Intensive nursing care. The ministry of presence.

The nurse's presence offers meaningful support to people in critical care situations. Because crisis and suffering dispirit a person, there is an increased sense of vulnerability, isolation, and alienation, as well as a decreased sense of relationship and being heard in an environment that is already overwhelming, often associated with pain, frightening, and unfamiliar. The nurse's presence can lessen these negative effects of suffering as one comes alongside and enters that suffering by listening and being available in a way that involves self-giving. In this way, the nurse is fully attentive with all of self, as opposed to seeming to be. The idea of being present may be threatening to a nurse because it requires exposing one's vulnerability in order to come alongside one who is already very ragged and exposed. The silence also may be intimidating as the nurse chooses to wait with a person who is in turmoil and wrestling emotionally, mentally, physically, or spiritually. Another challenge for the nurse is confronting traditional attitudes about what it means to "be professional" and "therapeutic." The experience of presence is an awesome privilege humbly received as one realizes the personal cost to the one who chooses to share inner wrestling and brokenness. Presence occurs only with the permission or invitation of the one suffering and only when the nurse is willing to accept the invitation and also be that vulnerable. Because suffering often triggers spiritual wrestling in addition to emotional, mental, and physical pain, the nurse may be invited to come alongside a person in a role that interfaces with that of the chaplaincy.(ABSTRACT TRUNCATED AT 250 WORDS)