Mental health care settings are challenging work environments that affect the mental well-being and health of patients and nurses (Hamaideh, 2017). The stressful conditions in psychiatric inpatient and outpatient settings pose challenges to nurses providing safe and effective care to patients (Hamaideh, 2017; Jeffery & Fuller, 2016). The adverse work environments of psychiatric–mental health nurses (PMHNs) can have a significant effect on their mental well-being and ability to deliver quality health care (Jeffery & Fuller, 2016).
Caring efficacy in nurses has become a concern across the nursing discipline because caring for others is the central focus of nursing and is crucial for quality health care (Lamke, Catlin, & Mason-Chadd, 2014). Caring efficacy refers to nurses' belief in their ability to care for patients and includes conveying a caring orientation and forming caring relationships with patients (Alavi, Bahrami, Zargham-Boroujeni, & Yousefy, 2015; Lamke et al., 2014; Reid, Courtney, Anderson, & Hurst, 2015). Efficient nursing care provides a satisfying experience for patients and family members during hospitalization (Alavi et al., 2015).
Self-compassion has been recognized as an important component to facilitate high-quality and compassionate health care delivery (Wiklund-Gustin & Wagner, 2013). Self-compassion refers to compassion toward oneself and refers to how individuals assess themselves in challenging circumstances (Neff, 2016). Neff (2016) theorized nurses being compassionate toward themselves are likely to be compassionate toward others, which may have a direct relationship to caring efficacy. Self-compassion relates to caring because compassion for another person may radiate from compassion for the self (Raab, 2014). Wiklund-Gustin and Wagner (2013) posited the “butterfly effect of caring” (p. 175), explaining that the nurturance of a compassionate self can contribute to a compassionate attitude when caring for others.
PMHNs are often exposed to traumatic events, including acting out behaviors, suicidal gestures and acts, aggression, and violence (Ananthakrishnan et al., 2013; Zeng et al., 2013). Increasing pressures in the workplace may influence nurses' emotional well-being and ability to provide care (Ozkara San, 2015). In addition, the detrimental effects of working in high-stress environments, such as in-patient and outpatient mental health units, affect nurses' productivity and perceived caring efficacy. Nurses also may lose their caring behavior toward patients because of compassion fatigue, which has been a problem in nursing for decades (Ozkara San, 2015).
Neff (2016) suggested that nurses embrace the concept of self-compassion as a protective factor for occupational stress, which can lead to a change in their perception of caring efficacy. Holttum (2015) discussed the importance of self-compassion and self-care for nurses in fostering compassionate care for patients. Lack of self-compassion could have adverse effects in providing compassionate and quality care to patients among mental health workers (Holttum, 2015). More knowledge is needed on the connections between the variables that allow PMHNs to care for patients and create caring relationships (Alavi et al., 2015).
Neff's Self-Compassion Model
Self-compassion refers to compassion toward oneself and involves understanding how individuals assess themselves in challenging circumstances (Neff, 2016). Neff's (2016) self-compassion model includes three major components with six attributes, including self-kindness versus self-judgment, common humanity versus isolation, and mindfulness versus over-identification. Self-compassion as a construct comprises positive and negative attributes and has been found to link positively to positive affect and negatively to negative affect (Yarnell & Neff, 2013). Self-compassion involves harmonizing one's awareness through maintaining a state of equilibrium by seeing the discomforts and burdens of daily life as part of larger life experiences.
Self-Kindness vs Self-Criticism or Self-Judgment
Self-kindness is an opposite trait to punitive self-criticism and refers to assessing oneself with a sense of empathy rather than with the harsh criticism of self-judgment (Neff, 2016). Self-kindness embodies an awareness of inadequacy without being critical, and functions as a solution to resentment and frustration by calmly accepting painful life situations (Beaumont, Durkin, Hollins Martin, & Carson, 2016). Self-kindness, or understanding oneself, is healthier than punitive self-criticism and harsh self-judgment (Neff, 2016). Self-judgment leads a person to have a disapproving attitude about one's inadequacies and flaws (Beaumont et al., 2016).
Common Humanity vs Isolation
The second attribute of self-compassion is common humanity, which characterizes the nature of human beings as inadequate, vulnerable, and sometimes helpless during times of suffering (Neff, 2016). Common humanity involves visualizing one's personal and social experiences as common occurrences and as part of broader life experiences. The act of separating and isolating personal experiences from broader experiences common to humanity can lead to isolation, or the feeling of being separated from others when considering one's inadequacies (Bluth & Blanton, 2014). Isolation refers to individuals wanting to separate themselves from others when thinking about their own inadequacies (Neff, 2016). The acceptance of common humanity as a universal shared human connection of experiences could transform a professional to become considerate and open-minded to criticism (Neff, 2016).
Mindfulness vs Over-Identification
The third and final component of self-compassion is mindfulness, a state of being cognizant of one's present moment of experience and being thoughtful and alert within the moment (Neff, 2016). Being cognizant of one's present moment allows an individual to balance perceptions of negative and positive life experiences with clarity rather than over-identifying with negative emotions (Bluth & Blanton, 2014). Over-identification involves focusing on and exaggerating the negative aspects of one's life or experiences (Neff, 2016).
Perceived Caring Efficacy
According to Reid et al. (2015), perceived caring efficacy refers to nurses' beliefs in their abilities to care for patients. Caring efficacy includes nurses' perception of conveying a caring orientation and forming caring relationships with patients (Alavi et al., 2015; Lamke et al., 2014; Reid et al., 2015). Perceived caring efficacy is an important component in nursing care because it can promote healing and help improve the health care outcomes of patients (Scott, 2014).
According to Alavi et al. (2015), patients can receive positive benefits, such as better treatment results and early recovery from illness, because of improved caring efficacy in nurses. The quality of care has a direct effect on lessening the duration of hospital stay leading to improved patient satisfaction (Scott, 2014). Caring efficacy can also enhance the ability of a nurse to build therapeutic nurse–patient relationships by gaining the trust and cooperation of patients, families, and interdisciplinary team members (Alavi et al., 2015). Caring efficacy has been linked to nurses' motivation, commitment to professional responsibilities, and success at personal and organizational levels (Alavi et al., 2015).
Caring is reflected in the nursing profession as a manifestation of compassion delivered through acceptance, perseverance, action, and courage while providing care for clients (Ledoux, 2015). Recent studies regarding caring efficacy in nursing and health care populations include work on identifying the characteristics of caring efficacy (Alavi et al., 2015), the effectiveness of self-care training programs in improving caring efficacy (Lamke et al., 2014), and the relationship between caring efficacy and emotional well-being (Chana, Kennedy, & Chessell, 2015). Nurses, especially those who work with patients with mental illnesses, encounter stressful emotional and behavioral situations that can affect nurses negatively, leading to diminished caring efficacy (Chana et al., 2015). Although studies regarding the caring efficacy of nurses are gaining momentum, few researchers have studied the association between perceived caring efficacy and self-compassion among PMHNs.
Psychiatric–Mental Health Nurses and Demographic Variables
PMHNs encounter workplace challenges that can diminish their ability to provide safe and effective health care delivery. Workplace challenges include manipulative behaviors by patients, treatment resistance, misuse of privileges, and exploitation of professional relationship boundaries (Brunero, Jeon, & Foster, 2015). Given the adverse conditions of psychiatric–mental health nursing, self-compassion may be a crucial component of perceived caring efficacy in PMHNs. Recent empirical research on PMHNs has pertained to workplace challenges, such as the experiences relevant to caring for disturbed patients in acute inpatient psychiatric settings (Chambers, Kantaris, Guise, & Välimäki, 2015); the connections between workplace violence, staff resilience, posttraumatic growth, and life satisfaction in PMHNs (Itzhaki et al., 2016); connections between PMHNs' attitudes, self-efficacy, and adult inpatient aggression (Verhaeghe et al., 2016); and time spent by PMHNs working in service-related activities, direct care, and indirect care (Goulter, Kavanagh, & Gardner, 2015).
Demographic factors such as number of patients PMHNs care for in each shift (Goulter et al., 2016) and years of work experience in psychiatric care (Verhaeghe et al., 2016) adversely impact nurses' professional commitment and accountability, which can lead to diminished health care delivery among PMHNs (Wiklund Gustin & Wagner, 2013). What is lacking in the literature is research on the relationship between demographic variables, such as nurse:patient ratios and years of work experience in psychiatric–mental health settings, and perceived caring efficacy. Knowledge of the relationship between demographic variables and perceived caring efficacy in PMHNs will contribute to the discipline of nursing by providing a better understanding of the impact of specific work-related factors on PMHNs' self-compassion and perceived caring efficacy.
Research Questions and Hypotheses
Table 1 lists four research questions and associated hypotheses that were examined in the current study. The first two research questions involve the positive and negative aspects of self-compassion, respectively, and their relationships with caring efficacy. The third and fourth research questions involve selected demographic variables (i.e., nurse:patient ratio and total years of work experience in psychiatric–mental health facilities) and their relationships with caring efficacy.
Research Questions and Hypotheses
A convenience sample of registered PMHNs who were members of the American Psychiatric Nurses Association (APNA) participated in the current study. Participants were recruited through the APNA Member Bridge, an open online forum for communication, knowledge sharing, and networking accessible to all APNA members. A power analysis conducted using G*Power 22.214.171.124 determined that a minimum sample size of 82 was needed to detect a moderate correlation (0.30) at a significance level of 0.05 with 0.80 power. The online survey received a total of 163 respondents. After excluding participants who did not agree to the informed consent, participants with missing responses, and participants who reported zero years of work experience, the final sample comprised 98 PMHNs.
Table 2 and Table 3 display descriptive statistics for the sample demographic characteristics. A majority of participants were women (n = 90, 91.8%) ranging in age from 23 to 86 (mean = 48.2, SD = 12.46 years). The largest proportion of participants indicated their highest level of nursing education was a Bachelor of Science in Nursing (BSN) (n = 40, 40.8%) or master's degree (n = 32, 32.7%). Most participants were staff nurses (n = 55, 56.1%), followed by nurse practitioners (NPs) and clinical nurse specialists (CNSs) (n = 28, 28.6%), managers (n = 10, 10.2%), and directors or senior level managers (n = 5, 5.1%). Participants had been working as mental health nurses for an average of 16.51 years (SD = 12.38 years), ranging from 1 to 50 years. The average nurse:patient ratio reported by participants was one nurse for every 14.37 (SD = 43.37) patients.
Participant Demographics (N = 98)
Descriptive Statistics for Continuous Demographic Variables
The instruments used to collect data for the current study included a demographic questionnaire, the Self-Compassion Scale (SCS; Neff, 2003), and the Caring Efficacy Scale (CES; Coates, 1997). The items in the demographic questionnaire included age, gender, experience, hospital position, nurse:patient ratio, and highest level of nursing education. For the experience item, participants free-entered the number of years they had been working as a PMHN. For nurse:patient ratio, participants free-entered the number of patients per nurse in the mental health unit where they worked.
The SCS is a 26-item self-report questionnaire designed to assess self-compassion and includes six subscales corresponding to the positive and negative attributes of self-compassion (i.e., self-kindness, common humanity, mindfulness, isolation, self-judgment, and over-identification). Respondents rated each item on the SCS using a Likert scale from 1 (almost never) to 5 (almost always). Cronbach's alpha reliability coefficients for the SCS subscales ranged from 0.74 to 0.93 in the current study.
The CES is a tool used to measure a nurse's confidence in his/her capacity to convey an explicit caring approach and to foster a caring relationship with patients. The tool contains 30 items that participants rated on a 6-point Likert scale ranging from −3 (strongly disagree) to 3 (strongly agree). The reliability of the CES in the current study was 0.92. Table 4 displays descriptive statistics for the composite scores for each subscale of the SCS and CES.
Summary of Composite Scores for the Self-Compassion and Caring Efficacy Variables
An online survey (hosted through SurveyMonkey®) was conducted to collect the data. The study procedures were approved by the Institutional Review Board of the author's affiliated university prior to data collection. Data collection took place from May 26, 2017 to June 18, 2017. With permission from the secretary of APNA, an invitation and link to the online survey was posted on the APNA website and in their monthly newsletter. In addition, APNA Member Bridge was used to invite members via e-mail. The online survey contained an informed consent, demographic questionnaire, the CES, and the SCS. After all data were collected, they were downloaded from SurveyMonkey and entered into SPSS version 24.0 for analysis. Pearson correlations were conducted to determine the relationships between the variables of interest. Each correlation was evaluated using a statistical significance level of 0.05.
Research Question 1 concerned the relationships between positive attributes of self-compassion and perceived level of caring efficacy in PMHNs. Pearson correlations revealed that self-kindness (r = 0.27, p = 0.006), common humanity (r = 0.27, p = 0.008), mindfulness (r = 0.30, p = 0.003), and the total SCS positive attributes score (r = 0.31, p = 0.002) were positively correlated with caring efficacy, meaning that participants who scored higher in positive attributes of self-compassion tended to score higher in their perceived level of caring efficacy. Therefore, null hypothesis H10 was rejected.
Research Question 2 concerned the relationships between negative attributes of self-compassion and perceived level of caring efficacy in PMHNs. Pearson correlations revealed that self-judgment (r = −0.23, p = 0.020), isolation (r = −0.27, p = 0.007), over-identification (r = −0.21, p = 0.042), and the total SCS negative attributes score (r = −0.23, p = 0.021) were negatively correlated with caring efficacy, meaning participants who scored higher in negative attributes of self-compassion tended to score lower in their perceived level of caring efficacy. Therefore, null hypothesis H20 was rejected.
Research Question 3 concerned the relationship between nurse:patient ratio and perceived level of caring efficacy in PMHNs. The Pearson correlation between nurse:patient ratio and caring efficacy was not significant (r = −0.02, p = 0.876). To account for the sample's heterogeneity in the nurses' positions in the hospital, separate correlations were conducted for staff nurses only and the remainder of the sample (i.e., NPs, CNSs, managers, and directors or senior level managers). The correlation between nurse:patient ratio and caring efficacy was not significant among staff nurses (r = 0.16, p = 0.256) or the other nurse types (r = −0.09, p = 0.586). These results indicate that nurse:patient ratio was not related to perceived level of caring efficacy. Therefore, null hypothesis H30 was not rejected.
Finally, Research Question 4 concerned the relationship between the total years of work experience in psychiatric–mental health facilities and perceived level of caring efficacy in PMHNs. The Pearson correlation between work experience and caring efficacy was not significant (r = 0.12, p = 0.253). The correlation between work experience and caring efficacy also was not significant among staff nurses (r = 0.22, p = 0.115) or the other nurse types (r = 0.04, p = 0.788). These results indicate that years of work experience was not related to perceived level of caring efficacy among PMHNs. Therefore, null hypothesis H40 was not rejected.
The purpose of the current correlational quantitative study was to examine the relationships between work-related demographic variables, self-compassion, and perceived caring efficacy among PMHNs. The results of the demographic data showed a majority of the participating PMHNs were female. The demographic findings of gender are largely consistent with prior research (Wieland, 2015). Wieland (2015) indicated a high percentage (87.5%) of PMHNs were females and had a mean age of 54 years. In the current study, 40.8% of participants (n = 98) indicated their highest level of nursing education was a BSN degree, which was consistent with Allen's (2016) study showing 39% of the PMHNs held a BSN degree as the highest level of education. However, internationally, the majority of PMHNs have a diploma or an associate's degree (Mahmoud, 2017). Allen (2016) proposed that an advanced level of education may be related to increased participation in professional organizations, such as the APNA.
According to the APNA (2019), APNA members are PMHNs with various levels of education and practical experience, and 60% of their members are advanced practice nurses (APNs), followed by 40% who are RNs in various positions at psychiatric inpatient and outpatient settings. However, the current study revealed that only 28% of participants were APNs. This study focused on examining perceived caring efficacy among PMHNs and that might have led APNs to assume that the study pertained only to PMHNs working at the bedside and was not intended for APNs.
In the current study, participants had been working as PMHNs for an average of 16.51 years (range = 1 to 50 years), which showed most participants were PMHNs with many years of working experience. The demographic findings also revealed the average nurse:patient ratio reported by participants were one nurse for every 14.37 patients. Staggs (2015) found that at 461 adult inpatient psychiatric units in 327 U.S. hospitals, except in the state of California, 70% of hospitals had psychiatric unit staffing exceeding California's mandated 1:6 licensed staffing ratio. In the current study, most PMHNs had <10 patients per shift, but directors and senior managers reported a larger nurse:patient ratio, which may have been the reason for the high ratio. Nurse managers and directors may have reported a high nurse:patient ratio because they are accountable for all patients admitted to psychiatric units (Kath, Stichler, Ehrhart, & Sievers, 2013). The job description of nurse managers and directors includes direct and indirect working relationships with patients under their supervisory care (Kath et al., 2013).
Level of Self-Compassion
In the current study, participants had a higher level of positive attributes of self-compassion than the previously reported score among general nurses in Durkin, Beaumont, Hollins Martin, and Carson's (2016) study. Of the three positive attributes of self-compassion, participants scored the highest in the mindfulness attribute, followed by common humanity and self-kindness. The positive attribute of self-compassion, self-kindness, is rarely explored as an attribute in the health care context. The positive attribute, common humanity, helps nurses appreciate the shared commonality and vulnerability of being unsuccessful, committing errors, and holding feelings of inadequacy (Neff, 2016). In the current study, PMHNs scored moderately high (mean = 3.66, SD = 0.89) regarding the common humanity attribute of compassion. Often PMHNs may fail to perceive common humanity as a part of the shared human experience when they constantly encounter individuals with mental illness who are devastated by the severity of illness (Hamaideh, 2017). Participants reported having a higher level of mindfulness of self-compassion. Although previous research (Alispahic & Hasanbegovic-Anic, 2017) identified that the mindfulness attribute may relate to age, further correlational research to study mindfulness in PMHNs may reveal evidence regarding the influence of age on the mindfulness attribute of self-compassion.
Based on the current study results, participating PMHNs were experiencing higher levels of negative self-compassion attributes, with the highest in the self-judgment attribute, followed by over-identification and isolation. Consistent with this finding, Rao and Kemper (2016) reported higher levels of negative self-compassion attributes among health professionals. As participants of the current study work in a highly stressful environment, they are often exposed to high stress, as well as emotional and behavioral environments that might affect nurses negatively. However, no prior studies have focused on evaluating the level of negative attributes of self-compassion among PMHNs.
Level of Caring Efficacy
Mean participants' score of caring efficacy was 5.13 on a 1 to 6 Likert scale, measured by the CES. No previous studies exist regarding the caring efficacy levels of PMHNs or the demographics examined in the current study. Therefore, the finding of a high caring efficacy level requires further research for supporting the evidence.
The study results showed a positive association between higher perceived levels of caring efficacy among PMHNs along with a significant increase in positive attributes of self-compassion. Participants who scored higher in the negative attributes of self-compassion reported a significant decrease in perceived level of caring efficacy. Furthermore, variables of nurse:patient ratio and total years of work experience in psychiatric–mental health facilities were not significantly correlated with caring efficacy among PMHNs. Although the findings on self-compassion in relation to caring efficacy demand additional validation using descriptive and causal relationship study designs, the current findings provide new information regarding the relationship between positive and negative attributes of self-compassion on caring efficacy in PMHNs. Neff's (2016) model of self-compassion was found to be supportive and suitable for studying caring efficacy in PMHNs.
Participants were self-selected PMHNs who are members of APNA and utilize the APNA Member Bridge online forums for discussing professional and career-related matters. The culture of the research population may be different from specific hospital nurses; therefore, the results may not be generalized to nurses working in all psychiatric inpatient and outpatient units or other areas. In addition, nursing educational levels and the gender ratio of participants may not be representative of the larger PMHN population. For example, the percentage of participants who had a BSN level of education (40%) was considerably lower than the national average (55%; American Association of Colleges of Nursing, 2016). In addition, correlational designs indicate relationships between variables but do not allow for inferences to be drawn regarding causal relationships (Vogt, 2011).
Implications for Nursing Leadership, Education, and Practice
Study results may inspire nursing leaders to realize PMHNs may have higher levels of caring efficacy manifested through their caring behaviors, if they can adopt self-compassion–based work environments, where nurses are encouraged to nurture the positive attributes of self-compassion. Nurse leaders may use the findings to devise specific strategies or training programs aimed at enhancing the positive attributes of self-compassion and countering the negative attributes of self-compassion to promote caring efficacy among PMHNs. In addition, health care administrators may better understand the need to improve self-compassion among PMHNs, potentially leading to decreased professional burnout and increased caring efficacy (Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler, 2011).
Self-compassion training, or at least awareness, should be integrated into the baccalaureate-level curricula to address the importance of teaching and learning self-compassion and its relationship to nurses' abilities to provide effective patient care. The current findings have implications for nursing education by including self-compassion training, mindfulness practices, and stress reduction programs into curricula to help future nurses nurture self-compassion, thereby potentially leading to increased compassion for patients and increased caring efficacy. Didactic and clinical practicum professors of psychiatric nursing practice should lead and mandate the addition of self-compassion–based training in curricula design to help increase positive attributes of self-compassion among students and lessen the negative attributes that might hinder efficacy in a caring relationship with patients.
Self-compassion is significant to the practice of nursing because self-compassion leads to caring efficacy or nurses' perceived abilities to provide efficient care, based on the study results. Identifying and supporting those nurses with low levels of self-compassion may have crucial implications for practice. Screening PMHNs for low self-compassion may provide nurse leaders a methodical approach to offering training in self-compassion, which may enhance perceived caring efficacy in nurses caring for patients with mental illnesses.
Recommendations for Future Research and Study Replication
Future researchers should include PMHNs who are not members of APNA and replicate this study in different settings using random sampling. The current study was the first quantitative inquiry pertaining to self-compassion in PMHNs; therefore, replication of the study would solidify and add to the findings. Future researchers should focus on which specific components of self-compassion contribute to factors other than caring efficacy, such as emotional health, physical well-being, and work satisfaction among PMHNs. For example, a fair amount of research exists on mindfulness (Beaumont et al., 2016; Bluth & Blanton, 2014), but less exists on common humanity and self-kindness. Future researchers should evaluate the effectiveness of Neff's (2003, 2016) self-compassion model to support nursing practice to improve the caring efficacy of nurses working in specialties other than psychiatric–mental health.
The study design did not involve examining the effect of cultural and ethnic differences pertaining to self-compassion and perceived levels of caring efficacy. Future recommendations include extending the population to ethnically diverse nurses. Future studies might focus on gender factors in relation to caring efficacy among PMHNs to provide appropriate assistance. In addition, more qualitative studies are required in the future to acquire in-depth information regarding self-compassion and caring efficacy in PMHNs in a specific physical setting, such as a mental health unit of a hospital. Last, the current research did not entail sufficient examination of the staffing needs for psychiatric–mental health care. Thus, future researchers should examine the importance of staffing in relation to improving caring efficacy to help understand how staffing patterns in psychiatric–mental health settings are related to caring efficacy.
Caring efficacy in nursing is an increasing concern as nurses have an obligation to be confident in their ability to provide the best care for patients (Reid et al., 2015). Although the research (Alavi et al., 2015; Lamke et al., 2014; Reid et al., 2015) has pertained to addressing caring efficacy concerns across the nursing discipline, the current study focused on examining the relationship between self-compassion and perceived caring efficacy among PMHNs. Self-compassion is a foundation for delivering compassionate care to patients (Barratt, 2017). Nurses who are compassionate toward themselves are likely to be compassionate toward others, which may have a direct relationship to perceived caring efficacy (Neff, 2016; Raab, 2014; Wiklund-Gustin & Wagner, 2012). Although self-compassion–based studies are relatively new to nursing, the results of the current study are supportive to existing empirical literature.
Self-compassion is important to a sense of caring efficacy because self-compassion rests on the idea that caring for the self can enhance caring for others (Wiley, 2017). PMHNs should learn to be compassionate to themselves to enhance their confidence in caring for patients with mental illness. Self-compassion and caring efficacy could be encouraged and developed through training and interventions that may benefit PMHNs and other health care professionals by protecting them from burnout and stress while enhancing patient care. It is the responsibility of nursing professionals to bridge the gap that exists between being compassionate to oneself and caring for others in providing sustained compassionate care.
- Alavi, A., Bahrami, M., Zargham-Boroujeni, A. & Yousefy, A. (2015). Characteristics of caring self-efficacy in pediatric nurses: A qualitative study. Journal for Specialists in Pediatric Nursing, 20(3), 157–164 https://doi.org/10.1111/jspn.12110 PMID: doi:10.1111/jspn.12110 [CrossRef]25845908
- Alispahic, S. & Hasanbegovic-Anic, E. (2017). Mindfulness: Age and gender differences on a Bosnian sample. Psychological Thought, 10(1), 155–166 https://doi.org/10.5964/psyct.v10i1.224 doi:10.5964/psyct.v10i1.224 [CrossRef]
- Allen, D. E. (2016). APNA member survey results: Role of psychiatric nurses in hospital emergency departments. Journal of the American Psychiatric Nurses Association, 22(3), 245–247 https://doi.org/10.1177/1078390316644325 PMID: doi:10.1177/1078390316644325 [CrossRef]27055471
- American Association of Colleges of Nursing. (2016). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
- American Psychiatric Nurses Association. (2019). About APNA. Retrieved from https://www.apna/org/i4a/pages/index.cfm?pageid=3277
- Ananthakrishnan, A. N., Khalili, H., Pan, A., Higuchi, L. M., de Silva, P., Richter, J. M. & Chan, A. T. (2013). Association between depressive symptoms and incidence of Crohn's disease and ulcerative colitis: Results from the Nurses' Health Study. Clinical Gastroenterology and Hepatology, 11(1), 57–62 https://doi.org/10.1016/j.cgh.2012.08.032 PMID: doi:10.1016/j.cgh.2012.08.032 [CrossRef]
- Barratt, C. (2017). Exploring how mindfulness and self-compassion can enhance compassionate care. Nursing Standard, 31(21), 55–63. doi:10.7748/ns.2017.e10671 [CrossRef]28097993
- Beaumont, E., Durkin, M., Hollins Martin, C. J. & Carson, J. (2016). Compassion for others, self-compassion, quality of life and mental well-being measures and their association with compassion fatigue and burnout in student midwives: A quantitative survey. Midwifery, 34, 239–244 https://doi.org/10.1016/j.midw.2015.11.002 PMID: doi:10.1016/j.midw.2015.11.002 [CrossRef]
- Bluth, K. & Blanton, P. W. (2014). Erratum to: Mindfulness and self-compassion: Exploring pathways to adolescent emotional wellbeing. Journal of Child and Family Studies, 23(7), 1313–1314 https://doi.org/10.1007/s10826-013-9846-7 doi:10.1007/s10826-013-9846-7 [CrossRef]
- Brunero, S. J., Jeon, Y. H. & Foster, K. (2015). The journey of positioning self as both mental health nurse and qualitative researcher: A critical reflection. Journal of Psychiatric and Mental Health Nursing, 22(7), 543–548 https://doi.org/10.1111/jpm.12238 PMID: doi:10.1111/jpm.12238 [CrossRef]26234189
- Chambers, M., Kantaris, X., Guise, V. & Välimäki, M. (2015). Managing and caring for distressed and disturbed service users: The thoughts and feelings experienced by a sample of English mental health nurses. Journal of Psychiatric and Mental Health Nursing, 22(5), 289–297 https://doi.org/10.1111/jpm.12199 PMID: doi:10.1111/jpm.12199 [CrossRef]25944483
- Chana, N., Kennedy, P. & Chessell, Z. J. (2015). Nursing staffs' emotional well-being and caring behaviours. Journal of Clinical Nursing, 24(19–20), 2835–2848 https://doi.org/10.1111/jocn.12891 PMID: doi:10.1111/jocn.12891 [CrossRef]26178012
- Coates, C. J. (1997). The caring efficacy scale: Nurses' self-reports of caring in practice settings. In Guzzetta, C. E. (Ed.), Essential readings in holistic nursing (pp. 24–30). Gaithersburg, MD: Aspen.
- Durkin, M., Beaumont, E., Hollins Martin, C. J. & Carson, J. (2016). A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses. Nurse Education Today, 46, 109–114 https://doi.org/10.1016/j.nedt.2016.08.030 PMID: doi:10.1016/j.nedt.2016.08.030 [CrossRef]27621200
- Goulter, N., Kavanagh, D. J. & Gardner, G. (2015). What keeps nurses busy in the mental health setting?Journal of Psychiatric and Mental Health Nursing, 22(6), 449–456 https://doi.org/10.1111/jpm.12173 PMID: doi:10.1111/jpm.12173 [CrossRef]25939246
- Hamaideh, S. H. (2017). Mental health nurses' perceptions of patient safety culture in psychiatric settings. International Nursing Review, 64(4), 476–485 https://doi.org/10.1111/inr.12345 PMID: doi:10.1111/inr.12345 [CrossRef]
- Holttum, S. (2015). Students, inclusion, help-seeking and compassionate caring. Mental Health and Social Inclusion, 19(2), 61–67 https://doi.org/10.1108/MHSI-02-2015-0005 doi:10.1108/MHSI-02-2015-0005 [CrossRef]
- Itzhaki, M., Peles-Bortz, A., Kostistky, H., Barnoy, D., Filshtinsky, V. & Bluvstein, I. (2015). Exposure of mental health nurses to violence associated with job stress, life satisfaction, staff resilience, and post-traumatic growth. International Journal of Mental Health Nursing, 24(5), 403–412 https://doi.org/10.1111/inm.12151 PMID: doi:10.1111/inm.12151 [CrossRef]26257307
- Jeffery, D. & Fuller, P. (2016). Witnessing violence: What are the experiences of mental health nurses?Mental Health Practice, 20(2), 15–21 https://doi.org/10.7748/mhp.2016.e1100 doi:10.7748/mhp.2016.e1100 [CrossRef]
- Kath, L. M., Stichler, J. F., Ehrhart, M. G. & Sievers, A. (2013). Predictors of nurse manager stress: A dominance analysis of potential work environment stressors. International Journal of Nursing Studies, 50(11), 1474–1480. doi:10.1016/j.ijnurstu.2013.02.011 [CrossRef]23522937
- Lamke, D., Catlin, A. & Mason-Chadd, M. (2014). “Not just a theory”: The relationship between Jin Shin Jyutsu® self-care training for nurses and stress, physical health, emotional health, and caring efficacy. Journal of Holistic Nursing, 32(4), 278–289 https://doi.org/10.1177/0898010114531906 PMID: doi:10.1177/0898010114531906 [CrossRef]24771664
- Ledoux, K. (2015). Understanding compassion fatigue: Understanding compassion. Journal of Advanced Nursing, 71(9), 2041–2050 https://doi.org/10.1111/jan.12686 PMID: doi:10.1111/jan.12686 [CrossRef]25981240
- Mahmoud, A. S. (2017). Psychiatric nurses' attitude and practice toward physical restraint. Archives of Psychiatric Nursing, 31(1), 2–7 https://doi.org/10.1016/j.apnu.2016.07.013 PMID: doi:10.1016/j.apnu.2016.07.013 [CrossRef]28104053
- Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M. & Pfahler, C. (2011). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341–352. doi:10.1007/s10488-011-0352-1 [CrossRef]21533847
- Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101 https://doi.org/10.1080/15298860309032 doi:10.1080/15298860309032 [CrossRef]
- Neff, K. D. (2016). Does self-compassion entail reduced self-judgment, isolation, and over-identification? A response to Muris, Otgaar, and Petrocchi. Mindfulness, 7(3), 791–797 https://doi.org/10.1007/s12671-016-0531-y doi:10.1007/s12671-016-0531-y [CrossRef]
- Ozkara San, E. (2015). Concept analysis of nurses' happiness. Nursing Forum, 50(1), 55–62 https://doi.org/10.1111/nuf.12099 PMID: doi:10.1111/nuf.12099 [CrossRef]
- Raab, K. (2014). Mindfulness, self-compassion, and empathy among health care professionals: A review of the literature. Journal of Health Care Chaplaincy, 20(3), 95–108 https://doi.org/10.1080/08854726.2014.913876 PMID: doi:10.1080/08854726.2014.913876 [CrossRef]24926896
- Rao, N. & Kemper, K. J. (2017). Online training in specific meditation practices improves gratitude, well-being, self-compassion, and confidence in providing compassionate care among health professionals. Journal of Evidence-Based Complementary & Alternative Medicine, 22(2), 237–241 https://doi.org/10.1177/2156587216642102 PMID: doi:10.1177/2156587216642102 [CrossRef]
- Reid, C., Courtney, M., Anderson, D. & Hurst, C. (2015). The ‘caring experience’: Testing the psychometric properties of the Caring Efficacy Scale. International Journal of Nursing Practice, 21(6), 904–912 https://doi.org/10.1111/ijn.12327 PMID: doi:10.1111/ijn.12327 [CrossRef]
- Scott, P. A. (2014). Lack of care in nursing: Is character the missing ingredient?International Journal of Nursing Studies, 51(2), 177–180 https://doi.org/10.1016/j.ijnurstu.2013.08.006 PMID: doi:10.1016/j.ijnurstu.2013.08.006 [CrossRef]
- Staggs, V. S. (2015). Correlates of licensed and unlicensed nurse staffing levels on in-patient psychiatric units. Journal of Nursing Care Quality, 30(4), 359–365 https://doi.org/10.1097/NCQ.0000000000000120 PMID: doi:10.1097/NCQ.0000000000000120 [CrossRef]25760391
- Verhaeghe, S., Duprez, V., Beeckman, D., Leys, J., Van Meijel, B. & Van Hecke, A. (2016). Mental health nurses' attitudes and perceived self-efficacy toward inpatient aggression: A cross-sectional study of associations with nurse-related characteristics. Perspectives in Psychiatric Care, 52(1), 12–24 https://doi.org/10.1111/ppc.12097 PMID: doi:10.1111/ppc.12097 [CrossRef]
- Vogt, W. P. (2011). Dictionary of statistics and methodology: A nontechnical guide for the social sciences (4th ed.). Thousand Oaks, CA: Sage.
- Wieland, D. M. (2015). Psychiatric-mental health nurses' exposure to clients with problematic internet experiences: A mixed-methods pilot study. Journal of Psychosocial Nursing and Mental Health Services, 53(10), 31–40 https://doi.org/10.3928/02793695-20150923-02 PMID: doi:10.3928/02793695-20150923-02 [CrossRef]26489102
- Wiklund Gustin, L. & Wagner, L. (2013). The butterfly effect of caring: Clinical nursing teachers' understanding of self-compassion as a source to compassionate care. Scandinavian Journal of Caring Sciences, 27(1), 175–183 https://doi.org/10.1111/j.1471-6712.2012.01033.x PMID: doi:10.1111/j.1471-6712.2012.01033.x [CrossRef]
- Wiley, K. K. (2017). Caring for yourself while caring for others. Journal of Emergency Nursing: JEN, 43(2), 95 https://doi.org/10.1016/j.jen.2017.01.010 PMID: doi:10.1016/j.jen.2017.01.010 [CrossRef]28372776
- Yarnell, L. M. & Neff, K. D. (2013). Self-compassion, interpersonal conflict resolutions, and wellbeing. Self and Identity, 12(2), 146–159 https://doi.org/10.1080/15298868.2011.649545 doi:10.1080/15298868.2011.649545 [CrossRef]
- Zeng, J. Y., An, F. R., Xiang, Y. T., Qi, Y. K., Ungvari, G. S., Newhouse, R. & Chiu, H. F. (2013). Frequency and risk factors of work-place violence on psychiatric nurses and its impact on their quality of life in China. Psychiatry Research, 210(2), 510–514 https://doi.org/10.1016/j.psychres.2013.06.013 PMID: doi:10.1016/j.psychres.2013.06.013 [CrossRef]23850435
Research Questions and Hypotheses
|Research Question||Null Hypothesis (H0)||Alternative Hypothesis (Ha)|
|1. What are the relationships between positive attributes of self-compassion and the perceived level of caring efficacy in PMHNs?||There are no statistically significant relationships between positive attributes of self-compassion and perceived level of caring efficacy in PMHNs.||There are statistically significant relationships between positive attributes of self-compassion and perceived level of caring efficacy in PMHNs.|
|2. What are the relationships between negative attributes of self-compassion and perceived level of caring efficacy in PMHNs?||There are no statistically significant relationships between negative attributes of self-compassion and perceived level of caring efficacy in PMHNs.||There are statistically significant relationships between negative attributes of self-compassion and perceived level of caring efficacy in PMHNs.|
|3. What is the relationship between the nurse:patient ratio and perceived level of caring efficacy in PMHNs?||There is no statistically significant relationship between the nurse:patient ratio and perceived level of caring efficacy in PMHNs.||There is a statistically significant relationship between the nurse:patient ratio and perceived level of caring efficacy in PMHNs.|
|4. What is the relationship between the total years of work experience in PMH facilities and perceived level of caring efficacy in PMHNs?||There is no statistically significant relationship between the total years of work experience in PMH facilities and perceived level of caring efficacy in PMHNs.||There is a statistically significant relationship between the total years of work experience in PMH facilities and perceived level of caring efficacy in PMHNs.|
Participant Demographics (N = 98)
| Female||90 (91.8)|
| Male||8 (8.2)|
| Staff nurse||55 (56.1)|
| Manager||10 (10.2)|
| Director/senior manager||5 (5.1)|
| Other (NP, CNS)||28 (28.6)|
|Highest nursing education|
| Diploma||1 (1.0)|
| Associate's degree||14 (14.3)|
| BSN||40 (40.8)|
| Master's degree||32 (32.7)|
| Doctorate||11 (11.2)|
Descriptive Statistics for Continuous Demographic Variables
|Age (years)||23 to 86||48.2 (12.46)||50||40|
|Time working as a mental health nurse (years)||1 to 50||16.51 (12.38)||15||15|
|Nurse:patient ratio (patients per one nurse)||1 to 400||14.37 (43.37)||6||6|
Summary of Composite Scores for the Self-Compassion and Caring Efficacy Variables
| Positive attributes||1.46 to 5.00||3.67 (0.81)||3.85||4.31|
| Self-kindness||1.20 to 5.00||3.56 (0.90)||3.60||3.60|
| Common humanity||1.25 to 5.00||3.66 (0.89)||3.75||4.00|
| Mindfulness||1.25 to 5.00||3.80 (0.92)||4.00||4.50|
| Negative attributes||1.31 to 4.46||2.69 (0.70)||2.65||2.46|
| Self-judgment||1.00 to 5.00||2.70 (0.84)||2.80||2.80a|
| Isolation||1.00 to 4.75||2.58 (0.96)||2.50||2.00a|
| Over-identification||1.00 to 5.00||2.63 (0.94)||2.63||3.25|
|Caring Efficacy Scale|
| Caring efficacy||1.63 to 6.00||5.13 (0.69)||5.30||5.07a|