Resilience Is the Antidote to Nursing Trauma

Resilience is a phenomenon we often think of relative to patients and families who persevere despite overwhelming odds. I remember such a family from decades ago whose memory remains with me to this day.

The patient was a high school senior hospitalized for treatment of acute leukemia that was diagnosed after successful treatment for pediatric osteosarcoma. Despite hope, prayers, and a fierce fighting spirit, this charismatic teenager died. Her mother, a breast cancer survivor at the time, soon developed a recurrence, ultimately succumbing to brain metastases. Within a year, the patient’s father was treated for lung cancer and died. The middle child, a daughter who was extremely impacted by her sister’s cancer experience, became an oncology nurse. She got married, worked for a year on an in-patient oncology unit, and then, we later learned, died of the same sarcoma that had been diagnosed in her sister. This family scenario sounds made up and impossible to be true. But it indeed happened. Left to integrate these horrendous losses into their young lives were the 2 youngest children, in elementary school at the time this spiral of loss and grief began. Now they are in their late 30s, and I continue to wonder, how were they able to persevere?

The ability to live beyond exposure to considerable emotional trauma and overwhelming sorrow is also germane to health professionals, particularly nurses. Yet research on resilience in this cohort is a contemporary focus, which currently lacks a universally accepted definition.¹ Components of resilience include characteristics of persistence and survivorship, growing from adversity, and being dynamic in nature.^1,2 What remains questionable is if resilience can be learned or if it is an innate coping construct.

Hart and colleagues reviewed the research on the phenomenon of resilience in nursing. Their findings outline contributing factors that negatively impact resilience in professional nursing practice. They include the concept of “psychological emptiness” emanating from workplace frustrations, such as not having their opinions valued or personal perspectives honored. “Diminished inner balance” was demonstrated when nurses struggled with navigating the competing demands of their work and personal lives. “Workplace dissonance” was especially prevalent in new graduates who experienced anxiety and ambiguity related to gaps evident between academic preparation and the real world of nursing practice. On the contrary, intrapersonal characteristics were delineated that enhance resilience in nursing. These include the nurses’ use of hope, self-efficacy, cognitive re-framing, toughening up, and making grounded connections.2 Research is still evolving regarding the corollaries of nurses’ resilience and interventions to enhance its effectiveness. However, early findings are instructive in considering future investigations.

A Chinese study of over 1000 nurses attempted to discern the relationship between burnout and resilience.³ There were 2 keys: the perception of work setting change and turmoil as a normal part of life versus a threat to life. Nurses who viewed adversity as a normal component of their profession appeared better able to cope with emotional strain when it appeared. This supports the positive nature of reframing as an intervention option, as well as the potential of teaching strategies that enhance resilience.

A program to build resilience in palliative care clinicians was also reported.⁴ In creating a paradigm, conceptual model, and curriculum to move clinicians toward resilience, the researchers posited that a multipronged intervention was required. This included teaching clinician resilience skills using cognitive behavioral therapy, positive psychology, and mindfulness and including the integration of workplace engagement strategies that paralleled clinician resilience skill building. These addressed enabling control, structuring rewards, building community, promoting fairness, recognizing values, and calibrating workload.

The benefits of fostering resilience in nurses are many. These include the retention of seasoned and highly credible nurses, enhancement of their professional career satisfaction, and ultimately, optimum care of patients and their families. Our work is highly complex and emotionally laden. Thus, it is inherent that we will be wounded by it. We must invest time and resources into the prevention of the negative emotional sequelae of nursing in order to maximize our science. Building resilience is key.

References

• Aburn G, Gott M & Hoare K (2016). What is resilience? An integrative review of the empirical literature. J Adv Nurs, 72(5): 980-1000.
• Hart PL, Brannan JD, De Chesnay M (2014). Resilience in nurses: An integrative review. J Nurs Management, 22: 720-734.
• Guo Y, Luo Y, Lam L, Cross W, Plummer V, Zhang J (2018). Burnout and its association with resilience in nurses: A cross-sectional study. J Clin Nurs, 27: 441-449.
• Back AL, Steinhauser KE, Kamal AH, Jackson VA (2016). Building resilience for palliative care clinicians: An approach to burnout prevention based on individual skills and workplace factors. J Pain Symp Man, 52(2): 284-291.