After a baby is admitted to our neonatal intensive care unit, nurses have several goals in our initial talks with the infant's visitors. Two big ones always come to mind for me right away: to instill a sense of confidence among family members and to help keep the baby free from infection. For a long time, I failed to connect the two issues, but I've learned that they do intersect at a curious place: the handshake.
I'm a handshaker. Chalk it up to a conservative, old school upbringing. I try to shake hands with every father I meet in our unit. I think that dads are frequently ignored in the NICU, and I think a handshake is a good start to making a professional impression and to making fathers feel valued. Every once in a while, however, my handshake does not have the intended effect. Recently I extended my hand to a father and he looked at me like I was an outright whackadoo, saying that he had just sanitized with Purell.
This set me out on a quest for more information about provider-patient interactions, infection and expectations. Here's what I found. Apparently, around 80% of patients like handshakes from their physicians. A handshake with a mom can even be a neonatal diagnostic tool. Just be careful not to get hurt! However, my PubMed search turned up no data on the infection control ramifications in any setting, nothing about handshakes by nurses and nothing on the social expectations of NICU families in particular.
What do you think? If I wash my hands at the beginning of the shift and I use hand sanitizer before every baby contact and after every baby contact, is it okay to continue with my handshakes? For my part, in the absence of some data, I'm forging ahead... even if it gets me the occasional odd look.
Go with the handshakes!!! :) (I don't think I'd trust a doctor who did NOT try to shake hands.)
ReplyDeleteThanks, Diana! Your blog really piqued my curiosity. I've seen several coworkers and friends experience distressing HG. Keep up the good work!
ReplyDeleteAs an inpatient in the Netherlands (MRSA rate = v low indeed) the doctor came in, shook my hand, washed them then went to examine the baby. Washed hands, shook next patients hand etc. Repeat for EVERY woman in that room (there were 4 of us) She may have had shares in Nivea.
ReplyDeleteI introduced myself to the doctor attending my baby with "hi, I'm ...'s mum"; his response "oh are you, good for you". He then went on to ignore me as I stood there feeling like an idiot and I finally left the NICU in tears after a couple of minutes. I say go with the handshake for the mums as well as the dads; parents don't forget and it signifies a partnership in care for the baby.
ReplyDeleteAnonymous #1 - It definitely must seem like we have some financial interest in medical-grade gloves, hand sanitizers and skin care products at times!
ReplyDeleteAnonymous #2 - What an awful experience. I am so sorry. I know that won't ever to be easy to forget. As I was searching PubMed I found some interesting results indirectly related to my blog entry. Apparently simple touch can facilitate business deals, encouraging the client to take more risk and spend more money. And clinic patients who received friendly touch were more likely to underperceive the time they had spent waiting to see a doctor.
Yes, I say keep up the handshakes. As long as you are following good infection control via purell and handwashing, I think it is good you are a hand shaker. You are always going to get some member of the population who does not like what you are doing, no matter what it is you do. So you really cannot please all the people all of the time. I think the majority of people see it as a sign of politeness. I know I do.
ReplyDeleteI can see it from that father's point of view. He sanitized his hands so he could touch his baby, then if he shakes hands with you, he'll need to sanitize again. Myself, I really don't want to shake hands with anyone in the hospital. I try to avoid touching door knobs or any other surfaces that a lot of people touch, esp. during flu season. I would see it as a friendly gesture and would probably shake with you, but I'd be uncomfortable about it.
ReplyDeleteThank you for giving us a view from the other side, Debbie. Part of this issue may be that I made an erroneous assumption about the education that had already been provided to the baby's father.
ReplyDeleteOn my unit, nurses and visitors are supposed to follow the same procedure for sanitizing their hands. That is, we both should sanitize our hands at the door, then we should sanitize again before touching a baby and after touching a baby.
As Dad had just walked in, he would have needed to Purell his hands again prior to touching the baby. This is particularly important in the neonatal ICU, since the environment surrounding the baby's bed is commonly contaminated by activities such as diaper changes and airway suctioning. The hand scrub at the door serves little purpose once you've happened to touch the counter or the top of the incubator.
Again, thanks for the comment. I can easily see this father's thoughts as well, even if I don't agree with them personally.
being a post partum nurse and the mom of 2 kids who were in the NICU, I applaud you for reaching out to the dads.
ReplyDeleteWhen our kids were in the NICU, I know how important it was that my husband feel a part of the care of our kids. I also know how freaked out we all got about washing our hands and touching things after doing so! But handshakes can instil a sense of partnership in ways that talking can't, especially with men.
As a nurse, I try hard to acknowledge the father and other family members in the room and talk to them too and shake hands if they extend it to me (and then run for the sanitizer again!). But I don't tend to offer my hand 1st, but I'm not a hand shaker by nature.
I say, keep at it, keep shaking hands and for those who choose not to, then so be it. Also, it could be a great chance for education about how surfaces aren't "clean" and how they need to sanitize again!
When the A(H1N1) pandemic was at its worst, some of the wards in the hospital where I work decided to suspend temporarily the practice of shaking hands with patients and their families. They sent out information about this. Soon afterwards, it was pointed out by the doctor responsible for protection against contageous diseases a ban on handshaking was not one of the actions likely to reduce the spread of A(H1N1). He recommended other strategies instead.
ReplyDeleteI see that this post is somewhat old, but I just had to say this. If I find the original information (and if it is publicly available on the Internet), then I will post a link. It's in Norwegian, but with Google translator, I think anyone can get an idea of what is said there.
J.