Abstract

This study attempted to determine how compassion influenced American nursing's conception of quality in the nurse-patient relationship during the 1950s when public and professional dissatisfaction with nursing service demanded major reforms to improve the quality of service. Methods of inquiry included historical research to identify and gather evidence and philosophical analysis to interpret the data. Primary historical sources, published and unpublished, were used exclusively for the period 1947-1959. Both primary and secondary sources provided a context for the period prior to 1947. ;Research showed that "formal" scientific and bureaucratic approaches to improve quality of care dominated the published nursing literature. Notions of "nursing science" were vague, however, until defined in 1959 by Dorothy Johnson as a combination of applied biological, medical, and social sciences. "Informal," unpublished evidence from archival sources, in contrast, showed that several of the nursing profession's leaders believed nurses' compassion, their ability to respond to suffering, was essential to improve the quality of care. ;During the 1950s, dominant scientific and bureaucratic approaches rested upon several assumptions: that quality in care depended upon the careful definition of nursing roles and functions; that professional expertise was based on scientific knowledge, technical skill, and objectivity; and that bureaucratic, analytic methods of organizing work would increase efficiency and nursing status. Nursing as a compassionate-humanistic enterprise made other assumptions: that care is defined by the nurse's responsiveness to patients' experiences of suffering; that care is attentive to the subjective elements of an individual's purposes, and that care is synthetic, combining all interventions, objective and subjective, that serve to alleviate patients' suffering. ;The investigator concluded that dominant scientific-bureaucratic approaches to nursing practice compromised compassionate-humanistic patient care. Further analysis suggests, however, that a dominant compassionate-humanistic approach to care need not compromise scientific-bureaucratic elements of practice because compassion synthesizes all strategies that might alleviate patients' suffering