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Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
August, 2012, Vol. 12, Issue 08
Documentation in Hospice: What Do Employers Expect?
By Ann Catlin, LMT, NCTMB, OTR
Hospice organizations that hire or contract massage therapists expect professionalism. They expect sound documentation skills. Although there isn't a lot of consistency in how documentation is carried out, what IS consistent is the requirement to do it, and do it well.I once spoke with a hospice director who told me, "We use to have a massage therapist but it didn't work out." When I asked her what went wrong, she said one reason was that, "her documentation was poor quality." The take-away message here is: Sharpen your documentation skills and accept that it is an important part of the job if you want to work in any aspect of our health care system.
The main reason you became a massage therapist most likely wasn't because you were excited about doing paperwork or writing progress notes. Ask any nurse or physical therapist or physician and they will tell you it isn't their favorite thing, either. I've found if I re-frame my ideas about documentation, then an attitude adjustment is quick to follow. What follows are good reasons to pay close attention to your documentation skills.
Credibility: How you represent your work in progress notes reflects your degree of professionalism in the eyes of employers and coworkers.
Efficacy: Progress notes provide a means to track effectiveness of techniques or approaches in attaining desired goals.
Functional Outcomes: Your notes tell a story, over time, about the difference massage makes in your client's activities of daily living.
Improved relationship with colleagues: When your documentation provides valuable information for coworkers, your work is taken more seriously and you demonstrate that you are a team player.
Legal record: Documentation is your legal record of the services you provided.
Marketable skills: When applying for a position in hospice, highlight experience you have with healthcare documentation.
Don't just take my word for it. I did an online search for massage therapy jobs in hospice and in almost all notices job requirements referred to documentation skills. It's also worth noting that the number of job notices online is growing. Here are a few examples taken from postings that mention expectations with regards to documentation:
Keeping SOAP Notes Simple
For those of you whose eyes cross at the mention of progress notes, I want to offer a simple guide that is relevant to hospice. Since many use SOAP notes, it's likely you will be required to use this format. Think of a SOAP note as a picture of the session, showing the reader what you observed of your client; what you did, how your client responded and what you plan to do for future sessions.
S = Subjective information. In this section, record verbal comments your client makes about any of these things: their reason for and desired outcome of the session; a description of symptoms; the effect of symptoms on activities of daily living; and pain levels or other discomfort. It's common for the hospice care team to determine levels of pain using a pain scale the Wong-Baker Faces and Ruler Pain Rating Scale. You should also record any other relevant comments by the patient or family caregivers.
O= Objective observations. This section includes both observations of the client and what you did during the session. Describe just the facts about your observations — only what you can see, hear, touch or smell. Observations might include, but are not limited to special communication needs; breathing patterns; movement; muscle texture; functional mobility; body posture or position; skin condition; facial expression; sign of stress or agitation; interpersonal interaction; alertness; observation of confusion or memory loss; and non-verbal signs of pain.
The record of what you did should include information about site restrictions, precautions taken, the length of the session, bed or wheelchair positioning adaptations performed, massage or bodywork techniques that were utilized and which area of the body was addressed.
Descriptive language of the techniques used could include: focused touch, gentle compression, petrissage/kneading, effleurage/stroking, gentle stretching, holding, shared breathing, gentle rocking, moisturizing, abdominal massage, manual lymphatic drainage, energetic modality and caregiver instruction or support.
A= Assessment. Record the immediate results of the session including observed client responses and changes. Examples of observable responses might include signs of decreased pain; positive verbal comments; decreased agitated behaviors; fell asleep; increase in social interaction; appears more engaged; decreased muscle tension; relaxation response; deeper breathing; appears more alert; change in facial expression; improved movement; postural change; skin changes; returned touch; and improved ability to perform an activity of daily living.
P=Plan. This section includes information relevant to the treatment plan, including frequency of future sessions; additional client needs; treatment recommendations for future sessions and desired outcomes; client requests; and a need for caregiver instruction.
On the Job
I interviewed several massage therapists employed in hospice or long-term care about what documentation is required of them. As expected, it varies a great deal. Some organizations use electronic systems and more organizations are transitioning to electronic record keeping. Some organizations provide the therapist with documentation forms developed by the company. Other therapists must provide their own forms. Some use a structured SOAP note form with checklists, others write narrative notes or a combination of the two. Most organizations place the therapist's documentation in the medical record or other patient chart.
Valerie Stoughton Hartman is a Complementary Therapy Hospice and Palliative Care Nurse and Chairman of the National Hospice and Palliative Care Organization (NHPCO) Allied Therapy Section. She says that complementary therapies have taken a place in mainstream services provided by hospice programs in the United States. While many hospices appreciate and grow volunteer complementary therapy programs, others remain committed to hiring hospice prepared therapists.
When it comes to documentation, the industry is in the midst of figuring out best practices. As it stands right now, documentation standards are dictated by each individual hospice program. Administrators make executive decisions in order to assure accurate documentation reflects the purposeful use of a modality. Hired therapists have a responsibility in the referral process, interdisciplinary team communication, evaluation, assessment and provision of service. Volunteer expectations are often much less demanding. The NHPCO is a resource for program development if a massage therapist volunteers or is hired to work with a hospice program that is a member of the organization.
I agree with Valerie when she encourages massage therapists working in hospice to join the NCHPP Allied Therapy Section, which oversees allied therapy and complementary therapy use and integration in end of life care. We can all have a voice in establishing best practices in this rapidly growing field of massage.
Click here for more information about Ann Catlin, LMT, NCTMB, OTR.
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