Iran Journal of Nursing

Introduction
Patient care is the basis of the nursing profession, and the theoretical principles of nursing are based on understanding caring behaviors. These behaviors consist of two main components: instrumental and expressive. The instrumental component deals with physical and technical behaviors, while the expressive component is related to emotional and psychological behaviors. Despite the importance of caring behaviors, there is a big difference in their prioritization, which can affect patient care. Compassion is one of the aspects of patient care. Compassion for others, in any form, requires self-compassion, and there is a close connection between them. 
The outbreak of COVID-19, which began in China, was a threat to the global health. Nurses were in the front line of battle against COVID-19. In this regard, they were at high risk of contracting COVID-19 and had concerns about its transmission to others. Considering the importance of caring behaviors in nurses in the patient care during the COVID-19 pandemic, and the difference in the prioritization of caring behaviors by nurses in different countries, this study aims to determine the relationship between self-compassion and caring behaviors of nurses during the COVID-19 pandemic.

Methods
This cross-sectional study was conducted on 124 nurses working in selected hospitals affiliated to Iran University of Medical Sciences from March to May 2022. The samples were selected using a convenience sampling method. After giving full explanations related to the study objectives and obtaining informed consent from the participants, data collection was done using the demographic and occupational information form, Wolf’s caring behaviors inventory (CBI), and Neff’s self-compassion scale (SCS). Due to the COVID-19 pandemic, the questionnaires were prepared online using Google form. The questionnaires were completed by self-report method. The CBI has four subscales of assurance (8 items), knowledge and skills (5 items), respectfulness (6 items) and connectedness (5 items). The total score ranges from 24 to 96, with a higher score indicating higher caring behaviors. The SCS has 26 items and six domains of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification. The total score ranges from 26 to 130, with a higher score indicating higher self-compassion. To analyze data from SPSS software, vesion 22 was used. Mean and standard deviation were used to describe quantitative variables and frequency and percentage were used to describe qualitative variables. Kolmogorov-Smirnov test was used to determine the normality of data distribution. Spearman’s correlation test, Mann-Whitney U test and Kruskal-Wallis test were used to check the difference in the study variables. Linear regression analysis was used to determine the relationship between the main variables of the study.

Results
Most of the participants were female (79.8%) and married (68.5%), had a master’s degree in nursing (80.6%), were working a s nurse (63.7%), had age <30 years (50.8%), and had <10 years of work experience (70%). The mean total score of CBI was 82.06±7.76, which is a relatively high score. The highest score was related to the dimension of knowledge and skill. The mean total score of SCS was 79.47±12.73, which shows a moderate level of self-compassion. The highest score was related to the dimension of mindfulness. The results of the Spearman correlation test showed that the relationship between self-compassion and caring behavior was positive and significant (P<0.05). Also, the linear regression model showed a significant and direct linear relationship between the two variables. The findings showed that self-compassion score was significantly different based on marital status and gender (P<0.05). The mean score was higher in married nurses compared to singles and in females compared to males. Also, the caring behaviors score was significantly different based on work experience and job position (P<0.05). The score was higher in those with more than 15 years of work experience and in supervisors.

Conclusion 
The results showed a significant and direct relationship between self-compassion and caring behaviors of Iranian nurses during the COVID-19 pandemic, such that the higher self-compassion causes an increase in their caring behaviors. In fact, our results indicate that the self-compassion of nurses can improve the quality of patient care. Therefore, it is recommended to provide nurses with education about self-compassion and self-care skills to improve their caring behaviors.

Ethical Considerations
Compliance with ethical guidelines
This study received approval from the Ethics Committee of Tarbiat Modarres University (Code: IR.MODARES.REC.1400.346). Prior to the study, explanations about the study objectives and methods were given to the participants. They were assured of the confidentiality of their information. They all signed an informed consent form.

Funding
This article was extracted from the master’s thesis of Amene Shirvani in community health nursing, funded by Tarbiat Modarres University.

Authors' contributions
All authors contributed to conceptualization and design, methodology, data collection and analysis, initial draft prepation, and final approval. Amene Shirvani and Anoshirvan Kazemnejad contributed to study supervision. 

Conflict of interest
The authors declare no conflict of interesting.

Acknowledgments
The authors would like to thank the participants and the Tarbiat Modarres University for their cooperation and support.


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