New hospital massage guidelines could pave the way for massage therapy in medical settings

More hospitals across the U.S. are including massage in their patient services, to help address common patient issues such as pain, stress, insomnia and anxiety—which has resulted, as MASSAGE Magazine has previously reported, in an increased need for a set of agreed-upon competencies massage therapists need to work well in the hospital environment.

The Academic Collaborative for Integrative Health’s (ACIH) Hospital Based Massage Therapy Task Force recently released a document, “Hospital Based Massage Therapy (HBMT) Competencies for Optimal Practice in Integrated Environments,” containing three sets of competencies designed for massage therapists practicing in hospitals.

The task force included MK Brennan, R.N., L.M.T.; Dale Healey, D.C., Ph.D.; Carolyn Tague, C.M.T.; and Beth Rosenthal, Ph.D.

The competencies project, which began in spring of 2012, includes online survey input from more than 30 hospitals that offer massage services, and also draws from the ACIH’s previous 2011 work identifying “Competencies for Optimal Practice in Integrated Environments.”

“Having competencies for massage therapy is particularly important given massage therapy’s increasing popularity in the hospital setting and the fact that this type of practice involves working with medically complex patients,” noted the background section of the HBMT Task Force’s research summary poster, available on their website.

According to the ACIH’s website, the new HBMT competencies document “promises to pave the way for expanded high quality massage therapy practice in hospital settings.”

What Does This Mean for Massage?

New hospital massage guidelines could pave the way for massage therapy in medical settings

MASSAGE Magazine spoke with MK Brennan, one of the members of the task force, about the implications of this body of work for massage educators as well as massage therapists and hospitals that might employ them.

“Our goal is to have [the competencies] be appropriate for hospitals to be able to use in hiring massage therapists, or as they work to develop massage therapy programs,” said Brennan.

“Since standards are diverse throughout the nation, and massage therapy is relatively new in hospital settings, but is gaining in popularity … hospital administrators or [human resources departments] may not really know what to be looking for as they look to onboard massage therapists.

“What we really developed is a framework,” she added, noting that actual requirements for employment will likely vary from hospital to hospital.

In addition to this framework’s potential usefulness to those in charge of hiring, schools and continuing education providers may use it to shape their hospital-based massage course offerings.

Massage therapists interested in hospital work may also review the competencies to help determine whether their skills and credentials lend themselves well to working in this unique environment.

A Summary of the Framework

New hospital massage guidelines could pave the way for massage therapy in medical settings

The competencies in the task force’s document are divided into three smaller groupings:

  1. Hospital environment
  2. Massage protocols
  3. Therapeutic presence.

The first set of competencies comprises those related to the hospital environment, which is usually very different from other settings in which massage therapists may be used to working.

To thrive in a hospital setting, according to the document, massage therapists must generally be able to “work with patients, families, staff, and individuals of other professions to maintain a climate of mutual respect, shared values and safety.”

These environment-related competencies involve respecting patient confidentiality, embracing and respecting diversity, cooperating with patients and other medical professionals, developing trust, maintaining high ethical and quality standards, staying within one’s scope of practice, and practicing personal self-care; as well as understanding how to use and contribute to patient medical charts; working with medical terminology; reporting non-compliance amongst staff; demonstrating familiarity with common medical devices; making decisions based on current massage research; practicing infection control; staying current on required trainings and health screenings; and working with informed consent.

The second competency grouping includes massage techniques and how they relate to patients’ conditions. Therapists should “demonstrate understanding of massage protocols within a hospital environment,” according to the document. This includes understanding medical conditions and symptoms, adjusting massage based on patients’ needs, identifying and observing precautions and contraindications, working around common hospital equipment, recognizing one’s own limitations, and practicing proper body mechanics.

The third main competency, therapeutic presence, covers effective communication with other members of the care team, recognizing how one’s work fits into the overall care patients receive, being attuned to patients’ stress and other emotions, effectively holding space for patients, maintaining appropriate boundaries with patients and staff, and practicing self-care.

Hospitals vs. Other Environments

Brennan noted that the environment itself can often be the most challenging aspect of working in a hospital.

As private practitioners or in a spa setting, “you have a nice, quiet room; nice music playing; unencumbered movement for the therapist … and in a hospital setting it’s very different,” she said.

Patients may have intravenous lines, catheters and other encumbrances the therapist must work around, and surrounding noise and other interruptions can be frequent.

Charting and HIPAA

New hospital massage guidelines could pave the way for massage therapy in medical settings

“There’s also the differences in communication, the detail needed for your charting,” Brennan added. “Communicating with the medical team, the interdisciplinary aspect of it.”

Therapists commonly draw information from and add their notes to the same charts used by doctors, nurses and other medical staff, so the ability to read, understand and contribute to these documents is critical, she said.

In addition to having good written communication skills, you must also understand common medical terminology, conditions and symptoms, as well as have a good grasp of your scope of practice and the limitations of your work.

Understanding and abiding by the rules of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is also necessary, Brennan said, adding that there is more oversight of this area in a hospital setting. (She also noted that massage therapists in any setting should already be in compliance with HIPAA.)

Emphasis on Self-Care

New hospital massage guidelines could pave the way for massage therapy in medical settings

Therapist self-care is also of utmost importance; it is included in the hospital environment grouping as well as in the other two groupings of competencies. Maintaining appropriate boundaries, practicing proper body mechanics and generally modeling health and wellness habits are all mentioned in the document.

As with any setting in which massage is practiced, the potential exists for therapists to subject themselves to repetitive use injuries, overwork and burnout if they do not make self-care a priority. However, the hospital environment can bring with it additional self-care challenges, such as the critical skill of maintaining boundaries when clients are suffering from grave illnesses or injuries.

Brennan, who is a nurse as well as a massage therapist, noted that hospital-based work can easily take an emotional toll.

“When you’re working with individuals that are ill or have had surgery [or have] end-of-life issues, it brings a whole different flavor to the work,” she said. “It does take some training to make sure that you’re emotionally able to handle those.”

Because most massage therapists typically train by working on healthy individuals, they may want to take continuing education courses in delivering compassionate care while maintaining appropriate boundaries, Brennan added. Such training is common in nursing, but not in standard massage education.

Adoption of the Competencies

New hospital massage guidelines could pave the way for massage therapy in medical settings

While the document she and her team put together could help simplify the hiring process for massage therapists, Brennan noted, those the actual hiring practices vary from hospital to hospital: Onboarding of massage therapists could be a responsibility of an administrator, human resources professional, or the nursing or therapies department; a massage therapist could be hired as a staff member or as an independent contractor; and therapists’ supervisors may often be nurses.

Right now, Brennan said, the adoption of the competencies is largely a grassroots effort; she and her colleagues have released their document via the ACIH website and also shared it with survey respondents at the hospitals that have input included in it.

“Certainly having articles in MASSAGE Magazine and other journals will help get the word out that this has been done,” she said.

About the Author

Allison Payne, a former Online & Associate Editor for MASSAGE Magazine, is now a freelance writer and editor based in central Florida. She has written many articles for MASSAGE Magazine and, including “Your Video Toolbox: Take Online Marketing to the Next Level” (June) and “[Lawsuit Settled] Arizona Animal Massage Therapists Win Right to Practice” (April 5).