Mindful presence, the third COMFORT module, positions nurses as being purposefully attentive to the moment, actively engaged in the present, sensitive to context, nonjudgmental, and empathic. In comforting patients and families, nurses can provide an emotional climate for the expression of regrets, discussion of spiritual concerns, and the sadness resulting from life's human shortfalls. Through empathic, active listening and nonverbal attentiveness, nurses can demonstrate the acceptance, patience, trust, and attitude of letting go that will permit the patient and family to express spiritual, religious, and existential suffering and make meaningful connections in the midst of loss. Instrumental to Domain 5 of quality palliative care, nurses are charged with regularly exploring and assessing patient fears, beliefs, preferences, and desires. Simply talking about these concerns is noted as being meaningful to patients and families (Visser & Wysmans, 2010). A nurse's compassionate presence does not include having the right answers, but rather "being there" for patients.
Case Study: Herb
Herb is a 79-year-old Korean War veteran in a Veterans Affairs long-term care facility with a diagnosis of advanced small-cell lung cancer. After one round of chemotherapy, he opted to end treatment. Herb is aware of his impending death and cries often. Last night, he went to the nurse's station and talked with his favorite nurse about his life regrets, three previous marriages, enduring grief from the loss of his son, and his anguish that he "gave up on God." The nurse can operationalize mindful presence in the following ways.
Practice effective and empathic listening: Stop other activities, look at the patient and family, listen without interrupting, clarify the patient and family's feelings, focus on the meaning of the message, observe the patient and family's body language, and practice saying nothing (i.e., using silence) to allow the patient and family to share.
Perform self-reflection: What issues were significant to the patient and family? How were they feeling and why? How were you feeling and why? What were the consequences of your actions with the patient and family? What knowledge was most informative? Finally, how did this situation connect with previous patient and family experiences?