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Nurses use of touch in palliative care: To touch and to be touched

Conference Paper · October 2015

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Christine J McPherson Lacie White

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 Nurses use of touch in palliative care: To touch and to be touched
Christine J. McPherson & Lacie White
University of Ottawa
Background and aims
Nursing is a deeply intimate profession where touch is integral in providing care to another. Indeed, there
is widespread recognition that touch offered with an intention to foster presence, trust, and
communication in the nurse-patient exchange (hereafter referred to as intentional touch) can be deeply
supportive, comforting and healing1, 2.
Despite its significance, the highly intersubjective and context-dependent nature of intentional touch
makes it difficult to research, teach, and implement in practice. Research on intentional touch is limited,
with a focus on outcomes rather processes, and it is rarely addressed in nursing education; limiting
understanding of how to foster and use intentional touch in nursing practice, or the meanings associated
with its use3, 4. In partial consequence, nurses’ report les comfort with using touch in non-task related
functions to connect with patients in their care5.
The aims of this poster are to raise awareness of intentional touch as an uncertain aesthetic practice and
encourage nurses to reflect on intentional touch within their own practice.
Underlying what is a seemingly simple behavior (touch) is a
highly complex, intersubjective and context-dependent act that
has meaning for those involved
An uncertain aesthetic practice
Intentional touch cannot be implemented prescriptively into nursing practice. Instead,
it involves integrating knowledge derived from various sources (e.g. aesthetic,
empirical, personal, emancipatory, and ethical) to guide nursing practice 5-8.
Intentional touch draws heavily on aesthetic patterns of knowing, or the art of
nursing where nurses’ perceive and respond to individual and contingent needs of the
unfolding, moment-to-moment experiences they find themselves in5. Here an
awareness or knowledge of the Self and of the Self in relation to others (personal
knowing) is essential to perceiving and attending to these moments and offering
authentic intentional touch5-8.
Through a willingness and awareness to use intentional touch, nurses can themselves
be touched affectively by the experience5, 8.
Personal and professional boundaries
Personal and professional boundaries can influence how intentional touch is integrated in nurses’
practice.
Intentional touch in caring for patients at the end of life and their families involves a level of engagement,
relational intimacy and emotional closeness that may be unfamiliar and uncomfortable for some.
Concerns regarding the violation of professional boundaries, and the need to avoid discomfort associated
with being with the suffering of others may limit the level of nurses’ engagement8-10.
Within nurse-patient interactions the physical act of touch manifests itself in a
profoundly intimate way; touching both the nurse and patient affectively.
Authors’ contact information
School of Nursing, Faculty of Health Sciences, Guindon Hall
451, Smyth Road, Ottawa, Ontario K1H 8M5. Canada
Christine J. McPherson cmcphers@uottawa.ca
Lacie White lwhit025@uottawa.ca
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Cultivating awareness
Cultivating awareness and the possibilities of intentional touch in practice requires nurses to reflect on
their ability to attend to these moments, and a willingness to identify personal, physical, and emotional
barriers that can inhibit closeness in the nurse-patient relationship and therapeutic practices9, 10.
Skillful ways to enact intentional touch requires nurses to appreciate individual differences and respect
personal, social and cultural contexts as well as the connection between Self and other when offering
intentional touch in a particular encounter with a patient and family.
One means to cultivate this awareness and to foster aesthetic and personal knowing is through the use of
stories or narratives11. Narratives are,
“essential to convey and preserve knowledge about the skill of involvement (getting the right kind of
involvement and interpersonal distance to fit the situation), because relational skills always involve the
concrete other and are always context dependent” (p. 9)11.
Read the story below “Touching Terror”
Touching Terror: One nurse's experience of touch in practice
An image that continues to come to my mind over-and-over again is of a man, Jerry who after two
days of unresponsiveness, bedbound and appearing to be imminently dying, found his way out of bed
and on to the floor. Sandra found him and called for me to quickly come and help. Jerry was a frail,
tiny man – skin and bones. He was rolling around on the cold floor in his oral secretions and urine. He
moaned. We all stood frozen for a moment. I asked Sandra to prepare all the medications we could. To
the volunteer I asked for warm blankets and a pillow. After a few moments of back and forth in my
mind from connecting with Jerry and recoiling at the sight of his suffering, I crouched down placing a
pillow under his head. Etched in my memory is the fear and relentless terror in his eyes. I take a
breath now, as I most certainly did then, to be able to stay with him. Staying with him until my
colleagues were ready to assist him back to bed. I held his body with mine, breathing deeply and
relaxing my body, even as I could feel the tension in his. Deeply meeting what he communicated in his
movements, moans, and most of all his eyes, I said, “I am here, we are here, we are not leaving.” And I
am on the floor with him, holding his head, not leaving his eyes, waiting for colleagues. And I can feel
and see him settle. We had not yet given him all we could in terms of medications. Yet, in sharing the
experience with him, his body softened, and his eyes lost the magnitude of terror.
Reflections
Consider the following:
• What are your stories of using touch in practice?
• Do you remember times when you found touch supportive in your clinical practice? Have there been times
in your practice when you have been hesitant or found it uncomfortable to use touch with/in your
practice? What did those moments look like?
• When you read the story below and/or hear others share their stories of intimate physical encounters in
practice – what happens? What do you experience in body, mind, emotion?
• What are tools and/or methods that you use, or could use to cultivate a capacity to touch (emotionally
and physically) the shared embodied experiences with patients at end of life and their families? Consider
how the breath was used in the story above to stay calm and grounded in the body; while being in contact
with one who is suffering.
References
1. Connor, A., & Howett, M. (2009). A conceptual model of intentional comfort touch. Journal of Holistic Nursing, 27, 127-135.
2. Fredriksson, L. (1999). Modes of relating in a caring conversation: A research synthesis on presence, touch and listening. Journal of Advanced Nursing, 30, 1167-1176.
3. Estabrooks, C., & Morse, J. (1992). Toward a theory of touch: The touching process and acquiring a touching style. Journal of Advanced Nursing, 17(4), 448-456.
4. Pedrazza, M., Minuzzo, S., Berlanda, S., & Trifiletti, E. (2014). Nurses’ comfort with touch and workplace well-being. Western Journal of Nursing Research, 37, 781-798.
5. Chinn, P. L., & Kramer, M. K. (2011). Integrated theory and knowledge development in nursing (8th ed.). St. Louis, MO: Mosby/Elsevier.
6. Benner, P. (2004). Relational ethics of comfort, touch, and solace: Endangered arts? American Journal of Critical Care, 13, 346-349.
7. Green, C. (2013). Philosophic reflections on the meaning of touch in nurse–patient interactions. Nursing Philosophy, 14(4), 242-253.
8. Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in nursing science, 1(1), 13-24. (could add more recent or use
9. Picco, E., Santoro, R., & Garrino, L. (2010). Dealing with the patient’s body in nursing: Nurses’ ambiguous experience in clinical practice. Nursing inquiry, 17(1), 39-46.
10. Van Dongen E., & Elema R. (2010). The art of touching: The culture of ‘body work’ in nursing. Anthropology and Medicine, 8, 149–162.T
11. Benner, P. (1991). The role of experience, narrative, and community in skilled ethical comportment. Advances in Nursing Science, 14(2), 1-21.
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