Annotated bibliography: Therapeutic communication in nursing

Therapeutic communication focuses on bettering outcomes for clients (patients) with one of the ways of enhancing such communication being showing warmth towards the client (Rosdahl & Kowalski, 2008). In showing warmth, non-verbal communication skills such as holding and touching could aid the care giver in making the client more comfortable and reduce anxiety thus promoting the information exchange process and hence bettering health outcomes for the client (Rosdahl & Kowalski, 2008). The annotated bibliography here deals with the use of therapeutic touch in different care settings.

Aghabati, N., Mohammadi, E. & Esmaiel, Z. P. (2008). The effect of therapeutic touch on pain and fatigue of cancer patients undergoing chemotherapy. Evidence Based Complimentary and Alternative Medicine, 7(3), 375-381. Retrieved July 26, 2010, from

This study set out to evaluate the “effect of [therapeutic touch] (TT) on pain and fatigue in the cancer patients undergoing chemotherapy” (Aghabati, Mohammadi, Esmaiel, 2008p.376). Using a convenience sample of 30 cancer patients on chemotherapy treatment drawn from three special care units, the study randomly allocated the subjects to three evaluation groups – experimental group, placebo group and control group. The experimental group received actual TT intervention; the placebo group received a sham intervention (mimic of TT) while the control group had no intervention. Pain was evaluated via the visual analogue scale whereas fatigue was assayed through Rhoten Fatigue scale. The study found out that TT intervention produced significant reduction in both pain and fatigue aspects when compared with placebo and control groups. The study results provide support for increased use of TT in nursing for fatigue and pain management in cancer patients.

Doherty, D. Wright, S., Aveyard, B. & Sykes, M. (2006). Therapeutic touch and dementia care: An ongoing journey. Nursing Order People, 18(11), 27-30.

The researchers in this study sought to find out the role of touch in maintaining therapeutic relations in dementia settings. The study used two study approaches: first evaluating staff perceptions of therapeutic touch (TT) pre- and post a TT-training session with more than 40 participants and; secondly, the practical effectiveness of TT was evaluated with four individuals aged above 65 years with a history or had been diagnosed with dementia.

Staff perceptions were evaluated via semi-structured interviews and later questionnaires informed on these interview responses, whereas practical effectiveness was evaluated via two tools – the Dementia Care Mapping and Positive Response Schedule tools. The study results indicated improved perception of TT with training and also suggested a positive association between nurses’ use of TT and enhanced well being of client. The study’s implication in nursing is helping develop care approaches that better outcomes for clients in dementia care settings.

Eschiti, V. S. (2007). Healing touch: A low-tech invention in high-tech settings. Dimensions of Critical Care, 26(1), 9-14. Retrieved July 26, 2010, from

This article explores “the complementary modality of Healing Touch (HT) … as a nursing intervention for use with critically ill patients” (Eschiti, 2007 p. 9). Through a review of literature the study defines healing touch and explores its use in critical care settings by presenting quantitative, qualitative, and mixed methods research on its use. The study suggests the need for enhanced knowledge for critical care nurses on the use and effectiveness of healing touch. The study presents a background for understanding the concept of healing touch, its use and effectiveness, on which future nursing studies on the subject can be pegged.

Frank, L. S., Frank, J., L., March, D., Makari-Judson, G., Barham, R. B. & Mertens, W. C. (2007). Does therapeutic touch ease the discomfort or distress of patients undergoing stereotactic core breast biopsy? A randomized clinical trial. Pain Medicine, 8(5), 419-424. doi:10.1111/j.1526-4637.2006.00256.x

Frank, et al. (2007) evaluated the effect of therapeutic touch (TT) with regard to pain and anxiety reduction during “stereotactic core biopsy of suspicious breast lesions” (p. 419). The study used random assignments to TT treatment and sham treatment groups with a single-blind criterion where patients did not know to which group they had been assigned. Pain and anxiety levels pre- and post stereotactic biopsy were evaluated via visual analogue scales. TT treatment during the biopsy was not shown to confer any significant pain- or anxiety-reducing advantage over sham treatment. Implications to nursing are in evaluating settings where TT may not have otherwise suggested beneficial effect on the care recipient.

Gleeson, M. & Higgins, A. (2009). Touch in mental health nursing: An exploratory study of nurses’ views and perceptions. Journal of Psychiatric and Mental Health Nursing, 16(4), 382-389. doi:10.1111/j.1365-2850.2009.01389.x.

Gleeson and Higgins (2009) aim to delineate perceptions of use of physical touch as a therapeutic nursing approach in a psychiatric setting. The study uses a qualitative descriptive exploratory study design to evaluate psychiatric nurses’ views on the use of touch in psychiatric settings. With a sample size of 10 registered psychiatric nurses, the study found out that though touch was employed on psychiatric settings, its therapeutic effect was thought to only arise when used cautiously, guided by effective interpersonal skills. Such aspects as sensitivity to clients’ needs, respect for personal space, culture and possibility of misinterpretation of touch for sexual advance were found to influence extent and manner of therapeutic touch use. The study bears implications for nursing in proposing possible hindrances to use of therapeutic touch to better care outcomes.

Gregory, S. & Verdouw, J. (2005). Therapeutic touch: Its application for residents in aged care. Australian Nursing Journal, 12(7), 23-25. Retrieved July 26, 2010 from

Gregory and Verdouw (2005) explored how effective therapeutic touch (TT) is in various behavioral and physiological health conditions experienced by aged care residents. The study used a pre-test/post-test design with care givers receiving advance training from experienced instructors. A sample size of 121 case studies was employed ranging in conditions from physiological ones – 57 % (e.g. arthritis, ulcers, and edema) to behavioral – 40% – such as dementia and anxiety (2005, p. 24). The study findings suggested use of TT to have positive health outcomes both in the physiological and behavioral conditions, thus having implications in nursing for its relevance in bettering care for aged individuals living in institutionalized settings.

Jackson, E., Kelly, M., McNeil, P., Meyer, E., Schlegel, L., & Eaton, M. (2008). Does therapeutic touch help reduce pain and anxiety in patients with cancer? Clinical Journal of Oncology Nursing, 12(1), 113-120. doi: 10.1188/08.CJON.113-120.

With nursing care being associated with positive outcomes in cancer therapy this study purposed to evaluate how effective therapeutic touch (TT) is in pain and anxiety management in cancer patients. The study reviewed literature linking TT, pain or anxiety, and cancer excluding non research study-based literature such as opinions and patient-written narratives. Through three databases searches (PubMed®, CINAHL®, and Cochrane Library) 12 studies (4, 3, 5 studies respectively) that met the inclusion criteria were identified for analysis. Analysis was based on level of evidence arranged in a predetermined evidence level-rating system with the sample size, purpose of the study, research variables, methods and instruments used, and outcomes for each study being noted. Based on the reviewed studies the authors found out that TT helped reduce pain and anxiety in cancer patients. The research implications for nursing are in use of TT in pain and anxiety management to alternate or compliment western medication.

Leder, D. & Krucoff, M. W. (2007). The touch that heals: The uses and meanings of touch in the clinical encounter. The Journal of alternative and Complementary Medicine, 14(3), 321-327. doi: 10.1089/acm.2007.0717.

Leder and  Krucoff (2007) explain the unique properties of touch as means of conferring perception, instituting action and generating an expression, that could make it a potential healing force candidate in clinical encounters. The paper delineates factors such as the correct blending of compassion and skills of the nurse and the active receptivility of the patient that differentiates a therapeutic touch from other “touches.” When these factors are present in a ‘touch interaction’ the paper argues that the connection between the care giver and recipient that is required to promote healing is established. The study delineates important aspects of therapeutic touch such as delivery which presents a case for the need to learn skills for effective delivery within the nursing perspective.

MacIntyre, B., Hamilton, J., Fricke, T., Ma, Wenjun, Mehle, S. & Michel, M. (2008). The efficacy of healing touch in coronary artery bypass surgery recovery: A randomized clinical trial. Alternative Therapies in Health and Medicine, 14(4), 24-32. Retrieved July 26, 2010 from

MacIntyre, et al. (2008) evaluated whether therapeutic touch (healing touch) could result into improved health outcomes. Using various measures – “post operative length of stay, incidence of postoperative atrial fibrillation, use of anti-emetic medication, amount of narcotic pain medication, functional status, and anxiety” (p. 24) –  the study randomly assigned 237 study subjects to three treatment groups – one without intervention, one with partial intervention and a fully healing touch intervention group. The study results revealed positive outcomes with respect to anxiety and length of stay but other measures did not significantly differ among the groups. Such results provide some support for use of therapeutic touch in patient care. Implications for nursing are in evaluating the effectiveness of therapeutic touch in bettering specific health outcomes (e.g. pain, anxiety) in care provision.

Salzmann-Erikson, M. & Eriksson, H. (2005). Encountering touch: A path to affinity in psychiatric care. Issues in Mental Health Nursing, 26(8), 843-852. doi: 10.1080/01612840500184376

With studies suggesting positive outcomes of therapeutic touch in psychiatry contrary to widely held perception of its inappropriateness, Salzmann-Erikson and Eriksson (2005) sought to find out “the meaning of touch for patients who have been hospitalized for psychosis” (p. 845). The study used 4 out-patients (2 men and 2 women) who had previous hospitalization experience for psychosis before becoming out-patient clients. Interviews were conducted with the participants each lasting a maximum of 60 minutes where the participants view on what physical touching meant to them was sought. Analysis or transcripts from interview records indicated four meanings of touch to psychosis treatment clients – that physical touch was a central need they yearned for, that touching made the feel connected and gave them a sense of belonging, that touching helped them communicate their feelings, and that touch was a sign of being acknowledged. The study identified the importance of touch in bettering psychiatric treatment hence having implications for its use by the psychiatric nurses.

Vickens, C. R. (2008). Healing touch and therapeutic touch in the psychiatric setting: Implications for the advanced practice nurse. Visions: The Journal of Rogerian Nursing Science, 15(1), 46-52.

Illustrating the effectiveness and thus demonstrating why energy-based treatment modalities such as healing touch (HT) and therapeutic touch (TT) are needed in psychiatric care is the concern of this article (Vickens, 2008). Through review of literature and presentation of the researchers personal experience the paper suggests HT and TT to be effective in bettering treatment of such disorders as anxiety and depression. The implication for the study is in how psychiatry practice nurses could use these therapies to better client outcomes.

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