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May I Hug You? Supporting Personal Boundaries in the Health Care Setting

Paradisi, Julianna RN, OCN

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AJN, American Journal of Nursing: March 2020 - Volume 120 - Issue 3 - p 47
doi: 10.1097/01.NAJ.0000656344.46834.05
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“May I hug you?” My patient and I had just finished a rather lengthy conversation, the kind of authentic communication that reaffirms the humanity connecting us all—the number one reason I love being a nurse. Sitting in a chair across from me, she reached out her hand for me to shake. I sensed she felt the same connection I did but was too shy to ask for more.

“May I hug you?” I asked. Tears formed in her eyes as she stood, and we hugged. The circle was complete.

Not everyone is comfortable being touched. I'm a hugger. I connect easily with patients and throughout my career have given and received more spontaneous hugs than I can hope to count. Lately though, for a variety of reasons, I've begun to ask permission before hugging a patient.

Foremost, I've developed a stronger advocacy toward the right to personal boundaries. I am not you is a good thing to remember when meeting anyone for the first time, whether they are a patient, coworker, or child. Not everyone is comfortable being touched.

‘Handshake-free zones.’ A while ago, I met a new resident while visiting a patient in her hospital room. After introducing ourselves, I reached out my hand to welcome the new resident. She stared at my hand, withholding hers, as our patient watched. I withdrew my hand as inconspicuously as possible, slightly embarrassed. It occurred to me the resident might subscribe to establishing “handshake-free zones” in hospitals, an idea gaining popularity in our era of super infections.

Paradoxically, at a personal appointment with a physician new to me, she reached out her hand to shake mine. Although I shook her hand, for some reason she mistakenly interpreted a hesitancy on my part and went to great lengths to explain that she always washes her hands before entering exam rooms.

PTSD, sensory disorders, and the #MeToo movement. Preventing the spread of infection is only one consideration, however. Because of media articles and reports, I'm more sensitive to the fact that uninvited touch can cause anxiety in people with sensory disorders, with some forms of PTSD, or who are victims of abuse. They might not feel comfortable communicating their discomfort in a health care setting where they are dependent on the help of physicians and nurses who represent authority.

The #MeToo movement has successfully heightened boundary sensitivity in the workplace as well. I became a nurse during an era where nurses and physicians interacted in ways that by today's standards could be viewed as harassment. For instance, sometimes shoulder rubs were exchanged between colleagues while charting notes at the nurses' desk. Was it suspect then too, but we were too naive to notice? Nothing ever came of shoulder rubs, at least in my experience, but it's been about 20 years since I last saw a physician giving a nurse a shoulder rub at the nurses' desk. Just saying.

Asking permission. Developing sensitivity to patient and coworker comfort levels with touch isn't an admission that hugging or shaking hands is bad, but an acknowledgment that we are individuals with our own likes, dislikes, and preferences. It's now part of my practice to ask permission before automatically hugging a patient or new acquaintance.

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