Grand Theory

Topics: Nursing, Nurse, Nurse education Pages: 25 (7967 words) Published: January 24, 2013

Toward a Mid-Range Theory of Nursing Presence
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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: 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.)...

References: American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Retrieved from Education/bacessn.htm American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http:// EthicsStandards/CodeofEthics.aspx American Nurses Association. (2003). Nursing’s social policy statement (2nd ed.). Silver Spring, MD: Author. American Nurses Association. (2004). Scope and standards of practice. Silver Spring, MD: Author. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley. Bottorff, J., & Varcoe, C. (1995). Transitions in nurse patient interactions: A qualitative ethology. Qualitative Health Research, 5(3), 315–331. Buber, M. (1958). I and thou. New York: Charles Scribner’s Sons. Carper, B. (1978). Fundamental patterns in knowing. Advances in Nursing Science, 1(1), 13–23. Chase, S. (2001). Response to “the concept of nursing presence: State of the science.” Scholarly Inquiry for Nursing Practice: An International Journal, 15(4), 323–326. Cohen, M., Hausner, J., & Johnson, M. (1994). Knowledge and presence: Accountability as described by nurses and surgical patients. Journal of Professional Nursing, 10(3), 177–185. Covington, H. (2003). Caring presence: Delineation of a concept for holistic nursing. Journal of Holistic Nursing, 21(3), 301–317.
Toward a Mid-Range Theory of Nursing Presence
Curley, M. (1997). Mutuality-an expression of nursing presence. Journal of Pediatric Nursing, 12(4), 208–213. Dochterman, J., & Bulechek, G. (2004). Nursing interventions classifications. St. Louis, MO: Mosby. Doona, M., Chase, S., & Haggerty, L. (1999). Nursing presence: As real as a milky way bar. Journal of Holistic Nursing, 17(54), 54–70. doi: 10.1177/089801019901700105 Doona, M., Haggerty, L., & Chase, S. (1997). Nursing presence: An existential exploration of the concept. Scholarly Inquiry for Nursing Practice: An International Journal, 11(1), 3–16. Duis-Nittsche, E. (2002). A study of nursing presence. (Unpublished doctoral dissertation). University of TexasGraduate School of Biomedical Sciences at Galveston. Easter, A. (2000). Construct analysis of four modes of being present. Journal of Holistic Nursing, 18, 362–377. doi: 10.1177/089801010001800407 Engebretson, J. (2000). Caring presence: A case study. International Journal of Caring, 4(2), 33–39. Executive Office of Health and Human Services. (2007). Good moral character policy. Retrieved from http://www. nursing_good_moral_policy.pdf Ferlic, A. (1968). Existential approach in nursing. Nursing Outlook, 16, 30–33. Finfgeld-Connett, D. (2006). Meta-synthesis of presence in nursing. Journal of Advanced Nursing, 55(6), 708–714. doi: 10.1111/j1365-2648.2006.03961.x Finfgeld-Connett, D. (2008). Qualitative comparison and synthesis of nursing presence and caring. International Journal of Nursing Terminologies and Classifications, 19(3), 111–119. doi: 10.1111/j.1744-618X.2008.00090.x Fredriksson, L. (1999). Modes of relating in a caring conversation: A research synthesis on presence, touch and listening. Journal of Advanced Nursing, 30(5), 1167–1176. Gardner, D. (1985). Presence. In G. Bulechek & J. McCloskey (Eds.), Nursing interventions: Treatments for nursing diagnoses (pp. 316–324). Philadelphia: W. B. Saunders. Gilje, F. (1992). Being there: An analysis of the concept of presence. In D. A. Gaut (Ed.), The presence of caring in nursing (pp. 53–67). New York: NLN. Godkin, J. (2001). Healing presence. Journal of Holistic Nursing, 19(5), 5–21. doi: 10.1177/089801010101900102 Hanneman, S. (1996). Advancing nursing practice with a unit-based clinical expert. Image: Journal of Nursing Scholarship, 28(4), 331–337. Hessel, J. (2009). Presence in nursing practice: A concept analysis. Holistic Nursing Practice, 23(5), 276–281. Hines, D. (1992). Discovering the artistry in relating. Journal of Holistic Nursing, 10(4), 294–305. Kaiser, L. (2005). From presence to “e-presence” in online nursing education. (Unpublished doctoral dissertation). University of San Diego. Karl, J. (1992). Being there: Who do you bring to practice. In D. A. Gaut (Ed.), The presence of caring in nursing (pp. 1–13). New York: NLN. Keogh, B., & Gleeson, M. (2006). Caring for female patients: The experience of male nurses. British Journal of Nursing, 15(21), 1172–1175. Kim, H. S. (2000). The nature of theoretical thinking in nursing (2nd ed.). New York: Springer Publishing Company.
81 © 2011 Wiley Periodicals, Inc. Nursing Forum Volume 46, No. 2, April-June 2011
Toward a Mid-Range Theory of Nursing Presence
Kleiman, S. (2007). Revitalizing the humanistic imperative in nursing education. Nursing Education Perspectives, 28(4), 209–213. Levine, M. (1977). Nursing ethics and the ethical nurse. American Journal of Nursing, 77(5), 845–847. Mardsen, C. (1990). Real presence. Heart & Lung, 19(5), 540–541. McKivergin, M., & Daubenmire, M. (1994). The healing process of presence. Journal of Holistic Nursing, 12(1), 65–81. Melnechenko, K. (2003). To make a difference: Nursing presence. Nursing Forum, 38(2), 18–24. Nelms, T. (1996). Living a caring presence in nursing: A Heideggarian hermeneutical analysis. Journal of Advanced Nursing, 24, 368–374. Osterman, P., & Schwartz-Barcott, D. (1996). Presence: Four ways of being there. Nursing Forum, 31(2), 23–30. Parse, R. (1992). Human becoming: Parse’s theory of nursing. Nurse Science Quarterly, 5(1), 35–41. Parse, R. (2003). Community: A human becoming perspective. Sudbury, MA: Jones and Bartlett. Paterson, J., & Zderad, L. (1976). Humanistic nursing. New York: NLN. Peplau, H. (1952). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. New York: Putnam. Pettigrew, J. (1988). A phenomenological study of the nurse’s presence with persons experiencing suffering. (Unpublished doctoral dissertation). Texas Woman’s University. Pilkington, F. (2005). The concept of intentionality in human science nursing theories. Nurse Science Quarterly, 18(2), 98–104. doi: 10.1177/0894318405274807
M. A. McMahon and K. A. Christopher
Quality and Safety Education for Nurses. (2010). About QSEN. Retrieved from qsen.php Rankin, E., & DeLashmutt, M. (2006). Finding spirituality and nursing presence: The student’s challenge. Journal of Holistic Nursing, 24(4), 282–288. doi: 10.1177/ 0898010106294423 Simulation Innovation Resource Center. (n.d.). Homepage. Retrieved from Smith, T. (2001). The concept of nursing presence: State of the science. Scholarly Inquiry for Nursing Practice: An International Journal, 15(4), 299–322. Tarlier, D. (2004). Beyond caring: The moral and ethical bases of responsive nurse-patient relationships. Nursing Philosophy, 5, 230–241. Tavernier, S. (2006). An evidence-based conceptual analysis of presence. Holistic Nursing Practice, 20(3), 152–156. Technology Informatics Guiding Education Reform. (n.d.). About TIGER. Retrieved from http://www.tigersummit. com/About_Us.html Vaillot, M. C. (1966). Existentialism: A philosophy of commitment. American Journal of Nursing, 66, 500–505. Watson, J. (1988). Nursing: Human science and human caring. New York: NLN. Watson, J. (1999). Postmodern nursing and beyond. London: Harcourt Brace and Company. Watson, J. (2002). Intentionality and caring-healing consciousness: A practice of transpersonal nursing. Holistic Nursing Practice, 16(4), 12–19.
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