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Vol. 23, No. 12, DECEMBER 2006

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A Present of Presence

The most precious gift we can offer others is our presence.
—Thich Nhat Hanh, Buddhist monk and peace activist

Still the Focus of Intense Debate
The presence of family members—open visitation being an essential component—is a vital component of human connection. Yet it continues to generate intense debate among healthcare professionals. How can we acknowledge that patients do not exist in isolation and then isolate them by withholding access to their families? How do we explain this shameless disconnect with a straight face?
Our pediatric colleagues figured it out and strive to include families in every aspect of patient care. On the other hand, those of us who care for adults act as if something changes when that child reaches age 18.

Where you stand has a profound influence on what you see.
—Marie Manthey

Vulnerability and the need for support are not functions of chronological or developmental age. The healing value of a person’s family persists throughout life, even though the actual family members may change with the passing years. Ask any nurse whose family member has been hospitalized. The view is different from the other side of the care equation, isn’t it?

Where We Get Stuck
We seem to get stuck by assuming that open visiting hours and family presence during invasive procedures must look the same for everyone. Presence means something different for each person, just as family does, so an absolute rule is not feasible in today’s healthcare environment. Free-for-all family presence makes no more sense than rigidly controlled presence.
We all know about situations where visiting hours need to be controlled for safety or advocacy reasons. We also know when allowing family presence is the right thing, even if on the surface it is “against the rules.” A family’s behavior sometimes gets in the way of our ability to give care. But if family presence becomes an indispensable part of our care, could it be that, as someone wisely suggested, a difficult family is simply one with unmet needs?

Not Incredibly Easy
Adjusting for individual needs can be daunting in a world where standardization and efficiency are highly prized. Nonetheless, is it any more challenging than multisystem organ failure or any other complex clinical situation? Difficult, yes, because critical care is not incredibly easy. Impossible? Never! Not for compassionate and intellectually talented professionals like us.
During this holiday season, would you join me in looking for instances where you see human connections being made? In your busy workplace, recognize the moments where you, your colleagues and families are giving the gift of presence. Celebrate as you tell others these stories of new awareness and insight. If you wish to share them with me as well, please write to me at insights@aacn.org.

See something a new way and you’ll never see it the old way again. Each of my columns this year will feature a different graphic so we can share a different dimension of seeking insights.—MFT

Which way are the cubes facing? Up or down?
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