Professional Presence and Mindfulness in Nursing Practice

Introduction to Professional Presence in Nursing

A nurse's overall comportment and communication style, collectively referred to as professional presence, has become increasingly central to core competencies in healthcare. Professional presence impacts the way an individual nurse — and even an entire institution — is perceived by patients and the community. Nurse leaders need to focus more on human resources and professional development practices that stimulate professional presence and related competencies in what is colloquially known as bedside manner. Research is increasingly revealing the direct correlation between patient satisfaction and the minute details of a nurse's presence, including manner of dress (Ketchem, 2016). Each model of health and healing, including the physical body model, the body-mind model, the body-mind-spirit model, the bio-psycho-social model, the Eastern model, and the Western model, all inform models of professional comportment, demeanor, and presence. Furthermore, professional presence impacts the extent of a nurse's influence on nursing practice, patient care, institutional policy, organizational culture, and even public policy in healthcare.

Models of Health and Healing

Each model of health and healing offers different options and opinions on ideal professional presence and modes of nursing influence. The body-mind-spirit model presents a holistic vision of healthcare, impacting approaches to patient care in multiple healthcare settings, including psychiatric care (Rentala, Fong, Nattala, et al., 2015). Within a body-mind-spirit model, the nurse cultivates a professional presence in accordance with the philosophical principles of holistic care. Cultural competencies remain critical to the body-mind-spirit model, as well as to the bio-psycho-social model of healthcare.

The bio-psycho-social model is akin to the body-mind-spirit model, taking into account cultural and sociological factors impacting healthcare, attitudes towards healthcare and wellness, and beliefs about healing. By contrast, the physical body model of healthcare promotes a more singular vision of the role of the nurse, which in turn impacts professional presence and demeanor. The physical body model may not entirely discount the spiritual or cultural dimensions of healing, but it does pre-empt those issues in favor of allopathic medical interventions.

Models of health and healing impact beliefs and worldviews, including those that inform what it means to be human. Whereas the physical body model sets existential and eschatological concerns aside from the healthcare equation — while still respecting patient autonomy, individuality, and cross-cultural views on healing — the bio-psycho-social model does far more to incorporate spiritual values and viewpoints into models of what it means to be human.

The different models of healthcare also impact professional presence. Nurse leaders ascribing to the physical body model will ensure that their nursing staff segregate issues related to spirituality from medical care, whereas those promoting the body-mind-spirit or bio-psycho-social model might encourage nursing staff to allow spirituality to inform healthcare (O'Brien, 2018). In either case, professional presence encompasses all aspects of interpersonal communication and organizational culture under one cohesive rubric of healthcare. The nurse leverages emotional intelligence and professional competencies in order to promote high quality of care and positive patient outcomes.

Influence on Nursing Practice and Personality

Models of healthcare influence attitudes towards what it means to be human, professional presence, and other aspects of nursing practice. For example, the physical body model of healthcare has a direct impact on nursing practice in that complementary or alternative modalities might be discounted in favor of evidence-based interventions. The bio-psycho-social model of healthcare would also stress evidence-based practice interventions while acknowledging the importance of spirituality in caring for patients (Potter, Perry, Stockert, et al., 2016). Administrative decisions — linked to the design of the healthcare institution, institutional policies and procedures, leadership style, and organizational structure — are also pragmatic concerns connected with models of healthcare and professional presence.

Results from the Jung personality test indicate an INFP (Introvert-iNtuitive-Feeler-Perceiver) profile. This personality type can be private and reserved, yet still dedicated and caring in attitude towards patients. A preference for solitude and quiet reflection can make one understated in team environments, which directly impacts professional presence. In accordance with an alignment to the bio-psycho-social model of healthcare, this intuitive approach allows for spiritual values and beliefs to influence patient healthcare decisions. Valuing compassion and harmony over rigid logic and order, an INFP can also be a perfectionist who pays great attention to detail and meeting deadlines.

These test results align with personal relationships, favorite activities, and career choices. Close one-on-one relationships and a preference for intimacy over broad social networking are characteristic, as is a preference for deep conversation over shallow interaction. Favorite activities reflect this personality type as well — a preference for spontaneous travel over organized tours, for example, reflects the perceiving and intuitive dimensions of the INFP profile. Career choices similarly show INFP tendencies, as there is a natural draw to the softer side of healthcare and patient interactions rather than the methodical, rigid approach of allopathic medicine.

However, being an INFP does present challenges and even barriers to communication and decision-making in professional nursing practice. Although open-minded, an INFP can become frustrated when people with more extraverted communication styles dominate discussions. Because the natural inclination is towards being reserved, there is a tendency to withhold opinions to allow others to speak. Yet doing so allows dominant members of the team to prevail in a discussion before a dissenting view can be asserted. With greater self-awareness, it becomes possible to work with opposite personality types more effectively.

Mindfulness Practice and Whole Person Goals

Mindfulness refers to an ongoing state of self-awareness in personal and professional practice. In nursing, mindfulness has already been well established as a means to reduce burnout and other symptoms of stress (Song & Lindquist, 2015). Nurses can incorporate the evidence-based principles of mindfulness into their professional practice in order to wield greater and more meaningful influence on patient outcomes. A mindfulness practice can and should be individualized to align with the nurse's interests, goals, and beliefs. Similarly, a mindfulness practice can be in accordance with one's Jungian personality type.

As an INFP, for instance, a nurse who favors interactions based on intuition, feeling, perceptions, and solitary meditations on the meaning of human existence is naturally drawn to questions about how colleagues envision their roles as healers. Curiosity about colleagues' attitudes towards emerging healthcare technologies and approaches to medical interventions — whether they ascribe to Western or Eastern healthcare modalities — reflects this orientation. Considering both the bio-psycho-social and the physical body models of healthcare, mindfulness techniques can enhance professional presence and influence within an organization and potentially on healthcare public policy as well.

Professional goals as a healthcare provider are closely connected to the whole-person goals one cultivates. Whole-person goals include the ability to empathize with others who are different and whose beliefs differ significantly from one's own. If one aims to eventually contribute to the improvement of global healthcare expectations and standards, those whole-person goals should reflect training and core competencies. Professional presence and influence therefore need to reflect whole-person goals.

Two specific goals should pertain to each of the four aspects of the whole person: physical, vital or rhythmic, mental/emotional, and biographical/spiritual dimensions. The two specific goals discussed here relate to the improvement of physical health and social wellbeing. Physical health goals specifically include weight loss and preventative care, framed in terms of vital and rhythmic objectives such as sleep patterns and metabolic regulation. Physical health goals also encompass mental and emotional health and the reduction of stress. The biographical issues that impact professional presence and personal comportment also play into the way balance is maintained in approaching patient care.

With physical health as a major personal and professional goal, it becomes easier to relate to patients' physical health goals and patient outcomes. Similarly, with social and emotional intelligence as predominant goals, one can focus on becoming a better caregiver who is sensitive to the needs of patients even when their worldviews or cultural backgrounds differ. Mindfulness is the key to recognizing one's own biases and beliefs, while also respecting those of patients (Van der Riet, Rossiter, Kirby, et al., 2015). With mindfulness incorporated into personal and professional presence, a nurse can also become a more astute and influential nurse leader.

Conclusion

Professional presence refers to how a nurse presents the healthcare profession as a whole, and specifically embodies the mission and values of the healthcare organization. Measured using standardized means like the Jung personality type, a nurse can assess individualized tendencies towards certain types of professional comportment. Mindfulness and self-awareness enhance the nurse's ability to provide optimal evidence-based patient care. The healing environment is culturally sensitive and ultimately provides patients with the physical, psychological, and spiritual healing necessary for holistic care.

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