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The compassion deficit and what to do about it: a response to Paley.

In a recent paper published in this journal entitled Cognition and the compassion deficit: the social psychology of helping behaviour in nursing, John Paley analyzes the two reports by Robert Francis on the Mid Staffordshire NHS Trust (Mid Staffs) and suggests that, contrary to the findings and the general consensus both inside and outside the nursing profession, there was no ‘failure of compassion’, but rather ‘an interlocking set of contextual factors that are known to affect social cognition’. That is to say, the appalling and sustained failure of care occurred not because the nurses lacked compassion but because they quite literally did not see that patients were suffering from a lack of the most basic care. Furthermore, and arising from this reading of the situation at Mid Staffs, he concludes that a focus on compassion and caring in the recruitment and education of students is misconceived and will be ineffective. Paley’s paper is an extended version of an editorial published in Nurse Education Today entitled Social psychology and the compassion deficit (Paley, 2013), to which we wrote a response (Rolfe & Gardner, 2014). Such are the educational, professional, and political implications of Paley’s arguments that we feel it necessary also to respond to this latest version. Our critique attempts to address Paley’s thesis from three perspectives. We argue that his argument is based on two studies in particular that are fundamentally flawed, that the findings are taken out of context, and that there is, in any case, a simpler account, also grounded in social psychological theory, which better explains the findings from these studies. We end with a challenge to Paley’s conclusion that the problem ‘cannot be corrected or compensated for by teaching ethics, empathy and compassion to student nurses’ (Paley, 2014) by advocating a curriculum focused on the arts and humanities in order to help students to recognize, understand, and respond to the suffering of others.