Date of Award

Summer 6-27-2023

Embargo Period

7-10-2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Nursing Science

Department

Nursing

College

College of Nursing

First Advisor

Michelle Nichols

Second Advisor

Diana Layne

Third Advisor

Ken Catchpole

Fourth Advisor

Heather Evans

Abstract

Abstract

Background: Resilience commonly refers to the ability of an individual or organization to continue to maintain routine, normal, function despite sudden disruptions. Purpose: The purpose of this dissertation research was to provide a deeper understanding of healthcare team resilience. The goal of this research dissertation was to investigate how resilience manifested itself in the healthcare team during the COVID-19 pandemic.

AIM 1: What is the concept of resilience in healthcare teams?

AIM 2: Identify the barriers and facilitators of healthcare team resilience during the COVID-19 pandemic.

AIM 3: Describe how the pandemic influenced healthcare team decision making.

Methods: In the first manuscript we performed a comprehensive systematic analysis that delves into the concept of healthcare team resilience in the literature. Based on these results, in the second manuscript the authors utilized an adapted model developed by the research team that frames the healthcare team as a cohesive and aware entity, rather than merely a group of individuals or a subset of personnel within a healthcare system. Finally, the third manuscript uses this adapted model to present research findings from interviews on resilience culture, based on a thematic analysis.

Findings: In chapter 2, we found 41 distinct definitions of the concept, with three defining attributes: 1) resilience is triggered by an a priori disruptive event that serves as a catalyst activating the healthcare team's latent potential; 2) this potential leads to the actualization of skills and abilities that enable the team to respond to the disruption in an adaptive manner; 3) the team’s adaptive response enables them to continue executing responsibilities in the face of the disruption. This contributed to AIM 1 by describing the concept of resilience in healthcare teams during COVID-19. The concept analysis brought to light a significant disparity arising from the prevailing literature primarily emphasizing individual resilience as a lens to understand healthcare team resilience, thus potentially obscuring any hidden aspects of resilience within the healthcare team. This discrepancy underscored the necessity to develop a comprehensive model to explore healthcare team resilience during COVID-19 that acknowledges the healthcare team as a singular cognizant entity and not an individual or group of individuals. In chapter 3, we found by integrating knowledge and principles from the domains of resilience engineering, systems engineering, patient safety, and naturalistic decision- making we could create a framework by which AIM 2 and AIM 3 could be addressed. An adapted model was created. The exploration of the barriers and facilitators of resilience and the impact of COVID-19 on the decision-making processes in healthcare teams could be thoroughly explored using the adapted model. A qualitative descriptive study was conducted in 2021 and data were analyzed using reflexive thematic analysis. Chapter 4 presents the findings of this study related to AIM 2 and AIM 3. The study utilized the adapted model as a guide for the interview questions. The author developed the interview questions, which were reviewed and approved by faculty mentors. The author interviewed (N=22) interprofessional healthcare participants who worked during the COVID-19 pandemic. A thematic analysis of the interview data resulted in the identification of five themes related to resilience in the healthcare team during COVID-19: working in a pressure cooker; healthcare team cohesion; applying past lessons to current challenges; knowledge gaps, and altruistic behaviors. The evidence indicates that the pressures form working during COVID-19 and gaps in explicit knowledge, negatively influenced adaptive behaviors to maintain healthcare team resilience. Team cohesion, tacit knowledge and altruistic behaviors positively influenced adaptive behaviors and decision making.

Conclusion: This compendium presents the exploration of resilience within healthcare teams amidst the challenges posed by the COVID-19 pandemic. The literature review revealed that the conventional approach to understanding the concept and measuring healthcare team resilience primarily focused on individual resilience. However, this research recognized the need for an adapted model that recognizes the healthcare team as a cohesive and cognizant entity to identify barriers and facilitators of resilience that may be otherwise obscured when solely emphasizing the resilience of individuals, or specific groups. Through a reflexive thematic analysis, several significant findings were identified regarding the impact of the COVID-19 pandemic on the healthcare team: 1) Emotionality played a crucial role in influencing adaptive behaviors, encompassing emotions such as fear, stress, anxiety, and frustration; 2) Drawing upon their tacit knowledge gained from prior experiences, the healthcare team demonstrated the capacity to anticipate and effectively respond to the crisis despite their lack of explicit knowledge, and 3) The solidarity and camaraderie within the healthcare team not only bolstered their overall functionality but also facilitated unified decision-making processes.

Rights

Copyright is held by the author. All rights reserved.

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