Resilience and self-compassion affect selfhandicapping in Turkish undergraduate nursing students: A correlational study

Correlación de la resiliencia y la autocompasión con el autosabotaje en estudiantes turcos de enfermería

The mean age of the students included was 20.50 ± 1.49. The data on descriptive characteristics of the 369 participants of the study are presented in table 1.

Table 1
Participant demographic characteristics (N = 369)

CD-RISC: Connor-Davidson Resilience Scale; SHS: Self-Handicapping Scale; F: One-way ANOVA test; t: Independent sample t test; p: p value a: 1-2, b: 1-3, c: 1-4 *p < 0.05 **p ≤ 0.001

No significant differences were found between gender, place of residence, family type, employment status, and father’s education level with the scales’ scores. Also, no significant differences were found between the year of study and the CD-RISC scale. We found statistically significant differences between the Self-Handicapping and Self-Compassion Scale (p < 0.05). Accordingly, first-year students had significantly lower CD-RISC scores than those of the second, third, and fourth year. In addition, the mean scores of the first year students on the Self-Compassion Scale were significantly higher than those of the fourth year (table 1).

We found a statistically significant difference between the perceived economic level and all three scales (p < 0.05). Accordingly, the CDRISC score averages of those with more income than their expenses are significantly higher than those with equal and lesser income. In addition, those with more income than their expenses have a lower mean score on the Self-Handicapping Scale and a significantly higher mean score on the Self-Compassion Scale. No significant relationship was found between the maternal education status of the students and their mean scores on the SelfHandicapping and Self-Compassion scales. However, a statistically significant difference was found between maternal education status and the CD-RISC score (p < 0.05). Thus, while the mean scores of the students with mothers having a primary or secondary education level were significantly lower than those with mothers having a high school education level, their scale mean scores were significantly higher than those with mothers with a university education level.

When examining the relationship between the scales with the voluntary choice of profession and perceiving social support of the students participating in the research, we identified a statistically significant difference with all three scales (p < 0.05). Accordingly, the mean scores of the CDRISC and Self-Compassion Scale for students who voluntarily chose their profession and perceived social support were significantly higher than those of the other group. However, their mean scores on the Self-Handicapping Scale were significantly lower (table 1).

The results of the study revealed that the students had a high level of resilience with a mean of 63.91 ± 14.54 points on the CD-RISC scale, a high tendency to self-handicapping with a mean of 82.68 ± 11.32 points on the Self-handicapping Scale, and a high level of self-compassion with a mean of 13.92 ± 2.87 points on the Self-Compassion Scale. We identified a negative and significant relationship between CD-RISC scores and tenacity and personal competence, tolerance of negative effect, and tendency toward spiritual items (p < 0.05). Subsequently, we could argue that as the tenacity of students increases, their tendency to self-handicap decreases.

We found a positive correlation between the mean score of the CD-RISC and that of the Self-Compassion Scale and its sub-dimensions (p < 0.05) (table 2). Thus, we interpret that as the tenacity of students increases, their self-compassion also increases. Similarly, we observed a significant negative correlation between the mean scores of the Self-Handicapping and the Self-Compassion scales and its sub-dimensions of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification (p < 0.05). Considering this result, we could affirm that as the self-care of students increases, their tendency to self-handicap decreases (table 2).

Table 2
Relationships between scales and sub-dimensions

CD-RISC: Connor-Davidson Resilience Scale; SHS: Self-Handicapping Scale; r: Pearson correlation analysis *p < 0.05 **p < 0.001

As a result of the regression analysis evaluating the effects of the CDRISC scale and its sub-dimensions on self-handicapping, we found a statistically significant variance (p < 0.000), explained by two sub-dimensions (tenacity and personal competence with a tendency toward spirituality). When the CD-RISC sub-dimensions were considered together, their effect on the variance of the Self-Handicapping Scale scores was 22%. The regression analysis between the Self-Compassion Scale sub-dimensions on self-handicapping showed a statistically significant variance (p < 0.05), explained by five sub-dimensions (self-judgment, common humanity, isolation, mindfulness, and over-identification). When the Self-Compassion Scale sub-dimensions were considered together, their effect on the variance of the Self-Handicapping Scale scores was 36.9%. The variance explained by the CD-RISC and Self-Compassion Scale total scores regarding the Self-Handicapping Scale was statistically significant. According to the analysis, the effect of the CD-RISC and Self-Compassion Scale scores on the variance of the Self-Handicapping Scale scores was 30.2% (p = 0.000) (table 3).

Table 3
Multivariate regression analysis model for Self-Handicapping Scale

CD-RISC: Connor-Davidson Resilience Scale; SE: Standard error * p < 0.05 **p < 0.001 a R = 0.476, R2 = 0.227, Adjusted R2= 0.220, p = 0.000 b R = 0.616, R2 = 0.380, Adjusted R2= 0.369, p = 0.000 a R = 0.553, R2 = 0.305, Adjusted R2= 0.302, p = 0.000

Students need protective factors such as resilience and self-compassion to effectively cope with stressful situations, maintain logical awareness, and protect their physical and psychological health ^14,15. Studies conducted with nursing students have shown that these individuals often struggle to use effective coping strategies to face difficult circumstances ^6,14-16 and, in turn, may resort to self-handicapping behaviors ⁵. This study aimed to determine the relationship between resilience, self-handicapping strategies, and self-compassion levels in nursing students responsible for providing health care.

While no significant differences were found between the year of study and the CD-RISC scale, we identified a statistically significant difference between the Self-Handicapping and the Self-Compassion Scale. Some related studies reported that students’ mean scores on CD-RISC increase as they approach their senior year ^15,17. However, other reports support the findings of this study ^3,18, which found no significant relationship. Although no difference regarding resilience was determined between first- and fourth-year students, the decrease in mean CD-RISC scores revealed the need to review the current program curriculum and offer more psychological support to students.

When comparing the year of study with the mean scores on the SelfHandicapping Scale, we noted that the first-year students’ scores were significantly lower. In other studies, the authors stated that nursing education is more stressful for students than other health disciplines, particularly in the third and fourth years, when students’ stress levels are higher ^19,20. It is possible that the intensification of vocational course content and clinical practices, as students advance in the program, causes an increase in stress levels ^19,21,22. Unlike the results of this study, others reported no significant differences between the year of study and the Self-Handicapping Scale mean score ^16,20.

The comparison between the year of study of nursing students and their Self-Compassion Scale scores showed that the mean scores of first-year students were significantly higher than those of senior students. This finding is congruent with the work of Nazik and Arslan, who also examined the self-compassion of nursing students ²³. In the study conducted by Bulduk et al., with nursing students, since no fourth-year students were included in the evaluated population, the authors did not make a comparison for this year of study ¹⁴.

We observed that resilience and self-compassion were higher among nursing students with good economic status. Similar studies conducted with nursing students emphasized that perceived economic situation affects an individual’s psychological health ^21,24. In addition, we found that the Self-Handicapping Scale mean scores of the students with income exceeding their expenses were lower than those of students with income below their expenses. In contrast, other studies reported no significant differences between the income level perceived by the students and their selfhandicapping mean scores ^16,25.

According to this study’s findings, the CD-RISC and Self-Compassion Scale mean scores of the students who chose their profession voluntarily were significantly higher than those of the other group, and their SelfHandicapping Scale mean scores were significantly lower. Nursing encompasses the understanding of loving and helping people, requires resilience to stressful life events, and should be consciously selected ^3,21. In similar studies on this subject, the students dissatisfied with their career choice had high levels of self-handicapping ^16,26,27. Doing work with love and willingness increases the quality of the labor by enhancing self-esteem. People who love their professions may differ in their resilience and coping strategies when faced with difficulties ^5,28.

We found that the mean scores of the CD-RISC and Self-Compassion Scale were significantly higher in nursing students with perceived social support. However, their Self-Handicapping Scale mean scores were significantly lower than those of the other group. Some studies have shown that social support is a buffering factor for stress and positively affects a person’s physical and psychological health by reducing the effects of stress ^29,30. Likewise, we identified a strong and positive relationship between psychological resilience levels and perceived social support ^3,31. However, studies like the one of Şahin et al. (2017) did not find a relationship between the psychological resilience of nursing students and social support ¹⁵.

Regarding the Self-Compassion Scale, the mean scores of the nursing students with perceived social support were significantly higher than those of the other group. In the published literature, we did not find a study that examined the relationship between perceived social support, self-compassion, and self-handicapping. However, according to our observations, having high self-compassion enables nursing students to encourage themselves in a kind, loving, and patient manner when in painful and distressful emotional states. Since self-compassion affects some psychological variables, it is a concept that should be considered within the scope of nursing education.

We identified a significant difference between the mother’s education status of the participants and the CD-RISC scores. Some studies have stated that the education level of parents is an important factor in raising children and adolescents as individuals with strong resilience ³². In contrast, mothers with low education raise their children with strict discipline, negatively affecting their resilience ³³.

The relationship between the scales’ scores of the participating nursing students is supported by studies that reported moderate or high resilience and self-compassion ^15,27,34,35. Similar to reports in the literature, we found that the self-handicapping tendencies of students were also high ^6,16. A significant negative relationship was found between the Self-Handicapping Scale scores and the CD-RISC subdimensions of tenacity and personal competence, tolerance of negative affect, and tendency towards spiritual items. These results suggest that as the level of resilience increases, the tendency of self-handicapping decreases among the students. During undergraduate education, nursing students encounter many stressors related to the academic and clinical environments ^4,19,21. Some individuals can use effective coping strategies to protect themselves and gain psychological strength by turning difficult situations into opportunities ^4,6. However, some cannot cope with such events effectively and may self-handicap to legitimize their failure when facing stressful events ⁶.

A positive and significant correlation was found between the mean scores of the participating students on the CD-RISC and Self-Compassion Scale and its sub-dimensions. According to the results, as the resilience of the students increases, their self-compassion also rises. This positive and significant relationship has been reported in other studies ^36-38. In conclusion, self-compassion is a protective factor that enhances resilience. In addition, when we examined the relationship between the scores of the Self-Handicapping and the Self-Compassion Scales, we found a significant negative correlation between them and some of their sub-dimensions. Considering this result, as students’ self-compassion increases, their tendency to self-handicapping decreases. Similarly, the literature review revealed that self-handicapping negatively correlates with self-compassion ²⁵.

We determined that psychological resilience and self-compassion explained 22 and 36.9% of the variance in self-handicapping among nursing students, respectively. The effect of both scales explained 30.2% of the variance. We observed that as psychological resilience and self-compassion increase among students, their self-handicapping behaviors decrease. A review of the literature indicated that high self-handicapping is related to a tendency to shame, low self-esteem, and low resilience ^25,26,39-41. In a similar study, Yildirim and Demir found that self-esteem explained 30% of the self-handicapping variance ²⁵. The inverse relationship between these two variables can be best explained by considering the motivation of selfhandicap or with low self-esteem individuals to protect themselves.

Our study results suggest that most predictor variables of the scales significantly contribute to explaining the self-handicap variable. Nurses are the most affected occupational group by work stress and burnout among health professionals. This status is due to stressors, such as working conditions, workload, multiple roles, collaborating with different disciplines, caring for many patients in a limited time, and making critical decisions ^4,42. Inexperienced nurses -new to the profession- are more affected than experienced nurses ^39,43. During their education, nursing students can cope with age-specific individual problems and stressors they face in the academic and clinical environment. Thus, nursing students should be strongly supported in all aspects to prepare them for the profession.

Since the study was conducted in a single province, the results cannot be generalized to all nursing students. The small number of students included is another limitation of this study.

Psychological resilience and self-compassion are qualities that nurses should have when helping people with health problems. By increasing the psychological resilience and self-compassion levels of nursing students -who will work as health care professionals-, they can ensure better quality care by strengthening effective coping skills. Based on the results of this research, we consider important to include topics in the curriculum involving effective coping methods to enhance psychological resilience and self-compassion.

People with high self-compassion accept positive and negative feedback because they feel less threatened by the assessments of themselves ⁸. However, self-handicapped people perceive negative feedback as a threat and avoid facing their failures to protect themselves; they even may attribute those situations to others. In this context, considering the psychological needs of nursing students can help them increase their self-compassion, preventing them from externalizing their failures. Additionally, we suggest creating various programs and intervention studies that could contribute to more compassionate and flexible behaviors toward healthcare providers and others.

The authors thank the nursing students included in this study.