PD400 class 1, 2, 3, 4

Question 1

palliative care

Answer 1

Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses.

Question 2

thanatology

Answer 2

Thanatology is the scientific study of death and the losses brought about as a result. It investigates the mechanisms and forensic aspects of death, such as bodily changes that accompany death and the postmortem period, as well as wider psychological and social aspects related to death.

Question 3

permits for setting up business

Answer 3

putting up walls for building permit

permit for setting up plumbing/sink

permit for setting up electricity

Before going for permits, you have set up municipal building plan

Question 4

booking/schedule software?

Answer 4

..

Question 5

janitor, receptionist, IT, other therapists, lawyer, banker/financial advisor, accountant, laundry/cleaner, realtor,

what about –> MPT, PT, nutritionist, etc.
(These should be included in “range of community resources for referral … for ongoing patient support”)

Answer 5

professional support team

external expertise to employ

Question 6

pcpi

Answer 6

Practice Competencies and Performance Indicators

Question 7

vision/mission statement

Answer 7

..

Question 8

business model

Answer 8

..

Question 9

technicians and entrepreneurs have different skill sets

Answer 9

..

Question 10

vision statement

Answer 10

future focus

what you want to become

embrace envisoned “
–> meant to inspire

first step developing realistic vision

pen picture of business

could be 3-5 year
5-10 years
10-20 years (huge business)

Question 11

vision statemnt of the CMTBC

Answer 11

innovative regulation that shapes the future of exemplary health care

Question 12

mission statement

Answer 12

enduring statement of purpose that dinstinguishes one organization from other siimlar organizations

what is our business?

describes organization’s purpose, clientele, services, markets, philosophy, and basic technology

allows client to distinguish one business from another and decide which is more suitable for them?

Question 13

Mission Statement CMTBC

Answer 13

Ensuring the public’s right to safe, ethical and competent massage therapy through excellence in regulation.

Question 14

three basic legal structures

Answer 14

sole proprietorships

partnerships

corporations

Question 15

sole proprietorship

Answer 15

You alone own it and are 100% responsible for its debts and liabilities. All earnings are taxed as your personal income. This is the most popular small business structure because it’s simple and straightforward.

Question 16

partnerships

Answer 16

Two or more owners agree to share profits and losses according to their share in the firm. In a general partnership, all partners are liable for debts; in a limited partnership, one or more partners limit their liability by not actively managing the business.

Question 17

corporations

Answer 17

The company earns revenue, incurs losses and pays taxes separately from its owners. Companies often pay tax at a lower rate than individuals. Owners’ liability is limited to what they invest in the company, and they have options as to when and how they take money out of the company.

Question 18

sole proprietorship or partnership – are good for…

Answer 18

You will be the sole owner or own the business with just a few partners

You plan to start the business using only personal savings or investments from friends and family

You expect business revenues to support only you and your partners or family members

You plan to do most of the work yourself

You will borrow personally on behalf of the business

You are in a low personal income bracket

Your business is highly unlikely to face a lawsuit or get into debt

You have limited net worth (personal assets)

If you answered yes to most of these questions, you should operate your business as a sole proprietorship or partnership

Question 19

corporation — good for…

Answer 19

Ownership will be divided among several shareholders

You expect significant start-up costs

You will be hiring employees and paying out wages and salaries

You will require additional financing beyond savings and investments from family and friends

You expect increasing revenues and a rising asset base

You will probably need to raise equity or issue debt, either now or later

You will put a full management and organizational structure in place

You expect to look into income-splitting and tax-deferral options

You want to protect your existing substantial net worth

If you answered yes to most of these questions, you should operate your business as a corporation

Question 20

accountant

Answer 20

find a good accountant

the accountant that was responsible for Laurie’s debt to CRA was negligent, so find someone who is talented and who has experience with accounting for healthcare professionals

Question 21

disability insurance

Answer 21

one case of someone who didn’t get disability insurance,

and they broke their scaphoid rock climbing

and afterwards they tried to get disability insurance

and they were refused disability insurance

but if they had gotten it previously it would have been fine (?)

Question 22

note clause in insurance

Answer 22

have you had a claim in the last ___ months/years

—> premiums could go up

—> could get refused (?)

Question 23

other expenses/insurance

Answer 23

professional liability insurance

general liability private

CMTBC dues (?)

continuing education (500/yr ?)
—> optional, but recommended
—> Tax write-off?

Question 24

other sole proprietorship expenses

Answer 24

GST

taxes

rent (for studio space)

business license

CPR recertification

Question 25

figure out the TAX WRITE OFFS

Answer 25

..

Question 26

GST

Answer 26

investing GST and earning interest before paying it out to CRA

Question 27

how to find good accountant?

Answer 27

someone who has experience with HCP

ask other RMTs –> ask them who they use as an accountant

ask for multiple opinions from multiple accountants (?)

Question 28

note also CPP/ RRSP contributions

Answer 28

..

Question 29

laundry expenses

Answer 29

laundry services

e.g.
3700/year (308/mo)

Question 30

insurance

Answer 30

you have to read the contract carefully, because the contracts be very different, and price reflects differences

Question 31

if employer supplies everything to “Contractor” CRA says that they are no longer “Contractors” but
Employees

Answer 31

to avoid this, employer can avoid supplying everything

E.g.
Oil

But supplies:
laundry, reception, billing, etc.

Question 32

note independent contractor vs employee

Answer 32

(?)

employee gets to keep the entire charged fee

—> But they pay rent to clinic owner

—> owner may supply things like laundry, billing, reception, etc. – RMT brings oil
—> However, not all owners will provide all of this
—-> some owners will require RMT to do more

—> But in this case, clinic/reception will take care of providing clients/patients for RMT

VS. Employee

—> Employee receives a percentage of the charged fee –> But they don’t pay rent to owner
(E.g. 70/30, or 60/40 split)
—> Generally speaking everything is provided to the RMT

Question 33

Class 2

Answer 33

..

Question 34

what type of people does Commercial Real estate sales/leasing (possibly) typically attract?

Answer 34

Commercial Real Estate Sales and Leasing usually attracts the Type A personality,

often with Bachelor of Commerce Degree

and in the higher levels of Corporate Realty an MBA is a requirement.

Question 35

how do agents in commercial corporate firms begin their career?

Answer 35

Agents in Commercial Corporate Firms are mentored for a long time and start as assistants to more experienced agents,

often given the grunt work and will do the bulk of the showings, enquiries and weeding out of leads.

Question 36

how do residential real estate agents start their careers?

Answer 36

Residential Realtors often start careers with minimum educational requirements, usually 6 month course with 6 month post-licensing training as required by the BCFSA.

The personality types most often attracted to residential are much more the “Touchy Feely” people,

most are focused only on residential sales helping buyers and sellers. 

Question 37

commercial

Answer 37

Work in teams, at a larger Corporate Brokerage with Jr. Agent qualifying all prospects

May or may not be a Member of a Real Estate Board

Are Licensed and Bound by the Standards of Practice of the British Columbia Financial Services Authority (BCFSA)

Question 38

(commercial real estate members/agents) Expect prospects to be organized and already know the following:

Answer 38

Location – why that location

Budget - with financing in place

Business Plan

Partnership or Incorporation Docs Avail

Understanding of physical requirements

Understanding of leasing jargon

Other professionals engaged such as Lawyers & Accountants

Question 39

residential re agent

Answer 39

Usually works independently, under the umbrella of a brokerage ( ie Oakwyn)

Usually focuses on a specific geographic area or neighbourhood

Can be a specialist for types of properties, such as Condos, Detached homes

Could work for a Developer on a Sales team at a pre-sale showroom, instead of in Re-Sale property

Majority of Re-Sale agents are members of the Real Estate Board in their area.

Are Licensed and Bound by the Standards of Practice of British Columbia Financial Services Authority (BCFSA)

Question 40

commercial…

Answer 40

Commercial Tenancy is only governed by Contract Law – there is no consumer advocate !

It is highly suggested you engage a commercial real estate lawyer to review any leases prior to signing

There is a somewhat standard offer to lease, they can run 20-50 pages.

Question 41

if issue with commercial realtor?

Answer 41

If you have an issue with conduct of a Commercial Realtor you can lodge a complaint with BCFSA

Question 42

residential…

Answer 42

Residential Tenancies are governed under the Residential Tenancy Act of BC under the Ministry of Municipal Affairs & Housing

If a property is managed by a Licensee you have recourse with both the BCFSA and Residential Tenancy Branch

If you have issue with Landlord, can deal with RTB directly

Must use the standard forms to be enforceable – RT lease is 6 pages plus any addendums for included items or terms outside of the standard terms.

Question 43

what is interest in land?

Answer 43

..

Question 44

register a lease

Answer 44

One of the fundamental aspects of a commercial lease is the ability to register a lease of 5 years or more against the Title of the property.

Question 45

property id

Answer 45

All properties are identified by a unique 9 digit number called the Property Identification Number (PID) at the Land Title Registry of BC.

Question 46

title

Answer 46

Title – shows who is the Registered Owner of the Property and any Charges which may affect dealings in the property such as Mortgages, Liens, Judgments, Easements or Statutory Rights of Way and Leases of more than 5 years !

Question 47

ending lease early?

sold w/o knowledge?

Answer 47

This is important as it means the building you establish your business in can not be sold without your knowledge and your lease should have provisions for compensation for breaking the lease early or assumption of lease and notice to existing tenants of a change of ownership of the building.

Question 48

how are comercial rental rates often calculated?

Answer 48

Commercial Rental Rates are often calculated and expressed based on the Total Area of the property

such as $28/sqft.

Question 49

sq ft of property is convention

but most legal documents will refer to ….?

Answer 49

The Sq Ft of the property is the convention but most legal documents such as site surveys and architectural drawings will refer to Square meters 

Question 50

components of rent (formula)

Answer 50

base rent (E.g. $28/Sqft – annual rate)

leasable area (e.g. 1000 sqft)

common area costs (e.g. $12/Sqft)

property tax ($12,000)

—> $4,333.00

Question 51

triple net lease define

Answer 51

A triple net lease (NNN) assigns sole responsibility to the tenant for all costs relating to the asset being leased, in addition to rent.

“Triple net refers to leases where a tenant rents an entire freestanding commercial building and pays for all property expenses.”

Question 52

escalating lease

Answer 52

lower lease rate in first years,

get higher in later years

(incentive to business owner to have less burden in initial years of business?)

(alternatively, just to keep up with inflation)

Question 53

commercial real estate terminology

Answer 53

An excellent website for easy to understand Commercial Real Estate information is at https://www.bdc.ca

Question 54

incidental expenses

Answer 54

Your costs on top of base rent. These can include property tax, insurance, utilities, maintenance,common area costsand repairs.

Question 55

common area maintenance

Answer 55

Anincidental expensein some commercial real estate leases. All tenants generally share common area costs. Examples include fees for snow removal, janitorial services, landscaping, grass cutting and property management.

Question 56

gross rent lease

Answer 56

A type of commercial real estate lease under which you pay a single amount to the landlord that covers base rent and allincidental expenses.

Question 57

modified gross lease

Answer 57

A type of a commercial real estate lease under which you and the landlord share certainincidental expenses.

Question 58

net lease

Answer 58

A type of commercial real estate lease under which you typically pay for one incidental expense directly. In a single net lease, you usually pay the base rent plus property taxes (though in some cases, you might pay for insurance or utilities instead). The landlord pays all other expenses.

Question 59

double net lease

Answer 59

A type of commercial real estate lease under which you usually pay the base rent plus two incidentals—for example, property taxes and insurance. The landlord covers all other expenses

Question 60

triple net lease

Answer 60

A type of commercial real estate lease under which you typically pay the base rent, plus property taxes, building insurance and utilities, as well as other operating and maintenance costs. The landlord assumes no costs, other than those for structural repairs.

Question 61

percentage rent lease

Answer 61

A type of commercial real estate lease under which you pay a base rent plus a percentage of gross sales over a certain minimum. These are usually used in malls and other multi-tenant retail locations.

Question 62

tenant improvement allowance

Answer 62

A cash amount offered by a landlord to help you pay for renovations to a leased space. The allowance is usually a certain amount of money per square foot of rented space. It is sometimes offered as atenant inducement.

Question 63

tenant inducements

Answer 63

Incentives offered by a landlord to encourage you to rent a space. Examples include several months rent free or help with paying forleasehold improvements.

Question 64

trade fixtures

Answer 64

Items in a leased space that you can take with you when you move out.

A trade fixture can generally be easily removed without damaging the property.

Examples include furniture, inventory and computers.

Get advice from a commercial real estate lawyer before signing a lease to clearly define trade fixtures and to seek exclusions for assets you want to take with you when you leave.

Question 65

turnkey improvements (aka turnkey buildouts)

Answer 65

Renovations that a landlord carries out at your request when you sign a lease. A landlord may agree to these as a tenant inducement.

Question 66

Leasehold improvements (also known as tenant improvements)

Answer 66

Renovations to a leased commercial real estate space to make it suitable for your business. Unless otherwise specified in the lease, any improvement that is attached to the building usually becomes the property of the landlord—meaning you can’t take it with you when you move out.

E.g.
Examples can include machinery, flooring and built-in shelving. Get advice from a commercial real estate lawyer when negotiating a lease to seek exclusions for assets that you want to take with you when you leave.

Question 67

leasehold improvement loan

Answer 67

If necessary, you can always apply for a leasehold improvement loan, a short-term loan (often amortized over five or six years) that you can use to pay for renovations to a leased space.

You can sometimes negotiate a principal holiday for the first six to 12 months of the loan.

Depending on the value of the improvement, a bank may accept the improvement as collateral for the loan, which could result in a lower interest rate than that for an unsecured loan.

Question 68

principal payment holiday

Answer 68

The principal payment holiday concerns principal instalments only of amortising loans or leases granted to performing borrowers, and is granted for a period no longer than 12 months depending on the product type. Any principal instalments that fall due during the payment holiday are paid at a future date.

Question 69

collateral define

Answer 69

something pledged as security for repayment of a loan, to be forfeited in the event of a default.

Question 70

money speak

Answer 70

..

Question 71

amortizaiton

Answer 71

Amortization – A stream of Payments over time - ie: mortgage with an interest rate for the “Use of the Money” for a specified time period

Question 72

fully amortized

Answer 72

after the stream of payments the debt is zero

Question 73

term mortgage

Answer 73

after the stream of payments there is an outstanding balance owning (sp.??? owing?)

Question 74

principle

Answer 74

the amount lent

Question 75

interest rate

Answer 75

the user fee for the $$ – I.e. 3.4% per annum, compounded quarterly

Question 76

principle and interest

Answer 76

annual, monthly, bi-monthly

Question 77

collateral

Answer 77

what secures the loan — what creditors can take from you if you Default on your payments

Question 78

personal guarantee

Answer 78

could put a lien on your house — Best to “incorporate” your business – may not absolve you from being personally liable for the debts of the Business

Question 79

unsecured debt

Answer 79

no collateral for loan

Question 80

depreciation

Answer 80

the decrease in Value of an Asset over Time.

Buildings are considered fully depreciated at 40 years, even if they have a long economic life left in them

Question 81

Capital Cost Allowance

Answer 81

(the amount of depreciation you can claim on your taxes for an asset is less and less over time until fully depreciated)

Question 82

types of property

Answer 82

..

Question 83

Live-Work Strata Titled Space to Purchase or Lease

Answer 83

These types of spaces are typically loft type condos that are specifically zoned to be able to have a business license associated with address.

Each municipality has specific zoning requirements.

Many sole practitioners find this a dual investment as they can live and operate the business out of the same location while building equity in real estate that they own.

Many investors have bought into these types of developments and rent out these spaces as well.

Question 84

Strata Titled Office Spaces for Purchase

Answer 84

This type of space has become more popular in the last 20 years. These are located in office buildings in many of the commercial districts of the lower mainland.

The advantages are also that you can build equity in real estate, have more control over your improvements and the long term stability of growing a business knowing what your overhead is going to be based on a mortgage and not a lease.

You can sometimes find these spaces for lease from the owner.

Question 85

Storefront – Retail

Answer 85

The costs for this type of location are quite high in established commercial districts.

In the suburbs you may still find a reasonable rental rate in an older strip mall or shopping center.

You may be governed by specific hours of operation and tenant improvement fees for changing signage, this is often negotiated.

Question 86

Professional Buildings – Medical-Dental

Answer 86

The obvious choice – rents vary greatly and the vacancy rates in most of these buildings are currently low – with average rates being $50-$75 sq. ft.

Question 87

Packaged Offices

Answer 87

This might be a good choice if you want to start small and have the ability to expand – or if you want to have a full service facility without the overhead.

They usually have a reception area, a receptionist that will answer a phone with your specific business name.

Often there is a lunch room, washrooms, conference room, and opportunity to have cross promotions with other businesses.

May be more suitable for a consultative practice as these spaces are often small.

Monthly rates range from $500-$1500 depending on the size of the office and services chosen.

Question 88

A. Employee

Answer 88

Simplest/Easiest arrangements. You work for someone else. You are classified as an employee and are protected and supported by BC labor laws

Question 89

pros employee

Answer 89

Simple. You have set hours, set days, holidays. You show up to work, you are paid an hourly wage, and bonuses if any

You get vacation pay, taxes deducted, CPP, EI

You may/may not get health benefits, Life, Critical Illness (CI), Travel medical

(Usually) You don’t worry about marketing, promotions, costs of business cards, uniforms, oils, supplies, etc.

You are protected by the terms of a contract that govern your employment (ie. Employer can’t change things on you that are contrary to the terms of the contract)

You work, you go home, you get your weekends/days off. Pretty sweet.

When the toilet paper runs out, it’s not your problem. It’s someone else’s.

Question 90

Cons (employee)

Answer 90

You don’t make very much. Not even close to RMT’s that work for self or run a practice. You are often paid a sub-standard rate with very little room to move up or improve.

You are bound by a contract and must adhere to owner’s/business’s work policies (holidays, dress code, etc). Ie, if you don’t like something or don’t agree with something, you don’t really have a choice

You have to get vacation and holidays approved ahead of time (ie. You can’t just go away for 3 weeks if you wanted to)

You can’t just ad hoc change things regarding your employment.
–> Days worked
–> Pay
–> Vacation

No tax write offs. That dinner you had, that trip you took? That seminar…. nada

If you miss too many days, you can be terminated

If you underperform, you can be terminated

If they don’t like you, feel threatened by you, or have a change in heart, you can be terminated.

Question 91

B. Business for Self

Answer 91

Also known as sole proprietor or independent contractor

You are basically running a business within a business.

Question 92

e.g.

Answer 92

For example. Mr. RMT is renting a space at Columbia Integrated Health Centre. (CIHC)

Mr. RMT pays a flat rate rent for usage of the room or a percentage of billings which represents that rent. Patients perceive Mr. RMT as a therapist at CIHC. Mr. RMT generates income, collects GST, remits GST, pays himself, incurs expenses, has tax write offs etc.,. All of this is under the company name of ”Massages “R” Us”. (owned by Mr. RMT)
Mr. RMT is an independent contractor/sole proprietor that is running a massage therapy business called Massages R us located at CIHC.

Question 93

Business for self (pros)

Answer 93

Therapists potentially make way more money than employees

The harder you work, the more $ you make

You make more per hour

Therapists have more say and input into their practice

Therapists have more freedom to dictate their holidays, days and hours

Therapists now have multiple tax write off opportunities

Less chance of being terminated

You are an entrepreneur and officially a business person

Question 94

Business for self (cons)

Answer 94

Work more hours that don’t generate income. Ie, paperwork, marketing, meetings, errands, supply runs, etc..

If you don’t work, you don’t get paid. That holiday you take for 4 weeks… well, you’re not making any money

You need to spend time and money on lawyers, accountants, book-keepers, Insurance, to support your business. Meetings, phone calls, etc…

You need to spend money on supplies, seminars, insurance,

Extra level of stress. Guaranteed!

Question 95

C. corporation

Answer 95

Very similar in structure to a sole proprietor and independent contractor however YOU are the boss, and YOU wear all the hats.

Comes with all the benefits of the Independent contractor

There is no personal liability. Ie you are protected from being sued personally

You have the benefit of a lower tax rate for corporations than sole proprietors

You have access to professional support systems such as:
—> CFIB
—> Chambers of commerce
—> BBB

You have recognition as a legitimate legal business entity.

You are responsible for EVERYTHING!!!! Toilet paper, photo copier, maintenance, security issues, hiring, firing, etc… everything.

You work way harder and way more hours that you don’t get paid for.

Question 96

Some self reflection

Answer 96

How do you want to practice?

What are some of the pros vs cons of practicing by yourself vs being part of a team?

Question 97

Pros (corporation)

Answer 97

The business lives and dies by you and you alone

You make all the decisions. You live with all the consequences

No drama.

You get have to hire/fire anyone

Great for people who have leadership tendencies

Question 98

Cons (corporation)

Answer 98

The elevated and constant stress levels are immeasureable

The business lives and dies by you and you alone.

What if you get sick or injured? Go on holidays? Emergencies?

Question 99

When is a good time to start my own business?

Answer 99

1. Is it based on $$$ saved? Is it based on opportunity? Is it based on your support system?
2. Location. Where do I don’t mind driving/commuting to everyday? Is it close to home? Where is there the most need with the least amount of saturation?
3. What is the lease rate? How big of a space is it? What are the triple net costs?
4. What is TRIPLE NET?
   —> Utilities, insurance, and rent rolled into 1 rent.
5. Is it stratified? Can I purchase it vs leasing it? (in Vancouver, good luck with this one)
   —> What are the pros and cons of renting vs buying?
   —> You need to calculate how much a monthly lease is vs mortgage willl be? Amortize it over the next 20 years? Is it worth it?
6. Do you have partners, staff, or are you going to do it by yourself?

Question 100

if you purchase/owned

Answer 100

It’s yours, no one can raise rent, kick you out, tell you what type of business to run

Most up front costs
—> Lawyers, taxes, bank costs, interest

Amortirize it over 25- 30 years, you own it.

You can build up equity that you can use for growth or expansion

More worth it to put more money into renovations

You are pretty set at that location forever..

Question 101

if you lease/rent

Answer 101

Less up front costs
Ie lawyers, banks, taxes

You don’t own it so no equity

After 25-30 years, you still don’t own it

If you move, you lose the $ you put in for renovations.

Pro: you can move easier

Question 102

ongoing costs of running a business

Answer 102

A. Measurable costs
Lease/Rent/Mortgage

Billing/scheduling software

Cleaners and cleaning supplies

Front desk/admin

Marketing/promotions (business cards, brochures, pamphlets, etc..)

Webpage/design/SEO/Google Ads/Social media

Admin related: Tables, chairs, desks, computers, printers, paper, stationary etc…

Clinic related: Massage tables, stools, pillows, sheets, bolsters, lotions, gels, laundry

Business license, general liability insurance, professional liability, CI, DI, LI, AD & D,

Utilities (internet, phone, hydro, cable, security monitoring etc…)

Banking charges, fees, accounts, overdraft protection

Interest on loans borrowed

Question 103

B. Non-Measurable costs

Answer 103

Managing the team
–> Conflict resolution,
–>Mentoring /guiding/supporting
–> Training

Hiring/Firing staff, entry/exit interviews – all this takes lots of time/resources.

Day to day maintenance and up keep of the offices space

Trouble shooting – What happens when things break down?

Accounting, Accounts receivables, outstanding invoices

Payroll – takes time to do
Marketing - someone needs to do it

Team building – organization and carrying out

Developing and maintaining systems within the office -

Security/patient complaint resolution

Question 104

So what are the benefits of owning your own clinic/corp?

Answer 104

You make more $ actively and cover your costs passively.
You can see the “potential” income that the business can make and that you yourself can make

–> Passively via income from the associate therapists.

–> Actively via keeping 100% of what you bill from your treatment

Better protection, tax bracket, and recognition.

You get to make all the decisions

No body can ever fire you or tell you what to do.

There is gratification and reward in being an entrepreneur and creating a business to help others succeed.

Question 105

Less stress in your life? More stress. A business is like a child. You have to nurture and treat it as if it’s your life. It lives and dies with you.

Answer 105

Time with family? How important is that?

Question 106

note working after 5pm

Answer 106

people with coverage generally work 9-5

Question 107

note that if you start with Jane then decide to switch

Answer 107

you can access charts (records) and put them in your own personal storage to keep (for 16 years for patients)

Question 108

Class 3

Answer 108

…

Question 109

intro to loss grief and bereavement

Answer 109

..

Question 110

“Nothing that grieves us can be called little; by the eternal laws of proportion a child’s loss of a doll and a king’s loss of a crown are events of the same size.”

(Mark Twain quote)

Answer 110

I.e. showing empathy towards the things that makes people grieve

Question 111

ACute frief is

Answer 111

definite syndrome with boht psychoogical and physical symptoms

Question 112

grief has both ___ and ___ Sx

Answer 112

physical and psychological

Question 113

grief may occur immediaitely after a….

Answer 113

crisis

Question 114

it could also be…

Answer 114

delayed

Question 115

may be…

Answer 115

exagerated

Question 116

may APPEAR to be…

Answer 116

absent

Question 117

typical pattern of grief is

Answer 117

distorted

Question 118

Distorted patterns of grief can be transformed into a

Answer 118

Distorted patterns of grief can be transformed into a normal grief reaction with appropriate clinical interventions.

Question 119

loss

Answer 119

The experience of loss is universal.

Loss involves pain.

Losses that are significant produce emotional upheaval.

Loss requires change and adjustment to situations that are new, uncertain, and unchosen.

Loss can impact many lives.

Question 120

other emotions related to grief

Answer 120

anger

situational depresison

irritability

annoyance

intolerance

frustration

—> all may be exacerbated by sleep deprivaiton, ongoing changes in lifesryle, burdens of caregiving, and/or fear of separation & unknown

Question 121

bereavement

Answer 121

the state of deep grief or loss

Question 122

mourning

Answer 122

the period of accepting loss

Question 123

grief

Answer 123

generally thought to be an inward expression

Question 124

sudden death vs expected death

Answer 124

If grief begins with a sudden death, there is no time to prepare.

Emotional forces and thought processes are scattered as the shock of loss overwhelms physical and mental defenses.

There is no time to gather the coping mechanisms that protect us from emotional overload.

This grief is frequently more acute than when a person has time to prepare for the loss and change in family dynamics.

Grief is just as heartfelt, but it may be easier to withstand by having the process spread over a manageable time period.

Question 125

physical responses to grief

Answer 125

panic

difficulty swallowing

increaesd HR/BP

exhaustion

insomnia

mm pain

altered eating patterns

headaches

Question 126

sinus headaches

Answer 126

Sinus headaches are headaches that may feel like an infection in the sinuses (sinusitis). You may feel pressure around the eyes, cheeks and forehead.

Question 127

sadness and depression vs immune system

Answer 127

Sadness and depression significantly lower resistance to opportunistic diseases, which may lead to physical illness in addition to emotional stress.

Question 128

grief passing vs IS

Answer 128

When the pain of loss is accepted, healing begins.

Question 129

when massage therapist is asked to attend funeral

Answer 129

When life is done and there is nothing left but the process of dying, massage therapists are uniquely equipped to support the dying person and attending family or friends by addressing pain, nausea, anxiety, depression, anger, stress, and fatigue.

Because massage therapy is a generalist form of healthcare, it is possible and even likely that massage therapists will be invited to share in the process of death as clients or their family members die.”

—-> It is up to therapist to decide whether to attend

Question 130

how often are statements told to grievers perceived as helpful

Answer 130

“According to one study, a person can expect to hear approximately 121 phrases in the three days following a death, of which only 19 are perceived as helpful by the grievers.”

Question 131

platitude define

Answer 131

a remark or statement, especially one with a moral content, that has been used too often to be interesting or thoughtful.

plat = flat
—> dullness, banality

Question 132

platitudes…

Answer 132

Platitudes are a form of communication that involve the use of trite, usually untrue statements in an attempt to alleviate emotional pain that we may feel helpless to “fix” in any other way.

Examples of platitudes are:
“Time heals all wounds” and
“this grief will pass”.

Question 133

why do people struggle to say something helpful to someone grieving

Answer 133

Perhaps it ‘s because of our cultural death phobia, and the way it pathologies everything related to sadness.

If we’re not better at dealing with grief, then it’s because we have never been taught better.

Unfortunately, that leaves the majority of us with only one stock phrase in our repertoire, “I’m sorry for your loss.”

Question 134

what not to say?

Answer 134

Grief is intensely personal so avoid saying
“ I know just how you feel” You don’t.

A simple “I’m sorry for your loss” can let survivors know that you care, or a good place to start if you are not sure what to say.

But, it can be a little like the cashier saying “Have a nice day “at the grocery store.

Never point out “It was for the best “

or “you can always get another job/pet/house
(this belittles the relationship that was lost by implying that it is easily replaceable.

Question 135

what can you say? …?

Answer 135

“I don’t know how to help you , but I want to try.”

“I don’t know what to say”

“This must be hard for you”

“I don’t have an answer for that”

“ I am sorry you are suffering right now.”

“I am sorry for whatever challenges might lie ahead for you.”

“Please accept my deepest condolences, I can’t imagine what you are going through right now.”

“I am sorry to hear about______ . I am sure you are going to miss them terribly.”

Question 136

protecting yourself during other people’s grief process

Answer 136

In health care we tend to protect ourselves from grief by
detaching when the pain of caring is overwhelming.

You must resolve your feelings about death and loss, or you
cannot give effective care.

The term “burnout ‘ implies that your fire to
help has gone out.

Question 137

loss of enthusiasm in profession?

Answer 137

The loss of enthusiasm for your profession is a high price to
pay for caring.

Question 138

what can you do to maintain enuthusiasm in profesison?

Answer 138

Develop outside interests that direct your mind away from health care.

Protect yourself by taking time for yourself. Do things you enjoy.

Rest, relax and eat right.

Read literature regarding grief and “letting go” (?)

Talk to your spiritual adviser about your doubts and fears.

Take comfort from your faith and your support groups of family and friends

Question 139

burnout vs grief

Answer 139

Burnout looks a lot like grief.

When we fail to take care of ourselves, we risk losing ourselves, so BURNOUT ,may actually be an expression of the grief we feel about that loss.

Question 140

Burnout and ICD (international classificaiton of diseases)

Answer 140

“Is recognised in the International Classification of Disease (ICD), sponsored by the World Health organization (WHO).

The ICD codes diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury and diseases.

The ICD recognises burnout as “problems related to life-management difficulties.”

Question 141

caregiver fatigue

Answer 141

“Is a particular form of burnout resulting from increased caregiving in combination with ever decreasing energy reserves.”

Question 142

caregiver fatigue vs apathy

Answer 142

“They may become disconnected to the point of not caring about the ill person because they have no energy left to give.”

Question 143

caregivers and MT

Answer 143

“Massage therapy represents an excellent diversion from caregiving because it encourages caregivers to focus on themselves, which is opposite of what is usually demanded of caregivers.”

Question 144

3 fundamental principles t remmeber when working with loss/grief

Answer 144

1) There is no right or wrong way to grieve.

2) Grief has no set timetable. It is like a river and sets its own course.

3) Normal grieving often involves extreme thoughts and roller coaster emotions.

“As you strive to be a compassionate listener these principles can be a touchstone in helping grieving individuals feel understood at a time when they often feel terribly alone.“

Question 145

guidelines for comuniating with terminally ill patients

Answer 145

Avoid rote responses. Each person and family are unique and deserve to be treated as such.

Relate person to person. Show humour as well as sorrow.

Use your mind, eyes and ears to hear what is said as well as what is not said.

Respect the individual’s pattern of communication and ways of dealing with stress. This is not the time to promote change!

Humility and honesty are essential. Be willing to admit that you do not know the answer.

Maintain a sense of calm. This will help the client’s sense of control.

Never force the client to talk. Respect the client’s need for privacy and be sensitive to the client’s readiness to talk.

Let the client lead the discussion to the future. Be comfortable with focusing on the here and now.

Be willing to allow the client to see some fears and vulnerabilities. It is much easier to open up to someone who is “human and vulnerable” than to someone who appears to have all the answers.

Question 146

special concerns for palliative care

Answer 146

..

Question 147

primary goal of massage therapy

Answer 147

The primary goal of massage treatment in advanced cancers is comfort and enhancement of quality of life. The gentlest and simplest techniques are often the most effective.

Question 148

what to do as condition progresses

Answer 148

Body systems are weakening and close observation is necessary to ensure treatment adaptions are made as needed.

Question 149

pain medicaiton and illness

Answer 149

At this stage touch can sometimes increase the sensation of pain. Flexibility is required. Strong pain medication may significantly impair the patient’s ability to give reliable feedback.

Question 150

what about rest of medical team of pt

Answer 150

Regular contact with the medical team will help keep you current about medication and health status changes.

Question 151

bedsores / decubitus ulcers (pressure ulcers)

Answer 151

There is a susceptibility of decubitus ulcers. Maintaining good skin lubrication and circulation, especially over bony areas, can help prevent their formation. Massage is not advised once redness of bedsore begins as it can speed up the breakdown.

Question 152

preparedness for conversations about death

Answer 152

You may need support if you are uncomfortable or unprepared for conversations about death.

Question 153

investment in ongoing relationship (?)

Answer 153

Investment in ongoing relationships is slowly withdrawn and should not be taken personally.

Question 154

palliative care boundaries

Answer 154

Therapeutic boundaries keep caregivers emotionally whole and healthy.

They help us to be available to clients when providing care and also to walk away when our work is done.

Question 155

boundaries with dying patients

Answer 155

For individuals working with the dying, therapeutic boundaries may be more difficult to establish and maintain.

It takes considerable energy and training for caregivers to repeatedly care for patients in long term care and then let go of patients as they die.

This repetitive process can erode boundaries and affect the caregiver’s ability to provide objective care. But how do you know if boundaries are intact?

Question 156

in what scenarios must extra measures be taken to maintain therapeutic boundaries?

(If someone answers yes to any of these questions, it may mean that they need help with maintaining their therapeutic boundaries.)

Answer 156

Do you feel like family to this patient?

Have you checked in with the patient’s status when I am not scheduled to work?

Do you feel that you are the only person who knows best what this patient needs?

Question 157

what do dying patients need?

Answer 157

medicaitons

support (friends, family, emotional, practical, spiritual)

comfort

estate management (organizing belongings)

respect

choices

autonomy

patient-centered care

therapy

Question 158

palliative care

Answer 158

any form of medical care or tx that concentrates on reducing the Sx of disease rather than curing disease

relieving painor easing problem without solving the cause

treatment approach is indiivdualizd and usually involves a health care team from sevreal/many disciplines

Question 159

palliative

Answer 159

litearl definition:

means to cloak or disguise

Question 160

the WHO defines palliative care as

Answer 160

an approach to care that provides relief from pain/SSx for people close to dying

Question 161

difference b/w palliative care and hospice

Answer 161

Bothpalliative care and hospice careprovide comfort.

Butpalliative carecan begin at diagnosis, and at the same time as treatment.

Hospice carebegins after treatment of the disease is stopped and whenitis clear that the person is not going to survive the illness

Question 162

grief theory

Answer 162

Elizabeth Kubler Ross

Question 163

Elizabeth Kubler Ross book

Answer 163

“On Death and Dying”

Question 164

5 stages of grief

Answer 164

the book “On Death and Dying” which introduced the world to the five stages of grief…the basis of the Kubler Ross model , a theory based on her experience and interviews with terminally ill patients.

Question 165

Original application of 5 stages of grief

Answer 165

Originally this model was applied to those facing the reality of their own death but before long practitioners found the constructs of this neat and tidy model fit nicely with the analysis and treatment of grieving individuals.

Question 166

Elizabeth Kubler Ross the 5 stages

Answer 166

Denial

Anger

Bargaining

Depression

Acceptance

Question 167

Denial

Answer 167

Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It’s a defense mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death is not particularly easy to avoid or evade indefinitely.

Question 168

Anger

Answer 168

Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps us stay detached and non-judgmental when experiencing the anger of someone who is very upset.

Question 169

Bargaining

Answer 169

Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example “Can we still be friends?…” when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it’s a matter of life or death.

Question 170

Depression

Answer 170

Also referred to as preparatory grieving. In a way it’s the dress rehearsal or the practice run for the ‘aftermath,’ although this stage means different things depending on whom it involves. It’s a sort of acceptance with emotional attachment. It’s natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality.

Question 171

Acceptance

Answer 171

Again this stage definitely varies, according to the person’s situation. Broadly speaking, it’s an indication that there is some emotional detachment and objectivity. Dying people can enter this stage early, often a long time before the people they leave behind will enter this stage. note: others necessarily pass through their own individual stages of dealing with loss.

Question 172

is 5 stages of grief model entirely accurate /effective ?

Answer 172

not adequate theory
–> narrow in focus
–> we experience more than that (5 stages)

however, EKR opened the converstation (or reopened?) –> got us paying attention to the matter

Question 173

EKR model

Answer 173

It is just a theory

There are many theories

The 5 stages of grief are not an absolute truth.

Like all theory it is based on a hypothesis (an educated guess) There is research that which supports this theory and research to contradict the theory.

Do not expect grief to fall into a neat and easy pattern, formula, or timeline

Question 174

2. it is not linear

Answer 174

“Grief is not a one way tunnel, it’s more like a labyrinth”

They do not happen in a particular order, if at all.

The stages are just tools , based on the experiences of many grievers.

Question 175

3. stages may repeat

Answer 175

“It is common to feel that you are making progress one day only to get knocked on your derriere the next.”

Question 176

4. it is not all encompassing

Answer 176

Grief is really complex.

Question 177

5. there is no end point

Answer 177

The 5 stages leave you with a feeling that there is some finite end point to grieving.

The theory will reach its end point , but your experience with grief won’t.

Question 178

did EKR ultimately agree with 5 stages theory

Answer 178

Elizabeth Kubler-Ross, pioneer of the conscious dying movement, lived to regret having described the common features of the grief journey in stages.

She came to see that everyone grieves differently and that science collapses in the face of the mysteries of the heart.

There is no map for the landscape of loss, no established itinerary, no cosmic checklist, where each item ticked off gets you closer to success.

You cannot succeed in mourning your loved ones. You cannot fail.

Nor is grief a malady, like the flu. You will not get over it.

You will only come to integrate your loss, like the girl who learned to surf after her arm was bitten off by a shark. The death of a loved one is an amputation.

You find a new center of gravity, but the limb does not grow back.

When someone you love very much dies, the sky falls. And so you walk around under a fallen sky.

Question 179

life transitions, aging, loss

Answer 179

Death is a part of the cycle of life.

Therapists may be invited to share in client transitions.

Question 180

pointsto ponder

Answer 180

What are your family’s attitudes about death and dying?

How might these personal beliefs contribute to your reaction if you are presented with a client who is dying?

How might you respond professionally, independent of personal beliefs?

Question 181

Massage Therapy at End of Life

Answer 181

Speak plainly and avoid lies or games about death.

Actively listen.

Provide information and perspective within the capacity of professional role.

Offer supportive treatments with no promises of cure.

Question 182

Palliative and Hospice Care

Answer 182

Provides relief from symptoms for people who are dying.

Death is a normal part of life.

No efforts are made to hasten or postpone death.

Emphasis on ensuring quality of life.

Question 183

Palliative and Hospice Care ..

Answer 183

Care integrates psychological and spiritual aspects.

Employs a team approach including counseling.

Offers support for both patients and families.

Question 184

When working with clients in palliative care:

Answer 184

Be present.

Offer choice.

Negotiate a stop signal.

Create an atmosphere of calm.

Question 185

Massage Therapy
and Palliative Care

At the stable palliative stage:

Answer 185

Ask about client status and prognosis.

Employ careful infection control and adapt to site restrictions.

Seek client goals.

Establish informed consent.

Adapt treatment to fit client capacity and comfort.

Question 186

At the transitional palliative stage:

Answer 186

Check in with client if conscious or able to respond.

Verify client status with caregivers.

Seek permission to massage.

Anticipate need for crisis management.
—> incontinence
—> vomiting
—> bleeding

Question 187

At the transitional palliative stage… :

Answer 187

Strategize treatments to facilitate:

lymphatic drainage
limb movement
joint mobilization
optimal respiration

Question 188

End of life stage

Answer 188

Check in with client if conscious and able to respond.

Verify status with caregivers.

Provide pain relieving techniques, gentle joint mobilization.

Observe client carefully for signs of distress.

Cease treatment if treatment unwanted or client in pain.

Question 189

Caregiver Fatigue

Answer 189

Form of burnout occurring when caring for ill family or friends

Fatigue occurs as levels of care increase.

Reduced sleep and insomnia

Results in caregivers feeling:
—> Inadequate
—> Exhausted
—> Disconnected

Question 190

Depression Increases When Ill Person Lives With Caregiver

Answer 190

Caregivers can never get away from responsibilities.

They must separate disease from impulse to help.

They have a low sense of personal accomplishment and sense of failure:
—> Emotionally exhausted
—> Hopeless and despairing

Question 191

Responding to Caregiver Fatigue

Answer 191

Watch for signals of burnout or caregiver fatigue.

—> Clients may not know how to explain their situation.

Listen for the unspoken story.

—> If information appears to be missing, clarify.

Match client goals with therapist skills, not the other way around.

Employ empathic investigation

—> “What would I want a therapist to ask me right now if I were this client?”

Question 192

In Summary

Answer 192

Don’t overlook massage therapy’s powerful medicine.

—> In the face of complex circumstances, massage therapists can offer respite, rest, recuperation.

—> Pay attention to client stories of secrets or scars.

Employ concise communication skills when working with clients who are cognitively challenged.

Be prepared to support clients through life transitions and even death.

Question 193

Class 6 (PROFESSIONAL COMMUNICATION)

Answer 193

..

Question 194

suicide

Answer 194

“Suicide is a difficult topic to discuss- and the biggest barrier to preventing suicide is the stigma around it.

Question 195

biggest barrier to preventing/discussing suicide

Answer 195

and the biggest barrier to preventing suicide is the stigma around it.

Question 196

how many Canadians died in 2020 as a result of suicide

Answer 196

In 2020, about 3800 Canadians died by suicide.

Question 197

what can we do when we reach out to people who are thinking about suicide?

Answer 197

When we reach out to people who are thinking about suicide, we can help them see that there is hope, they’re not alone, and help is available.”

Question 198

Who does suicide affect?

Answer 198

People with mental illness- 90%

Men- 75%

Trans people- 1 in 3 trans youth

LGBQ people- LGBQ youth are 7 times more like than straight youth

Indigenous People- risk varies

Question 199

How to help someone in crisis

Answer 199

Talking honestly, responsibly and safely about suicide can help you determine if someone needs help.

Question 200

if you want to help to help someone in crisis, try:

Answer 200

listening and showing concern.

talking with them and reassuring them that they’re not alone

letting them know you care

connecting them with help

Question 201

listening and showing concern.

Answer 201

showing concern can be an immediate way to help someone

listening won’t increase the risk of suicide and it may save a life

Question 202

connecting them with a:

Answer 202

crisis line

counsellor

trusted person ( neighbour, friend, family member or Elder

Question 203

responding to a suicidal person

Answer 203

“Ask direct questions such as “Are you considering suicide?”

THE MORE SPECIFIC AND DEADLY THE PLAN, THE GREATER THE RISK.

Take answers seriously and don’t ignore the signals.

Question 204

are we responsible for decisions others make?

Answer 204

We are not responsible for the decisions that someone else makes. However, we are often in the best position to recognize and initiate the first response to someone’s signals of suicide.

Question 205

what percentage of suicides occur without warning?

Answer 205

Some suicides (20%) occur without any warning and others take place despite the very caring responses of friends, family and counsellors. Suicide is ultimately a personal choice- it is not our job to ‘save’ someone else’s life, only to offer them other options.”

Question 206

basic terms associated with suicide

Answer 206

intent

means

plan

suicidality

suicidal

suicide attempt

Question 207

intent

Answer 207

motive behind action

Question 208

means

Answer 208

the way the person intends to …

Question 209

plan

Answer 209

fully formed and clear idea of how to accomplish suicide

Question 210

suicidality

Answer 210

the qualities of suicidal thinking or behaviour that a client may experience acutely or chronically

Question 211

suicide attempt

Answer 211

self-initiated, potentially fatal action of taking one’s life

Question 212

nonsuicidal self injury

Answer 212

cutting, burning, or harming oneself.

intent is to harm, not take one’s life

Question 213

completed suicide

Answer 213

act of taking one’s life and is used to describe death by suicide

this term is explicitly to avoid using the phrase “successful/succeeded” suicide
–> b/c no suicide can be considered a “success”

Question 214

what to do when clients are at risk of suicide?

Answer 214

learn risk factors, warning signs, and where to get help

talk openly about what you have observed, about suicide, and concerns regarding clients’ well-being

actively listen if client is expressing feelings

offer hope that alternatives are available (I.e. through professional help)

seek patient’s permission to contact doctor or mental health professional to inform him or her of your concerns

seek peer supervision to manage feelings associated with client’s crisis

Question 215

What NOT to do when clients are at risk of suicide

Answer 215

offer reassurance that things will get better

judge the client for feeling suicidal

debate the morality of suicide

avoid asking the person why they feel suicidal

agree to keep a client’s thoughts or actions secret

Question 216

Mental health first aid

Answer 216

Assess the risk of suicide and/or harm.

Listen non judgementally.

Give reassurance and information.

Encourage the person to get appropriate professional help.

Encourage other supports.

Question 217

if it is clear that patient is suicidal, then therapist must

Answer 217

“If it is clear that clients feel acutely suicidal, then therapists have an urgent responsibility to act on their behalf.

Question 218

acutely suicidal clients should not be…

Answer 218

Acutely suicidal clients should not be left alone or allowed to leave.

Call emergency services and do not leave them alone until help has arrived

It may be necessary to call a client’s physician, even if the client does not want the call to be made or to call the client’s emergency contact.”

Question 219

questions to ask about non-suicidal self-injury

Answer 219

I notice that you have some scars, …

textbook says that you should ask “are you currently cutting?”
—> however, that seems like it is not the best question to ask, as only a professional would be able to potentially know just based on seeing the injury

Question 220

THE ADULT GUARDIANSHIP ACT

definition of “abuse”

Answer 220

The Adult Guardianship Act (the “Act”), defines “abuse” as “the deliberate mistreatment of an adult that causes theadult

a. physical, mental or emotional harm,or

b. damage or loss in respect of the adult’s financialaffairs,

—> and includes intimidation, humiliation, physical assault, sexual assault, overmedication, withholding needed medication, censoring mail, invasion or denial of privacy or denial of access tovisitors.”

Question 221

Under Part 3 of the Act

Answer 221

Under Part 3 of the Act, anyone who has information indicating that an adult is abused or neglected (including self-neglect), and is unable to seek support and assistance becauseof:

1. physicalrestraint,
2. a physical handicap that limits their ability to seek help,or
3. an illness, disease, injury or other condition that affects their ability to make decisions about the abuse orneglect

may report this information to a designatedagency.

Question 222

is there legal duty to report abuse?

Answer 222

While there is no legal duty to report under the Act, it is worth noting that anyone who makes such a report will be protected from subsequent legal action, so long as the report was not made falsely ormaliciously.

Question 223

designated agencies to report abuse

Answer 223

Designated agencies include:

the five regional health authorities,
the Providence Health Care Society;
and Community Living BC (for adults with developmentaldisabilities).

Question 224

For more information, including contact information for designated agencies, see …

Answer 224

Public Guardian and Trustee of British Columbia website

Question 225

DUTY TO REPORT CHILD ABUSE AND NEGLECT UNDER CHILD, FAMILY AND COMMUNITY SERVICE ACT

Answer 225

As medical professionals, registered massage therapists have an important role to play in keeping children safe. That role is to be aware of, and alert to, the signs of child abuse and neglect. A “child” is a person under 19 years ofage.

Question 226

legal definition of child

Answer 226

a person under 19 years of age

Question 227

Anyone who has reason to believe that a child has been or is likely to be abused or neglected has a legal duty to …

Answer 227

Anyone who has reason to believe that a child has been or is likely to be abused or neglected has a legal duty under Part 3 of the Child, Family and Community Service Act to report the matter.

Reports may be made to a child protection social worker at either a Ministry of Children and Family Development office, or at a First Nations child welfare agency that provides child protectionservices.

Question 228

3 agencies to report child abuse

Answer 228

See the

a) Ministry of Children and Family Development website

b) and the Reporting Child Abuse

c) and Keeping Kids Safepages

Question 229

source to find helpful information about recognizing and responding to child abuse and neglect

Answer 229

The BC Handbook for Action on Child Abuse and Neglect for Service Providers also provides helpful information about recognizing and responding to child abuse andneglect.

Question 230

adults vs children

Answer 230

adults, you may report

children, you MUST report legally if you suspect abuse

Question 231

in communaiton with othe rHCP

Answer 231

use their terminology /lingo

–> E.g. if they say “client” – return message/email with “client” even if you prefer to use “patient”

Question 232

communicating with patients

Answer 232

if you use specific terminoogy, explain what it means

E.g. U trapezius
–> “a muscle that shrugs your shoulders”
—> you could evne show them a picture

E.g. Strain
–> “an injury involving tearing of some/many muscle fibres”

Question 233

good communicaiton

Answer 233

1. Potentially helpful in care of client
2. Affects your image and gives you credibility
3. Affects image of your profession

Question 234

referrals

Answer 234

Remember, their reputation is on the line if they refer a patient to you, so they want to be absolutely confident you will provide not only great results, but also stellar
service

Question 235

key concepts

Answer 235

Confidentiality
Exclusionary zones
File disposition
Inter and intraprofessional dialogue
Legal consequences of documentation

Question 236

Legal Standards of Healthcare

Answer 236

Legal standards of healthcare imply each of the following:

Accountability
Confidentiality and privacy
Safety and security

Question 237

What Does It Mean To Be Professional?

Answer 237

Mutual values and commitment

Self-regulation

Shared body of knowledge and skills

Application of sound judgment and evidence

Question 239

What Does It Mean To Be Professional?

Answer 239

Mutually agreed upon standards and ethics

Social and therapeutic contract

Respectful communication

Question 240

(The Role of Documentation) The Role of Documentation

Answer 240

..

Question 241

(The Role of Documentation) As a medical record to:

Answer 241

Document client condition
Measure outcomes
Reflect clinical decisions

Question 242

As a legal record for:

Answer 242

Third party or insurance payer actions

Court proceedings

Question 243

Guidelines for Creating Legal Documents

Answer 243

Record all information accurately and legibly, including:

–> Date of treatment, time, and billing date.
–> Employ accepted terminology and abbreviations.

Include all correspondence and referrals.

Keep client records secure and private.

Question 244

Documentation Can Be Used As Evidence

Answer 244

Evidence demonstrates that something is true.

Good evidence depends on data.

All client records are considered evidence.

Question 245

Evidence-Informed Practice

Answer 245

In order to support practice decisions, consider:

Available research.
Profession’s best practices.
Objective clinical findings.

Question 246

Evidence-Informed Practice (2)

Answer 246

Evidence-informed practice is easiest to defend when called as a court witness.

Problems with records arise when therapists include the following:

Judgments about client attitudes.
Therapist intuition.
Unproven claims.
Potential sales pitches.
Imprecise professional jargon.

Question 247

Documenting Emotional States

Answer 247

Include client words to describe emotional state in subjective findings:
—> For example, sad, mad, glad

Include client behaviors that confirm therapist impression in objective findings:
—> Include client behaviors that confirm therapist impression in objective findings:

Question 248

Documenting Emotional States (2)

Answer 248

Avoid diagnostic words like “depressed”.

–> Unless client indicates diagnosis confirmed by MD

Question 249

Current Record-Keeping Options

Answer 249

Electronic health records (EHR)

—> Core data from multiple sources

—> Submitted by different providers

—> Data available to all who have secure access

—> Commonly used in hospitals or institutions

Question 250

Current Record-Keeping Options (2)

Answer 250

Electronic management records (EMR)

—> Office-based or cloud network systems

—> Electronic versions of paper records

—> Kept by healthcare professionals

Question 251

Security and E-Records

Answer 251

In order to protect data from loss or theft, client records must be:
Password protected.
Securely and frequently backed up.

Question 252

Progress Reports

Answer 252

Keep other healthcare professionals informed about a client condition.

Most common format is “SBAR”.

Question 253

SBAR

Answer 253

SBAR, which stands for Situation, Background, Assessment, and Recommendation (or Request), is a structured communication framework that can help teams share information about the condition of a patient or team member or about another issue your team needs to address.

Question 254

SBAR Reporting Framework

Answer 254

S = situation
B = background
A = assessment
R = recommendation

Question 255

Discharge Reports

Answer 255

Sent at end of treatment series to:

• Summarize achievements.
• Comment about outcomes.
• Bring closure to client chart.

Useful in third-party files to indicate beginning and end of treatment

Question 256

MEDICAL DOCTORS – what they want to know – what they don’t care about

Answer 256

Want to know:
1. Did you get their referral
2. How long and what results are expected?

Don’t really care about:
1. What techniques you are doing.
2. Your assessment if it is the same as theirs.
3. Your technical jargon.

Question 257

Medical-Legal Reports

Requested when determining whether or not:

Answer 257

Client should receive an award as a result of a lawsuit.

Client insurance benefits should stop or continue.

Question 258

Contracts

Contracts exist to protect both parties.

Answer 258

Usually arranged between clinic owners and associates

Both parties responsible to ensure that contract reflects their best interests.

Question 259

Contracts Are Binding Whether or Not They Are Legal

Answer 259

??

Question 260

verbal contract

Answer 260

No documented evidence of agreement

Difficult to enforce

No protection

Question 261

written contract

Answer 261

Agreement is only as good as the terms of the contract

Essential to review carefully before signing

Question 262

Two Ways That Contracts Affect
the Therapeutic Relationship

Answer 262

File disposition

Exclusionary zones

Question 263

File Disposition

Answer 263

File disposition determines who owns the client file.

Question 264

Client information

Answer 264

The information about a client is the property of the client.

Question 265

Client file (paper or electronic version)

Answer 265

The recorded file of this information is considered a business asset.

Question 266

Exclusionary Zones

Answer 266

Noncompetition clause

Question 267

noncompetition clause

Answer 267

When a therapist leaves a clinic, this clause describes:

—> How closely a therapist may work to the previous location.

—> Period of time before a therapist may advertise new clinic location.

Question 268

When Signing a Contract

Remember:

Answer 268

All contracts are binding.

Don’t sign unless you’ve understood the fine print.

Refuse contracts that don’t allow professional obligations.

Evaluate the opportunity based on the contract.

Question 269

Inter and Intra professional Dialogue

Answer 269

Interprofessional
Between professions

Intraprofessional
Within a profession

Question 270

Point to Ponder

Answer 270

Would you communicate differently with your peers than with nonmassage therapy professionals?

Question 271

Interprofessional Networks Are Good for Business

Answer 271

Strong professional networks enrich client care:

1) Send thank-you notes for referrals.

2) Follow up with progress notes.

3) When care questions arise, consult with other professionals on the client’s healthcare team.

4) Finish treatment plans with discharge notes.

Question 272

how many regulated health professions are there in BC?

how many of them are self regulated vs government regulated (/appointed)

–> which profession is that?

Answer 272

There are 26 regulated health professions in British Columbia, of which 25 are self-regulating professions governed by 22 regulatory colleges under the Health Professions Act.

One profession (emergency medical assisting) is regulated by a government-appointed licensing board under a separate statute.

Question 273

22 REGULATORY COLLEGES

Answer 273

The colleges have been delegated the authority under provincial legislation to govern the practice of their members in the public interest.

Their mandate at all times is to serve and protect the public.

The primary function of the colleges is to ensure their members are qualified, competent and following clearly defined standards of practice and ethics.

Question 274

all colleges

Answer 274

All colleges administer processes for responding to complaints from patients and the public and for taking action when it appears one of their members is practicing in a manner that is incompetent, unethical, illegal or impaired by alcohol, drugs or illness.

Question 275

Professional – Professional Relationships

Answer 275

Health care professionals need to collaborate and cooperate with one another in order to help patients resolve health care problems.

Three problem areas:
1. Role stress
2. A lack of inter-professional understanding
3. Autonomy struggles

Question 276

1. Role stress

Answer 276

The nature of health care work contributes to job stress.
There are two types of role stress:

1. role conflict
2. role overload

Question 277

1) role conflict

Answer 277

Relates to professionals that are socialized to fit one role, yet are expected to fit another role.

New graduates learn that their ideals and aspirations are seldom the same as the values that receive praise on the job.

The discrepancy between these two very different value systems creates role conflict. (Nurses and social workers often experience stress and burnout carrying out their professional responsibilities).

Question 278

2) Role overload.

Answer 278

Workload and scheduling stressors.

Question 279

Assuming that role stress (e.g., role conflict and role overload) is common among health professionals,
what effects does role stress have on interpersonal relationships among health care providers?

Answer 279

..Is often the underlying source of professional –professional tensions.

Role stress leaves the professional in a vulnerable position, more easily stressed by minor conflicts with co-workers.

The role overload of one professional may interfere with the role functioning of another.

Professionals may withdraw from one another as a means of coping or may be unwilling to invest energy in maintaining professional relationships.

Question 280

2. Lack of interprofessional understanding

Answer 280

Why do health professionals know so little about one another’s roles?

Question 281

Why do health professionals know so little about one another’s roles?

Answer 281

Professional education that takes place in virtual isolation from other health disciplines is a major cause.

The greater the gap in understanding of one another’s roles, the more negative we are toward collaborative decision-making.

Limited amount of contact that exists between HCP on a daily basis.

Busy schedules.

Question 282

territorial disputes

Answer 282

In recent years, HCP’s roles have expanded considerably, leading to confusion as to which professional has expertise in a particular area.

This increases territorial disputes.

When HCP roles overlap considerably, it is not unusual for one to think that the other is trying to take over power or responsibilities.

This can result in unproductive competition.

Question 283

3. Autonomy Struggles

Answer 283

Autonomy- the freedom to be self-governing or self-directing.

The degree of autonomy depends on:

1) The permissible scope of practice for that group contained in the provincial licensing laws.

2) The ability of that group to secure access to necessary health facilities, such as hospitals.

3) The ability of that group to obtain reimbursement from private and third-party payers.

Question 284

How do discrepancies in professional autonomy affect professional relationships?

Answer 284

The dominant profession tends to underestimate the professionalism or competence of other professionals.

Question 285

Interprofessional Bias

Answer 285

Stems from a lack of awareness

• Focus on the issue.
• Acknowledge what is true.
• Avoid blaming.

Question 286

When Communicating With Other Professions

Answer 286

Put aside professional rivalries or defensiveness.

Focus on what is best for each client.

Educate other professions in an evidence-informed way.

Question 287

When faced with interprofessional bias or conflict, use an “I” statement

Answer 287

..

Question 288

In Summary

Answer 288

Professional practice and client-centered care is good for business.

Professional accountability ensures client-centered care.

Legal obligations require attention to documentation, confidentiality, and a predictable standard of evidence.

Question 289

In Summary (2)

Answer 289

Contracts are legally binding and must be carefully considered before being accepted.

Interprofessional communication creates opportunities for networking, education, and dialogue.

Question 290

role stress

Answer 290

conflicts related to different roles of HCP (?)

Question 291

class 7

Answer 291

..

Question 292

Body mechanics:

Answer 292

Mechanics is the analysis of the action of forces on matter or material systems. (American Heritage dictionary-1995)

Question 293

body awareness

Answer 293

A more accurate term and tool for describing the endeavor to achieve efficiency in massage practices would be Body awareness.

Body awareness incorporates a fuller understanding of the action of forces on the human body.

Question 294

massage therapists need to

Answer 294

Massage therapists need to listen to their bodies

The best way to maintain body mechanics and avoid injury is to pay close attention to how you feel as you work.

Question 295

ergonomics

Answer 295

Is the use of tools in a way that helps the human body, as opposed to adapting the human body to fit the standard tools.

Question 296

biggest investment in ergonomic tool

Answer 296

Our biggest investment and most important ergonomic tool (besides our bodies) is our table.

Buy a hydraulic table if you can afford it.

If not, invest in a small step stool and/or a pair of clogs that you can easily slip into and out of, in order to adjust your height.

—> Or, purchase an office chair with a hydraulic adjustment.

Question 297

Self-care:

Answer 297

According to The American Heritage Dictionary, (1995), care means to be concerned or interested.

Self-care is turning our concern and interest to maintaining one’s own good health in order to work easily and well.

Question 298

It is imperative to

Answer 298

to make preparations before a session (stretching and strengthening) and after (icing to relieve inflammation, and stretching to counteract curling of your upper back)

Question 299

psychological self-care

Answer 299

Psychological self-care (finding social support, setting good and safe boundaries for yourself and your guests) is as important as a regimen of exercise, good nutrition and adequate rest.

Question 300

we need to

(physical/psychological needs)

Answer 300

We need to learn to care for ourselves in body, mind, heart and spirit.

Learning to attend to our physical and psychological needs is at he heart of the issue and is the essence of self-care.

Question 301

Tai chi chuan

Answer 301

Not a bodywork discipline per se, but has some strong influences.

Means “supreme ultimate martial art exercise”.

Question 302

in Asia, Tai chi is regarded as

Answer 302

Throughout Asia. Tai chi is not regarded as a martial art, but rather as a part of therapeutic remedies prescribed by traditional Chinese medicine.

Question 303

the movements of tai chi

Answer 303

The movements of Tai Chi percolate life force from the body’s center (hara) and send it circulating around the body.

Question 304

Yoga

Answer 304

Means to join together or yoke.

Is intricately intertwined with ayurvedic medicine.

Is an example of static unassisted stretching

Question 305

Taking Self-Care Seriously

Answer 305

..

Question 306

Therapists who work with emotionally challenged clients are at risk for:

Answer 306

Burnout.

Vicarious traumatization. (a term used to describe what happens when helpers such as healthcare professionals feel traumatized by the experiences of their clients.)

Question 307

who is most at risk for burnout / vicarious trauma?

Answer 307

Highly Motivated and Caring Therapists Most at Risk

Question 308

Signs and symptoms of burnout and vicarious traumatization include:

Answer 308

A lack of work and home life balance.

A feeling of disconnection from the world and others.

Withdrawal from friends and social activities.

Cynicism, despair, anger, fear, and a lack of motivation.

Diminished capacity to manage day-to- day activities.

Nightmares and intrusive imagery.

Question 309

Finding Solutions to Burnout and Vicarious Traumatization

Answer 309

Observe personal responses to clients carefully.

Establish work, play, and rest balance.

Maintain connections with others.

Question 310

Peer Supervision

Answer 310

..

Question 311

a peer acts as

Answer 311

A peer acts as professional sounding board.

Discussions help therapists:
—> Understand responses to client situations.

—> Learn how their responses put them and clients at risk.

—> Clarifying boundaries.

Question 312

who can work as peer supervisors?

Answer 312

psychotherapists

counselors

massage therapists experienced in psychological dynamics of patient relationsihp

Question 313

types of peer supervision

Answer 313

formal, contractual

informal mentoring occasion

correspondence, phone

group supervision

peer support groups

Question 314

problems that indicate peer supervision

Answer 314

confusion about a therapeutic relationship

feeling ineffective and unable to establish boundaries

encoutners with high-risk or vulnreable clients

feeling bored/angry with clients

surprising responses to clinical situations

feeling burned out and exhausted

Question 315

how peer supervision works?

Answer 315

reflection and problem solving

identifying blind-spots and weaknesses of care

consideration of transference and counter-transference

helping to establish healthy boundaries

providing time with experienced mentor

Question 316

in summary

Answer 316

Working with emotionally challenged clients means:

—> Adhering to a predictable framework.

—> Knowing how to ask questions.

—> Ensuring that clients are safe to receive treatment.

—> Responding empathically if clients become triggered.

—> Committing to therapist self-care, peer support or supervision.