The 6Cs of Nursing 1

THE 6CS OF NURSING

Student’s Name:

Program:

Module:

Module number:

The Date

3035 Words

Student registration no.

 The 6Cs of Nursing 2

Two of the 6Cs of nursing

The 6Cs of nursing set out the values and standards required of nurses. They are

meant to ensure that nurses look after patients with care and compassion and that the

professionals are competent, can communicate effectively, are courageous enough to

improve care and commit to delivering the best care every day (Bradshaw, 2016). In this

regard, the 6Cs represent an attempt towards ensuring that all patients can access the

highest quality care. I would argue that compassion and communication are most of the six

principles. While communication without being compassionate can be inhumane for the

patient, compassion in the absence of good communication is a meaningless intrusion into

the patient’s life. This means that nurses must ensure that they communicate their actions

effectively in consideration of best evidence when showing compassion to their patients.

Compassion

Compassion refers to the way nurses provide care through relationships that are

guided by respect, empathy, and dignity (Durkin, et al., 2018). Besides, compassion can be

described as intelligent kindness and forms the basis of people’s perception of quality care

(Young, 2016). Only compassion has the potential to impel and empower practitioners to

acknowledge and get the urge to alleviate or remove patients’ suffering or pain. According to

Henderson and Jones (2017), a nurse can only show compassion once he recognises the

patient’s suffering, highlights the need for empathy, and uses his skills to identify pain even

in cases when the patient cannot communicate. Sirois et al. (2015) studied compassion

within relationships existing between nurses and patients suffering from chronic disease and

highlighted the complex and interpersonal nature of compassion. Zamanzadeh et al. (2018)

also identified the seven dimensions that describe compassion as listening, paying attention,

confronting, getting involved, giving help, being present and understanding. With

Student registration no.

 The 6Cs of Nursing 3

compassion, patients are likely to feel that nurses understand how it feels to be in their shoes.

In this sense, communication is critical in compassion.

Communication

Communication is the key to achieving successful caring relationships between

nurses and patients. Listening to the patient is equally important to what nurses say and do

as it portrays the idea that no decision about the patient should be made without the

patient’s input (Kornhaber, et al., 2016). Communication, therefore, benefits both the nurse

and the patient. Given the importance of effective communication in the nursing practice,

there is substantial evidence base describing the various ways to use verbal and non-verbal

skills to facilitate effective communication. Communication drives the other 6C values.

According to van Vliet et al. (2017), communication brings all the other Cs together as

otherwise; care would not have a positive impact. Patients seeking health care can

experience communication difficulties for various reasons including physical, mental health

or learning problems (Fakhr-Movahedi, et al., 2016). The ability of the patient to

communicate is also prone to fear and anxiety. It is therefore important for nurses to develop

effective communication skills in a wide range of situations. This highlights the role played

by effective communication, especially when involving people in their care.

Reflection of an incident

While depression is treatable, it affects millions of people from all walks of life with the

majority of them failing to seek treatment (National Institute for Health and Clinical Excellence,

2018). As a result, it gets in the way people’s life, causes pain and hurts not just the victims

from also everyone around them. That said, the companionship and support offered to the

victim are important to their recovery. The victims need help to cope with the symptoms of

depressions, overcome suicidal thoughts, and become optimistic about life. A

Student registration no.

 The 6Cs of Nursing 4

great starting point is to learn the aspects of depression and how to approach the victim

(Royal College of Psychiatrists, 2015). However, while reaching out to the victim, it is

important to be careful with one’s emotions. As a student nurse, I once helped a girl who

was suicidal after she posted depressing things on Facebook. On reading her posts, I

messaged her and invited her for coffee. During our meetings, I listened to her story,

talked about my experience with depression and how I overcame it. I then gave her

advice and where to get support to get over her depression.

During this encounter, the girl greatly appreciated the fact that I empathised with

her difficulties. It was evident that my show of empathy portrayed acceptance and

understanding, therefore contributing to the girl’s perception of a working relationship.

This helped in building confidence in her potential for recovery. The compassion and

positive regard that I showed the girl boosted her morale, and to some extent relieved

her of the negative self‐ image that she felt due to her depression. In this regard, she

appreciated having someone who accentuated the potential to manage depression. A

key element of having an open conversation with the girl is that it made it easier to gain

a greater perspective of her experiences and feelings, therefore ending the inconclusive

ruminating that may have caused the depression. Instead, the patient considered

possible adjustments to improve her well‐ being. Crucially, the nature of communication

between us gave the girl a feeling that she was being carefully listened to, and the

authentic conversation aided my understanding of the situation.

I developed a therapeutic interpersonal relationship with the girl, which I would describe

as a relationship that the girl perceived to encompass supportive and non-judgmental behaviour,

therefore, resulting in a safe environment despite the girl’s stressful experiences. Furthermore,

this relationship continued for an extended period until the girl recovered.

Student registration no.

 The 6Cs of Nursing 5

Typically, Percival et al. (2017) indicate that a therapeutic interpersonal relationship

displays empathy, effective communication and the willingness to facilitate and offer

support. Consequently, the nature of relationships engendered an environment for

interactions thereby facilitating effective communication. Percival et al. (2017)

associate this form of relationships between nurses and patients with patient

satisfaction, improved quality of life, and reduced depression.

In the initial stages of our conversations, I explored different strategies to

communicate about my intentions to develop a therapeutic alliance with the girl. This is

because I acknowledged the fact that the relationship between us was probably the

most important factor for alleviating the suicidal thoughts. This alliance would have

enabled me to better understand the girl’s suicidal intentions, which is necessary when

coming up with alternatives for coping. According to Henderson and Jones (2017),

developing a therapeutic rapport is a requisite for establishing a therapeutic alliance,

and this begins during the first contact between the nurse and the suicidal person. I

used rapport-building strategies to approach the girl on Facebook. To achieve this, I

explained my role and the reasons for my interests in her case. This was followed by

asking her willingness to communicate and possibly her preference for how I should

address her. Having been comfortable with the conversation, the girl agreed to a

meeting a comfortable setting. All the while, I took the time to listen to her story.

The encounter with the girl shows that developing a therapeutic interpersonal alliance

with a suicidal patient depends on the level of communication and compassion displayed.

Listening comes in as an interpretive activity and makes the interpersonal dialogue richer, as I

could forge new understandings in the girl’s emotionally charged situations. NICE (2018)

guidelines on how to manage depression refer to the provision of person‐centred care. This can

only be achieved through effective relationship and good communication with the patient,

Student registration no.

 The 6Cs of Nursing 6

which form the basis of a collaborative decision-making approach. According to

Brunsteins (2018), depressed patients with a constructive relationship with nurses

tend to comply with the prescribed interventions and experience improved outcomes

compared to patients lacking such a relationship.

Lessons from the reflection about the 6Cs

The reflection depicts the role of the nurse as one that entails assisting a suicidal patient

to alter her constricted thinking and move towards a life-oriented position. Ultimately, I had to

incorporate the 6Cs of nursing to assist the suicidal girl to untangle and address the causes of

her suicidal feelings, develop a sense of hope, and connect with the outside world. Suicidal

patients tend to be hopeless and helpless and may find it convenient to often transmit their

feelings to the nurse (Evans, et al., 2017). This leaves the nurse with the task of carefully

monitoring and responding to their reactions and avoids interfering with the recovery of the client

(especially this case that was chronically suicidal). The nurse must, therefore, identify the

principles of the 6Cs that best fit the formation of a therapeutic alliance, which were

communication and compassion in my case. The choice of these principles prevented the effect

of attitudes held by the nurse, beliefs regarding suicide, or gender role expectations.

When handling patients with mental health problems, it is important to acknowledge the

benefit they may get from open relationships with the nurse. Percival et al. (2017) describe an

open relationship as one which the patient is listened to, understood and encouraged. As a

result, the patient will feel cared for, safe, and supported. Researchers have mentioned the

importance of these aspects in respect of psychotherapeutic treatments, and yet not all

practitioners happen to be confident in working relationship with patients. According to

Kornhaber et al. (2016), an opportunity to discuss personal history with the nurse increases the

practitioner’s understanding and ability to contribute to the healing process. On the other

Student registration no.

 The 6Cs of Nursing 7

hand, Vandewalle et al. (2019) highlight how suicidal patients find it difficult to talk to a

practitioner for reasons like poor past experiences of help‐seeking, fear of stigmatisation

and the fear of wasting the nurse’s valuable time. It, therefore, takes active communication

to encourage the patient to express her feelings. Coupled with compassion, active listening

is an indication that the practitioner is willing and able to help the patient. What matters is

the quality of relationship with patients, rather than its duration.

After my engagement with the girl, she was able to give an account of her

experience with the relationship. From her account, it was evident that she was impressed

with my attitude and bearing, which are the basis of compassion. Another feature of my

approach was the sharing of my personal experience with depression and how I overcame

it. Percival et al. (2017) define this as ‘congruence’, where the nurse can draw from their

own experience and disclose about their self in a manner that builds the relationship. In this

regard, congruence was perhaps what I had in mind when seeking comparability with the

patient. A compassionate clinical relationship involves the feeling of empathy, an experience

that both the practitioner and patient can always remember and an experience that every

patient would wish for (Brunsteins, 2018). Empathy is, therefore, an integral part of

healthcare, with a focus on the cognitive and emotive aspects, as it puts the nurse in the

place of the patient by listening and bearing the patient’s companionship and solidarity.

Percival et al. (2017) describe compassion as part of Maslow's model that triggers

self‐acceptance. It, therefore, helps to combat the root causes of depression. Indeed,

cognitive interventions are not enough to necessarily improve health outcomes of patients

experiencing feelings of worthlessness. The nurse’s ability to exhibit inner compassion may

help to cultivate confidence in the patient. Being part of the 6Cs of nursing, compassion and

communication requires the nurse to be kind and understanding to the patient, accept the

Student registration no.

 The 6Cs of Nursing 8

patient’s failures and imperfections as part of the human nature, and to neither avoid nor over-

identify with the patient’s feelings. Young (2016) argues that applying the 6Cs provides sufficient

emotional security alongside improved health outcomes with the potential of rectifying debilitating

health, feelings and thoughts, particularly in the case of depressed patients. This was proven by

how the girl valued efforts that I put to help her with depression. Nurses should therefore usefully

reinforce the application of the 6Cs of nursing in practice.

The 6Cs are given significant value when developing therapeutic alliances by both

the patient and nurse. In this regard, both parties give a gift of self. The patient feels safe

enough to share what she feels, and the nurse engages in active listening to understand the

patient’s perspective. van Vliet et al. (2017) believe that the nurses and patients interaction

process results in a helping relationship. In this regard, the reflective experience brings out

communication and compassion as axiomatic components that increase the power and

efficacy of the interaction. Of all the 6Cs, the nurse’s communication skills form the basis of

a patient-centred relationship (Henderson & Jones, 2017). The nurse can only create a

climate of trust through effective communication skills. Besides, the nurse gets to understand

how to respond to the patient’s health problems. With an application of the 6Cs, the nurse

and patient are guaranteed of achieving positive health outcomes in the form of a reduction

in patient's distress. On the other hand, compassion is the cornerstone of maintaining

sufficient objectivity, focusing the communication on the patient, and preventing

inappropriate emotional involvement by the nurse when interacting with the patient. In this

regard, Henderson and Jones (2017) argue that low compassion would fail to obtain critical

information from the patient, lack of emotional support, and possibly increase distress for the

person who is supposed to be helped.

Lessons from the assignment and how to apply this in my future role as a student nurse

Student registration no.

 The 6Cs of Nursing 9

From this assignment, it is clear that the interaction between the nurse and patient

should have meaning and purpose. Besides, high-quality interactions between the nurse and

patient are meant to achieve the desired health outcomes as well as increase the psychological

wellbeing of the vulnerable population. Every encounter with the patient should reflect the 6Cs of

nursing. As a student nurse, my role is to achieve the patient’s well-being, which is only possible

through interaction. This experience should be developed in whatever healthcare setting or

cultural context. Interacting with the patient was not just an irrelevant incidence, but rather an

experience that saw the establishment of a therapeutic link between the nurse and patient. This

means that the 6Cs of nursing create comprehension-oriented interactions between nurses and

patients, where actions are exchanged. The nurse plays a symbolic role that makes the

experience, not as a stimulus-response connection, but rather a purposive action-reaction

interaction (Wiechula, et al., 2016).

From the assignment, I learnt that the 6Cs of nursing determine the difference

between average and excellent nursing care. Interactions between nurses and patients are

the basis of nursing care towards recovery (Price, 2017). While some relationships last a few

hours, others are likely to go on for days or months. However, it is interesting to note that

every relationship is unique and enriches both the patient and the nurse. Learning about the

6Cs brings to the realisation that the focus of healthcare is the patient, whose needs need to

be met. Nurses must consider factors like the patient’s cultural preference, emotional state,

physical condition, needs, and willingness to communicate (Henderson & Jones, 2017). The

assignment also highlights the importance of respecting the uniqueness of patients as it

affects their response to changes in health. The assignment, therefore, highlights the role of

the student nurse in building a nurse-patient relationship by integrating the principles of the

6Cs. Acceptance of the patient does not mean approving or agreeing with their views, but

rather portraying a non-judgmental attitude.

Student registration no.

 The 6Cs of Nursing 10

The future of nursing depends on nursing students considering that they are placed

between public expectations of receiving compassionate care and expectations of the profession

of continuing to meet the changing healthcare needs. While this assignment focuses on the

expectations from registered nurses, it enlightens student nurses about the values, attitudes, and

perceptions they should have in the delivery of quality care. The 6Cs should motivate the student

nurse to come up with strategies for understanding the patient within their own set of values. If

the student nurse will be able to set the appropriate boundaries, he will end up with a mutual and

reciprocal relationship with the patient, therefore, enabling the provision of person-centred

nursing care, which meets the needs of the patient while maintaining the nurse’s professional

satisfaction (Price, 2017). The assignment portrays the importance of the 6Cs in determining the

nature of the nurse-patient relationship.

Student nurses need to realise that patients feel better when they are aware that the

nurses truly understand them. Accurate adherence to the 6Cs by the nurse makes it easy to

realise whether the patient’s feelings are being suppressed or denied. When these feelings

surface and the nurse can explore them, the patient will find comfort in the therapeutic

relationship (Zamanzadeh, et al., 2018). Student nurses should, therefore, focus on personal

development and learn how to promote patient’s self-concept through the principles of the 6Cs.

Moreover, I believe that compassion and communication are human traits that can be learned,

developed and grown throughout the career. From the era of Florence Nightingale, effective

care has relied on the ideal of good being good people to demonstrate quality care (Henderson

& Jones, 2017). The 6Cs referred to in this assignment represent the qualities of the nursing

practice, which should be nurtured within the ethos of clinical practice. There should be a

symbiotic relationship between learning institutions that provide nursing programs and clinical

practice that exposes the student nurses to the art of nursing. Furthermore, student nurses are

expected to demonstrate all the 6Cs after completing nurse

Student registration no.

 The 6Cs of Nursing 11

training. However, Durkin et al. (2018) assert that the principle of compassion must

be assessed during appraisals and recruitment interviews of registered nurses.

While the majority of existing research focuses on the values, attitudes and

perceptions of registered nurses with regards to compassionate care (O'Driscoll, et al.,

2018; Bradshaw, 2016), they side-line nursing students. This challenges pre-registration

programmes to balance competing demands and prepare student nurses with the

capability of delivering healthcare care within the realm of the 6Cs. This assignment,

therefore, enlightens the student nurse about the factors that shape values, attitudes

and perceptions of quality care with regards to the 6Cs. The assignment, therefore,

helps the student nurse to have a reflection of the components of compassionate care

whereas educators focus on the development of curricula capable of nurturing student

nurses to develop and apply the 6Cs of nursing in practice.

Student registration no.

 The 6Cs of Nursing 12

References

Baillie, L., 2017. An exploration of the 6Cs as a set of values for nursing

practice. British Journal of Nursing, 26(10), pp. 558-563.

Bradshaw, A., 2016. An analysis of E ngland's nursing policy on compassion and

the 6 C s: the hidden presence of M. S imone R oach's model of caring. Nursing

inquiry, 23(1), pp. 78-85.

Brunsteins, P., 2018. Empathy and Vicarious Experience. Congruence or Identical Emotion?.

Philosophies, 3(2), pp. 6-14.

Durkin, M., Gurbutt, R. & Carson, J., 2018. Qualities, teaching, and measurement of

compassion in nursing: A systematic review. Nurse education today, Volume 63, pp. 50-58.

Evans, E. C., Deutsch, N. L., Drake, E. & Bullock, L., 2017. Nurse–Patient

interaction as a treatment for antepartum depression: A mixed-methods analysis.

Journal of the American Psychiatric Nurses Association, 23(5), pp. 347-359.

Fakhr-Movahedi, A., Rahnavard, Z., Salsali, M. & Negarandeh, R., 2016. Exploring

nurse’s communicative role in nurse-patient relations: A qualitative study. Journal of

caring sciences, 5(4), p. 267.

Henderson, A. & Jones, J., 2017. Developing and maintaining compassionate care in nursing.

Nursing Standard, 32(4), p. 60.

Kornhaber, R., Walsh, K., Duff, J. & Walker, K., 2016. Enhancing adult therapeutic

interpersonal relationships in the acute health care setting: An integrative review.

Journal of multidisciplinary healthcare, Volume 9, pp. 537-546.

Student registration no.

 The 6Cs of Nursing 13

National Institute for Health and Clinical Excellence (NICE), 2018. Depression in Adults:

The treatment and management of depression in adults. [Online]

Available at: https://www.nice.org.uk/guidance/cg90

[Accessed 13 November 2019].

O'Driscoll, M. et al., 2018. Compassion in practice—Evaluating the awareness,

involvement and perceived impact of a national nursing and midwifery strategy

amongst healthcare professionals in NHS Trusts in England. Journal of clinical

nursing, 27(5-6), pp. e1097-e1109.

Percival, J., Donovan, J., Kessler, D. & Turner, K., 2017. ‘She believed in me’. What

patients with depression value in their relationship with practitioners. A secondary

analysis of multiple qualitative data sets. Health Expectations, 20(1), pp. 85-97.

Price, B., 2017. Developing patient rapport, trust and therapeutic relationships.

Nursing Standard, 31(50).

Royal College of Psychiatrists, 2015. Depression. [Online]

Available at:

https://www.rcpsych.ac.uk/mental-health/problems-disorders/depression

[Accessed 13 November 2019].

Sirois, F. M., Molnar, D. S. & Hirsch, J. K., 2015. Self-compassion, stress, and

coping in the context of chronic illness. Self and Identity, 14(3), pp. 334-347.

van Vliet, L. M. et al., 2017. Examining the effects of enhanced provider–patient

communication on postoperative tonsillectomy pain: protocol of a randomised control

trial performed by nurses in daily clinical care. BMJ open, 7(11), p. e015505.

Vandewalle, J. et al., 2019. Contact and communication with patients experiencing suicidal

ideation: a qualitative study of nurses’ perspectives. Journal of Advanced Nursing.

Student registration no.

 The 6Cs of Nursing 14

Wiechula, R. et al., 2016. Umbrella review of the evidence: what factors influence the caring

relationship between a nurse and patient?. Journal of Advanced Nursing, 72(4), pp. 723-734.

Young, L., 2016. Mentoring and the 6Cs. Nursing Standard, 30(24), pp. 49-58.

Zamanzadeh, V. et al., 2018. Factors facilitating nurses to deliver compassionate

care: a qualitative study. Scandinavian journal of caring sciences, 32(1), pp. 92-97.

Student registration no.