The conceptual structure of physical touch in caring

Effects of yoga and the addition of Tui Na in patients with fibromyalgia

OBJECTIVES

This study aimed to verify whether techniques of yoga with and without the addition of Tui Na might improve pain and the negative impact of fibromyalgia (FMS) on patients' daily life.

DESIGN

Forty (40) FMS women were randomized into two groups, Relaxing Yoga (RY) and Relaxing Yoga plus Touch (RYT), for eight weekly sessions of stretching, breathing, and relaxing yogic techniques. RYT patients were further submitted to manipulative techniques of Tui Na.

OUTCOME MEASURE

Outcome measures comprised the Fibromyalgia Impact Questionnaire (FIQ), pain threshold at the 18 FMS tender points, and a verbal graduation of pain assessed before treatment and on the followup. The visual analog scale (VAS) for pain was assessed before and after each session and on the follow-up.

RESULTS

Seventeen (17) RYT and 16 RY patients completed the study. Both RY and RYT groups showed improvement in the FIQ and VAS scores, which decreased on all sessions. The RYT group showed lower VAS and verbal scores for pain on the eighth session, but this difference was not maintained on the follow-up. Conversely, RY VAS and verbal scores were significantly lower just on the follow-up.

CONCLUSIONS

These study results showed that yogic techniques are valid therapeutic methods for FMS. Touch addition yielded greater improvement during the treatment. Over time, however, RY patients reported less pain than RYT. These results suggest that a passive therapy may possibly decrease control over FMS symptoms.

Nursing in Bangladesh: Rhetoric and reality

In the past decade concern has been raised through independent channels that nurses in Bangladesh do not provide active hands on care directly to patients as envisioned when the British nursing model was first introduced decades ago. The objective of the study was to observe the activities nurses engaged in during their working hours on major medical and surgical wards. A total of 24,587 min of nursing activities were recorded by three observers in 18 hospitals between the hours of 05.00 and 23.00 h over a 3 month period. These were compared with reports of the nurses about their activities, and indirectly with the activities outlined in the nursing curriculum. Nurses in government hospitals spent only 5.3% of their working time in direct contact with their patients. Paperwork and indirect patient care occupied nurses for 32.4% of their time while 50.1% fell under the category of unproductive time such as time away from the ward and chatting with other nurses. Hospital support workers and patients' relatives acted as nurse surrogates. When asked how they spent their day, nurses reported what the curriculum specifies but not what was observed. As a consequence policy decisions have not consistently reflected this reality. By contrast, nurses in the hospitals outside the government system were found to spend 22.7% directly with patients. A deeper understanding of nurse's behaviour on the wards is required to determine the desired role of the nurse that will, in turn, feed into nursing policy and decisions related to resource allocation.

Caring for female patients: the experiences of male nurses

This article presents the results of two small qualitative studies, which examined the experiences of six male registered psychiatric nurses (RPN) and five male registered general nurses (RGN) when caring for patients of the opposite sex. Semi-structured interviews were used to collect the data. The focus of the interviews was an attempt to describe the male nurses' experiences of caring for women with a particular emphasis on interventions that involved physical touch. Themes were generated from both studies and the common themes are presented here. Male nurses in this study were often apprehensive about using physical touch and they used coping strategies in response to their fears of being accused of using touch inappropriately. Several factors also influenced the male nurses when using physical touch as an intervention. These findings suggest that learning about caring for female patients needs to be included in the undergraduate curriculum and that further research on the experience of men as nurses is required.

Concept Development of Nursing Information

This article proposes a definition of nursing information. Nurses use information to plan, implement, and evaluate patient care. They seek information from colleagues, books, electronic sources, and equipment, and give information to multiple audiences. Even with the pervasiveness of information in nursing practice, there has been little research aimed at developing a definition of nursing information. This study was undertaken to start filling that gap. The Hybrid Model of Concept Development served as the study design. This model consists of three phases: theoretical, fieldwork, and final analytical. In the theoretical phase, a working definition of nursing information was developed. The fieldwork phase involved observations and interviews of 13 expert nurses working in a critical care unit. The qualitative data obtained from the fieldwork phase were analyzed to refine and extend the working definition. Previously identified categories in the definition--context, form, communication, and value--were validated in the analysis. New categories--multidimensionality, intervening/doing, and power--emerged during the final analytical phase, and the definition was revised to include this new knowledge. The utility of the definition of nursing information and its impact on nursing practice, information technology, and theory development is discussed.

Evaluation of healing by gentle touch in 35 clients with cancer

An uncontrolled, preliminary evaluation of healing by gentle touch in clients with cancer was carried out at The Centre for Complementary Care in Eskdale, Cumbria. All clients attending The Centre between 1995 and 2001 were invited to participate. Data were collected from 35 clients with cancer. Outcome measures included pre- to post-treatment changes in physical and psychological functioning. Assessments were made using a questionnaire with visual analogue scales for subjective rating of symptoms and the EuroQoL (EQ-5D), a generic state of health measure. Wilcoxon Signed Ranks tests showed statistically significant improvements in psychological and physical functioning, with positive effects on quality of life. The most pronounced improvements were seen in ratings for stress and relaxation, severe pain/discomfort, and depression/anxiety, particularly in those with the most severe symptoms on entry. The study found no adverse effects resulting from the treatment. These findings indicate that healing is a safe and effective adjunct to conventional medical treatment with the potential to ameliorate some of the more stressful aspects of cancer, including those inherent in current cancer treatment strategies. Rigorous evaluation of this modality by prospective, randomised, controlled trial is strongly warranted, as are investigations into its potential for use in palliative care.

Meanings of giving touch in the care of older patients: becoming a valuable person and professional

Touch is central to nursing and health care workers frequently touch their patients, consciously or unconsciously in their interactions with them. Most literature has studied touch from a patient perspective, thus inquiry about professionals' experiences are rare. The aim of this study was to illuminate meanings of giving touch in nursing care of older patients. To understand the meaning of lived experiences of giving touch in care of older patients, interviews with 12 health care professionals in northern Sweden were analysed using a phenomenological-hermeneutic approach influenced by the philosophy of Ricoeur. The findings show that giving touch in the care of older patients is a transforming experience, where one suddenly perceives oneself as both a valuable person and professional who no longer powerlessly confronts patients' haunted and disrupted bodies, but who, by means of touch, has gained power to ease this suffering. The experience also transforms the way one regards older patients. Instead of seeing a severely demanding patient suffering from dementia and/or pain, one is able to see the person behind the disease as a human being, like oneself. A relationship described as calm, friendly and humane is created between caregiver and patient when giving touch, a relationship that transcends the moment of touch and influences one's way of caring. This understanding is presented using the theoretical framework of the philosophy of Marcel. Giving touch has the power to shed new light on health care professionals' experiences of caring for older patients suffering from dementia and/or pain, giving them the power to be a valuable person and professional.