Influence of self-compassion on fatigue and psychological wellbeing among psychiatric nurses

Self-compassion is the capacity to exhibit empathy or compassion for oneself when faced with failure, insufficiency, or suffering [1, 2]. Several studies have indicated that self-compassion can assist individuals in coping with adverse life situations and minimizing their harmful outcomes, such as burnout and fatigue [3, 4].

Three interrelated elements have been identified to determine self-compassionate responses to personal negative feelings and events [5]: self-kindness as opposed to self-judgment, a sense of common humanity as opposed to isolation, and mindfulness as opposed to over-identification. Self-kindness is a compassionate attitude toward oneself in the presence of pain. Common humanity refers to the understanding that life’s stressors and experiences are shared human experiences, as opposed to a perception that they are unique. Mindfulness is a kind of balanced awareness that neither minimizes nor magnifies the discomfort of our current experience [6] as we cannot demonstrate self-compassion without recognizing that we are experiencing suffering [7]. It has been claimed that self-compassion can improve the mental health of healthcare providers by encouraging optimism, happiness, and a broader perspective on challenges [8].

An issue that nursing staff face at work is fatigue, which inhibits them from functioning properly. Fatigue is a critical challenge and a significant problem among nurses who experience higher workloads, which further causes various issues, such as distress and burnout. Fatigue has an adverse influence on nurses and causes physical, cognitive, and emotional issues that may affect their quality of life. In contrast, self-compassion helps nurses enhance their ability to manage emotions and prevent some negative outcomes of nursing, such as burnout and fatigue [9].

Psychiatric mental health nurses frequently work in extremely demanding settings and circumstances and are exposed to various stressors instantly. Stressors, including work pressure, excessive complexity, skipping breaks, longer work hours than agreed upon, lack of resources and staff, and unsatisfactory patient outcomes, can make psychiatric nurses feel psychologically depleted and put them at risk of mental illness. Self-compassion improves an individual’s overall wellbeing and health [10]. Self-compassion may serve as a protective factor and help psychiatric nurses maintain psychological wellness [11‐13]. Unfortunately, the impact of self-compassion on the health and wellbeing of psychiatric nurses is less understood. Moreover, studies examining the relationship between fatigue and self-compassion and psychological wellbeing among nurses are limited [14], particularly psychiatric nurses, worldwide and in Egypt [15‐17].

Individuals with a high degree of self-compassion hardly ever adopt maladaptive coping strategies, such as self-criticism, contemplation, thought suppression, and avoidance, when confronting their own experiences. Improving one’s own self-compassion can also effectively reduce fatigue [5]. Consequently, identifying the relationship between self-compassion, fatigue, and psychological wellbeing might enhance our understanding of how self-compassion may translate into reduced fatigue and increased psychological wellbeing among psychiatric nurses.

Although self-compassion can promote positive wellbeing among adults, there is a lack of research in this area that should be addressed. This study was designed to explore the influence of self-compassion on fatigue and psychological wellbeing among psychiatric nurses.

This study was designed to assess the influence of self-compassion on fatigue and psychological wellbeing among psychiatric nurses. Also, to evaluate the possible contributing factors for self-compassion, fatigue, and psychological wellbeing among psychiatric nurses.

A cross-sectional study was conducted with convenience sample of 50 registered nurses working in the Psychiatric Department of the Psychiatry and Neurology Hospital of [Assiut University] between October 2023 and February 2024. The questionnaire was distributed 3 days each week throughout three work shifts (morning shift from 10 a.m. to 12 p.m., afternoon shift from 4 p.m. to 6 p.m., and night shift from 9 p.m. to 11 p.m.). A pilot study was conducted involving 10 nurses working at the Psychiatric Department of the Psychiatry and Neurology Hospital of Assiut University to evaluate the questionnaire’s clarity, feasibility, and applicability. Modifications were made to evaluate any additional problems or difficulties, such as question sequencing and clarity. The nurses included in this pilot study were excluded from the overall sample.

Tools of the study: This study used a specially structured assessment questionnaire that was designed by the researchers after reviewing the different related studies and literature to collect the required data; the assessment questionnaire was categorized as follows:

Sociodemographic data: This was developed by researchers based on previous literature. It included age, sex, residence, educational level (diploma (2 years) or Bachelor (4 years), marital status, years of experience, the number of working hours per week, working shifts per month, the number of nurses caring for patients during a shift, and previous training about self-compassion.

The Self-Compassion Scale—Short Form (SCS-SF): It is a widely recognized tool for assessing self-compassion. It is a condensed version of the original Self-Compassion Scale (SCS), developed by Kristin Neff, which includes 26 items. The short form contains 12 items that cover the same six components: self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification. This scale provides a quick yet effective way to measure self-compassion, maintaining strong psychometric properties similar to the full version. This scale consists of 12 items scored on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always) [18]. Cronbach’s alpha for the scale is 0.86 [19]. The total self-compassion is the sum of all items divided by the number of items. The mean and standard deviation of the total scores for the studied sample were calculated. Individuals with scores greater than one standard deviation above the mean were classified as belonging to the high self-compassion, while those with scores lower than one standard deviation below the mean were categorized as belonging to low self-compassion. Individuals with scores falling between these two ranges were classified as moderate self-compassion. An overall score of 1–2.5 denotes low self-compassion, 2.5–3.5 denotes moderate self-compassion, and 3.5–5.0 denotes high self-compassion.

The fatigue assessment scale (FAS): The FAS consists of 10 items: five questions measure physical fatigue, and five questions measure mental fatigue. The scale’s internal consistency was 0.90. Each question is answered using a 5-point Likert-type scale ranging from 1 (“never”) to 5 (“always”). The total score can range from 10 to 50; those < 22 indicate “normal” (healthy) levels of fatigue, those between 22 and 34 indicate mild-to-moderate fatigue, and those > 35 indicate severe fatigue [20]. In this study, we used Arabic version [21].

Psychological wellbeing scale: It was formerly used to measure six aspects of wellbeing and happiness: autonomy, environmental mastery, personal growth, positive relationships with others, life purpose, and self-acceptance. To determine subscale scores for each participant, the responses to each subscale item are added. Higher scores indicate greater psychological wellbeing [22].

Sociodemographic data: Table 1 displays the socio-demographic characteristics of the psychiatric nurses in this study. Fifty psychiatric nurses were recruited and categorized into three groups based on their scores on SCS-SF: Group 1: low self-compassion (n = 13), Group 2: moderate self-compassion (n = 27), and Group 3: high self-compassion (n = 10).

FAS and psychological wellbeing scale results: No significant difference in FAS scores was observed among the groups. Meanwhile, Group 1 had the highest mean FAS score (29.69 ± 7.59), whereas Group 3 had the lowest mean FAS score (23.50 ± 5.23). Severe fatigue was observed in Group 1 and 2 only, whereas normal fatigue was more prevalent in Group 3(60%) than in other groups (Table 2).

Statistically significant differences in the total and subscale scores of the Psychological Wellbeing Scale were observed between the groups. Group 1 had the lowest mean total and subscale scores, whereas Group 3 had the highest mean total and subscale scores.

Relational studies: Correlation between the total scores in SCS-SF, the FAS, and the Psychological Wellbeing Scale and other parameters (Table 3) found that the total FAS score had a negative correlation with age (r =  − 0.28; p = 0.042) and a positive correlation with being married (r = 0.28; p = 0.044). The total score on SCS-SF had a strong positive correlation with the total score on the Psychological Wellbeing Scale (r = 0.72; p < 0.0001).

Univariate linear regression between self-compassion and other parameters (Table 4) reported psychiatric nurses with high self-compassion were significantly more likely to be male (p = 0.04), have a lower overall fatigue score (p = 0.028), and have better psychological wellbeing (p = 0.0001).

Univariate linear regression between fatigue and other parameters and univariate linear regression between psychological wellbeing and other parameters (Tables 5 and 6) shows psychiatric nurses with high fatigue scores were more likely to be female (p = 0.047), married (p = 0.042), have diploma (p = 0.04), have less self-compassion (p = 0.028), and have poorer psychological wellbeing (p = 0.04).

Mental health nurses must deal with patients at many levels, ranging from patients with psychological issues to those with physical disorders, from children to adults, and from inpatients to those in critical situations [24]. They face many challenges and experience several negative events. Self-compassion appears to be an important tool for dealing with unpleasant events [25]. Individuals with high self-compassion respond less emotionally to unfavorable events, produce more reasonable and less harsh perceptions of their experiences, and do not develop bad feelings when thinking of stressful or bad situations [4]. Therefore, we evaluated the relationships between self-compassion and fatigue and psychological wellbeing among psychiatric nurses and determined its possible risk factors.

In this study, psychiatric nurses with lower self-compassion were younger, had fewer years of experience, and cared for fewer patients during a shift. In contrast, nurses with high self-compassion were aged ≥ 45 years, were from urban areas, had a bachelor’s degree in nursing (high academic degree), were working < 45 h per week, and were caring for ≥ 10 patients per shift. Two studies found that increased age and having longer clinical experience are related to low compassion fatigue [26] and high compassion satisfaction [27] as experienced nurses may have higher professional performance and coping methods to care for psychiatric patients and they are confident in their ability to respond effectively to situations [27].

Regarding high education, a study found that students who practice high levels of self-compassion are less likely to suffer from anxiety or procrastination, both of which can impair academic progress [28].

Regarding working hours, higher self-compassion ratings were correlated with decreased working hours, as working few hours help reduce the negative effects associated with stressful situations at work [29]. In contrast, living in urban areas helps reduce traffic time and stress to get in work as this study was conducted at an urban hospital.

This study found no significant difference in FAS scores among the groups. The low self-compassion group had the highest mean FAS scale score (worst score), whereas the high self-compassion group had the lowest mean FAS scale score (better score). Additionally, statistically significant differences in the total and subscale scores on the Psychological Wellbeing Scale were observed among the groups. The lowest mean total and subscale scores on the Psychological Wellbeing Scale were observed in the low self-compassion group, whereas the high self-compassion group had the highest mean total and subscale scores.

In a previous study, nurses working in special care departments, such as the emergency room, intensive care unit, and operating room, reported higher levels of fatigue, which could be because these nurses must care for patients who have more severe diseases or injuries and are more physically dependent [30]. Furthermore, the role of a mental health nurse is significantly different from that of a general nurse, although both nurses are responsible for patient care. Even so, the care demanded by psychiatric patients is significantly different from that required by a patient with physical diseases [24].

It has been demonstrated that individuals with high self-compassion are more likely to have good psychological wellbeing and have a stronger sense of satisfaction than those with low self-compassion [31]. In contrast, individuals who lack self-compassion are more likely to have psychological issues and fatigue [10].

This finding is consistent with those of Durkin and colleagues, who investigated the relationship between self-compassion and wellbeing among community nurses and discovered that community nurses who reported high levels of self-compassion also reported less burnout and more compassion for others [32].

Moreover, the total FAS score was associated with younger age and being married. Additionally, univariate linear regression studies found that psychiatric nurses with high self-compassion were significantly more likely to be male, have a low fatigue, and have high psychological wellbeing. Psychiatric nurses with high fatigue scores were more likely to be female, be married, have a diploma, have less self-compassion, and have less psychological wellbeing. Similarly, fatigue was associated with female sex [33], lower education level [34], being divorced or married [35], and poor psychological wellbeing [36].

This study established the influence of self-compassion on fatigue and psychological wellbeing among psychiatric nurses by providing important insights and substantial proof. As a result, we hope that the findings of this study will be applicable not only to mental nursing but to all nursing disciplines.

We recommend creating an educational intervention program about self-compassion that can reduce fatigue and improve the psychological wellbeing of psychiatric hospital nurses. An intervention program for all psychiatric nurses should be established to increase self-compassion knowledge, attitudes, and abilities to protect them from fatigue and psychological distress. Also, a self-compassion training program should be addressed at various population levels, such as schools, jobs, or public service. To attract participants, it must be free or low-cost.

This study has some limitations: (a) first, the convenience sample limits the generalization of the findings; (b) second, the study was limited to Assiut University’s Psychiatry and Neurology Hospital; (c) third, we did not exclude nurses with psychiatric disorders or medical conditions that might have affected their levels of compassion and psychological wellbeing.

Psychiatry nurses with higher self-compassion had lower fatigue score and better psychological wellbeing. Gender and education level were significant factors for self-compassion and fatigue. Future studies should evaluate therapies and techniques for improving self-compassion among psychiatric nurses to reduce fatigue and increase psychological wellbeing.