Resilience Training for Nurses: A Meta-Analysis

Xin Zhai, BSc; Li-na Ren, BSc; Yan Liu, BSc; Chao-jun Liu, MD; Xiao-guang Su, BSc; Bai-e Feng, BSc


Journal of Hospice and Palliative Nursing. 2021;23(6):544-550. 

In This Article

Abstract and Introduction


Nurses frequently face stressful situations during work, which makes resilience an essential quality of their personality to cope with professional stress and to prevent burnout. Resilience can be improved by training and practice. To analyze the effect of resilience training in nurses, studies reporting the changes in resilience before and after resilience training were identified by conducting the literature search in electronic databases. Meta-analyses of standardized mean differences (SMDs) between postintervention and preintervention scores of resilience and other related variables were performed. Thirteen studies (576 nurse participants) were included. Resilience training improved the resilience scores of the participants (SMD, 0.58; 95% confidence interval [CI], 0.23–0.94; P = .001), whereas there was no improvement in the resilience scores of nurses who did not participate in resilience training (SMD, −0.13; 95% CI, −0.54 to 0.27; P = .523). The stress (SMD, −0.60; 95% CI, −0.80 to −0.40; P < .00001), anxiety (SMD, −0.50; 95% CI, −0.80 to −0.20; P = .001), depression (SMD, −0.43; 95% CI, −0.67 to −0.19; P < .0001), and burnout (SMD, −1.01; 95% CI, −1.25 to −0.76; P < .0001) scores of the participants were also decreased after resilience training. In conclusion, resilience training improved the resilience scores of nurses, which was also associated with improvements in stress, depression, anxiety, and burnout scores. However, because of the variations in training contents and measuring tools, only generalized assessments could be made.


Resilience is the ability to face challenges, exhibit stress tolerance, and integrate change.[1] It is a complex, contextual, dynamic, and multifaceted attribute of personality in which an individual recovers, adjusts, and bounces back after experiencing adversity, trauma, or tragedy by coping and adapting it positively.[2–5] After conducting a comprehensive review of literature on resilience, Aburn et al identified 5 themes that characterized resilience definitions postulated by different authors. These were rising above to overcome adversity, adaptation and adjustment, a common attribute inherent to all, good mental health as a proxy for resilience, and an ability to bounce back.[6] Resilience not only helps one to recover but may also cause an individual to bounce back (become stronger) or even to thrive (attain a superior level of functioning).[7] It makes individuals emotionally stable, enhances well-being, and helps in professional growth.[8]

The nursing profession is usually constrained with nurse shortage, workload excess, limited autonomy, bullying, violence, and frequent exposure to stressors. Moreover, increased healthcare needs due to more frequent pandemics and increasing longevity are also putting pressure on nursing. These factors lead to high rates of stress, burnout, and nurse turnover and are also associated with higher infection rates and poor patient satisfaction.[9–11] Resilience has a protective role against nurse turnover, stress-related disorders, emotional exhaustion, conflict, and burnout and is linked to better patient satisfaction, job satisfaction, and social support.[12–14] In nurses, resilience-promoting factors that can be addressed in resilience-building strategies include intrinsic factors such as optimism, sense of purpose, faith, belief, empathy, self-care, self-efficacy, control, coping, flexibility, adaptability, and emotional intelligence, whereas extrinsic factors include social, professional, and organizational support; resourcefulness; and role models.[15]

Resilience can be considered as a process of learning from an adverse environment to move forward by using positive, optimistic, and adaptive attires of personality, which not only is important for nurses to maintain self-efficacy and professional efficiency but also has impacts on physical and mental health and quality of life.[16] Resilience has not been found to be associated with demographic variables, which shows that every individual has the capacity to build and strengthen resilience. However, the degree of resilience varies among individuals, which makes resilience building a complex process.[17] It has been asserted that every nurse has at least some resilience and can develop and strengthen resilience with the help of some specific learning activities such as seeking mentorships, maintaining life balance, spirituality, positivity, personal growth, and reflection.[18]

Fostering resilience in nurses is considered an important intervention to address the emotional dissonance of nurses and to mitigate the adverse effects of stressors on their biopsychosocial well-being.[15,19,20] Practically, resilience training for nurses has been found to yield promising results.[11,21] Several authors have reported the quantitative outcomes of resilience training for nurses, but the outcomes vary across these studies, which necessitate a systematic review of this subject. The present study aimed to analyze the quantitative changes in resilience in nurses as a result of resilience training by carrying out a systematic review of studies involving resilience training for nurses and performing meta-analyses of quantifiable outcomes of selected studies.