Complete Your CE Test Online - Click Here knowledge base may be very different from that of other practitioners in your neighborhood, state, or country. Licensing agencies and professional societies establish standards of quality and professional expertise in the field and ensure that licensed individuals are keeping pace with recent developments through continuing education requirements. Scope of practice Scope of practice refers to your area of competence, usually obtained through formal study, training, and/or professional experience, and one for which you’ve received certification or other proof of qualification. Unlike other standardized training programs or fields of study, schools of professional massage therapy and state requirements vary significantly in the number of necessary hours of study and curriculum. Some schools provide substantial training in specialized procedures, such as lymphatic-drainage techniques or hydrotherapy, while others may only touch upon these subjects, if they are discussed at all. Choosing to provide services for which you are not appropriately trained or competent is a dangerous personal decision that undermines the profession and may carry weighty legal implications. Your personal level of discretion and ethical standards will largely determine the manner in which you advertise your services, describe your education and professional experience, and list credentials. You will have to decide for yourself if you can rightfully claim substantive experience in a discipline for which you’ve attended a three-hour workshop or watched a series of instructional videos, or when you can properly call yourself an expert in one modality or another. Misrepresenting one’s educational achievements, credentials, or abilities is a serious breach of responsibility that endangers client safety and reflects poorly on the profession as a whole. If a subject is outside your area of expertise, don’t hesitate to say so, and direct the client to appropriate informational resources or professional services. Make sure any information or suggestions you pass along are supported by the professional community and recent research findings, and are appropriate and safe for the client. Safety Practitioners are required to abide by industry standards of safety and hygiene. Client draping, towels, the table surface, and other relevant items or materials must be cleaned according to accepted standards of sanitation, and meet all legal health and safety requirements (including universal precautions relating to communicable diseases). Practitioners should know how to cover cuts and use sanitizing supplies such as disinfectant hand wipes effectively. Practitioners must have the skills and knowledge to assess a client’s condition and provide safe and appropriate therapy. They must be attuned to verbal and non-verbal client feedback, and alert to possible contraindications for massage. Sometimes these decisions are less than clear-cut, requiring a bit of research or consultation with medical personnel more familiar with the client’s condition. Never allow the client, the client’s relatives, or even the client’s doctor to pressure you to proceed if you have any doubts regarding the safety of a specific procedure for a specific client. You are ultimately responsible for any injury sustained by the client during or resulting from massage and the medical and legal liability associated with it – even if the client’s physician specifically recommended or prescribed the bodywork. If you have strong concerns about the client’s health related to medication or procedures received through another source, suggest that the client have a trusted health care professional review the course of treatment. Pronouncements like this should not be made flippantly, as they could be the basis of legal action against you for practicing medicine without a license. If you believe your client has a serious medical condition or may have suffered an injury, tell the client immediately and refer him/her to the appropriate health care professional. Do not discuss the condition with the client’s doctor or anyone else unless you have explicit permission from the client to do so. Be sure to document your referral and the reasons for it in the client record. Keep scope of practice in mind when you give advice or make recommendations to clients. While listening attentively to your client is a relatively risk-free venture, sharing your opinions is not. Depending on the topic of conversation and your specific comments, you may be engaging in high-risk behavior whenever you have casual conversations with a client. Resisting requests for “advice” in any subject outside your areas of expertise is your safest option, but it is natural to be drawn into discussions with a client, especially one you’ve come to know well. Advice can be a dangerous and slippery slope for practitioners in large part because they may have some knowledge and experience regarding a topic that is health-related, but not strictly within their scope of practice. If you have found an effective nutritional supplement or exercise program that relieves the same symptoms your client is experiencing, you may have a strong impulse to share that information with your client. Or, you may want to warn your client away from a health regime that you consider ineffective or potentially dangerous. When giving your point of view, make sure you delineate a professional recommendation, based on years of experience and study, from suggestions or opinions of a more personal or general nature. Help your client distinguish between subject matter in which you are, and are not, professionally qualified. If a health or medical issue is outside your scope of practice, recommend that the client see a qualified health professional regarding the matter. Patient autonomy, informed consent, and right to refuse Informed consent refers to a patient’s right to understand his or her condition and participate in decisions regarding that care or condition. The patient, or patient’s guardian, is required to sign a written statement acknowledging agreement to proposed treatment terms and awareness of the known risk factors associated with them. It is through this process that a health care practitioner informs a patient about the risks and benefits of a proposed therapy and allows the patient to decide whether the therapy will be undertaken. It is based on the moral and legal premise of patient autonomy, and is the formal application of the client’s right to make decisions about his/her own health care. The principle of autonomy (self-rule) is based on the principle of respect for persons, which holds that individual persons have the right to make their own choices and develop their own life plan. In a health care setting, the principle of autonomy translates into the principle of informed consent: You shall not treat a client without his/her informed consent. In order to affirm autonomy, every effort must be made to discuss treatment preferences with clients and to document them in written records. In massage therapy, informed consent usually takes the form of an agreement between the practitioner and client that states their shared objectives, proposed treatment plan, expected outcome(s), and anticipated time frame for results. It may also refer to the client’s medical history, asserting that the client has informed the practitioner about all known physical or medical conditions and current medications, and will inform the practitioner if any of these conditions change. The notice of informed consent in massage therapy typically includes a statement explaining the role of massage therapy in pain and stress reduction or other specified purpose, and its limitations: ● ● Massage therapy does not take the place of medical examinations, care, or treatment. ● ● The practitioner is not a doctor and does not diagnose medical conditions or prescribe medication. ● ● Clients should continue to consult their primary caregivers or other specialists for ongoing health care and medical conditions. ● ● Clients should consult their primary caregiver to review health care recommendations before making significant changes in their health and exercise regimen or diet. Page 2 Massage.EliteCME.com