Diane A. Drake

Evaluation of physically and mentally fatiguing tasks and sources of fatigue as reported by registered nurses

AIMS To identify fatiguing tasks and develop a model of sources of fatigue in nursing work. BACKGROUND Research has identified multiple factors contributing to occupational fatigue; however, comprehensive consideration of diverse factors identified by nurses as contributing to fatigue in nursing work systems is lacking. METHODS Content and frequency analyses were performed on previously unpublished data from an online survey of registered nurses. Responses from 100 registered nurses to questions related to the most fatiguing tasks in their work and factors that cause those tasks to be most fatiguing were analysed. RESULTS Physically demanding patient care tasks, and organisation, management and logistics tasks, respectively, were listed as the most frequent physically and mentally fatiguing. Time and multitasking demands were listed frequently as sources of both fatigue dimensions. CONCLUSIONS Registered nurses reported working in environments that include physically and mentally fatiguing tasks. They identified factors related to work content demands, including physical and mental task demands as well as time and multitasking demands, as most frequently contributing to fatigue. IMPLICATIONS FOR NURSING MANAGEMENT This work and our conceptual model of sources of fatigue provide a framework to support nurses, nursing managers and administrators to develop strategies to reduce fatigue among RNs.

Hospital nurse force theory: a perspective of nurse fatigue and patient harm.

This article is focused on the primary finding of the 2010 Institute of Medicine report asserting that nurses practice to the full extent of their education and training. An evolving theoretical perspective for hospital nursing practice is proposed as a basis for reaching this goal. This article describes the background and current factors influencing professional hospital nursing practice, presents a theoretical model for future research designed to optimize the power of hospital nursing practice, using a newly evolved concept of “nurse force,” and discusses the implications of nurse force theory on perspectives of hospital nurse fatigue and patient harm.

A work systems analysis approach to understanding fatigue in hospital nurses

Abstract Occupational fatigue is an important challenge in improving health and safety in health care systems. A secondary analysis of cross-sectional data from a survey sample comprised 340 hospital nurses was conducted to explore the relationships between components of the nursing work system (person, tasks, tools and technology, environment, organisation) and nurse fatigue and recovery levels. All components of the work system were significantly associated with changes in fatigue and recovery. Results of a tree-based classification method indicated significant interactions between multiple work system components and fatigue and recovery. For example, the relationship between a task variable of ‘excessive work’ and acute fatigue varied based on an organisation variable related to ‘time to communicate with managers/supervisors’. A work systems analysis contributes to increased understanding of fatigue, allowing for a more accurate representation of the complexity in health care systems to guide future research and practice to achieve increased nurse health and safety. Practitioner Summary: This paper explored the relationships between nursing work system components and nurse fatigue. Findings revealed significant interactions between work system components and nurses’ fatigue and recovery. A systems approach allows for a more accurate representation of complexity in work systems and can guide interventions to improve nurse health and safety.

Association Between Serum 25(OH)D Level and Nonspecific Musculoskeletal Pain in Acute Rehabilitation Unit Patients.

OBJECTIVE Nonspecific musculoskeletal pain can be difficult to manage in acute rehabilitation unit (ARU) patients. We investigated whether vitamin D status is a potential modifiable risk factor for nonspecific musculoskeletal pain in ARU patients. MATERIALS AND METHODS This cross-sectional study focused on 414 adults from an inpatient ARU in Mission Viejo, California, between July 2011 and June 2012. On ARU admission, all patients had serum 25-hydroxyvitamin D (25(OH)D) levels measured and were assessed for nonspecific musculoskeletal pain. We performed multivariable logistic regression to test the association of serum 25(OH)D level with nonspecific musculoskeletal pain while adjusting for clinically relevant covariates. RESULTS Among these 414 patients, mean (SD) 25(OH)D level was 29 (12) ng/mL, and 30% had nonspecific musculoskeletal pain. After adjustment for age, sex, race, body mass index, Functional Independence Measure score, Deyo-Charlson Comorbidity Index, fractures, steroid use, history of osteoporosis/osteomalacia, and patient type (orthopedic, cardiac, neurological, spinal cord injury, or traumatic brain injury), serum 25(OH)D level was inversely associated with nonspecific musculoskeletal pain (odds ratio [OR] per 10 ng/mL, 0.67; 95% confidence interval [CI], 0.48-0.82). When 25(OH)D level was dichotomized, patients with levels <20 ng/mL had higher odds of nonspecific musculoskeletal pain (OR, 2.33; 95% CI, 1.23-4.17) compared with patients with levels ≥20 ng/mL. CONCLUSIONS In adult patients, serum 25(OH)D level on admission to ARU was inversely associated with nonspecific musculoskeletal pain. These data support the need for randomized, controlled trials to test the role of vitamin D supplementation to improve nonspecific musculoskeletal pain in ARU patients.

Interpretation of Hospital Nurse Fatigue Using Latent Profile Analysis.

There has been a lack of consensus in the literature related to the conceptualization, definition, and measurement of hospital nurse fatigue. Using latent profile analysis, the Hospital Nurse Force Theory provided a conceptual format to identify 3 profiles of nurse fatigue from subjective reports of hospital patient care nurses in a survey cohort. All fatigue and adaptation variables demonstrated significant inverse relationships. Describing nurse fatigue in profiles that include measures of acute, chronic, physical, and mental fatigue dimensions provided a new and expanded view of nurse fatigue to monitor trends comprehensively and evaluate fatigue risk management strategies.

Relationships between Wellness, Fatigue, and Intershift Recovery in Hospital Nurses

Fatigue and recovery have been associated with health, safety, and performance outcomes in hospital nurses. There is a growing emphasis on fatigue risk management and health promotion programs to support nurses and promote quality in hospitals. However, little is known about the relationships between fatigue and wellness measures in nurses. This study used a tree-based classification method to identify associations between self-reported fatigue, recovery and wellness measures in a survey study of hospital nurses. Significant relationships between multiple wellness measures and acute fatigue, chronic fatigue, and intershift recovery levels were identified. Specifically, the findings include critical levels of wellness measures where fatigue and recovery change. These findings have implications for ongoing efforts to develop effective fatigue management programs in this population.

Venous thromboembolism knowledge among older post-hip fracture patients and their caregivers.

Patient education about venous thromboembolism (VTE) prevention is needed to prevent complications and costly re-hospitalization. Nurses are uniquely positioned to provide vital education as patients transition from the inpatient setting to after discharge. Still, little is known about patient knowledge deficits and those of their caregivers. The purpose of this study was to explore VTE prevention knowledge in a sample of older hip fracture patients and family caregivers. At the time of hospital discharge, surveys were completed by hip fracture surgery patients (≥65; n=30) and family caregivers (n=30). Participants reported needs for more prophylactic anticoagulation and side effects education. Mean education satisfaction was 3.49 out of 5 among patients and 3.83 among caregivers. Focused patient education regarding the wisdom of VTE prevention, potential risks involved, and patient and caregiver roles in advocating for better prevention measures is needed for these patients at risk for hospital readmission secondary to VTE.