Fatigue in nurses and medication administration errors: A scoping review

Association of Virtual Nurses' Workflow and Cognitive Fatigue During Inpatient Encounters: Cross-Sectional Study

Background

The virtual nursing delivery model enables the provision of expert nursing care from a remote location, using technology such as audio and video communication, remote monitoring devices, and access to electronic health records. Virtual nurses spend an extensive amount of time on computers to provide care, and little is known about how this workflow may affect and contribute to cognitive fatigue.

Objective

This study aimed to use eye tracking technology and pupil size variation to determine instances of virtual nurse cognitive fatigue during their typical workflow.

Methods

This study examined the virtual nursing workflow by recording and analyzing virtual nurse encounters using eye tracking. This cross-sectional study was conducted during regular 12-hour shifts at a major Southeastern health center in the United States.

Results

The study found that 75% (22/29) of virtual nursing encounters demonstrated a first fatigue instance at 9.8 minutes during patient discharges and at 11.9 minutes during patient admissions.

Conclusions

This study provides valuable insights into virtual nursing workflow design and how it may impact the cognitive fatigue levels of nurses providing inpatient virtual care.

Hallmarks of nursing students exhibiting unsafe clinical practices: a qualitative study

BACKGROUND

Maintaining and promoting patient safety is a shared responsibility among all participants in the health care system. Educators are required to balance patients' rights to receive safe care and create a suitable and safe environment for nursing students to learn. Therefore, early identification of students with unsafe clinical practice and intervention may be important measures for improving patient safety. Therefore, the present study was conducted with the aim of identifying the main hallmarks of nursing students with unsafe clinical practice.

METHODS

This qualitative study was conducted with 19 faculty members, nursing students, and supervisors of medical centers. Data collection was performed through purposive sampling and semi structured interviews. Data analysis was performed via conventional qualitative content analysis via MAXQDA10 software.

RESULTS

The results of the study led to the identification of 2 main categories, "Underdeveloped knowledge and cognitive capacity" and "Underdeveloped personal-professional capacity", and 6 and 4 subcategories, respectively, as the main hallmarks for identifying students with unsafe clinical practice.

CONCLUSION

The findings of this qualitative study expand our understanding of the hallmarks of nursing students with unsafe clinical practice. Undergraduate nursing students with unsafe clinical practice may not have acquired sufficient development and progress in terms of knowledge, skills, and personal-professional characteristics or may not be able to demonstrate them in their practices. Nursing schools must ensure that students have the necessary knowledge, skills, competencies, and personal-professional characteristics to participate in clinical training programs. It is recommended that students with unsafe clinical practices be identified early so that patient safety is maintained and that students are supported in order to correct their weaknesses and improve.

The beneficial influence of night-shift napping on brain core cognition networks in nurses experiencing sleep deprivation: A preliminary resting-state fMRI study

PURPOSE

This study investigated the restorative effects of napping on cognitive brain networks in night-shift nurses experiencing sleep deprivation (SD).

METHODS

Functional magnetic resonance imaging data and neurocognitive assessments were collected from 20 nurses during three sessions (rested wakefulness (RW), SD, and night-shift napping (NS-NAP)). Functional connectivity (FC) was performed in three core cognitive networks, including the default-mode network (DMN), central executive network (CEN), and salience network (SN).

RESULTS

The SD session showed decreased FC across almost the entire DMN, while only showed increased FC in several key nodes of the CEN and SN. Napping partially mitigated SD-related FC alterations within the DMN and essentially restored FC abnormities in both the CEN and SN. Changes in neurocognitive performance observed between SD and NS-NAP sessions were correlated with alterations in FC within the DMN.

CONCLUSION

The functional integration of core neurocognitive networks can be restored to varying degrees through appropriate NS-NAP practices, potentially improving neurocognitive performance in nurses experiencing SD.

CLINICAL TRIAL NUMBER

not applicable.

"I can't endure it" vs. "I can handle it" - experiencing work fatigue risk for nurses: a qualitative study

BACKGROUND

Work fatigue has become a significant challenge for nursing staff, yet there is a paucity of qualitative research that explores their lived experiences in this context. This study aims to examine clinical nurses' experiences with work fatigue risk and to identify the hindering and facilitating factors contributing to this issue.

METHODS

In this study with descriptive phenomenological method, semi-structured interviews with 25 nurses conducted in the meeting room of a hospital from June to August 2024. Colaizzi's seven-step analysis method was used for data analysis.

RESULTS

Three main themes with twelve subthemes were identified. The primary themes included: (1) phases of work fatigue risk experience, (2) hindering factors of work fatigue risk management, and (3) facilitating factors of work fatigue risk management. Nurses faced a combination of facilitators and inhibitors in managing work fatigue. While some nurses demonstrated a positive attitude towards their work, others showed a strong intention to leave the profession.

CONCLUSIONS

Our findings offer a nuanced understanding of the dynamic stages of nurses' work fatigue experience, highlighting both hindering and facilitating factors that influence the management of work fatigue risk. Nurses encounter multiple challenges in managing work fatigue effectively, underscoring the need for comprehensive strategies. These strategies should address structural barriers while fostering individual resilience, ultimately promoting a healthier and more sustainable work environment.

Exploring Well-Being Disparities: A Comparative Analysis of Urban and Rural Clinicians Using the NIOSH Worker Well-Being Questionnaire

BACKGROUND

Clinician well-being is crucial to the healthcare system, particularly during the COVID-19 pandemic, which intensified psychological distress among clinicians. This study examines well-being disparities between rural and urban clinicians using the NIOSH Worker Well-Being Questionnaire (WellBQ).

METHODS

A cross-sectional survey was conducted with 222 clinicians from one urban and three rural hospitals in North Carolina between September and December 2022. The WellBQ assessed well-being across five domains. Data analysis identified concerning thresholds based on positive and negative responses, with discrepancies resolved through independent reviews and focus group validation.

FINDINGS

In the work evaluation and experience domain, rural hospitals reported concerns with time paucity and work overload, while urban hospitals focused on work-related fatigue and job engagement. Rural hospitals noted issues with job benefits, health programs, and schedule flexibility, whereas urban hospitals emphasized the lack of supportive work culture and management trust. Both settings reported concerns in the physical environment and safety climate domain, including sexual harassment, physical violence, and bullying. Health status concerns in rural hospitals included overall stress and poor mental health, while urban hospitals highlighted chronic health conditions and risky drinking.

CONCLUSION

This study identified significant well-being disparities between rural and urban clinicians, with urban hospitals showing higher concerning thresholds. Future research should refine these thresholds, explore workplace violence causes, and assess long-term impacts on clinician well-being.Applications to Practice:This study reveals significant well-being disparities between rural and urban clinicians, emphasizing the need for tailored occupational health interventions.

Medication administration errors and predictive role of resilience and emotional exhaustion in a sample of Iranian nurses

BACKGROUND

Medication errors, mainly in the administration phase are, one of the most prevalent and critical problems in healthcare, so it is crucial to examine the factors that influence the incidence of medication administration errors among nurses. Nurses' burnout caused by emotional exhaustion often results in frequent errors, compromising patient safety. Conversely, nurses' resilience level has been linked to promoting professional development and enhancing the level of patient safety and care. This study aimed to ascertain whether nurse emotional exhaustion and resilience can predict medication administration errors.

METHODS

A cross-sectional descriptive correlational study was conducted on 272 nurses from February 2024 to April 2024 in the teaching hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The data of the study was collected through the demographic information questionnaire, the medication administration errors questionnaire, the short version of the Resilience Scale (RS-14), and the emotional exhaustion scale. Data were analyzed using descriptive and analytical statistics such as independent t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple linear regression in SPSS-22.

RESULTS

nurses' mean scores for medication administration errors, emotional exhaustion, and resilience were 10.29 ± 10.02, 29.97 ± 7.92, and 56.65 ± 8.28, respectively. The regression model indicated that the rise in resilience, age, and work experiences are associated with decreased levels of medication administration errors as much as 0.42, 0.51, and 0.80 times respectively. This model explained 23% of the variance in medication administration errors in nurses (F = 18.054, p < 0.001).

CONCLUSIONS

The level of resilience among nurses was found to play a very important role not only in preventing medication administration errors but also in preventing nurse emotional exhaustion. Accordingly, teaching positive coping methods when dealing with stressful situations must be given top priority in all healthcare settings to promote nurses' standard of care, reduce the likelihood of medical errors, and prevent emotional exhaustion. Additionally, nurses must receive continuous, dedicated training on drug knowledge, including side effects, as well as the correct techniques of drug administration.

How should we manage fatigue in on-call workers? A review of guidance materials and a systematic review of the evidence-base

On-call work is known to contribute to disrupted sleep, fatigue, and an increased risk of incidentor injury. This review aimed to a) identify current on-call management strategies that are suggested or required by regulatory bodies, and b) determine if there is empirical evidence to support these strategies in managing the fatigue of on-call workers. A grey literature search produced 65 relevant guidance materials. A systematic inductive thematic process identified consistent strategies included in these materials: 1) regularity/predictability of shifts, 2) fatigue management policy, 3) prescriptive rule sets, 4) fitness for work assessment, 5) on-the-day control measures, 6) risk assessment, 7) training and education, and 8) call management. Subsequently, a systematic review identified 17 original studies on the effectiveness of fatigue management strategies in on-call workers. Very little research has been done on fatigue management strategies for on-call workers outside of some prescriptive hours of work limitations. These limitations generally reduced fatigue, but often had the unintended consequence of increasing workload, which may inadvertently increase overall risk. Training, education, and call management (e.g., protected naps during on-call periods) also had some supporting evidence. The current gap in evidence emphasises the critical need for research on tailored on-call fatigue management strategies.

Relationship between staff experience and patient outcomes in hospital settings: an overview of reviews

OBJECTIVES

This review aimed to investigate the relationship between staff experience and patient health and experience outcomes in hospital inpatient settings.

DESIGN

Systematic review of reviews.

METHODS

Searches were performed in Medline (OVID), CINAHL and Google Scholar using key terms from relevant review articles. The search was conducted on 28 August 2023. Inclusion criteria were systematic or narrative reviews in English from 2020 onwards, focusing on inpatients in hospital and related tertiary care facilities, examining the relationship between staff experience and patient outcomes. A review of reviews approach was used, with broad definitions for staff experience (eg, hospital culture, stress and burnout) and patient outcomes (eg, adverse events and patient experience). Independent screening and quality appraisal were conducted by two researchers. An evidence map of links between staff experience and patient outcomes was created. The methodological quality of systematic reviews was assessed using the AMSTAR 2 tool and narrative reviews with the SANRA tool.

RESULTS

From 2365 citations, 21 reviews (18 systematic, 3 narrative) were included. Review quality ranged from moderate to high. Mapping revealed 66 associations between staff experience and patient outcomes. Common associations included burnout, stress and fatigue with adverse events (six reviews); communication with patient satisfaction (four reviews) and teamwork with patient satisfaction (four reviews).

CONCLUSIONS

Staff burnout, teamwork and communication practices directly impact adverse events and patient satisfaction. These findings guide hospital managers and clinicians in improving health service policies and practices. Further research is needed to strengthen the evidence base.

Developing nurse and midwife centred rostering principles using co-design: a mixed-methods study

BACKGROUND

Current nursing and midwifery rosters are based on guidelines which may no longer adequately meet the needs of health services or staff and often result in decreased job satisfaction, poor health and wellbeing, and high turnover. Little is known about the rostering needs and preferences of contemporary nurses and midwives in Australia. The aim of this study was to identify the rostering concerns, needs and preferences of nurses and midwives, and co-design acceptable, equitable and feasible rostering principles.

METHODS

A mixed-methods design using a co-design approach with three components: survey, discussion groups, and co-design workshops. Nurses and midwives employed at three public health services in Victoria, Australia were invited to participate. The quantitative (survey) data were analysed using descriptive statistics and the qualitative (discussion groups and co-design workshops) data using thematic analysis.

RESULTS

Surveys were completed by 715 nurses and midwives including unit (n = 14) and roster (n = 13) managers. Nurses and midwives (n = 688) were mostly satisfied with their roster (mean satisfaction score = 57.4). Many had responsibilities or commitments which impacted their roster availability (n = 406, 61.6%) and over half had taken personal leave due to roster-related fatigue (n = 335, 59.1%) or unmet roster requests (n = 310, 54.7%). Midwives reported significantly less satisfaction (p < 0.001) and more challenges with current roster practices than nurses. Roster and unit managers described spending considerable time preparing and reworking rosters. Thirty-nine nurses and midwives participated in a focus group and outlined concerns about the fairness and equity of current roster practices, and the adverse impact on their health, work, and personal lives. Ninety-one nurses and midwives participated in a co-design workshop and identified a need for roster practices and guidelines which ensure flexibility, fairness and equity, and fatigue management.

CONCLUSIONS

Although nurses and midwives were mostly satisfied with their rosters, they often experienced frustrations and challenges with current roster guidelines and practices as well as adverse effects on their health and work and personal lives. Nurses and midwives identified a preference for fair and equitable rosters which provide flexibility and enable them to manage their other commitments and responsibilities, reduce roster-related fatigue, and provide high quality patient care.

Effects of working conditions on the perception of night work safety and health effects on nurses

AIM

To examine night working conditions by shift work type and identify the effects of night working conditions on nurses' perceptions of shift work safety and health effects.

BACKGROUND

Night work is the main factor affecting nurses' health. However, the safety of night working conditions has not been sufficiently examined in previous studies.

METHODS

This study used a cross-sectional research design and an online survey using a tool released by the Australian Manufacturing Workers' Union, and the responses of 348 shift work nurses in Korea were analyzed. Logistic regression analysis was used to examine the effects of shift work conditions on the perceived safety of night work and health effects. The STROBE reporting guidelines were utilized, and data were collected from December 1 to December 31, 2021.

RESULTS

The adjusted logistic regression analysis showed that perceived threat to safety and the health effects of shift work were not significant according to shift type. However, night-shift-work nurses who worked alone (P = 0.003), lacked an emergency recovery system (P = 0.026), and had difficulty commuting perceived a threat to their health (P = 0.007). Additionally, nurses who experienced loss of concentration (P = 0.006) and inadequate rest time (P < 0.001) perceived the health effects of shift work.

DISCUSSION

Urgent monitoring of night work conditions is necessary for the 2-shift work type. Nurses must work night shifts together and an emergency system should be established for their safety.

CONCLUSION

Night work conditions should be improved to prevent the hazards of night work and its negative health effects on nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study suggests the necessity of a policy to enhance night work safety, including emergency coping systems and sufficient inter-shift rest time.

Sleep quality, coping, and related depression: A cross-sectional study of Turkish nurses

BACKGROUND

The sleep quality of nurses affects both their health and standard of nursing care. Working conditions, depression, and coping potential can also lead to sleep problems.

INTRODUCTION

Sleep plays a crucial role in overall health at every stage of life. The purpose of this study is to determine the effect of sleep quality, depression, and coping mechanisms on the performance of nurses, whose sleep quality is strongly affected due to shift-based work.

METHODS

The sample of this descriptive correlational study consisted of 133 healthcare workers. Data were collected using the Personal Information Form, Beck Depression Inventory (BDI), Coping Response Inventory (CRI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) and evaluated using the t test, Mann-Whitney U test, one-way ANOVA, Enter method, and linear regression.

FINDINGS

One in three nurses reported having poor-quality sleep, and one in two nurses said they felt sleepy during the day. With declining sleep quality, the nurses' ability to cope with stress diminished, and their degree of depression increased.

DISCUSSION

The nurses' financial situation and level of depression were key factors that influenced their quality of sleep and capacity to handle stress. To improve nurses' sleep, the shift pattern needs to change.

CONCLUSION

To increase the quantity of sleep and enhance mental health, changes should be made to the shift schedules of nurses to allow for appropriate rest and reduce daytime sleepiness.

IMPLICATIONS FOR NURSING PRACTICE AND POLICIES

Improved working conditions for nurses and updated nursing standards are required to improve nurses health and wellbeng.

Artificial Intelligence-Driven Approaches to Managing Surgeon Fatigue and Improving Performance

Surgeon fatigue significantly affects cognitive and motor functions, increasing the risk of errors and adverse patient outcomes. Traditional fatigue management methods, such as structured breaks and duty-hour limits, are insufficient for real-time fatigue detection in high-stakes surgeries. With advancements in artificial intelligence (AI), there is growing potential for AI-driven technologies to address this issue through continuous monitoring and adaptive interventions. This paper explores how AI, via machine learning algorithms, wearable devices, and real-time feedback systems, enables comprehensive fatigue detection by analysing physiological, behavioural, and environmental data. Techniques such as heart rate variability analysis, electroencephalogram monitoring, and computer vision-based behavioural analysis are examined, as well as predictive models that provide proactive solutions. These AI-driven systems could suggest personalized break schedules, task redistribution, and interface adaptations in response to real-time fatigue indicators, potentially enhancing surgical safety and precision. However, ethical challenges, including data privacy and surgeon autonomy, must be carefully navigated to foster acceptance and integration within clinical settings. This review highlights AI's transformative potential in optimizing fatigue management and improving overall outcomes in the operating room​​​​​.

Leisure crafting and work engagement among Chinese ICU nurses: The multiple mediation effect of recovery experience and humanistic care ability

AIMS

Based on the conservation of resources theory, this study explored the intermediary role of intensive care unit (ICU) nurses' recovery experience and humanistic care ability between leisure crafting and work engagement.

BACKGROUND

As the ICU is an important life-saving department, the level of work engagement of nurses directly affect the quality of life and health outcomes of patients. Actively seeking countermeasures to improve the work engagement level of ICU nurses is of great significance to enhancing the nursing quality of the ICU. According to the theory of resource conservation, the resources owned by individuals are limited and must be replenished promptly and effectively to maintain relatively stable physical, mental, and working states. Therefore, determining ways for ICU nurses to supplement the consumed resources effectively and efficiently in a limited time to maintain a high level of work engagement is the main concern of this study.

METHODS

In this cross-sectional study from January 2023 to March 2023, 478 ICU nurses were recruited by convenience sampling. The survey tools included the Leisure Crafting Scale, the Utrecht Work Engagement Scale-9, the Caring Ability Inventory, and the Recovery Experience Questionnaire. Descriptive data and Pearson correlation coefficients were analyzed via SPSS 26.0 (IBM Corp.). PROCESS v4.0 (by Andrew F. Hayes) Macro Model 6 was applied to analyze the serial multiple mediator models. We used the STROBE checklist to report the results.

RESULTS

First, the results showed that leisure crafting, humanistic care ability, and recovery experience were positively correlated with work engagement. Second, recovery experience and humanistic care ability played a partially mediating role between leisure crafting and work engagement, respectively. Third, recovery experience and humanistic care ability also had a serial mediation effect between leisure crafting and work engagement.

CONCLUSION

The findings of the study indicated that improving nurses' active control of leisure time may have particularly positive effects on ICU nurses' work engagement through increasing recovery experience and humanistic care ability.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Administrators can formulate intervention measures to improve the leisure crafting level of ICU nurses, promote work-life balance, which enhances recovery and supports engagement with patient-focused humanistic care, and have a positive impact on the work engagement of ICU nurses.

Usability of Light-Linking Technology for Infusion Line Identification: A Simulation Study With ICU Nurses

Critical care nurses are faced with increasing task loads due to increasing patient complexity. In addition to this complexity, most critical care patients have a maze of infusion and monitoring lines that must be navigated when administering medications. Task load is escalated when a nurse must identify an injection port and administer a medication rapidly. This study tested a commercially available light-linking infusion line identification device. Researchers compared standard labeling practices to the light-linking technology on time to injection, error rate, usability, and task load. Forty-seven intensive care nurses completed 188 critical care simulations using a randomized cross-over design. Simulations were carried out in both daylight and low-light conditions. The light-linking technology reduced overall time to injection compared to standard labeling practices and demonstrated a significant decrease in time to injection in low-light settings, greater perceived usability, and lower perceived task load. Injection error rate could not be adequately assessed, but 6 of 8 errors were committed in low-light conditions.

A Cross-Sectional Survey of Swedish Primary Healthcare Nurses' Discontent With Their Current Job

Nursing staff turnover is an increasing problem for healthcare globally. In Sweden, the shortage of nurses in primary healthcare has increased significantly in recent years. This development is alarming because primary healthcare, both in Sweden and internationally, is responsible for a large part of healthcare. The aim of this study was to explore working conditions (change fatigue, leadership climate, and social support from colleagues) and characteristics of primary care nurses who are discontent with their current job, i.e., those with high turnover intentions and poor job satisfaction in Sweden. This was a cross-sectional survey of 466 registered nurses working in Swedish primary healthcare. Data were analyzed using descriptive statistics and logistic regression. The results demonstrate that 21.1% of the responding nurses are discontent with their current job and have considered quitting. Being discontent had significant associations with poor leadership climate (p < 0.001), lack of social support from colleagues (p < 0.001), change fatigue (p < 0.001), poor health (p < 0.001), and working more than 40 h per week (p=0.02). The results have implications for how healthcare organizations structure the work of nurses in primary healthcare and how they can attract and retain future staff to these workplaces.

Presenteeism and missed nursing care: a descriptive, correlational and observational study

BACKGROUND

Missed nursing care poses a significant challenge for healthcare staff in terms of patient safety and care quality.

OBJECTIVE

To evaluate presenteeism and missed care attitudes of nurses and to determine the correlation between presenteeism and missed care.

METHODS

This descriptive, correlational, and observational study was conducted between February and August 2023. The Stanford Presenteeism Scale-Short Form and the MISSCARE Survey were used to collect the data among nurses at two public hospitals in a city in Turkey. The study was completed with 229 nurses representing 27.4% of the total number of nurses who met the inclusion criteria. The data was analyzed using a comprehensive analytical approach, including Cronbach's alpha analysis, frequency and percentage distribution, the Shapiro-Wilk test of normality, correlation coefficient analysis, Pearson correlation coefficient, and the Bonferroni test.

RESULTS

The participants' mean age was 30.22 ± 7.14 years, and 74.2% of them were female. 53.3% of the participants reported difficulty providing patient care due to material shortages, and 62.9% experienced challenges delivering care due to the intensity of paperwork in the clinic. Nurses who felt that paperwork intensity affected patient care and were not confident in their care provision had higher levels of presenteeism (p = 0.041) and a significantly higher frequency of missed care instances (p < 0.001).

CONCLUSIONS

Material shortages and high paperwork intensity are contributing factors to the difficulties experienced by nurses in their practice. These difficulties may lead to an increase in presenteeism and instances of missed nursing care. It is important to address these challenges to ensure adequate care provision and reduce the likelihood of presenteeism among nurses. The correlation between presenteeism and instances of missed nursing care highlights the impact of presenteeism behaviors on the quality of patient care.

A generic approach to developing human factors-quality assessment tools exemplified by the warehouse error prevention tool

This study proposes a generic approach for creating human factors-based assessment tools to enhance operational system quality by reducing errors. The approach was driven by experiences and lessons learned in creating the warehouse error prevention (WEP) tool and other system engineering tools. The generic approach consists of 1) identifying tool objectives, 2) identifying system failure modes, 3) specifying design-related quality risk factors for each failure mode, 4) designing the tool, 5) conducting user evaluations, and 6) validating the tool. The WEP tool exemplifies this approach and identifies human factors related to design flaws associated with quality risk factors in warehouse operations. The WEP tool can be used at the initial stage of design or later for process improvement and training. While this process can be adapted for various contexts, further study is necessary to support the teams in creating tools to identify design-related human factors contributing to quality issues.

Awareness of standard precautions, circumstances of occurrence and management of occupational exposures to body fluids among healthcare workers in a regional level referral hospital (Bertoua, Cameroon)

BACKGROUND

Healthcare workers (HCW) are exposed to infectious agents within biological materials including blood, tissues, other body fluids and on medical supplies, contaminated surfaces within the care delivery environment. Trends in occupational injuries are influenced by the level of awareness and observance of standard precautions (SP) among HCWs. This study aimed to assess the level of awareness of SP, exposure to body fluids, reporting pattern and management among HCWs in a Referral Hospital.

METHODS

The present hospital-based cross-sectional study was carried out from 1st November 2020 to 31st May 2021. The exhaustive sampling method was used and a total of 120 consenting HCWs were invited to participate. A self-administered questionnaire addressed questions related to knowledge, experience, circumstances of exposure, reporting, management of occupational exposure to body fluids, hepatitis B vaccination status. Data were analyzed using R Statistic version 4.3.1. A p-value < 0.05 was considered significant.

RESULTS

Out of the 120 participating HCWs, 104 (86.7%) reported at least one accidental exposure to body fluids over the last year. Men (aOR = 4.19; p = 0.277) and HCWs aged 35 and over (aOR = 4.11; p = 0.114) were more at risk for AEB even though the difference was not statistically significant. Nurses/midwives (aOR = 65.9; p-value = 0.0005) and cleaners (aOR = 14.7; p-value = 0.0438) faced the highest risk of exposure. Lack of knowledge (79%) and patient agitation (49%) were the most reported reasons for exposure. Half of the participants (53%) reported that they used a personal protective equipment during care. Face mask (59.2%) and gowns (30.8%) were the most commonly used PPE. Most HCWs (62%) did not report AEB. Half of the affected HCWs (50.8%) received a course of post-exposure antiretroviral therapy. Few HCWs (4.2%) were fully immunized against Hepatitis B.

CONCLUSIONS

Most HCWs reported an accidental exposure to body fluids over the last year. Midwives and nurses were disproportionally affected socio-professional groups. Two-thirds of the AEB were undeclared. Only half of the participants reported using PPE systematically. Hepatitis B vaccination coverage was low. There is need to strengthen the observance of standard precautions, including preventive vaccination and the systematic reporting and management of AEB.

Relationship between depression and burnout among nurses in Intensive Care units at the late stage of COVID-19: a network analysis

BACKGROUND

Mental health problems are critical and common in medical staff working in Intensive Care Units (ICU) even at the late stage of COVID-19, particularly for nurses. There is little research to explore the inner relationships between common syndromes, such as depression and burnout. Network analysis (NA) was a novel approach to quantified the correlations between mental variables from the perspective of mathematics. This study was to investigate the interactions between burnout and depression symptoms through NA among ICU nurses.

METHOD

A cross-sectional study with a total of 616 Chinese nurses in ICU were carried out by convenience sampling from December 19, 2022 to January19, 2023 via online survey. Burnout symptoms were measured by Maslach Burnout Inventory-General Survey (MBI-GS) (Chinese version), and depressive symptoms were assessed by the 9-item Patient Health Questionnaire (PHQ-9). NA was applied to build interactions between burnout and depression symptoms. We identified central and bridge symptoms by R package qgraph in the network model. R package bootnet was used to examined the stability of network structure.

RESULTS

The prevalence of burnout and depressive symptoms were 48.2% and 64.1%, respectively. Within depression-burnout network, PHQ4(Fatigue)-MBI2(Used up) and PHQ4(Fatigue)-MBI5(Breakdown) showed stronger associations. MBI2(Used up) had the strongest expected influence central symptoms, followed by MBI4(Stressed) and MBI7 (Less enthusiastic). For bridge symptoms. PHQ4(Fatigue), MBI5(Breakdown) and MBI2(Used up) weighed highest. Both correlation stability coefficients of central and bridge symptoms in the network structure were 0.68, showing a high excellent level of stability.

CONCLUSION

The symptom of PHQ4(Fatigue) was the bridge to connect the emotion exhaustion and depression. Targeting this symptom will be effective to detect mental disorders and relieve mental syndromes of ICU nurses at the late stage of COVID-19 pandemic.

Sleep quality and fatigue among nurses working in high-acuity clinical settings in Saudi Arabia: a cross-sectional study

BACKGROUND

Poor sleep quality is prevalent among nurses worldwide. Around two-thirds of nurses doing shift work are known to experience sleep problems and fatigue. Fatigue and sleep problems are linked to poor performance, impaired alertness, injuries, chronic diseases, compromised healthcare quality, and medical errors, all of which detrimentally impact nurses and threaten patients' safety. This area of research has received insufficient attention in Saudi Arabia; therefore, the purpose of this study was to examine the levels of sleep quality and perceived fatigue and their association among nurses working in acute care settings in comprehensive hospitals in Saudi Arabia.

METHODS

A descriptive cross-sectional study using the Pittsburgh Sleep Quality Index and Chalder Fatigue Scale. Data was obtained via an online questionnaire that was distributed to nurses using the QuestionPro platform through hospital administrators, social media (WhatsApp), and personal contact.

RESULTS

A total of 173 nurses completed the online survey. Most participants reported poor sleep quality (n = 127, 73.4%) and severe perceived fatigue (n = 156, 90.2%). Furthermore, the study revealed a significant correlation between the overall sleep disturbance and fatigue global scores (r = 0.57, P < 0.001), indicating that poor sleep quality was significantly associated with higher fatigue levels among the study sample.

CONCLUSIONS

The current study found a significant association between sleep quality and severe fatigue in nurses working in high acute care settings in Saudi Arabia. It is very clear from the results that nurses are experiencing poor sleep and severe fatigue, which in turn, will negatively impact the nurse's quality of life and patient safety.

Advancing fatigue management in healthcare: risk-based approaches that enhance health service delivery

Given the need for 24/7 healthcare services, fatigue is an inevitable consequence of work in this industry. A significant body of regulatory advice and hospital services have focused primarily on restricting work hours as the primary method of mitigating fatigue-related risk. Given the inevitability of fatigue, and the limited capacity of labour agreements to control risk, this commentary explores how the principles of fatigue risk management might be applied in a healthcare setting.

Fatigue and fallibility: the perils of prolonged shifts for neonatologists

Sleep deprivation is a major challenge for neonatologists, who face increasing demands in the complex healthcare system. Current neonatal intensive care unit (NICU) schedule models often include extended shifts and overnight call, which can lead to sleep deprivation. This lack of sufficient sleep poses adverse health risks to neonatologists and can impair cognitive function, which increases the risk of medical errors and compromises patient safety. This paper proposes reducing shift durations and implementing policies and interventions to reduce fatigue among neonatologists and improve patient safety. The paper also offers policymakers, healthcare leaders, and NICU physicians valuable insights on potential ways to promote the health of the neonatologist workforce and safety in the NICU.

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.