Predicting nurse fatigue from measures of work demands

The predictive role of resilience and the ethical climate of hospital in the fatigue of surgical technologists working in operating rooms

BACKGROUND

Fatigue in surgical technologists is of paramount importance and is known as a priority because it can be regarded as a threat to the nurse's health and patient's safety. The fatigue level of healthcare workers can be affected by some factors, while the role of part of these factors is less known. This study aimed to determine the predictive role of resilience and the hospital ethical climate in the fatigue of surgical technologists working in operating rooms (ORs).

METHODS

This is a cross-sectional study conducted on 217 surgical technologists working in ORs of hospitals affiliated with Shiraz University of Medical Sciences. Data were collected using Connor-Davidson's Resilience scale, Olson's Hospital Ethical Climate Survey, and the Multidimensional Fatigue Inventory, and then analyzed using Pearson's correlation coefficient and multiple regression analysis.

RESULTS

87.1% and 12.9% of surgical technologists reported low and high fatigue, respectively. All fatigue subscales had significant and negative relationships with resilience (p < 0.05). Moreover, the relationship between fatigue and ethical climate was significant (p = 0.02). The multiple linear regression model showed the predictive role of resilience in fatigue (β=-0.29, P < 0.001). According to the model, 10% of the change of fatigue was related to resilience and ethical climate.

CONCLUSION

The present study demonstrated the relationship between resilience and ethical climate with fatigue. Moreover, resilience was a predictor of the surgical technologists' fatigue, so that their fatigue decreased with increasing resilience. However, future studies are recommended to determine other factors influencing fatigue in surgical technologists.

Health status and ergonomics education: A comparison between student nurses and first-year nursing staff

AIMS

To (a) compare student nurses' health status and levels of ergonomics knowledge and awareness to those of first-year nursing staff and (b) investigate the association between nurses' ergonomic compliance and health status with their educational preparedness.

DESIGN

This cohort study compared ergonomics awareness and knowledge, and health status of nurses when they were students and after their first-year working in medical facilities.

METHODS

In total, 133 4th-year student nurses completed a survey; 45 of them completed a second survey after working 1 year in a medical facility. Their health status was compared over time using repeated-measures ANOVA. Correlation tests were used to analyse associations between ergonomics knowledge and awareness, health status, demographic variables and educational preparedness.

RESULTS

Respondents in both surveys displayed weak knowledge of ergonomic principles significantly associated with increased pain intensity and educational preparedness.

PATIENT CONTRIBUTION

Ergonomics training should be expanded during nursing studies and first-year training to prevent long-term health disorders.

Pediatric nurses' fatigue descriptions in occupational injury reports: A descriptive qualitative study1

Background

Despite the high risks associated with occupational fatigue in healthcare, few organizations require nurses to screen and report fatigue symptoms. As a result, little is known about if and how nurses would report fatigue while on the job.

Objective

To determine if hospital-based pediatric nurses reported fatigue as part of an active injury reporting method.

Methods

This secondary analysis of qualitative data used a descriptive design with content analysis. Data from the parent study were collected at a U.S. pediatric hospital where nurses verbally reported on-shift injuries or near misses and pre- and post-shift health status via a digital voice recorder. Researchers used content analysis to independently code data for nurses' references to fatigue. Codes were then analyzed for patterns and themes.

Results

Approximately 30% (n = 104) of participants reported fatigue-related content. Emergent themes were Work Stressors, Individual Risk Factors, Fatigue Descriptors, Adverse Outcomes from Fatigue, Fatigue Buffers, Descriptors for Buffered Fatigue, and Favorable Outcomes from Buffered Fatigue. Fatigue descriptions align with prior literature, demonstrating the accuracy of the voice recorder data collection method. In addition, nurses expressed uncertainty about the appropriateness of reporting fatigue symptoms.

Conclusion

Findings from this study support pediatric nurses will report fatigue, when provided an opportunity. Additional efforts are needed to better understand effective ways to improve fatigue reporting among nurses, including harnessing current technology for real-time reporting and how to change the culture around fatigue reporting.

Job strain and burnout in Spanish nurses during the COVID-19: resilience as a protective factor in a cross-sectional study

BACKGROUND

Nurses are frequently exposed to chronic stress in the workplace generating harmful effects such as job strain and burnout. On the contrary, resilience has been shown to be a beneficial variable. The objective of this study was to analyze the relationship between dimensions of the Job Demand Control-Support model, resilience and burnout in nurses, and examine the mediating role of resilience between job strain and burnout.

METHODS

A descriptive, cross-sectional study reported in line with the STROBE guidelines. Active nurses were invited to complete an online questionnaire in September, 2020. With snowball sampling, 1013 nurses, with a mean age of 34.71, filled out the Job Content Questionnaire, the Maslach Burnout Inventory and the Resilience Scale.

RESULTS

The results showed the existence of four groups of professionals based on job strain. The nurses in the "High Strain" group (high demands and low control) showed higher scores in emotional exhaustion and cynicism, while those in the "Active Job" group scored higher in personal realization and resilience. The findings showed that job strain affects burnout in nurses, and this effect is mediated by resilience.

CONCLUSIONS

The findings of this study showed that a high level of resilience could exert a fundamental role in ensuring well-being and proper job performance by nurses. Nursing managers should see to the personable variables or competencies that provide and favor an opportunity for nurses to widen and improve their practice, in pursuance of satisfying and responding better to people's needs and the systems they work for.

Mediating role of emotional labour strategy in the association between patient/visitor incivility and nurses' fatigue: a cross-sectional study

OBJECTIVE

Fatigue is a common problem among nurses, and patient/visitor incivility is thought to lead to nurses' fatigue. However, the mechanism by which patient/visitor incivility leads to nurses' fatigue has not been well studied. The aim of this study is to examine whether the association between patient/visitor incivility and fatigue among Chinese nurses is mediated by emotional labour strategy.

DESIGN

A cross-sectional study.

METHODS

In November 2019, a stratified cluster sample of 1207 nurses from two hospitals in China was used to collect data on fatigue, patient/visitor incivility and emotional labour strategy through online questionnaires. Emotional labour strategy has three dimensions: surface acting (SA), deep acting and natural acting. Complete responses were provided by 1036 (85.8%) participants. Student's t-test, one-way analysis of variance, Pearson correlation analysis and the PROCESS procedure (A modeling macro installed in SPSS to analyse mediation.) were adopted to analyse the data.

RESULTS

Patient/visitor incivility and SA were positively related to fatigue (p<0.01), while natural acting was negatively related to fatigue (p<0.01). SA played as a mediator in the association between patient/visitor incivility and nurses' fatigue (95% CI 0.047 to 0.113, p<0.05).

CONCLUSION

Patient/visitor incivility could contribute to Chinese nurses' fatigue. When nurses were exposed to patient/visitor incivility, they were more likely to use the SA emotional labour strategy, which would lead to fatigue. Nursing administrators should be aware of the seriousness of nurses' fatigue.

Effects of 90 Min Napping on Fatigue and Associated Environmental Factors among Nurses Working Long Night Shifts: A Longitudinal Observational Study

For nurses working long night shifts, it is imperative that they have the ability to take naps to reduce fatigue, and that an appropriate environment is prepared where such naps can be taken. We verified the effects of 90 min napping on fatigue and the associated factors among nurses working 16-h night shifts. We investigated 196-night shifts among 49 nurses for one month. Wearable devices, data logging devices, and questionnaires were used to assess nap parameters, fatigue, and environmental factors such as the napping environment, ways of spending breaks, and working environment. Nurses who nap at least 90 min on most night shifts had more nursing experience. Multivariable logistic regression analysis showed that the environmental factors significantly associated with total nap duration (TND) ≥ 90 min were noise, time spent on electronic devices such as cellphones and tablets during breaks, and nap break duration. The night shifts with TND ≥ 90 min showed lower drowsiness after nap breaks and less fatigue at the end of night shift compared to those with TND < 90 min. Nurses and nursing managers should recognize the importance of napping and make adjustments to nap for at least 90 min during long night shifts.

Coincidence Analysis: A Novel Approach to Modeling Nurses' Workplace Experience

OBJECTIVES

The purpose of this study is to identify combinations of workplace conditions that uniquely differentiate high, medium, and low registered nurse (RN) ratings of appropriateness of patient assignment during daytime intensive care unit (ICU) work shifts.

METHODS

A collective case study design and coincidence analysis were employed to identify combinations of workplace conditions that link directly to high, medium, and low RN perception of appropriateness of patient assignment at a mid-shift time point. RN members of the study team hypothesized a set of 55 workplace conditions as potential difference makers through the application of theoretical and empirical knowledge. Conditions were derived from data exported from electronic systems commonly used in nursing care.

RESULTS

Analysis of 64 cases (25 high, 24 medium, and 15 low) produced three models, one for each level of the outcome. Each model contained multiple pathways to the same outcome. The model for "high" appropriateness was the simplest model with two paths to the outcome and a shared condition across pathways. The first path comprised of the absence of overtime and a before-noon patient discharge or transfer, and the second path comprised of the absence of overtime and RN assignment to a single ICU patient.

CONCLUSION

Specific combinations of workplace conditions uniquely distinguish RN perception of appropriateness of patient assignment at a mid-shift time point, and these difference-making conditions provide a foundation for enhanced observability of nurses' work experience during hospital work shifts. This study illuminates the complexity of assessing nursing work system status by revealing that multiple paths, comprised of multiple conditions, can lead to the same outcome. Operational decision support tools may best reflect the complex adaptive nature of the work systems they intend to support by utilizing methods that accommodate both causal complexity and equifinality.

Occupational fatigue, workload and nursing teamwork in hospital nurses

AIMS

To evaluate the relationships between workload, nursing teamwork and nurse fatigue and the moderating effect of nursing teamwork on the relationship between workload and fatigue.

DESIGN

This cross-sectional online survey study used data from 810 United States hospital nurses collected between March and April 2021.

METHODS

Workload, nursing teamwork and fatigue were measured using the Quantitative Workload Inventory, the Nursing Teamwork Survey, and the Occupational Fatigue Exhaustion Recovery scale. Hierarchical multiple linear regression models were used.

RESULTS

All the nursing teamwork subscales (i.e. trust, team orientation, backup, shared mental model, team leadership) were significantly negatively related to acute and chronic fatigue. Nursing teamwork components of team orientation, shared mental model and team leadership moderated the relationship between workload and chronic fatigue. The relationships between workload and chronic fatigue were stronger when these components of nursing teamwork were high. No moderating effects were found with acute fatigue.

CONCLUSION

Efforts to increase nursing teamwork may be a promising strategy in managing nurse fatigue. It is equally important to monitor and modify high workload to protect nurses from elevated fatigue.

IMPACT

WHAT PROBLEM DID THE STUDY ADDRESS?: Fatigue is negatively associated with the health and safety of hospital nurses and patients. Nursing teamwork has been shown to improve the nursing care of hospitalized patients; yet, it is rarely explored in relation to nurse fatigue. WHAT WERE THE MAIN FINDINGS?: Greater nursing teamwork is significantly associated with lower acute and chronic fatigue. The relationships between workload and chronic fatigue were stronger when nursing teamwork (i.e. team orientation, shared mental model and team leadership) was high than when nursing teamwork was low. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Improving nursing teamwork, in addition to monitoring and modifying workloads, can be a promising approach for managing fatigue in healthcare organizations.

Post-Work Recovery from Fatigue and Sleep Episodes among Nurses Who Are Engaged in 16-Hour Night Shifts: A Prospective Observational Study

Poor recovery from fatigue among shift-working nurses can cause a transition from acute to chronic fatigue. We aimed to clarify the relationship between nurses' recovery from fatigue and sleep episodes after 16 h night shifts while considering age. This prospective study included 62 nurses who worked 16 h night shifts. Fatigue was assessed by a questionnaire before, during, and after the night shift, and the morning following the night shift. Sleep episodes were continuously measured using a wearable device. We performed a hierarchical cluster analysis of multivariate sleep parameters in first and main sleep episodes after night shifts. A linear mixed model was used to estimate the difference between clusters in recovery from fatigue after the night shift, considering age. The participants were classified into a high sleep quality group (HSQG) and low sleep quality group (LSQG) in sleep episodes after the night shift. There was a significant main effect of clusters, and HSQG was significantly more effective than LSQG in recovering from fatigue. However, no main effects of age or interaction were observed. The quality of first and main sleep episodes at home was associated with recovery from the night shift to the next day, regardless of age.

Put your feet up: The impact of personality traits, job pressure, and social support on the need for recovery after work

The need for recovery after work (NFR) is an important warning of work-related fatigue. NFR is linked to prolonged work-related efforts and depletion of resources, creating a need for temporary respite from work demands. The aim of the current study was to investigate the relationships between NFR and the five-factor model (FFM), comprising the personality traits of emotional stability (ES), extraversion (E), agreeableness (A), conscientiousness (C), and openness to experience (O). Perceived job pressure and perceived social support were included as mediators. The study was conducted using structural equation modelling (SEM) on cross-sectional data from a sample of 681 participants from several work sectors (N females = 376, N males = 305; M age = 46.9 years; SD = 11.1). The results showed that NFR was affected both directly and indirectly by FFM traits. High ES and high O contributed directly to reduced and increased NFR, respectively. High perceived social support contributed to reduced NFR, while high perceived job pressure contributed to increased NFR. High ES contributed indirectly to reduced NFR through perceived job pressure and social support, high O contributed indirectly to increased NFR through perceived social support, and high E contributed indirectly to increased NFR through perceived job pressure. A and C were not related to NFR. The findings demonstrate that personality traits, especially ES, are firmly related to NFR and highlight the importance of incorporating personality factors into studies of work environmental factors on NFR.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-02950-1.

Addressing Occupational Fatigue in Nurses: A User-Centered Design Approach for Fatigue Risk Management

OBJECTIVE

To understand hospital nurses' current fatigue risk management (FRM), identify design goals and principles, and obtain feedback on FRM design concepts.

BACKGROUND

FRM systems can address fatigue and associated risks, yet they are not widely implemented in hospital nursing. This may be due to a lack of contextually appropriate FRM tools.

METHODS

A user-centered design approach was used, including interviews with 21 hospital nursing stakeholders.

FINDINGS

Nurses described integrated fatigue monitoring and management activities to pursue balance between work demands and capacity to meet those demands as individual nurses, within the unit, across the hospital, and over time. Seven principles were identified and applied to 2 initial design concepts for tools to support FRM. Participants' feedback on designs was positive.

CONCLUSIONS

This study advances the science and practice for FRM in nursing. The design principles and concepts from this study can be used to facilitate implementation of FRM systems in hospitals.

Effects of a modified shift work organization and traffic load on air traffic controllers' sleep and alertness during work and non-work activities

A 'compressed' shift schedule (substitution of a rest day by a shift, shortening the duration of work breaks) was introduced for a better fit with aircraft traffic load. Thereafter, the company asked for a survey assessing the effects of the compressed shift system. Air traffic controllers (ATCOs) completed retrospectively a specific questionnaire assessing the effects of shift schedule (modified vs. initial) and of traffic load on fatigue, alertness (on-shift, upon awakening, during daily non-work activities), and sleep (duration, satisfaction). Work organization had marginal and unexpected effects, which might indicate ATCOs' disapproval of the intervention. Traffic load affected sleep satisfaction and alertness during work and non-work activities. Specific effects of shift included reduced sleep time prior to morning shifts compared to night shifts, whereas alertness and fatigue were rated at comparable levels for both shifts. Results suggest that shiftwork features which favor sleep loss across a work cycle have deleterious consequences on alertness and increase the need for recovery, which are further enhanced by traffic load.

Using Kinect body joint detection system to predict energy expenditures during physical activities

The purpose of this study was to explore the potential of Kinect body joint detection to facilitate the calculation of energy expenditure during exergame exercises. Two Kinect-based biomechanical models - mechanical energy (KineticE) and work (WorkE) were employed to estimate the energy expenditure during four Wii™ exergame session. Consequently, two stepwise regression models were developed from nineteen participants' data and then validated by five holdout participants. The data collected using an accelerometer (r = 0.835, p < 0.001) had the highest correlation as compared to that of the WorkE (r = 0.805, p < 0.001) and KineticE (r = 0.466, p < 0.001) correlations with the reference indirect calorimetry using Quark activity energy expenditure (QuarkAEE). The regression results show that KineticE and the weight of the participant were significant factors for mechanical energy prediction (AEEKinetic). However, according to the work prediction equation (AEEWork), only WorkE was significant. The new energy prediction models showed significant agreement with the standard QuarkAEE (AEEKinect, r = 0.641, p = 0.02; AEEWork, r = 0.793, p < 0.001), and they were comparable to accelerometer predictions (r = 0.682, p = 0.001). The findings indicate that Kinect can be a potentially viable alternative to measure energy expenditures. The models can be applied with higher accuracy, especially when the activity demands high body movements.

Applicability of Physiological Monitoring Systems within Occupational Groups: A Systematic Review

The emergence of physiological monitoring technologies has produced exceptional opportunities for real-time collection and analysis of workers' physiological information. To benefit from these safety and health prognostic opportunities, research efforts have explored the applicability of these devices to control workers' wellbeing levels during occupational activities. A systematic review is proposed to summarise up-to-date progress in applying physiological monitoring systems for occupational groups. Adhering with the PRISMA Statement, five databases were searched from 2014 to 2021, and 12 keywords were combined, concluding with the selection of 38 articles. Sources of risk of bias were assessed regarding randomisation procedures, selective outcome reporting and generalisability of results. Assessment procedures involving non-invasive methods applied with health and safety-related goals were filtered. Working-age participants from homogeneous occupational groups were selected, with these groups primarily including firefighters and construction workers. Research objectives were mainly directed to assess heat stress and physiological workload demands. Heart rate related variables, thermal responses and motion tracking through accelerometry were the most common approaches. Overall, wearable sensors proved to be valid tools for assessing physiological status in working environments. Future research should focus on conducting sensor fusion assessments, engaging wearables in real-time evaluation methods and giving continuous feedback to workers and practitioners.

Effects of Fatigue and Grit on Club Sports Coaches

The objective of this research is to identify the level of general fatigue (FG), physical fatigue (FF) and concentration/motivation (C/M) in sports coaches. Two components of grit, consistency of interest (CI) and perseverance in effort (PE), are also assessed. The possible effects of sex, age, marital status, employment contract, work dedication and grit on FG, FF and C/M in sports coaches are examined. This cross-sectional study analyses 335 sports club coaches (21.2% women, 78.8% male) with a mean age of 29.88 (SD = 9.97) years, at a significance level of p < 0.05 for all analyses. Different aspects of fatigue were determined using the Spanish translation of the Multidimensional Fatigue Inventory-20 (IMF-20). The Grit-S scale was used to measure the ability to persevere, have passion and commit. The results indicated that men scored higher in FF, C/M and PE, while women obtained higher values in FG and CI. Non-contract coaches had higher FG, CI and PE, while coaches with contracts scored higher on C/M and FF. In conclusion, coaches with higher CI had higher FG, and high levels of PE were associated with low FG levels.

Understanding fatigue in a naval submarine: Applying biomathematical models and workload measurement in an intensive longitudinal design

Fatigue is a critically important aspect of crew endurance in submarine operations, with continuously high fatigue being associated with increased risk of human error and long-term negative health ramifications. Submarines pose several unique challenges to fatigue mitigation, including requirements for continuous manning for long durations, a lack of access to critical environmental zeitgebers (stimuli pertinent to circadian physiology; e.g., natural sunlight), and work, rest and sleep occurring within an encapsulated environment. In this paper, we examine the factors that underlie fatigue in such a context with the aim of evaluating the predictive utility of a biomathematical model (BMM) of fatigue. Three experience sampling studies were conducted with submarine crews using a participant-led measurement protocol that included assessments of subjective sleepiness, workload (NASA-Task Load Index [TLX] and a bespoke underload-overload scale), and sleep. As expected, results indicated that predicting KSS with a BMM approach outperformed more conventional linear modelling approaches (e.g., time-of-day, sleep duration, time awake). Both the homeostatic and circadian components of the BMM were significantly associated with KSS and used as controls in the workload models. We found increased NASA-TLX workload was significantly associated with increased average KSS ratings at the between-person level. However, counter to expectations, the two workload measures were not found to have significant linear or quadratic relationship with fatigue at the within-person level. An important outcome of the research is that applied fatigue researchers should be extremely cautious applying conventional linear predictors when predicting fatigue. Practical implications for the submarine and related extreme work context are discussed. Important avenues for continued research are outlined, including directly estimating BMM parameters.