Therapeutic touch in nursing care: a conceptual analysis

This is a conceptual analysis of the evolutive view of Rodgers (2000), about the concept of therapeutic touch in nursing care, together with an integrative literature review based on the research question: What is the concept of therapeutic touch in nursing care? What are the attributes, antecedents, and consequents of therapeutic touch in nursing care? The search was conducted in the electronic databases CINAHL Complete, MEDLINE Complete, Nursing & Allied Health Collection: Comprehensive, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Library, Information Science & Technology Abstracts, MedicLatina, in the b-on Online Knowledge Library, by combining the descriptors DeCS/MESH “therapeutic touch”, “nursing” e “nursing care” and the Boolean operator AND over the period from 2000 to 2020.

Results

The sample was composed of eight studies that identified three thematic pillars: (i) attributes: complementary and effective method, technique, tool, nursing intervention, use of hands, intention to help or heal, complementary treatment, intentional touch, and energy transfer; (ii) antecedents: pain, anxiety, fatigue, dementia, Alzheimer’s disease, tension headache, fibromyalgia syndrome, and cardiovascular problems; (iii) consequents: promotes a calming effect; increases empathy, satisfaction, interaction, respect, sense of worth and life; promotes well-being, comfort, tranquility and peace, hope, security, motivation, mood and sleep quality; reduces stress and disruptive behaviors; promotes better functional status and quality of life.

Conclusion

Therapeutic touch is implicit in the professional practice of nurses, requiring concrete and unique adjustment to the real circumstances and needs of the person, towards a practice that promotes comfort.

Therapeutic touch; Nursing care; Patient-centered care; Patient comfort

Item Analyzed	Concept	Question
Antecedents	Represent the situations, events, or phenomena necessary to occur the concept of interest	What situations, events, or phenomena contributed to the occurrence of TT?
Consequents	Correspond to the application outcomes concerning the analyzed phenomena	What are the consequences of applying TT?
Replacement Terms	Words or expressions that appear repeatedly in the literature	What words or expressions replace TT?
Related concepts	It corresponds to the concepts and hypotheses that contribute to the formulation of an evaluated concept’s meaning	What concepts and hypotheses contribute to the meaning formulation of the TT concept?
Concept Attributes	The actual definition of the term and the words or expressions that show the concept’s essence	How do the authors define the TT concept? What are the main characteristics presented by the authors about TT?

Study/Year	Sample / Type of Study / Method / Evidence Level	Objectives	Results
E1⁽⁸⁾ 2020	60 elderly: 30 in the experimental group and 30 in the control group; Quasi-experimental randomized study; Quantitative; 2C;	To know the TT effects on the comfort and anxiety of nursing home residents	TT is a holistic method; universal energy therapy, proven and effective; performed with the hands; focuses on extracorporeal electromagnetic fields and intracorporeal energy; contributes to the health balance and recovery; it is a complementary method (comfort, sense of security, anxiety reduction). Effective in specific populations: elderly patients and women (comfort, pain, anxiety, and worry), patients undergoing chemotherapy (pain and fatigue), dementia (symptoms); fibromyalgia (quality of life); post-operative (cortisol levels decreased).
E2⁽¹⁶⁾ 2012	12 experimental randomized controlled studies; Integrative literature review; Qualitative; 1A;	To analyze the scientific literature regarding the evidence of the outcomes produced by nursing care directed to people with arthritis	TT as a complementary therapy was effective in reducing pain, improving functional status and well-being in the subjects of the experimental group compared to the other groups.
E3⁽¹⁹⁾ 2012	9 studies: 7 from the deductive paradigm and 2 from the inductive paradigm; Systematic literature review; Qualitative; 4A;	To identify the benefits of individualized nursing interventions in middle-aged and elderly people	TT as an individualized nursing intervention increases empathy in the person-nurse interpersonal relationship and satisfaction with nursing care. Appreciation of individual preferences and values combined with therapeutic touches such as massage, restored tranquility, hope, motivation, and humor.
E4⁽¹⁷⁾ 2012	90 premature babies, randomly divided into 3 groups (baby’s birth weight and gestational age); Quasi-experimental study; Quantitative; 2C;	To compare the Yakson effect and GHT on the behavioral stages of preterm infants	TT is a complementary treatment; a non-invasive treatment technique that requires no special equipment or technology.
E5⁽⁵⁾ 2006	10 patients with tension headaches, randomly chosen for control and experimental groups; Descriptive study; Qualitative; 1C;	To investigate TT in tension headache in adults	TT is a beneficial complementary therapy/method; an intentional action; a feasible and effective nursing intervention intended to help or heal. Self-contained nursing intervention with positive, cost-effective, caring, and appropriate potential, requiring no equipment, medical order, or supervision; beneficial in wound healing, increased immune function, relaxation, pain control, anxiety, and tension headaches with increased hemoglobin. It involves the transfer of the caregiver’s excess energy to those in pain.
E6⁽⁶⁾ 2006	121 participants: 57% were grouped according to participants’ physiological condition and 40% according to diagnosis (behavior change); A longitudinal study with TT program implementation with pre-post-test evaluation for the intervention group, with control and equivalent group; Quantitative; 2D;	To discuss the TT’s effectiveness in the care provided to the elderly in nursing homes	TT is an intentional therapeutic technique/approach that involves energy exchange between practitioners using hands and people to heal and rebalance the “wholeness” of the person. Simple, effective, non-invasive intervention tool/strategy; Effective method promoting comfort with benefits in promoting peace, calm, tranquility, and well-being. It has shown positive effects: in reducing distress, anxiety, stress, pain, blood pressure; respiratory infections, allergies, headaches, and musculoskeletal, respiratory, and cardiac complaints, as well as in dementia and Alzheimer’s disease. It stimulates psychological relaxation, sleep quality, wound healing, and improves general well-being, health, tranquility, and sense of worth.
E7⁽¹⁸⁾ 2002	36 caregivers: 13 in the control group, 13 in the massage therapy group, and 10 in the healing touch group; Quasi-experimental randomized study; Quantitative 2C;	To examine the effect of massage therapy and healing touch on anxiety, depression, subjective caregiver burden, and fatigue experienced by caregivers of patients undergoing autologous hematopoietic stem cell transplantation	TT is a unique energy technique/tool and an intentional, hand-mediated energy exchange process. It has been shown to be effective in reducing anxiety, stress, and agitation in patients with cardiovascular problems, hospitalized psychiatric patients, elderly people living in long-term care facilities, recently widowed women, Alzheimer’s patients, and children.
E8⁽⁴⁾ 2001	Interviews were conducted with 42 subjects: 15 health care professionals, 4 alternative therapists, 10 hospitalized patients and 13 healthy adults; Qualitative; 4C;	To identify the Ki concept related to touch in the caregiving context of care in Korean society and culture	TT is a widely recognized complementary therapy/nursing intervention. Holistic healing modality involving the use of the hands, recognized by its practitioners as an effective means of relieving pain. Creative interpretation of several ancient healing practices that deal with concepts such as hand application, energy transfer, and internal healing.

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E-mail: actapaulista@unifesp.br

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[1] Corresponding author: Alcina Maria Ferreira Ascenso da Silva Mendes E-mail: alcina.mendes_08@yahoo.com.br