Archives of Nursing and Care

Review Article - Archives of Nursing and Care (2025) Volume 8, Issue 1

Evolution of Defense Mechanisms Through the Reflective Portfolio: Building Resilience in Nursing Students

Olivier Morenon*

Department of Applied Sciences, University of Applied Sciences of Western Switzerland, Switzerland

Corresponding Author:
Olivier Morenon
Department of Applied Sciences, University of Applied Sciences of Western Switzerland, Switzerland
E-mail: olivier.morenon@he-arc.ch

Received: 03-Jul-2024, Manuscript No. OANC-25-140600; Editor assigned: 05-Jul-2024, PreQC No. OANC-25-140600 (PQ); Reviewed: 19-Jul-2024, QC No. OANC-25-140600; Revised: 03- Jan-2025, Manuscript No. OANC-25-140600 (R); Published: 10-Jan-2025, DOI: 10.37532/ oanc.2025.8(1).85-89

Abstract

This exploratory qualitative study investigates the impact of reflective learning portfolio writing on the activation and evolution of defense mechanisms among nursing students, with the aim of developing resilience skills. Conducted with six students from a specialized higher education institution in Western Switzerland, the analysis is based on semi-structured interviews to explore how reflective writing initially stimulates the use of basic defense mechanisms, before encouraging a transition to more mature and adaptive mechanisms. These ones are crucial to the metallization process, thereby facilitating healthier emotional management and contributing to the strengthening of resilience. The results highlight the critical role of reflective writing as a pedagogical tool for the development of key resilience skills, including self-assessment, metacognition and the ability to link theory and practice. The study underscores the importance of integrating reflective writing into nursing education programs, to prepare students to face professional challenges with adaptability and robustness. This research contributes to a better understanding of the interplay between reflective writing and resilience in nursing students, offering valuable directions for the development of pedagogical strategies aimed at enhancing resilience.

Keywords

Defense mechanisms • Nursing • Students • Resilience • Psychological learning • Writing • Education • Nursing

Introduction

Nursing studies expose students to numerous challenges in a demanding academic and professional career. The dropout rates underline the rigor of the training, sometimes exacerbated by precarious internship conditions, pressure from supervisors, and insufficient preparation to manage complex or destabilizing cases [1]. Despite these challenges, in France, around 80% of nursing students entering the 1st year obtain their first year diploma, demonstrating their resilience [2]. Resilient processes were observed to explain this success rate despite a vulnerable study context [3]. This observation has led to the emergence of favorable recommendations for the creation of educational programs focused on promoting resilience, in order to prevent premature abandonment of training and careers, and to improve the quality of patient care [4,5].

Resilience, essential for nurses and healthcare students, integrates psychological, biological and sociocultural dimensions. Supported by defense mechanisms, it evolves towards a phase of mentalization, transforming experiences via self-reflection into symbolized representations [6-9]. The importance of defense mechanisms is therefore essential when they are used in a flexible and diversified manner [10]. In order to ensure an optimal resilience process, it is essential that initial defense mechanisms such as splitting, denial or flight are replaced by mechanisms promoting mentalization. There are different mechanisms of high adaptive level, called “mature”, such as affiliation, altruism, humor, anticipation and sublimation, among others. The classification of defense mechanisms provides a framework for understanding how these psychological processes contribute to mental health and the mentalization process.

Nursing resilience, influenced by personal and professional factors such as working conditions, corporate culture, managerial skills, organizational support, and the quality of team relationships, allows subjects to adapt positively to work stress, avoid psychological harm, and provide highquality care. Resilience support can focus on things such as self-esteem, self-confidence, optimism, independence, stress management, positive attitudes, sociability and social interactions.

The resilience of nursing students mobilizes individual and environmental protective factors, as well as defense mechanisms, to adapt, resist and carry out their professional project in a vulnerable learning context. It also involves the development of skills based on reflexivity, positive reinforcement, self-esteem, optimism and the prevention of situations likely to weaken them. The effectiveness of educational programs specifically designed to build resilience in these students has been demonstrated by previous research, highlighting the importance of developing skills such as emotional regulation, optimism, effective communication, resolution problems and flexibility.

Six teaching approaches that promote resilience in nursing students have been identified in research: peer activities, reflective practice, tutoring, problem-based learning, inquiry-based learning, and apprenticeship experiential More specifically, the reflective learning portfolio promotes the acquisition of skills necessary for resilience. It includes written work, projects and presentations, demonstrating student progress. It encourages reflection on learning, collecting argumentative data, differentiating and associating them, as well as developing metacognitive skills, self-assessment and the ability to establish links between theory and practice. Indeed, reflective practice helps individuals adapt to difficult situations and understand how they overcame challenges, thus strengthening personal effectiveness, one of the resilience skills.

Objective and method

This article explores the defense mechanisms activated when writing a reflective portfolio in nursing education, examining how this teaching method encourages the use of immediate mechanisms and promotes more elaborate mechanisms to develop student resilience.

This qualitative study, conducted via six semistructured interviews with students (4 women and 2 men, aged 19 to 26) in the first year preparatory to health courses at a university in western Switzerland, aims to examine the mechanisms of defense employees during the writing of their learning portfolio and their influence on mentalization. The participants, eager to share their experiences and with a Bachelor project in nursing, allowed a detailed analysis of psychological dynamics. The semistructured interviews, enriched by an empathetic approach and reformulations, facilitated the collection of homogeneous information, thus respecting the principles of humanistic psychology. The objectives of the study and the use of the contributions were explained, guaranteeing confidentiality and anonymity of the recordings and transcriptions. Following this, participants signed informed consent.

Data analysis was carried out using an inductive thematic method, with Nvivo software to identify word frequencies and sentiments, followed by indepth thematic analysis. In this exploratory study, we decided not to use a psychometric tool for observing defense mechanisms due to criticism from researchers. Rather, we leveraged our academic expertise and professional experience in psychoanalysis to interpret the data.

Literature Review

The use of Nvivo did not reveal words recurring regularly in a consistent manner. The vocabulary used to express situations and experiences was varied and adapted to individual backgrounds. From the thematic analysis, 3 emerged: Ineffective defense mechanisms for mentalization, those that promote it, and the development of skills for resilience. In the text, the terms E1, 2, 3, 4, 5 or 6 are used to designate the verbatims of interviews number 1, 2, 3, 4, 5 or 6.

Defense mechanisms not effective for mentalization

The resilience process involves the activation of defense mechanisms to protect the ego during the first instance, and to elaborate during the second instance. Some who are immediately mobilized can hinder the mentalization process. During the interviews, avoidance, projection and reaction formation, and rationalization emerged.

Avoidance: Participants frequently mentioned avoiding initial difficulties by procrastinating and expressed general difficulty opening up. For example, one student said: Some “avoid writing the portfolio and procrastinate. It’s not because they don’t want to do the portfolio, it’s because they don’t want to talk about themselves, they don’t want to open up or they have general difficulty doing so” (E1). Along the same lines, a participant declared: “So I started working on it at the last minute, which made me push back the submission date until the beginning of February” (E5).

Projection and reaction formation: In high school, E3 dodged a project in conflict with his teacher showing his propensity to blame others during conflicts: “As I was at war with my teacher, I did not want to deal with the subject of women and sport so I chose another theme, samurai women during the Japanese war. Initially frustrated at not studying medicine, E3 had a projective attitude. Reflective writing changed her perspective, opening her to other careers after an internship in geriatrics: “Now that I have completed an internship in geriatrics in a nursing home, I am much more open to other fields than medicine. I explained it in my portfolio” (E3). This development has led to a more constructive management of conflicts and frustrations, enriching learning through questioning, a key resilience skill.

Rationalization: Some participants rationalized the avoidance of conflicts by questioning the usefulness of engaging in them before writing their reflective assessment: “In the end, what is the point of getting into a conflict? ” (E4).

Defense mechanisms favoring the mentalization process

Participants in this study reported using various defense mechanisms promoting the mentalization process, including intellectualization, rationalization, sublimation, self-affirmation, and humor.

Rationalization: “I didn’t feel any stress about the portfolio.” (E1); “Distinguishing your objectives made writing much easier” (E2); “There was no point in procrastinating... it allows me to be clearer about my choices for the future” (E5); “There are more solutions and then we perhaps need to question the method” (E6).

Intellectualization: “For me, it was a bit like putting together all the theoretical courses. By writing, I was able to step back and look at things from a different angle. Writing about aspects that are important to me is necessary as a caregiver” (E2). This reflection is echoed in other testimonies: “I realized that the internship was not adapted to my interests until after having finished it” (E1); “what I learned... I also used my lessons” (E4), “I will continually question my actions” (E6).

Sublimation: “(while writing) I worked on these aspects that were important to me as a caregiver... Honestly, I fully invested” (E2); “Having all of this written down has really helped me to maybe be a little less emotional in these situations... By writing, I’ve put those negative emotions aside to focus on what I’ve learned” (E4 ).

Developing skills that promote resilience

In the process of learning and personal development, reflective writing proves to be a powerful tool for strengthening students’ resilience. This method leads them to develop and affirm key skills, such as self-esteem, confidence, optimism, open-mindedness and flexibility, preparing them to face present and future challenges: “my ideas are clear, I know what I think and what I want or don’t want” (E1); “I think it also showed me that I was capable of writing, which I strongly doubted at the beginning of the portfolio” (E5); “This does not mean that I cannot change my mind in the future, but it allows me to be clearer about my choices for the future” (E5); “Now that I have completed an internship in geriatrics in a retirement home, I am much more open to other fields than medicine” (E3); “There are more solutions and then we perhaps need to question the method” (E6).

Finally, the feeling of self-efficacy emerges from the realization that distinguishing what to work on makes things “much easier…” (E2); and commitment to continuous improvement, as expressed: “What has at least one advantage is that I will continually question my actions” (E4)

Discussion

Certain defense strategies such as avoidance and rationalization may hinder the development of effective thinking and resilience in nursing students, limiting their ability to constructively cope with challenges. They can prevent learning and negatively affect interpersonal interactions. It is essential to adopt educational approaches to promote reflection and emotional management in order to overcome these difficulties. Reflective portfolios help students examine their emotional reactions and correct maladaptive defense mechanisms. They thus recognize these challenges and explore problem-focused strategies to improve their coping.

Research distinguishes adaptive defense mechanisms, such as intellectualization, sublimation, and humor, essential in mentalization and stress management. Intellectualization allows for objective analysis, sublimation transforms negative emotions into positive actions, and humor reduces anxiety, providing an optimistic perspective. These mechanisms, observed during interviews and through reflective writing, build resilience by helping to process emotions constructively, transforming stressful experiences into opportunities for growth.

Psychology is essential in pedagogy, requiring teachers to understand relational dynamics. Perrenoud highlights the need for theoretical knowledge of emotional phenomena to guide student reflection without hasty interpretations, thus addressing the complexities of human relationships influencing identity and power dynamics. Expertise in psychoanalysis, recommended not for playing the role of therapist, helps define the limits of their support.

Reflective writing, supported by the recognized benefits of expressive writing on psychological well-being and stress reduction, provides a safe space for the free expression of emotions and thoughts. Reflective writing transforms students’ stressful or traumatic experiences, promoting personal healing and meaningful growth. Professionally, writing can have a significant impact on job satisfaction, coping and soft skills among healthcare professionals. Similar approaches may be advantageous in an integrative work-study nursing educational context. This approach not only aims to develop academic knowledge, but also seeks to provide students with the necessary tools for: Effective management of emotions, better selfunderstanding, and an increased ability to cope resiliently with challenges. multiple challenges inherent to the nursing profession.

Reflective writing proves essential for the development of resilience skills, facilitating the expression of thoughts and the analysis of experiences provided that it is supported to maximize its benefits and prevent negative impacts on well-being. This practice improves self-awareness and self-assessment, essential when facing professional challenges . Portfolios allow personalized teaching, focused on individual needs. Regular monitoring reinforces learning and personal development, thus promoting resilience. Teachers, by providing topics for reflection and constructive feedback, play a key role in the acquisition of academic and social skills. The integration of reflective writing in education, especially in health, supports the professional development of students and strengthens their resilience, preparing them for professional challenges with effective coping strategies.

Limits

The main limitations of our study are the sample size and the particularity of the nursing training context, which may influence the interpretation of the results. Additionally, measuring and evaluating defense mechanisms presents many challenges, particularly regarding the reliability and validity of assessment instruments. It is difficult to directly observe defense mechanisms due to their involuntary and unconscious nature, making the design of accurate and repeatable assessment tools difficult. The precision of the latter is often low, which limits the reliability of empirical studies in the field of scientific psychology. However, the absence of psychometric tools can lead to interpretation errors. We have been aware of these elements and we have presented the conclusions in the form of a hypothesis in order to avoid any wild interpretation.

Research prospects

To avoid wild interpretation, we are considering the use of a specific observation grid and the validation of interpretations with the participants while remaining cautious about other possible biases. Indeed, although these grids aim to objectify observations, the challenges of selfidentification of these mechanisms (erroneous self-disruption, denial, etc.) will be considered in our future approach.

A three-year longitudinal study in nursing would provide insights into the evolution of defense mechanisms and their role in resilience, highlighting personal and environmental factors of resilience, including the impact of social support and working conditions.

By analyzing the effect of reflective writing on all elements of the resilient process, we will seek to understand how it promotes the management of challenges and personal and professional development, aiming to optimize this practice to strengthen resilience in future caregivers.

Conclusion

Our study reveals the importance of defense mechanisms in reflective writing for nursing students, showing their impact on the development of resilience. Reflective writing is seen as a way to promote introspection and the adoption of adaptive defense mechanisms. Highlighting the need for educational methods that strengthen resilience for better emotional management and self-confidence, our conclusions nevertheless remain cautious due to limitations related to the interpretation of defense mechanisms and the small size of the sample. In order to deepen the research, we suggest a complete analysis of all the resilience factors mobilized and the skills developed following reflective writing. We encourage nursing trainers to bring innovation to their teaching approaches, with the aim of equipping future healthcare professionals with the essential skills in a vulnerable and constantly evolving healthcare context.

References