Hospice Navigator

Body Language Tips: What your Hands are Saying

2011-08-04T11:00:00.001-07:00

While body language can be interpreted in many ways and it's not an exact science, it is often possible to read body language and have a basic understanding of a persons mood or dispositions and the rapport that people have with each other through observing non-verbal communication. This issue focuses on reading everything that hands can tell you and ways to use your hands to influence interactions with others:

What's in a Handshake?

How we shake hands gives alot of information about us. We often make judgments based on what we experience even in a handshake and it influences our perception of the other person. Do you look the person in the eye when shaking hands? Do you have a strong grip? When someone turns your hand to face upwards in a handshake, their presentation is one of dominance. This is also true when they grip your hand tightly and powerfully. The handshake is absolutely of significance depending on the purpose of the meeting, the roles of the people meeting each other and the circumstances around the meeting. When the handshake is vertical with both parties shaking with equal pressure, the mood is set for a positive rapport.

During a handshake touching any other part of the body is considered too intimate unless you have an established relationship with them. The exception to this rule is however, a touch to the elbow, which is not considered to be an intimate part of the body. Having said that, different cultures have rituals and norms that govern the initial meeting which will influence your ability to read their body language. When considering meetings for business or networking, researching the people who will be present, cultural norms and managing your own behavior can help to guide the meet and greet in the right direction.

Positive Hand Signals

There's no better hand signal than the thumbs up sign to signal something positive. It can also be cheezy depending on who, how, why and where the thumbs up signal is used. Our friend Borat is a master at awkward and inappropriate gestures that get him into trouble. Having awareness of appropriate signalling, timing and positive body language can absolutely help the interactions.

When we show our palms when talking it means we are being honest and telling the truth. When you talk using your hands and showing your palms, it influences others to tell the truth too.

When someone places their head on their open hands as if on a platter, they are signalling their admiration and respect for you. Some cultures use this type of signalling consistently and during greetings as a sign of respect. Be sure to mirror their respect with gestures that are respectful in return.

Rubbing hands together signals that the person is expecting something positive, with the speed of hand rubbing giving information about who will reap the benefit. It often signals excitement too, so this kind of gesture can set the tone in the room. Hopefully the expected positive event will come true and the person's credibility is not tarnished.

Placing hands in a steepled gesture gives an air of authority and confidence. Depending on the situation, this can be either a good behavior or a bad one. Similarly, holding hands behind the back also shows an air of confidence. Pay attention to hand gestures and postures you might routinely see among people in leadership positions. These gestures impact how you feel about the person in addition to other pieces of information that helps to form your opinion.

Negative Hand Signals

We also know when certain hand signals are threatening or negative. With this in mind, it is never a good thing to use any of the hand signals that will elicit a negative response if you are hoping for a positive rapport. You might also want to think twice about dominating and hostile postures that will spill the beans on how and when you plan to take charge.

Hands held on the hips symbolizes a dominant posture. If the thumbs are tucked into pants pockets, this posture is one of aggression. You can probably guess that there is something bubbling underneath the exterior. Thumbs protruding from pants pockets show an air of superiority which is not often a welcome sign.

Pointing at someone is essentially an annoying gesture that can also be interpreted very negatively depending on the interaction and the disposition of the people involved. Finger pointing in a tense or negative conversation adds fuel to the fire and makes the situation worse. Situations that escalate out of control require managing before they get to the finger pointing stage. If the finger pointing has started, a time out followed by a mediation might be the only solution.

When hands are clenched the person is feeling anxious and negative and is holding back their emotions or a negative reaction. Similarly holding wrists behind your back is an attempt at self control in a negative situation. You might also see people squirming and eyes darting when they are trying their best to hide their disdain.

When you observe someone picking at their clothes, this can be a signal that they have an opinion about the situation or about you or someone else that they are keeping to themselves and are unwilling to share.

Body Language Influences

As with most issues related to human nature there are other influences that impact the interpretation and perception of some behaviors, so we can never say that we can read and interpret behaviors and body language with 100% accuracy.

Most commonly, gender differences will influence both interactions between the genders and those commonly used by each gender. When entering a room, women tend to use 27 distinct behaviors while men displayed only 12 distinct gestures.

Being mindful of body language behaviors unique to certain cultures is important too. For instance. The thumbs up sign in Latin America, West Africa, Greece, Russia and the south of Italy is an overtly offensive gesture that will elicit a very negative response. The peace sign with the back of the hand displayed in the British Isles, Ireland and Australia has a similar meaning. A summoning finger signifies "death" in Singapore and in the Phillippines, this gesture is how you might call a dog over, a sure sign of disrespect when directed towards another person.

Familiarity plays a role specifically related to the level of comfort between the people and the level of knowledge people have about each other. Touching and embracing increases between people that know each other making the interaction more personal and often more relaxed.

The setting where people interact influences behaviors also. In a formal setting, relaxed interactions are less likely such as in a professional setting or a work related interaction. Signs of affection or extremes of emotion are not considered appropriate in a formal setting either, so you may witness people controlling their behavior with gestures that hide their true thoughts and feelings.

Pay attention to body language next time you are in a crowd and perhaps use some of these tips to influence the interaction in a positive way!

The Hospice Navigator Crazy Busy Tip: 4 important assessment tools

2011-06-01T09:51:00.001-07:00

Medicare regulatory requirements for hospice care include proving how patients with life limiting disease meet hospice eligibility requirements. These guidelines known as the local coverage determinations (LCD's) are issued by Medicare Administrative Contractors (MAC's). The LCD's are approved by the Center for Medicare and Medicaid Services (CMS) and are used to determine ongoing eligibility for hospice care. Visit CMS's Hospice Center to view the LCD's in your state.

Proving hospice eligibility is a grey area since prognostication is a "best guess" scenario supported by many variables. At the very least, hospice clinicians need to document the guidelines cited in the LCD's for disease specific evidence of decline in clinical status where applicable in addition to non-disease specific indicators. Thereafter, comorbid conditions and other factors that add to the clinical picture can be highlighted in addition to the unique patient specific factors that influence each patient's trajectory of illness. Graphing the decline in clinicals status over time may be helpful to the clinical team in focusing assessments and evaluating the meaning of findings in the bigger picture.

The next step in documenting patient eligibility is to quantify the severity of disease or symptoms experienced. Hospice clinicians can best support these requirements by utilizing standardized assessment scales and tools. These tools are required in the LCD's but are also indicative of the extent of disease and add to the probability of decline in the coming weeks and months. In this crazy busy issue, we will cover 5 scales listed in the local coverage determinations that help to prove hospice eligibility. At the very least, hospice clinicians should be using these scales where appropriate:

Crazy Busy Tip #1: The Palliative Performance Scale

The palliative performance scale is a modification of the Karnofsky performance scale specifically for patients receiving palliative care. The scale uses 5 observer rated domains to assess functional status. Results correlate with actual survival and median survival time in cancer patients. Lower scores are indicative of poor performance and poor prognosis. Using the palliative performance scale to determine care needs is useful as the patient's disease progresses.

Hospice Eligibility: A palliative performance scale (PPS) of 70% or less is required for hospice eligibility. Further requirements depend on the terminal disease. Median survival of patients with a palliative performance scale of 70% is 145 days. A palliative performance scale of 40% or less is indicative of a poor prognosis in patients with stroke. The trajectory of decline towards death is different depending on the terminal disease. Differences that we must be mindful of include for example: Cancer patients tend to be functional with a higher PPS for a longer period of time & when decline occurs, the decline is rapid. Dementia patients on the other hand will decline slowly over a longer period of time and therefore, attention to small changes from one week to the next is needed.

How to: Nurses and physicians should document the palliative performance scale routinely during assessment visits and interdisciplinary team discussions. The initial assessment provides the baseline for which the patient's decline in clinical status is measured. Decline in the palliative performance scale over time is indicative of hospice eligibility in conjunction with disease specific findings. Documenting the hospice's and clinical teams response to care needs highlighted by the palliative performance score constitutes a specialist level use of the scale. Nurses and physicians who document the scale as a matter of course are instrumental in helping build the case for hospice eligibility in addition to describing the patients functional state.

Caution: Inconsistencies in the palliative performance score across disciplines and over time is indicative of inaccurate assessment and use of the palliative performance scale. Patient's whose palliative performance scale improves over time should be assessed for continued hospice eligibility. Staff training is indicated if the palliative performance score is variable depending on which team member is assessing the patient.

Crazy Busy Tip #2: The Functional Assessment Staging Tool (FAST) score

The FAST score was developed by Barry Reisberg, MD at New York University Medical Center's Aging and Dementia Research Center. The FAST score measures the stages of Alzheimers disease. In the absence of a definitive Alzheimers diagnosis, the FAST score is used to assess dementia however, other types of dementia do not follow the decline trajectory as defined in the FAST score. Late stage dementia is characterized by severe cognitive decline, loss of verbal skills and loss of psychomotor skills.

Hospice Eligibility: A FAST score of 7 is required for hospice eligibility per the local coverage determinations. Further to the requirement, the patient must also be "unable to ambulate" which correlates with a FAST score of 7C. Additional requirements include inability to dress without assistance (6A), inability to bathe without assistance (6B), urinary and fecal incontinence (6D & E) and no consistent meaningful verbal communication (7A) with either stereotypical phrases only or 6 or fewer intelligible words. Bear in mind that the duration of each stage can be 12-18 months, clearly showing that the FAST score in itself is not a definitive indicator of hospice eligibility. Comorbid conditions add significant value to proving eligibility when they affect day to day functioning, cause complications and further decline. Focusing on attributing decline to the dementia or to the comorbid condition should not be undertaken as it does not paint a clear picture of the patient's condition if relevent clinical information is not assessed and documented based on association with a disease process.

How to: Patients with a hospice diagnosis of dementia or related disorders should have the FAST score assessed routinely. Nurses and physicians should document the FAST score on admission, during assessment visits and interdisciplinary team discussions. The initial assessment provides the baseline for which the patient's decline in status is measured. To complete the FAST score, the score is the highest consecutive level of disability. Decline in the FAST score is expected over time. Nurses and physicians who document the scale as a matter of course are instrumental in helping build the case for hospice eligibility in addition to describing the patients cognitive and functional state.

Caution: Do not complete the FAST score in clinical documentation if the patient does not have dementia or alzheimers disease. In these cases, the FAST score does not offer any value or information that supports the terminal condition. Inconsistencies in documentation of the FAST score across disciplines or over time raise a red flag as far as credibility of the scoring. If the hospice diagnosis is Dementia & the patient is ambulatory without assistance, the patient is most likely not eligible for hospice care. Consideration of all comorbid conditions and determination of the hospice diagnosis that best suits the patients status is recommended.

Crazy Busy Tip #3: The New York Heart Association (NYHA) Classification

The NYHA Classification, published in 1928, is a functional classification system for heart disease. It is based on clinical severity, prognosis and relates symptoms to everyday activities and quality of life.

Hospice Eligibility: If the hospice diagnosis is heart disease, the NYHA classification should be stage IV to meet the criteria for hospice eligibility. Stage IV heart disease is charachterized by symptoms of heart failure or anginal syndrome at rest. Symptoms include chest pain, dyspnea, weakness and inability to tolerate activity without discomfort. Additional criteria necessary for hospice eligibility with a terminal diagnosis of heart disease includes optimal treatment of heart disease, the patient declines or is ineligibility for surgical intervention, an ejection fraction of ≤ 20% and a history of a one of the following in the last 12 months: Treatment resistent SVT or ventricular arrhythmia, unexplained syncope, cardiac arrest, brain embolism of cardiac origin and / or concomitant HIV disease. If the patient is not symptomatic at rest and does not require routine use of medications to alleviate symptoms, the hospice team should evaluate 1. hospice eligibility 2. comorbid conditions 3. the appropriateness of the hospice diagnosis.

How to: When assessing the patient at rest, symptoms related to heart disease must be present. If patient is aided by oxygen, clinicians should evaluate if the patient is symptomatic on room air. Assessment of the presence of chest pain, dyspnea at rest and ability to tolerate activity is vital. Additionally, the use of medications to alleviate chest pain, manage other symptoms and the frequency of discomfort experienced should be documented as these medications show a requirement for treatment and resulting improvement in the experience of symptoms. If not documented, the presence of symptoms may not be accurately reported and give a contradictory account of the patient's status. Don't forget to ask about how the patient is at different times of the day, with activity and look for patterns in their symptom profile. The NYHA classification should not be documented unless the patient has documented heart disease.

Caution: Documentation of the patient's condition must support evidence of stage IV heart disease and the patient is expected to be symptomatic at rest. Documentation that shows independence & lack of symptoms does not support class IV disease. Medications for the management of symptoms associated with heart disease must be documented if symptoms are well controlled. If the patient does not have heart disease, do not complete the NYHA classification. If evidence of end stage heart disease is not present at rest, the hospice team must consider 1. the patient's eligibility for hospice care 2. the correct hospice diagnosis. Evidence of the severity of disease is supported by the results from an echocardiogram or MUGA scan. Every effort should be made to obtain a copy of these results to support the prognosis. If the ejection fraction is not 20% or less, the hospice team should consider the patient's clinical status and document how their condition meets hospice eligibility criteria.

Crazy Busy Tip #4: Body Mass Index (BMI)

While BMI is not an indicator of terminal disease, significant changes to the BMI over time assist in painting a picture of decline in clinical status. Evidence of weight loss is most often a strong predictor of decline in clinical status. The terminal illness offers information about whether weight loss is a factor that impacts the prognosis. For example, a patient with lung cancer with usual body weight of 140 lbs who lost 16 lbs in the past 6 months is a strong indicator of decline in clinical status. Alternatively, a weight loss of 16 lbs for a patient with heart disease and who is obese may be indicative of an improvement in their clinical status. Having a baseline reading and a history or progressive weight loss over the previous year is important to document in addition to the impact the weight loss has on the patients overall health. Even if the baseline was not obtained at the time of admission, a reading within the past year is helpful.

Hospice Eligibility: Weight alone is not a determinant of hospice eligibility however, weight loss of 10% of usual body weight in the past 6 months is an indicator of poor prognosis. An accurate account of exact weight loss is very helpful in evaluating decline over time and assisting in proving eligibility when there are only small changes that support decline in status. Establishing the BMI on admission, whether the BMI is within a normal range for the patient, weight loss over the previous 6 months and the relationship between the weight loss and the terminal diagnosis is advised and should be documented. Further development would include information about the patient's appetite, fluid intake and hydration status, type of food / nutritional intake, amount tolerated and other signs and symptoms that may influence the patient's ability to maintain their intake and weight.

How to: If possible, obtain a baseline height and weight on admission. Weight loss or gain in the past year should be documented and the patient's account of their usual body weight. If bodyweight is below normal for weight and height, this should be highlighted in addition to weight loss of 10% or more. Of note is weight loss that occurs rapidly with no explanation other than advancing disease. Use the formula above to calculate the BMI or you may download a free BMI calculator to your phone that will calculate the BMI for you. When documenting BMI, make sure also to document the height and weight.

Caution: BMI alone will not be sufficient to show the patient's decline in clinical status. The history and impact of weight loss on the patients clinical status is important to document. If the BMI is normal or the patient is obese, weight loss may not be significant in the clinical picture. If the BMI increases over time, the hospice team should evaluate the reason for weight gain and whether the patient continues to be eligible for hospice care. If the BMI increases as a result of weight gain associated with the terminal diagnosis such as fluid accumulation in patients with liver disease or heart disease, the hospice team should be vigilant about documenting why this increase has occurred. Often, hospice care and assistance in feeding provided by the hospice team may assist in weight gain. An important point to highlight when there is an improvement is whether hospice interventions have been effective in bringing about this positive result. If weight and BMI cannot be measured and documented, the hospice team should be descriptive about signs of weight loss or gain that they observe.

Documentation in the clinical record may be aided by the availability of assessment scales and tools through electronic medical records, through forms and tools available at each hospice organization or through self study and use of reference documents. Clinicians should use scales and tools where possible to standardize documentation of assessment observations and findings as approved by their hospice. Pocket guides and portable reference guides are most useful to facilitate the use of multiple scales during patient assessment.

In our next crazy busy tip of the week, we will explore non-disease specific evidence of decline in clinical status.

Brought to you by Practitioner Solutions. www.practitionersolutions.com.

In the End: 10 Things Not to Do During a Loved One's Last Hours

2011-04-29T20:07:00.001-07:00

I agree with point that you make here, but unfortunately most people don't know ahead of time and have to go through the process to peel off the layers and learn how to help a dying person die comfortably. I've learned most of my life lessons from my work with hospice patients and while some of the experiences were painful, they also needed to be experienced. We should be mindful that what we know as hospice and palliative care clinicians is our view & is not necessarily that of the patient's and families that we care for. For that reason, I would never recommend keeping the person home when they would want to be in the hospital. I had the pleasure of caring for a concentration camp survivor receiving chemotherapy and could not understand why she wanted every last drop of chemo until the MD explained to me that she made him promise to treat her up until her last breath. It's also a terrible feeling to wonder whether you made the right decision at the end of your loved one's life and have the belief that you made the wrong choice. Each scenario is different and requires individualized attention. There is no one size fits all and there are many ways to get to the same best conclusion. I'm grateful for the opportunity to read more end of life care articles and to talk with people about their thoughts and beliefs. Keep up the good work!
Read the Article at HuffingtonPost

Interesting Facts about popular Social Media Sites

2011-02-17T09:41:00.001-08:00

Did you Know?

There are 31 billion searches on google every month.
7% of internet users look for information online about end of life care (Pew).
In 2010, internet users worldwide increased by 14%.
There are 88.8 million domain names (AKA web addresses) registered
The number of blogs have risen dramatically to 152 million.
130 million photographs are uploaded to Flickr every month
Technology is advancing so quickly that by the time students graduate with a 4 year information technology degree half of what they learned will be outdated.
Google searches now integrate social searching so that information that you receive in your searches are further filtered to include postings and related online content from your friends, contacts and groups.

Need more convincing to get busy online?

Facebook has over 500 million users worldwide with 50% of them logging into Facebook every day.
150 million users access Facebook from their mobile devices
The recent events in Egypt highlight the power of social media platforms to report information that may otherwise be banned or miscommunicated.
People spend an average of 14 mins per day on facebook and have an average of 130 friends on their facebook profile.
Users not only use Facebook to connect with friends, families and groups they also Ask Questions, Perform Searches and Develop Campaigns to name a few!
The highest population signing on to and engaging on facebook are age 65 + which equates to approximately 18 million new users.
Facebook is the 3rd most visited website on the internet.

There are 175 million Twitter Users
85% of twitter members tweet less than once a day
5% of twitter accounts create 75% of all tweets.
50% of twitter accounts were created using a mobile device
53% of users are women

70% of you tube users are registered in the USA
50% of users are under 20 years old
Every week, enough material to release 60,000 movies is uploaded to You Tube
More and more people have the capacity to create, upload and share short video's with webcams, smartphones and mini-cam's
People love to watch engaging video's

Social Media is good for Business?

The marketing world is changing, advertising is changing and how people are engaged is really changing. The world of big billboards and flashy flyers is disappearing rapidly and replaced by inbound lead generation. Now, what does that mean? Well, when someone searches for hospice....they are looking for you, instead of you reaching out to them. 4% are ready to sign up, sign on or engage with you in some meaningful way. The rest are like sponges, looking for information and resources. When they land on your website, it must grab their attention, give them what they are looking for and somehow call them to action. This means that you must show them what you want them to do....call your main number, sign up for a newsletter, donate, volunteer and the list is endless. Your website and all your bloggers, tweeters, facebookers and engagers are portals of access for your organization and health system. It's that simple!

Do you have a Social Media Plan?

You may not! And you might be thinking about it! The ship is docked and waiting for you. At some point, when the time is right, you might make that move into the big unknown. In fact, the sooner you do, the better. Get help if you do not know what to do. Google: "Social Media" there are thousands of articles to read. Need policy examples, here are some to start: http://socialmediagovernance.com/policies.php

How is the Healthcare Industry doing with Social Media?

One statement: "Lost in Space"

Most healthcare organizations do not have their finger on the pulse of what is current and active on the social media scene. They are too busy and focused on the delivery of healthcare and haven't reacted quickly enough to the gaping hole in engaging people online. Their IT people are engaged but there is a disconnect on how to present medical information in a social way. Who should we follow? Take a page from Dr. Oz. Now there's a social doc. He's busy telling people really interesting things about their health and engaging them in discussion. He shows them that he cares and wants them to be healthy. He has the "move it or lose it campaign" and has enlisted experts to answer questions on the sharecare network. Brilliant! I'm getting on that train....how about you?

The solution:

Clinicians must engage online: Write Blogs, Answer Questions, Be reachable by email, Tweet
Create Clinical Social Media Roles in your organization. Start by forming a committee and learning, exploring the social world.
Decide what the Meaningful Use of Social Media is for your organization and proliferate great content and a cohesive mission.
Develop an innovative social media plan and implement it yesterday!
Each clinician is a resource in social media and their skills can be highlighted and showcased.
Don't have time? Pay someone to do it for you.
Use time and cost effective social media tools and platforms.
Take another look at your marketing / development plan. Do you have a budget for social media?

A moment of pause:

The ramifications of social engagement are of concern. Much is at stake in the protection first and foremost of patient confidentiality. Healthcare organizations build a brand and must protect it. Many negative comments and actions happen online. The development of social media policies, strict monitoring and an action plan to manage negative feedback is really important.

The effects of social media on privacy and the division between personal and professional life is getting very blurred. We are seeing the impact and sometimes uncomfortable effect of personal meets professional in the social media forum. While I'm engaged by the content of your presentation about the state of hospice care right now, I'm also interested in hearing about your vacation and seeing pictures of your family. How many of you are comfortable with that?

Even with our reservations and our awkwardness with how to engage people, we need to catch that ship and get on that train.

The Ship has left the Port, The train is Leaving the Station, Elvis has left the Building.

Feeling the pressure to act? That's how immediate the need is to engage with social media online.

What did the Mommy Tomato say to the Baby Tomato.....Ketchup!

Hope you won't have to!

4 tips to engage readers on Social Media about End of Life Care

2011-02-03T09:20:00.001-08:00

We know it's a difficult subject, and finding ways to engage readers, attract new readers and provide useful information is essential. We have an ever shortening attention span and on a daily basis are bombarded with information from many sources. Here are a few tips to help you focus your social media efforts to be as effective as possible:

What is the goal of your social media engagement?

Be mindful about what your articles and posts will compel your readers to do, such as: engage you further by contacting you, comment on your articles and posts, access your services, sign up for more information, call you, apply for a job, volunteer, donate etc. Knowing what you would like your readers to do, providing an avenue of access to you through email, telephone number, posting on your blog or social media site, sharing information etc. and preparing yourself and your staff for hearing from people as a direct result of your social media engagement is as important as the engagement itself.

Light-hearted heavy discussion!

Some people take the subject matter waaaayyy toooo seriously and are more passionate about it then the average Joe! Having said that, your expertise in the field is of great value if you can present it in an engaging vibrant way that is informative without too much negative emotion. When I teach about the dying process to massage therapy students I tell strange and engaging stories about the patients I've had the pleasure of serving mixed in with the educational material that they need to know.

Try smetniohg dfreirnet

I bet most of you were able to figure out the heading of this tip. And if you couldn't, it still grabbed your attention which is exactly what you hope to do when you communicate on the internet. Or maybe you find supernurse entertaining. She looks even better with her cape flapping in the wind. Whatever the method you use, knowing what will get readers attention is the key. People read websites in a predictable way, so placing your articles strategically on your site will result in more clicks on your links. Visual readers are engaged by pictures and colors while detail oriented readers love to see lists and tables that summarize the content. However you must put your listening ears on first, so you can get your finger on the pulse of what the people in your community are looking for. Then find interesting ways to present the material.

Is there anyone out there?

The last thing you want to do is to present information without engage your readers. Providing the opportunity to give feedback, creating a discussion forum, making professional online services available or even asking your readers to guide the discussion is very useful. People love to give their opinion and your goal is to provide resources and services around the subjects that they are looking for. If you don't.....you've missed the boat!

While your journey into the online world may be frought with questions, look to the people who are successful at it, and follow their lead. Identifying your mission for your organization in the social media forum and be an active participating tangible human in the process. On a personal level, we are doing well with our facebook, you tube, linked, myspace and blog pages, tracking and following our friends and families. Some of us tell the world far too much information, while others create a stellar online personality. It's up to you! You at least need to be on the train and enjoying the scenery!

Social Media Bloopers and No...No's!

2011-01-26T10:55:00.001-08:00

Hospice and palliative care organizations must pay attention to their image and reputation when engaging readers and followers on social media sites. Being associated with other reputable organizations and individuals is paramount to ensuring success. When engaging staff and other people on social sites, hospice & palliative care organizations must ensure the content, posts and comments meet an expected standard. Learning the hard way, can be a challenging and embarrassing lesson when it comes to media sites and content. Here are examples of bloopers and mis-steps that have happened online:

What happens online....stays online:

If you post something online, it's indelible forever. If the content is engaging and amusing, it will be shared far and wide! Sometimes the wrong stories, video's and pictures go viral for the wrong reasons. Having a screening, editing and approval process within your organization can help. People have been known to:

Post their personal issues on their professional profiles

Make derogatory remarks online that damages their online profile

Make remarks that were interpreted incorrectly and / or

Have skeletons in the closet that inadvertently became public knowledge.

Case in point.....

During your college days....years ago, you and your buddies posted explicit statements and pictures on your facebook page one night. A human resources staff member happened to do a google search one day and there you were re-exposed again. If it hasn't happened to you, you know someone who it happened to or you know someone who is at risk. College students are notorious.

Rules of Engagement:

Healthcare organizations have the added burden of ensuring patient confidentiality. Posting names, pictures, medical information and identifiers that can be associated with a patient without their consent or knowledge violates HIPAA rules. If hospice staff are posting on your / their social media pages a constant reminder is necessary regarding the rules of engagement. People have been known to:

Post pictures of themselves with a patient on their facebook page which include the patient's name, diagnosis and thoughts about the patient's health status.

Post a reply on a patient's blog page which was unsolicited and details their health information.

Provide patient contact information to unauthorized people online

Case in point.....

A woman in Ohio who had a surgical procedure sued her surgeon for publishing before and after photographs without her consent.

An EMS worker was fired for taking pictures of a naked trauma victim and posting these pictures on their facebook page.

A Los Angeles hospital banned the use of cell phones and laptops by employees after numerous photographs were discovered on employee social networking pages

Inappropriate Shenanigans

Have you ever posted or tweeted while under the influence of happy hour beverages! People tend to be impulsive and un-inhibited when under the influence. Comments are posted, cellphones get sequestered and suddenly someone has posted a comment on your social media site that is completely inappropriate. All PDA's, laptops and electronic devices should be password protected without exception when patient information is contained within and when your professional and personal reputation hang in the balance. Just like the statement "Friends should not let friends drive drunk".......friends should not let friends post on social media sites during happy hour. For those of you with a propensity for inappropriate spontaneity....a downloadable solution exists at http://socialmediasobrietytest.com/ Personal branding is an important professional activity not to be taken lightly.

Case in point......

A Missouri Congresswoman's facebook account apparently was hacked and a status update was posted which read: "I love lobbyists! All the free food and stuff you get. This job is awesome!"

What you say can be held against you

Have you seen defamatory comments about organizations and individuals online? Apparently, in a litigious society, the risk of being sued is significant. Any negative comments about any subject matter are best avoided on all social media sites representing any professional organization. Hospice & Palliative Care organizations are well served to distribute their policy about social media site use by employees and make policies known to patients, families and vendors. Prevention and developing a rapid response strategy to managing negative social media events should be part of the policy development.

Case in point......

A Chicago company sued a tenent for her defamatory tweet about a moldy apartment which cost her $50,000 due to the actual or perceived damage to the realty company's good name.

A $25,000 fine was suffered by the Dallas Mavericks owner for badmouthing the referees online after a team loss.

Social media monitoring is a necessary activity to screen for negative or inappropriate comments, remove posts that are deemed inappropriate and to police professional sites. While many organizations are cautious about social media use, they continue to expand and organizational presence is a must. Social media management companies offer the types of "listening" tools to offer monitoring and proactive management of postings online. This helps significantly to ensure appropriate and reputable posts so organizations never have to learn the hard and embarrassing way.

For more social media tips follow us on:

Facebook: http://www.facebook.com/#!/pages/Practitioner-Solutions/228008080081

Twitter: @eolnavigator

Blog: http://www.hospicenavigator.blogspot.com/

Need social media management? http://practitionersolutions.com/solutions/social-media-management/

Brought to you by Practitioner Solutions. www.practitionersolutions.com.

The Hospice Navigator Crazy Busy Tip of the Week: 5 Body Language Tips

2011-01-14T10:55:00.001-08:00

When working with a patient population with chronic and terminal illnesses, very often, stressful and difficult conversations take place frequently. Often the news is not good or not what the person wants to hear. Having the assessment skills and knowledge about how to read body language and react accordingly to manage the interaction in a positive way are important skills to have. Here are 5 tips that can help you navigate difficult interactions:

Crazy Busy Tip #1

When someone raises their eyebrow, this is a sign that they are not feeling threatened. When you raise your eyebrow, it often elicits a smile from the person your are interacting with, so the next time you receive an eyebrow raise....you know you have a good rapport with this person and they are comfortable with you. Why not try to foster a positive response from your patient by raising your eyebrows next time you talk to them? Maybe you will notice that they warm up to you easily!

Crazy Busy Tip #2

A person's eyes dilate strongly when they are stimulated by the conversation and are in a problem solving mode. You may use this to your advantage when you are discussing goals of care and the course of treatment. Paying attention to whether patients and family members have dilated pupils can give you a clue as to whether it is the right time to address important planning issues. When the pupils are dilated, chances are that decisions made will be positive ones.

Crazy Busy Tip #3

The first person to look away in an introduction is the more submissive. This can be helpful to understand family dynamics, who the decision makers are, and who is most likely to be leading the family discussions. It can be helpful to determine the hierarchy within a family and whether the people you are dealing with are in a dominant role. They may wish to dominate you in the relationship, which may make the relationship difficult and may be something that you must pay attention to.

Crazy Busy Tip #4

If a person's eyes are moving around and darting from one object to another, they are either nervous or bored. The type of interaction you are having with them will tell you which is true. If you have engaged them in conversation for an extended period of time, you can make an assumption that the conversation is now boring for them. If the conversation is about a difficult subject matter, chances are, they are nervous. You might want to try to reassure them and comfort them if it is a necessary discussion.

Crazy Busy Tip #5

A clue about whether someone is being open and honest is whether they are showing their palms. If palms are displayed, they are telling you the truth. If you talk with your palms facing upwards, it forces others to speak truthfully too! Try it!

For more useful tips and guidelines follow us on Facebook, Twitter or follow our Blog where we will keep you up to date with the latest Crazy Busy Tips & Tools.

Brought to you by Practitioner Solutions. www.practitionersolutions.com.

Social Media in Hospice and Palliative Care

2011-01-13T05:55:00.001-08:00

The internet has changed everything that we do both professionally and personally. With the emergence of social media sites such as Facebook, Twitter, Linked In, and MySpace opportunities have been created to engage different social groups and individuals who are looking for information about end of life care. Our attention is being constantly drawn to forums, emails, webinars and videos online for useful information to guide us.

While these discussions may be difficult in an online forum, the value is great and the reach to many populations is significant. Healthcare practitioners in hospice and palliative care must engage readers on the net and provide support and guidance in ways that are innovative and forward thinking.

Getting Started with Social Media Tips

Using social media to set yourself apart as an expert in hospice and palliative care is a great idea. Organizations and individuals may optimize presence as hospice and palliative care institutions, leaders in the community, using individual staff members and as a source of education are just a few ways to optimize your presence online. Being a credible resource starts with your reputation, the content of your online activity, accuracy of the information and your persistent repeated presence providing trustworthy information.
Added services and monitoring can further offer advantage when feedback, advice, access to resources and services can be provided in addition to online presence. This ultimately provides portals of access to care on a local level for organizations who interact well with their local community.
Opportunities to build networks, provide ongoing information and support, and build a close relationship with followers and "fans" already exist. Hospice and Palliative care organizations can provide information about hospice care and services available, support groups, fundraising activities, volunteer opportunities, and activities pertaining to supporting the community in end of life care.
How you present yourself online is your brand and this environment affords you the opportunity to develop a consumer focused brand appeal in keeping with your end of life care missions and philosophy. You brand differentiates you from other organizations in your community and may be the reason why consumers may choose to access care at your organization over other competitors. Your presentation, and how you engage the online community is paramount to ensuring your reputation is as you want it to be.
Joining social networks that are relevant to your area of expertise and manner in which you want to present yourself, your organization and your clinical experts online will ensure your efforts online meet your expectations.
Participating on online forums adds your voice to the discussion and alerts other participants to your existence. Often, participants will read more about the others who are participating when the comments and additions to the discussion are engaging.
Creating a blog to showcase your opinions, your organization and staff, subjects of interest, community education activities and end of life issues is of great value. This engages readers and allows them to provide feedback.

Social Media sites continue to emerge at an alarming rate to address the online needs of various communities. Staying abreast of these social sites and engaging the online community in discussion creates wonderful community engagement forums.

About Practitioner Solutions: Practitioner Solutions is a hospice consulting company led by Niamh van Meines a graduate of Columbia University's Nurse Practitioner Program. Practitioner Solutions is committed to helping clinicians, practitioners and organizations in achieving a specialist level of end of life care using innovative solutions.

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Brought to you by Practitioner Solutions. http://www.practitionersolutions.com/.

Holiday Grieving: How to Best Support the Mourning This Time of Year

2010-12-08T11:39:00.001-08:00

Thanks for this wonderful article which touches on the benefit of reflective listening and unconditional positive regard. For anyone who has bereavement issues and could benefit from support groups and activities, hospices provides bereavement support for families for 13 months after a loss. Your relative need not have been enrolled on hospice care for you to reap the benefit. All hospices are required to provide the services to anyone. Additionally, bereaved people can participate in activities arranged by hospices such as book fairs, bake sales, crafts, fund raisers etc and find support from being around people who understand.
Read the Article at HuffingtonPost

The Importance of End of Life Discussions

2010-11-30T18:57:00.001-08:00

Even though the holidays are over and the opportunities for discussion may have passed, it's still a good idea, at any time to have discussions about peoples wishes at the end of life. This discussion does not need to be viewed as morbid or related to illness that family members worry will bring about the end.....it can be seen merely as a necessary process to be undertaken by every member of your household and viewed as a gift to the people who would be charged with making the decision for you. View more information about these discussions on CNN. Need help with starting the discussion or putting a framework to your plan? "Five Wishes" can help. More information about completing the advance directive booklet from Aging with Dignity

ELNEC for Massage Therapists

2010-11-12T05:12:00.000-08:00

Touch is such an important aspect of end of life care. It conveys compassion and concern and is therapeutic if directed in a mindful and meaningful way. Massage therapists work in a number of settings where massage therapy is used with patients with terminal illness and who are approaching end of life. Massage therapy strokes and short protocols addressing certain areas of the body can be taught to caregivers and families to use during the dying process, so they can offer support, touch and a connection with the dying person. Massage therapy techniques can also be used in managing symptoms. Research confirms the effectiveness in assisting to manage symptoms and improve quality of life.

Massage therapists have little standardized training in end of life care. Most learn on the job and with experience working with dying patients. Some feel very prepared and confident in how they perform massage in end of life, others conquer their fears and still others proceed with caution and have little support.

A new massage therapy course has been developed to address the need for standardized training for massage therapists working with terminally ill patients. It follows the curriculum set by the End of Life Nursing Education Consortium and adds massage therapy techniques into the training program. Read more

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NHPCO publishes Hospice Facts and Figures

2010-10-06T20:59:00.000-07:00

The Highlights:

1,56 million received hospice care in 2009
41.6% of deaths occurred under the care of hospice
Mean survival on hospice care versus traditional care was 29 days longer
54% were female
38% were over 85 years of age
25% white, 22% black, 5% hispanic / latino, 9% multiracial, 2% Asian
Cancer accounts for less than half of all hospice admissions
Hospice care reduces medicare costs by an average of $2309 per patient.

5 hospice documentation tips

2010-10-05T20:54:00.000-07:00

Ever wondered what are the most important areas to concentrate on when documenting in a hospice patient's clinical record? Here are a few quick tips that, if followed, can go a long way.

Document the local coverage determinations (LCD) for the hospice diagnosis or general evidence of decline, if the hospice diagnosis is not covered by a disease specific LCD.
Document evidence of decline. Quantify the evidence of decline using timeframes, scales and any tool that can show in detail the decline that is occurring.
Document in detail the symptoms that the patient experiences, specifically related to the hospice diagnosis and quantify the patient's experience. If the patient's symptoms are well controlled, document the measures that are successfully controlling the symptoms.
Document collaboration with the interdisciplinary team regarding arrangements for care, response to changes in the patient's care needs and outcomes of interventions.
Document unplanned care, visits or calls to manage the patient's experience.

The Hospice Navigator Concept

2010-07-22T20:13:00.000-07:00

Hospices are increasingly challenged with enrollment of patients with advanced care needs. Often these care needs are in conflict with the hospice philosophy where patients are expected or required to forego all disease modifying treatments. These treatments include chemotherapy, radiation, surgery, dialysis, pulmonary ventilation, enteral and parenteral feeding. This presents a significant decision making dilemma for patients and their families who may not be ready to give up on treatment. Patients with a prognosis of 6 months or less are entitled to elect the hospice benefit, yet many hospices will not accept these eligible patients unless their treatment plan is changed.

Hospices are increasingly opening their hearts and minds to enrolling patients with advanced care needs. Yet there is a need for hospice clinicians who will manage the care of patients with these therapies. This care involves:

Intimate knowledge of standards of care for the terminal illness

Relationship building skills with patients, families, the interdisciplinary team and the primary care team

A process for approval of therapies

A way to deliver the care efficiently and effectively keeping all the parties involved informed and happy with the plan.

Say hello to the hospice navigator