A Nurses' Most Powerful Tool: Touch

Not all things in life can be defined, packaged, or simplified. We, not just as nurses, but as people, must be ever ready to accommodate and rethink our environment, our circumstances, and our choices. Even the most complicated situations can have the simplest of solutions. In a world which demands we move ever faster, practically forcing us to cut corners, it is important we remember to utilize our options and tools. This is an exploration/discussion of one of nurses' most simple, potent, and powerful tools: touch. Nurses Announcements Archive Article

A Nurses' Most Powerful Tool: Touch

For the record, I don't buy into a theory of a caring. No theory tells me to seek shelter from the rain or find food when I'm hungry and thus no theory tells me when to hold a hand or wipe the sweat from a brow. I don't pretend to disavow the work of higher educated, published nurses, but, as with so many things in life, I choose to rely on common sense, a gut feeling, and a self-serving skewed moral compass. That being said, I also choose to leave behind the idea of "therapeutic communication" in favor of honesty and genuine human interaction.

Personally, I blame it on Piglet, the hamster I owned when I was five. He bit my thumb when I tried to feed him a carrot. I have never been the same.

There is a crick in my neck and my throat is sore. Sore throat = snoring. Snoring = sleeping. But I'm not asleep...er....wasn't asleep. I was resting my eyes. I know for a fact that my right hand was still attached to my body the last time I saw it, and yet I cannot feel it. Or wiggle it. There is a burning thrum where something cool and metal has pushed against my thigh and I'm convinced my eyeballs are melting out of my head. Or at least trying to do so. Dare I open my eyes? What if they wander off? That would be a bit not good. I need them to see which would be helpful considering I can't quite recall where I am, though it would seem I am at least sitting down. That is good. Sleeping (resting!) while standing is dangerous, or so I'm told.

Ah, but there it is--the nudge to my shoulder. Right. Fine. Eyes open it is then.

The first reaction is to swipe at whoever (whomever? Ugh! Why in the hell are these lights so bright?!) tried to rouse me. How dare one disturb Her Royal Highness' mighty slumber! But the lingering notes of bovie smoke, prep solutions, and sterilants coupled with the monotone, rhythmic blip of what could only be an EKG stays my hand and brings my brain back online with the environmental equivalent of Ctrl+Alt+Delete.

PACU.

Drawn by a muffled snort of laughter, my eyes dart first to the grinning PACU nurse before following the stem of my numb arm to where it terminates in a gentle clasped grip with James. I try again to wiggle my fingers and watch as my pinky finger goes rogue to flip against his palm, effectively waking him long enough to give me a weak smile and a deep sigh before drifting to sleep once more.

"How long?" It's a raspy, half-octave too low grumble--making me sound less the nurse and more a 900 "service" operator. The rest of the question need not be spoken. Of course Amy would know. She was, after all, the one who woke me.

"Three minutes. Long enough to snore once. Don't think he noticed though." I sigh, rubbing my neck with my free hand, irritated with the persistent ache that brings me ever closer to cursing a blue streak. My muttering goes ignored as she turns away and begins tapping at the computer with an aggression that turns Hunt and Peck into Seek and Destroy.

My mouth is dry and my face has decided that my right hand has the right idea. How is it even possible to have a numb face? I shift a little in discomfort and go to speak only to be interrupted with, what seems to my addled mind to be, a magically appearing cup of coffee offered by the second recovery nurse who has stealthy appeared at my elbow.

I swear that all PACU nurses are psychic. Marvelous creatures, PACU nurses.

My caffeine toting savior, Mina, nods to my grunt of thanks and gestures lightly to James.

"So....what's his story?"

His story started with a bang. Literally.

The echo of the OR doors being slammed open drew me from my post even before the first muffled yell. Running footsteps, chaos, scrambling--never sounds one wants to encounter in what is supposed to be a structured environment conducive to concentration.

Within the OR itself, the pandemonium was stifling as the anesthesiologist, fresh to the scene nursing help and room staff struggled to keep a hysterical patient from floundering off of the surgical table. Beneath the cacophony of sound, of nearly shouted commands to "sir, just calm down", or "stay still, James", of exasperated declarations of a now infiltrated IV, of useless niceties, fluttered the gasping, terrified pleas of the patient.

Fear is no stranger to the world of the OR; it lurks behind our locked double doors and is a constant companion to those we treat. Fear is a powerful motivator and panic can turn the meek mighty and the mighty meek. In this case, the whippet thin young man actually broke the buckle on the table safety strap in his struggles and was becoming dangerously close to successfully flipping off the table. His hand flailed out for a moment and without any more forethought other than stopping an impending disaster (and a boat load of paper work), I caught and held his hand.

And like that, the fight left him.

With a nearly desperate sob, he slumped from his half-seated position, nearly pitching forward as he pulled me through the gathered clot of breathless staff until I stumbled flush to the table. I went to steady him, worried he would fall, wanting to check for injury, but froze at the softly cried, "No one ever touches me."

The room was hushed now, filled with a nearly deafening silence so rare in a place of chirping monitors, singing radios, and whirring surgical instruments. I stood, clasped still, bewildered and staring stupidly at the crying young man before darting my eyes up and to the others who stood back from the table but still huddled in the room. Eyes stared back at me from behind masks with face shields so rarely worn by those not scrubbing, regardless of OSHA mandates, and double gloved hands fluttered to pockets or behind backs. Those same eyes went with mine to where he gripped my naked hand with near crushing tenacity as if hanging on to a life line. In my ear, pitched to a barely there whisper meant to be lost under the sound of his crying and panting, drifted the words, "He's HIV positive."

Well, in my mind, there is only one response to that:

My arm which had hung suspended, halted by his words, dropped of its own volition and gathered him to me in a hug.

In some back corner of my mind, appalled voices mingled and whispered that it violated a hundred rules or reminders issued to me during my days in nursing school--something about not getting too close, getting too personal, caring too much, violating professional practice. But rules are made to protect what is right, not cage it and make it unattainable.

James curled close, tucking his head beneath my chin, trembling and wiping at his tear smattered face with his free hand. He stayed there, relieved, huddled, oblivious to the mute conversation taking place over his head between myself and the anesthesiologist.

Eyes to the IV: He's infiltrated, you realize I'm sure.

A light eye roll: Duh. Eyebrow quirk: So start another one.

Darting glance to the staff still at parade rest against the OR wall: And risk another wrestling match? Brow furrow: This is not going to be easy.

Gaze flicked to the patient information, back to the anesthesiologist: He's a kid--scarcely an adult. And it's an emergent procedure.

A fluttering hand gesture to the table: We really should lay him back down.

An experimental shift of weight causes the grip to be tightened and the breath to hitch in his throat. Single shoulder shrug: Nothin' doin'. He's quiet and I'm fine.

A prolonged, unblinking stare: You sure?

Subtle nod and a light sigh: Absolutely. Been through worse. Thank you for the concern.

Eyes to the IV and back again with flick of an eyebrow: Now, you going to get on with it, or would you like me to do that as well? You know....with my other free hand? Message received. The anesthesiologist set to his task of preparing to re-catheterize.

"I'm scared." It was a whimper, a breath, a plea.

"I know."

"I wish David were here," he sniffled, wiping again at his eyes in a way reminiscent of tired children fighting a nap.

"David? Who's David?" The tension was beginning to lose its hold, replaced instead with the inevitable adrenaline crash. Even so, I felt him stifle a flinch as he blurted, "my boyfriend."

"Is David waiting for you in the waiting room?"

"No. No one is. I'm alone."

"You're not. I'm here. We're all here." As if on queue, he followed my words with his eyes to the staff members still standing sentinel. A few waved, a few nodded.

"My hand hurts." I gave a snort of wry laughter before I could stop myself.

"Well you pulled out your IV. Generally speaking that doesn't feel so hot. We need to start another one so we can start your surgery."

"Ok." A beat. "I don't feel good."

"I would imagine you don't. Think you might throw up?"

Answer: yes. On my shoes, as a matter of fact. Considering there were still bits of blood clot stuck to shoe laces and spackling the treads from my foray in a dissecting ascending aortic aneurysm earlier in the night, I dare say the vomit was nothing more than the proverbial icing on the cake.

A bath blanket magically appeared over the contrast speckled puddle. Apparently protecting my footwear was out of the question, but covering up the evidence was very much in vogue.

He wept helplessly again, hiccupping stifled words in dismay and embarrassment, wincing from the pain in his abdomen. A bit of a pointed stare pulled one nurse from her post. She went and gathered warm blankets and cocooned them over his trembling body and around my shoulders, essentially wrapping us together.

A pair of gloved hands patted his face dry with a folded towel while another gently pried his arm away from his body, fastening a tourniquet in the beginnings of the ritual hunt for blood. His eyes went wide and his brow furrowed further in worry at the site of the 20g being angled towards his arm.

"I don't like needles."

"I understand but we can't move forward without an IV. Hold really still. Tell me about David. How did you two meet?' And there it was again--the heart rending spark--the flicker of grateful humanity and ghosting behind it, a fond smile and the uncoiling of nervous energy.

This is normally the part of the story I announce with glee that the IV only took one attempt and I would then go on to brag on the sheer magnificence that is my anesthesiologist. Alas, that sentence is only half true. I will still brag on the sheer brilliance of my anesthesiologist but I will say that it took three tries and through them all James flinched but didn't shy away, lost in the smoke screen of story telling and fond recollection.

Even as the IV was secured in place and the OR Morse Code resumed, he stayed there tucked tight to me, swaddled in warmed bath blankets, legs dangling lightly, haphazardly over the edge of the table, content until the glassy film of Versed and Fentanyl slipped over his eyes.

Well practiced hands fidget uncharacteristically with the circuit tubing: Want to get him settled?

"I don't know your name."

Eye contact, light headshake, one hand reaching up, gently tipping James head back to expose his face from where he hid, brushing the worry and film of sweat from his brow: No. He needs a last moment of security. The mask, if you please, provided you are comfortable beginning induction with him sitting up? An approving chuckle and the face mask pressed into my outstretched, expectant hand were the answer.

"Madeline."

"Real sleepy now, James," the anesthesiologist said gently, verbally releasing the waiting staff to move close once more in preparation to help properly position for intubation. As the Propofol threaded its way through the IV, the patient suddenly pulled away from where he rested propped against me with the mask lightly over his face.

"David is coming."

"We'll look for him."

"Will you be here when I wake up?"

"Of course."

"Sorry about your shooooo," he slurred off to sleep with a puffing snore earning a relieved laugh from the OR staff who quickly and carefully cradled him back to the table. I eased away, watching with a pleased smile as the intubation went beautifully, the drugs soothing the lines of fear and doubt from his forehead, my fellow staff members taking up their posts as advocates, guardians, healers.

I chew the inside of my cheek as I ponder for a second. "His story?" I shrug. "Not much. Emergency appy."

"We know you like us, but you never stick around. What's all....this." A sweeping hand gesture over my numb and his steel tight hands.

"What....this? He caught my hand when I was helping Amy settle him because someone," my hinting tease is met with an indignant and dismissive eye roll, "got stuck in traffic. Not my fault." I'm given a knowing and skeptical look from behind wire-rim glasses. Oh yeah, there's the hands perched on the hips in a perfect "Do I Detect Rhino Feces?" posture.

"And the snoring?" If there was a punctuation mark for a raised eyebrow, it would have just been used in spades.

I find myself unable to stop the tired smile from forming as I sip my coffee.

"It's been a long twenty four hours."

* * *

Author's note: The average thickness of a nitrile exam glove is 4mils. Double gloving = 8mils. Mils = the gauge of thickness in plastic manufacturing.

It was brought to my attention via a work recognition program that the above incident was considered going above and beyond the call of duty.

I couldn't disagree more. Affording a person some dignity, humanity and a safe haven is not an accomplishment. It is fulfilling basic human need and right.

Also I am, in no way, advocating sloppy technique or failure to utilize PPE. As an individual who literally has their hands in blood on a day to day basis, I am very aware of blood born pathogens and the ways in which they are spread. Please use your gloves, masks, etc. Protect yourself. Nuff said.

For more information on HIV, I encourage you to visit www.aids.gov.

As always, this is written at a point where exhaustion and stupidity run rampant in my world. All grammar mishaps, spelling errors and generalized confusion belong to me. They're mine, I tell you, mine! ::ahem:: Thank you for your time and attention.

MANDATORY DISCLOSURE: This is a piece....article....thingy...whatever, which involves real people, myself being one of them. As it takes place in the real world, it involves....well...the real world which may not always agree to personal sensibilities involving gender, race, religion, or lifestyle. I welcome all who choose to read and will happily discuss the issues and reflections of humanity, nursing, and genuine caring. My goal? To bring to life a snapshot of all those little unpredictable factors that come with providing healthcare to living, breathing, non-practice lab based human beings. Anyone who cannot suspend their own biases and discuss such matters in a non-oppressive, open-minded manner need not proceed. To the point, my world has enough drama in it, thank you, kindly keep yours to yourself. Also, this is one of my more longer ramblings. I regret nothing.

Sincerely,

Your Friendly Neighborhood Sociopath

All names, of course, have been altered. HIPAA is a cruel mistress and yet I find myself helpless to her will.

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CheesePotato

About CheesePotato, BSN, RN

CheesePotato: Noun. Constantly teaching. Forever learning. Overtired, dark humored, over caffeinated, occasionally sulking, chronically petulant. Delightfully unbalanced adrenaline junkie with a penchant for good wine. Always got your back.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Thank you for writing another beautiful masterpiece of a story, CheesePotato.

Also, thank you for reminding us about the importance of human touch. Too many people seem to forget about the artistic aspect of nursing care these days.

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Ditto @TheCommuter! Human touch is so important. Patients are hooked up to so many machines these days. It can seem so impersonal. But human touch balances that impersonal feel, and makes the patient feel as comfortable as possible. Great read.

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Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.

Thank you for a well done story. AND, as "the commuter" says, thank you for reminding us about the importance of human touch. Last week I had to shut my computer down and walk away because of an article about backrubs and foot care. I have never been so disappointed in my career choice as I was when I read the responses to the post. I have been medically retired for several years now and it was with great sadness that I left Nursing because it gave me a reason to get out of bed in the morning and I dearly loved what I did. Had a combination of illnesses and injuries not forced me out, I would still be working today, but from the responses I read the other day, I take it I would be doing so in a much different environment. I know things have changed greatly as a result of staffing cuts and financial shortages. Hospitals are working with different nurse patient ratios and shorter patient stays etc. Accordingly the staff doesn't do many of the things that were common place way back when. I read one of the post and in it they remembered doing "something called HS care or pm care or something, back in the 80's," There was a time when each and every patient received a back rub with lotion each night and it was considered part of what was called HS CARE. Most patients considered it the best part of being in the Hospital. They did of course, have the option of declining and some did but depending on their age, most were pleased with the added comfort measures. As some pointed out, some patients in various units were skipped over for obvious reasons, ie the psych patients and autistics etc. Also, there were times when simply sitting with some of the patients and holding their hands, as you said in your story, can make a world of difference. It saddens me to think that in today's world of Nursing, we no longer have time to do these things, simple things that were in yesterday's world, simply called Patient Care.

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Specializes in Sleep medicine,Floor nursing, OR, Trauma.

Thank you for the kind remarks. Indeed, it would seem that the artistic approach has been set aside in favor of higher census and faster patient/room turn overs.

What tends to be forgotten is that this lack of contact is, in fact, noticed and felt by the patients.

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Specializes in ICU, telemetry, LTAC.

Believe me, it is the sickest patients who most need to be touched. My RA patient this week was having some profound problems, and she helped remind me just how much a little hand holding can help. I had managed to be too busy to read her history and so missed the RA and was focusing on a bunch of other things, when I started her talking about her history. When she mentioned RA, it all sort of clicked. I stopped my fiddling with "stuff" in the room, took off my gloves, and looked at her hands. I held them and we talked about how much they hurt, even though they look pretty good now, and how much the pain just rules her days. I asked if she wanted some heat for them and she wound up with a bath basin hand soak which almost put her to sleep. She told her mom to go home for once because she would be just fine, and she wasn't known for doing that.

It makes me ill when my fellows spend less time with HIV patients just because of their status. When instructed to be very careful wiht them I think, well of course, we don't touch the icky stuff, we have good hand hygiene and standard precautions and for pete's sake the way it is best spread is not something I will have to worry about with my patients! I know a colleague with a very freakish, accidental exposure from a patient and I was so proud of her that she never treated the patient any differently, before or after.

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I'm not an ER/OR nurse...nothing as exciting, educated or interesting. In fact, I work mostly in Geriatrics. One of the most important/imperative places to me, that the gift of human touch is needed and needed so much more of...I'm often late for lunch or skip breaks (and yes I know I must take care of myself, and I do) to fetch extra tissues, look for that "misplaced" change purse or triple check w/ Mrs So & So to "be extra sure" she really doesn't need a pain pill after all.

Much of my best life experiences and knowledge has now/is now coming from taking that extra time to sit & chat, even for a few minutes, with my residents. I hear about life, work, love & even sex...I almost forgot that my "elderly" residents did indeed enjoy long marriages, family & ALL the aspects that make my own life sweet...

Most importantly, it is those few extra minutes each shift, making me late for lunch...that seem to make the biggest & most sincere differences in my elderly residents lives..they have kids/grandkids who are "victims" of this "yesterday, hurry-up, can't find the time to visit" world..Happily, some of these family members have bought/taught gramma to use a computer and communicate with them electronically, which is better than most..

The bottom line for me is..I agree, human touch is a priceless, appreciated, requirement in our profession...and the patients DO realize it and DO comment on it and it never hurts when your reputation is of kindness & compassion.

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Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.
I'm not an ER/OR nurse...nothing as exciting, educated or interesting. In fact, I work mostly in Geriatrics. One of the most important/imperative places to me, that the gift of human touch is needed and needed so much more of...I'm often late for lunch or skip breaks (and yes I know I must take care of myself, and I do) to fetch extra tissues, look for that "misplaced" change purse or triple check w/ Mrs So & So to "be extra sure" she really doesn't need a pain pill after all.

Much of my best life experiences and knowledge has now/is now coming from taking that extra time to sit & chat, even for a few minutes, with my residents. I hear about life, work, love & even sex...I almost forgot that my "elderly" residents did indeed enjoy long marriages, family & ALL the aspects that make my own life sweet...

Most importantly, it is those few extra minutes each shift, making me late for lunch...that seem to make the biggest & most sincere differences in my elderly residents lives..they have kids/grandkids who are "victims" of this "yesterday, hurry-up, can't find the time to visit" world..Happily, some of these family members have bought/taught gramma to use a computer and communicate with them electronically, which is better than most..

The bottom line for me is..I agree, human touch is a priceless, appreciated, requirement in our profession...and the patients DO realize it and DO comment on it and it never hurts when your reputation is of kindness & compassion.

I hate to disagree with you PROUD2BANLPN, especially with such an eloquently written post, but you do work in one of the more important and interesting areas of medicine, and you are right, human touch in geriatrics is extremely important, whether it's sitting quietly and holding someone's hand for a few minutes, massaging the beginings of a pressure area on frail skin, or giving a back rub and skin care after a warm bath, there are many ways to administer and share human touch in geriatric medicine, but more importantly don't diminish what you do by any means by comparing it to an ER or OR Nurse. I know for a fact that Geri nurses work their a$$e$ off, just the same as ER or OR Nurses or any other Nurse does. It may not be as glamorous, but you go home just as beat and just as satisfied or just as heartbroken and every other emotion that nurses feel. We are Nurses and we work with patients where ever they may be with what ever kind of problem they may have, because that's what we do, and we're good at it.

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Specializes in Sleep medicine,Floor nursing, OR, Trauma.

I couldn't agree more with the above post. What I do is not glamorous. It is seldom discussed--more like a dirty little secret.

What geriatric/LTC/floor nurses do is incredible. I dwell in the shelter of the double doors for a reason--face to face contact with a patient for prolonged periods makes my skin itch.

Besides, I have lost count of the number of warm stories told to me by patients telling me of the nurses taking such great care of them--nurses that eased their fear, battled their pain, and made them feel that, for just one moment, it was going to be okay.

I salute you. I applaud you.

One day, when I grow up, I want to be just like you.

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Brought tears to my eyes to read. I teared up for obvious reasons of feeling for the patient, the situation, the need and the beauty in knowing that despite our twisted sense of humor that can be frequently misunderstood by non-nurses, despite our coolness under stress and what my kids and friends have called lack of sympathy (what...they weren't dying from whatever incident they thought I lacked sympathy)...I teared up because it fills my heart to know WE are NURSES and we know what is needed and how to deliver it to those in need. Bless you for sharing the inspiration. Those are the kind of days that make all the blood and vomit on our shoes worth it!!

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