reflective essay on resilience in nursing

• Open access
• Published: 19 January 2022

Exploring nurse perceptions and experiences of resilience: a meta-synthesis study

• Eun Young KIM 1 &
• Sung Ok CHANG 2  

BMC Nursing volume  21 , Article number:  26 ( 2022 ) Cite this article

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A Correction to this article was published on 15 February 2022

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To understand nurse resilience by integrating the qualitative research results on nurses’ resilience-related experiences.

We applied the seven steps of the meta-ethnographic process by Noblit and Hare (1988). Five databases (PubMed, EMBASE, Web of Science, CINAHL and PsycINFO) were used to search for relevant studies published from January 2011 to September 2021.

Sixteen qualitative studies were included. The four themes of “self-development based on one’s inner self”, “fostering a positive attitude towards life”, “developing personal strategies for overcoming adversity” and “building professionalism to become a better nurse” illustrate that they want to improve their inner strength and develop themselves through self-examination.

In this study, we examined nurse resilience, and the results can provide fundamental conclusions useful for the development of an intervention study to improve nurse resilience.

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Introduction

Nurses are the largest occupational group in the medical health field. They account for approximately 59% of the total global medical health workforce [ 1 ], and play a very important role in patient care. Globally, in recent years the nursing profession has been a rapidly growing sector of the workforce [ 2 ]. However, nurses suffer stress and burnout related to their job, and this has a very negative effect on their mental health [ 3 ]. Problems that negatively affect the mental health of nurses can have serious consequences, such as decreased nursing professionalism, poor quality of care, increased social and financial losses, and increased turnover and resignation [ 4 , 5 ].

Nurse job satisfaction has been in decline over recent years, and nurses have been found to develop negative perceptions about their job [ 2 ]. Nurse job satisfaction is related to the turnover rate, which affects the quality of patient nursing care. As concern over nurse job satisfaction and burnout is increasing worldwide [ 6 ], timely studies of concepts that can ameliorate the negative job perceptions of nurses caused by their negative experiences are required.

Resilience is a positive concept that allows nurses to overcome stressful situations [ 7 ] and to adapt positively, resulting in the maintenance of their psychological well-being and mental health [ 8 , 9 ]. In a recent study, nurse resilience was found to significantly reduced nurse burnout [ 10 , 11 ]. Resilience is emerging as an important concept for reducing the psychological burden of nurses and increasing their physical and mental health, since resilience has been shown to have a mediating effect on the relationship between burn out and physical/mental health [ 12 ]. Recently an understanding of an individual’s culture is considered very important for understanding resilience [ 13 ], so when exploring resilience in nurses, a key occupational group in society, we need to pay attention to their culture.

Most people have life-threatening experiences or are exposed to one or more stressors in their lifetime [ 14 ]. Therefore, it is very important to improve and adapt mental health to aid recovery from the challenges and adversities one faces and to adapt positively. Since nurses in particular are exposed to wide-ranging stresses, the ability to overcome such adversity is particularly important for them. The concept of resilience originated in psychology [ 15 , 16 ] and can be described as an individual’s characteristics, processes, and outcomes [ 15 ].

According to Ungar [ 17 ], studying resilience requires a contextualized approach because the dynamic partnerships between individuals and social ecosystems can lead to positive adaptation when individuals face difficulties. Given this perspective, the issue of culture is very important, and exploring resilience in the context of the culture to which nurses belong can help to properly identify the dynamic property of resilience nurses. An understanding of resilience can be effectively applied to improving the mental well-being of nurses.

Research into nursing resilience has been steadily improving, and over the last 10 years the importance of the concept of resilience has become emphasized as related research has rapidly increased. In particular, resilience has been proposed as a solution to burn out [ 10 , 11 , 18 ] and mental health issues [ 19 , 20 ], which nurses frequently suffer from, and related research has been actively conducted.

Nurse resilience contains a complex and dynamic process that changes over time and according to the situation, embodying not only personal attributes but also external resources, and describes a nurse’s ability to adapt positively to stress and adversity [ 21 ].

Academic interest in nurse resilience has been increasing recently, and many qualitative studies are being conducted to explore the essence of nurse resilience. However, the diversity of these qualitative studies and the differences in their findings has hindered understanding of the core concepts of nurse resilience.

Qualitative meta-synthesis is a methodology for synthesizing and analyzing individual qualitative research [ 22 ]. This methodology is recognized as a useful tool for analyzing the meaning, experience, and perspectives that participants’ express [ 22 ]. It can help accumulate knowledge and derive expanded knowledge and new interpretations from the the areas of research and phenomena suggested by the results of existing studies [ 23 ]. The methodology also enables more specific suggestions for future studies [ 22 ].

Noblit and Hare developed one of meta-synthesis method, meta-ethnography in 1988 [ 24 ]. This method has the potential to lower study duplication, create new research questions, and promote higher-level analyses [ 25 ].

In this study, the results of qualitative studies on nurse resilience are integrated, a new interpretations are attempted. This study will help provide fundamental information for the research and development of interventions to improve nurse resilience. The purpose of this study was to systematically review and synthesize the qualitative evidence on the nurse resilience experience.

The aim of this study is to understand nurse resilience and to suggest directions for future research through the process of synthesizing and integrating qualitative research results on nurse resilience-related experiences.

We used a meta-synthesis methodology, which provides broad understandings of social phenomena, to integrate the findings of qualitative studies [ 26 ]. Since meta-ethnography is an interpretive approach suitable for higher-level analyses and the formation of new interpretations beyond the discoveries of individual qualitative research [ 24 ], it is suitable for the purpose of this study, which is to synthesize and newly interpret research on nurse resilience experience. We followed the meta-ethnography method, which is suitable for both preserving the interpretations of the primary data and forming new interpretations, theories and models [ 27 ]. We applied the seven steps of the meta-ethnographic process by Noblit and Hare [ 24 ]: (a) getting started, (b) deciding what is relevant to the initial interest, (c) reading the studies, (d) determining how the studies are related, (e) translating the studies into one another, (f) synthesizing those translations, and (g) expressing the synthesis.

The research questions were:

“How do nurses overcome adversity?”

“What are the characteristics of nurses resilience experiences?”

This review was prepared in accordance with ENTREQ (Enhancing transparency in reporting the synthesis of qualitative research Statement) guidelines [ 28 ]. This meta-synthesis study was registered (CRD42021275787) with PROSPERO, which is the International Register of Systematic Reviews.

Phase 1. Getting started & Phase 2. Deciding what is relevant to the initial interest.

Search methods

We used the narrative literature review method. As this method is mainly used for searching literature representing the entirety of the phenomenon of interest, it is suitable for meta-synthesis studies [ 25 ].

Before the literature search, the two authors discussed the search strategy and databases to be used to search for appropriate articles that meet the purpose and inclusion criteria of this study. The authors selected PubMed and EMBASE, which are considered the most important databases for literature searches in the medical field [ 29 ], and included Web of Science to broaden the search to the field of social science. In addition, CINHAL, a nursing database, and PsycINFO were important to include due to the psychological nature of the concept of resilience. Thus, literature searches were carried out across five databases overall (PubMed, CINAHL, EMBASE, Web of Science and PsycINFO). The representative search terms used in the search were “Nurses”, “Resilience, Psychological”, “Qualitative Research”, and “Hermeneutics” from the list of Medical Subject Headings (Mesh terms). The search terms were adapted according to the index terms of each database. The search terms were used with the Boolean operators “AND” and “OR” in different combinations. The search strategy of this study is presented in supplementary material Table S1. A flow chart of the systematic review of literature selection process of the present research is presented in Fig.  1 . A review study on a similar subject was conducted in 2012 [ 30 ]. In our search process we found that relevant studies had increased rapidly since 2011. Therefore, we limited the search results to the last 10 years to achieve a synthesis focusing on the latest research results.

Flowchart of systematic review for literature selection

The inclusion criteria required qualitative studies that were: (a) aimed at exploring the resilience of nurses, (b) published from January 2011 to September 2021 (c) peer-reviewed journals (d) published in English, and (e) full-text searchable. The exclusion criteria were (1) nurse experiences were not reported separately, (2) mixed methods were used but qualitative data could not be extracted or (3) necessary qualitative depth was lacking in the data analysis.

Through the search procedure, 1020 studies were identified. 528 studies were excluded as duplicates in Endnote, and the two authors independently reviewed each title and abstract, thereby excluding 394 studies. When the two authors independently reviewed the full-texts and discussed any disagreements, 82 studies were excluded because of a lack of focus on nurse perspectives, an inappropriate topic, insufficient qualitative criteria, or because the full text could not be found. After this process, 16 studies remained for inclusion (Fig.  1 ).

Quality appraisal

The Critical Appraisal Skills Programme (CASP) checklist, which contains 10 questions for assessing the reliability and rigor of individual studies, was used to appraise the 16 studies [ 31 ]. Two authors independently evaluated the 16 included studies using the CASP checklist. After the appraisal, the two authors compared the CASP results, and any disagreements were resolved through discussion. The degree to which the studies met CASP was evaluated to be 70% for 4 studies, 80% for 9 studies, and 90% for 3 studies. Since all the studies were evaluated as being 70% or higher, none were excluded from the evaluation process (Table  1 ).

Phase 3. Reading the studies & Phase 4. Determining how the studies are put together.

Data extraction

Two authors independently reviewed the studies in detail. Each author read the studies line by line and tried to derive meaningful concepts by extracting codes. Data extraction for the study was performed using a custom form in Microsoft Excel, including author details, participant characteristics, methods, and original citations [ 27 ]. Disagreements between the authors were solved through discussion.

Phase 5. Translating the studies into one another, Phase 6. Synthesizing the translations & Phase 7. Expressing the synthesis.

Data synthesis

Based on the meta-ethnography process [ 24 ], the 16 studies were independently read repeatedly by the two authors, data analysis was performed, and then the extracted data were summarized as concepts. In more detail, after organizing the papers in chronological order, the two authors independently read the 16 studies, repeatedly. They then summarized and extracted meaningful concepts and themes. The two authors compared the themes and concepts of the first paper with those of the second paper, and then compared the common themes of those two papers with the third paper to derive concepts and themes. To synthesize the key concepts and broader themes, this process was repeated until the final study. To extract the key concepts, the studies were read several times, and the key concepts of each study were listed and analyzed for comparison. The key concepts were formed based on the ‘first-order construct’ of the study. In the meta-ethnography analysis process, the data is divided into ‘first-order construct’, ‘second-order construct’, and ‘third-order construct’ [ 32 ]. The ‘first-order construct’ is the original study participant’s daily language as expressed in their own language in the original study, the ‘second-order construct’ is the researcher’s interpretation based on the ‘first-order construct’, and ‘third-order construct’ is a new interpretation of ‘second-order construct’ [ 32 , 33 ]. In this study the authors of the current paper extracted the key concepts of the ‘first-order construct’, then compared the similarities and differences to form the ‘second-order construct’, and finally derived the ‘third-order construct’, which represented the main themes of the current study, by abstracting the ‘second-order construct’. During this process of analysis and synthesis, the two authors continued to discuss their differences of opinion based on their respective academic and clinical backgrounds. The final analysis step, “expressing the synthesis,” was accomplished by collating the discussion results. In order to confirm the value of the data, the researchers asked one incumbent nurse and one nursing professor to confirm the appropriateness of the expression of the results and the choice of terminology, and after the discussion the results were amended accordingly and finalized. The quotes that best expressed each sub-theme were identified and are presented in the results.

Ethical consideration

As this study is a review study, as a meta-synthesis, human participants were not included. Therefore, an ethical committee review was not required.

Sixteen qualitative studies were included in this review study and the publication years of the included studies were from 2012 to 2021. A total of 241 nurses participated in the included reviewed studies. Their ages varied widely, from those in their 20s to those in their 60s, and they were generally of female gender. Their working departments were varied, and included the ICU, the geriatric ward, the emergency room, the psychiatric ward, and the general ward. The studies were conducted in Africa, Australia, Canada, Iran, Japan, Singapore, Taiwan, USA, and UK. In other words the studies were conducted in various countries around the world (Table 1 ). This study yielded four comprehensive themes of nurse resilience experience. These were ‘self-development based on one’s inner self’, ‘fostering a positive attitude towards life, ‘developing personal strategies for overcoming adversity’, ‘building professionalism to become a better nurse’. Table  2 shows the key concepts from the first-order constructs, the second order constructs, and the synthesized themes.

Theme I. Self-development based on one’s inner self

The sub-themes included in theme 1 were “recognizing and acknowledging signs of adversity” and “striving to develop oneself”. The nurses tried to find solutions by focusing on the signals that they had encountered adversity, and making an effort to grow through that adversity rather than collapse under it.

Sub-theme 1. Recognizing and acknowledging the signs of adversity

The nurses did not deny the signs of adversity, but recognized and acknowledged them. The nurses looked inside themselves to find problems and tried to reflect on themselves [A2-A5,A8,A11,A13–14,A16] . They tried to focus on the current situation [A2,A5,A8–9,A11–14] and showed an attitude of acceptance of the situation they were in rather than one of avoidance [A8–9,A11–14] . They believed in their abilities [A2,A5,A6,A9–10,A12–14] , tried to express their feelings honestly [A2,A6,A10,A11,A13] , and tried to recognize the warning signs of stress rather than ignore them [A5,A9,A11,A13] . They showed themselves as focusing on the state and demands of their bodies and emotions [A5–6, A8,A10–11,A16] .

“It is difficult....I feel it is a most difficult thing to reflect on my own feelings. I can understand other people, but I do not understand myself. I think I have experienced a kind of burnout.” (A2).

“I thought of ways when something happens so that one can go away, sit down and reflect and then maybe come up with whatever your own strategies are to come back stronger. So if the same thing comes at you again, you know where to run, which direction is faster” (A11).

Sub-theme 2. Striving to develop oneself

Rather than despair, the nurses wanted to grow on their own. They tried to maintain their physical health [A3–4,A11] and recognized a sense of self-efficacy [A5–6,A9,A11,A13–15] . In addition, they thought about and developed various ways to take care of themselves [A2-A4,A9,A11–15]. They were confident that they could overcome the adversity [A5–6, A9, A11, A13–15] and tried to control their emotions [A2,A5–6,A9,A11,A13–15]. Nurses tried not to ignore what others had to say and to learn from their experiences and expertise [A2–4,A6–7,A9–10, A16] . They tried new challenges [A2–5,A9,A11,A13] and had varied thoughts to solve problems [A2, A5, A9, A11–14]. The nurses showed patience and a willingness to move forward [A5,A9,A11,A13–14] .

“You know more or less that you have to do it and it is going to be tough going. The task could be from manageable to unmanageable depending on what is happening at the moment. I’m able to cope with stress.” (A13).

Theme II. Fostering a positive attitude towards life

In theme 2, the sub-themes included “accepting life positively” and “enjoying their own life”. In this theme, the power of nurse positivity is evident. The nurses showed that they were trying to overcome adversity with positivity. A positive view toward life and the desire to live their own lives gave the nurses strength in their professional lives.

Sub-theme 3. Accepting life positively

The nurses maintained a optimistic view toward life when overcoming life adversities [A1,A3–7,A9,A14–15] and maintained a sense of humor at work [A3–4,A6,A11] . They were grateful for life [A3–4,A6–7,A12] and tried to heal themselves by living a life of helping others [A2–4,A6,A15] . They remembered the good memories they had in the past, and drew positive thoughts from them [A1–2,A5–6,A15] . They found enjoyment and pride in what they did [A1,A5–6,A11,A15].

“But I try to look at the positive stuff . .. what we are able to do, what changes we were able to make as a result of a catastrophe or just a bad outcome. .. just pull my sleeves up and get in there and get it done and when I can, I do try to encourage communication and good feelings.” (A5).

““I think every type of nurse has their own type of black humor but I realized a lot of it is a coping mechanism and a way of protection to get yourself through the day” (A11).

Sub-theme 4. Enjoying their ownlife

Nurses tried to overcome the adversities they faced while enjoying life on their own terms [A1–2,A5,A11] . They tried to live a regular and healthy life, enjoy various leisure activities [A1–2,A5,A11,A13] and enrich their lives happily while creating their own hobbies [A1–2,A5,A13]. They coped with the situation by developing their own coping behaviors for managing crisis situations [A1–2,A5,A11,A13].

“You have to enjoy what you are doing. If you hate your work, it will be a constant stress. I feel that I don’t get stressed about it because I feel that no problem is difficult.” (A13).

“The joy of working is like a hurdle … like jumping over the hurdle. Each time I jump over a hurdle that I cross, there is always some satisfaction in the job.” (A13).

Theme III. Developing personal strategies for overcoming adversity

The sub-themes “staying away from stress” and “getting comfort through positive interpersonal relationships” were included in theme 3. Nurses were shown to develop their own strategies when overcoming adversities. They tried to stay away from situations that were stressful to them and formed their own defenses through positive interactions provided by wide-ranging human relationships. These methods of overcoming adversity were their own individual strategies learned through their own experiences.

Sub-theme 5. Staying away from stress

Nurses had to face varied sources of stress, but tried to avoid them , such as by trying to not create stressful situations or focusing on stress [A1,A9,A10–11]. They tried to maintain a work-life balance so that neither aspect became too large or too small, breaking the balance [A5–6,A8,A10–12]. In addition, by thoroughly separating their work and life, they tried to thoroughly protect their private life, avoiding the intrusion of work. They tried to respect their own privacy [A5–6,A8,A10–12].

“Sometimes, I can’t control myself. In such situations, I attempt to distance myself from that situation or the immediate environment. In these conditions, I ask my colleagues to continue care delivery and then, I leave the situation. I never stay in such a situation because I know that my presence will aggravate the problem. Thus, I leave that situation and start providing care to another patient.”  (A10).

“ I think that the only way for me to stay resilient is to keep stepping away from the bedside, because that’s where all the stress is for me, it’s at the bedside. You need to remove yourself from the situation ” “ I have to have this proper balance and this little routine to maintain a healthy, functional life, and I think the younger ones know that which is good.” (A11).

Sub-theme 6. Getting comfort through positive interpersonal relationships

In their professional positions the nurses developed a variety of interpersonal relationships, including relationships with patients, colleagues, and families. Nurses received comfort from their relationships with friends [A1,A3–5,A7,A10–12,A14–16] and comfort and support from their families [A1,A3–5,A7,A11–12,A14–16] . The nurses tried to maintain good relationships with their colleagues and other nurses and as colleagues they helped each other in difficult situations [A1–5,A7,A10–16] . In addition, they tried to grow one step at a time by orientating their own future direction through role models and mentors they could imitate [A1–2,A6,A11–12, A15], and they shared their feelings with people they could trust [A1–2, A5–6, A11–16]. They also received help from a mental health professionals for stress management [A6,A9,A12].

“It’s the people you work with. I have a lot of caring friends. I talk to my husband - he always backs me up. I think that how you deal with it.. . with another manager’s support. We meet for lunch sometimes — a laughs the best way — we quite often see the funny side.” (A4).

“Talking to colleagues because they know the scope of your job. They know what is happening in your ward, so they will be able to understand better.”, “I have good friends to whom I can confide my problems. I think it’s important you don’t bottle up your feelings too much, because you know you can just self-destruct if you’re not able to handle it. They may not be able to solve the problem; a listening ear does help.” (A13).

“I’m very fortunate as I have a large network of friends and colleagues that I can safely vent to or discuss things with or bounce ideas off that aren’t my staff. And I found that you really need that. It is pretty much a lifeline whether you’re a front-line manager or if you’re a director you need to have that core group of people that you can call and say, ‘Am I crazy’” (A11).

Theme IV. Building professionalism to become a better nurse

In theme 4, the sub-themes “planning their life for a better future” and “building self-esteem by thinking about the value of a job” were included. The nurses planned their future to live a better life than just leaving their lives to adversity. They felt that they had to develop themselves for a better future, prepare for a new life, and adapt to a new situation. They thought they had to rearrange their work by considering their priorities. This process led them to build their professionalism.

Sub-theme 7. Planning their life for a better future

In difficult situations, nurses thought about how to live their future. Even in difficult situations, the habit of planning for the future and thinking about the future rather than staying in the present and despairing was exhibited by nurses [A2–4,A6–7,A9,A13,A16] . They wanted to develop themselves, to prepare for new assignments including difficult situations [ A2–4,A6–7, A9,A14,A16] , and to adapt well to new situations [A2,A7,A9,A13–14,A16]. They re-prioritized their work and tried to work according to their priorities [A5,A8,A13–16].

“I always take an experience as an opportunity to learn from it. To grow. I mean, no experience is bad. It may be a bad experience but you can learn from it and try to move on and try to make things better” (A13).

Sub-theme 8. Building self-esteem by thinking about the value of a job

In difficult situations, nurses tried to gain the strength to overcome the crisis by reflecting on themselves being nurses [A2–4,A6,A9–13,A15–16] and on the value of their job [A2–4,A6,A9,A11–13,A15–16]. They took pride in their job, thought about the meaning and value of being a nurse, and tried to overcome crises while gaining satisfaction from the value of their work [A2–4,A6,A9,A11,A13–16]. They had a passion for their work [A2–4,A6,A9–16] and wanted to develop their knowledge and skills as nurses and upgrade themselves through individual development [A24,A6,A9,A12–13,A15].

“We are the backbone when patients come in. The nurse is the protector of the patient." (A14) " The patient survived because the nurse stuck out her hand and stopped the bleeding. I am proud of her.” (A11).

As nurses play a very important role in the medical field, they are exposed to wide-ranging difficulties because of the high intensity of their work. Research on the resilience of nurses, a positive force to overcome this, has recently attracted attention in both research and practice. This study synthesized the result of qualitative research on nurse resilience to explore nurse experiences of overcoming adversity.

According to the result of this study, when nurses felt that they were going through a difficult situation, they tried to recognize and acknowledge that situation by exploring their inner selves. They focused on themselves and tried to find out exactly what their situation and problems were through self-exploration and not evading issues. This can be thought of as a preparation process for problem solving. In the context of the more general resilience attributes found by previous studies, it can be noted that the nurse attributes discovered by this study, such as a belief in self-efficacy and a desire to improve oneself, are aspects of resilience in general [ 34 ]. In addition, the results of this study can support the results of previous studies that internal protection factors such as self-efficacy, optimism, emotional intelligence and self-management should be covered in the training of resilient nurses [ 35 ] .

However, nurse resilience included striving for self-development while focusing on reality. These results show that nurses in a crisis situation have a strong tendency to rapidly grasp problems, trust themselves and solve problems quickly. Also, the nurses showed that they wanted to solve problems and grow step by step rather than remaining in crisis. The subjects of this study were incumbent nurses in their 20s to 60s, including relatively young subjects, and it likely that the specific nature of the active and developmental results derived in this study reflect all of them having the profession of nursing in common.

Nurses tried to overcome adversity by accepting life positively and enjoying their own lives. In previous studies, this positivity property as a component of resilience was found to be universal across varied subjects, as a part of the concept of general resilience [ 33 , 36 ] and the resilience of chronic disease patients [ 37 ]. In addition, nurses showed the characteristics of wanting to be challenged in life and enjoy the life given to them. This can be seen as showing an active attitude to life, and, since nurses are generally made up of healthy young people, this showed a different aspect of resilience from those shown by patients who are highly dependent on their families and medical staff [ 37 , 38 ]. A positive and active attitude towards life could be an important factor to focus on in the development of future intervention research aiming to improve nurse resilience.

Nurses exhibited the resilience characteristics of avoiding stress and separating their lives from stress when overcoming adversity. They showed that they were trying to overcome adversity by guaranteeing the quality of their own lives. This characteristic results from the professional stress of a nurse, reflects the substantial stress they face at work, and is something we should pay attention to. The results of this study can support the findings of previous studies that nurses recognized work-life separation as a very important factor when considering resilience [ 39 ] . Nurses got comfort from wide-ranging human relationships. The human relationships of nurses were characterized by wanting to develop their relationships between colleagues to an intimate level, particularly friendship, and them securing comfort from these relationships with such close colleagues. Considering these characteristics of nurse resilience shows the need when developing future intervention studies to improve nurse resilience to create resilience programs that consider peer relationships.

As the nurses overcame adversity, they try to adapt themselves by developing themselves and preparing for new situations. They try to organize their lives while arranging work priorities. Nurses tried to overcome adversity by planning for the future and developing one step at a time. In addition, in the face of adversity they took pride in being nurses by reflecting on why they chose their profession and reminding themselves of its value. By raising their job satisfaction and passion for their work, their self-esteem was also raised. They wanted to grow further as nurses by constantly exploring and developing job-related knowledge and skills, and tried to overcome the difficult situations they faced through the process of growth. The aspect of resilience, that contains the meaning of growth, has been revealed in previous studies [ 40 ]. However, the resilience of nurses has more specific meanings than the previous concept of resilience in that nurses plan for a better future, value the professional meaning of nursing, and want to develop as nurses. This characteristics of the resilience of nurses who plan for the future in difficult situations and want to develop themselves further can suggest a direction for intervention research to enhance nurse resilience.

Due to the COVID-19 pandemic of recent years, many medical staff, including nurses, are struggling in the medical field. Several studies have been published that show that, in some countries, facing this difficult situation has lowered the resilience of nurses [ 41 , 42 ]. Resilience is the strength to overcome such crisis situations, and the importance of the ability of nurses to overcome these global medical crises is increasingly being emphasized [ 43 ]. Many studies have emphasized the need for intervention research to improve nurse resilience [ 44 ]. The results of this study can provide fundamental data on what factors to focus on when developing intervention studies to improve nurse resilience, which has been lowered in the pandemic situation. We need to focus on the inner self and plan interventions that will improve that aspect. Also, interventions that rebuild positive strength and allow nurses to overcome adversity and grow individually will be very helpful for them to overcome adversity. These varied approaches can be expected to give positive strength to nurses, particularly in the currently challenging medical field.

This study helps the understanding of resilience in nursing, and provides an appropriate lens for a contextualized approach to resilience research. This is very meaningful data from a socio-ecological point of view and emphasizes the importance of interactions between individuals and society [ 17 ], and is expected to ultimately play a positive role in the development of society.

This study has two strengths. First, the included studies are from very diverse countries, such as the United States, Japan, Australia, South Africa, the United Kingdom, Canada, Singapore, Iran, and Taiwan, reflecting studies of various cultures. Therefore, this study can provide universal knowledge that is applicable worldwide. Second, of the literature used in this study, all 16 articles were found to satisfy the quality evaluation criteria by 70% or more, so the study is based on an analysis of relatively high quality documents of well-organized structure.

Despite these strengths, this study has limitations. The nurses included in the literature were from wide-ranging sub-fields, and the specific stress characteristics of the particular departments were not reflected in the result. Therefore, in the future, conducting qualitative research on the resilience of nurses across nursing sub-fields is suggested. To resolve this, meta-synthesis studies could be conducted to elucidate the characteristics of nurses within more specific fields.

Future research

Resilience enhancement is an approach that maximizes human inner strength, and we can suggest an intervention that maximizes inner human resources by using mobile resources featuring excellent individual accessibility. Mobile health intervention applications have developed rapidly lately and their usefulness is recognized in nursing [ 45 ]. Recently, mobile health (mHealth) using smartphones for psychotherapy has been attracting attention as useful for the upcoming post-corona era [ 46 ]. Mobile applications can be useful resources for problem solving, and providing real-time information and stress reduction strategies for nurses in a variety of healthcare fields and settings [ 47 ]. In addition, since previous studies found smartphone app-based resilience interventions effective for resilience, emotional regulation, and psychological health promotion, the development of a smartphone app-based nurse resilience enhancement program can be expected based on the results of this study [ 48 ] .

Emphasizing resilience, a positive force for overcoming adversity, to nurses can play a very significant role in improving the quality of nursing care. In this study, nurses showed resilience to grow and develop themselves by focusing on their inner selves and finding ways to solve problems on their own. These can be considered as categories of nurse resilience and provide a framework to guide the development of an intervention program for improving nurse resilience. Based on the results of this study, to improve the quality of nursing care we should try to develop varied intervention programs that enhance nurses’ inner strength.

Availability of data and materials

All data generated or analyzed during this study is included in this published article.

Change history

15 february 2022.

A Correction to this paper has been published: https://doi.org/10.1186/s12912-022-00819-z

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Acknowledgements

This study was supported by a National Research Foundation of Korea grant funded by the Korea government (NRF-2021R1I1A1A01048956).

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Conceived and designed the study: EYK, SOC. Performed the data collection: EYK, SOC. Analyzed the data: EYK, SOC. Contributed materials: EYK, SOC. Wrote the first draft of the manuscript: EYK. Prepared figures and tables: EYK. Agree with manuscript results and conclusion: EYK, SOC. All the authors read and approved the final manuscript.

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Supplementary Information

Additional file 1., list of synthesized studies.

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A2. Shimoinaba K, O’Connor M, Lee S, Kissane D. Nurses’ resilience and nurturance of the self. Int J Palliat Nurs. 2015;21(10):504–10. https://doi.org/10.12968/ijpn.2015.21.10.504

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A4. Cope V, Jones B, Hendricks J. Why nurses chose to remain in the workforce: Portraits of resilience. Collegian. 2016;23(1): 87–95. https://doi.org/10.1016/j.colegn.2014.12.001

A5. Tubbert SJ. Resiliency in emergency nurses. J Emerg Nurs. 2016;42(1):47–52. https://doi.org/10.1016/j.jen.2015.05.016

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A7. Marie J, Hannigan B, Jones A. Resilience of nurses who work in community mental health workplaces in Palestine. Int J Ment Health Nurs. 2017;26: 344–54. https://doi.org/10.1111/inm.12229

A8. Prosser SJ, Metzger M, Gulbransen K. Don’t just survive, thrive: understanding how acute psychiatric nurses develop resilience. Arch Psychiatr Nurs. 2017;31(2):171–6. https://doi.org/10.1016/j.apnu.2016.09.010

A9. Wahaba SNB, Mordiffi SZ, Ang E, Lopez V. Light at the end of the tunnel: New graduate nurses’ accounts of resilience: A qualitative study using Photovoice. Nurse Educ Today. 2017;52:43–9. https://doi.org/10.1016/j.nedt.2017.02.007

A10. Imani B, Kermanshahi SMK, Vanaki Z, Lili AK. Hospital nurses’ lived experiences of intelligent resilience: A phenomenological study. J Clin Nurs. 2018;27(9–10), 2031–40. https://doi.org/10.1111/jocn.14310

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A12. Ramalisa RJ, du Plessis E, Koen MP. Increasing coping and strengthening resilience in nurses providing mental health care: Empirical qualitative research. Health SA. 2018;23:1094. https://doi.org/10.4102/hsag.v23i0.1094

A13. Ang SY, Uthaman T, Ayre TC, Lim SH, Lopez V. Differing pathways to resiliency: A grounded theory study of enactment of resilience among acute care nurses. Nurs Health Sci. 2019;21:132–8. https://doi.org/10.1111/nhs.12573

A14. Ang SY, Uthaman T, Ayre TC, Lim SH, Lopez V. A Photovoice study on nurses’ perceptions and experience of resiliency. J Nurs Manag. 2019;27(2):414–22. https://doi.org/10.1111/jonm.12702

A15. Lin C-C, Liang H-F, Han C-Y, Chen L-C, Hsieh C-L. Professional resilience among nurses working in an overcrowded emergency department in Taiwan. Int Emerg Nurs. 2019;42: 44–50. https://doi.org/10.1016/j.ienj.2018.05.005

A16. Udod S, Care WD, Graham JM, Henriquez N, Ahmad N. From coping to building nurse manager resilience in rural workplaces in western Canada. J Nurs Manag. 2021;Online ahead of print. https://doi.org/10.1111/jonm.13350

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KIM, E.Y., CHANG, S.O. Exploring nurse perceptions and experiences of resilience: a meta-synthesis study. BMC Nurs 21 , 26 (2022). https://doi.org/10.1186/s12912-021-00803-z

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Building Resilience in Nursing Students During the Pandemic

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Abstract: As a nursing professor at Goshen College, a small liberal arts college in Indiana, and a nurse practitioner working at an urgent care, I have realized that there are lessons from the clinic’s transformation into a COVID-19 testing center that can be applied to educating future nurses. As nurses, we must adapt to different work environments, ever-changing practices as research progresses, and a population whose needs are different now than they will be in five years. As nursing educators, these lessons are some of the most difficult to pass on to students as the majority of their nursing education occurs in a classroom or lab, and nearly all of their clinical experience occurs in a hospital. In this essay, I explore the ways in which I taught students about the resilience that nurses must have and how the transition at the urgent care has aided these efforts.

For those of us with limited online teaching experience, making hours of lecture videos could have been seen as the safe choice. But doing so would have shortchanged our students: we would not have replaced students honing their skills in lab or interacting with real patients during their clinicals. I discuss some of the methods our department used to combat these tendencies; for example, my students recorded themselves physically assessing family members. In addition to demonstrating our adaptability in teaching, the nursing faculty showed our students first-hand how resilient their professors have been: several of us practice, and a handful, including me, have increased our hours on the front lines of this pandemic in part because we view nursing as our vocation: we help whenever needed (White, 2002).

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Personal reflections on inner resilience: When the chips are down

We all need to be resilient to cope with the challenges of nursing and healthcare provision. In this blog I will reflect on working in a pressured healthcare system and what it means in relation to resilience. This is particularly important at a time when many nurses and other health care providers are at breaking point.

As a nurse of 36 years, I have experienced many changes in healthcare, driven by changing NHS policy, organisational form and function, internal reorganisations, and front-line service delivery. Never have I experienced such change in NHS form and function as we move from Clinical Commissioning Groups to new Integrated Care Systems (NHS England 2021) during a time when the NHS is under unprecedented pressure. This system wide change is ploughing ahead as we emerge from wave three of the Covid 19 pandemic. The last time the NHS faced such massive impacts was probably at its inception, post world war 2 with the ‘Spanish flu’ pandemic still in living memory.

Widespread fatigue, exhaustion and low morale is endemic across the whole health and social care system (Mehta et al 2021, De Kock et al 2021). Healthcare staff in hospitals, community, hospices, care homes and the independent sector have all worked throughout the pandemic. There has been no ‘down time’ to recover and reflect. As we move from Covid 19 restrictions to business as usual, the potential for a reduction in workload and pressure is unlikely. The NHS  is working hard to bring down waiting lists, maintain essential elective and non-elective activity . Hospital, emergency departments, urgent treatment centres and ambulance trusts are all under unprecedented pressure – see for example: https://bit.ly/3AdXdta ;   https://bit.ly/3lmyRa2 . This bleak picture, is with a backdrop of expected autumn and winter pressures. Alongside this there is the need for flu/Covid 19 vaccination campaigns to address waning immunity and a resurgence of flu, which was less last year due largely to the beneficial impact of Covid 19 restrictions.

Is this too bleak a picture? No. I think this is realistic and honest. But it is not all doom and gloom. Within this context there are examples of amazing dedication, hard work and resilience from nursing and other healthcare staff.

But where do we get our resilience from? Several studies have recently explored resilience for healthcare staff in context of the Covid 19 pandemic (Health et al 2021; Sumner et al, 2021). Undoubtably part of our resilience is intrinsic, this is our own inner ability to adapt and bounce back and considered to be the physical and psychological characteristics possessed by individuals (Heath et al, 2020). Some resilience is experiential, mechanisms we have learnt through experiences, good and bad, that we can draw on when things get tough. Some resilience is environmental, and in this context, I mean where we live, where we work and who we work with. Resilience is a complex phenomenon and it cannot be redacted from the behaviour of individual parts of the wider system. As such my own resilience impacts on and is affected by the wider context in which I live and work. Sumner et al, (2021) found that personal factors including the presence of meaning in life, and resilient coping styles are associated with more positive welfare outcomes in healthcare staff.

We say there is a need to ‘be kind’ in these stressful and challenging times. For me, kindness starts at home (i.e. in the workplace). Fundamental to  my resilience is the need to have emotional support, trust and stability, and kindness provides me the foundation of my resilience. The importance of having a meaningful life, treating everyone with equal dignity and respect and being kind to me, enables me to be kind to others. This is a simple concept in complex times, but one  I think all healthcare staff can relate to.

De Kock, J.H.et al (2021) A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-10070-3 . Accessed 2.9.21

Heath, C.et al (2020) Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review

NHS England (2021) https://www.england.nhs.uk/integratedcare/what-is-integrated-care/ .  Accessed 2.9.21

Mehta, S.et al (2021) COVID-19: a heavy toll on health-care workers. 9, 3, P226-228, March 2021 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00068-0/fulltext. Accessed 2.9.21

Sumner, R. C.  & Kinsella, E. L. (2021) Grace Under Pressure: Resilience, Burnout, and Wellbeing in Frontline Workers in the United Kingdom and Republic of Ireland During the SARS-CoV-2 Pandemic. https://www.frontiersin.org/articles/10.3389/fpsyg.2020.576229/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Psychology&id=576229 Accessed 2.9.21

Additional reading

www.redcross.org.uk/get-involved/teaching-resources/five-activities-of-kindness-and-resilience

www.macmillan.org.uk/coronavirus/healthcare-professionals/wellbeing/resilience

https://internationaljournalofwellbeing.org/index.php/ijow/article/view/153

www.psychologytoday.com/us/blog/the-athletes-way/201905/small-acts-kindness-boost-resilience-in-surprising-ways

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How to Write a Nursing Reflective Essay as a BSN Nursing Student

• Author Jermaine Huey
• Published November 29, 2023

Welcome to NursingWriters.net, your go-to resource for expert information and guidance on writing nursing essays. In this article, we will provide you, as a BSN nursing student , with a comprehensive guide on how to write a compelling nursing reflective essay. Reflective essays are a personal reflection on your experiences in the nursing profession, and we are here to help you navigate this writing challenge.

As a busy nursing student, we understand that you may have limited time to spare. That’s where NursingWriters.net comes in, empowering you to excel in your BSN program by providing expert guidance on different writing and comprehension challenges you may face. Let’s dive into the world of nursing reflective essays and discover how you can effectively express your thoughts and insights.

Key Takeaways:

• Reflective essays allow nursing students to reflect on their experiences and personal growth in the profession.
• A nursing reflective essay is different from a personal statement, focusing on self-reflection rather than academic achievements.
• Key elements to include in a nursing reflective essay are the inciting incident, personal reflections, vivid details, and actions taken.
• The introduction should grab the reader’s attention and provide a clear thesis statement.
• The body paragraphs should delve into the writer’s reflections and emotions with specific examples and anecdotes.

What Is a Reflective Essay in Nursing?

A reflective essay in nursing is a powerful tool that allows nursing students to analyze their experiences, emotions, and actions related to their nursing practice. It provides an opportunity for self-reflection, critical thinking, and personal growth. Reflective writing can help nurses develop a deeper understanding of their own practice, improve patient care, and enhance their professional development.

Reflective essays in nursing differ from personal statements in that they focus on specific experiences and their impact on the writer’s growth and development. These essays require the writer to critically reflect on their actions, emotions, and thoughts, and identify ways to improve their practice. By examining their experiences and applying reflective frameworks, nursing students can gain valuable insights into their strengths, weaknesses, and areas for growth.

When writing a reflective essay in nursing , it is important to follow a structured approach. This includes describing the incident or experience, analyzing personal thoughts and feelings, exploring the actions taken, and reflecting on the outcomes and implications. By structuring the essay effectively, nursing students can communicate their reflections in a clear and organized manner.

Key Elements to Include in a Nursing Reflective Essay

When writing a nursing reflective essay, it is important to include key elements that will make your essay comprehensive and impactful. These elements will help you convey your thoughts and experiences clearly, allowing the reader to gain a deeper understanding of your reflections on nursing practice.

Inciting Incident or Event

The first key element to include in your nursing reflective essay is the inciting incident or event. This is the moment or experience that triggered your reflection and made a significant impact on your practice. It could be a challenging patient encounter, an ethical dilemma, or a personal realization. By describing this event in detail, you set the stage for your reflective journey.

Personal Reflections

Your nursing reflective essay should also include personal reflections on the experience. This is where you delve into your thoughts, feelings, and emotions related to the inciting incident. Reflect on how the event made you feel, what you learned from it, and how it has influenced your growth as a nursing professional. Be honest and vulnerable in your reflections, as this will allow the reader to connect with your experience on a deeper level.

Vivid Setting and Descriptive Details

To create a vivid and engaging narrative, include specific details that paint a picture of the setting and the people involved. Describe the physical environment, the interactions between healthcare professionals and patients, and any other relevant details that contribute to the overall context of the experience. This will help the reader visualize the situation and understand the complexities of the event.

Actions Taken

Finally, it is important to describe the actions you took in response to the inciting incident. Discuss how you applied your nursing knowledge and skills to address the challenges or opportunities presented by the event. Reflect on the effectiveness of your actions and whether there were any areas for improvement. This demonstrates your ability to critically analyze your own practice and make informed decisions.

By including these key elements in your nursing reflective essay, you can create a comprehensive and impactful piece of writing that showcases your growth and development as a nursing professional.

How to Write the Introduction of a Nursing Reflective Essay

The introduction of a nursing reflective essay plays a crucial role in capturing the reader’s attention and setting the tone for the entire essay. It should provide a concise overview of the main points that will be discussed and create a sense of curiosity and engagement. Here are some tips to help you write an effective introduction for your nursing reflective essay:

• Start with an intriguing opening line: Begin your introduction with a captivating statement or anecdote that relates to the topic of your essay. This will grab the reader’s attention and make them eager to continue reading.
• Provide context and background information: Give a brief overview of the event or experience that you will be reflecting on in your essay. This will help the reader understand the context and significance of your reflections.
• Present a clear thesis statement: Your thesis statement should clearly state the main purpose of your essay and the specific points or themes that you will be exploring. This will give the reader a preview of what to expect in the body of the essay.

By following these tips, you can craft an introduction that captivates the reader and sets the stage for a compelling nursing reflective essay.

“As I walked into the busy hospital ward on my first day of clinical rotation, I couldn’t help but feel a mix of excitement and nervousness. Little did I know that this experience would become a pivotal moment in my nursing journey, shaping my understanding of empathy, communication, and patient-centered care. In this reflective essay, I will delve into the details of this encounter and explore the personal and professional growth that resulted from it.”

With an attention-grabbing opening, providing context, and presenting a clear thesis statement, your introduction will set the stage for a compelling nursing reflective essay that captures the reader’s attention and lays the foundation for your reflections.

Nursing Reflection Essay Tips and Examples

Writing a nursing reflective essay requires careful consideration and thoughtful analysis. Here are some tips to help you craft an impactful and meaningful reflection essay as a BSN nursing student . Additionally, we will provide examples to illustrate how these tips can be applied.

Tips for Writing a Nursing Reflection Essay:

• Start by choosing a specific experience or event that had a significant impact on your nursing practice. This could be a challenging patient encounter, a critical incident, or a personal realization that transformed your perspective.
• Reflect on the experience and consider how it affected your emotions, thoughts, and actions. What did you learn from the experience? How has it shaped your growth as a nursing professional?
• Focus on the key aspects of the experience that were particularly impactful or meaningful to you. Avoid including unnecessary details or deviating from the main message of your reflection.
• Use specific examples, anecdotes, or patient scenarios to support your reflections. This will make your essay more engaging and relatable to the reader.
• Consider the ethical implications of the experience and reflect on how it has influenced your approach to patient care and decision-making.
• End your essay with a reflection on the implications of your learning for future nursing practice. How will you apply the lessons learned to provide better care and improve patient outcomes?

Now, let’s take a look at two examples of nursing reflective essays to further illustrate these tips:

“During my clinical rotation in the Intensive Care Unit (ICU), I encountered a complex patient case that challenged my critical thinking skills and decision-making abilities. The patient was a middle-aged woman who had undergone a complicated surgery and experienced numerous post-operative complications. This experience taught me the importance of collaboration within the healthcare team and the significance of advocating for the patient’s best interests…”

“One of the most significant experiences during my nursing education was my time spent in the pediatric oncology unit. Witnessing the resilience and bravery of children facing life-threatening illnesses had a profound impact on my perspective as a nurse. It taught me the importance of providing holistic care, not only addressing physical needs but also supporting emotional well-being and promoting a positive environment for healing…”

These examples demonstrate how personal reflections, specific details, and professional insights can be incorporated to create a compelling nursing reflective essay. Remember to structure your essay in a clear and organized manner, ensuring that your reflections flow logically and coherently.

By following these tips and utilizing examples, you can create a compelling nursing reflective essay that showcases your growth and development as a nursing professional.

How to Conclude a Nursing Reflective Essay

The conclusion of a nursing reflective essay serves as the final reflection on the writer’s growth and learning from the experience. It is an essential part of the essay that summarizes the main points discussed and leaves a lasting impression on the reader. The reflective essay conclusion should bring closure to the essay by restating the thesis statement and highlighting the key takeaways from the essay.

To write a strong and impactful conclusion, start by restating the thesis statement in a clear and concise manner. This reminds the reader of the main focus of the essay and reinforces its significance. Next, summarize the key points discussed in the body paragraphs, highlighting the most important insights and reflections. This helps to reinforce the main ideas and ensures that they are not overlooked in the final reflection.

In addition to summarizing the main points, a thought-provoking statement or future outlook can be included to provide a sense of closure and leave the reader with something to ponder. This can be a reflection on how the experience has influenced the writer’s future practice or a call to action for continued personal and professional growth. By ending the essay on a strong and meaningful note, the conclusion enhances the overall impact of the nursing reflective essay.

A well-crafted conclusion is essential for a nursing reflective essay as it reinforces the main ideas, leaves a lasting impression on the reader, and provides a sense of closure. By following these tips, nursing students can create a powerful and impactful conclusion that enhances the overall effectiveness of their reflective essays.

Tips for Writing a Nursing Reflective Essay

Writing a nursing reflective essay can be a challenging task, but with the right approach, it can also be a rewarding experience. Here are some helpful tips and strategies to guide nursing students in their essay writing process:

• Start early: Give yourself plenty of time to brainstorm ideas, reflect on your experiences, and write and revise your essay. Starting early will help you avoid last-minute stress and allow for a more thoughtful and polished essay.
• Conduct thorough self-reflection: Before you begin writing, take the time to reflect on your experiences and emotions related to your nursing practice. Consider how these experiences have shaped your growth and development as a nurse, and what lessons you have learned along the way.
• Organize your thoughts and ideas: Create an outline or a rough structure for your essay to ensure a logical flow of ideas. Group similar thoughts and reflections together to create cohesive paragraphs, and use headings or subheadings to further organize your essay.
• Seek feedback: Share your essay with trusted peers or instructors and ask for their feedback. They can offer valuable insights, provide constructive criticism, and help you refine your essay to make it stronger and more impactful.

Additionally, it is important to pay attention to the technical aspects of your essay:

• Grammar and spelling: Proofread your essay carefully to ensure it is free of any grammatical or spelling errors. Use grammar and spell-check tools, and consider asking someone else to review your essay for a fresh perspective.
• Coherent writing style: Use clear and concise language to convey your thoughts and reflections. Avoid excessive jargon or technical terms, and focus on communicating your ideas effectively.
• Formatting guidelines: Follow any formatting guidelines provided by your instructor or institution. Pay attention to font style, size, spacing, and citation style if required.

By following these tips and strategies, nursing students can approach their reflective essay writing with confidence and produce compelling and insightful essays that showcase their growth and development in the nursing profession.

Reflective Tools and Models for Nursing Reflective Essays

Reflective tools and models can provide structure and guidance for nursing students when writing reflective essays. These tools help organize thoughts and experiences, allowing for a more comprehensive and meaningful reflection. By utilizing reflection models , nursing students can enhance their reflective writing skills and deepen their understanding of their own growth and development as healthcare professionals.

Gibbs’ Reflective Model

“Reflective practice is both an art and a science that requires ongoing commitment and practice.” – Gibbs

Gibbs’ Reflective Model is a widely used reflection framework in nursing. It consists of six stages: description, feelings, evaluation, analysis, conclusion, and action plan. This model encourages a structured approach to reflection, allowing the writer to systematically explore their thoughts and emotions, analyze the situation, and identify areas for improvement or further development.

Dewey’s Reflective Thinking Model

“We do not learn from experience, we learn from reflecting on experience.” – Dewey

Dewey’s Reflective Thinking Model focuses on the importance of reflection as a tool for learning and growth. It emphasizes the need to actively engage with experiences, thoughts, and emotions, and to critically evaluate them in order to gain deeper insights and understanding. This model encourages nursing students to think analytically and develop a continuous learning mindset.

Kolb Reflective Model

“Knowledge results from the combination of grasping experience and transforming it.” – Kolb

The Kolb Reflective Model is based on the concept of experiential learning. It consists of four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. This model encourages nursing students to engage in a cyclical process of learning, where they actively participate in experiences, reflect on them, conceptualize their insights, and apply their learning in real-life situations.

Schön Reflective Model

“Reflection-in-action is the heart of the learning process.” – Schön

Schön Reflective Model emphasizes the importance of reflection in the midst of action. It focuses on the ability to think and adapt in real-time, making decisions based on professional knowledge and experiences. This model encourages nursing students to develop a reflective mindset that allows them to learn and grow while actively engaging in their practice.

Benefits of Reflective Writing in Nursing

Reflective writing plays a crucial role in nursing practice, offering numerous benefits for nursing students and professionals alike. By engaging in reflective writing, nurses can enhance their self-awareness, develop their critical thinking skills, and gain a deeper understanding of patient experiences. This section will explore the advantages of reflective writing in nursing and its significance in healthcare.

Enhanced Self-Awareness

Reflective writing fosters self-reflection, allowing nurses to examine their thoughts, emotions, and actions in various clinical situations. Through this process, they gain a deeper understanding of their strengths, weaknesses, and areas for improvement. This heightened self-awareness enables nurses to provide more effective and compassionate patient care, fostering a patient-centered approach.

Improved Critical Thinking

Reflective writing encourages nurses to think critically about their experiences and the impact of their actions. It requires them to analyze and evaluate the effectiveness of their decision-making and problem-solving skills. By reflecting on past experiences, nurses can identify areas where they can enhance their clinical practice and make informed decisions based on evidence and best practices.

Increased Empathy and Understanding

Through reflective writing, nurses develop a deeper empathy and understanding of patient experiences. By reflecting on their interactions with patients, nurses can recognize the emotions, fears, and challenges faced by individuals in their care. This increased empathy enables nurses to provide more holistic and patient-centered care, improving the overall healthcare experience for patients.

Continuous Professional Development

Reflective writing is an essential tool for nurses’ continuous professional development. It allows them to document their growth, learning, and achievements throughout their nursing career. By regularly engaging in reflective writing, nurses can identify areas for further development, set goals for improvement, and ensure they are providing the best possible care to their patients.

Overall, reflective writing in nursing is a powerful tool that empowers nurses to enhance their self-awareness, critical thinking skills, and empathy. By engaging in this practice, nurses can continuously improve their clinical practice, provide high-quality patient care, and contribute to the ongoing development of the nursing profession.

Nursing Reflective Essay Examples

Looking for inspiration for your nursing reflective essay? Here are some examples that showcase different experiences, reflections, and growth in the nursing profession.

These examples demonstrate how nursing reflective essays can provide valuable insights into personal experiences, reflections, and professional growth. They serve as excellent references to help nursing students develop their own reflective writing skills and gain a deeper understanding of the nursing profession.

Writing a Nursing Reflective Essay for Nursing School Application

A nursing reflective essay can be a powerful tool for nursing school applications. It allows applicants to showcase their self-awareness, critical thinking skills, and passion for the nursing profession. When writing a nursing reflective essay for a nursing school application, there are a few key tips to keep in mind.

Reflect on your passion for nursing

Start by reflecting on what drew you to the nursing profession and why you are passionate about it. Consider your personal experiences, such as volunteering or shadowing healthcare professionals, and how they have shaped your desire to become a nurse. Highlight your commitment to providing compassionate and quality patient care.

Share personal experiences in healthcare settings

Provide specific examples of your experiences in healthcare settings, such as clinical rotations or internships. Reflect on the challenges you faced, the lessons you learned, and how those experiences have impacted your growth and development as a future nurse. Discuss any significant interactions with patients, healthcare teams, or mentors that have shaped your understanding of the nursing profession.

Align with the nursing school’s values and mission

Research the nursing school’s values, mission, and educational philosophy. Ensure that your reflective essay aligns with these principles and demonstrates your commitment to the school’s mission. Use the nursing school’s prompts or essay questions as a guide to structure your essay and address the specific criteria they are looking for in applicants.

By following these tips, you can write a compelling nursing reflective essay that effectively conveys your passion for nursing, showcases your experiences, and aligns with the nursing school’s values. Remember to proofread your essay carefully for grammar and spelling errors and seek feedback from mentors or trusted individuals in the nursing profession to ensure your essay is clear, concise, and impactful.

(Table) Tips for Writing a Nursing Reflective Essay for Nursing School Application

Writing a nursing reflective essay can be a transformative experience for BSN nursing students. It allows them to gain valuable insight into their own growth and development as future healthcare professionals. Throughout this comprehensive guide, we have provided expert information and guidance on how to write a compelling nursing reflective essay.

By understanding the purpose of a reflective essay and the key elements to include, nursing students can effectively showcase their personal experiences and reflections. Incorporating reflection models such as Gibbs’ Reflective Model or Kolb Reflective Model can also provide structure and depth to their essays.

At NursingWriters.net, we are dedicated to empowering busy nurses and providing them with the tools they need to excel in their BSN programs. Whether it’s writing a reflective essay or any other writing challenge, we are here to support and guide nursing students towards success.

What is a nursing reflective essay?

A nursing reflective essay is a personal essay where the writer reflects on their own experiences and how those experiences have shaped their growth and development in the nursing profession.

How is a reflective essay in nursing different from a personal statement?

While a reflective essay in nursing focuses on the writer’s personal experiences and reflections, a personal statement is more of a formal document that highlights the writer’s qualifications, achievements, and future goals in the nursing profession.

What are the key elements to include in a nursing reflective essay?

The key elements to include in a nursing reflective essay are the inciting incident or event, personal reflections on the experience, specific details to create a vivid setting, and a description of the actions taken by the writer. It is important to avoid including academic details and excessive focus on emotions.

How should I write the introduction of a nursing reflective essay?

To write an engaging and informative introduction for a nursing reflective essay, you can grab the reader’s attention with an intriguing opening line, provide context and background information, and present a clear thesis statement. Focus on the specific event or experience that will be the main focus of the essay.

How should I structure the body paragraphs of a nursing reflective essay?

The body paragraphs of a nursing reflective essay should have a clear structure. Use the first paragraph to present the thesis statement and provide background information on the event. Use subsequent paragraphs to explore your reflections, emotions, and actions taken. Use specific examples and anecdotes to make the essay more engaging.

How should I conclude a nursing reflective essay?

To write a strong conclusion for a nursing reflective essay, you can summarize the main points discussed in the essay, provide a final reflection on your growth and learning from the experience, restate the thesis statement, and leave the reader with a thought-provoking statement or future outlook.

What are some tips for writing a nursing reflective essay?

Some tips for writing a nursing reflective essay include starting early, conducting thorough self-reflection, organizing your thoughts and ideas, and seeking feedback from peers or instructors. Pay attention to proper grammar and spelling, coherent writing style, and adhere to any formatting guidelines provided.

How can reflective tools and models help with nursing reflective essays?

Reflective tools and models provide structure and guidance for nursing students when writing reflective essays. Models such as Gibbs’ Reflective Model, Dewey’s Reflective Thinking Model, Kolb Reflective Model, and Schön Reflective Model can be used as frameworks for organizing thoughts and experiences in a nursing reflective essay.

What are the benefits of reflective writing in nursing?

Reflective writing in nursing offers benefits such as enhanced self-awareness, improved critical thinking skills, increased empathy and understanding of patient experiences, and continuous professional development. It promotes lifelong learning and helps improve patient care.

Where can I find nursing reflective essay examples?

You can find nursing reflective essay examples that showcase different experiences, reflections, and growth. These examples incorporate personal reflections, specific details, and professional insights into nursing practice. They demonstrate the diversity of topics and experiences that can be explored in nursing reflective essays.

How can I write a nursing reflective essay for nursing school applications?

To write a nursing reflective essay for nursing school applications, reflect on your passion for nursing, personal experiences in healthcare settings, and future goals in the nursing profession. Address specific prompts and align the content with the nursing school’s values and mission.

How can writing a nursing reflective essay benefit BSN nursing students?

Writing a nursing reflective essay allows BSN nursing students to gain insight into their own growth and development as future healthcare professionals. It helps improve critical thinking skills, self-awareness, and understanding of patient experiences. It also promotes continuous professional development.

Jermaine Huey

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THE ROLE OF REFLECTION IN DEVELOPING RESILIENCE

When burdened by work related stress, our resilience is reduced, and we feel that we struggle to cope.

Resilience is defined as being able to adapt in the face of, often severe, difficulty (see Masten and Powell, 2003). It is a dynamic developmental process and is studied by looking at how competence develops in the face of adversity. When people’s adaptive abilities are in good working order, they can withstand hardship, but when they are stressed or overloaded this becomes more difficult.

How can reflection help to maintain or to rebuild resilience? Resilience has been shown to be made up of five areas:

• Competency (feeling successful)
• Belonging (feeling valued)
• Usefulness (feeling needed)
• Potency (feeling empowered)
• Optimism (feeling encouraged and hopeful)

In healthcare it is easy to feel that our successes are rare, there is little or no value to what we do and that we have little or no power and these feelings can result in feeling discouraged and hopeless.

However , using reflection can address three of the elements required for resilience:

• Critical thinking
• Collaboration

Support is an essential component of resilience development. We all need to feel that we are not alone, that we are valued, and our work appreciated. Taking time to talk to a peer or a friend can help to clarify feelings of worthlessness and impotence. The support mechanism of another person listening and asking how you felt, what you would have liked to have done and what your underlying values were, can mean that we feel supported a little more.

Being able to think critically as the participants in West’s (2001) research, can help to clarify the way through unclear and complex situations. “David” found it difficult to separate work issues and personal life issues but found that being asked some thought-provoking questions enabled that level of criticality to move the mists of confusion and to see things more clearly. Use some of the questions in this module to provide a starting point.

Resilient professionals are very often highly collaborative . Working in teams and with other people helps to mitigate against some of the feelings of hopelessness. Using reflective practices to identify ways to collaborate further and how to maximise those collective endeavours, can lead to a higher sense of value and contribution.

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Nurse leaders' resilience and their role in supporting nurses' resilience during the COVID‐19 pandemic: A scoping review

Saija sihvola.

1 Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio Campus, Kuopio Finland

Tarja Kvist

Anu nurmeksela, associated data.

Data sharing is not applicable. The article is a scoping review and entirely theoretical research.

To explore nurse leaders' resilience and their role in supporting nurses' resilience during the COVID‐19 pandemic.

The COVID‐19 pandemic has challenged health care systems on a global level. Nurse leaders are tasked with ensuring high‐quality care, even during crises, which requires active problem‐solving and confidence in the future—resilience from leaders.

A scoping review was conducted using inductive thematic analysis and the PCC (Participants, Concept, Context) framework. The PubMed, Scopus, CINAHL, and PsycINFO databases, as well additional studies and grey literature, were searched from December 2019 to June 2021.

The review included 12 studies. Nurse leaders' self‐awareness, self‐reflection, and coping strategies described their resilience during the pandemic. A relational leadership style, supportive and safe work environment, and adequate communication were found to support nurses' resilience.

Conclusions

There is scarce research concerning nurse leaders' resilience during the COVID‐19 pandemic. Future research needs to address nurse leaders' personal resilience due to the link with nurses' resilience.

Implications for Nursing Management

A healthy work environment is essential for nurses' resilience. During crises, nurse leaders should adopt relational leadership styles and actively interact with nursing staff.

1. BACKGROUND

A total of 183,525,264 COVID‐19 cases have been confirmed by 28 June 2021 (WHO,  2022a ). The current pandemic has introduced considerable stress to health care professionals' work. This stress (Haravuori et al.,  2020 ), along with the lack of resources (Senek et al.,  2020 ) and personal protective equipment, has challenged health care systems, professionals, and leaders on a global scale (Niehaus & Hod,  2020 ).

Nurse leaders are important to ensuring high‐quality care and supporting nurses in exhausting situations (Senek et al.,  2020 ). Surviving the pandemic requires action and commitment from nurse leaders (Cooper et al.,  2020 ), along with problem‐solving skills and confidence in the future. These aspects are components of resilience (Connor & Davidson,  2003 ), which is defined as a process that helps an individual confront stressors and adversity while the individual resources such as self‐efficacy, work–life balance, humour, optimism, support from others (Cooper et al.,  2020 ), and positive professional relationships (Tabakakis et al.,  2019 ) are important. Moreover, resilience is associated with work engagement (Cao & Chen,  2019 ) and buffers against mental illness (Manomenidis et al.,  2018 ).

There is no clear definition of nurse leaders' resilience, as only a few studies have covered this topic (Spiva et al.,  2020 ; Tau et al.,  2018 ). Based on previous research, nurse leaders' resilience covers the ability to deal with adversity in the workplace (Tau et al.,  2018 ) along with their personal strength (Spiva et al.,  2020 ; Tau et al.,  2018 ). However, nurse leaders with low resilience may find it difficult to empower others (Tau et al.,  2018 ). Before the COVID‐19 pandemic, nurse leaders showed varying levels of resilience, ranging from moderate (Tau et al.,  2018 ) to high (Spiva et al.,  2020 ).

Most studies concerning resilience in the field of nursing have been published during the last decade (Zanatta et al.,  2020 ) The results have shown that training may improve the resilience of nurses (Kunzler et al.,  2020 ) and nurse leaders (Spiva et al.,  2020 ). Furthermore, resilient nurse leaders may empower nurses by exuding confidence, caring about their well‐being (Tau et al.,  2018 ; Wei et al.,  2018 ), helping them identify and utilize their strengths, nurturing their professional development, and encouraging self‐care (Wei et al.,  2018 ).

Enhancing relationship management abilities and promoting professional development might be effective ways to improve nurse leaders' resilience (Spiva et al.,  2020 ). Moreover, relational leadership styles (e.g., transformational, authentic, servant, and ethical leadership) can foster a healthy work environment and positively impact nurses' job satisfaction, recruitment, and retention. Leaders must be able to encourage, motivate, and inspire their employees towards mutual goals, as well as mentor and guide employees, which entails scheduling adequate time for personal discussions (Cummings et al.,  2018 ).

This scoping review aimed to explore nurse leaders' resilience and their role in supporting nurses' resilience during the COVID‐19 pandemic. A preliminary search was conducted and no published or ongoing reviews on the topic were identified. To the best of our knowledge, the current study represents the first scoping review of this phenomenon. A scoping review was appropriate, as this method can clarify the range and nature of current evidence and highlight future avenues for research (Peters et al.,  2015 ).

The scoping review was conducted using thematic analysis (Vaismoradi et al.,  2013 ) according to the methodology for systematic scoping reviews and the PCC framework (Participants, Concept, Context) (Peters et al.,  2015 ).

2.1. Ethical considerations

The ethical approval is not required for the systematic scoping review.

2.2. Study aim and review questions

This scoping review aimed to explore nurse leaders' resilience and their role in supporting nurses' resilience during the COVID‐19 pandemic. The review questions were as follows:

• What is known about nurse leaders' resilience during the COVID‐19 pandemic?
• What is a nurse leader's role in supporting nurses' resilience?

2.3. Inclusion criteria

2.3.1. participants.

The research concerned professionals who worked as nurse leaders (nurse leader, nurse manager, nurse executive, nurse administrator, charge nurse, head nurse, chief nurse, nurse director) between December 2019 and June 2021. No limitations were set for the country or unit in which nurse leaders worked during the pandemic.

2.3.2. Concept

The included research could be either studies that assessed nurse leaders' resilience through validated scales (e.g., Connor‐Davidson Resilience Scale, Wagnild and Young Resilience Scale) or qualitative studies, texts, opinion papers, and documents that presented evidence related to the study aim. In this scoping review, resilience ( resilience , resilient , resiliency ) is defined as a nurse leader's ability or role in supporting nurses' resilience, along with their personal strength to deal with adversity.

2.3.3. Context

The research concerned all kinds of health care settings across the world in which nurse leaders worked during the COVID‐19 pandemic between December 2019 and June 2021.

2.4. Search strategy

A preliminary search of PubMed, PROSPERO, and the Cochrane and JBI Databases of Reviews was conducted, and no published or ongoing reviews on the topic were identified. Next, the PubMed, Scopus, CINAHL, and PsycINFO databases were searched to identify relevant articles. In addition, the search of grey literature focused on organisations such as the WHO and United Nations. Google Scholar was also searched. Both published and unpublished studies were considered. The reference lists of all studies were screened to identify additional studies. The searches were performed between December 2019 and June 2021. The search terms were nurse leader , nurse manager , nurse executive , nurse administrator , charge nurse , head nurse , chief nurse , nurse director AND resilience , resilient , resiliency AND COVID‐19 (Figure  1 ). Studies published in English were included. As the COVID‐19 pandemic began in December 2019 in Wuhan, China (WHO,  2022b ), we included studies that had collected data during the pandemic and would therefore be published no earlier than December 2019.

PRISMA (ScR) flowchart of study selection

This scoping review considered experimental and quasi‐experimental study designs, analytical and descriptive observational studies, qualitative studies, and systematic reviews, as well as texts, discussion papers, documents, and grey literature that presented evidence which answered the study question.

2.5. Selection phase

Following the search, all of the identified citations were uploaded into the Covidence systematic review management system (Covidence,  2021 ). The titles and abstracts of relevant studies were assessed against the inclusion criteria by independent reviewers; this was repeated for the full‐text versions of selected citations. Reasons for exclusion were discussed. The search results and study inclusion process reported in this review are presented in a flow diagram according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses extension for scoping reviews (PRISMA‐ScR) guidelines (Figure  1 ) (Tricco et al.,  2018 ).

2.6. Data extraction

Data were extracted manually by three independent reviewers. The extracted data included details about the authors, year of publication, country, population, context, methods, themes, subthemes, and key findings. Any disagreements were resolved through discussion.

2.7. Synthesis of results

The results were analysed through inductive thematic analysis. The included articles were read through carefully, after which the text was coded and organized into themes. The reviewers referred to the study questions throughout the analytical process (Vaismoradi et al.,  2013 ). The results are summarized as tabulated findings.

Of the 12 included studies, five were research articles, and seven were discussion papers. Grey literature was not found. Three of the research studies applied the quantitative and two qualitative methods. The studies addressed nurse leaders' resilience (Duncan,  2020 ; Jeffs et al.,  2020 ) and their role in supporting nurses' resilience during the COVID‐19 pandemic (Abd‐EL Aliem & Abou Hashish,  2021 ; Berkow et al.,  2020 ; Cariaso‐Sugay et al.,  2021 ; Chesak et al.,  2020 ; Dimino et al.,  2020 ; Duncan,  2020 ; Heuston et al.,  2021 ; Jeffs et al.,  2020 ; Kreh et al.,  2021 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ) (Table  1 ). The themes and subthemes identified from these articles are presented in Table  2 .

Details of studies included in the scoping review

Themes related to the resilience of nurse leaders and their role in supporting nurses’ resilience

3.1. Nurse leaders' resilience during the COVID‐19 pandemic

Of the 12 selected studies, two addressed nurse leaders' personal resilience (Duncan,  2020 ; Jeffs et al.,  2020 ). Duncan ( 2020 ) based the reported resilience of nurse leaders on available literature, whereas Jeffs et al. ( 2020 ) used semi‐structured interviews with four chief nurse executives (CNEs) to gauge nurse leaders' resilience.

Both Duncan ( 2020 ) and Jeffs et al. ( 2020 ) presented that strong resilience is needed during a pandemic. In these studies, resilience was seen as a nurse leader's ability to reflect and cope. Jeffs et al. ( 2020 ) found that the first months of the pandemic challenged CNEs' resilience. More specifically, CNEs were challenged by heavy workloads, long hours, an absence of information and/or data, rapid decision‐making, ethical dilemmas, and the prioritization of scare resources. Both papers stated that resilience was associated with self‐awareness, while Duncan ( 2020 ) highlighted the importance of coping strategies and self‐efficacy.

Nurse leaders can help others when they practice effective coping strategies (Duncan,  2020 ; Jeffs et al.,  2020 ). Resilience requires self‐reflection and self‐care abilities, both of which help leaders make decisions in difficult situations (Duncan,  2020 ). Sometimes leaders are even surprised by how novel conditions can make them modify their own leadership styles. During this pandemic, some nurse leaders also experienced strong support from their team and colleagues (Jeffs et al.,  2020 ).

3.2. Nurse leader's role in supporting the resilience of nurses

3.2.1. relational leadership styles.

Authentic, exemplary, ethical, and transformational leadership styles were presented to benefit nurse leaders in supporting nurses' resilience during the COVID‐19 pandemic (Abd‐EL Aliem & Abou Hashish,  2021 ; Dimino et al.,  2020 ; Duncan,  2020 ; Jeffs et al.,  2020 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ). The studies showed that crisis require nurse leaders to have a strong understanding of the situation as well as a visible leadership style (Dimino et al.,  2020 ; Jeffs et al.,  2020 ).

Dimino et al. ( 2020 ) stated that nurse leaders need to understand nurses' psychological capital (PsyCap), which encompasses an individual's levels of hope, efficacy, resilience, and optimism; all of these characteristics are also attributes of an authentic leader. Authentic nurse leaders also understand that there is a reciprocal relationship between leaders and staff members. Nurse leaders with the aforementioned attributes are well equipped to lead frontline nurses through the challenges of the COVID‐19 pandemic and help them develop resilience (Dimino et al.,  2020 ; Jeffs et al.,  2020 ). Moreover, nurse leaders should focus on skilled communication, collaboration, effective decision‐making, and appropriate staffing, as well as the meaningful recognition of staff. It was also proposed that authentic and transparent leadership styles support staff and organisational resilience (Duncan,  2020 ).

Regular communication was one method through which a nurse leader supported staff during the adaptation, change, progress, and promotion of resilience associated with remote work. The ability to inspire, i.e., Kouzes' and Posner's theory of Exemplary leadership, was reported to be invaluable during crises (Prestia,  2021 ). In addition, nurse leaders have a vital role in empowering nurses and supporting an organisation's commitment to safe and quality care (Markey et al.,  2021 ).

An ethical leadership style was also considered valuable during a crisis since it maintains a nurse leader's ethical attention via empathy, compassion, and active listening in a time when nurses may experience physical and emotional fatigue. It was highlighted that nurse leaders need periodic training and support about ethical leadership (Markey et al.,  2021 ).

3.2.2. Supportive and safe working environment

The included studies highlighted a supportive and safe working environment as one main theme to ensuring nurses' resilience (Abd‐EL Aliem & Abou Hashish,  2021 ; Berkow et al.,  2020 ; Cariaso‐Sugay et al.,  2021 ; Chesak et al.,  2020 ; Dimino et al.,  2020 ; Duncan,  2020 ; Heuston et al.,  2021 ; Jeffs et al.,  2020 ; Kreh et al.,  2021 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ).

Some of the included studies discussed professional (Markey et al.,  2021 ) and organisational resilience in addition to how nurse leaders support nurses' resilience (Abd‐EL Aliem & Abou Hashish,  2021 ; Chesak et al.,  2020 ; Duncan,  2020 ; Kreh et al.,  2021 ). Professional resilience was presented as the ability to increase work performance and ensure safe and quality care during crisis (Markey et al.,  2021 ), while organisational resilience concerned a nurse leader's ability to ensure a supportive and safe work environment (Abd‐EL Aliem & Abou Hashish,  2021 ; Chesak et al.,  2020 ; Duncan,  2020 ; Kreh et al.,  2021 ). A good working atmosphere was reported to enhance both nurses' professional (Markey et al.,  2021 ) and organisational resilience (Abd‐EL Aliem & Abou Hashish,  2021 ; Duncan,  2020 ; Kreh et al.,  2021 ), improve nurses' engagement with their work (Berkow et al.,  2020 ; Prestia,  2021 ), and benefit nurses' job involvement during a crisis (Abd‐EL Aliem & Abou Hashish,  2021 ).

A supportive and safe working environment requires good communication (Abd‐EL Aliem & Abou Hashish,  2021 ; Duncan,  2020 ; Jeffs et al.,  2020 ), leaders who enable others to act (Abd‐EL Aliem & Abou Hashish,  2021 ), cooperation (Abd‐EL Aliem & Abou Hashish,  2021 ; Chesak et al.,  2020 ; Duncan,  2020 ; Kreh et al.,  2021 ), shared vision (Abd‐EL Aliem & Abou Hashish,  2021 ; Duncan,  2020 ) and decision‐making (Chesak et al.,  2020 ; Dimino et al.,  2020 ; Duncan,  2020 ; Kreh et al.,  2021 ), sufficient personal protective equipment (Berkow et al.,  2020 ; Chesak et al.,  2020 ; Duncan,  2020 ; Kreh et al.,  2021 ; Leng et al.,  2021 ), and an adequate amount of information (Chesak et al.,  2020 ; Jeffs et al.,  2020 ; Prestia,  2021 ).

Supportive atmosphere included showing respect for nurses, leading them with empathy (Markey et al.,  2021 ), considering various opinions, and listening to nurses' concerns (Kreh et al.,  2021 ; Prestia,  2021 ). This entails a non‐judgmental environment, which can build professional resilience, support open discussion, and encourage ethical vigilance (Markey et al.,  2021 ). Moreover, a good atmosphere will improve nurses' personal resilience as well as answer the needs of vulnerable and high‐risk staff (Abd‐EL Aliem & Abou Hashish,  2021 ; Chesak et al.,  2020 ; Dimino et al.,  2020 ; Jeffs et al.,  2020 ; Kreh et al.,  2021 ).

Leng et al. ( 2021 ) found that resilient nurses can also experience mental stress while an isolated environment, physical and emotional fatigue, and intensive workload can be major sources of stress among nurses. For this reason, various researchers have recommended flexible working hours during the pandemic (Duncan,  2020 ; Kreh et al.,  2021 ). Furthermore, all nurses should have received adequate training and orientation, while a caring and authentic nursing leadership style can be a source of psychological support (Leng et al.,  2021 ).

During the COVID‐19 pandemic, leaders were recommended to observe nurses for any signs of distress and fatigue (Heuston et al.,  2021 ). Good communication, developing a mentoring relationship, social support, and encouraging hopefulness (Duncan,  2020 ), as well as the provided opportunities to connect and share experiences (Heuston et al.,  2021 ) were expected to build resilience among employees. Moreover, it was stated that resilience can be supported by encouraging staff to utilize their personal abilities, collaborate, find solutions to problems, recognize nurses' contributions, and help employees manage their disappointments (Dimino et al.,  2020 ). According to Berkow et al. ( 2020 ), leaders are also expected to prepare for the worst‐case scenario and organisational changes, as well as avoid making promises they cannot keep.

When supporting nurses, nurse leaders should foster authentic connections and proactively interact with staff (Cariaso‐Sugay et al.,  2021 ; Dimino et al.,  2020 ; Duncan,  2020 ; Heuston et al.,  2021 ; Jeffs et al.,  2020 ; Kreh et al.,  2021 ; Prestia,  2021 ). This ability to encourage nurses and create an emotional connection with them is an important part of promoting resilience. Nurses have reported that they appreciate having a connection to management (Kreh et al.,  2021 ; Leng et al.,  2021 ). In this way, recognizing and valuing staff has been highlighted as a good strategy for ensuring resilience among nurses (Jeffs et al.,  2020 ). Furthermore, staff members appreciate being listened to, the fact that their problems are addressed, and that they are affording opportunities for discussion (Kreh et al.,  2021 ; Markey et al.,  2021 ).

3.2.3. Nurse leaders' communication during the COVID‐19 pandemic

The included studies unanimously reported that nurse leaders' communication skills are essential to supporting nurses' resilience during a pandemic (See Table  1 ). Leaders should encourage hopefulness (Duncan,  2020 ) and optimism by sharing past experiences (Dimino et al.,  2020 ) and empowering staff to look forward to future opportunities (Dimino et al.,  2020 ; Markey et al.,  2021 ). Providing timely (Chesak et al.,  2020 ; Jeffs et al.,  2020 ) and accurate information (Chesak et al.,  2020 ; Prestia,  2021 ), along with conveying clear organisational goals (Dimino et al.,  2020 ), were considered important actions for leaders. During the pandemic, nurse leaders should focus on efficiency (Kreh et al.,  2021 ), rely on evidence (Prestia,  2021 ), use open dialogue (Berkow et al.,  2020 ; Markey et al.,  2021 ), and be transparent when discussing organisational challenges (Berkow et al.,  2020 ).

The included studies also emphasized that nurse leaders should be emotionally intelligent; in other words, they should proactively listen to nurses' opinions and concerns as well as recognize their moods (Heuston et al.,  2021 ; Jeffs et al.,  2020 ; Kreh et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ). Using positive language (Duncan,  2020 ), encouragement (Chesak et al.,  2020 ; Dimino et al.,  2020 ; Prestia,  2021 ), inspiration (Dimino et al.,  2020 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ), and gratitude (Abd‐EL Aliem & Abou Hashish,  2021 ; Dimino et al.,  2020 ; Leng et al.,  2021 ) were listed as important actions for nurse leaders during the COVID‐19 pandemic.

Cariaso‐Sugay et al. ( 2021 ) found that an intervention aimed at increasing nurse leaders' knowledge and confidence in disaster management can provide an effective approach for promoting nurses' resilience. In their study, the intervention had the most noticeable effect on the communication and connectivity knowledge subscale. The intervention framework was based on social cognitive theory (SCT) and the concept of self‐efficacy (Cariaso‐Sugay et al.,  2021 ).

4. DISCUSSION

This scoping review aimed to explore nurse leaders' resilience and their role in supporting nurses' resilience during the COVID‐19 pandemic. The findings indicate that there is a lack of research concerning nurse leaders' personal resilience, only two studies investigated this topic. In these studies, the findings were based on available literature (Duncan,  2020 ) and semi‐structured interviews (Jeffs et al.,  2020 ). Instead of addressing nurse leaders' personal resilience, most of the research published during the COVID‐19 pandemic focused on the leaders' ability to ensure nurses' resilience (Abd‐EL Aliem & Abou Hashish,  2021 ; Berkow et al.,  2020 ; Cariaso‐Sugay et al.,  2021 ; Chesak et al.,  2020 ; Dimino et al.,  2020 ; Heuston et al.,  2021 ; Kreh et al.,  2021 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ). Studies published prior to the current pandemic have shown a similar focus (Spiva et al.,  2020 ; Tau et al.,  2018 ). Based on the findings of this review, nurse leaders can help others when they possess effective coping strategies (Duncan,  2020 ; Jeffs et al.,  2020 ).

The included studies demonstrate that nurse leaders require strong resilience, which was mainly described through a leader's ability to reflect and cope. Furthermore, resilience requires nurse leaders to be aware of themselves (Duncan,  2020 ; Jeffs et al.,  2020 ) and the repercussions of their actions (Abd‐EL Aliem & Abou Hashish,  2021 ; Berkow et al.,  2020 ; Cariaso‐Sugay et al.,  2021 ; Chesak et al.,  2020 ; Dimino et al.,  2020 ; Duncan,  2020 ; Heuston et al.,  2021 ; Jeffs et al.,  2020 ; Kreh et al.,  2021 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ). However, information on the factors that impacted nurse leaders' resilience and what were the outcomes of their resilience was scarce. Previous studies have shown that resilience is a crucial part of effective nursing leadership (Cao & Chen,  2019 ; Hudgins,  2016 ; Tau et al.,  2018 ). Most of the included studies discussed how nurse leaders support nurses' resilience, while several studies also highlighted the importance of relational leadership styles (Abd‐EL Aliem & Abou Hashish,  2021 ; Dimino et al.,  2020 ; Duncan,  2020 ; Jeffs et al.,  2020 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ), a supportive and safe work environment (Cariaso‐Sugay et al.,  2021 ; Dimino et al.,  2020 ; Duncan,  2020 ; Heuston et al.,  2021 ; Jeffs et al.,  2020 ; Kreh et al.,  2021 ; Prestia,  2021 ), and communication skills in crisis management (Abd‐EL Aliem & Abou Hashish,  2021 ; Berkow et al.,  2020 ; Cariaso‐Sugay et al.,  2021 ; Chesak et al.,  2020 ; Dimino et al.,  2020 ; Duncan,  2020 ; Heuston et al.,  2021 ; Jeffs et al.,  2020 ; Kreh et al.,  2021 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ).

The included studies showed that—during crises—nurse leaders must demonstrate strong understanding and visible leadership (Dimino et al.,  2020 ; Jeffs et al.,  2020 ), both of which fall under relational leadership styles (Abd‐EL Aliem & Abou Hashish,  2021 ; Dimino et al.,  2020 ; Duncan,  2020 ; Jeffs et al.,  2020 ; Leng et al.,  2021 ; Markey et al.,  2021 ; Prestia,  2021 ). These relationship styles also emphasize reciprocal relationships between nurse leaders and staff (Dimino et al.,  2020 ; Jeffs et al.,  2020 ), along with the ability to empower employees (Markey et al.,  2021 ) and support organisational resilience (Duncan,  2020 ). In a study published before the COVID‐19 pandemic, Cummings et al. ( 2018 ) demonstrated that relational leadership styles benefit nurses' well‐being and job satisfaction, as well as organisational functioning (Cummings et al.,  2018 ).

All of the included studies linked a nurse leader's communication skills and support with nurses' resilience. These attributes included active interaction, a respectful working atmosphere (Abd‐EL Aliem & Abou Hashish,  2021 ; Leng et al.,  2021 ; Markey et al.,  2021 ), timely (Chesak et al.,  2020 ; Jeffs et al.,  2020 ) and accurate information (Chesak et al.,  2020 ; Prestia,  2021 ), clear organisational goals (Dimino et al.,  2020 ), and open dialogue (Berkow et al.,  2020 ; Markey et al.,  2021 ). The included studies also presented participative ways to lead (Abd‐EL Aliem & Abou Hashish,  2021 ; Chesak et al.,  2020 ; Dimino et al.,  2020 ; Duncan,  2020 ; Kreh et al.,  2021 ) and the provision of adequate personal protective equipment (Berkow et al.,  2020 ; Chesak et al.,  2020 ; Duncan,  2020 ; Kreh et al.,  2021 ; Leng et al.,  2021 ) as parts of a supportive and safe work environment. A previous systematic review showed that lighter workloads and social support were positively related to resilience among medical doctors (McKinley et al.,  2019 ). In the context of the COVID‐19 pandemic, Markey et al. ( 2021 ) stated that nurse leaders have an essential role in supporting nurses to continue working, increasing job performance, and ensuring safe and quality care. Previous studies have shown that a good work environment (Ying et al.,  2021 ) and resilience (Jo et al.,  2021 ) can improve nurse retention. Moreover, nurse leaders may empower nurses in participative ways, i.e., encourage them through confidence and care for their well‐being (Tau et al.,  2018 ; Wei et al.,  2018 ). It should also be noted that resilience is a prerequisite of high‐quality health care in the future (Hudgins,  2016 ; Tau et al.,  2018 ). This is because resilient nurse leaders are more likely to be satisfied with their job, which means they will remain in their position and inspire their staff to do the same (Hudgins,  2016 ).

4.1. Strengths and limitations

This review includes some strengths and limitations. The first strength is that an information specialist was consulted during the search process, and the PRISMA‐ScR extension tool for scoping reviews was used to structure the search. Another strength is that data extraction was performed by three independent reviewers. Concerning limitations, this scoping review included 12 search results, with only five representing research articles (Table  1 ). This indicates that more research is needed. Nevertheless, the review confirmed the importance of a nurse leader’ s personal resilience during crises (Duncan,  2020 ; Jeffs et al.,  2020 ). Future research should address nurse leaders' personal resilience and its levels because this attribute has profound effects on nurses' resilience and organisational functioning (Cline,  2015 ).

4.2. Conclusions

There is scarce research on nurse leaders' resilience during the COVID‐19 pandemic. Future research should address nurse leaders' personal resilience, which is integral to supporting nurses' resilience.

4.3. Implications for nursing management

A healthy work environment benefits nurses' resilience, while nurse leaders play a crucial role during pandemics. These professionals need sufficient preparation and training to work effectively in acute situations. During crises, nurse leaders should adopt relational leadership styles and actively interact with their employees.

CONFLICT OF INTEREST

There is no conflict of interest in this project.

ETHICS STATEMENT

Ethical approval was not required for this paper.

AUTHOR CONTRIBUTIONS

S.S. conceived the study design, performed the searches, and uploaded relevant citations into a systematic review management system. S.S., T.K., and A.N. selected the included studies, extracted data, and conducted a synthesis of the results, as well as drafted the manuscript. T.K. and A.N. approved the final version of the manuscript.

ACKNOWLEDGMENTS

We would like to thank the University of Eastern Finland Library's information specialist Maarit Putous for her support with this study's search terms.

This research did not receive a specific grant from any funding agency, commercial on not‐for‐profit sectors.

Sihvola, S. , Kvist, T. , & Nurmeksela, A. (2022). Nurse leaders' resilience and their role in supporting nurses' resilience during the COVID‐19 pandemic: A scoping review . Journal of Nursing Management , 1–12. 10.1111/jonm.13640 [ PMC free article ] [ PubMed ] [ CrossRef ]

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Reflective Learning and Nursing Burnout Essay

Introduction/background, critical literature review.

The work pressures related to the daily Frontline role of staff nurses make them prone to stress and burnout. For this reason, reflective learning is increasingly becoming an effective intervention for enhancing resilience and understanding of professional practice for improved nurse and patient outcomes (Jack, 2017).

The purpose of this evidence-based project is to evaluate the impact of the adaptation of reflective learning on nursing burnout in managing cardiac patients in a coronary care unit of King Fahad Medical City (KFMC) in the Kingdom of Saudi Arabia. Anecdotal evidence based on the statements of student nurses undertaking a clinical placement at the unit formed the basis for this project. The student nurses often complained of stress and burnout during their placement at KFMC’s coronary care unit. High levels of stress and burnout can affect the students’ learning outcomes.

The genesis of nursing fatigue or burnout in nursing practice is ascribed to occupational stress, heavy workloads, low staffing ratios, and exposure to trauma/suffering (Khater, Akhu-Zaheya, & Shaban, 2014). Emotional/physical fatigue may arise due to heavy workloads. Burnout manifestations may be high in a coronary care unit because of the high exposure to trauma that causes emotional exhaustion (Khater et al., 2014). Therefore, the intensification of burnout among the student nurses in KFMC’s coronary unit may be related to adverse survival prognosis, exposure to patient pain/mortality, and age (Jack, 2017). Burnout manifestations among the student nurses included detachment and sadness.

It is crucial for student nurses and RNs to work in a positive clinical environment for their wellbeing and quality patient care delivery. A strong relationship has been established between nurse wellbeing and clinical outcomes (Romano, Trotta, & Rich, 2013).

This implies that occupational burnout or fatigue has adverse impacts not only for nurses but also for patients. Jenkins and Warren (2012) indicate that, in clinical settings, student nurses and staff nurses experience of trauma/suffering and heavy workloads reduce their performance and patient safety outcomes. Interventions that promote self-care have the potential of reducing nursing stress and burnout. Reflective learning, where nurses gain “new insights of the self and practice” from clinical experiences can ensure better preparation for similar situations (Henderson, Cooke, Creedy, & Walker, 2012, p. 302). As such, engagement in reflective learning could offer some protection to burnout, leading to improved nurse wellbeing and patient outcomes.

For student nurses, clinical experiences with cardiac patients; however, cardiovascular nursing can be demanding emotionally and physically. Reflective learning, i.e., meditating and analysing individual clinical experiences, can promote workplace resilience and professional development (Foureur, Besley, Burton, Yu, & Crisp, 2013). Nurses working with cardiac patients are exposed to trauma or distress on a daily basis related to poor survival prognoses. Further, in addition to attending to the patient’s clinical needs, they also provide family/patient emotional support – professional demands that often cause anxiety (Gomez-Urquiza et al., 2016).

Reflective learning is the key to better workplace resilience and coping with a stressful and intellectually demanding coronary care environment. In this paper, a critical review of relevant scholarly literature will be performed to establish the relationship between reflective learning and nursing burnout in a coronary care unit.

Studies Worldwide

Nurses can improve their practice by engaging in reflective learning. A study by Crawley, Ditzel, and Walton (2012) involving American first-year nursing students found that reflective learning via storytelling builds confidence, awareness, and empathy in handling practice challenges. The authors conclude that the approach could be used to lower emotional exhaustion related to death or grief within critical care settings by enabling nurse students to construct “personal concepts around human experience” (Crawley et al., 2012, p. 49). Reflective learning through verbalised experiences/reflections allowed the student nurses to be sensitive and empathic to the practice complexities.

A disconnect exists between the pedagogical approaches for building the capacity to deal with stress/emotional fatigue and actual practice experiences. An integrative review by Dwyer and Hunter (2015) found that although reflection was a widely adopted instructional tool for improving the affective domain, the concept is rarely utilised in the American practice context. Thus, there is a need for interventions that support pedagogical and clinical preparation for demanding practice to build emotional and physical resilience in student nurses.

Analytical and critical thinking skills are emphasised in nursing practice. The compilation of a portfolio of evidence (PoE) based on clinical experiences is one way of enhancing reflective learning (Ticha & Fakude, 2015). A qualitative study examined the perceptions of student nurses in a South African medical university on reflective learning based on PoE compilation (Ticha & Fakude, 2015).

The results indicated that reflections captured in PoEs allowed the students to identify practice and classroom challenges and benefit from clinical learning experiences. In addition, through the reflective learning strategy, the subjects were able to develop the self-confidence and critical thinking skills required in nursing practice. Reflective practice also led to improved self-directed clinical learning. Therefore, the adaptation of reflective learning based on clinical experiences can motivate nurses to become critical thinkers and self-directed learners.

Besides critical thinking, self-care is considered to give adequate protection against stressors in practice contexts. Therefore, guiding nurses and learners through a journey towards self-care can enable them to manage nursing stress and burnout and enhance their efficacy. Blum (2014) evaluated a nursing program initiative that involved self-care activities taught to students in an American university.

The self-care practice activities involved mindfulness meditation and reflection in enabling the participants to learn from their experiences. The study found that self-care activities inspired and challenged students to deal with the stresses in their practices, be empathetic to others, and gain clarity on their professional goals (Blum, 2014). Further, through shared interactive experiences, the participants were able to identify self-care activities they can apply in practice.

Reflective practice is not self-criticism, but rather a source of psychological support for improved performance in the future. One way nurses can be motivated to engage in reflective practice is through clinical supervision groups. McAvey and Jones (2013) explored the views of clinical supervision groups in a London hospital on reflective learning as a tool for dealing with stressful and emotional issues in critical care environments. Participation in clinical supervision groups was shown to decrease burnout resulting from physical and emotional exhaustion. In addition, the groups provided a platform for nurses to compare practice with their peers, receive psychological support, and acquire practice skills required in critical care (McAvey & Jones, 2013).

Reflection is an important emotion-focused tool for reducing burnout to achieve improved wellbeing of nurses. Reducing nursing burnout contributes to improved patient care. Stewart and Terry (2014) explored educational interventions that could decrease nursing burnout in clinical environments through a systematic review. Their findings were consistent with those reported by McAvey and Jones (2013). Clinical supervision and training on stress management methods were found to contribute to lower burnout levels in nurses. Therefore, supportive relationships can enable staff nurses to deal with stress and burnout. In addition, professional/personal growth achieved through reflective learning can offer protection against burnout in critical care environments.

Studies in the Middle East

Studies carried out in Middle Eastern countries establish that engagement in reflective learning ameliorates stress and burnout by staff nurses. These findings are consistent with those of similar studies performed elsewhere in the globe. Baraz, Memarian, and Vanaki (2014) examined the reflective learning styles employed by Iranian student nurses in hospital settings. The qualitative study surveyed 15 baccalaureate student nurses in their clinical placements. The results indicated that the students utilised a variety of reflective learning methods in their practice with the main ones being “thoughtful observation, learning by thinking, and learning by doing” (Baraz et al., 2014, p. 529). The implication of these findings for practice is that classroom and clinical learning can be enhanced through reflective practice.

Reflective learning is particularly important during ICU placements due to the complex treatments involved. As such, the risk of stress and burnout for nurses and students is high. Vatansever and Akansel (2016) explored students’ views on ICU placements to determine student impact after the program at a Turkish university hospital. One of the key themes identified was the “comprehension of communication and empathy with ICU patients” (Vatansever & Akansel, 2016, p. 1043). Further, the analysis of the students’ views indicated that exposure to complex clinical procedures triggers reflective or experiential learning, which acts as a buffer against stress and burnout. However, the ICU can be a very stressful environment for students in their first placement.

A comparable study explored the clinical decision-making patterns of critical care nurses in a Jordanian hospital (Maharmeh, Alasad, Salami, Saleh, & Darawad, 2016). The study’s aim was to assess the use of reflective learning in routine patient care decisions. ICU cases require complex decisions that emotionally, intellectually, and physically draining. In this study, autonomy, collaborative decisions, and experience were found to reduce stress/fatigue in ICU environments. The ICU nurses exhibited great sensitivity and empathy to the patients under their care. Further, the authors concluded that reflective practice and experience increase the efficacy and confidence of ICU nurses in managing complex cases.

The risk of burnout and emotional fatigue is high in nursing practice. Social support systems that promote reflective learning can reduce the prevalence of fatigue/burnout among staff nurses. Ariapooran (2014) evaluated the prevalence of fatigue/burnout in 173 Iranian nurses and how they correlated with clinical support. The study found out that lack of social support contributes to compassion fatigue among nurses. In addition, a lack of engagement in support systems that promote reflective practice and collaboration increased the risk of nurse burnout. Thus, support systems that promote collaborative practice can help decrease the prevalence of burnout/fatigue in clinical settings.

Studies in Saudi Arabia

The prevalence of burnout in critical care and its impact on nurse outcomes has also been investigated in locally. Alharbi, Wilson, Woods, and Usher (2016) explored the impact of burnout/fatigue on job satisfaction among ICU nurses in a cross-sectional survey. The study found that burnout levels among Saudi nurses range between moderate to high in domains related to “emotional exhaustion and de-personalisation” (Alharbi et al., 2016, p. 715). Further, burnout was strongly correlated with low job satisfaction. Therefore, strategies, such as reflective learning, should be adopted in clinical settings to help nurses cope with stress and burnout.

On their part, Al-Sareari, Al-Khalidi, Mostafa, and Abdel-Fattah (2013) sought to determine the factors that contributed to fatigue among clinicians in Saudi healthcare centres. The qualitative survey found higher levels of emotional exhaustion among younger clinicians than older ones. This implies that experience and reflective learning can ameliorate the effect of stress in busy clinical settings. In addition, high levels of depersonalisation were seen in the younger nurse, implying that emotional intelligence develops with practice experience. Further, longer vacations were associated with low emotional exhaustion scores (Al-Sareari et al., 2013). Thus, vacations and experience can reduce the prevalence of job-related burnout among Saudi clinicians.

Job-related demands can adversely affect nurse performance. Al-Homayan, Shamsudin, Subramaniam, and Islam (2013) surveyed nurses working in busy Saudi public hospitals to identify the physical and emotional demands that cause poor performance. The main response to the heavy work demands was stress. The nurses also suffered from sleep deprivation due to the demanding nature of the public hospital environment.

The stress was ameliorated by organisational support for the nurses and care coordination. In addition, interpersonal support through staff motivation, consultation/collaboration, empathy, and share experiences was associated with reduced stress (Al-Homayan et al., 2013). This shows that collective reflections on shared experiences enhance resiliency among nurses working in a demanding clinical environment. Collective reflective learning also offers protection against emotional and physical stress inherent in critical care settings such as cardiac care units.

Alharbi, J., Wilson, R., Woods, C., & Usher, K. (2016). The factors influencing burnout and job satisfaction among critical care nurses: A study of Saudi critical care nurses. Journal of Nursing Management, 24 (6), 708-717. Web.

Al-Homayan, M., Shamsudin, M., Subramaniam, C., & Islam, R. (2013). Impacts of job demands on nurses’ performance working in public hospitals. American Journal of Applied Sciences, 10 (9), 1050-1060. Web.

Al-Sareari N., Al-Khalidi Y., Mostafa O., & Abdel-Fattah M. (2013). Magnitude and risk factors for burnout among primary health care physicians in Asir province, Saudi Arabia . Eastern Mediterranean Journal, 19 (5), 426- 433. Web.

Ariapooran, S. (2014). Compassion fatigue and burnout in Iranian nurses: The role of perceived social support . Iranian Journal of Nursing and Midwifery Research, 19 (3), 279-284. Web.

Baraz, S., Memarian, R., & Vanaki, Z. (2014). The diversity of Iranian nursing students’ clinical learning styles: A qualitative study. Nurse Education in Practice, 14 (5), 525-531. Web.

Blum, C. (2014). Practicing self-care for nurses: A nursing program initiative. Online Journal of Issues in Nursing, 19 (3), 120-129. Web.

Crawley, J., Ditzel, L., & Walton, S. (2012). Using children’s picture books for reflective learning in nurse education. Contemporary Nurse: A Journal for the Australian Nursing profession, 42 (1), 45-52. Web.

Dwyer, P., & Hunter, R. (2015). Preparing students for the emotional challenges of nursing: An integrative review. Journal of Nursing Education, 54 (1), 7-12. Web.

Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: Pilot of a mindfulness based program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse, 45(1), 114-125. Web.

Gomez-Urquiza, J., Aneas-Lopez, B., Fuente-Solana, E., Albendin-Garcia, L., Diaz-Rodriguez, L., & Fuente, G. (2016). Prevalence, risk factors, and levels of burnout among oncology nurses: A systematic review. Oncology Nursing Forum, 43( 3), 104-120. Web.

Henderson, A., Cooke, M., Creedy, D., & Walker, R. (2012). Nursing students’ perceptions of learning in practice environments: A review. Nurse Education Today, 32(3), 299-302. Web.

Jack, K. (2017). The meaning of compassion fatigue to student nurses: An interpretive phenomenological study. Journal of Compassionate Health Care, 4( 2), 1-13. Web.

Jenkins, B., & Warren, N. (2012). Concept analysis: Compassion fatigue and effects upon critical care nurses. Critical Care Nursing Quarterly, 35 (4), 388-395. Web.

Khater, W., Akhu-Zaheya, L., & Shaban, I. (2014). Sources of stress and coping behaviours in clinical practice among Baccalaureate nursing students. International Journal of Humanities and Social Science, 4 (6), 194-205. Web.

Maharmeh, M., Alasad, J., Salami, I., Saleh, Z., & Darawad, M. (2016). Clinical decision-making among critical care nurses: A qualitative study . Health, 8 , 1807-1819. Web.

McAvey, J., & Jones, T. (2012). Assessing the value of facilitated reflective practice groups. Cancer Nursing Practice, 11 (8), 32-38. Web.

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Ticha, V., & Fakude, L. (2015). Reflections on clinical practice whilst developing a portfolio of evidence: Perceptions of undergraduate nursing students in the Western Cape, South Africa. Curationis, 38 (2), 1502-1510. Web.

Stewart, W., & Terry, L. (2014). Reducing burnout in nurses and care workers in secure settings. Nursing Standard, 28 (34), 37-45. Web.

Vatansever, V., & Akansel, N. (2016). Intensive care unit experience of nursing students during their clinical placements: A qualitative study . International Journal of Caring, 9 (3), 1040-1049. Web.

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Bibliography

IvyPanda . "Reflective Learning and Nursing Burnout." April 4, 2024. https://ivypanda.com/essays/reflective-learning-and-nursing-burnout/.

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