Difficulties and strategies associated with nurse integration in critical care provision: a scoping review

Introduction: The nurses’ integration in specialized care provision to critically ill patients is an increasing concern in the context of hiring and mobilizing nursing professionals. An adequate integration is crucial for the nurses’ success and adaptation to the new service, as well as to ensure the quality and safety of the provided care. Objective: To map the existing knowledge on the difficulties experienced by nurses, as well as on the strategies that facilitate their integration in specialized care provision to the critically ill. Method: A scoping review was conducted, following the method proposed in the Joanna Briggs Institute Reviewers’ Manual 2015. The following were used as inclusion criteria: Population - nurses; Concept - the experienced difficulties and the strategies employed to facilitate the nurses’ integration; Context - the provision of care to the critically ill. A total of 13 articles, published until May 2020, were included. Results: The following difficulties were reported: communication issues with the team, as well as with the patients and/or their relatives; overall stress; dealing with complex health conditions, as well as with intricate procedures and/or techniques; work overload; high staff turnover rate between services; dealing with a patient’s death and/or with organ donation planning. The following were pointed out as facilitating strategies: simulated practice; performing teamwork; assignment of a nursing supervisor/tutor; receiving feedback; developing resilience mechanisms. Conclusion: As regards care provision, the nurses’ integration process requires planning and the inclusion of facilitating strategies is crucial. Simulated practice leads to the acquisition of fundamental skills, as does the assignment of a nursing supervisor/tutor and receiving feedback on the conducted tasks. In addition to overcoming the difficulties experienced, these strategies also allow developing resilience and coping mechanisms, which help prevent burnout and the adverse effects caused by the high staff turnover rate between services.