Tuesday, June 16, 2009

The Treaty of Waitangi

Integrating Treaty framework and Hauora values into my practice as a massage therapist:
Due date: 17th of June 2009:
Professional practice:
Victoria Walden:

Article 1: Governance:
The massage therapists’ role in the relationship between client and therapist is to help the client in any way possible in keeping within the scope of practice. The treaty policy and legislation for health department applies to our practice so ensure health of each client. Being aware of the treaty is part of the massage therapy requirements, the code of ethics states: ‘Respect the client’s boundaries with regard to privacy, disclosure, emotional expression and beliefs’ (code of ethics, Massage NZ).

Article 2: Authority:
Within the scope of practice for massage therapists the client will be able to speak their mind as a right and have a say as to how their treatment will proceed. There will be a partnership between client and therapist to produce an outcome that both are happy with. This is accomplished by: ‘Maintain open communication throughout the massage session ensuring ongoing informed client consent, explaining rational for proposed massage’ (code of ethics, Massage NZ).

Article 3: Equity:
The quality of how people are treated should be of the highest respect and professionalism. Under the massage scope of practice each client should be treated the same and also accommodating for those of disabilities. Therefore access, and acceptance/respect of every client, no matter their disadvantage. The therapist should also respect and know when they should refer on; ‘Acknowledge the limitations of their skills and, when necessary refer clients to the appropriate qualified health care professions’ (code of ethics, Massage NZ).

Article 4: Respect:
Within the scope of massage practice the client’s wishes, culture, beliefs will be respected, also to what the client wants for their treatment.
The code of ethics states what the therapist should NOT do for example; ‘Endanger the physical, mental or emotional health, well-being or safety of a client’ (code of ethics, Massage NZ).

Hauora = well-being:
Hauora/well-being is a very vital part within the practice of massage therapy for the therapist and the client to reach the goal they are both happy with.
There are 4 parts to Hauora, Cultural beliefs, Thoughts and feelings, physical side and family (the social aspect); This is how they fit into my massage therapy scope of practice:

Cultural beliefs: The cultural beliefs of the therapist will be addressed and also of the client. With regards to the client, the therapist will have the respect for any cultural beliefs of any client and will do their best to understand and to accommodate their requests. From the therapist, some rituals are a belief to them and therefore a compromise is needed between therapist and client. Communication is the key.

Thoughts and feelings: The client’s thoughts and feelings will be freely welcomed in the company between client and therapist. The client should feel happy enough to communicate their ideas and thoughts about treatment plan and also how the process will unfold. Communication is vital to form a bond between client and therapist.

Physical side: From the client and therapist having a professional relationship the physical aspects of the client’s health and also what they want untouched or left alone physically will be established. This aspect of the scope of practice is very important making sure keeping within scope of a massage therapist, taking care of the client.

Family (social aspect): From the social aspect of the massage therapy scope of practice the information can be found from sports to old injuries, especially involving other health professionals in the investigation of the client’s reason for coming to the practice (with clients consent). Within the massage scope of practice, the therapists will respect the wishes of the client, therefore as a young child or teenager may want an adult or friend present in the session, a translator maybe necessary for clients who do not speak English or for cultural beliefs or other the family may be present or in another room close by.

Hauora and the framework of the treaty are vital pieces of information and that should be respected and understood by all massage therapists coming into the business, as the saying goes, treat people with the same respected that you would want them to treat you.

Reference:
Massage New Zealand. (2009). Retrieved June 16th 2009, from http://www.massagenewzealand.org.nz/
My own thoughts
Group thoughts from class 12th June 2009

Sunday, May 10, 2009

Pathology

Pathology:
Conditions: Task 2 – Ankylosing Spondylitis
Victoria Walden
Due 18th May 2009

Description of Ankylosing Spondylitis:

Ankylosing means joining together or stiffening .
Spondylitis means inflammation of the vertebral bones of the spine.
Ankylosing spondylitis is a chronic, systemic, inflammatory arthritis leading to calcification and fusion (ankylosing) of the joints, usually the spine and scaroiliac joints (Salvo, S, G. 2008, p.132). This type of arthritis often runs in the family genes, also men are three times more likely to get this disease.
This disease is usually diagnosed in young adults with a peak onset between 20 and 30 years of age and can range from a mild to more severe disease in patients.

Etiology:

Ankylosing spondylitis is considered an autoimmune disease with the genetic basis (genetic basis means that is type of arthritis runs in the family genes, therefore if AS is common in a family, then it is more likely that in that family AS will occur)
With the disease this is the process of what occurs:
· Inflamed joints become infiltrated with inflammatory cells such as fibroblasts, repair begins.
· Collagen is laid down and organised into fibrous scar tissue.
· Tissues undergo the process of calcification and ossification (forming bone), leading to joint fusion and loss of flexibility.



Incidence:

One out of 10,000 people has Ankylosing spondylitis. It affects males more than females and usually is found between the ages of 20 and 40 (Springhouse, 2005).
It may develop in children younger than 10 years of age.

Signs and symptoms:

· This Disease affects the sacroiliac joints, intervertebral disk spaces and costo-vertebral joints commonly.
· It rarely affects the larger synovial joints e.g. hips, knees, shoulders.
· The spine becomes rigid and appears like bamboo, like in X-rays (Dr. Premkumar, K. 2000).
· Disease has exacerbations (can be made worse)and remissions (slight reduction of disease).
· Pain becomes worse when the body is at rest – pain reduces by mild activity.
· Patient complains of constant or irregular low back pain.
· Approximately 30% of this disease shows signs of systemic nature, such as fatigue, weight loss and low grade fever.
· 30% experience bowel inflammation with diarrhoea, eye inflammation and light sensitivity.
· Pain may radiate to the thigh area
· Through reduced movement of vertebral column the curvature of lumbar area is slowly lost.
· In the late stages of disease the spine becomes fixed.
· If costo-vertebral joints are fixed it can have an effect on lung volume.
· Kyphosis (hunchback) occurs when thoracic or cervical areas are affected and the weight of the head compresses the vertebral bodies therefore bends the spine forward, Head becomes hyperextended to maintain field of vision.



Indications and contraindications for massage therapy:

· Client should be positioned to what feels comfortable with plenty of support from pillows.
· Clients with Kyphosis need extra neck support.
· Pillow under knee can relieve tension on hamstrings, also cause pelvis to tilt backwards and straighten lumbar spine.
· From this disease Osteoparosis is common, which can lead to compression fractures
(Salvo, S, G. 2008, p.132).
· Ribcage expansion during inspiration is reduced if costo-vertebral joints are fused therefore client may experience breathing difficulties.
· AIM: Retain mobility of the joints, strengthen weak muscles and stretch tight muscles.
· YES: Gentle massage to the back and limbs.
· YES: Hot packs will help ease pain
· NO: Do not forcibly mobilize ankylosed joints.
· NO: No spinal manipulation
· NO: No deep pressure as osteoporosis is common.
· NO: Avoid massage to inflamed areas
· Advice client to sleep in supine position if possible
· Encourage client to do breathing exercises to regularly move the thorax (help breathing)
· MAJOR: Client maybe on painkillers therefore giving the wrong reading to pain scale.
· Address any other medical conditions e.g. osteoarthritis in treatment plan
· Physician consulted in clients with severe deformities.

References:

Dr. Premkumar, K. (2000). Pathology A to Z: A handbook for massage therapists, (2nd ed.). Canada: VanPub Books.

Professor, Dougadlas, M. (2005). Orphanet. Ankylosing spondylitis. May, 9th, 2009, from www.orpha.net/data/patho/GB/uk-Ankylosing-spondylitis.pdf

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists, (2nd ed.). Elsevier Health Science.

Wikipedia, Retrieved May, 9th, 2009 from http://en.wikipedia.org/wiki/ankylosing_spondylitis

Springhouse. (2005). Professional Guide to Diseases, (8th ed.). Lippincott: Williams & Wilkins.

Thursday, May 7, 2009

Professional Practice

Professional Practice
Assessment Task 1 – Blog 1
Victoria Walden
Due 8th of May 2009

Does the scope of practice as defined by massage New Zealand fit within the legal requirements under the act: Healthcare Professional Competency Assurance Act 2003.

Yes, the scope of practice defined by Massage New Zealand does fit within the legal requirements under the Healthcare Professional Competency Assurance Act 2003. The reasoning why this scope of practice does fit is because of the way that Massage New Zealand has arranged their wording in their scope and also the professional way they approached this task.
With regards to Massage New Zealand they have incorporated the clinic competence and also the educational competence. As through learning the scope of practice will increase in each massage therapist as they continue with their study. From the clinic side of things the scope of practice in detail shows what the massage therapist is able to do and to achieve the best results from each client, as each client is not the same.

Example from the Certified massage therapy scope of practice:
· Delivery of relaxation massage according to the treatment plan which
could include the following massage strokes - effleurage, petrissage, deep
longitudinal, broad cross fibre, compression, vibration, tapotement.

Example from the Remedial massage therapist scope of practice:
· Clinical reasoning of the client condition presenting where information
gathered from history taking and physical assessment is assimilated to
produce an effective and relevant treatment plan.

I feel that the Healthcare Professional Competency Assurance Act (HPCA) is very strict as to what the massage therapist scope of practice is. Yet I feel in some way if Massage New Zealand does go under the HPCA that the flexibility of adapting to each client will be lost, there will be more restrictions to our practice and less freedom. Then again it could give more structure and credibility to the profession of massage therapists if Massage New Zealand did go under the act. Also massage would be under a government recognition giving massage therapists a more high profile name, as David quoted in the elluminate session of what a professional is:

“Professional – work ...requires the application of theories, principles and methods typically acquired through completion of a baccalaureate degree or higher or comparable experience; requires the consistent exercise of discretion and judgement in the research, analysis, interpretation and application of acquired theories, principles and methods to work product (West Virginia Interactive, 2008).”
(Elluminate, 2009).

From this quote it states that we do, do all of these things and more. The next step in the massage industry I feel is to get the positive go ahead from the government and HPCA can help with that.
Does our scope of practice as defined by MNZ accurately reflect our scope of practice?

I believe that Massage New Zealand’s scope of practice does accurately reflect our scope of practice because like the scope of practice we are striving to be professionals within massage therapy.
I believe that we all have our own approach to the scope of the massage industry but we all have to follow by the guild lines that Massage New Zealand has produced. Through these guild lines (scope of practice) we as massage therapists can apply any treatment within the scope and effectively produce a professional healthcare relationship with each client.


References:
Elluminate April 8, 2009.
Massage New Zealand. (2009). Retrieved May 7th 2009 from www.massagenewzealand.org.nz

Wednesday, May 6, 2009

Evaluation of Research Findings

Research Methods Assessment Task 1 - Blog 4 - Evaluation of Research Findings
Victoria Walden
Due Date 1st May 2009 (with extension)

Bodywork e-News. Unraveling the mysteries of Unwinding. (2008). Retrieved May, 8, 2009 from http://www.terrarosa.com.au/articles/Terra_News2a.pdf

‘Unravelling the mysteries of unwinding’, is an article of information referring to the techniques of Myofascial Release. Through reading this article I found that it had some good aspects and some less ones.

The first aspect that I liked about it was that the introduction explains the title of the article in the first two sentences. For Example, ‘The term “unwind” is in general used with a meaning to relax, become less tense, or take an ease. “Unwind your body” is a common phrase used to promote relaxation bodywork (Bodywork e-News, 2008). From these first two sentences the article has set up the article to inform the reader about relaxation of the body.

Another great aspect to this article is that it is well laid out and easy read. If a client is to receive Myofascial Release, this background information could set their mind at ease. The pictures and the explanation of what would occur during the session are simple and easily understood.

Unfortunately after reading the article a few times I still do not know whom the article is written for, as Simon also states in his blog (S, Marks, 2009).
My reasoning to this outcome is that the article is lacking in depth. It only brushes the surface of a lot of topics, therefore only giving enough information for someone to keep looking in other sources to acquire the full details of the article.

Another reason, which points the way to whom this article is written for, is contained in the remarks through the article stating where Myofascial Release is offered and that taking a seminar would be beneficial and helpful. To me in an article that was written to inform personal about the Myofascial techniques should not have marketing statements through the article. I would however accept the marketing comments at the end of the article, therefore giving the reader something to think about after reading the information and how myofascial release can help them.

This follows on to my next point, where arrangement of the article’s information is not in an order that flows. The article jumps from one topic to the next, not introducing or rounding up each topic. Therefore from this I found that someone who did not yet understand a little about the topic would find this article hard to follow.

My last comment to this article is that the article describes emotional release yet never goes into any depth about its effects from this treatment. For example in a paragraph with describes Dr. Frymann as mainly having developed the technique of unwinding, the article states that ‘unwinding was never intended nor used by her to provoke emotional release.’

From this I read that the client may have an emotional release from the treatment. Unfortunately it does not state what this means. Throughout the article from what I can tell, the author wants to inform the reader of the connection of the muscles with the mind as a way of increasing release from different areas of the body. I feel that emotional release is a major part of that, yet it is not fully explained in the article.

From this I find that the article has potential and could be beneficial for first time clients to read about the effects of Myofascial Release as well as helping the client to understand what is going on in their body.

References:

LoBiondo-Wood, G., Haber, J. & Krainovich-Miller, B. (2002). Critical Reading Strategies: Overview of the Research Process. Chapter 2 In LoBiondo-Wood, G. & Haber, J. (editors). Nursing research: Methods, critical appraisal, and utilization. 5th ed.). St Louis: Mosby. Retrieved May, 8, 2009 from http://www.richard.ingram.nhspeople.net/student/critintro.htm#lobi

Marks. S. (2009). Essay. Retrieved May, 8, 2009 from http://sjsteven.blogspot.com/2009/05/research-methods-blog-4.html


Bodywork e-News. Unraveling the mysteries of Unwinding. (2008). Retrieved May, 8, 2009 from http://www.terrarosa.com.au/articles/Terra_News2a.pdf

Thursday, April 2, 2009

My Research Process

I have found through the research process so far, I have been in very foreign territory as I have found myself questioning everything I write down. The research process is a very complex way of researching and I for one have found it very difficult to understand especially the referencing of so many research resources like; articles, journals, text books, web site etc. The list goes on, as does my confusion as putting all of the resources information together does take time.

I found that asking questions is not a bad thing, and that no one is perfect. This helped me to understand the outlines that you must take to process the information that is provided in so many different forms.

· Looking at the research question provided, and reading it over a few times and looking up definitions that I don’t understand.
· Breaking up the research question into smaller parts and seeing if I can reword the question for my own understanding.
· Using the key words from the question, look up search engines using them.
· Reading articles using the key words to see if they jump out as it is quicker and more efficient.
· Using a brainstorm to decide order of writing.
· Using examples and comparing.
· Tying information all together.

Collaborative research:

Through the past few weeks my research has been involvement with my collaborative group task, where I am join by two other of my class peers and we come up with a research question/query that we have to research and prove fact of fiction.

We have taken different steps to come up with a decisive question/query. First we all went away and came up with different questions that we could research, we then came together and looked through the research questions that we came up with, disregarding questions that were too broad or not enough research material to help us in the research of that topic. We then broke down the question to which we were all interested in and also happy with. Our next step was to see if we were to do that topic that we had information that we could use. Then our last step in the process to getting the right question/query was to see if our lecturer agreed and to also help break it down again to make the topic we were about to research specific.

· Does massage support the rituals an athlete goes through before an event to address anxiety levels?

Next was the methodology which we had help from our lecture again and we came up with the idea of a questionnaire to receive good information for or topic question.

Again our group went away and came up with different questions that could be relevant to the topic. We then all met up and put together a few questions that could be possible to use. Then from the questions put together we will show our lecture getting her views on the topic.
We then have to look at the literature review so we all took two different physiological effects of massage on the human body and also to incorporate the fact that we are also seeing he anxiety levels of athletes.

Through this time this is what my collaborative group has come up with. I have found working with my peers on the topic a lot easier as I find that I sometimes get lost. It is great to be able to work with and learn from others in my class as I have learnt a lot from the way that they take the whole research process, also how they cope with it.
I find that research isn’t my speciality and that I do need to work on it. I am learning new skills and happy that I am able to apply them to my research.

Resourses:
Class notes.
My thoughts

Thursday, March 26, 2009

Pathology: Tennis Elbow

Etiology:
Etiology of the tennis elbow includes the age of the client as people over the age of 30 years of age are more prone to incurring tennis elbow. Other causes of the diseases is repetitive action of the muscles involved in tennis elbow, for example playing tennis for a number of years, using the same muscles, tendons and ligaments day after day will eventually cause tennis elbow. Other causes are; tightness of grip, unskilled tennis players, force and flexibility of the forearm extensors. Also tennis elbow can be caused by a direct hit or a fall onto the elbow (Brad Walker 1999).

Pathogenesis:
Pathogenesis which is the affects after the disease or in this case the tennis elbow, is that with tennis elbow, small micro tears form in the tendons and muscles that are the control for such movements as swinging a tennis racket. From these tears they restrict movement and inflict pain, they also lead to the formation of scar tissue and calcium deposits therefore putting a lot of pressure on the muscles and nerves that can cut off blood flow to those areas (Brad Walker 1999).

Morphological:
Morphological is the anatomical changes that occur from the tennis elbow. Therefore the changes within the tennis elbow disease are the micro tears of the tendons and muscles used that was mentioned in the pathogenesis.

Histological:
Histological is the cellular and extra-cellular matrix changes when tennis elbow is present in the elbow. When tennis elbow is present, as said above, there are going to be micro tears in the tissues therefore as when there is an injury of the tissue there is usually bleeding at the site as the tear very likely would damage small blood vessels. This fluid includes blood and also chemicals that are released into the extracellular fluid (Marieb, E,. Hoehn, K, 2007), that accumulates at the damaged site which contains protein that turns into scar tissue. When there is an overload of scar tissue it will result in restriction of movement and also preventing the structure to return to its normal state, also increasing the risk of re-injury.

Epidemiology:
Incidence:
- Approximately 1% - 3% are diagnosed with “tennis elbow” each year (Joshi, D, 2008)

Prevalence:
- Estimated that 40% to 50% of all tennis players will incur tennis elbow at one point in their carrier (Marc. C, Levesque, MD, PhD, MD, 2007).
- “Between January 2004 and June, 2007, the number of Patients receiving a “tennis elbow” diagnosis has risen by 25% (Joshi, D, 2008).”



Reference:

Joshi, D,. (2008). Arthroscopic Treatment for Tennis Elbow: Report Shows Excellent Outcomes. Retrieved 26th of March 2009 from
www.pearldiverinc.com/pdp/index.php/eng/Market-and-Company-Data/Extremity-Reconstruction/Arthroscopic-Treatment-for-Tennis-Elbow-Report-Shows-Excellent-Outcomes

Marc. C, Levesque, MD, PhD, MD,. (2007). Arthritis and Tennis Elbow. Retrieved 24th of March 2009 from www.webmd.com/osteoarthritis/guide/tennis-elbow?

Marieb, E, N,. Hoehn, K,. (2007). Human Anatomy and Physiology. 7th edition.

Research – Wikipedia, the free encyclopedia (2009). Retrieved 24th of March 2009 from www.wikipedia.org/wiki/tennis_elbow

Vicenzino, B,. (2009). Lateral Epicondylalgia. Retrieved 24th of March 2009 from www.newmaster.it/spine2009/doc/report_vicenzino_20090206.pdf

Walker, B,. (1999). The Stretching Institute. Tennis Elbow: Guide to the treatment and prevention of tennis elbow. Retrieved 24th of March 2009 from www.thestretchinghandbook.com/archives/tennis-elbow.php

Wednesday, March 25, 2009

Information Quality

Collins Concise English Dictionary defines quality as “The degree of excellence which a thing possesses” (1978).
Information quality has a degree of excellence therefore is essential to the construction and critiquing of the research for any given topic.

Through research you can find information from a lot of different sources; library, internet, books, journals, articles etc. From this you then have to define what good and poor quality is.

How do you define the difference? How do you collect the correct data analysis to produce a comprehensive outcome for your research?

Alastair Smith (2005) has an idea that is an easy way to sort through the poor and good quality of resource information found through the internet.
He starts by looking at the scope including; breadth, depth, time and format. He then goes to the content; accuracy, authority, currency, uniqueness, links made to other resources and quality of writing. Alastair also looks at the graphic and multimedia design, purpose, for what audience, reviews, working ability; user friendly, required computing environment, searching browsability and organisation, interactivity, connectivity and cost.
Alastair’s analysis of internet quality of information is both precise and detailed.

Also Wendy Lazarus and Laurie Lipper (2003) also came up with a concept to identify what information is quality and what isn’t on the internet. They came up with a very different approach where they use a point system to define if the information is quality or not.
They split the evaluation into three sections. The first section is the baseline requirements, for example the author or sponsor being clearly identified. The second section is standards for low-barrier web sites which includes the literacy level of text. The third section is the requirements for high-quality web sites, which includes information quality, presentation etc.

Information these days comes from a lot of different sources and from these two sources it seems the internet is not so different from articles, books, journals etc.

Wikipedia referenced a journal that they found, that gives a precise outline of the dimensions to find and identify information quality (Wang & Strong, 1996).

1. Intrinsic IQ: Accuracy, objective, believability, reputation.
2. Contextual IQ: Relevancy, value-added, timeliness, completeness, amount of information.
3. Representational IQ: Interpretability, ease of understanding, concise representation, consistent representation.
4. Accessibility IQ: Accessibility, access security.

Through the sources found I established that they all have a similar way of finding the best quality of information. For example Alastair’s concept of finding quality information is to first read and then eliminating the requirements as they are established in the text. Wendy and Laurie found that their concept of a point system established what grade of quality the information was produced. Together they both used similar questions towards the text to achieve an efficient way to identify quality information.

Coming back to my questions asked before: How do you define the difference?

I have found reading through my references that you find the biggest difference in the first two minutes of looking at the resources provided. For example, where is the Author or sponsor clearly stated? When the resource was last updated? Are the first few lines easy to read and understand?

How do you collect the correct data analysis to produce a comprehensive outcome for your research topic?
Through my research, Wang & Strong’s concept has a basic outline that provides a guideline to find the correct data analysis for producing a comprehensive outcome. I repeat their concept again:
1. Intrinsic IQ: Accuracy, objective, believability, reputation.
2. Contextual IQ: Relevancy, value-added, timeliness, completeness, amount of information.
3. Representational IQ: Interpretability, ease of understanding, concise representation, consistent representation.
4. Accessibility IQ: Accessibility, access security.


References:

Information quality – Wikipedia, the free encyclopedia (2009) Retrieved March 18, 2009 from http://en.wikipedia.org/wiki/information_quality

Smith, A.G., (2005). Criteria for evaluation of Internet Resources, Retrieved March 18 2009 from www.vuw.ac.nz/staff/alastair_smith/evaln/index.htm

Lazarus, W., Lipper, L., (2003). The Children’s Partnership. Guidelines For Content Creation And Evaluation, Retrieved March 18 2009 from www.contentbank.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=6643

Collins, W,. Collins Cincise English Dictionary. (1978).