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Chapter 8 The Patient-Safe Communication Strategy of Touch

Explore the significance of touch in patient care, including its physiological effects, the different types of touch, and guidelines for appropriate and caring touch.

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Chapter 8 The Patient-Safe Communication Strategy of Touch

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  1. Chapter 8The Patient-Safe Communication Strategy of Touch

  2. Patient-Safe Strategy of Touch • Touching takes practice • Nursing students are anxious about touching patients (bathing, assessing, doing procedures) • Nursing students need to learn to touch (or not to touch) patients who are emotionally distressed, in pain, anxious or agitated

  3. Touch….A basic human need • Failure to thrive in infants • Harlow’s experiments with monkeys • Cultural basis for how much touch is appropriate (in public) • Sidney Jourard (180 Puerto Rico; 110 Paris; 2 Gainesville, Florida; 0 London) • Italian, Jewish, Spanish, South American: More touching than German or British

  4. In North America • Taught to be very careful about touch • Fear being accused of sexual harassment or abuse • NEA Slogan: “Teach, Don’t Touch”

  5. Touch and Adults • The need for touch is still present but may be neglected or ignored • Hollender Survey of Adults: Reported a moderate desire to be held, with men as often as women Increased need for touch when depressed or anxious

  6. Physiological Response of the Body to Touch • Can be used to decrease the patient’s response to stress • Millions of receptors in skin send messages to the brain and stimulate the psychoneuroendocrine system—endorphins released, decreased production of cortisol (immune suppression), and norepinephrine (fight or flight)

  7. Caring Touch • A simple touch on the should or an arm around the waist can reduce heart rate and lower blood pressure • Massage has become very popular—hands with nails, feet and pedicures —stimulates flow of blood, removes lactic acid buildup and toxins, alleviates pain & congestion in muscles

  8. Caring Touch: Promotes Relaxation • Hold hand, stroke forehead, squeeze shoulder, stroke arm • Those who are dying, uncomfortable, or grieving • Elderly isolated in nursing homes can be “starved” for touch

  9. Caring Touch: Offers Encouragement • Place arm around shoulders • Hug or pat on back • Playful hitting or poking • Hold hand during procedures

  10. Task Touch • Physical assessment and procedures • Be gentle, soft, and caring with task touches • Hurried, rough, jarring touches convey a lack of respect —person treated like inanimate object

  11. Protective Touch • Restraining patients to prevent harm to themselves or others • Combine gentle with protective touch

  12. Inhibition of Touch • Lack of touch or use of task touch without caring touch (nurses distance themselves from pain and suffering) • Harsh or severe touches (release of frustration) • Patient characteristics: “unlikable,” contagious disease (AIDS), alcoholics, drug addicts “stigmatized”

  13. Getting Started With Touch • Shaking hands — meeting a patient • Entering personal space — intimate, personal, social, and public zones of personal space • Giving painful touches • Practice until you can perform procedure with expertise • Appropriate use of pain medication • Anticipatory guidance • Apologize during and after the procedure

  14. Hugging: Ask permission when entering the intimate zone of personal space • A-frame • Side to side • Bear hug

  15. Don’t Touch: Rules • History of abuse • Psychiatric patients • Sexually stimulating • Watch response of patient to touch, and become sensitive to patients who withdraw from touch

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