Wednesday, October 28, 2009

Professional practise Blog 7 Multidisciplinary Due Friday 29th October Hannah howley

Professional practise
Blog 7
Due Friday 29th October
Hannah howley

What does it mean to be a massage therapist and a multi-disciplinary healthcare provider?

To me, being a massage therapist means being able to provide clients with the opportunity to come and get some sort of treatment in the way of reducing stress, relaxing and finding a way of being prepared mentally and physically pre and post event sport. Also, being involved and helping clients with goals and understanding of themselves is also very rewarding. I personally also feel strongly about working with in your own chosen field and abiding by the scope of practise that comes with it. I believe it is part of showing professionalism and being aware of your boundaries and what you are and are not allowed to do.

With regards to being a multidisciplinary provider, it all really depends on what scope of practise you are eligible to provide, where you work and what other types of healthcare professionals that you are connected with whether you are working with a group of other therapists or if you are in close contact with other therapists so that you can provide good referrals. There are some differences between being a CMT (certified massage therapist) and an RMT (remedial massage therapist). CMT’s mean that you are able to provide relaxation massages and an RMT is that of a remedial massage therapist so therefore can help with pain and immobility issues. In this case, the CMT wouldn’t try and fix clients injuries in much depth other than just tensional releases, whereas the RMT can do both and therefore be a referral or a helper to the CMT. So it’s kind of like we all sort of work together but sticking to what we know in our own field. Moreover, if you wanted to combine business or use an integrated practise with physiotherapist or such like, it is important to know their field, their scope of practise and to understand and respect their position as they will do likewise. For me, that is something that I am interested in looking in to – working at somewhere like Sports Med Otago, where they have Physiotherapists, nutritionists and sport massage therapists. This is the type of situation where you would be working in an integrated healthcare environment.

Integrated healthcare, cross-disciplinary and inter-professional healthcare are all words that pretty much mean the same thing but also sum up multidisciplinary provision where you are working in a place where there are several different types of therapists all with different scopes and codes.

Being an effective MDP would be you understanding your own scope of practise and respecting and understanding others and this can be achieved through research, dialogue and involvement and by research I mean finding out what they do differently and why? Being involved also, is something that is also beneficial because the more you are involved with something the more educated you are about it which is a good thing in the healthcare profession. It is important in an environment as important as that of the healthcare branch because you are dealing with people within your business and outside of your business and by outside I mean you have the power to make referrals and it is strongly beneficial if you have a good understanding of others and also effective communication skills. Overcoming barriers is also something else to look at with regards to being an effective MDP. As quoted from our notes “differences tend to act as barriers to understanding and relationships” states pretty well that if you don’t understand or respect others and there scopes of practise then it’ll be a pretty hard road ahead. The appreciation of differences is key.

The main point here that I am trying to get across is to understand all (or the ones relevant to you, but still just as important to know about the others) the different types of SoP’s. When you understand them you are able to work well with other practitioners, you’re able to ask them for help if you need to and you are able to refer your clients on where necessary.

So in summary of my discussion on the benefits of being involved with or being a multidisciplinary provider, I think it is an effective way of furthering your own profession and skills to make the most of your business and give the best service and be consistent throughout. Your clients come to you because they like who you are and they like your service so improving it isn’t going to do any harm.


Class Notes

My Own Thoughts

Sunday, October 25, 2009

Professional Practise Blog 6 Professional Development, reflective practise and supervision Due 23rd October Hannah Howley

Professional Practise
Blog 6
Professional Development, reflective practise and supervision
Due 23rd October
Hannah Howley

Professional practise isn’t just something that is given to you. It is a sub heading for several influencing factors of a professional practise. As a massage therapist yourself, it is important to be learning new things and keeping up to date at all times and also being vigilant and knowing what areas you need to work on and improve and also notice the things that you are doing well.

Being able to reflect well on what you are doing is a great attribute and skill. The reflective practitioner strives to develop self-awareness and improvement on their effectiveness. Developing awareness to reactions within your environment and the interactions that you have with others makes for effective communication. Being able to notice how your attitude and moods around clients and other staff members is a good thing to be able to notice. You affect others around you by your moods so it is important to know how to make this better. It also has a big part to do with continual clients. If they aren’t happy with you or your service they may not want to come back.

Once you are able to identify your strengths and weaknesses and what you are doing well and what you can do better you will be able to begin to improve and you will be on your way to being successful and professional. A few steps that could be taken to improve the massage practise would be;

- Writing up more thorough S.O.T.A.P forms and asking yourself what you did well in the session and what you could improve on
- Asking a supervisor for help and feedback on how you are doing
- Having good client feedback forms with questions relating to the bigger picture and not just comfort levels (however that still is important).
- Writing up in a diary or journal or something of how you performed overall before, during and after the massage session.

All of these things help to support your professional development in several ways. However it is still important to notice the things that you are doing well. Practise, select, describe, reflect research plan, alter, practise and monitor.

Notice what you’re not happy with and change it.

When it comes to supervision, I believe that it is an important aspect of you professional development. For example, in the clinical situation we have at polytech, we always have someone there to guide us and supervise us as we are not fully qualified yet. If u weren’t aware of a supervisor u might want to go with asking the NZ association of counsellors (NZAC) as they have a list of registered supervisors around the area. The NZ association of pyscotherapists (NZAP), depending on whether it is necessary and can be incredibly valuable but not really an expectation of the professional body however this may change. It’s about self development and has an impact on other people. I feel that it is important to be able to have these ‘guides’ in place or available for you to contact if you need to especially to watch over your practise and give you feed back. It also sets your mind to the fact that you have someone you can ask for help and that you are not alone in the business. Creates mind/body security.

To have a professional practise, it is important to keep up with and follow all codes of conduct as well as your own routine and the way you work. Being able to understand yourself and the way you learn is very helpful to becoming successful. It’s also important to keep up with MNZ and continue to further your training at all times where possible. Once qualified, it would be a good idea to sign with the RMT’s not only for legal tax reasons but to be able to further knowledge and gain points for it. Like Debbie has said in her blog, it would be a good idea to join the professional development policy which is run through MNZ. It would help gain awareness and further education and knowledge while gaining points.

In summary, all of the above all have a influencing factor on professional development. Being able to reflect on your processes and do something about them to create a positive and effective change is a great attribute and can really help to see you become successful. It all ensures that your business is maintained at the highest level of professional performance. It creates an understanding of yourself which therefore leads to people enjoying their experience when they come to you.

Wednesday, September 23, 2009

Professional Practise Sustainability Blog 4 Due date 25 September 2009 Hannah Howley

Professional Practise
Blog 4
Due date 25 September 2009
Hannah Howley

What does it mean by being a sustainable massage practitioner and what would you do to achieve this?

Understanding the sustainability issues in today’s society is something to become familiar with. Not only for the environment but also for you own health, safety and benefits.

There are three elements of sustainability, environmental, social and economical, that I am going to talk about with regards to me as a massage therapist and a having a massage practise set up. The first being environmental;

There are some issues and considerations that one must look at for becoming a sustainable massage practitioner and that is to think about what type of products you are using for example, laundry detergent. This is not only full of harsh chemicals that are damaging to the product, but also to the skin and to the environment. It is something to think about when and if you have clients that have very sensitive skin. For example, I had a client once who was on medication for a skin condition, immediately I thought about the linen she was lying on and whether or not it would become irritating. I personally have very sensitive skin and can only use sensitive type powders and I am a fan of the eco-friendly type. It also gets to a point when the detergent becomes harmful to the environment.

Paper use is another issue that came up. Although it is not such a big deal at the current day, it would be good to start thinking about keeping an electronic client database on a laptop or computer to think about minimising paper use. Even though, it is one of the easiest materials to recycle.

Product purchases are another one to think about and the way that it is packaged, is it eco-friendly? biodegradable? And can it be recycled? If you are that way inclined are pro-environment it is good to look into things such as this.

These days, as we are in an economic crisis, power is one thing that has tried to be cut back on. With regards to a massage practise, simple things can be done to avoid using too much power, however with some negative aspects. Instead of using the drier to dry linen, hang out the washing, However sometimes it’s not always going to be possible due to weather implications. As far as the ‘eco-friendly’ light bulbs go, not always such a positive idea. They contain a substance called mercury which is very harmful and dangerous especially to pregnant woman. Considering you are working in a clinic, it is likely you will get a pregnant client. Another downfall to our ‘eco-friendly’ power saving light bulbs is that they take several minutes to even reach their full watt capacity, which isn’t such a big deal in a massage clinic as we like dim shades anyway; still, it’s not so ideal.

When it comes to maintaining the well-being of the environment and yourselves , it has got a lot to do with what we do to maintain the relationships of the community to the input of sustainability and how we go about doing so. Positive and negative remarks and discussions on eco-friendly products etc creates a bad impression on the product. It’s reminds me of the plastic bag situation at New World Supermarket at the moment. Having to pay an extra 5c for each plastic bag seems ridiculous but at the same time good for the environment. People generally kick up a fuss whenever they have to pay up for something. I know that I don’t buy a plastic bag for 5c because people have convinced me that it’s a stupid thing to do, but at the same time, we are effectively helping the environment by protecting it from plastic rubbish bags. So it’s a win/win situation, and a more positive one relating to social sustainability.

Social sustainability also looks at the health of the society and maintaining good positive sustainable relationships between yourself and the work you do and the activities you do.

Furthermore, economical sustainability is the financial aspect of the operation. It is also another element to look at. Everything over laps each other with regards to a sustainable massage practise, the environmental aspect, the social aspect and the economical aspect all intertwine to make it continuous and efficient. As long as you have the work coming in, to create the funds that you need to make the practise sustainable you will be able to provide the sustainable environment that you want that benefits you and your staff as well as you clients to maintain health and a safe environment.

Fritz, S. (2004). Mosby’s fundamentals of therapeutic massage (3rd ed.). Missouri: Mosby.
Class Notes
My Own Thoughts.

Monday, August 10, 2009

Professional Practice Blog 3 Ethics Due date: Friday 14th August Hannah Howley

Professional Practice
Blog 3
Due date: Friday 14th August
Hannah Howley

Massage therapy and relationship with ethical considerations.

Ethics have become more and more increasingly particular in hands-on practices such as Massage Therapy. Agreeing upon which is ‘good’ or ‘bad’ in the way of ethical considerations remains to be difficult.

We, as massage therapists, remain responsible for the health, safety and comfort of our clients and it is our duty to maintain these responsibilities.
Ethical considerations, to name a few that we need to take in to consideration are;

- Race & Colour
- Culture
- Age
- Sex
- Religion

All of these are important topics to look at. All clients are going to be individual and different from the client before and it is important to find out such things about your client before you ask them to do things for you, i.e. taking off clothing and lying under drapes. With regards to race and religion, this can be seen as culturally offensive and inappropriate (including any other person). Communication is very important when taking clients through your chosen assessment procedure. You have to make sure that they are aware of what you are going to be doing, where about on the body you will be working and whether or not they are comfortable with that decision. You, as a massage therapist also have to be ready to understand and respect the choice of the client if their decision does not match your own.

Client Relationships

Client relationships must be maintained at the highest level of interpersonal relationships. It must be of utmost professionalism. According to the code of ethics written by MNZ;

- A practitioner shall endeavour to serve the best interests of their clients at all times and provide the highest quality service possible.

- A practitioner shall at all times respect the confidence of their client and diagnostic
findings acquired during consultation and/or treatment shall not be divulged to anyone
without the client’s consent, except when required by law or where failure to do so
would constitute a menace or danger to the client or another member of the community.

- A practitioner shall not enter into an intimate or sexual relationship with a patient whilst
the patient is under their care. (MNZ Code of Ethics, pdf)

The Massage Therapist and their responsibilities to themselves,

It is ethical, that the massage therapist, or anyone working in the business, strives to achieve professional appearance and image of themselves and the profession in general.
The MT should have all qualifications displayed on the wall or on a desk (any where visible to the clients) and it should be done so honestly.
The MT should at all times make sure the treatment and treatment process is coincided with the relevant scope of practice and that all techniques used are suitable to the existing condition.

Practitioners should always maintain the professionalism of the clinic. It must always have a code of ethics and clients rights and responsibilities visible on entry to the client. The MT must not interfere with any ongoing treatment given by any other practitioner and must call the other health care provider if there are any queries and only if you get client consent. The MT must not criticise the work of any other practitioner as this is seen as very rude and it will make you seem like you are superior to others and it doesn’t look good.


The Ethics of Touch, Ben Benjamin and Cherie Sohnen-Moe. (SMA Inc., Tucson, Ariz., 2003.)

MNZ Code of Ethics. pdf

My Own Thoughts

Fritz, S. (2004). Mosby’s fundamentals of therapeutic massage (3rd ed.). Missouri: Mosby.

Wednesday, August 5, 2009

Dementia Condition 2 Due date 14 August 2009 Hannah Howley

Condition 2
Due date 14 August 2009
Hannah Howley

Description of the condition:

Dementia AKA Alzheimer’s Disease meaning ‘deprived of mind’ is a disease of the mind and can also be a result of brain damage or injury. It is a cognitive impairment and may be static. It is a progressive degenerative disorder of the brain causing such things like memory loss, personality changes and eventually, death.


Age and degeneration are the main causes of the disease. Most etiologies contribute to loss of intellectual function, memory impairment and loss of judgement. The precise cause of the disease is not fully understood.


Dementia is far more common than that of the geriatric population and can develop at any stage of adulthood. It generally just affects older people. Although it is possible to develop dementia early in life, the chances of doing so increase dramatically with age.
Less than 10 percent of cases of dementia are due to causes which may presently be reversed with treatment
One in 50 people between the ages of 65 and 70 have a form of dementia, compared to one in five people over the age of 80.
Dementia affects approximately 5% of the US population or about 4.5million people. It affects half of all people living in rest homes. The incidence of Dementia increases with age.

Signs and symptoms:

Symptoms of dementia include loss of memory, confusion and problems with speech and understanding. Most etiologies contribute to loss of intellectual function, memory impairment and loss of judgement.

Symptoms of early dementia:

- Word finding difficulty
- Forgetting names, appointments and losing thing
- Difficulty performing familiar tasks i.e. driving, cooking, household chores
- Uncharacteristic behaviour
- Mood swings and Poor judgement

Intermediate Dementia

- Worsening of symptoms seen in early dementia
- Unable to carry out tasks i.e. washing, getting dressed, using the toilet
- Disrupted sleep
- Unable to learn new things
- Confusion
- Hallucinations
- Falling over
- Poor concentration and abnormal moods
Severe Dementia

- Worsening of symptoms seen in early and intermediate dementia
- Complete dependence on others for daily living
- Maybe unable to walk or move around
- Impairment of other movements i.e. swallowing
- Complete loss of long and short term memory
- Complications with nutrition, bladder control and infections

Indications for massage therapy:

According to MedicalNewsToday, Massage could offer a drug-free way to treat agitation and depression among dementia patients, but there are still too few studies about the practice to know for sure, according to a review of recent research.

In two studies, hand massage and gentle touching during conversation helped ease agitation and restore appetite in dementia patients over short periods of about an hour.
It can also counteract anxiety and depression which are also factors involved with dementia.
Massage also provokes a sense of relaxation and safety with soft and slow massage techniques i.e. relaxation massage with effleurage and petrissage strokes would be effective in engaging the nervous system and relaxing it.
Dementia clients respond well to touch. Massage does not increase or decrease the process of the disease but does improve the quality of life for clients to the extent that they become noticeably less disruptive.

Contraindications for massage therapy:

It is very important to keep in mind that most of these clients will be elderly and will generally have other on-going problems that may or may not contraindicate various kinds of body work. Also, the massage therapist must remember that communication will be quite difficult and it becomes the therapist’s responsibility to communicate effective non verbal signals about the bodywork to make sure that the client understands. Therapists must always be sensitive to the clients emotional and mental state/


Dementia, Retrieved on 31st July 2009 from

Frtiz S (2004). Mosby’s Fundamentals of Therapeutic massage, 3rd edition. Mosby, Missouri

Werner, R. (2005). A Massage Therapists Guide to Pathology (3rd ed.). Philadelphia: Lippincott Williams & Wilkins

Facts about Dementia and what to do, Retrieved on 31st July 2009 from;col1 peer reviewed.

Massage and Dementia, Retrieved on 31st July 2009 from

Dementia Symptoms, retrieved on 1st August 2009 from

Wednesday, June 17, 2009

Blog2 Professional practice

Professional Practice Blog 2 Treaty of Waitangi Hannah Howley

How the Treaty of Waitangi framework incorporates into Massage Therapy practice
In any sort of practice, culture and society must be established to promote a good ground basis of an understanding of other people and their beliefs. In this blog I will discuss the relevance of Maori culture to Massage Therapy.

Governance, authority, equity and respect are the four main categories we look at when establish cultural inputs into the clinic.

Governance to begin with is what we understand as ‘our role’ and being in charge of the practice you are doing. You must understand your role as a therapist, notice the treaty policy and legislation of the healthcare department, being aware of the treaty and knowing the cultural differences, be aware of the legislation of what you as a therapist are doing and of course policies and requirements. We must ensure the health and safety of our client at all times.

Authority, with regards to the scope of practice to MT, clients are allowed to have their own opinion about the therapists’ treatment plan and the way they go about delivering it. There is to be a partnership between client and therapist for each other to share their feelings and views. Communication is very important when there is someone with authorisations. The therapist always has rights to a client and must ensure these, but will not act as if they are higher or superior than the client.

Equity is a title we notice as ‘equal’. With regards to the Massage Therapy scope of practice, we must treat all clients equally, with the most utmost respect and total professionalism. MT’s must accommodate each individual client as they see fit, e.g. clients with disabilities. The significance of culture must be taken into account in this instance. Some cultures see touching of the head to be culturally insensitive. This is where communication is of importance, as some massage therapists tend to work into the head for neck treatments.

Respect. This is a title which is self-explanatory. The client is your client and you are their therapist. They have come to you for help and it is your position to maintain the respect and needs of your client. Understanding and appreciation of their needs, beliefs and wishes is something you have to be able to do.
The aim is to provide health care in an environment that is culturally sensitive to those who are using it. This is done out of respect for different cultural perspectives and needs. The client and the whanau must understand what is happening and what resources and support are available. (Timmins, K. Treaty Workshop, 2009)

Other considerations to think about with Maori clients are Taoka (Valuables). These are extremely important and have a lot of sentimental value. Therapists’ must be respectful of these and must discuss with the client before removing them e.g. necklaces, as they may be in the way of neck treatment. You must offer the client the opportunity to look after the Taoka when they have removed it if they agree to.

Four more elements I will look at are those from the 1988 Royal Commission on social policy for prerequisites for health and well-being.

Whanaungatanga –Family
- The family as an influence on health
- As a support system.
Taonga Tuku Iho – Cultural Heritage
- Access to Maori knowledge
- Access to family, hapu, iwi and the marae
- Intact Maori identity
Te Ao Turoa – The environment
- Physical environment
- Political environment
- Social-economic environment
- Social climate in terms of racial and ethnic equity
Turangawaewae – an idisputable land base
- Access to ancestral lands
- Self-esteem and self-respect


Bachelor of Midwifery/Diploma in Massage Therapy; Treaty Workshop. May 18th 2009

Durie,M.(1998). Whaiora: Maori health development(pp.69-74). Auckland, New Zealand: Oxford University Press.

My Own Thoughts

Thursday, June 4, 2009

Scope of practise

Assessment task 1
Due 8th May 2009
Scope of practise
Hannah Howley

Scope of Practice as defined by Massage NZL with relations to being a Massage Therapist.

"Scope of practice defines the knowledge base and professional parameters of a profession"
Fritz,(2004) (St. John, D, Assessment Task 1)

Now, this I found to be a good summarisation of what we know as ‘scope of practice’ in any area of work, namely, the healthcare profession. It is very important, not to mention, professional to have such guidelines to work from. Boundaries and such are very important when working hands on with another human being.

RMT’S must hold a National (NZQA) Diploma/Degree or equal in Therapeutic Massage. They must have a theoretical basis of knowledge in Human anatomy, Physiology, Pathology and the Theory of Massage. They must have completed a minimum of 30 supervised massage clinical hours during massage training or post graduation. Massage NZ,(2009)

RMT’S must comply with the MNZ RMT Scope of practice which is as follows

- Physical assessment
- Client history details forms
- Client reasoning and a treatment plan
- Delivery of soft-tissue treatments relevant to treatment plan and not missing out other strokes etc
- Evaluations
- Post treatment advice
- Professional presentation and behaviour according to MNZ ethics
- Referral of clients to appropriate healthcare professionals

Certified massage therapists also have a series of guidelines which they must follow and they must also hold a diploma or certificate in MT. They are as follows


- Gathering of client info specific to the client
- If relaxation massage is not appropriate, and need other treatment outside MNZ MMT Scope of practice, refer to an appropriate healthcare professional
- Client consent
- Delivery of treatments relevant to the treatment plan
- Delivery of soft tissue treatments according to industry accepted practices with regards to draping, communication etc
- Post treatment advice
- Professional appearance and ethics.

The scope of practice for both, are relatively straight forward but also broad at the same time. If the MT association was to become a lot bigger and well-known for its benefits, I believe that the scope of practice would have to become a little more in depth and be able to bring attention to new things. A good point that Deb’s made in her blog was that although a MT is requires us to have attained certain qualifications; it surely doesn’t say anything about on-going education for MT. It is very clear in today’s healthcare profession that things are changing and we are becoming more aware of different things and more knowledge is brought to us, which shows us that we need to have continual training on standby to not only become a better practitioner but also be able to provide higher qualities of treatment to our clients.

To sum up my findings, I feel satisfied with the current scope of practice for both professions as they do touch on ethical considerations and professional practice which I think are very important. Although they do need to be made a lot more in depth to prevail our knowledge and professionalism that little bit more.


My Own Thoughts

Massage New Zealand. (2009). Retrieved May 8th 2009 from

Massage New Zealand, Remedial Massage Therapists Scope of Practice. Retrieved June 5th 2009 from