Health & Medical intensive care

Promoting Staff Resilience in the Pediatric Intensive Care Unit

´╗┐Promoting Staff Resilience in the Pediatric Intensive Care Unit

Abstract and Introduction


Background Health care professionals experience workplace stress, which may lead to impaired physical and mental health, job turnover, and burnout. Resilience allows people to handle stress positively. Little research is aimed at finding interventions to improve resilience in health care professionals.

Objective To describe the availability, use, and helpfulness of resilience-promoting resources and identify an intervention to implement across multiple pediatric intensive care units.

Methods A descriptive study collecting data on availability, utilization, and impact of resilience resources from leadership teams and individual staff members in pediatric intensive care units, along with resilience scores and teamwork climate scores.

Results Leadership teams from 20 pediatric intensive care units completed the leadership survey. Individual surveys were completed by 1066 staff members (51% response rate). The 2 most used and impactful resources were 1-on-1 discussions with colleagues and informal social interactions with colleagues out of the hospital. Other resources (taking a break from stressful patients, being relieved of duty after your patient's death, palliative care support for staff, structured social activities out of hospital, and Schwartz Center rounds) were highly impactful but underused. Utilization and impact of resources differed significantly between professions, between those with higher versus lower resilience, and between individuals in units with low versus high teamwork climate.

Conclusions Institutions could facilitate access to peer discussions and social interactions to promote resilience. Highly impactful resources with low utilization could be targets for improved access. Differences in utilization and impact between groups suggest that varied interventions would be necessary to reach all individuals


Health care professionals (HCPs) experience significant workplace stress from a variety of sources. In pediatric intensive care units (PICUs), stress may result from intense skill set requirements, ethical dilemmas, caring for families who are under stress, caring for children who are suffering or dying, working with limited resources, challenging interpersonal relationships, and patient safety concerns. When serious safety events occur, HCPs are often unrecognized "second victims." They may experience emotional abuse, bullying, intimidation, humiliation, and neglect from coworkers. Finally, disproportional physical stress exists, with injury rates for HCPs at 5.6 per 100 full-time employees, 33% higher than the rate for all of private industry. Such physical stress and pain come with attendant psychological stress. These stressors may lead to negative consequences for PICU staff, including physical symptoms, impaired mental health, compassion fatigue, resignation, job turnover, and burnout.

Some HCPs have an unhealthy response to stressors, but others thrive and succeed. It is unclear why individuals respond to stressors in such different ways. One commonly cited possibility is resilience, an evolving concept that has been developing since the 1800s. Resilience is the ability of an individual to adjust to adversity, maintain equilibrium, retain some sense of control over his or her environment, and continue to move on in a positive manner. Resilience has multiple domains and has developed within numerous areas of study. Debate continues on issues, including the challenge of objective study, the multidimensional nature of resilience, and contrasting models of resilience as a dynamic process that can be modified or developed over a lifespan versus a fixed and unchanging trait.

Despite these challenges, research on resilience has identified personal factors (including self-efficacy, competence, confidence, optimism, and intelligence), environmental factors (including social support and a sense of connectedness), and learned behaviors such as self-reflection that strongly correlate with resilient outcomes. Contemporary, validated tools for assessing resilience have been created.

High resilience correlates with lower levels of burnout, depression, and anxiety in ICU nurses, and building resilience has been advocated as a method for nurses to cope with occupational stress. To the extent that positive change can be effected, the costs of burnout, lost work hours, staff turnover, and impaired recruiting of newcomers is operationally wasteful, clinically harmful, and professionally unconscionable.
Physical stress injury rates among health care providers are 33% higher than rates for all of private industry.
Using the theoretical framework from Jackson et al, which views resilience as an active process that can be developed and that, when strengthened, can diminish vulnerability to the negative impact of adversity in the workplace, little research has been aimed at finding effective and feasible ways to modify resilience in HCPs. Most published reports propose interventions that are vague, have limited outcome measures, or are resource-intensive. In a systematic review of 19 studies aimed at reducing occupational stress in HCPs, researchers concluded that there was limited evidence of a small but relevant reduction in stress from the studied interventions and that larger and better quality trials were needed.

Given this gap in the literature, we sought to describe the landscape of resilience-promoting resource availability, use, and helpfulness in a large cohort of PICUs with the hope of identifying an intervention that could later be implemented across multiple PICUs and assessed for efficacy. We also aimed to obtain baseline measurements of staff members' resilience in anticipation of such a future prospective intervention.

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