Compassionate Care Challenges and Barriers in Clinical Nurses: A Qualitative Study

Sima Babaei, Fariba Taleghani


Background: Compassion is the heart of nursing care. Barriers to compassion in nursing may be influenced by the prevailing culture and religion of a society. Determining the barriers to providing compassion‑based care would help nurses to plan better and more appropriate interventions. This study aimed to explore the challenges and barriers to compassionate care in nurses.

Materials and Methods: This ethnographic study was performed in 2014–2016. The study participants consisted of 40 nurses, 16 patients, and 8 family members in medical and surgical wards. Data collection was performed through observations and interviews. Data analysis was performed based on Strauss and Corbin’s constant comparative method.

 Results: Data analysis defined three themes as the challenges and barriers to compassionate care; challenges and barriers related to the contextual environment of hospitals, sociocultural challenges and barriers, and challenges; and barriers related to staff.

Conclusions: This study described the challenges and barriers to compassionate care. Therefore, to eliminate these barriers and challenges, corrective action should be taken by managers. Attention to teaching the concept of compassion and patient‑centered care and increasing the number of nurses and positive attitude toward the nursing profession in clinical environment can be effective in providing compassionate care.


Challenges, compassion, ethnography, Iran, nursing

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Dewar B, Nolan M. Caring about caring: Developing a model to implement compassionate relationship centered care in an older people care setting. Int J Nurs Stud 2013;50:1247‑58.

Davison N, Williams K. Compassion in nursing 1: Defining, identifying and measuring this essential quality. Nurs Times 2009;105:8‑16.

Burnell, L. Compassionate care: Can it be defined and measured? The development of the compassionate care assessment tool. Int J Caring Sci 2013;6:180‑7.

Agency for Healthcare Research and Quality (AHRQ). National Healthcare disparities report. Washington: Department of Health and Human Services 2013. Available from: research/mccrn.htm. [Last accessed on 2017 Oct 06].

Adult Inpatient Survey: Quality and Methodology Report. Care Quality Commission. 2017; Available from: uk/content/surveys. [Last accessed on 2018 Oct 24].

Proctor S. Can nurses show compassion? Nurs Manage 2008;14:10‑11.

Goodrich J, Cornwell J. Seeing the Person in the Patient. The Point of Care Review Paper. London: The King’s Fund Company; 2008.

Valizadeh L, Zamanzadeh V, Dewar B. Nurse’s perceptions of organizational barriers to delivering compassionate care: A qualitative study. Nurs Ethics 2018;25:580‑90.

Babaei S, Taleghani F, Kayvanara M. Compassionate behaviors of clinical nurses in Iran: An ethnographic study. Int Nurs Rev 2016;63:388‑94.

Esmaeili M, Cheraghi M, Salsali M. Barriers to patient – Centered care: A thematic analysis study. Int J Nurs Knowl 2014;25:2‑8.

Fakhr‑Movahedi A, Salsali M, Negharandeh R, Rahnavard Z. A qualitative content analysis of nurse–patient communication in Iranian nursing. Int Nurs Rev 2011;58:171‑80.

Kwak C, Chung BY, Xu Y, Eun‑Jung C. Relationship of job satisfaction with perceived organizational support and quality of care among South Korean nurses: A questionnaire survey. Int J Nurs Stud 2010;47:1292‑8.

Babaei S, Taleghani F, Kayvanara M. Contextual facilitators and maintaining of compassion‑based care: An ethnographic study. Iran J Nurs Midwifery Res 2017;22;91‑6.

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

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

Holloway I, Wheeler S. Qualitative Research in Nursing and Health Care, 4th ed. Oxford, UK: John Wiley & Sons Publication; 2013.

Grove S, Burns N, Gray JR. The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. New York: Elsevier Health Sciences; 2012.

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

Charmaz K. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. 2th ed. London, UK: Sage Publication; 2014.

Denzin NK, Lincon YS. Strategies of Qualitative Inquiry. 3th ed. London: Sage Publication; 2008.

Rassouli M, Zamanzadeh V, Abbaszadeh A, Nikanafar A, Alavi Majd H, Mirza Ahmadi F. Patient centered communication barriers: Experiences of patients with cancer, their family members and nurses. The Journal of Urmia Nursing and Midwifery Faculty 2013;11:753‑64. [Persian].

Selman LE, Brighton LJ, Hawkins A, McDonald C, Robinson S, KhanCert Clinlds SA, et al. The effect of communication skills training for generalist palliative care providers on patient‑reported outcomes and clinician behaviors: A systematic review and meta‑analysis. J Pain Symptom Manage 2017;54:404‑16.

West E, Mays N, Rafferty A, Rowan K, Sanderson C. Nursing resources and patient outcomes in intensive care: A systematic review of the literature. Int J Nurs Stud 2009;46:993‑1011.

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.

Kourkouta L, Papathanasiou IV. Communication in nursing practice. Mater Socio Med 2014;26:65‑7.

Zaidi D. On strengthening compassionate care for muslim patients. J Pastoral Care Counsel 2015;69:173‑6.

Kargar Jahromi M, Ramezanli S. Evaluation of barriers contributing in the demonstration of an effective nurse‑patient communication in educational hospitals of Jahrom, 2014. Glob J Health Sci 2014;6:54‑60.

Lyles W, Swearingen White S, Lavelle BD. The prospect of compassionate planning. J Plan Literat 2017;33:247‑66.

Prime Ministers Commission. Front Line Care: Report by the Prime Minister’s Commission on the Future of Nursing and Midwifery in England. London. 2010. Available from: DEP2010‑0551. [Last accessed on 2012 Jul 03].

Kissiwaa Amoah VM, Anokye R, Boakye DS, Gyamfi N. Perceived barriers to effective therapeutic communication among nurses and patients at Kumasi South Hospital. 2018. Available from: [Last accessed on 2018 Dec 01].


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