Title : Bio-psycho-social model perspective on burnout prevention and wellness promotion among intensive care nurses: A scoping review
Abstract:
Objectives: Even before the COVID-19 pandemic, burnout has been a critical issue in the nursing field; especially, Intensive care nurses (ICU nurses) are at greater risk of burnout under high-pressure workloads. The objective of this scoping review was, from the bio-psycho-social perspective, to explore and synthesize the characteristics and effects of interventions; and to identify perspectives required for future research on interventions for ICU nurses.
Methods: This study focused on research in which an intervention or response was implemented to address burnout among ICU nurses. We conducted a scoping review guided by the Arksey and O’Malley framework and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed, CINAHL, Web of Science, and Ichushi-Web were searched to identify relevant articles. Given inconsistencies in the definition of burnout in prior literature, the search period was limited to articles published from January 2019 when burnout was formally defined in the ICD-11 to July 2025. As no standardized definitions for each component of the bio-psycho-social model were identified, we operationalized each factor based on prior studies as follows. Biological factors included physiological, anatomical, and pathological aspects. Psychological factors encompass emotional, cognitive, belief-related, and behavioral aspects. Sociological factors include the social environment, social support, culture and norms, as well as interpersonal relationships.
Results: 14 articles were included in the final analysis. Overall, the articles were classified into two types of interventions: preventive care for nurses who were not experiencing burnout and wellness care for those who were already experiencing burnout. Eleven articles implemented various psychological interventions; of these, five were based on mindfulness, while others focused on resilience, self-compassion, and emotional intelligence. Two articles addressed nurse redeployment during the COVID-19 pandemic. Most of the articles employed a quantitative design. Further analysis found three key findings emerged. First, interventions addressing burnout among ICU nurses could be broadly categorized into two types: preventive care for nurses who were not experiencing burnout and recovery-oriented care for those who were already affected. Second, interventions tended to emphasize psychological approaches, with most incorporating two or more bio-psycho-social components; however, a psychological component was consistently included. Third, comparison of intervention components and outcome evaluations revealed a lack of alignment between the components targeted by the interventions and those assessed in outcome measures. In particular, biological evaluations and sociological evaluations were relatively limited.
Conclusions: Most burnout interventions for ICU nurses emphasize psychological approaches, with limited attention to biological and social factors. Our findings highlight important gaps and emerging comprehensive approaches in current intervention research.
Implications for Clinical Practice: These findings underscore the need for future burnout interventions to incorporate objective biological evaluations and adopt integrated bio-psycho-social approaches. Interventions that respect ICU nurses’ individual identities and values may improve the quality of support and contribute to the sustainability and stability of the nursing workforce.
