Post-Resuscitation Stress Among Nurses: A Systematic Review With Exploratory Quantitative Synthesis
Abbas Heydari, Zahra Sadat Manzari, Saeed Khayat KakhkiIntroduction
Post-resuscitation stress is a resuscitation-specific construct assessed using different forms of the Post-Code Stress Scale (PCSS). This review aimed to identify, critically appraise, and narratively synthesise quantitative evidence on post-resuscitation stress among nurses and to conduct exploratory quantitative synthesis where appropriate.
Methods
PubMed, Scopus, Web of Science Core Collection, and Google Scholar were searched from inception to 24 June 2026. Two reviewers independently performed study selection, data extraction, and methodological appraisal. Narrative synthesis was the primary approach. Random-effects analyses using restricted maximum likelihood estimation and Hartung–Knapp confidence intervals were conducted only for studies reporting a composite estimate and measure of dispersion.
Results
Five studies involving 1,452 nurses were included. PCSS forms varied from 14 to 20 scored items; four studies reported composite estimates, whereas the Slovenian pilot study contributed item-level findings only. Narrative synthesis identified recurrent stressors involving perceived inadequate performance, equipment and communication difficulties, insufficient supervisory support, moral or professional conflict, and inadequate opportunity for post-event recovery or discussion. The principal methodological concerns were non-probability sampling, limited representativeness of sampling frames, and incomplete response-rate reporting. Composite mean item scores ranged from 3.29 to 3.74 on the original 1–5 scale. The pooled mean item score was 3.48 (95% CI: 2.89–4.07; I 2 = 97.0%) in the three-study published-estimates analysis and 3.47 (95% CI: 3.16–3.78; I 2 = 97.4%) in the expanded four-study analysis including the final 18-item Persian PCSS estimate. Because of extreme heterogeneity and non-equivalent PCSS forms, both pooled estimates were interpreted as exploratory only.
Conclusion
Post-resuscitation stress was reported across diverse nursing settings, but differences in populations, resuscitation contexts, and PCSS item sets limit direct score comparison and the interpretation of pooled estimates. Standardised measurement and more transparent reporting are needed.