Date of Award

2011-12-01

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Andrea L. Hazen, PhD; Dennis L. Spence, PhD, CRNA

Keywords

call-shift fatigue, Certified Registered Nurse Anesthetists, nursing

Abstract

Purpose: The purpose of this study was to examine whether Certified Registered Nurse Anesthetists (CRNAs) experience fatigue during call and to assess their use of fatigue avoidance strategies (practices that prevent fatigue) and fatigue countermeasures (practices that decrease fatigue) to mitigate its effects. Method: Using a cross sectional descriptive survey design, data were collected from a randomly selected sample of 323 practicing CRNAs who worked call shifts. Data analysis: Data were analyzed using descriptive and multivariate statistics. Results: The sample was fairly evenly distributed with slightly more female respondents, 55% (n = 179). Fifty four percent worked a weekday call of ≤16 hours; 75% worked weekend shifts >17 hours. Nearly 43% described fatigue occurring 'often' (nearly every call), or 'frequent' (once/month), and 57% as 'occasional' (4 times/year), or 'rare' (once/year). Of 91 CRNAs who reported a patient care error, 63% reported frequent fatigue. The theory of unpleasant symptoms (Lenz et al., 1997) provided a conceptual pathway for fatigue influences: physiologic, psychological, and situational factors that can lead to health symptoms and affect performance. Open-ended descriptions of interventions were coded as physiologic, psychological, or situational tactics. 'Fatigue prevention' (sleeping longer, napping before call), was the primary fatigue avoidance strategy, while 'nutrition' (i.e. snacks, caffeine, etc.) was the primary fatigue countermeasure. Logistic regression results indicate the overall model of eight predictors was statistically reliable in distinguishing status of fatigue experience (–2 Log Likelihood = 385.08; Goodness of Fit = 3.59; x² (10) = 49.06, p = .000). Wald statistics indicate weekend call duration, fatigue avoidance strategy use, number of fatigue countermeasures used, and number of anesthesia days per week was significant in predicting fatigue status. Conclusion: This study presents findings related to the experience of fatigue and challenges the individual practitioner to be aware of fatigue's effect on performance, supports a relationship between healthcare worker fatigue and patient error, and adds to the scientific knowledge regarding the use of fatigue avoidance strategies and countermeasures. Fatigue awareness and education programs to promote healthy sleep and alertness should be developed, implemented, and evaluated.

Document Type

Dissertation: Open Access

Department

Nursing

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Nursing Commons

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