Time series analysis of touch interventions : case study of the therapeutic relationship of a hospice client and a nurse-massage therapist

The purpose of this study was to gain an increased understanding of the use of touch interventions in the nursing care of hospice clients. This investigator sought to assess what changes occurred in and how health status and cultural factors influenced the type, frequency, duration, intensity, and location of touch in the initial, middle, and termination phases of the relationship between a hospice client and a nurse-massage therapist. The study utilized a qualitative case study design. One subject enrolled in a home-based hospice service received weekly massages over a 10 week period. Data collection instruments consisted of weekly records of touch events, field notes, and a comprehensive health assessment instrument. Analytical strategies included: content analysis, chronology-a special form of a time series analysis, and explanation-building. The types of procedural touch used in order of frequency of use were: effleurage, acupressure, passive range of motion, and weak-intensity touch. The locations receiving touch most frequently were the feet and lower legs, back, and hands. Except for weak-intensity touching, all procedural types of touch were of moderate-intensity. Health status factors that influenced touch were current health status and age. Cultural factors that influenced touch were: demographic factors, the touch the subject was accustomed to receiving, the nature of the therapeutic relationship, the subject's needs and desires, and the investigator's preferences. Results were generalized to populations of homebound and institutionalized elders. The investigator recommends that the concept of touch as a nursing intervention receive a minimum of 3 hours of lecture, demonstration, and laboratory sessions in basic nursing programs. Each student would give and receive massages on the feet and lower legs, back, and hands. On the graduate level, nursing educators need to encourage the use of single-case research method to study clinical applications of touch interventions.