5 - Business & ethics Flashcards
Criteria for a professional
- Maintaining a specialized body knowledge
- Extensive training
- Having an orientation toward service
- Acting within a commonly excepted code of ethics
- Act within a certain scope of practice
- Have legal recognition through the certification of licensure by a professional association
- Being part of a professional association
Technician vs. Practitioner vs. Therapist
Technician:
- has expertise in a technical skill or process
- has the least amount of training
- most limited SOP
Practitioner:
- practices an occupation or profession
- Operates from a greater knowledge base
- has a larger SOP
Therapist:
- treats illness or disability
- Requires the highest educational background
- has the brightest SOP
Therapeutic massage definition
Massage is defined as the systemic manual or mechanical manipulations of the soft tissues of the body by: - rubbing - kneading - pressing - rolling - slapping - tapping for therapeutic purposes such as - promoting circulation of the blood and lymph - relaxation of the muscles - relief from pain - restoration of metabolic balance - other benefits both physical and mental
Scope of practice (SOP)
Knowledge base and practice parameters of a profession
A true professional will accept clients based upon the SOP
Scope of practice - two distinct professional words
- Wellness and personal services
2. healthcare services
Scope of practice - Wellness and personal services
Specific approach that focuses on assessment procedures to detect contraindications to massage and the need for a referral to other medical professionals
Follow the directions of the client and apply the specialized training of the therapist to normalize the body systems
Scope of practice - Healthcare services
Develop, maintain, rehabilitate and augment physical function.
May prevent or relieve physical dysfunction & pain as well as enhance client well-being.
Method may include assessment of soft tissue and joints and treatment with various techniques of soft tissue manipulation and hydrotherapy
Scope of practice - Limits of practice
Respect the scope of practice of the other professionals (acupuncture, athletic training, chiropractic, cosmetology, dentistry, and FedEx, medicine, naturopathic, nursing, osteopathy, physical therapy, podiatry)
Scope of practice - Limits of practice
It’s professional as limits to use ability to purchase massage
Personal: education, personal bias, specific interests, physical limitations
Professional: set boundaries that support each profession in the most successful professional structure.
“Know what you can and can’t do you cannot be all things to all people”
Scope of practice - Limits of practice - Realms of function
- Normal: Work that is satisfying intrinsically
- Dysfunctional: complex circumstances and athletic patterns
- Illness/trauma
Scope of practice - Limits of practice - Realms of function - Normal
Working with clients who are in good health.
Massage enhances and maintains normal functioning.
Promote and provide wellness through massage, education and preventive care
Scope of practice - Limits of practice - Realms of function - Dysfunctional
Working with clients who are beginning to break down due to physical or emotional stresses.
Provides support by dealing with the motor function often in conjunction with other wellness professionals.
Goals may include helping move the client towards normal functioning
Scope of practice - Limits of practice - Realms of function - Illness/Trauma & trauma
Working with other healthcare professionals in a comprehensive treatment plan.
Provide specific intervention as directed in a supervise setting
Ethics
“What is right “
Defines the behavior we expect of ourselves and others and societies expectations of a professional
Ethics - Mandatory ethics
Complying with the law as established by legislation whether local, state or national
Ethics - Aspirational Ethics
Striving for the highest possible benefit and welfare of the client.
Practicing and ethically in our profession is to promote and maintain the welfare of our client whilst following the laws as provided
Ethics - Professional code of ethics
Norms adopted by a professional group to correct choices and behavior in a manner consistent with professional responsibility within that profession
Ethics - Ethical principles
[MBLEX]
- Respect
- Client autonomy & self determination
- Veracity
- Proportionality
- Nonmaleficence
- Beneficence
- Confidentiality
- Justice/equality
Ethics - Ethical principles - Respect
[MBLEX]
Esteem and regard for clients, other professionals and oneself
Ethics - Ethical principles - Client Autonomy & self determination
[MBLEX]
Freedom to decide and right to sufficient information to make decision
Ethics - Ethical principles - Veracity
[MBLEX]
Right to the objective truth
Ethics - Ethical principles - Proportionality
[MBLEX]
Benefit must outweight burden of treatment
Ethics - Ethical principles - Nonmaleficence
[MBLEX]
Professionals sure do no harm and prevent harm from happening
Ethics - Ethical principles - Beneficence
[MBLEX]
Treatment should contribute to the client’s well-being
Ethics - Ethical principles - Confidentiality
[MBLEX]
Respect for privacy and information
Ethics - Ethical principles - Justice/equality
[MBLEX]
Justice/equality ?
Ethics - Standards of practice
Specific guidelines & rules that form a concrete professional structure.
They direct quality care and provide a means of measuring them.
Typically more tangible than ethical principles
Informed consent
[MBLEX]
An educational procedure that allows an individual client to decide if they want to work with a specific massage therapist.
Requires that client:
- understands what will occur during the massage session
- voluntarily participate
- is competent to give consent
Informed consent - Goals
[MBLEX]
- Support professional ethical behavior
- Reflects the ethical principle of client participation and self-determination in a client-centered approach
- Provides an opportunity to evaluate the options available and the risks involved
- Information about recourse options if the outcome of the massage is undesirable
Informed consent - Components
[MBLEX]
- What are the goals of the therapeutic program?
- What services will be provided?
- What behavior is expected of the client?
- What are the risks and benefits of the process?
- What are the practitioner’s qualifications?
- What are the financial considerations?
- How long is the session expected to last?
- What are the limitations of confidentiality?
- In what areas does the professional have mandatory reporting requirements?
Intake procedures
- Needs assessment
- Initial treatment plan
- Written policy information such as a brochure
- Informed consent process
Intake procedures - Needs assessment
- Based on the clients history and a physical assessment
- Is used to devise initial treatment plan
Intake procedures - Initial treatment plan
- States therapeutic goals, duration of the sessions, number of appointments needed to meet goals, cost, intervention to be used
- establishes objective progress measurement for identifying when goals have been reached
Intake procedures - Written policy information such as a brochure
- Type of service,
- training and experience,
- appointment polices,
- client/practitioner expectations,
- fees,
- statement of sexual appropriateness,
- recourse policy
Intake procedures - Informed consent process
- Therapist provides appropriate forms, discusses the information, establishes professionalism.
- Therapist reviews information point by point after client has read it.
- Both client and therapist signed the form
Confidentiality
Principle that client’s information is private and belongs to the client.
Built on respect and trust.
Client must sign a release of information form to allow professionals to exchange their private information.
- Confidentially also refers to public recognition of relationship (Client should not be a knowledges in public unless they recognize & greet the professional first)
- At no time should a therapist discuss a client with another individual unless approved by the client in advance
Professional Boundaries
[MBLEX]
Boundaries = emotional space surrounding us.
Designated by morals, values and experiences.
For professional purposes: another’s personal boundaries = the space about an arm’s length from you and until invited to come closer
Professional Boundaries - Personal vs. Professional vs Client’s
Personal boundaries - define by looking honestly at:
- fears
- frustrations,
- prejudices,
- biases
- personal and moral value systems
Professional boundaries - Personal boundaries provide guidelines for setting client boundaries
Client’s boundaries - determine & consider the client’s needs and wants to maintain the best professional relationship possible
Professional Boundaries - Right of refusal
- Client has the right to refuse the massage practitioner services at any time.
- Professional may refuse to massage or otherwise treat any person if a just & reasonable cause exists.
(explain the reason why and how it may affect the quality of care expected)
Therapeutic Relationship
[MBLEX]
Unidirectional focus in which the knowledge and skills of a professional are used to assist the client in achieving a therapeutic outcome.
Maintain professional boundaries & professional space to preserve therapeutic relationship.
Therapeutic Relationship - Power differential
[MBLEX]
Power imbalance between client and professional stemming from the difference in skills and knowledge.
It is a normal part of the therapeutic relationship & should be recognized but minimized to not make the client uncomfortable
Therapeutic Relationship - Transference
[MBLEX]
Personalization of professional relationship by client
When client sees massage professional in personal light instead of a professional manner.
May include demanding more therapy time than scheduled, bringing therapist personal gifts, proposal for friendship or sexual activities.
Therapeutic Relationship - Transference
[MBLEX]
Inability of the professional to separate therapeutic relationship from personal feelings and the client expectations
Feelings of attachment to the client and assuming too much responsibility for the outcome of the client
Therapeutic Relationship - Dual or multiple roles
[MBLEX]
When scopes of practice overlap and Professional has more than one area of expertise.
Feelings of intimacy may arise due to physiological & psychological responses to stimulation.
Professional and client must understand feelings on the psychological level to maintain a professional relationship.
Expl: I search for friends and family members.
Therapeutic Relationship - Diffusing feelings of sexual arousal
[MBLEX]
Same techniques relieving stress & providing relaxation may stimulate the entire sensory mechanism
Sympathetic autonomic nervous system controls the relaxation response and the sexual arousal response
Relaxation exposes the client to predisposing physiological factors present during sexual arousal
Therapeutic Relationship - Diffusing feelings of sexual arousal - Methods to deal with situation
[MBLEX]
- Recognize it and interrupt it, change what you’re doing.
- Be aware of your own physiological state.
- Adjust the intent of the session to stimulate a more sympathetic output response
- Change music, lighting, conversation & client’s position. - Stop working with your hands & use your forearms.
Ethical decision making
- Use problem-solving approach to enhance ethical decision making.
- Use basic communication skills to listen effectively and deliver a ‘I’ Message.
Identify & resolve conflict in the professional setting
Do not let personal judgment interfere with personal care given.
Clients best interest may conflict boundaries set by the therapist.
Expl: body odor keeps you from concentrating / client refuses medical intervention
Ethical decision making - 8 steps
- Gather facts to identify & define situation.
- Brainstorm possible solutions.
- Logically & objectively evaluate solutions. Look at both sides and pros & cons.
- Evaluate effect of each solution on the people involved
- Choose a solution and plan implementation.
- Implement plan and set a date for reevaluation.
- Determine the logical consequences if the plan is not followed.
- Reevaluate & make adjustments, then implement the refined plan
Communication skills
- Body language
- Spoken language
- Listening
Communication skills - Body language
Strong messages are sent this way.
Importance of congruence between how we are seen, what we say and what we feel
Communication skills - Spoken language
Use language appropriate for the professional message and to the situation.
Important to be aware of clients understanding of the words used and explain further if needed.
Tone properly used can convey importance to a topic or make a topic seem unimportant.
Communication skills - Listening
Effective listening involves development of focusing skills.
Occurs when we listen to understand what is being communicated.
Does not mean agreement with what is being said
We can’t plan & prepare an appropriate response if we’re not listening with focus
Communication skills - Listening - 2 types
Reflective listening: involves restating information to indicate that message is received & understood.
Active listening: clarifies a feeling attached to message without adding to or changing message.
Communication skills - Guidelines
‘I’-messages shares feelings and concerns.
‘You’-messages tend to put people down, blame, criticize & provoque anger hurt & feelings of worthlessness.
Attempt to minimize ‘you’-messages
Communication skills - ‘I’-message patern
- Describe behavior or problem you find bothersome (facts)
- State your feelings about the situation (impact on people).
- State consequence (logical cause &effect).
- Request preferred behavior or action (possibilities)
Conflict & conflict resolution
Expressed struggle between two or more parties who perceive incompatible goals, scarce resources or interference from the other party
Conflict resolution does not necessarily resolve tensions between people.
May simply align matters sufficiently to allow each person to make progress toward his/her goals.
> Written documentation must be maintained in regards to the resolution.
Objective documentation provided by the parties will help maintain clarity.
Conflict & conflict resolution - Denial or withdrawal
Denying conflict exists or refusing to knowledge it.
Creates a situation where conflicts grows & become unmanageable
Conflict & conflict resolution - Suppression or smoothing over
Down the differences that exist & tries to gloss over the conflict
Conflict & conflict resolution - Power or dominance
Decision made by someone in authority or by vote, results in winners and losers
Conflict & conflict resolution - Compromise or negociation
Results in each party assuming more power than delegated or both parties assuming the other will take responsibility
Conflict & conflict resolution - Integration and collaboration
All involved recognize the other interests, responsibilities and abilities.
Participants are expected to modify or consider their work in progress.
Process takes time, energy and openness
Conflict & conflict resolution - Communication during ethical dilemma
- Examine all aspects of the situation.
- Talk about it with the others involved.
- Begin conversations by identifying the problem.
- Use ‘I’-message format.
- Ask open-ended questions.
Conflict & conflict resolution - Barriers to communication
- Time constraints
- Old patterns
- Conflict avoidance
Conflict & conflict resolution - Time constraints
Take time to consider words to use (written or spoken) & on what is being said.
Allow time for other party to reflect and respond
Conflict & conflict resolution - Old patterns
Recognize how you have dealt with past conflicts and how you can react more positively in the future.
If necessary, leave situation and come back to it.
Reflect rather than react.
Conflict & conflict resolution - Conflict avoidance
Avoiding conflict often results in strong emotions & ineffective resolution.
Credentials & licensing - Government credentials
- Licensing - required of all constituents who practice the profession under the jurisdiction of the licensing body (protecting title usage)
- Certification - voluntary but required to use a title
- Registration
Dealing with suspected unethical or illegal behavior
- Self reflection before confrontation or action
Think carefully to personal motivation.
Should be based on genuine concern for fellow professional, clients, good of profession. Not based on personal values or moral beliefs. - Mentoring & peer support
Maintain confidentiality and only provide information relevant to issue. - Talking with those involved
If colleague or peer share concern, speak directly to individual who may be unaware of the breach - Format reporting
File a complaint with the appropriate government body
Scope of practice
Legal definition of activities a professional can or cannot do.
Scope of practice - Massage therapist
Therapist:
- have clients
- assess individuals for dysfunction
- based on assessment: determine appropriate treatment plan within scope of practice
- provide healthcare services in an attempt to remedy the perceived dysfunction
Intake form - Key areas
[MBLEX]
- Contact information for the client & for an emergency contact
- Employer & occupation
- Previous massage experience & reason for appointment
- Medical conditions (specific disease or dysfunction, issue that may affect massage application)
- Medications
Intake form - other areas required by TDLR
[MBLEX]
- For each client, keep accurate record of services dates, types of massage therapy & billing info. To be maintained for 5 years minimum.
- Obtain written consent of parent/guardian for person under age of 17
- On written request from client (or parent/guardian): provide written explanation of the service charges (even if charges paid by third party)
- Provide initial consultation priori 1st massage & obtain client’s signature on consultation document
- Notify client of department contact info for purpose of directing complaints (on written contract for service / on sign displayed in primary place of business / on a bill of service / other written & documented method)
Intake form - Consultation document
[MBLEX]
Shall include:
- Type of massage techniques anticipated to be used during therapy session
- Parts of client’s body that will be massages or areas that will be avoided (incl. indications/contraindications)
- Statement that licensee shall not engage breast massage of female clients without written consent
- Statement that draping will be used during session, unless otherwise agreed by both parties
- statement that if uncomfortable for any reason, client may ask to cease massage and licensee will end session
- Signature of client & licensee
SOAP noting - reasons why it’s important
[MBLEX]
- Allows tracking of client’s progress session to session
- provides history for a client, should they return with similar complaint in the future
- Provides essential paper trail or legal documentation & usually required to bill insurance plan or third party
- Provides therapist with a review of treatment protocol
SOAP noting - Meaning
[MBLEX]
S - Subjective findings
O - Objective findings
A - Analysis
P - Plan
Make sure writing is legible.
SOAP noting - Subjective findings
[MBLEX]
Subjective data recording from client’s point of view
Cannot be measured
May include:
- Key symptoms (quantified & qualified)
- Activities affected by situation
- Methods or activities client currently use to manage condition
Specifics may include:
- description of experienced pain,
- intensity,
- location,
- symptoms,
- frequency of occurence,
- duration
- onset
SOAP noting - Objective findings
[MBLEX]
Objective data acquired from:
- visual inspection,
- palpation
- other assessments
> List of assessment procedures should be recorded
List treatment goals & method of treatment used
SOAP noting - Analysis
[MBLEX]
Records an assessment of the effectiveness of the treatment session & a summary of most pertinent data from the session
> Most important area of the SOAP
Should include:
- Changes in client’s subjective
- Changes in therapist objective (hopefully measurable)
- Analysis of efficacy of methods used
SOAP noting - Plan
[MBLEX]
Expected methodology for future intervention
Usually includes:
- suggested frequency of appointments
- step by step process to achieve the treatment goals
- if appropriate, instruction for client’s self-care
- referrals made to client
