Resilience among nursing students in clinical placement
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Purpose: To understand the mechanism of coping with resilience and its implications for the well-being of nursing students in the context of clinical placement.
Design and Methods: Twenty-nine final year baccalaureate nursing students from a university, who had been identified as having low resilience and high burnout, high resilience and low burnout, or high resilience and high burnout in the first phase of the study, participated in ten focus groups and one interview. A thematic analysis was adopted in data analysis.
Findings: Two main themes were identified from the interviews: stressors from aligning students’ expectations with the demands of the clinical placement, and coping as a process of fitting into the ward culture. The students experienced stress from the practice demands of busy wards, striving for learning opportunities, and discovering the social rules. Use of self-regulation strategies such as reframing, conscious choice with a self-directed goal and perseverance are characteristics in coping among students with high resilience. External orientation and self-blame resulted in cognitive and psychological distress among students with high burnout. Students with high resilience and high burnout were able to maintain competency and reflect deeply on personal and professional issues despite the stress. Reflection facilitated self-awareness, which is essential to resilience. Preparing students to actively fit in using effective mechanisms for learning in the ward environment, and future studies on a resilience building intervention to develop self-awareness and resilience among nursing students at the personal and educational levels are recommended.
Conclusion: This study offers an understanding of the different manifestations (i.e. what) and mechanisms (i.e. how and why) of resilience in the process and outcomes of coping among nursing students with different profiles of resilience and burnout in the clinical placement. Theoretical understanding of resilience under high stress reveals the need to have functional efficacy in addition to psychological distress as the outcome measure in future studies.
Clinical significance: Understanding students’ expectations enhances the identification of stressors. Interventions to enable students to actively fit into the clinical environment, reflect, adopt self-regulation strategies, and make flexible use of personal resources and external support will boost students’ resilience in their clinical placement.
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