Incorporating Massage Therapy in Advance Practice Nursing

1. Incorporating Massage Therapy in Advance Practice Nursing By: Jill Collins & Sandy Seibert For NU 504 Integrative Healing April 27th, 2010

2. Introduction • Massage: “manipulation of tissues (as by rubbing, kneading or tapping) with the hand or an instrument for therapeutic purposes (Merriam-Webster, 2010) • Use of massage has been dated back to times of Hippocrates, the “father of medicine”, who said “the physician must be acquainted with many things, and assuredly with rubbing” (Massage today)

3. Introduction • Massage as been attributed to many clinical benefits including: • Lowering heart rate and blood pressure • Improving concentration • Strengthening the immune system • Lowering serum glucose levels in diabetics • Reducing anxiety • Increasing weight gain in premature infants • Reducing tension headaches

4. Introduction • Advance practice nurses have a unique opportunity to utilize complementary therapies such as massage for their clients • Advance practice nurses must familiarize themselves with potential benefits and adverse effects of these therapies as well as with their client’s needs to prescribe/recommend appropriate therapies.

5. Review of Literature • Purpose was to develop an understanding of the effects of massage therapy as an intervention on patients. • Six articles reviewed. Five articles reviewed effects on patients and on reviewed impact of brief massage on nurses. • Consensus was mostly positive in regard to the effects of massage therapy. Low cost. Not many studies on hospitalized patients.

6. Theoretical Framework • Myra Levine’s Conservation Model • Four principles to model • Conservation of energy (avoid excessive fatigue by balancing energy output/input • Conservation of structural integrity (maintains and restores structural integrity) • Conservation of personal integrity (maintaining person’s identity and self-worth) • Conservation of social integrity (acknowledges the patient as a social being)

7. Theoretical Framework • Using Levine’s theory, people with low back pain seek treatment attempting to restore structural integrity. It is then the responsibility of the advance practice nurse to recognize patient response and to then guide and support appropriate treatment choices such as massage therapy.

8. Cultural Issues • Massage or touch in itself has different cultural implications. Some cultures consider touch another, especially in the manner of massage, taboo. Other cultures believe strongly in the healing power of touch.

9. Legal Issues • Issues for both the prescriber of the therapy and the therapist. Practitioner must eliminate detrimental causes of pain before prescribing massage (i.e. DVT for leg pain as massage could dislodge and cause PE). Therapist must work within their scope of practice. If a patient discloses symptoms to a therapist, they should refer them to PCP instead of trying to manage themselves). • Billing issues regarding medically necessary treatment vs. recreational treatment

10. Ethical Issues • Informed consent • Patients must be informed of benefits and risks of the therapy • Confidentiality • All patient information and conversations should be kept confidential • Boundaries • Space boundaries for client and therapist. Must be comfortable with the therapy

11. Incorporation into Advance Nursing Practice • Studies show positive outcomes for multiple chronic and acute physical and mental conditions making it a feasible alternative healing modality to incorporate • Rising costs of conventional methods make massage therapy feasible as well • More cost effective for third party payors and for taxpayers

12. Incorporation into Advanced Nursing Practice • Limitations include contraindications and lack of insurance coverage. Most insurances do not cover massage at this time • Many stress related illnesses could be resolved by massage therapy • More research needs to be published on the actual dollar savings because money Is always a major driver behind insurance coverage • International organizations should share findings for better utilization of the therapy

13. References • Bost, N., & Wallis, M. (2006). The Effectiveness of a 15 Minute Weekly Massage in Reducing Physical and Psychological Stress in Nurses. Australian Journal of Advanced Nursing, 23 number 4, 28-33. • Cambron, J., Dexheimer, J., Coe, P., & Swenson, R. (2007). Side-Effects of Massage Therapy: A Cross-Sectional Study of 100 Clients. The Journal of Alternative and ComplementaryMedicine, 13, 793-796. • Cleary-Guida, M. B., Okvat, H. A., Oz, M. C., & Ting, W. (2001). A Regional Survey of Health Insurance Coverage for Complementary and Alternative Medicine: Current Status andFutureRamifications. The Journal of Alternative and ComlementaryMedicine , 7 number 3, 269-273. • Dryden, T., Baskwill, A., & Preyde, M. (2004). Massage Therapy for the Orthopaedic Patient. Orthopaedic Nursing, 23, 327-332. • Kaye, A., Swinford, J., & Lambert, T. (2008). The Effect of Deep-Tissue Massage Therapy on Blood Pressure and Heart Rate. The Journal of Alternative and ComplementaryMedicine, 14 number 2, 125-128. • Lee, A. C., & Kemper, K. J. (2000). Practice Patterns of Massage Therapists. The Journal ofAlternative and Complimentary Medicine , 6 number 6, 527-529. • Massage Today. (n.d.). Retrieved April 11th, 2010, from Massage Today: http://www.massagetoday.com/aboutmt • Melancon, B., & Miller, L. (2005). Massage Therapy versus Traditional Therapy for Low Back Pain Relief. Holistic Nursing Practice, May/June, 116-121. • Merriam-Webster Online. (2010). Retrieved April 11th, 2010, from Merriam-Webster Online: http://www.merriam- webster.com/dictionary/massage • Susan Kun Leddy. (2006). Integrative Health Promotion (second ed.). Sudbury Massachusetts: Jones and Bartlett Publishers. • Walton, M. (2009). Immediate effects of Effleurage Back Massage on Physiological and Psychological Relaxation. Nursing Journal of India, C Number 0, 230-232.