Conceptualizing resilience among health and care professionals since the onset of COVID-19: a systematic literature review

Technical Summary: Conceptualizing Resilience Among Health and Care Professionals Since the Onset of COVID-19

Problem Statement
Since the World Health Organization declared the COVID-19 pandemic on March 11, 2020, the construct of "resilience" has become central to the literature concerning health and care professionals. However, despite its extensive utilization across disciplines, the concept remains inconsistently defined. Its conceptual boundaries are fragmented, particularly regarding individual professionals operating within high-stress healthcare environments. This lack of a unified definition hinders the ability to effectively understand and support the workforce during and after the pandemic.

Methodology
This study employs a systematic literature review to identify, examine, and synthesize existing conceptualizations of resilience. The review adheres to the following rigorous protocols:

• Search Strategy: A systematic search was conducted across PubMed, Scopus, and PsycINFO (American Psychological Association) databases.
• Inclusion Criteria: The search targeted peer-reviewed articles published between March 2020 and March 2026, combining terms related to resilience, health and care professionals, and the COVID-19 or post-pandemic context.
• Screening and Registration: The screening process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study protocol was prospectively registered in the Open Science Framework (OSF) registries.
• Synthesis and Quality Appraisal: Data synthesis utilized thematic and conceptual analysis, reported in accordance with the Enhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ) guidelines. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT) version 2018.
• Study Selection: From an initial pool of 5,496 records, 3,128 unique records were screened, resulting in 38 studies that met all eligibility criteria for final synthesis.

Key Results
The synthesis of the 38 included studies reveals that resilience is conceptualized in four dominant, yet overlapping, ways:

1. Individual Psychological Trait: Resilience viewed as a fixed personal attribute.
2. Dynamic Adaptive Process: Resilience understood as a fluid capacity to adapt to changing circumstances.
3. Relational and Socially Embedded Capacity: Resilience situated within social networks and interpersonal interactions.
4. Morally and Professionally Situated Endurance: Resilience defined as the capacity to endure systemic pressures while maintaining professional and moral integrity.

A significant tension was identified in the literature between interpretations that focus on individual traits and those that emphasize systemic and contextual factors.

Proposed Framework and Contributions
Based on the synthesis, the authors propose that resilience among health and care professionals in the post-pandemic era is best understood not as a fixed attribute, but as a multidimensional, context-responsive process. This process is shaped by the interplay of psychological resources, relational support systems, and organizational conditions.

To address the fragmentation in current literature, the paper introduces two primary contributions:

1. An Integrative Conceptual Definition: A unified definition that encompasses the multidimensional nature of resilience.
2. The Three-Layer Onion Model of Professional Resilience: A conceptual model that visualizes resilience as emerging through interactions across three distinct but interconnected domains:
   • The Individual domain.
   • The Relational domain.
   • The Systemic domain.

Significance
The paper claims that its significance lies in moving beyond the fragmented and often trait-based interpretations of resilience that have dominated previous discourse. By synthesizing the literature since the onset of the pandemic, the study provides a more holistic framework that acknowledges the complex interplay between individual professionals and their broader environmental contexts. This integrative approach aims to offer a clearer conceptual foundation for future research and practice in supporting health and care professionals.