Scholars of the humanities want to get to the bottom of human behaviour. Touch has turned out to be an important part of interaction at service centres, and research focused on the topic led Kaarina Mononen to observe how the independence of residents can be supported. Often, touch and the support of independence are intertwined, much like other aspects of interaction.
Mononen’s research, focused on linguistic interaction, is based on a total of 55 hours of video material recorded at a service centre in southern Finland. The manner in which nurses touch the residents when offering everyday help became a subject of further examination, with ethnographic observation and background interviews as part of the study.
Touch is part of language
Nurses at service centres touch the residents, for example, to notify them of their presence, to express caring and to support independent activity. According to Mononen, even brief contact carries significance.
“Touching is part of overall communication, conveying kindness and mutual understanding. If speech, hearing or certain other parts of a person’s functional capacity are reduced, touching may compensate for such lost abilities: for instance, a nurse may catch the attention of a resident by touching them.
In nursing homes, contact can be extended to the aids used by residents, such as walkers and wheelchairs. Touching an aid can be meaningful and even expressive of closeness. For example, the nurse may guide a resident’s activities by tapping the handle of their walker: "Take a hold of this".
Through everyday interaction between nurses and care home residents, touch becomes part of interaction. Touching is often part of the dialogue conducted with a resident, for example, when guiding them to eat. When nurses are familiar with residents, they also know better whether and how to touch them.
However, no universal manuals on suitable or appropriate touching can be drawn up for nursing homes. The lack of clear guidelines can be annoying or frustrating, but knowing the residents is essential. Establishing a confidential relationship requires familiarity and takes time.
"Body language is also language."
“Contact is a big part of guiding activities and establishing personal relationships, and its range of tones are uncovered through research on the micro-level. Body language is also language,” Mononen points out.
Independent activities promote wellbeing
Service centres strive to support the independence of their residents. This is a value in itself, and part of rehabilitation nursing: independent activities support functional capacity. Encouragement for functional independence can be provided, for example, by offering alternatives: residents are asked whether they want to have coffee, and their initiatives and choices are praised. Mononen has examined praise and acknowledgment in an article (in Finnish only) published in the Gerolontogia (‘Gerontology’) journal.
“It matters how the form of help is chosen. Even if transporting residents to their rooms would be the quickest way, they are aided to move independently using gestures and encouragement. Passing through a door or getting up from a chair by yourself improves functional capacity and, at the same time, seems to extend to wellbeing. Situations and the condition of the residents vary from day to day, and this is taken into account when supporting autonomy,” Mononen describes.
Touch has a close connection with supporting and acknowledging individuals. Touching someone’s shoulder while guiding them may engender feelings of safety and calmness, something often associated with positive emotions. Then again, contact is also a necessity. The autonomy of nursing home residents is unavoidably diminished, and many nursing practices involve touching, regardless of whether those nursed want to be touched.
“It’s a daily balancing act between nursing and being patronising in nursing homes. This is the central point of tension in research focused on old age. On the one hand, you want to provide high-quality care and express intimacy, and on the other, caring can easily be perceived as excessive patronage and manipulation – particularly when those nursed are adults. What is of the essence is to concentrate on establishing a friendly atmosphere and to take individual differences into consideration.”
Even brief contact is enough to convey one’s presence, as indicated by Mononen’s previous research (in Finnish only) on linguistic interaction in elderly care.
Presence engenders efficiency
The quality, planning and price of care in Finnish service centres have become a topic of social debate, as people have been shocked by the dismal situation exposed in certain centres. Kaarina Mononen thinks that a mechanical way of thinking based on efficiency approaches the issue from the wrong direction.
“Technical help is of course needed, but nothing will replace humans in nursing. The touch of a robot is an idea based on absurd values. As a researcher of humans, I want to demonstrate the significance of a human presence.”
"Technical help is of course needed, but nothing will replace humans in nursing."
That significance is evidenced by nursing home residents responding to interaction, participating in conversations and taking some control in the situation. Through this, the sought-after efficiency will also emerge. Engaging in small talk or touching a resident at an appropriate stage engenders a good atmosphere, which makes it easier to carry out routines. Social activity is part of nursing, and fostering social relationships has been found to be meaningful also to nursing staff.
The professionalism and experience of nurses also constitute a relevant factor, in addition to which functional interaction requires permanence in the nursing home staff, as well as a reasonable workload for them: stressed-out and exhausted nurses cannot cope in their duties.
“Studying interaction is key to this: how people encounter each other and what meaning do words and gestures have in getting along. Language and communication are complex things,” Kaarina Mononen notes.