As a result of analyzing the collected data, eight categories were derived and then divided into two groups: perception, which represents a cognitive process, and strategy, which represents a process for transitioning to concrete implementation. Perception confirmed the process in which the subjects in difficulty became aware of the situation, thought about their responsibility to the patient and their own values, and became confident about problem-solving while considering their inner strength and growth. Strategy consisted of the process of evaluating oneself and one’s environment to discover the possibility of problem-solving, taking care of oneself first so as to remain strong, and finding a way to solve problems and grow one step further.
Categories in perception of the ways NH nursing staffs demonstrate resilience
Four categories were found under the perception of NH nursing staff resilience: grasping the situation, thinking about one’s responsibility for the resident and personal values, considering one’s strengths, and thinking of an improved self.
Category P1: Grasping the situation. When NH nursing staff were faced with a difficult situation, they first tried to find out what the situation was and its cause(s). They sought to determine whether the difficulty was caused by some specific situation, the environment, or themselves. Having awareness of the situation was crucial for setting their future direction in problem-solving.
There is too much work and too much complexity going on around me. In any difficult situation, the most important thing is to know why it happened. If I don't recognize the reason, it will mix with other situations, and I won't be able to identify it [Participant 3].
Category P2: Thinking about one’s responsibility for the resident and personal values When the nursing staff found themselves in a difficult situation, they thought of the residents and worried about the residents who would not be cared for. Since their job is to provide care for residents, they tried to do their best to fulfill their duties, even when they were difficult. Additionally, they recalled their values and beliefs while determining what they ought to do.
Due to the resignation of a coworker, I was forced to work excessive overtime. There were many days when I didn't want to go to work, but all I could think about were the faces of our patients. I pity them if I don't show up for work. The patients do nothing wrong. I persevere and overcome every time I think of my patients [Participant 5].
Since I was a child, I've been trained to be responsible, that whatever I do carries with it the burden of accountability. And, because having fun is crucial in any work, I strive to laugh and have fun when I'm having a bad day. It is quite effective [Participant 12].
Category P3. Considering one’s strength Nursing staffs strove to uncover their strengths in tough situations. They believed this was their fundamental ability to overcome obstacles and were sure that they could do so on their own.
As I faced numerous challenges, I recognized that responding to difficult events one by one would be more difficult. These trying times strengthened me. With patience, I look after my inner self. This approach allows me to see the situation objectively and concentrate entirely on myself [Participant 7].
Category P4. Thinking of an improved self Nursing staff found that developing and improving themselves were very helpful in overcoming difficult situations. They encouraged themselves not to give up, envisioning themselves as better off in the future. They studied more about the elderly and nursing, tried to show a more developed image, and thought about how to provide better caring to residents. To accomplish that, they thought they had to study and learn more. In addition to these occupational perspectives, they continued to strive to remain physically and mentally healthy human beings.
Inner growth, in my opinion, is attained via the process of overcoming adversity. Furthermore, I believe that the desire to grow, especially in the face of adversity, is the driving force behind issue solutions. To overcome obstacles, I believe that a goal must be set and that the objective must be forward-looking. I used to make a lot of mistakes when I was caring for patients, and I was angry because I thought I didn't have any qualifications. I thought at the time that I should learn more about nursing and expand my expertise [Participant 19].
Categories in strategy for supporting NH nursing staffs resilience It was identified that the strategy behind NH nursing staff resilience included four categories: Evaluation of oneself and one’s environment, taking care of oneself, finding concrete ways to manage the problem, and self-development for growth.
Category S1. Evaluation of oneself and one’s environment. For problem-solving purposes, the nursing staff evaluated themselves and their surroundings. To confront difficulties, they needed to figure out how much problem-solving capacity they and their environment possessed, as well as what resources were available to them. This is the most basic step in developing a plan, and the future course was determined based on this assessment.
It's important to know what level of problem-solving abilities I have, whether I'm in a supportive setting, and what kind of assistance I can get. I won't be able to solve anything if it is beyond my capabilities. First and foremost, I must gain a better understanding of myself and my environment in order to establish concrete plans for the future.
Category S2. Taking care of oneself. The nursing staffs respected themselves and believed that in order to get through the crisis, they first needed to take care of themselves. Through doing so, they attempted to improve their inner strength. They looked back on their prior experiences and sought to develop their strengths with the belief that they could overcome things on their own. Furthermore, they bolstered themselves with positive energy to avoid being overcome.
There was a moment when the patient's family was quite upset with me because I was not taking proper care of the patient, and I was hurt. I was crying a lot and having a terrible time, but whenever I'm exhausted, I remember that period. Even when things are difficult, I strive not to cry. I try to keep my mind in check so that I don't injure myself or that my heart becomes too hard. I believe in taking care of my inner self and strengthening it to prevent it from collapsing [Participant 1].
Category S3. Finding concrete ways to manage the problem. The nursing staffs devised specific solutions to the situation. They devised their own approaches for dealing with stress and common problems while developing bonds with their coworkers. Work-life balance was achieved by clearly separating work and personal life. These practical methods directly aided them in resolving their problems.
I try not to think about work when I get home. At home, I take time to unwind and heal while focusing only on myself [Participant 20].
Conversations with coworkers provide me great relief. To relieve stress, I normally get together with my coworkers after work and talk for a while. After discussing the tense situation, I begin to believe that serious work is not such a big deal. That is why I enjoy socializing with my coworkers [Participant 2].
Category S4. Self-development for growth. The nursing staffs devised ways toward personal growth based on the development of a stable live. They didn't merely consider how to deal with emergencies and challenges, but instead aspired to live a life of gradual development. They attempted to live lives that progressed by gaining information and expertise while also discovering particular strategies for improving themselves. In addition, they had concrete plans for the future.
For the future, I have particular plans. Life planning, in my opinion, is similar to constructing the skeleton of a building. No matter how difficult things are right now, if I have a clear strategy and vision, I will be on the correct track one day [Participant 17].
I want to write a book on my life. I feel that the difficult things I'm going through right now are laying the groundwork for me to achieve my goals in the future. That is why I try to keep a diary and write down both the good and bad days [Participant 9].
I'm studying and learning a lot in the hopes of one day becoming a nursing facility administrator. In two years, I intend to attend graduate school. It's a lot of fun to devote time to my personal development [Participant 10].