The focus of this scoping review relates to the influence of self-compassion upon midwives and nurses, and how this concept may assist midwives and nurses to remain healthy. According to the World Health Organization (WHO) [1], health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Therefore, health describes more than the mere integrity of the physical body [1]. Physical health and mental health are fundamentally connected and profoundly affect each other [2]. The WHO [3] specifically defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” More recently, Galderisi et al [4] has related mental health to social values and roles:

Self-compassion is a concept of Buddhist philosophy in which a person has the ability to treat oneself with kindness, warmth, and acceptance in times of need [5,6]. Neff [5] and Heffernan et al [7] have described self-compassion as turning compassion inward, and being kind to yourself, and to acknowledge your own humanity, imperfection, and fragility. Neff [5] defined self-compassion as: “being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness.”

Three interconnected components have been defined that determine self-compassionate reactions to personal negative emotions and experiences [5,8]: self-kindness versus self-judgment, sense of common humanity versus isolation, and mindfulness versus overidentification. Self-kindness describes an understanding behavior toward oneself in the face of suffering. Common humanity describes the recognition that life stresses and experiences are shared human experiences, rather than an interpretation that they are separate from those of others. Mindfulness describes the balanced awareness of negative thoughts and feelings rather than their overidentification. These individual components are assumed to interact to generate a self-compassionate frame of mind [9]. It has been reported that self-compassion and mindfulness can improve health care professionals’ mental health [10,11] by enhancing optimism [12,13], happiness [14], and by looking at problems from a larger perspective [15].

Understanding and increasing self-compassion in health care professionals continues to be an important yet underrepresented area of research. High rates of work-related stress and burnout in health care professionals [16] can lead to depression, anxiety, sleep disturbances, and fatigue [17]. It has been highlighted that when a person has the ability to have self-compassion, they are more inclined to have good interpersonal relationships and experience a greater sense of happiness when compared to a person who has an impairment in self compassion [18]. Adversely, a lack of self-compassion is associated with psychological distress [19].

Previous studies have suggested that the overall well-being of health care professionals has been influenced by self-compassion [20] by involving self-care behaviors such as allocating time for good nutrition [21], regular outdoor activities and exercise [20-22], and relaxation and spirituality activities [20,21,23]. Importantly, happiness levels can be improved through self-compassion and the use of adaptive behavioral and cognitive tasks [18,24].

Stressors such as a demanding clinical workload, high acuity, missing breaks, working more than their contracted hours, and insufficient resources and staff can lead to midwives and nurses feeling physically and mentally exhausted in the long term [20]. Midwives dealing with pregnant women experiencing stillbirth [25], and oncology nurses looking after patients who are in severe pain, distress, and approaching death [26] are examples of experiences that may lead to negative psychological outcomes. These factors and experiences can have a negative impact on the care given by these midwives and nurses [7].

However, it has been reported that high levels of self-compassion can positively increase overall health and psychological well-being [27-29], whereas low levels of self-compassion are associated with anxiety, stress, and depression [5]. Therefore, self-compassion may act as a protective factor, and help midwives and nurses to remain mentally and physically healthy.

Enhancing self-compassion as a focus of mindfulness education or training has been shown to increase compassionate self-care in health professionals [6,30]. Self-compassion education or training has been recommended for health professionals to help them cope with daily anxiety and stress while providing care, and increasing awareness of the benefits of self-compassion [14]. Therefore, this scoping review will search the literature investigating or exploring the influence of self-compassion for midwives and nurses. It is anticipated that the findings will inform educational needs with implications for self-compassion in clinical practice.

The initial aim of this scoping review was to identify the influencing factors of self-compassion on midwives. After an initial search, only three studies were found that reported on the influence of self-compassion for midwives [20,31,32]. The published literature appears to have focused mostly on nurses, with a distinct global gap in evidence investigating the influence of self-compassion among midwives. Due to a lack of research studies on midwives, the aim of this scoping review was expanded to include nurses.

The aim of this review is to scope all forms of contemporary literature to determine if there is evidence of self-compassion influencing the health of midwives and nurses. The review objectives are to identify studies that have either investigated or explored factors that influence midwives’ and nurses’ self-compassion, and map factors that positively or negatively impact their health. The review will also identify studies that have directly evaluated education or training programs that focus on self-compassion for midwives and nurses.

A scoping review was considered the most appropriate design to address the objectives of this review for several reasons. First, the aim and objectives of this review are broad, and unlike a systematic review or meta-analysis, this scoping review is not trying to answer a specific question but rather to “examine the extent, range, and nature of a research activity” [33]. Second, a scoping review is rigorous, and requires implementation of a comprehensive and systematic approach to searching for relevant literature. Undertaking a scoping review is considered the most appropriate approach to gather evidence from studies using a variety of methodologies, or where there are no reviews being undertaken on the specific topic [34].

This scoping review will primarily use the method established by Arksey and O’Malley [35], incorporating improvements suggested by Levac et al [33] and Peters et al [36], and the adjustments made by Tricco et al [37]. Methodological stages include (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. Adding two stages, (6) consultation and (7) disseminating the knowledge [33,37], will assist in contextualizing all of the methodological stages utilized to undertake this review. Reporting will be conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines [37]. The population, concept, and context (PCC) mnemonic will be used to develop the research questions and search strategy for this scoping review [37].

All references from the initial main search will be exported to Covidence (a web-based source selection tool) for eliminating duplicates, screening of titles and abstracts, and full-text reviews. After excluding duplicates, two reviewers will screen the title and abstract for each of the papers according to the proposed eligibility criteria. To refine the web-based source selection tool, pilot testing of a random sample of 25 titles/abstracts will be undertaken by the authors. Any discrepancies will be discussed and modifications will be made [42]. The full-text version of potential suitable papers will then be read and screened by two reviewers against the inclusion/exclusion criteria. A separate appendix will be submitted for excluded sources and the reasons for exclusion will be stated using Covidence [41]. Consensus will be reached by agreement.

If there are any cases of disagreement between the two reviewers, which cannot be resolved through discussion, a third independent reviewer will be asked to assess the paper(s) in question and consensus will be reached by agreement. The selection process will be reported using a PRISMA-ScR flow diagram [37].

Data charting will be used for extracting data from included studies in scoping reviews [33,35,36]. A standardized data extraction spreadsheet template will be developed using Microsoft Excel to extract data from all papers meeting the inclusion criteria. Data will be charted by one reviewer and checked by another reviewer. Any discrepancies will be resolved by consensus of the research team. Pilot testing of 5-10 full-text articles for data charting will be undertaken to ensure that key information is extracted completely [42]. Data extraction will be an iterative process, incorporating an initial trial of data charting and team consultation throughout the process to ensure consistency with the review purpose and questions, and to include new questions that may arise during the process. Regular communication between reviewers will facilitate this process and ensure the reliability of data charting. This approach will be based on providing the data necessary for addressing the main objective of this review; that is, to identify factors that influence midwives’ and nurses’ self-compassion, and map factors that positively or negatively impact their health. At present, these categories include (but are not limited to): bibliographic information of the study, study aims, research design, setting/context, number of participants, measure(s) used to assess the influential factors of self-compassion, self-compassion education or training (if applicable), analyses conducted, results of statistical analyses, and summary of findings. Furthermore, the authors of this scoping review will provide their own interpretations regarding conclusions, strengths, limitations, and recommendations of included studies. A draft of the data extraction tool is presented in Table 2. This draft will be modified and revised as necessary during the process of extracting data from each included study.

The purpose of this scoping review is to collate research findings and present an overview of all material reviewed, rather than a systematic synthesis of evidence that provides results on a narrowly defined question. Stage 5 of the review will be completed in three steps: analyzing (collating and summarizing) the data, reporting results, and applying meaning to the results.

The first step will involve analyzing quantitative data, and the results of individual studies will be analyzed and tabulated. Any qualitative data will be analyzed thematically and reported either narratively or tabulated. Additionally, further narrative description of all results will be provided to aid interpretation of the findings as they relate to the research questions. The tables will report on distribution of studies by type, year of publication, country of origin, research methods, all utilized scales, factors associated with self-compassion, and findings.

For reporting results, a narrative summary, represented by categories, will describe how the results relate to the review aim and objectives. The results will be classified in main conceptual categories that will be obtained during the results extraction. Specific factors that influenced completeness and usefulness will be grouped by domain, and the final list of factors will be determined and agreed on by all reviewers. The final synthesis of the reviewed literature will be presented in tables, graphs, or charts, complemented by a narrative description.

The final step will apply meaning to the results, and a narrative descriptive approach will be used to highlight gaps in existing research evidence, and consider the implications of findings within the broader context such as research, policy, and practice.

The consultation stage will be used to add methodological rigor, and to ensure applicability and usability of the results [33]. To reach this goal, the reviewers will share preliminary findings from stage 5 (collating, summarizing, and reporting results) with an independent self-compassion researcher/author and a midwife or a nurse to validate the findings. The feedback will be taken into consideration and integrated within the overall review findings.

According to the framework suggested by Levac et al [33] and Tricco et al [37], we consider it important to make the content of this scoping review available to key stakeholders (ie, midwives and nurses), with the goal of increasing awareness of the findings and facilitate evidence-informed decision making. Following the scoping review, the reviewers will disseminate the findings several ways by authoring a journal publication, an editorial conference presentation, and a written summary report for professional midwifery and nursing organizations and social media outlets.