Investigating what causes psychological ill-health for nurses, midwives and paramedics, and what we can do about it.

This review aimed to understand why, how, for whom and in which circumstances nurses, midwives and paramedics experience work-related psychological ill-health and to determine how to optimise benefit from interventions to mitigate this.

Researchers undertook an extensive realist review of the evidence, drawing on over 200 sources. The research focused mainly on the UK, but many of the findings are relevant to other international healthcare environments. Publications and guidance include evidence-based solutions.


A quick guide highlighting the key findings and recommendations

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The guide

We are happy to provide this free of charge, but would ask you to consider the following conditions for its use:

  • Please do not distribute this to anyone else – if anyone asks for a copy please ask them to obtain it via this website. This will enable us to track downloads and engagement which is crucial for us to measure the impact of our research.

If you use the guidance, or any part of it, we would be grateful if you would please:

  • Acknowledge the authorship team;
  • Send copies of any reports/papers that are produced to Professor Jill Maben ( or Professor Cath Taylor
  • Let us have any comments/suggestions that you feel might improve the guidance so that your experience can be incorporated into subsequent updates.
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The full NIHR research report

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Recording of event launching guidance for CUP2
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Taylor, C., Mattick, K., Carrieri, D., Cox, A., and Maben, J. (2022) 
‘The WOW factors’: Comparing Workforce Organisation and Wellbeing for doctors, nurses, midwives, and paramedics in England. British Medical Bulletin.


Taylor CMaben JJagosh J, et al Care Under Pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics


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