COVID-19 Stress Perception, Resilience, and Well-Being Among Nurse Practitioners in the Post-Pandemic Era: A Cross-Sectional Study

Wen-Di Lin; Pei-Ling Wu; Hsiang-Chu Pai

doi:10.69606/jps.v4i01.452

Authors

Wen-Di Lin Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
Pei-Ling Wu Department of Nursing, Chung Shan Medical University, Taichung City, Taiwan
Hsiang-Chu Pai Department of Nursing, Chung Shan Medical University, Taichung City, Taiwan

DOI:

https://doi.org/10.69606/jps.v4i01.452

Keywords:

COVID-19, resilience, well-being, Nurses, post-pandemic

Abstract

Background: The COVID-19 pandemic imposed sustained psychological stress on healthcare professionals, including Nurse Practitioners (NPs). In the post-pandemic era, understanding how perceived pandemic-related stress, resilience, and well-being interact is crucial for supporting workforce sustainability and mental health. Aims: To examine the relationships between perceived COVID-19 stress, resilience, and subjective well-being among NPs in Taiwan and identify key predictors of well-being. Methods: A cross-sectional correlational design. Online survey data were analysed and collected from 254 Taiwanese NPs between June and September 2023 using the Perceived Stress Scale of COVID-19, Resilience Scale for Adults, and Subjective Well-Being Scale. Data were analyzed using descriptive statistics, Pearson’s correlation, and multiple linear regression. Results: The regression model explained a significant portion of the variation in subjective well-being (R² 65.5%; adjusted R² = .655). Perceived COVID-19 stress was negatively associated with resilience (r = –.394, p < .01) and subjective well-being (r = –.373, p < .01). Resilience was strongly and positively correlated with well-being (r = .802, p < .01) and emerged as the strongest predictor in regression analysis (β = .802, p < .001). Perceived stress did not significantly predict well-being (p = .259). Conclusion: Nursing managers can incorporate resilience-enhancing strategies, such as stress management workshops, mentoring programs, peer support, and reflective practices, into organisational policies to strengthen workforce sustainability.

References

Asselmann, E., Bendau, A., Hoffmann, C., & Ewert, C. (2024). Self-compassion predicts higher affective well-being and lower stress symptoms through less dysfunctional coping: A three-wave longitudinal study during the COVID-19 pandemic. Journal of Happiness Studies, 25(5), 55. https://doi.org/https://doi.org/10.1007/s10902-024-00755-6

Brites, R., Brandão, T., Hipólito, J., Ros, A., & Nunes, O. (2024). Emotion regulation, resilience, and mental health: A mediation study with university students in the pandemic context. Psychology in the Schools, 61(1), 304-328. https://doi.org/https://doi.org/10.1002/pits.23055

Campo-Arias, A., Pedrozo-Cortés, M. J., & Pedrozo-Pupo, J. C. (2020). Pandemic-Related Perceived Stress Scale of COVID-19: An exploration of online psychometric performance. Revista Colombiana de psiquiatria (English ed.), 49(4), 229. https://doi.org/https://doi.org/10.1016/j.rcpeng.2020.05.001

Cavallari, E., Setti, I., Curcuruto, M., & Sommovigo, V. (2025). Coping in the Face of Verbal Aggression: The Role of Self-Efficacy in Protecting Healthcare Professionals’ Well-Being and Job Satisfaction. Behavioral Sciences, 15(4), 478. https://doi.org/https://doi.org/10.3390/bs15040478

Chen, J. (2025). Impact of family and social support in enhancing psychological well-being of young adults in China. BMC psychology, 13(1), 839. https://doi.org/https://doi.org/10.1186/s40359-025-03093-1

Chen, S., & Cheng, C. (2024). Unveiling coronasomnia: Pandemic stress and sleep problems during the COVID-19 outbreak. Nature and Science of Sleep, 543-553. https://doi.org/https://doi.org/10.2147/NSS.S459945

Chu, Y.-T., Hu, I.-C., Ko, C.-P., Chang, Y.-K., & Ho, C.-C. (2024). Self-perceived health status, psychological resilience, and life satisfaction of healthcare workers after 2 years of COVID-19 pandemic. Tungs' Medical Journal, 18(Suppl 1), S28-S34. https://doi.org/ DOI: 10.4103/ETMJ.ETMJ-D-24-00003

Çiçek, İ., Sipahioğlu, M., & Dilekçi, Ü. (2025). The Mediating Role of Occupational Self‐Efficacy and Resilience in the Relationship Between Occupational Stress and Subjective Well‐Being in Teachers: Validation of the Turkish Version of the Teacher Occupational Self‐Efficacy‐Short Form. Psychology in the Schools. https://doi.org/https://doi.org/10.1002/pits.70073

Coetzee, B., Haine, P., Kidd, M., Shongwe, L., Janse Van Vuuren, M., & Kagee, A. (2025). Coping in crisis: the role of sense of coherence, life satisfaction, and resilience in the relationship between depression, social support, fear of COVID-19, and perceived vulnerability to disease among nurses in South Africa. Journal of Health Psychology, 30(10), 2542-2556. https://doi.org/https://doi.org/10.1177/13591053241279000

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior, 385-396. https://doi.org/https://doi.org/10.2307/2136404

Czepiel, D., McCormack, C., Da Silva, A. T., Seblova, D., Moro, M. F., Restrepo-Henao, A., Martínez, A. M., Afolabi, O., Alnasser, L., & Alvarado, R. (2024). Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic. Cambridge Prisms: Global Mental Health, 11, e34. https://doi.org/https://doi.org/10.1017/gmh.2024.18

de Lisser, R., Lauderdale, J., Dietrich, M. S., Ramanujam, R., & Stolldorf, D. P. (2024). The Social Ecology of Burnout: a framework for research on nurse practitioner burnout. Nursing Outlook, 72(4), 102188. https://doi.org/https://doi.org/10.1016/j.outlook.2024.102188

Ditchburn, G., & Koh, R. E. (2024). Workplace pressure, employee stress, mental well-being and resilience in response to COVID-19 in Singapore. Evidence-Based HRM: A Global Forum for Empirical Scholarship, https://doi.org/10.1108/EBHRM-10-2022- 0252

Foster, K., Shakespeare‐Finch, J., Shochet, I., Maybery, D., Bui, M. V., Steele, M., & Roche, M. (2024). Psychological distress, well‐being, resilience, posttraumatic growth, and turnover intention of mental health nurses during COVID‐19: A cross‐sectional study. International journal of mental health nursing, 33(5), 1543-1552. https://doi.org/https://doi.org/10.1111/inm.13354

Friborg, O., Hjemdal, O., Rosenvinge, J. H., & Martinussen, M. (2003). A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment? International journal of methods in psychiatric research, 12(2), 65-76. https://doi.org/https://doi.org/10.1002/mpr.143

Hamada, A. H. (2025). Multilateral Organizations and Health Emergency Management During Crisis: The Case Study of The World Health Organization During Covid-19 Pandemic. https://doi.org/https://fount.aucegypt.edu/etds/2619?utm_source=fount.aucegypt.edu%2Fetds%2F2619&utm_medium=PDF&utm_campaign=PDFCoverPages

Hasan, A., & Alsulami, A. (2024). Mediating role of resilience and its impact on psychological well-being, and mental distress among mental health nurses. SAGE Open Nursing, 10, 23779608231219140. https://doi.org/https://doi.org/10.1177/23779608231219140

Hjemdal, O., Friborg, O., Stiles, T. C., Rosenvinge, J. H., & Martinussen, M. (2006). Resilience predicting psychiatric symptoms: A prospective study of protective factors and their role in adjustment to stressful life events. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 13(3), 194-201. https://doi.org/ https://doi.org/10.1002/cpp.488

Hollaar, M. H., Kemmere, B., Kocken, P. L., & Denktaş, S. (2025). Resilience-based interventions in the public sector workplace: a systematic review. BMC public health, 25(1), 350. https://doi.org/https://doi.org/10.1186/s12889-024-21177-2

Hsu, C.-L., Hung, H.-M., Chen, C.-J., & Lee, H.-F. (2024). Exploring the Relationship of Well-Being and Resilience on Sense of Personal Accomplishment Among Nurse Practitioners: A Cross-Sectional Correlational Study. Journal of Nursing Research, 10.1097. https://doi.org/DOI：10.1097/jnr.0000000000000000707

Huang, Y., Wang, Z., Li, Y., Zhao, Z., Wang, W., Cai, C., Wu, X., Liu, L., & Chen, M. (2025). Anxiety and burnout in infectious disease nurses: the role of perceived stress and resilience. BMC nursing, 24(1), 3. https://doi.org/https://doi.org/10.1186/s12912-024-02649-7

Konagalla, S. V., Azeem, M., Kumaravel, V., Machiraju, V. K., Nguyen, M., Decker, R. A., Pasham, S., Doma, S., Pendyala, R., & Shanmugam, V. (2025). The psychological impact on American healthcare workers during the COVID-19 pandemic: an initial scoping review. Academia Mental Health and Well-Being, 2(1). https://doi.org/https://www.doi.org/10.20935/MHealthWellB7570

Labrague, L. J., Rosales, R. A., Arteche, D. L., Santos, M. C., Calimbas, N. D. L., Yboa, B. C., Sabio, J. B., Quina, C. R., Quino, L. Q., & Apacible, M. A. (2025). Psychological resilience as a mediator between nurse faculty support and student nurses' clinical adjustment: Implications for nursing education. Journal of Professional Nursing, 57, 1-7. https://doi.org/https://doi.org/10.1016/j.profnurs.2024.12.007

Lee, K. E., Zhao, M., Monahan, L., & Huang, Y. (2024). Sociodemographic Disparity Patterns of Perceived Stress and Resilience Among Advanced Registered Nurse Practitioners During the Prolonged COVID-19 Pandemic. The Journal for Nurse Practitioners, 20(6), 105034. https://doi.org/https://doi.org/10.1016/j.nurpra.2024.105034

Liu, X., & Fernando, Y. (2024). Review Theories of Subjective Well-being and the Impact of Stress: The Mediating Effect of Resilience. International Journal of Innovation Research in Education, Technology and Management, 1(1), 33-42. https://doi.org/https://doi.org/10.61098/ijiretm.v1i1.112

Moisoglou, I., Katsiroumpa, A., Malliarou, M., Papathanasiou, I. V., Gallos, P., & Galanis, P. (2024). Social support and resilience are protective factors against COVID-19 pandemic burnout and job burnout among nurses in the post-COVID-19 era. Healthcare, https://doi.org/10.3390/healthcare12070710

Murat, M., Köse, S., & Savaşer, S. (2021). Determination of stress, depression and burnout levels of front‐line nurses during the COVID‐19 pandemic. International journal of mental health nursing, 30(2), 533-543. https://doi.org/https://doi.org/10.1111/inm.12818

Pasha, A., Inusah, A.-H. S., Nayem, J., Li, X., & Qiao, S. (2025). A Systematic Review of Psychological Resilience in the COVID-19 Responses: Current Research and Future Directions. medRxiv, 2025.2002. 2015.25322337. https://doi.org/doi: https://doi.org/10.1101/2025.02.15.25322337

Pedrozo-Pupo, J. C., Pedrozo-Cortés, M. J., & Campo-Arias, A. (2020). Estrés percibido relacionado con la epidemia de COVID-19 en Colombia: una encuesta en línea. Cadernos de Saúde Pública, 36, e00090520. https://doi.org/https://doi.org/10.1590/0102-311X00090520

Rodríguez‐Rey, R., Guerra Corral, M., Collazo‐Castiñeira, P., Collado, S., Caro‐Carretero, R., Cantizano, A., & Garrido‐Hernansaiz, H. (2024). Predictors of mental health in healthcare workers during the COVID‐19 pandemic: The role of experiential avoidance, emotion regulation and resilience. Journal of advanced nursing, 80(10), 4089-4102. https://doi.org/https://doi.org/10.1111/jan.16122

Rogers, M., Windle, A., Wu, L., Taylor, V., & Bale, C. (2024). Advanced Clinical Practitioners’ Resilience and Emotional and Spiritual Well‐Being During COVID‐19. Journal of Nursing Management, 2024(1), 8892903. https://doi.org/https://doi.org/10.1155/jonm/8892903

Sanabria-Delgado, D., Barrientos-Trigo, S., & Porcel-Gálvez, A. M. (2025). Exploring the Long‐Term Impact of Emotional Exhaustion on Frontline Nurse Managers Post‐COVID‐19: A Qualitative Study. Journal of Nursing Management, 2025(1), 9280686. https://doi.org/https://doi.org/10.1155/jonm/9280686

Shaheen, M. K., Eshah, N. F., Suliman, M. M., & Sa’d ALBashtawy, M. (2024). The effect of the COVID-19 pandemic on front-line nurses’ professional quality of life. Nursing Management, 31(6). https://doi.org/doi: 10.7748/nm.2023.e2074

Stephenson, P., & Warner-Stidham, A. (2024). Nurse reports of moral distress during the COVID-19 pandemic. SAGE Open Nursing, 10, 23779608231226095. https://doi.org/https://doi.org/10.1177/23779608231226095

Umbetkulova, S., Kanderzhanova, A., Foster, F., Stolyarova, V., & Cobb-Zygadlo, D. (2024). Mental health changes in healthcare workers during COVID-19 pandemic: A systematic review of longitudinal studies. Evaluation & the health professions, 47(1), 11-20. https://doi.org/https://doi.org/10.1177/01632787231165076

Wong, K. W., Wu, X., & Dong, Y. (2024). Interventions to reduce burnout and improve the mental health of nurses during the COVID‐19 pandemic: A systematic review of randomised controlled trials with meta‐analysis. International journal of mental health nursing, 33(2), 324-343. https://doi.org/https://doi.org/10.1111/inm.13251

Woo, B. F. Y., Ang, W. H. D., Rogers, M., & Zhou, W. (2025). Factors associated with resilience, spiritual and mental well‐being of advanced practice nurses: Implications for role integration. International nursing review, 72(1), e70015. https://doi.org/https://doi.org/10.1111/inr.70015

Chen, Y.Y., Lee, W.L., Tsai, S.H., & Tsai, C.W. (2013). A study on work stress, stress-coping strategies and well-being among hospital nurses. Journal of Meiho University, 32(2), 83-98. (Original work published in Chinese)

Taiwan association of nurse practitioners. (2025). Competence of Nurse Practitioners in Taiwan [Core Competencies]. https://www.tnpa.org.tw/about/core_competencies.php

Wang, S.Y. (2007). Associations of sense of self, resilience, and posttraumatic stress symptoms among burn patients [Master’s thesis, National Taiwan University]. https://doi.org/10.6342/NTU.2007.00229 (Original work published in Chinese)

Lai, P.C. (2012). A study of subjective well-being among nursing students [Master's thesis, Chung-Tai University of Science and Technology]. https://doi.org/10.6822/CTUST.2012.00082 (Original work published in Chinese)

Ditchburn, G., & Koh, R. E. (2024). Workplace pressure, employee stress, mental well-being and resilience in response to COVID-19 in Singapore. Evidence-Based HRM: A Global Forum for Empirical Scholarship, https://doi.org/10.1108/EBHRM-10-2022-0252

Moisoglou, I., Katsiroumpa, A., Malliarou, M., Papathanasiou, I. V., Gallos, P., & Galanis, P. (2024). Social support and resilience are protective factors against COVID-19 pandemic burnout and job burnout among nurses in the post-COVID-19 era. Healthcare, https://doi.org/10.3390/healthcare12070710