tag:blogger.com,1999:blog-15391444097373513372024-02-18T23:42:26.232-08:00TesstessTessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-1539144409737351337.post-71918535408819752592009-10-28T18:26:00.000-07:002009-10-30T03:59:33.098-07:00Professional Practice<span style="font-family:verdana;">Blog 7: Multi-disciplinary Work - Discuss the Place of Multi-disciplinary Work in Professional Practice.<br /><br /><em>What does it mean to be a massage therapist and a multi-disciplinary healthcare provider?</em><br /><br />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.<br /><br />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).<br /><br />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.<br /><br />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.<br />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.<br /><br />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.<br />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).<br /></span><p><span style="font-family:verdana;">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.</span></p><p><strong><span style="font-family:verdana;">References:</span></strong></p><p><span style="font-family:verdana;">Elluminate: Multi-Disciplinary Practice (28th October 2009). Otago Polytechnic Massage Therapy Diploma Course.<br /></span></p><p><span style="font-family:verdana;">My own thoughts.<br /></span></p><p><span style="font-family:verdana;">Opie, A. (1997) Effective Team Work in Healthcare: A Review of Issues Discussed in Recent Research Literature. <em>Health Care Analysis</em>, 5 (1). </span></p><p><span style="font-family:verdana;">Robinson, M. & Cottrell, D. (2005) Health Professionals in Multi-Disciplinary and Multi-Agency Teams: Changing Professional Practice. <em>Journal of Interprofessional Care</em>, 19 (6).</span></p>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-74332746446383832282009-10-28T18:20:00.000-07:002009-11-12T21:25:39.570-08:00Professional Practice<span style="font-family:verdana;">Blog 6: Professional Development, Reflective Practice & Supervision - Discuss the Place of Supervision in Professional Practice.<br /><br /><em>How does professional development, reflective practice & supervision act to support professional practice? </em><br /><br /></span><p><span style="font-family:verdana;">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.</span></p><p><span style="font-family:verdana;">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.</span></p><p><span style="font-family:verdana;">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).</span></p><p><span style="font-family:verdana;">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.</span></p><p><span style="font-family:verdana;">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:</span></p><p><span style="font-family:verdana;"><em>Practice</em> - 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. </span></p><span style="font-family:verdana;"><em>Select</em> - 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.<br /><br /><em>Describe</em> - 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.<br /><br /><em>Reflect</em> - 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.<br /><br /><em>Research</em> - 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?<br /><br /><em>Plan</em> - 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.<br /><br /><em>Alter practice</em> - 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.<br /><br /><em>Monitor</em> - 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.<br /><br />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.<br /><br /><strong>References:</strong><br /><strong></strong><br />Elluminate: Multi-Disciplinary Practice (21st & 22nd of October 2009). Otago Polytechnic Massage Therapy Diploma Course.<br /><br />My own thoughts.</span>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-22673490742565488622009-10-03T22:21:00.000-07:002009-10-15T20:56:07.517-07:00Professional Practice<span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Blog 5: Legalities - </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Consider legal requirements relevant to massage practice in New Zealand.</span></span></span><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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). </span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Of course, this legislation would additionally apply to sole traders due to the need for safe workplace practices in all business forms.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></div><span class="Apple-style-span" style=" ;font-family:Times;"><div style="border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 3px; padding-right: 3px; padding-bottom: 3px; padding-left: 3px; width: auto; font: normal normal normal 100%/normal Georgia, serif; text-align: left; "><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-style: italic; "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">How can I as an individual MT influence the development of government policy & laws that are supportive of the profession?</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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. </span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">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. </span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">References</span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Elluminate: Understanding Legal Process (24th September, 2009) Otago Polytechnic Massage Therapy Diploma Course.</span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Gagnier, J., Boon, H., Rochon, P. & Moher, D. (2006) Reporting Randomized, Controlled Trials of Herbal Interventions: An Elaborated CONSORT Statement. </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Annals of Internal Medicine</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">, 144 (5).</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">My own thoughts.</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">NZ Health Trust. (2009) NZ Health Trust Proposed Bill. Retrieved on the 7th October, 2009 from: http://www.nzhealthtrust.co.nz/proposed_bill.html</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Parliamentary Counsel Office (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Consumer Guarantees Act 1993</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/1993/0091/latest/viewpdf.aspx</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Parliamentary Counsel Office (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Health and Disability Commissioner Act 1994</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 7th October, 2009 from: </span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">http://www.legislation.govt.nz/act/public/1994/0088/latest/DLM333584.html</span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Parliamentary Counsel Office (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Health and Safety in Employment Regulations 1995</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 7th October, 2009 from: </span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">http://www.legislation.govt.nz/regulation/public/1995/0167/latest/viewpdf.aspx</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Parliamentary Counsel O</span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">ffice (2009) </span></span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Health Practitioners Competency Assurance Act 2003</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/2003/0048/latest/DLM203312.html</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Parliamentary Counsel Office (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Injury Prevention, Rehabilitation and Compensation Act 2001</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 7th October, 2009 from: </span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">http://www.legislation.govt.nz/act/public/2001/0049/latest/DLM99494.html</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Parliame</span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">ntary Counsel Office (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Medicines Act 1981</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/1981/0118/latest/DLM53790.html</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Parliamentary Counsel Office (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Privacy Act 1993</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/act/public/1993/0028/latest/DLM296639.html</span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Parliamentary Counsel Office (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Therapeutic Products and Medicines Bill 2006</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 7th October, 2009 from: http://www.legislation.govt.nz/bill/government/2006/0103/latest/versions.aspx</span></span></div></div></span>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-69749245110351217562009-09-30T19:00:00.000-07:002009-11-12T21:44:53.274-08:00Professional Practice<span style="font-family:verdana;"><span class="Apple-style-span">Blog 4: Sustainability - </span><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;">Discuss Issues of Sustainability and How They Relate to Massage Practice.</span></span></span> </span><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">Central to issues of sustainability in massage practice are the three main elements of Economic, Social and Environmental Sustainability. A balance of these three lead to a satisfied massage practitioner, a wider positive community/social network and environmental awareness, aiming to positively impact the world on a global scale.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">Economic Sustainability</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">This refers to the ability to make enough money to result in profit and reasonable quality of life for the practitioner, thus affecting the practitioner's mood, and everyone they come into contact with (explored more in social sustainability). The idea of business is that a profit is made, and that the business is not running at a loss, as most likely this is the main source of income for the practitioner, assisting with their survival (food/accomodation) and general expenses. In some ways, being imbalanced in the environmental and social areas of sustainability (buying products that end up being too expensive to realistically make a reasonable profit, e.g. expensive organic cotton sheets) may lead to a need to address this imbalance by purchasing in this case, cheaper sheets which may have been made by slave labour. However, this depends on the views of the practitioner. It is very possible to use and buy products that are both environmentally and socially sustainable, without a massive price tag (e.g. eco-friendly laundry powder, fair trade teas/coffee/sugar). These products may be marginally more expensive, but that entirely depends on whether you make the most of supermarket discounts, sales offers, bulk buys and wholesale prices when ordering these in. In some cases, it is cheaper to buy fair trade/eco-friendly (e.g. trade aid green tea, eco-friendly products that are on special), so it comes back to the intention of the practitioner.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">Social Sustainability</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">This refers to the effect that the massage practitioner and their massage practice has on the wider community network that they contact (via their clients).</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">The very intention of massage is to improve and maintain people's wellbeing by relaxing & treating them physically, helping them psychologically and generally assisting them on a holistic level. This has the trickle down effect of affecting all other people in that person's network that they contact in some way, usually positively. This as a whole affects society positively, leading to better relationships within the community, greater tolerance of others, lower crime rates and conflict, and more altruistic behaviour.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">From a survival point of view, a society with a more functional interpersonal network will have a greater chance of surviving, a higher birth rate, lower premature death rate (due to lower crime levels/conflicts), and be more egalitarian: not have so many issues related to inequality, which can lead to riots and strikes.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">In relation to the massage practice, practitioners can actively use their consumer power by choosing to purchase products that support social sustainability locally and overseas, by choosing items that donate a percent of the profit to charity, fair trade items and products, slave-free linens and furniture as a few examples.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">The massage practice could also network with grassroots businesses and local organisations that have socially conscious goals to contribute to social sustainability.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">Environmental Sustainability</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">To practice environmental sustainability within a massage business, the easiest ways to address this is by reducing power usage, using environmentally friendly laundry products, recyclable paper and buying recyclable packaging whenever possible, so mainly aiming to reduce throwaway plastic. The therapist can try using small glass bowls for mixing the oil in, for use during the massage rather than plastic bottles (this would be particularly beneficial for practitioners mixing aromatherapy oils prior to the massage) and storing oils in glass bottles.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">The massage therapist can look at using soy candles (instead of paraffin which is carcinogenic and adds to air pollution - Rezaei, Wang & Johnson, 2002) during the massage rather than electrical lighting, and switching off lights/appliances when not in use. By using more sheets rather than towels, and line drying linen where possible, this will reduce electricity usage and waste byproducts. Recycling grey water (water that has been used to wash dishes/linen) to use on the garden or potentially in the cistern is another method of conserving water. Again, using the power of active consumer choice, selecting an environmentally friendly power company and advocating for the use of eco-friendly practices and products in the massage industry will have an effect on a wider scale, particularly when networking with a group of like-minded practitioners, in an effort to lobby for positive, sustainable change.</span></span></div><div><span style="font-family:verdana;"></span> </div><div><span style="font-family:verdana;"></span></div><div><span style="font-family:verdana;"></span></div><div><span style="font-family:verdana;"></span></div><div><span style="font-family:verdana;">The three spheres of economic, social and environmental sustainability interlink with each other, contributing to sustainable practices and awareness on the part of massage therapy as a whole. The implementation of strategies that address these spheres of sustainability have a beneficial effect at a personal, social and finally global level, reaching far beyond the practitioner and the practice.</span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">References:</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">Elluminate: Sustainable Practice (23rd September, 2009) Otago Polytechnic Massage Therapy Diploma Course.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">My own thoughts.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size:medium;"><br /></span><span style="font-family:verdana;"></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;font-size:medium;">Rezaei, K., Wang, T. & Johnson, L. (2002) Combustion Characteristics of Candles Made from Hydrogenated Soybean Oil. Journal of the American Oil Chemists' Society, 79 (8).</span></span></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-77750811223618473782009-09-14T01:41:00.000-07:002009-10-15T21:19:39.453-07:00Pathology: Condition 3<span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Pathology: Immune, endocrine, gastrointestinal & renal systems</span></span><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Condition 3: Jaundice</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Final due: 16th October, Peer assessment due: 23rd October 2009.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Description:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Jaundice (Icterus) is the yellowing of the skin as a result of uncommonly high amounts of bilirubin in the blood plasma. Bilirubin affects skin pigment, is a byproduct of broken down haemoglobin and is metabolised in the liver. Therefore, blood disorders, diseases of the liver and gall bladder problems can affect the metabolism of these organs/tissues resulting in an unusually high level of bilirubin (Premkumar, 1999).</span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Jaundice is the physical symptom of a more serious underlying condition. Hepatic jaundice which is the most common type, is often co-morbid with other serious internal diseases affecting the liver, most often hepatitis (Brienza et al, 2006).</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Etiology:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Hepatic jaundice is typically caused by liver disease/failure, which can be caused by prescription drugs including antibiotics (Hussaini et al, 2007), alcohol leading to cirrhosis of the liver and other toxic substances, hepatitis, viral diseases such as malaria (Werner, 2005) and other chronic liver conditions (Suman & Carey, 2006). In very rare cases, there may be abnormal liver enzyme activity present from birth, this is known as congenital jaundice (Werner, 2005).</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Signs & Symptoms:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">The most obvious signs that jaundice is present are that the whites of the eyes, skin and mucous membranes will appear yellow (due to the pigment change caused by elevated levels of bilirubin). There may be a dull aching pain in the upper right quadrant of the abdomen and enlargement of the spleen in addition to jaundice in the case of co-morbid hepatitis (Premkumar, 1999)</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Light coloured stools and dark urine also indicate abnormal levels of bilirubin in the blood and the presence of jaundice (Werner, 2005).</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Morphology:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Jaundice may eventually result in bleeding disorders if the underlying condition responsible is left untreated, as the higher levels of bilirubin indicate that bile is not being adequately secreted, preventing the absorption of fats and therefore inhibiting the access of fat soluble vitamins (such as Vitamin K) that assist in normal blood clotting (Werner, 2005).</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Incidence & Prevalence:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Incidence and Prevalence of jaundice will depend entirely on the underlying hepatic condition, as jaundice is only a physically manifested symptom.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">In a study undertaken in France, medical researchers found that the incidence of drug-related hepatic injury was 14 in 100,000 citizens each year (Navarro & Senior, 2006). According to Wasley et al (2007) 20 - 30% of recently infected American hepatitis patients additionally presented with jaundice in 2005.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Indications for MT:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">The therapist must first identify the underlying condition resulting in the presence of jaundice, and take the necessary precautions according to this condition (Werner, 2005). Generally, reduced session length, relaxation style massage with light pressure only and avoidance of the liver and spleen areas (upper abdomen) are advised. If the patient presents with any form of hepatitis (including viral hepatitis) in addition to jaundice, the therapist must take stringent hygiene precautions, ask the client to leave their underwear on during the massage and preferably be vaccinated against all Hepatitis strains, particularly Hepatitis B (Premkumar, 1999).</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Contraindications for MT:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Avoid moderate to heavy massage of the abdomen due to possible enlargement of the liver and spleen or do not massage this area at all (depending on their underlying condition/s). Do not use heavier than relaxation pressure as this can easily lead to bruising, if the client presents with underlying bleeding disorders (Werner, 2005).</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"> Massage is generally contraindicated when jaundice is apparent (and the cause unknown), as this is a warning sign of a more serious hepatic illness and massage could inflame the liver further.<br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">References:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Brienza, N., Dalfino, L., Cinnella, G., Diele, C., Bruno, F. & Fiore, T. (2006) Jaundice in Critical Illness: Promoting Factors of a Concealed Reality. I</span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">ntensive Care Medicine</span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">, 32 (2).</span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Hussaini, S., O'Brien, C., Despott, E. & Dalton, H. (2007) Antibiotic Therapy: A Major Cause of Drug Induced Jaundice in Southwest England. </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">European Journal of Gastroenterology & Hepatology</span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">, 19 (1).</span></span></span></div><div><span class="Apple-style-span" style=""><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Navarro, V. & Senior, J. (2006) Drug-Related Hepatotoxicity. </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">The New England Journal of Medicine</span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">, 354 (7).</span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Premkumar, K. (1999) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Pathology A-Z: A Handbook for Massage Therapists</span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">. Calgary: Lippincott Williams & Wilkins, pp. 209 - 211</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Suman, A. & Carey, W. (2006) Assessing the Risk of Surgery in Patients With Liver Disease. </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Cleveland Clinic Journal of Medicine</span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">, 73 (4).<br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Werner, R. (2005) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">A Massage Therapist's Guide to Pathology</span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">. Philadelphia: Lippincott Williams & Wilkins.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Wasley, A., Miller, J. & Finelli, L. (2007) Surveillance for Acute Viral Hepatitis - United States 2005. </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">MMWR: Surveillance Summaries</span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">, 56 (SS03).</span></span></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-73765367590089107962009-08-12T17:05:00.001-07:002009-11-12T21:46:58.378-08:00Professional Practice<span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Blog 3: Ethics - </span></span><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Reflect on Ethical Principles Relevant to Massage Practice</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">.</span></span> <div><strong><span style="font-family:Verdana;"></span></strong> </div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><strong></strong></span></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">The Therapeutic Relationship</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">The dynamics of a complementary and harmonious client/therapist relationship begin with mutual respect and trust. It is important that neither the client's nor the therapist's boundaries are crossed, and each have a duty to the other to ensure this doesn't happen. Regular communication and feedback (during the treatment) are good ways to clarify ambiguous situations and language, which may threaten to upset this mutual balance. Taking notice of body language as an indicator of communication if the client is not speaking, is also important for the therapist to notice. Since the therapist is providing a paid service to the client there is an element of needing to be treated respectfully and having their needs met by the therapist: this is explored further in client centred care.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Client centred care</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Despite what the therapist may personally believe, to be successful professionally the client must always be the focus of the therapist's energies and intentions during the treatment. As a result of this client centred focus, the therapist is generally rewarded with money, as a form of energy exchange. </span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Considering the client has made a concession (by removing their clothes and being covered only by a sheet), it is the therapist's duty to respond to this by consciously aiming to improve the wellbeing of the client through touch.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">When it becomes obvious that the client's issues are beyond the scope of practice of the MT, it is necessary to refer the client on to a relevant healthcare professional. As always, the aim of the therapist is to ensure the client's interests are the foremost priority.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span"><div><span class="Apple-style-span"><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Ethics & the Meaning Response: Honesty vs. client's best interests.</span></span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">In most cases it is best to act with integrity as this may inevitably be in your client's best interests, even if at the time it does not appear that way. There are times when it is preferable to place the client's best interests above honesty, as a short-term solution. However honesty is generally the most important value to cultivate.</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">According to Benjamin et al (2004), the conflict here regards duties versus rights.</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">A duty is a moral obligation set in place by social custom, and is often enforceable by law. As healthcare practitioners we are bound by various duties outlined by the law and general social belief, integrating ethics and awareness.</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">A right includes basic human freedoms, such as the right to equal treatment, and the right to self-determination (a right which could potentially conflict with a practitioners duty of assisting others on the course of better health). This duty may for example, include referring a client intent on physically harming themselves or another on to an appropriate healthcare professional (thus interfering with their right), as opposed to allowing the client the right to self-determination in this instance.</span></span></span></div></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Power Differentials</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Due to the increased vulnerability the client has had to put themselves in so as to receive the massage, the client may feel subconsciously that the practitioner has more power and control then them, as they are fully clothed and standing over them while massaging. The client is literally physically powerless, as they lie on the massage table and may feel more vulnerable without their clothes on as a form of outer layer defence. In order to fully relax into their role, the client must be able to trust that the practitioner will not abuse this perceived power. Therefore it is crucial the practitioner ensures the client does not feel threatened when they are on the table, by acting in a way that allows the client to feel in control to some degree. Asking for regular feedback and giving the client control mechanisms (e.g. the pain/pressure scale) will not only allow the client to control aspects of the massage resulting in a more enjoyable and tailored treatment, but will subconsciously reaffirm the client's status as an equal to the practitioner (as seen in the therapeutic relationship) and in control. Regular feedback will assist with preventing and clarifying misunderstandings that could be the basis for lawsuits based on malpractice.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Transference and Counter-transference</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Transference</span></span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"> is where the client is not correctly 'seeing' the therapist as the separate, individual human being they are, but rather is transferring an archetype onto them, of someone who has had a deep emotional and/or physical connection to them, in a positive or negative way (For example, an idolized mother or an abusive father). McIntosh (2005) explores this theory of transference further by proposing that due to the higher proportion of domestic and sexual abuse carried out by males against females (as opposed to females against males), this may explain why some women are less comfortable in the presence of a male massage practitioner, particularly if they were abused in the past by a male figure. Of course, this situation can correlate to a male client and female practitioner, a male client with a male practitioner, or a female client with a female practitioner, depending on the client's history. The past issues relating to this transference may be more likely to be triggered when the client is receiving the massage and therefore is in an extremely vulnerable position, with the therapist in control by default.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Counter-transference</span></span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"> involves the same distortion of reality as transference by replacing the client as an individual with a gendered archetype from the practitioner's past. In the case of unresolved issues from childhood related to gender or personality traits, it is vital that the therapist ensures they receive supervision as part of their ongoing professional development to prevent this from negatively affecting the client/therapist relationship, and to assist them in consciously realising why they are having the reactions they are having to their client (Elluminate, 2009).</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span"><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Boundaries - personal and professional</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Therefore, due to the possible complications that can arise due to phenomena such as transference, boundaries are essential to ensure that these do not violate the ethical considerations that should be in place.</span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Personal boundaries are necessary to safeguard ourselves and provide a clear line between where one person ends and the other begins. Confidence and a developed awareness of ourselves are the result of having clear and defined personal boundaries.</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Professional boundaries ensure that clients are protected and feel safe, and the professional integrity of the practitioner is not compromised. Professional boundaries ensure the level of care delivered by the practitioner to the client is consistent. With the assistance of supervision, the practitioner does not cross the client's boundaries, but rather maintains an objective professional distance so that once again the client's best interests are top priority (Benjamin & Sohnen-Moe, 2004).</span></span></span></div></span></div><div><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">- Creating professional boundaries</span></span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">This includes: </span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Maintaining a professional appearance (tidy, non-suggestive clothing) </span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Keeping a professional distance, e.g. not sharing too many personal details</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Being aware of and respecting a client's personal space by observing their body language and touching base with them about this in the instance that their boundaries have been crossed</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Using respectful language, ie. no slang, not sexist, racist, ageist or in any other way discriminatory language</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Touch boundaries: exercising caution when touching them any other time than on the massage table (e.g. pat on the arm)</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Maintaining a professional looking massage environment and clinic</span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Enforcing fair and prompt payment for sessions (when necessary) </span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Keeping to scheduled session times.</span></span></span></div><div><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">- Crossing client's boundaries</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="FONT-STYLE: normal"></span></span></span></span></div><div><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="FONT-STYLE: normal"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Common ways in which the therapist may cross the client's boundaries include: </span></span></span></span></div><div><ul><li><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Working outside the MT scope of practice</span></span></span></li><li><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Acting as their psychologist/counsellor</span></span></span></li><li><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Unsolicited comments about their appearance, beliefs, decisions</span></span></span></li><li><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Treating a client presenting with contraindications</span></span></span></li><li><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Inviting the client into a friendship or other form of relationship</span></span></span></li></ul></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">In the instance that the therapist has crossed the client's boundaries, the best tactic to use is for the therapist to explain to the client that they have become aware of this situation, clarify what happened (from their point of view), apologise if it appears they did in fact cross the client's boundaries and progress on with the treatment once the client has given their consent.</span></span></div><div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Dual Relationships</span></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></span></div><div><span class="Apple-style-span"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">A dual relationship occurs when the boundaries within a client-therapist relationship blur into a friendship, making these boundaries more difficult to enforce. </span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">According to McIntosh (2005), dual relationships can be avoided by clearly defining and separating social and professional time. By practicing setting boundaries around one's time and one's therapeutic relationship with clients (even friends who have become clients), dual relationships will present less of an issue.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Malpractice</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">In the words of Snyder (2007), malpractice regards the negligent behaviour of the therapist when treating a client with whom there exists a therapeutic relationship, and this negligence results in the direct injury of the client. </span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">In a malpractice suit, the actions and intentions of the therapist are examined and compared to the actions and intentions expected of a standard massage therapist when treating a client (as outlined within the Code of Ethics, MNZ, 2009): "</span></span><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Serve the best interests of their clients and provide best practise quality of service</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">". In the case of a registered healthcare professional, a successful malpractice suit can result in the sanctioning of the practitioner and possibly a revocation of their practitioner's license as the most severe form of sanction.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="FONT-WEIGHT: bold"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">References:</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Benjamin, B. & Sohnen-Moe, C. (2004) </span></span><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">The Ethics of Touch: the hands-on practitioner's guide to creating a professional, safe and enduring practice</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. New York: Lippincott Williams & Wilkins. </span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Elluminate 1 & 2 (12th - 13th August, 2009) Otago Polytechnic Massage Therapy Diploma Course.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Massage New Zealand (2009) </span></span><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Code of Ethics</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. Retrieved on the 10th of August, 2009 from: http://massagenewzealand.org.nz/about-us/code-of-ethics/<br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">McIntosh, N. (2005) </span></span><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">The Educated Heart: Professional Boundaries for Massage Therapists</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. New York: Lippincott Williams & Wilkins, p. 126.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">My own thoughts.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Snyder, L. (2007) </span></span><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">Complementary and Alternative Medicine: ethics, the patient, and the physician</span></span></span><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size:medium;">. New York: Humana Press, p. 169</span></span></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-46829914824500111312009-07-26T01:58:00.000-07:002009-08-14T04:18:06.402-07:00Pathology: Condition 2<span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Pathology: Integumentary, circulatory & nervous systems</span></span><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Condition 2: Papulosquamous Dermatoses</span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Draft due: 27th July, Final due: 14th August, Peer assessment: 28th August 2009.</span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Description:</span></span></span></span></div><div><span class="Apple-style-span" style=" font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Contagious papulosquamous dermatoses are a group of skin diseases with various etiological factors, the most common types of which include tinea pedis (athlete's foot), tinea corporis (ringworm), scabies, and impetigo.</span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Considering that there are a wide variety of non-contagious papulosquamous dermatoses with similar signs and symptoms, it is best to ask the client if they are aware of their skin disorder and ask to see their medical records or refer on to get medical clearance before massaging them.</span></span></span></div><div><span class="Apple-style-span" style=" font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Etiology:</span></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Ringworm & Tinea are both fungal infections caused by a group of fungi known as dermatophytes. Warmth and humidity are optimum factors for the onset of these conditions, ringworm can be transmitted from animals to humans, whereas athlete's foot can be transferred via skin contact and infected objects (Premkumar, 1999).</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Scabies is caused by an infestation of the parasitic female scabies mite (sarcoptes scabiei) which is also transferred by skin to skin contact and close contact with contaminated towels, bedding, or hairbrushes.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Impetigo is caused by a streptococcus or staphylococcus bacterial infection which has breached the integumentary barrier (Schenck, 1999).</span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Signs & Symptoms:</span></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Papulosquamous dermatoses are typified by a papule, inflammation and usually the development of a plaque on the surface (Mondofacto, 1998).<br /></span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">In the case of Ringworm a distinct red circular rash appears, resembling a ring. This lesion can be itchy or present a burning sensation. </span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Athlete's foot is identified by pale weeping skin between the toes and red, flaky crusted skin at the site of the infection. Again, this may itch or burn, and the plaque formed by this crusted skin can weep a clear discharge.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">The presence of Scabies can be identified on close inspection as a tiny greyish burrow no more than 2-3mm in length which may have a visible mite at the end - usually a tiny dark dot (Fleisher, Ludwig & Silverman, 2002). This may not be visible to the naked eye, so the MT may look at other symptoms such as intense itching and as a result redness, where the affected skin has been repeatedly scratched. A skin scraping is the usual medical procedure for determining whether a scabies infestation is present.</span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">When impetigo is present, flat blisters are visible which rupture and as a result, crusts may emerge in a clustered group (Schenck, 1999).</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Morphology:</span></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">If left untreated, the fungal infections of ringworm and athlete's foot can complicate, resulting in secondary bacterial infections particularly in the case of an impaired immune system. The itching may lead to repeated scratching at the lesions which will irritate them, potentially spreading the fungus via the fingers and nails, and further destroying the integumentary barrier of the skin (Thiers, Sahn & Callen, 2009).</span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">The female scabies mite lays eggs at the end of its burrow in the skin, thus rapidly increasing the scabies population over a relatively small time. Optimum warmth and during night hours while the client is sleeping tend to encourage the growth of the infestation population, as this is when they are most active (Fleisher et al, 2002).</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">As Impetigo is contagious, it is most often transferred to the face via the hands and vice versa. In the case that it reoccurs after treatment, it may be that the bacteria have been lying dormant in the nostrils, in which case a topically administered antibiotic is necessary (Fry, 1997).</span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Incidence & Prevalence:</span></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">The incidence for Impetigo and similar fungal infections is higher in warm, humid and tropical climates providing an optimum breeding ground for bacterial infection, occurring most commonly in school age children and teenagers (Bracker, 2001).</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">In the US and Europe, Scabies appears to occur in cycles of infestation spanning 3-4 decades, in 0-6% of the population (Nelson & Woodward, 2006).</span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Indications for MT:</span></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">If the skin disorder has been examined and cleared by a medical professional as being non-contagious (e.g. psoriasis, pityriasis rosea, excema) the patient may benefit from massage, provided the total area of affected skin is not large (Mitchell & Penzer, 2000). In this case, massage over the unaffected areas can assist with the patient's healing process (Werner & Benjamin, 1998), allowing for the circulation of lymph, and the positive result this could have on non-contagious skin disorders which may have an underlying immune connection, ie. sores that appear as a result of the immune system in distress (Thiers et al, 2009).</span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Contraindications for MT:</span></span></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Tinea Corporis (Ringworm), Tinea Pedis (Athlete's Foot), Scabies and Impetigo are all contagious skin disorders, therefore if the client presents with any of the symptoms listed here (such as itching, redness and the appearance of crusted lesions), all skin to skin contact is contraindicated until treatment has ended and medical clearance is obtained.</span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Reference List:</span></span></span></span></div><div><span class="Apple-style-span" style=" font-weight: bold;font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style=" ;font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Bracker, M. (2001) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">The 5-minute Sports Medicine Consult</span></span><span class="Apple-style-span" style="font-size: medium;">. US: Lippincott Williams & Wilkins, p. 460.</span></span></div><div><span class="Apple-style-span" style=" font-weight: bold;font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style=" ;font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Elluminate session 2. (18th June, 2009) Otago Polytechnic Massage Therapy Diploma Course.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Fleisher, G., Ludwig, S. & Silverman, B. (2002) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">Synopsis of Pediatric Emergency Medicine</span></span><span class="Apple-style-span" style="font-size: medium;">. US: Lippincott Williams & Wilkins, p. 203.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Fry, L. (1997) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">An Atlas of Dermatology</span></span><span class="Apple-style-span" style="font-size: medium;">. London: Taylor & Francis, p. 83.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Mitchell, T. & Penzer, R. (2000) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">Psoriasis at your fingertips: the comprehensive and medically accurate manual on managing psoriasis</span></span><span class="Apple-style-span" style="font-size: medium;">. London: Class Publishing Ltd, p. 74.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Mondofacto. (1998) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">Skin Diseases: Papulosquamous</span></span><span class="Apple-style-span" style="font-size: medium;">. Retrieved on the 8th July, 2009 from: http://www.mondofacto.com/facts/dictionary?query=skin+diseases%2C+papulosquamous&action=look+it+up</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Nelson, A. & Woodward, J. (2006) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">Sexually Transmitted Diseases: A Practical Guide for Primary Care</span></span><span class="Apple-style-span" style="font-size: medium;">. New York: Humana Press, p.269.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Premkumar, K. (1999) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">Pathology A - Z: A Handbook for Massage Therapists</span></span><span class="Apple-style-span" style="font-size: medium;">. Calgary: Lippincott Williams & Wilkins.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Schenck, R. (1999) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">Athletic Training and Sports Medicine</span></span><span class="Apple-style-span" style="font-size: medium;">. New York: Jones & Bartlett Publishers, p. 572.</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Thiers, B., Sahn, R. & Callen, J. (2009) Cutaneous Manifestations of Internal Malignancy. </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">CA: A Cancer Journal for Clinicians, </span></span><span class="Apple-style-span" style="font-size: medium;">59 (2).</span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:verdana;"><span class="Apple-style-span" style="font-size: medium;">Werner, R. & Benjamin, B. (1998) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;">A Massage Therapist's Guide to Pathology</span></span><span class="Apple-style-span" style="font-size: medium;">. Michigan: Williams & Wilkins.</span></span></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-12821406838113351162009-06-15T23:06:00.000-07:002009-06-18T02:37:38.254-07:00Professional Practice<div><span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Blog 2: Treaty of Waitangi - </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">What does it mean to be a healthcare professional?</span></span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica"><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Explain the meaning of the articles of the treaty of Waitangi, their historical context and their significance to health practice in New Zealand.</span></span></span></p></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Within the Treaty of Waitangi there are four main areas of concern relating to the healthcare profession, governance, authority, equity and respect. Directly relevant to each of these areas are the 3 P's: Partnership, Protection and Participation. These elements are key in the development of a fair and equal interpersonal client relationship.</span></span></div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Governance</span></span></span></span></div><div><span class="Apple-style-span" style=" font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">In Article 1 of the Treaty of Waitangi, it was generally understood by the Maori chiefs that the idea of governance was administration to/overlooking of their land by the English queen. This idea was misunderstood by the English as implying sovereignty or power over the land given in exchange for the queen's protection. We can apply this concept of governance to our profession as massage therapists by ensuring that we look after our clients and administer to their needs, but do not confuse this with sovereignty or power over them/their decisions in exchange for our protection. In other words, this does not require them to compromise themselves or their cultural values in any way, in exchange for a massage treatment or other healthcare service.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">This also entails the responsibilities we have as healthcare practitioners to the welfare of our client (during the session and afterwards where appropriate).</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Lastly, the policy and legislation of the treaty and what this means when applied to all clients is important regarding best practice in the workplace.</span></span></div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Authority</span></span></span></span></div><div><span class="Apple-style-span" style=" font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">The idea of authority in Article 2 of the Treaty was primarily to do with the difference in perceptions of authority between the Maori chiefs and English representatives of the Crown. This article related mainly to control of the land; the Maori version indicates that the queen agrees that the Maori chiefs hold rangatiratanga (chieftainship) over the lands whereas the English version appears to imply that the land really belongs to the queen and is being gifted back to the Maori should they wish to retain it.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">In the Healthcare profession, as practitioners we are in the position of the governors and the client represents the chiefs. Therefore we need to ensure that we allow and encourage the authority of the client in an equal partnership. </span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Giving the client the opportunity to assist with planning the treatment or modifying it where necessary respects their equal authority within the client/practitioner relationship. As a rule, clients prefer to be treated as equal beings and this is acknowledging the democratic element that should be present between healthcare practitioner and client.</span></span></div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Equity</span></span></span></span></div><div><span class="Apple-style-span" style=" font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Here the words of debate are 'subjects' or 'citizens'. In the English version of article 3 in the Treaty, it is stated that the queen declares that the Maori will be protected and will maintain the same rights as British 'subjects' - a word which essentially places said 'subjects' on a lower platform to the queen who is located at the top. </span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">In the Maori version of article 3, the Maori accept the queens governance if the queen offers them the same protection and rights of British citizens (the people of England). This largely highlights a difference in the cultural views and understandings of the English and the Maori, and how the people in each culture are treated, including the hierarchical systems and their differences.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">With respect to Massage Therapy, equity relates to an awareness on the part of the practitioner ensuring that every client receives the most suitable treatment bearing in mind their personal circumstances. In this way, the treatment is tailored to the individual client and their individual needs, while maintaining an expected standard. An example would be providing wheelchair access to the massage premises to accomodate disabled clients. For Maori clients or other clients with integral cultural rituals an awareness and willingness to accomodate these on the part of the therapist is required. Maori clients may prefer to discuss altering a treatment that involves the head for example, and may take offence at sitting on a table as another example. The key here is to have the sensitivity to 'read' the client and understand how their cultural customs may affect their response to any part of the treatment. Specifically for a massage therapist, the best time to discuss cultural differences and protocol would be during the interview process at the start of the massage, when the treatment plan is proposed and negotiated by both parties (therapist and client).</span></span></div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Respect</span></span></span></span></div><div><span class="Apple-style-span" style=" font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style=" "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Only the Maori version of article 4 in the Treaty exists, which was an oral article and was subsequently not added into the written texts. This may be due to the English intention of assimilation, in which all indigenous religions and beliefs were converted to the main religion of England at that time, namely Christianity. However, the Maori article discusses the 'protection' of the 'Maori custom' by the Governer. </span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">In terms of healthcare, respect in this case is generally expected and comprises an unbiased deference to the client's cultural values and needs, what they are seeking to achieve as a result of the massage treatment and as an individual. This is a standard quality that massage therapist's should look at developing if it isn't already inherent in their nature, as it is crucial when operating within the realm of healthcare and in maintaining a positive reputation.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">References:</span></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Bachelor of Midwifery/Diploma in Massage Therapy; Treaty Workshop. May 18th, 2009.</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">Ministry of Health (2002) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">He Korowai Oranga: Maori Health Strategy</span></span></span><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">. Retrieved on the 15th June 2009 from:</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">http://www.moh.govt.nz/moh.nsf/0/8221e7d1c52c9d2ccc256a37007467df/$FILE/mhs-english.pdf</span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: verdana;">My own thoughts</span></span></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com1tag:blogger.com,1999:blog-1539144409737351337.post-69681766821191661672009-06-04T03:47:00.000-07:002009-06-05T02:33:22.085-07:00Research Methods<span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><div>Reflection on the Collaborative Task Process</div>Due: 5th June 2009</span></span><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">Overall I feel that my contribution to the collaborative research project has been sufficient, and the journey taken has been personally enlightening. Below I have listed my:</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">Contribution to the group:</span></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- Created the google doc for the group to use as the format structure for the group proposal</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- Coordinated the meeting of the group on two occasions, but this was generally a mutual consensus</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- Provided 5 references and intuitive ideas regarding the research question</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- Was present at most group meetings and actively involved with the process</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">Contribution to the references:</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"> </span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- Information on ethics and data analysis relevant to our group proposal: Cohen, Manion & Morrison (2007)</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- The effect of massage on the parasympathetic nervous system and the resultant relaxation effect, and how this would assist Chronic pain clients: Marieb (2004)</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- The presence of chronic local adaptation syndrome in clients suffering from chronic pain: McQuillan (2008)</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- Descriptions of chronic pain symptoms from an anonymised client, potential link between chronic pain and emotional/psychological trauma, referral of chronic pain patients to massage therapists by other healthcare providers: S. Farrimond, personal communication (2009)</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">- Links between neurophysiology/peripheral nerve pathways and chronic pain from a medical perspective: McQueen, personal communication (2009)</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">My Interpretations of the Topic:</span></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">At the conclusion of this group collaborative research proposal, I feel there is a strong link between chronic pain and emotional disorders, oversensitivity of the peripheral nerve pathways and chronic pain syndrome fits the profile of an individual prone to anxiety and depression. I feel that due to the lack of research to date conducted in the field of chronic pain there is a potential area for further exploration into the phenomena that is chronic pain syndrome. Our research indicates that massage therapy would play a viable role in the control and treatment of chronic pain symptoms, on both a physical and emotional level. </span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">So far, the medical system has attempted to treat chronic pain (e.g. with the instigation of pain clinics within hospitals nationwide (McQueen, personal communication, 2009)), but due to the lack of research and therefore lack of knowledge of this condition and its fundamental nature, the healthcare profession continues to be mystified by chronic pain sufferers and the syndrome itself, placing it in the 'too hard' basket.</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">I feel this offers an area of research particularly relevant to the Massage Therapy profession to explore in the future and the vital role massage could play in the treatment process.</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">My engagement with the group:</span></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">Initially, I attempted to act as coordinator for the meeting of our group, but as a result of the progression of the task I found myself leaning toward the editor style role, editing and culling the information rather than adding further research. </span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">I enjoyed this editing role more so than the role of researcher or coordinator, as I felt it suited my aptitude with language and writing.</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">I was a present force at most of the group meetings, continually engaging with the others and the task at hand.</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">My involvement with the workload:</span></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">I feel I contributed an acceptable portion of the references required, assisted with arranging group meetings and liaised with the other group members in a concerted manner throughout the group task. I believe I was appropriately involved with the journey taken by the proposal, from its initial formative stages through to its completion and presentation as a google document.</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">As a result of this collaborative group task process I have become interested in the role that massage therapy may play in the future, in relation to undefined/seldom researched health conditions. I have also discovered my strengths (and passions) lie mainly within the realm of the written word and editing, rather than in management or as a researcher with regards to this group project.</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">References:</span></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">Grinlinton, T., Howley, H., Marks, S. & Steven, S. (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">Collaborative Research Project: How Many Massage Sessions Does it Take to Reduce the Sudden Onset of Chronic Pain Symptoms?</span></span></span><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"> Dunedin: Otago Polytechnic Massage Therapy School.</span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size:medium;"><span class="Apple-style-span" style="font-family:verdana;">My own thoughts.</span></span></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-26593513661562638792009-05-30T20:24:00.000-07:002009-06-04T03:15:23.488-07:00Professional Practice<div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Blog 1: Scope of Practice as Defined by Massage New Zealand</span></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span class="Apple-style-span" style="FONT-STYLE: italic"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">'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?'</span></span></span></div><div><div><span class="Apple-style-span" style="font-weight: bold; "><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style="font-weight: bold; "><span class="Apple-style-span" style="font-weight: normal; "><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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). </span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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).<br /></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></span></div><div><span><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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. </span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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. </span></span></div><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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).</span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></div></span><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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. </span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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.</span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">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. </span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">However, with recognition as a healthcare profession under the HPCAA, we must realise that our Scope of Practice will be limited as a result.</span></span></div></div><div> </div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">References:</span></span></strong></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Briscoe, T. (2004). New Zealand's Health Practitioner's Competence Assurance Act: A missed opportunity for improvements to medical practice, </span></span></span><span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">The Medical Journal of Australia,</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"> 180 (1), p. 4-5.</span></span></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Gilbey, A. (2008). Use of Inappropriate Titles by New Zealand practitioners of acupuncture, chiropractic and osteopathy, </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">The New Zealand Medical Journal</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">, 121 (1278), p. 1.</span></span></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Massage New Zealand. (2009) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Certified Massage Therapist: Scope of Practice</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. Retrieved on the 20th May, 2009 from: </span></span><a href="http://massagenewzealand.org.nz/about-us/scope-of-practice-cmt/"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">http://massagenewzealand.org.nz/about-us/scope-of-practice-cmt/</span></span></a></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Massage New Zealand. (2009) </span></span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Code of Ethics</span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. Retrieved on the 20th May, 2009 from: http://massagenewzealand.org.nz/about-us/code-of-ethics/ <br /></span></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Massage New Zealand. (2009) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Remedial Massage Therapist: Scope of Practice</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. Retrieved on the 20th May, 2009 from: </span></span><a href="http://massagenewzealand.org.nz/about-us/scope-of-practice-rmt/"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">http://massagenewzealand.org.nz/about-us/scope-of-pr</span></span></a><a href="http://massagenewzealand.org.nz/about-us/scope-of-practice-rmt/"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">actice-rmt/</span></span></a></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Ministry of Health. (2008) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Health Practitioners Competence Assurance Act 2003</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. Retrieved on the 21st May, 2009 </span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">from: </span></span><a href="http://legislation.knowledge-basket.co.nz/gpacts/public/text/2003/an/048.html"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">http://legislation.knowledge-basket.co.nz/gpacts/public/text/2003/an/048.html</span></span></a></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Parliamentary Counsel Office of NZ. (2008) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Consumer Guarantees Act 1993</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. Retrieved on the 21st May, 2009 from: </span></span><a href="http://www.legislation.govt.nz/act/public/1993/0091/latest/DLM311053.html"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">http://www.legislation.govt.nz/act/public/1993/0091/latest/DLM311053.html</span></span></a></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Ward, R., Hruby, R. & Jerome, J. (2002) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Foundations for Osteopathic Medicine</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. USA: Lippincott Williams & Wilkins, p. 1034.</span></span></span></div></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-63271431038925109222009-05-19T00:51:00.000-07:002009-06-04T03:37:13.275-07:00Pathology: Condition 1<span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Pathology: Musculoskeletal<br />Condition 1: Osteoporosis</span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Final due: 5th June, Peer assessment: 19th June 2009.<br /><br /></span></span><strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Description:</span></span></strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /><br />Osteoporosis is defined as a systemic skeletal condition in which the bone tissue deteriorates faster than it is being formed, leading to thinning and weakness of bones. It is not possible to cure osteoporosis (Laroche, 2008), which is an irreversable, degenerative disease of the bone. According to Nevitt (1994), prevention is the best form of cure, as the loss of bone strength that occurs as a result of the loss of bone tissue is permanent. The risk is greatly increased in the elderly due to the slowed production of bone and the heightened possibility of falling and therefore fracturing bones. The best prevention is to build up stronger bones during childhood/adolescence when metabolism is at its peak, in order to reduce the likelihood of osteoporosis occurring later in life.<br /><br /></span></span><strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Etiology:</span></span></strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /><br /></span></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Osteoporosis is a standard part of the ageing process, and can occur as a secondary condition alongside other systemic diseases and endocrine disorders such as hyperthyroidism and diabetes (Sweet, Sweet, Jeremiah & Galazka, 2009).<br />It is characterised by loss of bone density and greater fragility of bone tissue, which is exacerbated by various etiological factors, such as a family history of osteoporosis, regular smoking and alcohol consumption and insufficient sun exposure, resulting in low vitamin D levels (Morgan & Kitchin, 2008). A diet low in calcium, certain medications (e.g. glucocorticoids) and low oestrogen levels also increase the likelihood of this disease (Sweet et al, 2009).<br /></span></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">In women, the onset of osteoporosis appears most commonly after menopause, in anorexics, and otherwise hormonally or nutritionally deficient individuals (Morgan & Kitchin, 2008).</span></span></span><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></div><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Signs & Symptoms:</span></span></span></div><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br />According to Premkumar (1999) bone pain and stress fractures may be present in the initial stages but as the progression is so subtle, the condition may go unnoticed until the event of a fracture, by which time the disease is in its advanced stage and acute damage has occurred. As osteoporosis is a subtle condition that gradually appears during the later stages of the client's life, there is no way of identifying the exact date of initial bone deterioration, and due to its irreversable nature it may require the remainder of the client's life to reach the peak of its expression. Loss of height and bone deformities such as kyphosis of the spine can indicate that the acute stages of the disease are present in the spinal bones (Holt, 2008).</span></span></span></div><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Morphology:</span></span></strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span><p><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">A deficiency in the minerals that form bone tissue, particularly calcium and phosphate, can force the body to extract these from the bones in an effort to achieve homeostasis. This leads to accelerated osteoclastic resorption (Laroche, 2008) which results in the bone tissue presenting as demineralised, brittle and fragile, breaking easily with little stress (Premkumar, 1999).</span></span></span></p><p><span><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Incidence:</span></span></span></span></p><p><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">1.3 million bone fractures per annum in the overall population have been caused by osteoporosis in the United States (Cooper, 1999). Within this population, 1 in 8 men will suffer from an osteoporotic fracture in their lifetime as will 1 in 2 white women (Sweet et al, 2009).</span></span></span></p><span><strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Indications for MT:</span></span></strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /><br />Exercise, gentle massage particularly excercising caution over bones and bone structures, light to medium massage pressure over stiff neighbouring muscles using the fingertips in a circular motion or alternatively, the palm of the hand (Salvo, 2008).<br /><br /></span></span><strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Contraindications for MT:</span></span></strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /><br /></span></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Deeper massage over bones and greater stroke pressure. Deep tissue massage techniques near the site of osteoporotic bone are also contraindicated as these may aggravate the progression of bone fractures and so must only be used with necessary caution by a qualified practitioner (Leidig-Bruckner et al, 1997).<br /><br /></span></span><strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">References:</span></span></strong><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Boschert, S. (2002) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Risk Factors Don't Always Predict Osteoporosis</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. San Francisco: Internal Medicine News. Retrieved on the 16th May, 2009 from: </span></span></span><a href="http://www.internalmedicinenews.com//article/PIIS109786900271086X/fulltext"><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">http://www.internalmedicinenews.com//article/PIIS109786900271086X/fulltext</span></span></span></a><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Cooper, C. (1999) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Epidemiology of Osteoporosis</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. Southampton: Osteoporosis International. Retrieved on the 16th May, 2009 from: </span></span><a href="http://www.springerlink.com/content/865w7gj0t4496n1p/fulltext.pdf?page=1"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">http://www.springerlink.com/content/865w7gj0t4496n1p/fulltext.pdf?page=1</span></span></a><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /><br />Holt, E. (2008) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Osteoporosis</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. Retrieved on the 16th May, 2009 from: </span></span></span><a href="http://www.nlm.nih.gov/medlineplus/ency/article/000360.htm"><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">http://www.nlm.nih.gov/medlineplus/ency/article/000360.htm</span></span></span></a><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /><br />Laroche, M. (2008) Treatment of Osteoporosis: All the Questions We Still Cannot Answer. </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">The American Journal of Medicine,</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"> 121 (9), p. 746.<br /><br />Leidig-Bruckner, G., Minne, H., Schlaich, C., Wagner, G., Scheidt-Nave, C., Bruckner, T., Gebest, H. et al. (1997) Clinical Grading of Spinal Osteoporosis: Quality of Life Components and Spinal Deformity in Women with Chronic Lower Back Pain and Women with Vertebral Osteoporosis. </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Journal of Bone and Mineral Research,</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"> 12 (4), pp. 663 - 675.<br /><br />Morgan, S. & Kitchin, B. (2008) Osteoporosis: Handy Tools for Detection, Helpful Tips for Treatment. </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">The Journal of Family Practice</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">, 57 (5), p. 313.<br /><br />Nevitt, M. (1994) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Epidemiology of Osteoporosis</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. San Francisco: University of California. Retrieved on the 16th May, 2009 from: </span></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/7984777">http://www.ncbi.nlm.nih.gov/pubmed/7984777</a></span></span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"></span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Premkumar, K. (1999) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Pathology A - Z: A Handbook for Massage Therapists.</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"> Calgary: Lippincott Williams & Wilkins.</span></span></span></div><div><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"><br /></span></span></span><span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Salvo, S. (2008) </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">Mosby's Pathology for Massage Therapists</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">. New York: Elsevier Health Sciences, p. 112.<br /><br />Sweet, M., Sweet, J., Jeremiah, M. & Galazka, S. (2009) Diagnosis and Treatment of Osteoporosis. </span></span><em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;">American Family Physician,</span></span></em><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: verdana;"> 79 (3), p.193 - 200, Table 2.</span></span></span><span style="font-family:arial;"> </span></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-63651674208337406852009-04-08T02:03:00.000-07:002009-05-08T01:54:01.864-07:00Assessment task 1 - Blog 4 - Evaluation of Research Findings, Tessa Grinlinton.<div><span class="Apple-style-span" style="font-family: arial; font-size: 13px; ">There is a large amount of unintentional ambiguity within the article 'Unravelling the Mysteries of Fascial Unwinding' which simply serves to confuse and frustrate the reader. This ambiguity reinforces the intuition that the writer may not entirely know about or understand the topic of which he is attempting to depict and explore.</span></div><div><span class="Apple-style-span" style="font-family: arial; font-size: 13px;"><br /></span></div><div><span class="Apple-style-span" style="font-family: arial; font-size: 13px; ">The paragraph related to 'forcing the tissue in some directions' suggests that the author/s have not fully explored the area of myofascial release in which either direct or indirect methods for unwinding the tissues are employed. The ambiguous word in question is 'forcing', we are never forcing the tissues in a harmful way, but in direct myofascial release and unwinding, we may be deliberately guiding them with slight 'force' against the areas of most restriction in order to encourage release in those areas.</span><br /></div><br /><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style="FONT-FAMILY: 'Georgia','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-: EN-NZ"><span style="font-size:85%;"><span style="font-family:arial;">The author contradicts themself in the ambiguous description of "sometoemotional release... again here we only deal with physical unwinding". By simply reading the term sometoemotional release we assume that a large portion of this will involve emotional and somatic releases, therefore we are not purely dealing with physical unwinding (which cannot be seperated from emotional or somatic phenomena, as they are all interconnected in the field of myofascial unwinding) but an infusion of all three. This would suggest that again the writer of this article has only investigated the topic from a limited set of viewpoints and has yet to see the whole picture. If they are however attempting to insinuate that pure physical unwinding has purely somatic and emotional effects they are still not linking the three bodies which are essentially part of this holistic field, and the ambiguous nature of the statement leaves the reader confused.</span></span></span></p><br /><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style="FONT-FAMILY: 'Georgia','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-: EN-NZ"><span style="font-size:85%;"><span style="font-family:arial;">In the article 'Unravelling the Mysteries of Fascial Unwinding' the researchers have compiled a very relevant list of specialised articles related to myofascial release and the ideomotor effect (in which the subject makes movements unconsciously facilitating said release). Neuromuscular therapy, craniosacral therapy and bodywork journals boost the quality of reference sources, an article in the new scientist appears from the heading to be representing a skeptics point of view regarding the phenomenon of fascial unwinding: '<span class="Apple-style-span" style="font-style: italic;">Greatest Myth of All</span>'. However on close inspection of the article in question, we discover that it relates in fact to the unconscious processes of the brain related to perception and action. Again, the ambiguity of the reference heading may reflect an ambiguity in the article itself, reflecting an ongoing theme of ambiguity projected by the author.</span></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style="FONT-FAMILY: 'Georgia','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-: EN-NZ"><span style="font-size:85%;"><span style="font-family:arial;">The '<em>Healing ancient wounds: the renegades system'</em> article is one of the main articles seeming to suggest that fascial unwinding and indeed tense fascia may have a psychological, subconscious and even spiritual connection, transcending original science based theory and simultaneously linking with it. There are also extensive references to neurobiology, the medical side of fascial unwinding and ideomotor reflexes, lending a scientifically proven base to these findings.</span></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><br /></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-family: arial; font-size: 13px;">Overall, the writer seems to have attempted to isolate and detach the phenomenon of fascial unwinding as a seperate event in order to portray it in a conventionally scientific format, unfortunately this has not worked in his favour due to the inherently holistic nature of fascial unwinding. He has utilised many quality reference sources, namely peer reviewed journals, but his downfall lies in his communication of these findings in what should have been an academically rigorous manner.</span></p><div><br /></div><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: 13px;">References:</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: 13px;"><br /></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: 13px;">Halligan, P. & Oakley, D. (2000) <span class="Apple-style-span" style="font-style: italic;">Greatest Myth of All</span>. New Scientist 168 (2265), 35 - 39.</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: 13px;"><br /></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: 13px;">My own thoughts.</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: 13px;"><br /></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: 13px;">Terra Rosa Bodywork E-News. (2008) <span class="Apple-style-span" style="font-style: italic;">Unravelling the Mysteries of Fascial Unwinding</span>. Retrieved on the 26th April 2009, from:<a href="http://74.125.95.132/custom?q=cache:5ptBtbTPEsoJ:www.terrarosa.com.au/articles/Terra_News2a.pdf+unraveling+the+mysteries+of+unwinding&cd=1&hl=en&ct=clnk" style=""><span class="Apple-style-span" style="color: rgb(0, 0, 0); text-decoration: none;"> </span></a><span class="Apple-style-span" style="font-size: 16px; "><a href="http://74.125.95.132/custom?q=cache:5ptBtbTPEsoJ:www.terrarosa.com.au/articles/Terra_News2a.pdf+unraveling+the+mysteries+of+unwinding&cd=1&hl=en&ct=clnk"><span style="font-family:arial;font-size:85%;">http://74.125.95.132/custom?q=cache:5ptBtbTPEsoJ:www.terrarosa.com.au/articles/Terra_News2a.pdf+unraveling+the+mysteries+of+unwinding&cd=1&hl=en&ct=clnk</span></a></span></span></p>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-85230986026302169902009-04-02T22:34:00.002-07:002009-04-03T04:48:15.919-07:00My Search Process: Memo<span class="Apple-style-span" style="font-size:small;"><div><span class="Apple-style-span" style="font-size: small;">I am really enjoying the spontaneous way in which our group arrived at its hypothesis, using a largely intuitively guided process. The qualitative and quantitative elements are neatly combined within the format of the question, allowing for a greater scope of analysis and possible "avenues for further investigation" (Cohen, Manion & Morrison, 2007, p.483) into the subject of chronic pain.</span></div><div><span class="Apple-style-span" style="font-size: 13px;"><br /></span></div><div><span class="Apple-style-span" style="font-size: 13px;">The difficulty I face is with the foreign terminology that comes with the territory of research methods and analysis, providing an immediate obstacle to overcome before I can delve deeper into the potential methodology and different research perspectives (e.g. triangulation). The concept of hypothetical questions and inference are equally difficult for me to familiarise myself with due to the challenge of understanding abstract theoretical concepts over concrete specific objects (as in the field of massage therapy, e.g. anatomy).</span></div><div><span class="Apple-style-span" style="font-size: 13px;"><br /></span></div><div><span class="Apple-style-span" style="font-size: 13px;">I notice that the polytechnic as an environment in which to commence this collaborative research assignment is indeed a good choice due to the close proximity of necessary resource facilities such as the Bill Robertson library, and within walking distance to the Medical and University libraries. The mood around this research site is both contemplative allowing for spontaneous intuitive expression to occur in relation to the collaborative research process and intellectually stimulating, encouraging deeper exploration and thought into the stages of said process.</span></div><div><span class="Apple-style-span" style="font-size: 13px;"><br /></span></div><div><span class="Apple-style-span" style="font-size: 13px;">So far, the group dynamics have been cohesive, collaborative and relatively intuitive during the initial phase of formulating a research question and delegating the tasks required to investigate this more thoroughly. However due to the round table nature of our group, all members are perceived as equal and this has resulted in an equal distribution of the workload, and tasks. The positive aspect of using this system is that the organically different viewpoints of each researcher regarding each task area will result in a greater diversity of data and information, as seen in triangulation.</span></div><div><span class="Apple-style-span" style="font-size: 13px;">This is the stage of the research process in that the use of mixed methods is particularly beneficial as the differing observations of each group member will allow for greater precision and deeper comprehension of the research question.</span></div><div><span class="Apple-style-span" style="font-size: 13px;"><br /></span></div><div><span class="Apple-style-span" style="font-size: 13px;">The value of time is fundamental to the quality of the research process, as deeper theories and intuitive possibilities cannot properly be expounded without ample time to posit questions and rework these to a refined hypothesis. Inevitably however, these many possibilities need to be narrowed down into "general and specific points" (Cohen et al, 2007, p.487) relating to the original research question so that our process may evolve successfully. This will then lead on to the next stage of the collaborative research process requiring more direct research and specific analysis than abstract theory.</span></div><div><span class="Apple-style-span" style="font-size: 13px;"><br /></span></div><div><span class="Apple-style-span" style="font-size: 13px;">At this point in time, I am simultaneously interested in the domain of research methods and the basis/structure of this and confused by the abstract nature of the subject which is largely intellectual and relies on the theories of individuals, which in its very essence will be reasonably diverse. In conclusion, I look forward to the continuing challenge posed by research methods and the resulting expansion of my own intellectual knowledge.</span></div><div><br /></div></span><div><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;">Reference List</span></span></div><div><span class="Apple-style-span" style="font-size: 13px; ">Class notes</span></div><div><span class="Apple-style-span" style="font-size: small;">Cohen, L., Manion, L. & Morrison, K. (2007) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: small;">Research Methods in Education</span></span><span class="Apple-style-span" style="font-size: small;">. New York: Routledge, p. 483, 487.</span></div><div><span class="Apple-style-span" style="font-size: 13px;">My own thoughts</span></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com1tag:blogger.com,1999:blog-1539144409737351337.post-77973086988160825532009-04-02T00:26:00.000-07:002009-04-02T17:58:49.559-07:00Pathology of Tennis Elbow (lateral epicondylitis)<div><p class="MsoNormal" style="MARGIN: 0cm 0cm 10pt"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;">Etiology:</span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 10pt"><span class="Apple-style-span" style="font-size: small;">Tennis elbow is a repetitive strain injury caused by recurrent twisting and jarring movements through the lateral forearm and elbow. Unlike its name suggests, it is not necessarily caused by playing tennis (O'Young, Young & Stiens, 2002). These initial movements cause minute tears in the muscular tissue and tendon fibres which have a cumulative effect resulting in pain from chronic overuse. Tendinitis is the initial inflammation of the forearm extensors and lateral epicondyle, which then develops into lateral epicondylitis (Shultz, Houglum & Perrin, 2005) as described below in Pathogenesis. Risk factors for the development of tennis elbow/lateral epicondylitis include middle age groups (30 - 50 year olds), professional athletes who use a racquet, bodybuilders and occupations such as construction and carpentry (Kraft, 2009).</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;">Pathogenesis:</span></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;"><br /></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;"> Once the tears have occurred, the continued repetition of jerky movements aggravates this tissue damage, resulting in inflammation through the radial portion of the forearm, restricting movement and causing pain (Cyriax, J., 1936). The radial tendon continues to rub against the inflamed periosteum of the lateral epicondyle, and according to Davies (2006) causes further swelling, pain when resting, restriction of movement and weakness through the affected forearm in the long term.</span></span></p><span class="Apple-style-span" style="font-size: small;"><br /></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;">Morphology:</span></span><span class="Apple-style-span" style="font-size: small;"> </span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: small;"><br /></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;">Once lateral epicondylitis has been triggered off by the initial tendinitis, morphological and histological changes occur. The fibroblasts and collagen fibres produced as part of the body's healing mechanism in response to injury, lay down a new extracellular matrix to knit together the tendinous tissues (Shultz et al, 2005). The collagen fibres then strengthen and harden into a tougher matrix of granulation tissue containing more fibroblasts, blood vessels, collagen and fibrinogen leading to 'scar' tissue (Wikipedia, 2009) at the site of the lesion.</span><span class="Apple-style-span" style="font-size: small;"><o:p></o:p></span></span></p><span class="Apple-style-span" style="font-size: small;"><br /></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;">Epidemiology: </span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-weight: normal; "></span></span></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;"><br /></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-weight: normal; "><span class="Apple-style-span" style="font-size: small;">Incidence - Tennis elbow/lateral epicondylitis affects 4-7 individuals per 1,000 patients as seen by a GP annually (Selby, 2004).</span></span></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span class="Apple-style-span" style="font-size: small;"><br /></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;">Prevalence - As indicated by research conducted by Allander (1974, cited in Pecina, 2004), tennis elbow/lateral epicondylitis was found to exist in 1 - 5% of a population of 15,268 individuals within an age range of 31 - 74 years.</span></span></p><span class="Apple-style-span" style="font-size: small;"><br /></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;">References:</span></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-weight: bold;"><span class="Apple-style-span" style="font-size: small;"><o:p></o:p></span></span></span></p><span class="Apple-style-span" style="font-size: small;"><br /></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;">Cyriax, J. (1936) The Pathology and Treatment of Tennis Elbow (Electronic Version). </span><i><span class="Apple-style-span" style="font-size: small;">The Journal of Bone and Joint Surgery, Inc</span></i><span class="Apple-style-span" style="font-size: small;">., 18, pp. 921 - 940.</span><span class="Apple-style-span" style="font-size: small;"><o:p></o:p></span></span></p><span class="Apple-style-span" style="font-size: small;"><br /></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;">Davies, C. (2006) </span><i><span class="Apple-style-span" style="font-size: small;">Self-Treatment of Tennis Elbow, Golfer's Elbow, Lateral Epicondylitis, Medial Epicondylitis, Elbow Tendinitis, Elbow Bursitis</span></i><span class="Apple-style-span" style="font-size: small;">: The Trigger Point Therapy Workbook. Retrieved the 30th March, 2009 from: </span><span style="color:blue;"><a href="http://www.triggerpointbook.com/tennisel.htm"><span class="Apple-style-span" style="font-size: small;">http://www.triggerpointbook.com/tennisel.htm</span></a></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;"> </span><span class="Apple-style-span" style="font-size: small;"><o:p></o:p></span></span></p><div><span class="Apple-style-span" style="font-size: small;"><br /></span></div><div><span class="Apple-style-span" style="font-size: small;">Kraft, J. (2009) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: small;">Tennis Elbow Isn't Just for Athletes</span></span><span class="Apple-style-span" style="font-size: small;">. Retrieved the 30th March, 2009 from: http://www.aopeoria.com/edu-art3.shtml</span></div><span class="Apple-style-span" style="font-size: small;"><br /></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;">O'Young, B., Young, M. & Stiens, S. (2002) </span><i><span class="Apple-style-span" style="font-size: small;">Physical Medicine and Rehabilitation Secrets</span></i><span class="Apple-style-span" style="font-size: small;">. Philadelphia: Elsevier Health Sciences, pg. 267.</span><span class="Apple-style-span" style="font-size: small;"><o:p></o:p></span></span></p><div><span class="Apple-style-span" style="font-size: small;"><br /></span></div><div><span class="Apple-style-span" style="font-size: small;">Pecina, M. & Bojanic, I. (2004) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: small;">Overuse Injuries of the Musculoskeletal System</span></span><span class="Apple-style-span" style="font-size: small;">. Florida: CRC Press LLC, p. 88.</span></div><div><span class="Apple-style-span" style="font-size: small;"><br /></span></div><div><span class="Apple-style-span" style="font-size: small;">Selby, M. (2004) </span><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size: small;">Clinical General Practice</span></span><span class="Apple-style-span" style="font-size: small;">. USA: Elsevier Health Sciences, p. 15.</span></div><span class="Apple-style-span" style="font-size: small;"><br /></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;">Shultz, S., Houglum, P. & Perrin, D. (2005) </span><i><span class="Apple-style-span" style="font-size: small;">Examination of Musculoskeletal Injuries</span></i><span class="Apple-style-span" style="font-size: small;">. Illinois: Human Kinetics, p. 280.</span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;"> </span><span class="Apple-style-span" style="font-size: small;"><o:p></o:p></span></span></p><span class="Apple-style-span" style="font-size: small;"><br /></span><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; LINE-HEIGHT: normal"><span style=""><span class="Apple-style-span" style="font-size: small;">Wikipedia. (2009) </span><i><span class="Apple-style-span" style="font-size: small;">Wound Healing</span></i><span class="Apple-style-span" style="font-size: small;">. Retrieved the 30th March, 2009 from: </span><a href="http://en.wikipedia.org/wiki/Wound_healing"><span style="color:blue;"><span class="Apple-style-span" style="font-size: small;">http://en.wikipedia.org/wiki/Wound_healing</span></span></a><span class="Apple-style-span" style="font-size: small;"><o:p></o:p></span></span></p><br /><p class="MsoNormal" style="MARGIN: 0cm 0cm 10pt"><o:p><span style="font-family:Calibri;"> </span></o:p></p><a href="http://en.wikipedia.org/wiki/Wound_healing"></a></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-17778374938029888032009-03-24T22:00:00.000-07:002009-03-25T21:26:06.440-07:00Information Quality<div>When searching for background information on a topic, references are fundamental in lending the information credibility and allowing the reader to research the findings to their own extent. They assist in crediting the original sources with exclusive findings allowing the researcher to elaborate on these results with their own exploration into the domain in question (Referencite, 2009). Correctly referenced information lends new or contrary research viability that it may not have had initially.</div><div><br /><div>Generally, references from a meta analysis are more reliable and thus a higher quality source of information. This is due to the enormity of the studies carried out and the overall consistency of the findings, reinforced by each relative study and summarized (Preiss, 1988).</div><div>References from sources that are not well known, difficult for other researchers to access, such as a first hand lecture, or a resource that is out of date e.g. an outdated textbook, are all of lower quality.</div><div><br /></div><div>References need to display a date of publication, as this places the information into an historical context, which may be crucial according to how cutting edge the research is. For example: breakthrough research into the causes of breast cancer may not benefit from outdated research with ambiguous conclusions, as further discoveries may have been made since this time (Tyburski, 1997).</div><div><br /></div><div>Ideally, references will allow the reader to investigate the idea proposed with ease and as a result be easy to access and understand. A way to sift out the quality references from the low quality involves briefly scanning the title to see whether it is clear cut or ambiguous sounding. A good quality reference will generally have a good title which hints at the research content, which will in turn generally be easy to follow and understand.</div><div><br /></div><div>Also observing which disciplinary area the research is alluding to and how relevant this is to massage practise, for example we may have a quality reference from a psychology journal which correlates to our research findings or area of interest, yet is not from within the massage therapy sphere of research. This is known as inter-disciplinary referencing (regarding theories) or cross-disciplinary referencing (regarding the practise in question) which according to Mann (2005) allows for greater insight into the research question from differing points of view.</div><div><br /></div><div><span class="Apple-style-span" style="font-weight: bold;">References:</span></div><div><br /></div><div>Mann, T. (2005) <span class="Apple-style-span" style="font-style: italic;">The Oxford Guide to Library Research.</span> US: Oxford University Press, p12.</div><div><br /></div><div>Preiss, R. W. (1988) <span class="Apple-style-span" style="font-style: italic;">Meta-analysis: A Bibliography of Conceptual Issues and Statistical Methods.</span> Annandale, VA: Speech Communication Association.</div><div><br /></div><div>Referencite. (2009) Plagiarism. Retrieved on the 23rd March, 2009 from http://www.cite.auckland.ac.nz/index.php?p=plagiarism</div><div><br /></div><div>Tyburski, G. (1997) <span class="Apple-style-span" style="font-style: italic; ">How to Evaluate Information.</span> Retrieved on the 2oth March, 2009 from http://www.virtualchase.com/quality/checklist.html<br /></div><div><br /></div></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0tag:blogger.com,1999:blog-1539144409737351337.post-92116748557264202402009-03-05T18:19:00.000-08:002009-03-06T16:55:04.274-08:00The Research Process<div><div>The research process consists of about nine total stages whether in the field of medicine, massage therapy or social sciences. These are: ideas/observations, background reading/literature review, the methodology and thus the methods, data collection and analysis, results and implications, conclusion, budget considerations and references. <br /></div><div><div><br /></div><div>During the initial stage an idea begins to form. In the medical arena this is facilitated by observation (McQueen, 2009). In more philosophical studies, it is assisted by the process of brainstorming and asking questions.</div><div><br /></div><div> </div><div> </div><div>The next natural step to take is to find out more information from other reputable sources about this idea, and whether this idea is new. Variations on the idea may also be uncovered, adding to its growth and refinement. This is also called the background reading/literature review portion, adding to the general knowledge about the subject matter and idea.</div><div><br /></div><div> </div><div> </div><div>The methodology employed is the next portion of the process and this determines the types of methods we use and why we use them in our quest for the truth (ontology) regarding this idea.</div><div><br /></div><div> </div><div> </div><div>The methods themselves are the next stage in which the hypothesis itself is put to the test through the use of these methods, which for example, may include measurements and baselines. (Corsini, 1994)</div><div><br /></div><div> </div><div> </div><div>Data collection and analysis is the part of the research process in which data gained via the methods is investigated, compared to norms and becomes the fatual basis in our goal to prove the hypothesis.</div><div><br /></div><div> </div><div> </div><div>Once we have collected the data and analysed it, we end up with a group of results (the size of which depends on the amount of tests undertaken.) From these results we can infer implications regarding the original hypothesis and what these implications may now mean for the area we are researching (eg. massage therapy).</div><div><br /></div><div> </div><div> </div><div>This would lead us to the conclusion of our proposal based on our recent inferences, results and data as well as related empirical research (Wikipedia, 2009) which may have been conducted around hypotheses of a similar nature.</div><div><br /></div><div> </div><div> </div><div>Budget considerations are necessary to ensure that the research proposal is viable and realistic to put into action.</div><div><br /></div><div> </div><div> </div><div>References allow your work to be traced and can invite readers of the research to conduct their own background reading on the subject, potentially drawing their own conclusions based on further exploration.</div><div><br /></div><div> </div><div> </div><div>The research process is a valuable tool with which researchers can expound the benefits or detriments of the hypothesis and subsequently, what this would mean for the profession in question.</div><div><br /></div><div> </div><div> </div><div><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size:medium;">References:</span></span></div><div><span class="Apple-style-span" style="font-style: italic;"><br /></span></div><div><span class="Apple-style-span" style="font-style: italic;"> </span></div><div><span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size:small;"> </span></span></div><div><span class="Apple-style-span" style="font-size: small;">Corsini, R. (1994) Encyclopaedia of Psychology. Michigan: J. Wiley & Sons.</span></div><div> </div><div> </div><div><span class="Apple-style-span" style="font-size: small;">McQueen, F. Telephone interview. Thursday 5th March, 2009.</span></div><div> </div><div><span class="Apple-style-span" style="font-size: small;">Empirical research. Wikipedia. Retrieved 6th March 2009 from: http://en.wikipedia.org/wiki/Empirical_research</span></div><div> </div></div></div>Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com1tag:blogger.com,1999:blog-1539144409737351337.post-5105250296280204092009-02-18T13:15:00.000-08:002009-02-18T13:23:13.579-08:00Who I am<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-XkqGs2pwqdk4fDuic7VykKzQ_fUXY66f_c4XH4QDH_QNyJH5HyT5wQUIM_zBo_yvAA9_CpQN74jBtyHIF3vP-ZPH73AbtwVyNaixqhw8ckMs8h76wxizhxiaycxiF_SMAPcgmLs431cw/s1600-h/17478362a4570622516b17613205l.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-XkqGs2pwqdk4fDuic7VykKzQ_fUXY66f_c4XH4QDH_QNyJH5HyT5wQUIM_zBo_yvAA9_CpQN74jBtyHIF3vP-ZPH73AbtwVyNaixqhw8ckMs8h76wxizhxiaycxiF_SMAPcgmLs431cw/s200/17478362a4570622516b17613205l.jpg" alt="" id="BLOGGER_PHOTO_ID_5304250967944299970" border="0" /></a><br />Hi there! I am a fulltime second year massage therapy student at the polytech, with my own massage and reiki practise on the side. Originally from Tamaki Makaurau (Auckland) this is my 6th & last year in Dunedin, before I fly away on my extensive OE.<br />Feel free to blog to my blog :)Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com1tag:blogger.com,1999:blog-1539144409737351337.post-75777418760077408842009-02-18T12:22:00.000-08:002009-02-18T12:38:57.136-08:00Early starts<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://news.nationalgeographic.com/news/2007/03/images/070323-owl-picture.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 204px; height: 284px;" src="http://news.nationalgeographic.com/news/2007/03/images/070323-owl-picture.jpg" alt="" border="0" /></a><br />For those of us that have the night owl style bodyclock, early starts are not always the most appropriate form of class time scheduling.. Something to think about!Tessa Ghttp://www.blogger.com/profile/00144424209285036284noreply@blogger.com0