Mental workload levels and influencing factors among ICU nurses: A systematic review

Abstract

Nursing in intensive care units (ICUs) represents one of the most demanding roles within the healthcare system. ICU nurses operate in high-pressure environments where rapid decision-making, technological proficiency, and emotional resilience are critical. The elevated mental workload associated with these roles is driven by factors such as high patient acuity, complex decision-making under pressure, technological demands, and environmental stressors. These challenges are compounded by staffing shortages and extended work shifts, which exacerbate cognitive fatigue and emotional exhaustion. If left unaddressed, the mental workload of ICU nurses can lead to burnout, reduced job performance, and compromised patient safety. Studies have revealed that mental fatigue increases nursing errors by 30 to 50%, directly impacting patient outcomes. Moreover, overburdened ICUs have been shown to have a 15% higher patient mortality rate than adequately staffed units do, underscoring the critical importance of addressing this issue. This paper examines the multifaceted contributors to mental workload in ICU settings, including high patient acuity, frequent decision-making under time constraints, and the cognitive demands of managing advanced medical technologies. The paper also explores organizational stressors, such as high noise levels and emotional interactions with patients' families, which further strain nurses’ mental and emotional capacities. Additionally, it highlights the cyclical nature of staffing shortages and burnout, where increased workload leads to increased turnover, further compounding the challenges faced by ICU teams. This paper underscores the need for healthcare systems to prioritize interventions that reduce mental workload, increase resilience, and foster supportive environments. By doing so, they can improve patient outcomes, safeguard nurses’ well-being, and ensure the sustainability of ICU care in the face of growing demands.