American Journal of Nursing 

(C) 2001 Lippincott Williams & Wilkins, Inc.

Volume 101(6), June 2001, p 11

Humane Resources: In defense of hugs in an age of paranoia.
[Departments: Viewpoint]

Saimons, Tamara L. BUS, RN, ACRN
Tamara L. Saimons is a staff nurse at Truman Street Health Services, a primary
care HIV-AIDS outpatient clinic, University of New Mexico Health Sciences
Center, Albuquerque.

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A human resources department representative came at lunchtime to present a
"mandatory" inservice about sexual harassment to our HIV-AIDS outpatient clinic.
I nearly choked on a sandwich when she told us not to touch patients anywhere
except above the neck, below the elbow, or below the ankle. "If a patient starts
to hug you," she said, "explain that hospital policy doesn't allow staff to have
physical contact with patients outside the head-elbow-ankle zone."

Apparently, our clinic had been identified as a "problem area" because of an
allegation of sexual harassment made by a staff nurse against our nurse manager.
And ours was not the only one. An inpatient unit had also been the alleged site
of improper physical contact, in which a nurse had hugged a family member during
a patient's care.

I imagined how withholding such demonstrations of emotional support would affect
our patients, who are already on the margins of society-because they have HIV or
AIDS or because they're gay or because they've used intravenous drugs. Why had
the hospital felt compelled to mandate such a procrustean solution to a problem
that seemed to be of minor significance?

Furthermore, even the administrator responsible for issuing the order didn't
agree with it, as evidenced by an e-mail communication:

I was told we were giving an inservice that said "NO touching." I think that is
ridiculous, given that nurses have to touch, both clinically and therapeutically.

Indefensibly, it's the patients in our clinic who will pay the price of such
what-if paranoid scenarios. Because I work in an HIV-AIDS clinic, I hear from
patients what it's like to live with the disease. Disclosure of HIV-positive
status to friends, colleagues, or family members is often out of the question.
Among diseases, HIV is uniquely the one that "dares not speak its name," because
of its tenacious associations with homosexuality and certain death. Patients
with AIDS are still stigmatized as members of an untouchable and infectious
caste.

As primary care nurses, we explain again and again the ways in which HIV is and
is not transmitted. It's not transmitted either by drinking from a water glass
or by kissing. It's not transmitted through casual contact, sweat, or tears.
People with HIV don't need to be trailed by someone wielding a bottle of bleach,
as was one patient, by his mother. HIV is not transmitted through touch.

In the clinic, nurses comfort and educate newly diagnosed patients and their
families and see them through the ups and downs of their relationships and the
struggles with substance abuse, antiretroviral drugs, and depression. We share
their elation when viral loads become undetectable and when CD4 + cell counts
rebound.

Although the number of deaths resulting from AIDS has declined dramatically in
this country, people still die from complications of it. We read their
obituaries and sometimes care for surviving partners. So when patients and
family members feel grateful and also safe enough to reach out to me for
physical contact, the last thing I'm going to do is refuse it.

Nurses enjoy the privilege of a human intimacy uncommon in most other professions.
We are allowed to touch people. We talk with them about private matters few
others do. Ideally, we treat the human being as a whole, someone with a wide
range of experiences, responses, and needs.

Eventually, the accused manager of our clinic took a staff position elsewhere,
and we were told to develop a "code of conduct"-which we have not yet done. We
should never have been asked to withhold the expression of compassion, our
"realness," simply because of institutional paranoia. The next time you hug a
patient, don't take for granted the fact that you can.Accession Number:
00000446-200106000-00002