Table 2.

Main information of articles about care stress of nurses.

Author (year)	Study type	Place of study	Sample size	Scale	Mean age or Age range	Main findings
Happell, Dwyer (13)	Qualitative exploratory	Australia	38	Interview	Not reported	High workloads, unavailability of doctors, unsupportive management, human resource issues (incorrect payments), interpersonal issues (bullying, communication problems and conflict between nurses), Relatives of patients, shift work, car parking, handover procedures, no common area for nurses, mental health issues were common cause of stress in nurses. Also, workload modification, leadership within the ward, changing shift hours, ensuring nurses get breaks, music in wards, organizational development, massage therapists on the wards are the main ways of stress management.
Cavalheiro, Moura Junior (9)	Cross-sectional	Brazil	75	Researcher made	23 to 47 years	There was no relationship between working shifts and marital status with stress. But direct relation was founded between individual differences, situations at work, and changes in sleep and wake with stress.
Hamaideh and Ammouri (33)	Cross-sectional	Jordan	464	Nursing stress scale	25 to 44 years	Inadequate preparation, lack of support, uncertainty concerning treatment, conflict with other nurses, conflict with other physicians were identified as stressors for nurses. Also, death and dying and workload are the common cause of stress among all groups of nurses.
Hosseini Moghaddam, Mohebbi (14)	Qualitative content analysis	Iran	16	Interview	25 to 48 years	Concern over transmitting the infection to one’s family, fear of the unknown aspects of the disease, concern over making wrong decisions, families’ insistence on quitting one’s job, working in difficult conditions, lack of personal protective equipment, feeling rejected by the personnel were the main causes of stress. Effective communication skills, experiencing personal-professional growth (improved learning), perception of positive feelings at the end of a crisis were the main ways of stress management.
Li, Liu (12)	Exploratory study	Taiwan	792	Nurse Stress Checklist	17 to 46 years	The most frequent areas associated with stress were: the participant cannot finish what s/he wants to do in terms of nursing work, the participant has limited time to complete his/her tasks properly, the participant needs time to interact with family and friends. In addition, caring behavior was significantly and negatively associated with stress.
Vahedian-Azimi, Hajiesmaeili (34)	Cross-sectional	Iran	100	Stressful Situations Instrument	29.4 years	levels of collaboration, working with a supervisor on the unit, and nurse–patient ratios were all positively associated with greater stress levels.
Harvey and Tapp (35)	Qualitative	Canada	9	Interview	34–58 years	Moral distress (stopping resuscitation), the unspoken ‘Unwritten rules’ of the ICU (conceal emotions about patients for not being judged), tampering with the human connection (the restrained emotions that may be experienced in autopilot may compromise the human connection and expert practice that are necessary in the care of the critically ill) were main reasons of stress. Also, relating and connecting, transformation as an altered professional identity (the change in ‘how I nursed) can support them.
Ibrahim, Isa (36)	Cross-sectional	Brunei	113	Spiritual Coping Questionnaire	30–39 years	Religious activities such as finding relief in prayer, focus on higher power, and feel the presence of God in everyday life was the main supportive action for preventing stress. Achieve inner peace, positive thinking, and selfcare were personal factors of stress management.
Pan, Wang (37)	Qualitative	China	33	Interview	28.33 years	Concern about occupational exposure (risk of contracting HIV infection), heavy workload, patients’ mental health problems and aggressive behaviors, and perceived discrimination from families and colleagues. Positive coping (using personality strengths, using problem-solving skills, seeking help), and negative coping (concealing work place, avoiding/suppression emotions) were the main ways of stress management.
Vioulac, Aubree (38)	Qualitative	France	23	Interview	40.9 years	Time management in providing care, role of emergencies and nurses’ experience, high technicality of specific HD treatment were related with stress of nurses.
Callaghan, Tak‐Ying (39)	Cross-sectional	China	500	Anxiety Stress Questionnaire	22 to 44 years	Nursing issues (work overload, dealing with emergencies, responsibilities inherent in job), interpersonal relationships (dealing with patients and relatives, relationships with colleagues, dealing with ward managers and supervisors), hospital administration (inadequate staff and overcrowded ward), duty issues (working night duty and working overtime), ward/clinic management issues (unsupportive seniors and frequent changes of departmental policy), promotion and career development issues (poor prospect for promotion, and taking part in staff development reviews), doctor-related (dealing with doctors, ward rounds, poor attitude of doctors) were the main factors of stress.
Okunogbe, Meredith (40)	Cross-sectional	USA	272	Checklist	26 to 45 years	Proportion of high-risk patients, provider satisfaction with help received, care coordination time were the main factors related to stress.
Siqueira, Teixeira (41)	Qualitative	Brazil	20	Interview	33 to 54 years	Empathy and projection of the other’s disease itself, causing sadness, and the absence of the other, due to illness, which generates work overload, that is, we have physical and psychic influences. The working conditions include physical, chemical and biological issues of the work organization, as well as aspects related to the health and safety of the professional.
Kowalczuk, Shpakou (42)	Cross-sectional	Poland	284	Mini-Cope inventory	Not reported	Active strategies (active coping, planning, positive reframing, acceptance, humor, religion, use of emotional support, use of instrumental support, self-distraction, denial, and venting), and avoidance strategies (substance use, behavioral disengagement, and self-blame) were stress management strategies.
Huang and Yu (6)	Cross-sectional	Taiwan	–	Researcher made	Not reported	Patient care (limitations for patients in ICU, workload, unfamiliarity with infectious diseases, inconsistency in operating standards, and not familiar with the samples), infection protection, and support system are the main reasons of stress. *
Shim and Jeong (43)	Cross-sectional	South Korea	178	Psychosocial Well-Being Index Short Form	41.68 years	Educational history and past experiences were the main factors that related with stress.
Beng, Chin (44)	Qualitative	Malaysia	20	Interview	30-40 years	Organizational challenges, care overload, communication challenges, differences in opinion, misperceptions and misconceptions, personal expectations, emotional involvement, death and dying thoughts, and appraisal and coping were the sources of stress. *
Rouhbakhsh, Badrfam (45)	Qualitative	Iran	20	Interview	35.5 years	The inconsistency in medical information, the obscurity of the disease, the likelihood of transmission to the family, unforeseen exposure to infectious droplets, the likelihood of getting infected, being shocked in the early days, resource allocation were the main reasons of stress. Also, visiting patients who have recovered, paying attention to the positive aspects of covid-19, hoping not to get infected, self- reassurance due to personal care, reducing the stress by observing the downward trend of the disease were protective factors against stress.
Garcia and Marziale (46)	Cross-sectional	Brazil	122	Researcher made	25 to 66 years	Lack of organizational information, insufficient time due to work overload, lack of clarity in the distribution of tasks and ineffectiveness in interpersonal communication were the main reasons of stress.
Lipp and Fothergill (47)	Qualitative	UK	12	Interview	Not reported	Decision to undergo an abortion (nurse must facilitate but not unduly influence the decision in the face of her own views), procedure, medical abortion, suspending judgement (being non-judgmental is a probable stressor), moral distress were the main reasons of stress. Also, personal approaches included personal qualities, being able to relax, having confidence and belief in one’s own abilities, having a sense of humor, and social support were effective ways to cope with stress.
Schoombee, van der Merwe (48)	Qualitative	South Africa	8	Interview	Not reported	Nurses’ roles as caregivers within the context of the hospital, work environment (high workload, and lack of resources), resistant patients (don’t obey), hospital hierarchies (staffs and patients), aggressive feelings, thoughts and actions between nurse and patient.
Hajiseyedrezaei, Alaee (49)	Cross-sectional	Iran	235	Expanded Nursing Stress Scale	Not reported	Difficulties in relationship between co-workers and nurse managers, death and dying, uncertainties about effectiveness of treatments, patients and their families, emotional unpreparedness were the most common reasons of stress among nurses.