How expert professional nurses practice and develop nurse presence in a critical care unit: A grounded theory study

Abstract

The intent of this thesis was to increase understanding of the nurse's presence in clinical nursing practice within the critical care setting. Nurse presence is employed to achieve an enhanced connection with patients and has been described as both being there for and being with the other. Highly technological intensive care environments have the potential to objectify patients and present unique challenges to nursing professionals attempting to integrate this aesthetic art into their care. Purpose. The purpose of this study was to examine how critical care nurses practice and develop nurse presence with their patients. Method. Grounded theory method was used. Data were obtained from semi-structured interviews with nine expert critical care nurse participants. Results. Presence as a practice emerged as a three phased process---commitment, presencing strategies and connection. The development of nurse presence as an evolutionary process was gradual, iterative and cumulative and was subject to two major influences---transitional influences and professional influences. Each patient experience with presence contributed to knowing the uniqueness of the individual as a whole person as well as to knowing a richer and deeper understanding of presence as a nursing practice. This integration of the practice and developmental components of this nursing phenomenon is described by the basic social process 'knowing the whole'. Conclusions. Presencing emerged as a powerful and humanizing, aesthetic element of nursing the critically ill. Unlike previous studies on this concept, the grounded theory method revealed three stages of practicing presence and demonstrated that it is learned.