Enhancing Nurse Well-Being: The Role of Self-Compassion in Flourishing

This study explores the relationship between self-compassion and flourishing among nursing staff at RSUD Salatiga. Utilizing a quantitative correlational design, data were collected from 131 nurses through purposive sampling and analyzed using Pearson's Product Moment Correlation. The self-compassion and flourishing variables were measured using the Self Compassion Scale Short Form (SCS-SF) and PERMA profiler, respectively. Results indicated a significant positive correlation (r = 0.266, p = 0.002), with self-compassion contributing 7.1% to the variance in flourishing. Descriptive statistics revealed that 33.6% of participants had high self-compassion, and 62.6% had very high flourishing. Most participants were women (80.2%) and adults aged 20-40 years (56.5%), groups typically associated with higher flourishing levels. The findings underscore the importance of self-compassion in enhancing nurses' well-being, supporting previous research on its role in emotional regulation, stress reduction, and overall mental health. Despite administrative challenges, this study offers valuable insights into promoting self-compassion to improve the quality of patient care in healthcare settings.


INTRODUCTION
Nursing staff are a crucial part of the medical workforce in hospitals, providing care and nursing services to patients.According to the International Council of Nurses (ICN), nurses are individuals with formal education in nursing who are licensed to practice nursing and have moral and ethical responsibilities to provide comprehensive and empathetic care to patients.The Indonesian Nursing Law, as stated in the Republic of Indonesia Law No. 26 of 2019, outlines the roles of nurses which include performing nursing actions, coordinating medical teams regarding patient care, documentation and reporting, providing health education, handling emergencies and additional support, maintaining patient safety standards, and providing emotional support to patients and their families.Despite their significant role in healthcare, nursing staff often face heavy workloads that can negatively impact their mental well-being.The challenges faced by nurses include difficulties in separating from family, concerns about disease transmission, feelings of failure in saving patients, and neglecting their own mental well-being as social workers (Siswadi et al., 2021).Another study also confirms that nurses experience higher levels of stress compared to other medical professionals (Safitri & Astutik, 2019).Nursing tasks are perceived as tiring, monotonous, boring processes, and mentally draining work demands when dealing with patients and their families, creating their own stressors (Hardiyanti & Permana, 2019).
A survey by the Indonesian National Nurses Association (PPNI) in 2023 found that 76.1% of Indonesian nurses experience work-related stress, and 36.7% to 71.6% of Indonesian nursing students also experience it, whereas the stress level among Slovakian nurses is 75.9% (Nurcahyo & Valentina, 2023).The high level of stress experienced by nurses affects their overall well-being, reflecting low levels of flourishing (Nurcahyanto & Rosa, 2022).Indicators of low flourishing among nurses include a lack of positive emotional expression, a lack of meaning in life, and low work performance (Rosa, Fauzan, & Suwarno, 2023).Flourishing has been described as the highest level of well-being for nurses in their work and life challenges (Tessy, Setiasih, & Nanik, 2022).
Flourishing, derived from the Latin word "flor" meaning flower or blooming, generally refers to the development of an individual's potential in various aspects such as spirituality, selfdevelopment, economy, and others, considered successful in achieving significant contributions to their family, work, and community (A'yuninnisa, Carminati, & Wilderom, 2023;Afiatin, Subandi, & Reginasari, 2023).It is also defined as the highest level of well-being achieved by having a purpose in life, self-mastery, acceptance of one's potential, and realizing one's potential for goodness (Edwina, Setyana, & Sembiring, 2022).Flourishing is achieved when individuals fulfill the five pillars of the PERMA scale (Seligman, 2018).The aspects of flourishing are known as PERMA (Positive emotion, Engagement, Relationship, Meaning, and Accomplishment or Achievement) (Seligman, 2018).Positive emotion plays a crucial role in well-being, including the implementation of positive emotions.Engagement involves full involvement or attachment of individuals to enjoy and focus on what they are doing in their personal or professional lives.Relationship refers to interactions between individuals in their social environment to meet needs, achieve meaningful lives, and strive for personal and mutual well-being.Meaning involves the individual's value of their life, making it something considered important, desirable, and meaningful, leading to well-being and happiness when achieved (Naehrig et al., 2021).Lastly, accomplishment or achievement is the reward or achievement individuals want to attain through their efforts to meet life goals.Factors influencing flourishing are divided into internal factors, external factors, and socio-demographic factors (Seligman, 2018).Internal factors include personality and life experiences.Studies show that internal personality factors such as patience, interest, tolerance for frustration, and college experiences play a significant role in students expressing their flourishing through academic website interactions (Widyaningrum & Yudhawati, 2023).External factors that influence flourishing include social support, such as the quality of social relationships, which fosters positive perceptions of oneself and the community.Studies indicate that poor college environments can reduce flourishing (Fajriati & Mangundjaya, 2023).Socio-demographic factors include gender, age, education level, and income, which also affect an individual's level of flourishing.Research indicates that sufficient income enables the use of social media, which can negatively impact flourishing if not used properly (Hamid, Rashid, Ishak, & Wulan, 2022).Additionally, studies emphasize the importance of social support in measuring the level of flourishing (Yudha & Urbayatun, 2020).Besides these explanations, flourishing is also influenced by self-compassion.Research indicates that higher levels of self-compassion correlate with higher levels of flourishing among healthcare workers (Njotowibowo & Engry, 2023) and students with higher self-compassion tend to experience higher levels of personal growth or flourishing (Zulfa & Prastuti, 2020).
Self-compassion is a behavior of self-appreciation and deep understanding of the difficulties individuals face without blaming or judging themselves, including aspects of self-kindness, common-humanity, and mindfulness, enabling individuals to overcome stress, maintain mental health, and achieve optimal well-being (Neff, 2017).The aspects of self-compassion include selfkindness, common-humanity, and mindfulness.Self-kindness relates to being kind to oneself in the context of happiness without overly criticizing one's suffering, failures, and shortcomings.Common-humanity involves viewing life's difficulties as normal human experiences.Mindfulness means having full awareness to not exaggerate negative aspects of one's experiences and focus more on positive aspects.Previous studies show a positive relationship between self-compassion and flourishing.This relationship is demonstrated indirectly through aspects of flourishing and self-compassion.First, possessing self-kindness (an aspect of self-compassion) has been proven to increase positive emotions (an aspect of flourishing), such as experiencing pleasant life experiences and rarely feeling depressed.Studies indicate that students and single women with high levels of self-kindness have lower depressive symptoms despite feeling lonely (Ausie & Poerwandari, 2021;Meini, & Suryadi, 2024).Additionally, individuals with higher levels of selfkindness tend to experience lower negative impacts of perfectionism on anger, aggression, and hostility (Abdollahi et al., 2022).Consistently, the ability to cultivate self-compassion can protect undergraduate students from academic burnout or depression (Farisandy et al., 2023).Selfcompassion also mediates the relationship between positive affect and gratitude levels in students (Septania, Saputra, & Sulastri, 2020).
Several previous studies also reveal the effectiveness of the Positive Mindfulness Program (PMP)-Part of Self-Compassion Treatment in reducing work burnout, preventing depression, and increasing flourishing in company employees (Fourianalistyawati, Uswatunnisa, & Chairunnisa, 2018;Krasner & Epstein, 2020;Zúñiga et al., 2021).Self-Compassion Therapy is also effective in reducing depression in diabetes mellitus patients (Harini, Sugiantara, & Candra, 2021).Through the Community Partnership Program (PKM) on self-compassion, female inmates also experienced improvements in their ability to provide emotional support to themselves and manage stress and psychological pressure (Widyastuty & Dewi, 2019).Among adolescents, the effectiveness of selfcompassion methods in regulating negative emotions was also observed (Hasmarlin & Hirmaningsih, 2019).Additionally, the effectiveness of self-compassion interventions was demonstrated in reducing fear of failure in early adults undergoing gap years (Isman, Nugroho, & Pratiwi, 2021).Art Therapy for HIV/AIDS patients aimed at enhancing self-compassion is also crucial for patients to have self-compassion (Madidar, 2021).The presence of self-compassion among psychology students is equally important for reducing emotional pressure through selfacceptance and commitment therapy (Gunawan & Oriz, 2022).However, contrary research suggests that flourishing training does not significantly positively impact self-compassion due to high negative affect and inconsistent scores on each aspect and situational factors related to the timing of research implementation among members of Ormawa University X Surabaya (Siagian, Septianeke, & Hartanti, 2022).Given these findings, self-compassion seems to play a crucial role in promoting flourishing.When individuals have high self-compassion, they tend to develop respect and appreciation for themselves even in difficult situations.They are more capable of dealing with mistakes, failures, or suffering with gentleness and understanding, rather than blaming or judging themselves.In this context, self-compassion helps reduce stress, anxiety, and depression, while increasing happiness, self-confidence, and motivation.Individuals with high self-compassion tend to achieve flourishing because they have a strong foundation in developing positive relationships with themselves and overcoming life's obstacles.However, research on the relationship between flourishing and self-compassion in Indonesia, particularly among nursing staff, is still limited.Therefore, this study aims to explore the significant relationship between flourishing and self-compassion among nursing staff.This research is also important in the context of nursing staff in Indonesia to enhance the understanding of good self-compassion abilities among nurses, which are considered capable of achieving flourishing and improving ideal and optimal patient care in hospitals.The results of this study are expected to contribute theoretically and provide new information on the importance of achieving flourishing among nursing staff at RSUD Salatiga.

METHOD
This study employs a quantitative research design with a correlational approach to examine the relationship between self-compassion and flourishing.The research variables include selfcompassion as the independent variable (X) and flourishing as the dependent variable (Y).Selfcompassion is defined as a behavior of self-appreciation and deep understanding of the difficulties individuals face without blaming or judging themselves, encompassing aspects of self-kindness, common humanity, and mindfulness.This was measured using the Self Compassion Scale Short Form (SCS-SF) by Neff (2017).Flourishing is described as a state reflecting growth, development, and positive achievements, measured using the PERMA profiler scale by Seligman (2018).
The population for this study comprised all nursing staff at RSUD Salatiga, totaling 238 individuals.Using Isaac and Michael's table for error rates of 10%, the sample size was determined to be around 125-127 individuals.After data collection, 131 nursing staff participated in this study, selected through purposive sampling based on criteria including having a minimum of two years of experience in health services.Data collection involved distributing questionnaires containing closed statements for each variable.The self-compassion scale consisted of the Self Compassion Scale-Short Form (SCS-SF) from Neff (2017), with 12 items and six Likert-scale response options, ranging from Strongly Agree (6) to Strongly Disagree (1).The scale's reliability coefficient was 0.929, indicating high reliability.The flourishing scale used was the PERMA-Profiler from Seligman (2018), consisting of 20 items with six Likert-scale response options, ranging from Strongly Agree (6) to Strongly Disagree (1).This scale also demonstrated high reliability with a coefficient of 0.872.A pilot test of the self-compassion scale resulted in 10 out of 12 items having good discrimination power, with items 2 and 5 failing the initial trial due to not meeting the corrected item-total correlation coefficient of r ≥ 0.30.The second trial confirmed no further items were dropped, and the scale showed good discrimination power for items 1, 3, 4, 6, 7, 8, 9, 10, 11, and 12 with an Alpha Cronbach reliability coefficient of 0.882.The flourishing scale had all 20 items passing the initial trial with good discrimination power (r ≥ 0.30) and an Alpha Cronbach reliability coefficient of 0.949.Data analysis involved classical assumption tests, including normality, linearity, and hypothesis testing.The normality test used the Kolmogorov-Smirnov Test, with a significance value (p>0.05) for normal data distribution.The linearity test used the Test for Linearity with a significance value (p<0.05)indicating linear data relationships.Hypothesis testing employed Pearson's Product Moment Correlation to verify the research hypothesis.Item selection and reliability analysis were conducted using SPSS 25 for Windows.

RESULT AND DISCUSSION Research Orientation and Data Collection
The research was conducted at Salatiga Regional General Hospital (RSUD Salatiga), a referral hospital owned by the Salatiga City Government, established in 1978.RSUD Salatiga provides healthcare services and serves as an educational center for the community.The hospital aims to improve the performance and welfare of its employees, including nursing staff, who are the focus of this study.The study aimed to assess the relationship between self-compassion and flourishing among the nurses.The data collection steps included identifying the research objectives, designing the study with a quantitative correlational approach, obtaining necessary permissions, determining the sample using purposive sampling, distributing questionnaires, and analyzing the data.To gather data, a Google Forms questionnaire link was distributed to the head nurses in several wards, including Wijaya Kusuma, Flamboyan, Anggrek, Hemodialysis, Poli, and Polek wards, from June 16-19, 2023.A total of 131 nurses participated.The reliability of the collected data was tested using corrected item-total correlation and Alpha Cronbach coefficients with SPSS 25 for Windows.Finally, the quantitative data interpretation and reporting were completed, and the research findings were shared with RSUD Salatiga and UKSW.The data collection faced several challenges, such as complex administrative processes and time constraints due to the busy schedules of the nurses.

Research Participants
The study population included all 238 nursing staff at RSUD Salatiga.Using Isaac and Michael's table with a 10% error rate, the sample size was determined to be around 125-127 participants.A total of 131 nurses participated, selected through purposive sampling based on criteria such as having at least two years of experience in healthcare services.

Descriptive Statistics
The categorization of variables used hypothetical scores with five categories: very low, low, medium, high, and very high.

Assumption Testing
The Kolmogorov-Smirnov test was used to assess normality, showing that both variables (self-compassion and flourishing) had normal distributions with significance values of 0.06 and 0.26, respectively (p > 0.05).Linearity was assessed using ANOVA, indicating a significant linear relationship between the variables with an F value of 9.837 and a significance value of 0.02 (p < 0.05).

Hypothesis Testing
Pearson's product-moment correlation showed a positive correlation between selfcompassion and flourishing with a correlation coefficient (r) of 0.266 and a significance value of 0.002 (p < 0.05).The coefficient of determination (R²) indicated that self-compassion accounted for 7.1% of the variance in flourishing.The hypothesis testing revealed a significant positive relationship between self-compassion and flourishing among the nursing staff at RSUD Salatiga.The correlation coefficient (r = 0.266) and significance value (p = 0.002) support the acceptance of Hypothesis 1 (H1), indicating that higher self-compassion is associated with higher flourishing.The study found that 33.6% of participants had high self-compassion, and 62.6% had very high flourishing.Conversely, 3.8% had very low self-compassion, and 0.8% had medium flourishing.Self-compassion contributed 7.1% to flourishing, with the remaining 92.9% influenced by other factors.According to Seligman (2018), flourishing is influenced by internal factors (personality and positive life experiences), external factors (social support), and socio-demographic factors (gender, age, education level, and income).Most participants were women (80.2%), who tend to have higher flourishing levels than men (Widyastuty & Dewi, 2019).Additionally, adult participants (20-40 years) comprised 56.5% of the sample, aligning with research indicating that emotional maturity and stability increase flourishing with age (Karmiyati & Wahyuningsih, 2019).
Self-compassion also plays a crucial role in promoting flourishing.Higher self-compassion levels are associated with better emotional regulation, reduced stress, anxiety, and depression, and increased happiness, self-confidence, and motivation (Njotowibowo & Engry, 2023).Effective interventions, such as Self-Compassion Therapy, have shown positive impacts on reducing depression and improving flourishing among healthcare workers (Harini, Sugiantara, & Candra, 2021).In conclusion, self-compassion significantly contributes to flourishing among nursing staff.High self-compassion helps individuals develop a positive relationship with themselves, face challenges with understanding and kindness, and achieve higher levels of flourishing.Despite the challenges faced during data collection, such as administrative processes and time constraints, the study provides valuable insights into the importance of self-compassion in enhancing the wellbeing of nursing staff at RSUD Salatiga.

Implications for Counseling and Guidance
The significant positive relationship between self-compassion and flourishing among nursing staff at RSUD Salatiga has important implications for counseling and guidance services within healthcare settings.Recognizing the role of self-compassion in enhancing overall wellbeing, counseling programs can be developed to specifically foster self-compassion among nurses.Firstly, counselors should incorporate self-compassion training into their regular sessions with healthcare workers.This can include techniques from Self-Compassion Therapy, which have been shown to reduce stress, anxiety, and depression while enhancing self-confidence and motivation (Harini, Sugiantara, & Candra, 2021).By teaching nurses how to be kinder and more understanding toward themselves, counselors can help them develop better emotional regulation and resilience.Secondly, it is essential to create a supportive work environment that encourages self-compassion.Counseling services should collaborate with hospital administration to promote a culture that values self-care and mutual support among staff.Workshops and seminars on selfcompassion can be organized regularly, and peer support groups can be established to provide ongoing encouragement and accountability.Thirdly, integrating self-compassion practices into daily routines can be beneficial.Counselors can guide nurses in mindfulness and relaxation exercises that promote self-awareness and self-kindness.These practices can be incorporated into brief breaks during shifts to help nurses manage stress and maintain emotional balance throughout the day.Additionally, counseling interventions should address external factors that influence flourishing, such as social support and work-life balance.Counselors can work with nurses to improve their social networks and strengthen relationships with colleagues, friends, and family.Ensuring that nurses have access to resources and support systems can significantly impact their overall well-being.Lastly, continuous evaluation and adaptation of counseling programs are crucial.Feedback from nursing staff should be regularly collected to assess the effectiveness of self-compassion interventions and identify areas for improvement.By tailoring programs to meet the specific needs of the staff, counseling services can more effectively promote flourishing and enhance the quality of care provided by the nursing team.By implementing these strategies, counseling and guidance services can play a pivotal role in improving the mental health and wellbeing of nursing staff, ultimately leading to better patient care and a more positive work environment at RSUD Salatiga.

CONCLUSION
This study found a significant positive relationship between self-compassion and flourishing among the nursing staff at RSUD Salatiga, with a correlation coefficient (r) of 0.266 and a significance value of 0.002.The research demonstrated that higher self-compassion is associated with higher flourishing, with self-compassion contributing 7.1% to the variance in flourishing, while the remaining 92.9% is influenced by other factors.The study highlighted that most participants were women and adults aged 20-40 years, groups that typically exhibit higher levels of flourishing.Effective interventions, such as Self-Compassion Therapy, have been shown to reduce depression and improve flourishing among healthcare workers.Despite facing challenges such as complex administrative processes and time constraints, the research provides valuable insights into the crucial role of self-compassion in enhancing the well-being of nursing staff, emphasizing its importance for developing positive self-relationships, emotional regulation, and overall mental health.

Table 1 .
Blueprint of Self-compassion Scale