focused
on health promotion and seeks to discern
positive outcomes from adversity, states of wellness
amidst difficult circumstances, including severe
illness. Schaefer and Moos (1992) identified
three broad categories of positive outcomes in
relationship to health: enhanced social resources
(supportive networks); enhanced personal resources
such as insight and self-reliance; and
development of problem-solving and help-seeking
skills. These roughly correspond with the critical
attributes of resilience.
Within these domains, the identification of protective
factors associated with competence in highrisk
individuals has important implications for
primary, secondary, and tertiary prevention. For
example, it is clear that certain families are at high
risk for psychiatric disorders such as depression,
schizophrenia, or substance abuse. It is equally
clear, however, that not all individuals in these
families either suffer from the disorder or are even
impaired.
We should examine protective factors in unaffected
family members from the perspective of
within-family variability. Such factors to consider
are (1) sibling interaction (differential treatment by
siblings, deidentification from siblings); (2) family
structure (birth order, sibling spacing); (3) parental
factors (differential treatment of offspring, interactions
between parent and offspring characteristics);
and (4) extrafamilial networks (peer groups, relatives,
teachers). We can then develop a variety of
interventions with a dual focus on protection and
risk.
Determining what keeps people healthy and
enhancing those skills is extremely relevant to
today's health care climate. As a profession we are
committed to the belief that health care delivery
must transform from an illness system to a health
system (American Nurses Association, 1991). How282
DYER AND McGUINNESS
ever, adversity and illness does happen. Therefore,
by including the concept of resilience in our
practice strategies, psychiatric-mental nurses may
significantly add to the promotion of mental health
as well as the prevention of mental illness.
REFERENCES
American heritage dictionary of the english language (3rd ed.)