Challenges to well‐being in critical care

Background Paediatric critical care (PCC) is a high‐pressure working environment. Staff experience high levels of burnout, symptoms of post‐traumatic stress, and moral distress. Aim To understand challenges to workplace well‐being in PCC to help inform the development of staff interventions to improve and maintain well‐being. Study Design The 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. Results Themes 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. Conclusions Staff'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 Practice Well‐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.