Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
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 previous articles by Ann Catlin, LMT, NCTMB, OTR.
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