As much as the role, impact, and importance of intentional touch in nursing practice is still poorly studied, the current research has revealed that it is one of the most fundamental elements of nursing care. The practice is particularly relevant in geriatric care considering the unique challenges and experiences of the population. Elderly patients are more likely to be isolated from friends and loved ones in addition to being psychologically and emotionally vulnerable, which means that therapeutic touch will have a significant impact on alleviating feelings of exclusion and loss. However, older adults are likely to benefit from touch since they perceive this form of therapy as consoling, and that it offers safety and warmth. However, it is evident hat this population might not have an opportunity to receive such therapy from caregivers. On the other hand, Lewin’s theory maintains that both individuals and groups in need of touch are within the forces that maintain the status quo, and hence the process of change is faced with many challenges.
Keywords: touch, care, acceptability, warmth, understanding
The concept of touch as a therapy requires more evidence-based investigations to provide practitioners with the knowledge of whether physically touching patients is an acceptable practice. In some contexts, physical touch could be deemed as acceptable and even beneficial than other situations. Therefore, nurses should demonstrate the knowledge on the context and distinguish circumstances where physical touch would be recommended and in other cases where it should be discouraged. While in some settings it would be highly inappropriate to hug or physically touch a patient, other areas of practice should be encouraged, such as geriatric care where hugging a patient would enhance health outcomes and optimize their general sense of well-being of feeling wanted, appreciated, and recognized.
Senior citizens are a vulnerable group of people and face both emotional and physical challenges. Provision of care for geriatric patients, therefore, requires patience, love, and tenderness. Most of these patients ail from dementia, Alzheimer’s, sundown syndrome, and delirium, among other conditions. The elderly also tend to suffer from loneliness since most of them live alone. As a result, they experience stress and anxiety. Provision of care to these populations require many approaches, such as administering medication, the nursing process, helping with activities of daily living, and hourly rounding. Some of these forms of care include; therapeutic touch, hand and foot massage, shoulder patting holding hands and hugging, especially if the patient is grieving a loved one or is terminally ill. All these could be implemented in the geriatric nursing care through a therapeutic touch program to create a more outstanding nurse to patient relationship.
Among human beings, physical contact or touch is often used to convey friendliness, compassion, and support. A hug is typically viewed as one way that humans use physical contact to communicate emotions and establish a sense of closeness to one another. Hugging as therapy reduces the intensity of disease symptoms and stimulates the release of oxytocin, which is a happiness-inducing hormone from human brain (Westman & Blaisdell, 2016). Hugging and physical contact, in general, is an effective stress reliever and blood flow enhancer.
The lack of human physical contact is a real issue for older adults. This group is particularly vulnerable to isolation, low cognitive ability, as well as the distrust, anxiety, and insecurity that results from the continued lack of human contact (Catlin, 2016). These factors are exacerbated when older adults and nurses need to apply one of the proven practices that aid in enhancing their outcomes. Moreover, as much as the benefits of touch in healthcare settings are well established, the context-dependent and intersubjective characteristics of the practice makes it particularly challenging to study, instruct, and eventually implement into practice. Studies on the subject are limited, and where they exist, they focus on the outcomes and not the processes involved in applying intentional touch in healthcare settings (Cai & Zhang, 2015). Besides, literature concerning the benefits of touch to geriatric care patients is scarce despite being a population that requires compassionate to compliment medical intervention.
With these gaps in mind, the capstone project sought to identify and examine the studies that have been conducted in this area and present their findings in a coherent manner that would lead to effective implementation. Notably, nursing education rarely addresses the importance of physical touch to patients, which makes practitioners uninformed about how to foster the process in a manner that optimizes patient outcomes. According to Stonehous (2017), an unfortunate outcome is that nurses have expressed their discomfort in using physical touch other than when it is required by the specific task such as physical assessment. Explicitly training nurses in applying the concept will minimize their hesitation to touch their patients therapeutically. By consolidating the evidence on the benefits, process, and fostering touch in nursing care, the capstone project can fill this gap and encourage more nurses to become accustomed to using this effective practice.
The nature of nursing practice makes it a profoundly intimate profession in which touching is an essential aspect of administering care. According to Dziopa and Ahern (nd), touch is a simple behavior with complex context-dependent and intersubjective components that bear significant meaning to those involved. Professional and personal boundaries also govern physical touch. Providing nursing care for elderly patients is particularly touch intensive in conducting a physical examination. However, studies are relatively few and not much is known about the specific mediators of old age that either foster or impede the connection between patient and practitioners through intentional touch (Catlin, 2016). In addition, the self-care limitations of such patients accounted for by their diminishing cognitive ability significantly affects their higher order needs, which should also be met in the primary or palliative care settings. These factors explain why geriatric patients would benefit substantially from therapeutic touch.
Older adults tend to benefit, particularly from touch-based therapy. Hanna and Suplee (2013) note that patients often perceive a touch as comforting, warm, and a source of security. However, Scales, Zimmermann, and Miller (2018) lamented that it is regrettable that this population is also the least likely to receive a human touch from caregivers. The authors further report that practitioners often experience heightened anxiety regarding physical contact with their elderly patients (Scales, Zimmermann, & Miller, 2018). Hence, this problem can be addressed by enhancing practitioners’ awareness of the role of touch in improving treatment outcomes. The knowledge and sense of competence will also increase the nurses’ confidence in using touch to establish a sense of closeness and alleviate the symptoms of their older patients.
Research on therapeutic touch for elderly patients is scarce. The goal of the project is to generate interest in the use of intentional touch by nurses caring for geriatric patients. In line with this endeavor, the project undertakes an assessment of the current practice and benefits in healthcare with the intention of generating recommendations that would guide caregivers into applying non-pharmacological interpersonal interventions such as intentional touch to boost geriatrics patient outcomes and overall experience (Scales, Zimmermann & Miller, 2018). The absence of this critical subject in current research means that understanding and implementation of the practice remains limited. Hence, the purpose of the capstone is to enhance practitioners’ knowledge and awareness of intentional touch as a highly beneficial practice and to encourage caregivers to consider implementing this therapeutic method in their clinical practices. Specifically, the purpose of the project is to encourage nurses caring for geriatric patients to connect with their clients more effectively through touch.
Nature of the Project
The study adopted a descriptive quantitative method for assessing practitioners’ awareness and usage of intentional touch, such as hugs, in their everyday clinical practice. Using a structured questionnaire, the attitudes of practitioners towards this form of therapy were also examined as the perceived impact on patient health outcomes and general well-being. Levin’s change theory will be applied as a common framework for spearheading and sustaining the type of change that supports patient outcomes. This model of change has been selected due to its popularity and effectiveness in healthcare settings and particularly in nursing practice (Manchester et al., 2014). Lewin’s theory of change is based on a triple step framework for change management. The underlying premise of this theory is that for organizations to survive and remain relevant, they should have the capacity to respond to the dynamic an volatile environments in which they exist. Health care settings are characterized by complex processes to which they should remain adaptive to implement sustainable changes.
The theory views individuals and groups as being constructed by forces that ensure the status quo is maintained, which means that change initiatives are often curtailed by rigid obstacles (Manchester et al., 2014). They are also influenced by an opposing force that supports change, and the tension created by the negative and positive forces establishes an equilibrium. For an organization to overcome the anxiety and move towards change, Lewin suggested application of three steps. They include unfreezing, changing by exploring alternatives and advantages, and subsequently freezing the changes to ensure that they are maintained for the long term in applying the steps to the study. Recommendations for unfreezing the current attitudes of nurses towards therapeutic touch will be made by highlighting the advantages of touch therapy in enhancing patient outcomes. The final step will ensure that the nurses integrate the strategy into their everyday practice.
The following represents the PICOT framing of the research questions, which informed the data collection and analysis strategy:
- Population: Elderly patients in geriatric patient care settings.
- Intervention: The use of therapeutic touch during nurse and patient interaction.
- Comparison: The health outcomes of patients whose nurses use therapeutic touch and those that do not.
- Outcome: Improved therapeutic relationships between nurses and patients, patients positive effect in terms of general well-being and quality of life, as well as patients’ self-reported perspectives on their sense of belonging, feeling loved, and feeling assured that they are receiving the best form of Care.
- Time: 7 days
Therefore, the overall research question will be: Among the geriatric population, how does the application of therapeutic touch affects patients outcomes, sense of general well-being, and quality if life compared to elderly patients that do not receive this type of intervention during one week?
The preceding sections have provided an introduction and background of the area of interest. In addition, the problem that was investigated as well as the purpose of the study were presented. Ultimately, the research questions that guided the study and a summary of the chapter are addressed. The following section examines the extant body of knowledge on the use of therapeutic touch in general and in geriatric patients specifically.
In this chapter, studies are investigated to identify critical concepts in the use of touch for enhancing patient outcomes. Physical contact or touch has been an important issue in nursing practice. While some factions argue against a nurse’s initiation of physical contact, others feel that it offers comfort, love, and communicates to the patients that the healthcare worker is committed to their recovery (Westman and Blaisdell, 2016). Supporters of physical contact between nurses and patients also believe that touch boosts an individual’s positive effect, thus increasing positive feelings that are central to the recovery process.
In the past, touch has been viewed as an important aspect of demonstrating care and compassion. Westman and Blaisdell (2016) reported that the laying of hands on sick patients or people in need of some comfort and compassionate care was a common practice centuries ago. As of the 1950s, Cai and Zhang (2015) report that touch as a form of therapy had become widely implemented in the U.S. and beyond. By that time, the American Holistic Nursing Association and other professional bodies had endorsed it.
The Role of Touch in Healing
Physical touch is an integral part of the therapeutic relationship. Intentional touch, which Hanna and Suplee (2013) describe as physical contact given with an intent to convey compassion, care, presence, and trust has been associated with patients’ feelings of being supported and comforted. Touch has also been associated with having a positive effect on the process of healing (Westman & Blaisdell, 2016). The benefits that speed up recovery time are linked to the improved mood and the secretion of feel-good hormones resulting from receiving an intentional comfort touch from a caregiver.
The Art of Touch
Therapeutic touch takes a range of different forms that convey positivity to the recipient. Blackburn (2015) described touch as an art form of caring practice and not something that can be prescriptively instructed in nursing education. Hence, this attribute implies that the practitioner should rely on his or her knowledge of ethical and personal implications of fostering touch. As a skill in the profession, touch the practitioner’s discernment and response to individual needs based on the circumstances. Essentially, it means that using touch effectively require the practitioner to be attuned to the emotional demands of the moment and to respond accordingly in a manner that relays care and compassion to the recipient of care (Catlin, 2016). Hence, this can entail hugging, rubbing, or simply touching the individual to offer consolation, encourage, and convey empathy (Cooper & Gosnell, 2018). Discernment of the context-specific factors enables practitioners to acknowledge and respond to the professional or personal boundaries that restrict the appropriateness of touch in specific conditions.
Physical touch as a form of treatment is regarded as therapeutic. Hence, this form of therapy comprises three critical components, including caring touch, protective touch, and task-oriented touch. A caring touch can be defined as physical contact that is not part of nursing care procedures, which involves physical reviews (Catlin, 2016). This form of contact includes hugging, holding hands, face touching, and shoulder patting. On its part, the protective touch entails holding the patient in a way that physically or emotionally shields him or her from harm. It may involve physically restraining the patient from enhancing the potency of a drug, which mostly applies for older patients experiencing an episode of agitation. Task oriented-touch relates to the physical examination of a patient’s health indicators, including blood pressure, injury, and other pointers. Therefore, practitioners should be adept at interpreting the mood as well as recognizing the individual differences that shape interactions. They should also be skillful in acknowledging and respecting the social, cultural, or personal contexts, and the perceived level of touch in any given interaction with a patient or family members. An extensive body of evidence has unequivocally established that physical touch has profound therapeutic effects on patients. In addition to significantly alleviating pain, therapeutic touch has the potential to boost immunity and enable agitated patients to relax.
Analysis of Nurses Hugging Patients in Geriatric Care
Catlin (2016) noted that fostering intentional physical touch to older patients, including those who are at the end of life requires a degree of relational intimacy, engagement, and emotional closeness that could be viewed by some as uncomfortable. The need to mitigate the possibilities of contravening professional boundaries as well as the desire to circumvent the discomfort that is typically associated with proximity to the suffering of others may impede the willingness of caregivers to engage with the patients and their family members.
Overcoming these challenges requires practitioners’ enhanced awareness and continued reflection of their ability to appropriately respond to the obstacles by recognizing the emotional, physical, personal, and contextual impediments that constrain the opportunities to foster closeness within the therapeutic relationship between a nurse and his or her patient. In addition, touch affects the attitudes of geriatrics towards a task or a therapist. A positive relationship between a therapist and the client is the foundation upon which improvements take place. The patient-client relationship usually has a profound impact on the recovery process as well as the time it takes to recover fully. Considering that touch is among the most effective strategies for establishing closeness with a client and building trust, it is clear that touch facilitates the establishment of strong relationships between patient and caregivers, which in turn generate positive effects that are pertinent to recovery from physical or mental illness (Catlin, 2016).
It is worth noting that therapeutic touch is also a form of specialized intervention for elderly patients with dementia. According to Cai and Zhang (2015), the treatment is a non-drug related therapy for patients with dementia who exhibit agitation, a common aspect of the disease. The authors found that therapeutic touch significantly improves the cognitive function, everyday behavior, and overall quality of life for elderly patients with dementia. The researchers also concluded that this form of intervention alleviates agitation, promotes relaxation, and enhances calmness.
Cohen-Mansfield, Marx, Dakheel-Ali, and Thein (2015) found that touch is among the most effective interventions for dementia compared to drug and non-drug treatments. Patients who were given massages and experienced the closeness of one-on-one interactions had better outcomes in terms of reduction of stress and anxiety, alleviation of extreme agitation, and a general enhancement of well-being and overall quality of life. The ability of physical contact to reduce the behavioral symptoms of dementia is especially significant considering that the symptoms tend to worsen the disease and place a burden to caregivers who have to calm and restrain the patients from harming themselves or others.
Foot and Hand Massage
Older adults may suffer from chronic pain. Through geriatric massage, these patients can cope with chronic pain. Studies reveal that hand and foot massage has both relaxing and healing properties. The geriatric massage incorporates the standard massage techniques, which targets the elderly population (Hughes, 2019). It includes gentle massage on the hands and feet of the elderly to counter or relax inflamed and stiff joints, as well as relieve foot pain. Hughes (2019) avers that hands have acupressure and reflexology points that easily become inflamed among the elderly. The author observes that both hand and foot massage can improve the motion of fingers and wrist, enhance blood circulation, and reduce trigger points, such as hyperirritable nodules, among the elderly. Schaub et al. (2018) aver that hand and foot massage are intimate approaches, but require mutual agreement. Hence, the nurse should introduce them gradually into the care setting and according to the pace and preference of the patient as well as the availability of the caregiver.In addition, the elderly battle two most common arthritis that affects the hand and feet; rheumatoid arthritis and osteoarthritis. These conditions can affect the grip strength, but through proper massage, the pain can be managed. Hand and foot massage can also put the elderly in a better and cheerful mood. Thus, these forms of massages should be incorporated into geriatric treatments because they reduce the chronic pains among older adults.
Recommendations Based on Evidence
The number and scope of the benefits support the endorsement of touch, including hugging, as a way for nurses to improve the outcomes of their patients and promote their overall sense of well-being. A touch, whether through hugging or merely touching the patient, is a profound gesture that communicates love and care, acceptability, warmth, understanding, among other positive emotions. Elderly patients have been identified as potential beneficiaries of intentional therapeutic touch, and it is, therefore, the mandate of nursing professionals to integrate this intervention in their everyday practice, especially when caring for the geriatric population. The implementation of therapeutic touch program will be done upon the admission assessment by asking the patient if they willing to be part of it while informing them about the benefits of therapeutic touch program, hand and foot massage, hugging, shoulder patting, and holding hands. The intervention will be done two to three days a week at the bedside or in a separated room designated for that purpose. The sessions would last for 2 to 5 mins. Thus, to enhance the effectiveness of the program, the patients, their families, and the nurses will participate in a survey.
Albeit noticeably limited, the studies conducted in this area have all concluded that people of all ages do not receive a non-task oriented touch from a caregiver. In addition to the psychological meanings communicated through therapeutic touch, it also triggers biological responses such as the release of hormones that stimulate a greater sense of well-being and improved quality of life. These positive effects are also linked to the alleviation of disease symptoms and the side effects of treatment as well as decreased recovery time.
- Do you experience joint pains?
- Are these pains manageable only through medication?
- Does your caregiver talk to you about additional activities, such as therapeutic touch, hand and foot massage for pain relief?
- What are your thoughts on implementing therapeutic touch, hand and foot massage to your care?
- Do you feel that your caregiver could improve in some areas?
- As a caregiver, do you feel that therapeutic touch, hand, and foot massage will improve care provision among the elderly?
- As the family, do you feel that your elderly family member will benefit from therapeutic touch, hand and foot massages?