In the book Radical Loving Care: Building the Healing Hospital in America, Erie Chapman, JD, MTS, president/CEO of the Baptist Healing Hospital Trust, Nashville, TN, writes "loving care does not require twice the time, but it does require more than twice the presence."
What would this actually look like in clinical practice? A nurse's shift, no matter what venue or specialty area, is filled many responsibilities, tasks to be performed, and new skills to be learned. Nurses, as scientific artists, are often experts at the scientific and technical aspects of their job; however, the artistry frequently takes a backseat.
The artistry of nursing is often what drew us to the profession in the first place: offering a kind, hopeful word and a warm, heartfelt touch; providing compassionate care that brings a sense of comfort; and bringing a relaxed smile to the face of a fearful and anxious patient.
The integration of the art and the science makes up the core essence of nursing practice. Consciously attending to the artistry will bring more balance to our work and is likely to enhance nursing satisfaction.
Patients come to us looking for a two things: expert technical care, and being attentively listened to and touched in some capacity.
Professional nurses know when physical touch is inappropriate; however, "the touch of the heart" can fulfill the loneliness and disconnection experienced when the patient is away from familiar surroundings.
Nurses are the first-line connectors for patients. When they look rushed or convey they don't have the time, patients are likely to do one of two things: they will be on the call bell all day long until they get their needs met, or they will not ring the call bell when there is an important need because they don't become a bother to the already-too-busy nurse.
Nurses are often more comfortable with relatively predictable outcomes of tasks and technological interventions. Sometimes the relational being-with-the-patient aspect of clinical practice feels like it takes nurses away from completing the work that needs to be accomplished.
The relationship-centered care model reminds nurses the quality of the relationship they have with patients' influences and shapes outcomes. Creating a caring-healing environment holds promise of advancing care to a new level and enhancing patient satisfaction.
My 78-year-old patient has been oxygen dependent for a few years. He was complaining of shortness of breath and requested more oxygen. I turned up the oxygen to 4L, and I could have given him a nebulizer treatment, but I got the sense he was very scared. As I was talking to him, I started rubbing his head. After a few minutes I could feel he was beginning to relax and was breathing more easily. I rechecked his oxygen status and it was still 94 percent, but when questioned, he stated he could breathe more easily. I turned down the oxygen and continue to rub his head. I felt a very real connection with him. When I came in the next day, I received in report that he had slept better the previous night than he had in days.
- Ellen Kaufman, BS, RN, staff nurse,
West Roxbury VA Hospital, West Roxbury, MA
What is Presence?
By definition, presence is "attendance or company; immediate vicinity; proximity; ability to project a sense of ease."
Nurses spend the least amount of their time in direct patient care activities and the majority is spent locating supplies and equipment, charting and engaging in other activities that take them away from being with their patients.
When nurses are not fully present - distracted by the multitude of responsibilities that vie for their attention - there is an increased potential for medication errors, patient falls and healthcare-associated infections and overlooked pressure ulcers. Current safety initiatives in hospitals include creating a work environment that enhances the ability of nurses to be more present.
The concept of 'nursing presence' has been noted over the years in the nursing literature (Hines, 1992; McKivergin & Daubenmire, 1994; Osterman & Schwartz-Barcott, 1996; Godkin, 2001; Melnechenko, 2003; Fingeld-Connett, 2006) and is viewed as a valuable way to create meaningful and trusting relationships.
The quality of the relationship developed influences the perception the patient has about the care received. The more present-in-the-moment the nurse is, the greater chance of enhanced patient satisfaction.