Care of the critically ill patient: the impact of stress on the use of touch in intensive therapy units


Renee Adomat, Lecturer in Intensive Care Nursing, Department of Nursing Studies, Medical School, Faculty of Medicine & Dentistry, The University of Birmingham, Edgbaston, Birmingham B15 2TT, England.


The literature suggests that stress is a major factor for nurses personally ‘disengaging’ from patients who are critically ill. This research aimed to investigate if nurses in a general intensive therapy unit (ITU) disengage from their patients by using touches that are mainly task orientated, rather than caring/social touches. This study sought to establish whether there was a relationship between categories of touch deployed by nurses and the individual characteristics of the nurses. The patient's prognosis (as perceived by the nurse) was also explored in relation to the touch types used. The nurses were observed and the observations were categorized with the use of an adapted taxonomy (Estabrooks 1989). This study also sought to identify potential stressors for nurses in ITU through a semi-structured interview. The analysis of the observational data indicated that there was no significant relationship between touch type and a patient's prognosis. However, there was a significant relationship between caringlsocial touch and a nurse's length of service (rs=−0.54, P < 0.01). The interview data discovered that the stressors were related to the organizational pressures of the environment in which care was delivered, rather than the involvement of caring for critically ill patients. This apparent contradiction of the literature contributes a further dimension in considering the impact of management changes and organizational structures upon nurses' stress, which has further implications for the delivery of care in ITUs.