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The motive for compassion can stem from personal or professional ideals, moral values or virtues. According to dictionary definition, ‘ideals’ are standards of perfection, ‘virtues’ are behaviours or qualities seen as morally good or desirable; and ‘morality’ reflects principles concerning the distinction between ‘right’ and ‘wrong’ (Concise Oxford English Dictionary, 2003).

Von Dietze and Orb (2000) explored the concept and defined compassion as a moral choice and not just an emotional connection between the nurse and patient and a response to suffering. Through exploring the international literature on compassion, they provided a perspective that distinguished compassion from empathy and sympathy, defining it as requiring deliberate participation in another person’s suffering and not just identifying their suffering, supporting the notion that there is more to compassionate practice than just recognising need and providing care. Their definition resonated with the recent NHS guidance, where compassion comprises the practical expressions of the ability to be there for patients ‘because we care’. It could be argued that moral choice, as a feature of compassionate practice, emphasises the requirement for a moral, ethical and an emotional engagement with the patient, intentionally caring about as well as caring for the patient. It is not just the practical acts of care such as feeding, helping maintain personal hygiene, and talking with patients that constitute compassionate practice but the attitude and moral virtue

in which these acts are carried out.

Compassion as a virtue allows nurses to make the ‘right’ decisions and demonstrate excellence in their practice. Interestingly, von Dietze and Orb (2000) also identify differences between compassionate practice as an affective or emotional approach where there are feelings of love and value for fellow human beings and compassionate practice as an altruistic participation in another person’s suffering requiring rational thought and not just sentiment. Such discussion resonates with Armstrong’s belief in compassion as an altruistic

component of what it is to be a human being living among other human beings (Armstrong, 2011). Von Dietze and Orb (2000) state:

‘Compassion is more than simply conveying our understanding of their suffering, it involves both insight and thoughtfulness and the ability to communicate these to a suffering person in such a way as to alleviate some of the suffering. However, it does not require us to immerse ourselves in their suffering so that we merely suffer too. ’ (von Dietze and Orb, 2000:169)

They explain that the practical expressions of compassion at the heart of nursing practice are the ability to ‘be there’ for the patient and offer solidarity, consolation and support. This in turn can be seen to require empathy, as understanding the patient’s experience would be required in order to offer solidarity and support. Von Dietze and Orb (2000) conclude that in order to maintain a compassionate approach nurses must proactively participate, re­ orientate some of their nursing practices, and emphasise the importance of compassion, so that compassion is at the core of that which defines successful nursing.

It can be argued that the ability to ‘be there’ for patients and take time to communicate with them, poses challenges to current nursing provision in a system where the reality of reduced hospital stays and the impact of scarce staff resources, mean patients and nurses spend less time in each other’s company (RCN, 2010a). Perhaps the reality of 21 Century nursing practice impacts upon the idealism of opportunity for sustained compassion. It could be surmised therefore that this could lead to a feeling of discomfort for nurses who wish to retain the contact and compassion and yet haven’t time or opportunity to develop the relationships with those for whom they care, in which compassion would thrive. However, compassion is very much part of the language of nursing practice, both required and desired within 21 century healthcare provision, whether or not it is a feasible or realistic expectation.

Another nursing theorist, Alan Armstrong (2006), proposes that as nursing is a practice, so nursing ethics should regard compassion as a virtue and this ‘trait or character’ in nurses needs to be better understood and valued. Many of the virtues identified by Armstrong (2006) are those recognised as professional ‘values’ within nurse-patient relationships; to act with kindness, compassion, courage, respectfulness, patience, tolerance, trustworthiness

and honesty. In addition to this, Armstrong suggests using a virtue-based approach to understanding nursing care could improve understanding of the role emotions and morals play in nursing (Armstrong, 2006). His philosophy attempts to redirect nurse education to consider whether students can learn to be virtuous and how virtues can be taught, distinguishing between the ‘obligation’ to enact the values of nursing and the ‘desire’ to enact the values of nursing. He concludes that high quality care that is therapeutic, in that it relieves suffering, is synonymous with a virtues-based approach to care. Such conclusions are supported by Ersser (1993) who explains that therapeutic relationships in nursing require nurses ‘relating’ to the person they are caring for in a way to optimise the therapeutic opportunity (Ersser, 1993:24).