Resilience Outcomes Research Articles

Protective Factors Predict Resilient Outcomes in Clinical High-Risk Youth with the Highest Individualized Psychosis Risk Scores.

Studying individuals at Clinical High Risk (CHR) for psychosis provides an opportunity to examine protective factors that predict resilient outcomes. Here, we present a model for the study of protective factors in CHR participants at the very highest risk for psychotic conversion based on the Psychosis Risk Calculator. CHR participants (N = 572) from NAPLS3 were assessed on the Risk Calculator. Those who scored in the top half of the distribution and had 2 years of follow-up (N = 136) were divided into those who did not convert to psychosis (resilient, N = 90) and those who did (nonresilient, N = 46). Groups were compared based on candidate protective factors that were not part of the Risk Calculator. Better functional outcome was also examined as an outcome measure of resiliency. Study Results: Exploratory analyses suggest that Hispanic heritage, social engagement, desirable life experiences, premorbid functioning and IQ are all potential protective factors that predict resilient outcomes. Reduced startle reactivity, brain area and volume were also associated with greater resilience. The primary focus of CHR research has been the risk and prediction of psychosis, while less is known about protective factors. Clearly, a supportive childhood environment, positive experiences, and educational enrichment may contribute to better premorbid functioning and brain development, which in turn contribute to more resilient outcomes. Therapies focused on enhancing protective factors in the CHR population are logical preventive interventions that may benefit this vulnerable population. Future CHR research might use similar models to develop a "protective index" to predict resilient outcomes.

Stress Resilience And Resilience Factors Across 9 European Samples During The COVID-19 Pandemic

Abstract While many describe changes in mental health over the pandemic, we investigate change in resilience over time during the pandemic. Stress resilience can be operationalised as stressor reactivity, that is, how much a person’s mental health is affected by the stressors that they experience. Utilising the individual participant data (IPD) meta-analyses megadataset available we first define and quantify how many stressors individuals. We then regress this stressor exposure on mental health within each sample to compute each sample’s normative stressor reactivity. Each person’s individual stressor reactivity is then calculated as the residual to this line at each time points. Resilient outcomes can be understood as lower reactivity as this indicates lower susceptibility to stressors. Stressor reactivity (SR) scores control for individual stressor exposure, therefore allowing us to investigate resilience factors during a time in which exposure to macro and micro stressors varied greatly between individuals. Further, SR scores are a harmonised outcome that can easily compared across different samples in the IPD dataset. Using this outcome, we present findings on resilience trajectories and identify factors that are associated with resilient outcomes. We also disentangle the role of current stressor exposure and prior stressors, showing that prior exposure to stressors increases vulnerability in subsequent exposures. Our findings show that stressor reactivity over time was more stable than mental health symptoms during the pandemic, therefore indicating that SR as an outcome offers new insights into the impact of the pandemic.

Navigating Crisis: Resilience and Mental Well-being in Post-COVID Cyprus Students

Abstract Background The mental health of university students is identified as a major challenge in public health, exacerbated by the COVID-19 pandemic. The pandemic and its aftermath have brought forth several stresses, which have had a substantial influence on university students’ mental health. Understanding how resilience, which is crucial in coping with adversity, influences students’ responses to these difficult circumstances is critical. Objectives This study aims to examine the relationship between resilience and mental health outcomes among university students in the Republic of Cyprus after the COVID-19 pandemic. Methods Using a parallel embedded mixed methods approach, resilience was measured using the Conner-Davidson Resilience Scale (CD-RISC) while mental health outcomes were assessed using the Symptom Checklist 90-Revised (SCL 90-R) among a preliminary sample of 470 students. The association between the two was assessed by linear regression analysis, adjusting for potential confounders, and also stratifying by gender. Results Preliminary findings from this ongoing study revealed a significant inverse relationship between resilience and mental health (beta= -0.58, 95% CI -0.88, -0.29), regardless of gender, age, or socioeconomic status. Stratifying by gender revealed for males, the association between resilience and mental health is (beta= -0.50, 95% CI -0.98, -0.32), whereas for females, it is (beta= -0.63, 95% CI -1.04, -0.22). In short, the influence of resilience on protecting mental health appears to be slightly more prominent in women than in males. Discussion This study enriches our understanding of the intricate interplay between the COVID-19 pandemic, resilience, and mental health outcomes among university students. By prioritizing the psychological well-being of this population group, our findings resonate with the World Health Organization’s advocacy for heightened mental health awareness during crises. Key messages • Prevalence of mental health issues post pandemic era among university students. • Resilience as a buffer for mental health crisis in young adults.

6.M. Scientific session: Risk And Resilience Factors Of Mental Health During COVID: European Multi-country Data Findings

Abstract The COVID-19 pandemic significantly affected mental health. It worsened the mental health and well-being of those already vulnerable or exposed to excess pandemic-related stress. In addition, lockdowns and other measures created additional obstacles to mental health support access. In response, the European Commission funded the RESPOND project in 2020, aimed at enhancing the preparedness of mental health systems for pandemics and global crises. As part of the RESPOND project, (meta-)analyses were conducted on prospective cohort datasets, national health register data, and multi-country individual participant data (IPD). The aim was to examine whether there was a change in prevalence rates of mental health conditions (e.g., anxiety and depression) in the general adult population of the EU during, compared to before and in between, the COVID-19 pandemic waves. Analyses on risk factors (e.g. sociodemographic- and economic factors, severity of COVID-19 infection, (lack of) social activity and support, and loneliness) associated with psychological distress and mental disorders as well as resilience and well-being (coping strategies and core value orientations) in the general population or specific vulnerable groups were conducted as well. This workshop will feature five talks covering various aspects of the RESPOND epidemiological analyses. First, an introduction and rationale of the RESPOND study on short- and long-term impacts of the COVID-19 pandemic and outbreak response, will be provided. Subsequently, findings from the multi-country longitudinal COvid MEntal healTh Survey (COMET) on forecasting psychological distress throughout the pandemic will be presented. Second, findings from the French TEMPO (Trajectoires EpideMiologiques en POpulation) cohort and merged datasets will be presented indicating associations and interactions between socioeconomic factors, mental health, and public health behaviours during the pandemic. Third, using data of a large Belgian prospective cohort, fluctuations in risk of psychological distress across study waves and the factors associated with individual trajectories of psychological distress during the COVID-19 pandemic will be presented. Fourth, the risk of SARS-CoV-2 infection, severe COVID-19 outcomes, and death among individuals with various mental disorders, based on Spanish health records, will be presented with specific attention to sex differences. Finally, based on the IPD meta-analyses of 9 European cohorts, findings on stressor reactivity, resilience trajectories, and factors associated with resilient outcomes and vulnerability are presented. By presenting a selection of findings from large datasets together, we aim to facilitate discussions on critical topics such as vulnerability and resilience to mitigate mental health impacts in future public health crises. Key messages • Targeting specific individual vulnerabilities appears to be more effective in reducing the pandemics’ mental health impact than solely responding to pandemic-related fluctuations. • Research and harmonised data on vulnerability and resilience factors are essential for guiding the development of targeted interventions and support systems for vulnerable populations during crises.

Overcoming Challenges and Promoting Positive Education in Inclusive Schools: A Multi-Country Study

Inclusive education faces significant challenges requiring deep understanding and comprehensive solutions. This study aims to establish a holistic framework for understanding the challenges in inclusive education, the core mission of inclusive schools, and the essential qualities of teachers. The methodology employed was qualitative, using the grounded theory method. A total of 59 experts from 13 countries participated in this study. Semi-structured asynchronous virtual interviews were conducted and analyzed using ATLAS.ti software (version 8). The results identified eight persistent challenges to inclusive education. In addition, positive education was highlighted as the fundamental core of inclusive schools, with emphasis on the development of learning, well-being, engagement, resilience, motivation, mental health, affective and social outcomes, creativity, and happiness. Finally, the integral profile of the inclusive teacher was defined based on a four-dimensional model. This groundbreaking study introduces a novel comprehensive framework that revolutionizes our understanding of the enduring challenges in inclusive education. Elucidating the core mission of inclusive schools and defining the essential qualities of inclusive teachers offers transformative insights. This study’s implications, future perspectives, and limitations provide a wealth of valuable information for policymakers, educators, and researchers, paving the way for innovative approaches and enhanced inclusive educational practices.

Enhancing Economic, Resilient, and Sustainable Outcomes Through Supplier Selection and Order Allocation in the Food Manufacturing Industry: A Hybrid Delphi-FAHP-FMOP Method

In the food manufacturing industry, which is critical to national economies, there is a growing imperative to meet heightened safety, quality, and environmental standards, particularly in the face of supply chain disruptions. This study addresses the gap in literature by integrating sustainable and resilient supply chain theories with risk management and low-carbon principles into a supplier selection framework. Utilizing the Delphi method, fuzzy analytic hierarchy process (FAHP), and fuzzy multi-objective programming (FMOP), we develop a decision-making model specifically calibrated for the food sector. Initially, the study establishes a comprehensive criteria system encompassing quality, cost, delivery, low-carbon, and risk management through a literature review and expert consultation. Subsequently, FAHP is employed to determine the relative importance of each criterion in supplier selection. Furthermore, FMOP is utilized to develop a decision-making model for optimizing supplier selection and order allocation. Validated through a numerical study based on a Chinese food manufacturer, the framework presents a practical tool for food manufacturers, ensuring supply chain stability while aligning with sustainability objectives. This research refines decision making and strengthens the competitive stance of food manufacturers, significantly propelling the industry’s green transformation.

From worries to resilience: a qualitative study of the psychosocial experiences of diverse adolescents and young adults with heart failure and their caregivers.

Despite advances in treatment and outcomes for paediatric heart failure, both physical and psychosocial comorbidities remain notable among this patient population. We aimed to qualitatively describe the psychosocial experiences of adolescent and young adults with heart failure and their caregivers' perceptions, with specific focus on personal challenges, worries, coping skills, and resilience. Structured, in-depth interviews were performed with 16 adolescent and young adults with heart failure and 14 of their caregivers. Interviews were recorded and transcribed. Content analysis was performed, and themes were generated. Transcripts were coded by independent reviewers. Ten (63%) adolescent and young adults with heart failure identified as male and six (37.5%) patients self-identified with a racial or ethnic minority group. Adolescent and young adults with heart failure generally perceived their overall illness experience more positively and less burdensome than their caregivers. Some adolescent and young adults noted specific worries related to surgeries, admissions, major complications, death, and prognostic/treatment uncertainty, while caregivers perceived their adolescent and young adult's greatest worries to be around major complications and death. Adolescent and young adults and their caregivers were able to define and reflect on adolescent and young adult experiences of resilience, with many adolescent and young adults expressing a sense of optimism and gratitude as it relates to their medical journey. This study is the first of its kind to qualitatively describe the psychosocial experiences of a racially and socioeconomically diverse sample of adolescent and young adults with heart failure, as well as their caregivers' perceptions of patient experiences. Findings underscore the importance of identifying distress and fostering resilient processes and outcomes in young people with advanced heart disease.

Turkish Cooks’ Leisure Experiences Shape Their Work Life Through Psychological Resilience: A Broaden-and-Build Theory Perspective

This study explored the impact of various leisure experiences—­awareness, boredom, challenge, and distress—on resilience, job satisfaction, and work enthusiasm among cooks in Turkey. Utilizing a quantitative research design, data were collected from 328 Turkish cooks through a structured survey. Path analysis revealed that boredom has a negative impact on resilience, whereas challenge has a positive influence. In turn, resilience significantly enhanced job satisfaction and work enthusiasm. The findings highlighted the nuanced roles of different leisure experiences in shaping resilience and work-related outcomes. This study underscored the importance of integrating engaging and challenging leisure activities into workplace wellness programs and vocational training to promote Turkish cooks well-being and productivity. It contributed to the theoretical understanding of leisure’s psychological benefits and offered practical strategies for enhancing resilience in Turkish culinary profession.

Introducing Resilience Outcome Expectations Scale: Development and Initial Validation

Introducing Resilience Outcome Expectations Scale: Development and Initial Validation

Negative Problem Orientation and Wellbeing Among Emerging Adults: The Mediating Roles of Optimism and Resilience

Understanding the roles of problem orientation for wellbeing during emerging adulthood is crucial to assist this cohort in successfully navigating the challenges of the transitional period. In this context, the present study investigates the interplay between negative problem orientation (NPO), resilience, optimism, and wellbeing among emerging adults. For this cross-sectional study, NPO, optimism, resilience, and wellbeing scales were administered to a total of 355 emerging adults (77% female, Mage= 21.33, SD = 2.35). The results revealed that NPO both directly and indirectly predicted wellbeing through optimism. However, contrary to the common assumption about positive outcomes of resilience, no significant mediating effects of resilience between NPO and wellbeing were observed. The study concludes with a discussion of both theoretical and practical implications of the findings.

Family Resilience and Its Influencing Factors in Patients With Cancer and Their Family Members: A Systematic Review.

This review aims to explore factors influencing family resilience in families providing care for patients with cancer and to provide suggestions for future research directions. Six electronic databases were searched including Web of Science, CINAHL, EMBASE, PsycINFO, PubMed and CNKI from their inception to December 2023. The article reference lists were also manually searched. The Mixed Method Appraisal Tool was used to assess the included studies in this review. The 27-item checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed to report this review. Twenty-one studies from six online databases reported that either individual or family factors have effects on family resilience and were described into five clusters on the basis of the Walsh model of family resilience, including demographic and clinical factors, personal strengths and resources, family stressors, family resilient coping processes and family resilient adaptation outcomes. Family resilience in cancer families plays a pivotal role in coping with family stressors and facilitating positive outcomes through domains of coping. Future researches need to explore factors related to family resilience from dyadic perspectives and to establish multidisciplinary intervention strategies for developing levels of family resilience in cancer families. PROSPERO: CRD42024535349.

Subjective experiences of language brokering among adolescents: Resilience, relationships, risky behaviors, and mental health outcomes.

Adolescents from immigrant families often translate or interpret communication on behalf of their parents, a process known as language brokering (LB). From a poststress growth framework, these LB experiences may yield opportunities for personal development and resilience or may contribute to risky behaviors and poor mental health. In this study, frequency of LB and subjective feelings of LB are tested as they relate to family relationships, resilience, risky behaviors, and mental health outcomes. In this study, 188 adolescents who language broker (female = 128, male = 60; Mage = 16.19 years, SD = 1.01; 5% African American/Black, 24% Asian American/Pacific Islander, 8.5% White, 52% Latino/Hispanic, and 11% mixed/multiracial) completed an online questionnaire about their frequency of LB (i.e., weekly and in general), extent of LB, feelings about LB (i.e., efficacy, burden, and intrusiveness), positive and negative attitudes toward LB, relationships with parents, engagement in risky behavior, and anxiety and depression symptoms. Findings indicated that feelings of efficacy and positive attitudes toward LB associated with resilience. Positive attitudes and a lack of negative attitudes associated with better family relationships. Risky behaviors were associated with age, extent and intrusiveness of LB, and a lack of positive attitudes. Female, extent of LB, and positive attitudes were related to anxiety. Building efficacy and fostering positive attitudes toward LB may foster positive outcomes and prevent deleterious outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relationship between Psychological Resilience and Health Outcomes in Older Adults with Advanced CKD

Relationship between Psychological Resilience and Health Outcomes in Older Adults with Advanced CKD

Balancing Stakeholder Interests in Sustainable Project Management: A Circular Economy Approach

Balancing stakeholder interests in sustainable project management presents a critical challenge, particularly when adopting a circular economy (CE) approach. This review explores the integration of circular economy principles such as reducing waste, reusing materials, and promoting recycling into project management while addressing the diverse and often competing interests of stakeholders. Sustainable project management aims to harmonize economic, environmental, and social objectives, making the alignment of stakeholder goals a complex yet essential task. Stakeholders, including investors, customers, regulators, local communities, and internal project teams, often have varying priorities, ranging from maximizing profitability to minimizing environmental impact and ensuring social responsibility. This study reviews key strategies for managing these competing interests through collaborative decision-making, transparency, and stakeholder engagement. Life Cycle Assessment (LCA), closed-loop supply chains, and sustainable procurement are examined as practical tools for integrating CE principles throughout the project lifecycle. Additionally, the review emphasizes the importance of education and communication in fostering stakeholder buy-in, enhancing long-term sustainability outcomes, and improving resource efficiency. Case studies from industries such as construction and renewable energy demonstrate how stakeholder collaboration in adopting CE practices leads to both environmental benefits and project success. The findings suggest that balancing stakeholder interests in a circular economy framework not only enhances sustainability but also drives innovation and competitiveness. This research underscores the need for continual engagement and adaptive strategies in project management, ensuring that stakeholder alignment with circular economy goals results in more resilient and sustainable project outcomes. Ultimately, adopting a circular economy approach within project management offers a viable pathway to achieving long-term sustainability and creating shared value among stakeholders.

Strategies, challenges, and outcomes of heat stress resilience in sub-Saharan African community-based cattle feedlots: a systematic review.

In sub-Saharan Africa, cattle feedlots face a significant challenge in dealing with heat stress. However, there is a lack of inclusive strategies for resilience in these situations. The aim of this systematic review is to investigate the strategies, challenges, and outcomes related to heat stress resilience in community-based cattle feedlots in sub-Saharan Africa. The PRISMA approach, which is a method for reporting systematic reviews and meta-analyses, was used to identify, screen, and analyze 30 peer-reviewed articles published over the last 20 years from Google Scholar and Scopus. The review found that key strategies to mitigate heat stress include providing shade through natural and artificial means, ensuring constant access to cool, clean water using water spraying systems and cooling ponds, and implementing nutritional adjustments such as high-energy feeds and electrolyte supplements. Additionally, genetic selection for heat-tolerant breeds and management practices like adjusting feeding times and improving ventilation were found to be effective in dealing with heat stress. In particular, local germplasm and genetic traits of cattle in sub-Saharan Africa play a crucial role in heat stress resilience. Indigenous breeds, which have adapted to the region's harsh climate over centuries, exhibit traits such as higher heat tolerance, better water-use efficiency, and improved feed conversion rates under heat stress conditions. This genetic resilience can be enhanced through targeted breeding programs aimed at amplifying these beneficial traits. Implementing these strategies resulted in improved cattle health and productivity, as evidenced by enhanced weight gain, better reproductive performance, and lower mortality rates. The socio-economic benefits of these strategies included reduced economic losses and increased farmer incomes, which in turn contributed to improved community health and nutrition. However, the review also identified significant challenges, including financial constraints, limited access to knowledge and training, and cultural resistance. To address these barriers, the review recommends increased investment in affordable cooling technologies, farmer education, and community-based initiatives. Additionally, leveraging the genetic strengths of local cattle breeds should be prioritized to maximize the effectiveness of heat stress resilience strategies.

How does family resilience develop among stroke survivors and their caregivers? A mixed-method study using a chain mediating model

BackgroundWalsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience among Chinese stroke survivors and their caregivers. ObjectivesTo explore the direct and indirect relationships between the family resilience of stroke survivors, perceived social support, self-perceived burden, self-efficacy, and the burden on their principal caregivers, and to examine the journey of adapting to family resilience among stroke survivors. DesignAn explanatory sequential mixed-method study. MethodsA quantitative assessment of perceived social support, self-perceived burden, self-efficacy, and family resilience was conducted among a cohort of stroke survivors. For a deeper understanding of the family resilience formation process, semi-structured, in-depth interviews were undertaken with a purposefully selected subset of participants, consisting of 15 stroke survivors and their principal caregivers who met the study criteria. Data analysis encompassed descriptive statistics, mediation models, and content analysis to integrate and interpret both quantitative and qualitative data. ResultsIn a comprehensive hospital in Guangdong Province, China, 379 participants—229 men (60.4%) and 150 women (39.6%)—completed a cross-sectional questionnaire survey. The quantitative phase revealed significant statistical differences (p < 0.05) in total family resilience scores among stroke survivors related to various factors, such as age, marital status, educational level, occupational status, average monthly income per capita, first-time onset, and types of stroke. Self-perceived burden and self-efficacy partially mediate the relationship between perceived social support and family resilience, contributing to a sequential chain-mediated effect. During the qualitative phase, in-depth interviews revealed a progressive trajectory from the initial shock of diagnosis through the ongoing presence of stress and challenges to the ultimate development of family resilience and an adaptive perspective toward the future. ConclusionsExploring the factors influencing family resilience in stroke survivors could assist healthcare professionals developing interventions to enhance family resilience and lessen the burden on principal caregivers from individual, family, and social perspectives.

Relationship between Perceived Family Resilience, Emotional Flexibility, and Anxiety Symptoms: a Parent-Adolescent Dyadic Perspective.

Family resilience is crucial for individual's psychological health. Previous studies explored the protective factors of anxiety at the individual level, with less attention paid to the impact of family interaction from a dyadic perspective. This study utilized the Actor-Partner Interdependence Mediation Model to investigate the relationship between family resilience, emotional flexibility, and anxiety symptoms. A sample of 2144 Chinese parent-adolescent dyads (36% upper grades of primary school, 64% secondary school, 49.39% girls; 70.38% mothers) was recruited. Perceived family resilience was inversely related to anxiety symptoms, directly or indirectly, through the mediation of emotional flexibility at the individual level. At the dyadic level, adolescents' perceived family resilience was significantly associated with parents' anxiety symptoms through their own or parents' emotional flexibility. Parents' perceived family resilience was inversely link to adolescents' anxiety symptoms through parents' emotional flexibility. Parents emotional flexibility also mediated the association between adolescents' perceived family resilience and their anxiety symptoms. These findings contribute to understanding the intricate dynamics of family resilience and psychological outcomes in parent-child relationships under adversity, emphasizing the need for child-centered interventions to improve family members' mental health.

User needs for coastal inundation at climate time scales: A multi‐sectoral case study in the coproduction of knowledge

AbstractCoastal regions are becoming increasingly vulnerable to flooding. Due to growing risk, there is a need for a variety of accessible flood inundation services and information to improve resilience and adaptation outcomes. To better understand these needs the National Oceanic and Atmospheric Administration's Office for Coastal Management and the Center for Operational Oceanographic Products and Services collaborated to host five virtual workshops during the COVID‐19 pandemic to understand inundation needs and deficits of five professional sectors: coastal planning, transportation and navigation, realty and insurance, health and human services, and natural resource and floodplain managers. This paper outlines the information collected from these workshops, shares recommendations for future research to improve equitable coastal resilience and highlights the value of remote engagement for knowledge coproduction. From the project results, we share cross‐cutting topics that emerged and propose a need for greater equity, inclusive engagement, interagency coordination and future research directions through scientist‐stakeholder coproduction workshops for improved coastal resilience.

Mentalization-based interventions in schools for enhancing socio-emotional competencies and positive behaviour: a systematic review.

Mentalization-based interventions (MBIs) have been increasingly applied in school settings to support the social-emotional development and mental health of children and adolescents. This systematic review aimed to synthesize the evidence on the effectiveness of MBIs implemented in educational contexts for students aged 6-18 years. A comprehensive search was conducted in PsychInfo, MEDLINE, EMBASE, Web of Science, and ERIC databases from inception to October 2023. The search strategy combined terms related to mentalization, school-based interventions, and the target age group. The review protocol was registered with PROSPERO (CRD42022302757). Inclusion criteria included peer-reviewed publications in English, studies published between 1980 and 2023, interventions based on mentalization principles, and a primary focus on children aged 6 to 18 years. Exclusion criteria involved non-mentalization based interventions and research outside the 6-18 age range. The risk of bias was assessed using the Quality Assessment Tools from the National Institutes of Health (NIH). Data were synthesized narratively due to the heterogeneity of study designs and outcomes. Of the 5,250 articles screened, 21 studies met the inclusion criteria, comprising over 7,500 participants. The reviewed interventions targeted various aspects of mentalizing, such as emotion-understanding, empathy, perspective-taking, and Theory of Mind. Significant improvements were found in social-cognitive abilities, emotion regulation, and mental health outcomes, including reductions in disruptive behaviours. Interventions that combined mentalizing training for both students and teachers showed promising results. However, the long-term sustainability of these benefits remains unclear. Limitations of the reviewed studies include the lack of control groups, small sample sizes, and variations in outcome measures. The findings highlight the potential of MBIs as a promising approach to fostering socio-emotional competence, positive behaviour, and well-being in school-aged children. Future research should aim to establish the active components and optimal delivery of these interventions through well-designed randomized controlled trials with larger, more diverse samples and extended follow-up periods. The integration of MBIs within educational systems holds promise for promoting resilience and positive mental health outcomes in young people. Embedding MBIs within school curriculums and evaluating cost-effectiveness are important next steps to guide widespread implementation.

Caring for the Unvaccinated During a Pandemic: Connecting Swanson's Theory of Caring.

Background and Purpose: Nurses frequently care for patients who make decisions against medical advice, a challenge that continues during and after the COVID-19 pandemic. This article explores U.S. nurses' experiences caring for unvaccinated COVID-19 patients and the resulting impacts using Swanson's Theory of Caring (STC). Methods: Data were gathered through an online survey collecting nurses' demographics, mental health screening data, and an open-ended question asking about a personal experience providing care to an unvaccinated COVID-19 patient. Researchers analyzed 128 responses using content analysis. STC served as the analytical framework. Results: Nurses' experiences were summarized into two main themes and four subthemes: (a) anger, frustration, fatigue, and resentment (24.2%) and (b) feeling a professional commitment to a nurse's duty (60.9%). Within the professional commitment theme, subthemes include the following: (a) patients can make an autonomous decision (15.6%); (b) feeling concerned for the patient (6.3%); (c) wanting to take action, educate, and vaccinate (29.7%); and (d) feeling moral conflict (9.3%). Results aligned with STC's five caring actions: knowing, doing for, being with, enabling, and maintaining belief. Implications for Practice: Nurses experienced emotional challenges caring for the unvaccinated during the pandemic resulting in psychological sequelae, including compassion fatigue and moral distress, in addition to positive outcomes of resilience and enhanced coping mechanisms. This study underscores the multifaceted nature of nurses' experiences and the emotional, ethical, and professional challenges they encountered when caring for unvaccinated COVID-19 patients. Nurse leaders should address these issues to enhance nurses' wellbeing and reduce compassion fatigue and dissatisfaction.