Factors limiting presence: Perceptions of nurses working in a public psychiatric hospital

BACKGROUND: Presence is a therapeutic skill that has a healing effect not only on the mental healthcare user but also the nurse. There was a need to explore nurses’ perceptions on factors that limit presence, especially in a public psychiatric hospital in a rural province such as North West, South Africa, where there are limited resources and nurses need to rely heavily on their therapeutic use of self. OBJECTIVES: To report on nurses’ perceptions of factors limiting presence when working in a public psychiatric hospital. METHOD: A qualitative descriptive inquiry was applied, with purposive sampling. Semistructured individual interviews were held with 10 nurses. Thematic data analysis was applied. RESULTS: Intrapersonal factors that were found to limit presence arose from the view that mental healthcare users (MHUs) are difficult to engage with; the tendency to view ‘good care’ primarily as physical care with limited insight into presence was also recognised. Interpersonal and transpersonal factors related to difficulties in communicating with MHUs and in the work environment. CONCLUSION: Addressing factors that limit presence were found to require courage, the overcoming of interpersonal distance and a transformational process. CONTRIBUTION: This article contributes important insights that can be used by nurse leaders to promote the practice of presence to improve the quality of psychiatric nursing care in developing contexts, such as a rural province in South Africa.