The Heart of Resilience: Theoretical Support for Student Nurses

John V. Yuhas
Edson College of Nursing and Health Innovation, Arizona State University

We are rapidly approaching the end of what the World Health Assembly designated as the International Year of the Nurse and Midwife. This comes in recognition of the 200th anniversary of Florence Nightingale’s birth on May 20, 1820. While the current pandemic has likely become one of the most challenging moments in nursing history, it has also been a time of great inspiration, hope, and pride within the profession. The COVID-19 pandemic has encouraged the nursing community to pause and reflect upon the historical foundations that have shaped our practice. How appropriate that we reflect upon Florence Nightingale, who grounded clinical standards of documentation, infection control and autonomy in a time of war. At every level of nursing, now is a moment to take great pride in our rich history and the history we are presently creating.

            Today, student nurses are navigating the already complex paradigm of the profession with the added challenges of cancelled clinical rotations, distance learning, modified graduate projects, research restrictions, isolation from supportive cohorts, and personal commitments. However, buried below the rigor of this curriculum lies the heart of resiliency, adaptation and self-transcendence. Turning to the great nursing theorists of our time offers keen insight to help restore balance in our work by elevating the importance of self-inquiry and spiritual development. This work is equal in its value to our clinical acumen and yet so often gets overlooked because we may not see it on a board exam. Now more than ever, there is a growing need to develop, nurture, and reconnect with the heart of nursing through these theoretical foundations.

            In her 1895 book Notes on Nursing, Nightingale defined the practice as putting the person in the best condition for nature to act, insisting that the focus of nursing was on health and the natural healing process, not on disease or reparation (Smith & Parker, 2015, p.4). While this definition has powerful implications in supporting our patients, it also calls upon us to evaluate our own personal surroundings and to focus on self-health and healing. Our commitment to this work holds powerful evidence-based rewards that enhance our scope of practice, translating to rewarding patient-centered care. As we continue to navigate the current challenges of a pandemic and the commitment to advancing our practice, the nursing Theory of Self-Transcendence inspires inquiry and practices that promote well-being in the face of difficult life situations (Smith & Liehr, 2014).

            Developed by Dr. Pamela Reed, a professor in the College of Nursing at the University of Arizona, the Theory of Self-Transcendence offers a framework to build resilience in our patients, colleagues and ourselves even in the darkest of hours. The theory builds upon two core assumptions. First, human beings are integral to their environment. Reed works from the concept of pandimensionality defined as the unbound connections in the human-environment process. The second assumption is that self-transcendence is a developmental imperative. Reed defines self-transcendence as expanding and redefining self-boundaries during health events and is evident in connections to our inner life, to others, and to imagined worlds (Smith & Parker, 2015). In Reed’s model, contextual factors that can influence the relationship among core concepts of vulnerability, well-being and self-transcendence include age, gender, ethnicity, education, illness intensity, social or spiritual support. When increased awareness of one’s own vulnerability becomes triggered through difficult life situations, positive inner strength (self-transcendence) is activated, creating well-being.

            This is where the nurse plays a key role in assisting patients along the path of expanding self-boundaries in the following four key areas: Intrapersonal where one builds greater awareness around beliefs, values and dreams; Interpersonal by deepening a connection to others, nature and the surrounding environment; Transpersonal, relating to dimensions beyond the ordinary observable world; and Temporally by integrating one’s past and future in way that gives meaning to the present (Smith & Parker, 2015). Nurses can help facilitate this journey for their patients and importantly for themselves through endless modalities including prayer, meditation, journaling, physical practices, support groups, volunteer work, group psychotherapy and creating environments of spiritual exploration. All of this begins to shift vulnerability with a powerful movement towards self-transcendence and well-being.

            As nursing students and practitioners working during this turbulent moment in history, we are so fortunate to draw upon the great theoretical work of our predecessors to remind us of the true heart of nursing. Our resiliency individually and as a profession is steeped in a rich tradition of care, compassion, empathy, and healing. Over the course of our profession we rely on gentle reminders to turn our attention inward. Taking inventory of our fluctuating vulnerability across the lifespan is indeed the seed of our expansion, resilience and overall well-being.

 References

Smith, M. J., & Liehr, P. R. (2014). Middle range theory for nursing. http://public.eblib.com/choice/publicfullrecord.aspx?p=1182694

Smith, M. C., & Parker, M. E. (Eds.). (2015). Nursing theories & nursing practice (Fourth edition). F.A. Davis Company.