Resilience in the operating room: developing and testing of a resilience model

The mediating role of perceived social support on the relationship between lack of occupational coping self-efficacy and implicit absenteeism among intensive care unit nurses: a multicenter cross‑sectional study

BACKGROUND

Implicit absenteeism is very common among nurses. Poor perceived social support of intensive care unit nurses has a negative impact on their mental and physical health. There is evidence that lack of occupational coping self-efficacy can promote implicit absenteeism; however, the relationship between lack of occupational coping self-efficacy in perceived social support and implicit absenteeism of intensive care unit nurses is unclear. Therefore, this study aimed to evaluate the role of perceived social support between lack of occupational coping self-efficacy and implicit absenteeism of intensive care unit nurses, and to provide reliable evidence to the management of clinical nurses.

METHODS

A cross-sectional study of 517 intensive care unit nurses in 10 tertiary hospitals in Sichuan province, China was conducted, of which 474 were valid questionnaires with a valid recovery rate of 91.6%. The survey tools included the Chinese version of Implicit Absenteeism Scale, the Chinese version of Perceived Social Support Scale, the Chinese version of Occupational Coping Self-Efficacy Scale and the Sociodemographic characteristics. Descriptive analysis and Pearson correlation analysis were performed using SPSS version 22.0, while the mediating effects were performed using AMOS version 24.0.

RESULTS

The average of intensive care unit nurses had a total implicit absenteeism score of (16.87 ± 3.98), in this study, the median of intensive care unit nurses' implicit absenteeism score was 17, there were 210 intensive care unit nurses with low implicit absenteeism (44.3%) and 264 ICU nurses with high implicit absenteeism (55.7%). A total perceived social support score of (62.87 ± 11.61), and a total lack of occupational coping self-efficacy score of (22.78 ± 5.98). The results of Pearson correlation analysis showed that implicit absenteeism was negatively correlated with perceived social support (r = -0.260, P < 0.001) and positively correlated with lack of occupational coping self-efficacy (r = 0.414, P < 0.001). In addition, we found that perceived social support plays a mediating role in lack of occupational coping self-efficacy and implicit absenteeism [β = 0.049, 95% CI of (0.002, 0.101)].

CONCLUSIONS

Intensive care unit nurses had a high level of implicit absenteeism with a moderate level of perceived social support and lack of occupational coping self-efficacy. Nursing managers should pay attention to the nurses those who were within low levels of social support and negative coping strategies, and take measures to reduce intensive care unit nurses' professional stress, minimize implicit absenteeism.

Impact of Structural Employee Empowerment on Hospital Ratings: Mediating Role of Social Climate and First-Line Managers' Resilience

Objective

The purpose of this article is to investigate the relationship between the structural empowerment of first-line health managers and health facility performance, examining the mediating roles of resilience and social climate in shaping the ratings of Slovak hospitals. Additionally, we aim to investigate the deeper mechanisms of this relationship, particularly the impact of resilience and the social climate, which can positively influence it.

Materials and Methods

The data collection was conducted through a questionnaire survey in February 2022. Respondents included 540 healthcare managers at the first level of management from 44 Slovak hospitals, all of which were part of the evaluation by the Institute for Economic and Social Reforms (INEKO). The analysis involved the use of the PLS-SEM method to examine the relationships between variables and assess direct and indirect effects, utilizing SmartPLS 3.3 software.

Results

The findings reveal a positive association between the structural empowerment of first-level managers and the ranking of health facilities. The hypotheses regarding the mediation of both variables - First-Level Managers' (FLMs) resilience and social climate - are supported, whether considered separately or jointly. In the case of joint mediation, a significant portion of the indirect effect is conveyed through FLMs' resilience, suggesting a potential avenue of support from hospital management to enhance health facility ratings.

Conclusion

Structural empowerment of first-line managers establishes the conditions for improving the ratings of health facilities. The total effect is significantly more pronounced in promoting their resilience and fostering a supportive social climate.

Development and validation of the Nurse Team Resilience Scale (NTRS) in the context of public health emergencies

BACKGROUND

Team resilience can help nurse to respond positively to adversity at work and maintain normal team function in complex and unstable environments. However, much less research attention has been paid to team resilience than to individual resilience, and nurses lack reliable and valid tools to measure team resilience. This study aimed to develop and evaluate the psychometric properties of a scale that measures the nursing team resilience in the context of a public health emergency.

METHODS

The study was conducted in three stages that item development, scale development, and scale evaluation. This scale was based on that of Morgan and Sharma et al. proposed four-factor team resilience model, and the draft scale was generated based on the literature review, existing scales, experts' validations, and cognitive interviews. During July 2022 to August 2022, the construct validity and the internal consistency reliability of the NTRS were evaluated through an online survey of 421 nurses.

RESULTS

The 8-item NTRS scale has good reliability and validity and is suitable for measuring the nurse team resilience. The EFA found a common factor solution and explained 72.33% of the common varianc and the CFA score showed construct validity. Reliability of the internal consistency of the scale with a good Cronbach alpha of 0.94.

CONCLUSION

This scale can assess team resilience in nurses that nursing education and management resources can be allocated to improve policies and training programs to provide effective positive support to nurses in challenging workplace situations and to enable greater health systems resilience in the future.

Exploring Resilience in Care Home Nurses: An Online Survey

Resilience is considered a core capability for nurses in managing workplace challenges and adversity. The COVID-19 pandemic has brought care homes into the public consciousness; yet, little is known about the resilience of care home nurses and the attributes required to positively adapt in a job where pressure lies with individuals to affect whole systems. To address this gap, an online survey was undertaken to explore the levels of resilience and potential influencing factors in a sample of care home nurses in Northern Ireland between January and April 2022. The survey included the Connor-Davidson Resilience Scale, demographic questions and items relating to nursing practice and care home characteristics. Mean differences and key predictors of higher resilience were explored through statistical analysis. A moderate level of resilience was reported among the participants (n = 56). The key predictors of increased resilience were older age and higher levels of education. The pandemic has exposed systemic weakness but also the strengths and untapped potential of the care home sector. By linking the individual, family, community and organisation, care home nurses may have developed unique attributes, which could be explored and nurtured. With tailored support, which capitalises on assets, they can influence a much needed culture change, which ensures the contribution of this sector to society is recognised and valued.

Mental health and job stress of nurses in surgical system: what should we care

BACKGROUND

Job stress has significant influence on the mental health of health care providers. The mental health and job stress of operating room nurses remain unclear. This study aimed to evaluate the mental health and job stress of nurses in surgical system in China, to provide evidences for clinical nurse management and care.

METHODS

The nurses in the surgical system of our hospital were investigated by questionnaire in December 2022. The general information questionnaire, symptom check list 90 (SCL-90) and nurses' job stressor scale (NJSS) were used for data collection. Pearson correlation and logistic analysis were conducted to evaluate the related influencing factors.

RESULTS

A total of 171 nurses in surgical system were investigated. The mental health level of nurses in operating room was low. The job pressure of the nurses in the operating room was in the middle level. The nursing profession and work, workload and distribution, working environment and resources, patient care, management and interpersonal relationship were all positively correlated with SCL-90 score of nurses in operating room. Logistic regression analysis indicated that age, year of work experience, professional ranks and titles both are the influencing factors of SCL-90 score and of nurses in operating room.

CONCLUSIONS

The mental health of nurses in surgical system is affected by work pressure, ages, working years and professional titles. These factors should be considered in the psychological intervention of nurses in operating room in order to improve the health of clinical nurses.

Investigation of Nurses' Wellbeing towards Errors in Clinical Practice-The Role of Resilience

Background and Objectives: The fatigue, stress, and burnout of nurses lead to them frequently making mistakes, which have a negative impact not only on the safety of the patients but also on their psychology. The ability to bounce back from mistakes is crucial for nurses. Nursing staff members' physical and mental health, particularly their depression, is far from ideal, and this ill health is directly correlated with the frequency of self-reported medical errors. The nurses' mental and physical health are also positively correlated with their perception of wellness support at work. This cross-sectional study aimed to investigate the status of nurses' mental and physical health regarding clinical errors and the impact of resilience on coping with these situations. Materials and Methods: A total of 364 healthcare professionals participated in this research; 87.5% of them were females and 12.5% of them were males. Most of the participants were 22-35 years old. The median number of years of employment was nine. Clinical nurses anonymously and voluntarily completed a special structured questionnaire that included questions from different validated tools in order to assess their state of physical and mental wellbeing after events of stress and errors made during their practice. Results: In total, 49.4% of the nurses had made an error on their own, and 73.2% had witnessed an error that someone else had made. At the time of the error, 29.9% of the participants were in charge of more than 20 patients, while 28.9% were responsible for a maximum of three patients. Participants who were 36-45 years old had more resilience (p = 0.049) and experienced fewer negative emotions than participants who were 22-35 years old. The participants who mentioned more positive feelings according to their mental state had greater resilience (p > 0.001). Conclusions: Errors were likely to happen during clinical practice due to nurses' negative experiences. The level of resilience among the nursing population was found to play a very important role not only in making mistakes but also in coping with errors during their daily routine. Wellness and prevention must be given top priority in all healthcare systems across the country in order to promote nurses' optimal health and wellbeing, raise the standard of care, and reduce the likelihood of expensive, avoidable medical errors. Healthcare administrations should promote prevention programs for stress occurrence in order to support nurses' wellbeing maintenance.

Anger and Aggression in Relation to Psychological Resilience and Alcohol Abuse among Health Professionals during the First Pandemic Wave

Mental health problems, behavior changes, and addictive issues have been consistently documented among healthcare workers during the pandemic. The objective of this study was to investigate the levels of anger and aggression in relation to psychological resilience and alcohol abuse among healthcare workers during the first wave of the COVID-19 pandemic. A total of 120 physicians and 123 nurses completed an online survey of the Dimensions of Anger Reactions-5 (DAR-5), the Brief Aggression Questionnaire (BAQ), the Brief Resilience Scale (BRS), and the Alcohol Screening questionnaire CAGE which is an acronym for the focus of the questions (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers). Demographic and professional data were also recorded. A total of 53 men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale and one out of ten respondents presented with current problematic alcohol use. Male participants demonstrated lower scores on the DAR-5 scale compared to females. Individuals with current problematic alcohol use displayed higher scores on the BAQ compared to those without alcohol use disorders. Regression analysis revealed that 16.4% of the variance in the BAQ scores can be attributed to scores on the DAR-5, 5.9% to the BRS scores, 2.1% to the CAGE scores, 1.7% to gender, and 1.2% to years of work experience. Mediation analysis highlighted the role of psychological resilience as a negative mediator in the DAR-5 and BAQ relationship. Professional experience and alcohol abuse emerged as positive and negative risk factors contributing to aggression and psychological resilience. The findings hold practical implications for implementing interventions to strengthen resilience in order to compensate for aggressive tendencies and discourage addictive issues.

Factors associated with perceived resilience among unergraduate nursing students: findings of the first cross-sectional study in Palestine

BACKGROUND

Resilience has emerged as a concept that could explain and predict good academic and well-being of students in stressful and traumatic situations. This study was conducted to assess resilience and identify predictors of high or low resilience scores among future nurses in Palestine.

METHODS

This cross-sectional study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology statement. Undergraduate nursing students in all academic years were recruited and asked to complete a questionnaire that contained the Trait Resilience Scale and the State-Resilience Scale. Multiple linear regression models were used to identify predictors of higher resilience scores and to control for potentially confounding factors.

RESULTS

In this study, 290 students completed the questionnaire (response rate = 92.4%). The means of trait, state, and combined resilience scores were 71.4 (SD: 7.5), 62.7 (SD: 6.7), and 134.1 (SD: 12.8), respectively. There was a significant moderate positive correlation between state resilience scores and trait resilience scores (r = 0.63, p < 0.001). Having a study routine on daily basis predicted higher trait (β = -0.20, p < 0.001), state (β = -0.12, p = 0.032), and combined (β = -0.18, p = 0.001) resilience scores. Trait and combined resilience scores were predicted by the absence of chronic diseases (β = 0.12, p < 0.05), experiencing addiction issues (β = -0.11, p < 0.05), living in Israeli seized areas (β = 0.16, p < 0.05), and living in a house with enough number of rooms per siblings (β = 0.13, p < 0.05). On the other hand, state and combined resilience scores were predicted by being in the first academic year (β = -0.18, p < 0.01), and state resilience scores were predicted by living in urban areas (β = -0.12, p < 0.05).

CONCLUSIONS

Undergraduate nursing students in Palestine reported relatively high trait and state resilience scores. Higher trait, state, and combined resilience scores were predicted by having a study routine on daily basis. More studies are still needed to investigate the relationship between resilience scores, perceived well-being, willingness to care, and the future success of nursing students in Palestine.

Patient safety and its relationship with specific self-efficacy, competence, and resilience among nursing students: A quantitative study

BACKGROUND

Patient safety is a relevant subject in the nursing curriculum. Each university programs patient safety teaching and practical training differently. However, few studies have sought to explore the relationship between patient safety as perceived by nursing students and other important psychosocial competencies in the nursing curriculum, such as self-efficacy, competence, and resilience.

OBJECTIVES

To analyze differential patient safety integration into three nursing education programs, and to assess agreement levels regarding patient safety climate, students' knowledge of patient safety and correlations with specific self-efficacy, competence and resilience.

METHODS

Participants were 647 undergraduate students from three universities. Patient safety climate and knowledge of patient safety (good praxis) were measured using the Hospital Survey on Patient Safety Culture for nursing students, and other psychosocial variables were also analyzed using other instruments: specific self-efficacy, perceived competence and resilience. Nursing education programs and patient safety climate were analyzed using the Rwg(j) and ICC measures of inter-rater agreement across different academic levels.

RESULTS

The ICC and Rwg indexes revealed high inter-rate agreement in all three universities. Differences were observed between Univ-2 and Univ-3 in patient safety climate scores and agreement values between academic levels. Differences in good praxis were found when academic levels were compared in Univ1-and Univ-2. Patient safety climate was found to correlate significantly with the psychosocial variables studied, but only in Univ-1.

CONCLUSIONS

Perceived patient safety climate differs between universities and academic levels. This competency is related to self-efficacy, competence and resilience, which endorses the assessment of patient safety integration from a broader perspective.

Development and Validation of a Chinese Resilience Scale for Young Children

(1) Background: Resilience research began in the child population as a validity scale to describe children's psychological wellbeing and ability to cope with negative events, and to some extent, to predict recovery and adaptation when they experience adversity again. In view of the important developmental implications of resilience in young children and the lack of a Chinese children's resilience scale, this study developed a resilience scale for young Chinese children based on a systematic review of existing international resilience scales and the characteristics of the Chinese cultural background. (2) Methods: The scale was developed by referring to existing scales, expert interviews, item collation and item finalization, developing original items, then deleting and determining items through item analysis, and finally, comparing with existing scales to obtain the internal and external validity of this scale. (3) Results: The results showed that the scale has good measurement properties, internal consistency reliability, and internal and external validity. (4) Conclusions: Through the development and validation of the Resilience Scale for young children in China, the scale can be used to measure the resilience of young children in China.

Resilience in Stroke Patients: A Concept Analysis

(1) Background: Resilience enables individuals to develop positive coping strategies when faced with adversity. However, knowledge on resilience in stroke patients remains limited, and resilience assessment methods continue to be debated. (2) Aim: To perform a concept analysis of resilience in stroke patients. (3) Methods: The Walker and Avant approach to concept analysis was adopted. Searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Chinese Electronic Periodical Services (CEPS) databases and grey literature using the keywords "stroke patient", "resilience", and "concept analysis". (4) Results: The defining attributes of resilience in stroke patients were classified into internal personality traits and external environmental support. Antecedents included physical, mental, and familial and social impairments caused by the disease, and the consequences were good adaptation, which included active cooperation with rehabilitation activities, positive thinking, goal setting, and harboring hope for the future. (5) Conclusion: Resilience is of a diverse and complex nature. Optimism and positivity, problem-solving ability, and familial and social support may assist in re-adjusting or restoring the balance between physical and mental health when a stroke patient faces adversity. Key factors affecting resilience in stroke patients should be further investigated in future research to assist in the development of effective interventional treatment measures.

R, Uy MM, Alrashidi N, Alreshidi MS, Mina E, Gonzales A. Resilience and Emotional Intelligence of Staff Nurses during the COVID-19 Pandemic

Although numerous scholars have studied resilience during the COVID-19 pandemic, research exploring its relationship with emotional intelligence is scarce. The aim of this study was to determine the relationship between the resilience and emotional intelligence (EI) of staff nurses during the COVID-19 pandemic. Data for this quantitative correlational study were gathered from the staff nurses of hospitals in the city of Hail, Saudi Arabia. The researchers employed simple random sampling, which yielded 261 staff nurses. Nationality (t = 6.422; p < 0.001) was found to have a significant relationship with resilience. Sex (t = 5.22; p < 0.001), ward assignment (t = 5.22; p < 0.001), age (F = 6.67; p < 0.001), and years of experience (F = 6.67; p < 0.001) revealed significant relationships with emotional intelligence. Resilience had a moderate positive relationship with EI (r = 0.55; p < 0.023), a weak positive relationship with self-emotion (r = 0.21; p < 0.003), and a very strong relationship with emotional appraisal (r = 0.85; p < 0.001). Improving emotional-intelligence skills is critical for assisting nurses during pandemic outbreaks. This can increase their individual and social resilience, while also improving their professional and life outcomes. These research findings suggest that emotional intelligence should be integrated into clinical practice and that EI data should be integrated into decision-making.

Stress and coping experience in Nurse Residency Programs for new graduate nurses: A qualitative meta-synthesis

Objectives

To determine the stress experience and coping styles of new nurses during Nurse Residency Programs (NRPs) by identifying, appraising, and synthesizing data from the qualitative studies.

Design

A systematic review and meta-synthesis of qualitative studies.

Review methods

Eleven databases were systematically searched for relevant publications in March 2022. All qualitative and mixed-method studies in English and Chinese that explored the stress and coping experience during NRPs of new graduate nurses were included. The qualitative meta-synthesis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two independent reviewers selected the studies and assessed the quality of each study. Meta-synthesis was performed to integrate the results.

Results

A total of 13 studies revealed 13 sub-themes and three descriptive themes: multi-dimensional stressors, somatic and emotional responses, coping resources and coping methods.

Conclusion

New nurses faced a lot of physical and emotional stress during NRPs, which had a negative impact on their physical and mental health. NRPs are a critical period for the career growth of new nurses. Effective management strategies must be implemented to improve nurse capacity, meet their needs, improve self-efficacy, and build organizational support, as this can improve the quality of clinical nursing and keep the enthusiasm and stability of the nursing team.

Working in hospitals during a pandemic: investigating the resilience among medical staff during COVID-19 outbreak through qualitative and quantitative research

Background:

Medical staff in hospitals were faced with great stress as a result of COVID-19’s sudden and severe occurrence, which makes investigating their resilience essential.

Aims and methods:

Using qualitative and quantitative research methods, this research studied medical staff (n = 403) working in a hospital during the COVID-19 pandemic and followed four main goals: First was evaluating the psychometric properties of the Persian version of Adult Resilience Measure-Revised (ARM-R). The second goal was investigating the personal, relational, social, and organizational issues facing the medical staff during the COVID-19 using semi-structural interviews. The third goal was to determine predictive effects of demographic and work-related variables on resilience using stepwise regression analysis. And the fourth was comparing resilience of three groups of the medical staff (coronavirus group consisted of the medical staff in direct contact with COVID-19 patients; emergency group who work in the emergency department who deal with both COVID and non-COVID patients; and non-coronavirus group who had no contact with COVID-19 patients) using one-way ANOVA.

Findings:

Results showed that internal reliability/consistency, content, and face validity of the Persian version of the ARM-R are acceptable. The construct validity of the test was also verified using exploratory factor analysis and indicated the two factors of personal and relational resilience. The content of the interviews was analyzed using manifest content analysis, and the results were divided into 27 subcategories and 3 main categories including personal, organizational, and family categories. Moreover, regression analysis revealed that the marital status and age of children can explain resilience variance in some medical staff groups. The results of ANOVA and post hoc test also showed that the total resilience of the non-coronavirus group was greater than the coronavirus and emergency groups; the relational resilience of the coronavirus and non-coronavirus groups was greater than the emergency, and non-coronavirus group’s personal resilience was greater than the emergency group.

Burnout, stress and resilience of an Australian regional hospital during COVID-19: a longitudinal study

Coronavirus disease 2019 (COVID-19) has placed huge strain on hospital staff around the world. The aim of the current longitudinal study was to investigate the resilience, stress and burnout of hospital staff located at a large, regional hospital in Victoria, Australia during the COVID-19 pandemic over time via cross-sectional surveys. The surveys were disseminated six times from August 2020 to March 2021, with the first three data collection points distributed during a state-wide lockdown. A total of 558 responses from various professional roles within the hospital over the survey period were included in the sample. Analysis of variance indicated significant main effects for the psychological variables across time, age, and workload. Hospital staff reported an increase in burnout levels throughout the eight-months. Significant negative relationships were observed between resilience and burnout, and between resilience and stress. A backward regression highlighted the contribution of resilience, stress, age, and nursing roles on burnout. Hierarchical regression analysis indicated that resilience contributed to the stress-burnout relationship. This study strengthens the evidence between resilience and burnout among healthcare workers and hospital staff and highlights the need for psychological wellbeing programs to be implemented for hospital staff impacted by a prolonged worldwide pandemic.

Resilience and job satisfaction among out-of-hospital emergency medical service professionals: A cross-sectional multi-centric study

AIM

We aim to describe the relationship between job satisfaction and compare levels of resilience among out-of-hospital emergency medical service professionals.

BACKGROUND

The study of the impact of the working environment on health professionals has raised great interest. Job-related variables and resilience can be a protective factor against stressful and demanding events at work.

METHODS

A cross-sectional survey comprising sociodemographic and job-related variables was conducted among 406 workers (doctors, nurses, psychologists, and ambulance technicians) from the out-of-hospital emergency medical system in Spain. Resilience was self-reported using the Connor-Davidson Resilience Scale.

RESULTS

Nursing professionals were less resilient compared with ambulance technicians (score difference 1.709, p = .008). As age increased, resilience was lower (r = -.118). Professionals with higher resilience scores were more satisfied in their work (OR = 1.06, 95% CI: 1.02-1.11), and professionals with higher psychological strength, gained from working with other colleagues, also showed greater job satisfaction (OR = 5.47, 95% CI: 2.55-11.73).

CONCLUSION

There was a positive association between resilience, job satisfaction and collaborative work. Professionals with greater psychological strength, gained from working with other colleagues, also showed higher levels of job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers can use these results to influence the work environment to enhance job satisfaction and hence improve the resilience of the out-of-hospital emergency health care professionals.

The Effect of Second-Victim-Related Distress and Support on Work-Related Outcomes in Tertiary Care Hospitals in Kelantan, Malaysia

After a patient safety incident, the involved healthcare providers may experience sustained second-victim distress and reduced professional efficacy, with subsequent negative work-related outcomes and the cultivation of resilience. This study aims to investigate the factors affecting negative work-related outcomes and resilience with a hypothetical triad of support as the mediators: colleague, supervisor, and institutional support. This cross-sectional study recruited 733 healthcare providers from three tertiary care hospitals in Kelantan, Malaysia. Three steps of hierarchical linear regression were developed for both outcomes (negative work-related outcomes and resilience). Four multiple mediator models of the support triad were analyzed. Second-victim distress, professional efficacy, and the support triad contributed significantly in all the regression models. Colleague support partially mediated the relationship defining the effects of professional efficacy on negative work-related outcomes and resilience, whereas colleague and supervisor support partially mediated the effects of second-victim distress on negative work-related outcomes. Similar results were found regarding resilience, with all support triads producing similar results. As mediators, the support triads ameliorated the effect of second-victim distress on negative work-related outcomes and resilience, suggesting an important role of having good support, especially after encountering patient safety incidents.

Mental 3D Visualization: Building Surgical Resilience for Performing High-Risk Procedures

OBJECTIVE

Psychological resilience has been studied in several demanding professions, including the military and competitive sports, yet specific strategies for managing stress are not commonly addressed during surgical training. The objective of this study was to investigate how surgeons view performance under pressure during high-risk surgical steps.

DESIGN

Using constructivist grounded theory, we conducted 12 individual semi-structured interviews with a theoretical sample teaching surgeons, representing 10 different specialties and a range of experience. We drew on Luthar's concept of resilience as positive adaptation, an active and flexible process in which critical choices are made in stressful situations. We asked about both protective and vulnerability factors contributing to resilience in high-risk surgery. We coded transcripts, transforming each category of codes into a visual schematic highlighting our findings related to performance under pressure and resilience, which we transformed into a conceptual model.

SETTING

Truman Medical Center, Kansas City, MO, tertiary hospital.

PARTICIPANTS

Twelve teaching surgeons from 10 different surgical specialties.

RESULTS

Mental 3D visualization is necessary for proper preoperative planning, enacting contingency plans in the face of intra-operative challenges, and managing emotions during high-risk surgery. Each of these factors informs staying calm under pressure and is necessary for building long-term surgical resilience. Negotiating challenges in high-risk surgery is contingent upon adapting to risk developed over time through surgical experience, mental 3D visualization, intentionality, and self-reflection.

CONCLUSIONS

Mental 3D visualization informs processes for staying calm under pressure and is essential for building long-term surgical resilience. We recommend that residency curricula offer progressive education on mental 3D visualization and foster intraoperative environments that promote adapting to risk.

Psychometric evaluation of the perceived perioperative competence scale-revised among the Chinese operating room nurses: a methodological research

Background

Perioperative competence is necessary to evaluate operating room nurses. The Perceived Perioperative Competence Scale-Revised (PPCS-R) is the only available tool developed specifically for the perioperative setting. However, there is a lack of research on the reliability and validity of this scale among Chinese nurses. Thus, the aim of this study is to translate, culturally adapt, and evaluate the psychometric properties of the Perioperative competence Scale-Revised (PPCS-R) among operating room nurses in China.

Methods

Instrument cultural adaptation was carried out through forward translation, back translation, expert panel evaluation and pretesting. The psychometric properties (content validation, item analysis, construct validation, and reliability coefficient) of the Chinese PPCS-R (C-PPCS-R) were examined. An online survey was completed from June to August 2020 by operating room nurses (N = 480) in five third-grade class-A hospitals in Beijing.

Results

The item analysis identified six items for scale reduction. Exploratory factor analysis showed the remaining 34 items loaded on six factors, which were named in accordance with the original scale. The six-factor model showed a good fit through confirmatory factor analysis. The item content validity index for the C-PPCS-R items ranged from 0.857 to 1.000, and that for the total scale was 0.875. Cronbach’s alpha was showed 0.787. Together, the six factors explained 68.62% of the variance.

Conclusions

The 34-item C-PPCS-R showed good validity and reliability to measure perceived competence among operating room nurses in the Chinese context. The scale can assist nurse managers to identify operating room nurses’ perceived competence, and provides evaluation criteria for career planning, performance appraisal, job assignment, and continuing education.

Organizational learning, resilience and psychological empowerment as antecedents of work engagement during COVID-19

Purpose

This paper aims to explore the relationship between organizational learning (OL) and work engagement (WE) in the Middle East region amid the COVID-19 pandemic and to test the mediating role of employee resilience (ER) and psychological empowerment (PE) on this relationship.

Design/methodology/approach

The sample size was 208 respondents working in the Middle East area during COVID-19. Hypotheses were tested using regression analysis with bootstrapping.

Findings

The findings indicate a significant positive impact of OL on WE. Moreover, both constructs – ER and WE – were identified as mediators for this relationship.

Practical implications

Practical implications within this study call for organizations to focus on promoting a learning culture in order to adapt and respond effectively to unprecedented external challenges.

Originality/value

The current study extends previous research and strengthens the antecedents of WE, namely, OL, ER and PE in the Middle East region while controlling for COVID-19 perceptions.

Bio-Psycho-Socio-Spirito-Cultural Factors of Burnout: A Systematic Narrative Review of the Literature

Background: Burnout is a widespread, multifactorial, and mainly psychological phenomenon. The pathogenesis of burnout is commonly described within the bio-psycho-social model of health and disease. Recent literature suggests that the phenomenon of burnout may be broader so that the three dimensions might not reflect the multifaceted and complex nature of the syndrome. Consequently, this review aims to identify the diversity of factors related to burnout, to define overarching categories based on these, and to clarify whether the bio-psycho-social model adequately describes the pathogenesis of burnout-holistically and sufficiently. Method: Five online databases (PubMed, PubPsych, PsychARTICLES, Psychology and Behavioral Sciences Collection, and Google Scholar) were systematically searched using defined search terms to identify relevant studies. The publication date was set between January 1981 and November 2020. Based on the selected literature, we identified factors related to burnout. We aggregated these factors into a comprehensible list and assigned them to overarching categories. Then, we assigned the factors to the dimensions of an extended model of health and disease. Results: We identified a total of 40 burnout-related factors and 10 overarching categories. Our results show that in addition to biological, psychological, and socio-environmental factors, various factors that can be assigned to a spiritual and work cultural dimension also play an important role in the onset of burnout. Conclusion: An extended bio-psycho-socio-spirito-cultural model is necessary to describe the pathogenesis of burnout. Therefore, future studies should also focus on spiritual and work cultural factors when investigating burnout. Furthermore, these factors should not be neglected in future developments of diagnosis, treatment, and prevention options.

Job stress and resilience in Iranian nurses during the COVID-19 pandemic: A case-control study

BACKGROUND

The COVID-19 pandemic has created a wide range of sociocultural pressures on nurses. Resilience is defined as one's ability to adapt to an unpredictable situation and it can be a factor in accepting an undesirable psychosocial situation.

OBJECTIVE

The aim of the present study was to examine resilience in nurses in the face of job stress during the COVID-19 pandemic.

METHODS

The study was carried out as a case-control study with participation of 400 nurses as the target group (nurses exposed to COVID-19 patients) and the control group (nurses not exposed to COVID-19 patients). To examine resilience and job stress, Conor and Davidson's questionnaire and OSIPOW questionnaire were used respectively.

RESULTS

The mean scores of job stress and resilience were significantly different between the target and control groups (p < 0.05). So that resilience in the target group was less than that in the control group. In addition, job stress in the target group was higher than that of the control group (p < 0.05). There was a significant and negative correlation between resilience and job stress and the correlation was stronger in the target group (p < 0.05).

CONCLUSIONS

Given the high job stress score in the participants and its negative correlation with resilience, there is need to provide the health personnel with efficient preventive and treatment approaches, improve and educate the principles of resilience, improve mental health services system, and introduce programs to control some of demographical factors in job stress such as physical activity, and employment status of nurses.

The effect of resilience and self-efficacy on nurses' compassion fatigue: A cross-sectional study

AIM

To measure the prevalence of compassion fatigue among Chinese clinical nurses and to examine the effects of resilience and self-efficacy on compassion fatigue.

DESIGN

A cross-sectional descriptive survey was conducted in accordance with the STROBE guidelines.

METHODS

Participants were recruited from three tertiary hospitals in central China from October 3 to December 15, 2019, using convenience sampling. Clinical nurses (n = 992) from different nursing departments completed the General Information Questionnaire, Professional Quality of Life Scale, Connor-Davidson Resilience Scale, and General Perceived Self-Efficacy Scale. Descriptive statistics, t-tests, one-way analysis of variance, Pearson or Spearman's correlation analyses, and multiple linear regression models were used.

RESULTS

Nurses experienced moderate levels of compassion fatigue (burnout and secondary traumatic stress). Resilience and self-efficacy were significantly negatively correlated with burnout but not with secondary traumatic stress. Linear regression analysis showed that resilience, self-efficacy, exercise, and physical conditions were the main predictors of burnout. Only physical conditions and marital status significantly predicted secondary traumatic stress.

CONCLUSION

Nurses are vulnerable to compassion fatigue in China. Resilience and self-efficacy significantly negatively predicted nurses' compassion fatigue. Physical conditions, healthy lifestyles, and social support are also important factors for compassion fatigue.

IMPACT

Our findings can be used to generate targeted intervention and coping strategies for nurses to improve their resilience and self-efficacy to alleviate compassion fatigue.

Work-Life Balance and Mental Health Needs of Health Professionals During COVID-19 Pandemic in Turkey

Health professionals constitute a group that is at a high risk of COVID-19. They have been found to experience difficulties in many issues, one of which is that they face the risk of infecting themselves and others due to interaction with high-risk patients. The present study investigates how demographical and individual factors and work addiction affected work-life balance and mental health needs of health professionals. The data of the present study were collected in the first wave of pandemic. The hypothesized structural equation model was rejected based on the fit indices. The second analysis of modified model was significant and indicated that whether health professionals live alone or with others such as family members had direct effects on work addiction, indirect effects on work-life balance, and needs for mental health. In addition, gender and working hours had direct effects on work-life balance. The highest effect on work-life balance was caused by work addiction. Moreover, work addiction had a moderate effect on mental health needs. As a result, the current study showed that work-life balance, work addiction, and the need for mental health were affected during the COVID-19 pandemic.

Understanding stress factors for scrub nurses in the perioperative period: A cross-sectional survey

PURPOSE OF THE STUDY

To assess the stress factors affecting operating theater nurses during the perioperative period.

PATIENTS AND METHODS

The study was conducted as a cross-sectional survey by means of a specifically drawn-up questionnaire based on the data available in the literature. Stress was measured on a 0/100 visual analogue scale (VAS).

RESULTS

Six hundred and twelve (612) persons responded. Stress associated with an operation amounted to 31.8; it was higher at the time of the procedure (49.6) and immediately beforehand (39.4), particularly among the least experienced nurses. The most widely represented stress factors were associated with the surgical team (perceived incompetence, lack of confidence), relational problems with regard to the surgeon, and team members' disruptive behavior. By contrast, familiarity with the team or the procedure seemed to shield the nurses from stress. Feelings of stress had a relatively frequent impact on quality of life (33%), family and personal life (26%), with chronic (recurrent or constant) stress symptoms reported among 20% of respondents.

CONCLUSION

Among operating theater nurses, stress associated with an operation was particularly strong among the least experienced professionals, when the type of procedure or the other team members were unfamiliar, and in the event of disruptive behavior. Stress factor improvement should be a priority, the objective being to enhance professional and personal quality of life, while better ensuring patient safety.

Psychosocial Factors Associated With Resilience Among Iranian Nurses During COVID-19 Outbreak

Background: In the face of COVID-19, healthcare workers need to cope with the ongoing stressors at play and keep psychological distress at a minimum level. This study examined the psychosocial and demographic factors associated with nurse's resilience in the hospitals of Ahvaz that is one of the top cities infected with COVID-19 in Iran.

Methods: The present cross-sectional study was conducted on 387 Iranian nurses in Ahvaz city. For data collection purposes, three online questionnaires (including Copenhagen Psychosocial, Demographic, and Connor–Davidson Resilience Scale) were distributed among the participants.

Results: The mean resilience score was equal to 61.8 ± 14.8 for 387 nurses. Resilience had a statistically significant negative correlation with quantitative demand (r = −0.273, P < 0.008), work pace (r = −0.262, P < 0.011), emotional demand (r = −0.226, P < 0.030), stress (r = −0.458, P < 0.000), and burnout (r = −0.287, P < 0.005). Multiple linear regression analysis indicated that stress, job satisfaction, burnout and age were the main predictors of nurses' resilience during the (COVID-19) pandemic (R² = 0.45).

Conclusions: We identified psychosocial and demographic predictive factors that may contribute to greater resilience among nurses during the COVID-19 outbreak. The findings of this study can be used to implement psychosocial interventions to amplify the resilience of medical staff during the COVID-19 outbreak.

Healthcare worker resilience during the COVID-19 pandemic: An integrative review

AIM

The purpose of this review was to examine resilience among healthcare workers during the coronavirus-disease-2019 (COVID-19) pandemic.

BACKGROUND

The COVID-19 pandemic has caused an unprecedented strain on healthcare workers internationally. Rising infection rates, inadequate personal protective equipment, and the lack of availability of hospital beds has resulted in further deterioration of the already-fragile mental health of healthcare workers. Resilient workers have lower rates of burnout and improved patient outcomes.

EVALUATION

PubMed and the Cumulative Index to Nursing and Allied Health Literature databases were searched using the terms resilience, nurse and COVID-19 to identify studies on resilience during the COVID-19 pandemic. Results were organized by outcome measures for comparison.

KEY ISSUES

Resilience scores among frontline healthcare workers worldwide during the COVID-19 pandemic in the studies reviewed were overall found to be in the moderate range. Data from the United States showed a decrease in nurse resilience, whereas participants from China had increased resilience compared with pre-pandemic levels.

CONCLUSIONS

Building resilience in nurses and other healthcare workers can serve as a protective factor against negative outcomes related to the job, including burnout, anxiety and depression, and can improve patient outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies for building resilience in healthcare workers are discussed.

Sustaining implementation facilitation: a model for facilitator resilience

BACKGROUND

Implementation facilitators enable healthcare staff to effectively implement change, yet little is known about their affective (e.g., emotional, mental, physical) experiences of facilitation. We propose an expansion to the Integrated Promoting Action on Research in Health Services (i-PARIHS) framework that introduces facilitation intensity and facilitator resilience to better assess facilitators' affective experiences.

METHODS

We used an instrumental case study and facilitator data (logged reflections and debrief session notes) from the Coordination Toolkit and Coaching initiative to conceptualize facilitation intensity and facilitator resilience and to better understand the psychological impact of the facilitation process on facilitator effectiveness and implementation success.

RESULTS

We define facilitation intensity as both the quantitative and/or qualitative measure of the volume of tasks and activities needed to engage and motivate recipients in implementation, and the psychological impact on the facilitator of conducting facilitation tasks and activities. We define facilitator resilience as the ability to cope with and adapt to the complexities of facilitation in order to effectively engage and motivate staff, while nurturing and sustaining hope, self-efficacy, and adaptive coping behaviors in oneself.

CONCLUSIONS

Facilitators' affective experience may help to identify potential relationships between the facilitation factors we propose (facilitation intensity and facilitator resilience). Future studies should test ways of reliably measuring facilitation intensity and facilitator resilience and specify their relationships in greater detail. By supporting facilitator resilience, healthcare delivery systems may help sustain the skilled facilitator workforce necessary for continued practice improvement.

TRIAL REGISTRATION

The project was registered with ClinicalTrials.gov ( NCT03063294 ) on February 24, 2017.

Moral Resilience in Nursing Education: Exploring Undergraduate Nursing Students Perceptions of Resilience in Relation to Ethical Ideology

Introduction

Moral resilience has recently been proposed as one strategy to address moral distress in nurses and nursing students. Central to nursing students’ capacity for moral resilience is how they understood and enact resilience with an element of realism, suggesting an ethical, ideological influence. Resilience is shown to differ significantly across students, and possibly because of a disconnect between a students’ perceived resilience and their ethical ideology. Yet, resilience seldom has been explored in relation to ethical ideology.

Objective

This study aims to explore self-reported resilience in relation to ethical ideology in undergraduate nursing students, compare differences in scores, and explore relationships between study variables and selected demographic characteristics.

Methods

A descriptive cross-sectional research design was followed. An online encrypted survey was conducted among a convenient sample of nursing undergraduates who met the eligibility criteria and provided implied informed consent. This study complied with ethical principles outlined in the Canadian Tri-Council Policy Statement for research with human subjects. Ethical approval was secured from the University’s Research Ethics Board. Data were analyzed using mean scores, standard deviations, independent sample t-test, variance analysis with post hoc–testing, and Pearson correlation to explore differences in perceptions and associations between study and selected demographic variables.

Results

Undergraduate students have a high level of self-reported resilience. Statistically significant differences in self-reported resilience across selected demographic variables were observed. The association between resilience and ethical ideology was not significant. Ethical relativism was significantly correlated with age and year of study.

Conclusion

Findings suggest that faculty cultivating resilience in nursing students pays attention to gender’s influence discourses in students’ perceptions of resilience and ethical ideology and provides students with opportunities for ethical self-reflection and dialogue to critically examine their ethical ideological perspectives and the influence these may have on moral resilience development. Implications for future research are discussed.

Resilience and Burnout in Pediatric Nurses in a Tertiary Children's Hospital

PURPOSE

To identify levels of burnout and resilience in pediatric nurses in a tertiary children's hospital in New Zealand.

METHODS

Registered nurses providing pediatric care participated in a survey that included the Connor-Davison resilience scale and Maslach burnout scale. Nurses identified specific factors related to workload stress and strategies for enhancing resilience.

RESULTS

Participants were 197 nurses. We found low levels of resilience and high levels of burnout, although personal accomplishment scores were high. Nurses with <10 years of experience who worked >40 hours per week had significantly higher levels of emotional exhaustion compared with those who had >10 or more years of experience or worked <40 hours per week. There were differences in resilience levels based on years of practice and hours worked. Levels of depersonalisation were higher in different ethnic groups.

CLINICAL IMPLICATIONS

Burnout remains a significant problem for pediatric nurses. Job demands are likely to rise with the increased complexity of children with long-term conditions and families requiring support. Developing supportive plans to strengthen resilience and limit burnout are required. Further research is needed on how organizations can foster resilience practices and limit burnout, nurses feeling emotionally exhausted, reducing depersonalisation, and enhancing feelings of personal accomplishment. Nurse leaders can role-model positive resilience practices when engaging their teams in open conversations about preventing or reducing burnout.

Factors Affecting Resilience of Nursing, Optometry, Radiography and Medical Laboratory Science Students

Background: The concern over the high level of stress experienced by students of the caring professions has led to increased attention being paid to the promotion of their resilience. Most earlier studies have focused on the resilience of medical and nursing students. There has been little exploration of the resilience and associated factors of students of other health-care disciplines. The aim of this study was to gather data from students of pre-registration health-care disciplines to identify the factors that influence their resilience. Method: Valid questionnaires were used to assess respondents’ resilience, self-efficacy, mindfulness, coping and trait positive and negative affect. The data were analyzed using descriptive statistics and univariate and general linear regression. Results: A total of 1320 university students from nursing, medical laboratory science, radiography and optometry were recruited. The results showed that the subjects’ resilience scores were lower than those of students in Western countries. We found self-efficacy and denial to be the common predictors for students of all disciplines. Conclusion: The resilience of students in the four disciplines was predicted by a combination of predictors. Faculties of universities and clinical mentors should collaborate in building resilience in their health-care students and support them to grow both personally and professionally during their careers.

The Impact of Practice Environment and Resilience on Burnout among Clinical Nurses in a Tertiary Hospital Setting

The purpose of this study was to examine practice environment, resilience, and burnout and to identify the impacts of practice environment and resilience on burnout among clinical nurses working at a tertiary hospital. A cross-sectional secondary data analysis was conducted using a convenience sample of 199 nurses. The nurses completed survey questionnaires regarding practice environment, resilience, and burnout. The majority of the nurses were below the age of 30, single, and worked in medical-surgical wards. Approximately, 92% of the nurses reported moderate to high burnout, with a mean practice environment score of 2.54 ± 0.34 and resilience score of 22.01 ± 5.69. Practice environment and resilience were higher in the low level of burnout than in the moderate to high level of burnout. After controlling for demographic and occupational characteristics, resilience and nursing foundations for quality of care were significant predictors of burnout (OR = 0.71, p = 0.001; OR = 0.01, p = 0.036, respectively), explaining 65.7% of the variance. In a mixed practice environment, increased resilience and nursing foundations for quality of care lowered nurses’ burnout. Our findings suggest that interventions focused on enhancing individual resilience and practice environment and building better nursing foundations for quality of care should be developed and provided to alleviate burnout in clinical nurses working at tertiary hospitals. Nursing and hospital administrators should consider the importance of practice environment and resilience in nurses in developing interventions to decrease burnout.

Relationship between resilience and professional moral courage among nurses

Nurses need to be resilient to be able to endure their working conditions, and their moral courage can affect their resilience. This work aimed at studying the relationship between resilience and professional moral courage among nurses working in hospitals. This descriptive cross-sectional study was conducted on 375 nurses working in teaching hospitals in the city of Ardabil in Iran in 2019. Data was collected using the following questionnaires: a demographic questionnaire, Sekerka et al. Moral Courage Scale and Davidson-Connor Resilience Scale. The reliability of the Davidson-Connor Resilience Scale, and Moral Courage Scale were found to be 89% and 85% using the test-retest method. The data were analyzed by Pearson correlation coefficient, t-test, variance analysis, and linear regression using the SPSS software version 24. In participating nurses, mean scores were 6.35±0.5 for total moral courage (favorable) and 79.35±0.35 (moderate) for resilience, respectively. A positive and significant relationship was observed between resilience and professional moral courage (P<0.05, r=0.1). Given the positive and significant relationship between resilience and professional moral courage, nurses require to have the high moral courage to enhance their resilience. Determining factors affecting moral courage and resilience, as well as finding strategies and creating an appropriate moral climate can increase nurses' morally courageous behaviors and resilience.

Moderating Effects of Structural Empowerment and Resilience in the Relationship between Nurses' Workplace Bullying and Work Outcomes: A Cross-Sectional Correlational Study

This cross-sectional correlational study aimed to evaluate the moderating effects of structural empowerment and resilience in the relationship between workplace bullying and nursing work outcomes. Data were collected from 435 nurses and nurse managers working at a tertiary hospital in Seoul, South Korea. The moderating effects were examined using stepwise hierarchical multiple regression models. The bootstrapping method was utilized to verify the magnitude and significance of the moderating effects. Structural empowerment showed a moderating effect in the relationship between workplace bullying and nursing work outcomes: for the conditional values above the average level of structural empowerment, workplace bullying was significantly associated with nursing work outcomes, while work outcomes were low regardless of workplace bullying for the conditional values less than average. However, resilience had no moderating effect. To improve work outcomes, bullying must be reduced and structural empowerment and resilience increased.

Nurses´ stressors and psychological distress during the COVID-19 pandemic: The mediating role of coping and resilience

Aims

This study analyses the cross‐sectional effect of sources of stress during the peak of COVID‐19 pandemic on nurses´ psychological distress, focusing on the mediating role of coping strategies, both problem focused and emotion focused and resilience.

Design

Cross‐sectional and quantitative analyses.

Methods

Structural equation modelling was performed using survey data obtained during the period between 1 April‐25 May 2020 in a sample of 421 nurses from 39 Spanish provinces.

Results

Results confirmed that: (a) All the stressors have a significant, direct, and negative relationship with nurses´ psychological distress; (b) Emotion‐focused strategies is negatively related to nurses´ psychological distress directly and indirectly through resilience; and (c) Problem‐focused strategies is positively related to nurses´ psychological distress and negatively and indirectly through emotion‐focused strategies.

Conclusion

This study identifies an important mediation sequence of stressors on psychological distress through the simultaneous concurrent effect of Problem‐focused and Emotion‐focused strategies and resilience. It shows that enacting the two coping mechanisms and resilience resources is important to achieve an adaptive effect on nurses´ mental health.

Impact

Nurses with insufficient preparation and those with high levels of fear of contagion do not enact proper coping strategies. Thus, these nurses need special consideration due to their risk of higher vulnerability.

Measuring resilience in children: a review of recent literature and recommendations for future research

PURPOSE OF REVIEW

Understanding variability in developmental outcomes following exposure to early life adversity (ELA) has been an area of increasing interest in psychiatry, as resilient outcomes are just as prevalent as negative ones. However, resilient individuals are understudied in most cohorts and even when studied, resilience is typically defined as an absence of psychopathology. This review examines current approaches to resilience and proposes more comprehensive and objective ways of defining resilience.

RECENT FINDINGS

Of the 36 studies reviewed, the most commonly used measure was the Strengths and Difficulties Questionnaire (n = 6), followed by the Child Behavior Checklist (n = 5), the Resilience Scale for Chinese Adolescents (n = 5), the Rosenberg Self-Esteem Scale (n = 4), and the Child and Youth Resilience Scale (n = 3).

SUMMARY

This review reveals that studies tend to rely on self-report methods to capture resilience which poses some challenges. We propose a complementary measure of child resilience that relies on more proactive behavioral and observational indicators; some of our preliminary findings are presented. Additionally, concerns about the way ELA is characterized as well as the influence of genetics on resilient outcomes prompts further considerations about how to proceed with resiliency research.

Psychosocial factors promoting resilience during the menopausal transition

Despite significant biological, psychological, and social challenges in the perimenopause, most women report an overall positive well-being and appear to be resilient to potentially negative effects of this life phase. The objective of this study was to detect psychosocial variables which contribute to resilience in a sample of perimenopausal women. A total of 135 healthy perimenopausal women aged 40-56 years completed a battery of validated psychosocial questionnaires including variables related to resilience, well-being, and mental health. First, using exploratory factor analysis, we examined which of the assessed variables related to resilience can be assigned to a common factor. Second, linear regression analyses were performed to investigate whether a common resilience factor predicts well-being and mental health in the examined sample of women. Optimism (LOT-R-O), emotional stability (BFI-K-N), emotion regulation (ERQ), self-compassion (SCS-D), and self-esteem (RSES) in perimenopausal women can be allocated to a single resilience-associated factor. Regression analyses revealed that this factor is related to higher life satisfaction (SWLS; β = .39, p < .001, adj. R² = .20), lower perceived stress (PSS-10; β = - .55, p < .001, adj. R² = .30), lower psychological distress (BSI-18; β = - .49, p < .001, adj. R² = .22), better general psychological health (GHQ-12; β = - .49, p < .001, adj. R² = .22), milder menopausal complaints (MRS II; β = - .41, p < .001, adj. R² = .18), and lower depressive symptoms (ADS-L; β = - .32, p < .001, adj. R² = .26). The α levels were adjusted for multiple testing. Our findings confirm that several psychosocial variables (optimism, emotional stability, emotion regulation, self-compassion, and self-esteem) can be allocated to one common resilience-associated factor. This resilience factor is strongly related to women's well-being as well as mental health in perimenopause.

Social Embeddedness of Firefighters, Paramedics, Specialized Nurses, Police Officers, and Military Personnel: Systematic Review in Relation to the Risk of Traumatization

Background: Firefighters, paramedics, specialized nurses working in Intensive Care Units (ICUs), Operating Rooms (OR), and Emergency Rooms (ER), police officers and military personnel are more frequently exposed to potentially traumatic events than the general population; they are considered high-risk professionals. To reduce the risk of traumatization it is of great importance to be embedded in a social environment with supportive relationships. Methods: We performed a systematic review (based on the PRISMA-Guidelines) looking for social connections within the environment in which high-risk professionals are embedded (work, home, community), to obtain evidence on the impact of these connections on the risk of traumatization. Additionally, we aim to identify relevant supportive relationships in the professionals' environments. We identified the relevant scientific literature by searching, without time, and language restriction, five electronic bibliographic databases: MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, and Web of Science. These databases were last searched in January 2019. Results: A qualitative analysis of the 89 eligible (out of 9,047 screened) studies shows that for firefighters, paramedics, and emergency nurses social connections in their work environment are predominantly supportive relationships and may protect them against traumatization. In other occupations (OR-nurses, ICU-nurses, police officers), however, social connections at work are not only a source of support but are also a source of stress. For military personnel study results are inconclusive as to whether their social connections at work or at home support them against traumatization. In so far as connections are supportive, their sources vary greatly from one occupational group to another; they differ between work vs. home as well as within work between peers vs. supervisor. Conclusions: Being embedded in a social environment, i.e., having social connections, is important but not always sufficient to protect high-risk professionals against traumatization. For, while these connections may be the antecedents of supportive relationships, they can also be the antecedents of damaging relationships. Additionally, the sources of supportive relationships differ among groups. This suggests that knowledge of how the social structures of the occupational groups differ may increase our understanding of the impact of social connections and relationships, including socialization, on the risk of traumatization of high-risk professionals.

The Protective Role of Resilience in Emotional Exhaustion Among Dental Students at Clinical Levels

Purpose

The epidemic of burnout among dental students has been repeatedly documented. This study aimed to assess burnout, specifically emotional exhaustion (EE), and examined the impact of protective and risk psychological factors for EE among clinical-level dental students in Saudi Arabia (SA).

Methods

A cross-sectional study was conducted, using a convenience sample of undergraduate dental students who were recruited from five separate dental schools. A self-administered questionnaire was distributed to 500 students to obtain socio-demographic data and to assess the students’ psychological characteristics (Maslach Burnout Inventory EE subscale, Dental Environment Stress Scale [DES] and Brief Resilience Scale [BRS]). Descriptive, bivariate and multivariable logistic regression analyses were performed.

Results

Of 272 respondents, 53% reported high EE. Adjusted multivariable logistic regression modelling demonstrated that students who reported higher BRS scores were significantly less likely to report high EE (adjusted odds ratio [AOR]=0.79, 95% CI=0.70–0.89, p<0.001). However, females were more than twice as likely as males to report high EE (AOR=2.27, 95% CI=1.14–4.61, p=0.024). In addition, students who reported higher DES scores also reported high EE (AOR=1.10, 95% CI=1.07–1.12, p<0.001).

Conclusion

The findings suggest that resilience is a protective factor against high EE, after adjusting for key characteristics. There is a need for a preventive programme that addresses EE, taking into consideration other unexplored underlying factors.

The Mediating Effect of Childcare Teachers' Resilience on the Relationship between Social Support in the Workplace and Their Self-Care

(1) Background: The purpose of this study is to examine the relationship between social support in the workplace for childcare teachers, resilience, and self-care. This study explores the inner mechanism that helps to strengthen self-care of childcare teachers, which enables teachers to provide quality care to children and promote their own wellbeing. (2) Methods: The survey was conducted from September to October 2018 for childcare teachers in Seoul and Gyeonggi Province using convenience sampling. Out of 550 questionnaires, 491 were returned, with 466 used for the analysis, excluding those with incomplete responses. The collected data were analyzed using descriptive statistics, correlation analysis, and mediation analysis. (3) Results: There were significant correlations between all variables. The mediation analysis showed a complete mediation of resilience. (4) Conclusion: Childcare teachers first have to take good care of themselves in order to perform well as a childcare professional. Educational materials and counseling programs tailored for childcare teachers need to be developed for better self-care and building greater resilience. Materials for directors of daycare centers, as well as teachers stressing the importance of social support for each other, will help childcare teachers’ effective functioning in their professional and personal life. Prevention and intervention programs for self-care will eventually help lower the costs of healthcare in society.

Perioperative nurses' experiences in relation to surgical patient safety: A qualitative study

Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture.

The Effect of Nurse Practice Environment on Retention and Quality of Care via Burnout, Work Characteristics, and Resilience: A Moderated Mediation Model

OBJECTIVE

The aim of this study was to explore the influence of nurse work characteristics, resiliency, and burnout on retention, and patient quality and safety.

BACKGROUND

With an ongoing nursing shortage, maintaining qualified nursing staff is critical. We explored the direct and indirect effects of practice environment, nurse work characteristics, and burnout on retention, and perceived quality and safety.

METHODS

Responses from 507 RNs were collected via an anonymous online survey. Theorized relationships were explored via path analysis and invariance testing.

RESULTS

Positive practice environment and favorable work characteristics lowered burnout and improved outcomes. The indirect effects of work characteristics and burnout were dependent upon individual level of resilience. Social capital minimized the effects of burnout for participants reporting below-average resilience.

CONCLUSIONS

Leader support was critical in shaping positive perception of the practice environment. A nurse leader's visibility and actions impact intent to stay. Results of this study may inform healthcare systems struggling to retain a robust, engaged nursing workforce.

Self-Efficacy and Clinical Characteristics in Casual Gamers Compared to Excessive Gaming Users and Non-Gamers in Young Adults

This study investigated differences in the self-efficacy and clinical characteristics which were found relevant to addictive behaviors in young adults according to time spent gaming. To our knowledge, this is the first study to explore self-efficacy in casual gamers relative to patients with internet gaming disorder (IGD) and non-gamers. In total, 158 young adults participated in this study and were divided into three groups: excessive gamers, who were diagnosed with IGD based on the Diagnostic and Statistical Manual of Mental Disorder-fifth edition (DSM-5, n = 71); casual gamers, who played games regularly but did not meet the criteria for IGD (n = 37); and non-gamers/controls, who did not engage in gaming (n = 50). All participants completed self-administered questionnaires, including measures of self-efficacy and clinical features such as the Barratt Impulsiveness Scale, Beck Depression Inventory, Beck Anxiety Inventory, Behavioral Activation/Inhibition Systems, aggression, and psychosocial well-being. There were significant differences in the self-efficacy according to the extent of gaming (excessive gamers < casual gamers < non-gamers). In addition, aggression, impulsivity, depression, anxiety, level of stress, and behavioral inhibition system scores were significantly higher in excessive gamers than in casual gamers and non-gamers. These findings showed that individuals who spend more time playing games tend to have lower self-efficacy. Our study suggests that self-efficacy may protect against or constitute a risk of excessive gaming, particularly among casual gamers. It is necessary to pay attention to enhancing psychological well-being through self-efficacy to prevent addiction in young adult gamers.

Nurse resilience: A concept analysis

Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty-nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self-efficacy, work-life balance/self-care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.

Assessment of the relation between religiosity, anxiety, depression and psychological resilience in nursing staff

The nursing profession is considered to be an emotionally demanding profession often lead to various psychological difficulties and extend level stress. Religiosity and religion in general, have been associated with positive outcomes in an individual's life such as higher self-esteem, better quality of life and psychological wellbeing. The purpose of this study was to examine the relation between nurses' religiosity, psychological resilience, and psychological wellbeing. In this cross-sectional study, 378 nurses participated. Dada were collected by using Centrality of Religiosity Scale, The Patient Health Questionnaire Two-Item Depression Scale, The Generalized Anxiety Disorder Questionnaire, Connor-Davidson Resilience Scale 25. Percentages, means, and standard deviations were calculated. In addition the parametric t-test and ANOVA were used. Also, logistic regression analyses were used to determine which factors affect the depression and anxiety of nurses. Results indicated differences with a probability of less than or equal to 0.05 were accepted as significant. For statistical analysis, we used the statistical program SPSS 25. According to our results although religious practices can be a protective factor for both depression and anxiety, religious beliefs and experiences can increase the levels of depression and anxiety as well.

Resilience and its correlates among first ischemic stroke survivors at acute stage of hospitalization from a tertiary hospital in China：a cross-sectional study

Objectives: To measure the resilience of elderly patients with first ischemic stroke in mainland China and to identify variables that may be correlated with resilience at the acute stage of hospitalization.Methods: A cross-sectional survey was carried out in departments of neurology of two tertiary hospitals, where a convenience sample of one hundred and forty-seven elderly patients with first ischemic stroke voluntarily participated in our study. Resilience was assessed using the Chinese version of Connor-Davidson Resilience Scale with three dimensions (tenacity, strength, and optimism). The General Self-Efficacy Scale and Medical Coping Modes Questionnaire were applied to evaluate the respondents' general self-efficacy and coping style. Functional independency was also measured using the Functional Independency Measure.Results: The mean score of the 147 respondents' resilience was 62.51 ± 14.69. Together, general self-efficacy, resignation, confrontation, per capital monthly income, and being main source of family income explained 68.1% of the variance in resilience. General self-efficacy, resignation, and confrontation were the strongest explanatory factors. Specifically, 63.4% of the variance in tenacity was explained for general self-efficacy, resignation, being main source of family income, surgical history, and per capital monthly income. 63.2% of the variance in strength was ascribed to general self-efficacy, resignation, per capital monthly income and avoidance. 32.5% of the variance in optimism was attributed to general self-efficacy, religion, and resignation.Conclusion: General self-efficacy and coping style may be implied orientation in enhancing resilience of elderly patients with first ischemic stroke at acute hospitalization. Moreover, economic status may predict level of resilience.HighlightsResilience was measured in 147 older first-episode ischemic stroke survivors at acute hospitalization.General-efficacy was the strongest predictor of resilience.Resilience was significantly influenced by resignation.Coping strategy should be emphasized early after stroke.