Cuaderno de enfermería. Revista científica
Vol. 3(1), 8-14, 2025
https://doi.org/10.62574/f1fak931
8
Challenges in the clinical practice of intensive care nursing. Systematic review
Retos en la práctica clínica de cuidados intensivos en enfermería. Revisión
sistemática
Erika Marcela León-Revelo
ut.erikalr78@uniandes.edu.ec
Universidad Regional Autónoma de los Andes, Tulcán, Carchi Ecuador
https://orcid.org/0000-0003-2050-0857
ABSTRACT
Objective: to analyse the challenges in clinical intensive care nursing practice through a systematic
review. Method: systematic review, population of 15 articles. Conclusion: the analysis of the main
challenges in clinical intensive care nursing practice highlights critical issues that affect both the
quality of care and the well-being of staff. Among the most relevant are work overload, burnout
syndrome and the omission of essential care, problems that derive from the high complexity of the
environment and the insufficiency of resources. Likewise, frequent complications such as delirium
and acquired weakness in the ICU require evidence-based interventions and greater staff training.
Descriptors: intensive care units; intensive care units neonatal; critical illness. (DeCS).
RESUMEN
Objetivo: analizar los retos en la práctica clínica de cuidados intensivos en enfermería desde una
revisión sistemática. Método: revisión sistemática, población de 15 articulos. Conclusión: El análisis
de los principales retos en la práctica clínica de cuidados intensivos en enfermería evidencia desafíos
críticos que afectan tanto la calidad del cuidado como el bienestar del personal. Entre los más
relevantes se encuentran la sobrecarga laboral, el síndrome de burnout y la omisión de cuidados
esenciales, problemas que derivan de la alta complejidad del entorno y la insuficiencia de recursos.
Asimismo, complicaciones frecuentes como el delirium y la debilidad adquirida en la UCI requieren
intervenciones basadas en evidencia y una mayor capacitación del personal.
Descriptores: unidades de cuidados intensivos; unidades de cuidado intensivo neonatal;
enfermedad crítica. (DeCS).
Received: 19/12/2024. Reviewed: 08/01/2025. Approved: 26/01/2025. Published: 01/02/2025.
Original brief
Cuaderno de enfermería. Revista científica
Vol. 3(1), 8-14, 2025
Retos en la práctica clínica de cuidados intensivos en enfermería. Revisión
sistemática
Challenges in the clinical practice of intensive care nursing. Systematic review
Erika Marcela León-Revelo
9
INTRODUCTION
Nursing in intensive care units (ICUs) faces complex challenges arising from the high
criticality of the patients and the demands inherent to the clinical environment.
Nursing professionals play an essential role in the comprehensive care of critical
patients, taking on responsibilities that include the prevention of complications such
as delirium and ICU-acquired weakness, the implementation of specialised care and
the management of safe transitions between the ICU and other hospital units
(1,2,3,5).
However, these functions are conditioned by factors such as work overload,
insufficient resources and the need for continuous training, which can lead to
problems such as burnout syndrome, job dissatisfaction and the omission of
essential care (1,12,15). Therefore, the complexity of care in the ICU not only
requires advanced technical skills, but also emotional and ethical competencies to
address the needs of patients and their families, which increases the pressure on
nursing staff (4,7).
The objective is to analyse the challenges in the clinical practice of intensive care
nursing from a systematic review.
METHOD
This work was carried out using a systematic review methodology, analysing 15
scientific articles following the guidelines established by the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.
The search was carried out in recognised scientific databases, such as PubMed,
Scopus, CINAHL and Web of Science, using MeSH terms and keywords related to
‘intensive care nursing’, ‘challenges in clinical practice’, ‘burnout’, ‘delirium’, ‘ICU-
acquired weakness’, ‘omission of care’ and ‘intervention strategies’. Filters were
applied to limit the results to studies published in English and Spanish between
January 2020 and October 2024.
Cuaderno de enfermería. Revista científica
Vol. 3(1), 8-14, 2025
Retos en la práctica clínica de cuidados intensivos en enfermería. Revisión
sistemática
Challenges in the clinical practice of intensive care nursing. Systematic review
Erika Marcela León-Revelo
10
RESULTS
Clinical practice in intensive care nursing faces numerous challenges that affect both
the quality of care provided to patients and the well-being of nursing staff. One of the
main problems is burnout syndrome and job dissatisfaction among nurses working
in intensive care units (ICUs). According to Quesada-Puga et al. (1), these conditions
not only affect the mental health of professionals, but also have an impact on the
quality of care received by patients. For this reason, it is essential to implement
strategies that reduce work-related stress and promote a healthier and more
satisfying work environment.
Another important challenge is the management of delirium in critically ill patients.
Gómez Tovar & Henao Castaño (2) comment that nursing interventions can be
effective in reducing this condition, but they warn that the lack of standardised
protocols and the variability in staff training make its application difficult. Likewise,
Alcaraz & Ángeles Saz Roy (13) mention that adequate management of delirium
begins with an accurate assessment, which highlights the need for accessible and
reliable diagnostic tools for nursing staff.
Weakness acquired in the ICU is another problem that requires attention. Xu et al.
(3) explain that this complication, which affects patient recovery, demands a
multidisciplinary approach and greater training of nursing staff to prevent it.
Evidence-based interventions are essential to address this problem and improve
clinical outcomes. On the other hand, the complexity of care in the ICU is also
associated with an increased risk of adverse events, especially during patient
transitions to other hospital units. According to Güven et al. (5), improving
communication and ensuring continuity of care are key aspects in reducing these
risks. In this sense, excessive workload also plays an important role. Stojakovic et
al. (12) and Vincelette et al. (15) point out that this overload contributes to the
omission of essential care in the ICU, while the validation of tools such as the ICU-
ONC instrument can be useful for identifying areas for improvement and optimising
Cuaderno de enfermería. Revista científica
Vol. 3(1), 8-14, 2025
Retos en la práctica clínica de cuidados intensivos en enfermería. Revisión
sistemática
Challenges in the clinical practice of intensive care nursing. Systematic review
Erika Marcela León-Revelo
11
the allocation of resources.
Specific interventions and continuous education are fundamental to improving
clinical practice. Li et al. (8) highlight the effectiveness of the anchored instruction
method in training nursing staff in cardiac surgery intensive care units, while Zhang
et al. (9) demonstrate that cluster care is effective in preventing complications such
as pressure ulcers. However, the implementation of these strategies requires
institutional commitment and constant staff training.
The emotional and ethical aspects of care also represent a significant challenge.
Piredda et al. (4) explore the experiences of nurses caring for highly dependent
patients, highlighting the ethical dilemmas and emotional burden they face. In this
sense, it is important to create spaces for emotional support and ethical reflection
for nursing staff, in this order, Yan et al. (11) analyse the care of patients with
neurodegenerative diseases, such as Alzheimer's, in the ICU, which adds a layer of
complexity to care due to the specific needs of these patients.
Innovations in clinical practice have also proven to be effective tools for improving
outcomes, while Bosco et al. (7) highlight the use of diaries written by nurses as a
strategy for improving the patient experience and facilitating communication with
their families. For their part, Wenger et al. (14) present a protocol based on pain
management, breathing and coughing, which has been shown to reduce unplanned
admissions in patients with traumatic rib fractures. These innovative practices must
be promoted and adapted to different contexts to maximise their impact.
Finally, workload and documentation in the ICU also represent a significant
challenge. Choi et al. (10) developed a mapping table for nursing notes based on
the concerns of professionals, which could facilitate documentation and improve the
efficiency of care. Likewise, Altimier (6) emphasises the importance of clinical
concepts in neonatal nursing, an area that also faces specific challenges within
intensive care units.
Cuaderno de enfermería. Revista científica
Vol. 3(1), 8-14, 2025
Retos en la práctica clínica de cuidados intensivos en enfermería. Revisión
sistemática
Challenges in the clinical practice of intensive care nursing. Systematic review
Erika Marcela León-Revelo
12
CONCLUSION
An analysis of the main challenges in the clinical practice of intensive care nursing
reveals critical issues that affect both the quality of care and the well-being of staff.
Among the most relevant are work overload, burnout syndrome and the omission of
essential care, problems that stem from the high complexity of the environment and
insufficient resources. Likewise, frequent complications such as delirium and
acquired weakness in the ICU require evidence-based interventions and greater staff
training. Insecure transitions between the ICU and other hospital units, together with
the lack of standardised protocols, increase the risk of adverse events, which
highlights the need to improve continuity of care.
FINANCING
Non-monetary
CONFLICT OF INTEREST
There is no conflict of interest with people or institutions linked to the research.
ACKNOWLEDGEMENTS
To the UNIANDES research department.
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Cuaderno de enfermería. Revista científica
Vol. 3(1), 8-14, 2025
Retos en la práctica clínica de cuidados intensivos en enfermería. Revisión
sistemática
Challenges in the clinical practice of intensive care nursing. Systematic review
Erika Marcela León-Revelo
13
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Cuaderno de enfermería. Revista científica
Vol. 3(1), 8-14, 2025
Retos en la práctica clínica de cuidados intensivos en enfermería. Revisión
sistemática
Challenges in the clinical practice of intensive care nursing. Systematic review
Erika Marcela León-Revelo
14
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