Exploring compassion: implications for contemporary nursing. Part 2

A range of contemporary political and professional literature endorse the principle of compassion in nursing as a core and underpinning philosophy fundamental to the profession. However, despite pledges to ensure that compassion lies at the heart of nursing, the concept has not been clearly defined. It is evident that uncovering the true meaning is complex and challenging owing to its subjective nature. In light of this, several implications must be considered. Effective student nurse recruitment is essential to ensure that the most appropriate individuals are selected. Contemporary marketing campaigns must be implemented, and recruitment strategies developed, which consider specific values and attitudes. Service user involvement in recruitment and selection, curriculum planning and learning and teaching strategies, and post-qualification education, can enhance nurses' understanding of the patient perspective and make headway in embedding compassion as a core nursing value. Additionally, effective role modelling in practice which demonstrates high-quality compassionate nursing care is essential. Nurses must be adequately supported in the clinical environment to facilitate compassionate behaviours and clinical leadership at all levels must uphold political and professional pledges to achieve this. Consideration of these implications for practice is essential to ensure that nurses are able to respond to patients with humanity and kindness, and deliver high-quality, compassionate care to all.     

Compassion: a concept analysis

Compassion is a quality deemed sine qua non for nursing and claimed to underpin the profession in its larger-than-life scope. Yet the meaning of the concept "compassion" (or "compassionate care") is neither clearly defined in nursing scholarship nor widely promoted in the context of contemporaneous everyday nursing practice. The term in its moral dimension has, at best, been downgraded as an optional practice in everyday nursing care and, at worst, dismissed as lofty ideals connected to other disciplines, such as religion and ethics. A concept analysis using Walker and Avant's strategic method as well as Rodgers's evolutionary paradigm was undertaken to clarify the meaning of the concept "compassion" and examine its relevance in the context of everyday nursing practice.     

Compassionate care: a moral dimension of nursing *

This paper focuses on the concept of compassion and its meaning for nursing practice. Compassion is often considered to be an essential component of nursing care; however, it is difficult to identify what exactly comprises compassionate care. To begin with, there is a general discussion of the meaning of compassion and an examination of its common usage. An argument then is presented that compassion is more than just a natural response to suffering, rather that it is a moral choice. The paper outlines the extent to which this concept has implications for nursing care, highlighting some of the obstacles that nurses need to overcome in order to maintain this essential moral value of the caring role.     

The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care

Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management 20, 7–19
The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care Aim The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. Background The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Key issues Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Conclusions Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. Implications for nursing management The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.     

Spiritual character and self-identity in nurses

Florence Nightingale gave us an image of nurses as providers of loving care to the world. To be a good nurse, one needs to be compassionate. To provide good care, one needs training to learn proper techniques. Nursing is more than providing care; it is a profession that requires an inner willingness to serve others. This is known as professionalism and spirituality. How does one decide to serve others? Unless a sense of calling is experienced, one cannot commit oneself to helping others. Nurses must know who they are in order to fulfill their duties. This article selected two nurse role models from recent history, Majorie Brooking and Chen Tsui-yu, to illustrate the proper role of the nurse and how one may follow in their footsteps. Eric Erikson's theory of identity is used to see how compassion is learned and developed. The article also discusses the meaning and images of "nurse" in history.     

All Nurses Are Leaders: 5 Steps to Reconstruct the Professional Identity and Brand Image of Nursing

Branding is a marketing technique that can allow professions to create a desirable image that uniquely differentiates them from others. Effective brands reinforce their desirable attributes using the marketing principle of consistency of message and action over time. However, nursing has consistently reinforced caring and compassion but insufficiently communicates the advanced roles of contemporary nurse leaders. This paper describes steps to create a consistent message that could align with the “nurse as leader” brand and professional identity that nurses desire to have linked to their profession. Until nursing controls its own message, it will not control its own image.     

Compassion fatigue within nursing practice: A concept analysis

“Compassion fatigue” was first introduced in relation to the study of burnout among nurses, but it was never defined within this context; it has since been adopted as a synonym for secondary traumatic stress disorder, which is far removed from the original meaning of the term. The aim of the study was to define compassion fatigue within nursing practice. The method that was used in this article was concept analysis. The findings revealed several categories of compassion fatigue: risk factors, causes, process, and manifestations. The characteristics of each of these categories are specified and a connotative (theoretical) definition, model case, additional cases, empirical indicators, and a denotative (operational) definition are provided. Compassion fatigue progresses from a state of compassion discomfort to compassion stress and, finally, to compassion fatigue, which if not effaced in its early stages of compassion discomfort or compassion stress, can permanently alter the compassionate ability of the nurse. Recommendations for nursing practice, education, and research are discussed.     

Compassion: Use it or lose it?: A study into the perceptions of novice nurses on compassion: A qualitative approach

BackgroundNurses and patients believe compassion to be one of the most important professional values. However, it is not known which factors influence compassionate behaviour in practice. There is a need for insight whether or not compassion in nursing practice flourishes or falters.ObjectivesThis study aims to explore how Dutch novice nurses perceive compassion within nursing care and gain insight in their strategies of sustaining and developing compassionate care.DesignThis study used an exploratory design, employing a qualitative approach.Data Sources14 in depth interviews with Dutch bachelor novice nurses with 0–5 years of practical experience took place.Review MethodsThematic analysis and inductive coding was used.ResultsFour themes emerged from the data. First, participants perceive compassion to be a part of their professional identity. Balancing between positive and negative environmental influences and their own perceptions was shown as a second theme. Thirdly, various strategies such as rebellion and conforming to the ideas on the workplace helped nurses to do so in daily practice. If nurses succeeded in dealing positively with various influences, a professional development was perceived over time. The fourth theme described the increased awareness of compassion and professional identity if strategies were successful. If not; insecurity, job dissatisfaction and ultimately consideration of job-retention was described.ConclusionCompassion is an essential value during the development of the professional identity of novice nurses. Dealing with meaningful emotions and experiences broadened nurses' personal awareness of compassionate care and stimulated a growth in their professional identity. Novices need support during their internships that builds empowerment and resilience in sustaining compassion. Furthermore, there is a need for role models and a corporative team spirit in order to coach novice nurses in compassionate behaviour.     

Nursing practice: compassionate deception and the Good Samaritan

This article reviews the literature on deception to illuminate the phenomenon as a background for an appraisal within nursing. It then describes nursing as a practice of caring. The character of the Good Samaritan is recommended as indicative of the virtue of compassion that ought to underpin caring in nursing practice. Finally, the article concludes that a caring nurse, responding virtuously, acts by being compassionate, for a time recognizing the prima facie nature of the rules or principles of truth telling.     

Student nurse socialisation in compassionate practice: a Grounded Theory study

Compassionate practice is expected of Registered Nurses (RNs) around the world while at the same time remaining a contested concept. Nevertheless, student nurses are expected to enact compassionate practice in order to become RNs. In order for this to happen they require professional socialisation within environments where compassion can flourish. However, there is concern that student nurse socialisation is not enabling compassion to flourish and be maintained upon professional qualification. In order to investigate this further, a glaserian Grounded Theory study was undertaken using in-depth, digitally recorded interviews with student nurses (n=19) at a university in the north of England during 2009 and 2010. Interviews were also undertaken with their nurse teachers (n=5) and data from National Health Service (NHS) patients (n=72,000) and staff (n=290,000) surveys were used to build a contextual picture of the student experience. Within the selected findings presented, analysis of the data indicates that students aspire to the professional ideal of compassionate practice although they have concerns about how compassionate practice might fit within the RN role because of constraints on RN practice. Students feel vulnerable to dissonance between professional ideals and practice reality. They experience uncertainty about their future role and about opportunities to engage in compassionate practice. Students manage their vulnerability and uncertainty by balancing between an intention to uphold professional ideals and challenge constraints, and a realisation they might need to adapt their ideals and conform to constraints. This study demonstrates that socialisation in compassionate practice is compromised by dissonance between professional idealism and practice realism. Realignment between the reality of practice and professional ideals, and fostering student resilience, are required if students are to be successfully socialised in compassionate practice and enabled to retain this professional ideal within the demands of 21st century nursing.     

Respiratory assessment in critical care units.

As healthcare delivery changes in critical care, nursing continues to extend its practice base. Nursing practice is expanding to incorporate skills once seen as the remit of the medical profession. Critical care nurses are equipping themselves with evidence-based knowledge and skills that can enhance the care they provide to their patients. Assessment of patients is a major role in nursing and, by expanding assessment techniques, nurses can ensure patients receive the care most appropriate to their needs. Nurses in critical care are well placed to perform a more detailed assessment which can help to focus nursing care. This article describes the step-by-step process of undertaking a full and comprehensive respiratory assessment in critical care settings. It identifies many of the problems that patients may have and the signs and symptoms that a nurse may not whilst undertaking the assessment and preparing to prescribe care.     

The certification process. History and significance for addictions nursing practice

The addictions nursing certification process will become a reality for the nurse. Ideally, this process will provide a method of ensuring quality care while maintaining self-regulation by the profession. The literature supports certification based on standards of care as a measure of that quality of care and as a voluntary mechanism selected by the practicing nurse. Many professional issues lie ahead for specialty nursing practice in the 1990s. The addictions nursing certification established by the NNSA offers a quality basis for certification implementation. The addictions nursing practice certification credential can provide the acknowledgement that the nurse has mastered a body of knowledge and skills reflective of a specialty nursing area.     

Clinical practice/education exchange: bridging the theory-practice gap

Nursing education is directed toward development of nursing practitioners competent to nurse effectively in the reality of our present society. A major challenge to the nursing profession is to find ways of merging theory and practice in the delivery of nursing education and patient care. One option for achieving this goal is for nurse educators to spend time in clinical practice updating their clinical skills and re-experiencing the realities of practice. Joint appointments with practice, intermittent periods of clinical update in practice and work role exchanges have all been utilized by the profession. However clinical practice/education exchange (CPEE) involving two people--one in clinical practice and the other in education--who exchange jobs for a fixed period of time is a relatively new concept. Central to a CPEE is the aim of enhancing student learning and facilitating meaningful links between theory and practice for them. Hence the exchange occurs between the education institute and the service area where students are placed. This article positions the CPEE within nursing literature and presents narrative accounts from a nurse educator and clinician who exchanged jobs for one year.     

Compassion fatigue and coping strategies for hospital nurses

Over-involvement in patient trauma and loss in clinical settings negatively affects nurses and may cause compassion fatigue. Compassion fatigue is associated with prolonged exposure to trauma cases, over-involvement in patient situations and over-extending caring energies. Nurses unable to adapt and cope may suffer physically and psychologically, reduce their quality of care, cause medical care costs to increase, and ultimately become frustrated and decide to leave the nursing profession. While current approaches to addressing compassion fatigue focus on evaluating individual nurse situations, adjusting attitudes, holding education programs, and bolstering support systems, little research attention has been directed toward the consequences of such on patient care or the origins of compassion fatigue in Taiwan nurses. This paper defines compassion fatigue, examines its importance and consequences, and delineates common nursing coping strategies in Taiwan. Findings expand domestic research on this phenomenon and suggest relevant theories and effective interventions to achieve remediation.     

Science and compassion: vacillation in nursing ideas 1940s-1960

The author's thesis is that during the mid-20th century, an intellectual shift toward scientific notions of care challenged the nursing profession's oldest practice values grounded in religious ideas of suffering and compassion. The author uncovers the vacillation between the expression of dominant scientific and rival compassionate ideas in the published and unpublished nursing literature of the 1950s. The evidence is first placed in a historical context of 20th century nursing history, explaining why the profession emphasized scientific approaches to care following World War II. The evidence is then placed into two larger contexts: (a) that of the greater body of scientific and humanistic writing during the period showing concern about the applications of science and technology and its moral implications, and (b) the context of early to mid-20th century notions of "positivism," highlighting the relationship between empirical knowledge and moral ideas that orient human actions. The article concludes with an analysis of implications for nursing practice.     

Nurse educators and the future of nursing

Calls for transformation in nursing education and practice abound. Nurses are part of a trusted profession, but they have been under-represented in conversations about health care compared with other, more vocal professionals. Nurses may not consider that they already have many leadership skills, and nurse educators in staff development roles are positioned to foster growth in other nurses. The relationship between nurse educators and their constituents provides the context for support that can motivate staff nurses to move beyond their concerns and accept challenges that may cause them some discomfort, such as writing for publication or public speaking. The leadership of nurse educators is essential to support colleagues who will shape the future of nursing.