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

"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.

Body care of older people in different institutionalized settings: A systematic mapping review of international nursing research from a Scandinavian perspective

Body care is considered a key aspect of nursing and imperative for the health, wellbeing, and dignity of older people. In Scandinavian countries, body care as a professional practice has undergone considerable changes, bringing new understandings, values, and dilemmas into nursing. A systematic mapping review was conducted with the aims of identifying and mapping international nursing research on body care of older people in different institutionalized settings in the healthcare system and to critically discuss the dominant assumptions within the research by adapting a problematization approach. Most identified papers reported on empirical research with a biomedical approach focusing on outcome and effectiveness. Conceptual papers, papers with a focus on the perspectives of the older people, or contextual and material aspects were lacking. The research field is dominated by four dominant assumptions: Body care as an evidence-based practice, body care as a relational ethical practice, the body as a body-object and a body-subject, the objects in the body care practices as nonrelational materialities. Given the complexities of professional body care practices, there is a need for other research designs and theoretical perspectives within nursing that expand our understanding of body care taking into consideration the multiple social and material realities.

Sexual Modesty in Sexual Expression and Experience: A Scoping Review, 2000 - 2021

Sexual modesty is the social, cultural, interpersonal, and psychological systems - defined by the tenets of Script Theory - that regulate individuals' sexual expression and experience at the social, legal, and interpersonal boundaries of acceptable/not-acceptable, private/public, and personal/social. Almost all aspects of sexual expression and experience are touched by the pervasive modesty standards for sexual communication, sexual display, sexual relations, and sexual behaviors. Sexual modesty influences an array of sexual and reproductive health outcomes. Many aspects of sexual modesty are enforced by legal as well as social, cultural, and religious proscriptions, including social shaming and ostracism as well as corporal and capital punishments. The purpose of this paper is to summarize a diverse literature related to sexual modesty from the years 2000 to 2021 in order to clarify its role in sexual health and sexual wellbeing and to identify directions for new research.

Bodywork and nursing practice: Development of a bodywork in nursing practice instrument

Nursing's continued focus on caring for physical aspects of patients' bodies underscores the importance of bodywork and shows nursing's privileged, professional access to patients. This instrument development study presents the first phases of a new instrument. It established a conceptual definition of nursing's bodywork and initial psychometric properties of the Nursing Bodywork Instrument. Literature sources generated codes and clusters for item development. Literature-based and expert content validity were demonstrated. A pilot study tested nurses' (N = 53) agreement with draft items. The highest-ranked items confirmed nurses' bodywork and reliance on technological devices when giving direct patient care. Known groups validity testing by groups' years as a nurse did not differ statistically. Internal consistency reliability was 0.98 on the 128-item instrument, pointing to the need for future reduction. Inter-item correlations suggested that factor analysis with a large sample size might generate domains descriptive of nursing's bodywork. A total of 125 items resulted from item analysis and subsequent item revision. All items were matched with clusters; for example, technologic device management, physical comfort facilitation, skin/wound management, self-care facilitation, and respiratory management include some item clusters.

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.

"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.

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

BACKGROUND

The way health care professionals touch patients and relatives in the intensive care unit plays a significant role. A negative feeling can be caused by being touched in the wrong way, this is why a holistic approach with respect for the patient is important for the ability to make the patient and their relatives feel secure, avoiding unnecessary suffering.

AIM

The aim of the study was to describe the meaning of caring touch that is given in the ICU from the health care professionals perspective.

METHOD

Qualitative interview study with health care professionals in the intensive care unit, analysed using inductive content analysis, resulting in two themes and four main categories.

FINDINGS

Two themes emerged: Imperative touch and emotional touch and four main categories: touch as a natural tool, create a prerequisite for touch, empathetic touch and conversant touch.

CONCLUSION

Caring touch can be used as a natural tool in the daily work in order to bring comfort and calm to the patient in the intensive care unit.

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.

More than just a task: intimate care delivery in the nursing home

Purpose: Intimate care procedures, such as bathing and toileting, are often regarded as simple, humble tasks. However, the provision of such care transforms a very private, personal activity into a social process. Understanding this complex process and the psychological impact it has on those providing and receiving care is critical in order to mitigate potential distress. The purpose of this study to examine the experience of delivering and receiving intimate personal care in the NH.

Methods: A focused ethnographic approach with participant observation, semi-structured interviews, focus groups and drop-in sessions, document review, and field notes. Data were analysed using constant comparative analysis.

Results: Quality care in this context is predicated on the care provider recognition of the emotional impact of care delivery on the care recipient. Our analysis identified that the overarching theme, of providing quality person-centred intimate care, requires creating and maintaining a relational space that promotes integrity.

Conclusions: The provision of intimate personal care consists of a complex interplay at the level of resident/care provider interaction (micro level); health care organization (meso level); and policy (macro level). Each of these levels interacts with and influences the other two. The components identified in our model may provide the basis from which to further examine resident experiences of quality intimate personal care.

"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.

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.

Losing touch

The need for human touch is universal among critical care patients and is an important component of the nurse-patient relationship. However, multiple barriers to human touch exist in the critical care environment. With little research to guide practice, we argue for the importance of human touch in the provision of holistic nursing care.

The Impact of the Theory of Nursing for the Whole Person on the Professional Practice of Nursing School Graduates

The Theory of Nursing for the Whole Person (TNWP) is a wholistic theory that focuses on the integration of body, mind, spirit, individual, family, and community. A qualitative descriptive research study explored Oral Roberts University graduates' perceptions of their use of the TNWP in practice. Analysis revealed six major themes. Respondents felt that the TNWP was a necessary tool to truly care for patients.

Nursing students' emotions evoked by the first contact with patient's body: A qualitative study

Providing personal care is one of the most significant activities of nursing care. Nursing students, who approach the patient's body for the first time, may experience a wide range of emotions, affecting their attitude toward the nursing profession and performance. Nevertheless, the emotional aspects related to providing personal care in nursing education have remained relatively neglected. A qualitative descriptive study was performed to describe the emotions felt by first-year nursing students when providing personal care and to analyze the situations which triggered their emotions. First-year students (N = 145) were asked to narrate episodes of body care evoking both positive and negative emotions. Emotions were analyzed according to Damasio's theory while trigger situations were inductively found through a content analysis. Our results show that first-year nursing students experienced mostly social emotions, with a significant triggering role played by patients. In most of the narratives, patients were seen as a source of (un)recognition and personal (un)satisfaction. In this pattern, the patients play a fundamental role in supporting their confidence. Providing emotional education and peer discussion/sharing may facilitate the ability of nursing students to become aware of their own feelings and to be focused on patient's needs.

Providing Personal Care to Patients: the Role of Nursing Students' Emotional Labor

Background Providing personal care may be a source of emotional difficulties and negative feelings for students interacting with patients during their first clinical placement. This study was done to describe the role of emotional strategies for first year nursing students providing personal care to patients and the relationship of these strategies to students' emotional exhaustion, self-efficacy, and turnover intention. Method A self-reported questionnaire was administrated to a convenience sample of 226 first-year undergraduate nursing students attending their first clinical placement in one Italian University hospital. Results Results suggested a positive link between students' cognitive re-evaluation of their experiences and their self-perceived self-efficacy. Attentional deployment was the strongest antecedent of emotional exhaustion. Emotional dissonance was the primary contributor to students' turnover intention. Emotional exhaustion mediated the relationship between emotional dissonance and turnover intention. Conclusion This research suggested that there are emotional coping strategies useful for protecting student nurses from emotional exhaustion and turnover intention and that these strategies are positively related to students' self-perceived self-efficacy in providing personal care.

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.

Dojemanje dostojanstva pacientov z vidika zdravstvenih delavcev

Uvod: Človeško dostojanstvo je neodtujljiva pravica vsakega posameznika, njegovo ohranjanje pa temeljna naloga zdravstvenih delavcev. Namen raziskave je bil ugotoviti, v kolikšni meri se med hospitalizacijo pacientom zagotavlja dostojanstvo ter kako to dojemajo zaposleni v zdravstvu.Metode: Raziskava temelji na eksplorativni kvantitativni raziskovalni metodi. Podatki so bili pridobljeni s strukturiranim vprašalnikom. V raziskavi je sodelovalo 267 priložnostno izbranih zdravstvenih delavcev iz petih slovenskih splošnih bolnišnic. Pridobljeni podatki so bili obdelani z bivariatno in multivariatno analizo.Rezultati: Splošno mnenje anketirancev o sodelavcih in njihovem zagotavljanju zasebnosti je dobro (x = 3,79, s = 0,70). Dojemanje dostojanstva se lahko pojasni v 52,18 % z osebno odgovornostjo zaposlenih (23,82 %), informiranostjo pacientov (16,62 %) in pacientovim sodelovanjem pri odločitvah (11,74 %). Poklicne skupine imajo različno stališče do informiranosti pacientov (F = 5,44, p = 0,001). Med vključenimi bolnišnicami so razlike v izvajanju aktivnosti: zapiranje vrat bolniške sobe (F = 9,07, p < 0,001), uporaba paravana ali zavese (F = 25,65, p < 0,001), nameščanje opozorila na vrata bolniške sobe (F = 28,16, p < 0,001) ter obveščanje pacientov o tem, kaj se bo dogajalo med intervencijami (F = 5,91, p = 0,001), aktivnosti pogosteje izvajajo zaposleni v zdravstveni negi s srednješolsko izobrazbo.Diskusija in zaključek: Med hospitalizacijo se dostojanstvo pacientom ne zagotavlja popolnoma, zato bodo rezultati lahko uporabni za načrtovanje izboljšanja strokovnega znanja, razumevanja področja dostojanstva ter infrastrukturnih in materialnih pogojev.

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.

A conceptual model of the risk of elder abuse posed by incontinence and care dependence

AIMS AND OBJECTIVES

To describe and critically analyse the thinking that led to the concept of an association between incontinence, care dependence and elder abuse.

BACKGROUND

Coercive or abusive continence care practices include chastising a person for their incontinence and overriding their attempts to resist continence care. Neglect in continence care is characterised by withholding or delaying responding to requests for help to maintain continence or to manage incontinence, and restricting a person's access to toileting assistance, incontinence aids or hygiene care.

METHODS

Contemporary biomedical understandings about incontinence and influencing concepts from the fields of sociology, psychology and nursing were analysed to inform the design of a conceptual model that elucidates possible associations between incontinence, care dependence and elder abuse.

RESULTS

Ideas generated from an analysis of the concepts led to the development of a model termed the "Model of Attributes to Abuse of Dependent Elders in Continence Care" (MADE-CC). The MADE-CC theorises factors that cause and contribute to abuse in continence care. Carer factors include physical and emotional exhaustion, frustration related to the inability to control or predict incontinence, resentment associated with constraints imposed by care dependence, disgust associated with physical contact with urine/faeces, limited knowledge and skills about incontinence and ethical conflicts concerning care. Care recipient factors include frequent and severe incontinence, cognitive impairment and a history of physical or psychological trauma. Social factors that are theorised include the stigmatised nature of incontinence, social taboos and cultural norms and the private nature of continence care.

CONCLUSIONS

The MADE-CC illuminates the potential risk of elder abuse posed by incontinence and care dependence. It should be used to improve ethical care of older people and stimulate debate about everyday ethics in the care of older people who are care dependent and to optimise their participation in decisions about their health and well-being.

IMPLICATIONS FOR PRACTICE

Nurses and carers should be aware of the multiple interrelated factors that contribute to the risk of elder abuse in the caregiving encounter, including the role of emotions.

Being Met as marked - patients' experiences of being infected with community-acquired methicillin-resistant Staphylococcus aureus (MRSA)

BACKGROUND

It is known that patients who acquired methicillin-resistant Staphylococcus aureus (MRSA) in hospitals suffer and feel as plague. Moreover, the patient interaction with nurses and physicians is described as frightening. Little is known about patient experiences after having acquired CA-MRSA concerning care and everyday life.

AIM

To reveal and interpret otherwise healthy patients' lived experiences of receiving care and their everyday life after having acquired community MRSA (CA-MRSA).

METHODS

A phenomenological hermeneutic approach guided by Ricouer was conducted. Interviews with twelve patients were transcribed verbatim into a text. The text was analysed in three phases: naive understanding, structural analysis and comprehensive understanding to reveal a possible being in the world. In this study, this referred to what it means to be infected with CA-MRSA.

RESULTS

The findings indicate that patients who acquired MRSA experience a changed body image. They suffer from ignorant and frightened behavior from healthcare workers, social contacts, and also of being bullied by colleagues. Despite this, patients assume great responsibility for protecting others. However, knowledgeable staff alleviate suffering and bring peace of mind to the patients.

CONCLUSIONS

Preventing patient's feelings of being a pest, an outsider living with fear, requires urgent education and understanding about resistant bacteria and how to meet an infected patient. The results describing patients, affected with MRSA, may contribute and touch the readers to better understanding of patient's changed body image and suffering and how to mitigate these feelings.

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.

Patient-nurse anesthetist interaction during regional anesthesia and surgery based on video recordings

PURPOSE

The purpose of this study was to interpret and describe the patient-nurse anesthetist (NA) interaction during regional anesthesia.

DESIGN

Video recordings conducted during orthopedic surgery at a surgical clinic in Sweden formed the basis for the study, in which three patients and three NAs participated.

METHODS

A hermeneutic analysis was conducted on the data.

FINDING

The findings of the analysis demonstrated that the NA was in either "present" presence or "absent" presence in the awake patient's visual field during surgery. The NA's professional actions at times dominated the patient's existential being in the intraoperative situation. The findings conveyed insights about the patient-NA interaction that open up possibilities for nurses to understand and reflect upon their own practice in an expanded way.

CONCLUSIONS

Using video recordings for reflections enables development of professional skills that positively influence the care quality for patients during regional anesthesia.

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.