What is resilience in hospice inpatient nursing? : A participatory action research study

Background: The palliative care nursing workforce is depleted and faces increased demands due to an ageing population likely to be living longer with life-limiting conditions. Resilience is often suggested as necessary to enable nurses to tolerate rising levels of stress yet is often poorly defined and understood. Assumptions that resilience is the responsibility of individual nurses are challenged. Aim: To explore resilience from the perspective of hospice nurses; understand what individual, interpersonal and organisational factors influence resilience; develop strategies for enhancing resilience in hospice inpatient palliative care nursing; and to review and evaluate such strategies. Methods: Participatory Action Research (PAR) was used to identify the nature of adversity in inpatient palliative care nursing and develop strategies, designed by nurses themselves, to enhance resilience. Phase one involved semi-structured interviews with 7 registered nurses and phase two included twelve, monthly meetings of a Collaborative Inquiry Group, who engaged in a process of planning, acting and reflecting on the key issues identified in phase one. Findings: Resilience in inpatient palliative care nursing is preceded by the following adversities: being affected by certain patients, feeling kept in the dark, and when teamwork is sub-optimal. Resilience occurs when nurses make meaning from adverse experiences in ways that prepare them for future occurrences. Meaning making involves certain mindsets, team support and cohesion, and the ability to develop a coherent narrative about experiences. It is possible for nurses to innovate, generate and implement strategies to enhance resilience without relying on typically used interventions such as mindfulness, relaxation, CBT or other techniques that lay responsibility to tolerate inordinate stressors on the individual nurse. Conclusion: There are particular adversities encountered by the inpatient palliative care nursing workforce that