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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 57-64

Job Stress among Iranian Nurses: A Meta-Analysis


1 Department of Health Services Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
2 Department of Nursing and Midwifery, School of Nursing and Allied Medical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
3 Department of Epidemiology and Biostatistic, Tabriz University of Medical Sciences, Tabriz, Iran
4 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Date of Submission04-Apr-2020
Date of Decision26-Apr-2020
Date of Acceptance24-Aug-2020
Date of Web Publication13-Jan-2021

Correspondence Address:
Mahnaz Afshari
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nms.nms_28_20

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  Abstract 


Background: Job stress is one of the most important factors in reducing the organizational productivity. Objective: This meta-analysis aimed to determine the prevalence of job stress among nurses in Iran. Methods: All articles published on the prevalence of job stress among Iranian nurses from January 1, 2004, to April 31, 2020, were searched in six databases. The reference lists of the articles were also checked for additional relevant studies. Finally, 25 articles were analyzed through Comprehensive Meta-Analysis software. Heterogeneity of studies was checked using the I2 index, Q-test and the possibility of publication bias by the Egger test. Metaregression was performed to assess the variables suspected to affect the heterogeneity at a significance level of 0.05. The outcomes of the study were combined using the random-effects model. Results: The overall prevalence of job stress in Iranian nurses was 37.5% (95% confidence interval [CI]: 28.5, 47.4). The highest prevalence was 96.4% in Tehran city in 2016 (95% CI: 90.3, 98.7), and the lowest prevalence was 2% in Kashan city in 2011 (95% CI: 0.7, 5.3). A significant correlation was observed between the prevalence of job stress and year (P = 0.0001), mean age (P = 0.002), and sample size (P < 0.0001). Conclusion: Job stress affects over a third of Iranian nurses. Health-care policy-makers and managers should decrease this stress by adopting appropriate strategies such as increasing welfare facilities, reconsidering job descriptions for different levels of nursing, providing support, increasing nurses' involvement in the decision-making process, improving communication between managers and nurses, and teaching problem-solving skills to them.

Keywords: Hospital, Job stress, Meta-analysis, Nurse, Prevalence


How to cite this article:
Isfahani P, Shamsaie M, Peirovy S, Bahador RC, Afshari M. Job Stress among Iranian Nurses: A Meta-Analysis. Nurs Midwifery Stud 2021;10:57-64

How to cite this URL:
Isfahani P, Shamsaie M, Peirovy S, Bahador RC, Afshari M. Job Stress among Iranian Nurses: A Meta-Analysis. Nurs Midwifery Stud [serial online] 2021 [cited 2021 Mar 6];10:57-64. Available from: https://www.nmsjournal.com/text.asp?2021/10/1/57/306874




  Introduction Top


Stress is linked to many diseases[1] and is an important reason for absenteeism in health-care organizations.[2] Occupational stress is defined as the harmful physical and emotional responses that occur when requirements of a job do not match the capabilities, resources, and needs of the worker.[3] It occurs when expectations of workers exceed their authority and abilities and leads to personal problems, inability to work, and disruptions in organizational performance.[4] Occupational stress, by increasing work-related incidents, delays, and absences, not only reduces workers' productivity, organizational commitment, and the quality of care but also predisposes them to hypertension and cardiovascular diseases.[5],[6]

Nursing is one of the most stressful professions and its multitude of stressors negatively affects the staff. It is very demanding and practitioners experience many ups and downs from the time they begin their studies until they retire. Working long shifts and mandatory or voluntary overtime are some of the factors that affect nurses' job satisfaction.[7],[8]

In Iran, 80% of health system workers are nurses. Besides, 80% of the works in hospitals is done by them.[9] The American National Institute of Health ranked nursing as the 27th among 130 most stressful jobs due to its effects on mental health. Like patients, nurses may experience stressors that they cannot adapt to.[10] Such stresses can impact on their performance in all aspects.[11] Studies have shown the prevalence of job stress in nurses is higher than that of the whole population, although it may vary among different countries as well as nursing specialties.[12] For example, in the US, 20% of intensive care units (ICUs) and general care nurses in various hospitals were found to suffering from anxiety and stress.[13] In Singapore, a survey showed 28% of nurses in a general hospital had anxiety disorders.[14] Howevre, a study reported that 69% of Iranian nurses suffer from job stress.[15]

The high prevalence of job stress is not unexpected due to the nature of nurses' jobs. Conflict with physicians, colleagues and supervisors, inadequate emotional preparation, discrimination, high workload, concern about treatment, dealing with patients' death, and interactions with patients and their families are the main sources of job stress for nurses.[16]

In recent years, several studies have been published on the prevalence of job stress among Iranian nurses;[17],[18],[19] however, these studies have not been managed to provide a full picture of this crucial problem. Reviewing and integrating the results of published studies can help hospital managers and policy-makers make evidence-based decisions to manage job stress in nurses.

Objectives

This meta-analysis aimed to estimate the prevalence of job stress among Iranian nurses.


  Methods Top


This research was a meta-analysis of studies on the prevalence of job stress among nurses in Iran. It followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline.[20]

Search strategy

Six electronic databases of PubMed (MEDLINE), Web of Science, Scopus, Magiran, Scientific Information Databases, and Google Scholar were systematically searched to identify relevant articles published between January 1, 2004, and April 31, 2020. Search keywords included job stress, occupational stress, job-related strss, work-related stress, workplace stress, nurses, hospital, Iran, and Iranian along with AND/OR boolean operators [Table 1]. The bibliographies of the identified articles were reviewed to find potentially useful sources.
Table 1: Search strategy in different databeses

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The initial search resulted in 14,705 articles. After excluding duplicates and irrelevant articles, 12,255 studies remained for abstract examination. By reviewing the abstracts, 2345 articles were removed because of the article type (i.e., qualitative studies), studying the nurses from other countries, or the causes of job stress. Furthermore, 14 articles were removed after examining the full texts as they did not report the prevalence of job stress or had not an appropriate sample size. Finally, 25 studies were eligible for inclusion in this meta-analysis [Figure 1].
Figure 1: Flowchart of selecting and reviewing the articles based on PRISMA statement

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Inclusion and exclusion criteria

Only cross-sectional studies on the prevalence of job stress in Iranian nurses that had been published until April 31, 2020, in the Persian or English languages were included. Studies in a language other than Persian or English, published after April 31, 2020, investigating the prevalence of job stress in only one ward of a hospital, reviews, books and dissertations, studies that did not report the prevalence of job stress in Iranian nurses, and qualitative studies were excluded.

Quality evaluation

The quality of the 25 included articles was assessed by using the 15-point scale developed by Mitton et al.[21] which assesses the quality of documents in five areas of literature review and identification of research gaps, research questions and design, population and sampling, data collection and capture, and analysis and results reporting. All items were scored on a four-point Likert scale, including 0 (not present/not reported), 1 (present but low quality), 2 (present and midrange quality), or 3 (present and high quality). Each article was rated independently by two researchers, and their disagreements were resolved through discussion or by consulting a third reviewer, if necessary. Finally, studies with moderate and high-quality were included in the meta-analysis.

The following data were extracted from each article and entered into an Excel spreadsheet: the title, the name of the first author, the year of publication, location of the study, sample size, methodology, mean age and work experience of the participants, and the rate of job stress among them.

Data analysis

Data were analyzed using the Comprehensive Meta-Analysis software (Version 2.2.064, the US, Biostate company). The I2 and Q-tests were used to examine the heterogeneity of the studies. The heterogeneity was divided into three categories of <25% (low heterogeneity), 25%–75% (moderate heterogeneity), and >75% (high heterogeneity). As the heterogeneity was high (I2 = 97.07) a random-effect model was used to synthesize the results.[22] The funnel plot and Egger's test were used to assess the potential for the publication bias,[23] and the results showed that publication bias was not statistically significant (P = 0.43). Finally, the effect of variables that could be the potential sources of heterogeneity was examined using the metaregression technique. Point estimation of job stress prevalence in nurses was calculated in forest plots at 95% confidence interval (CI), where the size of the box indicates the weight of each study and the lines on its sides represent the 95% CI.


  Results Top


In total, 25 articles were reviewed in this meta-analysis [Table 2]. All of the studies had a cross-sectional design (n = 25, 100%) and a majority of them were conducted in 2017 (4 articles), 2016 and 2012 (3 articles) [Figure 2]. More than half of the studies were published after 2010.
Figure 2: Frequency distribution of studied years

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Table 2: Characteristics of the included studies

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Most studies were done in educational hospitals in Esfahan, Tehran, Sistan and Baluchestan, and Hamedan provinces [Figure 3].
Figure 3: Frequency distribution of studied provinces

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Based on the random-effects model, the overall prevalence rate of job stress was 37.5% (95% CI: [28.5, 47.4]). The lowest prevalence was reported in Kashan city in 2012 at 2% (95% CI: [0.7, 5.3]), while the highest prevalence was observed in Tehran city in 2016 at 96.4% (95% CI: [90.3, 98.7]) [Figure 4].
Figure 4: Forest plot of the included studies

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The results were summarized by the sample size, geographic region, instruments used, and quality of the studies [Table 3]. Job stress was more prevalent among nurses working in the southern region of Iran. Furthermore, studies with a sample size smaller than 150, and studies with higher quality reported higher prevalence rates. The Gray-Taft nursing stress scale and Osipow's Job Stress scale were the most used scales and were used in seven and six studies, respectively. The rate of job stress was higher in studies that have used the Gray-Taft nursing stress scale.
Table 3: Subgroup analyses of the included studies

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A high level of heterogeneity was found among the studies (Q = 819.341; P = 0.0001). Thus, the variables (year, sample size, and age average) were entered into the meta-regression model to identify those that potentially caused heterogeneity. [Table 4] and [Figure 5] indicate that the sample size, year, and the nurses' mean age contributed to the heterogeneity of studies in the prevalence of job stress. The results revealed that the prevalence of job stress among nurses has decreased by 0.04% each year. One year increase in nurses' age decreased the prevalence of job stress by 0.006. Moreover, the results showed that one unit increase in sample size has lead to a 0.008 decrease in the prevalence of job stress among Iranian nurses.
Figure 5: Results of the meta-regression analyses

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Table 4: Results of meta-regression

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  Discussion Top


Based on a random-effects model, the prevalence of job stress among Iranian nurses was found to be 37.5%. Several studies have also examined the prevalence of job stress among nurses worldwide and reported different rates. For example, the prevalence of job stress among nurses in Thailand[48] and Saudi Arabia[49] was 26.2% and 34.2%, respectively, which are consistent with our findings. However, this rate was 93% in Zambia.[50] It seems that job stress is an inevitable problem in health care professionals, although its level is different in different contextes.

In recent years, many studies have been conducted on job stress among Iranian nurses. However, the results of these studies showed large dispersion and heterogeneity. A large part of the variation might be attributed to the different instruments used. Although about half of the studies reviewed used the Gray Taft Nursing Stress Scale or Osipow questionnaire, however, the rest of the studies had used other scales. The large variation in the scales used makes it hard to compare the results of the studies. Developing a job stress scale that is compatible with the conditions of Iran's hospitals would help future researchers to have a more reliable estimate of the prevalence of job stress among Iranian nurses. Nonetheless, the difference in the prevalence rates of job stress among nurses in different studies might also be attributable to the methods of rating, sample sizes, and the differences in the work settings and organizational climate.

Although some degrees of job stress is inevitable, however, high levels of it can decrease in performance of health care professionals, including nurses. A few earlier meta-analyses have also highlighted the prevalence of job stress among Iranian nurses.[15],[51] These reviewspaid attention to different aspects of the prevalence of job stress among nurses. For example, Ghanei Gheshlagh et al. published two systematic reviews. In the first article, they reviwed 11 articles and calculated the mean nurses' job stress score as 96.56.[15] In the second paper, the prevalence of occupational stress in nurses was examined and has reported to be about 89%.[51] However, the studies reviewed in these articles were not homogeneous and some of them had focoused only on nurses working in one ward such as emergency, ICU, or operation rooms. However, in the present study, the prevalence of job stress in all wards of a hospital has been considered.

This study showed that job stress is more prevalent among nurses working in the southern regions of Iran. Organizational factors and factors related to the work setting may be one of the reasons for this finding. Work settings that are unable to fulfill nurses' needs can negatively affect their mental health and induce them anxiety, stress, and job-related injuries. Today's healthcare organizations have a special focus on profit-making and pay less attention to the human aspect of the work.[52] Such a condition would increase the level of job stress and job satisfaction among health-care workers, especially nurses. However, understanding factors affecting job stress help nurse managers and hospital authorities to plan strategies for the improvement of nurses' psychosocial well-being, organizational effectiveness, and patient safety and health.

In this research, the prevalence of nursing job stress was shown to decrease by 0.008% for each unit increase in the sample size. This indicates that studies with smaller sample sizes might overestimate the prevalence of job stress. Therefore, studies on the prevalence of job stress among nurses must enjoy adequate sample size and the use of appropriate sampling methods.

The results indicated that the prevalence of job stress among nurses has decreased by 0.04% each year. Perhaps, this indicates that the actions taken in recent years such as accreditation, health system transformation plan implementation, could be somewhat effective in reducing job stress.

The results showed that every year of increase in nurses' age decreases the prevalence of job stress by 0.006%. This finding is consistent with the findings of Khodaveisi et al.[36] and might be attributed to the increased work experience and job compatibility of nurses with higher ages.

The present study used meta-analysis to determine the prevalence of job stress among Iranian nurses and provided useful information for policy-makers and administrators in Iran's health sector. However, this study also has some limitations as follows: (a) a wide variety of tools used for collecting data; (b) these studies carried out in a small number of cities in Iran, and (c) there was the lack of valuable information for a detailed survey. Further, countrywide and multicenter studies on the prevalence of job stress among Iranian nurses can provide precise and more reliable results.


  Conclusions Top


According to the results of this study, Job stress affects more than a third of the nursing staff in Iran. Therefore, it is important for health-care managers and policy-makers in Iran to identify the causes of the job stress, to reduce it, and develop cost-effective strategies to alleviate it. Health-care managers and policy-makers must prevent this by adopting appropriate strategies such as increasing welfare facilities, reconsidering job descriptions for different nursing levels, providing support, increasing nurses' involvement in the decision-making process, improving communication between managers and nurses, and teaching problem-solving skills to them.

Acknowledgment

The authors gratefully acknowledge the reviewers for their comments.

Financial support and sponsorship

This study was financially supported by the University of Medical Sciences. This article was derived from a thesis research project.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Biglari H, Ebrahimi MH, Salehi M, Poursadeghiyan M, Ahmadnezhad I, Abbasi M. Relationship between occupational stress and cardiovascular diseases risk factors in drivers. Int J Occup Med Environ Health 2016;29:895-901.  Back to cited text no. 1
    
2.
Kisakye AN, Tweheyo R, Ssengooba F, Pariyo GW, Rutebemberwa E, Kiwanuka SN. Regulatory mechanisms for absenteeism in the health sector: A systematic review of strategies and their implementation. J Healthc Leadersh 2016;8:81-94.  Back to cited text no. 2
    
3.
Park J. Work stress and job performance. Perspect Labour Income 2008;20:5-17.  Back to cited text no. 3
    
4.
Eghtedari A. Organization and Management. Tehran: Molavi Pub; 2001.  Back to cited text no. 4
    
5.
Kendall E, Murphy P, O'Neill VB. A Report to the Workers' Compensation and Rehabilitation Commission: Western Australia. Center for Human Services: Griffith University; 2000.  Back to cited text no. 5
    
6.
Shahbazi A, Rahmani N, Abbasi M, Amjad RN, Marioryad H, Khammar AR, et al. Association between occupational stress and risk factors of cardiovascular disease in locomotive operators. Iran Heart J 2018;19:20-6.  Back to cited text no. 6
    
7.
Kingama M. ICN on occupational stress and worker health. J Nurs Matters 2002;1:5.  Back to cited text no. 7
    
8.
Gadirzadeh Z, Adib-Hajbaghery M, Matin Abadi M. Job stress, job satisfaction, and related factors in a sample of Iranian nurses. Nurs Midwifery Stud 2017;6:125-31.  Back to cited text no. 8
  [Full text]  
9.
Hazavehei SM, Moghadam K, Melika S, Bagheri Kholenjani F, Ebrahimi H. The influence of educational interventions to reduce occupational stress: A systematic review. Health Safety Work 2017;7:363-74.  Back to cited text no. 9
    
10.
Mwachofi A, Walston SL, Al-Omar BA. Factors affecting nurses' perceptions of patient safety. Int J Health Care Qual Assur 2011;24:274-83.  Back to cited text no. 10
    
11.
Sorra JS, Dyer N. Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Serv Res 2010;10:199.  Back to cited text no. 11
    
12.
Gao YQ, Pan BC, Sun W, Wu H, Wang JN, Wang L. Anxiety symptoms among Chinese nurses and the associated factors: A cross sectional study. BMC Psychiatry 2012;12:141.  Back to cited text no. 12
    
13.
Mealer ML, Shelton A, Berg B, Rothbaum B, Moss M. Increased prevalence of posttraumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med 2007;175:693-97.  Back to cited text no. 13
    
14.
Chan AO, Huak CY. Influence of work environment on emotional health in a health care setting. Occup Med 2004;54:207-12.  Back to cited text no. 14
    
15.
Ghanei Gheshlagh R, Hosseini MA, Sayehmiri K. Job stress among Iranian nurses: A systematic review and meta-analysis. Sci J Nurs Midwifery Paramed Fac 2017;2:68-75.  Back to cited text no. 15
    
16.
McVicar A. Workplace stress in nursing: A literature review. J Adv Nurs 2003;44:633-42.  Back to cited text no. 16
    
17.
Sharafi H, Gholami P, Sadeghi S, Ghorbani M, Rezaei F. Job stress and related factors among staff of the operation room in Bandar Abbas. Iran J Rehab Res Nurs 2018;4:29-34.  Back to cited text no. 17
    
18.
Esfahani MN, Masoumi B, Mohamadirizi S, Mohamadirizi Sh. Job stress and work ability among emergency nurses in Isfahan, Iran. Nurs Midwifery Stud 2016;6:1-5.  Back to cited text no. 18
    
19.
Moallemi S, Adroom M. Comparison of job stress and job satisfaction amongst nurses of different units. Mil Caring Sci 2016;3:165-73.  Back to cited text no. 19
    
20.
Moher DL, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 2009;151:264-9.  Back to cited text no. 20
    
21.
Mitton C, Adair CE, McKenzie E, Patten SB, Waye Perry B. Knowledge transfer and exchange: Review and synthesis of the literature. Milbank Q 2007;85:729-68.  Back to cited text no. 21
    
22.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.  Back to cited text no. 22
    
23.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34.  Back to cited text no. 23
    
24.
Rahimi A, Ahmadi F, Akhond MR. An investigation of amount and factors affecting nurses' job stress in some hospitals in Tehran. Hayat 2004;10:13-22.  Back to cited text no. 24
    
25.
Mohebbifar R, Kiaei MZ, Khosravizadeh O, Sadeghi T, Hamed A. Job stress and its related factors in nurses of Qazvin University of Medical Sciences. J Med Educ Dev 2015;7:55-63.  Back to cited text no. 25
    
26.
Komeili-Sani M, Etemadi A, Boustani H, Bahreini M, Hakimi A. The relationship between nurses' clinical competency and job stress in Ahvaz university hospital, 2013. Clin Nurs Midwifery 2015;4:39-49.  Back to cited text no. 26
    
27.
Hossini SE, Hossini M. Relationship between job stress, catecholamine and physical diseases in nurses. Hormozgan Med J 2012;16:189-96.  Back to cited text no. 27
    
28.
Karimyar Jahromi M, Hojat M. The Etiology of burnout syndrome and the levels of stress among nurses. J Jahrom Univ Med Sci 2014;12:47-55.  Back to cited text no. 28
    
29.
Mehrabi T, Parvin N, Yazdani M, Rafat NA. A study of the severity of some occupational stresses in nurses. Iran J Nurs Midwifery Res 2007;12:21-4.  Back to cited text no. 29
    
30.
Hazavehei SM, Hosseini Z, Moeini B, Moghimbeigi A, Hamidi Y. Assessing stress level and stress management among Hamadan hospital nurses based on PRECED model. Ofoghe Danesh 2012;18:78-86.  Back to cited text no. 30
    
31.
Bahrami A, Akbari H, Mousavi MG, Hannani M, Ramezani Y. Job stress among the nursing staff of Kashan hospitals. Feyz 2011;15:366-73.  Back to cited text no. 31
    
32.
Noorian C, Parvin N, Mehrabi T. Evaluation of the relationship between occupational stress and general health condition in nurses working in Isfahan university hospitals 2005. J Community Health 2010;1,2:45-52.  Back to cited text no. 32
    
33.
Vahed A, Mardani Hamuleh M, Sanchuli J, Hamedi Shahraki S. Assessment of the relationship between mental health and job stress among nurses. J Jahrom Univ Med Sci 2010;8:34-40.  Back to cited text no. 33
    
34.
Sherbafinezhad J, Lak-Dizaji S, Namdar H, Ghojazadeh M, Fartash Naeimi A. Occupational stressors in nursing. J Nurs Midwifery Tabriz Univ Med Sci 2008;10:26-30.  Back to cited text no. 34
    
35.
Khalilzadeh R, Yavarian R, Khalkhali HR. The relationship of job stress, depression and anxiety of nursing staff of Urmia University of Medical Sciences. J Nurs Midwifery Urmia Univ Med Sci 2005;3:10-7.  Back to cited text no. 35
    
36.
Khodaveisi M, Mohammadi N, Omidi A. Frequency of job stress in clinical nurses. J Nurs Midwifery Hamadan Univ Med Sci 2005;13:44-55.  Back to cited text no. 36
    
37.
Khammar A, Amjad RN, Rohani M, Yari A, Noroozi M, Poursadeghian A, et al. Survey of shift work disorders and occupational stress among nurses: A cross-sectional study. Ann Trop Med Public Health 2017;10:978-84.  Back to cited text no. 37
  [Full text]  
38.
Poursadeghiyan M, Moghimian M, Amjad RN, Baneshi MM, Yari AR, Noroozi M, et al. Effects on job stress on Iranian clinical nurses. Ann Trop Med Publ Health 2017;10:985-88.  Back to cited text no. 38
    
39.
Poursadeghiyan M, Abbasi M, Mehri A, Hami M, Raei M, Ebrahimi MH. Relationship between job stress and anxiety, depression and job satisfaction in nurses in Iran. Soc Sci 2016;11:2349-55.  Back to cited text no. 39
    
40.
Javadi-Pashaki N, Darvishpour A. Survey of stress and coping strategies to predict the general health of nursing staff. J Educ Health Promot 2019;8:74.  Back to cited text no. 40
    
41.
Asefzadeh S, Kalhor R, Tir M. Patient safety culture and job stress among nurses in Mazandaran, Iran. Electron Phys 2017;9:6010-16.  Back to cited text no. 41
    
42.
Mosadeghrad AM. Occupational stress and turnover intention: Implications for nursing management. Int J Health Policy Manag 2013;1:169-76.  Back to cited text no. 42
    
43.
Najimi A, Goudarzi AM, Sharifirad G. Causes of job stress in nurses: A cross-sectional study. Iran J Nurs Midwifery Res 2012;17:301-5.  Back to cited text no. 43
    
44.
Karimi A, Adel-Mehraban M, Moeini M. Occupational stressors in nurses and nursing adverse events. Iran J Nurs Midwifery Res 2018;23:230-34.  Back to cited text no. 44
    
45.
Hosseini Z, Hazavehei MM, Imanzad M, Ghanbarnezhad A, Gharlipour Z. Occupational stress and mental health relationship in nurses. Adv Nurs Midwifery 2014;23:55-62.  Back to cited text no. 45
    
46.
Gorgich EA, Zare S, Ghoreishinia G, Barfroshan S, Arbabisarjou A, Yoosefian N. Job stress and mental health among nursing staff of educational hospitals in South East Iran. Thrita 2017;6:1-6.  Back to cited text no. 46
    
47.
Dehghankar L, Rahimi S, Samiei Siboni F, Mohamadkhani Ghiasvand A, Norouzi Parashkouh N, Jahani Hashemi H. Determinants of job stress for married nurses working in clinical educational hospitals in Qazvin. J Qazvin Univ Med Sci 2017;21:56-64.  Back to cited text no. 47
    
48.
Aoki M, Keiwkarnka B, Chompikul J. Job stress among nurses in public hospitals in Ratchaburi province, Thailand. Indian J Public Health Res Dev 2011;9:19-27.  Back to cited text no. 48
    
49.
Al Hosis KF, Mersal FA, Keshk LI. Effects of job stress on health of Saudi nurses working in Ministry of Health hospitals in Qassim region in KSA. Life Sci J 2013;10:1036-44.  Back to cited text no. 49
    
50.
Mwinga C, Mugala D. Prevalence and causes of stress among nurses at Ndola Central Hospital-A nurses' perspective. Int J Novel Res Healthc Nurs 2015;2:158-65.  Back to cited text no. 50
    
51.
Gheshlagh R, Parizad N, Dalvand S, Zarei M, Farajzadeh M, Karami M, et al. The prevalence of job stress among nurses in Iran: A meta-analysis study. Nurs Midwifery Stud 2017;6:143-8.  Back to cited text no. 51
  [Full text]  
52.
Galletta M, Portoghese I, Ciuffi M, Sancassiani F, Aloja E, Campagna M. Working and environmental factors on job burnout: A cross-sectional study among nurses. Clin Pract Epidemiol Ment Health 2016;12:132-41.  Back to cited text no. 52
    


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