Resilience constitutes a withstanding potential against illness, adaptation, and surviving, the ability to bounce back or recover from stress (Bruce et al., 2008). This could vary greatly with a magnitude of a disease manifestation. For example, cancer is a major health problem. It may promote psychological stress to the patient. In such circumstances, there is a need to show some degree of resilience which can be in turn induced by nursing interventions.
There is much significance for conducting investigations with regard to resilience in our area as there are currently more cancer patients who are in urgent need of psychological counseling. Their families are in great discomfort and hardly able to overcome the situation. It is reasonable to mention that this pathetic condition could be subsided by interventions where the concept of resilience is introduced. The present study elaborates this concept, keeping in view the existing literature.
The main aim of the purpose of the analysis is to identify reliable approaches to adolescent resilience interventions from the available databases and apply them in an evidence-based manner to the existing scenario where good numbers of individuals with cancer are in psychological distress. The other objectives of the study were to evaluate the psychometric properties and suitability of instruments for the study of resilience in adolescents.
Online search was made using the keywords resilience and instruments or scales using the MEDLINE, PsychINFO PsychARTICLES. CINAHL, PreCINAHL, and Academic Search Premier.
The search was repeated for the studies reporting the psychometric development of these instruments. We selected six psychometric development of instrument studies based on inclusion and exclusion criteria. We also used a data extraction table was to compare the six instruments.
The search process was in agreement with a previous study (Nancy et al., 2006). It was revealed that instruments such as Baruth Protective Factors Inventory [BPFI] and Brief-Resilient Coping Scale) were without any evidence and considered appropriate for adolescent population studies due to lack of research applications (Nancy et al., 2006).
The other instruments, such as Adolescent Resilience Scale [ARS], Connor–Davidson Resilience Scale, and Resilience Scale for Adults) had reasonable suitability for the study but required additional investigations. The best was the Resilience Scale [RS] instrument was the best due to its vast psychometric properties and applications in a variety of age groups, including adolescence. Here it may indicate that the RS is the most appropriate instrument to study resilience in the adolescent population (Nancy et al., 2006).
This may also indicate that evaluating the psychometric properties of an instrument is a laborious and complicated task. This has enabled us to gain a better understanding of important items to scale, standardize, and strengthen the validity of statistics. This could serve as a paradigm for the current and future measurement research with regard to psychometric development (Nancy et al., 2006).
There is a need to include a good number of documented studies of the psychometric development and evaluation of instruments and scales in addition to the uses, adaptations, and translations of measurement instruments. We have categorized the work plan based on the available methodologies reported elsewhere.
As Patients with cancer need to recover from stress, we have further extended our work. For this purpose, we used a new brief resilience scale according to the method mentioned in an earlier study (Marie Earvolino, 2007). Here our main aim was to predict the ability to bounce back or recover from stress.
We have examined its psychometric characteristics in four samples, including two student samples with cardiac and chronic pain patients. We found that the BRS was reliable and measured as a unitary construct.
It was reported to be positively related to personal characteristics, social relations, coping, and health in all samples (Marie Earvolino, 2007). It was negatively related to anxiety, depression, negative affect, and physical symptoms (Marie Earvolino, 2007). We observed significant stress-free changes in the patient’s behavior.
Therefore, it may indicate that BRS could serve as an indispensable tool to assess resilience as the ability to bounce back or recover from stress and may have the potential to provide unique and important information about people manage with health-related stressors. Here a great number of factors were considered such as good-natured, positive relationship, effective communication, sense of control over fate, efficient to play and love, sense of humor, problem-solving ability, decision-making ability, trust in others/hope for the future, beneficial critical thinking skills, management of emotions, desire to improve and high expectations. These factors were considered to be protective and potential to induce resilience (Marie Earvolino, 2007).
Next, the main aspect that should be given paramount importance is the factors that interact with each other in relation to the adolescent cancer experience (Roberta, 1999). This could be because adolescents with cancer would experience a spectrum of varied events. It is the sole perception of the patient to consider the stressors as emotional reactions. But this could vary greatly and, in turn, depends on the presence of vulnerability and protective factors that contribute to the degree of resilience in the adolescent to manage the stressors (Roberta, 1999).
Here responses of maladaptive and adaptive types could play a vital role in withstanding stressors. If the adolescent is more resilient, he or she will be able to move towards adaptation (Roberta, 1999). The adolescent ability to cope with a particular stress-inducing situation could provide a greater sense of self and increased social competence skills (Roberta, 1999). This enables the adolescent to become more successful in managing future stressful events. Here, enhanced self-esteem and social competence skills would serve as protective factors that might facilitate the adolescent’s ability to move toward adaptation (Roberta, 1999).
The important thing to be emphasized is that this model has all the components as interdependent and no need to act independently of each other. The interaction of components in several ways might determine the coping potential of adolescents with cancer-related and noncancer-related stressors (Roberta, 1999).
There is a further need to highlight the model that could be adopted for withstanding the stressors. It was reported that certain dangers should be made aware to the investigators and medical professionals despite the positive effects of this strategy (Roberta, 1999). Hence adopting a model was often considered as a limitation to understanding the experience of cancer in adolescents (Roberta, 1999). In this regard, there were several idealizations that imply that adolescents could beat cancer if they strive hard (Roberta, 1999).
However, practice might get affected by idealizations. According to this concept, adolescent patients who do not show resilience or fight back were considered as bad patients (Roberta, 1999). Patients not considered adolescents who show resilience or fighting back potential were regarded as good patients (Roberta, 1999).
A resilient adolescent is an individual who shows better-performing activities, is energetic, has future insights, responsibility, and caring, as well as has a positive self-concept (Roberta, 1999). The individuals selected in the presented study are very much in agreement with the earlier defined characteristics of an adolescent.
We found the individuals with changes conforming to an adolescent with high internalized values and are nurturing, socially perceptive, and socially mature.
In certain situations, multiple stressors might arise from illness and from normal developmental tasks in adolescents with cancer. Some of them could remain or become resilient even when faced with multiple challenges. In this particular instance, it is essential to know about the important contributing factor of adolescent cancer experience in caring for adolescents with cancer and childhood cancer survivors.
Further, there is a need to understand the psychosocial concerns and stressors associated with cancer. These are fear of treatments, treatment-related side effects, life being controlled by illness, changes in physical appearance, being treated differently, concerns with school and career, and existential issues (Roberta, 1999).
In a study, adolescent cancer patients were reported to appraise more events as stressful compared with younger and middle children. In addition, they were more concerned by limitations on age-appropriate activities than other children (Roberta, 1999). This could be due to the fact that a restrictive atmosphere enables children to feel fewer domains as stressful. In contrast, a more restrictive atmosphere habituated by younger children enables them to feel fewer domains as stressful (Roberta, 1999). An increase in independence during development may be another contributing factor for stress in adolescence.
There is a discrepancy in considering the stressors in the episode of cancer. In one instance, cancer may be regarded as one stressful event. Sometimes events related to the cancer experience were rarely examined as separate cancer stressors (Roberta, 1999).
These are diversity in symptomatology, prognosis, prescribed treatment, pain, hospitalizations, the incidence of relapse, and related events that make each individual’s experience unique (Roberta, 1999). It was revealed that treatment-related pain was identified as one of the worse things about having cancer by adolescents. Very often, a lack of recognition of the interaction between nonrelated cancer stressors and cancer stressors would turn out to be a drawback with examining cancer stressors (Roberta, 1999).
In order to overcome this situation, there is a need to use multifaceted approaches to assess stress and competence, the inclusion of developmental and sociodemographic factors in research methodologies (Roberta, 1999). This could be having future implications for theoretical and practical applications with regard to future intervention programs and social initiatives.
In view of the above literature support, the present study has the strong scientific background to assess the ability to bounce back in an individual with major health hazards like cancer.
Resilience for these individuals should become a mandatory intervention in an evidence-based manner. Healthcare professionals, including nurses, should review the existing literature for up-to-date information on the concept of resilience with regard to its applicability.
There is a need to understand the important contributing factors while validating the hypotheses or theoretical perspectives of the resilience concept. On the whole, this study has provided useful insights on resilience by taking cancer patients as a model and generating good research interest.
References
- Nancy, R., Ahren, Ermalyn, M., Mary Lou Sole, Jacqueline Byers. (2006).A review of instruments measuring Resilience. Issues in Comprehensive Pediatric Nursing, 29, 103–125.
- BruceW. Smith, Jeanne Dalen, Kathryn Wiggins, Erin Tooley, Paulette Christopher, and Jennifer Bernard.(2008). The Brief Resilience Scale: Assessing the Ability to Bounce Back. International Journal of Behavioral Medicine, 15, 194–200.
- Marie Earvolino –Ramirez. (2007).Resilience: A concept Analysis. Nursing Forum, 42, 73 -82.
- Roberta L Woodgate. (1999).Conceptual Understanding of Resilience in the Adolescent With Cancer: Part I. Journal of pediatric oncology, 16, 35-43.
- Roberta L Woodgate. (1999).Conceptual Understanding of Resilience in the Adolescent With Cancer: Part II. Journal of pediatric oncology, 16, 78-79.