Mapping interventions to causes

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 9Mapping interventions to causes

TABLE 29

Mapping interventions to causes

Risk factors for work-related stress (HSE Management Standards*)	Specific ‘cause’	Interventions: formal	Interventions: informal
	N/M/P causes	Interventions: formal	Interventions: informal
Demands (workload, work patterns, work environment)	Staff shortages and high attrition	Primary All of the systems/healthcare models are aimed at attracting and retaining staff Tackling retirement barriers may help with retention Removing pay cap/restraints/ensuring student bursary remains	Primary Creating a supportive positive workplace culture
	Pressure of work in service in which demand continues to increase/unmanageable workload	Primary Safe staffing monitor and planning	Primary Working conditions: minimum standards and delay and develop alternative roles Planned time out of setting
	Working long shifts with no/few breaks	Secondary Stress-management training Safe staffing monitor and planning	Primary Working conditions: minimum standards/rotas based on realistic forecasting
			Secondary Time out/downtime
	Inadequate work-life balance	Primary Adoption of WLB core standards	Take regular breaks/holidays from work Learn to say no/set boundaries
	Serve and sacrifice	Multifocal Schwartz Rounds	Policy for managing stress/staff mental health with action plan and strategy for implementation Learn to say no/set boundaries Take regular breaks/holidays from work Interests/hobbies outside of work Time out/downtime
	Exposure to repeated episodes of trauma	Secondary All psychosocial interventions, education, PTSD prevention, group reflection/debriefs Tertiary All tertiary interventions Multifocal	Chaplaincy service Rapid access referral pathways Learning and education (re: mental health) throughout career
		Schwartz Rounds Blue Light Programme Beyond Blue TASC	Manager/employee training in recognising early signs Mental health awareness for family/friends Support managers emotional well-being/needs Social/professional networks and suppor
			Secondary All stress-management All social support
	Experiencing death	Same as above	Same as above
	Prolonged/cumulative stress	All psychosocial interventions, education Schwartz Rounds	Same as above
	Emotional labour
	Profession-specific causes (potentially)
	Working on-call
	Lack of continuity of care
	Unnecessary call-outs
	Heavy cognitive load/rapid decisions	Secondary: stress-management	Secondary: stress-management
	High risk of sustaining injury
	Being a profession under scrutiny
Control (how much say in the way you work)	Lack of control/autonomy	Primary: Systems/healthcare models – Buurtzorg, Magnet, Caseload
Support (encouragement, sponsorship and resources provided by org, line managers and colleagues)	Not feeling supported/valued	Mentorship Leadership	Positive role models Mentoring/leadership
	Stigma	Frameworks/toolkits/standards to make mental health central to strategy and policy	NHS acknowledging/taking responsibility for role in supporting staff well-being Creating a supportive/positive workplace culture Systemic approach to well-being Chaplaincy service
	Not having space/time to debrief after trauma or having inappropriate support	TRiM #weCARE café Tea and empathy group	Space/time to care for self/others Access to safe confidential spaces for socialising, sharing and discussing experiences Managers checking in
	Not having basic ‘hygiene’ needs met	Wellness Intervention Time to Drink/Out of hours food initiatives	Essential needs met Basic needs being met at work
	Profession-specific causes (potentially)
	Lone working	Community of practice clinical networks
Relationships (promoting positive working to avoid conflict; dealing with unacceptable behaviour)	Poor relationships with colleagues/incivility/bullying	Primary Zero tolerance policies Implicit bias training Teamwork and QI initiatives	Primary Mandate staff to challenge poor behaviour Having a regular work partner/team stability
	Challenging relationships with patients, public, clients	Secondary Communication skills training
	Not feeling able to speak out	Leadership NHS Health and Wellbeing Framework (Wellbeing Guardians and FTSUG)
	Profession-specific causes (potentially)
	Fear of assault/abuse from public/patients
Role (clarity, not conflicting)	Transition shock/Reality shock (newly qualified)	Preceptorship programmes
	Values incongruence/theory-practice gap; moral distress
	Unclear role boundaries/clarity	Clinical supervision
	Role intensity	Job/role specific workshops
Change (organisational change management and communication)	Not being involved in change
Other risk factors
WHO?	Ageing population	Tackling retirement barriers
	Gender
	Ethnicity	Zero tolerance; implicit bias training; EDI projects
	Sexual orientation/gender identity	Zero tolerance; implicit bias training; Rainbow Badge and EDI projects.
	Disability	Zero tolerance; implicit bias training
WORK CONDITIONS	Pay	Remove pay caps/restraints; ensure student bursary remains
	Promotion opportunities
ROLE/TYPE OF JOB	Newly qualified	Preceptorship programmes
	Leaders		Support managers emotional wellbeing/needs
	Working in orphan specialties
	Working with high-risk patient groups
WHEN	After trauma exposure	As per above exposure to trauma/death/cumulative stress POPPY	As per above exposure to trauma/death/cumulative stress
	When under investigation/during complaints

: KEY: Red, No/few interventions/much evidence needed; yellow, some interventions/more evidence needed; green, some interventions/good evidence.

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 9, Mapping interventions to causes.
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Appendix 9Mapping interventions to causes

TABLE 29

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