Introduction. Nurses are involvedwith suffering on a daily basis and can in turn cause stress within the nurse, thus resilience is important to nurses in their everyday practice.Resilience as a conceptual model of healthy personality development, its application to help overcome stress and adversities faced by people throughout their lives. Resilience is generally described as the ability of an individual to successfully maintain skilled operation, and "bounce" from adversity and major stressor and the ability to not only survive life's challenges, but to learn and grow from them and become stronger as a result of these challenges. Edith Grotberg 1995) proposed that resilience is fostered from three sources. (I have), people who care and help , (I can), interpersonal and problem solving skills, and (I am) drawing on internal strength.
Aims of the study
To quantify the resilience among nurses, to determine which different personal characteristics affect or contribute to the resilience of nurses, creating resilience data sets that can be used by organizations to facilitate their decision-making process for implementing initiatives for the health and wellbeing of nurses and to establish strategies that help build resilience nurses.
Method and material.
Study design and setting
This study consisted of a cross-sectional design of nursing staff employed at An-Najah National University Hospital (NNUH ) based in Northern West Bank.
Sample and data collection
The convenience sample consisted of 119 nurses, Male:78/119( 65%) and Female:41/119( 35%), age ranges 21-63, In terms of marital status, there were single 70/119 (59%, ) married 49( 41%). In terms of living in urban and rural areas, 41/119 (34%) are living in cities, 70/119(59%) in villages and 8/119 (7%) in camps.
Outcome measures. Demographic Data sheet, included questions on gender, age, marital status, education, Grade Point Average (GPA) of secondary school examination, smoking, illness, addiction, living area, sibling, wife education, husband education, monthly income, problems with team leader, problems with teamwork, number of children. The researchers defined many factors in the current study based on resilience studies in the literature.
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 as follows (Table 1).
Table 1. 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 categories have been considered in the analysis of personal characteristics (Table 2).
Table 2. SRC is divided into six categories
State Resilience Check List (SRC)
All analyses were carried out using SPSS version 21.0 statistical program. 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
Nursing staff (n = 119) employed by NNUH are eligible to complete the questionnaires, there is no exclusion criteria.
The results were shown that the Mean (SD) of Trait Resilience Scale is 73.64(±8.6) and for State Resilience Scale is 61.67 (±8.44). In this study, nurses with extreme resilience have been considered. The results showed that 48/119 (40.3%) of nurses have extreme trait resilience (65-75) and 48/119 (40.3%) of nurses have extreme state resilience (87-90).
The only predictor variable that made a statistically significant contribution to resilience are as follows
Personal Characteristics of nurse who have extreme Trait Resilience Scale.
Nurses who have siblings (1-2) (P= .022), who own a house (P=.048), who have day shift only (P=.016), whose husband education is university (P=.020), who have not problem with the team work (P=.041) have significantly extreme traits resilience scale more than the other nurses.
Characteristics of nurse who have extreme state resilience scale
Nurses who have siblings (1-2) (P=.000), who own a house P=.024), who are traveling every day (P=.038), whose husband education is university (P= .008), who have not problem with the team work (P=.023) have significantly extreme state resilience checklist than the other students.
There were no relationships between the other variables and extreme resilience
Factor analyses of the Nurses SRC & TRC
Factor analyses of the Trait Resilience indicated that the TRC has 5 resilience factors while the SRC has 3 factors. Their factor loadings are presented in Tables above. For TRC the total variance explained by the 5 factors(components) is 63% while the total variance explained by the 3 factors (components) of SRC is 56%.
Based on these analyses of TRC, five factors were retained :
Factor I consisting of 9 items with factor loadings ranging from .436 to .790; and Factor II consisting of 6 items with factor loadings ranging from .412 to .736. Factor III consisting of 3 items with factor loadings ranging from .459 to .835,
factor IV consisting of one item with factor loadings ranging .441
factor V consisting of two items with factor loadings ranging .584 to .854. (Table 3)
Based on these analyses of SRC, three factors were retained :
Factor I consisting of 10 items with factor loadings ranging from .404 to .716; and Factor II consisting of 6 items with factor loadings ranging from .407 to .772. Factor III consisting of 3 items with factor loadings ranging from .446 to -.790.
Factor analyses of the Nurses SRC & TRC
Table 2 presented the explorative factor analysis conducted with a varimax rotation on the items of the SRC-15 items. Results indicated three factors that explained 56% of the total variance. These factors had eigenvalues greater than 1.0. Factor 1 explained 39.9% (eigenvalue: 5.978) of the variation in the scores of the SRC. Factors 2 and Factor 3 accounted for 8.6% (eigenvalue, 1.284) and 7.5% (eigenvalue, 1.127) respectively of the variance. The first factor of SRC identified as (Social support/ Staying positive, searching actively, reach out and stay connected with self-validation and well liked), presented by ( I am), defined by (9) items on the questionnaire, The second factor of SRC identified as (Social skills and competencies/ Managing self, like to make & stick with plans, have emotional intelligence and see the value in making others laugh) presented by (I can), defined by (5) items on the questionnaire, The third factor of SRC identified as (True role model/ Passion and ability to inspire, clear set of values, commitment to community, selflessness and acceptance of Others and ability to overcome obstacles), presented by (I have) and defined by one item on the questionnaire (Table 5).
For the TRC scale, the factor analysis showed that Five factors explained 62.7% of the total variance which is higher than that for the SRC. These factors also had eigenvalues greater than 1.0. Factor 1 explained 34.4% (eigenvalue: 6.186) of the variation in the scores of the TRC. Factors 2 and 3 accounted for 8.4% (eigenvalue, 1.517) and 7.5% (eigenvalue, 1.352) respectively, of the variance, Factors 4 and 5 accounted for 6.7% (eigenvalue, 1.203) and 5.7% (eigenvalue, 1.03) respectively, of the variance. The first factor of TRC identified as (self regulation/ A person with self regulation ability and strong psychosocial support) presnted by (I am) and defined by (8) items on the questionnaire, The second factor of TRC identified as (Internal strength/ A person that is goal-directed solution-seeking presented by (I am) and defined by (4) items on the questionnaire, The third factor of TRC identified as (Personal Strength/ A person that perceive "Problems are not stop signs, they are guidelines.”Presented by (I am)) defined by (2) items on the questionnaire, The forth factor of TRC identified as (Internal strength/A person with calm mind that bring inner strength and self confidence. Present (I am) defined by (2) items on the questionnaire, The fifth factor of TRC identified as (Coping skills/keeping your body and mind fit/ A person that fills the others hearts with so much happiness) Presented by ( I can) and defined by (2) items on the questionnaire (Table 6).
The individuals personal characteristics of nurses with extreme resilience are nurses who have sibling, own a house, are not traveling every day to the work place, whose husband education is university and who have not problem with the team work and who are working day shift only. Resilience appears to be predicted by other attributes and is not necessarily depends on an individual's personal characteristics.
This paper demonstrates the hallmarks of resilience demonstrated by nurses, factors o f resilience scales were (1) self regulations / Staying positive , searching actively, reach out and stay connected with self-validation and well liked, (2) Coping skills and competencies/ Managing self, like to make & stick with plans, have emotional intelligence and see the value in making others laugh , (3) True role model/ passion and ability to inspire, clear set of values, commitment to community, selflessness and acceptance of others, and ability to overcome obstacles, (4) Self regulation and strong psychosocial support (5) Internal strength/ A person that is goal-directed solution seeking (6) Personal Strength/ perceive "Problems are not stop signs, they are guidelines.” (7) Internal strength/ calm mind that bring inner strength and self confidence (8) Social skills/keeping body and mind fit/ fills the others hearts with so much love and happiness.
The level of the resilience of nurses was unchanged from Trait to State, these findings emphasize the importance of the organization to adopt the resilience based strategies programs to optimize resilience among nurses. Nurses are well positioned to adopt such methods improvement to facilitate better outcomes for patients.
Keywords: Nurses; resilience, social support, coping, internal strength, personal strength