Resilience in home and community care registered practical nurses: a scoping review

Figures & data

Figure 1. Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) flow chart.

Table 1. Data extraction of eight included articles.

Study	Type of article/Study design	Methods/Study duration	Purpose of study	Population/Participant characteristics	Setting	Inclusion/ Exclusion criteria	Key findings
Duncan (2019)	Narrative review	N/A	The objective of this paper was to discuss how the working environment can be improved for district (community) nurse teams and to foster team resilience	District nursing teams (bachelor’s degree program)	Community care, United Kingdom	N/A	Resilience is seen as the flexibility within the district nursing (DN) team to respond to changes in circumstances and demands. If the demand for DN team services is greater than the ability for the DN team to respond, resilience may be compromised. The four pressures that influence DN teams and their resilience are decreases in funding, increases in clinical and quality standards, increases in workload (caseload), and decreases in staff availability. Staff need safe caseloads, support, and professional development to exhibit resilience. District nurses cope with complexity, variety and uncertainty in their workloads. If demand and capacity are to be better aligned, the demand for DN services should be predicted and plans made accordingly, so that resources (staff numbers and professional development) are available.
Francis and Bulman (2019)	Empirical (mixed methods)	Quantitative: The Clinical Supervision Evaluation Questionnaire (CSEQ) was administered to look at nurses’ perceptions of the impact of clinical supervision. Qualitative: A follow-up focus group was done to understand nurses’ experiences of clinical supervision as it relates to resilience; Data was collected over 3 months (October to December 2017).	To explore how the implementation of a clinical supervision program might influence the development of resilience in a group of community hospice nurses	Community palliative care nurses N = 14, (quantitative), N = 5 (qualitative)	Home and community care, England	Participants needed to have one year of clinical supervision	Most participants agreed or strongly agreed that clinical supervision helped them develop self-awareness and confidence in dealing with their job. Similarly, most participants agreed or strongly agreed that clinical supervision also helped them to cope with stresses at work.
Hitt et al. (2012)	Narrative review	N/A	To identify and discuss ergonomic-related self-care strategies for home health nurses to improve resilience and quality of life	Home healthcare nurses	Mississippi, USA	N/A	To maintain resilience, HHC nurses need to practice self-care strategies in the workplace. HHC nurses need to commit to daily self-care, practice self-compassion, and use strategies such as journaling for self-reflection. Nurses need to be supported to feel a sense of control over their work, as they are often unable to control the patient environment. Nurses need to be supported in the development of social relationships. Additionally, HHC organizations need to provide nurses with resources to complete their work, tools and technology to support them, a comfortable work environment, a supportive work culture, and appropriate care policies
Judkins and Rind (2005)	Empirical (Quantitative)	Participants were provided with a package containing study information, demographic questions, and the scales for hardiness, job satisfaction, and stress. Hardiness was measured using the Hardiness Scale. Stress was measured using the Nursing Stress Scale. Job satisfaction was measured using the Mueller McCloskey Job Satisfaction Scale	The objective of this study is to look at the relationship between hardiness, job satisfaction, and stress in a home care nursing population	Home care nurses (n = 94) Sampling method: Convenience sample of RNs that were members of the Texas Association for Home Care and/or the National Association for Home Care; aged 21–50+ with majority (67%) between 41–50; 94% female, education: Associate degree (37.5%) or bachelor’s degree (27.1%); race: 86.5% Caucasian	Texas, USA	Study began after participants received 1 year of clinical supervision	Hardiness scores were in the high midrange. Home care nurses with high hardiness scores tended to experience less stress and better job satisfaction than those with low hardiness scores. Specifically, high-hardy nurses tended to experience less stress when they had a strong sense of commitment to their work. High-hardy nurses also tended to experience greater job satisfaction when they had a feeling of control over their work.
Moore (2014)	Commentary	N/A	To discuss the difficulties of accessing healthcare in a rural community and how nurses providing care in these communities need to be resilient and skillful	Rural community nurses	Norfolk, England	N/A	Nurses working in rural communities face unique challenges including underfunding, limited resources, staffing shortages, and isolation. They have limited contact with colleagues and may have to work in areas without cell reception. Nurses are required to use their skill and judgment to provide care in these difficult situations
Penz and Duggleby (2012)	Empirical (Qualitative, grounded theory)	The data in this study is part of a larger study on the experience of hope for community palliative care nurses. All participants, except 1, participated in 2 interviews of 45–75 minutes as part of this larger study. Rich data on the context in which community palliative care nurses provide care emerged during the interviews and was separately analyzed as part of this study; May 2008-July 2009	to develop an understanding of the context surrounding important work-life experiences for nurses providing community palliative care	Community Palliative care Registered nurses (n = 14), 37–58 (mean age 49.1), 100% female, 100% RNs, 100% Caucasian Purposive sampling	Community palliative care services, Canada	Currently providing direct care in community settings, experienced in palliative nursing practice (as determined by recruiters), and practicing in rural and/or urban settings.	Factors that positively influenced resilience in community palliative care nurses included a good sense of personal identify, pride in their knowledge and skill, autonomy, and feeling valued and respected. Factors that negatively influenced resiliency included poor organizational support, high workload, lack of resources, working in isolation, and limited opportunities to debrief with others
Rogers (2021)	Narrative review	N/A	To identify strategies that community nursing teams can enact to promote resilience and well-being	Community Nursing Teams	United Kingdom	N/A	Community nurses are trying to manage increased workloads and increased patient complexity with insufficient resources. To prevent burnout and to promote resilience, specialist practitioner qualified district nurses (SPQDNs) need to create supportive work environments that encourage self-care and the development of coping strategies. Routine monitoring of staff mental health (know signs and symptoms of stress and burnout) and wellbeing is encouraged for employers. This will lead to improved staff resilience, improved nurse retention, and higher quality patient care
van den Bulck et al. (2022)	Empirical (mixed methods)	In the first phase, electronic health records from the HHC organizations were analyzed to look for the total HHC hours that were provided to each client. These quantitative findings looked at the changes in service volume during the pandemic. In the second phase a sample of individuals from the various HHC organizations were recruited and focus groups were created. The qualitative findings from the focus groups looked at the experiences of those providing and receiving care during the pandemic; March 2020 to January 2021 (10 months)	The aim of the study was to understand how home health care (HHC) services responded to the demands of the pandemic and to understand the experiences of staff working in these organizations	District nurses (bachelor’s degree program); Selected from participants in pilot study	Four Dutch HHC organizations Various people were included, but at the nursing level: N = 11 district nurses	The homes were selected based on their involvement with a pilot study conducted on the development of case-mix classification for HHC in the Netherlands. The authors recruited different levels of stakeholders, including nurses. Other criteria was not specified.	Nurses’ resilience was negatively impacted during the pandemic because of increased workloads, staffing shortages, feelings of uncertainty and lack of safety, information overload, and having to make difficult decisions regarding which patients would receive home and community care services

Table 2. Medical subject heading (MeSH) terms used for the MEDLINE database.

Subject	MeSH terms
Nursing	“nursing;” “nurses”
Resilience	“resilience;” “psychological”
Home care services	“home care services,” “community health services,” “community health nursing,” “community health” and “home health nursing”

Table 3. The websites included in the gray literature search.

Subject	Website
Nursing-related	Registered Practical Nurses of Ontario or WeRPN; College of Nurses Ontario; Canadian Nurses Association; Registered Nurses Association of Ontario; Gerontological Nursing Association of Ontario
Health-related	Canadian Medical Association; World Health Organization; National Library of Medicine; Health Quality Ontario
Home care	Home Care Ontario; Ontario Community Support Association; and the Canadian Home Care Association.
Other	Canadian Gerontological Association; Google; Google Scholar

Table 4. Inclusion and exclusion criteria for the included scoping review articles.

Characteristics	Inclusion Criteria	Exclusion Criteria
Type of article	Primary studies, literature reviews, programmatic quality improvement papers, reports, editorials, websites, policy and/or position papers, and conference proceedings/abstracts
Language	English
Type of nurse	RNs, RPNs, licensed practical nurses (LPNs), district nurses (DNs), enrolled nurses (EN), and other international designations applied to individuals with formal nursing education and registration	Articles with a focus on health care partners, such as family members or other individuals without formal nursing education
Setting	Home and community care sector	Articles situated in the acute care setting, long-term home care, public health settings, and any other sector outside HCC
Resilience	Articles needed to explicitly address the concept of resilience*

*Note: In the CINAHL database search, the term “hardiness” was found as a synonym and index term for resilience and was included as a unique term. Articles addressing hardiness were included if the definition was congruent with Ungar’s (2011) operationalization of “resilience,” that is, if the article focused on the individual’s capacity to cope with challenges encountered in the workplace.

Table 5. A summary describing the characteristics of the eight papers included in the scoping review.

Parameter	Results
Total Publication Information	Total number of publications included: 8 Number of publications from 2012 to 2022: 7 Number of publications from 2002 to 2011: 1 Number of publications before 2002: 0
Types of publications	Quantitative research studies: 1 (paper questionnaire study) Qualitative research studies: 1 (telephone interviews, demographic form and personal journal entries) Mixed methods research studies: 2 (1: data analysis of health records & focus groups; 2: questionnaire and focus group) Review articles (narrative reviews): 3 Opinion/commentary papers: 1
Populations studied/identified	Registered nurses (RNs): 2 Not specified: 2 Not applicable (review/commentary papers): 4
Country of study	Canada: 1 United States of America: 2 England: 4 Netherlands: 1

Table 6. Definitions of resilience found in the articles included in the scoping review.

Article	Definition/Conceptualization of Resilience
Duncan (2019)	“the amount of flexibility in the team … at what point does the team become so over stretched that it cannot maintain a reasonable equilibrium between capacity (funding and staff availability) and demand (workload and both clinical and quality standards), causing it to buckle” (p. 419).
Francis and Bulman (2019)	“the ability to make it through stressful events, feel confident and in control at work, self-regulate emotions and expectations, and ultimately maintain equilibrium” (p. 387).
Hitt et al. (2012)
Judkins and Rind (2005)	“Hardiness is a constellation of personality characteristics that include commitment, control, and challenge” (p. 114)
Moore (2014)
Penz and Duggleby (2012)
Rogers (2021)	Use Traynor’s (2017) definition of resilience: “having the ability to endure setbacks and frustrations and as a process in which someone recovers promptly from a specific incident” (p. 226)
van den Bulck et al. (2022)

Table 7. A summary of findings describing personality and work-related characteristics of being resilient as an individual person and HCC nurse (domain one).

Personality traits of “being resilient” as an individual	Qualities of a resilient HCC nurse
Good sense of humour^b	Feel like they are making a difference^a,b
Flexible^b	Comfortable working independently^b,c
Easy-going^b	Enjoy new learning opportunities^a
Optimist and realist^b	See change as an opportunity to grow^a
Compassionate toward self^d	Work well under pressure^a
Strong advocate^b	Possess pride in their knowledge and skills^b
	Enjoy problem solving^a
	Good working relationships with colleagues^b
	Sense of belonging in the workplace^c
	Ability to navigate family dynamics and patient care within the patient’s home^b
	Able to manage grief^b
	Feeling valued and respected^b

References: Judkins and Rind (2005)^a; Penz and Duggleby (2012)^b; Rogers (2021)^c; Hitt et al. (2012)^d.

Table 8. A summary of findings from the literature describing nature of home and community care work, and organizational infrastructure, policy and practices contributing to being resilient as an HCC nurse (domain two).

Nature of the HCC nursing work	Infrastructure of Organization	Organizational Policy	Organizational Practices
Patient’s home is the workplace^a Patient’s ability to care for themselves^a Complexity of tasks^a	Resources to complete work tasks (i.e., time, computer access, documentation software)^a,b Lack of equipment in patients’ homes for nurses to meet clients’ needs^b	Staff shortages^b,c,d,e Changes to flexible scheduling^a,b Culture and policies in the organization^a Low quality of orientation and understanding of expectations of HCC employer^a Absenteeism/not scheduling days off^e Top-down decision-making^e	Poor support from the organization^a,b Communication within the organization^a Nurse’s access to information^a Strong leadership, good communication between nurses and other staff members (patients, leaders, referral agencies), and access to professional development positively impact resiliency^c

References: Hillmann and Guenther, 2021^a; Penz & Duggleby, 2012^b ; Duncan, 2019^c ; Moore, 2014^d; van den Bulck et al. 2022^e.

Table 9. Strategies to promote resilience amongst nursing staff (domain three).

Organizational strategies to promote resilience

Individual strategies to promote resilience

High quality mentorship^a,b Resilience training for nurses and leaders^a,b Assessment of resilience amongst staff^a,b Provide nurses with access to self-care resources^b,c Flexible scheduling^c,f Provide dedicated time for clinical supervision within the workplace^b,e Use strategies that promote nurses’ sense of control over their work (allow two nurses to attend an appointment together to brainstorm solutions, involve family and friends in their patient’s care, encourage nurses to use equipment when it is available and advocate for other services to be consulted when equipment is needed, and allow nurses to present complex cases to the larger team for discussion and problem solving)^c Develop escalation plans for times when caseload increases^d Use case management tools to manage caseload^d Create respite spaces for nurses, either in-person or virtually^b One-on-one sessions to provide nurses with feedback and support^b Coping and hardiness-building activities^a Provide opportunity for nurses to form meaningful relationships^c Promote creative problem-solving^a Include nurses in decisions that affect them^a Show appreciation and recognition of nurses^a Supports to address individual issues^e Development of a crises team to help with high level management functions^g

Self-care (do daily and incorporate activities such as journaling, self-reflections, action planning, exercise, good nutrition, and meditation/mindfulness)^c HCC nurses should incorporate small rewards and incentives as part of their self-care routine^c Review one’s daily habits and identify how healthy habits can be incorporated into one’s daily routine^c

References: Judkins and Rind (2005)^a; Rogers (2021)^b; Hillmann and Guenther (2021)^c; Drennan and Ross (2019)^d; Francis and Bulman (2019)^e; Penz and Duggleby (2012)^f, van den Bulck et al. (2022)^g.

Duncan, M. (2019). Getting the best out of staff in a district nursing team: Nurturing resilience. British Journal of Community Nursing, 24(9), 419–423. doi:10.12968/bjcn.2019.24.9.419

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Francis, A., & Bulman, C. (2019). In what ways might group clinical supervision affect the development of resilience in hospice nurses? International Journal of Palliative Nursing, 25(8), 387–396. doi:10.12968/ijpn.2019.25.8.387

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Hitt, J. M., Tatum, E., Mcnair, M., Harrington, M., Stanton, S. D., Askew, R., … Robertson, A. (2012). Self-care management practices for the home health nurse: Staying hale and hearty through enhanced self-care and ergonomics-with a case study. Home Healthcare Nurse, 30(5), 295–305. doi:10.1097/NHH.0b013e318252c49a

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Judkins, S., & Rind, R. (2005). Hardiness, job satisfaction, and stress among home health nurses. Home Health Care Management and Practice, 17(2), 113–118. doi:10.1177/1084822304270020

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Moore, A. (2014). Cold comfort care. Nursing Standard, 28(19), 20–22. doi:10.7748/ns2014.01.28.19.20.s26

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Penz, K., & Duggleby, W. (2012). It’s different in the home … the contextual challenges and rewards of providing palliative nursing care in community settings. Journal of Hospice and Palliative Nursing, 14(5), 365–373. doi:10.1097/NJH.0b013e3182553acb

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Rogers, A. (2021). Promoting health and wellbeing across community nursing teams: Role of the specialist practitioner district nurse. British Journal of Community Nursing, 26(5), 224–227. doi:10.12968/bjcn.2021.26.5.224

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van den Bulck, A. O. E., de Korte, M. H., Metzelthin, S. F., Elissen, A. M. J., Everink, I. H. J., Ruwaard, D., & Mikkers, M. C. (2022). In the eye of the storm: A quantitative and qualitative account of the impact of the COVID-19 pandemic on Dutch home healthcare. International Journal of Environmental Research and Public Health, 19(4), 1–16. doi:10.3390/ijerph19042252

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Ungar, M. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. American Journal of Orthopsychiatry, 81(1), 1–17. doi:10.1111/j.1939-0025.2010.01067.x

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Traynor, M. (2017). Critical resilience for nurses: An evidenced based guide to survival and change in the modern NHS. Routledge. https://doi.org/10.4324/9781315638928.

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Hillmann, J., & Guenther, E. (2021). Organizational resilience: A valuable construct for management research? International Journal of Management Reviews, 23(1), 7–44. doi:10.1111/ijmr.12239

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Drennan, V. M., & Ross, F. (2019). Global nurse shortages-the facts, the impact and action for change. British Medical Bulletin, 130(1), 25–37. doi:10.1093/bmb/ldz014

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