Homework 4 Work Capacity, Stress, and Fatigue in Nursing Work

Chenyang Bi

TO: Linsey Steege, Senior hospital administrator FROM: Chenyang Bi, Industrial and Quality Engineer DATE: November 3, 2011 SUBJECT: Work Capacity, Stress, and Fatigue in Nursing Work In modern society, with the pace of working and living speeding up, peoples mental, physical and emotional endurance are all facing a severe test. As to the several trends referred to the nursing work, they are apparently the consequence of the total fatigue, which means a state people are exposed to with multidimensional demands throughout the process. It would result in these nurses not being able to function at their normal capacity leading to an increased risk for injury or error. Furthermore, the total fatigue mainly consists of two types: mental fatigue and physical fatigue.

Mental Fatigue Firstly, the mental fatigue could cause perceived sense of weariness and reduced motivation, so the incorrect administration and documentation will occur. Besides, reduced alertness as well as reduced mental performance is also the consequence of mental fatigue, which can result in patient injuries and inharmonious relations between nurses and other employees. Physical Fatigue Physical fatigue makes people unable to continue functioning at the level of their normal abilities. The symptoms are always feelings of physical discomfort, decreased capacity to generate force, decreased power and loss of fine motor control. Just as a summary of the physical fatigue theory says (See Fitting the human : introduction to ergonomics / Karl H.E. Kroemer, page 61-62), fatigue restrict the blood flow through muscle tissue due to intramuscular pressure, deplete the available energy sources (especially ATP and CP) in the muscle, and form lactic acid (a byproduct of the energy conversion process), and so on. Therefore, the trends of muscle cramping and pain, general physical discomfort

should be resulted from the theory addressed above. The two nurses who suffered from heart attacks may have gone through a long period of both fatigues, changing to chronic problems. Nurses who left the positions should be out of the reasons associated with their less mental and physical capacity.

Initial Energy Analysis According to the data given, the total energy expenditure (TEE) during the 12 hour shift is calculated, and the result is: TEE=3.76kcal/min. The physical work capacity (PWC) can also be elicited through regression. The calculation result is: PWC=2.59kcal/min. Demands(D)=TEE, Capacity(C)=PWC So, D>C, the energy requirements are unacceptable for the nurses. (The elaborate process is shown in appendix.) In the former Activity Energy Expenditure Rates we see: Moving/pushing patient beds: 9.1 kcal/min (3 hours duration). So we must reduce the total working hours in the 3-hour duration to decrease the TEE, and make TEE no more than PWC. Through calculating, even rest 3 hours would not meet the demands. (The elaborate process is shown in appendix.)

Assessment Tools Besides the calculation, objective physiological measures and subjective surveys both can be used to evaluate the fatigue of nurses in nursing work. The objective physiological measures include: (All the data in the methods should be collected during working conditions.) 1. heart rate(HR): If the HR increases, the fatigue should be associated with physical fatigue; If the variability of the HR decreases, the fatigue should be associated with mental fatigue 2. EMG: If there are changes in frequency, RMS, and amplitude, the type should be

physical fatigue. 3. Body/skin temperature: Increased indicates physical fatigue 4. Oxygen uptake: Increased indicates physical fatigue 5. Reaction time: Decreased indicates mental fatigue The subjective surveys are self-assessment reports, so they can be done at any time.

Concerns related to the shift schedule 1. Circadian Rhythms: Two nurses sufferance from heart attack might be associated with the concern. Because most peoples heart rates are higher in the day and lower at night, if the nurses must work at night, there would be more risks in suffering heart-related problems for them. 2. Individual Differences: The trends of increasing error rates and patient injuries might be related to this concern. People are always divided into two types: morning types and evening types. The morning types have more difficulty adjusting to night shift work and are more likely to experience sleep and digestive disturbances than the evening ones. So if let the nurses of morning types work at night, the problems will arise, and vice versa.

Changes and Interventions To make the shift schedule more effective, some changes should be made: 1. Avoid early morning (5 or 6 am) start times; 2. Avoid schedules that use 12 hour shifts (use three 8 hour shifts); 3. At least 24 hours after each set of night shifts. These changes would effectively avoid the desynchronization, reduce the health and safety problems, and balance personal, psychological, social and medical concerns. There are at least two other interventions that could help improve the trends above: 1. Maintain regular eating patterns (balanced, varied meals): Good meals will bring good conditions and fitness, which would reduce the physical fatigue such as general physical discomfort, muscle cramping and pain.

2. Ensure that the nurses have a comfortable, dark, quiet place to sleep: After a sound sleep, the nurses can concentrate on their work and wont easily make mistakes in administering and documenting. I will be glad to discuss these trends with you further and follow through on any decisions you make. Attachments: 1. Total energy expenditure (TEE) = BM (Basal Metabolism) + AM (Activity Metabolism) + DM (Digestive Metabolism) BM=1.1kcal/min AM=6.5kcal/min*
2.5hrs 4.5hrs 60 min 60 min * +2.6kcal/min* * +2.0kcal/min* 1day 1day 1hr 1hr

60 min 2 hrs 60 min 3hrs * +9.1kcal/min* * 1day 1day 1hr 1hr

=975+702+240+1638= 3555kcal/day = 2.47kcal/min. 1400kcal DM=0.1* = 11.67kcal/hr = 0.1945kcal/min. 12hrs TEE=1.1kcal/min+2.47kcal/min+0.1945kcal/min=3.76kcal/min. 2. Regression analysis:
VO2-HR
1.6 1.4 1.2

VO2/(LO2/min)

1 0.8 0.6 0.4 0.2 0 0 50 100 HR/bpm 150 200

VO 2 =m*HR+b b=0.1704 m=0.007655 HRmax=183bpm So, VO 2 max=0.007655*183+0.1704=1.57LO 2 /min

PWC=0.33AC=0.33VO 2 max=0.33*1.57 LO 2 /min=0.5185 LO 2 /min

1 LO 2 /min=5kcal/min PWC=0.5185*5kcal/min=2.59kcal/min. 3. Rest amount nurses need: PWC=2.59kcal/min, E job =9.1kcal/min, E resting =1.1kcal/min Assume the amount of rest (unit: hours) during the 3 hours is t, apparently, t<3, and then the AM would be: AM=6.5kcal/min*
2.5hrs 4.5hrs 60 min 60 min * +2.6kcal/min* * +2.0kcal/min* 1day 1day 1hr 1hr

60 min 2 hrs 60 min (3 t )hrs * +9.1kcal/min* * 1day 1day 1hr 1hr

=975+702+240+546*(3-t) = (3555-546 t) kcal/day We must make sure that: TEE=1.1+

3555 1865.52 =3.10. 546 But this contradicts the precondition (t<3), so the answer doesnt exist.

3555 546t +0.1945 PWC=2.59 24 * 60