How does reflective practice, supervision and the professional development policy, support professional practice?

The link between vital components such as reflective practice, supervision and ongoing professional development are important to ensure your business will continue to grow into a successfully well rounded professional practice.

Reflective Practice

Reflective practice is about looking at the way you currently do things and scrutinising every detail to identify your strengths and weaknesses within the entire process of running your business. By recognizing your flaws or strengths you can then make a conscious effort to improve or try a different approach to the way something is presently working for you. I consider this a hugely beneficial process especially when first starting out in the Massage industry. When first starting there are so many things you are trying to get right treatment wise that details start to slip, and by carrying out reflective practice by creating a feedback form to give to clients you can find out how others see your business. This could include questions about environment, behaviour, treatment and other aspects of their experience as a client; this will give you an idea of any weaknesses you have missed yourself to work on.

Supervision

As a massage therapist I personally see supervision as a crucial element within the health industry because we deal with others emotions, energy and well being from people everyday. Supervision allows us time to discuss issues or any concerns we ourselves experience with a qualified trustworthy outsider and gain a different perspective we may have never thought of. Supervision can be in the form of just opening up to issues that have affected you and having someone listen, making frequent supervision beneficial to keeping an open and clear thought process needed to tackle day to day running of a professional well run practice.

Professional Development

Massage New Zealand (MNZ) recognises the need to keep MNZ therapists striving and enthusiastic towards Massage, they have set up a policy that is recognised by a points system, this is to ensure therapists continue to develop their skills and contribute to the professional future of Massage Industry in New Zealand.

I find this is an encouraging way to continually up-skill therapists once they are out practicing within the community and by boosting the public profile of Massage therapy within New Zealand by establishing a level of high standards that should be sought when choosing a therapist for treatment.

Reflective practice, Supervision and Professional practice are positive steps to be taken to ensure yourself, and your practice are maintained to a high quality, combined they all work to encourage a healthy sustainable positive environment within your business.

How can I as an individual massage therapist influence the development of government policy & laws that are supportive of the profession?

There are currently nine Laws and Policies in place to protect the New Zealand Health industry that our Government has developed for the public and practitioners to create a safe environment; however there is no set law or policy specific to Therapeutic Massage.

· Health and Safety in Employment Regulations 1995

· Consumer Guarantees Act 1993

· Medicines Act 1981

· Privacy Act 1993

· Health and Disability Commissioner Act 1994

· Health Practitioners Competency Assurance Act 2003

· Injury Prevention, Rehabilitation and Compensation Act 2001

· Local Body Requirements

· Occupational Health and Safety requirements

These nine policies and laws are only a guide for Massage Therapy and I feel are too broad, allowing anyone no matter their experience or training level to start up a business thus putting all Therapists in a collective box. This could negatively influence our industry and have a long lasting effect on our profession, with any future progress from professionally trained Therapists harshly criticised and not taken seriously.

As an individual I would be interested in actively supporting the development of any government law or policy that would protect the reputation of Massage Therapy.

I feel I can do this by:

• · Displaying Certification of my relevant training so the public can read my credentials.
• · Referring to others who are both educated and professional within their chosen fields of expertise, and informing our clients why we have chosen that particular healthcare provider to ensure they too see the importance of checking credentials before committing to treatment.
• · Educate clients of the different types of massage therapies out there and how they differentiate from each other, (e.g. Thermal Stone therapy does not only involve sitting hot stones on the body and leaving the client for an hour) and the levels of skill needed to carry out the session, for example beauty trained therapist should not administer rehabilitation therapy without relevant training.
• · By joining Massage New Zealand and encouraging other therapists too as well so we can improve numbers to have a stronger voice in society.
• · Become involved and encourage others to join local practitioners who feel the same to gain support from local counsels.
• · Enhance my own understanding of law/policy change by educating myself so I have a better perception.

I conclude that there justified concern for the need to have a system in place to regulate or rate therapists to assist the public when choosing a therapist of the quality they should expect to receive. Massage Therapists in modern society can influence the progression of obtaining Laws and Policies if they work as a unit to improve the safety of the public and provide protection to ourselves and the “Massage Therapy” name within our industry.

Acquired Immune Deficiency Syndrome (AIDS)

“AIDS is an epidemic disease, a potentially preventable, deadly infection for which there is no cure, no vaccine, and it is not under control.” (National Commission on AIDS, 1993).


Etiology

AIDS is the name given to the later stage of Human immunodeficiency virus (HIV) infection in which causes significant damage to the immune system. The course of AIDS is often grim and generally ends in total depletion of your immune system causing death from cancer or other over whelming infections.
HIV is transmitted through direct contact of body secretions, especially blood, semen, and vaginal secretions but also commonly enters the body via blood transfusions, blood-contaminated needles. AIDS can also be exchanged between Mother and Baby during pregnancy, childbirth or while breastfeeding. There are two versions of HIV, both of which can cause AIDS: HIV-1, which has spread throughout the world, and HIV-2, a far less common and not as harmful version that is largely restricted to West Africa.

Sandy Fritz describes AIDS as a group of symptoms caused by the transmission of a virus that causes a breakdown of the immune system. The AIDS syndrome causes a dysfunction in the bodies’ immune system, one of the body’s primary defenses against disease. (Fritz, 2000)



Pathogenesis

HIV affects nearly every organ system so opportunistic infections are common in people with AIDS.
Being HIV does not necessarily mean having full blown AIDS which only occurs after certain immune functions are completely destroyed after the HIV virus renders the immune system incompetent, thereby affecting the individuals capacity to ward off common infections. The time interval between exposure to the virus ranges from a few months to ten years, with appearance of symptoms depending on various factors like, treatment, immunity of the exposed person and Cell mediated Immunity.
The HIV virus infects the T-cells of the white blood cells of the immune system, these T-cells help clear disease causing substances from the body, as the HIV virus destroys more and more helper T-cells the immune system begins to break down and finally can no longer kill the HIV or any other invading germs therefore the diagnosis of AIDS is given.



Symptoms and Signs of HIV/AIDS

The symptoms of AIDS are usually due to the result of conditions that do not normally develop in healthy immune systems. Most of these are infections caused by everyday viruses and bacteria that are normally controlled by the immune system that HIV damages.

Signs and Symptoms of AIDS:

• Flu-like symptoms 2-4 weeks after exposure.
• Fevers.
• Sweats, particularly at night.
• Rash and swelling of lymph nodes in the groin, armpits and neck.
• Chills.
• Weakness.
• Loss of appetite.
• Fatigue.
• Diarrhea- unexplained chronic diarrhea in infection has many possible causes including common bacterial and parasite infections, but can also be a side effect of several drugs used to prolong the HIV status.
• Cancers- HIV patients have an increased chance of getting several cancers.
• Kaposi’s sarcoma- cancer like condition of the blood vessels that leave purple lesions on the skin.
• Pneumocystis Pneumonia- rare in healthy immune systems and is the first indication of AIDS in developing countries.

Prevention of AIDS

The spread of AIDS can be prevented by:

• Avoiding unprotected sex by use of condoms.
• Disposable Syringes.
• HIV testing for blood transfusions.
  
  

Epidemiology

Prevalence: In 2007 it was estimated that 33.2 million people lived with the disease worldwide and killed approximately 2.1 million people.
Incidence: One in four new infections occurs in Asia every day.
1,500 people effected with AIDS die in Asia every day.




Treatment of HIV/AIDS

Currently there is no cure or vaccine for AIDS or HIV, although expensive antiretroviral treatments slow the progression of HIV infection reducing the mortality and morbidity.
Commonly used Medications for treating HIV/AIDS:

• Abacavir,
• Amantadine,
• Indinavir,
• Lamivudine,
• Stavudine,
• Zidovudine.

Massage Indications:

Massage therapy boosts immune system by:

• Reducing stress and anxiety.
• Increasing white blood cell counts.
• Activating natural killer cells.

Massage can also help HIV/AIDS symptoms by decreasing pain by:

• Relieve muscle spasms and cramps.
• Reduce general body tension.
• Improve Edema
• Reduce inflammation.
• Increases blood flow to aid removal of toxins and increase oxygen and nutrients to areas with symptoms.
  

Massage Contraindications:

If there is no exchange of bodily fluids, HIV/AIDS cannot be transmitted.

• Infections that AIDS patients get in the later stage are contraindicated so get a thorough health status and check with physician.
• Avoid massaging rashes, sores, lesions or swelling.
• Use precautions. (Protective barriers disinfect linen with thorough washing; avoid contact if you have openings in the skin).
• If your linen does come into contact with bodily fluids, use 10% bleach solution; wash immediately with antiviral agent.

Working with HIV/AIDS Clients:

• Educate yourself about the etiology and pathology of AIDS.
• Collect a thorough client history.
• Survey the client and yourself for cuts, open wounds or bleeding.
• Keep your fingernails short so you don’t accidentally scratch the client.
• Wash your hands thoroughly with warm/hot water and soap.
• Reschedule if you are sick, since their immune systems are vulnerable.
  
  
  
  

References

Cutler, N. (2006). Massage Therapy for HIV/AIDS. Retrieved on September 26th 2009 from www.integrative-healthcare.org/mt/archives/2006/.html

Gnanakkan, J. (2005). The Effects of Therapeutic Massage on HIV and AIDS Patients. Canada. Massage Today Magazine.

Goldman, B. (1999). A Healing Touch: Massage Therapy and HIV/ AIDS. Retrieved on September 26th 2009 from www.thebody.com.

Frtiz, S. (2004). Mosby’s Fundamentals of Therapeutic massage (3rd Ed.). Missouri: Mosby

Medindia Health Network. (1997-2009). Retrieved on September 29th 2009 from www.medindia.net/patients/aids.htm.

Pathology for Massage Therapists.(1999-2009). Retrieved on July 19th 2009 from http://www.thebodyworker.com/pathology-

Premkumar, K. (2000). Pathology A to Z- a Handbook for Massage Therapists. (2nd Edition). Canada; VanPub Books.

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists (2nd Ed.). Elsevier Health Science.

Werner, R. (2005). A Massage Therapists Guide to Pathology (3rd Ed.). Philadelphia: Lippincott Williams & Wilkins.

Sustainability within a Massage Practice.
What does being a sustainable Massage Practice mean to me?

A sustainable massage practice to me means to build a successful business without causing a negative effect on the planet and creating a positive image for massage therapy. Sustainability includes environmental, social and economic aspects and as a therapist I believe you have to incorporate these three principles of sustainability into a modern business to eliminate wastage and improve on the state the environment is currently in.

What would you do to achieve this?

Environmentally: Achieving sustainability within my own practice I would address environmental issues initially by researching the power company I use and choosing a company that makes a point of running their power stations environmentally greener and more efficiently. This will cover my daily use of lighting/heating needed to operate a practice. I have found a more resourceful approach to drying sheets/towels and other materials needed daily in a practice by hanging it on a washing line or rack overnight also made faster by using sheets and polar fleece blankets instead of towels to minimise drying time. Energy efficient light bulbs are a worth while option for a practice, some of which can save up to 75% of energy then regular bulbs, however trying to make the most of natural light during day time hours is even better. Timers and thermostats on heating devices will stop overheating a room and save you in the long run on power.

Socially: To attain social sustainability I would be interested in developing networks with other like minded individuals to discuss and act on changing current habits and attitudes of larger companies on relevant aspects of their business, for example over packaging products they send out, or the materials they use to package their products. Forming these bonds with other healthcare professionals in the community opens up additional opportunities to obtain advice and refer clients to, effectively broadening your service and their overall care. Also by looking after myself and employees health and well being I will create a healthier and happier atmosphere where clients will feel calmer and relaxed on entering, passing this along to people they meet or come into contact with when they leave the premises.

Economically: To ensure my business builds economic growth I will have an effective business plan in place. A business plan that combines environmental and social aspects that looks after my client and employee’s health and comfort, but also my own. I will continue to look carefully at choosing longer lasting products, and make certain I provide a genuine caring service at all times, so I can form a lasting and profitable business within my community.

McQuillan, D. Elluminate. Sustainable Practice. September the 23rd 2009. Professional Practice.
My Own Thoughts.

Stoke

Stroke is the second single largest killer in New Zealand with more than 2000 people every year, (NZ Heart and Stroke Foundation, 2007).

Etiology:

According to the Heart and Stroke Foundation a stroke is defined as a sudden loss of brain function; a stroke occurs when brain cells die from oxygen deprivation, oxygen deprivation occurs if blood flow to the brain is blocked by a clot or vessels are damaged, without oxygen brain cells cannot function.

There are two types of Stroke:

Hemorrhagic: A Hemorrhagic stroke occurs when the blood vessels in the brain burst due to high blood pressure, artherosclerosis and congenital malformation. A burst vessel causes bleeding into the brain and increased blood flow into the damaged vessel, blood build up increases pressure in the brain damaging nerve cells and collapsing smaller blood cells.
Ischemic: Occurs when blood flow through the crucial blood vessels is blocked by a blood clot or plaque.


Pathogenesis (Signs and Symptoms):
The human brain is divided into regions. Each region controls different movements, senses, or intellectual functions (Fritz, 2004). Therefore, the effects of a stroke depend on which region of the brain is damaged. Fatigue will be an effect of any stroke, and different types of stroke can also cause similar damage.

The effects of a stroke depending on where the damage has occurred to the brain can vary for each patient.

Physical effects include: Weakness, paralysis, movement limitations, pain, fatigue and interruptions to sleeping patterns.
Strokes can also severely effect patients emotionally: Anxiety and depression are a common repercussion of a stroke.
Thinking, speech and memory difficulties can effect the patient mentally.

The American Stroke Association has identified several stroke warning signs. Someone having a stroke may not experience all of the warning signs and warning signs can come and go. Symptoms of stroke depend on the type and which area of the brain is effected. Signs of ischemic stroke usually occur suddenly, and signs of hemorrhagic stroke usually develop gradually (Chandrasoma & Taylor, 1997, p.929).

Symptoms of a stroke include:

• Immediate numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Immediate confusion, difficulty speaking or understanding.
• Difficulty seeing in one or both eyes suddenly.
• Sudden difficulty walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause.
• Paralysis on one side of the body.
• Speech problems may occur as a result of ischemic stroke.
  

Complications that may develop gradually as a result of immobility caused by stroke include the following:

• Blood clots.
• Bedsores.
• Fibrosis of connective tissue resulting in decreased mobility.
• Malnutrition.
• Pneumonia.
• Urinary tract infections.

Treatment :

Treatment for strokes usually involves Rehabilitation which includes physical therapy, speech therapy, and occupational therapy. Physical therapy involves using exercise and other physical means (e.g., massage, heat) to help patients regain the use of their arms and legs and prevent muscle stiffness in patients with permanent paralysis.
Your aim as a massage therapist should be to: help relax, ease pain, and comfort the person who has had a stroke with Massage. Massage therapy can also help to increase circulation to areas that are in need of more nutrients and blood flow and massage can also promote the release of endorphins that can help in pain control.

Treatment indications and contradictions for massage.

Aim:

• Prevent joint stiffness.
• Promote relaxation.
• Reduce pain.
• Decrease muscle spasticity.
  

Massage Guidelines:

• Massage strokes should be slow, soothing, and superficial.
• Joint mobilisations and passive stretching should be done within clients’ tolerance and not forced.
• The first few treatments should be brief (30mins max), a couple of times a week so you don’t tire the patient.
• Make sure the client is well supported and comfortable through out the session.
• Deep pressure massage is not recommended, due to pain relief they may not have an adequate pain tolerance.
• Check-in with their physician about their treatment.
• Refer to appropriate health care practitioners for diet and lifestyle modifications and treatment of underlying conditions .i.e. blood pressure, quit smoking, nutrition.
• May be on blood thinner medications.

Cause and prevention are often closely linked. A combination of factors that have been present or developing for a long period of time can contribute to a stroke. If someone has two or more of the risk factors below, stroke risk can be dramatically increased.

Controllable stroke risk factors:

• Check blood pressure
• Stop smoking
• Exercise regularly
• Limit alcohol intake
• Eat a healthy diet and reduce salt intake
• Lower cholesterol
• Control weight

Anyone who is high risk you should encourage to see their doctor, who will usually assess each risk factor for stroke (and heart disease) before deciding on necessary treatments.

Prevalence: Approximately 70% of ischemic stroke patients are able to regain their independence and 10% recover almost completely. Approximately 25% of patients die as a result of the stroke. The location of a hemorrhagic stroke is an important factor in the outcome, and this type generally has a worse prognosis than ischemic stroke.
More than 30% of stroke patients require assistance with daily living and approximately 15% require care in an assisted-living facility (e.g. nursing home, rehabilitation centre). Approximately 20% of stroke patients require help walking (e.g., cane, walker) and as many as 33% suffer from depression.

Incidence: Stroke affects all ages. In New Zealand each year, 40 stroke victims will be children and nearly 2,000 (a quarter of all strokes) will be under retirement age.

References:

Carlson, S. (2006). Massage for Stroke Patients. Retrieved August, 2nd 2009, from http://massagetherapy.suite101.com/article.cfm/massage_for_stroke_patients

Dr. Premkumar, K. (1959). Pathology A to Z: A handbook for massage therapists (2nd Ed.). Canada: VanPub Books.

Frtiz, S. (2004). Mosby’s Fundamentals of Therapeutic massage (3rd Ed.). Missouri: Mosby.

New Zealand Stroke Foundation Inc, (2007). Retrieved August, 7th 2009, from www.stroke.org.nz

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists (2nd Ed.). Elsevier Health Science.

Chandrasome, P, Taylor, C R (1997). Concise Pathology. Michigan: Appleton & Lange.

Treaty of Waitangi.

Explain the meaning of title articles of the treaty of Waitangi, their historical context and their significance to health practice in New Zealand.

The Treaty of Waitangi 1840The English version of the treaty was broken up into three articles in relation to who had sovereignty, property rights and protection from the queen, signing this version authorized English to take away all rights from Maori because their version was translated to give Maori the impression that the queen would become second to the chiefs power (rangitiratanga) granting Maori the same rights as British citizens, giving them protection from the arriving farmers/sealers and settlers.

Principles of the Treaty.
Protection/Partnership and Participation, Governance, Authority, Equity and Respect incorporated into a Massage practice.

As a therapist I have to ensure my key responsibility is to the client and understanding my role as a massage therapist to treat with respect and privacy while dealing with their health and well-being. Although this I feel is common sense and persistent with all clients. Authority is specified in equal measures to both client and therapist, written consent does not take away the right for unequal partnership and by creating a treatment programme with the clients input it will certify meeting their individual needs and the programmes effectiveness with overall greater results long term. To obtain equity within your practise each clientele should be treated as an individual and their healthcare programme should be tailored to their pain / expectations or injuries. Being respectful of client needs and beliefs including respecting their privacy and previous treatment from other professionals they have sought before you. Information can be sought by opening pathways of communication to allow your client to relax in your work environment, therefore if you do not understand certain elements to ones religion/ culture or beliefs, ask respectively.


Hauora = Health “your breath that’s the source of your life”.

Mason Durie’s replica of health promotion is founded on the Southern Cross constellation. The six stars represent key values of total health.

Healthy lifestyles- Improve the well-being and health of the client.

Cultural identity - Client is able to freely express their concerns and beliefs without judgement, and support of a family member is welcome.

Environment- Providing a space that is culturally sensitive and supports different cultures and has the total health of the client within focus.

Society- Participation with their treatment is encouraged and sought after.

Leadership- Management of oneself to maintain a healthy lifestyle.

Autonomy- Control and self governance of their jointly created care plan.




References:

Bachelor of Midwifery/Diploma in Massage Therapy; Treaty Workshop. May 18th 2009.

Durie,M.(1998). Whaiora: Maori health development(pp.69-74). Auckland, New Zealand: Oxford University Press.

My Own Thoughts.

Pathology Report on Rheumatoid Arthritis.



Rheumatoid Arthritis (RA) is a chronic systematic disease believed to be related to an antigen-antibody reaction that effects the joints of the body leaving them crippled and disfigured. The use of massage can be an important part of the prevention strategy of dealing with RA, which is considered the most severe type of joint inflammatory disease. (Donald W. Scheumann).


Etiology:
The Etiology of rheumatoid Arthritis is not fully understood, evidence however points towards a complex interaction between environmental (e.g. viral infections) and genetic factors. Risk factors believed to increase your chance of RA are:
- Female have a 2-3 times greater chance of developing RA than men.
- Positive family history of RA.
- Older age.
- Smoking.


Pathogenesis (Signs and Symptoms):
Early stage Rheumatoid Arthritis patients initially experience symptoms at just one location or a few widely spread sites, surfacing over weeks to months with signs of weakness or fatigue in the joint common. Joints more commonly effected by Rheumatoid Arthritis are those with a high ratio of synovium: articular cartilage. RA usually effects joints both sides equally and common joints are the wrists, metacarpals, interphalangeals, knees, ankles and toes, (Harris ED) but RA can also effect the hips, shoulders, cervical spine, TMJ, and sometimes small bones of the larynx causing hoarseness or narrowing of the airways. Rheumatoid joints are typically tingly, tender to the touch, and warm. Some patients complain of "puffy" hands resulting from increased blood flow to inflamed areas.


Treatment:
Once existence of RA has been confirmed your goals of treatment should be to:
- Reduce pain
- Limit inflammation
- Halt joint damage
- Improve function


RA is characterised by periods of painful, inflammatory flare-ups (acute phase) and remission (sub-acute phase).

ACUTE PHASE

Massage Caution:
- Massage is best avoided in its acute (flare) phase. RA is an inflammatory condition caused by agents in the circulatory system, anything that increases circulation also increases the risk that the disease may spread to other joints in the body. Massage is therefore contradicted during these flare-ups.

SUB-ACUTE PHASE
Massage is significant in the sub-acute remission stages of RA to encourage local circulation to improve mobility and aid the relaxation of muscle tissue to reduce stress that soft tissue surrounding the joints can trigger (Fritz, S.). During remission chronic pain presents both from physiological and psychological causes, the physiological from weight bearing on the effected joints and the psychological due to stress, anxiety and depression experienced after loss of normal function therefore massage is useful to clients for reduction of pain and stress management. (Charles C. Tuchtan…etc).

Massage Caution:
- Clients may be taking analgesic or anti-inflammatory medication that reduces sensitivity and masks pain. (Premkumar, K.).
- Surrounding muscles and tendons become stressed and tight from chronic pain making joints become stiff rather than inflamed.


Prevalence:
World wide Rheumatoid effects about 1% of the world’s population.

Incidence:
- Worldwide the annual incidence of RA is approximately 3 cases per 10,000
- 2-3 times greater chance of having rheumatoid arthritis if you are female with its most pronounced in patients under the age of 50 years old.
- About 1 in 10 RA patients will experience severe joint damage due to cartilage and bone decay, if left untreated permanent disfigurement can result.
- 10-20% of RA patients the disease goes into remission in the early stages or never develops beyond a mild case.
- Onset may be at any age, most often between 35 yr and 50 yrs of age.



References:

1) Charles C. Tuchtan, Vicki M. Tuchtan, David Stelfox. (2003). Foundations of Massage. (2nd Edition). (Pg 153). Australia: Elsevier Australia. 2)Donald W. Scheumann. (2006). The Balanced Body. (3rd Edition). (Pg 105). Philadelphia: Lippincott Williams & Wilkins.
3)Fritz, S. (2005). Sports & exercise massage. Missouri: Mosby.
4)Harris ED (2005). Clinical features of rheumatoid arthritis. Harris ED, Kelley WN. Kelley's Textbook of rheumatology. (7th Edition). Philadelphia: WB Saunders.
5)Premkumar, K. (2000). Pathology A to Z – A handbook for massage therapists (2nd Edition). Philadelphia: Lippincott Williams & Wilkins.
6)Saag KG, Cerhan JR, Kolluri S. (1997) Cigarette smoking and rheumatoid arthritis severity.