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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 61 carefully, but I also ask her parents. "Do you think she's enjoying the foot massage? Or am I tickling her?" Is she tensing because her shoulder hurts or because on the TV, above my head, Poppy and her troll friends are in danger of being eaten? With the help of her parents, I can adapt my pressure, change my approach, keep doing what I'm doing, or just know we're done for today. Success in communicating with patients is deeply connected to the commitment to communicate with all the people around them. This obviously includes their parents and family, but it also includes all the other members of their care team. Written and verbal communication with family and providers is as essential to providing good care as anything that happens during direct patient contact. Nonverbal communication is an integral part of the picture too. You are communicating all the time in ways you need to become more keenly aware of. (See "Nonverbal Communication Techniques," page 62.) The nurses and other providers in any hospital are extremely busy and extremely protective of their patients. This dynamic demands a bit of a communication balancing act. The massage therapist doesn't want to bother the medical staff, and, as a result, walks into a patient's room, passing the nurse, without speaking to them. If this happens, that nurse is likely to stop the therapist or chase them into the patient's room asking, "Who are you? Why are you here? Who said you could touch this patient?" Even if the therapist can answer all these questions reasonably and correctly, they have already made this nurse suspicious. The massage therapist is not trustworthy in the nurse's eyes. This nurse does not think of this therapist as part of the team. On the other hand, if the massage therapist tracks down a patient's nurse and asks a billion questions, the therapist is also showing that they don't belong. This nurse is busy. They aren't here to brief the massage therapist on the entire medical and social history of this patient and family. Why are you wasting my time? An effective massage therapist hones their communication. We train massage therapists to introduce themselves in a way that makes it clear they are a member of the care team. We know that we need to ask just one or two short questions that will show the nurse that we respect their time, we understand that the nurse knows things about this patient that we don't, and that we are asking only for the information that is needed to provide the best possible care to the patient. As professionals, we know how to construct these questions in a way that leaves space for information we may not expect, but that might be invaluable. For example, "Hi. I'm Kerry. I'm a massage therapist with the Palliative Care team. I was asked to see Jessica in 237." Then, we pause, and let that information go in. Wait for the nurse to make eye contact. Maybe this nurse doesn't know there is a massage therapist on the Palliative Care team. Maybe they didn't catch the massage therapist's name. Maybe they are writing an angry text message to their boss. Give them a second. Depending on the nurse's response, there are lots of possible questions a massage therapist could ask, but here are a few that can elicit useful answers and clinical trust: • My census was printed early this morning. Is there anything that might have changed for this patient since then? • Does this patient have any skin breakdown/wounds/devices I should be aware of and that might be covered or not immediately apparent? • Is anyone else at the bedside? • We frequently see a decrease in heart rate or respiratory rate during massage. Is there any reason that would be inadvisable for this patient? After a session, our massage therapists check back in with the nurse. We let them know if anything happened that might support or change the care they are providing. We thank them. Once communication with the nurse is complete, we close the encounter with another important piece of communication: the therapist's note in the Electronic Medical Record. Your note is intended to share the most important details of the time you spent with the patient. Most of the other members of the care team are not massage therapists, so typically we indicate the basics of what we did during the session, including the level of pressure we employed, how our work was received, and anything we observed about changes in patient vital signs or family interactions that other care providers should know about. It's essential to be factual, brief, and clear. We do not exaggerate, guess, or share our personal opinions. When massage therapists communicate with other providers, we must use the language they use. We need to ask them to clarify when we don't understand. We cannot pretend to know if we don't know. We must cultivate genuine curiosity about what the other providers know and see and experience as a result of their training, their position, and their interactions with the patients we share. At Healwell, we are passionate about using the Walton Pressure Scale in our Electronic Medical Record entries and in conversations with other massage therapists and providers. The Walton Pressure Scale provides a more objective measure and language about an otherwise subjective intervention. It also allows us to share common terms and understanding about how massage therapy was/is applied. You can find more information about the Walton Pressure Scale in Massage Therapy and Medical Conditions: A Decision Tree Approach by Tracy Walton (2011).

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