An Examination of Work Characteristics, Fatigue, and Recovery Among Acute Care Nurses

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Factors associated with the disinfection of devices attached to peripheral intravenous catheters performed by the nursing team in pediatric units

Background

Peripheral intravenous catheterization, as well as drug administration through it, represents one of the most performed procedures by the Nursing team and, for that, precautions need to be adopted to offer harm-free care.

Objective

To verify the association of Nursing professionals' work shift and training time with proper disinfection of intravenous catheter devices in pediatric units.

Methods

A cross-sectional and analytical study conducted between June and August 2021 in three hospitalization units of a Pediatric Hospital. The inclusion criterion was drug administration via peripheral intravenous catheters performed by Nursing professionals. The data were analyzed according to inferential statistics, adopting p ≤ .05 as significance level.

Results

There were a total of 385 observations of drug administration procedures. The device was not disinfected in 60.3% of the cases, there was no friction at the suitable time in 86.3%, and the disinfectant was not allowed to dry in 72.5%. The work shift exerted no influence on performance of the disinfection procedure (p = .376). However, longer training time was associated with a lower rate in performing such procedure (p < .001).

Conclusion

Performing friction below the recommended time can cause a false sense of prevention of catheter-associated bloodstream infection; therefore, training sessions and strategies for adherence to the disinfection procedures should be considered, mainly for professionals with more training time.

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.

Overtime and alertness of rotating-shift nurses: An observational study using ecological momentary assessment

AIMS AND OBJECTIVES

This study aimed to determine the effect of overtime on alertness at work among rotating-shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts.

BACKGROUND

Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work.

DESIGN

A prospective observational study was employed. The study followed STROBE checklist for observational studies.

METHODS

Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real-time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed-effect models were employed to investigate the association between overtime and alertness.

RESULTS

A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous-day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous-day overtime hours and consecutive overtime days in all shifts.

CONCLUSIONS

The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty.

RELEVANCE TO CLINICAL PRACTICE

Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

Comparison of physical activity, fatigue, and dynamic balance levels of health workers according to their working positions

BACKGROUND

Many studies have evaluated physical activity and fatigue. However, a causal relationship between physical activity, fatigue and balance in healthcare workers has not been established.

OBJECTIVE

To evaluate the activity levels, fatigue, and dynamic balance of health workers who work actively or in a desk job in many different units in the hospital.

METHODS

72 Health workers from two different groups participated in the study, 37 were active workers (AW), and 35 were desk workers (DW) at the Diyarbakir Gazi Yaşargil Training and Research Hospital. Participants were given a Sociodemographic Information Form, an International Physical Activity Questionnaire (IPAQ), and a 30-s Chair Stand Test (30-s CST) with a Modified Borg Scale (MBS) before starting work in the morning and at the end of work.

RESULTS

69.4% of the study participants were female, and 54.2% were between 20 and 30 years old. It was found that the values of moderate physical activity, walking, and total physical activity were significantly higher in active workers than desk workers (p = 0.000). There was no statistically significant difference between the means of work start and after work fatigue of both groups (p > 0.05). A statistically significant difference was found when the starting and finishing work values of the dynamic balance tests of the groups were compared (p = 0.006).

CONCLUSION

It was found that the level of physical activity and dynamic balance of individuals working at desk jobs was significantly lower than that of the active group.

The influence of workplace incivility on the fatigue of female nurses:the mediating effect of engagement

AIMS

To identify the associations of workplace incivility, engagement and fatigue among Chinese female nurses, and further explore whether engagement can play a mediating role.

BACKGROUND

Nurses are at a high risk of fatigue. However, no research has been done to examine the associations among nurses' workplace incivility, engagement and fatigue.

METHODS

The cross-sectional study was conducted in Jiangsu Province, China. Self-administered questionnaires were distributed to 1,200 female nurses, including The Fatigue Scale, Workplace Incivility Scale, Gallup Workplace Questionnaire and demographic variables. Valid responses were obtained from 1,035 (86.3%) of participants. Hierarchical multiple regression analysis was performed to examine the associations among workplace incivility, engagement and fatigue.

RESULTS

The mean fatigue score was 6.54±3.07. Workplace incivility and engagement were related to fatigue (P<0.01). Engagement partly mediated the association between workplace incivility and fatigue (a*b =0.086, bias-corrected 95% CI: 0.059, 0.116; P<0.01), and the proportion of the mediating effect accounted for by engagement was 33.0%.

CONCLUSION

Chinese female nurses suffered from high level of fatigue. The improvement of female nurses' engagement may be helpful to alleviate the impact of workplace incivility on fatigue.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers should reduce workplace incivility of female nurses by promoting engagement to reduce fatigue.