Describing objectively measured intensive care nurses' physical work activity behavioural patterns during a 12-hr shift

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.

Optimizing Nurse Workflow Efficiency: An Examination of Nurse Walking Behavior and Space Accessibility in Medical Surgical Units

OBJECTIVE

This study aimed to investigate the effect of spatial adjacencies on nurses' walking patterns and the subsequent impact on staff satisfaction with perceived accessibility and adjacency-related issues.

BACKGROUND

Recognizing the crucial importance of spatial adjacencies in healthcare facilities is essential, as they significantly affect staff morale, fatigue management, operational efficiency, error reduction, and overall patient care excellence, highlighting the need for objective assessments to evaluate the impact of facility layout and space configuration on workflow patterns and staff satisfaction in patient care units.

METHODS

Integrating on-site observations with survey data, we explored how spatial adjacencies affect staff walking behavior and satisfaction in two med-surgical unit floors.

RESULTS

The findings highlighted a significant frequency of movements between nurse stations, patient rooms, and medication areas. Regression analysis identified several contributing factors to staff satisfaction, including the proximity of supplies, team visibility, ease of access across departments, and the location of equipment rooms. Specifically, satisfaction with the proximity of supplies was positively associated with increased provider satisfaction with workflow, quality of care, and workplace. Additionally, valuable feedback from staff revealed concerns regarding break room placement, medication area functionality, and disparities in the availability of supplies.

CONCLUSION

This study highlighted the critical need for carefully planned spatial adjacency strategies to enhance workflow efficiency and raise clinical staff satisfaction within healthcare facilities. The actionable insights gleaned from this research offer valuable direction to architects, healthcare administrators, and design professionals, enabling the creation of environments that positively resonate with healthcare providers and improve healthcare operations.

Quantifying Workload and Stress in Intensive Care Unit Nurses: Preliminary Evaluation Using Continuous Eye-Tracking

OBJECTIVE

(1) To assess mental workloads of intensive care unit (ICU) nurses in 12-hour working shifts (days and nights) using eye movement data; (2) to explore the impact of stress on the ocular metrics of nurses performing patient care in the ICU.

BACKGROUND

Prior studies have employed workload scoring systems or accelerometer data to assess ICU nurses' workload. This is the first naturalistic attempt to explore nurses' mental workload using eye movement data.

METHODS

Tobii Pro Glasses 2 eye-tracking and Empatica E4 devices were used to collect eye movement and physiological data from 15 nurses during 12-hour shifts (252 observation hours). We used mixed-effect models and an ordinal regression model with a random effect to analyze the changes in eye movement metrics during high stress episodes.

RESULTS

While the cadence and characteristics of nurse workload can vary between day shift and night shift, no significant difference in eye movement values was detected. However, eye movement metrics showed that the initial handoff period of nursing shifts has a higher mental workload compared with other times. Analysis of ocular metrics showed that stress is positively associated with an increase in number of eye fixations and gaze entropy, but negatively correlated with the duration of saccades and pupil diameter.

CONCLUSION

Eye-tracking technology can be used to assess the temporal variation of stress and associated changes with mental workload in the ICU environment. A real-time system could be developed for monitoring stress and workload for intervention development.

Nurses' occupational physical activity and workload in a perioperative intensive care unit in Slovenia

The field of nursing includes heavy occupational physical demands, including walking and standing for longer periods of time, in addition to moving and lifting. As such, in the context of a typical work shift, many nurses generally achieve the World Health Organization's recommended 10,000 steps per day. This study aimed at estimating the daily physical activity and workload of nurses in a perioperative intensive care unit. The data sources for this study included data from the hospital information system on various procedures and interventions, and the Silva Ex3 Plus pedometers for measuring steps, kilometers, calories, and activity time across various shifts in a perioperative intensive care unit. Twenty nurses from Slovenia volunteered to participate in this observational study. Over 13 weeks, a nurse working an 8-hour shift walked an average of 5,938 steps (4.4 km). However, nurses who worked a 12-hour weekend day shift came very close to the World Health Organization's recommendation with an average of 9,003 steps (6.5 km). A total of 227 patients were admitted and an average of 80 nursing interventions were performed per day and there was a positive relationship between physical activity, workload, and patient admissions in the perioperative intensive care unit (p = 0.001). Results of this study could help managers better understand nurses' physical activity and workload during various shifts in the perioperative intensive care unit.

Levels of actigraphy-derived physical activity among Polish nurses: factors associated with the prevalence of selected metabolic disorders

Numerous studies demonstrate a relationship between physical activity and the development of non-communicable diseases. Nurses play a crucial role in the healthcare system, and their demanding work can have an impact on their health. The objective of this cross-sectional study was to assess physical activity in relation to factors predisposing to the occurrence of specific metabolic disorders among Polish nurses. The measurements included physical activity level using ActiGraph GT3X, body weight composition using Tanita MC-980, body mass index, waist circumference, blood pressure using Welch Allyn 4200B, lipid profile, and fasting blood glucose using CardioChek PA. The results indicate that nearly one-third (31.75%) of the total sample of studied nurses do not meet the criteria for the minimum amount of physical activity of at least moderate intensity. Furthermore, over half of the surveyed nurses (55.5%) were classified as overweight or obese based on BMI, and almost half (42.86%) had abdominal obesity. The regression model, employing linear regression, revealed that factors predisposing to selected metabolic disorders were age, engaging in multiple jobs, and the number of steps per day. There is a pressing need to implement comprehensive and supportive initiatives to improve the overall health condition of nurses in Poland through increased physical activity. Activating and supporting this professional group is an investment that benefits not only the nurses themselves but also the healthcare system and the entire nation.

Daily variation in physical activity during mechanical ventilation and stay in the intensive care unit

BACKGROUND

Early mobilisation of mechanically ventilated patients during their stay at an intensive care unit (ICU) can improve physical recovery. Yet, an objective and specified description of physical activities while in the ICU is lacking. Therefore, our aim was to describe the objectively assessed type, quantity, and daily variation of physical activity among mechanically ventilated patients while in the ICU.

METHOD

In an observational study in two mixed medical/surgical ICUs, we measured body posture in 39 patients on mechanical ventilation using a thigh- and chest-worn accelerometer while in the ICU. The accelerometer describes time spent lying, sitting, moving, in-bed cycling, standing and walking. Descriptive analysis of physical activity and daily variation was done using STATA.

RESULTS

We found that mechanically ventilated patients spend 20/24 h lying in bed, 3 h sitting and only 1 h standing, moving, walking or bicycling while in the ICU. Intervals of non-lying time appeared from 9.00 to 12.00 and again from 18.00 to 21.30, with peaks at the hours of 9.00 and 18.00.

CONCLUSION

ICU patients on mechanical ventilation were primarily sedentary. Physical activity of mechanically ventilated patients seems to be related to nurse- and/or physiotherapy-initiated activities. There is a need to create an awareness of improving clinical routines, towards active mobilisation throughout the day, for this vulnerable patient population during their stay in the ICU.

Nurses' Work-Related Mental Health in 2017 and 2020-A Comparative Follow-Up Study before and during the COVID-19 Pandemic

The COVID-19 pandemic put a lot of strain on healthcare organizations. Nurses account for over 50% of healthcare staff, and how nurses perform in their work is influenced by a number of human and work environmental factors. However, to our knowledge, there has not been a previous study with the intention to look at all areas that affect a sustainable working life and how these impact nurses' mental well-being. The aim of this study is to investigate the association between, and the effect of, different factors in nurses' work situations associated with nurses' work-related mental-health diagnoses, before and during the COVID-19 pandemic. A questionnaire was sent out to all 9219 nurses in the Swedish county of Skane in the spring of 2017 and during wave two of the COVID-19 pandemic in the fall of 2020. The data were analyzed through logistic regression analysis. The results showed that lack of joy in the daily work, an increased workload and lack of support from co-workers had an increased association with work-related mental-health diagnoses. Future research regarding the long-term impact of COVID-19 on all areas of nurses' professional and personal lives is needed.

Nurses' steps, distance traveled, and perceived physical demands in a three-shift schedule

BACKGROUND

The physical job demands of hospital nurses are known to be very high. Although many studies have measured the physical activities of nurses subjectively using questionnaires, it remains necessary to quantify and measure nurses' physical activity at work using objective indicators. This study was conducted to address this gap in the literature by analyzing nurses' physical activity using both objective measurements and subjective perceptions. The number of steps, distance traveled, and actual work hours were measured during work, and the influence of related factors was analyzed.

METHODS

Using a cross-sectional design, survey and activity tracking data were collected from nurses who worked in three shifts in two tertiary hospitals located in the capital region of South Korea. The participants comprised 117 nurses working in four different units (medical ward, surgical ward, intensive care unit, emergency room), and data from 351 shifts were used in the final analysis. Between-group differences in the main variables were analyzed using the t-test, the Mann-Whitney test, analysis of variance, or the Kruskal-Wallis test, as appropriate. The relationships were examined through multiple linear regression analysis.

RESULTS

The average number of steps and distance traveled were greatest for nurses working in the emergency room, followed by the intensive care unit, surgical ward, and medical ward (in descending order). Younger nurses and those with shorter unit experience tended to have the greatest number of steps and distance traveled.

CONCLUSION

Using activity trackers, this study derived physical activity measures such as number of steps and distance traveled, enabling an objective examination of physical activity during shifts. Nurses' level of physical activity differed depending on the type of nursing unit, nurses' age, and unit experience. These results suggest the need for support programs that are specific to the job demands of specific nursing units.

A cluster analysis of physical activity profiles and resilience in intensive care nurses

Purpose

Limited evidence exists regarding a group of nurses' physical activity patterns and association with resilience. Less is known about the physical activity health paradox in nurses (the positive health effects of leisure time physical activity vs the negative health effects of occupational physical activity). This study aimed to explore the profiles of intensive care nurses' physical activity behaviours and associations with resilience, following a developed study-specific job demands–recovery framework.

Design/methodology/approach

A cross-sectional study was conducted with intensive care unit (ICU) nurses to explore their physical activity profiles and associations with resilience. The Connor-Davidson Resilience Scale 25 (CD-RISC 25) was used to assess resilience, and accelerometry was utilised to record participants' four-day activity (two workdays, two non-workdays). Hierarchical cluster analysis was employed to define groups of nurses by activity behaviours.

Findings

Participants (N = 93) were classified as low actives (n = 19), standers (n = 36), sitters (n = 31) and movers (n = 7). During two 12-h shifts, movers had the highest mean level of dynamic standing and the lowest mean level of sitting. During two non-workdays, movers had the highest mean level of walking as well as the lowest mean level of sitting and sleep time.

Originality/value

The uniqueness of this study was that it analysed ICU nurses' physical activity profiles and associations with resilience using identified clusters. However, the small number of participants limited this study's ability to determine significant relationships between resilience and the grouped physical activity profiles.