or condition. In the hospice setting, the palliative massage practitioner will be part of the hospice team, a group of people including physicians, nurses, home health aides, social workers and counselors, spiritual or pastoral counselors as well as myriad volunteers. Any member of the team can then refer an individual for a palliative massage session, not just the attending physician; and the referral can be either for relief from physical symptoms, emotional symptoms or spiritual needs. The palliative massage practitioner can become an integral part of the hospice care team, working hand in hand with the doctors, nurses, social workers and any others who may be involved in end-of-life care. Each session is planned using the medical information, expressed interest of the client/patient, and the skills and abilities of the massage therapist to enhance the client’s well-being and feelings of comfort and ease. The massage practitioner working with hospice clients has to be able to deal with stressful and chaotic settings, work with clients hooked up to machines and tubes, in rooms where other people are coming and going. This contradicts the usual practice, where the therapist is in control of their therapeutic environment, creating the mood and scene they want for themselves. Therefore, being able to let go of preconceived notions about the ideal setup for a massage session is important for the palliative massage practitioner. Some types of bodywork are not appropriate for hospice clients; massage that is calming and relaxing will probably be most beneficial to the client. Massage for these individuals can enhance their quality of life, self-esteem, and acceptance. Palliative massage can relieve tired, sore muscles, improve circulation and relaxation, and leave clients feeling soothed and rested. Remember that touch is important at all stages of people’s progression through their illness, even when they can’t communicate verbally. Clients in hospice may be traumatized from all the invasive procedures they’ve gone through and the emotional ups and downs as well as the physical symptoms they are experiencing. You may need to be flexible to accommodate the needs of a client in the hospice setting, providing a “walking massage,” for example, if someone cannot sit or lie still for any period of time, or even getting on the bed with them if that is the only way they can be reached. Providing choice to clients on where and how they receive their massage is critical, because they have had most of their control stripped from them in dealing with their One of the important differences between a palliative massage practitioner and any other massage practitioner is the necessity of facing one’s own attitudes and/or fears regarding death and dying. Working with clients who are dying forces the palliative massage practitioner to confront these issues directly, even if they are disturbing or upsetting, to know one’s own limitations, and be able to assist clients in confronting their own fears of death of dying. One of the primary components of the Palliative Massage Code of Ethics is that the practitioner provides time and space to know and heal oneself. disease and their terminal diagnosis. Code of ethics for palliative massage A second, equally important component of the Palliative Massage Code of Ethics is confidentiality. The client’s right to privacy is paramount. Any information shared during a session, whether of a medical or non-medical nature, must be kept in the strictest confidence, with one exception: If something is disclosed during a session that another member of the hospice team needs to know, the palliative massage practitioner must disclose that information. Examples of information that might need to be disclosed would be suicidal tendencies, any incidents of abuse or neglect, or a need for changes in pain medication. Informed consent is necessary before the palliative massage practitioner can perform any massage services with a hospice client. This means that the individual has an opportunity to learn details of the treatment plan, including, for example,
the role of massage in that plan, how the client will be draped during massage, and their right to terminate the session, should they feel uncomfortable in any way. For individuals unable to give informed consent, such as those in advanced stages of Alzheimer’s disease, a primary caregiver, legal guardian, or other individual holding health care power of attorney, may give consent. The primary caregiver should be present during initial sessions to ensure that the client is comfortable and responds positively to the massage. Respect for the client’s boundaries and sense of personal space is paramount in palliative massage. Clients who are terminally ill may have already experienced multiple invasive procedures over a period of time; they may be resistant to touch, even pleasant and soothing touch. For that reason, it is critically important to establish a rapport with the client, be aware of his or her established boundaries and personal space, and consider the client’s needs throughout the process. The right of refusal belongs both to the client and the practitioner; the client may choose to terminate a session at any time, for any reason. The palliative massage therapist may also refuse to work with a particular client. If a practitioner is hesitant or reluctant to work with a particular client, it might affect the quality of care or treatment he or she receives. Maintaining professional boundaries is the next piece of the Palliative Massage Code of Ethics. Acceptable activities to perform during a palliative massage session include adjusting pillows, responding to requests for personal items, requests for water or something to drink, listening, holding a hand, and comforting a caregiver. Activities that are never acceptable are lifting and transferring a client, bathing a client, changing his/her undergarments, dispensing medication, engaging in any conduct which could be deemed sexually harassing or intimidating, or referring to a client in an inappropriately familiar way. Record keeping is a necessary part of the palliative massage practitioner’s duties. Keep careful notes on the time and date of each session, who was present, the observed condition of the client both before and after the session, and any comments or questions from the client regarding the session, or any other information that might be useful in evaluating the effectiveness of the massage program or hospice care. Palliative massage practitioners also recognize that a diagnosis of terminal illness impacts more than just the client — the family also suffers. Primary caregivers can also benefit from massage, allowing them to ease some of the stress they experience. An excellent way to integrate massage into the relationship between the caregiver and their loved one is to teach the caregiver some simple massage techniques that they themselves can perform on their loved one. This allows the caregiver to be involved in a positive aspect of caring for their loved one, along with the many mundane tasks that are usually the responsibility of caregivers. A third group that can benefit from palliative massage are members of the hospice team. Dealing with death and dying can be extremely stressful and draining for staff members. Massage can nurture hospice workers, helping them continue with their critically important work. Even a 15-minute chair massage can significantly improve one’s outlook. Environment Each practitioner must develop his or her own way to prepare for a palliative massage session. This may be a process of confronting, to some degree, your own fears about death and dying. Many palliative massage therapists find that an awareness of their own mortality and an understanding that death is a natural part of the life cycle are important to their preparation. Some practitioners take a few moments before a session to meditate, reflect, or pray, feeling this helps give them the mental and spiritual focus needed to provide maximum benefit to the client. Clients who have been poked, prodded, or otherwise handled poorly by caregivers over a period of months or years are likely
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Book Code: MTX1323
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