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RESEARCH ARTICLE

SELF-COMPASSION IN NURSING:
AN EVOLUTIONARY CONCEPT ANALYSIS
Aldren R. Remon, MSN, RN1*

Abstract
COVID-19 pandemic gives a new meaning to self-compassion thinking. Nurses in various fields or settings (e.g., hospital, CoViD-
19 isolation facility, community) provide care to patients and families who may be suffering and traumatized from the ongoing
disease outbreak. Thus, it is necessary to illuminate the concept of self-compassion to respond to the holistic needs of the nurses
who are at risk of developing compassion fatigue and burnout. This paper aims to examine the concept of self-compassion as it
relates to nursing using simplified Rodgers' (2010) evolutionary concept analysis. Rodger's evolutionary concept analysis is an
inductive method of analysis wherein concepts are viewed to develop over time and are highly influenced by the context in which
they are used. The data source was a search of literature published from 2010-2020 on CINAHL, Google Scholar, and Health
Source: Nursing/Academic Edition. The sifting process is utilized to ensure a comprehensive electronic database search.

This evolutionary concept analysis found four attributes of self-compassion in nursing: mindful attention, self-mastery, self-
kindness, and shared humanity. Regarding the antecedents of self-compassion, it is necessary to experience suffering, an event, or
a traumatic encounter. Consequently, these may result in compassionate care, positive well-being, and quality nursing care. In the
nursing context, compassion toward self has been seen to subtle. During the continually evolving Covid-19 pandemic, nurses must
be empowered to continuously envisage self-compassion in their daily practice. Frequent practice of compassion towards self can
potentially appreciate this way of being in the nursing discipline and the patients, families, or communities for which nurses
compassionately care for and serve.

Keywords: Self-compassion, Nursing, Evolutionary Concept Analysis, COVID-19 Pandemic

B ackground. COVID-19 pandemic gives a new meaning to


self-compassion thinking. Self-compassion is a construct
from the Buddhist idea that involves the extension of care,
not disregard their mental health during this pandemic. Recent
evidence has shown that health workers directly involved in the
diagnosis, treatment, and care of patients with COVID-19 are at
kindness, and understanding toward oneself when faced with risk of developing mental health symptoms (Kang, 2020; Khanal
shortcomings, inadequacies, or failures (American et al., 2020; Spoorthy, 2020). The increasing number of
Psychological Association, 2020). The dynamic nature and confirmed cases and deaths among nurses, additional work
various interpretations of this concept resulted in multiple burden, inadequate personal protective equipment (PPE), media
definitions. Notably, there has been a debate about the coverage, lack of specific treatment, vulnerability to infection and
conceptual clarity among definitions of self-compassion in having to stay in quarantine, as well as feelings of being
scholarly work (Bluth & Blanton, 2014; Germer & Neff, 2013). inadequately supported in the workplace, stigma faced by
This paper aims to clarify the concept of self-compassion in directly caring for COVID-19 patients, and understaffing, can
nursing. contribute to the mental burden of nurses. The psychological
health impact of the disease outbreak is usually neglected during
The rapid spread of SARS-CoV-2, the novel virus that causes pandemic management due to safety priorities and costs.
Coronavirus Disease (COVID-19), was considered as an
international public health event by the World Health Notably, the COVID-19 pandemic has evoked not only economic
Organization (WHO). The nursing community is at the forefront of upheaval but also emotional turmoil among nurses on the front
this unprecedented public health event. Arguably, nurses must line. Tamse (2020) highlighted fear, uncertainties, distress,

* Corresponding author: arremon@slu.edu.ph


1 Corresponding Author: Saint Louis University- School of Advanced Studies/SLU-Hospital of the Sacred Heart; PhD Candidate/ Chief Nurse

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anger, and frustrations as the most common impact of the Emotions derived from these experiences is an integral
COVID-19 pandemic on the emotional well-being of nurses. The component in the relationship between the nurse, patients, and
courageous stories, unrelenting pressure and grief, and reports families. Self-compassion has been described as the ability to be
of resource rationing decisions affected nursing care. Nurses' compassionate to oneself (Henderson & Jones, 2017) and
experiences of significant on-the-job anxiety, compassion involves linking association with others through understanding
fatigue (Houck, 2014; Mattioli, 2018), and burnout were (Neff, 2009). This ability is necessary for preparation for the nurse
aggravated by the COVID-19 Pandemic (Lai et al., 2020; Liu et to be compassionate to patients (Ferreras, 2019).
al., 2020, Wu et al., 2020, Lu et al., 2020). The veins of fear have
been in the lives of nurses months after the World Health The World Health Assembly designated 2020 as the International
Organization (WHO) declared the emergence of the novel Year of the Nurse and Midwife, a year-long effort to celebrate the
coronavirus across the globe. courageous work of nurses and midwives. Likewise, the
Philippine Government declared 2020 as the Year of Filipino
According to Germer (2020), self-compassion is a vital inner Health Workers to commemorate the immeasurable acts of
source for managing stress during the COVID-19 pandemic. heroism and selfless compassion of nurses and all health
Thus, understanding the definition and core attributes of self- workers, and give honor to those who sacrificed their lives in the
compassion in nursing is an essential self-care strategy that line of service, especially in this time of Coronavirus Diseases
nurses can acquire to sustain care. Self-compassion (SC) is not Pandemic (Proclamation No. 976, s. 2020). However, there are
synonymous with self-esteem, which involves confidence in still appalling reports of threats to nurses' safety and security,
one's worth or abilities. Reyes (2012) posit SC as a condition of such as shortages of human resources and Personal Protective
being that gives an insight into enduring the past, and the Equipment (PPE) and support from the hospitals (Rowan &
meaning of illness, pain, and suffering. SC is emphatically Laffey, 2020).
connected to sound mental working as far as unique joy, life
fulfillment, versatile adapting, enthusiastic insight, and In 2020, a concern for mental health amongst nurses has risen to
inspiration (Neff et al., 2005; Beekman et al., 2017), and a new level. As the COVID-19 pandemic prevails to impact
adversely linked to unfortunate working as far as less psychological health, nurses have unique insights into their
nervousness, stress, and sorrow (Yarnell et al., 2018; Long & colleagues' emotional well-being and the individuals for which
Neff, 2018). During the past 20 years, research into self- they provide care. Nursing as a profession exemplifies
compassion within nursing has been evolving but remains compassion. With nurses caring for COVID-19 patients being
ambiguous. The COVID-19 pandemic influenced nursing, among the foremost at risk for compassion fatigue and burnout
modifying how nurses render care in response to stringent during this pandemic era, it is evident that more needs to be
infection prevention and control measures. Self-compassion as reviewed and done. The studies' results, as mentioned above,
a self-care measure to mitigate the impact of burnout and and the need to further dissect the concept of self-compassion in
compassion fatigue remains to be a dynamic concept. Thus, it is the context of nursing during the COVID-19 pandemic prompted
necessary to further illuminate the concept of self-compassion the researcher to conduct a concept analysis. This paper aims to
within the context of nursing. examine the idea of self-compassion as it relates to nursing using
simplified Rodgers' (2010) Evolutionary Concept Analysis.
Nursing is a crucial element of health care in every setting. In
hospital settings, nurses comprise about 40% to 50% of the total Methods
workforce (Department of Health, Hospital Nursing Service
Administration Manual, The Nursing Service, 2019, p. 11). The basic building blocks of a theory are concepts. Walker and
Nursing encompasses autonomous and collaborative care of Avant (2018) defined the concept as a mental image of a
individuals of all ages, families, groups, and communities, sick or phenomenon, a construct in the mind about a thing or an action
well, and in all settings (International Council of Nurses, 2002). that represents a symbol or a building block of a more significant
The WHO highlights the vital roles of nurses in the promotion of spectrum. Concept analysis represents a strategy that permits a
health, prevention of illness, and the care of ill, disabled, and researcher to examine the attributes or characteristics of a
dying people. concept (Walker & Avant, 2018). Within nursing, concept
analysis is defined as the dissection of a concept into simpler
Nurses provide twenty-four seven (24/7) direct or indirect patient elements to promote clarity while providing mutual
care irrespective of holidays, public health emergencies, or understanding (Nuopponen, 2010). Rodgers (2000) offered a
catastrophes. Nurses in practice (e.g., hospital, CoViD-19 method of concept analysis referred to as an evolutionary view of
Facilities) provide care to patients and families who may be concepts, which “addresses contemporary concerns valuing
suffering and traumatized from the ongoing disease outbreak. dynamism and interrelationships within reality”.

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Figure 1. Sifting process.

This study utilized Rodgers' Evolutionary Concept Analysis Scholar, and Health Source: Nursing/Academic Edition.
(inductive method of interpretation) to examine the significance, Specifically, the input of "self-compassion" AND "nursing" as
use, emerging trends, and future development of the concept of search words initially resulted in 966 articles. The additional input
self-compassion as it unfolded over time in the context of nursing. of "nursing practice” AND “COVID-19 Pandemic” search terms in
According to Rodgers et al. (2018), concepts evolve and are the abovementioned databases yielded a total of 92 articles as
highly influenced by the context in which they are used. In this relevant to advance search using the time frame 2010-2020.
study, an updated idea is proposed based on the evolutionary Rodgers (2000), as cited in Tofhagen and Fagerstrom (2010),
method. recommended the inclusion of 30 studies or 20% of the total
number of references reviewed. After applying the inclusion and
Rodgers' evolutionary view was chosen for this inquiry because it exclusion criteria, 34 studies were reviewed vigorously in the
is rigorous, systematic, and reflects the advancement and use of core analysis phase.
science concepts. Pinto et al. (2017) suggests that the concept
development in this method remains dynamic, and past The core analysis phase involved reading the articles in their
definitions or researches are not “the truth" but contribute to entirety, focusing on the concept's context, antecedents,
knowledge. Specifically, this study employed simplified Rodgers' attributes, and consequences. During this phase, the author
evolutionary concept analysis, which consists of three (3) attempted to immerse in the idea to uncover patterns and further
phases: 1) Initial Phase (selection of concept for review, the allow main themes to emerge. Data saturation was achieved
concepts' context, collection of data for analysis, and choice of when the data repeats itself, and the supplementary data
texts; 2) Core Analysis Phase (presentation of concept's provides a totality of antecedents, characteristics, and
antecedents, attributes, consequences, and identification of consequences of the phases and between them.
model case), and 3) Further Analysis Phase.
Results and Discussion
The study employed the sifting process in the collection of data
analysis, as shown in Figure 1. The sifting process is an iterative The concept of self-compassion has become more relevant in
approach that involves exhaustive database search, screening nursing theoretical development. SC is presently seen as being
for relevance, and subsequent validation (Archer et al., 2015). warm and caring on occasions of difficulty, being thoughtful to
The following serves as the exclusion criteria of the concept self, accepting suffering or unpleasant events as they are, and
analysis: (1) articles not addressing the concept of self- being non-judgmental (Mathad et al., 2017; Germer & Neff,
compassion in nursing, (2) studies on psychometric 2013). According to Tóth-Király & Neff (2020), self-compassion is
development of self-compassion scale. In the conduct of the a universal experience that applies across several contexts. In
sifting process, the following search words and boolean nursing, self-compassion is a state of self-kindness, authentic
operators were used: 1) "self-compassion," and "nursing," or presence, wisdom, and commonality that transforms suffering
"nursing practice." Exhaustive electronic research was and leads to decisions that ameliorate nurses' and patients'
performed using the following databases: CINAHL, Google health and well-being (Reyes, 2011). These varied definitions

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Table 1. Self-compassion in Nursing

raise further debate about a more holistic and evolutionary nature Mindful attention balanced frame of mind that takes into
of self-compassion as a concept of interest. Self-compassion in consideration the present moment. Given the COVID-19
nursing has been explored and studied (Table 1). However, its pandemic, mindful attention allows nurses to objectively witness
application in the context of nursing service remains to be limited. the experience of suffering of both patients and nursing
colleagues with Coronavirus Disease. Rather than intensifying,
Defining Attributes of Self-compassion this attribute transforms suffering into an opportunity for
psychological growth.
Self-compassion is beyond compassion to oneself. Through the
core analysis, four attributes emerged to clarify the concept: Self-mastery emerged as an antecedent to self-compassion,
mindful attention, self-mastery, self-kindness, and recognition of wherein nurses have self-control. Self-mastery refers to the
humanity. These attributes mutually interact to develop a self- discipline of continuous learning and deepening of one's view
compassionate frame of mind in nursing. with the ability to learn from failure, thus building resilience (Neff,
2009; Gedik, 2019; Koehle et al., 2008). Self-mastery is often
Mindful attention focuses primarily on the acceptance of defined as self-control, the ability to exert a strong will against our
experience itself (Penge, 2019; Germer & Neff, 2013). Mindful impulses to steer our future to one of our choosing. But, this is
attention or mindfulness refers to the ability to use thought only one aspect of the term. Self-mastery requires having a vision
processes to regulate our behavior (Gregorio & Pinto-Gouveia, for your future self. It is being able to look at your mistakes,
2013). This defining attribute of self-compassion encompasses a acknowledge them, and learn from them.
dynamic cycle involving dedication, self-discipline, and
willfulness. In nursing, this can be performed by staying in the Self-compassion skills begin with understanding one's self. It
moment-to-moment experience (White, 2014; Matchim et al., involves being as kind to oneself as you are to others in need.
2011) with a patient or the healthcare team members. Matchim et Self-kindness is a critical attribute of self-compassion. According
al. (2011) summarized mindful attention as being sensitive to the to Neff (2009), self-kindness refers to a kind attitude towards self.
entire field of awareness where an individual can maintain focus Self-kindness is unconditional, wherein individuals believe that
without distraction. Germer (2020) further suggests that the they deserve to be loved and valued regardless of external
practice of self-compassion is a mixture of the mind and the heart. factors (i.e., social status) (Egan & Mantzios, 2018; Smith et al.,

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2018; Sims et al., 2020). Developing self-kindness necessitates reality, thereby breaking the cycle of negativity. Nurses, who
softening critical self-talk and becoming less dissatisfied with become aware of this choice, extend compassion to one's self.
perceived personal feelings (Dreisoerner, 2020). Self-kindness
in nursing is nurturing oneself through comfort and connection. An event as an antecedent of self-compassion refers to a
During this pandemic, self-kindness is crucial to our well-being, phenomenon (an observable fact at a given time) that is
both physically and emotionally. unpredictable and causes emotional distress (Skaggs & Barron,
2006). Unexpected situations such as disasters and pandemics
Nursing is a discipline to serve humanity. Neff (2009) describes are events related to nursing. The World Health Organization
shared humanity as seeing one's experiences as part of the more defined pandemic as "an epidemic occurring worldwide, or over
significant human experience instead of seeing them as distinct an extensive area, crossing international boundaries and usually
and isolated. In nursing, shared humanity encompasses affecting many people." Pandemics can overwhelm a hospital's
connectedness. This is reflected by remembering that everyone capacity to deliver nursing services (Liu et al., 2020; Levin et al.,
commits missteps and experiences difficulties during 2007). Nurses in healthcare facilities play a vital role in local
unprecedented times. The common humanity component of self- responses to emergencies, such as communicable disease
compassion, in contrast, allows further recognition of the related pandemics (Coronavirus Disease).
skills of self and others, thus breaking the cycle of self-isolation
Nurses respond to traumatic encounters in different ways.
(Taylor et al., 2019; Sara et al., 2020).
Traumatic encounters reflect incidents that can cause physical,
Antecedents of Self-compassion economic, psychological, or spiritual harm to an individual
(Nowicki et al., 2020; Mealer et al., 2009). Consequently, the
Antecedents refer to those things which precede the concept person who is experiencing
(Rodgers 2000; Tofthagom & Fagerstrom, 2010). According to
Germer (2020), self-compassion is a healthy response to the distressing encounter may feel disturbed, anxious, or
suffering. The experience of suffering in times of COVID-19 frightened. In nursing practice, a condition called post-traumatic
pandemic, which remains to be evident among nurses, has stress disorder (PTSD) can occur after the nurse encounters a
life-threatening incident or witnesses a death. Nursing practice
become an increasingly popular construct. Suffering as a
involves human-to-human interactions. These encounters are
profoundly personal state involves agony, grief, sorrow, pain, and
synonymous with the nurse's caring experiences, wherein
conflict due to an inability of individuals to find an answer to
interactions deem contact with the patient or client. Notably, in a
problems that altered their lives and the relationships with others
nurse-patient encounter, the nurse witnesses tragedies
(Ferrell & Coyle, 2008; Liu et al., 2007; Dev et al., 2018).
experienced by patients and their families. This encounter
Disease outbreaks such as the COVID-19 pandemic are anxiety- represents how the nurses described the changes in giving
provoking situations. Nurses in direct contact with COVID-19 nursing care on the unit.
patients are more exposed to traumatic events such as patients' Concept Consequences of Self-compassion
sufferings and deaths (Pappa et al., 2020). The surge of COVID-
19 confirmed cases in hospitals and isolation facilities further Consequences are identified themes that arise from the concept
resulted in nurses' experience of patient's suffering. In the (Rodgers 2000). The primacy for self-compassion entails the
context of the COVID-19 pandemic, nurses frequently following defining consequences: compassionate care, positive
experience a threat to self and exposure to events such as well-being, improved self-care, and safe and quality nursing
patient's distress or death and or loss of colleagues. Nurses' care. Self-compassion is a foundation of compassionate care
experience of suffering was aggravated by the risk of being (Mills et al., 2014; Gustin & Wagner, 2013). In nursing,
infected by COVID-19, fear of transferring the virus to their compassionate care remains to be a central tenet of nursing
families, and the physical or social isolation (separation from the service, integral to practice.
families and friends). Nurses' suffering can be manifested by a
pattern of decreased self-care, decreased ability to relate to Blomber et al. (2016) described compassionate care as a
others, and diminished autonomy (Reyes, 2011). collection of wisdom, love, compassion, and empathy.
Compassionate care is fundamental to nursing services
To give themselves compassion, nurses must accept the general (Wiklund & Wagner, 2013) and can be expressed as knowledge
suffering they are experiencing. The nurses' sufferings, when of a situation when the nurse is suffering (Crawford et al., 2014;
viewed over time, promote the realization that life has worth. Su et al., 2019; Henderson & Jones, 2017; Sims et al., 2020).
Then, nurses shift from the direction of pain to approaching Health care system challenges arise continually in nursing
sufferings with compassion, opting to immerse all facets of services. And navigating the turbulent nursing practice

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Figure 2. Conceptual Framework on Self-Compassion in Nursing

landscape during the COVID-19 pandemic has put more further reported that nurses who enact self-compassion deliver
pressure on nurses. According to Zamanzadeh et al. (2018), the more quality nursing care.
provision of organizational support and continuing professional
education can address nurses' capacity for compassionate care. Figure 2 shows the developed conceptual framework of self-
compassion nursing. The analysis found four intricately
Nurses with self-compassion can nurture positive well-being connected attributes: self-compassion as an emerging concept
and resilience in health care (Sinclair et al., 2017; Sirois, 2020). in these challenging times is characterized by mindful attention,
Well-being is a state of being healthy that integrates mental self-mastery, self-care, and shared humanity. The antecedents,
health (mind) and physical health (body), emotional health, and attributes, and consequences appeared to inform one another
satisfaction with life, and positive functioning (Bluth & Blanton, over time.
2015; Jarden, 2019). Nurses who are compassionate to
themselves exhibit a higher perspective, increased sense of Implications for Nursing Practice
well-being (Clevenger, 2018), and motivation to achieve new In nursing practice, clarity of the concept of self-compassion can
and attainable goals (Ko et al., 2018; Simmer-Brown & Fran, guide nursing actions and improve nursing outcomes. Self-
2011; Leary et al., 2007). compassion can be translated into practice when nurses derive
their interventions and care plans from the idea of self-
The cornerstone of health care practice is the provision of quality
compassion. Nursing interventions such as mindfulness
care. In nursing, quality care entails meeting client needs and
exercises, loving-kindness meditations, therapeutic touch, or the
expectations through conforming to relevant standards/
therapeutic use of self are effective strategies to translate self-
requirements (Grimley, 2017; Andrews et al., 2019). It is linked to compassion at the bedside (Hofmeyer et al., 2020; Reyes, 2012).
the degree to which the physical, psycho-social, and other care Notably, nurses can embrace self-care strategies (i.e., kind self-
needs of the patient were met. The nurses' relationship with talk, social connections, regular exercise) to foster self-
themselves sets the tone for every other relationship (i.e., nurse- compassion (Mills et al., 2020; Hofmeyer et al., 2020). The
patient) they engage with. Quality care is of critical importance awareness of SC's core attributes is necessary to embed it as a
among nurses in practice. Along with the definitions of self- habit among nurses in practice. Through the understanding of the
compassion, several recent studies reported that compassionate unique characteristics of self-compassion, nurses can provide
care resulted in quality nursing care (Sinclair et al., 2017; safe and quality care.
Clevenger, 2018’; Gishu et al., 2019). Raab (2014) found that
enacting self-compassion as a self-care intervention for nurses Self-compassionate individuals have better psychological well-
holds promise in increasing the effectiveness of clinical care. being, motivation, perspective-taking, better relationships, and
Sharma and Jiwan (2015) substantiated these findings and happiness (Vachon, 2016). In times of the pandemic, the skill to

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be self-compassionate should be integrated within the nursing frequent practice of compassion towards self can potentially
culture (Campion & Glover, 2017; Kelly & Tyson, 2016). Nurses appreciate this way of being in the nursing discipline and the
can use this ability to prevent burnout and compassion fatigue community for which nurses compassionately care for and serve.
proactively instead of being reactive in response to stressful
situations. Nurses can further use self-compassion as a self-care
strategy to lessen their vulnerability to COVID-19 related fatigue ____________________
or COVID-19-associated rapid-onset compassion fatigue and to
improve their psychological well-being (Hofmeyer et al., 2020, References
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Acknowledgment
caring - clinical nursing teachers' understanding of self-
compassion as a source to compassionate care. Scandinavian
The author was inspired by the creativity and dedication of
Journal of Caring Sciences, 27(1), 175–183. https://doi.org/ Nurses in SLU Hospital of the Sacred Heart during the
10.1111/j.1471-6712.2012.01033.x COVID-19 Pandemic. Despite the anxieties, limitations, and
White, L. (2014). Mindfulness in nursing: an evolutionary concept challenges faced, they were able to reflect the authentic
analysis. Journal of Advanced Nursing, 70 2, 282-94 . service and care to our patients beyond the standards
Wu, Y., Wang, J., Luo, C., Hu, S., Lin, X., Anderson, A. E., … Qian, Y. expected of them. Likewise, the author would like to thank Dr.
(2020). A comparison of burnout frequency among oncology Fareda F. Flores and his colleagues in the Department of
physicians and nurses working on the front lines and usual Health and Metro Psychiatry Inc. for allowing him to join the
wards during the COVID-19 epidemic in Wuhan, China. week-long workshop entitled Building Resilience and
Journal of Pain and Symptom Management. Preventing Burnout in Times of COVID-19: A Self-
https://doi:10.1016/j.jpainsymman.2020.04.008 Compassion Training for Health Care Communities.
Yarnell, L., Neff K., Davidson, O., & Mullarkey, M. (2018). Gender
Differences in Self-Compassion: Examining the Role of

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