Introduction Many studies have shown the psychological relationship of

 

Introduction

            The purpose of this concept analysis
is to study the term resilience.  Research
on resilience has increased dramatically over the last two decades and is
beginning to show the relationship on the impact on health and quality of life
(Windle, 2010).  The definitions of
resilience have been similar throughout the years.  These definitions have all included aspects
of positive adaptation, rebounding, or coping in the face of severe stress.  The following analysis will discover the
meaning of resilience within the nursing profession.  This concept analysis will also include
defining attributes, case scenarios, and a review of the antecedent and
consequences of the concept.  The concept
will be defined using dictionaries and literature both found within and outside
of the nursing field.    

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Definition

            Through the years, scientists,
psychologists, and health care professionals have used the term resilience. In
regards to nursing, the term resilience can be used when caring or people who
are facing physical and psychosocial adversities.  However, the term resilience originates from
the mid 17th century.  The Latin
origin ‘resilire’, which was later seen as ‘resilient’ means to leap back.  The noun, ‘resilience’, is derived from the
adjective ‘resilient’, which has two definitions: (1) (of substance or object)
able to recoil or spring back into shape after bending, stretching, or being
compressed, (2) (of a  person) able to
withstand or recover quickly from difficult conditions (Etymology dictionary
online, 2001).

 

Review
of Literature In Nursing and Other Disciplines

One of the definitions that is most
commonly associated with resilience is the ability to bend but not break, bounce
back, and possibly even grow in the face of adverse life experiences
(Southwick, Bonanno, Masten, Panter-Brick, & Yehuda, 2014).  The American Psychological Association (2014)
defines resilience as “the process of adapting well in the face of adversity,
trauma, tragedy, threats or even significant sources of stress”.  Many studies have shown the psychological
relationship of positive emotions and psychological resilience.

The idea of resilience has been studied
in the discipline of psychology. 
Psychological distress can be defined as a state of emotional suffering,
with the symptoms of anxiety and depression (Harker, Pidgeon, Klaassen, &
King, 2016).  Harker, Pidgeon, Klaassen
and King (2016), examined human service professionals and how this industry is
overloaded with employment-related stressors and emotionally demanding
interactions on a daily basis.  They
believed that building and sustaining resilience can buffer the impact of these
occupational stressors (Harker, Pidgeon, Klaassen, & King, 2016).  

The aim of the authors’ research was to
“improve understanding of the relationship between resilience, mindfulness,
burnout, secondary traumatic stress, and psychological distress among human
service professionals” (Harker, Pidgeon, Klaassen, & King, 2016).  The author’s hypothesized that high levels of
mindfulness and resilience would significantly lower the levels of burnout,
secondary traumatic stress, and psychological distress (Harker, Pidgeon,
Klaassen, & King, 2016).  The way the
authors’ measured the levels of a person’s psychological distress, burnout,
mindfulness, and resilience was using many different questionnaires.  The questionnaire used to measure resilience
was The Resilience Factor Inventory (RFI), which is a 60-item scale measuring a
person’s current mental level of resilience (Harker, Pidgeon, Klaassen, &
King, 2016).  The results confirmed the
authors’ hypothesis.  The authors’ found
that psychological distress, burnout, and secondary traumatic stress were
negatively related to resilience and that resilience and mindfulness were
positively realted (Harker, Pidgeon, Klaassen, & King, 2016).

These results are important in any
medical field because the higher levels of resilience a person has, the less
likely a medical professional will feel burnout, work fatigue, or stress
related to work.  These results show the
importance of a health care professional developing resilience and how many
hospitals, urgent care settings, psychologists, physical therapists should
implement and cultivate the idea of resilience in their work. 

Within the healthcare and nursing
setting, the term resilience can be used to describe many of the healthcare
workers.  Health care professionals have
high stress jobs that can lead to emotional and physical fatigue.  A study was conducted in 2014 to examine the
effects of interpersonal conflict and workload on job outcomes and examine if
resilience moderates the indirect effects of conflict and workload on job
outcomes.  The reason for this study was
to understand how resilience betters the negative effects of workplace
stressors.

A multimodal resilience-training program
was designed and implemented for a group of intensive care unit (ICU) nurses to
prove that resilience in nursing can be learned.  Highly resilient ICU nurses used positive
coping skills to address workplace stress and are able to continue working in
the ICU environment (Mealer et al. 2017). The objective of the study was to
gain data on mindfulness-based cognitive theapy resilience intervention for ICU
nurses to see if an intervention program is feasible (Mealer et al. 2017).  In order to prove this, focus groups were
held and interview questions assessed of mindfulness-based cognitive therapy to
reduce burnout syndrome in ICU nurses. 
The results of this study showed that there were limitations in finding
a resiliency program, however, if an institution can plan carefully, and the
nurses adhere to the program, then resilience can be learned and burnout
symptoms will decrease (Mealer et. Al 2017). 

This paper has discussed what makes a
person resilient, but what could make a whole culture resilient?  Dr. Panter-Brick, a biological and medical
anthropologist, defines resilience in a culture as “a process to harness
resources to sustain well-being” (Panter-Brick & Leckman, 2013).  To define this concept, she conducted
face-to-face interviews with over a thousand families in Afghanistan, a country
that is stricken with war.  In the Afghan
context, the word resilience primarily meant, “hope” (Southwick, Bonanno, Masten,
Panter-Brick, & Yehuda, 2014).  She
found that the Afghan families became resilient because of their ability to
hang on to the sense of hope.  This hope
or “meaning-making” is the essence of a cultural perspective on resilience
(Panter-Brick & Eggerman, 2012).  Dr.

Panter-Brick concluded that “What matters to individuals facing adversity is a
sense of ‘meaning-making’ – and what matters to resilience is a sense of hope
that does indeed make sense, despite chaos, brutality, stress, worry, or
despair (Southwick, et al.).  In order
for a society to become resilient, we need to provide people with the resources
that facilitate their ability to create a better future.   

Defining
Attributes

            Defining attributes are a cluster of
information of attributes most frequently associated with the concept (Walker
& Avant, 2005).  According to
Scoloveno (2016), there are three attributes that distinguish the concept of
resilience from other concepts.  These
defining attributes are: (1) self-esteem, (2) self-reliance, and (3) social
responsiveness (Scoloveno, 2016).

Definition

            Through research and literature
reviews, the term resilience can be defined as a dynamic concept that describes
and individual, or groups of people to recover quickly from difficult
conditions, to grow in the face of adverse life experiences, and to be able to
hang on to the sense of hope.  A person
or group who is resilient may also use positive coping skills to address stress
or negative experiences.

Cases

Model Case

            A model case is defined as a
scenario or situation that includes attributes of a concept (Walker &
Avant, 2005).  The following case is an
example of a model case for the concept of resilience. 

            Judy is a 25-year-old female who
grew up in a dysfunctional family environment. 
She is the primary caregiver for her father, who is widowed, and her
brother who has downs syndrome.  Judy’s
mother died when she was 15-years-old from Multiple Sclerosis (MS). Judy had
all of these responsibilities before getting married.  Judy had the support of her Aunt Maria, who
would come over to help clean, make dinner, and take her brother or father to
doctor’s appointments. 

            Judy is typically very social and
active.  She played sports in high school
and college.  Her friends would comment
on how Judy social, caring, and positive individual.  One day, Judy woke up and she suddenly
notices her left leg is dragging.  This
was alarming because not only is Judy is left-side dominant, but she is also
worried that it could be MS because of her familial history.  Judy’s husband brings her to the emergency
department where she is later diagnosed with a thrombolytic stroke. 

            Judy begins experiencing more
left-sided weakness, but is still able to talk and communicate
effectively.  She is happy because she is
still able to utilize her laughter and humor in such a difficult time, and this
is her primary coping mechanism.  She
remains very positive with family, friends, doctors, and nurses.  She is able to overcome her fear of needles
and undergo many tests to determine the cause of the stroke. 

            During Judy’s recovery process, Aunt
Maria offered for Judy and her husband to stay with her for a period of
time.  Since Judy is so positive, she
replied, “We won’t have to stay long.  I
fully intend on going to physical therapy and doing what I have to do to get
well.  I can control my outcome.”  When the nurses asked Judy how she is able to
remain so positive Judy replied, “I rely on my support systems.  I have also been through other crises in my
life and have been able to bounce back from them all.  I am very independent and will continue to
work through any adversity that comes my way.” 
Over the next year, Judy worked with the physical therapy staff to make
a full recovery from the stroke.  She now
takes blood thinners to prevent any further strokes, has continued to remain
active and social, and is now a new mother. 

            In this case, Judy is able to see
past the current negative situation life has thrown at her.  Judy is a young woman to have a stroke.  A person who is not resilient may change
their life views and think of this as something negative.  Judy truly encompasses the meaning of
“resilience” and is able to “bounce back” and overcome the thrombolytic stroke
and she is now flourishing in accomplishments. 
This is a model case of resilience. 

Borderline Case

            A borderline case, as defined by
Walker and Avant (2005), is a case that includes some of the defining
attributes, but not all of them.  A
borderline case my contain most of the attributes but differ significantly in a
length of time, intensity, or occurrence. 
The following is an example of a borderline case of the concept of
resilience. 

            Carmen is a 30-year-old Hispanic
female who has a 5-year-old daughter. 
Carmen and her daughter were recently rehoused after living in a
homeless shelter for several months. 
Carmen is currently eight months pregnant and has another 2-year-old son
who lives with the boy’s parents since she is homeless.  This is her second time being homeless in
less than a year.  Both episodes of
homelessness occurred after her friend, who she was financially dependent on,
was unable to support herself and her children anymore. 

            When Carmen moved to Atlanta, she
was initially highly motivated to find new housing for her family, but did not
realize how much worked needed to be done to find the financial help
needed.  She relied on other people to
give her this information instead of trying to find it herself.  Carmen eventually achieved her goal of
finding housing and was reunited with her 2-year-old son.  However, she did not have any long-term plans
of how she was going to maintain this stable housing, and she is not currently
seeking employment.  She is currently
living day-by-day. 

            Carmen’s case is a borderline case
of resilience.  Carmen only was able to
overcome her situation when she was faced with the reality of being separated
from one child, and the fact that she, and her daughter, were living in a
homeless shelter.  She only acted upon
the steps necessary to get her into the rehousing process.  Once she was able to find a house, she has
not done any planning for her future to fully remedy the cause of her
homelessness.  Carmen has not overcome
the risk for future episodes of homelessness. 

Related Case

            A related case is a case that is
related to the concept, but does not contain the defining attributes (Walker
& Avant, 2005).  The following is an
example of a related case of the concept of resilience. 

            Ron’s childhood was a little
different than most.  Ron grew up in an
unstable environment.  His mother
suffered from bipolar disease, but she never took her medications, and she
experienced more mania than depression. 
She would frequently show up to Ron’s functions in wild attire and often
have grand, outrageous ideas.  His father
was a somewhat functioning alcoholic, non-abusive towards Ron, but drank to
escape reality.  Ron’s family’s financial
stability was a roller coaster.  They
experienced many ups and downs.  At
times, they were able to live very lavishly when Ron’s father’s business was
flourishing, and other times, they had cars repossessed in their front
yard. 

            Ron attended a private boarding
school for high school.  Every semester,
he never knew if he would be asked to leave the school due to nonpayment of
tuition.  He was social and had many
friendships but was never really confident in himself.  Ron began drinking at boarding school and
continued to drink until he finished college. 
He graduated and wanted to become a lawyer.  He was able to finish law school in three
years, despite the drinking and the enormous amounts of financial debt he was
in. 

            Ron was able to pass the bar on his
first try, but was never able to hold a steady job as an attorney.  At the age of 35, Ron’s power would
frequently be shut down, he would have cars repossessed, or even get evicted
from apartments.  Despite these setbacks,
Ron was always able to get back on his feet. 
Ron believed he was a good attorney and had come a long way.  He lived his life the way he wanted to, with
no regrets.  

            Ron’s case is an example of a
related case because Ron was able to accomplish many things in his life.  Despite all the accomplishments, his life was
filled with constant setbacks, which he was never able to grow and learn from
these setbacks.  Ron just drifted through
his life, with all of his struggles, and never did anything to truly change the
root of the difficulties.  Ron continued
to lose jobs, drink, and not pay bills. 
If Ron was truly resilient, he would have made the necessary changes to
better his lifestyle, not continue to glide through life.  This is why Ron’s case is considered related
to resilience. 

Contrary Case

            A contrary case is a case that is
the opposite of the concept (Walker & Avant, 2005).  The following case represents a contrary case
of the concept of resilience. 

            Paula is a 37-year-old female who
has been married since the age of 19. 
Her husband is older, abusive, and dominating.  Although Paula never wanted this life for
herself, she was use to the abuse.  Her
mother was very abusive towards her and her stepfather was an alcoholic.  Paula never went to college because she never
believed that she could succeed.  She
worked as a secretary until she married her husband, and then quit her job to
take care of him.  Over the course of
their marriage, Paula had three children. 
Paula did not have many friends, spoke very little to her own parents,
and never truly bonded with her children. 
Paula turned out to be just as abusive to her children and her mother
was to her. 

            Paula decided she had enough of this
life and took her money and left her husband and children.  She had the belief that she could begin
working as a secretary again, but she always called out sick, was not very good
at her job, and did not like associating with people.  She found herself with little money, in a
single bedroom apartment, and living day-by-day.

            Paula met a new man, and they were
married three months later.  He was not
abusive, but did not speak much to Paula. 
Paula spent the entire marriage feeling isolated and miserable.  She never did anything to become
self-sufficient or to improve herself. 
Her husband died of a heart attack and only left her with the mortgage.  She was forced to sell the house, to go rent
an apartment, and to begin looking for a job again.  Paula attempted to reach out to her children,
but none of them would help her.  A
couple of years later, Paula died of lung cancer after smoking for almost 40
years. 

            This final case suggests an absence
of the attributes of overcoming, or resilience. 
Paula saw that she was in unfortunate situations, but was not able to
acknowledge the potential of better circumstances.   

Antecedent

            An
antecedent is an event that occurs before the occurrence of the concept (Walker
& Avant, 2005).  An antecedent from
the literature related to resilience is an experience or the risk of hardship
that may carry a significant threat for the development of something negative
(Windle, 2010).  Some examples of
significant threats or hardships would be stress, a serious diagnosis, poverty,
ill health, and bereavement. 
Vanderbilt-Adriance & Shaw (2008), caution that not all risks are
equivalent in severity; some may be acute, some may be chronic. This makes any
findings of resilience can only be considered within the context of the
specific hardship (Vanderbilt-Adriance & Shaw, 2008). 

Consequences

            Consequences are events or incidents
that emerge as a result of the occurrences of the concept (Walker & Avant,
2005).  Consequences are the end-points
that happen as a result of the antecedents. 
Looking at the previously used definitions of resilience, the outcome of
resilience should show the maintenance of development or functioning at a
normal, or greater than expected, level of development or functioning, given the
exposure to the hardship (Windle, 2010). 
An individual who has hardship and views it as a challenge, rather than
something to be feared, become more confident in their ability to mediate their
hardship.  Scoloveno identified four
consequences of resilience as psychological and physical integration, the
development of personal control, psychological adjustment and personal growth
(Scoloveno, 2016).  In the literature
researched in this concept analysis, consequences were seen as a decrease in
the feeling of being burnt out in a health care field, an increase in the
feeling of mindfulness, and an overwhelming feeling of hope in times of
despair. 

Empirical
Referents

            According to Walker & Avant
(2005), empirical referents are “classes or categories of actual phenomena that
by their existence or presence demonstrate the occurrence of the concept
itself” (Walker & Avant, 2005). 
There are multiple different self-rating scales that have been developed
and used in different populations such as: children, adolescents, adults, and
older adults (Garcia-Dia, DiNapoli, Garcia-Ona, Jakubowski, & O’Flaherty,
2013).  In their review, they found that
the Connor-Davidson Resilience Scale, the Resilience Scale for Adults, and the
Brief Resilience Scale received the best psychometric ratings (Garcia-Dia,
DiNapoli, Garcia-Ona, Jakubowski, & O’Flaherty, 2013). 

The Connor-Davidson Resilience Scale is
used with clinical and non-clinical populations to measure resilience using a
25-item scale.  Some of the examples of
the items on the scale are: able to adapt to change, can deal with whatever
comes, coping with stress, and pride in your achievements (Connor, &
Davidson, 2003).  The Resilience Scale
for Aduls measures five factors: personal competence, social competence, family
coherence, social support and personal structor (Garcia-Dia, DiNapoli,
Garcia-Ona, Jakubowski, & O’Flaherty, 2013).  And the Brief Resilience Scale is a four-item
rating scale.  This measures personal
coping resources, pain coping behavior, and psychological well-being
(Garcia-Dia, DiNapoli, Garcia-Ona, Jakubowski, & O’Flaherty, 2013). 

Conclusion

            The purpose of this analysis was to
take a further look into the concept of resilience, to determine what it means
to be resilient, and that the concept of resiliency may not be seen in every
person.  When a person has become
resilient, exposure to hardships, adversity, and risks may bot result in a poor
outcome.  Richardson states that,
“Resilience may be the driving force that controls the universe” but the opportunity
of positive adaptation to life’s hardships can be an option for everyone
(Windle, 2010).  

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