Article
Compassionate Knowing: Building a Concept Grounded in Watson’s Theory of Caring Science
Shannon M. Constantinides, RN; MSN1
Nursing Science Quarterly 2019, Vol. 32(3) 219–225
© The Author(s) 2019 Article reuse guidelines:
sagepub.com/journals-permissions DOI: 10.1177/0894318419845386
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Abstract
Compassionate knowing is the practice of intentional presence to relieve suffering. Inspired by Carper’s patterns of knowing, it is an additional form of knowing grounded in caring science. Likewise, the concept of compassionate knowing is framed by tenets of Buddhist philosophy and George’s emancipatory theory of compassion. Intentional presence is defined as a conscious and altruistic choice, born of moral virtue and selflessness, to act in a thoughtful, empathetic, and humanistic way that honors and gives meaning to the uniqueness of each patient and caring-healing nurse-client interaction. Relieving suffering is defined as the nurse responding to the needs of the patient with loving-kindness to alleviate a perceived or real threat to self-integrity.
Keywords
compassion, knowing, nursing, suffering
One of the most fundamental concepts in Buddhism is the idea that as sentient beings, we cannot escape the inevitable suffering that will occur in our lives (Hanh, 1999). Poet Mark Nepo (2012) echoed that philosophic ethos when he wrote, “the truth is that life will break us and burn us at some point on the journey. This is not being pessimistic or cynical but descriptive of the geography of being alive” (p. 115). Similarly, nurse theorist Jean Watson (2005) wrote that suffering is part of being human; without it, we would not develop depth, humility, or a compassionate nature. However, it is because we have the capacity to live compassionately that we can alleviate suffering and create peace and joy (Hanh, 1999). According to the Buddha, compassion (one of the Four Immeasurable Minds, or brahmaviharas) is what gives us the means to deal with and overcome our own suffering and suffering in the world (Dalai Lama & Chodron, 2014). The philosophical stance that compassion can be used to abate suffering is critically important for those in the healing professions.
The purpose of this paper is to introduce compassionate knowing, a concept grounded in Watson’s (2005) theory of caring science, as an additional form of knowing and contribution to the profession’s epistemology. The paper is format- ted in the context of Liehr and Smith’s (2018) 10-step concept-building process, which was used as a guide in developing compassionate knowing. The steps outlined in core qualities, reviewing relevant literature, contextualizing the concept within a theoretical framework, and summarizing findings from a nurse-interview on the concept Liehr and Smith (2018).
Compassionate Knowing: Creating the Concept
Practice Story/Critical Incident
While working as a family nurse practitioner in primary care, I was involved in an encounter wherein it occurred to me that the only “treatment” I provided the patient was compassion- ate presence. Over the ensuing months, this patient encounter stayed with me. It was what Liehr and Smith (2018) described as a “critical incident” (p. 359) or “practice story” (p. 359): an experience that sparked the beginning of my philosophic exploration of a phenomenon for which I could not quite place a name but which I believed likely applicable to all nurses, regardless of role or practice setting.
Naming the Phenomenon
The patient encounter had occurred during a time in which I was intensively studying Buddhist philosophy as part of scholastic activities in my PhD program. In sitting with, analyzing, this paper include identifying the practice story or critical incident that spurred investigation into the phenomenon or concept, the process of naming the concept and defining it 1 and reflecting upon the encounter, I began to review more deeply Buddhists’ texts on compassion. Likewise, I reflected upon my academic upbringing as a BSN and MSN student in the University of Colorado system and the impact Watson’s work on caring science had on both my clinical expression and subjective experience of nursing practice. I reread Watson’s (2005) Caring Science as Sacred Science, where in the intro- duction she wrote that “caring in its simple and profound forms of knowing-being-doing (are) the manifestation of Infinite Love of healing work in the world” (p. viii). In addition to the concept of compassion, the ideas of knowing and being resonated with me and what I had experienced.
1University of Colorado Health Medical Group Primary Care, Colorado Springs, CO, USA
Whatever it was that I had experienced with this patient, it had resulted in what Watson (2005) described as a transpersonal caring moment (or at least my interpretation of what that should look and feel like). I realized that I kept returning to ask myself the same question: How did I know what to do in that moment? How did I know that compassionate presence was the only “treatment” my patient needed? And in asking that final question, compassionate knowing, the practice of intentional presence to relieve suffering, was born.
Defining Core Qualities
During the concept-building process, two core qualities emerged: intentional presence and relieving suffering. Intentional presence is defined as a conscious and altruistic choice, born of moral virtue and selflessness, to act in a thoughtful, empathetic, and humanistic way that honors and gives meaning to the uniqueness of each patient and caring- healing nurse-client interaction (Watson, 2005). The critical aspects of intentional presence include a specific choice made by the nurse that is guided by an ethic of selflessness, a desire for action, and being present in the moment (Hanh, 1999; Watson, 2005). The desired outcome of the nurse’s decision is relieving suffering, which is defined as the nurse responding to the needs of the patient with loving-kindness to alleviate a perceived or real threat to self-integrity (Hanh, 1999; Watson, 2005). The critical aspects of relieving suffering include the result or outcome (relief) and suffering (as it is perceived by the patient) regardless of physical, emotional, sociopolitical, or other organic or inorganic etiology.
Review of Literature
To understand compassionate knowing, one must understand the central elements of the concept: compassion (and consequently, suffering) and knowing. A review of literature focused on the analysis of the concept of compassionate knowing was conducted using primarily the CINAHL (Cumulative Index to Nursing and Allied Health Literature), Ovid, and PubMed databases. Two items (both non-nursing literature) were found using the keywords “compassionate knowing.” Further keyword searches included “compassion- ate + knowing,” “ways of knowing in nursing,” “patterns of knowing in nursing,” “concept analysis + knowing,” “concept analysis + compassion,” and “concept analysis + suffering.” In this initial search, approximately three dozen references were found to meet criteria with keywords and appropriateness for the concept analysis, which included journal articles, abstracts, book chapters, and one book. From the review of literature, the two core qualities of com- passionate knowing were identified: intentional presence and relieving suffering. Additionally, the review of literature revealed a number of other papers published on additional patterns or interpretations of knowing in nursing beyond Carper’s (1978) original four.
Compassion Review
The Buddhist perspective on compassion. His Holiness the Dalai Lama stated that “compassion is not religious business, it is human business, it is essential for our own peace … (and) for human survival” (Georges, 2014, p. 51). According to the Buddha, compassion is what gives us the means to deal with and overcome the suffering we will experience and encounter in the world (Dalai Lama & Chodron, 2014). In fact, it is important to note that one of the most fundamental concepts in Buddhism is the idea that suffering in life is unavoidable and inescapable (Hanh, 1999). While the face-value of that ethos seems pessimistic, Buddhism teaches that we should not despair about the suffering that will occur in our lives and in the world around us (Hanh, 1999). Through compassion- ate living, we have the ability to abate suffering and create joy and peace (Dalai Lama & Chodron, 2014; Hanh, 1999). So while Buddhist teachings encourage compassion to shape our existences, I contend that it should then also be extended into a manifestation of caring in nursing practice.
Compassion, however, goes much deeper than being nice or wishing others well. Key qualities of compassion, both according to Buddhist philosophy and as seen in relevant nursing literature, include a feeling of empathy, an action of selflessness or altruism, reverence for equanimity, and being in the present moment. Famed Buddhist monk, teacher, and writer Thich Nhat Hanh (1999) described empathetic knowing related to suffering and compassion in this way: “if you want to garden, you have to bend down and touch the soil” (p. 42). Likewise, the Buddha taught that we must “touch (our) suffering and embrace it. Make peace with it” (Hanh, 1999, p. 45). The Buddhist tenet of anatman, or nonself (oneness), teaches that we are all inextricably connected (Dalai Lama & Chodron, 2014; Hanh, 1999). It is through anatman that we “recognize ourselves in everyone we meet” (Nepo, 2012, p. 224). Nurses, therefore, are able to know the pain and suffering of their patients, because they have touched and know the pain and suffering within themselves. His Holiness the Dalai Lama stated that practicing this type of reflective compassion creates a “constructive karma” (Dalai Lama & Chodron, 2014, p. 226) that then affects the well-being of others. It is through anatman and “empathy that we become a conduit for the human struggle until one person’s humanity reveals the whole of humanity” (Nepo, 2012, p. 224).
It would be remiss to bypass discussion of Karuna, a Buddhist tenet related to love and often translated to compassion (Hanh, 1999). Hanh explained that karuna, or compassion, is comprised of two components: com, which is understood as coming together with, and passion, which is understood as to suffer. The intention of karuna is to trans- form or relieve suffering and unburden the weight of sorrow and involves elements of deep, empathetic concern and “dwelling in the present moment” (Hanh, 1999, p. 173). Although suffering is inevitable, and while we should work toward alleviation of suffering, we should not let suffering paralyze us. Rather, Hanh wrote, we should let the happiness of the present moment fill our hearts. In this way, we can create peace, joy, and happiness through compassion.
Compassion in Nursing. Nepo (2012) wrote of compassion that “there is no substitute for going through things together” (p. 187). Traditionally and most frequently cited in nursing literature, compassion is defined as a conscious awareness of another’s suffering or distress coupled with a desire or wish to alleviate it. As nurse theorist Jane Georges (2014) wrote, “compassion goes beyond ‘having good thoughts’ or ‘being nice’ … it is an active consciousness, a way of being … mindfulness and honoring of the other persons … a capacity for connectedness with others” (p. 59). According to her emancipatory theory of compassion, Georges (2013) defined compassion as a “sympathetic consciousness of others’ dis- tress with a desire to alleviate it” (p. 2). Georges (2014) listed the following as characteristics of compassionate behavior: using mindfulness to construct meaning and thoughtfulness in response to human needs, acknowledging the uniqueness and divine nature of each individual, listening with authenticity, and seeking to understand. Georges (2011) also stated that in context to nursing’s larger role in society and ethical responsibility to pursue social justice and advocate for human rights:
The day we stop valuing compassion as an essential of nursing practice or resisting the creation of biotoxic, compassionless environments, we cease to be nurses. We may continue to call ourselves “nurses,” but we will have become something qualitatively different. (p. 134).
To that point, McCaffery and McConnell (2015) con- ducted a critical review of nursing literature on the concept of compassion, with findings echoing those of other nurse scholars: a number of related, yet not synonymous, terms are used in nursing when discussing compassion. These terms included caring, empathy, sympathy, a response to suffering, duty to love, care based on respect and dignity, intelligent kindness, a moral virtue, a choice, an elevated level of consciousness, a spiritual experience, a component of human character, a condition of human connectedness, a genuine connection, value-based care, and the essence of caring (McCaffery & McConnell, 2015). The authors concluded that compassion was viewed as a deeply significant and humanistic ethic, or moral virtue, requiring a deliberate choice by the nurse to move from an inner feeling of empathy and sympathy about the pain and suffering of another to an action stemming from sense of altruism and duty to care for others without regard to status or social rank (McCaffery & McConnell, 2015).
Burnell (2009), who also analyzed the concept of com- passion in nursing, cited Roach when she said that that com- passion “requires immersion into the pain, brokenness, fear, and anguish of another, even when that person is a stranger” (p. 319). Like McCaffery and McConnell, Burnell identified other terms related to compassion and compassionate care, including a humane quality, understanding the suffering of others and a desire to take-action, reaching out to all living beings, acting altruistically, selflessness, to show love, pity, or mercy; and to be receptive of a patient’s story.
Suffering Review
Nurses, by nature of their work, are surrounded by suffering. Arguably, it will be and has always been the underlying essence of the discipline to alleviate suffering. Georges (2014) stated, however, that despite this, she was “struck by both the centrality—and invisibility—of suffering” (p. 51) as a conceptual focus in nursing research. As of 2018, it is hard to disagree with Georges’ assessment. In reviewing nursing literature, one sees that while there is inquiry into suffering related to certain practice areas, patient populations, or illnesses and injuries, the analysis of suffering as a concept remains sparse. Broadly, suffering refers to the distress of another individual related to a real or perceived threat to self- integrity, which is alleviated by compassion to the self or from another (Georges, 2014; Hanh, 1999). Much as was the case with compassion, review of literature revealed a number of frequently used synonyms for or descriptors of suffering. The majority of these was contextualized by what Georges (2004) called a “European metanarrative” (p. 251) and were associated with discrete, acontextual, physical etiologies, such as pain or other noxious stimuli.
It is important to note the departure Georges and other nurse scholars have taken from the medically based, Eurocentric, patriarchal definition of suffering. Georges (2004), for example, has described suffering as not only the “trauma, pain, and disorders resulting from atrocities … (and) health conditions” (p. 251) but also the biopolitical spaces and social processes that contribute to or maintain an environment of suffering, or that diminish compassion. McCaffrey and McConnell (2015) expounded upon that sentiment, having stated that the external environment of nursing practice, particularly today’s market- driven, bureaucratized healthcare systems, can inhibit compassionate practice. So just as Buddhist philosophy encourages reflection deeply upon the source of our own suffering and that of others, Georges (2004) urged nurses to not look past the “social experiences shaped by political realities … (and) political factors that perpetrate suffering” (p. 251).
Knowing Review
Fundamental Patterns of Knowing. In her ground-breaking 1978 work Fundamental Patterns of Knowing in Nursing, Carper wrote that disciplines are grown out of the knowledge developed and applied within them. At the time of publication and several decades later in an interview, Carper would contend that the original patterns of knowing in nursing were designed to serve as an intellectual philosophy, rationale, and exemplars of how nursing should be thought about, learned, and taught (Carper, 1978; Eisenhauer, 2015). Essentially, the patterns of knowing were designed to serve as an epistemological basis for nursing. Carper’s original work included four fundamental patterns of knowing in nursing: empirics—the science of nursing; esthetics—the art of nursing; ethics—the moral rightness or wrongness in delivery of care; and personal knowing—the use of one’s self as a therapeutic instrument in care. Since publication in 1978, over two dozen nurse scholars have modified or added to Carper’s original four patterns of knowing.
The Concept of Knowing. In a review of literature on the concept of knowing, several core qualities were identified: It is personal, contextual, based on empirics and experience (as well as the combination, thereof), and as Carper pointed out, comes in a variety of patterns, ways, or forms. Many nurse scholars have contended that knowledge is produced or is a result of knowing and is unique to an individual’s social position, background, set of values and beliefs, worldview, interests, lived experience, and perception of lived experiences. Consequently, a number of papers have been published on the importance of intuition, or a gut-feeling, as a valid pat- tern of knowing in nursing. Additionally, Jacobs-Kramer and Chinn (as cited in White, 1995) and White (1995) contended that without multiple ways of knowing, nurses would be limited in their understanding of their roles and the profession in the context of sociopolitical structures, social justice, and emancipatory practice.
As mentioned, dozens of additional patterns or interpretations of knowing in nursing have emerged since Carper’s publication of the Fundamental Patterns in 1978. Watson (2005) acknowledged the importance of an evolving epistemology in nursing, having written that “advanced transpersonal caring modalities draw upon multiple ways of knowing” (p. 6). Zander (2007) wrote that, historically, knowing in nursing continues to develop as a concept. She stated that despite the evolution of knowing as a scholarly concept, nurses have historically used and will continue to rely upon myriad learning styles, intelligences, and any number of patterns or forms of knowing in practice of the discipline and provision of care (Zander, 2007).
Compassionate Knowing: Theoretical Foundation in Caring Science
Carper said in a somewhat recent interview that she did not view the fundamental patterns of knowing in nursing as a theory (Eisenhauer, 2015). Rather, Carper explained that because nursing is more than just a science or set of clinical and technical skills, she saw the concept of the fundamental patterns of knowing more as nursing’s intellectual and cultural philosophy (Eisenhauer, 2015). So while the concept of compassionate knowing was inspired by Carper’s (1978) Fundamental Patterns of Knowing in Nursing and derives a great deal of philosophic inspiration from Buddhism as well as Georges’ (2013) theory, it is rooted in Watson’s (2005) theory of caring science. Watson (2005) wrote that “science, morality, metaphysics, art, and spirituality co-mingle” (p. xiii) and that love, caring, and belonging form the foundation for both metaphysical and empirical wisdom and knowledge. Compassionate knowing creates a foundation for love, belonging, caring in nursing, and is what guides the choices and actions of how nurses manifest care toward patients, those around them, and themselves. It is what reminds nurses that through the alleviation of suffering, they extend actions of caring, peace, joy, and happiness into the lives of others and into the world around them (Hanh, 1999; Watson, 2005).
Caring Science and Compassion. In studying caring science as described by Watson (2005) and Buddhist teaching on compassion, one can see that there are numerous overlaps and shared philosophical assumptions. Watson (2005) cited Hanh when she wrote that compassion is a path that leads to joy. Through acts of compassion, nurses relieve suffering caused by illness, pain, violence, and despair (Watson, 2005). The result is that nurses’ use of compassion promotes equanimity, spreads peace and joy, radiates caring, and spreads love (Watson, 2005). Watson contended that it is because of their compassionate nature that nurses can maintain a sense of hope and find meaning in suffering. Watson (2005) also echoed philosophic tenets of Buddhism having written that “it is only when we acknowledge how much pain and suffering there is in our broken hearts and broken spirits, and bro- ken world … that we can offer comfort, peace, and grace” (p. ix). In summarizing the philosopher Sartre, Watson (2005) stated that when we suffer, “we long for something else, for what might be” (p. xiii), when in actuality we should be open to our pain (and the pain of others) and surrender to what is so that we may move forward with healing.
Watson’s (2005) instructions on how to practice transpersonal caring closely resemble Buddhist guidance on living compassionately: practicing mindful presence, looking and listening deeply, and being with intention with those around us who suffer and with whom we are connected in anatman. In order to practice compassion through transpersonal caring, Watson (2005) directs nurses to “be in the moment … become a part of the life history of each person, as well as a part of the larger, deeper complex pattern of life” (p. 6). The core concept of intentional presence within compassionate knowing is reflected in Watson’s (2005) tenets of transpersonal caring through her descriptions of intentionality, authentic presence, and the importance of the “spirit-to- spirit” (p. 6) connection between the nurse and patient. Likewise, she wrote that that through intentionality, “our very presence (as nurses) can and do make a difference in a person’s life” (Watson, 2005, p. 17).
In describing the tenet of anatman (unitary connection through nonself/oneness shared between all living beings), Buddhism teaches that “nothing can be by itself alone, that everything has to inter-be with everything else” (Hanh, 1999, p. 6). Likewise, Watson (2005) explained that the ontology of caring science includes the assumptions of unity, related- ness, connectedness, wholeness, and oneness. She wrote extensively on the concept of infinity and stated that by sharing what she considered a holy and sacred unitary connection with their patients, nurses become “part of the life history of each person as well as part of some larger, deeper, complex pattern of life” (Watson, 2005, p. 16). When nurses look into the faces of their patients with compassion, Watson con- tended, they look into the face of humanity.
In regard to compassionate behavior, Watson’s theory shares similar ideological assumptions as Buddhism. The Buddha taught, for example, that through compassionate living, one may obtain not only the relief of suffering but also enlightenment (Dalai Lama & Chadron, 2014; Hanh, 1999). Similarly, Watson (2005) explained that through compassionate actions as a manifestation of caring in nursing, the nurse and patient can experience transcendence of the mate- rial world to the shared infinite. According to Watson, caring as compassion is demonstrated through seeking deeper understanding, being mindfully and intentionally present, being in control of one’s self, working toward preservation of dignity and the abatement of vulnerability, showing concern and having veneration for life, and viewing all without judgment, as whole, and worthy of love. In this way, Nepo’s (2012) words seemingly summarize both caring science and Buddhist philosophy. He wrote that “life presents itself constantly through the miracle of the smallest part containing the whole while the Infinite Whole is always greater than the sum of the parts” (Nepo, 2012, p. 234).
Caring Science and Knowing. In both Buddhism and caring science, it is through oneness with their patients that nurses can empathetically know suffering and, consequently, extend the appropriate acts of compassion to promote healing (Hanh, 1999; Watson, 2005). The Buddhist principle of anatman and the assumption of nonself/oneness reflect not only compassion but also forms of knowing, particularly personal knowing (the therapeutic use of self) and narrative knowing (storytelling) to understand others and their sufferings as one in and of our own. To this point, Watson (2005) wrote that “knowing means striving to understand an event as it has meaning in the life of the other” (p. 155).
Watson (2005) described caring as the highest, most venerable form of knowing. She contended that caring in this form is what guides nurses’ practices and is the result of an integration of knowledge, knowing, and understanding the meaning of a lived experience from the perspective of others. It is through knowing that nurses remember their calling “to better (the) human condition and humanity’s evolution” (Watson, 2005, p. xiii). Watson said that for those in the healing professions, the knowledge generated by holding a patient in our hands supersedes clinical knowledge as it is informed first-and-foremost by a set of instinctual humanistic values.
Like the numerous scholars who have contributed additional forms of knowing to nursing epistemology, Watson (2005) advocated for “epistemological pluralism” (p. 29), or a diversity in ways of knowing, by taking the position that not only are there a variety of forms of knowing but that all available evidence should be used to create diverse epistemologies. For nursing to evolve, Watson (2005) urged those in the profession to acknowledge that “information is not necessarily knowledge; knowledge is not understanding; (and) understanding is not wisdom” (p. 67). Here, Watson supported her stance on epistemological pluralism contending that knowledge, understanding, and wisdom are not synonymous, that they are multifaceted, and that they are integrated parts of a larger whole. To highlight the multidimensionality and complexity of epistemological pluralism, Watson (2005) cited T.S. Elliot: “Where is the life we have lost in living? Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?” (p. 180).
Compassionate Knowing Grounded in Caring Science: A Contextualized Concept
Watson (2005) wrote that “one of the greatest honors and privileges one can have is to be able to care for another person” (p. 61) because it requires that we acknowledge with compassion and empathy the oneness of humanity. Compassionate knowing, therefore, is what guides the caring decisions, actions, and behaviors of nurses. Watson urged nurses to ask themselves how they can create a more caring and healing environment or experience. When modified, these questions can reflect compassion and knowing: How can I create a more compassionate environment? How can I look at this person with deeper compassion? What act of compassion will bring about healing and relieve suffering? How can I use my presence to extend compassion? While the outcome results from an act of compassion, the question and solution are a result of the nurse’s knowing. In terms of Jacobs-Kramer and Chinn’s (1988) and later White’s (1995) essential elements of knowing, compassionate knowing asks the following critical assessment questions: What is the cause of the suffering? What com- passionate actions will alleviate the suffering?
Nurses use compassionate knowing to “heal the illnesses of anger, sadness, hatred, (and) loneliness” (Hanh, 1999, p. 170) caused by suffering. Through compassionate knowing, nurses develop a sense of intentionality, calmness, and strength in the face of the suffering they encounter in their daily work. By journeying with their patients upon what Nepo (2012) called the “pathless path” (p. 181) of suffering, nurses make a place inside themselves to be present in body, being, mind, and heart. Compassionate knowing is how nurses relieve suffering through shared moments of authentic presence and ensuing oneness between the nurse and patient (Moccia, 1976; Watson, 2005). For nurses, compassionate knowing drives the altruistic actions of consciously and mindfully extending themselves to the living beings with whom they are inextricably connected through anatman (Dalai Lama & Chodron, 2014; Hanh, 1999; Kolts & Chodron, 2013; Watson, 2005).
Nurse Interview
While exploring and developing the concept of compassion- ate knowing, I had the opportunity to interview a registered nurse about the phenomenon. She is highly experienced, having practiced in a variety of settings in a career spanning nearly 30 years—most recently in the primary care clinic where I work. She went into nursing after having completed a bachelor’s degree in English and was open in her hesitation to speak with me, as her associate degree in nursing program had not exposed her to nursing theory. When discussing compassionate knowing, however, I was reminded of my initial thought: This applies to all nurses at any point along the spectrums of clinical or educational experience.
She spoke of making a choice to act with compassion but also making a choice as to how compassion should be expressed—whether that be through touch, tone of voice, choice of verbal syntax, attentiveness in listening, demeanor and nonverbal communication, and presence. What struck me was her adamant position that we, as nurses, chose to do this work. And while it is not always easy to be compassion- ate, we always have the knowing choice to act compassionately and a knowing choice as to how we extend compassion to our patients. She concluded our interview by saying this, “Everyone has a story. And you have to remember that. You can’t judge your patients. You just have to be with them in that moment … because that moment is their world.” This, to me, illustrated the foundation of compassionate knowing in caring science: nurses knowing, being, and doing in unity with their patients.
Conclusion
The concept of compassionate knowing, the practice of intentional presence to relieve suffering, is offered as an addition to the epistemology of nursing. Inspired by Carper’s (1978) original four patterns of knowing, it is a concept grounded in caring science that informs other patterns of knowing as a manifestation of caring in nursing: use of being, doing, and knowing to relieve suffering (Watson, 2005). In the conceptual model, intentional presence is defined as a conscious and altruistic choice, born of moral virtue and selflessness, to act in a thoughtful, empathetic, and humanistic way that honors and gives meaning to the uniqueness of each patient and caring-healing nurse-client interaction (Watson, 2005). Likewise, relieving suffering is defined as the nurse responding to the needs of the patient with loving-kindness to alleviate a perceived or real threat to self-integrity (Watson, 2005). The critical aspects of intentional presence include a specific choice made by the nurse that is guided by an ethic of selflessness, a desire for action, and being present in the moment (Hanh, 1999). The desired outcome of the nurse’s decision is relief of suffering. The critical aspect of relieving suffering includes the result or outcome (relief) and suffering (as it is perceived by the patient) regardless of physical, emotional, or other organic or inorganic etiology.
Watson (2005) stated that “caring and love are primal and universal … people need each other in loving and caring ways” (p. 19). I believe that it is the innate, humanistic capacity for compassion and the wish for others to be happy and free of suffering that inspires the caring actions of nurses. Compassionate knowing is manifestation of caring in nursing and is what allows nurses the “privilege of being permanently touched” (Nepo, 2012, p. 88) by what and who they encounter.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship and/or publication of this article.
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