Work-Related Fatigue and Recovery - Assignment Example

Work-Related Fatigue and Recovery Winwood, P.C., Winefield, A.H., Lushington, K. (2006), Work-related fatigue and recovery: the contribution of age, domestic, responsibilities and shift work, Journal of Advanced Nursing, 56, 4, 438-449. Introduction. In this quantitative article that explores the relationship between full-time working female nurses’ age, domestic duties, e.g., living with a partner, or caring for children or other dependents, recovery from shift work-related fatigue and development or evolution of maladaptive health outcomes, the authors used a questionnaire and reported on a sample of 846 full-time working nurses. The reason this article was chosen, and the nexus of its relevance as stated in the research questions, is that it specifically seeks to understand real issues as applied to real nurses (Akerstedt, et al. 2002). It takes into account the difference between many important demographic qualities. [104] Purpose of Study. The study is investigating possible contributors to maladaptive health outcomes in nurses who work full-time. Age and familial demands placed on the nurse are considered and weighed, as are the impacts of fatigue and recovery from night shift work. The outcomes were interesting, particularly the conclusion that domestic responsibilities are not significant contributors to maladaptive health outcomes. What was found to be significant was the shift pattern worked, especially night duty (Demerouti, et al. 2001). Interestingly, the effect of age was found to be equivocal with the younger nurses showing poorer recovery than the older group; it was shown that age was not associated with negative outcomes. [110] Literature Review. The literature review is well done and uses recent sources for those aspects of the discussion which require timely analysis, e.g., in 1990 it was well known that nurses worked in a stressful environment and so that old of a source is not a critical issue. When the authors begin discussing and citing information based on neuro-chemical studies, however, advances in that area of research would require up-to-date sources and older studies would lack reliable data. In this case, those aspects of the literature review that require modernity are properly supported with research performed within the previous year of this study (Newey & Hood 2004), and the sources used are reliable and known in the field. The authors are psychological researchers and not nurses; they do, however, use recognized studies from nurses and other scientists to support their points and give weight to their conclusions (Sheward, et al. 2005). While the authors certainly have hypotheses, the literature review is not biased, as the authors are very clear about certain confounding variables and their possible explanation. [177] Methods, Procedures and Ethics. The authors hypothesized that older, partnered nurses with dependants would report a slower recovery time from shift work. They also predicted that nurses working a rotation of different shifts including night duty would be associated with slower recovery and higher fatigue regardless of age. They designed the study using a questionnaire presented to 2,400 Australian nurses in two hospitals, forming an experimental final sample size of 1,280 nurses. The demographic characteristics of the sample were compared to the broader population of nurses working in Australia, and all significant distribution metrics of the sample population were consistent with the broader population (Graves & Simmons 2009). Thus the authors established a 95% confidence level at a P-value of 0.05. The questionnaire was designed using the new Occupational Fatigue Exhaustion Recovery scale (OFER) including its three subscales; Likert response scales of zero to six were used for all questions. The authors strongly defend this methodology for its psychometric characteristics of construct and validity, reporting an alpha coefficient from 0.80 to 0.85 and noting that the scale has been validated as a gender bias-free measurement of fatigue and recovery among many different sample populations; including nurses. The ethical considerations and standards were well addressed by the authors, who were granted approval for the study by the University of South Australia as well as the boards of both hospitals. Anonymity was assured through several methods; the participants were invited into the sample group by a mailer in their paycheck, and a postage-paid envelope was included for their use after they filled out the survey. Accordingly, the participants in the survey were competent to choose to participate, were encouraged to be honest in their responses by the guarantee of anonymity, and demonstrated no vulnerability at all (Lardy 2008). In all respects, the methods, procedures, and ethical constructions of this study were appropriate. [310] Results and Discussion. The results are presented in an organized and efficient way. In some respects, researchers found relationships that they expected to find, e.g., there was a strong positive correlation between a nurse’s age and length of experience in the field. One discovery was counter-intuitive, and ran somewhat opposite of researchers’ expectations; there was a finding with statistical significance that there is a tendency toward better recovery with the advancement of age. The overall results of this study failed to determine that full-time, working nurses who have spouses and children are at a higher risk for recovering from acute work fatigue or from being more prone to develop maladaptive fatigue symptomology than single nurses with no dependents. Researchers suggest that one possible reason for this is a result of the positive aspects of having familial support in buffering the effects of work stress (Davidhizar 2004). The most apparent variable that can increase the likelihood of fatigue or maladaptive symptoms is the work schedule itself. When the schedule varies non-routinely, and particularly when that work schedule involves night duty, nurses—particularly younger and less experienced nurses—are more prone to long-term stress and fatigue. [194] Overall Concerns. Overall I found this study to be relevant, reliable and well-reasoned, and the results useful within the profession. The authors made the article easy to read by using standard sub-headings and presenting tabular and graphical data in an easily-recognizable format. They created a reasonable hypothesis and, when the data did not support a major part of it, they immediately adjusted their methodology to compare other factors and evaluate what the cause of such contraindications might be. It was no surprise to find that older nurses with more experience handle the stress of shift work more readily than younger nurses. It was no real surprise to find that multiple shifts that include night duty increase the stress for nurses. It was however, somewhat surprising to find that the older nurses were less likely to have maladjusted health symptoms and that nurses with spouses and children tended to fare better that single nurses. [153] References Akerstedt T., Fredlund P., Gillberg M. & Jansson B. (2002) Workload and work hours in relation to disturbed sleep and fatigue in a large representative sample. Journal of Psychosomatic Research, 53, 1, 585–588 Davidhizar R. (2004) The change in values that drives the nursing shortage. Journal of Practical Nursing, 54, 1, 14–16 Demerouti, E., Bakker, A.B., Nachreiner, F. & Schaufeli, W.B. (2001) The job demands-resources model of burnout. Journal of Applied Psychology 86, 3, 499–512 Fang J., Kunaviktikul, W., Olson, K., Chontawan, R., & Kaewthummanukul, T. (2008) Factors influencing fatigue in Chinese nurses., Nurs Health Sci., 10, 4, 291-299 Folkard, S. & Tucker, P. (2003) Shift work, safety and productivity. Occupational Medicine (London), 53, 2, 95–101 Graves, K. & Simmons, D. (2009) Reexamining Fatigue: Implications for Nursing Practice, Critical Care Nursing Quarterly, 32, 2, 112-115 Gelinas, L.S. & Loh, D.Y. (2004) The effect of workforce issues on patient safety. Nursing Economics, 22, 5, 266–272 Huibers M.J., Bultmann U., Kasl S.V., Kant I., van Amelsvoort L.G., van Schayck C.P. & Swaen G.M. (2004) Predicting the two-year course of unexplained fatigue and the onset of long-term sickness absence in fatigued employees: results from the Maastricht Cohort Study. Journal of Occupational & Environmental Medicine, 46, 10, 1041–1047 Lardy, S. (2008) Decompress to fight disease. Why stress requires intervention. Adv Nurse Pract., 16, 8, 49-50 Newey, C.A. & Hood, B.M. (2004) Determinants of shift-work adjustment for nursing staff: the critical experience of partners. Journal of Professional Nursing, 20, 3, 187–195 Ross, S.J., Polsky D. & Sochalski J. (2005) Nursing shortages and international nurse migration. International Nursing Review 52, 4, 253–262 Sheward L., Hunt J., Hagen S., Macleod M. & Ball J. (2005) The relationship between UK hospital nurse staffing and emotional exhaustion and job dissatisfaction. Journal of Nursing Management, 13, 1, 51–60 Trossman, S. (2009) Fighting against fatigue. WSNA wants to ensure nurses are well-rested, patients are safe., American Nursing, 41, 1, 7 Tully, A. (2004) Stress, sources of stress and ways of coping among psychiatric nursing students. Journal of Psychiatric and Mental Health Nursing, 11, 43–47 Winwood P.C., Winefield A.H., Dawson D. & Lushington K. (2005) Development and validation of a scale to measure work-related fatigue and recovery: the Occupational Fatigue Exhaustion Recovery scale (OFER). Journal of Occupational and Environmental Medicine, 47, 6, 594–606 Winwood, P.C., Winefield, A.H., Lushington, K. (2006), Work-related fatigue and recovery: the contribution of age, domestic, responsibilities and shift work, Journal of Advanced Nursing, 56, 4, 438-449 Research Critique: Nurses and Family Presence during Resuscitation Knott, A., Kee, C.C. (2005), 'Nurses' beliefs about family presence during resuscitation', Applied Nursing Research, 18, 192-198. Introduction. This is a qualitative article that explores the experiences and feelings of nurses who have been present in acute situations where a patient was being given cardiopulmonary resuscitation while the patient’s family was in the room. The scope was broad in that nurses from ER, cardio units, ICU, neonatal as well as labor and delivery were included in the sample (Agard 2008). The reason this article was chosen is because it explores the personal side of nursing; as a qualitative study, it provides insight into the experiences, beliefs, and emotions of those nurses involved in the population sample, which was the stated aim of the article. [107] Purpose of Study. The study is investigating the feelings, experiences, and beliefs of nurses who have been involved in resuscitation activity where the family of the patient have been present. The conventional wisdom is that it is a bad idea for the family to be in the room during this event as it is stressful, traumatic, and some family members may become hysterical or try to interfere with the medical professionals (Demir 2008). New research, however, seems to be pointing to the possibility that family presence during resuscitation has both therapeutic and clinical value, showing positive effects regardless of patient outcome. [101] Literature Review. The literature review is constructed well, but the majority of sources are not what would be considered recent, even though the names of researchers cited in the article are known in the profession. The article appeared in the 2005 edition and there is one reference to a study performed in 2003; however, the vast majority of references in the literature review section have been written more than five years prior to the publication of this article. Nurses are writing the article under review, and so their credibility is strong; yet the reliance on what could be considered out-dated research is troubling (Moons & Norekval 2008). That said, there is a notation in the article that research on nurses’ opinions regarding these types of acute situations is minimal, and that may account for the “reaching back” to earlier years for the literature review. Nevertheless, I thought the authors could have found some more recent research to bolster their investigation. [160] Methods, Procedures and Ethics. In terms of the methodology, a descriptive qualitative model was chosen to maximize the variation of sampling while retaining a broader, more generalized inquiry in terms of the subject. It should be noted that the nature of qualitative research is such that it does not require conformation to explicit models or particularly grounded theory; the descriptive level of qualitative research allows it to summarize that data which closely resembles the events that participants in the sample present (Knott & Kee 2005). Thus, in this case, participants were given the opportunity to give voice to their feelings about the topic through a somewhat structured, open-ended interview schedule that encouraged the sharing of perceptions, opinions, and insights. As the scope of this research was the perspectives of family presence during cardiac resuscitation, the focus was upon nurses who had been employed in acute care settings who had also either personally observed or participated in resuscitation procedures where the patients’ families were either present or at least available. To broaden the group, researchers also looked to nurses who had experience in a multiplicity of hospital units so that the various work responsibilities of the sample group would provide the most variation possible in terms of the family presence at a resuscitation event. Accordingly, there was no other inclusion criteria used other than the experience and presence of the nurse at the seminal event. In terms of ethics, researchers’ obtained approval to conduct the study from the sponsoring university’s institutional review board, all respondents were professionally acquainted with the primary investigator, and each participant signed an informed consent including an agreement to have the interviews taped. For the sake of accuracy, all interviews were indeed recorded and transcribed verbatim to ensure accuracy and provide a foundation for any subsequent analysis. [300] Results and Discussion. The results are presented clearly and logically. The researchers established four general themes from the interviews; those conditions where family presence is an option, the utilization of the family presence at resuscitation to force a family decision regarding future resuscitation orders, the feeling of the nurses that they were under scrutiny during a very stressful procedure attempting to save a life, and the impact of actually seeing the resuscitation (or attempt at resuscitation) on the family members themselves. Obviously, the first natural concern of medical professionals is that family members do not interfere in the attempt to save a life (Marble & Hurst 2008). Many of the respondents commented on the importance of family members remaining calm, not interfering with any specific procedures, and particularly not creating conditions that required the nurse to divert attention from the patient to having to manage family members. Of all the comments recorded, perhaps the most important was the observation that if the family chose to remain in the room during a resuscitation effort, there should be one member of the staff specifically assigned to “family management” so that those nurses involved in the lifesaving procedures were free to concentrate their attention on that specific task. [205] Overall Concerns. Overall I found this study to be interesting regarding the personal experiences related by the nurses, but the nature of the qualitative collection of data leaves the reader simply feeling as an observer, rather than as a judge of scientific evidence. The authors made the article easy to read by using standard sub-headings and presenting their interview excerpts in a plain format. I think that the results of this study are helpful to the profession as a whole. The one concept I did find most interesting was the notion that some facilities encourage the staff to endure the family presence during a resuscitation attempt in an attempt to demonstrate to the family the traumatic efforts made and secure their agreement to not subject their relative to such extreme measures in the future, e.g., a Do Not Resuscitate (DNR) order. The idea is that if the families see what really happens, they will be less willing to subject their loved one (and the staff) to the rigors of such dramatic—and often unsuccessful—efforts. [175] References Agard, M. (2008) Creating advocates for family presence during resuscitation. Medsurg Nurs., 17, 3, 155-160 Cottle, E.M., & James, J.E. Role of the family support person during resuscitation. Nursing Standard, 23, 9, 43-47 Dalio, A.M. (2008) Family presence during cardiopulmonary resuscitation. American Journal of Critical Care, 17, 4, 310-311 Demir, F. (2008) Presence of patients' families during cardiopulmonary resuscitation: physicians' and nurses' opinions. Journal of Advanced Nursing, 63, 4, 409-416 Dudley, N.C., Hansen, K.W., Furnival, R.A., Donaldson, A.E., Wagenen, K.L., & Scaife, E.R. (2008) The Effect of Family Presence on the Efficiency of Pediatric Trauma Resuscitations. Annapolis Emergency Medicine, 11, 13, 215-230 Engelhardt, E. (2008) Family presence during resuscitation. Journal of Continuing Education Nursing, 39, 12, 530-531 Fallis, W.M., McClement, S., & Pereira, A. (2008) Family presence during resuscitation: a survey of Canadian critical care nurses' practices and perceptions. Dynamics, 19, 3, 22-28. Grudzen, C.R., Koenig, W.J., Hoffman, J.R., Boscardin, W.J., Lorenz, K.A., & Asch, S.M. (2009) Potential Impact of a Verbal Prehospital DNR Policy. Prehosp Emerg Care, 13, 2, 169-172 Hill, R., & Fuhrman, C. (2008) Presence of family members during resuscitation. Ann Emerg Med., 52, 3, 309-310 Knott, A., Kee, C.C. (2005), 'Nurses' beliefs about family presence during resuscitation', Applied Nursing Research, 18, 192-198 Marble, S.G., & Hurst, S. (2008) Innovative solutions: family presence at codes: a protocol for an oncology unit. Dimens Critical Care Nursing, 27, 5, 218-222 Maxton, F.J. (2008) Parental presence during resuscitation in the PICU: the parents' experience. Sharing and surviving the resuscitation: a phenomenological study. Journal of Clinical Nursing, 17, 23, 3168-3176 Moons, P., & Norekval, T.M. (2008) European nursing organizations stand up for family presence during cardiopulmonary resuscitation: a joint position statement. Progressive Cardiovascular Nursing, 23, 3, 136-139 Quest, T. (2008) Precious last moments: family presence during resuscitation. Medscape Journal of Medicine, 10, 10, 230 Tinsley, C., Hill, J.B., Shah, J., Zimmerman, G., Wilson, M., Freier, K., & Abd-Allah, S. (2008) Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics, 122, 4, e799-804 Zakaria, M., & Siddique, M. (2008) Presence of family members during cardio-pulmonary resuscitation after necessary amendments. J Pak Med Assoc., 58, 11, 632-635 Read More