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 firstname.lastname@example.org and follow him on Twitter @UoDMHN
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