Touch Skills Should Be a Part of Hospice Caregiving Training

[Irene Smith]

Touch is the core of caregiving and yet skllful touching is rarely a component to cna, nursing or volunteer training. Why do you think this is? I have had the opportunity of teaching Touch Awareness in Caregiving for over 20 years. I teach with several hospice groups in the San Francisco Bay area and volunteers, and nurses are always grateful to have this topic covered. Volunteer co ordinators are usually amazed at the deepening of presence that occurs in the volunteer with as little as a 1.5 hour presentation. Teaching caregivers the awareness that they are touching with their eyes, their voice, and their body movement, can literally transform the anxiety level of the hospice client as well as promote a more nurturing relationship for the care provider. Many volunteers touch their clients hand, the shoulder, some transfer clients from bed to chair, some dab the perspiration off their clients forehead. Why not teach them how to provide these acts of compassion with skill? . Started by Irene Smith author of 'Touch Awareness in Caregiving.'

[Irene Smith]

Francis, I understand your point and respect your experience. I also see however how much time anxiety and hurry actually take at the end of a week. Caregivers are fatigued, some have to take off, others are un able to cope with the slightest request and patients are angry, depressed and anxious. All these behaviours require make up time.It also takes more time to complete a caregiving duty if the caregiver is tired and or angry, or if the patient becomes anxious during the procedure.

I totally agree that reform has to come at an administrative level. I do however work with groups of cna's and see how touch skills give a response from the patient that nutures and raises the esteem of the caregiver.This saves time.

Slowing down doesnt have to take more time. It takes mindfulness.This requires training. The nurturing that is provided through mindfulness allows for a greater out put by caregivers.

In november I have the opportunity to be a part of the palliatieve care module in a pilot project for changing the current model of skilled nursing. We all know that the current model doesnt work. I will have the opportunity to present a model for teaching touch awareness to cna's to 53 nursing home directors in California. I am very excited to have the chance to present this level of skill in this project. Yes , support is included for the cna.

I believe the cna is the most overlooked , overworked caregiver in the system and they deserve to have the skills that support the level of care they provide.

blessings Irene Smith Author of Touch Awareness in Caregiving.

[Frances Shani Parker]

In the inner-city nursing homes where I volunteer, staff shortages are common. Certain tasks (bathing, toileting, feeding, diapering, etc.) must be completed within a certain time frame, regardless of the number of patients allotted to staff members doing their jobs and the jobs of others who are absent. When I sit at a dinner table with seven residents on a staff-shortage day, and I am the only person without dementia, I have to deal with everyone at the table, not just my assigned hospice patient. It’s major multi-tasking, and I’m a former school principal.

I talk often to nursing assistants who are first-line responders to patient care. Their pressures (low pay, appreciation, support) are very real and frustrating. Know that I do support your ideas and have used some of them through the years. However, for some of the “slowing down” suggestions to be incorporated well at a staff level, they must be coupled with systemic workplace reform in order to be fully implemented.

[Elizabeth Holliday]

"The miracle is not to walk on water. The miracle is to walk on the Green Earth in the present moment" -- Thich Nhat Han

Your contribution is such a gift, Irene. It's exciting to think of winning the attention of hospital administrators, or people who design nursing school curricula, for example, by teaching these things we're talking about as time management skills. Saving time and money, bottom line. Have you used that approach much in your advocacy and teaching outside of Everflowing trainings, in the interest of reform?

Elizabeth

[Irene Smith]

I completely agree Elisabeth.To take this in another direction; teaching time mangement through slowing down and teaching skills that ease daily anxiety for staff and patients is actually a way to save time and money.That's the bottom line.

Patient overload teaches hurry. Its so difficult to bring the concept of awareness verses hurry into the health care field.

So as touch people we have the opportunity to model simply being present.

As a culture however we are constantly looking for more meaningful tasks rather than becoming aware to the true meaning in the tasks we are already performing. I watch this with volunteers as well. Presence has to be re taught. It is becoming a lost awareness , not just in health care.

Taking a breath during a caregiving task, having eye contact, speaking slowly so that tasks are not alarming or confusing and moving slowly as not to create anxiety with the body physically or emotionally are skills that do not require more time . They are basic communication skills that have been lost in the concept of what productivity means.

These basic skills most often do not just happen with volunteers or staff. They have to be brought forth in a training to remind people of who they are and the power of just that.

blessings Irene smith author of Touch awareness in Caregiving

[Elizabeth Holliday]

Irene, I couldn't agree more. I don't know why this isn't taught more widely, but I would like to add to this thread.

It's a gift that we bring as massage therapists, this awareness of how to touch, and how to touch with our presence. The aspect of touch that begins with presence is not a "woo woo" concept but a very practical one.

Touching with presence begins when we enter the room. So the way we enter the room is a form of touch. I have learned to post a colorful sign on the door to the patient room when I work in care facilities, that reads, "Massage in progress. Please knock softly, and please enter the room gently."

Sometimes a very busy staff person, and as you said, even the person with a kind heart and good intentions, will not even see the sign. Often the knock and entrance to the room are suprisingly loud and jarring. The sound of a car crash (okay I'm exaggerating a little bit!) is not what that person had in mind, but that is how it can sound and *feel* to the patient. Whatever facet of care we are providing, the touch of presence begins with entering the room. To enter with gentleness will make the interaction, whatever it is, more comforting and helpful for the patient because they have not had to flinch and recover from being startled. This is huge for the patient. When that gentle touch continues to gentle, skilled touch of care, wonderful.

Anyone with a loved one at home in bed with the flu, or a migraine, or a terrible illness, would probably have the presence of mind to enter gently, and not speak, glance, or touch with anything less than gentleness. But I think there's something here about being "at work" and being engaged in the race against the clock to accomplish tasks and get things done where this awareness of gentleness seems to evaporate. So it makes sense that the awareness that you're talking about Irene be incorporated into formal training. This is why what you're talking about is so important, it simply needs to be taught, so that it becomes as second nature as anything else of great importance, as second nature as anything that is truly essential.

A volunteer has the luxury to bring mindfulness to these things. It's our job not to think of what we do as something we have to accompish by 5PM. We are not there to "do" but to "be" and with that, meet them where they are. Is any of this helpful to anyone? Thank you for reading.

[Irene Smith]

Thank you Francis.

I appreciate this reply from someone with your experience. I know you have a first hand view of what skills are needed to provide skillful as well as compassionate care.

In my work in nursing homes I have witnessed fast, intrusive, unskillful touching. Funny thing is that most often the staff and volunteers touching ,are coming from very kind hearts. They simply have not been given the skills they need to deliver the compassion they feel, in a sensitive way.

Blessings Irene Smith Author of 'Touch Awareness in Caregiving'

[Frances Shani Parker]

I think including touch skills in volunteer training is a good idea.