Elderly residents: perceptions of nurses' comforting touch

Importance of relationship quality and communication on foodservice for the elderly

In order to promote foodservice for the elderly, foodservice managers in Continuing Care Retirement Communities (CCRCs) must identify the main factors to enhance the satisfaction and behavioral intentions with food service. The purpose of this study was to investigate the relationships between relationship quality (consisting of trust, commitment, and satisfaction) and communication in the formation of elderly's behavioral intentions with food services at CCRCs. A survey was administered to residents in two CCRCs and a total of 327 residents participated. A tested structural equation model exhibited good model fit and explanatory power of the study construct. Satisfaction directly influenced word-of-mouth and service quality has an influence on commitment. Commitment was a significant determinant of behavioral intentions to eat more often in the dining room. Also, communication showed positive association with trust. The results provided strong evidence for the importance of satisfaction and communication as a consequence of relationship marketing efforts. Suggestions for future research to better understand the elderly' behavioral intention judgments were given.

Culturally congruent care for older people: Finnish care in Sweden

An increasing number of older people belong to minority and immigrant groups. This calls for new models on the subject of how to provide culturally adjusted care for these populations. The aim of this study is to describe how cultural congruency is used in care for older Finnish immigrants in order to promote their well-being. The study was conducted with an ethnographic design, based on participant observations and interviews among residents, staff, and visitors in the Finnish Home in Sweden. In the core of the cultural congruency is the use of the Finnish language, and the fact that both residents and staff have Finnish backgrounds. In addition to this, Finnish customs and celebrations, popular culture, and topics of discussion, are actively used in order to create a common ground for communication and shared understanding of the individual person. Cultural congruency, based on the residents' mother language, shared ethnic background with staff, and shared customs creates a common ground for communication and an understanding. This enables caring relationships, which, in turn, increases the residents' well-being.

Assessing cognitive ability in research: use of MMSE with minority populations and elderly adults with low education levels

The Mini-Mental State Examination (MMSE), originally designed to screen for dementia, is an instrument currently used extensively to assess cognitive status in clinical and community settings. This descriptive study compares standard MMSE scores to MMSE scores adjusted for age and education in a sample of 414 elderly Black and White women living independently in communities. After scores were adjusted, 14 participants (all Black) were moved from categories of mild cognitive impairment to unimpaired cognitive ability. However, even after scores were adjusted for age and education, White elderly adults still had higher mean scores than Black elderly adults (p = .003), suggesting that racial differences may have an effect on MMSE performance independent of age and education. Further research is needed to better understand the interaction of race and culture on MMSE outcomes. Implications are offered for appropriate use of the MMSE considering factors of age, education, and racial differences to guide evidence-based practice by gerontological nurses engaged in work with elderly populations.

Assaultive Behavior in Alzheimer's Disease: IDENTIFYING IMMEDIATE ANTECEDENTS DURING BATHING

To identify immediate antecedents of bathing-related physical assaults against caregivers by nursing home residents with Alzheimer's disease and related disorders, videotapes of nursing home residents who physically assaulted nursing assistants during baths were analyzed. Caregiver behaviors that occurred significantly (p < .01) more often during the 5 seconds preceding an assault included: calling the resident by name, confrontational communication, invalidation of the resident's feelings, failure to prepare the resident for a task, disrespectful speech, any touch, absence of physical restraint, and hurried pace of bath. Assaults were significantly more likely when caregivers sprayed water without a verbal prompt; the resident's feet, axilla, or perineum were touched; residents exhibited signs of temperature discomfort; and multiple caregivers were present. Improved caregiver training and individualized, gentler bathing methods should be investigated as methods of reducing assaults.

Physiotherapists' use of touch in inpatient settings

BACKGROUND AND PURPOSE

Although touch is a basic element in the practice of physiotherapy, no research has been done to establish the type and purpose of practitioner touch in clinical settings. The purpose of the present study was to determine how physiotherapists use touch in inpatient acute and rehabilitation settings.

METHOD

Fifteen physiotherapists with three or more years' experience were videotaped treating two to three patients. The participant physiotherapists reviewed a videotape of themselves and described the types of touch used and their intent behind each touch. Cross-case analysis was used to determine common themes in the descriptions. Mutually exclusive categories of touch were then refined, based on the cases.

RESULTS

The most common types of touch used by physiotherapists included assistive touch, touch used to prepare the patient, touch to provide information, caring touch, touch to provide a therapeutic intervention, and touch used to perceive information. The physiotherapists also used 33 different combinations of touch, that is, a single touch used for more than one purpose.

CONCLUSIONS

Inpatient physiotherapists clearly perform in a 'high touch' arena. Clinical experience was reported as the strongest factor in developing the physiotherapists' sensitivity to patient needs and their skill in using specific types of touch. Further research is needed concerning the way patients perceive and respond to the presence or absence of these various forms of practitioner touch.

Calming music and hand massage with agitated elderly

BACKGROUND

Agitated behavior is a widespread problem that adversely affects the health of nursing home residents and increases the cost of their care.

OBJECTIVE

To examine whether modifying environmental stimuli by the use of calming music and hand massage affects agitated behavior in persons with dementia.

METHOD

A four group, repeated measures experimental design was used to test the effect of a 10-minute exposure to either calming music, hand massage, or calming music and hand massage simultaneously, or no intervention (control) on the frequency and type of agitated behaviors in nursing home residents with dementia (N = 68). A modified version of the Cohen-Mansfield Agitation Inventory was used to record agitated behaviors.

RESULTS

Each of the experimental interventions reduced agitation more than no intervention. The benefit was sustained and increased up to one hour following the intervention (F = 6.47, p<.01). The increase in benefit over time was similar for each intervention group. When types of agitated behaviors were examined separately, none of the interventions significantly reduced physically aggressive behaviors (F = 1.93, p=.09), while physically nonaggressive behaviors decreased during each of the interventions (F = 3.78, p< 01). No additive benefit resulted from simultaneous exposure to calming music and hand massage. At one hour following any intervention, verbally agitated behavior decreased more than no intervention.

CONCLUSION

Calming music and hand massage alter the immediate environment of agitated nursing home residents to a calm structured surrounding, offsetting disturbing stimuli, but no additive benefit was found by combining interventions simultaneously.

Outcomes of comfort touch in institutionalized elderly female residents

Comfort touch as a holistic nursing intervention has gained considerable attention in the past decade. The purpose of this experimental study was to examine whether comfort touch improved the perceptions of self-esteem, well-being and social processes, health status, life satisfaction and self-actualization, and faith or belief and self-responsibility in 45 institutionalized elderly female residents. Results revealed that comfort touch significantly improved the perceptions of all elements. This article offers recommendations for practice, research, and education.

The conceptual structure of physical touch in caring

AIMS OF THE STUDY

This study was conducted to clarify and to conceptualize the phenomena of physical touch in caring.

BACKGROUND

Physical touch occurs frequently in patient care situations and has specific meanings within the context of caring. However, the concept of physical touch in caring has not been well articulated in the literatures, although the phenomena of touch and physical touch have been studied in relation to comfort, sense of well-being and connectedness.

DESIGN/METHOD

The Hybrid Model of concept development was applied to develop a conceptual structure of physical touch in caring, which included a field study carried out in Seoul, South Korea using in-depth interviews with 39 adult subjects consisting of health-care professionals, in-patients, and healthy persons.

RESULTS/FINDINGS

The concept of physical touch in caring emerged as a complex phenomenon having meanings on several different dimensions which were encompassed several attributes and the conceptual structure of physical touch in caring centred around five aspects of goals for physical touch: promoting physical comfort, promoting emotional comfort, promoting mind-body comfort, performing social role, and sharing spirituality.

CONCLUSIONS

Physical touch in caring as a concept having the dimensions of physical, emotional, social, and spiritual significance needs to be treated in a holistic way and it is possible to enrich the meanings and methods of physical touch in nursing so that its application may have effects that have positive impacts on patients' well-being and comfort.

Effects of video interaction analysis training on nurse-patient communication in the care of the elderly

This paper describes an empirical evaluation of communication skills training for nurses in elderly care. The training programme was based on Video Interaction Analysis and aimed to improve nurses' communication skills such that they pay attention to patients' physical, social and emotional needs and support self care in elderly people. The effects of the training course were measured in an experimental and control group. They were rated by independent observers, by comparing videotapes of nursing encounters before and after training. Forty nurses participated in 316 videotaped nursing encounters. Multi-level analysis was used to take into account similarity among same nurse encounters. It was found that nurses who followed the training programme, provided the patients with more information about nursing and health topics. They also used more open-ended questions. In addition, they were rated as more involved, warmer and less patronizing. Due to limitations in the study design, it could not be demonstrated that these findings can entirely be ascribed to the training course. Further research, incorporating a randomized controlled design and larger sample sizes, is recommended to determine whether the results can be attributed to this specific type of training.

Physical touch in nursing studies: a literature review

In nursing contexts a distinction is made between two types of touch: physical touch and therapeutic touch. Physical touch may be experienced as therapeutic, but that is not its explicit purpose in the same way as with therapeutic touch. Most of the touch studies reviewed in this article are from the United States of America, Canada and the United Kingdom and thus represent the culture of modern western society. The area covered by these studies is far from coherent, and even the results are to some extent contradictory. It follows that it is difficult to draw any firm conclusions from this review of the concepts, methods and main results of touch studies.

Non-verbal behaviour in nurse-elderly patient communication

This study explores the occurrence of non-verbal communication in nurse-elderly patient interaction in two different care settings: home nursing and a home for the elderly. In a sample of 181 nursing encounters involving 47 nurses a study was made of videotaped nurse-patient communication. Six non-verbal behaviours were observed: patient-directed eye gaze, affirmative head nodding, smiling, forward leaning, affective touch and instrumental touch. With the exception of instrumental touch these non-verbal behaviours are important in establishing a good relationship with the patient. To study the relationship between non-verbal and verbal communication, verbal communication was observed using an adapted version of Roter's Interaction Analysis System, which distinguishes socio-emotional and task-related communication. Data were analysed in hierarchical linear models. The results demonstrated that nurses use mainly eye gaze, head nodding and smiling to establish a good relation with their patients. The use of affective touch is mainly attributable to nurses' personal style. Compared to nurses in the community, nurses in the home for the elderly more often display non-verbal behaviours such as patient-directed gaze and affective touch.

The patient's perceived caring needs as a message of suffering

The aim of the study was to arrive at a deeper understanding of the patient's experience of caring needs, that is, of problems, needs and desires, by investigating and explaining how these will be expressed and shaped in the caring relation and to illuminate its implications for caring. The target population consisted of 38 patients in a medical ward and 37 patients in a surgical ward in a central hospital in Western Finland. The patients were interviewed in the wards and asked about perceived caring needs. By means of a hermeneutical process of interpretation a pattern emerged which was interpreted as pictures of themselves and of the nurses. These types of patients fell into three groups: the satisfied, the complaining and satisfied, and the complaining and dissatisfied patients. The types of nurses were divided into the competent and friendly, the competent and contact-creating and the competent and courageous. The patients' caring needs can be interpreted and understood from the standpoint of their experience of suffering, but also in relation to their experience of pleasure and comfort. The most conspicuous caring needs were experiencing confidence in the competence of the nurses, comfort, guidance, dialogue and closeness, which the patients expressed as problems, needs and desires. The patients' caring needs can contain new possibilities of growth and development. The nurse can relieve patients' suffering by promoting their experience of comfort. If the nurses' view of the limits of reality are extended to comprise the existential/ spiritual dimension of human beings as well, new possibilities will emerge of interpreting and understanding patients' caring needs as a message of suffering.

Intimacy--meeting needs and respecting privacy in the care of elderly people: what is a good moral attitude on the part of the nurse/carer?

This article explores notions of intimacy in the caring context. The aspects discussed are: privacy and intimacy; intimacy as emotional and/or physical closeness; intimacy as touch; sexual intimacy and normal ageing; sexual intimacy and patients suffering from dementia; and intimacy as trust. Examples are given and problems are identified, with reflection on the attitude and behaviour of the carer. It is suggested that when trying to make moral decisions in concrete situations it is imperative that the carer is aware of the values upon which his or her own thinking is based. It is argued that the guiding principle should be the moral assumption that the carer's responsibility can never be interpreted as a right to disregard the wishes of the patient. Hence, the key word in daily care is 'respect'.

Nurse-elderly patient communication in home care and institutional care: an explorative study

This study explores communication patterns between nurses and elderly patients in two different care settings. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients, a study was made of nurse-patient communication. The video recordings were observed using an adapted version of Roter's Interaction Analysis System, which yields frequencies of 23 types of verbal behaviours. These data were analyzed using correspondence analysis, to reduce them to a smaller number of verbal categories, in which two socio-emotional categories and three categories with task-related communication, could be distinguished. For each encounter five summary statistics corresponding to these categories were calculated. Using analysis of variance, it was shown that the amount of socio-emotional interaction in both settings appeared to be higher than was reported in previous studies into nurse-patient communication. Compared with the home for the elderly, communication was more task-related in home care.

The role of communication in nursing care for elderly people: a review of the literature

Communication in nursing care is an important topic assessing the specific needs of elderly patients and providing nursing care that is tailored to the individual patient's needs. In this review of the literature, we describe the role attributed to communication in theoretical nursing models and we report how research in communication in nursing elderly patients has taken place over the last ten years. It appears that since the eighties there has been an increase in observation studies into nurse-patient communication. There still is, however, a lack of observation instruments to do justice to the interactive nature of nurse-patient communication. Special attention should be paid to reliability and validity.

The right to touch and be touched

Touching is an integral part of human behaviour; from the moment of birth until they die, people need to be touched and to touch others. Touching is an intimate action that implies an invasion of the individual's personal, private space. In ethical terms, the question of touching is closely related to the patient's right to integrity and inviolability. The purpose of this study was to describe touching as it is experienced by elderly patients and nurses in long-term care. Touching was approached as a form of communication and as an important part of nursing practice. The participants, 25 patients and 30 nurses, were interviewed using a semistructured schedule. The data were analysed using the method of content analysis. The patients experienced touching by nurses as gentle, comforting and important. The nurses, for their part, experienced touching by patients as easy and natural. The patients rarely touched nurses more than was necessary. In some cases, nurses had to cope with violent touching by patients. Some women nurses interpreted touches by male patients as having a sexual nature and as annoying. This had taught male patients to avoid touching nurses. On the other hand, friendly and grateful touches by patients were very important to nurses. When used for emotional purposes only, touching presupposed a good relationship between nurses and their patients. Although touching is extremely common in nursing practice, there has been very little research into its meaning. More work is therefore needed to explore the role and meaning of touching in nursing.