Review Article

A New Strategy to Build Culture of Compassion in Nursing Practice

Ahmed Lateef Alkhaqani*

Ministry of health, Al-Najaf Direction, Al-Sadder Medical Hospital, Al-Najaf, Iraq

Received Date: 26/07/2022; Published Date: 10/08/2022.

*Corresponding author: Ahmed Lateef Alkhaqani* , Ministry of health, AlNajaf Direction, Al-Sadder Medical Hospital, Al-Najaf, Iraq


The strategy included the 6Cs (care, compassion, courage, communication, competence, and commitment), and in the follow-on framework, produced by National Health Service England in 2016, the 6Cs were included again. We are all very familiar with these words, and perhaps already, some may be thinking. Nurses and midwives are asked to demonstrate the 6Cs of nursing in ‘everything we do’. Mentors have a crucial role in the provision of health care and in educating nurses and midwives. This article explains the background to the 6Cs and highlights the other values frameworks that nurses and midwives must work within too. Nursing theorists have studied caring extensively and the earlier set of 6Cs. The meaning of the DH’s 6Cs is then explored in detail concerning previous research and nursing theory. The importance of ensuring the 6Cs are evident in ‘everything nurses do’ in the mentorship practice. Nurses look to the leadership skills of their mentor as a role model of skilled and professional nursing or midwifery care. Students require high-quality role models committed to the 6Cs and mentoring practice.

Keywords: New Strategy; Build Culture; Compassion; Nursing Practice


Values are generally defined as beliefs or principles that influence behaviour. Following several reports that revealed poor care quality with an apparent lack of compassion, England's Department of Health (DH) introduced the ‘6Cs’ as values for practice within a new nursing strategy. In 2016, the 6Cs were included in the new framework for nursing (1). This article sets out the background to the 6Cs, considers other sets of values relevant to nursing practice and theories of caring, and then explores the meaning of the DH’s 6Cs in detail.

Compassion is essential in the care of vulnerable people. Being compassionate involves recognizing and responding to a vulnerable individual with empathy while maintaining the dignity of those receiving care and providing care. Called Compassion in Practice, the vision is based on six values care, compassion, courage, communication, competence, and commitment. The vision aims to embed these values, known as the Six C’s, in all nursing, midwifery, and caregiving settings throughout the NHS and social care to improve patient care (2).

A nurse’s compassion is considered an extremely valuable feature of supervision because it supplies patients with proper emotional support, reducing misery and sadness and reinforcing their will to live more (3). Compassion is important in nursing because it aids in making patients feel better about themselves and guarantees that everything will be better in no time! If compassionate in nursing, they will have the ability to realize that the hospital management will do everything to make their condition finer. In easy words, patients cared for with appropriate compassion are more likely to feel stronger swiftly because they will have fewer reasons to worry (4).

This article aims to guide mentors on how to integrate the 6Cs into their mentorship practice when mentoring pre-registration nursing and midwifery students. It emphasizes the importance of mentors in role modeling concerning the 6Cs. Addressing each of the 6Cs in turn, the article outlines strategies that may be used in mentorship practice to endorse the 6Cs with pre-registration students. The purpose of the 6Cs was to ensure patients are looked after with care and compassion by competent professionals, communicate well, have the courage to make changes that improve care, deliver the best, and commit to providing this all day, every day (5). A nurse's compassion is considered an extremely valuable feature of supervision because it supplies patients with proper emotional support, reducing misery and sadness and reinforcing their will to live more (6).

Understanding the 6 Cs of Nursing

The six Cs are important to patient care and the professionals who deliver such care. These are vital for someone working within the care industry and can also be adapted to all aspects of a person's life.

Care is the first C; Care is defined as providing what is necessary for the health, welfare, maintenance, and protection of someone or something. The primary duty of the nurse is to care for the patient. Amongst all the C's this is the most important. Caring defines both us and our work. People receiving care expect it to be right for them consistently throughout every stage of their life. For example, caring for a person, listening to their wishes, considering their beliefs, treating them with dignity, and working in their best interests would demonstrate care in practice (6).

Compassion is defined as sympathetic pity and concern for the sufferings or misfortunes of others. The career needs to show compassion and understanding to their patients (7). Compassion is how care is given through relationships based on empathy, respect, and dignity. It can also be described as intelligent kindness and is central to how people perceive their care. Nursing and midwifery can demonstrate compassion in practice to fulfill the pre-registration standards for nursing and midwifery (8).

Courage has strength in the face of pain or grief, not only for yourself but also for the patient. The career will need the courage to treat the patient after being through. Courage enables us to do the right thing for the people we care for and speak up when we have concerns. It means we have the personal strength and vision to innovate and embrace new working ways (9).

Communication is a vital attribute needed, whether in nursing or any other profession. Without proper communication, nothing can be achieved. So, this is important, especially when it comes to nursing (7). Communication is central to successful, caring relationships and effective team working. Listening is as important as what we say and do. It is essential for “no decision about me without me”. Communication is the key to a good workplace with benefits for those in our care and staff alike (4).

Commitment towards the task and role as a career is vital, no matter how challenging. The job of a career is not easy and needed to commit yourself to work and provide the best care offered. A commitment to our patients and populations is a cornerstone of what we do. We need to build on that commitment to improve the care and experience of our patients. We need to take action to continue to make this vision and strategy a reality for all and meet the health and social care challenges ahead (2).

Competence goes without saying; one should be able to carry out the tasks presented and be fully trained to do so. Competence means all those in caring roles must have the ability to understand an individual’s health and social needs. It is also about having the expertise, clinical and technical knowledge to deliver effective care and the best treatments based on research and evidence (8).

The Importance of 6Cs in Nursing

The importance starts with basic behaviour. All the six things mentioned here are designed to empathize with the client. Being a career will need to ensure that the client is treated appropriately, dependent on their needs (10). The 6Cs have gained a high profile, and they appear to resonate with many within the nursing and midwifery workforce and beyond, but they should not be considered a simple framework for addressing problems within the complexity of healthcare (11). Reports from some NHS Trusts indicate a positive effect of applying the 6Cs framework, and the need for more robust evidence to support the 6Cs has been acknowledged. A more critical approach should be adopted towards the imposition of additional sets of values and principles without theoretical underpinning and a clear rationale, but there are few opportunities for healthcare professionals to debate current issues and health policy (12). It remains disappointing that the health and social care workforce cannot have one set of clearly defined core values that underpin practice and care delivery in all settings, thus supporting interprofessional and integrated care. The nurses are not only about being physically there for patients (2).

  • Suppose nurses are expected to support the patient to feel better emotionally. It would be best if they favoured caring behaviour in their bad times.
  • A nurse should communicate to patients with compassion and due respect to realize their worth and unique characteristics. In that case, it will encourage the patients to be stronger.
  • Compassion in nursing is so much needed that it is now one of the topmost healthcare service requirements.
  • Also need to put yourself in a patient’s shoes to understand what they are going through. Afterwards, it would be best to let them hold on to their dignity, self-determination, and persona throughout the procedure.

The points mentioned above are a few reasons why compassion is considered an essential skill in the nursing field and how to show compassion to patients boldly. Most likely see, compassion is frequently used as a feature similar to other conceptions such as empathy, sympathy, and tenderness because it is very important (8).

Practice Compassion in Nursing

While nurses attempt their best to show compassion to all patients, particular limitations in the healthcare system can make this more daring in the application. (13) A nurse is most likely to experience barriers, like a lack of time, support, staff, paperwork and productivity requirements, and unpleasant workplace culture (14). All of the issues mentioned above can affect a nurse’s capability to show compassion. In spite of these hurdles, two practices have been found to support compassionate care. The first one is forming strong team connections, and the second way is looking for routes in which nurses will learn that being compassionate is an easy task to carry (4).

Compassion and Peace of Mind: Patients who receive compassionate care from nurses tend to be more concerned about their illnesses, pains, and mental stress and are more likely to have pleasant feelings. Even if a patient is worried about undergoing surgery, getting better from a severe injury, or even fighting a dangerous disease, compassion can make the pain more endurable and relax worried patients’ thoughts. Compassion provides patients with support and confidence when they require it most (6).

Privacy and Dignity: Nurses who give compassion to patients will also feel dignity when their privacy is limited. For instance, if a nurse knocks before entering the room, the patient will realize that his privacy is important, even in a hospital environment. Knowing patient’s anxiety and uneasiness during particular medical tests will show concern for the patient’s dignity (1).

Respect: Adequate compassion reduces the patient’s concern because it makes them feel respected in times of uncertainty. Nurses who take the time to explain all the methods and medical examinations and pay attention to patients’ distress lend a hand to relax their minds and make them feel important about themselves. Being a nurse, showing the patient can understand their pain reduces the worry of being hospitalized. Respecting patients is more like showing a form of compassion that lets patients’ minds be at ease and aim at getting better instead of panicking about their health (7).


To conclude, this was all about the 6 Cs of nursing and why it is needed. These are the core values that will help to be the best career. Make sure to learn and practice all these values. The importance of ensuring the 6Cs are evident in ‘everything nurses do’ in the mentorship practice. Nurses look to the leadership skills of their mentor as a role model of skilled and professional nursing or midwifery care. The 6Cs should not be viewed in isolation as other values frameworks, including professional and organizational, must also be embraced. It is unclear why a different set of values was considered necessary for nursing, midwifery, and care staff when there were already identified national health service values that could have been extended to other parts of health and social care. The values identified in the 6Cs are relevant. However, 6C has become a valuable base for nurses, and midwives, influencing many professions in these fields and beyond.


Students require high-quality role models committed to the 6Cs and mentoring practice. Strategies that can be used in mentorship practice to endorse the 6Cs with pre-registration nursing and midwifery students have been outlined. Mentors committed to their mentoring role care for nurses with compassion and competence. This requires appropriate communication skills, effective role modelling, and the courage to give constructive feedback and make decisions to refer students who are not achieving. The 6Cs provide a basis for professional mentoring practice, together with the additional considerations of confirmation and consequence. A profession can learn from the large body of theoretical work and previous research on care and ethics that explores these values in greater depth. All these combined wills make a better care provider.

Funding: No funding was received for this study.

Conflicts of interest: The author declares no conflict of interest to declare for publication.


  1. NHS. Compassion in Practice. Evidencing the impact. 2016;(May):1–34.
  2. Baillie L. An exploration of the 6Cs as a set of values for nursing practice. Br J Nurs. 2017;26(10).
  3. Alkhaqani AL. Recognizing and management of arrhythmia : Overview of nurses ’ role. Int J Nurs Heal Sci. 2022;4(1):33–40.
  4. Chadwick D. Care, compassion, courage, commitment, communication and competence: The 6 Cs. J Perioper Pract. 2017;27(10):209–10.
  5. Alkhaqani AL. Effective of exercise therapy on functional balance , physical performance and quality of life among patients undergoing hemodialysis : randomized controlled trial. Nurs Commun. 2022;(January):1–9.
  6. NHS England. Introducing the 6Cs. NHS Engl. 2015;1–13.
  7. Baillie L. Perspectives: We need to talk about the 6Cs: perspectives on a recent debate. J Res Nurs [Internet]. 2015;20(4):331–6. Available from:
  8. Duffy K. Integrating the 6Cs of nursing into mentorship practice. Nurs Stand (Royal Coll Nurs (Great Britain). 2015;29(50).
  9. NHS. Compassion in Practice strategy and the 6Cs values. 2015;8. Available from:
  10. Alkhaqani A. Application of the consolidated standards of reporting trials (CONSORT) guideline in the nursing research. kufa J Nurs Sci. 2021;11(2):1–9.
  11. Alkhaqani A. Clinical Characteristics and Risk Factors of Chronic Kidney Disease Among Patients Attending Al-Sadder Medical Hospital in Al-Najaf City. Turkish J Physiother Rehabil [Internet]. 2021;32(3):15117–27. Available from:
  12. Alkhaqani AL. Nurses on the Front Lines Confronting COVID-19 Pandemic. Al-Rafidain J Med Sci ( ISSN 2789-3219 ). 2022;2:26–7.
  13. Alkhaqani AL, Abd Ali DK. Evaluate of the Physical Performance of Patients Undergoing Hemodialysis. J Cardiovasc Dis Res. 2021;12(6):197–205.
  14. Alkhaqani AL. Innovative strategies in nursing practice: new perspectives. Nurs Commun. 2022;6(0):e2022008.