Name: Logeswarry K.

Vesupathy
Title: Research Proposal

Research Topic: Evaluating the nurses’ resilience level and the factors associated
with the resilience of nurses among final year nursing students in a private university.

Introduction

Nowadays, nurses are facing increase number of patients with various diseases and
conditions that requires challenging treatments for recovery. According to Yilmaz
(2017), the intense pressure or tension due to the increase of patients with difficult
diagnosis, can lead to work related problems such as stress, facing traumatic
experiences and burnout. Following to the same article, the author mentioned that
nurses acquiring resilience will allow them to endure with their work surrounding and
this will lead in sustaining of a healthy and stable psychological work life (Yılmaz,
2017). Besides that, a study shows that increase level of stress among nurses occur
due to physiological and psychological illness, low job satisfaction, poor occupational
performance, high burnout and turnover which lead to reduction of quality of care
among patients by nurses and reduces patients satisfaction level ( Salem, et al.,
2022). Thus, Salem et. al,(2022) highlighted in the article that one of the main factor
to overcome the above situations is by nurses having resilience. On the other hand,
based on the one of the population growth model by World Health Organization in
year 2014, there will be an increase of global deficit of 7.2 million skilled health
professionals to 12.9 million by year 2035 (Yu, et al., 2019). This high turnover of
nurses in future causes nurses shortage in healthcare systems which will cause
biggest impact on healthcare organizations and management especially financial
problems and also lead to increase level of stress of burnout among employed
nurses. Relatively, stress and burnout not only experienced by nurses in healthcare
system but also the nursing students. Therefore, resilience is significant in opposing
the negative effects such as stress and burnout that improves the quality of life of
nurses in a healthcare system.

Problem Statement

Nursing is a noble profession where nurses possess the most significant positions or
job in a healthcare system to build a successful organization. According to Abdollahi,
et. al, (2021), perceived stress due to work related stressors such as prolonged
working hours, shortage of nurses, workplace violence, conflict among peers and
lack of financial and emotional support lead to nurses experiencing burnout.
Therefore, one of the psychological aspect that plays an important role in resolving
both perceived stress and job burnout is self compassion which encompasses with
resilience, self kindness, humanity and mindfulness (Abdollahi, et al., 2021). A part
from that, a study was conducted to investigate the burnout level of nurses in
Malaysia which shows one out of four nurses facing burnout in their workplace
especially nurses who are young and working in shifts (Zakaria, et al., 2022).
Relatively, Alameddine, et. al, (2021) mentioned in an article that there are
evidences reflects the enhancement of nurses’ resilience level can minimize the risk
of burnout among nurses and increases the job satisfaction together reduces the
idea for turnover among nurses. Moreover, the relationship between burnouts and
resilience among nurses shows that the trait of resilience among nurses aid them to
overcome and mitigate psychological stress and burnout in workplace (Majrabi,
2022). In addition, based on several studies, nursing profession stress level differs in
different degree of work and work location where emergency department is known
as one of the highest stress level workplace compare to other units in a healthcare
system (Pragholapati & Yosep, 2020). Hence, in the same journal, the author
explains that nurses with resilience able to overcome the challenges in various
working environment and resilience act as a universal capacity to minimize burdens
and prevent errors in the workplace (Pragholapati & Yosep, 2020).

Literature Review

Resilience is defined as a developmental process of an individual where he or she

possess an ability to manage stress and it provides a positive impact for recovering
from any traumatic experience (Yılmaz, 2017). Additionally, resilience is also
characterized as the capability to acclimatize the face of difficulty even though an
individual has already experienced challenges, adversity and negative impacts in
their life (Sohail, et al., 2022). Hence, resilience is an important trait that is required
among nurses in order to improve job performances and eliminate negative impacts.
Similarly, Son, et. al, (2022) mentioned in his article that poor resilience level causes
lack of mental health and lead to psychological distress such as stress, depression
and anxiety. Relatively, there are previous studies among healthcare workers which
was conducted during COVID 19 pandemic that shows psychological resilience is a
key factor to protect an individual from depression, perceived stress and burnout
(Son, et al., 2022). On the other hand, another study was conducted during COVID
pandemic phase among healthcare workers to examine the role of defense
mechanism incorporated with stress, burnout and resilience (Di Giuseppe, et al.,
2021). The findings of the study above provides an empirical proof on how the
epidemic influences psychological functioning of healthcare workers and it is
reported that healthcare workers who are fail to possess a maturity defensive
functioning will face a great distress and minimizes their resilience level (Di
Giuseppe, et al., 2021). Consequently, it is vital for nurses to create personal
resilience in order to overcome or cope their high level of stress due to poorly
equipped with resources in working facilities, to sustain job satisfaction and enable to
recognize work related problems (Henshall, et al., 2020). Nevertheless, the same
article has explained there are many interventions has been taken to enhance the
resilience level among nurses such as conduct resilience-enhancement
programmes, employed nurses provide training to student nurses and organize
resilience courses (Henshall, et al., 2020). Besides that, another study was
conducted in hospitals among nurses to recognize the resilence factors where the
results shows that majority of nurses has medium level of resilience because the
nurses has implemented coping mechanisms or protective factors that minimizes the
adversity such as stress and burnout (Silva, et al., 2020). In addition, an article
published in Journal of Psychiatry Nursing highlighted that the risk factors that
affects nurses resilience are the inability to cope with stress, psychological distress
and burnout which lead to turnover of nurses in a healthcare system (ÇAM &
BÜYÜKBAYRAM, 2017). Furthermore, a study was also conducted among Mexican
nurses to examine the resilience level associated with mental health and socio
demographic factors where the result shows the nurses with somatic symptoms such
as anxiety-insomnia, depression and social dysfunction have the lowest resilience
level ( Martínez Arriaga, et al., 2021).

A part from that, a study has also been carried out in exploring nurses perceptions
and experiences in applying resilience in their profession (KIM & CHANG, 2022).
Thus, the findings shows that nurses shows resilience when they are facing difficult
situations and they attempt to identify and accept the situation as process ahead for
problem solving (KIM & CHANG, 2022).

Conclusively, based on the studies that I have analyzed and discover,I have realized
that resilience level is significant in nursing profession to overcome problems and
conflicts in workplace due to factors such as burnout, stress, psychological distress
and many more. Therefore, I would like to conduct a study to evaluate the nurses’
resilience level and the factors associated with the resilience of nurses among final
year nursing students in a private university.

Research Aim/Objective

General objective

To evaluate the nurses’ resilience level and the factors associated with the resilience
of nurses among final year nursing students in a private university.

Specific objectives

1. To identify the factors that affects the nurses’ resilience level among final year
nursing students in a private university.

2. To recognize the factors that increases the nurses’ resilience level among final
year nursing students in a private university.

3. To examine the factors that decreases the nurses’ resilience level among final
year nursing students in a private university.

Research Questions
1. What is the highest nurses’ resilience level among final year nursing students in a
private university?

2. What is the lowest nurses’ resilience level among final year nursing students in a
private university?

3. What are the associated factors that increases the nurses’ resilience level among
final year nursing students in a private university?

4. What are the associated factors that decreases the nurses’ resilience level among
final year nursing students in a private university?

Research Hypothesis

1. (H0): There is no significant difference in the level of nursing resilience among

final year nursing students in a private university.

(Halt): There is a significant difference in the level of nursing resilience among final
year nursing students in a private university.

2. (H0): There are no associated factors that influences the level of resilience among
final year nursing students in a private university.

(Halt): There are associated factors that influences the level of resilience among final
year nursing students in a private university.

Methodology

A cross sectional study will be conducted among 50 final year students in a private
university using questionnaires which are categorized into three which are Section A
is demographic, Section B is by using Medical Professionals Resilience Scale
(MeRS) and Section C is by using Copenhagen Psychosocial Questionnaire
(COPSOQ). Firstly, the demographic questionnaire will be consisting with age,
gender, educational level, working department and marital status. Next, Medical
Professionals Resilience Scale (MeRS) was validated in Malaysian medical
professionals’ which consist of a 4-point Likert scale comprising of 37 items in total. It
defines resilience based on integrated resilience model in four domains mainly
control, resourcefulness, involvement and growth with six, four, 12 and 15 items in
each domain respectively (Sohail, et al., 2022). Lastly, Section C will be inclusive of
questions from COPSOQ questionnaire where it is developed to assess
psychosocial factors at work, stress, and the well-being of nurses.

Besides that, Cronbach’s Alpha test will be conducted as there are multiple Likert
questions in the questionnaire to determine the reliability. Data collection will be
done via random sampling where the collected data will be entered, assessed and
analysed using SPSS software using the latest version.

Ethical Consideration

Ethical approval will be obtained from the research unit of the private university and
Research Unit of University Science Malaysia. The study will be conducted
accordance to the guidelines and regulations declared by both research units.

References
Martínez Arriaga, R. J. et al., 2021. Resilience associated to Mental Health and Sociodemographic
factors in mexican nurses during COVID-19. Enfermería Global, 20(63).

Salem, S. M., Ahmed, M. Z. & Aldahshan, M. E., 2022. Resilience in Nursing: A Concept Analysis.
Menoufia Nursing Journal, 7(1), pp. 73-82.

Abdollahi, A., Taheri, A. & Allen, K. A., 2021. Perceived stress, self compassion and job burnout in
nurses: the moderating role of self-compassion. Journal of Research in Nursing, 26(3), p. 182–191.

Alameddine, M. et al., 2021. Factors Associated With the Resilience of Nurses During the COVID-19
Pandemic. Worldviews on Evidence-Based Nursing, 18(6), pp. 320-331.

ÇAM, O. & BÜYÜKBAYRAM, A., 2017. Nurses’ Resilience and Effective Factors. Journal of Psychiatric
Nursing, 8(2), pp. 118-126.

Di Giuseppe, M. et al., 2021. Stress, Burnout, and Resilience among Healthcare Workers during the
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Henshall, C., Davey, Z. & Jackson, D., 2020. Nursing resilience interventions–A way forward in
challenging healthcare territories. Journal of Clinical Nursing, Volume 29, pp. 3597-3599.
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