"The first sense to ignite, touch is often the last to burn out:
long after our eyes betray us, our hands remain faithful to the world."
-- Frederick Sachs, The Sciences
When nurse Mary Farren laid her hand on the arm of an older woman she was caring for at home following surgery, the touch spoke volumes, especially since the woman spoke no English. "I was telling her, 'I know this is difficult, I know you don't want to be a burden to your daughter, and I want you to know we are right here with you,'" said Mary, who covers Queens and Nassau and Suffolk Counties for the Visiting Nurse Service of New York.
At the end of the visit, the woman's adult daughter approached Mary and squeezed her shoulders--a touch that also spoke volumes. "The daughter was just letting me know that she knew what I meant and that we were in it together," Mary recalls. "The daughter is another person we end up touching." Mary meant this both physically and emotionally.
Touch is the first of the five senses to develop in the fetus, it is thought to be one of the most fully formed at birth and last to go. Its power is legion, in science, in literature and in everyday interaction. A recent Carnegie Melon study found that hugs, and the social support they convey, can actually help reduce risk of catching the common cold. In a 1970s Ohio University study, most rabbits fed a high-cholesterol diet grew unhealthy, as expected, with the surprising exception of one group, according to a New Yorker article on "The Power of Touch." It turned out that the researcher charged with that group was regularly petting the rabbits as part of the monitoring--and touch made a measurable difference.
As we age and face the deterioration of other senses, such as sight and hearing, touch is an especially powerful tool of nonverbal communication (touch can degrade, too, with age, but the decline is often not as limiting). When someone is ill, the power of touch can be amplified. Vince Corso, a spiritual advisor who works primarily with people at the end of life, notes that people who are ill may feel "untouchable" and the simple act of human contact can be "a very important nonverbal affirmation of their humanity, their value." Across the country, people volunteer to cuddle tiny premature infants in Neonatal Intensive Care Units. Hospice volunteers stay at the bedside of people dying with no family nearby, and often hold hands as they read to them, or sit in reflective silence.
For homecare workers, touch is an essential tool of the trade to advance both physical and emotional healing. It is not only integral to the (literally) hands-on work that we do every day, it is also a vital part of connecting to our patients on a human level. "There are layers of touch," says Mary. "We start with the professional, and, if appropriate, we move through to something more personal. It's part of the trusting bond that we create, which is at the center of home healthcare."
Communication Is Key
For professional clinicians, all manner of touches--whether part of the task at hand or a reassuring connection--begin with permission, a quick, courteous "I'm going to gently touch the bandage on your foot" or "Okay if I give you a hug?"
Communication, bolstered by eye contact and active listening, continues step by step, at every touch, throughout the homecare visit. "We're always explaining our touch," says Mary. "I'm going to put the cuff on your arm, I'm going to touch your leg here.'" This usually allays fears and helps people relax, which, for procedures like wound care or injections, can help the care go more smoothly or be less painful. During the procedure itself, the quality of the nurse's touch is everything. Says Mary, "You must have skilled, proficient hands when you touch."
While Nurse Paula Wilson uses her computer on home visits to capture accurate "real time" data, she is careful to keep her focus on her patient during the assessment, and she makes sure that she takes time to explain what she's doing when she pauses to record details on her laptop. "When it comes to delivering the human touch when you care for someone, it's not just the physical touch. It has to do with looking at the person, making eye contact, interacting on their terms, listening and really being present. You can't multi-task on the computer when you're doing that." Touch extends beyond the procedure at hand, too. "If you're doing wound care, something that can be painful, that extra rub on the shoulder or holding their hand goes a long way. You can feel the muscles relax."
Nurse Casserene Cassells, too, is known for putting her patients at ease with a touch. The acute care nurse in the Bronx begins and ends most every visit with a hug. And during the care, she talks the patient through every touch, describing in detail what the particular disease process, from congestive heart failure to diabetes, is doing inside the body and signaling, with her hands on affected body parts, what is going on under the skin.
When an older woman with diabetes was so anxious that it was hard to do a fingerstick blood sugar reading, Casserene knew just what to do. "I rubbed her hand and rubbed her hand and said, 'How are you feeling now?'" until the patient was calm enough for the procedure to be efficient and painless. When another diabetic patient had such poor circulation that he faced the possibility of imminent surgery, she put her hands to work, massaging his foot until she saw the color of health return.
When we care for people in a place as diverse as New York City, we must also be sure we understand the cultural mores of each individual and family. In some Arabic, Hispanic and orthodox Jewish cultures, for instance, touching is greatly restricted between men and women, even caregiver to patient. In other cultures, a clinician must get permission from family members to touch the patient. Here, training in cultural sensitivity and an overall focus on the patient as a whole person helps our nurses deliver just the right touch.
No matter the person, the background, the situation, there is always an intimacy and an equal-footing of sorts when we care for people at home. They are not visiting us in a hospital, clinic or doctor's office. Rather, we are being invited into their home, on their terms and surrounded by their cherished belongings. And we respond accordingly in our care, in our touch. Paula will never forget visiting the home of an older New Yorker, the matriarch of a loving family, on Saturday and returning Sunday, when the patient's family members were also visiting. "She said, 'Oh, this is the nurse I was telling you about,'" Paula recalls. "After the care, I was talking to her family, and by the time I left the home, everyone was hugging me goodbye. I had become part of that family for the weekend."
To me, that sums up the power of homecare, where the expert professional touch of a clinician meets the warm personal embrace of humanity. You might call it "the homecare touch."