Concept Analysis: Resilience
Resilience: A Concept Analysis The concept resilience has been the interest of many disciplines over the years, and is utilized by all people at some point in their lives. Concepts are building blocks that construct theories. A concept analysis will clarify the meaning, theoretical and operational definitions of the concept, for use in theory or research (Walker & Avant, 2011). The research on resiliency has increased and today, policy and practice stakeholders have interest on its impact on health, well-being, and quality of life (Zimmerman, 2005).
The purpose of this concept of analysis is to develop an operational definition of the theoretical concept of resilience. This will allow readers to understand or “get inside the concept”, to understand its workings (Walker & Avant, 2011), and apply resilience to evidence-based practice. Nursing by nature is a profession subject to a high degree of stress. The concept resilience illustrates a process whereby individuals bounce back from an adverse event and move on with their lives.
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Conflict in the workplace often leads to adversity causing stress in many new graduate nurses. According to the United Nations and World Health Organization, workplace stress has become a worldwide epidemic (Collins, 2006). Interpersonal conflict at work is an international workplace stressor, which has become a threat to the nursing profession here in the United States (Pines et al. , 2011). Research suggests the emergence of resilience in the nurses is a retention factor for nurses facing workplace conflict; however, new nurses are often underprepared to manage this stress.
In order for nurse educators to prepare students for conflict resolution and build resiliency, they need to have a better understanding of the psychological traits of resilience (Pines et al. , 2011). The Center for the American Nurses (2008), states complexity and adversities of the current healthcare environment requires resilience in nurses. New nurses who implore resilience are more likely to succeed in healthcare, despite workplace adversities. Review of Literature
Resilience is derived from the Latin word resilire, meaning to rebound or recoil (Haper, 2012), and possess many overlapping definition. In the physical sciences, resiliency refers to the ability of a material to resume its natural shape after experiencing affects by the application of forces (Whitson & Ramirez-Marquez, 2009). Economic resilience is defined as the responses to disasters that enable individuals and communities to avoid potential loss (Rose, 2004).
Educational resilience refers to the likelihood of success in academia, despite environmental adversities (Waxman, Gray, & Padron, 2003). The Business Dictionary (2012) defines resilience in terms of a material to resume its original size and shape, or the ability of equipment to absorb the impact of failure to continue to provide an acceptable level of service. The Merriam-Webster Dictionary (2012) and The American Heritage Dictionary (2000) both define resilience as the ability to recover after a change.
A constant theme noted in all definitions of resilience is an ability to recover or rebound despite adversity or change. The concept resilience is used throughout many disciplines, however it emerged a theoretical research topic in 1980 from the studies of children of schizophrenic mothers (Matsen, Best, & Garmenzy, 1990). Matsen et al. (1990) illustrated children with a schizophrenic parent, subjected to situations that negatively affect childhood development, thrived well and were competent in academic achievement.
This began the evolution to understand and define traits of resilience in individuals. The historical development of the concept resilience consists of two roots of construct; the psychological aspects of coping, and the physiological aspects of stress (Tusaie & Dyer, 2004). Researchers began to focus on the understanding of protective factors illustrating adaptation to adversity and contributing to positive outcomes (Tusaie & Dyer, 2004). The review of literature revealed many disciplines that incorporate or utilize the concept of resilience in their field.
Healthcare has also begun to define and understand resilience not only in relation to workplace interpersonal stress, but also among various specialty medical practice areas. The majority of literature discussing resilience was found within psychology and psychiatry. The terms invulnerable and invincible were used interchangeably to describe what currently known as the concept, resiliency. Invulnerable was identified as misleading as it defined the person was evading risk.
Research revealed individuals respond differently to adversity with varying degrees of vulnerability and resilience, thus invulnerable transformed into resilience (Earvolino-Ramirez, 2007). Rutter (1987), suggested resiliency is a fluid quality that allows the person to alter responses to risk or stressors. Research transitioned and began to define protective factors to understand human responses to adversity instead of locating factors that caused risk or stress (Rutter, 1987).
Protective factors are specific attributes a person must possess in order to have resilience (Earvolino-Ramirez, 2007). According to Rutter (1987), protective factors are valuable in understanding and learning approaches to resilience, as they reduce the negative effects of adversity. These factors are typically individual or environmental, and aid the individual in the resilience process to have a positive outcome when faced with adversity. Some examples of protective factors include being good natured, having positive relationships, flexibility, sense of humor, and healthy expectations.
These protective factors are merely indicators of the concept resilience, but how the individual utilizes or processes these factors is important when studying the concept resilience (Earvolino-Ramirez, 2007). Defining Attributes Protective factors are an important entity when discussing resilience; however they should not be confused with defining attributes. Walker and Avant (2011) refer to defining attributes as characteristics that appear repeatedly throughout literature, and if isolated should call the concept to mind.
The defining attributes of resilience consistency revealed in literature include; rebounding, optimism, and competence. Rebounding is the quality of bouncing back and moving on after adversity (Earvolino-Ramirez, 2007, Tusaie & Dyer, 2004, Pines et al. , 2011, Rose, 2004). Optimism is having a positive outlook on life, and allows individuals to define or explain adversity with a positive outcome (Tusaie & Dyer, 2004, Pines et al. , 2011, Waxman, Gray, & Padron, 2003). Competence fosters motivation to enable adaptive uses or resources when faced with adversity (Waxman, Gray, & Padron, 2003, Tusaie & Dyer, 2004).
Antecedents and Consequence Antecedents are incidents that must precede an event in order for the concept to occur (Walker & Avant, 2011). The main antecedent illustrated throughout literature is adversity. Resilience cannot occur unless there is a disruption, change, or challenge in one’s life. Resiliency occurs when one gains growth or insight in spite of the adversity (Flemming & Ledogar, 2008). Consequences are the incidents that occur as a result of concept (Walker & Avant, 2011). A significant consequence to resilience is coping.
Effective coping is the ability to function at optimal level when managing and adverse event in life (Whitson & Ramirez-Marquez, 2009). Another consequence of resilience is mastery, having the ability to adapt what was learned during previous adverse events and apply this knowledge to future events. The consequence of not having resilience is one would no longer be able to function after facing an adverse event in their life. They would ineffectively be able to cope or bounce back from the event. Model Case A model case of a concept displays all the defining attributes of the concept (Walker & Avant, 2011).
Carol was a new graduate nurse beginning her first job as a nurse on a busy orthopedic unit. She spent 6 weeks orienting with her preceptor, learning the functionality of the unit and began to utilize what she has learned in school. The time had come for Carol to be released from orientation and care for 5 orthopedic patients independently, without the constant oversight of her preceptor. She arrived to the unit excited to finally be fulfilling her dream, but nervous because she no longer had the preceptor to lean on. She approached the day thinking, “this is going to be a great day, I am confident I can handle this”.
Carol knew it was best to start off any new adventure with an optimistic and positive attitude. It was time to take report from the previous nurse. The off going nurse spent the entire report emphasizing all the negative things that happened that night and concluded the report with “I hope you have a better than shift than me. This is a difficult set of patients even for an experienced nurse like me”. The tone of the shift report escalated Carol’s anxiety and fear. Throughout the day Carol displayed competence as she carried out doctors’ orders, performed various nursing procedures, and cared for her patients without error.
More importantly, she displayed competence by realizing when she needed to ask for help and not try to manage on her own. Her day was extremely busy, and before she realized it, her shift was over. In the first few weeks, Carol experienced times of high stress, other colleagues making her feel like she was inferior when she asked a question, and more negative under tones when receiving report. Despite facing this adversity, Carol rebounded and remained optimistic that she would begin to feel more confident. Several years later, Carol is still a nurse on that orthopedic unit; however she is now the unit manager.
Borderline Case Borderline cases contain only some of the defining characteristics of the concept (Walker & Avant, 2011). Sarah was raised in an abusive family. When she was a teenager she turned to alcohol to as a means to cope with her environment. Sarah was in and out of trouble with the law many times throughout her life. During her last court appearance, the judge ordered her to inpatient treatment for alcoholism. While in treatment she met Judy, a nurse who seemed to understand and truly care about her issues. Sarah began to listen to Judy’s advice and attended her counseling regularly.
She began think she would try all she had learned in treatment and hoped to have a happy life. Sarah rebounded quite a bit when she was discharged. She found a safe place to live, obtained employment, and began college. However, when faced with adversity, she turned to drinking again. Sarah would go in and out of treatment for several years. Sarah had self-doubt, and never believed she could cope with adversity without the use of alcohol, and therefore, she never did. Related Case A related case illustrates a concept similar to resilience but differs upon further review (Walker & Avant, 2011).
Hardiness encourages effective mental and behavioral coping, and effective self-care (Maddi, 2006). Grace is the only child of two senior leadership professionals. Her parents work long hours, have frequent business trips, frequently leaving her home alone to care for herself. Grace always appears well dressed with good personal hygiene. She attends school regularly and appears happy and content. She never seems to mind when her parents are away. Grace displays the traits of hardiness, which confers with resilience but does not fully capture the meaning of its concept. Contrary Case
Contrary cases clearly illustrate the opposite of the concept (Walker & Avant, 2011). Karen, a nursing student, is in her first clinical rotation of nursing school. On her first day the instructor allowed the students to shadow a nurse for two hours, and then sit down with one of the patients and have a ten minute conversation utilizing therapeutic communication. Karen immediately began to get nervous and knew she just would not be able to talk to a patient today. She followed the nurse around for two hours, but frequently made excuses when the nurse needed to be in the patient room for any length of time.
The instructor noticed Karen’s apparent apprehension and pulled her aside. Karen and the instructor discussed therapeutic communication. The instructor even role-modeled the process with Karen to help her feel more at ease with her first patient experience. After several minutes of offering support and helping Karen overcome her fear, Karen stated, “I am never good at anything, I don’t know why I thought I could be a nurse”, and left the clinical site. The next day Karen resigned from the nursing program. Karen displayed no defining attributes of resilience, and thus was not able to overcome this adversity in her life.
Life is not without conflict, stress, and change. Having a strong theoretical understanding allows resilience to applicable across many disciplines. Knowing the defining attributes and characteristics of resilience, nurse leaders can capture moments to promote adaptation in times of conflict, and increase nurse retention. Health care benefits greatly from understanding what helps people bounce back from difficult times and keep them healthy. Today’s healthcare trend is based on health promotion, not disease prevention; the concept resiliency is an important factor in health promotion.
References Center For American Nurses 2008 Lateral Violence and Bullying in the WorkplaceCenter for American Nurses (2008). Lateral Violence and Bullying in the Workplace. Retrieved from http://centerforamericannurses. org/associations/9102/files/Position%20StatementLateral%20Violence%20and%20Bullying. pdf 201210122024531619734645 Collins M 2006 Taking a lead on stress: rank and relationship awareness in the NHS. Collins, M. (2006). Taking a lead on stress: rank and relationship awareness in the NHS. Journal of Nursing Management, 9, 310-317.