Experience of Touch in Health Care: A Meta-Ethnography Across the Health Care Professions

Abstract

Touch mediates health professionals' interactions with patients. Different professionals have reported their practices but what is currently lacking is a well-theorized, interprofessional synthesis. We systematically searched eight databases, identified 41 studies in seven professions-nursing (27), medicine (4), physiotherapy (5), osteopathy (1), counseling (2), psychotherapy (1), dentistry (1)-and completed a meta-ethnographic line-of-argument synthesis. This found that touch is caring, exercises power, and demands safe space. Different professions express care through the medium of touch in different ways. They all, however, expect to initiate touch rather than for patients to do so. Various practices negotiate boundaries that define safe spaces between health care professions and patients. A metaphor-the waltzintegrates the practice of touch. Health care professionals connect physically with patients in ways that form strong relationships between them while "dance steps" help manage the risk that is inherent in such an intimate form of connection.

Touch in health professional practice: a review

“…Kelly et al. used meta‐ethnography to systematically review research publications on touch and identified three themes: (i) touch communicates care and is a form of interaction beyond words; (ii) touch crosses boundaries and therefore needs safe spaces that are negotiated; and (iii) touching exercises power, being linked to status – although health professionals like to initiate touch, they are less comfortable when touch is reciprocated . Pedrazza et al.…”

“…The quantity and depth of literature on touch are most pronounced for nursing, although there is also some research in medicine, occupational therapy, and physical therapy. 5 For the nursing profession, physical touch has been categorised as having the following functions: task focused; to orientate; to express emotion; instrumental; protection; to show interest in another; alleviation of pain and/or fear; and to massage. 6 More holistically, touch has been conceptualised phenomenologically and explored through the lived experiences of those who touch and are touched.…”

“…6 More holistically, touch has been conceptualised phenomenologically and explored through the lived experiences of those who touch and are touched. 5 Benner writes of the 'disclosive space' created by the relationship between patient and professional: a space where solace, trust and reassurance are enacted, and in which touch is comforting and safe. 7 Kelly et al used metaethnography to systematically review research publications on touch and identified three themes: (i) touch communicates care and is a form of interaction beyond words; (ii) touch crosses boundaries and therefore needs safe spaces that are negotiated; and (iii) touching exercises power, being linked to status -although health professionals like to initiate touch, they are less comfortable when touch is reciprocated.…”

“…7 Kelly et al used metaethnography to systematically review research publications on touch and identified three themes: (i) touch communicates care and is a form of interaction beyond words; (ii) touch crosses boundaries and therefore needs safe spaces that are negotiated; and (iii) touching exercises power, being linked to status -although health professionals like to initiate touch, they are less comfortable when touch is reciprocated. 5 Pedrazza et al noted that nurses who felt secure, confident and comfortable in establishing patient relationships were better able to engage with comfort (expressive) touch, whereas novice nurses and male nurses expressed anxiety and insecurity in their care. These nurses were noted to prefer procedural touch as a mechanism for being 'effective and efficient' .…”

Therapeutic Touch in Exercise Videos: A Randomized Experiment of the Impact on the Evaluation of Therapists' Competence and Viewers' Self-Reliance

“…In many body-oriented therapies, like physiotherapy, different types of physical touch are an essential part of the treatment practice and the instruction of specific therapeutic movement exercises (Roger et al, 2002). Although the particular way of touching patients is assigned great importance in physiotherapy education and training (Roger et al, 2002;Nicholls and Holmes, 2012;Bjorbaekmo and Mengshoel, 2016;Kelly et al, 2018), this aspect is not examined in research on instructional exercise videos. Little is known about how the use of therapeutic touch in exercise videos affects viewers' perceptions of the instructor and their own contribution to treatment success.…”