Meta-synthesis of presence in nursing

This paper reports a meta-synthesis of the concept of presence.

Presence is a complex concept that is vague and poorly defined. It is often confused with other concepts such as caring, empathy, therapeutic use of self, support and nurturance. Adding to this confusion is the fact that presence has been fragmented into numerous types, used indiscriminately and combined with other concepts such as caring.

The nursing literature was searched using the cinahl, Dissertation Abstracts and Missouri Bibliographic Information User System databases and the keywords presence, concept analysis, qualitative studies, grounded theory, phenomenology and ethnography. The reference lists of the sources were also scrutinized. Four linguistic concept analyses and 14 qualitative studies of presence were identified and a meta-analysis was conducting using these.

Presence is an interpersonal process that is characterized by sensitivity, holism, intimacy, vulnerability and adaptation to unique circumstances. It consists of a process in which patients demonstrate a need for and openness to presence. In turn, nurses must be willing to enact presence and practice within an environment that is conducive to it. Nurses must also possess personal and professional maturity and base their practice on moral principles of commitment and respect for individual differences. The process results in enhanced mental well-being for nurses and patients and improved physical well-being for patients. In keeping with the nature of a process, the consequences of presence go on to influence its future enactment.

Advanced concept analysis methods should be used to further explicate presence and differentiate it from other nursing constructs. Until this is done, scholars are cautioned against parsing the term and combining it with vaguely defined nursing concepts such as caring. Researchers are urged to consider how presence can be preserved using tele-health technology and in time-sensitive healthcare settings.