<p>Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care.</p>

Bakgrund:Beröring är en viktig del i omvårdnaden som sjuksköterskan tillämpar naturligt. Beröring har en lugnande funktion och taktil massage som metod kan därmed tillämpas i syfte att lugna patienter med ångestproblematik. Syfte: Syftet var att belysa hur personer med ångest upplever taktil massage som behandlingsmetod. Metod: En litteraturstudie med systematiskt tillvägagångssätt tillämpades. Studien baserades på elva vetenskapliga artiklar. Resultat: Personer med ångest upplevde sin tillvaro som oerhört lidande. Massagen medförde i personens kaos en upplevelse av välbefinnande för kropp och själ och som även gav utrymme för att fly från tid, rum och tankar. Massagen ingav känslor av bekräftelse och respekt men som emellertid även upplevdes som en överträdelse av den personliga sfären. Diskussion: Att känna sig utvald upplevdes som något oerhört värdefullt. Kropp och själ var viktigt för individens utvecklande och totala harmoni. Integriteten var betydelsefull att poängtera då kroppen upplevdes som ett personligt och privat område. Slutsats: Det är viktigt att sjuksköterskan uppmärksammar effekterna av taktil massage. Detta medför att större förståelse och kunskap kring behandlingen kan erhållas. På så vis kan en bättre och mer optimal omvårdnaden erbjudas. / Background:Touch is an important part of nursing that the nurse applies naturally. Touch has a calming function and tactile massage can therefore be applied to calm patients with anxiety problems. Aim: The aim was to highlight how people with anxiety experience tactile massage as a treatment. Method: A literature review with a systematic approach was applied. The study is based on eleven scientific articles. Results: Individuals with anxiety disorders experience life as immense suffering. The massage brings a feeling of well being for body and soul into the person's chaos which also assists with scope to escape from time, space and thoughts. The massage entailed feelings of affirmation and respect which, however, also was seen as an infringement of the personal sphere. Discussion: To be experienced as chosen was seen as extremely valuable. Body and mind was significant for individual self-development and overall harmony. Privacy was important to point out since the body was perceived as a personal and private area. Conclusion: It is important that the nurse notes the effects of tactile massage. This leads to greater understanding and knowledge regarding the treatment that will allow a better and more optimal care offered.

Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care.

Syftet med denna litteraturstudie var att undersöka tillgänglig litteratur beträffande taktil beröring som alternativ smärtbehandlingsmetod samt vilka effekter taktil beröring har på patientens smärtupplevelse och för vårdgivande personal. Metoden som användes var Goodmans modell för evidensbaserad litteraturgranskning. Tio artiklar granskades enligt kriterier av Polit och Beck (2006) samt Willman et al (2006). Resultat visar vikten av beröring som metod för minskning av smärta, samt andra effekter som förbättrad sinnestämning och ökad livskvalitet hos patienter. Positiva och negativa effekter av beröringsbehandling för vård-personalen har tagits upp i några inkluderade studier. / The purpose of this literature study was to examine available literature regarding tactile touch as an alternative pain treatment method, and also the effects of tactile touch on the patients´ pain experience and to the care giving personnel. The method used was Goodman´s model for evidence based literature examination. Ten articles were examined following the criteria described by Polit and Beck (2006) and Willman et al (2006). The result shows the importance of tactile touch as a method for reducing pain and other effects as improved mood and life quality in patients. Some positive and negative effects by tactile touch treatment to the care giving personnel are also considered in some of the examined studies.