Good Practice Guideline On Malay Massage Notes
Good Practice Guideline for Malay Massage
Introduction
In Malaysia, Traditional and Complementary Units (T&CM Units) were established in Hospital Kepala Batas (October 2007), Hospital Sultan Ismail (January 2008), and Hospital Putrajaya (March 2008).
Malay massage is one of the T&CM modalities offered at these hospitals.
Since December 2009, three additional T&CM Units have begun operations at Hospital Sultanah Zahirah, Terengganu; Hospital Duchess of Kent, Sabah; and Hospital Umum, Sarawak.
This guideline was developed from a working paper presented in May 2009 regarding good practice guidelines for Malay traditional massage in chronic pain and post-stroke management.
Data analysis from the first three T&CM Units identified the following needs:
Proper and systematic documentation.
A standardized approach for patient assessment.
A standardized treatment plan for similar conditions across all integrated hospitals.
The purpose of this Good Practice Guideline is to:
Guide T&CM practitioners in standardized record keeping.
Provide a standardized approach to patient assessment and treatment.
Maintain ethical and professional conduct.
The guideline assists practitioners in examination, treatment, and discharge processes, aiding in decisions for specific clinical circumstances but are not strict standards or rules.
Practitioners must understand the guideline and apply it appropriately, tailoring treatment to each patient's specific needs.
Organization of the Guideline
The guideline is organized into four sections:
Section I: Assessment and diagnosis of the patient's problem (Evaluative Phase).
Section II: Treatment plan (Treatment Planning Phase).
Section III: Patient care and monitoring (Treatment Phase).
Section IV: Discharge assessment (Discharge Phase).
General Considerations
Record Keeping
General Considerations
All information must be recorded chronologically and contemporaneously.
Records should not be backdated or altered.
Corrections or additions should be initialed and dated.
Charts should be fully documented with relevant, objective information, excluding extraneous details.
Records must be complete for subsequent patient care or reporting.
Appendix 7 provides a case study example.
Legibility and Clarity
Records should be neat, organized, and complete for other healthcare providers or legal purposes.
A dated record of each visit, including changes in clinical picture or assessment, is required.
All entries should be written in ink.
Entries should not be erased or altered with correction fluid.
Changes should be initialed and dated in the margin.
Note-taking methods are a matter of preference for each practitioner.
Records must be in an agreed-upon language (Malay or English), either typed or legibly handwritten.
Patient records are confidential and must be kept properly.
Ethical Issues
During treatment, T&CM practitioners should:
Adhere to ethical conduct guidelines (refer to Code of Ethics and Code of Practice).
Maintain clinical boundaries using appropriate draping and communication.
Demonstrate responsible and caring concern for the patient.
Respond appropriately to emotional reactions during treatment.
Elicit ongoing feedback on clinical outcomes and provide patient education.
Maintain updated documentation on treatment and patient response.
Maintain communication with referring clinicians as appropriate.
Cleanliness and Sterility
Practitioners must maintain good personal hygiene.
Hands must be washed before patient examination and treatment.
Premises and equipment should be cleaned regularly and after each session.
Practitioners must take infection prevention measures (refer to the Malay Massage Practice Guideline, 2nd Edition 2009).
Opened massage oil containers should not be left exposed for long periods.
Instruments must be disinfected and sterilized according to recommended methods (Appendix 5).
Section I - Assessment and Diagnosis (Evaluative Phase)
This section focuses on practitioner preparation and integrating patient information to form and confirm a hypothesis about the patient’s problem. Key steps include:
Data gathering through patient examination.
Confirmation of the patient’s problem.
Creation of a summary of clinical findings.
Decision on whether to pursue treatment.
History Taking
Determine if the patient has a specific diagnosis on referral. If so, focus history taking on questions related to that condition.
For walk-in patients without a diagnosis, gather general information to clarify the presenting problem and suggest a diagnosis.
Physical Examination
Analyze the patient’s problems/impairments to further confirm the clinical diagnosis.
Practitioners are required to document all findings in the clerking form (Appendix 6a and 6b).
To Treat or Not To Treat?
Determine if the patient would benefit from massage therapy.
Confirm treatment appropriateness and identify any contraindications.
Refer the patient to the appropriate healthcare professional if needed.
Section II - Treatment Plan (Treatment Planning Phase)
Summarize clinical findings from the evaluative phase, distinguishing between areas of function and dysfunction.
Select appropriate treatment techniques.
For post-stroke patients, the concept is whole body massage; for chronic pain, it's half-body massage (Consensus Meeting, March 2009).
Treatment technique choice depends on identifying functional outcomes consistent with the patient's limitations.
Explain the treatment technique to the patient, including any potential harm; ensure the patient understands and accepts the risks.
Obtain patient consent before treatment. For minors or mentally impaired adults, obtain consent from a guardian.
The number and frequency of visits should be tailored to the individual patient. The following table summarizes a guide for the number of sessions to treat chronic pain and post stroke patients:
Chronic pain: 3 sessions within a week (either 3 consecutive days or alternate days). Assessment for effectiveness is done at the third session. The maximum session given in the unit for cases is 5 sessions.
Post stroke: 7 sessions broken down as follows: first week with 3 sessions; second week with 2 sessions; and third week with 2 sessions. Assessment is done at the 7th session. The maximum session given in the unit for cases is 10 sessions.
Section III - Patient Care and Monitoring (Treatment Phase)
This phase involves an ongoing cycle of treatment, re-examination, and treatment progression.
Evaluate the appropriateness of the care plan and the patient’s tolerance.
Avoid introducing too many techniques at once to easily identify responses.
Perform patient examinations to assess any clinical changes.
Re-examination focuses on changes in impairments and functional level from the baseline, and identification of positive or adverse responses.
Reassess impairments and functional level as recommended (Section II, Table I) and at other appropriate intervals.
Ideally, each treatment session incorporates patient examination and progression or modification of techniques or education.
Table 2: Duration of Malay massage therapy for chronic pain and post stroke cases:
New case | Follow up case | |
|---|---|---|
Chronic pain | 30 – 45 minutes | 30 minutes |
Post stroke | 30 – 60 minutes | 30 – 60 minutes |
Section IV - Discharge Assessment (Discharge Phase)
This phase involves transitioning the patient to another clinician or self-care.
Elicit the patient’s perceived discharge needs.
Inform the patient of post-discharge treatment requirements.
Prepare an initial discharge plan based on clinical findings.
Discuss discharge goals and arrangements with the patient and document the final plan.
Prepare the patient for pre-discharge education.
Complete and document pre-discharge examination to determine if functional outcomes have been achieved. Refer the patient for follow-up care as appropriate.
Advise on self-care, health maintenance, and prevention of recurrence.
Conclusion
This guideline assists T&CM practitioners of Malay Massage through the evaluative, treatment planning, treatment, and discharge phases.
It enhances the appropriateness of examinations, care plans, and interventions.
It also encourages adherence to the code of ethics and practice, maintaining a high level of professionalism.
Appendices
Appendix 1: Evaluative Phase
Appendix 2: Treatment Planning Phase
Appendix 3: Treatment Phase
Appendix 4: Discharge Phase
Appendix 5: Sterilization and Disinfection Methods
Appendix 6a: Clerking Form For Stroke for Use in Integrated Hospitals
Appendix 6b: Clerking Form For Chronic Pain for Use in Integrated Hospitals
Appendix 7: Case Study Example
Appendix 5: Sterilization and Disinfection Methods
Methods of Sterilization
Steam sterilization is the most widely used method for metal instruments. It is non-toxic, inexpensive, sporicidal, and rapid.
Effective when free from air, ideally at 100% saturated steam.
Pressure helps obtain the high temperatures required.
Recommended sterilizing temperatures and times:
Steam under pressure (autoclave, pressure cooker):
Required pressure: 15 pounds per square inch (101 kilopascals)
Temperature/Time:
115°C for 30 minutes
121°C for 15 minutes
126°C for 10 minutes
134°C for 3 minutes
Dry heat (electric oven):
Temperature/Time:
160°C for 120 minutes
170°C for 60 minutes
180°C for 30 minutes
Instruments made of rubber or plastic can be chemically sterilized (e.g., 6% stabilized hydrogen peroxide for six hours).
Boiling needles in water or soaking in alcohol is insufficient for sterilization.
Methods of Disinfection
A high level of disinfection is achieved by boiling instruments for 20 minutes.
Simplest and most reliable method for inactivating pathogenic microbes, including HIV, when sterilization is unavailable.
Hepatitis B virus and HIV are inactivated by boiling for several minutes; however, boiling should be continued for 20 minutes to be sure.
Chemical disinfection is used for heat-sensitive equipment.
Effective against a limited range of microorganisms.
Items must be dismantled and fully immersed.
Rinse disinfected items with clean water.
Unstable and may be corrosive/irritating.
Agents include:
Chlorine-based agents (e.g., bleach)
Aqueous solution of 2% glutaraldehyde
70% ethyl or isopropyl alcohol
Appendix 6a: CLERKING FORM FOR STROKE
This appendix provides a sample clerking form for stroke patients, including sections for patient information, vital signs, history, examination, and treatment plan.
Appendix 6b: CLERKING FORM FOR CHRONIC PAIN
This appendix provides a sample clerking form for chronic pain patients, including sections for patient information, vital signs, history, examination, and treatment plan.
Appendix 7: Case Study Example
Provides an example of a case study involving a 30-year-old male accountant with neck pain.
Patient Name : Mr M
Patient Address : 3, Jalan Kenanga, Seksyen 5, 40000 Shah Alam, Selangor
Patient I/C No. : 800205-14-5689
Patient Age : 30 years
Referral : none
The patient is a 30 years old man who works as an accountant at a local company. He presented with 4 months history of neck pain which has steadily increased in severity. The neck pain occurs at rest, at end of range of motion and during functional activity. The patient does not recall any injury or events preceding the onset of the neck pain. He also reports difficulty in driving due to tightness of neck muscles, and transient headaches (temporal region). He has no other medical illness. Despite the fact that Mr. M has suffered for 3 months, he has not yet sought any treatment for his neck pain. He does however, took various types of available over the counter pain relief medications. He reports that the medications provides him with temporary relief and enables him to continue working and has a good functional activity. But, for the last 1 month, the medications are providing with very minimal pain control. Since then, he finds that even getting up from bed is agonizing.
References
A list of references used in the guideline, including books, articles, and websites.