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NEW JERSEY Massage Therapy Continuing Education
Elite Learning
6 hours $50 00 INSIDE THIS BOOK:
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MNJ0524
What’s Inside
Chapter 1: Ethics in Massage Therapy (Mandatory)
1
2 CE Hours Ethical code and professional standards of conduct have been important values and concepts in professional massage, also within the boundaries that define therapeutic relationships. Chapter 2: Massage Therapy and the Stress Epidemic
12
1 CE Hour The purpose of this course is to discuss the positive role professional massage therapy can play in the stress epidemic in our modern culture. We will examine the negative physiological and biochemical processes that occur in the body under stress and counterpoint them with the beneficial processes that occur in the body during massage. We will also look at the cultural symptoms that contribute to our collective stress and discuss the statistics that qualify stress as a national epidemic. Chapter 3: Orthopedic Tests for Massage Therapists 22 1 CE Hour For injured clients seeking relief from their pain and movement dysfunctions, a quality massage therapist should seek short- and long-term solutions. This requires knowing what tissues are at fault and how. While this may seem simple and obvious (for example, pain in the neck is due to some neck muscle dysfunction) precisely pinpointing the causes of pain and dysfunction can be more complex. While it may not always be possible to know exactly what tissues are primarily at fault, there are many tests for soft tissue and joint injuries that therapists can conduct prior to (or even during) the massage treatment. Commonly referred to as “orthopedic tests,” these are assessments that test for skeletomuscular injuries and help sort out whether an injury is functional (muscular) or structural (skeletal) in nature. Chapter 4: Recognizing Headaches 34 1 CE Hour Headaches can be warning signs of underlying life-threatening conditions, however most are harmless and respond to basic treatments. Massage therapy has grown in acceptance as a viable treatment option, and more physicians have been suggesting it. New Jersey Law Review for Massage Professionals (Mandatory) (Text Summary Video Presentation) 48 1 CE Hour This course will guide the massage therapist through major features of the laws governing the massage/ bodywork profession in New Jersey. Key elements will be defined in cited terms as well as explained in clear, everyday language. Throughout this concise lesson, we untangle the often complicated terminology and bring the concepts to life so the massage professional can proceed confidently in navigating the dynamic, ever-evolving field of massage and bodywork. From scope of practice, forms of business, insurance and the latest NJ state updates, this course will present the crucial area of massage law so the professional can continue with confidence to safely serve his/her clients.
©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
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MASSAGE THERAPY CONTINUING EDUCATION
Book Code: MNJ0524
What are the requirements for license renewal? License Expires Frequently Asked Questions
Contact Hours Required
Mandatory Subjects
A maximum of 6 of the mandatory 20 credit hours of continuing education can be obtained by home-study or online
Biennial renewals expire every two years on November 30 of any even-numbered year
2 hours of Ethics 1 hour of NJ Laws and Rules
How much will it cost?
COURSE TITLE
CE HOURS
PRICE
Chapter 1:
Ethics in Massage Therapy (Mandatory)
2
$20.00
Chapter 2:
Massage Therapy and the Stress Epidemic
1
$10.00
Chapter 3:
Orthopedic Tests for Massage Therapists
1
$10.00
Chapter 4:
Recognizing Headaches
1
$10.00
$16.00 $50.00 FREE
New Jersey Law Review for Massage Professionals (Mandatory)
1
Best Value - Save $16.00 - All 5 Hours
6
How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you a New Jersey board-approved provider? Colibri Healthcare, LLC is approved by the National Certification Board for Therapeutic Massage and Bodywork (Provider #450215-06). Most states accept courses approved by this board. Are my hours reported to the New Jersey board? No. The board performs random audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Massage-Therapy you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 866-344-0973, Monday - Friday 9:00 am - Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Disclosures Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. 6:00 pm, Saturday 10:00 am - 4:00 pm EST. Important information for licensees:
Licensing board contact information: New Jersey Division of Consumer Affairs
Phone: (973) 504-6520 Website: https://www.njconsumeraffairs.gov/mbt
New Jersey Board of Massage and Bodywork Therapy 124 Halsey Street, 6th Floor | Newark, NJ 07102
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Book Code: MNJ0524
MASSAGE THERAPY CONTINUING EDUCATION
Purchase this five hour book and receive the mandatory “New Jersey Law Review for Massage Professionals” video course for Free (SEE BELOW FOR DETAILS) Elite Learning makes it easy to complete the CE you need in order to renew your New Jersey Massage Therapy license. HOW TO COMPLETE THIS BOOK
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Read the enclosed course materials and and answer the final exam questions.
• Visit EliteLearning.com/Book and enter book code MNJ0524 • Answer exam questions for the first 4 chapters. • Free NJ Law video will be automatically added to your cart.
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• Go to your online dashboard and watch the video. • Answer exam questions. • Download and print your certificate.
COMPLETE THE NJ LAWS AND RULES COURSE
If you’re only completing individual courses in this book Go to EliteLearning.com/Book and enter and enter code that corresponds to the course below, then click GO . Course Name Course Code All 5 Hours in the book MNJ0524 Ethics in Massage Therapy (Mandatory) MNJ02MT Massage Therapy and the Stress Epidemic MNJ01SE Orthopedic Tests for Massage Therapists MNJ01OT Recognizing Headaches MNJ01RH
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MASSAGE THERAPY CONTINUING EDUCATION
Book Code: MNJ0524
Chapter 1: Ethics in Massage Therapy (Mandatory) 2 CE Hours
By: Valerie Wohl, Ph.D. Learning objectives After completing this course, the learner will be able to: Define the concept of power dynamics. Distinguish between transference and countertransference. Describe the nature of the fiduciary role. List four ways a practitioner might work outside his or her scope of practice. Course overview This course addresses a range of issues of concern to the professional massage therapist and introduces a number of concepts important to the ethical practice of massage therapy. Successful completion of the course will equip you with the basic concepts and rationale for ethical decision- making in your practice, to help to navigate unknown ethical territory, identify questionable behavior, and develop a sense for “red flags” of potential conflict, as well as take steps to resolve these issues. Equally important, it will help you know when to seek professional guidance with a professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact Implicit bias in healthcare Implicit bias significantly affects how healthcare
Explain the risks of dual or multiple role relationships between practitioner and client. Explain the relationship between patient autonomy and agreements, including the client’s bill of rights, informed consent, and right to refuse treatment. List four strategies that reinforce appropriate boundaries. supervisor or mentor, or turn to other appropriate resources for professional assistance. This course fulfills two credits of mandatory coursework in Ethics, and: ● Explains concepts important to ethical theory and practice in professional massage therapy and bodywork. ● Examines the value and function of ethical codes and professional standards of conduct. ● Emphasizes the delineation of boundaries that define the therapeutic relationship. health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
PRINCIPLES OF PROFESSIONAL ETHICS
A Code of Ethics states the ethical responsibilities of the massage and bodywork professional. Standards of Practice further establish the expectations of professional conduct in regard to the law, confidentiality, business practices, roles and boundaries, and prevention of misconduct. This chapter is intended to clarify the meaning of statements and concepts central to the ethical practice of massage therapy. The nature of the practitioner-client relationship is a fiduciary one. This means the client trusts that the practitioner will act in the client’s best interests. The fiduciary obligation is the duty of the practitioner to do so. This concept is central to professional practice and the therapeutic relationship. While the practitioner and client share the same primary concern and objective – the client’s welfare – it is the practitioner, by virtue of his or her professional status, who is ultimately responsible for the client’s safety, security, and well-being. The practitioner bears the burden of accountability because he or she is in a position of authority or power in relation to the client.
Ethics refers to principles of right or good conduct. Professional ethics in massage therapy is the application of guiding principles of right conduct to the study, practice, and business of massage therapy. Unlike personal ethics, which are flexible and open to debate, professional ethical codes are formally defined, mandatory standards of conduct established by and for members of professional associations to ensure quality and integrity in the profession. Because virtually all state licensing authorities, certifying/ accrediting agencies, and professional associations establish their own standards of conduct and ethical guidelines for their members, you will need to refer directly to the organizations and academic or training institutions with which you are affiliated, as well as state, local, and national associations, to review the ethical guidelines that apply specifically to you and your practice. This course is based on standards of ethical behavior embodied in both the AMTA and NCBTMB Code of Ethics and Standards of Practice, and common to the ethical codes of other agencies regulating massage therapy.
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interest. The second is the requirement to refrain from doing what damages the patient’s interest. Different claims covered by the principle of beneficence may come into conflict and force difficult choices. Ideally, your relationship and interactions with the client are a partnership that promotes healthy behaviors, leads to sound, informed, health care decisions, and ensures the client’s voice is heard. The client’s best interests should always be your primary goal, and the guide for all your actions and decisions. If you ever suspect you are acting out of an unhealthy need or motive, or feel your interactions or relationship with the client are impeding rather than facilitating the therapeutic process, seek assistance and/ or supervision. Consult a professional massage therapy organization with which you are affiliated for guidance, supervision, and other professional resources. The following sections discuss key points of ethical massage therapy practice. Once you have successfully completed an approved training course, written examination (state and/or national) and, in some cases, a practical evaluation, you are deemed “competent” in the subject area of massage therapy, despite the fact that your specific skills, training, and knowledge base may be very different from that of other practitioners in your neighborhood, state, or country. Licensing agencies and professional societies establish standards of quality and professional expertise in the field and ensure that licensed individuals are keeping pace with recent developments through continuing education requirements. and professional experience, and list credentials. You will have to decide for yourself if you can rightfully claim substantive experience in a discipline for which you’ve attended a three-hour workshop or watched a series of instructional videos, or when you can properly call yourself an expert in one modality or another. Misrepresenting one’s educational achievements, credentials, or abilities is a serious breach of responsibility that endangers client safety and reflects poorly on the profession as a whole. If a subject is outside your area of expertise, don’t hesitate to say so, and direct the client to appropriate informational resources or professional services. Make sure any information or suggestions you pass along are supported by the professional community and recent research findings, and are appropriate and safe for the client. personnel more familiar with the client’s condition. Never allow the client, the client’s relatives, or even the client’s doctor to pressure you to proceed if you have any doubts regarding the safety of a specific procedure for a specific client. You are ultimately responsible for any injury sustained by the client during or resulting from massage and the medical and legal liability associated with it – even if the client’s physician specifically recommended or prescribed the bodywork. If you have strong concerns about the client’s health related to medication or procedures received through another source, suggest that the client have a trusted health care professional review the course of treatment. Pronouncements like this should not be made flippantly, as they could be the basis of legal action against you for
Individuals are treated ethically not only by respecting their decisions and protecting them from harm, but also by making efforts to secure their well-being. Such treatment falls under the principle of beneficence. The term “beneficence” is often understood to cover acts of kindness or charity that go beyond strict obligation. In this context, beneficence is understood in a stronger sense, as an obligation. Two general rules have been formulated as complementary expressions of beneficent actions in this sense: (1) do not harm and (2) maximize possible benefits and minimize possible harms (beneficence and nonmaleficence). The principle of beneficence requires us, other things being equal, to do good, or what will further the patient’s interest. The principle of nonmaleficence requires us, other things being equal, to avoid harm to the patient, or what would be against the patient’s interests. Both principles rest on the fundamental importance of what is in the patient’s interest. The first is the positive requirement to further the patient’s Accountability Professional organizations protect public safety by certifying the competence of their members through licensing and continuing education requirements. Accreditation and professional affiliations maintain quality control and show your accountability to clients, colleagues, and the profession, as a whole. They confirm that you abide by prevailing health and safety standards, conduct yourself in accordance with relevant legislation and/or professional regulations, and possess the specialized knowledge and skills of your field. Scope of practice Scope of practice refers to your area of competence, usually obtained through formal study, training, and/or professional experience, and one for which you’ve received certification or other proof of qualification. Unlike other standardized training programs or fields of study, schools of professional massage therapy and state requirements vary significantly in the number of necessary hours of study and curriculum. Some schools provide substantial training in specialized procedures, such as lymphatic-drainage techniques or hydrotherapy, while others may only touch upon these subjects, if they are discussed at all. Choosing to provide services for which you are not appropriately trained or competent is a dangerous personal decision that undermines the profession and may carry weighty legal implications. Your personal level of discretion and ethical standards will largely determine the manner in which you advertise your services, describe your education Safety Practitioners are required to abide by industry standards of safety and hygiene. Client draping, towels, the table surface, and other relevant items or materials must be cleaned according to accepted standards of sanitation, and meet all legal health and safety requirements (including universal precautions relating to communicable diseases). Practitioners should know how to cover cuts and use sanitizing supplies such as disinfectant hand wipes effectively. Practitioners must have the skills and knowledge to assess a client’s condition and provide safe and appropriate therapy. They must be attuned to verbal and non-verbal client feedback, and alert to possible contraindications for massage. Sometimes these decisions are less than clear- cut, requiring a bit of research or consultation with medical
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Advice can be a dangerous and slippery slope for practitioners in large part because they may have some knowledge and experience regarding a topic that is health- related, but not strictly within their scope of practice. If you have found an effective nutritional supplement or exercise program that relieves the same symptoms your client is experiencing, you may have a strong impulse to share that information with your client. Or, you may want to warn your client away from a health regime that you consider ineffective or potentially dangerous. When giving your point of view, make sure you delineate a professional recommendation, based on years of experience and study, from suggestions or opinions of a more personal or general nature. Help your client distinguish between subject matter in which you are, and are not, professionally qualified. If a health or medical issue is outside your scope of practice, recommend that the client see a qualified health professional regarding the matter. General guidelines require clients to be informed of the nature of their condition and the proposed treatment or procedure, its purpose, risks and benefits and their probability, risks and benefits of alternatives, and risks and benefits of not receiving the treatment. Failure to obtain adequate informed consent renders a health care professional liable for negligence or battery and constitutes medical malpractice. While informed consent is a well-established practice, it often fails to meet its stated purpose. Recent research findings strongly suggest that procedures to obtain informed consent may not adequately promote the patient’s comprehension of the information provided, rendering the consent not truly “informed.” Studies suggest that a majority of patients do not read a consent form before signing it, and less than half of the U.S. population understands commonly used medical terms. Additionally, clients with limited reading ability are at increased risk for medical errors, due to problems reading medication bottles, appointment slips, self-care instructions, and health education brochures. These clients are also likely to have trouble reading materials intended to aid in obtaining informed consent. Several methods of improving the procedures of obtaining informed consent have been proposed, including improving the readability of consent forms, asking clients for recall to establish understanding, adding additional stimuli, such as multimedia presentations and providing written information. The following section discusses “best practices” for informed consent forms, but also applies to other written material intended for the client. In order to ensure that clients understand the procedure to which they are consenting, it is important that all materials be presented in a comprehensible manner. Written health care materials, such as consent forms, are often written with a relatively complex sentence structure and vocabulary, making it difficult for the average adult to interpret the information. In addition, providing these materials in the language the client finds most familiar is likely to increase comprehension substantially for many individuals. Providing written information to clients regarding their diagnoses, proposed treatments, and other information given during informed consent discussion allows the patient to refer back to such information, which promotes comprehension. Some investigators have proposed that clients should receive written consent forms days before receiving a procedure.
practicing medicine without a license. If you believe your client has a serious medical condition or may have suffered an injury, tell the client immediately and refer him/her to the appropriate health care professional. Do not discuss the condition with the client’s doctor or anyone else unless you have explicit permission from the client to do so. Be sure to document your referral and the reasons for it in the client record. Keep scope of practice in mind when you give advice or make recommendations to clients. While listening attentively to your client is a relatively risk-free venture, sharing your opinions is not. Depending on the topic of conversation and your specific comments, you may be engaging in high-risk behavior whenever you have casual conversations with a client. Resisting requests for “advice” in any subject outside your areas of expertise is your safest option, but it is natural to be drawn into discussions with a client, especially one you’ve come to know well.
Patient autonomy, informed consent, and right to refuse Informed consent refers to a patient’s right to understand his or her condition and participate in decisions regarding that care or 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. It is through this process that a health care 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 the client’s right to make decisions about his/ her own health care. The principle of 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 health care setting, the principle of autonomy translates into the principle of informed consent: You shall not treat a client without his/her 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. In massage therapy, informed consent usually takes the form of an agreement between the practitioner and client that states their shared objectives, proposed treatment plan, expected outcome(s), and anticipated time frame for results. It may also refer to the client’s medical history, asserting that the client has informed the practitioner about all known physical or medical conditions and current medications, and will inform the practitioner if any of these conditions change. The notice of informed consent in massage therapy typically includes a statement explaining the role of massage therapy in pain and stress reduction or other specified purpose, and its limitations: ● Massage therapy does not take the place of medical examinations, care, or treatment. ● The practitioner is not a doctor and does not diagnose medical conditions or prescribe medication. ● Clients should continue to consult their primary caregivers or other specialists for ongoing health care and medical conditions. ● Clients should consult their primary caregiver to review health care recommendations before making significant changes in their health and exercise regimen or diet. In addition to being an ethical obligation of caregivers, legislation in all 50 states requires that clients be informed of all important aspects of a treatment and/or procedures, although the details of these laws and statutes differ greatly.
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Informed consent is always specific: The goal of the informed consent process is to ensure that clients have an opportunity to be informed participants in decisions about their health care. To achieve that goal, practitioners must explain the patient’s condition and inform the patient about treatment options and alternatives, including the risks and benefits of each, providing the information that a “reasonable person” in similar circumstances would want to know in making the treatment decision. A key element of the process is that the practitioner explains why he or she believes recommended treatments or procedures will be more beneficial than alternatives in the context of the patient’s diagnosis. Thus informed consent is always specific: to the individual patient, the clinical situation, and the recommended plan of care or recommended treatment(s) or procedure(s). Consent for multiple treatments: However, to say that consent is always specific is not the same as saying that separate consent is always required for every episode of repeated treatment. When the plan of care for a given diagnosis involves repeated treatments or procedures, practitioners should ensure the patient understands that he or she is consenting to multiple episodes of treatment. Separate consent is not required for each individual episode. If a patient’s condition changes enough to warrant a change in the plan of care, the practitioner must explain to the patient how the situation has changed, establish goals of care in light of the new situation, recommend a new plan of care, and obtain informed consent for the new plan or for specific treatment(s) or procedure(s) now recommended. Notification versus consent: Informed consent is also different from “notification,” that is, providing general Intake interview and documentation Clients should fill out a formal intake form on their first visit that should include: ● Client’s name, address, and telephone or other contact number(s). ● Reason for visit. ● Medical history. ● Insurance/payment methods (if applicable). ● Person to call in case of emergency, with their contact information. The client should also sign and date the following statements: ● Release of medical records. ● Notice of informed consent with scope and limitations of practice. ● Client’s Bill of Rights. A Client’s Bill of Rights typically includes the following information: ● Name of practitioner. ● Details of practitioner certification and list of credentials. ● Practitioner’s area of expertise, philosophy, and/or approach to massage. ● Fees and service schedule. ● Payment terms. ● Filing procedures for written complaints. ● A right to information statement, asserting the client’s right to the following information: Business management and promotion Conducting your business in an ethical manner is largely a matter of treating people fairly and decently, using your skills and time effectively, and adhering to high standards in your work. Your promotional materials, record keeping, financial dealings, and conduct in day-to-day business
information relevant to clients’ participation in health care. Similarly, every patient entering a health care facility must be notified that his or her records will be used for purposes of routine health care operations. Likewise, each patient should be notified that his or her information may be used for quality improvement purposes to enable the organization to fulfill its obligation to monitor the quality of care it delivers and to carry out quality improvement activities for the benefit of all clients. Notification informs clients not only about their rights, but also about organizational activities and processes that shape how care is delivered. Like informed consent, notification serves the goal of respecting clients as moral agents 14 . Informed consent should: ● Explain the patient’s condition and diagnosis clearly and concisely, in language he or she can understand. ● Inform the patient about the treatment(s) or procedure(s) you recommend, including: ○ The name, nature, and details of the recommended treatment(s) or procedure(s). ○ Indications for the recommended course of action. ○ Likelihood of success of the recommended treatment(s) or procedure(s) for this patient. ● Describe the expected benefits and known risks of the recommended treatment(s) or procedure(s). ● Describe reasonable alternatives to the recommended treatment(s) or procedure(s), including the expected benefits and known risks of each alternative. ● Identify the practitioners who will be involved in performing the treatment or procedure. ● Advise the patient if the recommended treatment or procedure is novel or unorthodox. ● Encourage the patient to ask questions. ○ Practitioner’s assessment of the client’s physical condition. ○ Recommended treatment, estimated duration of treatment, and expected results. ○ Copy of client’s health forms/records held by practitioner. ● Statement of confidentiality. ● Statement of refusal, explaining the client’s right to terminate a course of treatment at any time and choose a new practitioner. ● Clients’ right to invoke, explaining client’s right to invoke these rights without fear of reprisal. Both the practitioner and client are ensured the “right of refusal.” For a client, this means the right to refuse, modify, or terminate treatment regardless of any prior agreements or statements of consent. For a practitioner, this means the right to refuse to treat any person or condition for just and reasonable cause. These rights safeguard a client’s freedom to choose any practitioner, and a practitioner’s freedom to terminate treatment, if necessary. These rights might come into play in cases of negligence or abuse. For example, a practitioner can refuse to work with an abusive or unstable client, and a client can refuse treatment from a practitioner he or she suspects is practicing under the influence of alcohol, drugs, or any illegal substances.
matters should also be able to pass ethical scrutiny. Maintaining your practice in good standing means: ● Filing local, state, and federal taxes. ● Discussing and/or displaying fee schedules and billing practices prior to a first meeting. ● Making the client’s welfare your paramount concern.
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● Following generally accepted accounting practices. ● Keeping accurate financial records. ● Maintaining patient confidentiality. ● Respectful and cooperative collaboration with other professionals. ● Appropriate referrals, if necessary. As a massage professional, any negative perceptions of your marketing materials or advertisements tend to reflect Documentation and records Proper documentation and record keeping is a critical, routine aspect of a successful practice. Keep notes legible and accurate. If it is ever necessary to refer to files at some time in the future (a medical emergency or legal proceedings, for example), the context and details of your notes should be clear. Other health care personnel will need to know the background, presenting status, actions taken and the results, with some discussion of treatment strategies and expected objectives. Adhere to the following guidelines for preparing and maintaining records: 9 ● Maintain accurate and truthful records. Record only factual information, observations, and actions. Don’t record your opinions, or conjecture about the client or his/her condition. When recording statements made by your client (regarding an injury, for example), use quotation marks to demarcate the client’s words. Keep a separate file for personal notes or any material of a speculative nature. ● Make sure the forms you use to collect client information are appropriate to your practice and cover all pertinent areas. Make sure forms are free of errors and are easy to read and understand. Questions should be stated simply. Avoid jargon or complicated medical terminology, or define terms, as needed. Review forms on a regular basis, and revise or simplify confusing formatting or content. ● Take a comprehensive case history and review it with the client before beginning treatment. This should include an overview of the client’s general state of health and thorough medical history, his or her reason(s) for seeking massage therapy, onset and duration of problematic symptoms, medical history of family members (if appropriate), and occupational background. ● Train staff members to record client histories and other important information properly and thoroughly, and to ask appropriate follow-up questions if there is any ambiguity in a response. Implement some structure or mechanism to ensure this information is complete for every client and answers are recorded in sufficient detail. Review any personal or medical information taken by other staff members in a personal interview with the client to ensure information was recorded properly and in adequate detail. ● Areas that do not apply to a specific client should be marked “N/A” (non applicable) rather than left blank. Confidentiality Keep all original records in your possession. Provide copies of x-rays, notes, and records documenting client care for clients or health care facilities requiring their own copies. Share information only in cases where disclosure is required by law, court order, or another appropriate, professionally approved manner, according to legal requirements. Impress the importance of confidentiality and retaining original file copies upon all staff members. Institute the
poorly on your colleagues and the profession as a whole. Promotional materials should: ● Include your license number, place of business, and phone number. ● Refrain from using fear or guilt as motivational tactics. ● Avoid unrealistic, misleading, or sensational claims, or promises to cure specific conditions or ailments. ● Avoid using any wording or image that might be construed as sexual in nature. ● Adhere to truth-in-advertising standards. ● Develop a short, simple form that clients can use to note their progress (or lack of progress) at each visit. ● Document any client non-compliance with the care plan, including canceled appointments (DNKA = did not keep appointment), refusal or failure to follow health care instructions and/or take needed medication, activities or behaviors that pose a risk to the client’s health. Communicate the rationale for your opinion and do not proceed with any action that conflicts with your professional judgment. ● If you feel the client’s disregard for professional recommendations is putting him or her at risk, have the client sign a form acknowledging that he or she has been informed of the potential consequences of their action or inaction, and is choosing to refuse recommended treatment. ● Notes should be legible as well as accurate. Pay attention to your handwriting and use clearly written and recognized abbreviations. Remember that you and other people may need to refer to these notes years in the future. Make sure they are easy to read and understand. ● File records promptly and accurately. Establish a strict filing system and adhere to it, and be sure other staff members know the system and the importance of using it. ● The following guidelines were established for litigation purposes and should be standard practice in all health care environments: ○ Alter records as minimally as possible, and only when necessary. ○ If you find something in error, do not erase. Cross out the error using a single line, so as not to conceal what is written underneath, and write the word “error” above the incorrect statement. ○ If you review your records and feel the need to clarify a point, write the date and the additional comments with the note (labeled “addendum”). ○ If litigation is threatened, do not make any kind of change to the records. Not all file contents are subject to the same retention times. Keep records for current and former clients for as long a period as is practically possible, but at least the length of time specified by federal and state regulations as the legal minimum. Retain children’s records after they turn 18 for a length of time that equals the state’s statute of limitations. following procedures when providing copies, and make no exceptions: ● Have the client sign and date a release authorization form. ● Keep a copy of the release authorization with the client’s records. ● Copy only the information requested.
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Book Code: MNJ0524
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● Note in the client’s file: the party requesting the copy, what specifically was requested, and the date, to whom, and where the copy was sent. All information and matters relating to a client’s background, condition, and treatment are strictly confidential and should not be communicated to a third party (even one involved in the patient’s care) without the client’s written consent or a court order. Treat clients with respect and dignity: Handle personal information with sensitivity and keep the content of written records a private matter. Practitioners who can’t resist telling secrets or repeating gossip in their personal lives should be aware of the heavy penalties associated with jeopardizing client confidentiality in a professional context. New clients It is generally a good idea to assume that a new client knows nothing about massage therapy. Many massage therapists develop an information sheet to acquaint the client with basic massage concepts. Office personnel, customary procedures, and other useful points regarding their place of business, such as bathroom locations, and what to expect in a typical session, can be distributed to clients in the waiting room before their first session. Providing basic instructions and answers to common questions in a brief information sheet can be very effective in putting new clients at ease, especially when clients are new to the experience and unfamiliar with a facility’s personnel and way of conducting business. During the session, be sure to inform the client when you move from one area to another, especially when the movement is to a particularly vulnerable area, such as the abdomen. ● Assess sensitivity and tolerance and inform the client as you progress to deeper movements. ● Perform tapotement only with client permission, and after you are certain the individual is adequately informed about the process. ● Take care not to startle a client in a relaxed state.
Without an understanding that their disclosures will be kept secret, clients may withhold personal information. This can hinder caregivers in their efforts to provide effective interventions or to attain important public health goals. Disclosure of personal health information should protect patient confidentiality as much as possible. Where confidentiality cannot be maintained, clients should be informed about how their personal health information will be used and whether the information will be identifiable or anonymous. Coordination of health care, in daily practice, requires limited disclosure of information to other health care providers, companies related to client reimbursement or payment, etc. ● Inform the client regarding potential massage aftereffects, such as tenderness or soreness, and their expected duration. ● Ask the client as you near the end of the session if any area in particular needs further attention. ● Invite feedback and implement changes based on client comments. At the end of each session, discuss the client’s treatment plan and health objectives. Ask the client to assess his or her progress or lack of progress toward treatment goals. Answer any questions the client may have, and note the following information in the client’s record: ● If the client feels bruised, nauseated, or light-headed (check blood pressure and monitor). ● The length of the massage session. ● When the client should return for another session (session intervals/frequency). ● Anything the client can do to accelerate progress toward treatment goals. ● Anything the client should do or not do between sessions. ● What results the client can expect, and when. Practitioners who recommend clients replenish fluids after a session may want to provide bottled water at their office. It is not unusual for clients to unintentionally test professional boundaries, or practitioners to unknowingly relax them. When practitioners and clients are motivated by countertransference and transference, respectively, they are more susceptible to inappropriate impulses that can lead to misconduct. Transference refers to all the feelings experienced by the client, related to his or her past experiences and relationships, stirred up by or in the session. Transference is neither negative nor positive, but is “always a distortion; a projection of emotions from the past to current objects.” 3 Countertransference refers to all the feelings experienced by the practitioner, related to his or her previous relationships and experiences, that are stirred up during the session, including the practitioner’s conscious and unconscious response to the client’s transference of emotions. Be aware that transference and countertransference can activate strong emotional reactions and/or feelings of sexual attraction, raising unrealistic expectations on the part of clients and practitioners. Learn to identify emotional red flags of blurred professional/personal boundaries in your behavior. If you overreact, are preaching or lecturing or are uncomfortable, unsure of yourself, or dissatisfied in your interactions with a specific client, you may be experiencing countertransference, bringing emotions and reactions from your personal life into your professional environment.
Interpersonal dynamics and power in the therapeutic relationship Interpersonal dynamics exist in all relationships, and are a normal and necessary part of a therapeutic relationship between client and practitioner. An important part of this dynamic is a power differential; the imbalance in authority or power that results from your greater expertise in the area of massage therapy. Your education, skills, experience in the field, and professional certification give you an authoritative advantage over your clients.
With any position of power comes the potential for abuse. Massage therapists, like many health care professionals, forge close relationships with people in their care. The combination of physical and social interaction between practitioner and client can trigger strong emotional responses in one or both parties, leading to small improprieties as well as egregious misconduct. Asking your client, who is a lawyer, for free legal advice; requesting a church donation or selling your daughter’s Girl Scout cookies at the office; mentioning personal details about a client or repeating what was said during a session to a friend or spouse: All are subtle ways practitioners take unfair advantage of their relationships with clients. Even when clients appear to welcome, rather than resent, such requests or behavior, they are never appropriate and do not belong in a professional environment. It is equally inappropriate for practitioners to accept favors, free merchandise and services, or confidential information (such as stock tips) from a client. These interactions can distort the therapeutic relationship and obscure its primary objective.
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Book Code: MNJ0524
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Boundaries in the patient-practitioner relationship 12 Boundaries define the limits of appropriate behavior by a professional toward his or her clients. By establishing boundaries, a health care professional creates a respectful and protective space for the therapeutic relationship to occur. A boundary violation occurs when a health care professional’s behavior goes beyond appropriate professional limits. The intimate nature of massage therapy includes practitioners in important and sometimes highly stressful life events, and the mutual dependence of colleagues working in close concert all present the potential for blurring of limits to professional relationships. Remaining within the bounds established by the purpose of the relationship can be especially difficult in prolonged or long-term relationships. Even so, in all encounters, practitioners are responsible for retaining their professional boundaries. A variety of standards establish the limits of appropriate professional behavior, whether those limits are explicitly enumerated in standards of conduct, codes of ethics, or law, or tacitly conveyed through professional training and widespread acceptance. Individuals who seek help must rely on the professional they consult to be trustworthy: When practitioners behave in ways that call their professional judgment and objectivity into question, the trust on which the relationship depends is compromised. And when trust is compromised, the efficacy of the therapeutic relationship is negatively affected. Part of your responsibility in maintaining clearly defined boundaries is to protect the client from you, should you act or speak inappropriately, or be motivated by anything but your client’s best interests. Inappropriate behavior tends to make people uncomfortable. If you notice that a client Personal boundaries and self-disclosure Self-disclosure is the process in which the practitioner reveals personal (rather than general or professional) information about him/herself to the client. There are many different motivations for and types of self-disclosure. An incident may be deliberate or accidental, initiated by either the client or the therapist, and can be spoken or unspoken. An example of unspoken intentional self-disclosure is how you choose to decorate your workplace (with careful selection of a meaningful poster or picture, or a family photo, for example). Some self-disclosure is unavoidable, as your presence communicates facts about you such as your gender, and approximate age, etc. Some disclosure is accidental because it is not meant to be shared but is communicated through body language or tone of voice. Accidental self-disclosure also occurs in cases where a practitioner bumps into a client unexpectedly, when both are sitting in their doctor’s waiting room, for example. You may or may not want to disclose information about why you are there, and it may be difficult to find a safe middle ground, revealing enough to be professional and friendly, but not enough to compromise your own personal space and privacy. Exactly where should you draw the line? It is helpful to ask yourself two questions before self-disclosing: (a) how will it benefit the client? and (b) how will it affect your professional boundaries? You should also consider your own privacy. For example, what if you and your client attend the same Alcoholics Anonymous meeting? Would this make it hard for Dual/multiple role relationships A dual or multiple role relationship occurs when an individual either at the same time or different points in time engages in two role categories, for example, in addition
is not responding positively to massage therapy, make sure your behavior or comments are not a contributing factor. Relieving stress and physical stiffness or pain should be a relaxing and comfortable experience. If your behavior is appropriate but your client appears anxious or uncomfortable in the session, discuss your concern with the client. A boundary violation occurs when a health care professional’s behavior goes beyond appropriate professional limits. Boundary violations generally arise when a personal interest displaces the professional’s primary commitment to the patient’s welfare in ways that harm the patient or the patient-practitioner relationship. Interactions between health care professionals and clients are ethically problematic when they can reasonably be expected to affect the care the individual or other clients receive or the health care professional’s relationships with colleagues – or when they give the appearance of doing so. Boundaries are breached in two ways. Some breaches are inadvertent or not intentionally exploitative. These are known as boundary crossings . Commonly cited examples are a goodbye hug initiated by your client at the completion of treatment; non-sexual physical reassurance at times of extreme stress; running a session overtime; or selective self-disclosure. Repetitive boundary crossings are potentially harmful because they blur the boundary, thereby increasing the chances of boundary violation. Boundary violation is a significant and potentially harmful breach where the practitioner overrides the client’s rights or actually does harm to the client. Some examples are: affectionate or flirtatious communication; self-disclosure about the practitioner’s personal problems; or breaking confidentiality. you to get the full benefits of attending the meeting during times of stress or relapse? Self-disclosure is not always conscious and deliberate. Words can be blurted out, poorly thought out, or tinged with emotion. When in doubt, do not self-disclose. In a similar vein, it is usually best to keep emotional responses or judgments (both negative and positive) to yourself. A good rule of thumb is to monitor your own feelings without imposing them on your client. If you are distracted by a strong feeling, mentally put it to one side. Wait until after the session, then talk with a peer or supervisor or deal with it personally. As with other boundary crossing, self-disclosure should be client-focused, based on the welfare of the client. Different clients and practitioners have different personal boundaries, so appropriate boundaries must function within the client’s comfort zone. Remember that those personal and professional boundaries exist for the benefit of both the practitioner and the client. Changing or moving boundaries, which are the limits within which the therapeutic relationship occurs, results in an unclear or ambiguous relationship that is a risk to the safety of the client, although it may not appear to have negative repercussions at that time. Transgressions often have delayed consequences that do not appear harmful initially. Detecting boundary violations is complicated by the fact that transgressions are more often a process than an individual event or occurrence. Boundary violations may be subtle, or masked by the professional/patient relationship.
to the professional therapeutic relationship, there is also another relationship, such as relative, friend, student, business partner, or instructor. While it is perhaps best
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Book Code: MNJ0524
EliteLearning.com/Massage-Therapy
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