Ida Jean Orlando developed nursing processing theory, in this theory nurses are required to meet immediate developmental and physiological needs of patients and relieve the distress and discomfort, at the same time it requires nurses to access both verbal and nonverbal behavior of patients (Bousso et al., 2014). When focusing on concept analysis of compassion a distinction ought to be created between compassion and its related attributes that include empathy, sympathy, kindness and caring (Nuopponen et al., 2011). The emphasis on compassion is the desire to act immediately to alleviate the suffering of an individual (Schantz, 2007). Questions such as “Why am I doing this concept analysis” helps in the determination of the purpose of the concept analysis (Walker & Avant, 2011).
Walker and Avant theoretical framework in nursing suggested that the purpose of compassion concept analysis is to contribute towards development and understanding of What compassion is in relation to a provision of nursing care to elderly people and its acceptance to every nursing practice (Walker &Avant, 2011). Individual factors described as personal resources have been found to help nurses establish a compassionate relationship with patients such attributes include empathy, caring, being non-judgmental, approachable and kindness. However, there are other individual hindering factors that include working longer hours, fatigue and hunger, these factors have been identified as a hindrance to individual’s nurse ability to offer compassion. Organizational factors have also been identified as hindrance factors in compassionate care delivery.
The lack of compassion as a concept in nursing care have been reported among the patients, the reports have been documented in healthcare ombudsman and the patient’s association. The documented stories include patients experiencing poor, inadequate and negligent care from the nurses (Patients Association, 2011).
Definition of Compassion
Compassion is defined by Oxford English dictionary as “a feeling or emotion when a person is moved by the suffering or distress of another, and by the desire to relieve it” (Oxford English dictionary online, 2017). The concept of compassion has also featured in Buddhist religion where its defined as the desire to act upon the suffering of others. Moreover, compassion among the Buddhist encompasses attributes such as kindness, love, generosity and patience (Michie, 2012). In the context of nursing care, the concept of compassion is used to define basic kindness, with a deep awareness of an individual’s suffering jointly with the desire to help relieve it (Gilbert et al., 2014).
The idea of propagating, embedding, and sustaining compassion care within the complex health care system is so much dependent on addressing the issues and needs of the patients, their caregivers and the medical staff involved in service delivery per (MacArthur et al., 201). A research by Christiansen and colleagues revealed that compassion care can be experienced in the wards where nurses have shared values, respect each other’s contribution, free to explore ways to enhance care and encourage feedback, cording to study by (Christiansen et al., 2015) on the barrier and enablers of compassionate care, the research findings highlights the important role of individual nurses and relational, and organizational factors and leadership. Therefore, based on the research findings to support and delivery of compassionate care, the four interconnected elements need to be in place resulting to organizational capacity. The four elements include relational practice, leadership, practice development, and strategy. A cording to the model by (Tierney et al., 2017) compassion is commonly related to an individual, but in the context of healthcare, it is found be social in nature, given and received in a specific setting, and shaped by being part of the professional community. (Crawford et al 2015) and colleagues have challenged policy compassion care that is only based on individual’s behavior an argument brought forward by Tierney and colleagues compassionate care model.
Suffering has been described as the trigger for compassion in nursing practice, this is an opinion shared by both practicing nurses and patients in various published studies (Bousso et al., 2014; Cingel, 2011). When research participants express their suffering, it is not the physical suffering that is difficult to deal with but the emotional suffering that comes with it. Studies have shown that consequences of loss of self-worth are the main burden to individuals that suffers terminal illnesses. However, compassion is believed to be closely related to joyful moments (Sinclair et al., 2016). Compassion has been developed and integrated into health care systems of different health care providers with an aim of addressing the needs of patients, caregivers and the staff involved in caring for the patients (Christiansen et al., 2015).
The characteristics that are outlined and accepted as being important to the concept are referred as the defining attributes (Walker and Avant, 2005). With regards to nursing care the attributes that are related to compassion as a nursing concept are namely: kindness, empathy, being non-judgmental, listening and responding, dignity, caring, understanding how people are feeling, and person-centered (Adamson and Dewar, 2011).
The word kindness is the quality of being friendly, generous, and considerate (Oxford English dictionary online, 2017). Natural deposition can be the best word to describe kindness and its common in a pedagogical encounter (Clegg and Rowland, 2010). Kindness drives away the aspect of being self-centered with a view to paying attention to others sufferings coupled with a need to relieve them from the distress. Consequently, it can lead to vulnerability of an individual nurse (Forrest, 2011). Clegg and Rowland discussed kindness in the context of education but the same can be discussed as an attribute of compassion in nursing care. In nursing processing theory by Ida jean Orlando and interpersonal relationship theory kindness as an attribute of compassion plays a pivotal role.
Empathy defines our ability to understand the needs of the patient and it forms the basic unit for ethical conduct towards others, it is not possible to exercise sympathy and kindness as a virtue in the absence of empathy (Gault et al., 2016). Empathy and sympathy have sometimes been used interchangeably. However, a clear difference between the two do exist, empathy is intellectual and emotional awareness and fully understanding another person’s thought, feelings and behavior while sympathy is the sharing of an individual’s feelings and experiences (Bousso et al, 2014). Empathy and compassion are grouped together as a fundamental concept that constitutes person-centered care in nursing. The basic principle of understanding an individual’s needs and effort to relieve the suffering summarizes empathy as an attribute of compassion as a concept in the nursing care (RCN, 2014).
The sense of feeling self-worth best defines dignity (Gustafson, 2015), by openly acknowledging the suffering of others the human dignity is strengthened. Moreover, when people are treated with the dignity they experience self-control, value, and confidence. when dignity as an attribute is lacking, patients feels devalued, loss of self-control. Dignity as an attribute is paired to compassion, in ABCD of conserving care compassion, attitude, behavior, and dialogue are the key component (Christiansen et al., 2016). At the same time, compassion has featured prominently in RCN dignity campaign (RCN, 2009) and more recently on the report for consultation (NHS confederation, Age UK and Local Government Association, 2012).
Antecedent and Consequence
Antecedents are defined as situations or events that precede a concept and helps understanding of the social context in which a concept is applied besides favoring the refinement of the concept Antecedents help researchers understand the social context in which a concept is often used, as well as favoring the refinement of the concept (Bousso et al., 2014).
Suffering is a key ingredient that is required for the execution of compassion as a concept with regards to nursing care. The suffering of patients in the context of nursing care includes illness, vulnerability, and risk of illness (Michie, 2012). Suffering presents as a pattern of reduced ability to relate to others, luck or minimal self-care and diminished autonomy. Suffering in the context of compassion concept in nursing care is best described as a state of emotional reaction, psychological and physical response to illness or pain (Reyes, 2012). Self-compassionate and compassionate workplace are key critical components of antecedent for compassion nursing.
The vulnerability is also another condition that is required for compassion to take place (Dewar et al., 2010; Cingel, 2009), and alleviation of vulnerability is essential for the delivery of good nursing care to the patients. The need for professional ethics among the nursing officers has been necessitated by the fact that patients feel inferior in relation to the healthcare service providers and as result patients are vulnerable to exploitation and abuse (Sabei et al., 2016). It is for the reason why professionals need to recognize the influence that they have over the patients and they should recognize dependency and vulnerability of the patients.
When a concept occur the outcome of the event is the consequence (Brush et al., 2011; Walker and Avant, 2011). The positive processes yielding outcome include an individual moving beyond difficult circumstances, regaining hope and attaining sense of self-worth (Brush et al., 2011)
The occurrence of a compassion as concept can be measured by use of empirical referents
Several studies have pointed out cases where concept of compassion is missing (Hem and
Heggen, 2004), at the same time there are studies that have highlighted the presence of compassion (Dewar et al., 2011). Quantification and the process of outcome can be measured using related construct. However, there are no measures for overcoming when focusing on the concept of compassion. The framework of compassionate care in the health sector have been categorized as a related phenomenon and described through activities that include competence, self-esteem, hope, optimism, caring, empathy and dignity (Brush et al., 2011). Expectations and experiences of individual patients and their caregivers vary immensely, therefore a different approach is necessary when handling their psychological, emotional and physical needs (Patient Association, 2009, 2010; Parliamentary and HealthCare Service Ombudsman,2011).
Ken had been admitted at acute surgical ward for almost 2 months in the same ward there were other two patients, one week later another patient named John who required similar medical attention was admitted in the same ward. The condition of John was worsened by the fact that he also suffered psychological trauma and he was aggressive and rude to everyone including the nurses on duty attending to him. John even used vulgar language to nurse attending to him, this incidence could have a negative impact. John was viewed by his fellow patient as being disrespectful to the nurse consequently, none of the three patients wanted to associate with John. Contrary to the expectation of everyone in the ward including Ken the nurse did not stop attending to John. She went as far as explaining to John that it was her duty to treat him with dignity and not to judge him based on the incidences, besides the nurse didn’t discuss the incidences with her seniors. Having been admitted to other health facilities where such incidences led to shouting and assault from the nurse, Ken was quite highly impressed by the way the matter was handled by the nurse. Ken realized that the nurse showed an aspect of empathy and she was not judgmental. Moreover, the nurse could understand the feelings of the patient, the caring and a diplomatic approach that was taken by the nurse enabled Ken and other patients express empathy with John. From this perspective, the nurse had compassion and acted with kindness, empathy, care and conducted herself in a professional manner. Finally, John could accept his situation and be socially accepted in his new environment this results to his improved medical condition.
This case model illustrates three critical attributes of compassion: Empathy, Dignity, and kindness. the nurse in the case model has acted with compassion taking into consideration all the necessary attributes.
John was a patient who was admitted to the acute surgical ward at the same time he experienced psychological trauma due to being neglected by his family. John was very abusive and rude to the nurse who was attending to him, such incidences led to John being isolated by his friends and fellow patients in the ward. The nurse attending to John did not stop offering nursing services to John, she continued to care for him by ensuring that John was well fed, well dressed and that he received all the attention necessary to help him during the healing process. At the same time the nurse decided to discuss the patient’s behavior with her colleagues consequently Johns conduct became the talk of the entire hospital, other nurses also decided to avoid attending to Johns need based on the reported incidences. Moreover, none of the patients wanted to associate with him in the ward.
The story of the nurse and John illustrates the typical borderline case. The nurse was able to attend to John with care and empathy and this helped John in handling his situation. The nurse offered nursing services to John while observing two critical attributes of the concept of compassion. However, the nurse missed the third critical attribute that is dignity by talking to other people about the patient’s behavior she did not observe the dignity of the patient but also lacked professional ethics. The lack of the attributes consequently propagated isolation of John within the ward and loss of self-esteem.
John was a patient who was admitted to the acute surgical ward at the same time he experienced psychological trauma since he suffered neglect from his family members. John was very abusive and rude to the nurse who was attending to him, such incidences led to John being isolated by the nurse and other patients in the ward. Because of his arrogance and use of abusive language the nurse who was assigned duty to attend to his nursing needs responded by shouting at him and physically assaulting John, the nurse exploited Johns vulnerability and lack physical strength. The situation and suffering of John worsened due to lack of proper care and neglect by the nurse.
This case reflects a complete absence of the three critical attributes such as empathy, kindness, and dignity, this is a classic example of poor nursing practice and a total collapse of a concept of compassion.
The concept of compassion analysis has brought forward the three major attributes that include kindness, empathy, and dignity at the same time the antecedents such as suffering and vulnerability of the patient have been put in focus and finally the consequences of the lack of compassion have been illustrated. In developing the concept of compassion in the nursing theory hypothetical relationship between concept compassion and consequences have been established. Development and Implementation of the concept of compassion should be encouraged in health facilities to promote nursing science and promote health of individuals.
Adamson, E., & Dewar, B. (2011). Compassion in the nursing curriculum: making it more explicit. Journal of Holistic Healthcare, 8(3), 42.
Bousso, R. S., Poles, K., & Cruz, D. D. A. L. M. (2014). Nursing concepts and theories. Revista da Escola de Enfermagem da USP, 48(1), 141-145.
Brush, B. L., Kirk, K., Gultekin, L., & Baiardi, J. M. (2011, July). Overcoming: A concept analysis. In Nursing forum (Vol. 46, No. 3, pp. 160-168). Blackwell Publishing Inc.
Christiansen, A., O’Brien, M. R., Kirton, J. A., Zubairu, K., & Bray, L. (2015). Delivering compassionate care: the enablers and barriers. British Journal of Nursing, 24(16), 833-837.
Cingel, M. (2011). Compassion in care: A qualitative study of older people with a chronic disease and nurses. Nursing Ethics, 18(5), 672-685.
Cingel, M (2009) Compassion and professional care: exploring the domain. Nursing Philosophy. Vol. 10. Pages 124-136
Clegg, S., & Rowland, S. (2010). Kindness in pedagogical practice and academic life. British Journal of Sociology of Education, 31(6), 719-735
Crawford, P., Brown, B., Kvangarsnes, M., & Gilbert, P. (2014). The design of compassionate care. Journal of clinical nursing, 23(23-24), 3589-3599.
Dewar, B., Pullin, S., & Tocheris, R. (2011). Valuing compassion through definition and measurement: Belinda Dewar and colleagues describe a project thathas enabled clinicians to improve patients’ experience by identifying and changing aspects of care. Nursing Management, 17(9), 32-37.
Forrest, C. (2011). Nursing with kindness and compassion. Independent Nurse.
Gault, I., Reid, G., & Luthi, A. (2016). Essential Values for Communication, Compassion and Collaborative Care. Communication in Nursing and Healthcare: A Guide for Compassionate Practice, 1.
Gilbert, P., McEwan, K., Catarino, F., Baião, R., & Palmeira, L. (2014). Fears of happiness and compassion in relationship with depression, alexithymia, and attachment security in a depressed sample. British Journal of Clinical Psychology, 53(2), 228-244.
Gustafson, C. M. (2015). The Injustice of “Just” A Nurse: How Perceptions and Stigmas of Gender Have Influenced Nursing and How Compassion-Based Care and The Goals of The American End-Of-Life Movement Can Shape Medicine Moving Forward
Hem, M. H., & Heggen, K. (2004). Rejection–a neglected phenomenon in psychiatric nursing. Journal of Psychiatric and Mental Health Nursing, 11(1), 55-63.
MacArthur, J., Wilkinson, H., Gray, M. A., & Matthews-Smith, G. (2016). Embedding compassionate care in local NHS practice: developing a conceptual model through realistic evaluation. Journal of Research in Nursing, 1744987116678901
Michie, D. (2012). Enlightenment to Go: Shantideva and the Power of Compassion to Transform Your Life. Simon and Schuster.
Nuopponen, A. (2011). Methods of concept analysis-tools for systematic concept analysis (part 3 of 3). LSP Journal-Language for special purposes, professional communication, knowledge management and cognition, 2(1).
Patient’s Association (2011) We’ve been listening, have you been learning. Internet: www.patients-association.org.uk (Accessed 22/3/2017)
Penuel, W. R., Fishman, B. J., Yamaguchi, R., & Gallagher, L. P. (2007). What makes professional development effective? Strategies that foster curriculum implementation. American educational research journal, 44(4), 921-958
Reyes, D. (2012). Self-Compassion a Concept Analysis. Journal of Holistic Nursing, 30(2), 81-89
Sabei, S. D. A., & Lasater, K. (2016). Simulation debriefing for clinical judgment development: A concept analysis. Nurse Education Today, 45, 42-47.
Schantz, M. L. (2007, April). Compassion: a concept analysis. In Nursing forum (Vol. 42, No. 2, pp. 48-55). Blackwell Publishing Inc.
Sinclair, S., Norris, J. M., McConnell, S. J., Chochinov, H. M., Hack, T. F., Hagen, N. A., ... & Bouchal, S. R. (2016). Compassion: a scoping review of the healthcare literature. BMC palliative care, 15(1), 6.
Tierney, S., Seers, K., Tutton, E., & Reeve, J. (2017). Enabling the flow of compassionate care: a grounded theory study. BMC Health Services Research, 17(1), 174
Walker, L. O., & Avant, K. C. (2005). Strategies for theory construction in nursing.