How Quiet Presence Shapes Healing in Oncology Nursing

In ambulatory oncology settings, some of the most meaningful healing occurs not during active treatment but within the quiet spaces surrounding it. This reflective essay explores therapeutic silence and attuned presence as holistic nursing interventions that support emotional, relational, and spiritual well-being for individuals receiving cancer treatment. Drawing on mindfulness-based nursing literature, communication theory, and co-regulation neuroscience, it examines how nurses create conditions of safety and connection even in time-pressured environments. De-identified clinical narratives illustrate how silence can regulate the nervous system, facilitate meaning-making, and honor the patient’s inner experience. The essay concludes with practical reflections on cultivating presence withinbusy infusion settings and emphasizes the essential role quiet accompaniment plays in holistic oncology care.
KEY WORDS: holistic nursing, mindfulness, nurse–patient relationship, oncology nursing, therapeutic presence Holist Nurs Pract 2026;00(0):1–3

THE HEALING THAT HAPPENS IN THE QUIET

Infusion rooms are full of movement—IV pumps sounding, chairs reclining, clinicians reviewing labs and orders. Yet amid this bustle, some of the most profound moments in oncology care unfold in silence. Patients often arrive carrying fear about their diagnosis, uncertainty about their future, and the weight of decisions that reshape identity, relationships, and daily life. In the in-between spaces—
before an infusion begins, during a pause in conversation, or in the soft moments after a difficult update—quiet becomes a form of care. Over the years, I have learned that silence is not the absence of nursing. It is a kind of presence. It is the spaciousness nurses create when we resist the urge to fill every moment with explanation or reassurance. It is the steady, grounded posture that signals to the patient: You don’t have to hold this alone. This is holistic nursing at its essence—tending not only to the body but to the person’s full emotional and spiritual landscape. Mindfulness-informed nursing research describes presence as an active, intentional way of being with another person—calm, attuned, and fully engaged.¹ Silence is often what makes this engagement possible. It offers patients the room to breathe, to gather themselves, and sometimes to speak truths that surface only when there is enough stillness to notice them.

THERAPEUTIC SILENCE AS PRESENCE

Therapeutic silence is one of the oldest communication techniques in nursing, yet in fast-paced ambulatory oncology environments, it can easily be overshadowed by task-driven demands. When used intentionally, silence invites patients to explore their inner experience without pressure. It creates an emotional pause that allows meaning, grief, fear, or resilience to emerge naturally. Neuroscience provides a helpful lens for understanding why silence can be so regulating. Polyvagal theory suggests that individuals constantly scan their environment for cues of safety or threat, responding not only to words but to tone, posture, and nonverbal presence.² A nurse’s calm demeanor, steady breathing, and relaxed facial expression can activate the patient’s ventral vagal system—the pathway associated with connection and emotional stability. Silence, when paired with this grounded presence, can help shift a patient from a state of anxiety into one of regulation. One patient taught me this in a way I will never forget. On the morning of his first chemotherapy
infusion, he sat rigidly in the chair, hands clenched, breathing rapid and shallow. Instead of moving quickly through education, I sat beside him and allowed a moment of quiet to settle. When I finally asked, “What is the hardest part of today for you?” the answer
came not from a place of panic but from deeper truth: “My kids. I keep trying not to think about them watching me get sick.” The silence had opened a door that information alone could not.

ATTUNEMENT IN MOMENTS OF MEANING

Attunement is the ability to sense and respond to what another person is feeling before they fully articulate it. It requires noticing cues—posture, gaze, breath, emotional tone—and allowing the patient’s internal experience to shape our presence. In oncology care, where fear and vulnerability are often beneath the surface, attunement helps nursesrecognize when a patient needs quiet instead of conversation, or space instead of encouragement. A woman receiving immunotherapy after the death of her husband demonstrated the power of this attunement. It was her first treatment without him. I completed my assessment and then simply sat nearby. When she finally looked up, tears forming, she whispered, “He always sat right there.” The silence honored her grief before words could. In that moment, what she needed was not information or distraction, but witness. Another patient experienced panic during a taxane infusion after feeling tingling in her lips. Her vital signs were stable, but her fear escalated quickly. Instead of overwhelming her with reassurance, I slowed my breathing and softened my posture. She matched my pace. The physiologic coregulation that followed was palpable. Her shoulders lowered. Her breath steadied. When she finally spoke, her voice was quiet but steady: “Okay… I’m okay now.” This is the kind of healing silence makes possible.

QUIET AS RESPECT, MEANING, AND SPACE

Silence can be an ethical act. In a health care culture that often privileges efficiency and expertise, silence returns authority to the patient. It offers them uninterrupted time to express what matters most, to voice fear, or to sit with emotions that do not yet have language. For some, silence becomes spiritual space. Patients facing cancer often confront existential questions— Who am I now? What legacy am I leaving? What do I fear most? In those reflective moments, silence allows them to hear their own inner wisdom. One
patient, after a long stretch of quiet near the end of her infusion, said softly, “That was the first time I’ve felt like I could hear myself think since I was diagnosed.” The nurse’s task in such moments is not to guide the reflection but to protect the space in which it unfolds.
Holistic nursing literature underscores that healing involves far more than symptom management or disease-directed therapy. It encompasses meaning-making, connection, dignity, and presence—elements that arise naturally within silence.¹

CARRYING PRESENCE INTO BUSY CLINICAL ENVIRONMENTS

Time pressure is an unavoidable reality in outpatient oncology. Schedules are tight, turnover is rapid, and documentation is continual. Yet presence does not require long stretches of time. It requires intention. Research on mindful communication shows that even
brief, attuned interactions can reduce distress and strengthen the therapeutic relationship.³ In practice, this means taking one deep breath before entering a patient’s room to settle one’s own nervous system. It means meeting a patient’s gaze before reaching for the pump, or pausing for a moment after delivering difficult information. It means choosing to sit at eye level for even 10 seconds, communicating, I am here with you, even when the schedule is full. These micro-moments of stillness accumulate. They form the memory of care that patients carry with them long after treatment ends. They remind patients that they are not only recipients of medication but persons held in relationship. Presence also protects nurses. After emotionally heavy encounters, brief self-reflection—checking in with one’s breath, noticing tension in the body, or seeking peer support—helps prevent cumulative

THE MEDICINE BETWEEN THE MEDICINES

Infusion nurses practice at the intersection of science and humanity. We deliver complex therapies, monitor for reactions, educate, assess, and coordinate care. Yet woven through these clinical responsibilities is another form of work—quiet accompaniment. In the stillness between chemotherapy bags, between lab draws and assessments, between a patient’s fear and the next step in their treatment, nurses create spaces where healing can take root. Therapeutic silence is not an accessory to oncology nursing. It is a vital component of holistic care that supports regulation, connection, and meaning. In many cases, the nurse may be the only person who sits with the patient in stillness during their cancer journey. These moments—humble, unhurried, and often unnoticed—become some of the most enduring. Holistic nursing reminds us that healing often begins where words end. In those quiet spaces, patients find strength they did not know they had. And nurses, simply by being present, become part of the medicine

REFERENCES

1. White L. Mindfulness in nursing: an evolutionary concept analysis. J Adv Nurs. 2014;70(2):282-294. doi:10.1111/jan.12182
2. Porges SW. Polyvagal theory: a science of safety. Front Integr Neurosci. 2022;16:871227. doi:10.3389/fnint.2022.871227
3. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-doi:10.1001/jama.2009.1384

Author Affiliations: UMass Memorial Health, UMass Memorial Medical Center, Worcester, MA (Mrs Desy).
Courtney Desy is an oncology infusion nurse whose clinical practice focuses on relational communication, presence, and person-centered care in ambulatory oncology. She writes about holistic approaches to psychological and emotional support for patients receiving cancer treatment. Her work explores the healing potential of quiet attunement and nurse–patient connection within
high-acuity clinical environments.
Correspondence: Courtney A. Desy, BSN, RN, OCN, UMass Memorial Health, UMass Memorial Medical Center, 55 Lake Ave, N Worcester, MA
01655 (NurseAuthorCourtneyD@gmail.com).
Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/HNP.0000000000000777