Contextual Facilitators and Maintaining of Compassion-Based Care: An Ethnographic Study

Sima Babaei, Fariba Taleghani, Mahmoud Keyvanara


Background: Compassion is an important part of nursing. It fosters better relationships between nurses and their patients. Moreover, it gives patients more confidence in the care they receive. Determining facilitators of compassion are essential to holistic care. The purpose of this study was
to explore these facilitators.

Materials and Methods: This ethnographic study was conducted in
2014–2015 with 20 nurses, 12 patients, and 4 family members in the medical and surgical wards. Data collection was done through observations and in‑depth semi‑structured interviews with purposive sampling. The study was carried out in 15 months. Data analysis was performed using constant comparison based on Strauss and Corbin.

Results: Data analysis defined three main themes and eight subthemes as the fundamentals of compassion‑based care. Nurses’ personal factors with subcategories of personality, attitudes, and values and holistic view; and socio‑cultural factors with subcategories of kindness role model, religious, and cultural values are needed to elicit compassionate behaviors. Initiator factors, with subcategories of patient suffering, patient communication demands, and patient emotional and psychological necessity are also needed to start compassionate behaviors.

Conclusions: The findings of this study showed that nurses’ communication with patients is nurse’s duty in order to understand and respect the needs of patients. Attention should be paid to issues relating to compassion in nursing and practice educational programs. Indeed, creating a care environment with compassion, regardless of any shortcomings in the work condition, would help in the development of effective nursing.



Communication, compassion, ethnography, Iran, nursing care

Full Text:



Schantz ML. Compassion: A concept analysis. Nurs Forum 2007;42:48‑55.

Dewar B. Caring about caring: An appreciative inquiry about compassionate relationship centred care. Thesis for PhD degree. Edinburgh Napier University; 2011.

Flynn M, Mercer D. Is compassion possible in a market‑led NHS. Nurs Times 2012;7:12‑4.

Hooper C, Craig J, Janvrin DR, Wetsel MA, Reimels E. Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. J Emerg Nurs 2010;5:420‑7.

Oveis C, Horberg EJ, Keltner D. Compassion, pride, and social intuitions of self‑other similarity. J Pers Soc Psychol 2010;98:618‑30.

Suliman WA, Welmann E, Omer T, Thomas L. Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment. J Nurs Res 2009;17:293‑7.

Hudacek SS. Dimensions of caring: A qualitative analysis of nurses’ stories. J Nurs Educ 2008;47:124‑9.

Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med 2012;172:405‑11.

Babaei S, Taleghani F, Kayvanara M. Compassionate behaviors of clinical nurses in Iran: An ethnographic study. Int Nurs Rev 2016 [Epub ahead of print].

Crigger NJ, Brannigan M, Baird M. Compassionate nursing professionals as good citizens of the world. ANS Adv Nurs Sci 2006;29:15‑26.

Finfgeld‑Connett D. Qualitative convergence of three nursing concepts: Art of nursing, presence and caring. J Adv Nurs 2008;63:527‑34.

Straughair C. Exploring compassion: Implications for contemporary nursing. Part 1. Br J Nurs 2012;21:160‑4.

Esmaeili M, Ali Cheraghi M, Salsali M. Barriers to Patient‑ Centered Care: A Thematic Analysis Study. Int J Nurs Knowl 2014;25:2‑8.

Bolster D, Manias E. Person‑centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study. Int J Nurs Stud 2010;47:154‑65.

Manongi RN, Nasuwa FR, Mwangi R, Reyburn H, Poulsen A, Chandler CI. Conflicting priorities: Evaluation of an intervention to improve nurse‑parent relationships on a Tanzanian paediatric ward. Hum Resour Health 2009;7:50.

Zakaria Kiaei M, Salehi A, Moosazadeh Nasrabadi A, Whitehead D, Azmal M, Kalhor R, et al. Spirituality and spiritual care in Iran: Nurses’ perceptions and barriers. Int Nurs Rev 2015;62:584‑92.

Hammersley M, Atkinson P. Ethnography: Principles in practice, 3rd ed. London: Routledge; 2007.

Holloway I, Wheeler S. Qualitative Research in Nursing and Health Care, 3rd ed. John Wiley & Sons Publication, Oxford, UK; 2010.

Charmaz K. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. Sage Publication, London, UK; 2006.

Streubert HJ. Carpenter DR. Qualitative Research in Nursing, 5th ed. Philadelphia: Wolters Kluwer; 2011.

Guba EG, Lincoln YS. Naturalistic Inquiry. Sage Publication, Newbury Park, CA; 1985.

McEvoy L, Duffy A. Holistic practice–A concept analysis. Nurse Educ Practice 2008;8:412‑9.

Penney LM, David E, Witt LA. A review of personality and performance: Identifying boundaries, contingencies, and future research directions. Hum Resour Manage Rev 2011;21:297‑310.

Caris‑Verhallen WM, De Gruijter IM, Kerkstra A, Bensing JM. Factors related to nurse communication with elderly people. J Adv Nurs 1999;30:1106‑17.

Kaya N, Aştı T, Turan N, Karabay B, Emir E. The feelings of guilt and shame experienced by Nursing and Midwifery students. Nurse Educ Today 2012;32:630‑5.

Jasemi M, Valizadeh L, Zamanzadeh V, Taleghani F. The effect of motivational factors in providing holistic care: A qualitative study. Iran J Med Ethics History Med 2014;6:77‑87.

Magnusdottir H. Overcoming strangeness and communication barriers: A phenomenological study of becoming a foreign nurse. Int Nurs Rev 2005;52:263‑69.

Rassouli M, Zamanzadeh V, Abbaszadeh A, Nikanafar AR, Alavi‑Majd H, Mirza Ahmadi F, et al. Patient‑Centered Communication Barriers: Experiences of patients with cancer, their family members and nurses. J Urmia Nurs Mid Faculty 2014;11:753‑64.

Sheldon LK, Barrett R, Ellington L. Difficult communication in nursing. J Nurs Scholarsh 2006;38:141‑7.

Suikkala A, Leino‑Kilpi H, Katajisto J. Nursing student‑patient relationships: A descriptive study of students’ and patients’ views. Int J Nurs Educ Scholarsh 2008;5:1‑2.


  • There are currently no refbacks.