A work systems analysis approach to understanding fatigue in hospital nurses.

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.

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 METHODS: Content and frequency analyses were performed on previously unpublished data from an online survey of registered nurses.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.

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.