Concept Analysis of Warmth in Nursing
Article information
Abstract
Purpose
This study aimed to analyze and clarify the concept of warmth in nursing to establish a theoretical foundation and provide practical insights for improving patient-centered care. By defining the key attributes of warmth, this study seeks to contribute to the development of strategies for improving therapeutic nurse-patient relationships and holistic nursing care.
Methods
Using Walker and Avant's concept analysis framework, a total of 15 articles from the Korean and international literature related to warmth were reviewed.
Results
Warmth in nursing is defined as verbal and non-verbal behaviors that convey compassion, empathy, and dignity, fostering trust and emotional stability in patients. The key attributes of warmth identified in this study include humanity, communication, professionalism, and dignity. The antecedents of warmth were identified as the caregiver's recognition of emotional vulnerability and the need for empathy in situations where human dignity is at risk. The consequences of warmth include increased patient trust and satisfaction, improved emotional well-being, and the realization of holistic nursing care. To further clarify the concept, model, borderline, and contrary cases were analyzed.
Conclusion
This study systematically explores the attributes and significance of warmth in nursing by integrating previous research and linking it to specific nursing practices. These findings highlight the need for developing standardized assessment tools and implementing educational programs to facilitate the integration of warmth into nursing care. By reinforcing the role of warmth in clinical practice, this study provides a foundation for improving the quality of patient-centered care and strengthening the therapeutic nurse-patient relationship.
INTRODUCTION
1. Background
Recent advancements in artificial intelligence (AI) and robotic technology are transforming healthcare by enhancing patient safety and operational efficiency [1]. Automation technology enhances the efficiency of nursing tasks by replacing some repetitive duties such as monitoring, documentation, and information processing; this contributes to the reduction of nurses’ physical workload [1]. However, technical frustration related to understanding AI-based systems, and uncertainty regarding the emotional aspects of an inherently human domain that robots cannot replace continue to affect nurses’ emotional exhaustion and decrease job satisfaction [2]. In such an environment, nurses continue to be responsible for emotional labor and human interactions; the resulting heavy workload and emotional fatigue remain chronic issues in today's clinical settings. According to previous studies [3], 71.6% of nurses experience emotional exhaustion due to increased workloads and staff shortages. This leads to prioritization of task-oriented nursing over emotional interactions, ultimately resulting in a reduced expression of warmth due to weakened emotional engagement with patients.
Even within these challenging clinical realities, the essential value of nursing still lies in human-centered care [4]. Core elements of nursing such as empathy, emotional support, and human connection offer a form of warmth that technology cannot replicate. These components play a vital role in positively influencing patient experiences and treatment outcomes [5]. Continuous observation and face-to-face interaction provided by nurses, along with their emotional care and support, serve as crucial factors in offering emotional stability during the treatment process and ultimately contribute to improving patients’ overall health status [6]. Warmth is an important element expressed through nurses’ attitudes and behaviors. In moments when patients are physically and psychologically most vulnerable, the nurse's warm demeanor and emotional engagement go beyond mere medical interventions. They are central to building trust, providing emotional stability, and enhancing treatment outcomes [6]. This warmth encompasses not only kindness, but also gentleness and compassion, and serves as a fundamental expression of humanistic care, which includes attentiveness, concern, understanding, and generosity [7]. Although technological advancements may enhance certain aspects of efficiency in nursing practice, humanistic care provided by nurses is needed more than ever.
Warmth has traditionally been discussed primarily in the context of personal relationships, such as between parents and children [8-15]. However, warmth in nursing is fundamentally different in scope and purpose. According to Watson's Theory of Human Caring, nurses are called to realize holistic healing through authenticity, empathy, and building trust within interactions with patients [16]. These caring principles are conceptually linked to nursing practices that involve responding sensitively to patients’ emotions and forming relationships with a warm and compassionate attitude. While warmth in the parent-child relationship focuses on the parenting style aspects of affection and attentiveness [8], warmth in nursing can be understood as a human-to-human caring act that involves sensitively recognizing the patient's pain and anxiety and responding with compassion. This is closely related to nurses’ practical attitude of engaging in sincere communication with patients based on trust and respect, and forming relationships that promote emotional stability. Such approach aligns with the essence of caring emphasized in humanistic nursing [17]. Based on this perspective, warmth in nursing practice functions as more than a simple emotional expression; it serves as a crucial nursing behavior for promoting patients’ emotional stability and building therapeutic trust [6]. In clinical settings, nurses are often required to sensitively perceive patients’ emotions even within brief encounters, and to establish trust despite time constraints and limited resources. This role relies on a unique nursing sensibility that cannot be replaced by technical skills or knowledge alone. However, in real-world clinical environments, emotional interactions are often deprioritized due to factors such as staff shortages and fast-paced workflows, leading to a tendency for emotional support to be diminished [18]. Thus, warmth should be redefined not as an ancillary aspect of clinical care, but as an essential competency that determines patient recovery and quality of nursing care.
However, despite its significant role, warmth remains an underdefined concept in nursing literature. The concept of warmth is often used interchangeably with empathy, respect, compassionate care, and general caregiving, making it challenging to define and apply independently in nursing practice. Empathy refers to the ability to understand others’ thoughts and perspectives through their words and actions, as well as to recognize their emotions and convey this understanding back to them [19]. However, it does not necessarily involve immediate emotional interaction. Compassionate care emphasizes the ethical and moral responsibility to recognize others’ suffering and take action to alleviate it [20]. Respect reflects an attitude of acknowledging a patient's autonomy and dignity [21], but it is more closely related to a nurse's perception and values rather than emotional engagement. Additionally, caring encompasses long-term protection and the establishment of ongoing relationships [22]. In contrast, warmth primarily involves physical expressions (such as posture, eye contact, facial expressions, hand gestures, and tone of voice) and immediate emotional engagement, focusing on providing patients with a sense of emotional stability [7]. Thus, warmth is a distinct and independent concept that differs from existing related concepts. Given its impact on patients’ psychological stability and trust-building in nursing practice, it is necessary to systematically analyze how warmth can be applied in both nursing practice and education. However, research on warmth in nursing has been relatively limited. In the 1980s and 1990s, the concept of warmth was explored in studies on nurses’ non-verbal expressions [7] and the empathetic relationships between nurses and patients [23]. However, since the 1990s, studies directly investigating this concept have been scarce. This shift appears to be associated with the growing emphasis on nursing skills during this period [24], leading research to focus more on physical care and therapeutic interventions, while studies on emotional concepts have received less attention.
Therefore, this study applies Walker and Avant's [25] concept analysis method to clearly identify the attributes of the concept of warmth in nursing and propose specific applications of this concept in clinical practice and nursing education. This study ultimately aims to enhance the quality of patient-centered care and contribute to establishing a systematic approach that enables nurses to practice warmth in clinical settings. Furthermore, it seeks to provide a framework for warmth to be recognized as an essential component of therapeutic care, rather than merely an emotional expression, within nursing practice and education.
2. Purpose
The purpose of this study is to identify the clear attributes of warmth in nursing and establish a theoretical foundation by clarifying the concept and distinguishing it from similar concepts.
METHODS
1. Study Design
This study was conducted using Walker and Avant's [25] concept analysis procedure to identify the attributes of warmth in nursing care and provide a theoretical foundation for nursing practice. The specific steps of the process are as follows: To conduct a concept analysis, the process begins by selecting the concept and defining its purpose. Next, all uses of the concept are identified, followed by determining its defining attributes. A model case is then presented, along with additional cases, including borderline, contrary, related, and invented cases, to further clarify the concept. Subsequently, the antecedents and consequences of the concept are identified, and the process concludes by defining its empirical referents.
2. Data Collection
The literature review for this study was conducted based on the fact that research on warmth in nursing was conducted in the 1980s and 1990s, which, to our knowledge, has been rarely explored in later years. Therefore, January 1980 was set as the starting point for the search, covering studies published up to September 2024. Domestic databases (RISS, DBpia) and international platforms (CINAHL, PubMed) were searched using the keyword “ Warmth,” yielding 1,190 domestic and 5,511 international articles. After excluding duplicates, non-full-text, and irrelevant studies, 15 articles were selected for analysis. These articles were reviewed to identify the conceptual attributes of nurses’ warmth, with key characteristics classified and verified (Figure 1).
Flow diagram of study selection.
3. Researcher Preparation
The researchers prepared for this study by studying concept analysis during the completion of a nursing theory course. Additionally, they conducted a literature review on concept analysis to build a foundation for analyzing the concept of warmth in nursing care.
RESULTS
1. Literature Review on Warmth
The findings on the concept of warmth as used in various disciplines, including nursing, are summarized below (Table 1).
Concepts and Characteristics of Warmth in Multiple Disciplines
1) Dictionary definition
“ Warmth” was defined using the Standard Korean Language Dictionary [26] as “ warm love or compassion,” “ filial piety,” or “ a warm water spring.” For this study, the most relevant definition is “ warm love or compassion.” In English, warmth is associated with “ affection,” “ kindness,” and “ sympathy” [27], and can be defined as “ warm love or compassion characterized by affection, kindness, and empathy.”
2) Scope of the concept of warmth
(1) Concept usage by field
In child studies, parental warmth refers to parenting behaviors that express affection, interest, and support while acknowledging the child's independence and fostering open communication [8]. Warm parenting enhances children's thoughtfulness, altruism, and socio-emotional development while reducing aggression [9,10]. It promotes emotionally close relationships and a nurturing attitude [11].
In business administration, downward warmth involves leaders showing affection through support, protection, and forgiveness, fostering emotional solidarity and a familial atmosphere, which encourages altruistic commitment among subordinates [12,13].
In psychology, warm interpersonal relationships are key to forming and maintaining connections. In Korea, seemingly personal questions, such as about age or family, often serve to establish common ground and create closeness, reflecting warmth as a critical relational mechanism in Korean society [14,15].
The common concept of warmth, as examined through the above studies, is a process of forming and maintaining emotional bonds, expressing affection and interest toward others, and enhancing trust and a sense of belonging through a warm attitude. Thus, warmth is not merely an expression of emotion but an iterative process that builds trust in relationships, provides psychological stability, and fosters mutual respect. This can also be applied in nursing. Nurses build trust with patients through a warm attitude, and through this trust, nurses provide psychological stability, which embodies the concept of nursing.
(2) Concept usage in nursing
Hardin and Halaris [28] identified non-verbal behaviors expressing warmth in nurses, including smiling, laughter, leaning forward, nodding, and calm hand and foot movements. Nurses with high warmth display genuine smiles, steady eye contact, and calm movements, while those with low warmth exhibit loud laughter, frequent eye movements, and exaggerated gestures.
Kim [23] emphasized that beyond technical skills, nurses can enhance patient satisfaction by using non-verbal warm behaviors tailored to patient preferences, such as maintaining direct eye contact, smiling, and nodding during rounds or care. Patients felt warmth when nurses stood or sat within one meter, observing their affected area with a kind and attentive demeanor [7]. Kim [29] described warmth as encompassing comfort, compassion, understanding, and kindness.
A nurse's professional warmth reflects kindness, calmness, and thoughtfulness, conveyed through empathetic and attentive communication [30]. Without non-verbal expressions of empathy and respect, patients may misinter-pret a nurse's attitude as “ unfriendly” or “ mechanical” instead of warm and compassionate [7].
2. Provisional Criteria and Attributes of Warmth
In this stage of concept analysis, the repeated attributes of the concept are identified through a literature review [25]. Analyzing a wide range of literature on the concept of warmth in nursing, the following provisional criteria and attributes were identified.
1) Provisional criteria for nurses’ warmth
① Feeling compassion: showing care and concern for patients’ conditions.
② Showing empathy: understanding and sharing patients’ emotions.
③ Treating patients like family: providing care with a familial sense of connection.
④ Verbal communication: building trust and offering reassurance through words.
⑤ Nonverbal communication: using gestures like smiles and nodding to foster emotional bonds.
⑥ Acting as a counselor: engaging deeply with patients, offering personalized reassurance to make them feel genuine care.
⑦ Educating patients: sharing nursing knowledge to empower patients and overcome anxiety.
⑧ Providing nursing care: researching and delivering patient-tailored nursing care outside of working hours.
⑨ Protecting privacy: safeguarding embarrassment and minimizing exposure.
⑩ Promoting comfort: rubbing hands together to warm them before touching the patient and proactively offering assistance before being asked.
2) Attributes of warmth
A review of the scope of warmth as used in nursing literature reveals that nurses’ warmth is characterized by humanity, proficiency in verbal and non-verbal communication, professionalism in patient care, and the ability to uphold the dignity of patients. Through humanity patients feel respected and are able to establish a therapeutic relationship with nurses. Verbal and non-verbal communication help patients feel emotionally secure. Moreover, clear and kind communications decrease patients’ anxiety, positively affecting and improving trust in nurses. Professionalism is an element of warmth, as it involves deeply understanding patients’ health conditions and providing individualized care while acting as a practitioner and educator to support patients. Dignity involves protecting patients’ privacy and ensuring they do not experience embarrassment. In an environment where dignity is preserved, patients feel more secure, leading to increased trust in their nurses.
(1) Humanity (compassion, empathy, familial affection): ①, ②, ③
(2) Communication (verbal, non-verbal): ④, ⑤
(3) Professionalism (counselor, practitioner, educator): ⑥, ⑦, ⑧
(4) Dignity (privacy protection, comfort promotion): ⑨, ⑩
3. Model Case
A model case includes all attributes of the concept [25]. Mr. A, a corporate employee, experienced sudden chest pain, leading to cardiac arrest and a diagnosis of variant angina. Frustrated by his condition, he directed his distress toward the nurses. Nurse B, having experienced cardiac arrest herself, felt familial affection, empathized with his pain, and provided compassionate care (1). She maintained eye contact, spoke calmly, smiled, and held his hand while discussing health management (2). Going beyond her duties, she prepared educational materials tailored to his condition (3). Mr. A later requested counseling, where Nurse B listened, supported him emotionally, and provided guidance. During discharge, she prioritized his dignity by drawing curtains, warming her hands, and ensuring his comfort throughout procedures (4). With Nurse B's care, Mr. A's condition improved, leaving him hopeful for the future.
4. Additional Cases of the Concept
1) Contrary case
A contrary case illustrates the absence of the concept's attributes [25]. Mr. E, a mountain biking enthusiast, suffered a spinal injury and was admitted to the intensive care unit (ICU) where Nurse F worked. Though Nurse F initially attempted to empathize with Mr. E, who frequently reacted with distress and was hesitant to receive care, she soon became disengaged and exhausted. She provided only basic care, avoided eye contact and smiles, and neglected his emotional distress, even ignoring his tears. Nurse F also failed to ensure his privacy, leaving curtains open during bowel care. To her, Mr. E became merely a task, devoid of warmth or compassion.
2) Borderline case
A borderline case includes some, but not all, attributes of the concept [25], specifically (1) (humanity) and (4) (dignity). Mr. C, a soccer player, became paralyzed after a motorcycle accident, ending his career. Overcome with despair, he lashed out at staff and refused care. Nurse D empathized with his situation, offering emotional support and encouragement (1), even sharing his sorrow when he cried. One day, noticing Mr. C's discomfort with managing bowel movements, Nurse D took the initiative to assist him. She maintained his privacy by drawing curtains, warmed her hands for his comfort, and provided care with attentiveness and sensitivity. Through reassuring actions that uphold his dignity, she supported him in regaining his self-esteem (4).
3) Related case
In a similar case [25], Nurse G entered the patient's room with a warm smile and greeted Mr. H, a newly admitted older adult patient recovering from pneumonia. She introduced herself and asked, “ How are you feeling today?” while adjusting his pillow for comfort. Seeing his slightly anxious expression, she reassured him, saying, “ You’ re in good hands here. If you need anything, just press the call button, and we’ ll be right here.” After a brief conversation, she completed her routine check-up and moved on to her next patient.
5. Antecedents and Consequences of the Concept of Warmth
Identifying antecedents and consequences helps further clarify the attributes of the concept being analyzed [25]. Antecedents refer to events or conditions that occur prior to the emergence of the concept, while consequences are events or conditions that occur as a result of the concept (Figure 2).
Conceptual structure of warmth in nursing.
1) Antecedents
Kim and Kim [7] stated that warmth is demonstrated when individuals require not only physical recovery but also emotional stability and psychological well-being. Warmth is needed in nursing situations such as responding to patients’ requests, inquiring about their well-being, and providing words of hope and encouragement. In this study, warmth is understood to emerge not only from recognizing emotions such as shame, discomfort, helplessness, and despair, which negatively impact the dignity of the individual, but also from situations where the caregiver identifies the patient's emotional vulnerability and is willing and prepared to respond empathetically. The antecedents of warmth were identified as a recognition of the patient's emotional state, caregiver's relational sensitivity, and presence of empathic intention and a supportive environment that enables the expression of warmth.
2) Consequences
Nurses’ warmth brings positive outcomes for both patients and nurses, contributing to enhanced nursing quality and the realization of holistic care. When warmth is practiced, nurses provide high quality care that addresses not only patients’ physical needs but also their emotional and psychological needs [30]. This level of care transcends mere treatment, offering patients a genuine experience of compassion. Patients feel understood and cared for on a human level by their nurses, which builds trust and increases satisfaction with the treatment process. Furthermore, warm nursing care facilitates not only patients’ physical recovery but also their emotional stability, thereby achieving the goals of holistic nursing care [7]. Warmth serves as a core element of care, addressing both the body and mind of the patient. By deeply understanding the individual conditions and needs of patients, nurses are able to tailor their care accordingly. This fosters trust between patients and nurses, encouraging patients to take a more active role in their recovery, which ultimately leads to improved treatment outcomes and a higher quality of care.
6. Identification of Empirical Referents
The final step in concept analysis, empirical referents, demonstrates the presence of the concept's attributes in real-world settings and provides criteria for measuring the concept of nurses’ warmth [25].
In this study, we used the Ajou Compassionate Level Scale (ACLS) General Version developed by Kim and Shin [31] as the empirical reference for humanity. This tool is appropriate as nurses primarily interact with strangers and recognize their difficulties; this necessitates treating them with kindness and warmth, which reflect humanity. Yang's Therapeutic Communication Scale [32] was used as the empirical reference for communication. This effectively captures both verbal and non-verbal communication, including the use of friendly words, holding hands, and maintaining eye contact. We used Jang's Nursing Competence Scale [33] as the empirical reference for professionalism, which is widely utilized and comprises scientific, ethical, personal, and aesthetic aspects of nursing. Finally, the Patient Respect Scale developed by Part et al.[34] is the empirical reference for dignity, which includes elements related to privacy protection and confidentiality.
DISCUSSION
Warmth is an important factor in promoting patients’ physical and emotional stability and facilitating the formation of therapeutic nurse-patient relationships, ultimately contributing to their recovery [6]. However, the current clinical environments present structural limitations that make it difficult for nurses to fully express warmth due to factors such as high workloads and emotional exhaustion [3]. These factors not only hinder the expression of warmth but also weaken the therapeutic relationship between nurses and patients, ultimately negatively affecting patients’ treatment experiences and health outcomes [6]. There is a lack of systematic research on the concept of warmth, and concrete criteria and tools for measuring and applying warmth in clinical practice remain insufficient. Therefore, this study applies Walker and Avant's [25] concept analysis to clearly define the key attributes of warmth and establish a theoretical foundation for maintaining and enhancing warmth in clinical practice.
This study systematically analyzes the concept of warmth in nursing practice and aims to establish its attributes as distinct from other related concepts, such as empathy, respect, compassionate care, and caring, which are often used interchangeably. Warmth is differentiated from empathy in that while empathy involves cognitive elements that allow a nurse to understand and reflect on a patient's emotions [19], warmth focuses on forming emotional bonds through more immediate and intuitive responses. Similarly, if respect is an attitude that acknowledges a patient's autonomy and dignity and can be practiced without emotional interaction [21], warmth inherently involves emotional connection and trust-building, going beyond mere recognition and acceptance to active emotional engagement. Warmth is also distinct from compassionate care; while compassionate care emphasizes the ethical and moral responsibility to alleviate a patient's suffering [20], warmth is centered on more immediate and natural emotional expressions and interactions. Compared to caring, which involves long-term protection and the establishment of enduring relationships, warmth is primarily focused on fostering psychological stability and trust-building for the patient [22].
Warmth has been identified as a concept encompassing four key attributes: humanity, communication, professionalism, and dignity. First, humanity includes emotional characteristics such as compassion, empathy, and a sense of familial affection, which emerge as nurses understand and respond to patients’ emotions [35]. Previous studies [35] have reported that when nurses understand and empathize with patients’ emotions and provide emotional support to promote psychological stability, their therapeutic relationships are strengthened. Patients experience not only physical illness but also psychological anxiety and fear; in such situations, nurses’ emotional responses and compassionate care play a crucial role in alleviating anxiety and enhancing treatment outcomes. Psychological studies exploring warm interpersonal relationships [14] have emphasized emotional bonding and relationship maintenance, which aligns with the way nurses respect patients’ emotions and practice continuous care. In nursing, humanity is expressed not merely as kindness but as an active process of practicing empathy and compassion. Through this process, patients develop trust in nurses, actively engage in their treatment, and ultimately maximize therapeutic effects [35]. As a result, nurses’ humanity goes beyond a simple emotional response; it serves as a key factor in improving patients’ quality of life and realizing the fundamental values of nursing.
Second, communication is a key element in building trust with patients and encompasses both verbal and non-verbal communication skills [7]. Verbal communication refers to the process in which nurses use clear and empathetic language to provide therapeutic information and express emotional support to patients. Nonverbal communication, on the other hand, includes elements such as smiling, eye contact, gestures, and tone of voice, which contribute to fostering trust and providing psychological stability [7]. Previous studies have reported that both verbal and non-verbal expressions by nurses play a significant role in shaping patients’ perception of nurses as kind and compassionate [23]. Additionally, psychological studies [15] have suggested that warm communication contributes to relationship development and conflict resolution. This is particularly evident in communal relationships, where understanding and responding to the needs of others positively fosters trust building and relationship maintenance. These findings suggest that warm communication in nursing can contribute to building trust and promoting psychological stability in patients. As a result, patients are more likely to positively accept nurses’ explanations and actively cooperate with treatment plans. Furthermore, when effective communication is established between nurses and patients, patients may feel more comfortable in openly expressing their symptoms and emotions, which can lead to more accurate diagnoses and appropriate treatment interventions. However, warm communication is not always received the same way by all patients, and its effectiveness may vary depending on the patient's individual characteristics and cultural background. The impact of both verbal and non-verbal communication may differ based on a patient's cultural background, disposition, and personal experiences; non-verbal expressions of warmth do not always have a positive effect on all patients [36]. For instance, some patients may feel uncomfortable with physical contact or direct or indirect eye contact, and in certain cultures, such expressions may even cause discomfort [36]. Therefore, nurses should avoid using a one-size-fits-all communication approach and instead tailor their methods by considering the patient's personal preferences and cultural background. By doing so, they can effectively combine both verbal and non-verbal elements to establish a more effective therapeutic nurse-patient relationship.
Third, professionalism plays a crucial role in enabling nurses to fulfill their roles as counselors, practitioners, and educators while demonstrating warmth [23]. Nurses can establish therapeutic relationships by accurately assessing patients’ conditions and providing individualized treatment and emotional support accordingly. To practice warmth, nurses must deliver care based on clinical judgment, considering patients’ physical and psychological states. In this process, an approach that goes beyond mere emotional exchange and utilizes professional competence is essential [35]. Additionally, as an educator, nurses can enhance patients’ and caregivers’ understanding of the treatment process by continuously providing information and playing an educational role. This helps patients comprehend their condition and actively participate in their treatment, ultimately improving treatment adherence [35]. As a counselor, nurses can alleviate patients’ psychological burdens and provide emotional stability throughout the caregiving process, thereby fostering a trusting relationship. Through this trust, patients are more likely to actively cooperate in their treatment process [35]. In this manner, professionalism in nursing extends beyond technical skills, enabling personalized care that reflects patients’ individual needs. This can serve as a foundation for fostering relationships through warmth and practicing therapeutic care.
The final attribute, maintaining dignity, is a core aspect of warmth that ensures the protection of patients’ privacy and their physical and psychological well-being [7]. Nurses should minimize patients’ exposure, consider their comfort to prevent feelings of embarrassment or discomfort, and safeguard their self-esteem throughout the treatment process. According to research, when nurses provide care in a way that maintains patients’ dignity, patients perceive that their existence is respected, which can positively impact their psychological stability and trust-building [35]. In an environment where dignity is preserved, patients are more likely to exhibit a cooperative attitude during the treatment process, and their trust relationship with nurses is strengthened. In the field of child studies, parental warmth has been shown to enhance children's independence and self-esteem [8,37]. This suggests that dignity-preserving care through warmth in nursing can play a crucial role in enhancing patients’ psychological stability and therapeutic cooperation.
The antecedents of warmth were identified as the caregiver's recognition of the recipient's emotional vulnerability, relational sensitivity, and the presence of an empathic and supportive environment, particularly in situations that threaten human dignity. As a result of warmth, the provision of high-quality nursing care and the realization of holistic nursing were observed. Warmth enables patient-centered care, allowing patients to experience not only physical recovery but also emotional stability and psychological well-being [29]. This suggests that warmth extends beyond technical nursing skills to strengthen therapeutic relationships with patients and enhance the overall quality of care. Through the practice of warmth, nurses can comprehensively assess and respond to patients’ needs, ultimately improving treatment adherence and patient satisfaction.
The empirical criteria applied in this study (ACLS [31], Therapeutic Communication Scale [32], Nursing Competence Scale [33], and Patient Respect Scale [34]) are useful for assessing various attributes of warmth; however, they have certain limitations. First, although the practice of warmth may manifest differently depending on the context, existing measurement tools tend to evaluate warm behaviors primarily within specific situations. For example, the ACLS [31] focuses on assessing warmth in nurses’ interactions with strangers, but it has limitations in measuring warm behaviors that manifest within long-term therapeutic relationships. Additionally, the Therapeutic Communication Scale [32] encompasses both verbal and non-verbal communication; however, it has limitations in quantitatively evaluating the impact of nurses’ warm communication on patients’ psychological state and treatment adherence. This indicates the need for additional tools that measure warm attitudes and assess the effects of warm communication on patients’ emotional stability and treatment outcomes. The Nursing Competence Scale [33] is widely used to assess professional competency; however, it requires supplementation as ethical and personal competencies related to warm care are not equally considered alongside clinical competencies. In other words, more specific evaluation criteria are needed to assess how warm nursing functions as a tangible therapeutic intervention beyond being merely an ethical attitude. Additionally, while the Patient Respect Scale [34] can be used as a tool to measure dignity preservation, it lacks items that directly assess how patients perceive and experience warmth. Given that warmth is not merely a caregiving behavior but a process that fosters patients’ physical and psychological stability while building therapeutic trust, a tool for evaluating patients’ subjective experiences is necessary. Therefore, future research should focus on developing new assessment tools that reflect the multi-dimensional attributes of warmth and refine measurement instruments to analyze its effects more precisely from a patient-centered perspective.
This study is significant as it multidimensionally analyzes the concept of warmth and examines its practical applicability in nursing practice, thereby clarifying its conceptual definition and practical implications. While previous studies have often discussed warmth as an ethical attitude or emotional response of nurses, this study approaches warmth as a concept composed of four attributes: humanity, communication, professionalism, and dignity. This approach provides a more concrete and practical understanding of warmth in nursing practice. Through this framework, the study identifies warmth as a key element of therapeutic care that extends beyond mere emotional interaction, integrating it with nurses’ professional competencies. Additionally, it emphasizes the impact of warmth on patients’ physical, emotional, and psychological recovery, as well as its essential role in forming therapeutic relationships. Warmth should not be viewed simply as an emotional exchange but rather as a critical caregiving approach that strengthens therapeutic relationships and builds patient trust through nurses’ practical actions. Therefore, future research should focus on analyzing the specific impact of warm nursing on patients’ therapeutic experiences and developing standardized educational models for the implementation of warm care.
CONCLUSION
This study was conducted to analyze the concept of nurses’ warmth by focusing on its antecedents, outcomes, and empirical criteria, as well as to identify its key attributes and highlight its importance in nursing practice and the feasibility of humanistic nursing care. The study findings identified four core attributes of warmth: humanity, communication, professionalism, and dignity. The antecedents of warmth were identified as the caregiver's recognition of emotional vulnerability and the need for empathy in situations where human dignity is at risk, while the outcomes included the provision of high-quality, patient-centered care and the realization of holistic nursing care. The empirical criteria for assessing warmth included the ACLS [31], the Therapeutic Communication Scale [32], the Nursing Competence Scale [33], and the Patient Respect Scale [34]. While these tools were useful in evaluating various attributes of warmth, they had limitations in fully capturing the concept within specific contexts. To overcome these limitations, future research should focus on developing an integrated measurement tool that more precisely reflects the cognitive, emotional, and expressive components of warmth. In particular, it is essential to explore in greater depth the impact of warm nursing on patient health outcomes and the quality of care across diverse clinical settings, while also seeking policy and educational strategies to strengthen its practice. Through these efforts, warmth can be effectively integrated into nursing practice, ensuring that it becomes an essential aspect of nursing. Ultimately, this will contribute to enhancing the quality of patient-centered care and realizing holistic nursing care.
Notes
CONFLICTS OF INTEREST
The authors declared no conflict of interest.
AUTHORSHIP
Conceptualization or/and Methodology - Kim J-W and Park M; Data curation or/and Analysis - N/A; Funding acquisition - N/A; Investigation - N/A; Project administration or/and Super-vision - Park M; Resources or/and Software - Kim J-W and Park M; Validation - Kim J-W and Park M; Visualization - Kim J-W and Park M; Writing: original draft or/and review & editing - Kim J-W and Park M.
DATA AVAILABILITY
The data that support the findings of this study are available from the corresponding author upon reasonable request.