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Unformatted text preview: STANLEY VOL 29, NO 6, 2002 935 We can make our minds so like still waters that beings gather about us that they may see, it may be, their own images, and so live for a moment with a clearer, perhaps even with a fiercer life because of our quiet. W.B. Yeats, 1883 P resence has received significant attention in the nursing literature over the past several decades, but it remains difficult to translate into a meaningful paradigm for cli- nicians. Presence has been described as invisible and indivis- ible (Gilje, 1992), existential in scope (Doona, Haggerty, & Chase, 1997), a moment of encounter that requires a lifetime of preparation (Younger, 1995, p. 66), the most demanding aspect of caring (Davis, 1981), and having the power to cre- ate order out of chaos (McKivergin & Day, 1998, p. 96). On- cology practitioners understand that presence is essential to meaningful care (Block, 2001; King, 2001; Stanley, 2000). Patients with cancer recognize and value nursing presence across the illness continuum, but its significance increases as patients encounter the limits of treatment, face the realities of dying, and seek meaning in their lived experiences. If oncol- ogy nurses are to communicate the value of presence to healthcare systems that increasingly limit nursing time with patients, its meaning and worth must be understood. The pur- pose of this lecture is to review basic assumptions regarding the paradigm of nursing presence so that nurses may improve clinical practice and enhance patients experiences at the end of life. As members of the Oncology Nursing Society, we should take great pride in the fact that we are addressing nursing pres- ence. The selection of this topic for the Mara Mogensen Flah- erty Memorial Lecture validates its significance and conse- quence. It emphasizes that nurses value the individual often found trembling behind this illness called cancer and reminds us that nurses will search for and within the person until he or she is found, validated, and comforted. Today, we will briefly examine the meaning of suffering as it relates to the cancer ex- perience, review some basic assumptions regarding the para- digm of nursing presence, and consider narratives that illus- trate the experience of nursing presence. Suffering and the Cancer Experience The Nature of Suffering Suffering has been described as the perception of impend- ing destruction that extends beyond the physical and is con- nected to an experience that threatens a persons sense of wholeness (Cassell, 1982). It has been further portrayed as an amendment of the self, a loss of ones personhood and central purpose, and disclosure of an existence that no longer lays claim to control (Cassell; Ferrell, 1998; Stanley, 2000; Stoller- man, 1997; Younger, 1995). Suffering can devastate ones ability to communicate when words that give meaning to ex- periences cannot be found. This silence broadens the chasm between those who suffer and those who do not know how or...
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