The Determinants of Emergency Nurses’ Adaptive Performance; A Systematic Review

Abstract

This systematic review synthesizes heterogeneous evidence on determinants, constraints, and proximal capacities associated with emergency nurses’ adaptive performance in high-uncertainty clinical environments. Because direct adaptive-performance instruments remain uncommon in health care, the review distinguishes observable performance from closely aligned adaptive capacities, including resilience and coping, clinical judgment and triage competence, learning and evidence-use behavior, disaster competence, work engagement, and interpersonal or organizational adaptation. A systematic search with PRISMA-guided reporting covered English-language peer-reviewed empirical reports published from 2015 through 2025 and retained 57 eligible reports. Thirteen determinant domains were mapped in an evidence matrix and integrated through structured narrative synthesis. Across designs, evidence converged on a multilevel pattern in which excessive demands, traumatic stress, workplace violence, weak resources, and moral strain were associated with constrained adaptive functioning, whereas organizational support, supportive leadership, team resources, resilience, constructive coping, professional self-belief, training, and clinical competence were associated with greater adaptive capacity. The review integrates adaptive-performance, Job Demands-Resources, Conservation of Resources, and social-cognitive perspectives while distinguishing frequency of investigation from causal importance. Its contribution is to show that emergency-nursing adaptation is studied through fragmented but theoretically connected evidence streams, while direct multidimensional measurement and prospective testing of adaptive-performance pathways remain limited within emergency nursing.