Presence is a kind of unspoken movement in any given moment between people, in our case, between the nurse and a patient, or between nurses, that is experienced as ‘good care’, as having a healing effect, as a sacred moment, as satisfying the needs of the patient and the intention of the nurse. The DREAM guidelines can be a guide to make presence a reality.
Presence can’t be observed, it can only be experienced. Presence thus needs to be discovered through asking the nurse and the patient to express in some way what were moments they experienced that felt like presence, and what it meant to them. And naturally, presence would be defined differently by each individual. It is thus extremely difficult to define and describe presence, or then to find ways to cultivate or promote presence. I wonder, if a good way to discover presence is, perhaps, to ask nurses and patients to think about moments when they experienced healing, change, growth, movement, connection, even moments of awe and sacredness.
Such stories would help us to discover presence, to find the commonalities of those moments that we may use to paint the outer picture lines of the idea of presence, and each unique story would then colour in the picture in a unique way.
That brings us to the presence guidelines we developed. These guidelines are intended to be used by nurses to discover moments of presence, and in so doing, think about ways to facilitate relational nursing care.
The DREAM guidelines can be found at the Resources page on the Presence website.
The guidelines can be very helpful tools during in-service training and during reflections on how presence is already part of nurses’ way of nursing, and on what can be strengthened in the nurses’ way of ‘being with’ and ‘being there for’.
It is in no way meant as a prescription or the final answer about how to ‘practice presence’. It is a starting point for nurses to consider, to reflect on and to think about how it can help them to discover presence in their relationship and moments with one another and with patients. Questions that can be used to facilitate a reflective discussion with the Presence guidelines, are for example:
To practice
Reflect on each of the words that make up the acronym DREAM:
· What do the word and its description mean to you as a person?
· What are stories that you can share to illustrate the word and its description?
· How do you think the word and its description can be used to facilitate relational care?
· What else (apart from the DREAM) do you think can nurses do to connect with patients to provide in the unique needs of each patient?
· Think of a time when you experienced the interaction, the moment, the time spent with the patient, as a moment of ‘good care’, in other words a moment of growth, healing, a moment of connection and/or a moment through which needs were met? In what way did acknowledgement of the other person, and an attitude of ‘I want to be here’ play a role? How did this moment impact you, and the other person?
· What do you think nurses need in order to provide good care? What do patients view as good care?