Author(s)

Rose E. Constantino¹, Betty J. Braxter², Chi Ching Vivian Hui^3,4, Larissa C. Allen⁵, Lillian J. Wolfe⁵, Katherine H. Endres⁵, Jezyl Cempron Cutamora⁷, Laurence L. Garcia⁷, Daisy R. Palompon⁷, Kathleen Thimsen⁸, Brayden N. Kameg⁹, Margarete L. Zalon¹⁰

¹Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
²Undergraduate Affairs, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
³The Hong Kong Polytechnic University, Hong Kong, China.
⁴School of Nursing, Adjunct Faculty at the University of Pittsburgh, Pittsburgh, PA, USA.
⁵School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
⁶Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
⁷College of Nursing, Cebu Normal University, Cebu City, Philippines.
⁸School of Nursing, University of Nevada, Las Vegas, USA.
⁹Department of Health and Community Systems, University of Pittsburgh, PA, USA.
¹⁰Department of Nursing, University of Scranton, Scranton, PA, USA.

There are five vital signs that healthcare providers assess: temperature, pulse, respiration, blood pressure, and pain. Normal levels for the five vital signs are published by the American Heart Association, and other specialty organizations, however, the sixth vital sign (resilience) which adopts the measure of immune resilience is suggested in this paper. Resilience is the ability of the immune system to respond to attacks and defend effectively against infections and inflammatory stressors, and psychological resilience is the capacity to resist, adapt, recover, thrive, and grow from a challenge or a stressor. Individuals with better optimal immune resilience had better health outcomes than those with minimal immune resilience. The purpose of this paper is to conceptualize, contextualize, and operationalize all six vital signs. We suggest measuring resilience subjectively and objectively. Subjectively, use a 5-item guided interview revised from the Connor-Davidson Resilience Scale (CDRC), a scale of 10 items. The revised CDRC scale is a 5-item scale. The scale is rated on a 5-point Likert scale from 0 (not true) to 4 (true all the time). The total score ranges from 0 to 20, with higher total scores indicating greater resilience. The scale demonstrated good construct validity and internal consistency (α = 0.85) during the development of the scale. The CD-RISC had a good Cronbach’s alpha level of 0.85. The Revised CD-RISC can be completed in 2 - 4 minutes. To measure resilience objectively, we suggest using Immune Resilience (IR) levels, the level of resilience to preserve and/or rapidly restore immune resilience functions that promote disease resistance and control inflammation and other inflammatory stress. IR levels are gauged with two peripheral blood metrics that quantify the balance between CD8 and CD4 T-cell levels and gene expression signatures tracking longevity-associated immunocompetence and mortality- or entropy-associated inflammation. IR deregulation is potentially reversible by decreasing inflammatory stress. IR metrics and mechanisms have utility as vital signs and biomarkers for measuring immune health and improving health outcomes.

Conceptualization, Contextualization, Operationalization, Body Temperature, Pulse, Respiration, Blood Pressure, Pain, Resilience

Constantino, R.E., Braxter, B.J., Hui, C.C.V., Allen, L.C., Wolfe, L.J., Endres, K.H., Cutamora, J.C., Garcia, L.L., Palompon, D.R., Thimsen, K., Kameg, B.N. and Zalon, M.L. (2024) Resilience, the 6^th Vital Sign: Conceptualizing, Contextualizing, and Operationalizing All Six Vital Signs. Health, 16, 657-673. doi: 10.4236/health.2024.167046.