COMMUNICATION #2

EFFECTIVE THERAPIST-CLIENT COMMUNICATION: MASSAGE

To communicate well during massage includes paying attetion to listen to the verbal
cues the client gives but also just as important is to listen to the clients body.Listening
and bodily listening.
I see the challenge to maintain focussed on the client not just the hands on massage strokes and the task of massage ; relaxation or remedial .If I were to forget the ' whole person ' my client and I may have a totally unrelated opinion on the massage experience.

POST MASSAGE & REBOOKING

I think it is important to check in with my client after the massage session to ensure they
have the opportunity to comment on the massage if they choose. By using open questions
this may lead to comments and a way into rebooking . I think a direct closed question "do you want to come again in 2 weeks" is almost a challenge rather than a respectful enquiry. Also direct eye contact with this is also a challenge and may make my client uncomfortable. Respect and empathy and not holding eye contact for too long is more likely to allow the client to feel in control.

Communication

Areas of communication that impact on my practice as a massage therapist;

• Professional presentation; How I present myself to a client is always important. I can communicate this in a non-verbal way by; my appearance, how I decorate and maintain my rooms. Display qualifications relating to my practice. Body language is also important in this setting. Being alert and purposeful generates a feeling of confidence in my abilities from the client. The intention is to ensure my client feels safe and confident.

• Phone booking and reception skills; Listening skills, paraphrasing and tone of voice are important communication tools when I undertake making appointments and scheduling treatments. Before answering the phone or at reception my head needs to be clear of unrelated thoughts, so that I can listen to my clients name and hear what it is they need. By doing this I can paraphrase back to them to clarify and confirm that I have heard correctly. Tone of voice coveys interest, friendliness and respect. It is important my client feels welcome via the telephone or at my reception area. I want them to come back.

• Client welcome and greeting; It is important to make eye contact when welcoming my client and be respectful. I want them to feel welcome. At this time I want to be prepared and look prepared.

• Client interview ; Presenting questions in a way that information is obtained in an effective and timely manner is important for myself and the client. To ensure that I can safely and effectively provide massage treatment. It has to be effective in the time allocated so that I do not encroach on the available massage time. How I approach questions will determine how they are answered . An open question will allow me to to ask more questions on that subject or clarify anything. While a closed question will edict a yes or no answer . Paraphrasing is a useful tool as it allows me to make sure I have understood what I have heard and therefore need to practice good listening skills. Body language will convey to my client if I am interested and is another important component of a client interview.

Whilst thinking about how communication impacts on my practice I find there is no skill that isn't important.

Historical, Cultural and Philosophical approaches to massage

Massage is possibly the earliest form of healing care widely practised in the East but developed in some form in all cultures. The earliest document originated from China. The first Chinese medical text penned under a mythical author 'The Yellow Emperor, the title Huang-tei nei ching' dated at around 2,700 BC, documented the use of massage as beneficial. Massage in its earliest forms was practised by the Shaman or village healer through all cultures, generally the art was passed down through family generations. Chinese massage Amma is termed the grandparent of massage therapy.

By the 6^th Century the Japanese were using massage similar to Amma, but called it Shiatsu, focusing on energy points called Tsubo. Other Asian cultures including India developed their own forms of massage. The Hindu's practiced Ayur-Veda focusing on the meaning of life, prevention and treatment. The Eastern cultures practised massage to a holistic framework, based on consideration of the whole person treating, emotional, physical and spiritual needs of the person. Treatment may have included the use of herbal remedies, calling on spirits energy work focusing on meridians or pressure points (Acupressure), each area having different purposes related to the body or emotional/spiritual needs of the body.

The West began to understand the benefits of massage therapy during the 6^th and 7^th Centuries. Western massage developed by an increasing knowledge of anatomy and physiology- the mechanics of the human body focusing on the problem or symptom and the treating that in isolation. In direct comparison to the Eastern model of holistic care.

Western massage continued to be developed throughout the period of Greek and Roman dominance.

Key Figures of this time:

Hippocrates of Cos 460-375 BC

Known as father of Western medicine. Hippocrates followed the ideas of techne latrich or healing science. He emphasised the care of individual and the premise of causing no additional harm. He promoted the use of massage as a therapeutic tool in his essay on joints, therefore legitimising its use to the medical fraternity of the time.

Galen of Pergamon 130-200 BC

Follower of Hippocrates, a Roman physician. Pergamon increased knowledge of anatomy and medicine. He identified the benefits of exercise, baths and massage treatment which were documented in Sanitate Tuenda.

In the Middle Ages the collapse of the Roman empire and decline of intellectualised civilisation saw massage practice decline and become associated with paganism and witchcraft. Traditional healers and often midwives practised massage therapy but were persecuted by the churches for this.

During the period called The European Renaissance and Enlightenment 14-16^th century massage as a therapeutic treatment remerged with classical Greek and Roman medical text and beliefs revisited, along with an increase in medical knowledge. Andreas Vesalius published De Humani Corpus Fabrica (1543) a modern anatomy book for that period.. Girolamo Mercuriale (1530-1606) wrote the first sports medicine recognising the benefits of massage in a sporting (gymnastics) context in his book-De Arte Gymnastica. The benefits of massage associated with spa therapies and rehabilitation was recognised by the scholar and physician Timothy Bright (1551-1615) who published his medical work and taught his ideas to students at Cambridge university. This period of rebirth changed the views of the medical world to include massage as a legitimate form of treatment in all areas of health.

The 19^th century brought the Modern era and massage development was significantly influenced by several key people including;

Pehr Henrik Ling (1776-1839)

Ling a Swedish physiologist and gymnastic instructor developed a school of gymnastics. Ling's system of teaching gymnastics was based on 3 primary movements with an associated treatment programme which developed massage techniques and strokes. He became known as the 'father of Swedish massage.' But was criticised because his findings were based on gymnastics and he was not a physician.

Joahann Metzger 1817-1893

Promoted massage by medical and scientific knowledge increasing its therapeutic use within the medical profession, particular in the area of rehabilitation. Named massage strokes- effleurage tapotment.

Kellogg John Harvey 1852-1943

Popularised the benefits of massage and spa therapies in America through his work at Battle Creek Sanatorium and publishing a health magazine 'Good Health'. Kellogg criticised rubbing down rather than up- promoting discussion on this.

Contemporary massage

Contemporary massage has developed through the 20^th Century with advances in areas of orthopaedic, neuro-muscular and lymphatic drainage.

Key individuals involved have been:

Janet Travell 1901-1997

Recognised that muscles have memory and can stay contracted for long periods as a rigid knot found in muscle, tendons, fascia, ligaments and periosteun. Developed technique of release of these triggers points called Trigger Therapy.

Emil Vodder 1896-1986

Developed massage technique focusing on the lymphatic system. Using light repetitive strokes to a specific area encourages the movement of lymphatic fluid to lymph nodes for drainage filtration and elimination.

James Cyriax 1904-1985

'Father of orthopaedic medicine'. Advocate the use of deep tissue massage using cross-fibre technique without the use of lubricant in treatment of soft tissue injuries and pain.

Massage Scandals of the 1800's

In 1894 the British Medical Journal published an article calling massage parlours "hotbeds of vice", where prostitution was rife.This discredited the reputation of reputable masseurs.This situation had arisen due to many more nurses being trained because of military action overseas, the educational requirements had dropped. Part of their training encompassed massage, this allowed them to move away from nursing and unfortunately poor morals or need of money pushed some into prostitution with the massage parlour being the front for this activity.

To raise the standard of massage, 4 British nurses that were midwives established the Society of Trained Masseuses in late 1894.They recognised the need for acedemic pre-requisites for study,training in approved schools only,qualified teachers, examinations and voluntary membership.This became the first act of legitimising massage and physiotherapy.

Maori massage compared to Western massage

Maori massage is based on the whole person treating mind body and spirit that incorporates massage, manipulation, herbal medicine and counselling. It is often passed on through generations in a family Miri miri is a process that works on all four dimensions of the person. Their physical, spiritual, family and mental health. Romi Romi is deep tissue massage using elbows, feet, raakau (stick or wood), kohatu/toka (stones), moana(sea water).

Western massage is a physiological and anatomical ,science base form of massage.

As our knowledge of the human body has evolved through the centuries how we use massage has also grown with that knowledge. Starting with the body and limiting treatment to that. Then progressing to a belief that our mind can influence our body, our environment we live in socially also influences our health. So we are more ready to embrace the framework of the eastern traditions of holistic care and meld them with the scientific western base.

Mind-Body-Soul:

I have seen while working in palliative care how important it is to treat the 'whole person'. For example, in trying to achieve good pain control the medication is not as effective as Dr's had expected-until the patients 'total pain' has been addressed, pain control is not effective. This is usually an emotional or spiritual issue once this has been resolved or at least discussion or recognition of the problem identified pain relief can remain ineffectual. The human body is a most amazing, strong being. Our minds can overcome the shortcomings or problems our bodies encounter to a certain extent. Touch affects not only our physical self but can have positive and negative effects on our minds and spirit. It can frighten us or calm us. A touch can convey love, care, empathy, faith and can not be verified in a scientific way. Massage has a place in all therapeutic settings and I believe we affect our mind or soul each time we experience massage in an unconscious way. It is a privilege to be allowed to touch another body, respect and trust is a must for the masseur and the client that alone affects who we are and how we feel.There is recognized benefits for the use of Reiki, Acupuncture,those that use alternative methods are more likely to report a life-changing experience, transforming how they live or view the world,-unexplained by science but the soul knows!

Development of Massage in New Zealand:

In 1894 the Society of Trained Masseuses legitimised massage therapy,with standard of training and care. By the early 1900's New Zealand had over 300 massage therapists, but no standardised level of training.To remedy this a massage department was established at Dunedin hospital. Massage was taught at the hospital and Otago University until 1946, when the massage school became the school of physiotherapy.Soon after this in 1949,registered masseurs (Masseurs Registration Act 1920),were no longer allowed to use the word therapy in describing themselves or treatment, the 1920 Act had been superseded by the Physiotherapy Act. This entailed 600 hours of training to be able to practice massage which physio's generally do not want to do, increasing the need for massage therapists.

With increasing need and want for massage a national organisation was formed in 1985 by Bill Wareham-Massage Institute of New Zealand (MINZI), focusing on education, standard of teaching, annual conference and professional development.

1989 saw the formation of The New Zealand Assn of Therapeutic Massage Practitioners (MZATMP) by Jim Sandalford.Primary focus on development of a professional image,increasing public awareness of massage and sharing of information along with education. A name change occurred in late 1990's to Therapeutic Massage Assn.

2007 saw the merging of the 2 national associations to become Massage New Zealand.

Salvo,S (2007) Massage Therapy-Principles and Practice (3rd ed.) Saunders, Canada

The Impact of the Renaissance and Enligtenment periods on massage Retrieved from http:/wikieducator.org

A History of Massage in New Zealand Retrieved from http:/wikieducator.org

Elluminate notes-Felicity Molloy

http:/www.essortment.com/articles/eastern-western-massage-differences_3394.htm

http:/www.Holisticonline.com

Redfern,SJ., Ross,F. Nursing Older People

Sustainable Massage Practice

Sustainable Massage Practice- 14-Aug-2009

Principles of sustainability relating to massage practice can be categorised as operating as a business or individual therapist, whom considers the effect of their business / practice on people, planet and profitability; ( which has been termed- the triple bottom line) without compromising the resources needed for future generations. Also the ability of the individual to maintain their longevity within the massage profession must be taken into consideration.

Client focused care will sustain our practice as MT's this includes

· Professionalism-registration with national body

· Working within scope of practice

· Display relevant professional certificates

· Client confidentiality

· Secure and correct documentation for client details and treatment plan

· Attention to personal attire and hygiene

· Appearance and hygiene of practice setting

· Handling of appointment system

· Treatment completed within a set timeframe

It is important to have a good reputation within the community and be seen to be a legitimate health professional. This not only assists the individual but also other massage therapists and alternative health providers. It is difficult to sustain a business if you gain a reputation for poor quality of care, charge too high, are deemed not to give good value. Word soon permeates through a community and moves to other health practitioners.

Working with other parties is part of a business. It is important to maintain good working relationships with suppliers, other health professionals, financial institutions.

· Payment of accounts on time

· If needing to refer a client providing good documentation

· Client referred to you, provide timely feedback to referring party

· If an employer-be a good one. Others will want to work for you

· Establish suppliers where possible within the local community, which assists the sustainability of the local market.

To sustain business a profit needs to be made, this has to be balanced on a reasonable figure that the community can afford to pay for a massage session and the outgoings that are required to achieve the session. Which leads into purchasing products, how we best utilise energy required for cleaning and heating, building or clinic maintenance and the potential cost on the environment of our decisions in this area.

How our practice as massage therapists affects the environment can be considered when we purchase equipment and products.

· Where and how resourced and distributed

· What sort of packaging used-recyclable or not

· What ingredients used, are they from an endangered source

A protocol could be used so that the business only buys environmentally safe cleaning products, recyclable printing products. Practice heat and water efficiencies.

To ensure massage practice is more sustainable would be to have a mission statement and define the core values of the business and individual practice. This outlines values to maintain on a daily basis and a focus for a long term plan. Giving a template to work along and refer to in all facets of the business.

As a massage therapist self-care would make the individual more sustainable. As massage therapy is a physical career maintaining good body mechanics and strength is required. Ensuring rest periods between massage and practical scheduling of massage sessions will also assist this.

Ongoing professional development will lead massage therapists to be more sustainable leading to increased knowledge, continually improving client care, research and further development of massage therapy as a profession in New Zealand.

http:/www.sbcmontana.org/sustainability/whataresustainablebusinesspractices.html

http:/www.gw.govt.nz/section66.cfm-Greater Wellington Regional Council

Salvo (2007).

The ethics of professional practice

Client-centred care; this is a model of care with the focus clearly on the client which is based
on trust and respect.The massage therapist must maintain this focus to
provide professional care.This includes;
1. scope of practice
2. meeting educational requirements
3. standards or code of practice
4. working within ethical code ,MNZ code of ethics
To provide a care plan where the needs and expectations of the client
are met in a timely professional manner and referred to other health
professionals if in the best interests of the client.

Informed consent; Authority from the client for the therapist to provide treatment.This is a
legal document and must always be part of the treatment process.It is a
safeguard for therapist and client and should be discussed with the
client prior to them signing.This allows questions and clarification of the
massage treatment by the therapist and signals an ethical and
professional standard.

Scope of practice; The limitations of a therapists practice.This is the level of competency
of practical and theoretical learning of their qualification under which a
therapist can provide treatment.To practice any treatment beyond or
to lead a client into believing you had a higher level of knowledge would
be wrong and unethical.

Confidentiality; This is safeguarding the clients privacy ,safety and protection of client records.It would be unethical to pass on any information regarding a client unless it is to
another health professional and the client has given permission for this to occur.
Client records must be kept in a professional manner.This includes information stored in a
secure area, not left out so others may view them.

Boundaries; These are important so that the client-therapeutic relationship is not compromised. This includes-good time-keeping,

• having a clean and professional appearance
• the massage area ready and tidy and clean
• how a disgruntled or unhappy client is handled
• how appointments are handled
• late or missed appointments, how they are dealt with
• not allowing social/intimate behaviour to occur

Power differentials; An imbalance of power occurs as the client has come with a need which the therapist has the skill and knowledge to assist with.Therefore an impression of authority occurs over the client. The massage therapist must be careful not to be neglectful or mistreat this relationship maintaining good moral and professional ethics.

Relationships: Acquaintance/professional; therapist may work alongside other health professionals.Client confidentiality is important in this setting.

Friendship; when treating a friend it is important to maintain professional standards and limit social chatter .If the client-therapeutic relationship is compromised then it would be wise to refer the friend to another therapist.

Intimate; good ethics and professionalism would stipulate a referral to another health professional if a client-therapeutic relationship has changed in this way.Or a therapist may treat a family member and may be lax in completion of documentation and possible information that may be contra-indications.

Therapeutic; therapist provides a service of care within their skill and knowledge.Beneficence,to help or at least do no harm.

Transference;The client may transfer thoughts and feelings onto the therapist and imagines false meanings into conversations or actions attempting to personalize the relationship.Signs may be invitations to social events,personal gifts, unrealistic expectations of treatment.Ethical considerations at this point may be initially maintaining clear boundaries.Onto regular supervision and consider referral to other therapist.

Counter Transference;The reverse of transference. The therapists boundaries have become confused and the therapeutic relationship has been compromised.This may be identified by the therapists need to fix, remove the pain,to have an answer or love.Warning signs may be an attachment to the client, disproportionate disappointment at cancelled appointment.The ethical cosiderations remain as above for transference.

If we as massage therapists maintain and practice within a code of ethics we safeguard ourselves and our clients .

Salvo,Susan G.(2007). Massage Therapy, Principles and Practice.

Notes from Elluminate lecture Felicity Molloy. 6/7/09

More on The Story of Stuff-Do Ethics count.

In the clip on distribution contained in Story of Stuff; I agree that the real cost may
not be taken into account when we as the buyer purchase a product. But the reality
is if it was all taken into account only the very rich would be able to afford. So there
is the dilemma, keep prices to an affordable level, sustain these so the masses can
buy.To ensure the human cost is not unjust( low wages,pollution,energy,unsafe work enviroments), guidelines, best practice policies, legislation all need to be practised.For
this we need to look to our governments,national organisations related to particular
businesses, unions etc.To manage the 'true' cost we need to work with a code of ETHICS!

More on the Story of Stuff-Do ethics count

I think that sustainable and ethics are comparable concepts.If you believe in one
then the other can follow.If you want sustainability you probably also believe in
a code of ethics.
Greater Wellington Council (2004) site,
'For many people, it means a business that is concerned as much for the social
and enviromental consequences of its actions, as for its profitability".
This site also posts a model for decision making for businesses that are looking
at sustainability.
So Local Govt. is providing education for those that seek it out. so an informed choice
can be made.Sustainability and ethics are great ideals but it has to be operated in a
practical and realistic way.

Reference:
Great Wellington Regional Council:Sustainable business.Retrieved6/7/09 from
htt://www.gw.govt.nz/section66.cfm

Principles of sustainability- Do Ethics Count

Distribution is how we deliver a product to it's point of sale. This includes how the various ingredients travel to make that product and ? is the true cost realised.The Story of Stuff led me to think about the 'true cost' and how ethical is the price we pay,how we source the materials, how we treat the labour force that produces it, how we may be affecting the global and local enviroments. We go to The Wharehouse to buy say a hot water bottle and pay $3.99, did it really cost that much- product ingredients,packaging, wages,transport.I personally don't like to think that because I want to buy as cheap as I can that I am propensiating very low wages or dangerous working conditions.But it does make you start to think.Where are the ethics ? the company who has poor working practices or we who continue to expect the cheap price. Ethics
morally or in a business sense or societal are they different?

THE EFFECT OF MASSAGE STROKES

The Effects of massage on the Autonomic Nervous System (ANS).

The ANS responds to the effects of massage by way of involuntary responses. These are not consciously controlled and are activated by nervous impulses to smooth muscle, cardiac muscle and glands.The ANS is divided into the Sympathetic system ,
Parasympathetic system .
The Sympathetic nervous system is the bodies way of coping with danger or stress,real or percieved. Alternatively the Parasympathetic system is used to achieve balance in the body and maintain homeostasis.
During massage the parasympathetic dominates the sympathetic. As it is most active under a calm enviroment,which the massage room should be.
Intially the sympathetic system is aroused by the percieved vulnerability of lying on the massage table and awaiting first contact of the therapist.This is the 'Fight/Flight' reaction and is activated until the body feels a sense of trust and safety is established.
Once the body is encouraged to relax, aided by slow rythmic massage the parasympathetic system is activated. This causes the body to relax, destress and reduce the excretion of stress hormones.
Deeper massage will engage the sympathetic system to increase circulation to the areas that are being worked on.Tapotement, vibration, shaking , petrissage all activate the sympathetic system by 'exciting' the muscle to make small vigorous contractions.
In tandem the 2 divisions of the ANS play an important role in the way the body responds to massage.

The Effects of Massage Strokes.

Touch/Holding; Allows the body time to adjust to the enviroment.Mentally prepare for the
massage experience, know where the massage therapist is. Time to percieve
start and finish of area being worked on or beginning and end of session.

Effleurage/ Petrissage; allows spread of massage lubricant. Preparation to warm tissues prior
to more intense work on that area .It is also used following any deep
work.Generally effleurage is a more relaxing long stroke than the twisting ,
squeezing movement of petrissage,which is effective in breaking up fascial
adhesions.
The squeezing action of petrissage also produces a pumping action to move
fluids. Whereas the long strokes of effleurage towards the heart in a light to
moderate manner is effective in aiding the movement of lymph fluid. A deeper
stroke aids venous return.


Compression/
Tapotement/ These massage strokes stimulate muscles and nerves. They cause muscles to
Vibration; relax via reciprocal inhibition-ie, Tapotement can cause lengthening of
muscle spindles,-lengthen muscle,then contracts (reflexive contraction) to
protect any tissue damage by sudden lengthening.This is
then followed by general relaxation of the muscle.
Cupping tapotement can be used specifically over the back of the chest to a
aid the loosening of respiratory secretions and mucous.
All of these strokes are effective over clothing.
Compression although shares the benefits of the other strokes is specific in
providing pressure point work to relax muscle and relieve pain.And
mechanical movement of fluid.



Other Effects Of Massage

Blood Flow; Increases blood flow by mechanically assisting venous blood flow back to the
heart.

Lymph Flow; Increases lymphatic drainage-especially light to moderate massage towards
the heart.

Muscle Tension; Reduces muscle tension by relaxation,relieving tension and stiffiness

Connective Tissue;Breaks connective tissue adhesions and promotes tissue healing by increasing
collagen.

Sleep Patterns;Aids healthy patterns and deep sleep.

Digestion; Increases digestion which is stimulated by relaxation

Blood Pressure;Reduces blood pressure by promoting relaxation and reducing stress
hormones. May increase if massage painful.

Pain; Reduces pain by interrupting the pain cycle.Stimulates the production of endorphins
the body's natural analgesic.Reduces ischaemia and aids in the removal of metabolic
waste.

Mood; Improves due reduced stress/pain. Enhanced feeling of well-being. Renewed energy.

Concentration; Improves, directly linked to above mood improvement.

Satiety.Increases.

Bonding; Ability increases due to improvement in mood, concentration, satiety,reduced stress.

Sustainability-pondering!

Having watched The Story of Stuff, say its all totally true-how to change the model? If we the general public don't have power or money can we make a difference? I think the idea of the Corporations having the biggest influence may well have merit; why else does the govt bail them out.A bit simplistic! But a start !

Preparation for Massage

Appointment Booking;
Judy has rung the clinic to make an appointment for a back massage. Whilst making a time, I am able to ask Judy if she has had a massage before. She has never had a massage, so I enquire if there is anything in particular that she wants. Judy tells me she has had some shoulder and mid-back aches which she attributes to working at a desk all day.I clarify with Judy if she has seen her Doctor or a Physiotherapist and does she have clearance to have a back massage. I am pleased that she has been proactive and has spoken to her Doctor who has given her clearance to have a Relaxing back massage.

The next step is to establish how long the appointment will be, what sort of massage (relaxation) ,I also explain to Judy that I have a client record form and consent form that I ask that she completes on arrival and to allow 5-10 minutes for this ,clarifying this is additional time to the half hour massage time so that she will be aware of the total time she needs to allow for herself .
Finally I confirm Judy's contact details obtaining 2 numbers, home and cellphone, which allows me to TXT her the day prior to her morning appointment reminding her of the day and time.

CLIENT CONSULTATION DAY OF MASSAGE;
Judy arrives for her massage; I welcome Judy intoducing myself . There is an area with 2 armchairs and coffee table where we sit down so that I am able to give Judy the client information sheet and consent form for her to fill in. I explain why it is important that she is able to complete these so that I can treat her well and safely.
I leave Judy for a few moments to look over the forms and complete them telling her I am just going to check the massage room is warm enough.I do this so that Judy does not feel' hassled'whilst filling in the forms.

When I return I sit down with Judy and review the form with her so that I am able to clarify any injuries, allergies, any present conditions which contrindicate massage or need to be accommodated within the massage treatment.
Also allowing; Judy to ask any questions of me
Myself to clarify Judy's expectations
Any preferences re lubricant and allergies.
Explain massage process I will undertake today
Clarify my hygiene policy, re new drapes for each client, cleaning table

It is important not to rush through this process as intial impressions will set the confidence that this new client will hold in my ability and my standard of professionalism.

Moving through to massage room;
Because this is Judy's first visit to the clinic and first massage I show her the layout of the room and where the toilet facilities are . Fresh jug and glass of water if she would like a drink prior to , particulary beneficial after the massage.

Massage Time; I provide clear instructions to Judy about;
where to hang her clothes
how much of her clothing to remove
how to get on the table,where to place her head,body position
which drapes to place over herself.
To give Judy some privacy while she gets ready, I explain that I am nowing leaving the room to wash my hands,and will be back in 5 minutes and will knock before entering to make sure she is ready.

Reflection : I'm reviewing my notes and I am going to explore the benefits/issues touch in the texts, also pathogens,which should lead into hygiene & contraindications? Every thing was new,but got a handle on setting the scene/script for a basic massage. It was great to get hands on & I am excited about creating a new career, it feels right.

Definition: Posture- maintaining an optimal body postion for myself during activity.An awareness of self in a physical sense.For the client; education & explanation about their posture, to make them more posture aware & assist them to improve their well-being;assist their positioning on massage table for safe & effective massage.

Blanche Sturgess

I live in Oamaru, having moved from the North Island 1 year ago.

I enjoy spending time with family & friends, watching rugby,attending a gym 2-3 times week.

I am interested in massage as a new career path, following 20+ years in a nursing enviroment.

After graduating I would like to work independantly with my own practice, perhaps aligned with a physio.