Resilience-Building Interventions and Advanced Life Support Competency for Emergency Nurses in Palestinian Hospitals: A Scoping Review

ABSTRACT Background: Emergency nurses in Palestinian hospitals practice within a uniquely challenging healthcare environment characterized by geopolitical instability, resource limitations, and high trauma exposure. These conditions create chronic stress that impacts both psychological well-being and clinical performance. The interplay between psychological resilience and Advanced Life Support (ALS) competency represents a critical but understudied factor in ensuring quality emergency care in this context. Objective: This scoping review aimed to systematically map the available literature regarding resilience and ALS competency among emergency nurses in Palestinian hospitals. It sought to describe the evidence on psychological well-being and clinical performance, catalog any existing interventions, examine reported relationships between these domains, and identify critical knowledge gaps. Methods: Following PRISMA-ScR guidelines, we conducted comprehensive searches across seven electronic databases and grey literature sources from January 2000 to November 2025. Two independent reviewers screened titles/abstracts and full texts using pre-defined inclusion criteria. Data were extracted using a standardized form and synthesized narratively. Results: From 1,292 identified records, 18 studies met inclusion criteria. The evidence base was overwhelmingly descriptive (94.4% of studies): studies revealed high burnout prevalence (64-72.9%) with geographic variations and significant ALS competency gaps (e.g., 26.6% correct on resuscitation sequence). Only one intervention study was identified: simulation-based training demonstrated effectiveness for improving BLS competency. Critically, no resilience-focused interventions were found among Palestinian emergency nurses, and no studies directly examined the relationship between resilience-focused interventions and ALS competency outcomes. Conclusion: While both burnout and competency gaps are well-documented among Palestinian emergency nurses, the current literature is dominated by assessment studies. The near-complete absence of intervention research, particularly resilience-focused interventions, represents a critical research gap with urgent implications for practice and policy. Future research should prioritize developing and testing integrated interventions addressing both psychological well-being and clinical competency in this vulnerable population.