• active listening
• art of nursing
• caring
• caritas process
• centering
• presence

Nursing is hard work. Depending on the site of practice, it can be both physically and mentally taxing. Nurses are masters at multitasking-that is, performing several caring functions simultaneously during a patient encounter. Some nursing interventions are readily apparent and easily described, such as collecting vital signs data and changing dressings, whereas others are less visible yet equally important, such as interpreting the vital signs data, generating knowledge about the patient's situation, and then using that knowledge to inform practice. Equally invisible, yet important to the therapeutic caring environment, are the little things that nurses say, project, and do in the caring episode. In this chapter, we pause to reflect on the art of caring. We emphasize the need to preserve this central and unique function of nursing and suggest ways that nurses can ensure that the caring functions do not become a lost art as technologies are introduced into patient care environments.

We derive a definition of nursing science from the American Nurses Association's definition of nursing. Nursing science is the ethical application of knowledge acquired through education, research, and practice to provide services and interventions to patients to maintain, enhance, or restore their health and to acquire, process, generate, and disseminate nursing knowledge to advance the nursing profession. Caring functions, such as therapeutic communication, listening, touch, and mindfulness, are an integral part of nursing science because they also help patients to maintain, enhance, or restore their health. Although the new technologies, such as smart pumps, barcode medication administration systems, electronic health records (EHRs), wearables, and smartphones, being introduced into our practice environments are designed to increase efficiency, promote safety, and streamline the work of nursing, we need to ask, to what extent do these technologies disrupt the nurse-patient caring encounter? How can we continue to care effectively for our patients and promote a healing environment while incorporating the advantages and efficiencies that technologies provide? Johnson and Carrington (2023) advocate for adding technology as a fifth dimension of the original nursing metaparadigm (i.e., human, health, nursing, and environment). “To synchronize nursing practice with technology as part of what it means to be a modern-day human is to modernize nursing” (p. 6).

Much of the work of defining caring and developing caring theories has been done in nursing. The concepts of caring described by nurse theorists are widely applicable to all professional-patient encounters, and nurses can model caring behaviors for other professionals as they provide services and interventions to patients to maintain, enhance, or restore their health.

Anne Boykin and Savina Schoenhofer (2015) defined caring as an “altruistic, active expression of love and . . . the intentional and embodied recognition of value and connectedness” (p. 343). In their framework, the theory of nursing as caring, caring is created from each moment nurses are committed to nurturing the patient. Regardless of the challenges presented to nurses, such as technology, time restraints, staffing issues, or difficult patients, they need to reach deeply inside themselves to recognize that knowing the person is caring. Nurses must be able to enter into each nursing situation with the intentional commitment to fully care for the patient.

Caring as a concept is also worth exploring in the seminal work of Jean Watson. Dr. Watson (2015) described the following:

The Theory of Human Caring was developed between 1975 and 1979 while I was teaching at the University of Colorado. I tried to make explicit that nursing's values, knowledge, and practices of human caring were geared toward subjective inner healing processes and the life world of the experiencing person. This required unique caring-healing arts and a framework called “carative factors,” which complemented conventional medicine but stood in stark contrast to “curative factors.” (p. 322)

It is important to remember that Watson developed her theory during a time when the nursing profession was struggling to define itself and identify the unique contributions of nursing to patient care. In the theory of human caring, Watson defined caring as “healing consciousness and intentionality to care and promote healing” and caring consciousness as “energy within the human-environmental field of a caring moment” (Watson, 2015, p. 323). Think about the use of the word energy in these definitions, and pause to appreciate the level of cognitive energy that nurses expend as they care for patients. Nursing is hard work!

Watson further described the evolution of her theory from the original 10 carative factors to what she now calls caritas processes. As her work expanded, she recognized the need for “love and caring to come together for a new form of deep transpersonal caring” (Watson, 2015, p. 324). In the evolving theory, she has emphasized that the “relationship between love and caring connotes inner healing for self and others” (Watson, 2015, p. 324). The 10 caritas processes enumerated by Watson are summarized here:

1. The practice of loving kindness and equanimity within the context of caring consciousness
2. Being authentically present and enabling and sustaining the deep belief system and subjective life world of self and one being cared for
3. Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self, opening to others with sensitivity and compassion
4. Developing and sustaining a helping-trusting, authentic caring relationship
5. Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit of self and the one being cared for
6. Creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices
7. Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others' frames of reference
8. Creating a healing environment at all levels (a physical and nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated)
9. Assisting with basic needs, with an intentional caring consciousness, administering “human care essentials,” which potentiate alignment of mind-body-spirit, wholeness, and unity of being in all aspects of care, tending to both embodied spirit and evolving spiritual emergence
10. Opening and attending to spiritual-mysterious and existential dimensions of one's own life-death; soul care for self and the one being cared for (Watson, 2015, p. 325)

The Cycle of Caring described by Skovholt (2005) involves a series of professional attachments and then appropriate separations. Expert professionals are fully present for the person they are attempting to help. The difficulty for professionals is finding a balance between caring enough and caring too much, identified by Skovholt as professional underattachment and overattachment.

Think about a recent patient encounter. Were you fully present in the moment and conscious of the individual and their uniqueness? Did you smile and greet the patient by name and acknowledge visitors? Have you learned how to “smile with your eyes” while wearing a mask? Did you place your tablet (or computer on wheels) to the side, lean forward, adopt an open stance, and attentively listen to the concerns of the patient and family and offer them the opportunity to ask questions? Did you explain what you were doing with and for the patient and why? (See Figure 24-1.) Conversely, did you focus your attention on the tablet or computer, hide behind your mask, and talk at the screen as you clicked on the drop-down menus to document the patient encounter? Did the technology and the personal protective equipment create a barrier between you and the patient and their family? Did you depend solely on monitoring technologies to create your interpretation of the patient's experience? Was your assessment of the patient's current situation influenced by the objective representation of the person that the monitoring technologies present in the room created (O'Keefe-McCarthy, 2009)? “The overwhelming presence of technology at the clinical bedside has the power to become the strongest reference point that nurses use to inform, direct, interpret, evaluate, and understand nursing care” (O'Keefe-McCarthy, 2009, p. 787). We must remember that “[t]echnology, however, does not take into consideration the specific symptom presentation unique to the person experiencing the illness. Technology's use is not meant to replace the person-to-person interaction that is essential in any nurse-patient encounter” (O'Keefe-McCarthy, 2009, p. 792).

Figure 24-1 Active Listening

A healthcare professional attentively listens to an elderly patient.

© Monkey Business Images/Shutterstock

Patient-centered care is another way of describing the need for practitioners to focus on the subjective experience of patients with health challenges. Liberati et al. (2015) defined patient centeredness as “a collective achievement that is negotiated between patients and multiple health providers, comprising social practices and relationships that are woven together through the material and immaterial resources available in specific organizational contexts” (p. 47). They suggested that a focus on patient-centered care may have three outcomes:

• Patients can provide their subjective experience as an input to improve several, often undermined, aspects of healthcare delivery.
• Care providers might develop their capacity for reflexivity, which could improve their understanding of the implications of their actions.
• Patients and practitioners can thus provide insights into the overall health organization on how to innovate processes and facilities to better respond to local needs.

We will examine reflection on practice in more detail later in the chapter.

Central to the caritas processes described by Watson and the discussion about technology-mediated care by O'Keefe-McCarthy is the concept of a caring presence. Strategies for developing and enhancing caring presence are discussed in the latter part of this chapter.

The humanistic nursing theory developed by Paterson and Zderad also offers some insight into the less visible aspects of nursing care (Kleiman, 2010). These authors suggested that the basis of nursing is the response to the call for help in solving health-related concerns.

This call, a foundational concept of humanistic nursing, can be heard where nursing is offered, coming to our attention as a subtle murmur of pain, sorrow, anxiety, desperation, joy, laughter, even silence, that expresses the state-of-being of the protagonists in the drama of health-care delivery, our patients and ourselves. (Kleiman, 2010, p. 338)

Nurses hear the call and respond with their entire being. Their knowledge, experiences, ethics, and competencies shape the interaction with the patient as they respond.

In humanistic nursing we say that each person is perceived as existing “all-at-once.” In the process of interacting with patients, nurses interweave professional identity, education, intuition, and experiences, with all their other life experiences, creating their own tapestry which unfolds during their responses. (Kleiman, 2010, pp. 341-342)

Pause to reflect on how you create your own tapestry during patient interactions.

Nursing care requires conscious awareness of self and the uniqueness of each patient. It requires emotional energy expenditure as nurses seek to find ways to meet the calls of their patients. Nurses need to be aware of the potential for inadvertently dehumanizing the patient experience in their technology-laden practice environments. According to Kleiman (2010), “The context of Humanistic Nursing Theory is humans. The basic question it asks of nursing practice is: Is this particular intersubjective-transactional nursing event humanizing or dehumanizing?” (p. 349).

Several recent articles have begun to question the false dichotomy of technology and caring and have suggested that it is possible for technology and caring to coexist in the nurse-patient encounter. Martinez (2019) suggested that human connectedness can be facilitated by technology because technology allows us to know what is unknown about a person. “Technology when aimed at maintaining human connectedness thru the process of knowing then becomes an expression of caring” (p. 13). Locsin (2017) also discussed technological knowing as part of a discussion of the theory of technological competency as caring in nursing. “Knowing persons as a practice process of nursing is revealed in knowledgeable demonstration of intentional, deliberate, and authentic encounters with persons in technologically demanding nursing practice settings, particularly those in environments requiring specialized technological expertise” (p. 162). Finally, Tanioka et al. (2019) discussed the transactive relationship theory of nursing (TRETON) as it relates to the disruptive effects of the introduction of artificial intelligence (AI) into nursing and specifically the use of humanoid nurse robots to perform routine care functions. Several Japanese companies, as well as the universities of Louisville and Texas, are involved in designing and testing care assistive robots (beyond supply delivery or cleaning robots), which, if they become widely used, will indeed disrupt the typical nurse-patient relationship and precipitate new ways of thinking about the caring process. Review the information about two of these robots at these websites: www.softbankrobotics.com/emea/en/pepper and www.roboticsbusinessreview.com/rbr/rudy_assistive_robot_helps_elderly_age_in_place.

We must be fully present and self-aware in every patient encounter, seeking to deliver exactly what is needed in every situation. Yes, nursing is hard work, but when we are able to respond with our whole being, we may find that our patients and families are more satisfied with the care we provide and we also experience personal satisfaction and find joy in our profession.

Presence is the act of being there and being with our patients-fully focusing on their needs. “Presence is an interpersonal process that is characterized by sensitivity, holism, intimacy, vulnerability and adaptation to unique circumstances” (Finfgeld-Connett, 2008, p. 528). Paterson and Zderad explained presence as establishing a relationship by being fully available and open to the experiences of another (Penque & Snyder, 2014). Penque and Snyder defined three types of presence: physical presence, full presence, and transcendent presence. A nurse who is physically present is largely competent in carrying out care and efficient with interventions but inattentive to communication and nonverbal cues projected by the patient and family. When fully present, a nurse will greet the patient by name, communicate appropriately with the patient, and pay attention to what is being said and not said during the encounter. When nurses practice transcendent presence, they will first center themselves, clearing their mind of all potential distractions, and then use the patient's name and gentle touch to convey interest and responsiveness while carrying out the necessary physical interventions.

Paterson and Zderad felt that presence was a vital element of their theory of humanistic nursing (Penque & Snyder, 2014). Presence requires nurses to be open and responsive to the situations around them. If they are fully present to the patient in front of them, they will be able to notice the subtle changes that may not be evident if they were present only physically. The connection loss may cause the patient to feel that the nurse is detached from the situation. Penque and Snyder (2014) gave an example of presence from the book Tuesdays with Morrie by Mitch Albom:

Patients have complex problems and needs. They may be scared, angry, resistant to change, or happily oblivious to the extent of their health challenges. Nurses also have complex personal lives with many competing roles and issues that consume their energies. The workplace may be short staffed, resulting in care assignments that stretch them to their maximum. They may be struggling to learn to use the new technologies that are introduced nearly daily into their practice environments. As a result, nurses may feel disorganized, tired, angry, and emotionally spent.

Nurses need to take care of themselves first so that they can be effective in their patient and family care. Caring for themselves involves conscious attention to their health and health practices. In addition, nurses have a “responsibility to model health behaviors” (Leonard, 2014, p. 17). They should ask themselves whether they eat a balanced diet, get appropriate exercise, and get enough sleep. Do they have strategies to manage stress appropriately and adequate social support? To what extent should health professionals model healthy behaviors? Reflect upon what While (2015) asserted: “The personal health behaviours of health professionals may influence how patients view their credibility as a health promoter” (p. 113).

An approach to improve health is to set goals and keep track of the progress. A website from the University of Minnesota (n.d.) gives information on well-being and a self-assessment tool as well as tips on setting goals. As part of a Concepts of Health course, students are asked to develop a personal health plan and to journal periodically during the semester about their ability to stick to the plan. Here is an example of a simple plan: “I will increase my intake of fruit and vegetables and walk outside for 30 minutes at least 3 times per week.” As the students reflect on their ability to stick to the plan in the journal, caring for self is brought into conscious awareness. This simple self-reflective practice may be just the boost that is needed for a nurse to commit to self-awareness and self-care on a long-term basis (Figure 24-2).

Figure 24-2 Reminder: Take Care of Yourself

A cloud icon with a checked checkbox indicates a reminder to take care of yourself.

One additional strategy that the authors share with students is a breathing meditative exercise from tai chi and qigong called the five-element breathing sequence. This meditative exercise, which can be performed in less than 10 minutes and can be very energizing and stress reducing, is described in Box 24-1.

Box 24-1 Tai Chi and Qigong Five-Element Breathing Sequence

Stand with your feet shoulder-width apart. Relax your arms and shoulders. Inhale slowly as you straighten and then move both arms slightly back and then up with palms facing up (as though you are gathering a giant ball of energy). Stretch to your full height as you inhale. Exhale slowly as you press both palms down in front of you with hands slightly cupped and thumbs and index fingers nearly touching. Bend your knees slightly to sink down as you exhale. Turn your hands over (palms up) just below the waist, and inhale slowly as you raise your hands in front of you, to chest height. Straighten your legs as you inhale. (Imagine lifting a ball of energy.) Exhale slowly and extend the arms directly in front of you, chest high, and fan your hands open to release the energy in front of your chest. Bend the knees slightly to sink down as you exhale. Inhale slowly, with palms facing you, to gather the energy back toward your chest. Straighten your legs as you inhale. Press both arms straight out at shoulder height as you exhale. Pretend you are pushing on walls located on either side of you. Continue the exhalation as you bring your arms in front of you. Bend your knees slightly to sink down as you exhale. Inhale slowly as you gather the energy to your chest. Straighten your legs as you inhale and stretch to your full height. Exhale slowly as you raise your arms above your head to set the energy free. Bend your knees slightly to sink down as you exhale. Transition your hands to the beginning to repeat the sequence by inhaling as you bring your hands halfway down and exhaling the rest of the way. (You can also end here by bringing your palms together in closure, first inhaling and then exhaling as you slowly move your hands down in front of you.) Visit the following website for a demonstration of the five-element breathing sequence: www.youtube.com/watch?v=KtVCCLlkcKg.

The simplest and perhaps most effective strategy nurses can use to help them be fully present to their patients is to pause to take a few deep breaths to calm themselves and clear the clutter from their minds before they address each patient. Nurses' repeating a patient's name silently a time or two before they enter the room also helps. This practice, known as centering, enables nurses to “be available with the whole self and be open to the personal and care needs of the patient” (Penque & Snyder, 2014, p. 31). When nurses are with a patient, they must be certain that their mind is fully engaged in the interaction with this patient for the moment. They must be fully attentive to the patient, be both physically and mentally present, meet the patient where they are emotionally, listen actively to what the patient is saying, focus on the nonverbal cues the patient is projecting, touch the patient gently and reassuringly, and demonstrate acceptance (Penque & Snyder, 2014; Zerwekh, 2006). Being present can be used in any situation where nurses are addressing the wants and needs of the patient. It is important not to force the encounter on the patient for the benefit of the nurses' agenda (Penque & Snyder, 2014).

Nurses may feel that they do not have time to focus on caring presence. Caring opportunities are replaced by the time it takes to input all the information into the EHR and complete the measurable outcomes that are expected of them. The elimination of face-to-face interaction with the use of telephones, home monitoring, and other forms of telemedicine makes utilizing a caring presence more challenging. The theory of nursing as caring describes caring “as the end, rather than the means, of nursing, and that caring is the intention of nursing, rather than merely its instrument” (Boykin & Schoenhofer, 2015, p. 342).

A related and similar concept for practicing presence-caring between-is described in the nursing as caring theory (Boykin & Schoenhofer, 2015). Consider, for example, that nurses experienced in caring for elders with congestive heart failure will have expectations and preconceived ideas about what they will find in a patient situation. These expectations may not allow them to really “see” the whole patient and their experience of the illness. Caring between “is a loving relation into which nurse and nursed enter and which they cocreate by living the intention to care” (Boykin & Schoenhofer, 2015, p. 344). Nurses need to enter the situation knowing the patient as a caring person. This knowledge will create an acceptance confirming the patient as caring. The nurse's responsibility is not in determining what is wrong or needed in another but rather to be present in the situation to know the patient as caring and to foster a patient-specific caring environment. Nurses need to come to know their patients both intuitively and scientifically. Medical technologies provide an objective view of the patient, and nurses synthesize this view with their own perspective (wisdom), which is based on their experience, education, and intuition as applied to the patient's situation. Nurses must facilitate the caring encounter by helping patients to find words for their experiences to promote mutuality (Holopainen et al., 2019). This is the essence of caring.

One of the first skills nurses are taught in their basic nursing education programs is active listening. They are taught to get down to the same level of the patient, make eye contact, touch gently (if culturally acceptable), listen attentively and nod appropriately, restate and clarify what they heard, ask questions to seek additional information, listen for feelings that are not being explicitly stated, and use silence to encourage the patient to think and provide additional information to them (Watanuki et al., 2014; Zerwekh, 2006). These communication skills are fundamental to caring. Pause to reflect on the words of Garagnon and Roth (1999), who described the great limitation of language:

Between what I think,

What I want to say,

What I believe I'm saying,

What I say,

What you want to hear,

What you believe you understand,

What you want to understand,

And what you understand,

There are at least nine possibilities for misunderstanding. (p. 41)

Nurses should ask themselves when the last time was that they sat on a chair at a patient's bedside to get to the same level as the patient. Even a brief sit at the bedside can communicate volumes about their availability and willingness to listen, and getting off their feet for a moment certainly feels good. Have they ever experienced a patient who became emotional because they looked at the patient instead of at the computer? Nurses need to think carefully about the potential barriers to active listening that technology might present. Considering telephone encounters and eHealth, nurses must truly listen and be present to a patient whom they cannot see. What are some of the ways that these caring presence skills could be adapted for use in a telehealth encounter? What are the challenges of communicating at a distance yet being fully present for the patient?

The discussion of caring presence concludes with a definition of the art of nursing provided by Finfgeld-Connett (2008):

The art of nursing is the expert use and adaptation of empirical and meta-physical knowledge and values. It is relationship-centered and involves sensitively adapting care to meet the needs of individual patients. In the face of uncertainty, creativity is employed in a discretionary manner. Artful nursing promotes beneficent practice and results in enhanced mental and physical well-being among patients. It also results in professional satisfaction and personal growth among nurses. (p. 528)

All nurses must strive for beneficent practice that atones for the potential disruptions to the therapeutic nurse-patient relationship that their use of technology produces. More recently, caring encounters have been described as communion-in-caring. “A genuine sharing defines caring communion-as an intimate connection in time and space, an absolute, lasting presence” (Tuppal et al., 2022, p. 526). Overreliance on technology creates tension in caring encounters, and nurses should strive for “a soul-felt, in-sync connectedness” (p. 530). Nurses should strive to “contribute to human flourishing, affirm self-growth, others' growth and the community transformation through communion-in-caring” (p. 532).

As professionals, nurses should be constantly mindful of the need for practice improvement. Zande et al. (2014) discussed ethical sensitivity as a type of practical wisdom. Ethical sensitivity is integral to high-quality care and clinical decision-making. They advocated for reflection on practice:

Taking daily practice of care as point of entry for reflection is a way to discern both explicit moral knowledge and tacit moral knowing. Nurses and other professionals can contribute to improvement on quality of care by creating opportunities to reflect on daily ethical concerns in an inter-professional team. (p. 75)

Liberati et al. (2015) also advocated for the use of reflection to help professionals “observe their work from a different perspective. . . . Such an exploration may help providers to generate insights on how healthcare services, processes, and facilities could be modified to better respond to patients' needs” (p. 49).

One way for nurses to focus more specifically on their practice is to engage in reflective journaling (Figure 24-3). In the Concepts of Health course the authors teach, they ask students to complete a reflective practice assignment over a 6-week period. Students are directed to review concepts of caring presence and active listening and to commit to consciously using a strategy for 6 weeks. At 3 and 6 weeks, they are asked to complete the following reflective journal entry:

Figure 24-3 Reflective Practice

A circle bears the message: Follow effective action with quiet reflection. From the quiet reflection will come even more effective action.

Attributed to Peter Drucker (1909-2005).

(Attributed to Peter Drucker [1909-2005])

1. Write a brief description of the presence and therapeutic communication approaches you tried in your practice for the past 3 weeks. Provide specific examples of patient situations in which you tried the approach.
2. Reflect on the following:
   • What did you do well?
   • Which behaviors and skills do you need to improve?
   • How did you feel about the experience as it was happening? Did you plan thoroughly?
   • Did you achieve your objectives?
   • Which aspects of planning do you need to improve?
   • How will this experience affect your future practice?
3. Which professional development needs have you identified after reflecting on your performance? Which strategies will you use to address these needs?

Students frequently report that they enjoy this experience and that the exercise helps to remind them why they were originally attracted to nursing. They describe experiences where they felt an authentic connection to the patient. They also report that after 6 weeks of consciously practicing the strategy, it becomes a part of their daily practice. Centering is the most frequent strategy that the students choose to practice. A recent exploratory study of reflection grounded in caring theory reported three main themes: “Reflection provides an understanding of caring by developing a language of caring, reflection provides an understanding of seeing and meeting the person behind the illness and reflection contributes to increased self-understanding and awareness of oneself as a caring nurse” (Jaastad et al., 2022, p. 4).

Virtual reality, augmented reality, 3D printing, nanotechnology, sensor technologies, AI, and robotics are but a few of the technologies that will affect nursing practice in the future. Instead of shuddering at the thought of these technologies, embrace the wonderful and positive effects, efficiencies, convenience (for both patients and nurses), and improvements in healthcare afforded by them. What will nurses' future practice look like? How will education experiences change? What new nursing roles might emerge? To what extent will patient roles, responsibilities, and behaviors change?

The TRETON (Tanioka et al., 2019), mentioned earlier in the chapter, may provide insight into the blending of technology and caring and how nurses' future might be shaped. As Tanioka et al. described, this middle-range theory attempts to guide practice and research when humanoid nurse robots (HNRs) or other disruptive technologies are part of the care environment. Transactions will occur between robots, between robots and patients, and between nurses and robots, with nurses mediating the transactions. “Through nursing, human engagements and technological engagements will be coordinated in the encounters between the HNRs and the persons being cared for” (p. 314).

The five key assumptions of the TRETON follow:

1. Nursing includes relationships between and among human beings and intelligent machines such as HNRs.
2. Nurses adopt technologies that aid the practice of nursing.
3. Intelligent machines possess AI that can mimic human interactions.
4. Human-to-intelligent machine relationships are technology dependent.
5. Transactive relationships are guided by ethics in nursing. (Tanioka et al., 2019, p. 315)

In the study, a case example was presented where a nurse utilized Nicki (an HNR) to monitor vital signs of a patient with congestive obstructive pulmonary disease and asked the robot to provide relaxation videos to the patient and to help the patient communicate with his daughter at a distance. All interventions by the robot were nurse directed. “The health care robot Nicki was programmed to be a functional partner-in-caring to provide functional services that were relevant to Mr. Thomas's needs as identified by the nurse” (Tanioka et al., 2019, p. 315). Medical technologies hold promise in addressing future pressing healthcare needs as the population ages and nursing shortages emerge. Can you think of a recent time-intensive nursing situation where you could have been assisted by an HNR?

Despite technological innovation allowing nurses to “know” their patients and providing efficiencies in care by performing routine tasks, nurses can and will continue to be central to health care by virtue of their ethical, caring, and advocacy functions. Patients will be empowered to be partners in their health care and will look to nurses to help them manage that power.

Nursing practice relies on information and communication technologies that receive inputs from the nurses as well as all the patient care technologies. Computers, handheld devices, monitors, and other healthcare technologies are essential tools for nurses. Therefore, the nurse must have the ability to implement, monitor, and evaluate this equipment based on its inputs and outputs. The increased demands on the nurse make it easy to lose sight of the patient amid all these technologies. Nurses must look at monitors, devices, and other gadgets to receive information; often, it is easy to forget that the patient is at the core of their care. Nurses should embrace these new technologies as assistants to help them fully know their patients.

The authors hope that this brief overview of caring presence prompts nurses to be more mindful of their practice and that they, too, will commit to employing strategies that enhance their caring presence in all patient encounters. Nurses do not want their patients to feel that they are more focused on the machines that the patients are connected to or the workstations that they bring with them to the patient encounter than they are on them. Yes, technology is great, and it does help nurses collect meaningful data and generate knowledge about their patient situations. But equally important is the need to collect the human-to-human data that become available only when nurses step away from the technology and interact authentically with their patients.