Interventions to reduce ED occupational stress: A systematic review

Mrs Hui (Grace) Xu1,2,3, Dr  Kathryn Kynoch4, Dr Anthony Tuckett1, Dr Robert Eley1, Associate Professor Peter NewCombe1

1University of Queensland, St Lucia, Australia, 2Logan Hospital, Meadowbrook, Australia, 3Griffith University, Nathan, Australia, 4Queensland Centre for Evidence Based Nursing and Midwifery: A Joanna Briggs Institute Centre of Excellence, Mater Health, Brisbane, Australia

Background: High levels of occupational stress in Emergency Department (ED) can negatively impact staff and patient safety. A small number of studies have indicated that ED occupational stress management interventions can help to reduce long-term effects such as burnout.

Objective: To identify, appraise and synthesise the evidence on the effectiveness of interventions to reduce occupational stress in the ED.

Methods: A systematic review was undertaken utilising Joanna Briggs methods. Seven databases and five grey literatures resources were searched for articles in English published from January 2008 – February 2019. Two independent reviewers conducted full-text study selection, critical appraisal and data extraction. Results were combined with meta-analysis where appropriate.

Results: Thirteen studies, including four randomised controlled trials (RCT) and nine quasi-experimental studies, met the review inclusion criteria. Overall, individual-based interventions (10 studies) were more widely investigated than organizational-focused interventions (three studies). Educational interventions (EI; six studies) and mindfulness-based interventions (MBI; four studies) were the two types of commonly investigated individual-based interventions.  The use of EI resulted in a reduction in stress and/or burnout in all included studies even though all educational programs had varied teaching approaches and content. Studies that used MBI reported inconsistent results in stress and/or burnout reduction.  A meta-analysis of MBI showed no difference between the groups with or without intervention. In contrast, organizational-based interventions were found to decrease stress levels, but increase burnout levels.

Conclusion: The studies summarised in the review indicate that there is potential to use of EI and MBI to reduce ED occupational stress and burnout. The findings of this review generated new evidence for managers and organizations to consider when planning stress reduction interventions.


Hui (Grace) Xu is an experienced Nurse Practitioner in emergency medicine, PhD Candidate at the University of Queensland, Nurse Researcher with the Menzies Health Institute Queensland, and Adjunct Lecturer at Griffith University. Her research interests include staff wellness promotion, clinical education, vascular access devices and infection prevention. Her passion in promoting staff wellness and patient safety drives her interest in becoming a key driver and stakeholder of the Staff Wellness Committee in her emergency department.