New devices and software are responsible for many advances in medicine but they cannot be allowed to make us forget the value of human contact.
Nurses have seen the value of touch and must keep it in mind as healthcare technology advances. This is one of the key messages Australian academics made in a recent editorial in the Journal of Clinical Nursing.
They wrote that the increasing use of a variety of technological supports for nursing work may be at the expense of offering a comforting touch to patients.
While the authors say they are proponents of the use of technology, they add that nurses must pay careful attention to how they best integrate technology into practice to avoid risking the interpersonal relationship at the heart of their work.
“In embedding technology in nursing practice, it is imperative that we consider how this [affects] nurse-patient relationships,” they wrote. “We must not lose touch.”
Here, ACI sits down with lead author Sue Dean, a lecturer at the University of Technology Sydney, to discuss the ways touch can affect the patient experience and how nurses can ensure they aren’t losing sight of its importance.
ACI: Where did the idea to explore this area, as in your editorial “Is Technology Responsible for Nurses Losing Touch?” come from?
SD: I’ve taught communication in nursing programs for more than 20 years now and I was sitting around one morning with two colleagues, one of them Dr Jo Lewis whose area of expertise is palliative care, and another colleague, Dr Caleb Ferguson, whose area of clinical practice and research is in cardiac and stroke. Caleb has also published quite a bit on social media and technology, and the use of technology in nursing in a positive sense. We were just talking about technology and about patient-centred care and caring and compassion and how all of us were concerned at the literature that’s around now about nurses not being as compassionate and caring as we would like. We started thinking about whether technology played a role in that; hence we got together and wrote the editorial.
In your experience, why is nurse-patient physical contact so important?
There is lots of evidence around that touch has an important, therapeutic effect on patients. Even as early as when Florence Nightingale started training nurses in the mid-1880s, she included massage as a part of nurses’ qualifications. My co-authors and I, we know [the importance of touch] from years and years of experience just because we can see in patients how important it is when you just sit and hold the hand of somebody. You don’t have to say any words, you don’t have to do anything, just holding a hand has a therapeutic effect. Giving someone a massage [can be comforting]. Often there are no words to say to make a patient feel better or comforted and touch is important. We’ve seen over decades of nursing practice just how important that is.
What are some of the ways nurses may be offering comfort or support through physical touch that they may not realise?
Going back to my experience, things like just holding a hand when a patient has a painful experience. If someone is having an injection or a dressing or something that’s quite painful, just holding their hand. [I mean having] another nurse just saying to the patient: ‘Just squeeze my hand as hard as you can if it’s hurting you.’ People are inventing virtual reality things to put on patients when they’re undergoing painful procedures, to distract them. There are many innovations now in technology that are taking away the need to touch the patient.[Examples like] holding a patient’s hand are now being displaced by technology, and I don’t think anything can [adequately] replace the value and therapeutic benefit of somebody just touching somebody – hand-to-hand contact.
In what other ways is technological disruption having a direct effect on that physical contact?
A common thing that’s happening in nursing now is when patients are having their pulse taken by a pulse oximeter. A device is put on the patient’s finger to monitor a pulse. In the old days, and I would hope that many nurses still do it, nurses hold the hand and touch the patient to monitor a pulse rate. That’s often not being done now. Nurses just put on a machine and take the pulse. Of course that monitors the rate, but it doesn’t monitor a whole lot of other things that are important about monitoring a pulse rate and, certainly, patients miss out on having a nurse just touch them and hold their hand while they’re doing their pulse.
There are many effects. For example, there’s evidence around about how nurses are desensitised to the use of alarms in areas such as the ICU, because there are so many false alarms. Often when the alarms go off, nurses don’t even respond.
There are many opportunities for nurses to touch a patient, and often students tell us they’ve got so many tasks to do they haven’t got time to sit down and talk with a patient and hold their hand.
In what ways can technology exist side by side with a warm personal or tactile approach to patient care? What are some of the things nurses should keep in mind, other than just taking opportunities where they come?
Technology is here to stay and that technology is absolutely wonderful. Great advances have been made with technology, but, particularly as nurse educators, we need to role model the sorts of behaviours we would expect our students and graduates to undertake when they’re out in the clinical area. We need to talk to them all the time about things like touch, about how important it is.
Years ago, there was much evidence in the literature about the therapeutic effects of touch. Not so much now. People aren’t talking about it as much as they could be, and we need to raise awareness in our students about how important all of these things are. They need to maximise every opportunity they can, when they’re undertaking procedures with patients, to remember that holding someone’s hand or touching someone is often therapeutic.
Of course, along with the obvious benefits of touch to patients in an emotional sense, there are studies now that show touch releases oxytocin, which is [often referred to as] the ‘feel-good’ hormone. Early studies show that therapeutic touch raises hemoglobin levels. So there are also those added benefits.Do you have an idea for a story?
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