Study characteristics

Our database searches yielded 7,985 references, 184 of which were removed owing to duplication, resulting in 7,801 references undergoing primary screening by title and abstract. As a result of this screening, 567 references were identified as potentially relevant to the study objectives and subsequently went through secondary screening involving a full-text review (ESM eTable 1). In the end, 168 documents were found to be relevant to the study objectives and were included in this review. Reasons for exclusion at this level included no full text being available (n = 58) or being in the wrong setting (n = 137), wrong population (n = 96), wrong study design (n = 67), or wrong language (n = 21), among others. The PRISMA-ScR flow chart (Fig. 1) provides further details regarding the search and screening results.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews flowchart

PRISMA-ScR = Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews

The date range of publication of the included articles is between 2003 and 2023, with the majority being published between 2020 and 2023 (n = 77; 46%). Most of the documents were published in English (n = 163; 97%), followed by Portuguese (n = 3; 2%) and Spanish (n = 2; 1%). Most of the references were published in the USA (n = 56; 33%), Iran (n = 18; 11%), China (n = 12; 7%), and Australia (n = 8; 5%). Intervention-based studies (n = 61, 36%) used a range of methodologic approaches, including randomized control/clinical trial (n = 18; 30%), qualitative (n = 3; 5%), mixed methods (n = 3; 5%), descriptive quantitative (n = 2; 3%) and other nonrandomized quantitative (n = 35; 57%) designs. Among the remaining studies (n = 107; 64%), the methodologic approaches most used were quantitative descriptive (n = 35; 33%), qualitative (n = 46; 43%), and mixed methods (n = 4; 4%), among others (n = 22; 21%). Regarding the settings of the studies, we identified that RNs working in the ER (n = 43; 26%) and ICU (n = 63; 38%) environments were among the most frequently studied populations within the included references, and some studied both populations (n = 8; 5%). Other settings studied included COVID-19-specific ICUs (n = 8; 5%), neonatal and pediatric ICUs (n = 19; 11%), operating rooms (n = 6; 4%), emergency care services (n = 2; 1%), and nonspecific ACC departments (n = 17; 10%). Some articles focused on specific specialized units only, such as the burns unit (n = 1) and psychiatric care (n = 1). Table 1 and ESM eTable 2 provide additional information and characteristics about the included documents.

Table 1 Workplace stressorsQuality appraisal

Following the quality appraisal consensus process, a large portion of the included papers (n = 66; 39%) achieved the highest score. Still, most studies (n = 102; 61%) exhibited inconsistencies regarding at least 1 tool item, yet their overall quality and relevance warranted inclusion for result integration. Consequently, all articles were retained for synthesis. Electronic Supplementary Material eTable 3 provides detailed quality appraisal information based on the MMAT.

Findings

Following the inductive content analysis approach, we organized the results into 3 categories: 1) recognition of stressors, 2) coping strategies, and 3) influences on RNs’ coping strategies.

Recognition of stressors

In this category, we identified 54 reports dedicated to understanding the diverse stressors reported by RNs operating within ACC settings. These stressors were further mapped on the basis of the issue represented, including organizational, interpersonal, intrapersonal, and situational, as ESM eTable 4 describes. Electronic Supplementary Material eTable 5 provides further evidence of these stressors.

Coping strategies

We located 168 reports that delved into the coping mechanisms used by ACC RNs, and of those reports, 60 described interventions that were developed and implemented to support ACC RNs coping.

The coping strategies identified were organized into 4 subcategories: problem-focused, emotion-focused, meaning-focused, and social-seeking.22 Problem-focused strategies are those that aim to address or eliminate the root cause of stress.23 In contrast, emotion-focused coping strategies include those skills aimed at reducing some of the negative emotions that may arise from a distressing situation,23 such as anxiety, sadness, and anger. Meaning-focused coping strategies can be defined as a form of coping that revolves around cognitive skills aimed at developing meaning or purpose for a particular situation.22 Lastly, social-seeking coping strategies involve using forms of social interaction to support RNs in managing difficult work-related experiences.22 All categories of coping strategies were obtained from this review, including supporting examples from the literature.

Problem-focused coping strategies

We identified 45 reports that mentioned the use of problem-focused coping strategies. The most common skills described as problem-focused noted within our review were planning and problem-solving,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52 both of which aimed to describe how an individual develops their strategic road map for addressing a problem.23 Similarly, active coping, which refers to taking action to make things better during a stressful situation,23 was also commonly identified.26,30,31,37,38,39,40,41,53 Lastly, the use of control as a way of coping was mentioned within several documents, with some describing controlling oneself27,28,32,33,36,53,54,55 and the work environment56 and other documents describing prioritization of tasks55,57,58 and setting boundaries.59

Emotion-focused coping strategies

Within 78 reports, RNs in ACC settings described use of several emotion-focused coping strategies that may be considered healthy and/or unhealthy depending on their long-term consequences. The healthy coping strategies were described as providing a self-soothing or relaxing response, while unhealthy emotional coping strategies were described as promoting negative and harmful results.60 Strategies included humour,26,30,31,37,38,39,40,41,49,61,62,63,64,65 avoidance,24,25,27,28,32,33,34,36,44,45,46,48,49,50,53,54,61,63,65,66,67,68,69,70,71,72,73,74,75,76,77,78 distraction,26,30,37,38,39,40,