The elderly require a "special touch": touching expresses caring, and the quality of care improves.
Social Expectations - And Aging
Adjustment to aging is not just a function of the individual. It is also a function of the expectations, values and traditions of the society in which that person lives. If the society values old age, the elder will inevitably be labeled with more positive descriptions than are old people who live in a society that views them as burdensome and expendable.|1~
Unfortunately, in the context of our society, the past decade has emphasized technological advancement. While this has produced efficiency, it has also created a society often insensitive to the deeper needs of people. With respect to the elderly and ill, preoccupation with productivity, youth, and beauty has created numerous problems of alienation. Those with worn bodies and wrinkled skin are no longer "beautiful" in the eyes of the world. They are, in fact, often considered "untouchable." Frequently, even the elderly accept this form of stereotyping and therefore do not expect to have their touch needs met.
Caregivers have been raised with the same values and expectations as the rest of society, and sadly, this attitude permeates even the health care setting. Research has shown that among hospitalized patients, the psychotic and the elderly were touched the least.|2,3~ The literature inferred that much of the touching done to the elderly and the dying was "instrumental" (that is, required in the carrying out of tasks) rather than "expressive" (that is, to convey acceptance, nurturing and caring).|4~
This lack of caring touch administered to the elderly by health professionals is particularly distressing, for while human beings have need of touch and nurturing throughout the life-span, this need may actually increase with aging. The elderly often have no one else to fill this need, especially those whose children are far away or whose partner has died.
The Use of Expressive Touch
Nurses have traditionally been given societal permission to touch. Where expressive touch has been tried with the elderly, it seems to work. Caring touch helps elderly compensate for bereavement, dependency, and altered body image.|5~ It has been found to be therapeutic as a form of nonverbal communication and as a means of decreasing sensory deprivation, increasing reality orientation and alleviating pain.|6~ Nurturing touch is also effective in helping the elderly person feel less isolated and vulnerable during periods of intense personal stress.|7~
Nurses who do use expressive touch as an integral part of their caring techniques report that it is an excellent form of nonverbal communication. They feel that touch conveys trust, hope, and reassurance to their patients.
Practitioners also report that the patient is not the only one to benefit. Most caregivers describe personal feelings of reward when intentionally physically contacting another human being with the intent of instilling love and hope. In attempting to explain this process, Jean Watson|8~ stated that during truly caring acts, the consciousness of the nurse "blends" with the consciousness of the patient. Following such an interaction, the patient feels cared about, the relationship grows, and the lives of both are changed.
Therapeutic touch is a form of using expressive touch in a way that purposefully directs compassion and an intention to help toward the person needing care. It is a unique exchange between the person in the helping role and the person in need of help. Through this exchange both benefit.
Therapeutic touch is based on the assumption that human beings are, in a sense, energy fields, and that personal energy extends beyond the physical body. During times of illness and stress, the energy fields become unbalanced. The nurse's role is to smooth and rebalance the patient's energy.
Therapeutic touch, a modern version of laying on of hands, was first introduced into western nursing by Krieger.|9~ It has since been taught to, and practiced by, thousands of nurses who choose to make a difference in the lives of the patients they serve.
Research has demonstrated that therapeutic touch can be an effective pain reliever|10~ and has the ability to reduce anxiety in younger people|11,12~ as well as in the elderly.|13~ It has also been shown to increase hemoglobin.|14~
Clinicians are reporting excellent results in using the therapeutic touch with the elderly to promote sleep, to enhance feelings of well being with the depressed elderly, to decrease blood pressure, to decrease edema, and to facilitate healing.
I have used therapeutic touch in clinical practice with the elderly for several years, and have taught students the procedure. We never cease to be amazed at the benefits of this technique. The following case studies will illustrate this point and hopefully encourage the readership to investigate the possibilities of using therapeutic touch in their practices.
Case Study 1:
Mrs. C., an osteoarthritic cripple, experienced pain upon every movement. One morning she cried loudly as her husband attempted to assist her to the bed. I informed them that I had learned to use my hands in a special way, and that I believed I could help. They consented. The treatment brought an almost instantaneous calming sleep to the patient. Her amazed husband was pleased, for it usually took a long painful time for his wife to settle. I explained the concepts of therapeutic touch and taught Mr. C. to use this knowledge to alleviate his wife's pain. That was a milestone day. From then on, Mrs. C received therapeutic touch from her husband several times a day. The couple believe that it has made a significant difference in their quality of life.
Case Study 2:
Mr. S. was confused and restless most days and would wander frequently at night. Late one evening, after returning him to bed, I administered therapeutic touch in the form of a back rub. I will not forget how that anxious appearance turned to one of peace. He slept the remainder of the night, and much to everyone's surprise was calm for most of the following day.
Needing to test my assumptions, I administered therapeutic touch only every second evening for the four remaining evenings in the week. On nights when therapeutic touch was used, Mr. S. slept well and the day staff would report "calm days." On nights when routine treatment was given, he would wander, and would be restless throughout the following day.
I have taught numerous caregivers the technique of therapeutic touch. Those who use it in their practices with older patients feel strongly that it has much potential.
Clinically, it seems to be even more effective with the aged than with other populations. I have seen excellent results when therapeutic touch has been used to relieve swelling in edematous legs and arthritic joints. I have been amazed at the results of the use of therapeutic touch to promote healing of decubitus ulcers, fractured hips and lacerations. However, its greatest potential seems to be the almost instantaneous calm that overcomes the recipient. In long-term care, this has far-reaching implications.
I extend to my colleagues the challenge. It takes only compassion and a pair of hands. There is need to improve the quality of life for many aged. We know that one of these needs is the need for caring touch. Therapeutic touch fills that need, plus it offers much more. Reach out in a compassionate way with the intent to help. You, and those you care for, will benefit greatly.
Jane A. Simington, BSN, MN, is Assistant Professor of Nursing, The University of Alberta, Edmonton, Alberta, Canada. Information requests: 17892 93rd Street, Edmonton, Alberta, Canada T5Z 2H8.
1. Kermis MD. The Psychology of Human Aging: Theory, Research and Practice. Boston, Allyn & Bacon, 1984.
2. Barnette K. The effects of touch as they relate to nursing. Nursing Research 1972; 21:102-110.
3. Ashworth P. Communication in an intensive care unit, in Faulkner A (ed): Communication. Edinburg, Churchill-Livingstone, 1984.
4. Watson W. The meaning of touch: Geriatric nursing. Journal of Communication 1975; 25:104-112.
5. Burnside I. Nursing and the Aged. New York, McGraw-Hill, 1976.
6. Collins M. Communications In Health Care. Toronto, C.V. Mosby, 1983.
7. Ernst P, Shaw J. Touching is not taboo. Geriatric Nursing 1980; 1:193-195.
8. Watson J. New dimensions of human caring theory. Nursing Science Quarterly 1988; 1:175-181.
9. Krieger D. Therapeutic touch: The imprimatur of nursing. American Journal of Nursing 1975; 75:784-787.
10. Keller E, Bzdek VM. Effects of therapeutic touch on headache pain. Nursing Research 1986; 35:101-106.
11. Heidt P. Effects of therapeutic touch on anxiety levels of hospitalized patients. Nursing Research 1981; 30:32-37.
12. Quinn J. Therapeutic touch as energy exchange: Testing the theory. Advances in Nursing Science 1984; 1:42-49.
13. Simington J. The effects of therapeutic touch on the anxiety level of institutionalized elderly. Unpublished masters thesis. University of Saskatchewan, Saskatoon, Canada, 1990.
14. Krieger D. The Therapeutic Touch: How to Use Your Hands to Help and Heal. Englewood Cliffs, NJ, Prentice-Hall.
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|Author:||Simington, Jane A.|
|Date:||Apr 1, 1993|
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