3. Draft a treatment plan that addresses: a. Cautions, contraindications. b. Medication side effects. c. Therapeutic intentions. d. Assessments, positioning/draping. e. Modalities/techniques. CASE STUDY
Hyperglycemia issues: • Refer for evaluation by primary health care practitioner. Respiratory issues may present as: Shortness of breath, wheezing, chest tightness, and coughing. • Elevate client’s torso to 45 degrees when supine. • Address hypertonic muscles of respiration. • Slow pace of strokes to encourage deeper respiration. Lymphatic/immune system issues, or edema: • Elevate affected extremities, except if congestive heart failure (CHF) is diagnosed. • Increased susceptibility to infection, with a decreased ability to fight infection. • Defer massage if you or a household member has been exposed to any infectious condition. • Follow standard precautions for the prevention of transmission of pathogens in treatment space. Additional side effects Disrupted thermoregulation issues: • Warm client? Use lotion and 100 percent cotton sheets. Gently blot excess perspiration, and be aware that chilling may follow. • Chilly client? Warm client directly, not treatment room. Insomnia or agitation issues: • Slow pace of strokes; avoid friction, vibration, and percussion. • Ask if client prefers to be lulled to sleep or stimulated at session end. Fever or flu-like symptoms: • Fever is a contraindication to techniques with circulatory intent. Mood swing issues: • Assess medication compliance. • Remain neutral; accommodate behavior within acceptable boundaries and workplace policies. Fatigue issues: • Shorten session duration; limit techniques that require client participation. Utilizing drug information in patient assessment: • Investigate possible side effects for each drug. • Visually assess skin for areas to avoid. • Identify cautions/contraindications. • Describe available modalities, techniques. • Discuss and obtain informed consent for safe, effective treatment. Apply information to the treatment plan: 1. Select case profile: Identify cautions or contraindications created by health conditions. 2. Research each medication; summarize its side effects.
A massage therapist works at a spa where he believes the employer’s standards for cleanliness do not meet professional standards. The employer does not require oil or lotion containers to be cleaned as they are filled or at the end of the work day, does not require massage room surfaces to be cleaned on a daily basis, does not send dirty linens to a laundry service to be sanitized, and only requires hot stones heated in water to be sprayed with a disinfectant between clients. Reflection : Are there any state or federal regulating bodies that govern proper sanitation procedures in a healthcare setting? In the potential absence of regulatory codes, whose responsibility does the client’s safety become? Analysis : The answer to this problem may lie in each state’s particular regulations or the regulations suggested by each state’s massage licensing board, although it should be noted that the suggestions for cleanliness advanced by a massage therapy board may not have legal precedents. Where the law is applicable, sheets, towels, table surfaces, and other relevant items or materials must be cleaned according to all legal health and safety requirements. Where the law is lacking in comparison to a code of ethics or standards of practice a massage therapist may accept, therapists may have to take it upon themselves to protect themselves and their clients from potential safety hazards. In establishments where hot stones are used, for example, the standard of practice is such that hot stones should be scrubbed with hot water and soap between clients, and the water in the hot stone caddy exchanged for clean water before the next client receives a hot stone massage. One reason for this is that an undetected pathogen from one client may be transferred to the hot stones during a hot stone massage and possibly transferred to the next client who receives a hot stone massage if the same stones and water are used. It would be a clear violation of a therapist’s “do no harm” ethos to allow this happen, regardless of the employer’s standards of cleanliness. Ethically speaking, the therapist should consider educating the employer about the fundamentals principles of infection prevention as outlined by the Centers for Disease Control.
PATIENT AUTONOMY, INFORMED CONSENT, AND RIGHT TO REFUSE
Autonomy (self-rule) is based on the principle of respect for persons, which holds that individual persons have the right to make their own choices and develop their own life plan. In a healthcare setting, the principle of autonomy translates into the principle of informed consent: Therapists shall not treat clients without their informed consent. In order to affirm autonomy, every effort must be made to discuss treatment preferences with clients and to document them in written records (Sohnen-Moe, 2022). In massage therapy, informed consent usually takes the form of an agreement between the practitioner and client that states their shared objectives, the proposed treatment plan, expected outcome(s), and the anticipated time frame for results. It may also refer to the client’s medical history,
Informed consent refers to patients’ right to understand their condition(s) and participate in decisions regarding care of that condition. The patient or patient’s guardian is required to sign a written statement acknowledging agreement to proposed treatment terms and awareness of the known risk factors associated with them (Sohnen-Moe, 2022). Through this process, a healthcare practitioner informs a patient about the risks and benefits of a proposed therapy and allows the patient to decide whether the therapy will be undertaken. It is based on the moral and legal premise of patient autonomy and is the formal application of clients’ rights to make decisions about their own healthcare.
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Book Code: MMD0926
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