Mental health challenges faced by foreign nurses: a scoping review

• Date: 15 November 2024
• Pages: 657-681
• DOI: https://doi.org/10.1108/IJMHSC-03-2024-0036
• Published date: 15 November 2024
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations,Labour movements
• Author: Ferry Efendi,Setho Hadisuyatmana,Gulzar Malik,Wawan Febri Ramdani,Eka Mishbahatul Mar’ah Has,Erfina Erfina,Mamnuah Mamnuah

Mental health challenges faced by foreign

nurses: a scoping review

Ferry Efendi, Setho Hadisuyatmana, Gulzar Malik, Wawan Febri Ramdani,

Eka Mishbahatul Mar’ah Has, Erfina Erfina and Mamnuah Mamnuah

Abstract

Purpose –Foreign nurses encounter various challenges that impact their mental health, but there is a

lack of comprehensiveevidence on these difficulties and thestrategies to address them. This study aims

to synthesize the available evidence to identify these challenges and the strategies to support foreign

nurses.

Design/methodology/approach –A scoping review frameworkwas used with an exploration of seven

databases (CINAHL,Embase, MEDLINE, PsycINFO, Webof Science, PubMed and ProQuest Central)to

search for primary studies. Quantitative, qualitative and mixed-methods research were considered for

inclusion,with manual searches of reference lists forpotential additions. Studies publishedbetween 2013

and September2023, and written in Englishwere considered for inclusion.

Findings –About 22 of 1,077 identifiedstudies were finally included in this review. Three distinct themes

were identified as contributors to the nurses’ mental health challenges, and one theme emerged to

highlight strategies to overcome the challenges. These contributors included the influences of diverse

cultures, dynamics within the work environment, language barriers, separation from family and friends,

heavy workloads and pressures, disparities in health-care systems and experiences of discrimination.

Strategies identified to overcome the challenges were at individual, organizational and policy levels to

supportforeign nurses in navigating and mitigating stressors.

Originality/value –This study highlights the importance of targeted interventions to assist foreignnurses in

overcoming challenges that may affect their mental health and well-being. Moreover, strategic interventions

are crucial to support them in addressing the barriers they faced.

Keywords International migration, Internationally educated nurses, Mental health, Migrant nurses,

Well-being, Coping strategies, Resilience

Paper type Literature review

Introduction

Mental health is a pivotal aspect of overall well-being, and its significance is particularly

pronounced for health-care workers (Søvold et al.,2021). Nurses, in particular, face

significant levels of stress and emotional demands that impact their work performanceand,

further, psychological well-being (Babapour et al.,2022). During the COVID-19 pandemic,

nurses faced challenges unlike any experienced in previous years (Efendi et al.,2022).

Complex job demands, high expectations and emotional involvement in patient care

exacerbated their mental well-being (Babapour et al.,2022;Dartey et al.,2023). Multiple

studies indicate that job-associated stress is leading cause of mental distress, depleted

concentration, job dissatisfaction and decreased professional satisfaction (Galanis et al.,

2024;Labrague et al., 2020;Unaldi Baydin et al.,2020). The emotional nature of nursing,

coupled with workplace stress, can harm nurses’physical and emotional health, diminishing

their work performance and overallquality-of-life (Babapour et al., 2022;Koinis et al., 2015).

Earlier evidence indicates that foreign nurses were among the most prone to job-related

stress. The German Aging Survey (Deutscher Alterssurvey/DEAS) identified that more than

(Informationabout the

authorscan be found at the

end of this article.)

Received 24 March 2024

Revised 24 July 2024

Accepted 10 September 2024

DOI 10.1108/IJMHSC-03-2024-0036 VOL. 20 NO. 4 2024, pp. 657-681, ©Emerald Publishing Limited, ISSN 1747-9894 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTHAND SOCIAL CARE jPAGE 657

33% of foreign workers reported mild depressive symptoms compared to 26% of

nonforeign workers (Klaus and Baykara-Krumme, 2017). Another study indicates that

migrant nurses with Filipino backgrounds faced multiple challenges that made them

vulnerable to stress (Connor, 2016). They feel unwelcome and face bullying from other

nurses. Relationships with coworkers of the same cultural background either positively or

negatively impacted their work environment. Moreover, misunderstandings due to cultural

differences lead to conflicts and exacerbated stress (Connor and Miller, 2014). A

metaanalysis identified that foreignnurses are at a higher risk of experiencing mental health

issues such as, depression and anxiety, due to discrimination, communication challenges

and poor working conditions (Hasan et al., 2021). An earlier systematic review further

confirms that hat foreign nurses are at a higher risk of work-related injuries and

discrimination than their local counterparts (Schilgen et al.,2017).

However, the global demand for nurses remains on the rise, with estimates indicating a

need for approximately 13 million nurses by the year 2030 (WHO, 2020). To meet this

demand, importing internationally educated nurses (IEN) has become a common strategy

adopted by numerous countries to meet their domestic health demands (Pradipta et al.,

2023;Smith et al., 2022;Tsujita and Oda, 2023). According to Organisation for Economic

Co-operation and Development Indicators, in 2019, New Zealand, Switzerland, Australia

and the UK were among the countries supported by at least 20% of foreign nurses (OECD,

2021). Nurse migration inevitably benefits both the origin and receiving countries,

encompassing opportunities for personal and professional growth, enhancing household

income and supporting the health of the communities they serve (Pradipta et al., 2023;

Pressley et al., 2022). Despite these benefits, it is imperative to give sufficient attention to

the migrant nurses’ mental health and well-being.

In light of the global migration ofnurses, there is a need for a comprehensive understanding

of the challenges these nurses face and the strategies undertaken to overcome the

psychological challenges. The present review was undertaken to provide in depth insight

into the landscape of mentalhealth challenges faced by foreign qualified nurses withan aim

to draw conclusions that may contribute to the development of effective support

mechanisms in the health-care systems of host countries. Therefore, this scoping review

mapped the existing literature onthe mental health challenges faced by IENs and identified

the strategies and interventions that have been proposed or implemented to support their

mental health in host countries.

Methods

Design

This scoping review summarized evidencefrom peer reviewed articles reporting incidences

of psychological challenges faced and the strategies adopted by nurses who worked as

expatriates and lived as diasporas. The stepwise process of this review was informed by

Arksey and O’Malley (Arksey and O’Malley,2005), specifically:

䊏identifying the research question;

䊏determining the relevant studies;

䊏selecting studies for inclusion;

䊏charting the data; and

䊏collating, summarizing and reporting the study results.

The search results were documented and reported in a flow diagramfollowing the preferred

reporting items of systematic review and meta-analyses for scoping reviews (PRISMA-ScR)

checklist (Page et al.,2021).

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