Presence in Absence: A Daoist Critique of Interventionist Care and the Reconstruction of Nursing Presence.

Abstract

Presence is widely affirmed as a core moral value of nursing, yet dominant conceptualizations in both nursing philosophy and clinical practice consistently collapse it into observable intervention and active engagement, underpinned by an implicit subject-object dualist ontology. Derivative concepts such as silent presence and holding space have sought to recover non-interventional modes of care, yet most remain trapped within an action-oriented logic and stop short of fundamental ontological reorientation. Drawing on classical Daoist concepts of wu-wei (non-coercive action) and ziran (naturalness), this paper critiques the interventionist framing of presence and develops the Presence in Absence (PiA) framework. It articulates the dialectical relationship between presence and absence, arguing that deliberate withdrawal from the centre of action, positions of control, and the authoritative subject role constitutes not a deficit of care, but a fuller, ontologically deeper form of presence. By distinguishing PiA from adjacent nursing concepts and anchoring the argument in dementia care narratives, the paper further explores its implications for existential nursing knowledge, an ethics of existence, and existential intersubjectivity. This cross-cultural reconstruction restores the ontological depth of nursing presence, offering a philosophical anchor for addressing contemporary nursing's crisis of excessive action.