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Paediatric critical care (PCC) staff experience higher levels of burnout, moral distress and post-traumatic stress disorder compared with other healthcare staff groups; ‘SWell’, a recent wellbeing project involving half of the United Kingdom’s PCC units, has developed two simple, easy-to-deliver sessions to help.

鈥淚t has never been more critical to understand what threatens and protects the wellbeing of health care professionals who work in critical care,鈥� Dr Liz Crowe et al. from The University of Queensland鈥檚 wrote in a 聽on the subject; Crowe鈥檚 PhD research explored risk and protective factors contributing to paediatric intensive care staff burnout, with recommendations to reduce burnout and promote wellbeing.

Recently, in the UK, the Staff Wellbeing () project 鈥� in collaboration with and 鈥� has developed two simple, low-resource wellbeing sessions that can be delivered by staff for staff without specialist training;聽the results of which were published this year in .

This UK-based research set out to bridge a current gap in understandings, by developing interventions to mitigate risk factors and build protective factors for wellbeing that will enable staff working in PCC to deal with the coexistence of a deep sense of work satisfaction alongside the psychological distress often experienced.

The need for interventions

In addition to worldwide evidence consistently showing聽that PCC staff have higher levels of burnout, post-traumatic stress and moral distress than聽other healthcare staff groups, PCC staff also often feel little is offered to help them with their mental health. Further, a literature review by SWell project lead Professor Rachel Shaw from Aston University鈥檚聽 revealed that there were no existing, evidence-based interventions specifically designed to improve PCC staff wellbeing.

In the initial stages, the SWell project team identified the 鈥榓ctive ingredients鈥� likely to create successful intervention designs, with the aim of the project being to determine the acceptability and feasibility of implementing wellbeing interventions for staff working in PCC in UK hospitals. In total, 14 of the 28 UK PCC units were involved, 104 intervention sessions were run and 573 individuals attended.

鈥淭he significance of healthcare staff wellbeing was brought to the surface during the COVID-19 pandemic, but it鈥檚 a problem that has existed far longer than that,鈥� Shaw said. 鈥淎s far as we could see researchers had focused on measuring the extent of the problem rather than coming up with possible solutions.鈥�

Australian context

The SWell project researchers point out that there is a paucity of research examining PCC staff鈥檚 own perceptions of workplace wellbeing, though an Australian study is a notable exception.

With Crowe as lead author, this study 鈥� published in in 2023 鈥� was set in four paediatric intensive care units (PICU) in Australia and found that PICU staff identified threats to their wellbeing, including: feeling under-prepared for the role, distress associated with 鈥榣ingering鈥� cases, non-accidental injuries and the feeling of isolation due to being unable to share their distress with others.

Twenty staff were recruited for semi-structured interviews in this Australian study, the participants consisting of nine senior physicians, eight registered nurses and three allied health professionals whose time working in PICU ranged from 16 months to 36 years 鈥� though most (15) had worked in PICU for more than eight years.

The study concludes: strategies that enhance PICU work 鈥渁s meaningful and stimulating, promote a sense of belonging to the team, and support the use of humour, may assist health professionals to achieve a balance between risk and protective factors for wellbeing鈥�.

You can read a preview of聽Dr Crowe聽et al.鈥檚 鈥楩actors that may threaten or protect the wellbeing of staff working in paediatric intensive care environments鈥� at ; while Dr Crowe鈥檚 2022 PhD thesis聽鈥� 鈥楿nderstanding the risk and protective factors for burnout and wellbeing of staff working in the Paediatric Intensive Care Unit: PICU staff wellbeing鈥櫬� 鈥斅爃as been published open access in UQ鈥檚 eSpace and you can read it at .

Sessions

The two sessions were called 鈥榃ellbeing Images鈥� and 鈥楳ad-Sad-Glad鈥�.

Wellbeing Images

In 鈥榃ellbeing Images鈥�, images representing wellbeing are shown to a small group of staff, with a facilitated discussion using appreciative inquiry, which is a way of structuring discussions to create positive change in a system or situation by focusing on what works well, rather than what is wrong.

Mad-Sad-Glad

鈥楳ad-Sad-Glad鈥� is another small group reflective session; here, participants explore what makes them feel mad, sad and glad, and identify positive actions to resolve any issues raised.

Key ingredients

Social support, self-belief, and feedback and monitoring are the key ingredients in both sessions:

• social support involves providing a psychologically safe space where sensitive experiences and emotions can be shared without judgement, providing support for each other.
• self-belief involves boosting staff鈥檚 self-confidence and ability to identify and express their emotions in response to work; and
• feedback and monitoring encourages staff to monitor when they experience challenging emotions, what increases their stress and what might help boost their wellbeing in those scenarios.

Feedback

The project received high satisfaction and feasibility ratings, with feedback from staff both participating in and running the SWell interventions being very positive.

鈥淲e were relatively new to implementing wellbeing initiatives, but we recognised the need for measures to be put in place for an improvement in staff wellbeing, as staff had described burnout, stress and poor mood,鈥� said Donna Austin, an advanced critical care practitioner at University 黑料吃瓜群网 Southampton .

鈥淪Well has enabled our unit to become more acutely aware of the needs of the workforce and adapt what we deliver to suit the needs of the staff where possible. Staff morale and retention has been the greatest outcomes from us participating in the SWell study and ongoing SWell-related interventions.鈥�

One hospital staff member responsible for delivering the sessions said: 鈥淥ur staff engaged really well, and it created a buzz around the unit with members of the team asking if they could be 鈥榮welled' on shift. A really positive experience and we are keeping it as part of our staff wellbeing package.鈥�

Conclusions

The project concluded that it is feasible to deliver SWell sessions even on busy PCC units. In addition, staff wellbeing and depression scores improved following the sessions, indicating their likely positive impact on staff聽鈥� though further evaluations are needed to determine whether positive changes can be sustained over time following the SWell sessions.

鈥淭he SWell project was initiated to understand the challenges to wellbeing when working in paediatric critical care,鈥� Shaw explained, 鈥渢o determine what staff in that high-pressure environment need, and what could actually work day-to-day to make a difference.

鈥淪eeing PCC staff across half the paediatric critical care units in the UK show such enthusiasm and commitment to make the SWell interventions a success has been one of the proudest experiences in my academic career to date.鈥�

鈥楤uilding evidence-based interventions to improve staff well-being in paediatric critical care using the behaviour change wheel鈥�, a 2025 paper about the SWell interventions involving 14 of the UK鈥檚 28 PCC units, has been published open access and聽you can read it at . Resources and further information on the SWell is available at .

If you are affected by any of the issues discussed in this article, help is available. Beyond Blue has a 24/7 support service, please call聽1300 224 636.

Image credit: iStock.com/Inside Creative House