From American Holistic Nurses Association OCTOBER 2023

Massage is a healing approach that nurses can utilize to emphasize the interconnectedness of the mind, body and spirit, common in holistic practice. While it is based on ancient approaches to healing, holistic massage is making inroads to mainstream medicine with new therapeutic touch techniques that seek to provide relaxation, relief from pain, and the hastening of healing. The healing of power of massage works on physical as well as emotional and spiritual levels. In the holistic view, this balances a person’s energy elds and leaves them feeling refreshed.

Accepted as a form of Complementary Alternative Medicine (CAM), the massage profession has grown signi cantly and is increasingly practiced as a non-pharmaceutical intervention in traditional medical settings to treat a long list of ailments from arthritis to lupus. As holistic nurses, we are knowledgeable about CAM, and we are encouraged by principles of holistic practice to integrate massage, including new techniques, into our practice (ANA & AHNA, 2013).

While research into energy fields and other core concepts of therapeutic touch is scant, studies suggest holistic massage therapy works. For example, Krieger (1979), who studied biochemical reactions related to touch therapies, explored the successful incorporation of healing touch therapies into nursing practice. Another study combined analyses of six groups of cancer patients receiving massage therapy for palliative care and found that the intervention effectively “reduced the subjectively perceived symptoms of pain and also alleviated symptoms of anxiety and depression (Falkensteiner, 2011).” This augers well for more potential uses for therapeutic touch, particularly for chronically ill people. One problem is that measuring or quantifying the ef cacy of therapeutic touch can be challenging for clinical research. Studies are ongoing and will lead not only to wider acceptance of the therapy but also to increased training for holistic nurses who are well-positioned to integrate the therapy into individualized and empathetic treatment plans for patients.

Background of Intentional Touch
Throughout history, touch has been recognized as a powerful healing tool that transcends language and culture because humans are innately wired for touch. The stimulation of touch receptors in the skin helps soothe away pains and reduce stress reactions. A square inch of our skin has over 1000 nerves that can send signals to nurture our physical, mental, emotional, social, intellectual and spiritual well-being. Unmyelinated nerve bers, called C tactile bers or “CT bers,” are widely distributed throughout our skin. These CT bers respond to the various massage modalities and have been shown to generate a bio-chemical cascade within our bodies. (Löken et al., 2009).

Various massage techniques stimulate a hypothalamic neurohormone called oxytocin, also known as the “love hormone”. This hormone is secreted by the brain in part due to sensory stimulation and is linked to increased levels of social interaction, well-being, and stress resiliency (Mason & Mason, 2009). Engaging in intentional touch techniques such as massage during nursing assessments can lead to increased oxytocin levels, resulting in stronger social connections, reduced pain sensations, and an enhanced sense of serenity.

For nurses, providing intentional touch during patient assessments in clinical settings can lead to a more comprehensive and empathetic understanding of the patient’s condition. As nurses incorporate gentle massage techniques into their physical assessments, they will witness various bene ts for patients. Massage can help relax tense muscles, improve circulation, and reduce anxiety while promoting a sense of comfort and relaxation. This can be particularly bene cial for patients who are bedridden, experiencing pain, or anxious due to their medical condition.

The Procedure of Holistic Massage
When beginning a session, the practitioner takes time to center themselves to be able to fully support a holistic and healing experience for their patient. This preparation may involve the use of meditation, breathing exercises, or imagery to achieve an altered state of consciousness opened to sensing blocked energy elds that can impede wellness in a patient (https://

A typical Holistic Massage session gets underway with the patient lying on their back, abdomen, or side. Remember proper body mechanics and raise the patient’s bed if needed to an appropriate height. The nurse moves the gown (while being mindful of modesty) and applies lotion or powder to reduce friction. Firm long strokes and kneading motions are then used, starting from the neck and shoulders and moving over the entire back. Special attention is given to pressure areas, usually bony prominences such as shoulders and hips. The process can be as brief as one likes to complete a physical assessment while incorporating therapeutic touch and holistic massage techniques.

Effleurage (Stroking):
Effleurage is a fundamental massage technique that involves long, sweeping movements using the palm of the hand to glide over the contours of the body. When working on smaller areas, like the neck, the therapist may use the thumb and fingers. The strokes should be slow, rhythmic, and gentle with constant pressure applied in the direction of the venous stream (toward the heart). Effleurage helps to warm up the tissues, promote relaxation, and improve circulation.


Rolling Petrissage (Kneading):
Petrissage is a massage technique that entails using the ulnar side of the palm, along with the fingers and thumbs, to grasp and lift the skin andsubcutaneous tissues. The movements are similar to kneading dough. As the nurse’s hands move, the underlying tissues are gently manipulated, providing a deeper level of tissue mobilization. Kneading helps to release tension, improve blood ow, and promote the relaxation of muscle fibers.


Circular Friction:
Friction is a massage technique that involves using the whole palmar surface of the hand, fingers, and thumbs to apply pressure over limited areas. This movement is typically circular and involves applying pressure against the underlying tissues, which cannot be grasped. Friction is used to target specific points of tension or adhesions in muscles and connective tissues. It helps to break down knots, increase blood ow to the affected area, and improve mobility.

These three massage techniques, when applied in combination, can provide a comprehensive and effective holistic massage experience. Each technique serves a distinct purpose, contributing to the overall therapeutic effects of the massage.

Nurses can carefully adapt these techniques to suit the individual needs of their patients, ensuring a personalized and nurturing experience. Patients feel valued, heard, and cared for when nurses take the time to address their individual needs beyond just medical treatment. This holistic approach aligns with patient-centered care, which is becoming increasingly recognized as a key component of effective healthcare delivery.

Holistic Massage has emerged as one of the fastest-growing and most accessible forms of alternative health maintenance due to its comprehensive approach to healing. By recognizing the binding link between the mind, body, and spirit, and harnessing the power of intentional touch, nurses can use massage techniques to revolutionize the way we approach patient assessments and patient care. As more research continues to support the bene ts of this practice, holistic massage is likely to play an even more signficant role in healthcare and contribute to a more inclusive and compassionate approach to nursing and healing.

American Nurses Association (ANA) & American Holistic Nurses Association (AHNA). 2013). Holistic nursing: Scope and standards of practice (2nd edition). p. 13. ANA & AHNA.

Falkensteiner, M., Mantovan, F., Müller, I., & Them, C. (2011). The use of massage therapy for reducing pain, anxiety, and depression in oncological palliative care patients: a narrative review of the literature. ISRN Nursing, Part 7. 929868. https://

Ican School of Medicine at Mount Sinai. (2023). Therapeutic touch: what to expect.

Krieger Dolores. (1979). Therapeutic touch: How to use your hands to help or to heal. Prentice-Hall.

Löken, L. S., Wessberg, J., McGlone, F., & Olausson, H. (2009). Coding of pleasant touch by unmyelinated afferents in humans. Nature neuroscience, 12(5), 547-548.

Mason, C., & Mason, E. (2009). Haptic medicine. Strategy for the Future of Health pp. 368-385. IOS Press.

Christobal Mozingo Goodwin, MSN, RN, CDCES, HNB-BC, is a board-certfied holistic nurse and certi ed diabetes Educator. He is an award-winning educator who serves on the faculty at the Oregon School of Massage. As a Master-prepared Registered Nurse with over 30 years of combined healthcare, wellness, and workplace safety experience, Christobal is known for addressing the current healthcare crisis with holistic expertise. His areas of focus in holistic healthcare include Haptic Healing techniques such as holistic massage bodywork and intentional therapeutic touch. He may be contacted at

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