Did rest breaks help with acute fatigue among nursing staff on 12-h shifts during the COVID-19 pandemic? A cross-sectional study

COVID-19 pandemic: what factors compromised the mental capacity to work of nursing technicians?

OBJECTIVES

to identify the factors that influenced the mental capacity to work of nursing technicians during the COVID-19 pandemic.

METHODS

a cross-sectional study, carried out at two reference hospitals in assisting the population during the COVID-19 pandemic. A total of 237 professionals from Intensive Care Units participated and answered a questionnaire. Multiple linear regression models were used to assess the correlation between mental capacity to work and variables related to risks of contamination, institutional support and health.

RESULTS

lack of COVID-19 tests, lack of knowledge of routine, absences in 2021 and mental illness contributed to worse mental capacity to work. Management embracement and physical capacity were considered protective factors.

CONCLUSIONS

reduced work capacity in relation to mental demands can affect professional performance and quality of care, with implications for patients and health institutions.

Prevalence of psychological and mental health symptoms among nursing professionals during the COVID-19 pandemic in the Americas: Systematic review and meta-analysis

To assess the prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic on the American continent. A systematic review and meta-analysis of observational studies that estimated the prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic was performed through bibliographic database searches. A three-level meta-analysis model was used with the inverse variance method, tau was estimated via restricted maximum likelihood and logistic transformation, and heterogeneity was presented as tau2 and I2. Of the 7467 studies obtained, 62 were included in the meta-analysis, which involved 52 270 nursing professionals. The overall prevalence for at least one mental health symptom was 56.3% (50.4%, 62.1%; I2 = 98.6%, p < 0.001). Eight mental health symptoms were found; among them, the most prevalent were burnout (52.1%, 37.1%, 88.8%; I2 = 98.5%, p < 0.001) and fear (52.1%, 30.1%, 73.3%; I2 = 98.1%, p < 0.001). The prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic on the American continent was high, and strategies should be developed and implemented by managers and government agencies to promote the well-being, physical and mental health of nursing professionals. Studies like this one are necessary to highlight the need for efforts in the implementation of promotion and prevention actions to be developed by health organisations, managers and leaders with a view to improving the quality of life of nursing workers.

What alleviates the harmful effect of strain on recovery from work of 4478 health and social services workers? A cross-sectional study

AIM

To analyse whether the harmful effect of job demands on recovery can be alleviated by healthy lifestyle, psychological recovery experiences and job resources. We also describe their prevalence among employees in different types of eldercare service and in the health and social services sector in general.

DESIGN

Cross-sectional study.

METHODS

The data were collected using a self-report survey in 2020 in the health and social services sector organizations (n = 4478). Employees were classified as the following service types: general health and social services (N = 3225), home care (N = 452), service housing (N = 550) and outpatient and ward care (N = 202). The data were analysed using percentages, cross-tabulations and logistic regression analysis.

RESULTS

Poor recovery, high job demands, low appreciation and low autonomy in terms of worktime and breaks were more prevalent in eldercare. Employers could alleviate the risk of high job demands by offering job resources-appreciation, autonomy in terms of worktimes and breaks-and motivating employees to maintain healthy lifestyle habits and use recovery experiences such as relaxation.

CONCLUSION

The study emphasizes the importance of appreciation in the health and social services sector context. Even with moderate levels of appreciation employers can protect employees from poor recovery from work in the demanding health and social services work environment.

IMPACT

Eldercare employees face continuous and accumulating work strain at the same time as the sector struggles against a labour shortage. One way to prevent the harmful consequences of strain is to enhance recovery from work. Employers could alleviate the risk of high job demands and poor recovery by showing appreciation and giving employees more autonomy in terms of work time and breaks during the workday. This could also motivate employees to keep up healthy lifestyle habits and use their recovery experiences. Results are important especially in the daily management of HSS work. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Managers in the health and social services sector and eldercare can use these findings to promote recovery from work.

REPORTING METHOD

STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Workplace ostracism in healthcare: Association with job satisfaction, stress, and perceived health

AIMS

To examine (1) the association between healthcare workers' workplace ostracism and job satisfaction, stress and perceived health, and (2) whether this relationship is mediated by loneliness and self-esteem.

DESIGN

A cross-sectional study.

METHODS

Healthcare (N = 569) managers and employees (nurses, practical nurses, doctors and social workers) in Finland responded to a semi-structured survey in January 2021 and evaluated their experiences of workplace ostracism, job satisfaction, stress, perceived health, loneliness and self-esteem during the last year. To examine the association of these variables, linear regression and mediator model tests were performed.

RESULTS

Workplace ostracism had a clear direct association with job satisfaction, stress and perceived health. Loneliness fully mediated the relationship between workplace ostracism, stress and perceived health, and partly mediated the association between workplace ostracism and job satisfaction. Self-esteem partly mediated the association between workplace ostracism, stress, job satisfaction and perceived health.

CONCLUSION

The experience of workplace ostracism in organizations is a significant factor in job satisfaction, stress and perceived health. Healthcare organizations could strengthen job satisfaction and increase workers' well-being by strengthening social relationships in the organization and, via that, reducing turnover intention.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study gives understanding and information to the healthcare profession on how workplace ostracism affects work well-being and workplace relationships. Workplace ostracism decreases interaction, which can also endanger patient care if information is not openly exchanged.

IMPACT

This study indicated that workplace ostracism weakened job satisfaction more than loneliness. More commonality and consideration for others at work are needed because these factors may help increase work well-being and decrease exits from working life. Further research is needed on why workplace ostracism occurs in healthcare workplaces.

REPORTING METHOD

STROBE.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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 Relationship Between Rest Breaks and Professional Burnout Among Nurses

BACKGROUND

Professional burnout is a well-studied phenomenon marked by feelings of depersonalization, emotional exhaustion, and decreased accomplishment. Affecting nearly half of all nurses, burnout presents a threat to health outcomes of the nurse, patient, organization, and society. Despite a growing literature on professional burnout, specific interventions that address key contributing factors have not been well described.

OBJECTIVE

The primary aim of this integrative literature review was to evaluate the relationship between rest breaks and professional burnout among registered nurses.

METHODS

A literature search was performed in the APA (American Psychological Association) PsycInfo, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Cochrane Library, Embase, and PubMed databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a reporting guideline.

RESULTS

Five articles were selected for final synthesis; 1 was of "high" quality and 4 were of "good" quality. The literature showed that rest breaks were protective against professional burnout among registered nurses, especially when integrated with nursing management support, staffing support, and complementary strategies. Several threats to validity were identified as limitations among the articles selected for final synthesis.

CONCLUSIONS

Rest breaks are effective in decreasing professional burnout among registered nurses, especially when combined with management support, staffing support, and complementary strategies. Future research should focus on a deeper evaluation of staffing support models, as well as identifying how nursing leaders can integrate complementary strategies across health care settings to reduce burnout.

Nurses' Rest Breaks and Fatigue: The Roles of Psychological Detachment and Workload

BACKGROUND

Rest breaks have been shown to reduce acute fatigue, yet not all nurses who take rest breaks report lower fatigue. Psychological detachment-letting go of work-related thoughts-during rest breaks and workload may be key factors in explaining this phenomenon.

OBJECTIVE

To examine the mediating role of psychological detachment during rest breaks and determine how workload moderated that pathway to lower acute fatigue among hospital nurses.

METHODS

In this cross-sectional study, data were collected from 1861 12-hour shift nurses who answered an online survey between July and September 2021. The survey included measures of occupational fatigue, psychological detachment from work, workload, and questions on breaks, work, health, and demographics. Structural equation modeling was used in Mplus 8.9 software to estimate the direct and indirect effects of rest breaks on acute fatigue at 3 levels of workload.

RESULTS

Nurses, on average, reported high acute fatigue, rarely experienced psychological detachment during rest breaks, and reported heavy workloads. Around 60% were able to sit down for a break on their last shift but with patient-care responsibilities. The relationship between taking a rest break and acute fatigue was fully mediated by psychological detachment from work. However, this relationship only held in the context of manageable workloads.

CONCLUSION

Our findings showed that within-shift recovery is possible when nurses can psychologically detach from work during rest breaks. However, this within-shift recovery mechanism was disrupted for nurses with heavy workloads.

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.

Fatigue as a Cause of Professional Dissatisfaction Among Chinese Nurses in Intensive Care Unit During COVID-19 Pandemic

Aim

To clarify the mediating role of burnout and the moderating role of turnover intention in the association between fatigue and job satisfaction among Chinese nurses in intensive care units (ICU) during the COVID-19 pandemic.

Methods

A cross-sectional survey of fifteen provinces in China was conducted, using an online questionnaire, from December 2020 to January 2021, during the COVID-19 pandemic. A total of 374 ICU nurses (effective response rate: 71.37%) provided sufficient responses. Sociodemographic factors, job demographic factors, fatigue, burnout, job satisfaction, and turnover intention were assessed using questionnaires. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive modeling (GAM) were performed to examine all the considered research hypotheses.

Results

Fatigue was found to be negatively and significantly associated with job satisfaction. Moreover, burnout played a partial mediating role and turnover intention played a moderating role in the relationship between fatigue and job satisfaction.

Conclusion

Over time, a state of physical and mental exhaustion and work weariness among Chinese ICU nurses potentially results in job burnout and consequently promotes the level of job dissatisfaction. The results also found that turnover intention played a moderating role in the relationship between burnout and job satisfaction. Specific policies could be considered to eliminate nurses' fatigue and negative attitudes during times of public health emergencies.

The State of Rest Break Practices Among 12-Hour Shift Hospital Nurses in the United States

OBJECTIVE

This cross-sectional study aimed to explore the characteristics, content, and context of rest breaks taken by hospital nurses.

BACKGROUND

Nurses often miss, skip, or take interrupted breaks. To improve the quality of breaks and promote within-shift recovery, it is important to understand current rest break practices including break activities and contextual challenges around them.

METHODS

Survey data from 806 nurses were collected between October and November 2021.

RESULTS

Most nurses did not take regular breaks. Rest breaks were often interrupted, spent being worried about work, and rarely resulted in a relaxed state. Common break activities were having a meal or a snack, and browsing the Internet. Regardless of workload, nurses considered patient acuity, staffing, and unfinished nursing tasks when deciding to take breaks.

CONCLUSION

Rest break practices are of poor quality. Nurses mainly consider workload-related factors when taking breaks, which warrants the attention of nursing administration.

Work schedule characteristics and occupational fatigue/recovery among rotating-shift nurses: A cross-sectional study

AIMS

To determine the effects of work schedule characteristics on occupational fatigue and recovery among rotating-shift nurses in South Korea.

BACKGROUND

Understanding the effects of work schedule characteristics on occupational fatigue is important to prevent adverse nurse outcomes and to ensure patient safety.

METHODS

This study used secondary data analysis with a cross-sectional design. Data were collected on 436 rotating-shift nurses in 2018. Nurses' occupational fatigue and recovery were measured using the Occupational Fatigue Exhaustion/Recovery Scale. We used quantile regression models.

RESULTS

The scores for acute and chronic fatigue and intershift recovery were 70.40, 73.39, and 29.82, respectively. Overtime hours, number of night shifts, number of consecutive days off, and breaks were significant influential factors in some quantiles of acute fatigue, chronic fatigue, and intershift recovery, while total working hours was only associated with chronic fatigue in the 25th quantile.

CONCLUSIONS

The quantile and linear regression models revealed different results for work schedule factors that affect occupational fatigue and intershift recovery among rotating-shift nurses.

IMPLICATION FOR NURSING MANAGEMENT

These findings have important implications for developing targeted strategies and policies to reduce occupational fatigue and improve intershift recovery for rotating-shift nurses with different levels of occupational fatigue and recovery.