Challenges to well‐being in critical care

Abstract

BackgroundPaediatric critical care (PCC) is a high‐pressure working environment. Staff experience high levels of burnout, symptoms of post‐traumatic stress, and moral distress.AimTo understand challenges to workplace well‐being in PCC to help inform the development of staff interventions to improve and maintain well‐being.Study DesignThe Enhanced Critical Incident Technique (ECIT) was used. ECIT encompasses semi‐structured interviews and thematic analysis. We identified ‘critical incidents’, challenges to well‐being, categorized them in a meaningful way, and identified factors which helped and hindered in those moments. Fifty‐three nurses and doctors from a large UK quaternary PCC unit were consented to take part.ResultsThemes generated are: Context of working in PCC, which examined staff's experiences of working in PCC generally and during COVID‐19; Patient care and moral distress explored significant challenges to well‐being faced by staff caring for increasingly complex and chronically ill patients; Teamwork and leadership demonstrated the importance of team‐belonging and clear leadership; Changing workforce explored the impact of staffing shortages and the ageing workforce on well‐being; and Satisfying basic human needs, which identified absences in basic requirements of food and rest.ConclusionsStaff's experiential accounts demonstrated a clear need for psychologically informed environments to enable the sharing of vulnerabilities, foster support, and maintain workplace well‐being. Themes resonated with the self‐determination theory and Maslow's hierarchy of needs, which outline requirements for fulfilment (self‐actualization).Relevance to Clinical PracticeWell‐being interventions must be informed by psychological theory and evidence. Recommendations are flexible rostering, advanced communication training, psychologically‐informed support, supervision/mentoring training, adequate accommodation and hot food. Investment is required to develop successful interventions to improve workplace well‐being.

Managing well-being in paediatric critical care: a multiperspective qualitative study of nurses’ and allied health professionals’ experiences

“…This adds a unique layer of challenge to the PCC environment. 8 Paediatric nurses develop a relationship with patients’ parents, which coupled with extended hospital stays for some patients with complex conditions that have become more chronic as treatment options and survival rates change, can lead to challenges. Challenges might come through strong bonds being developed or to significant differences of opinion relating to treatment decisions, each of which can lead to moral distress or the blurring of boundaries between personal and professional lives.…”

“…Challenges might come through strong bonds being developed or to significant differences of opinion relating to treatment decisions, each of which can lead to moral distress or the blurring of boundaries between personal and professional lives. 8 9 …”

“…To date, research has focused on measuring the extent of the problem, but Butcher et al ’s 2023 review 14 and the small amount of qualitative research undertaken to explore workforce well-being in PCC to date 8 16–18 have shown us that further work is required to fully grasp the nature of staff experiences within the context of their lifeworld—their lived experience. 19 To do this, we need to examine in-depth how individuals make sense of what constitutes well-being to them, to understand how they experience challenges to their well-being and how they might be able to integrate well-being strategies into their everyday lives to build resilience at work.…”