CE INSTITUTE LLC BLOG

by Selena Belisle, Founder/Instructor, CE Institute LLC

To maintain a professional and desirable massage therapy work environment, make sure your workspace is:

• Free of clutter
• Temperature controlled (to the client’s comfort)
• Installed with appropriate or adjustable lighting
• Dark enough for the client to relax with at least 40 watts of light during bodywork
• Light enough so the client can safely navigate in and out of the room, as well as dress, undress, find their personal belongings, etc.
• Properly installed with smoke detectors, carbon monoxide detectors, proper exit signs, fire extinguishers and any other safety equipment as needed and/or required by law
• Stocked with appropriate cleaning supplies and disinfectants
• Operating with an efficient scheduling process with proficient ability to process client cancellations, changes and payments
• Operating with appropriate security to keep client records and appointments confidential
• Installed with stable flooring, including any rugs secured to the floors and no uneven surfaces where clients could trip
• Easily accessible for the client. Ensure table height is appropriate so client can safely mount and dismount the table
• Provide a stepstool if the table is too high and nonadjustable

The massage therapy reception and work space should be equipped with appropriate chairs for sitting, waiting or changing, especially when serving a frail clientele. With geriatric or orthopedic leg post-op clients consider:

• Low setting couches may be trendy and sleek but would be difficult for a client to sit or rise
• Chairs without arms may pose the same problem
• Provide chairs and seating arrangements that create easy accessibility, especially for a client that may be in pain

Ensure the bathroom is clean and has:

• Toilet paper
• Hot & Cold Running Water
• Soap or Hand Cleanser
• Ability for client to dry their hand
• Paper towel
• Washable linens (to be used one time then laundered
• Air dryer

Always Perform Proper Hand Hygiene:

• Before eating
• Before and after having direct contact with a client (whether it be a massage, manicure, facial, haircut, waxing appt., etc.)
• After contact with blood, body fluids or excretions, mucous membranes, non-intact skin or any questionable exposure
• After contact with a sharp object that could have cut skin
• If hands could be moving from a contaminated-body site area to a clean-body site during client contact
• After glove removal
• After using a restroom
• Use additional care as needed

High Standards of Personal Hygiene and Professional Service Considerations Include:

Clean uncontaminated clothing.  Refrain from wearing clothes that have come in contact with a client – these should be changed to prevent “cross contamination” from client to client.

Use hand towels to separate the client’s body from bodyworker clothing.  If the bodyworker lays a prone ankle over their shoulder, then a hand towel should be placed over the bodyworker’s shoulder to prevent contact between the client’s naked ankle and the bodyworker’s clothing.

Refrain from wearing clothes that are dirty, have body odor, etc. 

Keep a “change of clothes” readily accessible so that appointments would not be cancelled due to soiled clothing OR that appointments are not performed with soiled clothing

Refrain from wearing clothing that provides excess nudity, i.e. bodyworker should wear comfortable, conservative clothing with a professional appearance.  The bodyworker industry does not want clients to “get the wrong idea” of the nature of therapeutic work because the bodyworker is dressed inappropriately or “suggestive” for the wrong type of service.

Refrain from wearing clothing that has holes, political statements, foul language, considered controversial or anything that could be upsetting to any client or coworker.

Use your best judgement.  Bodyworkers regularly earn more than the “average” hourly American wage.  Bodyworker’s should take pride in their appearance, and “look the part” of a professional.

Avoid Halitosis (bad breath)

Clients and coworkers do not appreciate foul odors, including bad breath.  In fact, a client may avoid communicating with a bodyworker who has bad breath.  Avoid eating foods that could cause undesirable odor such as onions, garlic and anything else that may be considered undesirable. Communication is critical to a safe or successful massage therapy session, so consider having the following available to avoid halitosis:

• Breath mints
• Mouth wash
• Oral sprays
• Toothbrush with toothpaste

Hot Towel Massage Therapy & Bodywork Practices

Hot towels are often used in bodywork service but are often improperly prepared.  Many times, bodyworkers will prepare hot towels by throwing a few towels in a sink and running hot water over them.  Sinks can harbor bacteria and as such – should not be used to prepare hot towels without cleaning the sink first. 

Hot towels can also be made with a clean bowl.  Simply put towels in a clean bowl and pour hot water over them. Excess water should be “rung” from the wet towels and be placed in a hot towel cabi to maintain heat until the bodyworker is ready to use them. 

The inside of a warm most environment can be a bacterial breeding ground, so if a hot towel cabi is used, be sure to routinely clean/sanitize the inside.  This includes leaving the inside of the cabi door open when not in use.  Anaerobic bacteria (bacteria that cannot live in the presence of oxygen) will not be able to continue to grow in the present of oxygen with the door open.

Finger nails Must be Short and Clean

If the whites of the fingernail beds are showing, then make sure underneath the nail is cleaned prior to working on each client with a nail brush or other appropriate cleaning method

Some bodyworkers can perform bodywork with medium to long fingernails however this is not advised under normal bodywork circumstances.  That’s because of multiple factors including:

• Bacteria, virus and other undesirable agents can linger underneath the nail in this hard-to-reach area
• When working on clients with poor circulation, such as a diabetic geriatric client, a small cut to the skin (by a fingernail that’s too long), could create detrimental effects. A client in this medical condition generally has poor wound healing – and if the skin cut becomes infected, it’s possible the client could lose their limb or life with a systemic infection, all from a simple fingernail cut to the skin by a bodyworker.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#client #clientrelations #workenvironment #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #halitosis #hygiene #relax

by Selena Belisle, Founder/Instructor, CE Institute LLC

Professional massage experts agree that all therapists should refrain, under all circumstances, from initiating or engaging in any sexual conduct, sexual activities, or sexualizing behavior involving a client, even if the client attempts to sexualize the relationship.

I Met My Soulmate Situation

What experts “disagree” about is the “meeting of a soulmate” situation when working with a massage client.

As our culture works longer hours, a good deal of relationships start at work. So, this poses the question – what is someone supposed to do when two consenting adults would like to start a personal relationship above and beyond a practitioner/client relationship? What is someone supposed to do when they feel they have met their “soulmate” at work – and are in a forbidden practitioner/client relationship?

Apply the Following for Ethical Considerations

Some massage experts agree that it is okay to terminate the practitioner/client relationship to start a personal relationship. Ways to address this could include:

• Determine the “end-date” of the practitioner/client relationship to start a personal relationship. A specific date creates a clear defining moment of when the relationship changed for both parties, and with each other’s consent.
• Draw up a written contract that clearly states the practitioner/client relationship has been terminated for purposes of to start a personal relationship. Include details such as there is no payment exchange for massage or bodywork services in the new personal relationship.
• Consult a licensed attorney or whomever seems most appropriate for the situation when needed.  This includes whether or not the therapist should inform colleagues or superiors of this decision to change the client relationship status.

What to Do When You Are a Massage Therapist Employee
Informing an employer that you wish to start a personal or sexual relationship with a client would likely result in a reasonable loss of employment.  Also, not informing an employer could also result in a loss of employment if they found out.  It's almost a no win situation.

Every individual situation is different, and each individual must weigh their own pros, cons and ethical obligations to make their own decision to determine if changing a professional relationship with a client to a personal one is worth it.

Personal Experience

As a previous large employer of massage therapists, sometimes employing more than 40 at one-time, I've seen several instances where massage therapists have dated each other from work, which sometimes caused friction at work and was not a great idea for the staff as a team.

I also experienced one therapist tell me very professionally that she was mutually interested in dating one of her regular weekly clients, and they wanted to continue their massage sessions so this would not affect me.  My response was I was okay if they wanted to start dating, but that would mean it would be the end of his clientship at our massage establishment, which they both accepted.  We would no longer be able to service his massage appointments at our business to establish a clear line that the professional relationship has ended and a personal relationship has begun.

It is Never a Good Idea to Pursue a Personal Relationship with a Client

How you chose or navigate your own personal choices or interests with clients is a personal decision that each therapist must make for themselves.  What is important to remember is your professional and ethical obligations to the client, including how a power differential might have influenced the interest or start of the personal relationship.  It is NEVER a good idea for a health care provider to start dating their client.  However this has happened with proper and professional discretion amongst a few therapists, with successful navigation when ethics and clear communications were applied.

Soulmates are supposed to a once in a lifetime person.  Any massage therapist who is regularly dating their clients, regardless of professionally terminating the client relationship, would likely be seen as a sexual predator or someone who is abusing their power differential in the client relationship.  While some may understand that someone has met a soulmate at work, dating multiple people from work would not be approrpirate and is extremely ill-advised. In fact, it could be deemed unethical by a licensing board and result with a suspension, training requirements, fines, loss of licensure and become extremely damaging to your public image, nevermind a client who may have felt taken advantage of in the power differntial. A therapist also risks personal lawsuit or criminal action if a client claims a sexual relationship started during licensed healthcare services.

Also, even just one inappropriate sexual engagement with a client at work or outside of the establishment would be considered highly unethical, if not illegal.  A once in a lifetime exception, if there ever was one, would only apply when the professional client relationship is mutually terminated to consent to a new personal relationship that would strictly occur outside of the workplace to establish and maintain clear boundaries.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#client #clientrelations #ethics #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #sexualrelationship 

by Selena Belisle, Founder/Instructor, CE Institute LLC

It is important for massage therapists and bodyworkers to learn their scope of practice within their own state, city or municipal regions. In many states, the scope of massage includes the manipulation of soft tissues; however, this definition can vary from state-to-state.  For example, the Florida Board of Massage allows for "chemical preparations" of the body, which might include allowing a licensed massage therapist to practice a body scrub, foot scrub or spa body wrap.  But, in other states, licensed massage therapists may be prohibited from providing these types of spa therapies due to a narrower scope of practice.

Proper Training and Experience is Required for Client Service Applications

Some states may also have tricky or hypocritical scopes as well.  In Florida, a licensed massage therapist scope also includes electrical applications; however, almost all massage therapists know that LMTs do not receive rudimentary training in using electricity for therapeutic purposes.  So even when a scope of practice allows for techniques beyond your training, be wary of providing such a conundrum.  Just because something may be within your scope of practice, does not mean it would be correct or ethical to practice it - especially when a practitioner has limited or no training in the application.  It could be considered fraud, a medical error and more to apply any form of client services without proper training.

Massage Therapists do not Diagnose a Client's Medical Conditions

In any state, the scope of massage does not include medical diagnosis or other “more serious” medical procedures, i.e. surgery. Practitioners must recognize their limitations within their scope of practice, and educate clients about their scope of work, especially when a client requests work that is beyond the scope of practice. Examples include when a client asks a bodyworker about a suspicious mole on their body, the bodyworker must advise the client to see a dermatologist or other appropriate physician because the bodyworker cannot diagnose or treat suspicious moles.

Recognizing Changes in Your Client During Massage Appointments

If a client’s health is deteriorating over the course of bodywork appointments, whether it be during a single session or over a more extended period of time, the therapist should verbally recognize this with their client, and suggest the client seek appropriate medical attention for their health. For example, if a massage therapist notices a client is losing a drastic amount of weight (greater than 10% of total body mass per month), and the client is not on a diet or trying to lose this weight – then the practitioner should recommend the client to see a physician to address their changing body.

Never Operate Outside of Scope of Practice

Bodyworks should never operate outside of their scope of practice, even when:

1. They may possibly know the client’s body or health better than most physicians.
2. They feel they could provide better medical treatment than the treating physician for an ailment outside of a bodyworker’s scope of practice.
3. Even when the client recognizes that the bodyworker is not a doctor but wants their medical advice regardless.
4. A client cannot afford proper medical care.

While some massage therapists may be able to provide better care than others or none at all, it's important to not operate outside of a scope of practice, because this could put your license and the client in jeopardy.  Most massage therapists want to help, but it's never helpful when working outside of your scope of practice.  It's usually illegal, risky or dangerous to do so - and should be avoided at all costs.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#scopeofpractice #massagescope #ethics #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy 

by Selena Belisle, Founder/Instructor, CE Institute LLC

Communication is one of the most important keys or tools to a successful massage session.  It is a vital ethical duty to provide superior communication skills for a client.

by Selena Belisle, Founder/Instructor, CE Institute LLC

Address a Client's Massage Therapy Goal

Ascertain your massage client’s goals and address them during bodywork. Notify the client if any of their goals or medical conditions are unreasonable or contraindicated prior to starting service.

Set reasonable client expectations with a bodywork treatment plan, such as expected number of appointments to achieve client’s goals.  Explain to the client that there are no guarantees made with the treatment plan. A treatment plan is a set of goals that you wish to mutually achieve.

Do not continue to work on client if their bodywork goals are not being reasonably satisfied, or if the client’s medical condition deteriorates. Refer the client to a medical professional for greater medical evaluation if or when a (reasonable) client goals cannnot be met and the client continues with a health issue or pain.  it is vital to immediatley refer the client to a medical professional if their health deteriorates at anytime during the plan.

A Massage Therapy Treatment Plans Can Consist of Any of the Following:

• A signed treatment plan (by therapist and client) can show informed consent or agreement as to the mutual plan and goals
• Document appointments with proper record keeping.  This includes notating each appointment’s progress upon completion if anything was observed.
• Include any notes that seem relevant to the massage therapy treatment plan i.e. the client would like reduced pain; however, after the last appointment the client felt so good that they played 36 rounds of golf in one day – and their 36 golf rounds created extreme pain for the client on the following day. Client states they are now back to the original amount of pain they had prior to massage appointment(s).
• Using a SOAP note charting system can be helpful.
• Providing a well-formulated/documented bodywork treatment plan is a good ethical practice where the client can provide INFORMED CONSENT of the treatment plan, and the bodyworker can responsibly track the client’s progress!

Formulating a Treatment Plan When Massage Goals are Not Met
Set a reasonable number of massage therapy sessions to achieve client’s goals or improvement.  Educate the client that bodywork may not be able to achieve any reasonable goals - results are not guaranteed.  You can also notify your client that unfortunately the only way to ascertain progress is by the massage application itself.  And that the client should continue to see another medical professional to achieve their goals (i.e. physical therapist, etc.) if their goals were not met with the massage treatment plan.

Inform the client of the health benefits of bodywork, and allow the client to choose if they wish to continue with their bodywork sessions when/if you are not achieving their bodywork goals.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#soapnote #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #LMTsoapnote #recordkeeping #massagerecordkeeping

Massage therapists and bodyworkers are provided an extreme amount of “power" over their clients in order to provide service.  As such it's vital to earn and retain trust in the power differential of a therapeutic massage client relationship. 

Massage and bodywork clients are often:

• Naked
• Vulnerable
• Required to disclose personal details and medical information about oneself
• Sometimes required to leave a credit card number up front to secure an appointment

It is Our Ethical Duty as Bodyworkers to Protect Our Clients

Clients are often in an altered state of mind which can be rendered from our bodywork. Our clients and work require integrity and consciousness for safe and effective application, especially due to the nature of the requirements to provide bodywork.

What is Ethics?

Ethics is:  A set of moral principles

Ethics is: Rules of behavior

Ethics is: A branch of philosophy dealing with what is right and wrong

Ethics is: The morale principles influencing and governing conduct

Here are Some Important Massage-Related Vocabulary Words and Phrases for Massage Therapy Practice

What are Morals?  Standards and beliefs about what is acceptable or not acceptable.

What is Informed Consent? A full explanation of treatment is provided to a client that includes detailed information including service details and any possible benefits or risks, so that the client can make an INFORMED decision whether they would like this treatment, or not.

What is Scope? The range of elements of an expression over which an operator has control.

Accurately Represent Services When Advertising Massage 
Do not make claims such as “nursing care” or other abilities that are beyond the practitioner’s training, licensing or certification or scope of practice.

Massage Therapist Training to Provide the Best Available Services

Seek out legitimate training. Do not seek-out or support educational opportunities that are falsified (i.e. a CE Provider issues a Certificate for 12 LIVE CE Hours of training after only 6 Hours of attendance, etc.)

Continue training in respective field. Information, application, new contraindications, massage philosophies and even science can change over the years. Take responsibility to learn the newest information so that clients can receive the best service possible.

Professional Massage Groups, Agencies and Boards

Different agencies (i.e NCBTMB, AMTA, ABMP, FSMTA, etc.) have different Codes of Ethics.  It’s up to each individual practitioner to review all Codes of Ethics with each agency that they belong, and ensure that their practice is in-line with the agency’s ethics requirements.

To learn more about massage therapy practice including ethics and medical errors prevention, please click HERE to find a class and register for training with us.

#lmtethics #massageindustry #ethics  #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #massageethics 

by Selena Belisle, Founder/Instructor, CE Institute LLC

In evidence-informed and evidence-based practice, therapists are seeing more and more VAS score improvements with massage therapy application.

VAS stands for visual analog scale.  This visual analog scale (VAS) is used for an individual to rate their own pain with numbers ranging between one through ten. VAS was reportedly first used in 1921 by Hayes and Patterson.

While VAS is an easy and commonly used assessment to determine an individual's pain, there is conflicting evidence and debate about the accuracy or validity of the method.

Beyond the debate, massage therapists can use VAS to assess their client's pain both pre and post massage.  Recording any changes in the client's pain from each session will help massage therapists determine which massage therapy methods might provide the most pain relief for a client.

To learn more about massage therapy practice, please click the following website link to find or register for training with us at: https://ceinstitute.com/

#VAS #healthcare #visualanalogscore #healthcarepractices #lmt #massage #massagetherapist #bodywork #bodyworker #massagetherapy #soapnote #recordkeeping #massagerecordkeeping #pain #painassessment #painassessmenttool #assessmenttool

SOAP note charting is an easy, popular and effective way to keep records, including for the practice of massage.  SOAP is an acronym for:

• Subjective
• Objective
• Assessment
• Plan

A SOAP note provides a narrative of the client's issues.  The massage therapist records how they will address the client's issues with massage therapy application with a well formulated plan after assessment.

The following is a SOAP note example for massage therapy record keeping purposes.  In this SOAP note example, we will review how to record a client's massage therapy treatment to address a client's pain:

Subjective: here are some examples of questions for a client who seeks pain relief.  A massage therapists can ask as little or many of these questions as they wish - the more information, the better directed a practitioner will be to addressing a client's needs:

Onset:  When did their pain start?

Location:  Where is their pain?

Duration:  How long is the pain a problem?

Alleviating Factors:  Is there anything that relieves the pain?

Aggravating Factors: What makes the pain worse?

Chronology:  Better or worse since onset?  Is pain variable, constant, etc.?

Quality:  Is the pain sharp, stabbing, dull, etc.?

Additional Symptoms:  Is there any numbness, tingling, loss of coordination?

Treatment: What else has been done to address the pain? 

Temporal Pattern:  Is the pain every morning, all day, etc.?

Severity (think VAS which readers can learn more about in our school blog):  A scale of 1-10 can be used with 1 being almost no pain and 10 being intolerable, then the client can choose their # for the pain that they experience throughout the day, or when pressure is applied during the massage.

Objective: the bodyworker will document objective, repeatable, and traceable facts about the client’s status.  This includes:

• Client’s personal statistics
  • Age
  • Height
  • Weight
• Palpable tissue changes (softer, more pliable, etc.)
• Range of motion increases/decreases (use goniometer)
• Observed abnormalities
• Bruises
• Anything medically remarkable that would be relevant to the:
  • Client’s health
  • Bodywork contraindications

Assessment:  the bodyworker’s collective assessment of the client’s body (and goals) from the subjective and objective information.

Plan: describes what the bodyworker will perform for the client.  This can include the “Treatment Plan” as described earlier in this course, including:

• Number of minimum appointments needed to achieve goals
• Length of appointments needed to achieve goals
• Costs of Individual Appointments as recommended in the treatment plan
• Areas to be worked on (on the client’s body)
• Modalities to use in different areas of the client’s body
• Physical Address of Where Bodywork Will Occur
• Set Goals – the goals the client wants to achieve through bodywork
• Consent or Agreement

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#soapnote #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #LMTsoapnote #recordkeeping #massagerecordkeeping

by Selena Belisle, Founder/Instructor, CE Institute LLC

How does your massage therapy practice compare?  Quality massage practice includes ethical execution and much more:

• Operate within your professional licensed scope of practice.
• Set reasonable, mutally agreed massage goals with a treatment plan.
• Communicate about what will be provided for the massage service, including the application itself (oil, lotion, deep techniques, light work, etc.).
• Take interest in the client’s goals and try to satisfy them within the scope of practice.
• Continue communication during bodywork to ensure both the bodyworker and client are on the “same page” for:
• Work areas
• Pressure
• Temperature
• Music
• Lighting
• Draping, etc.
• Be on-time, especially when an appointment is provided with a time-limit.
• Communicate with the client if the appointment needs to be “cut short” due to tardiness issues.
• Explain any financial impacts to a shortened appointment up-front/prior to beginning the appointment.
• Always be clear about how long the actual hands-on time will be provided during the appointment.
• If a 50-minute “hour” is provided, explain to the client that there will be 50 minutes of bodywork with 10 minutes of change-time, discussion, or whatever will be provided in that 10-minute time-frame.
• Provide the full amount of service time. Do not “cut” the client short without:
• Obtain client consent to perform work as planned.
• Provide compensatory recognition if the practitioner must cut the session for their own reasons - not a client's reasons.
• Properly sanitize and disinfect the treatment room between clients.
• Use fresh clean linens for every client. Never “flip-over” or re-use the same sheets or fabric materials amongst different clients.
• Wash hands before and after every appointment.
• Wash lotions bottles, stones, and anything else that was touched or contaminated during the massage appointment.
• Perform the bodywork as the client requests.
• While a client may receive better benefits with deeper work, etc. – always honor whatever the client wishes for unless it cannot be provided safely or other reasonable considerations
• It is advised to start in the client’s chief complaint “cc”/primary concern area when reasonably possible.  Some massage therapists provide the same routine treatment, over-and-over again, regardless of a client’s individual needs.
• Starting the session in the client’s chief complaint area is better planning, so that the appointment time cannot run-out or end before addressing the client’s chief complaint.
• Follow the massage establishment's “rules”. Bodyworkers often partner with different vendors for business operations.
• Read and learn merchant agreement(s) if the bodyworker is responsible for accepting charge cards as payment. This responsibility falls to management if the bodyworker is employed by another who assumes payment collection responsibilities. There are many requirements within a credit card merchant agreement that must be observed, or else the bodyworker could lose the privilege of accepting credit cards if the customer complains or other penalties.
• ii. If services are advertised as “insured”, read and learn the insurance coverage and requirements.
• Follow insurance requirements so that the insurability remains intact, and so that the practice is not improperly advertising an insured benefit. For example, the ABMP provides Hot Stone Bodywork liability insurance to its insureds, only if and after the insured watches a brief video and accepts ABMP’s requirements for hot stone services.  Different insurance companies may have abnormal and/or additional requirements for it’s insureds.
• Honor and charge the prices as advertised.
• If an upgrade or extended appointment is requested or agreed to by the client, then share the additional charges with the client prior to executing the additional service.
• Keep the appointment positive. The bodyworker should not gossip or discuss other clients nor speak poorly of other medical professionals or treatments. Sharing personal issues or problems with clients is ill-advised and unethical.

While a total exhaustive list of practices to provide the best quality care is not possible in a short blog post, this list should get you started on the absolute essentials.  Also, different clients will have various needs - so the list of what should be provided could change depending on the individual appointment.

To learn more about massage therapy practice including ethics and medical errors prevention, please click HERE to find a class and register for training with us.

#ethics  #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #massageethics #lmtethics