Question

SAFETY/ QUALITY IMPROVEMENT ISSUE: FATIGUE AMONG NURSES

All work in healthcare can be evaluated using different process analysis tools.

Examine the selected improvement issue (FATIGUE AMONG NURSES) using one of the process tools.

Give reasons for your selection of the particular tool.

Create a diagram for the process tool with as much detail as possible. (You may create the diagram in the word processor, in a graphics software, or scan a hand-drawn image.)

Provide conclusions on the use of the process tool, including redundancies, misunderstandings, or inefficiencies in current systems and possible actions to consider.

INCLUDE REFERENCE

Answer 1

Compassion fatigue is a concept originally coined in the healthcare arena. Compassion fatigue has been noted to involve emotional, physical, and spiritual weariness or exhaustion related to chronic or prolonged exposure to trauma (emotional upset) or difficult situations and/or the continuous offering or giving of self. Few healthcare organizations acknowledge, discuss, or provide interventions for assisting with compassion fatigue. Yet, it is an important concept due to its individual, professional, and financial costs.

Nurses are considered caring, compassionate professionals. Individuals, families, and entire communities seek nurses for support, healing, and encouragement during times of physical, emotional, and spiritual anguish. A nurse's innate capacity to nurture and embrace another's suffering as if it is his or her own can be conceptualized as compassion. But with the continuous giving of oneself, nurses are at risk for developing compassion fatigue. As nurses, we cannot give if we are fatigued and worn. Nurses and healthcare organizations must first clearly and comprehensively understand the concept of compassion fatigue to recognize when they are at risk or experiencing signs and symptoms of compassion fatigue. They also will be able to identify compassion fatigue and be in a position to offer support. Through having an understanding of the concept, organizations and individuals can develop interventions tailored to their particular situations that reduce compassion fatigue and allow them to continue giving and providing excellent care.The purpose of this article is to analyze and define compassion fatigue, provide information on how to identify it, as well as offer potential protective mechanisms and alternatives to deal with compassion fatigue at the organizational level and from a Christian perspective.

Many nurses and nursing students express tiredness, mental exhaustion and emotional exhaustion, at least in my nursing, academic and teaching experiences. Compassion fatigue is considered an outcome of poorly handled stressful situations in which nurses may respond with self-harming behaviours like substance use. Evidence in this area is critically lacking.

Nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Longer shifts are detrimental to the wellbeing of nurses, care of clients and staff turnover. Longer shifts and simply doing shift-work increases the chances for nurses’: poor performance, obesity, chronic diseases, and injuries.

Nurses who are fatigued place other people at risk of harm during their commute to and from their nursing shift. It should also not be overlooked that nurses’ fatigue places clients at risk of harm from fatigue-related errors. Sleep must be made a priority by employers (when rostering) and nurses (in their personal lives). Nurses are more likely to experience decision regret if they are fatigued, lack adequate sleep and are not able to recover well between shifts. (Decision regret is described as being a ‘negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome.’)

Fatigue can also present as compassion fatigue: when a person is fatigued/exhausted to the point where they cannot properly take part in caring relationships.

Four key themes regarding compassion fatigue:

• physically feeling worn out;
• emotional symptoms;
• triggers (e.g. feeling overburdened); and,
• measures to overcome or prevent fatigue.

Compassion fatigue has been found to affect nursing performance. Higher rate of chronic fatigue are found amongst nurses that worked on their days off in comparison to the nurses that did not work on their days off. There is better recovery between shifts and less fatigue reported by nurses that claim to feel refreshed after sleeping.

There is lower physical performance amongst nurses that experience acute or chronic fatigue, and furthermore, it was noted that nurses with chronic fatigue considered themselves to be ‘less alert and less able to concentrate when providing patient care’. Both acute and chronic fatigue in nurses was linked to poorer communication.

Much has been written about compassion fatigue but few healthcare organizations acknowledge, discuss, or offer help for it. Understand compassion fatigue and identify unit and organizational interventions. Night-shift nurses were more likely to experience insomnia than nurses that had not worked night shifts. Chronic fatigue was more likely amongst current night-shift nurses; but intriguingly anxiety, depression and sleepiness were not found.

It is suggested that in order to prevent fatigue in nursing, improvements are needed for the individual’s lifestyle, organisational policies, and the workplace culture.