Time Management
By Suzanne Cunningham
I thought I had it sorted! However, as I tried to complete this assignment, by my third draft I began to realise just how far off the mark I am.
I started the year with high hopes and grand plans. I went through my diary and wrote in our schedule according to the online timetable. I made lists of my regular clients and my daughters activities. I even printed off the assessments from the course pages and put them all in date order in one assessment folder so I can work logically through them. My husband travels for work at irregular times and for extended periods, so I knew that I had to plan my life as if he is not here – if he is, bonus! Even before taking on the commitment of full time study I carefully considered my existing daily and weekly commitments and identified that I would be able to find a workable balance. I was going to fit it all in during school hours and the occasional late evening so that I would still be there for my family. I usually have extraordinary time management skills which have served me well in the past. To be honest, I really don’t know how it has all gone so pear shaped.
So while I have been sitting here trying to reflect on the important areas in my life that I need to prioritise (daily/weekly household tasks, my daughters activities, my study, my relationships, my work, my health), it has become clear that one of my biggest problems (or weaknesses) is the inability to identify which is the most important item and give it top priority (compared to identifying the most pressing problem that needs attention now). Does it change minute by minute, or day by day? Am I considering what is more important to others instead of what is more important to me, and is this wrong? This then lends itself to the second biggest problem of my inability to say no and to be less of a “people pleaser”.
Typically in the past I have taken other peoples schedules and worked mine around them. This could be because my husband has always travelled to varying degrees, so we have always had to work in around his schedule. Now that our daughter is getting older and has numerous activities each week, here is yet another schedule that I need to work around. Prioritising time for me is proving to be a major challenge. I usually book my clients in when it suits them, not necessarily when it works for me, and as time progresses I am seeing and feeling the negative impact all this “people pleasing” is having on my physical and emotional health.
I believe that I have time management in day-to-day family life fairly well nailed. My diary is my bible and it has all our external commitments listed to avoid double bookings or missing something. We are prepared and on time for events and activities. We eat and sleep at “normal” times, and there are always clean clothes to wear. However, it appears that I have some major work to do to get my own personal priorities and time management sorted so that my studies are given the due care and attention that I intended at the start of the year.
My first step is going to be to create a realistic schedule based on the three week cycle we have with our block courses. During the two weeks in between blocks there will be a limit to the number of clients I see in a day and in a week. I will also need to start occasionally accepting the offers of help from family members in an attempt to free up time I normally spend driving to, and waiting at, my daughter’s activities. Perhaps I will need to go as far as allocating a particular day of the week for a specific subject, just to ensure I concentrate on one thing at a time. Most importantly, I am going to prioritise some play-time for myself. I haven’t skated in months. It was my “happy place” when I felt down about being back in Dunedin. The personal challenge it presents is so rewarding when you master a new skill and break through boundaries. Not to mention the friendship and camaraderie I have with my fellow adult skaters. It really is a different experience that bonds you with others who are taking on this unusual challenge at a later stage in life.
Watch this space… The old and revitalised Suz will be back
Wednesday, May 20, 2009
Fundamentals Of Massage - Task 4
The Ethics of Professional Practice
By Suzanne Cunningham
Ethics - “The standards that govern the conduct of a person, especially a member of a profession” (Wiktionary, 2009). Massage therapists have a responsibility to themselves and their clients to set high ethical standards due to the unique relationship that exist between them. Just some of the ethical aspects to be considered will be outlined in this blog.
Client Centred Care
“In client-centered care, clients are [to be] considered first and foremost at every point in the planning, implementation, and evaluation… Clients are the experts on their own personal circumstances and wants” (Kols & Sherman, 1998). Therapists need to respect each client as an individual and tailor each session to be in the clients best interests. Clear communication will assist the therapist to obtain client information and informed consent prior to treatment.
Informed Consent
This is where a client gives permission for treatment based on a clear understanding of all the facts, and potential consequences of an action. The client must have the ability to reason the information they are given and must be provided with all the relevant details for consent to be given (Wikipedia 2009).
For massage, fully informed consent can be difficult due to the volume of information to be advised to the client. However, procedures and possible after-effects must be clearly communicated to and understood by the client prior to treatment. Minors or those who have some form of cognitive impairment should have a carer or legal guardian present to make informed consent decisions on their behalf. As part of the informed consent procedure, clinic policies, procedures and a scope of practice should be clearly available to the client.
Scope of Practice (SOP)
In order to have an honest SOP, Salvo (2007) advises that we need to understand our professional limits, and cautions that it is unethical to take on a client to whom we cannot provide adequate treatment (p. 24). Therapists who have a clearly defined SOP will be trained and have suitable experience to perform the specified treatments competently and professionally. Having an honest and clear SOP will promote therapeutic relationships with clients and professional relationships with other healthcare practitioners.
Relationships
Professionalism and trust are vital when developing both therapeutic and professional relationships.
This aspect has proved to be my personal challenge. It is easier to maintain professionalism when working with clients that I see only in the paid massage context. It is difficult to keep a professional distance when practicing on friends and family due to pre-existing relationships. In this situation, the balance of power is also altered (when compared to a paying client) as they are fulfilling my need to practice. This is an area in which I need to continue to develop to ensure I always maintain an acceptable level of professionalism in all massages.
If therapeutic relationships evolve into anything else, it is wise to refer the client to another therapist as they may be able to provide more objective treatment within professional boundaries.
Confidentiality
Many elements of client confidentiality are covered by the Privacy Act of 1993. Client records must be inaccessible to unauthorised persons. Only the client and persons explicitly authorised by the client are permitted to access them. Information in client records must also accurately reflect what has occurred during treatment. Inappropriate information should not be documented. For example, items such as work stress directly relating to a named third party should not be recorded. It is advisable to keep it generic and perhaps identify it as work related emotional stress.
Discussions about clients to third parties are also inappropriate. However, if it is an example of treatment techniques or results, providing the information supplied makes it impossible for the client to be identified in any way, this may be acceptable in some circumstances. This is an important rule in a city like Dunedin, where there are many surprising connections and relationships. If you happen to see a client outside the usual treatment environment, it is permissible to acknowledge them with eye contact and a smile, but the client must be the one to initiate any further contact. This respects their boundaries and privacy.
Boundaries
Boundaries clearly define roles and responsibilities in all relationships. By dressing in a professional manner (clean, tidy and appropriately), this sets an immediate boundary for the client. When this is backed by a warm but professional approach to the remainder of the massage process, the boundaries will remain clear and avoid any misunderstandings. According to Salvo (2007), “By having professional boundaries in place, we instil a sense of respect and dignity to our clients, to our profession and to ourselves” (p. 18). Occasionally, boundaries may shift and errors can occur like commenting on a clients appearance or the offering of psychological advice. However, continual monitoring of boundaries enables therapists to preserve the sanctity of the therapeutic relationship. Boundaries are vital to understanding and careful handling of the power differential that exist between a client and therapist.
Power Differentials
Clients place a large amount of trust in their therapist when removing clothing and allowing the therapist access to their body. They see therapists as the “professional” with superior knowledge and experience. By using the tools mentioned earlier in the blog, especially informed consent and boundaries, an ethical therapist will be able to maintain a successfully balanced relationship in a way in which there is no real or perceived abuse of power differentials. It is important for clients to understand that they have the right to stop treatment at any point if they feel this is not being handled appropriately.
Transference and Counter Transference
This is an interesting concept and also a frighteningly easy one to see how it can occur. Generally, we are raised in nurturing environments and taught to nurture others as best we can. However, when we are in a therapeutic relationship both client and therapist need to remain within professional boundaries.
If a client is displaying signs of transference (such as buying the therapist personal gifts, or inviting them to social occasions), this will need to be handled carefully to maintaining clear boundaries and if necessary, the client may need to be referred to another therapist.
On the flip side, there can be counter transference, which Salvo (2007) describes as the therapist bringing their unresolved issues or personal needs to the therapeutic relationship and having difficulty maintaining professionalism (p. 33). If a therapist displays these signs they need to carefully consider their behaviour and boundaries, and seek advice from their supervisor or counsellor. If this is not able to be resolved, the best course of action may be to end the therapeutic relationship to prevent it progressing and becoming unethical.
Conclusion
Understanding ethics in relation to professional massage practice has been an interesting learning experience. Many of these items at first seem like common sense which we all assume to have to some degree. However, as you delve deeper and make direct connections as to how they relate to a professional massage practice there are fundamental elements that are easily overlooked at first glance. Boundaries appear to be the strongest element that bonds all the others together. If as therapists we set high standards with the boundaries we put in place, everything else will hopefully reach the same standard. Individual attention to each step will still be required, but it is possible to have an outstanding ethical massage practice.
References
Kols, A and Sherman J (1998). Family planning programmes: Improving Quality, Population Reports, Series J, No 47. Retreived May 18, 2009 from http://www.infoforhealth.org/pr/j47/j47chap3.shtml
McQuillan, D, (2009). Fundamentals of Massage – Ethics. Retrieved May 18, 2009, from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html
Salvo, S (2007). Massage therapy principles and practice (3rd ed), St Louis, Saunders, Elsevier
Wikipedia. Retrieved May 18, 2009, from http://en.wikipedia.org/wiki/Informed_consent
Wiktionary, Retrieved May 18, 2009, from http://en.wiktionary.org/wiki/ethics
By Suzanne Cunningham
Ethics - “The standards that govern the conduct of a person, especially a member of a profession” (Wiktionary, 2009). Massage therapists have a responsibility to themselves and their clients to set high ethical standards due to the unique relationship that exist between them. Just some of the ethical aspects to be considered will be outlined in this blog.
Client Centred Care
“In client-centered care, clients are [to be] considered first and foremost at every point in the planning, implementation, and evaluation… Clients are the experts on their own personal circumstances and wants” (Kols & Sherman, 1998). Therapists need to respect each client as an individual and tailor each session to be in the clients best interests. Clear communication will assist the therapist to obtain client information and informed consent prior to treatment.
Informed Consent
This is where a client gives permission for treatment based on a clear understanding of all the facts, and potential consequences of an action. The client must have the ability to reason the information they are given and must be provided with all the relevant details for consent to be given (Wikipedia 2009).
For massage, fully informed consent can be difficult due to the volume of information to be advised to the client. However, procedures and possible after-effects must be clearly communicated to and understood by the client prior to treatment. Minors or those who have some form of cognitive impairment should have a carer or legal guardian present to make informed consent decisions on their behalf. As part of the informed consent procedure, clinic policies, procedures and a scope of practice should be clearly available to the client.
Scope of Practice (SOP)
In order to have an honest SOP, Salvo (2007) advises that we need to understand our professional limits, and cautions that it is unethical to take on a client to whom we cannot provide adequate treatment (p. 24). Therapists who have a clearly defined SOP will be trained and have suitable experience to perform the specified treatments competently and professionally. Having an honest and clear SOP will promote therapeutic relationships with clients and professional relationships with other healthcare practitioners.
Relationships
Professionalism and trust are vital when developing both therapeutic and professional relationships.
This aspect has proved to be my personal challenge. It is easier to maintain professionalism when working with clients that I see only in the paid massage context. It is difficult to keep a professional distance when practicing on friends and family due to pre-existing relationships. In this situation, the balance of power is also altered (when compared to a paying client) as they are fulfilling my need to practice. This is an area in which I need to continue to develop to ensure I always maintain an acceptable level of professionalism in all massages.
If therapeutic relationships evolve into anything else, it is wise to refer the client to another therapist as they may be able to provide more objective treatment within professional boundaries.
Confidentiality
Many elements of client confidentiality are covered by the Privacy Act of 1993. Client records must be inaccessible to unauthorised persons. Only the client and persons explicitly authorised by the client are permitted to access them. Information in client records must also accurately reflect what has occurred during treatment. Inappropriate information should not be documented. For example, items such as work stress directly relating to a named third party should not be recorded. It is advisable to keep it generic and perhaps identify it as work related emotional stress.
Discussions about clients to third parties are also inappropriate. However, if it is an example of treatment techniques or results, providing the information supplied makes it impossible for the client to be identified in any way, this may be acceptable in some circumstances. This is an important rule in a city like Dunedin, where there are many surprising connections and relationships. If you happen to see a client outside the usual treatment environment, it is permissible to acknowledge them with eye contact and a smile, but the client must be the one to initiate any further contact. This respects their boundaries and privacy.
Boundaries
Boundaries clearly define roles and responsibilities in all relationships. By dressing in a professional manner (clean, tidy and appropriately), this sets an immediate boundary for the client. When this is backed by a warm but professional approach to the remainder of the massage process, the boundaries will remain clear and avoid any misunderstandings. According to Salvo (2007), “By having professional boundaries in place, we instil a sense of respect and dignity to our clients, to our profession and to ourselves” (p. 18). Occasionally, boundaries may shift and errors can occur like commenting on a clients appearance or the offering of psychological advice. However, continual monitoring of boundaries enables therapists to preserve the sanctity of the therapeutic relationship. Boundaries are vital to understanding and careful handling of the power differential that exist between a client and therapist.
Power Differentials
Clients place a large amount of trust in their therapist when removing clothing and allowing the therapist access to their body. They see therapists as the “professional” with superior knowledge and experience. By using the tools mentioned earlier in the blog, especially informed consent and boundaries, an ethical therapist will be able to maintain a successfully balanced relationship in a way in which there is no real or perceived abuse of power differentials. It is important for clients to understand that they have the right to stop treatment at any point if they feel this is not being handled appropriately.
Transference and Counter Transference
This is an interesting concept and also a frighteningly easy one to see how it can occur. Generally, we are raised in nurturing environments and taught to nurture others as best we can. However, when we are in a therapeutic relationship both client and therapist need to remain within professional boundaries.
If a client is displaying signs of transference (such as buying the therapist personal gifts, or inviting them to social occasions), this will need to be handled carefully to maintaining clear boundaries and if necessary, the client may need to be referred to another therapist.
On the flip side, there can be counter transference, which Salvo (2007) describes as the therapist bringing their unresolved issues or personal needs to the therapeutic relationship and having difficulty maintaining professionalism (p. 33). If a therapist displays these signs they need to carefully consider their behaviour and boundaries, and seek advice from their supervisor or counsellor. If this is not able to be resolved, the best course of action may be to end the therapeutic relationship to prevent it progressing and becoming unethical.
Conclusion
Understanding ethics in relation to professional massage practice has been an interesting learning experience. Many of these items at first seem like common sense which we all assume to have to some degree. However, as you delve deeper and make direct connections as to how they relate to a professional massage practice there are fundamental elements that are easily overlooked at first glance. Boundaries appear to be the strongest element that bonds all the others together. If as therapists we set high standards with the boundaries we put in place, everything else will hopefully reach the same standard. Individual attention to each step will still be required, but it is possible to have an outstanding ethical massage practice.
References
Kols, A and Sherman J (1998). Family planning programmes: Improving Quality, Population Reports, Series J, No 47. Retreived May 18, 2009 from http://www.infoforhealth.org/pr/j47/j47chap3.shtml
McQuillan, D, (2009). Fundamentals of Massage – Ethics. Retrieved May 18, 2009, from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html
Salvo, S (2007). Massage therapy principles and practice (3rd ed), St Louis, Saunders, Elsevier
Wikipedia. Retrieved May 18, 2009, from http://en.wikipedia.org/wiki/Informed_consent
Wiktionary, Retrieved May 18, 2009, from http://en.wiktionary.org/wiki/ethics
Friday, April 3, 2009
Fundamentals - Task 2
The Effects of Massage on the Autonomic Nervous System
The Autonomic Nervous System (ANS) is sub-divided into the Parasympathetic Nervous System (PNS) and the Sympathetic Nervous System (SNS) Most of the organs within the body are controlled by these divisions which work together, yet antagonistically, to regulate body function and responses. “What one division stimulates, the other inhibits” (Marieb, 1998, p. 364).
The role of the PNS (the ‘resting and digesting’ department) maintains a neutral, homeostatic level of bodily functions such as digestion and respiration, generally conserving the body’s energy.
In contrast, the SNS becomes stimulated and responds to a real or perceived threat. When this division is aroused, primal ‘fight or flight’ instincts are initiated. Heart rate increases, production of saliva is halted, digestion is suppressed and blood is directed to areas of higher importance, such as limb muscles, which are prepared to protect the body.
Evolution has taught us be cautious. A persons’ first experience with massage may initially stimulate the SNS. Allowing a stranger into your personal space involves a level of trust which may raise anxieties triggered by previously negative experiences or even the fear of the unknown.
According to Beck (2006), massage can affect the ANS in different ways depending on the type of massage performed. A massage that is invigorating or does not meet the clients expectations, may stimulate the SNS. In contrast, a relaxing massage that meets or exceeds the client’s expectations appears to suppress the SNS, providing pleasant results such as slower heart rate, lower blood pressure and increased relaxation.
The Effects of Massage Strokes
Swedish/relaxation massage provides a range of techniques that are used to achieve differing effects.
Touch (holding) is often used at the commencement and conclusion of a massage. It has a range of subjective and reflexive effects. Touch is a great way of “giving [the client] the opportunity to become accustomed to you without distracting conversation” (Salvo, 2007, p. 143). This provides time for the client’s body to switch into ‘massage mode’, arousing the PNS, reducing heart rate and respiration.
The first moving stroke is Effleurage. Salvo (2007), states that “this action promotes venous blood flow” (p. 146) and “warms the body tissues making them more extensible”, (p. 148). This gliding stroke also prepares an area for deeper, more specific work, as well as moving wastes from an area and soothing tissues.
In comparison, Petrissage (kneading) is used for working deeper into the tissues and fascia. Salvo, (2007) indicates, that this has many effects including increasing blood flow, relaxing and lengthening muscles, softening superficial fascia and stimulating the release of pain relieving chemicals such as endorphins.
According to Beck (2006), “compression is another form of friction” (p. 397). He also claims that where kneading can involve lifting and squeezing the tissue away from skeletal structures, friction pushes one layer of tissue against another in order to flatten or stretch the tissue. Friction increases heat, which can increase the body’s metabolic rate, and making muscle connective tissue more pliable therefore function more efficiently.
Tapotement can have a “pleasurable, stimulating effect” (Salvo, 2007, p 163). It is a percussion style technique which stimulates nerve endings, increases blood flow and generally stimulates the client. This can be beneficial if your client needs to be more alert at the completion of the massage, compared to the ‘spacey’ feeling many experience after massage without tapotement.
Vibration:
The effects of vibratory movements depend on the rate of vibration, the
intensity of pressure and the duration of the treatment. This form of
massage is for soothing and bringing about relaxation and release of tension
when applied lightly. It is stimulating when applied with pressure. A
numbing effect is experienced when vibrations are applied for a prolonged period
of time. (Beck, 2006, p. 397).
Miscellaneous Effects of Massage
Many effects can be recorded scientifically by measuring the change in levels of hormones, blood flow, etc in the body.
Blood flow and Lymph flow: Beck (2006), states that “Clinical massage affects the quality and quantity of blood coursing through the circulatory system” (p. 299). He also states that that “both the lymphatic and venous circulation are accelerated by massage movements” (p. 717).
Muscle Tension: According to Salvo (2007) massage relieves muscular tension by increasing the blood flow in and around the muscle, and relaxes muscles by suppressing the sympathetic nervous system.
Connective Tissue: Massage softens fascia surrounding muscles, “allowing them to be stretched to their fullest resting length thereby increasing joint range of motion and freeing the body of restricted movements” (Salvo, 2007, p. 92). It may also promote healing of bone fractures and reduce formation of scar tissue and adhesions (Salvo, 2007).
Sleep patterns: Fritz (2009) indicates that massage can promote a deeper, more restful sleep. It increases release of serotonins, and other mood regulating neurochemicals. A parasympathetic dominance of the ANS promotes ideal internal sleep conditions.
Digestion: Stimulation of PNS during massage returns digestion to a balanced state. This also increases peristaltic activity in the colon, aiding elimination of wastes, potentially relieving constipation and other digestive disorders (Salvo, 2007).
“Blood pressure is decreased by blood vessel dilation” (Salvo, 2007, p. 89). Massage can increase blood flow by causing dilation of blood vessels.
Pain:
… massage provides pleasurable stimulation that is carried to the brain on
thicker, faster, more numerous fibres that actually override or drown out the
pain signals. Even though the diversion is temporary, it gives the
individual a chance to relax and disassociate with the noxious stimulus possibly
long enough to shut down the fight or flight reaction (Beck, 2006, p. 63).
“… massage also reduces the sensation of pain by increasing the concentration of endorphins… and other pain reducing neurochemicals in the central nervous system and blood stream” (Beck, 2006, p. 299).
Some effects of massage strokes are subjective (feelings and emotions). These vary based on individual experiences and personal bias. I believe the following areas affected by massage are subjective, and are therefore hard to measure as an absolute truth. However, some chemical changes in the body (such as increased serotonin levels) can support claims of psychological effects that are widely reported and warrant credit and value.
Mood: Massage can reduce muscle tension, stress, depression, fatigue and improve self esteem and body image. This may result in improved mood and general feeling of well-being.
Concentration: Tests results show that massage can improve, alertness and mental performance. “Increased speed and accuracy on maths calculations after 15 minute chair massage” (Class notes Elluminate 26/03/09 – Field, Ironson, et al, 1996)
Satiety: Feelings of contentment and satisfaction may be enhanced by massage. It can meet our psychological and physical need for attention, acceptance and nurturing touch. Increased levels of dopamine and serotonin released during massage lead to an improved mood and increased satiety. (Class notes from Elluminate 26/03/09)
Bonding: According to studies, oxytocin is connected to the ability to bond and form healthy relationships with other people. Tests showed levels of oxytocin may increase while receiving Swedish massage. (Oxytocin.org, 1999).
References:
Beck, M.(2006). Theory and practice of therapeutic massage (4th ed.) New York, Thompson Delmar Learning
Class notes
Hormone involved in reproduction may have role in the maintenance of relationships, (1999, July 14).. Retrieved April 01, 2009, from http://www.oxytocin.org/oxytoc/index.html
Marieb, E (1998). Human anatomy and physiology (4th ed.) Menlo Park, California. Benjamin/Cummings Science Publishing
Salvo, S (2007). Massage therapy principles and practice (3rd ed), St Louis. Missouri, Saunders, Elsevier
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