In the Founders' Address that I gave in November at the ARN Conference, I talked about "being present" with patients, families, faculty, and students. In other words, "being with" the individual. "Being present" with an individual is not from any deep-seated theoretical perspective of mine. It's just who I am. As I further explored this concept in the literature, articles used varying terms, mindfulness, mindful presence, presence, caring presence, nursing presence, mindful communication, and so forth. In some titles, both being present and mindfulness were included. What I thought was a simple concept is clearly not simple. Mindfulness in nursing has been defined as a "transformative process, where one develops an increasing ability to experience being present with awareness, acceptance and attention" (White, 2014, p. 283). Although this definition might merit some consideration as "being present," the article goes on to explain how it is associated with the well-being of a nurse. As further evidence, the literature is replete with articles evaluating and describing mindfulness-based stress reduction programs for both nurses and patients. So it seems the word "presence" more aptly describes what I mean in "being present."

In an integrative review by Stockmann (2018), the author identified 26 articles from 1966 to 2017 related to the use and outcomes of presence. Of the 26 articles, 14 described presence as a deliberate intervention that is goal driven and client centered. Two articles reported presence as intuitive, involving nurses sensing what action to take (p. 51). Other studies reported presence as a whole event involving the nurse being with the client with the whole of oneself while also doing for a client, whereas other studies documented that presence was a process. Stockwell summarized her review by defining presence as a deliberate intervention that involves physical, psychosocial, and spiritual nursing actions for the promotion of client well-being (p. 62).

Prince-Paul and Kelley (2017) use the term mindful presence in discussing presence in oncology nursing. They state that mindful presence requires the clinician to be fully present in the here and now, voiding distraction and judgment and being attuned to the experience to bear witness to physical and psychological needs (p. 481). Bernstein (2019) puts it simply as the ability to pay attention to what is happening "right now" in the room with the patient and not be distracted.

"Being present" is an important nursing intervention in the care of patients. It requires us as professional caregivers to be purposefully attentive to the moment, sensitive to context, nonjudgmental, and empathic (Fahlberg & Roush, 2016). Our presence, our way of being, can make or break relationships with patients and families and thus affect our interventions' effectiveness. A mindful presence is unhurried. The nurse's full attention is focused on the patient and family; however, the focus is not related to a task. A mindful presence is when we cannot do anything but be present. It is seeing the person, not the patient (Bernstein, 2019). Mindful presence is what we can offer every patient.

Part of being present with patients is mindful communication. Our facial expressions, tone of voice, body language, and choice of words can convey messages we never intended. Mindful communication is everything we learned about communication in our first nursing course. As Fahlberg and Roush (2016) explain, everything we say and do, no matter how big or small, may be analyzed, amplified, scrutinized, and worried over by anxious patients and families (p. 14). Mindful communication is also about mindful listening. It is listening, not just hearing. Hearing is a purely physiological activity, whereas listening is complex and requires effort. Silence is part of mindful communication, albeit most of us are afraid of silence with patients and families. We think that someone should be talking, and it should be us, the professional caregiver. But silence gives each person, patient, family member, or nurse, an opportunity to reflect, identify the meaning of what has been spoken, or develop questions. Mindful communication is not about self. The nurse does not provide a script in mindful communication. The patient and family write the script.

I close with quotes from two patients with chronic disease that describe their perspectives of presence and communication.

It's not what they do to me - I assume they know what they're doing. It's how they are "with" me. And whether they realize it or not, I can usually tell whether they're a great nurse or just okay as soon as they walk in the room. (Fahlberg & Rousch, 2016, p. 14)

I have been bewildered and angered by the absence of concern by many healthcare workers for the plight of the people for whom they care[horizontal ellipsis]. No (provider) has asked the questions that need to be asked. What has this disease done to your life? What has it done to your family? What has it done to your work? What has it done to your spirit? (Hsi et al., 2004, p. 7)

Conflict of Interest

The author has no conflicts of interest.

Funding

None.

Pamala D. Larsen, PhD, MS, RN

Editor-in-Chief

REFERENCES