Understanding Challenges to Wellbeing among Medical and Nursing Staff Working in Paediatric Critical Care: An Enhanced Critical Incident Technique Study

ABSTRACT

BACKGROUND AND AIM: Staff working in paediatric critical care (PCC) experience high levels of burnout, compassion fatigue and symptoms of post-traumatic stress. We aimed to identify critical incidents inside or outside work which challenged staff's wellbeing, what hindered and helped;to identify successful strategies for maintaining workplace wellbeing. METHOD(S) Using the Enhanced Critical Incident Technique, individuals were asked to reflect on situations which challenged their wellbeing and to provide wish list items that would improve their workplace wellbeing RESULTS: Seven themes were identified (n=53) Covid-19 represented a significant challenge to wellbeing, yet it stimulated positive conversations about vulnerability. Shiftwork was experienced as challenging, especially with an Ageing workforce. Being older though brought self-awareness of one's limits and successful wellbeing strategies. Clinical investigations were distressing, sometimes worsened by opaque procedures. Yet support from seniors was available and highly valued. Frustration with Leadership was expressed, but PCC were described as quick to innovate and act. Patient outcomes sometimes led to moral distress, but news about patients' successes post discharge was rewarding. Facilities were described as unsatisfactory, except for some well-maintained quiet spaces. Finally, personal circumstances (e.g. bereavement, relationship breakdown) impacted staff's ability to work productively, but friends and family provided much-needed respite. Wishlist items included self-rostering, recognising the impact of ageing and menopause, transparent investigation protocols, psychological support, communication training, comfortable spaces. CONCLUSION(S) Threats to wellbeing are multifaceted, but largely predictable. Knowing this, we need to develop protocols, support packages, and training to better equip staff to manage wellbeing prior to crisis.