Thursday, August 11, 2016

Professor Amany Farag, PhD, RN, recently learned that her proposed research project, which is titled “Keeping Patients Safe: Examining Predictors of Nurses’ Fatigue and the Moderating Effect of Inter-Shift Recovery on Patient Safety Outcomes,” has been selected for funding by a regulatory excellence grant from the National Council of State Boards of Nursing.

During this two-year, multisite study, Dr. Farag and her research team are expecting to learn more about personal and work-related factors placing nurses at high risk for fatigue; fatigue pattern over time, including variation of fatigue within and between nurses during work and non-work days; and, measures used by nurses to manage their work related fatigue.

A brief synopsis of the project is as follows:

“Long working hours coupled with intense physical and mental demands in a complex rapidly changing work environment, have subjected hospital nurses to substantial fatigue. Fatigue is a multi-causal and multidimensional phenomenon that can be aggravated by high work demands and poor inter-shift recovery. Several studies have linked nurses’ fatigue to work injuries, drowsy driving, medication errors, and poor patient safety outcomes. Although there is growing interest in identifying fatigue predictors; other than long working hours, rotating shifts (shift pattern), and poor sleep quality, there is limited empirical evidence about work environment and personal factors contributing to nurses’ fatigue. Furthermore, there is limited information about measures used by nurses to recover in-between shifts (inter-shift recovery). Whereas other industries such as aviation and commercial truck driving have investigated fatigue and its impact on their shift workers, and accordingly regulated working hours; nursing is lagging behind.”

As a health systems researcher, Dr. Farag has an inherent interest in safety and quality in health care. One of her research areas focuses on understanding human and system factors contributing to medication errors. As she searched through existing literature she came across the issue of nurses’ fatigue.

“Studies show that extended work hours alters nurses’ cognition and vigilance and places them at a greater risk for harming their patients (e.g., mediation errors) and themselves (e.g., drowsy driving). Shift work was the main predictor that was repeatedly listed in the literature,” noted Dr. Amany. “There was limited evidence about other factors that could increase nurses’ risk of work related fatigue and about the relationship between fatigue and medication errors. Going over the literature made me very intrigued about this area of research and left me with a lot of unanswered questions, so I decided to start this study.”

The research team collaborating with Dr. Farag includes fellow UI College of Nursing faculty members Patricia Groves PhD, RN, and Toni Tripp-Reimer, PhD, RN, FAAN, who is serving as a consultant; Sharon Tucker, PhD, RN, FAAN, director of nursing research and evidence-based practice & quality at UIHC; Linda Scott, PhD, RN, FAAN, professor and dean, School of Nursing at the University of Wisconsin-Madison; and study statistician Yelena Perkhounkova, PhD.

“I consider this study as my starting point to help me determine a ‘fatigue diagnostic’ – an initial assessment step that could provide me with the big picture about personal and organizational factors contributing to nurses’ fatigue,” explains Farag. “The study results will help me move forward to develop and pilot test an intervention or toolkit that can be used by nurses at home and/or work to manage their fatigue. Because fatigue has both personal and work-related component, I will be also targeting hospital administrators with work related intervention(s) that could be implemented at the work settings.”

Dr. Farag added that although the focus of this study is on nurses and their related fatigue, she hopes to translate her proposed intervention to other care providers and compare its effectiveness. In the future steps, she plans to collaborate with researchers from other industries such as human factors engineering, ergonomics, occupational health, sleep medicine, and other segments as she moves forward.

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