Guidance on Touch.

Summary.

In the course of their work, social care workers often have to touch service users in ways which are usually found only in close relationships, for example, within families.  The ways that people touch or are touched affects the quality of service users’ lives.  This 'Guide to Touch' covers some of the issues which arise from the closeness involved in touch.

The meaning of touch varies from individual to individual, from setting to setting and from one service user group to another.  Workers will need to consider the implications of the guidance offered in relation to each person with whom they work.

Principles.

In our culture, people usually do not touch each other very much, and when they do, it carries a variety of meanings.  Care Workers need to be aware that whether they touch service users and how they touch them are very significant to the service users.

Touch is involved in many sorts of personal and physical care and is a necessary part of the care of many service users, particularly if they are physically dependent.

Touch is also a way of relating directly to a person and communicating with him or her.  It may be used to...

• Demonstrate affection

• Show acceptance

• Emphasise signed communication

• Provide reassurance

• Give directions (for a person with visual disability)

• Gain attention to engage in communication (for a person with hearing impairment)

• Restrain

The meaning of touch is therefore very varied, depending upon the circumstances.

Any touch has to be in the service user’s interests and the way in which the person is touched must reflect the purpose of touching the person.

The way in which people are touched is critical to their view of its meaning for them.  People sense very quickly if the person touching them is being affectionate, helpful, casual, cruel or exploitative.  It is important to give the right message.  Even when the physical task is essentially practical, such as bathing or toileting, the way it is done carries particular messages.

Touching people in an appropriate way is also important because if physical contact is inappropriate or misunderstood, social care workers may be subject to allegations which could jeopardise their careers.

However, fear of the risk of allegations of misconduct must not prevent service users receiving the personal and emotional care which they need.  It is important for staff to feel confident in the way they touch service users, which is why they need to know what is acceptable and appropriate.

Who ?

When thinking about who is an appropriate person to touch a service user, it is vital for a worker to consider what he/she represents to that particular individual.  Personal likes and dislikes will play a part in any relationship.  In addition, many factors affect the power relationship between the worker and service user, including gender, race, disability, age, sexual identity and role.

The experiences of the service user will also make a big difference to their interpretation of being touched and the way that they feel about individual care workers.  For example...

• A person who has lived alone for many years may not have been touched by anyone for some time, and any touch may be seen either as being intrusive or alternatively a welcome opportunity for physical contact after a period of deprivation.

• The social care workers may remind the service user of a particular individual and the way that person treated them.  A confused person, for example, may see a member of staff as their parent and expect physical contact appropriate to a parent/child relationship.

• A person who has been sexually abused may dislike all personal contact because of the memories it arouses, whether they are a child with recent experiences or an adult who had buried unpleasant memories from their past.

• A person with set views about the appropriate sex of the person who should care for them may react if cared for by a person of the other sex.

Where ?

The environment in which a worker touches a service user affects their assessment of its significance...

• Some places are private, such as residents’ rooms and bathrooms in residential care homes.

• Other places are public, such as Day Care and the communal areas of residential homes.

How service users interpret the meaning of touch in public and private environments will be affected by their previous experiences, at home with their families for example, and by the culture of the place they are in and the common expectations of everyone involved.  In some places or families, people behave more distantly or formally, while in others, people are more tactile.

Where a person is touched on their body affects the way they interpret the contact.  Generally speaking, touching someone’s hand, arm or shoulder feels less intimate than when the torso or legs are touched.  Some people feel it is acceptable for a member of staff to touch their hair, but issues of culture, age or experience may mean that other people find this experience intrusive or patronising.

Again, the previous experience of service users will colour their feelings about particular areas of contact.  They may be affected, for example, by the way a parent soothed or abused them, the way that a partner showed affection, or the way a previous carer helped them.  Care workers need to be alert to what service users sign and to individual’s body language and non-verbal messages which indicate their feelings, such as tenseness or wincing.

When and Where ?

The context in which touch takes place between members of staff and service users is the decisive factor determining the emotional and physical safety for both parties.  If the contact is justifiable and acceptable to the wider community, the worker and the service user are safe, even though the contact may be private.  It is accepted that certain professions and jobs are privileged and their members may touch their clients.  These include hairdressers, aromatherapists, doctors and nurses.

Care workers who need to carry out certain tasks or play comforting roles are included, as long as they do not overstep accepted boundaries.

Although certain aspects of service users’ care have to be kept confidential, nothing should be kept secret, especially in relation to touch.  Where a matter is kept private to a service user and a single staff member, there is always the risk that the relationship becomes corrupted, and that the worker starts to behave secretly in an unacceptable way.  The service user may then feel unable to express their concern.

Care workers need to pay attention to what service users communicate about ways they fine best to deal with their care.

In cases where acceptable types of touch are particularly important to service users, a record should be made in their care plans and new members of staff should be made aware of their needs and wishes.

It is important that care workers do not provoke situations in which physical restraint is then needed.

Where a service user seems to have misconstrued the intentions behind physical contact, the worker involved should explain to colleagues immediately, record the incident and discuss it more fully in supervision.

Where a service user has a history of accusing staff of inappropriate touch or there is concern that this could occur, it should be recorded in the Care Plan and staff should therefore avoid possible compromising situations.

If any service user, member of their family, visitor, volunteer or member of staff becomes aware of inappropriate contact by staff, they should make it known to someone in a position to take action, preferably in accordance with the agency’s whistle-blowing or complaints procedures.  Abuse often starts from minor incidents and very casual contacts designed by the abuser to test out reactions, and the sooner such behaviour is stopped or corrected the better for everyone concerned, even if the events seem trivial.  Minor incidents may indicate the tip of a serious iceberg.

Bad Practice.

The following practices should be avoided...

• Workers should avoid all types of physical contact with which service users feel uncomfortable.

• Care workers should not make assumptions that contact which is acceptable in their own families or to themselves personally is necessarily acceptable to every service user.

• It is not appropriate for staff to invite service users into their homes.

• Favouritism should not be shown through offering more physical contact to some service users than others.

• Parts of the body that carry implications of intimacy should not be touched as a way of showing concern or affection, but only when personal care demands contact.

Training.

All new staff should read these Guidance Notes as part of their induction process and have regular opportunities at supervision and in-house training to be reminded of these Guidance Notes and any additions or changes.