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International Journal of Nursing Practice 2014; 20: 221–225

CLINICAL PAPER

Attitudes on intimate touch during

nursing care in China
Nan Lu MD Nurse Supervisor, Department of Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
Xiaoyan Gao BD Director, Department of Nursing, Beijing Jishuitan Hospital, Beijing, China
Shuang Zhang BD Head Nurse, Department of Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
Accepted for publication November 2012
Lu N, Gao X, Zhang S. International Journal of Nursing Practice 2014; 20: 221–225 Attitudes on
intimate touch during nursing care in China
Although intimate touch is essential to nursing practice, few studies have investigated patients’ wishes
and how nurses should perform in preserving patient privacy in China. A maximum-variation sample of
18 adults was selected, and semistructured interviews were conducted in two focus groups. Interviews
were recorded and transcribed, and thematic analysis was performed. Five themes emerged from the
interviews. These findings suggest that nurses should pay more attention to the patient’s attitudes, needs
and wishes.
Key words: intimate touch, patient privacy, qualitative research.

INTRODUCTION
an individual to control their bodily integrity or
personal Although patient privacy has been talked about and with
space and social contacts.2 Control includes
social power concern frequently, there are no related series of rules or
and freedom of choice.3 The term withdrawal is
used to legislation in China.
describe psychological privacy.3–6 The term
inaccessibility Privacy includes the right to independent decisions
is sometimes used to describe informational
privacy. Only based on personal beliefs, feelings or attitudes, the right to
the informational dimension relates to
confidentiality.1 control bodily integrity, and the right to decide when and
Privacy is a key ethical principle in hospitals.
Its impor- how sensitive information is shared. Privacy is thus a more
 tance is emphasized in law as well as in
textbooks in global term than confidentiality and has four dimensions:
China; yet there is only very limited empirical
research on social, psychological, physical and informational.1,2 Key
privacy. For example, the title is ‘Reflections on
respect elements of the concept of privacy, as seen from the
the privacy of patients’ and so on. Whereas
others is an individual’s point of view, are control, inaccessibility and
investigation to the nurse. For example, the title
is ‘The withdrawal. The physical and social dimensions of privacy
study on the attitude towards privacy of clinical
nurses’. are often defined by the term control, that is the ability of
Few studies have investigated the patient’s preferences regarding how nurses should perform in China.
This article discusses questions regarding the
break- Correspondence: Xiaoyan Gao, Department of Nursing, Beijing
down of a patient’s physical privacy, as mentioned
Jishuitan Hospital, Beijing 100035, China. Email: jstgxy@sina.com
above, when intimate touch occurs. Intimate touch is
doi:10.1111/ijn.12129 © 2013 Wiley Publishing Asia Pty Ltd
222 N Lu et al.
© 2013 Wiley Publishing Asia Pty Ltd the intimacy of physical disclosure and contact. Patients
regions of the entire country. We anticipated that
these permit their nurses to touch their bodies in comfortable
patients would represent a wide range of
perspectives on ways that would otherwise be inappropriate, and to see
the issue of intimate touch. them naked or
flawed.
We recruited nine patients who lived in a
suburban Nurses touch patients in order to perform clinical
area and nine in the downtown area. Each
participant tasks. Nurses touch areas of the patient’s body such as
reviewed and signed a consent form. The first
two authors genitalia for catheterization, buttocks for intramuscular
facilitated each focus group using a
semistructured inter- injection, perineum for washing, etc. Therefore, it is
view protocol that started with a broad opening
question believed that intimate touch should be defined as
(Appendix 1). We asked questions about male
nurses task-oriented touch.7
because several studies have described the
difficulties Hardinget al. define intimate physical touch as involving
male nurses have with touch,8,10–15 and some
studies have ‘inspection of, and possible physical contact with, those
suggested that some patients prefer to be touched
by parts of the body whose exposure can cause embarrassment
female rather than male nurses.16 to either the
patient or the nurse.’8
We asked the same questions in each group, and
Many routine nursing procedures involve intimate
follow-up questions were modified gradually in
the touch, yet little has been written about it. Most studies of
process of the interview, which were posed by us
and a patient’s anxiety about a nurse’s touch have focused on
other group members. Each session lasted 40 to
60 min male nurses but give little guidance on how to reduce that
 and was tape-recorded, wherein one of us
transcribed anxiety. Our study aimed to gain information from
each recording. At the end, we summarized
important patients that could help nurses.
points with participants to ensure accuracy and to solicit further comments. Afterward, we discussed our
notes STUDY DESIGN AND THEORETICAL SUPPORT There are uncertain laws and regulations that
outline the code of ethics or obligations for nurses in China. Also, we acknowledged that different nurses
understand codes of ethics in different ways and patients might interpret those actions differently.
Therefore, we hypothesized that asking patients about their preferences for intimate touch would be an
important step in fostering collaboration and respect.
and observations with each other, comparing responses with those from prior focus groups. We ended
data col- lection when redundancy in responses became evident.
We used a modified process of thematic analysis, as described by Aronson.17 We read the transcripts
inde- pendently, noting general categories of comments and labelling segments of the transcripts as
belonging to one or more of those categories. We then met and discussed our analyses, identifying
similarities and differences among our categories. Together, we refined these cat- egories into broader
themes and reclassified transcript segments. After reaching consensus on four themes, we METHODS
again examined the transcript segments to ensure
that We designed a qualitative investigation of using semi-
they supported the themes. No new themes
emerged in structured interviews in focus groups. We selected a pur-
this last analysis, and we determined that the
themes poseful, maximum-variation sample of adults in different
were strong. regions of the entire country. The
inclusion criterion was the ability to provide consent. The exclusion criterion was
RESULTS ever having been
a nursing student or employed as a
A total of 18 patients were divided into two
focus groups. nurse. Maximum-variation sampling (also called hetero-
Each consisted of nine patients. The sample age
ranged geneity sampling and diversity sampling), a method often
from 25 to 78 years (Mean = 48.3 years). All of
them had used with small sample sizes in qualitative research, con-
received intimate touch from nurses. (Table 1)
sists of selecting participants who are thought to offer
Five themes emerged from the data (Table 2).
diverse interpretations of the phenomenon of interest (in this case, attitudes about intimate touch), with
the
‘Touch me gently and slowly’ purpose of
gaining as broad a range of responses as pos-
Patients had much to say on how intimate touch
should sible.9 In this study, we selected patients from different
be provided when it was necessary. We asked specifically
Attitudes on intimate touch in nursing care 223
Table 1 General information

and ‘It was almost like I wasn’t there’. Patient 8 said that nurses should ‘explain what they are going to do
before Male
Female

doing it.’ Patient 15 said, ‘Don’t touch me without telling (n = 9)

(n = 9)

me’ and ‘Nurses should let me know touch will be nec- essary.’ Patients 12–15 said, ‘Nurses should speak
clearly and with a mild voice.’ One woman complained that her nurses talked to others in the room while
perform- ing nursing care and that she felt excluded from the conversation and ignored.
The most in-depth discussion among patients cen- tred on nurse–patient relationship, if care involved
intimate touch. Patient 17 said, ‘I don’t want it to be cold.’ Patient 18 suggested, ‘Establish a relationship
with the patient. Tell me your name. Tell me what the next plan of action is. Make a human connec- tion.’
Humour was helpful, patients 14–15 said, in reducing the tension around intimate touch. Patient 16 said
that silence during intimate touch made them uncomfortable.
‘No others besides me’ The patients preferred closed doors and a drawn curtain, not just to
their room but also to the treatment room, if that is where the intimate touch occurred. Patients 5–14 and
16 said, ‘Prepare a private room or separate me from the others with something like a screen.’ Patient 18
sug- gested, ‘Please allow my relative to stay here, it makes me relax.’ And patients addressed the need
for bodily privacy. They wanted minimal exposure, they said, with other body parts covered by blankets
that do not flap open when they are turned.
‘Female nurses are better’ Patient 7 said, ‘I don’t think the nurse’s gender makes a difference.
You don’t see that nurse as a male nurse or a female nurse; you see that person as someone who is there
to try to help you.’ Patient 11 said, ‘For me, gender doesn’t really matter. I just want them to be
competent.’
Most of the young female patients said they preferred a female nurse, and young male patients were
split in their preferences. Patient 4 stated, ‘If it happened that I could have someone of the same gender,
that might make me more at ease.’ Another young man (patient 5) said, ‘I don’t mind if a male nurse is
taking care of me, unless he has to touch my genitalia. Then I would prefer a female nurse.’
© 2013 Wiley Publishing Asia Pty Ltd Total (n = 18)
Age Age range, years 30–76 25–78 25–78 Mean age, years
(standard deviation)
51.8 (24.4) 48.4 (21.2) 48.3 (20.7)
Habitats (%) Suburban 5 (56) 4 (44.4) 9 Downtown 4 (44.4) 5 (56) 9 Marital status Single 2 1 3 Married 7 8 15 Education
Illiterate 1 1 2 College or below 6 7 13 Bachelor or above 2 1 3
Table 2 Data of five themes
Theme Male Female Total
Touch me gently and slowly 9 9 18 Explain and inquire 8 9 17 No others besides me 5 7 12 Female nurse is better 7 9 16 Refuse
nursing students 5 8 13
what that looks and feels like. Responses centred on the nurse’s approach and the quality of the touch.
They wanted to be touched gently and slowly. They wanted eye contact, but not to allow the eyes to gaze
on private areas of their bodies. For example, patients 2–5 and 7 said, ‘Touch gently, not roughly’, ‘Any
kind of rudeness would make me feel anxious and have a sense of loss in dignity.’ Patient 3 said, ‘Too
fast almost seems like they are trying to avoid the situation, or they are very impatient.’
‘Explain and inquire’ Patients in each focus group said it was of utmost impor- tance for the
nurse to first explain and inquire about their feelings and that this must occur before and at the start of
intimate touch. For example, the comments of patients 1–10 included, ‘They didn’t really explain that to
me’,
224 N Lu et al.
© 2013 Wiley Publishing Asia Pty Ltd
Few patients would not accept male nurses in China.
touching style.20 We deduce that nurses should
converse Patients 8–10 said, ‘When a man became a nurse, it was
with but not mindlessly chatter at patients. They
also different.’ They can accept a female nurse touching
stress the need to seek permission from patients
prior to them only.
touch and conclude that a ‘significant component of the propriety of touch is related to patient consent.20’
We ‘Refuse nursing students’
suggest that, whenever possible, nurses seek
permission Nursing students were not accepted by most patients
from patients before using intimate touch.
because they did not think the nursing students were
The need for nurses to ensure privacy is
covered clearly professional. Patients 3–11 and 14–18 said, ‘Students
in most basic nursing textbooks. Typically,
privacy is dis- should be taught, but I don’t want to be a model.’ Patient
cussed as minimizing exposure of a patient’s
body and 1 said, ‘Students are not professional, I don’t want
drawing curtains. Our patients mentioned that
they pre- him/her to touch me.’ Patient 2 said, ‘I prefer a profes-
ferred their relatives being present during
nursing care. sional nurse to take care of me, I feel more comfortable
We found no discussion in the literature about
how a and safe.’
patient accompanied by relatives could reduce their tension or increase their comfort. DISCUSSION
Regarding a nurse’s gender, Lodge et al.
report that Our participants wanted the nurse’s touch to be gentle
obstetric and gynaecologic patients had no
preference and not rough, slow and not fast. No other study com-
concerning their nurse’s gender if they had prior
experi- mented on such qualities of touch. Of course, preferences
ence with male nurses.21 Harding et al.8 and
Inoue et al.14 are quite subjective and we suggested nurses should pay
 found that male nurses felt they should seek
permission attention to cues from patients.
and explain procedures before providing intimate
touch, Overall, our patients said they wanted to know prior to
but those actions were to protect themselves
rather than intimate touch that it is necessary to the diagnostic or
to foster rapport. In contrast, most patients were
more therapeutic process and what it will involve. They wanted
likely to use female nurses in China. nurses to
explain before touching and to inquire about
The nurse’s gender has been a primary focus
of their feelings, such as listen to their concerns and answer
research; authors have noted that male nurses
fear their their questions. They wanted rapport and interaction with
touch will be misinterpreted by patients and that
patients their nurses and not only conversation focused solely on
have mixed feelings about intimate touch
provided by the nurse. Hence, it is necessary for nurses to be trusted
male nurses.8,10–14,19 by their patients. As
trust develops, patients become
In a 1998 qualitative study, both male and
female increasingly willing to open themselves up. In fact, many
nurses said they were ‘uneasy’ when providing
intimate nurses are uncertain about the implications of, or meas-
care to patients of the opposite sex who were
near their ures to prevent and correct, inappropriate behaviour.18
own age.10 In some cases, it is difficult to
distinguish between what
Morin et al. interviewed postpartum women
on their are strictly health needs and what are personal needs.
views about receiving intimate touch from male
nursing Although appropriate intimacy is essential for good
students and found that the women’s opinions
were nurse–patient relationships, to be effective, nurses must
shaped by several factors, including how they
felt about also become involved in a patient’s experience with
 their own attractiveness.22 illness. All of these
things, they said, increase their comfort with intimate touch.
CONCLUSIONS Edwards notes
that nurses use small talk as a distraction
The above findings suggest that nurses should
pay more that reduces the nurse’s and patient’s embarrassment.19
attention to a patient’s attitude and wishes. As a
rule, if The authors also note that humour can be used to reduce
a patient believes a nurse is doing something
inappropri- tension for both nurse and patient.
ate, it is so perceived, however well-intentioned.
Nurses Estabrooks and Morse identify cueing, in which nurses
should reflect on how they approach intimate
touch. monitor verbal and nonverbal cues from patients in evalu-
Black notes that respect for patients requires
commu- ating the effectiveness of their touch, as a ‘core variable’
nicating well, soliciting patient input in
decisions, in the development of an intensive-care unit nurse’s
and honouring patient values.23 We agree with Chad
Attitudes on intimate touch in nursing care 225
O’Lynn;7 that is, a patient’s preference must be consid-
14 Inoue M, Chapman R, Wynaden D. Male
nurses’ experi- ered in the development of evidence-based strategies for
ences of providing intimate care for women
clients. Journal intimate touch.
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Although patients varied in age and region, with regard to
382–389. nationality, the sample lacked
minority patients in China.
16 McCann K, McKenna HP. An examination of
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and actions as other than what is intended. Patients who are not Han, for example, might express stronger
preferences about touch and a nurse’s gender.
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