Professional Practice

Blog 7: Multi-disciplinary Work - Discuss the Place of Multi-disciplinary Work in Professional Practice.

What does it mean to be a massage therapist and a multi-disciplinary healthcare provider?

Multi-disciplinary practice among healthcare practitioners including massage therapists is becoming standard practice in the holistic treatment of patients/clients seeking professional help on a physical, emotional and/or spiritual level.

According to Opie (1997), multi-disciplinary teams of healthcare providers can deliver a cost-effective and resourceful service to a client whose needs may require the specializations of several practitioners with sufficiently different yet complimentary scopes of practice. The inevitable outcome of this is the overlapping of defined or implied roles, potentially causing conflict, due to the blurring of professional barriers defining respective scopes of practice (Robinson & Cottrell, 2005).

Furthermore, the healthcare hierarchy of professional dominance must involve mutual respect and understanding of others scopes of practice by massage therapists and practitioners generally, the boundaries defining these (by law or otherwise) and the respective roles that can lead to an interactive and successful multi-disciplinary team. The intention of reaching consensus in decisions and utilising other practitioners' strengths and specializations within the team results in optimum and cost-effective treatment, and can assist in the removal of barriers naturally arising between rival professions.

The incorporation of C.A.M (Complementary Alternative Medicines) into the standard medical healthcare system as recommended by W.H.O (World Health Organisation) is a step forward in the direction of holistic multi-disciplinary practice more in line with massage therapy and its expected route.
However, the biggest concern facing massage therapy as a profession in New Zealand is the current limited scope of practice that has been defined by our national representative body: Massage New Zealand. This is potentially restricting the crucial stage of growth our profession is in, where we are primarily interested in expanding rather than confining our scope of practice.

The main elements of successful multi-disciplinary practice within the field of massage therapy is the ability to refer to other practitioners with the relevant scope of practice (e.g. physio, osteopath, GP, counsellor) and to identify when it is clear that the client requires care outside of your scope of practice.
That said, this really depends on one's individual areas of professional strength as a massage therapist: a practitioner may be primarily trained in massage, but may also be a qualified and registered acupuncturist, immediately changing their position on the healthcare hierarchy and boundaries defining their scope of practice, challenging the strictly defined barriers of who can and can't refer to you/be referred to by you. The boundaries of scope of practice may also overlap, questioning the need for two practitioners with similar skills and specialisations in a multi-disciplinary team (e.g. a physiotherapist and a massage therapist, who are both trained in advanced assessment techniques and soft-tissue manipulation).

Maintaining positive multi-disciplinary relationships and mutual respect for your fellow healthcare colleagues, fosters an excellent environment for the implementation and growth of multi-disciplinary teams, when treating patients with requirements that span more than one practitioner's limited scope of practice. Both knowledge of our position in the established healthcare hierarchy and the existing boundaries of the massage therapy scope of practice are paramount to the professional image of our modality and reputation amongst other healthcare providers.

References:

Elluminate: Multi-Disciplinary Practice (28th October 2009). Otago Polytechnic Massage Therapy Diploma Course.

My own thoughts.

Opie, A. (1997) Effective Team Work in Healthcare: A Review of Issues Discussed in Recent Research Literature. Health Care Analysis, 5 (1).

Robinson, M. & Cottrell, D. (2005) Health Professionals in Multi-Disciplinary and Multi-Agency Teams: Changing Professional Practice. Journal of Interprofessional Care, 19 (6).

Professional Practice

Blog 6: Professional Development, Reflective Practice & Supervision - Discuss the Place of Supervision in Professional Practice.

How does professional development, reflective practice & supervision act to support professional practice?

Professional development, reflective practice and supervision actively undertaken by the massage practitioner can assist in the development of professional practice by adding to pre-existing knowledge and concepts, refining self-awareness and assisting the practitioner to better hone their interpersonal and situational skills in a workplace setting, within a predominantly people-oriented profession.

The massage practitioner may choose to develop their professional skills via further formal education, attending conferences, workshops or additional courses on related modalities (e.g. acupressure, Reiki, cranio-sacral therapy). Educating the wider public on aspects of massage therapy that are not common knowledge will add to the general perception of the therapeutic massage industry and career path. This can be done through the publication of journal articles relevant to the sphere of healthcare, giving talks/guest speeches on related aspects of massage therapy, printing personal opinion pieces and having a personal blog, all of which educate and improve awareness of massage therapy and what we hope to achieve as practitioners of this modality.

I personally believe that written articles on massage outlining the benefits to the individual/society as a whole may be more beneficial, due to the wider range of people likely to interact with this piece (read it/reference it) and the longevity of it (considering it is immortalised in a publication).

Reflective practice can be enhanced by allowing clients to voice their comments and observations in an anonymous way, such as via the use of anonymised feedback forms and boxes in which observations can be placed, as these will assist in refining the practitioner's processes by adding a valuable third party perspective.

Supervision is also crucial in the professional development of the massage practitioner, and can assist by following an eight step process that identify areas needing improvement, using the following stages:

Practice - The reflective practitioner needs to develop their self-awareness, reactions to their environment and look at how they personally deal with situations that arise. It is through practising that the practitioner can identify the areas that can be worked on, and be alerted to any need for reflection and/or supervision in their practices.

Select - identify a clinical situation that stands out from the rest as being particularly significant and useful to the practitioner's professional development via reflection. This situation may be emotionally charged, and appear intuitively important to the practitioner as something that must be addressed.

Describe - Remember the experience and its details, see from both the observer's point of view as well as first hand experience, fill in the knowledge gaps experienced then, and potentially, now.

Reflect - With the knowledge and clarity you now have regarding the situation, reflect on what happened, your role, the role of any other individual and how you felt about this/what you perceive they have felt, continually looking from all angles.

Research - Investigate the situation further, identify whether this is a common situation when the variables are kept constant, or an unusual situation. Were the actions of all parties involved typical/consistent with what occurred in the situation? Where can I as the practitioner improve my interactions to achieve a more favourable future result?

Plan - Identify strategies for improving the expected outcome of a potential situation, particularly ways in which altering or becoming aware of personal behavioural patterns/ways of interacting can affect this outcome.

Alter practice - The actual implementation of these strategies into the existing operational processes and personal ways of interacting in particular situations, especially ones similar to those outlined above.

Monitor - Methods of feedback and observation of the alteration and improvement of operational processes, regular supervision to give a third party perspective on the situation, and to assist with self-awareness in the outlined situations.

By actively choosing to improve on their pre-existing knowledge, skill base, interpersonal skills and self-awareness, the practitioner is in the best possible position to effectively develop their professional abilities and simultaneously support the massage industry via conscious self-improvement and public awareness of massage therapy as a viable and effective healthcare modality.

References:

Elluminate: Multi-Disciplinary Practice (21st & 22nd of October 2009). Otago Polytechnic Massage Therapy Diploma Course.

My own thoughts.

Professional Practice

Blog 5: Legalities - Consider legal requirements relevant to massage practice in New Zealand.

How the future of Massage Therapy will be determined via law, lies in the hands of current and future massage therapists, and can be strongly influenced by these individuals should they decide to lobby for or against any proposals made by parliament affecting the healthcare industry.  Massage Therapists are currently bound by several laws relating to healthcare provision, namely the Privacy Act, Health & Safety in Employment Regulations Act, Consumer Guarantees Act, Medicines Act, Health & Disability Commissioner Act, HPCAA and the Injury Prevention, Rehabilitation and Compensation Act.

The Privacy Act 1993 is relevant to Massage Therapists due to the need to keep clients details and information confidential and holding personal information securely.  Accuracy/correction of information and limited use/disclosure of information all matter greatly under the Privacy Act 1993 and must be adhered to by Massage Therapists for the simple reason that they are legally bound by the Act, as they are providing a healthcare service (massage).  

The Health & Safety in Employment Regulations Act 1995 outlines basic workplace safety, OSH principles, hazard identification and job competency, which in the context of massage therapy mainly applies to a situation in which more than one therapist works and outlines the duties of employees and employers.

Of course, this legislation would additionally apply to sole traders due to the need for safe workplace practices in all business forms.

Under the Consumer Guarantees Act 1993, the section most relevant to MTs would be Part 4: Supply of Services.  This again states the requirement that the service provided is of acceptable quality and performed with at least an average level of competency on the part of the therapist.  It also outlines the rights of the consumer in relation to the service they are under the impression they will receive according to advertising and other promotional material.

The Medicines Act 1981 restricts the prescription of medications by MTs (as we are not authorized prescribers) but outlines the rights of massage therapists in advising clients of alternative natural health products or herbal remedies under the exemptions clause in Part 2 of the Act: Dealing with Medicines and Medical Devices.

Another Act of note is the Health and Disability Commissioner Act 1994 which is in place to "promote and protect the rights of health consumers and disability services consumers", and covers relevant sections such as the rights of the massage client when receiving a health/disability service, advocacy, complaints and investigation procedures related to said service.  Therefore, adhering to this particular act is paramount to the integrity and legitimization of Massage Therapy as a healthcare profession.

Lastly, the Injury Prevention, Rehabilitation and Compensation Act 2001 covers the claims and entitlements process in the case of workplace accident or injury in New Zealand (ACC).  This debars lawsuits related to the above situation, and provides cover for those who suffer a workplace-related injury and subsequently require individual, social and vocational rehabilitation.  In the therapeutic massage industry this is more relevant to employees and clients.

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

The Health Practitioners Competence Assurance Act 2003 remains a recent topic of some debate, around which massage therapists are often divided, as they are with the Therapeutic Products and Medicines Bill.  These examples address issues we may face in the future relating to the standardization of an industry currently in its infancy, of which the main appeal is the often intuitively guided processes and relaxed approach to holistic health.

There are however, massage practitioners serious for recognition as registered healthcare providers with an equal level of professional clout as physiotherapists, chiropractors and other medical professionals.  Recognition under the HPCAA would allow this, but in doing so would standardize many of the processes currently non-standardized (e.g. pay rate) which could jilt massage from its position in the alternative healthcare field into a more mainstream medical position.

The Therapeutic Products and Medicines Bill 2006 (Trans-Tasman regulation of therapeutic products bill) main listed aims are to regulate complementary medicines and medical devices.  This is intended to meet international best practice standards, and to improve international reputation by "enhancing closer economic relations and facilitating trade".  However, the drawbacks of this bill are the augmented compliance costs which may result in the removal of many smaller businesses trading in alternative health products, and thus favouring corporate providers and pharmaceutical companies.

The main argument of the New Zealand Health Trust (2009) is that natural health products are different in chemical composition (Gagnier et al, 2006) to pharmaceutical medications, and are relatively low risk, so therefore do not require regulation.  

Knowledge of the current laws binding massage therapists are crucial to professional conduct as healthcare practitioners, and it is only through active participation and solidarity on the part of all Massage Practitioners in an association (MNZ) that any real change can be effected in the future, that will subsequently shape and alter our profession.  

References

Elluminate: Understanding Legal Process (24th September, 2009) Otago Polytechnic Massage Therapy Diploma Course.

Gagnier, J., Boon, H., Rochon, P. & Moher, D.  (2006) Reporting Randomized, Controlled Trials of Herbal Interventions: An Elaborated CONSORT Statement.  Annals of Internal Medicine, 144 (5).

My own thoughts.

NZ Health Trust.  (2009) NZ Health Trust Proposed Bill.  Retrieved on the 7th October, 2009 from: http://www.nzhealthtrust.co.nz/proposed_bill.html

Parliamentary Counsel Office (2009) Consumer Guarantees Act 1993.  Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/1993/0091/latest/viewpdf.aspx

Parliamentary Counsel Office (2009) Health and Disability Commissioner Act 1994.  Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/1994/0088/latest/DLM333584.html

Parliamentary Counsel Office (2009) Health and Safety in Employment Regulations 1995.  Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/regulation/public/1995/0167/latest/viewpdf.aspx

Parliamentary Counsel Office (2009) Health Practitioners Competency Assurance Act 2003.  Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/2003/0048/latest/DLM203312.html

Parliamentary Counsel Office (2009) Injury Prevention, Rehabilitation and Compensation Act 2001.  Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/2001/0049/latest/DLM99494.html

Parliamentary Counsel Office (2009) Medicines Act 1981.  Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/1981/0118/latest/DLM53790.html

Parliamentary Counsel Office (2009) Privacy Act 1993.  Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/1993/0028/latest/DLM296639.html

Parliamentary Counsel Office (2009) Therapeutic Products and Medicines Bill 2006.  Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/bill/government/2006/0103/latest/versions.aspx