Psychological wellbeing of healthcare professionals in regional, rural and remote emergency departments: an integrative review

BACKGROUND: Healthcare professionals working in regional, rural, and remote emergency departments are at increased risk of psychological distress, burnout, and emotional exhaustion due to demanding work environments and ongoing workforce pressures. Poor psychological wellbeing contributes to reduced workforce retention and may compromise the delivery of safe, equitable emergency care. However, evidence regarding their psychological wellbeing in these settings remains fragmented and lacks comprehensive synthesis. METHODS: An integrative review of global evidence on the psychological wellbeing of healthcare professionals working in regional, rural, and remote emergency departments was undertaken, focusing on challenges, contributing factors, supports, and reported outcomes. Five electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, and Scopus) were systematically searched from inception to June 2025. RESULTS: Seventeen primary studies from ten countries met inclusion criteria and were appraised using the Mixed Methods Appraisal Tool. Findings revealed multifactorial stressors, including workplace violence, excessive workloads, professional isolation, inadequate leadership, moral distress, and limited access to training, with nurses and female staff most affected. Supports were clustered into four domains: education and professional development, peer and social support, organizational support, and individual coping strategies. Most supports were descriptively reported, with outcomes identified as both positive and negative. In only two studies, structured interventions were formally evaluated, including a self-care program and the implementation of a Serenity Room. CONCLUSION: The review highlights that psychological distress among healthcare professionals working in regional, rural, and remote emergency departments is influenced by context-specific, systemic, and individual factors, yet evidence-based interventions addressing these issues remain scarce. Multi-level, co-designed strategies integrating organisational safety, training, and wellbeing supports are recommended as potential approaches to support healthcare staff psychological wellbeing, workforce sustainability, and equitable, high-quality emergency care in regional, rural, and remote settings. PROSPERO REGISTRATION NUMBER: CRD420251079431.