Nursing fatigue and patient safety errors in healthcare settings

¶ … nurses play a very important role in the emotional, spiritual, and physical care of the patient with different illness. When it comes to nursing homes, nurses are responsible for the well-being of the individuals there. Even though majority of the persons there are not critically there, they still depend on nurses for their care both medically and emotionally.

Sanghine (2013) reported that two nursing home nurses managed to turn off the alarms of nineteen patients at night so they would not be disturbed during their sleep. They were caught when the care home manager checked up on them in the middle of the night. IT was reported that elderly patients in ages 75 to 100 were not able to call for help. Not only that, they also reported ill treatment to the persons only because they preferred their own comfort and sleep before their duty at the nursing home.

The primary job a nurse at the nursing home is to look after all the needs of the elderly patient show are there. Primarily, the nurses are suppose to make sure that these patients maintain their hygiene, have clean beds and getting the nutrition that they need. Furthermore, the nurses need to look over their vital signs and make sure that their medication is given on time. Furthermore, they are also assigned the duty of administering intravenous injections or drawing blood as per need is required.

Seeing the description above, it is quite clear that nurses are quite overworked regardless of which setting they are in. Their responsibilities are quite a lot than what they can undertake. Seeing this, it is not surprising to note the amount of errors that occur because of nursing fatigue. Hughes & Rogers (2008) noted that lack of sleep and fatigue leads to life threatening errors caused by nurses. This can mean either insufficient Monitoring or wrong administration of the patient. Many patients who are in critical care needs to be observed very carefully. Any alarm sign if missed can lead to trouble in the future and can worsen the prognosis of the patients.

It has been stated that it is very common for nurses to fall asleep when they working nights (Scott et.al, 2006) It has been reported by one fifth of the nurses that they have trouble staying awake during night. A survey revealed that the rate of falling asleep in the night shift is around 35.5% (Lee.1992) Altered sleep patterns have been directly linked to effects like reduced motivation, cognitive problems, and reduced job performance. Lack of sleep has also been linked to the development of depression and other psychosocial problems as well (Baldwin et.al, 1997)

Overall, it has been shown that nursing fatigue and errors is linked to a probability of error in 34 events every day in a teaching hospital where are 1000 nursing shifts every day. This is a huge amount considering that people opt for hospital care because it is less prone to error and it is timelier. When admitted in a hospital, people are likely to get medications through an intravenous or an intramuscular route. This makes their condition even more sensitive. Any slight error can lead to fatal consequences for both the patient and the hospital where the patient is admitted.

Literature Review

Article 1: Rella, S., Winwood, P., & 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.

Purpose

This article written by Rella et.al (2009) talks about the chronic maladaptive fatigue evolution of nursing students in Australia. The major aim of this article was to look into the first hand experience and remarks that nursing students provided after being exposed to the long working hours.

This article is cross sectional design study that looks into the signs and symptoms of serious maladaptive stress and fatigue in the students. It looks onto how these students combat increased stress during the years and the effect o this stress on them.

Purpose

This article written by Chaudhary et al. (2009) discusses the impact of physical environment on the output that is given by nurses. The major objective in this article states that certain conditions can aggravate staff stress, failure and burnout. All of this would ultimately lead to nursing fatigue and would increase the chances of error. The major purpose was therefore to design possible responses that would ultimately enhance the performance of the nurses through their sound physical health.

This article is systematic review in which different variables such as lighting, furniture, noise levels and design layout are explored to affect the health, energy levels, fatigability and performance of the nurses. The focus groups in these studies therefore address the effects of environment on tasks such as storage, delivery and medication ordering.

Summary

This article talks about two different consequences of nursing fatigue, which are active failures and latent condition. In the active failure is an active error such as the administration of wrong medication or a wrong dose. This has been attributive to the cognition of the human mind along with the thought process of the person. This has been linked to variables like increased noise and decreased light in the working conditions. Factors such as the training of the staff, communication and design of the patient room were ultimately linked to latent conditions, which includes the environment in which the nurses have to work, and the stress level that exists in their working environment. The buildup of staff stress or nursing burn out was also attributed to the attitudes and behavior of the physicians under who they are working.

This article is relevant to the project because it devises different reason for nursing fatigue. This study goes on to raise a new point that is directly linked to our topic. It can therefore provide us with various reasons that could be the culprit behind nursing fatigue. Even though our project is not concerned with nurses in the acute care setting, some variables can still be applied in the nursing homes as well.

Project

A need for this practicum project

Kohn et.al (2000) noted that every year 44,000 Americans die every year from preventable medical errors. The cost of these adverse events in only America has been estimated up to 37.6 billion dollars. The highest amongst all of these events are medication errors that involve dose errors, route errors, missed doses and duplicate errors (Bates et.al, 1995)

This clearly shows the problems that can occur if nursing fatigue is not controlled. As mentioned before, these errors are such that can be preventable. Even in the context of nursing homes, this problem is aggravating the condition. Already, theses elderly persons are suffering and any mistakes would further worsen their condition. Furthermore, the ratio to elderly persons to nurses in these nursing homes is not fair. Many nurses complain that they are over worked and hence their work needs to be shared.

Description of the project

The project that I chose was that I conducted surveys in the nursing home to inquire the viewpoint of the nurses. In doing so, I specially wanted the nurse to right down which time suited them best. Furthermore, I inquire about their demands of breaks and how they think their fatigue can be reduced. Lastly, I wanted to include the discussion of the variables that were mentioned before. The article that was discussed above was linked more to the hospital settings and the affect of the environment in acute care settings. There was minimal discussion on the effect of environment and other variables on nurses in nursing homes. Keeping this in mind, I want to focus on the variables like the living conditions of the nurses, their access to fackltiie4s and their access to the administration of the nursing homes. All of this would us insight to the living conditions of the nurses and how they can be improved in the future.

Collaboration with preceptor

My preceptor helped me make the survey and the questionnaire and the survey related to the project. We chose our sample population in a very intricate manner. My preceptor was with me all along during the survey and tried his best to explain the project to the nurses. His cooperation really helped as he guided me in all the steps necessary. He provided me with some of the variables that were especially linked to nursing homes such as the presence or absence of a care manager within the nursing home.

Steps taken to implement project

The results gathered from this project were to be discussed with the nursing home's administration. Some of the most common suggestions were noted down for further action. Many nurses did choose to stay anonymous when declaring which time suited those best. By doing this, we made sure to allot the nurse whichever time suit his or her. Because the population only included nurses from one hospital, it was possible to do this.

Outcome of the project

Here are some of the changes that will be implemented.

More than one nurse will be allotted to critical patients in the night timings so the responsibility is not just on one nurse.

The nurses gave their input on how their living conditions could be improved.

Coffee and tea breaks are formally added in different timings so that all the nurses everyone gets a break.

Course Objectives

The following course objectives were met by the project mentioned above.

Objective 1: Analyze leadership & management roles in social systems; (performance)

This project specially goes on to target the administration of the nursing homes as it works to improve the communication between the administration and the nurses. The management of the nursing homes is quite directly linked to the way the nurses perform in them. The more responsible are about their duties and their responsibilities, the better management of the nursing home would be.

As it would be known, this problem has been present since a long time. Picking it out and coming up with a solution is quite beneficial to the entire society. It would not only affect one nursing home but if this is successful, it can be applied throughout the community. Ultimately, this would lead to decrease in errors and enhanced care of the elderly population.

Objective 2: Evaluate the effectiveness of organizational structure; (performance & social responsibility)

This project is a major social responsibility considering the amount of elderly population that is being admitted into nursing homes. With the advent of various chronic illnesses, the concept of end of life care has been increasing which is leading to increase load in these homes. Seeing how the load is increasing, there are not any drastic changes being made to the workforce in these nursing homes. Ultimately, the workload on the nurses is increasing which is contributing to nursing fatigue. This vicious cycle needs to be looked into before it goes on to create problems for the people admitted in the nursing homes. No matter how hard these nurses try, their increased fatigue is likely to cause problems.

Objective 3: Evaluate own critical thinking skills utilized in nursing practice; (critical thinking, creativity and performance)

This project goes on to inquire and gain input from the nurses. Even though we will provide them with the heading of environmental variables, but there are many opened ended questions available. This means that they can give their input on this matter. Seeing how this survey and questionnaire will gain input from different nurses, it will give rise to creative answers and different options. Not only will this help the administration but it will also give them insight about the thinking process of these nurses. This will enhance the creativity of the hospital administration and ultimately lead to increased performance.

Conclusion

Nursing fatigue is a growing problem all over the world today. Seeing how this problem can lead to many preventable disasters, there is something that needs to be done by it. Regardless of what status, all health care professionals have a moral, ethical and even a legal responsibility to take care of their patients in the right way. These personnel are ebbing paid to do their duty in the right way and hence they should refrain from making mistakes.

The major argument over here is that nurses are humans just like all of us. They are likely to get tired and be over worked. Furthermore, every person has a mental and physical threshold of working as well. Many nurses are victim to lack of sleep and nutrition, which is lead to poor psychosocial health for the nurses. The nursing profession involves both skill and empathy therefore; they need to make sure that they excel in all of these aspects. To combat and resolve all of this, the problem of nursing fatigue needs to be looked into. This project will therefore look into this problem and devise various strategies to solve it so that the entire concept of nursing fatigue can be reduced.