Concept Analysis – Compassion in Nursing
ept
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mpas thing miss ence and earch stu
1. Co
pe
dy
sio
ing
nce
hosp n as a co in health rceptions which
ital se
mpon
of pa
nursin ptualise th
care.
ent o
ttings
e me
T
g care
h
2. De
e stu tients
fn
. The
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it is p patients
alke
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ossib
comp
the m r & Avant
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assio
o
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e
n wh
This
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g
ion in
nable
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a
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unde rstood or wledge in the litera ider all ap xt of nurs ial review
rstan
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o
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and to for olde sion is in sis aims to at is not c ntribute
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Definition of Compassion
nised
.
Dictionary: ‘a strong feeling of sympathy and sadness for the suffering or bad luck of
others and a wish to help them9.
Buddhist: The desire to act upon the suffering of others: an ethical behaviour involving patience
and generosity with action10.
Nursing Theory: Nursing theorists suggest that what distinguishes compassion from related qualities
such as sympathy, empathy and kindness and caring is the intention to act upon the suffering of others11,12,13.
t
ins tha r
doma
o
policy ading to po es,
d
n
a
c
le
tcom
g,
ubli
lackin
nal ou
ithin p
o
w
re
ti
a
o
rn
m
e
onc
nd e
h care
nt the
wing c ts of healt al, social a 1,2,3,4,5.
5 prese
en
are
is a gro
ts
linic
ciation negligent c
There mental elem ce, poor c ophic even
o
s
s
A
str
rien
nt’s
nda
mes
the fu carer expe t times, cata4 d the Patie r, and at ti gs.
in
an
poo
issing
t and
and a
re sett
is
uate,
the m
sman
patien
mbud ced inadeq nd other ca imply that assion in th
O
h
lt
t
p
en
en
Sa
Hea
experi d for in NH e governm of what com are is
m the
e
o
v
fr
a
h
s
c
th
n
in
Report atients who e whilst care tives from r descriptio
assion
irec
lea
comp
in
bus
s of p
and a ports and d ere is no c ggest that xperience. er people
storie
u
e
th
s
re
t
7
to
of old
and
ent
2,3,6, . Ye
idence t outcomes ursing care
nd rec ssion1,
v
a
e
e
le
s
a
n
The
and litt ood patien ely to the n
comp
passio
g
rg
ient is
ks like
f com
.
ingred context loo damental to ons refer la al settings meaning o ised and
it
ti
t
n
p
a
n
g
s
fun
d
e
o
en
l ho
rec
curr
comm
genera apture the w it may be .
and re
c
ho
tice
ports
l aim to nd explore linical prac
il
w
The re
is
s
c
a
t analy ealth care cation and
h
u
oncep
This c context of sured in ed
e
a
e
th
m
in
ify
Ident
Compassion in Care
Is now a Government Directive!!
What do the public & the government mean when they refer to compassion?
All uses of the Concept: Compassion in Nursing Care
There are numerous perspectives of compassion & caring in nursing including altruistic11,12, cognitive13,14, quasi religious15,
and humanistic16 influences. In addition theorists present the moral, ethical, professional and contractual obligations
of nurses in regard to caring and compassion17,18,19, and recent directives call upon the nurses to deliver
compassionate care3,6.
Descriptions of compassionate care include, dignity and comfort20; taking time and patience to listen, to
offer explanation and demonstrate other communication attributes21; demonstrating empathy,
s
ill
ng w e;
ence
kindness and warmth22; and person centeredness, involvement and choice23,24.
e cari
nc
sequ
red th ; accepta
e
n
v
li
o
Whilst experiences reported in the media appear to reflect a lack of these qualities,
e
e
C
is d
eac
ssion faction; p17,18,25
the role of compassion within this debate remains unclear.
a
p
m
o
tis ,12,14,16,
11
hen c
rt; sa
utes
that w d to comfo urance
g Attrib
with
sted
s
Definin
ugge g and lea and reas
sociation vity;
s
as
in
is
It
iti
used
ealin fidence;
mmonly
ude: sens hip;
nce h
con
s most co and nursing incl
ns
enha
e relatio
g
acteristic
The char in regard to carin red approach; th powerment;
nt
n
em
;
ce
io
compass ndness; person tients and carers
eling;
ki
le are fe
pa
how peop sponsibility;
empathy; t – working with
s
tanding
re
rs
en
;
tion
place is
de
ng
em
edent
di
lv
un
on
on;
invo
n take
rents s of the ap2,p23li,2c4,a25.
,25.
the pers
Antec
ning; resp
sion ca rsing this is
s
a
p
Refe
knowing judgmental; liste 11,12,13,14,16,17,18
m
l
ple ,16,17,18,20,2
co
nu
t
f
m
a
a
o
a
tics
t
th
c
x
n
x
r
cy
i
ca
ir
cteris
and e11,12,13,14,15
being no
in orde ) In the conte ness, and
and advo
chara
Emp
ssion
ill
quired
g
r
ceted
ompa literature,
ition re at of sufferin ss or risk of,25
a
c
d
if
f
n
lt
o
o
u
ring o reflect
c
ne
re
,13,18
The
tions ry in the
nd m re.
as ca
g (or th
clude ill
ty12
e
ments
such
escrip
plex a
a
sufferin panded to in n vulnerabili
any d care deliv d the com ssion in c concepts olicy docu
m
a
re
ex
p
a
in
er
pa
se
hum
s and are.
e
There mpassion has expo ns for com ly with oth
c
report
receiv
of co t analysis
nditio
ngeab literature, assionate rse) must
ing
p
nd co d intercha
e
rk
p
u
a
e
c
o
m
n
(n
th
w
o
o
r
use
within garding c , the care
res of
This c
often
re
ressu
ssion
te care
laims
sion is
ompa
f the p ond.
mpas tation of c ons and c mpassiona the face o
y
o
e
c
b
rd
ti
d
n
o
o
p
e
in
has
an
Emerging issues for further exploration
The ,2w5. he repres tent descri er to give c challenge
2012
than it
T
18
ed
ord
ents in questions
nsis
d
o
13,17,
m
in
d
c
n
t
a
in
o
a
n
ir
y
th
a
v
ore
Questions
dignit
imed
sents ial care en voked m
is cla
ro
is pre
c

What does compassion in the context of nursing care look like?
ition it ,17,18,25. Th lth and so lysis has p swers.
n
a
a
In add ssion14
a
e
n
h
d
a
e
a

Is this the essential missing ingredient in health care today?
within is concept
provid
comp
far th

Can and should compassion be learned?
Thus

Can this be measured, or would we only see the actor playing a part?

Does this matter?

If imagination and fantasy help to develop a compassionate mind, would acting be a
good approach?

Did compassion ever exist in nursing?

Nursing: The art and the science; a journey through time. Is it a vocation or a profession?
What gets in the way of delivering compassionate care?
Borderline case
An example with some of the defining attributes but not all
Related case
An example of good practice - not compassion in nursing care yet
related and including some defining attributes
References
1. Alzheimer’s Society (2010) Counting the Cost: Caring for people with dementia on hospital wards. Alzheimer’s Society. London
2. Care Quality Commission (2009) National Patient Survey: In patient services. Internet: www.cqc.org.uk/patientsurveys/inpatientservices
(Accessed 20/12/2011)
3. Department of Health (2012) Prime Minister’s challenge on dementia: delivering major improvements in dementia care and research by 2015.
Internet: http://www.dh.gov.uk/health/2012/03/pm-dementia-challenge (Accessed 30/03/2012)
4. Parliamentary & Health Service Ombudsman (2011) Care and compassion? Report of the Health Service Ombudsman on ten investigations
into NHS care of older people. The Stationary Office. London
5. The Patient’s Association (2011) We’ve been listening, have you been learning. Internet: www.patients-association.org.uk (Accessed 13/12/2011)
6. NHS Confederation, Age UK & Local Government Association (2012) Delivering Dignity: Securing dignity in care for older people in hospitals
and care homes. A report for consultation. Internet: http://www.nhsconfed.org/Documents/Delivering%20Dignity.pdf (Accessed 20/03/2012)
7. Department of Health (2010) NHS Constitution: The NHS belongs to us all – Interactive version. Department of Health. London
8. Walker, L.O. & Avant, K.C. (2011) STRATEGIES FOR THEORY CONSTRUCTION IN NURSING. Prentice Hall. Upper Saddle River
9. Cambridge English Dictionary (2011) Internet: http://dictionary.cambridge.org/dictionary/british/compassion (Accessed 10/11/2011)
10. Michie, D. (2008) BUDDHISM FOR BUSY PEOPLE: FINDING HAPPINESS IN AN UNCERTAIN WORLD.Snow Lion Publications, New York
11. Dietze, E. & Orb, A. (2000) Compassionate care: a moral dimension of nursing. Nursing Inquiry. Vol. 7. Pages 166 – 174
12. Cingel, M (2009) Compassion and professional care: exploring the domain. Nursing Philosophy. Vol. 10. Pages 124-136
13. Schantz, M.L. (2007) Compassion: A Concept Analysis. Nursing Forum. Vol. 42. Issue No 2. Pages 48 – 55
14. Gilbert, P. (2010) The Compassionate Mind: A New Approach to Life’s Challenges. Constable. London.
15. Nightingale, F. (1969) Notes on nursing: what it is and what it is not. Dover Publications. New York
16. Benner, P. & Wrubel, J. (1989) The Primacy of Caring: Stress and Coping in Health and Illness. Addison-Wesley Publishing Co. Menlo Park, California.
17. Chambers, C. & Ryder, E. (2009) Compassion and Caring in Nursing. Radcliffe Publishing Ltd. Oxford.
18. Brykczynska, G. (1997) CARING: THE COMPASSION AND WISDOM OF NURSING. Arnold. London.
19. Benner, P.; Tanner, C. & Chesla, C. (2009) Expertise in Nursing Practice: CARING, CLINICAL JUDGMENT, AND ETHICS. 2ND Edition. Springer
Publishing Company. New York.
20. Smith, S.; Dewer, B. & Pullin, S. (2010) Relationship outcomes focused on compassionate care for older people within in-patient care settings.
International Journal of Older People Nursing. Vol 5 Issue No 2. Pages 128 - 136
21. Rendelmeir, D.A, Molin, J. & Tibshirani, R.J. (1995) A randomised trial of compassionate care for the homeless in the emergency department.
Lancet. Vol. 345. Pages 1131-1134
22. Epstein, R.M, Franks, P, Shields, C.G, Meldrum, S.C Miller, K.N, Campbell, T.I, & Fiscella, K. (2005) Patient-centred communication and diagnostic
testing. Annals of Family Medicine. Vol. 3. Pages 415 – 421Durston, P. (2006) Partners in Caring: A Partnership for Healing. Nursing Administration
Quarterly. Vol.30. Issue 2. Pages 105-111
23. De Haes, H. (2006) Dilemmas in patient centeredness and shared decision making: A case for vulnerability. Patient Education & Counselling Vol.
62. Pages 291-298
24. Durston, P. (2006) Partners in Caring: A Partnership for Healing. Nursing Administration Quarterly. Vol.30. Issue 2. Pages 105-111
25. Dewer, B. & Mackay, R. (2010) Appreciating and developing compassionate care in an acute hospital setting caring for older people.
International Journal of Older People Nursing. Vol. 5. Issue 4. Pages 299-308.
Contrary case
An example of poor practice – Uncompassionate care
Acknowledgement
Invented case
A fictional example
This analysis contributes towards a PhD research study which is supported by the first Claire Rayner scholarship for compassion in nursing.
Illegitimate case
A misrepresentation of compassion

Feelings of sadness and grief as the situation overwhelms the carer

Influence of society and technology

Peer behaviour and culture

Education and status in nursing

Habits and routines

Priorities and expectations of others

Stress of workload – being busy
Supporting statements

There is a call for compassion in nursing care (whatever this is in the context of healthcare)

Values and behaviours are learned through our experiences and relationships throughout life

Any action to implement, measure and sustain compassion in care is better than no
action at all

The notion of distress tolerance is presented in Paul Gilbert’s book, ‘The Compassionate
Mind’14. This may offer some value in terms of supporting nurses to remain
compassionate in today’s health care environment.
Examples of what does or does not constitute compassion in nursing care will emerge
throughout the research. These will be presented as ‘The Cases’ for compassion in nursing.
Model case
A story presenting ideal compassionate nursing care with all defining
attributes present
Author
Barbara Schofield, Nurse Consultant for Older People, Calderdale & Huddersfield NHS Foundation Trust
PhD student, University of Huddersfield