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.

Journey less travelled: Female nursing students’ experiences in providing intimate care in two nursing education institutions in Gauteng province, South Africa

Background

Intimate care is not facilitated in South African nursing education and training. Nursing students encounter it for the first time in clinical practice, where they see and touch the naked bodies of patients. The societal segregation of gender roles has led to the feminisation of the nursing profession, suggesting that women are more caring and maternal and that intimate care implementation comes more easily to them than to their male counterparts.

Aim

This study explored female nursing students’ experiences of intimate care for diverse patients.

Setting

The study was conducted in two nursing education institutions in Gauteng province, South Africa.

Methods

Descriptive phenomenology was used to describe the lived experiences of participants. Seventeen female nursing students were purposively sampled. Data were collected using semi-structured interviews and analysed using Moustakas’ (1994) eight steps.

Results

Four themes emerged: intimate care comprehension, preparedness for providing intimate care, reactions in providing intimate care and coping mechanisms when providing intimate care to diverse patients.

Conclusion

Intimate care forms a basis on which nursing students prioritise the physical needs of patients by providing care that exposes their bodies and requires touch. The students were taught to provide care with respect, maintaining patient autonomy and nursing professionalism. Unfortunately, age and gender barriers create feelings of discomfort and embarrassment. More needs to be done to support and empower nursing students in providing intimate care to diverse patients competently, confidently and comfortably.

Contribution

Understanding the experiences of participants in providing intimate care to diverse patients will assist nurse educators in intimate care facilitation and support. The female nursing students will be empowered and trained to execute intimate care in a manner that is culturally, religiously and ethically acceptable.

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.

Potential for misinterpretation: An everyday problem male nurses encounter in inpatient rehabilitation

AIMS

This study aims to report on the everyday concern of the 'potential for misinterpretation', which was the basic social problem revealed in a grounded theory study exploring male nurse practice in inpatient rehabilitation in Australia.

BACKGROUND

Male nurses account for approximately 10% of nursing workforce across western countries and they practice in a range of clinical areas; however, how they practice in inpatient rehabilitation remains unexplored.

METHODS

Constructivist grounded theory was used in this study and was conducted in two phases: (i) involved semi-structured interviews with 11 male nurses from October 2013 to June 2014 and (ii) observation of practice of 12 male nurses and semi-structured interviews with male nurses and 15 patients from February to April 2015.

RESULTS

Nurse participants encountered the intersection of two pervasive patient ideologies about male nurses. Patients perceived nursing to be women's work and that male nurses are sexual threats. These two intersecting ideologies created a concern for male nurses working in inpatient rehabilitation and that concern was labelled 'potential for misinterpretation'.

CONCLUSION

Gender stereotypes impacted on the ability of male nurses to practise nursing in inpatient rehabilitation. Male nurses were mindful on a daily basis that misinterpretation could, and did, happen in inpatient rehabilitation.

Barriers in performing physical assessment among nursing students: An integrative review

Objectives

This study aimed to identify barriers in performing physical assessments among nursing students through integrative review study.

Methods

The literature were searched in Medline, CINAHL, ScienceDirect, Web of Science, ProQuest, and Taylor & Francis Online using the descriptors barrier, physical assessment, nursing student et al. Only English-language and peer-reviewed journal articles were included, and there were no year restrictions.

Results

Twelve articles were selected for review. Two aspects were extracted: the barriers included personal challenges, challenges related to nursing education, challenges related to clinical practice; establishing competency-based education learning as a method to reduce physical assessment barriers. Student competencies and experiences were influenced by various factors that collectively hindered their successful performance of physical assessments.

Conclusions

The review findings provide valuable insights into the complex issues involved in the performance of physical assessments and guidance for improvement in practice. A collaborative effort should be made to address the issues often faced by nursing students in performing routine physical assessments. Also, more constructive and competency-based teaching methods should be integrated into academic and clinical settings.

You Can't Touch…or Can You? Dietitians' Perceptions of Expressive Touch in Client Encounters

Purpose: We explored Registered Dietitians' (RDs') perceptions about expressive touch (ET) as a means to provide client-centred care, a practice unreported to date. For this study, ET is defined as relatively spontaneous, responsive, and affective contact by dietitians. Methods: This exploratory study used an explanatory sequential mixed-methods approach. RDs in Northern Ontario were surveyed (54% response, n = 135) and these results were further explored in interviews with a subset of participants (n = 17). Analysis included descriptive and association statistics and qualitative description. Results: Most RDs considered ET a useful tool for effective client communication (66%-77%), yet they were hesitant to enact the practice (81%). Analysis of interviews revealed ET to be "situationally beneficial" with uptake influenced by an interplay of factors, described as: perceived client openness to touch, the environment, and RD comfort with touch. Greater uptake was reported among RDs working with distressed clients and clients in ambulatory clinics and long-term care. ET practice was limited by personal safety concerns, unknown client customs, and client misinterpretation. Conclusion: ET was valued by many RDs as an enhancement to client-centred care. Selective use of ET is influenced by the context of dietetic practice and by perceived client and RD comfort with the use of ET.

Mask-Ed (KRS Simulation) an approach to deliver intimate care for neophyte nursing students: the creator's experience

Nurses deliver intimate care to patients in a variety of ways, especially when attending to showering, bathing, toileting and managing chronic or surgical wounds located in body regions such as the genitalia or breasts. Neophyte undergraduate nursing students can experience fear and anxiety at the thought of carrying out this level of care; hence, there is a need for preparation prior to undertaking clinical placements when students encounter real patients. The preparation should begin in the laboratory context of their tertiary educational settings. Traditionally, task trainers and manikins have been used to demonstrate and practise this care in such environments. However, the realism of experiencing true human responses, by both the patient and student, can be lost through these modalities. In recent years, a simulation approach, Mask-Ed, has enabled intimate care to be taught to students in a university setting in Australia where the laboratory context provides a safety net. Mask-Ed involves the informed educator wearing highly realistic silicone props that include torsos, faces and hands. Having donned the props, the educator then transforms into another person. The newly created person has a backstory designed to enable the educator to become a platform for teaching and to coach students through the clinical experience. The following discussion explains the background to Mask-Ed and the underlying framework that is used to implement the technique to teach intimate care. Mask-Ed is considered one of the most realistic approaches to simulation and is used in healthcare facilities and tertiary educational institutions globally.

A Labor Support Workshop to Improve Undergraduate Nursing Students' Understanding of the Importance of High Touch in a High-Tech World

This article presents the development and evaluation of a labor support workshop aimed at providing senior undergraduate nursing students with education on the provision of labor support. In collaboration with a Lamaze educator, a two and half hour interactive educational session was developed. The workshop included both a didactic and a hands-on component which included physical labor support strategies, which could be utilized in the clinical setting. Pre-and postintervention data was collected on students' knowledge and self-efficacy in the provision of labor support, as well as, data on their use of these strategies while in the clinical setting. The labor support workshop was well received by students (4.9/5) and increased their self-reported knowledge (p = <.001) and self-efficacy (p = <.001) in the provision of labor support.

Differences in Gender-related Profile Characteristics, Perceptions, and Outcomes of Accelerated Second Degree Nursing Students

BACKGROUND

The New Careers in Nursing (NCIN) program provided scholarships and other supports to accelerated degree students at 130 nursing schools and collected data from the scholars at three time-points.

PURPOSE

The NCIN database was analyzed to identify gender-based differences in scholars' profile characteristics, program experiences, and post-graduation outcomes.

METHOD

An adaptation of Jeffreys's Nursing Universal Retention and Success Model guided the analysis. Gender differences were assessed after multiplicity adjustments for false positive rates.

RESULTS

Differences based on gender were found for profile characteristics, student affective factors, academic factors, professional integration factors, environmental factors, as well as academic, psychological and NCIN program outcomes. Results suggest that males were influenced by economic factors more than females when choosing nursing as a career. They had fewer concerns about financial aspects associated with being a student again yet secured employment sooner after graduation than female scholars. They did not view support services as important as did female students. They expressed confidence in their leadership competence more than their female counterparts.

CONCLUSION

Efforts are needed to better understand and address the nuanced gender-based perceptions and needs of nursing students who are male.

Perceptions, experiences and preferences of patients receiving a clinician's touch during intimate care and procedures: a qualitative systematic review

BACKGROUND

Clinical practice frequently involves the practitioner touching patients' bodies in areas that are highly personal. If inappropriately performed, such intimate touch may result in much anxiety, confusion and misinterpretation. Examination of evidence is necessary to guide practice in this area to mitigate risks and foster optimal clinician-patient relations and care.

OBJECTIVES

The objective of this qualitative systematic review was to identify and synthesize findings on the perceptions, experiences and preferences of patients receiving a clinician's touch during intimate care and procedures INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review considered studies that included patients who had received a clinician's touch during intimate care and procedures.

PHENOMENA OF INTEREST

The current review considered qualitative studies that evaluated patients' perceptions, experiences and preferences of a clinician's touch during intimate care and procedures.

TYPES OF STUDIES

The current review considered studies that collected qualitative data and included studies using designs such as phenomenology, grounded theory, ethnography, action research, qualitative description, focus group methodology and feminist research. In the absence of research studies, other text such as opinion papers and reports were considered.

CONTEXT

The current review considered studies that included patients' perceptions, experiences and preferences of a clinician's touch during intimate care and procedures. Intimate care is likely to occur in any clinical setting where patients need assistance with personal care, where physical examinations occur, or in settings were gynecologic, genitourinary, lower intestinal, dermatologic, cardiac or other procedures involving highly personal areas of the body are performed.

SEARCH STRATEGY

A three-step search strategy was used to find published and unpublished studies in English from 1970 to 2016, searching various databases which included searches of reference lists of studies selected for appraisal.

METHODOLOGICAL QUALITY

Included studies were assessed for methodological quality independently by two reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) prior to inclusion. Of the two studies included in the review, one did not discuss ontological and epistemological assumptions, and the other did not include the personal assumptions and role of the researcher.

DATA EXTRACTION

Data were extracted using the data extraction tool from the JBI-QARI. The data extracted included details about the phenomenon of interest, populations and study methods.

DATA SYNTHESIS

Qualitative findings were synthesized using JBI-QARI.

RESULTS

Two studies were included in this review. Seven findings were organized into three categories and one synthesized finding, "clinician respect". The finding suggests that clients prefer engaged and meaningful communication prior to and during an intimate touch encounter, expect autonomy over their bodies and desire shared decision making relative to how and by whom intimate touch is provided.

CONCLUSION

The synthesized finding from this review suggests that:More research is needed to explore the perceptions and preferences for intimate touch among diverse populations, generations, cultures and contexts. Particular exploration is needed for populations with additional vulnerabilities to misunderstandings, anxiety and abuse, such as pediatric and geriatric patients, and patients with physical, mental and cognitive impairments.

Mask-Ed: Breaking the Barrier of Fear of Intimate Care for Nursing Students

BACKGROUND

Nursing students learn to toilet, shower, and dress patients in the clinical laboratory with simulation modalities that lack the realism necessary to address the fears, values, and beliefs of nudity and intimate contact with patients.

METHOD

A high-fidelity Mask-Ed™ (KRS [Knowledgeable, Realistic, Spontaneous] simulation) intervention was developed and piloted with first-year nursing students around patient showering to increase confidence and skills around intimate care.

RESULTS

Students initially felt intimidated, awkward, nervous, and anxious about showering patients; however, after the Mask-Ed simulation, 93% reported feeling more confident and having insight into the patient experience. The realism of the scenario was a contributing factor.

CONCLUSION

Mask-Ed provides a platform for the educator to create realistic scenarios around intimate care that help students prepare, on many levels, for their initial clinical experiences. [J Nurs Educ. 2017;56(9):572-574.].

Perceptions, experiences and preferences of patients receiving the clinician's touch during intimate care and procedures: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

What are the perceptions, experiences and preferences of patients receiving the clinician's touch during intimate care and procedures?