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.