Home Health Care

Management & Practice

Volume 21 Number 5

Compassionate Care
August 2009 319-324
© 2009 Sage Publications
10.1177/1084822309331468
http://hhcmp.sagepub.com
hosted at
A Concept Analysis http://online.sagepub.com

Lori Burnell, RN, MSN, NEA-BC

Scripps Mercy Hospital

Compassion may be nursing’s most precious asset, yet the concept of compassion (or compassionate care) remains notably
absent from nursing scholarship and the practicalities related to contemporary care delivery models. The provision of com-
passionate care is more than a professional mandate or an attribute of a model expressed in theoretical terms; it is the result
of an authentic bond between a nurse and a patient. A concept analysis using Walker and Avant’s methodology is employed
using compassionate care as the virtue that allows a nurse to enter into the pain, suffering, and adversities a patient experi-
ences as a way of establishing a meaningful connection.

Keywords:   compassion; compassionate care; patient connection; nursing care

A n unfortunate phenomenon of modern day life is

that human beings rarely, if ever, experience truly
compassionate care on a personal level. This trend may
be in part a consequence of the media’s unbalanced
coverage of human suffering by its explicit, rehashing of
events that focus on the anguish, vulnerability, and power­
lessness of others (Höijer, 2004). Quite simply, misery
boosts ratings. In this author’s experience, persistent and
repetitive exhibitions of the pain and suffering of others
compounded by one’s own personal tragedies result in
an epidemic of emotional starvation in a society where
abuse, neglect, willful violation of one’s conscience
(e.g., guilt), and chronic suffering are commonplace.
The dire need for compassionate care has reached an
unprecedented level during this generation and is
unparalleled by any other time in history (Office of the
Press Secretary, 2004). This condition looms large in our
lives generally, but particularly in health care settings:
acute hospitals, long-term care facilities, hospice, and
home health care environments. Many of these patients
experience disaster, disease, and despair with their only
potential source of compassion being a nurse, someone
who barely knows them. In the midst of their fear and
weakness, patients look to their nurse for that beam of
hope and compassion to guide them.
Compassionate care, according to Roach (2007),
requires immersion into the pain, brokenness, fear, and
Author’s Note: Identification/names used in models are fictitious
and not intended to represent any specific individual/patient.
anguish of another, even when that person is a stranger.
Presumably, those who possess the desire to provide
compassionate care are among those who heed the great
call to join helping professions, including nursing. The
importance of providing compassionate care is found in
nursing attributes and compassion is prominently cited
as a principle of conduct guiding professional behaviors
(Milton, 2003; Roach, 2007). Indeed, the first provision
of the American Nurses Association’s (2001) Code of
Ethics calls for nurses to practice with compassion in a
way that respects every patient. According to the code,
“the nurse, in all relationships, practices with compassion
and respect for the inherent dignity, worth and uniqueness
of every individual, unrestricted by considerations of
social or economic status, personal attributes, or the
nature of health problems” (p. 7).
The purpose of this article is to provide a comprehensive
analysis of the concept of compassionate care in the
context of the nurse–patient relationship and to introduce
it as an essential topic for future nursing research.
Schantz (2007) supported this ideal by proclaiming
compassionate care as “nursing’s most precious asset”
and expressed her grave concern that “nursing discourse
featuring the profession’s altruistic ideals is not only
scarce, but lukewarm at best” (p. 48). Literature describing
relationship-based care and compassion as a mere
component of caring models has not clearly defined or
studied the influence of compassionate care and its effect
on patient care. This concept is more than a professional
mandate or attribute inherent in a care delivery model; it

319
320   Home Health Care Management & Practice
is characterized through actions that result when a nurse
establishes a unique bond with a patient. Accordingly,
this author will employ Walker and Avant’s (2005)
methodology for concept analysis to explore compas­
sionate care as the virtue that facilitates a nurse’s full
appreciation of the pain, suffering, and myriad hardships
the patient is experiencing through a means of establishing
this genuine connection (Schantz, 2007).
Identification of Concept Uses
Concept Selection: Compassionate Care
Concept analysis is a process incorporating a thorough
examination of the basic elements that compose a
thought, idea, or notion. Walker and Avant’s (2005)
method for ideal concept selection is based on interest,
work association, or something with a bothersome
source. The desire for nurses to embrace the concept of
compassionate care in their practice as a means of
establishing an authentic and significant connection with
each patient has been a heartfelt aspiration of this author,
one formed during her 30-year nursing career.
Compassion/Compassionate Concept Uses
The adjective compassionate merely means the
demonstration of compassion, which Wikipedia (2008a)
defined in its broadest sense as “an understanding of the
emotional state of another or oneself” (para. 1). Some of
the more common uses of the terms compassion and
compassionate were “a deep awareness of the sympathy
for another’s suffering” and “the humane quality of
understanding the suffering of others and wanting to do
something about it” (WordNet, 2008, para. 1). Wikinfo
(2004) described compassion as “a sense of shared suf­
fering, most often combined with a desire to alleviate or
reduce such suffering” (para. 1) and “to show special kind­
ness to those who suffer” (Wikipedia, 2008b, para. 1).
Contrary to these familiar definitions of compassion
and compassionate is the fictional character Compassion,
also known as Laura Tobin, found in the Eighth Doctor
Adventures novels. Compassion, an illusory being,
originally came from a people known as Remote, a splinter
group of the time traveling voodoo cult, Fraction Paradox
(Wikipedia, 2008c). “Indeed, the name ‘Compassion’ was
originally given to that iteration of Laura Tobin as an
ironic comment on her caustic personality” (para. 4).
The Society of the Universal Living Christ (n.d.)
identified compassion as “a primary law and prime
virtue [demonstrated] when a person is moved by the
suffering or distress of another and by the desire to
relieve it.” Compassion, according to this source, was
“empathy, not sympathy—identification with and under­
standing of another’s situation, feelings, and motives”
(para. 1). A similar meaning of compassion is “the desire
to help when a need is discovered” (God on the Net, n.d.,
para. 1).
Concept of Compassion Origin
The etymology of the word compassion, as well as
compassionate (i.e., showing compassion), stemmed from
the Aramaic word racham. Its translation dated back to
biblical times when the word meant “to love, pity, and be
merciful” (Walker, 2007, para. 1). Von Dietze and Orb
(2000) affirmed, “The English version of compassion has
been around since the 14th century, a word derived from
the Latin-com (together with) and pati (to suffer), literally
means to suffer with” (p. 168). Merriam-Webster’s (2007)
definition of compassionate was the demonstration of “a
sympathetic consciousness of others’ distress together
with a desire to alleviate it” (para. 1).
The Christian Bible urged believers to be compassionate
toward one another (1 Peter 3:8; New King James
Version). Despite theological differences, two other
prominent world religions shared similar views to those
of Christianity by declaring compassion as an overarching
ideal. One Muslim scholar (Engineer, n.d.) posited that
when people were compassionate, they represented the
true spirit of the Islamic faith demonstrated through
sensitivity to another’s needs. Representing Buddhism,
the 14th Dalai Lama taught that being compassionate
“compels us to reach out to all living beings” and “true
compassion is universal in scope . . . to act altruistically,
concerned only for the welfare of others, with no selfish
or ulterior motives” (Gordon, 1998, p. 1).
Compassionate Care
Beyond the realm of nursing, other uses of the com-
passionate care concept include the following:
• A benefit in the Canadian health insurance plan that
permits eligible workers the right to receive a tem-
porary leave of absence to provide care and support
for a gravely ill family member (Government of
Yukon, 2008);
• Compassionate Care, Inc. (2005), a service that
treats homebound and elderly clients as if they are
cherished family members, respecting their inde-
pendence for as long as possible; and
• A Center for Compassionate Care, a project of the
Elizabeth Hospice Foundation, a hospice organization

operating in North San Diego County (Elizabeth
Hospice, 2008).
The search for a Center for Compassionate Care
yielded numerous locations and sponsors of such named
programs throughout the United States representing vari-
ous hospices, comprehensive cancer treatment centers,
and support programs. Additionally, the voice for compas-
sionate care appears in facilitated panel discussions (i.e.,
Schwartz Center Rounds) throughout the country founded
by the Kenneth B. Schwartz shortly before he died of lung
cancer (Kenneth B. Schwartz Center, 2008).
Schwartz Rounds include patient and caregivers
meeting in front of an audience to share personal
experiences and insights with the intended goal of
improving communication and human connections. In
2005, Schwartz Center Rounds successfully branched
out from the hospital setting into nursing homes (Kenneth
B. Schwartz Center, 2007). The Schwartz Center also
offers a 5-month pastoral training program to clinicians
from various disciplines in spiritual care (Kenneth B.
Schwartz Center, 2004).
According to O’Brien (2003), “even if an individual
has become alienated from a religious denomination or
church, a terminal illness may be the catalyst for return
to the practice of one’s faith” (p. 273). It makes
professional as well as human sense to prepare one’s
mind and heart to help each patient compassionately,
address all of his or her pain, including spiritual pain. In
the words of Taylor (2007), “when patients verbalize
spiritual distress, they invite nurses to receive their story
and care for their spirit” (p. 15).
Nursing literature and research of the concept of
spiritual and compassionate care could be both broad
in scope and narrow in actual practice. Some sources
offered a global approach designed to reshape the
nursing profession, whereas others provided a model
advocating for a single, effective interaction between a
patient and a nurse. In both models, compassionate care
was the predominate theme. Crigger, Brannigan, and
Baird (2006) believed “nurses as compassionate profes­
sionals are called to collaborate with people of all nations
to seek a better future for all” (p. 23).
Christian nursing scholars believed the delivery of
compassionate care was a nurse’s primary ministry,
requiring a focus on “the whole person, in response to
God’s grace toward a sinful world, which aims to foster
optimum health and bring comfort in suffering and death
for anyone in need” (Shelly & Fish, 1988, p. 225). Others
viewed the impetus to providing compassionate care as a
calling from God (O’Brien, 2001, 2003; Uustal, 2003).
Burnell / Compassionate Care   321  
Compassionate Care Defining Attributes
Walker and Avant (2005) defined the characteristics of
a concept as one that appeared repeatedly throughout
literature, helping to provide insight into the application
of the concept. Prevalent characteristics of compassionate
care were (a) a dimension of caring, (b) sympathetic
consciousness of another’s distress, (c) sensitivity to the
pain and brokenness of another, (d) suffering alongside
another, (e) a spiritual connection with another person,
(f) attempting to comfort or alleviate the suffering, and
(g) a demonstration of the fruit of the Holy Spirit, a
biblical reference to the nine visible attributes of “love,
joy, peace, longsuffering, gentleness, goodness, faith,
meekness and temperance” (All About God Ministries,
Inc., 2008). These seven defining characteristics are
pertinent to this concept analysis, as they embody the
heart of compas­sionate care.
Compassionate Care Case
Model Illustrations
A model case exemplifies the use of all the defining
characteristics of the concept. Walker and Avant (2005)
deemed this ideal a “pure case of the concept, a
paradigmatic example, or a pure exemplar” (p. 69). To
promote further understanding of compassionate care,
three ideal examples as well as two additional illustrations
will be presented. The model cases illustrate the defi­
ning attributes of compassionate care and exemplify
it, whereas the borderline case includes some of the
defining attributes, and finally, the contrary example
demonstrates an absence of the all-defining attributes of
the concept of compas­sionate care. With the exception of
the global model case, the names of the patients and
caregivers in the remaining three examples were changed
along with potential identifying specifics to respect
confidentiality.
Global Model Case
In an interview, Mother Teresa recalled her first
patient experience when she cared for a single companion
in a borrowed apartment. After completing a course in
nursing, she went out, picked up a dying man at the edge
of a road, and brought him into her home where she
single-handedly nursed him back to health. Her mission
field was the slums where she rescued elderly individuals
dying in gutters, abandoned babies discarded in garbage
pails, and lepers rejected by both their families and
society (McGowan, 1997).
322   Home Health Care Management & Practice
First Model Nursing Case
Rosemary’s death rapidly approached as the cancer
metastasized throughout her body. After finishing a
hectic 13-hr shift, her nurse friend, Karen, rushed across
the street to the Hospice Compassionate Care Center to
visit her. Karen found Rosemary grimacing in bed
because of a kink in her morphine line. Karen quickly
and expertly reopened the intravenous line, repositioned
Rosemary, and picked up a book lying open at the
bedside. It was a Bible. Rosemary grabbed Karen’s hand
and held on for dear life. “Would you mind reading to
me?” Karen had a few minutes, so she began reading
where the pages were open.
These two had first met in the Oncology Unit where
Karen managed Rosemary’s chemotherapy after her first
surgery. Reflecting back on the past 3 months, tears
rolled down Karen’s cheeks as she contemplated the
future of Rosemary’s boys, who were the same age as
her own two sons. She made a mental note to contact
family bereavement follow-up services the next day to
seek consultation on how best to approach Rosemary’s
husband about the importance of accepting this support
to help each family member manage his or her grief and
to participate in annual celebrations of Rosemary’s life.
Second Model Nursing Case
Tommy was confused and he gave off an unpleasant
odor. It was another busy morning of being short staffed
in the skilled nursing facility, and even though Sarah was
in charge, she knew the staff could not handle assuming
care for another patient. Therefore, Sarah engaged in the
extensive routine of admitting the patient to his new
surroundings. Glancing up from her clipboard, she
noticed Tommy’s head hung in what appeared like
shame. In response to her kind and gentle inquiry,
Tommy finally mumbled, “I think I made a mess in my
pants.” As was her nature, Sarah decided to postpone all
the routine tasks to be done and instead patiently bathed
Tommy. While Sarah was tenderly washing his neglected
body, Tommy recognized the hymn she was humming
and started singing along with her. Before clocking out
at the end of the shift, Sarah returned to Tommy’s room
to say good-bye. It warmed her heart to see him sitting
upright in a chair and smiling as he thanked her for
“being his special angel.”
Borderline Case
A novice nurse reflected back on an impressionable
experience that took place at one of the first patient
residences she visited as a home health practitioner. She
was caring for Mrs. Johnston, a patient in her early 70s
with left-sided hemiplegia. In an unexpected moment
after she provided the care as she was assigned, Mr.
Johnston told the nurse that his wife had an inoperative
brain tumor. When the student saw tears well up in Mr.
Johnston’s eyes, her heart began to ache. The student
reported that she felt a tug on her heartstrings to comfort
Mr. Johnston and to pray with him. Intimidated by the
intensity of this situation, she instead walked away from
it. Three years passed and she still regrets not obeying
her inner-voice.
This is a borderline case of compassionate care, as
three of the defining characteristics were missing:
connecting with the patient, attempting to comfort the
patient, and heeding to a call of the student’s heart.
Contrary Case
Mr. Webster was a crotchety old man. Two weeks had
gone by and a different nurse had been assigned to care
for him every shift. One night he was particularly
demanding, shouting obscenities and frequently
summoning help by using his call bell. Frustrated, during
one of his many trips to Mr. Webster’s room, Jim moved
the call bell far from Mr. Webster’s reach and shut the
door on his way out. Upon returning to the central
nursing station, Jim boasted to his colleagues, “Good
news! I took care of everything and the geezer in 203
won’t be bothering us for awhile!”
Identification of Antecedents and
Consequences
Antecedents
Walker and Avant (2005) posited that “antecedents are
those events or incidents that must occur prior to the
occurrence of the concept” (p. 73). Schantz (2007)
succinctly described the primary antecedent of compas­
sionate care in her concept analysis: “for compassion to be
realized, suffering must be identified and acknowledged”
(p. 82). According to the Dalai Lama, compassion came
through morning meditation, dwelling on it throughout the
day, and reflecting on it in the evening (Barbauta, 2007).
A Christian commentator identified the precursor to
compassion simply as “willingness to leave one’s comfort
zone” (Bloom, 2002, para. 13).
Consequences
Conversely, Walker and Avant (2005) defined a con­
sequence resulting from a concept. Selected outcomes of

compassionate care were a decrease in suffering and an
increase in strength that others (e.g., patients) drew on
for healing (Golberg, 1998). However, it is this author’s
belief that a primary result of compassionate care, in the
context of this analysis, is its ability to bridge the human
gap created through suffering.
Definition of Empirical Referents
“Empirical referents are categories of an actual
phenomenon that, when present, actually demonstrate
the occurrence of a concept itself” (Walker & Avant,
2005, p. 73). Walker and Avant (2005) avowed that
empirical referents could interchange with the defining
attributes of a concept. For this analysis, the defining
attributes and empirical referents of a caring presence,
including the ability to recognize distress and be sensitive
to another’s suffering, sharing the suffering experience,
connecting spiritually, providing comfort measures,
and demonstrating the qualities of the Holy Spirit are
proposed as one in the same. These seven attributes, if
mentioned by patients interviewed after receiving treat­
ment in a setting that practiced compassionate care, would
confirm the experience. Without descriptive accounts
derived from the lens of patients, the concept of compas­
sionate care would be difficult to articulate.
Implications for Future Research
There are compelling reasons underpinning the
motivation behind a study designed to explore the ability
of patients to connect with nurses through the praxis of
compassionate care. To date, philosophical assumptions in
this context have not been established in nursing research.
The dialectical relationship between theory and practice
would be explored through principles of compassion
embedded into common nursing interventions. Prior to
initiating such a study, nurses working in a hospital setting
would be taught the concept of compassion according to
the attributes of professional caring that Roach (2007)
referred to as the “six Cs” (i.e., compassion, competence,
confidence, conscience, commitment, comportment).
After this model is successfully established into practice
and incorporated into routine care, patients would be
interviewed according to the interpretive paradigm of
hermeneutics. Through thematic analysis, the researcher
proposes to identify common experiences of these
compassionate care recipients. Bias control would be
managed by conducting multiple interviews with the same
patients, thereby allowing patterns of their perceived
experiences with compassionate care to emerge.
Burnell / Compassionate Care   323  
Conclusion
“As a human being, many a nurse will say that it was
compassion for others that inspired her to become a
nurse” (Schantz, 2007, p. 54). To fully appreciate and
further expound on the ideals that drew nurses into the
profession, compassionate care must be defined through
research encompassing lived patient experiences. Once
this is accomplished, praxis for compassionate care can
be embedded into the role of a professional nurse.
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Lori Burnell is vice president/chief nurse executive of Scripps
Mercy Hospital. In addition, Lori is working on her PhD in
Nursing at the University of San Diego. Her research interests
focus on compassionate care, defining and recognizing nurs-
ing’s role towards connecting with patients on an individual
basis. While caring behavior has been researched extensively,
true compassion for patients has not been well articulated in
nursing praxis.