Hospital nurse force theory: a perspective of nurse fatigue and patient harm

Flemish critical care nurses' experiences regarding the influence of work-related demands on their health: a descriptive interpretive qualitative study

BACKGROUND

Critical care nurses (CCNs) around the globe face other health challenges compared to their peers in general hospital nursing. Moreover, the nursing workforce grapples with persistent staffing shortages. In light of these circumstances, developing a sustainable work environment is imperative to retain the current nursing workforce. Consequently, this study aimed to gain insight into the recalled experiences of CCNs in dealing with the physical and psychosocial influences of work-related demands on their health while examining the environments in which they operate. The second aim was to explore the complex social and psychological processes through which CCNs navigate these work-related demands across various CCN wards.

METHODS

A qualitative study following Thorne's interpretive descriptive approach was conducted. From October 2022 to April 2023, six focus groups were organised. Data from a diverse sample of 27 Flemish CCNs engaged in physically demanding roles from three CCN wards were collected. The Qualitative Analysis Guide of Leuven was applied to support the constant comparison process.

RESULTS

Participants reported being exposed to occupational physical activity, emotional, quantitative, and cognitive work-related demands, adverse patient behaviour, and poor working time quality. Exposure to these work-related demands was perceived as harmful, potentially resulting in physical, mental, and psychosomatic strain, as well as an increased turnover intention. In response to these demands, participants employed various strategies for mitigation, including seeking social support, exerting control over their work, utilising appropriate equipment, recognising rewards, and engaging in leisure-time physical activity.

CONCLUSIONS

CCNs' health is challenged by work-related demands that are not entirely covered by the traditional quantitative frameworks used in research on psychologically healthy work. Therefore, future studies should focus on improving such frameworks by exploring the role of psychosocial and organisational factors in more detail. This study has important implications for workplace health promotion with a view on preventing work absenteeism and drop-out in the long run, as it offers strong arguments to promote sufficient risk management strategies, schedule flexibility, uninterrupted off-job recovery time, and positive management, which can prolong the well-being and sustainable careers of the CCN workforce.

Influence of Evidence-Based Design Strategies on Nurse Wellness

OBJECTIVES

The purpose of this study was to understand how specific evidence-based design strategies are related to aspects of nurse wellness.

BACKGROUND

Addressing burnout among the healthcare workforce is a system-level imperative. Nurses face continuous and dynamic physical and emotional demands in their role. Greater insight into the role of the physical environment can support efforts to promote nurse wellness.

METHODS

This exploratory qualitative study was conducted at new Parkland Hospital in Dallas, TX. We conducted five focus groups with nursing staff in July 2018. These sessions covered five topics related to nursing work in the facility which had been redesigned nearly 3 years earlier: (1) professional and social communication, (2) workflow and efficiency, (3) nurses' tasks and documentation, (4) ability to care for patients, and (5) nurses' overall health. We conducted a thematic analysis and first identified different aspects of wellness discussed by participants. Then, we examined how nurses related different design elements to different aspects of their wellness.

RESULTS

Participants included 63 nurses and nurse managers. They related environmental factors including facility size, break rooms, and decentralized workstations to social, emotional/spiritual, physical, intellectual, and occupational aspects of wellness.

CONCLUSIONS

It is critical to inform and integrate nurses at all levels into planning, design, and activation of new healthcare environments in order to ensure the well-being of nurses and, therefore, their ability to effectively support patients.

Predicting nurse fatigue from measures of work demands

Fatigue arising from excessive work demands is a known safety challenge in hospital nurses. This study aimed to determine which measures of work demands during nursing work are most predictive of hospital nurse fatigue levels at the end of the work shift. Measures of work demands of registered nurses from two hospital units in the United States were collected from organizational data sources, wearable sensors, and questionnaires. Fatigue levels were measured at the start and end of each shift using the Brief Fatigue Inventory. Multilevel linear regression analysis was used to predict end of shift fatigue based on work demand variables. The best fit model included multiple variables from organizational data sources and a physical activity variable measured by a wearable sensor. Organizational data can be used to create dynamic measures of work demands as they occur and predict end of shift fatigue levels in hospital nurses.

Factors correlating with prolonged fatigue among emergency department nurses

BACKGROUND

Fatigue affects nurses negatively and leads to physical, cognitive and emotional problems that may influence nurses' quality of life. However, there is a lack of studies about prolonged fatigue and its relationship with socio-demographic characteristics and job-related psychosocial factors among nurses, especially emergency nurses, worldwide and in Jordan.

AIMS

This study aims to assess the relationship between demographic factors, physical health, psychological distress and job-related psychosocial factors (psychological job demands, job control and social support) and prolonged fatigue among emergency department nurses in Jordan.

METHODS

A descriptive correlational study using a convenience sample was used to recruit 153 emergency nurses. Physical health Questionnaire, General Health Questionnaire, Job Content Questionnaire and Checklist Individual Strength were used.

RESULTS

The majority of emergency nurses experienced abnormally prolonged fatigue, moderate health, high psychological distress, high job demands and low job control and social support. Significant negative relationships were addressed between job control, social support and prolonged fatigue, whereas income had a negative weak relationship. Psychological distress and job demands had a positive weak relationship with prolonged fatigue. There was a significant positive weak relationship between psychological distress, job demands and prolonged fatigue. Job-related psychosocial factors (with exception of social support) and mental health were the predictors of prolonged fatigue.

CONCLUSIONS

Prolonged fatigue is a multidimensional phenomenon that can be affected by several factors such as job-related psychosocial factors and psychological health. These factors should be taken into consideration when testing and developing interventions to minimise prolonged fatigue among emergency nurses.

The Relationship of Childhood Adversity on Burnout and Depression Among BSN Students

BACKGROUND

Research evidence strongly suggests that Adverse Childhood Experiences (ACEs) predispose individuals to development of an increased sensitivity to stress and negative physical and mental health outcomes in adulthood.

PURPOSE

To determine if there was a relationship between the number of ACEs reported by first semester BSN students and their reported level of Burnout and Depression.

METHODS

211 students enrolled in the first semester of upper division courses of their BSN program completed self-report questionnaires which measured the number of ACEs, the level of Depression and the level of Burnout.

RESULTS

The number of reported ACEs by participants had a significant relationship on the levels of burnout and severity of depressive symptoms. Female students with a higher number of ACEs were more likely to report higher levels of Burnout A (Emotional Exhaustion) and Burnout B (Depersonalization), and higher depression severity scores compared to males.

CONCLUSION

Nursing programs should educate faculty concerning the frequency and range of adverse experiences that students may have had prior to admission to the nursing program, and the possible relationship with Burnout and Depression. Faculty can provide early information on counseling and support services.

A work systems analysis approach to understanding fatigue in hospital nurses

Occupational fatigue is an important challenge in improving health and safety in health care systems. A secondary analysis of cross-sectional data from a survey sample comprised 340 hospital nurses was conducted to explore the relationships between components of the nursing work system (person, tasks, tools and technology, environment, organisation) and nurse fatigue and recovery levels. All components of the work system were significantly associated with changes in fatigue and recovery. Results of a tree-based classification method indicated significant interactions between multiple work system components and fatigue and recovery. For example, the relationship between a task variable of 'excessive work' and acute fatigue varied based on an organisation variable related to 'time to communicate with managers/supervisors'. A work systems analysis contributes to increased understanding of fatigue, allowing for a more accurate representation of the complexity in health care systems to guide future research and practice to achieve increased nurse health and safety. Practitioner Summary: This paper explored the relationships between nursing work system components and nurse fatigue. Findings revealed significant interactions between work system components and nurses' fatigue and recovery. A systems approach allows for a more accurate representation of complexity in work systems and can guide interventions to improve nurse health and safety.

Interpretation of Hospital Nurse Fatigue Using Latent Profile Analysis

There has been a lack of consensus in the literature related to the conceptualization, definition, and measurement of hospital nurse fatigue. Using latent profile analysis, the Hospital Nurse Force Theory provided a conceptual format to identify 3 profiles of nurse fatigue from subjective reports of hospital patient care nurses in a survey cohort. All fatigue and adaptation variables demonstrated significant inverse relationships. Describing nurse fatigue in profiles that include measures of acute, chronic, physical, and mental fatigue dimensions provided a new and expanded view of nurse fatigue to monitor trends comprehensively and evaluate fatigue risk management strategies.

At pains to consent: A narrative inquiry into women's attempts of natural childbirth

BACKGROUND

With only 1.2% of all annual U.S. births registered as out-of-hospital births, national trends show an increase in medicalised hospital births. Caesarean sections have become the most common surgical procedure in the U.S.; Caesarean section rates have increased from 20.6% in 1997 to 31.5% in 2009. Furthermore, in 2009, 67% of hospital births utilised epidural analgesia and 26% used oxytocin augmentation. In response to the increased medicalisation of childbirth within the U.S., some women resist standardised medical procedures and instead choose to labour and birth without medical intervention.

AIM

The purpose of this study was to understand and contextualise the childbirth experiences of first-time mothers who planned to have a natural childbirth (without medical intervention) in the Midsouthern United States.

METHODS

Using narrative inquiry, we collected data from six participants through semi-structured life-story interviews.

FINDINGS

Utilising thematic analysis, four recurring themes emerged: (1) benefits and limitations of pre-labour self-education; (2) labouring women's experiences of relationality; (3) the importance of birth stories and expectations; and (4) the creation of false dilemmas and complexities of "informed choice."

DISCUSSION AND CONCLUSION

The women's stories suggest that U.S. medical establishments, the media, and society need to empower pregnant and birthing women by creating new narratives of labour and positive spaces of relationality. Furthermore, health care professionals need to critically examine their usage of the medical model of care while respecting women's choices and agency.

Relationships between Wellness, Fatigue, and Intershift Recovery in Hospital Nurses

Fatigue and recovery have been associated with health, safety, and performance outcomes in hospital nurses. There is a growing emphasis on fatigue risk management and health promotion programs to support nurses and promote quality in hospitals. However, little is known about the relationships between fatigue and wellness measures in nurses. This study used a tree-based classification method to identify associations between self-reported fatigue, recovery and wellness measures in a survey study of hospital nurses. Significant relationships between multiple wellness measures and acute fatigue, chronic fatigue, and intershift recovery levels were identified. Specifically, the findings include critical levels of wellness measures where fatigue and recovery change. These findings have implications for ongoing efforts to develop effective fatigue management programs in this population.

An integrative review: fatigue among nurses in acute care settings

OBJECTIVE

The aim of this study was to examine current research related to nurse fatigue and identify effective prevention strategies.

BACKGROUND

Work-related fatigue negatively affects patient safety and nurses' well-being and increases employer costs. Preventing fatigue and minimizing its negative consequences require knowledge of the contributing factors if effective interventions are to be designed and implemented.

METHODS

This review targeted original research (2002-2013) examining fatigue among nurses working in acute care settings.

RESULTS

Nurses experience high rates of fatigue. Shifts longer than 12 hours contribute to increased fatigue and errors, but the evidence was inconsistent with regard to age and fatigue level. Individual lifestyle, unit culture, and organization policies influence the prevalence and intensity of work-related fatigue.

CONCLUSIONS

Preventing work-related fatigue requires multifaceted approaches involving the organization, the clinical unit, and the individual.

Evaluation of physically and mentally fatiguing tasks and sources of fatigue as reported by registered nurses

AIMS

To identify fatiguing tasks and develop a model of sources of fatigue in nursing work.

BACKGROUND

Research has identified multiple factors contributing to occupational fatigue; however, comprehensive consideration of diverse factors identified by nurses as contributing to fatigue in nursing work systems is lacking.

METHODS

Content and frequency analyses were performed on previously unpublished data from an online survey of registered nurses. Responses from 100 registered nurses to questions related to the most fatiguing tasks in their work and factors that cause those tasks to be most fatiguing were analysed.

RESULTS

Physically demanding patient care tasks, and organisation, management and logistics tasks, respectively, were listed as the most frequent physically and mentally fatiguing. Time and multitasking demands were listed frequently as sources of both fatigue dimensions.

CONCLUSIONS

Registered nurses reported working in environments that include physically and mentally fatiguing tasks. They identified factors related to work content demands, including physical and mental task demands as well as time and multitasking demands, as most frequently contributing to fatigue.

IMPLICATIONS FOR NURSING MANAGEMENT

This work and our conceptual model of sources of fatigue provide a framework to support nurses, nursing managers and administrators to develop strategies to reduce fatigue among RNs.