Ontology of Virtual Nursing Presence
The article currently featured on the ANS website is titled “On Virtual Presence ,” authored by Valarie S. Grumme, MSN, RN, CCRN; Charlotte D. Barry, PhD, RN, NCSN, FAAN; Shirley C. Gordon, PhD, RN, NCSN; and Marilyn A. Ray, PhD, RN, CTN-A, FAAN. In this article the authors address the realities of maintaining a nurse-patient relationship in the context of online distant environments. While this article is featured, it is available for download at no cost, so we invite you to read the article and return here to share your comments and ideas on this timely topic!
Ms. Grumme shared this information about this work, based on her dissertation research:
My interest in virtual nursing presence evolved as an outcome of my dissertation research on the use of social media groups by persons in the transplant community. As a caring modality, nursing presence has been linked to traditional concepts of person with place, space, and time. However, advances in health care and communication technology have expanded nursing practice to nontraditional environments that preclude the physical presence of the nurse for a caring encounter. An increasing number of nurses are creating and maintaining nurse-patient relationships and practicing in a diverse range of specialties in virtual/distance environments. The question arose; can nursing presence be “real” in virtual/distance environments? To answer the question, I explored theoretical and philosophical constructs of presence from multiple disciplines, including nursing, engineering, cognitive and behavioral science, and communications.
To understand the phenomenon, I found that I first had to delve into the deep existential roots of what it means to be truly present with another. Marcel’s mystery of presence, “even if I cannot see you, if I cannot touch you, I feel that you are with me . . . ” resonated with me. In the existential writings of Buber, Marcel, Heidegger, and Levinas, the ontology of presence is interpersonal and relational; it includes interconnectivity, mutuality, intentionality, and love. Existential thought is reflected in the writings of many nurse theorists, including many attributes of presence: “being with”, “being there”, bearing witness, commitment, and love.
The next reflective question was, how can the shared intimate and interpersonal relationship of presence be manifested in a virtual environment? Virtual environments of care are supported by a technological medium, a form of interface that enables the relationship between the nurse and nursed. This concept is known as mediation. Multidisciplinary studies of virtual presence consistently describe successful perceptions of virtual presence as a sense of being immersed in the experience as if the technological medium was not there (non-mediation). Sandelowski alluded to this concept as well, describing a successful telepresence intervention where the shared experience of the caring conversation seeming dissolved the technological barrier between nurse and client.
The pandimensional nature of the internet extends the healing power of nurse caring to virtual environments, allowing persons to give and gain support for their unique expressions of health patterning without the constraints of place, space, and time. The nurse artfully and intentionally utilizes the ability to recognize pattern, problem-solve, and employ both moral and emotional intelligence to provide a therapeutic and caring encounter through the technological medium supporting the nurse-patient relationship. I offer a new ontology of virtual nursing presence:
Virtual nursing presence is the unbounded and loving gift of self, manifested in the intimate, mutual, and intentional relationship of the nurse and the nursed. It is a presence that transcends place, space, and time, cocreated within the technological medium that supports the caring encounter, and can have lasting and lingering effect.
Writing this article with my esteemed colleagues was a personal journey of exploration, discovery, and appreciation of the human capacity for caring, wherever that need might be. I thank you Dr. Chinn for the opportunity to share this knowledge with others. I see advances in technology that support nurse caring as an opportunity, not a burden. Care environments continue to evolve and challenge our ability to practice effectively. Extending our capacity to care into virtual environments adds another dimension to caring practice that will only continue to grow as we explore new frontiers and futures for humanity.
Barrett EAM. Virtual reality: a health patterning modality for nursing in space. Visions (Pensacola, FL). 1993;1:10-21.
Doona ME, Chase SK, Haggerty LA. Nursing presence: as real as a milky way bar. J Holist Nurs. 1999;17(1):54-70. doi:10.1177/089801019901700105.
Grumme, VS., Barry, CD., Gordon, SC. & Ray, MA. On virtual presence. ANS Adv Nurs Sci. 2016;39(1):48-59. doi:10.1097/ANS.0000000000000103
Kurzweil R. The Singularity is Near: When Humans Transcend Biology. New York, NY: Viking; 2005.
Lombard M, Ditton T. At the heart of it all: the concept of presence. J Comput Mediat Commun.1997;3(2). doi:10.1111/j.1083-6101.1997.tb00072.x.
Marcel G. The Philosophy of Existentialism. Secaucus, NJ: Citadel Press; 1956.
Oudshoorn N. How places matter: Telecare technologies and the changing spatial dimensions of healthcare. Soc Stud Sci. 2012;42(1):121-142. doi:10.1177/0306312711431817
Paterson J, Zderad L. Humanistic Nursing. New York, NY: Wiley; 1976.
Rogers M. Nursing science and the space age. Nurs Sci Q. 1992;5(1):27-34. doi:10.1177/089431849200500108
Sandelowski M. Visible humans, vanishing bodies, and virtual nursing: complications of life, presence, place, and identity. ANS Adv Nurs Sci. 2002;24(3):58-70. doi:10.1097/00012272-200203000-00007.
I am impressed but a m puzzled as to why there was no reference to Peplau? Starting from her 1952 book to the classic article on Loneliness ….she artifacts presence as the element the nurse brings to the relationship….and further r posits presence as mitigating the deleterious effects of panic(trauma in the lexicon of today)