Building Resilience: Strategies for Critical Care Nurses Before, During and After the Pandemic Crisis
DOI:
https://doi.org/10.31436/ijcs.v8i1.427Keywords:
COVID-19, Critical care nurses, ResilienceAbstract
Background: This integrative review investigates the resilience of critical care nurses before, during, and after the COVID-19 pandemic, highlighting changes over time and identifying strategies to address burnout and moral distress.
Methods: A systematic search across Google Scholar, BioMed Central, EBSCO CINAHL, and ELSEVIER Clinical Key Nursing databases included peer-reviewed articles from 2015 to 2024.
Results: The findings reveal significant shifts in resilience: pre-pandemic resilience was shaped by coping mechanisms and ethical work environments; during the pandemic, it was challenged by moral distress, staff shortages, and high patient loads; post-pandemic, adaptive resilience emerged, supported by mindfulness training, peer support, and organizational changes. Despite many studies and strategies, moral distress and burnout persist. Effective leadership, ethical organizational cultures, and targeted resilience-building programs are crucial for recovery.
Conclusion: The review concludes that resilience among critical care nurses is dynamic and adaptive but remains susceptible to organizational and individual challenges. Integrating personal and organizational strategies into nursing practice is essential for fostering resilience and addressing future crises. This study suggests ongoing research is necessary to evaluate the long-term impact of resilience-building interventions on nurse well-being and patient care.
References
Zhang B, Tao H, Xie M, Zhang J, Zhang M, Zhang Y. Factors associated with professional identity among ICU nurses during COVID-19: A cross-sectional study. Nurs Open. 2023;10(8):5701-10. doi:10.1002/nop2.1817.
Jackson D, Firtko A, Edenborough M. Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review. J Adv Nurs. 2007;60(1):1–9. doi:10.1111/j.1365-2648.2007.04412.x.
Gillespie BM, Chaboyer W, Wallis M. Development of a theoretically derived model of resilience through concept analysis. Contemp Nurse. 2007;25(1-2):124–35. doi:10.5172/conu.2007.25.1-2.124.
Donkers MA, Gilissen VJHS, Candel MJJM, van Dijk NM, Kling H, Heijnen-Panis R, et al. Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study. BMC Med Ethics. 2021;22(1):73. doi:10.1186/s12910-021-00641-3.
Latimer AL, Otis MD, Mudd-Martin G, Moser DK. Moral distress during COVID-19: The importance of perceived organizational support for hospital nurses. J Health Psychol. 2023;28(3):279-92. doi:10.1177/13591053221111850.
Liang Y, Wu K, Zhou Y, Huang X, Zhou Y, Liu Z. Mental Health in Frontline Medical Workers during the 2019 Novel Coronavirus Disease Epidemic in China: A Comparison with the General Population. Int J Environ Res Public Health. 2020;17(18):6550. doi:10.3390/ijerph17186550.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2019;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976.
Hassan EA, Elsayed SM. Exploring resilience in critical care nursing: a qualitative inquiry into continuous adaptation, collaborative unity, and emotional balance. BMC Nurs. 2025 Mar 3;24(1):238. doi:10.1186/s12912-025-02844-0.
Green AA, Kinchen EV. The Effects of Mindfulness Meditation on Stress and Burnout in Nurses. J Holist Nurs. 2021. doi:10.1177/08980101211015818.
Henshall C, Davey Z, Jackson D. Nursing resilience interventions-A way forward in challenging healthcare territories. J Clin Nurs. 2020;29(19-20):3597-9. doi:10.1111/jocn.15276.
Grimes K, Matlow A, Tholl B, Dickson G, Taylor D, Chan MK. Leaders supporting leaders: Leaders' role in building resilience and psychologically healthy workplaces during the pandemic and beyond. Healthc Manage Forum. 2022;35(4):213-7. doi:10.1177/08404704221090126.
Maben J, Bridges J. Covid-19: Supporting nurses' psychological and mental health. J Clin Nurs. 2020;29(15-16):2742-50. doi:10.1111/jocn.15307.
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53. doi:10.1111/j.1365-2648.2005.03621.x.
Alharbi J, Jackson D, Usher K. Personal characteristics, coping strategies, and resilience impact on compassion fatigue in critical care nurses: A cross-sectional study. Nurs Health Sci. 2019. doi:10.1111/nhs.12650.
Jun J, Costa DK. Is It Me or You? A Team Approach to Mitigate Burnout in Critical Care. Crit Care Nurs Clin North Am. 2020;32(3):395-406. doi:10.1016/j.cnc.2020.05.003.
Cadge W, Lewis M, Bandini J, Shostak S, Donahue V, Trachtenberg S, et al. Intensive care unit nurses living through COVID-19: A qualitative study. J Nurs Manag. 2021;29(7):1965–73. doi:10.1111/jonm.13353.
Stutzer K, Rodriguez AM. Moral Resilience for Critical Care Nurses. Crit Care Nurs Clin North Am. 2020;32(3):383-93. doi:10.1016/j.cnc.2020.05.002.
Guttormson JL, Calkins K, McAndrew N, Fitzgerald J, Losurdo H, Loonsfoot D. Critical Care Nurse Burnout, Moral Distress, and Mental Health During the COVID-19 Pandemic: A United States Survey. Heart Lung. 2022;55:127-33. doi:10.1016/j.hrtlng.2022.04.015.
Almeida C, Poeira AF. Burnout in Nurses of an Intensive Care Unit during COVID-19: A Pilot Study in Portugal. Healthcare (Basel). 2023;11(9):1233. doi:10.3390/healthcare11091233.
Brown L, Haines S, Amonoo HL, Jones C, Woods J, Huffman JC, et al. Sources of Resilience in Frontline Health Professionals during COVID-19. Healthcare (Basel). 2021;9(12):1699. doi:10.3390/healthcare9121699.
Zenani NE, Gause G, Sehularo L. Strategies to enhance resilience to cope with workplace adversities post-COVID-19 among ICU nurses. Curationis. 2022;45(1):e1-8. doi:10.4102/curationis.v45i1.2345.
Jackson J, Vandall-Walker V, Vanderspank-Wright B, Wishart P, Moore SL. Burnout and resilience in critical care nurses: A grounded theory of Managing Exposure. Intensive Crit Care Nurs. 2018. doi:10.1016/j.iccn.2018.07.002.
Othman SY, Hassan NI, Mohamed AM. Effectiveness of mindfulness-based interventions on burnout and self-compassion among critical care nurses caring for patients with COVID-19: a quasi-experimental study. BMC Nurs. 2023;22(1):305. doi:10.1186/s12912-023-01466-8.
Babanataj R, Mazdarani S, Hesamzadeh A, Gorji MH, Cherati JY. Resilience training: Effects on occupational stress and resilience of critical care nurses. Int J Nurs Pract. 2018; e12697. doi:10.1111/ijn.12697.
Ar?kan A, Esenay FI. Compassion fatigue and burnout in Turkish pediatric emergency nurses during the COVID-19 pandemic. J Pediatr Nurs. 2023;71:120-6. doi:10.1016/j.pedn.2022.11.004.
Goktas S, Gezginci E, Kartal H. The Effects of Motivational Messages Sent to Emergency Nurses During the COVID-19 Pandemic on Job Satisfaction, Compassion Fatigue, and Communication Skills: A Randomized Controlled Trial. J Emerg Nurs. 2022;48(5):547-58. doi:10.1016/j.jen.2022.06.001.
Alsaeed D, Al-Ozairi A, Alsarraf H, Albarrak F, Al-Ozairi E. Are we ready for the next pandemic? Lessons learned from healthcare professionals' perspectives during the COVID-19 pandemic. Front Public Health. 2023;30(11):1048283. doi:10.3389/fpubh.2023.1048283.
Lopez J, Bindler RJ, Lee J. Cross-Sectional Analysis of Burnout, Secondary Traumatic Stress, and Compassion Satisfaction Among Emergency Nurses in Southern California Working Through the COVID-19 Pandemic. J Emerg Nurs. 2022;48(4):366-75.e2. doi:10.1016/j.jen.2022.03.008.
Purvis TE, Saylor D. Burnout and Resilience Among Neurosciences Critical Care Unit Staff. Neurocrit Care. 2019. doi:10.1007/s12028-019-00822-4.
Alqahtani AM, Awadalla NJ, Alsaleem SA, Alsamghan AS, Alsaleem MA. Burnout Syndrome among Emergency Physicians and Nurses in Abha and Khamis Mushait Cities, Aseer Region, Southwestern Saudi Arabia. Sci World J. 2019;18:4515972. doi:10.1155/2019/4515972.
Talebian F, Hosseinnataj A, Yaghoubi T. The Relationship between Resilience and Moral Distress among Iranian Critical Care Nurses: A Cross-sectional Correlational Study. Ethiop J Health Sci. 2022;32(2):405-12. doi:10.4314/ejhs.v32i2.21.
Hasan F, Daraghmeh T, Jaber M, Shawahna R. Prevalence of burnout syndrome among anesthesiologists, anesthesia technicians, and intensive care unit nurses in Palestinian hospitals: a cross-sectional study. BMC Psychiatry. 2024;24(1):740. doi:10.1186/s12888-024-06196-y.
Alvares MEM, Thomaz EBAF, Lamy ZC, Nina RVAH, Pereira MUL, Garcia JBS. Burnout syndrome among healthcare professionals in intensive care units: a cross-sectional population-based study. Rev Bras Ter Intensiva. 2020;32(2):251-60. doi:10.5935/0103-507x.20200036.
Córdova-Martínez A, Pérez-Valdecantos D, Caballero-García A, Bello HJ, Roche E, Noriega-González D. Relationship between Strength and Professional Quality of Life of Nurses Working Hospital Emergency Departments. Int J Environ Res Public Health. 2023;20(3):2052. doi:10.3390/ijerph20032052.
Botha E, Gwin T, Purpora C. The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI Database Syst Rev Implement Rep. 2015;13(10):21–9. doi:10.11124/jbisrir-2015-2380.
Alzailai N, Barriball L, Xyrichis A. Burnout and job satisfaction among critical care nurses in Saudi Arabia and their contributing factors: A scoping review. Nurs Open. 2021;8(5):2331-44. doi:10.1002/nop2.843.
Bodini L, Bonetto C, Cheli S, Del Piccolo L, Rimondini M, Rossi A, et al. Effectiveness of a Mindful Compassion Care Program in reducing burnout and psychological distress amongst frontline hospital nurses during the COVID-19 pandemic: a study protocol for a randomized controlled trial. Trials. 2022;23(1):734. doi:10.1186/s13063-022-06666-2.
Giannetta N, Villa G, Bonetti L, Dionisi S, Pozza A, Rolandi S, et al. Moral Distress Scores of Nurses Working in Intensive Care Units for Adults Using Corley's Scale: A Systematic Review. Int J Environ Res Public Health. 2022;19(17):10640. doi:10.3390/ijerph191710640.
Friganovi? A, Seli? P. Where to Look for a Remedy? Burnout Syndrome and its Associations with Coping and Job Satisfaction in Critical Care Nurses-A Cross-Sectional Study. Int J Environ Res Public Health. 2021;18(8):4390. doi:10.3390/ijerph18084390.
de Azevedo Bringel JM, Abreu I, Muniz MMC, de Almeida PC, Silva MG. Health Professionals' Chronotype Association with Salivary Cortisol and Occupational Stress in Neonatal Intensive Care Units. Int J Environ Res Public Health. 2023;20(9):5683. doi:10.3390/ijerph20095683.
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