The ‘Concept of Resilience’ refers to the dynamic process and capacity to positively adapt within challenging conditions (A.P Association, 2016). Although this theoretical definition is a broad conceptual umbrella, resilience is directly applicable to many forms of life whether it is an object, system or person, however, it’s only when faced with obstacles or stress that the level of resilience becomes evident – whether the system or person submits or surmounts (Masten & Obradovic, 2006). Understanding the concept of resilience and contributing factors is vital to the success of the recovery process (Cook, Wears, Woods, Hollnagel, & Nemeth, 2008). Specifically, the health care system exists due to adversities, thus tailoring approaches in order to perceive adversities and stress as enhancing rather than debilitating will result in the best outcome for both health care worker and consumer (McGonigal, 2015).
It wasn’t until the 1970s-80s that psychological research pioneers developed the concept of resilience. A major voice in psychology, Norman Garmezy, published research in 1973 where the concept was initially introduced and formed a platform for further development (Wolff, 1995). Prior to Garmezy’s study, research within this area sought out areas of vulnerability and weakness in the context of adversity, however Garmezy investigated areas of strength and why some subjects were able to bounce back from difficult conditions whilst others could not. This new focus lead to identifying elements that predicted the level of resilience; these yield a combination of psychosocial elements and biological predispositions (Edward, 2013). Psychosocial factors can be separated into two subdivisions, ‘protective factors’ and ‘risk factors’. Protective factors are aspects of an individual’s background or personality that may facilitate success despite any challenges they encountered, examples include; supportive relationships, realistic planning, positive self esteem, effective communication, problem solving skills, optimism, and a stress resistant personality (Daniel & Wassell, 2007). Although, a lack of protective factors leads to ‘risk factors’, these are elements of a group of an individuals situation that predict a negative outcome and elevate the probability of an undesirable outcome (Daniel & Wassell, 2007). These factors include- internal; the individual (their emotions, internal locus of control: the attitude that they are the orchestrators of their own fates, and self concept) and external; relationships and condition of family and community (A.P Association, 2016).
This leads to the theory that resilience is not a static personality trait but rather a dynamic process influenced by the intensity, quantity, and longevity of these ongoing factors, if the weight of the stressors outweigh coping, the walls or resilience begin to collapse (Ciccetti, 2010). Adversity impacts people both physically and mentally, although coping mechanisms differ from person to person there are 2 common sorts of responses displayed by people; problem focused (efforts to change the circumstances) or emotion focused (altering perception of the circumstance, to appear less threatening and more desirable) (Friedman & Silver, 2006). The concept of resilience in health care advances further than risk factor identification, but progresses to what may lessen these impacts of adversity.
Many models and theories have explored the physical implications that stress and adversity have on the body, for example the ‘General Adaption Syndrome’ (GAS) which addresses the basic biology behind stress responses. This provides a platform to alter the perception of a stressor and converting stress into a growth technique and benefit from resilience (Greenblatt & Brogan, 2015). GAS consists of 3 stages in coping; 1. Alarm- the immediate response 2. Resistance-the bodies attempt to regain equilibria and 3. Exhaustion-the resistance to the stressor may be reduced or unsuccessful (Barkway, 2013). An example of the GAS system is the release of stress hormones and stress recover hormones, specifically Cortisol and Dehydroepiandrosterone (DHEA- a neurosteroid). Both Cortisol and DHEA are released during the ‘alarm’ stage, Cortisol continues to be released during the ‘adaption’ stage, whereas DHEA declines within the ‘adaption’ stage causing the person to feel anxious, sad and an overall stress feeling, this continues into the ‘exhaustion’ stage where hypercortisolism is observed, creating the feeling of depression and fatigue(Greenblatt & Brogan, 2015).
Studies have shown that this response can influence the situations outcome due to the ratio of DHEA to cortisol, aka. The growth index for your stress response. The larger the index is indicative that there is more DHEA than cortisol which is associated with thriving during and after stressful experiences (resilience) along with reduced risks of anxiety, depression, heart disease, neurodegeneration and other stress related illnesses. Contrastingly, higher levels of cortisol have been associated with worse outcomes for example, impaired immune function and depression (McGonigal, 2015).
Research conducted in the USA has found that those who perceive stress negatively, increase their chance of dying by 43% along with higher likelihoods of developing both acute and chronic illnesses (Keller et al., 2012).
Therefore, in a health care context where the ambition is to produce the best total health outcome it is vital to know how to influence both your own and someone else’s growth index. One way of doing this is through altering your perception towards stress or an adverse event (McGonigal, 2015).
As the concept of resilience develops, we become more aware of the capabilities that humans hold to acquire it. Not only are we biochemically capable of adapting to situations we also hold the ability to encourage resilience within others and ourselves (Edward, 2013). The stress response exemplified earlier involves stress hormones and neurosteroids that are fundamental elements of a concept called ‘stress inoculation’. This is a process that occurs after the body endures a stressful situation and the neurosteroids act in a vaccination type manner, this is; imprinting memories and coping strategies in the brain to prepare you for stress next time you encounter a similar situation and thus biochemically developing resilience (McGonigal, 2015). Although it has also been shown that altering thought and perception of a stressful situation can alter the overall outcome. This was displayed in the study held at the Columbia Business School, which put 2 groups of subjects through the same stressors with the only variable being their mindset. One group entered with the belief that stress physically and mentally debilitated you and other entered believing it enhances performance. Results displayed that those believing it enhanced performance released more DHEA and thus obtained a higher growth index(Crum, Salovey, & Achor, 2013). This reinstates the ability that we hold to control the outcomes of our actions. This can be achieved by making the conscious decision of educating ourselves and the patient that stress is enhancing opposed to debilitating, for example; increased respiration rate provides your brain with more oxygen, or that your pounding heart is allowing you to move and react faster (McGonigal, 2015). Another strategy is to change the way the nature of the adversity is viewed from internal (blaming self), stable (this will never end) and global (everything is ruined) to the opposing (Shehu & Mokwathi, 2008). This swap in perception increases your growth index and reduces negative side effects of stress whilst in turn, reinstates your internal locus of control (McGonigal, 2015). This exemplifies the capabilities of coping mechanisms and leads to how it can enable us to develop the dynamic process of resilience.
Adopting this knowledge and strategies, health care practitioners can intuitively observe risk and protective factors and alter their practice accordingly in order for the best outcomes to result. When a patient enters the health care system their sense of control is decreased and simultaneously increases their feeling of vulnerability, this causes the individual to feel that they are incapable of controlling possible outcomes and thus their adaptive skills become restrictive and possibly ineffective(Edward, 2013). Fostering resilience in patients through early intervention, reducing risks and minimising stressors, encouraging a different perception of stress, self esteem and support building, exploring coping mechanisms and positive lifestyle choices (Edward, 2013).
Although whilst caring for patients going through adversity or hardships it is equally important for the health care worker explore coping techniques and adopt resilience into their personal and work life. Health care as an occupation inevitably involves adversities and in order to successfully cope, knowledge of strengths/weaknesses and targeting personal coping mechanisms to this, improve understanding/communication/empathy with client and improve self-management, to prevent ‘burning out’, this will consequently improve the outcome for the patients outcome(American Nurses Association, 2013).
As exemplified throughout, the concept of resilience is applicable not only in the health care industry but across all walks of life. In this context, identifying and adapting to protective and risk factors and altering practice accordingly is immensely influential to the overall outcome to the patient and health care worker. This can be done through perception changing and the encouragement and adoption of support and coping mechanisms. It is important that encouragement of resilience and development is brought to the forefront of communities and increasing support in order to successfully assist those going through hardships.