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


Thirteen studies[22–34] were included (Figure 1). In these studies, 576 participants received resilience training, which included in-person workshops and/or web-/handout-based learnings and/or mind-body exercises. The characteristics of the included studies are given in Table S1 ( Supporting information file). Four comparative studies compared the instrumental scores of participants of resilience training with those of nonparticipant controls.[22,23,30,32] Two studies also randomized participants.[22,30] The schedules of these workshops were variable, ranging from consecutive sessions for 1 day to weekly sessions for up to 3 months. The quality of the included studies was moderate in general (Table S2a and b

Figure 1.

A flowchart of study screening and selection process.

Various instruments used to measure endpoints included the following: resilience, Connor-Davidson Resilience Scale,[22,23,25,30,32] Casey-Fink Graduate Nurse Experience Survey,[26] Workplace Resilience Inventory,[27] and Resilience Scale;[29] stress, Depression, Anxiety, and Stress Scale,[25,27] Expanded Nursing Stress Scale,[22] Perceived Stress Scale,[23,30,34] and Casey-Fink Graduate Nurse Experience Survey;[26] anxiety and depression, Generalized Anxiety Disorder 7-Item Scale,[23,30] Depression, Anxiety, and Stress Scale,[27,29] and Hospital Anxiety and Depression Scale;[32] affect, Coping Self-efficacy Scale,[27,33] Subjective Happiness Scale,[30] Pandemic Self-efficacy Scale,[31] Positive and Negative Affect Schedule,[34] and Inventory of Interpersonal Problems—Social Inhibition;[31] mindful awareness, Mindful Attention Awareness Scale[23,30] and Ryff's Scales of Psychological Well-Being;[27] and burnout, Copenhagen Burnout Inventory,[30] Maslach Burnout Inventory,[32] and The Professional Quality of Life Scale version 5.[25]

Compared with preintervention scores, the postintervention resilience scores of the participants of resilience training were increased (SMD, 0.583; 95% confidence interval [CI], 0.228–0.938; P = .001), whereas there was no significant change in the resilience scores of control nurses who did not participate in the training (SMD, −0.132; 95% CI, −0.537 to 0.273; P = .523; Figure 2). After resilience training, the participants reported that their stress levels were also reduced. The change in stress scores was statistically significant (SMD, −0.601; 95% CI, −0.800 to −0.403; P < .00001). There was no reduction in the stress scores of nurses who did not participate in the training (SMD, 0.042; 95% CI, −0.418 to 0.501; P = .859; Figure 3).

Figure 2.

A forest graph showing the preintervention and postintervention scores of individual studies and the overall estimate of the changes in the resilience scores after resilience training. CDRS indicates Connor-Davidson Resilience Scale; CGNES, Casey-Fink Graduate Nurse Experience Survey; NR, not reported; WRI, Workplace Resilience Inventory (Aff, affective; Beh, behavioral; Cog, cognitive); RS, Resilience Scale; RT, resilience training.

Figure 3.

A forest graph showing the preintervention and postintervention scores of individual studies and the overall estimates of the changes in stress scores after resilience training. CGNES indicates Casey-Fink Graduate Nurse Experience Survey; DASS-21, Depression, Anxiety and Stress Scale (21 items); eNES, Expanded Nursing Stress Scale; PSS, Perceived Stress Scale; RT, resilience training.

The burnout scores of nurse participants also decreased after resilience training (SMD, −1.01; 95% CI, −1.25 to −0.76; P < .0001). Anxiety and depression scores were also decreased in resilience training participants (SMD, −0.50; 95% CI, −0.80 to −0.20; P = .001 and SMD, −0.43; 95% CI, −0.67 to −0.19; P < .0001, respectively). Resilience training reduced negative affect (SMD, −0.22; 95% CI, −0.37 to −0.06; P = .007; Figure S1 and improved mindfulness (SMD, 0.80; 95% CI, 0.35–1.25; P = .001), self-efficacy (SMD, 0.44; 95% CI, 0.21–0.66; P < .0000), well-being (SMD, 0.43; 95% CI, 0.08–0.78; P = .017), and positive affect (SMD, 0.55; 95% CI, −0.11 to 1.21; P = .102) scores of the participants (Figure S2