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PREDICTING SELF-COMPASSION IN UK NURSING STUDENTS:
RELATIONSHIPS WITH RESILIENCE, ENGAGEMENT, MOTIVATION, AND
MENTAL WELLBEING
Yasuhiro Kotera1*, Vicky Cockerill1, James Chircop1, Greta Kaluzeviciute1, Sue Dyson1
1University of Derby, Kedleston Road, Derby DE22 1GB, United Kingdom
Citation
Kotera, Y., Cockerill, V., Chircop, J., Kaluzeviciute, G. & Dyson, S. (2021). Predicting self-
compassion in UK nursing students: Relationships with resilience, engagement, motivation,
and mental wellbeing. Nurse Education in Practice.
Acknowledgement
We thank Polly Barnes for her support in this project.
Highlights
• Resilience and mental wellbeing were significant predictors of self-compassion.
• Resilience was most strongly associated with self-compassion in all of our analyses.
• Self-compassion can be embedded in existing resilience training in nursing education.
• Existing mental wellbeing practices can also enhance self-compassion.
1
Abstract
Self-compassion, being kind towards oneself, has been identified as a key protective factor of
mental health. This is consistent with students’ experiences in the study of nursing, which
attracts a large number of students in the United Kingdom. Despite the importance of self-
compassion, knowledge in how to enhance self-compassion is under-researched. Self-
compassion interventions are commonly related to meditative exercises. In order to suggest
alternative approaches, relationships between self-compassion and more established
constructs need to be appraised. Accordingly, this study evaluated predictors of self-
compassion, examining its relationships with more established constructs examined in other
healthcare student populations: resilience, engagement, motivation and mental wellbeing. An
opportunity sample of 182 UK nursing students at a university in East Midlands completed
self-report measures about these constructs. Correlation and regression analyses were
conducted. Self-compassion was positively related to resilience, engagement, intrinsic
motivation and mental wellbeing, while negatively related to amotivation. Resilience and
mental wellbeing were identified as significant predictors of self-compassion. As resilience
and mental wellbeing are relatively familiar to many nursing lecturers and students, educators
can incorporate a self-compassion component into the existing resilience training and/or
mental wellbeing practices.
Keywords: self-compassion, resilience, nursing students, mental wellbeing, cross-
sectional study, regression analysis
2
Introduction
Mental Health and Mental Wellbeing of Nursing Students
Nursing is related to offering care for people at points of illness and vulnerability. In
order to provide quality care consistently, mental wellbeing of nurses is important as it helps
them to feel good and function well (Tennant et al., 2007), therefore the importance of mental
wellbeing in nurses has been emphasised (Xie et al., 2020). Mental wellbeing is commonly
regarded as a positive facet of mental health, relating to the subjective experience of
happiness and life satisfaction (hedonic perspective) and psychological functioning and self-
realisation (eudaimonic perspective) (Ryan and Deci, 2001). High stress can damage mental
wellbeing, leading to poor mental health (Tennant et al., 2007), which has been recognised in
nursing populations (Ogińska-Bulik and Michalska, 2020; Xin, Jiang and Xin, 2019). For
example, burnout is widely documented in nursing literature (Hofmeyer, Taylor and
Kennedy, 2020; Jarrad and Hammad, 2020; Waddill-Goad, 2019). Poor mental health of
nurses is a cause of concern for the healthcare sector (Kinman, Teah and Harriss, 2020).
Mental health education in the university has been identified as one solution for
improving poor mental health in the workplace (Geirdal, Nerdrum and Bonsaksen, 2019).
Accordingly, mental health and mental wellbeing of nursing students have been substantially
researched (Cilar et al., 2019; Kotera et al., 2020; Oates et al., 2020). Studying nursing is
often regarded as more stressful than other healthcare studies, leading to compromised mental
wellbeing in students (Tung et al., 2018; Turner and McCarthy, 2017; Walker and Mann,
2016). In addition to common stressors in higher education—pressure of academic work and
personal life factors—, nursing students are exposed to realities of clinical practice (Edwards
et al, 2015), such as offering care for the critically-ill in a short-staffed context (Zhao et al.,
2015), and intense fear for making errors (Yıldırım et al., 2017). Balancing academic work
3
and clinical work is stressful to many nursing students. For example, in the United Kingdom
(UK), the current standards for nursing programmes denote that student nurses will complete
2300 hours of theory and practice respectively during training (Nursing and Midwifery
Council [NMC], 2018). Such high demands for practice can damage nursing students’ mental
wellbeing (Edwards et al., 2010).
Taken together, the low levels of mental wellbeing in nursing students are
increasingly recognised by the key governing bodies. Development of mental health
awareness for student nurses is regarded as a central part of their proficiency standards
(NMC, 2018). Despite these policy-level changes (e.g., NMC’s standards for mental
wellbeing), little information is offered on how this should occur within the academic
curriculum.
Self-Compassion as Key for Mental Health
Self-compassion, commonly regarded as the ability to notice suffering in oneself and
others with a commitment to eliminate the suffering (Neff, 2003a), is strongly related to
positive mental health experiences in many healthcare student populations (Kotera, Green
and Sheffield, 2019b; Kotera and Ting, 2019b). Three components of self-compassion are (i)
being kind and understanding towards oneself (self-kindness), (ii) acknowledging that
suffering is part of human life (common humanity), and (iii) being present in the here and
now (mindfulness). Self-compassion is recognised as a significant element in cultivating
compassion for others, particularly in terms of seeing failure and suffering as an inherent part
of human experience.
Self-compassion has been strongly related to improving mental health in UK
university students, where students who were more kind towards themselves demonstrated
4
better mental health (Kotera et al., 2018b, 2019a). The positive relationship between self-
compassion and mental health has been seen in professional nurses (Dev et al., 2018) and
nursing students (Luo et al., 2019).
Challenges in Cultivating Self-Compassion
Though numerous psychological benefits of self-compassion have been reported,
interventions to cultivate self-compassion remain unexplored. Common interventions (e.g.,
the Mindfulness Self-Compassion programme; Neff and Germer, 2013) are predominantly
associated with meditative exercises, failing to support people who are not suited for this
approach. For example, some people do not engage with meditation because of its non-
directiveness (i.e., they feel drowsy or sleepy) (Bojic and Becerra, 2017). People who have
recurrent trauma may be scared to practice meditation as it can expose them to traumatic
memory (Zeldin, 2015). In order to suggest alternative approaches for self-compassion, this
study aimed to identify predictors of self-compassion from more established psychological
constructs, namely emotional resilience (hereafter ‘resilience’), academic engagement
(hereafter ‘engagement’), motivation and mental wellbeing. These variables were chosen as
they were particularly associated with mental wellbeing and self-compassion in previous
research (Kotera, Green and Sheffield, 2019a, 2019c).
Resilience
Resilience is associated with self-compassion (Kotera and Ting, 2019). Although
there is still no agreed definition, resilience is commonly regarded as a construct where
internal resources and behaviours are embraced in order to cope with difficulties and
challenges, thus leading to a strengthened personality and psychological coping mechanisms
(Grant and Kinman, 2014). Resilience drives one’s attention to strengths and opportunities,
5
rather than weaknesses and vulnerability, through reframing one’s perspectives (Russ, Lonne
and Darlington, 2009; Harrison, 2013). Resilient individuals may be affected by difficulties
(e.g., trauma, loss); however they are not lastingly overwhelmed by these experiences
(Tugade and Fredrickson, 2004). Resilient people cope with these challenges by acquiring
new skills (Carver, 1998). Resilience is associated with better mental health, potentiating
compassion, self-efficacy, and mindfulness (Robertson et al., 2015).
Resilience has also been underlined as a potential factor to help nurses cope with
professional difficulties without impacting one’s mental wellbeing (NMC, 2018b). However,
to date, no studies empirically investigated the effect of resilience on self-compassion in
nursing students.
Engagement
Engagement can be defined as the time and physical energy that students spend on
relevant activities. Engagement can be defined as the culmination of effort experienced by
students to study, practice, obtain feedback, analyse, and solve problems (Kuh, 2003).
Engagement is a common construct in academic research as it is related to positive
educational outcomes such as higher student achievement, higher grades and successful
obtainment of an academic degree (Kuh, 2003). Engagement is also related to positive
psychological outcomes including better mental health (Suárez-Colorado et al., 2019; Datu,
2018; Kotera and Ting, 2019), resilience (Turner, Scott-Young and Holdsworth, 2017), and
higher intrinsic motivation (Armbruster et al., 2009). Despite these diverse positive
relationships between engagement and other psychological constructs, the impact of
engagement on self-compassion has not been appraised in nursing students.
Motivation
6
One of the most established motivation theories, the Self-Determination Theory
(SDT) maintains that each individual has an inherent tendency to express their psychological
energy into self-actualisation and social adjustment. Intrinsic motivation can be expressed in
activities that are inherently interesting and fulfilling (i.e., undertaking the activity itself is a
reward) (Deci and Ryan, 1985). Intrinsic motivation is associated with better performance
(Baard, Deci and Ryan, 2006), mental wellbeing (Bailey and Phillips, 2016), improved life
satisfaction (Locke and Latham 2004), increased prosocial behaviour (Gagne, 2003) and
ethical judgment (Kotera et al., 2018b). In higher education, students’ intrinsic motivation is
associated with meaningfulness (Utvær, 2014) and improved academic performance
(Khalaila, 2015).
Extrinsic motivation, on the other hand, can be observed in activities that are means to
an end, such as money and status (Deci and Ryan, 1985). Extrinsic motivation is associated
with burnout (Houkes et al., 2003), shame (Kotera et al., 2018a), depression (Blais et al.,
1993), limited performance (Vallerand, 1997), and unethical judgment (Kotera et al., 2018b).
The third category of motivation, amotivation, is when individuals do not feel interest or
value in a certain activity such as going to university (Shen et al., 2010).
Self-compassion’s impact on motivation has been identified; self-compassion expands
beliefs about a personal weakness, which motivates students to make amends and allocate
more study time for a difficult test following an initial failure (Breines and Chen, 2012).
However, the impact of motivation on self-compassion has not been evaluated.
Mental Wellbeing
Mental wellbeing can be defined as a state of equilibrium between an individual’s
resource pool and the challenges faced through events or challenges (Dodge et al., 2012).
Mental wellbeing relates to the experiences of happiness, life satisfaction, fulfilment,
7
functioning and purpose in life (Henderson and Knight, 2012). Furthermore, mental
wellbeing is understood as the foundation for optimal psychological development, learning
effectiveness, social connectedness, and physical health (Barry et al., 2013; Clarke,
Kuosmanen and Barry, 2015). It is a multi-dimensional measure of mental health, indicating
not just the presence of a positive psychological state but also suggesting the degree with
which individuals are able to realise their potential, cope with life’s challenges, and thrive
mentally (Slade, 2010). A recent cross-cultural study about nursing students’ mental
wellbeing between Slovenia (n=90) and Northern Ireland (n=109) reported that most of the
students (61% and 71%, respectively) had average level of mental wellbeing (Cilar et al.,
2019). However, the study also noted that the rates of nursing students whose mental
wellbeing was ‘below average’ or ‘very low’ were not modest (10% for Slovenian and 26%
for Northern Irish), suggesting a need for evaluation.
In the UK and Canada, where mental health research and policy have attracted
increasing attention, focus has shifted towards promoting mental wellbeing rather than
eliminating mental health problems (Department of Health, 2009; Mental Health Commission
of Canada, 2009). The relationship between mental health and mental wellbeing has been
investigated in Malaysian university students, where the need for student support has been
highlighted as a measure to reduce negative mental health symptoms (Mey and Yin, 2015).
Mental wellbeing was used as a key construct in order to predict large variances in students’
mental health experiences (Kotera and Ting, 2019). In the UK, midwifery students’ mental
wellbeing was investigated, and the importance of regular contacts with peers and academics
were highlighted (Oates et al., 2020), whereas interpersonal conflicts and lack of professional
support were identified as detrimental factors to their mental wellbeing (Oates et al., 2019).
Moreover, mental wellbeing of healthcare trainees, including nursing students, has been
challenging in light of the COVID-19 pandemic. An open culture of trust and resilience has
8
been highlighted as a key factor in maintaining good mental wellbeing in these challenging
times (Shaw, 2020). Despite the fact that these findings suggest a need to examine mental
wellbeing in greater detail, the impact of mental wellbeing on self-compassion, another key
contributor to good mental health, has not been examined in UK nursing students, one of the
most stressed student populations in higher education.
Accordingly, this study aimed to appraise relationships of self-compassion through
experiences of resilience, engagement, motivation and wellbeing in UK nursing students.
Methods
Study Design
We employed a cross-sectional design in order to generate timely output, and to
examine all variables altogether. Correlation and regression analyses were performed.
Participants
Participants were 18 years old or older and enrolled in a nursing programme at an
East Midlands (UK) university. Nursing students who were not present on the day of the
study were excluded. Paper-based questionnaires, comprising 58 items to be completed
approximately in 10 minutes, were distributed in July 2019 by the programme tutors instead
of the researchers to avoid bias. Opportunity sample of 198 full-time students who were
informed of the study, of which 182 (92% response rate) completed five psychological scales:
self-compassion, mental wellbeing, engagement, motivation and resilience. Our sample size
exceeded the required sample size calculated by power analysis (84: two tails, p H1 = 0.30, α
= 0.05, Power = 0.80, p H0 = 0; Faul et al., 2009). Among 182 participants, 144 were female
students (79%), 30 were male students (16%), and 8 did not respond (4%); their ages ranged
9
from 18 to 52 years old (M ± SD = 30.04 ± 8.31 years old); 146 were undergraduate students
(80%) and 36 were postgraduate students (20%); 164 were British students, 10 were African
students (e.g., Zimbabwean), 6 were other European students (e.g., Spanish), and 2 did not
respond. Coloured paper was prepared for visually impaired students, however none of the
participants used it. Our sample included slightly more male students (16%) than the general
UK nursing students (10%; Office for Students, 2020). No compensation was awarded for
participation. Following the ethical guidelines, the withdrawn 16 students were not asked for
the reason; no reason nor complaint was received.
Ethical Considerations
Ethical approval was granted by the University Research Ethics Committee (Ref:
011017YK). The same participants were also included in a parallel study by the authors.
Anonymity was maintained throughout the study. The participants were asked to create a
unique participation code, which would be used if they had decided to withdraw. Participants
were able to withdraw from the study up to two weeks after completing the survey, by
emailing the lead author and noting the participation code and their intention to withdraw.
Should the participants experience distress during the study, the contact information of
mental health services inside and outside the university was provided.
Instruments
Self-compassion was assessed using the Self-Compassion Scale-Short Form (SCS-
SF), a shortened version of the 26-item Self-Compassion Scale (Neff, 2003), comprising 12
five-point Likert items (e.g., ‘I try to be understanding and patient towards those aspects of
my personality I don’t like’; 1=‘Almost never’ to 5=‘Almost always’; scores for items 1, 4, 8,
9, 11 and 12 are reversed). The mean score of the 12 items was regarded as the self-
10
compassion score (Raes et al., 2011). Cronbach’s alpha was high (α=.86; Raes et al., 2011
and α=.87 in our sample).
Brief Resilience Scale (BRS; six items) was used to measure the level of resilience
(Smith et al., 2008). The six items including ‘I have a hard time making it through stressful
events’ are responded on the five-point Likert scale (1=‘Strongly disagree’ to 5=‘Strongly
agree’; scores for the items 2, 4, and 6 are reversed). The mean score of all six items was
identified as the resilience score (Smith et al., 2008). BRS had high internal consistency
(α=.80-.91; Smith et al., 2008 and α=.86 in our sample).
Engagement was assessed using the Utrecht Work Engagement Scale for Students
(UWES-S), a 17-item scale appraising how active and confident students feel towards their
academic activities (Schaufeli and Bakker, 2004). The 17 items consider three subscales:
vigour (vitality that leads to substantial effort in academic work; six items, e.g., 'I feel fit and
vigorous when I'm studying or I'm in class'), dedication (commitment to academic work; five
items, e.g., ‘My study inspires me’), and absorption (positive immersion in academic work;
six items, e.g., ‘When I am studying, I forget everything else around me’), which are rated on
a seven-point Likert scale (0=‘Never’ to 6=‘Always (everyday)’) (Schaufeli et al., 2002).
UWES-S had high internal consistency (α=.63-.81; Schaufeli and Bakker, 2004). In this
study, the average of the total score for the engagement measure was used (Schaufeli and
Bakker, 2004; α=.90 in our sample).
Academic Motivation Scale (AMS; Vallerand et al., 1992) was used to assess
motivation. AMS consists of 28 items that refer to three types of motivation: intrinsic
motivation (12 items, e.g., 'For the pleasure I experience when I discover new things never
seen before'), (b) extrinsic motivation (12 items, e.g., 'Because eventually it will enable me to
enter the job market in a field that I like'), and (c) amotivation (four items, e.g., 'I can't see
why I go to university and frankly, I couldn't care less.'). Students are asked why they go to
11
university
1
, and respond on a seven-point Likert scale (1=‘Does not correspond at all’ to
7=‘Corresponds exactly’). AMS demonstrated adequate to high internal consistency
(α=.62-.91; Vallerand et al., 1992 and α=.81-.92 in our sample). Each type of motivation was
calculated by averaging the scores in all relevant items (Vallerand et al., 1992).
Lastly, mental wellbeing was measured using the Short Warwick-Edinburgh Mental
Wellbeing Scale (SWEMWBS; Ng Fat et al., 2017), the shortened version of the Warwick-
Edinburgh Mental Wellbeing Scale (WEMWBS; 14 items; Stewart-Brown and Janmohamed,
2008). SWEMWBS consists of seven positively worded items (e.g., ‘I’ve been feeling
relaxed’) responded on a five-point Likert scale (1=‘None of the time’ to 5=‘All of the time’)
reflecting the previous two weeks. The score was calculated by summing all items (Ng Fat et
al., 2017). The internal consistency of SWEMWBS was high (α=.84; Ng Fat et al., 2017 and
α=.89 in our sample).
Procedure
After securing ethical approval, an opportunity sample of nursing students was
recruited, as noted in the Participants section. Tutors of nursing modules, who were not the
researchers, announced about the study approximately two weeks in advance, and distributed
the paper-based questionnaire in the beginning of their lectures. Once filled, the
questionnaires were collected by the tutor, and handed to a research assistant (not the
researcher of this study), who converted the data into a digital format.
Data Analyses
1
The original AMS used the word ‘college (CEGEP)’ however to adjust to the UK settings, it was changed to
‘university’.
12
Analyses were conducted using IBM SPSS version 25.0. First, using Little’s Missing
Completely at Random (MCAR; Little, 1988), incomplete responses of p > .05 were
recovered (n=7). As noted in the Instrument section, all scales used in this study were
validated with high reliability. Prior to this study, the same study design was used to explore
mental wellbeing of other healthcare students (Kotera, Green and Sheffiled, 2019a, 2019c).
Second, the collected data were screened for outliers and the assumptions of parametric tests.
Third, correlations between their self-compassion, resilience, engagement, motivation and
mental wellbeing were calculated. Lastly, regression analyses predicting self-compassion by
resilience, engagement, motivation and mental wellbeing were conducted. As all motivation
variables and resilience were not normally distributed (Shapiro-Wilk’s test, p < .05), data
were square-root-transformed to satisfy the assumption of normality (Field, 2017).
Results
No outliers were identified. All variables demonstrated good internal reliability in our
sample (α=.81-92; Table 1).
Table 1. Descriptive statistics: Self-compassion, resilience, engagement, motivation and
mental wellbeing in UK nursing students (n=182)
Scale (Construct)
Subscale (Range)
Mean
SD
α
Self-Compassion Scale-Short Form (Self-Compassion)
Self-Compassion (1-5)
2.68
.70
.87
Brief Resilience Scale (Resilience)
Resilience (1-6)
3.17
.97
.86
Utrecht Work Engagement Scale for Students
(Engagement)
Engagement (0-6)
3.68
.96
.90
Academic Motivation Scale (Motivation)
Intrinsic Motivation (1-7)
4.39
1.21
.92
Extrinsic Motivation (1-7)
5.14
1.04
.85
Amotivation (1-7)
1.66
1.01
.81
Short Warwick-Edinburgh Mental Wellbeing Scale
(Mental Wellbeing)
Mental Wellbeing (7-35)
22.81
5.40
.89
13
Relationships among Self-compassion, Resilience, Engagement, Motivation and Mental
Wellbeing
Pearson’s correlation was calculated (Table 2). Self-compassion was positively
related to age, resilience, engagement, intrinsic motivation and mental wellbeing, while
negatively related to amotivation. Students who had high levels of self-compassion tended to
be older, more resilient, engaged, intrinsically motivated, and have better mental wellbeing
and lower levels of amotivation. Resilience was positively associated with age, engagement,
and mental wellbeing while negatively associated with gender and amotivation. Students who
were resilient tended to be older, male, more engaged, and have better mental wellbeing and
lower levels of amotivation. Engagement was positively related to age, intrinsic motivation
and mental wellbeing, while negatively associated with amotivation. Students who were
engaged tended to be older, intrinsically motivated, have better mental wellbeing and lower
levels of amotivation. Intrinsic motivation was positively associated with extrinsic motivation
and mental wellbeing. Intrinsically motivated students tended to be also extrinsically
motivated and have better mental wellbeing. Extrinsic motivation was negatively related to
age. Extrinsically motivated students tended to be younger. Lastly, mental wellbeing was
positively related to age and negatively related to amotivation. Students who had good mental
wellbeing tended to be older and have lower levels of amotivation.
14
Table 2. Correlations among self-compassion, resilience, engagement, motivation and mental
wellbeing in UK nursing students (n=182).
1
2
3
4
5
6
7
8
9
1
Gender (1=M, 2=F)
-
2
Age
-.18*
-
3
Self-Compassion
-.14
.15*
-
4
Resilience
-.17*
.18*
.69**
-
5
Engagement
-.01
.28**
.36**
.26**
-
6
Intrinsic Motivation
.04
.06
.23**
.10
.48**
-
7
Extrinsic Motivation
.10
-.17*
-.08
-.13
.07
.56**
-
8
Amotivation
-.13
-.04
-.23**
-.19**
-.37**
-.15
-.07
-
9
Mental Wellbeing
.05
.23**
.61**
.55**
.49**
.28**
.05
-.23**
-
*p < .05, **p < .01. Point-biserial correlation coefficients were reported for gender.
Predictors of Self-Compassion
To explore the relative contribution of resilience, engagement, motivation and mental
wellbeing to self-compassion, multiple regression analyses were performed (Supplemental
Materials). First, gender and age were entered to adjust for their effects (step one), and then
resilience, engagement, motivation and mental wellbeing were entered (step two). Extrinsic
motivation was removed from this analysis as it was not significantly correlated to self-
compassion. Multicollinearity was not a concern (VIF<10). Adjusted coefficient of
determination (Adj. R2) were reported.
Resilience, engagement, motivation and mental wellbeing accounted for 52% of the
variance in self-compassion indicating a large effect size (Cohen, 1988). Resilience and
mental wellbeing were significant predictors of self-compassion, where resilience (β = .50;
one unit increase on the resilience scale is associated with .50 unit increase on the self-
compassion scale) predicted self-compassion more strongly than mental wellbeing (β = .29;
one unit increase on the mental wellbeing scale is associated with .29 unit increase on the
self-compassion scale).
15
Discussion
This study aimed to elucidate relationships between self-compassion, resilience,
engagement, motivation and mental wellbeing in nursing students. Our analysis revealed that
self-compassion was positively related to resilience, engagement, intrinsic motivation and
mental wellbeing, while negatively related to amotivation. Furthermore, resilience and mental
wellbeing were identified as significant predictors for self-compassion, with resilience being
the strongest predictor.
Most notable finding from the present study is that resilience was strongly related to
self-compassion consistently. This may help educators place self-compassion (a rather new
construct) in the context of their education curriculum, linking it with resilience (a more
established construct). In nursing education, resilience has been introduced with its tailored
definition: nursing student resilience, a developmental process, which occurs when a student
successfully copes with stress and difficulties using the relevant coping mechanisms
(Stephens, 2013). Resilience in nursing students was found important in positive educational
outcomes such as academic success and empowerment (Thomas and Revell, 2016). It can be
promoted in several ways including classroom training (Pines et al., 2014), social media
(Stephens, 2012), as well as reflection and coaching (Hodges, Keeley and Grier, 2005).
Reflective or coaching practice was also found useful in reframing students’ negative
experience into positive one by focusing on what they have learned (Hodges et al., 2005;
Stephens, 2013). Our findings suggest that these practical interventions can also be used to
cultivate students’ self-compassion. As critical resilience (keen self-awareness in relation to
one’s impact to the society; Traynor, 2018) is highlighted in the current nursing practice—
encouraging nurses to understand themselves and recognise their resilience more holistically
(Traynor, 2018)—, connecting resilience with the self-compassion can be useful to nursing
16
education. Educators can incorporate a self-compassion component into their existing
resilience training.
In addition, a strong relationship between mental wellbeing and self-compassion
identified in both correlation and regression analyses suggests that supporting nursing
students’ mental wellbeing can also help cultivate their self-compassion. Previous studies
reported that the social factor is especially important to nursing students’ mental wellbeing:
good social support can enhance their mental wellbeing, while a lack of social support can
harm it (Oates et al., 2019, 2020). Social support, including the quality of relationships with
peers, was negatively associated with burnout (Lee et al., 2019), suicidal behaviours (Leal
and Santos, 2016) and general health (Fang, Fang and Fang, 2020) in nursing students.
Students’ evaluation for social support can be increased through social and recreational
activities (Leal and Santos, 2016), and cultivating a caring culture in the programme and
placement (Fang et al., 2020). These social approaches can also cultivate self-compassion in
nursing students, via supporting their mental wellbeing. Future research needs to evaluate the
effects of social approaches on self-compassion in nursing students.
Limitations
Several limitations to this study should be noted. First, opportunity sample was
recruited at one university for participant recruitment, limiting the generalisability of the
findings. Second, SCS-SF was used to measure self-compassion; however, there is an
ongoing discussion about its accuracy (Kotera and Sheffield, 2020). Third, self-report
measures were used, which may contain response biases (Kotera, Van Laethem and Ohshima,
2020). Fourth, our data were not normality distributed. Fifth, other possibly relevant
constructs such as grid or hardiness were not explored. Lastly, the causality of these variables
has not been elucidated. Longitudinal data would be needed to understand the temporal
17
patterning of the observed relationships, which may help identify effective approaches in
cultivating self-compassion in nursing students.
Conclusion
The importance of self-compassion has been increasingly reported, however,
knowledge on how to cultivate self-compassion is still under-researched. Our findings
indicate that resilience and mental wellbeing were consistently and closely related to self-
compassion. Nursing educators and practitioners may be able to incorporate self-compassion
into the existing resilience training and/or mental wellbeing practices to help cultivate nursing
students’ self-compassion. In addition to the classroom teaching, coaching practice to
develop resilient reframing skills and social approaches to enhance mental wellbeing may
improve nursing students’ self-compassion as well. Our findings can help to inform
alternative approaches for cultivating nursing students’ self-compassion.
18
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Supplemental Material
Multiple regression: Resilience, engagement, motivation and mental wellbeing to self-compassion
among nursing students (n = 182).
Self-Compassion
B
SEB
β
Step 1
Gender (1=M, 2=F)
-.06
.04
-.11
Age
.003
.002
.13
Adj. R2
.02
Step 2
Gender (1=M, 2=F)
-.04
.03
-.07
Age
-.001
.001
-.03
Resilience
.38***
.05
.50
Engagement
.05
.06
.07
Intrinsic Motivation
.03
.04
.04
Amotivation
-.04
.04
-.06
Mental Wellbeing
.11***
.03
.29
Δ Adj. R2
.52
B=unstandardised regression coefficient, SEB=standard error of the coefficient, β=standardised
coefficient; ***p<.001.
