Positive touch in neonatology: A fundamental nursing intervention focused on Laurie Gottlieb’s theory of Strengths-Based Nursing Care

Contributor: Marisa Sofia Potes Trindade Abrantes

Touch provides the first sensory input to develop in the womb and continues to play an important part in how children understand the world. It is, therefore, essential for children’s healthy growth and development.
Infants admitted to Neonatal Intensive Care Units (NICU) are often destitute of physical contact due to the complex, specialized instrument used during care. As well as the fragile state the patient finds due to the complex technical device used during maintenance of his health. Parents’ hesitation and lack of confidence to care for their children make their development and isolation from their children essential nursing concerns to promote their in development of a close parent-infant bonding. These views are defended by Kwah et al. (2018) and match my observation from my years of training in Portugal and the United Kingdom.

Nurses can assist in overcome fears by empowering parents with positive touch techniques. The term “positive touch” was initially defined by Bond (2002) and supported by Higman et al. (2015). Interacting with the baby and involving different types of touch, such as handling, holding, kangaroo care, and massage, help ease the anxiety felt by the parents and promote bonding. The most appropriate touch is hand-on-containment, as this will encourage the behavioral organization of the sick infant. Cullen et al. (2005) affirm that sensory impairment may result in disrupted sleep patterns and children avoiding touch since the information from our sensory receptors helps us make sense of our environment.

Positive touch should be performed when the infants are in the awake-alert state so that they can extract all the benefits from using this approach. Relaxation techniques can be used to help parents perform positive touch in the different and appropriate stages of their hospital stay. For example, prenatally, the womb provides a constant sensation of being held. When babies are born, they expect the same level of sensitivity. The experience of touch in early life influences the neurobiological development of multiple systems. It serves as a base for socio-moral behavior, as Narvaez et al. (2019) stated.

To implement positive touch in my practice, I use Laurie’s Gottlieb’s Strengths-Based nursing care theory (SBC) (Gottlieb, L, 2013). This theory was inspired by the writings of Florence Nightingale and has evolved from the McGill Model of Nursing, as affirmed by Gottlieb, L. (2013). These perspectives support my work because it advocates that the patient, and in this case, the parents as carers, must be empowered to bring change, positive things, and control to their lives. It considers the positive aspects and the aspects that have potential; however, it never denies the problems or deficits.

I can affirm that by using positive touch in neonatology, we can follow Laurie Gottlieb’s theory. This theory considers the best things, those that are working and those that show potential, as is true for the use of positive touch. Touch is an essential tool through which parents regulate their infants’ reactions and creates a pleasant interaction between mothers and babies. Baby will benefit mothers’ mood state, reflecting on the bonding created during their hospital stay (Zaferani et al., 2021).

Strengths based nursing (SBC) requires a broad knowledge base, education, and training. This is a holistic approach to health and healing, and provides a path to overcoming barriers to health and healing. Laurie Gottlieb believes this requires a radical approach to thinking and implementing nursing interventions that nurses can use as guidance for health professionals and the health system. If achieved, it will change nurses’ interventions and the health system to benefit patients and care-givers, and provide the key to a truly collaborative daily practice.

Nurses and parents are sometimes unaware of the patient’s experience of their health challenges, and can easily lose the perspective of the strengths, and the opportunities available to promote quality of life for the patients and families during their stay in neonatology. Positive touch can be the key to change. This theory will challenge nurses professionally and personally, as they are empowered to promote the child’s wellbeing, and the wellbeing of the parents. Parents will have the choice of how to deal with their situation and benefit from it, and the nurses have the empowerment to decide how they will help parents benefit from the challenges they face.


Bond, C., 2002, “Positive touch and massage in the neonatal unit: a British approach”, Semin. Neonatal, number 7, pp.477-486.

Cullen, L., Barlow, J. & Cushway, D., 2005, “Positive touch, the implications for parents and their children with autism: an exploratory study”, Complementary Therapies in Clinical Practice, number 11, pp.182-189.

Gottlieb, L. N. (2013). Strengths-based nursing care: Health and healing for person and family. New York: Springer.

Higman, W., Wallace, L., Law, S., Bartle, N. & Blake, K., 2015, “Assessing clinicians’ knowledge and confidence to perform kangaroo care and positive touch in a tertiary neonatal unit in England using the Neonatal Unit Clinician Assessment Tool (NUCAT)”, Journal of Neonatal Nursing, number 21, pp. 72-82.

Kwah, K., Whiteman, B., Grunfeld, E., Niccolls, C. & Wood, E., 2018, “Evaluation of an intervention to increase clinician knowledge and confidence to support breastfeeding, kangaroo and positive touch within neonatal units”, Journal of Neonatal Nursing, number 24, pp. 94-99.

Navaez, D., Wang, L., Cheng, A., Gleason, T., Woodbury, R., Kurth, A. & Lefever, J., 2019, “The importance of early life touch for psychosocial and moral development”, Psicologia: Reflexão e Crítica”, number 32, p.16.

Trotter, P., McGlone, F., Reniers, R. & Deakin, J., 2018, “Construction and Validation of the Touch Experiences and Attitudes Questionnaire (TEAQ): A Self-report Measure to Determine Attitudes Toward and Experiences of Positive Touch”, Journal of Nonverbal Behavior, number 42, pp.79-146.

Zaferani, S., Zabihi, A., Jafarian-Amiri, S., Akbarian-Rad, Z. & Hajian, K., 2021, “Evaluation the Effect of Positive Touch on Moods of Mothers of Premature Infants Hospitalized in NICU: A Randomized Clinical Trial”, Psychiatry Behav Sci, number 3.

About Marisa Sofia Potes Trindade Abrantes

I am a nurse since 2012, and my experience has always been in Paediatrics. I worked in the Children’s Intensive Care Unit for eight years in the United Kingdom and returned to Portugal, my home country, in December 2021, when I started working in Neonatology. This post was made in the curricular unit of nursing theories of the Master Course in Nursing of the Institute of Health Sciences of Portuguese Catholic University (Lisbon), with the pedagogical supervision of Professor Zaida Charepe (Ph.D., Associate Professor)

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