Article Text

other Versions

Download PDFPDF
Psychological impact of working in paediatric intensive care. A UK-wide prevalence study
  1. Gareth A L Jones1,
  2. Gillian A Colville2,
  3. Padmanabhan Ramnarayan3,
  4. Kerry Woolfall4,
  5. Yvonne Heward5,
  6. Rachael Morrison5,
  7. Amy Savage6,
  8. James Fraser7,
  9. Michael J Griksaitis8,
  10. David P Inwald9
  1. 1Faculty of Medicine, Imperial College London, London, UK
  2. 2Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
  3. 3Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Trust, London, UK
  4. 4Institute of Psychology, University of Liverpool, Liverpool, UK
  5. 5Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  6. 6Child Clinical Psychology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  7. 7Paediatric Intensive Care Unit, Bristol Children's Hospital, Bristol, UK
  8. 8Paediatric Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  9. 9Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr David P Inwald, PICU, Imperial College Healthcare NHS Trust, London W2 1NY, UK; d.inwald{at}


Objective To determine the prevalence of work-related psychological distress in staff working in UK paediatric intensive care units (PICU).

Design Online (Qualtrics) staff questionnaire, conducted April to May 2018.

Setting Staff working in 29 PICUs and 10 PICU transport services were invited to participate.

Participants 1656 staff completed the survey: 1194 nurses, 270 physicians and 192 others. 234 (14%) respondents were male. Median age was 35 (IQR 28–44).

Main outcome measures The Moral Distress Scale-Revised (MDS-R) was used to look at moral distress, the abbreviated Maslach Burnout Inventory to examine the depersonalisation and emotional exhaustion domains of burnout, and the Trauma Screening Questionnaire (TSQ) to assess risk of post-traumatic stress disorder (PTSD).

Results 435/1194 (36%) nurses, 48/270 (18%) physicians and 19/192 (10%) other staff scored above the study threshold for moral distress (≥90 on MDS-R) (χ2 test, p<0.00001). 594/1194 (50%) nurses, 99/270 (37%) physicians and 86/192 (45%) other staff had high burnout scores (χ2 test, p=0.0004). 366/1194 (31%) nurses, 42/270 (16%) physicians and 21/192 (11%) other staff scored at risk for PTSD (χ2 test, p<0.00001). Junior nurses were at highest risk of moral distress and PTSD, and junior doctors of burnout. Larger unit size was associated with higher MDS-R, burnout and TSQ scores.

Conclusions These results suggest that UK PICU staff are experiencing work-related distress. Further studies are needed to understand causation and to develop strategies for prevention and treatment.

  • intensive care
  • paediatric staffing
  • burnout
  • post traumatic stress
  • moral distress

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @MJGriksaitis, @dlawni

  • Contributors GALJ contributed to the literature search, study design, data collection, data analysis, data interpretation and writing. GAC contributed to the literature search, data analysis, data interpretation and writing. PR and KW contributed to data analysis, data interpretation and writing. YH, RM and AS contributed to data interpretation and writing. JF and MJG contributed to study design, data interpretation and writing. All authors have seen and approved the final manuscript.

  • Funding The investigation was funded by a grant from the Paediatric Intensive Care Society, UK. GALJ was funded by the NIHR Academic Clinical Fellowship scheme.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was registered with the HRA and received research ethics committee approval (IRAS: 218720, HRA REC: 17/HRA/0192).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.