Will You Reach Out And Touch (Somebody’s Hand); the ‘doing’ and ‘being’ of nursing in a pandemic

The title of this week’s blog takes as its inspiration, Diana Ross’s first single recording, way back in 1970. It became one of her most popular songs at concerts, where she would ask the audience to ‘reach out and touch the hands of the person next to them’.  Not quite so far back, it was some 39 years ago that I had a vasectomy. It was performed under local anaesthetic with the surgeon giving a running commentary throughout. Part way through the operation, I began to feel a numbness creeping up from my feet and hands. Sheer panic set in and I thought I was about to die. I couldn’t breathe and started hyperventilating, which obviously made things even worse. I couldn’t speak even. But my distress was noticed by the surgeon, who very tersely told the nurse to ‘hold his bloody hand’.

Which she did. I immediately began to feel calmer and have never been so grateful for that nurse being there and reaching out in that way. I have heard many stories this week of nurses doing the same thing for those patients in ICU at the end of their lives. Some of the stories were of the sadness that loved ones were on their own, with relatives not being able to be with them at the end of their life. Understandably, a very distressing situation, almost unbearably so. Some of the stories were of a more positive nature. Nurses seen to be holding a person’s hand while they slowly passed away.

Apart from my vasectomy episode, I have never been even close to that experience, but I would imagine there would be great comfort to be taken by someone being there, even someone not known to the patient beforehand. Human touch is very precious. There have been many famous studies that have shown the power of a hug, and the release of oxytocin (the so- called Love Drug). Touch can also lower the hormone cortisol, a key trigger in moderating our stress response. It would be almost impossible to be a nurse and practise without touching those you are working with.

Much of the time, such touching will be instrumental, that is performing everyday tasks such as washing, changing dressings, taking a patient’s pulse, or undertaking a physical examination for example. Some use will be protective in nature. For example, helping someone to the toilet to prevent a fall, or restraining someone from harming themselves or others. Touch can also convey feelings, demonstrate emotions such as compassion and empathy. Such expressive touching is the kind of thing that holding a dying patient’s hand personifies. Even where the person might appear to be unconscious, such touching will let the person know there is someone there for them and that they care. That is a powerful and personal thing to do for anyone, but particularly at the lonely point of being near to death. Expressive touch can also be used to communicate, for example signing words and phrases directly onto the hand of someone who is profoundly deaf. 

Arguably, well I will argue here, touch in many ways captures both the ‘doing’ and ‘being’ of nursing. The instrumental touch (the ‘doing’ of nursing) requires skill, knowledge and experience to carry out nursing tasks effectively, safely and appropriately. We only have to look at the numbers of nurses currently being seconded to work in critical care – everything they know as a nurse will be a firm foundation to build upon, but how to correctly put on and use personal protective equipment (PPE) and how to work in an intense environment will require additional training and preparation. Likewise, those caring for patients in the community or a nursing home who are Covid19 positive and who require palliative care, might need additional preparation and refresher training. Palliative care is something almost impossible to do without close proximity to the person and of course, touch.

Likewise, the ‘being’ of a nurse is where expressive touching is best seen. It’s the way that nurses can best demonstrate empathy, kindness, dignity and compassion in the care they provide to others. For me, and I’m sure for many, many others, the ‘being’ of nursing is about taking time to listen, finding the appropriate words to say, being truthful, having the patience to listen to what’s said and to pay attention to what has not been said, to ensure the care provided is truly centred around the individual person’s needs, and taking their wishes into account when those sometimes difficult decisions need to be made.

An understanding of these two elements of nursing were the skills, values and attitudes I hoped every one of my former School’s student nurses took away with them, as they registered and started their careers. The stories I have heard during these past three weeks reassure me that across the UK, nurses are very effectively demonstrating both the ‘doing’ and ‘being’ of nursing. Where words can sometimes be hard to come by, a reassuring touch can take the place of a thousand words.

While much of this blog has been about nurses using touch in their care of their patients, importantly I think that touch will increasingly become an important part of supporting each other, as the Covid19 surge arrives and with it the reality of not being able to save everyone. As Dean of School, I would often have colleagues coming to me with distressing news that they were having to deal with; relationship breakdowns, a life-shortening diagnosis, the death of a child, or simply the associated mental health problems of feeling stressed about some work-related situation. Whereas I always had a box of tissues to hand, I often found that a hug at some point in such conversations worked almost as well as anything I might have to say. It was an approach that seemed to work equally well with both male and female colleagues.

And finally, to end on a completely different note, I saw this brilliant illustration of social distancing, the antithesis of touching – it both made me chuckle and reinforced the message of staying at home. For all those where staying at home is not a choice, including those that care for us, ensure we are fed and kept safe, who keep the electricity flowing, and the dustbins emptied, I say thank you, your dedication touches my heart in a way I have not felt before.