Dr Ann Bradshaw, Oxford Brookes University
Compassion in Nursing
In 2013 the Francis Report found scandalous shortcomings in nursing care at Mid-Staffordshire Hospital. Too many nurses were not showing compassion to patients, and were not attending to their fundamental needs - to eat, to drink, to wash, to use the toilet. Francis argued that there was no excuse for this. What was required were ‘changes in attitude, culture, values and behavior’ (p. 1499). In response Chief Nursing Officers at the Department of Health published a statement of six values (6 Cs) that nurses needed, including compassion (DH 2012). This apparently rushed document contains no attributions, although it copies a Canadian nursing nun’s 5 Cs (Roach 1984). Its publication reveals a deep worry about the nature of care for vulnerable human beings.
Historically UK nurse training was an apprenticeship, learned on the wards under supervision of the ward sister, with blocks of class-based teaching. The basic practicalities of care for patients, such as washing, feeding, toileting and pressure ulcer prevention took primacy. Compassion was not a concept to be examined, a theory or an emotion, but a practical activity – a motivation to serve. The word most often used to describe the nurse’s expected attitude was ‘kind’. This is Roach’s approach to nursing as a vocation, albeit critically reviewed by an eminent theologian (Campbell 1985).
By the 1960s vocational values were being rejected. An editorial in Nursing Times in 1963 describes the importance of nurses meeting patients’ most basic needs, and concludes: ‘Many older nurses will recall being exhorted to “Carry that bedpan to the Glory of God”; if this is unacceptable to the humanists, then can we appeal to them to “Carry that bedpan to the dignity of Man”?’ Dame Muriel Powell (1967), Matron of St George’s Hospital, warned that in an increasingly secular age, nurses should not forget those qualities of mind and spirit, compassion, integrity and tolerance, which had sustained British nursing. She wondered if these values could remain without the ethical framework to sustain them. ‘In Britain the nursing profession has traditionally looked to the Christian religion for its concept of wholeness... If this framework is removed, will the rules still be relevant? It is commonly assumed that they will; but it is a question to which we have paid little attention; and it requires an answer. Is the humanity and the humanism of our age enough?’
This rejected ethical framework involves mutuality, vulnerability and dependence. Explicated by Buber (1959) and Levinas (1999), human beings have a responsibility towards each other. For Buber this is ‘I and Thou’; for Levinas it is attentiveness to the other. Kitwood (1997), who made famous a new approach to caring for the person with dementia, draws on Buber to argue that people with dementia remain persons, and that personhood is the primary category of human life. This is not individual persons, but persons in relationship. A similar understanding is held by MacIntyre (1999). The human being is vulnerable and dependent. This approach then holds that the nurse, as an agent of humanity, should support human flourishing by being a ‘good’ person, by being virtuous, compassionate and showing care for the other person – the stranger. And this is precisely Roach’s (1984) position, that ‘caring is the human mode of being’; although she is unacknowledged by Chief Nurses who took her ideas - ideas rejected by Campbell (1985).
Compassion is not primarily a concept. It is inseparable from the human way of being in the world. It runs deeply, theologically and ontologically, into the kind of person the nurse should become - revealed not in words but in her actions.
Buber M. (1959) I and Thou. T and T Clark, Edinburgh.
Campbell A.V. (1985) Book Review. International Journal of Nursing Studies. 22, 4, p. 345
Department of Health (2012) Compassion in Practice. Department of Health NHS Commissioning Board, London.
Kitwood T. (1997) Dementia Reconsidered: The Person Comes First. Open University Press, Milton Keynes.
Levinas E. (1999) Totality and Infinity. Duquesne University Press, Pittsburgh.
MacIntyre A. (1999) Dependent Rational Animals. Duckworth, London.
Mid-Staffordshire NHS Foundation Trust Public Inquiry (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Robert Francis, Chair). Stationery Office, London.
Nursing Times (1963) The Bedpan Round, editorial, p.281, March 8.
Powell M. (1967) The Challenge of Nursing Education Nursing Mirror pp.551-554, March 17; pp.581-584, March 24.
Roach M.S. (1984) Caring: the Human Mode of Being. Perspectives in Caring Monographs, University of Toronto.
Bradshaw, A. (2014) Compassion in nursing history: attending to the patient's basic human needs with kindness. In: Shea S. Wynyard R. and Lionis C. (eds) Providing Compassionate Healthcare Abingdon, Routledge.
Bradshaw A. (2014) Shaping the future of nursing: Developing an appraisal framework for public engagement with nursing policy reports Nursing Inquiry. DOI: 10.1111/nin.12072
Bradshaw A. (2014) Relink education with practice to restore compassion to nursing. BMJ ; 348 doi: http://dx.doi.org/10.1136/bmj.g3310 (Published 19 May 2014)
Bradshaw A. (2014) Listening to the patient's self reported testimony: the authentic hermeneutical witness to the compassionate nurse? Journal of Advanced Nursing 70(1), 60–67. doi: 10.1111/jan.12170.
Bradshaw, A. (2013) Does the McDonald's business model suit modern healthcare? Comment. Nursing Times 109, 9 p.11
Bradshaw, A. (2012). Gadamer's two horizons: listening to the voices in nursing history. Nursing Inquiry 195(9):518-22
Bradshaw A, (2012) Focus on the values of care to boost care - not checklists. Comment. Nursing Times 108, 3 p.13
Bradshaw, A. (2012). Is the ward sister still relevant to the quality of patient care? Nursing Times 108, 3 pp. 17-19
Bradshaw A. (2011). The future of clinical nursing: meeting the needs of patients for compassionate and skilled nurses. Editorial. Journal of Clinical Nursing 20, 1797–1800
Bradshaw, A. (2011). Care and compassion in nursing: reflections from nursing history. Nursing Times 107, 19/20 pp 12-14.
Bradshaw, A. (2010). An historical perspective on the treatment of vocation in the Briggs Report (1972). Journal of Clinical Nursing 19, pp. 3459-3467.
Bradshaw, A. (2010). Is the ward sister still relevant to the quality of patient care? A critical examination of the ward sister role past and present. Journal of Clinical Nursing 19, pp. 3555-3563.
Bradshaw, A. (2009). Measuring nursing care and compassion: The McDonaldized nurse? Journal of Medical Ethics 35, pp.465-468.