Saturday, May 30, 2009

Professional Practice

Blog 1: Scope of Practice as Defined by Massage New Zealand

'Does the Scope of Practice as defined by Massage New Zealand fit with the legal requirements under the Healthcare Practitioners Competence Assurance Act and does it accurately reflect our scope of practice as Massage Therapists?'

I strongly believe that to have a defined industry standard regarding the level of competency and professionalism required to call oneself a massage therapist is critical to the recognition of massage therapy as a viable healthcare profession. However this portends some positive and negative aspects.

In favour of defining a scope of practice within Massage Therapy, is the corresponding faith in the massage industry by the public, recognition by the government and therefore eligibility for ACC funding and access to MT by low income families via the public healthcare system (McQueen, personal communication, 21st May 2009) and academic recognition in the realm of research.
The drawbacks of defining an enforceable Scope of Practice are the resultant limitations placed on the massage therapist with regards to techniques used, staying within their personal scope of practice and qualifications required to practice as a healthcare professional (it may be that a qualification at diploma level is required in order to be recognised as such). 

Standardization of qualifications and the course framework will therefore become routine, and the expansion of massage therapy as a developing profession may be limited.  There are concerns over placing such definite boundaries around healthcare professions due to the HPCAA and the consequences of this: "The resulting legislation is complicated and undermines professional functioning. Its effect may be exactly the opposite of its intention.." (Briscoe, 2004).

There is currently no portion under either scope of practice defined by Massage New Zealand which specifically addresses the use of the title 'massage therapist' by practitioners who do not hold the relevant qualifications.  This would be legally enforceable under the HPCAA, but may not discount other related words such as 'bodyworker' being used by an unregistered massage practitioner.
Confusion may ensue if say, some practitioners have only completed some weekend courses in relaxation massage and proceed to advertise themselves as masseuses/masseurs, whereas other registered practitioners holding the requisite qualifications defined within the HPCAA are advertising themselves as massage therapists. 

The problem here lies with the terminology used: the general public particularly the older demographic, may need to be re-educated about the difference between these terms as some may not know a difference exists. For example, it is not likely, common or even legal in current society for an individual to advertise themselves as a doctor without the requisite medical qualifications and rigorous training. According to Gilbey (2008) if an individual attempts to portray themself as a doctor to the wider public but are not a registered healthcare professional, they are liable to be fined up to $10,000 under the HPCAA. 
For these reasons, a practitioner of massage would need to ensure that they were not breaching the terms of the HPCAA by incorrect use of title (e.g. massage therapist) according to what is outlined within the HPCAA, providing massage therapy is included the next time the Act is amended.

The Scope of Practice for both a Certified Massage Therapist and Remedial Massage Therapist is detailed thoroughly by Massage New Zealand, and fits with the current legislation defined under the Preliminary and Key Provisions 8: 'Health practitioners must not practice outside scope of practice.' (HPCAA, 2003) Essentially, the scope of practice outlined by MNZ applies mostly to the "delivery of soft tissue therapy" and basic client assessment. This places us securely within the defined scope of practice for massage therapy and hardly encroaches onto the turf of other healthcare disciplines.

I feel it is beneficial to have these boundaries in place as this will ensure that the research within the defined scope of practice is more thorough and that we may delve deeper into the profession of soft tissue manipulation and therapy, rather than spreading our focus over many other healthcare disciplines. We are massage therapists, therefore our main focus should realistically be on soft tissue manipulation.
Since the area of myofascial release has not been claimed as a main method of therapy by any other healthcare discipline (with the possible exception of osteopathic medicine (Ward, Hruby & Jerome, 2002)), it is most likely that massage therapy can claim this as a developing area of expertise directly relevant to the scope of practice within this field of study and research, as it is a manipulation of the fascia (soft tissue).
As a result of this proposed academic exploration into the sphere of massage therapy, we would be in a better position to achieve our desired goal as defined under the MNZ Code of Ethics: professional image.

Within the MNZ scope of practice, there also appears to be a glaring absence regarding practitioner competence, fitness to practice and quality assurance of the goods and services provided (in this case massage), which may also bring up legal issues concerning the Consumer Guarantees Act (1993). The intention of Section 3 in the HPCAA was to ensure the safety of the public, exclusion of practitioner liability and confidentiality of client and practitioner records except in special circumstances. This is important in terms of setting an industry standard that is reliable, professional, legally watertight, and protective for massage therapists as practitioners. As a result, the inclusion of this clause is crucial to the perception and reputation of massage therapy as a professional practice among clients, other healthcare practitioners and the general public.

Cultural competence also appears absent from the scope of practice defined by MNZ, however there is some vague mention of refraining from prejudicial behaviour and discrimination.  This is particularly unprofessional in New Zealand as all other spheres of healthcare (eg. midwifery, medicine, physiotherapy, etc) currently include a section on this and the relevance of the Treaty of Waitangi. 

Finally, there is a large amount of energy concentrated on ensuring that untoward sexual advances are not made by the massage therapist, and client relationships stay strictly professional.  This is over emphasized under the Code of Ethics reminding others of the earlier association between massage therapy and the sex industry, and while this is definately part of the history of massage, it is not wise to give it so much emphasis if our goal is to appear professional.

Overall, I feel that the Scope of Practice defined by MNZ is incomplete in places and too superficial in others and so does not fit with the legal requirements of the HPCAA.  In order for Massage Therapy to be included in the next amendment of the Act, a greater emphasis on legal, cultural and educational competence is vital and there must be clarity on why these are necessary.  
However, with recognition as a healthcare profession under the HPCAA, we must realise that our Scope of Practice will be limited as a result.

References:

Briscoe, T. (2004). New Zealand's Health Practitioner's Competence Assurance Act: A missed opportunity for improvements to medical practice, The Medical Journal of Australia, 180 (1), p. 4-5.

Gilbey, A. (2008). Use of Inappropriate Titles by New Zealand practitioners of acupuncture, chiropractic and osteopathy, The New Zealand Medical Journal, 121 (1278), p. 1.

Massage New Zealand. (2009) Certified Massage Therapist: Scope of Practice. Retrieved on the 20th May, 2009 from: http://massagenewzealand.org.nz/about-us/scope-of-practice-cmt/

Massage New Zealand.  (2009) Code of Ethics.  Retrieved on the 20th May, 2009 from: http://massagenewzealand.org.nz/about-us/code-of-ethics/ 

Massage New Zealand. (2009) Remedial Massage Therapist: Scope of Practice. Retrieved on the 20th May, 2009 from: http://massagenewzealand.org.nz/about-us/scope-of-practice-rmt/

Ministry of Health. (2008) Health Practitioners Competence Assurance Act 2003. Retrieved on the 21st May, 2009 from: http://legislation.knowledge-basket.co.nz/gpacts/public/text/2003/an/048.html

Parliamentary Counsel Office of NZ. (2008) Consumer Guarantees Act 1993. Retrieved on the 21st May, 2009 from: http://www.legislation.govt.nz/act/public/1993/0091/latest/DLM311053.html

Ward, R., Hruby, R. & Jerome, J. (2002) Foundations for Osteopathic Medicine. USA: Lippincott Williams & Wilkins, p. 1034.

No comments:

Post a Comment