Care Under Pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics (4 April 2024)

Summary

Nurses, midwives and paramedics make up over half of the healthcare workforce in the UK National Health Service and have some of the highest prevalence of mental ill health. This study in BMJ Quality & Safety explored why mental ill health is a growing problem and how we might change this. The authors identified the following key themes:

1. It is difficult to promote staff psychological wellness where there is a blame culture
2. The needs of the system often over-ride staff psychological well-being at work
3. There are unintended personal costs of upholding and implementing values at work
4. Interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors
5. It is challenging to design, identify and implement interventions.

They suggest that healthcare organisations need to rebalance the working environment to enable healthcare professionals to recover and thrive. This requires:

• high standards for patient care to be balanced with high standards for staff mental well-being.
• professional accountability to be balanced with having a listening, learning culture.
• reactive responsive interventions to be balanced by having proactive preventative interventions
• the individual focus balanced by an organisational focus.

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