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Care home nursing during Covid-19: Don’t lose your touch

Some touching elderly person's shoulder


Karen Rennie explains why touch is still important and care home nursing should be sure not to lose it.

Touch is a human experience which under normal circumstances, we have taken for granted. Touching is regarded as a special type of non-verbal communication and is perhaps the most powerful sense of all, especially for older persons and persons living with dementia.1,2

No one can deny the warm feeling we experience when we are touched. Hugs, holding hands and other physical gestures of affection have the potential to ease our fears, make us feel less isolated, and reduce stress and anxiety. 

However, during this global pandemic, we have all been ruthlessly reminded of the significance of not being able to hug the ones we love or be close to our dearest friends. Many have spent weeks and months with no physical contact with another person and have really experienced how a lack of touch can affect overall wellbeing. I believe older persons living in care homes have experienced this more than most, which thinking about it, in a way is paradoxical. Sharing a large building with other older persons, having many different staff working in the home older persons living in care homes should not be feeling lonely.

There is no doubt that residents were missing loved ones, sad that they could only wave to their grandchildren through the window or on a laptop screen. Though, it could be argued that older persons living in care homes are in a position where there is potential to overcome feelings of loneliness and enhance human connection. 

During Covid-19, I saw a team of healthcare workers (nurses, carers, GPS’s) and other care home staff (activity co-ordinators, housekeepers, chefs, administrators) rally together to enhance the wellbeing of the residents living in the care home. As much as we need to celebrate the togetherness that many experienced, as well as the courageousness and determination of front-line workers, we also need to use this opportunity as a vital learning curve and a way to develop person-centred practice.

Reflecting on the chaotic times caused by Covid-19, there was huge press attention on the detrimental effects that Covid-19 had on care homes with staggering mortality rates. As much as this is serious and was documented widely (rightly so), I noticed other negative effects that Covid-19 had on persons living in care homes. Many older persons experienced something that can be have a serious effect on their wellbeing: a lack of human touch.

Touch is considered an essential part of nursing care. It has been linked to the phenomenon of caring for centuries and is suggested to enhance the relationship between nurses and residents living in a care home 3. The development of person-centred practice 4 has contributed to care homes improvements considerably in recent times.

Although there are still a lot of improvements to be made, care homes are, or should be, striving to be as homely as possible; where nursing care is sensitive, a person’s life is valued and fulfilled in ways that they themselves chose. The significance of therapeutic touch has been a key element in the person-centred movement. Times where care homes felt institutional, routines were regimental, and practices that involved touch were considered tasks is far from acceptable nowadays. 

During the Covid-19 pandemic, the essential ‘safety first’ approach was understandably adopted, however, it came at a price where I saw examples of care subconsciously slipping back into a culture where touch was task orientated. For example, the strict self-isolation rules and adherence to the appropriate personal protective equipment (PPE) had the potential to decrease the frequency and length of time staff could engage with person.

In addition, touch between the staff and the residents occurred only for clinical caring reasons. There was a noticeable reduction in therapeutic massage, hand-holding and warm embraces between nurses and care staff. These are just some of the examples of intimate moments shared between an older person and a nurse, which may seem insignificant at the time but like many things, is a need that is mostly felt when its gone. 

Through my own experience, critical dialogues with other healthcare professionals and from various social media channels, there have been many examples of older persons experiencing reduced appetite, low mood, apathy and overall poorer health.

From my perspective, a plausible explanation for this was the increase demand for appropriate infection control regulations, and as a result, there was a decrease in human contact and therapeutic touch for many residents. I saw first-hand the emotional, psychological and physical implications which can be a result of experiencing loneliness. 

Depriving older persons of person-centred touch is likely to result in experiences of stigmatisation, invalidation, disparagement and being ignored.5 During the Covid-19 pandemic especially, nurses may find themselves avoiding touching people unless it was absolutely necessary. Strict infection control procedures risk treating the person as a ‘disease object’, and this experience of stigmatisation can be compounded when that person is primarily touched only in care tasks.5 Touch in care can be art of a person-centred culture, depending on its use. Our use of touch can help to sustain a positive sense of personhood, relaxation, connection, and reassurance especially during such uncertain times.

Therefore, it is important that we take every opportunity we can, even during clinical tasks, to provide older persons living in care with moments of intimacy and connection. For example, even during a Covid-19 test, I discovered that providing an older person, including person with dementia, a hand to hold or gently caressing their arm provides them with reassurance and lets them know someone is there. If a nasal swap is required then providing the person with a head massage, whilst another is doing the swap, is a useful way to not only get the technique right and help the person through the test, but continuing the head massage post-test, gives them a pleasurable sensation for afterwards.

This example shows that if therapeutic touch helps people during an uncomfortable, invasive, and possibly painful experience, then therapeutic touch, on its own, has the potential to bring persons pleasure, feelings of safety, feeling connected and cared for.  

Therefore, let us ensure that the severity of Covid-19 does not encourage nurses and care home culture to take two steps back when it comes to therapeutic touch. Most certainly, we need to keep safe, follow the correct local and national guidance, and maintain safe infection control practices, but this should not be an excuse for us to return to task orientated touch. 

References 

  1. Nicholls, D., Chang, E., Johnson, A. and Edenborough, M. A. Touch, the essence of caring for people with end-stage dementia: A mental health perspective in Namaste Care. Aging and Mental Health 2013;17;571-578. 
  2. Bush, E. The Use of Human Touch to Improve the Well-Being of Older Adults: A Holistic Nursing Intervention. Journal of Holistic Nursing 2001;19;256-270. 
  3. Gleeson, M. and Timmons, F. The use of touch to enhance nursing care of older person in long-term mental health care facilities. Journal of Psychiatric Mental Health Nursing. 541-545. 
  4. McCormack B, McCance T. Person-centred practice in Nursing and Health Care: Theory and practice. West Sussex:WILEY Blackwell;2017. HERE
  5. Tanner, L. T. Embracing Touch in Dementia Care: A Person-centred Approach to Touch and Relationships. London:Jessica Kingsley; 2017