Work Environment, Workload, and Mental Health Among Healthcare Staff in Critical Care Settings: A Systematic Review

Abstract

Critical care settings such as intensive care units, emergency departments, anesthesia units, and crisis-response hospital wards expose healthcare staff to high task density, moral pressure, unpredictable clinical events, and emotionally demanding encounters with patients and families. These conditions can affect staff mental health, quality of life, professional functioning, and patient safety. This systematic review synthesizes evidence on the relationship between the work environment, workload, and mental health outcomes among healthcare staff working in critical care settings. The review was structured according to the main reporting principles of PRISMA 2020. English and Persian literature was searched and verified through PubMed, Google Scholar, journal websites, SID, Magiran, and related databases. Eligible studies examined healthcare workers in critical care or comparable crisis settings and reported work-environment factors, workload, job stress, burnout, depression, anxiety, sleep problems, quality of life, coping, or patient-safety-related outcomes. Given the heterogeneity of study designs, settings, instruments, and outcomes, findings were synthesized narratively rather than statistically. The evidence consistently shows that high workload, insufficient staffing, rotating or night shifts, limited decision latitude, poor team communication, inadequate physical environments, and repeated exposure to death or ethical dilemmas are associated with poorer mental health. Burnout, emotional exhaustion, depressive symptoms, anxiety, sleep disturbance, moral distress, reduced quality of life, and lower perceived patient-safety culture were the most commonly reported outcomes. Protective factors included supportive leadership, meaningful teamwork, supervisor and peer support, resilience, fair scheduling, structured reflection, access to psychological support, and organizational attention to rest, staffing, and safety culture. Mental health in critical care staff is not merely an individual vulnerability; it is a system-level outcome shaped by the interaction between job demands, job resources, organizational culture, and personal coping capacity. Sustainable interventions should therefore combine workload redesign, staffing adequacy, shift planning, supportive supervision, psychological services, team communication, and staff participation in decision-making.