Abstract
Evolution of the construct of resilience from physiological and psychological research extends from the 1800s to the present. This review supports 3 observations: (1) the importance of a dynamic, interactive perspective for understanding resilience; (2) the complexity of the construct requires a holistic perspective; and (3) the importance of exposure to diverse experiences and educational perspectives for professional health care students.
Resilience is a vital attribute for nurses in their everyday work and particularly amidst the current nursing shortage. It denotes a combination of abilities and characteristics that interact dynamically to allow an individual to bounce back, cope successfully, and function above the norm in spite of significant stress or adversity. 1 Although researchers agree on multiple domains to the concept of resilience, it can be viewed as a qualitative categorical construct 2 or as a continuum of adaptation or success experiences. 3 Its complexity necessitates an additional holistic nursing perspective.
The domains of work or school performance, behavior adjustment, psychosocial adjustment, and physical health comprise overall resilience. 1,2,4 Because of a weak correlation among the domains of resilience, individuals may vary in resilience characteristics. For example, an individual from an abusive, impoverished childhood may demonstrate education and work resiliency by obtaining a doctoral degree and a high-paying job, but be unable to maintain intimate relationships and demonstrate impairment in the psychosocial domain. Therefore, current evidence suggests that the idea of overall resilience is of questionable utility. 3,5 Definitions that focus on aggregating various domains are likely to be weakly correlated with outcomes. So domain specificity is more useful in research and practice applications than is a global definition of resilience. 6
The domains of resilience are developmentally appropriate and change with different life stages. For example, in addition to the absence of illness, children who function above the norm scholastically and in peer relationships in spite of risk exhibit resilience. 7-11 In adolescence and young adulthood, resilience may be measured by accomplishments higher than the norm in career development, happiness, relationships, and physical well-being in spite of the presence of risk factors. 12 Resilience is not static.
Resilience has been studied particularly in relation to transitions of greatest stress. Developmental transitions include school entry, detachment from parents during adolescence, and childbearing. Transitions also occur in unexpected or externally controlled events such as disaster, family disruption, or unemployment. 13-17 These and other forms of stressful situations place individuals at risk for the development of psychosocial or physical symptoms. Individuals who do experience disruption from stress but then use personal strengths to grow stronger and function above the norm are considered resilient.
Although each individual possesses the potential for resilience, an interplay between the individual and the broader environment is responsible for the level of resilience. 1,7 Further, the interactions among risk and protective factors at an intrapersonal and environmental level are integral to the definition of resilience. The presence of risk factors indicates that a person has been identified as with a group that is more likely than other groups to develop a specific difficulty. 18 Risk factors do not predict a particular negative outcome with absolute certainty; they only expose individuals to circumstances associated with a higher incidence of that outcome. Risk factors stem from multiple life stressors, a single traumatic event, or cumulative stress from a number of individual and environmental factors. 1,3,4,16 The risk may be viewed from an epidemiological perspective that would include an entire group, such as children in poverty or on an individual basis such as an experience of trauma or an adverse event. 9 The balance between risk and protective factors is a dynamic process.
Protective factors are defined as operating to protect those at risk from the effects of the risk factors. Similar to risk factors, protective factors may be individual or environmental and they contribute to positive outcomes regardless of the risk status. 18 The manner in which risk and protective factors interact in the person demonstrating resilience is not clear. Understanding the root of causation often requires a focus on the presence or absence of specific unitary factors, and the nature of the interactions within the collectivity of risk and protective factors. When stress or the number of risk factors is greater than the number of protective factors, individuals who exhibited resilience in the past may be overwhelmed and develop symptoms in one of the domains of physical, psychosocial, behavioral school, or work. 4
The prevalence of resilience ranges from 15% to 50% depending upon the definition of resilience and the population studied. 8,9,14,19 These rates suggest that resilience does not function uniformly and automatically, but waxes and wanes in response to contextual variables.
Experts agree that the potential for change or plasticity exists across the life course. 10,11,15,20-22 This plasticity, or ability to bounce back in spite of adversity and function above the norm, provides reason for optimism about intervention programs to promote health and prevent illness. Therefore, the area of resilience is of interest to researchers, clinicians, and educators. Many forms of stress and adversity exist in our workplaces and in our world, but those who cope successfully and function above the norm in spite of adversity have valuable knowledge to share.