C – There are many Cs in our alphabet
C….There are many C’s in our alphabet -
Care,Communication, Consent, Contraindications
Care, - Care could be summed up in the therapy world as a “Sensitive, Reliable & Responsible” approach towards others - both clients & other professionals.
It goes without saying that this is a fundamental attitude that all therapists should exude…..but I’m going to say it again anyway as it still amazes me how often basic care and consideration when managing clients/patients is either ignored or considered unnecessary!
For example - support and comfort for the face & neck. Ankles that don’t ‘hang off’ the bed should be supported (fill the gap with a towel)
- cover areas that have already received massage to keep them warm, when moving to another area
- ensure your clients/ patients modesty is maintained at all times by using Drapes (towels)….I’m coming to this in a moment!
Communication, - key to understanding!
Unless we communicate well, whether in written, verbal or ‘none verbal’ terms, whatever strategies we employ we may fail to receive, interpret or question adequately. This might leave us vulnerable to complaint and therefore if you have any difficulties in any of the areas of communication you should seek advice or support.
For example - learn how to construct referral letters, report writing and communicating with other healthcare professionals effectively
- what are the ‘none verbal’ signs I should look for and how are they interpreted? Apart from the obvious withdrawal of a limb or area being worked on!
- how can I improve my verbal communication to ensure I am clear in my explanations, interpretations and observations? Especially while gaining informed consent.
If you need assistance then why not consider a OneTo One session?
Consent - without informed consent you cannot proceed to deliver any method, modality or technique to your friend, relative, client or patient.
The term used in therapy is ‘’Informed Consent’’. We will look at this in more detail when we get to ‘I’…..
Don’t get caught out there is no ‘’assumed’’ consent.
For example - just because someone takes off their clothes gets on your plinth or table, it doesn’t mean they have consented to receiving any massage or soft tissue treatment!!
Contraindications - who wouldn’t we massage? Remember Rule 1 ?
In determining who to rule out don’t forget Rule 2? Your communication and choice of questions is important. Your failure to ask appropriate questions is not the clients/patients failure to disclose that they are unsuitable for massage. Rule 3- the devils in the detail.
Questions usually start as fairly general or broad but should become more specific and appropriate as your ‘’history taking’’ , “interview” or “verbal assessment” of a clients needs/problems are investigated. The detail required?
What are the areas of contraindication/precaution & consideration for massage therapists and practitioners? We define these as a ‘’circumstance, condition or situation that precludes the delivery of massage’’
If we look at these on a continuum at one end there are ‘’Absolute’’ contraindications - people who will never receive massage and at the other end are those people who can ‘’Always’’ receive massage. These two groups of individuals make up only a very small percentage of those presenting for massage! Leaving the rest of the population in the ‘’More or Less’’ likely to be suitable which means asking questions (communicating effectively) to gather the information required to make the decision (Rule 3, Rule 2 & Rule 1)
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Categories of contraindications to consider - Why?
Decision - Rule 1 involves “open” or starting questions followed by more “closed” or direct questions.
Remember when recording the answers Yes/No is insufficient for safe & effective practice and will not protect you in the event of a claim!
There are “7” main areas of questioning to consider
Open question - Hows your general health? So often the response is “fine”, “ok” not only is this insufficient to judge someones suitability it is inadequate for recording keeping.
Why? In order to demonstrate duty of care & justify your actions in the event of a claim your records must show that you ruled out (Rule 1) anyone unsuitable at the earliest possible point in your discussion.
Closed questions - Are you well today? No coughs/colds or sore throats? (Rule 2 & 3)
Why? Now we know if we are likely to send an infection around the body or place unnecessary strain on their immune system which is already fighting a problem. (Rule 1)
Open question - Have you had your BP checked recently? Again the response varies from “yes”, “no” or my BP is “normal”. This does not provide us with sufficient information to judge someones suitability to receive massage. (Rule 1)
Why? Massage & soft tissue skills affect BP and in order to satisfy Rule 1 we need a detailed and up to date understanding of their BP status.
Closed questions - When was your BP last taken? Do you know the reading? Who took the BP?
why? Now we know the context in which the BP was assessed and can then decide on the impact this information may have on our decision to massage/not massage (Rule 1, 2 & 3)
Recording the information in detail to justify our actions.
Open question - Are you taking any medication? You will all have experienced the variety of answers to a question like this! “no”, “yes but its fine”, “nothing really”……
Why? Again our ability to ascertain the relevance or impact to any proposed massage is insufficient for safe & effective practice from vague answers like these.
Closed questions - The information we require is the name, dosage, frequency taken, over what period of time? For every medication / supplement / complementary remedy or “other” that they take. This could mean a lot of questions need to be asked.
For Example Do you take anything prescribed by the Dr? Do you buy any medications/tablets over the counter from the chemist? Do you have a prescription with you I could see? Can you tell me what the medication is for? Do you take any supplements? Do you take any performance enhancing medication/drugs? Do you take any drugs or recreational drugs? As you can see the list of what and how you ask a question could be infinite depending on the person you are talking too.
Why? To make the right choice Rule 1 means having a clear indication of what may affect the tissues of the body and whether these may have short or long term consequences for the delivery of our massage & soft tissue skills? Rule 2 & 3 will keep you safe.
Open question - Have you had any surgery? How people interpret this varies from only thinking of recent surgical interventions, to only serious operations.
Why? Again we have to be clear as to the nature of the surgery, when it took place and then decide its relevance to your proposed interventions - massage & soft tissue skills?
Closed questions - The information we require is all the surgery a person has received? When it took place date?month/year? Any “ongoing” treatment as a result of the surgery? To gain this level of information we must again ask a lot of questions.
For Example Tell me all the surgery you have had? Have you had your appendix, tonsils or wisdom teeth out? Have you ever had heart or abdominal surgery?
The depth and detail of these closed questions often depends on the age, gender and “reason for visiting you?” Remember Rule 3 in asking the questions Rule 2 in order to make justifiable decisions Rule 1
Open question - Do you have any medical conditions? This again is a question that often leads to a variety of answers. Often your interpretation of what a “condition” is and the clients/patients can vary dramatically!
Why? We need to know if a condition the person presents with is likely to alter our thoughts on the intervention, massage or soft tissue therapy, that we intended to deliver.
Closed question - the information we need to know is of any diagnosed or undiagnosed conditions - For example Arthritis, Asthma, diabetes etc and if they present with any condition, when they were diagnosed? By whom? Ongoing interventions such as treatment , medication, rehabilitation? To gain an understanding of their condition requires you to have dates, diagnosis, consultant involvement, other healthcare practitioner involvement & information concerning investigations - blood tests, X-Rays, Scans etc Rule 2, Rule 3 before Rule 1 can be answered
Open question - Are you allergic to anything? Again this is often interpreted in a variety of ways.
Why? We need to know whether anything in our treatment environment could cause an allergic reaction to our client and/or whether our massage medium may pose an individual a specific problem? Also knowing if they have dietary allergies and / or intolerances may affect our choice of methods?
Closed question - Do you have a nut allergy? Are you allergic to……for example cats/dogs or any cleaning products?
Why? You can then quickly “risk assess” the situation and or your intervention mediums etc
Anything Else You Think I Should Know?
Open question - this is an “open question” which is meant to make people think about anything else that they consider relevant?
Why? People forget even when being questioned carefully something important later!
Closed question - Has anyone ever said you shouldn’t have massage? Have you ever had a massage before?
Why? It may be you are not the first practitioner this individual has approached!
Stay safe not sorry apply all the rules to the best of your ability.
If you have asked and recorded all the detail of your questions and the individuals answers then you are safe and more likely to be effective if proceeding to massage and/or deliver soft tissue skills.
NB The clients failure to disclose when asked directly closed questions cannot be the failure of the therapist to have exercised their duty of care.
Record keeping can be a skill in itself as can having an adequate form to record all the information you receive on. If you need help, tuition and or information then arrange a One To One