Development and Validation of a Scale to Measure Work-Related Fatigue and Recovery: The Occupational Fatigue Exhaustion/Recovery Scale (OFER)

Reliability and validity of the Turkish version of The Digital Eye Strain Questionnaire

BACKGROUND

The rapid spread of digital technologies has become important in work and social life. However, prolonged use of digital screens, such as digital eye strain, negatively affects individuals. This has increased the importance of using valid and reliable scales to assess digital eye strain.

METHODS

To adapt the Digital Eye Strain Questionnaire (DESQ) into Turkish for validity and reliability. This study followed a methodological research design in accordance with the EQUATOR checklist. This methodological study was conducted in Istanbul with 401 individuals continuously exposed to digital screens for at least 2 h. Data were collected via the sociodemographic characteristics form, DESQ, and the Problematic Internet Use Scale (PIUS). The study was conducted in five consecutive stages: direct translation, synthesis of translations, back translation, expert committee evaluation, and validity and reliability analysis.

RESULTS

Individuals spent an average of 6.66 ± 3.20 h per day in front of a digital screen. The content validity index of the DESQ was found to be 0.962, and the confirmatory factor analysis results, the model's fit indices were high and statistically significant (χ2 = 161.689, sd = 62). The reliability analysis revealed that the Kuder‒Richardson 20 value was 0.787, and the item‒total correlation values ranged between 0.306 and 0.517. The parallel form correlation between the DESQ and PIUS scores revealed statistically significant relationships between the subdimensions and total scores.

CONCLUSIONS

The results prove that the Turkish version of the DESQ is valid and reliable for assessing digital eye strain.

Latent Profiles of Nurses' Insomnia, Fatigue, Recovery, Psychological Distress and Burnout During the COVID-19 Pandemic: Examining the Role of Organisational Support

AIMS

To identify latent profiles of insomnia, fatigue, recovery, psychological distress and burnout among hospital nurses; examine variations in personal and work-related characteristics across profiles; investigate associations between profiles and outcomes such as patient care quality, nursing work satisfaction and workplace satisfaction; and assess the moderating role of organisational support on these relationships.

DESIGN

A cross-sectional descriptive study.

METHODS

This study analysed survey data from 2488 hospital nurses using latent profile analysis, multinomial logistic regression and hierarchical multiple linear regression.

RESULTS

Four well-being profiles emerged: low, average, above-average and high well-being. Profiles differed significantly in personal and work-related characteristics. Nurses in the high well-being profile were associated with better patient safety, care quality and satisfaction. Organisational support moderated the negative associations between low well-being profiles and nursing work and workplace satisfaction.

CONCLUSION

Tailored interventions addressing factors associated with low well-being and enhancing organisational support may be beneficial for improving nurse well-being, delivering high-quality care and supporting nurse retention in sustainable healthcare environments.

IMPLICATIONS

Healthcare organisations should prioritise nurse well-being through targeted interventions, adequate staffing, recovery opportunities and stress management resources to support a resilient and sustainable workforce.

IMPACT

The findings revealed the diversity of well-being patterns among hospital nurses and provided insights for identifying subgroups at higher risk of impaired patient safety, reduced care quality and dissatisfaction with nursing work and the workplace. Greater organisational support was associated with weaker negative relationships between poor well-being and nurse outcomes.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No direct patient or public contribution.

Fatigue and coping strategies among Chinese night-shift nurses: a cross-sectional study

BACKGROUND

Night-shift work is a crucial component of nursing but is associated with significant fatigue, which may impact both nurse well-being and patient safety. Understanding the levels of fatigue and the coping strategies employed by nurses can help develop effective interventions. This study aimed to assess the fatigue levels of Chinese night-shift nurses and explore commonly used anti-fatigue strategies.

METHODS

A cross-sectional study was conducted in Zhejiang Province, China, using the Occupational Fatigue Exhaustion/Recovery Scale (OFER) questionnaire. The survey assessed acute and chronic fatigue levels, fatigue recovery, and anti-fatigue strategies among nurses. Statistical analysis was performed using SPSS 26.0.

RESULTS

Among the 371 valid responses, chronic fatigue levels (66.41 ± 24.17) were higher than acute fatigue levels (57.31 ± 15.61). Nurses with higher education levels reported lower acute fatigue, while older, more experienced nurses and those working in higher-grade hospitals had lower chronic fatigue. Common coping strategies included naps (63.88%) and stimulant consumption (54.72%), with coffee (45.37%) and milk tea (23.28%) being the most popular drinks.

CONCLUSION

Our findings indicate that Chinese night-shift nurses experience substantial fatigue, especially chronic fatigue, which is influenced by factors including education, age, clinical experience, exercise frequency, and hospital grade. Although personal coping strategies are common, they fall short in mitigating fatigue, underscoring the need for comprehensive interventions that combine individual and organizational measures.

CLINICAL TRIAL NUMBER

not applicable.

The Hidden Cost of Decision-Making Autonomy at Work: How Task Reflexivity and Construal Level Induce Mental Fatigue

Contrary to the traditional belief that decision-making autonomy enhances employee well-being, we investigate the cognitive circumstances and mechanisms through which daily decision-making autonomy leads to mental fatigue. Integrating self-regulation theory with construal-level theory, we propose that daily decision-making autonomy triggers cognitive activities related to task reflexivity, which subsequently results in next-day mental fatigue. We identify trait construal level as a key moderating factor, arguing that the indirect effect of decision-making autonomy on mental fatigue through task reflexivity is particularly pronounced when employees have a low (vs. high) trait construal level. Our hypotheses received support from two experience sampling studies in the United States and China. Specifically, we found that the detrimental effects of decision-making autonomy are indirect by nature and only manifest in certain employees.

Effect of environmental distraction on safety behavior: A path analysis approach

BackgroundEnvironmental variables can affect employee safety in different ways. These variables can reduce attention and concentration and cause distraction. Numerous studies have been conducted to examine the impact of distraction on safety, with results that have been inconsistent.ObjectiveBased on a comprehensive literature review, we propose the hypothesis that environmental distractions can affect safety behavior either directly or indirectly through other factors. This study was conducted to investigate this hypothesis.MethodsThis cross-sectional analytical study was conducted on 474 employees from manufacturing industries in Iran. Data were collected through a self-report questionnaire. Data analysis was performed using the path analysis method in IBM SPSS AMOS 24.0 software. The validity of the model was assessed using the root mean square error of approximation (RMSEA), comparative fit index (CFI), and the coefficient of determination (R²).ResultsBased on the results of the path analysis and model fit indices (CFI = 0.99, TLI = 0.99, χ²/df = 1.09, RMSEA = 0.014), environmental distraction indirectly affects safety behavior through fatigue, human-systems interaction, and situation awareness. The findings indicated that environmental distraction did not have a significant direct effect on safety behavior. Among the four variables studied, situation awareness had the greatest impact on safety behavior.ConclusionsThe study results indicated that more favorable workplace conditions (such as noise levels, temperature, colleagues' traffic, crowded work environments, and availability of private space) help prevent fatigue and improve human-system interaction. Consequently, reduced fatigue and enhanced human-system interaction lead to greater situation awareness and safer behaviors.

Nurses' Performance as a Mediator Between Nurses' Fatigue and Patient Safety Culture: A Structural Equation Model Analysis

AIM

To determine the relationships among nurses' fatigue, nurses' performance and patient safety culture.

DESIGN

Cross-sectional study.

METHODS

A multicentre study was conducted with 308 nurses working in 14 medical and surgical wards from four teaching hospitals in Iran. The sampling method was stratified with a proportional allocation. Data were collected via a demographic form, the Occupational Fatigue/Exhaustion Recovery (OFER-15), the Nurse Performance Instrument (NPI) and the Hospital Survey on Patient Safety Culture (HSOPSC). The data were analysed via structural equation modelling (SEM).

RESULTS

Nurse fatigue was significantly inversely related to performance and patient safety culture (p < 0.001). Path analysis revealed that each unit of reducing nurses' fatigue improved patients' safety culture by 0.286 units and that each unit of improved nurse performance improved patients' safety culture by 0.360 units. Additionally, each one-unit increase in a nurse's fatigue could decrease his or her performance by 0.860 units. SEM analysis confirmed the mediating effect of nurses' performance on the relationship between their level of fatigue and patient safety culture.

PRACTICE IMPLICATIONS

The proposed model can assist nursing managers and healthcare policymakers in developing practical strategies to mitigate and reduce nurses' fatigue and, consequently, improve nurses' performance and patient safety.

PATIENT OR PUBLIC CONTRIBUTION

All participants contributed to this research by completing self-reported scales.

Work intensification and occupational fatigue on nurses: a cross-sectional and correlational study

PURPOSE

This research aimed to determine the relationship between work intensification and occupational fatigue in nurses using a cross-sectional and correlational design.

METHODS

The sample included 597 nurses from public, private, and university hospitals in Istanbul, selected through convenience sampling. Data were collected using the "Nurse Information Form," the "Intensification of Job Demands Scale," and the "Occupational Fatigue Exhaustion/Recovery Scale." Analysis involved descriptive tests, correlation, and hierarchical linear regression.

RESULTS

Results showed higher-than-average levels of both chronic and acute fatigue, with acute fatigue being more prevalent. The mean intershift recovery score was below average. A significant positive correlation was found between chronic and acute fatigue, while a significant negative correlation was observed between both fatigue types and intershift recovery. Work intensification levels were above average and correlated positively with chronic and acute fatigue, except for intensified career-related planning. Conversely, a negative correlation was found with recovery, except for intensified skill-related learning demands. Regression analysis revealed that demographic and occupational characteristics of nurses other than age, work intensification, acute fatigue, and intershift recovery explained 59.8% of chronic fatigue. For acute fatigue, these factors explained 11.2%, and for intershift recovery, 12.8%.

CONCLUSIONS

This study highlights the correlation between work intensification and occupational fatigue in nurses, suggesting that increased work intensity leads to higher occupational fatigue. The findings contribute to the literature and assist nurse managers and decision-makers in preventing occupational fatigue by re-evaluating and regulating current working conditions where job demands are intensified.

A national cross-sectional study on latent profile analysis of occupational fatigue among Chinese nurses in the early post-COVID-19 era

Background

Occupational fatigue is a widespread condition within the nursing workforce, adversely affecting both nurses' health and patient safety. The protracted duration of the COVID-19 pandemic, approaching 3 years, has exacerbated the challenges faced by nurses globally. The escalation in patient numbers and the high incidence of infections among healthcare workers have intensified occupational fatigue. This study seeks to explore the enduring impact of the pandemic on occupational fatigue among Chinese nurses through a latent profile analysis, and to identify the associated risk factors.

Methods

A comprehensive survey was conducted involving 2,140 nurses from 186 hospitals across China during the initial phase of the post-COVID-19 era. The primary instruments utilized for data collection were the Occupational Fatigue Exhaustion Recovery Scale and the Effort-Reward Imbalance Questionnaire.

Results

Three distinct profiles of occupational fatigue were identified: a low fatigue/high recovery group (18.6%), a moderate fatigue/moderate recovery group (48.8%), and a high fatigue/low recovery group (32.6%). The vast majority of nurses reported experiencing moderate to high levels of occupational fatigue during the early stage of the post-coronavirus era. Significant predictors for membership in these fatigue profiles included marital status, possession of a master's degree or higher, working over five night shifts per month, experiencing COVID-19 symptoms, and exhibiting higher scores in extrinsic effort and overcommitment.

Conclusion

Chinese nurses exhibit a relatively high level of occupational fatigue in the early post-COVID-19 era, likely influenced by various socio-demographic and work-related factors. It is imperative to develop targeted interventions aimed at alleviating fatigue among specific groups of nurses to effectively address the challenges posed by occupational fatigue in the face of future public health disasters.

Turkish validity and reliability of Burnout Syndrome Assessment Scale for nurses working in intensive care units

AIMS

This study aimed to translate the Burnout Syndrome Assessment Scale (BOSAS) for Nurses Working in Intensive Care Units into Turkish validity and reliability.

METHODS

The questionnaire was planned to be of a methodological type and translation-back translation methods were used to translate it into Turkish. The content validity was established by submitting it to a panel of 12 faculty members with expertise in nursing. The Burnout Syndrome Assessment Scale (BOSAS) for Nurses Working in Intensive Care Units, the Maslach Burnout Inventory (MBI), and the Nurse Information Form were applied to 200 nurses. Internal consistency analyses were conducted using Cronbach's alpha coefficients and item analysis. Confirmatory factor analysis was employed to evaluate the construct validity. To ascertain the scale's stability over time, a test-retest method was implemented, involving the administration of a questionnaire to 150 intensive care nurses at two-week intervals. The MBI facilitated the assessment of the level of agreement between parallel forms, and intraclass correlations were computed.

RESULTS

Following confirming language equivalence for the scale, the content validity index was subsequently computed. The items' content validity indices (CVIs) ranged between 0.833 and 1.000 and were higher than the generally accepted standard level. Nevertheless, since most of the items related to the scale were explained over a single dimension, the factor analysis application was carried out over a single dimension. The MBI was used to assess the interreliability of the Burnout Syndrome Assessment (BOSAS) Scale for Nurses Working in Intensive Care Units in parallel forms. The scale's internal consistency coefficient demonstrated a high-reliability level, achieving a value of 0.95. The intraclass correlation coefficients (ICCs) obtained for each subdimension and overall questionnaire were high.

CONCLUSION

The Turkish adaptation of this scale is a valid and reliable tool for evaluating and identifying burnout among nurses in intensive care settings.

Research progress on assessment tools related to occupational fatigue in nurses: a traditional review

Nurse occupational fatigue is a significant factor affecting nursing quality and medical safety. Scientific and effective assessment of occupational fatigue is beneficial for strengthening nurse occupational health management, improving the quality of life for nurses, and ensuring patient safety. This article provides a narrative review of the content, reliability, validity, characteristics, application status, and advantages and disadvantages of assessment tools related to nurse occupational fatigue. These tools include single-dimensional assessment scales (Fatigue Severity Scale, Chinese version of Li Fatigue Scale), multidimensional assessment scales (Fatigue Scale-14, Fatigue Assessment Scale, Multidimensional Fatigue Scale, etc.), and other assessment tools. Our review reveals limitations in existing occupational fatigue assessment tools, such as variability in accuracy and applicability across different populations, and potential biases. These findings underscore the critical role of these tools in nursing management and occupational health, advocating for continuous refinement and innovation. Future research should focus on developing more comprehensive, context-specific tools to address the multifaceted nature of nurse occupational fatigue. Nursing managers must carefully select appropriate tools to effectively identify and mitigate fatigue, thereby enhancing nurse well-being and patient care quality.

Wearable heart rate sensing and critical power-based whole-body fatigue monitoring in the field

Whole-body fatigue (WBF) presents a concerning risk to construction workers, which can impact function and ultimately lead to accidents and diminished productivity. This study proposes a new WBF monitoring technique by applying the Critical Power (CP) model, a bioenergetic model, with a wrist-worn heart rate sensor. The authors modified the CP model to calculate WBF from the percentage of heart rate reserve (%HRR) and generated a personalized model via WBF perception surveys. Data were collected for two days from 33 workers at four construction sites. The results showed that the proposed technique can monitor field workers' perceived WBF with a mean absolute error of 12.8% and Spearman correlation coefficient of 0.83. This study, therefore, demonstrates the viability of wearable WBF monitoring on construction sites to support programs aimed at improving workplace safety and productivity.

Relationship between burnout and occupational fatigue exhaustion and recovery among orthopaedic nurses in Tabriz, Iran: a cross-sectional survey

OBJECTIVE

To examine the relationship between burnout and occupational fatigue exhaustion and recovery among orthopaedic nurses in Tabriz, Iran.

DESIGN

Descriptive, cross-sectional survey and correlational analysis.

SETTING

Two hospitals associated with Tabriz University of Medical Sciences, Iran, from August to September 2022.

PARTICIPANTS

92 bedside nurses in orthopaedic wards, each with >1 year of clinical experience.

OUTCOME MEASURES

Burnout was assessed using the Copenhagen Burnout Inventory, and occupational fatigue exhaustion/recovery was measured with the Occupational Fatigue Exhaustion/Recovery Scale. Pearson's correlation, independent t-test, one-way analysis of variance and multivariable linear regression analyses determined statistical significance.

RESULTS

The mean burnout score was 63.65 (±15.88) out of 100 and the recovery rate was 35.43 (±15.60) out of 100. There were significant correlations between total burnout and each of the exhaustion recovery dimensions: chronic fatigue (r=0.70), acute fatigue (r=0.65) and intershift recovery (r=0.56). Nurses exceeding 44 weekly work hours reported higher burnout (66.52±14.77, p=0.005) than those working fewer hours (56.25±16.12, p=0.005). Rotational shift status was associated with increased burnout (64.97±15.32) compared with fixed shifts (55.54±17.42, p=0.04). Chronic fatigue (B=0.39, 95% CI 0.21, 0.57; t=4.29, p<0.001) and intershift recovery (B=-0.241, 95% CI -0.46, -0.02; t=-2.16, p=0.035) were significant predictors of burnout.

CONCLUSIONS

Burnout is a critical concern among orthopaedic nurses and is significantly linked to occupational fatigue/recovery. Addressing chronic fatigue and enhancing intershift energy recovery could mitigate burnout risk. Therefore, optimising work conditions and schedules and developing tailored recovery protocols are vital to safeguarding orthopaedic nurses' well-being.

Types and Contributors to Occupational Fatigue

Although fatigue is commonly experienced in many highly demanding occupations (e.g., military, first responders, etc.), it is poorly defined. Fatigue can strongly affect occupational performance by negatively influencing the ability to interact with the world by altering the capacity to think, move, feel, see, and speak. The first step in fatigue risk management strategies is to establish a context. The context of this narrative review is to specifically describe and discuss the 6 overarching types of occupational fatigue: cognitive, physical, burnout, emotional, visual, and vocal fatigue, and how each affects varying occupations. Furthermore, fatigue type can be influenced by several intrinsic factors, such as sleep deprivation, circadian alignment, ultradian process, sleep homeostasis, and health factors. Similarly, extrinsic factors influence fatigue, such as workload, shift work, and environmental issues. Understanding the types and contributors to occupational fatigue may help clarify the context of occupational fatigue and serve to guide future occupational fatigue management.

Farmers' Mental Health: The Mediating Role of Chronic Fatigue

The agricultural environment is known to be particularly harmful to farmers' psychological health. To better understand how its impact is modulated, this study mainly focuses on the mediating role of chronic fatigue between A) loneliness at work, autonomy, workload, government regulations and policies and financial hardship, and B) life satisfaction, positive affect and psychological distress. The study is based on a sample of 453 Canadian dairy farmers. Structural equation modeling analyses confirmed the mediating role of chronic fatigue in the relationships between the factors studied, with the exception of financial hardship. Implications for research and the psychological burden affecting agricultural workers are discussed.

Occupational fatigue, compassion competence and caring behaviours of intensive care nurses: A structural equation modelling approach

BACKGROUND

No previous study has examined the direct effect of occupational fatigue, inter-shift recovery and compassion competence on caring behaviours, including assurance, knowledge-skill, respect and commitment in intensive care nurses.

AIM

We studied the direct effect of participating nurses' occupational fatigue, inter-shift recovery and compassion competence levels on their caring behaviours and the relationship among these variables.

STUDY DESIGN

This was a descriptive correlational study. All nurses who were registered members of the Turkish Intensive Care Nurses Association were invited to participate in this online survey. This study was conducted with 315 intensive care nurses using convenience sampling between April and July 2022. The data were collected using the Occupational Fatigue Exhaustion/Recovery Scale, which consists of three subscales: acute fatigue, chronic fatigue and inter-shift recovery; the Compassion Competence Scale, including communication, sensitivity and insight subscales; and the Caring Behaviours Inventory-24. In addition, a structural equation model was established using variables correlating with caring behaviours. Independent variables were occupational fatigue, inter-ship recovery and compassion competence; and the dependent variable was caring behaviours in this hypothesized model.

RESULTS

Three hundred and fifteen nurses completed the survey (315/1000) with a response rate of 31.5%. The increase in the inter-shift recovery levels of participants was statistically and positively associated with caring behaviours (95% confidence interval [CI]: 0.001-0.011, β = .154 [moderate effect size], p < .05). The sub-dimensions of the Compassion Competence Scale, that is, communication (95% CI: 0.110-0.443, β = .251 [moderate effect size]) and sensitivity (95% CI: 0.084-0.427, β = .241 [moderate effect size]), were statistically and positively associated with the caring behaviours of participants (p < .05). In addition, independent variables accounted for 35% (large effect size) of the total change in caring behaviours (R2 = 0.350).

CONCLUSIONS

This study suggests that the high inter-shift recovery and compassion competence levels of intensive care nurses are positively associated with their caring behaviours.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should consider the direct effect of occupational fatigue, inter-shift recovery and the compassion competence levels of intensive care nurses on their caring behaviours to provide high-quality care.

A Wake-Up Call to Address Nurse Fatigue

Research exploring differences in fatigue and sleep quality between day- and night-shift nurses highlights the urgent need for action to mitigate nurse fatigue. Nurses need to prioritize their sleep, and nurse leaders must take proactive measures such as providing education for all doing shiftwork, ensuring completion of job requirements during the shift, and creating a culture where nurses take their scheduled breaks.

Examining the Relationship Between Nurse Fatigue, Alertness, and Medication Errors

BACKGROUND

Working for extended hours in a physically and mentally demanding profession has subjected nurses to occupational fatigue. Limited evidence exists about nurse fatigue and alertness changes throughout shift work and their relationship with medication errors and near misses.

PURPOSE

The purposes of this study were to: (1) assess the relationship between nurses' fatigue and alertness, (2) evaluate nurses' fatigue and alertness changes throughout their shift, and (3) examine the relationship between nurses' fatigue, alertness, and medication errors and near misses.

METHODS

This prospective study is part of a larger mixed-method study. Fatigue and alertness data from 14 work and non-workdays were collected from a convenience sample of 90 nurses. A wearable actigraph (ReadibandTM) was used to measure alertness, while ecological momentary assessment (EMA) using text messaging was used to measure nurses' fatigue.

RESULTS

A 1-unit increase in fatigue was associated with a 1.06-unit reduction in nurses' alertness score (β = -1.06, 95% CI: [-1.33, -0.78], p < .01). Night-shift nurses experienced a 31-point reduction in alertness from the start to the end of the work shift. Nurses' fatigue, but not alertness, was associated with medication errors and near misses (OR = 1.26, 95% CI [1.07, 1.48], p = .01).

CONCLUSION

Initiating fatigue mitigation measures during mid-shift, especially for night-shift nurses, may be a viable option to mitigate fatigue and alertness deterioration among nurses and to maintain patient safety. The multifaceted nature of fatigue, as captured by EMA, is a stronger predictor of medication errors and near misses than device-measured alertness.

Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue

OBJECTIVES

Staff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff.

DESIGN

Cross-sectional descriptive study design.

SETTING AND PARTICIPANTS

A total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling.

METHODS

The participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics.

RESULTS

Hierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention.

CONCLUSIONS AND IMPLICATIONS

Staff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents' unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.

The Effects of Organizational Characteristics, Individual Nurse Characteristics, and Occupational Fatigue on Missed Care at Night

BACKGROUND

Missed care is defined as the omission or delay of necessary patient care and is internationally reported by nurses as a significant safety risk. Nurses working at night also report high levels of occupational fatigue that, coupled with inadequate staffing and practice environment support, may impede a nurse's ability to carry out the nursing process and lead to more missed care.

OBJECTIVE

The study's objective was to examine the interrelationships among organizational and nurse characteristics, occupational fatigue, and missed care among nurses working at night.

METHODS

A cross-sectional design was used. Participants included registered nurses (RNs) who worked at night in New Jersey acute care hospitals. Multiple linear regression and simple moderation analyses were performed to examine the associations.

RESULTS

Nurses reported missing necessary care at night. Unsupportive practice environments, high RN workloads, high patient-RN ratios, high chronic fatigue levels, and low intershift recovery were individually associated with missed care at night. High patient-to-RN ratios and chronic fatigue were independently associated with missed care. However, patient-to-registered-staffing levels had the most considerable effect on missed care at night. Nurses' years of experience and the number of hours of sleep between shifts were significant moderators of the relationship between occupational fatigue states and missed care.

DISCUSSION

This study is the first to examine the interrelationship between occupational fatigue levels, organizational and nurse characteristics, and missed care at night. There is an urgent need to implement strategies in hospital organizations that foster work schedules and adequate staffing patterns that lessen nurses' occupational fatigue levels to ensure our workforce's and patients' safety.

Development and evaluation of a scale to measure nurses' unsafe driving behaviour while commuting

Driving is the most prevalent form of commuting for most workers but is also perhaps the most hazardous mode of travel with unsafe driving contributing significantly to road traffic accidents. Despite nurses having been reported as being at higher risk of commuter-related accidents over the last three decades, little is known about unsafe driving behaviours among nurses while commuting, which is unique from other driving routines. Additionally, the lack of appropriate tools to measure such behaviours is apparent. This study aims i) to identify unsafe driving behaviours among nurses while commuting and ii) to develop a scale to assess nurses' unsafe commuting driving behaviours. The study employed a multiphase and multimethod approach to develop the scale, which was subject to stringent validation and evaluation. Themes were specified via the Nominal Group Technique (NGT). Six themes were identified namely: i) violations and reckless driving, ii) negative emotions, iii) drowsy driving iv) mind wandering, v) error and vi) carelessness. Content and face validity were sought through expert review. A total of 442 nurses' data were collected across multisite hospitals for evaluation. Exploratory factor analysis (EFA) resulted in recovered structure and was confirmed through Confirmatory Factor Analysis (CFA) with structural equation analyses being conducted to test predictive validity. All constructs met adequate validity and reliability. Nurses' unsafe driving behaviours while commuting were identified with a novel scale to assess them being both developed and validated. The resulting MyUDWC scale is a suitable tool for measuring nurses' unsafe driving behaviours while commuting.

Utility of salivary cortisol profile as a predictive biomarker in nurses' turnover risk: a preliminary study

BACKGROUND

Predicting nurse turnover risk is crucial due to the global nursing shortage; however, existing predictors, such as fatigue and burnout, lack objectivity. Salivary cortisol is a non-invasive marker of stress and fatigue, but its utility in predicting nurse turnover risk is unknown. We examined whether salivary cortisol profiles across three different day shifts in a month are predictors of the extent of nurses' reluctance to stay in their current jobs.

METHODS

This preliminary longitudinal study followed forty female nurses who engaged in shift work at a university hospital for 3 months. Data at enrollment were collected including demographics, working conditions, chronic fatigue (the Japanese version of the Occupational Fatigue/Exhaustion Recovery Scale), and burnout (Japanese Burnout scale). Salivary cortisol was measured before the three different day shifts (after awakening) during the first month, and the means of these measurements were used as the cortisol profile. The extent of reluctance to stay was assessed using the numerical rating scale at 3 months.

RESULTS

Among the forty female nurses (mean [SD] age, 28.3 [5.1]), all completed follow-up and were included in the analysis. The cortisol profile was associated with the extent of reluctance to stay (P = 0.017), and this association was significant despite adjustments for chronic fatigue and burnout (P = 0.005). A multiple regression model with chronic fatigue, burnout, and job tenure explained 41.5% of the variation in reluctance to stay. When the cortisol profile was added to this model, the association of the cortisol profile was significant (P = 0.006) with an R2 of 0.529 (ΔR2 = 0.114).

CONCLUSIONS

This preliminary study conducted in an actual clinical setting indicated the potential of the salivary cortisol profile across three different day shifts in a month to predict nurses' reluctance to stay in their current jobs. The combination of subjective indicators and the cortisol profile would be useful in predicting nurses' turnover risk.

The insomnia, fatigue, and psychological well-being of hospital nurses 18 months after the COVID-19 pandemic began: A cross-sectional study

BACKGROUND

Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts.

PURPOSE

To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress.

DESIGN

Cross-sectional.

METHODS

Data were collected online mainly through state board and nursing association listservs between July-September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting.

RESULTS

Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices.

CONCLUSION

Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices.

RELEVANCE TO CLINICAL PRACTICE

Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

The measurement of fatigue in clinicians within hospital settings: A systematic review of measurement properties

Medical staff fatigue leads to accidents and mistakes and puts patient safety at risk. A measure of fatigue in the workplace may help to quantify, predict, and manage fatigue. This review aimed to evaluate instruments used to measure fatigue in medical staff within hospitals. A systematic review following the JBI methodology was undertaken. A search for articles was conducted in 2021. Included articles (all validation studies) were assessed for methodological quality using the COSMIN checklist. Measurement property data was evaluated for Quality of Evidence using GRADE methodology. Ten studies representing five instruments were reviewed: Occupational Fatigue Exertion and Recovery scale (now superseded); Occupational Fatigue Exertion and Recovery scale (15-item); Multidimensional Fatigue Inventory; Need for Recovery Scale; and the Swedish Occupational Fatigue Inventory. Four instruments show promise for measuring fatigue in hospital medical staff, however, there is limited certainty in the measure property estimates. The Quality of Evidence for measurement properties for all instruments is insufficient. Further validation studies following the COSMIN standards are needed before recommendations for use can be made.

The Job Leeway Scale: Initial Evaluation of a Self-report Measure of Health-Related Flexibility and Latitude at Work

Purpose Evidence suggests that workers manage health-related challenges at work, in part, by using available leeway to perform work differently. The purpose of this study was to evaluate the reliability and validity of the Job Leeway Scale (JLS), a new 18-item self-report questionnaire designed to assess worker perceptions of available flexibility and latitude to manage health-related challenges at work. Methods Workers seeking assistance for workplace difficulties due to chronic medical conditions (n = 119, 83% female, median age = 49) completed the JLS along with other workplace and health measures. Construct validity was assessed using exploratory factor analysis (EFA), and concurrent validity was assessed by associations with related measures. Results Mean item scores ranged from 2.13 to 4.16 within a possible range of 0-6. The EFA supported three underlying factors: organizational leeway (9 items), task leeway (6 items), and staffing leeway (3 items). Internal consistency (alpha) ranged from 0.78 to 0.91 for subscale scores and 0.94 for the total score. The JLS showed moderate correlations with other work outcome measures including work fatigue, self-efficacy, engagement, and productivity. Conclusion The JLS is a promising new measure with initial support for its reliability and validity to assess worker beliefs of available flexibility to manage health symptoms at work, and this construct may have organizational implications for worker support and accommodation.

Fatigue in nurses and medication administration errors: A scoping review

BACKGROUND

Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs.

OBJECTIVE

Examine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings.

METHOD

Arksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue.

RESULTS

Thirty-eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies.

RELEVANCE TO CLINICAL PRACTICE

Fatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re-evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care.

Sociotechnical Work System Approach to Occupational Fatigue

INTRODUCTION TO THE PROBLEM

Occupational fatigue is a characteristic of excessive workload and depicts the limited capacity to complete demands. The impact of occupational fatigue has been studied outside of health care in fields such as transportation and heavy industry. Research in health care professionals such as physicians, medical residents, and nurses has demonstrated the potential for occupational fatigue to affect patient, employee, and organizational outcomes. A conceptual framework of occupational fatigue that is informed by a sociotechnical systems approach is needed to (1) describe the multidimensional facets of occupational fatigue, (2) explore individual and work system factors that may affect occupational fatigue, and (3) anticipate downstream implications of occupational fatigue on employee well-being, patient safety, and organizational outcomes.

CONCEPTUAL FRAMEWORK OF OCCUPATIONAL FATIGUE

The health care professional occupational fatigue conceptual framework is outlined following the Systems Engineering Initiative for Patient Safety (SEIPS) model and adapted from the Conceptual Model of Occupational Fatigue in Nursing. Future research may apply this conceptual framework to health care professionals as a tool to describe occupational fatigue, identify the causes, and generate solutions. Interventions to mitigate and resolve occupational fatigue must address the entire sociotechnical system, not just individual or employee changes.

Understanding mental fatigue and its detection: a comparative analysis of assessments and tools

Mental fatigue has shown to be one of the root causes of decreased productivity and overall cognitive performance, by decreasing an individual's ability to inhibit responses, process information and concentrate. The effects of mental fatigue have led to occupational errors and motorway accidents. Early detection of mental fatigue can prevent the escalation of symptoms that may lead to chronic fatigue syndrome and other disorders. To date, in clinical settings, the assessment of mental fatigue and stress is done through self-reported questionnaires. The validity of these questionnaires is questionable, as they are highly subjective measurement tools and are not immune to response biases. This review examines the wider presence of mental fatigue in the general population and critically compares its various detection techniques (i.e., self-reporting questionnaires, heart rate variability, salivary cortisol levels, electroencephalogram, and saccadic eye movements). The ability of these detection tools to assess inhibition responses (which are sensitive enough to be manifested in a fatigue state) is specifically evaluated for a reliable marker in identifying mentally fatigued individuals. In laboratory settings, antisaccade tasks have been long used to assess inhibitory control and this technique can potentially serve as the most promising assessment tool to objectively detect mental fatigue. However, more studies need to be conducted in the future to validate and correlate this assessment with other existing measures of mental fatigue detection. This review is intended for, but not limited to, mental health professionals, digital health scientists, vision researchers, and behavioral scientists.

Subjective Perceptions of Occupational Fatigue in Community Pharmacists

INTRODUCTION

Community retail pharmacists are experiencing unsafe levels of stress and excessive demands within the workplace. One aspect of workload stress that has been overlooked among pharmacists is occupational fatigue. Occupational fatigue is a characteristic of excessive workload including increased work demands and reduced capacity and resources to complete the work. The goal of this study is to describe the subjective perceptions of occupational fatigue in community pharmacists by using (Aim 1) a previously developed Pharmacist Fatigue Instrument and (Aim 2) semi-structured interviews.

METHODS

Wisconsin community pharmacists were eligible to participate in the study and recruited via a practice-based research network. Participants were asked to complete a demographic questionnaire, a Pharmacist Fatigue Instrument, and semi-structured interview. Survey data were analyzed using descriptive statistics. Interview transcripts were analyzed using qualitative deductive content analysis.

RESULTS

Totally, 39 pharmacists participated in the study. From the Pharmacist Fatigue Instrument, 50% of the participants stated they had times where they were not able to go above and beyond standard patient care on more than half of the days they worked. A total of 30% of the participants reported that they found it necessary to take short-cuts when providing patient care on more than half of the days they worked. Pharmacist interviews were separated into overarching themes including mental fatigue, physical fatigue, active fatigue, and passive fatigue.

CONCLUSIONS

The findings highlighted the pharmacists' feelings of despair and mental fatigue, fatigue's connectedness to interpersonal relationships, and the complex nature of pharmacy work systems. Interventions aimed at improving occupational fatigue in community pharmacies should consider key themes of fatigue that pharmacists are experiencing.

Occupational stress and burnout among intensive care unit nurses during the pandemic: A prospective longitudinal study of nurses in COVID and non-COVID units

Background

Intensive care unit (ICU) nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses' workload and further exacerbated their stress and burnout. This work investigates occupational stress and burnout experienced by ICU nurses working with COVID and non-COVID patients.

Method

A prospective longitudinal mixed-methods study was conducted with a cohort of ICU nurses working in medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-h shifts. Data on occupational stress and burnout prevalence were collected using validated questionnaires. Physiological indices of stress were collected using wrist-worn wearable technologies. Participants elaborated on the causes of stress experienced each shift by completing open-ended questions. Data were analyzed using statistical and qualitative methods.

Results

Participants caring for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p < 0.001) in comparison to non-COVID unit participants. No differences in stress levels were found when the same participants worked with COVID and non-COVID patients at different shifts (p = 0.58) at the COVID unit. The cohorts expressed similar contributors to stress, based in communication tasks, patient acuity, clinical procedures, admission processes, proning, labs, and assisting coworkers.

Conclusion

Nurses in COVID units, irrespective of whether they care for a COVID patient, experience occupational stress and burnout.

Influence mechanism and impacting boundary of workplace isolation on the employee's negative behaviors

Introduction

Based on social identity theory, by introducing organizational identification as mediating variable and identification orientation as moderating variable, this paper studies the influence mechanism and impacting boundary of workplace isolation on employee fatigue and turnover intention.

Methods

Based on logic relationship, seven basic hypotheses are put forward to construct the theoretical model of the problem. Based on the 300 effective questionnaires being obtained from employees in Mainland China, the empirical investigation adopts the three-phase lag time design. By regression analysis and bootstrap test.

Results

(1) Workplace isolation has a significant positive effect on employee's work fatigue; (2) Workplace isolation has a significant positive effect on employee's turnover intention; (3) Organizational identification plays a partial mediating role between workplace isolation and work fatigue; (4) Organizational identification plays a partial mediating role between workplace isolation and employee's turnover intention; (5) Employee identification orientation negatively moderates the relationship between workplace isolation and organizational identification, that is to say, the higher the degree of identification orientation, the more inhibited the negative impact of workplace isolation on organizational identification; (6) Employee identification orientation has a negative moderating effect, namely, compared with the low degree of employee identification orientation, the higher the employee identification orientation, the positive effect of workplace isolation on work fatigue and turnover intention through organizational identification become weaker.

Discussion

Understanding these influencing mechanisms will have a great influence on guiding managers to mitigate the negative effects of “workplace isolation” in practice and improve the work efficiency of employees.

Attenuated Cardiovascular Reactivity to Acute Psychological Stress Predicts Future Fatigue Symptoms in Truck Drivers

OBJECTIVES

This study aimed to investigate the impact of a 6-month health intervention on truck drivers' cardiovascular reactivity to stress and whether cardiovascular reactivity was predictive of depression, anxiety, or fatigue symptoms at 6-month follow-up.

METHODS

Two hundred thirty-eight truck drivers completed a 6-month cluster randomized controlled trial to increase physical activity and completed a stress protocol (Stroop and mirror-tracing tasks) with measurements of heart rate, systolic blood pressure, and diastolic blood pressure taken, alongside fatigue, anxiety, and depressive symptoms assessment. Measures were taken at 0 and 6 months.

RESULTS

Analyses showed a negative relationship between 0-month diastolic blood pressure reactivity and 6-month persistent fatigue. Trends toward negative relationships between systolic blood pressure reactivity and future anxiety and fatigue symptoms at 6 months were evident.

CONCLUSIONS

Our findings may have serious implications, as fatigue can be a major cause of road traffic collisions in truck drivers.

A fuzzy Bayesian network DEMATEL model for predicting safety behavior

Objectives. Safety behavior significantly affects safety performance in the workplace. This study aimed to develop a Bayesian network (BN) model for managing and improving safety behavior. Methods. This study was carried out in the chemical industries in Iran. The data were gathered by a questionnaire consisting of 13 variables including organization safety priority, systems design, safety communication, safety education, work strategy, human-system interaction, mental workload, environmental distractions, work pressure, fatigue, sleepiness, safety knowledge and locus of control. The BN structure was created using the fuzzy decision-making trial, evaluation laboratory method and expert opinions. Belief updating was used to determine variables with the strongest effect on safety behavior. Results. Locus of control, organization safety priority and safety knowledge were the best predictors of safety behavior. Moreover, it was found that improving organization safety priority and safety knowledge is the best intervention strategy to improve safety behavior significantly. Conclusions. BN is a powerful tool that can model causal relationships among variables. Improving organization safety priority and safety knowledge can lead to the maximum possible level of safety behavior.

The Emergency Medical Services Sleep Health Study: A cluster-randomized trial

BACKGROUND

Greater than half of emergency medical services (EMS) clinician shift workers report poor sleep, fatigue, and inadequate recovery between shifts. We hypothesized that EMS clinicians randomized to receive tailored sleep health education would have improved sleep quality and less fatigue compared to wait-list controls after 3 months.

METHODS

We used a cluster-randomized, 2-arm, wait-list control study design (clinicaltrials.gov identifier: NCT04218279). Recruitment of EMS agencies (clusters) was nationwide. Our study was powered at 88% to detect a 0.4 standard deviation difference in sleep quality with 20 agencies per arm and a minimum of 10 individuals per agency. The primary outcome was measured using the Pittsburgh Sleep Quality Index (PSQI) at 3-month follow-up. Our intervention was accessible in an online, asynchronous format and comprised of 10 brief education modules that address fatigue mitigation topics prescribed by the American College of Occupational Environmental Medicine.

RESULTS

In total, 36 EMS agencies and 678 individuals enrolled. Attrition at 3 months did not differ by study group (Intervention = 17.4% vs. Wait-list control = 18.2%; p = .37). Intention-to-treat analyses detected no differences in PSQI and fatigue scores at 3 months. Per protocol analyses showed the greater the number of education modules viewed, the greater the improvement in sleep quality and the greater the reduction in fatigue (p < .05).

CONCLUSIONS

While intention-to-treat analyses revealed no differences in sleep quality or fatigue at 3 months, per protocol findings identified select groups of EMS clinician shift workers who may benefit from sleep health education. Our findings may inform fatigue risk management programs.

The associations of decent work with wellbeing and career capabilities: a meta-analysis

Introduction

As a global sustainable development goal, the decent work notion has been promoted all over the world at theoretical, practical, and research levels for the purpose of enhancing people's capacity to enjoy freedom, equity, security, and human dignity at work. However, conclusive findings of the impact of decent work on people's wellbeing and longer-term career development are still missing due to a lack of systematic reviews on this topic. This study aims to (a) investigate the associations of decent work with people's wellbeing and their capabilities for sustaining career development and (b) examine the differential associations across different subgroups.

Methods

Databases of literature archived on or before 4 March 2022 were searched. A total of 46 studies met the inclusion criteria and were included in the analysis for the combined Pearson correlation coefficient (r) to estimate the associations of decent work with wellbeing and career capabilities, among which 30 studies (16,026 participants) were used for calculating the association between decent work and wellbeing whereas 26 studies (12,384 participants) were used for decent work and career capabilities.

Results and discussion

First, decent work demonstrates a medium association with wellbeing (r = .48, 95% CI [.45, .51]), and a medium association with career capabilities (r = .44, 95% CI [.40, .49]). Second, no significant differences with respect to the association of decent work with wellbeing and career capabilities were identified across subgroups categorized by developed/developing countries, population type, social status of participants as employee or student, participants from vulnerable/general groups, aspects of wellbeing/career capabilities, and study design. These results pose important implications for informing future research and practice to measure and promote decent work across the world.

Well-Being, Occupational Fatigue, and Sleep Quality among Filipino Nurses working during COVID-19

Fatigue is a common symptom experienced by nurses before the pandemic, but this experience is heightened by the coronavirus (COVID-19) pandemic. The literature has ample evidence of nurses experiencing occupational or work-related fatigue. In addition, human error is a significant consequence of fatigue that can significantly impact patient outcomes and be devastating for a nurse. Guided by Lazarus and Folkman's Transactional Theory of Stress and Coping, we conducted a descriptive, correlational and cross-sectional study aimed to 1) explore the level of occupational fatigue and sleep quality among Filipino nurses working during the COVID-19; 2) determine the relationships between occupational fatigue, sleep quality, and subjective wellbeing among Filipino nurses working during COVID-19 pandemic. One hundred twenty-six Filipino nurses across the United States working during the pandemic were surveyed using RedCap. The study showed that Filipino nurses had moderate to high acute and chronic fatigue levels, lower intershift recovery, and good sleep quality. Evidence and opportunities for health care administrations to create strategies to enhance the wellbeing of their largest and most valuable workforce.

Assessment of Alarm Fatigue Risk Among Oncology Nurses in Jordan

Introduction

Using technology in the clinical setting where clinical alarms frequently occur, resulting in many false alarms, which is called alarm fatigue, alarm fatigue may increase nurses' distraction, and that might negatively affect patient safety.

Objective

This study aimed to assess alarm fatigue among oncology nurses in Jordan.

Methods

A descriptive cross-sectional design was used in a non-profit specialized cancer center. A self-reported questionnaire was answered by nurses who participated in the study.

Results

A total of 222 questionnaires were analyzed with a more than 95% response rate. More than half of the sample (60.4%) were females. The participants were young nurses with a mean age of 25.18 ± 3.33 years. The total mean score of alarm fatigue was 31.62 ± 7.14 on a scale ranging from zero to 52. Post-hoc analysis showed that the palliative unit (25.73 ± 7.22) and emergency room (28.73 ± 6.62) had low scores of total mean alarm fatigue than remaining area of practice, such as the ICU (33.92 ± 6.99); p-value: .004.

Conclusion

Alarm fatigue is a global issue affecting many practice areas. An educational program is recommended for nurses to learn how to deal with alarm fatigue. In order to effectively manage alarms, nurses' education and individual training are crucial.

The relationship between safety climate and safety performance: A review

INTRODUCTION

Since its inception more than four decades ago, research on safety climate has been conducted in many industries. Subsequently, a plethora of systematic literature reviews on safety climate in various work environments has focused on research trends and measurement scales. Yet, despite these reviews, the overall picture of how safety climate influences performance is still not well understood. The current study reviews existing literature on safety climate, specifically how it affects safety performance.

METHOD

Literature searches were conducted using EBSCOhost and Web of Science databases in March 2021. We included English-language, peer-reviewed studies that reported the results of research done on safety climate and safety performance. We extracted data (contextual, theoretical, methodological and definition of safety performance) from these studies and were deductively analyzed and categorized into common themes.

RESULTS

One hundred and sixty-two safety climate studies were identified. We found that studies on safety climate-performance were conducted in 16 types of industries while 23 different theories explained the safety climate-performance relationship. The quantity and quality of variables and methods used varied considerably across the surveys. Safety climate is predominantly used as a predictor while safety-related behavior is the most common definition of safety performance among the articles we reviewed. Few papers from the current review were methodologically strong, suggesting that current evidence on the link between safety climate and safety performance still suffers from common method bias.

CONCLUSIONS

Although literature has provided evidence for the positive effect on safety performance via a strong safety climate, strong and convincing methods are still lacking and the causality of an improved safety climate still needs to be demonstrated.

PRACTICAL APPLICATIONS

The findings of the current review offer a better understanding of how employers can improve safety climate in the workplace in various settings.

Research priorities to reduce risks from work hours and fatigue in the healthcare and social assistance sector

BACKGROUND

The services of Healthcare and Social Assistance (HCSA) workers are needed by society around the clock. As a result, these workers are exposed to shift work and long work hours. The combination of demanding work schedules and other hazards in the HCSA work environment increases the health and safety risks to these workers, as well as to their patients/clients and the public.

METHODS

This paper has three aims: (1) provide an overview of the burden of shift work, long hours, and related sleep and fatigue problems in this sector; (2) suggest research priorities that would improve these; and (3) discuss potential positive impacts of addressing these research priorities for the health and safety of workers and the public. The authors used a modified Delphi approach to anonymously rank-order priorities for improving HCSA worker health and safety and public safety. Input was also obtained from attendees at the 2019 National Institute for Occupational Safety and Health (NIOSH) Work Hours, Sleep, and Fatigue Forum.

RESULTS

The highest rated research priorities were developing better designs for work schedules, and improving the HCSA culture and leadership approaches to shift work and long work hours. Additional priorities are identified.

CONCLUSION

Research in these priority areas has the potential to benefit HCSA workers as well as their patients/clients, employers, and society.

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.

How do high-performance work systems affect work fatigue: The mediating effect of job responsibility and role overload

Work fatigue refers to physical, mental, and emotional exhaustion, resulting in the inability to work. Hitherto research indicate a close relationship between high-performance work systems and work fatigue, and there may be a double-edged sword effect of high-performance work systems on work fatigue. However, a comprehensive theoretical framework has not been developed to understand the relationship between them. Based on the challenge-hindrance stress model, this study employs role overload and job responsibility as mediating variables in a conceptual framework to understand the impact of high-performance work systems on work fatigue. Using the partial least square structural equation model and a sample of 360 employees in China, the mediating effects of role overload and job responsibility were confirmed. Further, the internal mechanisms of how high-performance work systems affect work fatigue are discussed, its adverse effects are confirmed, and its practical implications are proposed.

Psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery Scale among shift-work nurses

Objectives

Shift‐work nurses are at a higher risk of inadequate recovery from fatigue and developing maladaptive fatigue with significant health consequences. Therefore, it is necessary to monitor fatigue and recovery levels with a reliable scale. We investigated psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery scale (OFER‐J) for shift‐work nurses.

Methods

Japanese shift‐work nurses responded to self‐administered questionnaires at baseline (n = 942) and one month later (n = 334). The confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to verify the structural validity and the correlation analysis and one‐way analysis of variance were conducted to test the construct and discriminative validity. Cronbach's alpha coefficient, intra‐class correlation coefficient (ICC), and smallest detectable change (SDC) were calculated to assess reliability.

Results

The CFA showed high correlations between the factors and whilst the goodness‐of‐fit of the three‐factor model was suboptimal, it was in an acceptable range. Most modifications included the error covariance of the Acute Fatigue (AF) and Intershift Recovery (IR) items. The EFA showed that Chronic Fatigue (CF) and AF were not clearly separated, indicating that the two AF items dropped out. Construct and discriminative validity were also well indicated. Cronbach's alpha coefficients were 0.75–0.85. Only CF showed sufficient reproductivity (ICC = 0.74). The SDC for CF, AF, and IR was 14.0, 17.1, and 18.7, respectively.

Conclusions

The validity and reliability of the OFER‐J were verified as acceptable for shift‐work nurses. The OFER‐J could contribute to a data‐based approach to fatigue management in nursing management practice.

Chronic Fatigue Predicts Hospital Nurse Turnover Intentions

OBJECTIVE

The objective of this study was to determine the impact of workforce engagement factors on hospital nurse turnover intentions.

BACKGROUND

Nurse turnover intentions are impacted by occupational fatigue and burnout, which are differentially impacted by fatigue, meaning and joy in work, and work-related resilience.

METHODS

One hundred fifty-one nurses from a southwestern hospital completed online surveys. Path analyses evaluated relationships among variables.

RESULTS

Chronic occupational fatigue was the only significant predictor of turnover intentions among nurses. Although strongly associated with emotional exhaustion and depersonalization (burnout components), burnout did not predict turnover intention. High levels of chronic fatigue predicted lower meaning and joy in work and lower work-related resilience. Although significantly correlated, meaning and joy in work and resilience did not predict total burnout scores when analyzed in causal models.

CONCLUSIONS

Nurse administrators should focus efforts on factors such as chronic occupational fatigue that are likely to impact nurses' decisions to leave their positions.

A human factors approach to evaluate predicators of acute care nurse occupational fatigue

Nurses function at the point of care and assume a significant role in intercepting errors. They work in a mentally and physically demanding profession that is comprised of shift-work, subjecting nurses to considerable fatigue. Yet, few studies constructed a comprehensive model that integrates personal and occupational factors to explore their relationship with various types of fatigue (acute, chronic, physical, mental, and total). Here, we examine this type of comprehensive fatigue-model, in a report that represents one aim of a larger, mixed-methods study. The study sample comprised of 1137 registered nurses working in eight hospitals in a Midwestern state. Nurses reported higher levels of acute and total fatigue than chronic and physical fatigue. Staffing and resource adequacy, exercise, and sleep were among the strongest predictors. Since fatigue is a multi-faceted construct, a comprehensive fatigue-management strategy that targets both day and night-shift nurses is the optimal way to manage nurse fatigue.

A Worksite Self-management Program for Workers with Chronic Health Conditions Improves Worker Engagement and Retention, but not Workplace Function

Purpose An increasing number of workers in the US have chronic health conditions that limit their ability to work, and few worksite interventions have been tested to improve worker coping and problem solving at work. The purpose of this study was to evaluate a worksite-based health self-management program designed to improve workplace function among workers with chronic health conditions. Methods We conducted a randomized, controlled trial of a worksite self-management program ("Manage at Work") (clinicaltrials.gov #NCT01978392) for workers with chronic health conditions (N = 119; 82% female, ages 20-69). Most workers were recruited from the health care or light manufacturing industry sectors. Workers attended a 5-session, facilitated psychoeducational program using concepts of health self-management, self-efficacy, ergonomics, and communication. Changes on outcomes of work engagement, work limitation, job satisfaction, work fatigue, work self-efficacy, days absent, and turnover intention at 6-month follow-up were compared to wait-list controls. Results The most prevalent chronic health conditions were musculoskeletal pain, headaches, vision problems, gastrointestinal disorders, respiratory disorders, and mental health disorders. The self-management program showed greater improvement in work engagement and turnover intent at 6-month follow-up, but there was no evidence of a parallel reduction in perceived work limitation. Trends for improved outcomes of work self-efficacy, job satisfaction, and work fatigue in the intervention group did not reach statistical significance in a group x time interaction test. Conclusions Offering a worksite self-management program to workers with chronic health conditions may be a feasible and beneficial strategy to engage and retain skilled workers who are risking disability.Clinical trial registration: Clinicaltrials.gov #NCT01978392.

Psychological distress, depression symptoms and fatigue among Quebec nursing staff during the COVID-19 pandemic: A cross-sectional study

Aim

To describe the state of health of Quebec nursing staff during the pandemic according to their exposure to COVID‐19, work‐related characteristics and sociodemographic factors (gender, generational age group). State of health was captured essentially by assessing psychological distress, depression symptoms and fatigue.

Design and methods

A large‐scale cross‐sectional study was conducted with 1,708 nurses and licenced practical nurses in Quebec (87% women, mean age of 41 ± 11 years). The survey included several questionnaires and validated health‐related scales (psychological distress, depression symptoms and fatigue). The STROBE guidelines were followed in reporting the study's findings.

Results

Results showed that the prevalence of psychological distress and depression symptoms was moderate to severe. Women, generation Xers and Yers, nurses who cared for COVID‐19 patients and those with a colleague who was infected with COVID‐19 at work scored higher for fatigue, psychological distress and depression.

Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses

PURPOSE

This study aimed to evaluate the relationships among nurse fatigue, individualized nursing care, and nurse-reported quality of care.

DESIGN

The study used a cross-sectional design. Data from 858 registered nurses providing bedside care in hospitals were collected between March and April 2021 in the United States.

METHODS

Participants completed a self-administered online survey, including the Occupational Fatigue Exhaustion Recovery scale, the Individualized Care Scale-Nurse version, and a single item assessing nursing care quality. Relationships among the study variables were examined using multiple linear and logistic regression models.

FINDINGS

Nurses' higher levels of acute fatigue were significantly associated with decreased perceptions of individualized nursing activities provided to patients on their last shifts, specifically related to personal life condition and decision-making control. Nurses' higher levels of chronic fatigue were significantly associated with decreased perception of individualized nursing activities provided to patients on their last shifts related to clinical condition, personal life condition, and decision-making control. Nurses with higher levels of acute or chronic fatigue, and who perceived their nursing care activities as less individualized were less likely to assess their quality of care as excellent.

CONCLUSION

These findings suggest that addressing hospital nurses' acute and chronic fatigue may contribute to promoting the delivery of individualized nursing care and in improving patients' quality of care.

CLINICAL RELEVANCE

Healthcare institutions are encouraged to regularly monitor and manage nurse fatigue to improve the delivery of individualized and quality nursing care to their patients.

Occupational Fatigue and Associated Factors among Saudi Nurses Working 8-Hour Shifts at Public Hospitals

Introduction

Shift work and demanding work schedules contribute to occupational fatigue, negatively affecting patient safety and nurses' well-being, consequently placing nurses and patients at risk for injury and adverse health outcomes. For preventing fatigue and minimizing its negative consequences, information about its characteristics and associated factors is required.

Objectives

This study aimed to assess occupational fatigue "acute fatigue, chronic fatigue, and inter-shift recovery" among Saudi nurses working 8-h shifts. Further, we explored factors associated with fatigue from nurses' perspectives.

Methods

We conducted a mixed-method study with a convenience sample of Saudi nurses (N = 282) working in four public hospitals in Saudi Arabia. Data were collected using the nurses' profile form; the occupational fatigue exhaustion recovery (OFER) scale, for relevant quantitative data; and open-ended questions for qualitative data. We used descriptive and inferential statistics for analysing the quantitative data and content analysis of the qualitative data.

Results

The results showed that Saudi nurses rated themselves moderately fatigued with working 8-h shifts. The inter-shift recovery subscale showed a negative correlation with chronic fatigue and acute fatigue (r = -0.518, r = -0.356, P < 0.001). Sleeping problems, meals per day, and frequency of exercise showed significant relations with chronic fatigue among nurses (p < 0.05). In addition, three categories were derived from the qualitative content analysis. Saudi nurses reported work-related, psychosocial, and individual factors as major contributors to fatigue and recovery.

Conclusion

Occupational fatigue is a multidimensional issue, and nurses and nurse managers are challenged with reducing its prevalence and negative impact on nurses and patients. Our quantitative and qualitative findings suggest the need for a comprehensive approach to fatigue management and mitigation, including organizational support, creative workforce planning, flexible work schedules, and psychosocial support. Fatigue reduction and prevention policies and educational programs are vital strategies to improve nurses' well-being and inter-shift recovery.

The relevant factors of work-related fatigue for occupational vibration-exposed employees

Background

To date, little is known about the effects of factors linked to work-related fatigue on vibration-exposed workers. Thus, the purpose of this study was (1) to assess the effects of vibration exposure time per week and work-related fatigue on workers and (2) to identify factors associated with work-related fatigue caused by long-term exposure to occupational vibration.

Methods

This study used data collected from the 5th Korean Working Conditions Survey. A total of 34,820 non-vibration-exposed and 10,776 vibration-exposed employees were selected from the data. The χ² and multiple logistic regression were used to determine the effect of vibration exposure time per week and the effects of factors of work-related fatigue on workers.

Results

The prevalence of work-related fatigue in vibration-exposed workers (30.5%) was higher than that of non-exposed workers (15.9%). The prevalence of work-related fatigue was higher for female and workers with depression, anxiety, and shift work, and those with authority to control their work pace had statistically significantly higher odds than those who did not. The employees who had the authority to control their order of work (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.81–0.95) and method of work (OR: 0.90; 95% CI: 0.82–0.98) had statistically significantly lower odds than those who did not. The OR of work-related fatigue symptoms was highest among employees whose vibration exposure time per week were 30.0%–40.0% (OR: 2.36; 95% CI: 1.96–2.83). Lower OR was observed as vibration exposure time per week decreased.

Conclusions

The results of the present study suggest an association between occupational vibration and work-related fatigue and longer vibration exposure time per week, causing an increased prevalence of work-related fatigue symptoms. Measures to protect workers exposed to occupational vibration from work-related fatigue must be taken.