Chart 3.

Summary of included studies after database search, Rio de Janeiro, Brazil, 2023

Year of publication Country	Study design	Summary of results
2000 Brazil14	Quali-quantitative	Psychosocial factors were analyzed based on the most valued quality-of-life aspects, with a positive evaluation, though differences were observed between two nursing teams.
2002 Brazil15	Qualitative	From the perspective of social representations, various psychological defense mechanisms are used individually to cope with patient pain, suffering, and death.
2009 Brazil16	Qualitative	Workloads within the institution cause physical and mental strain, leading to alienation regarding quality of work life. This results in emotional conflicts, stress, and physical pain. Workers feel discouraged or incapable of providing quality care, leading to psychological distress.
2009 Brazil17	Quantitative	Nursing is considered one of the most stressful hospital professions due to the complexity of tasks requiring high attention and dedication. An individualized approach to prevent burnout is suggested, considering each professional’s perception of stressors in their work environment.
2010 Brazil18	Literature review	Predisposing factors for stress include work overload, role conflicts, devaluation, and working conditions. Symptoms include tachycardia, loss of appetite, chills, anxiety, and joint pain.
2011 Portugal19	Quantitative	Men, a minority in the study group, perceived higher levels of psychosocial risks. Individuals over 50 years old, those who were married or in a partnership, reported a greater perception of health risks. Working in hospitals was associated with a higher risk of job dissatisfaction related to social and family support. Strong social support was linked to a lower perception of risks, while self-concept played a role in reducing risks related to personal values and both physical and psychological health.
2011 Brazil20	Quantitative	Critical levels of factors contributing to feelings of pleasure, professional fulfillment, and freedom of expression were identified. At the same time, factors causing distress, professional burnout, and lack of recognition were also found at critical levels among nurses and nursing technicians.
2012 Brazil21	Qualitative	Key findings, analyzed through content analysis, include low work recognition, intensified workload leading to overload, ethical dilemmas between personal values and professional demands, institutional rigidity, and distress related to patient deaths.
2013 Brazil22	Literature review	Few studies were found on stressors and preventive measures for stress, highlighting a gap in essential care for promoting worker health.
2013 Brazil23	Qualitative	Nurse residents in specialized hospital units are exposed to numerous psychosocial risk factors, including physical and mental workload, intensified work pace, role ambiguity, interpersonal conflicts, low autonomy, limited control, and precarious working conditions. The health impacts on residents were identified through complaints of fatigue, stress, and exhaustion.
2013 Brazil24	Quantitative	Key issues identified included low work recognition and support, work overload, night shifts (causing sleep disturbances), difficulties in relationships with supervisors, ethical dilemmas between personal values and professional responsibilities, institutional rigidity, and challenges in coping with patient deaths. Coping strategies observed among workers included denial, trivialization of suffering, rationalization, and avoidance.
2014 Brazil25	Quantitative	Low intellectual discernment, weak social support, and experiencing either highly demanding or passive work were identified as the main risk factors for impairments in the physical domain of quality of life.
2014 Brazil26	Qualitative	Workloads within the institution were found to cause physical and mental exhaustion, leading to emotional conflicts and health repercussions, such as stress and bodily pain.
2014 Brazil27	Quantitative	Regarding pleasurable factors, freedom of expression received a satisfactory evaluation, while professional fulfillment was assessed critically. For distress factors, professional burnout was critically evaluated, whereas lack of recognition was considered satisfactory.
2015 Chile5	Quantitative	ICU nurses perceive psychosocial factors and mental workload across multiple dimensions of their work.
2015 Brazil28	Quantitative	The prevalence of burnout syndrome was 55.3% (n = 72), while 27.7% of cases were suspected common mental disorders. Among these, 80.6% were associated with burnout (p < 0.0001). Income and thinking about work during time off were identified as protective factors against burnout in moderate-stress active work (OR = 0.26; 95% CI: 0.09-0.69) and passive work (OR = 0.22; 95% CI: 0.07-0.63). The findings confirmed that psychosocial factors were involved in the development of burnout in the studied group.
2018 Brazil29	Quantitative	Preventive measures are essential to control mental health disorders and prevent unnecessary harm to nursing professionals’ health, quality of life, institutions, and even the social security system. While stress can act as a stimulus for new challenges, the organization and nature of nursing work contribute to the insidious development of burnout.
2018 England30	Reflection	A 100% positive response was reported for the reflective debriefing intervention, which emphasized the importance of interprofessional collaboration in successfully addressing moral distress among health care workers. This approach may help protect workers from burnout, emotional detachment, and even leaving the profession.
2020 Brazil31	Literature review	The importance of the nursing staff’s work must be recognized across all health care settings, especially in emergency situations. Therefore, in addition to adequate working conditions, psychosocial support is essential for preserving these professionals’ mental health, benefiting both workers’ well-being and the quality of patient care.
2020 Brazil5	Quantitative	Health care workers working in hospital settings are exposed to various occupational stressors that directly impact their well-being, including long work hours and constant exposure to pain, suffering, and death. There is a critical need to promote workers’ mental health to ensure optimal professional performance and deliver high-quality patient care.
2021 The Netherlands34	Quantitative	The levels and causes of moral distress vary among ICU workers and differ from those observed in the historical control group. Targeted interventions addressing moral distress during crises are desirable to improve mental health, enhance ICU staff retention, and maintain the quality of patient care.

ICU = intensive care unit; OR = odds ratio.