Touch mediates health professionals’ interactions with patients. Different professionals have reported their practices but what is currently lacking is a well-theorized, interprofessional synthesis. We systematically searched eight databases, identified 41 studies in seven professions—nursing (27), medicine (4), physiotherapy (5), osteopathy (1), counseling (2), psychotherapy (1), dentistry (1)—and completed a meta-ethnographic line-of-argument synthesis. This found that touch is caring, exercises power, and demands safe space. Different professions express care through the medium of touch in different ways. They all, however, expect to initiate touch rather than for patients to do so. Various practices negotiate boundaries that define safe spaces between health care professions and patients. A metaphor—the waltz—integrates the practice of touch. Health care professionals connect physically with patients in ways that form strong relationships between them while “dance steps” help manage the risk that is inherent in such an intimate form of connection.
AitaV.McIlvainH.SusmanJ.CrabtreeB. (2003). Using metaphor as a qualitative analytic approach to understand complexity in primary care research. Qualitative Health Research, 13, 1419–1431.
2.
BeachM. C.InuiT. (2006). Relationship-centered care. Journal of General Internal Medicine, 21(Suppl. 1), S3–S8.
3.
BennerP. (2004). Relational ethics of comfort, touch, and solace—Endangered arts?American Journal of Critical Care, 13, 346–349.
4.
*BjorbækmoW. S.MengshoelA. M. (2016). “A touch of physiotherapy”—The significance and meaning of touch in the practice of physiotherapy. Physiotherapy Theory and Practice, 32, 10–19.
5.
BondasT.HallE. O. (2007). Challenges in approaching metasynthesis research. Qualitative Health Research, 17, 113–121.
6.
BottorffJ. L. (1991). A methodological review and evaluation of research on nurse-patient touch. In ChinnP. L. (Ed.), Anthology on caring (pp. 303–343). New York: National League for Nursing Press.
7.
BottorffJ. L. (1992). The use and meaning of touch in caring for patients with cancer. Oncology Nursing Forum, 20, 1531–1538.
8.
BrittenN.CampbellR.PopeC.DonovanJ.MorganM.PillR. (2002). Using meta-ethnography to synthesise qualitative research: A worked example. Journal of Health Services Research & Policy, 7, 209–215.
9.
*BurkholderD.TothM.FeisthamelK.BrittonP. (2010). Faculty and student curricular experiences of nonerotic touch in counseling. Journal of Mental Health Counseling, 32, 168–185.
10.
*CarlssonG.DahlbergK.DrewN. (2000). Encountering violence and aggression in mental health nursing: A phenomenological study of tacit caring knowledge. Issues in Mental Health Nursing, 21, 533–545.
11.
CarpenterJ. (2008). Metaphors in qualitative research: Shedding light or casting shadows?Research in Nursing and Health, 31, 274–282.
*ChangS. O. (2001). The conceptual structure of physical touch in caring. Journal of Advanced Nursing, 33, 820–827.
14.
*CocksedgeS.GeorgeB.RenwickS.Chew-GrahamC. A. (2013). Touch in primary care consultations: Qualitative investigation of doctors’ and patients’ perceptions. British Journal of General Practice, 63, e283–e290.
15.
*CocksedgeS.MayC. (2009). Doctors’ perceptions of personal boundaries to primary care interactions: A qualitative investigation. Communication & Medicine, 6, 109–116.
16.
*ConsedineS. (2007). Knowing hands converse with an expressive body: An experience of osteopathic touch (Master’s thesis). Auckland: Unitec New Zealand.
17.
*Dell’AcquaM. C. Q.AraujoV. A. d.SilvaM. J. P. d. (1998). Toque: Qual o uso atual pelo enfermeiro [Touch: What is the current use by the nurse?]. Rev Latino-am Enfermagem,6(2), 17–22.
18.
DexterS.LaMagdeleineD. R. (2002). Dominance theater, slam-a-thon, and cargo cults: Three illustrations of how using conceptual metaphors in qualitative research works. Qualitative Inquiry, 8, 362–380.
19.
*EdwardsS. (1998). An anthropological interpretation of nurses’ and patients’ perceptions of the use of space and touch. Journal of Advanced Nursing, 28, 809–817.
20.
ElmirR.SchmiedV.WilkesL.JacksonD. (2010). Women’s perceptions and experiences of a traumatic birth: A meta-ethnography. Journal of Advanced Nursing, 66, 2142–2153.
21.
EstabrooksC.MorseJ. (1992). Toward a theory of touch: The touching process and acquiring a touching style. Journal of Advanced Nursing, 17, 448–456.
22.
*EvansJ. A. (2002). Cautious caregivers: Gender stereotypes and the sexualization of men nurses’ touch. Journal of Advanced Nursing, 40, 441–448.
23.
FaircloughN. (1989). Language and power. London: Longman.
24.
FeilchenfeldZ.DornanT.WhiteheadC.KuperA. (2017). Ultrasound in undergraduate medical education: A systematic and critical review. Medical Education, 51, 366–378.
25.
*FisherM. J. (2009). “Being a chameleon”: Labour processes of male nurses performing bodywork. Journal of Advanced Nursing, 65, 2668–2677.
26.
FredrikssonL. (1999). Modes of relating in a caring conversation: A research synthesis on presence, touch and listening. Journal of Advanced Nursing, 30, 1167–1176.
27.
*GleesonM.HigginsA. (2009). Touch in mental health nursing: An exploratory study of nurses’ views and perceptions. Journal of Psychiatric and Mental Health Nursing, 16, 382–389.
28.
GleesonM.TimminsF. (2005). A review of the use and clinical effectiveness of touch as a nursing intervention. Clinical Effectiveness in Nursing, 9, 69–77. doi:10.1016/j.cein.2004.12.002
29.
*GrantB. M.GiddingsL. S.BealeJ. E. (2005). Vulnerable bodies: Competing discourses of intimate bodily care. The Journal of Nursing Education, 44, 498–504.
30.
*HardingT.NorthN.PerkinsR. (2008). Sexualizing men’s touch: Male nurses and the use of intimate touch in clinical practice. Research and Theory for Nursing Practice, 22, 88–102.
31.
HargreavesS. (1982). The relevance of non-verbal skills in physiotherapy. Australian Journal of Physiotherapy, 28, 19–22.
32.
*HarrisonC.JonesR. S.HuwsJ. C. (2012). “We’re people who don’t touch”: Exploring clinical psychologists’ perspectives on their use of touch in therapy. Counselling Psychology Quarterly, 25, 277–287.
33.
*HelmJ.KinfuD.KlineD.ZappileM. (1997). Acquisition of a touching style and the clinician’s use of touch in physical therapy. Journal of Physical Therapy Education, 11, 17–25.
34.
*HillerA.GuilleminM.DelanyC. (2015). Exploring healthcare communication models in private physiotherapy practice. Patient Education and Counseling, 98, 1222–1228.
35.
InghamA. (1989). A review of the literature relating to touch and its use in intensive care. Intensive Care Nursing, 5, 65–75.
36.
*InoueM.ChapmanR.WynadenD. (2006). Male nurses’ experiences of providing intimate care for women clients. Journal of Advanced Nursing, 55, 559–567.
37.
*JensenG. M.GwyerJ.ShepardK. F.HackL. M. (2000). Expert practice in physical therapy. Physical Therapy, 80, 28–43.
38.
JohnstonC. (2014). The physician’s first touch. Canadian Medical Association Journal, 186, 80–80.
39.
JonesS. E.YarbroughA. E. (1985). A naturalistic study of the meanings of touch. Communications Monographs, 52, 19–56.
40.
KangasS.WarrenN. A.ByrneM. M. (1998). Metaphor: The language of nursing researchers. Nursing Research, 47, 190–193.
41.
KellyM.TinkW.NixonL.DornanT. (2015). Losing touch? Refining the role of physical examination in family medicine. Canadian Family Physician, 61, 1041–1043.
42.
*KeoghB.GleesonM. (2006). Caring for female patients: The experiences of male nurses. British Journal of Nursing, 15, 1172–1175.
43.
KumagaiA. K.WearD. (2014). “Making strange”: A role for the humanities in medical education. Academic Medicine, 89, 973–977.
44.
LakoffG.JohnsonM. (2008). Metaphors we live by. Chicago: University of Chicago press.
45.
*LuN.GaoX.ZhangS. (2014). Attitudes on intimate touch during nursing care in China. International Journal of Nursing Practice, 20, 221–225.
46.
MalpassA.ShawA.SharpD.WalterF.FederG.RiddM.KesslerD. (2009). “Medication career” or “moral career”?The two sides of managing antidepressants: A meta-ethnography of patients’ experience of antidepressants. Social Science & Medicine, 68, 154–168.
47.
ManningP. K. (1979). Metaphors of the field: Varieties of organizational discourse. Administrative Science Quarterly, 24, 660–671.
48.
*MarcinowiczL.KonstantynowiczJ.GodlewskiC. (2010). Patients’ perceptions of GP non-verbal communication: A qualitative study. British Journal of General Practice, 60, 83–87.
49.
*McBrienB. (2010). Emergency nurses’ provision of spiritual care: A literature review. British Journal of Nursing, 19, 768–773.
50.
*McCannK.McKennaH. P. (1993). An examination of touch between nurses and elderly patients in a continuing care setting in Northern Ireland. Journal of Advanced Nursing, 18, 838–846.
51.
Merleau-PontyM. (2013). Phenomenology of perception (LandesD. A., Trans.). London: Routledge. (Original work published 1945)
52.
MilesM. B.HubermanA. M. (1994). Qualitative data analysis: An expanded sourcebook. Thousand Oaks, CA: Sage.
53.
MoherD.LiberatiA.TetzlaffJ.AltmanD. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151, 264–269.
54.
MooreJ. W. (1991). Touch: The magic of therapy and communication. Journal of Hand Therapy, 4, 1–5.
55.
*MorseJ. M. (1983). An ethnoscientific analysis of comfort: A preliminary investigation. Nursing Papers/ Perspectives in Nursing, 15(1), 6–20.
*O’LynnC.KrautscheidL. (2011). “How should I touch you?” A qualitative study of attitudes on intimate touch in nursing care. The American Journal of Nursing, 111(3), 24–31.
58.
*PascoA. C. Y.MorseJ. M.OlsonJ. K. (2004). Cross-cultural relationships between nurses and Filipino Canadian patients. Journal of Nursing Scholarship, 36, 239–246.
59.
PatersonB. L.ThorneS. E.CanamC.JillingsC. (2001). Meta-study of qualitative health research: A practical guide to meta-analysis and meta-synthesis (Vol. 3). Thousand Oaks, CA: Sage.
PattersonM. M. (2012). Touch: Vital to patient-physician relationships. The Journal of the American Osteopathic Association, 112, 485–485.
62.
PattonM. Q. (1990). Qualitative evaluation and research methods. Thousand Oaks, CA: Sage.
63.
PeplerC. J. (1984). Congruence in relational messages communicated to nursing home residents through nurse aide touch behaviors (Doctoral dissertation). University of Michigan, Ann Arbor.
64.
PhelanJ. E. (2009). Exploring the use of touch in the psychotherapeutic setting: A phenomenological review. Psychotherapy: Theory, Research, Practice, Training, 46, 97–111.
65.
*PiccoE.SantoroR.GarrinoL. (2010). Dealing with the patient’s body in nursing: Nurses’ ambiguous experience in clinical practice. Nursing Inquiry, 17, 39–46.
66.
PosthumaB. W. (1985). Learning to touch. Canadian Journal of Occupational Therapy, 52, 189–193.
67.
*RogerJ.DarfourD.DhamA.HickmanO.ShaubachL.ShepardK. (2002). Physiotherapists’ use of touch in inpatient settings. Physiotherapy Research International, 7, 170–186.
68.
RoutasaloP. (1999). Physical touch in nursing studies: A literature review. Journal of Advanced Nursing, 30, 843–850.
69.
*RoutasaloP.IsolaA. (1996). The right to touch and be touched. Nursing Ethics, 3, 165–176.
70.
*RoutasaloP.IsolaA. (1998). Touching by skilled nurses in elderly nursing care. Scandinavian Journal of Caring Sciences, 12, 170–178.
71.
*Salzmann-EriksonM.ErikssonH. (2005). Encountering touch: A path to affinity in psychiatric care. Issues in Mental Health Nursing, 26, 843–852.
72.
SandelowskiM.DochertyS.EmdenC. (1997). Focus on qualitative methods. Qualitative metasynthesis: Issues and techniques. Research in Nursing and Health, 20, 365–372.
73.
*SchifterC. C.BogertM.BostonD. (1999). Acquisition of a touching style. Journal of Dental Education, 63, 400–406.
74.
SchmittR. (2005). Systematic metaphor analysis as a method of qualitative research. The Qualitative Report, 10, 358–394.
75.
*ShattellM. M.StarrS. S.ThomasS. P. (2007). “Take my hand, help me out”: Mental health service recipients’ experience of the therapeutic relationship. International Journal of Mental Health Nursing, 16, 274–284.
76.
*TommasiniN. R. (1990). The use of touch with the hospitalized psychiatric patient. Archives of Psychiatric Nursing, 4, 213–220.
77.
*TuneD. (2001). Is touch a valid therapeutic intervention? Early returns from a qualitative study of therapists’ views. Counselling and Psychotherapy Research, 1, 167–171.
*Van DongenE.ElemaR. (2001). The art of touching: The culture of “body work” in nursing. Anthropology & Medicine, 8, 149–162.
80.
VergheseA. (2009). A touch of sense. Health Affairs, 28, 1177–1182.
81.
*WatsonW. H. (1975). The meanings of touch: Geriatric nursing. Journal of Communication, 25, 104–112.
82.
WeissS. J. (1979). The language of touch. Nursing Research, 28, 76–80.
83.
WestlandG. (2011). Physical touch in psychotherapy: Why are we not touching more?Body, Movement and Dance in Psychotherapy, 6, 17–29.
84.
*WilliamsA. (2001). A literature review on the concept of intimacy in nursing. Journal of Advanced Nursing, 33, 660–667.
85.
*WilliamsS.HarricharanM.SaB. (2013). Nonverbal communication in a Caribbean Medical School: “Touch is a touchy issue.”Teaching and Learning in Medicine, 25, 39–46.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
