Interventions in included documents

Jill Maben; Cath Taylor; Justin Jagosh; Daniele Carrieri; Simon Briscoe; Naomi Klepacz; Karen Mattick

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Maben J, Taylor C, Jagosh J, et al. Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review. Southampton (UK): National Institute for Health and Care Research; 2024 Apr. (Health and Social Care Delivery Research, No. 12.09.)

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Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review.

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Appendix 8Interventions in included documents

TABLE 26

Empirical evaluations of interventions: characteristics

Citation	Professional group N/M/P	Intervention(s) (description)	Target: primary/secondary/tertiary or multifocal	Formal/informal	Single/programme (or multiple interventions)
Anderson ¹⁴⁴	N (critical care)	Mindfulness-based stress reduction (MBSR)	Secondary	Formal	Single
Stacey ¹²⁷	N (newly qualified)	Resilience-based clinical supervision with compassion focused therapy (in addition to standard preceptorship)	Multifocal (primary and secondary)	Formal	Single
Whiting ¹¹⁰	N (children’s palliative care)	CPD/Career Progression Programme for Children’s Palliative Care Nurses London (CHaL) comprising Mary Seacole Leadership and Action Learning Sets (ALSs) 6-month programme for senior nurses	Primary	Formal	Programme
Younge ¹¹⁸	N (inflammatory bowel CNSs)	CBT-based clinical supervision for inflammatory bowel disease clinical nurse specialists	Multifocal (primary and secondary)	Formal	Single
O’Neill ⁷⁸	N (liaison psychiatry)	Psychologist-facilitated reflective practice groups (liaison psychiatry nurses)	Secondary	Formal	Single
Delaney ¹⁶⁴	N (all/mixed)	Mindful self-compassion training	Secondary	Formal	Single
Jackson ⁷³	N (newly qualified)	Facilitated peer support within preceptorship programme	Multifocal (primary and secondary)	Formal	Programme
Slade ¹⁰³	M – all	POPPY (PTSD prevention training) for midwives	Multifocal (secondary and tertiary)	Formal	Programme
Warriner ¹⁰⁸	M – all	Mindfulness training	Secondary	Formal	Single
Wain ¹⁷⁵	M (newly qualified)	Preceptorship programme	Multifocal (primary and secondary)	Formal	Programme

TABLE 27

Commentary/editorials: recommended interventions

Citation	Professional group N/M/P	Intervention(s) (description), primary/secondary/tertiary/multifocal	Target: primary/secondary/tertiary/multifocal	Formal/informal/both	Number of interventions
Cedar ⁹⁶	N (end of life)	Primary: chaplaincy service; creating positive workplace culture; positive role models Secondary: exercise; hobbies/interest outside work; diet and nutrition; sleep; mindfulness; yoga/meditation Multifocal: Schwartz Rounds	Multifocal	Both	10
Best ⁸¹	N (all)	Primary: creating positive workplace culture, mentorship Secondary: mindfulness practice; talking with colleagues/peer support	Multifocal	Both	4
Dunlop ¹¹⁹	N (children’s N in rural/remote community locations)	Primary: community of practice clinical network	Primary	Formal	1
Bosanquet ⁸⁷	N (all)	Primary: Buurtzorg; creating positive workplace culture; Secondary: space and time to care for self/self-compassion; mindfulness practice; reflective practice; cultivate/encourage positive beliefs/coping; team culture/relationships with colleagues; access to safe confidential spaces. Tertiary: telephone support line Multifocal: clinical supervision	Multifocal	Both	10
Byrne ¹⁵¹	M (all)	Primary: leadership training	Primary	Informal	1
Warwick ¹⁵⁵	M (all)	Primary: safe staffing monitor and planning; remove pay cap/restraints; ensure student bursary remains	Primary	Formal	3
Clarke ¹⁵⁸	M (all)	Primary: social/professional networks and support Secondary: space/time to care for self; exercise; hobbies/interest outside work; diet/nutrition; breaks/holidays; self-care herbal remedies/massage; stress-management/coping; positive beliefs/coping; talking to family/friends;	Multifocal	Informal	10
Copp ⁹¹	M (all)	Secondary: stress-management training Tertiary: talking therapies; complementary therapies	Multifocal	Formal	3
Winter ¹²⁰	M (all)	Primary: manager/employee training to recognise early signs Tertiary: CBT/ACT	Multifocal	Both	2
Axcell ¹⁰¹	M (all)	Primary: systemic approach to well-being Secondary: team culture/relationship with colleagues	Multifocal	Informal	2
Barker ¹⁵⁶	M (all)	Primary: NHS acknowledge/take responsibility; Secondary: space/time to care for self/others; cultivate positive beliefs/coping; learn to say ‘no’/boundaries; talk with colleagues/peer support; Multifocal: clinical supervision	Multifocal	Both	6
Barker ¹⁶⁸	M (all)	Secondary: Lego as art therapy	Secondary	Informal	1
Anonymous ¹¹⁶	M (all)	Primary: mentorship Secondary: team culture/relationships with colleagues	Multifocal	Both	2
Barker ¹⁴⁸	M (all)	Primary: leadership training; positive role models Multifocal: clinical supervision	Multifocal	Both	2
Leversidge ¹⁵⁷	M (all)	Primary: RCN Caring for You campaign	Primary	Formal	1
Mendes ⁷⁹	P (all)	Primary: implicit bias training	Primary	Formal	1
Mendes ¹⁶⁶	P (all)	Secondary: NHS in Mind; Calm App; Headspace App; talking to family/friends Tertiary: telephone support line	Multifocal	Both	5
Daubney ¹⁶⁹	P (all)	Secondary: humour	Secondary	Informal	1
Smith ²²⁹	P (all)	Secondary: reflective practice	Secondary	Informal	1
Mildenhall ⁸⁰	P (all)	Secondary: debriefs; talking to family/friends	Secondary	Both	2
Daubney ³³	P (all)	Secondary: TRiM; humour	Secondary	Both	2
Mendes ¹⁰⁵	P (all)	Primary: Assault on Emergency Workers Bill; World Suicide Prevention Day Secondary: debriefs; exercise	Multifocal	Both	4
Johnston ¹⁰⁹	P (all)	Tertiary: counselling; SWAST Staying Well Service	Tertiary	Formal	2
Gilroy ¹¹⁴	P (all)	Primary: NHS England Healthy Workforce Framework; manager/employee training to recognise early signs; mental health awareness for family, friends, loved ones Secondary: Road to Mental Readiness Programme Tertiary: EMDR Multifocal: Blue Light Programme	Multifocal	Both	6
Paranjape ¹³¹	P (all)	Primary: public showing kindness and compassion	Primary	Informal	1
Paranjape ¹²⁴	P (all)	Secondary: reflective practice Tertiary: counselling	Multifocal	Both	2
Peate ²⁸⁸	General workforce	Primary: World Mental Health Day	Primary	Formal	1
Sibson ²⁸⁹	Emergency care workforce	Primary: mentorship Secondary: debriefs; talking with colleagues/peer support Multifocal: clinical supervision; Blue Light Programme	Multifocal	Both	5
Quaile ⁹⁵	Ambulance staff	Primary: tackle retirement barriers. Secondary: talking with colleagues/peer support Tertiary: counselling Multifocal: Blue Light Programme; TASC	Multifocal	Both	5
TOTALS			Multifocal: 16 Primary: 7 Secondary: 5 Tertiary: 1	Formal: 7 Informal: 7 Both: 15	Range 1–10 (Mean 3.3)

TABLE 28

Interventions in the included literature reviews

Citation	Profession	Type of review	Focus of review	Intervention(s) (number of included papers), primary/secondary/multifocal	Target: primary/secondary/tertiary or multifocal	Formal/informal/both	Evaluated or emergent finding?
Brand ³¹	Whole NHS	Systematic review	Whole systems approaches/interventions	Primary: implement Boorman whole system changes; collaborative care model; Secondary: mindfulness; exercise; diet/nutrition; Multifocal: NHS workplace well-being intervention; Workplace Social Capital Intervention	Multifocal	Formal	Evaluation
Albendin-Garcia ⁸⁶	M (all)		Burnout: Prevalence related factors	Primary: caseload model; leadership (protective)	Primary	Formal	Emergent
Welford ⁷⁷	M (all)		Burnout: factors influencing	Primary: caseload model; tackle retirement barriers; flexible working Multifocal: preceptorship	Multifocal	Formal	Emergent
Bacchus⁹⁰	M (newly qualified)		Factors affecting emotional well-being in newly qualified midwives	Primary: mentorship; positive role models Multifocal: preceptorship	Multifocal	Both	Emergent
Hunter ¹⁶⁵	M (all)		Evaluation of Mindfulness	Secondary: mindfulness	Secondary	Formal	Evaluation
Elliott-Mainwaring ⁸³	M (all)	Systematic narrative review	Impact of power and hierarchy on staff safety	Primary: mandate staff to challenge poor behaviour; introduce minimum standards for working conditions; rotas based on realistic forecasting; learning and education throughout career	Primary	Informal	Emergent
Bresesti ¹⁰⁶	N (neonatal intensive care)		Interventions to reduce occupational stress	Secondary: mindfulness, stress-management training, positive psychology training	Secondary	Formal	Evaluation
Buckley ⁹³	N (paediatric nurses)	Scoping	Scoping review about burnout in paediatric nurses	Secondary: mindfulness; job/role specific workshops Multifocal: clinical supervision	Multifocal	Formal	Emergent
Chanmanga ⁶⁰	N (community)		Recruitment and retention of adult community nurses	NONE
Freeling ⁶¹	N (all)		Presenteeism	NONE
Gribben¹³⁰	N (adult oncology)	Integrative review	Burnout and work-life balance: factors contributing	Primary: positive workplace culture; positive role models; Secondary: talking with colleagues/peer support; team culture/relationships with colleagues	Multifocal	Informal	Emergent
McDermid ²³	N (emergency nurses)		Factors contributing to turnover	NONE
Oates ¹¹¹	N (high secure forensic)	Integrative review	Experiences and implications for recruitment/retention	Primary: tackle retirement barriers; planned time out of setting Secondary: team culture/relationships with colleagues Multifocal: clinical supervision	Multifocal	Both	Emergent
Webster ¹²²	N (all)	Scoping review	Using technology for social and emotional well-being	Secondary: mindfulness; stress-management training; positive psychology training	Secondary	Formal	Evaluation
Aryankhesal ¹⁶²	N (all) – and physicians	Systematic review	Interventions to reduce burnout	Secondary: mindfulness; positive psychology training; communication skill; professional identity development programme; job/role specific workshops; yoga/meditation	Secondary	Both	Evaluation
Hawkins ¹²³	N (newly qualified)	Integrative review	Exposure to negative workplace behaviour	Primary: zero tolerance policies; leadership training	Primary	Both	Emergent
Rajamohan ¹⁵²	N (nursing home)		Relationship between staff and job satisfaction, stress, turnover	Primary: caseload model (person centred care model)	Primary	Formal	Emergent
Stacey ³²	N (all)	Scoping review	Nurse resilience conceptualisation	Primary: mentorship Secondary: resilience training; care provider support programme; yoga/meditation; stress-management techniques;talking to colleagues/peer support Tertiary: CBT/ACT; restorative supervision	Multifocal	Both	Emergent
Yu ¹⁶⁷	N (all)	Systematic Review	Personal and work-related factors associated with resilience	Secondary: coping skills; social support	Secondary	Informal	Emergent
Cummings ¹²⁹	N (all)	Systematic review	Leadership styles and outcomes	Primary: leadership training	Primary	Informal	Emergent
Foster ¹¹²	N (mental health)	Scoping review	Interventions to support coping with stressful work environments	Secondary: mindfulness; stress-management; resilience training; communication skills; Tertiary: CBT/ACT Multifocal: clinical supervision	Multifocal	Formal	Evaluation
Ejebu ⁶²	N (all)	Scoping review	Experiences and preferences about shift patterns	NONE
Barleycorn ⁹⁸	N (emergency nursing)		Awareness of secondary traumatic stress	Primary: leadership training; manager/employee training to recognise early signs Secondary: exercise; diet/nutrition; sleep; learn to say no/boundaries; time-out/downtime; talking with colleagues/peer support	Multifocal	Informal	Emergent
Dodd ³⁵	P (ambulance service – all)		PTSD	Primary: chaplaincy service; manager/employee training to recognise early signs Secondary: TRiM; talking with colleagues/peer support; space/time for self-care Multifocal: Blue Light Programme; Beyond Blue	Multifocal	Both	Emergent
Anderson ⁹⁴	P (all)		Impact of shift work on family system	Primary: flexible working/plan own workload; mental health awareness for family/friends Multifocal: clinical supervision	Multifocal	Both	Emergent
Lancaster ¹⁰⁷	P (ambulance service – all)		Use of humour	Secondary: humour	Secondary	Informal	Emergent
Brooks ²¹	P (ambulance – all)		Predictors of PTSD	NONE
Clark ²²	P (ambulance – all)		Interventions for UK ambulance service staff	Primary: mindfulness; humour; coaching; Tertiary: CBT/ACT; EMDR; complementary therapies Multifocal: Blue Light Programme;	Multifocal	Formal	Evaluation
Auth ¹⁸	P (emergency service staff)	Qualitative evidence synthesis	Mental health and help seeking in trauma-exposed emergency service staff	Primary: regular work partner; Secondary: exercise; TRiM; humour; time out/downtime; talking to friends/family; talking with colleagues/peer support; managers checking in Tertiary: telephone support line Multifocal: Schwartz Rounds	Multifocal	Both	Emergent

This work was produced by Maben et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.

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Maben J, Taylor C, Jagosh J, et al. Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review. Southampton (UK): National Institute for Health and Care Research; 2024 Apr. (Health and Social Care Delivery Research, No. 12.09.) Appendix 8, Interventions in included documents.
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