Psychological, lifestyle and coping contributors to chronic fatigue in shift-worker nurses

Scoping review: The effects of diet, physical activity and sleep on motor and physical fatigue in people with multiple sclerosis

Physical and motor fatigue are debilitating symptoms common in multiple sclerosis (MS). Lifestyle interventions may be effective in managing MS-related fatigue. This scoping review aims to: (i) identify and summarise lifestyle interventions including those focused on diet, physical activity, and sleep, or multicomponent interventions for physical and motor fatigue management in MS; and (ii) provide recommendations for future research in this area. Database searches of MEDLINE (Ovid), Cochrane (Cochrane Library), Scopus (Elsevier), CINAHL (EBSCOhost), and Embase (Ovid) were conducted. To be included in this scoping review, studies were to be published in a peer reviewed scientific journal, focused on a non-pharmacological lifestyle intervention (physical activity, exercise, sleep, diet, or a combination), and written in English. Forty-one studies were included for analysis. Included participants were predominantly female, living with relapsing-remitting MS, with a median age of 48 years. The design of the studies comprised mainly of randomised control trials and pilot/feasibility studies. All included studies incorporated a physical activity intervention, with most examining aerobic/endurance exercise. Most studies reported an effect on improving physical/motor fatigue and a large proportion incorporated an endurance training program. To build on the current evidence and progress MS-fatigue related recommendations, further studies with larger sample sizes and a more inclusive range of MS types are required. Finally, with a gap of research investigating the role of diet and sleep on motor and physical fatigue in MS, research into this field is critically needed.

Mental Health Consequences of the COVID-19 Outbreak Among Emergency Department Healthcare Workers

Study Objective: The present study is aimed at providing an assessment of the changes in burnout, job strain, isostrain, sleepiness, and fatigue levels over time and identifying factors associated with these symptoms among healthcare workers in French emergency departments (EDs). Method: We conducted a prospective, multicenter study in four EDs and an emergency medical service. Participants completed questionnaires at inclusion and at 90 days to assess burnout, job strain, isostrain, sleepiness, and fatigue. Results: A total of 211 respondents (43.5%) completed the questionnaires at inclusion. At the beginning of the study, 84 (40.8%) participants presented symptoms of burnout, 86 (43.2%) had symptoms of job strain, and 58 (29.4%) of isostrain. Forty-two (20.1%) healthcare workers presented symptoms of sleepiness, and 8 (3.8%) had symptoms of fatigue. We found that symptoms of burnout were more frequent for healthcare workers with a previous psychiatric history (55.3% vs. 39.1%, p = 0.02) and were lower among participants who had at least one dependent child (33.1% vs. 48.3%, p = 0.013). Symptoms of job strain were higher among administrative staff compared to physicians (55.6% vs. 28.7%, p = 0.01) and among healthcare workers with managerial responsibilities compared to those without (45.6% vs. 28.8%, p = 0.015). Symptoms of isostrain were higher among administrative staff (42.3%) compared to paramedics (34.1%) and physicians (19.8%, p = 0.026). Conclusion: We identified that potential factors associated with the emergence of symptoms of burnout and job strain are suggested, underlining several areas of improvement for the prevention against mental health disorders in the specific population of ED healthcare workers. Trial Registration: ClinicalTrials.gov identifier: NCT04383886.

Self-management with alcohol over lifespan: psychological mechanisms, neurobiological underpinnings, and risk assessment

Self-management includes all behavioural measures and cognitive activities aimed at coping with challenges arising throughout the lifespan. While virtually all of these challenges can be met without pharmacological means, alcohol consumption has long been instrumentalized as a supporting tool to help coping with problems arising selectively at adolescence, adulthood, and ageing. Here, we present, to our knowledge, the first systematic review of alcohol instrumentalization throughout lifespan. We searched MEDLINE, Google Scholar, PsycINFO and CINAHL (from Jan, 1990, to Dec, 2022) and analysed consumption patterns, goals and potential neurobiological mechanisms. Evidence shows a regular non-addictive use of alcohol to self-manage developmental issues during adolescence, adulthood, and ageing. Alcohol is selectively used to overcome problems arising from dysfunctional personality traits, which manifest in adolescence. A large range of psychiatric disorders gives rise to alcohol use for the self-management of distinct symptoms starting mainly in adulthood. We identify those neuropharmacological effects of alcohol that selectively serve self-management under specific conditions. Finally, we discuss the adverse effects and associated risks that arise from the use of alcohol for self-management. Even well-controlled alcohol use adversely impacts health. Based on these findings, we suggest the implementation of an entirely new view. Health policy action may actively embrace both sides of the phenomenon through a personalized informed use that allows for harm-controlled self-management with alcohol.

Evaluating the psychometric properties of the fatigue severity scale using item response theory

BACKGROUND

Fatigue is a common daily experience and a symptom of various disorders. While scholars have discussed the use of the Fatigue Severity Scale (FSS) using item response theory (IRT), the characteristics of the Japanese version are not yet examined. This study evaluated the psychometric properties of the FSS using IRT and assessed its reliability and concurrent validity with a general sample in Japan.

METHODS AND MEASURES

A total of 1,007 Japanese individuals participated in an online survey, with 692 of them providing valid data. Of these, 125 participants partook in a re-test after approximately 18 days and had their longitudinal data analyzed. In addition, the graded response model (GRM) was used to assess the FSS items' characteristics.

RESULTS

The GRM's results recommended using seven items and a 6-point scale. The FSS's reliability was acceptable. Furthermore, the validity was adequate from the results of correlation and regression analyses. The synchronous effects models demonstrated that the Multidimensional Fatigue Inventory (MFI) enhanced depression, and depression enhanced FSS.

CONCLUSION

This study suggested that the Japanese version of the FSS should be a 7-item scale with a 6-point response scale. Further investigations may reveal the different aspects of fatigue assessed by the analyzed fatigue measures.

Well-Being, Occupational Fatigue, and Sleep Quality among Filipino Nurses working during COVID-19

Fatigue is a common symptom experienced by nurses before the pandemic, but this experience is heightened by the coronavirus (COVID-19) pandemic. The literature has ample evidence of nurses experiencing occupational or work-related fatigue. In addition, human error is a significant consequence of fatigue that can significantly impact patient outcomes and be devastating for a nurse. Guided by Lazarus and Folkman's Transactional Theory of Stress and Coping, we conducted a descriptive, correlational and cross-sectional study aimed to 1) explore the level of occupational fatigue and sleep quality among Filipino nurses working during the COVID-19; 2) determine the relationships between occupational fatigue, sleep quality, and subjective wellbeing among Filipino nurses working during COVID-19 pandemic. One hundred twenty-six Filipino nurses across the United States working during the pandemic were surveyed using RedCap. The study showed that Filipino nurses had moderate to high acute and chronic fatigue levels, lower intershift recovery, and good sleep quality. Evidence and opportunities for health care administrations to create strategies to enhance the wellbeing of their largest and most valuable workforce.

Health, Occupational Stress, and Psychosocial Risk Factors in Night Shift Psychiatric Nurses: The Influence of an Unscheduled Night-Time Nap

BACKGROUND

Occupational stress and shift work (including night shift work) are associated with physical and psychological health consequences in healthcare providers in general and those working in psychiatric establishments in particular. The aim of this study was to assess the impact of occupational risk factors and unscheduled night-time naps on self-reported health disorders among nurses working in a French psychiatric hospital.

METHODS

We performed a 12-month observational field study of experienced nurses working at Philippe Pinel Psychiatric Hospital (Amiens, France) between September 2018 and September 2019. A comparative descriptive study of two groups of nurses who filled out a questionnaire on health and occupational stress was performed: nurses working permanently on the night shift (the night shift group, who took unscheduled naps), and nurses rotating weekly between morning and afternoon shifts (the day shift group).

RESULTS

The night and day shift groups comprised 53 and 30 nurses, respectively. There were no intergroup differences in health disorders, sleep quality, occupational stress, and risk factor perception. Correlation analyses showed that in the day shift group, a low level of support from supervisors was associated with elevated levels of distress, anxiety, and gastrointestinal disorders. In the night shift group, a greater overall work load was associated with elevated levels of anxiety and distress. These findings indicated that the nurses on the night shift had adapted well to their working conditions.

CONCLUSIONS

An organizational strategy including an unscheduled night-time nap might improve health among night shift nurses.

Effects of Factors Related to Shift Work on Depression and Anxiety in Nurses

Background

Although shift work is the foundation of the provision of 24-h continuous care in hospitals, it can negatively impact mental health in hospital workers such as nurses. Despite the connection between mental health and overall health, little is known about the effect of shift work-related factors on mental health in this population.

Objectives

We investigated the effect of scheduling practices, physical and psychological characteristics related to shift work, and personal habits during shift work on depression and anxiety among nurses.

Methods

In this multi-center cross-sectional study, 11,061 nurses from 20 hospitals in the Shandong Province of China completed an online survey between December 2020 and February 2022. Multivariate ordered logistic regression analysis was performed to examine shift-related factors associated with depression and anxiety in the study population.

Results

The completion rate of all nurses' questionnaires was 83.00% (n = 9,181). Among the 9,181 respondents, 66.20% (n = 6,078) were shift nurses. Depression and anxiety were found in 58.82 and 62.08% of shift nurses, respectively, and these rates were influenced by fatigue during shift work, psychological stress before/during/after night shifts, feeling of being refreshed after resting before/after night shifts, using sleep medication before/after night shifts, physical discomfort during night shifts, busyness during night shifts, food intake during shift work, working > 40 h/week during shift work, and sleep quality before/after night shifts.

Conclusions

Depression and anxiety in shift nurses may be addressed by reducing their workload, sources of stress during night shifts, and facilitating rest and relaxation.

The Mediating Role of Coping Style in the Relationship Between Sleep Quality and Burnout: A Cross-Sectional Study Among Psychiatric Nurses

Background

Although sleep quality is clearly associated with job burnout as shown in the existing research, the mechanism underpinning such relationship remains undefined. This work, thus, aimed to assess the current situation of sleep quality and burnout in Chinese psychiatric nurses, and to analyze the relationships between sleep quality, burnout and coping style, in order to provide possible targets to enhance mental health and wellbeing among psychiatric nurses.

Method

This cross-sectional study was carried out in seven rehabilitation centers located in four different regions of China. The Pittsburgh Sleep Quality Index, the Epworth Sleeping Scale, the Maslach Burnout Inventory General Survey, and the Coping Style Questionnaire were distributed to 853 nurses in various mental hospitals, with a total of 664 participants being recruited in the final research.

Results

The results of this current study showed a high prevalence of sleep disorders and burnout in Chinese psychiatric nurses. Moreover, emotional exhaustion (r = 0.456), cynicism (r = 0.323) and negative coping style (r = 0.191) in nurses were all positively correlated with total Pittsburgh Sleep Quality Index (PSQI) score, while professional efficacy (r = -0.079) and positive coping style (r = -0.140) were negatively correlated with total PSQI score. More interestingly, of all negative coping strategies, we found that self-blame had the most significant effect (β = 0.156).

Conclusions

The above results showed that coping style mediates the association of poor sleep quality with job burnout in Chinese psychiatric nurses. This study claimed that there is an urgent need to development the coping skills to sustain a healthy work life for nurses.

Post-Work Recovery from Fatigue and Sleep Episodes among Nurses Who Are Engaged in 16-Hour Night Shifts: A Prospective Observational Study

Poor recovery from fatigue among shift-working nurses can cause a transition from acute to chronic fatigue. We aimed to clarify the relationship between nurses' recovery from fatigue and sleep episodes after 16 h night shifts while considering age. This prospective study included 62 nurses who worked 16 h night shifts. Fatigue was assessed by a questionnaire before, during, and after the night shift, and the morning following the night shift. Sleep episodes were continuously measured using a wearable device. We performed a hierarchical cluster analysis of multivariate sleep parameters in first and main sleep episodes after night shifts. A linear mixed model was used to estimate the difference between clusters in recovery from fatigue after the night shift, considering age. The participants were classified into a high sleep quality group (HSQG) and low sleep quality group (LSQG) in sleep episodes after the night shift. There was a significant main effect of clusters, and HSQG was significantly more effective than LSQG in recovering from fatigue. However, no main effects of age or interaction were observed. The quality of first and main sleep episodes at home was associated with recovery from the night shift to the next day, regardless of age.

Use of psychoactive substances by night-shift hospital healthcare workers during the first wave of the COVID-19 pandemic: a cross-sectional study based in Parisian public hospitals (ALADDIN)

OBJECTIVES

This study aimed to estimate the prevalence of psychoactive substance (PAS) use in night-shift healthcare workers (NSHW) during France's first COVID-19 wave (March-May 2020).

DESIGN

Observational cross-sectional online survey.

SETTING

39 public hospitals in the Assitance Publique des Hôpitaux de Paris (AP-HP) network in the Parisian area.

PARTICIPANTS

A total of 1238 nurses, assistant nurses, X-ray technicians, managers, lab technicians, midwives and childcare assistants working at night or alternating between days and nights answered the questionnaire.

INTERVENTION

Online survey.

OUTCOME MEASURES

PAS use prevalence after weighting data for sex, age and profession using calibration on margins, in order to be representative of all AP-HP NSHW. We used the Fagerström scale and the Alcohol Use Disorders Identification Test Concise to assess PAS use.

RESULTS

The weighted estimated prevalences of daily smoking, alcohol drinking and tranquilliser use in participating NSHW were 21.4, 1.3 and 2.4%, respectively. Twelve per cent (11.7%) of our study sample used opioids. During the first COVID-19 wave, PAS use remained stable except for tobacco use, with 8.6% of participants reporting an increase. Previous 3-month prevalences of tranquilliser and opioid use were significantly higher than in the general population.

CONCLUSION

Daily smoking (especially in younger men) and tranquilliser and opioid use were highly prevalent in NSHW in the AP-HP network during France's first COVID-19 wave. Specific interventions for quitting smoking and addressing determinants of tranquilliser and opioid use in NSHW need to be developed and evaluated to improve quality of life in these essential, underdiagnosed and undertreated health personnel.

The Societal Influences and Quality of Life Among Healthcare Team Members During the COVID-19 Pandemic

Background: The coronavirus infection disease 2019 (COVID-19) pandemic is likely to put healthcare professionals across the world in an unprecedented situation. Methods: A total of 683 healthcare workers were recruited in this study. Short form-12 items (SF-12), Societal Influences Survey Questionnaire (SISQ), and Disaster-Related Psychological Screening Test (DRPST) were used to survey participants. Multiple linear regression and structural equation model (SEM) were used to explore the possible factors to the societal influences and quality of life. Results: After multiple linear regression analysis, female, older, more education years, married, regular intake, and posttraumatic stress disorder (PTSD) frequency had positive association with SISQ. To physical component summary (PCS) of SF-12, chronic illness, sleep score, PTSD frequency, and social distance had negative association, and exercise habits had positive association. A mental component summary (MCS) value of SF-12, age, participate in social activities, and social information had positive association, and PTSD frequency, sleep score, social anxiety, and depression had negative association. Under SEM analysis, PTSD had positive influence on SISQ. Sleep score and MCS value had negative influences on SISQ. PTSD severity, older age, sleep score, smoking, and nursing staff had negative influences on PCS value. Young age, PTSD frequency, sleep score, and depression had negative influences on MCS value. Conclusion: Healthcare team members with severe PTSD symptoms suffered more societal influences. Relative to PTSD severity, PTSD frequency was more important to the quality of life. Members of older age who frequently participate in clubs, volunteers, or charity activities had better mental life quality.

The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study

BACKGROUND

Healthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied.

OBJECTIVE

To determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures.

DESIGN

A quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested).

SETTING

Participants were tested in a northwestern US university's nursing simulation laboratory.

PARTICIPANTS

A volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals.

METHODS

Simulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness.

RESULTS

In our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors.

CONCLUSIONS AND RELEVANCE

Nurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts-if any-on patient care. Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

Effects of Fatigue and Grit on Club Sports Coaches

The objective of this research is to identify the level of general fatigue (FG), physical fatigue (FF) and concentration/motivation (C/M) in sports coaches. Two components of grit, consistency of interest (CI) and perseverance in effort (PE), are also assessed. The possible effects of sex, age, marital status, employment contract, work dedication and grit on FG, FF and C/M in sports coaches are examined. This cross-sectional study analyses 335 sports club coaches (21.2% women, 78.8% male) with a mean age of 29.88 (SD = 9.97) years, at a significance level of p < 0.05 for all analyses. Different aspects of fatigue were determined using the Spanish translation of the Multidimensional Fatigue Inventory-20 (IMF-20). The Grit-S scale was used to measure the ability to persevere, have passion and commit. The results indicated that men scored higher in FF, C/M and PE, while women obtained higher values in FG and CI. Non-contract coaches had higher FG, CI and PE, while coaches with contracts scored higher on C/M and FF. In conclusion, coaches with higher CI had higher FG, and high levels of PE were associated with low FG levels.

The relationship between health-promoting behaviors, menopause syndrome, and sleep quality in Chinese middle-aged nurses: A cross-sectional study

BACKGROUND

Nursing staff are on the front line of providing healthcare that addresses patients' needs. Sleep quality is highly related to work performance and quality of life among nurses.

AIMS

This study aimed to examine the influence of sociodemographic variables, menopause syndrome, and health-promoting behaviors on sleep quality in a sample of middle-aged nurses in China.

METHODS

A cross-sectional design was employed. A consecutive sample of 424 nurses was recruited from a university-affiliated hospital in Bengbu, China. Self-reported, structured questionnaires, including sociodemographic surveys, the Kupperman Menopausal Index, the Health Promoting Lifestyle Profile II, and the Pittsburgh Sleep Quality Index, were administered between October 2018 and July 2019. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

RESULTS

Study participants had a mean sleep quality level of 5.30 points (SD = 3.16), indicating potential sleep problems. The results of regression models showed that menopause syndrome and spiritual growth were important predictors of sleep quality for premenopause, perimenopause, and postmenopause groups.

CONCLUSION

Middle-aged nurses with more severe menopause syndrome and less spiritual growth might experience worse sleep quality.

RELEVANCE TO CLINICAL PRACTICE

This study highlights important factors influencing the level of sleep quality in Chinese middle-aged nurses. Identifying the factors that are associated with sleep quality may help with the development of proper interventions.

Posttraumatic stress symptoms among health care workers during the COVID-19 epidemic: The roles of negative coping and fatigue

Healthcare workers (HCWs) exposed to Coronavirus disease 2019 (COVID-19) are not immune to stressors. This study aimed to explore the prevalence of posttraumatic stress symptoms (PTSS) among HCWs during the COVID-19 epidemic and investigate the associations among negative coping, fatigue and PTSS. A total of 507 HCWs from Anhui province enrolled in the study and completed the cross-sectional survey including demographic data, Simplified Coping Style Questionnaire (SCSQ), 14-item Fatigue Scale (FS-14), and PTSD Checklist-civilian Version (PCL-C). Univariate linear regression, Pearson correlation and Mackinnon's four-step procedure were performed in the statistical analysis. Results indicated that the prevalence of PTSS among HCWs during the pandemic was 24%. Univariate linear regression showed HCWs aged 31-40 years exhibited significantly higher scores of PTSS than those aged 51-60 (β = 0.20, 95% CI: 0.59 to 9.41). Having at least one child was associated with a higher risk of developing PTSS (β = 0.01, 95% CI: 0.36 to 5.45). Negative coping and fatigue were positively correlated with all three PTSS (all P < 0.001), including re-experiencing, avoidance and hyper-arousal. Fatigue has mediated the association between negative coping and PTSS among HCWs during the pandemic (ab = 0.09, SE = 0.03, bootstrap 95% CI: 0.04 to 0.14). A considerable proportion of HCWs was traumatized during the COVID-19 outbreak. Hence, the institutions should screen out and pay close attention to HCWs who tend to use negative coping (e.g., withdrawal thinking, distraction and blaming others) and arrange work scientifically to avoid overfatigue and PTSS amid the public health crisis.

The physical and mental health of the medical staff in Wuhan Huoshenshan Hospital during COVID-19 epidemic: A Structural Equation Modeling approach

Introduction

Early in the epidemic of coronavirus disease 2019, the Chinese government recruited a proportion of healthcare workers to support the designated hospital (Huoshenshan Hospital) in Wuhan, China. The majority of front-line medical staff suffered from adverse effects, but their real health status during COVID-19 epidemic was still unknown. The aim of the study was to explore the latent relationship of the physical and mental health of front-line medical staff during this special period.

Methods

A total of 115 military medical staff were recruited between February 17th and February 29th, 2020 and asked to complete questionnaires assessing socio-demographic and clinical characteristics, self-reported sleep status, fatigue, resilience and anxiety.

Results

55 medical staff worked within Intensive Care and 60 worked in Non-intensive Care, the two groups were significantly different in reported general fatigue, physical fatigue and tenacity (P<0.05). Gender, duration working in Wuhan, current perceived stress level and health status were associated with significant differences in fatigue scores (P<0.05), the current perceived health status (P<0.05) and impacted on the resilience and anxiety of participants. The structural equation modeling analysis revealed resilience was negatively associated with fatigue (β=-0.52, P<0.01) and anxiety (β=-0.24, P<0.01), and fatigue had a direct association with the physical burden (β=0.65, P<0.01); Fatigue mediated the relationship between resilience and anxiety (β=-0.305, P=0.039) as well as resilience and physical burden (β=-0.276, P=0.02).

Conclusion

During an explosive pandemic situation, motivating the effect of protective resilience and taking tailored interventions against fatigue are promising ways to protect the physical and mental health of the front-line medical staff.

Factors associated with workplace fatigue among midwives in southern China: A multi-centre cross-sectional study

AIMS

To identify the level of workplace fatigue among midwives and factors influencing their fatigue.

BACKGROUND

Midwives who play an important role in medical care are prone to experience workplace fatigue, which negatively affects their well-being and work quality.

METHODS

A multi-centre cross-sectional study was conducted among 666 Chinese midwives from 38 hospitals in March 2019. Data were collected by four questionnaires of self-designed demographic questions, the Pittsburgh Sleep Quality Index, the Social Support Self-Rating Scale and the 14-item Fatigue Scale. Descriptive statistics, univariate analysis and multiple linear regression were used to analyse the data.

RESULTS

Midwives had moderate levels of fatigue with the mean scores of physical fatigue, mental fatigue and total fatigue being 9.53, 6.25 and 15.79, respectively. Multiple linear regression results showed that sleep quality, social support, job satisfaction, occupational injuries, adverse life events, frequency of irregular meals and employment type were statistically significant factors influencing fatigue among the participants.

CONCLUSIONS

Physical and mental fatigue were generally common among midwives and were affected by personal-related and work-related factors, sleep quality and social support.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators have the opportunity to advocate for improved health policy under the two children rule to prevent workplace fatigue amongst midwives.

A framework for studying risk factors for lower extremity musculoskeletal discomfort in nurses

Lower extremity musculoskeletal discomfort (MSD) is prevalent, but understudied, in nurses. A comprehensive, theoretical, aetiological model of lower extremity work-related MSD in hospital in-patient staff nurses was developed through a review of the literature to provide a framework for aetiological and intervention research. The framework informed the design of a survey of 502 hospital staff nurses. Symptom prevalence ranged from 32% in hip/thigh to 59% in ankle/foot regions. Logistic regression modelling using survey data showed that different work and personal factors were associated with discomfort in different regions of the lower extremity. Individual factors (e.g. older age, higher BMI or having any foot condition), physical factors (e.g. higher frequency of patient handling), psychosocial factors (e.g. lower job satisfaction) were associated with discomfort in one or more parts of the lower extremity. Future research should target these factors for intervention, to attempt to reduce occurrence of lower extremity discomfort in nurses. Practitioner Summary: Practitioners may find useful the illustrated, theoretical aetiological model of factors that could influence the prevalence of lower extremity discomfort in nurses. The model could guide conversations with nurses and observational analyses of nursing work. The model and survey results may provide ideas for intervention exploration. Abbreviations: MSD: musculoskeletal discomfort; BMI: body mass index; MSK: musculoskeletal; ICU: intensive care unit; NLERF: nurses' lower extremity MSD risk factor; NASA-TLX: NASA-task load index.

Fatigue and recovery in shiftworking nurses: A scoping literature review

OBJECTIVES

To identify factors impeding or enhancing recovery from fatigue in shiftworking nurses.

DESIGN

Scoping literature review methodology was implemented to identify key concepts around recovery from fatigue in shiftworking nurses to provide a narrative around these paradigms.

DATA SOURCES

Five electronic data bases were searched: CINAHL, MEDLINE, PROQUEST Health and Medicine, ScienceDirect and PsycINFO to identify primary studies on fatigue and recovery in shiftworking nurses from 2000 to 2019 inclusive.

REVIEW METHODS

Preliminary searches were completed between September and December 2017 and finalised in January 2020. Research was drawn from nursing only samples employed under shiftwork scheduling.

RESULTS

31 studies were included in this scoping review. Factors impeding and enhancing recovery at work and home are identified as impacting on fatigue outcomes. Findings indicate recovery from fatigue in shiftworking nurses are most significantly affected by high work and job demands and the 'when' and 'how' of shiftwork scheduling; all reported to impede recovery from shiftwork related fatigue. The most noteworthy facilitators of recovery were work control and control over shiftwork scheduling, break opportunities at work, age and being part of a family structure. There was a dearth of research identified around the time frames of the progression from acute to chronic fatigue and the in-depth role of recovery in this transition. As chronic or long-term fatigue can develop from an acute or recoverable fatigue this may significantly impact on shiftworking nurses' health and wellbeing.

CONCLUSIONS

This scoping review highlights the complicated nature of shiftwork scheduling and the impact it can have on recovery from fatigue in shiftworking nurses. Multiple methods and ways of measuring fatigue, recovery and shiftwork were identified in the studies. The results describe factors impeding and enhancing recovery from fatigue as occurring within both the workplace and during time away from work. Thus, this review provides improved understanding of the barriers and facilitators in recovery from fatigue and the potential accumulation of fatigue over time. These findings are important for shiftworking nurses, nursing managers and hospital administrators, and society, who are dependant on nurses' care.

When and how do hospital nurses cope with daily stressors? A multilevel study

BACKGROUND

During their workday, nurses face a variety of stressors that are dealt with using different coping strategies. One criticism of the contextual models of work stress is that they fail to focus on individual responses like coping with stress. Neverthless, little is know about the momentary determinants of coping in nurses.

OBJECTIVES

To identify the momentary predictors of problem-focused approaching coping and emotion-focused approaching coping, as well as those for seeking social support and refusal coping strategies, during the working day in nurses.

DESIGN

This study uses descriptive, correlational, two-level design with repeated measures.

SETTINGS

Wards of two University hospitals.

PARTICIPANTS

A random cohort of 113 nurses was studied.

METHODS

An ecological momentary assessment was made of demand, control, effort, reward, nursing task, coping, mood and fatigue, and of coping style by questionnaire. Multilevel two-level statistical analyses were performed in order to identify both within person and between person relationships.

RESULTS

Different momentary types of coping were associated with different tasks. The problem-focused coping could be explained by the direct care and medication tasks, demand, planning coping style, mood, and negatively by acceptation coping style. Emotion-focused coping could be explained by documentation and medication tasks (negatively), mood, demand, distraction, and disengagement coping styles. Seeking social support coping could be explained by the task of communication, mood, fatigue (negatively), and seeking emotional support as a coping style. Refusal coping could be explained by mood, and the coping style of focusing and venting emotions. Refusal coping is not specific to any task.

CONCLUSIONS

The choice of the coping strategy depends on the task, of their appraisal and on the different styles of coping.

Prevalence of Poor Sleep Quality in Nursing Staff: A Meta-Analysis of Observational Studies

Objective: Poor sleep quality is common in nursing staff. This meta-analysis aimed to examine the pooled prevalence of poor sleep quality in nursing staff. Methods: A systematic search in PubMed, EMBASE, PsycINFO, and Web of Science databases was performed. Studies that reported sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) were synthesized using a random-effects model. Results: Fifty-three studies were analyzed. The pooled prevalence of poor sleep quality was 61.0% (95% CI: 55.8-66.1%). The pooled total PSQI score was 7.13 ± 0.18 (95% CI: 6.78-7.50). The pooled component scores were 1.47 ± 0.20 (95% CI of mean score: 1.08-1.85) in sleep latency, 0.91 ± 0.15 (95% CI of mean score: 0.61-1.21) in sleep duration, 1.59 ± 0.13 (95% CI of mean score: 1.35-1.84) in overall sleep disturbances, 0.33 ± 0.18 (95% CI of mean score: 0-0.67) in sleeping medication, 1.21 ± 1.20 (95% CI of mean score: 0.83-1.60) in daytime dysfunction, 1.39 ± 0.14 (95% CI of mean score: 1.11-1.67) in subjective sleep quality, and 0.66 ± 0.11 (95% CI of mean score: 0.44-0.87) in habitual sleep efficiency. Subgroup and meta-regression analyses found that PSQI cutoff values, mean age, body mass index (BMI), sample size, study quality, and work experience moderated the prevalence of poor sleep quality. Conclusions: Poor sleep quality appears to be common in nursing staff. Considering its negative impact on health, effective measures should be taken to improve poor sleep quality in this population. Longitudinal studies should be conducted to examine the contributing factors of nurses' poor sleep quality.

How the Lagged and Accumulated Effects of Stress, Coping, and Tasks Affect Mood and Fatigue during Nurses' Shifts

Nurses experience significant stress and emotional exhaustion, leading to burnout and fatigue. This study assessed how the nurses' mood and fatigue evolves during their shifts, and the temporal factors that influence these phenomena. Performing a two-level design with repeated measures with moments nested into a person level, a random sample of 96 nurses was recruited. The ecological momentary assessment of demand, control, effort, reward, coping, and nursing tasks were measured in order to predict mood and fatigue, studying their current, lagged, and accumulated effects. The results show that: (1) Mood appeared to be explained by effort, by the negative lagged effect of reward, and by the accumulated effort, each following a quadratic trend, and it was influenced by previously executing a direct care task. By contrast, fatigue was explained by the current and lagged effect of effort, by the lagged effect of reward, and by the accumulated effort, again following quadratic trends. (2) Mood was also explained by problem-focused and emotion-focused coping strategies, indicative of negative mood, and by support-seeking and refusal coping strategies. (3) Fatigue was also associated with direct care and the prior effect of documentation and communication tasks. We can conclude that mood and fatigue do not depend on a single factor, such as workload, but rather on the evolution and distribution of the nursing tasks, as well as on the stress during a shift and how it is handled. The evening and night shifts seem to provoke more fatigue than the other work shifts when approaching the last third of the shift. These data show the need to plan the tasks within a shift to avoid unfinished or delayed care during the shift, and to minimize accumulated negative effects.

Prevalence and Influencing Factors on Fatigue of First-line Nurses Combating with COVID-19 in China: A Descriptive Cross-Sectional Study

Nurses’ work-related fatigue has been recognized as a threat to nurse health and patient safety. The aim of this study was to assess the prevalence of fatigue among first-line nurses combating with COVID-19 in Wuhan, China, and to analyze its influencing factors on fatigue. A multi-center, descriptive, cross-sectional design with a convenience sample was used. The statistical population consisted of the first-line nurses in 7 tertiary general hospitals from March 3, 2020 to March 10, 2020 in Wuhan of China. A total of 2667 samples from 2768 contacted participants completed the investgation, with a response rate of 96.35%. Social-demographic questionnaire, work-related questionnaire, Fatigue Scale-14, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Chinese Perceived Stress Scale were used to conduct online survey. The descriptive statistic of nurses’ social-demographic characteristics was conducted, and the related variables of work, anxiety, depression, perceived stress and fatigue were analyzed by t-tests, nonparametric test and Pearson’s correlation analysis. The significant factors which resulted in nurses’ fatigue were further analyzed by multiple linear regression analysis. The median score for the first-line nurses’ fatigue in Wuhan was 4 (2, 8). The median score of physical and mental fatigue of them was 3 (1, 6) and 1 (0, 3) respectively. According to the scoring criteria, 35.06% nurses (n=935) of all participants were in the fatigue status, their median score of fatigue was 10 (8, 11), and the median score of physical and mental fatigue of them was 7 (5, 8) and 3 (2, 4) respectively. Multiple linear regression analysis revealed the participants in the risk groups of anxiety, depression and perceived stress had higher scores on physical and mental fatigue and the statistically significant positive correlation was observed between the variables and nurses’ fatigue, the frequency of exercise and nurses’ fatigue had a statistically significant negative correlation, and average daily working hours had a significantly positive correlation with nurses’ fatigue, and the frequency of weekly night shift had a low positive correlation with nurses’ fatigue (P<0.01). There was a moderate level of fatigue among the first-line nurses fighting against COVID-19 pandemic in Wuhan, China. Government and health authorities need to formulate and take effective intervention strategies according to the relevant risk factors, and undertake preventive measures aimed at reducing health hazards due to increased work-related fatigue among first-line nurses, and to enhance their health status and provide a safe occupational environment worldwide. Promoting both medical and nursing safety while combating with the pandemic currently is warranted.

Exploring Perceptions of the Work Environment among Psychiatric Nursing Staff in France: A Qualitative Study Using Hierarchical Clustering Methods

Most studies on workers’ health are based on non-specific models of occupational stress, thereby limiting the understanding and research on efficient interventions. This qualitative approach aimed to explore the structure of resources and constraints in the working environment of nurses in a deliberately open approach. Semi-structured interviews were conducted with 37 nurses working in closed and open inpatient psychiatric wards in a French university hospital. The data were statistically analyzed using a hierarchical clustering method. Our model highlighted a systemic structure, describing the interactions, including patients, nurses, doctors, and managers in a specific material, communicational, and organizational environment. The results show a discursive structure organized around dimensions pertaining to “environment”, “patients”, “medical-care group”, and “the individual”. Our model showed interest in an interdisciplinary approach that encompasses occupational medicine and social psychology.

Lifestyle and Shiftwork: Designing and Testing a Model for Health Promotion of Iranian Nurses

BACKGROUND: Lifestyle is one factor that forms the nurses' health, particularly those who work in shiftwork schedules. AIMS: The aim of this study was to design and test a model for health promotion of Iranian nurses. In this model, nurses' lifestyle was considered as the precedent, physical and mental health as the outcomes, and sleep disturbance and chronic fatigue as the mediators. METHODS: A cross-sectional study using structural equation modeling was conducted among 240 shiftworker nurses in Iran. The data collection was performed using the Persian versions of the Survey of Shiftworkers Questionnaire and Life Style Questionnaire. Bootstrap in Preacher and Hayes' Macro program was used for testing mediation. RESULTS: Lifestyle had a weak significant direct effect on physical (β = 0.13, p < .04) and mental health (β = 0.12, p < .02), and it had a significant indirect effect on physical health via chronic fatigue (β = -0.11, p < .001) and sleep disturbance (β = -0.05, p < .01). This variable only had a significant indirect effect on mental health via chronic fatigue (β = -0.19, p < .001). The final model proposed a new significant path between sleep disturbances and chronic fatigue (β = 0.22, p < .001). CONCLUSIONS: Therefore, the hospital officials can enhance the nurses' physical and mental well-being by providing interventions and training courses on aspects of healthy lifestyles, such as physical activity, avoidance of smoking, and maintenance of body weight.

How Do Nurses Cope with Shift Work? A Qualitative Analysis of Open-Ended Responses from a Survey of Nurses

Nurses are frequently required to engage in shift work given the 24/7 nature of modern healthcare provision. Despite the health and wellbeing costs associated with shift work, little is known about the types of coping strategies employed by nurses. It may be important for nurses to adopt strategies to cope with shift work in order to prevent burnout, maintain wellbeing, and ensure high quality care to patients. This paper explores common strategies employed by nurses to cope with shift work. A workforce survey was completed by 449 shift working nurses that were recruited from a major metropolitan health service in Melbourne, Australia. Responses to open-ended questions about coping strategies were analysed using the framework approach to thematic analysis. Four interconnected main themes emerged from the data: (i) health practices, (ii) social and leisure, (iii) cognitive coping strategies, and (iv) work-related coping strategies. Although a range of coping strategies were identified, sleep difficulties often hindered the effective use of coping strategies, potentially exacerbating poor health outcomes. Findings suggest that in addition to improving nurses' abilities to employ effective coping strategies on an individual level, workplaces also play an important role in facilitating nurses' wellbeing.

Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units

AIM

To assess 12-h shift Intensive Care Unit (ICU) nurses' fatigue and identify the associated demographic factors.

BACKGROUND

Literature reveals inconsistencies as to whether 12-h shifts decrease or increase nurse fatigue levels.

METHODS

A cross-sectional survey of 67 ICU nurses working 12-h shifts was undertaken to determine their fatigue levels in two hospitals. The Occupational Fatigue Exhaustion/Recovery Scale (OFER), Spearman's correlation, ANOVA, t-tests, and Chi-Square were used for analyses.

RESULTS

57 out of 67 participants experienced low to moderate chronic fatigue; 36 of those exhibited low to moderate acute fatigue levels; 46 reported low to moderate inter-shift fatigue. Age (ρ = 0.03, r² = -0.28), number of family dependents (ρ = 0.03, r² = -0.27), and years of nursing experience (ρ = 0.03, r² = -0.27) were moderately negatively correlated with acute fatigue, while frequency of exercise per week (ρ = 0.01, r² = -0.31) was moderately negatively correlated with chronic fatigue. Hospital A had higher chronic fatigue levels than Hospital B. Age (ρ < 0.01), age group (ρ = 0.03), shift schedule (ρ = 0.02), and nursing experience (ρ = 0.03) were significantly related to the difference in chronic fatigue levels between the two hospitals.

CONCLUSIONS

More than half of the 12-h shift ICU nurses studied in both hospitals had low to moderate fatigue levels. Age, number of family dependents, years of nursing experience, and frequency of exercise per week were identified as key factors associated with fatigue. The difference in chronic fatigue levels between hospitals suggests that implementing more support for younger and/or less experienced nurses, better strategies for retaining more experienced nurses, and fewer rotating shifts could help reduce fatigue.

Exploring the associations between shift work disorder, depression, anxiety and sick leave taken amongst nurses

This study aimed to evaluate the association between shift work disorder and mental health in hospital-based nurses. Staff completed an online survey comprising demographic questions, the Shift Work Disorder Questionnaire, Patient Health-9 and the General Anxiety Disorder-7 scale. Sick leave data were collected from archival records from the Human Resources Department. Two hundred and two nurses (95% female; age M = 35.28 years ± SD = 12) participated (42% of eligible staff). Those at high risk of shift work disorder had higher depression (M = 7.54 ± SD = 4.28 vs. M = 3.78 ± SD = 3.24; p < 0.001) and anxiety (M = 5.66 ± SD = 3.82 vs. M = 2.83 ± SD = 3.33, p < 0.001) compared to those at low risk. Linear regression models showed that being at high risk of shift work disorder was the most significant predictor of depression, explaining 18.8% of the variance in depression (R²  = 0.188, adjusted R²  = 0.184, F(1, 200) = 46.20, p < 0.001). Shift work disorder combined with the number of night shifts and alcoholic drinks on non-work days accounted for 49.7% of the variance in anxiety scores (R²  = 0.497, adjusted R²  = 0.453, F(3, 35) = 11.51, p < 0.001). Mean sick leave in those with high risk of shift work disorder was 136.17 hr (SD = 113.11) versus 103.98 hr (SD = 94.46) in others (p = 0.057). Depression and years of shift work accounted for 18.9% of the variance in sick leave taken (R²  = 0.189, adjusted R²  = 0.180, F(2, 175) = 20.36, p < 0.001). Shift work disorder is strongly associated with depression and anxiety, providing a potential target to improve mental health in shift workers. Depression, in turn, is a significant contributing factor to sick leave.

A comparison of nurse shift workers' and non-shift workers' psychological functioning and resilience

AIMS

To investigate the impact of shift work on the psychological functioning and resilience of nurses by comparing nurses who work shifts and nurses who work regular hours.

DESIGN

A comparative descriptive design using an online self-report questionnaire.

METHOD

Data were collected from employed Registered and Enrolled Nurses (N = 1,369) who were members of the Queensland Nurses and Midwives Union (QNMU) in 2013. The survey included standardized measures of resilience, depression, anxiety, compassion satisfaction, compassion fatigue, and intention to leave the profession.

RESULTS

Generalized Linear Mixed Model analysis revealed shift workers had significantly lower levels of compassion satisfaction. However, there were no significant differences between the groups on resilience, depression, anxiety, stress, compassion fatigue or intention to leave nursing.

CONCLUSION

The findings suggest that shift work is not associated with worse psychological functioning or lower resilience in nurses. However, this study requires replication using a longitudinal design to confirm these findings.

Relationships between Exercise Behavior and Anger Control of Hospital Nurses

PURPOSE

This study examined the relationships between nurses' exercise behavior and their anger control using a cross-sectional descriptive design.

METHODS

The participants were 290 nurses in South Korea, who completed a survey questionnaire on general characteristics, the stage of exercise behavior change, and anger emotion, evaluated using state anger and anger expression method.

RESULTS

Those who engaged in regular exercise behavior exhibited lower levels of state anger and higher levels of anger control than those who did not. In the prediction model, a significant association of exercise behavior with anger control was found. The levels of anger control decreased as the age, education level, and work experiences of nurses decreased. Anger control scores were significantly higher than anger suppression scores and anger expression-out scores in the hospital nurses.

CONCLUSION

Engaging in regular exercise may help nurses manage anger emotions better.

Psychological status of nursing survivors in China and its associated factors: 6 years after the 2008 Sichuan earthquake

PURPOSE

Nursing survivors are often not only the victims but also the rescuers in a disaster. Severe natural disasters can cause them long-term psychological impact. This study aimed to investigate the psychological status of nursing survivors and its associated factors 6 years after the severe earthquake that occurred in Wenchuan, Sichuan, on May 12, 2008.

METHODS

The study used a cross-sectional design. A total of 597 nurses who survived the earthquake and took care of victims were recruited about 6 years after the disaster. They completed a self-report questionnaire assessing information about demographics, earthquake-related characteristics, psychological status, posttraumatic stress disorder, and posttraumatic growth and resilience.

RESULTS

The mean score on the Symptom Checklist-90-Revised (SCL-90-R) was (123.56±41.26). Of symptoms indicated by the SCL-90-R, obsessive-compulsive dimension had the highest score (1.62±0.62). The psychological status of nursing survivors differed with the title, monthly per capita household income, financial loss, health status, residential satisfaction, and satisfaction with leaders and colleagues. Severe financial loss and poor health status were significant factors of psychological distress. In addition, psychological status was negatively related to posttraumatic stress disorder and posttraumatic growth, and positively related to resilience.

CONCLUSION

Nursing survivors had a relatively normal level of psychological status 6 years after the 2008 Sichuan earthquake. However, psychological symptoms such as obsessive-compulsive patterns still remained. Interventions focusing on the improvement of financial subsidies and physical health may be particularly useful in reducing psychological problems after the disaster.

Povezava med neprespanostjo in delazmožnostjo zaposlenih v zdravstveni negi

Uvod: Spanje je aktivni proces, ki pomembno vpliva na kakovost delovnega življenja. V ta namen je bila izvedena raziskava o odnosu med neprespanostjo in delazmožnostjo zaposlenih v zdravstveni negi.Metode: V kvantitativni opisni raziskavi so bili v letih 2014 in 2015 obravnavani zaposleni iz ene splošne bolnišnice in dveh domov upokojencev v Sloveniji. Z enostavnim slučajnostnim izborom je bilo v stratificiran vzorec vključenih 21,26 % (n = 81) v zdravstveni negi zaposlenih žensk iz teh treh zavodov. Podatki, pridobljeni z anketo (Cronbach α = 0,624), so bili analizirani z deskriptivno statistiko in s korelacijsko analizo.Rezultati: Večina anketirank opravlja od tri do sedem nočnih izmen mesečno (x = 3,76, s = 2,51). Vse anketiranke imajo težave z nespečnostjo (n = 81, 100 %), večina jih s težavo ostaja budnih na delovnem mestu (n = 52, 64,2 %). Težave z budnostjo na delovnem mestu se povezujejo s slabšim splošnim počutjem (r = 0,236, p = 0,034) in so pogostejše ob večjem številu nočnih izmen v mesecu (r = −0,322, p = 0,003). Anketiranke so mnenja, da neprespanost povečuje verjetnost napak pri delu (n = 60, 74,1 %), upočasnjuje hitrost odzivanja na nepričakovane urgentne situacije na delovnem mestu (n = 58, 71,6 %) ter slabo vpliva na njihovo komunikacijo s pacienti (n = 48, 59,2 %).Diskusija in zaključek: Podobno kot druge tuje raziskave o zaposlenih v zdravstveni negi tudi ta potrjuje, da se neprespanost zaradi nočnega dela povezuje s slabšim počutjem, utrujenostjo in zmanjšano delazmožnostjo.

Fatigue in Intensive Care Nurses and Related Factors

BACKGROUND

Fatigue negatively affects the performance of intensive care nurses. Factors contributing to the fatigue experienced by nurses include lifestyle, psychological status, work organization and sleep problems.

OBJECTIVE

To determine the level of fatigue among nurses working in intensive care units and the related factors.

METHODS

This descriptive study was conducted with 102 nurses working in intensive care units in the West Black Sea Region of Turkey. Data were collected between February and May 2014 using a personal information form, the Visual Analogue Scale for Fatigue (VAS-F), the Hospital Anxiety and Depression Scale and the Pittsburg Sleep Quality Index.

RESULTS

The intensive care nurses in the study were found to be experiencing fatigue. Significant correlations were observed between scores on the VAS-F Fatigue and anxiety (p=0.01), depression (p=0.002), and sleep quality (p<0.001).

CONCLUSION

Anxiety, depression and quality of sleep were significantly affected by the intensive care nurses' levels of fatigue. These results can be of benefit in taking measures which may be used to reduce fatigue in nurses, especially the fatigue related to work organization and social life.

A survey of the prevalence of fatigue, its precursors and individual coping mechanisms among U.S. manufacturing workers

Advanced manufacturing has resulted in significant changes on the shop-floor, influencing work demands and the working environment. The corresponding safety-related effects, including fatigue, have not been captured on an industry-wide scale. This paper presents results of a survey of U.S. manufacturing workers for the: prevalence of fatigue, its root causes and significant factors, and adopted individual fatigue coping methods. The responses from 451 manufacturing employees were analyzed using descriptive data analysis, bivariate analysis and Market Basket Analysis. 57.9% of respondents indicated that they were somewhat fatigued during the past week. They reported the ankles/feet, lower back and eyes were frequently affected body parts and a lack of sleep, work stress and shift schedule were top selected root causes for fatigue. In order to respond to fatigue when it is present, respondents reported coping by drinking caffeinated drinks, stretching/doing exercises and talking with coworkers. Frequent combinations of fatigue causes and individual coping methods were identified. These results may inform the design of fatigue monitoring and mitigation strategies and future research related to fatigue development.

Coping strategies and social support needs of experienced and inexperienced nurses performing shiftwork

AIM

The aim of this investigation was to compare perceptions of nurses exposed to short or longer term shift work and their experiences working under this type of scheduling.

BACKGROUND

Shift work is a crucial component of nurses' working lives, ensuring continuous care for patients. This study fills a research gap around the personal experiences of shift working nurses and the strategies used to manage the impacts of shift work.

DESIGN

Qualitative case study design.

METHODS

Constructivist methodology, including in-depth semi-structured interviews conducted in 2015, was used for the study. Iterative review and inductive analysis of transcripts from nine recently graduated nurses and twelve experienced nurses enabled identification and verification of key themes.

FINDINGS

Three main areas of difference between new and experienced nurses relating to shift work challenges in a nursing environment emerged: perceptions about the utility of working in shifts, coping strategies and social support at home and work. Most experienced nurses found shift work advantageous, especially those with dependents. Coping strategies included flexible shift arrangements in both groups. Experienced nurses detailed the importance of support from family and friends while inexperienced nurses described feeling disconnected from social supports. Experienced nurses cited a lack of support from nursing managers as problematic.

CONCLUSIONS

Findings suggest shift selection mitigated challenges of shift work for both inexperienced and experienced nurses, indicating autonomous roster selection is critical. Similarly, social support at work from senior nurses and management and at home played an important role in nurses' coping.

A study into psychosocial factors as predictors of work-related fatigue

OBJECTIVE

To explore and determine relationship between psychosocial factors and work-related fatigue among emergency and critical care nurses in Brunei.

METHODS

Cross-sectional study conducted on all emergency and critical care nurses across Brunei public hospitals from February to April 2016.

RESULTS

201 nurses participated in the study (82% response rate). A total of 36% of the variance of chronic fatigue was explained by stress, trust in management, decision latitude, self-rated health, and work-family conflict. Burnout, self-rated health, commitment to workplace, and trust in management explained 30% of the variance of acute fatigue. Stress, work-family conflict and reward explained 28% of the variance of intershift recovery after controlling for significant sociodemographic variables. Smoking was identified as an important sociodemographic factor for work-related fatigue.

CONCLUSIONS

Psychosocial factors were good predictors of work-related fatigue. A range of psychosocial factors were established, however more research is required to determine all possible causation factors of nurses' work-related fatigue.

Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses

Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses’ practice that should be monitored by nursing management.

The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts

BACKGROUND

Shift work is considered necessary to ensure continuity of care in hospitals and residential facilities. In particular, the night shift is one of the most frequent reasons for the disruption of circadian rhythms, causing significant alterations of sleep and biological functions that can affect physical and psychological well-being and negatively impact work performance.

OBJECTIVES

The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction.

METHODS

This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in 17 wards of a general hospital and a residential facility of a northern Italian city. This study involved 213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data collection was the "Standard Shift Work Index," validated in Italian. Data were statistically analyzed.

RESULTS

The response rate was 86%. The nurses engaged in rotating night shifts were statistically significantly younger, more frequently single, and had Bachelors and Masters degrees in nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in comparison with the day shift workers, in a statistically significant way.

CONCLUSION

Our results suggest that nurses with rotating night schedule need special attention due to the higher risk for both job dissatisfaction and undesirable health effects.

Prevention of fatigue and insomnia in shift workers-a review of non-pharmacological measures

Background

Excessive fatigue and insomnia are common among shift workers and can lead to negative effects such as reduced work performance, processing errors, accidents at work, absenteeism, reduced quality of life, and symptoms of depression. Moreover, work in rotating shifts can be a risk factor for different somatic and psychiatric diseases and may contribute to poor health, especially in elder adults and women. This review aims to show non-pharmacological preventive measures against fatigue and insomnia in shift workers.

Method

Computerized literature searches in MedLine and in the Cochrane Library were performed with the following key words: shift work disorder, fatigue, insomnia, shift work, measures, treatment, therapy, strategies and coping. The search was limited to non-pharmacological studies that were conducted on human subjects and published as English-language articles in peer-reviewed journals since 1970. Additional studies were identified through the reference sections of relevant articles. Eighteen articles on fatigue in shift workers, including six original research articles with a total sample size of 3504 probands consisting of industrial workers, office employees, aircraft maintenance engineers, and non-shift workers working in simulated shifts, were analyzed, as well as seven articles on insomnia, including an original research article with a sample size of 26 media workers. Also, 4 reviews on shift work disorder were analyzed.

Main

The occurrence of fatigue and insomnia in shift workers associated with a working period is described as shift work disorder. Estimations on the prevalence of shift work disorder in shift workers vary between 5 % and about 20 %; about one in three shift workers is affected by insomnia and up to 90 % of shift workers report regular fatigue and sleepiness at the workplace. We concluded that there is a necessity for treatments to improve the sleep quality of the shift working population. The most common non-pharmacological recommendations to improve sleep quality and to reduce insomnia and fatigue were scheduling, bright light exposure, napping, psychoeducation for sleep hygiene, and cognitive-behavioral measures.

Conclusion

Some important preventive coping strategies for fatigue associated with shift work such as napping and exposure to bright light have already been investigated and are generally approved. A few studies also provide good evidence for the efficacy of cognitive-behavioral techniques in the treatment of chronic primary and comorbid insomnia. These coping strategies summarized in this paper should be considered in the workplace health promotion programs of each work environment to improve working conditions for shift workers and to save money.

A macroergonomic perspective on fatigue and coping in the hospital nurse work system

Occupational fatigue in hospital nurses is associated with increased nurse turnover, and decreased nurse health and patient safety. The goal of this study was to explore the factors contributing to or preventing fatigue, and barriers and facilitators to individual nurse coping in hospital work systems. Interviews were conducted and analyzed using a directed qualitative content analysis approach guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model. Themes related to sources of fatigue within each of the five primary components of the SEIPS work system were identified, along with barriers and facilitators to nurses' experiences and strategies for coping with fatigue. Findings from this study provide guidance on what nurses perceive as contributing to fatigue and factors that are helpful and harmful to coping with fatigue within their work system. Implications for fatigue risk management systems (FRMS) are also discussed, in particular the importance of maintaining nurse autonomy in decision-making when implementing fatigue interventions or countermeasures.

The Association between Job-Related Psychosocial Factors and Prolonged Fatigue among Industrial Employees in Taiwan

Background and Objectives

Prolonged fatigue is common among employees, but the relationship between prolonged fatigue and job-related psychosocial factors is seldom studied. This study aimed (1) to assess the individual relations of physical condition, psychological condition, and job-related psychosocial factors to prolonged fatigue among employees, and (2) to clarify the associations between job-related psychosocial factors and prolonged fatigue using hierarchical regression when demographic characteristics, physical condition, and psychological condition were controlled.

Methods

A cross-sectional study was employed. A questionnaire was used to obtain information pertaining to demographic characteristics, physical condition (perceived physical health and exercise routine), psychological condition (perceived mental health and psychological distress), job-related psychosocial factors (job demand, job control, and workplace social support), and prolonged fatigue.

Results

A total of 3,109 employees were recruited. Using multiple regression with controlled demographic characteristics, psychological condition explained 52.0% of the variance in prolonged fatigue. Physical condition and job-related psychosocial factors had an adjusted R² of 0.370 and 0.251, respectively. Hierarchical multiple regression revealed that, among job-related psychosocial factors, job demand and job control showed significant associations with fatigue.

Conclusion

Our findings highlight the role of job demand and job control, in addition to the role of perceived physical health, perceived mental health, and psychological distress, in workers’ prolonged fatigue. However, more research is required to verify the causation among all the variables.

Relationship Between Shift Work and Personality Traits of Nurses and Their Coping Strategies

BACKGROUND & OBJECTIVE

Because of social progress, population growth, industrialization, and the requirements of some jobs, a significant percentage of employees are working in shifts. Shift work is considered a threat to health that could have unfavorable effects on various aspects of human life. This study investigated the relationship between shift work and the personality traits of nurses and their coping strategies in a selection of non-governmental hospitals in Tehran in 2014.

METHODS

This applied cross-sectional descriptive research employed the Standard Shift work Index and Eysenck Personality Questionnaire (EPQ) which, after confirmation of its validity and reliability (Cronbach's alpha 0.73), were distributed among 305 nurses from 6 non-governmental hospitals in Tehran selected through cluster random sampling. Data was analyzed in two statistical levels: descriptive and inferential.

RESULTS

Results revealed that 43.6% of the nurses participating in the study were introverted and 56.4% were extroverted. There are significant relationships between age and physical health (P=0.008), sex and physical health (P=0.015), educational level and physical health (P=0.014), sex and cognitive, somatic anxiety (P=0.006), age and social-family status (P=0.001), marital status and social-family status (P=0.001), having a second job and social-family status (P=0.001), educational level and sleep and fatigue (P=0.002), work experience and coping strategies (P=0.044), and sleep and fatigue and personality traits (P=0.032).

CONCLUSION

Complying with the standards of working hours for nurses and avoiding overtime when scheduling, especially for nurses with more work experience, can prevent the severe complications of shift work, enhance health, and ultimately enhance the quality of care. By improving the physical, psychological, and social health of nurses, the quality of patient care can be expected to improve, too.

Depression, Anxiety and Symptoms of Stress among Hong Kong Nurses: A Cross-sectional Study

Recent epidemiological data suggests 13.3% of Hong Kong residents suffered from Common Mental Disorders, most frequently mixed anxiety and depressive disorder. This study examines the weighted prevalence and associated risk factors of depression, anxiety and stress among Hong Kong nurses. A total of 850 nurses were invited to participate in this cross-sectional study. Participants completed the Depression, Anxiety and Stress Scale 21 and multiple logistic regression was used to determine significant relationships between variables. Chronic past-year illness and poor self-perceived mental health were significant correlates of past-week depression, anxiety and stress. It confirmed further positive correlations between depression and divorce, widowhood and separation, job dissatisfaction, disturbance with colleagues, low physical activity levels and sleep problems. Marital status; general medicine; sleep problems, and a lack of leisure significantly correlated with anxiety. Stress was significantly associated with younger age, clinical inexperience, past-year disturbance with colleagues, low physical activity, no leisure and drinking alcohol. Nurses were more depressed, anxious and stressed than the local general population, with over one-third of our respondents classified as subject to these disorders.