Journal of Advanced Nursing, 1997, 25, 123–129

The trait and process of resilience

Cynthia S. Jacelon MS RN CRRN
Doctoral Candidate, Division of Nursing, School of Education, New York University;
Rehabilitation Clinical Nurse Specialist, Berkshire Medical Center, Pittsfield, MA;
Clinical Assistant Professor, University of Massachusetts, Amherst, USA

Accepted for publication 1 February 1996

JA CELO N C.S. ( 1997) Journal of Advanced Nursing 25, 123–129

The trait and process of resilience
Resilience is the ability of people to ‘spring back’ in the face of adversity. It is an
important concept for nurses as we endeavour to assist individuals to meet the
challenges of living with illness and ageing. Researchers from many disciplines
in both the social and health sciences have investigated resilience of
individuals throughout the life cycle in a variety of situations related to health
as well as other life events. Some researchers have investigated resilience as a
trait of individuals while other view resilience as a process. This article reviews
the current literature on resilience from many disciplines and discusses
implications for nursing practice and research.

behaviour, controversy exists as to the mechanism of resili-

ADVERSITY
The ability of some people to weather adversity is of great
interest to nurses. By identifying the traits of these people,
or the process they employ to maintain or recover integrity,
nurses may be able to predict which clients are at risk from
succumbing to their circumstances, encourage those who
have the potential to persevere, and promote development
of skills useful in successfully negotiating variations in
health. The ability to resist or recover from adversity is
resilience: the ability to ‘rebound or spring-back’ (Oxford
English Dictionary 1971). Garmezy (1993) is most eloquent
in describing the resilient person:
The central element in the study of resilience lies in the power
of recovery and in the ability to return once again to those patterns
of adaptation and competence that characterized the individual
prior to the pre-stress period… ‘to spring back’ does not suggest
that one is incapable of being wounded or injured.
Metaphorically, it is descriptively appropriate to consider that
under adversity, a [resilient] individual can bend… yet sub-
sequently recover…
(Garmezy 1993 p. 129)
Many studies investigating individual responses to
adverse circumstances have been conducted. Although
there is general agreement as to the outcome of resilient
Correspondence: Cynthia S. Jacelon, 21 Teawaddle Hill Road, Leverett, MA
01054-0513, USA.
ence. Garmezy (1993), Beardslee & Podorefsky (1988),
Rabkin et al. (1993), Antoni & Goodkin (1988), and others
investigated resilience as a trait inherent in individuals.
Rutter (1987) proposed a process incorporating protective
factors. Fine (1991) and Flach (1980, 1988) view resilience
as a process which one may be able to learn. Investigations
have focused on infants (Fonagy et al. 1993), adolescents
(Beardslee & Podorefsky 1988), young adults (Steele et al.
1993), and older adults (Wagnild & Young 1990, Solomon
& Prager 1992).
Physicians and psychologists have studied individuals
who have managed to stay optimistic and engaged in life
in the face of physical illness or threats to psychological
health (Beardslee & Podorefsky 1988, Rabkin et al. 1993),
resilient individuals’ ability to resist cancer (Antoni &
Goodkin 1988), and their ability to survive intensely
stressful situations such as war (Solomon & Prager 1992,
Aldwin et al. 1994). Nurses have studied older womens’
resilience following major loss and have developed the
Resilience Scale (Wagnild & Young 1990, 1993). Studies
in this review have been chosen to demonstrate the bre-
adth of ideas surrounding resilience and the diversity of
the literature.
RESILIENCE AS A TRAIT
Resilience as a trait was defined by Wagnild & Young
(1993): ‘… a personality characteristic that moderates the

© 1997 Blackwell Science Ltd 123

C.S. Jacelon
negative effects of stress and promotes adaptation …’
( p. 165). Miller (1988), in a paper reviewing individuals’
responses to stress, suggests a combination of body chem-
istry and personality factors that predispose individuals
to resilience. Studies in this school of thought focus on
identifying the physical and psychological characteristics
that allow subjects to rise above adversity.
Resilience as a trait in children and adolescents
Resilience in children has been the focus of much atten-
tion. Studies of children in poverty (Garmezy 1993), ado-
lescents with parents who suffer from affective disorders
(Beardslee & Podorefsky 1988), children of divorced par-
ents (Mulholland et al. 1991), and long-term behaviour of
children with attention deficit hyperactive disorder
(Hechtman 1991) have all been investigated. Findings from
these studies suggest a constellation of characteristics that
constitute resilience.
Cowan & Work (1988) reviewed the literature pertaining
to resilience or ‘invulnerability’ (p. 597). Their review
identified three clusters of characteristics which provide
the framework for the discussion of resilience in children.
These clusters are: (a) personal predisposition — activity
level, social responsivity and autonomy; (b) warm, sup-
portive family environments; and (c) extrafamilial peer
and adult support sources and positive role models
( p. 599).
In an address to the Conference on Community Violence,
Garmezy (1993) described characteristics of children who
sustained their competency despite being raised in pov-
erty. He identified a triad of ‘protective factors’ (p. 132)
consistently present in the literature. These factors were
similar to those discussed by Cowen & Work (1988): (a) per-
sonal characteristics of the child — activity level, reflec-
tiveness, cognitive skills, and a positive responsiveness to
others; (b) the presence of a caring adult and a warm cohes-
ive family; and (c) strong external support — a maternal
substitute or school or church affiliation.
Resilient adolescents
Beardslee & Podorefsky (1988) studied adolescents who
were functioning well in spite of living with parents with
major affective disorders. The authors also identified per-
sonal, family and community traits associated with resili-
ent individuals. The purposes of the study were to
(a) assess the stability of the adolescents’ adaptive func-
tioning over time; (b) characterize their adaptive behav-
iour; and (c) investigate their self-understanding and
interpersonal relationships.
The study used a longitudinal design composed of two
interviews occurring from 18 months to 3 years apart. The
subjects in the initial large sample were solicited in a non-
random way from three diverse groups: parents participat-
ing in a large study of the course and outcomes of serious
124 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 123–129
affective illness, door to door survey of neighbourhoods in
which families with parents with affective disorders lived,
and a random sample of subjects of a pre-paid health plan.
The selected families were Caucasian, English speaking,
and had children 6–19 years old who lived with their
mother. The sampling method was designed to determine
similarities between groups of adolescents at risk and
those not at risk.
The second interview was the focus of this study. The
second sample was chosen from subjects in the initial
study. In order to be selected, subjects had to have had
good overall ratings at the time of the initial study, a family
history of psychiatric disorder and a lack of major current
psychiatric involvement. Eight male and 10 female ado-
lescents met the criteria and agreed to participate. The
subjects in the second sample were not average; they had
no history of medical problems, had a mean intelligence
quotient of 113·5 (97–137), and had no diagnosed learning
disabilities (Beardslee & Podorefsky 1988 p. 65). The major
weaknesses of the report were lack of discussion of validity
of the interview or instruments used and methods of stat-
istical analysis.
Beardslee & Podorefsky (1988) found the characteristics
of resilient adolescents in their sample similar to the triad
identified by Cowen & Work (1988). At a personal level,
they had high activity levels and good work and academic
records. These young people were ‘doers and problem
solvers’ (p. 67). The adolescents demonstrated self-
understanding and the ability to reflect on changes in
themselves and their parents. They could distinguish
clearly between themselves and their parents’ illness and
know they were not responsible for their parents’ illness.
They could think and act independently.
At the family level, the resilient subjects studied by
Beardslee & Podorefsky (1988) had, in several instances,
assumed the caretaker role, or had a sibling who had
assumed the role, to provide stability and cohesiveness in
an otherwise disrupted family. In a review article compar-
ing this study with two others, Beardslee (1989) identified
the presence of a close confiding relationship as protective
against future stressful occurrences (p. 267). Finally, like
the impoverished children in Garmezy’s (1993) study,
almost all the subjects in the study had external support
through established close supportive relationships with
friends, adults outside the family or siblings.
Children of divorced parents were studied by
Mulholland et al. (1991). The focus of the study was aca-
demic performance but, in the discussion, Mulholland
et al. (1991) identified the need for investigations of resili-
ent children in the midst of divorce to identify protective
factors that allowed some subjects to weather the divorce
without the classic symptoms of maladjustment (p. 279).
The final study in this group is Hechtman’s (1991)
review of studies investigating the long term outcome of
attention deficit hyperactive disorder (ADHD). Hechtman

identified several personal traits as characteristics of resili-
ent subjects: absence of health problems; positive tem-
perament factors — activity, adaptability, and social
responsiveness; higher than average intelligence; positive
self-esteem; autonomy; and good peer relationships.
Hechtman’s review diverges from the other studies in
relation to family factors promoting resilience. In addition
to warm, cohesive families, children from two-parent fam-
ilies fared better than those from one parent homes.
Resilience was also related to socioeconomic status.
Community factors important to outcomes in children
with ADHD included strong community support and the
influence of church or school. It is to be noted that
Hechtman was reviewing studies which focused on the
outcomes of children with ADHD in the general popu-
lation, whereas other studies discussed above investigated
a specific portion of the population selected by socioecon-
omic status (Garmezy 1993) or family type (Beardslee &
Podorefsky 1988, Mulholland et al. 1991) so that some of
the variables identified by Hechtman were controlled.
In all the studies of children noted above, the constel-
lation of personal, family and community characteristics
of resilient individuals was consistent. When assessing cli-
ents’ abilities to respond to health problems, nurses should
take this constellation of characteristics into account.
Resilience as a trait in adults
We now move to investigations of adult responses to ill-
ness or adversity. This group is diverse, including gay
men’s response to acquired immune deficiency syndrome
(AIDS) (Rabkin et al. 1993), Antoni & Goodkin’s (1988)
correlational investigation of cervical neoplastic growth in
women, and studies of resilience in older women by
Wagnild & Young (1990, 1993).
In an excellent study of long term survivors of AIDS,
Rabkin et al. (1993) used a survey approach to investigate
psychological and behavioural aspects of quality of life
and health care use in a population of inner-city gay men.
The sample was a purposefully selected non-random
sample composed entirely of urban gay men with AIDS;
they were not intravenous drug users and had survived at
least 3 years after their first opportunistic infection. The
authors state that this sample was not typical of people
with AIDS across the country. During the design phase of
the study, the authors conducted pilot interviews and had
learned that the experiences of women and of intravenous
drug users with AIDS were significantly different from
those of the sample population. The responses of 53
subjects were included in the study.
Rabkin et al. (1993) used a lengthy semi-structured inter-
view and several self-rating scales to evaluate the subjects.
The focus of the interviews was assessment of current
mood disorders, psychiatric distress, future outlook,
quality of life, and physical functioning.
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 123–129
Resilience
The study indicated that the same traits identified in
investigations of children were important in this group.
Like resilient children, these AIDS survivors had extraordi-
nary personal resources: intelligence, education, wide-
ranging interests, and the ability to adapt to change. They
had a positive outlook and could articulate goals for the
future. Most of them had a confidant; all had access to com-
munity resources such as services and adequate housing.
Subjects with cancer
In a study investigating the relationship between immuno-
suppression and a chronic state of psychological distress,
Antoni & Goodkin (1988) report that promotion of cervical
carcinogenesis may be associated with specific personality
traits and coping styles. The study was designed to repli-
cate and expand on a previous study by the same authors.
There were two directional hypotheses: (a) a more resilient
group, characterized by an optimistic outlook and active
interpersonal style, would resist promotion of cervical
intraepithelial neoplasia (CIN); and (b) high levels of pessi-
mism, hopelessness, social alienation, and somatic anxiety
would potentiate the promotion of CIN. The independent
variable was personality and the dependent variable was
the degree of atypical neoplastic growth on the cervix of
CIN and invasive carcinoma. A correlational design was
used with planned comparisons and stepwise multiple
regression.
Seventy-five subjects identified by abnormal pap smear
at an outpatient clinic were divided into five groups
according to degree of cervical neoplasia. Subjects partici-
pated in a semi-structured interview and were adminis-
tered the Millon Behavioural Health Inventory after being
examined by a physician and before the results of the
examination were reported. Demographic data for the
entire sample as well as for individual groups was
evaluated.
The findings revealed a number of associations between
psychosocial variables and neoplastic promotion. Both
hypotheses were supported. Subjects with cancer were
found to have significantly (P<0·01) higher scores in pre-
morbid pessimism, future despair, life-threat reactivity,
and somatic anxiety than the control, CIN I, or CIN II
groups. The subjects with cancer were also found to have
a passive and conforming personality style. The CIN III
group scored between the first three groups and the cancer
group; this suggests a continuum.
This was a very interesting study, unfortunately the
discussion of results focused on the characteristics of
subjects who had cancer and demonstrated lower resili-
ence rather than those subjects who might have been
more resilient. Implications for resilience must be
inferred through comparisons with the cancer group. The
reliability of the results were strengthened by the fact
that this study is a replication of a previous study.
However the actual number of subjects in each group was
125
C.S. Jacelon
very small (10–18) and more confidence could be placed
in these results with larger numbers. Sample size was not
justified in the study, nor was there sufficient information
to compute power.
In a qualitative study using a grounded theory approach,
Wagnild & Young (1990) endeavoured to describe the qual-
ities that characterize elderly women who can adjust to
major life losses. Twenty-four Caucasian women between
67 and 92 years old were interviewed. According to
Bowers (1988), this is a rather large number of participants
for a qualitative study. The article does not explain the
reasons for this number of participants. The study partici-
pants appear to have been selected prior to the start of
interviews, not as the theory emerged from the data. All
participants were identified by directors of senior citizens
centres as having adjusted well after a major loss. Criteria
for inclusion were social involvement, a mid to high level
of morale as measured by the Philadelphia Geriatric Center
Morale Scale (Lawton 1975), and self-reported successful
adjustment. Losses included the death of a loved one, loss
of employment, loss of health, and losses associated with
relocation.
Each participant was interviewed once in a semi-
structured audio-taped session conducted in the partici-
pant’s home. Descriptive data were obtained and partici-
pants were asked to respond to a series of questions about
a particular loss within the last 5 years, although the
authors indicated that ‘the interview was flexible enough
that the women could talk freely about their lives’
(Wagnild & Young 1990 p. 253). Bowers (1988), suggests
that interview schedules are inappropriate in this method;
instead the direction of interviews should be based upon
directions from previous interviews.
Wagnild & Young identified the following themes emerg-
ing from the data: (a) equanimity — a balanced perspective
of one’s life experience; (b) perseverance — persistence in
spite of adversity, and a willingness to continue the strug-
gle; (c) self-reliance — a belief in oneself and capabilities;
(d) meaningfulness — the realization that life has a
purpose and the value of one’s contributions; and
(e) existential aloneness — the realization that each
person’s life path is unique. The authors compared
their findings to the available literature and noted its
congruence.
Measurement
The final study to be presented investigating resilience as
a trait is also by Wagnild & Young (1993). The purpose of
this study was to test an instrument developed to measure
resilience in people. Based on their 1990 research pre-
sented above, and a review of the literature, Wagnild &
Young operationalized measurement of the five identified
components in the Resilience Scale (RS).
The 25-item scale was developed from the responses of
participants in the study described above. All items are
126 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 123–129
worded positively and rated on a seven-point scale, 1 being
‘strongly disagree’, 7 being ‘strongly agree’. Possible scores
range from 25 to 175. Pilot testing was conducted on 39
undergraduate nursing students. After refinement, a mail
survey was conducted. Questionnaires were mailed to
1500 older adults in the pacific northwest, of which 810
(54%) were returned. Responses were anonymous. The
purpose of the study was to validate the RS. Subjects were
asked to complete several well established instruments
including the Life Satisfaction Index (LSI), Philadelphia
Geriatric Center Morale Scale (PGCMS), the Beck
Depression Inventory (BDI), and a measure of physical
health (PH). The authors expected that these scales would
correlate either negatively or positively with the RS. All
scores did correlate, and in the proposed direction (LSI
positive, PGCMS positive, BDI negative, PH positive) at
P≤0·001.
Results were analysed using correlational analyses and
factor analyses to examine internal consistency and val-
idity of the RS. Principal components analysis revealed
two factors which explained 44% of the variance. Factor I,
personal competence, included self-reliance, indepen-
dence, determination, invincibility, mastery, resourceful-
ness, and perseverance (Wagnild & Young 1993). Factor II,
acceptance of self and life, included adaptability, balance,
flexibility, and a balanced perspective of life. The instru-
ment was included in the article, and the article was pub-
lished in a journal dedicated to instrument development.
Limitations of the RS were discussed, areas needing
refinement were identified, and potential uses for the RS
were identified.
The literature reveals several studies discussed above
which focus on identification of resilience as a constel-
lation of traits of individuals. Personal factors such as
activity level, reflectiveness, superior cognitive skills,
positive responsiveness to others, equanimity, persever-
ance, self-reliance, meaningfulness and existential alone-
ness have been identified as traits of resilient people.
Family situations which include a caring adult, a warm
supportive environment and close confidants were found
to be important to resilient youngsters and AIDS victims.
Finally, several studies identified strong community
support as a feature of the live of resilient people.
RESILIENCE AS A PROCESS
Flach (1980, 1988) described the dynamic process of resili-
ence as a system which can be learned at any point in
life. Rutter (1987) proposed a number of protective factors
by which ‘catalytic modification of a person’s response
to risk’ (p. 329) occur. Fine (1991) discussed the process
of resilience with respect to the demands of physical
and neurologic trauma in rehabilitation settings. Studies
in this section will be presented in order by the age of
subject.

Resilience as a process in children
Fonagy et al. (1993) proposed and investigated a model for
child parent attachment. Specifically they were interested
in intergenerational transmission of maladaptive relation-
ship patterns. The actual study conducted by Fonagy et al.
is outside the scope of this paper, but the definition used
for resilience aptly describes the process point of view.
[Resilience] is the indication of a process which characterizes a
complex social system at a moment in time… resilience cannot
be seen as anything other than a set of social and intrapsychic
processes which take place across time given felicitous combi-
nations of child attributes, family, social and cultural
environments.
(Fonagy et al. 1993 p. 233)
Rutter (1985) proposed a model in which resilience and
vulnerability are opposite ends of a continuum. Individual
response to adversity falls at some point along the con-
tinuum. The response will be determined by the dynamic
interplay of ‘protective factors’ and ‘interactive processes’
( p. 600). ‘[P]rotective factors may have no detectable effect
in the absence of any subsequent stressor; their role is to
modify the response to later adversity’ (p. 600). Factors
included qualities of the person, such as sex or age, and
experiences, not necessarily positive. For example, there
is a school of thought which suggests that exposure to
stressful situations has an inoculating effect, enabling
people to better cope with stress later in life.
Interactive processes were described by Rutter (1985) to
be the additive interaction of a constellation of variables
‘… the interactive processes need to be considered over
time… and not just as some kind of chemistry at the single
point in time when an individual encounters stress or
adversity… the timing of an event may either increase or
decrease stress effects’ (Rutter 1985 p. 601). Rutter con-
cluded discussion of the process of resilience by suggest-
ing that ‘The promotion of resilience in individuals does
not lie in avoiding stressful situations, but in encountering
stress at a time and in a way that allows self-confidence
and social competence …’ (p. 608).
In 1987, Rutter published a follow-up article to the 1985
model proposed above. He further investigated the exist-
ence and effects of protective factors and identified them
with respect to risk mechanisms. Risk mechanisms lead
directly to disorder, whereas protective factors operate
indirectly, with their effects apparent only by virtue of
their interactions with the risk variable. These protective
mechanisms and risk factors come into play during ‘key
turning points’ (p. 316) in people’s lives. Although Rutter
(1985, 1987) and Garmezy (1993) both described protective
factors in relation to the individual’s response to environ-
mental change, Garmezy focused his investigation on the
identification of these factors, whereas Rutter sought to
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 123–129
Resilience
describe the process by which the protective factors
worked.
Resilience as a process in adults
Fine (1991), in her work with physically disabled individ-
uals, found that ‘personal perceptions and responses to
stressful life events are crucial elements of survival, recov-
ery, and rehabilitation, often transcending the reality of
the situation or the interventions of others’ (p. 493). It was
important for these individuals to belong to a social group,
have hope, find meaning and purpose to their lives, be
able to step back and view their situation from the position
of a spectator, attempt novel strategies at problem solving,
transform disturbances into adaptive behaviour, and
finally to recognize there is more to oneself than the
current circumstance suggests.
Fine (1991) identified a two-stage process of resilience.
In the acute phase of the process, energy is directed at
minimizing the impact of the stress and stressor. In the
reorganization phase, a new reality is faced and accepted
in part or in whole (p. 499). Although inspiring, Fine’s
article is silent on the details of her work. She alluded to
‘a study of outcome’ (p. 493), ‘themes in narratives[s] I
encountered’ (p. 495), and other references to interviews
with disabled individuals, but there is no mention of the
research design or findings.
Two studies, Baumeister (1982) and Steele et al. (1993),
used quasi-experimental designs to investigate the pro-
cesses used by resilient individuals to maintain integrity.
Both investigations focused on the effects of threats to self-
esteem on individuals’ self-concept. The design and find-
ings of these studies are outside the scope of this paper
but are mentioned as examples of studies investigating the
process of resilience.
The final author to be discussed is Flach. Flach (1988),
in a self-help text, identified a normal process of disrup-
tion and reintegration which characterizes the life cycle.
Resilience is part of the cycle. Using a developmental per-
spective, Flach presented the idea of ‘bifurcation points…
the points in life when major shifts occur’ (p. 14). Similar
to Rutter’s (1987) key turning points, bifurcation points
represent moments of extreme change in the life cycle.
Cyclical
The process is cyclical, beginning with a bifurcation point
stress which disturbs the homeostatic processes of the
individual. This leads to disruption in normal routines
and, ultimately, to chaos. At this point resilience is
initiated leading to reintegration and a new homeostatic
structure at a higher level of functioning. Like Fine (1991),
Flach identified two stages of resilience, disintegration and
reintegration.
Using case presentations to illustrate the process of
resilience throughout the life cycle, Flach (1988) suggested
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C.S. Jacelon
strategies for improving one’s capacity for resilience by
improving self-esteem, developing autonomy, and improv-
ing creativity. Flach’s self-help text is easy reading and
informative, but it does not seem to be substantiated by
current scientific literature. While Rutter (1985, 1987) and
Garmezy (1993) are frequently cited as resources and are
at the forefront of the investigation of resilience, Flach
(1980, 1988) has rarely been cited and has not been a lively
participant in the debate. This book for lay people would
have been strengthened by research on the proposed
model.
The investigation of the process of resilience has
included several proposed models. Rutter (1985) proposed
a continuum from vulnerability to resilience as a means
to conceptualize the individual’s response to adversity. In
Rutter’s model, characteristics or experiences of the indi-
vidual function as protective factors and mediate the
response to stress. Fine (1991) identified resilience as a
two-stage process: an acute phase and a reintegration
phase. Finally, Flach (1988) proposed a model similar to
Fine’s (1991), in which the normal response to a stressor
is disruption followed by reintegration. Flach (1988)
assured the reader ‘… resilience is a strength most of us
can develop with thought and practice’ (p. xv).
DI SCUSSION
Resilience has been identified as a constellation of traits.
It has also been identified as a process by which individ-
uals respond to environmental stimuli. One possible solu-
tion to the confusion can be found in the Oxford English
Dictionary (1971). Resilience is the ability to ‘rebound or
spring back’ (p. 2509). ‘Resilition’ is the process of resili-
ence (p. 2509). By identifying resilience and resilition
accurately, the focus of research can become more clear
and implications for practice can more readily be ascer-
tained. Areas of agreement, such as the traits of resilient
children, suggest implications for nursing practice.
Researchers who have focused on identifying traits of
individuals have, for the most part, come to agreement.
Cowan & Work (1988) identified a triad of personal,
family and community factors in individuals who are
successful despite adversity in their lives. Resilient sub-
jects were of above average intelligence with a wide range
of interests and activities. Self-reliance or independence
was identified as another characteristic of resilient
people. A positive outlook was important. A strong sense
of self or the trait of existential aloneness are also
important.
Positive family factors were found to contribute to resili-
ence. Active engagement in social activities was another
important trait. In summary, resilient people have many
personal resources, including above-average intelligence,
active engaged lives, a strong sense of self, self-reliance
and independence, and a positive outlook.
128 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 123–129
CONCLUSI ONS
The research of resilience as a trait would benefit from use
of the Resilience Scale by other researchers and on subjects
different from those studied by Wagnild & Young (1993).
Individual traits such as humour, autonomy and enthusi-
asm should be examined for their significance in relation
to resilience. The role of social ties also warrant further
investigation as all researchers did not mention this issue.
Resilience as a trait indicates the concept may be inherent
in some individuals. Research should focus on ways to
identify the presence of the trait. Nurses in practice could
then better focus resources by capitalizing on the resilient
person’s strengths and by providing assistance to people
who are not inherently resilient.
Less agreement exists among authors proposing a pro-
cess of resilience. The body of literature is less developed.
Several mechanisms for the process of resilience have been
proposed, and some specific ideas, such as the inoculation
effect of stress, have been tested. Lack of clarity exists
regarding steps in the process. Resilience may be a two-
step process or may be more complicated. Resilience as a
process that can be taught is far from the interaction of
many variables described by Rutter. Studies which meas-
ure the ability for subjects to learn resilience would be
useful.
Another area requiring further research is the process of
resilience in different populations. Muecke (1992), in her
study of refugees, called for a shift of focus from pathology
to refugee health. Muecke suggested that what appears to
be illness from a medical perspective may represent a stage
in a resilient process.
Nurses work with clients in situations which tax the
clients’ resources. As the climate within which nursing
care is provided shifts from inside the hospital to the com-
munity, the resilience of the individuals we work with
will increase in importance. The length of stay in hospitals
is declining, and the resources available for health care are
diminishing, nurses are increasingly called upon to assist
clients to respond to health problems rapidly.
If methods were developed to assess client resilience
and interventions were developed to improve resilience,
nurses could then include measures to improve client
resilience in plans of care. Nurses could foster resilience
in people before illness occurred, then focus interventions
on bolstering the clients’ resilience during crisis.
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