INTRODUCTION:

A nurse is expected to dedicate a considerable proportion of his/her time and emotional energy for patient care each day. While the nurse training prepares them well forth is role, working so hard can cause exhaustion over time if self-care is not performed. Fatigue is commonly observed in nurses. Every day, during every shift, nurses may experience mental, physical, or spiritual fatigue. Workload, work hours, work structures, and several other factors can indirectly or directly cause and affect safety . Nurse fatigue is a subjective feeling of tiredness

(experienced by nurses) that is physically and mentally penetrative. It ranges from tiredness to exhaustion, creating an unending overall condition that interferes with an individuals’ physical and cognitive ability to function as per the normal capacity. [1] It is multidimensional in both its causes and manifestations; it is influenced by several factors, such as physiological (e.g., circadian rhythms), psychological (e.g., stress, alertness, and sleepiness), behavioural (e.g., work and sleep patterns) and environmental (e.g., work demand) factors. Fatigue often involves a combination of physical (e.g., sleepiness) and psychological (e.g., compassion fatigue and emotional exhaustion) factors. It may significantly interfere with functioning and may persist despite rest periods [2]

Nurses are constantly exposed to the pain and suffering of those in their care. With each patient interaction, the nurse is faced with the patient’s distress and isolation. For a number of nurses, the loss of compassion is an inevitable outcome of these exposures.Such interactions and exposures can be stressful to the nurse over a long period of time. Compassion fatigue, or secondary traumatization, is the final stage in a long period of stress. Secondary traumatization, also known as compassion fatigue, can occur in those who work closely with or study victims of traumatic events. Secondary traumatization is also an occupational risk to professionals who provide direct or indirect patient care. [3]

A comprehensive definition of nurse fatigue is nurse fatigue is a subjective feeling of tiredness (experienced by nurses) that is physically and mentally penetrative. It ranges from tiredness to exhaustion, creating an unrelenting overall condition that interferes with individuals’ physical and cognitive ability to function to their normal capacity. [4] It is multidimensional in both its causes and manifestations; it is influenced by many factors: physiological(e.g.,circadianrhythms),psychological(e.g.,stress,alertness,sleepiness),behavioural (e.g., pattern of work, sleep habits) and environmental (e.g., work demand). Its experience involves some combination of features: physical (e.g., sleepiness) and psychological e.g,compassion fatigue, emotional exhaustion).It may significantly interfere with functioning and may persist despite periods of rest.[5]

METHODOLOGY:

Deals with the methodology adopted to assess the fatigue staff nurses in, Bhilai, C.G. It includes the description of research approach, research design, setting of the study, sample and sampling technique, development of data collection tools, procedure for data collection and plan for data analysis.

PROBLEM STATEMENT:

“A descriptive study to assess the fatigue among the nurses working in hospital area at Shri Shankaracharya Institute of Medical Science Hospital (Bhilai)”

OBJECTIVES:

Ø To assess the level of fatigue among staff nurses.

Ø To find the association between the level of fatigue with selected socio demographic variables.

HYPOTHESIS:

H1- There will be significant association between the fatigues with socio demographic variables at p>0.5

ASSUMPTION

Nurses working in the hospital will be having work related fatigue which affects their pattern of nursing care provided by them.

RESEARCH APPROACH

The research approach used in this study is quantitative Non Experimental research approach.

RESEARCH DESIGN

Non Experimental Descriptive Research Design.

TARGET POPULATION

In this study the target populations are the staff nurses including Nursing In charge and sister and interns in Shri Shankaracharya Institute Of Medical Science Hospital (Bhilai) Chhattisgarh to assess the fatigue level among them

ACCESSIBLE POPULATION

Accessible population refers to the portion of the target population which researcher can access. In this study the accessible populations are staff nurses working in Shri Shankaracharya Institute of Medical Science Hospital (Bhilai, C.G. Bhilai, Chhattisgarh

SETTING OF THE STUDY

The setting for the present study is Shri Shankaracharya Institute Of Medical Science Hospital ,Bhilai, C.G.The selection of this setting is done for the present study on the basis of geographical proximity, feasibility of the study, administrative approval, co-operation and availability of the sample.

SAMPLE AND SAMPLING TECHNIQUE

The sample size included for the study consists of 45 staff nurses of age group 22 to 60 years in Shri Shankaracharya Institute Of Medical Science Hospital (Bhilai C.G. and non probability Convenient sampling technique was used.

SAMPLE SIZE

The sample size for the present study consists of total 45 staff nurses of age group 22 to 60 years working in Shri Shankaracharya Institute Of Medical Science Hospital (Bhilai, C.G.

SAMPLE SELECTION CRITERIA

Exclusion Criteria:

Ø Staff nurses who were absent during the period of data collection

Ø Staff nurses who are unwilling to participate.

Inclusion Criteria:

Ø Staff Nurses who are posted in ICU, OPD, wards and other specialized units of Shri Shankaracharya Institute Of Medical Science Hospital (Bhilai C.G.

Ø Staff nurses who are willing to participate in the program.

Ø Category of staff includes Nursing In charge, Nursing sister and Nursing Intern

TOOL

SECTION A: - Socio demographic data.

SECTION B: - Rating scale to assess the level of fatigue among staff nurses

DESCRIPTION

SECTION A: - Comprises of 10 socio demographic data questions – age, gender, marital status, number of children if married, type of family, working hour, working unit, medical history, any previous experience of fatigue countermeasures feasibility program and if yes, did you use it in your daily routine.

SECTION B: - Comprises of 15 questions related to chronic and acute fatigue and inter shift recovery.

RATING SCALE

OCCUPATIONAL FATIGUE EXHAUSTION RECOVERY (OFER) SCALE.

DATA COLLECTION METHOD

· Formal written permission was taken from, Director of Shri Shankaracharya Institute Of Medical Science Hospital (Bhilai C.G

· Non Probability Convenient sampling of 45 subjects was done.

· The investigator introduces her to the participants and the objectives of the study were explained.

· The informed consent will be obtained from the participants.

· Questionnaires for demographic data and rating scale were administered for data collection.

PLAN FOR DATA ANALYSIS

· Organization of data in master sheet.

· Socio demographic data would be analyzed using descriptive statistics that is frequency and percentage.

· Chi square analysis for association with Socio demographic variables.

ETHICAL CONSIDERATION

For the present study, the investigator took into consideration of ethical issues from, Director of Shri Shankaracharya Institute Of Medical Science Hospital (Bhilai C.G Anonymity of the participant was ensured. Confidentiality of the data was maintained

RESULTS AND DISCUSSION:

Section A (socio demographical variables)

Gender: majority of 40(88%) were belongs to female and 5(12.2%) of the male.

Monthly income: majority80 (80%) were earning between Rs.10,000-15000 and (20%) of them were earning Rs.5000-10,000

Educational qualification: majority 30 (66.6%) were Bsc nursing graduates, 10(22.2%) have completed their GNM Nursing and 5 (12%) of them have completed Post BSC nursing

Resident: majority 84% of them stay in house, 12% stay in hostel and other 4% stay as paying guest

Marital status: 60% (27) majority of staff nurses were married where as 40 %( 18) staff nurses were single

Type of Family: 80% (36) majority of staff nurses were belongs to nuclear family where as 20 %( 9) were belongs to joint family

Section B

TABLE: 1 Showing Level of Fatigue of Nurses N=45

Levels of fatigue	Scores	Frequency	%	Mean	SD
Intershift recovery	15 – 35score	10	22.2	53.6	22.6
Acute fatigue	36 – 70score	20	44.4
Chronic fatigue	71 -105score	15	33.3

The pie graph depicts that 10(22%) of nurses have intershift fatigue, 20 (44%) majority of the nurses have acute fatigue and 15 (33%) of nurses have chronic fatigue

TABLE: 2: Chi square to check Association between the level of fatigue with Selected Socio Demographic Variables. N=45

Sr. NO.

Socio Demographic variables

Intershift recovery

Acute fatigue

Chronic fatigue

Chi-square

Critical value at p>0.05

Inference

Age :-

a) 22-30 year

b) 31-40 year

c) 41-50 year

d) 51-60 year

4.5

7.85

N/S

Gender:

a) Male

b) Female

0.0062

3.84

N/S

Marital status:-

a) Single

b) Married

1.9

3.84

N/S

Number of children:

a) None

b) One

c) Two

d) More than two

2.05

5.99

N/S

Type of family:-

a) Nuclear

b) Joint

0.68

3.84

N/S

Working hour:-

a) Less than 8 hours

b) 8 hours

c) More than 8 hours

N/S

Working unit:-

a) ICU

b) Other specialized unit

c) Wards

d) OPD

2.25

5.99

N/S

Medical history:

a) No specific illness

b) Physical illness

c) Psychological illness

1.69

3.84

N/S

There was no significant association between level of fatigue and the socio demographical variables

CONCLUSION:

The objective was to assess the level of fatigue among staff nurses. According to Table.1depicts In overall analysis of level of fatigue among staff nurses was10(22%) of nurses have intershift fatigue, 20 (44%) majority of the nurses have acute fatigue and 15 (33%) of nurses have chronic fatigue. There was no significant association between level of fatigue and the socio demographical variables.The findings of the study have several implication in the following fields for nursing practice, nursing administration ,nursing education and nursing research .The study can be replicated on larger samples in different settings to have a wider applicability by generalization.

LIMITATIONS:

The result of this study are limited by use of Winwood et al’Occupational Fatigue Exhaustion /Recovery Scale. The sample size was relatively small.The study was limited only to one hospital. Convenient sampling was used and the results cannot be generalized beyond the nurses participating in the study.

RECOMMENDATIONS:

It can be applied to a larger sample for a wide detailed inference.A similar study can be done to assess the fatigue level among teaching faculty.A comparative study can be done to assess the fatigue level among staff nurses between government and private hospital.The similar study can be done to assess the fatigue level among communityhealth workers.

IMPLICATIONS:

The implications drawn from the present study can be applied in nursing practice, education, administration and research as it may help to reduce the fatigue among staff nurses and provide better quality based competent nursing care.

Nursing Practice

Provide proper working environment to staff nurses and avoid extra hours of work. To relieve work strain and build healthy nursing workforce, hospital nursing administration and staff nurses need to collaborate to address issues that increase their fatigue.Provide short break of 5 to 10 minutes between the working hours.Provide appropriate staff patient ratio.Less experienced nurses could learn from more experienced nurses how to work efficiently without experiencing excessive work stress.A multidisciplinary team should be there in teaching nurses and other hospice health care professionals about the fatigue and its contributing factors.

Nursing Administration

Management should implement strong policies and promote healthy work style among nurses, to ensure that nurses take adequate rest during the shift to prevent fatigue.Address the overall work environment for nurses.Identify situations and settings in their own organization that promote fatigue in nursing staff and create an unsafe environment for patients.Organize relaxation techniques for nurses and encourage them to participate it.Designate positions for an adequate number of registered nurses to providequality care and assure that nurses are able to work an appropriate schedule including breaks and without overtime.Seek creative options to fill registered nurse positions including part time, partial shifts, and other strategies

Nursing Education

A nurse educator plays a vital role in bridging the gap between theory and clinical practice.Nurse educators could have an impact on health care organizations by helping .To promote policy change, providing awareness of the risks of fatigue, and showing the benefits of appropriate coping skills.Educating nursing students in regard to fatigue as a contributing factor in error and fatigue countermeasures.Structuring their own clinical assignments to assure that nursing students are not assigned to clinical work schedules that would promote fatigue andincrease error.Workshops, community presentations, and other opportunities for continuing education regarding compassion fatigue risk, are vital implications for nursing that have evolved from this research.All undergraduate, graduate and post graduate curricula should provide Information about the risks and the effects of fatigue, as well as stress and burnout, in nursing.

Nursing Research

Research the use of creative staffing patterns to meet patient needs. Research the use of checklists for preventing error. Research the potential value of various approaches to crew resource management and their applicability to health care environments. Research groups support new research on the relationship between nurse fatigue and work schedules, adequate rest and recuperation and patient safety, to be carried out in all settings in which nurses work.Research the relationship between compassion fatigue and self-transcendence provides empowerment among the nursing profession and other health care entities to establish prevention and intervention measures that promote self-care, create positive patient care outcomes, and enhance the function and productivity of nursing’s future.

REFERENCES:

1. Dorrian, J., Lamond, N., and Dawson, D. (2000). The ability to self-monitorperformance when fatigued.Journal of Sleep Research, vol. 9, no. 2, pp. 137–144.

2. Canadian Nurses Association. (2010). Nurse Fatigue and Patient Safety. Ottawa

3. Secondary Traumatization, Burnout, And Vicarious Traumatization,August 2005,Smith College Studies In Social Work 75(2):81-101,Doi: 10.1300/J497v75n02_06

4. Scott, L. D., Arslanian-Engoren, C., and Engoren, M. C. (2014). Association of sleep and fatigue with decision regret among critical care nurses. American journal of critical care : an official publication, American Association of Critical-Care Nurses, 23(1), 13–23. https://doi.org/10.4037/ajcc2014191

5. Winwood, P. C., Winefield, A. H., Dawson, D., and Lushington, K. (2005). Development and validation of a scale to measure work-related fatigue and recovery: The Occupational Fatigue Exhaustion/Recovery Scale (OFER). Journal of occupational and environmental medicine, 47(6),594–606. https://doi.org/10.1097/01.jom.0000161740.71049.c4

Received on 29.11.2020 Modified on 07.12.2020

Asian J. Nursing Education and Research. 2021; 11(1):136-140.

DOI: 10.5958/2349-2996.2021.00035.5