The use of complementary and alternative medicine (CAM) within the traditional hospital environment is increasing. In a nationwide survey, conducted in 2010 by the American Hospital Association’s Health Forum and the Samueli Institute, 42 percent of hospitals that responded said they provide CAM—such as massage therapy, aromatherapy and guided imagery—up from 14 percent in 2000. The survey also found the factor driving CAM implementation at hospitals is patient demand.
Michigan’s Beaumont Health System, where I manage the massage program, has embraced massage therapy as a valuable addition to standard medical practice. “I’m so proud of our clinical massage program,” said Thomas Lanni, vice president of oncology, medicine and imaging at Beaumont Health System. “It is a valued service in our health care system, not only shown to improve quality of life for patients but also overall patient satisfaction.”
As more institutions incorporate massage therapy into standard care, many massage therapists have begun to find opportunities within a hospital or medical setting. A hospital-based massage therapy program can be a rewarding, viable career option for a massage therapist. Massage therapy is increasingly embraced in many different medical fields, including oncology, cardiovascular and maternal medicine. Massage can have a powerful, positive impact for patients undergoing stressful procedures, surgery or chemotherapy, or for any patient experiencing pain or anxiety.
A Unique Environment
While the methodology and application of massage remains largely unchanged from one venue to another, there are some critical differences in hospital-based massage therapy compared with a private office or spa setting. The hospital environment contains fluorescent lights, noises, hustle and bustle, and constant commotion, which is a far cry from the soothing tranquility of a spa. The most important difference, though, involves clientele.
The hospital-based massage therapist works with patients with varying degrees of illness, including those near the end of life. These patients require special accommodations to ensure massage is always beneficial and does not cause any harm or otherwise exacerbate their condition. In caring for patients, the massage therapist must be willing to work with medical professionals as a member of the medical team.
What follows are some practical observations, conditions and situations a massage therapist should bear in mind when considering hospital-based employment.
The Medical Team
In a hospital setting, massage therapists are expected to understand the scope of their work. A patient may receive treatment not only from medical doctors and nurses but also from physical and occupational therapists, so the massage therapist must understand how her treatment fits into the patient’s treatment plan overall. The massage therapist is part of a team that works together to provide the best care possible.
“You can safely and successfully integrate evidence-based holistic medicine like massage therapy into outpatient and inpatient care,” said Paul Misch, M.D., health systems chair in the Department of Family Medicine at Beaumont.
The primary challenge of working in a hospital setting is working with patients undergoing a wide variety of medical procedures. Therefore, it is critical for massage therapists to gain the respect and trust of the medical staff. To do this, massage therapists must be able to work within a hospital setting and accept the hospital hierarchy that is in place. The massage therapist must also be able to clearly and professionally communicate with the health care team.
Furthermore, it is important to realize that in some organizations, such as Beaumont, massage therapists are not independent contractors, but are considered employees of the health system. This arrangement can be an advantage, as many massage therapists are eligible to receive standard benefits; however, they are also expected to comply with hospital standards and policies. This may include things such as a dress code mandating the massage therapist wear scrubs, and restrictions or prohibitions on the use of perfume or cologne, acrylic nails and nail polish. Many hospitals require mandatory testing for tuberculosis and an annual influenza vaccine.
For accreditation purposes, hospitals require employees to complete yearly online training and education modules, many of which may require a substantial time commitment. This training covers such topics as communicable diseases and the Health Insurance Portability and Accountability Act. Finally, the massage therapist must follow hospital regulations regarding when to use a gown and gloves for a session and how to clean a room after a session.
Many hospitals have an integrative medicine department within which massage therapists work. Depending on the hospital, a medical professional may refer a patient for massage; patients can request a massage for themselves without a physician order; relatives or caregivers may obtain massage for a patient; or massage is offered on an outpatient basis, as well as to family members. At some hospitals, patients are charged per treatment session, while other hospitals offer free massage to increase patient satisfaction, often financing these efforts through philanthropy funds or the use of volunteer massage therapists.
Outcome Targets
Massage therapists must clearly define their outcome targets, which are often different from the outcomes desired for a healthy client. The desired outcome for a hospitalized patient may be simply to provide comfort through gentle touch that may reduce pain and anxiety and promote rest and relaxation. Furthermore, it is important to realize that working with critically ill or dying people may be stressful or emotionally draining for a highly empathetic massage therapist. Before considering hospital-based work, you must consider whether you will be able to cope with consistently working with the very ill.
Although a hospital environment offers unique challenges to a massage therapist, it also offers opportunities for personal and professional growth.
“I have grown so much as a person and therapist because of my many experiences massaging the incredibly diverse patient population that only a hospital setting can provide,” said Kendra Duncan, L.M.T., who works at Beaumont.
And Beaumont massage therapist Dia Mason, L.M.T., N.C.T.M., said, “In a hospital environment, massage therapists are respected members of the medical community and are considered part of the treatment team. Each massage of a patient can be different and challenging, from treating those who are medically compromised to those who are not.
“Massage therapists who treat in a hospital environment continually update their education and search to find innovative and different ways to treat patients,” Mason continued. “This is why my work in the hospital is a passion and not a job, where I not only discover the best in my patients, but [in] myself.”
Training
Postgraduate training after massage school is critical to provide services safely and effectively in a hospital setting—and as the demand for medical massage grows, hospitals are responding by creating specialized training for massage therapists. Such programs educate massage therapists in a variety of areas, including CAM research, working on a medical team, and how to properly handle frail patients who would not typically be encountered in a private practice setting.
The massage therapy program at the Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Palliative Medicine at Icahn School of Medicine at Mount Sinai in New York, New York, for example, offers training to licensed massage therapists interested in learning to work with seriously ill patients and their families. The program enables massage therapists to build the skills needed to work safely and effectively in the acute care setting with seriously ill patients.
At the Mayo School of Health Sciences in Rochester, Minnesota, the hospital-based massage therapy course instructs students on the massage therapist’s role as part of the integrative health care team in an acute care hospital setting; skills of integrative health practices; how to apply massage in a safe, appropriate, effective and compassionate manner with patients and health care staff; professional boundaries; body mechanics and communication skills; and hospital-based policies related to safety and infection control.
Memorial Sloan Kettering Cancer Center in New York, New York, offers training in medical massage for cancer patients; how to identify lymphedema in the cancer population; common medications prescribed for cancer patients; how massage therapy can be integrated into an oncology-medicine team; and how hospital practices and contraindications affect massage treatments.
Bingham Memorial Hospital in Blackfoot, Idaho, trains students to work as part of the health care team, and teaches massage techniques that are compatible in a hospital, medical or spa setting.
Beaumont’s hospital-massage training program includes an externship component that includes a hands-on rotation through various clinical departments in the hospital, which provides massage therapists the chance to experience working with patients while being supervised. The program also teaches massage therapists how to accommodate the patient’s condition, diagnosis, treatment and side effects that may result from treatment.
Make a Difference
For many massage therapists, the hospital setting offers an enriching and fulfilling work opportunity that differs from the traditional private office or spa setting.
For massage therapists who choose to embrace the physical and emotional challenges of working with patients, can work within the structure of a medical setting, and are willing to learn the requisite medical terminology, hospital-based employment can offer a financially and emotionally rewarding opportunity, one that allows massage therapists to truly make a difference in patients’ lives.
About the Author
Karen P. Armstrong, B.C.T.M.B., is manager of clinical massage and the oncology/hospital massage program at Beaumont Health System in Grosse Pointe, Royal Oak and Troy, Michigan. She teaches oncology and hospital massage continuing education through Beaumont’s Schools of Allied Health.