A Relationship with Resilience by Grant King

#selfcare provokes #goodcaregrant

I believe that it was the above tweet that instigated a conversation leading to this blog post.   As part of a twit-chat looking at self-care in nursing, I noted the relationship between nurses’ self-care and the quality of healthcare they provide.   Around the same time I was teaching and writing about the concept of resilience in a healthcare context.   I came to reflect on the role of resilience in both the lives of those who provide healthcare and of those that may require it.

“The human capacity for burden is like bamboo- far more flexible than you’d ever  believe at first glance.” ― Jodi Picoult

Resilience is the ability to cope with, and then positively adapt, following a period of adversity (Haddadi and Besharat 2010).   There are a number of factors that act as risks to our resilience.  These include dysfunctional relationships, trauma and social disadvantage (Chesterton 2009).

Social connectedness, a sense of hope and rewarding opportunities all foster and protect our resilience (Chesterton 2009).  Research shows that resilience has a direct impact on the experience of ill health, across the health spectrum and across the lifespan (Min et al 2013, Caltabiano et al 2006, Shin et al 2006 and Payne and Butler 2003).   It is a quality that is dynamic and through experience and intervention can be positively enhanced (Earvolino-Ramirez 2007).

Resilience enhancing experiences and interventions include activities such as identity building work, learned optimism, emotional literacy improvement, strengths development and peer coaching (Grant and Kinman 2013, McAllister and McKinnon 2009).   Improved resilience offers improved health outcomes and so healthcare professionals should seriously consider its role in the lives of those they care for (McAllister and McKinnon 2009).    However is it just in the lives of those who receive healthcare that we should reflect on the role of resilience?

“Caring for others skilfully involves a high degree of self-giving.  Whilst the self can certainly grow and flourish in this altruistic experience, it can also suffer” (McCallister and McKinnon 2009 p. 371).

Aitken et al. (2012) report that 42% of nurses they sampled described themselves as “burned out”.   It is argued that resilience is a key characteristic needed in nursing to cope with and adapt positively to the demands of the role (McDonald et al 2013 and Stephens 2013).   To enhance occupational resilience Grant and Kinman (2013) discuss four evidence based strategies.  These strategies are engaging in reflective practice, utilising good quality mentoring, participating in relaxation and accessing experiential learning.  If we regard the literature’s view that health professionals, with nurses in particular, experiencing a disproportionate amount of stress in their work (McAllister and McKinnon 2009) then we can see the urgency in ensuring we engage in these resilience building activities and do so in a routinized way.

It is worth noting here that some other terms can be found and mistakenly used as synonyms for resilience.  One such is the concept of “hardiness”.  In 1979 Kobasa wrote a seminal piece introducing the concept of hardiness which was described as the ability to buffer, offer resistance to and cope with stressful situations.  Contemporary understanding of hardiness describes three core elements, consisting of commitment, control and challenge (Khoshaba and Maddi 2008, Jameson 2014).

What differentiates resilience for me is the positive adaption following adversity whereas hardiness seems to focus on the concept of adversity survival.   I think many of us can picture ‘hardy’ individuals.  They might be seen as strong and smart survivors.  And yet, it was Darwin in 1809 who said “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change”.

“This has been my vocation to make music of what remains.” ― Itzhak Perlman

 Resilience literature (McAllister and McKinnon 2009, Chesteron 2009) describes some of the common characteristics that resilient people display.  These qualities include the ability to set reasonable goals and maintain focus in attaining them.  Resilient people express their emotions appropriately including providing support and comfort to others in compassionate and helpful ways.   Finally another key characteristic of people described as being more resilient is their ability to cope with stress, risk and conflict in flexible and novel ways, while not feeling overwhelmed and defeated by the situation.   Are these the qualities and characteristics we’d like to see in ourselves, our colleagues and those we care for?

“When I encourage someone, I see it as an investment in their resilience.” ― Steve Karagiannis

 I believe that as we centralise the concept of resilience in our healthcare education and practice that we will observe a cycle of health improvement.    As healthcare practitioners build their personal resilience through the activities previously noted their ability to offer that necessary “skilful self-giving” increases.  Acknowledging and appreciating that will naturally encourage a greater resilience focus in practice delivery.  #selfcare provokes #goodcare…or perhaps even #greatcare? As we support people to develop a greater ability to positively adapt from adversity, their lives become richer and more independent.  As we support and see success, we feel success….#greatcare provokes #selfcare, perhaps?

“It’s crazy, how similar we are. Here’s both of us, working through our stuff, trying to make something positive out of something really bad.” ― Jenny Han

In conclusion, I refer to the image I’ve associated to this piece of writing.  Two people are walking down a hill.  The sun is low in the sky; it’s late in the day.  They both carry things with them.  Some things have been useful; some may have been a hindrance.  They both brought different types of expertise with them. It’s been a long journey.  It was unpredictable at times.  They endured the uphill together and now enjoy the gentler slopes, for a time.  It was their relationship with resilience that got them to where they are now.  It is their relationship with resilience that will take them to, and through, their next mountain to climb.

Grant King is a Lecturer in Nursing (Mental Health) and Associate Fellow of the Higher Education Academy at the University of Dundee  School of Nursing and Midwifery.  You can email him at g.king@dundee.ac.uk and follow him on Twitter @UoDMHN

References

AITKEN, L. et al. 2012. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.  British Medical Journal, 344, p. 1717.

CALTABIANO, M. et al., 2006. Resilience and health outcomes in the elderly. Proceedings of the 39th Annual Conference of the Australian Association of Gerontology, pp. 1-11.

CHESTERTON, J. 2009 Mental health promotion and prevention. In: P. BARKER, ed.  Psychiatric and mental health nursing the craft of caring. London: Hodder Arnold, 2009, pp.571-585

EARVOLINO-RAMIREZ, M. 2007. Resilience: a concept analysis.  Nursing Forum, 42(2), pp. 73-82.

GRANT, L. and KINMAN, G. 2013. The importance of emotional resilience for staff and students in the ‘helping’ professions: developing an emotional curriculum. Bedfordshire: The Higher Education Academy

HADDADI, P. and BESHARAT, M. 2010. Resilience, vulnerability and mental health, Procedia Social and Behavioural Sciences, 5, pp. 639-642.

JAMESON, P. 2014. The effects of a hardiness educational intervention on hardiness and perceived stress of junior baccalaureate nursing students. Nurse Education Today, 34, pp. 603-607

KHOSHABA, D. and MADDI, S. 2008. Harditraining: managing stressful change. 4th ed Hardiness Institute: California

KOBASA, S. 1979. Stressful life events personality and health an inquiry into hardiness.  Journal of Personality and Social Psychology, 37, pp. 1-11

MCALLISTER, M. and MCKINNON, J. 2009. The importance of teaching and learning resilience in the health disciplines: a critical review of the literature, Nurse Education Today, 29, pp. 371-379.

MCDONALD, G.  et al. 2013.  Personal resilience in nurses and midwives effects of a work based educational intervention. Contemporary Nurse, 45(1), pp/ 134-143

MIN, J. et al., 2013. Psychological resilience contributes to low emotional distress in cancer patients. Supportive Care in Cancer, 21(9), pp. 2469-2476.

PAYNE, H. and BUTLER, I. 2003. Quality Protects research briefing No. 9: Promoting the mental health of children in need. Totnes: Research in Practice.

Research in Practice available from http://www.rip.org.uk.

SHIN, Y. et al., 2006. Resilience and health related quality of life in children with chronic illness. J Korean Acad Child Health Nurs., 12(3), pp. 295-303.

STEPHENS, T. 2013. Nursing student resilience a concept clarification. Nursing Forum, 48(2), pp. 125-133.

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3 Responses to A Relationship with Resilience by Grant King

  1. Robin Ion says:

    Great blog Grant – have posted a link on our student FB page
    Regards
    Robin

    Like

  2. Speaking as a resilient grandmother and a woman who identifies as a psychiatric survivor I disagree with this statement:

    “What differentiates resilience for me is the positive adaption following adversity whereas hardiness seems to focus on the concept of adversity survival.”

    I believe that resilience and hardiness go hand in hand, are equally important for any person who finds themselves in a state of emotional crisis or mental distress and having to access psychiatric treatment. Where they may be subject to forced medication and be judged as being “without capacity”. I speak from experience. And from the position of caring for many other family members in the same situation. Over 40 years of caring.

    I would add resistance and non-conformity to the mix in terms of retaining and regaining positive mental health. It has worked for me and for many others. Resisting negative prognoses and self blame, not complying with rules and behaviours which are detrimental to human beings or disregard their rights. Standing up for human rights and standing with the oppressed, whatever the situation. Regardless of the cost. That is a demonstration of strength and resilience, in my opinion.

    As a child I was resilient and hardy, recovering after arm and leg breaks when out playing rigorously and adventurously in the school holidays, aged 6 and 7 respectively. Like my granddaughter I ran before I could walk. Nothing much has changed now I’m 62 years young. Being a survivor means I can bounce back, pick myself up again after adversity and ill-health, physical or mental. It also means I can empathise with others who are struggling and get alongside side them, mutually, until they are back on their feet again. Doing it under their own steam.

    As a community education and development worker since 1980 it was always about empowerment and lifelong learning. Level playing fields and making straight paths. Being tough, resilient and hardy does not automatically translate into a lack of compassion and a disregard for the pain of “others”. I wanted to give voice to my thoughts and hope they are of use.

    Like

  3. Reblogged this on Chrys Muirhead and commented:
    My comment: “Speaking as a resilient grandmother and a woman who identifies as a psychiatric survivor I disagree with this statement:

    “What differentiates resilience for me is the positive adaption following adversity whereas hardiness seems to focus on the concept of adversity survival.”

    I believe that resilience and hardiness go hand in hand, are equally important for any person who finds themselves in a state of emotional crisis or mental distress and having to access psychiatric treatment. Where they may be subject to forced medication and be judged as being “without capacity”. I speak from experience. And from the position of caring for many other family members in the same situation. Over 40 years of caring.

    I would add resistance and non-conformity to the mix in terms of retaining and regaining positive mental health. It has worked for me and for many others. Resisting negative prognoses and self blame, not complying with rules and behaviours which are detrimental to human beings or disregard their rights. Standing up for human rights and standing with the oppressed, whatever the situation. Regardless of the cost. That is a demonstration of strength and resilience, in my opinion.

    As a child I was resilient and hardy, recovering after arm and leg breaks when out playing rigorously and adventurously in the school holidays, aged 6 and 7 respectively. Like my granddaughter I ran before I could walk. Nothing much has changed now I’m 62 years young. Being a survivor means I can bounce back, pick myself up again after adversity and ill-health, physical or mental. It also means I can empathise with others who are struggling and get alongside side them, mutually, until they are back on their feet again. Doing it under their own steam.

    As a community education and development worker since 1980 it was always about empowerment and lifelong learning. Level playing fields and making straight paths. Being tough, resilient and hardy does not automatically translate into a lack of compassion and a disregard for the pain of “others”. I wanted to give voice to my thoughts and hope they are of use.”

    Like

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