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Yang Q, Yang L, Yang C, Wu X, Xu Z, Wang X. How is work-family conflict linked to nurse-assessed patient safety among intensive care unit nurses? A serial multiple mediation analysis. Aust Crit Care 2024:S1036-7314(24)00078-X. [PMID: 38762342 DOI: 10.1016/j.aucc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 05/20/2024] Open
Abstract
AIM The aim of this study was to test whether rumination and negative affectivity mediate the relationship between work-family conflict and nurse-assessed patient safety among intensive care unit nurses. BACKGROUND Most intensive care unit nurses experience work-family conflicts that jeopardise patient safety. Although prior studies have explored the effect of work-family conflict on patient safety, few have investigated whether work-family conflict is associated with patient safety through rumination and negative affectivity among intensive care unit nurses. DESIGN Cross-sectional study. METHODS This study included 209 intensive care unit nurses from five general hospitals. The Work-Family Conflict Scale, the Ruminative Response Scale, the Positive and Negative Affect Schedule-Negative Affectivity, and three items indicating nurses' perception of overall patient safety were used to gather data. Associations between work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were assessed using correlation and serial multiple mediation analysis. RESULTS Work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were significantly correlated (p < 0.01). Work-family conflict can have not only a direct negative impact on the nurse-assessed patient safety (effect = -0.0234; standard error [SE] = 0.0116; 95% confidence interval [CI]: lower limit [LL] = -0.0464, upper limit [UL] = -0.0005) but also an indirect impact on nurse-assessed patient safety through three paths: the independent mediating role of rumination (effect = -0.0118; SE = 0.0063; 95% CI: LL = -0.0251, UL = -0.0006), the independent mediating role of negative affectivity (effect = -0.0055; SE = 0.0039; 95% CI: LL = -0.0153, UL = -0.0001), and the chain-mediating role of rumination and negative affectivity (effect = -0.0078; SE = 0.0031; 95% CI: LL = -0.0152, UL = -0.0027). CONCLUSION Our findings indicated that work-family conflict could influence nurse-assessed patient safety through increasing rumination and negative affectivity among intensive care unit nurses. Based on the results, interventions aimed at decreasing work-family conflict would be beneficial for intensive care unit nurses' emotional stability and patient safety.
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Affiliation(s)
- Qianqian Yang
- Liaocheng People's Hospital, Medical School of Liaocheng University, Liaocheng, Shandong Province, 252000, China; School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, 250012, China.
| | - Linlin Yang
- Nursing Department of Liaocheng People's Hospital, Liaocheng, Shandong, China.
| | - Chunling Yang
- Nursing Department of Liaocheng People's Hospital, Liaocheng, Shandong, China.
| | - Xia Wu
- Nursing Department of Taian City Central Hospital, Taian, Shandong, China.
| | - Zhen Xu
- Intensive Care Unit of Taian City Central Hospital, Taian, Shandong, China.
| | - Xiaobing Wang
- Obstetrics Department, Liaocheng People's Hospital, China.
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Farag A, Gallagher J, Carr L. Examining the Relationship Between Nurse Fatigue, Alertness, and Medication Errors. West J Nurs Res 2024; 46:288-295. [PMID: 38454783 DOI: 10.1177/01939459241236631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Working for extended hours in a physically and mentally demanding profession has subjected nurses to occupational fatigue. Limited evidence exists about nurse fatigue and alertness changes throughout shift work and their relationship with medication errors and near misses. PURPOSE The purposes of this study were to: (1) assess the relationship between nurses' fatigue and alertness, (2) evaluate nurses' fatigue and alertness changes throughout their shift, and (3) examine the relationship between nurses' fatigue, alertness, and medication errors and near misses. METHODS This prospective study is part of a larger mixed-method study. Fatigue and alertness data from 14 work and non-workdays were collected from a convenience sample of 90 nurses. A wearable actigraph (ReadibandTM) was used to measure alertness, while ecological momentary assessment (EMA) using text messaging was used to measure nurses' fatigue. RESULTS A 1-unit increase in fatigue was associated with a 1.06-unit reduction in nurses' alertness score (β = -1.06, 95% CI: [-1.33, -0.78], p < .01). Night-shift nurses experienced a 31-point reduction in alertness from the start to the end of the work shift. Nurses' fatigue, but not alertness, was associated with medication errors and near misses (OR = 1.26, 95% CI [1.07, 1.48], p = .01). CONCLUSION Initiating fatigue mitigation measures during mid-shift, especially for night-shift nurses, may be a viable option to mitigate fatigue and alertness deterioration among nurses and to maintain patient safety. The multifaceted nature of fatigue, as captured by EMA, is a stronger predictor of medication errors and near misses than device-measured alertness.
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Affiliation(s)
- Amany Farag
- College of Nursing, The University of Iowa, Iowa City, IA, USA
| | - Jacob Gallagher
- Department of Health and Human Physiology, The University of Iowa, Iowa City, IA, USA
| | - Lucas Carr
- Department of Health and Human Physiology, The University of Iowa, Iowa City, IA, USA
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Martin CV, Joyce-McCoach J, Peddle M, East CE. Sleep deprivation and medication administration errors in registered nurses-A scoping review. J Clin Nurs 2024; 33:859-873. [PMID: 37872866 DOI: 10.1111/jocn.16912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
AIM To explore whether sleep deprivation contributes to medication errors in registered nurses (RNs). BACKGROUND Sleep deprivation is a potential issue for RNs, particularly those who work shifts. Sleep deprivation has been found to have a negative impact on numerous cognitive processes. Nurses administer several medications to patients a day, potentially while sleep deprived-anecdotal reports suggest that this could result in an increased risk of error occurring. DESIGN A scoping review was conducted using the Prisma-ScR extension framework to explore what is known about the effect of RNs' sleep deprivation on medication administration errors. METHODS A search of databases generated 171 results. When inclusion and exclusion criteria were applied, 18 empirical studies were analysed. Studies included retrospective analysis of errors, surveys of perceptions of causes and observational studies. RESULTS Data indicated that RNs consider fatigue, which may be caused by sleep deprivation, to be a contributing factor to medication errors. The search only identified three observer studies, which provided conflicting results as to whether lack of sleep contributes to the error rate. Of the numerous tools used to measure sleep, the Pittsburgh Sleep Quality Index was the most frequently used. CONCLUSION Although RNs anecdotally consider a lack of sleep potentially contributes to medication errors, there is insufficient research to provide robust evidence to confirm this assumption. NO PATIENT OR PUBLIC CONTRIBUTIONS Patient or public contributions were not required for this scoping review. RELEVANCE TO CLINICAL PRACTICE Sleep deprivation is a potential issue for nurses, especially those who work shifts. Poor sleep impacts cognitive processes that potentially could increase errors. Nurses should be aware of the impact sleep may have on patient safety.
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Affiliation(s)
- Christopher Vincent Martin
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Ballarat, Victoria, Australia
| | - Joanne Joyce-McCoach
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Monica Peddle
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Christine Elizabeth East
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Mercy Health, Melbourne, Victoria, Australia
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Kabbadj K, Amekran Y, Damoun N, Taiek N, El Hangouche AJ. Sleep quality and shift work among Moroccan nurses: A cross-sectional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 12:453. [PMID: 38464634 PMCID: PMC10920774 DOI: 10.4103/jehp.jehp_664_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/31/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Sleep is vital for physical and mental health. The nursing profession is often associated with unique challenges when it comes to sleep quality. Nurses are often faced with irregular work schedules, including night shifts and rotations, high-stress levels, and significant job demands that can contribute to sleep problems and hinder their productivity at work. This study aimed to assess sleep quality in Moroccan nurses and to investigate the relationship between sleep quality and shift work. MATERIALS AND METHODS This was a cross-sectional study carried out between August 8, 2022 and September 30, 2022 among 260 nurses working day or night shifts in the province of Tétouan, northern Morocco. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality in day and night shift nurses. Data on sociodemographic characteristics and shift work were also collected. Descriptive and inferential statistical analyses were performed. Regression models were used to study the association between participant characteristics and sleep quality. RESULTS Among all participants, 60.4% had poor sleep quality. The results of the study revealed that there was no significant association between shift work and sleep quality among nurses in Morocco. CONCLUSION Given that the majority of nurses suffer from sleep disorders, an action plan to raise awareness and promote good sleep in this population should be implemented.
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Affiliation(s)
- Kaoutar Kabbadj
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Youssra Amekran
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Narjisse Damoun
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Nora Taiek
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Abdelkader Jalil El Hangouche
- Department of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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Chen S, Wu H, Sun M, Wei Q, Zhang Q. Effects of shift work schedules, compensatory sleep, and work-family conflict on fatigue of shift-working nurses in Chinese intensive care units. Nurs Crit Care 2023; 28:948-956. [PMID: 37078518 DOI: 10.1111/nicc.12909] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Shift work is inevitable for nurses in intensive care units. Various studies explored nurses' fatigue in multiple hospital wards. However, few studies focused on fatigue among nurses in intensive care units. AIMS To determine the association between shift work schedules, compensatory sleep, work-family conflict, and fatigue of shift-working nurses in critical care units. STUDY DESIGN A descriptive cross-sectional multi-center study was conducted in March 2022 among intensive care nurses from five hospitals. METHODS Data were collected by online survey, including self-designed demographic questions, the Fatigue Scale-14, the Chinese adult daytime sleepiness scale, and the work-family scale. Pearson correlation was conducted for bivariate analysis. Independent-sample t-test, one-way ANOVA, and multiple linear regression analysis were performed to examine fatigue-related variables. RESULTS A total of 326 nurses responded to the survey with an effective response rate of 74.9%. The mean scores of physical fatigue and mental fatigue were 6.80 and 3.72, respectively. The bivariate analyses showed that work-family conflict was positively correlated with physical (r = 0.483, p < .001) and mental fatigue (r = 0.406, p < .001). Multiple linear regression results showed that work-family conflict, daytime sleepiness, and shift system were statistically significant factors influencing physical fatigue (F = 41.793, p < .001). Work-family conflict, sleep duration after the night shift, and daytime sleepiness were the main influencing factors of mental fatigue (F = 25.105, p < .001). CONCLUSIONS Nurses with higher work-family conflict, daytime sleepiness, and working 12-h shifts have higher levels of physical fatigue. Higher work-family conflict, shorter sleep duration after night shifts, and daytime sleepiness are associated with higher mental fatigue among intensive care nurses. RELEVANCE TO CLINICAL PRACTICE Nursing managers and nurses should consider work-family factors and compensatory sleep in their efforts to reduce fatigue. It is necessary to strengthen work-supporting strategies and compensatory sleep guidance for nurses to promote fatigue recovery.
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Affiliation(s)
- Shanshan Chen
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huihui Wu
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mimi Sun
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing Wei
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qixia Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Im C, Song S, Kim K. The associations of psychological burnout and time factors on medication errors in rotating shift nurses in Korea: A cross sectional descriptive study. Nurs Open 2023. [PMID: 37115503 DOI: 10.1002/nop2.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 03/16/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
AIM To describe the associations of psychological burnout and time factors on hospital nurses' medication errors. DESIGN A cross-sectional survey design was used. METHODS A structured questionnaire pertaining to psychological burnout, time factors and medication error was administered to 200 bedside nurses working at two tertiary university hospitals in Korea. The associations between the psychological burnout, time factor and medication error were analysed with the zero-inflated negative binomial regression for over-dispersed and over-abundant zeros count data. RESULTS Higher psychological burnout, shorter meal time during duty and longer weekly overtime were associated with an increased likelihood of medication error of nurses working in tertiary university hospitals. For medication safety, nurse managers should provide appropriate administrative support to nurses to cope with psychological burnout of nurses. Work time management should also be considered as human factors to satisfy the needs of nurses, such as securing meal times and maintaining a low level of weekly overtime.
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Affiliation(s)
- Cheongin Im
- Department of Nursing, College of Medicine, Inha University, Incheon City, South Korea
| | - Suyoung Song
- Department of Nursing, College of Medicine, Inha University, Incheon City, South Korea
| | - Kyoungja Kim
- Department of Nursing, College of Medicine, Inha University, Incheon City, South Korea
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Gusman E, Standlee J, Reid KJ, Wolfe LF. Work-Related Sleep Disorders: Causes and Impacts. Semin Respir Crit Care Med 2023; 44:385-395. [PMID: 37072022 DOI: 10.1055/s-0043-1767787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Insufficient sleep syndrome, shift work disorder, and obstructive sleep apnea (OSA) not only significantly impact the health of affected individuals, but also pose a threat to public safety. This article describes the clinical manifestations and impact of these sleep disorders, particularly as they pertain to workers' health and those with safety-sensitive positions. Sleep deprivation, circadian rhythm disruptions, and excessive daytime sleepiness-hallmarks of insufficient sleep, shift work disorder, and OSA, respectively-all lead to a series of cognitive deficits and impaired concentration that affect workers in a wide variety of fields. We describe the health consequences of these disorders along with treatment strategies, with a focus on current regulatory standards and the under-recognition of OSA in commercial drivers. Given its large scale, there is a need for improved guidelines and regulations for the screening, diagnosis, treatment, and long-term follow-up of OSA in commercial motor vehicle drivers. Increased recognition of the ways in which these sleep disorders impact workers will pave the way for significant improvements in occupational health and safety.
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Affiliation(s)
- Elen Gusman
- Department of Pulmonary and Critical Care Medicine, Northwestern Medicine, Chicago, Illinois
| | - Jordan Standlee
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Kathryn J Reid
- Department of Neurology, Division of Sleep Medicine, Northwestern Medicine, Chicago, Illinois
- Center for Circadian and Sleep Medicine, Northwestern Medicine, Chicago, Illinois
| | - Lisa F Wolfe
- Department of Pulmonary and Critical Care Medicine, Northwestern Medicine, Chicago, Illinois
- Department of Neurology, Division of Sleep Medicine, Northwestern Medicine, Chicago, Illinois
- Center for Circadian and Sleep Medicine, Northwestern Medicine, Chicago, Illinois
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Shi F, Li Y, Zhao Y. How do nurses manage their work under time pressure? Occurrence of implicit rationing of nursing care in the intensive care unit: A qualitative study. Intensive Crit Care Nurs 2023; 75:103367. [PMID: 36543721 DOI: 10.1016/j.iccn.2022.103367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/24/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was to explore the experience of intensive care unit nurses under time pressure and the occurrence of implicit rationing under time pressure. METHODS In-depth audio-recorded interviews were conducted with 18 intensive care unit nurses. Colaizzi seven-step analysis of phenomenological data was used. FINDINGS Three themes emerged from the analysis: the influence of internal and external environments, perceived differences in time pressure, and broad coping styles. CONCLUSIONS Under the influence of various factors, including continuous or intermittent time pressure, nurses employ strategies to deal with the pressure. Sometimes, these strategies allow them to complete all their necessary work. However, with the increase in time pressure, sometimes some work that must be done is changed into work that should be done in the consciousness of nurses. In such cases, nurses choose the strategy of implicit rationing to deal with time pressure.
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Affiliation(s)
- Fang Shi
- Department of Intensive Care Unit, the First Affiliated Hospital of Soochow University, No. 899 Pinghai Street, Suzhou, Jiangsu, People's Republic of China
| | - Yuntao Li
- Department of Intensive Care Unit, the First Affiliated Hospital of Soochow University, No. 899 Pinghai Street, Suzhou, Jiangsu, People's Republic of China
| | - Yingnan Zhao
- Department of Intensive Care Unit, the First Affiliated Hospital of Soochow University, No. 899 Pinghai Street, Suzhou, Jiangsu, People's Republic of China.
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Magerøy MR, Wiig S. The effect of full-time culture on quality and safety of care – a literature review. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2023. [DOI: 10.1108/ijhg-11-2022-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PurposeThe purpose of this study is to increase knowledge and understanding of the relationship between full-time-culture and the outcome for quality and safety of care.Design/methodology/approachThe paper is a literature review with a qualitatively oriented thematic analysis concerning quality or safety outcomes for patients, or patients and staff when introducing a full-time culture.FindingsIdentified factors that could have a positive or negative impact on quality and patient safety when introducing full-time culture were length of shift, fatigue/burnout, autonomy/empowerment and system/structure. Working shifts over 12 h or more than 40 h a week is associated with increased adverse events and errors, lower quality patient care, less attention to safety concerns and more care left undone. Long shifts give healthcare personnel more flexibility and better quality-time off, but there is also an association between long shifts and fatigue or burnout. Having a choice and flexibility around shift patterns is a predictor of increased wellbeing and health.Originality/valueA major challenge across healthcare services is having enough qualified personnel to handle the increasing number of patients. One of the measures to get enough qualified personnel for the expected tasks is to increase the number of full-time employees and move towards a full-time culture. It is argued that full-time culture will have a positive effect on work environment, efficiency and quality due to a better allocation of work tasks, predictable work schedule, reduced sick leave, and continuity in treatment and care. There is limited research on how the introduction of full-time culture will affect the quality and safety for patients and staff, and few studies have been focusing on the relationship between longer shift, work schedule, and quality and safety of care.
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Li WC, Zhang J, Kearney P. Psychophysiological coherence training to moderate air traffic controllers' fatigue on rotating roster. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:391-404. [PMID: 35212002 DOI: 10.1111/risa.13899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
The nature of the current rotating roster, providing 24-h air traffic services over five irregular shifts, leads to accumulated fatigue which impairs air traffic controllers' cognitive function and task performance. It is imperative to develop an effective fatigue risk management system to improve aviation safety based upon scientific approaches. Two empirical studies were conducted to address this issue. Study 1 investigated the mixed effect of circadian rhythm disorders and resource depletion on controllers' accumulated fatigue. Then, study 2 proposed a potential biofeedback solution of quick coherence technique which can mitigate air traffic controllers' (ATCOs') fatigue while on controller working position and improve ATCOs' mental/physical health. The current two-studies demonstrated a scientific approach to fatigue analysis and fatigue risk mitigation in the air traffic services domain. This research offers insights into the fluctuation of ATCO fatigue levels and the influence of a numbers of factors related to circadian rhythm and resource depletion impact on fatigue levels on study 1; and provides psychophysiological coherence training to increase ATCOs' fatigue resilience to mitigate negative impacts of fatigue on study 2. Based on these two studies, the authors recommended that an extra short break for air traffic controllers to permit practicing the quick coherence breathing technique for 5 min at the sixth working hour could substantially recharge cognitive resources and increase fatigue resilience. Application: Present studies highlight an effective fatigue intervention based on objective biofeedback to moderate controllers' accumulated fatigue as a result of rotating shift work. Accordingly, air navigation services providers and regulators can develop fatigue risk management systems based on scientific approaches to improve aviation safety and air traffic controller's wellbeing.
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Affiliation(s)
- Wen-Chin Li
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
| | - Jingyi Zhang
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
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Wangsan K, Chaiear N, Sawanyawisuth K, Klainin-Yobas P, Simajareuk K, Boonsawat W. Which Shiftwork Pattern Is the Strongest Predictor for Poor Sleep Quality in Nurses? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13986. [PMID: 36360864 PMCID: PMC9658910 DOI: 10.3390/ijerph192113986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Shiftwork is related to an increased risk of several diseases, including gastric ulcers, myocardial infarction, and diabetes. Several shiftwork patterns are related to poor sleep quality, such as a quick returns or extended shifts. This study aimed to find the shiftwork patterns strongly associated with poor sleep quality amongst nurses. A cross-sectional analytical study was conducted among nurses working for at least one month. The sub-groups were the good sleep quality group (n = 150) and the poor sleep quality group (n = 472). Eligible participants were asked to complete a self-reported questionnaire comprising personal characteristics, job characteristics, shiftwork characteristics, and sleep quality. Factors associated with poor sleep quality were determined using logistic regression analysis. Two factors associated with poor sleep quality remained in the final model: viz., depression and backward rotational shift. The only independent factor for poor sleep quality was a backward rotational shift with an adjusted odds ratio (95% CI) of 1.946 (1.344, 2.871). In conclusion, compared with other shift patterns, backward shiftwork was the most significant factor associated with poor sleep quality and should be avoided.
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Affiliation(s)
- Kampanat Wangsan
- Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Naesinee Chaiear
- Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Piyanee Klainin-Yobas
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine Clinical Research Centre, National University of Singapore, Singapore 119077, Singapore
| | - Kanjana Simajareuk
- Nursing Division, Srinagarind Hospital, Faculty of Medicine, Khon Kaen 40002, Thailand
| | - Watchara Boonsawat
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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12
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Cho H, Sagherian K, Scott LD, Steege LM. Occupational fatigue, workload and nursing teamwork in hospital nurses. J Adv Nurs 2022; 78:2313-2326. [PMID: 35396873 DOI: 10.1111/jan.15246] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/26/2022] [Accepted: 03/23/2022] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Hyeonmi Cho
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Knar Sagherian
- College of Nursing, The University of Tennessee Knoxville, Knoxville, Tennessee, USA
| | - Linda D Scott
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Zeytinoglu IU, Sayin FK, Neiterman E, HakemZadeh F, Geraci J, Plenderleith J, Lobb D. Hours of work and on-call weeks preferences of Canadian midwives: relationships with intention to stay in the profession. BMC Health Serv Res 2022; 22:950. [PMID: 35883071 PMCID: PMC9316842 DOI: 10.1186/s12913-022-08287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Midwives have long workdays and work many weeks on call. There is a concern that these extended work schedules can negatively affect their intention to stay in the profession. Purpose This study provides evidence on Canadian midwives’ preferences for and experiences with policies and guidelines which limit the hours of work and weeks per year preferred to be on call, and examines the relationship between preferences and midwives’ intention to stay in the profession. Methods Data come from our 2018 pan-Canadian survey of midwives. Descriptive statistics of 720 midwives’ preferences and experiences are provided. In the correlations followed by the OLS regressions, 596 midwives’ data are used to test the associations between preferences and intention to stay in the profession. STATA (version 15) is used. A thematic analysis of 274 midwives’ responses to the open-ended survey question is conducted to give voice to midwives on what can be done for retention. Results Three quarters of the 720 respondents prefer policies and guidelines to limit hours of work in a 24-hour period, though less than half have policies and guidelines on hours of work. More than half prefer to have fewer on-call weeks or never to be on call, less than a third prefer same number of on-call weeks, and only 2% prefer more weeks to be on call. Midwives are currently working on average 33 weeks per year on call. OLS regression analysis shows that ‘met preference’ for hours of work and on-call weeks are positively associated with intention to stay. In responding to the open-ended survey question, midwives recommend limiting the consecutive hours of work and on-call weeks to manageable hours and weeks to retain them in the profession. Conclusion Midwives whose preferences are met are the ones intending to stay in the profession. There is, however, a large number of midwives with ‘unmet needs’ preferring to have policies and guidelines to limit the hours but do not have that currently, and would like to work fewer weeks on call than currently. These are the midwives who are not intending to stay in the profession. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08287-6.
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Affiliation(s)
- Isik U Zeytinoglu
- DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M4, Canada.
| | - Firat K Sayin
- Sobey School of Business, Saint Mary's University, 923 Robie Street, Halifax, Nova Scotia, B3H 3C3, Canada
| | - Elena Neiterman
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Farimah HakemZadeh
- School of Human Resource Management, Faculty of Liberal Arts and Professional Studies, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Johanna Geraci
- College of Midwives of Ontario, 21 St Clair Ave E #303, Toronto, Ontario, M4T 1L9, Canada
| | - Jennifer Plenderleith
- DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4M4, Canada
| | - Derek Lobb
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada
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Ofoma UR, Drewry AM, Maddox TM, Boyle W, Deych E, Kollef M, Girotra S, Joynt Maddox KE. Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care. Resuscitation 2022; 177:7-15. [PMID: 35724851 PMCID: PMC9296566 DOI: 10.1016/j.resuscitation.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Survival rates following in-hospital cardiac arrest (IHCA) are lower during nights and weekends (off-hours), as compared to daytime on weekdays (on-hours). Telemedicine Critical Care (TCC) may provide clinical support to improve IHCA outcomes, particularly during off-hours. OBJECTIVE To evaluate the association between hospital availability of TCC and IHCA survival. METHODS We identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. We used 2-level hierarchical multivariable logistic regression to investigate whether TCC availability was associated with better survival, overall, and during on-hours (Monday-Friday 7:00 a.m.-10:59p.m.) vs. off-hours (Monday-Friday 11:00p.m.-6:59 a.m., and Saturday-Sunday, all day, and US national holidays). RESULTS 14,373 (32.2%) participants suffered IHCA at hospitals with TCC, and 27,032 (60.6%) occurred in an ICU. There was no difference between TCC and non-TCC hospitals in acute resuscitation survival rate or survival to discharge rates for either IHCA occurring in the ICU (acute survival odds ratio [OR] 1.02, 95% CI 0.92-1.15; survival to discharge OR 0.94 [0.83-1.07]) or outside of the ICU (acute survival OR 1.03 [0.91-1.17]; survival to discharge OR 0.99 [0.86-1.12]. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival (P =.37 for interaction) or survival to discharge (P =.39 for interaction). CONCLUSIONS Hospital availability of TCC was not associated with improved outcomes for in-hospital cardiac arrest.
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Affiliation(s)
- Uchenna R Ofoma
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA.
| | - Anne M Drewry
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Thomas M Maddox
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA; Healthcare Innovation Laboratory, BJC Healthcare and Washington University School of Medicine, St. Louis, MO, USA
| | - Walter Boyle
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Elena Deych
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Marin Kollef
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Saket Girotra
- Division of Cardiovascular Diseases, Department of Medicine, University of Iowa Hospitals and Clinics and the Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Karen E Joynt Maddox
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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15
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Yansane A, Tokede O, Walji M, Obadan-Udoh E, Riedy C, White J, Kalenderian E. Burnout, Engagement, and Dental Errors Among U.S. Dentists. J Patient Saf 2021; 17:e1050-e1056. [PMID: 32251244 DOI: 10.1097/pts.0000000000000673] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Errors can happen during patient care, and some result in harm to the patient. Work place stress has been well established in dentistry, but its relation with errors in the delivery of patient care is less understood. The authors evaluated the relationship between burnout, work engagement, and self-reported dental errors among American dentists. METHODS From May to August 2016, a national sample of American Dental Association member dentists were sent a validated, electronic survey assessing their levels of burnout, work engagement, and dental errors. RESULTS Of the 391 responding dentists, 46.1% reported concern that they had made a dental error in the last 6 months, 12.1% of the dentists were informed by dental staff that they may have committed an error in the last 6 months, 16% were concerned that a malpractice lawsuit would be filed against them, and 3.6% were actively involved in a malpractice lawsuit. In the adjusted analysis, multivariate logistic regression showed that dentists with either high burnout risk were more likely to report concern over a perceived error within the last 6 months. CONCLUSIONS The results suggest that dental provider burnout is potentially a key predictor of reporting perceived dental errors. It is imperative that the dental profession continue to study the effects of work-related stress, develop professional practices that decrease burnout, and reduce errors. PRACTICAL IMPLICATIONS Efforts that minimize the potential for burnout may help reduce the occurrence of errors and improve the quality of care provided to dental patients.
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Affiliation(s)
- Alfa Yansane
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
| | - Oluwabunmi Tokede
- Oral Health Policy and Epidemiology Department, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Muhammad Walji
- Diagnostic and Biomedical Sciences Department, University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Enihomo Obadan-Udoh
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
| | - Christine Riedy
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Joel White
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
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Waldfogle GE, Garibaldi AE, Neigel AR, Szalma JL. 'I need a break': the effect of choice of rest break duration on vigilance. ERGONOMICS 2021; 64:1509-1521. [PMID: 34328396 DOI: 10.1080/00140139.2021.1960428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
Vigilance is the ability to sustain attention for an extended period of time and to respond to infrequently occurring critical signals. One of the most replicable findings within the vigilance literature is the performance decrement; the decline in performance as time on task increases. In an effort to attenuate the decrement, and decrease the workload and stress associated with vigilance, the present study investigated the role of choice of rest break duration on vigilance performance, perceived workload, and stress. Participants were assigned to one of three conditions: (1) choice condition, (2) no-choice condition (yoked-control), and (3) a no-break control condition. Participants completed a sensory vigilance task and common measures of workload and stress. A vigilance decrement was observed in all conditions. Participants in the choice condition exhibited more conservative responses and fewer false alarms than the no-choice condition. Across all conditions, task engagement and worry decreased, and distress increased. Practitioner Summary: This study shows the impact of rest breaks and autonomy on vigilance task performance. The findings suggest that resource theory is a plausible explanation for the vigilance decrement. Additionally, providing a choice in rest break length changes the operator's criterion following the break. Abbreviations: TSA: transportation security administration; SART: sustained attention to response task; ERP: event-related potential; S-DT: self-determination theory; ISI: interstimulus interval; DSSQ: dundee stress state questionnaire; CFQ: cognitive failures questionnaire; BP: boredom proneness; NASA-TLX: NASA task load index; IMI: intrinsic motivation inventory.
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Affiliation(s)
- Grace E Waldfogle
- Performance Research Laboratory, Psychology Department, University of Central Florida, Orlando, FL, USA
| | - Allison E Garibaldi
- Performance Research Laboratory, Psychology Department, University of Central Florida, Orlando, FL, USA
| | - Alexis R Neigel
- Performance Research Laboratory, Psychology Department, University of Central Florida, Orlando, FL, USA
| | - James L Szalma
- Performance Research Laboratory, Psychology Department, University of Central Florida, Orlando, FL, USA
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Ryu IS, Shim J. The Influence of Burnout on Patient Safety Management Activities of Shift Nurses: The Mediating Effect of Compassion Satisfaction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212210. [PMID: 34831966 PMCID: PMC8621116 DOI: 10.3390/ijerph182212210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022]
Abstract
This study aims to investigate the levels of burnout, compassion satisfaction (CS), and patient safety management activities (PSMA) among nurses on shift work in general hospitals and to examine the mediating effect of CS on the relationship between burnout and PSMA. This was a descriptive-correlational study, conducted with a convenience sample of 301 nurses from four general hospitals. Data were collected from 1 August to 4 September 2021, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Tukey test, Pearson's correlation coefficient, and multiple regression analyses. Mediation analysis was performed according to the Baron and Kenny, and Sobel Tests. Significant relationships were found between shift nurses' burnout and CS (r = -0.66, p < 0.001), burnout and PSMA (r = -0.32, p < 0.001), and PSMA and CS (r = 0.32, p < 0.001). Compassion satisfaction showed partial mediating effects on the relationship between burnout and PSMA (Z = -3.21, p = 0.001). The higher the burnout of shift-working nurses, the lower the patient safety management activity. Therefore, an effective support system at the organizational level as well as individual efforts are necessary to enhance CS and reduce burnout of shift-working nurses.
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Affiliation(s)
- I Seul Ryu
- Department of Nursing, Dongguk University Hospital, Gyeongju 38067, Korea;
| | - JaeLan Shim
- College of Nursing, Dongguk University, Gyeongju 38066, Korea
- Correspondence:
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18
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Min A, Hong HC, Son S, Lee TH. Alertness during working hours among eight-hour rotating-shift nurses: An observational study. J Nurs Scholarsh 2021; 54:403-410. [PMID: 34791773 DOI: 10.1111/jnu.12743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to identify the patterns of the decline in the alertness of rotating-shift nurses during working hours across different shift types (day, evening, and night) using an objective measure. DESIGN An observational study using ReadiBand wrist actigraphs was conducted. METHODS Data were collected from June 2019 to February 2020. Participants were rotating-shift nurses (N = 82) who provided direct nursing care for patients in acute care hospitals in South Korea. Nurses wore actigraphs continuously for 14 days on their non-dominant hand to identify sleep-wake cycles and predict their alertness scores hourly. All participants completed a sleep diary. FINDINGS Nurses working during night shifts had lower average alertness scores (mean = 77.12) than nurses working during day (mean = 79.05) and evening (mean = 91.21). Overall, alertness showed a declining trend and the specific patterns of decline differed across shifts. Participants with alertness scores less than 70 or 80 demonstrated a significant decline in alertness across all shifts. CONCLUSIONS Distinct patterns of decline in alertness per nursing shift were revealed. Each shift feature should be considered when developing interventions to increase nurses' alertness, promote high-quality care provision, and ensure patient safety. CLINICAL RELEVANCE The implementation of interventions to increase alertness among shift nurses is needed at the organizational level, and the cooperation of nursing managers and administrators is required.
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Affiliation(s)
- Ari Min
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Sungtaek Son
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Tae Hee Lee
- Department of Applied Statistics, Yonsei University, Seoul, South Korea
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Kapetanos K, Mazeri S, Constantinou D, Vavlitou A, Karaiskakis M, Kourouzidou D, Nikolaides C, Savvidou N, Katsouris S, Koliou M. Exploring the factors associated with the mental health of frontline healthcare workers during the COVID-19 pandemic in Cyprus. PLoS One 2021; 16:e0258475. [PMID: 34648565 PMCID: PMC8516220 DOI: 10.1371/journal.pone.0258475] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/28/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The spread of COVID-19 into a global pandemic has negatively affected the mental health of frontline healthcare-workers. This study is a multi-centre, cross-sectional epidemiological study that uses nationwide data to assess the prevalence of stress, anxiety, depression and burnout among health care workers managing COVID-19 patients in Cyprus. The study also investigates the mechanism behind the manifestation of these pathologies, as to allow for the design of more effective protective measures. METHODS Data on the mental health status of the healthcare workers were collected from healthcare professionals from all over the nation, who worked directly with Covid patients. This was done via the use of 64-item, self-administered questionnaire, which was comprised of the DASS21 questionnaire, the Maslach Burnout Inventory and a number of original questions. Multivariable logistic regression models were used to investigate factors associated with each of the mental health measures. RESULTS The sample population was comprised of 381 healthcare professionals, out of which 72.7% were nursing staff, 12.9% were medical doctors and 14.4% belonged to other occupations. The prevalence of anxiety, stress and depression among the sample population were 28.6%, 18.11% and 15% respectively. The prevalence of burnout was 12.3%. This was in parallel with several changes in the lives of the healthcare professionals, including; working longer hours, spending time in isolation and being separated from family. DISCUSSION This study indicates that the mental health of a significant portion of the nation's workforce is compromised and, therefore, highlights the need for an urgent intervention particularly since many countries, including Cyprus, are suffering a second wave of the pandemic. The identified risk factors should offer guidance for employers aiming to protect their frontline healthcare workers from the negative effects of the COVID-19 pandemic.
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Affiliation(s)
| | - Stella Mazeri
- The Roslin Institute and The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Despo Constantinou
- Infection Control Services, Nicosia General Hospital, Lemesou, Cyprus
- Cyprus Nurses and Midwives Association, Nicosia, Cyprus
| | - Anna Vavlitou
- Intensive Care Unit, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | - Christoforos Nikolaides
- Cyprus Nurses and Midwives Association, Nicosia, Cyprus
- Infection Control Services, Limassol General Hospital, Nikaias, Kato Polemidia, Cyprus
| | - Niki Savvidou
- Infection Control Services, Paphos General Hospital, Paphos, Cyprus
| | - Savvas Katsouris
- Infection Control Services, Larnaca General Hospital, Larnaca, Cyprus
| | - Maria Koliou
- Department of Pediatrics, School of Medicine, University of Cyprus, Nicosia, Cyprus
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20
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Choi DS, Kim SH. Factors Affecting Occupational Health of Shift Nurses: Focusing on Job Stress, Health Promotion Behavior, Resilience, and Sleep Disturbance. Saf Health Work 2021; 13:3-8. [PMID: 35936202 PMCID: PMC9346939 DOI: 10.1016/j.shaw.2021.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background This study aims to allow the development of efficient measures to improve occupational health of shift-working nurses focusing on job stress, health promotion behavior, resilience, and sleep disturbance. Methods It was conducted on a subject panel of 137 nurses who were aware of the purpose of the study and agreed to participate. They worked three shifts at a tertiary hospital or a general hospital located in metropolitan city B. The collected data were analyzed by the independent t test and one-way analysis of variance and post-tested by Scheffe's test, Pearson's correlation coefficients, and multiple linear regression analysis using SPSS/WIN 25.0. Results The significant influencing factors on sleep disturbance were of those whose subjective health status was ‘normal’ (β = 0.29, p < .001), ‘not healthy’ (β = .40, p < .001), who have job stress (β = .22, p = .003), and who have health promotion behavior (β = -0.17, p = .023). The overall explanatory power was 31.1% (F = 16.31, p < .001). Conclusion Through this study, nurses' subjective health status and job stress of working shifts were found to be important factors influencing the sleep disturbance level, and the most influencing factor was identified as the subjective health status.
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21
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James L, Elkins-Brown N, Wilson M, James SM, Dotson E, Edwards CD, Wintersteen-Arleth L, Stevens K, Butterfield P. 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. Int J Nurs Stud 2021; 123:104041. [PMID: 34411842 DOI: 10.1016/j.ijnurstu.2021.104041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Lois James
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA; Sleep and Performance Research Center, Washington State University, WA, USA.
| | - Nathaniel Elkins-Brown
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA.
| | - Marian Wilson
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA; Sleep and Performance Research Center, Washington State University, WA, USA.
| | - Stephen M James
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA; Sleep and Performance Research Center, Washington State University, WA, USA.
| | - Elizabeth Dotson
- Department of Criminal Justice & Criminology, Washington State University, WA, USA.
| | - Charles D Edwards
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA.
| | - Laura Wintersteen-Arleth
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA.
| | - Kevin Stevens
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Room 426B, Spokane, WA 99202, USA.
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Nurses' experiences and preferences around shift patterns: A scoping review. PLoS One 2021; 16:e0256300. [PMID: 34398904 PMCID: PMC8367008 DOI: 10.1371/journal.pone.0256300] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To explore the evidence on nurses’ experiences and preferences around shift patterns in the international literature. Data sources Electronic databases (CINHAL, MEDLINE and Scopus) were searched to identify primary studies up to April 2021. Methods Papers reporting qualitative or quantitative studies exploring the subjective experience and/or preferences of nurses around shift patterns were considered, with no restrictions on methods, date or setting. Key study features were extracted including setting, design and results. Findings were organised thematically by key features of shift work. Results 30 relevant papers were published between 1993 and 2021. They contained mostly qualitative studies where nurses reflected on their experience and preferences around shift patterns. The studies reported on three major aspects of shift work: shift work per se (i.e. the mere fact of working shift), shift length, and time of shift. Across all three aspects of shift work, nurses strive to deliver high quality of care despite facing intense working conditions, experiencing physical and mental fatigue or exhaustion. Preference for or adaptation to a specific shift pattern is facilitated when nurses are consulted before its implementation or have a certain autonomy to self-roster. Days off work tend to mitigate the adverse effects of working (short, long, early or night) shifts. How shift work and patterns impact on experiences and preferences seems to also vary according to nurses’ personal characteristics and circumstances (e.g. age, caring responsibilities, years of experience). Conclusions Shift patterns are often organised in ways that are detrimental to nurses’ health and wellbeing, their job performance, and the patient care they provide. Further research should explore the extent to which nurses’ preferences are considered when choosing or being imposed shift work patterns. Research should also strive to better describe and address the constraints nurses face when it comes to choice around shift patterns.
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Jankowska-Polańska B, Czyrniańska M, Sarzyńska K, Świątoniowska-Lonc N, Chabowski M. Impact of fatigue on nursing care rationing in paediatric haematology and oncology departments - a cross-sectional study. BMC Nurs 2021; 20:139. [PMID: 34376202 PMCID: PMC8353779 DOI: 10.1186/s12912-021-00663-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rationing of nursing care is a relatively new concept. It refers to an error of omission and has a direct influence on the quality of nursing care and treatment outcomes. Nurses who experience chronic fatigue often fail to perform their duties properly, which may lead, for instance, to medical errors attributed to impaired judgment. Therefore, it is necessary to identify factors which give rise to fatigue, leading to rationing of nursing care, and develop strategies to eliminate them. The primary objective of the study was to assess the impact of fatigue on nursing care rationing in paediatric haematology and oncology departments. The secondary objective of this study was to identify the factors, which may influence the nursing care rationing. Methods The study was conducted among 95 nurses (aged between 23 and 58 years) workinginthe Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation of the University Teaching Hospital in Wroclaw. Participation in the study was voluntary and anonymous. Our own sociodemographic questionnaire, the Basel Extent of Rationing of Nursing Carequestionnaire and the modified fatigue impact scale (MFIS) were used in the study. Results The level of fatigue among the nurses participating in the study, as measured by the MFIS, was high, namely 28.97 ± 16.78. It was found that the fatigue of the nurses influenced most often the psycho-social dimension of QoL (1.78 ± 1.05), and least often - cognitive (1.24 ± 0.78). A correlation analysis showed that all aspects of fatigue had a statistically significant positive impact on care rationing (p < 0.05), i.e. the greater the fatigue, the higher the level of care rationing. A regression analysis showed that a 12-h shift pattern was an independent predictor of the level of care rationing (r = 0.771, p < 0.05). Conclusions Nurses working in paediatric haematology departments report a high level of fatigue. Work pattern is an independent determinant of nursing carerationing. A high level of nursing care rationing was found for nurses working 12-h shifts. Trial registration The study was approved by the Bioethics Committee of the Wroclaw Medical University, Poland (February 8th 2019, No. 205/2019).
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Affiliation(s)
- Beata Jankowska-Polańska
- Division of Nervous System Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Bartla Street 5, 51-618, Wroclaw, Poland.
| | - Monika Czyrniańska
- Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation, "Cape of Hope" Transregional Paediatric Oncology Centre, BorowskaStreet 213, 50-556, Wroclaw, Poland
| | - Kathie Sarzyńska
- Internal Medicine Nursing Student Scientific Circles, Wroclaw Medical University, Bartla Street 5, 51-618, Wroclaw, Poland
| | - Natalia Świątoniowska-Lonc
- Division of Nervous System Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Bartla Street 5, 51-618, Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Surgery, 4thMilitary Teaching Hospital, Weigla Street 5, 50-981, Wroclaw, Poland.,Division of Oncology and Palliative Care, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Bartla Street 5, 51-618, Wroclaw, Poland
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Smith A, McDonald AD, Sasangohar F. The Impact of Commutes, Work Schedules, and Sleep on Near-Crashes during Nurses' Post Shift-Work Commutes: A Naturalistic Driving Study. IISE Trans Occup Ergon Hum Factors 2021; 9:13-22. [PMID: 34157964 DOI: 10.1080/24725838.2021.1945708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OCCUPATIONAL APPLICATIONSDriving and survey data were collected from nurses following the night-shift and analyzed with logistic regression and frequency analysis. The analyses showed that prior near-crashes and drive length contributed significantly to near-crashes. The frequency analysis showed that most near-crashes occurred on major roadways, including principal arterials, major collectors, and interstates, within the first 15 minutes of the drive. These results highlight the urgent need for countermeasures to prevent drowsy driving incidents among night-shift nurses. Specifically, nurses and hospital systems should focus on countermeasures that encourage taking a break on the post work commute and those that can intervene during the drive. This may include the use of educational programs to teach nurses the importance of adequate rest or taking a break to sleep during their drive home, or technology that can recognize drowsiness and alert nurses of their drowsiness levels, prompting them to take a break.
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Affiliation(s)
- Alec Smith
- Wm' Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Anthony D McDonald
- Wm' Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
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Anton N, Hornbeck T, Modlin S, Haque MM, Crites M, Yu D. Identifying factors that nurses consider in the decision-making process related to patient care during the COVID-19 pandemic. PLoS One 2021; 16:e0254077. [PMID: 34214122 PMCID: PMC8253418 DOI: 10.1371/journal.pone.0254077] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Nurse identification of patient deterioration is critical, particularly during the COVID-19 pandemic, as patients can deteriorate quickly. While the literature has shown that nurses rely on intuition to make decisions, there is limited information on what sources of data experienced nurses utilize to inform their intuition. The objectives of this study were to identify sources of data that inform nurse decision-making related to recognition of deteriorating patients, and explore how COVID-19 has impacted nurse decision-making. Methods In this qualitative study, experienced nurses voluntarily participated in focused interviews. During focused interviews, expert nurses were asked to share descriptions of memorable patient encounters, and questions were posed to facilitate reflections on thoughts and actions that hindered or helped their decision-making. They were also asked to consider the impact of COVID-19 on nursing and decision-making. Interviews were transcribed verbatim, study team members reviewed transcripts and coded responses, and organized key findings into themes. Results Several themes related to decision-making were identified by the research team, including: identifying patient care needs, workload management, and reflecting on missed care opportunities to inform learning. Participants (n = 10) also indicated that COVID-19 presented a number of unique barriers to nurse decision-making. Conclusions Findings from this study indicate that experienced nurses utilize several sources of information to inform their intuition. It is apparent that the demands on nurses in response to pandemics are heightened. Decision-making themes drawn from participants’ experiences can to assist nurse educators for training nursing students on decision-making for deteriorating patients and how to manage the potential barriers (e.g., resource constraints, lack of family) associated with caring for patients during these challenging times prior to encountering these issues in the clinical environment. Nurse practice can utilize these findings to increase awareness among experienced nurses on recognizing how pandemic situations can impact to their decision-making capability.
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Affiliation(s)
- Nicholas Anton
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Tera Hornbeck
- School of Nursing, Purdue University, West Lafayette, IN, United States of America
| | - Susan Modlin
- School of Nursing, Purdue University, West Lafayette, IN, United States of America
| | - Md Munirul Haque
- RB Annis School of Engineering, University of Indianapolis, Indianapolis, IN, United States of America
| | - Megan Crites
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States of America
- * E-mail:
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Danesh MK, Garosi E, Golmohamadpour H. The COVID-19 Pandemic and nursing challenges: A review of the early literature. Work 2021; 69:23-36. [PMID: 34024803 DOI: 10.3233/wor-213458] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has put health systems under unprecedented pressure, challenging their workforce, especially nurses. OBJECTIVE The current paper presented a review of the early literature concerning emerging nursing challenges during the early stages of the COVID-19 pandemic. METHODS A systematic search of the published literature between January and May 2020 was carried out in Medline, Science Direct, and Google Scholar to identify relevant quantitative and qualitative studies. RESULTS Twenty-two original articles were retrieved, the majority of which were survey studies from China. Synthesis of the evidence resulted in four overarching themes including "being physically and mentally drained in the face of fear and uncertainty," "shortage of personal protective equipment and usability issues," "psychosomatic disturbances among nurses," and "moderators to mitigate nurses' challenges." CONCLUSIONS Providing care for demanding COVID-19 patients, nurses experienced a gruelling situation, during which a significant amount of psychological and physical distress was inflicted to them. However, receiving proper support from their organization and society could improve the condition substantially. Further research is required to explore the impact of the COVID-19 pandemic on nurses, especially from Western countries.
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Affiliation(s)
- Mojtaba K Danesh
- Department of Occupational Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Garosi
- Department of Occupational Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamedeh Golmohamadpour
- Department of Occupational Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Thompson BJ. Fatigue and the Female Nurse: A Narrative Review of the Current State of Research and Future Directions. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:53-61. [PMID: 33786531 PMCID: PMC8006794 DOI: 10.1089/whr.2020.0107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
Background: The female nurse exhibits a multitude of personal and environmental characteristics that renders this population especially prone to fatigue. The consequences of fatigue in nurses are widespread and impactful at the personal, organizational, and societal levels. These include high injury rates and burnout in the nurse and poor patient and organizational outcomes. Objective: This article discusses the implications of fatigue in female nurses, including the impacts of fatigue across multiple entities (e.g., worker, patient, organization). It also reviews the current state of the research, including recent work on nurse fatigue and work schedule characteristics, and key areas for future work that would help empirically establish approaches to counter the detrimental and widespread effects of fatigue. Method: A narrative literature review was conducted resulting from an analysis of the literature limited to peer-reviewed studies. Results: A confluence of factors combines to elevate the prevalence and risk of fatigue in the female nurse. Numerous measures have established that performance-based fatigue results from nursing work schedules in nurses. Data also demonstrate that fatigue accumulates across successive shifts. Recent evidence supports the use of objective fatigue measures, including psychomotor reaction time and muscle function-related variables. Current gaps in the literature are delineated in the text. Conclusions: Strategic and well-designed research studies, as well as recent technological advances in fatigue tracking tools have the potential to help workers, administrators, and organizations develop fatigue management programs that could reduce the heavy burdens of fatigue on a multitude of health, safety, and economical outcomes.
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Affiliation(s)
- Brennan J Thompson
- Kinesiology and Health Science Department, Utah State University, Logan, Utah, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, Utah, USA
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Bae SH. Relationships between comprehensive characteristics of nurse work schedules and adverse patient outcomes: A systematic literature review. J Clin Nurs 2021; 30:2202-2221. [PMID: 33616252 DOI: 10.1111/jocn.15728] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
AIMS To review the comprehensive characteristics of adverse nurse work schedules and to synthesise the evidence of their relationships with adverse patient outcomes. BACKGROUND To manage nurse shortages and fluctuations in patient censuses, nurses often work overtime. This increases nurses' work hours and causes them to have fewer breaks. Such extended work schedules, long shift length, long weekly work hours and insufficient beaks can be considered as adverse nurse work schedules. Understanding how these adverse nurse work schedules affect patient outcomes is important to ensure patient safety. DESIGN A systematic review of nursing and healthcare literature was conducted in this study. METHODS Eight electronic bibliographic databases (CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS and Web of Science) were used to search research articles published from 2000 to 2019. The study selection process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). RESULTS From the search, 2,366 articles were identified, 22 of which were included in this review. Working more than 12 hours in a day had an adverse effect on patient outcomes, as was working more than 40 hours per week. There were mixed findings in the relationship between nurse overtime and adverse patient outcomes. CONCLUSIONS This study found a conclusive relationship between excessive nurse work hours and adverse patient outcomes. This review highlights the importance of managing adverse nurse schedules such as long daily and weekly work hours to improve patient safety and prevent adverse patient outcomes. RELEVANCE TO CLINICAL PRACTICE Study findings support the importance of monitoring and regulating nurse work schedules and adverse scheduling practices to improve nurse well-being and health and to prevent adverse patient outcomes.
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Affiliation(s)
- Sung-Heui Bae
- College of Nursing, Graduate Program in System Health Science and Engineering (BK 21), Ewha Womans University, Seoul, Republic of Korea
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Fratissier A, Gauberti P, Morello R, Clin B. Impact of 12-hr shifts in general hospitals: Study conducted in two intensive care units. Nurs Open 2021; 8:656-663. [PMID: 33433955 PMCID: PMC7877150 DOI: 10.1002/nop2.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/27/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022] Open
Abstract
AIM To evaluate the impact of 12-hr shifts on health status, working conditions and satisfaction among nurses and healthcare auxiliaries in medical and surgical intensive care units in a general hospital. DESIGN This study was a descriptive and prospective questionnaire study of personnel involved in the organization of 12-hr shifts. METHODS The EVREST questionnaire was used, with the addition of two questions on respondents' health status and five questions on their job satisfaction. The study consisted of a first phase immediately before work was organized in 12-hr shifts and a second within 7-9 months of application of this organization. RESULTS Positive effects were found among day nurses including decreased periods of pressure during the working day and improved work-life balance. Conversely, night nurses, who are not in favour of 12-hr shifts, reported dissatisfaction caused by a deterioration both in working conditions and in work-life balance.
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Affiliation(s)
- Anne Fratissier
- CHU CaenService de santé au travail et pathologie professionnelleCaenFrance
| | - Philippe Gauberti
- CHU CaenService de santé au travail et pathologie professionnelleCaenFrance
| | - Rémy Morello
- INSERM U1086 «ANTICIPE»CaenFrance
- CHU CaenUnité de biostatistique et recherche cliniqueCaenFrance
| | - Bénédicte Clin
- CHU CaenService de santé au travail et pathologie professionnelleCaenFrance
- INSERM U1086 «ANTICIPE»CaenFrance
- Université de Caen NormandieCaenFrance
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Liu JL, Jin JW, Lai ZM, Wang JB, Su JS, Wu GH, Chen WH, Zhang LC. Emergency tracheal intubation during off-hours is not associated with increased mortality in hospitalized patients: a retrospective cohort study. BMC Anesthesiol 2020; 20:265. [PMID: 33087063 PMCID: PMC7576761 DOI: 10.1186/s12871-020-01188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background The prognosis of hospitalized patients after emergent endotracheal intubation (ETI) remains poor. Our aim was to evaluate the 30-d hospitalization mortality of subjects undergoing ETI during daytime or off-hours and to analyze the possible risk factors affecting mortality. Methods A single-center retrospective study was performed at a university teaching facility from January 2015 to December 2018. All adult inpatients who received ETI in the general ward were included. Information on patient demographics, vital signs, ICU (Intensive care unit) admission, intubation time (daytime or off-hours), the department in which ETI was performed (surgical ward or medical ward), intubation reasons, and 30-d hospitalization mortality after ETI were obtained from a database. Results Over a four-year period, 558 subjects were analyzed. There were more male than female in both groups (115 [70.1%] vs 275 [69.8%]; P = 0.939). A total of 394 (70.6%) patients received ETI during off-hours. The patients who received ETI during the daytime were older than those who received ETI during off-hours (64.95 ± 17.54 vs 61.55 ± 17.49; P = 0.037). The BMI of patients who received ETI during the daytime was also higher than that of patients who received ETI during off-hours (23.08 ± 3.38 vs 21.97 ± 3.25; P < 0.001). The 30-d mortality after ETI was 66.8% (373), which included 68.0% (268) during off-hours and 64.0% (105) during the daytime (P = 0.361). Multivariate Cox regression analysis found that the significant factors for the risk of death within 30 days included ICU admission (HR 0.312, 0.176–0.554) and the department in which ETI was performed (HR 0.401, 0.247–0.653). Conclusions The 30-d hospitalization mortality after ETI was 66.8%, and off-hours presentation was not significantly associated with mortality. ICU admission and ETI performed in the surgical ward were significant factors for decreasing the risk of death within 30 days. Trial registration This trial was retrospectively registered with the registration number of ChiCTR2000038549.
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Affiliation(s)
- Jun-Le Liu
- Department of anesthesiology, Union Hospital, Fujian Medical University, XinQuan Road 29th, Fuzhou, 350001, Fujian, China
| | - Jian-Wen Jin
- Department of Clinical Medicine, Fujian Health College, 366th GuanKou, Fuzhou, 350101, Fujian, China
| | - Zhong-Meng Lai
- Department of anesthesiology, Union Hospital, Fujian Medical University, XinQuan Road 29th, Fuzhou, 350001, Fujian, China
| | - Jie-Bo Wang
- Department of anesthesiology, Union Hospital, Fujian Medical University, XinQuan Road 29th, Fuzhou, 350001, Fujian, China
| | - Jian-Sheng Su
- Department of anesthesiology, Union Hospital, Fujian Medical University, XinQuan Road 29th, Fuzhou, 350001, Fujian, China
| | - Guo-Hua Wu
- Department of anesthesiology, Union Hospital, Fujian Medical University, XinQuan Road 29th, Fuzhou, 350001, Fujian, China
| | - Wen-Hua Chen
- Department of anesthesiology, Union Hospital, Fujian Medical University, XinQuan Road 29th, Fuzhou, 350001, Fujian, China
| | - Liang-Cheng Zhang
- Department of anesthesiology, Union Hospital, Fujian Medical University, XinQuan Road 29th, Fuzhou, 350001, Fujian, China.
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Koch D, Kutz A, Conca A, Wenke J, Schuetz P, Mueller B. The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study. J Adv Nurs 2020; 76:3483-3494. [DOI: 10.1111/jan.14560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/02/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Daniel Koch
- Division of General Internal and Emergency Medicine University Department of Medicine Kantonsspital Aarau Aarau Switzerland
- Department of Clinical Nursing Science Kantonsspital Aarau AG Aarau Switzerland
| | - Alexander Kutz
- Division of General Internal and Emergency Medicine University Department of Medicine Kantonsspital Aarau Aarau Switzerland
| | - Antoinette Conca
- Department of Clinical Nursing Science Kantonsspital Aarau AG Aarau Switzerland
| | - Juliane Wenke
- Department of Clinical Nursing Science Kantonsspital Aarau AG Aarau Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine University Department of Medicine Kantonsspital Aarau Aarau Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine University Department of Medicine Kantonsspital Aarau Aarau Switzerland
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Gerace A, Rigney G. Considering the relationship between sleep and empathy and compassion in mental health nurses: It's time. Int J Ment Health Nurs 2020; 29:1002-1010. [PMID: 32406147 DOI: 10.1111/inm.12734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/30/2022]
Abstract
Sleep plays a critical role in overall health, well-being, and daytime functioning. Provision of 24-hour care means that nurses undertake shift work and therefore have been found to commonly not get the recommended amount of sleep, resulting in sleep deprivation. Research to date has focused on how sleep deprivation impacts their cognitive performance (e.g., reaction time, memory consolidation); however, less considered is how nurses' sleep impacts on their ability to understand and provide emotional care to consumers. In this paper, we examine how sleep may influence nurses' ability to empathize and provide compassionate care, both of which are fundamental aspects of their work. We begin by considering the unique challenges nurses face as shift workers and the impact of sleep on physical and psychological functioning. We examine how empathy and compassion drive nurses' attempts to understand consumers' perspectives and experiences and motivate them to want to help those in their care. Work directly investigating the relationship between sleep and these processes indicates emotional recognition and experience are hampered by poor sleep, with greater compassion towards oneself or from others associated with better sleep. Much of this work has, however, been conducted outside of the nursing or health professional space. We discuss issues that need to be addressed in order to move understanding forward regarding how sleep impacts on mental health nurses' empathy and compassion, as well as how an understanding of the sleep-empathy/compassion link should be an important priority for nurse education and well-being.
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Affiliation(s)
- Adam Gerace
- School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia
| | - Gabrielle Rigney
- School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia
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McElroy SF, Olney A, Hunt C, Glennon C. Shift work and hospital employees: A descriptive multi-site study. Int J Nurs Stud 2020; 112:103746. [PMID: 32928504 DOI: 10.1016/j.ijnurstu.2020.103746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hospitals staff with 12-hour and other shift work patterns to account for daily and seasonal workload requirements. Research in healthcare and industries requiring shift work suggests there may be negative health consequences to the workers related to fatigue and other factors. Due to the 24/7 nature of healthcare, it is important to understand the impact of shift work on employees. OBJECTIVES The objectives of this study were to investigate how shift work impacts satisfaction with time for social and home activities, based on the Social and Domestic Survey, and chronic fatigue. In addition, an exploration of drowsy driving was undertaken. DESIGN AND SETTING This study was a multi-site, descriptive survey study, conducted in 4 acute care hospitals in one metropolitan area in the central United States. PARTICIPANTS Participants included healthcare workers in five 24/7 departments: nursing, respiratory therapy, laboratory, radiology and pharmacy. METHODS Measures included demographics, work characteristics, and scales including the: Social and Domestic Survey, Circadian Type Inventory, and Chronic Fatigue Scale along with data regarding drowsy driving and automobile accidents/near misses. Data were analyzed using descriptive statistics for sample characteristics. An exploratory factor analysis was conducted on the Social and Domestic Survey. Group differences were tested using Mann-Whitney U tests and regression analyses. RESULTS The sample included 1563 subjects (24% RR). The mean age was 40 years. Nursing comprised 77% of the sample, 88% were female, 85% were in a direct patient care role, 67% worked day shift, and 49% worked 12-hour shifts. Pay was important for working night shift, but home life was important for day shift. Night shift (p<0.001) and 12-hour shift workers (p<0.001) had higher chronic fatigue. However, after controlling for other factors, working night shift remained a significant predictor of chronic fatigue and lower satisfaction with time for daily tasks and family/social life, whereas working 12-hour shifts predicted higher satisfaction with daily tasks and periodic life activities. Thirty-five percent of workers reported altering their driving behavior at least half the time due to drowsy driving and 19% had an automobile accident or near miss due to drowsy driving. CONCLUSIONS Findings suggest that night and long shifts can have negative effects on fatigue, family, and social life. Drowsy driving and accidents/near misses frequently occur due to drowsy driving. Leaders should continue to study the 24/7 work environment and test measures to improve the safety of shift workers.
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Affiliation(s)
- Susan F McElroy
- Children's Mercy - Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Adrienne Olney
- Children's Mercy - Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Cheri Hunt
- Children's Mercy - Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Sumińska S, Nowak K, Łukomska B, Cygan HB. Cognitive functions of shift workers: paramedics and firefighters - an electroencephalography study. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2020; 27:686-697. [PMID: 32436781 DOI: 10.1080/10803548.2020.1773117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction. Working shifts has a negative impact on employee health and cognitive efficiency. The purpose of this study was to investigate the impact of shift work on cognitive functions - attention and working memory - using both behavioural and electrophysiological measures. Methods. The study was carried out on a group of 34 shift employees (18 paramedics, 16 firefighters) and on 17 day workers. Participants performed the attention network test and the N-back task with two conditions (1-back, 2-back) while the electroencephalography signal was recorded. Results. Observations included a higher amplitude of the P200 potential in paramedics (compared to the control group), a higher amplitude of the P300 potential after work than on a day off and the lowest increase in power in the θ band after the night shift. In firefighters, lower α desynchronization and lower synchronization in the α/β band were observed after a 24-h shift. Paramedics and firefighters had longer reaction times (N-back task). Conclusions. The results suggest that paramedics experience problems with sustained attention. Paramedics process visual stimuli in a different way; after a night shift, performing the tasks required more engagement of cognitive resources. For firefighters, a decrease in visual attention functions and cognitive inhibition was observed.
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Affiliation(s)
- Sylwia Sumińska
- Central Institute for Labour Protection - National Research Institute (CIOP-PIB), Poland
| | - Kamila Nowak
- Central Institute for Labour Protection - National Research Institute (CIOP-PIB), Poland
| | - Barbara Łukomska
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Poland
| | - Hanna B Cygan
- Bioimaging Research Center, Institute of Physiology and Pathology of Hearing, Poland
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Ayas NT, Jeklin AT, Tholin H, Rogers AE, Dodek P, Hirsh-Allen AJ, Norena M, Wong H. Consecutive nursing shifts and the risk of hypoglycemia in critically ill patients who are receiving intravenous insulin: a multicenter study. J Clin Sleep Med 2020; 16:949-953. [PMID: 32065114 PMCID: PMC7849663 DOI: 10.5664/jcsm.8382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVES Intensive care unit nurses commonly work multiple consecutive 12-hour shifts that leave little time for sleep between work shifts. Working multiple consecutive shifts could compromise vigilance and patient care, especially with respect to managing high-risk medications such as insulin infusions. We hypothesized that as the number of consecutive shifts worked by nurses increases, the rate of hypoglycemia in patients who are receiving an insulin infusion would also increase. METHODS We identified patients who had hypoglycemia (glucose ≤ 3.5 mmol/L, 63 mg/dL) between December 2008 and December 2009 in 3 intensive care units in Vancouver, British Columbia, Canada. For each hypoglycemic event, we counted the number of shifts worked on consecutive days during the previous 72 hours by the bedside nurse who was caring for the patient at the time of hypoglycemia (case shift). For each case shift, we identified up to 3 control shifts (24, 48, and 72 hours before the hypoglycemic event in the same patient when there were no hypoglycemic events) and counted the number of consecutive shifts worked by those nurses in the previous 72 hours. This analysis allowed us to control for patient-associated confounders. Conditional logistic regression was used to determine the association between number of consecutive shifts worked and occurrence of hypoglycemic events. RESULTS A total of 282 hypoglycemic events were identified in 259 patients. For 191 events, we were able to identify 1 or more control shifts. Compared with nurses who had not worked a shift in the preceding day, the odds ratio of a hypoglycemic event was 1.68 (95% confidence interval: 1.12-2.52), 2.16 (95% confidence interval:1.25-3.73), and 2.54 (95% confidence interval: 1.28-5.06) for nurses who were working their second, third, or fourth consecutive shift, respectively. CONCLUSIONS Working multiple consecutive nursing shifts is associated with increased risk of hypoglycemic events in patients in an intensive care unit.
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Affiliation(s)
- Najib T Ayas
- Program in Critical Care Medicine, Providence Health Care, Vancouver, British Columbia, Canada
- Critical Care Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Sleep Disorders Program, University of British Columbia Hospital, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada
| | - Andrew T Jeklin
- School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Harriet Tholin
- Intensive Care Unit, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ann E Rogers
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Peter Dodek
- Program in Critical Care Medicine, Providence Health Care, Vancouver, British Columbia, Canada
- Critical Care Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada
| | - A J Hirsh-Allen
- Sleep Disorders Program, University of British Columbia Hospital, Vancouver, British Columbia, Canada
| | - Monica Norena
- Center for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada
| | - Hubert Wong
- Center for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada
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Shift length and working practices in UK hospital settings: An online survey of heads of midwifery. Midwifery 2020; 87:102709. [PMID: 32348897 DOI: 10.1016/j.midw.2020.102709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE There is currently a lack of data that records how midwives are expected to work in hospital settings. The aim of this study was to determine the prevalence of 12-h shifts and current working practices of hospital-based midwives. DESIGN An online survey conducted between December 2018 and March 2019. Descriptive data are summarised regionally and nationally. SETTING NHS Trusts providing maternity services in hospital settings in the UK PARTICIPANTS: The link to the survey was emailed to Heads of Midwifery in 155 NHS Trusts FINDINGS: Responses were received from 94 of the 155 NHS Trusts (60.65%). Some responses included data for more than one hospital, so results are summarised for 97 hospitals. 12-h shifts were the most prevalent shift length, with only 4.1% of hospitals still routinely operating shorter shifts. 55% of hospitals limit the maximum number of consecutive shifts to three, but this can be influenced by different factors. More than half of midwives (55.67%) will be rostered to start a day shift within 24-h of finishing a night shift. 70% of hospitals do not currently record the number of midwives working beyond their contracted hours but 68% report formal methods of recording missed rest breaks. Regional differences were seen in the use of other personnel to support the midwifery workforce. CONCLUSIONS Shift schedules and the lack of formal methods to record the number of midwives working beyond their contracted hours may be a cause for concern due to the potential impact on recovery times. Further research is required to explore how working practices may affect midwives and their ability to provide care for women and their babies.
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Ponsin A, Fort E, Hours M, Charbotel B, Denis MA. Commuting Accidents among Non-Physician Staff of a Large University Hospital Center from 2012 to 2016: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17092982. [PMID: 32344841 PMCID: PMC7246704 DOI: 10.3390/ijerph17092982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
Road risks (commuting and on-duty accidents) have been responsible for 44% of work-related fatalities compensated by the French system of Social Security in 2012 and still represented 37% in 2018. Our objective was to assess risk factors for commuting accidents among the non-physician staff in a French university hospital. We conducted a case-control study of commuting accidents from 2012 to 2016. Cases were identified and controls were randomly selected from the hospital's personnel file with matches by year of the accident, gender and age. Risk factors were assessed using conditional logistic regression analysis. An increased risk was observed for 2 × 8 hour shifts, crude OR = 1.40 (95% CI = 1.05-1.86) compared to daytime schedules, but not confirmed in the multiple model. Being a duty officer and not working the day before the accident were associated with increased risk of accidents with adjusted OR = 1.9 (95% CI = 1.1; 3.3) and OR = 1.5, (95% CI = 1.1; 2.1), respectively. The risk increased as the distance between home and work increased, such as adjusted OR = 2.2 (95% CI = 1.4; 3.4) for a distance of >3.6 to 9 km, OR = 2.6, (95% CI = 1.7; 4.0) for a distance of >9 km to 19 km, and OR = 4.2, (95% CI = 2.8; 6.2) for >19 km vs. <3.6 km. The distance between home and work, not working the day before the accident, and certain categories of personnel were related to commuting accidents.
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Affiliation(s)
- Alexandre Ponsin
- Service de médecine et santé au travail, Hospices Civils de Lyon-165 chemin du grand Revoyet, 69495 Pierre Bénite, France
| | - Emmanuel Fort
- Univ Lyon, Univ Eiffel, Univ Lyon 1, Ifsttar, UMRESTTE, UMR T_9405, 69373 Lyon, France; (E.F.); (M.H.); (B.C.); (M.-A.D.)
| | - Martine Hours
- Univ Lyon, Univ Eiffel, Univ Lyon 1, Ifsttar, UMRESTTE, UMR T_9405, 69373 Lyon, France; (E.F.); (M.H.); (B.C.); (M.-A.D.)
| | - Barbara Charbotel
- Univ Lyon, Univ Eiffel, Univ Lyon 1, Ifsttar, UMRESTTE, UMR T_9405, 69373 Lyon, France; (E.F.); (M.H.); (B.C.); (M.-A.D.)
- CRPPE de Lyon, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - Marie-Agnès Denis
- Univ Lyon, Univ Eiffel, Univ Lyon 1, Ifsttar, UMRESTTE, UMR T_9405, 69373 Lyon, France; (E.F.); (M.H.); (B.C.); (M.-A.D.)
- Service de médecine et santé au travail, Hospices Civils de Lyon, 59 Bd Pinel, 69677 Bron cedex, France
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Gander P, O'Keeffe K, Santos-Fernandez E, Huntington A, Walker L, Willis J. Development and evaluation of a matrix for assessing fatigue-related risk, derived from a national survey of nurses' work patterns. Int J Nurs Stud 2020; 112:103573. [PMID: 32334846 DOI: 10.1016/j.ijnurstu.2020.103573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/19/2020] [Accepted: 03/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multiple aspects of nurses' rosters interact to affect the quality of patient care they can provide and their own health, safety and wellbeing. OBJECTIVES (1) Develop and test a matrix incorporating multiple aspects of rosters and recovery sleep that are individually associated with three fatigue-related outcomes - fatigue-related clinical errors, excessive sleepiness and sleepy driving; and (2) evaluate whether the matrix also predicts nurses' ratings of the effects of rosters on aspects of life outside work. DESIGN Develop and test the matrix using data from a national survey of nurses' fatigue and work patterns in six hospital-based practice areas with high fatigue risk. METHODS Survey data included demographics, work patterns (previous 14 days), choice about shifts, and the extent to which work patterns cause problems with social life, home life, personal relationships, and other commitments (rated 1 = not at all to 5 = very much). Matrix variables were selected based on univariate associations with the fatigue-related outcomes, limits in the collective employment contract, and previous research. Each variable was categorised as lower (score 0), significant (score 1), or higher risk (score 2). Logistic multiple regression modelling tested the independent predictive power of matrix scores against models including all the (uncategorised) work pattern and recovery sleep variables with significant univariate associations with each outcome variable. Model fit was measured using Akaike and Bayesian Information Criterion statistics. RESULTS Data were included from 2358 nurses who averaged at least 30 h/week in the previous fortnight in one of the target practice areas. Final matrix variables were: total hours worked; number of shift extensions >30 min, night shifts; breaks < 9 h; breaks ≥ 24 h; nights with sleep 11pm to 7am; days waking fully rested; and roster change. After controlling for gender, ethnicity, years of nursing experience, and the extent of shift choice, the matrix score was a significant independent predictor of each of the three fatigue-related outcomes, and for all four aspects of life outside work. For all outcome variables, the model including the matrix score was a better fit to the data than the equivalent model including all the (uncategorised) work pattern variables. CONCLUSIONS A matrix that predicts the likelihood of nurses reporting fatigue-related safety outcomes can be used to compare the impact of rosters both at work and outside work. It can be used for roster design and management, and to guide nurses' choices about the shifts they work.
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Affiliation(s)
- Philippa Gander
- Sleep/Wake Research Centre, Massey University, Private Box 756, Wellington 6140, New Zealand.
| | - Karyn O'Keeffe
- Sleep/Wake Research Centre, Massey University, Private Box 756, Wellington 6140, New Zealand
| | - Edgar Santos-Fernandez
- Sleep/Wake Research Centre, Massey University, Private Box 756, Wellington 6140, New Zealand
| | | | - Leonie Walker
- School of Health Sciences, Massey University, New Zealand
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Schubel L, Muthu N, Karavite D, Arnold R, Miller K. Design for cognitive support. DESIGN FOR HEALTH 2020:227-250. [DOI: 10.1016/b978-0-12-816427-3.00012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Olson JA, Artenie DZ, Cyr M, Raz A, Lee V. Developing a light-based intervention to reduce fatigue and improve sleep in rapidly rotating shift workers. Chronobiol Int 2019; 37:573-591. [PMID: 31823658 DOI: 10.1080/07420528.2019.1698591] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Over a quarter of employees in North America and a fifth of those in the European Union do shift work. Working these schedules increases fatigue, sleepiness, and errors at work. In the long term, it may also increase the risk of cardiovascular disease, gastrointestinal problems, and cancer. Some of these consequences may be partly due to circadian misalignment, in which sleep and activity patterns no longer align with one's circadian rhythms. Previous research has found that controlling light exposure can improve circadian alignment in individuals who work permanent night shifts. However, light-based interventions are rarely tested with rapidly rotating shift schedules, which include more than one type of shift within the same week (e.g., day shifts followed by night shifts). Further, many of the available interventions are seldom used in the workplace and may be less feasible in healthcare environments. In hospitals, the health and safety of both workers and patients can be compromised by increases in fatigue. We thus developed a practical intervention based on circadian and sleep hygiene principles to reduce some of the negative consequences associated with shift work. We then tested this intervention in a feasibility study of 33 nurses working rapidly rotating shifts. The study took place over two separate periods: the control (observation) period and the intervention period. Each period included two to four consecutive night shifts as well as the two days before and after those shifts. Nurses completed daily self-report questionnaires during both periods. During the intervention period, the nurses additionally followed a fatigue reduction plan. The plan involved 40 min of bright light exposure from a portable light box before night shifts, light avoidance using sunglasses after those shifts, and suggestions regarding the ideal times to sleep and nap. Results showed that nurses complied with the large majority of these recommendations. During the intervention period, nurses reported less fatigue, fewer work errors, better and longer sleep, and a more positive mood. Moreover, nurses with a preference for evenings (i.e., later chronotypes) reported the strongest benefits. Though more controlled studies are needed to assess causal mechanisms and long-term effectiveness, these promising results suggest that light-based interventions are feasible and may be effective at reducing fatigue in rapidly rotating shift workers.
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Affiliation(s)
- Jay A Olson
- Department of Psychiatry, McGill University, Montreal, Canada
| | | | - Mariève Cyr
- Department of Psychiatry, McGill University, Montreal, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Amir Raz
- Department of Psychiatry, McGill University, Montreal, Canada.,Institute for Interdisciplinary Behavioral and Brain Sciences, Chapman University, Irvine, USA
| | - Virginia Lee
- Department of Nursing, McGill University, Montreal, Canada.,Department of Nursing, McGill University Health Centre, Montreal, Canada
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Neigel AR, Claypoole VL, Smith SL, Waldfogle GE, Fraulini NW, Hancock GM, Helton WS, Szalma JL. Engaging the human operator: a review of the theoretical support for the vigilance decrement and a discussion of practical applications. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2019. [DOI: 10.1080/1463922x.2019.1682712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alexis R. Neigel
- Performance Research Laboratory, University of Central Florida, Orlando, Florida, USA
| | - Victoria L. Claypoole
- Performance Research Laboratory, University of Central Florida, Orlando, Florida, USA
| | - Samantha L. Smith
- National Research Council Research Associateship Program, Dayton, Ohio, USA
| | - Grace E. Waldfogle
- Performance Research Laboratory, University of Central Florida, Orlando, Florida, USA
| | - Nicholas W. Fraulini
- Performance Research Laboratory, University of Central Florida, Orlando, Florida, USA
| | - Gabriella M. Hancock
- Stress & Technology Applied Research (STAR) Laboratory, California State University – Long Beach, Long Beach, California, USA
| | | | - James L. Szalma
- Performance Research Laboratory, University of Central Florida, Orlando, Florida, USA
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Association of Working Hours and Patient Safety Competencies with Adverse Nurse Outcomes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214083. [PMID: 31652889 PMCID: PMC6862320 DOI: 10.3390/ijerph16214083] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022]
Abstract
The environment of health organizations can determine healthcare quality and patient safety. Longer working hours can be associated with nurses’ health status and care quality, as well as work-related hazards. However, little is known about the association of hospital nurses’ working hours and patient safety competencies with adverse nurse outcomes. In this cross-sectional descriptive study, convenience sampling was employed to recruit 380 nurses from three tertiary care hospitals in South Korea. Data were collected using structured questionnaires from May to June 2016. Hierarchical linear regression analysis was used to identify the association of working hours and patient competencies with adverse nurse outcomes among 364 participants selected for analysis. Most nurses worked over 40 h/week. Working hours (β = 0.202, p < 0.001) had the strongest association with adverse nurse outcomes. Low perceived patient safety competencies (β = −0.179, p = 0.001) and frequently reporting patient safety accidents (β = 0.146, p = 0.018) were also correlated with adverse nurse outcomes. Nursing leaders should encourage work cultures where working overtime is discouraged and patient safety competencies are prioritized. Further, healthcare managers must formulate policies that secure nurses’ rights. The potential association of overtime with nurse and patient outcomes needs further exploration.
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Ofoma UR, Basnet S, Berger A, Kirchner HL, Girotra S. Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends. J Am Coll Cardiol 2019; 71:402-411. [PMID: 29389356 DOI: 10.1016/j.jacc.2017.11.043] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed. OBJECTIVES This study sought to examine temporal trends in survival differences between on-hours and off-hours IHCA. METHODS We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines-Resuscitation registry during 2000 to 2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday to Friday 7:00 am to 10:59 pm) versus off-hours (Monday to Friday 11:00 pm to 6:59 am, and Saturday to Sunday, all day). RESULTS Among 151,071 participants, 79,091 (52.4%) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0% in 2000, 25.2% in 2014; off-hours: 11.9% in 2000, 21.9% in 2014; p for trend <0.001 for both). However, there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (p = 0.75) or a relative scale (p = 0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1% in 2000, 71% in 2014; off-hours: 46.9% in 2000, 68.2% in 2014; p for trend <0.001 for both) and the difference between on-hours and off-hours narrowed over time (p = 0.02 absolute scale, p < 0.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (p for trend < 0.001 for both), the absolute and relative difference persisted. CONCLUSIONS Despite an overall improvement in survival, lower survival in IHCA during off-hours compared with on-hours persists.
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Affiliation(s)
- Uchenna R Ofoma
- Department of Critical Care Medicine, Geisinger Health System, Danville, Pennsylvania.
| | - Suresh Basnet
- Department of Critical Care Medicine, Winchester Medical Center, Winchester, Virginia
| | - Andrea Berger
- Biomedical & Translational Informatics, Geisinger Health System, Danville, Pennsylvania
| | - H Lester Kirchner
- Biomedical & Translational Informatics, Geisinger Health System, Danville, Pennsylvania
| | - Saket Girotra
- Division of Cardiovascular Diseases, Department of Medicine, University of Iowa Hospitals and Clinics and the Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
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Ose SO, Tjønnås MS, Kaspersen SL, Færevik H. One-year trial of 12-hour shifts in a non-intensive care unit and an intensive care unit in a public hospital: a qualitative study of 24 nurses' experiences. BMJ Open 2019; 9:e024292. [PMID: 31289050 PMCID: PMC6629459 DOI: 10.1136/bmjopen-2018-024292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to provide recommendations to hospital owners and employee unions about developing efficient, sustainable and safe work-hour agreements. Employees at two clinics of a hospital, one a non-intensive care and the other a newborn intensive care unit (ICU), trialled 12-hour shifts on weekends for 1 year. METHODS We systematically recorded the experiences of 24 nurses' working 12-hour shifts, 16 in the medical unit and 8 in the ICU for 1 year. All were interviewed before, during and at the end of the trial period. The interview material was recorded, transcribed to text and coded systematically. RESULTS The experiences of working 12-hour shifts differed considerably between participants, especially those in the ICU. Their individual experiences differed in terms of health consequences, effects on their family, appreciation of extra weekends off, perceived effects on patients and perceived work task flexibility. CONCLUSIONS The results indicate that individual preference for working 12-hour shifts is a function of own health situation, family situation, work load tolerance, degree of sleep problems, personality and other factors. If the goal is to recruit and retain nurses, nurses should be free to choose to work 12-hour shifts.
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Affiliation(s)
| | | | | | - Hilde Færevik
- Department of Health Research, SINTEF, Trondheim, Norway
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Gander P, O'Keeffe K, Santos-Fernandez E, Huntington A, Walker L, Willis J. Fatigue and nurses' work patterns: An online questionnaire survey. Int J Nurs Stud 2019; 98:67-74. [PMID: 31319337 DOI: 10.1016/j.ijnurstu.2019.06.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/28/2019] [Accepted: 06/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fatigue resulting from shift work and extended hours can compromise patient care and the safety and health of nurses, as well as increasing nursing turnover and health care costs. OBJECTIVES This research aimed to identify aspects of nurses' work patterns associated with increased risk of reporting fatigue-related outcomes. DESIGN A national survey of work patterns and fatigue-related outcomes in 6 practice areas expected to have high fatigue risk (child health including neonatology, cardiac care/intensive care, emergency and trauma, in-patient mental health, medical, and surgical nursing). METHODS The 5-page online questionnaire included questions addressing: demographics, usual work patterns, work in the previous two weeks, choice about shifts, and four fatigue-related outcomes - having a sleep problem for at least 6 months, sleepiness (Epworth Sleepiness Scale), recalling a fatigue-related error in clinical practice in the last 6 months, and feeling close to falling asleep at the wheel in the last 12 months. The target population was all registered and enrolled nurses employed to work in public hospitals at least 30 h/week in one of the 6 practice areas. Participation was voluntary and anonymous. RESULTS Respondents (n = 3133) were 89.8% women and 8% Māori (indigenous New Zealanders), median age 40 years, range 21-71 years (response rate 42.6%). Nurses were more likely than New Zealand adults in general to report chronic sleep problems (37.73% vs 25.09%, p < 0.0001) and excessive sleepiness (33.75% vs 14.9%, p < 0.0001). Fatigue-related error(s) in the last 6 months were recalled by 30.80% and 64.50% reported having felt sleepy at the wheel in the last 12 months. Logistic regression analyses indicated that fatigue-related outcomes were most consistently associated with shift timing and sleep. Risk increased with more night shifts and decreased with more nights with sleep between 11 p.m. and 7 a.m. and on which nurses had enough sleep to feel fully rested. Risk also increased with roster changes and more shift extensions greater than 30 min and decreased with more choice about shifts. Comparisons between intensive care/cardiac care and in-patient mental health nursing highlight that fatigue has different causes and consequences in different practice areas. CONCLUSIONS Findings confirm the need for a more comprehensive and adaptable approach to managing fatigue. We advocate an approach that integrates safety management and scientific principles with nursing and management expertise. It should be data-driven, risk-focused, adaptable, and resilient in the face of changes in the services required, the resources available, and the overall goals of the healthcare system.
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Affiliation(s)
| | - Karyn O'Keeffe
- Sleep/Wake Research Centre, Massey University, New Zealand.
| | | | | | - Leonie Walker
- School of Health Sciences, Massey University, New Zealand
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Neigel AR, Claypoole VL, Szalma JL. Effects of state motivation in overload and underload vigilance task scenarios. Acta Psychol (Amst) 2019; 197:106-114. [PMID: 31132570 DOI: 10.1016/j.actpsy.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 02/24/2019] [Accepted: 05/13/2019] [Indexed: 11/24/2022] Open
Abstract
Vigilance, or sustained attention, is the ability to maintain attention for prolonged periods of time. Interestingly, to date, few studies on vigilance have focused on the role of state motivation in sustaining attention. To address this disparity in the literature, the present study examined the effect of two types of state motivation on vigilance performance across task types (cognitive or sensory) and across the number of displays (one, two, or four). A sample of 105 participants completed a 24-min overload or underload vigilance task in a research laboratory. Participants were randomly assigned to either a cognitive or sensory vigilance task, and were randomly assigned to monitor one, two, or four displays for target stimuli. The results indicated that intrinsic state motivation predicted correct detection performance and state success motivation predicted sensitivity, but not false alarm performance, response bias, or global workload. We conclude with a discussion of the theoretical and practical applications of this research.
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Kalánková D, Žiaková K, Kurucová R. Approaches to understanding the phenomenon of missed/rationed/unfinished care - a literature review. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bernstrøm VH, Alves DE, Ellingsen D, Ingelsrud MH. Healthy working time arrangements for healthcare personnel and patients: a systematic literature review. BMC Health Serv Res 2019; 19:193. [PMID: 30917819 PMCID: PMC6437911 DOI: 10.1186/s12913-019-3993-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/06/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND A number of working time arrangements have been linked to negative consequences for both health personnel and their patients. A common hypothesis put forth to explain these findings suggests that certain working time arrangements lead to negative patient consequences due to the adverse impact they have on employee health. The purpose of this study is to use systematic reviews to investigate whether employee health explains the relationship between working time arrangements and patient safety. METHODS A systematic literature review was performed including published reviews and original studies from MEDLINE, PsycINFO, Cinahl and Web of Science investigating working time arrangements for healthcare personnel, employee health and patient safety. In addition, we screened reference lists of identified reviews. Two reviewers independently identified relevant publications according to inclusion criteria, extracted findings and assessed quality. RESULTS Six thousand nine hundred thirty papers were identified, of which 52 studies met our criteria. Articles were categorized into five groups according to how they approached the research question: 1) independent analyses of relationship between working time arrangements and employee health, and of working time arrangements and patient safety (5 studies); 2) relationship between working time arrangements on both employee health and patient safety (21 studies); 3) working time arrangements and employee health as two explanatory variables for patient safety (8 studies); 4) combinations of the above analyses (7 studies); 5) other relevant studies (5 studies). Studies that find that working time is detrimental to employee health, generally also find detrimental results for patient safety. This is particularly shown through increases in errors by health personnel. When controlling for employee health, the relationship between working time arrangements and patient safety is reduced, but still significant. CONCLUSIONS Results suggest that employee health partially (but not completely) mediates the relationship between working time arrangements and patient safety. However, there is a lack of studies directly investigating employee health as a mediator between working time arrangements and patient safety. Future studies should address this research gap.
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Affiliation(s)
- Vilde H. Bernstrøm
- OsloMet – Oslo Metropolitan University, Work Research Institute, P.O.Box 4 St. Olavs Plass, N-0130 OSLO, Oslo, Norway
| | - Daniele Evelin Alves
- OsloMet – Oslo Metropolitan University, Work Research Institute, P.O.Box 4 St. Olavs Plass, N-0130 OSLO, Oslo, Norway
| | - Dag Ellingsen
- OsloMet – Oslo Metropolitan University, Work Research Institute, P.O.Box 4 St. Olavs Plass, N-0130 OSLO, Oslo, Norway
| | - Mari Holm Ingelsrud
- OsloMet – Oslo Metropolitan University, Work Research Institute, P.O.Box 4 St. Olavs Plass, N-0130 OSLO, Oslo, Norway
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Affiliation(s)
- L Reinke
- Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands
| | - J E Tulleken
- Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands
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