Bai Y, Lin CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004; 55:(9)1055-1057

Covid-19: why compassionate leadership matters in a crisis. 2020. (accessed 1 February 2022)

Barzilay R, Moore TM, Greenberg DM Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers. Transl Psychiatry. 2020; 10:(1)

Caruso CC. Negative impacts of shiftwork and long work hours. Rehabil Nurs. 2014; 39:(1)16-25

Chen Q, Liang M, Li Y Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry. 2020; 7:(4)e15-e16

Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020; 368

Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiol Health. 2020; 42

Johns G. Presenteeism in the workplace: a review and research agenda. Journal of Organizational Behavior. 2010; 31:(4)519-542

Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ. 2020; 369

Lai J, Ma S, Wang Y Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3:(3)

Liu Q, Luo D, Haase JE The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020; 8:(6)e790-e798

Maunder R. The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: lessons learned. Philos Trans R Soc Lond B Biol Sci. 2004; 359:(1447)1117-1125

Mental Health Foundation. Coronavirus: The divergence of mental health experiences during the pandemic. 2022. (accessed 28 January 2022)

Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. A critical care societies collaborative statement: burnout syndrome in critical care health-care professionals. A call for action. Am J Respir Crit Care Med. 2016; 194:(1)106-113

NHS Employers. Commissioning occupational health services. 2019. (accessed 28 January 2022)

Raudenská J, Steinerová V, Javůrková A Occupational burnout syndrome and post-traumatic stress among healthcare professionals during the novel coronavirus disease 2019 (COVID-19) pandemic. Best Prac & Res Clin Anaesthesiol. 2020; 34:(3)553-556

Schäfer SK, Lass-Hennemann J, Groesdonk H Mental health in anesthesiology and icu staff: sense of coherence matters. Front Psychiatry. 2018; 9

Shorter M, Stayt LC. Critical care nurses' experiences of grief in an adult intensive care unit. J Adv Nurs. 2010; 66:(1)159-167

Tam CW, Pang EP, Lam LC, Chiu HF. Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: stress and psychological impact among frontline healthcare workers. Psychol Med. 2004; 34:(7)1197-204

Traynor M. Critical resilience for nurses. An evidence-based guide to survival and change in the modern NHS.Abingdon: Routledge; 2017

Spending on and availability of health care resources: how does the UK compare to other countries?. 2018. (accessed 28 January 2022)

World Health Organization. Psychological first aid: Guide for field workers. 2011. (accessed 28 January 2022)

Wu P, Fang Y, Guan Z The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009; 54:(5)302-311

Xiang YT, Yang Y, Li W Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020; 7:(3)228-229

Evaluating a psychological support service focused on the needs of critical care and theatres staff in the first wave of COVID-19

10 February 2022
Volume 31 · Issue 3



In response to COVID-19, the authors used clinical psychology resources from their hospital's Pain Medicine Department to provide direct support to critical areas.


The degree to which the service met the needs of staff and managers between March and August 2020 was evaluated.


A total of 51 staff were referred. Most were nurses (43%), followed by theatre practitioners (36%), healthcare assistants (9%), consultants (8%), administrative (2%) and support staff (2%). Working status, reason for referral and presenting difficulties at first appointment and outcome were recorded. Staff were sent an anonymous survey following intervention.


Staff reported high rates of burnout, anxiety and low mood, with 22% experiencing exacerbation of pre-existing mental health problems. All staff reported benefit from the intervention and managers provided positive feedback.


Establishing a supportive service that included psychology benefited both staff and managers at the peak of the pandemic. Recommendations are provided.

Intensive care units and theatres are known for high medical complexity and working pressures (Ward and Chijoko, 2018). Since the start of the COVID-19 pandemic, such services were forced to adapt and maintain resilience, in addition to coping with existing pressures. Frontline roles are recognised as being directly associated with chronic illness (Caruso, 2014), including mental health issues, which can adversely affect a health professional's ability to care for patients (Moss et al, 2016).

Research from previous pandemics has shown that working with additional pressures has both a physical and psychological impact on healthcare workers. For example, about 10% of those working in health care during the SARS pandemic had post-traumatic stress symptoms (Wu et al, 2009) and up to 35% experienced emotional distress (Maunder, 2004). Furthermore, during a pandemic there is a risk of staff developing moral injury, which is a term used to describe psychological distress caused by failure to prevent or act in a situation that results in a violation of moral values (Greenberg et al, 2020).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content