The Reviving – Touch – As a Nursing Intervention in Patient Care by NRS. Deborah J. Yusufu RN, RM, RCCN, BNSc, PGDE, MSc (Pla & Admin) Department Of Nursing Asokoro District Hospital, Abuja [email protected] Being A Presentation During The Annual International Nurses Week, Held At Officers’ Mess And Suites, Nigeria Air Force (Naf) Conference Centre, Plot 496 Ahmadu Bello Way, Kado, Abuja From 7th – 12th May, 2019
- Types of touch
- The Perception of touch
- Intimate touch
- Perspectives on intimate touch
- Measures to revive “Touch” in nursing
Perhaps no aspect of care is as essential to nursing as touch.
Nurses touch patients to perform clinical tasks, communicate caring, and ensure comfort.
Nurse authors have discussed touch for well over 100 years. Still, before 1990, much of the literature related to touch focused on defining the different kinds of touch only.
- The use of touch in nursing is not new. There is evidence of a well developed use of touch in the early 19th century.
- Currently there is a resurgence of interest in touch and its use in nursing.
There may be several reasons for this interest.
- The first may be concerned with an attempt to counteract the dehumanizing effects of a patient's stay in a modern hospital. The highly stressful nature of a 'high tech' hospital environment can adversely affect patients' well-being.
- Nurses are in an ideal position to use touch to provide a high level of personal contact in an unfamiliar hospital environment.
- Secondly nurses are constantly reviewing the principles from which they practice.
- The current trend in nursing is moving away from a concept of nursing based on a medical model of practice towards practice that encompasses holistic principles.
- The principles of holistic practice, treating the person as a unified whole, underlie most forms of complementary therapy.
- Its use along with other advances in nursing care has been shown significantly to increase the quality of care nurses provide.
- Despite the fact that touch is essential to nursing practice, few studies have investigated patients' preferences for how nurses should perform tasks involving touch.
- It is on this note that this paper seek to discuss the topic “reviving – touch – as a nursing intervention in patient care”.
- Consequently, in our highly technical world of medicine, drugs, computers and machines, however, what place does touch have in health and healing?
Why is Touch Important in Nursing
- In the past touch as well being used to demonstrate care and compassion, has been central to healing.
- The laying of hands has been practiced for centuries. The authors look at the importance of Touch in Nursing care, and suggest that greater awareness of how touch affects patients would be of benefit to Nurses
- Touch is a very powerful means of communication. Lightly touching a person’s hand can convey your concern and affection to them. But as with eye contact, the touch has to be appropriate.
Types of touch
Touch is categorized according to purpose as follows:
- Instrumental, procedural, or necessary touch, as occurs when changing a dressing, is task oriented.
- Expressive, comforting, or unnecessary touch, as when a nurse holds a patient's hand, addresses emotional needs.
3. Protective touch, as when a nurse moves a patient's hand away from ventilator tubing, prevents a potentially dangerous event.
- Most researches since the 1990s has examined how often these types of touch are used, the parts of the body associated with them, and nurses' and patients' general perceptions of touch.
- Many studies suggest that instrumental touch is used far more often than expressive touch and that patients often accept the necessity of instrumental touch.
4. Expressive touch is usually applied to the arms, hands, shoulders, and knees; some patients report that they find this kind of touch physically or emotionally comforting, although not all patients do.
A single encounter may comprise several types of touch, such as expressive and instrumental, but most researchers don't specify how they distinguish one type of touch from another.
Therefore, it's not clear how one might categorize a nurse's firm, supportive grasp of the arm of a patient who has ataxia:
- Is it instrumental, since it assists with ambulation;
- expressive, since it reassures a patient who might fear falling; or
- protective, since it guides a patient away from injury?
The Perception of touch
- How nurses and patients perceive touch stems from a variety of influences.
- The nurses’ gender - male nurses fear their touch will be misinterpreted by patients.
- Patients have mixed feelings about intimate touch provided by male nurses.
- In a study, both male and female nurses said they were "uneasy" when providing intimate care to patients of the opposite sex who were near their own age.
- Morin and colleagues interviewed postpartum women on their views about receiving intimate touch from male nursing students and found that the women's opinions were shaped by several factors, including how they felt about their own attractiveness.
- There are no studies that examined patients' perspectives on intimate touch provided by female nurses.
- In therapeutic touch therapists place their hands on or near their patients body with the intention to help or heal. In doing so, therapists believe that they are consciously directing or modulating an individual’s energies by interacting with his or her energy field.
- Touch is central to nursing practice and is necessary for completing tasks and communicating caring.
- Touch is so central to nursing that few nurses give it much thought, unless that touch is likely to provoke discomfort for either the client or nurse.
- Such discomfort typically arises when touch involves private or emotionally sensitive areas of the body.
- Touch of this type is required of nurses when conducting physical assessments, performing procedures, or assisting with hygiene, this type of touch as intimate touch.
- Intimate touch is defined as task-oriented touch to areas of the body that may invoke discomfort, anxiety, or fear among caregivers or clients or may be misinterpreted as sexual in nature.
- Such areas of the body include, but are not limited to, the breasts, lower abdomen, genitals, perineum, buttocks, and inner thighs.
- Many task-oriented nursing actions require the use of intimate touch, and clients expect nurses to know how to touch them appropriately.
Perspectives on intimate touch
- Several studies have described the difficulties male nurses have with touch, and some studies have suggested that some patients prefer to be touched by female rather than male nurses.
- The following four themes emerged:
1.'Communicate with me.' - Communication was of the utmost importance and must occur before intimate touch could take place. For example, nurses should "explain what they are going to do before doing [it]";
- Communication should convey professionalism and respect. For example, a patient may be angered when addressed with the pronoun "we" (as in "How are we doing today?").
2.'Give me choices.' patients feel powerless and devalued by not being given the chance to express their preferences concerning intimate touch. Nurses should not assume what patients wanted and needed.
- Patient may want to be involved in deciding whether intimate touch was necessary and whether there were alternatives.
- If intimate touch was needed, patient may want control over the procedure.
3. 'Ask me about gender.' Patients may vary in their responses to intimate touch about the nurse's gender. It is believed that nurses are trained to "do a job" and would perform the work professionally, competently, and in a way that conveys respect.
- Hence [the nurse's] gender may not make a difference.
- You don't see that nurse as a male nurse or a female nurse; you see that person as someone who is there to try to help you.
- 'Touch me professionally, not too fast and not too slow.' Patients wanted to be touched professionally.
- They wanted a firm but not rough touch. For example, "Touch firmly and with a purpose"; "Touch firmly, not tentative, not caressing". Nurses should project a confident and professional appearance.
Measures to revive “Touch” in nursing
- Touching should be taught in nursing school, as many nurses tend to learn such skills by trial and error on the job, an inconsistent method that's not in line with evidence-based practice.
- Guidance should be made available on how nurses should provide intimate touch so that it communicates respect for the patient.
3. Nurses should ask patients or the general public how nurses should touch them when intimate touch is necessary, especially in light of the emphasis in recent years on patient-centered care in nursing.
- Asking patients about their preferences for intimate touch would be an important step in fostering collaboration and respect.
# 6 Cs of Nursing
- Nursing operate on 6 core values which are commonly known as the 6 Cs .
Each has a value on its own.
- Care – Keeps the individual and improves the health of the whole community.
Nursing is all about care, the care has to be consistent, professional,
- Compassion – is how care is given through relationships based on empathy respect & dignity, Intelligent kindness
- Competence – All those in caring roles must have the ability to understand and individuals health & social needs.
- Communication – is central to successful caring. Listening is as important as what we say and do.
- Courage- enables us to do the right thing for the people we care for.
- Commitment - to our patients and population is a cornerstone of what we do. We need to build on our commitments to improve the care and experience of our patients.
Nurses who operate on these values ensure that the job get done in an effective and efficient manner and that patients are save and treated well.
This refers treating patients correctly in a respectful and non - judgmental manner. Consideration should be paid to their beliefs and dignity should be protected at all times. They should be able to provide a high level of care.
Nurses often work in a very stressful conditions but in doing so they must remain compassionate. Even if a patient is particularly difficult or its coming to the end of their shift they should show compassion.
- Nurses must exercise clinical judgment in deciding when, where, and how to touch patients. The patient's perspective on intimate touch can help the nurse in those decisions. Overall, patients want to know before intimate touch is provided, why it's necessary and what it will involve.
- Patients expect nurses to project a professional image and speak in a professional manner.
- Although male nurses seek permission and explain procedures before providing intimate touch, but those actions were to protect themselves rather than to foster rapport.
- It is believed that most employers don't require nurses to obtain formal consent from patients before performing any task requiring intimate touch;
- However, we suggest that, whenever possible, nurses should seek permission from patients before using intimate touch.
- Patients expect nurses to abide by their preferences for how intimate touch is to be provided when it's necessary. Of course, preferences are quite subjective, and nurses should pay attention to cues from patients.
The Practice of Finding Your Power
Skill #1 – THIRD EYE
- Notice when I am not being effective – not getting desired result
- What’s my part of the mess?
- Take responsibility for my contribution to the results.
- Find myself in the results I get.
- Anytime we think the problem is” out there,” that though is the problem.
- Ask myself:
- Am I being effective? Am I getting the results I want?
- If not, how am I contributing to these results?
Skill #2 - ACT
- Between stimulus and response, there is a gap.
- If I will not be part of the solution.
- I should not be part of the problem.
- The healing power lies in my touch
- Touch more! they live.
- Care more! stand out.
Thank You For Listening
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