Clinical Connections: Time to create a healthy work environment in ICU: a review of current evidence and commentary

Abstract

The intensive care unit (ICU) is a stressful environment for clinicians, patients and patients’ family members. The purpose of this paper is to critically synthesize and discuss recent evidence on: a) the association between the conditions prevailing in ICUs and disturbing psychological responses in clinicians, as well as patients and their family, and b) effective interventions and healthcare policy development towards this goal. A number of studies suggest that prolonged work-related stress is associated with neuro-biological and psychological distress in ICU personnel, which might be severe enough to compromise clinicians’ ability to work and provide proper care. People hospitalized in ICUs, even after discharge, frequently suffer from psychiatric symptoms, and so do their family members. Interventions at an organizational level aiming to support ICU nurses’ professional role within the demands and stressors of the ICU environment are pivotal. Similarly, prospective studies to support the implementation of evidence-based strategies are also needed. Overall, reformation of occupational health policies is obligatory. At the same time, approaches aiming to support ICU clinicians at an individual level, including training and education, such as development of stress-management skills, and coping with the stressors, such as enhancement of resilience, physical strength or taking time away from work, although valuable, they do not make the work-environment less toxic.