Understanding the impact of the physical health care environment on nurse fatigue

Preliminary Development of Items for a Nurses' Physical Environmental Stress Scale

RESEARCH PURPOSE

This study aimed to develop a preliminary Nurses' Physical Environmental Stress Scale (NPESS) that explores the relationships between the physical environment in the intensive care unit (ICU) and work-related stress among ICU nurses.

BACKGROUND

Working within the healthcare field is stressful and comes with a high level of responsibility for nurses, especially ICU nurses. The ICU work environment is associated with risk factors such as excessive workload, increased expectations, and long working hours that can lead to burnout among nurses. There is some evidence that environmental design has the potential to prevent or mitigate work-related stress; however, an adequate assessment tool to identify physical environmental stressors or supports for moderating stress is lacking.

METHODS

To develop the preliminary environmental assessment tool, an exploratory sequential methodology was used. The approach consisted of three distinct phases, including (a) a qualitative content analysis of existing focus group data, (b) a qualitative content analysis of pertinent literature related to environmental assessment tools in a healthcare context, and (c) the development and refinement of the NPESS assessment tool. Tool refinement was based on interviews with ICU nurses.

RESULTS

The resulting NPESS tool was comprised of seven sections (sounds, lighting, smells, staff respite spaces, staff workspaces, patient rooms, and aesthetic qualities) containing a total of and 81 items that address factors that were identified as potential moderators of environmental stress in ICU settings.

CONCLUSIONS

The resulting NPESS assessment tool provides a feasible approach for evaluating ICU settings to identify possible improvements to reduce stress among nurses. Future research will be conducted to assess the validity and reliability of the final tool by distributing it to a larger sample of ICU nurses.

Developing Resilient Community Spaces in Healthcare Facilities: An Exploratory Study of a Public Health Crisis

OBJECTIVES

This exploratory study aimed to investigate the impact of the COVID-19 pandemic on the design of healthcare facilities, particularly those featuring communal spaces. It sought to identify strategies that were implemented, learned, or recognized when adapting to the limitations imposed by protective measures during the pandemic.

BACKGROUND

Third places are social gathering places outside of home and work. Over time, these community-centric places evolved from free-standing getaways to more integrated niches in diverse contexts including healthcare. Their numerous advantages for users include enhancing community bonds and collaboration among healthcare workers. The onset of the COVID-19 pandemic resulted in a need to rethink the design of such spaces to make them more adaptable and resilient.

METHODS

An exploratory qualitative study was conducted through in-depth semi-structured interviews with sixteen practitioners involved in healthcare architecture and design projects during the pandemic. Data were analyzed using a thematic analysis approach.

RESULTS

Findings indicate that the design of shared spaces in healthcare facilities for pandemic-like situations requires a special focus on modifiability and multifunctionality, achievable through strategies such as the use of movable, unconnected, and rearrangeable furniture or partitions that could swiftly change the function of a space. Other strategies include the capacity for compartmentalization of spaces, fostering indoor-outdoor connections, integrating advanced technology, and implementing effective infection control measures. Detailed emergent themes and examples of experienced constraints are discussed.

CONCLUSIONS

Insights gained from our findings can be applied to new and ongoing healthcare design projects to ensure resiliency during normal and pandemic conditions.

Home health care nurse routing and scheduling problem considering ergonomic risk factors

Home health care routing and scheduling is a complex problem that requires many aspects to be considered simultaneously. One of the important aspects is ergonomics. Home health care nurses are at higher risk of work-related health problems such as musculoskeletal disorders and burnout since they are frequently exposed to physical, mental, and environmental ergonomic risks in their jobs. Therefore, it is essential to integrate ergonomic considerations into the construction of daily schedules for home health care nurses to mitigate these health risks. The purpose of this study is to present a mathematical model that incorporate ergonomic risks. We introduce a set of constraints into our model to prevent nurses from encountering excessive workloads. To assess the workload, we propose a subjective assessment method and employ a fuzzy inference system to calculate nurses' perceived workload levels. We applied our model to a several numerical examples to investigate the impact of workload on the nurse daily schedules. We observed that, at a specified workload level, there may be alternative solutions where the number of patients visited is the same. Therefore, we defined an objective function to maximize patient visits while minimizing nurses' workload levels as much as possible. As a result, our model generates solutions that effectively reduce nurse workloads, leading to more balanced schedules. Thus, our study offers a comprehensive approach to home health care scheduling by incorporating ergonomic considerations, ultimately enhancing both patient care and nurse well-being.

The association between workplace physical environment and nurses' safety compliance: A serial mediation of psychological and behavioral factors

Aim

This study describes Jordanian intensive care unit nurses' satisfaction with their physical environment and investigates the association between workplace physical environment and nurses' safety compliance. Additionally, the study offers serial mediation analyses of psychological and behavioral factors between satisfaction with the workplace physical environment and nurses' safety compliance.

Introduction

Compliance with safety measures is a vital indicator of safety performance, as less compliance directly reflects undesirable safety outcomes among nurses, like occupational accidents, injuries, and fatalities. Social cognitive theory and the safety triad model contribute to understanding safety compliance behaviors to safety procedures. Thus, enhancing safety compliance in healthcare organizations remains a challenge and concern.

Methods

A quantitative research method was used based on cross-sectional and descriptive data from eight governmental hospitals in Jordan. The population included all intensive care unit nurses in the Ministry of Health's hospitals (n = 1104). A cluster sampling technique selected 285 nurses to participate. Empirical results were obtained through structural equation modeling (i.e., Smart PLS-SEM), which has become popular in this kind of research.

Results

The mean of Jordanian ICU nurses' satisfaction with the workplace physical environment was 3.36, which is moderate. Although the Smart PLS findings did not support the direct association between the workplace physical environment and nurses' safety compliance, serial mediation of safety participation in the workplace physical environment and nurses' safety compliance and perceived safety management commitment confirm the indirect association in the study model.

Conclusion

This study fills a gap in available safety and nursing literature, especially when considering the scarce studies that investigated the physical elements in the workplace and both safety compliance and safety participation. The findings are valuable for academicians, health providers, and policymakers and may trigger creative ideas and interventional solutions to improve nurses' safety compliance in healthcare organizations.

Coping and Caregiving: Leveraging Environmental Design to Moderate Stress Among Healthcare Workers in the Emergency Department Setting

BACKGROUND

Due to exposure to overwhelming work stressors, approximately half of emergency department (ED) physicians and nurses experience burnout, leading to lower productivity, lower quality of care, higher risk of medical errors, higher rates of absenteeism, and eventually turnover. Growing evidence suggests that the physical environment can be leveraged to support healthcare workers' well-being.

OBJECTIVES

This study aimed to identify (1) self-care behaviors that healthcare workers engage in to help them cope with job-related stress, (2) where they engage in those behaviors, (3) attributes of the built environment that may support coping behaviors.

METHODS

A mixed-methods study was conducted in three EDs, using online questionnaires (n = 85) and interviews (n = 20).

RESULTS

Job-related stress was derived from interruptions, workload and inability to take breaks, insufficient workspace, lack of privacy, unpredictability of EDs, and security concerns. Talking with a colleague, getting something to eat or drink, listening to music, and taking a walk were considered destressing activities. The bathroom was considered a place for destressing by the majority of participants, followed by outside areas, physician-only areas, and care team stations. Supportive environmental features included sufficient workspace, maximized privacy, reduced noise and clutter, controlled temperature and lighting, spaces for decompressing, spaces for documentation, close-by breakrooms with enough eating space and massage chairs, chairs with back support, standing desks, food options, and convenient bathrooms.

CONCLUSIONS

Design decisions play an important role in supporting stress reduction among healthcare workers. This study provides several strategies to achieve this aim.

Overwork Among ICU Nurses: Identification of Risk Factors

OBJECTIVE

This study aimed to describe the current situation and explore overwork predictors among ICU nurses in China.

BACKGROUND

Overwork is a comprehensive condition of labor where employees work for extended periods with high intensity and high pressure, which can negatively affect their health. Limited literature exists regarding the prevalence, characteristics, professional identity, and environment of overwork among ICU nurses.

METHODS

A cross-sectional design study was conducted. The Professional Identification Scale for Nurses, the Practice Environment Scale of the Nursing Work Index, and the Overwork Related Fatigue Scale (ORFS) were used. To explore relationships between variables, univariate analysis or bivariate correlations were used. Multiple regression was used to identify predictors of overwork.

RESULTS

Almost 85% of nurses were categorized as overworked, of which, 30% were moderately to severely overworked. Gender, form of employment, stress related to ICU nursing technology and equipment updates, nurses' professional identity, and nurse working environment accounted for 36.6% in the ORFS.

CONCLUSIONS

Overwork is common among ICU nurses. Nurse managers need to develop and implement strategies to better support nurses to prevent overwork.

Visibility and Accessibility of Hand Hygiene Stations and Fatigue Among Nurses Working in Long-Term Care (LTC) During the COVID-19 Pandemic

OBJECTIVES

Evaluate the relationship between nurses' perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses' fatigue during the COVID-19 pandemic.

BACKGROUND

LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses' fatigue.

METHODS

The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses' perception of having visible and accessible HHS and fatigue among LTC nurses.

RESULTS

The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC.

CONCLUSIONS

This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses' fatigue during the pandemic. A conceptual framework has been proposed for future studies.

The Role of Healthcare Facility Design on the Mental Health of Healthcare Professionals: A Literature Review

OBJECTIVE

This study aims to review and synthesize the empirical evidence about the connection between healthcare facility design and the mental health of healthcare professionals by reviewing the relevant literature.

BACKGROUND

Mental exhaustion of healthcare professionals is becoming a critical issue in healthcare, especially during the pandemic. The physical design of healthcare facilities has significant potential to reduce and prevent the mental exhaustion of healthcare professionals by removing environmental stressors and providing restorative experiences. However, the built environment is not fully utilized as an intervention to support healthcare professionals.

METHODS

Relevant articles were identified from the Medline, PsycINFO, PubMed, and Web of Science databases using a combination of search terms representing environmental design factors and health outcomes. Identified articles were reviewed by their titles, abstracts, and full texts using the inclusion and exclusion criteria.

RESULTS

The search yielded 27 empirical articles investigating the relationships between environmental design factors and staff mental health outcomes, including stress, fatigue, job satisfaction, burnout, and well-being. Healthcare design aspects that were investigated in the identified articles include overall facility and perception (e.g., aesthetic appeal and impression, belonging to the surroundings, safety), specific spaces (e.g., patient area, staff workspace), intangible elements (e.g., exterior view, light, sound), and interior space and ergonomics (e.g., material finishes, furniture).

CONCLUSIONS

Through the synthesis of the current literature regarding the relationships between healthcare facility design and the mental health of healthcare professionals, this study provides implications for supporting healthcare professionals through the design of the healthcare facility.

Mediating role of emotional labour strategy in the association between patient/visitor incivility and nurses' fatigue: a cross-sectional study

OBJECTIVE

Fatigue is a common problem among nurses, and patient/visitor incivility is thought to lead to nurses' fatigue. However, the mechanism by which patient/visitor incivility leads to nurses' fatigue has not been well studied. The aim of this study is to examine whether the association between patient/visitor incivility and fatigue among Chinese nurses is mediated by emotional labour strategy.

DESIGN

A cross-sectional study.

METHODS

In November 2019, a stratified cluster sample of 1207 nurses from two hospitals in China was used to collect data on fatigue, patient/visitor incivility and emotional labour strategy through online questionnaires. Emotional labour strategy has three dimensions: surface acting (SA), deep acting and natural acting. Complete responses were provided by 1036 (85.8%) participants. Student's t-test, one-way analysis of variance, Pearson correlation analysis and the PROCESS procedure (A modeling macro installed in SPSS to analyse mediation.) were adopted to analyse the data.

RESULTS

Patient/visitor incivility and SA were positively related to fatigue (p<0.01), while natural acting was negatively related to fatigue (p<0.01). SA played as a mediator in the association between patient/visitor incivility and nurses' fatigue (95% CI 0.047 to 0.113, p<0.05).

CONCLUSION

Patient/visitor incivility could contribute to Chinese nurses' fatigue. When nurses were exposed to patient/visitor incivility, they were more likely to use the SA emotional labour strategy, which would lead to fatigue. Nursing administrators should be aware of the seriousness of nurses' fatigue.

The Turkish version of the Nurses' Occupational Stressor Scale: A validity and reliability study

PURPOSE

The study was conducted to test the validity and reliability of the Turkish version of the "Nurses' Occupational Stressor Scale," which was developed to determine the occupational stressors that nurses experience during work.

DESIGN AND METHODS

"Nurses' Introductory Form" and "Nurses' Occupational Stressor Scale" were used to collect the research data.

FINDINGS

The factor loading values of the scale items varied between 0.351 and 0.670. X² /SD was 2.27, Goodness of Fit Index (GFI) = 0.92, Adjusted GFI = 0.92, Comparative Fit Index = 0.91, Root Mean Square Error of Approximation = 0.061, and Standardized Root Mean Square Residual = 0.055. As a result, the scale was shaped with 21 items and a single dimension.

PRACTICE IMPLICATIONS

"Nurses' Occupational Stressor Scale" is a valid and reliable scale. Using this scale, stressors in nurses' work environment can be measured, and while intervention is applied, the effectiveness of such intervention can be evaluated.

The effects of indoor ambient temperature at work on physiological adaptation in night shift nurses

AIM

To examine the effects of indoor ambient temperature on thermal comfort, night work tolerance (fatigue, sleepiness and night adaptation) and urinary melatonin in night shift nurses.

BACKGROUND

Night shift induces physical stress and mental stress. Night shift work and ambient temperature are associated with work performance. The working environment must be improved for successful night shift working. However, the effects of indoor ambient temperature on night shift nurses are unclear.

METHODS

In this crossover study, 20 participants were divided into two groups of 10 and were assigned to work in one of two thermo-controlled environments (23°C vs. 26°C) during two consecutive night shifts. Thermal and humidity sensation vote, night work tolerance, body temperature and urinary melatonin were assessed.

RESULTS

There were significant differences between the two groups in thermal sensation and body temperature. There were no significant differences in humidity sensation vote or night work tolerance. Urinary melatonin levels decreased significantly during the second 23°C night shift.

CONCLUSION

A temperature of 23°C may exert a positive effect on night shift adaptation.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses and nursing managers should assess thermal comfort during night shifts, and improved thermal comfort level should be provided to nurses.