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THE IMPACT OF WORK-RELATED STRESS: SCIENTIFIC EVIDENCE AND

APPLICATIONS IN HEALTHCARE

Maria Eduarda Iank1

Wesley Soares da Cunha2

Clesio Aparecido Marinho3

Gabriel Villela da Costa4

Abstract: Occupational stress represents a growing challenge for workers and organizations, with

signiﬁ cant effects on health, professional performance, and institutional costs. This article presents a

literature review based on classical authors and recent national and international studies regarding the

main causes, impacts, and strategies for preventing and coping with work-related stress. It adopts an

applied approach with emphasis on the healthcare sector, due to the high exposure of professionals to

intense demands, continuous contact with human suffering, and recurring structural limitations. As

empirical support, a structured questionnaire was applied to nursing professionals working in hospital

institutions, allowing a comparison between the ﬁ ndings from the literature and the local reality. The

results indicated that 60% of the participants identiﬁ ed work overload as the main stressor, followed by

lack of professional recognition (40%). Regarding the impacts, 80% reported symptoms of physical and

emotional exhaustion, while 60% stated that stress negatively affects productivity. The most relevant

strategies involved institutional psychological support (100%), redistribution of tasks and regular breaks

(80%), and individual self-care practices (60%). It is concluded that the prevention of occupational

stress requires integrated actions between individuals and organizations, with humanized management,

structured psychological support, and professional recognition being strategic elements for promoting

1 Tecnólogo em Gestão Empresarial - FATEC

2 Tecnólogo em Gestão Empresarial - FATEC

3 Mestre em Engenharia de Produção

4 Tecnólogo em Gestão da Produção Industrial - FATEC

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healthier, more productive, and sustainable work environments.

Keywords: occupational stress; worker’s health; burnout; quality of work life; hospitals.

INTRODUCTION

Workplace stress is one of the main challenges faced by contemporary organizations,

recognized by the World Health Organization (WHO, 2020) as one of the greatest threats to the

physical and mental health of workers. It is a complex phenomenon characterized by physiological,

cognitive, and emotional responses triggered when work demands exceed an individual’s coping

capacity, resulting in a prolonged state of tension capable of compromising professional performance

and quality of life.

According to Lazarus and Folkman (1984), stress should not be understood as an automatic

reaction to external pressures, but as a dynamic process of cognitive evaluation between the

individual and the environment. In this sense, stress manifests itself when perceived demands

exceed the resources available to cope with them, producing overload and emotional imbalance.

Thus, occupational stress involves both objective working conditions and subjective interpretations,

highlighting its multifactorial nature.

In the context of healthcare, work-related stress takes on even more critical dimensions.

Professionals working in hospitals and care units face long hours, high technical and ethical

responsibility, limited material and human resources, and continuous exposure to pain, suffering, and

death. These conditions make the hospital environment particularly susceptible to the development of

work-related disorders, including burnout syndrome, classiﬁ ed by the WHO (2019) as an occupational

phenomenon resulting from chronic stress that is not adequately managed, originally described by

Maslach and Jackson (1981).

Recent studies, such as those by Barello, Palamara, and Grafﬁ gna (2020) and Nowrouzi et al.

(2017), indicate that emotional overload, the intensity of work demands, and insufﬁ cient organizational

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support are among the main factors associated with illness among healthcare professionals. These

ﬁ ndings reinforce the need to reassess management models and institutional policies aimed at

promoting quality of life at work, especially in hospital settings characterized by high healthcare

pressure.

Given this scenario, this article aims to analyze the causes, impacts, and coping strategies

for occupational stress in the healthcare ﬁ eld, articulating evidence from the scientiﬁ c literature with

empirical data obtained through a questionnaire applied to nursing professionals working in hospital

institutions. By integrating theoretical review and ﬁ eld investigation, it seeks to understand how the

phenomenon manifests itself in the local context and to contribute to the formulation of preventive

measures and institutional actions aimed at promoting well-being and the sustainability of hospital

work.

LITERATURE REVIEW

Fundamental Concepts

Occupational stress is widely recognized as one of the main challenges to worker and

organizational health. The World Health Organization (WHO, 2020) deﬁ nes work-related stress as

a physical and emotional response that occurs when professional demands do not correspond to the

worker’s capabilities, resources, or needs, characterizing an imbalance between demands and coping

possibilities.

According to Lazarus and Folkman (1984), stress should be understood as a cognitive

evaluation process in which the individual interprets the environment and judges whether they possess

sufﬁ cient resources to cope with the demands imposed. When there is a perception of imbalance, the

organism activates physiological and emotional defense mechanisms that, when maintained for long

periods, can generate wear and tear and illness.

In the hospital setting, stress is intensiﬁ ed by the nature of the activities performed.

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Healthcare professionals constantly deal with emergency situations, human suffering, and a

high level of responsibility for the lives of others, which favors the development of physical and

emotional exhaustion. Burnout syndrome, described by Maslach and Jackson (1981), is one of the

main manifestations of chronic stress, characterized by emotional exhaustion, depersonalization, and

reduced professional accomplishment.

Complementing this approach, McEwen (1998) introduced the concept of allostatic load,

which represents the accumulated physiological wear and tear resulting from continuous exposure to

stress. According to the author, prolonged adaptive responses can generate a signiﬁ cant biological cost,

contributing to the development of cardiovascular diseases, metabolic disorders, and immunological

dysfunctions.

Figure 1 - Conceptual diagram of the occupational stress process

Source: Adapted from WHO (2020), Lazarus and Folkman (1984), Maslach and Jackson (1981) and

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McEwen (1998).

Main Causes of Occupational Stress

Workplace stress results from multiple factors, which vary according to organizational

culture and the characteristics of the professional activity. In hospital settings, these causes become

even more relevant due to the complexity of the environment and the high operational demands.

According to Nowrouzi et al. (2017), work overload is one of the most recurring causes,

intensiﬁ ed by prolonged working hours, a shortage of human resources, and the need to work under

constant pressure. Bhui et al. (2016) also highlight ambiguity and role conﬂ ict, characterized by a lack

of clarity in responsibilities or by contradictory demands.

Lack of autonomy and participation in decision-making is also cited as a relevant factor.

The European Agency for Safety and Health at Work (EU-OSHA, 2014) emphasizes that workers

with less control over their activities tend to exhibit higher levels of emotional stress. Furthermore,

communication failures, lack of recognition, and deﬁ ciencies in leadership contribute to increased

psychological burnout (BORGES et al., 2023).

The physical environment also exerts a signiﬁ cant inﬂ uence. The National Institute for

Occupational Safety and Health (NIOSH, 1999) highlights that factors such as noise, inadequate

lighting, extreme temperatures, and lack of breaks contribute to increased stress and reduced

performance. Table 1 presents the main causes of occupational stress identiﬁ ed in the literature.

Table 1 – Main causes of occupational stress

Cause Authors Observed impacts

Work overload Nowrouzi et al. (2017) Fatigue, exhaustion, and irritability

Role ambiguity Bhui et al. (2016) Conﬂ icts and job insecurity

Lack of autonomy EU-OSHA (2014) Reduced motivation and engagement

Poor communication Borges et al. (2023) Disorganization and tension between teams

Inadequate physical environment NIOSH (1999) Discomfort and decreased productivity

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Source: own elaboration based on the authors cited.

Impacts of Occupational Stress

The effects of prolonged stress manifest themselves comprehensively, affecting the individual,

the team, and the organization. At an individual level, stress compromises emotional and physiological

balance, and can lead to anxiety disorders, depression, insomnia, muscle pain, and cardiovascular

diseases (McEwen, 1998; WHO, 2020).

In healthcare professionals, these impacts become even more pronounced. Barello et al.

(2020) demonstrated that emotional exhaustion is among the main causes of absenteeism, directly

affecting the quality of patient care. Furthermore, stress compromises concentration and decision-

making abilities, critical aspects in the hospital environment.

In an organizational context, stress results in absenteeism, increased turnover, and reduced

productivity, raising operational costs and the risk of errors (EU-OSHA, 2014; NIOSH, 1999).

Furthermore, it compromises the organizational climate and work relationships.

Figure 2 – Levels of impact of occupational stress

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Source: Adapted from McEwen (1998), EU-OSHA (2014) and Barello et al. (2020).

Prevention and Coping Strategies

The literature shows that managing occupational stress requires integrated actions at different

levels. Bhui et al. (2016) and Nowrouzi et al. (2017) highlight that individual and organizational

interventions should work in a complementary way.

At the individual level, practices such as mindfulness, relaxation techniques, physical activities,

and emotional education contribute to strengthening psychological resilience. At the organizational

level, actions such as task redistribution, clear deﬁ nition of roles, effective communication, professional

recognition, and institutional psychological support stand out (NIOSH, 1999; WHO, 2020).

In the hospital setting, Barello et al. (2020) suggest the implementation of support groups,

listening spaces, and programs focused on quality of life at work. Table 2 presents the main strategies

for preventing and coping with occupational stress.

Table 2 – Main causes of occupational stress

Level of intervention Examples of actions Authors

Individual Mindfulness, relaxation, psychological support; Bhui et al. (2016)

Organizational Task redistribution, internal communication; NIOSH (1999)

Institutional (hospital) Support groups, wellness programs; Barello et al. (2020)

Source: adapted from Bhui et al. (2016), NIOSH (1999) and Barello et al. (2020).

RESEARCH METHODOLOGY

The methodology of this study describes the path taken to understand the impact of stress

in the work environment, with an emphasis on healthcare professionals, who are considered more

susceptible to physical and emotional burnout resulting from work demands. The research was

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conducted in two main stages: a literature review, of a theoretical nature, and ﬁ eld research, of an

empirical nature, allowing for the articulation between the ﬁ ndings of the scientiﬁ c literature and the

reality observed in the hospital context.

According to Gil (2019), the methodology guides the researcher in obtaining and analyzing

data, ensuring consistency and reliability of the results. In this sense, this study is characterized as

applied research, with a mixed approach (qualitative and quantitative), since it integrates theoretical

analysis, statistical data, and subjective perceptions of the participants.

Materials and methods

The ﬁ eld research was conducted through the application of a structured questionnaire to

healthcare professionals working in hospital institutions in the region. The instrument, composed of

29 questions, was organized into four sections: sociodemographic and professional proﬁ le; causes

of occupational stress; perceived impacts on health and performance; and coping strategies and

suggestions for improvement.

The closed-ended questions were developed using a ﬁ ve-point Likert scale, ranging from 1

(strongly disagree) to 5 (strongly agree), while the open-ended questions allowed for the collection of

participants’ subjective perceptions. The questionnaire was administered in person and anonymously,

respecting the ethical principles of research.

The data were analyzed using a mixed-methods approach. Quantitative analysis was

performed based on descriptive statistics, considering frequencies and percentages of agreement

(responses 4 and 5 on the Likert scale), according to IBGE guidelines (1993). Qualitative analysis was

conducted using the content analysis technique, according to Bardin (2011), allowing the identiﬁ cation

of thematic categories related to the causes, impacts, and coping strategies of occupational stress.

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RESULTS AND DISCUSSION

This section presents and analyzes the results obtained through the application of the

questionnaire to ﬁ ve nursing professionals. The analysis was structured around three main axes:

causes of occupational stress, impacts on health and professional performance, and coping strategies,

allowing for a comparison between empirical data and ﬁ ndings from the literature. The results were

interpreted based on the percentage frequency of agreement (responses 4 and 5 on the Likert scale),

allowing for the identiﬁ cation of predominant patterns in the participants’ perceptions.

Causes of occupational stress

The data show that work overload is the main stress factor in the hospital environment

investigated. In the sample analyzed, 60% of participants reported frequently experiencing excessive

tasks, corroborating the ﬁ ndings of Nowrouzi et al. (2017), who point to the intensity of work demands

as a central element in the emotional burnout of healthcare professionals.

Lack of professional recognition was indicated by 40% of respondents, reinforcing the

relevance of institutional appreciation for psychological well-being, as highlighted by Bhui et al.

(2016). Poor communication and an inadequate physical environment were mentioned by 20% of

participants, suggesting a lower prevalence of these factors in the analyzed context.

On the other hand, lack of autonomy was not identiﬁ ed as a relevant factor (0%), indicating that,

in this speciﬁ c scenario, professionals do not perceive decision-making restrictions as determinants

of stress. This result shows that the phenomenon can vary according to organizational and cultural

characteristics. The consolidated results are presented in Table 3.

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Table 3 – Main causes of occupational stress identiﬁ ed by participants

Cause Percentage of responses Evidence in the literature

Work overload 60% Nowrouzi et al. (2017)

Lack of autonomy 0% EU-OSHA (2014)

Poor communication 20% Borges et al. (2023)

Lack of recognition 40% Bhui et al. (2016)

Inadequate physical environment 20% NIOSH (1999)

Source: own elaboration (2026).

Impacts of stress on health and professional performance

The results indicate that occupational stress has signiﬁ cant impacts on the physical and

mental health of professionals. In the sample analyzed, 80% of participants reported symptoms of

physical and emotional exhaustion, demonstrating a strong impact at the individual level, consistent

with McEwen (1998) and Barello et al. (2020).

Furthermore, 60% stated that stress negatively interferes with productivity, while 40%

indicated that they had already considered changing sectors or institutions, suggesting possible

organizational consequences such as increased turnover and loss of human capital.

The overall average agreement was approximately 56%, indicating a predominance of

moderate to high perceived stress. This result reinforces the consistency of the data, even considering

the small sample size.

Table 4 – Impacts of occupational stress on health and performance (n = 5)

Impact assessed Percentage of responses Evidence in the literature

Physical and emotional symptoms 80% Individual

Interference with productivity 60% Professional

Consideration of changing sectors 40% Organizational

Interference in labor relations 60% Professional/Social

Stress-related absences 20% Organizational

Source: own elaboration (2026).

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The distribution of these impacts can be seen in Figure 2, which summarizes the individual,

professional, and organizational dimensions of occupational stress.

Figure 2 – Levels of impact of occupational stress

Source: own elaboration (2026).

Coping and prevention strategies

The results demonstrate consensus regarding the need for structured interventions in the

organizational environment. All participants (100%) highlighted the importance of institutional

psychological support, demonstrating the demand for formal support policies.

Furthermore, 80% highlighted the importance of redistributing tasks and adopting regular

breaks, indicating that organizational changes can signiﬁ cantly reduce workload. Meanwhile, 60%

recognized the importance of individual practices such as self-care, relaxation, and mindfulness.

These ﬁ ndings are consistent with Bhui et al. (2016) and Barello et al. (2020), who advocate

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for the integration of individual and organizational strategies in coping with occupational stress.

Table 5 – Coping strategies identiﬁ ed in the research and literature

Level Suggested action Percentage (questionnaire) Theoretical reference

Individual Mindfulness, relaxation, self-care 60% Bhui et al. (2016)

Organizational Task redistribution, breaks,

psychological support.

80% NIOSH (1999)

Institutional Listening spaces and wellness

programs

100% Barello et al. (2020)

Source: own elaboration (2026).

Discussion of results

The integrated data analysis conﬁ rms that workload overload is the main stress factor in the

hospital setting, consistent with the literature. This result highlights that the intensity of demands

remains a critical variable in healthcare work management.

It is observed that individual impacts (80%) are more signiﬁ cant than professional (60%)

and organizational (40%) impacts, indicating that stress initially manifests in the psychophysiological

dimension of the worker. This pattern can be interpreted in light of the concept of allostatic load

(McEwen, 1998), according to which continuous exposure to stress generates cumulative effects on

health.

The unanimous agreement regarding the need for institutional psychological support

reinforces the importance of structured organizational interventions. The results indicate that

coping with occupational stress requires integrated actions, involving professional recognition, work

reorganization, and ongoing psychological support.

Despite the sample size limitation, the data are consistent with the scientiﬁ c literature,

demonstrating that occupational stress remains a signiﬁ cant challenge in the hospital environment. In

this sense, the adoption of integrated strategies is essential to promote healthier, more productive, and

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sustainable work environments.

FINAL CONSIDERATIONS

This article aimed to analyze the causes, impacts, and coping strategies for occupational

stress in the hospital setting, combining a literature review and empirical research. The combination

of these approaches made it possible to understand the phenomenon in an integrated way, relating

theoretical foundations to the reality observed among nursing professionals in the Sertãozinho region

(SP).

The results showed that work overload is the main stressor (60%), followed by lack of

professional recognition (40%), while factors such as poor communication and inadequate physical

conditions were less relevant (20%). These ﬁ ndings conﬁ rm the literature, especially the studies by

Nowrouzi et al. (2017) and Bhui et al. (2016), which highlight the intensity of work demands and

professional recognition as central determinants of occupational stress in the health ﬁ eld.

Regarding the impacts, manifestations on an individual level predominated, with 80% of

participants reporting symptoms of physical and emotional exhaustion and 60% indicating impaired

productivity. These results suggest that stress initially manifests at the psychophysiological level

and can evolve into organizational consequences, such as turnover and reduced performance. This

interpretation aligns with the concept of allostatic load (McEwen, 1998), which highlights the

cumulative effects of prolonged stress on health.

Regarding coping strategies, the need for structured actions within the institutional

environment was highlighted, with unanimous agreement on the importance of psychological support

(100%). Organizational measures, such as task redistribution and regular breaks (80%), and individual

strategies, such as self-care practices (60%), were identiﬁ ed as complementary, demonstrating that

coping with stress requires an integrated approach between the individual and the organization.

One limitation is the difﬁ culty in obtaining respondents and their geographical scope, which

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restricts the generalizability of the results. However, the data obtained are consistent with the scientiﬁ c

literature, indicating relevant trends for the analyzed context. It is recommended that future research

expand the number of participants and include different professional categories in order to deepen the

understanding of the organizational variables that inﬂ uence occupational stress.

It is concluded that managing occupational stress constitutes a strategic challenge for

healthcare institutions, making the implementation of policies focused on humanized management,

continuous psychological support, and professional development fundamental. Investing in the mental

health of workers not only prevents illness but also contributes to improving the quality of services

provided, promoting healthier, more productive, and sustainable work environments.

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