REVIEW ARTICLE
Healthcare worker resilience during the COVID-19 pandemic: An integrative review
Rachel G. Baskin MSN, RN, CPN,
Robin Bartlett PhD, RN,
Corresponding Author
Rachel G. Baskin MSN, RN, CPN
M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
Correspondence
Rachel Baskin, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA.
Email: [email protected]; [email protected]
Search for more papers by this authorRobin Bartlett PhD, RN
Capstone College of Nursing, University of Alabama, Tuscaloosa, Alabama, USA
Search for more papers by this authorRachel G. Baskin MSN, RN, CPN,
Robin Bartlett PhD, RN,
Corresponding Author
Rachel G. Baskin MSN, RN, CPN
M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
Correspondence
Rachel Baskin, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA.
Email: [email protected]; [email protected]
Search for more papers by this authorRobin Bartlett PhD, RN
Capstone College of Nursing, University of Alabama, Tuscaloosa, Alabama, USA
Search for more papers by this authorAbstract
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.
CONFLICT OF INTEREST
None.
Open Research
DATA AVAILABILITY STATEMENT
Author elects to not share data.
REFERENCES
- Afshari, D., Nourollahi-darabad, M., & Chinisaz, N. (2021). Demographic predictors of resilience among nurses during the COVID-19 pandemic. Work, ahead of print, 68, 297–303. https://doi.org/10.3233/WOR-203376
- Altmayer, V., Weiss, N., Cao, A., Marois, C., Demeret, S., Rohaut, B., & Le Guennec, L. (2020). Coronavirus disease 2019 crisis in Paris: A differential psychological impact between regular intensive care unit staff members and reinforcement workers. Australian Critical Care, 142–145. https://doi.org/10.1016/j.aucc.2020.11.005
- Awano, N., Oyama, N., Akiyama, K., Inomata, M., & Kuse, N. (2020). Anxiety, depression, and resilience of healthcare workers in Japan during the Coronavirus Disease 2019 outbreak. Internal Medicine, 59(21), 2693–2699. https://doi.org/10.2169/internalmedicine.5694-20
- Balay-odao, E., Alquwez, N., Inocian, E., & Alotaibi, R. (2021). Hospital preparedness, resilience, and psychological burden among clinical nurses in addressing the COVID-19 crisis in Riyadh, Saudi Arabia. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.573932
- Barzilay, R., Moore, T., Greenberg, D., DiDomenico, G., Brown, L., White, L., Gur, R. C., & Gur, R. E. (2020). Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers. Translational Psychiatry, 10(1), 1–8. https://doi.org/10.1038/s41398-020-00982-4
- Cai, W., Lian, B., Song, X., Hou, T., Deng, G., & Li, H. (2020). A cross-sectional study on the mental health among health care workers during the outbreak of the Corona Virus Disease 2019. Asian Journal of Psychiatry, 51. https://doi.org/10.1016/j.ajp.2020.102111
- Cameron, F., & Brownie, S. (2010). Enhancing resilience in registered aged care nurses. Australasian Journal on Ageing, 29(2), 66–71. https://doi.org/10.1111/j.1741-6612.2009.00416.x
- Catania, G., Zanini, M., Hayter, M., Timmins, F., Dasso, N., Ottonello, G., Aleo, G., Sasso, L., & Bagnasco, A. (2020). Lessons from Italian front-line nurses' experiences during the COVID-19 pandemic: A qualitative descriptive study. Journal of Nursing Management, 29, 404–411. https://doi.org/10.1111/jonm.13194
- Cimiotti, J., Aiken, L., Sloane, D., & Wu, E. (2012). Nurse staffing, burnout, and health-care associated infection. American Journal of Infection Control, 40, 486–490. https://doi.org/10.1016/j.ajic.2012.02.029
- Colville, G., Dalia, C., Brierly, J., Abbas, K., Morgan, H., & Perkins-Porras, L. (2015). Burnout and traumatic stress in staff working in paediatric intensive care: Associations with resilience and coping strategies. Intensive Care Medicine, 41, 364–365. https://doi.org/10.1007/s00134-014-3559-2
- Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor–Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76–82. https://doi.org/10.1002/da.10113
- da Silva, F., & Neto, M. (2021). Psychiatric symptomatology associated with depression, anxiety, distress, and insomnia in health professionals working in patients affected by COVID-19: A systematic review with meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 104. https://doi.org/10.1016/j.pnpbp.2020.110057
- Davidson, J. R. T. (2018). Connor-Davidson Resilience Scale (CD-RISC) manual. http://www.connordavidson-resiliencescale.com/CD-RISC%20Manual%2008-19-18.pdf
- de Pablo, G., Vaquerizo-Serrano, J., Catalan, A., Arango, C., Moreno, C., Ferre, F., Shin, J., Sullivan, S., Brondino, N., Solmi, M., & Fusar-Poli, P. (2020). Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. Journal of Affective Disorders, 275, 48–57. https://doi.org/10.1016/j.jad.2020.06.022
- Delgado, C., Upton, D., Ranse, K., Furness, T., & Foster, K. (2017). Nurses' resilience and the emotional labour of nursing work: An integrative review of empirical literature. International Journal of Nursing Studies, 70, 71–88. https://doi.org/10.1016/j.ijnurstu.2017.02.008
- Firew, T., Sano, E., Lee, J., Flores, S., Lang, K., Salman, K., Greene, M. C., & Chang, B. P. (2020). Protecting the front line: A cross-sectional survey analysis of the occupational factors contributing to healthcare workers' infection and psychological distress during the COVID-19 pandemic in the USA. BMJ Open, 10(10). https://doi.org/10.1136/bmjopen-2020-042752
- Garcia, C., Abreu, L., Ramos, J., Castro, C., Smiderle, F., dos Santos, J., & Bezerra, I. (2019). Influence of burnout on patient safety: Systematic review and meta-analysis. Medicina, 55(9). https://doi.org/10.3390/medicina55090553
- Gillespie, B., Chaboyer, W., Wallis, M., & Grimbeek, P. (2007). Resilience in the operating room: Developing and testing of a resilience model. Journal of Advanced Nursing, 59(4), 427–438. https://doi.org/10.1111/j.1365-2648.2007.04340.x
- Goh, Y., Yong, Q., Chen, T., Ho, S., Chee, Y., & Chee, T. (2020). The impact of COVID-19 on nurses working in a university health system in Singapore: A qualitative descriptive study. International Journal of Mental Health Nursing, 30, 643–652. https://doi.org/10.1111/inm.12826
- Guo, Y., Luo, Y., Lam, L., Cross, W., Plummer, V., & Zhang, J. (2018). Burnout and its association with resilience in nurses: A cross-sectional study. Journal of Clinical Nursing, 27(1–2), 441–449. https://doi.org/10.1111/jocn.13952
- Hu, D., Kong, Y., Li, W., Han, Q., Zhang, X., Zhu, L., Wan, S., Liu, Z., Shen, Q., Yang, J., He, H., & Zhu, J. (2020). Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine, 24. https://doi.org/10.1016/j.eclinm.2020.100424
10.1016/j.eclinm.2020.100424 Google Scholar
- Huang, L., Wang, Y., Liu, J., Ye, P., Chen, X., Xu, H., Qu, H., & Ning, G. (2020). Factors influencing anxiety of health care workers in the radiology department with high exposure risk to COVID-19. Medical Science Monitor, 26. https://doi.org/10.12659/MSM.926008
- Institute for Healthcare Improvement Multimedia Team. (2020). How leaders can promote health care workforce well-being. Institute for Healthcare Improvement. http://www.ihi.org/communities/blogs/how-leaders-can-promote-health-care-workforce-wellbeing
- Jose, S., Dhandapani, M., & Cyriac, M. (2020). Burnout and resilience among frontline nurses during COVID-19 pandemic: A cross-sectional study in the Emergency Department of a tertiary care center, North India. Indian Journal of Critical Care Medicine, 24(11), 1081–1088. https://doi.org/10.5005/jp-journals-10071-23667
- Kılınç, T., & Çelik, A. (2020). Relationship between the social support and psychological resilience levels perceived by nurses during the COVID-19 pandemic: A study from Turkey. Perspectives in Psychiatric Care. https://doi.org/10.1111/ppc.12648
- Kim, S., Park, O., Kim, H., & Kim, J. (2019). Factors influencing well-being in clinical nurses: A path analysis using a multi-mediation model. Journal of Clinical Nursing, 28(23/24), 4549–4559. https://doi.org/10.1111/jocn.15045
- Labrague, L., & de los Santos, J. (2020). COVID-19 anxiety among frontline nurses: Predictive role of organisational support, personal resilience and social support. Journal of Nursing Management, 28, 1653–1661. https://doi.org/10.1111/jonm.13121
- Lapum, J., Nguyen, M., Fredericks, S., Lai, S., & McShane, J. (2020). “Goodbye … through a glass door”: The emotional experiences of working in COVID-19 acute care hospital environments. Canadian Journal of Nursing Research, 0(0), 1–11. https://doi.org/10.1177/0844562120982420
- Leng, M., Wei, L., Shi, X., Cao, G., Wei, Y., Xu, H., Zhang, X., Zhang, W., Xing, S., & Wei, H. (2020). Mental distress and influencing factors in nurses caring for patients with COVID-19. Nursing in Critical Care, 26, 94–101. https://doi.org/10.1111/nicc.12528
- Li, X., Zhou, Y., & Xu, X. (2020). Factors associated with the psychological well-being among front-line nurses exposed to COVID-2019 in China: A predictive study. Journal of Nursing Management. https://doi.org/10.1111/jonm.13146
- Liang, Y., Wu, K., Zhou, Y., Huang, X., Zhou, Y., & Liu, Z. (2020). Mental health in frontline medical workers during the 2019 Novel Coronavirus Disease epidemic in China: A comparison with the general population. International Journal of Environmental Research and Public Health, 17(18). https://doi.org/10.3390/ijerph17186550
- Lin, J., Ren, Y., Gan, H., Chen, Y., Huang, Y., & You, X. (2020). Factors associated with resilience among non-local medical workers sent to Wuhan, China during the COVID-19 outbreak. BMC Psychiatry, 20, 1–7. https://doi.org/10.1186/s12888-020-02821-8
- Liu, Q., Luo, D., Haase, J., Guo, Q., Wang, X., Liu, S., Xia, L., Liu, Z., Yang, J., & Yang, B. (2020). The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study. The Lancet, 8(6), e790–e798. https://doi.org/10.1016/S2214-109X(20)30204-7
- LoGuidice, J., & Bartos, S. (2021). Experiences of nurses during the COVID-19 pandemic: A mixed methods study. AACN Advanced Critical Care. https://doi.org/10.4037/aacnacc2021816
- Lorente, L., Vera, M., & Peiró, T. (2020). Nurses´ stressors and psychological distress during the COVID-19 pandemic: The mediating role of coping and resilience. Journal of Advanced Nursing, 77, 1335–1344. https://doi.org/10.1111/jan.14695
- Luceño-Moreno, L., Talavera-Velasco, B., Garcia-Albuerne, Y., & Martín-García, J. (2020). Symptoms of posttraumatic stress, anxiety, depression, levels of resilience and burnout in Spanish health personnel during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 17(15). https://doi.org/10.3390/ijerph17155514
- Luthar, S., & Cicchetti, D. (2000). The construct of resilience: Implications for interventions and social policies. Development and Psychopathology, 12(4), 857–885. https://doi.org/10.1017/S0954579400004156
- Lyu, H., Yao, M., Zhang, D., & Liu, X. (2020). The relationship among organizational identity, psychological resilience and work engagement of the first-line nurses in the prevention and control of COVID-19 based on structural equation model. Risk Management and Healthcare Policy, 13, 2379–2386. https://doi.org/10.2147/RMHP.S254928
- Meybodi, A., & Mohammadi, M. (2020). Identifying the components of spirituality affecting the resilience of nurses. Journal of Nursing Management, 1–7. https://doi.org/10.1111/jonm.13235
- Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
- Nathiya, D., Suman, S., Singh, P., Raj, P., & Tomar, B. (2021). Mental health outcome and professional quality of life among healthcare worker during COVID-19 pandemic: A (FRONTLINE-COVID) survey. Annales Médico-Psychologiques. https://doi.org/10.1016/j.amp.2020.12.017
- National Academies of Sciences, Engineering, and Medicine. (2019). Taking action against clinician burnout: A systems approach to professional well-being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521
- National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982
- Ni, M., Li, T., Yu, N., Pang, H., Chan, B., Leung, G., & Stewart, S. (2015). Normative data and psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) and the abbreviated version (CD-RISC2) among the general population in Hong Kong. Quality of Life Research, 25, 111–116. https://doi.org/10.1007/s11136-015-1072-x
- Ou, X., Chen, Y., Liang, Z., Wen, S., Li, S., & Chen, Y. (2020). Resilience of nurses in isolation wards during the COVID⁃19 pandemic: A cross-sectional study. Psychology, Health & Medicine. https://doi.org/10.1080/13548506.2020.1861312
- Pang, Y., Fang, H., Li, L., Chen, M., Chen, Y., & Chen, M. (2021). Predictive factors of anxiety and depression among nurses fighting coronavirus disease 2019 in China. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12817
- Poll Everywhere. (n.d.). Poll Everywhere (graphic). https://www.polleverywhere.com/
- Resnick, B. (2020). Covid-19 lessons learned from the voices of our geriatric nurses: Leadership, resilience, and heroism. Geriatric Nursing, 41(4), 357–359. https://doi.org/10.1016/j.gerinurse.2020.06.008
- Roberts, N. J., McAloney-Kocaman, K., Lippiett, K., Ray, E., Welch, L., & Kelly, C. (2021). Levels of resilience, anxiety and depression in nurses working in respiratory clinical areas during the COVID pandemic. Respiratory Medicine, 176. https://doi.org/10.1016/j.rmed.2020.106219
- Rodríguez-Rey, R., Palacios, A., Alonso-Tapia, J., Pérez, E., Álvarez, E., Coca, A., Mencía, S., Marcos, A., Mayordomo-Colunga, J., Fernández, F., Gómez, F., Cruz, J., Ordóñez, O., & Llorente, A. (2019). Burnout and posttraumatic stress in paediatric critical care personnel: Prediction from resilience and coping styles. Australian Critical Care, 32(1), 46–53. https://doi.org/10.1016/j.aucc.2018.02.003
- Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412–420. https://doi.org/10.4037/ajcc2015291
- Schäfer, S. K., Lass-Hennemann, J., Groesdonk, H., Volk, T., Bomberg, H., Staginnus, M., Brückner, A. H., Holz, E., & Michael, T. (2018). Mental health in anesthesiology and ICU staff: Sense of coherence matters. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00440
- Sheraton, M., Deo, N., Dutt, T., Surani, S., Hall-Flavin, D., & Kashyap, R. (2020). Psychological effects of the COVID 19 pandemic on healthcare workers globally: A systematic review. Psychiatry Research, 292. https://doi.org/10.1016/j.psychres.2020.113360
- Taylor, R. (2019). Contemporary issues: Resilience training alone is an incomplete intervention. Nursing Education Today, 78, 10–13. https://doi.org/10.1016/j.nedt.2019.03.014
- Tomlin, J., Dalgleish-Warburton, B., & Lamph, G. (2020). Psychosocial support for healthcare workers during the COVID-19 pandemic. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyg.2020.01960
- Tsehay, M., Belete, A., & Necho, M. (2020). Factors associated with psychological distress and brief resilient coping level during the COVID-19 pandemic among health-care professionals in Dessie, Ethiopia. Psychology Research and Behavior Management, 13, 1213–1221. https://doi.org/10.2147/PRBM.S288562
- Van Bogaert, P., Timmermans, O., Weeks, S., van Heusden, D., Wouters, K., & Franck, E. (2014). Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events- a cross-sectional survey. International Journal of Nursing Studies, 51, 1123–1134. https://doi.org/10.1016/j.ijnurstu.2013.12.009
- Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
- Yıldırım, M., Arslan, G., & Özaslan, A. (2020). Perceived risk and mental health problems among healthcare professionals during COVID-19 pandemic: Exploring the mediating effects of resilience and coronavirus fear. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-020-00424-8
- Yörük, S., & Güler, D. (2020). The relationship between psychological resilience, burnout, stress, and sociodemographic factors with depression in nurses and midwives during the COVID-19 pandemic: A cross-sectional study in Turkey. Perspectives in Psychiatric Care. https://doi.org/10.1111/ppc.12659
- Zotero.org. (n.d.). Zotero. https://www.zotero.org/
