Touching People

I wrote this for students in a nursing class -- you might find it interesting because it gives you a look on the other side.

Nurses touch patients. There is a right way to do this and it can be learned.

I begin with my experiences as a patient, in hospitals, clinics, and doctors' offices, going back to childhood. When the nurse or doctor touched me, putting their hands somewhere on my body, it always felt good.

It's kind of difficult to describe how it felt -- sort of warm and cool at the same time, and both comforting and firm.

If a doctor or nurse touched me and it didn't feel good, I would get out of there really fast, but this has never happened.

The nursing student might recall experiences of being touched by health care people. Did it always feel good? Try to remember how it felt.

New nursing students are not used to touching people in the way that doctors and nurses do, especially the men. It's a little scary and it feels awkward and embarrassing, but think of it simply as a skill, something you can learn, something that you will get better at with practice and experience.

Consider the body. In our culture, for the most part, the safe areas are the arms, shoulders, neck, head, and the feet below the knees.

I like to make a "get acquainted" touch when I first meet a patient at the hospital, usually by putting my hand on their arm for a second. This gives the patient a chance to get used to me. It gives them a chance to object -- with words, rarely, but more often with a kind of flinching that can be quite subtle. It's hardly ever happened to me, but if that does happen, I back off a few feet, and give the patient some space, and begin to talk instead.

If I have the time, but often enough I'm dealing with a necessity and must act fairly quickly. I still go through an approach procedure, even if it's very compressed in time. "Hello, I'm Fred, I'm the Nursing Assistant and I'm going to help you move into a more comfortable position so that you can eat your dinner." Then I come closer, but a hand on their shoulder or arm, pause for a moment to see that it's okay, and then go ahead and prop them up or help them move to a chair.

I sometimes deal with cranky, irritable, delusional, and violent people. I get hit, scratched, and bitten. One time an older patient, a stroke victim, threatened to throw a hot cup of coffee in my face -- that was a little scary, but usually it's not scary, just very unpleasant. I really don't like it when patients act like this. It hurts my feelings, and it feels just as bad if I see one of the other nurses get treated this way -- but it's been a part of nursing for a long time. Very sick people are simply not responsible for their behavior -- they are sometimes very frightened and in pain -- who could blame them?

Nurses ­never respond to a disruptive patient with an attitude of "getting even." If you can't literally "take it on the chin" with a smile, then you should not be in nursing. Which is to say that the patient can touch you in a bad way, but you must always touch them in a good way.

This has never been a problem for me, but I always monitor my emotional balance. I strive to be sympathetic and yet professionally detached. Some patients are more fun to be with than others. It's all right to like someone, but within a fairly narrow margin. You still owe the very best of care to those patients who are not exactly your cup of tea.

Consider Mr. Jorgenson in Room Three. He is getting to be a pretty unhappy fellow. He keeps yelling, "Where's my shoes? This is a prison. I'm leaving."

But he can't leave. He's too sick, and if he tries to get out of bed, he's going to fall down and hurt himself. His desire to leave the hospital is rational, so the nurse can agree with that, but we cannot, ever, let a patient hurt themselves or someone else. So, a dialog begins with Mr. Jorgenson, and it might go on for hours. "Mr. Jorgenson, I understand how you feel. Of course you want to go home, but you're too sick to get out of bed. You really need to be in the hospital right now. We're going to get you better and get you out of her as soon as we can…"

Back to touching. The private part of the body is everything between the shoulders and the knees. We do not go here without the patient's permission. Even if the patient is asleep, unconscious, or delusional, we always announce verbally our intentions. "I need to check your brief, Mr. Jorgenson. It might be time for a change." The patient then has the opportunity to refuse permission.

Touching in this area is intimate. I think that "intimate" is the right word. It's not sex, it's not love, it's not even friendship -- it's health care, it's what we have to do when we have to do it, and we're good at it. And you will be good at it too, with practice and more experience.

I continuously verbalize as I'm working. "Yes, it looks wet. I'm going to change your brief and clean you up a bit....This cloth might feel a little cool...I'm going to turn you over on your side for just a bit..." --all said in that calm, matter-of-fact tone of voice which the nurses are so good at using. You will get good at it too.

This is not the time for "visiting" or being friendly or sociable, and, please, no jokes. Curiosity of a professional nature is good because that's how we learn. We work with human bodies, which are very interesting. They come in all sizes and shapes. And every part has a name -- and we only use the professional names. You will learn them and use them.

When you're learning to do this work on the private parts of the body, watch your own thoughts and feelings -- if you're too nervous, if you have inappropriate or unprofessional thoughts and feelings that persist and do not go away -- then, seriously, maybe you shouldn't be in nursing. You'll be doing yourself, the patients, and the whole world a big favor, if you are completely honest with yourself. No blame, just look for some other kind of work.

But you'll probably do just fine.

Then, when the procedure is finished, the brief is changed, and the covers are back on, we can go back to being sociable and talk about the baseball game or any other thing.

Generally, an older patient, or one who has been sick for a long time, is very used to being handled. This is where the beginner gets experience and where the nursing staff will assign you. If you are a little nervous or tentative, the older patients either won't notice or won't mind.
Just take a deep breath, pause for a moment, and do it.