PA RT I N G T H O U G H T S . . .

Dosing Kindness As a Therapeutic

Intervention
■ Patti Rager Zuzelo, EdD, RN, ACNS-BC, ANP-BC, FAAN

Holist Nurs Pract 2016;30(4):241–243

There is a great need for kindness in this world, and Developing a strategy to demonstrate small and large
nurses often witness life circumstances best addressed kindnesses during patient/client encounters is one
with gentleness, compassion, and kindheartedness. way to acknowledge the needs of the care recipient’s
The need for a dose of human kindness can be subtly whole self. Kind interactions with colleagues
or desperately displayed during all sorts of health likely promote teamwork, collegiality, and healthy
encounters that occur across a variety of settings at the work environments. Self-kindness is also important
sharp point of care. Kindness by definition is the to promote self-care, self-forgiveness, and well-being.
quality or state of being kind.1 It is associated with Ultimately, dispensing kindness across caring
behaviors, including considerate or kind acts.2 A domains that include patients/clients, colleagues,
worthy nurse may be perceived as kind, but this virtue and self reflects a conscious choice to gently and
has significant value only when associated with an compassionately interact without negative judgments
action. in an effort to “boost not knock” and to offer tender and
The challenge for providers of all types is figuring useful care. Providing conscious kindness in deliberate,
out how to deliver kind care within the context of a purposeful dosing may also assist in developing
health care system that is typically ambiguous, attentive and mindful practice routines. Nurses should
resource-strapped, bureaucratic, complex, and consider regularly dispensing doses of kindness
fast-paced. Fatigue and irritability are often associated as a strategy to address holistic health care needs.
with intense work environments, and these emotions
are counterproductive to consistently providing doses
of kindness to those who need it most. Technologies PATIENT/CLIENT KINDNESS NEEDS
are often essential and useful; however, this utility
may have a toll on attentiveness and human Nurses often encounter elderly clients who are
connection, thereby reducing opportunities for painfully lonely. Loneliness occurs across a variety of
displays of kindness during the care encounter. relationship types, including health care relations.3
Nurses and other providers need to consider a Karhe and Kaunonen3 analyzed the concept of
deliberate and consistent approach to dosing kindness loneliness within the context of health care. Findings
during interactions with patients/clients and colleagues. revealed 7 aspects of loneliness and offered
implications for care. Social loneliness is likely a
Author Affiliation: Graduate Nursing, Doctoral Department, College of
more commonly recognized loneliness type as it
Nursing and Health Professions, Drexel University, Philadelphia, Pennsyl- relates to an absence of a sense of belonging.3(pE27)
vania. Loneliness experienced in relations with health care
The author has disclosed that she have no significant relationships with, or providers is another type of loneliness3 and, perhaps,
financial interest in, any commercial companies pertaining to this article.
most amenable to the influence of kindness offered by
Correspondence: Patti Rager Zuzelo, EdD, RN, ACNS-BC, ANP-BC,
FAAN, Graduate Nursing, Doctoral Department, College of Nursing and
nurses and providers.
Health Professions, Drexel University, 3141 Chestnut St, Philadelphia, PA Loneliness in health relations is associated with a
19104 ([email protected]). lack of being heard and recognized as a unique
DOI: 10.1097/HNP.0000000000000154 individual.3 Lonely individuals within this context

241

Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
242 HOLISTIC NURSING PRACTICE • JULY/AUGUST 2016

experience feelings of objectification and transactional dynamic, including heavy workloads with long hours,
exchanges.3 Dosing kindness would likely address poor and ineffective interprofessional relationships,
some of these feelings of disconnection and and insufficient resources. There are few intervention
dehumanization, particularly since eye contact, studies that offer substantive recommendations for
attentiveness, active listening, and genuine curtailing and preventing violence.6 Violence
interactions did much to alleviate this particular reporting rates are low within the health care system,
loneliness typology.3 Patients experiencing health care likely due to inadequate or nonexistent reporting
loneliness want connectedness, and kind nurses could systems and also the tendency of nurses and other
certainly focus on relating to these care recipients in providers to excuse violent behaviors because of an
powerfully authentic ways that could include empathetic and caring worldview that may
personalization of care conversations and connecting countermand the obligation to report.6 The American
using active listening and empathy. Nurses Association recognizes incivility, bullying, and
Loneliness is a critically important concern in violence as important concerns in nursing and has set
health care that may respond to kindness dosing; a zero tolerance policy.7
certainly, it is unlikely that kindness will worsen or A violent environment is nontherapeutic, and it
exacerbate feelings of loneliness. The prevalence of contributes to high staff turnover and increased
loneliness is reported as 12% in older men and 38% in numbers of errors.8 Using kindness as a deliberate
older women.4 Approximately 1 in 5 older American strategy to mitigate workplace violence makes sense.
adults face loneliness.4 While there is a need to better Published literature provides many examples of
understand interventions that could best improve bullying and incivility that are unkind. Simple
states of loneliness, doses of kindness dispensed messaging that emphasizes the importance of kind and
during occasions of interactions could offer gentle communication is important. Reminding
opportunities for men and women to share and explore colleagues of the obligatory nature of the “golden
their sense of isolation and aloneness. rule” is not a trivial intervention. When nurses role
There are other opportunities for kindness model kindness and demonstrate actions that are
administration in addition to those occasions of consistent with the belief that team members should
patient/client loneliness. Responding to varying and be treated in the same ways that they themselves hope
diverse needs including biopsychosocial, spiritual, and and expect to be treated, powerful examples are
practical or material needs provides chances for then available for others to witness, including new
dosing kindness. Small gestures that might include nurses, students, patients, physicians, and other
sharing a personal story or joke, taking the time to sit providers.
and connect, offering personal information, listening Small acts of kindness are important contributions
to anecdotal information about past experiences or to the practice milieu, and the ripple effects associated
family circumstances, and chatting about a pet or with these actions can be persuasive and penetrating in
hobby are examples of deliberately connecting in an their influence on communication norms. Taking the
authentic fashion as an act of kindness. These time to assist others with care, inquiring as to
strategies demonstrate nursing presence.5 The colleagues’ well-being, smiling, avoiding and
reciprocal giving and receiving that occur during stopping gossip, and actively listening are a few
moments of a caring presence also buoys the provider examples of doses of kindness extended to colleagues.
and, occasionally, may rekindle professional
enthusiasm or relieve feelings of professional burnout
or disconnectedness. Acts of kindness often have their SELF-COMPASSION AND
own rewards and contribute to an environment of SELF-KINDNESS
holistic healing.
Nursing work is often joy-filled and satisfying, but it is
also difficult and performance expectations are high.
EXTENDING KINDNESS TO As a result, it is likely that nurses will intermittently
COLLEAGUES experience feelings of inadequacy and powerlessness.
Most will make mistakes on occasion and some may
Workplace dynamics can be uncivil and violent. There fail to act correctly, thereby compromising patients’
are many factors that encourage a sick organizational welfare and their own ethos of care.9 Self-kindness is

Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
 Dosing Kindness As a Therapeutic Intervention 243

a component of self-compassion.10 Germer and Neff10 interventions demonstrates authentic commitment to

offer strategies to develop skills that enable and holistic nursing practice.
promote self-compassion. They assert that failure and
imperfection are normal. Avoiding self-flagellation
over real or perceived inadequacies is important, as REFERENCES
these negative conversations with the self can be 1. Kindness. In: American Heritage R Dictionary of the English Lan-
destructive and pathological. guage. 5th ed. http://www.thefreedictionary.com/kindness. Published
It is likely that nurses are kinder in their responses 2011. Accessed May 11, 2016.
to others than they are when responding to 2. Kindness. In: Collins English Dictionary—Complete and Unabridged.
12th ed. http://www.thefreedictionary.com/kindness. Published 2014.
self-critique. Learning how to forgive oneself and Accessed May 11, 2016.
offer kindness and compassion to the self are holistic 3. Karhe L, Kaunonen M. Patient experiences of loneliness: an evo-
interventions in self-care. Germer and Neff10 lutionary concept analysis. ANS Adv Nurs Sci. 2015;38:E21-E34.
doi:10.1097/ANS.0000000000000096.
comment that learning how to be self-compassionate 4. Theeke LA. Predictors of loneliness in U.S. adults over age
promotes resiliency, a highly desirable characteristic. sixty-five. Arch Psychiatr Nurs. 2009;23:387-396. doi:10.1016/
Kindness is demonstrated in acts of goodwill that j.apnu.2008.11.002.
5. Covington H. Caring presence delineation of a concept for holistic nurs-
are authentic, caring, and compassionate. Nurses and ing. J Holist Nurs. 2003;21:301-317. doi:10.1177/0898010103254915.
other health care professionals should consider 6. Zuzelo PR. The clinical nurse specialist handbook. In: Workplace Vio-
strategies to mindfully dose kindness during lence: Creating and Sustaining a Healthy Place to Work. Sudbury, MA:
interactions with patients/clients, colleagues, and self. Jones & Bartlett Publishers; 2010:chap 7.
7. American Nurses Association. Incivility, bullying and workplace
It is likely that acts of kindness will positively affect violence. http://www.nursingworld.org/Bullying-Workplace-Violence.
suffering, violence, and loneliness, as well as Published 2015. Accessed May 11, 2016.
disenfranchisement. There are opportunities to add 8. American Association of Critical-Care Nurses. AACN Standards for
Establishing and Sustaining Healthy Work Environments. A Journey to
doses of kindness to our plans of care for others and Excellence. 2nd ed. http://www.aacn.org/wd/hwe/docs/hwestandards.
self. The importance of these opportunities should not pdf. Published 2015. Accessed May 11, 2016.
be minimized, as these actions serve to model kind 9. Wolf ZR, Zuzelo PR. “Never again” stories of nurses: dilem-
mas in nursing practice. Qual Health Res. 2006;16:1191-1206.
and compassionate behaviors to patients, families, doi:10.1177/1049732306292544.
colleagues, and others. Helping restore wholeness to 10. Germer CK, Neff KD. Self-compassion in clinical practice. J Clin Psy-
self and others via kind and compassionate caring chol. 2013;69:856-867. doi:10.1002/jclp.22021.

Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.