A growing concern has been rising within public and policy domains as fundamental elements in providing safe and quality health care have been lacking. This has led to poor patient care, as well as pitiable clinical, emotional, and social outcomes. On some occasions, catastrophic events have been witnessed as reports from Health Ombudsman and Patient’s Association indicate. For example, the reports present stories from patients who have had experiences characterized with poor, inadequate and negligent care, and abuse while receiving nursing care. These reports have led stakeholders within health care to affirm there are unrecorded stories that are similar. As a result, directives from the government have implied the reports are due to nursing roles being undertaken by practitioners lacking compassion. Although the compassion concept was introduced about the study of burnout among nurses, it refers to care which is fundamental in attaining good patient experiences and outcomes. As a result, it has been adopted as a synonym for secondary traumatic stress disorder, which is considered to be far removed from the original meaning of the term (Gustin, & Wagner, 2012).
The basic premises of care for self and others are closely related to efforts undertaken to restore interpersonal bonds with a sense of belonging with others and supporting peoples’ reconciliation with suffering. Compassion is a way that accomplishes the restoration of human connectedness while creating new meanings and healthy senses of self. This led caring science theorists Eriksson, Roach, and Watson to highlight the importance of compassion in providing care to self and others (Sitzman & Watson, 2013) They asserted this concept is a basic element of care relating to human interactions that are not specific to nursing actions in unique contexts. Jean Watson’s Theory of Human Caring has genuinely contributed experiences with strong motives focusing on compassion for patients and caregivers capacities and abilities to self-care. As Sitzman and Watson (2013) recorded, ingenuity in human compassion acts as the strongest link to ensure that the patients get good care and if in doubt of the intentions of the caregiver, the patient may no benefit from compassionate human care.
The method used in this concept analysis will reveal several categories of compassion including causes, process, and manifestations. For example, the report will provide recommendations largely referring to nursing care of patients in general hospital settings. The characteristics of each of the categories will be specified in line with theoretical definition, model case, additional cases, empirical indicators, and operational definition. Ultimately, the concept analysis will strive to capture the current meaning of compassion in the context of health care and explore how nursing practices and education can be improved by applying Jean Watson’s Human Caring Theory.
Literature Review
Clark (2016) is among the researcher who has in the recent past focused on further exploring Watson’s theory. The characteristics of the compassion concept are based on its diverse definitions. Compassion is a strong feeling of sympathy and sadness for bad luck and suffering towards other people hence; developing the will and desire and help them. Buddhists define compassion as the desire to act upon the suffering of others, as it is an ethical behavior involving patience and generosity (Cowden & Cummings, 2012). Concerning Watson’s Human Caring Theory, compassion is applied to distinguish qualities such as sympathy, kindness, and empathy when providing nursing care through intentional actions to ease patients’ pain and suffering. This has led compassion care to be a government directive. The public and government refer and use the concept of compassion in nursing care in numerous perspectives including cognitive, humanistic, ultraistic, and quasi-religious influences (Gustin, & Wagner, 2012).
Consequently, the theoretical definition presents the ethical, professional, moral, and contractual obligations of nursing practices concerning providing compassionate care. Recently, directives have been calling upon nursing practitioners encouraging them to deliver compassionate care by describing it using terms such as comfort and dignity. Thus, compassion is a concept encouraging nursing practitioners to take time, be patient, listen, and offer explanations and demonstrations through communication attributes allied to empathy, warmth, and kindness. Watson (2015) asserted that through communication, one gets to understand the patient more and is also able to focus on empathy, sensitivity kindness and empowerment, which are some of the most important nursing practices under the model.
Arslan‐Özkan, Okumuş & Buldukoğlu (2014) conducted a study on the effect of nursing care as conceptualized in Watson’s theory on human distress, self-efficacy, and adjustment in infertile women. According to the findings of the study, nursing professionals and all caregivers must acknowledge the need for personalized care as it remains at the core of the theory as proposed by Watson. They should know their patients to understand how they feel and offer quality care without being judgmental by listening and advocating for quality nursing care responsibly. This was also confirmed by Santos, Bousso, Vendramim, Baliza, Misko & Silva (2014) in their study which found that one of the most important elements in the provision of care as conceptualized by Watson was through communication and learning about specific patient’s needs. Thus, it is important for nurses to possess inner beauty relating to specific psychological factors such as personality, intelligence, and grace. They are vital in responding to experiences and perceptions of patients, public, and the government that something is missing in health care.
Antecedents and Consequences of Compassion Nursing Concept
The antecedents and consequences of compassion nursing concept are diverse. There are four items comprising compassionate attributes that describe the qualities of a thoughtful nurse capable of identifying the needs of a patient and his or her family. The items are; providing hope, kindnesses, and understanding, irrespective of the situation as they describe the elements of a caring, compassionate nurse found in subscale. This research is dedicated to the theory and science of human caring as it aligns with elements of subscale representing the four aspects of compassionate care. Thus, compassion attributes include encouraging, appreciating patient and family members, considering their needs, and being empathetic (Cowden, & Cummings, 2012).
Capable practitioners refer to nurses who are skilled and able to fulfill the responsibilities of their profession. Thus, compassion is achieved through competence, which involves years of preparation and arduous practice, and disciplined effort along with the compensations and fulfillment that it brings. It also involves being skilled, and confidence to be confidently compassionate for a nurse to be committed when delineating what he/she does when caring. Thus, the antecedents of compassion refer to the conditions required to address and reduce patients’ suffering due to illnesses, the risk of acquiring diseases, and the human vulnerabilities adversely affecting health conditions. Conversely, the consequences refer to suggestions affirming that compassion should be delivered to enhance qualities of care applied for patients to heal and attain comfort, peace, satisfaction, confidence, reassurance, and acceptance.
Measures of Compassion
There are various ways to measure the presence of compassion. This concept analysis has exposed complex and multifaceted characteristics and conditions required in providing compassionate care. The notion of compassion has been interchangeably used with other concepts such as respect, dignity, being care and understanding. The literature has represented compassion to consistently describe the concept as a vital attribute nursing practitioners ought to apply to provide quality care. Thus, the literature is exerting pressure in the nursing profession among other health and social care environments to provoke care givers to be compassionate (Gustin, & Wagner, 2012).
It should also be noted that nursing is a journey of art and science. It is also a vocation and profession invoking feelings among patients and caregivers. Thus, it influences societies, technologies, peer behaviors, cultures, education levels, habits, routines, and status of nursing practices. This further determines the priorities and expectations applied by nursing practitioners despite facing stressful workloads in busy environments as they strive to support patients seeking nursing care to attain health. The nursing profession, therefore, relies on values and behaviors, which are learned through experience. Actions implemented to measure and sustain compassion in care should, therefore, distress tolerance as this offers support for nurses to consistently provide compassionate care across various health care environments and settings (Cowden, & Cummings, 2012).
Jean Watson’s Theory of Human Caring has been providing theoretical frameworks in interpreting concepts and languages referring to a patient as ‘the other’. It, therefore, attempts to honor patients as human beings as people who ought to be assisted in leading dignified lives sustaining mutual humanity as these qualities make affirm every individual is unique and irreplaceable. As Arslan‐Özkan, Okumuş and Buldukoğlu (2014) asserted, mutuality and differences among human beings become evident in various aspects of compassionate care as it is challenging prerequisite for care facilitating self-compassion for others and self to alleviate pain and suffering. Jean Watson’s Theory of Human Care, therefore, strives to affirm that compassionate care should not be regarded as an intervention from care givers to patients. In their study, Santos, Bousso, Vendramim, Baliza, Misko & Silva (2014) emphasized on the importance of ensuring that the unique needs of every patient are at the center of the caregiving process. This has led nursing practitioners to understand compassion in five themes. According to Gustin and Wagner (2012) the themes include being there with self and others, being non-judgmental, respecting vulnerability, providing a voice for the things that need to be said, heard, and done, and being able to accept compassion from others. These themes hold different subthemes as discussed in the model case below.
Model Case
The elderly members of the community often suffer from various health conditions including chronic illnesses. Jean-Marie aged eighty-seven years old has been suffering from Alzheimer’s disease for six years. Although she has five children and eight grandchildren who love and care for her, on multiple occasions, she fails to recognize them. For six months after the diagnosis, her children ensured she received medical care as an inpatient. The physicians and nurses, however, advised them that it would be better to provide the patient with home-based care as this would enhance her ability to remember familiar settings and family members paying her visits at home. The children, however, could not provide her with the quality home-based care she needed as they had to sustain their careers and families.
As a result, they employed a nurse caregiver to cater for all her needs on a daily basis. They acknowledged that the nurse caregiver had to be compassionate to provide her with the quality care she needed. The first caregiver, however, was not compassionate as she would hardly spend time with Jean-Marie to provide the human to human connection Alzheimer’s patients require. She would also raise her voice at the patient on multiple occasions. As a result, the family had to let her go and hire another caregiver after three months.
The newly hired male nurse has been caring for Jean-Marie since then. The family describes him as a very compassionate caregiver always striving to ensure Jean Marie’s social and health care needs are satisfactorily addressed. For example, he understands that she often experiences anxiety attacks during which she needs one of her children to be present to calm down. During such painful occurrences, he provides her with anti-anxiety medications that calm her in case none of her children can be present. In case the children are nearby, he either drives her or waits for their arrival. In the past year, these painful attacks have been rampant. The nurse caregiver, however, has neither complained nor neglected her. Instead, he has advised the children to talk to a doctor to prescribe stronger anti-anxiety medication.
Jean Marie’s children assert that he cares for their mother beyond his responsibilities and pay grade. For example, he develops a schedule through which he takes Jean Marie for shopping an activity he realized she enjoys more than going for a movie or synchronized swimming lessons for the elderly. He also acknowledged she does not like to exercise. He supplemented her dietary needs by identifying foods she would love to consume without compromising her nutritional needs. Thus, he embraced the role of being a cook despite the children ensuring the patient has a regular cook catering for her dietary needs. The male nurse care giver has therefore been providing Jean-Marie with compassionate care by being sympathetic, kind, and understanding that the patient needs her pain and suffering alleviated for her dignity to be restored.
Alternatives or Opposites of the Model Case
Jean Marie’s case proves that Watson’s theory of human caring embraces the concept of compassion. The first female nurse lacked compassion hence, unable to provide the patient with the quality care she needed. For example, Jean Marie’s eldest daughter Ashley asserts that the caregiver would either fail or forget to bath her mother. After confronting the nurse caregiver, Ashley acknowledged that the caregiver could not relate or understand the pain and suffering the patient was undergoing as she would ensure she alleviates it. Ashley also acknowledged that the nurse caregiver would spend days without spending time with the patient to provide the human-to-human connection. This is because she would provide the patient with food and medicine as scheduled and leave to watch television in the main room leaving Jean-Marie alone in the bedroom. Thus, the patient’s level of human contact had declined adversely affecting her emotional and social conditions aggravating the pain and suffering attributed to Alzheimer condition.
Before the nurse caregiver was replaced, the children decided to give her one more chance by putting her on one-month probation. They installed cameras all over the house without her knowledge to watch how she relates with their mother and provide the quality care Jean-Marie needed. During the first day, the caregiver and the patient were required to engage in a form of exercise, as the physician believed this would enhance Jean Marie’s physical, mental, and psychological abilities. Unfortunately, the caregiver induced the patient to sleep and spent most of the day either on social media or watching television. They also noted that the caregiver did not provide the patient with her daily bath. During the second day, the caregiver also failed to provide the patient with the human contact she desired. They also witnessed the caregiver lock the patient in the bedroom as she experienced an anxiety attack. She neither attempted to calm Jean-Marie down nor offer her medication to ease the emotional and psychological pain she was clearly experiencing. They, therefore, concluded that the nurse tasked in caring for their mother was not kind, sympathetic, or empathetic as she did not attempt to understand the patient’s suffering hence, offer the compassionate and human care needed.
Conclusion
Compassion is a concept that was developed to define and measure characteristics comprising, commitment, comportment, confidence, and care from the patient’s perspective. Describing components of compassionate care based on Watson’s Human Caring Theory affirms that it is a precious asset or concept that can be recognized, quantified, or monitored for effectiveness. Consequently, the model case affirms that compassion enables caregivers to interact and relate with their patients encouraging them to provide quality care alleviating their pain and suffering. Thus, Jean-Marie can lead a comfortable quality life despite the Alzheimer condition. This is because the nurse provides her with compassionate and human care alleviating her pain and suffering. This has encouraged the patient to give neither up nor let the chronic condition hinder her from being leading a happy, contended and quality life.
References
Arslan‐Özkan, İ., Okumuş, H., & Buldukoğlu, K. (2014). A randomized controlled trial of the effects of nursing care based on Watson's Theory of Human Caring on distress, self‐efficacy and adjustment in infertile women.Journal of advanced nursing, 70(8), 1801-1812.
Clark, C. S. (2016). Watson’s Human Caring Theory: Pertinent Transpersonal and Humanities Concepts for Educators. Humanities, 5(2), 21.
Cowden, T. L., & Cummings, G. G. (2012). Nursing theory and concept development: A theoretical model of clinical nurses’ intentions to stay in their current positions. Journal Advanced Nursing, 68(7), 1646-1703.
Gustin, W. L., & Wagner, L. (2012). The butterfly effect of caring: Clinical nursing teachers’ understanding of self-compassion as a source to compassionate care. Scandinavian Journal of Caring Sciences.
Santos, M. R. D., Bousso, R. S., Vendramim, P., Baliza, M. F., Misko, M. D., & Silva, L. (2014). The practice of nurses caring for families of pediatric inpatients in light of Jean Watson. Revista da Escola de Enfermagem da USP, 48(SPE), 80-86.
Sitzman, K., & Watson, J. (2013). Caring science, mindful practice: Implementing Watson's human caring theory. Springer Publishing Company.
Watson, J. (2015). Responsible, Assertive, Caring Communication in Nursing. Communication in Nursing, 1.
