Factors Associated with Work-Related Fatigue and Recovery in Hospital Nurses Working 12-Hour Shifts

Sleepiness and fatigue are two interrelated, but distinct phenomena; observed in a number of psychiatric, medical and primary sleep disorders. Despite their different implications in terms of diagnosis and treatment, these two terms are often used interchangeably, or merged under the more general lay term of 'tired'. Sleepiness is multidimensional and has many causes (multidetermined) and distinguished from fatigue by a presumed impairment of the normal arousal mechanism. Despite its ubiquity, no clear consensus exits as yet as to what constitutes sleepiness. Definitions of sleepiness, to date, are at best operational definitions, conceptualized so as to produce specific assessment instruments. As a result, while a number of subjective and objective measurement tools have been developed to measure sleepiness, each only captures a limited aspect of an otherwise heterogeneous entity. Fatigue is an equally complex phenomenon, its nature captured by a number of conceptualizations and definitions. Measures of fatigue have remained subjective, with a 'gold standard' for its measurement remaining elusive. Despite a high prevalence and high degree of morbidity, fatigue has remained a relatively under appreciated symptom, from both a clinical and research point of view.

In 1993, an extensive review on the role of psychosocial factors in the development of musculoskeletal problems was published by Bongers et al (1993). Since then, additional reviews on this topic have been published; however, none of these focussed on upper limb problems. In this systematic review, the methodological quality of all studies was assessed and levels of evidence were apriori defined. The large majority of the studies reported an association between at least one work-related psychosocial factor and adverse upper extremity symptoms or signs. High-perceived job stress was consistently associated with all upper extremity problems (UEP) in high and lower quality studies. Although not often studied, non-work-related stress was also consistently associated with UEP. In addition, there was some evidence for a relationship between high job demands and UEP, although the results did not meet the pre-set criterion for consistency. High job stress and non-work-related stress reactions are consistently associated with UEP. In addition, high job demands is also in most studies associated with these disorders. Firm conclusions on the role of these factors in the etiology of UEP are not possible due to the cross-sectional nature of most studies.