Abstract
Building resilience is a key concern for adult educators today as we face unprecedented global challenges such as the coronavirus disease-19 (COVID-19). Nowhere is this more apparent than in educational initiatives with health professionals who experience many stressors in their work, now amplified by the pandemic. This paper reports the results of focus groups with three interprofessional primary healthcare teams in rural Nova Scotia, Canada, in the fall of 2021. The aim was to learn about their lived experience during the first year of the pandemic, as a basis for considering how resilience could be nurtured and supported in rural team-based collaborative practices settings. Findings reveal that, while each collaborative team experienced recognized COVID-19 workplace stressors, they leveraged a store of collective resilience to navigate the pandemic. The trust, sense of purpose, and shared problem-solving skills they derived from working in collaborative structures over time enabled them to regain equilibrium and to adapt to new norms, and to transform thier practices. The study highlights the power of collaborative learning to strengthen overall ability for resilient performance, and the adaptive capacity that is required to deliver and sustain quality healthcare. The study highlights the need for continuing professional education that values naturally occurring practice-based learning. Adult educators are well positioned to support health professionals and health systems to nurture and support resilient action. They bring an understanding of effective collaborative tools and processes that foster dialogue and collective awareness that leads to a shared identity and understanding. As this study reveals, it is this shared identity and capacity arising within a group that enables them to draw on their collective sources of support to deal with adversity.
Introduction
It has long been recognized that healthcare professions face numerous stressors within their clinical practice, including time pressures, workload demands, multiple roles, and emotional issues (including compassion fatigue) (De Hert, 2020). Continued exposure to environmental stressors can seriously impact their physical and mental wellbeing, resulting in burnout and, in some cases, traumatic stress-like symptoms (Arrogante & Zaldivar, 2017). These outcomes can contribute to health professionals experiencing a disproportionately high level of stress related illnesses (De Hert, 2020; Tisdell & Palmer, 2018). Not only is the wellbeing of health professionals affected, but also their ability to practice effectively in caring for others (Golechha et al., 2022). For adult educators who work with and teach these professionals, and for those who work in adult education in a variety of settings, resilience is a key concern (James & Thériault, 2020).
Although pervasive across all health professions, there is evidence that frontline healthcare providers are the most vulnerable to burnout because of their prolonged exposure to stress (De Hert, 2020; O'Sullivan et al., 2020; Zarei et al., 2019). Broadly recognized COVID-19 stressors include adapting to rapid change and new protocols, and making difficult choices to ensure urgent ongoing public health problems are addressed, while minimizing risk to health professionals, their families, and communities (Lu et al., 2020). Before COVID-19 in the spring of 2020, the prevalence of severe burnout among Canadian physicians, nurses, and other healthcare professionals was 30%–40%; by spring 2021 these rates were greater than 60% (Maunder et al., 2021). A recent survey by the Ontario Nurses Association (2022) indicates over 75% of Canada's nurses are burnt out, with many leaving their profession or retiring due to unacceptable working conditions.
Considering that resilience may be an important protective factor against deteriorating psychological responses to the pandemic, researchers have been examining the resilience of frontline healthcare providers across COVID-19 (Baskin & Bartlett, 2021; Golechha et al., 2022; Grailey et al., 2021; Huffman et al., 2021). Basic needs such as sleep, life satisfaction, and psychological resilience as determinants of quality of life have been significantly tested as these professionals respond to the pandemic (Bazdag & Ergun, 2021). Yet, much of this research focuses on acute care settings (emergency, intensive care, etc.) in urban and metropolitan settings (De Hert, 2020; Golechha et al., 2022). Less is known about rural primary healthcare settings, which are recognized to have entered the pandemic “already chronically underserviced, facing inadequate health care infrastructure, with limited clinical resources, and equipment and health care personnel shortages” (O'Sullivan et al., 2020, p. 1188). These researchers make the case that when rural risks and needs are overlooked as part of the overall mainstream pandemic planning, the potential for burnout is significant and threatens the overall rural resilience. This exacerbates social and economic inequality in rural settings.
This case study explores the lived experience of some of these healthcare professionals during the “first wave” of COVID-19 (March 2020–October 2021). The context is primary healthcare, the area of healthcare that focuses on frontline healthcare services, including the diagnosis and treatment of illness and injury (WHO, 2010). Those who work in primary healthcare, often referred to as “primary providers,” are involved in direct provision of first contact healthcare services (e.g., physicians, nurse practitioners, pharmacists). Within a primary healthcare model of service delivery, different healthcare professionals with diverse knowledge, skills, and talents work together (interprofessionally) in “collaborative practice teams” to improve access to care by putting patients in front of the right healthcare professionals at the right time (WHO, 2010).
Although many other primary healthcare professionals work in rural contexts in Nova Scotia (family practice physicians, pharmacists, nurses, dieticians, etc.), these rural interprofessional teams are of particular interest. They have long been recognized to improve communication, save time, reduce duplication of effort, improve working relationships, and provide a better experience for people who use health and social care services (Bosch & Mansell, 2015). Recent COVID-19 research suggests they are ideally equipped to support populations at greatest risk of adverse health outcomes during pandemics, including older adults and patients with chronic physical and mental health conditions (Donnelly et al., 2021), who generally populate rural settings.
These teams are also a hallmark of the collaborative care model of service delivery launched in Nova Scotia in 2008 to strengthen and increase access to primary healthcare, particularly in rural communities, where challenges in accessing healthcare (demographics, geography, access to providers, etc.) are an enduring reality (Nova Scotia Health Authority, 2017). Since 2008, more than 90 interprofessional collaborative practice teams have been launched in rural Nova Scotia. Similar interprofessional team models have been established and evaluated across Canada, including primary care networks in Alberta, local community service centers in Quebec, and nurse practitioner led clinics in Northern Ontario (Aggarwal, 2022). Their common link is increasing access to healthcare in rural settings. Yet, little is known about how these teams learn to cope with the stress of limited resources and major traumas, such as the pandemic, or about how this learning is best supported. Resilience in healthcare is important because it enables the delivery of quality care. In the context of COVID-19, prioritizing the physical and mental wellbeing of the healthcare workforce is an important step in assuring quality healthcare outcomes.
The Health Resilience Context
The resilience of a health system refers to its “capacity to anticipate and respond to shocks, such as public health emergencies, in an adaptive manner that includes appropriate action against the shock and optimal maintenance of routine core functions” (Haldane et al., 2021, p. 7). Further, systemic resilience has two components:
Burnout results when individual resilience is failing or exhausted. It is defined by Gregory et al. (2018) as an individual's unique “stress reaction to the workplace, characterized by emotional exhaustion, depersonalization, and reduced self-efficacy” (p. 338). Burnout is a complex phenomenon characterized by the interpersonal relationship among the provider, the service user, and the healthcare organization (Newell, 2017). Yet, despite this theory that burnout involves some breakdown in the relationship between the employee and their workplace, interventions have generally focused on building the individual's resilience to “withstand this imbalance rather than identifying and ameliorating the cause” (Gregory et al., 2018, p. 338). They argue that those in the organizational leadership need to look beyond the outcome of interventions aimed at improving individual self-care—especially if the individual is not able to effect changes to the environmental conditions that precipitated burnout in the first place.
In fact, proponents of resilient thinking have long recognized that for sustainable system change, action must be taken at several levels (i.e., organizational and individual) if overall system-level resilience is to be secured (Robertson et al., 2016; Skovholt & Trotter-Matheson, 2016). COVID-19 researchers agree such whole system approaches—those that combine organizational-directed interventions with workplace support interventions (e.g., counseling, training) that enhance staff wellbeing—offer the greatest potential to reduce occupational stress and burnout and to build the foundational resilience that enables health professionals to navigate pandemics and other unexpected adverse conditions (De Hert, 2020; Johnson et al., 2020; Rieckert et al., 2021).
The Health and Learning Context
Those of us who teach or work directly with health professionals working on the front lines are reminded daily of their educational challenges, the conditions in which they work, and the impact on their lives. How to encourage learning to be resilient is a concern for many of us in continuing professional education as we observe the “chaotic conditions where interconnected and interdependent professionals toil to handle relentless change and ambiguity” (Bierema, 2018, p. 27). As adult educators, we understand the strong, mutually reinforcing relationship between education and health, where improvements in one have a clear positive impact on the other (English & McKay, 2022). As such, we have long argued that resilience learning should be part of the educational content of a health professional's pre-service education and continuing professional education, and it should be taught in a way that promotes reflection and application to foster strength, focus, and endurance in the workplace (McAllister & MacKinnon, 2009; McCann et al., 2013). Yet prior to the pandemic, a consensus remained among educational scholars that, overall, the education of health professionals had not adequately supported this learning or “addressed the issue of self-care and coping with stress, burnout, and compassion fatigue so prevalent in health systems” (Tisdell & Palmer, 2018, p. 21). As Tisdell and Palmer (2018) observed, “a high emotional intelligence among health care providers is more positively correlated with quality of health care; hence its cultivation among health care workers is desirable” (p. 22).
COVID-19 has provided a more recent opportunity to study resilience and to examine ways to increase resilience. As such, educational scholars are now examining not only the impact of COVID-19 on adult learning and education in health contexts, including rural health contexts (O'Sullivan et al., 2020), but also the continuing professional education supports that can foster resilience and wellbeing among primary healthcare professionals (Donnelly et al., 2021). The voices of the participants in this study provide a starting point in understanding how individuals learn, grow, and develop resilience in light of traumas or challenges such as the pandemic. Given that most studies of resilience in healthcare are frequently tightly focused on individual learning, with only limited focus on team learning (Haraldseid-Drifland et al., 2022), the lived experience of these teams can provide insights on how collaborative learning occuring in everyday team practice might translate into resilient performance and an ability to handle unforeseen adverse events. This paper is intended to add to adult education and lifelong learning literature focusing on the interrelatedness of healthcare, continuing professional education (CPE), and transformative learning.
Methodology and Research Context
An exploratory case study provided the methodology for orienting this study. Data collection involved three focus group interviews with rural collaborative practice teams in a single health district in Nova Scotia, Canada the fall of 2021. Each focus group had five or more participants. Teams were physician-led and populated by allied health professionals (e.g., nurses, dieticians, physiotherapists, administrators), making the teams homogeneous in composition. In total, the study involved 18 participants. They were all well-educated for their professional roles, and the span of ages was 30–60 with the average age being 45. They were 60% female and 40% male. Except for three members of one team, all others were English first language speakers, and all were Caucasian, representing the local population mix. Though located in three separate communities, participants were all in the same geographic area of the province, which is predominantly white, rural, with a lower socio-economic status. It should be noted that this research focuses on the first year of COVID-19 (March 2020-October 2021), often referred to as the “first wave” of the pandemic, when Nova Scotia had very low case counts due to strict provincial public health measures and a COVID-Zero strategy in Atlantic Canada. Team accounts revealed many commonly shared and interrelated experiences, with only subtle differences in the overall experience. It is these commonly shared experiences and responses to COVID-19 that are the focus of the next section of this paper. In this next section, individual team member affiliation is noted by Team 1, Team 2, and Team 3.
Team Experience and Learning
The lived experience of resilience in healthcare workers is shaped by many personal, interpersonal, and work-related factors (Brown et al., 2021). A framework developed by Grailey et al. (2021) to explore the lived experiences of healthcare workers on the front line during the first wave of COVID-19 is adapted here to profile emergent themes in this study, including (a) changes in workplace stressors; (b) changes in psychological safety; and (c) changes in team dynamics and innovation. Like the Grailey et al. (2021) study, the timeframe of this study spanned the ‘first wave’ of the COVID-19 pandemic, similarly revealing the impact of the pandemic on these factors, but in a rural interprofessional team setting. Verbatim quotes are included in the next section of this paper to bring these teams’ shared experience and ideas more vividly to life.
Changes in Workplace Stressors
COVID-19 workplace stressors were universally highlighted by all three teams. These included those widely recognized in other healthcare settings, namely, a dramatically increased workload and rapidly changing protocols and policies (daily), as well as staff shortages and technological change (Lu et al., 2020). Susan's (Dietitian, Team 2) account highlights her team's early experience navigating these workplace stressors and implications for the team and patients’ learning early in the pandemic: First, we moved to the phone [telehealth], then to virtual visits, and this was expanded to X-ray and even access to blood work, which patients needed to go online for. These changes were often overwhelming for our patients … and that was only one thing in this never-ending change that we had to respond to, creating a lot more work and stress for us behind the scenes. For example, switching to telehealth and virtual care there was a lot more steps added because we now had to educate ourselves and the patients on all this technology. (Susan, Dietitian, Team 2) We were not prepared in any way for such a complete disruption, and initially there was no debriefing or communication from our leadership … only “did you read what you’re supposed to read, this is the change … now go and do it.” We would just get something sorted and we were told to change it. There might be a plan … it's just not communicated well, and I wondered if they [leadership/health authority] were taking advantage of the timeline to implement things that would normally be implemented more slowly … and at our expense. (Paul, Office Manager, Team 2) Like everyone else, initially, I felt disoriented and challenged to “pivot” so often, with so little understanding of anything. However, at a point in that first year, the zone leadership team started daily check-ins as a structure for communication and staying in touch, and it helped us as a team to know how and what others were doing across the health authority. At that point, I decided to trust the process and our team, since from earlier experiences I knew we had our patients in mind and each other's backs. (Mary, Nurse, Team 3)
Changes in Psychological Safety
Mental strain and the risk of psychological distress during the pandemic have been associated with providing direct care to patients with COVID-19, knowing someone who has contracted or died of the disease or being required to undergo quarantine or isolation themselves (Wu et al., 2020). However, in this study, the risk factors and fears cited were distinctly different and included adequately treating patients due to a lack of prior experience, not having answers to potential problems, as well as uncertainty about the future of COVID-19. These risk factors can likely be linked with the low case count in Nova Scotia across the first year of the pandemic and the nature of family practice medicine, outside of acute and emergency care. Yet, as Kia's (Nurse, Team 1) comments reveal, the unknown future of the pandemic remained an ongoing serious risk and fear that contributed to her feeling unsafe in her chaotic workplace. Demands on us were more complex and new procedures unfamiliar. We were also down one admin person for periods of time, and there was fear around being re-deployed to acute and critical care, as others in my team had been, increasing the risks for us. These thoughts preoccupied and exhausted us early on, and self-care was challenging in an environment where you had to do what you must do—sleep, go back and repeat—all the time not knowing how long we would have to keep this pace up, or what the risks to us and to care were. In the worst of it, in April to early May [2020], there was a lot of mental exhaustion, and more frustration and tears than we’d like to admit. (Kia, Nurse, Team 1)
In addition to exhaustion from work and uncertainty about the future, Jean (Dietitian, Team 1) commented on stressors outside of her workplace that added to the mental strain experienced by team members as parents of school age children: We were exhausted from working; we were isolated from everyone in those first few months because we were health care providers, and then later there was taking care of our kids who were at home and learning virtually … and we had no help from anyone else other than our team. We had no self-care; you were just surviving under all this pressure with no release. (Jean, Dietitian, Team 1)
Psychological safety, defined as an environment safe for interpersonal risk-taking (Dominquez-Salas et al., 2021), however, was restored within the first year when adapting to rapid change became normalized and when restricted access (for health professionals) to family and social supports eased. At this point, a more accepting environment to share concerns among colleagues was noted by Julia (Nurse, Team 3), and collegial and community support became critical lifelines: The support of our team colleagues became critical to surviving those days. Initially, we didn’t talk about our fears but over time … we just learned how to adapt, and we leaned on each other a lot. Things changed so quickly from day-to-day you had to be aware that something could/would change, and you just had to adapt to it … and gestures like the little hearts on people's doorsteps were encouraging as evidence that we had community support for our efforts. (Julia, Nurse, Team 3)
As the next section highlights, normalization of the pandemic in the lives of these interprofessional teams opened spaces for creativity and opportunities for collaborative risk-taking and innovation.
Changes in Team Dynamics and Innovation
Like all collaborative primary healthcare teams in Nova Scotia during COVID-19, these teams shared collective responsibility for problem-solving and making decisions for patient care, despite expressing uncertainty about the quality of their care. Yet, as highlighted by Liam (Physician, Team 3), the trust and collaborative relationships created by more than 10 years of working in the interprofessional team structure were a major asset and source of resilience in navigating the pandemic risks with some confidence: While we had many new and unsettling challenges, we had a history of working together as a collaborative team, and we knew our patients and community very well, so we could strategize and prioritize resources and responses quickly. Stepping back to let a team member lead was a usual way of working for us, so we were able to work more autonomously as a unit, and to adapt and readapt to changing priorities. As a result, we were able to maintain a good standard of care, and there was less stress in the team, and we were able to adapt and move forward, one day at a time. (Liam, Physician, Team 3) We had to be nimble, to develop new ways of working and communicating and ‘workarounds’ but we’ve often had to step into roles outside our normal job description to help each other … and so we found this skill helped us to adapt to COVID, to think more creatively about what was possible and needed, and who could do what. Each of our roles were critical in assuring overall safety, and we were accustomed to flexing and problem solving in this way. (Valerie, Physiotherapist, Team 2) Provincial mandates are often one-size-fits-all, and they often don’t make sense in rural communities … for example, blood tests during COVID-19 could only be booked online, but our community is 90% seniors; most have never used a computer, and internet is patchy at best here. As we always do, we quickly found a “workaround” with volunteers and our team helping with these bookings in the evenings. Yet it would be good to be given the latitude to find our own solutions, because we do that every day here, and we know what can work here and what can’t. (Bob, Physician, Team 2)
As Patricia (Dietician, Team 1) highlights, the limits placed on her team during the pandemic had opened space for new ways of thinking and working to emerge: We didn’t have a frame of reference for all of this, so we had to think “outside of the box” and yet within the boxes of the protocols. It was new ground … but we are a small facility, and we knew what might work well here, and in the process realized some new ways that worked well for everyone, that we will maintain. Telephone consults now mean diabetics don’t need to get in their car and come into the centre for a five-minute conversation on how their sugars were over the last few weeks. This assured patient safety and now means we can see more people who need to be seen, when they need to be seen, and more quickly. These developments were empowering and taught us how we could involve community partners and patients more in care. (Patricia, Dietician, Team 1)
Clearly, as this statement suggests, the opportunity existed in these spaces for teams to evaluate assumptions guiding their traditional ways of working and to change them in ways that were innovative and responsive while at the same time guaranteeing safety and creating greater efficiencies. What follows is a summary and discussion of the lived experience of these rural teams across the “first wave” (year) of the pandemic. The implications for adult education and continuing professional education, as well as the study limitations, and areas for future research, are then highlighted.
Summary and Conclusion
The purpose of the study was to learn about the lived experience of rural interprofessional collaborative teams across the first year of the pandemic as a basis for understanding how resilience learning might be nurtured and supported in rural team-based collaborative practice settings. The study reveals the teams experienced psychological distress and mental exhaustion. Initially, they felt challenged to cope with an increased workload, fear of the disease, and uncertainty about system-level communication and support. In this regard, their experiences resonate with most frontline providers in the first year of COVID-19. Yet, while the challenging demographics and historic patterns of inequitable resourcing of rural health were acknowledged, such as limited clinical resources and staff shortages (O'Sullivan et al., 2020; Petrie et al., 2021), no pandemic related workplace stressors specific to their rural contexts were identified.
Rather, despite these recognized rural challenges and pandemic related occupational stressors and risk factors, a significant level of collective resilience, defined by Delgado et al. (2021) as a “shared identity and capacity arising within a group that enables them to draw on their collective sources of support, to deal with adversity” (p. 376), was apparent in the accounts of the teams. For these teams, a history of working together and stepping up to help each other with tasks contributed to a sense of ‘banding together’ that enabled them to move beyond disorientation and shock to action and innovation in response to the pandemic. It has been noted that a critical source of collective resilience in emergencies and disasters is the trend to come together psychologically and behaviorally (Delgado et al., 2021; Jordan et al., 2022).
The relatively rapid pace with which all three teams were able to adapt and direct their responses—what Susan referred to as thinking and working “outside the box, and yet, within the boxes of the COVID protocols”—is evidence of an
Rural health researchers describe this ability of healthcare teams to build and draw on their collective knowledge of what is possible and to quickly evaluate options in terms of their fit for the needs of a community, as an
Underlying the resilient performance demonstrated by these teams across the first wave of the pandemic was a significant level of continuous learning that advanced their adaptive and absorptive capacity. Learning how to navigate the pandemic mimicked their everyday collaborative work processes and contributed to a shared understanding of how to respond to the new and uncertain challenges they faced. The ability to adapt was not just dependent on individual actions, but on their collective learning and their shared contextual knowledge. Valerie's insights on the nimbleness and flexibility of her team suggest that her individual resilience was learned and enabled by being part of her team, and she drew strength and resilience from the team's collective learning and action. Trust, dialogue, and communication became central tools in leveraging their collective resilience, enabling these teams to cope, to adapt to a new normal state in response to the disruption, and to return to some ‘normal’ condition or transformed state of functioning without compromising system performance (Wiig et al., 2020).
As learning emerges as a key enabler of resilient action in this study, continuing education strategies to support resilience leaning are important to consider. The findings of this study reinforce that collaborative learning occurring through interactions with others through work practices, such as teamwork and problem-solving, contributed to their resilient performance. According to Wiig et al. (2020), these kinds of local adaptations, incremental learning, and transformations happen in everyday interactions and work practices in healthcare, without anyone necessarily knowing. In this study, teams demonstrated collective resilience developed from continuous learning that served as a foundation in their early response to the pandemic. The synergistic interplay between personal, relational, and organizational (team) factors further strengthened their learning and collective resilience, enabling them not only to respond to the pandemic, but to transform individual, interactive, and organizational practices. This ability to enact adaptations and address the changes while continuing to deliver a quality service is evidence of growing resilience and transformative learning in action (Romano et al., 2022).
Adult educators can play a key role in supporting this kind of practice-based learning by developing collaborative tools and processes that foster awareness and dialogue that lead to a shared understanding of how to navigate unexpected challenges and adversity. For example, a community of practice (CoP) is an important continuing professional education strategy that could offer an accessible way for healthcare workers who interact regularly to improve the quality of care through learning and knowledge sharing. As is reinforced in this study, in collective supportive spaces, individuals can share experiences, teams can collectively and critically reflect on adverse situations, raise new questions regarding how to face adverse and unexpected situations in the future, and expose and talk about vulnerability as a shared experience (Delgado et al., 2021). Such critically reflective spaces, tools, and processes are recognized to support the development of both
According to Haraldseid-Driftland et al. (2022), a resilient organization is one that recognizes that “the ability to adapt and respond to challenges and changes relates to the ability to both work and learn, collaboratively, which enables healthcare professionals to actively develop a shared understanding and provide quality care” (p. 2). Adult educators can support the efforts of health systems to create a supportive learning culture, where practitioners can develop these mutually supportive relationships to learn and grow together through their collaborative practice experiences. As this study reveals, it is this shared collective identity and capacity arising within a group or organization that enables its members to draw on its collective sources of support to deal with adversity (Delgado et al., 2021). The shared values and culture of ongoing collective learning had a significant impact on how these teams went about their everyday practice. Interprofessional learning was ongoing and supported by building trusting relationships and having shared values that contributed to their ability to adapt and to regain equilibrium in circumstances of change.
Findings from this study reinforce the extent to which collaborative learning enhances an individual's capacity for resilient performance. At the same time, resilience researchers Haraldseid-Driftland et al. (2022) view individual action as an indirect reflection of systemic resilience and suggest that efforts to strengthen resilience in healthcare must take a systems perspective that enables teams, or units, to collaborate to learn how to adapt to their changing circumstances. In addition to intentional educational activities (e.g., seminars or simulation activities), these researchers encourage the creation of spaces for reflection and awareness, through activities of daily work, as a mechanism for supporting individual, team, and organizational learning that contributes to systemic resilience. Obviously continuing professional education strategies of this kind would require supportive time and space within practice environments and the involvement of all team members to allow for divergent experiences and ideas in the group.
Findings from this study reinforce the value of a whole system approach to fostering resilience in healthcare—one that combines organizational-directed interventions to change workplace factors which create stress, with workplace support interventions (e.g., counselling, training) to enhance staff wellbeing. As established earlier, this approach offers the greatest potential to reduce occupational stress and burnout and to build strong systemic resilience, which enables health professionals and teams to navigate disruptive and unexpected adverse conditions.
Adult educators can be instrumental in supporting healthcare systems in these efforts to strengthen their ability for resilient performance. Because resilience can be mobilized before, during, or after a disturbance (Wigg et al., 2020), adult educators can begin by assessing existing levels of individual and organizational resilience. Given the high level of interdependence among healthcare professionals and other healthcare stakeholders, efforts by adult educators to support resilience learning might best be undertaken in group contexts, where health professionals who work together also learn together. Adult educators can develop continuing professional education strategies that can aid healthcare organizations to support the process of collective learning and change and can support organizational efforts at remaking or transforming individual, interactive, or organizational policies and practices that can assure resilient action and quality healthcare.
As adult educators, we can be attentive to these positive findings and can also question if these findings would be consistent with a broader sampling of interprofessional collaborative practice teams in different settings, possibly urban areas, and with other groups of healthcare providers. A systems perspective of resilience demands collaboration and learning within and across healthcare system levels. As educational researchers we can study the interactions of daily collaborative work in healthcare which are generative of learning and changes in practice. In understanding the underlying learning processes of how and why collaborations occur, we are better able to support the process of collective learning and change that contributes to individual, organizational, and systemic resilience. Learning for resilience is not a well-researched topic in adult education and health and will need much more attention and consideration, given the increasing complexity of modern life and healthcare. Further attention and study of the links between health and learning are also needed, as pandemics are not over, and healthcare is continuously challenged.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Correction (March 2024):
This article is updated with minor corrections since its original publication.