Occupational Fatigue Exhaustion Recovery Scale (OFER) for Work-Related Fatigue Research

Running head: PHD PROPOSAL
PHD PROPOSAL
Name of Student
Name of University
Author’s Note

1PHD PROPOSAL
Abstract
Various empirical studies link persistent failure to recover from acute fatigue to the evolution
of chronic fatigue. However, existing fatigue measurement scales do not tend to distinguish
between acute and chronic fatigue elements well, and none include a measure of effective
recovery from fatigue. The 15-item Occupational Fatigue Exhaustion Recovery (OFER)
scale has been developed and validated in three study populations specifically to measure
work-related fatigue. The OFER scale possesses robust, gender-bias free psychometric
characteristics. Its three subscales identify and distinguish between chronic work-related
fatigue traits, acute end-of-shift states and effective fatigue recovery between shifts. These
studies confirm the mediating role of inter-shift recovery in the evolution of adaptive end-of-
shift fatigue states to maladaptive persistent fatigue traits. The OFER scale is suggested as a
potentially valuable new tool for use in work-related fatigue research.

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Table of Contents
Introduction................................................................................................................................4
Background................................................................................................................................8
Literature review......................................................................................................................11
Prevalence of Work-related Fatigue.........................................................................................13
Type of Work-related fatigue...................................................................................................15
Factors associated with fatigue................................................................................................16
Consequences of work-related fatigue.....................................................................................17
Management of fatigue............................................................................................................18
Gender experience and expectation.........................................................................................19
Study Aim................................................................................................................................22
Research questions...................................................................................................................22
Research objectives..................................................................................................................23
Research hypothesis.................................................................................................................23
Significance of the study..........................................................................................................23
Significance of this study.........................................................................................................24
Methodology............................................................................................................................24
Study design.............................................................................................................................25
Study location...........................................................................................................................27
Sampling population and selection..........................................................................................28

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Sampling frame........................................................................................................................28
Sampling techniques................................................................................................................28
Determination of sample size...................................................................................................29
Data collection process............................................................................................................30
Components of questionnaires.........................................................................30
Semi-structured interviews.............................................................................30
Quality control.........................................................................................................................31
Content validity..........................................................................................31
Pre-testing of the questionnaires.......................................................................31
Face validity..............................................................................................31
Data analysis.............................................................................................32
Ethical considerations..............................................................................................................32
Beneficence...............................................................................................33
Non-Maleficence.......................................................................................33
Autonomy...............................................................................................33
Justice...................................................................................................34
Confidentiality..........................................................................................34
Facilities and resources................................................................................35
Gantt chart for study activities........................................................................35
APPENDIX A: QUESTIONNAIRE........................................................................................56
SECTION B: Occupational Fatigue Exhaustion Recovery Scale (OFER 15).........................59

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APPENDIX B: QUESTIONNAIRE........................................................................................62
Understanding the Reliability and Validity of the questionnaire.............................................64

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Introduction
This doctoral research proposal will discuss the concept of fatigue as it relates to the
nursing profession. The context of the proposed study is Jordan, situated in the Middle East.
The proposal will outline the background and justification for the study and the search
strategy and literature related to fatigue generally. The methodology and design will be
discussed, as will the ethical considerations.
The study aims to address the level of fatigue of male and female nurses and what
their individual coping strategies are to mitigate work related fatigue. This is the first mixed
method nursing study of its kind in Jordan, especially as it addresses gender issues related to
fatigue in selected Jordan hospitals.
Nurses are present on the front line of healthcare, which is both a rewarding and tiring
experience. Due to the arising of different issues, like insufficient levels of staffing or
exponential increase in the responsibilities of healthcare, the pressures on the modern nurses
are immensely increased, which are often the instances of increased levels of fatigue in the
environment of healthcare (Parahoo, 2014). The reason behind these increased levels is
probably lack of sleep, which results in affecting the health issues and safety issues of both
patients and nurses. The American Nurses Association (ANA) is working to counter these
harmful effects because of the reality of the dangerous fatigue in workplace. This nurse
fatigue has become the primary concern, which further emphasizes the importance and need
of this proposal. This proposal will help in addressing the issues related to fatigue efficiently.
The following approval will help in generating data, which can be further used to solve these
fatigue issues in the field of Nursing (Holloway & Galvin, 2016). From the past surveys, it
was observed that the levels of mental fatigues were more than physical fatigue. In addition,

6PHD PROPOSAL
the levels of chronic fatigue were lesser than acute fatigue. Moreover, the increased levels of
total fatigue were due to the longer shift timings and hours in a week.
Nursing care is a 24-hour occupation, often requiring nurses to work two or three
shifts, as opposed to standard working hours, with the demands and expectations of patients
and hospitals placing nurses under considerable pressure (Yuan et al., 2011). Nurses may also
work extended hours without regular breaks, and they are likely to experience fatigue
(Corless et al., 2008).
The prevalence of fatigue among nurses is also attributed to these ongoing demands
of caregiving and other job-related fatigue factors, such as rapid admission and discharge
cycles and high patient acuity levels which require increasingly complex occupational skill
sets (Kubo, Takahashi, Sallinen, Kubo, & Suzumura, 2013). There are many negative
consequences of work-related fatigue of nurses working and health organizations that affect
the patients (Burton, 2010; Scott, Rogers, Hwang, & Zhang, 2006). Fatigue is known to
adversely affect the quality of care, client satisfaction, and patient and nurse safety (Nagai et
al., 2011; Witkoski & Dickson, 2010).
Fatigue has resulted in the negative performance of the nurses in the healthcare environment
(Rose et al., 2017). Often different terms like exhausted, lethargic and tired are used on the
behalf of Fatigue. It is a symptom, which is often misinterpreted with drowsiness by the
patients. Although, both the symptoms, fatigue and drowsiness, explains the sleep
requirement, but they are different and should be identified by the doctors (Naviaux et al.,
2016). Fatigue is a physiological process that can occur due to prolonged working hours,
disruption of circadian rhythms from a lack of sleep, or from doing the same type of
monotonous work for a long period (Sadeghniiat-Haghighi & Yazdi, 2015). Fatigue has been

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characterized previously as a workplace hazard associated with the safety and health of
workers (Hairong Yu, Anli Jiang, & Jie Shen, 2016).
Previous studies found the prevalence rate of fatigue among nurses is different from
one country to another Norway, United Kingdom, Netherlands, Canada, and United States of
America the prevalence of the fatigue among nurses was 22%, 38% , 25% , 55.5%, 37.9%
respectively (Barker & Nussbaum, 2011; Bryant-Lukosius, 2010; Ho et al., 2013). In the
Middle East, 48.8%, of Palestinian Nurses suffered from work-related fatigue with a high
level of emotional exhaustion (Hamdan, 2017). As well as there is study has done in turkey
showed the rate of fatigue 40% among nurses (Kuguoglu, Aytekin, & Yilmaz, 2014).
Work-related fatigue risk management has been defined as a strategy to minimise the level
and cause of fatigues among workers in the workplace (Gander et al., 2011). Risk
management studies for fatigue are limited to the safety of patients and wellbeing of nurse in
the health care system (Aurich-Barrera, Wilton, & Shakir, 2012). So, is there a need for
broader more comprehensive studies ally? What are you trying to say here?
The majority of studies have focused on the development and improvement in risk
management systems to ameliorate fatigue in the workforce, as well as the general public
from fatal harms, which happens when the medicine have negative impact or it goes wrong
and negative consequences (Drury, Craigie, Francis, Aoun, & Hegney, 2014). The adequate
risk management strategies will be helpful for addressing the causes of fatigue and enhance in
satisfaction of job with minimisation of nursing fatigue (Van Mol, Kompanje, Benoit,
Bakker, & Nijkamp, 2015). Many hospitals still lack management policies for addressing and
monitoring the level of fatigue among nurses and measurement the experiences and
expectation for male and female nurses in the same place. Furthermore, most of the nurses
are using some individual’s strategies like prioritizing sleep by putting enough effort,