Pensar Enfermagem / v.29 n.01 / february 2025
DOI: 10.71861/pensarenf.v29i1.357 /e00357
Review Article)
How to cite this article: Poltozie AF, Rocha CMF, Mattioni FC, Souza CD, Riquinho DL, Duarte FV,
Domingues HS. Support network for nurses during the COVID-19 pandemic: a scoping review. Pensar Enf
[Internet]. 2025 Feb; 29(1): e00357. Available from: https://doi.org/10.71861/pensarenf.v29i1.357
Support network for nurses during the COVID-19
pandemic: a scoping review
Abstract
Introduction
The COVID-19 pandemic, which emerged at the end of 2019, had profound impacts on
health, the economy, society, and culture worldwide. Healthcare professionals, especially
nurses, were on the front lines, facing high risks of infection and work overload.
This scenario led to stigmatization and social isolation, exacerbating physical and mental
exhaustion due to inadequate support and conflicting workplace relationships.
Objective
To map the scientific literature on nurses’ support networks during the COVID-19
pandemic.
Methods
We conducted an exploratory scoping review following the Joanna Briggs Institute
guidelines. The study search was performed using specific descriptors and the mnemonic
combination of population, concept, and context (PCC), defining the population as nurses,
the concept as support networks, and the context as the pandemic. The consulted databases
included the Virtual Health Library, which comprises the Latin American and Caribbean
Health Sciences Literature, the Spanish Bibliographic Index of Health Sciences, the Nursing
Database, and the Cumulative Index to Nursing and Allied Health Literature. Additionally,
we consulted the following virtual libraries: Cochrane Library, Scientific Electronic Library
Online, PubMed, and Web of Science. Two researchers selected studies with the assistance
of Rayyan® software. The data were analyzed and presented descriptively.
Results
Nineteen articles met the inclusion criteria, most of them quantitative, totaling 9,221
participating nurses, published between 2020 and 2023 in various countries. All studies
measured perceived social support, with the Multidimensional Scale of Perceived Social
Support being the most frequently used instrument. We categorized the studies into four
dimensions: 1) support for mental health, 2) support for workload and stress, 3) support
for resilience, and 4) support regarding nurses’ perceptions of workplace social networks.
Conclusion
There is no single effective social support model for all nurses; personalized adaptations
are necessary. Investing in support networks will strengthen the healthcare system and
promote healthier and more resilient nursing practices. This study recommends the
promotion of diverse support networks, the strengthening of peer and leadership support,
and the implementation of public policies to improve nurses’ mental health.
Keywords
Nurses; Social Support; COVID-19.
Angeline Francines Poltozie1
orcid.org/0009-0001-3679-1196
Cristianne Maria Famer Rocha2
orcid.org/0000-0003-3281-2911
Fernanda Carlise Mattioni3
orcid.org/0000-0003-3794-6900
Camilo Darsie de Souza4
orcid.org/0000-0003-4696-000X
Deise Lisboa Riquinho5
orcid.org/0000-0002-6604-8985
Filipe Vincensi Duarte6
orcid.org/0009-0003-0713-1310
Henrique da Silva Domingues7
orcid.org/0000-0001-7860-5622
1 Master. Universidade Federal do Rio Grande do Sul,
Porto Alegre, Brazil.
2 PhD. Universidade Federal do Rio Grande do Sul,
Porto Alegre, Brazil.
3 PhD. Universidade Federal do Rio Grande do Sul,
Porto Alegre, Brazil.
4 PhD. Universidade de Santa Cruz do Sul, Santa Cruz
do Sul,, Brazil.
5 PhD. Universidade Federal do Rio Grande do Sul,
Porto Alegre, Brazil.
6 Master. Universidade Federal do Rio Grande do Sul,
Porto Alegre, Brazil.
7 PhD. Universidade de Jaén, Jaén, Spain.
Corresponding author:
Henrique da Silva Domingues
E-mail: hda@ujaen.es
Received: 12 oct 2024
Accepted: 17 feb 2025
Editor: Helga Rafael Henriques
Domingues, H.
Review Article
Introduction
The COVID-19 pandemic, which emerged in late 2019,
produced impacts that extend beyond the epidemiological
sphere, also affecting the economic, social, cultural, and
political domains on a global scale.
It is important to highlight that authors such as Horton1
present solid and significant arguments when defining
COVID-19 as a syndemic. This term describes the interaction
between two or more epidemic-origin pathologies directly
related to biopsychosocial conditions, which are
exacerbated by preexisting conditions and their direct
consequences for the population. However, in this context,
the term pandemic was chosen to refer to COVID-19.
In the fight against a new virus, for which there was no
known therapy at the time and, consequently, with
vulnerable institutional protocols, multiprofessional
healthcare teams were largely composed of nursing
professionals on the front lines of care.2 Moreover, these
professionals experienced the COVID-19 pandemic
firsthand, along with all the vulnerabilities it brought, such
as high infection risk, workload overload, lack of protective
equipment, discrimination and social stigma due to the
possibility of spreading the disease, and isolation from their
families and loved ones.3-8
The pandemic disrupted daily life and, in many cases, family
structures on a global scale, making it essential to address
mental health issues during the pandemic period, given the
uncertainties imposed by the new reality.9 One example is
data from a study on the psychological distress faced by
healthcare workers, which showed that most nursing
professionals experienced high levels of anxiety (51.44%)
and insomnia (33.17%).10
Another study on the same topic, conducted with nursing
professionals in Brazil, also revealed the presence of other
psychological disorders among participants, such as appetite
and sleep disturbances, fatigue, guilt, depression, sadness,
distress, stress, vulnerability, and irritability, reaffirming the
impact of COVID-19 on this workforce.11 Furthermore,
previous reviews have predominantly focused on mental
health issues among nursing professionals related to the
COVID-19 pandemic.12
Vedovato et al.13 argue that working conditions in the
healthcare sector are intrinsically linked to workers’ health
and emotions. However, regardless of their specific field,
healthcare professionals consider caregiving a fundamental
aspect of their profession, contributing to the well-being and
health of the broader population. Unfortunately, they
remain vulnerable to workplace challenges and systemic
shortcomings, which directly affect their physical and
mental health.
Since there is a direct relationship between family support
networks, workers’ health, and COVID-1914, it is crucial to
better understand the influence of family support on health
during the pandemic. This is because nursing professionals
exhibited high levels of burnout, and the absence of an
adequate support network, coupled with conflicting work
relationships and disruptions in their personal lives due to
social distancing, led to significant illness among many
of them.15
Given this, we believe that understanding and analyzing who
provided support to these professionals and how this
support was delivered, given the current healthcare
landscape, may have various impacts on the health of
nursing professionals who, like myself, leave their loved
ones behind every day to care for others.
Although previous reviews have explored topics related to
mental health during the pandemic12, there remains a gap in
the systematic analysis of the support networks available to
these professionals. This highlights the need to conduct a
scoping review of the available national and international
scientific literature to identify gaps concerning nurses’
support networks during the COVID-19 pandemic, as well
as the determining factors behind these circumstances.
Considering the need to deepen studies on this still
underexplored topic, the findings may serve as a basis for
implementing health actions aimed at analyzing social
support networks specifically for nurses. Additionally, they
may help identify factors associated with the lack of such
support for professionals who worked during the COVID-
19 pandemic. Ultimately, this research contributes to
strengthening support networks for nursing teams in future
catastrophic and pandemic situations.
Based on the above, we established the following guiding
question: How was the support network for nurses
structured during the COVID-19 pandemic? Thus, this
study aimed to map the scientific literature on nurses’
support networks during the COVID-19 pandemic.
Methods
To formulate the guiding question for this study—How was
the support network for nurses structured during the
COVID-19 pandemic?—we adopted a structured sequence
based on the PCC mnemonic strategy (Population, Concept,
Context): Population: nurses; Concept: support network;
Context: pandemic. This approach aimed to achieve the
proposed objective of mapping the scientific literature on
nurses’ support networks during the COVID-19 pandemic.
It is important to highlight that using the PCC framework
enhances data quality and clarity, providing a more precise
orientation for formulating the research question.16
We selected descriptors based on the Health Sciences
Descriptors (DeCS) and Medical Subject Headings (MeSH),
along with their alternative terms in English, following the
PCC acronym and research question. Additionally,
uncontrolled descriptors were included to increase search
specificity, as demonstrated in Table 1.
After selecting the descriptors and their equivalents, we
initiated the literature search. The search was conducted in
April 2024 across the following databases: the Virtual
Health Library, which includes the Latin American and
Caribbean Health Sciences Literature (LILACS), the
Spanish Bibliographic Index of Health Sciences (IBECS),
the Nursing Database (BDENF), and the Cumulative
Index to Nursing and Allied Health Literature (CINAHL).
In addition, we consulted the virtual libraries Cochrane
Library, Scientific Electronic Library Online (SciELO), and
Pensar Enfermagem / v.29 n.01 / february 2025
DOI: 10.71861/pensarenf.v29i1.357 /e00357
Review Article
the National Library of Medicine (PubMed and Web of
Science). Reference lists of relevant literature were also
examined.
During the bibliographic searches, we used Boolean
operators AND and OR to combine descriptors and
alternative terms in English. The search strategy was
adjusted for each database’s specific domain in
collaboration with a health sciences librarian; however,
descriptor combinations remained consistent, as shown in
Table 2.
Table 1. Mnemonic Combination (PCC Acronym), Research Question, and Descriptor Selection
Acronym
Question
Descriptors
Search strategy
P
Nurses
“Nurses”*
(Enfermeiras OR enfermeiros
OR Nurses OR “trabalhadores
de enfermagem” OR
Profissionais de enfermagem”)
C
Support network
Social support
Caregivers
(“Apoio Social OR “Redes de
apoio social” OR Social
Support” OR “Support,
social”) (“Cuidadores OR
Caregivers”) (“Família OR
Family”) (“Relações Familiares
OR Family Relations”)
(“Características da Família
OR Family Characteristics”)
C
Pandemics
COVID-19
Pandemics
COVID-19
(“Pandemias OR Pandemics”)
(“COVID-19 OR COVID-
19”)
* “Nursing workers” is not a DeCS term, but we used it considering the broader concept of the nursing workforce.
Table 2. Search strategy and number of articles identified in different databases
Database
Search strategy
Total
PubMed
(Nurses OR nurse) AND (“Social Support” OR “Support, Social” OR Caregivers
OR Family OR “Family Relations”) AND (COVID-19 OR “COVID 19” OR “2019-
nCoV Infection” OR “SARS-CoV-2Infection” OR “SARS Coronavirus2” OR
“COVID-19 Pandemic” OR “COVID19 Pandemic” OR “Pandemic,COVID-19”
OR “COVID-19 Pandemics”)
266
Web of
science
(Nurses OR nurse) AND (“Social Support” OR “Support, Social”) AND (COVID-
19 OR “COVID19” OR “2019-nCoV Infection” OR “SARS-CoV-2 Infection” OR
“SARS Coronavirus2” OR COVID-19 Pandemic” OR” COVID 19 Pandemic” OR
“Pandemic, COVID-19” OR “COVID-19 Pandemics”)
361
SciELO
(Enfermeiras OR enfermeiros OR Nurses OR “trabalhadores de enfermagem” OR
“Profissionais de enfermagem” OR “Enfermeras y Enfermeros”) AND (“Apoio
Social” OR “Redes de apoio social” OR “Social Support” OR “Apoyo Social”) AND
(COVID-19 OR COVID 19 OR” Infecção pelo SARS-CoV-2” OR “Infecção por
SARS-CoV-2” OR “Infecção por Vírus COVID-19” OR “Pandemia COVID-19”
OR “Pandemia por COVID-19” OR “COVID19” OR “2019-nCoV Infection” OR
“SARS-CoV-2 Infection” OR “SARS Coronavirus 2” OR “COVID-19 Pandemic”
OR “COVID 19 Pandemic” OR “COVID-19 Pandemics”)
18
BVS
LILACS
BDENF
IBECS
(Enfermeiras OR enfermeiros OR Nurses OR “trabalhadores de enfermagem” OR
“Profissionais de enfermagem” OR “Enfermeras y Enfermeros”) AND (“Apoio
Social” OR “Redes de apoio social” OR “Social Support” OR “Apoyo Social”) AND
(COVID-19 OR COVID19 OR “Infecção pelo SARS-CoV-2” OR “Infecção por
LILACS = 18
BDENF = 13
IBECS = 6
Domingues, H.
Review Article
SARS-CoV-2” OR “Infecção por Vírus COVID-19” OR “Pandemia COVID-19”
OR “Pandemia por COVID-19” OR “COVID 19” OR “2019-nCoV Infection” OR
“SARS-CoV-2 Infection” OR “SARS Coronavirus 2” OR”COVID-19 Pandemic”
OR “COVID 19 Pandemic” OR “COVID-19 Pandemics”)
CINAHL
(Nurses OR nurse) AND (“Social Support” OR “Support, Social”) AND (COVID-
19 OR “COVID19” OR “2019-nCoV Infection” OR “SARS-CoV-2 Infection” OR”
SARS Coronavirus2” OR “COVID-19 Pandemic” OR “COVID 19 Pandemic” OR
“Pandemic,COVID-19” OR “COVID-19 Pandemics”)
124
The inclusion criteria encompassed original articles,
experience reports, theoretical and reflective studies, and
gray literature (preprints, theses, dissertations, manuals,
books, and conference proceedings) published in
Portuguese, Spanish, or English that addressed the research
question. We excluded review articles. No time limit was
established. Two researchers, beginning with a review of
titles and abstracts, conducted article selection
independently. In cases of disagreement between the two
researchers, a third researcher was consulted to determine
inclusion or exclusion. Subsequently, full-text articles were
reviewed for data extraction and analysis. The retrieved
studies were organized using the Rayyan® software,17
configured to remove duplicate records. The preliminary
version is publicly available on the Open Science
Framework platform and can be accessed via the following
link: https://osf.io/9jsmw/.
Data analysis
We defined the final sample through the retrieval and full-
text review of the selected studies. The results were analyzed
descriptively and comparatively, taking into account other
studies on the topic, after being entered into an Excel®
spreadsheet. Data extraction and analysis were based on the
following indicators: authors, year and country of
publication, study type, objective, population, results, and
recommendations related to the support network for nurses
during the COVID-19 pandemic.
Data aggregation, synthesis, and presentation
During data analysis, we compiled and reported results to
provide an overview of the entire body of material. The
findings were presented descriptively and organized into
tables and graphs that we designed to address the research
objective and guiding question.
Results
The search strategies employed in this scoping review led
to identifying 806 studies. After removing duplicates and
excluding studies that did not meet the inclusion criteria, 19
studies were included.18-36 In our review, we did not identify
additional studies from the references of the selected
articles that could be included. Figure 1 illustrates this
process using a PRISMA flow diagram.
In this review, 17 of the 19 included studies (90%) adopted
a cross-sectional descriptive quantitative approach.
Additionally, there were one retrospective cohort study and
one qualitative study based on thematic analysis, totaling
9,221 nurses as participants. The studies were published
between 2020 and 2023 and conducted in various
countries, including China 27-29, 34, Turkey 22, 25, 26, the United
States 32, 33, Greece 23, 24, Iran 21, 36, Jordan 18, Brazil 20, Peru
19, South Korea 27, Poland 30, and Japan 35, covering the
period between 2020 and 2023 (Table 3).
Domingues, H.
Review Article
Table 3: Characteristics of the studies included in the review
Authors,
year, and
country
Journal
Objective
Study design
Measurement
instrument
Population
Results
Recommendations
Alnazly et
al. (2021),
Jordânia.
Plos One
Assess fear,
depression, anxiety,
stress, social
support, and
associated factors
among Jordanian
healthcare workers
during the COVID-
19 pandemic.
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
363
healthcare
workers
(majority
nurses)
High perception
of social support
received from
significant
individuals,
family, and
friends, with
significant
individuals being
the most
prominent. A
positive
correlation was
found between
perceived social
support and
reduced fear,
depression,
anxiety, and
stress.
Healthcare centers
should ensure
support for
healthcare workers
and their families
during the COVID-
19 pandemic,
including medical,
financial, and
psychosocial
assistance. Regular
meetings, peer
support, and
psychological
assessments should
be promoted.
David et
al., (2023),
Brasil.
Plos One
Map and analyze
social support
networks in nursing
work among
professionals who
fell ill or were
suspected of
COVID-19
infection and
sought emergency
reference services
for healthcare
professionals in Rio
de Janeiro and
Fortaleza during the
early stages of the
pandemic in Brazil.
Descriptive
cross-sectional
quantitative
study
Two ad hoc
questions
95 nurses
Nurses were
highlighted as the
primary providers
of social support,
followed by
physicians,
laboratory
assistants, and
physiotherapists.
They also
demonstrated
greater centrality
than other
professional
categories in the
studied states.
It is suggested that
recognition and social
support be
strengthened to
enhance team
coordination and
resilience in
healthcare settings
during crises such as
the COVID-19
pandemic.
Ebrahimi
et al.
(2021),
Iran.
Work
Investigate the
effect of workload
and perceived social
support on the
quality of life of
nurses working in
COVID-19
inpatient hospital
units.
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
336 nurses in
hospital
inpatient
units
Perceived social
support had a
positive effect on
quality of life and
was a moderating
factor in the
relationship
between work
overload and
quality of life,
with an emphasis
on family support.
It is recommended
that nurses increase
social support levels
to provide better
psychological support
for healthcare
personnel during the
COVID-19 pandemic
era.
Ersin et
al., (2021),
Turquia.
Perspectives in
Psychiatric
Care
Determine the
perceptions of
mental well-being
and social support
among nurses
working in a
hospital dedicated
to treating COVID-
19 patients.
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
333
volunteer
nurses
A significant
positive
relationship was
observed between
nurses’ mental
well-being and
their perception
of social support,
with the friends’
subscale being the
most prominent.
It is important to
provide counseling
services to strengthen
nurses’ mental well-
being and social
support.
Esteban et
al. (2021),
Peru.
Salud
Uninorte
Determine whether
concerns about
COVID-19, social
support, and
anxiety are
predictors of
depression among
Peruvian nurses
during the public
health emergency.
Descriptive
cross-sectional
quantitative
study
Workplace Social
Support Scale
216 nurses
Perceived social
support in the
workplace was
correlated with
lower concerns
about COVID-19
infection.
The need to develop
intervention
programs to prevent
and reduce emotional
distress among
frontline nurses
during a pandemic.
Pensar Enfermagem / v.29 n.01 / february 2025
DOI: 10.71861/pensarenf.v29i1.357 /e00357
Review Article
Authors,
year, and
country
Journal
Objective
Study design
Measurement
instrument
Population
Results
Recommendations
Galanis et
al. (2022),
Grécia.
Vaccines
Analyze the
relationship
between burnout
related to COVID-
19 and the
willingness to
receive a booster
vaccine among
nurses, while also
evaluating whether
social support can
mitigate this
relationship.
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
963 nurses
Overall social
support was
positively
correlated with
willingness to get
vaccinated and
significantly
moderated the
relationship
between COVID-
19-related stress
and vaccine
acceptance.
Strengthen social
support and
implement awareness
programs on
immunization.
Galanis et
al. (2023),
Grécia.
MedRxiv
Evaluate the effect
of social support on
nurses’ resilience
and investigate the
impact of
demographic
characteristics on
their resilience.
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
963 nurses
Perceived social
support from
significant others
was associated
with increased
resilience.
Develop policies to
promote a
harmonious work
environment,
resilience, and
productivity.
Strengthening
collegiality is essential
to improving nurses’
resilience.
Izci et al.
(2022),
Turquia.
Journal of
Nursing
Management
Investigate the
effects of workload,
occupational stress,
and social support
on nurses’ self-
perceptions
regarding their
parenting roles
during the COVID-
19 pandemic, as
well as the impact
of
sociodemographic
characteristics of
nurse parents on
occupational stress
and workload
during the
pandemic.
Descriptive
cross-sectional
quantitative
study
The Swedish
Demand-Control-
Support
Questionnaire
198 nurses
Nurse parents
whose spouses
also work in
healthcare tend to
experience lower
occupational
stress.
Additionally, shift
work factors
indicate that these
professionals have
a significant
impact on the
stress levels they
experience.
Nurse managers can
implement strategies
to mitigate
occupational stress
among nursing staff.
Enhancing nurses’
stress management
skills and providing
crisis training are also
recommended.
Kilinç et
al. (2020),
Turquia.
Perspectives in
Psychiatric
Care
Determine the
relationship
between social
support and
perceived levels of
psychological
resilience among
nurses in Turkey
during the COVID-
19 pandemic.
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
370 nurses
As nurses’
perceived social
support level
increases,
regardless of its
source, their
psychological
resilience also
improves.
Implement protective
measures to
safeguard nurses’
mental health,
enhance social
support, and develop
effective strategies to
cope with emotional
stress.
Kim et al.
(2020),
Coreia do
Sul.
Sustainability
Investigate how
social support
affects work
engagement and
how nurses’
intention to stay in
their jobs is
influenced by social
support in the
current COVID-19
situation.
Descriptive
cross-sectional
quantitative
study
Three ad hoc
questions
377 nurses
Perceived family
social support
demonstrated the
highest level of
job commitment.
A moderate-to-
high level of job
commitment and
a higher intention
to stay were
observed when
social support was
perceived through
communication
channels.
Strengthen social
support for nurses,
especially those
facing high-stress
situations such as
pandemics.
Domingues, H.
Review Article
Authors,
year, and
country
Journal
Objective
Study design
Measurement
instrument
Population
Results
Recommendations
Li et al.
(2022),
China.
Journal of
psychosocial
nursing
Provide basic data
and a scientific
foundation for
establishing
effective
psychological
interventions
during public health
emergencies.
Descriptive
cross-sectional
quantitative
study
Perceived Social
Support Scale
248 nurses
Global perceived
social support was
negatively
correlated with
obsessive-
compulsive
symptoms,
anxiety, and
depression. No
correlation was
found between
nurses’ job-related
psychological
stress and
perceived social
support. Family
was identified as
the primary
source of social
support.
Strengthen
communication.
Develop clear and
effective strategies
for infection
prevention and
control, establish
response and
emergency plans, and
provide timely
training for frontline
nurses. Nurses
should be actively
encouraged to accept
support from family,
friends, and
colleagues.
Liao et al.
(2020),
China.
Journal of
Clinical
Nursing
Assess stress
response levels,
self-efficacy, and
perceived social
support among
nurses working
during the COVID-
19 outbreak and
investigate potential
factors influencing
their stress.
Descriptive
cross-sectional
quantitative
study
Perceived Social
Support Scale
1,092 clinical
nurses
A higher level of
global perceived
social support was
associated with
lower stress
levels.
Regulating self-
efficacy and
perceived social
support among
nurses proved to be a
viable approach to
alleviating stress.
Pergol-
Metko et
al. (2023),
Polônia.
Heath
care
Determine nurses’
perception of social
support and
identify the
relationship
between social
support and
compassion fatigue
and burnout.
Retrospective
cohort
quantitative
study
Multidimensional
Scale of Perceived
Social Support
856 nurses
A higher level of
perceived social
support was
associated with
lower compassion
fatigue, greater
job satisfaction,
and reduced
burnout risk.
Healthcare
administrators should
encourage self-care
among nurses by
promoting healthy
habits and work-life
balance.
Governmental
investments are
essential to
strengthening the
healthcare system and
meeting population
needs.
Qian et al.
(2022),
China.
International
Journal of
Clinical and
Experimental
Medicine
(1) Assess the
psychological state
and perceived social
support of nurses
not involved in
epidemic outbreaks
during the COVID-
19 pandemic, and
(2) investigate the
relationship
between
psychological state
and perceived social
support among
these nurses.
Descriptive
cross-sectional
quantitative
study
Perceived Social
Support Scale
1,187 nurses
Social support
from friends,
family, and other
significant
individuals was
significantly
correlated with
lower levels of
depression,
anxiety,
obsessive-
compulsive
disorder, and
hypochondria.
Managers should
provide guidance and
timely assistance
when professionals
experience emotional
issues, ensuring team
cohesion among
nurses at all levels.
They should also
work to improve
perceived social
support, increase job
efficiency, and better
protect public health.
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DOI: 10.71861/pensarenf.v29i1.357 /e00357
Review Article
Authors,
year, and
country
Journal
Objective
Study design
Measurement
instrument
Population
Results
Recommendations
Sahay et
al. (2022),
Estados
Unidos.
Sustainability
Identify available
sources of support
for nurses during
global health crises
and determine the
types of support
nurses receive
during such crises
Qualitative
study
Thematic analysis
using qualitative
questions
24 hospital
nurses
Nurses primarily
sought support
from their
colleagues at
work, while
avoiding direct
family support.
They also
received different
forms of
emotional,
practical, and
institutional
support during
the pandemic.
Strengthening peer
support platforms,
such as workplace
support groups, is
recommended to
enhance nurses’
resilience and
sustainability.
Additionally, policies
supporting both
work-life balance and
institutional backing
should be
implemented during
crises such as
COVID-19.
Scherr et
al. (2021),
Estados
Unidos.
Open Nursing
Analyze symptoms
of depression,
anxiety, and post-
traumatic stress
disorder (PTSD)
and their impact on
nurses’ job
performance.
Additionally,
determine whether
resilience and social
support moderate
these relationships.
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
177 nurses
Higher levels of
global perceived
social support
were associated
with lower levels
of depressive
symptoms.
Promoting resilience
and social support
may help mitigate the
effects of providing
patient care during
COVID-19.
Shen et al.
(2021),
China.
Psychology,
Health &
Medicine
Investigate the
prevalence of
mental health issues
and social support
among neonatal
nurses during the
COVID-19
outbreak and
explore the
correlation between
these factors.
Descriptive
cross-sectional
quantitative
study
Social Support
Rating Scale
848 neonatal
nurses
Higher levels of
global social
support were
associated with
better
psychological
conditions (lower
anxiety,
depression, and
stress levels).
Nurse managers
should identify key
groups for targeted
interventions and
provide effective
emergency training
and psychological
support for nursing
teams.
Tatsuno et
al. (2021),
Japão.
Acute
Medicine &
Surgery
Analyze whether a
high level of
perceived social
support has a
protective effect on
the mental health of
intensive care
nurses during the
COVID-19
pandemic.
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
334 intensive
care nurses
A low level of
global perceived
social support was
associated with a
higher probability
of anxiety and
depression
symptoms, as well
as a significant
association with
post-traumatic
stress.
Establish a mental
health support system
not only for nurses
directly caring for
COVID-19 patients
but also for those
working in intensive
therapy units.
Promoting nurses’
self-care and
recognizing their
work are essential
measures to reduce
stress and prevent the
development of post-
traumatic stress
disorder.
Vafaei et
al. (2020),
Irã.
Psychology
Research and
Behavior
Management
Compare perceived
social support,
quality of life, and
depression levels
among obstetric
healthcare
professionals caring
for pregnant
women diagnosed
with COVID-19
(both positive and
negative cases)
Descriptive
cross-sectional
quantitative
study
Multidimensional
Scale of Perceived
Social Support
275 nurses
No significant
associations were
found between
sources of
support, quality of
life, and the
nursing
profession.
Continuous mental
health assessments
for healthcare
professionals and the
implementation of
adequate
psychological support
to address pandemic-
related challenges are
necessary.
Domingues, H.
Review Article
Authors,
year, and
country
Journal
Objective
Study design
Measurement
instrument
Population
Results
Recommendations
across eight cities in
Iran.
Pensar Enfermagem / v.29 n.01 / february 2025
DOI: 10.71861/pensarenf.v29i1.357 /e00357
Review Article
Considering care networks and aiming to answer the central question of this scoping review (How was the support network for
nursing workers structured during the COVID-19 pandemic?), the included studies were analyzed and categorized into four
dimensions of support networks (Table 4).
Table 4. Categories of analysis of the studies
Support network dimensions
for:
Articles
Mental health
Ersin et al., 2021; Esteban et al., 2021; Galanis et al., 2022; Li et al., 2022; Scherr et al.,
2021; Shen et al., 2021; Tatsuno et al., 2021; Alnazly et al., 2021; Vafaei et al., 2020; Qian
et al., 2022.
Workload, occupational
stress, and compassion fatigue
Ebrahimi et al., 2021; Izci et al., 2022; Liao et al., 2020; Pergol-Metko et al., 2023.
Resilience and job
commitment
Galanis et al., 2023; Kilinç et al., 2020; Kim et al., 2020.
Social support networks in the
workplace
David et al., 2023; Sahay et al., 2022.
Regarding the type of social support, all studies measured perceived social support. The most frequently used instrument was
the Multidimensional Scale of Perceived Social Support, applied in ten of the included studies, followed by the Perceived Social
Support Scale, used in three studies (Table 1).
From the analysis of the reviewed studies on social support among nurses during the COVID-19 pandemic, we identified six
different types of support networks.
Among them, the most prominent were global social support, family, friends, colleagues, other significant individuals, and
institutional support. Figure 1 below illustrates the frequency with which each type of social support was mentioned in the
reviewed articles, highlighting the variety and significance of these networks in ensuring nurses’ well-being and performance in
crisis contexts.
Graph 1. Identification of support networks
* The total number of support networks differs from the total number of included articles because some studies measured both
global support and specific subscales.
n=2
n=4
n=4
n=6
n=7
n=9
Perceived institutional social support
Perceived social support from colleagues
Perceived social support from other significant individuals
Perceived family social support
Perceived social support from friends
Global perceived social support
Types of support networks
Review Article
12 | Domingues, H.
Support networks for mental health
A total of ten studies addressed the topic of support
networks and their relationship with nurses’ mental health.
Shen et al.34 concluded that higher levels of perceived global
social support were associated with better psychological
conditions among nurses, showing significant negative
correlations with anxiety (r = -0.153), depression (r = -
0.243), and stress (r = -0.128).
Ersin et al.22 observed a positive and significant relationship
between nurses’ mental well-being and their perception of
social support from the family subscale (r = 0.301; p < 0.05),
friends (r = 0.369; p < 0.05), and other significant
individuals (r = 0.296; p < 0.05).
Galanis et al.23 found that COVID-19-related burnout had
a negative correlation with perceived global social support
(r = -0.183, p < 0.001). Conversely, global social support
was positively correlated with the willingness to get
vaccinated (r = 0.136, p < 0.001). Moreover, global social
support played a significant mediating role in this dynamic,
bridging the relationship between COVID-19-related
burnout and vaccination willingness (β = 0.0437).
Li et al.28 concluded that perceived global social support was
negatively correlated with negative emotional states,
including depression (r = -0.206; p < 0.05), obsessive-
compulsive disorder (r = -0.185; p < 0.05), and
hypochondria (r = -0.234; p < 0.05).
Scherr et al.3 found that perceived global social support
moderated the relationship between treating COVID-19
patients and mental health symptoms among nurses.
Hierarchical regression analyses showed that social support
was inversely correlated with depressive symptoms (p <
0.001). Additionally, a significant interaction was identified
between treating COVID-19 patients and social support,
indicating that the association between social support and
depressive symptoms was stronger among nurses who
treated COVID-19 patients than those who did not.
Tatsuno et al.35 reported that lower levels of perceived
global social support were associated with a higher
probability of experiencing anxiety symptoms (OR = 0.979,
95% CI 0.96–0.99) and depressive symptoms (OR = 0.953,
95% CI 0.93–0.97).
Alnazly et al.18 concluded that Jordanian healthcare workers
during the COVID-19 pandemic perceived high levels of
emotional, instrumental, and informational support from
their social networks. This support was most evident in the
significant others subscale, followed by family and friends.
Furthermore, global social support showed a significant
positive correlation with fear, depression, anxiety, and stress
(r = 0.20).
Qian et al.31 found significant negative correlations between
perceived social support and depression (r = -0.291),
neurasthenia (r = -0.317), fear (r = -0.170), obsessive-
compulsive disorder (r = -0.241), and hypochondria (r = -
0.131), with all p-values < 0.001. These results indicate that
higher levels of social support from all sources (friends,
family, and other significant individuals) are associated with
better mental health outcomes.
Esteban et al.19 reported that perceived workplace social
support was correlated with a lower level of concern
regarding COVID-19 infection.
The findings from the ten studies on support networks and
nurses’ mental health highlighted that a high level of global
social support was associated with better psychological
well-being, including reduced anxiety, depression, and
stress. Furthermore, perceived social support played a
significant mediating role, positively influencing vaccination
willingness and mitigating the impact of COVID-19-related
burnout. Finally, the results also demonstrated that social
support moderated mental health symptoms,
particularly among nurses directly involved in treating
COVID-19 patients.
Support networks for workload, occupational stress,
and compassion fatigue
The review of four studies identified different aspects
related to social support, workload, occupational stress, and
compassion fatigue among nurses during the COVID-19
pandemic.
Izci et al.25 found that nurses with spouses working in the
healthcare sector experienced lower levels of occupational
stress, suggesting a possible benefit of specific family
support. Workload varied significantly depending on shift
type and work unit, with nurses in pandemic-designated
units facing higher levels of stress (p < 0.05).
Hossein et al. observed that perceived global social support
had a significant direct positive effect (r = 0.574, p < 0.05)
on quality of life. Additionally, perceived social support also
acted as a moderator (r = 0.164, p < 0.05), reducing the
negative impact of workload on nurses’ quality of life.
Liao et al.29 found significant negative correlations between
stress response and perceived global social support
(r = -0.211, p < 0.001). Social support from friends was
identified as a key factor in reducing acute stress response
(Beta = -1.401, p < 0.001).
Pergol-Metko et al.30 investigated compassion fatigue
among nurses in Poland and found significant correlations
between perceived global social support and compassion
fatigue (r = -0.35, p < 0.001). Higher levels of perceived
social support from partners (r = -0.29, p < 0.001), family (r
= -0.30, p < 0.001), and friends (r = -0.33, p < 0.001) were
associated with lower compassion fatigue and greater
job satisfaction.
The findings from the four reviewed studies indicate that
nurses with spouses working in the healthcare sector
Pensar Enfermagem / v.29 n.01 / february 2025
DOI: 10.71861/pensarenf.v29i1.357 /e00357
Review Article
experienced lower levels of occupational stress. Perceived
global social support had a positive effect on quality of life
and moderated the negative impact of workload. Support
from friends played a crucial role in reducing acute stress
response. Additionally, higher levels of perceived social
support from partners, family, and friends were associated
with lower compassion fatigue and greater job satisfaction
among nurses.
It is important to clarify that compassion fatigue refers to
the emotional and physical exhaustion healthcare
professionals may experience when caring for patients
facing intense suffering. This phenomenon occurs when
continuous exposure to others’ suffering leads to
exhaustion, reducing empathy and resulting in emotional
detachment and lower job satisfaction.
Support networks for resilience and job commitment
Three studies explored the topic of the relationship between
support networks, resilience, and nurses’ job commitment.
The study by Galanis et al.24 revealed that perceived support
from other significant individuals (b = 0.106, p < 0.001) and
friends (b = 0.047, p = 0.02) was positively correlated with
resilience. The research highlighted the importance of a
strong support network, as it identified that the average level
of support from significant individuals, family, and friends
was higher among those with a greater perception
of resilience.
Kilinç et al.26 identified a positive relationship between
perceived social support and nurses’ psychological
resilience. The correlations between resilience and the
subscales of perceived social support (family, friends, and
other significant individuals) were significant: family support
(r = 0.338, p = 0.000), support from friends (r = 0.372, p =
0.000), and support from another significant person (r =
0.377, p = 0.000). The total perceived global social support
scale also showed a strong correlation (r = 0.424, p = 0.000)
with resilience, emphasizing that higher levels of perceived
social support were associated with greater psychological
resilience among nurses during the pandemic.
Kim et al.27 concluded that family support was the most
significant factor in job commitment, whereas perceived
support from colleagues had the least influence.
Job retention intention was highest among those who
perceived social support from the government and
the media.
The three studies included in this dimension showed that
perceived support from significant individuals and friends is
positively associated with resilience. Additionally, higher
levels of perceived overall social support were significantly
correlated with greater psychological resilience. Family
support was identified as the most influential factor in job
commitment.
Support networks related to nurses’ perceptions of
workplace social support
Two studies explored support networks related to nurses’
perceptions of workplace social support.
David et al.20 examined perceived social support and
professional networks among nurses in Brazil during the
COVID-19 pandemic, concluding that nurses were the
primary providers of social support, followed by general
practitioners, laboratory technicians, and physiotherapists.
In Rio de Janeiro, in addition to nurses, the multidisciplinary
training team also had a significant score in centrality
measures, while in Fortaleza, the general administration and
physicians from other specialties were equally important.
Centrality was highest for nurses in both states, highlighting
them as key mediators within support networks.
Sahay et al.32 explored nurses’ perceptions in the United
States regarding social support during the COVID-19
pandemic, emphasizing a preference for peer support due to
the shared understanding of the challenges faced. Nurses
avoided seeking support from their families to protect them
from additional stress and instead relied on coworkers as
surrogate family members. The types of support included
haptic support, such as hugs that provided emotional
comfort, emotional support through sharing difficult
experiences, and practical support at work, such as covering
shifts. Additionally, institutional support, including regular
updates and material assistance, helped nurses feel
supported by their organizations during the crisis.
The two studies included in this dimension found that
nurses are central in providing social support, followed by
other healthcare professionals. There was a preference for
peer support due to the shared understanding of the
challenges faced, while some nurses avoided seeking
support from their families to protect them from additional
stress.
Recommendations suggested by the studies
The findings of the analyzed studies highlight the
importance of social support in promoting nurses’ well-
being, particularly during crises such as the COVID-19
pandemic. As shown in Table 1, the recommendations
include fostering support networks among colleagues and
supervisors24, strengthening family support through
programs that encourage family involvement and facilitate
work-life balance18, 24, implementing wellness and health
programs that promote nurses’ physical and mental well-
being24, 28, and adopting organizational policies that enhance
work-life balance18, 24. Additionally, early psychological
interventions, effective communication of pandemic-related
information, and clear prevention and control strategies
were essential in reducing stress and supporting nurses’
mental health. 28, 35
Discussion
In this study, we mapped the scientific literature on support
networks for nurses during the COVID-19 pandemic.
Understanding how nursing professionals, particularly
during the pandemic, managed to cope with such intense
challenges is essential. As cited in the theoretical framework
of this dissertation, interpersonal and environmental
interactions are fundamental to human development and
help overcome daily obstacles through relationships based
Review Article
14 | Domingues, H.
on friendship, work, and affection.37 In the context of
nursing, social support networks play a vital role in
providing emotional, instrumental, and informational
support,38, 39 which is essential for maintaining health and
managing the heavy workload and stress.
Among the 19 studies included in this review on support
networks for nursing professionals during the COVID-19
pandemic, it was possible to categorize them into four main
dimensions. These dimensions address the relationship
between support networks and mental health, occupational
stress, compassion fatigue, resilience, job commitment, and
nurses’ perceptions of workplace support.
Our results showed a significant relationship between
perceived social support and nurses’ mental health during
the COVID-19 pandemic, as social support contributed to
lower frequencies of anxiety, depression, and stress
symptoms, improving psychological well-being.18, 22, 23, 27,
33-35 Additionally, it positively influenced vaccine uptake23
and reduced infection-related concerns.
The findings in this dimension align with the theory
proposed by Cohen and Wills,40 which suggests that social
support can reduce perceived stress and enhance coping
abilities. This is consistent with the broader literature
highlighting the importance of social support networks in
promoting the mental health of healthcare professionals,
particularly during crises.41 This type of support plays a key
role in reducing work-related stress and strengthening
mental health, emphasizing the importance of both family
and social support.42
This perspective is also in accordance with the social
support model,43 which identifies emotional, informational,
and instrumental support as essential for workers’ health
and well-being.
In this regard, a literature review12 on the mental health of
frontline nursing professionals during the COVID-19
pandemic highlighted the initiative by COFEN to establish
a support network for nursing professionals. This network
focused on providing targeted psychological support and
guidance on integrative and complementary health practices,
aiming to reduce stress, anxiety, and the emotional and
physical challenges faced by these professionals. Another
aspect emphasized in the review was the regulation of
psychological services, such as the “e-Psi Register,” which
enabled remote consultations via technology, benefiting not
only healthcare professionals but also the general population
in emergencies. Additionally, the review cited initiatives
such as informational videos from the Ministry of Health,
telehealth consultations, and support projects by Fiocruz in
partnership with state agencies. These interventions
underscored the importance of psychological support and
integrative practices in preserving healthcare professionals’
mental health in critical contexts.12
The relationship between epidemic events and occupational
stress, workload, and compassion fatigue is not a new
phenomenon for nurses during crises. In this context,
during the 2003 SARS-CoV outbreak in Singapore, many
healthcare professionals exhibited symptoms of stress.43
Similarly, following the 2015 Middle East Respiratory
Syndrome (MERS) outbreak in South Korea, nursing teams
also reported symptoms of post-traumatic stress disorder.43
For this reason, the findings from this scoping review
highlight the importance of support networks in stressful
periods.
Izci et al.25 concluded that nurses with spouses working in
the healthcare sector experienced lower levels of
occupational stress, suggesting that family support is
beneficial. Beyond family support, other forms of social
support were also significant. The study by Liao et al.29
found significant negative correlations between stress
response and perceived social support, particularly from
friends. Complementing this, Hossein et al. demonstrated
that perceived global social support had a direct positive
effect on quality of life and acted as a moderator, reducing
the negative impact of workload.
These findings reinforce the concepts of social support,
emphasizing the role of family support in managing
occupational stress. This perspective aligns with the
understanding that social support can mitigate the negative
effects of workload on health and well-being.44
Our findings also indicate that social support plays a
fundamental role in nurses’ resilience and job commitment,
as evidenced in the studies by Galanis et al.24 and Kilinç et
al.26 included in this research. These results align with a 2021
document review,45 which also concluded that nurses’
psychological resilience increases with higher levels of
perceived social support in a pandemic context. According
to the authors, resilience is essential in nursing due to the
constant exposure to human suffering and stressful working
conditions.45 The resilience theory46 also supports our
findings by highlighting the importance of protective
factors, such as social support, in the ability to recover from
adversity. Therefore, evidence suggests that professionals
are more likely to engage in their work when they perceive
a high level of social support.
Our review also identified findings regarding perceptions of
social support networks in the workplace context. David
et al.20 emphasized the importance of nurses within support
networks, while Sahay et al.32 highlighted the significance of
peer support due to a shared understanding of their
difficulties. The support provided included emotional and
practical measures, as well as institutional support strategies
that helped nurses feel supported during the crisis.
The results indicate that healthcare professionals require a
strong and diverse social support network, especially in
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DOI: 10.71861/pensarenf.v29i1.357 /e00357
Review Article
times of high demand and pressure, such as during the
COVID-19 pandemic.
Including multiple sources of support in an overall analysis
of the results reveals the complexity of nurses’ emotional
and social needs. According to Sluzki,47 support networks
can be classified into formal and informal systems, which
function complementarily. While the formal system relies on
government services and social assistance, the informal
system, consisting of social and civic institutions and
personal relationships, provides resources that are often
more individualized and immediate. Cohen and Wills40
emphasize the importance of balancing personal needs with
the nature of social support sources. The authors argue that
no single form of social support universally serves as an
effective mechanism for everyone. Instead, since support is
adapted to each individual’s circumstances and personal
preferences, nurses must identify and utilize appropriate
support resources that align with their specific needs and
situations.
Finally, the recommendations derived from the studies
suggest that establishing support networks among
colleagues and supervisors, improving family support
through work-life balance programs, implementing physical
and mental wellness initiatives, and adopting organizational
policies that promote work-life balance are fundamental
strategies. This approach aligns with the principles of
humanization policies in Brazil, which emphasize the
empowerment of various stakeholders involved in
healthcare and the reduction of barriers to access.
The proposed recommendations not only benefit healthcare
professionals but also enhance the quality of care provided
to patients in accordance with the holistic health approach,
which considers physical, mental, and social well-being as
interdependent and equally important factors.
Conclusion
The findings confirm the reviewed theory that social
support plays a significant role in support networks for
nurses’ health and well-being during crises such as the
COVID-19 pandemic. Through the 19 included studies, this
review demonstrated that nurses’ support networks are
primarily characterized by four main categories: mental
health; workload, occupational stress, and compassion
fatigue; resilience and job commitment; and workplace
social support networks.
The analysis of nurses’ support networks revealed the
predominant presence of six types of support sources:
global social support, family support, support from friends,
support from colleagues, support from other significant
individuals, and institutional support. Based on the
conducted analyses, we concluded that no single social
support system is universally effective for all nurses.
Adaptations must be made according to individual
situations and personal preferences. Thus, nurses must
identify and utilize support resources tailored to their
specific needs in various contexts.
Investing in the creation and strengthening of these support
networks will enable a more rapid response to nurses’ needs
and reinforce the healthcare system as a whole. To maintain
a healthy and sustainable nursing practice, it is essential to
ensure that nurses receive appropriate care. By asking,
“Who cares for the caregivers?”, we acknowledge the
importance of establishing environments and policies that
support nurses and strengthen support networks, not only
fostering their physical and mental health but also
recognizing their vital role in society and ensuring that they
can continue providing high-quality care to their patients.
Based on the findings, we can recommend actions to
strengthen healthcare support, including: 1) developing
strategies that promote diverse support networks to benefit
the mental health of nursing professionals; 2) promoting a
supportive work environment by implementing policies that
strengthen peer and leadership support within institutions;
3) creating initiatives that encourage family support, such as
programs that integrate nurses’ families to enhance
resilience; 4) ensuring effective communication by
implementing clear prevention and control strategies aimed
at reducing stress and supporting nurses’ mental health; and
5) implementing public policies that reinforce formal social
support for nurses, particularly through the psychosocial
care network.
Study limitations and implications
The scoping review conducted in this dissertation aimed to
explore the field of study, identify knowledge gaps, and
accurately assess the available evidence. We acknowledge
that while this methodology provides a comprehensive
overview of the topic, it has limitations, such as the lack of
in-depth analysis of individual studies, the heterogeneity of
the articles, and the absence of a systematic quality
assessment of the studies. Nevertheless, this approach
allowed us to identify significant themes and emerging
trends, establishing a solid foundation for future research
and recommending appropriate interventions in the field.
For future studies, we recommend further research on social
support for nurses in the Brazilian context. Additionally, it
is important to investigate ways to strengthen both formal
and informal social support networks within the healthcare
system. Moreover, future research should explore received
social support in contrast to perceived social support, as this
could provide a more comprehensive understanding of the
needs and effectiveness of the available support systems.
Authorship
Poltozie AF: Conception and design of the study; Data
collection; Data analysis and interpretation; Critical revision
of the manuscript; Approval of the final version of the
manuscript and taking responsibility for it;
Rocha CMF: Conception and design of the study; Data
collection; Data analysis and interpretation; Critical revision
of the manuscript; Approval of the final version of the
manuscript and taking responsibility for it;
Mattioni FC: Conception and design of the study; Data
collection; Data analysis and interpretation; Critical revision
of the manuscript; Approval of the final version of the
manuscript and taking responsibility
Review Article
16 | Domingues, H.
Souza CD: Conception and design of the study; Data
collection; Data analysis and interpretation; Critical revision
of the manuscript; Approval of the final version of the
manuscript and taking responsibility
Riquinho DL: Conception and design of the study; Data
collection; Data analysis and interpretation; Critical revision
of the manuscript; Approval of the final version of the
manuscript and taking responsibility
Duarte FV: Conception and design of the study; Data
collection; Data analysis and interpretation; Critical revision
of the manuscript; Approval of the final version of the
manuscript and taking responsibility
Domingues HS: Conception and design of the study; Data
collection; Data analysis and interpretation; Critical revision
of the manuscript; Approval of the final version of the
manuscript and taking responsibility
Conflicts of interest and Funding
No conflicts of interest have been declared by the authors.
Sources of support / Financing
The study was not funded.
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