Smile, happy or healthcare woman with technology in scholarship medicine internship.Written by Dr. Sci. Jelena Veličković,

Every year millions of women experience perimenopause as a major biological transition; however, this time is often misinterpreted or regarded with low importance by society and healthcare providers. The cyclical change in estrogen and progesterone levels experienced during this time influences almost all of the major systems in the body, such as temperature regulation, cognition, sleep, and mood changes, and some aspects of cardiovascular and lipid metabolism (Santoro, 2016). Perimenopause is even more unpredictable since body changes occur in varying levels of severity from one month to another. This is a natural biological event, but it is not necessarily an easy or insignificant one since it tends to influence daily living for many women. Taking women’s experiences seriously can make the difference between care that helps and care that dismisses what they are going through.

What is Perimenopause?

Perimenopause is the transitional phase leading up to menopause, experienced between the ages of 40 and 50. However, it can begin earlier or later for some women. During the phase, there is more variability in the levels of estrogen, progesterone, FSH, and LH. This is far more unpredictable than the pre-reproductive phases of estrogen or the phases of estrogen that occur after menopause (Talaulikar, 2022).

Menopause is diagnosed retrospectively after 12 months of amenorrhea, whereas perimenopause is a dynamic process that takes longer between four to ten years with more variability in the pattern of menstruation as well as hormone secretion patterns (Harlow et al., 2012). A Staging of Reproductive Aging Workshop (STAW +10) proposes markers for early or late perimenopause through variations of menstruation pattern length or endocrine features, allowing practitioners to classify women for stages of reproductive aging. This is all related to the physical discomfort that women may go through as their ovaries become less active with the onset of perimenopause. These endocrine changes affect thermoregulation, neurotransmitter activity, circadian rhythms, cardiovascular function, and lipid metabolism.

Physical Symptoms of Perimenopause

Even though every woman’s experience is different, some of the physical symptoms occur at such a high rate that they are clearly documented by research studies. This is what causes the differences in the transition of the perimenopausal woman.

1. Vasomotor Symptoms (Hot Flashes and Night Sweats)

They are frequently listed as the most common symptoms of perimenopause. Women can have them in various ways like getting sudden hot sensations, turning red in the face, experiencing heart palpitations, or having a feeling of warmth radiating over the body. Night sweats could also interfere with the woman’s sleep. This could then result in other issues such as fatigue, irritation, or mood swings, which would then impair one’s work performance since one could feel self-conscious in their work or social setting (Thurston, 2018).

2. Irregular Menstrual Cycles

Changes in the menstrual cycle can be an early sign of perimenopause. Some women experience shorter cycles, more menses, or periods of amenorrhea, whereas some women experience longer cycles or spotting. In later stages, breaks between periods grow, often 60 days or more without a bleed. That shift points to shifting estrogen levels from the ovaries, tied closely to what’s called STRAW+10 (Harlow et al., 2012).

3. Interruption of Restorative Sleep

Most women experience disruption to their natural sleeping patterns; during perimenopause, sleep disruptions occur between 50-60% of the time. It has been found that these sleep disturbances may exacerbate anxiety and contribute to increased levels of mood fluctuation. Contributing factors to these sleep disturbances include: hot flashes, night sweats, body rhythm changes, anxiety, and disturbed sleeping patterns (Kravitz & Joffe, 2021). The poor sleep quality associated with these factors increases irritability, difficulty with cognitive function, and stress reaction, and can create additional challenges for women who were already vulnerable to poor quality sleeping patterns before menopause occurred.

4. Musculoskeletal Pain

Muscle and joint issues, like tightness, soreness, or general aches, are often linked to perimenopause today. Studies found about 7 out of 10 women go through this (Lu et al., 2020). Newer findings point to what’s called a “menopause-related musculoskeletal pattern,” involving weaker muscles, thinner bones, plus greater chances of developing joint wear (Wright et al., 2024).

5. Urogenital and Sexual Changes

A drop in the levels of estrogen causes related signs and symptoms that affect the tissues of the vagina, vulva, bladder, or urethra. Some of the signs include dryness, irritation, painful sexual intercourse, or more frequent urination. These signs are related to low levels of estrogen in the area; collectively, they are referred to as the genitourinary syndrome of menopause (GSM). These signs affect sexual health, self-confidence, and daily functioning (The North American Menopause Society, 2020). Some of the signs may also be linked with other gynecologic conditions, such as uterine fibroids, painful or irregular bleeding or pressure in the pelvis.

These somatic complaints indicate real physiological phenomena, as opposed to psychological attribution, which further verifies the need for experience verification of women in such a transition.

Cognitive and Emotional Changes During Perimenopause

The hormonal changes in perimenopause affect memory, mood, and stress responses. These cognitive and emotional changes often come out of the blue and may fluctuate from month to month.

1. Cognitive Fog and Attention Difficulties

Women frequently face “brain fog” symptoms during the peri-menopause phase. These issues can include poor focus or inability to concentrate, difficulty organizing their ideas, and a feeling of having too many simultaneous thoughts; problems with effective communication, notable barrier to completing multiple tasks simultaneously, and inability to easily find or recall appropriate words when talking about something to a third party. Current research indicates that women’s cognitive difficulties during this stage of their lives are due to small disruptions in both attention and short-term memory rather than an actual cognitive disability of the brain (Greendale et al., 2009). Consequently, when women’s cognitive difficulties interfere with appropriate functioning in their daily activities or with the demands of their job, women may develop feelings of anxiety and doubt about their cognitive abilities.

2. Mood Swings

Estradiol influences neurotransmitters such as serotonin, dopamine, and norepinephrine which play a part in how we feel emotionally about ourselves. When estrogen levels fluctuate, mood may fluctuate, which can lead to increased feelings of agitation, depression and anxiousness or intensity of response to external pressure. Also, some women that had previously been able to cope with their emotions may experience rapid changes in their mood that do not coincide with their current situation (Han et al., 2023).

3. Anxiety and Emotional Reactivity

Alteration in the HPA (hypothalamic-pituitary-adrenal) axis may cause worsening of anxiety symptoms by increasing the recognition of agitation, anxiety and emotional reactivity. For example, an increase in these feelings may develop in women that had previously never experienced the feelings of anxiety prior to going through the menopause transition. The likelihood of developing these vulnerabilities can also be exacerbated by both poor sleep quality and the added stress of day-to-day living (Han et al., 2023).

4. Increased Vulnerability to Stress

Life’s hectic years sometimes line up with perimenopause. Many women balance jobs, kids’ needs, helping older relatives, or dealing with personal health stuff. Hormone shifts during this phase can amplify tension – making it tougher to cope, no matter how steady daily pressures stay. Knowing these reactions come from physical changes helps ease guilt. It opens space for gentler, kinder choices when tending to your well-being.

These mood and cognitive shifts are real and biologically based. They demonstrate the importance of support in all contexts – at home, at work, and in healthcare facilities.

How Perimenopause Affects Daily Life and Relationships

Women can face mood swings and exhaustion during perimenopause despite being responsible for work, family, and other obligations. With fluctuating symptoms, simple activities become hard to cope with. While a woman may have phases where she feels competent to deal with her responsibilities, she may experience phases of feeling emotionally or physically overwhelmed, which can influence her self-confidence. Poor sleep and sudden hot flashes can worsen her level of concentration and patience. A study among middle-aged women portrays a picture where women dealing with severe vasomotor symptoms or anxiety often experience greater difficulty with daily activities and social interactions as well as social encounters. At work, some women may become distant or less engaged in activities because she remains uncertain if others will see her as inconsistent in her roles. With her relationships, a woman with perimenopause symptoms can be perceived as impatient or distant emotionally rather than being exhausted because of hormones, which can become a common issue if misunderstood. Research suggests doctors and nurses can help with such relationships by making emotions sound more common, describing symptoms, or admitting reactions to stressful situations. Speaking freely without shame and developing methods to cope with stressful situations can make a huge impact in making coping with symptoms a less complicated situation without disturbing emotions and everyday life skills (Avis et al., 2009).

Barriers to Seeking Support

Even though many of women go through perimenopause signs, plenty wait before getting help. They often link those changes to pressure, getting older, or feeling like they’re not doing enough, instead of seeing them as part of shifting hormones, which means care might come late. Shame about growing older, fear doctors won’t take them seriously, and habits that tell women to tough it out can make things harder to talk about. If someone’s working full-time or looking after others, admitting struggle might feel risky, as if it shows they can’t handle their duties. These hurdles might leave women feeling alone during perimenopause, despite how widespread and medically acknowledged the signs are. More awareness, open conversations, and supportive healthcare can make women feel safe to seek help sooner.

How to Provide Support to Women During Perimenopause

Supporting someone through perimenopause means listening carefully, remaining patient, and exploring how physical changes may correlate with changes in emotional state, relationships or stress levels. Many women who are experiencing this phase of life may also be working and taking care of others or attempting to live up to their own expectations; the combination of these factors increases the likelihood of experiencing greater symptoms. The support provided can be of tremendous value when life becomes overwhelming.

1. Listen Without Minimizing

Women often say they’re brushed off when talking about perimenopause. Comments like “we all go through this” or “that’s just getting older” might downplay real struggles. But paying close attention, repeating what you hear, and treating their feelings as valid builds trust. When people feel heard, it lessens guilt and makes them more likely to share openly.

2. Encourage Symptom Tracking

Tracking symptoms can give a greater sense of control and clarity. Using a symptom diary or a mobile app enables the user to identify potential triggers for these symptoms and track any cyclical patterns associated with them and, consequently, help the user effectively communicate with their doctor about their concerns. The act of tracking symptoms also assists women in becoming more aware of their own bodies and help them collaboratively make decisions together with their healthcare providers.

3. Support Sleep Hygiene

Sleep disruption is one of the most challenging aspects of perimenopause, affecting emotional stability, concentration, and overall functioning. Supportive measures that can improve sleep quality include:

  • maintaining a consistent bedtime and wake time
  • practicing relaxation strategies before bed
  • minimizing caffeine and alcohol in the evening
  • reducing screen exposure before sleep
  • keeping the bedroom cool to offset night sweats
  • choosing breathable fabrics or menopause friendly bedding

Sticking to a regular schedule, cutting back on things that keep you up, or tweaking your bedroom setup often helps. Once rest gets better, lots of women notice sharper focus, feeling more even-keeled, and handling everyday challenges with less struggle.

4. Foster Healthy Lifestyle Habits

Lifestyle changes can ease symptoms and enhance overall well-being. Staying active helps control body temperature, lifts mood, also keeps muscles and joints strong. Practices like yoga or tai chi, along with meditation and slow breathing,  can reduce stress and support better emotional balance. Eating whole foods, drinking enough water, eating at steady times can also help balance energy levels and reduce physical discomfort. Even though daily habits won’t eliminate symptoms completely, studies show that they can bring noticeable improvements for many women (Innes et al., 2010; Nguyen et al., 2020; Khan et al., 2023).

5. Promote Shared Understanding in Relationships

Spouses, kids, or relatives might see mood shifts or low stamina as personal issues instead of signs tied to hormonal changes. Getting loved ones informed about perimenopause can reduce blame, improve communication, and create a more supportive home. Once they understand the hormonal cause they are more like to respond with patience and empathy instead of frustration.

6. Encourage Medical Evaluation When Needed

Even though perimenopause is a natural life stage, certain symptoms require medical evaluation:

  • heavy or prolonged bleeding
  • significant mood changes
  • persistent pain
  • functional impairment

To find out what else might be wrong, a medical professional may perform blood tests, such as checking thyroid, estradiol, FSH, LH, or metabolism.

When to Refer for Clinical Care or Specialized Support

Healthcare professionals should encourage referral when:

  • Symptoms seriously interfere with day-to-day functioning
  • Bleeding patterns point to endometrial pathology
  • Mood symptoms point to depression or anxiety
  • Cognitive changes are severe or progressive
  • Vasomotor symptoms disrupt sleep and quality of life

Evidence-based interventions include menopausal hormone therapy, cognitive-behavioral therapies for menopausal symptoms, non-hormonal medications, lifestyle strategies, and integrative health approaches (The North American Menopause Society, 2023).

Improving Quality of Life for Women Living with Perimenopause

Since hormone fluctuations vary from person to person perimenopause hits each woman differently. Daily routines, stress, and environment also influence how symptoms show up. Understanding what’s happening in the body helps, but noticing changes in focus, mood, or energy is just as important. Support from loved ones works best when it comes from listening rather than assumptions.

This phase is about more than hormones alone. It affects the body, emotions, and mental well-being, shaping daily life and relationships. When guidance is based on reliable information instead of myths, women can manage symptoms more confidently. Feeling heard, respected, and gently supported plays a key role in maintaining quality of life.

Author Bio

Dr. Sci. Jelena Veličković is a molecular biologist and geneticist specializing in medical and forensic genetics. With over ten years of experience in clinical diagnostics and academic research, she has authored peer-reviewed studies in prenatal genetics, thrombophilia, oncogenetics, and molecular biology. Her work spans international research centers and clinical laboratories, where she has advanced molecular diagnostic methods including PCR microbiology, liquid biopsy, and NGS analysis. She is committed to applying evidence-based genetic insights to enhance diagnostic accuracy and support clinical decision-making.

 

References:

Avis, N. E., Colvin, A., Bromberger, J. T., Hess, R., Matthews, K. A., Ory, M., & Schocken, M. (2009).
Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: The Study of Women’s Health Across the Nation. Menopause, 16(5), 860–869.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2743857/

Greendale, G. A., Huang, M. H., Wight, R. G., Seeman, T., Luetters, C., Avis, N. E., & Karlamangla, A. S. (2009).
Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 75(21), 1888–1896.

https://pubmed.ncbi.nlm.nih.gov/19470968/

Han, Y., Zhang, Y., Li, X., & Wang, L. (2023).
Neuroendocrine pathogenesis of perimenopausal depression. Frontiers in Psychiatry, 14, 1162501.

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1162501/full

Harlow, S. D., Gass, M., Hall, J. E., Lobo, R. A., Maki, P., Rebar, R. W., … & the STRAW+10 Collaborative Group. (2012).
Executive summary of the Stages of Reproductive Aging Workshop +10: Addressing the unfinished agenda of staging reproductive aging. Menopause, 19(4), 387–395.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3340903/

Innes, K. E., Selfe, T. K., & Vishnu, A. (2010).
Mind–body therapies for menopausal symptoms: A systematic review. Maturitas, 66(2), 135–149.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3031101/

Khan, S. J., Kapoor, E., Faubion, S. S., & Kling, J. M. (2023).
Vasomotor symptoms during menopause: A practical guide on current treatments and future perspectives. International Journal of Women’s Health, 15, 273–287.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9938702/

Kravitz, H. M., & Joffe, H. (2011).
Sleep during the perimenopause: A SWAN story. Obstetrics and Gynecology Clinics of North America, 38(3), 567–578.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3185248/

Lu, C., Liu, P., Zhou, Y., Meng, F., Qiao, T., Yang, X., Li, X., Xue, Q., Xu, H., Liu, Y., Han, Y., & Zhang, Y. (2020).
Musculoskeletal pain during the menopausal transition: A systematic review and meta-analysis. Neural Plasticity, 2020, Article 8842110.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7710408/

Nguyen, T. M., Do, T. T. T., Tran, T. N., & Kim, J. H. (2020).
Exercise and quality of life in women with menopausal symptoms: A systematic review and meta-analysis of randomized controlled trials. International Journal of Environmental Research and Public Health, 17(19), 7049.

https://www.mdpi.com/1660-4601/17/19/7049

Santoro, N. (2016).
Perimenopause: From research to practice. Journal of Women’s Health, 25(4), 332–339.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4834516/

Talaulikar, V. S. (2022).
Menopause transition: Physiology and symptoms. Best Practice & Research Clinical Obstetrics & Gynaecology, 81, 22–36.

https://pubmed.ncbi.nlm.nih.gov/35382992/

The North American Menopause Society. (2020).
The 2020 genitourinary syndrome of menopause position statement. Menopause, 27(9), 976–992.

https://pubmed.ncbi.nlm.nih.gov/32852449/

The North American Menopause Society. (2023).
The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573–590.

https://pubmed.ncbi.nlm.nih.gov/32852449/

Thurston, R. C., & Joffe, H. (2018).
Vasomotor symptoms and menopause: Findings from the Study of Women’s Health Across the Nation. Obstetrics and Gynecology Clinics of North America, 45(4), 535–552.

https://pubmed.ncbi.nlm.nih.gov/29390899/

Williams, R. E., Kalilani, L., DiBenedetti, D. B., Zhou, X., & Fehnel, S. E. (2009).
Health-related quality of life and menopausal transition: Observations from the WOMAN study. Maturitas, 62(2), 153–159.

https://pubmed.ncbi.nlm.nih.gov/19157732/

Additional References

Cleveland Clinic. Perimenopause Overview. Access here

Healthline. Perimenopause: Feeling Like “I’m Dying”? Access here

Ohio State University Wexner Medical Center. Why Perimenopause Affects Your Mood. Access here

American Society for Reproductive Medicine. Menopausal Transition: What Is It? Access here

 

 

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

Trauma Informed Care: Emotional Abuse

Posted on by Mark Moran

Abuse has many faces.  It can be physical, it can be sexual and it also can be emotional.  Prolonged emotional abuse which is chronic overtime chips away at the person and places him or her into a state of constant survival.  Instead of stress responses acting as responses in the moment to survive, they become a constant state of existence.  This is one of the primary differences between PTSD and C-PTSD.  Under long periods of repeated duress due to emotional abuse or even neglect, the brain rewires itself to exist within a survival state.  With no acute emotional wound but a collection and series of events, emotional abuse or any type of abuse that is chronic or repeated, becomes difficult to discern what started ignition from survival response to survival state itself.   The delicate balance of allstasis or the ability to remain stable adjusts to constant change eventually reaches a state of allostatic load that eventually can crash in which the survival state becomes a new state that overtakes the person.

Emotional abuse is abuse. Please also review AIHCP’s Trauma Informed Care Program

Please also review AIHCP’s Trauma Informed Care Program as well as AIHCP’s numerous behavioral healthcare certifications

Neglect and Emotional Abuse

Emotional abuse is a trauma overtime that can lead to a survival state due to the repeated abuse or neglect.   Around 80 percent of all maltreatment of children can be reduced to emotional abuse and neglect.  While these things do not necessarily require physical or sexual abuse, they gradually wear the person down.  This is especially true of children with developing brains that can be hindered by chronic emotional abuse or neglect.

According to Contreras, neglect as a type of abuse categorized as omission (2024, p. 183).  With neglect and emotional abuse, the child or even person enters into a state of survival mode.  One is on red alert constantly for what may go wrong in a particular day due neglect or emotional abuse.  When those limits are met, just like any stress, the person is able to adjust or lose ability to cope and falls victim to the stressor, trauma or abuse.  These individuals will have emotional regulation issues, hyper or hypo arousal states, and react to the abuse in different ways according to these states.  Individuals under constant barrage can fall into fight, flight, fawn or fade as the daily barrage of abuse or neglect degrades their personhood, identity and mood.  In these cases to survive the prolonged neglect and abuse, the person appeases, becomes aggressive with others, looks to escape confrontations, look to please, or fade into thinking there is no true abuse (Contreras, 2014, p. 201-202).  From this, neglect and emotional abuse drains the person of self, identity  and self worth, replacing daily actions into survival responses adapted for prolonged exposure to the stressors or minor traumas of the day.  It is because of this that many who have gone through such abuse or neglect, develop C-PTSD.

Emotional Abuse and Neglect

Neglect to basic needs, both physical and mental are detrimental to children and their development into mentally stable adults.  Neglect and emotional abuse not only hurts the development of the brain but also can lead to physical ailments due to the constant state of survival.

Chronic emotional abuse according to Contreras is any words or non physical actions that hurt, belittle, weaken, manipulate or frightens a person.  In addition the abuse causes distortion and confusion that shakes the person’s very stability in life.  Many forms of mental abuse are carried on through neglect, but also intimidation, manipulation, objectification, gaslighting, yelling, and even obsessive jealousy (2024, p. 184).   Individuals are left with exhaustion, depression, low self esteem, and feel trapped.  In doing so they look for maladaptive ways to cope with trauma.  Many times, especially children, but also adults, can become stuck in a co-dependent relationship which are detrimental to all levels of their existence.  While the person is not in a life or death situation,  the person does develop a shattered sense of self.  This is accomplished through mind games, devaluation, and scheming that mentally undermines the person.  Contreras lists manipulation, gaslighting and objectification as key ways of controlling and harming the person (2024, p. 187-189).

Manipulation, gaslighting and objectifying another human being are all types of emotional abuse. Please review AIHCP’s behavioral health certification programs

Manipulation

Contreras defines manipulation as a type of subtle abuse to debilitate a person’s will and capabilities to obtain personal gain,  control, submission, obedience and pleasure from the abused (2024, p. 187).    Individuals who are constantly manipulated lose sense of self, and self esteem leading them to feel used, depressed and hopeless.  If they do not respond to the manipulation, many emotionally and neglected fear abandonment and rejection from the abuser.

Gaslighting

According to Contreras, gaslighting is an effective for abusers to control and manipulate their victim.  They do so by making the individual doubt his or her own reality making the person feel crazy or insecure (2024, p. 188).  It intentional to control the person and keep them within the abuser’s web of chaos.

Objectifying 

In many cases, those who are emotionally abused, as well as physical, are objectified as property.  The person loses autonomy of self.   Contreras lists a variety of ways objectification occurs.  Instrumentality refers to using the person as a tool to meet an end or satisfy one’s own goals.  Denial of autonomy refers to the inability for the person to act on his or her own without consent from the abuser. Ownership refers to a person’s literal autonomy belonging to the abuser to be used and sold as the abuser sees fit.   Denial of subjectivity dismisses the abused and his or her experiences or feelings as not worthy of attention or need.  Finally silencing refers to taking away the person’s voice (Contreras, 2024, p. 190-191).

Individuals who objectify other human beings in general lack any form of empathy, are ego-centric, and put their needs and goals over everyone.  They are usually tied to the personality disorder of narcissism (Contreras, 2024, p. 189).

Unfortunately, this leads to trauma bonding which according to Contreras, leads the abused to an attachment with the abuser that disempowers the individual into a perpetual state of defeat under the mirage of being loved (2024, p. 192).

Conclusion

Please also review AIHCP’s healthcare certification as well as its trauma informed care program

Severe neglect, as well as emotional abuse is a different wound than physical wounds.  They may not inflict immediate death or harm but they lead to a chronic breaking of the spirit and the person’s development.  It leads to a host of emotional and mental problems that destroy the mind and soul.  Due to its usual chronic state and repeated offenses, it wears the person down and can manifest in states of C–PTSD where the person enters into a constant survival state that breaks down not only the mind but the body.  It steals the joy of life and the dreams of others.

Please also review AIHCP’s Trauma Informed Care Certification as well as AIHCP’s Healthcare Certifications

 

Additional Blog

PTSD vs C-PTSD.  Click here

Resource

Contreras, A. (2024). Traumatization and Its Aftermath: A Systematic Approach to Understanding and Treating Trauma Disorders”

Additional Resources

Valdez, R. (2025). “Signs of Emotional Abuse”. VeryWellMind. Access here

Pietrangelo, A. & Raypole, C. (2025). “How to Recognize the Signs of Emotional Abuse”. Healthline. Access here

“Emotional Abuse”. Psychology Today.  Access here

“What Is Emotional Abuse”. National Domestic Violence Hotline.  Access here