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How can we help the nurses to overcome or prevent fatigue and stress at work due to their long working hours.

Challenges Associated with Long Working Hours among Nurses

Work time longer than 12 hours are quite common and popular among nurses working in hospitals and directly affects the care that they deliver to the patients and the wellbeing of the nursing professionals as well. The actual length of working shifts are most often unpredictable due to the fluctuations in the needs and health demands of the patients and the unanticipated charges of staffing. This subsequently results in working unplanned for overtime, beyond the actual scheduled time of the nursing staff (Van Bogaert et al. 2013). Under circumstances when the long working shifts are most often combined with overtime, and shifts that rotate between night and day, the nursing staff show an increased likelihood of suffering from burnout and fatigue that compromises the patient care.

Despite presence of certain regulations on the cumulative working time, and shift length for the resident doctors, there are no appropriate policies on nursing work hours. In the words of Caruso (2014) stress in workplace has been identified as a major risk factor that threatens the health and safety of all employees. Owing to the constantly changing environment of the healthcare sector, the working conditions are gradually becoming increasingly stressful and demanding, thus increasing the work hours for the nursing staff and deteriorating their quality of life and job satisfaction. This scoping project proposal will aim to suggest strategies and tools that can be implemented to help the nurses overcome or prevent stress and fatigue at work, due to their long working hours. This scoping project will act as the primary outline for the change that is intended to be proposed in healthcare departments to reduce the workload, fatigue and burnout among nurses, with the aim of lowering rates of clinical error. The scoping paper will recognise the scope related to future work practice needed to help the nurses to overcome or prevent fatigue and stress at work due to their long working hours.

The proposal intends to conduct a consultation program over a period of one month, where the nurses will be made to attend one hourly session with various stakeholders on alternate days of a week. The consultation procedure will be observed from the perspective of both the client and the consultant. Considering the different challenges that are associated with the healthcare sector, nursing staff must be provided an opportunity to solve their problems that lead to stress and fatigue due to workload and longer shift timings, and accomplish their goals. An occupational health advisor will be involved in the program. Phillips et al. (2015) states that occupational health advisors act as leaders of the public healthcare in workplaces and hold specialization in caring and enhancing the wellbeing of all employees at work. Consultation with such an advisor will enable the nursing staff to assess their needs and issues, with the aim of promoting good health and reducing burnout. The nursing staff will be given the opportunity to directly contact the advisors and approach them will stress related questions. This consultation will have the direct benefit of assisting the nurses to identify and prevent their work-related stress, assess their stress conditions, risk assessment, and understand the coping strategies.

Strategies to Help Nurses Overcome or Prevent Fatigue and Stress at Work

Job stress most often creates hazardous impacts on the health of the nurses, besides interfering with their capabilities to cope with the job demands (Faragher, Cass and Cooper 2013). Hence, the occupational health advisor will suggest different strategies that will help nurses reduce their stress levels and burnout, thereby lessening the chances of medication errors that occur thereafter. During the hour long session that nurses will be taught about various relaxation techniques that they should adhere to, in order to remain at work, while reducing stress levels. Sonnentag et al. (2016) took into consideration the fact that stress leads to a disruption of sleep, among the affected people, consultation with a sleep specialist will also be crucial. Sound sleep plays a crucial role in optimal health and wellbeing of individuals. Difficulty in sleeping due to stress often reduces the overall health related quality of life.

Consultation with a psychologist will take place in the form of counseling session where the nurses will be subjected to cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) for relieving them of the stress symptoms that are a direct manifestation of workload (Hayes et al. 2013). Physician support groups are responsible for managing stress and averting burnout among professionals. During the program, physician will create an environment that allows the nurses to share confidential information related to their thoughts and concerns on clinical errors, effect of long working hours, and personal matter. The physician will be responsible for fostering a trustworthy relationship with the nurses, thus helping them cope with their stress.

A lifestyle consultant has the role of promoting drive and guidance to their clients for enhancing their career, lives and relationship. The consultant will analyse the personal environment and lifestyle of the nurses, assess their personal space, and formulate solutions towards accomplishing different goals. Consultation with nursing supervisors will help in proper assigning and scheduling of the nursing staff in an appropriate manner, in order to reduce their work pressure and lessen working time to eight hours.

Following implementation of slow breathing, muscle relaxation techniques, and counseling by the advisors, the nurses will be provided with the self-administered Ardell Wellness Stress Test, a stress assessment tool that adopts a holistic approach towards stress management. Making the nurses provide responses to the set of 25 questions that focus on mental, physical, emotional, social, and spiritual aspects of health will help in determining the efficacy of consultation with occupational health advisor for stress reduction (Agaoglu and Esen 2014). The Epworth Sleepiness Scale (ESS) tool will be used for assessing the impact of long shift hours and workload on the daytime functioning of the nurses (Wright and Lack 2014). The sleep therapist will provide assistance to complete the questionnaire that will measure the daytime sleepiness of the nurses, which might lead to medication errors. Providing answers to questions that focus on the likelihood of dozing off under certain situations. Upon obtaining scores that establish a relation between stresses and sleep disorder, pharmacotherapy and/or behavioural therapies will be implemented.

Consultation Program

Progress of the patients following implementation of cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) will be assessed with the use of the self-administered psychological instrument, the Perceived Stress Scale, comprising of 10 questions. This psychological instrument is most commonly used for determining the degree to which a person perceives certain situations as stressful (Warttig et al. 2013). A patient satisfaction survey tool will help in measuring quality improvement. According to Thayaparan and Mahdi (2013) the Patient Satisfaction Questionnaire Short-Form (PSQ-18) will be used for the same where the 18 items will determine the general satisfaction, technical quality, interpersonal manner, communication, time spent with doctors, financial aspects, and accessibility and convenience. The incidence of adverse health incidents due to clinical errors will be measured by assessing the database and clinical records of the hospital. This will help in the establishment of an association between medical negligence and the number of clinical errors.

The McCloskey/Mueller Satisfaction Scale will help in reporting the nurse job satisfaction, thereby providing an insight into the intention of nurses to stay employed in the hospitals (Gurková et al. 2013). This will be followed by face-to-face interviews. Staff productivity will be analysed via a 360-degree feedback method that will use comments from all nursing staff and their co-workers, based on their interaction with each other (Bracken and Church 2013). Employee retention rate will be calculated by dividing the number of nurses who left during a certain time frame, by the total employees present at the end of the time period (Bode, Singh and Rogan 2015). The aforementioned stress assessment scores will prove beneficial in gathering information about the number of nurses who are affected due to burnout syndrome. Accuracy of care and nursing competencies and qualification will be better measured via the conduction of face-to-face interviews of the nursing staff and the hospital administrators who monitor the former’s actions.

Analysis of the inter-professional team involvement and perspectives and how they will impact on project plan

Inter-professional care is an essential part if the healthcare service delivery system. It assists in achieving improved care and optimal output via working together through sharing of the skills. Successful delivery of the inter-professional care depends on the overall contribution of the inter-professional team members based on their respective skills and competencies (Kaini 2015). The members of the inter-professional team for this project plan include healthcare professionals from different healthcare domains like psychologist, physicians, sleep therapist and lifestyle therapist. The inter-professional team involvement will be done through proper engagement. Engagement is an interactive approach where two parties engage in exchange of dialogue with answers leading towards more questions and the final output is development of understanding between the interactive parties. The process of engagement among the healthcare professionals can be done through interactive communication process. According to Reeves et al. (2013), active communication among the members of the multidisciplinary healthcare professional team helps increase the overall team collaboration. Increase in the team collaboration will help to promote better stress related outcome among the nursing professionals. The main communication strategies that can be used among the healthcare professionals of a multidisciplinary team in order to improve their overall involvement in the project plan include SBAR approach. SBAR is a situational briefing guide that is used for standardised communication format. SBAR is an acronym where S stands for Situation (what is going on with the patient or the selected focus group), B stands for Background (the clinical background of the patient), A stands for Assessment (proper assessment of the problem) and R stands for recommendation (what needs to be done for the patients) (Whittingham and Oldroyd 2014). Using SBAR approach will help the healthcare professionals: psychologists, physicians, sleep therapist and lifestyle therapists to indulge in active decision making planning based on the needs of the nursing professionals in order to cope up with their escalating workplace stress and job burnout.

Relaxation Techniques

Among the inter-professional team, the role of the psychologist is effective counselling. According to Conley, Travers and Bryant (2013), counselling helps in effective stress management. It is the role of a psychologist to generate a sense of trust with his or her client and thereby helping to look over different approaches of their life through different perspective. The development of trust helps in the generation of therapeutic relation this in turn will help to promote person-centred care plan for effective management of stress. The mental aspect of a patient influences the physical health parameter. The main physical complication arising from stress includes headache, constipation, nausea pain in joint and muscles. So it will be the role of the physicians to take into consideration the physical health complications of the nursing professionals arising out of stress (Toussaint et al., 2016). Nakamura (2017), highlighted that increase level of stress leads to the development of insomnia due to disturbance in sleep. The hamper in the sleep quality further affects the mental and the physical health status of the nursing professionals and thereby increasing their level of job burnout and stress. It will be the role of the sleep therapist to provide effective interventions in sleep management and this can be done under active collaboration with psychologist and physicians. Lifestyle change also plays an important role in modulating the level of stress. The change in the lifestyle through the modulation of the diet plan under the active collaboration and engagement with the healthcare physicians will help to promote better health-related outcome (Riekert et al. 2013). Thus effective engagement of the inter-disciplinary team will help to reduce the level of stress among the nursing professionals through comprehensive approach.

In order to promote active collaboration among the inter-professional team in by project, I will employ multidisciplinary communication strategy. Multidisciplinary communication strategy will help to increase the level of involvement and engagement among the healthcare professionals and this will help to promote overall outcome of the project plan. The main communication strategy that I will use in order to increase effective collaboration and engagement among the multidisciplinary team members is verbal communication. According to Keyton et al. (2013), verbal communication strategy can be broken down into two categories written and oral communication. Write communication mainly includes e-mail, text and chats. Oral communication strategy includes phone calls, video calls and face-to-face conversation. In my project planning, I will emphasise over face-to-face mode of communication. Przybylski and Weinstein (2013) highlighted that face-to-face communication helps in effective exchange of thoughts through direct speech and eye contact along with exchange of ideas among the interacting groups therefore helping to increase the overall engagement and better understanding of the process. Mavridis (2015) stated that communication strategies also include non-verbal mode of communication. Non-verbal mode of communication is mainly guided by the body language, facial expression, and tone of voice. However, non-verbal mode of communication is not effective in exchange of ideas however; the use of proper non-verbal mode of communication among the healthcare professionals of the multidisciplinary team will help to promote the effective and trustworthy relationship with the inter-disciplinary team. The development of trustworthy relationship will help to increase the effective exchange of ideas and information and thus facilitating collaboration among the team members.

Counseling and Physician Support Groups

In order to influence effective collaboration and engagement among the inter-professional team, I will follow an amalgamation of the both verbal and non-verbal communication strategies. According to Rowlands and Callen (2013), establishment of effective communication among the healthcare professionals of a multidisciplinary team members helps in proper exchange of the patient information (nursing professionals who are suffering from stress). The qualitative study conducted by Rowlands and Callen (2013) through semi-structured interview face-to-face communication among the healthcare professionals might not be feasible under all circumstances. The reason highlighted against this is, the healthcare professionals like the psychologist, occupational therapists and the physicians remain busy with the packed schedule and hence it is not feasible from their end to take part in face-to-face communication. Such initiatives are required to be taken in order to facilitate written communication through mails and chats.  However, though emails and chats will be allowed as a medium of communication among the inter-professional team members, I will mainly highlight over the face-to-face communication in order to increase the level of trust and understanding among the members of the multidisciplinary team. Proper engagement among the team members will help to facilitate development of effective strategies and tools for evaluating the level of stress among the nursing professionals in the clinical ward.

Conclusion

Thus from the above discussion, it can be concluded that the main diagnostic tools that can be used for the process of consultation in the project planning for reducing the level of stress among the nursing professionals include Epworth Sleepiness Scale, Ardell Wellness stress test and Perceived stress scale. The collection of the data from the perspective of the nursing professionals who are suffering from stress include McCloskey/Mueller Satisfaction Scale. This is a self-assessment scale. Multidisciplinary team members will be asked to use 360 degree feedback method in order to evaluate the level of staff productivity. The level of patient satisfaction will be measured through PSQ-18 survey. The paper also highlighted that effective collaboration among the healthcare professionals of a multidisciplinary team will help to improve the overall health-outcome of the stress-level among the nursing professionals. In order to increase the level of engagement and collaboration among the multidisciplinary team, amalgamation of the verbal and non-vernal mode of communication will be used.

References

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Caruso, C.C., 2014. Negative impacts of shiftwork and long work hours. Rehabilitation Nursing, 39(1), pp.16-25.

Conley, C.S., Travers, L.V. and Bryant, F.B., 2013. Promoting psychosocial adjustment and stress management in first-year college students: The benefits of engagement in a psychosocial wellness seminar. Journal of American College Health, 61(2), pp.75-86.

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