The meaning of caring touch for healthcare professionals in an intensive care unit: A qualitative interview study

The Benefits of Caring Massage® for Patients and Nurses: A Delphi Study

Background: The Caring Massage® (CM) consists of nurse-patient physical and mental contact. It promotes empathetic presence and emotional closeness and strengthens trust and safety in the nurse-patient relationship. However, previous studies have underexplored and under-evaluated its effectiveness on different body areas. This study aimed to identify the body areas to be treated and assess CM's influence on the nurses performing it and patients receiving it. Method: A Delphi study was conducted to gather expert opinions on Caring Massage®. A preliminary list of body areas and variables influenced by CM was developed from a literature review and submitted to panelists to identify outcomes, achieving an acceptable content validity rate. Patient and nurse variables as influenced by CM were categorized into "Bio-Physiological Outcomes" (BPOs), "Psychological Outcomes" (POs), and "Sociological Outcomes" (SOs). Two Delphi rounds were conducted between July and October 2024. Results: A total of 86 panelists were recruited, who identified 58 variables (7 body areas, 29 patient variables, and 22 nurse variables). Feet, legs, back, hands, shoulders, and arms were identified as key CM treatment areas. Patient outcomes identified as highly influenced by receiving CM were quality of sleep (BPO), emotional well-being (PO), and nurse-patient relationship (SO). Nurse outcomes highly influenced by performing CM were physical well-being (BPO), body respect (PO), and consideration of the patient as a person (SO). Conclusion: Caring Massage® influences multiple aspects concerning both the patients receiving it and nurses performing it. This study addressed the heterogeneity observed in the literature, providing a foundation for future studies and encouraging further investigations.

Touch, communication and affect: a systematic review on the use of touch in healthcare professions

BACKGROUND

The following systematic review explores the uses and understandings of physical, human-to-human touch engagements in healthcare professions. Given its central importance as both a diagnostic tool and a form of non-verbal communication, this review sought to understand the communicative, social and affective dimensions of touches a part of healthcare, medical or nursing interventions. We attempt to understand how touch communication seems to be structured in the literature, and what tends to be communicated via touch, but also to highlight how the dogmatic distinction between 'instrumental' and 'expressive' touches might have obscured a socio-affective matrix within all touches.

METHODS

The synthesis produced was informed by 36 empirical studies involving either direct observation of touch practices, or recollection and discussion with healthcare professionals. The studies were selected from five databases in March 2022. In order to minimise risks of bias, the corpus was screened by two independent reviewers and underwent quality appraisal through the Mixed Methods Appraisal Tool. The final dataset was then analysed, synthesised and presented according to the principles of thematic synthesis.

RESULTS

We outline how medical touch has been mostly categorised as either 'instrumental' or 'expressive', with only the latter usually described as serving a communicative purpose, despite its lower incidence. We further highlight how touch seems to be operating across a fragile boundary between 'reassuring presence' and 'control', and thus requires carefulness by practitioners, and an understanding of boundaries. Then, we describe how the literature presented gender, cultural background and personal preference as elements influencing the use and perception of touch. Lastly, touch-mediated communication has been presented in some of the literature as a co-produced practice based on bodily, affective and contextual mutual attunement. Such an understanding radically reconfigures the patient as an active co-participant, as well as pushing against the conceptual boundary between instrumental and expressive touch, recognising how to affect cuts across human-made dichotomies.

CONCLUSION

We argue that communication might happen in all instances of touch, while also advocating for empirical work to outline and describe the adaptive physical dynamics (e.g. changes in speed, pressure, temperature) that regulate and alter even medical procedures for communicative purposes. We also discuss the need for social scientists to radically re-conceptualise not only the theoretical scaffolding behind medical touch, but also the methodologies deployed to investigate it-advocating for a renewed attention to bodily and interactional dynamics, particularly through the deployment of (micro-)phenomenological tools, broader ethnographical engagements, or sensors for automatic recognition of bio-signals.

LIMITATIONS

The review could be at risk of bias given it sampled only studies written in English, French, Italian, Spanish and Finnish, thus not highlighting potentially different cultural and theoretical perspectives emerging from non-EuroAmerican contexts. Moreover, only 36% of studies included discuss patients' perspectives.

SYSTEMATIC REVIEW REGISTRATION

This review was not registered.

Impact of Gentle Touch Stimulation Combined with Advanced Sensory Stimulation in Patients in a Minimally Conscious State: A Quasi-Randomized Clinical Trial

Touch, particularly affective touch mediated by C-tactile fibers, plays a key role in emotional regulation and therapeutic interventions. However, tactile stimulation is underutilized in sensory stimulation (SS) protocols for brain injury patients, despite its potential to enhance consciousness and promote recovery through neural and autonomic regulation. Tools like the Neurowave enable advanced multisensory stimulation, including audio-visual and emotional inputs, but lack tactile components. Integrating gentle touch stimulation with such systems could further enhance neuroplasticity, improve heart rate regulation, and support recovery in patients with disorders of consciousness. In this study, twenty patients affected by minimally conscious state (MCS) were divided into two groups: an experimental group (EG n.10) and a control group (CG n.10). Both groups underwent standard neurorehabilitation, including conventional physiotherapy and speech therapy. The key difference was in the type of sensory stimulation. The EG received advanced sensory stimulation with the Neurowave system (which provides audio-visual and emotional sensory stimulation) in addition to gentle touch stimulation. The CG received conventional sensory stimulation without the Neurowave and neutral gentle touch stimulation. Each patient was evaluated by a multidisciplinary rehabilitation team, using clinical scales such as coma recovery scale-revised (CSR-R), level of cognitive functioning (LCF), before (T0) and after (T1) treatment. Additionally, heart rate (HR) and neurophysiological outcomes (P300) were also recorded for both groups (EG and CG). The MANOVA model revealed a significant interaction effect between group and phase on P300 latency (F (1, 18) = 10.23, p < 0.001, η2 = 0.09), indicating that the intervention involving gentle touch stimulation significantly influenced the P300 latency in the EG. The findings of this study contribute to our understanding of the therapeutic potential of emotional multisensory stimulation, which also includes gentle touch stimulation, in MCS rehabilitation. By demonstrating significant effects on both neurophysiological and functional measures, our results support the integration of tactile interventions into comprehensive neurorehabilitation programs.

Caring touch as communication in intensive care nursing: a qualitative study

PURPOSE

This article describes intensive care nurses` experiences of using communicative caring touch as stroking the patient`s cheek or holding his hand. Our research question: "What do intensive care nurses communicate through caring touch?"

METHODS

In this qualitative hermeneutically based study data from two intensive care units at Norwegian hospitals are analysed. Eight specialist nurses shared experiences through individual, semi-structured interviews.

RESULTS

The main theme, Communicating safety and presence has four sub-themes: Amplified presence, Communicating security, trust and care, Creating and confirming relationships and Communicating openness to a deeper conversation. Communicative caring touch is offered from the nurse due to the patient`s needs. Caring touch communicates person-centred care, invites to relationship while respecting the patient's dignity as a fellow human being. Caring touch conveys a human initiative in the highly technology environment.

CONCLUSION

Caring touch is the silent way to communicate care, hope, strength and humanity to critical sick patients. This article provides evidence for a common, but poorly described phenomenon in intensive care nursing.

The "Doing" of Compassionate Care in the Context of Childbirth from a Women's Perspective

Women who are giving birth need to be met with compassion and understanding from healthcare professionals. However, there are growing concerns about the perceived lack of compassion in the delivery of healthcare services in general and maternity care in particular. We conducted 15 qualitative interviews with women who had given birth in Norway within the previous year, asking them to describe their experiences of compassionate care. We aimed to explore what healthcare professionals "do" that is experienced as compassionate. The analysis was informed by Paul Gilbert's theory of compassion and a concept analysis of compassionate midwifery undertaken by Ménage and colleagues. The compassionate caring actions of healthcare professionals that were identified in the women's narratives generated five themes: attuning actions, validating actions, contextualizing actions, empowering actions, and small acts of kindness. The findings build on the prior theoretical concepts used for the study and provide a nuanced account of how women perceive compassionate care from healthcare professionals. They could contribute to understanding more of the meaning and nature of compassionate care during childbirth. The analysis indicates the importance of ensuring that compassionate care is at the very core of maternity care services.

"I am Here"-The Importance of Caring Touch in Intensive Care. A Qualitative Observation and Interview Study

Purpose: The purpose of the study was to illuminate the experience of caring touch in intensive care from the perspectives of patients, next-of-kin, and healthcare professionals. Design and Method: This study was explorative, and data were collected through qualitative observations (n = 9) with subsequent interviews (n = 27) at two general intensive care units. An inductive approach was embraced to be open-minded to the participants' experiences. Findings: The results are presented in one generic category-caring touch creates presence-which generated five subcategories: to touch and be touched with respect, touch as guidance and communication, touch causes suffering, touch creates compassion, and touch creates security. Conclusion: When the ability to communicate with words is lost, it is body language that reveals what a person is trying to express. Nurses create a way of being present with the patients by touching them, to communicate I am here for you. Caring touch is a tool to show compassion and respect and to protect the integrity of the lived body. The caring touch is soothing and comforting for the patient and next-of-kin and creates security. It also helps to awaken the motivation to get healthy, which is needed in an environment that is foreign.

The nurses' touch: An irreplaceable component of caring

BACKGROUND

Touch is an integral part of human interaction. Health care makes significant use of touch, and for most healthcare professionals, it is indispensable to their practice. An essential and inevitable facet of the nursing profession is the touching of patients during the provision of care. Unfortunately, touch is seldom considered in the nursing framework today.

AIMS

To emphasize the importance of touch in contemporary nursing practice in a highly technological environment.

MATERIALS AND METHODS

A search was conducted on February-May 2022. The initial search identified 84 articles and the final analysis included 38 articles that met the inclusion criteria (touch; touch in health care; touch and nursing; touch and technology; nursing and technology; nursing and caring; touch and caring).

RESULTS

The nurses' touch will always be an irreplaceable component of caring in nursing.

DISCUSSION

There can be no substitute to the expressive touch of a nurse. As the technological revolution in nursing is inevitable, it is imperative that nurses consider how much these technologies impact the nurse-patient relationships.

CONCLUSION

The study emphasized the importance of touch in contemporary nursing practice. The study found that the nurses' touch will always be an irreplaceable component of caring in nursing. The finding will have an impact on nurses and patients situated in highly technological healthcare environments.

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.

Assessing individual differences in attitudes towards touch in treatment settings: Introducing the touch & health scale

Individuals commonly receive touch in treatment settings, but there is limited research on how they perceive it. The current project sought to address this gap by: 1) developing the Touch & Health Scale (THS) - a novel instrument to measure attitudes to touch in treatment settings 2) assessing inter-individual differences in THS scores, and 3) examining the association between individuals’ THS scores and wellbeing. Data of a large U.K. adults sample ( N > 12,000) were used. THS showed Cronbach’s α between 0.636 and 0.816 and significant correlations ( p < 0.001) with day-to-day attitudes to touch. THS scores differed as a function of extraversion and avoidant attachment style. Participants with more positive attitudes to touch in treatment settings showed greater wellbeing. Overall, the study highlights the importance of a personalised approach to touch in treatment settings and provides a new scale that may act as a screening tool for this purpose.