Concept Analysis of Compassionate Care among Nurses: A Hybrid Model

Article information

J Korean Acad Fundam Nurs. 2025;32(2):275-286

Publication date (electronic) : 2025 May 31

doi : https://doi.org/10.7739/jkafn.2025.32.2.275

Ae Kyung Chang¹⁾, Jin Ah Kim²⁾, Yu Kyung Jin²⁾, Woo Jung Hong²⁾, Yeon Kyung Cho²⁾, Ah Young Kim^3),

¹⁾PhD, RN, Professor, College of Nursing Science, Kyung Hee University, Seoul, Korea

²⁾MSN, RN, College of Nursing Science, Kyung Hee University, Seoul, Korea

³⁾PhD, RN, College of Nursing Science, Kyung Hee University, Seoul, Korea

Corresponding author: Kim, Ah Young College of Nursing Science, Kyung Hee University 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-961-9524, Fax: +82-2-961-9398, E-mail: isd3200@khu.ac.kr

Received 2025 February 20; Revised 2025 May 2; Accepted 2025 May 19.

Abstract

INTRODUCTION

As the healthcare paradigm shifts from disease-centered to patient-centered care, healthcare organizations increasingly adopt patient-centered visions and policies [1]. However, in a competitive environment, the focus on service evaluation, cost-effectiveness, and patient retention necessitates a deeper understanding of true patient care [2]. A 2013 National Health Service inquiry reported neglect and poor care for dementia patients, highlighting the need to improve healthcare standards and address the loss of compassion in nursing [3,4]. While empathy is widely recognized in healthcare sector, the definition of compassionate care in clinical practice has received relatively less attention [2]. In Korean clinical practice, influenced by Confucian ideology, the focus is more on providing one-directional care with dignity rather than viewing the patient as an object of compassion [5].

Compassion, rooted in religious and philosophical traditions as a universal love and moral disposition, involves a genuine desire to help beyond an emotional response to others’ suffering [6,7]. It is associated with respecting patients as unique and dignified individuals [8] and actively helping them, rather than merely feeling sadness or pity [9]. Compassion is essential for healthcare providers, especially when caring for physically and emotionally vulnerable patients. It represents the essence of nursing and a critical quality for nurses. Responding to patients’ needs with compassion is a professional standard and a key factor in improving the quality of nursing care [8,11].

In contrast, empathy involves cognitively and emotionally placing oneself in another person's situation and understanding their feelings and thoughts [6]. Although empathy and compassion are conceptually distinct, some literature has noted that they are occasionally used interchangeably in clinical discourse [12,13]. Therefore, distinguishing between these concepts is essential for clarity in nursing practice and research. Empathy can be seen as a prerequisite for compassion, which entails deeper engagement with others’ suffering, expressing internal feelings externally, and taking action to alleviate suffering [9].

A lack of compassion in patient care is linked to negative outcomes, patient dissatisfaction, and low treatment adherence [8,14]. Conversely, nurses’ compassion improves health outcomes and patient satisfaction through positive interactions, making it essential for quality healthcare experiences [15]. Adequate compassion in nurses also increases their satisfaction and resilience, positively impacting work productivity by reducing care time and costs [16]. The International Council of Nurses and the American Nurses Association emphasize compassionate care as the core of nursing [2].

Since Von Dietze and Orb [9] introduced ‘ compassionate care’ by emphasizing that identifying with others’ suffering implies action, various conceptual analyses have been conducted in international nursing literature [6,8,17]. Su et al. [17] defined it as empathy-driven, involving a nurse's desire to alleviate suffering and use therapeutic communication. Burnell described it as ‘ caring, awareness of others’ suffering, sensitivity, shared experience of suffering, spiritual connection, and efforts to alleviate suffering.’ Marivic et al. [8] reported it as ‘ recognition, connection, altruism, humanistic responses, and acts of compassion.’

However, most of these studies have focused on nursing students rather than clinical nurses, limiting the applicability of findings to real-world practice [6,18]. Furthermore, they often used compassion and compassionate care interchangeably, without fully addressing their conceptual distinctions [12]. Prior studies have rarely compared the perspectives of nursing students and practicing nurses, despite the likelihood that clinical experience fundamentally shapes how compassionate care is understood and delivered [19].

In addition, existing research and measurement tools related to compassion have been predominantly developed in Western countries, where cultural norms and professional values differ significantly from those in Korea [19,20]. For instance, in Korean clinical settings, heavily influenced by Confucian values, compassion may be expressed more implicitly and hierarchically, emphasizing duty and dignity over emotional connection [21]. Such cultural factors are rarely accounted for in existing tools, which limits their relevance and validity in Korean contexts.

Korean nursing research has primarily focused on outcomes such as compassion fatigue or compassion satisfaction, rather than on the concept of compassionate care itself. Although a ‘ compassion competence measurement tool’ [22] has been developed, it mainly assesses individual-level skills and does not sufficiently address the organizational or sociocultural attributes of compassion within the Korean healthcare setting.

Moreover, compassionate care remains an abstract and multifaceted concept that is often conflated with related terms like patient-centered or holistic care. While patient-centered care emphasizes patients’ preferences and autonomy, it may inadvertently minimize the nurse's active role in emotional engagement, thus diminishing the relational aspect of care [23]. This underscores the need for a more balanced and reciprocal understanding of the nurse-patient relationship [1,24].

Therefore, to bridge the gap between theory and practice, and to ensure cultural and contextual relevance, this study aims to conceptually analyze compassionate care from the perspective of Korean clinical nurses. A hybrid model that integrates theoretical analysis with fieldwork is recommended for examining abstract and culturally embedded concepts [25].

METHODS

1. Study Design

This concept analysis was conducted using Schwartz-Barcott and Kim's [25] mixed-model method, which includes theoretical, fieldwork, and final analysis stages. The study aimed to identify the attributes of compassionate care in existing literature, analyze qualitative data on nurses’ experiences, and define compassionate care through comparative analysis of the attributes from literature review and fieldwork.

1) The theoretical phase

In this phase, a literature review on ‘ compassionate care’ was conducted, covering the period from 1983, when the term began appearing in nursing research, to April 2024. Domestic and international databases such as PubMed, CINAHL, Embase, Research Information Sharing Service (RISS), and National Digital Science Library (NDSL) were searched using keywords like ‘ compassion’, ‘ compassionate care’, and ‘ nurse’. After excluding duplicates from an initial pool of 250 articles, 200 were extracted. Among these, five domestic and 45 international articles were selected for detailed review. Finally, 36 international and two domestic papers containing attributes and definitions of ‘ compassion’ and ‘ compassionate care’ were chosen (Figure 1). These articles were analyzed to derive meaningful attributes and tentative definitions, considering the relationship between related and similar concepts of compassionate care.

Figure 1.

Conceptual framework of compassionate care by nurses: antecedents, attributes, and consequences.

2) The fieldwork phase

To clarify the potential attributes and definitions of compassionate care identified in the theoretical phase, qualitative data were collected and analyzed through individual in-depth interviews with 18 nurses. Purposive sampling was used to select clinical nurses who met the inclusion criteria. The inclusion criteria were: (1) nurses with at least one year of clinical experience, and (2) nurses who have provided compassionate care through direct patient interaction. The exclusion criteria included: (1) nurses who were currently not engaged in direct patient care. The participants were selected from various wards (Intensive Care Unit [ICU], emergencies, and general wards). The re-cruitment period was from May 18, 2024, to June 25, 2024. Among the participants, one was male, three were married, and their ages ranged from 25 to 53 years, with clinical experience ranging from 2.6 to 29 years. Their educational backgrounds comprised 11 bachelor’ s, 6 master’ s, and 1 doctoral degree, and they worked in 13 general wards, 3 specialty wards, and 2 intensive care units (Table 1).

Table 1.

Demographics of Participants (N=18)

Interviews were conducted by all six researchers to ensure a diverse range of perspectives and to enhance the data collection process. Each researcher conducted interviews independently, following a standardized interview guide to ensure consistency across all sessions. Transcription was carried out by multiple members of the research team, who independently transcribed the recordings and then reached a consensus through discussion to ensure accuracy. Data were collected through semi-structured in-depth interviews until data saturation was achieved, with each interview lasting 40∼50 minutes. The main questions were: “ Tell me about an experience of compassionate care that you have provided or witnessed”, “ In what nursing situations does compassion appear?”, “ What factors shape compassionate care?”, “ What does compassionate care mean to you, personally and professionally?”, and “ How do you think compassionate care affects your relationships with patients, caregivers, and staff?”.

The interview data were analyzed using conventional content analysis, following the qualitative content analysis method by Waltz et al. [26]. Initially, the lead researcher and team members thoroughly read the transcriptions to immerse themselves in the data, identifying meaning units and labeling them with primary codes. These codes were then classified into subcategories and grouped into broader categories and main themes. To ensure neutrality and minimize bias, different team members independently inspected the transcripts and themes at each coding stage. The research group collectively reviewed and discussed these themes to ensure the accuracy and integrity of the findings. Throughout the data collection process, interview recordings were analyzed to extract and categorize meaningful content, allowing for a comprehensive understanding of nurses’ experiences with compassionate care, the circumstances under which it occurred, and its manifestation in the patient-caregiver relationship.

3) The final analysis phase

In the final analysis stage, the results of the theoretical stage and fieldwork stage were compared and analyzed to integrate the attributes and indicators of nurses’ compassionate care according to the main areas, and to identify the final definition. Throughout this process, insights and feedback were sought from experienced nursing professionals and academic experts in the field to ensure the ro-bustness and applicability of the findings.

RESULTS

1. Theoretical Phase

1) Definition and related concepts of compassion and compassionate care

The term ‘ compassion’ originates from the Latin words com (together) and pati (to suffer with), meaning to suffer together [6]. It is defined as ‘ a feeling or emotion moved by the pain or suffering of another and wishing to relieve it’ [28]. ‘ Compassionate’ is an adjective referring to ‘ compassion,’ and ‘ care’ means ‘ to look after or protect’ [29]. Therefore, compassionate care is defined as ‘ feeling one's own pain at another's suffering and providing concern and care to alleviate it.

In literature, compassion is often used interchangeably with empathy, sympathy, and pity [20]. Sympathy involves a desire to help someone escape suffering, but it is more egocentric, focusing on alleviating one's own discomfort about their suffering [8]. Empathy involves adopting another's perspective and vicariously experiencing their feelings, but unlike compassion, it does not entail action and remain internal [11,20]. Pity involves feeling compassion someone in a severely distressing situation, often viewing them as weak or inferior, whereas compassion emphasizes the dignity of the individual and does not differentiate between human beings [9,30].

Concepts related to compassionate care include patient-centered and holistic care. Patient-centered care respects and responds to individual patient preferences, needs, and values [1]. While both Compassionate and patient-centered care emphasize patient dignity, compassionate care is reciprocal and interdependent in the patient-nurse relationship [4,17], whereas patient-centered care delegates decision-making to the patient [1]. Holistic care addresses the physical, mental, emotional, and spiritual needs of patients, viewing them as the sum of their bodies, minds, and spirits [31]. Compassionate care, however, involves a deeper understanding of human pain and suffering, aiming for optimal well-being and functioning, regardless of the presence of illness [32].

2) Meaning of compassion and compassionate care in nursing

Compassion is central to nursing, involving participation in others’ experiences, sensitivity to pain and sharing in suffering [33]. It is moral choice expected of nurses, not an innate personal trait or a mere emotional response [9,11]. Compassionate care entails an internal motivation to do good and actions aimed at comforting or eliminating patient suffering [8,9,11]. It requires rational thought, evaluation, and sufficient nursing knowledge and skills, with competence being a key aspect from the patient's perspective [2]. Compassionate care involves understanding what others value, connecting closely, and acting meaningfully [4], including relational skills like emotional presence, humility, humanity, respect, and patient involvement [4]. Patients perceive it as good communication and concern [34], benefiting both patients and nurses by facilitating healing, building trust, and increasing nurse satisfaction [8].

In a previous study, nurses defined compassionate care with dimensions like ‘ attention,’ ‘ listening,’ ‘ engagement,’ ‘ helping,’ and ‘ understanding’ [35], while nurses, patients, and families characterized compassionate care as ‘ effective interactions,’ ‘ professionalism,’ and ‘ continuous comprehensive care’ [36]. Patients also described it as ‘ meaningful relationships,’ ‘ patient expectations,’ ‘ caring qualities,’ and ‘ competent professionals’ [2].

3) Attributes and definitions of compassionate care identified in the theoretical phase

The concept of compassionate care that emerged from the theoretical phase consisted of cognitive, relational, and behavioral domains, and nine attributes were derived. The cognitive domain includes recognizing individual situations requiring compassionate care and emotionally immersing oneself in the patient's pain to evoke an empathetic response, comprising three attributes: “ recognizing individual needs”, “ humanism”, and “ immersion in suffering”. The relational domain is based on the emotional bond and trust between the patient and nurse in forming a therapeutic relationship, with two attributes: “ supportive communication” and “ trusting relationship”. The behavioral domain involves the actual implementation of compassionate care behaviors, reflecting the internal motivation to alleviate the patient's suffering, includes four attributes: “ collaborative care,” “ professional care,” “ individualized care,” and “ ethical care” (Table 2).

Table 2.

Comparison of Theoretical Phase and Fieldwork Phase Attributes of Compassionate Care

DISCUSSION

This study aimed to understand compassionate care among Korean clinical nurses and clarify this concept using a mixed-methods design. Participants included nurses from various departments such as medical and surgical wards, intensive care units, and isolation wards in general hospitals. Despite diverse careers and clinical experiences, participants displayed similar attitudes toward compassionate care, likely due to compassion's deep roots in religious ideologies about human frailty and suffering [6,11]. Compassion manifests in all nursing situations, not just in alleviating pain or suffering. However, Korean nursing research has mainly focused on spiritual care during end-of-life care [37], highlighting the need for a consensus to facilitate a universal understanding of compassionate care.

The attributes of Korean nurses’ compassionate care were structured into cognitive, relational, and behavioral domains in both the theoretical and fieldwork phases, which matches existing studies that conceptualized compassionate care as “ understanding suffering,” “ creating a trusting relationship,” and “ making efforts to alleviate patients’ suffering” [14,38]. This also matches psychological and organizational studies that present compassion in the form of cognitive, emotional, and behavioral aspects [7,30].

The cognitive domain involves situational awareness, where nurses recognize expressions of distress, sadness, fear, and frustration caused by patients’ suffering and identify needs from the patient's perspective, leading to the attributes of ‘ individual need recognition’ and ‘ engagement with suffering.’ ‘ Recognizing individual needs’ aligns with previous findings that compassionate care involves attentiveness to patients’ needs and respect for their beliefs, values, preferences, and customs [39]. Similarly, cardiac unit nurses identified ‘ the ability to enter another's world’ as part of compassionate care, understanding and expressing patients’ situations and emotions [40]. Empathy, which includes understanding others’ situations, emotions, and motivations [20], is essential for compassionate care [17,41] and extends to a behavioral intention to help.

‘ Engagement with suffering’ is described in the literature as ‘ awareness of suffering’ [38] and ‘ deep understanding of suffering and motivation to alleviate it’ [14]. This includes deeply accepting others’ feelings, with some participants feeling the patient's pain alongside them. While consistent identification with patients’ pain can lead to compassion fatigue and burnout [8], this study found that nurses practicing compassionate care reported increased self-efficacy and self-esteem. This aligns with reports that nurses who actively help patients experience satisfaction, well-being [14], and intrinsic rewards [34]. Thus, compassionate care benefits both nurses and patients without causing emotional burnout or requiring unilateral sacrifice.

The relational domain involves understanding and connecting with patients through relationships, characterized by ‘ emotional connection’ and ‘ trusting relationships.’ Compassion is a way of life that emphasizes relational aspects among colleagues, patients, and families [4,42]. Participants viewed ‘ rapport’ and ‘ two-way communication’ as key elements of ‘ emotional connection,’ enabling better patient understanding. Repeated interactions and rapport building are crucial in the patient-nurse relationship [12,34]. ‘ Two-way communication’ aligns with research suggesting patient feedback is vital for restoring health [34] and enhancing compassionate care practice [4,43]. Compassionate care, integrated into daily practice, does not require significant time investment [4].

Supportive communication, another subdomain of ‘ emotional connection,’ includes both verbal and nonverbal communication, crucial for compassionate care [10,40]. Interpersonal skills, such as getting to know the patient, showing respect, and active listening, are essential for compassionate care [12,14]. Iranian nurses emphasize active listening, eye contact, and honest behavior as measures of compassionate care [36].

The ‘ trusting relationship’ attribute values therapeutic relationships with patients and caregivers, aligning with Singh et al. [16], who noted the importance of family relationships in Canadian palliative care. Compassionate care involves ‘ bonding interactions’ to build trust, reflecting the unique caregiving culture in Korea and the sense of solidarity central to compassionate care [9]. It requires intentional effort beyond typical nursing roles, including touch, listening, and silence [38,39]. Improving clinical environments to allow quality interactions with patients is necessary for compassionate care.

Finally, the behavioral domain involves meeting patients’ needs through compassionate care behaviors, including attributes of therapeutic partnership care, professional care, personalized care, ethical care, and holistic care. Compassionate care emphasizes engaging with others’ suffering through rational understanding [9] and a commitment to action that extends beyond the mere desire to alleviate distress [44]. This study identified therapeutic partnership care-the nurse's active and compassionate involvement with patients and families through emotional and therapeutic cooperation-as a key behavioral attribute of compassion. This finding aligns with Pfaff and Markaki's [45] framework of compassionate care as a partnership, particularly in palliative and end-of-life contexts. As effective communication and patient involvement are known to enhance care outcomes [40], these results support the view that compassionate care functions as a motivational process that fosters participatory, collaborative relationships between nurses and patients [46].

‘ Professional care’ was identified as an important attribute, aligning with previous studies emphasizing nurses’ confidence, skill, and competence [2,36]. Compassionate care integrates clinical excellence, ethical values, and responsiveness to needs, linking moral virtue with the scientific and technical aspects of nursing [11], improving patient perceptions of care quality [38].

‘ Personalized care,’ reflecting individual needs, aligns with prior findings of ‘ individualized care’ [17], preserving patient respect, identity, values, and self-esteem [4]. ‘ Ethical care’ relates to the moral and humanitarian values of nursing, encompassing dignified care of the dying [45], privacy respect [11], patient rights [36], and nursing's philosophical foundation [10,36]. Compassionate care motivates nurses to practice ethical values altruistically, respecting patient dignity [8].

‘ Holistic care’ was emphasized, consistent with studies suggesting nursing addresses all human needs and continuous patient problem management [36]. In the US, Neo-natal Intensive Care Unit nurses and physicians reported ‘ professional commitment’ and family-involved communication as key components of compassionate care [47]. Compassionate care is comprehensive, including patients’ emotional and spiritual needs. Previous studies noted that prescription-based tasks can hinder holistic care, emphasizing the need for supportive work environments and managers [48]. Thus, fostering human-centered, rather than task-oriented, organizational cultures is essential for providing compassionate care in clinical practice.’

In comparison to previous international concept analyses, such as Burnell's framework including sensitivity, awareness of suffering, and efforts to alleviate suffering, or Su et al.'s concept of empathy-driven therapeutic communication [6,17], this study expands upon the behavioral domain by including relational and ethical practices specific to Korean clinical settings. Attributes such as trusting relationship and therapeutic partnership care-interpreted as emotional partnership with patients and families-highlight the cultural context where Confucian values and family-centered decision-making are prominent.

Moreover, previous measurement tools, such as the Compassion Competence Scale developed by Lee and Seomun [22], include subdomains like communication, sensitivity, and insight. While these tools effectively capture individual competencies, they do not reflect the relational, organizational, and sociocultural dimensions found in this study's results. For instance, the emphasis on ethical care and holistic care emerged from real clinical interactions rather than theoretical abstraction, suggesting that compassionate care is enacted through professional judgment and moral presence in context-specific ways.

Therefore, this study contributes to a more practice-based and culturally embedded understanding of compassionate care, offering a conceptual structure grounded in the experiences of Korean clinical nurses, and complementing the existing literature by revealing culturally distinct, behavior-oriented attributes.

Nevertheless, this study has some limitations. First, it only considered the perspectives of clinical nurses, without including those of patients or families. A more comprehensive understanding of compassionate care could be achieved through triangulated perspectives. Second, while participants came from various departments, they were all drawn from general hospital settings, which may limit the generalizability of findings to other healthcare contexts such as long-term or community-based care. Finally, although this study considers the cultural aspects of compassionate care, further research is needed to compare these findings with those from other cultural contexts and healthcare systems. Developing and validating a culturally sensitive measurement tool for compassionate care based on these findings is also recommended.

CONCLUSION

This hybrid concept analysis study used a mixed methods approach to identify the nature and attributes of compassionate care. The results revealed that compassionate care consists of three domains (cognitive, relational, and behavioral) and 11 attributes, defining it as ‘ recognizing individual patient needs, immersing oneself in their suffering, building a trusting relationship through emotional connection, and providing therapeutic partnership, professional, personalized, ethical, and holistic care.’ These findings clarify the complex concept of compassionate care in nursing literature, contributing to domestic nursing research and guiding nursing practice. They can also serve as a basis for developing intervention programs to improve the quality of nursing care.

Based on these findings, further research is recommended to explore patients’ and families’ perspectives on compassionate care, develop a compassionate care measurement tool, and create strategies to promote compassionate care among clinical nurses, considering its cognitive, relational, and behavioral aspects

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