Grand Theory

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AN INDEPENDENT VOICE FOR NURSING

Toward a Mid-Range Theory of Nursing Presence
nuf_215 71..82

Michelle A. McMahon, MSN, RN, and Kimberly A. Christopher, PhD, RN, OCN Michelle A. McMahon, MSN, RN, is a Student in the PhD in Nursing Program, College of Nursing, University of Massachusetts Dartmouth, North Dartmouth, MA; Kimberly A. Christopher, PhD, RN, OCN, is Associate Professor, College of Nursing, University of Massachusetts Dartmouth, North Dartmouth, MA. Keywords Nursing presence, mid-range theory, nurse education, relational skills Correspondence Michelle A. McMahon, MSN, RN, Student in the PhD in Nursing Program, College of Nursing, University of Massachusetts Dartmouth, North Dartmouth, MA E-mail: michelleamc345@gmail.com BACKGROUND. Presence is widely accepted as a core relational skill within the nursing profession. Nurse educators are challenged to ensure that the humanistic aspects of client care are included in the Bachelor of Science in Nursing (BSN) curriculum. Introducing and teaching presence skills early in the BSN curriculum will ensure the essential value of relational engagement with clients. Nursing literature, however, notes presence is a challenging concept for BSN students. Articulating a midrange theory of nursing presence will facilitate students’ conceptual understanding of presence and guide nurse educators to teach presence skills. AIMS. To propose a mid-range theory of nursing presence. Within the theoretical model, identify development opportunities to improve student nurse use of presence as a relational skill. METHODS. An extensive literature review was conducted. Materials were synthesized and the mid-range theory was developed. DISCUSSION. Kim’s nurse-client domain provided the perspective that guided the parameters of the theory. Professional nursing presence is dependent upon the combination of five variables: individual nurse characteristics, individual client characteristics, shared characteristics within the nurse-client dyad, an environment conducive to relational work, and the nurse’s intentional decisions within the practice domain. The variables are described and the relationships among variables depicted in the model. Specific nurse-sensitive points during a nurse-client interaction determine or influence the nurse presence intervention and dose. Areas designed to teach or improve relational skills are identified for the BSN educator. CONCLUSION. A mid-range theory of presence contributes to our understanding of the relational aspects of nursing practice within the contemporary healthcare environment. Identifying strategies to teach BSN students presence skills will facilitate the incorporation of the humanistic aspects of client care in the undergraduate curriculum.

Presence as a concept is widely accepted as a core relational skill within the profession of nursing (Covington, 2003; Gardner, 1985; Gilje, 1992). In the contemporary healthcare setting—characterized by economic and time constraints, nursing shortages, agency expectations, and accreditation mandates— nursing’s relational work is at risk (Cohen, Hausner, & Johnson, 1994; Doona, Haggerty, & Chase, 1997; Finfgeld-Connett, 2008; Melnechenko, 2003). The

scope of nursing practice continues to expand and practicing nurses are challenged to prioritize the humanistic aspects of nursing care as they integrate increasing numbers of technical and scientific expectations. In addition, nurse educators are challenged to ensure that the humanistic aspects of client care are included in the baccalaureate curriculum (Kleiman, 2007). Current baccalaureate education emphasizes integration of informatics (Quality and Safety 71

© 2011 Wiley Periodicals, Inc. Nursing Forum Volume 46, No. 2, April-June 2011

Toward a Mid-Range Theory of Nursing Presence
Education for Nurses, 2010; Technology Informatics Guiding Education Reform, n.d.) and simulationbased learning strategies (Simulation Innovation Resource Center, n.d.)...
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