Received: 24 May 2021 | Revised: 1 August 2021 | Accepted: 16 August 2021

DOI: 10.1111/nuf.12644

RESEARCH MANUSCRIPT

Explaining nurses' experience of stresses and coping

mechanisms in coronavirus pandemic

Azam Ghorbani PhD1 | Mahboobeh Shali PhD2 | Pegah Matourypour PhD1 |

3 4
Ehsan Salehi Morkani BS | Mohammad Salehpoor Emran MS |
Alireza Nikbakht Nasrabadi PhD1

1
Department of Medical Surgical Nursing,
School of Nursing and Midwifery, Tehran Abstract
University of Medical Sciences, Tehran, Iran
Introduction: Nurses face several stresses during a pandemic. Therefore, it seems
2
Department of Critical Care Nursing and
Nursing Management, School of Nursing and
necessary to use appropriate adaptation and coping methods to reduce the de-
Midwifery, Tehran University of Medical structive effects of physical and psychological stresses. This study aimed to explain
Sciences, Tehran, Iran
nurses' experience of stresses and coping methods used for care of patients with
3
Isabn‐e‐Maryam Hospital, Isfahan University
of Medical Sciences, Isfahan, Iran Covid‐19.
4
Department of Community Health Nursing, Method: A qualitative approach with descriptive phenomenological method was
School of Nursing and Midwifery, Tehran applied in this study. Sixteen nurses working in hospitals were selected by purposeful
University of Medical Sciences, Tehran, Iran
sampling. Through in‐depth, individual and semi‐structured interviews, the nurses
Correspondence shared their experiences in caring for Covid patients. The transcripts of recorded
Alireza Nikbakht Nasrabadi, PhD, School of
interviews were typed verbatim and then analyzed based on Colaizzi's method.
Nursing and Midwifery, Tehran University of
Medical Sciences, Tehran, Iran, Tehran Results: Four main categories and 12 subcategories, which were named conceptually
University of Medical Sciences, Tohid Sq,
based on their nature were shaped. The main categories included; self‐support in the
1419733171 Tehran, Iran.
Email: Nikbakht@tums.ac.ir midst of crisis, sheltered by family from distance, hospital influence in the
environment, and social support on both sides of infinity.
Funding information
Tehran University of Medical Sciences and Conclusion: Although healthcare workers have accepted the exposure to Covid‐19
Health Services : 99210048398 as part of their profession, provision of quality care in crisis situations is not possible
without supporting the healthcare workers and paying attention to their mental
health. It is recommended to take a precise approach to predict, recognize and
manage psychological harms of healthcare workers.

KEYWORDS
adaptation, Covid‐19, nurse, phenomenology, stress

1 | INTRODUCTION
The coronavirus has now become a major global health problem,
which affects all nations, all continents, and all races.1 Healthcare
workers bear the main burden of pandemics, and unfortunately many
of them become infected and die from the disease, and this increases
their psychological stress.2 Studies have shown that nurses who deal
3 4,5
with emerging diseases such as SARS, MERS, Ebola, H1N1
suffer from problems like loneliness, isolation, anxiety, fear, fatigue,
and sleep disorder, as well as other physical and mental problems like
occupational stress.
Occupational stress imposes high costs on employees and or-
ganizations, and is associated with poor organizational efficiency,
increased resignation, occurrence of various physical and mental
disorders, frequent sick leave, increased work accident, poor staff
performance, and reduced job satisfaction.8,9 If the occupational
6 7
stress is not identified in nurses and no measure is taken to prevent it,
it will have irreparable consequences. These tensions and stresses

Nursing Forum. 2021;1–8. wileyonlinelibrary.com/journal/nuf © 2021 Wiley Periodicals LLC | 1

2 |
affect the relationship between clients and the nurses and sometimes
increase treatment costs and, most importantly, cause job burnout in
nurses. 10
Therefore, in the process of pandemics, multidimensional
social support, cognitive evaluation, provision of guidance for posi-
tive coping strategies and stimulation of positive emotions, and
adaptation to new conditions caused by pandemics are important
measures that can be taken to promote the nurses' mental health.2
Adaptation, in the general sense, refers to all strategies for
managing stressful life situations, both real and unreal threats, in
which a person uses his power and support of others11 to strengthen
his physical and mental health.12 Therefore, getting acquainted with
methods of coping with and overcoming stress can help promote
mental health and increase the effectiveness and productivity of
human resources.
Given the fact that nurses' experiences and perceptions are
formed as a result of constant exposure to real‐world situations,
understanding their feelings and experiences in regard to job stress
and their methods of adaptation to these stresses, particularly during
the Covid‐19 pandemic, is very important and necessary. In fact, by
studying these experiences and elucidating their obvious and hidden
aspects, it is possible to analyze them. To reach such an under-
standing, specific research methods, such as qualitative approach, are
needed in nursing that allow for a comprehensive review and analysis
of personal experiences. Also, since in this study, the research team
had experience working with covid patients and had dealt with these
tensions closely and tangibly, the topic of this study was the subject
of interest for them. Therefore, this qualitative study was conducted
to explain the stresses and coping mechanisms used by nurses in
caring for covid patients using their lived experience and work culture
in the current situation, as they work at the front line of fight against
Covid‐19 pandemic.
2 | M E TH O D
According to the main research question, which is related to the
nurses' lived experience of stresses and coping mechanisms, philo-
sophy and phenomenological method were used as an appropriate
13
and selective approach for this study. This study was conducted
during December to March 2020. The research environment con-
sisted of teaching hospitals affiliated to University, and the place of
interview was determined in coordination with the participants. In
this study, purposeful sampling method was used to select the eli-
gible participants. Accordingly, speaking Persian, having a bachelor's
degree in nursing, having no hearing or speech problem, having ex-
perience of caring for patients with coronavirus, and willingness to
share personal experiences voluntarily and consciously were among
the criteria for entering the study.
In qualitative research, the number of participants in the study is
not predetermined and sampling continues until reaching data sa-
turation, which was obtained in the present study after 14 interviews
with nurses. In this study, semi‐structured and in‐depth interviews
were used to collect information. To eliminate the researcher's bias
GHORBANI ET AL.
and presumptions, key questions were asked during the interview.
The interview questions included: “What does come to your mind
when you hear the word stress in a pandemic”? “What does stress in
caring for a patient with Covid‐19 mean to you”? “Do you remember
the cases of your stress while caring for covid patients”? “When you
were experiencing stress, what mechanisms did you used to cope
with the stress”? “What factors do you think have influenced or could
have influenced the situations you have experienced”?
Exploratory questions such as “Can you explain more?” and
“What do you mean?” were also used during the interviews. The
duration of each interview was between 45 and 70 min and the first
researcher personally conducted all the interviews to increase the
data integrity.
Colaizzi's seven‐stage method was used to analyze the data. At
the first stage, each interview was recorded, transcribed verbatim,
and reviewed several times to get a sense of the whole. At the
second stage, important sentences were extracted by underlining
method. At the third stage, the initial codes were extracted. At the
fourth and fifth stages, the developed concepts were divided into
sub‐concepts and the results were turned into main themes, re-
spectively. At the sixth and seventh stages, a comprehensive and
unambiguous description of the phenomenon was developed, and
then validated by presenting some of the results and extracted
concepts to the participants (member check) to be confirmed by them
and in a case of ambiguity, some corrections were made.14 In quali-
tative studies, the process of data validation is obtained by providing
the participants with some of the extracted codes and classes for
conformation.14 The coding was done simultaneously and in-
dependently by first and second authors, and 90% agreement was
reached between them. Finally, the codes, categories and themes
obtained by the research team were discussed in group discussion
and finalized. Data were analyzed by MAXQDA software version 10.
Considerations of rigour and trustworthiness were addressed
by adopting Guba and Lincoln's (1985) guidelines.15 Credibility was
established using member and peer‐checking, reviewers' pro-
longed engagement with data, and maximum variance in partici-
pant selection. Regarding member‐checking, part of the interviews
and codes were also presented back to the participants for review
to ensure that the data reflects the real experiences and percep-
tions of the participants. For peer‐checking, the interrater agree-
ment between reviewers was calculated and approved. We
considered transferability through providing a rich description of
data collection, analysis processes, and findings. This method en-
hances the applicability and generalizability of results in other si-
milar contexts.
Ethical principles observed by the researchers in this study in-
cluded; obtaining an approval from the Institutional Review Board of
Tehran University of Medical Sciences (coded: IR.TUMS.MEDICI-
NE.REC.1399.629), obtaining informed consent from the participants
before entering the study, giving participants the right to withdraw
from the study at any time, maintaining anonymity and confidentiality
of information, and providing results to the participants at their
request.
GHORBANI ET AL. | 3

3 | F I ND I NG S 3.2 | Prioritizing physiological needs

Sixteen nurses Participated in this study Nine participants were
female and seven were male with a mean age of 42 ± 3.1 years
and work experience of 18 ± 6.3 years. After data analysis, 301
primary codes were extracted. The main theme of this study was
the evolving support circle, and information were classified in
four main categories of self‐support in the midst of crisis,
sheltered by family from distance, hospital influence in the
environment, and social support on both sides of infinity.
The main categories consisted of 12 subclasses, which are
described below (Table 1).
3.1 | Self‐support in the midst of crisis
Various factors create stress during an outbreak of a disease, which
can endanger the physical and mental health of nurses. Ignoring
physiological needs, ambiguity caused by an unknown disease, and
lack of information about the new disease were the sources of stress.
In this study, self‐support was one of the most important methods of
coping with stress caused by Covid‐19 pandemic. Study participants
used a variety of coping methods such as prioritizing physiological
needs, creating a positive perception of a vague future, adapting to
stress over time, increasing information in response to the crisis, and
relying on divine help.
One of the common experiences of all nurses in caring for covid
patients was negligence to address physiological needs.
“We could not eat easily. At that time, for example, we re-
luctantly ate a fruit juice. For a simple sleep, we did not dare to lie on
our bed because we were scared of being infected with the virus. But
we had to eat and rest so we could continue.” (P4).
As time went on and the importance of strengthening the im-
mune system against covid‐19 became clear, nurses adopted stra-
tegies to improve their physical condition during and after the shift
at home.
“I remember at the first few days the children were not eating
anything from morning to noon due to the fear! But little by little they
get used to it. They began to bring fruit juices or snacks. It is very
difficult to breathe under these masks, and it makes the throat very
dry, so we have to use more liquids. Of course, the conditions are
difficult and we wash and disinfect our hands a lot.” (P5).
3.3 | Creating a positive image of a vague future
Being at the forefront of fight against a new virus that is highly
transmissible and carries the risk of death, and also for which there is
no specific treatment, had created a confusing situation for nurses.
“We did not know what was going to happen. We came to work and
saw they have provided some special clothing for us, which we had to
wear when taking care of patients infected with Covid‐19 dis-

T A B L E 1 Extracted main theme, categories and subcategories of ease.” (P2).

data analysis In the current situation, nurses tried to self‐regulate, think po-
sitively and provide a clear vision of the future to deal with the crisis.
Theme Main categories Subcategories
“We were afraid of where the world is going towards, but we
The evolving Self‐support in the Prioritizing physiological needs
could do nothing, so we tried to cheer each other up with positive
support circle midst of crisis
Creating positive image of a ideas and predictions.” (P4).
vague future

Adapting to stress over time

increasing information in 3.4 | Adapting to stress over time

response to the crisis

Relying on and believing in According to the participants' experiences, people's reaction to

divine help Covid‐19 has changed over time and people's sensitivity and fear of

Sheltered by family Parental support the disease has decreased.

from distance “Nothing special happened. Over time, the fear became much
Spouses: hesitant companions
less. The staff got to know the disease more and their stress level
Distanced loved ones decreased.” (P6).
Hospital influence Stressful hospital atmosphere
in the
Hospital support
environment
3.5 | Increasing information in response to the
Social support on Cyberspace: Is it poisoning the crisis
both sides of mind or increasing
infinity awareness?
One of the factors that cause stress and tension in dealing with a
People; from appreciation to
pandemic is the lack of accurate information about the disease. This
negligence
information requirement, especially at the beginning of a pandemic,
4 |
forces the treatment team to obtain up‐to‐date information they
need from scientific sources to care for patients.
“Every day a lot of articles are published describing more com-
plicated things about the virus. Well, I read these articles every day.
Almost every day, I am following the information provided by every
article in the WHO's website.” (P1).
3.6 | Relying on divine help
Although increasing information, emphasis on physiological needs,
and creating positive thinking have been identified as personal stra-
tegies for coping with pandemic stress, participants had a special
place for spirituality in dealing with the pandemic. Reliance on God
and spirituality was one the strategies used by nurses in this study for
coping with stress.
“I will observe the protocols as much as I can and leave the rest
to God.” (P14).
“Patience and relying on God were the only factors that at least
kept me going during that time and helped me to endure the situa-
tion.” (P1).
3.7 | Sheltered by family from distance
In all participants in this study, the stress caused by the possibility of
family members becoming infected with Covid‐19 was much more
pronounced than they themselves. Fear of injury to family members,
parents, spouses, or children, and sense of remorse that comes from
transferring the disease from hospital to family were the greatest
stress experienced by the participants. In contrast, encouragement
and family support has had a positive effect on nurses' adaptation to
stress. The family has been introduced as a strong and reliable in-
stitution in helping nurses adapt to the job stress.
3.8 | Parental support
One of the causes of stress during the pandemic was the possibility
of being a carrier and the fear of infecting family members. Most
nurses distanced themselves from their families to protect them and
minimized contact with them. On the contrary, this distance had
created tension and nostalgia in the nurses.
“The nurses were more concerned about their family than
themselves and one of their requests was a place where they could
stay and do not go home! Some of them really did not go home for
two or three months. All they had was phone and video call. In short,
they were all mentally disturbed.” (P2).
However, the support and encouragement of parents have been
the real incentive for healthcare workers in coping with existing
stresses and providing the best possible care to patients with
Covid‐19.
GHORBANI ET AL.
“I wanted to resign because of my parents' health and stay at
home and take care of them, but my father said you are a soldier
and now your country is at war with the disease and needs
you.” (P4).
3.9 | Spouse; a hesitant companion
According to the participants' experiences, the behavior of spouses
due to the fear, ignorance, and anxiety about the disease and the
spread of infection to the family was one of the factors that caused
stress in nurses.
“When my husband heard that, the hospital I work in has become
a referral center for Covid‐19, he completely separated himself from
us. He was in a complete stress.” (P13).
Even the spouses of some staff objected their work. This dis-
satisfaction doubled the stress for nurses.
“We had many cases among our colleagues, whose families,
especially their husbands, called and objected. One or two persons
did not allow their spouses to come to work!” (P2).
Given the important role of the spouses, their support and
companionship was an important factor in encouraging and
strengthening the morale of nurses.
“I used to come home and try to get some rest. My husband was
not doing house work before, and I had to do it by myself. But now,
he will do all the works. I mean, he helps me a lot and let me rest. I am
comfortable at home, and he looks after me.” (P4).
“My spouse is trying to take care of me. For example, we do not
eat anything for several hours in the shift and we come home we are
hungry and thirsty. When I go home, I go to the bathroom and wash
and disinfect my clothes for an hour, and when I come out I see my
husband has made carrot juice or tea for me. Well, that is something
that encourages you.” (P5).
3.10 | Distanced loved ones
Fear and stress caused by possibility of transmitting the infection to
children has caused the nurses to separate themselves from their
children. In many cases, nurses had left their children with their
parents or friends, and they themselves had been living in con-
valescent homes and hospitals while providing care for covid pa-
tients. All these efforts had been made by them to reduce their
concerns about their children.
“I have not seen my children for about a month. I left them at my
mother's house and I cannot go to see them at all. I think its better
that way.” (P3).
“Well, I was considering the family situation, that we have two
small children. If I get infected, what can I do to keep my kids away
from infection? That was when I sent my wife and children to her
father's home and I stayed alone at home! That way I was more
comfortable.” (P7).
GHORBANI ET AL.
3.11 | Hospital influence on the environment
Since hospitals are the main center for providing care during a pan-
demic, hospital staffs, especially nurses are most exposed to the
stress of a pandemic, especially if the disease is unknown. On the one
hand, the hospital environment can cause stressors such as poor
performance of managers, lack of equipment and facilities, and lack
of experienced staff that leads to increased stress and tension in
staff. On the other hand, by providing support programs and services
such as adequate and quality equipment, proper management and
planning, we can reduce stress and increase the adaptation of nurses
and hospital staff to the stress caused by the disease.
3.12 | Stressful hospital atmosphere
The care environment for the participants was a circle that included
managers, equipment, colleagues, patients and patients' families.
Each of these has a potential to be a source of tension during a
pandemic.
In the experience of nurses, lack of personal protective equip-
ment (PPE), poor quality of personal equipment, lack of proper gui-
dance on how to use the equipment, and the existence of
discrimination in the distribution of PPE were among factors that
caused stress for nurses.
“They had made announcement that certain wards do not need
to use full PPEs, or for instance, maintenance workers do not need to
use N95 face mask. This is while the maintenance workers sometimes
have to work in ICU or covid wards to repair something. These things
caused some of the personnel to get infected.” (P7).
The medical environment always bears the challenge of man-
power shortages. During a pandemic, due to the illnesses and resig-
nation of a large number of employees, the medical systems face a
greater challenge than before. This has leads to increased workload
and doubles the stress in employees.
“Eight patients, two of whom were intubated and required many
medications, needed at least three staffs that didn't had. The number
of staff is very low.” (P3).
To make up for the shortage of staff in the wards, many nurses
from other wards and hospitals volunteered to work with centers
that were caring for covid patients. Although this was a very good
supportive measure, the unfamiliarity of volunteers with the condi-
tions of covid ward has had its negative effects on creating tension
for the staffs.
“One time a nurse from another hospital came to help us. She
was a good nurse, but she did not know our routines and did not
know where the equipment was. She herself increased our
work (P1).”
Another stressor is having the first experience of pandemic and
not having crisis management skills, which puts a lot of stress on staff,
the health care system and patients. Crisis management is an art that
requires sufficient knowledge, skills and experience.
| 5
“Anyway, the situation was critical and many colleagues had lost
themselves. They were scared, but the hospital management warned
to punish those leave the work or do not turn up for work, instead of
trying to calm the staff down!” (P13).
Resignation and leaving the service due to pandemic stress is one
of the repeated behaviors in health care workers. These people cause
stress and anxiety and discourage other nurses due to the high stress
and tension they experience.
“Some of them were highly stressed! They were very scared! This
fear and stress was passed on to us. In every shift they came, they
said that we wanted to give up.” (P14).
3.13 | Hospital support
Planning and implementing support measures by hospital managers
play a key role in reducing stress and tension in the hospital en-
vironment and promoting adaptation and relaxation of staff. Sup-
portive measures such as providing a convalescent home, providing
adequate and quality equipment, and managing, organizing and
planning properly, as well as creating a healthy and happy atmo-
sphere for consulting and care provision are among them.
In hospitals that provide care for patients with Covid‐19, one of
the measures taken by the management is the creation of con-
valescent home for staff. Recovery during off‐shift time is one of the
ways to adapt to stress caused by covid pandemic.
“I was afraid I would get sick myself. But after the introduction of
convalescent homes I was happy that I at least have somewhere to go.
Some families have a negative view of us. For example, if someone in
the family became infected, we are the ones to blame.” (P15).
Using personal equipment is one of the ways to protect against
Covid‐19. Proper equipment was an important factor in reducing
stress and adapting to pandemic situation in nurses.
“Well, there were still some stressful situations, but when we
wanted to take blood sample from the patient or inject a medicine,
we had no stress, because we had proper PPE.” (P4).
The hospital managers are like the ships' captains, and at times of
turmoil and storm, all medical staff expect courageous support and
planning from managers. Timely presence of managers and supervisors
on the wards and departments, meeting the needs of employees and
providing all requirements for the delivery of quality care in a safe
environment are some of the prerequisites for adapting to the stress
caused by Covid‐19 pandemic. In this regard, one of the head nurses
who had management experience in the field of Covid‐19 stated.
“The first patient who came into the emergency room was a man.
He came to the nursing station and said that he has been told that he
has Covid‐19. The first thing I did was put on my personal protective
clothing and then began to do his admission work to reduce the fear
of my colleagues.” (P5).
The resistance of colleagues in providing care and standing
against the disease was the experience mentioned by the participants
in adapting to the pandemic.
6 |
“Some people were so stressed, that in every shift, they were
saying they want to give up. but others talked to them and said it is
not a very good thing to quit your job when others are coming to
work. Also, since this disease is so transmittable, it is possible for all
of us to get infected even if we quit our job.” (P12).
Joy creation in times of crisis was one of the privileges im-
plemented in the hospitals that provided care for covid patients.
Performing joyful programs, dancing, singing, and short plays were
some of the strategies used to adapt to stress. These programs were
performed either spontaneously or under the supervision of hospital
management and social work department.
“A number of programs was coordinated by the hospital social
work department with music and theater groups, and were
performed in the hospital yard for patients and their families. They
were a kind of recreational activities for them to reduce their
stress. Of course, they also had appositive effect on the staffs'
stress.” (P7).
3.14 | Social support on both sides of infinity
In times of crisis, movements and processes are formed in the society
that, in a positive direction, can facilitate education, awareness and
support, or in a negative direction, can create more tensions and
stress such as spreading false and terrifying news and information.
Managing these processes and guiding them in the right direction is
an important factor in controlling critical situations and using positive
potentials. According to the participants' experiences, social support
in the pandemic is on two sides of infinity, which means that it is
either completely positive and effective or completely negative and
ineffective that causes more stress.
3.15 | Cyberspace: Is it poisoning the mind or
increasing awareness?
The outbreak of Covid‐19 disease has revolutionized the way people
use the media, and perhaps made people realize the importance of
social media in today's world. The spread of coronavirus has allowed
people to communicate with messengers through cyberspace. It also
made it possible for students to communicate with their teachers and
professors through online social networks, and allowed many cere-
monies and meetings to be held in cyberspace. It even forced people
who were not so interested in online shopping to do most of their
shopping online.
“Almost every day I follow the information that comes in. Getting
information and training helps us to overcome the fear and
stress.” (P12).
However, while information is spreading through cyberspace,
false information is also spreading and creating stress.
“At the beginning of the pandemic, coronavirus was unknown
and there was not many information about it. Even a series of videos
that became viral in cyberspace doubled the staffs' stress.” (P2).
GHORBANI ET AL.
3.16 | People; from appreciation to negligence
According to the participants' experiences, people's reaction and
response to the treatment team during a pandemic varies from in-
finite positive (appreciation, cooperation, and observance of health
protocols) to infinite negative (negligence). Negligence and non-
observance of mandatory protocols in pandemic is one of the factors
that facilitate disease spread and increase the stress level. The ap-
preciation of clients has been effective in adapting to nurses' stress to
a large extent.
“Some people, even when one of their family members becomes
infected and hospitalized, still refuse to wear a mask and do not
believe in social distancing. In general, they either hide the disease or
do not take it seriously at all.” (P2).
On the contrary, observation of appreciation and understanding
by patients and companions was largely effective in reducing fatigue
and creating a good feeling in nurses. This understanding and support
was a factor in increasing cooperation between patients and their
companions.
“Perhaps 90% of the patients who were admitted just realized how
hard our work was and understood that we were working for them with
all our heart and soul. They all expressed that, they never thought our
job is such a hard work. And then they were appreciating us.” (P2).
4 | D IS CU SS IO N
The aim of this study was to explain the nurses' experiences of stresses
and coping mechanism with them in the care of patients with Covid‐19
disease. Based on the experiences of participants, the sources of stress
included failure to address physiological needs, fear of a vague future,
lack of accurate and up‐to‐date information, fear of family infection, lack
of equipment or inadequate equipment, incorrect information in cy-
berspace, unfamiliarity of volunteers with the principles of working in
specialized wards, and negligence of people in society in observing
health protocols. In the study of Shanafelt et al.1 the sources of stress
included lack of access to equipment, exposure to coronavirus at work,
transmission of infection to family, insufficient competence in providing
care to patient, and lack of access to up‐to‐date information. In Lee
et al.'s16 study, employees referred to the sense of interpersonal isola-
tion and fear of transmitting the virus to their relatives as the sources of
stress. The use of personal protective equipment also created high
stress for them.
Participating nurses referred to ambiguity and fear of uncertain
future as one of the reasons for their stress. In Mowbray17 study, fear
of the unknown leads to more anxiety and this fear can lead to la-
beling, and discrimination. In response to this stress, increasing in-
formation, having faith and trusting in God have been some of the
strategies used for coping with the stress by the participants. In a
study conducted by Varasteh Moghaddam et al.18 the most common
adaptation mechanisms used by nurses included self‐confidence, in-
creasing knowledge and awareness, relying on abilities, and having
purpose in life.
GHORBANI ET AL.
One of the sources of stress from the nurses' point of view was
the spread of false information and rumors through the media and
cyberspace. According to the findings of other studies, exposure to
information through the media causes great stress in individuals.19,20
In this regard, the media can use up‐to‐date and accurate information
from valid databases such as the Centers for Disease Control and
Prevention (CDC) and the World Health Organization (WHO). The
media can prevent the spread of false information and reduce stress
by emphasizing on developing vaccines and successful prevention
methods. Sharing the experiences of people who have successfully
recovered from Covid‐19 also helps to adapt to the stress.
The nurses participating in the study used self‐support strategies
and also the support of family, hospital, colleagues, media, and the
public to adapt to the stress caused by the pandemic. Lambert and
Lambert21 found that nurses in each country or work sector resort to
different coping strategies to deal with stress. Lambert believed that
nurses in Asian countries often use emotional‐oriented coping methods
and in Western countries, they mainly use problem‐oriented methods.
One of the limitations of present study was limiting the study
environment to hospitals affiliated to Tehran University of Medical
Sciences. However, maximum sampling variation was done.
4.1 | Recommendation
Further studies in other contexts and diverse treatment environ-
ments (educational, privet, and governmental settings) are re-
commended. Such research could reveal valuable experiences of
other nurses, and the most efficient and effective coping skills that
they used. The present study was conducted with a qualitative ap-
proach, so it's recommended to test the findings of this study by
quantitative approach and methods.
4.2 | Implications
Although healthcare workers have accepted exposure to Covid‐19 as
part of their profession, provision of quality care in crisis situations is not
possible without supporting the healthcare workers and paying atten-
tion to their mental health. According to the results of this study, nursing
managers should carefully investigate and identify the causes of stress
and psychological strain that result from caring for patients with a new
pandemic disease in treatment settings. Then, to control these factors
and minimize these tensions in different levels of nursing, they should
make appropriate policies and plans. Maintaining the health of nursing
staff in critical pandemic situations is vital.
5 | C ONC LUS I ON
Due to the global prevalence of Covid‐19 disease and its mortality
rate, health care workers are more likely than others to be exposed to
psychological problems and stress as they are in the first line of
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dealing with this disease. Although health workers have accepted
exposure to Covid‐19 as part of their professional life, it is not pos-
sible to provide quality care in crisis situations without the support
and consideration of employees' mental health. An accurate approach
is recommended to be taken to predict, recognize and manage mental
harms or illness of healthcare worker, especially nurses, and it is vital
to provide organizational, national and global measures to pro-
tect them.
ACKNOWLEDGME NT S
The authors would like to thank Tehran University of Medical
Sciences, for their fiscal support. We also express our gratitude to the
nurses and colleagues for their cordial help. This research was
financially supported by Vice‐Chancellor of Tehran University of
Medical Sciences, Tehran, Iran (Grant number: 99210048398).
CONFLIC T OF INTERESTS
The authors declare that there are no conflict of interests.
A U T H O R S C O N T RI B U T I O N S
Alireza Nikbakht Nasrabdi, Mohammad Saleh Emran, Pegah
Matourypour, and Azam Ghorbani designed the project. Azam
Ghorbani, Ehsan Salehi, Mohammad Saleh Emran, and Pegah
Matourypour managed the project and collected all the interviews
and field notes. Alireza Nikbakht Nasrabdi, Mahboobeh Shali, Pegah
Matourypour, and Azam Ghorbani analyzed the qualitative data.
Azam Ghorbani, Mahboobeh Shali, and Pegah Matourypour were
responsible for manuscript preparation. All authors contributed
towards reviewing the paper before submission. The author(s) read
and approved the final manuscript.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
ORC I D
Azam Ghorbani https://orcid.org/0000-0003-1240-745X
Mahboobeh Shali https://orcid.org/0000-0003-4094-8878
Pegah Matourypour https://orcid.org/0000-0002-9476-0267
Ehsan Salehi Morkani https://orcid.org/0000-0001-6474-2503
Mohammad Salehpoor Emran https://orcid.org/0000-0002-
3687-8347
Alireza Nikbakht Nasrabadi https://orcid.org/0000-0002-
3970-4158
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How to cite this article: Ghorbani A, Shali M, Matourypour P,
Salehi E, Saleh Emran M, Nikbakht Nasrabdi A. Explaining
nurses' experience of stresses and coping mechanisms in
coronavirus pandemic. Nursing Forum. 2021;1‐8.
https://doi.org/10.1111/nuf.12644