# Resilience and sense of agency among healthcare professionals during crisis

## TL;DR

This study shows that psychological traits like resilience and psychological capital are important for healthcare workers' sense of control during crises, more than just their experience.

## Contribution

The study demonstrates that psychological resources predict perceived agency in healthcare professionals during crises, beyond traditional factors like experience.

## Key findings

- Psychological capital and resilience were strongly linked to perceived agency in healthcare professionals during crises.
- Paramedics and EMTs reported higher perceived agency than nurses and physicians.
- Spirituality was found to predict perceived agency among healthcare professionals.

## Abstract

Healthcare professionals (HCPs) are central to emergency response, and their effectiveness depends not only on clinical expertise but also on psychological resources. Strengthening these resources may sustain workforce capacity and safeguard care under crisis conditions. This study examined the contribution of psychological capital—particularly resilience—to perceived agency among Israeli HCPs during mass casualty incidents and violent conflict after 7th of October 2023. The objective was to assess whether psychological resources predict perceived effectiveness beyond traditional factors, with implications for preparedness, organisational support, and policy. Findings may inform interventions relevant to resource-restricted environments and adaptable to developing countries.

The study was designed as an observational-cross-sectional study, conducted using encrypted online questionnaires distributed via QR codes in trauma centres, dispatch stations, and professional forums. Participants were qualified physicians, surgeons, nurses, paramedics, and EMTs providing patient care during the conflict. Instruments measured psychological capital (PCQ-24), resilience (CD-RISC 10), and perceived agency (RSES).

204 HCPs participated (mean age 37.4, SD = 11.6; 61.8% male). Psychological capital (r = 0.387, p < 0.001) and resilience (r = 0.485, p < 0.001) were strongly associated with agency, surpassing prior experience. Paramedics/EMTs reported higher agency than nurses/physicians (p < 0.001). Spirituality also predicted agency (β = 0.142, p = 0.022).

Psychological capital and resilience are key determinants of HCPs’ perceived agency in crises. Embedding resilience-building into public health systems, alongside organisational and policy measures, may enhance workforce readiness across conflict, disaster, and health threats. These findings are especially relevant to resource-limited settings, where psychological preparedness may be a cost-effective means to support frontline staff and sustain delivery.