Resilience Concept

Definition: Resilience is a dynamic process that encompasses the capacity of individuals, teams, organizations, and systems to resist, adapt to, recover, or grow from a challenge. 

The Essentials (2021, p. 63) describes resilience as the ability to survive and thrive in the face of adversity. Resilience can be developed and internalized as a measure to improve retention and reduce burnout. Building positive relationships, maintaining positivity, developing emotional insight, creating work-life balance, and reflecting on successes and challenges are effective strategies for resilience building.

Domain	Competency	Sub-competencies
Domain 2: Person-Centered Care	2.1 Engage with the individual in establishing a caring relationship. 2.2 Communicate effectively with individuals.	2.1a Demonstrate qualities of empathy. 2.1b Demonstrate compassionate care.
	2.2 Communicate effectively with individuals.	2.2a Demonstrate relationship-centered care.  2.2c Use a variety of communication modes appropriate for the context.  2.2d Demonstrate the ability to conduct sensitive or difficult conversations.  2.2f Demonstrate emotional intelligence in communications
Domain 10: Personal, Professional, and Leadership Development	10.1 Demonstrate a commitment to personal health and well-being	10.1a Demonstrate healthy, self-care behaviors that promote wellness and resiliency.  10.1b Manage conflict between personal and professional responsibilities
	10.2 Demonstrate a spirit of inquiry that fosters flexibility and professional maturity.	10.2a Engage in guided and spontaneous reflection  of one’s practice.  10.2b Integrate comprehensive feedback to improve performance.  10.2c Commit to personal and professional development.  10.2f Participate in ongoing activities that embrace principles of diversity, equity, inclusion, and antidiscrimination.

1. R3 (Renewal, Resilience and Retention) Tools and Modules

Resources developed for The Renewal, Resilience and Retention of Maryland Nurses Initiative by Dr. Cynda Rushton, Johns Hopkins School of Nursing

Faculty Suggestions for Use:

Formats for the assets include video, self-guided modules, reflective practices, guided practices, and simulation. They range from 4 minutes to 12 minutes each; many are self-paced. The modules were designed to be integrated into existing courses or curricula in prelicensure or NRP programs. They have been used as course assignments, during scheduled class time, as prep, or as a follow-up to course content with application and discussion of the module content. (American Journal of Nursing 2024, 2–3).
Source: American Journal of Nursing. 2024. Dean’s Notes. Summer. https://www.ajj.com/sites/default/files/deansnotes/summer24.pdf.

2. National Academy of Medicine’s (NAM) Action Collaborative on Clinician Well-Being and Resilience

See description and suggestions for uses under Self-Care and Mindfulness concepts.

3. The Institute for Healthcare Improvement Open School

The Institute for Healthcare Improvement Open School is a large library of online courses, which offers an effective way for healthcare students and professionals from around the world and across disciplines to gain essential training and skills in quality improvement, patient safety, leadership and other topics. They are free to students, residents, and faculty. This particular offering is titled “Why is Psychological Safety So Important in Health Care?” and includes a video by Amy Edmondson, an expert in psychological safety, learning objectives, and discussion questions.

Faculty Suggestions for Use:

IHI is widely respected for its mission, purpose, and impact. Faculty have assessed the courses as excellent.
Used the reflective exercises.

4. Building Personal Resilience

This article, Building personal resilience from American Nurse, provides a succinct summary of personal resilience and how it can be developed to enhance the individual nurse’s ability to cope with the challenges of a stressful and chaotic healthcare environment.

Faculty Suggestions for Use:

Educators at the beginning of the semester asked students to read the article after the first day of class.
As part of classroom discussion and homework, students were asked to develop a personal, comprehensive resilience plan prior to graduation.
Another program, used this article as part of an assignment to explore an online resource or app for mindfulness, stress, relaxation, sleep, etc.

5. Stress First Aid

Stress First Aid for Health Care Workers is a framework to improve recovery from stress reactions, both in oneself and in coworkers. Manuals and workbook can be downloaded. A series of webinars is also available.

Watson, P. & Westphal, R.J. (2020). Stress First Aid for Health Care Workers. National Center for PTSD.

Faculty Suggestions for Use:

This resource was used by several schools and was recommended for use in almost any course and for all students. The courses in which it was used included acute care clinical and senior leadership courses.
One school integrated it into the student orientation.
Another school had students develop a case study to help identify areas of stress and next steps and then present information to their class.

6. HeartMath

Faculty Suggestions for Use:

HeartMath is used extensively in practice or experiential learning sessions; feedback from students and working nurses is excellent.
Used for short centering activities before classes/exams.
Used for written reflections second and third terms.
Students appreciated that the tools could be used on the fly and reported that content was practical, easy to understand, and required no additional reading.

7. Self-Care for Nurses: 100+ Ways to Rest, Reset, and Feel Your Best by Xioely Famighetti (2022)

This book is inexpensive and provides quick references for wellness activities. One pilot school used this book along with their practice partner to initiate several activities including creating a wellness room in the hospital for students and practicing nurses.

1. Have Students Review: NAM Action Collaborative on Clinician Well-Being and Resilience Conceptual Model: Factors Affecting Clinician Well-being and Resilience
Instruct students to find evidence-based articles related to the conceptual model (refer to the NAM Clinician Well-Being Collaborative website). Have students meet in in-person or virtual small groups to discuss specific questions related to the conceptual model. The following questions could be included in student assignments or embedded in classroom discussions:

List at least three evidence-based examples of how nurses can promote their individual resilience.
Identify how the promotion of nurse resilience can positively impact their colleagues’ and patients’ resilience.
List at least three evidence-based examples of how nurses can influence their inter-professional team’s resilience.
Discuss societal and cultural impacts on clinician and patient resilience and identify methods to positively influence these factors within healthcare.
Identify the components of a psychologically safe learning environment and identify methods to engender psychological safety.

2. Have students watch the Institute for Healthcare Improvement Open School Video - Why is Psychological Safety So Important in Health Care

Alternatively, have students respond to the following questions (from the IHI website above) either individually, or have them discuss with a small group of classmates:

Do you agree with each of Amy Edmondson’s observations about the benefits of a psychologically safe work environment? Why or why not?
In your experience, how have environments in which you’ve worked contributed to or detracted from the four outcomes Edmondson mentioned? What other factors besides psychological safety influenced these outcomes?
Edmondson talks about the importance of individual and organizational learning. In your experience, what is the relationship between these two types of learning? How does individual learning become organizational learning, and vice versa?
Edmondson describes “the very real risks that are always present in the healthcare setting.” What are these risks?
Edmondson also talks about employee retention as being valuable to patients, organizations, and colleagues. What do you see as the benefits for each group?

3. To build personal resilience the following integrative learning strategies are suggested:

At the beginning of your first class for the semester, share the one-page document with the list of personal protective factors (PPF) that are essential to one’s ability to cope with challenging situations. (Layout 1 (myamericannurse.com) - (Didactic Learning Strategy)
Ask students to identify their personal protective factors (PPF) (Layout 1 (myamericannurse.com) (Based on previous learning experiences- Integrative/Experiential Learning Strategy)
Start every class session with a quick review of the list of the 4Ps essential to building our PPFs. Use the handout “Build resilience with the 4Ps” for this activity (Layout 1 (myamericannurse.com) (Didactic and Integrative Learning Strategy)
Use the “Build a resilience plan” tool to develop a plan for resilience that will help you overcome daily challenges and what is to come (Layout 1 (myamericannurse.com) (Reflective Writing Strategy)
Complete a personal plan for increased resilience and then find an accountability partner who will commit to joining you as you implement the plans (Experiential Learning).

Using the IHI video as a baseline for discussion, have each small group summarize their group discussion and submit their results to faculty. Have a large group discussion in an in-person or virtual real-time classroom meeting. Discuss small group findings and have students critically think through and discuss how the recommendations may be implemented into practice, what barriers may present themselves, and how they would overcome those barriers.

For building resilience, the expected outcome would be for the students to be able to identify strategies that they can immediately begin to use in their daily life activities to strengthen their 4Ps. Ideally, faculty could assess student engagement in these activities.

The Ohio State University Faculty Wellness Tool Kit

Op-Ed: We need a national strategy to help health workers recover from the stress of the pandemic (Los Angeles Times)

Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being  (New England Journal of Medicine)

Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being

National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience podcast  (American Society of Health-System Pharmacists)

Do you know what’s in the landmark report on Clinician Burnout from the National Academy of Medicine? podcast (MissingLogic, LLC)

Making the Case for the Chief Wellness Officer in America’s Health Systems (Health Affairs)

To Care is Human: Collectively Confronting the Clinician Burnout Crisis (New England Journal of Medicine) 

The Ohio State University LIVEWELL Webinars - Incorporating Wellness Strategies into Teaching & Learning

Dr. Amit Sood resilience training and research

Melnyk et al. article: Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review

University of Wisconsin Center for Healthy Minds