A resilience framework for nurse managers: insights from appreciative inquiry in private healthcare

Nurse managers in the South African private healthcare sector lead complex clinical and operational services while responding to workforce, organisational and patient-care demands, highlighting the need for contextually relevant approaches to support resilience in nursing leadership. This study aimed to operationalise, evaluate and refine a preliminary resilience framework for nurse managers through a participatory Appreciative Inquiry process, generating an evidence-informed, contextually grounded framework that can be used in initiatives to strengthen leadership capacity and promote sustainable workforce wellbeing. A participatory qualitative research design, guided by Appreciative Inquiry, was employed with 18 nurse managers working in South African private healthcare facilities. The preliminary framework was operationalised through the Discovery, Dream and Design phases using online group sessions that facilitated collaborative reflection, contextual adaptation and co-construction. The Destiny phase evaluated the refined framework in relation to acceptability and feasibility. Data were analysed using thematic analysis, with findings informing contextual refinement of the framework. Participants understood resilience as a multidimensional and relational leadership capacity shaped by personal strengths, organisational support and culture, and social support networks. The Appreciative Inquiry process refined the preliminary framework by translating these interconnected dimensions into contextually relevant strategies for nurse manager practice. The refined framework retained its ecological orientation while providing greater practical specificity for the South African private healthcare context. Nurse managers evaluated the framework positively, with a mean overall evaluation score of 4.61, indicating high perceived acceptability and feasibility. Qualitative feedback indicated that the framework was relevant, practical and suitable for integration into leadership-development and organisational support initiatives. The study provided a basis for operationalising, evaluating and contextually refining a resilience framework for nurse managers through a participatory approach. Findings indicate that nurse manager resilience is an interconnected construct in which individual resources are influenced by organisational environments and professional relationships. Appreciative Inquiry facilitated collaborative reflection and contextual adaptation, contributing to a strengths-based framework perceived as acceptable and feasible for practice. However, the study represents framework refinement rather than validation; further implementation and outcome-based research is required to evaluate its applicability, effectiveness and longer-term contribution to nurse manager resilience.