Introduction
Heart failure has symptoms such as shortness of breath, fatigue, anxiety, and pulmonary congestion, which eventually lead to the heart’s inability to adequately pump blood around the human body [1]. It affects more than 64 million people worldwide, and therefore attempts to decrease its social burden have become a major global public health priority [2]. Heart failure remains a leading cause of morbidity and mortality, imposing high health-related costs on both patients and society. Diagnostic and therapeutic advances in recent years have led to an increase in the survival rate of patients with heart failure [3]. Heart failure has a collective survival rate of 10% (ten years post diagnosis) [4]. However, in Iran, non-adherence to treatment and reduced health literacy has resulted in a higher mortality rate for those diagnosed (18.2%) [5]. Such disparities are concerning where Global Millenium Development Goals remain committed to reducing inequalities. Since patients with heart failure may experience sudden and unexpected challenges including in many cases, death, addressing the concept of nursing care is critical in this context [6, 7].
Background
Nurses play a critical role in providing high quality care for those affected [8]. A key element of this care is compassion [9]. Indeed, compassionate nursing care provides understanding about how suffering may be reduced [10], which in turn improves the quality of care along with patient satisfaction [9]. Consequently, many studies have investigated the concept of compassion in nursing care. For example, one study conducted in the United States of America (USA) demonstrated how compassion is a key building block of high-quality patient care [11]. Similar findings have been reported in research conducted in Australia [12], Finland [13], and Sweden [8]. Nevertheless, where nurses feel helpless in their pursuit of improving the condition of patients with heart failure, they can experience profound stress [14], though the provision of compassionate nursing care has also been positively linked to workplace resilience [15]. Such nuanced findings provide opportunities for deeper exploration. Whilst nurses’ perceptions in providing compassionate care in other clinical settings in Iran (e.g., pediatric oncology, intensive care units and geriatric wards) have been the investigated [16‐19], no study in Iran has yet investigated the lived experiences of nurses in providing compassionate care to patients with heart failure. This is an important gap identified in the Iranian literature, particularly where outcomes for those with heart failure are markedly poor. Given this lack of evidence on the delivery of compassionate nursing care to patients with heart failure in Iran, there is a key opportunity to contribute deeper understandings with regards to the delivery of such care and uncover the meaning of Iranian nurses providing compassionate care to patients in this context, drawing from their lived experiences. Such understandings will be important as Iran looks to overcome its challenges in this area.
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Considering the above, the research team, which includes nurses with extensive experience in this field sought to answer the following research question: “What is the meaning of nurses providing compassionate care to heart failure patients according to their lived experiences? The lead researcher remained reflective of their clinical nursing experience and records in this context having worked with heart failure patients, both as a nurse and as a nursing researcher throughout. Hermeneutic phenomenology was employed as a research method in this task, as this phenomena has yet to be uncovered in the context of Iran. The aim of this study was to uncover the meaning of nurses providing compassionate care to heart failure patients according to their lived experiences.
Materials & methods
Design
This study employed a qualitative approach, drawing from hermeneutic phenomenology, which combines phenomenology (the exploration of lived experience) with hermeneutics (focusing on interpretation and meaning-making) [20]. The design of this study is guided by Heideggerian hermeneutic phenomenology in particular [21]. Hermeneutic phenomenology is the theory and practice of interpreting and understanding different types of human contexts, where individual lived experiences and interpretation are essential elements to understand the phenomenon that is to be explored [22]. Indeed, Hermeneutic phenomenology is a philosophical approach that enables researchers to understand meanings hidden in human interaction through their lived experiences along with deep explorations of a particular phenomenon. In this way, insights are also created through the discovery of meanings [20]. Such insights can then be used to understand the world in new ways, enabling new directions to open up in the process of change. Epistemologically, hermeneutic phenomenology observes relationships between the knower and what can be known where losses of certain kinds of knowledge about the human experience, such as meaning making have arguably ensued [22]. In their works, Heidegger removed any distinction between ones person and their experience, interpreting them as co-constituting each other and unable to exist without the other. As such, bracketing is impossible, as one cannot stand outside the pre-understandings of one’s experience [21].
Setting and participant recruitment
This qualitative study was carried out in two referral cardiac teaching centers located in Tehran, where heart failure patients from all over Iran are being treated and cared for. The sampling method was purposive. Nurses were eligible to participate if they were in full-time employment and had experience (< 1 year) of caring for patients with heart failure. After visiting study site, we coordinated with head nurses, who acted as gatekeepers for recruitment. Primarily, potential and eligible participants were given information about the study and its objectives via email and a recruitment flyer. We continued to recruit, aiming for maximum variation in age, gender, education level and time caring for heart failure patients until data saturation was reached.
Data collection
This study was reported in accordance with the Standards for Reporting Qualitative Research (SRQR) [23]. Data collection commenced in December 2023 and continued for 3 months. Semi-structured and face-to-face interviews were used to collect data from participants. All interviews were conducted by the first author, as an academic nurse, who had received training in qualitative research methods. Prior to the interview taking place, timings and interview arrangements were agreed between the researcher and participant. Each interview lasted between 45 and 60 min, and were undertaken in the conference room of the inpatient department. All participants (n = 14) were interviewed whilst off duty, once. Though interviews were held in a conversational style, we also collected brief demographic data including age, sex assigned at birth, number of years’ experience in caring for heart failure patients, and level of education to ensure a representative sample and enable reporting on the samples relative diversity. The interview guide was developed by the research team, drawing from previously published research conducted in similar contexts and according to the aim of this study (Appendix 1).
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Data analysis
Data collection and analysis were carried out simultaneously. Interview texts were translated into English and analysed manually. The 7-step method of Diekelmann et al. (1989) was used to make sense of the data [24]. This method of data analysis is frequently used in tandem with hermeneutic phenomenology due to its ability to enable researchers to make sense of the data and unearth new meanings in a structured way through the following steps:
1)
Reading all interviews to get a general idea.
2)
Writing interpretative summaries for each interview.
3)
Analyzing the selected versions of interview texts through group analysis and identifying themes and subthemes.
4)
Returning back to the interview text or participant in order to clarify ambiguity and resolve disagreement and contradictions in the interpretation of data and writing a general and composite analysis of each interview text.
5)
Comparing interview texts in order to identify, determine and describe common meanings.
6)
Identifying and extracting the constitutive pattern that connects the themes.
7)
Presenting the final findings in the form of main themes.
Accordingly, each transcription was first reviewed several times to generate an overall general sense of meaning and understanding. An interpretive summary was then written for each of the interview texts, and an early attempt was made to understand and extract the meanings hidden in them. The research team subsequently exchanged thoughts with regard to how sub-themes and themes may be shaped around the meanings identified. With the continuation of subsequent interviews, the previous themes became clearer and developed further, giving rise to new themes and subthemes. In order to clarify and resolve any disagreements and contradictions in the interpretations, the researchers continuously returned back to the interview texts and participants to clarify any ambiguity. In essence, the research team embraced a hermeneutic circle of interpretation – moving back and forth between different parts of the data and the whole interview transcript, alongside researchers’ interpretations. Finally, the level of openness was improved as the research team achieved consensus in their interpretations. A sample of data analysis is presented in Table 1.
Table 1
A sample of data analysis
Themes | Subthemes | Meaning units | Narratives |
|---|---|---|---|
Humanizing compassionate care | Put yourself in the patient’ s shoes | -Listening to patients -Understanding patients -Looking after patients | “We provide compassionate care to patients by listening to them, understanding them and looking after them”. (Participant (P) 3) |
The superiority of altruism over duty | -Being altruistic towards patients at all times -loving patients -Taking care of patients on a level beyond ones duty | “It is important to be altruistic towards patients at the present moment, and I should say, at all moments. It’s about loving them, so you have to take care of them on a level beyond the call of duty.” (P11) | |
Relying on the pillar of honesty in giving information to patient | Honest explanations about illness for patients | “I always want to give patients an honest explanation about their illness.” (P12) | |
Respecting the patient’s cultural beliefs | Provision of care by nurses of the same sex | “Some aspects of care for patients in our country must be done in a compassionate manner by nurses of the same sex”. (P4) | |
The paradox of compassionate care | Satisfaction through compassion | -Seeing the positive results of compassionate care in one’s personal life -The joy of work -Having a ‘good feeling’ | “I have seen the result of compassionate care for patients in my own life, where I enjoyed my work, I was satisfied with it and had a good feeling.” (P7) |
Compassion fatigue | -Turning into a wilted flower -Decreased hope for patient recovery | “When compassionate care lasts for a long time, we turn into a wilted flower. It gets worse and hope for the patient recovery decreases”. (P10) |
Rigor
Credibility, transferability, dependability and confirmability were used as criteria to determine rigor [25]. In order to determine credibility, prolonged engagement, rich and comprehensive descriptions, member-checking, triangulation, and reflexivity were used. Thus, the opinions of the research team were used in connection with the process of data collection and analysis. Final findings were discussed and reflected upon with some of the participants as well as two people holding doctoral nursing degrees. In order to determine the transferability of our findings, detailed information within the method section, including the sampling style, data saturation and procedures of data gathering and analysis were provided. Moreover, complete reports and contextual data relating to nurses’ lived experiences are provided to allow for the use of this evidence in other contexts. In addition, the diversity of our sample in terms of demographic data (e.g., sex, age, and job experience and level of education) also strengthen the credibility and transferability of findings. In order to determine dependability, the reflections and insights of an external observer (a researcher who is familiar with both the phenomenon under study and qualitative research) were also used. To determine confirmability, all activities were recorded in detail and a report of the research process was finalized in partnership with the wider research team. Lastly, the research team aimed to avoid confirmation bias by remaining reflective throughout and including all data in their analysis, whether it supported their hypothesis or not.
Results
A total of 14 nurses aged between 27 and 55 years, and with 2–7 years’ experience of caring for patients with heart failure participated in this study. The majority were assigned female at birth (n = 9), and held a bachelor’s degree (n = 10). The remainder (n = 4) had a master’s degree. (Table 2)
Table 2
Characteristics of the nurses
No. | Age (year) | Sex assigned at birth | Education level | Work experience related to heart failure care (year) |
|---|---|---|---|---|
1 | 38 | Female | Bachelor’s degree | 5 |
2 | 55 | Female | Bachelor’s degree | 7 |
3 | 42 | Female | Master’s degree | 5 |
4 | 38 | Male | Bachelor’s degree | 6 |
5 | 43 | Male | Bachelor’s degree | 7 |
6 | 32 | Female | Bachelor’s degree | 7 |
7 | 30 | Female | Master’s degree | 6 |
8 | 34 | Female | Bachelor’s degree | 5 |
9 | 27 | Male | Bachelor’s degree | 2 |
10 | 39 | Female | Bachelor’s degree | 7 |
11 | 41 | Female | Bachelor’s degree | 6 |
12 | 43 | Female | Master’s degree | 5 |
13 | 32 | Male | Bachelor’s degree | 5 |
14 | 36 | Male | Master’s degree | 7 |
Data analysis revealed two themes and six subthemes along with one constitutive pattern. The constitutive pattern was revealed in the form of the following phrase: “the unbreakable chain of human relations in compassionate care delivered to heart failure patients”. Themes and sub-themes expressed the meaning of compassionate care for heart failure patients according to the lived experiences of nurses and are presented below with poignant quotes used to highlight prominent overall sentiments.
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Theme one: humanizing compassionate care
Participants revealed their attempts to maintain human values while providing compassionate care to heart failure patients. Based on this, while having empathetic behavior towards patients, they were also honest in giving them accurate information about their illness. Moreover, they considered altruism superior to duty and respected the patient’s cultural beliefs above all. This first theme included the following 4 sub-themes (1) empathic behavior, (2) superiority of altruism over duty, (3) relying on the pillar of honesty in giving information to patients, and (4) respecting the patient’s cultural beliefs.
Subtheme: put yourself in the patient’ s shoes
Compassionate nursing care was provided to patients with heart failure through empathetic behaviours such as understanding and listening to them along with imagining themselves or a family member in the place of their patient. Our sample often described how such care was delivered and the impacts it had on their patients.
“We provide compassionate care to heart failure patients by listening to them, understanding them and looking after them. Patients want a good nurse who would listen to their problems and calm them down. I have really felt that I have been a source of comfort for patients at times like this”. (Participant (P) 3)
In providing compassionate care for heart failure patients, nurses had empathy with them in the most challenging situations. For example, in cases of impaired cardiac function or extremely low ejection fraction, they understood how the patient may be feeling and put themselves in their shoes.
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“It is important to compassionately put ourselves in the patients’ shoes. For example, put ourselves in a patient’s shoe who has a very low ejection fraction. What that makes us really feel? Or put ourselves in a patient’s shoe whose cardiac function is completely impaired … I have experienced that, and I thought as if my sister, father or mother or one of my relatives are hospitalized here. There is no difference.” (P5).
Subtheme: the superiority of altruism over duty
In this subtheme, the superiority of altruism over duty in providing compassionate care to heart failure patients revealed itself in the form of providing services beyond duty, being altruistic towards patient at all times, going extra mile for patients with foreign citizenship, and comforting patient’s family after their death.
The lived experiences of the nurses in this context revealed that they do not have a mechanistic view of the patient when providing compassionate care, rather, they express love for their patients as human beings.
“We don’t work with objects, we work with human beings who are incapacitated due to heart failure, so it is important to be altruistic towards patients at the present moment, and I should say, at all moments. It’s about loving them, so you have to take care of them on a level beyond the call of duty.” (P11).
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In this context, compassionate care was provided for heart failure patients, regardless of their race or nationality. In this regard, nurses went above what was required of them in their job description to ensure such patients had their healthcare costs covered. These were considered to be actions related to the delivery of compassionate care.
“Regardless of the color, race or nationality of the heart patient, we provide compassionate care to all patients. For example, in this center, we have many patients from Afghanistan, who generally have economic problems and bear all the treatment costs themselves. Many times, I have consulted with the hospital director to reduce the healthcare costs for these patients. Although this is not in my job description, but I believe that this is the nature of compassionate care”. (P2)
According to the lived experiences of these nurses, altruism in compassionate care has a spectrum that includes not only heart failure patients, but also their families. This was evidenced through nurses consoling family members following the death of patients, despite their busy workloads.
“Even when a patient goes into cardiac arrest and despite all our efforts, resuscitation is unsuccessful and patient dies, the ward is very busy and our duties within the ward increase, but we make time for the patient’s family and console them. I want to say that this altruism in compassionate care should include patients’ families”. (P9)
Subtheme: relying on the pillar of honesty in giving information to patient
Nurses expressed a need to provide patients with honest information in relation to their condition in a compassionate manner. They considered this to be one of the patient’s rights. According to them, the nurse is the mirror of reality in this regard.
“I try to give patients the necessary explanations about heart failure with honesty and based on compassion. I mean all information, including the diagnosis, the course of the disease, the state of cardiac output, the results of laboratory tests and para-clinical procedures. In fact, my colleague and I try to be a complete mirror of reality for patients”. (P1)
Nurses expressed the ways in which they were trying to provide honest information to patients in providing compassionate care. This was especially evident in cases where the nurses suspected that the patient was a candidate for a heart transplant.
“I always want to give patients an honest explanation about their illness, because their heart as a vital organ is impaired and they may eventually need a transplant, so I think they have the right to know what has happened to them and what they should expect.” (P12).
Subtheme: respecting the patient’s cultural beliefs
Evidently, nurses experience the provision of compassionate care for heart failure patients as influenced by cultural elements. This influence is also manifested in a spectrum that ranges from hospitalization to post patient death. Therefore, nurses see the need to respect cultural beliefs as being very important in this regard.
Indeed, it was very important for these nurses to consider the role of culture in providing compassionate care. As an example, one nurse expressed how they paid attention to the cultural views of patients regarding caregiving by someone of the same sex.
“Some aspects of care for heart failure patients in our country must be done in a compassionate manner by nurses of the same sex. For example, if a female patient requires an electrocardiogram (ECG) and a male nurse performs the ECG, the patient’s privacy may be violated from the patient’s point of view. In this situation, the patient may feel embarrassed, which has cultural roots”. (P4)
Based on the lived experiences of nurses, the culturally-based elements of compassionate care for the patient, even after death are considered crucial. As such, nurses covered the patient’s body and asked for God’s forgiveness, as this was considered to be in line with their cultural norms.
“It is the patient’s right to be respected in terms of cultural norms, whether he is in the hospital or when he dies. After the death of a patient, I make sure to cover his body and recite prayer for him and ask God for his forgiveness, because I believe that the deceased should be respected. On the other hand, this is in our cultural teachings and the patients also believe in it, and I consider it obligatory to perform it for the patient after his death”. (P13)
Theme two: the paradox of compassionate care
Nurses had experienced contradictory situations in providing compassionate care to their heart failure patients. They expressed experiences both in relation to the satisfaction of providing compassionate care to the point of reaching self-fulfillment and also the exhaustion caused by the very compassionate care they provide. Two subthemes related to this main theme including (1) satisfaction through compassion and (2) compassion fatigue.
Subtheme: satisfaction through compassion
Nurses associated the providing of compassionate care to patients with a sense of openness at work, enjoying work and being satisfied with it. This was revealed as a unique experience that overshadowed their personal and professional lives.
“I have seen the result of compassionate care for heart failure patients in my own life, where I enjoyed my work, I was satisfied with it and had a good feeling. I also felt an openness in spirit as if work is being useful to patient. First, it creates openness in my spirit and then it gives me energy to continue working and living a better life.” (P7).
Nurses expressed the positive consequences they experienced of providing compassionate care, and the pride of the work that leads them to self-fulfillment.
“All the good things that happen to me, I’m sure, it goes back to caring for these patients. This is the satisfactory result of our work and it’s one of the beautiful aspects of this kind of care that ultimately comes with a self-fulfillment for us. I have experienced this satisfaction in compassionate care of heart failure patients in a magnificent, great and unparalleled way.” (P14).
Subtheme: compassion fatigue
Nurses experienced fatigue caused by the compassionate care they delivered to heart failure patients. They describe being victims of compassionate care, as it ultimately leads to burnout for them and their consequential and paradoxical failure to subsequently provide effective compassionate care to patients.
Compassionate care for a heart failure patient was described by one nurse as being similar to the life of a flower, which is fresh at the beginning of life, but fades as it continues.
“Compassionate care for a heart failure patient is like the life of a flower. At first, we take care of patients compassionately and they feel much better. You know, we are fresh like a flower and enjoy the compassion in care, but when this care lasts for a long time, we turn into a wilted flower. It gets worse and hope for the patient recovery decreases”. (P10)
Nurses also highlighted how the continuation of compassionate care for patients was associated with nurse ‘meltdowns’. In this regard, nurses faced a range of psychological problems and it was feared that these problems would jeopardize their provision of effective care.
“I feel that over time I am melting down by providing compassionate care for these patients. I am afraid that it will reach a point where I can no longer provide effective care for them. In fact, I feel that I have become a victim of compassion for patients. I personally, get nervous easily, my social connections are reduced, and I develop anxiety, headaches and even a feeling of worthlessness. I am faced with the suffering and pain of patients, especially when a patient is at the end of his life and finally dies after a lot of effort. Seeing the death of these patients somehow creates extreme fatigue in me.” (P6).
The constitutive pattern
The unbreakable chain of human relations in compassionate care delivered to heart failure patients.
Based on the lived experience of nurses, the compassionate care given to heart failure patients refers to a care that benefits from a humanistic approach. Compassionate nursing care delivered to heart failure patients in this context is based on values such as empathy, honesty, altruism and respect for the patient’s cultural beliefs during their life and even after their death. Indeed, compassionate care for heart failure patients is a multifaceted phenomenon that considers the wholeness of the human being and is a care that looks at the whole patient. However, this type of care, while bringing fulfillment to nurses, is challenging for them as they experience a paradox that both makes them happy and threatens to exhausts them. This care has a reality in its meaning. Although it is mixed with negative reflections, it does not lead to a break in the human relationship between nurses and patients, rather, it creates an unbroken chain of human relationships between them. The understanding of nurses providing compassionate care changes over time as it becomes challenging and imposes psychological stress upon nurses. However, even in these difficult circumstances, it is sustained by the meaningful relationships built.
Discussion
In this study, the meaning of compassionate care for heart failure patients was uncovered through the lived experiences of nurses. The constitutive pattern derived from this research aligns with the guiding philosophy of hermeneutic phenomenology, because according to Heidegger; “the world in which a person lives is a world shared with others, and being with others is an experience that comes from being in the world” [21]. Essentially, findings explain how the lived experiences of nurses relate to the world in which they share with heart failure patients. Evidently, nurses have created an unbreakable chain of human relationships in providing compassionate care to heart failure patients. In this regard, they experience humanizing compassionate care as well as the paradox of compassionate care. Participants provided compassionate care for heart failure patients based on personal and professional values. Similarly in the Netherlands, evidence highlights how providing compassionate care in this way strengthens the relationship between nurses and patients, and that there is a shared humanity in this care [26]. Likewise, in England, compassion in care was described as something which improves the quality of relationship between the carers and their patients [27]. As a research team, we consider that this perhaps demonstrates how humanizing compassionate care in nursing is a universal experience in strengthening relationships and is important in a context where understandings relate to increasing the survival rate of those with heart failure.
Through the lived experience of nurses, we explain how having empathy (a component of compassion) towards patients leads to better patient outcomes and satisfaction. Similar findings have been reported in Australia [28], and the USA [11]. Indeed both empathy and altruism are considered to be the building blocks of compassion in care [29, 30], as is further demonstrated from research conducted in Canada [31]. Considering the above, future healthcare services will need to cultivate and nurture such compassion in nursing care, particularly in pursuit of better outcomes and engagement.
Honesty was considered key in providing illness-related information and compassionate care for heart failure patients in this context. Nurses used the following metaphor to describe this phenomenon as a “mirror of full reality”. Interestingly, in Heidegger’s thought, the truth emerges when the existence of beings come out of concealment [21]. Indeed cardiologists also contend that heart failure patients need to know more about their disease regardless of its severity [32], preferably as early as possible in the diagnosis [33]. Attention on this particular factor in nursing care and beyond may in turn increase the particularly low survival rates of patients with heart failure presently seen in Iran.
The lived experience of nurses further illuminated how nurses respect the patients’ cultural beliefs both during their life and after their death in order to provide compassionate and humanistic care for them. Heidegger similarly contends that we are not alone, but live with others and alongside them, and so we must respect each other’s rights [21]. Nurses further narrated that some patients can experience a kind of cultural shame when care procedures are undertaken by a nurse perceived to have a different sex from them. Indeed, findings demonstrate that compassionate care is based on culture and is greatly influenced by the cultural norms and values of the society in which people live. Similar findings have also been reported from Canada [31]. Referring to clinical experiences in caring for heart failure patients, researchers in this Canadian study posit that without a proper understanding of society’s cultural roots from which the patient comes from, it is not possible to provide compassionate care for them. A such, cultural considerations will be an important element of compassionate care going forward [31].
Findings concerningly unearth the paradox of providing compassionate care for heart failure patients. This paradox refers to both satisfactions gained by nurses from the delivery of compassion in care and the fatigue caused by such care. In this regard, the increase of one element can lead to the decrease of the other. Elsewhere, the presence of this paradox has reportedly resulted in lower care quality and poorer outcomes when compassion fatigue emerges [34, 35]. For nurses, satisfaction through compassion in care led to openness in their work and life, and also self-fulfillment, turning the compassionate care of heart failure patients into an unparalleled experience for them. However, metaphors such as the “withering flower”, “melting down with the passage of time” and “being a victim of compassion for patient”, which were evident in the nurses’ narratives, indicated that by drowning in the sorrow and pain of patients, they were experiencing a series of disturbing psychological symptoms. Compassion fatigue in nurses providing care for patients with life-threatening conditions is widespread [36], particularly where patients have chronic conditions [37]. Such compassion fatigue can result in psychological distress and discomfort [38, 39], which is concerning as this can endanger nurses’ personal and professional lives [40]. Despite the compassion fatigue noted, nurses expressed feelings of joy when they experienced certain human events whilst providing compassionate care. Given the above, it will be important to facilitate and promote compassionate nursing care alongside robust work-related psychological support for the workforce in this context to maintain and nurture it safely.
Limitations
A key strength of this study is its rigor and uniqueness in a context where limited evidence exists. Given the significance of its findings, this research paves the way for further extensive studies in the field. Nevertheless, the findings of phenomenological studies are co-constructions developed through interpretation of both researchers and participants. Thus, our findings must not be wholly generalized to all nurses in other contexts. Nevertheless, the purpose of qualitative research such as this is not to provide generalizability of findings, as findings depend on the context and are affected by the culture of research setting. As this study only included data derived from interviews with nurses, future studies could incorporate the perceptions of other healthcare professionals and patients to gain a deeper understanding of the lived experiences of compassionate care for heart failure patients.
Conclusions
This study is the first phenomenological study to explore compassionate nursing care delivered to patients with heart failure in Iran. The findings reported broaden understandings of compassionate care in this context, helping to clarify the meaning of this concept for other nurses whilst also being a guide for them to provide care based on cultural context. Compassionate nursing care must be nurtured, promoted and upscaled whilst at the same time providing robust work-related psychological support for the workforce delivering it. Our findings inform other nurses and healthcare settings about the negative reflections associated with the delivery of compassionate care. As a research team we considered that this knowledge may have a preventive effect on nurses experiencing compassion fatigue, and ultimately lead to the development and continuation of compassionate care in this context. This research also provides useful evidence for managers developing compassionate care in clinical practice. Nevertheless, nursing managers should also consider how they may mitigate the development of compassion fatigue in this pursuit. For example, nursing managers may refer nurses to psychologists to identify and address symptoms of compression fatigue before any negative impacts have time to manifest. The findings presented here may further be used in nursing education to develop compassionate care for heart failure patients. In this regard, training programs such as compassion-based education for nurses should be considered.
Acknowledgements
The researchers are thankful to all of the participants who participated in this research.
Declarations
Ethics approval and consent to participate
Recruitment commenced after ethical permission for the study was granted by the ethics committee of Iran University of Medical Sciences (IR.IUMS.REC.1402.482). Written informed consent was obtained from all participants, and the right to withdraw at any stage of the research was respected. All procedures were carried out in compliance with the ethical rules and regulations of the Helsinki Declaration.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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