Exploring nurse perceptions and experiences of resilience: a meta-synthesis study

Exploring nurse perceptions and experiences of resilience: a meta-synthesis study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring nurse perceptions and experiences of resilience: a meta-synthesis study Eun Young Kim, Sung Ok Chang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-929372/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Jan, 2022 Read the published version in BMC Nursing → Version 1 posted 8 You are reading this latest preprint version Abstract Aim To understand nurse resilience in depth by integrating the qualitative research results on nurses' resilience-related experiences. Methods : We applied the seven steps of the meta-ethnographic process by Noblit and Hare (1988). Six databases (PubMed, CINAHL, EMBASE, Web of Science, Cochrane, and Google Scholar) were used to search for studies published from January 2011 to August 2021. Results Sixteen qualitative studies were included. The four themes of “self-development though focusing on one’s inner self”, “building a positive strength for life”, “developing one’s own strategy for overcoming diversity” and “forward thinking to become a better nurse by planning for the future” illustrate that they want to promote their inner strength and develop themselves through self-examination. Conclusion : Through this study, we can understand more deeply about the resilience of nurses, and the results can provide basic data for the development of intervention study to improve the resilience of nurses. Nursing Resilience Nurses Perception Experiences Qualitative Review Figures Figure 1 Introduction Nurses are the largest occupational group in the medical health field. They account for approximately 59% of the total global medical health workforce [ 1 ], and play a very important role in patient care. Globally, in recent years the nursing profession has been a rapidly growing sector of the workforce [ 2 ]. However, nurses suffer stress and burnout related to their job, and this has a very negative effect on their mental health [ 3 ]. Problems that negatively affect nurses' mental health have serious effects such as reducing nursing professionalism, lowering the quality of care, and increased social financial loss [ 4 ]. As nurses' job satisfaction has been declining over recent years, nurses have been found to increasingly be highly likely to have negative perceptions about their job [ 2 ]. Nurse job satisfaction is related to the turnover rate, which affects the quality of patient nursing care. As concern over nurse job satisfaction and burnout is increasing worldwide [ 5 ], timely studies of concepts that can ameliorate the negative job perceptions caused by the negative experiences of nurses are required. Resilience is a positive concept that allows nurses to overcome stressful situations [ 6 ] and to adapt positively, resulting in psychological well-being and the maintenance of mental health [ 7 , 8 ]. In a recent previous study, nurse resilience was found to significantly reduced nurse burnout [ 9 , 10 ]. Resilience is emerging as an important concept for reducing the psychological burden of nurses and increasing their physical and mental health, since resilience has been shown to have a mediating effect on the relationship between burn out and physical/mental health [ 11 ]. Background Most people have life-threatening experiences or are exposed to one or more stressors in their lifetime [ 12 ]. Therefore, it is very important to improve and adapt mental health to recover from the adversities one faces and to adapt positively. Since nurses in particular are exposed to wide-ranging stresses, the positive ability to overcome such adversities can play a very important role for them. The concept of resilience originated in psychology [ 13 , 14 ] and can be described as an individual's characteristics, processes, and outcomes [ 15 ]. Research into nursing resilience has been steadily improving, and over the last 10 years the importance of the concept of resilience has become emphasized as the related research has rapidly increased. In particular, resilience has been proposed as a solution to burn out [ 9 , 10 , 16 ] and mental health issues [ 17 , 18 ], which nurses frequently suffer from, and related research has been actively conducted. Nurse resilience is a complex and dynamic process that changes over time and according to the situation, embodying not only personal attributes but also external resources, and describes a nurse's ability to adapt positively to stress and adversity [ 19 ]. Academic interest in nurse resilience has been increasing recently, and many qualitative studies are being conducted to explore the essence of nurse resilience. However, there has been a practical limit to understanding the concept of nurse resilience through previous studies due to the diversity of the qualitative studies and the differences in their findings on the essence of nurse resilience. Qualitative meta-synthesis is a methodology for synthesizing and analyzing individual qualitative research [ 20 ]. This methodology is recognized as a useful tool for analyzing the meaning, experience, and perspective of participants' expressions [ 20 ]. It is a methodology for accumulating knowledge and deriving expanded knowledge and new interpretations from the results of the areas of research and phenomena suggested by existing studies [ 21 ]. It is also a research methodology that enables more specific suggestions for future studies [ 20 ]. Noblit and Hare developed another meta-synthesis method, meta-ethnography in 1988 [ 22 ]. This method has the potential to lower study duplication, create new research questions, and promote higher-level analyses [ 23 ]. In this study, the results of qualitative studies on nurse resilience are integrated, a new interpretation is attempted and aspects of resilience phenomena are comprehensively elucidated. This study will help provide basic information for the research and development of interventions to improve nurse resilience. The purpose of this study was to systematically review and synthesize the qualitative evidence on nurse resilience experience. Aim The aim of this study is to understand nurse resilience in depth and to suggest directions for future research through the process of synthesizing and integrating qualitative research results on nurses' resilience-related experiences. Design We used a meta-synthesis methodology, which provides broad understandings of social phenomena, to integrate the findings of qualitative studies [ 24 ]. We followed the meta-ethnography method which is suitable for both preserving the interpretations of the primary data and forming new interpretations, theories and models [ 25 ]. We applied the seven steps of the meta-ethnographic process by Noblit and Hare [ 22 ] : (a) getting started, (b) deciding what is relevant to the initial interest, (c) reading the studies, (d) determining how the studies are related, (e) translating the studies into one another, (f) synthesizing those translations, and (g) expressing the synthesis. The research question was “How do nurses overcome adversities?”, “What are the characteristics of nurses’ experiences of resilience?” This review was prepared in accordance with ENTREQ (Enhancing transparency in reporting the synthesis of qualitative research Statement) guidelines [ 26 ]. This meta-synthesis study was registered (CRD42021271541) with PROPERO, which is the International Register of Systematic Reviews. Search methods We used the traditional literature review method. As this method is mainly used for searching literature representing the entirety of the phenomenon of interest, it is suitable for meta-synthesis studies [ 23 ]. Literature searches were carried out using six databases (PubMed, CINAHL, EMBASE, Web of Science, Cochrane, and Google Scholar). The search terms used in the search were "Nurses", "Resilience, Psychological", "Qualitative Research", "Hermeneutics" from the Mesh Terms. The search terms were used with the Boolean operators “AND” and “OR” in different combinations. A flow chart of the systematic review of literature selection process of the present research is presented in Fig. 1. The inclusion criteria required qualitative studies that were: (a) aimed at exploring the resilience of nurses, (b) published from January 2010 to September 2021 (c) peer-reviewed journals (d) published in English, and (e) full-text searchable. The exclusion criteria were (1) nurses' experiences were not reported separately, (2) mixed methods were used but qualitative data could not be extracted or (3) necessary qualitative depth was lacking in the data analysis. Through the search procedure, 1361 studies were identified. 564 studies were excluded as duplicates, and 699 studies were excluded because they were regarded as not being related to the topic after reading their title and abstracts. 82 studies were excluded after reviewing their full-texts because of a lack of focus on nurses’ perspectives, an inappropriate topic, insufficient qualitative criteria, the full text couldn’t be found, or the study was over 10 years old. After this process, 16 studies remained for inclusion (Fig. 1). Quality appraisal The Critical Appraisal Skills Programme (CASP) checklist, which contains 10 questions for assessing the reliability and rigor of individual studies, was used to appraise the 16 studies [ 27 ]. Two authors independently evaluated the 16 included studies using the CASP checklist. After the appraisal, the two authors compared the CASP results, and any disagreements were resolved through discussion. The degree to which the studies met CASP was evaluated to be 70% for 4 studies, 80% for 9 studies, and 90% for 3 studies. Since all the studies were evaluated as being 70% or higher, none were excluded from the evaluation process (Table 1 ). Table 1 Summary of the included studies Article. No. Author, year/Country Research type Aims Sample size (F:M) Age of participants (in years) Nursing experience (years) Working department Data collection Data analysis Percentage that meets CASP A1 Mealer et al., 2012/USA Qualitative study To identify mechanisms employed by highly resilient ICU nurses to develop preventative therapies to obviate the development of PTSD in ICU nurses 27, (27:0) mean : 46 Total: mean18.5 Intensive Care Unit Semi-structured telephone interviews Thematic analysis 80% A2 Shimoinaba et al., 2015/Japan Qualitative study To explore the nature of nurses’ resilience and the way it is developed 18, (18:0) 29–53 mean : 37.8 Total :7–26 In this department : 2–8, mean37.8 Palliative Care Unit Face to face in-depth interviews Grounded theory 80% A3 Cope et al., 2016/Australia Qualitative portraiture methodology To explore residential aged care nurses working in interim, rehabilitation and residential aged care perceptions of resilience 3,(not reported), 32–57 Total :mean28 An aged care environment Semi-structured interviews painting with words Thematic analysis 70% A4 Cope et al., 2016(2) /Australia Qualitative portraiture methodology To explore why nurses chose to remain in the Western Australian workforce; to develop insights into the role of resilience of nurses to manage the context of nursing work; and, to identify the key characteristics of resilience displayed by those nurses 9,(not reported) Not reported Not reported Interim and residential aged care, academic setting, tertiary acute care setting Individual interviews, field notes, memos and gesture drawings interviews Phenomenology 70% A5 Tubbert, 2016/USA Qualitative study To explore the resiliency characteristics of certified emergency nurses 16 (68.8%:31.2%) Mean :50 Total :30 In this department : 20 Emergency department Face to face interview Content analysis 80% A6 Benade et al., 2017/South Africa Explorative descriptive qualitative research To explore and describe the strengths and coping abilities of nurses caring for older persons and to formulate recommendations to strengthen their resilience 43 (43:0) Not reported Total : not reported In this department : <6month :2 1year < 5years : 5 5years 10years: 27 Aged care department in an urban environment Focus group interview Content analysis 70% A7 Marie et al., 2017/UK Interpretive qualitative design To observe and describe the environment within community mental health workplaces, to explore the challenges facing Palestinian community mental health nurses (CMHNs) inside and outside their workplaces, and to examine their sources of resilience 15 (8:7) 24–60 Not reported Mental health workplace Face-to-face in depth interviews Thematic analysis 80% A8 Prosser et al., 2017/Canada Interpretative phenomenological method To understand how registered nurses in the acute psychiatric setting develop resilience to sustain his or her practice. 4(not reported) Not reported Total : 2–21 In this department : 2–16 Acute psychiatric units Semi-structured face-to- face interview Interpretative phenomenological analysis. 90% A9 Wahab et al., 2017/Singapore descriptive qualitative design using Photovoice To explore the new graduate nurses’ accounts of resilience and the facilitating and impeding factors in building their resilience 9(6:3) Mean : 24 Total: mean 1 In this department : not reported Oncology, General Medicine, General Surgery, Psychiatry and Paediatric wards Focus group interview, photographs Content analysis 80% A10 Imani et al., 2018/Iran Phenomenology study To explore Iranian hospital nurses’ lived experiences of intelligent resilience 10 (4:6) 34–52 Total : 11–28 In this department : not reported Different types of wards In-depth interview The Colaizzi’s (1978) seven-step approach 70% A11 Jackson et al., 2018/UK Grounded theory To better understand nurse burnout and resilience in response to workplace adversity in critical care 11(11:0), 20s:5, 30s:3, 40s:1, 50s:2 Total :4–36 In this department : not reported Intensive care unit Open-ended interviews Grounded theory 90% A12 Ramalisa et al., 2018/ South Africa Empirical qualitative research To explore and describe how to strengthen the resilience of nurses in a work environment with involuntary mental health care users. 24(not reported) Not reported Total :2–8 In this department : not reported Psychiatric ward Open-ended interview Thematic analysis 80% A13 Ang et al, 2019/Singapore Qualitative grounded theory design To generate a comprehensive account of the experiences of nurses as they cope with stress and demands of work, and to develop knowledge of the phenomenon of resilience among nurses. 15(15:3), 24–68 mean:38 Not reported General hospital Individual interviews Glaserian constant comparison method 80% A14 Ang et al., 2019(2)/ Singapore Photovoice study To explore the meaning of resilience to nurses and their perceived resilience enhancing factors 8(7:1) 27–68 Not reported Accident and emergency department Focus group interview, photo Content analysis 80% A15 Lin et al, 2019/Taiwan Construction-grounded theory To explore and understand the experiences of resilience among nurses in an overcrowded emergency department (ED) 13(13:0) 23–39 Total : not reported In this department : 2–17 Emergency department In-depth interview Construction-grounded theory 90% A16 Udod et al, 2021/Canada Qualitative study To investigate the role stressors, and how coping strategies cultivated nurse managers’ resilience in rural workplaces. 16(15:1) 30s : 5 40s:9 Over 60:2 Total : mean4.6, 10–35 In this department : mean 7.28, 1–17 Rural site in western Canada Individual semi-structured interview Thematic analysis 80% F:female; M:male; CASP: Critical Appraisal Skills Programme checklist Data extraction Two authors independently reviewed the studies in detail. They each read the studies line by line and tried to derive meaningful concepts by extracting codes. Data extraction for the study was performed using a custom form in Microsoft Excel, including author details, participant characteristics, methods, and original citations [ 25 ]. Disagreements between the authors were solved through discussion. Data synthesis Based on the meta-ethnography process [ 22 ], the 16 studies were independently read repeatedly by the two authors, data analysis was performed, and then the extracted data were summarized as concepts. In more detail, after organizing the papers in chronological order, the two authors independently read the 16 studies, repeatedly. They then summarized and extracted meaningful concepts and themes. The two authors compared the themes and concepts of the first paper with those of the second paper, and then compared the common themes of those two papers with the third paper to derive concepts and themes. This process was repeated until the last study to synthesize the key concepts and broader themes. To extract the key concepts, the studies were read several times, and the key concepts of each study were listed and analyzed for comparison. The key concepts were formed based on the ‘first-order construct’ of the study. In the meta-ethnography analysis process, the data is divided into ‘first-order construct’, ‘second-order construct’, and ‘third-order construct’ [ 28 ]. The 'first-order construct' is the original study participant's daily language as expressed in their own language in the original study, the 'second-order construct’ is the current researcher’s interpretation based on the ‘first-order construct’, and ‘third-order construct’ is a new interpretation of ‘second-order construct’ [ 28 , 29 ]. In this study the authors of the current paper extracted the key concepts of the ‘first-order construct’, then compared the similarities and differences to form the ‘second-order construct’, and finally derived the ‘third-order construct’ representing the main themes of the study by abstracting the 'second-order construct'. During this process of analysis and synthesis, the two authors continued to discuss their differences of opinion based on their respective academic and clinical backgrounds. The final analysis step, "expressing the synthesis," was accomplished by collating the discussion results. The quotes that best expressed each sub-theme were identified and are presented in the results. Ethical consideration As this study is a review study, as a meta-synthesis, human participants were not included. Therefore, an ethical committee review was not required. Results 16 qualitative studies were included in this review study and the publication years were from 2012 to 2021. A total of 241 nurses participated in the included reviewed studies. Their ages varied widely, from those in their 20s to those in their 60s, and they were generally of female gender. Their working departments were varied, and included the ICU, the geriatric ward, the emergency room, the psychiatric ward, and the general ward (Table 1 ). This study yielded four comprehensive themes of nurse resilience experience. Those are ‘self-development by focusing on one’s inner true self’, ‘building a positive strength for life’, ‘developing one’s own strategy for overcoming adversity’, ‘forward thinking to become a better nurse by planning for the future’. Table 2 shows the key concepts from first-order construct, the second order constructs, and the synthesized themes. Table 2 Synthesized themes of nurses’ resilience experience Key concepts from first-order constructs Sub-themes (Second order constructs) Synthesized themes (Third order constructs) Self-reflection A2, A3, A4, A5, A8, A11, A13, A14, A16 Focusing on the present A2, A5, A8, A9, A11, A12, A13, A14 Accept the situation not avoiding A8, A9, A11, A12, A13, A14 Believe in one’s ability A2, A5, A6, A9, A10, A12, A13, A14 Expressing their feelings honestly A2, A6, A10, A11, A13 Recognizing the warning signs of stress A5, A9, A11, A13 Pay attention to physical and emotional demands A5, A6, A8, A10, A11, A16 1. Recognizing and acknowledging the signs of adversity I. Self-development by focusing on one's inner self Trying to maintain physical health A3, A4, A11 Perceiving self-efficacy A5, A6, A9, A11, A13, A14, A15 Developing various ways of self-care A2, A3, A4, A9, A11, A13, A14, A15 Having self-confidence A5, A6, A9, A11, A13, A14, A15 Trying to control emotions A2, A5, A6, A9, A11, A13, A14, A15 Learning from others' experience and expertise A2, A3, A4, A6, A7, A9, A10, A16 The taking on new challenge A2, A3, A4, A5, A9, A11, A13 Flexible thinking to solve an issue A2, A5, A9, A11, A12, A13, A14 Preserving and moving forward A5, A9, A11, A13, A14 2. Striving to grow themselves Keeping optimistic attitude in life A1, A3, A4, A5, A6, A7, A9, A14, A15 Maintaining a sense of humor at work A3, A4, A6, A11 Gratitude for life A3, A4, A6, A7, A12 Living a life of helping others A2, A3, A4, A6,, A15 Remembering good experiences from the past A1, A2, A6, A15 Finding joy and pride in what they do A1, A5, A6, A11, A15 3. Accepting life as positive Ⅱ. Building positive strength for life Living a regular and healthy life A1, A2, A5, A11 Enjoying a variety of leisure activities A1, A2, A5, A11 Creating their own hobbies A1, A2, A5 Developing their own personal coping behaviors A1, A2, A5, A11 4. Enjoying their life given to them Avoiding stress A1, A9, A10, A11 Keeping work-life balance A5, A6, A8, A10, A11, A12 Keep distance life from work (Setting boundaries between home and work) A5, A6, A8, A11, A12 5. Staying away from stress Ⅲ. Developing their own adversity overcoming strategy Comfort from friendships A1, A3, A4, A5, A7, A10, A11, A12, A14, A15, A16 Getting help from family relationships A1, A3, A4, A5, A7, A11, A12, A14, A15, A16 Maintaining good relationship with colleagues A1, A2, A3, A4, A5, A7, A10, A11, A12, A14, A15, A16 Positive role model A1, A2, A6, A11, A12, A15 Sharing their feelings with someone whom they trust A1, A2, A5, A6, A11, A12, A13, A14, A15, A16 Get help from experts A6, A9, A12 6. Forming one's own defenses through interactions with human relationships Developing self for the future A2, A3, A4, A6, A7, A9, A14, A16 Preparing for new assignments A2, A3, A4, A6, A7, A9, A14, A16 Adaptation to a new situation A2, A7, A9, A14, A16 Prioritizing work A5, A8, A13, A14, A15, A16 7. Planning their life for a better future Ⅳ. Forward thinking to become a better nurse by planning for the future Sense of professional pride A2, A3, A4, A6, A9, A10, A11, A12, A13, A15, A16 Value of being a nurse A2, A3, A4, A6, A9, A11, A12, A13, A15, A16 Satisfaction with career A2, A3, A4, A6, A9, A11, A13, A14, A15, A16 Passion to work A2, A3, A4, A6, A9, A10, A11, A12, A13, A15, A16 Developing their knowledge and skills A2, A3, A4, A6, A9, A12, A13, A15 8. Building self-esteem by thinking about the value of a job Theme Ⅰ. Self-development by focusing on one’s inner self The sub-themes included in theme 1 were "recognizing and acknowledging signs of adversity" and "striving to grow oneself". The nurses tried to find a solution by focusing on the signals of the adversity they encountered, and made an effort to grow through the adversity rather than collapse under it. Sub-theme 1. Recognizing and acknowledging the signs of adversity The nurses did not deny the signs of adversity, but recognized and acknowledged them. The nurses looked inside themselves to find problems and tried to reflect on themselves. They tried to focus on the current situation, and showed an attitude of acceptance to the situation they were in rather than one of avoidance. They believed in their abilities, tried to express their feelings honestly, and tried to recognize the warning signs of stress rather than ignore them. They showed themselves to focus on the state and demands of their bodies and emotions. “It is difficult....I feel it is a most difficult thing to reflect on my own feelings. I can understand other people, but I do not understand myself. I think I have experienced a kind of burnout.” (A2) “I thought of ways when something happens so that one can go away, sit down and reflect and then maybe come up with whatever your own strategies are to come back stronger. So if the same thing comes at you again, you know where to run, which direction is faster” (A11) Sub-theme 2. Striving to grow themselves Rather than despair, the nurses wanted to grow on their own. They tried to maintain their physical health and recognized a sense of self-efficacy. In addition, they thought about and developed various ways to take care of themselves. They were confident that they could overcome adversity and tried to control their emotions. Nurses tried not to ignore what others had to say and to learn from their experiences and expertise. They tried new challenges and had various thoughts to solve problems. The nurses showed patience and a willingness to move forward. “You know more or less that you have to do it and it is going to be tough going. The task could be from manageable to unmanageable depending on what is happening at the moment. I'm able to cope with stress.” (A13) Theme Ⅱ. Building a positive strength for life In theme 2, the sub-themes included “accepting life as positive” and “enjoying the life given to them”. In this theme, the positive power of nurses is evident. The nurses showed that they were trying to overcome adversity with positivity. A positive attitude toward life and the desire to live the life that was given to them and enjoy life became positive strengths for the nurses. Sub-theme 3. Accepting life as positive The nurses maintained a positive attitude toward life when overcoming life adversities and maintained a sense of humor at work. They were grateful for life and tried to heal themselves by living a life of helping others. They remembered the good memories they had in the past, and drew positive thoughts from them. They found enjoyment and pride in what they do. “But I try to look at the positive stuff. .. what we are able to do, what changes we were able to make as a result of a catastrophe or just a bad outcome. .. just pull my sleeves up and get in there and get it done and when I can, I do try to encourage communication and good feelings.” (A5) “‘‘I think every type of nurse has their own type of black humor but I realized a lot of it is a coping mechanism and a way of protection to get yourself through the day” (A11) Sub-theme 4. Enjoying their life given to them Nurses tried to overcome the adversities they faced while enjoying life on their own terms. They tried to live a regular and healthy life, enjoy various leisure activities, and enrich their lives happily while creating their own hobbies. They coped with the situation by developing their own coping behaviors for crisis situations. “You have to enjoy what you are doing. If you hate your work, it will be a constant stress. I feel that I don't get stressed about it because I feel that no problem is difficult.” (A13) “The joy of working is like a hurdle…like jumping over the hurdle. Each time I jump over a hurdle that I cross, there is always some satisfaction in the job.” (A13) Theme Ⅲ. Developing their own strategy for overcoming adversity The sub-themes “staying away from stress” and “forming one’s own defenses through interactions provided by human relationships” were included in theme 3. Nurses were shown to develop their own strategies when overcoming adversities. They tried to stay away from situations that were stressful to them and formed their own defenses through positive interactions provided by wide-ranging human relationships. These methods of overcoming adversities were their own strategies learned through their own experiences. Sub-theme 5. Staying away from stress Nurses had to face varied sources of stress, but tried to avoid them, such as by trying not to create stressful situations or not focusing on the stress. They tried to maintain a work-life balance so that neither of them became too large or too small, and the work-life balance did not become broken. In addition, by thoroughly separating their work and life, they tried to protect their life thoroughly, avoiding the intrusion of work into their life, and they tried to respect their own privacy. “Sometimes, I can’t control myself. In such situations, I attempt to distance myself from that situation or the immediate environment. In these conditions, I ask my colleagues to continue care delivery and then, I leave the situation. I never stay in such a situation because I know that my presence will aggravate the problem. Thus, I leave that situation and start providing care to another patient.” (A10) “ I think that the only way for me to stay resilient is to keep stepping away from the bedside, because that’s where all the stress is for me, it’s at the bedside. You need to remove yourself from the situation ” “ I have to have this proper balance and this little routine to maintain a healthy, functional life, and I think the younger ones know that which is good.” (A11) Sub-theme 6. Forming one’s own defenses through interactions provided by human relationships In their professional positions the nurses developed a variety of interpersonal relationships, including relationships with patients, colleagues, and families. Nurses received comfort from their relationships with friends and comfort and support from their families. The nurses tried to maintain good relationships with their colleagues and other nurses and as colleagues they helped each other in difficult situations. They were also comforted by the developing friendships with their colleagues. In addition, they tried to grow one step at a time by orientating their own future direction through role models and mentors they could imitate. They also received help from a mental health professionals for stress management. “It’s the people you work with. I have a lot of caring friends. I talk to my husband - he always backs me up. I think that how you deal with it.. . with another manager’s support. We meet for lunch sometimes — a laughs the best way — we quite often see the funny side.” (A4) “Talking to colleagues because they know the scope of your job. They know what is happening in your ward, so they will be able to understand better.”, “I have good friends to whom I can confide my problems. I think it's important you don't bottle up your feelings too much, because you know you can just self-destruct if you're not able to handle it. They may not be able to solve the problem; a listening ear does help.” (A13) “I’m very fortunate as I have a large network of friends and colleagues that I can safely vent to or discuss things with or bounce ideas off that aren't my staff. And I found that you really need that. It is pretty much a lifeline whether you're a front-line manager or if you're a director you need to have that core group of people that you can call and say, ‘Am I crazy’” (A11) Theme Ⅳ. Forward thinking to become a better nurse by planning for the future. In theme 4, the sub-themes “planning their life for a better future” and “building self-esteem by thinking about the value of a job” were included. The nurses planned their future to live a better life than just leaving their lives to adversity. They felt that they had to develop themselves for a better future, prepare for a new life, and adapt to a new situation. They thought they had to rearrange their work by considering their priorities. Sub-theme 7. Planning their life for a better future In difficult situations, nurses thought about how to live their future. Even in difficult situations, the attitude of planning for the future and thinking about the future rather than staying in the present and despairing was exhibited by nurses. They wanted to develop themselves, to prepare for new assignments including difficult situations, and to adapt well to new situations. They re-prioritized their work and tried to work according to their priorities. “I always take an experience as an opportunity to learn from it. To grow. I mean, no experience is bad. It may be a bad experience but you can learn from it and try to move on and try to make things better” (A13) Sub-theme 8. Building self-esteem by thinking about the value of a job In difficult situations, nurses tried to gain the strength to overcome the crisis by reminding themselves of themselves as nurses and reflecting on the value of their job. They took pride in their job, thought about the meaning and value of being a nurse, and tried to overcome the crisis while gaining satisfaction from their worthwhile job. They had a passion for their work and wanted to develop their knowledge and skills as nurses and upgrade themselves to the next level through their own development. “We are the backbone when patients come in. The nurse is the protector of the patient […] the patient survived because the nurse stuck out her hand and stopped the bleeding. I am proud of her.” (A11) Discussion As nurses play a very important role in the medical field, they are exposed to wide-ranging difficulties because of the high intensity of their work. Research on the resilience of nurses, a positive force to overcome this, has recently attracted attention in both research and practice. This study synthesized the result of qualitative research on nurse resilience to explore nurses’ experiences of overcoming adversities. According to the result of this study, when nurses felt that they were going through a difficult situation, they tried to recognize and acknowledge that situation by exploring their inner selves. They focused on themselves and tried to find out exactly what their situation and problems were through self-exploration and not evading the issue. This can be thought of as a preparation process for problem solving. In the context of the more general resilience attributes found by previous studies, it can be noted that the nurse attributes discovered by this study, such as a belief in self-efficacy and a desire to improve oneself, are aspects of resilience in general [ 30 ]. However, nurse resilience included wanting to grow on their own while focusing on reality. These results show that nurses in a crisis situation have a strong tendency to rapidly grasp the problem, trust themselves and solve the problem quickly. Also, the nurses showed that they wanted to solve problems and grow step by step rather than staying in crisis. The subjects of this study were incumbent nurses in their 20s to 60s, including relatively young subjects, and it likely that the specific active and developmental results derived in this study reflect all of them having the profession of nurse in common. Nurses tried to overcome adversity by building positive strength in their lives by accepting life positively in crisis situations and enjoying the life given to them. In previous studies, this positivity property as a component of resilience was found to be universal across varied subjects, as part of the concept of general resilience [ 29 , 31 ] and the resilience of chronic disease patients [ 32 ]. In addition, nurses showed the characteristics of wanting to live hard and enjoy the life given to them. This can be seen as showing an active attitude to life, and since nurses are generally made up of healthy young people, this showed a different aspect of resilience from those shown by patients who are highly dependent on their families and medical staff [ 32 , 33 ]. A positive and active attitude towards life could be an important factor to focus on in the development of future intervention research aiming to improve nurses resilience. Nurses exhibited resilience characteristics for avoiding stress and separating their lives from stress when overcoming adversity. They showed that they were trying to overcome adversity by guaranteeing their own life. This characteristic results from the professional stress of a nurse, reflecting the substantial stress they face from work, and this is something we should pay attention to. Nurses formed their own defense mechanisms through wide-ranging human relationships. The human relationships of nurses were characterized by them wanting to develop their relationships between colleagues to an intimate level, particularly friendship, and them securing comfort from their relationships with such close colleagues. Considering these characteristics of nurse resilience can help create a resilience program that considers the relationships between peers when developing future intervention studies to improve nurse resilience. As the nurses overcame adversity, they try to adapt themselves by developing themselves and preparing for new situations. They tried to organize their life while arranging work priorities. Nurses tried to overcome adversity by planning for the future and growing one step at a time. In addition, in the face of adversity they had pride as a nurses through reflecting on why they became nurses and reminding themselves of the value of their profession. By raising job satisfaction and the passion for their job, their self-esteem was also raised. They wanted to grow further as nurses by constantly exploring and developing job-related knowledge and skills, and they tried to overcome the difficult situations they were in through the process of growth. The characteristic of resilience, that contains the meaning of growth, was revealed in previous studies [ 34 ]. However, the resilience of nurses has more specific meanings compared with the previous concept of resilience in that nurses plan for a better future, value the professional meaning of nursing, and want to grow as nurses. The characteristics of the resilience of nurses who plan for the future in difficult situations and want to grow one step further can suggest a direction for intervention research to enhance nurse resilience. Resilience enhancement is an approach that maximizes human inner strength, and we can suggest an intervention that maximizes human inner resource by using mobile with excellent individual accessibility. Mobile health intervention applications have developed rapidly lately and their usefulness is recognized in nursing [ 35 ]. Mobile applications can be useful resources for problem solving, providing real-time information and stress reduction strategies for nurses in a variety of healthcare fields and settings. [ 36 ]. The present study can suggest basic data and directions for the development of programs to improve nurse resilience. This study has two strengths. First, the included studies are from very diverse countries, such as the United States, Japan, Australia, South Africa, the United Kingdom, Canada, Singapore, Iran, and Taiwan, reflecting studies of various cultures. Therefore, this study can provide universal knowledge that can be applied worldwide. Second, of the literature used in this study, all 16 articles were found to satisfy the quality evaluation criteria 70% or more, so the study is based on an analysis of relatively high quality documents of well-organized structure. Despite these strengths, this study has limitations. The nurses included in the literature were from wide-ranging sub-fields, and the specific characteristics of specialist departments regarding stress were not reflected in the result. Therefore, in the future, conducting qualitative research on the resilience of nurses across nursing sub-fields is suggested. To resolve this, meta-synthesis studies to elucidate the characteristics of nurses within more specific fields can be conducted. Conclusion Emphasizing resilience, a positive force for overcoming adversities, to nurses can play a very significant role in improving the quality of nursing care. When the nurses in this meta study overcame their adversity, they showed the resilience characteristic of wanting to grow a little more by focusing on the inside and trying to find a way to solve the problem on their own. These can be considered as categories of nurse resilience and provide a framework to guide the development of an intervention program for improving nurse resilience. Based on the results of this study, to improve the quality of nursing care we should try to develop varied intervention programs that enhance nurses’ inner strength. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and material All data generated or analyzed during this study is included in this published article Competing interests No conflicts of interest have been declared by the authors. Funding This study was supported by a National Research Foundation of Korea grant funded by the Korea government (NRF-2021R1I1A1A01048956). Authors' contributions Conceived and designed the study : EYK, SOC Performed the data collection : EYK, SOC Analyzed the data: EYK, SOC Contributed materials : EYK, SOC Wrote the first draft of the manuscript : EYK Prepared figures and tables : EYK Agree with manuscript results and conclusion : EYK, SOC Acknowledgements None References World Health Organization. State of the World’s Nursing Report-2020. 2020. https://www.who.int/publications/i/item/9789240003279/ . Accessed 30Aug 2021. Waltz LA, Munoz L, Johnson HW, Rodriguez T. Exploring job satisfaction and workplace engagement in millennial nurses. J Nurs Manag. 2020;28(3):673–81. https://doi.org/10.1111/jonm.12981 Khamisa N, Oldenburg B, Peltzer K, Ilic D. Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health. 2015;12(1):652–66. https://doi.org/10.3390/ijerph120100652 Yarbrough S, Martin P, Alfred D, McNeill C. Professional values, job satisfaction, career development, and intent to stay. Nurs Ethics. 2017;24(6):675–85. https://doi.org/10.1177/0969733015623098 Lu H, Zhao Y, While A. Job satisfaction among hospital nurses: A literature review. Int J Nurs Stud. 2019;94:21–31. https://doi.org/10.1016/j.ijnurstu.2019.01.011 Cusack L, Smith M, Hegney D, Rees CS, Breen LJ, Witt RR, Rogers C, Williams A, Cross W, Cheung K. Exploring environmental factors in nursing workplaces that promote psychological resilience: Constructing a unified theoretical model. Front Psychol. 2016;7:600. https://doi.org/10.3389/fpsyg.2016.00600 Foster K, Roche M, Giandinoto J, Furness T. Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses: A descriptive correlational study. Int J Ment Health Nurs. 2020;29(1):56–68. https://doi.org/10.1111/inm.12610 Gao T, Ding X, Chai J, Zhang Z, Zhang H, Kong Y, Mei S. The influence of resilience on mental health: The role of general wellbeing. Int J Nurs Pract. 2017;23(3):e12535. https://doi.org/10.1111/ijn.12535 Wei H, Roberts P, Strickler J, Corbett RW. Nurse leaders’ strategies to foster nurse resilience. J Nurs Manag. 2019;27(4):681–87. https://doi.org/10.1111/jonm.12736 Guo Y-F, Luo Y-H, Lam L, Cross W, Plummer V, Zhang J-P. Burnout and its association with resilience in nurses: A cross-sectional study. J Clin Nurs. 2018;27(1–2): 441–9. https://doi.org/10.1111/jocn.13952 Arrogante O, Aparicio-Zaldivar E. Burnout and health among critical care professionals: The mediational role of resilience. Intensive Crit Care Nurs. 2017;42:110–5. https://doi.org/10.1016/j.iccn.2017.04.010 Southwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda R. Resilience definitions, theory, and challenges: Interdisciplinary perspectives. Eur J Psychotraumatol. 2014;5(1):25338. https://doi.org/10.3402/ejpt.v5.25338 Fletcher D, Sarkar M. Psychological resilience: A review and critique of definitions, concepts, and theory. Eur Psychol. 2013;18(1):12–23. https://doi.org/10.1027/1016-9040/a000124 O’Dougherty-Wright M, Masten AS, Narayan AJ. Resilience processes in development: Four waves of research on positive adaptation in the context of adversity. In: S. Goldstein & R. B. Brooks. Handbook of Resilience in Children, 2nd ed. Boston, MA: Springer;2013 Fletcher D, Sarkar M. Psychological resilience: A review and critique of definitions, concepts, and theory. Eur Psychol. 2013;18(1):12–23. https://doi.org/10.1027/1016-9040/a000124 Kelly LA, Gee PM, Butler RJ. Impact of nurse burnout on organizational and position turnover. Nurs Outlook. 2021;69(1):96–102. https://doi.org/10.1016/j.outlook.2020.06.008 Foster K, Roche M, Delgado C, Cuzzillo C, Giandinoto J, Furness T. Resilience and mental health nursing: An integrative review of international literature. Int J Ment Health Nurs. 2019;28(1):71–85. https://doi.org/10.1111/inm.12548 Mealer M, Jone J, Meek P. Factors Affecting Resilience and Development of Posttraumatic Stress Disorder in Critical Care Nurses. Am J Crit Care. 2017;26(3):184–92. https://doi.org/10.4037/ajcc2017798 Cooper AL, Brown JA, Rees CS, Leslie GD. Nurse resilience: A concept analysis. Int J Ment Health Nurs 2020;29(4):553–75. https://doi.org/10.1111/inm.12721 Lachal J, Revah-Levy A, Orri M, Moro MR. Metasynthesis: An original method to synthesize qualitative literature in psychiatry. Front psychiatry. 2017;8:269. https://doi.org/10.3389/fpsyt.2017.00269 France EF, Wells M, Lang H, Williams B. Why, when and how to update a meta-ethnography qualitative synthesis. Syst Rev. 2016;5:44. https://doi.org/10.1186/s1364 3-016-0218-4 . Noblit GW, Hare RD. Meta-ethnography: Synthesizing qualitative studies. Sage; 1988 Campbell R, Pound P, Morgan M, Daker-White G, Britten N, Pill R, Yardley L, Pope C, Donovan J. Evaluating meta-ethnography: Systematic analysis and synthesis of qualitative research. Health Technol Assess. 2011;15:1–164. doi: 10.3310/hta15430 Harwood L, Clark AM. Understanding pre-dialysis modality decision-making: A meta-synthesis of qualitative studies. Int J Nurs Stud. 2013;50:109–20. https://doi.org/10.1016/j.ijnur stu.2012.04.003 France EF, Uny I, Ring N, Turley RL, Maxwell M, Duncan EAS., Jepson RG, Roberts RJ, Noyes J. A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases. BMC Med Res Methodol. 2019;19(1):1–18. https://doi.org/10.1186/s1287 4-019-0670-7 Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Metholdol. 2012;12:181. https://doi.org/10.1186/1471-2288-12-181 Critical Appraisal Skills Programme. CASP (Qualitative) checklist. 2018. https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf/ . Accessed 15 Aug 2021. Cahill M, Robinson K, Pettigrew J, Galvin R, Stanley M. Qualitative synthesis: a guide to conducting a meta-ethnography. British Journal of Occupational Therapy. 2018;81(3):129–37. https://doi.org/10.1177/0308022617745016 Toye F, Seers K, Allcock N, Briggs M, Carr E, Barker K. Meta-ethnography 25 years on: challenges and insights for synthesizing a large number of qualitative studies. BMC Med Res Methodol, 2014;14:80. https://doi.org/10.1186/1471-2288-14-80 Earvolino-Ramirez M. Resilience: A concept analysis. Nurs Forum. 2007;42(2):73–82. https://doi.org/10.1111/j.1744-6198.2007.00070.x Aburn G, Gott M, Hoare K. What is resilience? An Integrative Review of the empirical literature. J Adv Nurs. 2016;72(5):980–1000. https://doi.org/10.1111/jan.12888 Kim EY, LeeY-N, Chang SO. How do patients on hemodialysis perceive and overcome hemodialysis? Concept development of the resilience of patients on hemodialysis. Nephrol Nurs J. 2019;46(5):521–530 Rosa F, Bagnasco A, Aleo G, Kendall S, Sasso L. Resilience as a concept for understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease (COPD): an integrative review. Nurs Open. 2016;4(2):61–75. https://doi.org/10.1002/nop2.63 Masten AS. Ordinary magic. Resilience process in development. American Psychologist. 2001;56(3):227–38. https://doi.org/10.1037//0003-066X.56.3.227 Ehrler F, Wu DTY, Ducloux P, Blondon K. A mobile application to support bedside nurse documentation and care: a time and motion study. JAMIA open. 2021;4(3):ooab046. https://doi.org/10.1093/jamiaopen/ooab046 Baccin CRA, Dal Sassso GTM, Paixão CA, De Sousa PAF. Mobile Application as a Learning Aid for Nurses and Nursing Students to Identify and Care for Stroke Patients: Pretest and Posttest Results. Comput Inform Nurs. 2020;38(7):358–66. https://doi.org/10.1097/CIN.0000000000000623 Additional Declarations No competing interests reported. Supplementary Files ENTREQ0923.docx Appendix1.docx Appendix 1. List of Synthesized Studies Cite Share Download PDF Status: Published Journal Publication published 18 Jan, 2022 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Major revision 16 Nov, 2021 Reviews received at journal 25 Oct, 2021 Reviewers agreed at journal 25 Oct, 2021 Reviewers invited by journal 04 Oct, 2021 Editor assigned by journal 28 Sep, 2021 Editor invited by journal 27 Sep, 2021 Submission checks completed at journal 27 Sep, 2021 First submitted to journal 23 Sep, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-929372","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":54488102,"identity":"982088b6-fab8-4bec-a720-acb41d1655b8","order_by":0,"name":"Eun Young Kim","email":"","orcid":"","institution":"Korea University","correspondingAuthor":false,"prefix":"","firstName":"Eun","middleName":"Young","lastName":"Kim","suffix":""},{"id":54488104,"identity":"cf6998cf-5a15-41fa-b453-b7515c448806","order_by":1,"name":"Sung Ok Chang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYNCCAzYGcLYEkVrSSNdymAQt8jNyD7/4cOa8Mb/04YMfGGrsGCRnH8CvxeBGXprljBu3zST70pIlGI4lM0jzJRDQIpFjZszz4baNwRkeAwkGtgMMcjwEHQbWcg6ohf/zD4Z/RGhhuJFj/JjnxgEzoC1sEoxtBxikCWkxOPPGjHHGmWRjyR42M4vEvmQeyR5CDmvPMf7w4ZidYT8P8+MbH77ZyUmcIeQwBgY2REwkMDAQ9AkIMH8gRtUoGAWjYBSMYAAAxTY92gCPGWcAAAAASUVORK5CYII=","orcid":"","institution":"Korea University","correspondingAuthor":true,"prefix":"","firstName":"Sung","middleName":"Ok","lastName":"Chang","suffix":""}],"badges":[],"createdAt":"2021-09-23 06:59:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-929372/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-929372/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-021-00803-z","type":"published","date":"2022-01-19T03:03:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":14082333,"identity":"0d2cba55-ef69-48e1-ab26-64d85a765702","added_by":"auto","created_at":"2021-09-28 19:07:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40080,"visible":true,"origin":"","legend":"The flow of this study ","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-929372/v1/818bc55fe3975842d84fc962.png"},{"id":18218421,"identity":"2d5f130f-40ea-4c6f-80b5-9adc969af723","added_by":"auto","created_at":"2022-02-15 03:03:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":623085,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-929372/v1/8b75b7ee-2e2f-4a8d-94bc-52e6957e789a.pdf"},{"id":14082331,"identity":"3a51eec8-c3e5-4aa6-839d-f2e9f41fd3e8","added_by":"auto","created_at":"2021-09-28 19:07:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18776,"visible":true,"origin":"","legend":"","description":"","filename":"ENTREQ0923.docx","url":"https://assets-eu.researchsquare.com/files/rs-929372/v1/fbda2cdf291b65a90869b074.docx"},{"id":14082332,"identity":"17a010d2-c681-4faf-9247-35dd191b352a","added_by":"auto","created_at":"2021-09-28 19:07:47","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":13554,"visible":true,"origin":"","legend":"Appendix 1. List of Synthesized Studies","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-929372/v1/57c3f2b3166a85e354797215.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring nurse perceptions and experiences of resilience: a meta-synthesis study \u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNurses are the largest occupational group in the medical health field. They account for approximately 59% of the total global medical health workforce [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and play a very important role in patient care. Globally, in recent years the nursing profession has been a rapidly growing sector of the workforce [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, nurses suffer stress and burnout related to their job, and this has a very negative effect on their mental health [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Problems that negatively affect nurses' mental health have serious effects such as reducing nursing professionalism, lowering the quality of care, and increased social financial loss [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs nurses' job satisfaction has been declining over recent years, nurses have been found to increasingly be highly likely to have negative perceptions about their job [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nurse job satisfaction is related to the turnover rate, which affects the quality of patient nursing care. As concern over nurse job satisfaction and burnout is increasing worldwide [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], timely studies of concepts that can ameliorate the negative job perceptions caused by the negative experiences of nurses are required.\u003c/p\u003e \u003cp\u003eResilience is a positive concept that allows nurses to overcome stressful situations [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and to adapt positively, resulting in psychological well-being and the maintenance of mental health [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In a recent previous study, nurse resilience was found to significantly reduced nurse burnout [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Resilience is emerging as an important concept for reducing the psychological burden of nurses and increasing their physical and mental health, since resilience has been shown to have a mediating effect on the relationship between burn out and physical/mental health [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eMost people have life-threatening experiences or are exposed to one or more stressors in their lifetime [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, it is very important to improve and adapt mental health to recover from the adversities one faces and to adapt positively. Since nurses in particular are exposed to wide-ranging stresses, the positive ability to overcome such adversities can play a very important role for them. The concept of resilience originated in psychology [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e] and can be described as an individual\u0026apos;s characteristics, processes, and outcomes [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Research into nursing resilience has been steadily improving, and over the last 10 years the importance of the concept of resilience has become emphasized as the related research has rapidly increased. In particular, resilience has been proposed as a solution to burn out [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e] and mental health issues [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e], which nurses frequently suffer from, and related research has been actively conducted.\u003c/p\u003e\n\u003cp\u003eNurse resilience is a complex and dynamic process that changes over time and according to the situation, embodying not only personal attributes but also external resources, and describes a nurse\u0026apos;s ability to adapt positively to stress and adversity [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAcademic interest in nurse resilience has been increasing recently, and many qualitative studies are being conducted to explore the essence of nurse resilience. However, there has been a practical limit to understanding the concept of nurse resilience through previous studies due to the diversity of the qualitative studies and the differences in their findings on the essence of nurse resilience.\u003c/p\u003e\n\u003cp\u003eQualitative meta-synthesis is a methodology for synthesizing and analyzing individual qualitative research [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. This methodology is recognized as a useful tool for analyzing the meaning, experience, and perspective of participants\u0026apos; expressions [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. It is a methodology for accumulating knowledge and deriving expanded knowledge and new interpretations from the results of the areas of research and phenomena suggested by existing studies [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. It is also a research methodology that enables more specific suggestions for future studies [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eNoblit and Hare developed another meta-synthesis method, meta-ethnography in 1988 [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. This method has the potential to lower study duplication, create new research questions, and promote higher-level analyses [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eIn this study, the results of qualitative studies on nurse resilience are integrated, a new interpretation is attempted and aspects of resilience phenomena are comprehensively elucidated. This study will help provide basic information for the research and development of interventions to improve nurse resilience. The purpose of this study was to systematically review and synthesize the qualitative evidence on nurse resilience experience.\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003ch2\u003eAim\u003c/h2\u003e\n \u003cp\u003eThe aim of this study is to understand nurse resilience in depth and to suggest directions for future research through the process of synthesizing and integrating qualitative research results on nurses\u0026apos; resilience-related experiences.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec4\"\u003e\n \u003ch2\u003eDesign\u003c/h2\u003e\n \u003cp\u003eWe used a meta-synthesis methodology, which provides broad understandings of social phenomena, to integrate the findings of qualitative studies [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. We followed the meta-ethnography method which is suitable for both preserving the interpretations of the primary data and forming new interpretations, theories and models [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. We applied the seven steps of the meta-ethnographic process by Noblit and Hare [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e] : (a) getting started, (b) deciding what is relevant to the initial interest, (c) reading the studies, (d) determining how the studies are related, (e) translating the studies into one another, (f) synthesizing those translations, and (g) expressing the synthesis.\u003c/p\u003e\n \u003cp\u003eThe research question was \u0026ldquo;How do nurses overcome adversities?\u0026rdquo;, \u0026ldquo;What are the characteristics of nurses\u0026rsquo; experiences of resilience?\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eThis review was prepared in accordance with ENTREQ (Enhancing transparency in reporting the synthesis of qualitative research Statement) guidelines [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. This meta-synthesis study was registered (CRD42021271541) with PROPERO, which is the International Register of Systematic Reviews.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec5\"\u003e\n \u003ch2\u003eSearch methods\u003c/h2\u003e\n \u003cp\u003eWe used the traditional literature review method. As this method is mainly used for searching literature representing the entirety of the phenomenon of interest, it is suitable for meta-synthesis studies [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eLiterature searches were carried out using six databases (PubMed, CINAHL, EMBASE, Web of Science, Cochrane, and Google Scholar). The search terms used in the search were \u0026quot;Nurses\u0026quot;, \u0026quot;Resilience, Psychological\u0026quot;, \u0026quot;Qualitative Research\u0026quot;, \u0026quot;Hermeneutics\u0026quot; from the Mesh Terms. The search terms were used with the Boolean operators \u0026ldquo;AND\u0026rdquo; and \u0026ldquo;OR\u0026rdquo; in different combinations. A flow chart of the systematic review of literature selection process of the present research is presented in Fig.\u0026nbsp;1.\u003c/p\u003e\n \u003cp\u003eThe inclusion criteria required qualitative studies that were: (a) aimed at exploring the resilience of nurses, (b) published from January 2010 to September 2021 (c) peer-reviewed journals (d) published in English, and (e) full-text searchable. The exclusion criteria were (1) nurses\u0026apos; experiences were not reported separately, (2) mixed methods were used but qualitative data could not be extracted or (3) necessary qualitative depth was lacking in the data analysis.\u003c/p\u003e\n \u003cp\u003eThrough the search procedure, 1361 studies were identified. 564 studies were excluded as duplicates, and 699 studies were excluded because they were regarded as not being related to the topic after reading their title and abstracts. 82 studies were excluded after reviewing their full-texts because of a lack of focus on nurses\u0026rsquo; perspectives, an inappropriate topic, insufficient qualitative criteria, the full text couldn\u0026rsquo;t be found, or the study was over 10 years old. After this process, 16 studies remained for inclusion (Fig. 1).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003eQuality appraisal\u003c/h2\u003e\n \u003cp\u003eThe Critical Appraisal Skills Programme (CASP) checklist, which contains 10 questions for assessing the reliability and rigor of individual studies, was used to appraise the 16 studies [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. Two authors independently evaluated the 16 included studies using the CASP checklist. After the appraisal, the two authors compared the CASP results, and any disagreements were resolved through discussion. The degree to which the studies met CASP was evaluated to be 70% for 4 studies, 80% for 9 studies, and 90% for 3 studies. Since all the studies were evaluated as being 70% or higher, none were excluded from the evaluation process (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of the included studies\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"11\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eArticle. No.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAuthor, year/Country\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResearch type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAims\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003cp\u003e(F:M)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge of participants (in years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNursing experience (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWorking department\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eData collection\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eData analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage that meets CASP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMealer et al., 2012/USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo identify mechanisms employed by highly resilient ICU nurses to develop preventative therapies to obviate the development of PTSD in ICU nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27, (27:0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emean : 46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal: mean18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntensive Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemi-structured telephone interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThematic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShimoinaba et al., 2015/Japan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore the nature of nurses\u0026rsquo; resilience and the way it is developed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18, (18:0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u0026ndash;53\u003c/p\u003e\n \u003cp\u003emean : 37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal :7\u0026ndash;26\u003c/p\u003e\n \u003cp\u003eIn this department : 2\u0026ndash;8, mean37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePalliative Care Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFace to face in-depth interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrounded theory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCope et al., 2016/Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative portraiture methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore residential aged care nurses working in interim, rehabilitation and residential\u003c/p\u003e\n \u003cp\u003eaged care perceptions of resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,(not reported),\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u0026ndash;57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal :mean28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAn aged care environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemi-structured interviews\u003c/p\u003e\n \u003cp\u003epainting with words\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThematic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCope et al., 2016(2) /Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative portraiture methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore why nurses chose to remain in the Western Australian workforce; to develop insights into the role of resilience of nurses to manage the context of nursing work; and, to identify the key characteristics of resilience displayed by those nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,(not reported)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterim and residential aged care, academic setting, tertiary acute care setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndividual interviews, field notes,\u003c/p\u003e\n \u003cp\u003ememos and gesture drawings interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhenomenology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTubbert, 2016/USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore the resiliency\u003c/p\u003e\n \u003cp\u003echaracteristics of certified emergency nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e(68.8%:31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean :50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal :30\u003c/p\u003e\n \u003cp\u003eIn this department : 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFace to face interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContent analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBenade et al., 2017/South Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExplorative descriptive qualitative research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore and describe the strengths and coping abilities of\u003c/p\u003e\n \u003cp\u003enurses caring for older persons and to formulate recommendations to strengthen their\u003c/p\u003e\n \u003cp\u003eresilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (43:0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal : not reported\u003c/p\u003e\n \u003cp\u003eIn this department : \u0026lt;6month :2\u003c/p\u003e\n \u003cp\u003e1year\u0026thinsp;\u0026lt;\u0026thinsp;5years : 5\u003c/p\u003e\n \u003cp\u003e5years\u0026thinsp;\u0026lt;\u0026thinsp;10years : 4\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10years: 27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAged care department in an urban environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFocus group interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContent analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarie et al., 2017/UK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterpretive qualitative design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo observe and describe the environment within community mental health workplaces, to explore the challenges facing Palestinian community mental health nurses (CMHNs) inside and outside their workplaces, and to examine their sources of resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (8:7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental health workplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFace-to-face in depth interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThematic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProsser et al., 2017/Canada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterpretative phenomenological method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo understand how registered nurses\u003c/p\u003e\n \u003cp\u003ein the acute psychiatric setting develop resilience to sustain his or her practice.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(not reported)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal : 2\u0026ndash;21\u003c/p\u003e\n \u003cp\u003eIn this department : 2\u0026ndash;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcute psychiatric units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemi-structured face-to- face interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterpretative phenomenological analysis.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWahab et al., 2017/Singapore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edescriptive qualitative design using Photovoice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore the new graduate nurses\u0026rsquo; accounts of resilience and the facilitating and impeding factors in building their resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(6:3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean : 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal: mean 1\u003c/p\u003e\n \u003cp\u003eIn this department : not reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOncology, General Medicine, General Surgery, Psychiatry and Paediatric wards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFocus group interview, photographs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContent analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImani et al., 2018/Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhenomenology study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore Iranian hospital nurses\u0026rsquo; lived experiences of intelligent resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (4:6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u0026ndash;52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal : 11\u0026ndash;28\u003c/p\u003e\n \u003cp\u003eIn this department : not reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifferent types of wards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn-depth interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe Colaizzi\u0026rsquo;s (1978) seven-step approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJackson et al., 2018/UK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrounded theory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo better understand nurse burnout and resilience in response to workplace adversity in critical care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(11:0),\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20s:5,\u003c/p\u003e\n \u003cp\u003e30s:3,\u003c/p\u003e\n \u003cp\u003e40s:1,\u003c/p\u003e\n \u003cp\u003e50s:2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal :4\u0026ndash;36\u003c/p\u003e\n \u003cp\u003eIn this department : not reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntensive care unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpen-ended interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrounded theory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRamalisa et al., 2018/ South Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmpirical qualitative research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore and describe how to strengthen the resilience of nurses in a work environment with involuntary mental health care users.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(not reported)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal :2\u0026ndash;8\u003c/p\u003e\n \u003cp\u003eIn this department : not reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychiatric ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpen-ended interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThematic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAng et al, 2019/Singapore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative grounded theory design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo generate a comprehensive account of the experiences of nurses as they cope with stress and demands of work, and to develop knowledge of the phenomenon of resilience among nurses.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(15:3),\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026ndash;68\u003c/p\u003e\n \u003cp\u003emean:38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndividual interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGlaserian constant comparison method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAng et al., 2019(2)/ Singapore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhotovoice study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore the meaning of resilience to nurses and their perceived resilience enhancing factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(7:1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u0026ndash;68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAccident and emergency department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFocus group interview, photo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContent analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLin et al, 2019/Taiwan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstruction-grounded theory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo explore and understand the experiences of resilience among nurses in an overcrowded emergency department (ED)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(13:0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal : not reported\u003c/p\u003e\n \u003cp\u003eIn this department : 2\u0026ndash;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn-depth interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstruction-grounded theory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUdod et al, 2021/Canada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo investigate the role stressors, and how coping strategies cultivated nurse managers\u0026rsquo; resilience in rural workplaces.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(15:1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30s : 5\u003c/p\u003e\n \u003cp\u003e40s:9\u003c/p\u003e\n \u003cp\u003eOver 60:2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal : mean4.6, 10\u0026ndash;35\u003c/p\u003e\n \u003cp\u003eIn this department : mean 7.28, 1\u0026ndash;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural site in western Canada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndividual semi-structured interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThematic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003eF:female; M:male; CASP: Critical Appraisal Skills Programme checklist\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003eData extraction\u003c/h2\u003e\n \u003cp\u003eTwo authors independently reviewed the studies in detail. They each read the studies line by line and tried to derive meaningful concepts by extracting codes. Data extraction for the study was performed using a custom form in Microsoft Excel, including author details, participant characteristics, methods, and original citations [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Disagreements between the authors were solved through discussion.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003eData synthesis\u003c/h2\u003e\n \u003cp\u003eBased on the meta-ethnography process [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e], the 16 studies were independently read repeatedly by the two authors, data analysis was performed, and then the extracted data were summarized as concepts. In more detail, after organizing the papers in chronological order, the two authors independently read the 16 studies, repeatedly. They then summarized and extracted meaningful concepts and themes. The two authors compared the themes and concepts of the first paper with those of the second paper, and then compared the common themes of those two papers with the third paper to derive concepts and themes. This process was repeated until the last study to synthesize the key concepts and broader themes. To extract the key concepts, the studies were read several times, and the key concepts of each study were listed and analyzed for comparison. The key concepts were formed based on the \u0026lsquo;first-order construct\u0026rsquo; of the study. In the meta-ethnography analysis process, the data is divided into \u0026lsquo;first-order construct\u0026rsquo;, \u0026lsquo;second-order construct\u0026rsquo;, and \u0026lsquo;third-order construct\u0026rsquo; [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. The \u0026apos;first-order construct\u0026apos; is the original study participant\u0026apos;s daily language as expressed in their own language in the original study, the \u0026apos;second-order construct\u0026rsquo; is the current researcher\u0026rsquo;s interpretation based on the \u0026lsquo;first-order construct\u0026rsquo;, and \u0026lsquo;third-order construct\u0026rsquo; is a new interpretation of \u0026lsquo;second-order construct\u0026rsquo; [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]. In this study the authors of the current paper extracted the key concepts of the \u0026lsquo;first-order construct\u0026rsquo;, then compared the similarities and differences to form the \u0026lsquo;second-order construct\u0026rsquo;, and finally derived the \u0026lsquo;third-order construct\u0026rsquo; representing the main themes of the study by abstracting the \u0026apos;second-order construct\u0026apos;. During this process of analysis and synthesis, the two authors continued to discuss their differences of opinion based on their respective academic and clinical backgrounds. The final analysis step, \u0026quot;expressing the synthesis,\u0026quot; was accomplished by collating the discussion results. The quotes that best expressed each sub-theme were identified and are presented in the results.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec10\"\u003e\n \u003ch2\u003eEthical consideration\u003c/h2\u003e\n \u003cp\u003eAs this study is a review study, as a meta-synthesis, human participants were not included. Therefore, an ethical committee review was not required.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e16 qualitative studies were included in this review study and the publication years were from 2012 to 2021. A total of 241 nurses participated in the included reviewed studies. Their ages varied widely, from those in their 20s to those in their 60s, and they were generally of female gender. Their working departments were varied, and included the ICU, the geriatric ward, the emergency room, the psychiatric ward, and the general ward (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). This study yielded four comprehensive themes of nurse resilience experience. Those are \u0026lsquo;self-development by focusing on one\u0026rsquo;s inner true self\u0026rsquo;, \u0026lsquo;building a positive strength for life\u0026rsquo;, \u0026lsquo;developing one\u0026rsquo;s own strategy for overcoming adversity\u0026rsquo;, \u0026lsquo;forward thinking to become a better nurse by planning for the future\u0026rsquo;. Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the key concepts from first-order construct, the second order constructs, and the synthesized themes.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSynthesized themes of nurses\u0026rsquo; resilience experience\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKey concepts from first-order constructs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSub-themes\u003c/p\u003e\n \u003cp\u003e(Second order constructs)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSynthesized themes\u003c/p\u003e\n \u003cp\u003e(Third order constructs)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-reflection \u003csup\u003eA2, A3, A4, A5, A8, A11, A13, A14, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eFocusing on the present \u003csup\u003eA2, A5, A8, A9, A11, A12, A13, A14\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eAccept the situation not avoiding \u003csup\u003eA8, A9, A11, A12, A13, A14\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eBelieve in one\u0026rsquo;s ability \u003csup\u003eA2, A5, A6, A9, A10, A12, A13, A14\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eExpressing their feelings honestly \u003csup\u003eA2, A6, A10, A11, A13\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eRecognizing the warning signs of stress \u003csup\u003eA5, A9, A11, A13\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePay attention to physical and emotional demands \u003csup\u003eA5, A6, A8, A10, A11, A16\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Recognizing and acknowledging the signs of adversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI. Self-development by focusing on one\u0026apos;s inner self\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrying to maintain physical health \u003csup\u003eA3, A4, A11\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePerceiving self-efficacy \u003csup\u003eA5, A6, A9, A11, A13, A14, A15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eDeveloping various ways of self-care \u003csup\u003eA2, A3, A4, A9, A11, A13, A14, A15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eHaving self-confidence \u003csup\u003eA5, A6, A9, A11, A13, A14, A15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eTrying to control emotions \u003csup\u003eA2, A5, A6, A9, A11, A13, A14, A15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLearning from others\u0026apos; experience and expertise \u003csup\u003eA2, A3, A4, A6, A7, A9, A10, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eThe taking on new challenge \u003csup\u003eA2, A3, A4, A5, A9, A11, A13\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eFlexible thinking to solve an issue \u003csup\u003eA2, A5, A9, A11, A12, A13, A14\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePreserving and moving forward \u003csup\u003eA5, A9, A11, A13, A14\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2. Striving to grow themselves\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKeeping optimistic attitude in life \u003csup\u003eA1, A3, A4, A5, A6, A7, A9, A14, A15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMaintaining a sense of humor at work \u003csup\u003eA3, A4, A6, A11\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eGratitude for life \u003csup\u003eA3, A4, A6, A7, A12\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eLiving a life of helping others \u003csup\u003eA2, A3, A4, A6,, A15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eRemembering good experiences from the past \u003csup\u003eA1, A2, A6, A15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eFinding joy and pride in what they do \u003csup\u003eA1, A5, A6, A11, A15\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3. Accepting life as positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡ. Building positive strength for life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving a regular and healthy life \u003csup\u003eA1, A2, A5, A11\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eEnjoying a variety of leisure activities \u003csup\u003eA1, A2, A5, A11\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eCreating their own hobbies \u003csup\u003eA1, A2, A5\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eDeveloping their own personal coping behaviors \u003csup\u003eA1, A2, A5, A11\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4. Enjoying their life given to them\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAvoiding stress \u003csup\u003eA1, A9, A10, A11\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKeeping work-life balance \u003csup\u003eA5, A6, A8, A10, A11, A12\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eKeep distance life from work (Setting boundaries between home and work) \u003csup\u003eA5, A6, A8, A11, A12\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5. Staying away from stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ. Developing their own adversity overcoming strategy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComfort from friendships \u003csup\u003eA1, A3, A4, A5, A7, A10, A11, A12, A14, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eGetting help from family relationships \u003csup\u003eA1, A3, A4, A5, A7, A11, A12, A14, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMaintaining good relationship with colleagues \u003csup\u003eA1, A2, A3, A4, A5, A7, A10, A11, A12, A14, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePositive role model \u003csup\u003eA1, A2, A6, A11, A12, A15\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSharing their feelings with someone whom they trust \u003csup\u003eA1, A2, A5, A6, A11, A12, A13, A14, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eGet help from experts \u003csup\u003eA6, A9, A12\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6. Forming one\u0026apos;s own defenses through interactions with human relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeveloping self for the future \u003csup\u003eA2, A3, A4, A6, A7, A9, A14, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePreparing for new assignments \u003csup\u003eA2, A3, A4, A6, A7, A9, A14, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eAdaptation to a new situation \u003csup\u003eA2, A7, A9, A14, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePrioritizing work \u003csup\u003eA5, A8, A13, A14, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7. Planning their life for a better future\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅣ. Forward thinking to become a better nurse by planning for the future\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSense of professional pride \u003csup\u003eA2, A3, A4, A6, A9, A10, A11, A12, A13, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eValue of being a nurse \u003csup\u003eA2, A3, A4, A6, A9, A11, A12, A13, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSatisfaction with career \u003csup\u003eA2, A3, A4, A6, A9, A11, A13, A14, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003ePassion to work \u003csup\u003eA2, A3, A4, A6, A9, A10, A11, A12, A13, A15, A16\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eDeveloping their knowledge and skills \u003csup\u003eA2, A3, A4, A6, A9, A12, A13, A15\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8. Building self-esteem by thinking about the value of a job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec12\"\u003e\n \u003ch2\u003eTheme Ⅰ. Self-development by focusing on one\u0026rsquo;s inner self\u003c/h2\u003e\n \u003cp\u003eThe sub-themes included in theme 1 were \u0026quot;recognizing and acknowledging signs of adversity\u0026quot; and \u0026quot;striving to grow oneself\u0026quot;. The nurses tried to find a solution by focusing on the signals of the adversity they encountered, and made an effort to grow through the adversity rather than collapse under it.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec13\"\u003e\n \u003ch2\u003eSub-theme 1. Recognizing and acknowledging the signs of adversity\u003c/h2\u003e\n \u003cp\u003eThe nurses did not deny the signs of adversity, but recognized and acknowledged them. The nurses looked inside themselves to find problems and tried to reflect on themselves. They tried to focus on the current situation, and showed an attitude of acceptance to the situation they were in rather than one of avoidance. They believed in their abilities, tried to express their feelings honestly, and tried to recognize the warning signs of stress rather than ignore them. They showed themselves to focus on the state and demands of their bodies and emotions.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;It is difficult....I feel it is a most difficult thing to reflect on my own feelings. I can understand other people, but I do not understand myself. I think I have experienced a kind of burnout.\u0026rdquo;\u003c/em\u003e (A2)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I thought of ways when something happens so that one can go away, sit down and reflect and then maybe come up with whatever your own strategies are to come back stronger. So if the same thing comes at you again, you know where to run, which direction is faster\u0026rdquo;\u003c/em\u003e (A11)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec14\"\u003e\n \u003ch2\u003eSub-theme 2. Striving to grow themselves\u003c/h2\u003e\n \u003cp\u003eRather than despair, the nurses wanted to grow on their own. They tried to maintain their physical health and recognized a sense of self-efficacy. In addition, they thought about and developed various ways to take care of themselves. They were confident that they could overcome adversity and tried to control their emotions. Nurses tried not to ignore what others had to say and to learn from their experiences and expertise. They tried new challenges and had various thoughts to solve problems. The nurses showed patience and a willingness to move forward.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;You know more or less that you have to do it and it is going to be tough going. The task could be from manageable to unmanageable depending on what is happening at the moment. I\u0026apos;m able to cope with stress.\u0026rdquo;\u003c/em\u003e(A13)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec15\"\u003e\n \u003ch2\u003eTheme Ⅱ. Building a positive strength for life\u003c/h2\u003e\n \u003cp\u003eIn theme 2, the sub-themes included \u0026ldquo;accepting life as positive\u0026rdquo; and \u0026ldquo;enjoying the life given to them\u0026rdquo;. In this theme, the positive power of nurses is evident. The nurses showed that they were trying to overcome adversity with positivity. A positive attitude toward life and the desire to live the life that was given to them and enjoy life became positive strengths for the nurses.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec16\"\u003e\n \u003ch2\u003eSub-theme 3. Accepting life as positive\u003c/h2\u003e\n \u003cp\u003eThe nurses maintained a positive attitude toward life when overcoming life adversities and maintained a sense of humor at work. They were grateful for life and tried to heal themselves by living a life of helping others. They remembered the good memories they had in the past, and drew positive thoughts from them. They found enjoyment and pride in what they do.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;But I try to look at the positive stuff. .. what we are able to do, what changes we were able to make as a result of a catastrophe or just a bad outcome. .. just pull my sleeves up and get in there and get it done and when I can, I do try to encourage communication and good feelings.\u0026rdquo;\u003c/em\u003e (A5)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026lsquo;\u0026lsquo;I think every type of nurse has their own type of black humor but I realized a lot of it is a coping mechanism and a way of protection to get yourself through the day\u0026rdquo;\u003c/em\u003e (A11)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec17\"\u003e\n \u003ch2\u003eSub-theme 4. Enjoying their life given to them\u003c/h2\u003e\n \u003cp\u003eNurses tried to overcome the adversities they faced while enjoying life on their own terms. They tried to live a regular and healthy life, enjoy various leisure activities, and enrich their lives happily while creating their own hobbies. They coped with the situation by developing their own coping behaviors for crisis situations.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;You have to enjoy what you are doing. If you hate your work, it will be a constant stress. I feel that I don\u0026apos;t get stressed about it because I feel that no problem is difficult.\u0026rdquo;\u003c/em\u003e (A13)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;The joy of working is like a hurdle\u0026hellip;like jumping over the hurdle. Each time I jump over a hurdle that I cross, there is always some satisfaction in the job.\u0026rdquo;\u003c/em\u003e (A13)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec18\"\u003e\n \u003ch2\u003eTheme Ⅲ. Developing their own strategy for overcoming adversity\u003c/h2\u003e\n \u003cp\u003eThe sub-themes \u0026ldquo;staying away from stress\u0026rdquo; and \u0026ldquo;forming one\u0026rsquo;s own defenses through interactions provided by human relationships\u0026rdquo; were included in theme 3. Nurses were shown to develop their own strategies when overcoming adversities. They tried to stay away from situations that were stressful to them and formed their own defenses through positive interactions provided by wide-ranging human relationships. These methods of overcoming adversities were their own strategies learned through their own experiences.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec19\"\u003e\n \u003ch2\u003eSub-theme 5. Staying away from stress\u003c/h2\u003e\n \u003cp\u003eNurses had to face varied sources of stress, but tried to avoid them, such as by trying not to create stressful situations or not focusing on the stress. They tried to maintain a work-life balance so that neither of them became too large or too small, and the work-life balance did not become broken. In addition, by thoroughly separating their work and life, they tried to protect their life thoroughly, avoiding the intrusion of work into their life, and they tried to respect their own privacy.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes, I can\u0026rsquo;t control myself. In such situations, I attempt to distance myself from that situation or the immediate environment. In these conditions, I ask my colleagues to continue care delivery and then, I leave the situation. I never stay in such a situation because I know that my presence will aggravate the problem. Thus, I leave that situation and start providing care to another patient.\u0026rdquo;\u003c/em\u003e(A10)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eI think that the only way for me to stay resilient is to keep stepping away from the bedside, because that\u0026rsquo;s where all the stress is for me, it\u0026rsquo;s at the bedside. You need to remove yourself from the situation\u003c/em\u003e\u0026rdquo; \u0026ldquo;\u003cem\u003eI have to have this proper balance and this little routine to maintain a healthy, functional life, and I think the younger ones know that which is good.\u0026rdquo;\u003c/em\u003e (A11)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec20\"\u003e\n \u003ch2\u003eSub-theme 6. Forming one\u0026rsquo;s own defenses through interactions provided by human relationships\u003c/h2\u003e\n \u003cp\u003eIn their professional positions the nurses developed a variety of interpersonal relationships, including relationships with patients, colleagues, and families. Nurses received comfort from their relationships with friends and comfort and support from their families. The nurses tried to maintain good relationships with their colleagues and other nurses and as colleagues they helped each other in difficult situations. They were also comforted by the developing friendships with their colleagues. In addition, they tried to grow one step at a time by orientating their own future direction through role models and mentors they could imitate. They also received help from a mental health professionals for stress management.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s the people you work with. I have a lot of caring friends. I talk to my husband - he always backs me up. I think that how you deal with it.. . with another manager\u0026rsquo;s support. We meet for lunch sometimes \u0026mdash; a laughs the best way \u0026mdash; we quite often see the funny side.\u0026rdquo;\u003c/em\u003e (A4)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Talking to colleagues because they know the scope of your job. They know what is happening in your ward, so they will be able to understand better.\u0026rdquo;, \u0026ldquo;I have good friends to whom I can confide my problems. I think it\u0026apos;s important you don\u0026apos;t bottle up your feelings too much, because you know you can just self-destruct if you\u0026apos;re not able to handle it. They may not be able to solve the problem; a listening ear does help.\u0026rdquo;\u003c/em\u003e (A13)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;m very fortunate as I have a large network of friends and colleagues that I can safely vent to or discuss things with or bounce ideas off that aren\u0026apos;t my staff. And I found that you really need that. It is pretty much a lifeline whether you\u0026apos;re a front-line manager or if you\u0026apos;re a director you need to have that core group of people that you can call and say, \u0026lsquo;Am I crazy\u0026rsquo;\u0026rdquo;\u003c/em\u003e (A11)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTheme Ⅳ. Forward thinking to become a better nurse by planning for the future.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIn theme 4, the sub-themes \u0026ldquo;planning their life for a better future\u0026rdquo; and \u0026ldquo;building self-esteem by thinking about the value of a job\u0026rdquo; were included. The nurses planned their future to live a better life than just leaving their lives to adversity. They felt that they had to develop themselves for a better future, prepare for a new life, and adapt to a new situation. They thought they had to rearrange their work by considering their priorities.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec21\"\u003e\n \u003ch2\u003eSub-theme 7. Planning their life for a better future\u003c/h2\u003e\n \u003cp\u003eIn difficult situations, nurses thought about how to live their future. Even in difficult situations, the attitude of planning for the future and thinking about the future rather than staying in the present and despairing was exhibited by nurses. They wanted to develop themselves, to prepare for new assignments including difficult situations, and to adapt well to new situations. They re-prioritized their work and tried to work according to their priorities.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I always take an experience as an opportunity to learn from it. To grow. I mean, no experience is bad. It may be a bad experience but you can learn from it and try to move on and try to make things better\u0026rdquo;\u003c/em\u003e (A13)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec22\"\u003e\n \u003ch2\u003eSub-theme 8. Building self-esteem by thinking about the value of a job\u003c/h2\u003e\n \u003cp\u003eIn difficult situations, nurses tried to gain the strength to overcome the crisis by reminding themselves of themselves as nurses and reflecting on the value of their job. They took pride in their job, thought about the meaning and value of being a nurse, and tried to overcome the crisis while gaining satisfaction from their worthwhile job. They had a passion for their work and wanted to develop their knowledge and skills as nurses and upgrade themselves to the next level through their own development.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;We are the backbone when patients come in. The nurse is the protector of the patient [\u0026hellip;] the patient survived because the nurse stuck out her hand and stopped the bleeding. I am proud of her.\u0026rdquo;\u003c/em\u003e (A11)\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs nurses play a very important role in the medical field, they are exposed to wide-ranging difficulties because of the high intensity of their work. Research on the resilience of nurses, a positive force to overcome this, has recently attracted attention in both research and practice. This study synthesized the result of qualitative research on nurse resilience to explore nurses\u0026rsquo; experiences of overcoming adversities.\u003c/p\u003e \u003cp\u003e According to the result of this study, when nurses felt that they were going through a difficult situation, they tried to recognize and acknowledge that situation by exploring their inner selves. They focused on themselves and tried to find out exactly what their situation and problems were through self-exploration and not evading the issue. This can be thought of as a preparation process for problem solving. In the context of the more general resilience attributes found by previous studies, it can be noted that the nurse attributes discovered by this study, such as a belief in self-efficacy and a desire to improve oneself, are aspects of resilience in general [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, nurse resilience included wanting to grow on their own while focusing on reality. These results show that nurses in a crisis situation have a strong tendency to rapidly grasp the problem, trust themselves and solve the problem quickly. Also, the nurses showed that they wanted to solve problems and grow step by step rather than staying in crisis. The subjects of this study were incumbent nurses in their 20s to 60s, including relatively young subjects, and it likely that the specific active and developmental results derived in this study reflect all of them having the profession of nurse in common.\u003c/p\u003e \u003cp\u003eNurses tried to overcome adversity by building positive strength in their lives by accepting life positively in crisis situations and enjoying the life given to them. In previous studies, this positivity property as a component of resilience was found to be universal across varied subjects, as part of the concept of general resilience [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and the resilience of chronic disease patients [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In addition, nurses showed the characteristics of wanting to live hard and enjoy the life given to them. This can be seen as showing an active attitude to life, and since nurses are generally made up of healthy young people, this showed a different aspect of resilience from those shown by patients who are highly dependent on their families and medical staff [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. A positive and active attitude towards life could be an important factor to focus on in the development of future intervention research aiming to improve nurses resilience.\u003c/p\u003e \u003cp\u003eNurses exhibited resilience characteristics for avoiding stress and separating their lives from stress when overcoming adversity. They showed that they were trying to overcome adversity by guaranteeing their own life. This characteristic results from the professional stress of a nurse, reflecting the substantial stress they face from work, and this is something we should pay attention to. Nurses formed their own defense mechanisms through wide-ranging human relationships. The human relationships of nurses were characterized by them wanting to develop their relationships between colleagues to an intimate level, particularly friendship, and them securing comfort from their relationships with such close colleagues. Considering these characteristics of nurse resilience can help create a resilience program that considers the relationships between peers when developing future intervention studies to improve nurse resilience.\u003c/p\u003e \u003cp\u003eAs the nurses overcame adversity, they try to adapt themselves by developing themselves and preparing for new situations. They tried to organize their life while arranging work priorities. Nurses tried to overcome adversity by planning for the future and growing one step at a time. In addition, in the face of adversity they had pride as a nurses through reflecting on why they became nurses and reminding themselves of the value of their profession. By raising job satisfaction and the passion for their job, their self-esteem was also raised. They wanted to grow further as nurses by constantly exploring and developing job-related knowledge and skills, and they tried to overcome the difficult situations they were in through the process of growth. The characteristic of resilience, that contains the meaning of growth, was revealed in previous studies [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, the resilience of nurses has more specific meanings compared with the previous concept of resilience in that nurses plan for a better future, value the professional meaning of nursing, and want to grow as nurses. The characteristics of the resilience of nurses who plan for the future in difficult situations and want to grow one step further can suggest a direction for intervention research to enhance nurse resilience.\u003c/p\u003e \u003cp\u003eResilience enhancement is an approach that maximizes human inner strength, and we can suggest an intervention that maximizes human inner resource by using mobile with excellent individual accessibility. Mobile health intervention applications have developed rapidly lately and their usefulness is recognized in nursing [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Mobile applications can be useful resources for problem solving, providing real-time information and stress reduction strategies for nurses in a variety of healthcare fields and settings. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The present study can suggest basic data and directions for the development of programs to improve nurse resilience.\u003c/p\u003e \u003cp\u003eThis study has two strengths. First, the included studies are from very diverse countries, such as the United States, Japan, Australia, South Africa, the United Kingdom, Canada, Singapore, Iran, and Taiwan, reflecting studies of various cultures. Therefore, this study can provide universal knowledge that can be applied worldwide. Second, of the literature used in this study, all 16 articles were found to satisfy the quality evaluation criteria 70% or more, so the study is based on an analysis of relatively high quality documents of well-organized structure.\u003c/p\u003e \u003cp\u003eDespite these strengths, this study has limitations. The nurses included in the literature were from wide-ranging sub-fields, and the specific characteristics of specialist departments regarding stress were not reflected in the result. Therefore, in the future, conducting qualitative research on the resilience of nurses across nursing sub-fields is suggested. To resolve this, meta-synthesis studies to elucidate the characteristics of nurses within more specific fields can be conducted.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEmphasizing resilience, a positive force for overcoming adversities, to nurses can play a very significant role in improving the quality of nursing care. When the nurses in this meta study overcame their adversity, they showed the resilience characteristic of wanting to grow a little more by focusing on the inside and trying to find a way to solve the problem on their own. These can be considered as categories of nurse resilience and provide a framework to guide the development of an intervention program for improving nurse resilience. Based on the results of this study, to improve the quality of nursing care we should try to develop varied intervention programs that enhance nurses\u0026rsquo; inner strength.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study is included in this published article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflicts of interest have been declared by the authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by a National Research Foundation of Korea grant funded by the Korea government (NRF-2021R1I1A1A01048956).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceived and designed the study : EYK, SOC\u003c/p\u003e\n\u003cp\u003ePerformed the data collection : EYK, SOC\u003c/p\u003e\n\u003cp\u003eAnalyzed the data: EYK, SOC\u003c/p\u003e\n\u003cp\u003eContributed materials : EYK, SOC\u003c/p\u003e\n\u003cp\u003eWrote the first draft of the manuscript : EYK\u003c/p\u003e\n\u003cp\u003ePrepared figures and tables : EYK\u003c/p\u003e\n\u003cp\u003eAgree with manuscript results and conclusion : EYK, SOC\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. State of the World\u0026rsquo;s Nursing Report-2020. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240003279/\u003c/span\u003e\u003c/span\u003e. Accessed 30Aug 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaltz LA, Munoz L, Johnson HW, Rodriguez T. Exploring job satisfaction and workplace engagement in millennial nurses. J Nurs Manag. 2020;28(3):673\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jonm.12981\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhamisa N, Oldenburg B, Peltzer K, Ilic D. Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health. 2015;12(1):652\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph120100652\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYarbrough S, Martin P, Alfred D, McNeill C. Professional values, job satisfaction, career development, and intent to stay. Nurs Ethics. 2017;24(6):675\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0969733015623098\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu H, Zhao Y, While A. Job satisfaction among hospital nurses: A literature review. Int J Nurs Stud. 2019;94:21\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijnurstu.2019.01.011\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCusack L, Smith M, Hegney D, Rees CS, Breen LJ, Witt RR, Rogers C, Williams A, Cross W, Cheung K. Exploring environmental factors in nursing workplaces that promote psychological resilience: Constructing a unified theoretical model. Front Psychol. 2016;7:600. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2016.00600\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoster K, Roche M, Giandinoto J, Furness T. Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses: A descriptive correlational study. Int J Ment Health Nurs. 2020;29(1):56\u0026ndash;68. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/inm.12610\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao T, Ding X, Chai J, Zhang Z, Zhang H, Kong Y, Mei S. The influence of resilience on mental health: The role of general wellbeing. Int J Nurs Pract. 2017;23(3):e12535. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ijn.12535\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei H, Roberts P, Strickler J, Corbett RW. Nurse leaders\u0026rsquo; strategies to foster nurse resilience. J Nurs Manag. 2019;27(4):681\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jonm.12736\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo Y-F, Luo Y-H, Lam L, Cross W, Plummer V, Zhang J-P. Burnout and its association with resilience in nurses: A cross-sectional study. J Clin Nurs. 2018;27(1\u0026ndash;2): 441\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jocn.13952\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArrogante O, Aparicio-Zaldivar E. Burnout and health among critical care professionals: The mediational role of resilience. Intensive Crit Care Nurs. 2017;42:110\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.iccn.2017.04.010\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSouthwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda R. Resilience definitions, theory, and challenges: Interdisciplinary perspectives. Eur J Psychotraumatol. 2014;5(1):25338. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3402/ejpt.v5.25338\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFletcher D, Sarkar M. Psychological resilience: A review and critique of definitions, concepts, and theory. Eur Psychol. 2013;18(1):12\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1027/1016-9040/a000124\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Dougherty-Wright M, Masten AS, Narayan AJ. Resilience processes in development: Four waves of research on positive adaptation in the context of adversity. In: S. Goldstein \u0026amp; R. B. Brooks. Handbook of Resilience in Children, 2nd ed. Boston, MA: Springer;2013\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFletcher D, Sarkar M. Psychological resilience: A review and critique of definitions, concepts, and theory. Eur Psychol. 2013;18(1):12\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1027/1016-9040/a000124\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly LA, Gee PM, Butler RJ. Impact of nurse burnout on organizational and position turnover. Nurs Outlook. 2021;69(1):96\u0026ndash;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.outlook.2020.06.008\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoster K, Roche M, Delgado C, Cuzzillo C, Giandinoto J, Furness T. Resilience and mental health nursing: An integrative review of international literature. Int J Ment Health Nurs. 2019;28(1):71\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/inm.12548\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMealer M, Jone J, Meek P. Factors Affecting Resilience and Development of Posttraumatic Stress Disorder in Critical Care Nurses. Am J Crit Care. 2017;26(3):184\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4037/ajcc2017798\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooper AL, Brown JA, Rees CS, Leslie GD. Nurse resilience: A concept analysis. Int J Ment Health Nurs 2020;29(4):553\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/inm.12721\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLachal J, Revah-Levy A, Orri M, Moro MR. Metasynthesis: An original method to synthesize qualitative literature in psychiatry. Front psychiatry. 2017;8:269. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyt.2017.00269\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrance EF, Wells M, Lang H, Williams B. Why, when and how to update a meta-ethnography qualitative synthesis. Syst Rev. 2016;5:44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s1364 3-016-0218-4\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoblit GW, Hare RD. Meta-ethnography: Synthesizing qualitative studies. Sage; 1988\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell R, Pound P, Morgan M, Daker-White G, Britten N, Pill R, Yardley L, Pope C, Donovan J. Evaluating meta-ethnography: Systematic analysis and synthesis of qualitative research. Health Technol Assess. 2011;15:1\u0026ndash;164. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3310/hta15430\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarwood L, Clark AM. Understanding pre-dialysis modality decision-making: A meta-synthesis of qualitative studies. Int J Nurs Stud. 2013;50:109\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijnur stu.2012.04.003\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrance EF, Uny I, Ring N, Turley RL, Maxwell M, Duncan EAS., Jepson RG, Roberts RJ, Noyes J. A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases. BMC Med Res Methodol. 2019;19(1):1\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s1287 4-019-0670-7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Metholdol. 2012;12:181. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-2288-12-181\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCritical Appraisal Skills Programme. CASP (Qualitative) checklist. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf/\u003c/span\u003e\u003c/span\u003e. Accessed 15 Aug 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCahill M, Robinson K, Pettigrew J, Galvin R, Stanley M. Qualitative synthesis: a guide to conducting a meta-ethnography. British Journal of Occupational Therapy. 2018;81(3):129\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0308022617745016\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToye F, Seers K, Allcock N, Briggs M, Carr E, Barker K. Meta-ethnography 25 years on: challenges and insights for synthesizing a large number of qualitative studies. BMC Med Res Methodol, 2014;14:80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-2288-14-80\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEarvolino-Ramirez M. Resilience: A concept analysis. Nurs Forum. 2007;42(2):73\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1744-6198.2007.00070.x\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAburn G, Gott M, Hoare K. What is resilience? An Integrative Review of the empirical literature. J Adv Nurs. 2016;72(5):980\u0026ndash;1000. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jan.12888\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim EY, LeeY-N, Chang SO. How do patients on hemodialysis perceive and overcome hemodialysis? Concept development of the resilience of patients on hemodialysis. Nephrol Nurs J. 2019;46(5):521\u0026ndash;530\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosa F, Bagnasco A, Aleo G, Kendall S, Sasso L. Resilience as a concept for understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease (COPD): an integrative review. Nurs Open. 2016;4(2):61\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/nop2.63\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasten AS. Ordinary magic. Resilience process in development. American Psychologist. 2001;56(3):227\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037//0003-066X.56.3.227\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEhrler F, Wu DTY, Ducloux P, Blondon K. A mobile application to support bedside nurse documentation and care: a time and motion study. JAMIA open. 2021;4(3):ooab046. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jamiaopen/ooab046\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaccin CRA, Dal Sassso GTM, Paix\u0026atilde;o CA, De Sousa PAF. Mobile Application as a Learning Aid for Nurses and Nursing Students to Identify and Care for Stroke Patients: Pretest and Posttest Results. Comput Inform Nurs. 2020;38(7):358\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/CIN.0000000000000623\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Resilience, Nurses, Perception, Experiences, Qualitative Review ","lastPublishedDoi":"10.21203/rs.3.rs-929372/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-929372/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim \u003c/strong\u003eTo understand nurse resilience in depth by integrating the qualitative research results on nurses' resilience-related experiences.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods :\u003c/strong\u003e We applied the seven steps of the meta-ethnographic process by Noblit and Hare (1988).\u003cstrong\u003e \u003c/strong\u003eSix databases (PubMed, CINAHL, EMBASE, Web of Science, Cochrane, and Google Scholar) were used to search for studies published from January 2011 to August 2021.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eSixteen qualitative studies were included. The four themes of “self-development though focusing on one’s inner self”, “building a positive strength for life”, “developing one’s own strategy for overcoming diversity” and “forward thinking to become a better nurse by planning for the future” illustrate that \u0026nbsp;they want to promote their inner strength and develop themselves through self-examination.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e : Through this study, we can understand more deeply about the resilience of nurses, and the results can provide basic data for the development of intervention study to improve the resilience of nurses.\u003c/p\u003e","manuscriptTitle":"Exploring nurse perceptions and experiences of resilience: a meta-synthesis study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-09-28 19:07:45","doi":"10.21203/rs.3.rs-929372/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-11-16T12:25:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-10-25T10:26:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"db7b40b5-6c8e-4b58-b89a-ead2d2cb4e2b","date":"2021-10-25T09:52:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-10-04T15:34:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-09-28T12:11:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-09-27T12:36:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-09-27T12:35:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2021-09-23T06:45:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccab653d-7425-4b6e-a41a-837d5908c0e3","owner":[],"postedDate":"September 28th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":7508761,"name":"Nursing"}],"tags":[],"updatedAt":"2022-02-15T03:03:24+00:00","versionOfRecord":{"articleIdentity":"rs-929372","link":"https://doi.org/10.1186/s12912-021-00803-z","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2022-01-19 03:03:24","publishedOnDateReadable":"January 19th, 2022"},"versionCreatedAt":"2021-09-28 19:07:45","video":"","vorDoi":"10.1186/s12912-021-00803-z","vorDoiUrl":"https://doi.org/10.1186/s12912-021-00803-z","workflowStages":[]},"version":"v1","identity":"rs-929372","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-929372","identity":"rs-929372","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}