Article 12

                The Meaning of Touch to Patients Undergoing Chemotherapy 

September 10.1188/15.ONF.517-526 

Katherine E. Leonard, and Melanie A. Kalman 

 

Purpose/Objectives: To explore the experience of being touched in people diagnosed with cancer and undergoing IV chemotherapy.  

Research Approach: Qualitative, phenomenological.  

Setting: Central New York and northern Pennsylvania, both in the northeastern United States.  

Participants: 11 Caucasian, English-speaking adults.  

Methodologic Approach: Individual interviews used open-ended questions to explore the meaning of being touched to each participant. Meanings of significant statements, which pertained to the phenomenon under investigation, were formulated hermeneutically. Themes were derived from immersion in the data and extraction of similar and divergent concepts among all interviews, yielding a multidimensional understanding of the meaning of being touched in this sample of participants.  

Findings: Participants verbalized awareness of and sensitivity to the regard of others who were touching them, including healthcare providers, family, and friends. Patients do not classify a provider’s touch as either task or comfort oriented. Meanings evolved in the context of three primary themes: building rapport within the healthcare setting, adjusting to changing patterns of touch with family and friends, and intentionally incorporating the therapeutic use of touch.  

Conclusions: The experience of being touched encompasses the quality of presence of providers, family, or friends. For touch to be regarded as positive, patients must be regarded as inherently whole and equal. The quality of how touch is received is secondary to and flows from the relationship established between patient and provider.  

Interpretation: This study adds to the literature in its finding that the fundamental quality of the relationship between patient and provider establishes the perceived quality of touch. Previous studies have primarily divided touch into two categories: touch that is intended to provide comfort and touch that is incidental to providing care. This distinction was not substantiated by the perceptions of patients in the current study. Participants identified that being viewed as a whole and vital individual in the context of relationships with others, including providers, was fundamental to perceiving any form of touch to be positive, rather than invasive or uncomfortable.  

IMPLICATION OF PRACTICE: 

The ability to provide a conscious caring presence is essential for nurses in all settings. It requires a level of self-examination and maturity, particularly for younger nurses faced with the demands of the modern healthcare setting. If nurses do not approach each interaction with their patients in a manner that fully affirms each person’s essential integrity, they will fail to embody the quality that is precious and integral to nursing as a profession. Benner (2004) noted that touch “is invisible, rarely charted, and almost never suggested in a nursing care plan,” as well as that “comforting touch, solace, and presenting (i.e., being present and available to the patient) are left in the region of the art of nursing practice” (p. 346). Genuine engagement with, as well as attention and responsiveness to, the unique qualities of each person who also happens to be a patient is key to the provider being perceived as offering excellent care. The power of intersubjective relationship while carrying out task-oriented touch was related by a female participant in her late 50s with colorectal cancer when she recalled that in the midst of a difficult IV insertion, she felt caring come through the hands of the man who was doing the procedure. 

In their study of hope and healing in patients with lung cancer, Eustache, Jibb, and Grossman (2014) discussed mindfulness on the part of providers, noting that they must be “mindful of the whole person, not simply his or her fragmented parts, by helping to navigate the clinical context, assisting in the search for meaning and the rebuilding of hope, and being companions at each step of the healing journey” (p. 506). 

The forging of a relationship based on an essential equality between patient and provider permits deeper healing, particularly when touch is incorporated into the ongoing journey. In many cases, hospital nurses are not able to consistently care for a particular patient. However, based on themes taken from interviews with the study participants, even small interactions in which nurses or other providers engage patients as complete and equal human beings have deep meaning and are viewed positively by patients. 

Qualitative, phenomenologic research methods designed to use open-ended questions have the power to elicit profound expressions of personal experience regarding particular areas of interest. In the healthcare setting, increased use of qualitative research can help to better define variables to be used with increasingly more specific research designs. Research concerning the provision of massage therapy to people living with a diagnosis of cancer shows widely varying results (Ahles et al., 1999; Lawvere, 2002; Rexilius, Mundt, Erickson Megel, & Agrawal, 2002; Smith, Kemp, Hemphill, & Vojir, 2002; Sturgeon, Wetta-Hall, Hart, Good, & Dakhil, 2009; Toth et al., 2013). Based on findings from the current study, such incorporation of patient-perceived quality of relationship with the massage therapist may add depth and control to similar studies. 

 

Discussion Starting Points:  

Please choose two for your response: 

How does this research article compare to our practice, policy, and procedure? 

What are the advantages and disadvantages of the proposed recommendations in the article? 

What are the advantages and disadvantages of implementing the article's recommendations on your unit and/or hospital? 

Was the correct method used? Why or why not?