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In observation of the Thanksgiving holiday, AMTA National Office will be closed Wednesday, November 22, 2017 at 2:00 PM CST
through Friday, November 24, 2017. 
You can reach us during our normal business hours starting Monday, November 27, 2017.

Inpatient Hospital-based Massage Therapy


Inpatient Hospital-based Massage Therapy

From increased concern about the opioid epidemic to patients who are looking for more integrative, holistic ways to manage pain and anxiety while in the hospital, massage therapy in the health care setting is becoming a viable option for care—and is being supported by more and more research.

What this boon means is that massage therapists interested in working with hospitals have opportunities that might not have existed in the recent past. But with this opportunity also comes a need to fully understand the health care environment in general and the hospital environment more specifically.

Following, you’ll find information about working in the hospital setting, including how massage therapy can help, what you can expect and what’s expected of you.


How Massage Therapy Helps in the Hospital Setting

Pain

Pain management is both a critical and challenging issue for patients who are either about to undergo or are recovering from surgical or operative procedures. Still, if postoperative pain is effectively managed at the acute state or during immediate post-surgical periods, studies have found patients are often able to recover uneventfully and return to their normal daily activities.1

Even knowing this, a significant number of patients still transition into chronic post-surgery pain or persistent post-surgical pain, defined as pain lasting longer than two to three months after surgery.1,2

Other functional outcomes are also affected by uncontrolled post-surgery pain, mainly sleep, mood and quality of life.3 The fear and anxiety that patients preparing for surgery commonly feel also complicates both pre- and post-surgical pain management and increases the likelihood they’ll develop chronic post-surgery pain.4,5

The good news, however, is that research is also showing massage therapy can help patients better manage pain. For example, a collaborative metaanalysis of research on massage therapy for pain, conducted by Samueli Institute and commissioned by the Massage Therapy Foundation with support from the American Massage Therapy Association, concluded that massage therapy can be effective for reducing pain intensity/severity and anxiety in patients undergoing surgical procedures.6

Additionally, a 2012 study published in The Journal of Thoracic and Cardiovascular Surgery showed that massage therapy significantly reduces pain, anxiety and muscular tension in cardiac surgery patients while also enhancing relaxation, which may be especially needed in the hospital setting where patients may be dealing with pain for a variety of reasons. “The most common reason that massage therapy is requested is usually related to uncontrollable pain that the patient is experiencing,” say Maegan Dollof and Stacey Gilbert, who are massage therapists at Centura Health Integrative Medicine.

Jennifer Hauschulz, BCTMB, Mayo Clinic Integrative Medicine and Health, agrees, explaining how she’s seen firsthand how pain—especially postsurgical pain—can be helped by massage therapy.

Stress and Anxiety

There are many reasons why hospital patients may feel stress and anxiety, and, like pain, leaving these feelings unchecked can interrupt healing. “Many times the pain is exacerbated by the stress and anxiety that the patient is experiencing in the hospital,” Dollof and Gilbert explain. “Spending 15–30 minutes with a patient providing massage therapy techniques can lower a patient’s blood pressure and improve their oxygen levels while also decreasing the pain and anxiety they may be feeling.”

Immobility and Sleeplessness

For some patients, hospital stays can be long, sometimes extending 100 or more days, according to Hauschulz, and massage therapy can help these patients better cope with some of the common side effects of long stays, like sleeplessness or restlessness.

Immobility, too, can be a big issue for patients who are there for surgery or older patients who are unable to leave their bed during a hospital stay. Muscle pain can result, and there is increased risk for conditions like bed sores, too. “Massage therapy provided to inpatients helps alleviate aches and pains associated with the lack of mobility,” explains Dan Halpain, a hospital-based massage therapy instructor at Pacific College of Oriental Medicine San Diego. “It is used to increase circulation to extremities, reduce the formation of bed sores and improve sleep.”

Isolation

Just as sleeplessness could result from long hospital stays, hospitals can sometimes be very isolating, and massage therapy has the potential to help a patient better deal with feelings of loneliness. “[Hospital massage therapy] can help the patient not feel [as] isolated,” says Jeremy Miller, a massage therapist at Allina Health Minnetonka Clinic.


What’s Expected of Massage Therapists in the Hospital Setting

Understand the Patient

Massage therapists need to be familiar with a patient’s symptoms and diagnosis before starting the massage so they can provide massage that is most beneficial and doesn’t interrupt other treatment protocols or exacerbate symptoms.

“It is important to be aware of the patient and what medications they are on so that this can be taken into account,” Dolloff and Gilbert explain. “Patients on pain medications may not be able to indicate when pressure is too much. Patients on medications that include blood thinners and chemotherapy may bruise easily. Working around incisions and IV sites is a must.”

Another precaution to keep in mind is whether the patient has any medical devices you’ll need to work around during a massage session. Miller insists that if a patient has any medical lines or patches, the massage therapist needs to avoid the local area that the lines or patches surround so that any important medication a patient is receiving is distributed properly.

Halpain agrees, explaining that massage therapists should be knowledgeable and familiar with the medical devices they are likely to encounter during massage, as well as why the medical devices are there.

Teamwork

According to Dolloff and Gilbert, massage therapists in a hospital setting will work with certified nursing assistants, nurses, physicians, physical and occupational therapists, and social workers, to name a few—in short, a wide variety of health care professionals who will be interacting with the patient in a wide variety of ways.

Many times, however, the nursing staff may be a massage therapist’s biggest source of information. “The nurse is always the most valuable resource and will give the massage therapist information and instructions about areas to avoid, positioning and moving the patient, and valuable insight into the patient’s condition and what kind of day the patient is having, as well as suggestions for areas that might be addressed,” Halpain explains.

Nurses, too, are likely going to be the ones who recognize the need for massage therapy. “Oftentimes, it is the nursing team that recognizes that massage therapy may help their patient, and they reach out to the physicians to get the order in place for the patient,” Dolloff and Gilbert add.

Flexibility and Focus

“Negotiating the unfamiliar environment at first can be challenging,” Halpain says. “Massage therapists are used to having much more control over things like the room environment, and the timing and flow of the massage treatment.” That’s not the case with massage therapy in a hospital setting, where often you’ll be massaging patients as they lay in bed, for example, or have to work around other health care professionals and medical equipment.

Hauschulz agrees, explaining that massage therapy may be interrupted and will often be much shorter than the 30-, 60- or 90-minute sessions you might traditionally associate with massage. “It’s tough to be able to give even a 20-minute treatment without being interrupted by other medical staff,” she says. “We have to be prepared for anything and think on our feet.”

Your work will always focus on the patient. “The primary role for massage therapists in the hospital setting is to bring comfort,” Dolloff and Gilbert explain. “Oftentimes when patients are touched, it’s for gathering medical information. Massage is the one time that a patient is being touched not to gather medical information, but simply to nurture and bring comfort.” That said, Dolloff and Gilbert add, the type of touch used will generally be more nurturing than treatment-oriented, lighter rather than deeper.

Education and Training

According to massage therapists in the health care field, proper skills and training are required to work in the hospital environment. If you plan to work with a specific group of people, take note of the kind of education you have attained prior to applying for hospital positions. Likewise, if your work with a group of people requires further education, take time to enroll in more classes if need be, and stay up to date on any recent research concerning that topic.

In this setting, you’re also going to need to be able to chart a patient’s treatment using correct medical terminology. “The focus during treatment charting is how the patient changed physically as well as emotionally, so our treatment notes focus on that,” Dolloff and Gilbert explain. “Keeping it short is also important so that it is easy to read for the care team.”

Emotional Resilience

“We talk a lot about compassion fatigue,” Hauschulz notes. “We’ve probably all felt it. We work with many age groups and see patients who could be our kid or our dad or our mom or even ourselves, and it’s a struggle not getting wrapped up in the emotions of it all.”

“In the inpatient setting, it’s very common to have emotional burnouts because the patients are actually ill and [it’s your job] to be fully present,” Miller adds.

In this regard, adds Halpain, massage therapists need to remember that they are not there to heal patients. “Having strong emotional resiliency and boundaries is important,” he says.

Dolloff and Gilbert also encourage massage therapists to remember they are often seeing patients at their worst, so be generous and accepting when possible, giving patients the benefit of the doubt. “Listening to feedback from patients is important,” they say. “But don’t take negative comments from them personally.”

Related: Research - Massage Therapy Complements In-Patient Care


Massage & Health Care Resources

FREE Massage Career Guide: Working in a Health Care Environment

Communicating + Collaborating with Health Care Professionals

Growing Your Massage Practice: Sample Intro Letter to Physicians


References

References
1. DeFrances CJ, Cullen KA, Kozak LJ. National hospital discharge survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat. 2007;13 (1):1 209.

2. Peng Z, Li H, Zhang C, et al. A retrospective study of chronic post-surgical pain following thoracic surgery: Prevalence, risk factors, incidence of neuropathic component, and impact on qualify of life. PloS One. 2014;9 (2).

3. Finan P, Goodin B, Smith M. The association of sleep and pain: An update and a path forward. J Pain. 2013;14 (12):1539–52.

4. Clarke H, Woodhouse LJ, Kennedy D, Stratford P, Katz J. Strategies aimed at preventing chronic postsurgical pain: Comprehensive perioperative pain management after total joint replacement surgery. Physiother Can. 2011;63(3):289–304.

5. Adams R, White B, Beckett C. The effects of massage therapy on pain management in the acute care setting. Int J Ther Massage Bodywork. 2010;3(1):4–11.5.

6. Courtney Boyd, MA Cindy Crawford, BA Charmagne F. Paat, BS Ashley Price, BS Lea Xenakis, MPAWeimin Zhang, PhD. The Evidence for Massage Therapy (EMT) Working Group. The impact of massage therapy on function in pain populations—A systematic review and meta-analysis of randomized controlled trials: Part III, surgical pain populations. Pain Medicine. Volume 17, Issue 9, 1 September 2016, Pages 1757–1772.

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Kim K., AMTA member since 2003

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