Practising caring presence is recognised as an important nursing intervention indispensable to high-quality, patient-centred care. An awareness of the real world of professional nurses (PNs) practising caring presence will assist in expanding and supporting the existing literature on the same. A clear and rich description of what the concept of caring presence entails within the unique South African nursing context may guide nurses in the art of this nursing skill, enhance their professionalism and facilitate the formulation of recommendations on how to encourage nurses to implement the practice of caring presence within nursing.
This study explored and described the lived experiences of PNs practising caring presence in a rural public hospital.
The study setting was a 120-bed, level-two district hospital in the North West Province of South Africa.
A descriptive phenomenological method, specifically Husserl’s approach, informed this study. Semi-structured interviews were conducted with a purposive sample of 10 PNs. Data were coded and analysed using Colaizzi’s seven-step method.
Five themes emerged from the data analysis: professional caring presence, ethical caring presence, personal caring presence, healing caring presence and what caring presence is not.
Professional nurses experience practising caring presence as professionally and personally fulfilling, as an expression of their passion for the profession, as a way of portraying ethical care, as a willingness to be personally present and as a healing experience that involves commitment and taking care of patients holistically. Unprofessional, unethical behaviour and depersonalisation of patients were indicated as uncaring behaviour.
The concept of caring presence is recognised as an extremely significant, valued core attitude in nursing practice, as well as a crucial element in quality healthcare (Kostovich
According to Turpin (
The need for caring presence has been recognised worldwide (Valentine
This study was undertaken in response to the challenge of exploring what it means to practise caring presence in the nursing profession. Caring presence is experienced internally and is thus difficult to fully describe, understand or enumerate (Turpin
At the same time, clear and accurate knowledge regarding caring presence unique to
To gain an in-depth understanding of the concept, caring presence can be explored from both the nurse’s and the patient’s viewpoints (Andrus
Caring presence is defined by Kostovich (
Phenomenologically, Kisiel and Sheehan (
A PN is a nurse who is registered with the South African Nursing Council (SANC) under Section 31 of the
The purpose of this study was to explore and describe PNs’ lived experience of practising caring presence in the context of a rural public hospital in the North West Province, South Africa.
A descriptive phenomenological method, specifically Husserl’s approach, informed the design of this study. This approach entails a stance that asks ‘what do we know as persons?’ and is applied to carefully portray ordinary conscious experience of everyday life (Polit & Beck
This study was carried out at a rural public hospital in the North West Province. The hospital mostly serves patients from remote and poverty-stricken areas. This 120-bed, level-two district hospital with an average bed occupation of 66% forms part of the public healthcare sector. This facility provides a comprehensive service, which includes operating theatres; a high-care unit; trauma and emergency care; neonatal unit; and maternity, medical surgical, gynaecological and paediatric wards. At the time of the research, the total number of nursing staff was 225, with a total of 59 PNs.
For the purpose of this study, the target population (Grove et al.
The researcher involved a gatekeeper (Byrne
The sample was selected according to inclusion criteria. Participants were selected based on the criteria that they had to be PNs employed for at least 1 year in a rural public hospital in the North West Province, identified by a mediator as a PN who practises caring presence, and willing to participate.
Fourteen possible participants were identified through this process of recruitment and sampling, and 10 participants gave their informed, voluntary consent to participate. Data were collected until quality-rich data were generated and until the repetition of data was apparent (Burns & Grove
Semi-structured, face-to-face individual interviews were preferred as the means of data collection, for the rich data they provide, such as nuances of the participants’ experiences that may be conveyed through facial expressions, gestures, blushing or tears (Polit & Beck
Two open-ended questions were asked to encourage participants to fully describe their experience (Welch
Can you please describe a situation where you practised caring presence as a professional nurse?
How do you experience practising caring presence?
Each interview took about 45 min to 1 h. This included the time to create a rapport. The researcher recorded descriptions of the participants’ behaviours and demeanour during the interactions in the interview context by means of field notes to support the emerging themes.
As participants were interviewed, the researcher reflected on their responses and made memos and notes. Following the interviews, the data were transcribed from the audio recorder to a Microsoft Word document by the researcher. The researcher engaged in prolonged immersion with the data whilst identifying and describing the true
Data were coded and analysed using Colaizzi’s (
Each transcript was read and re-read in order to obtain a general feel of the content.
Each transcript was reviewed, and significant statements were extracted.
Each significant statement was reflected upon to formulate meanings.
The formulated meanings were organised into clusters of themes:
These clusters were referred back to the original transcripts for validation. Discrepancies were noted amongst or between the various clusters, avoiding the temptation to ignore data or themes that did not fit.
Results were integrated into an exhaustive description of the phenomenon under study.
An exhaustive description of the phenomenon under study was formulated in as unequivocal a statement of identification as clearly as possible.
Participants were asked about the findings as a final validating step in order to compare the researcher’s descriptive results with their experiences. This step aimed to validate the study findings using the member-checking technique. Participants were provided written summaries of the findings (themes and sub-themes) and thereafter their views on the study findings were obtained via telephone calls. Minor revisions were integrated into the final description of the interviewee’s experience, but overall they agreed that the themes and sub-themes were a true reflection of their experiences.
From the transcribed interviews, 319 significant statements were extracted, leading to the development of 319 formulated meanings, reflecting the lived experience of these PNs. Eleven theme clusters were formed, which were further merged into five emergent themes.
During a training and information session, which was held in the boardroom at the hospital, the researcher conducted a PowerPoint presentation in which she shared with the mediators an introduction to the research activities, the purpose of the project, selection of the study population, as well as the methods and procedures by which data would be collected. Furthermore, she provided an explanation of the risks and benefits of the study, and confirmed the anonymity, voluntary participation and confidentiality of the participants. The mediators agreed to sign confidentiality agreements in order to protect the identity of the participants and to recruit the participants by sending an invitation to all participants meeting the inclusion criteria. The identified participants were given time (at least 24 h) to consider whether they wanted to participate. The voluntary consent was also confirmed prior to the audio-recorded, semi-structured interviews. Participants were ensured that they could withdraw from the study without any threats to their well-being at any time if they wished so.
The researcher assured that the transcripts and records were coded and numbered, and all data were kept confidential. Consequently, there were no links or clues to the identity of the participants. The audio recordings were destroyed by deleting them from the audio recorders after the transcribing process.
Trustworthiness was demonstrated in providing rigour and strength to the study in accordance with the principles of credibility, dependability, confirmability, transferability and authenticity (Polit & Beck
Ethical considerations were adhered to in the following ways. The research proposal for the study was submitted and permission to pursue the study was obtained from the North-West University (NWU) Health Research Ethics Committee (HREC), Potchefstroom Campus (Ethics number NWU-00331-16-A1). In addition, the North West Department of Health as well as the chief executive officer (CEO) of the rural public hospital granted permission to conduct the research. The researcher utilised the informed consent form provided by the HREC of the NWU, Potchefstroom Campus. This consent form clearly stipulates the ethical principles of voluntary participation, beneficence, respect for people and justice.
Coding table.
Demographic profile of participants.
Number of participants | Age | Gender | Nursing qualifications | Work experience | Nursing unit |
---|---|---|---|---|---|
1 | 58 | Female | Nursing Diploma | 23 years | Neonatal |
2 | 32 | Female | Nursing Degree | 10 years | Gynaecology |
3 | 30 | Female | Nursing Diploma | 8 years | Theatre |
4 | 27 | Female | Nursing Diploma | 5 years | HIV wellness clinic |
5 | 31 | Female | Nursing Diploma | 9 years | Outpatients eye clinic |
6 | 56 | Female | Nursing Diploma | 26 years | Outpatients eye clinic |
7 | 31 | Female | Nursing Diploma | 8 years | Theatre |
8 | 25 | Female | Nursing Degree | 3 years | Oncology |
9 | 30 | Male | Nursing Degree, Trauma specialised | 8 years | Casualty |
10 | 31 | Male | Nursing Diploma, Theatre specialised | 9 years | Casualty |
HIV, human immunodeficiency virus.
In their experience of practising caring presence, participants felt that
‘Yes, without passion, I could not do it … Passion goes for everything … You do it hundred per cent (silence). Everything comes with passion.’ (T1, P2, L48-50)
‘…I said to her, no, no, no, I am not here for the paperwork, I am here for the patients, you see.’ (T1, P4, L126-127)
‘We must be role models to the younger nurses to show them that we really care for our patients.’ (T 10, P53, L70-71)
‘The other thing, neh, is that you cannot nurse in a rural village, with a broken heart or with anger, it is so (silence) wrong.’ (T2, P12, L135-36)
Literature confirms that passion is the core characteristic that enables nurses to practise professional caring presence (Ketchem
The participants described
‘But if I know I am fighting for my patients, their right to life, to get a chance.’ (T7, P42, L261)
‘Then I have to advocate for them. I beg them to give them a chance.’ (T4, P22, L59–60)
Ethical responsibility and moral sensitivity are particularly relevant to caring presence (Ray & Turkel
In their experience of practising caring presence, some participants revealed a desire to meet the
‘I try to become part of their family, or like a family member who cares genuinely. Yes, yes. I will go that far to come close to my patient.’ (T8, P49, L134–136)
‘It’s on a daily basis, neh, usually I am happy when I go home … I go home seeing a difference in the patients’ condition.’ (T1, P2, L53-55)
‘I feel I
‘I was actually giving my all for this patient. That is caring presence for me.’ (T7, P41, L226-227)
These findings reflect Palmiery’s (
[A]s human beings, our presence is automatically care: it expresses the way in which we are, who we are, able to be, given our limits, and the context, both material and relational, in which we live. (p. 66)
When a nurse is personally present, compassionate care becomes real, and this state is needed for those who intend to facilitate healing (Welch
The participants regarded the practice of caring presence as an experience grounded in a
‘Yes, to see the patient with physical, spiritual and emotional needs. Not only a body, but a person with more needs. Like I say to help the patient to heal.’ (T4, P24, L124-125)
‘All patients, sister, do have physical, emotional and spiritual needs, OK? I take care of all the needs and am present for the patient holistically.’ (T9, P53, L63-66)
‘I also take care of the patient’s spiritual needs. It is important to listen and if he needs to pray, let him pray and support him.’ (T10, P53, L56-58)
‘In rural areas, we have many social-economic problems. We must guide and assist the patients accordingly. It is very important.’ (T7, P45, L380-381)
‘Before you come to work, you must focus to be present. You must talk to yourself, you know what, today I am going to work for my patient, I am going to treat that patient that need me, because I am a nurse.’ (T2, P13, L144-149)
The nursing literature supports these experiences of the participants in similar ways, for example, the use of the self as an instrument of healing (McKivergen & Daubenmire
The participants further identified
‘In the ward, with thirty to forty patients, I have to give medication, I have to do vitals, I have to assist the patients. In the meantime I (am) needed with resuscitation. How are we able to cope?’ (T6, P34, L151-156)
‘What they are doing is, they sit with their phone (silence). It is WhatsApp (silence) or Facebook? Um (silence).’ (T1, P5, L147-149)
‘That the role-models also don’t care and that they are also on their phones … and they are also not there for their patients (silence). Even you can go for a lunch for 3 h (silence). Because the same manager goes for hours! And when she comes back, she just sits in the office. If you do this, they will follow you.’ (T1, P6, L193-194)
‘You must not call the patient by his diagnosis. You must say, Mr so and so and Mrs so and so. If you call them the laparotomy-patient, they don’t feel all-right. It is not fair to the patient.’ (T5, P29, L87-92)
Bright (
Having selected a descriptive phenomenological design for this study, the researcher was able to incorporate the participants’ beliefs, insights, thoughts, actions and multiple realities regarding the practice of caring presence into an exhaustive description of the essence of their lived experiences. Furthermore, the semi-structured interview technique enabled the researcher to draw rich descriptions from the participants about the phenomenon of interest. In addition, the research findings were confirmed when literature integration was applied.
Through this research, the researcher gained insight into the description of specific and unique moments of this experience, thus making known the significance and transformative potential of caring presence in the nursing profession, for future use in the practice, education and research fields. Based on the findings, integrated with available literature, it could be concluded that the essence that represents the true nature of the phenomenon of practising caring presence in a rural public hospital shared by the participants regarding their lived experiences is:
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The following limitations were identified in this study. Owing to the fact that this was a qualitative study, the research findings cannot be generalised to all PNs in the South African healthcare sector. However, the information captured the nuances of this lived experience as lived by these PNs practising caring presence in the context of a rural public hospital. The study was conducted only at one rural public health facility in the North West Province, thus limiting the study’s findings to this specific setting and to the PNs. The study reflected the lived experiences of only 10 participants, identified by the mediator, who volunteered to participate in the study. Data saturation was, however, reached. Owing to the high workloads of the participants, the urge to finish the interview as soon as possible in order to return to their units was observed by the researcher, even though data saturation was obtained.
The recommendations focus on enhancing and encouraging the practice of caring presence in the nursing profession. Therefore, based on the findings and conclusions of this study, the following recommendations are made.
Curriculum planners in charge of the degree programme should give more emphasis to the practice of caring presence in the nursing profession so that the value and transformative potential of the practice of caring presence can be understood by students to ensure patient-centred quality care and professionalism.
Educators should give more emphasis to the importance of self-awareness and the therapeutic use of the self in the training of nurses.
A vibrant passion for the nursing profession should be cultivated and maintained so that nurses can come to practise caring presence and build meaningful relationships with patients.
Professional nurses should portray professionalism and competence.
Professional nurses should engage in continued professional development by means of workshops, in-service training and motivating courses. In this way, they can become role models to enhance the practice of caring presence, professionalism and a caring attitude amongst all nursing categories.
Professional nurses should realise the importance of leading by example for other nursing categories to facilitate the practice of caring presence, professional attitudes and behaviour.
Ethical awareness and moral responsibility towards patients can be encouraged by means of courses and workshops.
Professional nurses can facilitate and encourage the importance of patient advocacy and referral.
Professional nurses can facilitate caring presence by being role models to other nursing categories, in portraying good, ethical conduct and showing genuine interest in the well-being of their patients.
A willingness to be personally available, to walk the extra mile and to offer the gift of self should be recognised and encouraged by organisational management.
The provision of workshops and in-service training regarding the significance of being personally present for patients can enhance the practice of caring presence in the nursing profession and thereby improve the quality of nursing care.
Dedication and commitment to take care of patients holistically and to render individualised, patient-centred nursing care should be part of hospital policy.
Awareness of the dimensions of being a healing caring presence can be enhanced by means of inviting experts on this issue, motivating nursing personnel to practise caring presence within the nursing profession.
Hospital and nursing management should identify and address barriers that hinder the practice of caring presence by providing adequate resources, both human and monetary, to foster the practice of caring presence.
Depersonalisation of patients should be recognised and seriously addressed by nursing management by means of implementing a system where nursing personnel who treat patients in an unethical, uncaring way (as objects) receive negative reports and warnings.
Research on the relationship between passion for the nursing profession and the practice of caring presence.
Research on PNs’ lived experience of practising caring presence in the private healthcare sector in South Africa.
The findings of this qualitative, descriptive and phenomenological study can be used to expand and support the existing literature regarding the practice of caring presence. Consequently, the rich information and insight gained from the lived experiences of the PNs in this study add to the nursing body of knowledge, specifically regarding the understanding of the concept of caring presence from a South African point of view.
The authors are grateful to Dr A. van der Wath (co-coding), Ms C. Kruger (technical outlay) and Elcke du Plessis-Smit (editing) for their contributions.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Petronella Hobbs who conducted this research for a master’s dissertation at the North-West University (NWU) wrote the manuscript. E.d.P. and P.B. were the supervisors, and they critically reviewed the manuscript.
This work is based on the research supported in part by the National Research Foundation (NRF) of South Africa (Grant Number: 105914). The grant holder (E.d.P.) acknowledges that opinions, findings and conclusions or recommendations expressed in this publication are that of the authors and that the NRF accepts no liability whatsoever in this regard.
Data sharing is not applicable to this article as new data were created and analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.