Simple sessions for PCC staff wellbeing

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.

“It has never been more critical to understand what threatens and protects the wellbeing of health care professionals who work in critical care,” Dr Liz Crowe et al. from The University of Queensland’s Centre for Health Services Research wrote in a 2023 study on the subject; Crowe’s 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 (SWell) project — in collaboration with Birmingham Children’s Hospital and NHS England — has developed two simple, low-resource wellbeing sessions that can be delivered by staff for staff without specialist training; the results of which were published this year in Nursing in Critical Care.

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 that PCC staff have higher levels of burnout, post-traumatic stress and moral distress than 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’s Institute of Health and Neurodevelopment 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 ‘active ingredients’ 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.

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

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Australian context

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

With Crowe as lead author, this study — published in Intensive and Critical Care Nursing in 2023 — 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 ‘lingering’ 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 — though most (15) had worked in PICU for more than eight years.

The study concludes: strategies that enhance PICU work “as 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”.

You can read a preview of Dr Crowe et al.’s ‘Factors that may threaten or protect the wellbeing of staff working in paediatric intensive care environments’ at doi.org/10.1016/j.iccn.2023.103476; while Dr Crowe’s 2022 PhD thesis — ‘Understanding the risk and protective factors for burnout and wellbeing of staff working in the Paediatric Intensive Care Unit: PICU staff wellbeing’  — has been published open access in UQ’s eSpace and you can read it at doi.org/10.14264/d6cde7e.

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Sessions

The two sessions were called ‘Wellbeing Images’ and ‘Mad-Sad-Glad’.

Wellbeing Images

In ‘Wellbeing Images’, 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

‘Mad-Sad-Glad’ 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’s 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.

“We 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,” said Donna Austin, an advanced critical care practitioner at University Hospital Southampton paediatric intensive care unit.

“SWell 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.”

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

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 — though further evaluations are needed to determine whether positive changes can be sustained over time following the SWell sessions.

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

“Seeing 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.”

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‘Building evidence-based interventions to improve staff well-being in paediatric critical care using the behaviour change wheel’, a 2025 paper about the SWell interventions involving 14 of the UK’s 28 PCC units, has been published open access and you can read it at doi.org/10.1111/nicc.13228. Resources and further information on the SWell is available at www.swell-staff.com.

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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 1300 224 636.

Image credit: iStock.com/Inside Creative House