Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses

Latent profile analysis of operating room nurses' occupational fatigue and its relationship with attentional control

BACKGROUND

Occupational fatigue in operating room nurses may influence their attentional control. However, few previous studies have explored the correlation between occupational fatigue and attentional control in operating room nurses. To better understand operating room nurses' occupational fatigue and its relationship with attentional control, this study aimed to identify the latent profiles and their factors that influence operating room nurses' occupational fatigue as well as differences in attentional control across each latent profile.

METHODS

A cross-sectional study was conducted from May 2024 to July 2024, and a total of 386 operating room nurses were recruited from 6 hospitals in Chengdu. The participants completed the Occupational Fatigue Scale and the Attentional Control Scale. Latent profile analysis (LPA) was employed to identify latent profiles of occupational fatigue among operating room nurses. The predictors of occupational fatigue in different latent profiles were assessed via multinomial logistic regression analysis. One-way ANOVA and the Kruskal-Wallis test were used to compare the scores on the attentional control scale for each latent profile of nurses' occupational fatigue.

RESULTS

This study identified three latent profiles of operating room nurses'. occupational fatigue: the "low-fatigue/high-recovery group" (n = 80, 21.2%), the "high-fatigue/low-recovery group" (n = 113,29.3%) and the "moderate-fatigue/mod-erate-recovery group" (n = 193, 49.4%). The results of the multinomial logistic regression analysis suggested that age, work experience, educational level and monthly income were predictors of operating room nurses' occupational fatigue. There were significant differences in attentional control among the different pr-ofiles of occupational fatigue (P < 0.001). The scores for attentional focus were. Significantly different across each profile (P < 0.001), whereas the scores for at-tentional shift were not different across profiles (P = 0.342).

CONCLUSIONS

Operating room nurses' occupational fatigue can be divided into three latent profiles. Reducing chronic and acute fatigue while enhancing intershift recovery can improve nurses' attentional control and improve the overall service quality of the hospital. Nursing managers should identify operating room nurses who are at risk and implement targeted interventions to reduce occupational fatigue.

TRIAL REGISTRATION

This study does not involve clinical trials or interventional procedures and therefore does not meet the criteria for clinical trial registration.

The Effect of the Difficulties Faced by Palliative Care Nurses on Perceived Quality of Palliative Care: A Cross-Sectional Descriptive Study

AIM

This study examined how the difficulties experienced by palliative care nurses while providing care affect the quality of palliative care perceived by nurses.

BACKGROUND

The increase in chronic diseases with the ageing population has brought about a greater need for palliative care. Palliative care nurses play a central role in improving patients' quality of life, while also facing emotional and physical challenges. The impact of these challenges on nurses' job satisfaction and the quality of care provided constitutes a critical area of research for understanding the effectiveness of palliative care services.

METHOD

The study was conducted in a descriptive, cross-sectional and correlational design with nurses working in palliative care services (N = 243) in Türkiye between October 2023 and March 2024. The data were collected through an introductory form, The Palliative Nursing Care Quality Scale and the Palliative Care Difficulties Scale. The relationship between the two variables was examined using Pearson correlation analysis, while the impact of palliative care challenges and education level on perceived palliative care quality was investigated through multiple linear regression analysis.

RESULTS

In this study, the data were normally distributed and it was found that the nurses' total mean score was 72.42 ± 8.26 (min: 18-max: 90) on the Palliative Nursing Care Quality Scale and 40.85 ± 10.50 (min: 15-max: 75) on the Palliative Care Difficulties Scale. Total mean palliative care quality score was found to be significantly higher among nurses with postgraduate degrees. Moreover, the palliative care difficulty scores were significantly higher for males, nurses with palliative experience of 1 year or less, and those who did not select the palliative care unit willingly. A negative correlation was observed between the nurses' quality of palliative care and their palliative care difficulties.

CONCLUSION

It was seen that perceived quality of palliative care decreased as the difficulties encountered in palliative care increased. It is recommended to develop training programmes tailored for nurses and ensure continuous professional development to reduce the difficulties nurses face in palliative care and enhance the perceived quality of palliative care.

Patient communication as the missing item in clinical nursing education: A qualitative content analysis study

BACKGROUND

One of the basic goals of nursing education is to upgrade students' patient communication skills. In this regard, students' experiences in relationships with patients can be the cornerstone of their knowledge. Therefore, the present study's objective was to divulge nursing students' experiences in communicating with patients during their study course.

MATERIALS AND METHODS

The qualitative method used in this research involved conventional content analysis. The study participants were nursing students, both undergraduate and graduate, in Iran who were selected through purposeful sampling. The research took place in 2022 at the hospital or the nursing and midwifery faculty of the Birjand University of Medical Sciences. In total, 12 interviews were conducted until data saturation was reached. The interviews were carried out in clinical settings as per the students' preferences, where they interacted with patients. Each interview lasted 45-60 minutes, typically in one or two sessions.

RESULTS

Data analysis resulted in the extraction of 37 subcategories, 10 categories, and five themes. All the concepts that emerged during conventional content analysis revolved around nursing students' experiences and were in line with the study's objectives. The themes included sustainability of communication, divergent communication, communicational modeling, patient communication as the missing component of clinical nursing education, and communication as the essence of care.

CONCLUSION

It is necessary to pay special attention to and enrich nursing educational curricula with patient communication courses and play the role of appropriate communicational models that can help greatly promote the health of patients.

Cross-sectional Study Reveals Moderate Professional Benefits Among Nurses in a Multicultural Healthcare System

The global nursing shortage poses challenges to healthcare accessibility, clinical outcomes, and patient safety. Researchers have explored factors that influence nursing attrition, and the Nurses' Perceived Professional Benefits (NPPB) is one such factor that has gained attention. This cross-sectional study aims to assess the NPPB among registered nurses in Macao, a multicultural city with a unique healthcare system. A 33-item online questionnaire was used to collect data from 279 nurses. The questionnaire measured NPPB across 5 dimensions: positive occupational perception, personal enhancement, recognition from family and friends, decent nurse-patient relationships, and team belongingness. This study indicated that Macao nurses had a moderate level of NPPB. Nurse-patient relationships, income, and job stability received the most positive responses, while team belongingness received the lowest scores. These findings suggest that improvements are needed in team building, providing more opportunities for specialized training, and offering more career advancement opportunities.

Psychological detachment from work during nonwork time as a moderator and mediator of the relationship of workload with fatigue and sleep in hospital nurses

OBJECTIVES

To examine differences in psychological detachment from work during nonwork time by nurses' personal and work-related characteristics, and to examine the moderating and mediating effects of psychological detachment on the relationships between nursing workload and fatigue and sleep.

METHODS

This study employed a cross-sectional design with a self-administered online survey. Survey data from 827 hospital nurses providing direct patient care in the United States were used. Moderating and mediating effects of psychological detachment between workload and fatigue/sleep relationships were assessed using Hayes' PROCESS macro in SPSS.

RESULTS

There were significant differences in psychological detachment from work based on age, highest nursing degree, work experience, shift length, weekly work hours, and frequency of providing care to patients with COVID-19. The associations of workload with physical fatigue, mental fatigue, and sleep quality were weakened when psychological detachment was high. Psychological detachment statistically mediated the associations between workload and fatigue and sleep problems.

CONCLUSION

Healthcare organizations are encouraged to facilitate nurses' psychological detachment during time-off to protect them from fatigue and sleep problems.

Impact of authentic leadership on nurses' well-being and quality of care in the acute care settings

INTRODUCTION

Both nurses' well-being and quality of care are top priorities of the healthcare system. Yet, there is still a gap in understanding the extent and how authentic leadership influences them. This information is needed to inform the development of effective interventions, organizational practices, and policies. Thus, this study aimed to test the mechanism by which nurses' perception of their managers' authentic leadership impacts nurses' well-being and perception of quality of care, given the role of the nursing practice environment and nurses' psychological capital.

DESIGN

A cross-sectional design was used.

METHODS

This study recruited a random sample of 680 nurses from six hospitals in Saudi Arabia. A final sample of 415 completed the surveys, with a response rate of 61%. Structural equation modeling was performed to test the hypothesized model.

RESULTS

The study showed that nurses' perceptions of authentic leadership in their managers positively and directly affect their perceptions of quality of care but do not directly affect nurses' well-being. Both the nursing practice environment and psychological capital fully mediated the relationship between authentic leadership and nurses' well-being. However, the nursing practice environment partially mediated the relationship between authentic leadership and perceptions of quality of care.

CONCLUSION

The findings contribute to understanding the crucial role of authentic leaders' style in nurses' well-being and quality of care through its positive impact on the nursing practice environment and psychological capital.

CLINICAL RELEVANCE

Designing interventions and policies that specifically target nursing managers' authentic leadership style has implications for enhancing nurses' well-being and the quality of patient care. Institutional measures are needed to help leaders practice an authentic leadership style to create a positive nursing practice environment and cultivate nurses' psychological capital, both of which contribute to nurses' well-being and attaining a better quality of care. Further work is required to highlight the outcomes of implementing an authentic leadership style relevant to other leadership styles.

Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study

PURPOSE

There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care.

DESIGN AND METHODS

A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model.

RESULTS

The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (β = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (β = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (β = 0.636, p = .000).

CONCLUSIONS

Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care.

PRACTICAL IMPLICATIONS

The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.

A brief mindfulness-based intervention, sleep quality, sleep duration, and fatigue among nurses: A randomized controlled trial

AIMS

The purpose of the current study was to investigate the effectiveness of a mindfulness-based intervention in improving sleep duration, sleep quality, and fatigue among Jordanian nurses.

DESIGN AND METHODS

A randomized controlled trial was used to conduct this study. Data from 123 nurses (60 nurses in the interventional group and 63 nurses in the control group) were collected and analyzed. The primary outcome measures were compared between the intervention and control groups using repeated measure MANOVA to assess changes in sleep duration, sleep quality, and fatigue over time.

RESULTS

The results showed that there was a statistically significant multivariate effect of the intervention on the linear combination of the dependent variables (sleep duration, sleep quality, and fatigue) (V = 0.23, F (3, 119) = 12.02, p < .001) with Partial η2 of 0.23. Follow-up analysis showed that the intervention group had lower sleep disturbances (Mean difference = -6.53, CI = -7.79 to -5.26) and less fatigue (Mean difference = -13.36, CI = -17.24 to -9.47) than the control group.

CONCLUSIONS

The current study showed that the mindfulness-based intervention effectively addresses sleep quality and fatigue in nurses, which in turn is expected to positively impact the health care system.

CLINICAL RELEVANCE

Mindfulness-based interventions effectively address sleep quality and fatigue associated with nurses' job performance and outcomes. Implementing brief mindfulness-based interventions is crucial as they can be self-implemented and fit into nurses' busy schedules.

Occupational fatigue, compassion competence and caring behaviours of intensive care nurses: A structural equation modelling approach

BACKGROUND

No previous study has examined the direct effect of occupational fatigue, inter-shift recovery and compassion competence on caring behaviours, including assurance, knowledge-skill, respect and commitment in intensive care nurses.

AIM

We studied the direct effect of participating nurses' occupational fatigue, inter-shift recovery and compassion competence levels on their caring behaviours and the relationship among these variables.

STUDY DESIGN

This was a descriptive correlational study. All nurses who were registered members of the Turkish Intensive Care Nurses Association were invited to participate in this online survey. This study was conducted with 315 intensive care nurses using convenience sampling between April and July 2022. The data were collected using the Occupational Fatigue Exhaustion/Recovery Scale, which consists of three subscales: acute fatigue, chronic fatigue and inter-shift recovery; the Compassion Competence Scale, including communication, sensitivity and insight subscales; and the Caring Behaviours Inventory-24. In addition, a structural equation model was established using variables correlating with caring behaviours. Independent variables were occupational fatigue, inter-ship recovery and compassion competence; and the dependent variable was caring behaviours in this hypothesized model.

RESULTS

Three hundred and fifteen nurses completed the survey (315/1000) with a response rate of 31.5%. The increase in the inter-shift recovery levels of participants was statistically and positively associated with caring behaviours (95% confidence interval [CI]: 0.001-0.011, β = .154 [moderate effect size], p < .05). The sub-dimensions of the Compassion Competence Scale, that is, communication (95% CI: 0.110-0.443, β = .251 [moderate effect size]) and sensitivity (95% CI: 0.084-0.427, β = .241 [moderate effect size]), were statistically and positively associated with the caring behaviours of participants (p < .05). In addition, independent variables accounted for 35% (large effect size) of the total change in caring behaviours (R2 = 0.350).

CONCLUSIONS

This study suggests that the high inter-shift recovery and compassion competence levels of intensive care nurses are positively associated with their caring behaviours.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should consider the direct effect of occupational fatigue, inter-shift recovery and the compassion competence levels of intensive care nurses on their caring behaviours to provide high-quality care.

Effect of compassion fatigue on emotional labor in female nurses: Moderating effect of self-compassion

Emotional labor is common in nursing but may be affected by the mental state of nurses. This study explored the effect of compassion fatigue on emotional labor and whether self-compassion moderates this effect of compassion fatigue.

METHODS

A two-stage survey design with a convenience sample. Participants were female nursing staff recruited from emergency departments, intensive care units, ward nursing units, and outpatient departments of medical centers, regional hospitals, and district hospitals in Taiwan. A total of 300 questionnaire copies in each of the first and second stages were distributed, and 272 pairs of responses were retrieved (valid response rate = 91%). The reliability and validity of the questionnaire were tested, and confirmatory factor analysis was conducted with AMOS 21. The proposed hypotheses were verified using hierarchical regression conducted with SPSS version 25.0.

RESULTS

This study revealed that compassion fatigue positively predicted surface acting (β = 0.12, p < 0.05) and negatively predicted deep acting (β = -0.18, p < 0.01) and expression of genuine emotions (β = -0.31, p < 0.01). In addition, self-compassion negatively moderates the relationships between compassion fatigue and surface acting (β = -0.12, p < 0.05), and positively moderates the relationships between compassion fatigue and expression of genuine emotions (β = 0.15, p < 0.01).

CONCLUSIONS

To avoid excessive consumption of emotional resources, nurses with high compassion fatigue may employ surface acting by engaging in emotional labor without making an effort to adjust their feelings. Nurses need also be sympathized with, and such sympathy can come from hospitals, supervisors, colleagues, and, most crucially, the nurses themselves. Hospital executives should propose improvement strategies that can prevent the compassion fatigue on nurses, such as improving nurses' self-compassion.

Examining Nurses' Perception of Shift Work and Evaluating Supportive Interventions

BACKGROUND

Health care requires a delicate equilibrium of nurse health safety and patient safety outcomes. Shift work can disrupt this balance, resulting in poor outcomes for staff and patients.

PROBLEM

Limited evidence exists on nurses' perceptions of shift work, fatigue countermeasures use, and interest in risk-mitigating interventions.

METHODS

An online survey of nurses was conducted. Survey questions assessed perceptions of shift work, use of fatigue countermeasures, and potential interventions.

RESULTS

The participants perceived multiple differences between day and night shifts when asked about their ability to complete both work- and life-oriented tasks. Use of fatigue countermeasures was more common while working night shift. Potential interventions included the use of blackout curtains, an on-site exercise facility, consulting a nutritionist, and block scheduling.

CONCLUSIONS

Health care leaders should consider nurses' perceptions and interests when incorporating initiatives to mitigate the negative effects of shift work.

Competencies expected of undergraduate nursing students: A scoping review

AIM

Nursing competencies are crucial indicators for providing quality and safe care. The lack of international agreement in this field has caused problems in the generalization and application of findings. The purpose of this review is to identify the core competencies necessary for undergraduate nursing students to enter nursing work.

DATA SOURCES

We conducted a structured search using Scopus, MEDLINE (PubMed), Science Direct, CINAHL, Web of Science, and Google Scholar.

REVIEW METHODS

We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute, supported by the PAGER framework, and guided by the PRISMA-ScR Checklist. Inclusion criteria included full-text articles in English, quantitative and qualitative research related to competencies for undergraduate students or newly graduated nurses, competency assessment, and tool development from 1970 to 2022. We excluded articles related to specific nursing roles, specific contexts, Master's and Ph.D. curricula, hospital work environment competencies, and editorial.

RESULTS

Out of 15,875 articles, we selected 43 studies, and data analysis with summative content analysis identified five themes named individualized care, professional nursing process, nursing administration, readiness, and professional development.

CONCLUSION

Considering the dynamics of competencies and their change with time, experience, and setting, it is necessary to update, localize, and levelling of the proposed competencies based on the culture of each country.

IMPACT

These competencies provide a guide for undergraduate nursing curriculum development and offer a framework for both clinical instruction and the evaluation of nursing students.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Consecutive Shifts: A Repeated Measure Study to Evaluate Stress, Biomarkers, Social Support, and Fatigue in Medical/Surgical Nurses

Nurses report that they are required to work during their scheduled breaks and generally experience extended work times and heavy workloads due to staffing shortages. This study aimed to examine changes in personal, work-related, and overall stress, as well as biological responses and fatigue experienced by nurses during three consecutive 12 h workdays (i.e., the typical "three-twelves" schedule). We also considered the moderating effects of social resources. This prospective study of 81 medical/surgical nurses who completed questionnaires and provided saliva samples at four designated intervals (i.e., pre-shift and post-shift on workdays 1 and 3). Fatigue reported by night shift nurses increased significantly over three consecutive workdays (p = 0.001). Day shift nurses said they encountered more social support than those on the night shift (p = 0.05). Social support moderated the relationship between work-related stress at baseline and reported fatigue on day 3.

When nurses become ill, are they able to identify the predictors of the quality of care they received?

<b>Background</b>: Nurses are the most qualified judges for quality of nursing care (QNC) because they have the greatest experience with standard care. It is vital to examine QNC from the perspective of nurses who have experience as hospitalized patients or as caregivers in order to perform an accurate assessment of the nursing care that is delivered to meet the needs of patients.<br /> <b>Aims</b>: To examine the predictors of QNC from the perspective of nurses as patients and/or as caregivers for hospitalized relatives.<br /> <b>Methods</b>: This study aimed a cross-sectional correlational design that utilized a convenience sample of 231 registered nurses recruited from eight hospitals in three health care sectors in Jordan. Data were collected using caring behaviors inventory, nurse professional competence scale, and using a single item rating scale that asked nurses to respond to the overall QNC.<br /> <b>Results</b>: The hierarchical multiple regression showed that QNC scores was predicted with a high variance (61%) explained. The strongest predictive contribution was from nursing competencies. Only 34% of the participants gave positive scores for the overall QNC, and their perception was moderately positive.<br /> <b>Conclusion</b>: It is necessary to examine QNC from the perspective of nurses who have experience as hospitalized patients or as caregivers.

The better work, better care framework: 7 strategies for sustainable healthcare system process improvement

Healthcare systems are under pressure to control costs and improve performance. Efforts to apply improvement trends such as "Lean" and other industrial engineering approaches have led to degradation of the working environment for healthcare professionals. Research is increasingly demonstrating how poor working environments contribute to declines in care quality and has led to calls for a "quadruple aim" with a focus on the working environment alongside quality, cost, and patient experience factors. This paper contributes to the debate by using a "systems" perspective to propose seven strategies by which healthcare systems might be improved without compromising the working environment. This article presents a rationale for these strategies based on current organisational psychology and human factors research and how these strategies might be deployed in practice. The authors argue that better working conditions leads to better care for patients and presents a viable approach for both practitioners and researchers to pursue the "Better Work, Better Care" agenda.

Occupational stress and burnout among intensive care unit nurses during the pandemic: A prospective longitudinal study of nurses in COVID and non-COVID units

Background

Intensive care unit (ICU) nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses' workload and further exacerbated their stress and burnout. This work investigates occupational stress and burnout experienced by ICU nurses working with COVID and non-COVID patients.

Method

A prospective longitudinal mixed-methods study was conducted with a cohort of ICU nurses working in medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-h shifts. Data on occupational stress and burnout prevalence were collected using validated questionnaires. Physiological indices of stress were collected using wrist-worn wearable technologies. Participants elaborated on the causes of stress experienced each shift by completing open-ended questions. Data were analyzed using statistical and qualitative methods.

Results

Participants caring for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p < 0.001) in comparison to non-COVID unit participants. No differences in stress levels were found when the same participants worked with COVID and non-COVID patients at different shifts (p = 0.58) at the COVID unit. The cohorts expressed similar contributors to stress, based in communication tasks, patient acuity, clinical procedures, admission processes, proning, labs, and assisting coworkers.

Conclusion

Nurses in COVID units, irrespective of whether they care for a COVID patient, experience occupational stress and burnout.

Shift work organization on nurse injuries: A scoping review

BACKGROUND

Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety.

OBJECTIVE

To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse.

METHODS

A scoping review was conducted using search results from five bibliographic databases.

RESULTS

Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes.

CONCLUSIONS

Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.

Self-reported work-related accumulative fatigue of nurses: A cross-sectional study in public hospitals in China

Objectives

Work-related fatigue is a serious safety risk to nurses and their patients. This study aimed to assess self-reported work-related accumulative fatigue of nurses and its associated factors.

Methods

A questionnaire survey of 2,918 clinical nurses conveniently sampled from 48 public hospitals across six provinces in China was conducted. The "Self-diagnosis Checklist for Assessment of Workers' Accumulated Fatigue" was adopted to assess the level of work-related accumulative fatigue of the study participants. Chi-square tests and ordinal regression analyses were performed to determine the sociodemographic characteristics associated with work-related accumulative fatigue.

Results

About one third of respondents reported low work-related accumulative fatigue, compared with 23.1% reporting high and 24.6% reporting very high levels of work-related accumulative fatigue. Higher levels of work-related accumulative fatigue were associated with female gender (AOR = 0.614 for male relative to female, p = 0.005), age between 30 and 40 years (AOR = 1.346 relative to >40 years, p = 0.034), 5-10 years of work experience (AOR = 1.277 relative to >10 years, p = 0.034), and bachelor or above degree qualifications (AOR = 0.806 for associate degree relative to bachelor or above degree, p = 0.007). Those who worked in rural county hospitals (AOR = 0.816 for metropolitan relative to rural county hospitals, p = 0.006) and resided in central China (AOR = 1.276 relative to western China, p = 0.004) had higher odds of reporting higher levels of work-related accumulative fatigue.

Conclusion

High levels of work-related accumulative fatigue are evident in nurses of public hospitals in China. The problem is more serious in the female nurses in their mid-career and those who worked in the central region and rural setting.

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

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

Occupational fatigue, workload and nursing teamwork in hospital nurses

AIMS

To evaluate the relationships between workload, nursing teamwork and nurse fatigue and the moderating effect of nursing teamwork on the relationship between workload and fatigue.

DESIGN

This cross-sectional online survey study used data from 810 United States hospital nurses collected between March and April 2021.

METHODS

Workload, nursing teamwork and fatigue were measured using the Quantitative Workload Inventory, the Nursing Teamwork Survey, and the Occupational Fatigue Exhaustion Recovery scale. Hierarchical multiple linear regression models were used.

RESULTS

All the nursing teamwork subscales (i.e. trust, team orientation, backup, shared mental model, team leadership) were significantly negatively related to acute and chronic fatigue. Nursing teamwork components of team orientation, shared mental model and team leadership moderated the relationship between workload and chronic fatigue. The relationships between workload and chronic fatigue were stronger when these components of nursing teamwork were high. No moderating effects were found with acute fatigue.

CONCLUSION

Efforts to increase nursing teamwork may be a promising strategy in managing nurse fatigue. It is equally important to monitor and modify high workload to protect nurses from elevated fatigue.

IMPACT

WHAT PROBLEM DID THE STUDY ADDRESS?: Fatigue is negatively associated with the health and safety of hospital nurses and patients. Nursing teamwork has been shown to improve the nursing care of hospitalized patients; yet, it is rarely explored in relation to nurse fatigue. WHAT WERE THE MAIN FINDINGS?: Greater nursing teamwork is significantly associated with lower acute and chronic fatigue. The relationships between workload and chronic fatigue were stronger when nursing teamwork (i.e. team orientation, shared mental model and team leadership) was high than when nursing teamwork was low. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Improving nursing teamwork, in addition to monitoring and modifying workloads, can be a promising approach for managing fatigue in healthcare organizations.