The condition of the nurses in the Jordan university hospital are one of the major area of investigation. The work related fatigue among the nurses are quite common. However, it is quite common to have work related fatigue for the persons who are engaged in such kind of work. The nurses of the Jordan University hospital are not different. Although, it is a worldwide problem now a days. The nurses are the key factors in giving direct care to the patient in the hospital environment. It is very much important to manage the work related fatigue among the nurses as the fatigue of the nurses are directly related to the issue of patient safety (Farokhzadian, Nayeri & Borhani, 2015). So it is very much important to manage and take proper steps in order to minimize the work related fatigue among the nurses of various hospital setting. A proper risk management strategy can minimize the effect of work related fatigue among the nurses of Jordan. A lack in introduction of risk management system has been proven very much effective in reducing the risks of the nurses (Lerman et al., 2012). In this report, the requirement of and usefulness of a proper risk management system in the hospital setting are proposed that are supported by various studies in different countries of the world.
Among the shift worker, specifically among nurses, it is very common to have the problem of work-related fatigue. It refers to as a physical or mental tiredness that prevent a person from doing an act normally due to prolonged mental or physical exhaustion even without taking rest or time of recovery (Rose, Seidler, Nübling, Latza, Brähler, Klein, et al., 2017; The University of Western Australia, 2016, online).
Work-related fatigue is also referred to as ranging from acute to chronic states of dysfunction due to increased stressor exposure of worker and it is also associated with the interfering with functional abilities at maximum state of working capacities. The severity of the fatigue is known to generally be associated with the level of physical and mental stress of the nurses. The effect of fatigue is associated with the performance of the nurses. Fatigue is a natural physiological phenomena that may occur due to prolonged working hour, doing a same type of work for a long time and due to disruption of circadian rhythm. Occupational fatigue may cause various mental health problems such as anxiety, depression among the nurses. Moreover it can be stated that there is a direct relation between the work related fatigue among the nurses and patient safety as due to onset of fatigue there is a high chance of human error in the hospital setting. It may be fatal to the patient. According to Rasouli et al. (2011), the nurses of specific departments such as oncology and hematology are prone to have moderate to high risk of fatigue.
According to Winwood et al. ( 2005) , there are 3 types of work-related fatigue that includes inter-shift ( recovery ) fatigue, acute fatigue and chronic fatigue. However, it is quite difficult to differentiate between acute and chronic fatigue. Acute work-related fatigue refers to a feeling of lack in energy due to previous work activities. It can also be defined as a protective mechanism in response to immense work demands (Winwood, Winefield, & Lushington, 2006a, p. 438). “Whereas chronic work-related fatigue results from high levels of acute fatigue in addition to insufficient recovery between work shifts which can persist even during rest days and holidays” (Winwood et al., 2005, p. 594). Chronic fatigue is more related with negative effects on worker’s health than that of the acute fatigue (Winwood et al., 2005). Work related fatigue existed more among the nurses who did not comfortable at the start of a new shift (Winwood et al., 2005).
Work related fatigue all the nurses of various departments. In Canada, almost 55.5% nurses always felt fatigue during their work and 80% of nurses felt fatigue after their work (CNA & RNAO, 2010). In USA, 37.9% of total workforce felt work related fatigue and among them nurses had a higher prevalence rate (Barker & Nussbaum, 2011).
In terms of manifestations and causes, a work related fatigue is multidimensional in nature. Corless et al. ( 2008), showed that the etiology of work-related fatigue in multifunctional in nature and it is related to various number of psychological and physiological factors. Along with this, in another study by Bültmann et al. ( 2002) showed correlation between psychosocial work-stressor and onset of work-related fatigue. Moreover, there are various environmental factors (e.g. work demand), physiological factor (e.g. circadian rhythm), psychological factors (e.g. stress, sleepiness, alertness), behavioral factors (e.g. the pattern of work and sleep) ( CAN & RNA, 2010).
In recent times, work related fatigue has become a major distressing factor for the nurses in the hospital environment of Jordon. A huge number of hospitals in Jordan are facing difficulties related to the risk management system of the work-related fatigue and recovery strategies so that, the retention ratio of the nurses can be improved. Along with this, the fatigue related error among the nurses can also be lowered. In a cross sectional study by Liu et al. ( 2016) showed that, work related fatigue greatly affected the intent to stay among new nurses as due to work related fatigue they did not want to stay. In this study, they also found that, any personal characteristics did not affect the nurses’ intent to stay, only the work related fatigue can affect intent of staying. In a study it was seen that, nurses resigned from their job due to emotional distress, exhaustion, and unhealthy work place. In addition to this, nurses also reported absenteeism and feeling of burnout due to their work related fatigue. They also had reported that, they had not enough time for recovery after a exhaustive session. According to a study conducted by Garrett (2008) found that burnout is one the key factor behind the work related fatigue and dissatisfaction of job. Moreover, the job satisfaction rate is four times in comparison with the average rate of entire workers in USA (MacKusick & Minick , 2010).
Health care system refers to a dynamic and complex process that covers shift work, long work hours, increasing work load that can cause nurse’s fatigue (Barker & Nussbaum, 2011; Winwood, Winefield & Lushington, 2006). These factors are associated with the high turnover rates, enhanced patient acuity, complexity of care are introducing risks in the working environment and along with this threating the nurses’ and patient safety (Ellis, 2008).
According to Saleh, Awadalla, El-masri, &Sleem (2014), the problem of fatigue must be addressed as it has capabilities to pose enhanced risk of errors, timing error, manual handling error and medication error. The nurses of busy departments such as emergency departments and the nurses who had prolonged shift mainly experienced the fatigue.
Therefore, by assessing work place fatigue and its effect on the nurse, it is seen that the fatigue is a major concern for the nurses as this affects the overall performance of the nurses in many ways. This study tries to identify the effective risk management system that is used by nursses or hospitals to manage work-related fatigue among nursing personnel.
To ensure a healthy environment for the nurses is very much important as it is associate with the care giving to the patients. Moreover, any kind of error by the nurses due to their fatigue, can be harmful the patients and this may alter the patient safety also. Son it can be said that, an ideal risk management system is required to enhance the patient safety and health condition of the nurses.
According to Van Mol et al. (2015), the work related fatigue in nurses may be due to repeated task, high-intensity work load, and minimal control. In addition to this, there are various personal causative factors for the onset of fatigue. For example, lack of job satisfaction, lack of resilience level of the nurse and in addition to this, organizational factor such as poor insurance support facility from the management can also be a causative factor for the onset of fatigue among the nurses.
Yang & Kim (2012) also suggested that there were various diverse factors such as age, education, demand of life, self-care may also contribute to the onset of fatigue by altering the issues such as dissatisfaction related payment, excessive workload, stress due to the same type of work. In this scenario, the psychological factors can be defined as empathy. However, it can be said that if the causative factors for the onset of fatigue can be identified, then it will be easier to implement various measures in order to reduce the risk of fatigue among the nurses. This study will also highlight the that fact that, which department’s nurses are more vulnerable to develop fatigue for their work . It will help to increase the safety condition. However, there will be a few errors and injuries, but the overall situation will be improved for the nurses and other health care worker.
Aim: To rectify the requirements of risk management system for work-related fatigue among the nurses and it will help measure and address the nurse’s fatigue in University hospital of Jordan
According to Olds & Clarke (2010), fatigue refers to the extreme feelings of exhaustions due to physical and mental illness. It is assumed to be a crucial cause of ill health and a causative factors that can contribute to the negative patient outcomes in the health industry. The list of dependent variables are described below.
Moreover, there are mainly three types of fatigue such as compassionate fatigue, physical fatigue, and mental fatigue. Compassionate fatigue is mostly seen among the nurses and it is caused due to the caring for very vulnerable and ill patients and witnessing, experiencing loss and death of the patients due to their profession ( Boyle, 2015). The nurses reported about medium to greater acute fatigue level in addition with the inter-shift procedure of recovery and medium extent of chronic fatigue.
Working in an unsafe condition may cause fatal and non-fatal injuries of the employees and also may cause negative outcome from the patient and chronic diseases. In this research the risk faced by the nurses due to various health challenges in the hospitals in Jordon will be analyzed.
In Jordon a huge number of hospitals are working on implementing adequate fatigue related risk management system and that will ultimately help in improving culture at the work places and issue of effective risk management system. In a study by Bérastégui et al. (2018), showed that, a few business organization has taken proactive steps that is highly attentive towards the duty of offering schedules for safety in work place and of care. In addition to this, they has also been focusing on recovery time, time for resting, permitting sufficient time to sleep.
The work related factors, that contributed to the onset of fatigue in the health care giver specially nurses, are irregular shift work, reduced time between shifts, long working hours, stressful working condition which are derived from patient caseloads and type of nursing care (Rella, Winwood, & Lushington, 2009).
The primary demographic variables are marital status, age of the nurses, income level, shift length, employment experience and nurse education.
By this research, the following secondary research questions will be addressed:
The aim of this research is described below:
‘Identifying Effective Risk Management for work-related Fatigue among Nurses
The discrete objective of this research are as below.
From the above proposed research questions, the following hypotheses are developed for this research proposal.
H0 = In the first case, the null hypotheses will be that , there is no risk management strategies and also no recovery strategies are used by the hospitals of University hospital of Jordan. This may affect the level of fatigue among the nurses of the University hospital of Jordan.
H1= The alternative hypotheses will be that, the university hospitals of Jordan are using various risk management strategies and recovery techniques that are influencing the level of fatigue among the nurses.
H0= The work factors have no direct relation with the fatigue of the nurses.
H2= The work factors are directly affecting the work-related fatigue among the nurses of the university hospital of Jordan.
H0= Fatigue coping strategies cannot abolish the effect of the work-related fatigue among the nurses of Jordan.
H3= Fatigue coping strategies can abolish the negative impacts of the work related fatigue among the nurses.
Smith-Miller et al. (2014) suggested that, job nursing demands mental, physical and psychological attachment and that causes onset of fatigue among the nurses. According to Ho et al. (2013), work related fatigue is one of the major problem of the nurses and also for other medical personnel and it is also associated with the alteration of the patient safety. In that study, the number of participants was 1833 and among them the prevalence rate of fatigue was almost 30.9%. In their study, they observed that, the younger participant nurses are more prone to work related fatigue and those participants were mostly at the age group of 20-29 years. The medical personnel had the higher rate of fatigue than that of the administrative workers of that particular hospital. In addition to this, it was also observed that the healthy participants complained less about the fatigue due to their work than that of the unhealthy participant nurses. Patterson & Yearly (2010), suggested that, fatigue among the nurses is linked with increased medical errors and that ultimately causes reduction in patient safety . Cotter (2011) observed that, the work related fatigue among the nurses can be observed due to the prolonged working hours and as well as long shift-timings. Ho et al. (2013) also found that, work related fatigue can be observed due to other various issues such as smoking, age, job category, sex. In this study, it was seen that, about 31.7% nurses had complained about the work related fatigue and along with this, sleepiness and lack in concentration was also reported by the nurses who already had work related fatigue.
The prevalence of fatigue among the nurses is not same for all countries in the world. It was observed that UK, Norway and Netherlands had the prevalence rate of 38%, 22% and 25% respectively. The higher prevalence rate of fatigue among the medical personnel than that of the administrative workers was due to the overtime works of the nursing personnel. The study showed that, the fatigue among the nursing personnel hampered the patient safety along with enhancing the risk of needlestick mishaps among the health care giver. Work-related fatigue is very important to maintain a good relationship among the patients and nurses. This will create a good relationship and that will ultimately help in betterment of the patient satisfaction and patient safety. Fatigue can create alteration in nurses’ behavior and that may lead to decreased patient safety ( Potter et al., 2010).
Work related fatigue may also create the issue of decreased job-satisfaction, absenteeism and in addition the percentage of job-leaving among the nurses was also increased. A study conducted by Mahmoudi et al. (2010), showed that the fatigue of nurses was directly assocaited to the work load and time of resting period of the nurses. Nurses with high work load had complained more about the work related fatigue. In the same study, it was seen that, the nurses who had less resting period during their shift timing had higher number of compalins related to fatigue. Raftopoulos et al. (2012) showed in their study that, prevalence rate of fatigue among the nurses was 91.9% ( n= 1482). Yarmohammadi et al. (2017) conducted a study with a 112 nurses of Kermanshah hospital and among the total sample population, 56.8% and 43.8% were female and male respectively. In this study, nurses with evening and night shifts, nurses who were dissatisfied with their work, and master degree nurses had a high percentage of work related fatigue. Moriarty et al. (2010) described that it is very important to have clear idea of physiological fatigue in order to understand the occupational fatigue among the nurses. However, fatigue cannot be measured directly, but the signs and symptoms can be easily detected.
The psychological and physical factors are directly involved in the onset of work related fatigue. The study conducted by Yarmohammadi et al. (2017), showed that, the 67.9% participants had complianed about low to moderate level of fatigue. High level of fatigue was reported by 23.2% of total sample size. Almost 8.9% of participants had reported about very level of fatigue. The identification of various factors related to the work related fatigue will help to reduec the work related fatigue. In the study, it was also found that the nurses had more number compalins who had over-night and evening shifts than that of the nurses who were in the rotational shift system or morning shifts. Work related fatigue can also craete physical problems, lack of motivation in their work, higher physical endeavor, more drowsiness and that may alter the pateint safety. In a hospital setting, it is very much common to have a 12 hours shifts of the nurses in the whole world (Estryn-Behar & Van der Heijden, 2012). According to Lerman et al. (2012) safety and the worker’s health are directly related to each other. A well risk management system in the workplace will improve the worker’s health. It is seen that, the healthier employees are less claiming about their health and they also have better productivity. In addition to this, when the employees of any organization gets rest, they have the better productivity rate and also lower rate of absenteeism. It can be said that, the nurses in the hospital are unable to have proper sleep and it is also a major contributive factor to the work related fatigue of the nurses. A FRMS can be used as an effective risk management system in the hospital settings. It is a fatigue management system that is designed to improve the outcomes of the work related fatigue among the workers. The type of the works done by the nurses have direct relation with the work related fatigue of the nurses. It has become one of the most area of concern for the modern industry and as well as for the health care workers such as nurses. The main reason of the fatigue of the nurses are mainly the job role of the nurses, disruption in the sleep patterns of the nurses, prolonged work hour of the nurses. It can be said that the fatigue is the ultimate outcome of the various works such as waking time, workload, prolonged work hour, that are done by the nurses. It seen that work load is directly associated with the onset of fatigue among the nurses of various hospital and health care setting. Along with this, mental work load is also affect the onset of fatigue among the nurses (Sadeghniiat-Haghighi & Yazdi, 2015). Fatigue coping strategies that is techniques for managing fatigue among the nurses is very much effective to mitigate the effect of work related fatigue among the nurses. According to a study by Farokhzadian, Nayeri & Borhani (2015), it was seen that a proper risk management system is very much effective in managing work related stress among the nurses in a hospital setting. However it is also true that, the risks in the health care setting cannot be eliminated, but it can be minimized by using proper risk management system. A clinical risk management (CRM) system was introduced to the health care setting in Iran in order to improve the condition of the nurses. In this study, it was seen that, participant had reported an improved condition after the introduction of the CRM system in their hospital setting. So it can be said that, in Jordan the University hospitals should use the risk management system so that the work related fatigue among the nurses can be minimized and managed in a very well manner.
According to Steege & Pinekenstein (2016), this model defines a data-driven perspective that is aiming at lowering the nurses’ fatigue and also reducing the other consequences.
This three primary components of this model are as follows-
In this section, the methodology, research design, location of the study, population size for this research and sampling techniques will be discussed. In addition to this, the method of measuring quantitative data analysis and a suggested plan for the data analysis are also highlighted. In later part, the ethical considerations are also described.
In a study by Coolican (2017), the aim of a quantitative research methods is to examine the objective theories by examining the association of the predictors. In another study by Taylor, Bogdan, and DeVault, (2015), sugeested that, information ( in form of numbers) or data are included in the quantitative research design. For the large sample size, this method can be used. Generally it is seen that, to support a hypothesis and to draw a specific conclusion, quantitative method is used. This method of research is under the philosophy of positivism. A positivist research shows faith in conceptualization of the objective realities. In a quantitative research method, there is a statistically significant association for addressing the explanation and measurement of objective base measures. In addition to this, this method also concentrate on the correlation and causation. In this research, the main intention is to find the effective risk management system for the work related fatigue, codes conduct related to health and safety , poor work place conditions.An explanatory research method is mainly associated with the causes. It has primary focus on the assessment of explanation among the various diverse characteristics. It tries to identify and explain a causal association that is relevant to the research. In this type of research researcher construct research hypothesis and then examine the hypothesis to justify it. This method is more susceptible to place the quantitative method characteristically a survey.
In order to answer all the research questions and to achieve the research aim and objectives, the following research design is suggested. The aim of this research is to prove the chosen hypothesis along with this, is to find and measure other important factors that can be associated with the fatigue of the nurses. In addition, this research will follow the explanatory method among the three research method. In this study, quantitative data analysis method will be used to examine the collected data along with the statistical analysis and mathematical analysis.
The participants of this study comprises of the nurses of the university hospital of Jordon. All the nurses will be invited to participate in this study. There are a few inclusion and exclusion criteria for the nurses for participation.
The inclusion criteria are as follows-
The exclusion criteria is
The main target population for this research is the nurses of the University hospital in Jordon. The maximum number of the selected target population is dependent on the number of the nurses of the hospitals. The participant nurses will be from different university hospitals area that is different floors and units. Along with this, the selection procedure of the nurses will be done in a random process.
Data analysis refers to a process of searching into data for bringing out the meaning of experiences of the participants who have participated in the study (Hennink, Huttr, & Bailey, 2010). In this study, the data analysis will occur along with the data collection procedure simultaneously. This will help the researcher to explore the prominent issues in a better manner.
In this method, FAS (Fatigue Assessment Scale) will be used to measure the total fatigue of the subject population. In this method, there will be 10 to 15 items that are rated on 5 points Linkert Scale and it has range from 1 being “Never” and 5 being “Always”. It is expected that, the scale has adequate reliability an in addition it has content validity in order to measure the fatigue of the general people. In addition to this, another fatigue measurement scale named “Occupational Fatigue Exhaustion Recovery Scale”, will be used for measuring the current states of fatigue. This scale will mainly analyze the fatigue coping methods specially the recovery of the workers between two shifts.
This scale will also composed of 10-15 items and give feedback by use of 7 point Linkert scale that ranges from 1 being “ strongly disagree” to 7 being “ strongly agree” and this scale is based on the experiences and fatigue strain of the subjects. The final score will be written as a proportion of fatigue. Among the nurses, this scale is used in a wide manner and it is expected that this scale will reflect internal consistency and higher test-retest reliability.
The few factors related to fatigue-related risk management are family support, self-care, breaks and naps, positive social support, workload management, quality nursing environment, & Inter-shift recovery (Sadeghniiat-Haghighi & Yazdi, 2015).
|
Fatigue related risk management |
Related factors Family- support, self-care, breaks and naps, positive social support, workload management, quality nursing environment, & Inter-shift recovery. |
The factors related to coping strategies are based on task reallocation, self-regulation, fatigue reduction and error monitoring.
The factors related to work factors might include shift work, workload, understaffing issues, reduction in work abilities, job dissatisfaction, work position, Job demand (Lerman et al., 2012).
|
Coping strategies |
Related factors shift work, workload, understaffing issues, reduction in work abilities, job dissatisfaction, work position, Job demand. |
The socio demographic factors such as ethnicity, age, income, work schedule, marital status, employment, sleeping time per night. The nature of fatigue is dependent on the mental, physical and compassionate type of fatigue (Fiabane, et al., 2013).
|
Work related Fatigue |
Socio demographic Factor ethnicity, age, income, work schedule, marital status, employment, sleeping time per night |
The quantitative analysis will utilize a cross-sectional analysis method by using epidemiology based measurement process. (SPSS), version 23.0, will be used to analysis the data.
During the data collection method by using the questionnaire method, the subjects will be asked a series of demographic questions. By this method, we can fulfill two purposes: firstly, the gained information will help to gain further context to other participants’ and secondly, it will help in breaking the hesitation for interaction among the nurses. The subject population will be university hospital nurses of Jordon. Therefore, questionnaire will be given to the nurses in their work place.
The internal consistency of the sub scale for OFER and FAS will be examined by using the Cronbach alpha test method. After that, those data will be assessed by using the SPSS software (Version 23.0).
In this study, the ethical approval will be collected from the UPM, Human Research Ethics Committees, Ministry of health in Jordan and UON. In addition to this, other ethical considerations such as privacy of the personal data of the participants will be maintained. Nurses would be given adequate time in order to give their best response to the researcher’s questions. This would enrich the quality of the research. The respondents will have the complete right of withdrawing themselves from the study, even before the timeframe given to them. There is need of so many works that is important to enhance the standard of the proposal up to the expected standard of the SoNM. It is also very important to secure the data so that it cannot be used in other purposes. In order to secure the data, password should be used and the researcher will only have the access of the passwords and data. In addition to this, the data should have back up files so that it can be retrieved in any diverse condition. The collected quantitative data will be analyzed with the help of SPSS software.
From this study, the expected result may help the various organizations such as construction organizations or manufacturing organization to review the occupational safety and health issues of their workers. In addition, they can also maintain a good condition of the workplace. As a whole it can be said that, it is very important to develop a proper code of conduct, procedures and policies to understand the difficult working environment of the workers.
There are several limitations such as the study type. As it is a cross-sectional study, the study cannot be described as an on-going study. Secondly, another limitation is the lack of resources that is money, time, and other resources as well and this may hamper the quality of the research. Along with this, limited number of nurse subjects is also another major limitations of this study.
The organizations which are associated with dealing with hazardous work places, must need various procedures and policies to execute the job. It is very much necessary to give proper training to all the workers about the codes of conduct. It is recommended not to pose any discrimination in terms of the demographic characteristics such as religion, ethnicity, gender, age of the workers. In addition to this, there should be stringent control, proper monitoring procedure, use of appropriate techniques and tools in order to monitor the activities of the worker. As a part of this plan, feedback from the workers related to the work procedure and workplace safety can be collected. It is the duty of the human resource department and management to implement a stringent and straight policies for all workers. It is very important to understand the various scenarios of diversified communities and they should be helped as per their need so that they can their maximum effort in their work.
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