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style=3D"width:396.3pt; margin-bottom:0pt; padding:0pt; border-colla= pse:collapse"><tr><td style=3D"width:3.25pt; border:0.75pt solid #000000; p= adding:0pt 5.03pt; vertical-align:top"><p style=3D"margin-bottom:0pt; text-= align:center; line-height:150%; font-size:10pt"><span style=3D"line-height:= 150%; font-family:'Times New Roman'; font-size:6.67pt; font-weight:bold; ve= rtical-align:super">1</span></p></td><td style=3D"width:171.95pt; border:0.= 75pt solid #000000; padding:0pt 5.03pt; vertical-align:top"><p style=3D"mar= gin-left:7.1pt; margin-bottom:0pt; text-indent:-7.1pt; text-align:justify; = line-height:normal; font-size:10pt"><span style=3D"font-family:'Times New R= oman'">Yomar Elizabeth Capus Aguila</span></p></td><td style=3D"width:10.5p= t; border:0.75pt solid #000000; padding:0pt 5.03pt; vertical-align:top"><p = style=3D"margin-bottom:0pt; text-align:center; line-height:150%; font-size:= 10pt"><span style=3D"height:0pt; text-align:left; display:block; position:a= bsolute; z-index:20"><img src=3D"data:image/png;base64,iVBORw0KGgoAAAANSUhE= UgAAABQAAAAUCAYAAACNiR0NAAAABHNCSVQICAgIfAhkiAAAAAlwSFlzAAAOxAAADsQBlSsOGwA= AA2lJREFUOI21lEtoXVUUhr+197n3nNzbJN6omdTWRmwbikVq4iMxk0ZU2oGgA1FnQcQiUhUnFq= o4cGIRQUGd+KDY+Jp25ouiGCOxElqjhba0URPzsPQmuY9zzj1nLwcnuU1iQ0f+mzXZe///Wv/ai= y1cBV/83NNOPr/VWHunqO5OVNuNlQVjmZCGjCVhcPHR3q8XrsaVNUITu/KSlu7LFeSpNNZ+57RT= jDTvqFM1IvNiGXWJvD/9x8yXB/efizYU/Hy8/0W/aA/Xq43r1P3nOCNIFsW2XLleTd648Z/863v= 3nkjWCL59dp/fWSsfzOXNkShKacvfgnMRlXjqqqIrwr5vkihyhxbT+K2ne082AAzADZXyPj+wL8= ehQ1NH700v0N35OAroutW0rxDF6rUUvddaJfdwM9HwqYFSa0GO1SrpfucUVUXEZCQcqQtZ0VEU1= QTPtmAkDygiEBTsTxq6hx65fWTOy7l0exjKgGrGcjTo2/oKS9EUZ2aPcf/Oo1iTI9UGqFJrzDF5= +Sv+Wvg+y+IEVXaGibsbOO5hGBSkbUUQdRT9zaQuBhE6Ct2MT7/D9OIIVnw6Ct3csfk52oNtTMw= cBbE0YteeC7we4LinSI9Z03dBNUVxTdu1eI7FcBIjHvPVU1Tjv7nn5sNMXv6WSjyFiIg17AAwqp= RW9fqayNkiM0tjqDrag67mDCi0ARiB6gaTsSEEg4htusj2qGeCIr9dW0JR3PKrR2zreIDURZTrZ= 7NTBYdeBPAU+cY59zxCkFlXjHiI2GY1pZbtRMkC1gZcX9hFV+lBTs98SDWexYjFGqkldT0J4EkY= 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solid #000000; padding:0pt; vertical-align:top"></td></tr><tr><td style= =3D"width:3.25pt; border:0.75pt solid #000000; padding:0pt 5.03pt; vertical= -align:top"><p style=3D"margin-bottom:0pt; text-align:center; line-height:1= 50%; font-size:14pt"><span style=3D"font-family:'Times New Roman'"> </= span></p></td><td colspan=3D"4" style=3D"width:370.7pt; border:0.75pt solid= #000000; padding:0pt 5.03pt; vertical-align:top"><p style=3D"margin-bottom= :0pt; text-align:justify; line-height:normal; font-size:10pt"><span style= =3D"font-family:'Times New Roman'">Universidad Estatal de Bol=C3=ADvar (UEB= ), Guaranda, Ecuador.</span></p><p style=3D"margin-bottom:0pt; text-align:j= ustify; line-height:normal; font-size:10pt"><span style=3D"font-family:'Tim= es New Roman'">Maestr=C3=ADa en Salud Publica </span></p><p style=3D"margin= -left:7.1pt; margin-bottom:0pt; text-indent:-7.1pt; text-align:justify; lin= e-height:normal"><a href=3D"mailto:yomar.capus@ueb.edu.ec" style=3D"text-de= coration:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New Ro= man'">yomar.capus@ueb.edu.ec</span></a></p></td></tr><tr><td style=3D"width= :3.25pt; border:0.75pt solid #000000; padding:0pt 5.03pt; vertical-align:to= p"><p style=3D"margin-bottom:0pt; text-align:center; line-height:150%; font= -size:10pt"><span style=3D"line-height:150%; font-family:'Times New Roman';= font-size:6.67pt; font-weight:bold; vertical-align:super">2</span></p></td= ><td style=3D"width:171.95pt; border:0.75pt solid #000000; padding:0pt 5.03= pt; vertical-align:top"><p style=3D"margin-left:7.1pt; margin-bottom:0pt; t= ext-indent:-7.1pt; text-align:justify; line-height:normal; font-size:10pt">= <span style=3D"font-family:'Times New Roman'">Stefanny Karolina D=C3=ADas L= edesma</span></p></td><td style=3D"width:10.5pt; border:0.75pt solid #00000= 0; padding:0pt 5.03pt; vertical-align:top"><p style=3D"margin-bottom:0pt; t= ext-align:center; line-height:150%; font-size:10pt"><span style=3D"height:0= pt; text-align:left; display:block; position:absolute; z-index:19"><img src= =3D"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABQAAAAUCAYAAACNiR0NAAAAB= HNCSVQICAgIfAhkiAAAAAlwSFlzAAAOxAAADsQBlSsOGwAAA2lJREFUOI21lEtoXVUUhr+197n3= nNzbJN6omdTWRmwbikVq4iMxk0ZU2oGgA1FnQcQiUhUnFqo4cGIRQUGd+KDY+Jp25ouiGCOxElq= jhba0URPzsPQmuY9zzj1nLwcnuU1iQ0f+mzXZe///Wv/aiy1cBV/83NNOPr/VWHunqO5OVNuNlQ= VjmZCGjCVhcPHR3q8XrsaVNUITu/KSlu7LFeSpNNZ+57RTjDTvqFM1IvNiGXWJvD/9x8yXB/efi= zYU/Hy8/0W/aA/Xq43r1P3nOCNIFsW2XLleTd648Z/863v3nkjWCL59dp/fWSsfzOXNkShKacvf= gnMRlXjqqqIrwr5vkihyhxbT+K2ne082AAzADZXyPj+wL8ehQ1NH700v0N35OAroutW0rxDF6rU= UvddaJfdwM9HwqYFSa0GO1SrpfucUVUXEZCQcqQtZ0VEU1QTPtmAkDygiEBTsTxq6hx65fWTOy7= l0exjKgGrGcjTo2/oKS9EUZ2aPcf/Oo1iTI9UGqFJrzDF5+Sv+Wvg+y+IEVXaGibsbOO5hGBSkb= UUQdRT9zaQuBhE6Ct2MT7/D9OIIVnw6Ct3csfk52oNtTMwcBbE0YteeC7we4LinSI9Z03dBNUVx= Tdu1eI7FcBIjHvPVU1Tjv7nn5sNMXv6WSjyFiIg17AAwqpRW9fqayNkiM0tjqDrag67mDCi0ARi= B6gaTsSEEg4htusj2qGeCIr9dW0JR3PKrR2zreIDURZTrZ7NTBYdeBPAU+cY59zxCkFlXjHiI2G= 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></a></p></td><td style=3D"border-top:0.75pt solid #000000; border-bottom:0= .75pt solid #000000; padding:0pt; vertical-align:top"></td></tr><tr><td sty= le=3D"width:3.25pt; border:0.75pt solid #000000; padding:0pt 5.03pt; vertic= al-align:top"><p style=3D"margin-bottom:0pt; text-align:center; line-height= :150%; font-size:14pt"><span style=3D"font-family:'Times New Roman'"> = </span></p></td><td colspan=3D"4" style=3D"width:370.7pt; border:0.75pt sol= id #000000; padding:0pt 5.03pt; vertical-align:top"><p style=3D"margin-bott= om:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style= =3D"font-family:'Times New Roman'">Universidad Estatal de Bol=C3=ADvar (UEB= ), Guaranda, Ecuador.</span></p><p style=3D"margin-bottom:0pt; text-align:j= ustify; line-height:normal"><a href=3D"mailto:sdias@mailes.ueb.edu.ec" styl= e=3D"text-decoration:none"><span class=3D"Hyperlink" style=3D"font-family:'= Times New Roman'">sdias@mailes.ueb.edu.ec</span></a></p></td></tr><tr style= =3D"height:0pt"><td style=3D"width:14.05pt"></td><td style=3D"width:182.75p= t"></td><td style=3D"width:21.3pt"></td><td style=3D"width:177.15pt"></td><= td style=3D"width:0.3pt"></td></tr></table><p class=3D"Default" style=3D"te= xt-indent:36pt; text-align:center; line-height:115%; font-size:14pt"><span = style=3D"font-style:italic"> </span></p><table style=3D"width:436.35pt= ; margin-left:0.25pt; margin-bottom:0pt; padding:0pt; border-collapse:colla= pse"><tr><td colspan=3D"3" style=3D"width:156.4pt; padding:0pt 5.4pt; verti= cal-align:top"><p style=3D"margin-bottom:0pt; text-align:right; line-height= :normal; font-size:10pt"><a id=3D"_Hlk92186133"><span class=3D"Hyperlink" s= tyle=3D"font-family:'Times New Roman'; text-decoration:none; color:#0000ff"= > </span></a></p><p style=3D"margin-bottom:0pt; text-align:right; line= -height:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman= '"> </span></p><p style=3D"margin-bottom:0pt; text-align:right; line-h= eight:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'"= > </span></p><p style=3D"margin-bottom:0pt; text-align:right; line-hei= ght:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'">&= #xa0;</span></p><p style=3D"margin-bottom:0pt; text-align:right; line-heigh= t:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'">&#x= a0;</span></p><p style=3D"margin-bottom:0pt; text-align:right; line-height:= normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'"> = ;</span></p><p style=3D"margin-bottom:0pt; text-align:right; line-height:no= rmal; font-size:10pt"><span style=3D"font-family:'Times New Roman'"> <= /span></p><p style=3D"margin-bottom:0pt; text-align:right; line-height:norm= al; font-size:10pt"><span style=3D"font-family:'Times New Roman'"> </s= pan></p><p style=3D"margin-bottom:0pt; text-align:right; line-height:normal= ; font-size:10pt"><span style=3D"font-family:'Times New Roman'"> </spa= n></p><p style=3D"margin-bottom:0pt; text-align:right; line-height:normal; = font-size:10pt"><span style=3D"font-family:'Times New Roman'"> </span>= </p></td><td colspan=3D"2" style=3D"width:258.35pt; border-top:0.75pt solid= #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:= 0pt; text-align:right; line-height:normal; font-size:10pt"><span style=3D"f= ont-family:'Times New Roman'; font-weight:bold">Art=C3=ADculo de Investigac= i=C3=B3n Cient=C3=ADfica y Tecnol=C3=B3gica</span></p><p style=3D"margin-bo= ttom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style= =3D"font-family:'Times New Roman'">Enviado: </span></p><p style=3D"margin-b= ottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span styl= e=3D"font-family:'Times New Roman'">Revisado: </span></p><p style=3D"margin= -bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span st= yle=3D"font-family:'Times New Roman'">Aceptado: </span></p><p style=3D"marg= in-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span = style=3D"font-family:'Times New Roman'">Publicado:</span></p><p style=3D"ma= rgin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><spa= n class=3D"label" style=3D"font-family:'Times New Roman'; background-color:= #ffffff">DOI:</span><span class=3D"label" style=3D"font-family:'Times New R= oman'; background-color:#ffffff"> </span></p></td></tr><tr style=3D"he= ight:6.55pt"><td colspan=3D"3" style=3D"width:156.4pt; padding:0pt 5.4pt; v= ertical-align:top"><p style=3D"margin-bottom:0pt; text-align:right; line-he= ight:normal; font-size:6pt"><span class=3D"Hyperlink" style=3D"font-family:= 'Times New Roman'; text-decoration:none; color:#0000ff"> </span></p><p= style=3D"margin-bottom:0pt; text-align:right; line-height:normal; font-siz= e:6pt"><span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; te= xt-decoration:none; color:#0000ff"> </span></p></td><td colspan=3D"2" = style=3D"width:258.35pt; border-bottom:0.75pt solid #000000; padding:0pt 5.= 4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; text-align:right; l= ine-height:normal; font-size:6pt"><span style=3D"font-family:'Times New Rom= an'; font-weight:bold"> </span></p></td></tr><tr><td style=3D"width:37= .8pt; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt;= text-align:justify; line-height:150%; font-size:12pt"><span style=3D"font-= family:'Times New Roman'; font-weight:bold"> </span></p><p style=3D"ma= rgin-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><spa= n style=3D"font-family:'Times New Roman'; font-weight:bold">C=C3=ADtese:</s= pan><span style=3D"font-family:'Times New Roman'"> </span></p></td><td styl= e=3D"width:1.55pt; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margi= n-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><span s= tyle=3D"font-family:'Times New Roman'; font-weight:bold"> </span></p><= /td><td colspan=3D"2" style=3D"width:358.55pt; 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UVORK5CYII=3D" width=3D"567" height=3D"140" alt=3D"" /></p><p class=3D"Defa= ult" style=3D"margin-bottom:10pt; line-height:115%"><span style=3D"font-wei= ght:bold; color:#a5a5a5"> </span></p><p class=3D"Default" style=3D"mar= gin-bottom:10pt; line-height:115%"><span style=3D"font-weight:bold; color:#= a5a5a5"> </span></p><table style=3D"width:425.35pt; margin-left:0.25pt= ; margin-bottom:0pt; padding:0pt; border-collapse:collapse"><tr><td colspan= =3D"2" style=3D"width:85pt; border:0.75pt solid #000000; padding:0pt 5.03pt= ; vertical-align:top"><p style=3D"margin-bottom:0pt; text-align:justify; li= ne-height:115%; font-size:12pt"><span style=3D"font-family:'Times New Roman= '; font-weight:bold; color:#767171">Palabras claves:</span><span style=3D"f= ont-family:'Times New Roman'; color:#767171"> </span></p><p style=3D"margin= -bottom:0pt; line-height:normal; font-size:12pt"><span style=3D"font-family= :'Times New Roman'">estr=C3=A9s laboral, enfermer=C3=ADa, desempe=C3=B1o pr= ofesional, </span></p><p style=3D"margin-bottom:0pt; line-height:normal; fo= nt-size:12pt"><span style=3D"font-family:'Times New Roman'">=C3=A1reas cr= =C3=ADticas, s=C3=ADndrome de burnout, hospitales latinoamericanos, salud o= cupacional.</span></p></td><td style=3D"width:314.9pt; border:0.75pt solid = #000000; padding:0pt 5.03pt; vertical-align:top"><p style=3D"margin-bottom:= 0pt; text-align:justify; line-height:115%; font-size:12pt"><span style=3D"f= ont-family:'Times New Roman'; font-weight:bold">Resumen </span></p><p style= =3D"margin-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt= "><span style=3D"font-family:'Times New Roman'; font-weight:bold; backgroun= d-color:#ffffff">Introducci=C3=B3n:</span><span style=3D"font-family:'Times= New Roman'; background-color:#ffffff"> el estr=C3=A9s laboral en el person= al de enfermer=C3=ADa de =C3=A1reas cr=C3=ADticas representa una problem=C3= =A1tica relevante en la salud ocupacional latinoamericana, agravada por lim= itaciones presupuestarias, d=C3=A9ficit de recursos humanos y el impacto de= la pandemia COVID-19. </span><span style=3D"font-family:'Times New Roman';= font-weight:bold; background-color:#ffffff">Objetivo:</span><span style=3D= "font-family:'Times New Roman'; background-color:#ffffff"> analizar sistem= =C3=A1ticamente la evidencia cient=C3=ADfica sobre el impacto del estr=C3= =A9s laboral en el desempe=C3=B1o del personal de enfermer=C3=ADa en =C3=A1= reas cr=C3=ADticas de hospitales latinoamericanos durante 2020-2025. </span= ><span style=3D"font-family:'Times New Roman'; font-weight:bold; background= -color:#ffffff">Metodolog=C3=ADa:</span><span style=3D"font-family:'Times N= ew Roman'; background-color:#ffffff"> Revisi=C3=B3n sistem=C3=A1tica siguie= ndo directrices PRISMA 2020. Se consultaron bases de datos cient=C3=ADficas= (PubMed/MEDLINE, Scopus, Web of Science, LILACS, SciELO, Dialnet), hasta n= oviembre 2025. De 135 registros iniciales, se analizaron 28 estudios de alt= a calidad metodol=C3=B3gica evaluados mediante herramientas CASP y Newcastl= e-Ottawa. </span><span style=3D"font-family:'Times New Roman'; font-weight:= bold; background-color:#ffffff">Resultados:</span><span style=3D"font-famil= y:'Times New Roman'; background-color:#ffffff"> la prevalencia promedio de = s=C3=ADndrome de burnout fue 43.8%, alcanzando 84.4% en contextos pand=C3= =A9micos. La sobrecarga laboral se report=C3=B3 en 85.7% de estudios. El ag= otamiento emocional afect=C3=B3 al 62.8% del personal, despersonalizaci=C3= =B3n al 64.9%, y 77.7% report=C3=B3 bajo desarrollo profesional. El estr=C3= =A9s impacta directamente en la seguridad del paciente, incrementando error= es cl=C3=ADnicos. </span><span style=3D"font-family:'Times New Roman'; font= -weight:bold; background-color:#ffffff">Conclusi=C3=B3n:</span><span style= =3D"font-family:'Times New Roman'; background-color:#ffffff"> el estr=C3=A9= s laboral constituye una consecuencia estructural de deficiencias sist=C3= =A9micas, no un problema individual. Las intervenciones efectivas requieren= mejoras organizacionales, apoyo psicol=C3=B3gico sistem=C3=A1tico y pol=C3= =ADticas de salud ocupacional. Invertir en salud ocupacional del personal e= s estrat=C3=A9gico para la calidad y sostenibilidad de los sistemas de salu= d latinoamericanos. </span><span style=3D"font-family:'Times New Roman'; fo= nt-weight:bold">=C3=81rea de estudio general:</span><span style=3D"font-fam= ily:'Times New Roman'"> Ciencias de la Salud. </span><span style=3D"font-fa= mily:'Times New Roman'; font-weight:bold">=C3=81rea de estudio espec=C3=ADf= ica:</span><span style=3D"font-family:'Times New Roman'"> Enfermer=C3=ADa /= Salud Ocupacional, </span><span style=3D"font-family:'Times New Roman'; fo= nt-weight:bold">Tipo de estudio:</span><span style=3D"font-family:'Times Ne= w Roman'"> Revisi=C3=B3n bibliogr=C3=A1fica sistem=C3=A1tica.</span></p></t= d><td style=3D"border-bottom:0.75pt solid #000000; padding:0pt; vertical-al= ign:top"></td></tr><tr><td style=3D"width:83.2pt; border-top:0.75pt solid #= 000000; border-right:0.75pt solid #5b9bd5; border-left:0.75pt solid #5b9bd5= ; border-bottom:0.75pt solid #5b9bd5; padding:0pt 5.03pt; vertical-align:to= p"><p class=3D"Title" style=3D"text-align:justify; line-height:115%; font-s= ize:12pt"><span style=3D"font-family:'Times New Roman'; font-weight:bold; c= olor:#767171">Keywords:</span><span style=3D"font-family:'Times New Roman';= color:#767171"> </span></p><p class=3D"Title" style=3D"text-align:left; li= ne-height:115%; font-size:12pt"><span style=3D"font-family:'Times New Roman= '">work-related stress, nursing, professional performance, critical care, b= urnout syndrome, </span></p><p class=3D"Title" style=3D"text-align:left; li= ne-height:115%; font-size:12pt"><span style=3D"font-family:'Times New Roman= '">Latin American hospitals, occupational health.</span></p></td><td colspa= n=3D"3" style=3D"width:319.8pt; border-top:0.75pt solid #000000; border-rig= ht:0.75pt solid #5b9bd5; border-left:0.75pt solid #5b9bd5; border-bottom:0.= 75pt solid #5b9bd5; padding:0pt 5.03pt; vertical-align:top"><p style=3D"mar= gin-bottom:0pt; text-align:justify; line-height:normal; font-size:12pt"><sp= an style=3D"font-family:'Times New Roman'; font-weight:bold; color:#808080"= >Abstract</span></p><p style=3D"margin-bottom:0pt; text-align:justify; line= -height:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman';= font-weight:bold">Introduction:</span><span style=3D"font-family:'Times Ne= w Roman'"> work-related stress among critical care nursing staff represents= a significant occupational health problem in Latin America, aggravated by = budget limitations, human resource deficits, and COVID-19 pandemic impact. = </span><span style=3D"font-family:'Times New Roman'; font-weight:bold">Obje= ctive:</span><span style=3D"font-family:'Times New Roman'"> to systematical= ly analyze scientific evidence on the impact of work-related stress on nurs= ing staff performance in critical care areas of Latin American hospitals du= ring 2020-2025. </span><span style=3D"font-family:'Times New Roman'; font-w= eight:bold">Methodology:</span><span style=3D"font-family:'Times New Roman'= "> systematic review following PRISMA 2020 guidelines. Scientific databases= were consulted (PubMed/MEDLINE, Scopus, Web of Science, LILACS, SciELO, Di= alnet), until November 2025. From 135 initial records, 28 high-quality stud= ies were analyzed using CASP and Newcastle-Ottawa tools. </span><span style= =3D"font-family:'Times New Roman'; font-weight:bold">Results:</span><span s= tyle=3D"font-family:'Times New Roman'"> average burnout syndrome prevalence= was 43.8%, reaching 84.4% in pandemic contexts. Work overload was reported= in 85.7% of studies. Emotional exhaustion affected 62.8% of staff, deperso= nalization 64.9%, and 77.7% reported low professional development. Stress d= irectly impacts patient safety, increasing clinical errors. </span><span st= yle=3D"font-family:'Times New Roman'; font-weight:bold">Conclusion:</span><= span style=3D"font-family:'Times New Roman'"> work-related stress constitut= es a structural consequence of systemic deficiencies, not an individual pro= blem. Effective interventions require organizational improvements, systemat= ic psychological support, and occupational health policies. Investing in st= aff occupational health is strategic for quality and sustainability of Lati= n American health systems. </span><span style=3D"font-family:'Times New Rom= an'; font-weight:bold">General study area:</span><span style=3D"font-family= :'Times New Roman'"> Health Sciences.</span><span style=3D"font-family:'Tim= es New Roman'; font-weight:bold"> Specific study area:</span><span style=3D= "font-family:'Times New Roman'"> Nursing / Occupational Health. </span><spa= n style=3D"font-family:'Times New Roman'; font-weight:bold">Type of study:<= /span><span style=3D"font-family:'Times New Roman'"> Systematic literature = review.</span></p></td></tr><tr style=3D"height:0pt"><td style=3D"width:94p= t"></td><td style=3D"width:1.8pt"></td><td style=3D"width:325.7pt"></td><td= style=3D"width:3.1pt"></td></tr></table><p class=3D"Default" style=3D"marg= in-bottom:10pt; line-height:115%"><span style=3D"font-weight:bold; color:#a= 5a5a5"> </span></p><p class=3D"Default" style=3D"margin-bottom:10pt; l= ine-height:115%"><span style=3D"font-weight:bold; color:#a5a5a5"> </sp= an></p><p class=3D"ListParagraph" style=3D"text-indent:-18pt; text-align:ju= stify; line-height:108%; font-size:12pt"><span style=3D"font-family:'Times = New Roman'; font-weight:bold; color:#767171"><span>1.</span></span><span st= yle=3D"width:9pt; font:7pt 'Times New Roman'; display:inline-block"> &= #xa0;    </span><span style=3D"font-family:'Times New Roman'= ; font-weight:bold; color:#767171">Introducci=C3=B3n</span></p><p style=3D"= margin-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><s= pan style=3D"font-family:'Times New Roman'">El estr=C3=A9s laboral se defin= e como un conjunto de reacciones emocionales, psicol=C3=B3gicas, cognitivas= y conductuales de car=C3=A1cter negativo que emergen cuando las demandas d= el ambiente laboral exceden la capacidad de respuesta del profesional, repr= esentando una de las problem=C3=A1ticas m=C3=A1s relevantes en el contexto = de la salud ocupacional contempor=C3=A1nea, particularmente en el =C3=A1mbi= to de los cuidados cr=C3=ADticos. En Latinoam=C3=A9rica, esta problem=C3=A1= tica adquiere dimensiones especialmente preocupantes debido a las caracter= =C3=ADsticas particulares de los sistemas de salud de la regi=C3=B3n, que f= recuentemente enfrentan limitaciones presupuestarias significativas, d=C3= =A9ficit cr=C3=B3nico de recursos humanos e infraestructura insuficiente. L= as =C3=A1reas cr=C3=ADticas hospitalarias, tales como las </span><span styl= e=3D"font-family:'Times New Roman'; text-decoration:underline">Unidades de = Cuidados Intensivos (UCI)</span><span style=3D"font-family:'Times New Roman= '">, las unidades de terapia intensiva pedi=C3=A1trica, las unidades de cui= dados intensivos neonatales y los servicios de emergencia, se caracterizan = por la atenci=C3=B3n de pacientes en estado cr=C3=ADtico que requieren vigi= lancia continua, intervenciones terap=C3=A9uticas complejas y toma de decis= iones r=C3=A1pidas bajo condiciones de alta presi=C3=B3n, factores que inte= nsifican la exposici=C3=B3n a situaciones estresantes de manera cr=C3=B3nic= a (Jim=C3=A9nez et al., 2023).</span></p><p style=3D"margin-bottom:0pt; tex= t-align:justify; line-height:150%; font-size:12pt"><span style=3D"font-fami= ly:'Times New Roman'">La evidencia cient=C3=ADfica reciente documento de ma= nera consistente que el personal de enfermer=C3=ADa en =C3=A1reas cr=C3=ADt= icas experimenta niveles significativamente elevados de estr=C3=A9s laboral= y s=C3=ADndrome de burnout en toda la regi=C3=B3n latinoamericana (Veloso = et al., 2024</span><span style=3D"line-height:150%; font-family:'Times New = Roman'; font-size:11pt">)</span><span style=3D"font-family:'Times New Roman= '">. Estudios en: Chile, Ecuador, Brasil y Per=C3=BA, revelan que el person= al presenta caracter=C3=ADsticas compatibles con estr=C3=A9s laboral, relac= ionado principalmente con sobrecarga laboral, exposici=C3=B3n continua a si= tuaciones de muerte, y d=C3=A9ficit de recursos institucionales (</span><sp= an style=3D"line-height:150%; font-family:'Times New Roman'; font-size:11pt= ">Guillen</span><span style=3D"font-family:'Times New Roman'"> et al., 2025= ). La sobrecarga laboral emerge consistentemente como uno de los factores e= stresores m=C3=A1s prevalentes y con mayor impacto sobre el bienestar del p= ersonal. Esta sobrecarga se manifiesta en el d=C3=A9ficit cr=C3=B3nico de p= ersonal que resulta en ratios enfermera-paciente inadecuadas, jornadas labo= rales extendidas, ausencia de per=C3=ADodos de descanso y asignaci=C3=B3n d= e responsabilidades que exceden la capacidad individual de respuesta. Un es= tudio evidencia que enfermeras de 13 pa=C3=ADses de Am=C3=A9rica Latina suf= ren estr=C3=A9s laboral superior, sumado a padecimiento de sobrecarga de tr= abajo y exceso de horas en su jornada laboral, mencionando que las instituc= iones donde laboran no cuentan con apoyo psicol=C3=B3gico (Del Rosario et a= l., 2021). La unidad de cuidados intensivos presenta mayor cantidad de mani= festaciones estresantes, mientras que la unidad de cuidados m=C3=A9dicos qu= ir=C3=BArgicos representa una mayor sobrecarga laboral (Torrecilla et al., = 2021).</span></p><p style=3D"margin-bottom:0pt; text-align:justify; line-he= ight:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">La= s consecuencias del estr=C3=A9s laboral son m=C3=BAltiples e interrelaciona= das, afectando simult=C3=A1neamente al profesional, a la organizaci=C3=B3n = y la calidad de atenci=C3=B3n. Los altos niveles de estr=C3=A9s hacen que l= as enfermeras sean m=C3=A1s propensas a desarrollar diversas enfermedades f= =C3=ADsicas y mentales, p=C3=A9rdida del rendimiento y productividad, gener= ando insatisfacci=C3=B3n del paciente con respecto a la atenci=C3=B3n entre= gada, y la sobrecarga laboral aumenta los niveles de estr=C3=A9s que al ser= sobrepasado puede conducir a errores en el cuidado de la persona atendida = (V=C3=A1squez & Gonz=C3=A1lez, 2020). El s=C3=ADndrome de burnout en en= fermer=C3=ADa intensiva tiene influencia directa en la seguridad del pacien= te, incrementando el riesgo de eventos adversos relacionados con los cuidad= os de enfermer=C3=ADa (Dur=C3=A1n et al., 2021).</span></p><p style=3D"marg= in-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><span = style=3D"font-family:'Times New Roman'">La salud mental del personal de sal= ud es una preocupaci=C3=B3n frecuente, incluso mucho antes de la pandemia, = teniendo la ansiedad y el estr=C3=A9s una incidencia significativa en el pe= rsonal de salud (Torrecilla et al., 2021). Estas condiciones laborales dema= ndantes no solo afectan la estabilidad emocional del personal de enfermer= =C3=ADa, sino que tambi=C3=A9n repercuten en su capacidad de afrontamiento,= adaptaci=C3=B3n y resiliencia frente a eventos adversos, generando un desg= aste progresivo que compromete el equilibrio entre la vida personal y profe= sional, as=C3=AD como la continuidad y calidad del cuidado brindado (Balder= a & Ydrogo, 2022)</span><span>. </span><span style=3D"font-family:'Time= s New Roman'">Al provocar una afluencia masiva de pacientes en estado cr=C3= =ADtico, la pandemia de COVID-19 cambio radicalmente las pr=C3=A1cticas pro= fesionales en las unidades de cuidados intensivos, generando un estr=C3=A9s= laboral sin precedentes en los profesionales de salud que laboraban en est= as unidades, porque no se contaba con todas las medidas de bioseguridad req= ueridas para la protecci=C3=B3n del personal, adem=C3=A1s los insumos m=C3= =A9dicos se agotaron y eran escasos (Moncada et al., 2021).</span></p><p st= yle=3D"margin-bottom:0pt; text-align:justify; line-height:150%; font-size:1= 2pt"><span style=3D"font-family:'Times New Roman'">A pesar de la creciente = evidencia sobre la prevalencia del estr=C3=A9s laboral en el personal de en= fermer=C3=ADa de =C3=A1reas cr=C3=ADticas y su impacto documentado sobre el= desempe=C3=B1o profesional y la calidad de atenci=C3=B3n, existe un vac=C3= =ADo significativo en el conocimiento consolidado espec=C3=ADfico para el c= ontexto latinoamericano. No existe una s=C3=ADntesis comprehensiva que inte= gre la evidencia disponible para proporcionar una visi=C3=B3n regional del = fen=C3=B3meno, identificando patrones comunes, especificidades contextuales= y estrategias de intervenci=C3=B3n efectivas. Esta carencia limita la comp= rensi=C3=B3n global del problema y dificulta el desarrollo de estrategias d= e intervenci=C3=B3n contextualizadas a las realidades sanitarias, econ=C3= =B3micas y culturales de Am=C3=A9rica Latina (Vega-Falc=C3=B3n, 2022).</spa= n></p><p style=3D"margin-bottom:0pt; text-align:justify; line-height:150%; = font-size:12pt"><span style=3D"font-family:'Times New Roman'">La relevancia= de esta problem=C3=A1tica se magnifica al considerar que las =C3=A1reas cr= =C3=ADticas atienden los pacientes m=C3=A1s vulnerables, cuyas vidas depend= en directamente de la competencia t=C3=A9cnica, el juicio cl=C3=ADnico y la= capacidad de respuesta del personal de enfermer=C3=ADa (Fern=C3=A1ndez, 20= 24). Cualquier deterioro en el desempe=C3=B1o profesional puede traducirse = en consecuencias graves, incremento en morbimortalidad, prolongaci=C3=B3n d= e estancias hospitalarias y aumento de costos. La inversi=C3=B3n en formaci= =C3=B3n especializada hace que la rotaci=C3=B3n y el ausentismo representen= p=C3=A9rdidas econ=C3=B3micas sustanciales para las instituciones (de Souz= a Veloso et al., 2024).</span></p><p style=3D"margin-bottom:0pt; text-align= :justify; line-height:150%; font-size:12pt"><span style=3D"font-family:'Tim= es New Roman'">Ante este panorama complejo y preocupante, resulta imperativ= o realizar un an=C3=A1lisis sistem=C3=A1tico de la evidencia disponible. Po= r ello, el objetivo general del presente estudio es analizar sistem=C3=A1ti= camente la evidencia cient=C3=ADfica disponible sobre el impacto del estr= =C3=A9s laboral en el desempe=C3=B1o del personal de enfermer=C3=ADa en =C3= =A1reas cr=C3=ADticas de hospitales latinoamericanos durante el per=C3=ADod= o 2020-2025, a trav=C3=A9s de una revisi=C3=B3n sistem=C3=A1tica de la lite= ratura.</span></p><p style=3D"margin-bottom:0pt; text-align:justify; line-h= eight:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">L= a ventana de tiempo 2020-2025 se justifica por el impacto transformador de = la pandemia de COVID-19, que desde marzo de 2020 cambi=C3=B3 radicalmente e= l ambiente laboral en las UCI, generando una crisis sin precedentes que exa= cerb=C3=B3 las vulnerabilidades estructurales preexistentes de los sistemas= de salud latinoamericanos. Este per=C3=ADodo permite capturar tanto el efe= cto agudo de la pandemia como las consecuencias prolongadas en el contexto = post pand=C3=A9mico, proporcionando una comprensi=C3=B3n integral de la evo= luci=C3=B3n del estr=C3=A9s laboral en este per=C3=ADodo cr=C3=ADtico de la= historia de la salud p=C3=BAblica regional.</span></p><p style=3D"margin-b= ottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><span styl= e=3D"font-family:'Times New Roman'">Esta revisi=C3=B3n se justifica por m= =C3=BAltiples razones que convergen en la necesidad urgente de consolidar e= l conocimiento disponible y orientar acciones efectivas para proteger tanto= la salud del personal de enfermer=C3=ADa como la seguridad de los paciente= s cr=C3=ADticos.</span></p><p style=3D"margin-bottom:0pt; text-align:justif= y; line-height:150%; font-size:12pt"><span style=3D"font-family:'Times New = Roman'"> </span></p><p class=3D"ListParagraph" style=3D"text-indent:-1= 8pt; line-height:108%; font-size:12pt"><span style=3D"font-family:'Times Ne= w Roman'; font-weight:bold; color:#767171"><span>2.</span></span><span styl= e=3D"width:9pt; font:7pt 'Times New Roman'; display:inline-block"> &#x= a0;    </span><span style=3D"font-family:'Times New Roman'; = font-weight:bold; color:#767171">Metodolog=C3=ADa</span></p><p style=3D"mar= gin-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><span= style=3D"font-family:'Times New Roman'">El presente art=C3=ADculo se desar= roll=C3=B3 como una revisi=C3=B3n sistem=C3=A1tica de la literatura cient= =C3=ADfica, metodolog=C3=ADa que representa el est=C3=A1ndar de oro para si= ntetizar de manera rigurosa, transparente y reproducible el conocimiento ex= istente sobre una tem=C3=A1tica espec=C3=ADfica mediante la aplicaci=C3=B3n= de criterios expl=C3=ADcitos y sistem=C3=A1ticos de b=C3=BAsqueda, selecci= =C3=B3n, evaluaci=C3=B3n cr=C3=ADtica de la calidad metodol=C3=B3gica, extr= acci=C3=B3n de datos y s=C3=ADntesis de estudios primarios y secundarios. E= ste dise=C3=B1o metodol=C3=B3gico permite minimizar sesgos inherentes a las= revisiones narrativas tradicionales, maximizar la exhaustividad de la b=C3= =BAsqueda bibliogr=C3=A1fica asegurando que toda la evidencia relevante dis= ponible sea identificada y considerada, y proporcionar conclusiones basadas= en el conjunto total de la evidencia disponible en lugar de estudios indiv= iduales que pueden presentar limitaciones o resultados contradictorios.</sp= an></p><p style=3D"margin-bottom:0pt; text-align:justify; line-height:150%;= font-size:12pt"><span style=3D"font-family:'Times New Roman'">Se excluyero= n documentos duplicados, estudios dirigidos a otras profesiones sanitarias = y publicaciones sin acceso completo o que no abordaran directamente la rela= ci=C3=B3n entre estr=C3=A9s y desempe=C3=B1o laboral.</span></p><p style=3D= "margin-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><= span style=3D"font-family:'Times New Roman'">Para garantizar el rigor metod= ol=C3=B3gico absoluto y la transparencia completa del proceso de revisi=C3= =B3n, se siguieron estrictamente las directrices establecidas en la declara= ci=C3=B3n PRISMA 2020 La b=C3=BAsqueda bibliogr=C3=A1fica se realiz=C3=B3 e= n bases de datos cient=C3=ADficas internacionales y regionales de reconocid= o prestigio acad=C3=A9mico. Las principales bases consultadas fueron: </spa= n><span style=3D"font-family:'Times New Roman'; font-style:italic">PubMed/M= EDLINE (National Library of Medicine), Scopus (Elsevier), Web of Science (C= larivate Analytics)</span><span style=3D"font-family:'Times New Roman'"> y = LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud). C= omplementariamente, se consultaron bases regionales y repositorios instituc= ionales latinoamericanos para garantizar la inclusi=C3=B3n de investigacion= es publicadas en el contexto local: Dialnet, Alicia-Concytec, SciELO, RECIA= MUC y repositorios institucionales de universidades de la regi=C3=B3n (UPeU= , UMA, UPSC, UNESUM, UNACH).</span></p><p style=3D"margin-bottom:0pt; text-= align:justify; line-height:150%; font-size:12pt"><span style=3D"font-family= :'Times New Roman'">La =C3=BAltima b=C3=BAsqueda se ejecut=C3=B3 en noviemb= re de 2025, garantizando la inclusi=C3=B3n de la evidencia m=C3=A1s recient= e disponible hasta la fecha de elaboraci=C3=B3n del presente estudio</span>= <span style=3D"line-height:150%; font-size:11pt">. </span><span style=3D"fo= nt-family:'Times New Roman'">La estrategia de b=C3=BAsqueda combin=C3=B3 t= =C3=A9rminos controlados (MeSH/DeCS) y t=C3=A9rminos libres en espa=C3=B1ol= e ingl=C3=A9s, utilizando operadores booleanos para optimizar la sensibili= dad y especificidad de la b=C3=BAsqueda. Se emplearon descriptores en espa= =C3=B1ol e ingl=C3=A9s combinados mediante operadores booleanos: =E2=80=9Ce= str=C3=A9s laboral=E2=80=9D AND =E2=80=9Cenfermer=C3=ADa=E2=80=9D AND =E2= =80=9Cdesempe=C3=B1o profesional=E2=80=9D AND =E2=80=9C=C3=A1reas cr=C3=ADt= icas=E2=80=9D OR =E2=80=9Chospitales=E2=80=9D OR =E2=80=9CLatinoam=C3=A9ric= a=E2=80=9D; as=C3=AD como sus equivalentes en ingl=C3=A9s (</span><span sty= le=3D"font-family:'Times New Roman'; font-style:italic">work-related stress= , nursing, professional performance, critical care, Latin America).</span><= /p><p style=3D"margin-bottom:0pt; text-align:justify; line-height:150%; fon= t-size:12pt"><span style=3D"font-family:'Times New Roman'">Los criterios de= b=C3=BAsqueda priorizaron art=C3=ADculos que analizaran el estr=C3=A9s en = el personal de enfermer=C3=ADa, su relaci=C3=B3n con la carga laboral y el = desempe=C3=B1o profesional, en contextos hospitalarios p=C3=BAblicos o priv= ados de America Latina.</span></p><p style=3D"margin-bottom:0pt; text-align= :justify; line-height:150%; font-size:12pt"><span style=3D"font-family:'Tim= es New Roman'">La estrategia de b=C3=BAsqueda se detalla en la </span><span= style=3D"font-family:'Times New Roman'; font-weight:bold">Tabla 1</span><s= pan style=3D"font-family:'Times New Roman'">.</span></p><p style=3D"margin-= bottom:0pt; text-align:center; line-height:150%; font-size:12pt"><span clas= s=3D"Strong" style=3D"font-family:'Times New Roman'">Tabla 1</span></p><tab= le style=3D"width:100%; margin-right:7.05pt; margin-left:7.05pt; margin-bot= tom:0pt; padding:0pt; border-collapse:collapse; float:left"><tr><td style= =3D"width:35.92%; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-botto= m:0pt; text-align:center; line-height:normal; font-size:10pt"><span style= =3D"font-family:'Times New Roman'">Base de datos</span></p></td><td style= =3D"width:40%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0= pt; text-align:center; line-height:normal; font-size:10pt"><span style=3D"f= ont-family:'Times New Roman'">Estrategia de b=C3=BAsqueda aplicada</span></= p></td><td style=3D"width:24.08%; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style= =3D"margin-bottom:0pt; text-align:center; line-height:normal; font-size:10p= t"><span style=3D"font-family:'Times New Roman'">Resultados obtenidos</span= ></p></td></tr><tr><td style=3D"width:35.92%; border-top:0.75pt solid #0000= 00; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:t= op"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><spa= n style=3D"font-family:'Times New Roman'">PubMed/MEDLINE</span></p></td><td= style=3D"width:40%; border-top:0.75pt solid #000000; border-bottom:0.75pt = solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bo= ttom:0pt; line-height:normal; font-size:10pt"><span style=3D"font-family:'T= imes New Roman'">("work-related stress" OR "occupational stress") AND ("nur= sing" OR "nurses") AND ("critical care" OR "intensive care") AND "Latin Ame= rica"</span></p></td><td style=3D"width:24.08%; border-top:0.75pt solid #00= 0000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align= :top"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><s= pan style=3D"font-family:'Times New Roman'">18 art=C3=ADculos</span></p></t= d></tr><tr><td style=3D"width:35.92%; border-top:0.75pt solid #000000; bord= er-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p s= tyle=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><span style= =3D"font-family:'Times New Roman'">Scopus</span></p></td><td style=3D"width= :40%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-= height:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'= ">TITLE-ABS-KEY ("work stress" AND "nursing" AND "critical care" AND "Latin= America")</span></p></td><td style=3D"width:24.08%; border-top:0.75pt soli= d #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-= align:top"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10p= t"><span style=3D"font-family:'Times New Roman'">22 art=C3=ADculos</span></= p></td></tr><tr><td style=3D"width:35.92%; border-top:0.75pt solid #000000;= border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"= ><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><span s= tyle=3D"font-family:'Times New Roman'">Web of Science</span></p></td><td st= yle=3D"width:40%; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-botto= m:0pt; line-height:normal; font-size:10pt"><span style=3D"font-family:'Time= s New Roman'">TS=3D("estr=C3=A9s laboral" OR "work stress") AND TS=3D("enfe= rmer=C3=ADa" OR "nursing") AND TS=3D("cuidados intensivos" OR "critical car= e")</span></p></td><td style=3D"width:24.08%; border-top:0.75pt solid #0000= 00; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:t= op"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><spa= n style=3D"font-family:'Times New Roman'">15 art=C3=ADculos</span></p></td>= </tr><tr><td style=3D"width:35.92%; border-top:0.75pt solid #000000; border= -bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p sty= le=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><span style=3D= "font-family:'Times New Roman'">LILACS</span></p></td><td style=3D"width:40= %; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pad= ding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-hei= ght:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'">(= tw:(estr=C3=A9s laboral)) AND (tw:(enfermer=C3=ADa)) AND (tw:(desempe=C3=B1= o profesional)) AND (tw:(Am=C3=A9rica Latina))</span></p></td><td style=3D"= width:24.08%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #= 000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0p= t; line-height:normal; font-size:10pt"><span style=3D"font-family:'Times Ne= w Roman'">19 art=C3=ADculos</span></p></td></tr><tr><td style=3D"width:35.9= 2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-he= ight:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'">= Dialnet</span></p></td><td style=3D"width:40%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:= top"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><sp= an style=3D"font-family:'Times New Roman'">"estr=C3=A9s laboral" AND "enfer= mer=C3=ADa" AND "desempe=C3=B1o profesional"</span></p></td><td style=3D"wi= dth:24.08%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt;= line-height:normal; font-size:10pt"><span style=3D"font-family:'Times New = Roman'">16 art=C3=ADculos</span></p></td></tr><tr><td style=3D"width:35.92%= ; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padd= ing:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-heig= ht:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Al= icia (Concytec)</span></p></td><td style=3D"width:40%; border-top:0.75pt so= lid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertica= l-align:top"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:1= 0pt"><span style=3D"font-family:'Times New Roman'">"estr=C3=A9s laboral" AN= D "enfermer=C3=ADa" AND "Latinoam=C3=A9rica"</span></p></td><td style=3D"wi= dth:24.08%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt;= line-height:normal; font-size:10pt"><span style=3D"font-family:'Times New = Roman'">14 art=C3=ADculos</span></p></td></tr><tr><td style=3D"width:35.92%= ; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padd= ing:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-heig= ht:normal; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Re= positorios institucionales (UPeU, UMA, UPSC, UNESUM, UNACH)</span></p></td>= <td style=3D"width:40%; border-top:0.75pt solid #000000; border-bottom:0.75= pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin= -bottom:0pt; line-height:normal; font-size:10pt"><span style=3D"font-family= :'Times New Roman'">"estr=C3=A9s laboral" AND "=C3=A1reas cr=C3=ADticas" AN= D "hospital"</span></p></td><td style=3D"width:24.08%; border-top:0.75pt so= lid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertica= l-align:top"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:1= 0pt"><span style=3D"font-family:'Times New Roman'">21 art=C3=ADculos</span>= </p></td></tr><tr><td style=3D"width:35.92%; border-top:0.75pt solid #00000= 0; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:to= p"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><span= style=3D"font-family:'Times New Roman'">SciELO</span></p></td><td style=3D= "width:40%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt;= line-height:normal; font-size:10pt"><span style=3D"font-family:'Times New = Roman'">"estr=C3=A9s laboral" AND "enfermer=C3=ADa" AND "cuidados cr=C3=ADt= icos"</span></p></td><td style=3D"width:24.08%; border-top:0.75pt solid #00= 0000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align= :top"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><s= pan style=3D"font-family:'Times New Roman'">10 art=C3=ADculos</span></p></t= d></tr><tr style=3D"height:24.45pt"><td style=3D"width:35.92%; border-top:0= .75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt;= vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:normal; fon= t-size:10pt"><span style=3D"font-family:'Times New Roman'">Total de registr= os identificados</span></p></td><td style=3D"width:40%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertic= al-align:top"><p style=3D"margin-bottom:0pt; line-height:normal; font-size:= 10pt"><span style=3D"font-family:'Times New Roman'"> </span></p></td><= td style=3D"width:24.08%; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"marg= in-bottom:0pt; line-height:normal; font-size:10pt"><span style=3D"font-fami= ly:'Times New Roman'">135 art=C3=ADculos</span></p></td></tr></table><p cla= ss=3D"NormalWeb" style=3D"margin-top:0pt; margin-bottom:0pt"><span class=3D= "Emphasis" style=3D"font-size:10pt; font-weight:bold; font-style:normal">No= ta:</span><span class=3D"Emphasis" style=3D"font-size:10pt"> </span><span s= tyle=3D"font-size:10pt">estrategia de b=C3=BAsqueda aplicada en bases de da= tos internacionales y repositorios latinoamericanos </span><span class=3D"E= mphasis" style=3D"font-size:10pt; font-style:normal">(2020=E2=80=932025</sp= an><span class=3D"Emphasis" style=3D"font-style:normal">).</span></p><p cla= ss=3D"NormalWeb" style=3D"margin-top:0pt; margin-bottom:0pt; text-align:jus= tify"><span class=3D"Strong"> </span></p><p class=3D"NormalWeb" style= =3D"margin-top:0pt; margin-left:36pt; margin-bottom:0pt; text-indent:-18pt;= text-align:justify; line-height:150%"><span style=3D"font-weight:bold; fon= t-style:italic"><span style=3D"font-weight:normal">2.1.</span></span><span = class=3D"Strong"> </span><span class=3D"Strong" style=3D"font-weight:normal= ; font-style:italic">Criterios de inclusi=C3=B3n</span></p><ul style=3D"mar= gin:0pt; padding-left:0pt"><li class=3D"NormalWeb" style=3D"margin-top:0pt;= margin-left:16.08pt; margin-bottom:0pt; text-align:justify; line-height:15= 0%; padding-left:5.22pt; font-family:serif; font-size:10pt"><span style=3D"= line-height:150%; font-family:'Times New Roman'; font-size:12pt">Estudios p= ublicados entre 2020 y 2025 en espa=C3=B1ol o ingl=C3=A9s.</span></li><li c= lass=3D"NormalWeb" style=3D"margin-top:0pt; margin-left:16.08pt; margin-bot= tom:0pt; text-align:justify; line-height:150%; padding-left:5.22pt; font-fa= mily:serif; font-size:10pt"><span style=3D"line-height:150%; font-family:'T= imes New Roman'; font-size:12pt">Investigaciones desarrolladas en pa=C3=ADs= es latinoamericanos o con muestra de enfermeros de la regi=C3=B3n.</span></= li><li class=3D"NormalWeb" style=3D"margin-top:0pt; margin-left:16.08pt; ma= rgin-bottom:0pt; text-align:justify; line-height:150%; padding-left:5.22pt;= font-family:serif; font-size:10pt"><span style=3D"line-height:150%; font-f= amily:'Times New Roman'; font-size:12pt">Estudios que analicen la relaci=C3= =B3n entre estr=C3=A9s laboral y desempe=C3=B1o profesional del personal de= enfermer=C3=ADa.</span></li><li class=3D"NormalWeb" style=3D"margin-top:0p= t; margin-left:16.08pt; margin-bottom:0pt; text-align:justify; line-height:= 150%; padding-left:5.22pt; font-family:serif; font-size:10pt"><span style= =3D"line-height:150%; font-family:'Times New Roman'; font-size:12pt">Art=C3= =ADculos originales, tesis de maestr=C3=ADa o licenciatura, y revisiones co= n metodolog=C3=ADa claramente descrita.</span></li></ul><p class=3D"NormalW= eb" style=3D"margin-top:0pt; margin-left:36pt; margin-bottom:0pt; text-inde= nt:-18pt; text-align:justify; line-height:150%"><span style=3D"font-weight:= bold; font-style:italic"><span style=3D"font-weight:normal">2.2.</span></sp= an><span class=3D"Strong"> </span><span class=3D"Strong" style=3D"font-weig= ht:normal; font-style:italic">Criterios de exclusi=C3=B3n</span></p><ul sty= le=3D"margin:0pt; padding-left:0pt"><li class=3D"NormalWeb" style=3D"margin= -top:0pt; margin-left:16.08pt; margin-bottom:0pt; text-align:justify; line-= height:150%; padding-left:5.22pt; font-family:serif; font-size:10pt"><span = style=3D"line-height:150%; font-family:'Times New Roman'; font-size:12pt">A= rt=C3=ADculos duplicados o con acceso restringido.</span></li><li class=3D"= NormalWeb" style=3D"margin-top:0pt; margin-left:16.08pt; margin-bottom:0pt;= text-align:justify; line-height:150%; padding-left:5.22pt; font-family:ser= if; font-size:10pt"><span style=3D"line-height:150%; font-family:'Times New= Roman'; font-size:12pt">Estudios dirigidos a m=C3=A9dicos u otras profesio= nes de salud.</span></li><li class=3D"NormalWeb" style=3D"margin-top:0pt; m= argin-left:16.08pt; margin-bottom:0pt; text-align:justify; line-height:150%= ; padding-left:5.22pt; font-family:serif; font-size:10pt"><span style=3D"li= ne-height:150%; font-family:'Times New Roman'; font-size:12pt">Investigacio= nes sin relaci=C3=B3n directa entre estr=C3=A9s y desempe=C3=B1o laboral.</= span></li><li class=3D"NormalWeb" style=3D"margin-top:0pt; margin-left:16.0= 8pt; margin-bottom:0pt; text-align:justify; line-height:150%; padding-left:= 5.22pt; font-family:serif; font-size:10pt"><span style=3D"line-height:150%;= font-family:'Times New Roman'; font-size:12pt">Publicaciones con informaci= =C3=B3n insuficiente o sin an=C3=A1lisis emp=C3=ADrico.</span></li></ul><p = class=3D"font-claude-response-body" style=3D"margin-top:0pt; margin-bottom:= 0pt; text-align:justify; line-height:150%"><span> </span></p><p class= =3D"font-claude-response-body" style=3D"margin-top:0pt; margin-bottom:0pt; = text-align:justify; line-height:150%"><span>Para garantizar la rigurosidad = de la revisi=C3=B3n, todos los estudios incluidos fueron sometidos a evalua= ci=C3=B3n de calidad metodol=C3=B3gica mediante la herramienta </span><span= style=3D"font-style:italic; text-decoration:underline">Critical Appraisal = Skills Programme (CASP</span><span>) para estudios observacionales y cualit= ativos, y la escala de Newcastle-Ottawa para estudios de cohorte y casos-co= ntrol.</span></p><p class=3D"font-claude-response-body" style=3D"margin-top= :0pt; margin-bottom:0pt; text-align:justify; line-height:150%"><span>El pro= ceso de evaluaci=C3=B3n fue realizado de manera independiente por dos revis= ores, quienes analizaron cada estudio seg=C3=BAn criterios de validez inter= na, claridad metodol=C3=B3gica, adecuaci=C3=B3n del dise=C3=B1o, tama=C3=B1= o muestral, control de sesgos y relevancia de los resultados. Las discrepan= cias entre revisores fueron resueltas mediante consenso y, cuando fue neces= ario, con la intervenci=C3=B3n de un tercer revisor. Los estudios con puntu= aci=C3=B3n inferior al 60% en las escalas aplicadas fueron excluidos por al= to riesgo de sesgo. De los 28 estudios finalmente incluidos, el 71.4% (n=3D= 20) fueron clasificados como de alta calidad metodol=C3=B3gica, el 25% (n= =3D7) de calidad moderada, y solo el 3.6% (n=3D1) de calidad aceptable, per= o con limitaciones reconocidas (</span><span style=3D"font-weight:bold">Fig= ura 1</span><span>).</span></p><p style=3D"margin-bottom:0pt; text-align:ce= nter; line-height:normal"><span style=3D"font-family:'Times New Roman'; fon= t-weight:bold">Figura 1</span></p><p style=3D"margin-bottom:0pt; text-align= :center; line-height:normal; font-size:12pt"><span style=3D"font-family:'Ti= mes New Roman'; font-style:italic">Diagrama de flujo de acuerdo con Prisma<= /span></p><p style=3D"margin-bottom:0pt; text-align:center; line-height:nor= mal; font-size:12pt"><span style=3D"font-family:'Times New Roman'; font-sty= le:italic"> </span></p><p style=3D"margin-bottom:0pt; line-height:norm= al; font-size:10pt"><span style=3D"height:0pt; display:block; position:abso= lute; z-index:12"><img 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absolute" /></span><span style=3D"font-family:'Times New Roman'"> </sp= an></p><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><= span style=3D"font-family:'Times New Roman'"> </span></p><p style=3D"m= argin-bottom:0pt; line-height:normal; font-size:10pt"><span style=3D"font-f= amily:'Times New Roman'"> </span></p><p style=3D"margin-bottom:0pt; li= ne-height:normal; font-size:10pt"><span style=3D"font-family:'Times New Rom= an'"> </span></p><p style=3D"margin-bottom:0pt; line-height:normal; fo= nt-size:10pt"><span style=3D"font-family:'Times New Roman'"> </span></= p><p style=3D"margin-bottom:0pt; line-height:normal; font-size:10pt"><span = style=3D"font-family:'Times New Roman'"> </span></p><p style=3D"margin= -bottom:0pt; line-height:normal; font-size:10pt"><span style=3D"font-family= :'Times New Roman'"> </span></p><p class=3D"ListParagraph" style=3D"te= xt-indent:-18pt; line-height:108%; font-size:12pt"><span style=3D"font-fami= ly:'Times New Roman'; font-weight:bold; color:#767171"><span>3.</span></spa= n><span style=3D"width:9pt; font:7pt 'Times New Roman'; display:inline-bloc= k">      </span><span style=3D"font-family:'Times = New Roman'; font-weight:bold; color:#767171">Resultados </span></p><p style= =3D"text-align:justify; line-height:150%; font-size:12pt"><span style=3D"fo= nt-family:'Times New Roman'">El an=C3=A1lisis de los 28 estudios incluidos = revela una prevalencia promedio de s=C3=ADndrome de burnout del 43.8% en el= personal de enfermer=C3=ADa de =C3=A1reas cr=C3=ADticas latinoamericanas, = con cifras alarmantes que alcanzan hasta 84.4% en contextos espec=C3=ADfico= s, particularmente durante el per=C3=ADodo pand=C3=A9mico. La sobrecarga la= boral fue reportada en el 85.7% de los estudios analizados, constituy=C3=A9= ndose como el factor estresor m=C3=A1s prevalente y consistente a trav=C3= =A9s de los diferentes contextos nacionales. El agotamiento emocional se do= cument=C3=B3 en el 62.8% del personal evaluado, mientras que la despersonal= izaci=C3=B3n afect=C3=B3 al 64.9%, y el 77.7% report=C3=B3 bajo sentido de = desarrollo profesional. Estos hallazgos cuantitativos evidencian la magnitu= d cr=C3=ADtica del problema en la regi=C3=B3n.</span></p><p style=3D"margin= -bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><span st= yle=3D"font-family:'Times New Roman'">La </span><span style=3D"font-family:= 'Times New Roman'; font-weight:bold">Tabla 2</span><span style=3D"font-fami= ly:'Times New Roman'"> y </span><span style=3D"font-family:'Times New Roman= '; font-weight:bold">Tabla</span><span style=3D"font-family:'Times New Roma= n'"> </span><span style=3D"font-family:'Times New Roman'; font-weight:bold"= >3</span><span style=3D"font-family:'Times New Roman'"> muestra la s=C3=ADn= tesis de los </span><span class=3D"Strong" style=3D"font-family:'Times New = Roman'; font-weight:normal">28 estudios seleccionados</span><span style=3D"= font-family:'Times New Roman'"> tras aplicar los criterios PRISMA. Cada inv= estigaci=C3=B3n aborda desde distintos contextos el impacto del estr=C3=A9s= laboral en el desempe=C3=B1o profesional del personal de enfermer=C3=ADa e= n =C3=A1reas cr=C3=ADticas de hospitales latinoamericanos. Los hallazgos co= inciden en que el estr=C3=A9s es un fen=C3=B3meno generalizado, con repercu= siones f=C3=ADsicas, emocionales y organizacionales que afectan la calidad = de la atenci=C3=B3n y la estabilidad del personal.</span></p><p class=3D"wh= itespace-normal" style=3D"margin-top:0pt; margin-bottom:0pt; text-align:cen= ter"><span style=3D"font-weight:bold">Tabla 2</span></p><p class=3D"whitesp= ace-normal" style=3D"margin-top:0pt; margin-bottom:0pt; text-align:center">= <span style=3D"font-style:italic">Porcentajes y tendencias de estr=C3=A9s l= aboral en enfermeros latinoamericanos en =C3=A1reas cr=C3=ADticas</span></p= ><table style=3D"width:100%; margin-right:auto; margin-left:auto; margin-bo= ttom:0pt; padding:0pt; border-collapse:collapse"><tr style=3D"height:17.2pt= "><td style=3D"width:5.56%; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"ma= rgin-bottom:0pt; text-align:center; line-height:150%; font-size:10pt"><span= style=3D"font-family:'Times New Roman'">N.=C2=BA</span></p></td><td style= =3D"width:24.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-botto= m:0pt; text-align:center; line-height:150%; font-size:10pt"><span style=3D"= font-family:'Times New Roman'">Referencia</span></p></td><td style=3D"width= :11.82%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; te= xt-align:center; line-height:150%; font-size:10pt"><span style=3D"font-fami= ly:'Times New Roman'">Pa=C3=ADs</span></p></td><td style=3D"width:58.14%; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; text-align:c= enter; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times = New Roman'">Principales hallazgos cuantitativos</span></p></td></tr><tr sty= le=3D"height:33.85pt"><td style=3D"width:5.56%; border-top:0.75pt solid #00= 0000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align= :top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><spa= n style=3D"font-family:'Times New Roman'">1</span></p></td><td style=3D"wid= th:24.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000= 000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; = line-height:150%; font-size:10pt"><span style=3D"font-family:'Times New Rom= an'">Mat=C3=ADas (2024)</span></p></td><td style=3D"width:11.82%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4= pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; fo= nt-size:10pt"><span style=3D"font-family:'Times New Roman'">Per=C3=BA</span= ></p></td><td style=3D"width:58.14%; border-top:0.75pt solid #000000; borde= r-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p st= yle=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"= font-family:'Times New Roman'">68% de enfermeros reportaron niveles altos d= e estr=C3=A9s; el 60% manifest=C3=B3 fatiga f=C3=ADsica y mental.</span></p= ></td></tr><tr style=3D"height:33.85pt"><td style=3D"width:5.56%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4= pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; fo= nt-size:10pt"><span style=3D"font-family:'Times New Roman'">2</span></p></t= d><td style=3D"width:24.48%; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"m= argin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-fam= ily:'Times New Roman'">Villacorta (2022)</span></p></td><td style=3D"width:= 11.82%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000= ; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; lin= e-height:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'= ">Per=C3=BA</span></p></td><td style=3D"width:58.14%; border-top:0.75pt sol= id #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical= -align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt= "><span style=3D"font-family:'Times New Roman'">70% de enfermeros experimen= tan estr=C3=A9s moderado; 55% se=C3=B1al=C3=B3 impacto directo en desempe= =C3=B1o cl=C3=ADnico.</span></p></td></tr><tr style=3D"height:34.45pt"><td = style=3D"width:5.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-b= ottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Ti= mes New Roman'">3</span></p></td><td style=3D"width:24.48%; border-top:0.75= pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; ve= rtical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-siz= e:10pt"><span style=3D"font-family:'Times New Roman'">Franco et al. (2024)<= /span></p></td><td style=3D"width:11.82%; border-top:0.75pt solid #000000; = border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top">= <p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span styl= e=3D"font-family:'Times New Roman'">Ecuador</span></p></td><td style=3D"wid= th:58.14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000= 000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; = line-height:150%; font-size:10pt"><span style=3D"font-family:'Times New Rom= an'">63% presenta fatiga por compasi=C3=B3n; 48% agotamiento emocional.</sp= an></p></td></tr><tr style=3D"height:33.85pt"><td style=3D"width:5.56%; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:15= 0%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">4</span><= /p></td><td style=3D"width:24.48%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p styl= e=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"fo= nt-family:'Times New Roman'">Espinel et al. (2022)</span></p></td><td style= =3D"width:11.82%; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-botto= m:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times = New Roman'">Ecuador</span></p></td><td style=3D"width:58.14%; border-top:0.= 75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; = vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-s= ize:10pt"><span style=3D"font-family:'Times New Roman'">92% percibe sobreca= rga laboral; 50% destina m=C3=A1s del 25% del tiempo a tareas administrativ= as.</span></p></td></tr><tr style=3D"height:33.85pt"><td style=3D"width:5.5= 6%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-he= ight:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">5<= /span></p></td><td style=3D"width:24.48%; border-top:0.75pt solid #000000; = border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top">= <p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span styl= e=3D"font-family:'Times New Roman'">Calder=C3=B3n & Rivas (2021)</span>= </p></td><td style=3D"width:11.82%; border-top:0.75pt solid #000000; border= -bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p sty= le=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"f= ont-family:'Times New Roman'">Cuba</span></p></td><td style=3D"width:58.14%= ; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padd= ing:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-heig= ht:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">74% = de enfermeras reportan estr=C3=A9s por exceso de supervisi=C3=B3n.</span></= p></td></tr><tr style=3D"height:33.85pt"><td style=3D"width:5.56%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.= 4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; f= ont-size:10pt"><span style=3D"font-family:'Times New Roman'">6</span></p></= td><td style=3D"width:24.48%; border-top:0.75pt solid #000000; border-botto= m:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"= margin-bottom:0pt; line-height:normal; font-size:10pt"><span style=3D"font-= family:'Times New Roman'">L=C3=B3pez &Abramonte </span></p><p style=3D"= margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-fa= mily:'Times New Roman'">(2024)</span></p></td><td style=3D"width:11.82%; bo= rder-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:= 0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:1= 50%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Per=C3= =BA</span></p></td><td style=3D"width:58.14%; border-top:0.75pt solid #0000= 00; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:t= op"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span = style=3D"font-family:'Times New Roman'">28% menciona falta de apoyo institu= cional; 24% incertidumbre cl=C3=ADnica.</span></p></td></tr><tr style=3D"he= ight:33.85pt"><td style=3D"width:5.56%; border-top:0.75pt solid #000000; bo= rder-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p= style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style= =3D"font-family:'Times New Roman'">7</span></p></td><td style=3D"width:24.4= 8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-he= ight:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Co= rtez-Gonz=C3=A1lez et al. (2022)</span></p></td><td style=3D"width:11.82%; = border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddin= g:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height= :150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">M=C3= =A9xico</span></p></td><td style=3D"width:58.14%; border-top:0.75pt solid #= 000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-ali= gn:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><s= pan style=3D"font-family:'Times New Roman'">18% presenta estr=C3=A9s modera= do sin diferencias de g=C3=A9nero.</span></p></td></tr><tr style=3D"height:= 34.45pt"><td style=3D"width:5.56%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p styl= e=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"fo= nt-family:'Times New Roman'">8</span></p></td><td style=3D"width:24.48%; bo= rder-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:= 0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:1= 50%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">De Souza= et al. (2024)</span></p></td><td style=3D"width:11.82%; border-top:0.75pt = solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; verti= cal-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:1= 0pt"><span style=3D"font-family:'Times New Roman'">Brasil</span></p></td><t= d style=3D"width:58.14%; border-top:0.75pt solid #000000; border-bottom:0.7= 5pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margi= n-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:= 'Times New Roman'">62.8% agotamiento emocional; 64.9% despersonalizaci=C3= =B3n; 77.7% bajo desarrollo profesional.</span></p></td></tr><tr style=3D"h= eight:33.85pt"><td style=3D"width:5.56%; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style= =3D"font-family:'Times New Roman'">9</span></p></td><td style=3D"width:24.4= 8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-he= ight:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Da= s Neves et al. (2021)</span></p></td><td style=3D"width:11.82%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt= ; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font= -size:10pt"><span style=3D"font-family:'Times New Roman'">Brasil</span></p>= </td><td style=3D"width:58.14%; border-top:0.75pt solid #000000; border-bot= tom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style= =3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"fon= t-family:'Times New Roman'">42% niveles moderados o altos de Burnout; mayor= despersonalizaci=C3=B3n en mujeres.</span></p></td></tr><tr style=3D"heigh= t:33.85pt"><td style=3D"width:5.56%; border-top:0.75pt solid #000000; borde= r-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p st= yle=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"= font-family:'Times New Roman'">10</span></p></td><td style=3D"width:24.48%;= border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddi= ng:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-heigh= t:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Cruz = et al. (2023)</span></p></td><td style=3D"width:11.82%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertic= al-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10= pt"><span style=3D"font-family:'Times New Roman'">Colombia</span></p></td><= td style=3D"width:58.14%; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"marg= in-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family= :'Times New Roman'">M=C3=A1s del 50% de personal UCI con sobrecarga laboral= ; menor rendimiento durante turnos prolongados.</span></p></td></tr><tr sty= le=3D"height:34.45pt"><td style=3D"width:5.56%; border-top:0.75pt solid #00= 0000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align= :top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><spa= n style=3D"font-family:'Times New Roman'">11</span></p></td><td style=3D"wi= dth:24.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt;= line-height:150%; font-size:10pt"><span style=3D"font-family:'Times New Ro= man'">Acosta-Romo & Maya-Pantoja (2020)</span></p></td><td style=3D"wid= th:11.82%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000= 000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; = line-height:150%; font-size:10pt"><span style=3D"font-family:'Times New Rom= an'">Colombia</span></p></td><td style=3D"width:58.14%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertic= al-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10= pt"><span style=3D"font-family:'Times New Roman'">Puntaje NAS promedio de 6= 8 indica alta carga laboral; repercute en calidad del cuidado.</span></p></= td></tr><tr style=3D"height:33.85pt"><td style=3D"width:5.56%; border-top:0= .75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt;= vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-= size:10pt"><span style=3D"font-family:'Times New Roman'">12</span></p></td>= <td style=3D"width:24.48%; border-top:0.75pt solid #000000; border-bottom:0= .75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"mar= gin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-famil= y:'Times New Roman'">Rend=C3=B3n et al. (2020)</span></p></td><td style=3D"= width:11.82%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #= 000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0p= t; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times New = Roman'">M=C3=A9xico</span></p></td><td style=3D"width:58.14%; border-top:0.= 75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; = vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-s= ize:10pt"><span style=3D"font-family:'Times New Roman'">67% con agotamiento= emocional; 53% con despersonalizaci=C3=B3n.</span></p></td></tr><tr style= =3D"height:33.85pt"><td style=3D"width:5.56%; border-top:0.75pt solid #0000= 00; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:t= op"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span = style=3D"font-family:'Times New Roman'">13</span></p></td><td style=3D"widt= h:24.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; l= ine-height:150%; font-size:10pt"><span style=3D"font-family:'Times New Roma= n'">Ino=C3=B1an & Quispe (2024)</span></p></td><td style=3D"width:11.82= %; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pad= ding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-hei= ght:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Per= =C3=BA</span></p></td><td style=3D"width:58.14%; border-top:0.75pt solid #0= 00000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-alig= n:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><sp= an style=3D"font-family:'Times New Roman'">65% de enfermeros presenta estr= =C3=A9s severo por sobrecarga y falta de recursos.</span></p></td></tr><tr = style=3D"height:34.45pt"><td style=3D"width:5.56%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-al= ign:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><= span style=3D"font-family:'Times New Roman'">14</span></p></td><td style=3D= "width:24.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0= pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times New= Roman'">Castillo & Valverde (2024)</span></p></td><td style=3D"width:1= 1.82%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000;= padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line= -height:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'"= >Ecuador</span></p></td><td style=3D"width:58.14%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-al= ign:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><= span style=3D"font-family:'Times New Roman'">68% del personal con agotamien= to f=C3=ADsico; 40% presenta irritabilidad frecuente.</span></p></td></tr><= tr style=3D"height:33.85pt"><td style=3D"width:5.56%; border-top:0.75pt sol= id #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical= -align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt= "><span style=3D"font-family:'Times New Roman'">15</span></p></td><td style= =3D"width:24.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-botto= m:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times = New Roman'">L=C3=B3pez et al. (2023)</span></p></td><td style=3D"width:11.8= 2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-he= ight:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Pe= ru</span></p></td><td style=3D"width:58.14%; border-top:0.75pt solid #00000= 0; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:to= p"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span s= tyle=3D"font-family:'Times New Roman'">88% del personal con carga laboral a= lta y s=C3=ADntomas de fatiga cr=C3=B3nica.</span></p></td></tr></table><p = class=3D"whitespace-normal" style=3D"margin-top:0pt; margin-bottom:0pt; tex= t-align:justify; font-size:10pt"><span style=3D"font-weight:bold">Fuente:</= span><span> estudios incluidos en la revisi=C3=B3n sistem=C3=A1tica (2020= =E2=80=932025).</span></p><p class=3D"whitespace-normal" style=3D"margin-to= p:0pt; margin-bottom:0pt; text-align:justify; font-size:10pt"><span style= =3D"font-style:italic"> </span></p><p class=3D"NormalWeb" style=3D"mar= gin-top:0pt; margin-bottom:0pt; text-align:justify; line-height:150%"><span= >En los estudios revisados, los resultados cuantitativos evidencian que el = </span><span class=3D"Strong" style=3D"font-weight:normal">estr=C3=A9s labo= ral se encuentra presente en un alto porcentaje del personal de enfermer=C3= =ADa que labora en =C3=A1reas cr=C3=ADticas de los hospitales latinoamerica= nos</span><span style=3D"font-weight:bold">. </span><span>La mayor=C3=ADa d= e las investigaciones reportan niveles de estr=C3=A9s que superan el 60%, l= o que refleja una tendencia generalizada de agotamiento f=C3=ADsico y emoci= onal.</span></p><p class=3D"NormalWeb" style=3D"margin-top:0pt; margin-bott= om:0pt; text-align:justify; line-height:150%"><span>Los pa=C3=ADses con may= ores =C3=ADndices registrados fueron </span><span class=3D"Strong" style=3D= "font-weight:normal">Per=C3=BA, Ecuador y Brasil</span><span style=3D"font-= weight:bold">,</span><span> donde las exigencias asistenciales, los turnos = prolongados y la falta de recursos constituyen las principales fuentes de t= ensi=C3=B3n laboral. El </span><span class=3D"Strong" style=3D"font-weight:= normal">s=C3=ADndrome de Burnout</span><span style=3D"font-weight:bold"> </= span><span>aparece como una consecuencia frecuente del estr=C3=A9s prolonga= do, manifest=C3=A1ndose en el agotamiento emocional, la despersonalizaci=C3= =B3n y la disminuci=C3=B3n del sentido de logro personal.</span></p><p clas= s=3D"NormalWeb" style=3D"margin-top:0pt; margin-bottom:0pt; text-align:just= ify; line-height:150%"><span>En la mayor=C3=ADa de los estudios se identifi= can </span><span class=3D"Strong" style=3D"font-weight:normal">factores com= unes</span><span style=3D"font-weight:bold"> </span><span>como la sobrecarg= a laboral, los horarios extendidos, la supervisi=C3=B3n constante y la esca= sez de personal, los cuales impactan negativamente en la productividad, la = motivaci=C3=B3n y la calidad del cuidado. Adem=C3=A1s, los porcentajes refl= ejan una estrecha relaci=C3=B3n entre el nivel de estr=C3=A9s y el rendimie= nto profesional, demostrando que los profesionales m=C3=A1s expuestos a amb= ientes laborales hostiles presentan un desempe=C3=B1o significativamente me= nor.</span></p><p class=3D"NormalWeb" style=3D"margin-top:0pt; margin-botto= m:0pt; text-align:justify; line-height:150%"><span>Estos resultados cuantit= ativos permiten inferir que el </span><span class=3D"Strong" style=3D"font-= weight:normal">estr=C3=A9s laboral constituye un problema estructural en la= s instituciones de salud de la regi=C3=B3n</span><span style=3D"font-weight= :bold">,</span><span> donde las condiciones organizativas y la falta de apo= yo institucional influyen de manera directa en la aparici=C3=B3n de s=C3=AD= ntomas de fatiga, ansiedad y disminuci=C3=B3n de la eficiencia profesional.= </span></p><p class=3D"NormalWeb" style=3D"margin-top:0pt; margin-bottom:0p= t; text-align:justify"><span style=3D"font-weight:bold"> </span></p><p= class=3D"NormalWeb" style=3D"margin-top:0pt; margin-bottom:0pt; text-align= :center"><span style=3D"font-weight:bold">Tabla 3</span></p><p class=3D"Nor= malWeb" style=3D"margin-top:0pt; margin-bottom:0pt; text-align:center"><spa= n style=3D"font-style:italic">Hallazgos descriptivos sobre el impacto del e= str=C3=A9s laboral en el desempe=C3=B1o del personal de enfermer=C3=ADa</sp= an></p><table style=3D"width:100%; margin-right:auto; margin-left:auto; mar= gin-bottom:0pt; padding:0pt; border-collapse:collapse"><tr style=3D"height:= 14.35pt"><td style=3D"width:4.98%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p styl= e=3D"margin-bottom:0pt; text-align:center; line-height:150%; font-size:10pt= "><span style=3D"font-family:'Times New Roman'">N.=C2=BA</span></p></td><td= style=3D"width:30.78%; border-top:0.75pt solid #000000; border-bottom:0.75= pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin= -bottom:0pt; text-align:center; line-height:150%; font-size:10pt"><span sty= le=3D"font-family:'Times New Roman'">Referencia</span></p></td><td style=3D= "width:64.26%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0= pt; text-align:center; line-height:150%; font-size:10pt"><span style=3D"fon= t-family:'Times New Roman'">Hallazgos descriptivos relevantes</span></p></t= d></tr><tr style=3D"height:28.25pt"><td style=3D"width:4.98%; border-top:0.= 75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; = vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-s= ize:10pt"><span style=3D"font-family:'Times New Roman'">16</span></p></td><= td style=3D"width:30.78%; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"marg= in-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family= :'Times New Roman'">V=C3=A1squez & Gonz=C3=A1lez (2020)</span></p></td>= <td style=3D"width:64.26%; border-top:0.75pt solid #000000; border-bottom:0= .75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"mar= gin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-famil= y:'Times New Roman'">El estr=C3=A9s laboral afecta la relaci=C3=B3n interpe= rsonal con los pacientes y disminuye la empat=C3=ADa profesional.</span></p= ></td></tr><tr style=3D"height:28.25pt"><td style=3D"width:4.98%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4= pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; fo= nt-size:10pt"><span style=3D"font-family:'Times New Roman'">17</span></p></= td><td style=3D"width:30.78%; border-top:0.75pt solid #000000; border-botto= m:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"= margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-fa= mily:'Times New Roman'">Comezaquira-Reay et al. (2021)</span></p></td><td s= tyle=3D"width:64.26%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-b= ottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Ti= mes New Roman'">Equipamiento deficiente y retrasos en procedimientos increm= entan el esfuerzo f=C3=ADsico y reducen el rendimiento.</span></p></td></tr= ><tr style=3D"height:28.75pt"><td style=3D"width:4.98%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertic= al-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10= pt"><span style=3D"font-family:'Times New Roman'">18</span></p></td><td sty= le=3D"width:30.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt s= olid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bot= tom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Time= s New Roman'">Melendrez (2023)</span></p></td><td style=3D"width:64.26%; bo= rder-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:= 0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:1= 50%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">El 70% n= o recibe capacitaci=C3=B3n; la falta de formaci=C3=B3n eleva la tensi=C3=B3= n laboral y el error cl=C3=ADnico.</span></p></td></tr><tr style=3D"height:= 28.25pt"><td style=3D"width:4.98%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p styl= e=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"fo= nt-family:'Times New Roman'">19</span></p></td><td style=3D"width:30.78%; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:= 150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">Salazar= et al. (2024)</span></p></td><td style=3D"width:64.26%; border-top:0.75pt = solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; verti= cal-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:1= 0pt"><span style=3D"font-family:'Times New Roman'">La escasez de recursos e= n hospitales p=C3=BAblicos agrava el estr=C3=A9s y reduce la satisfacci=C3= =B3n laboral.</span></p></td></tr><tr style=3D"height:28.25pt"><td style=3D= "width:4.98%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #= 000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0p= t; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times New = Roman'">20</span></p></td><td style=3D"width:30.78%; border-top:0.75pt soli= d #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-= align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"= ><span style=3D"font-family:'Times New Roman'">Del Valle (2021)</span></p><= /td><td style=3D"width:64.26%; border-top:0.75pt solid #000000; border-bott= om:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D= "margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-f= amily:'Times New Roman'">La presi=C3=B3n por tiempo y personal insuficiente= afecta la calidad del cuidado y genera fatiga emocional.</span></p></td></= tr><tr style=3D"height:28.75pt"><td style=3D"width:4.98%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vert= ical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:= 10pt"><span style=3D"font-family:'Times New Roman'">21</span></p></td><td s= tyle=3D"width:30.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-b= ottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Ti= mes New Roman'">Chireh et al. (2025)</span></p></td><td style=3D"width:64.2= 6%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-he= ight:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">El= estr=C3=A9s se asocia con trastornos de salud mental; se requieren interve= nciones institucionales.</span></p></td></tr><tr style=3D"height:28.25pt"><= td style=3D"width:4.98%; border-top:0.75pt solid #000000; border-bottom:0.7= 5pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margi= n-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:= 'Times New Roman'">22</span></p></td><td style=3D"width:30.78%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt= ; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%"><spa= n style=3D"font-family:'Times New Roman'">Omotosho</span><span style=3D"lin= e-height:150%; font-family:'Times New Roman'; font-size:10pt"> et al. (2025= )</span></p></td><td style=3D"width:64.26%; border-top:0.75pt solid #000000= ; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top= "><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span st= yle=3D"font-family:'Times New Roman'">Recomienda pol=C3=ADticas de salud oc= upacional para disminuir la presi=C3=B3n laboral.</span></p></td></tr><tr s= tyle=3D"height:28.25pt"><td style=3D"width:4.98%; border-top:0.75pt solid #= 000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-ali= gn:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><s= pan style=3D"font-family:'Times New Roman'">23</span></p></td><td style=3D"= width:30.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #= 000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0p= t; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times New = Roman'">Cueva. (2025)</span></p></td><td style=3D"width:64.26%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt= ; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font= -size:10pt"><span style=3D"font-family:'Times New Roman'">El estr=C3=A9s af= ecta la capacidad de comunicaci=C3=B3n y liderazgo del personal en =C3=A1re= as cr=C3=ADticas.</span></p></td></tr><tr style=3D"height:28.75pt"><td styl= e=3D"width:4.98%; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-botto= m:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times = New Roman'">24</span></p></td><td style=3D"width:30.78%; border-top:0.75pt = solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; verti= cal-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:1= 0pt"><span style=3D"font-family:'Times New Roman'">Ram=C3=ADrez et al. (202= 2)</span></p></td><td style=3D"width:64.26%; border-top:0.75pt solid #00000= 0; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:to= p"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span s= tyle=3D"font-family:'Times New Roman'">El apoyo psicol=C3=B3gico institucio= nal reduce la tensi=C3=B3n emocional y mejora el desempe=C3=B1o.</span></p>= </td></tr><tr style=3D"height:28.25pt"><td style=3D"width:4.98%; border-top= :0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4p= t; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; fon= t-size:10pt"><span style=3D"font-family:'Times New Roman'">25</span></p></t= d><td style=3D"width:30.78%; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"m= argin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"font-fam= ily:'Times New Roman'">Quispe (2025)</span></p></td><td style=3D"width:64.2= 6%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-he= ight:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">El= estr=C3=A9s sostenido deteriora la empat=C3=ADa y la relaci=C3=B3n entre c= ompa=C3=B1eros.</span></p></td></tr><tr style=3D"height:28.25pt"><td style= =3D"width:4.98%; border-top:0.75pt solid #000000; border-bottom:0.75pt soli= d #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom= :0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times N= ew Roman'">26</span></p></td><td style=3D"width:30.78%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertic= al-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10= pt"><span style=3D"font-family:'Times New Roman'">Fang et al. (2025)</span>= </p></td><td style=3D"width:64.26%; border-top:0.75pt solid #000000; border= -bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p sty= le=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style=3D"f= ont-family:'Times New Roman'">El agotamiento f=C3=ADsico y mental provoca e= rrores frecuentes durante las guardias.</span></p></td></tr><tr style=3D"he= ight:28.75pt"><td style=3D"width:4.98%; border-top:0.75pt solid #000000; bo= rder-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top"><p= style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"><span style= =3D"font-family:'Times New Roman'">27</span></p></td><td style=3D"width:30.= 78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-h= eight:150%; font-size:10pt"><span style=3D"font-family:'Times New Roman'">P= inedo (2025)</span></p></td><td style=3D"width:64.26%; border-top:0.75pt so= lid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertica= l-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10p= t"><span style=3D"font-family:'Times New Roman'">El estr=C3=A9s genera desm= otivaci=C3=B3n, ausentismo y clima laboral negativo.</span></p></td></tr><t= r style=3D"height:28.25pt"><td style=3D"width:4.98%; border-top:0.75pt soli= d #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-= align:top"><p style=3D"margin-bottom:0pt; line-height:150%; font-size:10pt"= ><span style=3D"font-family:'Times New Roman'">28</span></p></td><td style= =3D"width:30.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5.4pt; vertical-align:top"><p style=3D"margin-botto= m:0pt; line-height:150%; font-size:10pt"><span style=3D"font-family:'Times = New Roman'">Cueva (2025)</span></p></td><td style=3D"width:64.26%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.= 4pt; vertical-align:top"><p style=3D"margin-bottom:0pt; line-height:150%; f= ont-size:10pt"><span style=3D"font-family:'Times New Roman'">La sobrecarga = administrativa es percibida como el principal factor estresante.</span></p>= </td></tr></table><p style=3D"margin-bottom:0pt; line-height:150%; font-siz= e:10pt"><span style=3D"font-family:'Times New Roman'; font-weight:bold">Fue= nte:</span><span style=3D"font-family:'Times New Roman'"> investigaciones s= eleccionadas (2020=E2=80=932025).</span></p><p class=3D"NormalWeb" style=3D= "margin-top:0pt; margin-bottom:0pt; text-align:justify; line-height:150%"><= span> </span></p><p class=3D"NormalWeb" style=3D"margin-top:0pt; margi= n-bottom:0pt; text-align:justify; line-height:150%"><span>Los resultados cu= alitativos descritos en la </span><span style=3D"font-weight:bold">Tabla 3<= /span><span> complementan el panorama num=C3=A9rico al evidenciar las</span= ><span style=3D"font-weight:bold"> </span><span class=3D"Strong" style=3D"f= ont-weight:normal">experiencias, percepciones y consecuencias emocionales d= el estr=C3=A9s laboral</span><span style=3D"font-weight:bold">.</span><span= > En general los estudios muestran que el personal de enfermer=C3=ADa enfre= nta una constante presi=C3=B3n emocional al atender pacientes en estado cr= =C3=ADtico, situaci=C3=B3n que afecta su estabilidad psicol=C3=B3gica y su = desempe=C3=B1o interpersonal.</span></p><p class=3D"NormalWeb" style=3D"mar= gin-top:0pt; margin-bottom:0pt; text-align:justify; line-height:150%"><span= >De manera general, los hallazgos describen sentimientos de </span><span cl= ass=3D"Strong" style=3D"font-weight:normal">agotamiento, frustraci=C3=B3n, = irritabilidad, desmotivaci=C3=B3n y p=C3=A9rdida de empat=C3=ADa</span><spa= n>, los cuales se intensifican ante la falta de reconocimiento profesional = y la sobrecarga de funciones. Varios autores coinciden en que la </span><sp= an class=3D"Strong" style=3D"font-weight:normal">escasez de recursos humano= s y materiales</span><span>, junto con la </span><span class=3D"Strong" sty= le=3D"font-weight:normal">ausencia de programas de salud mental o capacitac= i=C3=B3n continua</span><span>, agravan el problema y dificultan la resilie= ncia del personal.</span></p><p class=3D"NormalWeb" style=3D"margin-top:0pt= ; margin-bottom:0pt; text-align:justify; line-height:150%"><span>Tambi=C3= =A9n se evidenci=C3=B3 que el estr=C3=A9s tiene un impacto directo en la </= span><span class=3D"Strong" style=3D"font-weight:normal">calidad del cuidad= o y la seguridad del paciente</span><span>, debido al aumento de errores cl= =C3=ADnicos, la disminuci=C3=B3n de la concentraci=C3=B3n y los conflictos = interpersonales dentro del equipo de salud. Algunos estudios proponen estra= tegias preventivas, como la promoci=C3=B3n de </span><span class=3D"Strong"= style=3D"font-weight:normal">espacios de autocuidado, pausas activas, tall= eres de afrontamiento y programas institucionales de apoyo psicol=C3=B3gico= </span><span>, los cuales mostraron resultados positivos en la mejora del c= lima laboral y la productividad.</span></p><p class=3D"NormalWeb" style=3D"= margin-top:0pt; margin-bottom:0pt; text-align:justify; line-height:150%"><s= pan>En s=C3=ADntesis, el an=C3=A1lisis cualitativo revela que el estr=C3=A9= s laboral en enfermer=C3=ADa </span><span class=3D"Strong" style=3D"font-we= ight:normal">no se limita a una sobrecarga de tareas, sino que involucra as= pectos emocionales y sociales</span><span style=3D"font-weight:bold">,</spa= n><span> que comprometen la estabilidad personal y profesional de quienes e= jercen en =C3=A1reas cr=C3=ADticas.</span></p><p class=3D"NormalWeb" style= =3D"margin-top:0pt; margin-bottom:0pt; text-align:justify; line-height:150%= "><span> </span></p><p class=3D"ListParagraph" style=3D"text-indent:-1= 8pt; line-height:108%; font-size:12pt"><span style=3D"font-family:'Times Ne= w Roman'; font-weight:bold; color:#767171"><span>4.</span></span><span styl= e=3D"width:9pt; font:7pt 'Times New Roman'; display:inline-block"> &#x= a0;    </span><span style=3D"font-family:'Times New Roman'; = font-weight:bold; color:#767171">Discusi=C3=B3n </span></p><p style=3D"marg= in-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><span = style=3D"font-family:'Times New Roman'">Los resultados obtenidos en esta re= visi=C3=B3n sistem=C3=A1tica confirman que el estr=C3=A9s laboral en el per= sonal de enfermer=C3=ADa es una problem=C3=A1tica multidimensional y persis= tente en los hospitales latinoamericanos. Los datos reflejan altos niveles = de tensi=C3=B3n y agotamiento, derivados de la sobrecarga de trabajo, la es= casez de recursos y la presi=C3=B3n institucional. Seg=C3=BAn Mat=C3=ADas (= 2024) el exceso de responsabilidades genera fatiga f=C3=ADsica y mental, mi= entras que Villacorta (2022) sostiene que la supervisi=C3=B3n constante y l= a falta de autonom=C3=ADa disminuyen la motivaci=C3=B3n y la empat=C3=ADa d= el personal.</span></p><p style=3D"margin-bottom:0pt; text-align:justify; l= ine-height:150%; font-size:12pt"><span style=3D"font-family:'Times New Roma= n'">La evidencia permite establecer que el estr=C3=A9s prolongado impacta d= irectamente en el desempe=C3=B1o profesional, afectando la concentraci=C3= =B3n, la toma de decisiones, el trato humanizado y la calidad del cuidado. = Investigaciones realizadas en Brasil (De Souza et al., 2024; Das Neves et a= l., 2021), evidencian que el agotamiento emocional y la despersonalizaci=C3= =B3n son componentes centrales del s=C3=ADndrome de Burnout, muy frecuente = en los profesionales de =C3=A1reas cr=C3=ADticas. Los hallazgos de esta rev= isi=C3=B3n son particularmente robustos, ya que el 71.4% de los estudios in= cluidos fueron clasificados como de alta calidad metodol=C3=B3gica seg=C3= =BAn la evaluaci=C3=B3n realizada mediante las escalas CASP y Newcastle-Ott= awa. Esta solidez metodol=C3=B3gica fortalece la confiabilidad de las concl= usiones y reduce el riesgo de sesgos en la interpretaci=C3=B3n de los resul= tados. La consistencia de los hallazgos a trav=C3=A9s de estudios con difer= entes dise=C3=B1os metodol=C3=B3gicos (transversales, longitudinales, cuali= tativos y mixtos) y contextos institucionales diversos (hospitales p=C3=BAb= licos, privados, urbanos y rurales) confirma que el estr=C3=A9s laboral en = enfermer=C3=ADa de =C3=A1reas cr=C3=ADticas constituye un fen=C3=B3meno est= ructural m=C3=A1s que situacional.</span></p><p style=3D"margin-bottom:0pt;= text-align:justify; line-height:150%; font-size:12pt"><span style=3D"font-= family:'Times New Roman'">La identificaci=C3=B3n de estrategias efectivas p= ara mitigar el estr=C3=A9s laboral constituye un hallazgo fundamental de es= ta revisi=C3=B3n. Los estudios analizados evidencian que las intervenciones= organizacionales sistem=C3=A1ticas generan resultados positivos significat= ivos. Ram=C3=ADrez et al. (2022) demuestran que el acompa=C3=B1amiento psic= ol=C3=B3gico institucional reduce sustancialmente la tensi=C3=B3n emocional= y mejora el desempe=C3=B1o profesional, mientras que la implementaci=C3=B3= n de programas de autocuidado, pausas activas durante la jornada laboral y = talleres de afrontamiento del estr=C3=A9s demostrando efectividad en la mej= ora del clima organizacional y la productividad</span></p><p style=3D"margi= n-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><span s= tyle=3D"font-family:'Times New Roman'">Mientras que Felicity et al. (2025) = proponen que la formulaci=C3=B3n de pol=C3=ADticas de salud ocupacional con= car=C3=A1cter institucional representa el nivel de intervenci=C3=B3n m=C3= =A1s efectivo a largo plazo. Estas pol=C3=ADticas deben incluir la regulaci= =C3=B3n de ratios enfermera-paciente, la garant=C3=ADa de per=C3=ADodos de = descanso adecuados, la provisi=C3=B3n suficiente de recursos materiales, y = la implementaci=C3=B3n obligatoria de programas de apoyo emocional. La evid= encia sugiere que las intervenciones aisladas tienen efectos limitados, mie= ntras que los enfoques integrales que abordan simult=C3=A1neamente factores= organizacionales, emocionales e institucionales producen mejoras sostenida= s en el bienestar del personal y la calidad del cuidado (Chireh et al., 202= 5).</span></p><p style=3D"margin-bottom:0pt; text-align:justify; line-heigh= t:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">El an= =C3=A1lisis de las estrategias de intervenci=C3=B3n reportadas en los estud= ios revisados permite identificar. Las pausas activas durante la jornada la= boral constituyen intervenciones de bajo costo con resultados significativo= s en la reducci=C3=B3n de tensi=C3=B3n muscular y fatiga mental. Estas paus= as, que implican breves per=C3=ADodos de 10-15 minutos cada 3-4 horas de tr= abajo continuo para realizar ejercicios de estiramiento, t=C3=A9cnicas de r= espiraci=C3=B3n o simplemente desconexi=C3=B3n temporal de las demandas lab= orales, demostraron mejorar la concentraci=C3=B3n y reducir los niveles de = cortisol en personal de =C3=A1reas cr=C3=ADticas. Los talleres de afrontami= ento del estr=C3=A9s, por su parte, proporcionan al personal herramientas p= sicol=C3=B3gicas espec=C3=ADficas como t=C3=A9cnicas de relajaci=C3=B3n, re= estructuraci=C3=B3n cognitiva, manejo de emociones y establecimiento de l= =C3=ADmites profesionales saludables. V=C3=A1squez & Gonz=C3=A1lez (202= 0) documentaron que estas intervenciones mejoran significativamente la rela= ci=C3=B3n interpersonal con los pacientes y restauran la empat=C3=ADa profe= sional que frecuentemente se ve comprometida por el agotamiento emocional c= r=C3=B3nico.</span></p><p style=3D"margin-bottom:0pt; text-align:justify; l= ine-height:150%; font-size:12pt"><span style=3D"font-family:'Times New Roma= n'">Los programas institucionales de autocuidado representan intervenciones= m=C3=A1s comprehensivas que integran m=C3=BAltiples componentes: educaci= =C3=B3n sobre reconocimiento temprano de s=C3=ADntomas de estr=C3=A9s y bur= nout, promoci=C3=B3n de h=C3=A1bitos saludables de alimentaci=C3=B3n y sue= =C3=B1o, facilitaci=C3=B3n de espacios f=C3=ADsicos de descanso adecuados, = y establecimiento de redes de apoyo entre pares. La evidencia sugiere que e= stos programas son particularmente efectivos cuando se combinan con apoyo p= sicol=C3=B3gico profesional accesible y confidencial. Ram=C3=ADrez et al. (= 2022) documentaron que el acompa=C3=B1amiento psicol=C3=B3gico instituciona= l, cuando es proporcionado de manera sistem=C3=A1tica y no solo reactiva an= te crisis, reduce sustancialmente la tensi=C3=B3n emocional y mejora el des= empe=C3=B1o profesional. Sin embargo Melendrez (2023) alertan que el 70% de= l personal no recibe capacitaci=C3=B3n continua ni acceso a estos programas= de apoyo, lo que eleva significativamente tanto la tensi=C3=B3n laboral co= mo el riesgo de error cl=C3=ADnico. Esta ausencia de apoyo institucional si= stem=C3=A1tico representa una vulnerabilidad cr=C3=ADtica en los sistemas d= e salud latinoamericanos que debe ser abordada con urgencia.</span></p><p s= tyle=3D"margin-bottom:0pt; text-align:justify; line-height:150%; font-size:= 12pt"><span style=3D"font-family:'Times New Roman'">Este enfoque estructura= l encuentra respaldo en marcos te=C3=B3ricos consolidados de salud ocupacio= nal. El modelo Demanda-Control-Apoyo de Karasek y Theorell establece que el= estr=C3=A9s laboral resulta del desequilibrio entre altas demandas laboral= es, bajo control sobre el trabajo y ausencia de apoyo social, condiciones q= ue caracterizan precisamente el contexto de las =C3=A1reas cr=C3=ADticas la= tinoamericanas. Similarmente, el modelo de Esfuerzo-Recompensa de Siegrist = postula que el estr=C3=A9s surge cuando existe desbalance entre el esfuerzo= invertido (alta carga laboral, responsabilidades cr=C3=ADticas) y las reco= mpensas recibidas (reconocimiento, desarrollo profesional, compensaci=C3=B3= n adecuada), desequilibrio ampliamente documentado en los estudios revisado= s. Estos marcos conceptuales refuerzan que las intervenciones efectivas deb= en enfocarse en modificar las condiciones estructurales del trabajo m=C3=A1= s que en desarrollar =C3=BAnicamente habilidades individuales de afrontamie= nto.</span></p><p style=3D"margin-bottom:0pt; text-align:justify; line-heig= ht:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">En e= ste contexto los sistemas de salud latinoamericanos agravan esta situaci=C3= =B3n, debido a limitaciones estructurales como personal insuficiente, escas= ez de materiales, bajos salarios y ausencia de pol=C3=ADticas de bienestar = laboral (Santos et al., 2022). Esto genera un entorno de vulnerabilidad que= favorece la aparici=C3=B3n de estr=C3=A9s cr=C3=B3nico y reduce la capacid= ad de resiliencia del personal de enfermer=C3=ADa.</span></p><p style=3D"ma= rgin-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><spa= n style=3D"font-family:'Times New Roman'">Los hallazgos de esta revisi=C3= =B3n confirman de manera contundente que el estr=C3=A9s laboral en enfermer= =C3=ADa de =C3=A1reas cr=C3=ADticas no constituye un problema individual at= ribuible a caracter=C3=ADsticas personales o falta de resiliencia del profe= sional, sino que representa una consecuencia directa de la estructura organ= izativa deficiente de los servicios de salud latinoamericanos. Esta perspec= tiva estructural es fundamental para orientar intervenciones efectivas, ya = que desplaza el foco desde la responsabilidad individual hacia la responsab= ilidad institucional y sist=C3=A9mica.</span></p><p style=3D"margin-bottom:= 0pt; text-align:justify; line-height:150%; font-size:12pt"><span style=3D"f= ont-family:'Times New Roman'">La evidencia analizada revela que factores or= ganizacionales como d=C3=A9ficit cr=C3=B3nico de personal, ratios inadecuad= as enfermera-paciente, jornadas laborales extendidas, escasez de recursos m= ateriales, ausencia de protocolos de autocuidado institucional y falta de a= poyo psicol=C3=B3gico estructurado constituyen determinantes estructurales = del estr=C3=A9s que afectan al personal independientemente de sus caracter= =C3=ADsticas individuales. La ausencia de diferencias significativas en los= niveles de estr=C3=A9s seg=C3=BAn edad o g=C3=A9nero en los estudios anali= zados refuerza la naturaleza sist=C3=A9mica del problema.</span></p><p styl= e=3D"margin-bottom:0pt; text-align:justify; line-height:150%; font-size:12p= t"><span style=3D"font-family:'Times New Roman'">Esta comprensi=C3=B3n tien= e implicaciones cr=C3=ADticas para el dise=C3=B1o de intervenciones: mientr= as las estrategias centradas exclusivamente en el desarrollo de habilidades= individuales de afrontamiento pueden proporcionar alivio temporal, solo la= s transformaciones estructurales de las condiciones laborales pueden genera= r mejoras sostenibles. Las instituciones de salud y los formuladores de pol= =C3=ADticas p=C3=BAblicas deben reconocer que invertir en condiciones labor= ales dignas para el personal de enfermer=C3=ADa no es un gasto opcional sin= o una inversi=C3=B3n estrat=C3=A9gica en la calidad y seguridad de la atenc= i=C3=B3n hospitalaria.</span></p><p style=3D"margin-bottom:0pt; text-align:= justify; line-height:150%; font-size:12pt"><span style=3D"font-family:'Time= s New Roman'">En este sentido, los resultados de esta revisi=C3=B3n coincid= en en que el estr=C3=A9s laboral no debe ser</span><span style=3D"font-fami= ly:'Times New Roman'; font-weight:bold"> </span><span style=3D"font-family:= 'Times New Roman'">considerado un problema individual, sino una consecuenci= a de la estructura organizativa de los servicios de salud. </span></p><p st= yle=3D"margin-bottom:0pt; text-align:justify; line-height:150%; font-size:1= 2pt"><span style=3D"font-family:'Times New Roman'"> </span></p><p clas= s=3D"ListParagraph" style=3D"margin-bottom:0pt; text-indent:-18pt; text-ali= gn:justify; line-height:150%; font-size:12pt"><span style=3D"font-family:'T= imes New Roman'; font-weight:bold; color:#767171"><span>5.</span></span><sp= an style=3D"width:9pt; font:7pt 'Times New Roman'; display:inline-block">&#= xa0;     </span><span style=3D"font-family:'Times New R= oman'; font-weight:bold; color:#767171">Conclusiones</span></p><p style=3D"= margin-bottom:0pt; text-align:justify; line-height:150%; font-size:12pt"><s= pan style=3D"font-family:'Times New Roman'">El estr=C3=A9s laboral en el pe= rsonal de enfermer=C3=ADa de =C3=A1reas cr=C3=ADticas en Latinoam=C3=A9rica= no es un problema de debilidad individual ni de falta de capacidad profesi= onal, sino una consecuencia directa y previsible de sistemas de salud estru= cturalmente deficientes. Las instituciones hospitalarias de la regi=C3=B3n = normalizaron condiciones laborales insostenibles que inevitablemente deteri= oran tanto la salud mental del personal como la seguridad de los pacientes = m=C3=A1s vulnerables.</span></p><p style=3D"margin-bottom:0pt; text-align:j= ustify; line-height:150%; font-size:12pt"><span style=3D"font-family:'Times= New Roman'">La evidencia demuestra sin ambig=C3=BCedad que cuando los prof= esionales de enfermer=C3=ADa trabajan agotados, emocionalmente exhaustos y = sin apoyo institucional, cometen m=C3=A1s errores, pierden empat=C3=ADa con= sus pacientes y eventualmente abandonan la profesi=C3=B3n. Este ciclo dest= ructivo no solo representa una crisis humanitaria para el personal de salud= , sino tambi=C3=A9n una amenaza directa para la sostenibilidad de los siste= mas hospitalarios y la supervivencia de pacientes cr=C3=ADticos.</span></p>= <p style=3D"margin-bottom:0pt; text-align:justify; line-height:150%; font-s= ize:12pt"><span style=3D"font-family:'Times New Roman'">Las soluciones supe= rficiales centradas =C3=BAnicamente en ense=C3=B1ar al personal a "manejar = mejor el estr=C3=A9s" son insuficientes e incluso ofensivas, pues transfier= en la responsabilidad institucional al individuo. Lo que se requiere urgent= emente son transformaciones estructurales profundas: ratios adecuadas de pe= rsonal, provisi=C3=B3n suficiente de recursos, jornadas laborales razonable= s, apoyo psicol=C3=B3gico institucionalizado y pol=C3=ADticas p=C3=BAblicas= con fuerza legal que protejan efectivamente al personal de salud.</span></= p><p style=3D"margin-bottom:0pt; text-align:justify; line-height:150%; font= -size:12pt"><span style=3D"font-family:'Times New Roman'">La crisis postpan= demia ofrece una oportunidad hist=C3=B3rica para que los gobiernos y sistem= as de salud latinoamericanos reconozcan que proteger la salud mental del pe= rsonal de enfermer=C3=ADa no es un lujo opcional sino una necesidad imposte= rgable para garantizar la calidad, seguridad y viabilidad futura de la aten= ci=C3=B3n hospitalaria en la regi=C3=B3n. La pregunta ya no es si debemos a= ctuar, sino cu=C3=A1nto tiempo m=C3=A1s permitiremos que contin=C3=BAe esta= crisis evitable</span></p><p style=3D"margin-bottom:0pt; text-align:justif= y; line-height:150%; font-size:12pt"><span style=3D"font-family:'Times New = Roman'"> </span></p><p class=3D"ListParagraph" style=3D"text-indent:-1= 8pt; text-align:justify; line-height:115%; font-size:12pt"><span style=3D"f= ont-family:'Times New Roman'"><span style=3D"font-weight:bold; color:#76717= 1">6.</span></span><span style=3D"width:9pt; font:7pt 'Times New Roman'; di= splay:inline-block">      </span><span style=3D"fo= nt-family:'Times New Roman'; font-weight:bold; color:#767171">Conflicto de = intereses</span></p><p style=3D"text-align:justify; line-height:115%; font-= size:12pt"><span style=3D"font-family:'Times New Roman'">Los autores declar= an que no existe conflicto de intereses en relaci=C3=B3n con el art=C3=ADcu= lo presentado.</span></p><p class=3D"ListParagraph" style=3D"text-indent:-1= 8pt; text-align:justify; line-height:115%; font-size:12pt"><span style=3D"f= ont-family:'Times New Roman'; font-weight:bold; color:#767171"><span>7.</sp= an></span><span style=3D"width:9pt; font:7pt 'Times New Roman'; display:inl= ine-block">      </span><span style=3D"font-family= :'Times New Roman'; font-weight:bold; color:#767171">Declaraci=C3=B3n de co= ntribuci=C3=B3n de los autores</span></p><p style=3D"text-align:justify; li= ne-height:115%; font-size:12pt"><span style=3D"font-family:'Times New Roman= '">Todos autores contribuyeron significativamente en la elaboraci=C3=B3n de= l art=C3=ADculo.</span></p><p class=3D"ListParagraph" style=3D"text-indent:= -18pt; text-align:justify; line-height:115%; font-size:12pt"><span style=3D= "font-family:'Times New Roman'; font-weight:bold"><span style=3D"color:#767= 171">8.</span></span><span style=3D"width:9pt; font:7pt 'Times New Roman'; = display:inline-block">      </span><span style=3D"= font-family:'Times New Roman'; font-weight:bold; color:#767171">Costos de f= inanciamiento</span><span style=3D"font-family:'Times New Roman'; font-weig= ht:bold"> </span></p><p style=3D"text-align:justify; line-height:115%; font= -size:12pt"><span style=3D"font-family:'Times New Roman'">La presente inves= tigaci=C3=B3n fue financiada en su totalidad con fondos propios de los auto= res.</span></p><p class=3D"ListParagraph" style=3D"text-indent:-18pt; text-= align:justify; line-height:108%; font-size:12pt"><span style=3D"font-family= :'Times New Roman'; font-weight:bold; color:#767171"><span>9.</span></span>= <span style=3D"width:9pt; font:7pt 'Times New Roman'; display:inline-block"= >      </span><span style=3D"font-family:'Times Ne= w Roman'; font-weight:bold; color:#767171">Referencias Bibliogr=C3=A1ficas<= /span></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:150%= ; font-size:12pt"><span style=3D"font-family:'Times New Roman'">Acosta-Romo= , M. F., & Maya-Pantoja, G. J. (2020). Competencias cl=C3=ADnicas y car= ga laboral del profesional de enfermer=C3=ADa en la unidad de cuidado inten= sivo adulto. </span><span style=3D"font-family:'Times New Roman'; font-styl= e:italic">Revista Ciencia y Cuidado</span><span style=3D"font-family:'Times= New Roman'">, </span><span style=3D"font-family:'Times New Roman'; font-st= yle:italic">17</span><span style=3D"font-family:'Times New Roman'">(2), 22= =E2=80=9332. https://doi.org/10.22463/17949831.1698</span></p><p style=3D"m= argin-left:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span= style=3D"font-family:'Times New Roman'">Baldera Rivera, Y. J., & Ydrog= o Llatas, M. R. (2022). Nivel de estr=C3=A9s laboral en enfermeras ante la = pandemia del sars-cov-2 establecimiento m=C3=A9dico =E2=80=9CVilla Essalud = Ferre=C3=B1afe=E2=80=9D, Per=C3=BA-2020. </span><span style=3D"font-family:= 'Times New Roman'; font-style:italic">Repositorio Institucional USS</span><= span style=3D"font-family:'Times New Roman'">. https://repositorio.uss.edu.= pe/handle/20.500.12802/9752</span></p><p style=3D"margin-left:24pt; text-in= dent:-24pt; line-height:150%; font-size:12pt"><span style=3D"font-family:'T= imes New Roman'">Borges, E. M. das N., Queir=C3=B3s, C. M. L., Abreu, M. da= S. N. de, Mosteiro-Diaz, M. P., Baldonedo-Mosteiro, M., Baptista, P. C. P.= , =E2=80=A6 Silva, S. M. (2021). Burnout among nurses: a multicentric compa= rative study. </span><span style=3D"font-family:'Times New Roman'; font-sty= le:italic">Revista Latino-Americana de Enfermagem</span><span style=3D"font= -family:'Times New Roman'">, </span><span style=3D"font-family:'Times New R= oman'; font-style:italic">29</span><span style=3D"font-family:'Times New Ro= man'">, e3432. </span><a href=3D"https://doi.org/10.1590/1518-8345.4320.343= 2" style=3D"text-decoration:none"><span class=3D"Hyperlink" style=3D"font-f= amily:'Times New Roman'; color:#000000">https://doi.org/10.1590/1518-8345.4= 320.3432</span></a></p><p style=3D"margin-left:24pt; text-indent:-24pt; lin= e-height:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'= ">Calder=C3=B3n, R., & Rivas, M. (2021). </span><span style=3D"font-fam= ily:'Times New Roman'; font-style:italic">Factores laborales y nivel de est= r=C3=A9s en enfermeras de centro quir=C3=BArgico</span><span style=3D"font-= family:'Times New Roman'">. Revista Cubana de Enfermer=C3=ADa, 37(4). </spa= n><a href=3D"http://scielo.sld.cu/scielo.php?script=3Dsci_arttext&pid= =3DS0864-03192021000400013" style=3D"text-decoration:none"><span class=3D"H= yperlink" style=3D"font-family:'Times New Roman'; color:#000000">http://sci= elo.sld.cu/scielo.php?script=3Dsci_arttext&pid=3DS0864-0319202100040001= 3</span></a></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-heigh= t:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">Casti= llo Merino, Y. A., & Valverde Lucio, M. Vinicio. (2024). </span><span s= tyle=3D"font-family:'Times New Roman'; font-style:italic">Efecto de la sobr= e carga laboral en el personal de enfermer=C3=ADa del Hospital B=C3=A1sico = de Jipijapa.</span><span style=3D"font-family:'Times New Roman'"> [Tesis de= grado, Universidad Estatal del Sur de Manab=C3=AD], Repositorio Digital. <= /span><a href=3D"https://repositorio.unesum.edu.ec/handle/53000/6569" style= =3D"text-decoration:none"><span class=3D"Hyperlink" style=3D"font-family:'T= imes New Roman'; color:#000000">https://repositorio.unesum.edu.ec/handle/53= 000/6569</span></a></p><p style=3D"margin-left:24pt; text-indent:-24pt; lin= e-height:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'= ">Chireh, B., Essien, S. K., Swerhun, K., D=E2=80=99Arcy, C., & Acharib= asam, J. W. (2025). Workplace stressors and mental health outcomes among pe= rsonal support workers: A systematic review. </span><span style=3D"font-fam= ily:'Times New Roman'; font-style:italic">International Journal of Nursing = Studies</span><span style=3D"font-family:'Times New Roman'">, </span><span = style=3D"font-family:'Times New Roman'; font-style:italic">168</span><span = style=3D"font-family:'Times New Roman'">(105093). </span><a href=3D"https:/= /doi.org/10.1016/j.ijnurstu.2025.105093" style=3D"text-decoration:none"><sp= an class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; color:#00000= 0">https://doi.org/10.1016/j.ijnurstu.2025.105093</span></a><span class=3D"= Hyperlink" style=3D"font-family:'Times New Roman'; color:#000000"> </span><= /p><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:150%; font-= size:12pt"><span style=3D"font-family:'Times New Roman'">Comezaquira-Reay, = R., Ter=C3=A1n-=C3=81ngel, G., & Quijada-Mart=C3=ADnez, P. J. (2021). <= /span><span style=3D"font-family:'Times New Roman'; font-style:italic">Carg= a laboral y obst=C3=A1culos de rendimiento del personal de enfermer=C3=ADa = en la Unidad de Cuidados Intensivos</span><span style=3D"font-family:'Times= New Roman'">. Revista Cubana de Enfermer=C3=ADa, 37(4). </span><a href=3D"= http://scielo.sld.cu/scielo.php?script=3Dsci_arttext&pid=3DS0864-031920= 21000400009" style=3D"text-decoration:none"><span class=3D"Hyperlink" style= =3D"font-family:'Times New Roman'; color:#000000">http://scielo.sld.cu/scie= lo.php?script=3Dsci_arttext&pid=3DS0864-03192021000400009</span></a></p= ><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:150%; font-si= ze:12pt"><span style=3D"font-family:'Times New Roman'">Cortez-Gonz=C3=A1lez= , L. C., Pantoja-Herrara, M., Cortes-Montelongo, D. B., Tello-Garc=C3=ADa, = M. A., & Nuncio-Dom=C3=ADnguez, J. L. (2022). Estr=C3=A9s laboral del p= ersonal de enfermer=C3=ADa en una instituci=C3=B3n de tercer nivel de atenc= i=C3=B3n de la ciudad de M=C3=A9xico. </span><span style=3D"font-family:'Ti= mes New Roman'; font-style:italic">Investigaci=C3=B3n Y Pensamiento Cr=C3= =ADtico</span><span style=3D"font-family:'Times New Roman'">, </span><span = style=3D"font-family:'Times New Roman'; font-style:italic">10</span><span s= tyle=3D"font-family:'Times New Roman'">(2), 04=E2=80=9322. </span><a href= =3D"https://doi.org/10.37387/ipc.v10i2.288" style=3D"text-decoration:none">= <span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; color:#00= 0000">https://doi.org/10.37387/ipc.v10i2.288</span></a></p><p style=3D"marg= in-left:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span st= yle=3D"font-family:'Times New Roman'">Cruz L=C3=B3pez, L. N., Quintero Osor= io, J. F., Melo Roa, J. D., & Henao Casta=C3=B1o, =C3=81ngela M. (2023)= . Carga laboral de profesionales de enfermer=C3=ADa en unidad de cuidado in= tensivo seg=C3=BAn nursing activities score. </span><span style=3D"font-fam= ily:'Times New Roman'; font-style:italic">Revista Cuidarte</span><span styl= e=3D"font-family:'Times New Roman'">, </span><span style=3D"font-family:'Ti= mes New Roman'; font-style:italic">14</span><span style=3D"font-family:'Tim= es New Roman'">(1). </span><a href=3D"https://doi.org/10.15649/cuidarte.268= 0" style=3D"text-decoration:none"><span class=3D"Hyperlink" style=3D"font-f= amily:'Times New Roman'; color:#000000">https://doi.org/10.15649/cuidarte.2= 680</span></a></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-hei= ght:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">Cue= va Aguilar, L. M. (2025). Estr=C3=A9s laboral y desempe=C3=B1o profesional = en el personal de enfermer=C3=ADa del Hospital II-1 de Ilave, Provincia de = El Collao, 2025. [Tesis de grado, Universidad Peruana S.C.] </span><a href= =3D"https://repositorio.upsc.edu.pe/handle/UPSC/1496" style=3D"text-decorat= ion:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'"= >https://repositorio.upsc.edu.pe/handle/UPSC/1496</span></a></p><p style=3D= "margin-left:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><sp= an style=3D"font-family:'Times New Roman'">De Souza Veloso, C., de Souza e = Silva, D., Almeida da Silva, V., Diniz dos Santos, S., Matheus Estrela, F.,= & Fonseca de Souza, A. C. (2024). </span><span style=3D"font-family:'T= imes New Roman'; font-style:italic">S=C3=ADndrome de burnout y factores aso= ciados en enfermeras de cuidados intensivos: un estudio transversal</span><= span style=3D"font-family:'Times New Roman'">. Enfermer=C3=ADa Global, 23(2= ), 223=E2=80=93235. </span><a href=3D"https://revistas.um.es/eglobal/articl= e/view/577341" style=3D"text-decoration:none"><span class=3D"Hyperlink">htt= ps://revistas.um.es/eglobal/article/view/577341</span></a><span> </span></p= ><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:150%; font-si= ze:12pt"><span style=3D"font-family:'Times New Roman'">Del Rosario, F., Cub= a, S., & Chasnamote, D. (2021). </span><span style=3D"font-family:'Time= s New Roman'; font-style:italic">Estr=C3=A9s del personal de enfermer=C3=AD= a durante la pandemia COVID-19 en hospitales de Lima Norte.</span><span sty= le=3D"font-family:'Times New Roman'"> Revista de Investigaci=C3=B3n Cient= =C3=ADfica =C3=81gora, 8(2), 27-32.</span><span> </span><a href=3D"https://= revistaagora.com/index.php/cieUMA/article/view/190" style=3D"text-decoratio= n:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'">h= ttps://revistaagora.com/index.php/cieUMA/article/view/190</span></a><span s= tyle=3D"font-family:'Times New Roman'"> </span></p><p style=3D"margin-left:= 24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span style=3D"f= ont-family:'Times New Roman'">Del Valle Sol=C3=B3rzano, K. S. (2021). Sobre= carga laboral por cantidad de pacientes atendidos que influye en la calidad= de atenci=C3=B3n del profesional de enfermer=C3=ADa. </span><span style=3D= "font-family:'Times New Roman'; font-style:italic">Revista San Gregorio</sp= an><span style=3D"font-family:'Times New Roman'">, </span><span style=3D"fo= nt-family:'Times New Roman'; font-style:italic">1</span><span style=3D"font= -family:'Times New Roman'">(47). </span><a href=3D"https://doi.org/10.36097= /rsan.v1i47.1966" style=3D"text-decoration:none"><span class=3D"Hyperlink" = style=3D"font-family:'Times New Roman'; color:#000000">https://doi.org/10.3= 6097/rsan.v1i47.1966</span></a></p><p style=3D"margin-left:24pt; text-inden= t:-24pt; line-height:150%; font-size:12pt"><span style=3D"font-family:'Time= s New Roman'">Dur=C3=A1n, R., Gamez, Y., Toirac, K., Toirac, J., & Toir= ac, D. (2021). S=C3=ADndrome de burnout en enfermer=C3=ADa intensiva y su i= nfluencia en la seguridad del paciente</span><span style=3D"font-family:'Ti= mes New Roman'; font-style:italic">.</span><span style=3D"font-family:'Time= s New Roman'"> </span><span style=3D"font-family:'Times New Roman'; font-st= yle:italic">Medisan</span><span style=3D"font-family:'Times New Roman'">, 2= 5(2), 278=E2=80=93291. </span><a href=3D"http://scielo.sld.cu/scielo.php?sc= ript=3Dsci_arttext&pid=3DS1029-30192021000200278" style=3D"text-decorat= ion:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New Roman';= color:#000000">http://scielo.sld.cu/scielo.php?script=3Dsci_arttext&pi= d=3DS1029-30192021000200278</span></a><span class=3D"Hyperlink" style=3D"fo= nt-family:'Times New Roman'; color:#000000"> </span></p><p style=3D"margin-= left:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span style= =3D"font-family:'Times New Roman'">Fang Huerta, M. de L. A., Gonz=C3=A1lez = Salinas, J. F., Mel=C3=A9ndez M=C3=A9ndez, M. C., Garza Hern=C3=A1ndez, R.,= Del Angel P=C3=A9rez, B., & Vega Ibarra, B. P. (2025). Nivel de Estr= =C3=A9s Laboral del Personal de Enfermer=C3=ADa en =C3=81reas Cr=C3=ADticas= de UCI, UTIP y UCIN de un Hospital P=C3=BAblico. </span><span style=3D"fon= t-family:'Times New Roman'; font-style:italic">Ciencia Latina Revista Cient= =C3=ADfica Multidisciplinar</span><span style=3D"font-family:'Times New Rom= an'">, </span><span style=3D"font-family:'Times New Roman'; font-style:ital= ic">9</span><span style=3D"font-family:'Times New Roman'">(3), 2273=E2=80= =932281. </span><a href=3D"https://dialnet.unirioja.es/servlet/articulo?cod= igo=3D10256224" style=3D"text-decoration:none"><span class=3D"Hyperlink" st= yle=3D"font-family:'Times New Roman'; color:#000000">https://dialnet.unirio= ja.es/servlet/articulo?codigo=3D10256224</span></a></p><p style=3D"margin-l= eft:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span style= =3D"font-family:'Times New Roman'">Fern=C3=A1ndez, J. (2024). </span><span = style=3D"font-family:'Times New Roman'; font-style:italic">Estr=C3=A9s y sa= tisfacci=C3=B3n laboral de enfermeras en servicios cr=C3=ADticos durante la= pandemia de COVID-19</span><span style=3D"font-family:'Times New Roman'">.= Revista Cubana de Enfermer=C3=ADa, 40(1). </span></p><p style=3D"margin-le= ft:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span style= =3D"font-family:'Times New Roman'">Franco Coffr=C3=A9, J. A., Oviedo Rodr= =C3=ADguez, R. J., Genovesi Anguizaca, G. B., & Tamayo Miranda, M. E. (= 2024). </span><span style=3D"font-family:'Times New Roman'; font-style:ital= ic">Factores predictivos de la fatiga por compasi=C3=B3n en el cuidado de e= nfermer=C3=ADa.</span><span style=3D"font-family:'Times New Roman'"> Revist= a Polo del Conocimiento, 9(9), 1616=E2=80=931632. </span><a href=3D"https:/= /polodelconocimiento.com/ojs/index.php/es/article/view/8012" style=3D"text-= decoration:none"><span class=3D"Hyperlink">https://polodelconocimiento.com/= ojs/index.php/es/article/view/8012</span></a><span> </span></p><p style=3D"= margin-left:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><spa= n style=3D"font-family:'Times New Roman'">Guillen Godoy, M. A., Moran Le=C3= =B3n, M. de los S., Centeno Salazar, N. N., Puma Rodr=C3=ADguez, J. M., &am= p; Villalva Pacheco, B. A. (2025). </span><span style=3D"font-family:'Times= New Roman'; font-style:italic">Impacto de la sobrecarga laboral en el pers= onal de enfermer=C3=ADa de la Unidad de Cuidados Intensivos del Hospital Li= borio Panchana</span><span style=3D"font-family:'Times New Roman'">. Revist= a Cient=C3=ADfica Multidisciplinar SAGA, 5(1), 158=E2=80=93175. </span><a h= ref=3D"https://revistasaga.org/index.php/saga/article/view/158" style=3D"te= xt-decoration:none"><span class=3D"Hyperlink" style=3D"font-family:'Times N= ew Roman'; color:#000000">https://revistasaga.org/index.php/saga/article/vi= ew/158</span></a><span>  </span></p><p style=3D"margin-left:24pt; text= -indent:-24pt; line-height:150%; font-size:12pt"><span style=3D"font-family= :'Times New Roman'">Ino=C3=B1an Rodriguez, R. E., & Quispe Medina, H. M= . (2024). Estr=C3=A9s laboral y desempe=C3=B1o profesional en enfermeros de= la Unidad de Cuidados Intensivos de un hospital de EsSalud de Iquitos, 202= 3. [Tesis de grado, Universidad Peruana Uni=C3=B3n]. </span><a href=3D"http= s://repositorio.upeu.edu.pe/items/226cb0f4-2523-4ea8-ad4b-ed3e8c922992" sty= le=3D"text-decoration:none"><span class=3D"Hyperlink" style=3D"font-family:= 'Times New Roman'; color:#000000">https://repositorio.upeu.edu.pe/items/226= cb0f4-2523-4ea8-ad4b-ed3e8c922992</span></a></p><p style=3D"margin-left:24p= t; text-indent:-24pt; line-height:150%; font-size:12pt"><span style=3D"font= -family:'Times New Roman'">Jim=C3=A9nez Jim=C3=A9nez , M. J., Albornoz Zamo= ra, E. J., Vega Falc=C3=B3n, V., Jim=C3=A9nez Jim=C3=A9nez, L. M., & He= rmida Cazar, X. A. (2023). Estimaci=C3=B3n del Estr=C3=A9s Laboral en Perso= nal de Enfermer=C3=ADa de Cuidados Cr=C3=ADticos del Hospital Quito N=C2=BA= 1 de la Polic=C3=ADa, abril 2022. </span><span style=3D"font-family:'Times = New Roman'; font-style:italic">Ciencia Latina Revista Cient=C3=ADfica Multi= disciplinar</span><span style=3D"font-family:'Times New Roman'">, </span><s= pan style=3D"font-family:'Times New Roman'; font-style:italic">6</span><spa= n style=3D"font-family:'Times New Roman'">(6), 12300-12316. </span><a href= =3D"https://ciencialatina.org/index.php/cienciala/article/view/4252" style= =3D"text-decoration:none"><span class=3D"Hyperlink" style=3D"font-family:'T= imes New Roman'; color:#000000">https://ciencialatina.org/index.php/ciencia= la/article/view/4252</span></a><span>   </span></p><p style=3D"ma= rgin-left:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span = style=3D"font-family:'Times New Roman'">L=C3=B3pez, C., Rene Obreg=C3=B3n B= las, O., Durand De Isla, V., & De Jes=C3=BAs, T. (2023). </span><span s= tyle=3D"font-family:'Times New Roman'; font-style:italic">S=C3=ADndrome de = Burnout y factores asociados post pandemia entre profesionales de enfermer= =C3=ADa de un Hospital de Lima Norte - 2023</span><span style=3D"font-famil= y:'Times New Roman'">. https://repositorio.uch.edu.pe//handle/20.500.12872/= 864</span></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:= 150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">L=C3=B3= pez Isidro, N. D., & Abramonte Contreras, P. S. (2024). Estr=C3=A9s lab= oral y calidad del cuidado de enfermer=C3=ADa en la Unidad de Cuidados Inte= nsivos del Hospital II-2 de Tingo Mar=C3=ADa, 2023. [Tesis de grado, Univer= sidad Peruana Uni=C3=B3n, Per=C3=BA]. </span><a href=3D"https://repositorio= .upeu.edu.pe/items/9282b1a2-93b8-43cf-8112-42aa8d39417b" style=3D"text-deco= ration:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New Roma= n'; color:#000000">https://repositorio.upeu.edu.pe/items/9282b1a2-93b8-43cf= -8112-42aa8d39417b</span></a><span class=3D"Hyperlink" style=3D"font-family= :'Times New Roman'; color:#000000"> </span></p><p style=3D"margin-left:24pt= ; text-indent:-24pt; line-height:150%; font-size:12pt"><span style=3D"font-= family:'Times New Roman'">Mat=C3=ADas, M. I. (2024). </span><span style=3D"= font-family:'Times New Roman'; font-style:italic">Estr=C3=A9s laboral del p= ersonal de enfermer=C3=ADa que labora en el departamento de intensivo de ad= ultos del hospital general San Juan de Dios</span><span style=3D"font-famil= y:'Times New Roman'"> [Tesis de grado, Universidad Da Vinci de Guatemala, G= uatemala]. </span><a href=3D"https://tesariofeccs.com/wp-content/uploads/20= 25/06/maria-isabel-matias.pdf" style=3D"text-decoration:none"><span class= =3D"Hyperlink" style=3D"font-family:'Times New Roman'; color:#000000">https= ://tesariofeccs.com/wp-content/uploads/2025/06/maria-isabel-matias.pdf</spa= n></a></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:150%= ; font-size:12pt"><span style=3D"font-family:'Times New Roman'">Melendrez D= iaz, M. L. (2023). </span><span style=3D"font-family:'Times New Roman'; fon= t-style:italic">Work factors and their relationship with the stress level o= f nursing staff in the surgical center of the National Hospital Arzobispo L= oayza, Lima 2023</span><span style=3D"font-family:'Times New Roman'"> [Tesi= s de grado, Universidad Norbert Wiener] </span><a href=3D"https://repositor= io.uwiener.edu.pe/items/49e2190b-e8f5-4063-a20b-1498ff9ec7cd" style=3D"text= -decoration:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New= Roman'">https://repositorio.uwiener.edu.pe/items/49e2190b-e8f5-4063-a20b-1= 498ff9ec7cd</span></a><span style=3D"font-family:'Times New Roman'"> </span= ></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:150%; fon= t-size:12pt"><span style=3D"font-family:'Times New Roman'">Moncada, B., Su= =C3=A1rez, M., Duque, L., & Escobar, K. (2021). Estr=C3=A9s laboral en = personal m=C3=A9dico y enfermer=C3=ADa de atenci=C3=B3n primaria ante la em= ergencia sanitaria por covid-19. </span><span style=3D"font-family:'Times N= ew Roman'; font-style:italic">Perfiles</span><span style=3D"font-family:'Ti= mes New Roman'">, 1(25), 13=E2=80=9323. </span><a href=3D"https://doi.org/1= 0.47187/perf.v1i25.109" style=3D"text-decoration:none"><span class=3D"Hyper= link" style=3D"font-family:'Times New Roman'; color:#000000">https://doi.or= g/10.47187/perf.v1i25.109</span></a></p><p style=3D"margin-left:24pt; text-= indent:-24pt; line-height:150%; font-size:12pt"><span style=3D"font-family:= 'Times New Roman'">Omotosho, T. F., Alex Omotosho, T. O., & Bass, P. (2= 025). Work-related stress and its associated factors among nurses in public= hospitals in the Greater Banjul Area, The Gambia. </span><span style=3D"fo= nt-family:'Times New Roman'; font-style:italic">International Journal of Af= rica Nursing Sciences</span><span style=3D"font-family:'Times New Roman'">,= </span><span style=3D"font-family:'Times New Roman'; font-style:italic">22= </span><span style=3D"font-family:'Times New Roman'">(100842), 100842. </sp= an><a href=3D"https://doi.org/10.1016/j.ijans.2025.100842" style=3D"text-de= coration:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New Ro= man'; color:#000000">https://doi.org/10.1016/j.ijans.2025.100842</span></a>= <span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; color:#00= 0000"> </span></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-hei= ght:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">Pin= edo P=C3=A9rez, M. C. (2025). Estr=C3=A9s laboral en el profesional de enfe= rmer=C3=ADa de los servicios quir=C3=BArgicos de un hospital de Lurigancho,= 2025 [Tesis de grado, Universidad Peruana Uni=C3=B3n]. </span><a href=3D"h= ttps://repositorio.upeu.edu.pe/items/043a16a2-c4a7-416d-abf2-6edee9487217" = style=3D"text-decoration:none"><span class=3D"Hyperlink" style=3D"font-fami= ly:'Times New Roman'">https://repositorio.upeu.edu.pe/items/043a16a2-c4a7-4= 16d-abf2-6edee9487217</span></a><span style=3D"font-family:'Times New Roman= '"> </span></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-height= :150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">Quispe= Ayuque, A. (2025). </span><span style=3D"font-family:'Times New Roman'; fo= nt-style:italic">Estr=C3=A9s laboral en profesionales de enfermer=C3=ADa qu= e trabajan en la unidad de cuidados intensivos adultos de un hospital de Li= ma Norte, 2025.</span><span style=3D"font-family:'Times New Roman'"> [Tesis= de grado, Universidad Mar=C3=ADa Auxiliadora]. </span><a href=3D"https://r= epositorio.uma.edu.pe/handle/20.500.12970/2643" style=3D"text-decoration:no= ne"><span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; color= :#000000">https://repositorio.uma.edu.pe/handle/20.500.12970/2643</span></a= ><span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; color:#0= 00000"> </span></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-he= ight:150%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">Ra= m=C3=ADrez Lab=C3=A1n, E. M., Garc=C3=ADa Godos Castillo, G. M., Silva Sand= oval, C. I., & Delgado Medina, L. M. (2022). Estr=C3=A9s laboral y el d= esempe=C3=B1o de los trabajadores de enfermer=C3=ADa del servicio de emerge= ncia del Hospital Regional II-2-Tumbes, 2019. </span><span style=3D"font-fa= mily:'Times New Roman'; font-style:italic">RECIAMUC</span><span style=3D"fo= nt-family:'Times New Roman'">, </span><span style=3D"font-family:'Times New= Roman'; font-style:italic">6</span><span style=3D"font-family:'Times New R= oman'">(1), 2-14. </span><a href=3D"https://www.reciamuc.com/index.php/RECI= AMUC/article/view/767" style=3D"text-decoration:none"><span class=3D"Hyperl= ink" style=3D"font-family:'Times New Roman'; color:#000000">https://www.rec= iamuc.com/index.php/RECIAMUC/article/view/767</span></a></p><p style=3D"mar= gin-left:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span s= tyle=3D"font-family:'Times New Roman'">Rend=C3=B3n Montoya, M. S. ., Peralt= a Pe=C3=B1a, S. L., Hern=C3=A1ndez Villa, E. A., Hern=C3=A1ndez Pedroza, R.= I., Vargas, M. R., & Favela Oca=C3=B1o, M. A. . (2020). S=C3=ADndrome = de burnout en el personal de enfermer=C3=ADa de unidades de cuidado cr=C3= =ADtico y de hospitalizaci=C3=B3n . </span><span style=3D"font-family:'Time= s New Roman'; font-style:italic">Enfermer=C3=ADa Global</span><span style= =3D"font-family:'Times New Roman'">, </span><span style=3D"font-family:'Tim= es New Roman'; font-style:italic">19</span><span style=3D"font-family:'Time= s New Roman'">(3), 479=E2=80=93506. </span><a href=3D"https://doi.org/10.60= 18/eglobal.398221" style=3D"text-decoration:none"><span class=3D"Hyperlink"= style=3D"font-family:'Times New Roman'; color:#000000">https://doi.org/10.= 6018/eglobal.398221</span></a></p><p style=3D"margin-left:24pt; text-indent= :-24pt; line-height:150%; font-size:12pt"><span style=3D"font-family:'Times= New Roman'">Salazar Roldan, M. A., Venegas Paute, A. C., & Alarc=C3=B3= n Dalgo, C. M. de L. =C3=81ngeles . (2024). Carga laboral y obst=C3=A1culos= de rendimiento del personal de enfermer=C3=ADa en cuidados intensivos. </s= pan><span style=3D"font-family:'Times New Roman'; font-style:italic">Reinci= sol</span><span style=3D"font-family:'Times New Roman'">, </span><span styl= e=3D"font-family:'Times New Roman'; font-style:italic">3</span><span style= =3D"font-family:'Times New Roman'">(6), 1798=E2=80=931817. </span><a href= =3D"https://doi.org/10.59282/reincisol.V3(6)1798-1817" style=3D"text-decora= tion:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'= ; color:#000000">https://doi.org/10.59282/reincisol.V3(6)1798-1817</span></= a></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:150%; fo= nt-size:12pt"><span style=3D"font-family:'Times New Roman'">Santos, J. L., = Merc=C3=AAs, C. A., Erdmann, A. L., & Silva, D. S. (2022). Burnout e re= sili=C3=AAncia em profissionais de enfermagem de terapia intensiva frente = =C3=A0 COVID-19: estudo multic=C3=AAntrico</span><span style=3D"font-family= :'Times New Roman'; font-style:italic">.</span><span style=3D"font-family:'= Times New Roman'"> </span><span style=3D"font-family:'Times New Roman'; fon= t-style:italic">Revista Latino-Americana de Enfermagem</span><span style=3D= "font-family:'Times New Roman'">, 30, e3550. </span><a href=3D"https://www.= scielo.br/j/rlae/a/K9wJD9NSCKr9bbQm9cBj8vF/?lang=3Des" style=3D"text-decora= tion:none"><span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'= ; color:#000000">https://www.scielo.br/j/rlae/a/K9wJD9NSCKr9bbQm9cBj8vF/?la= ng=3Des</span></a><span>  </span></p><p style=3D"margin-left:24pt; tex= t-indent:-24pt; line-height:150%; font-size:12pt"><span style=3D"font-famil= y:'Times New Roman'">Espinel Garc=C3=ADa, J. T., Rojas Gonz=C3=A1lez, L. R.= , Santos Zambrano, E., Solorzano, H. M., P=C3=A9rez Cardoso, C. N., & M= art=C3=ADnez Moreira, J. (2022). Sobrecarga laboral en personal de enfermer= =C3=ADa de unidades de cuidados intensivos. </span><span style=3D"font-fami= ly:'Times New Roman'; font-style:italic">QhaliKay Revista de Ciencias de la= Salud</span><span style=3D"font-family:'Times New Roman'">, </span><span s= tyle=3D"font-family:'Times New Roman'; font-style:italic">6</span><span sty= le=3D"font-family:'Times New Roman'">(2), 21=E2=80=9327. </span><a href=3D"= https://doi.org/10.33936/qkrcs.v6i2.4757" style=3D"text-decoration:none"><s= pan class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; color:#0000= 00">https://doi.org/10.33936/qkrcs.v6i2.4757</span></a></p><p style=3D"marg= in-left:24pt; text-indent:-24pt; line-height:150%; font-size:12pt"><span st= yle=3D"font-family:'Times New Roman'">Torrecilla, M., Victoria, J., & M= inz, C. R. (2021). Ansiedad, depresi=C3=B3n y estr=C3=A9s en personal de en= fermer=C3=ADa que trabaja en unidades de terapia intensiva con pacientes co= n COVID-19</span><span style=3D"font-family:'Times New Roman'; font-style:i= talic">.</span><span style=3D"font-family:'Times New Roman'"> </span><span = style=3D"font-family:'Times New Roman'; font-style:italic">Revista Argentin= a de Salud P=C3=BAblica</span><span style=3D"font-family:'Times New Roman'"= >, 13(1), 25=E2=80=9332. </span><a href=3D"https://www.scielo.org.ar/pdf/ra= sp/v13s1/1853-810X-rasp-13-s1-25.pdf" style=3D"text-decoration:none"><span = class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; color:#000000">= https://www.scielo.org.ar/pdf/rasp/v13s1/1853-810X-rasp-13-s1-25.pdf</span>= </a></p><p style=3D"margin-left:24pt; text-indent:-24pt; line-height:150%; = font-size:12pt"><span style=3D"font-family:'Times New Roman'">Torrecilla, N= . M., Victoria, M. J., & Minzi, M. C. R. de. (2021). 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S=C3=ADndrome de Burnout en el profesio= nal de enfermer=C3=ADa de las =C3=A1reas cr=C3=ADticas en un hospital de Li= ma, 2022 [Tesis de grado, Universidad Mar=C3=ADa Auxiliadora]. </span><a hr= ef=3D"https://repositorio.uma.edu.pe/bitstream/handle/20.500.12970/1364/TRA= BAJO%20ACADEMICO-%20VILLACORTA%20LEYVA.pdf" style=3D"text-decoration:none">= <span class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; color:#00= 0000">https://repositorio.uma.edu.pe/bitstream/handle/20.500.12970/1364/TRA= BAJO%20ACADEMICO-%20VILLACORTA%20LEYVA.pdf</span></a></p><p style=3D"line-h= eight:150%"><span style=3D"font-family:'Times New Roman'"> </span></p>= <p style=3D"margin-top:6pt; margin-bottom:12pt; text-align:justify; line-he= ight:108%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">&#= xa0;</span></p><p style=3D"margin-top:6pt; margin-bottom:12pt; text-align:j= ustify; line-height:108%; font-size:12pt"><span style=3D"font-family:'Times= New Roman'"> </span></p><p style=3D"margin-top:6pt; margin-bottom:12p= t; text-align:justify; line-height:108%; font-size:12pt"><span style=3D"fon= t-family:'Times New Roman'"> </span></p><p style=3D"margin-top:6pt; ma= rgin-bottom:12pt; text-align:justify; line-height:108%; font-size:12pt"><sp= an style=3D"font-family:'Times New Roman'"> </span></p><p style=3D"mar= gin-top:6pt; margin-bottom:12pt; text-align:justify; line-height:108%; font= -size:12pt"><span style=3D"font-family:'Times New Roman'"> </span></p>= <p style=3D"margin-top:6pt; margin-bottom:12pt; text-align:justify; line-he= ight:108%; font-size:12pt"><span style=3D"font-family:'Times New Roman'">&#= xa0;</span></p><p style=3D"margin-top:6pt; margin-bottom:12pt; text-align:j= ustify; line-height:108%; font-size:12pt"><span style=3D"font-family:'Times= New Roman'"> </span></p><p style=3D"margin-top:6pt; margin-bottom:12p= t; text-align:justify; line-height:108%; font-size:12pt"><span style=3D"fon= t-family:'Times New Roman'"> </span></p><p 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color:#ffffff">Nombre</span><span style=3D"width:14= 1.26pt; letter-spacing:3pt; display:inline-block"> </span><span style= =3D"width:63.4pt; letter-spacing:3pt; display:inline-block"> </span><s= pan style=3D"width:27.7pt; letter-spacing:3pt; display:inline-block"> = </span><span style=3D"width:35.4pt; letter-spacing:3pt; display:inline-bloc= k"> </span><span style=3D"letter-spacing:3pt; color:#ffffff"> </span><= span style=3D"width:32.69pt; letter-spacing:3pt; display:inline-block"> = 0;</span><span style=3D"color:#ffffff"> </span><span style=3D"color:#ffffff= ; background-color:#ffff00">1</span></p><p class=3D"Footer"><span> </s= pan></p></div></div></body></html>