Any discussion about resilience must begin by acknowledging that challenges, setbacks and obstacles occur naturally and, as such, may not be entirely controlled or avoided. Irrespective of one's best efforts, environments change, people demonstrate their human capacity for failure and organisations face increasing pressure to respond in a competitive market (Hatler and Sturgeon, 2013). The only constant in the universe is change. We all suffer knocks to our confidence at times, which can cause us to question the lives we have built and who we are. Consider those who have lost their job, received a serious health diagnosis or are dealing with the illness of a loved one. Resilience is essential to rise above adversity; those who are resilient display a greater capacity to continue forward in the face of difficulty or crisis — but what exactly is resilience, and can it be learned?
What is resilience?
Resilience is not a new concept. History is filled with the biographies and poetry of men and women whose greatness was achieved primarily through the resilience with which they met and overcame adversity (Power, 2014). However, it was in the 1970s that the concept of resilience began to truly emerge when child psychologists began to track and evaluate children who had lived through traumatic home circumstances. The children studied were from a variety of settings, including poverty-stricken areas, abusive situations, parents with illnesses including mental health concerns and so on. Researchers were amazed that despite such chaos and upheaval within their childhood, children from such backgrounds had grown up to live healthy adult lives (Turner, 2014). This led psychologists to ask themselves the question, ‘What is the human trait or characteristic that enables people to thrive in the aftermath of tragedy or adversity?’ The answer to this question eventually led to the term resilience.
While hardship is not usually sought or welcomed, there are things we can learn from it that we would not otherwise know. Hitting ‘rock bottom’ has the potential to be transformative, and enable connection with the life force of resilience that transcends or rises above stressful — and even traumatic — circumstances (Bennis, 2007).
Can resilience be learned?
Although the complexity of change offers us many learning moments, it also has the potential to stir up feelings of apprehension as people can often be uncomfortable with change. Uncertainty is a part of life; however, people differ in their response to change and stressful circumstances. When times get tough, some people manage to carry on, whereas others can become overwhelmed and filled with anxiety and self-doubt.
Some individuals thrive in challenging situations. They focus on their strengths, enabling them to adapt to change in a healthy way that broadens their perspective and enhances their contribution. Power (2014) suggested that such individuals model a capacity to engage with the difficult aspects of life rather than withdrawing when things do not go as planned, focusing their energy on opportunities rather than on the constraints they face. Waltner-Towes et al (2003) conceived resilience as a buffering process — one that may not eliminate risks or adverse conditions, but does help individuals to deal with them effectively.
So what makes some individuals able to do this? Is resilience an inborn trait, or is it one that can be developed? Though there may be some genetic components to resilience, experts agree that for the most part, it is a learned trait, and that no matter where you are on the continuum right now, you can strengthen your resilience (Power, 2014).
Strengthening resilience
Put simply, there is no quick fix — strengthening resilience takes time, and the focus and practice of developing key attitudes and attributes has been the subject of research for many years.
What makes a resilient individual?
Some qualities that characterise resilience include:
‘There is nothing good or bad, but thinking makes it so!
Optimist vs. pessimist interpretation
According to Power (2014), the thinking that ‘makes it so’ is our explanatory style — the habitual ways we interpret what happens to us. Seligman (1998) suggested that the difference between people who give up in the face of adversity and those who persevere, is often rooted in the way they habitually explain to themselves the events that they experience. Seligman (1998) defined one's explanatory style as one of optimism or pessimism — put simply, a way of viewing the world where you either maximise your strengths and accomplishments or you focus on your weaknesses and setbacks. Every person who experiences a setback or failure is stopped in their tracks, at least briefly. Power (2014) suggested that optimists recover faster; they are better able to keep things in perspective and act again sooner because of the way they process and explain the failure to themselves.
Individuals with a pessimistic mindset internalise a failure or setback. They view it as ongoing and likely to occur again; they also perceive it to be typical of their lives, and their own fault, following a tendency to blame themselves when something goes wrong. A pessimistic mindset puts people at risk for depression, anxiety and low self-esteem (Power, 2014).
In contrast, optimists confronted with the same challenges weather the setbacks better. Such individuals process and explain a personal setback to themselves from a more encouraging viewpoint, and look for what went wrong with the situation, avoiding placing the blame with themselves. An optimistic mindset enables individuals to not only learn from their setbacks and move forward, but also to contribute to improved health and success — both personally and professionally.
Power (2014) has suggested that building capacity for optimistic thinking makes good sense as it allows people to become proactive and productive in the face of setbacks or failure, remaining calm and objective, and to make better decisions — this is the essence of resilience.
From a pessimist to an optimist
In order to change one's behaviour, one must first change their way of thinking about an event. One of the most effective strategies for adapting to untoward events is the ability to reframe the event in a more manageable and less threatening way (Hatler and Sturgeon, 2013).
ABCD model
The ABCD model devised by Ellis (1991) and revised by Seligman (2011) enables individuals to recognise their beliefs about the causes of negative events and their emotional connections. Ellis (1991) suggested that changing our interpretation of an event, asking ourselves better questions, and disputing our automatic beliefs enables us to take more positive action. ABCD stands for:
The aim of the ABCD model is to enable individuals to ‘listen’ to their inner dialogue and the constant stream of thoughts they experience when they encounter a stressful or difficult situation. Identifying thinking that can derail resilience, constrict one's problem-solving abilities or compromise relationships is essential to the disputing strategy. Power (2014) suggested that changing the negative things we say to ourselves when we experience setbacks is a central skill of resilience. This further supports that it is not what happens to us that determines our ability to absorb disruptive experiences and stay on purpose when the going gets tough — rather, it is what we say to ourselves, how we interpret the event and the extent to which we believe it is possible to influence these events.
As an exercise, during a future adverse event you face in your personal or professional life, listen closely for your inner dialogue, observe the consequences and dispute any self-limiting statements you identify. Try the activity in Box 1 as a starting point.
While we may not be able to control what happens to us, how we react to events is within our control. What we focus on expands — the way we think about a situation can actually diminish or enlarge the sense of personal control we have over it.
Resilience: the cure for all stress?
It must be made clear that resilient people still experience monumental setbacks; resilience does not mean ignoring feelings of disappointment, sadness or loss, or that a person becomes immune to emotional scars from trauma. Resilience also does not mean being strong enough to do everything alone; in fact, being able to ask for support is a key component of resilience (Power, 2014).
Viktor Frankl, an Austrian neurologist and psychiatrist, who was imprisoned in concentration camps during World War II, suggested that we cannot avoid suffering, but we can choose how to cope with it, find meaning in it, and move forward with renewed purpose (Frankl, 1984). This further suggests that choosing to believe life is meaningful is a commitment, particularly when events look bleak. When all familiar goals are snatched away, what remains is the ability to choose one's attitude in a given set of circumstances.
A need for resilience in veterinary nursing
Lloyd and Campion (2017) examined occupational stress in the veterinary nursing profession and identified that available evidence, although limited, did suggest there were veterinary nurses in the profession who regard their role as stressful. The authors noted that while occupational stress is not a unique concept relating to human or animal health care, unique occupational stressors, such as euthanasia, do exist within the UK veterinary profession.
Despite the challenges of the role, however, many veterinary nurses continue to deliver high-quality care and have fulfilling careers. Anecdotal evidence would suggest though that this is not the case for all veterinary nurses. The development of resilience and the promotion of staff wellbeing can be enabled by several factors at an individual and organisational level.
Organisational culture
Organisational culture has an impact on caregiver wellbeing (Goetzel et al, 2004). High job demands are associated with exhaustion and can have a cumulative effect on one's outlook and ability to respond to change and untoward events (Sherman, 2004; Maben et al, 2012). Examples of such demands include caring for patients and families experiencing progressive illness, death and bereavement, and offering comfort and support through challenging times of uncertainty, loss, anxiety and pain.
Employee wellbeing has been highlighted as a key priority in the NHS with a number of reports outlining the need for NHS organisations to become more efficient at managing the wellbeing and resilience of their employees (Boorman, 2009; Black, 2012). Links between staff wellbeing and productivity have been recognised and Boorman (2009) suggested that staff wellbeing on a psychological, physical and social level has a direct impact on engagement in the workplace. This further suggests that interventions aimed at improving staff wellbeing and resilience should be developed and undertaken to improve employee satisfaction, as well as to enable greater organisational outcomes such as increased productivity, patient satisfaction and low rates of absenteeism. It seems prudent to suggest that such interventions are extrapolated to the field of veterinary nursing to help increase resilience — but how?
Examining the role of nurse leaders and managers
Jackson and Daly (2011) suggested that recognising and responding to emotions associated with adversity is an important step in building resilience. Such recognition starts with oneself, then moves to recognition of emotional reactions among staff members. Being mindful of the relationship between feelings, thoughts, and behaviours enables the resilient nurse leader/manager to anticipate responses from staff and consider contingencies for dealing with concerns.
Senior nurse leaders and managers may help staff to build resilience at a personal and group level by developing the ability to explain events and required change in ways that are compatible with the values of the staff. While leaders and managers cannot directly alter ways of thinking, they can certainly offer alternatives; for example, asking questions such as ‘If __ happens, what would we do differently than we are doing now? How would that look or feel?’ Such questions enable staff to move toward creating a plan for change, instead of remaining stuck in discontent and dissatisfaction (Hatler and Sturgeon, 2013). This is in congruence with Sergeant and Laws-Chapman (2012) who suggested that viewing stressful events as inevitable (rather than shocking), and planning ways to maintain focus and composure, can support resilience in the workplace.
Debrief and support in the workplace
Lloyd and Campion (2017) offered that debriefing in the workplace can be an important component of stress reduction, but that it is often neglected within the veterinary profession. Debriefing after a stressful situation such as euthanasia enables appraisal of the event which in turn will more likely promote an adaptive rather than a maladaptive style of coping (Fletcher and Sarkar, 2013).
Finally, organisations can also develop systems at work that encourage resilience: good regular interactions between team members are important as they enable members to know when colleagues are experiencing difficulty within or outside the workplace, thus enabling additional support if required. Teams can make rules about simple caring actions for their colleagues. Actions may be as basic as providing a listening ear or ensuring someone gets a rest break, or more complex, such as suggesting a colleague take a step back from an emotional case or seek external help from a counsellor or other health professional.
Conclusion
Modern veterinary practice creates high-stress scenarios as people drive themselves to meet external demands and objectives; retaining a healthy, resilient workforce is therefore essential. This requires nurse leaders and managers to develop expertise in building resilience among staff members. Such skill development is not achieved overnight, but by applying approaches over time (such as those outlined within this article). This can enhance staff members' ability to move beyond surviving and towards actually thriving despite challenging times.
More research on how to improve resilience in the veterinary nursing profession is needed. A good starting place would be to interview veterinary nurses who have remained in practice for several years to gather information on their personal journeys and how resilience has played a factor in career longevity. This may further increase awareness of occupational stress and promote more widespread inclusion of topics such as self-care and resilience-building into veterinary nursing training programmes.