Abstract

The
present study was conducted to explore the relationship between resilience
self-compassion, mindfulness and emotional well-being of doctors working in
critical and non-critical care units of patients. It was hypothesized that
there is likely to be positive relationship between resilience,
self-compassion, mindfulness and emotional well-being of doctors and
resilience, self-compassion and mindfulness are likely to be positive
predictors of emotional well-being of doctors working in critical care and non critical
care units of patients. Further it was also hypothesized that there are likely
to be gender differences in resilience, self-compassion,
mindfulness and emotional well-being of doctors. Data was collected from
doctors (N = 100) with age range of 24 to 55 (M = 28.27, SD = 5.88) using
convenient sampling technique. The Brief Resilience Scale (Smith et al. 2008),
Self-compassion Scale (Neff, 2003), Mindfulness Attention Awareness Scale
(Brown & Ryan, 2003) and Scale of Positive and Negative Experiences (SPANE,
Diener et al. 2009) were used to collect data. The results of correlation
analysis showed that there was positive and significant correlation between
resilience, self-compassion, mindfulness and emotional well-being of both
groups of doctors. Regression analysis revealed that self-compassion was only
significant predictor of emotional well-being. Moreover, significant gender differences
were found on emotional well-being. Nevertheless, resilience, self-compassion
and mindfulness abilities are alike in male and female doctors.

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Keywords:
Resilience, Self-compassion, Mindfulness, Emotional well-being, Critical care
units.

 

 

Many
medical professionals face stressful situations while treating their patients
in critical situations, which adversely affect quality of care, emotional
well-being and ultimately threatens professionalism. Self compassion and
mindfulness protect against the harmful impact of tension and boost emotional
wellbeing that has been displayed to enhance resilience in doctors (Olson,
Kemper, & Mahan, 2015; (Hassan El-Ghoroury, Galper, Sawaqdeh, & Bufka,
2012).

Resilience is the ability to successful adaptation to stress,
flexibility, internal strength, bouncing back, and even growth in the face of
adversity. American Psychological Association (2016) has defined the resilience
in term of ability to maintain flexibility and balance in your life as you deal
with stressful circumstances and traumatic events.  Wagnild and Young’s (1993) explain the
resilience as “a personality characteristic that moderates the negative effects
of stress and promotes adaptation” (p. 165).

Compassion is defined as identifying the suffering of others
and a desire to alleviate that suffering. Compassion in psychological science
has been described as sympathy, empathy, selflessness, altruism and kindness
(Gilbert, 2005). Self-compassion involves treating yourself with
care and concern when considering personal mistakes, failures, and painful life
situations and an
understanding that one’s experience is part of the common human experience (Wei, Liao, Ku, & Shaffer, 2011). It
consists of three interacting components: (i) self-kindness versus
self-judgment, (ii) a sense of common humanity versus isolation, and (iii)
mindfulness versus over-identification. Self-kindness refers to the tendency to
be caring and understanding with oneself rather than being harshly critical.
Rather than attacking and berating oneself for personal shortcomings, the self
is offered warmth and unconditional acceptance. The sense of common humanity in
self-compassion involves recognizing that humans are imperfect, that all people
fail, make mistakes, and have serious life challenges.
Mindfulness is the ability to hold one’s painful thoughts and feelings
in balanced awareness rather than over-identifying with them (Neff, 2003). Self-compassion
is negatively associated with depression, anxiety, rumination, and thought
suppression; and positively with life satisfaction and social connectedness (Raes, 2010).  

Mindfulness is another approach
quite similar to self-compassion. Mindfulness is the condition of remain
observant to and conscious of what is happening in our surroundings, a trait of
being aware and conscious in terms to enhance well-being (Brown, & Ryan,
2003). Literature
suggests that being high on mindfulness can leads towards lower levels of
affect, depression and anxiety (Brown & Ryan, 2003; Shapiro, Oman,
Thoresen, Plante, & Flinders, 2008) and successful self-regulation and
tolerance of emotional stimuli (Creswell, Way, Eisenberger, & Lieberman,  2007). With healthcare staffs who are more
mindful, general health outcomes may be equally beneficial for both staff and
patients. If one is low in mindfulness, avoiding or being unable to tolerate
undesirable, aversive or difficult moments in health care settings which may reflect
inadequate self care, and can cause poor patient care.

Emotional
well-being is a positive sense of well-being which enables an individual to be
able to function in society and meet the demands of everyday life. According to
Kahneman and Deaton (2010) emotional well-being is the emotional quality of an
individual’s everyday experiences, the frequency and intensity of experiences
of joy, fascination, anxiety, stress, 
sadness, anger, and affection that make one’s life pleasant or unpleasant.

Over the years mindfulness and self-compassion have become one of the most
desirable personality characteristics in different age groups/ professions, thus,
understanding and addressing these robust trends among medical professionals
has become a major priority too (Horst, Newsom, Stith, 2013; Neely,
Schallert, Mohammed, Roberts,& Chen, 2009). Kinman, and Grant, (2010)
reported the resilience as a protective factor that enhances the power to
overcome tensions in social workers. Egan, Mantzios, and Jackson, (2016),
unveiled the training benefits of self-compassion and mindfulness in health
practitioners towards patients.

A caring for oneself is required before caring for others can occur, and
this care will need to be in the form of workplace compassion education or
self-compassion. As Medical practitioners face the stressful situations in
their profession life so this study has been designed to identify that how self
compassion and mindfulness linked to resilience and ultimately buffer against
emotional well-being of the doctors working in critical and non-critical care
units of patients.

Keeping
in view the rationale of the study, following hypotheses have been formulated:-

l  There are likely to be positive relationship between
resilience, self-compassion, mindfulness and emotional well-being of doctors
working in critical and non-critical care units of the patients.

l  Resilience, self-compassion and mindfulness are likely to be
positive predictors of Emotional well-being.

l  There are gender differences in resilience, self-compassion,
mindfulness and emotional well-being of doctors.

 

 

 

 

 

 

 

Method

Sample

The current study employed cross sectional research design. Sample of
100 doctors working in critical care units (n = 50) and non-critical care units
(n = 50) of patients in different government hospitals of Lahore city including
General Hospital, Jinnah Hospital and Services Hospital were selected by using
purposive sampling technique. The age range of the sample was 24-55 years (M =
28.27, SD = 5.88). Description of demographic variables can be seen in Table I.

Measures

Brief
Resilience Scale

        The
Brief Resilience Scale (Smith et al. 2008) has been designed to assess the
ability to bounce back or recover from stress. It consists of six items (e. g,
”when difficulties come in my life I retrieve back quickly”). Items are
scored on five point rating scale (1 = strongly disagree, 5 = strongly agree).
This scale has good internal consistency with Cronbach’s alpha ranging from .84
to .91 and test-retest reliability of .69 at one month period (Smith et al. 2008).
Reliability analysis (internal consistency) was carried out for The Brief
Resilience Scale in the present study which showed ? value .53.

Self-Compassion
Scale (SCS)

       The SCS (Neff, 2003) consists of 26
items assessing six different aspects of self-compassion including
self-kindness, self-judgment, common humanity, isolation, mindfulness and
over-identification. Items are scored on 5-point Likert scale (1 = almost never
to 5 = almost always). Neff (2003) has reported internal consistency of a .92,
and test-retest reliability of .93. Alpha reliability for the current study was
.76.

Mindfulness
Attention Awareness Scale (MAAS)

            The MAAS (Brown & Ryan,
2003) is a 15 item scale designed to examine a core characteristics of
dispositional mindfulness such as receptive awareness of and attention to what
is taking place in the present (e.g., “I find it difficult to stay focused on
what’s happening in the present”). It has been found to be a psychometrically
adequate instrument with alpha coefficient ranging from .80 to .90 ((Brown
& Ryan, 2003). This scale has 6-point rating scale with categories “Almost
Always”, “Very Frequently”, and “Somewhat Frequently” for responses. For
present study alpha reliability of the scale was .85.

Scale
of Positive and Negative Experience (SPANE)

         SPANE, (Diener et al. 2009) was
utilized to measure the emotional well-being of the participants. This scale is
a 12 item questionnaire which includes six items to assess positive feelings
and six items to assess negative feelings. Three items per scale are general
(e.g., positive, negative) and three items for both scales are specific (e.g.,
joyful, sad). The items are rated on five point Likert scale ranging from 1 =
never to 5 = always. Internal consistency generally ranges from .80 to .90. And
reliability alpha for the current study was .76.

Demographic
Information Questionnaire

 The demographic information questionnaire
includes questions about age, gender, education, marital status, family system,
monthly family income, hospital name, department name in which working, and job
experience in years.

 

Procedure

            Formal
permission was sought from respective authorities prior to data collection. A
letter explaining nature of the study and what would be expected from the
participants was produced to the Medical Superintendent of concerned hospitals.  The potential participants were contacted
during their duty hours and were briefed about the purpose of the research.
Before taking the information from the participants, written consent was signed
by every participant.  In consent form it
was clarified that information obtained from the participants would be used for
research purpose and would be used for research purpose only. After obtaining
their consent and willingness to participate in research, protocol
questionnaires were handed over to fill up. The data was collected on
individual basis and assessment protocols were filled in by the participants in
the researcher’s presence. It took a participant about 25-30 minutes to
complete questionnaire.

 

 

 

 

 

 

 

 

 

Results

Descriptive
statistics were computed to examine demographic characteristics of the sample
and inferential statistics was used for hypotheses testing. To examine the
relationship between gender, age, marital status, resilience, self-compassion,
mindfulness and emotional well-being, Pearson product moment correlation was
carried out. To clarify the relationship between possible predictors and
emotional well-being and its domains, multiple hierarchical regressions was
conducted.

Following
are the descriptive analysis and reliability for each assessment tool and their
subscales.

Correlation
analyses demonstrated that in critical care unit of patients, there was
significant negative relationship between gender and age. Gender was also
negatively related with resilience, self-compassion and mindfulness quality of
the doctors. Age was positively related with resilience, self-compassion and
mindfulness and inversely related with emotional well-being of the doctors and
these relationships were non-significant. Doctors’ resilience was positively
related with self-compassion and mindfulness and emotional well-being.
Self-compassion is only significantly related with emotional well-being.

Whereas
demographic variables of non critical care units of patients revealed that age
had significant positive relationship with gender. Marital status had positive
significant relationship with age and resilience. Similarly mindfulness had
positive relationship with self-compassion. Emotional well-being had highly
significant relationship with mindfulness and self-compassion. The positive
domain of emotional well-being had positive relationship with mindfulness and
emotional well-being whereas the negative domain had negative relationship with
resilience but positive relationship with self-compassion and emotional
well-being.

Multiple
regression analysis was carried out by entering resilience, self-compassion and
mindfulness as predictors of doctor’s emotional well-being. Results in table 4 showed
that overall modal explained the 16% of the variance for emotional well-being
and it was significant at F (3, 96) = p

To
examine the gender differences in resilience, self-compassion, mindfulness and
emotional wellbeing of doctors, a series of Independent sample t test was
applied. Results are presented in Table 5. Analyses revealed that there were
mean differences in resilience; self-compassion and mindfulness scores of
doctors but these differences were not significant. However, gender differences
were found in emotional well-being of male and female doctors and these differences
were significant. Overall males were better in self resilience,
self-compassion, mindfulness and emotional well-being as compared to females.

 

 

 

 

 

Discussion

The current study investigated the relationship among resilience,
self-compassion, mindfulness and emotional well-being of doctors working in
critical care and non-critical care units of the patients. Further, this study
explored the resilience, self-compassion, and mindfulness as predictors of
emotional well-being of doctors. Furthermore, gender differences regarding all
study variables were explored. It was hypothesized that resilience,
self-compassion and mindfulness are likely to be positively related with
emotional well-being in both groups of doctors. The results of current study
indicated that several positive factors (resilience, mindfulness and self-
compassion) are positively associated with higher emotional well-being and
negatively related with negative aspect of emotional well-being. These results
are in agreement with the findings by Sirois, Kitner, and Hirsch, (2015) who
explained that psychological factors such as resilience, self-compassion and
mindfulness may play a role in an individual’s ability to maintain a positive
sense of wellbeing even during stressful times. As such, these factors could
increase the overall wellbeing of doctors. One of the previous researches has
confirmed that individuals who are self-compassionate should evidence greater
psychological health than those with low levels of self-compassion, because the
inevitable pain and sense of failure that is experienced by all individuals is
not ampli?ed and perpetuated through harsh self-condemnation (Dyrbye et al.,
2010). Doctors who receive mindfulness cum self-care training are more likely
to demonstrate greater wellness and social support when compared with an adult
norm group (Roach & Young, 2007; Smith, Mike-Robinson, & Young, 2007; Myers,
Mobley & Booth, 2003).

       Second it was hypothesized that
resilience, self-compassion and mindfulness are likely to be positive
predictors of emotional well-being. Result of current research has suggested
that doctors who are more self compassionate have better emotional well-being.
On the contrary, resilience and mindfulness abilities had little practical
utility in emotional well-being of doctors. These results are in line with the
findings of Galla, (2016) who reported that self-compassion predicts enhanced
emotional well-being more consistently within-person than mindfulness.
Specifically, increases in self-compassion predicted reductions in perceived
stress, rumination, depressive symptoms, and negative affect, and conversely,
increases in positive affect and life satisfaction (Neff, & McGehee, 2010). These findings support  Byrne, Bond, and London, (2013) findings that
as wellbeing increases, positive coping skills increase and maladaptive ones
decrease including depression and anxiety (see also Germer & Neff, 2013).
In other words, paying close attention to subjective experience through the
cultivation of mindfulness may promote meta-cognitive insights and
compassionate attitudes that in turn foster enhanced emotional well-being
(Kabat-Zinn, 2003).

Analyses
of the present research further revealed that sex divergence was significant
only in emotional well-being of male and female doctors. Overall men were
better in self resilience, self-compassion, mindfulness and emotional
well-being as compared to women. This is in line with an abundant literature on
aspects that women’s emotional wellbeing is more at risk with more women
admitting to suffering from certain emotional wellbeing issues than men
(Hagborg, Fors, & Fahlke, 2017; Shaffer, Yates, & Egeland, 2009). 

From
the present research, it can be concluded that emotional well-being of doctors
is a crucial part of working effectively with patients. Along with emotional
well-being, other psychological factors like resilience, self-compassion and
mindfulness in doctors to be necessary in helping doctors to grow
professionally. In our research it was revealed that doctors who were more self
compassionate had better emotional well-being. Whereas, resilience and
mindfulness abilities had little practical utility in emotional well-being of
doctors. Moreover significant gender differences in emotional well-being of
doctors were found. However both males and females doctors had almost equal
level of resilience, self-compassion and mindfulness abilities.

Limitation of the
present research is that participants were drawn from one city of Pakistan
(i.e., only from Lahore), therefore the sample was small in diversity, and this
factor may limit the generalizations of results. Secondly, the sample size was
small as the time span provided for data collection and the entire research was
limited.