Presence: four ways of being there.

Presence is an important but confusing concept in nursing. At times, it is used to simply characterize a nurse's physical presence, while, at other times, it is used in a highly metaphysical sense to depict a nurse's full physical, psychological, and spiritual presence. As a concept, presence has not been clearly defined. Its core characteristics need to be identified and separated from those characteristics that reflect its variability. The authors establish a definition of presence as "being there" based on the essence of the concept as it is used in the nursing literature; identifying four ways in which presence varies based on the quality of being there, the focus of the nurse's energy, and the nature of the nurse-patient interaction; and address possible outcomes of each type.