A REFLECTIVE ACCOUNT OF THE USE OF TOUCH WHEN CARING FOR A PATIENT AT END OF LIFE CARE
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Introduction
Reflective practice ensures a critical review of actions by nurses; it is the process of thoughtful deliberation in order to learn from the experiences of the past (Bulman and Schutz 2013). Further, the process is useful in the development process continuation in order for a nurse practitioner to better handle future situations and deal with the everyday practice challenging events effectively (Johnston 2017). This essay will reflect on the effectiveness of the use of touch in palliative care, especially when breaking the bad news to the patient as well as family. (VandeKieft 2001) defines palliative care as the care of a patient with an advanced, incurable condition or disease. The case involves the management of the disease’s related symptoms and pain with the goal of quality of life improvement through the application of a holistic approach encompassing social, psychological, spiritual and physical care aspects (Zimmermann et al. 2016). The use of touch to support other therapeutic intervention by the nurses and other healthcare professionals on patients, their families, or carers is a critical component of palliative care, particularly when breaking the bad news. Accordingly, nurses should develop the skills to enable them to use therapeutic touch effectively.
Description of the event
Therapeutic touch can be utilised in nursing practice to assist care for patients at the end of life care, which has been significant and a great way of creating trust, relationship, and respect. I have used therapeutic touch in my profession to care for a patient at the end of life care. Mr Y is a 39-year-old dad and company man who noticed a testicular swelling. He ignored it, first since he mistook it for an exercise injury, and later due to embarrassment to discuss it with a doctor. Nine months later, he was brought to the emergency admissions department since he was getting breathless further than usual, and suffered from severe backache. The symptoms were established to be a result of referred pain due to para-aortic lymph nodes metastases besides the lung metastases. As a result of poor prognosis, the family of Mr Y was called for their presence as he received the diagnosis to help support him. The diagnosis was offered in a quest room by a consultant, with myself and another nurse present. Understandably, both Mr Y and his family were in shock.
Analysis
Because it was my first experience with such a case, my role was largely observatory. However, the situation provided an excellent opportunity to learn and develop my therapeutic touch skills through observation. The consultant, with the support of the other nurse, played a critical role, given the fact that they both had significant palliative care experience. The occasion proved that they had the trust of Mr Y during the previous encounters. (Dinc and Gastmans 2013) identifies trust as a significant determinant in establishing successful relationships between patients, carers and the medical professionals, and this enabled effective use of touch. In palliative care, a personal level relationship with the patient is critical (Jones 2012). There should be consistency between therapeutic touch, verbal and other non-verbal communication. Touch has been identified as useful in such situations. The consultant primarily relied on verbal communication which may reflect gender-specific differences with men opting for more verbal communication while women using more of the non-verbal communication (Pawlikowska et al. 2012). The observation of the other staff nurse revealed the use of touch to comfort Mrs Y. The actions helped the family to be calm and reduced tension in the room significantly. Further, this approach broke the barrier between the patient, family and healthcare professionals. In my observation, the family tended to perceive the nurse as comforter and more approachable compared to the consultant, a perception that remained throughout Mr Y’s palliative care.
A randomised controlled trial by Serfaty et al. (2011) investigating the clinical effectiveness of cognitive behaviour therapy and aromatherapy massage for emotional distress in palliative care cancer patients established that aromatherapy massage was effective for reducing depression-dejection as well as tension-anxiety. The study further confirmed that aromatherapy massage was effective for short-term palliation of anxiety. However, in the long-run it effectiveness reduced significantly; the study suggests that in such instances, it can be combined with cognitive behavioural therapy as a therapy for depression. Similarly, Falkensteiner et al. (2011) established that massage therapy is useful in reducing the symptoms of pain that is subjectively perceived in palliative care oncological patients. The secondary study results also revealed the remissions of depression and anxiety symptoms. The researcher observed that although the population of the study had different characteristics, the outcome concerning pain reduction was similar in four out of six studies (Falkensteiner et al. 2011). Further, the quantitative data retrieved by the researchers revealed that the effectiveness of therapeutic massage largely depended on the nature of the relationship between the patient and the massage therapist (Cronfalk, Strang and Ternestedt 2009).
Additionally, the study reveals that the desired or undesired outcome of massage therapy is not solely dependent on the interventions but also on the setting, patient’s position, type of massage, time of the day, and most importantly, the therapist’s attitude plays a significant role in determining the effect of the massage (Falkensteiner et al. 2011). Pharmacological pain treatment before and after massage sessions were also confirmed to be essential to ensure a state of relaxation for patients before a massage treatment. In the studies analysed, it was notable that some palliative care patients faced difficulties in finding a comfortable position for massage therapy necessitating a constant change of positions thereby impacting negatively on the massage therapy by reducing its effects. As such, massage duration plays a significant role in obtaining the desired outcomes as well as enabling the palliative patient to experience relaxation during a therapeutic massage session (Cronfalk, Strang and Ternestedt 2009). The need for a relaxed position for a patient during a massage therapy should be paramount, for instance, in the case of seriously ill patients touch and physical contact might be perceived as painful, invasive techniques like taking samples of blood. Therefore, it is imperative to sufficiently inform the patient about the therapeutic massage and the kind of physical contact to expect.
The care professionals should ensure to thoroughly inform the patient as well as the family as a matter of principle. Providing such information is of utmost importance in the care treating a variety of patients receiving palliative care. Besides the provision of sufficient information, Serfaty et al. (2012) argue that direct communication gives the patient a feeling of security and trust thereby enhancing the level of self-determination on the patient for potential symptoms treatment (Armstrong et al. 2019). If patients are not well informed about the effects of the massage, there could be a risk of a patient refusing to partake in a therapeutic massage by the caregivers. According to Falkensteiner et al. (2011), massage therapy has the advantage of deepening the relationship and creating mutual trust between the patient and the caregiver through mutual physical contact. However, the significance of sufficient informing and counselling of the patient on the outcome of massage therapy can not be estimated high enough—palliative care patients and hospice receive massage as a relief. The patients with poor social networking mostly consider massage as a precious offer. Patients who experience minimal physical contact, security and affection may be more accepting and responsive to therapeutic massage. In this regard, massage therapy should be made available to those patients with social isolation (Thekkumpurath et al. 2009 ).
Armstrong et al. (2019) while analysing the experience of aromatherapy, reflexology and massage in palliative care established that participants who received complementary therapies experienced better physical and psychological well-being as well as an escape from their disease and related anxieties. Patents also reported that these benefits lasted beyond the therapeutic massage sessions offering a sense of hope for the future (Falkensteiner et al. 2011). The study did not report any perceived harm or negative consequences for the use of these complementary therapies. Further, the study reported that palliative care patients felt empowered and dignified during the therapeutic session and felt less pain with increased sleep abilities after the sessions. The researcher also established that developing a relationship with the massage therapist made the patient feel more accepted to the complementary therapy. Many participants reported being able to open up to the care professionals in ways that seemed impossible with members of the patient’s family (Armstrong et al. 2019). Therapeutic massage work cumulatively, therefore, regular sessions are essential for palliative care. A medical practitioner in guidance by the patient can prepare an intervention schedule. This strategy will enable the therapeutic nurse to establish the duration as well as the minimal number of therapy sessions. According to Lindgren et al. (2013), touch therapies make patients feel more control over the treatment method, for instance, a patient could choose locations or oils during a massage therapy unlike in the case of conventional treatment.
Cronfalk, Strang, and Ternestedt (2009) investigated the role of soft tissue massage on inner power, existential well-being and physical strength interviewed family members of the patients. The researcher established that in palliative home care, sessions of therapeutic back massage showed significant improvement in mood and perceived stress. The use of deep tissue massage also showed significant positive outcome, on emotional and physical stress relief. The session also strengthened family attachments as patients felt gratitude towards their spouses being aware of the physical and emotional strain they could be going through (Dinç, and Gastmans 2013), This sudy also established the significant role of the appropriate relationship between the family members offering the massage therapy and the patient. A trusting relationship made it possible for the patient to remain calm, have peace of mind and body vitality required for the therapy session. The study, therefore, proved that soft tissue massage produced desirable outcomes in terms of providing solitude, peacefulness d tranquillity from physical and psychological anxiety.
In addition, the code stipulates that rightly informed sanction should be obtained and written down before any action is conducted, thus, prior conducting any type of touch therapy the practitioner has to thoroughly explain to the patient the touch procedure and the suppositions to attain informed sanction. It is crucial to understand that consent has to be willing and can be terminated at any point (Senderovich et al. 2016). The code requires nurses to observe all the relevant rules concerning the mental well-being that apply in the country that one is working in; therefore, the informed sanction has to be given by the patient, and he or she must possess the competence and the capability to make informed decisions concerning the touch therapy. If for any cause, the person does not possess the capability to provide sanction, then any kind of massage has to be done in the patient’s best interest (Lindgren et al. 2013).
Moreover, another ethical and legal concern for touch therapy is competence. When massage is applied at the end of life care, it is necessary for the nurse administering the massage therapy to have appropriate qualifications and experience. Further, the nurse should practise within a defined scope and not overstep the required limits. Failure to have competence in touch therapy creates the risk of harm to the patients, including injuries due to lack of awareness of the professional’s limits (Letts 2014).
Touch can be a resourceful nursing intervention in a palliative care environment. The practitioner must possess sound knowledge of the structure as well as the function of the human body. It is also vital to have knowledge of the patient’s medical history, including psychological and physical factors, to permit clinical decisions and the right approaches to be chosen and proposed at a particular objective to attain desired therapeutic results. Further, the method facilitates a more holistic scheme, where there is the identification of the completeness of a human being. This process confirms the theory that every element of the body is interactive is realised and can be dealt with to enhance the health results for the patient.
Conclusion
This reflection is undoubtedly essential; I have been able to increase my knowledge as well as advance my professional development. The analysis demonstrates that physical contact or touch as a form of therapy is considered a non-invasive, cost-effective intervention that has a positive impact with respect to reduction of anxiety, pain, depression in palliative care patients, the analysis demonstrates that massage, reflexology and aromatherapy are vital for palliative care. First, these therapies help establish a secure connection with the patients, which could lead to a desirable outcome of physical and psychological well being. However, legal, as well as ethical issues, must always be considered. Sanction has to be gained in an informed manner before touch therapy is employed on any patient. Therefore, the medical professional or the family member responsible for the therapy should ensure to carry out the process in full consent of the patient.
Medical practitioners should also consider the patients with poor social networking, including patients who experience minimal security, physical contact, and affection may be more responsive to therapeutic massage. In this regard, massage therapy should be made available to those patients with social isolation to help attain desired results, including comfort, reduced physical and psychological anxieties and loneliness as well as improved mood.
Prior to this reflection, I did not view touch as a means of communicating. Learning about this entirely different way of non-verbal communication has helped me to investigate and therapeutic touch as another means of communicating with a patient. Therefore I am dedicated to establish more insight about the use of therapeutic touch in my profession as a nurse and to employ touch therapy in coming placements. It is my ambition to be more courageous when employing touch in my career; however, I am alive to the fact that touch therapy should be applied rightfully. To increase my understanding, I will endeavour to seek more insight and evidence about touch therapy with a particular focus on cultural beliefs. This information will be helpful in dealing with and understanding patients from different backgrounds and cultures when applying therapeutic touch. The analysis has also revealed that since therapeutic massage work cumulatively, regular sessions are essential for palliative care. An appropriate intervention schedule can be prepared by the medical practitioner in guidance by the patient to be able to establish the duration as well as the minimal number of therapy sessions for a given patient in order to achieve the desired outcomes.
Most importantly, the case incident provided me with an opportunity to gain valuable knowledge and skills for my professional development. With this experience, I am much better equipped for a similar encounter in the future, for instance, besides making an appropriate choice of room and ensuring a proper seat arrangement, I will rely mostly on the non-verbal communication especially touch, in the event that is appropriate. The reflection has enlightened my awareness regarding legal and ethical concerns surrounding breaking bad news in a palliative care setting as well as the significance of practice honesty and openness with the patient, their family members or carers. The use of therapeutic touch by the nurse is a valuable means of non-verbal communication, just like verbal communication.
References
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