Sleep/Wake Research Centre, Massey University, New Zealand.
Sleep/Wake Research Centre, Massey University, New Zealand.
Int J Nurs Stud. 2019 Oct;98:67-74. doi: 10.1016/j.ijnurstu.2019.06.011. Epub 2019 Jul 1.
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.
This research aimed to identify aspects of nurses' work patterns associated with increased risk of reporting fatigue-related outcomes.
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).
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.
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.
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.
轮班和延长工作时间导致的疲劳会影响患者护理以及护士的安全和健康，并增加护士的离职率和医疗保健成本。
本研究旨在确定与报告与疲劳相关的结果风险增加相关的护士工作模式的各个方面。
对预计存在高疲劳风险的 6 个实践领域（包括新生儿科的儿童健康、心脏护理/重症监护、急诊和创伤、住院心理健康、医疗和外科护理）的护士工作模式和与疲劳相关的结果进行全国性调查。
这份 5 页的在线问卷包括以下问题：人口统计学、通常的工作模式、过去两周的工作情况、对轮班的选择以及与疲劳相关的四个结果——至少 6 个月存在睡眠问题、嗜睡（埃普沃斯嗜睡量表）、在过去 6 个月内回忆起在临床实践中与疲劳相关的错误，以及在过去 12 个月内开车时感觉快要睡着了。目标人群是在这 6 个实践领域中，每周至少工作 30 小时的注册和在册护士。参与是自愿和匿名的。
共有 3133 名受访者（89.8%为女性，8%为毛利人（新西兰原住民）），中位年龄为 40 岁，范围为 21-71 岁（响应率为 42.6%）。与一般的新西兰成年人相比，护士更有可能报告慢性睡眠问题（37.73% vs 25.09%，p<0.0001）和过度嗜睡（33.75% vs 14.9%，p<0.0001）。过去 6 个月内有疲劳相关错误的护士比例为 30.80%，而过去 12 个月内有 64.50%的护士表示开车时感到困倦。逻辑回归分析表明，疲劳相关结果与轮班时间和睡眠最一致相关。夜班越多，夜间睡眠时间在晚上 11 点到早上 7 点之间且护士有足够的睡眠感到完全休息的次数越少，风险就越大。轮班变动和超过 30 分钟的轮班延长次数越多，风险就越大，而选择轮班的次数越多，风险就越小。重症监护/心脏护理和住院心理健康护理之间的比较突出表明，疲劳在不同的实践领域有不同的原因和后果。
研究结果证实，需要采取更全面和适应性更强的方法来管理疲劳。我们提倡一种将安全管理和科学原则与护理和管理专业知识相结合的方法。它应该是数据驱动的、以风险为重点的、适应性强的，并且能够在服务需求、可用资源和医疗保健系统的总体目标发生变化时保持弹性。
