Philosophical views of existentialism assisted with the development of the concept of presence for nursing. Sartre (1943/1984) described awareness as a means toward knowing a person and a way of presence. Sartre coined the term authentic self as bringing self to “being with” a person. Heidegger (1962), in his philosophical teachings, introduced the term Dasein or “being there” for another. “Being” is the unique quality of a person and is experienced through sharing one’s authentic self (Heidegger, 1962). According to nursing author T. P. Nelms (1996), being is presence and the heart of nursing practice. Thus, being there and being with are core definitions of presence. Preliminary to developing a presence scale, Kostovich (2012) had 10 registered nurses validate the following definition of presence: “Nursing presence is an intersubjective human connectedness shared between the nurse and patient” (p. 169).

The connection between philosophy and nursing regarding the concept of presence began to emerge in the 1960s. Vaillot (1962) used the
phenomenon of presence to describe therapeutic relationships as crucial to patient care. Two other pioneers in this field, Paterson and Zderad (1976), described presence as the process of being available with the whole of oneself and open to the experience of another through a reciprocal interpersonal encounter. According to Paterson and Zderad (1976), presence is an intervention the nurse uses to establish a relationship with the patient.

Benner (1984) coined the verb presencing to denote the existential practice of being with a patient. “Presencing” is one of the eight competencies Benner identifies as constituting the helping role of the nurse. This view of presence in nursing was supported by Parse (1998), who characterized presence as “the primary mode of nursing practice” (p. 40). More recently, McMahon and Christopher (2011) have developed a midrange theory of nursing presence in which they identified five variables that characterize presence: individual client characteristics, the characteristics of the nurse, shared characteristics with the nurse-patient dyad, the environment, and the intentional decisions of the nurse related to practice. Kostovich (2012) developed a model for presence that includes antecedents and possible outcomes.

Presence may be reciprocal when both parties are connecting and may be meaningful to both the patient and the nurse. Melnechenko (2003) noted: “to be invited to share in another’s unfolding health, to be asked to journey with another through the process of moving and choosing, is without doubt an honor and privilege” (p. 24). The transactional characteristic of presence was emphasized by McKivergin and Day (1998). Hessel (2009), in a concept analysis of presence, noted that presence involves a spiritual connection that is felt when the nurse and patient share the experience of being together. In presence, the nurse is available to the patient with the wholeness of his or her unique individual being. Presence can be characterized as an exchange in which meaningful awareness on the part of the nurse helps to bring integration and balance to the life of the patient (Snyder, Brandt, & Tseng, 2000) and perhaps satisfaction and meaning for the nurse.

Two classifications of presence have been developed (McKivergin & Daubenmire, 1994; Osterman & Schwartz-Barcott, 1996). The continuum in both classifications extends from merely being physically present with the patient to being available with the wholeness of self. Exhibit 3.1 describes the dimensions of presence and provides an example of each type of presence. It is only the transcendent (Osterman & Schwartz-Barcott, 1996) or therapeutic presence (McKivergin & Daubenmire, 1994) that constitutes the complementary therapy designated as presence.

Presence is an intervention used by nurses but takes practice if used as a complementary therapy. Nurses may increase their use of transcendent presence by practicing journaling, mindfulness, active listening, unitasking, holding silence with a partner, focus on the breath, and purposeful activities such as smiling and centering. These activities enable a person to experience presence and evoke it as an intervention when needed.

The universality of presence and caring has been documented (Jonsdöttir, Litchfield, & Pharris, 2004). Presence transcends cultures and modes of communication. The Buddhist way of life through mindfulness implies one is attentive, aware, and fully present in the moment (Kabat-Zinn, 1990). Even if the nurse and patient are unable to communicate verbally, the patient perceives the presence of a caring nurse. The psychological evidence of presence is apparent. According to Paulson (2004), presence requires an emotional, subjective interaction in which the nurse conveys genuine concern for patients, not just as patients but as human beings.