Caregiver Fatigue: Implications for Patient and Staff Safety, Part 1

Examining the impact of 12-hour day and night shifts on nurses' fatigue: A prospective cohort study

Background: Fatigue is prevalent among hospital nurses and has been linked to medical errors and decreased patient safety. However, little is known regarding the relationship between occupational physical activity, sedentary behavior, and fatigue. Objective: To assess the impact of 12-hour shifts on nurses' fatigue and its relationship to occupational physical activity and sedentary behavior. Design: Prospective-cohort study design Setting(s): Midwestern trauma one academic medical center Participants: A total of 80 registered nurses working 12-hour day and night shifts participated in this study and completed momentary measures of fatigue (texting, aim one). Only 52 participants were included in aim two analyses (included activity monitoring, aim two). Methods: Occupational patterns of momentary fatigue was measured via ecological momentary assessments. Occupational physical activity and sedentary behaviors (e.g., step count, time spent sitting, standing, and walking) were measured for 14 continuous days using the ActivPAL3 micro activity monitor. Mixed models were used to examine the effects of shift type and time within a shift on occupational fatigue. General estimation equations were used to examine the relationship between time spent sitting, standing, and walking on fatigue. Results: Regardless of shift type, nurses exhibited a significant rise in fatigue; however, the rise was greater during night shifts compared to day shifts. Walking was positively associated with fatigue during day shifts, and negatively associated with fatigue during night shifts. Conclusions: The rise in fatigue was greater among nurses working night shifts compared to day shifts, which could place them at greater risk for fatigue-related consequences. The relationship between walking and fatigue was moderated by shift-type. Tweetable abstract: Nursing fatigue rises during 12-hour shifts, but the rise is greater for those working night shifts @DrRobertoBenzo.

The impact of implementing a psychiatric emergency hotline on the reduction of acute hospitalizations in a Swiss tertiary hospital

BACKGROUND

Inpatient treatment is not the most beneficial treatment setting for many patients with psychiatric disorders and overcrowding is a recurrent problem for psychiatric hospitals. Therefore, it is important to develop strategies to limit avoidable inpatient treatment. This study sought to evaluate the impact of an emergency hotline that was developed to better manage psychiatric patients, particularly for identifying those requiring a hospital admission.

METHODS

This pre-post intervention quality improvement study compared changes in the management of psychiatric patients' admission before and after the introduction of an emergency hotline where a specialist in psychiatry examines all inpatient referral from private practitioners. Main outcomes were the change in proportion of hospital admissions after referral from a private practitioner before and within 3 months after the intervention. Secondary outcomes were the average length of hospital stay, proportion of non-voluntary admission, the time required for triage and the impact of the intervention on treatments' costs. Fisher's Exact test was used to test the primary hypothesis of difference in the proportion of hospitalized patients before and after introduction of the emergency hotline. Secondary outcomes were tested with Student's t-test for continuous variables and Fishers's Exact test for proportions.

RESULTS

Among 45 admission requests from private practitioners during the 3 months after introduction of the new emergency hotline, 25 (55.6%) were accepted as inpatient treatment, while 20 (44%) were redirected to more appropriate outpatient treatments. There was a highly significant difference from the baseline period during which all 34 requests were accepted (44% vs 100%, p < 0.001). In addition, for the patients hospitalized after the introduction of the emergency hotline there was a trend-level reduction of the average length of stay (9.32 days vs 17.35 days).

CONCLUSION

Implementation of an emergency hotline manage by a specialist in psychiatry for admissions to acute psychiatric wards is feasible and simple to use. Importantly, it allows to significantly decrease the proportion of hospitalizations. Additional studies are needed to assess the generalizability of these exploratory results to other health care settings.

Fatigue and the Female Nurse: A Narrative Review of the Current State of Research and Future Directions

Background: The female nurse exhibits a multitude of personal and environmental characteristics that renders this population especially prone to fatigue. The consequences of fatigue in nurses are widespread and impactful at the personal, organizational, and societal levels. These include high injury rates and burnout in the nurse and poor patient and organizational outcomes. Objective: This article discusses the implications of fatigue in female nurses, including the impacts of fatigue across multiple entities (e.g., worker, patient, organization). It also reviews the current state of the research, including recent work on nurse fatigue and work schedule characteristics, and key areas for future work that would help empirically establish approaches to counter the detrimental and widespread effects of fatigue. Method: A narrative literature review was conducted resulting from an analysis of the literature limited to peer-reviewed studies. Results: A confluence of factors combines to elevate the prevalence and risk of fatigue in the female nurse. Numerous measures have established that performance-based fatigue results from nursing work schedules in nurses. Data also demonstrate that fatigue accumulates across successive shifts. Recent evidence supports the use of objective fatigue measures, including psychomotor reaction time and muscle function-related variables. Current gaps in the literature are delineated in the text. Conclusions: Strategic and well-designed research studies, as well as recent technological advances in fatigue tracking tools have the potential to help workers, administrators, and organizations develop fatigue management programs that could reduce the heavy burdens of fatigue on a multitude of health, safety, and economical outcomes.

Impact of nurse's worked hours on medication administration near-miss error alerts

Long working hours have been shown to negatively impact adverse events in health care. In this study, a retrospective correlational design was used to evaluate the relationship between working hours and near-miss medication error alerts. During a two-year period, 5372 nurses triggered 420,706 near-miss alerts on 9, 285, 786 medication administrations. Nurses who worked 60 h or more in a week yielded an average near-miss rate of 4.0% compared to 3.0% (p <.001) for nurses who did not. Nurses working extended hours had a significantly increased risk of triggering a near-miss alert compared to those not working extended hours.

Night-shift nurses and drowsy driving: A qualitative study

BACKGROUND

Drowsy driving following the night shift is persistent among nurses resulting in elevated rates of vehicle crashes and crash-related injuries and deaths. While considerable effort has been dedicated to the development of countermeasures, implementation of these countermeasures in nursing has lagged behind other shift work oriented industries. Developing effective countermeasures for drowsy driving in nurses requires a thorough characterization of nurse's perceptions of drowsy driving and potential mitigations.

OBJECTIVE

The objective of this research was to elicit night shift nurses' perceptions of drowsy driving, countermeasures, and educational and technological interventions.

DESIGN

Perceptions were elicited through a semi-structured interview protocol. The protocol design was driven by previously identified research gaps. Questions focused on four topics: perceptions of drowsy driving, current practices and methods to mitigate drowsiness during the shift and commute, preferences and expectations for training on drowsiness management, and, preferences and expectations for technological mitigations.

SETTING

The data collection took place at a large urban hospital in Texas, USA.

PARTICIPANTS

Thirty night-shift nurses were recruited with voluntary sampling. No nurses declined to participate after initially consenting. The participants were male and female nurses who currently worked a 12 hour night shift. The nurses had between 1 and more than 20 years of experience and worked in a variety of units.

METHOD

The interview recordings were transcribed by the research team and entered into a qualitative data analysis software. Transcripts were analyzed by two independent coders with a grounded theory approach to identify common themes and subthemes across participants.

FINDINGS

Feelings of drowsiness typically manifested immediately following the shift or during the post work commute. Nurses responded to drowsiness by engaging in multiple ineffective countermeasures (e.g., listening to music) and effective countermeasures (e.g., naps) were used sparingly. Experiences and mitigation methods traversed through the nurses' social network although they did not always alter behavior. Nurses were uncertain but enthusiastic about educational and technological interventions preferring practical training and auditory interactive alerts.

CONCLUSIONS

The findings suggest a strong need for real time drowsiness interventions during or immediately prior to nurses' post work commutes. Nurses' enthusiasm for training and technology to prevent drowsy driving suggests high levels of readiness and acceptance for such interventions. Future work should focus on the development and implementation of practical training and technological interventions for drowsy driving in nurses.

Cross-sectional study of aggression against Spanish nursing personnel and effects on somatisation of physical symptoms

INTRODUCTION

Violence against nursing personnel in their place of work is a severe problem generating important consequences for these workers. Even though there is a large body of research on the subject, the emotional impact of aggression against healthcare workers continues to be debated.

OBJECTIVES

The objective of this quantitative, observational cross-sectional study was to analyse the effects of aggression against nursing personnel and the mediating role of anxiety in somaticising physical symptoms.

METHOD

The sample was made up of 1357 nursing professionals who answered questionnaires evaluating their sensitivity to anxiety and the presence of somatic symptoms.

RESULTS

Of the professionals who indicated that they had been the victims of aggression by family members or patients in the previous year, 52.8% said it had happened to them on one occasion, 25.2% had experienced two episodes, while 6.9% and 15.1% said they had undergone three or more aggressions, respectively. Although 89.3% of the professionals affected by acts of indicated that they had not undergone physical or psychological consequences, there was a higher prevalence of somatic alteration among workers who had been victims of violence in the workplace. Furthermore, aggression at work had a direct effect on physical somatisation, which in turn acted as a mediator in the level of anxiety of nursing professionals. Thus, aggression increased the level of anxiety of nurses through the appearance of somatic symptoms.

CONCLUSIONS

The results are discussed based on some of the consequences that appeared after episodes of aggression in the healthcare sector and their relationship.

The Continuing Saga of Nurse Staffing: Historical and Emerging Challenges

Registered nurses are the backbone of America's health systems, providing care and support to patients across the lifespan. Appropriate nurse staffing is critical to ensure safe and effective care for patients. Nurse staffing is a complex topic; nurse administrators find themselves facing escalating challenges to meet staffing needs. These challenges can be attributed to a variety of factors, both historical and new. This article examines the current factors contributing to nursing shortages, nurse staffing challenges, and the implications of inappropriate staffing on both financial and patient outcomes.

Fatigue in Intensive Care Nurses and Related Factors

BACKGROUND

Fatigue negatively affects the performance of intensive care nurses. Factors contributing to the fatigue experienced by nurses include lifestyle, psychological status, work organization and sleep problems.

OBJECTIVE

To determine the level of fatigue among nurses working in intensive care units and the related factors.

METHODS

This descriptive study was conducted with 102 nurses working in intensive care units in the West Black Sea Region of Turkey. Data were collected between February and May 2014 using a personal information form, the Visual Analogue Scale for Fatigue (VAS-F), the Hospital Anxiety and Depression Scale and the Pittsburg Sleep Quality Index.

RESULTS

The intensive care nurses in the study were found to be experiencing fatigue. Significant correlations were observed between scores on the VAS-F Fatigue and anxiety (p=0.01), depression (p=0.002), and sleep quality (p<0.001).

CONCLUSION

Anxiety, depression and quality of sleep were significantly affected by the intensive care nurses' levels of fatigue. These results can be of benefit in taking measures which may be used to reduce fatigue in nurses, especially the fatigue related to work organization and social life.

Integrated Imaginative Distention Therapy to Cope with Fatigue. DIMMI SI Study: The First Randomized Controlled Trial in Multiple Sclerosis

Introduction

Fatigue is a frequent, disabling, and difficult to treat symptom in neurological disease and in other stress-related conditions; Integrated Imaginative Distention (IID) is a therapy combining muscular and imaginative relaxation, feasible also in disabled subjects; the DIMMI SI trial was planned to evaluate IID efficacy on fatigue.

Methods

The design was a parallel, randomised 1:1 (intervention:waiting list), controlled, open-label trial. Participants were persons with multiple sclerosis (pwMS), persons with insomnia (pwINS), and health professionals (HP) as conditions related to fatigue and stress. The primary outcome was the post-intervention change of fatigue; secondary outcomes were changes in insomnia, stress, and quality of life (QoL). Eight IID weekly training group sessions were delivered by a skilled psychotherapist. The study lasted 12 months.

Results

One hundred and forty-four subjects were enrolled, 48 for each condition. The mean change in Modified Fatigue Impact Scale (MFIS) score among exposed was 7.7 [95% CI 1.1, 14.4] (P = 0.023) in pwMS; 7.1 [1.9, 12.3] (P = 0.007) among pwINS, and 11.3 [4.3, 18.2] among HP (P = 0.002). At the last follow-up, the benefit was confirmed on physical fatigue for pwMS, on total fatigue for pwINS and HP.

Conclusions

DIMMI SI is the first randomized controlled trial evaluating the efficacy of IID on fatigue. IID resulted a complementary intervention to reduce fatigue in stress-related conditions, in both health and disease status. NCT02290990ClinicalTrials.gov.

Electronic supplementary material

The online version of this article (doi:10.1007/s40120-017-0081-9) contains supplementary material, which is available to authorized users.

Characteristics of nursing professionals and the practice of ecologically sustainable actions in the medication processes

Objectives:

to verify the correlation between the characteristics of professionals and the practice of sustainable actions in the medication processes in an ICU, and to determine if interventions such as training and awareness can promote sustainable practices performed by nursing staff in the hospital.

Methods:

before-and-after design study using Lean Six Sigma methodology, applied in an intensive care unit. Nursing staff were observed regarding the practice of ecologically sustainable actions during medication processes (n = 324 cases for each group (pre and post-intervention)) through a data collection instrument. The processes analyzed involved 99 professionals in the pre-intervention phase and 97 in the post-intervention phase. Data were analyzed quantitatively and the association of variables was accomplished by means of statistical inference, according to the nature of the related variables.

Results:

the education level was the only characteristic that showed to be relevant to an increase in sustainable practices, with a statistically significant difference (p = 0.002). When comparing before and after the intervention, there was an increase in environmentally friendly actions with statistically significant differences (p = 0.001).

Conclusions:

the results suggest that institutions should encourage and invest in formal education, as well as training of health professionals to promote sustainable practices in the hospital.

Exploring nurse leader fatigue: a mixed methods study

AIM

To describe hospital nurse leaders' experiences of fatigue.

BACKGROUND

Fatigue is a critical challenge in nursing. Existing literature focuses on staff nurse fatigue, yet nurse leaders are exposed to high demands that may contribute to fatigue and associated risks to patient, nurse and organisational outcomes.

METHODS

A mixed method approach comprising semi-structured interviews and the Occupational Fatigue Exhaustion Recovery scale with 21 nurse administrators (10 nurse managers and 11 nurse executives) from hospitals in a Midwestern state.

RESULTS

Most nurse leaders experience fatigue; nurse managers reported higher levels of chronic fatigue. Participants identified multiple sources of fatigue including 24 h accountability and intensity of role expectations, and used a combination of wellness, restorative, social support and boundary setting strategies to cope with fatigue. The consequences of nurse leader fatigue include an impact on decision-making, work-life balance and turnover intent.

CONCLUSIONS

The high prevalence of nurse leader fatigue could impact the turnover intent of nurse administrators and quality of care.

IMPLICATIONS FOR NURSING MANAGEMENT

This study highlights the significance and consequences of nurse leader fatigue. As health care organisations continue to raise awareness and establish systems to reduce nurse fatigue, policies and programmes must be adapted to address nurse leader fatigue.