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Critical Appraisal: Fatigue, Burnout, Work Environment Essay (Critical Writing)

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Updated: Jun 18th, 2022

The selected article by Yu et al. (2020) seeks to explore the impact of 12-hour shifts on nursing fatigue in intensive care units (ICU). The purpose of the study is to investigate the real-world application of literature on nurse fatigue, with information being useful on developing a support environment to reduce nurse fatigue considering that nursing burnout is commonly associated with long working hours. The study follows a cross-sectional survey design. The appropriate cohort studies critical appraisal checklist will be utilized to consider the validity, reliability, and applicability of the study.

The study design is a cross-sectional survey with ICU nurses from two hospitals in different cities. The questionnaire survey is appropriate since fatigue levels have to be evaluated by the subject themselves and it is a subjective individual measure. The survey utilized the Likert scale which helps to quantify the data and collect a wide range of response measurements (Taherdoost, 2019). The sample had to meet similar requirements of full-time ICU RN and working 12-h shifts regularly. After clearing for criteria, only 67 out of 112 responses, and the small sample size was discussed in limitations as reducing statistical significance and generalizability, particularly in areas outside of the ICU. The self-reporting factors creates potential for bias due to nurse personal interests. The study utilized a well-established Occupational Fatigue Exhaustion/Recovery (OFER) scale instrument to measure subject’s fatigue (Yu et al., 2020).

The results found that 85% of participants showed low and moderate chronic fatigue levels, while 15% demonstrated moderate and high levels. 54% nurses reported low/moderate acute fatigue, and 69% low/moderate inter-shift fatigue. T-tests and chi-square used to compare hospital results and independent variables. Spearman’s correlation sought to establish a relationship between demographic factors and types of fatigue. The ANOVA test analysis found statistical significance for any demographic factors, including age, nursing experience, and exercise frequency to fatigue. The following results meet general reliability requirements and statistical tests are standard for this type of research (Vaske, 2019).

Nurse fatigue is directly associated with factors of burnout, turnover, and patient safety, which makes it critical to consistently study the subject to ensure a better and safe work environment (Al Ma’mari et al., 2020). These are valid results that can be applied to the nursing population at major hospitals, suggesting that shift scheduling has minor impact on fatigue levels. Yu et al. (2020) note that the majority of nurses cope well with 12h shifts, and actually shorter 8h shifts had a more detrimental effect on rest due to the necessity to travel to work more frequently. However, the statistical significance of certain demographic factors suggests the support should be established for inexperienced nurses or those who are less adaptable, overall encouraging collaboration between managers and nurses to provide improved shift schedules.

The article by Yu et al. (2020) explores the impact of 12h shifts on various types and levels of nursing fatigue, also investigating the involvement of demographic factors. The research uses strong methods and highly tuned instruments but maintains certain weaknesses such as sample size and lack of generalizability of results. Generally, the study can be considered valid and reliable but requires further research due to its small sample. However, the recommendations for applicability are useful in terms of supporting individual nursing staff in managing fatigue levels.

References

Al Ma’mari, Q., Sharour, L. A., & Al Omari, O. (2020). British Journal of Nursing, 29(1), 28-34. Web.

Taherdoost, H. (2019). International Journal of Academic Research in Management, 8(1), 1-10. Web.

Vaske, J. J. (2019). Survey research and analysis (2nd ed.). Sagamore Publishing.

Yu, F., Somerville, D., & King, A. (2019). Applied Nursing Research, 50, 1-7. Web.

Appendix A

General Appraisal Overview for All Studies

Date: November 20, 2020
Reviewer:
Article Citation (APA):
Yu, F., Somerville, D., & King, A. (2019). . Applied Nursing Research, 50, 1-7. Web.
PICOT Question:
In intensive care unit nurses (P), do 12-hour shifts (I) in comparison to shorter 8-hour shifts (C) impact fatigue levels (O) over a full-time fortnight period (T)
Overview/General Description of Study
  • Purpose ofStudy:

To investigate the real-world application of literature on nurse fatigue, with information being useful on developing a support environment to reduce nurse fatigue.

  • StudyDesign: Cross-sectional survey
  • General Description ofStudy:

The study stems from inconsistencies in literature on whether traditional 12-h shifts have long-term detrimental impacts on fatigue levels. The researchers surveyed 66 nurses in two hospitals using the OFER scale and other statistical tests for analysis. It was found that the majority of nurses had low to moderate fatigue levels.

Research Question(s) or Hypotheses:
No specific question or hypothesis stated.
Study Aims:
The research seeks to assess the impact of 12-h shifts on ICU nurse’s fatigue and identify associated demographic factors
Sampling Technique, Sample Size, and Characteristics:
Out of 112 distributed questionnaires, 85 were returned, and 67 were eligible to participate. Researchers conducted surveys on ICU nurses on two urban hospitals in two different cities. To be included the nurses had to be an ICU RN, working full-time, working 12-h shifts regularly
Major Variables Studies:
  • IndependentVariable(s): Survey analysing fatigue levels after 12-h shifts
  • Dependent (outcome)Variable(s): Nurse fatigue levels and impacting demographic factors
Variable Analysis Used (include whether appropriate to answer research questions/hypothesis or discover themes): The questionnaire used the Occupational Fatigue Exhaustion/Recover (OFER) scale, with results analysed utilizing Spearman’s correlation, ANOVA, t-tests, and chi-square. This type of variable analysis is appropriate in this context, as it helped to significantly identify demographic and behavioural factors which either contributed to fatigue or helped manage it which was a secondary part to the research.

Appendix B

Rapid Critical Appraisal Questions for Cohort Studies

VALIDITY
1. Are the results of the study valid? Generally, the results of this study are valid. They may not be generalizable, but researchers followed all respective scientific procedures and appropriate data analysis to consider, which contributed to the study discussion and its impact on the respective field
a. Was there a representative and well-defined sample of patients at a
similar point in the course of the disease?
Yes No Unknown
b. Was follow-up sufficiently long and complete? Yes No Unknown
c. Were objective and unbiased outcome criteria used? Yes No Unknown
d. Did the analysis adjust for important prognostic risk factors and
confounding variables?
Yes No Unknown
Comments The study was focused on nurses, not patients, so the first point is unapplicable. The sample was well-defined and both cohorts were examined under similar circumstances. The follow up was sufficient with the comprehensive surveys and even some interviews. Unbiased criteria such as the OFER scale was used alongside standard questions. The analysis sought to adjusts for variables such as demographic factors.
RELIABILITY
2. What are the results? The majority of nurses cope well with 12h shifts, and actually shorter 8h shifts had a more detrimental effect on rest due to the necessity to travel to work more frequently.
a. What is the magnitude of the relationship between predictors (i.e.,
prognostic indicators) and targeted outcome?
There does not seem to be a significant relationship between 12-h shift length and nurse fatigue, with the primary fatigue elements stemming from demographic and personal factors influencing the individual
b. How likely is the outcome event(s) in a specified period of time? A fortnight period was utilised, which is a standard work period, in full time positions. The nurses had already been working full-time 12-h shifts so outcomes are bound to be evident in this period.
c. How precise are the study estimates? The study estimates are precises given the overwhelming statistical analysis, but standard deviation is given in all the results, with some having broad margins as based on the scales used. P values remained under.7 for the majority of results.
APPLICABILITY
3. Will the results help me in caring for my patients? In a manner of speaking yes. The study deals
a. Were the study patients similar to my own? Yes No Unknown
b. Will the results lead directly to selecting or avoiding therapy? Yes No Unknown
c. Are the results useful for reassuring or counseling patients? Yes No Unknown
Comments: In this case, the applicability of the study can be useful for the nursing workforce. This is a valid and ongoing discussion, and the results may alleviate some concerns regarding shift length on fatigue but rather to focus on other factors..
Would you use the study results in your practice to make a difference in patient outcomes?
  • Ifyes,how? Patients are relying on nurses consistently as frontline workers, to be present, alert, and present the best care. It is necessary to find the optimal solutions for managing shift schedules and nursing fatigue for the healthcare providers to be at peak professionalism and performance during their shifts and making medical decisions.
  • If yes,why?
  • If no, whynot?
Additional Comments/Reflections:
Overall, this was a small study, which potentially did not necessarily fit all cohort characteristics. It used a cross-sectional design survey, and this felt as the best approach to the analysis. There was a number of limitations to the study such as small sample size and self-reporting questionnaire, but it remains a valid scientific inquiry that can be considered reliable and have applications to practice and nursing management.
Recommendation for article use within a body of evidence:
The researchers recognise that the study findings are contradictory to multiple literature on the topic. However, this study presents the unique perspective of analysing demographic and environmental factors which may be contributing to fatigue as well. Within the body of evidence it can serve an important role of providing introspective on influences on nursing fatigue and how nursing management can be applied to the healthcare workforce in guiding them in best practices to avoid this critical concern.
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