Massage for the Hospital Patient and Medically Frail Client
by Gayle MacDonald, MS, LMT
2005, Lippincott Williams & Wilkins
review by Teresa Ramsey


The scope of this book is very large. Gayle MacDonald, MS, LMT, is to be congratulated for taking on such a big project, and doing a good job with it. This manual is practical, reality based, and structured for a quick read in sections that appeal to an individual, or used as a text in the classroom setting. MacDonald also achieves her goals, on the whole, of providing a guide for the student in the hospital setting in developing safe approaches with massage, to assist with decision making in various clinical settings, establishing protocols, making referrals, and educating medical staff, the patient, and family.

Her intent is to assist the massage therapist to adapt skills they already have so they can function safely, effectively with a broad cross section of people in hospitals, nursing homes, chiropractic offices, and any clinical setting where people would have chronic or acute health care issues that can be affected positively or negatively with massage. The primary modifications she focuses on in modifying massage are: pressure considerations, site restrictions, and positioning adjustments. She covers these aspects extensively in the manual. It is very clear she holds the comfort and success for the individual massage therapist at heart, so they can function within the scope of practice, and offer what we all know to be ancient medicine, so endurable because it works (when done properly).

There are 13 chapters, a section on medical abbreviations, medical terms, a short review of various touch modalities besides Swedish Massage, samples of documentation forms, and answers to test questions posed at the end of each chapter. The format is to present the information, give tips that are very practical for someone unfamiliar with the hospital setting, share information from individual massage therapists’ experience, a summary of the chapter and test questions. As I read this manual, I took notes on each chapter, and there are a lot of notes. It’s a lot for me to write and a lot for you to read. Instead, here are the topics covered:

History of massage and where it is today (interesting; one has to start somewhere)

Research review (some strong, some sections are out of date, nice biblio support)

Adapting to Hospital Culture (very good, very important)

Infection Control Practices (very good, very important)

Pressure, Site, and Position (Technical terms not explained within context of this section. Glossary needs to be positioned nearby. Good photos)

Common Reasons for Hospitalizations or Medical Treatment (Good overall. The weaknesses in this manual begin to show up here. More later).

Common Medical Devices and Procedures (Good information; need to stay within scope of practice)

Medications (Complex issue. This has to be addressed; yet it places too much responsibility on the massage therapist. The nurse needs to be educated about massage and make the decision about contraindications or modifications of touch)

Referrals, Orders, and Intake (liability issues, access to patient charts or not, confidentiality, ethics, communication with medical staff. Very important info)

Massage Session (introduces the spiritual aspects of touch, nurturing, compassion, listening, bringing comfort, sense of wholeness, while maintaining clean boundaries)

Documentation (styles of documentation such as SOAP,CARE, CARP, examples, and how to communicate with nurse about this essential information)

Blazing New Trails (individual accounts of programs in various hospital settings)

This is a great place to begin and we must express appreciation to Gayle MacDonald for taking this on and getting it to print, and for Lippincott Williams & Wilkins to seek it, support it and see it through to publishing it. A lot of massage therapists will benefit. However, the work isn’t done yet. There are some weaknesses in this manual that need to be addressed, and hopefully the publishers will be eager to take the next step to fill in the missing pieces.

When I first picked up the book, looked at the contents page, I flipped back to the Trailblazer section. I am a BSN, LMT, CIMI with many years hospital nursing experience in Med Surg and Obstetrics nursing. I train newborn massage instructors who have started programs in hospitals across the US and internationally. Naturally, I would be drawn to read the individual’s account of massage in the NICU. Besides being a little miffed no mention was made of my program, it alerted me to look for places where other “experts” weren’t consulted. The weaknesses of the book begin to show up in the research section. If you look at the dates of the most current research, some of it is very old (even if its still good), and there are gaps or shortages of reference materials. “Experts” can be a resource for this type information. There is an inadequacy of consultation with experts. I found this to be true for obstetrics, lymphedema, and infant massage at least. I am only a little “expert” in a narrow part of the big picture. A book like this needs to pull in lots of experts. The editor could have pointed this out, and a current literature search done at a medical school library, a list of associations where further training could be taken, and experts sought out for guidance in content. Since I am Education Director for NANMT, it just touched a raw nerve in the opening sections where the author says so and so is a nurse and a massage therapist…. NANMT has a long way to go to educate people about our presence. Wouldn’t it have been nice to be consulted by the publisher or the editor as this book was being put together?

This is a book well worth having. I recommend it and also recommend a supplement that addresses the gaps.