This is a touchy issue. Beyond touchy-feely, it touches on matters from the everyday (the sort of distance from others we feel comfortable with), to the traumatic (eg people’s experience of abuse). It is also one where there are huge differences between cultures and communities including age and social groups.
All this is further complicated on wards by:
- Caring physically and therefore intimately touching patients
- Patients’ states of mind
- The use of physical interventions to control very disturbed patients
- The power imbalance between patients and staff
- Staff fears about touch being misinterpreted by patients or others, sometimes with even an anxiety about legal action
- The high percentage of mental health patients, especially women, who have a history of physical and/or sexual abuse
- Mixed sex staff and patient groups
On the one hand, in most cultures safe touch is a very acceptable, welcome part of social contact between people of the same gender and, to a lesser extent, between men and women. And for most UK communities, a gentle hand on hand or arm around the shoulder is more consoling than gentle words can be. This can be especially so for children, women and patients with dementia.
NMC guidelines are very clear that any touch which is sexually motivated is not allowed and is a disciplinary issue. It’s important to know what the NMC say: ‘Physical contact is an integral part of healing. Supportive physical gestures as part of a therapeutic caring relationship can be essential in helping a client or in providing reassurance. In advocating a policy of zero tolerance of abuse, the NMC continues to support appropriate physical contact as a therapeutic part of nursing and midwifery practice’ (Practitioner-client relationships and the prevention of abuse, 2002, by NMC)
Wanting to make a physical connection with a patient is usually motivated by warm, human, caring feelings. But people vary greatly in how they interpret, feel about and respond to others touching them, especially in a hospital situation where they’re probably feeling vulnerable, anxious, frustrated, uncertain and other unsettling emotions.
Q. 1 How do you feel about physical contact with patients during conversations?
- Are you a person who tends to include physical touch when talking with others?
- Can you think of a time when you had a strong response to someone in a position of trust touching you during a conversation? What did you feel?
- Can you think of a time when you were surprised by how someone responded to you touching them during a conversation? Describe why they might have responded in this way.
- What sorts of factors can help you know how an individual patient might respond to being touched during a conversation?
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