Abstract ability to maintain flexibility and balance in your

AbstractThepresent study was conducted to explore the relationship between resilienceself-compassion, mindfulness and emotional well-being of doctors working incritical and non-critical care units of patients.

It was hypothesized thatthere is likely to be positive relationship between resilience,self-compassion, mindfulness and emotional well-being of doctors andresilience, self-compassion and mindfulness are likely to be positivepredictors of emotional well-being of doctors working in critical care and non criticalcare units of patients. Further it was also hypothesized that there are likelyto be gender differences in resilience, self-compassion,mindfulness and emotional well-being of doctors. Data was collected fromdoctors (N = 100) with age range of 24 to 55 (M = 28.

27, SD = 5.88) usingconvenient 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 correlationanalysis showed that there was positive and significant correlation betweenresilience, self-compassion, mindfulness and emotional well-being of bothgroups of doctors. Regression analysis revealed that self-compassion was onlysignificant predictor of emotional well-being. Moreover, significant gender differenceswere found on emotional well-being. Nevertheless, resilience, self-compassionand mindfulness abilities are alike in male and female doctors.

Keywords:Resilience, Self-compassion, Mindfulness, Emotional well-being, Critical careunits.  Manymedical professionals face stressful situations while treating their patientsin critical situations, which adversely affect quality of care, emotionalwell-being and ultimately threatens professionalism. Self compassion andmindfulness protect against the harmful impact of tension and boost emotionalwellbeing 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 ofadversity.

American Psychological Association (2016) has defined the resiliencein term of ability to maintain flexibility and balance in your life as you dealwith stressful circumstances and traumatic events.  Wagnild and Young’s (1993) explain theresilience as “a personality characteristic that moderates the negative effectsof stress and promotes adaptation” (p. 165).Compassion is defined as identifying the suffering of othersand a desire to alleviate that suffering.

Compassion in psychological sciencehas been described as sympathy, empathy, selflessness, altruism and kindness(Gilbert, 2005). Self-compassion involves treating yourself withcare and concern when considering personal mistakes, failures, and painful lifesituations and anunderstanding that one’s experience is part of the common human experience (Wei, Liao, Ku, & Shaffer, 2011). Itconsists of three interacting components: (i) self-kindness versusself-judgment, (ii) a sense of common humanity versus isolation, and (iii)mindfulness versus over-identification. Self-kindness refers to the tendency tobe caring and understanding with oneself rather than being harshly critical.

Rather than attacking and berating oneself for personal shortcomings, the selfis offered warmth and unconditional acceptance. The sense of common humanity inself-compassion involves recognizing that humans are imperfect, that all peoplefail, make mistakes, and have serious life challenges.Mindfulness is the ability to hold one’s painful thoughts and feelingsin balanced awareness rather than over-identifying with them (Neff, 2003). Self-compassionis negatively associated with depression, anxiety, rumination, and thoughtsuppression; and positively with life satisfaction and social connectedness (Raes, 2010).  Mindfulness is another approachquite similar to self-compassion. Mindfulness is the condition of remainobservant to and conscious of what is happening in our surroundings, a trait ofbeing aware and conscious in terms to enhance well-being (Brown, & Ryan,2003). Literaturesuggests that being high on mindfulness can leads towards lower levels ofaffect, depression and anxiety (Brown & Ryan, 2003; Shapiro, Oman,Thoresen, Plante, & Flinders, 2008) and successful self-regulation andtolerance of emotional stimuli (Creswell, Way, Eisenberger, & Lieberman,  2007). With healthcare staffs who are moremindful, general health outcomes may be equally beneficial for both staff andpatients.

If one is low in mindfulness, avoiding or being unable to tolerateundesirable, aversive or difficult moments in health care settings which may reflectinadequate self care, and can cause poor patient care.Emotionalwell-being is a positive sense of well-being which enables an individual to beable to function in society and meet the demands of everyday life. According toKahneman and Deaton (2010) emotional well-being is the emotional quality of anindividual’s everyday experiences, the frequency and intensity of experiencesof 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 mostdesirable personality characteristics in different age groups/ professions, thus,understanding and addressing these robust trends among medical professionalshas 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 toovercome tensions in social workers. Egan, Mantzios, and Jackson, (2016),unveiled the training benefits of self-compassion and mindfulness in healthpractitioners towards patients.A caring for oneself is required before caring for others can occur, andthis care will need to be in the form of workplace compassion education orself-compassion.

As Medical practitioners face the stressful situations intheir profession life so this study has been designed to identify that how selfcompassion and mindfulness linked to resilience and ultimately buffer againstemotional well-being of the doctors working in critical and non-critical careunits of patients.Keepingin view the rationale of the study, following hypotheses have been formulated:-l  There are likely to be positive relationship betweenresilience, self-compassion, mindfulness and emotional well-being of doctorsworking in critical and non-critical care units of the patients.l  Resilience, self-compassion and mindfulness are likely to bepositive predictors of Emotional well-being.l  There are gender differences in resilience, self-compassion,mindfulness and emotional well-being of doctors.       MethodSample The current study employed cross sectional research design.

Sample of100 doctors working in critical care units (n = 50) and non-critical care units(n = 50) of patients in different government hospitals of Lahore city includingGeneral Hospital, Jinnah Hospital and Services Hospital were selected by usingpurposive 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.MeasuresBriefResilience Scale        TheBrief Resilience Scale (Smith et al.

2008) has been designed to assess theability 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 arescored on five point rating scale (1 = strongly disagree, 5 = strongly agree).This scale has good internal consistency with Cronbach’s alpha ranging from .84to .

91 and test-retest reliability of .69 at one month period (Smith et al. 2008).Reliability analysis (internal consistency) was carried out for The BriefResilience Scale in the present study which showed ? value .53.Self-CompassionScale (SCS)       The SCS (Neff, 2003) consists of 26items assessing six different aspects of self-compassion includingself-kindness, self-judgment, common humanity, isolation, mindfulness andover-identification. Items are scored on 5-point Likert scale (1 = almost neverto 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. MindfulnessAttention Awareness Scale (MAAS)            The MAAS (Brown & Ryan,2003) is a 15 item scale designed to examine a core characteristics ofdispositional mindfulness such as receptive awareness of and attention to whatis taking place in the present (e.

g., “I find it difficult to stay focused onwhat’s happening in the present”). It has been found to be a psychometricallyadequate instrument with alpha coefficient ranging from .80 to .

90 ((Brown& Ryan, 2003). This scale has 6-point rating scale with categories “AlmostAlways”, “Very Frequently”, and “Somewhat Frequently” for responses. Forpresent study alpha reliability of the scale was .85.Scaleof Positive and Negative Experience (SPANE)         SPANE, (Diener et al. 2009) wasutilized to measure the emotional well-being of the participants.

This scale isa 12 item questionnaire which includes six items to assess positive feelingsand 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. Andreliability alpha for the current study was .

76.DemographicInformation Questionnaire The demographic information questionnaireincludes questions about age, gender, education, marital status, family system,monthly family income, hospital name, department name in which working, and jobexperience in years. Procedure            Formalpermission was sought from respective authorities prior to data collection. Aletter explaining nature of the study and what would be expected from theparticipants was produced to the Medical Superintendent of concerned hospitals.  The potential participants were contactedduring their duty hours and were briefed about the purpose of the research.Before taking the information from the participants, written consent was signedby every participant.  In consent form itwas clarified that information obtained from the participants would be used forresearch purpose and would be used for research purpose only.

After obtainingtheir consent and willingness to participate in research, protocolquestionnaires were handed over to fill up. The data was collected onindividual basis and assessment protocols were filled in by the participants inthe researcher’s presence. It took a participant about 25-30 minutes tocomplete questionnaire.          ResultsDescriptivestatistics were computed to examine demographic characteristics of the sampleand inferential statistics was used for hypotheses testing. To examine therelationship between gender, age, marital status, resilience, self-compassion,mindfulness and emotional well-being, Pearson product moment correlation wascarried out. To clarify the relationship between possible predictors andemotional well-being and its domains, multiple hierarchical regressions wasconducted.Followingare the descriptive analysis and reliability for each assessment tool and theirsubscales.

Correlationanalyses demonstrated that in critical care unit of patients, there wassignificant negative relationship between gender and age. Gender was alsonegatively related with resilience, self-compassion and mindfulness quality ofthe doctors. Age was positively related with resilience, self-compassion andmindfulness and inversely related with emotional well-being of the doctors andthese relationships were non-significant. Doctors’ resilience was positivelyrelated with self-compassion and mindfulness and emotional well-being.Self-compassion is only significantly related with emotional well-being.Whereasdemographic variables of non critical care units of patients revealed that agehad significant positive relationship with gender.

Marital status had positivesignificant relationship with age and resilience. Similarly mindfulness hadpositive relationship with self-compassion. Emotional well-being had highlysignificant relationship with mindfulness and self-compassion. The positivedomain of emotional well-being had positive relationship with mindfulness andemotional well-being whereas the negative domain had negative relationship withresilience but positive relationship with self-compassion and emotionalwell-being. Multipleregression analysis was carried out by entering resilience, self-compassion andmindfulness as predictors of doctor’s emotional well-being. Results in table 4 showedthat overall modal explained the 16% of the variance for emotional well-beingand it was significant at F (3, 96) = p < .001. Resilience (?=.

03) waspositive but non-significant predictor of emotional well-being. Self-compassion(?=.35) was positive and significant predictor of emotional well-being.Mindfulness (?=.10) was positive but non- significant predictor of emotionalwell-being. These results suggest that doctors who are more self compassionatehave better emotional well-being. On the contrary, resilience and mindfulnessabilities had little practical utility in emotional well-being of doctors.Toexamine the gender differences in resilience, self-compassion, mindfulness andemotional wellbeing of doctors, a series of Independent sample t test wasapplied.

Results are presented in Table 5. Analyses revealed that there weremean differences in resilience; self-compassion and mindfulness scores ofdoctors but these differences were not significant. However, gender differenceswere found in emotional well-being of male and female doctors and these differenceswere significant. Overall males were better in self resilience,self-compassion, mindfulness and emotional well-being as compared to females.

     DiscussionThe current study investigated the relationship among resilience,self-compassion, mindfulness and emotional well-being of doctors working incritical care and non-critical care units of the patients. Further, this studyexplored the resilience, self-compassion, and mindfulness as predictors ofemotional well-being of doctors. Furthermore, gender differences regarding allstudy variables were explored. It was hypothesized that resilience,self-compassion and mindfulness are likely to be positively related withemotional well-being in both groups of doctors. The results of current studyindicated that several positive factors (resilience, mindfulness and self-compassion) are positively associated with higher emotional well-being andnegatively related with negative aspect of emotional well-being.

These resultsare in agreement with the findings by Sirois, Kitner, and Hirsch, (2015) whoexplained that psychological factors such as resilience, self-compassion andmindfulness may play a role in an individual’s ability to maintain a positivesense of wellbeing even during stressful times. As such, these factors couldincrease the overall wellbeing of doctors. One of the previous researches hasconfirmed that individuals who are self-compassionate should evidence greaterpsychological health than those with low levels of self-compassion, because theinevitable pain and sense of failure that is experienced by all individuals isnot ampli?ed and perpetuated through harsh self-condemnation (Dyrbye et al.,2010). Doctors who receive mindfulness cum self-care training are more likelyto demonstrate greater wellness and social support when compared with an adultnorm group (Roach & Young, 2007; Smith, Mike-Robinson, & Young, 2007; Myers,Mobley & Booth, 2003).       Second it was hypothesized thatresilience, self-compassion and mindfulness are likely to be positivepredictors of emotional well-being. Result of current research has suggestedthat doctors who are more self compassionate have better emotional well-being.

On the contrary, resilience and mindfulness abilities had little practicalutility in emotional well-being of doctors. These results are in line with thefindings of Galla, (2016) who reported that self-compassion predicts enhancedemotional well-being more consistently within-person than mindfulness.Specifically, increases in self-compassion predicted reductions in perceivedstress, 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 thatas wellbeing increases, positive coping skills increase and maladaptive onesdecrease including depression and anxiety (see also Germer & Neff, 2013).In other words, paying close attention to subjective experience through thecultivation of mindfulness may promote meta-cognitive insights andcompassionate attitudes that in turn foster enhanced emotional well-being(Kabat-Zinn, 2003). Analysesof the present research further revealed that sex divergence was significantonly in emotional well-being of male and female doctors. Overall men werebetter in self resilience, self-compassion, mindfulness and emotionalwell-being as compared to women. This is in line with an abundant literature onaspects that women’s emotional wellbeing is more at risk with more womenadmitting to suffering from certain emotional wellbeing issues than men(Hagborg, Fors, & Fahlke, 2017; Shaffer, Yates, & Egeland, 2009).

 Fromthe present research, it can be concluded that emotional well-being of doctorsis a crucial part of working effectively with patients. Along with emotionalwell-being, other psychological factors like resilience, self-compassion andmindfulness in doctors to be necessary in helping doctors to growprofessionally. In our research it was revealed that doctors who were more selfcompassionate had better emotional well-being. Whereas, resilience andmindfulness abilities had little practical utility in emotional well-being ofdoctors. Moreover significant gender differences in emotional well-being ofdoctors were found.

However both males and females doctors had almost equallevel of resilience, self-compassion and mindfulness abilities.Limitation of thepresent research is that participants were drawn from one city of Pakistan(i.e., only from Lahore), therefore the sample was small in diversity, and thisfactor may limit the generalizations of results. Secondly, the sample size wassmall as the time span provided for data collection and the entire research waslimited.