Factors that impact staff wellbeing in neonatal and paediatric critical care environments

The wellbeing of clinical staff in neonatal and paediatric critical care has become a pressing concern in the post-Covid-19 healthcare environment. These high-intensity settings are marked by emotional demands, workforce strain, and increasing systemic challenges. Since the pandemic, staff have reported rising psychological distress, emotional exhaustion, and attrition, raising questions about the long-term sustainability of this essential workforce. This thesis comprises two interconnected studies exploring factors impacting staff wellbeing and identifying effective support strategies. Study One is a systematic review of 15 studies published since Covid-19, assessing interventions designed to reduce stress and burnout among neonatal and paediatric intensive care staff. Interventions included mobile health apps, debriefing programs, reflective practice groups, educational sessions, and dedicated respite spaces. Most initiatives were individual-focused, rooted in positive psychology, aiming to boost personal traits like gratitude, mindfulness, and emotional regulation. These approaches implicitly framed distress as a failure of internal coping, largely ignoring the organisational and systemic contributors to staff stress. Methodological weaknesses—such as small sample sizes, unvalidated outcomes, and limited follow-up—further undermined the evidence base for intervention effectiveness. Study Two involved qualitative interviews with 15 staff from Irish NICU and PICU units to explore their lived experiences and coping strategies. Thematic analysis revealed six key themes highlighting staff’s deep emotional commitment and professional pride, even amid chronic structural challenges. Participants described feeling motivated and engaged, but hampered by systemic barriers such as understaffing and organisational inflexibility, which limited their ability to provide the care they valued. Peer support, team cohesion, and quiet spaces were cited as vital for emotional recovery. However, many wellbeing programs were seen as superficial and disconnected from the day-to-day realities of care work. Broader issues, like the Irish housing crisis, also contributed to stress through financial strain, housing insecurity, and long commutes, further exacerbating emotional fatigue. Together, these studies reveal a disconnect between current wellbeing supports and staff realities. While Study One showed a reliance on individualised, psychological approaches, Study Two demonstrated that staff distress stems not from lack of resilience but from persistent, unresolved structural challenges. The findings call for a fundamental rethinking of how wellbeing is conceptualised and supported in critical care settings. Rather than more individual-based solutions, what is needed are systemic, co-designed strategies that target root causes of distress and reflect the real-world contexts in which staff operate. Implications include the urgent need to address institutional and socio-economic conditions affecting staff, such as workplace culture, resource allocation, and housing instability. Without systemic reform, rising stress and attrition threaten not only workforce viability but also the quality and safety of care. Supporting critical care staff must go beyond fostering resilience—it requires transforming the systems in which care is delivered.

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