ABSTRACT
BACKGROUND: Nurses who work at night have used naps to alleviate their sleepiness and fatigue. Research has shown night shifts, sleepiness, and fatigue predict nurses' missed workdays. Thus, nighttime napping may have a beneficial consequence of reducing nurses' sickness absences. The purpose of this brief report was to describe the difference in rates of short-term sickness absence before and after implementation of a 30-min nap opportunity in one U.S. hospital for 12-hr shift nurses. METHODS: The study was a retrospective pre-post evaluation design. Eight units provided nap opportunities for the nurses. Full-time nurses were classified into night and rotating shifts based on their 2 years of scheduling patterns. Absence data were extracted from the hospital's timekeeping system and annual absence rates were computed. A single linear mixed model with rank transformed data was conducted for each group. Median estimates, minimum and maximum, and p-values were reported. FINDINGS: The median absence rates for night shift nurses were 4.3% and 4.0% for the pre-napping and post-napping implementation periods, respectively; however, this difference was not statistically significant (p = .241). The median absence rates for rotating shift nurses were 2.0% and 3.9% for the pre-napping and post-napping implementation periods, respectively; and the difference increase was statistically significant (p < .001). CONCLUSION/APPLICATION TO PRACTICE: A nap policy which provides nurses with the opportunity to take nighttime naps did not benefit their sickness absence rates. Future research needs to examine the actual napping process on sickness absences, as well as explore other sickness management avenues.
Subject(s)
Nurses , Sleep , Humans , Sleepiness , Retrospective Studies , Work Schedule Tolerance , Fatigue/prevention & controlABSTRACT
Northern and Southern Raglai are two closely related Austronesian dialects (Chamic branch) spoken in south-central Vietnam. Although they are mutually intelligible, Northern Raglai is described as having a voicing contrast in onset stops, while Southern Raglai is assumed to have replaced the Chamic voicing contrast with a register contrast realized on the whole syllable (but primarily on its vowel). A production study of the two dialects confirms that Northern Raglai preserves a voicing contrast, even if most women exhibit partial devoicing of their voiced stops, and that Southern Raglai has developed a register contrast based on F1 and phonation cues at the beginning of vowels. The weights of the acoustic properties of voicing and register are similar across ages and genders, suggesting that the two laryngeal contrasts are phonetically stable. Even if there is little evidence of change in progress, a close inspection of the Northern Raglai voicing contrast reveals voicing-conditioned modulations of F1 and perturbations of phonation after partially devoiced stops that could be precursors of a register system similar to that of Southern Raglai. We argue that this is a pathway to registrogenesis and speculate about the articulatory laryngeal mechanisms that could trigger registrogenetic changes. Our data also show that the Northern Raglai voicing contrast is unstable in aspirated stops and that voiced aspirated stops typically have a partially voiceless and partially voiced aspiration.
Subject(s)
Phonetics , Voice , Cues , Female , Humans , Language , Male , PhonationABSTRACT
Although clinical nurses' involvement in research is a role expectation, efforts to engage clinical nurses in nurse-led research have had notably mixed results. These efforts have most typically been single discipline-focused (nursing), although nursing care is a collaborative, interdisciplinary practice. Adding an interdisciplinary strategy to multiple other efforts to engage clinical nurses in research may contribute to more nurse involvement. Here, we describe the use of a hospital-based endowed chair in nursing research to simultaneously engage nursing and other disciplines in a monthly dialogue about clinically relevant, research-related challenges and solutions. Outcomes indicate that the research-related dialogue among nurses and interprofessional colleagues would likely not have taken place without this approach.
Subject(s)
Nurses , Nursing Research , Communication , Hospitals , HumansABSTRACT
ABSTRACT: For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.
Subject(s)
Fatigue/epidemiology , Fatigue/prevention & control , Nurses/psychology , COVID-19/nursing , Humans , Workforce/statistics & numerical data , Workplace/organization & administration , Workplace/psychologyABSTRACT
BACKGROUND: Sleepiness during the night shift is associated with errors, accidents, injuries, and drowsy driving. Despite scientific evidence that supports brief naps to reduce sleepiness, and guidance documents from policy organizations, napping has not been widely implemented. METHODS: An initiative to translate scientific evidence about napping was implemented in one hospital over one year. The initiative included garnering leadership support and resources, building a translation team, evaluating the evidence, responding to operational concerns, developing an implementation strategy, and then implementing and evaluating the results. Night shift nurses were surveyed pre and post nap implementation for drowsy driving, sleepiness, and work and coworker relationships. Qualitative data documented the nurses' perceptions about napping. FINDINGS: Three-fourths of the units that were eligible to nap successfully implemented and sustained napping. Most nurses felt refreshed by a brief nap and felt safer on the drive home, but one-fourth worried about or had sleep inertia symptoms. Drowsy driving remained unacceptably high. CONCLUSION: The initiative was successfully implemented on most nursing units. The mixed reaction to napping, and the unfavorable drowsy driving outcome point to the need for additional interventions to reduce sleepiness.
Subject(s)
Nursing Staff, Hospital , Sleep , Work Schedule Tolerance , Automobile Driving , Hospital Administration , Humans , Nurses , Shift Work Schedule/adverse effects , Sleepiness , Surveys and QuestionnairesABSTRACT
Preventive measures range from napping to installing driver monitoring systems in cars.
Subject(s)
Accidents, Traffic/prevention & control , Automobile Driving , Nurses/statistics & numerical data , Sleep Deprivation , Work Schedule Tolerance , Adult , Female , Humans , Male , SleepABSTRACT
Nurses are at risk for work-related fatigue, which can impact their health, well-being, and job readiness. The purpose of this study was to examine the levels, types, and factors associated with fatigue in registered nurses (RNs) in direct patient care (DCRNs) and in non-direct patient care (non-DCRNs) roles. A cross-sectional survey was administered to 313 RNs. Measures included: Multidimensional Fatigue Symptom Inventory, Occupational Fatigue Exhaustion Recovery, Brief COPE, PROMIS® Global Sleep Disturbance, and Job Content Questionnaire. Acute fatigue levels in RNs were similar to those in diseased populations, and nearly 50% reported moderate/high levels of chronic fatigue. DCRNs reported higher levels of acute and chronic fatigue than non-DCRNs, but the differences were small and disappeared when accounting for other factors associated with fatigue including sleep disturbance, job strain, workplace support, maladaptive coping, and especially intershift recovery, which accounted for 20%-41% of fatigue variability. This study suggests that it may not be only nurses providing direct patient care who are at risk for acute and chronic fatigue. Intershift recovery may be particularly important in alleviating acute and chronic fatigue in nurses.
Subject(s)
Adaptation, Psychological , Fatigue , Nurses/psychology , Nursing Staff, Hospital/psychology , Occupational Stress/psychology , Adult , Chronic Disease , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Patient Care , Safety , Sleep , Surveys and Questionnaires , WorkplaceABSTRACT
Objectives Fatigue, a common complaint in workers, has been related to sickness absence (SA). The purpose of this systematic review and meta-analysis was to determine the prospective association between fatigue and SA in the working population. Methods An electronic literature search was conducted in five databases: PubMed, Embase, CINAHL, Psyc-INFO and Cochrane CENTRAL. Longitudinal studies were selected that focused on fatigue and future SA in workers. Random-effects meta-analyses were conducted and pooled estimates [95% confidence intervals (CI)] were obtained for the association between fatigue and risk of long-term SA in total and by sex. Heterogeneity was assessed by I 2statistics. Results Of the 16 included studies in the review, 14 provided supportive evidence for an association between fatigue and SA. The meta-analysis of 9 studies (provided 15 estimates) that were mostly of high quality showed that baseline fatigue increased the risk of long-term SA by 35% (95%CI 1.23-1.47) in workers. Heterogeneity was low-moderate (I 2=40%). The pooled estimates for an increased risk for long-term SA were 35% (95% CI 1.18-1.54) in fatigued men and 22% (95% CI 0.93-1.60) in fatigued women however this relationship was not statistically significant. Conclusion There is conclusive evidence for the prospective association between worker fatigue and long-term SA. Whereas most studies in the review measured chronic fatigue and long-term SA, there was insufficient data for the meta-analysis to draw conclusions on fatigue type. Future research is needed in this area as well as greater exploration of fatigue and long-term SA in women.
Subject(s)
Absenteeism , Fatigue/epidemiology , Workplace/statistics & numerical data , Global Health , Humans , Longitudinal Studies , Occupational Health , Quality of Life , Risk Factors , Sex Factors , Sleep/physiologyABSTRACT
This study examined the associations between bio-mathematical fatigue-risk scores and sickness absence (SA) in hospital nurses over 18 months. Work schedules and SA data were extracted from the hospital's attendance system. Fatigue-risk scores were generated for work days using the Fatigue Audit InterDyne (FAID) and Fatigue Risk Index (FRI). Over the study period, 5.4% of the shifts were absence shifts. FAID-fatigue ranged from 7 to 154; scores for a standard 9-5 work schedule can range from 7 to 40. Nurses with high FAID-scores were more likely to be absent from work when compared to standard FAID-scores (41-79, ORâ¯=â¯1.38, 95%CIâ¯=â¯1.21-1.58; 80-99, ORâ¯=â¯1.63, 95%CIâ¯=â¯1.37-1.94 andâ¯≥â¯100, ORâ¯=â¯1.73, 95%CIâ¯=â¯1.40-2.13). FRI-fatigue ranged from 0.9 to 76.8. When FRI-scores were >60, nurses were at 1.58 times (95%CIâ¯=â¯1.05-2.37) at increased odds for SA compared to scores in the 0.9-20 category. Nurse leaders can use these decision-support models to adjust high-risk schedules or the number of staff needed to cover anticipated absences from work.
Subject(s)
Fatigue/diagnosis , Models, Biological , Nursing Staff, Hospital/statistics & numerical data , Sick Leave/statistics & numerical data , Absenteeism , Decision Support Techniques , Forecasting , Humans , Nursing Staff, Hospital/organization & administration , Personnel Staffing and Scheduling , Rest , Retrospective Studies , Risk Assessment , Sleep , Time Factors , Transportation , WorkloadABSTRACT
BACKGROUND: The optimal performance of nurses in healthcare settings plays a critical role in care quality and patient safety. Despite this importance, few measures are provided in the literature that evaluate nursing performance as an independent construct from competencies. The nine-item Nursing Performance Instrument (NPI) was developed to fill this gap. PURPOSE: The aim of this study was to examine and confirm the underlying factor structure of the NPI in registered nurses. METHOD: The design was cross-sectional, using secondary data collected between February 2008 and April 2009 for the "Fatigue in Nursing Survey" (N = 797). The sample was predominantly dayshift female nurses working in acute care settings. Using Mplus software, exploratory and confirmatory factor analyses were applied to the NPI data, which were divided into two equal subsamples. Multiple fit indices were used to evaluate the fit of the alternative models. RESULTS: The three-factor model was determined to fit the data adequately. The factors that were labeled as "physical/mental decrements," "consistent practice," and "behavioral change" were moderately to strongly intercorrelated, indicating good convergent validity. The reliability coefficients for the subscales were acceptable. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The NPI consists of three latent constructs. This instrument has the potentialto be used as a self-monitoring instrument that addressesnurses' perceptions of performance while providing patient care.
Subject(s)
Nursing Care/standards , Nursing Staff/psychology , Surveys and Questionnaires , Work Performance , Adult , Cross-Sectional Studies , Factor Analysis, Statistical , Fatigue , Female , Humans , Male , Middle Aged , Nursing Evaluation Research , Nursing Staff/statistics & numerical data , Reproducibility of ResultsABSTRACT
AIMS: To examine the relationship between fatigue and sickness absence in nurses from a paediatric hospital over 12 months of follow-up. A secondary aim was to identify other work and personal factors that predict sickness absence. BACKGROUND: Sickness absence is often related to worker-fatigue, yet few studies have explored this relationship in nurses despite documented high fatigue levels. DESIGN: The study used retrospective cohort design. METHODS: Baseline data on 40 nurses from an intervention study were linked to absence data using the hospital's attendance records (2012-2013). A total of 6,057 work shifts were studied of which 5.2% were absence episodes. Fatigue was measured by the Occupational Fatigue Exhaustion Recovery scale. The questionnaire included instruments assessing sleep disturbances, workload and personal characteristics. Generalized linear mixed models were used to test the associations between fatigue, work, personal factors and sickness absence, while accounting for non-independency of repeated measures. RESULTS: With 1SD increase in acute fatigue scores, nurses were 1.29 times more likely to be absent from work. Factors such as intershift recovery, perceived workload, obstructive sleep apnoea and marital status also predicted sickness absence, that is, with 1SD increase in workload scores, nurses were 1.23 times more likely to be absent from work. Nurses with obstructive sleep apnoea had two times higher odds of sickness absence. CONCLUSION: Sickness absence is related to acute fatigue in paediatric nurses and to workload. Nursing leaders can monitor these factors to reduce sickness absence and screen for sleep apnoea and assist nurses in receiving the appropriate treatments.
Subject(s)
Absenteeism , Fatigue , Nursing Staff , Pediatric Nursing , Sick Leave , Acute Disease , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Occupational Stress , Retrospective Studies , Workforce , Young AdultABSTRACT
Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses' practice that should be monitored by nursing management.
Subject(s)
Fatigue/psychology , Nursing Staff, Hospital , Personnel Staffing and Scheduling , Work Performance/standards , Workload/psychology , Adult , Cross-Sectional Studies , Fatigue/classification , Female , Humans , Male , Middle Aged , Occupational Diseases/psychology , Sleep/physiology , Surveys and Questionnaires , Work Schedule Tolerance , Young AdultABSTRACT
Throughout the industrialized world, nearly one in five employees works some form of nontraditional shift. Such shift work is associated with numerous negative health consequences, ranging from cognitive complaints to cancer, as well as diminished quality of life. Furthermore, a substantial percentage of shift workers develop shift work disorder, a circadian rhythm sleep disorder characterized by excessive sleepiness, insomnia, or both as a result of shift work. In addition to adverse health consequences and diminished quality of life at the individual level, shift work disorder incurs significant costs to employers through diminished workplace performance and increased accidents and errors. Nonetheless, shift work will remain a vital component of the modern economy. This article reviews seminal and recent literature regarding shift work, with an eye toward real-world application in clinical and organizational settings.
Subject(s)
Fatigue , Occupational Health , Sleep Disorders, Circadian Rhythm/physiopathology , Workplace , Age Factors , Humans , Risk Management , Sex Factors , Sleep Disorders, Circadian Rhythm/epidemiology , Sleep Disorders, Circadian Rhythm/therapyABSTRACT
PURPOSE: Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric forms measure symptoms and function of pediatric patients experiencing chronic disease by using the same measures. Comparability is one of the most important purposes of the PROMIS initiative. This study aimed to test the factorial structures of four symptom measures (i.e., Anxiety, Depression, Fatigue, and Pain Interference) in the original English and the Chinese versions and examine the measurement invariance of the measures across two cultures. METHODS: Four PROMIS Pediatric measures were used to assess symptoms, respectively, in Chinese (n = 232) and American (n = 200) children and adolescents (8-17 years old) in treatment for cancer or in survivorship. The categorical confirmatory factor analysis (CCFA) model was used to examine factorial structures, and multigroup CCFA was applied to test measurement invariance of these measures between the Chinese and American samples. RESULTS: The CCFA models of the four PROMIS Pediatric symptom measures fit the data well for both the Chinese and American children and adolescents. Minor partial measurement invariance was identified. Factor means and factor variances of the four PROMIS measures were not significantly different between the two populations. CONCLUSIONS: Our results provide evidence that the four PROMIS Pediatric symptom measures have valid factorial structures and a statistical property of measurement invariance across American and Chinese children and adolescents with cancer. This means that the items of these measures were interpreted in a conceptually similar manner by two groups. They could be readily used for meaningful cross-cultural comparisons involving pediatric oncology patients in these two countries.
Subject(s)
Cross-Cultural Comparison , Neoplasms/ethnology , Quality of Life/psychology , Adolescent , Asian People , Child , Ethnicity , Humans , Male , Neoplasms/therapy , Patient Reported Outcome Measures , Self Report , United StatesABSTRACT
A web-based questionnaire was used to assess the utility of constructs from the Theory of Planned Behavior (TPB) and the Prototype Willingness Model (PWM) to predict intentions and willingness to engage in drowsy driving in a sample of 450 university students. Those students who reported more favorable attitudes and subjective norm and greater perceived control and willingness in relation to drowsy driving behavior were more likely to report stronger intentions to engage in drowsy driving behavior. Augmenting the TPB constructs with the PWM construct of willingness significantly explained up to an additional 8 percent of the variance in drowsy driving intention. Perceived behavioral control and willingness were consistently the strongest predictors of drowsy driving intention in the augmented model, which together with the control (personal) variables explained up to 70 percent of the variance in intention. Thus, the Theory of Planned Behavior and the Prototype Willingness Model may be useful for understanding motivational influences on drowsy driving behavior in young people and present promising theoretical frameworks for designing more effective interventions against drowsy driving in this population.
Subject(s)
Attitude , Automobile Driving/psychology , Intention , Planning Techniques , Risk-Taking , Students/psychology , Female , Humans , Motivation , Perception , Surveys and Questionnaires , UniversitiesABSTRACT
UNLABELLED: : BACKGROUND: Nurses who work the night shift often experience high levels of sleepiness. Napping has been adopted as an effective countermeasure to sleepiness and fatigue in other safety-sensitive industries, but has not had widespread acceptance in nursing. PURPOSE: To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps. METHODS: In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units for which the executive nursing leadership had given approval. Unit nurse managers' approval was sought, and where granted, further explanation was given to the unit's staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period. RESULTS: Successful implementation occurred on only one of the six units, with partial success seen on a second unit. Barriers primarily occurred at the point of seeking the unit nurse managers' approval. On the successful unit, 153 30-minutes naps were taken during the study period. A high level of sleepiness was present at the beginning of 44% of the naps. For more than half the naps, nurses reported achieving either light (43%) or deep (14%) sleep. Sleep inertia was rare. The average score of helpfulness of napping was high (7.3 on a 1-to-10 scale). Nurses who napped reported being less drowsy while driving home after their shift. CONCLUSION: These data suggest that when barriers to napping are overcome, napping on the night shift is feasible and can reduce nurses' workplace sleepiness and drowsy driving on the way home. Addressing nurse managers' perceptions of and concerns about napping may be essential to successful implementation.
Subject(s)
Sleep Deprivation , Work Schedule Tolerance , Canada , Education, Nursing, Continuing , Humans , Pilot ProjectsABSTRACT
Workplace violence is an enormous problem worldwide; incidents where the perpetrator is a current or former employee are an important dimension. This large cross-sectional survey examined the prevalence of this problem among a U.S. state government unionized public sector workforce. Using participatory action research methods, we conducted a web-based survey of members of that workforce from a single northeast U.S. state, receiving 11,874 completed surveys (response rate: 71.8%). Overall, 10.0% of the respondents indicated that they had been bullied at work during the prior 6 months, with 71.9% of those who reported regular bullying identifying the perpetrator as a supervisor and/or top management. The prevalence of bullying was similar to the rates reported in Europe and Scandinavia (5%-30%). Those reports also identified the person(s) responsible for the behavior as being predominantly of higher status within the organization.
Subject(s)
Bullying/statistics & numerical data , Crime Victims/psychology , Interpersonal Relations , Labor Unions , Occupational Diseases/psychology , Workplace Violence/psychology , Adult , Crime Victims/statistics & numerical data , Female , Humans , Job Satisfaction , Male , Middle Aged , Occupational Diseases/epidemiology , Prevalence , Surveys and Questionnaires , United States/epidemiology , Workplace Violence/statistics & numerical data , Young AdultABSTRACT
BACKGROUND: Many patients with chronic obstructive pulmonary disease (COPD) suffer from poor sleep quality. We hypothesized that poor sleep quality in otherwise stable patients predicted exacerbations in these patients. METHODS: This is a secondary analysis of the results of a previously published randomized trial of azithromycin in 1,117 patients with moderate to severe COPD who were clinically stable on enrollment. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Other quality of life indices included the Medical Outcome Study 36-item Short Form Health Survey and the St Georges Respiratory Questionnaire. Outcomes included time to first exacerbation and exacerbation rate. RESULTS: Sleep quality was "poor" (Pittsburgh Sleep Quality Index >5) in 53% of participants but was not related to age or severity of airflow obstruction. Quality of life scores were worse in "poor" sleepers than in "good" sleepers. Major classes of comorbid conditions, including psychiatric, neurologic, and musculoskeletal disease, were more prevalent in the "poor" sleepers. Unadjusted time to first exacerbation was shorter (190 versus 239 days) and exacerbation rate (1.7 versus 1.37 per year) was greater in the poor sleepers, but no differences were observed after adjusting for medications and comorbid conditions associated with poor sleep. CONCLUSION: Poor sleepers had greater exacerbation rates than did good sleepers. This appeared to be due largely to them having more, or more severe, concomitant medical conditions and taking more medications.
Subject(s)
Pulmonary Disease, Chronic Obstructive/complications , Self Report , Sleep Wake Disorders/etiology , Sleep , Acute Disease , Aged , Comorbidity , Disease Progression , Humans , Middle Aged , Polypharmacy , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/psychology , Quality of Life , Risk Factors , Severity of Illness Index , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/physiopathology , Sleep Wake Disorders/psychology , Time FactorsABSTRACT
Cognitive behavioral therapy for insomnia (CBT-I) is effective for treatment of primary insomnia. There has been no synthesis of studies quantifying this effect on insomnia comorbid with medical and psychiatric disorders using rigorous selection criteria. The objective of this study was to quantify the effect of CBT-I in studies including patients with medical or psychiatric disorders. Studies were identified from 1985 through February 2014 using multiple databases and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I in adult patients with insomnia diagnosed using standardized criteria, who additionally had a comorbid medical or psychiatric condition. Twenty-three studies including 1379 patients met inclusion criteria. Based on weighted mean differences, CBT-I improved subjective sleep quality post-treatment, with large treatment effects for the insomnia severity index and Pittsburgh sleep quality index. Sleep diaries showed a 20 min reduction in sleep onset latency and wake after sleep onset, 17 min improvement in total sleep time, and 9% improvement in sleep efficiency post-treatment, similar to findings of meta-analyses of CBT-I in older adults. Treatment effects were durable up to 18 mo. Results of actigraphy were similar to but of smaller magnitude than subjective measures. CBT-I is an effective, durable treatment for comorbid insomnia.
Subject(s)
Cognitive Behavioral Therapy , Sleep Initiation and Maintenance Disorders/therapy , Adult , Comorbidity , Female , Humans , Male , Mental Disorders/epidemiology , Middle Aged , Sleep Initiation and Maintenance Disorders/epidemiology , Treatment OutcomeABSTRACT
OBJECTIVES: To gain a better understanding of the state-by-state differences in allowable delegated activities for Certified Nurse Aides (CNAs) working in long-term care settings, this exploratory descriptive study assessed what are the allowable tasks for CNAs based on findings from each state board of nursing. Specifically, findings from each state determined whether the care tasks allowed were consistent with those delineated by the 42 CFR § 483. DESIGN: This descriptive study included data drawn from all 50 states' regulatory offices or health care services agencies. Data were obtained from the regulations listed on each state's board of nursing, department of health, department of aging, department of health professions, department of commerce, and office of long-term care, among like agencies. MEASURES: The Code of Federal regulations (42 CFR § 483) listed 9 tasks that are allowable by each state. These tasks are identified as items 1 to 9: (1) personal care skills, (2) safety/emergency procedures, (3) basic nursing skills, (4) infection control, (5) communication and interpersonal skills, (6) care of cognitively impaired residents, (7) basic restorative care, (8) mental health and social service needs, and (9) residents' rights. RESULTS: Nine tasks delineated in the 42 CFR § 483 were identified as allowable in each state. On data analysis, it was found that 11 states noted that CNAs were able to perform workplace tasks that could be considered "expanded" care tasks, tasks beyond the basic care tasks listed in the 42 CFR § 483. CONCLUSIONS: Findings from this exploratory study aid in limiting the confusion around the application of workplace duties across states, providing a useful description of the care tasks CNAs are allowed to perform in an attempt to find uniformity state-by-state. Overall, states reported considering expanding the scope of practice or authorized duties for CNAs to strengthen patient care and safety. States may choose to expand CNA authorized duties so as to equip CNAs with specific training so that the CNA is able to provide a certain level of care when or if he or she is needed to do so. Without uniformity of CNA authorized duties, it is difficult to interpret whether expanding the scope of the CNA can result in outcomes such as improved patient care. State regulations vary and there were state boards of nursing that were not sure about the true extent of CNA workplace responsibilities.