Tender Loving Care: A Conceptual Analysis

Main Article Content

Kumiko Kido
Akemi Mitani
Yuko Uemura


Background: Studies have shown that combining tender loving care (TLC) with the treatment of patients with recurrent miscarriages can improve pregnancy outcomes. The importance of TLC has long been recognised in studies on psychiatric, gerontological, and end-of-life nursing in Western countries. Recently, randomised controlled trials (RCTs) have been used to examine the improvement in outcomes with the addition of TLC to the treatment of patients with recurrent miscarriages; however, no conclusions have been reached. TLC is a highly beneficial and harmless intervention that is not necessary for conducting RCTs. Therefore, healthcare professionals need to be aware of exercising TLC when treating patients with recurrent miscarriages. However, the concept of TLC is ambiguous and its definition is unclear.

Purpose: This study aimed to conduct a conceptual analysis of TLC and clarify its constructs. Clarifying the definition of TLC will provide professionals with basic information that will be helpful when exercising TLC with patients who experienced repeated miscarriages despite of hopes of having a baby.

Methods: This study was conducted using Walker and Avant’s concept analysis approach. Research published between the first edition of the journal till January 2022 were searched, and the titles and abstracts of the studies were reviewed to determine their suitability. Consequently, 28 articles, all of which were in English, were selected for conceptual analysis. The were CINAHL Plus with Full Text and MEDLINE databases were examined. The search term used was ‘tender loving care’.

Results: The results of the conceptual analysis of TLC revealed the following antecedents, defining attributes, and consequences. The antecedents involve patients with the following diseases or disabilities: (1) suffering from mental or physical distress, (2) facing significant barriers in life (illness, disability, etc.), and (3) being unable to manage their mental health and well-being through self-care.

Conclusion: In this study, a conceptual analysis of TLC was conducted using Walker and Avant's (2000) method. As a result of the conceptual analysis, ‘tender loving care’ was defined as ‘the care for mentally or physically distressed or impaired subjects by health professionals, parents, and teachers based on compassion and empathy, who perceive the condition of the subject and respond appropriately, thereby reducing tension, distress, and anxiety and achieving a state of mental and physical well-being’.

Article Details

How to Cite
Kido, K., Mitani, A. ., & Uemura, Y. . (2023). Tender Loving Care: A Conceptual Analysis. Women, Midwives and Midwifery, 3(2), 13-23. https://doi.org/10.36749/wmm.3.2.13-23.2023


Aung, S.K.H. (1996). Loving kindness: the essential Buddhist contribution to primary care. Humane health care international, Apr;12(2): E12.

Carson, V. (2001). Depression as a complicating factor for home care patients. Caring, 20(1):30–3.

Davis, C. (2006). Tender, loving care. Nursing Standard,21(13):20-1.https://doi.org/10.


Dodick, D.W. (2006). Chronic Daily Headache. The New England Journal of Medicine, 354:158–165. https://doi.org/10.1056/NEJMcp042897

Domar, A.D., Smith, K., Conboy, L., Iannone, M., Alper, M. (2010). A prospective investigation into the reasons why insured United States patients drop out of in vitro fertilization treatment. Fertility and Sterility, 94(4):1457–1459. https://doi.org/10.1016/j.fertnstert.2009.06.020

Evaluation and treatment of recurrent pregnancy loss: a committee opinion. (2012a). Fertility and Sterility, 98(5):1103–1111. https://doi.org/10.1016/j.fertnstert.2012.06.048

Evaluation and treatment of recurrent pregnancy loss: a committee opinion. (2012b). Fertility and Sterility, 98(5): 1103–1111. https://doi.org/10.1016/j.fertnstert.2012.06.048

Gigengack, R.K., van Baar, M.E., Cleffken, B.I., Dokter, J., van der Vlies, C.H. (2019). Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix. Burns, 45(5): 1057–1065. https://doi.org/10.1016/j.burns.2019.02.005

Halamandaris, V.J. (2005). A tribute to Susan Goldwater Levine and Hospice of the Valley. Caring, 24(11):16–20.

Hopstaken, R.M. (2015). Pneumococcal vaccine for pneumonia mostly unnecessary. Nederlands Tijdschrift Voor Geneeskunde, 159: A9383.

Jaspers, T., Hanssen, G.M.J., van der Valk, J.A., Hanekom, J.H., van Well, G.Th.J., Schieveld, J.N.M. (2009). Pervasive refusal syndrome as part of the refusal–withdrawal–regression spectrum: critical review of the literature illustrated by a case report. European Child & Adolescent Psychiatry, 18:645–651. https://creativecommons.org/licenses/by-nc/2.0

Jauniaux, E. (2006). Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. Human Reproduction, 21(9):2216–2222. https://doi.org/10.1093/humrep/del150

Kagitani, F., Uchida, S., Hotta, H. (2008). Effects of Electrical Stimulation of the Superior Ovarian Nerve and the Ovarian Plexus Nerve on the Ovarian Estradiol Secretion Rate in Rats. The Journal of Physiological Sciences, 58(2): 133–138. https://doi.org/10.2170/physiolsci.RP001508

Kendrick, K.D., Robinson, S. (2002). ‘Tender Loving Care’ as a Relational Ethic in Nursing Practice. Nursing Ethics, 9(3): 291–300. https://doi.org/10.1191/0969733002ne511

Khaskheli, M. and S.B. (2010). Subjective pain perceptions during labour and its management. The Journal of the Pakistan Medical Association, 60(6):473–476.

Khouzam, H.R. (2002). Customer service vs patient care. Connecticut Medicine, 66(3): 161–2.

Krasuska, M.E., Stanis?awek, A., Mazurkiewicz, M., Daniluk, J. (2002). Palliative care--transiting old tradition and values into the modern health care practice. Annales Universitatis Mariae Curie-Sklodowska, 57(2): 186–93.

Lachmi-Epstein A, M.M.B.A. (2012). Psychological and mental aspects and “tender loving care” among women with recurrent pregnancy losses. Harefuah, 151(11): 6337–654.

Lalos, A., Lalos, O., Jacobsson, L., von Schoultz, B. (1985). Psychological Reactions to the Medical Investigation and Surgical Treatment of Infertility. Gynecol Obstet Invest, 20, 209–217. https://doi.org/10.1159/000298996

Larsen EC, C.O. (2012). Recurrent miscarriage--causes, diagnostics and treatment. Ugeskr Laeger, 174(41): 2448–2452.

Li, T.C. (1998). Guides for practitioners: Recurrent miscarriage: principles of management. Human Reproduction, 13(2):478–482. https://doi.org/10.1093/humrep/13.2.478

Matthiesen, L., Kalkunte, S., Sharma, S. (2012). Multiple Pregnancy Failures: An Immunological Paradigm. American Journal of Reproductive Immunology, 67(4):334–340. https://doi.org/10.1111/j.1600-0897.2012.01121.x

Mutiso, S.K., Murage, A., Mwaniki, A.M. (2019). Factors associated with a positive depression screen after a miscarriage. BMC Psychiatry, 19, 8. https://doi.org/10.1186/s12888-018-1991-5

Nystrom, A.E.M., Segesten, K.M. (1994). On sources of powerlessness in nursing home life. Journal of Advanced Nursing, 19(1): 124–133. https://doi.org/10.1111/j.1365-2648.1994.tb01060.x

Rasmark Roepke, E., Hellgren, M., Hjertberg, R., Blomqvist, L., Matthiesen, L., Henic, E., Lalitkumar, S., Strandell, A. (2018). Treatment efficacy for idiopathic recurrent pregnancy loss - a systematic review and meta-analyses. A cta Obstetricia et Gynecologica Scandinavica, 97(8): 921–941. https://doi.org/10.1111/aogs.13352

Redshaw, M., Hockley, C., Davidson, L.L. (2007). A qualitative study of the experience of treatment for infertility among women who successfully became pregnant. Human Reproduction, 22(1):295–304. https://doi.org/10.1093/humrep/del344

Salvador, J.T. (2016). Hope beyond the aging lines: Exploring the lived experiences of elderly in the Philippines. In: 27th International Nursing Research Congress. Sigma Theta Tau International, Cape Town, South Africa. http://hdl.handle.net/10755/616363

Seely S. (1990). Why hospice day care? The American Journal of Hospice Care, 7(1):16–17.

Simionescu, G., Doroftei, B., Maftei, R., Obreja, B.-E., Anton, E., Grab, D., Ilea, C., Anton, C. (2021). The complex relationship between infertility and psychological distress (Review). Experimental Therapeutic Medicine, 21, 306. https://doi.org/10.3892/etm.2021.9737

Strachan-Hall, E. (2016). Secret quality of love. Nursing Management, 23(5):15–15. https://doi.org/10.7748/nm.23.5.15.s22

Strumpf, E., Lang, A., Austin, N., Derksen, S.A., Bolton, J.M., Brownell, M.D., Chateau, D., Gregory, P., Heaman, M.I.(2021). Prevalence and clinical, social, and health care predictors of miscarriage. BMC Pregnancy Childbirth, 21, 185. https://doi.org/10.1186/s12884-021-03682-z

Sugiura-Ogasawara, M., Ozaki, Y., Katano, K., Suzumori, N., Kitaori, T., Mizutani, E., (2012). Abnormal embryonic karyotype is the most frequent cause of recurrent miscarriage. Human Reproduction, 27, 2297–2303.

Sugiura-Ogasawara, M., Ozaki, Y., Kitaori, T., (2009). Diagnosis and treatment methods for recurrent miscarriage cases. Reproductive Medicine and Biology, 8, 141–144. https://doi.org/10.1007/s12522-009-0029-6

Wales, H.W., Hiday, V.A., (2006). PLC or TLC: Is outpatient commitment the/an answer? International Journal of Law Psychiatry, 29(6): 451–468. https://doi.org/10.1016/j.ijlp.2006.08.001

Wen, C.P. (2005). Role of parents and peers in influencing the smoking status of high school students in Taiwan. Tobacco Control,14(1): i10–i15. http://dx.doi.org/10.1136/tc.2003.005637

Yokota, R., Okuhara, T., Okada, H., Goto, E., Sakakibara, K., Kiuchi, T.(2022a). Association between Stigma and Anxiety, Depression, and Psychological Distress among Japanese Women Undergoing Infertility Treatment. Healthcare, 10(7):1300. https://doi.org/10.3390/healthcare10071300

Yokota, R., Okuhara, T., Okada, H., Goto, E., Sakakibara, K., Kiuchi, T.(2022b). Association between Stigma and Anxiety, Depression, and Psychological Distress among Japanese Women Undergoing Infertility Treatment. Healthcare,10, 1300. https://doi.org/10.3390/healthcare10071300