CULTURAL COMPETENCE COLUMN CULTIVATING COMPASSION ACROSS CULTURES. Sue Kim, PhD, RN, NP Jacquelyn H. Flaskerud, PhD, RN, FAAN

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1 Issues in Mental Health Nursing, 28: , 2007 Copyright c Informa Healthcare USA, Inc. ISSN: print / online DOI: / CULTURAL COMPETENCE COLUMN CULTIVATING COMPASSION ACROSS CULTURES Sue Kim, PhD, RN, NP Jacquelyn H. Flaskerud, PhD, RN, FAAN About a year ago I (Sue Kim) felt a lump in my breast and thus began a winding journey into cancer land: surgery, chemotherapy, radiation. This new journey as a patient opened my senses and increased my level of sensitivity, especially in encounters with health professionals. Whether only for a fleeting moment or on a recurring basis, each person contributed to my recovery according to their particular levels of knowledge and skills. However, there were subtle differences: Some individuals made me feel connected and understood without demonstrating particularly extraordinary skills, while others were clearly clinical experts in their field yet their efficiency felt strangely insufficient. These encounters provided a trigger point for a trail of questions relating to an important quality that appeared to be quite unrelated to professional status, years of experience, or area of expertise: Compassion. Compassion is a familiar concept and fundamental ideal to those who seek to provide help and healing, and indeed is integral to nursing as a caring discipline. Webster s (1989) classic definition of compassion is a feeling of deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its causes (p. 229). The questions that came to mind were: Do we value compassion in nursing? Can it be taught? Does it differ in expression across cultures? Nurses caring work, the art of nursing, builds intrinsically upon a humane quality of being aware of and understanding the suffering of others and seeking to comfort and assist. Without it the spirit of nursing withers. Yet, we are cautious about being compassionate. In psychiatric nursing we are taught to be empathetic, a dispassionate, intellectual identification of oneself with another, but not sympathetic, an emotional identification, at the heart of the definition of compassion. Our literature warns us of the dangers of too much compassion compassion fatigue, a term that is used interchangeably with burnout (Figley, 2002; Sabo, 2006). We 931

2 932 S. Kim and J. H. Flaskerud put our energies into identifying the multidimensional symptoms of, and prescriptions to avoid and treat compassion fatigue (Figley, 2002; Welsh, 1999) as well as various instruments to measure the phenomenon (Sabo, 2006) and not enough energy into cultivating compassion in our students and peers. As a patient, compassion was a valued part of my cancer care. Realizing its importance, I began to wonder whether compassion can be cultivated, especially across different cultural contexts. I believe the underdevelopment of compassion is closely tied to neglect of our inner state and a failure to connect with it. Caught up in executing tasks, we do not take time to listen to and reflect on our inner selves. As a result showing compassion to others is a struggle and we are more comfortable repeating glib responses and maintaining a safe distance rather than risking attempts to connect. One approach to cultivating compassion can be found in the personal iceberg metaphor of the Satir model (Satir et al., 1991). The seed of compassion is innate in everyone and we need to provide better conditions to make it grow. The Satir model suggests that we are prone to react to the behavior, action, or story that is revealed at the tip of the iceberg, but that delving deeper opens an awareness of underlying feelings, perceptions, expectations, and yearnings that ultimately express the inner self. When we realize there are basic needs or yearnings that are universal (e.g., the need for autonomy, physical nurturance, integrity, acceptance, meaning etc.), a connection is formed between the sufferer and helper. Recognizing and honestly addressing our inner yearnings allows compassion to develop and stimulates intrapersonal as well as interpersonal growth. However, reaction patterns that overlook our inner state subsequently alienate us from our natural state of compassion (Rosenberg, 2003). Do our nursing curricula sufficiently prepare students to seriously contemplate compassion and do we have tangible resources to direct ourselves to practice it? How may sensitivity to compassion be applied to the classroom and bedside? First of all, taking time to self-reflect and dwell on an experience can renew our ability to listen to and identify with our inner selves. Identifying our thoughts, feelings, and yearnings that arise in the clinical situation is equally as important as evaluating the tasks that were done and outcomes that were obtained. Reflective journaling, such as a diary, may be used to practice and hone this awareness. The next step is to consider what the inner yearning of those around us might be. Role playing with an observer paying particular attention to nonverbal communication patterns and offering cues may facilitate this process. What are the similarities and differences in how culture might influence the expression of compassion? Examining religious cultural

3 Cultural Competence 933 contexts demonstrates similarities: Compassion is considered a virtue in most major religions and philosophies and can be a reinforcing influence on its expression. For example, Buddhist cultures are based on the idea that life is suffering, inherently extending into taking others suffering into account. McHolm (2006) offers biblical examples that illustrate how Christian principles also underscore compassion. Despite different religious beliefs, the common thread of valuing compassion may be utilized to form a sense of connection in personal encounters and reinforce our personal commitment to develop compassion. There are cultural differences as well. Western patients and nurses are more likely to say and acknowledge what they re feeling, opening the door for the nurse to express compassion. In the East patients don t express their feelings openly to health personnel and for the nurse to try to express feelings for them might be awkward or considered presumptuous this is a professional, not a personal relationship. I have worked as a nurse in both Korea and the U.S. and believe that compassion can be expressed in both cultures through acts of human caring touching, listening, and acknowledging and relieving another s pain and suffering. Cultural norms of gender roles also may frame how compassion is conceptualized and reacted to. For example, in many cultures compassion may be considered a feminine trait where women are expected to assume nurturing, encouraging and sustaining roles in contrast to authoritative and decisive qualities considered masculine traits. Within such a social milieu, nursing, primarily comprised of women, may comply with these prescriptions. More recently with the rise of women s independence, nursing may attempt to compensate for patriarchal influences by covertly shying away from compassion and shifting towards an image of objective professionalism and measurable science. Does the growing fixation with advanced competencies, algorithms, and recognition for nursing activities (preferably in the form of reimbursements or research funds) that seems to permeate nursing today, to some degree reflect this view of nursing? From experiences as a patient and a nurse comes the appreciation of the need for knowledge, skills, and status in the nursing profession, but there is an equal need for compassion in nursing care, regardless of culture. REFERENCES Figley, C. R. (2002). Treating compassion fatigue. UK: Psychology Press. McHolm, F. (2006). Prescription for compassion fatigue. Journal of Christian Nursing, Fall,

4 934 S. Kim and J. H. Flaskerud Rosenberg, M. (2003). Nonviolent communication: A language of life (2nd ed.). Encinatas, CA: PuddleDancer Press. Sabo. B. M. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice, 12(3), Satir, V., Banmen, J., Gerberm, J., & Gomori, M. (1991). The Satir model: Family therapy and beyond. Palo Alto, CA: Science and Behavior Books. Webster s. (1989). Webster s encyclopedic unabridged dictionary of the English language. New York: Gramercy. Welsh, D. J. (1999). Care for the caregiver: Strategies for avoiding compassion fatigue. Clinical Journal of Oncology Nursing, 3(4),

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