Review Article

Love in Nursing: A Concept Analysis

Introduction

Love is a universal concept and is considered as a human attribute. It exists in the encounters between people and creates a relationship, solidarity, empathy, and a deep sense of unity. This emotional state is transmitted from person to person and stimulates a sense of sympathy among people. In this case, the person will share emotions such as their happiness and sadness with others, and so love will emerge. Love is not a skill that is learned, but a sensation experienced by individuals that affects their personality; as a result, new and unknown aspects of the person’s identity are manifested.¹ Love creates a sense of responsibility, respect, and understanding of others. True love is unconditional and creates loyalty in the person. Everybody needs to be a lover and beloved.² Love is not limited to loving a particular person, but also is a range of love for humans such as a romance relationship, a friend, love for a child, love for siblings, love for neighbors, love for a partner, or even, to love a particular activity such as sport, work, or specialty.³

What is love in nursing? The answer is moral responsibility. The relational context has a nurse constantly exposed to patient situations that give rise to expressions of love as moral responsibility. It is a form of love that centers on the ability of our being, or at least the possibility of our being, to transcend its everyday form to a metaphysical state of being moral.⁴ Love as a moral act is the basis of communication and makes the person more intimate with himself and others. In communication, love acts as a stimulant and creates a sense of solidarity and unity. The existence of humans is summarized in loving each other. Love reduces the separation between people and connects them. Although the separation and independence of human attributes are the basis for the creation of love, people have to communicate with each other to have a better life.⁵

The nursing profession is the based on caring. Care is the combination of love and respect for others. Love in nursing is beyond the traditional role of nurses and leads to more interest and commitment in nurses as a result of integrated and patient-centered care.⁶ Love as an aspect of human care means respect for kindness, self-esteem, dignity, and human values. It is the great concept in human care and modern nursing. It empowers nurses and develops feelings of power and independence in them. Respect for human dignity, observance of values and humanitarian relations and, allocation of sufficient time for patient care is the result of love in nursing.⁷ When a nurse enters into a patient’s room, a magnetic field of expectation is created. In this deeper, more expanded way of thinking about the power, beauty, and energy of love, a caring moment becomes an energetic vibrational field of cosmic love. The connections between caring, loving, and infinity become the process of facing our humanity as a mystery, thus mirroring humanity of self and other back on itself. Such a human-to-human act of caring within a given moment becomes a basic foundation for facing our humanity, uniting us and the cosmic energy of love, as one.⁸

There are many concerns about nursing care without love; and some of nurses have been criticized by researchers in this regard. They have postulated that the flame of love in nursing is dimed and that some of nurses do not care for their clients with love.⁵ Some have also reported that modern nursing has deviated from love because of the large workload, lack of time, low numbers of nurses, financial problems and short-term employment. Naturally, caring without love is a defective care, and this is a challenge for the nursing profession today.⁷ Love has a long history in nursing research. However, the concept and meaning of love in nursing has not paid due attention and it is not clear whether this concept differs from its current meaning in nursing careers. Hence, there are questions about what the concept of love in nursing is or what its pros and cons and consequences are. Accordingly, and considering that no Persian or English language study was available on the concept of love in nursing, this study examined the concept of love in nursing and its characteristics. The aim of this study is to describe and discuss the concept of love and the way it is related to nursing. The research questions are: What is the concept of love in nursing? What are the pros and cons and what are the consequences of love in nursing?

Methods

This study used the Walker and Avant’s model of concept analysis. The concept analysis is used to better understand the concepts and also is an essential step in the development and extension of a theory.⁹ By clarifying an obscure concept, we can clarify its implications in the clinical practice that are frequently used and which are sometimes ambiguous. Walker and Avant provided eight steps for analyzing a concept.¹⁰ These steps are as follows: 1. selecting a concept, 2. determining the purpose of the analysis, 3. identifying all uses of the concept, 4. defining the characteristic attributes of the concept definition; 5. identifying a model case, 6. identifying the borderline and opposite cases, 7. identifying the antecedents, and 8. identifying the consequences.¹¹

Selecting the Concept

The primary focus is on determining the concept of interest, and the proper terminology for conducting the analysis. The concept is not just one word; it is a belief or a characteristic of a word.¹² The term in this study is love in nursing. The equivalent of love in the Persian Dehkhoda dictionary is “to love extremely, fascination, affection, attachment, and friendship.”¹³ In Webster’s Dictionary, love is «passion, amour, mania, and affection.”¹⁴

Data Collection

Databases such as SID, PubMed, Web of Science, CINHAL, SCOPUS and Google Scholar were searched. The terms “love”, “Concept analysis” and “nursing” were used for searching in international sources. MESH was also used to identify synonyms. No time limit was considered in searching the databases and all studies were published until December 2017.

Keywords were determined and were searched in the databases by two experts in the field of nursing. Then a search of resources and databases was carried out by one of the research colleagues to ensure that information and articles were searched adequately. To do this, first, all articles related to the keywords were entered into the list. After reviewing the title of the articles, all unrelated and repetitive articles were excluded from the review. References of the articles were also searched for relevant articles. All articles related to the topic of love in nursing, that their full texts were readily available in Persian or English languages, and published in scholarly and academic journals, were included in the study. Studies that were conducted on other occupations and therapeutic groups, studies that were not related to the subject, or their full texts were not available, were excluded from the review. The word love is closely associated with words such as compassion and affection and sometimes they are used interchangeably, while they are different. So these studies were also excluded.

In the initial search, 142 articles were found but finally eight articles remained relevant and entered the study. Due to the limited number of retrieved studies, the quality of the studies was not evaluated. The search strategy is shown in .

The Purpose of The Analysis

In this study, using the Walker and Avant’s approach, the meanings of love, and the characteristics of the concept of love in nursing were examined. Also, for the application of the concept in the nursing practice, some uses and applications were described to increase the understanding of this concept and help better use of the concept of love in nursing.

Results

Definition of the Concept and Identification of its Uses

Love Definitions in the Dictionaries

In Webster’s dictionary, love means too much interest in another that stems from an emotion, motherhood, or affinity, and this interest and desire may last for many years in the heart of the person. Still, the other meaning of love is the feeling of attachment, passion, enthusiasm, loyalty, intimacy, and a sense of goodwill without the prospect of any profit.¹⁴ In Oxford dictionary, love is defined as a sense of passion and sexual attractiveness, an interest in and enjoyment of something or love of someone or something.¹⁵ In Dehkhoda’s Persian dictionary, love is defined as love to the point of extreme, fascination, affection, attachment, excessive friendship, attachment to someone, attachment to something, interest, friendship, pleasures (not associated with sexual orientation), and a waiver of popular defects.¹³

Definition and Application of Love in Different Fields

Biological love: The limbic system is an important structure for love. This system includes thalamus and hypothalamus, and the hypothalamus is directly involved in behavioral and sexual function. The adrenaline hormone, which is secreted through the stress of the adrenal gland, is one of the hormones involved in love. With the secretion of this hormone, a person experiences heart palpitations, sweating, and pupillary expansion, and this is a condition that occurs in the course of love. Endorphin, oxytocin, dopamine, and vasopressin are other hormones secreted in response to love in the brain.¹⁶

The psychology of love: Sternberg considers love as a psychological phenomenon, which consists of three components of intimacy, passion, and commitment. Honor in a person leads to a sense of proximity, bondage, and solidarity. The passion leads to romantic relationships and physical attractiveness, and commitment makes the person commit to maintaining love in the long run.¹⁷ However, Freud believes that love is intertwined with sexuality and every human being experiences it since childhood. Sexually, it is suggestive of the sons’ intention to their mothers (Oedipus complex and of the daughters’ tendency toward their fathers (Electra complex).¹⁸ Maslow is another psychologist who has talked about love, but his theory is completely different from Freud’s view. Maslow believes that every healthy person has a sense of belonging to others and wants to be of interest to others, in other words, to be beloved. Maslow has put love and belonging to another as one of its pyramid components.⁶

Love in philosophy: Plato expresses love as a desire for permanent possession and ownership. People are always looking for things in their lives to meet their needs. Meeting the need is associated with happiness. Plato believes that everything in this world, including man is in the process of acquiring something, is immersed in love and without love, there will be no world.¹⁹ Michael Boilan, a contemporary philosopher, considers love as a function and a concept that causes change and growth in humans. He also believes love is a strong motive for being good.¹⁶ Aristotle considers love as a link between individuals for their flourishing. He considers friendship and not sexual relations the highest of love. In his view, the purest form of love is a love based on benevolence and goodness for others, for themselves and not for pleasure.²⁰ But Persian language philosophers have tried to have a comprehensive definition of love. For example, Shahabuddin Sohrevardi, who is called Sheikh Ishraq, believes that the word “love” has been taken from Sweetheart. The sweet heart is an herb that grows next to other trees and heavily around them.²¹ It can be inferred from this phrase that love means embracement of the beloved by the lover. In others word, it means that, the lover wanders around and care for the beloved.

Love in nursing: Parse one of the nursing theorists says ‘…caring is being with someone towards a moment of joy. It is a state of constituting. In constituting, the nurse and the patient engage in a relationship of authenticity through which both have the potential to grow, but while the patient’s values, beliefs and desires may not necessarily be those of the nurse, the subject-to-subject relationship, has the nurse reach out to the patient’s call even though the reaching out exposes the nurse to change and the possibility of negative consequences to the self.’ From this description it appears that intentional reflective love is what enables the nurse and the patient to be truly present to each other and is of the quality that enables the nurse to risk and therefore potentially sacrifice their own welfare for the sake of another.⁴

Another nursing theorist, who deals with the concept of love, is Watson. Watson places great importance on human care. He believes that the nurse will communicate with the patient, and this communication will lead to self-awareness and development of both the patient and the nurse. Watson emphasizes the concept of love in care and states that care must be taken in conjunction with love and respect, and that this is not possible unless we have love, respect, and self-esteem for ourselves.²² Watson sees love and care as complementary to one another, which leads to personality excellence.²³ Accordingly, the relationship created between nurse and patient is based on love and the care provided is based on interest, respect, mutual understanding and accountability.² Because the nurse bridges between the patient’s discomfort and suffering with health and well-being, he takes steps to reduce the severity of the patient’s suffering and to improve the health of the individual. The foundation of nursing is caring and the caring feature is love. Therefore, love can be considered as a motive for nursing.¹

Eriksson claims that ‘caring is based on love’ and that ‘the basic structure for all kinds of caring is the relationship between the patient and the nurses’. Thus caring is a natural manifestation of human love and is based on the motive of caritas, through which compassion awakens a desire to alleviate another’s suffering. The basis of every kind of caring is, therefore, unconditional caritative ethics, a responsibility and a desire to do what is good.⁴

Determining of Love Definition Features

Features are often used when discussing concepts⁹ and play a key role in differentiating between different concepts.²⁴ Rivero and Erdmann examines the humanitarian care of nurses and describes love as interest, anxiety, respect, understanding, and mutual responsibility.² Rykkje et al explore the influence of love on care in her study. They used the theory of Ericsson to describe love as kindness, charity, and philanthropy in care.⁵ In an article, Emakpor and Nyback consider love in the understanding of others, a sense of benevolence, responsibility, and sacrifice.¹ In general, it can be said that there was not much study in literature review on the concept of love in nursing. However, in these few studies, the most frequent characteristics that are related to the concept of love in nursing include a sense of responsibility, benevolence, attention and concern, respect, and understanding of others as a human being, regardless of their negative consequences for themselves.

Identifying the Model Case

The case model illustrates an example of applying a concept to the clarification of the actual features of the concept, and thus the reader finds out how to interpret the concept.²⁵

Example: Mrs. B-N is a nurse working in the emergency department. She has 10 years of experience in different wards. In the night shift, a 37-year-old woman comes in with dyspnea and severe agitation. Mrs. B-N immediately leads the patient to the bed and calls to the doctor. The patient is given oxygen and she asks the patient and her family about the onset and the time of dyspnea and symptoms. She carefully listens to the patient’s and her family’s descriptions with calmness. The nurse tells the patient and her family that she is taking all the necessary measures quickly and tries to reduce the patient’s dyspnea and anxiety with the help of the treatment team. She says I know how hard it is for you to tolerate shortness of breath and I will try to help you fix it. The patient does not tend to sleep, and believes that she becomes worse with sleep. The nurse respects the patient’s wishes and takes care of the patient in the sitting position. The nurse takes the necessary steps and the patient gets better and falls asleep. The nurse is present several times on the patient’s bedside, and every time she carefully observes the patient for a few moments and examines the vital signs, respiratory symptoms and the patient’s complexion. She asks the patient’s family to refer to her, and see if they have any questions or problem. To observe the patient’s peace and tranquility, the room lighting is dimmed and silence is established and the sound of the monitor is minimized.

The Borderline Case

The borderline case has some of the features of the concept, but it does not have all of these characteristics. It is in fact similar to the model cases, but it can be distinguished on the basis of the lack of certain features of the concept.⁹

Example: Mr. M-M is a nurse specialist with 5 years of work experience. A 50-year-old man with chest pain is hospitalized in the ward. The patient calls the nurse and says he feels nausea. The nurse asks him if there is pain in the chest and neck. The patient responds no. The nurse tells the patient that it may be related to his heart, so he will take an electrocardiograph (ECG) for sure. After taking the ECG, the patient asks if his heartbeat is good. The nurse does not respond and says, “I will call the doctor”. The nurse advises him to stay on the bed and not worry, but the patient is so worried and stares at the nursing station. The nurse contacts the doctor and executes the order promptly. The nurse looks at the patient regularly and asks if he feels better. The patient states that his nausea has decreased. Yet, he still seems anxious. The nurse assures him that there is no need to worry and that they look after him and keep him under the control.

The Opposite Case

The opposite case does not have any of the features of the concept, and this difference is quite clear and easily recognizable by people.⁹

Example: Mrs. R-H is a nurse in the orthopedic unit with 12 years of work experience. Mr. M is in the hospital because of a fracture in his left leg. A surgery was performed on the patient in the previous day and the patient’s leg was dressed. The patient is suffering from severe pain in the fractured area and calls the nurse regularly. The nurse tells him to wait until her work is finished. After a few minutes, the nurse comes to the patient’s bedside and asks about her problem. Then, he leaves the room without saying a word. The patient still feels pain and waits for the nurse. Finally, he is disappointed and calls the nurse again. The nurse tells him that she is busy and when she is finished, she will treat him and asks the patient not to call her anymore.

Identification of the Antecedents and the Consequences

Antecedents of Love in Nursing

Antecedents are events or incidents that must be revealed before the concept emerges.⁹ The antecedents of nursing love dates back to previous experiences as well as their childhood. Beliefs, values, and art can affect love in nursing. Humanitarian values are created in relation to the relationship, feelings of commitment, and action. In this case, a nurse will understand the meaning of his life in the meaning of the life of others including his/her clients, and following that, the humanitarian feelings and deeds will be the basis of his professional life.²⁶ Another antecedent, is the love of nurse for himself. This means before a nurse loves his/her clients, s/he must love him/herself,²² and after that, the love makes the nurse a self-centeredness and s/he moves in the relationship with clients from “I to you”.⁵ Thorkildsen et al calls love as the core of morality, the basic characteristics of man and in caring, love is a stimulus.²⁷ Love in a nurse creates a sense of responsibility, attention, respect, understanding of others and unconditional loyalty.²

Consequences of Love in Nursing

Consequences are events that are revealed after the concept emerges.⁹ The provision of romantic care improves the nurse-patient’s relationships, and as a result, the type of care is provided would be a complete care.⁵ In this case, a deep sense of being-with and correlation is created, and then the patient would easily share his suffering with the nurse, which induce the patient a sense of recovery and relieves his/her pain and discomfort.¹ In addition, nursing with love makes the nurse more aware of human values. Love in nursing is the basis for caring and healing treatments, which is vital for the patient and nurses. Nursing leads to the preservation of humanity and human dignity if it is accompanied by love and humanitarian values. In this way, the nurse will have a vivid role in the evolution of humanity and human values.⁸

Empirical Representation of Love

The empirical representation is related to the classes and groups of the real phenomena, which shows how the concept is conceived and understood.⁹ Wahlin et al conducted a study on 12 treatment staff in 1995 to investigate the implementation love in care. They conclude that love in caring is humility, attention, intimacy, and respect for the patient.²⁸ In a study in 2000, Fitzgerald and van Hooft asked participants how love in nursing is? The participants expressed that love is goodness to others without any expectation and carrying out more care than the duty.²⁹ Fitzgerald and asks in another study: What is love in nursing and midwifery? The answer is moral responsibility. The relational context has a nurse and midwife constantly exposed to patient situations that give rise to expressions of love as moral responsibility. It is a form of love that centers on the ability of our being, or at least the possibility of our being, to transcend its everyday form to a metaphysical state of being moral. It enables a nurse and midwife to transcend the isolation associated with their personal being as a self-project, to be ‘for’ the patient as a first priority.⁴ Stickley and Freshwater conducted a study in 2002 to examine the role of nurse therapy with focus on love. The study results provided a framework for the presentation of love in caring that includes a balance between profession, attention, patience, and concentration.³⁰ Thorkildsen et al in a study in 2013 examined the essence of love in the face of suffering. They achieved three major themes including: love as a power, love as the basis, and love as a moral art.²⁷

The authors did not find a special independent tool to measure love in nursing. Therefore, based on what was said, we define love in nursing as follows: providing nursing care with responsibility, benevolence, attention and concern, respect and understanding of others as a human being, regardless of their negative consequences for themselves.

Implications for Nursing/Practice

This study presents the conception of loving humane care as an intersubjective relationship between nurses and the people. The love in nursing is understood as the ability to providing nursing care with responsibility, benevolence, attention and concern, respect and understanding of others as a human being, regardless of their negative consequences for themselves. Defining attributes of love in nursing are shown in Table 1.

Discussion

The results of this study, based on the purpose of analyzing the concept of love in nursing, showed that performing nursing care along with responsibility, benevolence, attention, and concern, respect, and understanding of others as a human being, regardless of their negative consequences are signs of care-giving with love. In this case, a friendly human relationship is created between the nurse and the people. During this relationship, there is a love that leads to attention, interest, respect, acceptance of responsibility, and understanding of the health of individuals. Empathy in the nurses leads to seeing themselves as patients. Therefore, care is taken according to the needs and circumstances of the individual. This makes the rights of others be observed more fully. All of this makes nursing practice as a profession and as a valuable technique.² In today’s civilized world, it seems that the nature of humanity has been forgotten on the path of modern medicine. We have forgotten that we are cultivated with love, beauty, elegance, and forgiveness. It reminds us that the soul of humanity has been damaged and humanity has undergone a change. Therefore, attention to care with love is important as the basis for nursing.⁸ As a moral act, care is mixed with love that is a universal value. The existence of love makes the care-givers gain a deeper understanding of the patient and improve the suffering of the patient while alienation with love in care ultimately increases the suffering and discomfort of the patient.³¹ Care without love is an alarm because love is a moral value and the foundation of being. Therefore, caring without love is caring without regard for human values, which causes many concerns in nursing. Love creates creativity in care. With love in the care of the relationship between the nurse and the patient, which forms the basis of human values, the feeling of kindness, support, goodness and value, and self-esteem are created in the individual, and this care will be a complete care. Communication and love are two key concepts in care-giving. The relationship forms the basis of spiritual care, and love forms the basis of love as kindness and affection. Love is a vital force that promotes the sense of goodness of the patients and helps them to maintain them.⁵ As Watson say, the ethics of love and caring, becomes the first principle for facing and sustaining the infinity of our profession. If we follow this ethical demand, nursing would play a critical role in moving humanity toward the omega point, ever closer to God and the mysterious sacred circle of living, trusting, loving, being, and dying. She concluded with a Teilhard de Chardin quote: love in all its subtleties is nothing more, and nothing less, than the more or less direct trace marked on the heart …this is the ray of light which will help us to see more clearly.⁸ His words interpret love in nursing beautifully. In this study, we only included documents published in English or Persian languages. Accordingly, documents in other languages were not included in the analysis. The number of Persian and English articles in the field of love in nursing was very limited. Of course, in search, several articles were found related to concepts such as sympathy, compassion, pity and kindness that are closely related to love; but these articles were not generally related to love; hence, they were excluded from the study. Unavailability of the full text of some articles is another limitation of this study.

Conclusion

The concept of love is a simple yet complex one, and its meaning in nursing literature has interfered with other related concepts. The analysis of this concept clarifies its meaning and encourages it to be used more semantically. Understanding the meaning of love in nursing can promote nursing practice in two ways. First, the nurses are examining their values ​​and beliefs. Second, they find out how to interact with patients. Care with love comes in the form of accountability, benevolence, attention and concern, respect, and understanding of others as a human being, regardless of their negative consequences for themselves. According to the above, it can be concluded that love has a more comprehensive definition of each of these words, and it can be said that love is a collection of these words, and the link between these words represents the word of “Love.” All of these make nurses a sense of being valued and self-esteem and reduces their suffering despite all the problems they have.

Acknowledgment

This article was derived from the PhD dissertation in nursing. The protocol for the research was registered and approved by the ethical committee of Kashan University of Medical Sciences, Iran (IR.KAUMS.NUHEPM.REC. 1398 .058).

Ethical Issues

None to be declared.

Conflict of Interest

The authors declare no conflict of interest in this study.

Author’s Contributions

ShBB designed the review protocol in collaboration with MAH. ShBB developed the search strategy and drafted the protocol. MAH and ShBB were searches and conduct data selection and extraction. Both authors involved in data analysis and interpretation of results. Both authors have read and approved the final manuscript.

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Figure 1. Search strategy.

Research Highlights

References

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