A Patient-Centered Nursing Resilience Framework for Acute Care

Thesis Abstract

This study addresses the escalating stressors in acute care settings that challenge the continuity and safety of patient care, including high patient turnover, complex comorbidities, and rapid decision-making demands on nursing staff, by developing a patient-centered resilience framework that integrates individual, team, and organizational determinants of resilience. The aim is to formulate a theory-driven framework to enhance patient-centered outcomes through resilient nursing practice in acute care. Specific objectives are (1) to identify patient, nurse, and system-level factors that constitute resilience from the patient-centered perspective; (2) to synthesize evidence from existing resilience constructs with patient-centered care principles into a coherent framework; (3) to validate the framework through empirical data and stakeholder input; (4) to evaluate preliminary associations between resilience constructs and patient outcomes such as satisfaction, safety incidents, and length of stay; (5) to propose measurable indicators and implementation guidelines for clinical practice. A mixed-methods design is employed, anchored in an explanatory sequential approach. The study will be conducted in three tertiary acute care hospitals over 18 months. The quantitative strand targets a census-based sample of 420 patients and 260 nursing staff from medical–surgical units, using stratified random sampling for patients and purposive sampling for staff, ensuring representation across age, gender, and illness severity. Instruments include the Patient-Centered Care Quality Scale, the Nurses’ Resilience Scale, the Connor–Davidson Resilience Scale (CD-RISC-25) adapted for clinical context, and patient safety incident checklists extracted from hospital reporting systems. Validity and reliability will be established through content validity with expert panels, pilot testing (n=40 patients, n=30 nurses), and Cronbach’s alpha checks (target ? ? 0.80). Data analysis will employ structural equation modeling (SEM) to test the hypothesized relationships among patient-centeredness, resilience constructs, and outcomes, complemented by hierarchical linear modeling (HLM) to account for nested data (patients within units). Mediation analyses will examine whether nurse resilience mediates the relationship between organizational support and patient outcomes. The qualitative strand will involve semi-structured interviews with 40 patients (including those with high-care needs) and 30 nursing staff across units, guided by purposive sampling to maximize variation. Thematic analysis will be conducted using Braun and Clarke’s framework, with triangulation against quantitative findings. A subset of 12 focus groups with multidisciplinary stakeholders (nurses, physicians, nurse managers, quality d) will explore contextual facilitators and barriers to implementing a patient-centered resilience framework. The theoretical underpinning draws on the Theory of Patient-Centered Care and the Resilience in Healthcare framework, integrating concepts from Bandura’s Social Cognitive Theory to elucidate self-efficacy in managing care demands, and the Job Demands-Resources (JD-R) model to map strain and resource interactions. A new integrative model will be developed that positions patient-centered resilience as a dynamic ensemble of patient engagement, nursing flourishing, team coordination, and organizational enablers. Expected findings include (a) identification of core resilience domains—patient engagement, relational continuity, adaptive staffing, psychological safety, and learning culture; (b) empirical validation of a supra-model linking these domains to improved patient satisfaction, reduced adverse events, and shorter length of stay; (c) evidence that nurse resilience mediates improvements in patient-centered outcomes, particularly under high-demand conditions; (d) practical indicators and care pathways for implementing the framework in acute care settings. The study will contribute to knowledge by operationalizing patient-centered resilience in a framework suitable for measurement, intervention design, and evaluation, bridging gap between resilience theory and patient-centered practice in acute care. It will offer a validated set of metrics, a theoretical synthesis, and an implementation roadmap that informs policy, nursing education, and organizational strategies to sustain resilient, patient-centered care. The main conclusion anticipates that embedding resilience as a core, patient-centered construct in acute care will enhance care quality, safety, and patient experience, with recommendations for leadership commitment, interdisciplinary training, staffing models, and continuous feedback mechanisms to monitor resilience outcomes.