Implementing a fatigue countermeasures program for nurses: a focus group analysis.

OBJECTIVE: The purpose of this study was to describe the structural, organizational, and environmental factors associated with the implementation a fatigue countermeasures program for nurses (FCMPN). BACKGROUND: The industrial sector has developed fatigue management programs to improve safety for employees and customers. However, fatigue management programs have not been developed for nurses. METHODS: The oral descriptions of 46 staff nurses and 8 nurse managers participating in an FCMPN were audiotaped, transcribed, and analyzed. RESULTS: Staff nurses identified awareness, restfulness, and lifestyle control as FCMPN benefits, whereas challenges included work culture, physical environment, and emotional turmoil. Nurse managers perceived ease of program implementation, employee-employer partnerships, and research engagement as benefits. Challenges included lack of support, nursing/organizational culture, and dissonance in staff levels and organizational policies. CONCLUSION: Although FCMPNs are feasible and sustainable in healthcare, a paradigm shift may be needed for a robust implementation of an effective FCMPN that improves patient safety.

An interventional approach for patient and nurse safety: a fatigue countermeasures feasibility study.

BACKGROUND: Studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long work hours coupled with insufficient sleep and fatigue are even riskier. Although other industries have developed programs to reduce fatigue-related errors and injury, fatigue countermeasures program for nurses (FCMPN) are lacking. OBJECTIVES: The objective of this study was to evaluate the feasibility of an FCMPN for improving sleep duration and quality while reducing daytime sleepiness and patient care errors. Selected sleep variables, errors and drowsy driving, were evaluated among hospital staff nurses (n = 47) before and after FCMPN implementation. METHOD: A one-group pretest-posttest repeated-measures approach was used. Participants provided data 2 weeks before the FCMPN, 4 weeks after receiving the intervention, and again at 3 months after intervention. RESULTS: Most of the nurses experienced poor sleep quality, severe daytime sleepiness, and decreased alertness at work and while operating a motor vehicle. After the FCMPN, significant improvements were noted in sleep duration, sleep quality, alertness, and error prevention. Although significant improvements were not found in daytime sleepiness scores, severity of daytime sleepiness appeared to decrease. Despite improvements in fatigue management, nurses reported feelings of guilt when engaging in FCMPN activities, especially strategic naps and relieved breaks. CONCLUSIONS: Initial findings support the feasibility of using an FCMPN for mitigating fatigue, improving sleep, and reducing errors among hospital staff nurses. In future investigations, the acceptability, efficacy, and effectiveness of FCMPNs can be examined.

Meeting the complex needs of the health care team: identification of nurse-team communication practices perceived to enhance patient outcomes.

Nurses occupy a central position in today's increasingly collaborative health care teams that place a premium on quality patient care. In this study we examined critical team processes and identified specific nurse-team communication practices that were perceived by team members to enhance patient outcomes. Fifty patient-care team members were interviewed to uncover forms of nurse communication perceived to improve team performance. Using a grounded theory approach and constant comparative analysis, study findings reveal two critical processes nurses contribute to as the most central and consistent members of the health care team: ensuring quality decisions and promoting a synergistic team. Moreover, the findings reveal 15 specific nurse-team communication practices that comprise these processes, and thereby are theorized to improve patient outcomes.

Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions.

This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in team-based health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.