Resiliency and its Relationship with Secondary Traumatic Stress among Nursing Staff during COVID-19 Pandemic

Document Type : Original Article


1 Department of Health Education and Health Promotion, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

2 Department of Pediatric Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

3 Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

4 Department of Internal Medicine, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

5 Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran & Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran


Background: Nurses are front-line health-care workers for patients with severe Coronavirus disease (COVID-19) symptoms. The aim of this study was to determine the resiliency of nurses and its relationship with secondary traumatic stress (STS) in pandemic conditions.
Methods: This cross-sectional study was performed on 233 nurses working in a medical center providing services to patients with COVID-19 in southeast Iran from May to August 2020. Data were collected using demographic questionnaire, Connor-Davidson Resilience Scale (CD-RISC) and The Secondary Traumatic Stress Scale (STSS). Pearson correlation coefficient was used to determine the relationship between variables and data were analyzed through SPSS22.
Results: The mean STS score of nurses was 40.82 ± 11.7. The results showed a significant relationship between STS score and Job satisfaction. The mean score of resilience was 60.91± 17.1 in nurses. The resiliency score showed significant difference based on work experience and exposure to COVID-19 disease. The results of correlation test showed that the overall stress score was significantly related to all aspects of resilience except trust (p < 0.05).  Also, based on the multiple regression model, positive acceptance (one of the dimensions of resilience) and exposure to COVID-19 disease were the predictors of STS. 
Conclusion: The results showed that there is a significant and inverse relationship between resiliency score and STS. Therefore, according to the present conditions, it is recommended to design programs to improve resilience and reduce stress of nurses during COVID-19 pandemic.


  1. Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al Jabir A, et al. World Health organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020; 76:71-6. doi: 10.1016/j.ijsu.2020.02.034.
  2. Zakeri MA, Hossini Rafsanjanipoor SM, Kahnooji M, Ghaedi Heidari F, Dehghan M. Generalized anxiety disorder during the COVID-19 outbreak in Iran: The role of social dysfunction. J Nerv Ment Dis. 2021; 209(7):491-6. doi: 10.1097/NMD.0000000000001320.
  3. Zakeri MA, Hossini Rafsanjanipoor SM, Sedri N, Kahnooji M, Sanji Rafsanjani M, Zakeri M, et al. Psychosocial status during the prevalence of COVID-19 disease: the comparison between healthcare workers and general population. Curr Psychol. 2021; 40(12):6324-32. doi: 10.1007/s12144-021-01582-1.
  4. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020; 395(10223):507-13. doi: 10.1016/S0140-6736(20)30211-7.
  5. Zakeri MA, Maazallahi M, Ehsani V, Dehghan M. Iranian psychosocial status during and after COVID‐19 outbreak mandatory quarantine: A cross‐sectional study. J Community Psychol. 2021: 49(7):2506-16. doi: 10.1002/jcop.22647.
  6. Malakoutikhah AR, Zakeri MA, Salehi Derakhtanjani A, Dehghan M. Anxiety, anger, and mindfulness as predictors of general health in the general population during COVID‐19 outbreak: A survey in southeast Iran. J Community Psychol. 2022: 50(2):916-27. doi: 10.1002/jcop.22690.
  7. Jiang Y, Wang H, Chen Y, He J, Chen L, Liu Y, et al. Clinical data on hospital environmental hygiene monitoring and medical staff protection during the coronavirus disease 2019 outbreak. MedRxiv. 2020. doi: 10.1101/2020.02.25.20028043.
  8. Said NB, Chiang VCL. The knowledge, skill competencies, and psychological preparedness of nurses for disasters: A systematic review. Int Emerg Nurs. 2020; 48:100806. doi: 10.1016/j.ienj.2019.
  9. Zakeri MA, Dehghan M, Ghaedi Heidari F, Pakdaman H, Mehdizadeh M, Ganjah H, et al. Mental health outcomes among health-care workers during the COVID-19 outbreak in Iran. Mental Health Review Journal. 2021; 26(2):152-160. doi: 10.1108/MHRJ-10-2020-0075.
  10. Hossini Rafsanjanipoor SM, Zakeri MA, Dehghan M, Kahnooji M, Sanji Rafsanjani M, Ahmadinia H, et al. Iranian psychosocial status and its determinant factors during the prevalence of COVID-19 disease. Psychol Health Med. 2022; 27(1):30-41. doi: 10.1080/13548506.2021.1874438.
  11. Zakeri MA, Hossini Rafsanjanipoor SM, Zakeri M, Dehghan M. The relationship between frontline nurses' psychosocial status, satisfaction with life and resilience during the prevalence of COVID‐19 disease. Nurs Open. 2021; 8(4):1829-39. doi: 10.1002/nop2.832.
  12. Sharma P, Davey A, Davey S, Shukla A, Shrivastava K, Bansal R. Occupational stress among staff nurses: Controlling the risk to health. Indian J Occup Environ Med. 2014; 18(2):52-6. doi: 10.4103/0019-5278.146890.
  13. Bride BE, Robinson MM, Yegidis B, Figley CR. Development and validation of the secondary traumatic stress scale. Research on social Work Practice. 2004; 14(1):27-35. doi: 10.1177/1049731503254106.
  14. Magtibay DL, Chesak SS, Coughlin K, Sood A. Decreasing stress and burnout in nurses: Efficacy of blended learning with stress management and resilience training program. J Nurs Adm. 2017; 47(7-8):391-5. doi: 10.1097/NNA.0000000000000501.
  15. World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak, 18 March 2020. World Health Organization; 2020.
  16. Ogińska-Bulik N, Kobylarczyk M. Relation between resiliency and post-traumatic growth in a group of paramedics: The mediating role of coping strategies. Int J Occup Med Environ Health. 2015; 28(4):707-19. doi: 10.13075/ijomeh.1896.00323.
  17. Duan W, Guo P, Gan P. Relationships among trait resilience, virtues, post-traumatic stress disorder, and post-traumatic growth. PloS one. 2015; 10(5):e0125707. doi: 10.1371/journal.pone.
  18. Ssenyonga J, Owens V, Kani Olema D. Posttraumatic growth, resilience, and posttraumatic stress disorder (PTSD) among refugees. Procedia Soc Behav Sci. 2013; 82:144-8. doi: 10.1016/j.sbspro.2013.06.238.
  19. Norris FH, Stevens SP, Pfefferbaum B, Wyche KF, Pfefferbaum RL. Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. Am J Community Psychol. 2008; 41(1-2):127-50. doi: 10.1007/s10464-007-9156-6.
  20. Bazmandegan G, Kamiab Z, Ghaffari-Nasab M, Khaloobagheri E, Zinaddini M, Movahedi F, et al. The Association between Professional Quality of Life, Occupational Burnout, Depression, Anxiety, and Stress among Iranian Nurses (2019). J Occup Health Epidemiol. 2022; 11(1):83-90. doi: 10.52547/johe.11.1.83.
  21. Zakeri MA, Rahiminezhad E, Salehi F, Ganjeh H, Dehghan M. Burnout, anxiety, stress, and depression among iranian nurses: Before and during the first wave of the COVID-19 pandemic. Front Psychol. 2021; 12:789737. doi: 10.3389/fpsyg.2021.789737.
  22. Connor KM, Davidson JR. Development of a new resilience scale: The Connor-Davidson resilience scale (CD-RISC). Depress Anxiety. 2003; 18(2):76-82. doi: 10.1002/da.10113.
  23. Samani S, Jokar B, Sahragard N. Effects of resilience on mental health and life satisfaction. Iranian Journal of Psychiatry and Clinical Psychology. 2007; 13(3):290-5. [In Persian].
  24. Mirsaleh YR, Ahmadi K, Davoudi F, Mousavi SZ. Validity, reliability, and factor structure of secondary trauma stress scale (STSS) in a sample of warfare Victims' children. Iranian Journal of Psychiatry & Clinical Psychology. 2014; 20(2):134-43. [In Persian].
  25. Ogińska Bulik N, Michalska P. Psychological resilience and secondary traumatic stress in nurses working with terminally ill patients-The mediating role of job burnout. Psychol Serv. 2021; 18(3):398-405. doi: 10.1037/ser0000421.
  26. Ang SY, Hemsworth D, Uthaman T, Ayre TC, Mordiffi SZ, Ang E, et al. Understanding the influence of resilience on psychological outcomes-comparing results from acute care nurses in Canada and Singapore. Appl Nurs Res. 2018; 43:105-13. doi: 10.1016/j.apnr.2018.07.007.
  27. Babanataj R, Mazdarani S, Hesamzadeh A, Heidari Gorji M, Yazdani Cherati J. Resilience training: Effects on occupational stress and resilience of critical care nurses. Int J Nurs Pract. 2019; 25(1):e12697. doi: 10.1111/ijn.12697.
  28. Beck CT. Secondary traumatic stress in nurses: A systematic review. Arch Psychiatr Nurs. 2011; 25(1):1-10. doi: 10.1016/j.apnu.2010.05.005.
  29. Duffy E, Avalos G, Dowling M. Secondary traumatic stress among emergency nurses: A cross-sectional study. Int Emerg Nurs. 2015; 23(2):53-8. doi: 10.1016/j.ienj.2014.05.001.
  30. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine. 2020; 24:100424. doi: 10.1016/j.eclinm.2020.100424.
  31. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020; 24(1):200. doi: 10.1186/s13054-020-02926-2.
  32. Amini F. The relationship between resiliency and burnout in nurses. J Res Dev Nurs Midw. 2013; 10(2):94-102. [In Persian].
  33. Kester K, Wei H. Building nurse resilience. Nurs Manage. 2018; 49(6):42-5. doi: 10.1097/01.NUMA.0000533768.28005.36.
  34. Louise Duncan D. What the COVID-19 pandemic tells us about the need to develop resilience in the nursing workforce. Nurs Manage (Harrow). 2020; 27(3):22-7. doi: 10.7748/nm.2020.e1933.
  35. Gerami Nejad N, Hosseini M, Mousavi Mirzaei S, Ghorbani Moghaddam Z. association between resilience and professional quality of life among nurses working in intensive care units. Iran Journal of Nursing. 2019; 31(116):49-60. doi: 10.29252/ijn.31.116.49. [In Persian].
  36. Babaei S, Haratian M. Compassion satisfaction and fatigue in Cardiovascular nurses: A cross-sectional descriptive study. Iran J Nurs Midwifery Res. 2020; 25(3):212-16. doi: 10.4103/ijnmr.IJNMR_112_19.
  37. Zakeri MA, Bazmandegan G, Ganjeh H, Zakeri M, Mollaahmadi S, Anbariyan A, et al. Is nurses' clinical competence associated with their compassion satisfaction, burnout and secondary traumatic stress? A cross-sectional study. Nurs Open. 2020; 8(1):354-63. doi: 10.1002/nop2.636.
  38. Hooper C, Craig J, Janvrin DR, Wetsel MA, Reimels E. Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. J Emerg Nurs. 2010; 36(5):420-7. doi: 10.1016/j.jen.2009.11.027.
  39. Griffiths N, Barr P, Galea C. Relation of demographic characteristics with burnout, secondary traumatic stress and compassion satisfaction in NICU nurses. J Paediatr Child Health. 2017; 53(2):39. doi: 10.1111/jpc.13494_109.
  40. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Archives of Clinical Infectious Diseases. 2020; 15:e102848. doi: 10.5812/archcid.102848. [In Persian].
  41. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020; 7(3):e14. doi: 10.1016/S2215-0366(20)30047-X.
  42. Yin X, Zeng L. A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence, relatedness, and growth theory. Int J Nurs Sci. 2020; 7(2):157-60. doi: 10.1016/j.ijnss.2020.04.002.