Identification, evaluation and control
of physically demanding patient-handling tasks in an acute care facility
by Linsey M. Barker
Ph.D. Dissertation Abstract, July 2009
Click
Here
to access the full dissertation document
High rates of medical errors are well documented within the healthcare
industry. Nurses, in particular, play a critical role in the quality
and safety of healthcare services. Fatigue is a factor that has been
linked to stress, safety, and performance decrements in numerous work
environments. Within healthcare, however, a comprehensive definition of
fatigue encompassing multiple dimensions has not been considered, but
is warranted since nurses perform tasks consisting of diverse physical
and mental activities. As such, “total fatigue” was examined, as were
interactions between its underlying dimensions and the effects of these
dimensions on performance, in the context of actual and simulated
nursing work.
In a survey study (Chapter 2), registered nurses reported relatively
high levels of mental, physical, and total fatigue, and higher levels
of fatigue were associated with perceived decreases in performance.
Work environment variables, such as work schedule or shift length, were
also related to differences in reported fatigue levels.
An experimental study investigated causal effects of mental and
physical fatigue on mental and physical performance (Chapter 3). Mental
fatigue affected a measure of mental performance, and physical fatigue
had a negative effect on measures of physical and mental performance. A
multidimensional view of fatigue that considers direct and crossover
effects between mental and physical dimensions of fatigue and
performance is relevant when quantifying effects of fatigue on
performance.
A model of the relationships between fatigue dimensions and performance
in nursing was developed using structural equation modeling techniques
(Chapter 4). The model supported the existence of a total fatigue
construct that is directly affected by mental and physical fatigue
levels. The final model also provides quantitative path coefficients
defining the strength of relationships between mental and physical
dimensions of fatigue, total fatigue, and mental and physical
performance.
The current research provides an increased understanding of fatigue
levels in registered nurses across work environments, as well as the
underlying causal mechanisms between dimensions of fatigue and
performance decrements. The findings and the final model can aid in
designing interventions to reduce or eliminate the contributions of
fatigue to the occurrence of medical errors.