3.1.1 Perceived impacts on patients.

The HCPs described various impacts of the interventions reported by patients. Some HCPs reported the TM had positive effects on patients such as feelings of relaxation or increases in confidence. In contrast, the perceived impacts of the machine on patients were more heterogeneous. According to the HCPs, some patients felt discomfort with the use of the machine and others asked to keep using it.

Patients’ feelings of relaxation right after receiving TM were described as improving their sleep. Relaxation was also perceived as leading the patient to feel more confidence in the caregiver.

“The patient was so happy and then he told me, ‘You know, sometimes I get up to go have coffee, and that night I stayed in bed and slept.’” (249–250, IG)

“I think that it helps the patients a little bit to free themselves to speak; the fact of being a little more relaxed, I think it gives them a little more confidence, and that’s important.” (242–244, IG)

The HCPs further raised the question of touch in the hospital context. They deemed it important in a care setting and felt it could have beneficial impacts on patients such as reassuring them. However, the HCPs also reported that sometimes touch is absent in daily care practices.

“I would say that touch in general brings something to the patient, just touching the hand, the shoulder to reassure. We can see that it benefits them because some have been in hospital for 3–4 months, and nobody has touched them.” (227–229, IG)

“It’s the human relationship: We take the time; we have a physical contact, an exchange. I think they are more valued, and I think that in the end, it is good” (233–234, IG)

The HCPs reported that the machine was appreciated by some patients but not others. The dislike of the machine reduced patients’ motivation to receive the intervention or their desire to use it any further. One of the first reasons mentioned was the fact that patients felt discomfort when using it.

“I didn’t have just one, I had several, and after a while I thought, well, is it worth offering? Because they try once, they feel pain, and they don’t want to try it a second time.” (68–70, CG)

However, some patients did not share this discomfort. One nurse stated, “Well, I remember that a patient told me that she was going to buy it for her personal use at home” (104–105, CG).

3.1.2 Health care professionals’ affective and cognitive experiences.

The interventions induced various experiences (emotions and thoughts) in the HCPs and those influenced their motivation to continue giving the interventions to patients. While the HCPs in the IG emphasized a need for mental availability and a surge of emotions, the HCPs in the CG described concerns related to the use of the machine.

In the IG, participants described the importance of the mental availability of the massage provider. The HCPs often emphasized the importance of being in a calm and benevolent state of mind to perform TM.

“You have to be relaxed to be able to bring relaxation as well.” (330, IG)

“Mind at rest and the mind totally focused on the patient.” (445, IG)

In contrast, the HCPs described that if they were stressed or tense, the patient would feel it, and it would hinder the process. The HCPs explained this effect in terms of positive or negative energy they could transmit to patients. Furthermore, positive emotions such as feelings of relaxation and having rewarding experiences arose in the HCPs from the TM intervention. The positive impact of TM on the HCPs enhanced their willingness to give TM. However, when giving TM was impossible due to a lack of time or availability, the HCPs felt frustrated.

“They feel it when we are stressed; they tell us, ‘Ah, today you are different.’” (461–462, IG)

“I found it frustrating not to do it at all, […] as my colleague said, for me, it’s a pleasurable care that gives pleasure to the patient, and it also gives me pleasure to give him this care.” (77–79, IG)

The TM intervention also elicited negative emotions such as disgust, discouragement, or guilt and led the HCPs to seek strategies to reduce those feelings.

“I had a lady who doesn’t wash herself, so it’s difficult to do these foot massages, […] so I washed her. It was a lady who didn’t want to shower, so I washed her feet anyway before doing the massage because it smelled bad.” (32–36, IG)

“One time, it discouraged me because the patient, I visited him on the third day, asking him the question, ‘Did you like the massage?’ and he told me, ‘What massage?’ He had completely forgotten; I had taken the time to massage him, and on the third day, he had forgotten, so I said it’s useless.” (275–278, IG)

In the CG, negative perceptions arose from the use of the machine. The HCPs did not feel comfortable to further press patients to participate in the study and use the machine. In addition, they described the installation of the machine as burdensome and time consuming. The HCPs argued that the machine did not decrease their amounts of work but instead added more tasks for them to do. This caused the HCPs to feel like technicians when using the machine. They compared it with massage, which they considered a familiar procedure, therefore requiring less time. All this strengthened the participants’ lack of motivation to use the machine.

“Well, as I imagine, it’s a technician’s time, it doesn’t make me want to practice this care, it’s not a treatment, it’s an installation, that’s it.” (245–247, CG)

“I think that yes, compared to the caregivers, it’s more, they’re better at massaging than going to get a machine, setting it up, doing all that, I think. You must go and get the key, get the machine, put the key back; it’s a whole little process. It’s a whole process that takes time and you have to think about it.” (217–220, CG)

3.1.3 Patient-professional relationships.

Changes in the relationship between professional and patient were highlighted through changes in interaction and communication. Communication is described in terms of the exchange of information between two or more individuals. Interaction can be described as a process whereby one’s action influences the action of another person (mutual influence). TM was reported as facilitating communication between the patients and HCPs in IG, whereas little to no communication was described in the CG. Furthermore, in the IG, the HCPs noticed changes in their interactions with patients.

The HCPs in the IG reported having discussions during TM. The HCPs described touch as facilitating their interaction with the patient. They also described TM as leading to a different interaction than they experienced in “standard” nursing care. They described those exchanges as being easier thanks to the feelings of relaxation and confidence.

“It’s the human relationship; we take the time, we have a physical contact, an exchange. I think they are more valued, and I think that in the end, it is good because it stimulates other emotions, and it feels good.” (233–235, IG)

“It’s an exchange, and the approach of the care is different than the toilet. It has nothing to do, it is easier with them, they feel more comfortable, more relaxed.” (19–20, IG)

However, in the CG, most of the HCPs reported a lack of communication with their patients. They explained that installing the machine did not lead to any interactions with the patients, making communication difficult. The HCPs opposed the machine compared to the massage they were doing before bedtime, during which they could better communicate about the patients’ care.

“In the end, we don’t share much with the patient; it doesn’t necessarily make you want to do it.” (227–228, CG)

“In the evening, we still had to remove the stockings, rub and massage as well, so you get direct feedback from the patient, who says, ‘Well, I prefer this kind of massage,’ whereas [with] the machine, they don’t say anything; they just say it hurts, is it possible to remove it? But there is no more communication.” (146–150, CG)

3.2.1 Conceptual tensions.

One barrier to the implementation of TM or the massage machine in nursing care was the attitudes of the HCPs toward them. In the CG, the machine was described as nothing more than a machine, and ambivalence around the legitimacy of TM in nursing care was reported. In the IG, the HCPs described TM as a pleasure care, which is opposed to “standard” nursing care. The legitimacy of TM in nursing care was questioned, and the perception of TM as a means of care was at best ambivalent. This, in turn, led the HCPs to perceive TM as not a priority and often to set aside the intervention. However, if conditions such as validation of the hierarchy and scientific or empirical evidence were met, TM could be considered a potential nursing care. In the CG, the machine was perceived as bringing relaxation or discomfort but was not mentioned as a care.

Most of the HCPs in the IG described TM as a pleasure care because of the perceived pleasure felt by the patients and care providers during the intervention. The HCPs contrasted this care with other “standard” nursing care and described TM as differing in the way patients and HCPs feel.

“So, in fact, it’s not a medical care; it’s a pleasure care, I would say. We see the person differently, and the person has the impression of forgetting their illness.” (17–18, IG)

“We can also convey something and not just be […] purely medical, convey something else.” (377–378, IG)

“[TM is] other care that is not just care, such as taking blood pressure, but a benevolent care.” (572–573, IG)

TM was also described as a complementary approach that could be implemented in other care. The HCPs reported using the gestures of TM during the time before bed. Not only did the HCPs use TM with patients, but they also reported using it among themselves or in their private lives.

“At night, when we do our nursing, we’ll have the gestures to put the cream on the legs and arms properly, too. I would say that it has brought something.” (174–176, IG)

“I would like to say that yes, in addition, it is also good between us because we massage each other. In fact, at the computer, it’s also beneficial; it brings us closer together.” (216–217, IG)

“I found it good personally because I learned something new that I use with my son.” (644–645, IG)

TM was perceived by the HCPs as not being a priority compared to other nursing care. This was further illustrated by the concerns the HCPs expressed over not being available for primary care during TM sessions. This caused some HCPs to overlook the intervention despite having taken part in the training.

“I’m not going to leave my colleagues alone with an overloaded service, so yeah, the priority at one point was not massages, frankly.” (147–148, IG)

“So, I’m a bit divided because at the same time, I tell myself that it must not be easy to find the right moment if the colleagues need help and we are doing the massage;, it’s true that we can’t stop it just like that” (79–82, IG)

“So, I think that in fact it’s not a question of unwillingness, because well, doing the training was on a voluntary basis, so well, um, we all came, we all wanted to do it, to do it well, and we didn’t have the opportunity to practice it.” (142–145, IG)

However, when TM was acknowledged and validated by superiors and empiric evidence, it is described as an acceptable care. This change in attitude lead to feel more comfortable to devote time and attention to TM.

“And also, that it’s validated by the superiors […]. Validated [by the supervisor], yeah, we are doing right.” (397, IG)

“The fact that there is a study on it also I think shows that there is research behind it and that there are effects behind it that are expected.” (288–289, IG)

“Since it is accepted as care, we don’t have to feel guilty about saying, well, I’m doing a massage while my colleagues are doing the dishes or whatever.” (532–534, IG)

3.2.2 Organizational tensions.

This theme grouped the descriptions of organizational barriers encountered in implementation of the interventions. The HCPs in both the CG and IG reported barriers related to patients, colleagues, the organization of the institution, and time.

The HCPs reported that the large number of patients per health care staff member made the intervention difficult without neglecting other patients. The HCPs further described the complexity of their patients’ cases and pathologies. They contrasted it with the context of a rehabilitation unit, which in theory, should have fewer complex cases.

“We have patients who are chronic, patients who are complex cases. Yeah, it’s difficult.” (180–181, IG)

“As we organize our work differently, we should have lighter patients who really require re-education and rehabilitation, patients that we had 20 years ago. Now we have acute care, people who take a lot of our time; their health condition is very precarious, so that’s also time consuming.” (565–569, IG).

In addition, the HCPs described the limited number of health care staff to take care of the patients. This led to work overloads, which, in turn, led to stress and exhaustion in the HCPs. Problems related to the institutional organization were also mentioned, such as changes in organization, a lack of information regarding the intervention, or the roles of the staff.

“We have a new organization too; it’s … we have to adapt, but it’s also difficult. It’s not a change of organization that makes us less tired or that we have more time for our patients.” (182–185, IG)

“I don’t think we’ve all been involved in this. I, for example, never had information about this machine. I think a lot of us didn’t necessarily.” (183–184, CG)

Finally, time was a concern regarding these interventions. The HCPs in both the CG and IG described that because of time constraints (which were rendered even more salient by the COVID-19 pandemic), they could not do the intervention.

“There are days when we have a little bit of time, so we’ll say to ourselves, ‘Let’s take advantage of this,’ and there are days when we don’t even have time to sit down to eat.” (86–87, CG)

“Frankly, I didn’t have the time. There was a period that was a bit overloaded, and we finished the evening rounds; we just had time to finish, to make the transmissions, and the colleague would arrive.” (130–132, IG)

They further reported that the time allocated to the intervention was too long.

“It’s a little process that seems to take time, and you must think about it. You take at least 15 minutes each time to prepare it, I think, and then you must install it, come back 15 minutes later; you must take it back.” (219–222, CG)

“I didn’t do the 15 minutes; that’s not possible. It’s extremely complicated to find that time, to be available at all levels, to be in front of the patient and find 15 minutes to massage.” (169–172, IG)

However, the care providers in the IG came up with a suggestion to improve the implementation of TM. The HCPs said it would be easier to implement TM at certain times of the day, such as in the afternoon or evening before the patients go to sleep. Indeed, the HCPs reported the importance of having a calm setting to perform TM. Therefore, this time of the day would allow them to have an appropriate setting.

“For me, it would be the afternoon, not the morning shift, because the morning is often busy, running around.” (314–315, IG)

“In the afternoon, or maybe it would be a little complicated, but at bedtime for a little bit, to do good before the night, it could also be a good idea.” (321–323, IG)

As for the machine, the suggestion was to have it “self-service, more of a self-service style, like the bikes they have in the unit, for example; they can go to their sessions by themselves” (92–93, CG).