International Nurses Day: Presence, not presents

In the context of the multidisciplinary team it can feel awkward to single out any one profession for praise - but nurses offer unique and valuable skills, says Dawne Garrett, Professional Lead for Older People and Dementia Care at the Royal College of Nursing

The birthday of Florence Nightingale, 12 May, is International Nurses Day and is the day we honour the nurse, statistician, campaigner and leader.

As practitioners working with older people we are well versed in multidisciplinary working, without which we could not provide the care and interventions older people need. We understand the value of inter- and sometimes intra- professional working, so powerful words about our individual professions can seem inappropriate in the context of today’s role blurring and cross-boundary peripatetic care.

I was tempted to write about the development of advanced nursing roles, our ability to embrace and excel at activity previously undertaken by other professions. I could to articulate our flexibility, creatively and pragmatism, all things I hold dear. 

Nurse’s day encourages my pride. Nursing is a unique profession with a body of knowledge and values specific to nursing, so this is an opportunity to raise the concept of 'presence'. I’m going to think about the presence of nursing, both physically and emotionally.

Presence involves being with another person in a close way, including physical proximity, engaged availability and attending to personal needs.

The physical is obvious; we are alongside, nearby, within reach, 24 hours a day - the largest healthcare group and most trusted profession. We are privy to the private, the errors, the declarations, the confessions and the intimate, often seeing best and the worst in people, including our friends and colleagues. As nurses we frequently witness to the events that people hide from each other. 

Back in 2006, Deborah Finfgeld-Connett1 carried out a meta-analysis of 'presence' in nursing, explaining this interpersonal process was characterised by sensitivity, holism, intimacy, vulnerability and adaptation to unique circumstances but often confused caring, empathy, therapeutic use of self, support and nurturance. It is a complex concept but perhaps the one that is uniquely nursing. It results in enhanced mental well‐being for nurses and patients and improved physical well‐being for patients. 

As nurses we have long acknowledged the emotional labour involved in our profession and often reflect on those activities that both protect and reward us as clinicians. Presence requires both a need and an openness in patients and a conducive environment.

Presence involves being with another person in a close way, including physical proximity, engaged availability and attending to personal needs. It also involves sensitive verbal communication to manage psychological and spiritual concerns; however, these issues may also be addressed non‐verbally.

Finfgeld-Connett’s findings suggest that nurses who enact presence must be personally and professionally mature. They should know and accept themselves on a personal level. Professionally, they must possess clinical competence and expertise in the physical and psychosocial domains of nursing practice. From a moral perspective, presence is underpinned by a commitment to help, and a respect for individual differences may be the zenith of nursing.  

So yes we are the advanced practitioners running frailty units, the Nurse Consultants leading intermediate care services, the newly qualified nurse providing personal care, the academics delivering ground breaking research. 

More importantly we are there beside our older people bringing our presence as we manage life and death with professionalism and integrity. Happy Nurses Day!

1.     Finfgeld-Connett D. Meta-synthesis of presence in nursing. J Adv Nurs 2006;55(6):708-14.


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