Niamh van Meines is a nurse practitioner, currently self employed as a nurse consultant. She is also a licensed massage therapist, and a skilled clinical leader and educator in oncology, homecare, hospice and palliative care. Together with Barbara Goldschmidt, she has written the new book, Comforting Touch in Dementia and End of Life Care: Take My Hand.
Here, Niamh explains why touch is so essential to care.
Can you tell us a bit about the paths that led you to massage therapy, and to its applications in integrative health and palliative care?
I was a homecare nurse and wanted to offer therapy that would be comforting to my patients in ways that nursing did not routinely provide care. While massage therapy is within the scope of practice for nurses, I did not feel prepared to perform massage effectively, especially with patients who had chronic and terminal illness. I decided to go to the Swedish Institute of Massage Therapy and my interest in incorporating massage into nursing practice came from there. There are multiple studies that show the beneficial effect of massage therapy on the symptoms associated with disease, so I believe massage can be utilized as a symptom management technique. This is very useful in palliative and hospice care where multiple therapies, treatments and modalities are used to alleviate the distress that patients experience.
How did the new book come about, and what is it about, generally?
Barbara asked me to join her in writing this book as she had developed the hand massage protocol and implemented it in a nursing home. My expertise in hospice and palliative care and perspective on providing comfort for patients through multiple avenues resulted in a wonderful collaboration with this book. We both had an interest in providing ways for caregivers to help and to feel that their efforts are effective in providing comfort, so teaching hand massage to caregivers is a great opportunity to change not only the patient’s experience, but also the caregiver’s experience too.
How does the book reflect your general philosophy about care?
I believe that caring for any person who is ill begins with compassion which can be delivered in many ways. Touch is one of the most fundamental ways to offer support and caring and is often underestimated or disregarded in healthcare settings. Touch is often mechanistic and task oriented, so teaching healthcare practitioners to incorporate hand massage redirects their actions to that of a caring activity, which also has an affect on their perspective on helping to “heal”. A hand massage is a wonderful, easy introduction to using touch. From a caregiver’s perspective, they often feel disconnected from the person who is ill or weary of touching them, so it’s a wonderful way to approach the ill person and provide care in a manner that is satisfying to the ill person and to the caregiver, and safe. The hands are the most logical place to start as it often is the first place that we touch when communicating with and meeting people for the first time.
What are the benefits of touch as a way of connecting with people, as opposed to other methods of communication?
Touch can convey so many things that other forms of communication do not. Touch can be directed in many ways. It can have a calming effect or a stimulating effect that can be tailored to the goals of the touch experience. The hands are one of the easiest ways to approach someone; merely by shaking hands, you can have a dramatic effect. Touch can be more powerful than other forms of communication especially when someone is sick. Touch directed in a caring way can have more meaning than words, which makes it a useful tool when teaching caregivers to express through touch what they cannot often express through words.
What are some common obstacles people encounter when trying to use hand massage?
Caregivers often feel inadequate or unprepared to do massage. They have fears of being awkward or ineffective. They are not sure if they are doing it right. The beauty though, is that any touch whether awkward or not, can positively influence the giver and receiver. People often have difficulty slowing down and paying attention to energetic influences. This also comes with practice, so people need encouragement to keep practicing and over time, how they feel about the massage will change.
How can the book help caregivers overcome this and other obstacles?
This book touches on many areas that most people do not think about, especially from an energetic perspective and from an eastern approach to touch. It teaches people about the simplicity of touch and how it can have a dramatic effect. We hope that the framework in the hand massage protocol allows people to take the first step towards incorporating massage into their everyday caregiving.
This book can be used as a guide to doing a hand massage protocol. We encourage caregivers to have the book with them when doing massage, so that they can reference the steps and view the illustrations. It can also be used as a teaching tool in a classroom setting.
What are some examples of best practice?
Best practices always put the receiver’s needs first. Safety and comfort are a priority, so the giver must ensure the receiver is not suffering or in distress before performing massage. We also encourage caregivers to discuss the use of massage with the healthcare team to obtain permission, but also to find out if there are cautions and contraindications to massage. Because the receivers often have significant illness, it’s always best to err on the side of caution and pay attention to the receivers reaction to massage. This is truly a client-centered approach. And lastly, don’t take it too seriously. Massage should be light-hearted and friendly, an experience to be enjoyed not just by the receiver, but by the giver too.
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