Sei sulla pagina 1di 11

Adolescent Resilience:

An Evolutionary Concept Analysis

Nancy R. Ahern, MEd, MSN, RN

Resilience is a concept that has enormous utility in nursing, although there is a need for concept clarity as it relates to
adolescence. The purpose of this article is to describe the concept and apply the Evolutionary Model of Concept Analysis to
resilience in adolescents. A literature search and an analysis of 22 articles specific to the adolescent population were
completed. The literature review revealed adolescent resilience to be a composite of attributes that include the characteristics
of the adolescent, sources of social support, and available resources. Implications for nursing and a proposed model of
adolescent resilience are presented.
n 2006 Elsevier Inc. All rights reserved.

ANDY IS A 16-year-old who lives on the

streets. She panhandles for money and pilfers
through restaurant garbage for food. Yet, she has
her bfamily Q and a place to sleep (somewhere).
Candy is resilient; for her, bresilienceQ means
survival. Although Candy is fictitious, her story
is not. Much has been written about this concept,
yet little is understood about its presence in the
adolescent population.
Adolescent resilience is a concept of enormous
utility in nursing. The concept of resilience has
been commonly referred to as the ability to
bspring backQ and is similarly defined in research and clinical practice. Garmezy (1991)
defines the concept as the tendency to spring
back, rebound, or recoil, whereas Wagnild and
Young (1993) define resilience as the ability to
successfully cope with change and misfortune.
Resilience is also defined as a personality trait
that can aid an individual to bbounce backQ or
heal from stress and disaster, yet there are still
inconsistencies with its use in the adolescent
population. Definitions of the concept vary
depending on the sample, setting, and variables
under study.
The purpose of this article is to (a) describe the
concept of resilience as it applies to adolescents
and (b) apply Rodgers evolutionary model of
concept analysis to resilience in adolescents. A
better understanding of this concept will enable
nurses to enhance resilience in adolescents during
life transitions and periods of adversity.

Journal of Pediatric Nursing, Vol 21, No 3 (June), 2006


Resilience is a concept that can be viewed as a
categorical construct or as a continuum of adaptation or success (Hunter & Chandler, 1999;
Tusaie & Dyer, 2004). Resilience, as a construct,
changes over time. Its roots can be found in two
bodies of literature: the psychological aspects of
coping and the physiological aspects of stress
(Tusaie & Dyer, 2004). The early studies of
resilience focused on the factors or characteristics
that help individuals succeed from adversity
(Garmezy, 1991; Rutter, 1987). As knowledge on
the concept developed, it became obvious that
individual and environmental factors may be
necessary but not sufficient to fully understand
resilience. The dynamic processes among the
factors mediate between the person and the
environment and the person and the outcome
(Tusaie & Dyer, 2004). Thus, empirical evidence
led to the development of models of resilience and
instruments that operationalized the concept.
Accordingly, resilience can vary with the individuals stage of development and can be expressed

From the School of Nursing, Southern Regional Campus,

University of Central Florida, Orlando, FL.
Address correspondence and reprint requests to Nancy R.
Ahern, MEd, MSN, RN, 913 East First Avenue, New Smyrna
Beach, FL 32169. E-mail:
0882-5963/$ - see front matter
n 2006 Elsevier Inc. All rights reserved.



in behaviors at each stage that can be interpreted as

positive (e.g., promote health) or negative (e.g.,
impair health) (Hunter & Chandler, 1999). Resilience is considered to be multidimensional having
moderating (e.g., positive peer relationships) and
mediating factors (e.g., competencies and expectancies) (Criss, Pettit, Bates, Dodge, & Lapp, 2002;
Freitas & Downey, 1998). In essence, the phenomenon of resilience is a reflection of the relationship
between personal characteristics and factors in the
environment that result in ones (i.e., individual or
group) ability to meet the stress and adversity with
coping and adaptation. Researchers contend that the
concept may be a set of traits (Jacelon, 1997), an
outcome (Olsson, Bond, Burns, Vella-Brodrick, &
Sawyer, 2003; Vinson, 2002), or a process (Olsson,
Bond, Burns, Vella-Brodrick, & Sawyer, 2003).


Sample and Setting

A search of the literature from a variety of
databases indicates a plethora of reviews on
resilience. A literature search of the concept of
resilience was conducted from the disciplines of
nursing, medicine, psychology, sociology, and
education using the CINAHL, Academic Search
Premier, Health and Wellness Resources, PubMed,
and PsychINFO databases. Over 5,000 articles
were located that included the term resilience in the
subject key word. These articles spanned the last
5 7 years. Because of this large number, the
search was limited to the last 5 years, human
subjects, and English articles from the adolescent
population using the key words badolescent or teen
or youthQ and bresilience.Q Seventy-five of the most
recent articles were reviewed for relevancy (empirical and theoretical articles). These articles were
retrieved via online journals and from library visits
or interlibrary loan requests. Seventeen articles met
all search criteria and were selected for analysis.
An additional five articles (older than 5 years) were
retrieved to enhance the analysis. These 22 articles
represented research studies and literature syntheses on adolescent resilience. The majority of the
22 articles retrieved for analysis were from nursing
and social sciences. This breakdown included
nursing (n = 9), social sciences (n = 11), medical
(n = 1), and education (n = 1). Additional articles
were also selected from the original 75 articles,
because they were cited frequently by other
authors, many of which were seminal writings


(1993 1998). Although not chosen for analysis,

these writings provided a clearer understanding of
the concept. The remaining articles were discarded
due to irrelevant discussion of the topic.

Because resilience is a dynamic concept that
can change with time, the evolutionary concept
analysis method was selected as the most appropriate for application (Rodgers, 1989; Rodgers,
2000). This method is based on philosophical
positions that view a concept as an abstraction
expressed in some form (Rodgers, 2000). The
evolutionary view stresses the belief that concepts
are influenced by contextual factors and may vary
over time. According to Rodgers (1989, 2000), the
goal of evolutionary concept analysis is the
clarification and development of concepts rather
than a description of their essence. This method
involves the following activities: (1) identification
of the concept of interest and associated expressions (including surrogate terms); (2) identification
and selection of an appropriate realm (setting and
sample) for data collection; (3) collection of data
relevant to identify the attributes and contextual
basis of the concept; (4) analysis of data regarding
characteristics of the concept; (5) identification of
an exemplar of the concept, if appropriate; and
(6) identification of implications, hypotheses, and
implications for further development of the concept. The activities of this method were completed
with the exception of the exemplar of the concept.
Empirical and theoretical articles were selected
(as outlined above) and analyzed using this concept
analysis process.

Data Analysis
Each of the 22 articles on adolescent resilience
was coded with a reference number and a letter
designating the discipline. These articles were read
and summarized in a table based on the dimensions
of the evolutionary model. Data were analyzed in
terms of these model dimensions. The remaining,
more general articles were read to provide background information on the concept of resilience.

The Concept of Resilience

The concept has been studied chiefly in relation
to times of transition that are accompanied by
stress (Luthar, Cicchetti, & Becker, 2000; Olsson
et al., 2003; Tusaie & Dyer, 2004). Transitions



include stress and/or adaptation experienced by

populations at risk including at-risk children
(Mandleco & Peery, 2000; Tiet et al., 1998); poor
Appalachian adolescents (Markstrom, Marshall, &
Tryon, 2000); at-risk youth (Ungar, 2004); Black
adolescent mothers (Hess, Papas, & Black, 2002);
domestic violence (Kragh & Huber, 2002); multicultural adolescent students (Davey, Eaker, &
Walters, 2003; Hunter & Chandler, 1999; Jackson,
Born, & Jacob, 1997; Olsson et al.); and homeless
adolescents (Rew, Taylor-Seehafer, Thomas, &
Yockey, 2001), among others. Scholars and
researchers have attempted to advance the understanding of resilience and the factors affecting this
concept, yet further clarification is needed. Definitions of the concept are inconsistent, and there is
a gap in the literature regarding resilience in the
healthy adolescent. The reader is referred to Table 1
for a comparison of resiliency definitions.
Definitions of this concept are inconsistent,
most likely to serve the purpose of the researcher
or to fit the framework of reference being used by
the researcher. For example, Rutter (1987) and
Garmezy (1991) refer to resilience as a personality
characteristic of children from at-risk environments, whereas McCubbin and McCubbin (1989)
define the concept in terms of the characteristics,
dimensions, and properties of families that help
families to resist disruption in crisis situations.
Polks (1997) synthesis of the concept suggests
that resilience is a middle range theory. According
to Polk, this synthesis exercise was undertaken
as a means to further delineate the concept.
Mandleco and Peery (2000) posit that if resilience is a middle range theory that should cross
phenomena, there generally seems to be a lack of

agreement regarding (1) the age domain covered

by the construct, (2) the circumstances where it
occurs, (3) its definition, (4) its boundaries, or (5)
the adaptive behaviors described (p. 100). According to Mandleco and Peery (2000) the importance
of specific factors promoting resilience, however,
remains in disarray, as one does not know which
influencing factors are the most significant for a
particular individual or an individuals subsequent
responses to stress. Definitions need to correlate
with outcomes specifically in research and practice applications rather than as a global definition
of resilience.
Several authors developed models to construct
theory in an attempt to clarify ambiguity related to
the concept (Kulig, 2000; Mandleco & Peery,
2000; Rew & Horner, 2003). The concept has also
been operationalized numerous times. Such examples include the Baruth Protective Factors inventory (Baruth & Carroll, 2002), the Adolescent
Resilience Scale (Oshio, Kaneko, Nagamine &
Nakaya, 2003), the Resilience Scale (Wagnild &
Young, 1993), and the Resilience Scale for Adults
(Friborg, Hjemdal, Rosenvinge, & Martinussen,
2003). Friborg et al. (2003) validate the resilience
scale for adults which measures the presence of
protective factors important for maintaining mental
health. The scale developed by Wagnild and Young
was tested with adult women, but according to
the authors, the scale has been used successfully
with adolescents.

Adolescent Resilience
Much has been written regarding the developmental perspective of resilience. Rutter (1993)
noted that resilience was developmental in nature,

Table 1. A Comparison of Resiliency Definitions



Garmezy (1991)
Greenspan (1982)

Infants and children

Hunter and Chandler (1999)

Inner city, vocational

high school adolescents
Children and adolescents

Mandleco and Peery (2000)

Markstrom et al. (2000)
Rew et al. (2001)

Rural, low income,

Appalachian adolescents
Homeless adolescents

Rouse and Ingersoll (1998)

Adolescents in high school

Wagnild and Young (1993)

Adult women


The capacity to recover and maintain adaptive behaviors after insult.

The capacity to successfully undertake the work of each successive
developmental stage.
Process of defense using such tactics as insulation, isolation,
disconnecting, denial, aggression, as a process of survival.
Capacity to respond, endure, and/or develop and master in spite of
experienced life stressors.
Adaptive, stress resistant personal quality that allows the individual to
thrive despite unfortunate life experiences.
Beliefs in ones personal competence and acceptance of self and life
that enhance individual adaptation.
The ability to succeed, mature, and gain competence in a context of
adverse circumstances or obstacles.
The ability to successfully cope with change and misfortune.


Table 2. Adolescent Resilience Literature: An Analysis of 22 Sources



Sample, Setting, and Study Type

Concept Attributes

Aronowitz and
Morrison-Beedy (2004)T

443 poor African American teens

Cross-sectional secondary analysis


Blum (1998)y

Review of literature


Born, Chevalier,
and Humblet (1997)T

303 youth offenders



Cook (2000)T

32 Multicultural teens who attend church

Qualitative review

Dependent on prior experiences


Cosden (2001)y

Adolescents with learning disabilities

Review of literature

Internal and external risks

and protective factors


Davey et al. (2003)T

181 Low-middle-class adolescent

multicultural students
Descriptive, correlational



Haase et al. (1999)T

Adolescents with cancer

Testing of adolescent resilience model
Multisite longitudinal,
qualitative and quantitative

Individual, family, and social

protective factors

Not a trait
Interactive (person and environment)
Personal and social components

Surrogate Terms

(A) At-risk behaviors

(C) Less risky behavior with
preventive interventions
(S) Future time perspective key mediator
between connectedness and resilience
(A) Stress, negative life behaviors
(C) Flexible
(S) Graded phenomena, developmental


(A) Exposure to cumulative risk, stable

relationships, absence of diagnostic labels,
good adaptation to institution
(C) Related to gravity of delinquent offenses
and persistence, personal factors
rather than environment
(A) Stress, poverty, church attendance
(C) Foster identification, self-regulatory
behaviors, self-worth
(S) Religion, culture
(A) Self-esteem, peer relationships,
depression, social support, hyperactivity
(C) Development or not of drug abuse
(A) Extrovert, agreeable, open to new
experiences, compensatory with
disagreeableness and emotional instability
(C) Higher self-worth, better coping
(S) Stable environment
(A) Illness-related risk
(symptom distress, uncertainty)
(C) Courageous coping (confrontive, optimistic,
supportant), derived meaning (hope and
spiritual perspective), defensive coping
(emotive, fatalistic, evasive)








Antecendents (A), Consequences (C), and Sociocultural (S)

Hess et al. (2002)T

181 African- American first-time mothers

Low-income Living with 3 generations

Context-specific Interactive


Hunter (2001)T

40 Varied cultural and

socioeconomic status teens
Concept clarification
Pilot study

Various dimensions
Resilience can hurt the adolescent
Question if a healthy state


Hunter and Chandler


Interactive complex developmental

exists along a continuum
Question if a healthy state


Jackson et al. (1997)y

Kenny, Gallagher,
and Silsby (2002)T


Mandleco and Peery


51 Tenth- and eleventh-grade

inner-city vocational students
Triangulated design, pilot study
with scale development
Review of literature
100 Urban multicultural high
school students
Two-phase quantitative and
qualitative analyses
Review of literature
Development of framework


Markstrom et al.

113 Rural, poor, African American

and Caucasian adolescents
Descriptive, correlational


(A) Family social support,

Problem-focused coping skills
(C) Coping predicts resiliency
(S) Socioeconomic status influence


Oshio et al. (2003)T

207 Undergraduate Japanese students

Assessment of the construct validity of
the Adolescent Resilience Scale

Successful adaptation
despite challenging
or threatening circumstances


Rew and Horner (2003)y

Development of resilience framework for

reducing health-risk behaviors in adolescents

Interaction of risk
(vulnerability) and protection

(A) Difficulties and adversities;

change; painful life experiences
(C) Individuals can maintain mental
health without deterioration
(S) Psychological recovery process of
individuals unknown
(A) Risks, vulnerability (C) Protection
(S) Multiple factors


Interaction between internal

and external factors

(A) Social support, maternal and infant

characteristics, maternalinfant interactions;
multiple challenges of adolescent parenting
(C) Personal characteristics and supportive
maternal relationships related positively
with positive parenting
(S) 5 years associated with positive resiliency
(A) Presence of consistent loving, caring,
mentoring adults at time of adversity
(C) Depends on type, severity, and duration of loss;
connected forms of resilience; without caring adults,
survival and self-protective forms of resilience
(S) Environmental and cultural
influences, not understood
(A) Stress, protective factors
(C) Resilience develops along a
continuumsurvival; possibly maladaption
(S) Cultural influences


(A) Parental attachment,

academic achievement
(C) Academic success; protection against depression
(S) Cultural influences
(A) variety of risks
(C) Put abilities to good use, acknowledge losses

Psychosocial well-being





(continued on next page)



Table 2. continued


Sample, Setting, and Study Type

Concept Attributes


Rew et al. (2001)T

59 Homeless adolescents aged 1522 years


Interaction of risk
(vulnerability) and protection


Rouse (2001)T

170 Urban Caucasian high school

sophomore students
Descriptive, correlational



Rouse and Ingersoll (1998)T

Interpersonal and environmental factors


Tiet et al. (1998)T

1514 Adolescents in school

1285 Youth and caretaker dyads
Correlational cross-sectional data set
from multiple sites


Woodgate (1999a)y

Dynamic process


Woodgate (1990b)y

Adolescents with cancer

Historical overview of the concept,
summary of definitional
issues, conceptual model
Adolescents with cancer
Synthesis of literature


Protective and vulnerability factors

Antecendents (A), Consequences (C), and Sociocultural (S)

(A) Homeless perception of resilience
(C) Survival and protected (less lonely,
less hopeless, less risky behavior)
(S) Homeless resilience may be different
(A) Increased motivation, economically
deprived stressful environment, goal-directed
(C) GPA N2.75
(S) Caucasian, environment not all supportive
(A) Exposure to risk-taking behaviors
(C) Less likely to adopt risky behavior
(A) Exposure to risk, high IQ, better family
functionality, closer parent monitoring, sense of
direction and hope, higher educational aspirations
(C) Less likely to adopt risky behavior
(A) Stressors or risk situations; protective
or vulnerability factors
(C) Outcomes

Surrogate Terms

Behavioral competence
Behavior competence


(A) Multiple stressors from cancer and

normal growth and developmental tasks
(C) Improved quality of life; outcomes
adjustment versus maladjustment

Note. Number = assigned number; N = nursing; S = social sciences; M = medical; E = education.

TEmpirical reference.
yTheoretical reference.



originating from biology and early life experiences. Protective factors of individuals are different
during different stages of development. According
to Rutter (1993), parental caring during the infant
period is very protective, but in contrast, such
parental behavior may hinder healthy development
during adolescence. Greenspan (1982) contends
that resilience is the capacity to successfully
undertake the work of each successive developmental stage. The link between resilience and
development appears to result from the fact that
the processes are interactive and endure over time
with supportive environments. Rouse (2001) further argues that different types of resilience during
different developmental periods are possible.
For these reasons, resiliency models have been
used by nurse scholars. Haase, Heiney, Ruccione, &
Stutzer (1999) proposed the adolescent resilience
model. This model was developed through triangulation research of adolescents with chronic illness,
especially cancer. The components of this model
include individual protective factors (courageous
coping, hope, and spiritual perspective), family
protective factors (family atmosphere and family
support and resources), and social protective factors
(health resources and social integration) (Haase
et al., 1999). According to the researchers, the
outcome factors depicted by the model include
resilience (self-esteem, self-transcendence, and
confidence/mastery) and quality of life (sense of
well-being) (Haase et al., 1999).
Another model, the youth resilience framework,
was developed by Rew and Horner (2003) to
address individual and sociocultural risk factors
and protective resources that could enhance or
hamper the positive and negative health outcomes
in adolescence. In this model, resilience represents
the interaction between risk factors (vulnerability)
and protective resources (protection) (Rew &
Horner, 2003). Using this framework, interventions
to improve health outcomes enhance resiliency in
efforts to decrease high risk behaviors.
There are contradictory findings documented in
the literature regarding resilience among adolescents. In most cases, resilience in this population is
considered to be positive (Rew & Horner, 2003;
Rew et al., 2001; Rouse, 2001), although some
researchers question if it is a healthy state
(Hunter, 2001; Hunter & Chandler, 1999). Similarly, while studying resilience in adolescents with
cancer, Haase (1997) determined that these individuals developed defensive coping to deal with the
adversities of their diagnosis, and if left unchecked,

this defensive coping had the possibility of adversely affecting the physical health of these adolescents.
In addition to these inconsistencies, there has been
little documentation in the literature regarding
resilience as a state in the healthy adolescent.
A variety of risks and protective factors for
adolescent resilience are documented in the literature. Table 2 summarizes the attributes and contextual basis for the concept of adolescent resilience for
the 22 articles analyzed.
Numerous terms have been used to describe
resilience in the adolescent. Such terms include
invulnerables, resistants, thrivers, invincibles, and
inoculated; conversely, those who lack resilience
have been called maladaptive, vulnerable, distressed, and succumbers (Markstrom et al., 2000).
Resiliency has been measured according to such
concepts as self-esteem, academic performance,
physical health, coping, adaptation, and absence of
mental disease and/or delinquent behavior. Additional terms used in describing resilience include
connectedness, self-control, self-worth, mutuality,
survival, adaptive, and hardiness. There are a
number of common factors present in the articles
reviewed, including the developmental and interactive nature of the concept. For most, there appears
to be the presence of some type of risk or risks in
the adolescents life that triggers a protective
mechanism. Although the protective factors were
different in many cases, those factors acted as a
buffering agent to minimize the negative outcomes.
In contrast, the interpretations were different for
some researchers. These authors (Hunter, 2001;
Hunter & Chandler, 1999) question whether resilience is a healthy state. Rew et al. (2001)
determined that resilience was possible in the
vulnerable population of the homeless adolescent.
In fact, many of the researchers view the concept as
multidimensional or a continuum of behaviors. The
domains of the concept may change depending on
the developmental stage of the individual and its
usage within specific samples and settings.
This author offers a general definition and a proposed model of adolescent resilience. Adolescent
resilience can be defined as the process of
adaptation to risk that incorporates personal characteristics, family and social support, and community resources (see Figure 1). The authors model is
an adaptation of the Rew and Horners (2003)
youth and resilience framework. The proposed



Figure 1.

Proposed model of adolescent resilience. Reprinted with permission from Elsevier.

model of adolescent resilience includes a continuum with one pole of this continuum including risk
(internal and external factors) and the opposite pole
incorporating protection (individual and sociocultural). Resilience can thus be considered as the
outcome of the triadic influences of risk, protection, and interventions (Rew & Horner, 2003). The
greatest difference between the Rew and Horner
framework and this authors model is that interventions are seen as having an earlier influence on
the concept of resilience in the authors proposed

model. Although the adolescent may not need

interventions to enhance resilience, the interventions are available, if needed. In addition, this
authors adaptation clearly indicates the potential
interactions of the internal and external factors as
well as connections among the individual, family,
and community.
Based on the concept analysis of resilience in
adolescents using the Rodgers evolutionary model
of concept analysis, the literature review revealed
confusion regarding a global definition for the



concept during adolescence. Adolescent resilience

can be conceptualized as a composite of attributes,
including characteristics of the adolescent, sources
of social support, and available resources. A
definition, an adolescent resilience model, and
implications are proposed to promote resiliency
during adolescence.
The concept of adolescent resilience is multidimensional and consists of a continuum of behaviors. Although a global definition offers direction

for the researcher, the concept needs clarification

and definition specific to the adolescent population
under study. This concept is dynamic and changes
over time. In light of the evolution of the risks and
protective factors possessed by this population
group, the definition of the concept will continue
to evolve.
Research trends are already shifting from identifying the characteristics of resilient adolescents to
identifying the processes that encourage resilience
under unfavorable conditions. An understanding of
resilient characteristics and the processes that
enhance resilience in adolescents will enable

Table 3. Adolescent Resilience: Implications for Nursing

Research Implications

Practice Implications

! Further define the concept in differing situations,

age groups, and settings
! Test proposed resiliency models,
frameworks, and scales
! Explore the hypothesis that resilience
may be an unhealthy state
! Study risks and protective factors in healthy,
resilient adolescents
! Develop and test a resilience scale based on the
proposed model of adolescent resilience

! Identify risk factors in adolescents

n General health
n Health-risk behaviors as identified by the National Youth Risk Behavior Survey
(e.g. alcohol/drug use, sexual behaviors, dietary behaviors, physical activity,
and behaviors contributing to injury) (CDC, 2004) or the Search Institutes Forty
Developmental Assets (Search Institute, 2004)
n Genetic predisposition
n Temperament
n Gender (males at greater risk, Garmezy & Rutter, 1985)
n Cognitive ability (lower abilities may put child at greater risk, Rouse, 2001)
n Lack of family and/or community resources or support
! Assess protective factors
n Use of the Search Institutes Forty Developmental Assets (Search Institute)
these factors can be assessed (examples):
B Support (family, adult, neighborhood, school climate)
B Empowerment (community values, youth resources, safety)
B Boundaries and expectations (family, school, and neighborhood boundaries,
adult role models, positive peer influences, high expectations)
B Constructive use of time (home and community)
B Commitment to learning (motivation, reading, school engagement)
B Positive values (integrity, honesty, caring, responsibility)
B Social competencies (conflict resolution, cultural competence, decision making)
B Positive identity (personal power, self-esteem, sense of purpose,
positive view of the future)
! Assess resiliency in adolescents of differing ages, situations, and settings (based
on one of the valid and reliable resilience scales)
! Encourage interventions to promote protective factors possessed by this population
n Positive coping
n Positive self-esteem
n Seek opportunities to improve cognitive abilities (tutors and other resources)
n Development of positive and supportive relations (family, community
members, and/or mentors)
n Improvement of general health (refer to National Youth Risk Behavior Survey results)
n Refer to community (school or church, etc.) or social services
resources to additional support
n Use of the Forty Assets Model for improvement of healthy development
(Search Institute, 2004)
! Support resilient behaviors under unfavorable conditions
! Anticipatory guidance and appropriate educational strategies to meet the
adolescents learning needs



nurses to promote such behaviors during life

transitions and periods of adversity. However,
minimal research has been conducted with healthy
adolescents who are confronted with everyday
stressful events rather than severely adverse conditions. Several recommendations are proposed for
future research. Because risks and needs of
adolescents can vary greatly from year to year,
research needs to be conducted and the concept
clarified at different ages during the adolescent
period. In addition, more studies need to be
conducted with regard to the bhealthy, well-adjustedQ adolescent. Although health and adjustment
may be subjective and unpredictable, there is little
empirical evidence on resilience of this population.
The concept needs to be further explored to
determine if resilience is an unhealthy state as
hypothesized by Haase (1997), Hunter (2001), and
Hunter and Chandler (1999). Until more is known
about adolescent resilience, practice implications
can assist the clinician with the nursing care of this
population. In addition, the nurse can use the
proposed model of adolescent resilience to better
understand this concept (Table 3).

Nursing is a human science concerned with
promoting the physical and mental health and wellbeing of others. Thus, resilience is a critical
attribute for nurses. The concept signifies a
combination of abilities and characteristics that
interact dynamically allowing an individual to
bounce back, cope successfully, and function to
the best of their ability despite stress and disaster
(Tusaie & Dyer, 2004). Research on resiliency is
significant, because efforts are made to identify
both the processes of vulnerability and protection
that should help explain why and how resiliency is
exhibited (Rutter, 1987). An understanding of
this concept by nurses will better prepare them
to perform resiliency assessments and intervene
appropriately to enhance well-being and positive
The author thank Karen Hassey Dow, PhD, RN,
FAAN, and Judith P. Ruland, PhD, RN for the
review and critique of this manuscript.

Aronowitz, T., & Morrison-Beedy, D. (2004). Resilience to
risk-taking behaviors in impoverished African-American girls:
The role of motherdaughter connectedness. Research in
Nursing and Health, 27, 29 39.
Baruth, K. E., & Carroll, J. J. (2002). A formal assessment of
resilience: The Baruth protective factors inventory. Journal of
Individual Psychology, 58, 235 244.
Blum, R. W. (1998). Healthy youth development as a model
for youth health promotion. Journal of Adolescent Health, 22,
368 375.
Born, M., Chevalier, V., & Humblet, I. (1997). Resilience,
desistance and delinquent career of adolescent offenders.
Journal of Adolescence, 20, 679 694.
Centers for Disease Control and Prevention (CDC). (2004).
Youth risk behavior surveillance US 2003. MMWR Morbidity
Mortality Weekly Report, 53, 1 100. Retrieved December 4,
2004, from
Cook, K. V. (2000). bYou have to have somebody watching
your back, and if thats God, then thats mighty bigQ: The
churchs role in the resilience of inner-city youth. Adolescence,
35, 717 730.
Cosden, M. (2001). Risk and resilience for substance abuse
among adolescents and adults with LD. Journal of Learning
Disabilities, 34, 352 358.
Criss, M. M., Pettit, G. S., Bates, J. E., Dodge, K. A., & Lapp,
A.L. (2002). Family adversity, positive peer relationships and

childrens externalizing behavior: A longitudinal perspective on

risk and resilience. Child Development, 73, 1220 1237.
Davey, M., Eaker, D. G., & Walters, L. H. (2003). Resilience
processes in adolescents: Personality profiles, self-worth, and
coping. Journal of Adolescent Research, 18, 347 362.
Freitas, A. A., & Downey, G. (1998). Resilience: A dynamic
perspective. International Journal of Behavioral Development,
22, 263 285.
Friborg, O., Hjemdal, O., Rosenvinge, J., & Martinussen, M.
(2003). A new rating scale for adult resilience: What are
the central protective resources behind healthy adjustment?
International Journal of Methods in Psychiatric Research, 12,
65 76.
Garmezy, N. (1991). Resilience in childrens adaptation to
negative life events and stressed environments. Pediatric
Annals, 20, 459 466.
Garmezy, N., & Rutter, M. (1985). Acute reactions to stress.
In M. Rutter, L. Hersov (Eds.), Child and adolescent
psychiatry: Modern approaches (2nd ed., pp. 152 176).
Oxford: Blackwell.
Greenspan, S. (1982). Developmental morbidity in infants in
multi-risk families. Public Health Reports, 97, 16 23.
Haase, J. (1997). Hopeful teenagers with cancer: Living
courage. Reflections, 23, 20.
Haase, J. E., Heiney, S. P., Ruccione, K. S, & Stutzer, C.
(1999). Research triangulation to derive meaning-based quality


of life theory: Adolescent resilience model and instrument

development. International Journal of Cancer Supplement, 12,
125 131.
Hess, C. R., Papas, M. A., & Black, M. M. (2002). Resilience
among African American adolescent mothers: Predictors of
positive parenting in early infancy. Journal of Pediatric
Psychology, 27, 619 629.
Hunter, A. J. (2001). A cross cultural comparison of resilience
in adolescents. Journal of Pediatric Nursing, 16, 172 179.
Hunter, A. J., & Chandler, G. E. (1999). Adolescent resilience.
Image: Journal of Nursing Scholarship, 31, 243 252.
Jacelon, C. S. (1997). The trait and process of resilience.
Journal of Advanced Nursing, 25, 123 129.
Jackson, S., Born, M., & Jacob, M. (1997). Reflections on
risk and resilience in adolescence. Journal of Adolescence, 20,
609 616.
Kenny, M. E., Gallagher, L. A., Alvarez-Salvat, R., &
Silsby, J. (2002). Sources of support and psychological distress
among academically successful inner-city youth. Adolescence,
37, 161 182.
Kragh, J. R., & Huber, C. H. (2002). Family resilience and
domestic violence: Panacea or pragmatic therapeutic perspective? Journal of Individual Psychology, 58, 290 304.
Kulig, J. C. (2000). Community resiliency: The potential for
community health nursing theory development. Public Health
Nursing, 17, 374 385.
Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The
construct of resilience: A critical evaluation and guidelines for
future work. Child Development, 71, 543 562.
Mandleco, B. L., et al. & Peery, J. C. (2000). An organizational framework for conceptualizing resilience in children.
Journal of Child and Adolescent Psychiatric Nursing, 13, 99 115.
Markstrom, C. A., Marshall, S. K., & Tryon, R. J. (2000).
Resiliency, social support, and coping in rural low-income
Appalachian adolescents from two racial groups. Journal of
Adolescence, 23, 693 703.
McCubbin, M., & McCubbin, H. (1989). Theoretical orientations to family stress and coping. In C. R. Figley (Ed.), Treating
stress in families (pp. 3 - 43). New York: Brunner/Mazel.
Olsson, C. A., Bond, L., Burns, J. M., Vella-Brodrick, D. A.,
& Sawyer, S. M. (2003). Adolescent resilience: A concept
analysis. Journal of Adolescence, 26, 1 11.
Oshio, A., Kaneko, H., Nagamine, S., & Nakaya, M. (2003).
Construct validity of the adolescent resilience scale. Psychological Reports, 93, 1217 1222.
Polk, L. V. (1997). Toward a middle-range theory of
resilience. Advances in Nursing Science, 19, 1 13.


Rew, L., & Horner, S. D. (2003). Youth resilience framework

for reducing health-risk behaviors in adolescents. Journal of
Pediatric Nursing, 18, 379 388.
Rew, L., Taylor-Seehafer, M., Thomas, N. Y., & Yockey, R.
D. (2001). Correlates of resilience in homeless adolescents.
Journal of Nursing Scholarship, 33, 33 43.
Rodgers, B. L. (1989). Concepts, analysis and the development of nursing knowledge: The evolutionary cycle. Journal of
Advanced Nursing, 14, 330 335.
Rodgers, B. L. (2000). Concept analysis: An evolutionary
view. In B. L. Rodgers & K. A. Knafl (Eds.), Concept
development in nursing (pp. 77 - 102). Philadelphia: Saunders.
Rouse, K. A. (2001). Resilient students goals and motivation. Journal of Adolescence, 24, 461 472.
Rouse, K. A., & Ingersoll, G. M. (1998). Longitudinal
health endangering behavior risk among resilient and nonresilient early adolescents. Journal of Adolescent Health, 23,
297 302.
Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57,
316 331.
Rutter, M. (1993). Resilience: Some conceptual considerations. Journal of Adolescent Health, 14, 626 631.
Search Institute. (2004). Forty developmental assetsk.
Retrieved December 1, 2004, from
Tiet, Q. Q., Bird, H. R., Davies, M., Hoven, C., Cohen, P., &
Jensen, P.S., et al. (1998). Adverse life events and resilience.
Journal of the American Academy of Child and Adolescent
Psychiatry, 37, 1191 1201.
Tusaie, K., & Dyer, J. (2004). Resilience: A historical review
of the construct. Holistic Nursing Practice, 18, 3 8.
Ungar, M. (2004). A constructionist discourse on resilience:
Multiple concepts, multiple realities among at-risk children and
youth. Youth and Society, 35, 341 365.
Vinson, J. A. (2002). Children with asthma: Initial development of the child resilience model: Practice applications of
research. Pediatric Nursing, 28, 149 158.
Wagnild, G. M., & Young, H. M. (1993). Development and
psychometric evaluation of the resilience scale. Journal of
Nursing Measurement, 1, 165 178.
Woodgate, R. L. (1999). Conceptual understanding of
resilience in the adolescent with cancer: Part I. Journal of
Pediatric Oncology Nursing, 16, 35 43.
Woodgate, R. L. (1999). Review of the literature on resilience
in the adolescent with cancer: Part II. Journal of Pediatric
Oncology Nursing, 16, 78 89.