Nursing Fatigue and Risk Management: Gender Experience and Expectation

Research proposal
1

Table of Contents
INTRODUCTION..............................................................................................4
BACKGROUND...............................................................................................5
Effect of nursing workforce challenges on nursing fatigue...............................6
Fatigue and nursing......................................................................................7
Fatigue management and Safety risks paragraph...........................................8
Gender reasons for shortage paragraph......................................................10
Gender imbalance, religious and culture affecting nursing roles paragraph....13
LITERATURE REVIEW....................................................................................14
Literature Search
.........................................................................................................
14
The articles that were excluded from the review included those that focused on
specific populations rather than nurses (for instance industrial workers,
paramedic personnel, doctors, pregnant women, children, and geriatric people.
14
Results........................................................................................................15
Prevalence of nursing work-related fatigue
..................................................................
15
Factors associated with fatigue
....................................................................................
18
Consequences of work-related fatigue
.........................................................................
18
Management of fatigue
................................................................................................
20
Culture, religious and fatigue among nurses
................................................................
22
The view of Islam and culture in nursing in Jordan
.......................................................
23
2

Theoretical frame work or conceptual framework
........................................................
24
Literature Gap.............................................................................................24
Significance of the study..............................................................................25
STUDY AIM..................................................................................................26
Research Questions.....................................................................................26
Research Objectives
.....................................................................................................
26
Research Hypothesis
....................................................................................................
27
METHODOLOGY...........................................................................................27
Study design...............................................................................................27
Recruitment sites and characteristics...........................................................28
Population sample.......................................................................................29
Sampling frame...........................................................................................30
Sampling techniques...................................................................................30
Semi-structured interviews
..........................................................................................
31
Determination of sample size.......................................................................31
Data collection process................................................................................32
Components of questionnaires.....................................................................33
QUALITY CONTROL.......................................................................................33
Content validity
............................................................................................................
33
Pre-testing of the questionnaires
.................................................................................
34
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DATA ANALYSIS...........................................................................................34
ETHICAL CONSIDERATIONS...........................................................................34
Consent form
...............................................................................................................
35
Confidentiality
..............................................................................................................
35
Facilities and resources
................................................................................................
35
Gantt chart for study activities
.....................................................................................
35
REFERENCES...................................................................................................0
APPENDIX.......................................................................................................8
Appendix 1: UON HREC and UPM HREC
..........................................................................
8
Appendix 2: Ethics approval from KAUH&JUH
.................................................................
8
Appendix 3: Questionnaire
.............................................................................................
8
Appendix 4: Structured Interviews
...............................................................................
12
Appendix 5: Understanding the Reliability and Validity of the questionnaire
...............
13
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Nursing fatigue and risk management: gender experience and expectation
INTRODUCTION
This doctoral research proposal outlines and discusses the concept of fatigue as it
relates to the nursing workforce in three Jordanian hospitals. Jordan is a Muslim Arab
country located in the Middle East, bordered by Saudi Arabia on the Eastern and Southern
side, with Iraq to the North-East, Syria to the North and Palestine. This led to weaker
systems of heath care in Jordan. Jordaner has an estimated population of 10.309 million.
The proposal provides a background and justification for the research study, a literature
search strategy and review of literature related to fatigue generally. The sections in the study
contains the research questions, (objectives, and hypotheses), significance of the study, and
the research methodology and design are also provided. Additionally, the study describes
the ethical considerations relevant to the study’s research integrity.
There are many reasons that lead to fatigue in registered nurses working in acute and
chronic healthcare settings. While different situation in relation to the patient’s medical
emergency might arise at any point of time, the nurses have to be very proactive all the time
– in accordance to what their role demands. The social environment where a nurse works is
generally high passed, provided the atmosphere in acute and emergency settings – there is
an extensive need for proactivity from the nurses attending the patients (who are in critical
stage) in the departments (Lachman, 2015). While a very disruptive work place culture is
persistent in most of the hospitals of middle-east – there is an urgent need for cultural
improvement in the organisational framework so that the stress, anxiety and fatigue amongst
the nurses are reduced (Gonzalez et al., 2015). This disruption lead to various complication
in the clinical policies that is to be followed and there are different set of problems that
leads its way in to the clinical picture due to socio cultural disruption amongst the nurses.
There issues are non-adherence to medication guidelines, patient care guidelines, patient
centred care policies and evidence based practice framework. Behavioural issues arise
amongst the fatigued nurses and this burnout almost affects the physical and mental status
of the nurses leading to an array of psychosocial problems within the clinical environment.
This workplace disruption in the clinical environment, amongst the nurses can be due
to various levels of differences between the nurses working in the same department of the
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same organisation. The chief types of differences and opinion clashes between the nurses
were reported to occur, by many research studies, because of cultural and religious
diversity. The cultural background of the nurse in addition or rather a special emphasis with
the religious background of the nurse has been identified by different research studies, as
the cardinal problem of this workplace disruption and these highlighted areas are the major
reasons that lead to fatigue or burnout amongst the registered nurses working in a clinical
environment (Dotevall, Winberg & Rosengren, 2018).
Fatigue is state of extreme physical, mental or psycho- physical exhaustion resulting
from a prolonged strenuous activity. The daily lives of nurses demand a high functioning
performance that is demanding both at the physical and the psychological level. Without a
proper release it can lead to various complex psychosocial issues amongst the nurses and
even mental complications. The study investigates the level of fatigue in nurses (male and
female), and explores their individual coping strategies used 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 nursing fatigue.
BACKGROUND
The Jordanian health care system is divided into three administrative regions:
Northern, Central and the Southern. The central region is the largest, comprised of 62.8% of
the total population, and is served by 75 hospitals, including Jordan University Hospital
(JUH), which is a teaching hospital. The northern region is smaller, comprising of 27.8% of
the population and served by 28 of the hospitals, the largest of which is King Abdullah
University Hospital ( KAUH) (Ajlouni, 2011; Department of Statistics, 2018). KAUH is also
a teaching hospital. The southern region is the smallest, comprising 8.4% of the total
population and has 13 hospitals. In each of these regions, the health care system includes
three sectors: public, private, and non-governmental organisations (NGO), or international
agencies (Ministry of Health, 2016). Most of the NGOs are related to the public sector. In the
three sectors and three regions combined, there are 116 hospitals (31 public, 12 military
hospitals, 2 university hospitals, and 66 private hospitals) with a total bed capacity of 12,497
beds (Worldometers RTS algorithm, 2019). Jordan is considered a lower middle income
country in the Eastern Mediterranean Region (Department of Statistics, 2018).
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Jordan is a significant medical centre for the Jordanian region. It has efficient health
services (Nazer & Tuffaha, 2017; Zamil, Areiqat, & Tailakh, 2012) due to the high level of
clinical knowledge in the teaching hospitals (Ajlouni, 2011). Due to the fact that patients in
different advanced medical centres in Jordan are referred to Jordan from all parts of the
Middle East (Mrayyan, 2007, p. 83). Additionally, within Jordan, patients with complicated
cases are referred from smaller hospitals to the two large teaching hospitals JUH and KAUH.
The quality of services provided or delivered by the Jordanian health care system is quite
significant but there are different sets of formidable workforce challenges that are yet to be
faced and countered in order to deliver a profound patient centred clinical care – profound
from all the aspects. This is particularly the case for the nursing workforce as they are the
only professionals, who by nature of their work – need to work very closely with the patients
admitted in the hospital every day and as a matter of fact – most of the challenges in the
health care system are actually faced by the nurses in the clinical environment and this causes
a lot of fatigue in the nurses.
Effect of nursing workforce challenges on nursing fatigue
One of the main issues in the healthcare system for nurses and other health care workers in
Jordan is fatigue (Higher Population Council, 2016). Nurses in the workforce provide care
across a 24 hour rotating roster designated by an average of 12 hour shifts as opposed to
standard working hours, with the demands and expectations of patients and hospitals placing
them under considerable pressure (Yuan et al., 2011). Nurses are likely to have stress,
anxiety and fatigue due to the very long working hours in a high strung environment and
because of the fact, they hardly get any breaks in the shift hours to replenish their mood and
energy (LaRocco, Saleh, & AlAshram, 2018). Population council identifies fatigue as an
important psycho social issue amongst the nurses. As a matter of fact, there is very little
research measuring the prevalence rates of fatigue amongst the nursing staff s working in the
hospitals of Arab countries that includes Jordan as well. There is a report that in Jordanian
emergency department (K. M. Ismail, Malak, and Alamer 2019), that reported an acute
fatigue conditions persistent amongst among nurses.
The table below show the population of nurses based on gender as per Jordan Department of
Statistics.
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Table 1: Statistics on nursing population based on gender
Gende
r
Total
nurses
in
Jorda
n
Publi
c
Secto
r
Privat
e
Sector
Outsid
e
Jordan
Militar
y
Sector
Educatio
n
Sector
KAU
H
JU
H
Male 13495 3362 2732 2404 944 194 263 206
Female 18526 4038 3174 1182 3180 457 406 488
Total 32021 7400 5906 3586 4124 651 669 694
As per the findings, it can be well observed that the number of males in Jordan
choosing a nursing profession is considerable lesser than the number of Jordan females who
has chosen nursing as their profession. The reason can be due to a cultural, a sociocultural
stigma attached to nursing being a ‘feminine’ profession and the social perception in
addition to the economic underpinning related to the field of nursing in Jordan has led to
decreased number of males taking up nursing as a profession in Jordan.
Fatigue and nursing
There is an increased number of refugees who has come into Jordan during the wars
in Syria, Libya, Iraq (Worldometers RTS algorithm, 2019; Yearbook, 2018). The influx of
immigrants has increased the incidents of various communicable diseases in the country of
Jordan(WHO. and High Health Council (2019). The prevalence of communicable diseases
has increased in the camps and in the middle of the country as well due to spread of refugees
(Coutts, Fouad, & Batniji, 2013; Sami et al., 2014). The population studies have improved the
understanding of the distribution of these diseases in different and specific parts of the
country.
Another important finding, revealed by a research, that the shortage of nurses in the country
of Jordan has caused more work pressure to be taken by each nurse that has caused increased
levels of stress and resultant fatigue amongst the nurses. In Jordan, the nursing workforce
shortage condition has arisen – partly as a result of nurses leaving the profession and leaving
Jordan to work in other countries where the conditions are seen to be better. Nursing in
Jordan is also reported to be characterised by poor working conditions, unsupportive work
8