Background:Individuals with physical disabilities are more likely to develop pressure ulcers due to restricted mobility and diminished sensation. Stroke is the most prevalent medical diagnosis associated with pressure injuries. Pressure ulcer (PU) is a common complication associated with strokes. Timely recognition and implementation of preventive measures are essential in preventing the development of pressure ulcers. This study aimed to explore the effectiveness of nursing interventions in preventing pressure ulcers among immobile stroke patients. Materials and Methods:A simple random sampling technique was used to recruit 128 patients; 64 patients were assigned to the control group and 64 to the intervention group. Patients were recruited from the neurological ward at Rizgary Teaching Hospital, Erbil City, Kurdistan region of Iraq, and from the intensive care unit (ICU) at the East Emergency Hospital. Data collection tools included the Braden scale, a risk assessment tool for PUs, and a structured questionnaire. The Chi-square test, logistic regression, and an independent sample t-test were used to analyze the data. The significant level was set as a p < 0.05. Results:Heart diseases, diabetes mellitus, smoking, advanced age, and friction and shear were the main risk factors for PUs development among immobile stroke patients. The nursing educational interventional program was highly effective in reducing the incidence of PUs among immobile stroke patients (t = 4.130, p < 0.001). Conclusions:Appropriate nursing interventions and patient education can significantly reduce the incidence of PUs as well as prolong the development of PUs among immobile stroke patients.
Background:Venous thromboembolism (VTE), encompassing deep venous thrombosis and pulmonary embolism, presents a significant clinical risk for women undergoing surgical intervention for gynecologic malignancies. Enhanced prophylactic strategies are vital to mitigating these complications. This study evaluates the efficacy and safety of oral apixaban compared to subcutaneous enoxaparin for postoperative VTE prevention in this high-risk population. Materials and Methods:This randomized clinical trial was conducted from March 2022 to March 2023. One hundred eligible patients undergoing gynecologic cancer surgery were randomized to receive either oral apixaban (2.5 mg twice daily) or subcutaneous enoxaparin (40 mg daily). The primary endpoints included the incidence of thromboembolic events and bleeding complications, monitored up to 12 weeks postoperatively. Results:This cohort consisted of 48 patients in the apixaban group and 52 in the enoxaparin group. Postoperative complications included vaginal bleeding (8.32% apixaban vs. 3.85% enoxaparin), hematoma (2.15% apixaban vs. 3.85% enoxaparin), and ecchymosis (6.37% apixaban vs. 9.62% enoxaparin). None of these differences achieved statistical significance (p > 0.05). Both groups demonstrated comparably high levels of treatment adherence and patient satisfaction. Conclusions:Apixaban and enoxaparin demonstrated comparable efficacy and safety profiles in preventing postoperative VTE following gynecologic cancer surgery. Given its oral administration route, apixaban may serve as a feasible alternative to enoxaparin, potentially enhancing patient compliance. Further large-scale studies are warranted to validate these findings.
Background:Traumatic childbirth significantly elevates the risk of developing post-traumatic stress disorder (PTSD) and fear of childbirth (FOC). This study aimed to investigate the effects of a psychoeducational intervention, incorporating relaxation training, on PTSD and FOC in pregnant women with a history of traumatic childbirth. Materials and Methods:This randomized controlled trial included 70 pregnant women in Hamadan, Iran, with a history of traumatic childbirth. Participants were randomly assigned to either an intervention group (n = 35) or a control group (n = 35). The intervention group underwent an 8-session psychoeducation protocol that integrated relaxation training, delivered between 24 and 32 weeks of gestation, while the control group received standard prenatal care. PTSD symptoms were assessed using the PSS-SR, and FOC was measured with the CAQ at baseline and at 36 weeks of gestation (4 weeks' postintervention). Data analysis was conducted using ANCOVA in Stata-13. Results:Four weeks' postintervention, the intervention group exhibited a statistically significant reduction in PTSD scores compared to the control group (adjusted mean difference: -9.23; 95% CI: -11.28, -7.18; p < 0.001; Cohen's d = 2.29). Similarly, FOC scores were significantly lower in the intervention group (adjusted mean difference: -5.02; 95% CI: -7.00, -3.05; p < 0.001; Cohen's d = 1.30). Conclusions:A structured psychoeducational intervention for childbirth preparation that incorporates relaxation training effectively alleviates PTSD symptoms and reduces fear of childbirth in pregnant women with a history of traumatic childbirth. The substantial effect sizes observed underscore its clinical relevance.
Background:Although effective communication between midwives and mothers is linked to positive physiological and emotional outcomes, research on this topic within maternity wards remains limited, and both perspectives have not been adequately explored. A comprehensive understanding of these perceived impacts is essential to highlight the importance of communication in maternity care. This study aims to explore the perceived impacts of effective midwife-mother communication in the maternity ward. Materials and Methods:A qualitative approach was adopted to explore perceptions of effective midwife-mother communication using the conventional content analysis method. Semi-structured interviews were conducted between July and October 2023 with 11 midwives and 12 postpartum mothers in the maternity wards of Ahvaz, Iran. Participants consisted of midwives working in maternity units and mothers who had experienced vaginal births, selected through purposive sampling. Data were analyzed using a thematic analysis approach. Results:Thematic analysis revealed one central theme: the rebirth of the meaning of natural childbirth, supported by three themes: 1) reshaping mothers' beliefs and attitudes toward childbearing, 2) meaning-making in natural childbirth, and 3) improving the quality of midwifery services. Conclusions:Effective communication between midwives and mothers can help restore values and positive emotions and redefine the meaning and experience of natural childbirth. It is recommended that comprehensive frameworks or guidelines for effective communication be developed and integrated into midwifery curricula, training programs, and clinical interventions. Future studies should focus on communication processes and barriers across different maternity care settings to identify effective practices and areas for improvement.
Background:The COVID-19 pandemic has placed significant physiological, physical, and psychological burdens on populations worldwide. Childbearing, as a fundamental aspect of human life, can be negatively affected during such crises. This study aimed to evaluate the impact of the COVID-19 pandemic on miscarriage rates and to investigate the potential association between spontaneous abortions and maternal blood groups. Materials and Methods:A retrospective analytical cross-sectional study was conducted using 8,613 hospital records from two healthcare centers in Ramsar and Tonekabon, Iran. Miscarriage rates were analyzed relative to total delivery requests during the pre-pandemic (2017-2019) and pandemic (2020-2022) periods. In the second phase, unexplained spontaneous abortions were examined in relation to maternal ABO and the Rhesus factor (Rh) blood groups across both periods. Results:The analysis revealed a significant increase in miscarriage rates during the pandemic, despite a general decline in delivery requests. In the study sample, blood group distribution was A: 29.86%, B: 21.53%, O: 43.06%, and AB: 5.56%, while 9.72% were Rh-negative and 90.28% Rh-positive. Although abortions appeared more common in certain blood groups (notably B and O), statistical analysis showed no significant association between miscarriage and maternal individual blood types before or during the pandemic. Conclusions:The findings suggest that physiological and psychological stressors during the pandemic may have contributed to increased miscarriage rates. Health systems should implement integrated strategies, including mental health support and enhanced prenatal care, to reduce adverse pregnancy outcomes during pandemics or similar crises.
Background:Hypertension is a major public health challenge, and low self-efficacy undermines adherence to lifestyle change and treatment. Family-centered empowerment may strengthen self-efficacy, yet evidence in Iranian patients with hypertension is limited. This study evaluated the effect of a family-centered empowerment program on self-efficacy in adults with hypertension. Materials and Methods:In this randomized clinical trial (Zahedan, Iran; November 2020-September 2021), 70 patients were randomized 1:1 to intervention (four weekly 60-min family-centered empowerment sessions with a primary caregiver) or usual care. The primary outcome was hypertension self-efficacy (17-item validated scale) measured at baseline, immediately post-intervention, 1 month, and 3 months. Repeated-measures analysis of variance (ANOVA) tested time, group, and time × group effects; partial eta squared (η 2 p) and Cohen's d complemented p values. Results:Groups were comparable at baseline (all p > 0.05). Repeated-measures ANOVA showed a significant time × group interaction for total self-efficacy (F = 148.72, p < 0.001; η 2 p ≈ 0.69). The intervention group improved across all time points, whereas the control group remained largely stable. At 3 months, total self-efficacy was 53.40 (2.87) (intervention) versus 46.48 (3.64) (control; p < 0.001; Cohen's d = 2.11). Similar patterns were observed for dietary adherence (32.22 (1.30) vs 28.45 (2.13); p < 0.001; d = 2.14), treatment adherence (12.88 (1.45) vs 11.65 (1.69); p < 0.001; d = 0.78), and disease management (8.28 (0.98) vs 6.37 (1.00); p < 0.001; d = 1.93). Conclusions:A structured family-centered empowerment program meaningfully increased self-efficacy in patients with hypertension over 3 months, with large effect sizes across total and domain scores. Given its cultural fit and low resource needs, integrating this model into routine nursing practice may enhance hypertension self-management.
Background:Pediatric patients often experience significant distress and discomfort during intravenous (IV) cannulation. The noninvasive vibratory buzzy device, which utilizes vibration technology, has emerged as a potential solution for mitigating procedural pain in children. However, its application and effectiveness have not been investigated in the United Arab Emirates. Materials and Methods:This quasi-experimental study was conducted among children (aged between two and six years) on admission. The children were selected consecutively and assigned to either the intervention group (IVG) or control group (CG). The IVG (n = 5) had the buzzy vibration applied proximal to the IV insertion site along with routine care, while the CG participants (n = 51) received only routine care. Pain level was assessed using the face, legs, activity, cry, and consolability (FLACC) scale before and during IV catheter insertion. Results:Results showed that 31 (62%) of children in the IV group were between four and six years old. The pre-intervention FLACC scores in the IVG indicated moderate pain in 21 (41%), mild pain in 20 (39%), and severe pain in 9 (18%). During the intervention, the IVG experienced mild-to-no pain, whereas the CG reported mild-to-moderate pain. A significant negative correlation between pain score and age was observed in the CG (r = -0.2, P = 0.037), indicating higher pain scores in younger children. Conclusions:Vibratory stimulation using a noninvasive buzzy device effectively reduced procedural pain during cannulation.
Background:Breast cancer represents a major public health concern and is associated with significant psychological challenges. This study aimed to evaluate the effect of a mobile health (mHealth) intervention on fatigue and body image fear among breast cancer survivors. Materials and Methods:This randomized controlled trial was conducted with 104 women with breast cancer in Mazandaran Province, Iran during 2023-2024. Participants were randomly assigned to an intervention group (n = 52) or a control group (n = 52). The intervention was delivered through social media platforms. Data were collected at pretest, post-test, and follow-up using a demographic questionnaire, the Cancer Fatigue Scale (CFS), and the Littleton Body Image Concern Inventory (BICI). Independent t-tests, ANCOVA, and repeated-measures ANOVA were used for data analysis at a 0.05 significance level using SPSS software. Results:The mean (SD) age of participants was 51.43 (8.47) years, and 91 (87.50) had a diploma-level education or lower. Results showed that body image fear and fatigue scores at post-test and follow-up were significantly lower in the intervention group compared to the control group (F = 300.1, p < 0.001). Post hoc tests indicated that the mean total fatigue score in the intervention group differed from the control group by 8.83 points, and the mean total body image fear score differed by 19.30 points. Conclusions:The findings demonstrate that the mHealth intervention had a positive effect on reducing fatigue and body image fear in breast cancer survivors. These results support the incorporation of mHealth as an effective approach within the health sector for decision-making and policy development.
Background:Long COVID, a chronic and multisystemic consequence of coronavirus infection, significantly reduces patients' quality of life due to persistent symptoms. Transitional care (TC) is essential to ensure continuity and coordination of care and to reduce the risk of hospital readmissions. This study aims to identify the barriers to providing effective TC for long COVID patients within the Iranian healthcare system. Materials and Methods:This qualitative descriptive study used thematic analysis. Participants-10 long COVID patients, 5 family caregivers, and 16 healthcare providers-were selected via purposeful sampling from outpatient clinics and rehabilitation centers affiliated with Isfahan University of Medical Sciences, Iran. Between November 2022 and May 2023, 33 semistructured, in-depth interviews (30-40 min each) were conducted, audio-recorded, transcribed verbatim, and analyzed using MAXQDA (v. 20) until data saturation. Trustworthiness was ensured using Guba and Lincoln's criteria. Results:Barriers to effective TC for long COVID patients were systematically classified into three main themes with 10 subthemes. The main theme included inefficient healthcare infrastructure, nonintegrated management, and lack of comprehensive continuous care. Conclusions:The findings revealed that the Iranian healthcare system lacks integrated TC for long COVID patients. Addressing these barriers requires policy-level reforms, standardized care pathways, and investment in community-based and rehabilitation services. Strengthening TC could bridge the current gaps and significantly improve outcomes for long COVID patients in Iran. The findings provide insights into structural and operational challenges in TC delivery and highlight the need for policy reforms to improve outcomes for long COVID patients.
Background:The surgical creation of an ostomy can substantially affect patients' daily functioning and quality of life (QoL). However, no previous study has evaluated QoL among ostomy patients in Iraq, and the influence of demographic and clinical factors remains insufficiently explored. Materials and Methods:This cross-sectional study included 200 ostomy patients recruited from three oncology centers in Baghdad, Iraq. QoL was assessed using the City of Hope-Quality of Life Ostomy Questionnaire (CoH-QoL-OQ). Associations between demographic and clinical variables and QoL were analyzed using multivariate analysis of covariance (MANCOVA), adjusting for age and sex. Results:Based on the total QoL score, none of the patients had a good QoL; 92.00% had moderate QoL and 8.00% had low QoL. Patients aged ≥48 years had lower overall QoL compared with younger patients (η² =0.05, p = 0.001). Lower QoL was also observed in patients with malignant tumors before surgery (η² =0.10, p < 0.001) and those receiving chemotherapy after surgery (η² = 0.07, p = 0.001). Social QoL differed significantly across marital status, ostomy type, tumor type, and treatment methods (all p < 0.01). Conclusions:Iraqi ostomy patients experience low-to-moderate QoL. Age, marital status, ostomy type, tumor malignancy, and postsurgical treatment methods are significant determinants of QoL in this population.
Background:Abortion is one of the most complex and controversial issues in ethics, legislation, and health. Strict abortion restrictions and population growth policies have increased the complexity of abortion in Iran. Thus, this study aimed to explore women's attitudes toward Elective Abortion (EA). Materials and Methods:This exploratory qualitative study was conducted between January and September 2024. Participants included 20 women (aged 15-49 years) with no previous history of abortion, purposively selected from eight healthcare centers in Hamadan, Iran. Data were gathered through in-depth, semi-structured interviews, and analyzed through Graneheim and Lundman's conventional content analysis. Trustworthiness was ensured according to Guba and Lincoln's criteria. Results:The five main themes regarding factors influencing women's attitudes toward EA included moral and religious beliefs, violation of the right to live, sheer panic, modern rethinking, and an insecure future. The 10 categories of these themes were God's will, respectability of life, EA as antisocial behavior, EA as murder, heavy penalty, physical, and mental consequences, changes in values, ambiguities in maternal roles, socioeconomic insecurity, and familial insecurity. Conclusions:Moral and religious beliefs, fears, and personal, socioeconomic, and value changes can influence women's attitudes toward EA. Therefore, implementing multifaceted strategies in shaping reproductive health policies, emphasizing individual, economic, and social components, is essential for the assessment and management of EA.
Background:Family and society, as key sources of support in the patient adaptation process, can play a substantial role. However, the contribution of family and society to patients' coping methods, encompassing both positive and negative effects, has not been sufficiently studied. This qualitative study explores the challenges of living with scleroderma, the related strategies, and the dual impact of family and society on patients' coping strategies. Materials and Methods:This study was conducted using a qualitative approach with conventional content analysis in 2023-2024. Data were collected via semi-structured interviews with 22 patients and eight family caregivers who were selected through purposive sampling in Ahvaz, Iran. The interviews continued until data saturation was achieved. All interviews were analyzed using Graneheim and Lundman's approach. Results:The findings included eight categories and 22 subcategories. The categories include the following: disrupted cohesion and functional breakdown, psychological stressors, family support dynamics, disrupted support circles, dynamic social support, gaps in the society support network, comprehensive care management, and maladaptive coping mechanisms. Conclusions:This study highlights the absence of an independent scleroderma association in Iran and underscores the role of nurses, evidence-based platforms, and media advocacy in amplifying patients' voices. Addressing stigma, cultural misconceptions, social isolation, and financial hardship requires targeted interventions and policymaking. Particularly, nursing interventions, through educational workshops and innovative tools such as AI-based platforms, can enhance patients' social and informational support.
Background:Infertility is a life-altering condition that not only affects reproductive capacity but also deeply disrupts emotional intimacy and marital stability in couples. Understanding couples' experiences of changes in marital relationships following infertility can be valuable for healthcare providers' care planning. This study aimed to explain the experiences of infertile couples regarding sexual issues and intimate relationships. Materials and Methods:This study was conducted using a qualitative content analysis approach based on the method proposed by Graneheim and Lundman. Data were collected through semistructured interviews with 14 infertile couples using purposive sampling at the infertility treatment center of Birjand University of Medical Sciences, Birjand, Iran. Coding and classification of data were performed using MAXQDA 2020. Results:The results indicated the negative impact of infertility on marital life and intimate relationships between couples, which can be understood by the four categories that emerged from the data: shock to marital life, couple's intimacy downhill, diminished bed-life pleasure, and prescribed, instead of pleasurable sex. Conclusions:This study highlights the profound impact of infertility on couples' sexual and intimate relationships, emphasizing the need for holistic treatment approaches. Healthcare providers-especially nurses and infertility counselors-should incorporate psychosexual support into routine infertility care. By offering culturally sensitive counseling and facilitating open communication between partners, professionals can help couples preserve emotional intimacy and marital stability throughout the treatment process.
Background:Horizontal violence (HV) in healthcare settings refers to any type of violence among healthcare providers and is a serious challenge in nursing. Many different factors may put nurses at risk for HV. This study aimed to explore the antecedents of HV among nurses. Materials and Methods:This qualitative content analysis was conducted in 2022-2023. Participants were 15 nurses purposefully selected from five hospitals affiliated to Hamadan University of Medical Sciences, Hamadan, Iran. In-depth semistructured interviews were conducted for data collection. The main interview question was, "Have you ever experienced HV in your relationships with your colleagues?" Graneheim and Lundman's conventional content analysis was used for data analysis. Results:The antecedents of HV among nurses were grouped into two main categories, namely, nurses' personality traits and the violence-laden culture of nursing. The subcategories of specific personality traits were bullying personality and oppressed personality, and the subcategories of the violence-laden culture of nursing were managers' discriminatory and unjust behaviors and the tense work atmosphere of nursing. Conclusions:Nurses' personality traits, managers' discriminatory and unjust behaviors, and the tense work atmosphere of nursing are among the most important antecedents of HV among nurses. These factors can negatively affect nurses' physical, mental, emotional, and social health, reduce their job motivation, lead to their intention to quit nursing, and undermine care quality.
Background:There is growing evidence that routinization in nursing care is a concerning issue that directly affects the quality of nursing care and nurses' ability to be creative and innovative in care, flexibility, and ability to provide individualized care, and comprehensiveness in care at the global level. This study aimed to identify factors associated with routinization in nursing care. Materials and Methods:The method of Whittemore and Knafl was employed to conduct this integrated review, which consisted of five stages: identification and determination of the purpose, search for sources, data evaluation, data analysis, and results presentation. Evidence search was conducted using the keywords nursing care, routine, routines, routinization, and their Persian equivalents separately or in combination using the AND and OR operators in the databases PubMed, Web of Science, CINAHL, Scopus, SID, Medex, Magiran, and IranDoc from the beginning to October 2024. After screening and checking for eligibility, the articles were evaluated using the Joanna Briggs Institute's critical appraisal tools. Results:A total of 23 articles met the inclusion criteria and were included in the final review. The most important factors affecting routinization were categorized into 4 categories: individual factors, organizational factors, communication factors, and patient-related factors. Conclusions:The results of this study indicate the need for critical interventions to address factors that can influence routinization in nursing care. Overall, studies highlight the complexity and dependence of routinization in care on various factors, including workload, work environment, and nurse characteristics.
Background:Investigating the status of nurse-patient communication in Palliative Care (PC) and understanding the factors affecting it helps to provide effective patient-centered care and optimize care strategies in PC settings. Therefore, this review was conducted with the aim of determining the status of nurse-patient communication in PC and factors affecting it. Materials and Methods:This systematic search was conducted in both Iranian and international databases, including Scientific Information Database (SID), Magiran, Scopus, Web of Science (WOS), Public Medical Database (PubMed), and ProQuest, using keywords: "Palliative Care" AND "Communication" AND "Nurses" to find related articles published until 2024. Inclusion criteria for the articles included original studies whose results focus on nurse-patient communication in PC. Results:Nurses do not communicate comfortably and effectively with patients in the PC setting, especially in conversations related to advanced care plans, end-of-life care, and prognosis. This communication is influenced by factors such as trust issue between patient and nurse, individual preparation of nurse and patient, effective collaboration between nurses and physicians, the nurse's skill in being a good listener and establishing empathetic interaction with patient, and allocation of sufficient time for nurse-patient communication. The use of structured communication models, such as Sage and Thyme, Comfort, can help nurses to be a more effective communicator. Conclusions:The results of present study showed that nurses do not have effective conversations with patients in the context of PC. Therefore, in order to improve nurses' communication skills, training programs are suggested to be designed and implemented in accordance with the identified needs of nurses in relation to difficult conversations with patients.
Background:High turnover among newly graduated nurses poses a serious challenge to healthcare systems, contributing to staff shortages, compromised patient safety, and increased operational costs. This narrative review aimed to identify the key factors influencing turnover intention in this group. Materials and Methods:This narrative review involved a literature review across the Science Direct, SID, Google Scholar, Scopus, PubMed, and Magiran databases for English and Persian language studies published between 2010 and 2022, ultimately selecting 19 relevant studies. The findings revealed that both individual and organizational factors play significant roles in shaping nurses' decisions to leave their jobs. Results:Turnover intention among newly graduated nurses was influenced by distinct individual and organizational factors. On the individual level, risk factors included emotional instability, sleep disturbances, job-related stress, poor communication with patients, insufficient clinical skills, role conflict, and role ambiguity. Protective factors that reduced turnover intention were strong professional commitment, conscientiousness, and psychological capital such as resilience and optimism. Organizational factors also had a major impact. High workload, workplace bullying, rude or unprofessional colleagues, and lack of adequate resources increased the likelihood of turnover. In contrast, supportive leadership and positive workplace relationships helped retain newly graduated nurses. Conclusions:We recommend that policymakers establish safe staffing ratios and antibullying policies, managers prioritize leadership development and clinical resources, educators enhance communication training, and institutions implement resilience programs and mentorship. These evidence-based actions are essential to improve nurse retention and advance patient care quality through a stable nursing workforce.
Background:Health behavior encompasses the behaviors and decisions individuals make regarding their daily activities, which can impact their health and well-being. This study aimed to explore the application and effectiveness of Nola Pender's health promotion model in nursing practice. Materials and Methods:This narrative review was conducted between 2018 and 2022. The keywords, such as "Nola, Pender," "lifestyle," "effectiveness," and "Nursing," were used, both in English and Spanish. These keywords were individually searched in international databases, such as Scielo, PubMed, Science Direct, and Google Scholar. Inclusion criteria were full texts of original articles and articles related to the use and effectiveness of the Nola Pender model in nursing practice. Studies with abstracts only, other nursing models, duplicates, or insufficient methodological rigor were excluded. Each article was evaluated for methodological rigor, clarity of objectives, study design, and relevance to nursing. A total of 32 articles met the criteria. Results:The analysis of the selected documents identified applications of the model in the promotion of eating habits, sexual and reproductive health, management of arterial hypertension, chronic obstructive pulmonary disease, participation in community activities and lifestyles in general. The Pender model proved to be effective in adherence to treatment, stress management and cardiovascular disease, hand hygiene, smoking reduction, and exercise promotion. Conclusions:The scientific literature analyzed shows the effectiveness of the Nola Pender model in nursing practice for health-promoting behaviors both individually and collectively. The model proposed by Pender provides different strategies with beneficial results for the health and well-being of people.
Background:The COVID-19 pandemic has resulted in a severe shortage of nurses in health care systems worldwide. The first and acute phase of COVID-19 was challenging for health systems due to the unknown nature and complexity of the disease. This study aimed to extract the factors that influenced the shortage of nurses during the first and the acute phase of COVID-19. Materials and Methods:Based on the PRISMA guidelines, a systematic search was conducted in PubMed, ScienceDirect, Cochrane, Scopus, and Web of Science databases from the start of the COVID-19 outbreak to 2021. Studies were screened separately; the inclusion criteria were applied. The risk of bias was assessed with the Hoy tool, and data extraction was conducted. Factors were extracted and categorized by thematic analysis. Results:In total, 1035 studies were found. Finally, 11 original papers met the eligibility criteria. Most studies (seven) were cross-sectional. After thematic analysis, the results showed that the nursing shortage during the COVID-19 outbreak can be attributed to three main categories: 1) The pandemic perceived threat, 2) Internal and External Factors, and 3) Professional and Psychosocial Support. Conclusions:This study highlighted the need for the healthcare system to switch from reactive crisis management to proactive and resilient strategies. To prevent nurse burnout and attrition and guarantee the continuity of care in future emergencies, it is essential to plan to address perceived threats and strengthen support systems in addition to implementing multilevel interventions in organizational and psychological domains. This integrated strategy will convert vulnerability into readiness and resilience.
