An integrative review of resilience among nursing students in the context of nursing education. — TEI-tagged view

Pimwalunn AryuwatpersName, Margareta AsppersName, Annica LövenmarkpersName, Matanee RadabutrpersName, Jessica HolmgrenpersName (2022date). “An integrative review of resilience among nursing students in the context of nursing education..” Nursing Opentitle·j.

Object of study — resilienceterm·dom among nursing studentsterm·key in nursing educationterm·key

Research question — how resilienceterm·dom in nursing studentsterm·key is conceptualised, what affects it, and how it is promoted

Contribution — three research focuses on nursing studentsterm·key' resilienceterm·dom: its concept, what affects it, and its mediating role in holistic healthterm·dom

Full text — tagged

An integrative reviewterm·key of resilienceterm·dom among nursing studentsterm·key in the context of nursing educationterm·key.

Abstract This integrative reviewterm·key aimed to examine empirical research on resilienceterm·dom among nursing studentsterm·key in the context of nursing educationterm·key. Resilienceterm·dom helps nursing studentsterm·key handle challenges, such as changing learning styles and experiencing their first clinical practice.

An integrative reviewterm·key.

The search terms focused on resilienceterm·dom and health in nursing studentsterm·key and nursing educationterm·key. The database used in this reviewterm·mth were CINAHL Plus, PubMed and MEDLINE. The Mixed Methods Appraisal Tool appraised the studies' quality.

This study explored 52 records and revealed three current research focuses related to nursing studentsterm·key' resilienceterm·dom: (1) the concept and description of resilienceterm·dom, (2) the characteristics affecting resilienceterm·dom and (3) the mediating role of resilienceterm·dom in maintaining holistic healthterm·dom. Recommendations include adding a resilienceterm·dom topic to the nursing curriculum, providing resilienceterm·dom enhancement programs, examining the relationship between resilienceterm·dom and holistic healthterm·dom and exploring the influence of resilienceterm·dom about global health crises.

Resilienceterm·dom among nursing studentsterm·key plays a vital role in helping them to overcome adversities during their nursing educationterm·key. Additionally, after graduation, nursing studentsterm·key can continue contributing to society as resilient Registered Nurses in the future.

Keywords: health, integrative reviewterm·key, nursing educationterm·key, nursing studentsterm·key, resilienceterm·dom INTRODUCTION Health is precious, as it is preferable for one's state of being and a personal resource to function in everyday life. Health can be viewed positively as the personal ability to accomplish vital goals to make one's life more satisfactory (Nordenfelt, 2014 ), which is closely aligned with the concept of resilienceterm·dom. Early studies on resilienceterm·dom explored the notion as a trait concept (Genet & Siemer, 2011 ; Waugh et al., 2011 ), whereas later studies described resilienceterm·dom as a process deployed in response to complex and challenging events and circumstances (Graham, 2018 ; Phillips et al., 2019 ; Schönfeld et al., 2017 ). Resilienceterm·dom is commonly described as the ability to bounce back from negative challenges and adversities in life (Anderson et al., 2019 ; Baltacı, 2021 ). In addition, the concept of resilienceterm·dom as a process of adaptation is associated with what Nordenfelt ( 2014 ) has described as the second‐order ability of a person to achieve their vital goals in the given or acceptable circumstances.

BACKGROUND Transitioning from adolescence to adulthood is a challenging part of life for nursing studentsterm·key as they have to face new and unexpected challenges, such as increased use of digital tools in the classroom and clinical education and changing timetable of clinical practice (Agu et al., 2021 ; Aslan & Pekince, 2021 ; Huang et al., 2020 ; Sveinsdóttir et al., 2021 ). Nursing studentsterm·key have to deal with new experiences both in the classroom and in clinical education, such as being challenged by new pedagogy and taking care of real patients for the first time during the first clinical practice. They must adapt to the higher education system (which sometimes requires that they live away from their families), deal with the high expectations of academic achievement and face new peer pressure challenges (Hollenbach, 2016 ; Olsen, 2018 ; Patton et al., 2016 ; Shearer, 2016 ; Simpson & Sawatzky, 2020 ). During their education, more complex challenges may ascend, such as uncertainty of course deadlines, extended duration of clinical practice, being under a high level of stress and lockdown of their institutes during new emerging pandemics (Agu et al., 2021 ; Harries et al., 2021 ; Huang et al., 2020 ; Luberto et al., 2020 , Roldán‐Merino et al., 2022 ; Usher et al., 2020 ).

Resilienceterm·dom is broadly recognized as one of the vital facets related to one's positive health (Phillips et al., 2019 ; Santrock, 2019 ). A high level of resilienceterm·dom is advantageous for adolescents when they face the challenges and responsibilities of adulthood, especially when experiencing adverse circumstances (Graham, 2018 ; Phillips et al., 2019 ; Schönfeld et al., 2017 ). Several challenging problems may arise during the transition period for nursing studentsterm·key. First, the transition periods from adolescence to adulthood and from academic learning to clinical training may put them under a lot of pressure that can put their health at risk, especially their mental health (Phillips et al., 2019 ; Santrock, 2019 ). Furthermore, resilienceterm·dom has been recognized as essential for undergraduate and graduate nursing studentsterm·key (Jackson, 2018 ). Recent studies in nursing educationterm·key have indicated the importance of resilienceterm·dom as a positive influence that can help nursing studentsterm·key deal with the adversities, such as the impact on their quality of life, increased level of academic burnout and psychological distress during the lockdown period of the severe pandemic (Cuartero & Tur, 2021 ; Guillasper et al., 2021 ; Labrague & Ballad, 2021 ; Sweeney, 2021 ; Usher et al., 2020 ).

Numerous studies have suggested that resilienceterm·dom could contribute to personal growth due to the experience of negative, challenging and difficult circumstances throughout one's academic years (Amsrud et al., 2019 ; Kaewmanee et al., 2018 ; Olsen, 2018 ; Sangon et al., 2018 ). However, most studies on resilienceterm·dom and health in nursing studentsterm·key have mainly focused on the relationship between resilienceterm·dom and psychological health or well‐beingterm·dom (Alzayyat & Al‐Gamal, 2014 ; Delgado et al., 2017 ; Miremadi, 2015 ; Patton et al., 2016 ). Thus, a need to explore the relationship between resilienceterm·dom and a more holistic understanding of health. In addition, understanding how resilienceterm·dom in nursing studentsterm·key is conceptualized in the context of academic learning and, more specifically, in clinical training would be valuable. Further research is also needed in this regard (Reyes et al., 2015a ; Thomas & Revell, 2016 ).

Two previous reviewsterm·mth related to resilienceterm·dom in nursing studentsterm·key provide key information on the general concept of resilienceterm·dom and some factors that can affect it in nursing studentsterm·key, especially in the context of clinical education Reyes et al., 2015a ; Thomas & Revell, 2016 ). However, the definitions and concepts of resilienceterm·dom have changed over time and are commonly clarified according to specific populations (Stephens, 2013 ). Although there is a growing amount of research on resilienceterm·dom in nursing, a clear explanation of resilienceterm·dom in nursing studentsterm·key remains limited (Reyes et al., 2015b ). Empirical studies on resilienceterm·dom have led researchers in the nursing field to examine the phenomenon in the nursing discipline, especially in the context of new and critical challenges that have emerged in nursing educationterm·key, such as the recent trend of nursing studies on the effects of the COVID‐19 pandemic (Agu et al., 2021 ; Cygan et al., 2021 ). The variation in definitions and conceptual descriptions of resilienceterm·dom in nursing and nursing educationterm·key may create confusion or ambiguity for researchers. Therefore, the concept of resilienceterm·dom needs to be clarified in the context of nursing educationterm·key.

This integrative reviewterm·key aimed to investigate empirical research on resilienceterm·dom among nursing studentsterm·key in the context of nursing educationterm·key. The purpose of the integrative reviewterm·key was to answer the following research questions: How is resilienceterm·dom among nursing studentsterm·key conceptualized in the context of nursing educationterm·key in empirical research?

What may impact resilienceterm·dom in nursing studentsterm·key in the context of nursing educationterm·key?

How is resilienceterm·dom promoted in nursing studentsterm·key in the context of nursing educationterm·key?

DESIGN In this study, Whittemore and Knafl's framework of integrative reviewterm·key method was used to analyze and synthesize both quantitative and qualitative publications about resilienceterm·dom in the context of nursing studentsterm·key (Whittemore & Knaft, 2005 ). The integrative reviewterm·key method allowed for the consideration of empirical research related to resilienceterm·dom in nursing educationterm·key. Whittemore and Knafl's framework for data collection, analysis and synthesis consists of five stages: problem identification, literature search, data evaluation, data analysis and presentation.

METHOD Literature search The literature search was conducted using the following databases: CINAHL Plus, PubMed and MEDLINE, with support from a librarian at Mälardalen University . The keywords used in the search included the terms resilienceterm·dom, resiliency and health, along with the following terms: nursing studentsterm·key, student nurses, nursing educationterm·key, clinical practice and clinical education. Publications were included if (a) the findings addressed resilienceterm·dom in nursing studentsterm·key, (b) participants in the studies were nursing studentsterm·key, (c) the study design was empirical, (d) the content was written in English and (e) the date of publication was between January 2011 and December 2021.

The reasons for choosing publications after January 2011 were to isolate the most recent literature addressing the research questions and to reviewterm·mth the empirical studies that best reflected the recent issues related to resilienceterm·dom in nursing educationterm·key. Publications were excluded if (a) they focused on resilienceterm·dom among other populations, such as other healthcare students, new nurse graduates, school nurses and nurse educators; (b) they discussed resilienceterm·dom as an implication rather than part of the study findings; (c) they were not empirical research studies, such as discussion and reviewterm·mth papers; (d) they were unpublished dissertations and theses; (e) they could not be accessed in full‐text form and (f) they did not focus on nursing educationterm·key.

The search strategy was carried out, documented and illustrated, as shown in Figure 1 (PRISMA flow diagram of the literature search, available to view in the online version), based on the Preferred Reporting Items for Systematic Reviewsterm·mth and Meta‐Analyses (PRISMA) guidelines (Moher et al., 2009 ). A total of 1246 records were retrieved. Additional records identified through other sources (e.g., websites and organizations) were not included in this integrative reviewterm·key.

PRISMA flow diagram of the literature search The topics of the 1246 records were primarily reviewed to screen for duplication of the studies, after which some duplicate articles were removed. A total of 714 abstracts were reviewed to search for relevance based on the inclusion criteria. Next, 585 records were excluded for not focusing on resilienceterm·dom in nursing studentsterm·key, not being original research articles, or addressing resilienceterm·dom as an implication or intervention rather than as part of the study findings; hence, these were excluded from the reviewterm·mth. The remaining 129 records were assessed for eligibility, of which 77 were excluded for reasons such as not focusing on nursing studentsterm·key, not being related to nursing educationterm·key and not being empirical research studies. Finally, 52 publications consisting of 41 quantitative studies, nine qualitative studies and two mixed methods studies met the inclusion criteria and were included in the data analysis of this integrative reviewterm·key.

Data evaluation Records included in the final sample were appraised for quality using the Mixed Methods Appraisal Tool (MMATterm·mth; Hong et al., 2018 ). The MMATterm·mth is a critical tool for the appraisal stage of reviewsterm·mth that includes qualitative, quantitative and mixed methods studies. The tool assesses the methodological quality of five types of studies: qualitative research, randomized controlled trials, non‐randomized studies, quantitative descriptive studies and mixed methods studies (Hong et al., 2018 ). The 52 included studies were evaluated for quality based on the MMATterm·mth checklist. The characteristics and summaries of the included studies are illustrated in Table 1 (Characteristics and summary of included studies, available to view in the online version).

Characteristics and summary of included studies Data analysis The final studies selected for the reviewterm·mth were empirical in nature. The literature included a variety of study designs, such as descriptive, correlational, longitudinal, mixed methods, participatory action research, grounded theory and phenomenological. Generally, evaluation is more complex with various methodologies (Whittemore & Knafl, 2005 ). The research questions guided the analysis of the 52 articles, and the studies were compared and analysed for similarities and differences. Data with similar contexts were assembled. The four steps of data analysis, including data reduction, data display, data comparison and conclusion drawing and verification, were applied to obtain mutual themes and patterns and ensure the findings' rigour.

ETHICS Research Ethics Committee approval was not required for this study.

RESULTS General characteristics of the included studies The 52 included studies were from 19 countries, including Australia, Belgium, Canada, China, Denmark, Egypt, India, Indonesia, Israel, Nigeria, Philippines, Saudi Arabia, Singapore, Spain, South Africa, South Korea, Taiwan, Turkey, the United Kingdom and the United States. Concerning the participant characteristics in the included records, 48 studies targeted undergraduate nursing studentsterm·key only, with a total of 14,701 participants; three studies targeted both undergraduate and postgraduate levels, and one study targeted both nursing studentsterm·key and other health students from different disciplines. However, the majority of participants in these four studies were undergraduate nursing studentsterm·key, with a total of 1345 participants. The number of postgraduate nursing studentsterm·key was 103, and 250 students from other disciplines were included as participants. In summary, 16,046 undergraduate nursing studentsterm·key participated in the included studies.

Concepts and descriptions of resilienceterm·dom in nursing studentsterm·key Resilienceterm·dom has been viewed as an ability or process and a psychological trait. Among most included studies, concepts and descriptions of resilienceterm·dom in nursing studentsterm·key were broadly defined with existing concepts and definitions of resilienceterm·dom. Only three studies specifically provided definitions of resilienceterm·dom, while 13 articles did not mention a specific definition. Froneman et al. ( 2016 ) defined resilienceterm·dom as the ability of both nursing educators and students to effectively cope with stressors throughout their academic years. In contrast, Keener et al. ( 2021 ) referred to resilienceterm·dom among nursing studentsterm·key as a developing process among individuals through individual protective factors to deal with perceived stressterm·dom and difficulties. Similarly, Reyes et al. ( 2015b ) identified resilienceterm·dom as a dynamic process that allows one to handle adversities and challenges during nursing educationterm·key.

The majority of the included studies referred to nursing studentsterm·key' resilienceterm·dom as the ability to positively recover or bounce back from facing adversities or opposing challenges (Ching et al., 2020 ; Clohessy et al., 2019 ; Drach‐Zahavy et al., 2021 ; Eaves & Payne, 2019 ; Ertekin Pinar et al., 2018 ; Fernández‐Martínez et al., 2021 ; Grande et al., 2021 ; Hamadeh Kerbage et al., 2021 ; Keener et al., 2021 ; Kim, 2019 ; Labrague, 2021 ; Lekan et al., 2018 ; Liang et al., 2019 ; Lopez et al., 2018 ; Mathad et al., 2017 ; Orkaizagirre‐Gómara et al., 2020 ; Ozsaban et al., 2019 ; Sahu et al., 2019 ; Sam & Lee, 2020 ; Smith & Yang, 2017 ; Vestphal et al., 2020 ; Wang et al., 2021 ; Yıldırım et al., 2021 ). Several studies specifically mention resilienceterm·dom in nursing studentsterm·key as the ability to successfully handle academic stressors and attain academic success (Abiola et al., 2017 ; Beauvais et al., 2014 ; Chow et al., 2018 ; Chow et al., 2020 ; Hwang & Shin, 2018 ; Ozsaban et al., 2019 ; Wang et al., 2021 ).

Additionally, resilienceterm·dom was addressed as contributing to health conditions and well‐beingterm·dom in nursing studentsterm·key (Chow et al., 2018 ; Eaves & Payne, 2019 ; Elzohary et al., 2017 ; Hamadeh Kerbage et al., 2021 ; Ríos‐Risquez et al., 2016 ; Serçe et al., 2021 and Spurr et al., 2021 ). Moreover, resilienceterm·dom was connected to the personal growth of nursing studentsterm·key, as they can learn from overcoming adversities and gain a positive outlook for their future (Hasson et al., 2021 ; Liang et al., 2019 ; Lopez et al., 2018 ). Among the included studies, resilienceterm·dom was described as an important trait or essential characteristic of nursing studentsterm·key. Resilienceterm·dom was described as a fixed trait (Clohessy et al., 2019 ), a personal resource (Drach‐Zahavy et al., 2021 ; Yun et al., 2020 ), a flexible trait (Eaves & Payne, 2019 ; Grande et al., 2021 ), a positive adaptation (Ertekin Pinar et al., 2018 ), psychosocial characteristic or quality (Lee & Kim, 2021 ; Yıldırım et al., 2021 ), essential quality (Smith & Yang, 2017 ), adjustable phenomenon or state (Tian et al., 2019 ) and a personality trait (Van Hoek et al., 2019 ) in the included studies.

Characteristics affecting resilienceterm·dom in nursing studentsterm·key Some demographic characteristics have been shown to affect resilienceterm·dom in nursing studentsterm·key, including inadequate income (Ching & Cheung, 2021 ; Ertekin Pinar et al., 2018 ; Hamadeh Kerbage et al., 2021 ; Yıldırım et al., 2021 ; Yıldız, 2021 ), age (Ching & Cheung, 2021 ; Ertekin Pinar et al., 2018 ; Hasson et al., 2021 ), gender (Arries‐Kleyenstüber, 2021 ; Ching & Cheung, 2021 ), marital status (Yıldırım et al., 2021 ), year of study (Elzohary et al., 2017 ; Fernández‐Martínez et al., 2021 ; Yıldırım et al., 2021 ), religion (Sigalit et al., 2017 ) and living conditions (Yıldırım et al., 2021 ). However, some have argued that age does not affect resilienceterm·dom (Arries‐Kleyenstüber, 2021 ; Grande et al., 2021 ). For instance, Grande et al. ( 2021 ) argued that gender and year of study were not associated with resilienceterm·dom in nursing studentsterm·key.

Some intrapersonal characteristics were associated with nursing studentsterm·key' resilienceterm·dom. Specifically, several factors were reported to have positive effects on resilienceterm·dom, including high self‐confidence (Clohessy et al., 2019 ; Ertekin Pinar et al., 2018 ), no intention to quit nursing educationterm·key (Elzohary et al., 2017 ; Hwang & Shin, 2018 ), positive thinking (Clohessy et al., 2019 ; Liang et al., 2019 ), high self‐efficacy (Ching & Cheung, 2021 ; García‐Izquierdo et al., 2018 ), no experience of childhood trauma (Dong et al., 2021 ), being satisfied with life (Elzohary et al., 2017 ), an accomplishment of academic success such as having high‐grade point average (GPA) (Grande et al., 2021 ) and high self‐compassion (Kotera et al., 2021 ).

Referring to the interpersonal characteristics reported in the included literature, social supportterm·dom was identified in eight studies as an essential factor that can affect nursing studentsterm·key' resilienceterm·dom, with students who received social supportterm·dom being reported to have higher resilienceterm·dom levels (Clohessy et al., 2019 ; Dong et al., 2021 ; Elzohary et al., 2017 ; Ertekin Pinar et al., 2018 ; Hwang & Shin, 2018 ; Lekan et al., 2018 ; Ozsaban et al., 2019 ; Yıldırım et al., 2021 ). In addition, mindfulnessterm·dom was another positive influencing factor for developing resilienceterm·dom in nursing studentsterm·key (Ching & Cheung, 2021 ; Chow et al., 2018 ; Mathad et al., 2017 ). Some studies have highlighted that resilienceterm·dom can also be affected by and developed through academic learning, clinical practice and skills training (Ertekin Pinar et al., 2018 ; Hasson et al., 2021 ; Liang et al., 2019 ).

Mediating role of resilienceterm·dom in nursing studentsterm·key' health Resilienceterm·dom has played a vital role as a mediator between the various factors influencing nursing studentsterm·key' health and well‐beingterm·dom. Devi et al. ( 2021 ) indicated that resilienceterm·dom is a vital mediator of psychological health and factors such as stress, anxiety and depression in the context of experiencing clinical practice. Kong et al. ( 2016 ) identified resilienceterm·dom as an important mediator between emotional intelligence and clinical communication ability in nursing studentsterm·key during clinical training. During the COVID‐19 pandemic, another study showed that resilienceterm·dom mediated between life satisfaction and well‐beingterm·dom among nursing studentsterm·key (Labrague, 2021 ).

Resilienceterm·dom can not only be affected by various factors, as described in the previous section, but it can also influence nursing studentsterm·key' health and education. For instance, several studies have shown that nursing studentsterm·key' well‐beingterm·dom is affected by resilienceterm·dom (Abiola et al., 2017 ; Chow et al., 2018 ; Hasson et al., 2021 ; Kim, 2019 ; Kim et al., 2021 ; Labrague, 2021 ; Ríos‐Risquez et al., 2016 ; Serçe et al., 2021 ; Smith & Yang, 2017 ; Spurr et al., 2021 ). Perceived stressterm·dom was another factor shown to be affected by resilienceterm·dom among nursing studentsterm·key during their nursing educationterm·key (Drach‐Zahavy et al., 2021 ; Elzohary et al., 2017 ; Kim et al., 2021 ; Lekan et al., 2018 ; Sahu et al., 2019 ; Sam & Lee, 2020 ; Smith & Yang, 2017 ).

Additionally, resilienceterm·dom can affect factors that influence nursing studentsterm·key' lives and their contributions to their nursing studies. Life satisfaction was shown to be affected by resilienceterm·dom in studies by Elzohary et al. ( 2017 ), Kim ( 2019 ) and Labrague ( 2021 ). A low level of resilienceterm·dom is associated with high academic stress in others (Mcdermott et al., 2020 ; Ozsaban et al., 2019 ; Van Hoek et al., 2019 ). Moreover, a high resilienceterm·dom level was reported to affect several factors in nursing studentsterm·key, including higher satisfaction and achievement in clinical practice (Lopez et al., 2018 ); less or no intention to drop out (Eaves & Payne, 2019 ; Van Hoek et al., 2019 ); having post‐traumatic growth (Li et al., 2014 ; Yıldız, 2021 ) and overcoming bullying during their nursing educationterm·key (Mott, 2014 ).

DISCUSSION This integrative reviewterm·key revealed that the current scope of knowledge related to resilienceterm·dom among nursing studentsterm·key in the context of nursing educationterm·key focuses on three main aspects: (1) the concept and description of resilienceterm·dom as either an ability, a process, or a psychological trait; (2) the characteristics affecting nursing studentsterm·key' resilienceterm·dom and (3) the important role of resilienceterm·dom as a mediator in helping nursing studentsterm·key maintain their holistic healthterm·dom.

The concept of resilienceterm·dom among nursing studentsterm·key has been generally mentioned in most literature as a psychological notion. Although nursing studentsterm·key' resilienceterm·dom was mentioned as being associated with nursing studentsterm·key' health, such an understanding of the concept has not yet been clearly described in the context of nursing educationterm·key. Furthermore, a model with a specific definition of resilienceterm·dom has not been employed and tested in the resilienceterm·dom literature (Stephens, 2013 ), and a specific description of resilienceterm·dom related to nursing educationterm·key should be clearly defined in the literature (Thomas & Revell, 2016 ).

Resilienceterm·dom among nursing studentsterm·key with diverse demographic backgrounds in terms of age, gender and living conditions was found to differ. Specifically, this integrative reviewterm·key revealed that older nursing studentsterm·key seemed to be more resilient. This could reflect the influence of learning and life experiences. Edwards et al. ( 2016 ) argued that age could predict resilienceterm·dom only in young students in their study on the predictors of resilienceterm·dom in students between 16–21 years old. Moreover, gender and living conditions were unrelated to students' resilienceterm·dom in other health disciplines, such as medical students (Oliveira et al., 2017 ). Another study reported that male nursing studentsterm·key have lower resilienceterm·dom during clinical practice, which could be associated with the experience of specific barriers to being a male nursing studentterm·key, both in school and in social life (Yang et al., 2017 ). Furthermore, resilienceterm·dom is related to a specific type of personality in nursing studentsterm·key (Škodová & Bánovčinová, 2018 ).

Intrapersonal characteristics in nursing studentsterm·key, such as high self‐efficacy, being positive, high self‐confidence, high self‐compassion and being satisfied with life, were identified as factors affecting resilienceterm·dom. In response to changes in health care and nursing educationterm·key related to the advent of the COVID‐19 pandemic, nursing studentsterm·key needed the ability to adapt to new challenges in both classroom‐based and clinical‐based education (Bradford, 2021 ). In addition, a recent study highlighted the positive relationship between academic self‐efficacyterm·dom and resilienceterm·dom among nursing studentsterm·key (El‐Sayed et al., 2021 ; Warshawski, 2022 ). Traditional classroom activities had to be converted to virtual and distance learning, and nursing practicum rotations had to be managed with limitations. These challenges in nursing educationterm·key pushed nursing studentsterm·key to develop strong, positive intrapersonal characteristics that could help them increase their resilienceterm·dom.

This integrative reviewterm·key also addressed some vital interpersonal characteristics, such as social supportterm·dom, which play an essential role in maintaining and enhancing nursing studentsterm·key' resilienceterm·dom. During the COVID‐19 pandemic, several studies indicated the importance of the direct effect of social supportterm·dom on nursing studentsterm·key' resilienceterm·dom (Cuartero & Tur, 2021 ; El‐Sayed et al., 2021 ; Warshawski, 2022 ), and a mediated role of resilienceterm·dom between social supportterm·dom and quality of life among nursing studentsterm·key (Pineda et al., 2022 ). Female nursing studentsterm·key were reported to perceive more social supportterm·dom than male nursing studentsterm·key (Cuartero & Tur, 2021 ). In addition, a high level of resilienceterm·dom in nursing studentsterm·key was reported to be associated with adequate social supportterm·dom (Caton, 2021 ). Similarly, a high level of resilienceterm·dom was associated with perceived social supportterm·dom among university students (Hamdan‐Mansour & Hamdan‐Mansour, 2014 ) and adolescents (Hidayat & Nurhayati, 2019 ). Moreover, social supportterm·dom was a significant predictor of resilienceterm·dom among adolescents (Çiçek, 2021 ). Students at the higher education level with a high level of resilienceterm·dom were found to be more likely to successfully reach out for support (Md Khalid, 2021 ).

Nursing studentsterm·key' resilienceterm·dom can be defined as the ability to adapt to difficult situations and obstacles. Resilienceterm·dom can be viewed as the ability to recover quickly from an adverse, challenging circumstance to accomplish vital goals. Nursing studentsterm·key who have high resilienceterm·dom seem to be able to connect with their inner strengths, which helps them bounce back from negative challenges during their nursing educationterm·key. The COVID‐19 pandemic is one example of negative encounters impacting nursing studentsterm·key' stress levels (Gallego‐Gómez et al., 2020 ). Therefore, resilienceterm·dom can help nursing studentsterm·key maintain their holistic healthterm·dom and well‐beingterm·dom and cope with stress during their nursing educationterm·key. Bouncing back can be a valuable means to maintaining one's holistic healthterm·dom (Nordenfelt, 2014 ). In addition, Ozsaban et al. ( 2019 ) pointed out that nursing studentsterm·key with high levels of resilienceterm·dom will be more likely to successfully recover from unpleasant experiences that can affect their physical, mental and social health, which they may encounter in both classrooms and clinical placements. A recent study on resilienceterm·dom in nursing studentsterm·key during the COVID‐19 pandemic defined resilienceterm·dom in nursing studentsterm·key as the ability related to successful adaptation to life‐threatening conditions (Mohammadi et al., 2022 ).

Limitations The findings of this reviewterm·mth may be limited by the inclusion criteria applied to the studies found in a specific database. The included studies were also limited to those published from 2011–2021. Since only empirical studies on resilienceterm·dom in nursing studentsterm·key written in English were reviewed, it is possible that studies in other languages could have improved our understanding of nursing studentsterm·key' resilienceterm·dom.

CONCLUSION This integrative reviewterm·key explored and analysed the scope of knowledge related to resilienceterm·dom among nursing studentsterm·key in the context of nursing educationterm·key. Three key themes were highlighted, which include the concept and description of resilienceterm·dom, the characteristics of nursing studentsterm·key that affect their resilienceterm·dom and the vital role of resilienceterm·dom as a mediator of holistic healthterm·dom in nursing studentsterm·key. Furthermore, this integrative reviewterm·key has some critical implications for nursing research. First, stakeholders in nursing educationterm·key should add the topic of resilienceterm·dom to nursing curricula and provide special training to enhance resilienceterm·dom in nursing studentsterm·key. Future research should focus on exploring the connection between resilienceterm·dom and holistic healthterm·dom in nursing studentsterm·key. Moreover, research focusing on the relationship between nursing studentsterm·key' resilienceterm·dom and their demographic, intrapersonal and interpersonal characteristics would be a valuable contribution to nursing educationterm·key.

The findings of this integrative reviewterm·key have some implications for nursing educationterm·key. Nursing educators, nursing preceptors and policymakers are encouraged to add the topic of resilienceterm·dom to the nursing curriculum to improve nursing educationterm·key. In addition, specific programs related to nursing studentsterm·key' intrapersonal characteristics to enhance resilienceterm·dom should be provided as brief training sessions before they begin their clinical education. Furthermore, the interpersonal characteristics of nursing studentsterm·key, such as social supportterm·dom, must be considered throughout their nursing educationterm·key. This integrative reviewterm·key also suggests that future research on resilienceterm·dom and holistic healthterm·dom among nursing studentsterm·key needs to be conducted. Specifically, more research related to resilienceterm·dom in nursing educationterm·key should focus on exploring the relationship between resilienceterm·dom and the characteristics that affect its development among nursing studentsterm·key. Furthermore, future research on the influence of resilienceterm·dom in nursing studentsterm·key in the context of global health crises, such as emerging infectious diseases, may significantly contribute to nursing educationterm·key and the nursing profession.

AUTHOR CONTRIBUTIONS PA has assumed overall responsibility for the study. However, MA, AL, MR and JH have contributed to the design and planning of the study, writing of the manuscript, critical discussions and revisions. PA was responsible for collecting, mapping and initially analysing the data. The final analysis of the data and the framing of the results were performed together by all authors. PA revised the final manuscript and completed it for submission.

FUNDING INFORMATION The study was funded by Mälardalen University and Praboromarajchanok Institute, the Ministry of Public Health Thailand.

CONFLICT OF INTEREST The authors have no conflict of interest to declare.

ACKNOWLEDGEMENTS The authors would like to thank Mälardalen University and Praboromarajchanok Institute, the Ministry of Public Health Thailand for financial support.

AryuwatpersName, P. , AsppersName, M. , LövenmarkpersName, A. , RadabutrpersName, M. , & HolmgrenpersName, J. (2023). An integrative reviewterm·key of resilienceterm·dom among nursing studentsterm·key in the context of nursing educationterm·key. Nursing Open, 10, 2793–2818. 10.1002/nop2.1559 DATA AVAILABILITY STATEMENT Data openly available in a public repository that issues datasets with DOIs.

REFERENCES Associated Data Data Availability Statement Data openly available in a public repository that issues datasets with DOIs.