essay on 6cs of nursing

The 6Cs of Nursing Application Essay

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The 6Cs of nursing is a healthcare strategy developed by the National Health Service (NHS) of England in 2012 as a response to declining quality of care and concerns about the lack of care and compassion between healthcare providers and staff to their patients. The strategy was first developed for nursing, care staff, and midwives, but has since been expanded to all staff including caterers, doctors, and chief executives. The 6Cs consist of care, compassion, courage, communication, commitment, and competence, making up the general strategy of Compassion in Practice. The aim was to implement these values into practice and interactions with patients, with support or actionable goals that various positions could act upon to enact the 6Cs (Baillie, 2017). The strategy has since seen tremendous success and been adopted in some form across the Commonwealth countries.

Surgery is often a highly invasive procedure which requires patients to experience challenging recoveries. There can be a range of complications ranging from discomfort and pain to more serious such as hemorrhage, infection, or venous thromboembolism. Post-op care generally requires greater attention to patients, focus on providing appropriate care (such as cleaning wound site, changing bandaging and catheter, and medication adherence, among others), and compassionate care as post-op patients are in a often in a more vulnerable and fragile state (Stephenson et al., 2020). The first aspect of care should be delivered as appropriate, ensuring that the patient is checked-up on and all procedures are done at the correct time. The concept of competence goes together with care, as competence in post-op care is critical often to ensure stable recovery and even safety of the patience. Competence in post-op care includes specific knowledge of the patient and their condition and risk factors, working proactively with the provider team to provide safe and high-quality care (Dahlberg et al., 2022).

Compassion in post-op care and management can take on many forms. Oftentimes, healthcare staff, including nurses, are highly overwhelmed. One way that compassion delivery can be optimized for health professionals is to take a targeted approach, meaning acknowledging the patient and their needs, and seek to focus their efforts on addressing the most important needs of the patient. The better these needs and expectations are met, the more it is generally correlated with increased satisfaction (Heinze et al., 2020). Compassion and subsequent satisfaction are important in post-op care, as it is associated with better patient outcomes and faster recovery and discharge.

Commitment in nursing is more abstract, commonly defined as both loyalty and responsibility to the profession as well as the commitment to provide optimal patient care. Due to the various complex nature of post-op care management, commitment is required, meaning that nurses cannot simply relax or let things go. With post-op patients, nurses must be in check, consistently providing monitoring, supportive care, and react to any arising complications based on their training and protocols regardless of any potential challenges that may arise. Finally, the last aspect is communication, which is critical at any stage of the healthcare process but hold significant importance for post-op care. When the nursing team is present, provides coherent information, and offers holistic communication, combining both technical knowledge and emotional support, patients report a feeling of being cared for and satisfaction in post-op (Sugai et al., 2013). Post-operative patient education and strong communication leads to better health outcomes such as lower pain scores and reducing the use of narcotics, along with faster recovery.

Baillie, L. (2017). An exploration of the 6Cs as a set of values for nursing practice. British Journal of Nursing, 26 (10), 558–563. Web.

Dahlberg, K., Sundqvist, A.-S., Nilsson, U., & Jaensson, M. (2022). Nurse competence in the post-anaesthesia care unit in Sweden: A qualitative study of the nurse’s perspective. BMC Nursing, 21 (1). Web.

Heinze, K., Suwanabol, P. A., Vitous, C. A., Abrahamse, P., Gibson, K., Lansing, B., & Mody, L. (2020). A survey of patient perspectives on approach to health care: Focus on physician competency and compassion. Journal of Patient Experience, 7 (6), 1044-1053. Web.

Stephenson, C., Mohabbat, A., Raslau, D., Gilman, E., Wight, E., & Kashiwagi, D. (2020). Management of Common Postoperative Complications. Mayo Clinic Proceedings, 95 (11), 2540–2554. Web.

Sugai, D. Y., Deptula, P. L., Parsa, A. A., & Don Parsa, F. (2013). The importance of communication in the management of postoperative pain. Hawaii Journal of Medicine & Public Health, 72 (6), 180–184. Web.

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6Cs of Nursing Essay – A Quick Guide For Students

Published by Alvin Nicolas at November 23rd, 2022 , Revised On January 31, 2024

As a professional nurse, you are supposed to have the 6cs of nursing at the tips of your fingers. But if you are still a student and a bit unfamiliar with the concept, this is important for you. The 6cs are vital aspects of patient care and nursing that you should be aware of.

These criteria have remained the same throughout the recent developments and old techniques. While the healthcare sector is changing rapidly due to new technological advancements, the latest findings and inventions, these 6 Cs help professional nurses make sure that the patients are still being treated carefully and compassionately like they always have been.

Because they are such a vital set of values for all health and social care professionals, It would be a good idea for us to dive deep into what the 6Cs of nursing are and why they are so Inextricably linked with the assistance and care you need to provide to the patient and your growth in the nursing career as a professional. Stick to the 6 Cs no matter how hectic your shift is or how difficult a new situation is to guarantee you continue to accomplish what you do best!

Also Read: Interpersonal skills in a nursing essay

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Established by Jane Cummings, The Chief Nursing Officer of NHS England in December 2017, the 6 Cs of nursing comprise;

Communication

They were created to articulate and define the principles underlying the culture and practice of healthcare organizations that provide care and assistance to patients.

Importance of 6cs of Nursing in the Field

Nurses are the backbone of our healthcare system and are vital to the NHS in the United Kingdom. As a result, it is not surprising that more people are working in the nursing field than in any other healthcare profession! The 6 Cs were implemented as a national care plan to guarantee that all nurses function under the same values. They are as follows:

To develop a compassionate relationship with the patient and collaborate effectively with the team, a nurse must have excellent communication skills.  The nurse should be an exceptional listener to be informed and updated about the hospital’s management, the doctor’s decisions, and the client’s conditions and complaints to make the patient feel heard and looked after.

The dedication and commitment of nursing professionals to their patients enable them to take the required actions at the right time to raise the standard of care they get and guarantee a positive patient experience.

The foundation of the relationships nurses develop with their patients revolves around empathy, respect, and care. Compassion in nurses is crucial as it gives the patient a sense of reliability. It can also be referred to as informed kindness.

The essence of your job as a nurse is to care. The care nurses provide contributes a hefty amount to the overall well-being of a community. Patients anticipate that their assistance and care will be tailored to fit their needs best and will be constant through every phase of their illness and stay at the healthcare centre.

Nurses should have the courage to act in their patient’s best interests. Nurses’ responsibility is to voice their or the patient’s concerns and possess the inner fortitude to quickly adjust to every new setting and conquer the disincentive that comes their way.

A nurse must have the innate capacity to comprehend their patients’ social and health needs to be considered competent. Possessing all the necessary expertise and clinical and technical knowledge supported by evidence will help the nurse excel in the field and provide the best medical attention to the patients.

Final Words

Each of the six values carries equal weight and focuses on putting patients at the “heart of everything” nurses do. The 6 Cs were intended to be explicitly included in planning advice and universally endorsed and embraced by everyone involved in commissioning and providing care.

Incorporate the 6Cs in your essay, or an even better idea is to get assistance from experts and professionals in the field of nursing to ace your academics.

What are the 6cs of a nursing essay?

By following the 6 Cs of the nursing essay, you will be able to write a compelling nursing essay. The 6 Cs are stated below.

• Communication – for better collaboration with the team and patients. 
• Commitment – dedication towards the patients and nursing profession. 
• Compassion – to give patients a sense of reliability 
• Care – constantly caring through every phase of a patient’s treatment. 
• Courage – to act in the patient’s best interest 

Competence – processing all the nursing expertise and knowledge successfully.

How do communication and commitment help in writing a good nursing essay?

Communication:

• Helps to clearly convey ideas and information to the reader.
• Improves the structure and organisation of the essay, making it easier to follow.
• Helps to clarify any doubts or questions the reader may have.
• Contributes to the professionalism and credibility of the essay.

Commitment:

• Helps to maintain focus and ensure that the essay meets the required standards.
• Contributes to the quality of the content by motivating students to conduct thorough research and analysis.
• Helps to identify and address any weaknesses or gaps in the essay.
• Shows dedication and passion for the subject matter, which can make the essay more compelling and engaging for the reader.

How do I reference the 6cs of nursing?

Jane Cunnings, The chief nursing officer of the national health service (NHS), in England, established the 6 Cs of nursing essay in 2017. 

The 6Cs of nursing can be referenced using the following citation format:

Department of Health (2012). Compassion in Practice: Nursing, Midwifery and Care Staff – Our Vision and Strategy. London: Department of Health.

How to reference the 6cs of nursing in Harvard referencing style?

In Harvard referencing style, the 6Cs of nursing can be referenced in the following format:

Department of Health. (2012). Compassion in Practice: Nursing, Midwifery and Care Staff – Our Vision and Strategy. London: Department of Health.

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An argumentative essay makes an original argument in response to the subject matter under discussion. In an argumentative essay, the author supports their stance on the topic by presenting evidence material.

Before we describe a narrative essay, it will make sense to understand what is an essay and what are the different types of essay.

A student of the school, college, or university is assigned to write academic essays throughout the academic career. An essay can be described as a brief composition of informative writing.

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Explaining the 6 cs of nursing, the 6cs of nursing - care, compassion, competence, communication, courage, and commitment, were introduced in 2012 to ensure that individuals with healthcare needs receive the highest level of care and compassion from dedicated and skilled healthcare professionals. in this blog, we explore the profound significance of these values and their collective impact on nursing care..

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Introduction to the 6 Cs

The 6 Cs of nursing were introduced in December 2012 by NHS England’s Chief Nursing Officer, Jane Cummings. These six core values are at the heart of the Compassion in Practice strategy, guiding principles that every healthcare provider and professional must embrace and implement.

The 6Cs of nursing include the following key attributes:

These values are the foundation for ensuring the delivery of high-quality care daily, by a diverse range of healthcare professionals, including:

• Support workers
• Disability support workers
• Personal care assistants

In the following sections, we will explore the purpose and significance of each of the 6 Cs defined by the NHS . By understanding the unique essence of each value, we can better appreciate their profound impact on healthcare practices and individuals’ health outcomes.

Care and support services must be tailored and constantly adjusted to the individual. This personalised approach can contribute to individuals achieving their treatment and life goals, leading a more independent and fulfilling life, and having a more active role in the community.

The value of care is defined as:

The care we deliver helps people improve their overall well-being and independence, and with that, it helps improve the health of the whole community. Caring defines us as an organisation and our work. People receiving care from our clinicians at Nurseline Community Services expect it to be right for them and provide support throughout every stage of their recovery.

By aligning care plans with an individual’s specific needs and aspirations, we empower people to actively participate in their own care and make informed decisions. This collaboration fosters a sense of ownership and empowerment, leading to improved treatment and better overall health outcomes.

2. Compassion

In addition to the quality of treatment and support plans, the way care is delivered holds significant importance. At the heart of this process are healthcare professionals, who play a crucial role in providing compassionate care while upholding the dignity and rights of the individuals they support.

The value of compassion is defined as:

Compassion is how care and support are given through the value of strong bonds based on empathy, respect and dignity. It can also be portrayed as intelligent kindness. The most important thing is how people perceive their care and what feelings they nurture while receiving it.

Listening to and understanding the needs of individuals is a crucial capability that healthcare professionals must possess. Through active and empathetic listening, professionals gain valuable insights into the individual’s concerns, preferences, and goals. This empowers them to provide person-centred care tailored to the specific needs and aspirations of the individual.

3. Competence

Competence is linked to recruiting healthcare workers and teams and ensuring each person is qualified to provide support. The value is used to assess the personal values of applicants to a specific role, their qualifications, and leadership potential to improve people’s lives and achieve positive outcomes .

The value competence is defined as:

Competence means that all those providing care must have the ability to understand an individual’s health and social needs.  It is also about having the expertise of clinical and also technical knowledge to deliver effective care and treatment plans based on research and evidence and proven processes.”

By prioritising competence in care, healthcare providers and teams demonstrate their commitment to ensuring the highest standards of care provision. It involves a comprehensive approach that encompasses both qualifications and personal attributes, creating a workforce that is equipped to deliver exceptional support services and positively impact the lives of those they serve.

4. Communication

Communication is vital for providing quality care and support to people with healthcare needs. Team members can establish and maintain effective work relationships with excellent communication and coordination. This is vital as good communication can minimise the risks of errors regarding record–keeping, monitoring of medical records, and reporting.

The value of communication is defined as:

Communication is based on successful and caring relationships and effective teams that work in sink… it is the key to a good workplace also for those receiving our care.

Furthermore, communication between clinicians and the people they serve is crucial. Care should be tailored to the individual’s preferences, needs and desires. With good communication, the care and support team can better understand and adjust the services for individuals.

Courage is crucial for care and support delivered in a challenging environment and conditions where the safety of the supported individual is at risk. It’s important to understand how to keep oneself safe while ensuring the individual receiving support remains safe, and their well-being is cared for.

The value of courage is defined as:

Courage gives us the strength to do the right thing for the people we care for and speak up and find suitable solutions when we have concerns. It means we have the strength, agility, and vision to innovate and embrace new ways of working and thinking.

The value of courage also helps healthcare professionals speak up when they notice errors, mistakes, or anything else that can jeopardise the care and support services. While it can be intimidating to speak up, it’s essential to respectfully speak up to ensure that care is not being negatively impacted.

6. Commitment

Commitment to individuals receiving support is the foundation of healthcare. Healthcare professionals must be committed to the vision, strategy, and approach to achieve positive outcomes.

The value of commitment is defined as:

Commitment is something that is very valuable to hold. People almost always look up to healthcare workers and even express curiosity about their private lives. This means people working in the healthcare industry need to look after their own health and conduct themselves as role models. Therefore, carers need to continuously strive to be a guide and role models for the people under their care.

Furthermore, healthcare professionals must be committed to caring for their own emotional, mental, and physical well-being. This ensures they can provide unparalleled care to the people they serve.

Importance of the 6Cs in Nursing

The 6 Cs in nursing are essential guiding principles for healthcare professionals and providers. These values help improve the healthcare sector by encouraging healthcare professionals to advocate for individuals, uphold ethical principles, and challenge practices that may compromise individuals’ safety or well-being. Collaboration and teamwork are highlighted, promoting effective communication, mutual respect, and shared goals among healthcare professionals, ultimately leading to improved care coordination and positive outcomes.

The 6 Cs are person-centred , ensuring that people receiving care have their needs, preferences and desires met. These values are all about ensuring the right and quality care is delivered in the right place, at the right time, by the right professionals.

Furthermore, the 6 Cs foster continuous improvement by encouraging professionals to develop their skills, improve their knowledge, and engage in reflective practice. By promoting a culture of lifelong learning and improvement, the 6 Cs contribute to ongoing professional growth, innovation, and the delivery of high-quality care.

The 6Cs in Nurseline Community Services

Nurseline Community Services  provides compassionate nurse-led mental health support, tailoring our services to the unique needs and preferences of each individual we serve.

Our aim is for people to improve their well-being and build a sense of self and purpose. Through person-centric care, Nurseline Community Services helps the people we serve remain as active and independent as possible.

We apply the 6 Cs of nursing in our support, everyday activities, and interactions to ensure we provide transformative care.

Our offices are located in  Bristol , Birmingham , and Gloucester .

To learn more about how we can support you, or a loved one, contact us today.

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The 6Cs of Nursing: Professional Values Explained

The so-called '6cs of nursing' are the core values and expectations drawn up by nhs england..

NHS England

The 6Cs of Nursing are embedded into the everyday life of a healthcare professional.

The so-called ‘6Cs of Nursing’ are the core values and expectations drawn up by NHS England Chief Nursing Officer Jane Cummings; they initially launched in December 2012 but remain central to this day.

Embedded into everything nursing, midwifery, and care staff do, NHS England sets out the 6Cs of nursing as follows.

The 6Cs of Nursing

Care is our core business, and the care we deliver helps the individual person and improves the whole community’s health.

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.

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 treatments based on research and evidence.

Communication is central to successful, caring relationships and effective team working. Listening is as important as what we say. It is essential for ‘No decision without me’. Communication is the key to a good workplace with benefits for those in our care and staff alike.

Courage enables us to do the right thing for the people we care for, and to speak up when we have concerns. It means we have the personal strength and vision to innovate and embrace new ways of working.

Commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improving the care and experience of our patients. We need to take action to make this vision and strategy a reality for all and meet the health and social care challenges ahead.

Compassion in practice.

Embraced and implemented by NHS Trusts around the country, national organisations such as the Nursing and Midwifery Council and Royal College of Nursing have consistently promoted the 6Cs of nursing.

They were developed through ‘Compassion in Practice’, a three-year strategy that was concluded in March 2016 and took on the recommendations of several reviews; The NHS Constitution for England (2013), Francis Report, Hard Truths, Winterbourne View, The Keogh Review, Don Berwick Report, The Cavendish Review • Clwyd-Hart Review.

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Reflective Account of Developing 6 C's for Health Care Assistant

Info: 2955 words (12 pages) Reflective Nursing Essay Published: 3rd Nov 2020

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• “6 c’s implemented by the NHS in 2012”-
• Department of health and social care (2012) Top nurses announce new strategy to build culture of compassionate care across the NHS. Available at:  
• (https://www.gov.uk/government/news/top-nurses-announce-new-strategy-to-build-culture-of-compassionate-care-across-the-nhs )(accessed:09/12/2019)
• “When we feel compassion, we find it easier to listen deeply, understand more fully and demonstrate empathy”-
• According to (Embracing empathy in health care, London, radcliffe publishing, Bikker et al, 2014. p.25)
• “Caring defines us and our work. People receiving care expect it to be right for them consistently throughout every stage of their life”-
• Definition of care according to website- National health service- (2012) The 6 c’s. Available at:
• (https://www.england.nhs.uk/6cs/wp-content/uploads/sites/25/2015/03/introducing-the-6cs.pdf) Accessed on the 09/12/19
• “Being aware of yourself, your abilities, your strengths and your weakness’s enables you to develop all of them into practice”
• According to (Sapin. 2013. Essential skills for youth work practice, 2nd edn, London, sage publications ltd)
• according to (Koprowska. 2014. communication and interpersonal skills in social work, 4th edn, London, sage publications ltd)- “knowing your role, within the setting you are in and the people you work with will help you manage your own personal feelings when they maybe involved in a situation”
• By then using a reflective account tool such as (Johns, 1994. model for structured reflection [10th edition]).
• “non-verbal behaviour is as important as, or even more important than, your words” (Egan. 2014. The skilled helper, 10th edn, Belmont, Cengage learning)
• is “SOLER, this stands for facing the sender squarely, with an open posture, leaning towards the other, making good eye contact and remaining relatively relaxed or natural in these behaviours” (Egan. 2014. The skilled helper, 10th edition, Belmont, Cengage learning, inc.)
• I make use of certain facial expressions such as smiling and nodding according to (parris. 2012. An introduction to social work practice, maiden head, McGraw-Hill Education) these are known as nonverbal prompts.
• “Spoken messages are like a braid of which only one strand is the word themselves” (koprowska. 2014. Communication and interpersonal skills in social work, 4th edition, London, Sage publications Ltd).

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Career Advice > Professional Development > Upskilling and Promotions > The 6 Cs of Nursing

The 6 Cs of Nursing

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In 2012, the 6 Cs of nursing practice were developed following a series of high-profile patient care cases in England where the care provided was notably poor. After these events, a strategy based off a public investigation was created to guide nurses, midwives, and other healthcare staff members in the delivery of high-quality, compassionate care. This strategy included the 6 Cs of nursing.

Like the ethical principles of nursing , the 6 Cs are fundamental to nursing practice. They support nursing professionals as they deliver excellent care, ultimately resulting in improved health outcomes for patients.

• Communication

Together, they help make up the foundation of nursing practice as we know it today. Let’s take a closer look at each C individually.

Care is the obvious first among the 6 Cs of nursing — it’s the core principle of the nursing practice. Care is best understood as whatever techniques, therapies, or treatments nurses use to support a patient’s healing.

The concept of care is multifaceted; care includes a variety of interventions, such as helping a patient bathe, monitoring a patient after a surgical procedure, or simply listening and responding to the concerns of the patient and their family. Nurses of all levels connect to patients through the care they provide.

2. Compassion

The concept of compassion stems from the empathy nurses feel toward others. Nurses must understand how a patient feels, but the defining element of compassion is the desire to lessen the patient’s distress. Compassion takes deliberate thought on the part of the nurse, and it should be at the heart of each and every patient interaction.

3. Competence

As you probably already know, nurses must remain up to date on the latest evidence and knowledge surrounding nursing practice. It is very important for each nurse to regularly assess their knowledge base and take steps to improve it. Meeting your state’s continuing education requirements for nurses helps keep you at the top of your game. IntelyEdu can help you find courses and certificate programs that fit into your schedule.

As one of the more practical of the 6 Cs of nursing, competence also means that each nurse should know their scope of practice within the medical system. This helps patient care continue smoothly and can guide nurses when they need to seek out help from other medical professionals.

4. Communication

Obviously, communication is extremely important in the nursing field. A nurse must be able to communicate with other healthcare providers in a timely, competent, and effective manner. Effective therapeutic communication also aids in the development of a positive relationship with the patient. Cultural sensitivity, tone of voice, and appropriate language all help communication be more effective with each person the nurse comes in contact with.

Almost every working day, nurses must confront situations and challenges that may cause tension or fear. These situations may arise from patient care, or they may stem from interactions with other healthcare professionals . Nurses must be courageous, doing what they believe is right and beneficial for the patient in all regards. They must also have the courage to stand by the values and standards of the profession. Looking for inspiration? Check out the story of nursing pioneer Mary Seacole.

6. Commitment

The final of the 6 Cs of nursing is commitment. Nurses must be committed to taking care of patients and providing the highest-quality care possible. Commitment to your patient’s needs takes many forms, including a willingness to show up for your shift ready and on time, every time.

Commitment also means upholding the professional code of nursing. Working in the healthcare field can be very challenging. Each nursing professional must develop coping skills to manage anxiety and successfully perform in their respective jobs. Commitment is key for guiding patients toward better health.

Practicing the 6 Cs of Nursing

The 6 Cs of nursing can be used to transform the patient care experience. They should be considered in regard to each patient while being tailored to enhance the individual’s treatment plan. The 6 Cs should be used to help patients retain independence while improving their health and wellbeing. Also, they can be beneficial for improving the experience of care for each patient.

For example, competence helps nurses deliver high-quality care and measure the impact of that care on patient outcomes. Communication can help build and strengthen leadership among nurses. Finally, commitment can be applied to help ensure safe staffing levels with nurses who have the right skills for the job.

Let’s say a new grad nurse has a question about a particular medication that is being administered to a patient. The nurse asks his preceptor to explain the medication’s purpose and potential side effects. The preceptor shares this information with the new nurse and tells him some of the adverse reactions to be on the lookout for. This is an example of competence, communication, and commitment in action.

The 6 Cs of nursing should be used no matter your level of nursing education or practice area. With everyone practicing these concepts, patient care efforts will continue to improve.

Demonstrate the 6 Cs of Nursing Every Day

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The 6Cs – care, compassion, courage, communication, commitment and competence – are a set of core nursing values that were developed as part of national policy for the NHS in England. They formed the central plank of Compassion in Practice , a strategy document that was drawn up by former NHS England chief nursing officer Jane Cummings and launched in December 2012.

What are Compassion in Practice and the 6Cs of nursing?

Here we summarise key nursing policy documents that were intended to set…

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• The 6 Cs of care

The 6 Cs are a set of values required by all patient-facing health and social care staff. This includes not only registered healthcare professionals, but also clinical support staff and non-clinical staff who may come into contact with patients or members of the public. 

Care is our core business and that of our organisations; and the care we deliver helps the individual person and improves the health of the whole community.

Caring defines us and our work. People receiving care expect it to be right for them consistently throughout every stage of their life.

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.

Competence means all those in caring roles mist 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 treatments based on research and evidence.

Communication

Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say. It is essential for ‘No decision without me’.

Communication is the key to a good workplace with benefits for those in our care and staff alike.

Courage enables us to do the right thing for the people we care for, to speak up when we have concerns.

It means we have the personal strength and vision to innovate and to embrace new ways of working.

A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients.

We need to take action to make this vision and strategy a reality for all and meet the health and social care challenges ahead.

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“The 6Cs are the values and behaviours of Care, Compassion, Competence, Communication, Courage and Commitment” -

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Launched in December 2012, Compassion in Practice – our culture of compassionate care, is the three year vision for nursing drawn up by Jane Cummings CNO for England. This short film introduces the 6Cs , with further detail provided within this paper .

The 6Cs are the values and behaviours of Care, Compassion, Competence, Communication, Courage and Commitment and are perceived as the quality markers of a nursing service. As Specialist Nurses we can engage with our employers and service users by articulating how our services embody the 6Cs.

An overview of the first year of implementation of the 6Cs into practice is described in this document . Started originally as a vision for nursing, NHS Employers describes the 6C’s as contributing to a significant social movement of cultural change across the NHS to improve the way care is provided. The 6Cs are now being rolled out to all NHS staff (Doctors and allied health professionals) and more information can be found here .

The 6Cs Live website provides supporting literature, blogs and chat forums. You may consider that the 6Cs describe fundamental constructs in nursing, and that these have always been key values within nursing, there is debate both on twitter and the nursing press surrounding this. Engaging with the process specialist nurses have an opportunity to showcase their work and highlight the complexity of their nursing care.

Using this Apollo  6Cs template   you can produce a one page 6Cs description of your work. This Coloplast Charter Stoma Care Nursing Service  can be used as a guide to develop your own unique 6C’s service descriptor.

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An exploration of the 6Cs as a set of values for nursing practice

Affiliation.

• 1 Senior Lecturer in Nursing, The Open University.
• PMID: 28541109
• DOI: 10.12968/bjon.2017.26.10.558

In 2012, after several high-profile cases of poor quality care in England and concerns about a lack of compassion and a need to refocus on values, the Department of Health in England published a new strategy for nursing, midwifery and care staff: Compassion in Practice. The strategy included the 6Cs (care, compassion, courage, communication, competence and commitment) and in the follow-on framework, produced by NHS England in 2016, the 6Cs were included again. 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, produced by a Canadian nurse Sister Simone Roach, is explained in the article. The meaning of the DH's 6Cs is then explored in detail with reference to previous research and nursing theory.

Keywords: 6Cs; Care; Compassion; Nursing; Values.

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Open access 6cs and ten commitments: nurses’ understanding and use of courage, fiona barchard senior lecturer in adult nursing and programme and curriculum lead, faculty of health and society, university of northampton, england, judith sixsmith professor in public health improvement and implementation, university of northampton, england, sarah neill associate professor in children’s nursing, university of northampton, england, clency meurier senior lecturer in adult nursing, university of northampton, england.

Aim This article reports the initial findings of a study that explored nurses’ understanding of courage, in the context of the 6Cs and the Leading Change, Adding Value framework. The aim was to explore how nurses’ understanding of courage can inform future practice, thus enabling preparation and support for nurses’ use of courage in practice settings, and to enhance understanding of their use of it in everyday professional practice.

Method The study used unstructured interviews in a grounded-theory approach, in which a theory is constructed by analysing data, underpinned with epistemology of social constructionism, a theory that examines shared assumptions about reality. Twelve qualified nurses were interviewed in depth about their understanding of courage in professional practice. A literature review was also undertaken.

Results Nurses discussed their understanding of courage in terms of being in a situation they do not want to be in, speaking up and taking risks.

Conclusion Understanding nurses’ view of courage and its influence on practice can inform future recruitment and retention policies and practice, thus preparing and supporting nurses in the use of courage in practice settings.

Nursing Management . 23, 10, 26-31. doi: 10.7748/nm.2017.e1550

[email protected]

This article has been subject to external double-blind peer review and checked afor plagiarism using automated software

None declared

Received: 30 June 2016

Accepted: 21 December 2016

Published: 27 February 2017

courage - grounded theory - nursing management - the 6Cs - understanding - unstructured interviews

Introduction

This article outlines the initial results of a constructionist grounded-theory research study of the understanding of courage in the context of nursing. Cummings and Bennett ( 2012 ) define courage as the attribute that ‘enables us to do the right thing for the people we care for, be bold when we have good ideas, and to speak up when things are wrong’. In the 6Cs, shorthand for the values that underpin healthcare, courage is denoted as an essential nursing attribute ( Cummings and Bennett 2012 ). This is supported in Leading Change, Adding Value ( Cummings 2016 ), the national framework for nursing, midwifery and care staff.

As Cummings ( 2016 ) notes, ‘we know that compassionate care delivered with courage, commitment and skill is our highest priority’, which confirms that courage is important to nursing practice. Yet although there are various studies of the other five Cs, namely commitment ( Gould and Fontenla 2006 ), compassion ( Straughair 2012a , 2012b ), competence and caring ( Rhodes et al 2011 ) and communication ( Kourkouta and Papathanasiou 2014 ), relatively little work on courage and its role in nursing practice could be found.

Concept of courage

Grounded theory discourages literature reviews before data collection, to ensure that understanding derives from participants rather than from researchers’ preconceptions. However, literature reviews can be useful, for example in writing research proposals ( Charmaz 2014 ), so a preliminary literature review was conducted in 2015 to determine if the subject had been explored.

The library of the University of Northampton, Nelson, CINAHL, Cochrane, EthOS, Medline and Ovid, Google Scholar and the internet were searched for research on courage in nursing. The search terms used were ‘courag*’ and ‘nursing’ in any order in the title or abstract in the past ten years. Articles sought were in English and the field of nursing was not specified. No primary research UK studies were found but there were three from outside the UK. Two of them were European (Swedish and Danish), namely Lindh et al ( 2010 ), who conducted a hermeneutical enquiry into moral strength, and Thorup et al ( 2012 ), whose interpretative study explored courage specific to vulnerability, suffering and ethics. The third paper, a hermeneutic research study exploring courage in practice, originated in New Zealand ( Spence 2004 ) and suggests that courage in practice is essential.

Four more discussion and opinion papers that met the search criteria were identified. One of them ( Gallagher 2010 ), which originated in the UK, discussed the concept of moral distress and courage, finding it to be an organisational, political and individual responsibility. The other three papers were sourced from the US. A further 12 papers with only courage in the title and specific to nursing were identified in the same search (ten US, one European and one UK), and were a mix of opinion pieces and discussion articles. The review indicates that courage is seldom mentioned in nursing literature, which supports the observations of Spence ( 2004 ) and Murray ( 2010 ).

Lindh et al ( 2010 ) state that, despite courage being identified as a fundamental component of nursing ( Spence 2004 , Cummings and Bennett 2012 ), there is a lack of knowledge about nurses’ courage in practice. Writers such as Gallagher ( 2010 ), Lachman ( 2010 ), LaSala and Bjarnason ( 2010 ), Lindh et al ( 2010 ) and Thorup et al ( 2012 ) identify factors that affect the development of courage. These include constraints within organisational cultures ( Gallagher 2010 ), nurses’ characteristics such as resilience ( Lindh et al 2010 ), experience and intuition in providing courageous care ( Thorup et al 2012 ), and supportive working environments ( LaSala and Bjarnason 2010 ).

Many other papers used words similar to ‘courage’, for example ‘advocacy’, ‘moral strength’ or ‘virtue’, but these were not included as the aim was to explore courage as it is named in the 6Cs ( Cummings and Bennett 2012 ).

To truly appreciate what nurses understand by ‘courage’, we need to ask them. Given the paucity of research ( Spence 2004 , Lindh et al 2010 , Murray 2010 ), this study aimed to explore nurses’ understanding of the concept.

The aims of the study were to explore how nurses’ understanding of courage can inform future practice, thus enabling preparation and support for nurses to use courage in practice settings, and to enhance understanding of adult nurses’ use of courage in everyday professional practice.

Three initial themes from analysis of the findings are presented and discussed below, and are applied in the context of Leading Change, Adding Value ( Cummings 2016 ). This nursing framework is designed to enable delivery of the triple aims of the Five Year Forward View ( NHS England 2014 ): better outcomes, better experiences for patients and staff, and better use of resources.

According to the 6Cs: ‘Courage enables us to do the right thing for the people we care for, to speak up when we have concerns and to have the personal strength and vision to innovate and to embrace new ways of working.’

Methodology

Constructionist grounded theory was used because of constructionism’s social, rather than individual, emphasis. Nurses do not work in isolation or with an individual focus ( Nursing and Midwifery Council (NMC) 2015a ); instead they work in a socially constructed culture, where social processes, historical culture and interactions are evident ( Young and Collin 2004 , Read 2013 ). Social constructionism is congruent with grounded theory as an appropriate epistemological model for exploring shared social meaning and understanding ( Mills et al 2006 ). Grounded theory is a structured but flexible methodology, and data are collected with simultaneous and sequential analysis. Charmaz’s ( 2014 ) approach includes emphasis on action and coconstruction of meaning with the participants.

Adult nurses were recruited from local acute care providers and the community through fliers and self-nomination. There were 12 female participants, and their practice settings and other demographics are shown in Table 1 . Most participants had experience of work in community and acute settings.

Table 1

Demographics.

Adult nurses were recruited as the researcher is undertaking a professional doctorate and her area of practice is adult nursing. Additionally, the Francis report on failings in care at the Mid Staffordshire NHS Foundation Trust ( Francis 2013 ) describes failings in ‘courage’ that, while not exclusively related to adult nursing, were mostly located in general wards and departments. Unstructured interviews, consistent with constructionist grounded theory ( Age 2011 ), took place in locations chosen by participants and lasted on average one hour. The interviews sought to reveal participants’ salient views and what meanings they attached to the word courage ( Bowling 2009 , Prescott 2009 ). The opening question was: ‘Could you tell me what’s your understanding of courage in nursing?’

Data were transcribed and coded, to categorise findings to form theoretical themes, using line-by-line coding, and repeatedly re-examined so that the researcher remained open and receptive to unexpected directions depending on the information ( Charmaz 2014 ). The aim was to analyse rather than simply describe the data ( Corbin and Strauss 2008 ).

During coding, memos, including written explanations, ideas and linkages about the data, helped to strengthen and build categories ( Charmaz 1983 ), enabling movement from description to conceptualisation ( Charmaz 2012 ). NVivo software, which encourages data analysis during collection ( Bringer et al 2006 , Bazeley 2007 , Hutchinson et al 2010 ), was used.The 12 interviews raised 86 codes related to nurses’ understanding and use of courage. The codes were refined into a series of themes, three of which are discussed below.

Ethical concerns including anonymity, confidentiality, informed consent, withdrawal, briefing and debriefing, and protection from harm, were all addressed, ethical approval was granted, and recommendations were followed. Participants received a comprehensive information sheet detailing their involvement in the study, the potential risks of taking part and how the information would be used. They were reassured that consent was voluntary, and that they could withdraw at any point before analysis, after which all data would be anonymised. Data held were anonymised, password protected and securely stored. At the request of the university ethics committee, a protocol was devised in case an issue of concern, for example relating to patient or staff safety, was raised during interviews.

The development of a conceptual theory has yet to be completed. Once finalised, it will be published in another article. The three initial themes included here are as follows: being in a situation you do not want to be in, speaking up and taking risks.

Being in a situation you do not want to be in

Several participants exhibited courage by staying in a situation they did not like. This involved emotional factors, such as facing their fears, going into the unknown or feeling out of their comfort zone, and practical knowledge such as when to take themselves out of a situation.

P7 talked about dealing with distressing emotional situations in acute settings: ‘…it’s a situation you don’t want to be in, that you wouldn’t have chosen to be in, so yeah, I think that’s courage definitely’, while P10 spoke in general terms about her understanding of courage in the community: ‘I guess, perhaps being out of your comfort zone from your every day to day, sort of work.’

P9, also a community nurse, spoke of the personal-safety aspect of courage and how she faced situations and stayed in them, but also knew when to remove herself: ‘Yes, so, so it’s courage in the, the true sense of bravery, as in I need to save myself, from, from the situation as it were.’

These participants described various situations they had had to stay in, when they would have rather not, including dealing with challenging families or patients, managing unexpected deaths, and walking into unknown situations, such as when starting to work with new patients in the community. Most participants had not considered these as courageous acts until they were asked to reflect on them, after which they agreed with the sentiment expressed by P7: ‘Actually lots of things that we do were courageous but we don’t really think of it like that.’

This theme suggests that nurses are prepared to face discomfort, stay in situations when they are needed, and will face their fears, even though it is difficult and may require them to tolerate personal discomfort.

As P6 noted: ‘You don’t necessarily always feel comfortable in what you’re doing… it is, again, it’s facing those fears.’

Nurses might need support to face these situations for the benefit of their patients.

Speaking up and keeping quiet

Despite the NMC’s ( 2015a ) expectation that nurses will challenge and question changes in the traditional hierarchy of the NHS, and a proposed new style of leadership ( King’s Fund 2012 ), participants found that it can be difficult to speak up and to have a voice. P3 and P4, both community nurses with more than 30 years’ experience, said: ‘It’s having the courage to have a voice’, and ‘… having the courage to say “No” to them’. Both were relating their experiences of challenging authority or hierarchical processes if they thought something was wrong.

P2 had a similar experience in an acute setting when two departments were being combined: ‘Nobody had the courage to speak up; everybody accepted what happened, why it happened; nobody had the courage to challenge it and, if they did challenge it, nobody had the courage to, to back them up and say we can’t do this anymore.’

These findings show that even experienced nurses can find speaking up difficult and challenging, so implications for practice include considering how nurses are educated and developed to find their voices.

Taking risks

Participants suggested that being courageous could be considered as taking risks, and these risks could include losing their registration, opening themselves up to emotional distress, and being placed in the difficult position of having to ‘fight’ for something they believed in. Despite the post-Francis climate, there were only infrequent mentions of aggression and whistleblowing.

P10, a community nurse with 25 years’ experience, said: ‘I think it’s, it’s perhaps, being very brave, taking risks, being out of comfort zone, prepared to take risks’, in the context of having difficult conversations with patients or their families. P4 related both nursing and personal aspects to risk taking as follows: ‘… but, at the end of the day, I couldn’t leave him so I did (treated the patient), but I put my job on the line then; I put my registration on the line’, when talking about treating a patient when she was not sure she should do so.

She also said, as she recalled a patient who she felt emotionally distressed about 20 years after caring for them: ‘I don’t know; is compassion connected to courage? I suppose courage in letting yourself feel’. These comments suggest a complex interplay of different facets in relation to risk, including bravery, physical and psychological risk, and fear of losing their registration. Some interpreted risk differently, for example as being exposed to emotional pain when practising compassion.

Overall, this theme has depth and complexity, and implications for practice include supporting nurses to manage the risks they face.

The themes described above indicate something of nurses’ understanding of courage. Finding the courage to stay in a difficult situation is challenging, and this notion of courage is evident in the work of Gallagher ( 2010 ) and Edmonson ( 2010 ). Gallagher ( 2010 ) notes that moral distress affects nurses’ health and ability to provide care, which in turn affects job satisfaction, while Edmonson ( 2010 ) suggests that distress leads to burnout, desensitisation, and disengagement.

This has implications for the retention of nurses who may need support, for example through guided reflection or clinical supervision ( Rolfe 2002 ), to enable them to continue to face these challenges. Revalidation supports reflective practice, and could enhance retention if nurses use it to unpick some of the difficulties they face ( NMC 2015b ).

Speaking out revealed that nurses need courage to find their voice on a daily basis. This is also identified by Lindh et al ( 2010 )’s review of research on courage, which found that remaining true to convictions is a struggle for nurses who may face losing their jobs if they speak out, and Lachman ( 2010 ), who suggests that nurses usually know what to say but may not do so because they fear embarrassment or punishment. This is supported by Gallagher ( 2010 ), while Francis ( 2013 ) notes that staff could be discouraged from speaking out by fear and bullying.The final theme was risk. Lindh et al ( 2010 ) also found that courage was related to nurses’ willingness to expose themselves to risk, while Gallagher ( 2010 ) suggests that organisational, individual or cultural factors can influence this, and proposes that organisations need to embrace moral courage.

The findings should be considered in the context of recruitment using value-based interviewing ( Health Education England 2016 ). They imply that healthcare services need to recruit people who are willing to challenge and take risks, and offer relevant development opportunities throughout professionals’ careers to enhance retention.

The ten commitments in Leading Change, Adding Value ( Cummings 2016 ) support the desire to deliver care of the highest standard, which requires courage, yet the evidence suggests that nurses still find this challenging. This study shows that courage is crucial to realisation of the ten commitments. For example, commitment 3, that ‘we will work with individuals, families and communities to equip them to make informed choices and manage their own health’, and 5, that ‘we will work in partnership with individuals, their families, carers and others important to them’, are echoed by P1: ‘Everything being a test of courage for the best patient outcome.’ Meanwhile, P3 and P4 spoke of their difficulty in finding their voices to achieve these commitments.

Commitment 6, that ‘we will actively respond to what matters most to our staff and colleagues’, implies that nurses need courage to find their voices, as does commitment 9, that ‘we will have the right staff in the right places and at the right time’. Finally, and crucially, commitment 8 states that ‘we will have the right education, training and development to enhance our skills, knowledge and understanding’. P9 noted: ‘Courage is very closely linked to confidence, isn’t it, and experience; that, if you are confident in your knowledge and you’re confident in what you think is right, then you have the courage to shout about it.’

Peate’s ( 2015 ) article, entitled Without courage the other Cs will crumble, is supported by the notion that courage enables other virtues ( Walston 2004 ). This study suggests that even experienced nurses can find using courage demanding, and this should inform recruitment and retention policies. Not only do we require recruitment of nurses who can challenge and take risks, we need to retain them by ensuring there are adequate preparation, training, support and opportunities to enable them to reflect on using courage in practice. As Lachman ( 2010 ) notes, courage is far from redundant, and is still relevant today as nurses encounter numerous situations that call for it.

Limitations

All the participants were female nurses working with adults, so findings and conclusions could be gender- or field-specific. The nature of the study means it was limited in terms of time and participant numbers, so it might be difficult to realise true theoretical saturation ( Charmaz 2014 ).

Among other limitations, the researcher inevitably brought herself into the interviews ( Charmaz 2014 ), while race, culture and gender influence what is said and how it is said, and consequently what is found and written about. Additionally, researchers and participants belong to ‘other identities’ such as nurse, teacher or researcher, and these factors influence conclusions.

To increase the reliability and authenticity of findings, the study procedures are made clear and are repeatable. Reflexivity is central to the analysis, and to improve credibility an audit trail of detailed analysis articulates emergent theoretical concepts ( Gasson 2004 ).

It would be interesting to compare results with male nurse participants, and nurses from other disciplines and settings, to see if their experiences are similar. This study involved a mix of acute and community nurses, but findings are presented as one. Future studies could explore these settings separately.

The examples described in this article of how nurses confront and remain in difficult situations, speak out even when they fear the consequences ( Francis 2013 ) and take risks are just some of the challenges they face in using courage.

Only the initial coding for the research themes presented in this article is complete, which means that at a conceptual level emergent theory has yet to be explored with further theoretical sampling. However, the implications for practice are becoming clear. Nursing can benefit by considering courage at the point of recruitment, and nurses can benefit from education, support and reflection that begin at recruitment and continue through revalidation and lifelong learning. This could help retain nurses in a profession of which they are immensely proud, but which can be challenging and have a personal cost.

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