title: Facilitators and barriers to adjustment of international nurses: an integrative review.
abstract: BACKGROUND
  There is a scarcity of research focusing on issues encountered by international nurses (INs) in their adjustment to foreign health-care environments. Increasingly, INs are relied upon to address staffing shortages in many Western countries. As such, it is vital to identify what facilitates and what the barriers are to the successful adjustment in order to assist their integration into new workplace environments.
  
  
  OBJECTIVE
  This integrative review identifies facilitators and barriers encountered by INs as they adjust to foreign health-care environments.
  
  
  METHODS
  Based on Cooper's Five Stages of Integrative Research Review, a systematic search of eight electronic databases was conducted, combined with hand and ancestral searches. Two authors independently reviewed each qualified study for relevance and significance. Subsequently, facilitators and barriers were identified and categorized into themes and subthemes.
  
  
  RESULTS
  Twenty-nine studies conducted in Australia, Canada, Iceland, UK and the USA were included in this review. Findings indicated that positive work ethic, persistence, psychosocial and logistical support, learning to be assertive and continuous learning facilitated the adjustment of INs to their new workplace environments. In contrast, language and communication difficulties, differences in culture-based lifeways, lack of support, inadequate orientation, differences in nursing practice and inequality were barriers.
  
  
  CONCLUSIONS
  The review findings provide the basis for the development and testing of an evidence-informed programme to facilitate the successful adjustment of INs to their new work environments.
authors: Department of Physiological Nursing, School of Nursing, University of Nevada, Las Vegas, NV 89154-3018, USA. jennifer.kawi@unlv.edu
authors: J
authors: J
authors: Kawi
authors: Y
authors: Y
authors: Xu
mesh_terms: D000223:Adaptation, Psychological; D001242:Assertiveness; D001291:Attitude of Health Personnel / Q000208:ethnology*; D002322:Career Mobility; D003144:Communication Barriers; D018864:Cultural Diversity; D004509:Education, Nursing, Continuing; D054242:Emigrants and Immigrants / Q000193:education / Q000523:psychology*; D005551:Foreign Professional Personnel / Q000193:education / Q000523:psychology*; D006272:Health Facility Environment / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000523:psychology*; D015279:Organizational Culture; D012107:Research Design; D012917:Social Adjustment; D012944:Social Support; D017132:Workplace / Q000458:organization & administration / Q000523:psychology