From spotlight - Spring 2018 - Caring more compassionately
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Steve Fouch looks at a Christian understanding and application of compassion
'I would rather feel compassion than know the meaning of it' Thomas Aquinas
Sometimes we know something when we see it, but we cannot fully explain it or define it in words. Compassion is something we all recognise when we see it in practice, but pinning it down to a clear definition is harder to do.
It is more than disinterested love - it is a real feeling for the suffering of another person, and then acting on it.
Children can show it at a very early age. I remember after my mother died, my wife was quietly weeping when my one-year-old daughter, who had just learnt how to walk, toddled over and gently laid her head in my wife's lap and stroked her hand. She could not speak and had no idea why her mother was weeping, but she did understand that Mummy needed comfort.
Empathy is innate, at least in part, determined genetically and by our upbringing. (1) It is ironic then that other research shows that medical and nursing schools can have a dampening effect on empathy! (2) Working in an environment that does not give you to time to care, or where you constantly deal with the most awful of human experiences can erode empathy. Workplace culture can further add to this - we have probably all worked a shift or more on a ward where the ethos is to get by with doing the essentials and no more; where going the 'extra mile' for a patient is frowned upon, as it shows up the lack of compassion in the rest of the team. I have worked in a few such units as an agency nurse - and in every case asked never to be sent back again!
Understandably, there is now a drive to teach compassion again as part of nurse training. The media and general public are horrified by the idea that compassion can be taught; this is not something that can be learnt in a classroom, they argue.(3)
And in many ways, they are right. Compassion is not an academic discipline. However, it is something that can be cultivated and grown within us.
Compassion as a Christian virtue
'Throughout nursing history, compassion has been viewed as a quality associated with an individual's character. Compassion stems from virtue. It is about the intent and practised disposition of the nurse. It is nurtured in, and by, the culture and ethos of clinical practice.'
Anne Bradshaw (4)
Our Western understanding of virtue stems (at least in part) from the Greeks who saw the virtues as principal human strengths that generate and are generated by the character of the individual. However, in Greek thinking the main virtues were mostly seen as masculine (courage, strength, restraint, wisdom) and compassion was not regarded as one of them. Indeed, if anything it was seen as a weakness in a man, and of only passing value as displayed by a woman to her family (and even harmful if expressed to strangers or foreigners!). (5)
In modern thinking, virtue is not innate but a habit of heart and mind that is developed studiously by effort over time until it becomes 'second nature'. Therefore, a person of virtue is very much self-made, while those who lack virtue have only themselves to blame. (6)
In the Bible, virtue is something quite different.
Firstly, it tells us that compassion is a central part of God's character. (7) God created a world to be good and fruitful, but human disobedience and sinfulness caused it to become fallen and broken. (8) Pain and suffering are a consequence of the fall. (9)
The Bible speaks throughout of a God who passionately cares for his creation and acts constantly out of compassion towards his people. (10) Christians are called to walk in his footsteps and to display his character. (11)
Christian understanding of compassion is also shaped by our understanding of the incarnation. God himself entered our suffering by becoming human, a servant and ultimately a condemned man who died for us. (12) As John Wyatt says:
Because Jesus was a baby, all babies are special. Because Jesus was a dying man, all dying people are special. (13)
Jesus, by identifying with us so completely endowed our humanity with a profound dignity and worth. For Christians compassion comes with a strong sense of respect for the dignity of the person in need. It is not 'pity-love', but 'respect-love', recognising the image of God in the other person.
Finally, the Bible recognises humanity's inability to be truly virtuous. We are fallen, sinful beings unable to live according to God's will. (14) So, we can only become virtuous by the inner transformation of our self by repentance, acceptance of Christ as Lord and Saviour and by the indwelling power of the Holy Spirit. (15) It is about a transformation of character and will, in which we play a part, but which is ultimately God's work in us. (16) As NT Wright puts it:
Christian virtue, including the ninefold fruit of the Spirit (17) is both the gift of God and the result of the person of faith making conscious decisions to cultivate this way of life and these habits of heart and mind. (18)
So, for Christians, compassion becomes one of the highest of all virtues. It expresses the very heart and actions of God himself. It was this that spurred the early church into action, caring for abandoned infants, the poor, the dying and the disabled, to the scandal of respectable Roman and Greek society. In so doing, they laid the foundations of what has become the modern nursing profession. (19)
Caring with compassion
So, how do we put this into practice?
It starts with prayer - recognising our need for God to fill us with compassion - for our patients and colleagues (especially the 'difficult ones'). Take time out when you have a break to be quiet for a few moments; remember the Lord, lift up your day to him, be aware of his presence. Refocus on what really matters, not on the immediate pressures you face, and ask him to help you see the people behind the difficult patients and colleagues or the pushy managers. Ask his help to love the unlovely as he loves them.
Compassion requires attentiveness. Constant observation, not just of the physical state of our patients, but of their psychological and spiritual state is essential. This leads to the minute, pre-emptive responses and interventions that take our care from just being a response to immediate needs to anticipation of unexpressed need.
Compassion shows itself in the little things - the quiet word to the distressed patient, the rearranged pillow, the cup of tea made right and put in the correct place for the patient to reach it, and the reading of the body language that prompts the question about pain relief before the patient needs to ask. It is about listening, not just to the words used, but to the unspoken concerns and fears. (20)
My youngest daughter hurt her arm in a fall when she was about seven. For the best part of a day she walked around wincing and holding it gingerly, so I took her to A&E in the evening. It was busy, and we had a very long wait in a crowded room, but eventually she was seen by the paediatric triage nurse, who talked kindly to her, asking her about what had happened, how it hurt, what she had been doing all day, and so on. She held eye contact throughout her conversation as she gently flexed my daughter's arm and returned it to a normal position. Within seconds, my daughter relaxed and was no longer in pain. The nurse had spotted almost at once that the pain and gingerliness were down to anxiety, and not to any real injury. With a few further checks, we were discharged. Through observation, making my daughter the focus of attention, gentleness and a great deal of clinical experience, the problem was resolved in seconds. In other, more brusque hands, we would have had to go for x-rays and more tests. Compassion given over the course of a couple of minutes saved my daughter (and the NHS) needless time and hassle!
All this takes time and practice. In particular, it means we need to be watching and learning from others with more experience. It is also challenging on a busy unit where your interaction with a patient may be one-off and over in minutes. Preparation and attentiveness, even in pressurised situations can make all the difference.
Keeping compassion alive means taking care of yourself. Sleep, exercise and healthy food will all help you to re-charge physically and mentally. Feed your soul too. Prayer and Scripture, worship and church are all vital to this, but so is good company, listening to music, and spending time in the natural world. Sabbath rest, solitude and silence are all ordained by God as essential to our spiritual well-being. Take your days off and use them well!
Finally, remember that as compassion is a Christian virtue, it grows by the work of the Holy Spirit in us and by the application of our wills and effort to allow God to change us. Think about how you can show compassion to patients and colleagues on each shift and pray into those situations.
Learn these skills of attentiveness to the needs of your patient, but treat it not just as a clinical skill but as a Christian virtue that God is growing in you. As you show this virtue in your clinical practice, notice how it rubs off on your colleagues.
1. Therrien A. Genes have a role in empathy, study says, BBC News, 12 March 2018 bbc.in/2DwJuiP
2. Hojat M, et al. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Academic Medicine 2009; September: 84:1182-1191.
3. Whitehead M, Can compassion be taught to student nurses? Nursing Times, 21 May 2013 bit.ly/2FXYwQA
4. Bradshaw A. Compassion: What history teaches us. Nursing Times 2011; 107(19,20): 12-14
5. Ferngen B. Medicine & healthcare in Early Christianity. Johns Hopkins University Press, 2009:87-95
7. Exodus 34:6
8. Genesis 1 & 2
9. Genesis 3
10. Psalm 116 (esp. v4-9); Isaiah 30:7-9
11. Ephesians 5:1,2; 1 John 2:6
12. Philippians 2:1-11
13. Wyatt J. Matters of Life and Death. London: Inter-Varsity Press, 2009:78
14. Romans 3:21-25
15. 2 Corinthians 3:18
16. Philippians 2:12-13
17. Galatians 5:22-23
18. Wright N T. Virtue Reborn. London: SPCK Publishing, 2011: Chapter 6 Kindle Location 3579
19. Davey F. Introduction to Heralds of Health, Browne, Davey & Thompson Eds. London: Christian Medical Fellowship, 1985:1-16
20. Whelan J C, Fairman J & D'Antonio P [eds]. Routledge Handbook on the Global History of Nursing Oxon: Routledge. 2013: Chapter 10, Nolte K, Protestant Nursing Care Germany in the 19th Century: Concepts and social practice: 217-236