Exploring resilience in pre-registration undergraduate nursing students: A constructivist grounded theory study

Resilience has been posited as an important characteristic in nursing and identified as a key factor in managing stress, promoting wellbeing and reducing attrition in university students (USs). Despite this, resilience in the context of nurse education remains under-researched, particularly in the United Kingdom (UK). This study aimed to address this gap in extant knowledge and develop a more comprehensive understanding of resilience in UK undergraduate (UG) student nurses (SNs). A constructivist grounded theory (CGT) approach, underpinned by symbolic interactionism and social constructivism, was utilised to investigate how UG SNs in one UK university conceptualised resilience and to identify the factors that support and challenge it. Factors that co-created, sustained, and developed resilience in SNs were termed ‘constructs of resilience’ (CoR).

Second-year student nurses (n=24) were interviewed using focus groups. Data were analysed by using initial, focussed, and theoretical coding, supported by constant comparative analysis and reflexivity. The analysis generated six key themes: the challenges of studying nursing; organisational belonging and connectedness; struggling to maintain balance; external CoR; internal CoR; and the components of resilience. Internal CoR that enhanced resilience included persevering, coping, prioritising, recognising and expressing, courage, balancing, bouncing back, accepting, and a passion for nursing. External factors were relational in nature and centred on the relationships students had with family, friends, peers, patients, mentors and academic staff. Two over-arching themes were found to be significant in SN resilience: connectedness and belonging; and positive relationships.

A new definition and grounded theory of resilience in SNs are presented, contextualising resilience as a transactional constructivist concept. The Chain Theory of Resilience in Student Nurses (CTRSNs) evolved from synthesising the SN voice captured in this study with four existing theories Ecological Systems Theory (Bronfenbrenner, 1979); salutogenesis (Antonovsky, 1979); Relational Cultural Theory (RCT) (Jordan, 2006); Ungar’s (2004) transactional constructivist approach to resilience and three concepts: co-creation; holism; and connectedness. The theoretical perspectives elicited from this study provide a novel insight into understanding resilience in SNs, presenting an original contribution to the extant knowledge base and an opportunity to further enhance resilience in SNs. The developed grounded theory offers a foundation for further research to explore and identify the CoR in other nurse education settings, both nationally and internationally. The model also has broader applicability to other disciplines, and settings, outside of nursing and higher education (HE).