Resilience: An Integrated Review

Occupational Health Challenges for Aviation Workers Amid the Changing Climate: A Narrative Review

Although there are many forecasts regarding the impact of climate change on the aviation sector, a critical but frequently neglected dimension is the occupational safety risks faced by aviation professionals. This narrative review explores the potential impacts of the changing climate on the health and safety of aviation personnel. Furthermore, we examine the significance of resilience in helping these workers adapt and effectively manage climate-related challenges in their professional lives. Climate change poses increasing threats to the well-being of flight personnel through elevated temperatures, heightened ultraviolet radiation exposure, increased mental workload from extreme weather events, and other psychological stressors. Building resilience through workforce training, planning, and adaptation can reduce vulnerability. In future research, the iterative process of selecting measurement components to gauge the impact of climate change should balance feasibility, relevance for stakeholders, and accurately capturing exposure effects. For instance, while salivary cortisol measures stress biologically, assessments of depression or burnout may provide more nuanced insights on pilot health for industry decision-makers managing climate impacts. In conclusion, a strategic emphasis on enhancing the physical and psychological well-being of the aviation workforce is imperative for facilitating a more efficient adaptation within the sector. This is of paramount importance, considering the critical function that aviation serves in fostering human connectivity. Consequently, it is essential for regulatory bodies and policymakers to prioritize the safeguarding of employee health in the face of climate change challenges.

The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses

INTRODUCTION

Moral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses.

METHODS

A cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience.

RESULTS

Four distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams.

DISCUSSION

Our study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.

Sleep Quality and Its Relationship to Anxiety and Hardiness in a Cohort of Frontline Italian Nurses during the First Wave of the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has had a considerable impact on the psychological and psychopathological status of the population and health care workers in terms of insomnia, anxiety, depression, and post-traumatic stress disorder. The primary aim of this study was to describe and evaluate the impact of the pandemic on insomnia levels of a cohort of Italian nurses, particularly those involved in the care of COVID-19 patients. The secondary aim was to identify the interaction between insomnia and hardiness, anxiety, and sleep disturbances.

MATERIALS AND METHODS

A descriptive-exploratory study was conducted using an online survey during the first wave of the COVID-19 pandemic (March to July 2020). The questionnaire consisted of multiple-choice, open-ended, closed, and semi-closed questions. The psychometric tools administered were the Dispositional Resilience Scale (DRS-15), the State-Trait Anxiety Inventory (STAI-Y), and the Insomnia Severity Index (ISI).

RESULTS

a cohort of 1167 nurses fully completed the questionnaire (86.2% of total respondents). The insomnia scale survey showed an increase in post-pandemic scores compared to those before the pandemic, implying that insomnia levels increased after the first pandemic wave. Insomnia scores were directly correlated with anxiety levels (r = 0.571; p ≤ 0.05) and inversely correlated with hardiness levels (r = -0.324; p < 0.001). Multivariate analysis revealed the following protective factors: not having worked in COVID-19 wards, high levels of hardiness (commitment), and the presence of high pre-pandemic insomnia disorder. The main risk factor for insomnia reported in the analysis was a high anxiety score.

DISCUSSION AND CONCLUSION

Anxiety represented the main risk factor for insomnia severity in our sample, while hardiness was confirmed as a protective factor. Thus, it is necessary to design further studies to identify additional risk factors for poor sleep quality and to develop educational courses and strategies aimed at enhancing rest and sleep quality, especially for frontline nurses.

Prevalence and Risk Factors of Internet Gaming Disorder Under the COVID-19 Pandemic Among University Students in Macao

Introduction

During the COVID-19 pandemic, the zero-tolerance policy implemented in Macao affected university students' life and learning styles.

Objectives

This study aimed to investigate the prevalence of internet gaming disorder (IGD) and analyze its risk factors among university students of Macao amid the COVID-19 pandemic.

Methods

Two hundred and twenty-nine university students were recruited by convenience sampling. The cross-sectional investigation was conducted using the 9-item Chinese version of the IGD Scale, the Chinese Version of the Self-Compassion Scale, and the Chinese version of the Brief Resilience Scale.

Results

The prevalence was 7.4%. Compared to Non-IGD gamers, the IGD gamers were more likely to be the older, male gender, with a longer gaming history, with more game hours per day in the last month, and with a lower self-compassion score and resilience.

Conclusion

The prevalence of IGD increased. Students who are the older, male gender, with more gaming time, low self-compassion, and low resilience, have a high possibility of IGD.

Association of Child Sexual Abuse Victimization and Murderous Behaviors and the Mediating Role of Psychological Adjustment among College Students in China

A history of child sexual abuse (CSA) is associated with a variety of psychological issues and conduct disorders in adolescents. However, little is known about the association between CSA and its characteristics and murderous behaviors in young adults. The purpose of this study was to examine this relationship and explore the mediating effect of psychological adjustment (PA). A cross-sectional study was conducted with 4034 college students in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding the history of CSA, self-perceived PA and murderous behaviors. PA was evaluated by two of the most important indicators: resilience and emotional release. Mediation analyses were computed via parallel mediation models. Of the participants, 14.1% reported experiencing CSA. After controlling for potential confounders, CSA victimization was robustly and positively associated with murderous ideation (OR: 2.36, 95% CI: 1.77-3.14), murderous plans (OR: 4.02, 95% CI: 2.63-6.12), murderous preparation (OR: 3.87, 95% CI: 2.37-6.31), and murderous attempts (OR: 5.35, 95% CI: 3.11-9.21). CSA victimization that was persistent and of the combined contact or noncontact types greatly increased the risk of murderous behaviors. A dose-response relationship was observed between the duration of experienced CSA and murderous behaviors. Furthermore, the results of the mediation analysis revealed that PA partially mediated the relationship between CSA victimization and murderous behaviors. Therefore, PA protects against the development of murderous behaviors in abused individuals. These findings have important implications for the prevention and intervention of murderous behaviors in adolescents who experienced CSA, highlighting the importance of considering PA as a protective role in this relationship.

Early Childhood Stimulating Environment Predicts Later Childhood Resilience in an Indian Longitudinal Birth Cohort Study

Background: Human resilience is dynamic and generated through myriad interactions starting from early childhood. Resilience can improve quality of life and longevity. Objective: The current analysis evaluates childhood resilience at 9 years of age and its associations with concurrent cognition and early childhood factors, using longitudinal follow-up of a community birth cohort in Vellore, south India. Methods: Resilience was assessed using the Child and Youth Resilience Measure and cognition utilizing the Malin’s Intelligence Scale for Indian Children. Early childhood variables included growth stunting, maternal depression scores, home environment scores, and socio-economic status (SES) at 2 years of age. Statistical evaluation included bivariate analysis with further multi-variate regression for each resilience domain and the total resilience score. Findings: Out of 251 newborns recruited into the original birth cohort, 205 (81.7%) children were available for the 9-year follow-up. Mean (SD) scores in individual, caregiving, and context domains of resilience were 26.34 (3.2), 19.52 (1.6), and 20 (1.8) respectively. Individual resilience domain was associated with verbal cognition scores at 9 years of age (0.07, p = 0.019) and total home environment scores (0.16, p = 0.027) at 2 years of age, when adjusted for stunting, maternal depression, and SES. The total resilience score was associated only with concurrent verbal intelligence (0.08, p = 0.026) after adjustment with early childhood factors. Analysis of individual home environment factors showed that daily stimulation was associated with the individual domain of resilience. Conclusions: Follow-up of an Indian birth cohort showed that in addition to concurrent cognitive abilities, childhood resilience was related to early childhood stimulating home environment. Promoting optimal stimulating home environments in low-resource settings to nurture holistic childhood development including mental health is essential.

The mediating role of resilience in the relationship between social support and quality of life among patients after radical cystectomy: A structural equation model analysis

AIM

This study aimed to examine the relationship between social support and quality of life in urostomy patients and identify the mediating role of resilience in that relationship.

DESIGN

A cross-sectional design.

METHODS

Participants included 232 patients who were recruited from a tertiary hospital in Beijing during March 2020 and August 2020. They completed questionnaires about perceived social support, resilience and ostomy-related quality of life. Structural equation modelling was performed to analyse the data.

RESULTS

The mean age of patients was 65.79 (SD = 8.67) years, and the mean length of time after surgery was 42.14 (SD = 15.76) months. Urostomy patients' quality of life, social support and resilience were all above moderate. Social support had a positive direct effect on the quality of life and a positive indirect effect on the quality of life through the mediating role of resilience.

Coping and Resilience Strategies among Ukraine War Refugees

(1) Background: The war in Ukraine has triggered a huge humanitarian crisis: millions of refugees have escaped from their homes looking for shelter beyond Ukraine's borders. This emergency offers a unique opportunity to investigate and to document those characteristics of the human condition that emerge in exceptional circumstances provoked by war. Based on considerations derived from recent studies on resilience, the research at the base of this paper was conducted to better understand the circumstances, states of mind, and coping mechanisms of the refugees leaving their homes looking for security. (2) Methods: A qualitative approach was applied, resorting to semi-structured interviews (n = 94) to closely explore the traumatic experiences lived by refugees and to identify their coping strategies. (3) Results: The data obtained pointed to a plurality of coping and resilience strategies. Maintaining communication with separated loved ones as well as experiencing accompaniment by helpers and hosts emerged as principal elements for coping and resilience. It was found that a prior development of interior life or practice of prayer served as psychological "capital" that increased their resilience. (4) Conclusion: The results point to the need to care for social networking, attention by hosts, and cultivating interior life as keys for resilience.

Can resilience promote calling among Chinese nurses in intensive care units during the COVID-19 pandemic? The mediating role of thriving at work and moderating role of ethical leadership

Background

Nurses working in the intensive care unit (ICU) clung tenaciously to their job during the COVID-19 pandemic in spite of enduring stressed psychological and physical effects as a result of providing nursing care for the infected patients, which indicates that they possessed a high degree of professionalism and career calling. The aim of this study was to explain the associations between resilience, thriving at work, and ethical leadership influencing the calling of ICU nurses.

Methods

From December 2020 to January 2021 during the COVID-19 pandemic, a cross-sectional survey of 15 provinces in China was conducted using an online questionnaire. A total of 340 ICU nurses (effective response rate: 64.89%) completed sufficient responses to be used in the study. Sociodemographic factors, job demographic factors, resilience, calling, thriving at work, and ethical leadership were assessed using the questionnaire. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive model (GAM) were performed to examine all the considered research hypotheses.

Results

Resilience was positively and significantly associated with calling. Moreover, thriving at work partially mediated the relationship between resilience and calling. The indirect effect of resilience on calling was 0.204 (p < 0.0001), and the direct effect of resilience on calling through thriving at work was 0.215 (p < 0.0001). The total effect of resilience on calling was 0.419 (p < 0.0001). In addition, ethical leadership played a moderating role in the relationship between resilience and calling (β = 0.16, p < 0.05).

Conclusion

Greater resilience can positively predict increased calling among Chinese ICU nurses during the COVID-19 pandemic. Moreover, thriving at work is a mechanism that partly transmits the positive effects of resilience on calling. Overall, nurses possessing greater resilience tend to maintain thriving at work in the face of such adversity, further resulting in subsequently increased calling. Besides, findings suggest that there is stronger influence of resilience on calling among nurses working in an organization managed by an ethical leader. The current findings may offer two insights for nursing practitioners and policymakers in the postpandemic world. First, resilience training and intervention are necessary to foster nurses' sense of thriving at work in the nursing industry, further promoting career calling. Second, better training and effort on the development of ethical leadership for leaders in nursing practice are essential to encourage followers to engage in social learning of ethical behaviors and abiding by normatively appropriate conduct, further enacting prosocial values and expressing moral emotions.

Towards interventions on school dropouts for disabled learners amidst and post-COVID-19 pandemic

Background

Despite objective arguments for inclusive education, there is a dearth of mechanisms to reduce dropouts amongst disabled learners in the extant literature. Thus, this article is one of the outputs of a study, which was conducted after a consistent observation of dwindling numbers of disabled learners who succeed in basic education in South Africa. Of late, the dropout rate increased because of adherence to lock down regulations amidst the coronavirus disease 2019 (COVID-19) pandemic. This triggered the need for research on co-creating interventions to mitigate the rate of dropouts amongst disabled learners.

Objective

The article explores underlying obstacles that induce school dropouts for disabled learners amidst and post-COVID-19 and postulates interventions accordingly.

Methods

Descriptive-narrative research upheld reality as emerging from empirical experiences of parents and guardians of disabled children, heads of primary and secondary schools, social workers, the Department of Social Development and Basic Education, and provincial associations for disabled persons that focus on children. Lived experience-based opinions were obtained from provinces with different economic growth, namely, Limpopo and Gauteng. Forty-one in-depth one-on-one interviews and two focus group discussions used Google Meet. The collected data were analysed using Creswell’s qualitative data analysis framework (steps) and Atlas.ti.8.

Results

The findings show a consistent pattern that the COVID-19 pandemic exacerbated the parents and guardians’ fear of exposing and risking their learners to the health crisis. Based on the parents and guardians’ narrative, mainstream school administrations discriminate and are unwilling to enrol disabled learners. Furthermore, the narrative from the school leadership shows that teachers use exclusive teaching and learning methods for the enrolled disabled learners because of ignorance, misconception, misunderstanding, misinterpretation of disability, disability inclusion, and reasonable accommodation.

Conclusion

Based on the finding, it is clear that dropouts amongst disabled learners can be alleviated by using a systematic multi-stakeholder local community-based intervention approach. This, therefore, implies that government authorities and agencies should incorporate disability into mainstream policies that guide planning, budgeting, staffing, and mobilisation of other resources. This would ideally enhance the provision of learning opportunities to disabled learners whilst supporting their diverse educational needs without dichotomies set by ‘ability and disability’, or normal and abnormal. In this manner, inclusive education can contribute to the educational success of disabled learners through developing sustainability and resilience amongst disabled learners.

Promoting and Risk Factors of Nurses' Hardiness Levels during the COVID-19 Pandemic: Results from an Italian Cohort

Aim: Few studies in the literature specifically address the hardiness of nurses during the COVID-19 pandemic. Thus, the primary aim of this study was to assess the impact of COVID-19 on the hardiness levels in an Italian cohort of nurses. The secondary aims were to assess the level of hardiness in nurses directly caring for patients with COVID-19 and to verify the presence of related risk and promoting factors. Methods: A descriptive and explorative study was performed through an online survey from March to July 2020. The survey was composed of a multiple answer questionnaire with open, closed, and semi-closed-ended questions. Hardiness and anxiety were assessed using two psychometric instruments: the Dispositional Resilience Scale (DRS-15) and State-Trait Anxiety Inventory (STAI-Y). Results: A total of 1250 nurses completed the questionnaire entirely (92.3% of respondents). The average length of service was 17.8 ± 11.5 years. A decrease in the hardiness was recorded after the first wave of COVID-19 if compared to the baseline (mean Δ DRS-15 total = 1.3 ± 5.0), whereas in the subsample of nurses caring for COVID-19 patients, the total hardiness level decreased more consistently (mean Δ DRS Total = 1.9 + 5.3). Multivariate analysis showed that high levels of anxiety were risk factors for reducing hardiness. In contrast, anxiety, when associated with a greater length of service, was a promoting factor for the increase in hardiness. Conclusions: The correlation between anxiety and years of length of service appears to be pivotal. Future research should focus on the role of anxiety to establish its actual role as a predictor of hardiness.

Informal caregivers of people with heart failure and resilience: A convergent mixed methods study

AIM

To develop a comprehensive understanding of resilience and its associated factors among informal caregivers of people with heart failure.

DESIGN

Transnational multicentre convergent mixed methods approach.

METHODS

This study was conducted in three European countries: Italy, Spain and the Netherlands; during February 2017 and December 2018. In total, 195 caregivers completed the Connor-Davidson Resilience Scale, Caregiver Burden Inventory and Hospital Anxiety and Depression Scale. From a nested sample 50 caregivers participated in semi-structured face-to-face interviews. Data were analysed using qualitative content analysis, multiple regression and joint displays.

RESULTS

The caregivers' mean age was over 60 years. The quantitative results showed that caregivers experienced anxiety and depression regardless of a good score of resilience and moderate level of burden. Regression analysis showed that the resilience was associated with caregiver depression. From qualitative findings three resilience inhibiting (psychological outlook, physical weariness and affective state) and two promoting factors (community interconnectedness and self-comforting activities) were generated. Mixed analysis confirmed that depression decreased caregivers' resilience.

CONCLUSIONS

Caregivers of people with heart failure experience continuous stress and anxiety resulting in reduced resilience. Collaborative efforts are needed to build multifaceted interventions and programs to enhance caregivers' resilience by targeting the factors identified in this study.

IMPACT

The quality of informal caregiving is affected by the resilience of caregivers. No research has explored the resilience levels and its factors in this population. Depression, psychological outlook, physical weariness and affective state are negative factors of caregivers' resilience. Personal strategies combined with social and community support and belongingness enhance caregivers' resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers' resilience.

Psychological Hardiness and Spirituality in Patients with Primary Brain Tumors: A Comparative Study

The purpose of this research was to compare healthy individuals with patients having primary brain tumors (PBTs) with respect to their psychological hardiness and spirituality. In this study, a comparative and descriptive research design was employed. The research sample included 122 individuals: 61 patients with PBTs and 61 healthy individuals. When healthy individuals were compared with patients with PBTs, it was found that the patients with PBTs had significantly lower mean scores for spirituality and psychological hardiness. The study revealed that spirituality (β = .661) and age (β = - .270) were statistically significant predictors of psychological hardiness (p < .001). These variables explained 53% of the total variance. To decrease the negative effects of PBTs on psychological hardiness, nurses and other health staffs should focus on strategies that strengthen patients' spirituality.

Resilience in Adult Health Science Revisited-A Narrative Review Synthesis of Process-Oriented Approaches

Purpose: This article aims to identify how the term “resilience” is addressed in adult health science due to ongoing criticism about the lack of consistency in its conceptualization.

Method: Two databases (PubMed and PsycArticles) were searched to retrieve reviews published from 2015 up until 2020 on the general conceptualization of resilience. All reviews had to meet specific inclusion criteria, which resulted in the inclusion of 18 articles. After discussing different conceptualizations regarding the process-oriented approach of resilience in adult health research, we will highlight some mechanisms that are supposed to be involved in the resilience process.

Results: Research on resilience in health sciences confronts three core difficulties: defining positive outcome for a processual construct, describing different trajectories within the process, and identifying mechanisms that mediate resilience.

Conclusion: The definition of resilience in mental health research as a multidimensional adaptation process is widely accepted, and multiple research paradigms have contributed to a better understanding of the concept. However, the definition of a processual construct in a way that allows for high expert consensus and a valid operationalization for empirical studies remains a challenge. Future research should focus on the assessment of multiple cross-domain outcomes and international and interdisciplinary prospective mixed-method longitudinal designs to fill in the missing links.

Letters from the pandemic: Nursing student narratives of change, challenges and thriving at the outset of COVID-19

AIM

The aim of this study is to explore the experience of third year baccalaureate nursing students during the outbreak of the COVID-19 pandemic.

DESIGN

Research design is a narrative analysis of archived letters written by nursing students in Spring 2020.

METHODS

Letters and other media were written between 1 April and 20 May 2020. Fifty-six letters, some with accompanying audio or visual media, were submitted in late May 2020. Approval from the University Institutional Review Board was obtained to explore the letters through narrative analysis (Riessman, 2008). As the letters were considered archival, consent from the students for the analysis was not indicated. Once thematic categories were identified independently, the authors discussed the findings until a list of narrative categories and narrative exemplars were agreed on.

RESULTS

Three main thematic categories were found: stories of change, challenges and thriving.

CONCLUSION

Findings were consistent with prior research and reveal new opportunities for understanding the perspectives and needs of undergraduate nursing students during times of crisis. Action by administrators and faculty are recommended.

Evolution and impact of self-efficacy during French COVID-19 confinement: a longitudinal study

Based on social cognitive theory, we propose that self-efficacy is a personal resource that protects people from the impact of confinement in the context of the COVID-19 pandemic. In a longitudinal study where 197 French citizens were surveyed over 8 weeks of confinement (though only 25 participants responded each of these 8 weeks), we examined the relationships between general self-efficacy and positive affect, negative affect and adaptive performance at work. Consistent with theoretical expectations, self-efficacy was relatively stable during confinement and was positively related to positive affect and negatively related to negative affect. Self-efficacy was also positively correlated with all dimensions of adaptive performance at work during confinement. The role of self-efficacy as a protective factor against depressive risks induced by the stressful COVID-19 pandemic is discussed.