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What do nurses need to become present?

When reading the Self-Transcendence Theory of Pamela Reed, I realised that this mid-range theory has a meaningful application for Presence. Self-transcendence is the ability of a human being to become more aware of who they are and what matters to them, to relate on a deeper level with others and the environment, to integrate experiences of past event so that it has meaning for the present and to connect spiritually. Self-transcendence can be achieved through self-acceptance, finding meaning and purpose, reaching out to others and through spiritual growth.

The theory posits that nurses, as human beings, can be in a state of conservation – where their own basic needs are not met and they have to struggle to survive. In such a state, I can imagine that it is extremely difficult to reach out to another human being and be present with and for the other, as all energy is directed towards addressing the gaps that are felt within. An example I can think of is the nursing manager that is under pressure from both team members and upper management to meet deadlines and manage a rapidly changing, resource-scarce and high demand healthcare environment, without being properly trained to do so, and who are experiencing personal problems.

The theory further indicates that nurses can be in a state of self-enhancement. This is a state that surpasses the state of survival, and where nurses’ basic needs are met, but where they are in pursuit of meeting personal development goals. A nurse focused on studies and learning has little energy and space left to see others and be with and for others on a deeper level. In fact, in these two lower stages the nurse herself is in need of Presence. The same example of above applies, the mentioned nurse manager may decide to participate in formal studies and personal and professional growth in order to be better able to cope with work and life demands.

If the nurse manager continues to search for meaning, reach out to others and experience spiritual growth, he/she may enter the next state, namely openness to change. The nurse becomes open to consider new viewpoints, start to see the viewpoint of others and start to consider how these views may have meaning for him/her. The nurse may still focus more on own needs than on the needs of others, but he/she is maturing through the process of being open to change. The life event of being in such a difficult situation as described above, or any other profound life event makes the nurse aware of her own vulnerability and challenges her to search for meaning. The maturing nurse makes a choice to be open and consider a range of different views in the process of meaning making.

Nurses then may reach a state of self-transcendence, where they are able to accept and integrate difficulties and find meaning therein, see beyond their own needs only and reach out to others, share their wisdom, and find spiritual meaning. This is the nurse who – in the exact same difficult work and life circumstances – finds the time and energy to really notice colleagues and patients and their needs, and listen in a caring and attentive way. The nurse manager is now ready and willing to enter with them the difficult experiences of their team members and patients. Such a way of being, in itself, fosters a deeper experience of meaning, fulfillment, joy and serenity.

Presence thus requires a high level of readiness and maturity of nurses. Nurses need to be cared for and care for one another to move towards self-transcendence, in order to reach out and be there with and for patients.

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