Foster resilience in nursing students to better prepare them for their professional role. A cross-sectional study
Aidah Alkaissi*¹, PhD, Nizar Said¹ MSN, Shorouq Qadous¹, MSN, Omar Al-Mahmoud, MSN, Mahdia AlKony¹, MSN
¹ An-Najah National University, faculty of Medicine and Health Sciences, Nursing and Midwifery Department, Nablus- Palestine
Corresponding author*.Dr. Aidah Alkaissi, An-Najah National University, faculty of Medicine and Health Sciences, Nursing and Midwifery Department, Nablus- Palestine.
P.O. Box 7. E mail [email protected], Tel. 0097080(597395520.
Resilience is defined as the ability to overcome adversity and includes how to learn to grow stronger from the experience. Understanding resilience in nursing students is necessary because of higher levels of academic stress."Nursing Student resilience is an individualized development process that takes place through the use of personal protective factors to successfully navigate perceived stress and adversity. Accumulated success leads to improved coping ability and well-being. Resilience characteristics can be fostered and rebuilt leading to competent cognitive, social and school functioning
To quantify resilience and to investigate the contribution of demographic variables to resilience levels reported by nursing students, to investigate in what ways has resilience been promoted among nursing students and the results of this study provide basic information needed to enhance the resilience of nursing students who will play important roles as healthcare providers in the future.
Design: A descriptive and cross-sectional design was applied, with questionnaires as tools.
The sample consisted of 314 nursing students selected based on convenience sampling. The study was carried out at an-Najah National University. The sample had a mean age of 20.01 (SD = 1.343), with an age range of between 18 and 25; (47%; n = 146 male and 53%; n = 168 female), In terms of marital status, there were single 309/314 (98.5%, ) married 5/314 ( 1.5%). In terms of living in urban and rural areas, 87/314 are living in cities (25%), 209/314(67%) in villages and 18/314(6%) in camps. Of the respondents, 251/314(79.5%) indicated that they only studied and 62/314 (20%) combined work and study.
Nursing students (n = 314) at An-Najah National University are eligible to complete the questionnaires, there is no exclusion criteria
personal characteristics of the nursing students that could contributed to resilience gathered by using personal characteristics sheets including gender, civil status, study academic year, living district, the secondary examination grade, university grade, university level (first, second, third, fourth year), smoking, illness, divorce / separation of parents, family housing, type of family ( nuclear / extended), traveling each day to the university, addiction, living area (city, village, camp), number of siblings, live in students accommodation, part-time work by the student, total revenues of student family, father education, mother education, if mother work, study status (every day/ only before examination) and Internet problems.
To measure resilience behaviour , all the students have answered the Trait Resilience Scale (TRC) and State Resilience Scale (SRC) which had reliable psychometric proporties. The total score of TRC is computed by summing all responses, and individual scores range from 18 to 90,consists of 18 items of childhood resilience components in which participants scored themselves on each item (5-points Likert scale from strongly disagree =1 to strongly agree =5) as a child rather than at the present time with higher scores reflecting greater trait resilience. TRC is divided into six categories in the present study.
TRC is divided into six categories
Trait Resilience Check list (TRC)
The total score of SRCis achieved by summing all responses that ranges from 15 to 75, it has 15 items with a 5-point Likert scale (from strongly disagree =1 to strongly agree =5) with higher scores reflecting greater state resilience to which they describe themselves at the present time. SRC is divided into six categories. In this study, students with extreme resilience based on the above categories have been considered in the analysis of personal characteristics.
SRC is divided into six categories
State Resilience Check List (SRC)
All analyses were carried out using SPSS, version 21.0. Each participant completed three self-administered questionnaires, which were analyzed using descriptive statistics(Frequencies and Percentages), Chi Square Test and Factor Analysis. Significance was set at a level of 0.05
The results were shown that the Mean (SD) of Trait Resilience Scale is 71.50 (±7.51) and for State Resilience Scale is 62.63 (±6.742). The results showed that 70/314 (22.3%) of nursing students have extreme trait resilience scale (65-75) and 135/314 (43.0%) of nursing students have extreme state resilience scale (87-90).
The results indicated a statistically significant relationship between extreme trait resilience and personal characteristics. The study showed that the students who have recorded extreme scores of trait resilience scale were students who are living in Palestine 48 (P= .040), non-smokers (p = 0.046), who have no addiction problems (P = 0.026), whose studying every day (P = 0.000), whose mothers education at the university level (P = 0.0150, and whose total revenues of their families more than 5000 NIS (P = 0.015) have significantly higher extreme Trait Resilience Scale than the other students.
The study was also shown that the students who have recorded extreme scores of state resilience scale were female students (P = 0.046), first-year students (P=0000), students who do not have any disease (P= 0. 008), students whose living district originally is Palestine 48 (P= .044), students who are living in the cities (P = 0.037), students who have siblings (1-5) (0.040), students who are not travelling every day (P = 0.032), students who have part time work (P = 0.035), students whose study status each day (P = 0.006), students whose total income of their families more than 5,000 NIS (P = 0.008), and students living with another (1-4) students (P = 0.034) have significantly higher extreme State Resilience scale than the other students. There were no significant relationships between the other variables and extreme resilience
Factor analyses of the Trait Resilience indicated that the TRC has 5 resilience factors while the SRC has 4 factors. Their factor loadings are presented in (Tables 1,2) . For TRC the total variance explained by the 5 factors(components) is 52% while the total variance explained by the 4 factors(components) of SRC is 50% .
Factor analyses of the Nursing Students SRC & TRC
Table 3 presented the explorative factor analysis conducted with a varimax rotation on the items of the SRC-15 items. Results indicated four factors that explained 50.2% of the total variance. These factors had eigenvalues greater than 1.0. Factor 1 explained 26.6% (eigenvalue: 3.987) of the variation in the scores of the SRC. Factors 2 accounted for 8.5% (eigenvalue, 1.272) of the variance, Factors 3 and Factor 4 accounted for 7.8% (eigenvalue, 1.165) and 7.4% (eigenvalue, 1.108) respectively of the variance. The first factor of SRC identified as (Personal strength/A goal-oriented/
looking for adventurous with confidence) presented by (I am and I can), defined by (5) items on the questionnaire, The second factor of SRC identified as (strong relationship/ power and control over your own/ a role model, presented by (I have), defined by (4) items on the questionnaire, The third factor of SRC identified as (Coping skills/ believing that life is orchestrated by someone can be reassuring and not something to do with, rather making things better presented by (I can), defined by (3) items on the questionnaire, and The fourth factor of SRC identified as (Strong relationship/ open up and light up the life and Putting things in perspective presented by ( I have), and defined by (2) items on the questionnaire.
Table 4, For the TRC scale, the factor analysis showed that Five factors explained 51.6% of the total variance which is higher than that for the SRC. These factors also had eigenvalues greater than 1.0. Factor 1 explained 23.6% (eigenvalue: 4.250) of the variation in the scores of the TRC. Factors 2 and 3 accounted for 9.4% (eigenvalue, 1.694) and 7.03% (eigenvalue, 1.266) respectively, of the variance, Factors 4 and 5 accounted for 5.8% (eigenvalue, 1.050) and 5.7% (eigenvalue, 1.024) respectively, of the variance. The first factor of TRC identified as (Internal and personal skills/thinking skills and social, emotional development. Building positive relationship) presented by (I am and I have)) defined by (7) items on the questionnaire, The second factor of TRC identified as (interpersonal strength/use affirmations- give you a future filled with hope),
defined by (3) items on the questionnaire, The third factor of TRC identified as (Social support and resources/staying true and train your temper) defined by (4) items on the questionnaire, The forth factor of TRC identified as (Internal and personal strength/ Demonstrate using the process "I'm having a hard time staying calm" presented by (I am) and defined by (3) items on the questionnaire, The fifth factor of TRC identified as (Personal strength/polynomial equation (Family + Student + School + Policymakers = Student Success) presented by (I am) and defined by one item on the questionnaire.
The present study confirmed the four factors in the SRC ( measuring resilience, “at the present time“) as (1) Personal strength/A goal-oriented/ looking for adventurous with
confidence, (2) Strong relationship/ power and control over their own and having a role model, (3) Coping skills/ believing that life is orchestrated by someone can be reassuring- not something to do with, rather making things better, and (4) Strong relationship/ open up and light up the life and Putting things in perspective.
Additionally, the TRC (measuring resilience,“since childhood“) categorized the five factors,
(1) Internal and personal skills/thinking skills and social, emotional development and building positive relationship,(2) Interpersonal strength/ use affirmations- give you a future filled with hope, (3) Social support and resources/staying true and train your temper, (4) Internal and personal strength/ Demonstrate using the process "I'm having a hard time staying calm", (5) Personal strength/ polynomial equation ,“Family + Student + School + Policymakers = Student Success“.
This study described the relations between the different personal characteristics and resilience in the nursing students and concluded that the resilience is multi-factorial in nature. Resilience promoted from the three sources (I have), people who care and help, (I can), coping skills, and (I am) draws on internal and personal strength. Further research is needed to learn how nursing students resilience can be developed and promoted.
Keywords: Nursing students; resilience, social support, coping, internal strength, personal strength