Ghaderi et al.

BMC Nursing (2024) 23:313 BMC Nursing

https://doi.org/10.1186/s12912-024-01967-0

RESEARCH Open Access

Predictive factors of occupational stress

among nurses during the COVID-19
pandemic: a cross-sectional study in Kashan,
Iran
Zahra Ghaderi1 , Zahra Tagharrobi2 , Zahra Sooki2 and Khadijeh Sharifi2*

Abstract
Background Considering the severe and sudden changes in the job conditions of nurses during the covid-19
pandemic, the increase in job tensions during this critical period and its consequences on the quantity and quality of
nursing care, this study aims to investigate the job stress of nurses during the covid-19 pandemic and its predictors in
Iran.
Methods This cross-sectional study was conducted on 400 nurses in ‘Kashan’, Iran, who were randomly selected
using stratified sampling. Data were collected using two questionnaires on occupational stress and potential related
factors. The data were analyzed in SPSS version 16.
Results The results showed that the occupational stress of nurses in Iran was at a medium to high level with a mean
and standard deviation of 103.773 ± 15.742 (scale of 34–136). Factors such as satisfaction with physical health, quality
of work life, satisfaction with the availability of facilities, sense of coherence, education level, work experience, job
burnout, male gender, being native, and workplace were predictors of occupational stress and explained 23.3% of the
variance in occupational stress score. The highest contribution was related to satisfaction with physical health.
Conclusion Considering the consequences of occupational stress for nurses, it is crucial for health and nursing
authorities to take these factors into consideration in policy-making and planning.
Keywords COVID-19, Iranian nurses, Occupational stress

*Correspondence:
Khadijeh Sharifi
[email protected]
1
Department of Nursing, Trauma Nursing Research Center, Faculty of
Nursing and Midwifery, Kashan University of Medical Sciences, Kashan,
Iran
2
Faculty of Nursing and Midwifery, Trauma Nursing Research Centre,
Kashan University of Medical Sciences, Kashan, IR, Iran

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Ghaderi et al. BMC Nursing (2024) 23:313 Page 2 of 8

Background Considering the consequences of nurses’ occupational

Occupational stress is an emotional, cognitive, behav- stress and the impact of the environment and structure
ioral, and psychological response to the harmful aspects on the level of stress and changes in working conditions
of the work environment [1]. It occurs when the expec- during pandemics such as COVID-19, and the contradic-
tations from an individual exceed their abilities and tions in previous studies regarding related factors, this
capabilities [2]. Nurses, due to the nature of their pro- study was conducted.
fession, are constantly exposed to various occupational
stressors. The level of occupational stress was reported Methods
to be 124.06 ± 32.58 (scale of 46–201) in Chaudhari et Study design
al.‘s (2018) study in India [3], 66.2% in Baye et al.‘s (2020) This cross-sectional study was conducted between
study in Ethiopia [4], and 109.06 ± 16.22 (scale of 175 − 35) August and September 2022 (Simultaneously with one of
in Ghadirzadeh and Adib-Hajbaghery’s (2017) study in the peak of COVID-19 in ‘Kashan’, Iran) in hospitals affil-
Iran [5]. iated to ‘Kashan’ University of Medical Sciences in Iran.
With the onset of the COVID-19 pandemic, nurses
experienced unprecedented levels of occupational stress Sampling method
due to being at the forefront of the fight against this The study population included all nurses who were
unknown disease with high mortality rates. Among these employed in seven hospitals affiliated to ‘Kashan’ Univer-
stresses were shortages of medical facilities and equip- sity of Medical Sciences in Iran. To determine the sample
ment [6], wearing heavy protective clothing and masks size, a previous study by Farhadi et al. (2013) was con-
for long periods [7], extremely high work pressure, long sulted, which reported occupational stress using the Taft
working hours, cancellation of many personal and recre- and Anderson questionnaire as 121.36 ± 19.88 [25]. Based
ational programs, being away from family, limited close on formula number one and considering the accuracy of
contact with family and friends, and concern about trans- one tenth of a standard deviation, the sample size was
mitting the disease to loved ones [2, 8]. Some studies estimated to be 383 individuals. However, considering
reported nurses’ occupational stress during the COVID- potential attrition, 400 individuals were selected for the
19 pandemic in different amount; in Saudi Arabia study using stratified random sampling based on hospital
6.92 ± 2.91 (scale of 0–10) [9], in Jordan 94.59 ± 6.08 (scale wards in all seven hospitals.
of 34–136) [10], in China 91.42 ± 26.09 (scale of 35–140) Formula number 1
[2], in Egypt 193.55 ± 44.94 (scale of 57–228) [11], and in
Iran 72% [12]. S2Z2
During the COVID-19 pandemic, nurses experienced d2
significant job-related stress, which resulted in vari-
ous negative consequences such as reduced efficiency,
decreased attention and focus, impaired decision-making Inclusion and exclusion criteria
skills, increased absenteeism, decreased organizational The inclusion criteria for participants were being
commitment, reduced job satisfaction [13], an increased employed in clinical activities in hospital wards (inpatient
tendency to quit [14] and burnout [15], a higher likeli- departments), having at least one year of work experience
hood of clinical errors and decreased quality of nursing in clinical settings, willingness to participate in the study,
care [4]. not having any known psychological disorders (self-
Studies on factors related to occupational stress indi- reported), and having a university degree in nursing. The
cate various contradictory factors. Some studies have exclusion criteria were dropping out of the study dur-
shown a significant statistical relationship between occu- ing questionnaire completion and providing incomplete
pational stress and marital status [16], gender, workplace, responses to the questionnaires.
work experience [17, 18], work overload [19], shift work,
mental health [17], education level [5, 20], number of Measures
children [21], role ambiguity, job change, job satisfaction, The data collection tools consisted of two questionnaires:
spiritual health [22], quit job, quality of work life [14], job The Personal and Occupational Characteristics Ques-
burnout, resilience [23], and sense of coherence [24]. tionnaire and “the Gary Toft and Anderson’s Job stress
Some studies have not shown a significant statistical Questionnaire” Especially for nurses.
relationship between occupational stress and age, mari- The first questionnaire, a 36-item questionnaire on per-
tal status [17, 21], coworker support [19], education level, sonal and occupational characteristics, was developed
patient safety [16], gender, work experience [21], work by the researcher based on a review of the literature.
shifts, job position, income [5], workplace, overtime The qualitative content validity of this questionnaire was
hours, and number of children [20]. confirmed by six faculty members from the Nursing and
Ghaderi et al. BMC Nursing (2024) 23:313 Page 3 of 8

Midwifery department at ‘Kashan’ University of Medi- made with the nurse regarding the delivery time. Each
cal Sciences in Iran. The questionnaire was consisted of nurse was assigned a unique code.
two sections: personal characteristics (17 questions) and
occupational characteristics (19 questions). Personal Data analysis
characteristics included gender, marital status, age, edu- Data analysis was performed using SPSS software version
cation level, family income, number of children, ethnic- 16. Measures of central tendency and dispersion were
ity, regular exercise, sleep and nutrition status, religious used to describe quantitative variables, while absolute
beliefs and adherence, history of COVID-19 infection, and relative frequencies were used for categorical vari-
history of COVID-19 infection in family members, fam- ables. Skewness and kurtosis indices were used to test for
ily and friend support and satisfaction with physical and normality of quantitative data, with a range of ± 2 consid-
mental health. The occupational characteristics section ered as normal.
included workplace, clinical work experience, experience The collected data were analyzed in two stages. In the
working in COVID-19 wards and temporary COVID-19 first stage, univariate tests were used to examine the rela-
wards (inpatient and temporary hospitalization depart- tionship between each potential categorical factor. Inde-
ments for COVID-19 patients), amount of overtime pendent t-tests were used for dichotomous factors, and
work per month, dominant work shift, quality of work one-way analysis of variance (ANOVA) or non-paramet-
life, interest in nursing profession, job satisfaction, sat- ric equivalent (Kruskal-Wallis) was used for non-normal
isfaction with staffing levels in each shift, job burnout, data. Pearson correlation coefficient was used for quan-
work-family conflict, satisfaction with salary and wages, titative factors. In the second stage, multiple stepwise
physician’s behavior and performance towards oneself, linear regression analysis was conducted to investigate
colleagues’ behavior and performance towards oneself, the precise role of potential factors in determining varia-
satisfaction with behavior and performance of head nurse tions in the occupational stress score, while removing the
towards oneself, nursing office officials’ behavior and per- confounding effect of other factors. Variables that were
formance towards oneself, patient feedback, and satisfac- significant in the univariate analysis (with a P-value < 0.2)
tion with availability of medical equipment and facilities. were included in the multiple regression analysis. A sig-
The second questionnaire was the Gary Taft and nificance level of less than 0.05 was considered in all
Anderson Nursing Stress Scale, which consisted of 34 analyses.
questions in 7 domains [26]. Responses to the items were Missing data for the item “satisfaction with the behav-
rated on a Likert scale as not-stressful (1 point), rarely ior and performance of the head nurse” were replaced
stressful (2 points), sometimes-stressful (3 points), and with the mean score. Additionally, missing data for the
always-stressful (4 points). The total score ranged from item “satisfaction with the performance of the head
34 to 136, with higher scores indicating greater levels of nurse” (for nurses who had served as head nurses for a
stress. The reliability and validity of this questionnaire long time) were also replaced with the mean score.
have been established in the Iranian population, with a
Cronbach’s alpha coefficient of 0.77 reported by Salemi Results
et al. (2017) [27]. In the current study, both Cronbach’s The questionnaires were distributed among 400 nurses
alpha and McDonald’s omega were calculated to be 0.934. working in the hospitals affiliated to ‘Kashan’ Univer-
sity of Medical Sciences, and all the questionnaires were
Data collection method analyzed. Overall, 76% of the participants were female,
The first author visited the nursing offices of each of the 83.3% were married, and 84.8% had a bachelor’s degree.
seven hospital and obtained permission to conduct the The mean age of the participants was 34.41 ± 7.17 years,
research. A list of all departments where nurses were and the mean work experience was 10.29 ± 6.86 years.
clinically active, along with the number and names of The mean level of interest in nursing profession, satis-
nurses employed in those departments, was obtained. faction with the behavior of nursing office officials, and
Nurses were randomly selected from each department satisfaction with salary and benefits were approximately
based on the inclusion criteria and desired sample size. 7.43, 5.85, and 3.61 (scale of 0–10), respectively. The
The researcher visited each department at the begin- mean score of nursing stress among the participants was
ning of each shift, explained the research, and obtained 103.773 ± 15.742 (scale of 34–136). The results of the
written and verbal consent from eligible nurses. Neces- Univariate analysis showed that there was a statistically
sary explanations on how to complete the questionnaires significant relationship between age, gender, education,
were provided, and the questionnaires were collected at employment status, being native, number of children,
the end of the shift. In cases where the questionnaire was regular exercise, nutritional status, workplace, job posi-
not completed on the scheduled date, an agreement was tion, work experience in the COVID-19 ward, work expe-
rience in the temporary COVID-19 ward, work-family
Ghaderi et al. BMC Nursing (2024) 23:313 Page 4 of 8

Table 1 Occupational stress scores of nurses categorized by personal and job variables
Variables Mean ± SD Test type P-value
Gender Male 99.010 ± 16.274 t = 3.446a 0.001
Female 105.276 ± 15.292
Marital status Single 102.323 ± 17.242 f = 0.379b 0.685
Married 104.075 ± 15.460
Divorced 100.500 ± 17.678
Education level Associate degree 90.000 ± 21.342 test statistic = 9.311c 0.010
Bachler’s degree 103.056 ± 15.917
Master’s degree 109.339 ± 12.477
Being native No 109.353 ± 17.668 t = − 2.171a 0.031
Yes 103.254 ± 15.476
Regular exercise No 104.986 ± 15.029 t = − 2.241a 0.026
Yes 100.975 ± 17.012
Sleep status Completely inappropriate (0) 106.048 ± 16.612 f = 1.678b 0.154
Slightly appropriate (1) 103.032 ± 17.537
Relatively appropriate (2) 104.349 ± 14.478
Very appropriate (3) 97.393 ± 16.324
Completely appropriate (4) 99.00 ± 5.292
Nutrition status Completely inappropriate (0) 105.846 ± 18.010 f = 4.409b 0.002
Slightly appropriate (1) 107.208 ± 14.065
Relatively appropriate (2) 103.768 ± 15.211
Very appropriate (3) 96.500 ± 18.197
Completely appropriate (4) 93.333 ± 14.052
Adherence to beliefs Not at all (0) 104.143 ± 16.896 test statistic = 0.201c 0.936
Weak (1) 100.063 ± 19.317
Average (2) 103.578 ± 14.200
High (3) 104.538 ± 18.103
Very high (4) 103.975 ± 15.051
Workplace Emergency 102.164 ± 15.398 test statistic = 32.210c 0.009
Internal 104.193 ± 14.206
Surgical 100.867 ± 17.368
Pediatric 100.417 ± 18.812
ICU 104.228 ± 16.132
CCU 105.350 ± 13.484
Dialysis 99.375 ± 17.629
Obstetrics and Gynecology 102.500 ± 16.521
Operating Room 106.800 ± 15.796
Neonatology 107.100 ± 7.564
NICU 121.400 ± 8.809
Angiography 101.375 ± 16.265
Psychiatric Emergency 97.143 ± 16.028
Adult Psychiatric Inpatient 111.375 ± 12.961
Child Psychiatric Inpatient 98.833 ± 13.920
COVID 104.400 ± 15.792
Ophthalmology and ENT 115.00 ± 10.559
Experience working in COVID-19 inpatient wards No 107.908 ± 13.266 t = − 2.327a 0.020
Yes 102.970 ± 16.073
Experience working in COVID-19 temporary wards No 107.853 ± 13.253 t = − 2.507a 0.013
Yes 102.831 ± 16.134
History of COVID-19 infection No 107.111 ± 14.136 t = − 1.680a 0.094
Yes 103.251 ± 15.933
History of COVID-19 infection in family members No 105.133 ± 15.353 t = − 0.492a 0.623
Yes 103.662 ± 15.788
Ghaderi et al. BMC Nursing (2024) 23:313 Page 5 of 8

Table 1 (continued)
Variables Mean ± SD Test type P-value
Dominant work shift Morning 104.870 ± 16.325 f = 2.900b 0.056
Evening 105.738 ± 14.086
Night 101.439 ± 16.098
Work-family conflict No 100.047 ± 16.968 t = 4.067a < 0.0001
Yes 106.555 ± 14.171
Family income Insufficient 103.296 ± 17.642 f = 0.127b 0.883
Sufficient 104.008 ± 14.662
More than sufficient 106.333 ± 12.662
Family support None 106.867 ± 19.310 f = 2.020b 0.091
Low 106.333 ± 15.228
Moderate 105.446 ± 14.876
High 101.771 ± 15.573
Very high 100.828 ± 15.976
Friend support None 107.327 ± 15.293 f = 4.137b 0.003
Low 105.939 ± 16.772
Moderate 102.447 ± 16.772
High 104.381 ± 14.186
Very high 93.091 ± 20.789
a
Independent t-test bANOVA cKruskal–Wallis

Table 2 Occupational stress score of nurses categorized by quantitative personal and occupational variables and sense of coherence
Variables Correlation coefficienta Result
Age (years) 0.168 0.001
Number of children 0.108 0.031
Work experience (years) 0.184 < 0.0001
Overtime per month (hours) − 0.077 0.122
Satisfaction with the adequacy of the number of personnel in each shift (scale of 0–10) -0.108 0.030
Interest in the nursing profession (scale of 0–10) 0.014 0.786
Job satisfaction (scale of 0–10) -0.149 0.003
Quality of work life (scale of 0–10) -0.198 < 0.0001
Job burnout (scale of 0–10) 0.134 0.007
Satisfaction with salary and wages (scale of 0–10) -0.052 0.296
Satisfaction with physical health status (scale of 0–10) -0.280 < 0.0001
Satisfaction with mental health status (scale of 0–10) -0.279 < 0.0001
satisfaction with the behavior and performance of physicians towards oneself (scale of 0–10) -0.191 < 0.0001
satisfaction with the behavior and performance of colleagues towards oneself (scale of 0–10) -0.182 < 0.0001
satisfaction with the behavior and performance of head nurse towards oneself (n = 390) (scale of 0–10) -0.056 0.270
satisfaction with the behavior and performance of nursing office officials towards oneself (scale of 0–10) -0.152 0.002
satisfaction with patient feedback (scale of 0–10) -0.123 0.014
Satisfaction with availability of medical equipment and facilities (scale of 0–10) -0.171 0.001
the sense of coherence -0.170 0.001
a
Pearson

conflict, support from friends, satisfaction with the num- The multiple linear regression model showed that the
ber of personnel in each shift, job satisfaction, quality simultaneous presence of 10 variables in the model was
of work life, job burnout, satisfaction with physical and significant in predicting nursing occupational stress.
mental health, satisfaction with the behavior of physi- Satisfaction with physical health, quality of work life,
cians, satisfaction with the behavior of colleagues, sat- satisfaction with facilities and equipment, and sense of
isfaction with the behavior of nursing office officials, coherence had a negative effect on occupational stress.
satisfaction with feedback from patients, satisfaction with Education level, work experience, and job burnout had a
the availability of facilities and equipment, and sense of positive effect on nursing occupational stress. Being male
coherence with nursing stress (Tables 1 and 2). and native were associated with lower levels of occu-
pational stress. Workplace was also a significant factor
Ghaderi et al. BMC Nursing (2024) 23:313 Page 6 of 8

affecting occupational stress (P-value < 0.001, F = 11.848). level, employment status, native status, regular exercise,
Additionally, this analysis showed that 23.3% of the vari- nutrition status, workplace, job position, experience in
ance in nursing occupational stress scores was explained COVID-19 ward, experience in temporary COVID-19
by these 10 variables, with the greatest contribution com- hospitalization ward, work-family conflict and social
ing from satisfaction with physical health (R2 = 0.078) support, age, number of children, satisfaction with staff-
(Table 3). ing levels in each shift, work satisfaction, quality of work
life, job burnout, satisfaction with physical and mental
Discussion health, behavior of physicians, behavior of colleagues,
The present study aimed to investigate the predictors of the behavior of nursing office officials, satisfaction with
nursing occupational stress. The findings showed that patient feedback, availability of facilities and equipment,
the mean total score of nursing occupational stress was and sense of coherence.
103.773 ± 15.742 (scale of 34 to 136), indicating a higher- The results of the multivariate analysis showed that
than-average level of occupational stress among nurses satisfaction with physical health, quality of work life,
during the COVID-19 pandemic. The results of the study availability of facilities, sense of coherence, education
by Zhan et al. (2020) were consistent with the present level, work experience, job burnout, male gender, native
study, showing moderate to high levels of occupational status, and workplace were influential factors on nurs-
stress among Chinese nurses during the pandemic [2]. ing occupational stress. Additionally, the multivariate
Tayyib and Alsulami (2020) also reported higher than analysis indicated that 23.3% of the variance in nursing
average levels of occupational stress among nurses in occupational stress scores could be explained by the 10
Saudi Arabia during this period [9]. The findings of the aforementioned variables, with the greatest contribution
study by Alkhawaldeh et al. (2020) in Jordan showed coming from satisfaction with physical health. Consis-
moderate levels of occupational stress among nurses dur- tent with the findings of this study, Hendy et al. (2021)
ing this outbreak [10]. However, Said and El-Shafei (2021) reported that during the pandemic, factors predicting
reported high levels of nursing occupational stress in nursing occupational stress in Egypt included workplace,
Egypt [11]. Nursing occupational stress has been consis- education level, participation in COVID-19-related train-
tently found to be moderate to higher than average and ing courses, fear of infection, fear of transmitting the
in fact, it has been worthy of attention in all studies dur- disease to family members, unavailability of protective
ing the COVID-19 pandemic. Differences may be influ- equipment, performance of officials, nurse shortage, and
enced by variations in shift work and workload, societal the stigma of COVID-19 [31].
expectations, workplace stressors, amount of rest and The results of the study by Zhan et al. (2020) in China
free time, time spent with family, friends, and engaging in also showed a significant correlation between nursing
group and physical activities [28–30], as well as the num- occupational stress levels and daily working hours, num-
ber of pandemic-related deaths in the region and avail- ber of night shifts per week, work experience, and educa-
ability of medical and protective equipment [6]. tion level [2]. Jamali et al. (2012) in Mashhad, Iran also
The results also show that nursing occupational stress reported that nursing occupational stress was related to
has a significant relationship with gender, education

Table 3 Results of multiple linear regression on factors affecting occupational stress score
Model B 95% CI B SE Beta t value p-value
lower bound Upper bound
constant 120.076 105.210 134.942 7.561 - 15.881 < 0.0001
Satisfaction with physical health -0.864 -1.538 -0.190 0.343 -0.131 -2.521 0.012
education 4.969 1.139 8.789 1.948 0.117 2.551 0.011
Gender -6.313 -9.614 -3.012 1.679 -0.171 -3.760 < 0.0001
Work experience 0.519 0.304 0.734 0.110 0.226 4.740 < 0.0001
Quality of work life -0.856 -1.572 -0.141 0.364 -0.125 -2.354 0.019
Being native -8.291 -13.283 -3.300 2.539 -0.147 -3.266 0.001
Job burnout 0.724 0.139 1.309 0.298 0.109 2.435 0.015
Satisfaction with availability of medical -0.892 -1.573 -0.210 0.347 -0.130 -2.573 0.010
equipment and facilities (scale of 0–10)
Workplace 0.361 0.054 0.667 0.156 0.108 2.314 0.021
the sense of coherence -1.680 -0.313 -0.023 0.074 -0.106 -3.281 0.023
Note R2 = 0.078 Adjusted R2 = 0/233 F = 11/848 P < 0/0001
*The missing items of ten questionnaires related to “Satisfaction with the Performance of the Head Nurse” (which was answered by nurses who had been in the
position of head nurse for a long time) was replaced with a mean
Ghaderi et al. BMC Nursing (2024) 23:313 Page 7 of 8

Technology Vice Chancellorship of ‘Kashan’ university of medical science

gender, education level, and the level of nurse’s awareness (‘KAUMS’) and the nurses who participated in the study.
[32].
The most influential factor on the level of nursing occu- Author contributions
ZG gathered the data, ZT analyzed and interpreted the patient data, KS
pational stress in this study was satisfaction with physical supervised the project, ZS and KS validated the process of project. All authors
health status. Several studies in this field have indicated read and approved the final manuscript.
that physical health is a significant source of stress for
Funding
nurses. Moreover, working in an environment that does ‘This research was funded by KAUMS’.
not prioritize their well-being can have a detrimental
effect on their physical health, as evidenced by research Data availability
The datasets used and/or analyzed during the current study are available from
conducted prior to the COVID-19 outbreak. Unfortu- the corresponding author upon reasonable request.
nately, the pandemic has only served to exacerbate and
intensify this pre-existing issue [32, 33]. The findings of Declarations
the Melnyk study (2022) indicated that during the pan-
demic, only 25% of nurses had good physical health sta- Ethics approval and consent to participate
The necessary permits and approvals for this study were obtained from the
tus, and more than 50% of them reported that COVID-19 Research Deputy and Ethics Committee of ‘Kashan’ - Iran (with numbers
pandemic impacted their physical health negatively [34], ‘40128’ dated ‘22/03/1401’ and IR. ‘KAUMS.NUHEPM’ ‘.1401.026’, respectively) in
which can lead to increased occupational stress, absen- accordance with the Declaration of Helsinki. Participants were provided with
information about the research and its objectives, the confidentiality of the
teeism, and a decrease in the quantity and quality of obtained information, their right to withdraw from the study, and their access
nursing care. to the study findings. Verbal and written informed consent were obtained
from all participants.

Study strengths and limitations Consent for publication

The present study has several strengths, including a rela- Not applicable.
tively large sample size, stratified sampling, and the use of
Competing interests
multivariate analysis alongside univariate analysis. How- The authors declare no competing interests.
ever, there are limitations to consider. For instance, some
variables, such as work-family conflict, were measured Received: 29 November 2023 / Accepted: 22 April 2024
using only one question.

Conclusions and implication

In the multiple linear regression model, 10 variables References
1. Simionescu M, Pellegrini A, Bordea EN. The effects of COVID-19 pandemic on
including satisfaction with physical health, work-life stress vulnerability of nursing students according to Labour Market Status.
quality, satisfaction with facilities, sense of coherence, Healthcare (Basel). 2021;9(2227–9032 (Print)):633. https://doi.org/10.3390/
education level, work experience, job burnout, gender healthcare9060633.
2. Zhan Y, Ma S, Jian X, Cao Y, Zhan X. The current situation and influencing
(male), being native, and workplace explained 23.3% of factors of job stress among frontline nurses assisting in Wuhan in fighting
the variance in nurses’ occupational stress score, with COVID-19. Front Public Health. 2020;8:579866. https://doi.org/10.3389/
the greatest contribution coming from satisfaction with fpubh.2020.579866.
3. Chaudhari AP, Mazumdar K, Motwani YM, Ramadas D. A profile of occupa-
physical health. Given that healthcare systems world- tional stress in nurses. Annals Indian Psychiatry. 2018;2(2):109. https://doi.
wide faced challenges during the COVID-19 pandemic, org/10.4103/aip.aip_11_18.
and there were sudden and significant changes in nurses’ 4. Baye Y, Demeke T, Birhan N, Semahegn A, Birhanu S. Nurses’ work-related
stress and associated factors in governmental hospitals in Harar, Eastern
work conditions, and also in order to prepare for cri- Ethiopia: a cross-sectional study. PLoS ONE. 2020;15(8):e0236782. https://doi.
ses and problems that threaten the life of humanity it is org/10.1371/journal.pone.0236782.
essential for researchers to investigate occupational stress 5. Ghadirzadeh Z, Adib-Hajbaghery M, Matin Abadi M. Job stress, job satisfac-
tion, and related factors in a sample of Iranian nurses. Nurs Midwifery Stud.
and related factors among nurses during the pandemic to 2017;6(3):125–31. https://doi.org/10.4103/NMS.NMS_26_17.
enable health system officials and planners to implement 6. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’ knowledge
appropriate interventions to improve working conditions. and anxiety toward COVID-19 during the current outbreak in Iran. Arch Clin
Infect Dis. 2020;15(COVID–19):e102848.
7. Atique S, Bautista JR, Block LJ, Lee JJ, Lozada-Perezmitre E, Nibber R, O’Connor
Supplementary Information S, Peltonen L-M, et al. A nursing informatics response to COVID-19: perspec-
The online version contains supplementary material available at https://doi. tives from five regions of the world. J Adv Nurs. 2020;76(10):2462–8.
org/10.1186/s12912-024-01967-0. 8. Jackson D, Bradbury-Jones C, Baptiste D, Gelling L, Morin K, Neville S, Smith
GD. Life in the pandemic: some reflections on nursing in the context of
Supplementary Material 1 COVID‐19. Journal of clinical nursing. 2020;.
9. Tayyib NA, Alsolami FJ. Measuring the extent of stress and fear among reg-
istered nurses in KSA during the COVID-19 outbreak. J Taibah Univ Med Sci.
Acknowledgements 2020;15(5):410–6. https://doi.org/10.1016/j.jtumed.2020.07.012.
This article is based on a master’s thesis in psychiatric nursing. The researchers 10. Alkhawaldeh JM, Soh KL, Mukhtar F, Peng OC, Alkhawaldeh HM, Al-Amer R,
would like to express their gratitude and appreciation to the Research and Anshasi HA. Stress management training program for stress reduction and
Ghaderi et al. BMC Nursing (2024) 23:313 Page 8 of 8

coping improvement in public health nurses: a randomized controlled trial. J 24. Kikuchi Y, Nakaya M, Ikeda M, Okuzumi S, Takeda M, Nishi M. Relationship
Adv Nurs. 2020;76(11):3123–35. https://doi.org/10.1111/jan.14506. between depressive state, job stress, and sense of coherence among female
11. Said RM, El-Shafei DA. Occupational stress, job satisfaction, and intent to nurses. Indian J Occup Environ Med. 2014;18(1):32.
leave: nurses working on front lines during COVID-19 pandemic in Zagazig 25. Farhadi M, Hemmati Maslakpak M, Khalkhali H. Job stressors in critical care
City, Egypt. Environ Sci Pollut Res. 2021;28(7):8791–801. nurses. Nurs Midwifery J. 2014;11(11):0.
12. Zare S, Kazemi R, Izadi A, Smith A. Beyond the outbreak of COVID-19: factors 26. Gray-Toft P, Anderson JG. The nursing stress scale: development of an instru-
affecting burnout in nurses in Iran. Annals Global Health. 2021;87(1). https:// ment. J Behav Assess. 1981;3(1):11–23.
doi.org/10.5334/aogh.3190. 27. Davarniya R. Efficacy of cognitive behavioral stress management therapy
13. Mosadeghrad AM. Occupational stress and turnover intention: implications on job stress in nursing staff in Intensive Care Units. Zanko J Med Sci.
for nursing management. Int J Health Policy Manage. 2013;1(2):169. https:// 2017;18(57):44–57.
doi.org/10.15171/ijhpm.2013.30. 28. Qiu Y, Wu Q, Chen R, Guan C. Research on psychological stress and mental
14. Jafari M, Habibi Houshmand B, Maher A. Relationship of occupational stress health of medical staff in COVID-19 prevention and control. Int J Disaster Risk
and quality of work life with turnover intention among the nurses of public Reduct. 2021. https://doi.org/10.1016/j.ijdrr.2021.102524.
and private hospitals in selected cities of Guilan Province, Iran, in 2016. J 29. Tang CJ, Lin YP, Chan EY. From expert to novice’, perceptions of general ward
Health Res Community. 2017;3(3):12–24. nurses on deployment to outbreak intensive care units during the COVID-19
15. Asheghi H, Asheghi M, Hesari M. Mediation role of psychological capital pandemic: a qualitative descriptive study. J Clin Nurs. 2021. https://doi.
between job stress, Burnout, and Mental. Health among Nurses. 2020;8(2):99– org/10.1111/jocn.16029.
108. https://doi.org/10.32598/jpcp.8.2.716.1. 30. Zhang J, Lai S, Lyu Q, Zhang P, Yang D, Kong J, Qi Y, Yuan W, et al. Diet and
16. Keykaleh MS, Safarpour H, Yousefian S, Faghisolouk F, Mohammadi E, Gho- nutrition of healthcare workers in COVID-19 epidemic—Hubei, China, 2019.
mian Z. The relationship between nurse’s job stress and patient safety. Open China CDC Wkly. 2020;2(27):505. https://doi.org/10.46234/ccdcw2020.121.
Access Macedonian J Med Sci. 2018;6(11):2228. https://doi.org/10.3889/ 31. Hendy A, Abozeid A, Sallam G, Abboud Abdel Fattah H, Ahmed Abdelkader
oamjms.2018.351. Reshia F. Predictive factors affecting stress among nurses providing care at
17. Charkhat Gorgich EA, Zare S, Ghoreishinia G, Barfroshan S, Arbabisarjou A, COVID-19 isolation hospitals at Egypt. Nurs open. 2021;8(1):498–505. https://
Yoosefian N. Job stress and mental health among nursing staff of educa- doi.org/10.1002/nop2.652.
tional hospitals in South East Iran. Thrita.2017;6(1). https://doi.org/10.5812/ 32. Jamali J, Tabatabaee SS, Yousefi M, Ghavami V, Akhlaghi S. Comparison of job
thrita.45421. stress of nurses working in COVID-19 ward and other wards and its relation-
18. Dalivand FK, Sadeghi P, Ramazanalipoor M, Hasani M. Comparison of depres- ship with their level of knowledge about COVID-19. Horizons Med Educ Dev.
sion, anxiety and occupational stress in nurses of psychiatric and nursing 2022;13. https://doi.org/10.22038/HMED.2021.56543.1139.
hospitals in Tehran. Medical Journal of Mashhad University of Medical Sci- 33. Kamau C, Medisauskaite A, Lopes B. Inductions buffer nurses’ job stress,
ences.2019;61(1). https://doi.org/10.22038/MJMS.2019.15033. health, and organizational commitment. Arch Environ Occup Health.
19. Kokoroko E, Sanda MA. Effect of workload on job stress of Ghanaian OPD 2015;70(6):305–8. https://doi.org/10.1080/19338244.2014.891967.
nurses: the role of coworker support. Saf Health work. 2019;10(3):341–6. 34. Melnyk BM, Hsieh AP, Tan A, Teall AM, Weberg D, Jun J, Gawlik K, Hoying
https://doi.org/10.1016/j.shaw.2019.04.002. J. Associations among nurses’ mental/physical health, lifestyle behaviors,
20. Mortaghi Ghasemi M, Ghahremani Z, Vahediane Azimi A, Ghorbani F. Nurses shift length, and workplace wellness support during COVID-19: important
job stress in therapeutic educational centers in Zanjan. Sci J Boyeh Gorgan implications for health care systems. Nurs Adm Q. 2022;46(1):5. https://doi.
Fac Nurs Midwifery. 2011;8(1):42–51. org/10.1097/NAQ.0000000000000499.
21. Aslani Y, Davoodvand S, Mirzaei Z. Analysis of the Dimensions and Influential
Factors in Occupational Stress in the Operating Room Staff of the Teaching
Hospitals in Shahrekord, Iran (2017). Journal of Clinical Nursing and Mid- Publisher’s Note
wifery. 2019;8(1). Springer Nature remains neutral with regard to jurisdictional claims in
22. Masoumi M, Tahmasebi R, Jalali M, Jafari F. The study of the relationship published maps and institutional affiliations.
between job stress and spiritual health of nurses working in intensive care
ward at Bushehr Hospitals. Nurs J Vulnerable. 2016;3(8):37–47.
23. Shakerinia I, Mohammadpour M. Relationship between job stress and resil-
iency with occupational burnout among nurses. J Kermanshah Univ Med Sci.
2010;14(2):e79518.