Tabhair Dom Do Lámh

Tabhair dom do lámh
(give me your hand)
Hand Massage Education Programme

The use of hand massage to alleviate anxiety
Caring for People Living with Dementia

Prepared by project team:
Dympna Tuohy, Margaret Graham, Teresa Tuohy and Kevin Johnson
September 2022, Department of Nursing and Midwifery, University of Limerick


Introduction
This education programme on hand massage outlines the theoretical basis to hand massage in alleviating anxiety for people living with dementia. It provides a pictorial guide to the steps involved in providing hand massage. It is recommended that this resource be used in tandem with the video on hand massage entitled Tabhair dom do lámh (available on the Department of Nursing and Midwifery, University of Limerick website). It was initially developed in 2014/2015 (Tuohy et al, 2015) and has been revised in 2022
Background on using hand massage
• Massage can be a process for reducing physiological and psychological stress in older people (Harris and Richards 2010, Westman, & Blaisdell, 2016, Yucel et al, 2019)
• Therapeutic touch aims to facilitate healing and build and maintain communication with people with dementia (Meehan1998; Nicholls et al, 2013, Airosa et al, 2016)
• Hand massage may be an indicator of caring touch
Hand Massage and Nursing: Research example
Funded (scholarship) study entitled “Exploring nurses’ experiences of using hand massage to alleviate anxiety for individuals with dementia in residential settings” undertaken by Larkin, A. (2017) in the Department of Nursing & Midwifery, University of Limerick
Method: A qualitative descriptive approach was employed, and data was collected from semi-structured interviews held with eleven nurses working with patients with dementia in five residential care settings. Ethical approval granted.
Findings:
• Hand massage can be effective as an intervention to alleviate anxiety.
• Benefits for the patients: As a direct intervention using soothing and rhythmic touch but also in opening doors and creating opportunities for communication between the giver (the nurse) and the recipient (the patient).
• The act of giving hand massage benefitted the nurse participants. Engaging in hand massage enhanced their self-awareness and reflection on ways of caring. Being able to “tune in”, be present to the experience of touching hands gave a sense of connection on an emotional and physical level.
• Participants felt they were caring for patients in meaningful and tangibly beneficial ways. In some instances, hand massage had the effect of calming the collective atmosphere of the room in which the intervention was being given. This sense of atmospheric ease was noted by staff, visitors and families.

Benefits of Hand Massage
• Promote calmness, relaxation, sleep and comfort
• Relieve anxiety, stress and agitation
• Connects nurse/carer and person
Special Considerations
Before and during the hand massage, the carer/nurse must:
• Obtain informed consent
• Be aware of and take cognisance of:
• The person’s verbal and nonverbal responses
• The person’s underlying physical conditions e.g., pain, immobility, skin conditions
• The person’s normal routine e.g., mealtimes, rest and activities
• Timing
Assessment
• Individualised person-centred approach
• Use of appropriate communication
• Assess for pain, discomfort, hunger, and thirst etc.
• Assess for fear and anxiety relating to the use of therapeutic touch
• Check whether something is troubling the person …does s/he have something to say? May need time to say it
Timing for Hand Massage
Be aware of specific triggers for restlessness for individual patients
Be alert to patient cues (verbal and nonverbal) for more or less touch
Provide hand massage before certain activities e.g.
• Getting dressed
• Administration of medication
• Going to bed

Some Questions
How does hand massage benefit the patient? It reduces anxiety and promotes relaxation
How do I know it works? Studies have shown both physiological and psychological positive changes in response to hand massage (Harris and Richards 2010, Westman, & Blaisdell, 2016, Yucel et al, 2019).


The Skill of Hand Massage
There are general principles to be adhered to (Setting up, Establishing Contact), as well as specific steps in hand massage. Prior to commencing the hand massage, Effleurage should be included.
General Principles
Setting up: massage is relaxing, to enhance the experience there are a few simple steps to help create the right mood in which to carry out hand massage
• a quiet, warm area is preferable
• a pillow or cushion (place underneath the hand)
• towel
• oil or hand cream
• soothing music enhances the experience
• follow good hand washing practice
Establishing contact:
• Take a few moments to establish a bond of communication with the person, to explain what you are going to do and to prepare yourself for the massage
• Focus or ‘centre’ yourself by becoming aware of how you are feeling and by letting go of outside concerns so that you can concentrate on the massage.

Steps in Hand Massage
1. Place a towel under the arm and hand
2. Apply oil/cream to forearm using an effleurage movement working from wrist to elbow, always work in the direction of the heart.
3. Take person’s hand palm down over your own palm, use small brushing movements with your thumb to work upwards between the joints of the fingers towards the wrist.
4. Move towards the fingers, gently massage the joints between your thumb and forefinger as you move towards the tips of the fingers.
5. Repeat with each finger, finishing with the thumb.
6. Turn person’s hand over and gently massage the outside of the palm area, using small brushing movements with your thumb. Move towards the fingers, gently massage the joints between your thumb and forefinger as you move towards the tips of the fingers. Finish with a slight pull to the finger to stretch it out.
7. Gently hold the hand for a moment
8. Cover the hand with a towel.
9. Repeat the massage on the other arm and hand.
10. When you have finished the massage check that the person is warm and comfortable, remain with the person for at least five (5) minutes. Offer a glass of water for them to drink if they choose.

Effleurage (smoothing stroke)
This is a smooth, sliding movement which soothes the skin and distributes the oil/cream.
It is always worked towards the heart, effleurage improves circulation, lymph flow and the function of the muscles. It is used between movements throughout the massage to provide continuity and to prepare a new area with oil/cream.

Evaluation of the Hand Massage
Reflective Cues
• What went well?
• How do we know it was effective? Consider: person feedback using cues such as verbal and nonverbal responses
• What was the value of using hand massage in caring for the individual person?
• How did the use of hand massage promote the nurse/carer-person relationship?
• How has it influenced your care?










Hand Massage


A step-by-step process through photographs

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References List
Airosa, F. Falkenberg, T, Öhlén, Gand Arman, M. (2016) Tactile massage as part of the caring act a qualitative study in short-term emergency wards Journal of Holistic Nursing 34 (1)13–23
Harris, M. and Richards, C. (2010) The physiological and psychological effects of slow-stroke back massage and hand massage on relaxation in older people. Journal of Clinical Nursing, 19, 917-926.
Larkin, A. (2017) “Exploring nurses’ experiences of using hand massage to alleviate anxiety for individuals with dementia in residential settings” unpublished thesis University of Limerick: Limerick.
Meehan, T.C. (1998) Therapeutic touch as a nursing intervention. Journal of Advanced Nursing, 28 (1)117-125.
Nicholls, D., Chang, E., Johnson, A. and Edenborough (2013) Touch, the essence of caring for people with end-stage dementia: a mental health perspective in Namaste Care. Aging Mental Health 17(5):571-8. DOI: 10.1080/13607863.2012.751581

Tabhair dom do Lámh (Irish) is a an early 17th century tune from Ireland composed by Rory Dall O'Cahan. The tune was revived by Seán Ó Riada
Tuohy, D., Graham, M.M., Johnson, K., Tuohy, T. and Burke, K, (2015) Developing an educational dvd on the use of hand massage in people with dementia: An innovation. Nurse Education In Practice, 15(4):299-303. DOI: 10.1016/j.nepr.2015.03.010
Westman, K.F. and Blaisdell,C. (2016) Many Benefits, Little Risk: The Use of Massage in Nursing Practice AJN 116(1) 34-39, available at https://nursing.ceconnection.com/ovidfiles/00000446-201601000-00021.pdf

Yucel, S.C., Arslan, G.G. and Bagci, H. (2020) Effects of hand massage and therapeutic touch on comfort and anxiety living in a nursing home in Turkey: A randomized controlled trial Journal of Religion and Health 59:351–364 https://doi.org/10.1007/s10943-019-00813-x
Sponsors: Sponsored and supported by the Department of Nursing and Midwifery, University of Limerick
Collaborators in partnership
Kath Burke, RGN previously Clinical Nurse Manager, St Camillus Hospital, Limerick
Alisha Mac Mahon BA Irish Music and Dance student at the Irish World Academy of Music, University of Limerick performed and recorded the music
Department of Nursing and Midwifery, University of Limerick for programme development support