Fostering positive emotions, psychological well-being, and productive relationships in the intensive care unit: A before-and-after study

Published:September 13, 2022DOI:



      Intensive care units (ICUs) are emotionally demanding workplaces. Exposure to stress can negatively impact ICU staff members' emotional resilience, health, and capacity to provide care. Despite recognition of the benefits of promoting “healthy workplaces”, there are limited interventional studies aimed at improving the well-being of ICU staff.


      The aim of this study was to assess the effectiveness of a multifaceted intervention for improving well-being of staff working in a tertiary ICU.


      A before-and-after interventional study was conducted over a 2-year period, between 2019 and 2021. Interventions included social activities, fitness, nutrition, and emotional support. An electronic version of the PERMA-Profiler questionnaire was used to assess the well-being of a convenience sample of ICU staff before (n = 96) and after (n = 137) the intervention. Ten focus groups (each involving 12–18 nurses) were held to explore nurses' perceptions of the intervention's effectiveness.


      After the intervention, a significantly greater proportion of participants described their work week as draining (32% vs 19%, χ2 = 4.4 df + 1, P = 0.03) and at least a bit harder than normal (38% vs 22%, χ2 = 6.4 df + 1, p = 0.01) compared to baseline surveys. However, well-being scores after the intervention (mean = 6.95, standard deviation = 1.28) were not statistically different (p = 0.68) from baseline scores (mean = 7.02, standard deviation = 1.29). Analysis of focus groups data revealed three key categories: boosting morale and fostering togetherness, supporting staff, and barriers to well-being.


      After the intervention, there was a preserved level of well-being from baseline despite a statistically significant increase in staff reporting the work week as draining and at least a little bit harder than normal. These findings must be considered in light of the COVID-19 pandemic, which started after baseline data collection and continues to impact the community, including staff workload and pressures in intensive care. The study findings may inform strategies for improving ICU staff members' well-being.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Australian Critical Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Van Mol M.C.
        • Nijkamp M.D.
        • Bakker J.
        • Schaufeli W.B.
        • Kompanje J.O.
        Counterbalancing work-related stress? Work engagement among intensive care professionals.
        Aust Crit Care. 2018; 31: 234-241
        • Azarsa T.
        • Davoodi A.
        • Khorami Markani A.
        • Gahramanian A.
        • Vargaeei A.
        Spiritual well-being, attitude toward spiritual care and its relationship with spiritual care competence among critical care nurses.
        J Caring Sci. 2015; 4: 309-320
        • Bourgault P.
        • Lavoie S.
        • Paul-Savoie E.
        • Gregoire M.
        • Michaud C.
        • Gosselin E.
        • et al.
        Relationship between empathy and well-being among emergency nurses.
        Journal of Emergancy Nursing. 2015; 41: 323-328
        • Galletta M.
        • Portoghese I.
        • Coppola R.C.
        • Finco G.
        • Campagna M.
        Nurses well-being in intensive care units: study of factors promoting team commitment.
        Nurs Crit Care. 2016; 21: 146-156
        • Rippstein-Leuenberger K.
        • Mauthner O.
        • Sexton J.
        • Schwendimann R.
        A qualitative analysis of the Three Good Things intervention in healthcare workers.
        BMJ. 2017; 7: 1-5
        • Shoorideh F.A.
        • Ashktorab T.
        • Yaghmaei F.
        • Alavi Majd H.
        Relationship between ICU nurses' moral distress with burnout and anticipated turnover.
        Nurs Ethics. 2015; 22: 64-76
        • Stewart M.T.
        • Reed S.
        • Reese J.
        • Galligan M.M.
        • Mahan J.D.
        Conceptual models for understanding physician burnout, professional fulfillment, and well-being.
        Curr Probl Pediatr Adolesc Health Care. 2019; 49
        • Health Workforce Australia
        Leadership for the sustainability of the health system: Part 1 - a literature review.
        (Retrieved from)
        • Vahedian-Azimi A.
        • Hajiesmaeili M.
        • Kangasniemi M.
        • Fornes-vives J.
        • Humsucker R.L.
        • Rahiminbashar F.
        • et al.
        Effects of stress on critical care nurses: a national cross-sectional study.
        J Intensive Care Med. 2019; 34: 311-322
        • Unjai S.
        • Forster E.M.
        • Mitchell A.E.
        • Creedy D.K.
        Compassion satisfaction, resilience and passion for work among nurses and physicians working in intensive care units: a mixed method systematic review.
        Intensive Crit Care Nurs. 2022; (103248): 103248
        • Dawson A.J.
        • Stasa H.
        • Roche M.A.
        • Homer C.E.
        • Duffield C.
        Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies.
        BioMed Central Nurse. 2014; 13: 11
        • Makowiecki M.
        • Valentina U.
        • Urbani M.A.
        • Cecchi M.
        • Maielli M.
        • Ardis S.
        Subjective well-being of Italian healthcare professionals during the SARS-CoV-2 outbreak: a quasi-experiment.
        Int J Well-being. 2020; 10: 26-38
        • Moss M.
        • Good V.S.
        • Gozal D.
        • Kleinpell R.
        • Sessler C.N.
        A critical care Societies collaborative statement: burnout syndrome in critical care health-care professionals.
        Am J Respir Crit Care Med. 2016; 194: 106-113
        • Seligman M.E.P.
        • Csikszentmihalyi M.
        Positive psychology: an introduction.
        Am Psychol. 2000; 55 (4): 5
        • Jarden R.J.
        • Sandham M.
        • Siegert R.J.
        • Koziol-McLain J.
        Intensive care nurses' well-being: a systematic review.
        Aust Crit Care. 2020; 33: 106-111
        • Kelly L.A.
        • Johnson K.L.
        • Bay R.C.
        • Todd M.
        Key elements of the critical care work environment associated with burnout and compassion satisfaction.
        Am J Crit Care. 2021; 30: 113-120
        • Seligman M.E.
        Flourish: a visionary new understanding of happiness and well-being.
        Penguin Books, 2011
        • Adams J.M.
        • Zimmermann D.
        • Cipriano P.F.
        • Pappas S.
        • Batcheller J.
        Improving the work life of health care workers: building on nursing's experience.
        Med Care. 2018; 56: 1-3
        • Butler J.
        • Kern M.
        The PERMA-Profiler: a brief multidimensional measure of flourishing.
        Int J Well-being. 2016; 6: 1-48
        • West M.D.
        Employee engagement and NHS performance.
        (Retrieved from)
        • Brand S.L.
        • Coon J.T.
        • Fleming L.E.
        • Carroll L.
        • Bethel A.
        • Wyatt K.
        Whole-system approaches to improving the health and well-being of healthcare workers: asystematic review.
        PLoS One. 2017; 12
        • Brown J.A.
        Healthy workplaces and ethical environments: a staff nurse's perspective.
        Crit Care Nurs Q. 2009; 32: 253
        • Jarden R.J.
        • Sandham M.
        • Siegert R.J.
        • Koziol-McLain J.
        Intensive care nurse conceptions of well-being: a prototype analysis: intensive care nurse conceptions of wellbeing: a prototype analysis.
        Nurs Crit Care. 2018; 23: 324-331
        • Holloway I.
        • Wheeler S.
        Qualitative research in nursing and healthcare.
        Wiley, 2013
        • Davidson J.E.
        • Graham P.
        • Montross-Thomas L.
        • Norcross W.
        • Zerbi G.
        Code lavender: cultivating intentional Acts of kindness in response to stressful work situations.
        Explore. 2017; 13: 181-185
        • Elliott R.
        • Crowe L.
        • Abbenbroek B.
        • Grattan S.
        • Hammond N.E.
        Critical care health professionals' self-reported needs for wellbeing during the COVID-19 pandemic: a thematic analysis of survey responses.
        Aust Crit Care. 2022; 35: 40-45
      1. Adams AMN, Chamberlain D, Giles TM. Understanding how nurse managers see their role in supporting ICU nurse well-being—a case study. J Nurs Manag. 2019;27(7):1512-1521.

        • Galati C.
        • Avard B.
        • Ramsay L.
        Case study of a stepped-care psychological service for healthcare professionals working in critical care.
        Aust Health Rev. 2021; 45: 633-637
        • Bae S.
        Intensive care nurse staffing and nurse outcomes: a systematic review.
        Nurs Crit Care. 2021; 26: 457-466
        • Jarden R.J.
        • Sandham M.
        • Siegert R.J.
        • Koziol-McLain J.
        Strengthening workplace well-being: perceptions of intensive care nurses: strengthening workplace wellbeing: perceptions of intensive care nurses.
        Nurs Crit Care. 2019; 24: 15-23