Resilience and Mental Well-being in Pediatric Oncology
What is Resilience?
In general, resilience refers to the ability to successfully cope with stressful circumstances such as traumatic experiences, misfortune, failure, or other risk conditions, as well as to mitigate the negative consequences of stress. Resilience competence is a fundamental coping competence . The concept is closely linked to the model of salutogenesis (A. Antonovsky). Resilience is not to be understood as a universal ability, but as a live area-specific competence that is variable, situation-specific, dynamic, and learnable.
Psychological Resilience according to Sisto et al. 2019 is:
- The ability to adapt positively positively to existential life conditions while maintaining one's own
orientation with good self-awareness and a sense of coherence. - A dynamic processthat develops over time and involves a form of adaptive
functioning that allows us to cope with challenges. - Openness to change and an opportunity for (post-traumatic) growth.
What is Salutogenesis?
The salutogenesis concept (1979) of medical sociologist Aaron Antonovsky (1923-1994) examines the conditions that contribute to people staying healthy despite stress.
Crucial here is the understanding of health and illness as manifestations of a continuum, influenced by the balance between stressors and sources of resistance.
The central core of the model is the construct of the sense of coherence. It describes the global orientation that expresses the extent to which one has a continuous, enduring, yet dynamic feeling of confidence that:
- the events of the inner and outer environment over the course of life are structured, predictable, and explainable
(sense of comprehensibility). - the resources are available to meet the demands posed by these events
(sense of manageability). - these demands are understood as challenges that are worth committing to and engaging with
(sense of meaningfulness).
Why is resilience important in helping (healthcare) professions?
Increased risk of mental illness in helping professions due to witnessing stressful situations, illness, trauma, and death leads to high emotional demands.
Mental health and well-being require special attention as the topic is often
not addressed or taught in education.
Self-care and measures to maintain health and well-being (mental hygiene)
can strengthen one's own resilience and have a preventative effect.
For self-protection: Develop strategies and habits that prepare
for psychological stress and help cope with it.
Prerequisites include the observation of psychological and physical stress factors as well as the individual reactions to them, and a pronounced ability for self-awareness.
Further Prevention Options (Selection)
Exchange with colleagues (supervision, intervision/ peer consulting).
Mindfulness (observing and recognizing one's own reactions, thoughts, feelings).
Relaxation techniques.
Self-awareness of physical and emotional signals such as sleep disorders, headaches, irritability, vegetative overexcitability, etc.
Strengthening of Self-Esteem and Self-Confidence.
Changing dysfunctional beliefs.
Self-efficacy – Develop confidence in your own strengths.
Promoting social skills (e.g., respecting one's own boundaries, communicating needs, asking for favors or help, providing relief).
Solution-focused and resource-oriented work.
Activate resources.
What does mental hygiene mean?
Mental hygiene encompasses all measures that serve to protect and maintain mental health, such as lifestyle habits and behaviors that support coping with everyday or extraordinary stresses. The different measures and behaviors can be very different individually and should be variably applicable and consistent for each person depending on the situation. Below you can create a collection of your resources in the work context, where
both those that you already use and those that you would like to use can be noted.
Intervision/ peer consultation
Intervision or peer consulting is the meeting of a group or team to discuss a situation from the professional field. The participants reflect on their professional actions, support each other in problem-solving, and thus expand their specialist knowledge and their competence to act. Problem-solving takes place in an autonomous, experience-oriented learning process. An important and valuable resource of intervision is the multiperspectivity that is brought to the consultant by the advisory group. The solution potential increases with a higher number of participants.
Intervision is based on equality, voluntariness, and personal responsibility, which means it is professional and solution-oriented self-help counseling in which members of the group advise each other. The starting point of each intervision is a problem or a specific question. It is the responsibility of the case presenter to implement the action options or to test the proposed solutions in practice.
Benefits
- Employees can learn from colleagues
- Low costs
- When an intervision group is established in an organization, it can evolve into a trusted community where employees feel comfortable sharing their problems freely.
Disadvantages
- Number of Participants
- Organizational effort/ Scheduling
- The knowledge and time of an intervention group may not be sufficient to solve problems that are deeply rooted.
- A deeply rooted problem exists, for example, when the case presenter is not very open to new things and cannot engage with new perspectives, or when a conflict has progressed too far.
Possible Benefits
- Enhancement of professional competence
- Expanding alternative courses of action and questioning previous actions
- Quality assurance of one's own work
- Differentiated awareness of one's own role
- Change of perspective/ Recognizing patterns
- Reducing work-related pressure through peer support/ psychohygiene
- Increasing one's own consulting competence
- Critical examination of the personal 'framework theory' of professional action
Key characteristics of intervision
- Goal-oriented, solution-oriented, self-directed, shared professional focus of the group, equal standing of participants
- Basic structure: (1) Case presentation, (2) peer consultation with development of solution approaches, alternative courses of action, (3) next steps, (4) evaluation and conclusion
- Ideal group size: 5-8 people
- Duration: 30-120 minutes, depending on the concept/design
Intervision process
- The case presenter provides a brief case presentation with the relevant information and a specific
question - Questions to clarify the case from the group + corresponding answers
- Discussion within the group about the presented case and their own ideas, feelings, etc. related to it.
The case presenter does not participate in the discussion but only listens and is not addressed directly (no advice is given). - Final question to the case presenter: What do you take away from the session or what resonated with you?
Roles in Intervision
Case presenter: brings a consultation request to the intervision group, presents the case as vividly as possible, including the content, factual, and emotional levels.
Consultants/Advisors: form the core of the intervision group, share their perceptions with the case presenter, engage with their perspective and accept the problem presented with respect and interest, reflect on the case against their own professional background, and exchange ideas on it.
Moderator: facilitates the systematic process, separates roles if necessary, moderates transitions, and acts as timekeeper to ensure that the various process phases are adequately structured in terms of content and time.
If necessary, Observer: not mandatory, but can significantly enrich the process through feedback, takes notes during the consultation, and only speaks at the end of the process.
Important basic rules for communication
- Appreciative, non-judgmental basic attitude of the members towards each other
- Active, attentive, and accepting listening of the participants
- Avoiding generalizations, judgments, interpretations, lecturing, and giving advice
- Checking perception by asking the other person if one's own impression is correct
- Make clear and concrete statements, e.g., use 'I' instead of 'one'.
- Be mindful of your inner signals, communicate feelings and wishes authentically and selectively: I don't share everything, but what I do share is real, deliberately chosen, and sincere.
Simple application option: structuring intervision as a Reflecting Team
- Case description: Case presenter introduces a case in the presence of a group (approx. 5 min)
- Clarification of questions: Group asks clarifying questions about the case (5-10 min)
- Objective: Case presenter formulates 1-2 specific questions/concerns (3 min)
- The case presenter moves into the observer position and listens to the group without commenting.
- Peer consultation with development of solutions: The group engages in reflective exchange about the presented case and generates hypotheses, solutions, alternative courses of action, expresses thoughts without directly addressing the case presenter (10-20min)
- The case presenter is offered possible solutions that can be accepted or
rejected, depending on how helpful they are perceived to be.
- The case presenter is offered possible solutions that can be accepted or
- Planning and evaluating next steps
- The case presenter provides brief feedback on what was heard and further steps or intentions resulting from the intervision (3-5 min)
Sources and Further Reading
Degenkolb-Weyers, S. (2016). Resilienz in therapeutischen Gesundheitsfachberufen, Wiesbaden: Springer Fachmedien
Diegelmann, C., Isermann, M., Zimmermann, T. (2020) Therapie-Tools Psychoonkologie, Weinheim: Beltz
Dorsch. (2021) Lexikon der Psychologie. Verlag: Hogrefe;
Herbach, A. (2019) Systemische Intervision für den Alltagsgebrauch. Wiesbaden: Springer Fachmedien
Huber, G. (2012) Sozialwissenschaftliche Aspekte. In Schüle & Huber (Hrsg.) Grundlagen der Sport- und Bewegungstherapie. S 134-139. Köln: Deutscher Ärzte-Verlag
Lippmann, E. (2013) Intervision. Kollegiales Coaching professionell gestalten. 3. Überarb. Auflage, Berlin: Springer-Verlag
Sendera, A. & Sendera, M. (2013) Trauma und Burnout in helfenden Berufen, Wien: Springer-Verlag
Sisto A., Vicinanza F., Campanozzi L. L., Ricci G., Tartaglini D., Tambone V. (2019). Towards a transversal definition of psychological resilience: a literature review. Medicina 55:745.
Wustmann, C. (2004). Resilienz. Widerstandsfähigkeit von Kindern in Tageseinrichtungen fördern. Weinheim: Beltz
Wellensiek, S. K. (2017) Handbuch Resilienztraining. 2., aktualisierte Auflage, Weinheim: Belt
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