"It is really so exhausting": Exploring intensive care nurses' perceptions of 24-hour long shifts

The effect of progressive relaxation exercise on fatigue level of intensive care nurses: A randomised controlled trial

OBJECTIVE

The aim of this study is to examine the effect of progressive muscle relaxation exercise on the fatigue level of intensive care nurses.

METHODS

In this clinical trial, the participants were randomly assigned to the intervention (n = 38) and control (n = 37) groups after obtaining necessary approvals. The nurses in the intervention group applied progressive muscle relaxation every day for 4 weeks, with each session lasting for 15 min. None of the participants in the control group were subjected to any intervention. Data were collected using a questionnaire and the fatigue severity scale (FSS) (the lower the total score, the less the fatigue). The questionnaires were applied at the baseline, and the FSS was applied at the baseline and the end of the first, second, third, and fourth weeks.

RESULTS

While the FSS mean scores of the intervention and control groups at baseline were 4.84 ± 1.01 and 5.23 ± 0.96, respectively (p = 0.086), the FSS mean score of the intervention group (3.13 ± 1.58) was significantly lower than the score of the control group (4.12 ± 1.70) at the fourth week (p = 0.011). Also in the 1st, 2nd, and 3rd weeks of the study, the FSS scores of the nurses in intervention group decreased statistically significantly compared to that of the nurses in the control group.

CONCLUSIONS

This study indicated that a 4-week progressive muscle relaxation intervention alleviated fatigue in intensive care nurses.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05435664 (Clinicaltrials.gov).

[Tiredness, fatigue and exhaustion: all the same or manifestations of a continuum?-Food for thought]

Owing to the COVID-19 pandemic and the associated post-COVID syndrome, the concept "fatigue" has gained significant importance. However, both the definition and the causes of fatigue differ depending on the disease pattern in question. Moreover, individuals who describe their symptoms in everyday clinical settings seem almost universally to use the terms tiredness, fatigue and exhaustion synonymously. In 2007, Olson described these three terms as being distinct states in her view, but that they can be placed in relation to each other on a continuum. Taking up this consideration, an overview of current research is provided. For this purpose, the published literature of the last 2 years was searched for the terms "tiredness", "fatigue" and "exhaustion". Some common diagnostic instruments can be found. However, the great variety of instruments used to capture the three terms is striking. Despite these different diagnostic and definition possibilities, different therapeutic measures can be derived for each of the three symptoms. It is crucial, especially with regard to further therapy, to separate the three terms tiredness, fatigue and exhaustion from each other and to consider each of them separately on the common continuum. This is the only way to establish both an accurate diagnosis and the successful individual therapy that goes along with it.

Registered Nurse’s Perception on Nursing Brand Image during the COVID-19 Pandemic Era in Indonesia

BACKGROUND: Coronavirus disease 2019 (COVID-19) has changed the image of nursing globally. However, the nursing brand image remains limited to explore among registered nurses during the COVID-19 pandemic era in Indonesia. AIM: This study aims to explore registered nurse’s perception of nursing brand image in Indonesia during the COVID-19 pandemic era. METHODS: The descriptive qualitative study was conducted using purposive sampling technique. This study enrolled 15 registered nurses who cared for COVID-19 patients. The semi-structured interview was conducted face-to-face within 45–60 min through WhatsApp video calls. Colaizzi’s methods and NVivo 12TM Plus were used for data analysis. RESULTS: The data analysis revealed five themes, namely, (1) Caring as a nursing brand image; (2) Interprofessional collaboration culture; (3) Providing 24-h holistic care; (4) Being more respected; (5) Becoming a long-life learner. CONCLUSION: During COVID-19 pandemic era, nurses perceived that nursing brand image becomes more positive in Indonesia.

Work hours and overtime of nurses working in Cambodian hospitals

Aim

To examine the nature and prevalence of Cambodian nurses’ work hours and overtime and related factors

Background

The chronic shortage of nursing workforce is a major cause of overtime among nurses.

Introduction

Nursing shortage and working overtime among nurses negatively affect nurse and patient outcomes, but nurses’ work hours and overtime in Cambodia have not been comprehensively examined.

Methods

A multicenter cross‐sectional study was conducted in four Cambodian hospitals. Data were collected from 253 nurses providing direct nursing care using a questionnaire. The STROBE checklist was used for reporting this study.

Results

More than a fifth of staff nurses worked more than 48 h, which is the legal work hour limit in Cambodia. Two major reasons for working mandatory or voluntary overtime, on‐call or 24‐h on‐call were (a) not wanting to let down colleagues and (b) able to get all work done. The number of patients cared for was related to whether or not nurses worked 48 h or more.

Conclusion

Overtime work and adverse nurse scheduling are common in Cambodia.

Implications for nursing and health policy

Nurse managers and healthcare institutes in Cambodia need to monitor Cambodian nurses’ work hours, which are often beyond the legal work hour limit. Moreover, it is important to understand why nurses work overtime and develop health policies, strategies, and programs that can help promote patient and nurse safety and retain qualified nursing staff. The 24‐h on‐call practice needs to be regulated according to the labor policy in healthcare institutes to prevent adverse nurse and patient outcomes.

Comparison of 12 and 24-hours shift impacts on ICU nursing care, efficiency, safety, and work-life quality

BACKGROUND

Nursing care quality is a central concern of health policy, and nurses' shift schedules affect the quality of care and their work-life status internationally. A lack of reliable information on the differences between 24- and 12-h shifts on care quality, nursing care quality, patient safety, and adverse and missed events warranted investigation in Cambodia.

AIM

We aimed to examine the impacts of 12-h shifts compared with 24-h shifts. The purpose was to find evidence to support the use of maximum 12-h shifts by registered nurses working in ICU contexts.

METHOD

A convergent mixed-method approach was chosen to highlight the issues around the long hours of shift work. We designed a 12-week coaching course during the implementation of 12-h shifts and assigned 30 nurses each to an experimental group and a control group. Data from quantitative surveying of 58 participants were combined with focus group discussions of 20 participants to gather qualitative insights. Pre- and post-test analysis involved descriptive statistics and the Wilcoxon sign rank test for quantitative analysis and then merged with qualitative findings from content analysis. Reporting of this study was steered by the STROBE and COREQ guidelines for quantitative and qualitative findings, respectively.

RESULTS

Quantitative results showed the increased quality of nursing work-life, nursing care quality, and patient satisfaction; decreased missed care and adverse events were significantly associated with the 12-h shift. Qualitative data supported nurses preferring 12-h rather than 24-h shift options.

DISCUSSION AND CONCLUSIONS

Changing rosters to 12-h shifts in the intervention caused increases in the study variables' scores. Results indicate the benefits of 12-h shifts on the quality of nursing work-life, nursing care quality, missed care, adverse events, and patient safety.

IMPLICATIONS FOR NURSING AND NURSING POLICY

We found that 24-h shifts had deleterious impacts on care quality and safety and nurse satisfaction with work. Health and nursing policymakers are urged to provide resources and strategize to implement 12 h shifts as soon as possible since the current 24-h shifts of nurses affect the patient quality of care and their health and safety and that of the nurses.

Nurses' experiences and preferences around shift patterns: A scoping review

Objective

To explore the evidence on nurses’ experiences and preferences around shift patterns in the international literature.

Data sources

Electronic databases (CINHAL, MEDLINE and Scopus) were searched to identify primary studies up to April 2021.

Methods

Papers reporting qualitative or quantitative studies exploring the subjective experience and/or preferences of nurses around shift patterns were considered, with no restrictions on methods, date or setting. Key study features were extracted including setting, design and results. Findings were organised thematically by key features of shift work.

Results

30 relevant papers were published between 1993 and 2021. They contained mostly qualitative studies where nurses reflected on their experience and preferences around shift patterns. The studies reported on three major aspects of shift work: shift work per se (i.e. the mere fact of working shift), shift length, and time of shift. Across all three aspects of shift work, nurses strive to deliver high quality of care despite facing intense working conditions, experiencing physical and mental fatigue or exhaustion. Preference for or adaptation to a specific shift pattern is facilitated when nurses are consulted before its implementation or have a certain autonomy to self-roster. Days off work tend to mitigate the adverse effects of working (short, long, early or night) shifts. How shift work and patterns impact on experiences and preferences seems to also vary according to nurses’ personal characteristics and circumstances (e.g. age, caring responsibilities, years of experience).

Conclusions

Shift patterns are often organised in ways that are detrimental to nurses’ health and wellbeing, their job performance, and the patient care they provide. Further research should explore the extent to which nurses’ preferences are considered when choosing or being imposed shift work patterns. Research should also strive to better describe and address the constraints nurses face when it comes to choice around shift patterns.

COVID-Well Study: Qualitative Evaluation of Supported Wellbeing Centres and Psychological First Aid for Healthcare Workers during the COVID-19 Pandemic

Supported wellbeing centres were set up in UK hospital trusts as an early intervention aimed at mitigating the psychological impact of COVID-19 on healthcare workers. These provided high quality rest spaces with peer-to-peer psychological support provided by National Health Service (NHS) staff volunteers called 'wellbeing buddies', trained in psychological first aid. The aim of the study was to explore the views of centre visitors and operational staff towards this COVID-19 workforce wellbeing provision. Qualitative semi-structured interviews were undertaken with twenty-four (20F, 4M) employees from an acute hospital trust in the UK. Interviews were digitally recorded and transcribed, data were handled and analysed using thematic analysis. Interviews generated 3 over-arching themes, and 13 sub-themes covering 'exposure and job roles', 'emotional impacts of COVID-19 and 'the wellbeing centres'. Supported wellbeing centres were viewed as critical for the wellbeing of hospital employees during the first surge of COVID-19 in the UK. Wellbeing initiatives require managerial advocacy and must be inclusive. Job-related barriers to work breaks and accessing staff wellbeing provisions should be addressed. High quality rest spaces and access to peer-to-peer support are seen to benefit individuals, teams, organisations and care quality. Training NHS staff in psychological first aid is a useful approach to supporting the wellbeing of the NHS workforce during and beyond the COVID-19 pandemic.