to have concerns or fears about being touched in any way. Spend some time to get to know the client, to understand something about him or her, why they are interested in massage, and what they would like to get out of the treatment. Then work together to develop a safe, effective, and meaningful massage treatment plan. The practitioner should clarify any questions he or she has about the client’s stage of illness, the progression of the disease, and any special needs or limitations that would be useful information in creating a treatment plan. Effective palliative massage requires a proper external, as well as internal, environment. The ambiance should be relaxing, comforting, and supportive. Keep the voice soft and concerned, communicating your empathy and sincere desire for the client’s well-being. Make a conscious effort to be mentally and spiritually, as well as physically, present in the session. Deep breathing exercises can be beneficial for both the client and the practitioner, helping to release tension and bring focus to the present moment. Active listening and good verbal and nonverbal communication skills, in addition to technical proficiency, are important parts of the treatment in palliative massage. People nearing death can become extremely emotionally vulnerable. Massage can help clients release their emotional burdens; they may need to cry or discuss their fears. Use a bed or a chair, depending on your client’s condition and preference. The bed should be at a height where the practitioner can comfortably keep the knees soft, and touch the bent knuckles to the bed. Use clean sheets, large towels, or blankets to drape the client. Lubricants like oil, cream, and powder can make the massage more comfortable for elderly clients, who may have fragile skin. Music, soft lighting, and aromatherapy can be used to enhance the ambiance, making it more relaxing and pleasurable, and increasing the benefits of massage. Position the client as comfortably as possible during the session. Paralysis, amputations, skin sensitivity, decubitus ulcers, and breathing difficulties can be obstacles to client safety and comfort. Prone positioning is often not possible, but extra pillows can be used to keep the client comfortable and help him/her get the maximum benefit possible from massage. To end a palliative massage session, allow the client to lie quietly and integrate the benefits received. You may want to ask them how they are feeling now, or if there has been any change in their condition during the massage, or ask if they have any Massage at the end of life Part of providing support to the client, the family, other caregivers, and members of the hospice or medical team is learning to recognize the signs that death may be imminent. There are several characteristic indications that death is 48 hours away or less. Withdrawal is one of the first signs; the client begins to turn inward, focusing less on the physical body and more on the internal spirit. At this stage, active massage is not necessary; instead, you may choose to simply sit with the client, holding hands, if that is comfortable, and provide a gentle reminder that you are there, and they are not alone. Metabolic changes and decreased oxygen intake may cause the client to become disoriented, anxious, or restless. Palliative massage can help ease “terminal restlessness,” a syndrome common in the last days of life. Breathing can become noisy and irregular as a person nears death. Respiration may increase in some cases, though generally as we die, the breathing slows down, as do the rest of our bodily functions. The client may experience apnea, or cessation of breathing, characterized by breathing at intervals of 10-40 seconds, also seen in clients who snore or have chronic sinus or respiratory problems. The practitioner may want to elevate the client’s head to ease breathing. Typically, as a person nears death, he will stop eating and drinking, sleep more and more, and become less responsive. Individuals nearing death, like individuals in coma, can often
questions for you regarding the massage. Some practitioners consider silent meditation or hand-holding effective integrating techniques for ending the palliative massage session. Some clients prefer to talk or share their feelings after a massage; others are silent. Let your client guide the closure; never pressure them to pray or hand-hold, if it is not in their character. Well-being and safety The palliative massage practitioner is concerned not only with the safety and well-being of the client, but his/her own, as well. Monitor your own emotional health for signs of stress, and maintain a healthy balance in your life by recognizing your own limitations and strengths, building support networks for yourself, and developing strategies for dealing with grief and loss; all are necessary to your emotional health. The way a practitioner dresses, his/her personal health, hygiene, tone of voice, body language, and overall manner are all factors influencing the quality of the session. Dressing comfortably as well as professionally is important; neat, well-cared for clothing that allows the practitioner to move and interact easily enhances the professional image. Appropriate body dynamics and positioning during treatment minimize the possibility of injuries on the job, the most common of which are tenosynovitis, inflammation of the tendon sheath, which results from repetitive strain, and carpal tunnel syndrome, a swelling of the sheath around the tendons in the wrist, causing weakness, pain and tingling in the thumb and the hand. Maintain a proper center of gravity, with correct breathing and positioning of the arms. Stand in a slight forward lunge, with soft knees, and your hips aligned with the area you are massaging. Leaning and bending stress the lower back, and should be avoided. Proper diet, exercise and sleep, as well as good hygiene, are crucial components of safety in palliative massage. Maintain clean skin, hair and clothing, wash hands frequently with antibacterial soap and water to preventing the spread of germs and infection. Universal precautions other than hand washing, such as wearing gloves, mask and/or gown are sometimes appropriate, depending on the client’s condition at the time. The practitioner must maintain good personal health, and be well-rested, healthy, and energetic during the session to provide the most effective, caring treatment of clients. Remember that palliative massage practitioners risk their clients’ health as well as their own if they choose to work with a cold, flu or other illness. hear clearly, so it is appropriate to continue to speak in a comforting way to the client. Clients with spiritual beliefs may benefit from visits with clergy or spiritual advisors. Changes in skin temperature can also be a sign that death is imminent. As we near death, circulation of blood to our extremities is reduced, preserving blood and oxygen flow for the vital last function of breathing. Thus, someone who is nearing death may have extremely cold hands, feet, and legs. Additionally, they may be clammy or damp from decreased blood flow. Blankets or light coverings can make the client feel more comfortable during this time. Some clients nearing death experience what we might think of as hallucinations; seeing people who other people do not see, or feeling that a dead relative or loved one visited them during the night. In many cases, these images or feelings comfort the individual, but sometimes they can be frightening. The practitioner may want to ask the client if he or she would like to talk about the experience. The practitioner may choose to remind the family and loved ones that they may want to say good-by, to let the dying person know that those left behind will be all right. The opportunity to provide final reassurance to loved ones and remember their presence in our lives can be tremendously important and beneficial, for the individual who is dying as well as his/her family members and friends.
EliteLearning.com/Massage-Therapists
Book Code: MTX1323
Page 14
Powered by FlippingBook