Table 3 Data synthesis
No | Authors/ year/ setting | Key findings | Codes | Sub-categories | Categories |
|---|---|---|---|---|---|
1 | Mo et al., 2020 China | • Anxiety and stress were identified among nurses. • Factors that accounted for stress included the nurse being the only child in the family, the severity of patients’ conditions, the duration of work hours per week, and anxiety | Anxiety and stress | Psychological issues | Psychosocial challenges |
2 | Sagherian et al., 2020 United States | • Insomnia, fatigue (acute and chronic), low-to-moderate inter-shift recovery, emotional exhaustion, depersonalization, psychological distress (depression and anxiety) and post-traumatic stress disorder. • Contributing factors included being a frontline nurse, and increased working hours per week. These resulted in insomnia, fatigue, low inter-shift recovery, burnout and PTSD). • Rest breaks were identified as means of coping with challenges | Insomnia, fatigue, low-to-moderate inter-shift recovery, emotional exhaustion, depersonalization, psychological distress and post-traumatic stress disorder | Psychological issues | Psychosocial challenges |
3 | Arnetz et al., 2020 United States | Sources of Stress among Nurses • fear of exposure to COVID-19 infection. • fear of the death of patients, co-workers and loved ones. • the feeling of inadequacy and helplessness in caring for COVID-19 patients • scarcity of PPEs and the discomfort related to wearing them • false information sharing on COVID-19 | Fear of contracting the disease and exposure to death Helplessness Inadequate PPE supply False information | Fear Psychological issues Inadequate resources Poor information flow | Sources of Stress among Nurses Psychosocial challenges |
4 | Cai et al., 2020 China | • Key work-related challenges: depression, anxiety, insomnia, and PTSD. • The factors that impacted these challenges included nurses’ unit of work (highest among nurses at COVID-19 units), changes in the physical state of nurses, and doubt about the fight against the pandemic. • Access to online psychological information was valuable and served as a sufficient protection impact factor for anxiety, insomnia, and PTSD symptoms | Depression, anxiety, poor sleep, and PTSD Access to psychological information | Psychological issues Access to information | Psychosocial challenges Coping strategy |
5 | Coffré & de los Ángeles Leví Aguirre, 2020 Ecuador | • Fear/stress associated with caring, dissatisfaction with working extended hours, and increased turnover intention • Factors relating to frequency, intensity and possibility of transmission of COVID-19 to relatives, getting infected through handling patients, and lack of personal protection equipment. Lack of treatment and vaccines for the virus; television and social media news reportage about COVID-19; observing anxious and frightened colleagues, and having possible symptoms of the disease Coping strategies • Exhibition of a positive attitude; • Assurance had improved COVID-19 cases, with no relations getting infected. • Sticking to the same or even reducing shift hours at work • Safety nursing practice • Strictly following personal protection measures, • Maintaining separate clothing for the street and work. • Acquiring more knowledge about the disease. • Avoiding public places. • Strategic communication with relatives and friends. • Improved nutrition, • Physical exercise and recreation. Expression of feelings. | Stress and extra working hours Fear of the disease and transmitting it to others Psychological approach to coping Adherence to safety protocols Communication Taking good care of oneself | Psychological issues Fear Coping mechanism | Psychosocial challenges Sources of stress Coping |
6 | Galletta et al., 2021 Italy | Work-related challenges included • Fear of putting family at risk of getting infected • The feeling of inadequacy in preparation for the pandemic • High level of rumination about the pandemic Causes of work stress: • Watching colleagues crying at work-induced stress among nurses. • Increased job stress • Increased job demand • Worry about getting infected. | Fear of the disease Inadequacy and helplessness Visible helplessness | Fear Psychological and social issues Psychological and social issues | Source of stress Psychosocial challenges Psychosocial challenges |
7 | Marthoenis et al., 2021 Indonesia | • Most nurses experienced depression, anxiety, stress and social rejection by family and neighbours • Associated risk factors included: ♣ Nature of the work area of the nurse (COVID-19 and non-COVID-19 centres), ♣ Financial hardship due to the pandemic, ♣ Social rejection by family due to nurses’ proximity to COVID-19 patients. ♣ Frequent watching of news on TV about COVID-19. ♣ Persistent use of crowded places. ♣ Feeling worried about the pandemic. Optimism that the government may win against COVID-19 and appropriate behaviour such as wearing a face mask whenever they leave their homes. | Depression, anxiety, stress Social rejection by family | Psychological issues Social issues | Psychological challenges |
8 | Poortaghi et al., 2021 Iran | • Nurse managers volunteered to support frontline nurses during shortages and work overload. • Introduction of flexible work schedule through rearrangement of the workforce by reassigning high-risk staff, e.g., aged, pregnant and lactating nurses, and nurses with underlying medical conditions to work areas of low risk of COVID-19. • The preventive measures include training on COVID-19, provision of adequate PPEs and allocation of places for quarantining of patients and staff was ensured • Financial incentives • Close communication between staff and managers • Increased off time between shifts | Support from nurse managers Flexible work schedule | Availability of support Flexible work schedule | Coping Coping |
9 | Sadang, 2021 Philippines | • Fear and worry • Increased workload & burnout • Stigmatization • Higher risk of contracting and spreading the virus, • Rise in infected cases • Poor knowledge of patients and the public on COVID-19 | Fear and worry Burnout and stress Stigmatization | Psychological issues Psychological issues Social issues | Psychosocial challenges Psychosocial challenges Psychosocial challenges |
10 | Lorente et al., 2021 Spain | • Fear of infection and death and dying • Higher levels of rumination • Watching co-workers cry at the workplace. • Increased job demand • Lack of appropriate support system at the workplace. • Emotion-focused coping (to improve resilience, insufficient preparation, lack of support, and fear of infection) • Problem-focused coping (stress from work overload). | Fear of infection and death Rumination Emotion-focused coping Problem-focused coping | Fear Psychological issues Coping mechanism Coping mechanism | Source of stress Psychosocial challenges Coping Coping |
11 | Moradi et al., 2021 Iran | • Lack of organizational support • Physical exhaustion • Uncertainties • Psychological stress | Limited support Stress and exhaustion | Limited support Exhaustion | Source of stress |
12 | Xiong et al., 2020 China | • Anxiety • Depression The self-efficacy coping • Psychological assistance intervention o Guiding Principles for psychological intervention during COVID-19 o Psychological guidelines books o Psychological assistance hotlines Online psychological counselling | Anxiety and depression Psychological support | Psychological issues Support | Psychosocial challenges Coping |
13 | L. Zhang et al., 2021 China | • Burnout • High level of emotional exhaustion • High level of depersonalization • Low level of personal accomplishment • Mental health guidance • Stress coping techniques | Exhaustion and burnout Psychological support | Psychological issues Coping mechanism | Psychological challenges Coping |
14 | Zheng et al., 2021 China | • Depression • Anxiety • Stress | Anxiety, depression, and stress | Psychological issues | Psychosocial challenges |
15 | Waage et al., 2021 Norway | • Change in sleep duration • Poor sleep quality | Altered sleep | Psychological issues | Psychosocial challenges |
16 | X. Zhang et al., 2021 China | • Burnout • Psychological distress • Posttraumatic stress Adaptive coping | Burnout and distress Adaptive coping | Psychological issues Coping mechanism | Psychosocial challenges Coping |
17 | Zhan et al., 2020 China | • Job stress | Stress | Stress from the job | Sources of stress |
18 | McFadden et al., 2021, United Kingdom | • Lower levels of well-being and quality of working life • Positive coping strategies (e.g., active coping, positive reframing, acceptance) and negative coping strategies (e.g., venting, behavioural disengagement, self-blame) were used | Well-being and quality of working life Positive coping and negative coping | Psychological issues Coping strategies | Psychosocial challenges Coping |
19 | Nowell et al., 2021 Canada | • Nurses lacked confidence and experienced a state of chaos and anxiety • Workplace factors including the adequacy of personal protective equipment, clear information and guidance, supportive leadership, teamwork and adequate staffing influenced nurses’ confidence. | Lack of confidence, chaos and anxiety Personal protective equipment, clear information, guidance, supportive leadership, teamwork, adequate staffing | Psychosocial issues Coping strategies | Psychosocial challenges Coping |
20 | Fteropoulli et al., 2021 United Kingdom | • Prevalence of moderate to severe anxiety and clinically significant depression. • Depression and occupational burnout were significant risk factors for poor quality of life. • A significant risk factor for poor psychological outcomes was perceptions of inadequate workplace preparation to deal with the pandemic • Approach (active efforts to deal with the problem), Support-seeking (seeking support from the environment), and Avoidance (avoiding dealing with the problem) coping were strategies used to overcome the psychosocial impacts of the COVID-19 pandemic. | Anxiety, depression, occupational burnout, poor quality of life Inadequate workplace preparation Approach, support-seeking and avoidance | Psychological outcomes Coping strategies | Psychological challenges Coping |
21 | AlJhani et al., 2021 Saudi Arabia | • Burnout was higher among nurses. • Adaptive (religion, acceptance, active coping, planning and positive reframing and maladaptive coping (self-distraction, venting and denial were used by nurses as coping strategies. | Burnout Adaptive coping, maladaptive coping | Psychological issues Coping strategies | Psychological challenges Coping |
22 | Molero-Jurado et al., 2021 Spain | Coping strategies such as rumination, self-blame, blaming others, positive refocusing, positive reappraisal and acceptance were related to the presence of health problems (presence of anxiety/insomnia, social dysfunction, and depression). | Rumination, self-blame, blaming others, positive refocusing, positive reappraisal and acceptance | Coping strategies | Coping |
23 | Cui et al., 2021 China | • Anxiety symptoms and stress were high among nurses • Positive professional attitudes and being trained in emergency preparedness cope well with anxiety and stress | Anxiety and stress Positive professional attitude, emergency preparedness | Psychological issues Coping strategies | Psychological challenges Coping |
24 | Alameddine et al., 2021 Lebanon | • Burnout (personal, work-related and client-related) was low and moderate among most of the nurses • Resilience was associated with burnout; burnout tends to reduce resilience and vice versa | Burnout Resilience | Psychological issues Resilience | Psychological challenges Coping |
25 | Htay et al., 2021 Multi-countries | Among the common coping strategies used during the COVID-19 pandemic included getting family support, positive thinking, prayers and worshipping according to one’s beliefs and adequate sleep and food intake. | Family support, positive thinking, religious activities, recreation, staying away from fake news, sleep and a good diet | Coping strategies | Coping |
26 | Kotrotsiou et al., 2021 Greece | Positive approach, search for social support, wishful thinking, avoidance and problem-solving assertion strategies correlated significantly with the socio-demographic characteristics of nurses. | Positive approach, social support, wishful thinking, avoidance, problem-solving assertion | Stress management strategies | Coping |
27 | Engelbrecht et al., 2021 South Africa | • Nurses had higher levels of PTSD • Approach coping (acceptance, use of instrumental support, use of emotional support, positive reframing, religion, planning and active coping), avoidant coping (self-distraction, denial, venting, substance use, behavioural engagement and self-blame), humour and religion were some of the strategies used to cope with the PTSD. | Post-traumatic stress disorder Acceptance, support, reframing, planning, self-distraction, denial, venting, substance use, engagement, self-blame, humour, religion | Psychological issue Coping strategies | Psychological challenge Coping |
28 | Hummel et al., 2021 Parts of Europe | • Different levels of depression, anxiety, and stress for each of the 8 European countries. • The causes included uncertainty about when the epidemic will be under control, worry about inflicting COVID-19 on family, worry about nosocomial spread, frequent modification of infection control procedures, conflicts at work as the equivocal definition of responsibility between doctors and nurses and blame from commanding • Among the strategies used in coping included taking protective measures (washing hands, wearing a mask, taking own temperature, etc.), actively acquiring more knowledge about COVID-19 (symptoms, transmission pathway, etc.), video-chatting with family and friends by phone to share concerns and support, engaging in recreational activities (online shopping, social media, internet surfing, etc.), engaging in health-promoting behaviours (more rest, exercise, balanced diet, etc.) and switching thoughts and facing the situations with a positive attitude | Depression, anxiety, stress Uncertainty, family worry, infection, conflicts Protective measures, more knowledge, video chatting, recreation, health promotion, positive attitude | Psychological issues Work-related challenges Coping strategies | Psychological challenges Coping |
29 | Norman et al., 2021 United States | • Moral distress was high among participants and was associated with PTSD symptoms, burnout, and work and interpersonal functional difficulties • Worries about infecting family, not being able to visit or assist loved ones who had become ill, and not being able to do enough for COVID-19 patients were factors that contributed to moral distress. | Distress, PTSD, burnout, functional difficulties | Psychosocial issues | Psychosocial challenges |
30 | Ali et al., 2020 United States | • Increased stress, burnout, anxiety, depression and fatigue among frontline nursing staff • The stress of nursing staff was related to taking care of COVID-19 patients, assignments and workload, worry from personal life, friends and colleagues, lack of knowledge about COVID-19, and the work environment • Avoidance, problem-solving, transference, spending time with children, the use of arts and crafts and drinking alcohol were some of the coping strategies used. | Stress, burnout, anxiety, depression, fatigue Avoidance, problem-solving, transference, time with children, alcohol | Psychosocial issues Coping strategies | Psychosocial challenges Coping |
31 | Norful et al., 2021 United States | • Fear of uncertainty and physical and psychological manifestations of stress were common in nurses • Shifting information, a lack of PPE, and fear of infecting others were the causes of worry for nurses. • Resilience building through organizational efforts, individualized stress mitigation, social support, social media and organizational transparency were reported to be effective against rising stressors. | Fear, uncertainty, stress Resilience, stress mitigation, social support | Psychological issues Coping strategies | Psychological challenges Coping |
32 | Jerg-Bretzke et al., 2021 Germany | • Stress was high among nurses during the COVID-19 pandemic • The greatest sources of stress included fear of a patient dying, fear of infecting loved ones and family, physical or mental exhaustion and change in tasks. | Stress Fear of dying, mental exhaustion, changes in task | Psychological issues | Psychological challenges |
33 | Said and El-Shafei, 2020 Egypt | • Occupational stress is higher among frontline nurses Workload, dealing with death and dying, inadequate emotional preparation, problems relating to supervisors and peers, discrimination, conflicts with physicians, uncertainty concerning treatment, and patients and their families were the major causes of stress among nurses. | Occupational stress Workload, death and dying, emotional preparation, the problem with people, discrimination, conflicts, uncertainty | Psychological issues | Psychological challenges |
34 | Alameddine et al., 2021 Lebanon | Most nurses had moderate resilience. Personal competence, high standards, tenacity, trust in one’s instinct, tolerance of negative effects, strengthening effects of stress, positive acceptance of change and secure relationships, control and spirituality improved the resilience of nurses. | Resilience, competence, high standards, tenacity, tolerance, positive acceptance, control, spirituality | Resilience | Coping |
35 | Hamama et al., 2021 Israel | • Job stress and psychological distress were reported among nurses. • Causes of stress included inadequate PPE at their workplace, little information on how to manage safety workplace and inadequate attention by organizations to the needs arising from the COVID-19 outbreak | Job stress, distress Inadequate resources, lack of information, limited attention | Psychological issues | Psychological challenges |
36 | Kowalczuk et al., 2021 Poland | • Excessive sleepiness and insomnia were identified among nurses • Coping strategies include active strategies (active coping, planning and positive reframing), support-seeking and emotion-oriented strategies (religion, use of emotional support, use of instrumental support, venting and self-blame) and avoidant strategies (acceptance, behavioural disengagement, denial, self-distraction, substance use, humour, religion) were used to advance in overcoming sleep problems. | Sleep disorders Active coping, support-seeking, avoidance | Psychological issues Coping strategies | Psychological challenges Coping |
37 | Khatatbeh et al., 2021 Jordan | • Nurses experienced emotional reactions (feelings of fear, worries, and anxiety), social stigma, extreme workload • Factors that increased the fear, stress, and anxiety included having an old aged parent with co-morbidity in the home, worry of spreading the infection to family and inadequate knowledge and unclear situation of the COVID-19 | Fear, worry, anxiety, stigma, increased workload | Psychosocial issues | Psychosocial challenges |
38 | Hong et al., 2021 South Korea | • Nurses were rated as having clinical depression and also presented anxiety, insomnia and work-stress | Depression, anxiety, insomnia and work-stress | Psychological issues | Psychological challenges |
39 | Lee et al., 2021 South Korea | • Nurses experienced work-related stress in the form of depression, anxiety, or insomnia. • Coping behaviours included having conversations with people, partaking in hobbies and exercise, partaking in behaviours such as smoking and drinking and using social network services (SNS) via the internet | Depression, anxiety, insomnia, stress Conservation, hobbies, exercise, smoking, drinking alcohol, social media usage | Psychological issues Coping strategies | Psychological challenges Coping |
40 | Betke et al., 2021 Poland | Problem-focused strategies (active coping, planning and positive reframing) were used by nurses to deal with stress. | Planning, active coping, reframing | Coping strategies | Coping |
41 | Chui et al., 2021 Malaysia | • There was stress and depression among nurses • Highly stressed or depressed nurses tend to adopt avoidance (self-blame, venting and substance use), religion, reframing, active coping, planning and emotional support were used regardless of the stress or depression levels experienced. | Stress and depression Avoidance, religion, emotional support, planning, substance use, self-blame, venting, reframing | Psychological issues Coping strategies | Psychological challenges Coping |
42 | Aboutiq and Borchardt, 2021 United States | • Occupational stress was high • The top occupational stressors included wearing a face mask at all times in the hospital, unpredictable staffing and scheduling, not enough staff to adequately cover the unit, feeling helpless in the case a patient fails to improve, and being assigned to a COVID-19 patient. | Stress Wearing a face mask, under-staffing, scheduling, helplessness, assigning to COVID-19 patient | Psychological issues | Psychological challenges |
43 | Marcolongo et al., 2021 Italy | • The study showed nurses exhibiting anxiety, depression and fear caused by the COVID-19 pandemic. Low resilience was also recorded. • Acceptance, planning, active coping, instrumental and emotional support, and self-distraction are the most used strategies by health workers. | Anxiety, depression, fear and low resilience Active coping, avoidance, emotional support | Psychological issues Coping strategies | Psychological challenges Coping |
44 | McFadden et al., 2021 United Kingdom | • Low quality of working life • The most frequently used coping strategy was acceptance, behavioural disengagement, family–work segmentation | Quality of work-life Acceptance, disengagement, family-work segmentation | Psychosocial issue Coping strategies | Psychosocial challenges Coping |
45 | Labrague and de los Santos, 2020 Philippines | Fear of COVID-19 and psychological distress were high among nurses | Fear, psychological distress | Psychological issues | Psychological challenges |