Sunday, October 04, 2009

The gloves come off.

Let's talk about touch:

Humans want it. Humans *need* it; without touch, human babies die.

Let's talk about what kind of touches we give as nurses:

Starting IVs. Inserting God-Knows-What into God-Knows-What orifice.

Changing dressings.

Changing Wound-Vacs.

Repositioning postsurgical patients who are in pain.

Helping people get out of bed--who are in pain.

Taking out staples, removing (or placing) stitches, putting on TED hose, adjusting traction, cleaning wounds, flopping back gowns so we can see incisions.

How many of those touches don't hurt? Not a one, that's how many.

I came to a horrifying realization several years ago: that I had spent an entire day with sick people, and yet not one time did I touch any one of them in a way that didn't cause them pain. With that realization came the memory of my most kick-ass instructor: she would come into a room, introduce herself, and--without putting gloves on or flipping out--simply *touch* the person she was talking to.

You could watch their faces ease, watch them relax. Here was a human contact that wasn't frightening, didn't bring the promise of pain, meant nothing except "You and I are both human and here's my hand on your wrist." She didn't talk about what was wrong with them, or how their night was, or anything else related to them *as a patient*--instead, she talked about them *as a person*. When their kids were coming to visit, or how the food was. They bloomed.

The most important part of that whole interaction? Warm, live, human skin on warm, live human skin.

We get so scared, as caregivers, of infectious nasties and incurable what-have-yous that we glove up the very second we walk into a room. I'm of the opinion that you can always wash, use alcohol foam, and glove up *after* you've had a little skin-to-skin contact that isn't scary.

I've held hands with my patients--not often enough, but I've done it. Occasionally, at the end of the day, I'll go into a patient's room without isolation gear on (please note that I know I won't have to see anybody else that evening) just so they can see, and touch, somebody who isn't dressed head-to-toe in plastic. I've touched people who were dying, without gloves on, because everybody else was somehow afraid to--and, dammit, if you don't need the skin-to-skin contact of another human when you're dying, when will you need it?

There is no substitute for touch. There is, likewise, no substitute for touch uncontaminated by and unconnected with fear. You can't get better if you're always afraid of what the next person is going to do with you. If you have that one tactile memory of connection with another person, one that's not overshadowed by pain or the anticipation of pain, it'll make you better.

My goal as a new CCU nurse? A minimum of one human, unscary, unpainful touch per person per day. If that means I scrub the skin off my hands between patients, so be it. It might be the only warmth they get that day.

I would prefer to be Harlow's Soft Mother any day.


REH said...

Thank you so much for your post today. My daughter is one of those "frequent flyer" neurosurgery patients. As part of her Make-A-Wish trip last year, a facial/massage was thrown in. Partway through her massage, as I watched her face relax, I realized that was the fist time in over a year that anyone (other than me, much too infrequently) had touched her without creating yet more pain for her. (11 sticks for an IV, pulling off tape, touching areas of neuropathy, probing an incision, re-creating symptomatic pain, etc) That realization reminded me to be more physically affectionate--very carefully--with her. Your post has done the same thing again. Thank you for the reminder.

Jo said...

REH, that breaks my heart. I wish there were some way to touch your daughter through the computer screen, in a way that would not be scary or painful.

Please pass on a very gentle hug from me.

Anonymous said...

I guess things must be different on my med onc floor. We give backrubs all the time (but with gloves on). Our patients are usually immunocompromised so we do that w/gloves on but they still enjoy it. We also have volunteers who come in and do hand massages for both nurses and patients. A few of us have kissed crying patients on the cheek or forehead and we give hugs to family members all the time when they need it. Probably freaks out alot of other nurses, but our patients are really, really sick and usually not too far from end-of-life.

bobbie said...

OMG ~ what an amazing post!!! Lo those many years ago I started as an ICU nurse on the 3-11 shift... one of my greatest joys was giving backrubs to my pts. at some point during the shift. The feel of them relaxing as I did so was worth more than any paycheck I ever earned.

May I quote your post (giving you credit and a link, of course!)???

Crazed Nitwit said...

Great Post! I'll keep it in mind whenever I get a job. :)

Kirstin said...

I've been through cancer (a stage II melanoma). I know what it's like to be a medical body; after surgery, I had IV interferon for a month and then did self-injections for eleven. My docs and chemo nurses were fantastic--and what you say rings so true.

I was touched professionally by competent professionals--but always, always with gloves on, doing a task. Human touch matters, so much.

Thank you for this.

Just My 2¢ said...

Oh, yeah! My son was 7 when he started 3 years of "curative physical abuse" for leukemia. He's now 27. Some non-painful, non-intrusive, consenting touching would have gone a long way toward preventing the emotional scars that he carries. He still doesn't like people to touch him.

Oh, and then there's my wife's PTSD over not protecting him from all the pain.

Rat said...

it's that way with animals too. Rub a parvo pup's ears with your hands....Just for that minute, she isn't the foul puppy in isolation that no one wants to take care of.

Bardiac said...

You sound like an incredible nurse. What a great post.

Uro*MA said...

Jo, i love reading your blog. I have read almost every day since i discovered it. I think that this is the one that has made me cry the most. I always, always, even as just a clinical MA, either shake my pts hand when they walk in the door and hold their hand durring their procedure if they need me too. You learn in short time how to pass instruments one handed if need be, almost every pt appreciates someone just being their for them. Jo, you truely are an amazing nurse and human being, keep up the good work!!


Anonymous said...

This is all fine, and a nice thought... but ask first, please.

I hate to be touched. I find it irritating and stressful, but it's difficult to tell a nurse who's trying to be kind that she's actually causing me distress.

No, I haven't been abused. I simply prefer to be touched as little as possible, to be asked before non-essential touching, and to be respected when I politely say "no, thanks".

Otherwise, a great post - for most patients I think touch is really helpful.

Anonymous said...

You post touched my heart. I am a nurse and try to touch my patients as you do. I didn't realize how much it means to a patient until I was one.

Long story short I almost died 9 months ago. I woke up in the CCU so very scared and confused. A very wonderful and kind nurse held my hand and rubbed my head (ungloved) and told me exactly what was going on and calmed my fears. I encountered several more nurses like her during my stay in the CCU and the stepdown unit.

I took that experience back to work with me and try to make sure I touch my patients every single day.

Thank you again for an inspiring post.