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A way of knowing, being, valuing and living with compassion energy: a unitary Science and Nursing as Caring perspective.

INTRODUCTION

The workplace challenges that nurses face today can have immediate and long term negative consequences for the nurse and the patient. The nurse desires to answer the call from the patient with compassion in the midst of a complex and rapidly changing health care system. Nurses experience fatigue within the taxing physical and emotional constancy of caregiving. Changes in the current healthcare delivery system have led the nursing profession toward increased emphasis on promotion of self-care, health and well-being for both the nurse and the patient. Dossey and colleagues remind us that it is difficult to be a healing presence with others if one's own vessel is empty (Dossey, Keegan & Guzzetta, 2005). When we give of ourselves to others at a time when we need to replenish our own sense of vigor, the quality of that relationship may deplete rather than nourish either participant (Dunn, 2005).

The purpose of this paper is to propose the use of the concept of compassion energy between the nurse and the patient as a response to the concept of compassion fatigue. The paper will draw a link between Rogerian Science of Unitary Human Beings (SUHB)(Rogers, 1970) and Nursing as Caring (NAC)(Boynkin & Schoenhofer, 2001) theories through the lens of compassion energy, a concept that may emerge during the nurses' presence with the patient. Chinn & Kramer (1991) described the process of creating a useful conceptual meaning as a way of creating a useful meaning rather than assigning a definition. SUHB and NAC theories provide a creative synthesis among a theoretical idea, direct observation and personal experience to build a conceptual framework called compassion energy (Boykin & Schoenhofer, 2001; Chinn & Kramer, 1991; Dunn, 2007; Rogers, 1970).

Compassion Fatigue connotes negative outcomes leading to burnout that occurs within the caregiving experience. It is postulated that when the nurse experiences burnout or compassion fatigue, the ability to nurse is lost and all that remains is the ability to perform essential technical tasks. There is also substantial societal risk that when nurses develop compassion fatigue related to practice issues and the workplace environment, they are more likely to leave nursing practice, which contributes further to the already serious nursing shortage (Dunn, 2009). Therefore, with Rogerian thinking, nurses' caregiver stress, burden and compassion fatigue are viewed as mutual processes which limit the individual caregiver's ability to nurture, and contribute to a reduction in the profession's numbers.

COMPASSION FATIGUE

Compassion fatigue has emerged conceptually as a natural consequence of caring for others who are in pain, suffering or traumatized (Figley, 1995; Joinson, 1992). As constant caregivers, nurses are at increased risk for denying their own physical, social, emotional and spiritual needs. The nurse may be emotionally traumatized or suffer through her or his own efforts to empathize and be compassionate with others. This experience can lead to diminished self-care and extreme self-sacrifice in the process of caring for the patient. The nurse in this situation becomes at risk for compassion fatigue (Dunn, 2005).

Joinson (1992) was the first to use the term compassion fatigue while studying burnout in nurses working in emergency departments. Joinson (1992) described the experience of compassion fatigue as being vertically ill, which she defined as functioning as a nurse, but not attending to one's own emotional needs. The nurse may also lose the ability to nurture. Nurses at risk for compassion fatigue are empathetic, caring individuals, but they may absorb the traumatic stress of those they help. The duration of the experience may also become a factor, as well as exposure to the extreme situations of death, dying or other destructive processes (Figley, 1995; Joinson, 1992).

Figley (1995) described compassion fatigue as a natural consequence of behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other. It is conceptualized as the stress that results from helping or wanting to help a traumatized or suffering person. The nurse who is unable to be present with the traumatized or suffering person may exhibit avoidance behavior (Dunn, 2009; Johnston, 2007).

In other situations the nurse may encounter patterns of oppression and powerlessness, leading to despair and isolation. This situation can lead to patterns of ineffective communication, resulting in unhealthy patterning outcomes. The mind, body, spirit and emotions exist as an undivided whole. Newman (1994, 2008), posits that this is where we can find meaning in the whole person to identify underlying patterns. Once the nurse identifies patterns towards compassion fatigue, she or he could potentially be empowered to make changes in care and self care strategies, or come to recognize signals when stress occurs. It is postulated that the nurse can then transform her or his consciousness to a higher level and reduce her or his mutual participation in the patterning of compassion fatigue (Newman, 1994).

COMPASSION ENERGY

Johnston (2007) poses that there is an inclination for nurses to protect themselves from the devastation of suffering encountered during their mutual participation in the lives of those for whom they care. This immunity, so to speak, is achieved by patterning from a distance even though this may seem incongruent with our mutual human-environmental field. There is a need to strengthen the capacity of compassion to remain fully present to individuals and their families during times of suffering (Johnston, 2007).

To understand compassion energy capacity, a review of compassion is necessary. Fox (1979) describes "What Compassion is Not--an emphasis that gradually leads to a fuller unveiling of What Compassion Might Mean" from a spiritual context (p. 2). Within Fox's perspective, the pattern of compassion is the interdependence of human beings, in which all are a part of and inseparable from one another and all involved in one another. Fox is concerned that compassion is being exiled through our western worldview, and states that compassion may be viewed as pity when in truth it should be viewed as celebration (p. 2). According to Fox, celebration is a letting go of ego and the difficulties of entering into the others' suffering, making it possible to experience a relief of the others' suffering. Within this view, the compassionate nurse seeks to know and understand their interconnectedness with the patient, and in this moment of mutuality the nurse is able to recognize and alleviate her or his suffering (Dunn, 2009; Fox, 1979; Roach, 2002).

Roach (2002) defines compassion as

"a way of living born out of an awareness of one's relationship to all living creatures. It engenders a response of participation in the experience of another's sensitivity to the pain and brokenness of the other and a quality of presence that allows one to share with and make room for the other" (p. 89).

Roach addresses Fox's concern for compassion being exiled by stating that compassion involves a simple, unpretentious presence with each other. Roach asserts that as a society we have developed sophisticated techniques to acquire compassion; yet compassion is a gift and cannot be acquired by advanced skills and techniques (Dunn, 2009; Fox, 1979; Roach, 2002).

SYNTHESIS WITHIN THE THEORIES OF NURSING AS CARING AND SUHB

Chinn & Kramer (1991) offer the process of creating conceptual meaning as a tool to create a useful meaning rather than to prescribe a definition. This author has developed the concept of compassion energy and has explored it within the theories of Nursing as Caring (NAC) and Science of Unitary Human Beings (SUHB) (Dunn, 2009). NAC is enhancing personhood through knowingly participating in nurturing relationships with caring others in the moment (Boykin & Schoenhofer, 2001). Once the nurse answers the call of the other with compassion and intent to alleviate suffering or celebrate joy, a mutual processing of energy occurs (Dunn, 2009). This energy transforms the nurse and the other to a higher level of consciousness, where compassion fatigue does not exist (Dunn, 2009; Newman, 1994; Rogers, 1970).

NURSING AS CARING

Compassion energy is regenerating of nurses' capacity to foster interconnectedness when the nurse answers the call with the intent to nurse (Dunn, 2009). NAC explores compassion as an attribute of the nurse that enhances well-being by transforming experiences with the outcome of well-being for both the nurse and the nursed in the context of the nursing situation (Boykin & Schoenhofer, 2001).

Within this worldview, all persons are caring and personhood is a process of living grounded in caring (Boykin & Schoenhofer, 2001, p. 1). Persons are viewed as complete and continuously growing, fully caring and unfolding caring possibilities, moment to moment (Boykin & Schoenhofer, 2001, p. 4). The nurse is being with the patient by answering the call with compassionate caring. The nurse enters into the world of the other person with the intention of knowing the other as caring person (Boykin & Schoenhofer, 2001, p. 5). The nature of nursing is a reciprocal relationship characterized by its grounding in person as caring, and as persons connected in oneness in caring with others and the universe. Thus, the theoretical framework for compassion energy honors freedom, creativity, and interconnectedness (Boykin & Schoenhofer, 2001; Rogers, 1970).

ROGERS SCIENCE OF UNITARY HUMAN BEING

Rogers' (1970) asserts that when one person interacts with another there is an integration of energy fields; each becomes the other's environment. Nurses caring for the patient experience this energy and their patterning is enhanced. Compassionate caring can create the energy to fill the empty vessel to enjoy the mutual process pattern manifestation of the person-environment interaction as a positively charged concept which this author calls compassion energy. Watson (1999) describes caring acts as an intentional consciousness that is energetic and has the possibility to potentiate healing and wholeness. The phenomenon of energy is dynamic, "all things are viewed as forming an intricate whole and change emerges from the whole" (Todaro-Franceschi, 1999, p. 30). Energy is transforming and manifests itself uniquely in self-care, health, wellbeing and healing.

Compassion energy has been conceptualized through the theories of NAC and SUHB. Smith (1999) analyzed caring concepts from the literature and synthesized caring concepts within the theoretical perspective of Rogers' Science of Unitary Human Beings using a caring concept clarification process. Smith identified the synthesis of five constitutive meanings of caring in the Science of Unitary Human Beings: manifesting intention, attuning to dynamic flow, appreciating pattern, experiencing the infinite, and inviting creative emergence.

One generally considers a person to be compassionate if that person appreciates the suffering of the other and attempts to create change in alleviating that suffering, as it is integral. Thus, compassion manifests as a cognitive, emotional and motivational force. In dynamic flow with self through intention with the other, a compassionate human energy connectedness is manifested. SUHB and NAC theories provide a potential focus of mutuality for creative synthesis of pattern within a theoretical idea, direct observation and personal experience to build a conceptual framework called compassion energy.

The Palette for Compassion Energy Model (Dunn, 2008) depicted above represents how nurses' compassion energy artfully makes use of her or his aesthetic painter's palette to experience the interconnectedness of patterning, living, valuing, uniqueness, being, wholeness, intention and knowing to energize the patterning to all living persons (Dunn, 2008). Thereby, one gains a higher degree of harmony within the mind, body, spirit and emotion which generates self-knowledge, self-reverence, self-healing and self-care processes for both the nurse and the patient (Watson, 1999).

The experience of processing energy when the nurse answers the call is a source of vitality, liveliness, responsibility and passion (Pembroke, 2006). A number of qualities are associated with energetic care such as humility, attentiveness, compassion and tenderness. A giving of self for others is clearly a fundamental concept in the ethic of care (Pembroke, 2006). By alternating rhythms, moving back and forth in the dance of relating, shifting perspectives and patterns of responsiveness, the nurse has the capacity to self generate vigor and find meaning and experience in compassionate caring. The value of underpinning the practice of nursing with compassion gives meaning to answering the nursing calls with the vigor of compassion energy (Boykin & Schoenhofer, 2001; Dunn, 2008; Johnston, 2007; Mayeroff, 1971; Newman, 1994; Rogers, 1970).

[FIGURE 1 OMITTED]

IMPLICATIONS FOR PRACTICE AND RESEARCH

The purpose of nursing as a social process is to provide knowledgeable compassionate service, where persons have the creative potential to experience patterns in life and human freedom to maximize their potential in optimal health and well-being (Rogers, 1970). Nursing science explains and further discovers life processes and knowledge of persons. The nature of nursing praxis is for enlightenment moment to moment, and is reflective. Nurses need to understand compassion in the discipline and practice of nursing in terms of well-being and health promotion of both the nurse and nursed.

Compassion is the lived experience of the nurse with the nursed within the mutual energy of interconnectedness. It is in the encounter of the nurse/person with the patient/person that an opportunity of mutuality occurs in which the nurse has the capacity to reshape patterns while becoming energized. The art of nursing occurs when nurses reflectively experience the feeling and the energy of compassion with colleagues and the patients to regenerate the nurses' capacity to foster interconnectedness (Dunn, 2008). Viewed within this perspective of boundaryless mutuality, compassion becomes a key attribute for the call of the nurse.

Researchers continue to collect and analyze data regarding the evolving concept, compassion energy. This paper intends to add to the body of nursing knowledge to develop modalities, actions and resources for nursing practice to enhance nurses personal well-being, health and relationship with self and others.

A future implication for formal and informal caregivers is to explore compassion energy patterning of human behavior, whereby energy is experienced and patterns reshaped to enhance quality of life for caregivers and care-recipients (Lu & Wykle, 2007).

CONCLUSION

The Science of Unitary Human Beings and Nursing as Caring provide a meaningful conduit through which to reformulate compassion fatigue into compassion energy through immersion in theoretical conceptualization. By creating a middle range level of discourse to enable the application of compassion energy, compassion energy is conceptualized as the intention, wholeness, uniqueness and patterning of individuals as a transformation of compassion, promoting health and well-being in mutually positive patterning. Data continues to be collected and analyzed based on the evolving compassion energy concept. But continued strenuous focus on the negative concept of compassion fatigue seems to this researcher to be less fruitful than transforming this traditionally negative view into a positive view. The positive model has the potential to expand from formal to informal caregivers and care recipient encounters, intentionally regenerating interconnectedness and transforming compassionate practice to a higher level of consciousness.

References

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Dunn, D. J. (2005). Compassion fatigue of the nurse as caregiver. Unpublished manuscript. Vanderbilt University, Nashville, Tennessee.

Dunn, D. J. (2007, October). A way of knowing, being, valuing and living with compassion energy: A unitary science perspective. Paper presented at the conference of the Rogerian Scholars, Cleveland, OH.

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DOROTHY J DUNN MSN APRN BC FNP DOCTORAL CANDIDATE, CHRISTINE E. LYNN COLLEGE OF NURSING
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Author:Dunn, Dorothy J.
Publication:Visions: The Journal of Rogerian Nursing Science
Article Type:Report
Date:Jan 1, 2009
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