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Tactile touch in intensive care: Nurses' preparation, patients' experiences and the effects on stress parameters
University College of Borås. School of Health Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care.

Place, publisher, year, edition, pages
Borås: Högskolan i Borås och Karlstads Universitet , 2008. , 91 p.
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 11
Keyword [en]
complementary method, stress, oxytocin, lifeworld research
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-17138ISBN: 978-91-85659-15-9 (print)OAI: oai:DiVA.org:hj-17138DiVA: diva2:478082
Public defence
Högskolan i Borås, Borås (Swedish)
Opponent
Supervisors
Note
Borås: Högskolan i Borås, Institutionen för vårdvetenskap. Karlstad: Karlstads Universitet, Avdelningen för omvårdnad.Available from: 2012-06-05 Created: 2012-01-15 Last updated: 2012-06-05Bibliographically approved
List of papers
1. A transition from nurse to touch therapist: a study of preparation before giving tactile touch in an Intensive Crae Unit.
Open this publication in new window or tab >>A transition from nurse to touch therapist: a study of preparation before giving tactile touch in an Intensive Crae Unit.
2006 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 22, no 4, 239-245 p.Article in journal (Refereed) Published
Abstract [en]

Tactile touch is a complementary therapy that is rarely undertaken in intensive care units (ICUs) in Sweden. This study was a part of a larger project that examines whether tactile touch can relieve the suffering of patients in the ICU. The aim of this study was to describe nurses’ lived experience of preparation before giving tactile touch in an ICU. Four assistant nurses and one registered nurse, each with diplomas in tactile touch working at three different ICUs in Sweden, participated in the study. A phenomenological approach was chosen to achieve experience-based and person-centred descriptions. Data were collected through interviews and analysed following Giorgi's method. The main finding was that before providing tactile touch, the nurses needed to add the new role as touch therapists, to their professional one. The essential aspect being the transition from nurse to touch therapist. Findings included a general structure, with four constituents; a sense of inner balance, an unconditional respect for the patients’ integrity, a relationship with the patient characterised by reciprocal trust, and a supportive environment. Furthermore, the study underlines the difficulties to integrate a complementary caring act, such as tactile touch, in a highly technological environment.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-17137 (URN)10.1016/j.iccn.2006.01.002 (DOI)
Available from: 2012-01-15 Created: 2012-01-15 Last updated: 2012-06-05Bibliographically approved
2. The outcome of tactile touch on oxytocin in intensive care patients: a randomised controlled trial
Open this publication in new window or tab >>The outcome of tactile touch on oxytocin in intensive care patients: a randomised controlled trial
Show others...
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 19, 2624-2633 p.Article in journal (Refereed) Published
Abstract [en]

Aim.  To explore the effects of five-day tactile touch intervention on oxytocin in intensive care patients. The hypotheses were that tactile touch increases the levels of oxytocin after intervention and over a six-day period.

Background.  Research on both humans and animals shows a correlation between touch and increased levels of oxytocin which inspired us to measure the levels of oxytocin in arterial blood to obtain information about the physiological effect of tactile touch.

Design.  Randomised controlled trial.

Method.  Forty-four patients from two general intensive care units, were randomly assigned to either tactile touch (= 21) or standard treatment – an hour of rest (= 23). Arterial blood was drawn for measurement of oxytocin, before and after both treatments.

Results.  No significant mean changes in oxytocin levels were found from day 1 to day 6 in the intervention group (mean −3·0 pM, SD 16·8). In the control group, there was a significant (= 0·01) decrease in oxytocin levels from day 1 to day 6, mean 26·4 pM (SD 74·1). There were no significant differences in changes between day 1 and day 6 when comparing the intervention group and control group, mean 23·4 pM (95% CI −20·2–67·0).

Conclusion.  Our hypothesis that tactile touch increases the levels of oxytocin in patients at intensive care units was not confirmed. An interesting observation was the decrease levels of oxytocin over the six-day period in the control group, which was not observed in the intervention group.

Relevance to clinical practice.  Tactile touch seemed to reduce the activity of the sympathetic nervous system. Further and larger studies are needed in intensive care units to confirm/evaluate tactile touch as a complementary caring act for critically ill patients.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-17135 (URN)10.1111/j.1365-2702.2008.02324.x (DOI)
Available from: 2012-01-15 Created: 2012-01-15 Last updated: 2012-06-05Bibliographically approved
3. The outcome of tactile touch on stress parameters in intensive care: A randomized controlled trial
Open this publication in new window or tab >>The outcome of tactile touch on stress parameters in intensive care: A randomized controlled trial
Show others...
2008 (English)In: Complementary Therapies in Clinical Practice, ISSN 1744-3881, Vol. 14, no 4, 244-254 p.Article in journal (Refereed) Published
Abstract [en]

The study aimed to investigate the effects of a five-day tactile touch intervention in order to find new and unconventional measures to moderate the detrimental influence of patients’ stressors during intensive care. The hypothesis was that tactile touch would decrease stress indicators such as anxiety, glucose metabolism, blood pressure, heart rate and requirements of sedative drugs and noradrenalin. A randomized controlled trial was undertaken with 44 patients, which were assigned either to tactile touch or standard treatment (a rest hour). Observations of the stress indicators were made before, during and after the intervention or standard treatment. The study showed that tactile touch led to significantly lower levels of anxiety. The circulatory parameters suggested increased circulatory stability indicated by a reduction in noradrenalin requirement. The results need to be further validated through studies with larger sample sizes.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-17136 (URN)10.1016/j.ctcp.2008.03.003 (DOI)
Available from: 2012-01-15 Created: 2012-01-15 Last updated: 2012-06-05Bibliographically approved
4. Enjoying tactile touch and gaining hope when being cared for in intenisve care: A phenomenological hermeneutical study
Open this publication in new window or tab >>Enjoying tactile touch and gaining hope when being cared for in intenisve care: A phenomenological hermeneutical study
2009 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 6, 323-331 p.Article in journal (Refereed) Published
Abstract [en]

Touch has been a part of the healing process in many civilisations and cultures throughout the centuries. Nurses frequently use touch to provide comfort and reach their patients. The aim of this study was to illuminate the meaning of receiving tactile touch when being cared for in an intensive care unit. Tactile touch is a complementary method including the use of effleurage, which means soft stroking movements along the body. The context used to illuminate the meaning of receiving tactile touch was two general intensive care units (ICUs). Six patients, who have been cared for in the two ICUs, participated in the study. A phenomenological–hermeneutical method based on the philosophy of Ricoeur and developed for nursing research by Lindseth and Norberg [Lindseth A, Norberg A. A phenomenological hermeneutical method for researching lived experience. Scandinavian Journal of Caring Sciences, 2004;18:145–53] was chosen for the analysis. Data consisted of narratives, which were analysed in three recurring phases: naïve understanding, structural analyses and comprehensive understanding. Two main themes were found: being connected to oneself and being unable to gain and maintain pleasure. The comprehensive understanding of receiving tactile touch during intensive care seems to be an expression of enjoying tactile touch and gaining hope for the future. This study reveals that it is possible to experience moments of pleasure in the midst of being a severely ill patient at an ICU and, through this experience also gain hope.

Keyword
Intensive care, Tactile touch, Phenomenological hermeneutic, Narratives
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-17134 (URN)10.1016/j.iccn.2009.07.001 (DOI)
Available from: 2012-01-15 Created: 2012-01-15 Last updated: 2012-06-05Bibliographically approved

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