Great Tenderness in All Things

In a nutshell . . . .

This page introduces you to the idea of tenderness in nursing practice. Great tenderness in all things is one of the two Practice Competence & Excellence (PCE) dimension ideas that underlie how the other six PCE ideas are implemented.

You may not be familiar with the idea of tenderness because it is not often mentioned in nursing literature. However, you will find that great tenderness in all aspects of nursing care was central to the nursing care of the 19th century Irish nurses, whose practice provides the foundation for Careful Nursing.

You'll notice that Great tenderness is close in meaning to the ideas of the Therapeutic Milieu dimension. But it's part of the PCE dimension because the historical documents indicate it has to do with direct clinical care of patients.

You'll find that in nursing literature tenderness is a hard-to-grasp idea because, although it is used in the title or articles, it is almost never defined. The historical documents and one nursing article that does provide a definition indicate that tenderness has a deeply spiritual quality.

Review of research on tenderness in nursing and psychology is presented and links to further reading are provided.

Introduction

Great tenderness in all things is the first of two Practice Competence and Excellence (PCE) concepts that underpin how nurses implement the additional six concepts of this dimension (Meehan, 2012); they provide the context for PCE. Before continuing, please take a minute to review the two figures on the PCE introduction page above to remind yourself how this concept relates to the other seven PCE concepts.

Background of tenderness in Careful Nursing

The importance of great tenderness in the care of the sick is associated particularly with Catherine McAuley. In her guidelines for care of the sick, McAuley emphasises that "Great tenderness must be employed . . ." McAuley 1832, p.8); that nurses must have "great tenderness of all things" (McAuley 1837). Sullivan (2012) observes that the words tender and tenderness were characteristic of McAuley's description of nursing practice. McAuley also felt great tenderness for her nurse companions (Sullivan 2012) and instructed them to employ tenderness in their relationships with one another; to treat one another with "tender concern and regard" (McAuley 1832, p. 37), and always in a respectful manner.

Meaning of tenderness

Because the words tender or tenderness are not often used in contemporary nursing it is useful to explore their meaning. In her use of these words, Catherin McAuley clearly likened their meaning to the tender love of Jesus Christ, especially for the poor and sick (Sullivan 2012). In entreating those nursing the poor and sick to employ great tenderness, McAuley meant for them to be aware of Christ's love for them and to act as instruments of His healing love in their care for the sick and in their care for one another.

The words tender and tenderness originate in the prehistoric Indo-European root ten meaning to stretch. Tender developed to mean stretching or extending toward and paying attention to something or someone, offering something; also stretching oneself forward eagerly with intention and with all one's strength (Partridge 1958, pp.703-704).

A 19th century dictionary gives a detailed range of meanings of tender as it would have been used in nursing practice (Porter, 1864-1891); tender as a noun, for example, a nurse as a tender; "one who tends; one who takes care of any person or thing; a nurse" (p. 1484). In this sense meanings of tender as an adjective are being susceptible to "softer feelings" such as love, kind concern, forgiveness and compassion; being careful not to injure; being gentle and unwilling to cause pain. Tenderness used as a noun is defined as the quality or state of being tender in any sense of these adjectives. 

This background suggests that the meaning of tenderness as it relates to nursing practice is two-fold: drawing on and expressing the spiritual love of the philosophical principle, Infinite Transcendent Reality in life processes, and attending to patients with "soft feelings" such as kindness and gentleness with the intention to protect them and foster their health. 

Nursing research on tenderness

Only one nursing study related to tenderness appears in nursing literature; a doctoral study entitled Tenderness and Technique: Nursing Values in Transition (Meyers 1960). Meyers defines tenderness as personal attentiveness and tender loving care in nurse-patient relationships and contrasts it with technique, defined as knowledge and technical skill.

Based on findings of a descriptive survey, Meyers proposes that when nurses in the 1950s became increasingly concerned with professionalism, they turned to technique and advanced knowledge and skills, at the expense of expressing tenderness. She argues that tenderness must be reintegrated into nursing so that nurses practice with a balanced synthesis of knowledge and feeling; 'technical competence necessarily involves tenderness' (p.7).

Psychology research on tenderness

Most research on tenderness is published in psychology literature. Building on earlier work on emotions, Kalawski (2011) examines tenderness in relation to love, empathy and sympathy. He views love not as an emotion but as a disposition which has many varieties. He conceptualises tenderness as a momentary emotional surge which specifically 'corresponds to the love of caregiving' (p. 159.) and as a probable basic emotion.

Kalawski concludes that tenderness may be a necessary component of empathy and sympathy. Viewing his findings in the light of theory and previous research, he distinguishes tenderness as a distinct elementary emotion which can be considered in the same category as anger, fear and joy.

In two sets of comparative experimental laboratory studies Lischer et al., (2011) and Niezink et al., (2012) examine tenderness and sympathy as components of empathy and both report similar findings. Feelings of sympathy are evoked in response to another person's obvious current need, whereas feelings of tenderness are evoked in response to another person's perceived vulnerability, even when the person has no obvious current need. Niezink et al., suggest that tenderness is a response to another person's long term vulnerability and need for protection.

Tenderness in discursive nursing literature

Occasional articles about tender care or tender loving care appear in the nursing literature. Mostly, their authors claim that tender loving care is an essential characteristic of nursing practice but they fail to define tender. In only one article (Kendrick & Robinson 2002) is the meaning of tender explored; it is concluded to be a type of behaviour related to spiritual love in nurse-patient relationships.

An example of nurses' underlying awareness of tenderness in their practice and its clinical action quality appears in one of the few articles in the nursing literature titled tenderness, 'A little tenderness goes a long way' (Galland 2008). The author describes her unexpected encounter with her own capacity for tenderness while practicing as a very stressed, over-worked staff nurse, feeling rushed and impatient with a very sick patient. The patient's indirect request for comfort and consolation and the author's intuitive response opens up for her a memorable experience of the simplicity and profound importance of tenderness in nursing practice. Analysis of this article offer pointers for exploratory clinical research on tenderness. 

Great tenderness in all things: a possible revised definition

Great tenderness in all things is reaching unconditionally in mind and spirit toward people who appear vulnerable, with an attitude of loving kindness and the intention to help them. Great tenderness also encompasses being aware in mind and spirit of the healing love of Infinite Transcendent Reality in life processes and seeking to be an instrument of this spiritual love. Ability to express great tenderness depends on ability to empathise with other people's experiences in order to recognise their vulnerability. Ability to empathise depends on attentiveness to others and the patience to recognise their vulnerability.

Your great tenderness in all things self-rating:

On a scale of 1 to 10, how do you rate your ability to have great tenderness in all things in your care of patients?

On a scale of 1 to 10, how do you rate your ability to express great tenderness in all things toward colleagues with whom you practice? 

Based on your assessment of your current ability to practice with great tenderness in all things in your care of patients and toward colleagues with whom you practice, decide what you will do to further develop this ability in your practice.

Make your own 'I will' statements . . . 

Examples of great tenderness of all things 'I will' statements: 

. . . take time to think about the concept of having great tenderness in all things in

 my practice and how I will express this

. . . think "great tenderness of all things" each time I enter my ward/practice area

. . . remember to think "great tenderness of all things" when I approach patients

. . . discuss how to express "great tenderness of all things" with practice colleagues 

 

References

Galland L. (2008) A little tenderness goes a long way. Nursing, 38(9), 56.

Kalawski JP. (2010) Is tenderness a basic emotion? Motivation and Emotion, 34, 158-167.

Kendrick KD. & Robinson, S. (2002) 'Tender loving care' as a relational ethic in nursing practice. Nursing Ethics, 9, 291-300.

Lischer DA, Batson, CD. & Huss E. (2011) Tenderness and sympathy: distinct empathic emotions elicited by different forms of need. Personality and Social Psychology Bulletin, 37, 614-625.

McAuley MC. (1832) [Hand-written Manuscript of the Original Rule of The Sisters of Mercy]. Dublin: Archives of the Sisters of Mercy.

McAuley MC. (1837). Letter to Elizabeth Moore, July 27th. Published in Sullivan M. (ed.)(2004) The Correspondence of Catherine McAuley 1818-1841 .Dublin: Four Courts Press.

Meehan TC. (2012). The Careful Nursing philosophy and professional practice model. Journal of Clinical Nursing, 21, 2905-2916.

Meyer GR. (1960) Tenderness and Technique: Nursing Values in Transition. Los Angles: University of California Institute of Industrial Relations.

Niezink LW, Siero FW, Dijkstra P. Buunk, AP. & Barelds DP. (2012) Empathic concern: distinguishing between tenderness and sympathy. Motivation and Emotion, 36, 544–549.

Partridge E. (1958) A Short Etymological Dictionary of Modern English. New York: The Macmillan Company, pp. 703-704.

Porter N. (Ed.). (1964-1891) Webster's International Dictionary of the English Language. Springfield, Mass., G.C. Merriman & Co:, p. 1891.

Sullivan M. (2012) The Path of Mercy: The Life of Catherine McAuley. Dublin: Four Courts Press.

 

Therese C. Meehan¬© July 2020