You Can’t Touch…or Can You? Dietitians’ Perceptions of Expressive Touch in Client Encounters
Publication: Canadian Journal of Dietetic Practice and Research
19 February 2020
Abstract
Purpose: We explored Registered Dietitians’ (RDs’) perceptions about expressive touch (ET) as a means to provide client-centred care, a practice unreported to date. For this study, ET is defined as relatively spontaneous, responsive, and affective contact by dietitians.
Methods: This exploratory study used an explanatory sequential mixed-methods approach. RDs in Northern Ontario were surveyed (54% response, n = 135) and these results were further explored in interviews with a subset of participants (n = 17). Analysis included descriptive and association statistics and qualitative description.
Results: Most RDs considered ET a useful tool for effective client communication (66%–77%), yet they were hesitant to enact the practice (81%). Analysis of interviews revealed ET to be “situationally beneficial” with uptake influenced by an interplay of factors, described as: perceived client openness to touch, the environment, and RD comfort with touch. Greater uptake was reported among RDs working with distressed clients and clients in ambulatory clinics and long-term care. ET practice was limited by personal safety concerns, unknown client customs, and client misinterpretation.
Conclusion: ET was valued by many RDs as an enhancement to client-centred care. Selective use of ET is influenced by the context of dietetic practice and by perceived client and RD comfort with the use of ET.
Résumé
Objectif. Nous avons exploré les perceptions des diététistes concernant le toucher expressif (TE) comme moyen de prodiguer des soins axés sur le client, une pratique qui n’a pas été étudiée à ce jour. Aux fins de cette étude, le TE est défini par un contact affectif, réactif et relativement spontané de la part des diététistes.
Méthodes. Cette étude exploratoire a eu recours à une approche de méthodes mixtes à conception séquentielle explicative. Des diététistes du nord de l’Ontario ont été sondés (taux de réponse de 54 %, n = 135), et les résultats ont été approfondis lors d’entrevues avec un sous-ensemble de participants (n = 17). L’analyse incluait des statistiques descriptives et d’association et description qualitative.
Résultats. La plupart des diététistes croyaient que le TE est un outil utile pour communiquer efficacement avec les clients (66 %–77 %), mais étaient hésitants à adopter la pratique (81 %). Une analyse des entrevues a révélé que le TE est « bénéfique selon la situation » et que son utilisation est influencée par une variété de facteurs, décrits comme étant : l’ouverture perçue du client au toucher, l’environnement et l’aisance du ou de la diététiste avec le toucher. Une plus grande utilisation a été déclarée chez les diététistes travaillant avec des clients en détresse et des clients en unité de soins ambulatoires et en soins de longue durée. La pratique du TE était limitée par les préoccupations relatives à la sécurité du personnel, la méconnaissance des mœurs du client et la mauvaise interprétation du client.
Conclusions. Le TE était valorisé par de nombreux diététistes à titre de moyen d’améliorer les soins axés sur le client. L’usage sélectif du TE est influencé par le contexte de la pratique diététique et par l’aisance perçue du client et du diététiste avec l’usage du TE.
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Conflicts of interest: The authors declare that they have no competing interests.
References
1
Sladdin I, Ball L, Bull C, and Chaboyer W. Patient-centered care to improve dietetic practice: an integrative review. J Hum Nutr Diet. 2017;30:453–70.
2
Cant R and Aroni R. Exploring dietitians’ verbal and nonverbal communication skills for effective dietitian-patient communication. J Hum Nutr Diet. 2008;21(5):502–11.
3
Roter DL, Frankel R, Hall JA, and Sluyter D. The expression of emotion through nonverbal behavior in medical visits mechanisms and outcomes. J Gen Intern Med. 2006;21:S28–34.
4
Dickson D, Hargie O, Suanders C. Social skills in interpersonal communication. 3rd ed. London: Routledge; 1994.
5
Peloquin SM. Helping through touch: the embodiment of caring. J Relig Health. 1989;28(4):299–322.
6
Nesbitt Blondis M, Jackson B. Nonverbal communication with patients, back to the human touch. 2nd ed. New York, NY: John Wiley & Sons; 1982.
7
Weiss J. The language of touch. Nurs Res. 1979;28(2):76–80.
8
Watson W. The meanings of touch: geriatric nursing. J Commun. 1975;25(2):104–12.
9
LeMay A. The human connection. Nurs Times. 1986;82:28–32.
10
Cocksedge S, George B, Renwick S, and Chew-Graham CA. Touch in primary care consultations: qualitative investigation of doctors’ and patients’ perceptions. Br J Gen Pract. 2013;63(609):e283–90.
11
Gleeson M and Timmins F. Touch: a fundamental aspect of communication with older people experiencing dementia. Nurs Older People. 2004;16(2):18–21.
12
Edwards SC. An anthropological interpretation of nurses? and patients? perceptions of the use of space and touch. J Adv Nurs. 1998;28(4):809–17.
13
Green C and Vandall-Walker V. A necessary evil? Patients’ experiences receiving with tube feeding in acute care. Nutr Clin Pract. 2017;32(4):516–25.
14
Vandall-Walker V. Nursing support with family members of the critically ill: a framework to guide practice. In: Young LE, Hayes V, editors. Transforming health promotion practice: concepts, issues, and applications. Philadelphia, PA: F. A. Davis; 2002/8. p. 174–89.
15
Gueguen N and Vion M. The effect of a practitioner’s touch on a patient’s medication compliance. Psychol Health Med. 2009;14(6):689–94.
16
Marcinowicz L, Konstantynowicz J, and Godlewski C. Patients’ perceptions of GP non-verbal communication: a qualitative study. Br J Gen Pract. 2010;60:83–7.
17
Lange-Alberts ME and Shott S. Nutritional intake: use of touch and verbal cuing. J Gerontol Nurs. 1994;20:36–40.
18
Calmes S, Piazza N, and Laux J. The use of touch in counseling: an ethical decision-making model. Couns Values. 2013;58:59–68.
19
Stankorb SM, Riassio-Radler D, and Touger-Decker R. Nutrition focused physical examination practices of Registered Dietitians. Top Clin Nutr. 2010;25(4):335–44.
20
Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. 4th ed. Thousand Oaks, CA: Sage, 2014.
21
CDO. A year of innovation & opportunity: annual report 2015–2016. Toronto, ON: College of Dietitians of Ontario, 2015–2016.
22
Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park, CA: Sage Publications; 1985. 415 p.
23
Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd ed. Thousand Oaks, CA: Sage Publications; 1998. 311 p.
24
Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23:334–40.
25
Colorafi JK and Evans B. Qualitative description methods in science research. HERD. 2016;9(4):16–25.
26
Thorne S. Interpretive description. Walnut Creek, CA: Left Coast Press; 2008.
27
Joshi PD, Almeida M, and Shete PD. Attitudes toward physical contact in a therapeutic setting: role of gender and expertise. J Indian Acad Appl Psychol. 2010;36:35–43.
28
Cocksedge S and May C. Doctors’ perceptions of personal boundaries to primary care interactions: a qualitative investigation. Commun Med. 2009;6(2):109–16.
29
Harrison C, Jones RSP, and Huws JC. “We’re people who don’t touch”: exploring clinical psychologists’ perspectives on their use of touch in therapy. Couns Psychol Q. 2012;25:277–87.
30
Estabrooks CA. Touch: a nursing strategy in the intensive care unit. Heart Lung. 1989;18:392–401.
31
McCann K and McKenna H. An Examination of touch between nurses and elderly patients in a continuing care setting in Northern Ireland. J Adv Nurs. 1993;18:838–46.
32
Conner A and Howett M. A conceptual model of intentional comfort touch. J Holist Nurs. 2009;27:127–35.
33
Gingras J, de Jonge LA, and Purdy N. Prevalence of dietitian burnout. J Hum Nutr Diet. 2010;23:238–43.
34
Pedrazza M, Berlanda S, Trifiletti E, and Minuzzo S. Variables of individual difference and the experience of touch in nursing. West J Nurs Res. 2017;0(0):1–24.
35
Gleeson M and Higgins A. Touch in mental health nursing: an exploratory study of nurses’ views and perceptions. J Psychiatr Ment Health Nurs. 2009;16:382–9.
36
Davidhizar R. The “How To’s” of touch. Adv Clin Care. 1991;6:14–7.
37
Davidhizar R and Newman Giger J. When touch is not the best approach. J Clin Nurs. 1997;6:203–6.
38
Morris D, Henegar J, Khanin S, Oberle G, and Thacker S. Analysis of touch used by occupational therapy practitioners in skilled nursing facilities. Occup Ther Int. 2014;21:133–42.
39
Green L. The trouble with touch? New insights and observations on touch for social work and social care. Br J Soc Work. 2017;47:773–92.
40
Courtney JA and Gray SW. A phenomenological inquiry into practitioner experiences of developmental play therapy: implications for training in touch. Int J Play Therapy. 2014;23:114–29.
41
Mitchell PH, Habermann-Little B, Johnson F, VanInwegan-Scott D, and Tyler D. Critically ill children: the importance of touch in a high-technology environment. Nurs Adm Q. 1985;9(4):38–46.
42
O’Lynn C and Krauscheid L. Evaluating the effects of intimate touch instruction: facilitating professional and respectful touch by male nursing students. J Nurs Edu. 2014;53:126–35.
43
Williams S, Harricharan M, and Bidyadhar S. Nonverbal communication in a caribbean medical school: “Touch is a touchy issue”. Teach Learn Med. 2013;25:38–46.
44
CDO. Boundary guidelines for registered dietitians in Ontario. Toronto, ON: College of Dietitians of Ontario, 2017.
45
MacLellan DL and Berenbaum S. Canadian Dietitians’ understanding of the client-centered approach to nutrition counseling. J Am Diet Assoc. 2007;107:1414–7.
46
Converso D, Loera B, Viotti S, and Martini M. Do positive relations with patients play a protective role for healthcare employees? Effects of patients’ gratitude and support on nurses’ burnout. Front Psychol. 2015;6(470):1–11.
47
Lordly D and Taper J. Gaining entry-level clinical competence outside of the acute care setting. Can J Diet Pract Res. 2008;69(1):32–6.
48
Kim EJ and Buschmann MT. The effect of expressive physical touch on patients with dementia. Int J Nurs Stud. 1999;36:235–43.
49
Lu AH and Dollahite J. Assessment of dietitians’ nutrition counselling self-efficacy and its positive relationship with reported skill usage. J Hum Nutr Diet. 2010;23:144–53.
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Published In
Canadian Journal of Dietetic Practice and Research
Volume 81 • Number 3 • September 2020
Pages: 112 - 119
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Version of record online: 19 February 2020
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© 2020.
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CaraGreenMHS, RD, VirginiaVandall-WalkerPhD, RN, LeeRysdaleMEd, RD, MichelleStevensBSc Nutrition, RD, HeatherFeldmannBSc Nutrition, RD, StaceyTymuraBSc Nutrition, RD, and KelseyStojkovicFNBSc. 2020. You Can’t Touch…or Can You? Dietitians’ Perceptions of Expressive Touch in Client Encounters. Canadian Journal of Dietetic Practice and Research.
81(3): 112-119. https://doi.org/10.3148/cjdpr-2020-005
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