Name: Logeswarry K.

Vesupathy
Title: Research Proposal

Research Topic: Evaluating the nursing students' resilience level and its association
with psychological factors among nursing students in Universiti Sains Malaysia
(USM).

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, marital conflict 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, it is predicted that there will be an increase of global
deficit from 7.2 million skilled health professionals to 12.9 million by year 2035 (Yu,
et al., 2019). This high turnover of nurses in future may cause nurses shortage in
healthcare systems which will cause biggest impact on healthcare organizations and
management especially financial problems together lead to increase level of stress
or burnout among employed nurses. Relatively, stress and burnout not only
experienced by nurses in healthcare system but also the nursing students. Hence,
according to Hussien (2022), resilience defines as the ability to manage and face
hardships and it’s a skill that allow an individual to endure problems and challenges.
Therefore, it is significant for nurses to acquire maximum level of resilence to
succeed psychological stability and to overcome workplace stressors (Salem, et al.,
2022).

Definition of resilience

The word resilience inherited from a Latin term resilire which defines as to rebound
or leap back (Vella, et al., 2019). Based on American Psychological Association,
resilience derives as the process of adapting well in the face of adversity, trauma,
tragedy, threats or even significant sourcesof stress ( Southwick, et al., 2014).
However, back before 20th century, the verb resilience referred in three terms as
good enhancement outcomes despite high risk status,maintenance of competence
under stress and process of recovery from trauma (Fleming & Ledogar, 2008).
Hence the latest meaning of resilience in healthcare system shows that healthcare
professionals deliver high quality care consistently, able to endure unsettling
situations and possess continuity to adapt, learn and improve in any situations (Wiig,
et al., 2020).

Justification of study

Nurses known to be one of the significant healthcare providers in healthcare

network. However, currently in a global level, healthcare system is facing shortage of
nurses. Many earlier studies has expressed that lack of nurses in healthcare
structure could create a exceedingly stressful environment due to poor trait in
handling conflict situations and inability to cope psychological condition such as
stress or depression (Alkaissi, et al., 2021). In addition, nursing students who are
experiencing transition from academic education to clinical placement facing high
pressure especially causing affect to their mental well-being( Aryuwat, et al., 2022).
Hence,one of the main quality that allow nurses or nursing students to overcome
obstacles and challenges they face in their education and working environment is
resilience (Chow, et al., 2020). Moreover, trait of resilience is required among
undergraduate and graduate nursing students to recover from burnout and
psychological distress together to enhance their standard of life (Aryuwat, et al.,
2022).
Theoretical framework of resilience

There are six key theorists in the search of resilience that has provided the basic
understanding of resilience such as Michael Rutter, Norman Garmezy, Emmy
Werner, Suniya Luthar, and Michael Ungar (Shean, 2015).

Emmy Werner The ability to cope efficiently with the internal stresses of their
vulnerabilities and external stresses (Shean, 2015).
(1982)

Norman Garmezy It is formed to redirect the capacity for recovery and sustained
adaptive traits that may follow preliminary retreat or incapability
(1991)
upon commencing a high pressure event (Shean, 2015).

Suniya Luthar A dynamic process consist of positive adaptation within the

context of important adversity (Shean, 2015).
(2000)

Michael Ungar The product from discussions between individuals and their
surroundings for the resources to define themselves as healthy
(2004)
among conditions collectively viewed as adverse (Shean, 2015).

Michael Rutter An interactive concept that consist of mixture of serious risk

experiences and a positive psychological result produced
(2006)
through the experiences (Shean, 2015).

Betty Neuman Its is known as an essential trait for professionals who are
working in the nursing profession due the stressors involved in
(1982)
the field. The Neuman Systems Model was introduced to focus
on stress factors that related to the profession (Hannoodee &
Dhamoon, 2023).
Conceptual Framework using Neuman’s System Model

Betty Neuman has created Neuman’s Systems Model on year 1970s and published
in year 1982 which has been used as a conceptual framework to determine nurse
resilience and its associated factors (Alligood, 2021). The Neumans System Model
was developed to define an individual in a system that responds to environmental
stressors such as physiological, psychological, sociocultural, developmental, and
spiritual variables ( Nimako & Basatan , 2022). Thus, in this context of this study,
Neuman’s Systems Model is used as a framework to explain the association
between variables which are resilience level among undergraduate nursing students,
demographic factors and its psychological factors. In this Neumans System Model,
the central core represents of undergraduate USM nursing students as the client
system. The dotted lines / lines of resistance are the resilience level that protect the
client from the interference of demographic and psychological factors that has not
been restricted by normal line of defense, which shows what has the client has
evolved over time. When the resilience level is unproductive due to influence of
either one of the factors, it causes a reaction in the client’s system. There are
elements in both lines of resistance and in the defense (x), such as high turnover,
marital conflict, poor quality care for patients and many more which may show the
response of the client to the psychological and demographical factors. The outer
dotted line (y) represents the flexible line of defense, which will act as a system
buffer or as the interventions.
Figure 1 below shows the Conceptual Framework of my research study using
Neuman’s System Model.

Figure 1

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).

Operational Definition

Research Questions

1. What is the level of resilience among undergraduate USM nursing students?

2. Is there any association between level of resilience with gender, years of study,
education level and age in undergraduate USM nursing students?

3. Is there any association between resilience level and psychological factors among
undergraduate USM nursing students?

Research Objectives

General objective

To evaluate the resilience level among undergraduate nursing students in USM and
its association to psychological factors.

Specific objectives

1. To determine the resilience level among undergraduate USM nursing students.

2. To investigate the association between resilience level with gender, years of study,
education level and age in undergraduate USM nursing students.

3. To identify the association between resilience level and psychological factors

among undergraduate USM nursing students.

Research Hypothesis

1. The resilience level among undergraduate USM nursing students is high.

2. There is an association between level of resilience with gender, years of study,

education level and age in undergraduate USM nursing students.

3. There any association between resilience level and psychological factors among
undergraduate USM nursing students.

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).

On the other hand, in a study to determine the stress level among nursing students,
the result shows that the senior year students or most experienced nursong students
experiencing higher levels of anxiety and stress ( Onieva-Zafra,, et al., 2020). In
addition, in a study done in Indonesia to recognize the difference in the level of
stress with both gender shows that female nurse has higher stress level at working
environment compare to male (Puspitasari, et al., 2020).
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 Design

A cross-sectional quantitative research design.

Study Area

Universiti Sains Malaysia.

Study Population

The target study population are nursing students from diploma and degree program
of Universiti Sains Malaysia. The sampling group will be 1 st year to 4th year diploma
and degree nursing students in USM.

Subject Criteria

Inclusion criteria:

1. Diploma USM nursing students from first year until final year.

2. Degree USM nursing students from first year until final year.

Exclusion criteria:

1. Postgraduate or Masters USM nursing students.

2. USM nursing students who have already completed or graduated from diploma
and degree nursing program.

3. Diploma and degree USM nursing students with history of psychological distress
or illness.

Sample size estimation

Sampling Method

The sample was recruited using convenience sampling method.

Research Tool

The research tool is by using questionnaires which are categorized into three which
are Section A is demographic, Section B is by Connor-Davidson Resiliency Scale
(CD-RISC) and Section C is by using. Firstly, in Section A consist of a detailed
information on a range of demographic items, including their age, gender, years of
study, and education level.

Next, the Connor-Davidson Resiliency Scale (CD-RISC) is known to be a valid tool

to measure the resilience level among healthcare groups (Nia, et al., 2023). In
Section B, CD-RISC consist of 25 items with scoring on a five-point Likert scale and
range from 0 (“Not true at all”) to 4 (“True nearly all the time”). The questionnaire
score ranges from 0 (lower degree of resilience) to 100 (greater degree of
resilience). Items are incorporated with five domains which are self-competency
(item 1- 8), management of negative emotions or stress (items 9 -15), positive
reaction upon to change ( items 16 -20), reflection of perceived control (items 21-23)
and self spirituality (items 24-25) (Velickovic, et al., 2020). The Cronbach’s alpha
coefficient of the Resilience Scale to be 0.956.
(Khordeh, et al., 2022).

Lastly, Section C will be inclusive of questions from COPSOQ questionnaire short

version where it is developed to assess psychosocial factors at work, stress, and the
well-being of nurses. The questionnaire consists of 44 items with 5-point Likert scale
from never to always. However, there are only 34 questions selected that the factors
consist of demands at work, influence and development, interpersonal relationship
and leadership, quality of leadership, job insecurity and job satisfaction (Liang, et al.,
2018).

Operational Definition

Resilience:

The ability of systems to resist, absorb, and recover from or adapt to an adverse occurrence
during operation that may cause harm, destruction, or loss of ability to perform mission-
related functions.
Data Collection Method

The process of data collection will be taken place after receive approval from the
ethics committees of the study. The expected duration for the data collection from
the participants will be approximately in two months. The participants will be
provided with a consent form prior to data collection and briefing will be given on the
purpose of the study. The participants identity and personal information will be
confidential. The questionnaire and consent form will be provided to the participants
via Google form by maintaining per entry an individual to avoid from multiple entry or
personal bias.

Data Analysis

The data which has been collected will be entered and analysed using the Statistical
Package for the Social Sciences (SPSS) Version 28. The descriptive data will be displayed
as mode, median, mean, standard deviation (SD), variance and percentages. This will
enable the researchers to conduct a differentiation between variables in the study and
measurement in connection with key variables. The Pearson correlation coefficient test will
be used to analyse the correlations between the variables and the CD-RISC and COPSOQ
score. Simple linear regression test used to recognize the association of potential factors
with nursing students’ resilience level

Study Flow Chart

The researcher aims to complete the study in 7 to 8 months’ time. The Gantt chart below
outline the flow or process of the study.

Gantt Chart

Timeline Aug Sept Oct Nov Dec Jan Feb Mac Apr

Activity

Research

Proposal

Approval of pilot
study

Data collection

Data analysis

Result and writing

Final submission

Expected Results – dummy table

Table 1 shows sample characteristics (N = 132)

Respondent characteristic Number (n) Percentage (%)

Gender
- Male
- Female

Ethnicity
- Malay
- Chinese
- Indian
- Other

Marital status
- Single
- Married

Education Level
- SPM
- Diploma

Semester
-2
 -3
-4
-5
-6

Duration of clinical posting

- 3 months to 6 months
- 6 months to 9 months
- 9 months to 12 months
- 12 months to 15 months
- 15 months to 18 months

History of Medical Illness

- Yes
- No

Table 2

CD-RISC total score and COPSOQ total score of USM nursing students

CD- RISC (Total score) COPSOQ (Total score)

Characteristics
Mean (SD) range Mean (SD) range

Gender
- Male
- Female
p – value

Semester
-2
-3
-4
-5
-6
p – value

Duration of clinical posting

- 3 months to 6 months
- 6 months to 9 months
- 9 months to 12 months
- 12 months to 15 months
- 15 months to 18 months
p – value
p – value computed using independent t- test

Table 3

Factors associated with resilience level of USM nursing students

Bivariate Analysis Multivariate Analysis

Characteristics Mean (SD)/ P B SE

correlation
coefficient

Gender
- Male
- Female

Semester
-2
-3
-4
-5
-6

Duration of clinical posting

- 3 months to 6 months
- 6 months to 9 months
- 9 months to 12 months
- 12 months to 15 months
- 15 months to 18 months

CD-RISC total score

COPSOQ

Limitations of study

There are a some limitations in this study. Firstly, the sample size of the participant is small
as nursing students only recruited from one university. Thus, including nursing students from
other universities can strengthened the study and able to improve the external validity of the
findings. Additionally, there were only two tools used to investigate the variables of the study.

Ethical Consideration

Ethical approval will be obtained from Faculty of Nursing Universiti Sains Malaysia (USM)
and Research Unit of Universiti Sains Malaysia. The study will be conducted accordance to
the guidelines and regulations declared by both departments or units.
 Connor-Davidson Resilience Scale (CD-RISC)

No. Items Not true at all True all the time

1 Prefer to take the lead in problem solving 1 2 3 4 5

2 When things look hopeless, I don’t give up 1 2 3 4 5
condition

3 Strong sense of purpose 1 2 3 4 5

4 Think of self as strong person 1 2 3 4 5
5 In control of my life 1 2 3 4 5
6 I like challenge 1 2 3 4 5
7 One can achieve one’s goals 1 2 3 4 5
8 Not easily discouraged by failure 1 2 3 4 5
9 Under pressure, focus and think clearly 1 2 3 4 5
10 Make unpopular or difficult decisions 1 2 3 4 5
11 Can handle unpleasant feelings 1 2 3 4 5

12
Know where to get help 1 2 3 4 5
13 Have to act on a hunch 1 2 3 4 5
14 Things happen for a reason 1 2 3 4 5

15 Tend to bounce back after illness or hardship 1 2 3 4 5

16 Best effort no matter what 1 2 3 4 5
17 Able to adapt to change 1 2 3 4 5
18 Coping with stress strengthens 1 2 3 4 5
19 Past success gives confidence for new 1 2 3 4 5
challenges

20 Pride in your achievements 1 2 3 4 5

21 One works to attain one’s goals 1 2 3 4 5
22 See the humorous side of things 1 2 3 4 5
23 Sometimes fate and God can help 1 2 3 4 5
24 Close and secure relationships 1 2 3 4 5
25 Can deal with whatever comes 1 2 3 4 5
The following is an optional topic, Tick the option you agree with to indicate your level of agreement or
disagreement, among them “not true at all (=1); a little true (=2); somewhat true (=3); mostly true (=4);
true all the time (=5)”.

The Copenhagen Psychosocial Questionnaire (COPSOQ)

COPSOQ questions used in stress-related psychosocial work factors survey

never/hardly very
Demands at work: occasionally often always
ever often

C1 Do you have to work very fast?

Is your workload unevenly distributed, so that

C2
it piles up?

How often do you not have time to complete

C3
all your work tasks?

Does your work put you in emotionally

C4
disturbing situations?

Do you get emotionally involved in your

C5
work?

Does your work require that you hide your

C6
feelings?

never/hardly very
Influence and development: occasionally often always
ever often
 Do you have a large degree of influence on
C7
the decisions concerning your work?

Can you influence the amount of work

C8
assigned to you?

Do you have any influence on what you do at

C9
work?

C10 Can you play a leading role in the work?

Do you have the possibility of learning new

C11
things through your work?

C12 Can you decide when to take a break?

C13 Is your work meaningful?

Do you feel that the work you do is

C14
important?

Would you like to stay at your current place

C15
of work for the rest of your worklife?

Do you think your work is extremely

C16
important to yourself?

never/hardly very
Interpersonal relations and leadership: occasionally often always
ever often

At your place of work, are you informed well

C17 in advance about, for example, important
decisions, changes, or plans for the future?

Do you receive all the information that you

C18
need in order to do your work well?

How often do you get help and support from

C19
your colleagues?

How often do you get help and support from

C20
your nearest superior?

How often do you talk with your superior

C21
about how well you carry out

your work?

How often do you talk with your colleagues

C22
about how well you carry out your work?

Is there good co-operation between your

C23
colleagues at work?
C24 Do you feel you are part of work team?

to a very small to a small to a very large

Quality of leadership general to a large extent
extent extent extent

Is your immediate
C25 superior good at
work-planning?

Is your immediate
C26 superior good at
solving conflicts?

Job insecurity No Yes

C27 Are you worried about becoming unemployed?

Do you worry about that new technology making you / your

C28
work redundant?

Are you worried about being difficult for you to find another
C29
job if you became unemployed?

Are you worried about being transferred to another job

C30
against your will?

strongly strongly
Job satisfaction dissatisfied general satisfied
dissatisfied satisfied

Are you satisfied with your job

C31
prospects?

Are you satisfied with the

C32 hardware facilities in your work
place?

Are you satisfied with the way

C33 you play an ability at your
work?

Taken together, are you

C34
satisfied with your work?
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).

Morse, J. M. et al., 2021. Developing the Resilience Framework for Nursing and Healthcare. Global
Qualitative Nursing, Volume 8.

Nimako, B. P. & Basatan , T. N., 2022. Burnout and Job Performance of Nurses in Adult Care Settings
During COVID-19 Pandemic. International Journal of Nursing Science, 12(1), pp. 1-14.

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

Southwick, S. M. et al., 2014. Resilience definitions, theory, and challenges: interdisciplinary

perspectives. European Journal of Psychotraumatology, Volume 5.

Velickovic, K. et al., 2020. Psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC)
in a non-clinical population in Sweden. Health Qual Life Outcomes, 18(132), pp. 1-10.

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.

Alligood, M. R., 2021. Nursing Theorists and Their Work E-Book: Nursing Theorists and Their Work E-
Book. 10 ed. s.l.:Elsevier Health Sciences.

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
COVID-19 Emergency: The Role of Defense Mechanisms. International Journal of Environmental
Research and Public Health, Volume 18, pp. 1-12.

Fleming, J. & Ledogar, R. J., 2008. Resilience, an Evolving Concept: A Review of Literature Relevant to
Aboriginal Research. Canadian Institues of Health Research, 6(2), pp. 7-23.

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.

Hussien, R. . M., 2022. Relationship Between Resilience And Psychological Distress Among Hospital
Staff Nurses. Journal of Positive School Psychology, 6(9), pp. 809-822.
Ihara, H. et al., 2010. Development and Psychometric Validation of the Resilience Scale for Nurses.
Jpn J Gen Hosp Psychiatry（JGHP）, 22(3), pp. 210-220.

Khordeh, N. K. et al., 2022. The COVID-19 fear, anxiety, and resilience among emergency nurses.
Frontiers in Psychology, Volume 13, pp. 1-7.

KIM, E. Y. & CHANG, S. O., 2022. Exploring nurse perceptions and experiences of resilience: a meta-
synthesis study. KIM and CHANG BMC Nursing, 21(26).

Liang, Y.-Z.et al., 2018. Relationship between stress-related psychosocial work factors and
suboptimal health among Chinese medical staff: a cross-sectional study. BMJ Open, Volume 8, pp. 1-
11.

Lia, Z.-S. & Hasson, F., 2020. Resilience, stress, and psychological well-being in nursing students: A
systematic review. Nurse Education Today, Volume 90, pp. 1-13.

Majrabi, M., 2022. Nurses Burnout, Resilience and Its Association with Safety Culture: A Cross
Sectional Study. Open Journal of Nursing, 12(1), pp. 70-102.

Nia, H. S. et al., 2023. Psychometric evaluation of the Connor-Davidson Resilience Scale among
Iranian population. BMC Psychiatry, 23(92), pp. 1-9.

Pragholapati, A. & Yosep, I., 2020. The Correlation Of Resilience With Nurses Work Stress In
Emergency Unit Rumah Sakit Al Islam (RSAI) Bandung. Sorume Health Science Journal, 1(1), pp. 9-18.

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

Shean, M., 2015. Current theories relating to resilience and young people : A literature review.
Melbourne: Victorian Health Promotion Foundation.

Silva, S. M. d. et al., 2020. Resilience factors in nursing workers in the hospital context. Journal of
School of Nursing Uinvesity of Sao Paulo, Volume 54, pp. 1-7.

Sohail, M. et al., 2022. Psychometric Properties Of Medical Professionals Resilience Scale (Mers) For
Medical Doctors In Pakistan. Research Square, pp. 1-13.

Son, H. S. et al., 2022. Healthcare Workers’ Resilience Mediates the Influence of Organizational
Commitment and Anxiety Response to Viral Epidemic on Their Quality of Life in the COVID-19
Pandemic. Frontiers in Psychiatry, Volume 12, pp. 1-9.

Vella, Cynthia, S.-L., P. & N. B., 2019. A Theoretical Review of Psychological Resilience Defining
Resilience and Resilience Research over the Decades. Archives of Medicine and Health Sciences, 7(2),
pp. 233-239.

Wiig, S. et al., 2020. Defining the boundaries and operational concepts of resilience in the resilience
in healthcare research program. BMC Health Services Research, 20(330).

Yılmaz, E. B., 2017. Resilience as a strategy for struggling against challenges related to the nursing
profession. Chinese Nursing Research, Volume 4, pp. 9-13.

Yu, F. et al., 2019. Personal and work-related factors associated with nurse resilience: A systematic
review. International Journal of Nursing Studies, Volume 93, pp. 129-140.
Yu, F. et al., 2019. Personal and work-related factors associated with nurse resilience: A systematic
review. International Journal of Nursing Studies, Volume 93, pp. 129-140.

Zakaria, N., Zakaria, N. H., Abdul Rassip, M. N. A. B. & Lee, K. . Y., 2022. Burnout and coping
strategies among nurses in Malaysia: a national-level cross-sectional. BMJ Open, Volume 12, pp. 1-
14.
Dimensions Mean SD
Demands at Work

Quantitative demand

Emotional demand
Demands for hiding
emotions

Influence at work
Possibilities for development
Meaning of work
Degree of freedom at work
Commitment to the workplace
Predictability
Recognition (reward)
Interpersonal relation and leadership
Quality of leadership
Social support from supervisor
Feedback at work
Sense of Community
Job satisfaction and insecurity
Insecurity at work
Job satisfaction
Health and well being
General health
Mental Health
Vitality
Demographic
 Age
Education Level
Years of study

Connor–davidson p-value

Variables resilience scale

(CD-RISC) score

Age groups (year)    **

18- 25
25-32
32-39
39-46
46-55
Gender    *
- Male
- Female
Education Level *

- Diploma
- Degree

Years of Study    **

- 1st year
 - 2nd year
- 3rd year
- 4th year
* Independent t -test.

** One-way ANOVA test.

Factors r p-value
Demand at work
Quantitative demand
Work pace
Emotional demand
Interpersonal relation and
leadership
Quality of leadership
Work individual interface
Job satisfaction
Health and well-being
General health
Burnout
Stress
Demographic
Age
Education
Work experience
Factors that B S. E β p-value
affect the
resilience level