● Get the word out on social media. Use rainbows, because the rainbow flag is commonly used as a symbol of LGBTQ pride and LGBTQ social movements, and let the community know the practice welcomes LGBTQ clients. ● Stay educated about LGBTQ terminology and concerns. Be flexible and willing to change as health care professionals that must stay informed and meet client needs. ● Of course, client confidentiality is a top priority for all clients, and professionals must make sure that all clients understand that their information will never be shared or discussed. This can eliminate any concern about clients might have about their privacy. ● Add a phrase such as, “All Are Welcome Here,” or “Welcoming Practice,” to your marketing materials. This way, people will know the practice is supportive of diversity and will be more comfortable visiting the practice. ● Invite back each client that receives care or contacts the practice for information and be sure to address the mental and physical benefits of the practice. ● Keep an open mind and conduct self-assessment to evaluate beliefs and values. By examining those values and keeping an open mind practitioners grow and change. As the great Maya Angelo said, “I did then what I knew how to do. Now that I know better, I do better.” ● Pain medication and respiratory distress/consciousness. The question here being whether the pain is so great that it is necessary to adversely affect consciousness and cause some respiratory distress by the higher use of medications to suppress the pain. Is it better to control the pain or for the patient to be more alert? ● Having to go into a neighborhood recognized as dangerous in order to provide home care for a patient. The massage and bodywork professional will not be directly involved in the decision making process to address the issues above. They will be directly and closely involved with the client as the family and healthcare team carry out these decisions. The therapist may witness procedures that conflict with their values, beliefs, and in some cases, their interpretation of ethical standards. The therapist must thoroughly understand the scope of the end of life and hospice care before they commit to accepting clients into their care. In order to assist the massage and bodywork therapist to identify, analyze, and determine appropriate action in cases of ethical conflict, it is necessary to compare standards of practice established by the National Certification Board for Therapeutic Massage & Bodywork and related ethical principle from the National Hospice and Palliative Care Organization (NHPCO) (NCBTMB, 2009; Carlin, 2016). This will assist the therapist to increase their knowledge base concerning the basis for end or life procedures, determine their role in client care, and resolve ethical issues that impact their delivery of massage services in hospice care. NHPCO Related Principle Provide clients and their families with the highest possible level of quality end-of-life care and services, while maintaining professional boundaries that respect their rights and privacy (National Hospice and Palliative Care Organization Ethics Committee, 2006).
Gael Wood (2016) proposes ten things that the massage and bodywork professional can do to welcome LGBTQ individuals to their practice. She notes that many members of this community worry that they will not feel comfortable and are hesitant to seek services. Wood provides the following information to welcome LGBTQ clients: ● Look over intake form, as they may contain outdated or unnecessary questions about gender, marital status or the relationship to an emergency contact. A quick fix is to have a blank to fill out rather than a box to check. Also determine if any of the health questions could be reworded or are unnecessary. ● Use gender-neutral bathroom signs, if there is a single bathroom. A bathroom is a bathroom, after all. A great bonus of this is less waiting for the right one to be empty. ● Be aware when asking personal questions. A simple “Do you have children?” can be hard on some clients, for various reasons. Stick to asking clients about their needs and activities that will inform ability to provide an effective massage or bodywork session. ● Reach out in person at local events like pride days or LGBT Center events. Just search Google for LGBTQ events in the city. Practitioners may volunteer, give a talk about stress, and how massage can help relieve it, or offer chair massage. Ethical considerations of hospice massage Massage and bodywork professionals follow ethical standards and guidelines within their scope of practice. If that includes working with clients in hospice care the practitioner must be prepared to face ethical issues that may lead to dilemmas related to hospice end-of-life care. As massage therapy is increasingly integrated into all phases of modern day health care from infancy to gerontology, the practitioner may be called upon to work with clients in hospice or other forms of end of life care. Advances in medical treatment, technology, and changes in attitudes, and legislation about care for the terminally ill presents ethical dilemmas and conflict for the family and all care givers. Dr. Richard Fife, an ethicist, states: “In hospice care, staff members are constantly faced with the possibilities and realities of ethical dilemmas” (Fife, 2005). He reports findings from a two-year study of ethical dilemmas faced by hospice staff. Some of the most common issues included Fife notes are as follows: ● Working with clients who have been admitted without a do-not-resuscitate (DNR) order. ● Withdrawal or withholding of nutrition/hydration. ● Patient autonomy versus patient safety and physical needs. ● Conflicts with the patient’s family or significant others. ● Conflict over whether to follow a patient’s wish to be discharged from a hospice unit when the staff member feels that the primary caregiver is incompetent to take care of the patient. NCBTMB Standard v: Roles and Boundaries Adhere to ethical boundaries and perform the professional roles designed to protect both the client and the practitioner, and safeguard the therapeutic value of the relationship (NCBTMB 2009).
ROLES, BOUNDARIES & PRINCIPLE
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