In a darkened hospital palliative care room, a husband sits in a chair beside his deceased wife in the wee, small hours of a winter's morning. A nurse enters the room and, with a few quiet words, gently wraps him in a warm blanket. In that moment, the man feels safe and cared for.
"Touch is fundamental to the human experience," says Joanne Durkin, from the University of New England's School of Health.
But even Ms Durkin was surprised just how often touch came up when she began collecting data in 2018 for her doctoral study on how compassion is expressed and received in hospitals. Although the term "touch hunger" or "skin hunger" had already been coined - to describe the craving for physical touch - it wasn't common parlance. COVID-19 had yet to burst on to the scene and health professionals were rarely required to don personal protective equipment (PPE).
Fast-forward two years, and poignant stories like that of the grieving husband are now informing a new discussion about the importance of touch to our lives.
No hugs, no handshakes
"To stem the tide of coronavirus infections we've seen stay-at-home-orders and social distancing introduced, a rise in telemedicine, and gloves made mandatory in every health setting," Ms Durkin says ."We now live in a world of no hugging or handshaking, and constant warnings to keep our distance. Many people, especially the elderly and those with chronic illnesses, have been deprived of human touch and we're beginning to realise what we're missing."
We have long understood that touch is an essential component of socio-emotional, physical, cognitive and neurological development, and an important form of non-verbal communication. Babies need touch to thrive and, without affectionate touch, adolescents can exhibit higher levels of aggression.
Ms Durkin's latest research is a direct spin-off from her compassion study. It demonstrates that, in healthcare, intentional, respectful touch is central to establishing an authentic connection, providing comfort, and conveying reassurance in times of distress. And all this communication between a patient and their carer can occur without a word being uttered.
It's difficult to comprehend personalised nursing care without touch. It's unavoidable when providing treatment and meeting a patient's basic needs (such as feeding, bathing and toileting), but Ms Durkin has concluded that a nurse's touch also builds rapport and trust, and conveys safety.
"Nurses are adept at integrating intentional and comforting touch into their practice, whether it be mopping a person's brow, wiping their tears or patting their shoulder to calm them," she says. "Sometimes it's just a fleeting moment, but our interviews suggest that touching moments between nurses and patients are highly valued and can significantly impact patients' lives for many years. They benefit the nurses, too.
There is simply no substitute for the kind touch of another human being.
Craving connection
So COVID-19 restrictions that have brought isolation and great loneliness to people all over the world may be causing another pandemic right under our noses - of "touch hunger".
"The coronavirus has highlighted how not being able to have an affectionate hug or have someone hold your hand can cause its own suffering," Ms Durkin says. "After months of isolation, people have begun to crave the human connection, the human touch. Telephone and Zoom calls are a pale imitation and people are at risk of developing touch hunger, which has been associated with increases in stress, anxiety and depression."
However, the solutions may be just as problematic. Navigating the murky waters of touch can be treacherous.
"Even in healthcare, where it is commonplace, there has been confusion and concern that touch may be misinterpreted or harmful," Ms Durkin says. "Health professionals can be concerned that their use of comforting or empathetic touch might invade a patient's personal space, be culturally inappropriate or inadvertently cause harm. The litigious climate of healthcare creates aversion to touch in the event that it violates patients' boundaries and damages the patient/health professional relationship.
"But patients in our study described nurses knowing when to touch and use touch appropriately, and how the touch conveyed compassion and alleviated their suffering and distress.
While we absolutely need to understand that some people have boundaries that must be respected, we seem to have forgotten the positive impact of touch in our lives.
So, what is the major lesson for health professionals?
"We understand how not touching and keeping a safe distance is necessary to keep us and others safe,” says Ms Durkin. "The use of PPE is critical and the cost of not having PPE is immense. Within this context of no touch, or gloved touch, many are recognising the importance of touch by its absence. We need to remain aware of the important role that touch plays in a patient's healing, and how it can help create a caring and compassionate relationship with patients. More widely, we need to remain aware of the role that touch, that incidental or deliberate comforting touch, plays in our day-to-day lives."
Acutely aware that her study of touch has wider societal implications, Ms Durkin is now looking to survey a wider cross-section of people about what touch means to them.
Read more at https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jocn.15488
