The conceptual structure of physical touch in caring

The Nurses' Perception of Expressive Touch: An Integrative Review

Introduction: Nurses use physical touch to interact with patients and address their needs. Human touch benefits social development, stress/anxiety reduction, and rapport building. Touch has been a part of nursing care for centuries, however nurses' perceptions of expressive touch are not easily ascertained from the literature. Literature currently offers one review on the perceptions of various medical professionals regarding touch of all kinds. No reviews specific to the nurses' perception of expressive touch exist. This integrative review provides a greater understanding of nurses' perceptions of expressive touch. Methods: Using Cooper's steps for integrative review, CINAHL, Medline, Academic Search Premier, and Complimentary Index were searched from 2000-2022; using search term expressive touch or caring touch or compassionate touch and nurse/nurses/nursing and perception or perspective. Results: Of 283 articles identified, 22 articles remained for full-text review after duplicate removal and application of inclusion/exclusion criteria. Five topics on nurses' perceptions of expressive touch were identified: Comfort with touch and job satisfaction, expressive touch as an essential part of nursing practice, expressive touch as a form of compassion and/or communication, the impact of expressive touch on the humanization of patients in the nurses' perception, and nurse discomfort with expressive touch. Conclusion: This integrative review provides findings that assist in understanding nurses' perceptions of expressive touch. Further research should examine the impact of gender, education, and experiences on nurses' perceptions as they use expressive touch in nursing practice.

An integrative review of clinician-administered comforting touch interventions and acute stress responses of preterm infants

PROBLEM

Preterm infants experience numerous stressors in the neonatal intensive care unit. Non-pharmacological interventions, including maternal comforting touch, reduce stress responses of preterm infants; however, the effects of clinician-administered comforting touch are unclear. The purpose of this integrative review was to synthesize findings from clinical trials to determine the effect of clinician-administered comforting touch on preterm infants' acute stress responses.

ELIGIBILITY CRITERIA

Eligible clinical trials were published in English between 2001 and October 2021 and reported effects of clinician-administered comforting touch on acute stress responses in preterm infants.

SAMPLE

Thirty clinical trials were included.

RESULTS

Researchers tested the effect of comforting static touch, massage, massage with kinesthetic stimulation, sensorial saturation, and Yakson. There was significant heterogeneity in study design, comparison condition, and context of intervention delivery. Results varied; some studies demonstrated efficacy of comforting touch in reducing acute stress responses and others showed no effect. Generally, comforting touch provided during stressful procedures was associated with lower stress responses compared to standard care and was an effective adjunct to other stress management strategies. However, comforting touch alone was insufficient for managing pain, especially during skin-breaking procedures.

CONCLUSIONS

While comforting touch may be a useful part of stress management plans for preterm infants, additional research is needed to determine when comforting touch is appropriate and effective.

IMPLICATIONS

Comforting touch is beneficial to preterm infants and should be provided for stress management. For highly intrusive or painful procedures, comforting touch can be provided as part of a comprehensive stress management plan.

In good hands: the phenomenological significance of human touch for nursing practices

Prevailing understandings of the nurse's touch tend to be focused on its consoling, instrumental and communicative utility. What seems to be missing is an exploration of the ethical and existential significance of the nurse's touch. As an aspect of nearly every human experience, touch has a depth and breadth of meanings that are hard to compass. We experience the world through our bodies, feeling our way through our lives. In the nurse's world, touching contact with the person in care is often considered to be a fundamental gesture, inherent to nursing practices. Still, touch is often hidden, subsumed by the tasks of nursing themselves. In order to explore the meaningfulness of the nurse's touch, I start with considering the sense of touch itself, exploring possibilities of the nurse's touch. The experience of the nurse's touch is investigated further through phenomenological reflection on descriptive accounts of the nurse's touch from poetry, fictional prose, neonatal nurse interviews, as well as scholarly and personal accounts. These examples show insights into the nurse's touch as a site for an ethical encounter.

Tactile Interaction with a Humanoid Robot: Effects on Physiology and Subjective Impressions

This study investigated how touching and being touched by a humanoid robot affects human physiology, impressions of the interaction, and attitudes towards humanoid robots. 21 healthy adult participants completed a 3 (touch style: touching, being touched, pointing) × 2 (body part: hand vs buttock) within-subject design using a Pepper robot. Skin conductance response (SCR) was measured during each interaction. Perceived impressions of the interaction (i.e., friendliness, comfort, arousal) were measured per questionnaire after each interaction. Participants’ demographics and their attitude towards robots were also considered. We found shorter SCR rise times in the being touched compared to the touching condition, possibly reflecting psychological alertness to the unpredictability of robot-initiated contacts. The hand condition had shorter rise times than the buttock condition. Most participants evaluated the hand condition as most friendly and comfortable and the robot-initiated interactions as most arousing. Interacting with Pepper improved attitudes towards robots. Our findings require future studies with larger samples and improved procedures. They have implications for robot design in all domains involving tactile interactions, such as caring and intimacy.

"Awareness to touch": A qualitative study of nurses' perceptions of interpersonal professional contact after an experiential training

AIM

This study aimed to explore nurses' perceptions of touch in their professional practice and how these perceptions were articulated in discourse, among participants who attended a specific training on touch and those who did not.

BACKGROUND

Touch is an essential part of nursing practice. Research showed that the use of touch influences patients' general well-being, improving a sense of presence and infusing security and encouragement. Nurses' attitude towards touch influence positively their job satisfaction and reduces burnout syndrome risks. Nevertheless, there are very few studies describing specifically nurses' perceptions and opinions about the use of interpersonal physical contact in the clinical setting. Also, an educational perspective focusing on touch seems missing from nursing curricula and research.

DESIGN

A qualitative methodology was adopted. Focus groups were organized to explore how nurses define and interpret touch and its relevance in their professional practice. The findings obtained in a previous quantitative step of this research inspired the formulation of the questions posed to nurse participants.

METHODS

Six focus groups were conducted in three Italian hospitals, which also hosted a one-day training on touch. For each hospital, a purposive sampling approach was used to organize two focus groups: one was made up of nurses who attended the training, and one was made up of nurses who did not. Qualitative thematic analysis was used to identify recurring patterns of meaning by which touch is discussed and interpreted in the focus groups.

RESULTS

Registered nurses (N = 39) from different clinical experiences participated in six focus groups. The analysis identified four themes: 1) Touch preferences, 2) Touch and Contact as a natural dimension, 3) Touch as a "praxis" and 4) Reflexivity on Touch. All six focus groups showed a general awareness of interpersonal touch and discussed it as a highly valorized (personal and professional) dimension. Specifically, the trained nurses showed a greater variety and richness of their lexicon, a semantic and imaginary repository by which they described their experience and competence.

CONCLUSIONS

This study highlights that nurses consider touch as an important, essential part of their practice. Moreover, it suggests that specific training on interpersonal touch in nursing care facilitate nurses to shift their perceptions from a generic, abstract and "personal" dimension, into an articulated, disciplined and specialized practice. This has implications for education on touch in nursing.

Embodied Ethics: Phenomenology of the NICU Nurse's Touch

This study was a phenomenological exploration of the ethics of the nurse's touch in the Neonatal Intensive Care Unit (NICU). I explore several examples of touching encounters as gathered from NICU nurses through interview and observation, and organize the lived meanings around several thematic statements. These include the learning touch: finding a way to hold the baby, the marking touch: when touch lingers long after physical contact, the missing touch: touching without physical contact, the gnostic touch: the possibility of knowing an other and ourselves, and the call of touch: drawn to hold. Exploring the touching gestures of NICU nurses discloses the relational ethics inherent to caring practices. By attempting to articulate these practices, the hope is that the significance and contribution of the nurse's touch might be recognized and brought forward to our individual and professional consciousness, conversations, and curricula.

Impacts of Touch massage on the experience of patients with chronic pain: A protocol for a mixed method study

BACKGROUND

Chronic pain is a major public health problem. It affects the quality of life of many patients and their families and compromises physical and social functioning and psychological well-being. Non-pharmacological interventions are increasingly being used as a complement to chronic pain care. One of these interventions is Touch massage (TM) that can provide relaxation, comfort and well-being. In addition to its various physiological functions, TM can be used as a social communication tool.

MATERIALS AND METHODS

This is a cluster study with an exploratory qualitative part. Two groups will be considered: the experimental group will benefit from a TM delivered by trained members of care team and the control group will benefit from an intervention of the same duration with a foot massage device. At least 4 sessions will be delivered and spread over two weeks. Sample size calculation showed that 78 participants (39 per group) need to be included. As for the qualitative part, semi-structured interviews will be conducted to investigate the patients' perception of the intervention; focus groups will explore the satisfaction and general perception of the health care teams.

EXPECTED RESULTS

Incorporating TM interventions into care planning could bring benefits in supporting patients suffering from chronic pain. TM is expected to increase the patients' feelings that their pain is seriously considered; physical and psychological support should help improve their sense of comfort and well-being and hence their quality of life. This practice might thus improve the caregiver-patient relationship with TM as a providing a new means of establishing communication through touch.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04295603, Registered on March 4, 2020.

"Permission to Touch": Nurses' Perspectives of Interpersonal Contact during Patient Care

The purpose of this study was to describe nurses' perceptions about the use of interpersonal touch in their clinical practice. A qualitative descriptive approach with content analysis method was used to identify common themes. Registered nurses (N = 22) participated in focus groups and individual interviews. Three themes emerged from the analysis: (a) touch and massage as a resource, (b) individualized boundaries, and (c) professional role conflict. While the approach to touch varied, stories about the positive impacts that touch can have on patient care were consistently evident throughout the data. Implications for practice include incorporating areas from the themes into the development of educational programs focusing on how to integrate touch into practice as a comforting resource, while keeping individual's preferences in mind.

The expression and receipt of compassion through touch in a health setting; a qualitative study

AIM

To investigate and understand how compassion is expressed by nurses and received by patients in a hospital setting.

BACKGROUND

Concerns regarding the absence of compassion in a healthcare setting has necessitated further research in the field. To define and measure compassion is difficult and problematic. Compassion is subjective and in the contemporary literature the views of patients are under-represented. Touch is an important component of nursing practice and can also be considered problematic.

DESIGN

Secondary analysis of narrative interviews.

METHODS

Secondary analysis of 12 participant interviews with nurses (n-4) and patients (n-8). Data were collected between August 2018 and August 2019.

FINDINGS

Compassion was expressed and received through touch for nurses and patients. Patients receive compassion through the touch of the nurse and this touch conveyed comfort and safety. Touch allowed for the establishment of an authentic connection between nurse and patient. Nurses used touch to express compassion and patients received compassion when they were comforted with touch. Compassion was present in incidental touch and deliberate comforting touch. Nurses were respectful of the meanings of touch. Patients describe nurses knowing when to touch and using touch appropriately.

CONCLUSIONS

Nurses in our study were respectful of the meaning of touch for their patients and described using touch to convey compassion. Patients in our study perceived compassion through the touch by the nurse. Through these narratives, touch is revealed as an essential part of compassionate practice conveying safety, authenticity and connection.

IMPACT

Patients in this study describe receiving compassion through the use of touch which made them feel safe. Nurses in this study used touch to create an authentic connection with patients and were aware of the different meanings of touch. Avoiding touch, being wary of touch, or considering touch taboo robs patients of compassion moments.

A qualitative research synthesis exploring professional touch in healthcare practice using the threshold concept framework

Touch is an integral part of human life. Consequently, touching and being touched are also fundamental to healthcare practice. Despite a significant literature on touch, it is rarely conceptualized or discussed in terms of the student journey from layperson to practitioner. We chose to explore professional touch using the threshold concepts framework (TCF), which provides a theoretical model for exploring the way in which learners encounter, engage with and understand fundamental concepts in a discipline. This qualitative research synthesis (QRS) describes the use of the TCF to identify key issues involved in developing and using professional touch. Through a cross-professional analysis and synthesis of recent international literature, we aimed to identify key characteristics of the transitional journey for professional touch. Three orders of analysis were applied, employing a methodology described by Major and Savin-Baden (An introduction to qualitative research synthesis: managing the information explosion in social science research, Routledge, London, 2010). Following identification of threshold characteristics in the overall sample of articles, second order analysis revealed the nuances of professional touch associated with the characteristics. The final synthesis led to identification of five themes: touch as dialogue; being changed by touch; multiple boundaries of touch; multiple meanings of touch and influences on touch. Whilst providing support for some assertions within the literature, this QRS also offers new insights into the complexity of professional touch. Given the paucity of explicit learning and reflection around professional touch in training programmes of health professionals, the TCF reveals ways in which professional preparation might be improved to promote understanding of the role and impact of touch in practice.

Doing care work on the fly - exploring the unnoticed socio-emotional skills of male ambulance staff

Prehospital ambulance work is a healthcare arena hitherto neglected by sociologists of health and illness. This is unfortunate because it is an interesting and dynamic area, and in contrast to most healthcare sectors, it is male dominated. Via ethnographic fieldwork, this article examines the particular caring practices and socio-emotional skills that ambulance staff use in practising prehospital care work. The empirical analysis outlines six recurring prehospital practices: medicine work, machine work, scene management, becalming work, communication work and bodywork. Each practice represents a different element of prehospital care practice and is best understood as a repertoire, as many different assemblages of these care practices can work effectively in prehospital situations. The article concludes that despite institutionalised blue-collar masculinity, numeric dominance and scarce formal education in ambulance psychology, male ambulance staff are generally proud and reflexive care practitioners.

Designing Nursing Care Practices Complemented by Robots: Ethical Implications and Application of Caring Frameworks

The nurse of today must be able to master a variety of technologies. This article will discuss the current state of robots, explore the ethical framework of the Care-Centered Value Sensitive Design (CCVSD) and the caring theory of Nursing As Caring theory as it relates to the sacred nurse-patient relationship. Integrating both an ethical and caring framework will serve the nursing profession as it wrestles with the role and function robots can and will be used in clinical practice in order to protect the nurse–patient relationship. As technology advances, we must remember some human experiences are not programmable.

Nurses' Experience of Body Nursing Care: A Qualitative Study

As a practice, nursing centers on patients' bodies and how they live the experience of illness and disability through their bodies (embodiment). International nursing studies conducted on the topic of body care primarily include theoretical studies, whereas empirical studies remain sparse. The aim of this study was to describe nurses' perceptions of the role of their bodies and the bodies of patients during body care. This study used a descriptive phenomenological study based on Husserl's philosophical perspective. A purposive sample of 11 Italian registered nurses representing the highest level of nursing education, different clinical experience levels, and different clinical specialties were interviewed. Data were collected between July 2015 and September 2015. Open-ended interviews were analyzed using Giorgi's descriptive phenomenological method. Lincoln and Guba's strategies were used to ensure the trustworthiness of the data. In addition to the overarching theme, "Body care is the heart of nursing," 4 major themes with 13 subthemes emerged from the data. The 4 major themes were as follows: (1) "Body care encompasses the essence of person"; (2) "Body care touches the heart of person"; (3) "The body generates opposite strategies of care"; and (4) "In time, the body 'nourishes' the helping relationship." Nurses considered body and embodiment concepts central to nursing. Body care is treated as an experience with extraordinary emotional contents, allowing nurses to discover the essentials of human nature.

Experience of Touch in Health Care: A Meta-Ethnography Across the Health Care Professions

Touch mediates health professionals' interactions with patients. Different professionals have reported their practices but what is currently lacking is a well-theorized, interprofessional synthesis. We systematically searched eight databases, identified 41 studies in seven professions-nursing (27), medicine (4), physiotherapy (5), osteopathy (1), counseling (2), psychotherapy (1), dentistry (1)-and completed a meta-ethnographic line-of-argument synthesis. This found that touch is caring, exercises power, and demands safe space. Different professions express care through the medium of touch in different ways. They all, however, expect to initiate touch rather than for patients to do so. Various practices negotiate boundaries that define safe spaces between health care professions and patients. A metaphor-the waltz-integrates the practice of touch. Health care professionals connect physically with patients in ways that form strong relationships between them while "dance steps" help manage the risk that is inherent in such an intimate form of connection.

Prospective Evaluation of Physical Contact with Critically Ill Child on Caregiver Spiritual Wellbeing

OBJECTIVES

To evaluate whether a pediatric intensive care unit initiative promoting physical contact between caregiver and patient improves caregiver spiritual wellbeing. The secondary objectives were to evaluate caregiver perceptions of care before and after the initiative and to follow unplanned extubation rate as a marker of safety of the initiative. We hypothesized that caregiver spiritual wellbeing and caregiver perceptions of care would improve with implementation of our physical contact initiative known as Project ROSE (Reach Out, Soothe, and Embrace).

STUDY DESIGN

Project ROSE was a practice change initiative promoting physical contact between caregiver and hospitalized child in an academic quaternary care pediatric intensive care unit. Caregivers' spiritual wellbeing and perceptions of care were surveyed at days 1 and 4, then compared pre- and postimplementation of the unit-wide initiative. Wilcoxon rank sum tests compared groups (pre- and post-Project ROSE). A total of 331 caregivers returned surveys.

RESULTS

We analyzed 331 surveys (pre, n = 174/post, n = 157). Caregiver spiritual wellbeing at enrollment (day 1) was no different between groups (P = .47). Caregiver spiritual wellbeing on day 4 was greater in the postintervention group (pre 40.0 [32.0, 44.0] vs post 42.0 [37.5, 45.0] P = .03). Caregiver perceptions of care improved postintervention. There was no change in the unplanned extubation rate between groups.

CONCLUSION

Project ROSE improved caregiver spiritual wellbeing and perceptions of care, was implemented safely, addresses a need in family-centered care of critically ill pediatric patients, and merits consideration for integration into practice.

Variables of Individual Difference and the Experience of Touch in Nursing

We aim to investigate nurses’ feelings of comfort or discomfort with three different types of touch: task-oriented contact, touch promoting physical comfort, and touch providing emotional containment. A questionnaire was administered to a sample of 198 nurses. We present results of multiple regression analysis identifying some antecedents of nurses’ feelings of comfort with touch, namely, attachment style, worry, gender, and length of service. Worry is negatively associated with task-oriented contact and touch promoting physical comfort. Attachment security and length of service are associated with comfort with touch aimed at emotional containment; female nurses feel more comfortable than male nurses in performing this type of touch. Practical implications of findings are discussed in relation to the promotion of focused training courses for practitioners who are willing to improve the quality of care services.

Rethinking presence: a grounded theory of nurses and teleconsultation

AIMS AND OBJECTIVES

To develop a theory that offered an evidence-based insight into the use of teleconsultation by nurses.

BACKGROUND

Teleconsultation is the use of video to facilitate real-time, remote interaction between healthcare practitioners and patients. Although its popularity is growing, there is little understanding of how teleconsultation impacts on the role of nurses.

DESIGN

The study adopted a constructivist grounded theory method, supplemented by the use of Straussian analytical approaches.

METHODS

Using selective and theoretical approaches, registered nurses with experience of using video in health care were sampled. Data were collected using semi-structured interviews exploring experiences, knowledge and feelings surrounding teleconsultation. Interviews were recorded, transcribed and subjected to three-stage, nonlinear manual analysis (open, axial and selective coding).

RESULTS

Theoretical saturation occurred after 17 interviews. The core category identified from the data was 'nursing presence' Four subcategories of nursing presence were identified: operational, clinical, therapeutic and social. The degree to which presence could be achieved was dependent upon three influencing factors - enablers, constraints and compensation.

CONCLUSIONS

Nurses provide different types of presence during teleconsultation, with the degree of presence dependent on specific characteristics of video-mediated communication. Where the use of video constrains the delivery of presence, nurses use a range of compensatory mechanisms to enhance patient care.

RELEVANCE TO CLINICAL PRACTICE

Teleconsultation provides an innovative approach to enhancing the delivery of health care. This study provides nurses with insight into the impact of teleconsultation on their professional role, and an understanding of how best to use video-mediated communication to support patient care.

The Respect That Other Deserves: A Game Between Forces and Weaknesses in the Field of Health Care

Caring for people with diminished faculties and forms of disease and handicap that break down their personality places high demands on care staff. Anchored in a caring science with a holistic and humanistic approach, this article analyzes the trajectories of control that emerge in nurse care interactions. A suggested answer is the responsibility of the nurse to be aware of the power inequality, to recognize the potential for patients to feel intimidated, and to create a therapeutic alliance. The right use of power in the nurse-patient interaction guarantees that the patient's needs are foremost and the patient's vulnerability is sheltered.

Effects of mediated social touch on affective experiences and trust

This study investigated whether communication via mediated hand pressure during a remotely shared experience (watching an amusing video) can (1) enhance recovery from sadness, (2) enhance the affective quality of the experience, and (3) increase trust towards the communication partner. Thereto participants first watched a sad movie clip to elicit sadness, followed by a funny one to stimulate recovery from sadness. While watching the funny clip they signaled a hypothetical fellow participant every time they felt amused. In the experimental condition the participants responded by pressing a hand-held two-way mediated touch device (a Frebble), which also provided haptic feedback via simulated hand squeezes. In the control condition they responded by pressing a button and they received abstract visual feedback. Objective (heart rate, galvanic skin conductance, number and duration of joystick or Frebble presses) and subjective (questionnaires) data were collected to assess the emotional reactions of the participants. The subjective measurements confirmed that the sad movie successfully induced sadness while the funny movie indeed evoked more positive feelings. Although their ranking agreed with the subjective measurements, the physiological measurements confirmed this conclusion only for the funny movie. The results show that recovery from movie induced sadness, the affective experience of the amusing movie, and trust towards the communication partner did not differ between both experimental conditions. Hence, feedback via mediated hand touching did not enhance either of these factors compared to visual feedback. Further analysis of the data showed that participants scoring low on Extraversion (i.e., persons that are more introvert) or low on Touch Receptivity (i.e., persons who do not like to be touched by others) felt better understood by their communication partner when receiving mediated touch feedback instead of visual feedback, while the opposite was found for participants scoring high on these factors. The implications of these results for further research are discussed, and some suggestions for follow-up experiments are presented.

Tactile Massage as Part of the Caring Act: A Qualitative Study in Short-Term Emergency Wards

AIMS AND OBJECTIVES

The aim of this study was to illuminate the nursing staff's lived experiences and meaning in giving tactile massage (TM) while caring for patients in short-term emergency ward.

METHOD

Data were collected through individual qualitative interviews with six nurses and eight assistant nurses working with TM in short-term emergency wards in two hospitals in Sweden. The narratives were analyzed using a phenomenological hermeneutical method.

FINDINGS

Nurses experienced providing TM to patients as a present awareness in connection with compassion for the patient. TM provided the nurses with a tool to ease patient suffering and pain. Three dimensions were found where touch became a tool of doing, was an aware presence as a mindful being, and was embodied in a human-to-human connection with a changed caregiver.

CONCLUSION

Given the current high-tech health care system with overcrowded units and a shortage of nursing staff, TM could be included as a caring tool to improve the caring in caregiving, allowing nurses to act in aware presence by touch to encourage health and well-being for both the patient and themselves.

Development and Initial Validation of the Nurses’ Comfort With Touch Scale

Background and Purpose: The extent to which nurses feel comfortable about the use of touch may affect the frequency and quality of nursing touch-based interventions. No valid instrument exists to assess nurses’ feelings of comfort with touch. In this study, the nurses’ scale was developed and preliminary validated. Methods: Items were generated through semistructured interviews. After testing the content validity with a team of experts, the psychometric properties were tested with a sample of 451 nurses. Results: Explorative factor analysis yielded a five-factor solution, which was supported by confirmatory factor analysis. Examination of concurrent validity revealed that comfort with touch was correlated with positive affective states and emotional self-efficacy. Conclusion: Future directions and implications for nursing research, education, and practice are discussed.

Analysis of touch used by occupational therapy practitioners in skilled nursing facilities

Instrumental touch is identified as having purposeful physical contact in order to complete a task. Expressive touch is identified as warm, friendly physical contact and is not solely for performing a task. Expressive touch has been associated with improved client status, increased rapport and greater gains made during therapy. The purpose of the study was to observe the frequency of expressive and instrumental touch utilized by an occupational therapist during an occupational therapy session. Thirty-three occupational therapy professionals, including occupational therapists and occupational therapy assistants, employed at skilled nursing facilities in southwest Florida were observed. Data were collected on the Occupational Therapy Interaction Assessment. The results of the data analysis showed a positive relationship between the gender of the therapist and the frequency of expressive touch. The data also showed that a large majority of touches were instrumental touch and pertained to functional mobility. The results of the study can contribute to a better understanding of the holistic aspects of occupational therapy. By the use of more expressive touch, occupational therapy practitioners may have a positive, beneficial effect on both the client and the therapy process as a whole. Further research is needed to determine the effect an occupational therapy setting has on the frequency of instrumental and expressive touch. A larger sample size and a distinction between evaluation and treatment sessions would benefit future studies.

Nurses’ Comfort with Touch and Workplace Well-Being

Touch is an essential part of caregiving and has been proved to be useful to reduce pain. Nevertheless, little attention has been paid to nurses’ perceptions of touch. The aim of this article was to examine the relationship between nurses’ feelings of comfort with touch and their well-being at work. A sample of 241 nurses attending a pain management training course completed a questionnaire, including the following measures: Comfort with Touch (CT) scale (task-oriented contact, touch promoting physical comfort, touch providing emotional containment), Maslach Burnout Inventory (MBI; emotional exhaustion, cynicism), and Job Satisfaction. Results of structural equation models showed that touch providing emotional containment was the main predictor of emotional exhaustion. Emotional exhaustion, in turn, was positively related to cynicism and negatively related to job satisfaction. In addition, the direct path from touch providing emotional containment to cynicism was significant. Practical implications of the findings are discussed.

Children undergoing cancer treatment describe their experiences of comfort in interviews and drawings

Children with cancer often undergo a long course of treatment, described as painful, and associated with feelings of discomfort and need of comfort. The aim of this descriptive interview study was to investigate how children, aged 3 to 9 years, undergoing cancer treatment describe their experience of comfort. The children were interviewed and asked to make drawings. Data were content analyzed and four themes were constructed--enduring discomfort, expressing discomfort, finding comfort, and comforting others. The findings show that the children endured discomfort during treatment, and were sometimes able to express it. They found comfort especially from their family and from hospital staff. The children also described that they comforted family members. The findings are in accordance with previous research about children's and adults' accounts of comfort. An incidental finding is that parents were surprised when they listened to the children's accounts of their experience of discomfort and comfort and achieved a better understanding of their children.

Application of the M technique to two severely disabled children in Belarus

Following the early-morning explosion of reactor four at the Chernobyl nuclear plant on 26 April 1986, radioactive fallout fell over 80% of Belarus. More than 2.2 million people were affected, including thousands of children. As a result, there are now over 50,000 children in 600 orphanages in Belarus. Many of the orphanages are without basic amenities and are operating in dire circumstances. This article outlines two case studies of orphaned children with profound disabilities in one of these orphanages. The first author, a nurse volunteer from Ireland, used a method of touch called the 'M technique' to calm and soothe the children. The M technique is a gentle repetitive method of touch that can be learnt in a few hours. The results suggest that even when the situation appears very challenging, simple touch can have a beneficial effect.

Interpersonal touch: physiological effects in critical care

INTRODUCTION

Nurses use several forms of touch in patient encounters. Interpersonal touch elicits specific physiological and psychological responses, including neuroendocrine effects and reduction of stress. Critical illness is a state of excessive physiological and psychological stress.

AIMS

To critically review evidence on the effect of touch on physiological outcomes in critically ill individuals. Results of intervention studies in adult critical care settings were reviewed along with supportive evidence from studies in other populations.

METHODS

Critical literature review based on studies published in MEDLINE, PubMed, Cinahl, Embase, and Cochrane databases.

RESULTS

Eleven studies were reviewed. Significant effects of interpersonal touch included lower systolic and diastolic blood pressure and respiratory rate, improved sleep, and decreased pain. Almost no results were replicated owing to discrepancies among studies. Although the effect of touch on cardiovascular autonomic status appears considerable, several confounders must be considered. In noncritically ill populations, replicable findings included increased urinary dopamine and serotonin, natural killer cytotoxic activity, and salivary chromogranin. Effects on plasma cortisol and immune cells were variable. Effects appear to vary according to amount of pressure, body site, duration, and timing: Moderate pressure touch may elicit a parasympathetic response in contrast to light touch, which may elicit a sympathetic response. Moreover, touch effects may be mediated by the density of autonomic innervation received by the body areas involved and repetition of sessions.

CONCLUSION

The physiological pathway mediating the effects of touch is unclear. Although no concrete conclusions can be drawn, research evidence suggests that touch interventions may benefit critically ill individuals.

Patients' and caregivers' attributes in a meaningful care encounter: similarities and notable differences

In today's healthcare system, there is an imbalance between what patients expect of caregivers' care and their perception of the care they get. How is it possible to reduce this imbalance? The aim of this paper was to describe attributes associated with meaningful encounters in the Swedish healthcare system based on patients' and caregivers' written narratives and to note the differences and similarities between the attributes identified by the two groups. This paper is a qualitative descriptive study. The analysis was guided by qualitative content analyses. Based on patients' narratives, attributes associated with a meaningful encounter fell into four categories: the kind-hearted caregiver, the thoughtful caregiver, the mutually oriented caregiver, and the helpful caregiver. Based on caregivers' narratives, the attributes were categorized as being humane, caring through physical contact, caring by nurturing communication, joy and laughter in care, and a sense of mutuality. The results show that there are both similarities and differences in patients' and caregivers' opinions about the attributes of a meaningful encounter. Knowing more about the attributes associated with meaningful encounters makes it possible for caregivers to individualize care for patients and makes it easier to help and support patients in what they most need support with.

[Effects on couples' communication, intimacy, conflict and quality of life by foot massage between immigrants]

PURPOSE

The purpose of this study was to evaluate the effects on immigrant couples' communication, intimacy, conflict and quality of life when using foot massage.

METHODS

The research design consisted of pre-and-post test consecutive experimental design through a nonequivalent control group. Data were collected July 6, 2009 to February 27, 2010. The 36 couples were divided into two groups, experimental and control with 18 couples in each group. Foot massage was applied twice a week for 6 weeks by the couples in the experimental group.

RESULTS

There were statistically significant increases in communication (p=.011), intimacy (p<.001), quality of life (p=.017) between the couples in the experimental group compared to the control group. There was also a statistically significant decrease in conflict (p=.003) between the couples in the experimental group compared to the control group.

CONCLUSION

Foot massage can be applied as a nursing intervention for improvement of marital relationship in immigrant couples.

Expert Holistic Nurses’ Advice to Nursing Students

Purpose: The purposes of this study were to describe the advice that expert holistic nurses gave to nursing students regarding the theory and practice of holistic nursing and to describe nursing students’ experience and perceptions of their interaction with the experts. Design: This was a qualitative descriptive study. Methods: Nursing students who attended the 2008 and 2009 conferences of the American Holistic Nurses Association interviewed expert holistic nurses, asking them for advice for beginners. Students recorded the interviews on paper and wrote their perceptions of interacting with experts. The data were examined for recurring themes. Findings: The most common advice from the experts was regarding the importance of self-care, person-centered care, touch, and lifelong learning. Students’ perceptions of the interviews included feeling empowered to accomplish goals, gaining a greater understanding of holistic nursing, and feeling admiration for the holistic nurse experts. Conclusion: Giving students the opportunity to interact with nurse experts in an individual, informal setting is a useful educational strategy that increases knowledge, promotes socialization to the nursing profession, and offers students opportunities for professional networking.

Dealing with the patient's body in nursing: nurses' ambiguous experience in clinical practice

The core of nursing in western countries is interaction with the patient and with his/her body in particular. As all nursing practices revolve around caring for the patient's body, nurses need to understand the frailty of the body, the intimacy surrounding it, the story it tells, as well as the discomfort and difficulties both illness and close contact can generate in the nurse-patient relationship. With this study, we wanted to explore the ward experiences of a small group of nurses in their day-to-day interaction with patients and their bodies, to highlight their perceptions and possible difficulties in providing care. We collected qualitative data from in-depth interviews with 14 nurses working in departments of general internal medicine, neurology, and geriatrics. The interviews were conducted between April and June 2006 and interpreted using an interpretive phenomenological approach. Analysis of the interview transcripts revealed that while the nurses recognize the centrality of the body in nursing, they also expressed a certain ambiguity toward it: being able to improve a patient's well-being through attentive care to the body is a major source of job satisfaction, but various coping and defense strategies are deployed to overcome care-giving situations that elicit avoidance or refusal reactions to the patient's body.

Swedish District Nurses' experiences on the use of information and communication technology for supporting people with serious chronic illness living at home--a case study

The aim of this case study was to describe two District Nurses' (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi-structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.

A Conceptual Model of Intentional Comfort Touch

This article discusses the application and integration of intentional comfort touch as a holistic nursing practice. A review of the literature on touch and its related concepts is included. Although nurses use touch frequently in patient encounters, it is not always used intentionally or deliberately to enhance care. The article compares and contrasts intentional comfort touch with nonintentional or procedural touch. The use of intentional comfort touch in innovative clinical settings with diverse and at-risk populations is described. Based on clinical experiences and the current literature, a conceptual model of intentional comfort touch is proposed. The application of touch is discussed as is the meaning and importance of intentional touch for students, faculty, and patients.

The "con" of concept analysis A discussion paper which explores and critiques the ontological focus, reliability and antecedents of concept analysis frameworks

This paper draws on the work of Paley and Duncan et al in order to extend and engender debate regarding the use of Concept Analysis frameworks. Despite the apparent plethora of Concept Analysis frameworks used in nursing studies we found that over half of those used were derived from the work of one author. This paper explores the suitability and use of these frameworks and is set at a time when the numbers of published concept analysis papers are increasing. For the purpose of this study thirteen commonly used frameworks, identified from the nursing journals 1993 to 2005, were explored to reveal their origins, ontological and philosophical stance, and any common elements. The frameworks were critiqued and links made between their antecedents. It was noted if the articles contained discussion of any possible tensions between the ontological perspective of the framework used, the process of analysis, praxis and possible nursing theory developments. It was found that the thirteen identified frameworks are mainly based on hermeneutic propositions regarding understandings and are interpretive procedures founded on self-reflective modes of discovery. Six frameworks rely on or include the use of casuistry. Seven of the frameworks identified are predicated on, or adapt the work of Wilson, a school master writing for his pupils. Wilson's framework has a simplistic eleven step, binary and reductionist structure. Other frameworks identified include Morse et al's framework which this article suggests employs a contestable theory of concept maturity. Based on the findings revealed through our exploration of the use of concept analysis frameworks in the nursing literature, concerns were raised regarding the unjustified adaptation and alterations and the uncritical use of the frameworks. There is little evidence that these frameworks provide the necessary depth, rigor or replicability to enable the development in nursing theory which they underpin.

Narratives of children with chronic illness about being comforted

The aim of the study was to examine how children with chronic illnesses narrate their experience of being comforted in hospital. During interviews, seven children, 4-10 years old described their experiences and made drawings. Thematic content analysis revealed following themes: being physically close to one's family, feeling safe and secure, staff being there for the children, and children being there for parents and siblings. Mother was identified as the most important comforter. The findings suggest that trusting in the staff's knowledge and professional skills is a prerequisite for children to feel "at home", and safe in hospital. Being close to one's family is even more important.

A concept development of 'being sensitive' in nursing

'Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of ;being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept ;being sensitive' means in nursing, and subsequent clarification of ;being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified.

A one-day education in soft tissue massage: Experiences and opinions as evaluated by nursing staff in palliative care

Objective:

Increasing awareness of well-being aspects of physical touch has spurred the appreciation for soft tissue massage (STM) as part of palliative care. Educational programs are available but with no specific focus on utilization for this kind of care. The aim was to study the feasibility of a 1-day course in STM in clarifying nursing staff's experiences and opinions, but also to shed light on their motivation and ability to employ STM in the care of dying cancer patients.

Method:

In all, 135 nursing staff participated. The course consisted of theory and hands-on training (hand-foot-, back massage). Focus-groups with 30/135 randomly chosen participants were conducted 4 weeks after the intervention. This study engaged a qualitative approach using content analysis.

Results:

The overall opinion of the 1-day course was positive. The majority experienced the contents of the course to be adequate and sufficient for clinical care. They emphasized the pedagogical expertise as valuable for the learning process. The majority of nurses shared the opinion that their extended knowledge clarified their attitudes on STM as a complement in palliative care. Still, a few found it to be too basic and/or intimate. Three categories emerged during the analysis: experiences of and attitudes toward the education, experiences of implementing the skills in every-day care situations, and attitudes to the physical body in nursing care.

Significance of results:

The approach to learning and the pedagogical skills of the teacher proved to be of importance for how new knowledge was perceived among nurses. The findings may encourage hospital organizations to introduce short courses in STM as an alternative to more extensive education.