Prioritizing Patient Comfort While Optimizing Staff Safety

Patient anxiety is common during dermatologic procedures and may contribute to discomfort, sudden unanticipated movements, and an overall negative experience. Patients often request hand holding by family members or clinical staff while undergoing procedures, particularly during injection of local anesthesia. In some cases, trainees may also offer hand holding with the intention of improving patient comfort. While well-intentioned, hand holding may not be practical during an ongoing procedure and could pose ergonomic concerns for the clinical team. Family members are typically not present during procedures to lend a hand, and their presence may divert focus from the patient.¹ Additionally, patients experiencing heightened anxiety may inadvertently apply excessive grip force, potentially creating a risk of hand or finger injury for clinicians.  

Tactile Strategies

Here, we present our approach to integrate patient-centered care with team safety. We reassure patients that their comfort is a priority, while offering alternative tactile strategies to hand holding to mitigate anxiety without placing physical demands on staff. Although no hand injuries related to hand holding have occurred in our practice, variability in grip strength and sustained hand positioning underscore the importance of proactive ergonomic awareness. To address these concerns, patients are offered readily available tactile substitutes, including a rolled towel (Figure 1), a rolled patient gown (Figure 2), or a stress ball (Figure 3) to hold and squeeze during the procedure. These options allow patients to engage in tactile distraction while minimizing staff involvement and potential ergonomic strain. This interaction also serves as a natural entry point for discussions with trainees regarding procedural safety, ergonomics, and physician longevity. Optimizing procedural ergonomics has been shown to support long-term clinician health, and evidence from the surgical literature highlights the value of early educational interventions addressing these principles.^2,3

Figure 1. Use of a rolled towel as a tactile distraction during administration of local anesthetic prior to Mohs surgery. The patient holds a tightly rolled towel in his hand during lidocaine injection, providing a simple, low-cost tactile stimulus that may reduce procedural anxiety and perceived pain while avoiding hand-to-hand contact and minimizing ergonomic and safety concerns for clinical staff. 

Figure 2. Use of a folded cloth gown as a tactile aid during local anesthetic injection prior to Mohs surgery. 

Figure 3. Use of a stress ball as a tactile aid during local anesthetic injection prior to Mohs surgery. 

Other Strategies

Nonpharmacologic strategies such as verbal reassurance, music, hand holding, and the use of stress balls are commonly employed to reduce anxiety during dermatologic surgery. However, evidence supporting the effectiveness of these strategies within the specialty of dermatologic surgery remains limited. Prior studies have demonstrated no significant differences in pain, anxiety, or patient satisfaction with interventions such as hand holding or stress ball use compared with standard care.4 In contrast, data from other procedural fields suggest potential benefit. Randomized and observational studies in endovenous procedures and port catheterization have shown significant reductions in intraoperative anxiety and pain with the use of stress balls.^5,6 Despite mixed evidence, the low cost, ease of implementation, and minimal risk of these interventions support their use as adjuncts for managing intraoperative and perioperative anxiety and pain in dermatologic surgery.

Summary

In summary, our approach is cost-effective and prioritizes patient comfort while supporting workflow efficiency and staff safety. Offering tactile alternatives in place of hand holding allows prioritization of patient-centered care while simultaneously supporting physician and staff ergonomics and promoting procedural safety education for trainees.