a. The study framework used in this study was clearly identified as Lee et al., (2004) model of impaired sleep. This model provides that sleep loss or poor quality of sleep is as a result of inadequate sleep or disruption of sleep. It also provides that secondary factors that may also affect sleep include lifestyle situations and health-related problems.
b. The discussion used in the framework aims to link the concept of sleep loss and the increase of a person’s inability to perform various duties. The article cites various key areas affected by loss of sleep. The framework focuses on the ability of Fatigue Countermeasures program for nurses (FCMPN) to reduce fatigue among nurses providing care and eliminate patient errors.
The major study concepts in this article include: cognitive-behavioral, physiological, emotional and social outcomes (Reed, 2013).
Variable Identification and Definitions
Independent variable: Fatigue Countermeasures program for nurses (FCMPN)
Conceptual definition: The model of impaired sleep as provided by Lee et al’s., concept gave a guideline on the process of the study of FCMPN. The conceptual definition provided by the article is that this is a joint effort by the employer or the employing institution and the employee where comprehensive programs are designed to help manage fatigue in the working environment. The concept guided the study on the various factors affecting sleep, and the different adverse outcomes to be observed during the study. Cognitive-behavioral responses were potentially studied for their association with a decrease in sleep loss and improvement and sleep quality among the nurses selected for the study. The focus was on the sleep duration, sleepiness among the nurses during the day and their level of alertness. Sleep loss, quality of sleep, lifestyle situations and health related problems provided some of the key areas to focus on when determining some of the major causes of impaired sleep among the nurses.
Operational definition: the National Aeronautics and Space Administration Ames Research Center’ uses this program to collect information and provide education about the components of FCMPN including fatigue, sleep, neurobehavioral and sleep misconceptions. The feasibility of using the FCMPN as a form of intervention for nurses who suffer from fatigue and other errors related to illnesses in full time hospital staff was applicable in the study. Baseline line data, subsequent and final data was collected as detailed in the Scott, Hofmeister, Rogness and Rogers (2010, p. 253) article.
Dependent Variables:
Sleep Quality
Conceptual definition: There is no conceptual definition of sleep quality, but it can be defined as the amount and level of sleep in accordance to the time a nurse has during a day. It varies with the disruption and total time of sleep in a single day.
Operational definition: the subjective sleep quality was measured with the use of Pittsburgh Quality index that has 19 items that helps in computing sleep quality. It covers sleep habits and it was used in the study for 4 weeks (Scott, Hofmeister, Rogness and Rogers 2010, p. 253) during baseline data collection. It was also used during the 6-12 weeks of the study during and after the intervention.
Sleep duration
Conceptual definition: There was no conceptual definition of sleep duration, but it can be defined as the total amount of time an individual sleeps without any disruption (Rella, Winwood, & Lushington, 2009).
Operational definition: sleep duration was measured using logbooks that collected information about the different schedules and working hours of nurses working in hospitals. It also collected information on the difficulties nurses had in staying awake and the wake patterns. Sleep quality was operationalized through the collection of data from 15-34 items filled in the logbooks by the nurses under study.
Day time sleepiness
Conceptual definition: Day time sleepiness is defined as the ability or inability of a nurse to doze off during the day under various situations.
Operational definition: Day time sleepiness was measured using the Epworth scale (ESS) that measured and evaluated the severity of daytime sleepiness among nurses. There were various situations that provided a measure of the severity under differing circumstances. The scores ranged from 0-24, (Scott, Hofmeister, Rogness and Rogers 2010, p. 254)
Vigilance
Conceptual definition: it is conceptually defined as the inability to remain alert during duty hours.
Operational definition: Vigilance was measured using drowsiness and unplanned sleep episodes that occurred when a nurse was at work or while they were driving.
Risk for accidents and errors
Conceptual definition: Not clearly conceptually defined in the article, but can be defined as the probability of accidents and errors occurring when nurses are going about their duties. Operational definition: the risks of accidents and errors occurring were measured through the Logbook of accident and error data. Here, participants were asked to respond to three questions and describe the errors and near errors during their work period.
Short term memory
Conceptual definition:
Sample and setting
a. Sample Inclusion and Exclusion Criteria: The population under study was nurses working full time in a hospital setting practicing under different selected units. They had to be working for at least 36 hours per week. “Inclusion criteria for the study included the following qualifications: (1) adult; (2); full time nurse staff; (3) nurses working in different work shifts (4); complete and return the demographic form.Subjects were excluded (exclusion criteria) because of (1); their roles i.e. specialized roles as discharge planning (2); advance nurse practice (3); nurse managers.
b. Sampling method is clearly identified and states that the participants had to be full time nurses practicing in the different selected units within a health facility. The selection of participants from the different hospitals selected from acute care were similar in size, had the same patient acuity and same staffing levels in order to increase confidence of validity of the results collected,
c. Sample Size was identified as 67 medical-surgical nurses. A power analysis was done to determine the sample size needed for the study. The sampling frame that was available for the study was 147 medical-surgical nurses, but 67 full time hospital nurse staff enrolled to participate in the study (Scott, Hofmeister, Rogness & Rogers 2010, p. 251)
d. Of the 147 eligible subjects identified to fit in to the sampling frame, every one of them received a cover letter that requested them to complete a demographic questionnaire that would aid in determining their suitability to participate in the study. The participants had to fill the demographic form and return it to the principal investigator (PI) who determined whether they met the inclusion criterion or not by the use of postage-paid envelopes. Out of the 142 eligible participants, 62 full-time hospital staff enrolled to participate in the study.
e. The original sample size was 147 and only sixty two (43%) enrolled in the study. The 67 participants in the study had different attributes with 96.8 percent being white and the same percent also comprised of women participants. 52 nurses worked on a 12 hour shift while 4 worked on evening shifts. Nurses working the night and day shifts were 29 and 24 respectively.
f. The original sample size used at the baseline collection of data was 62, but at the intervention period, only 47 participants were providing data used in the study. Nurses working on second jobs were 4.
g. Institutional Review Board (IRB) and Informed Consent: The study participants were requested to fill a questionnaire. The study details were emailed to them, and those who were willing to participate in the study filled the forms. A scripted approach was used to provide additional information to the study participants including informed consent forms.
h. Setting: The study had a natural setting and it was done in work and home settings. The participants had to fill the log books whenever they had to fill them. The setting was appropriate as it focused on their work experience and home experiences (Mock, 2003).
Measurement Methods
Statistical Analyses and Results
a. Analysis Techniques: The sample used in this study was described with use of frequencies, percentages, mean, and standard deviation. The dependent variables in the study were described with the use of mean, standard deviation and frequencies that reflected the nature of the sample and results. Frequencies were determined for the activities that showed a measure of scores. The difference in results with the progress and implementation of FCMNP were collected during four different stages (baseline, 6 weeks, 9 weeks, and 12 weeks). Data was collected at the different stages of baseline, intervention and after intervention. The different frequencies and results were graphed to provide a clear indication of the severity of the sleepiness using the Epworth sleepiness scale.
b. The results were organized according to the dependent variables in the study. They were linked to the study purpose, the objectives of the study, the questions and hypothesis.
Findings
a. Link of findings to the framework is high as the findings make it clear that sleep impairment leads to poor performance. The study provides a link between FCMPN and improvements in sleep duration, quality and alertness when one is going on about his or her duties. However, there were little improvements in daytime sleepiness after the implementation of FCMPN.
b. Expected findings: “The use of FCMPN as an intervention tool for nurses working in various units can help improve the quality of sleep, the sleep duration and alertness at work. The purpose of the study was achieved as per its findings and results.
c. The unexpected findings in the study were in the lack of improvements from the day time sleepiness and no improvement after intervention (Brown 2007).
d. Consistency of the study findings with other studies was noted as the overall results showed that working for long hours result in poor performance and increased in errors. The studies provided a clear link between errors while performing duties and fatigue among nurses.
Study Limitations
“There were various study limitations in this study including the use of convenience sampling and other pre-experimental research that affects the ability of the study to generalize data. There was no reliability of log books as the data may have been inaccurate.
Generalizations
The study links the results of the study to the role of nurses in the health care system. It notes that the implementation of fatigue management education can help reduce fatigue among night shift nurses. The countermeasures will help mitigate fatigue cases in health institution and go a long way in reducing errors that occur due to lack of sufficient sleep among nurses.
Nursing Implications
The study provides a clear application of this study to the nursing units. Its implementation among night shift nurses will help reduce fatigue and errors that may occur. The researchers indicate that by sharing fatigue management, nurses will report to work fit to perform their duties efficiently and effectively.
Recommendations for Further Research
The article provides that future research should focus on the acceptability, the efficacy and the overall effectiveness of FCMPN. This will help come up with future details of ways that can be used to improve and reduce fatigue among day- shift workers who had shown little improvements in this study research.
References
Brown, C. R. (2007). Where are the patients in the quality of health care?. International Journal for Quality in Health Care, 19(3), 125-126.
Mock, V. (2003). Clinical Excellence Through Evidence-Based Practice: Fatigue Management as a Model. Oncology Nursing Forum, 30(5), 787-795.
Reed, K. (2013). Nursing fatigue and staffing costs. Nursing Management (Springhouse), 44(4), 47-50.
Rella, S., Winwood, P. C., & Lushington, K. (2009). When does nursing burnout begin? An investigation of the fatigue experience of Australian nursing students. Journal of Nursing
Management, 17(7), 886-897.
Scott, L.D., Hofmeister, N., Rogness. N. & Rogers, A.E. (2010). An Interventional Approach for Patient and Nurse Safety. Nursing Research. 59, (4) 250-258.
