Blackwell Science, LtdOxford, UKINMInternational Journal of Mental Health Nursing1445-83302005 Blackwell Publishing Asia Pty Ltd142142148Feature ArticleTHE PHENOMENON

OF RESILIENCEK.-L. EDWARD

International Journal of Mental Health Nursing (2005) 14, 142148

Feature Article
The phenomenon of resilience in crisis care mental
health clinicians
Karen-leigh Edward
School of Nursing, Faculty of Health and Behavioural Sciences, Deakin University, Burwood, Auastralia

ABSTRACT: The purpose of this study, undertaken in 2003, was to explore the phenomenon of
resilience as experienced by Australian crisis care mental health clinicians working in a highly
demanding, complex, specialized and stressful environment. For the purpose of this research, the term
resilience was defined as the ability of an individual to bounce back from adversity and persevere
through difficult times. The six participants for this study were drawn from Melbourne metropolitan
mental health organizations the disciplines of nursing, allied health and medicine. A number of
themes were explicated from the participants interview transcripts Participants identified the
experience of resilience through five exhaustive descriptions, which included: The team is a protective
veneer to the stress of the work; Sense of self; Faith and hope; Having insight; and Looking after
yourself. These exhaustive descriptions were integrated into a fundamental structure of resilience for
clinicians in this role. The studys findings have the potential to inform organizations in mental health
to promote resilience in clinicians, with the potential to reduce the risk of burnout and hence staff
attrition, and promote staff retention and occupational mental health.
KEY WORDS: community psychiatric nursing, education and practice development, mental health
care, phenomenology.

INTRODUCTION Resilience defined

This paper presents the phenomenological methodology The term resilience has been described as springing
and findings of a study undertaken in 2003 exploring the back, rebounding, returning to the original form or posi-
phenomenon of being resilient as experienced by crisis tion after being bent, readily recovering, [and] buoyant
care mental health clinicians in mental health services in (The Oxford Modern English Dictionary 1996, p. 864),
the Melbourne metropolitan area, Australia. This paper [and] ability to rise above difficult situations (Criss et al.
will, in the first instance, offer a definition for resilience; 2002). For the purpose of this research the term resil-
a background to the study that was undertaken will be ience is defined as the ability of an individual to bounce
provided in order to provide a context for the findings; a back from adversity, persevere through difficult times,
brief overview of the method used and the results of the and return to a state of internal equilibrium or a state of
study will be presented. The paper concludes with some healthy being (Brodkin & Coleman 1996; Henderson
suggestions for future research. 1998).
Over a number of years I have worked in a range of
mental health-care settings, including the specialized area
Correspondence: Karen-leigh Edward, School of Nursing, Faculty of psychiatric crisis care. Psychiatric crisis intervention is
of Health and Behavioural Sciences, Deakin University, 221 Burwood recognized as a highly complex, specialized and demand-
Highway, Burwood, Australia. E-mail: kedward@deakin.edu.au
Karen-leigh Edward, RPN, BN, Grad Dip Psych, MHSc. ing area of clinical practice. Mental health clinicians
Accepted November 2004. working in the area of crisis care are required to act
THE PHENOMENON OF RESILIENCE
autonomously within the parameters of their role, which
is primarily concerned with facilitating a seamless, appro-
priate and timely mental health service to clients in the
least restrictive manner (DHS 1986). Service provision
for people in crisis, therefore, occurs within a stringent
legal framework as outlined by the Mental Health Act
of Victoria (1986). Examples of such crisis situations
include: life-threatening events including attempted/suc-
cessful suicide, exacerbation of acute psychotic symptoms
resulting in potential harm to the person or others, and
domestic violence as a result of a psychiatric illness, such
as a person experiencing symptoms of paranoid schizo-
phrenia (Davison & Neale 2001). The nature of such
complex and often unpredictable situations accompanied
by the ever-present potential risk of harm is an added
stressor on the mental health clinician in intervening in
such crises. Given the level of stress of such a work envi-
ronment, the potential risk for burnout is considered
by many researchers as extremely high in Australia
(Armstrong 2002; Lilly 2002; RANZCP 2002).
Despite the unrelenting and demanding nature of
psychiatric crisis care work, many of my professional
colleagues who entered this field 1020 years ago have
not succumbed to the pressure of the workplace but
rather, have continued to remain enthusiastic, empathic
and skilled in their clinical approach to care, while others
became burnt-out (i.e. to make or become exhausted,
especially as a result of long-term stress (Skovholt 2001)).
This situation seemed to be more than coping in a stress-
ful moment. These clinicians appeared to have an ability
to move beyond the stressors of the moment time and
time again. Witnessing such an ability ignited in me a
process of questioning about the essential nature of what
I was seeing and what I believed was resilience. As a
means of expanding a taken-for-granted understanding
of this phenomenon, I engaged in a search of the litera-
ture for further enlightenment about the topic.
Literature review
The notion of resilience has been the focus of study for
many years with the vast majority of the research relating
to this topic being located within the quantitative para-
digm. Resilient behaviours have been explored through a
descriptive and exploratory correlational design to look at
the relationship of resilience in homeless adolescents
(Rew et al. 2001); another study examined whether there
was a correlation between personality constructs in rela-
tion to adolescent behaviour and resilience (Hart et al.
1997); resilience has also been explored using a combina-
tion of questionnaire and observational measures to
investigate the additive and interactive effects of multiple
143
risk, emotionality and self-regulation in predicting chil-
drens adjustment problems and positive adjustment
(Lengua 2002); Criss et al. (2002) used a descriptive,
exploratory correlational design with regression analysis
to explore a longitudinal perspective on risk and resilience
in relation to family adversity; resilience has been
explored by an examination of age differences in
perceived coping resources and satisfaction with life
(Hamarat et al. 2002; Himelein and McElrath 1996)
examined cognitive coping strategies associated with
resilience in a nonclinical sample of children who had
been sexually abused.
From a qualitative perspective, there appears to be
fewer research studies undertaken when compared to
quantitative studies pertaining to the topic of resilience.
Examples of available research on the phenomenon of
resilience follows: a qualitative analysis was conducted
concerning resilient factors in people who have a history
of experiencing violence in the family (Humphreys 2001);
and a qualitative examination of the phenomenon of resil-
ience among formerly incarcerated adolescents in an
attempt to capture the essence of that particular lived
experience (Todis et al. 2001).
Resilience appears to have been explored to a great
degree in children and adolescents in terms of looking at
resilient behaviours in the face of adversity in this age
group. The results of such research provides suggestions
for educators and supportive communities for youth who
have experienced trauma, family dysfunction and other
forms of adverse life events (Todis et al. 2001; Wang et al.
1997; Werner 1993; Werner & Smith 1982, 1992; Wolin
& Wolin 1993). After a search of Proquest, Ovid, Gale
Journals online, Harvard Business Review, Blackwell Syn-
ergy and Medline, no Australian-based published works
on the phenomenon of resilience in clinicians working in
the area of crisis care were found.
Contribution of the study
The findings of this study have the potential to provide
further insight and understanding about the phenomenon
of resilience through the perspective of crisis care clini-
cians in mental health; additionally the findings have
the potential to contribute to extant knowledge of this
phenomenon.
The outcomes of this study have the prospect to con-
tribute to crisis care clinicians knowledge of resilience
through the inclusion of such information in teaching
modules and clinical role modelling for clinicians working
in complex, demanding and stressful work environments.
And finally, the findings of this study may offer a basis for
future research into the nature of resilience.
144
METHOD
Focus of the study
The central question that gave focus to this study was:
How do you experience personal management of the
stresses, complexities and demands of your role as a crisis
care mental health clinician? Further questioning
throughout the interview process was recursive in nature
as a means of eliciting in-depth information and to act as
points of clarification.
Participant selection
As the purpose of this study was to explore whether there
is a phenomenon of resilience for this particular partici-
pant group, the researcher did not assume that partici-
pants had a previous experience of resilience. Participants
who met the following inclusion criteria were invited to
take part in this study. The inclusion criteria were:
Participants over the age of 18 years.
Currently working in mental health crisis care.
The participants in this study were all experienced
practising crisis care clinicians in mental health. This
studys participants undertake crisis assessment, interven-
tion and consultation in mental health in a range of set-
tings, some of which are as follows: clients home, the
emergency department of a hospital, police station, other
community venue, and within another health-care
service.
Six participants took part in this study. All participants
were mental health clinicians currently working in the
area of mental health crisis care in the Melbourne met-
ropolitan region. Of the six participants, five were female
and one was male. The participants were recruited from
the disciplines of nursing [four participants], allied health
[one participant] and medicine [one participant].
Accessing the participants
The process of professional networking was employed as
a means of inviting potential participants those who met
the inclusion criteria to be part of this study. Of the six
participants, four were approached in person and two by
phone. At the point of initial contact, each person was
given a brief overview of the focus of the study the
focus, time commitment of participants, and the need for
them to be interviewed. Those who expressed interest in
participating were invited to meet with this researcher at
which time a more comprehensive overview of the
intended study, both verbally and in writing, was pro-
vided. Potential participants who continued to express
interest in being part of the study were invited to attend
K.-L. EDWARD
an interview for the purpose of sharing their experiences
of being resilient. After the interview, a follow-up time
was made with the participant to review their significant
statements and the fundamental structure of the phe-
nomenon for the purpose of validation.
Information gathering
Information was gathered through in-depth focused, indi-
vidual interviews lasting between 30 and 60 min. The
interviews, which were tape-recorded, were conducted at
a mutually agreed time and place. Four participants
wished to be interviewed at their place of work, while two
participants preferred to be interviewed at their home
residence. Prior to commencing the interviews, I spent
time in quiet general conversation with each of the par-
ticipants as a means of creating a comfortable environ-
ment in which the participants would feel at ease talking
about their experiences. This type of interview was
directed towards understanding the participants experi-
ences in their own words. Participants were encouraged
to speak freely about their personal experience of resil-
ience in the context of their experiences in working in
mental health crisis care. As each interview was audio-
taped it allowed the researcher to actively listen to each
participant while providing an accurate account of each
persons lived experience.
For the purpose of obtaining a full understanding of
the phenomenon under investigation, I reiterated the
term resilient as defined for the purposes of this study
and asked each participant: What has been your experi-
ence of being resilient as a crisis care clinician in the area
of mental health?
Prompting questions used to encourage the partici-
pants to elaborate on their experiences were: Tell me
about your thoughts and feelings relating to these expe-
riences? and What strategies of resilience did you use?
I felt that each participant appeared comfortable with
the process as demonstrated by the depth of information
received. The participants were also reminded that I
would contact them once transcription and analysis was
completed. Each participant was provided with contact
details and encouraged to contact me if they felt the
need.
Information analysis
Information analysis was undertaken using Colaizzis
(1978b) seven-step approach. The outline of the seven-
step approach to analysis is as follows:
THE PHENOMENON OF RESILIENCE
1. Transcribing all the subjects descriptions.
This included direct transcription of the participants
narratives from the audio tape used to collect their
experiences.
2. Extracting significant statements.
This section of analysis produced 191 significant state-
ments. Significant statements were those made by par-
ticipants that related specifically to resilience.
3. Creating formulated meanings.
Significant statements were assigned with meanings
by the researcher according to Colaizzis (1978b)
methodology.
4. Aggregating formulated meanings into clusters.
Formulated meanings were then grouped into cluster
groups.
5. Writing exhaustive descriptions.
Descriptions were written related to the cluster
groups. These descriptions were exhaustive in that
they included all elements grouped into a narrative in
order to capture the essence of what participants
intended.
6. Identifying the fundamental structure of the concept.
The fundamental structure is a compilation of all
exhaustive descriptions into a narrative that describes
the essential elements of resilient behaviours identi-
fied by the participants.
7. Returning to subjects for validation.
In Colaizzis (1978b) method of phenomenological
analysis, validation of the narratives from participants
is an important step. This particular stage allows par-
ticipants to correct any material that is perceived by
them as incorrect. Validation of the essence of the
phenomenological description occurred for partici-
pants following extraction of significant statements for
individual participants. Returning to participants for
validation also occurred after the fundamental struc-
ture was compiled (Colaizzi 1978a,b).
Ethical considerations for this study
Informed consent approval for proceeding with this
study was received through RMIT University Ethics
Committee, Victoria, Australia. Each participant received
a full explanation both verbally and in writing about the
studys purpose, the information gathering process, time
commitment of participants, assurances of anonymity and
confidentiality, their right to withdraw at any time without
prejudice, and that the findings of this study will be pub-
lished at the completion of the inquiry. Written informed
consent was obtained prior to commencement of the
interview.
145
Confidentiality
Participants were informed that tape-recorded material
would be only accessed by my academic supervisor and I
for the purpose of recording experiences and analysis of
the data. The participants were also informed that on
completion of the analysis process the tape-recorded nar-
ratives would be returned to the institution for storage.
Participants were informed that any names or places
would not be used in the final transcriptions and would
thus be withheld in the final presentation of the paper.
Each participant chose their own pseudonym for the
purpose of maintaining confidentiality. The pseudonyms
have been withheld in the final presentation of the paper.
Participants were recruited from four different mental
health services that were not directly service connected
in order to provide confidentiality for participants given
the small number of staff working in these facilities.
Storage of information
On completion of this study, all information obtained
from the participants in the form of audio-transcriptions
was returned to the institution for storage.
Level of risk
Participants were asked to share personal information in
relation to their experience of resilience. Given the per-
sonal nature of what was being asked of the participants,
I believed that the potential existed for participants to
experience some discomfort while reflecting on their
experiences. In consideration of such a situation occur-
ring a number of strategies were set in place: all partici-
pants were informed prior to interview that they could
withdraw from the study at any time without prejudice,
and that any information they had provided would not be
used unless their explicit permission was obtained.
Debriefing was to be offered if requested or otherwise
indicated as required by participants in the first instance.
If ongoing debriefing or counselling was required by
participants, the researcher would broker and link the
individual to an appropriate service provider.
Rigour of the study
Phenomenology is based on the belief that experience can
be translated only by the individual who has lived it, and
is used as a research method to determine what an expe-
rience means for the persons who have had the experi-
ence and are able to provide a comprehensive description
of it (Rice & Ezzy 1999; p. 16). Sandelowski (1993)
argues that reliability of the individuals descriptions and
reviewing are threats to validity in qualitative inquiry.
According to Sandelowski (1993) descriptions are
146
memories of past events that are told in the present
moment and the participants often change their descrip-
tions from one account to the next, however, in reality it
is the same experience retold as if a new experience.
Rigour in qualitative research is believed to be more
about fidelity or trustworthiness of the essence of a phe-
nomenon (Sandelowski 1993). Research undertaken by
Guba and Lincoln (1985, 1989), which examined rigour
in qualitative analysis, posited that trustworthiness of the
information allows for greater accuracy (Guba & Lincoln
1985, 1989; Rice & Ezzy 1999; Sandelowski 1993). This
concept has been endorsed by other qualitative research-
ers (Brink 1991; Giorgi 1992; Holloway & Wheeler 1997;
Koch 1994; Morse & Field 1995; Parse 2001; Parse et al.
1985; Rice & Ezzy 1999; Sandelowski 1993), and in this
context Guba and Lincolns (1985, 1989) model offered a
general framework for assessing trustworthiness of qual-
itative information, which consists of credibility, transfer-
ability, dependability and confirmability, and was the
framework used in this research.
RESULTS
Phrases and statements directly pertaining to resilience
were considered significant statements and extracted
from each of the participants interview transcripts in
keeping with Colaizzis (1978b) analysis process. This pro-
cess produced 191 significant statements, examples of
significant statements are presented in Table 1.
Consistent with Colaizzis methodology (Colaizzi
1978a,b), formulated meanings were assigned to each sig-
nificant statement. These formulated meanings were
sorted into groups that represented specific theme clus-
ters (Table 2), and the aggregated theme clusters were
then referred back to the original significant statement in
order to validate them (Colaizzi 1978a,b).
TABLE 1: Example of significant statements
Debriefing with the team/with colleagues is important to keeping my
anxieties down.
[Keeping work and home separate is important to keeping stress down].
I can leave work and its gone most of the time and I find this keeps
my anxieties down.
The other way I continue to try to deal with stress and crisis pressure
is the use of humour. I remember that consumers are also human and
that if I was in their position I would like it and so I try to include in
the conversation some more light-hearted conversation to help the
person feel happier. It is also a good way to release the anxiety in the
situation and the stress you or the client are under to talk about
something good and share a bit of a laugh.
I think on a personal level it [resilience] is about building up your
credibility and confidence in a team.
K.-L. EDWARD
The next step in the analysis process (Colaizzi 1978a,b)
involved integrating the significant statements, the for-
mulated meanings, and the clusters of themes into a nar-
rative description of the phenomenon of resilience as
experienced by the participants in this study.
There were four descriptions of resilience that
emerged as experienced by the crisis care clinicians in
mental health who participated in this research (Table 3).
The final step in the analysis described a statement of
the fundamental structure of the phenomenon under
investigation. The fundamental structure of the phenom-
enon of resilience on crisis care mental health clinicians
in mental health is achieved through analysis and is an
integration/blending of the phenomenons components as
documented in the descriptions.
TABLE 2: The eight theme clusters that emerged throughout this
process
Having nonwork-related support or tasks can reduce anxiety and bolster
resilience.
Resilience is fostered through professional development.
Resilience is experienced when you have insight into the work you do.
Resilience is a result of using creativity, flexibility and humour in your
work.
Resilience is promoted through having a sense of faith, advocating for
others and having a sense of morality.
Resilience is a product of experience, clinical expertise, a sense of
autonomy, responsibility and confidence.
Resilience is promoted through support at work.
Resilience in crisis care is associated with keeping work separate from
home.
TABLE 3: Descriptions of resilience that emerged
1. Being resilient in crisis care roles in mental health is consistent with
having a sense of self, the clinicians level of experience, clinical
expertise, confidence, flexibility, creativity with clinical situations and
the ability to take on the responsibilities associated with the role of
crisis work in an autonomous and accountable way.
2. Resilience is connected with having a sense of faith, advocating for
another and using an empathic and humanistic (client-centred)
approach. Crisis care clinicians in mental health feel less work-
related tension or anxiety (and as a result feel more resilient) when
they felt they had made a positive contribution in their clinical role.
3. Resilience is experienced when you have insight into your clinical
role. This can be achieved through feedback, introspective analysis,
professional development and comprehensive dissemination of
work-related information.
4. Looking after oneself in terms of exercise, relaxation, having a
balanced diet, getting adequate sleep, having a good social network
or having hobbies promotes a sense of well-being and in
consequence facilitates greater opportunities for resilient behaviour
for work-related stressors.
THE PHENOMENON OF RESILIENCE
IMPLICATIONS OF THE STUDYS FINDINGS
Resilient behaviour is a valued quality in todays stressful
and changing health-care world, given the current prob-
lems associated with retention and recruitment of health-
care professionals in Australia (Armstrong 2002; Lilly
2002; RANZCP 2002). When working in the complex,
highly specialized and stressful environment of crisis care
in mental health, resilience as a coping strategy may per-
mit people to develop confidence in effectively dealing
with changes, reframing negative experiences into posi-
tive and self-enhancing ones, and creating positive
outcomes.
Providing further insight and understanding about the
phenomenon of resilience through the conceptual lens
of crisis care clinicians in mental health has the potential
to inform crisis care clinicians knowledge of resilience.
Such insights and understandings can be made available
for inclusion in professional development activities
directed towards fostering resilience in clinicians, thus
reducing the risk of burnout and staff erosion (DHS
2003).
The results of this study are intended to provide a basis
for further inquiry into the phenomenon of resilience.
Future research into the experience of resilience into
other areas of the mental health profession has the poten-
tial to add richness to the findings of this study and could
provide insight to inform or assist mental health organi-
zations in terms of training, retention, recruitment and
selection of staff for highly skilled and complex roles
within mental health.
CONCLUSION
This study focused on the meaning of resilience as
described by crisis care clinicians in the mental health
field. This research was undertaken to explore if what I
have observed in colleagues for two decades from this
service area was in fact resilience. By using Colaizzis
(1978a,b) phenomenological approach to qualitative
inquiry, valuable insights into the unique experiences of
participants was achieved. These themes were Sense of
Self, Faith and Hope, Having Insight and Looking
after Yourself. Future research into the experience
of resilience in other areas of the mental health pro-
fession has the potential to add richness to the findings of
this study, and could provide further insight to inform or
assist mental health organizations (additionally, other
broader organizations where roles for staff are complex)
in terms of training, retention, recruitment and selection
of staff.
147
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