Perspective Piece

Mitigating low-value care: Reflections on love and respect for patient


Background & Aim: Low-value care is care that has little or no benefit to the patient, with the potential to cause harm and incur unnecessary spending to patients and society or waste limited resources. This paper's aim is to reflect on how love and respect for patients are valuable in mitigating the occurrence of low-value care. 
Methods & Materials: A descriptive theoretical and empirical literature analysis was employed to reflect on the impacts of love and respect for a patient on mitigating low-value care.
Results: The feelings of uncomfortable atmosphere, dissatisfaction, and distrust by the patient due to a deficit of love and respect for the patient could lead to a high rate of patronizing low-value care from unprofessional health workers, which could lead to the occurrence of complications. However, when care is based on optimal love and respect, it eventually brings about patients' satisfaction and continued utilization of high-value care choices from experienced health professionals.
Conclusion: It is imperative to apply love and respect for patients in healthcare practices; otherwise, a surge in the occurrence of low-value care caused by patients' requests and expectations is possible. There is a need for a deep understanding of low-value care in nursing through research studies. 

1.WHO. Delivering quality health services: a global imperative for universal health coverage. World Health Organization 2018. Accessed June 24, 2022. Available from:
2.Nigusie A, Endehabtu BF, Angaw DA, Teklu A, Mekonnen ZA, Feletto M, et al. Status of Compassionate, Respectful, and Caring Health Service Delivery: Scoping Review. JMIR Human Factors. 2022; 9(1). e30804.
3.Rad M, Mirhaghi A, Shomoossi N. Loving and humane care: a missing link in nursing. Nursing and Midwifery Studies. 2016; 5(2): e34297. doi: 10.17795/nmsjournal34297.
4.Verkerk EW, Huisman-de WG, Vermeulen H, Westert GP, Kool RB, van Dulmen SA. Low-value care in nursing: a systematic assessment of clinical practice guidelines. International Journal of Nursing Studies. 2018; 87: 34-9.
doi:10.1016/j.ijnurstu.2018. 07.002. Vries EF, Struijs JN, Heijink R, Hendrikx RJ, Baan CA. Are low-value care measures up to the task? A systematic review of the literature. BMC Health Services Research. 2016 Dec;16(1):1-2.
6.Carman KG, Liu J, White C. Accounting for the burden and redistribution of health care costs: who uses care and who pays for it. Health Services Research. 2020 Apr;55(2):224-31. doi:10.1111/1475-6773.13258
7.Maria EA, Wendy C, Paul N, Hester V. What not to do: Choosing wisely in nursing care. International Journal of Nursing Studies. 2019; 101(14): 103420.
8.Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, et al. Evidence for overuse of medical services around the world. Lancet. 2017; 390 (10090):156-168. S0140‑6736(16)32585‑5.
9.Badgery-Parker T, Pearson SA, Dunn S, Elshaug AG. Measuring hospital-acquired complications associated with low-value care. JAMA Internal Medicine. 2019 Apr 1;179(4):499-505. doi: 10.1001/jamainternmed.2018.7464
10.Verkerk EW, Tanke MA, Kool RB, van Dulmen SA, Westert GP. Limit, lean or listen? A typology of low-value care that gives direction in de-implementation. International Journal for Quality in Health Care. 2018 Nov 1;30(9):736-9. doi:10.1093/intqhc/ mzy100.
11.Kini V, Breathett K, Groeneveld PW, Ho PM, Nallamothu BK, Peterson PN, Rush P, Wang TY, Zeitler EP, Borden WB, American Heart Association Council on Quality of Care and Outcomes Research. Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation: Cardiovascular Quality and Outcomes. 2022 Mar;15(3):e000105.
12.Norton WE, Chambers DA. Unpacking the complexities of de-implementing inappropriate health interventions. Implementation Science. 2020 Dec;15(1):1-7.
13.Maratt JK, Kerr EA, Klamerus ML, Lohman SE, Froehlich W, Bhatia RS, Saini SD. Measures used to assess the impact of interventions to reduce low-value care: A systematic review. Journal of General Internal Medicine. 2019 Sep;34(9):1857-64.

14.Karlsson M, Pennbrant S. Ideas of caring in nursing practice. Nursing Philosophy. 2020 Oct;21(4):e12325.
15.Eriksson K. Vårdandets idé. [The Idea of Caring]. In K. Eriksson (Ed.), Vårdvetenskap. Vetenskapen om Vårdandet och det Tidlösa i Tiden [Caring Science The Science of Caring and the Timeless in Time]. Stockholm, Sweden: Liber. (In Swedish). 2018.
16.Alvsvåg H. Philosophy of caring. In M. R. Alligood (Ed.), Nursing theorists and their work, 9th ed. St. Louis, MO: Elsevier. 2017.
17.Watson J. University Press of Colorado; Louisville, Colorado: Unitary caring science: the philosophy and praxis of nursing; 2018.
18.Wei H, Watson J. Healthcare interprofessional team members' perspectives on human caring: A directed content analysis study. International Journal of Nursing Sciences. 2018; 6(1):17-23. Published 2018 Dec 13. doi:10.1016/j.ijnss.2018.12.001
19.Devi B, Pradhan MS, Giri MD, Lepcha MN. Watson’s theory of caring in nursing education: challenges to integrate into nursing practice. Journal of Positive School Psychology. 2022 Apr 9:1464-71.
20.Sadat-Hoseini AS, Khosropanah AH. Comparing the concept of caring in Islamic perspective with Watson and Parse's nursing theories. Iranian Journal of Nursing and Midwifery Research. 2017 Mar;22(2):83-90.doi: 10.4103/ijnmr.IJNMR_311_14.
21.Adib-Hajbaghery M, BolandianBafghi S. Love in nursing: A concept analysis. Journal of Caring Sciences. 2020 Jun;9(2):113-19.
22.Stonestreet E. "Love and Respect as Moral Attitudes and Practices of Recognition". Philosophy Faculty Publications. 2019; 110. Available from:
23.Agussalim, Asikin M, Nasir M, Podding T, Alamsyah, Rahman. Caring Behavior of Nurses Increase Level of Client's Satisfaction in Clinical Area. American journal of biomedical Science and Research. 2020; 10(5). AJBSR.MS.ID.001544.
doi: 10.34297/AJBSR.2020.10.001544.
24.Chandra S, Ward P, Mohammadnezhad M. Factors associated with patient satisfaction in outpatient department of Suva Sub-divisional Health Center, Fiji, 2018: a mixed method study. Frontiers in Public Health. 2019 Jul 2;7:183. doi: 10.3389/fpubh.2019.00183
25.Birkhäuer J, Gaab J, Kossowsky J, Hasler S, Krummenacher P, Werner C, Gerger H. Trust in the health care professional and health outcome: A meta-analysis. PloS one. 2017 Feb 7;12(2):e0170988.
doi: 10.1371/journal.pone.0170988
26.Rockwell MS, Michaels KC, Epling JW. Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study. BMC health services research. 2022 Dec;22(1):37.
27.Ella RE, Samson-Akpan PE, Mgbekem MA, Edet G. Factors influencing patients perception of nurses respect for their dignity in a public hospital in calabar, Nigeria. International Journal of Humanities Social Sciences and Education (IJHSSE). 2016 Aug;3(8):72-81.
28.Jemal K, Hailu D, Mekonnen M, Tesfa B, Bekele K, Kinati T. The importance of compassion and respectful care for the health workforce: a mixed-methods study. Journal of Public Health. 2021 Mar 11:1-12.
29.Goodrich J. What makes a compassionate relationship between caregiver and patient? Findings from the ‘anniversary’Schwartz Rounds. Journal of Compassionate Health Care. 2016 Dec;3(1):1-8.
30.AnAaker A, Elf M. Sustainability in nursing: a concept analysis. Scandinavian Journal of Caring Sciences. 2014 Jun;28(2):381-9.
IssueVol 9 No 4 (2022): Autumn QRcode
SectionPerspective Piece(s)
care love low-value respect satisfaction

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Jafaru Y. Mitigating low-value care: Reflections on love and respect for patient. NPT. 2022;9(4):261-266.