Development and Initial Validation of the Nurses' Comfort With Touch Scale.

Background and Purpose: The extent to which nurses feel comfortable about the use of touch may affect the frequency and quality of nursing touch-based interventions. No valid instrument exists to assess nurses' feelings of comfort with touch. In this study, the nurses' scale was developed and preliminary validated. Methods: Items were generated through semistructured interviews. After testing the content validity with a team of experts, the psychometric properties were tested with a sample of 451 nurses. Results: Explorative factor analysis yielded a five-factor solution, which was supported by confirmatory factor analysis. Examination of concurrent validity revealed that comfort with touch was correlated with positive affective states and emotional self-efficacy. Conclusion: Future directions and implications for nursing research, education, and practice are discussed.Keywords: nurse; nurses' comfort; nurse-patient relationship; pain; touchThe profession of nursing is undergoing a fundamental transformation (BrieskornZinke, 2008) because of the new challenges raised by the demographic and epidemiological changes of the present-day society. For instance, the aging of the population has generated a growing need for palliative care, shifting the focus from mortality or morbidity as clinical outcomes to quality of life (Meffert & Becker, 2013). In recent years, greater attention has been paid to the psychological and spiritual well-being of patients (Lin & Bauer-Wu, 2003; Tse, Leung, & Ho, 2012), because it is acknowledged that patients experiencing a subjective sense of comfort and well-being are more likely to cope effectively with pain and illness. This is the core premise of Kolcaba's (1994, 2001) comfort theory, which describes nursing as the process of identifying patients' comfort needs and addressing them through the development and implementation of appropriate nursing interventions. In this context, physical touch can play a key role. In the process of caring, touch can be used not only to promote physical comfort and alleviate pain but also to convey emotional support and spiritual sharing (Chang, 2001). Despite its potential benefits, physical touch-especially its perception among nurses and patients-has received only marginal attention in nursing research (Gleeson & Timmins, 2005). The extent to which nurses feel comfortable about the use of touch may affect both the frequency and quality of nursing touch-based interventions. Unfortunately, a reliable and valid instrument does not exist to measure nurses' feelings of comfort with touch (CT). For this reason, this study aims to develop and conduct an initial validation of the nurses' CT scale.BACKGROUND AND CONCEPTUAL FRAMEWORKIn the comfort theory, Kolcaba (1994, 2001) states that patients have explicit and implicit needs for comfort that, if met, motivate them to engage in health-seeking behaviors, thus enhancing the likelihood of better outcomes for both the patients and the institutions. Comfort, defined as "the state of having met the basic human needs for ease, relief, and transcendence (Kolcaba, 1991), can be achieved in relation to physical, psychospiritual, social, or environmental needs that patients may experience in stressful health care situations. According to comfort theory, nursing is the process of identifying patients' comfort needs, designing and implementing appropriate interventions to address those needs, by taking into account relevant intervening variables. In this process, physical touch represents a key element, as it can provide relief from pain and generate feelings of ease (e.g., by reducing anxiety) and transcendence (e.g., by strengthening the patient's motivation) as well. The importance of touch is underlined also in Watson's (1999, 2008) theory of human caring, one of whose basic principles is the use of the self to create a healing environment for patients via intentional touch and authentic presence (e. …