WEBVTT 00:00:00.040 --> 00:00:06.280 position:50% align:middle - [Moderator] Beverly Hittle is an assistant professor from the University of Cincinnati College of Nursing. 00:00:06.280 --> 00:00:12.600 position:50% align:middle Her extensive nursing background, working shift work in the acute care setting, inspired her research path 00:00:12.600 --> 00:00:20.657 position:50% align:middle of investigating the intersection of organizational and individual factors contributing to worker poor sleep. 00:00:20.657 --> 00:00:26.400 position:50% align:middle She has an MSN and PhD focused in occupational health nursing. 00:00:26.400 --> 00:00:31.465 position:50% align:middle Supported by a training grant from the National Institute for Occupational Safety and Health, 00:00:31.465 --> 00:00:37.045 position:50% align:middle also known as NIOSH, in 2019, she was a scholar and residence at NCSBN. 00:00:37.045 --> 00:00:42.239 position:50% align:middle She is currently funded, through NIOSH, working with researchers in the Center for Work 00:00:42.239 --> 00:00:44.075 position:50% align:middle and Fatigue Research. 00:00:44.075 --> 00:00:50.457 position:50% align:middle They're preparing to launch a project examining the effectiveness of the NIOSH online educational program 00:00:50.457 --> 00:00:57.509 position:50% align:middle on nurse sleep and well-being entitled, Training for Nurses on Shift Work and Long Work Hours. 00:01:04.357 --> 00:01:06.967 position:50% align:middle - [Dr. Hittle] Hello, and thank you for the introduction. 00:01:06.967 --> 00:01:09.653 position:50% align:middle And thank you to everyone for joining this session. 00:01:09.653 --> 00:01:14.447 position:50% align:middle Before we start, I would like to provide the following disclaimer that the views expressed 00:01:14.447 --> 00:01:16.305 position:50% align:middle in this presentation are my views. 00:01:16.305 --> 00:01:21.359 position:50% align:middle It does not necessarily reflect the views or position of my employer or the contracting work 00:01:21.359 --> 00:01:24.581 position:50% align:middle at the National Institute for Occupational Safety and Health. 00:01:24.581 --> 00:01:30.459 position:50% align:middle Today's presentation is based on some of the work I've been doing to provide recommendations on sleep, 00:01:30.459 --> 00:01:32.179 position:50% align:middle fatigue in shift work. 00:01:32.179 --> 00:01:38.009 position:50% align:middle We will review how to define fatigue in the context of shift work, the status of sleep and fatigue 00:01:38.009 --> 00:01:43.458 position:50% align:middle in healthcare, recommendations for managing fatigue among healthcare leadership and workers, 00:01:43.458 --> 00:01:47.419 position:50% align:middle barriers to fatigue management, how to overcome those barriers, 00:01:47.419 --> 00:01:49.139 position:50% align:middle and future research needs. 00:01:50.244 --> 00:01:52.694 position:50% align:middle We have all seen the headlines. 00:01:52.694 --> 00:01:58.709 position:50% align:middle Those of you in attendance who were practicing at the bedside, you know firsthand the toll that COVID-19 has 00:01:58.709 --> 00:02:01.662 position:50% align:middle taken on nurses and other healthcare practitioners. 00:02:01.662 --> 00:02:08.297 position:50% align:middle For the rest of us, we are hearing from friends and colleagues about how caring for COVID-19 patients 00:02:08.297 --> 00:02:10.859 position:50% align:middle has affected the healthcare workforce. 00:02:10.859 --> 00:02:17.028 position:50% align:middle One thing is clear, nurses and other healthcare providers are exhausted physically and mentally. 00:02:17.028 --> 00:02:20.071 position:50% align:middle But what does it mean to be fatigued? 00:02:20.071 --> 00:02:25.526 position:50% align:middle We each may have our own perception, and certainly in the face of the coronavirus pandemic, 00:02:25.526 --> 00:02:30.530 position:50% align:middle fatigue among healthcare workers seems to be all-encompassing and compounded by emotions 00:02:30.530 --> 00:02:32.940 position:50% align:middle of grief and isolation. 00:02:32.940 --> 00:02:36.430 position:50% align:middle Generally, in the sleep and fatigue, and occupational health world, 00:02:36.430 --> 00:02:41.625 position:50% align:middle when we talk about fatigue, many is the definition published by Dr. Steve Lerman and colleagues 00:02:41.625 --> 00:02:48.130 position:50% align:middle on behalf of the American College of Occupational Environmental Medicine Presidential Task Force. 00:02:48.130 --> 00:02:54.987 position:50% align:middle They defined fatigue as the body's response to sleep loss or to prolonged physical or mental exertion. 00:02:54.987 --> 00:03:01.316 position:50% align:middle Sleep loss, physical and mental fatigue, they collectively and they individually lead 00:03:01.316 --> 00:03:05.748 position:50% align:middle to decreased alertness and response time, contributing to injuries and errors. 00:03:05.748 --> 00:03:13.275 position:50% align:middle In addition to poor cognitive functioning, sleep and the disruption to circadian rhythms 00:03:13.275 --> 00:03:18.303 position:50% align:middle caused by shift work can also contribute to poor health outcomes for workers. 00:03:18.303 --> 00:03:23.226 position:50% align:middle You can see in this slide some of the sequela of poor sleep and circadian rhythms disruption. 00:03:23.226 --> 00:03:30.780 position:50% align:middle Although some of these outcomes may not present for many years, mental health outcomes including emotional 00:03:30.780 --> 00:03:33.257 position:50% align:middle regulation are more immediate effects. 00:03:33.257 --> 00:03:38.040 position:50% align:middle From a healthcare regulatory standpoint, it is important to mitigate the effects of 00:03:38.040 --> 00:03:42.522 position:50% align:middle healthcare fatigue which may contribute to adverse events involving patients. 00:03:42.522 --> 00:03:47.962 position:50% align:middle Yet the coronavirus pandemic has placed a tremendous strain on the healthcare workforce, 00:03:47.962 --> 00:03:51.940 position:50% align:middle exposing the importance of supporting worker health. 00:03:51.940 --> 00:03:57.826 position:50% align:middle With that, we need to also place increased importance on promoting workers' sleep 00:03:57.826 --> 00:04:02.567 position:50% align:middle and health to ensure that we have a workforce available to care for the public. 00:04:03.783 --> 00:04:07.418 position:50% align:middle So how fatigued and tired is the nursing workforce? 00:04:07.537 --> 00:04:14.057 position:50% align:middle A recent study from nurse scientists at the University of Tennessee and the University of Madison Wisconsin 00:04:14.057 --> 00:04:18.789 position:50% align:middle compared nurses caring for COVID-19 patients versus those who were not. 00:04:18.789 --> 00:04:23.297 position:50% align:middle Nurses caring for COVID-19 patients reported more insomnia and fatigue, 00:04:23.297 --> 00:04:28.775 position:50% align:middle but the fact is both groups were reporting moderate to high acute and chronic fatigue. 00:04:28.775 --> 00:04:36.710 position:50% align:middle On workdays, almost 83% of all the nurses reported sleeping below the recommended 7 hours of sleep. 00:04:36.710 --> 00:04:43.103 position:50% align:middle Similar sleep duration statistics have been noted in the literature about nurses prior to COVID-19. 00:04:43.103 --> 00:04:47.401 position:50% align:middle Although the situation has clearly worsened from a mental health standpoint, 00:04:47.401 --> 00:04:52.891 position:50% align:middle the case can be made that sleep and fatigue existed prior to the onset of the pandemic 00:04:52.891 --> 00:04:57.958 position:50% align:middle and will be a persistent issue to address in the post-COVID-19 era. 00:04:58.708 --> 00:05:03.960 position:50% align:middle We know there are organizational factors that contribute to worker sleep and fatigue, 00:05:03.960 --> 00:05:08.479 position:50% align:middle workload, work timing, extended work hours, and culture. 00:05:08.479 --> 00:05:15.694 position:50% align:middle Workload, nursing is a very stressful profession and the physical and mental demands required of nurses 00:05:15.694 --> 00:05:17.466 position:50% align:middle can contribute to fatigue. 00:05:17.466 --> 00:05:22.809 position:50% align:middle Think of the number of patients a nurse can care for within a shift, think of the acuity of the patients, 00:05:22.809 --> 00:05:27.126 position:50% align:middle the number of steps the nurse must take between rooms and supplies on the unit, 00:05:27.126 --> 00:05:30.764 position:50% align:middle the multiple tasks required of nurses within a shift. 00:05:30.764 --> 00:05:35.416 position:50% align:middle Oftentimes, the workload is so high, nurses are not able to take breaks. 00:05:35.416 --> 00:05:41.044 position:50% align:middle As nurses, we know these factors contribute to fatigue and there is evidence to support nurses' 00:05:41.044 --> 00:05:43.221 position:50% align:middle personal knowledge and lived experience. 00:05:43.221 --> 00:05:48.121 position:50% align:middle Work timing, likewise work timing, this refers to like, the time that someone would be at work, 00:05:48.121 --> 00:05:52.406 position:50% align:middle so such as like night shift, evening shift, early mornings, rotating shifts. 00:05:52.406 --> 00:05:57.514 position:50% align:middle These are all the work hours that can contribute to disruption to our natural circadian rhythms 00:05:57.514 --> 00:06:00.169 position:50% align:middle in our sleep and also cause fatigue. 00:06:00.169 --> 00:06:04.846 position:50% align:middle But of course, we require nurses to provide care in 24-hour facilities. 00:06:04.846 --> 00:06:07.941 position:50% align:middle So this is kind of something we can't avoid. 00:06:07.941 --> 00:06:13.293 position:50% align:middle Extended work hours, these are the shift lengths, shifts extending beyond 10 hours 00:06:13.293 --> 00:06:17.541 position:50% align:middle and weekly overtime, including voluntary and mandatory overtime. 00:06:17.541 --> 00:06:20.004 position:50% align:middle Finally, culture. 00:06:20.004 --> 00:06:25.153 position:50% align:middle Organizational safety and professional culture, they have all embraced the three factors, 00:06:25.153 --> 00:06:27.186 position:50% align:middle the other three factors in many ways. 00:06:27.186 --> 00:06:31.062 position:50% align:middle There's a [inaudible] that we have seen with little sleep and long work hours 00:06:31.062 --> 00:06:32.717 position:50% align:middle in the healthcare industry. 00:06:32.717 --> 00:06:38.181 position:50% align:middle In my research, advanced nurse practitioners have told me how the medical profession's culture 00:06:38.181 --> 00:06:42.700 position:50% align:middle surrounding work hours has influenced their own actions and beliefs related to sleep, 00:06:42.700 --> 00:06:48.457 position:50% align:middle where they feel they are compelled to come to work regardless of illness and fatigue. 00:06:48.457 --> 00:06:53.794 position:50% align:middle We see a culture in healthcare where napping while at work, even if it's on a break, 00:06:53.794 --> 00:06:55.926 position:50% align:middle is still considered a fireable offense. 00:06:55.926 --> 00:07:00.982 position:50% align:middle Individually, these work factors can cause fatigue, but we also need to think about, like, 00:07:00.982 --> 00:07:06.062 position:50% align:middle how they intersect for experiencing, like, multiple factors at once can create 00:07:06.062 --> 00:07:07.583 position:50% align:middle like a compounding effect. 00:07:07.583 --> 00:07:14.275 position:50% align:middle Folkard and Lombardi, in a very seminal paper, developed a risk index model to predict the risk 00:07:14.275 --> 00:07:16.933 position:50% align:middle of adverse event when working shift work. 00:07:16.933 --> 00:07:24.480 position:50% align:middle This model was based on kind of weekly work hours and shift components like, shift length, breaks, timing. 00:07:24.480 --> 00:07:30.655 position:50% align:middle And the researchers found substantial increase in risks for injuries and errors with each, like, 00:07:30.655 --> 00:07:36.253 position:50% align:middle subsequent night shift so that by the third night shift in a row, the risk was 17% higher 00:07:36.253 --> 00:07:39.456 position:50% align:middle and by the fourth night shif t in a row, it was 36% higher. 00:07:39.456 --> 00:07:43.396 position:50% align:middle And similarly, the risks increased exponentially with longer shifts. 00:07:43.396 --> 00:07:51.516 position:50% align:middle So overlaying these factors resulted in even higher risks, and there's evidence to support this in nursing. 00:07:51.516 --> 00:07:58.312 position:50% align:middle So in shift working nurses, Dr. Geiger-Brown, she had published work demonstrating how 00:07:58.312 --> 00:08:06.448 position:50% align:middle every adverse work condition that shift working nurses experienced, such as overtime, shift length, you know, 00:08:06.502 --> 00:08:12.262 position:50% align:middle shift timing, when they increased the odds... when they overlay, they increase the odds of nurses 00:08:12.262 --> 00:08:14.118 position:50% align:middle reporting sleep problems. 00:08:15.500 --> 00:08:16.902 position:50% align:middle So where does this leave us? 00:08:16.902 --> 00:08:18.212 position:50% align:middle How should we proceed? 00:08:18.212 --> 00:08:19.865 position:50% align:middle Are there any solutions? 00:08:19.865 --> 00:08:25.042 position:50% align:middle The path recommended by experts in the field as well as healthcare accrediting professional organizations 00:08:25.042 --> 00:08:30.754 position:50% align:middle such as the American Nurses Association and the Joint Commission is to institute fatigue 00:08:30.754 --> 00:08:31.994 position:50% align:middle risk management systems. 00:08:31.994 --> 00:08:33.445 position:50% align:middle But what does that even mean? 00:08:33.445 --> 00:08:40.673 position:50% align:middle Fatigue risk management is a multilayered approach to preventing and/or reducing fatigue in the workplace. 00:08:40.673 --> 00:08:44.171 position:50% align:middle It is building layers of defense against fatigue. 00:08:44.171 --> 00:08:49.994 position:50% align:middle So it should be incorporated into a safety management system where sleep and fatigue becomes an important 00:08:49.994 --> 00:08:52.190 position:50% align:middle part of the organizational culture. 00:08:52.190 --> 00:08:55.584 position:50% align:middle This type of system is used in other industries. 00:08:55.584 --> 00:08:57.653 position:50% align:middle You can see it on the airline industry. 00:08:57.653 --> 00:09:04.256 position:50% align:middle It is designed to be a collaborative safety effort among employers and employees using the tenets 00:09:04.256 --> 00:09:08.484 position:50% align:middle of the just culture philosophy which we are aware of in the healthcare industry. 00:09:08.484 --> 00:09:14.413 position:50% align:middle I now want to take a minute to look specifically at the responsibilities of each of these groups. 00:09:14.413 --> 00:09:19.337 position:50% align:middle So to mitigate fatigue, general recommendations for an organization 00:09:19.337 --> 00:09:25.903 position:50% align:middle would include to provide time for rest, educate and train, and then to monitor for fatigue. 00:09:25.903 --> 00:09:30.051 position:50% align:middle So with providing time for rest, workers should have a minimum 00:09:30.051 --> 00:09:32.803 position:50% align:middle of 11 hours off in between shifts. 00:09:32.803 --> 00:09:39.212 position:50% align:middle They need time off to recover from multiple shifts in a row, they need sufficient breaks while at work. 00:09:39.212 --> 00:09:45.134 position:50% align:middle Heavy workloads may require short breaks every two to three hours while they're working 00:09:45.134 --> 00:09:49.663 position:50% align:middle and these strategies can really help to address the workload and extended work hours 00:09:49.663 --> 00:09:52.640 position:50% align:middle as well as mitigate some of the effects of work timing. 00:09:52.640 --> 00:09:58.325 position:50% align:middle Educate and train, the education and training should provide workers with information on the risks 00:09:58.325 --> 00:10:03.535 position:50% align:middle associated with insufficient sleep and fatigue, as well as any evidence-based strategies to employ 00:10:03.535 --> 00:10:05.235 position:50% align:middle while working shift work. 00:10:05.235 --> 00:10:09.864 position:50% align:middle It is really important to train healthcare workers on these topics as they often do not receive this type 00:10:09.864 --> 00:10:12.081 position:50% align:middle of education with their schooling. 00:10:12.081 --> 00:10:17.254 position:50% align:middle Education and training can also help dispel some of the cultural issues surrounding sleep and fatigue 00:10:17.254 --> 00:10:18.924 position:50% align:middle in the healthcare industry. 00:10:18.924 --> 00:10:26.450 position:50% align:middle Monitoring for fatigue includes detecting where sleep and fatigue may contribute to health and safety issues. 00:10:26.450 --> 00:10:34.173 position:50% align:middle In the 2017 study, less than 10% of nurse leaders reported that their organization had a system in place 00:10:34.173 --> 00:10:36.854 position:50% align:middle for monitoring fatigue among nurses. 00:10:36.854 --> 00:10:41.347 position:50% align:middle With an estimated $411 billion lost annually in the U.S.economy 00:10:41.347 --> 00:10:46.368 position:50% align:middle due to poor sleep at the workplace, monitoring for fatigue would seem to be a major 00:10:46.368 --> 00:10:49.479 position:50% align:middle cost-saving initiative to the healthcare industry. 00:10:49.479 --> 00:10:55.231 position:50% align:middle Monitoring also supports the culture change by telling workers that this is a priority for the organization. 00:10:56.300 --> 00:10:59.833 position:50% align:middle And now for the employees, general recommendations include 00:10:59.833 --> 00:11:05.265 position:50% align:middle to use time off for rest, arrive fit for duty, and engage in education and training. 00:11:05.265 --> 00:11:10.388 position:50% align:middle When workers have time off from work, they really should take the time to sleep, 00:11:10.388 --> 00:11:12.898 position:50% align:middle particularly when in between shifts. 00:11:12.898 --> 00:11:17.858 position:50% align:middle Again, there's a professional culture within nursing of self-sacrificing which is very noble, 00:11:17.858 --> 00:11:21.340 position:50% align:middle but we need to instill some self-care in the professional norms. 00:11:21.340 --> 00:11:25.144 position:50% align:middle Rest and rejuvenation is needed to provide care. 00:11:25.144 --> 00:11:30.429 position:50% align:middle Arriving fit for duty, we all know employers cannot tell workers 00:11:30.429 --> 00:11:35.539 position:50% align:middle how to spend their time away from the job, but they can expect workers to show up 00:11:35.539 --> 00:11:37.023 position:50% align:middle and be ready to work. 00:11:37.098 --> 00:11:41.224 position:50% align:middle Sleep and fatigue should become a part of the fitness for duty conversation. 00:11:41.224 --> 00:11:47.004 position:50% align:middle So when someone is awake for 17 hours or more, they begin to exhibit cognitive deficits 00:11:47.004 --> 00:11:48.578 position:50% align:middle similar to alcohol intoxication. 00:11:48.578 --> 00:11:51.796 position:50% align:middle So if this is the case, we all should be expecting sleep and rest 00:11:51.796 --> 00:11:54.214 position:50% align:middle to be a part of the fitness for duty. 00:11:54.214 --> 00:12:00.174 position:50% align:middle And engaging in training and education, this includes attending training programs 00:12:00.174 --> 00:12:02.708 position:50% align:middle as well as employing the learned strategies. 00:12:02.708 --> 00:12:09.097 position:50% align:middle So of course, there always barriers and situations, and I want to discuss a few of these. 00:12:09.097 --> 00:12:12.030 position:50% align:middle The first being that no one size fits all. 00:12:12.030 --> 00:12:17.617 position:50% align:middle There are general recommendations, but how organizations tackle these will vary. 00:12:17.617 --> 00:12:19.847 position:50% align:middle Different organizations have different needs. 00:12:19.847 --> 00:12:24.976 position:50% align:middle Consider the variations that we see in staffing and the staff resources at an urban facility 00:12:24.976 --> 00:12:30.722 position:50% align:middle versus a rural facility among different hospital sizes, patient populations. 00:12:30.722 --> 00:12:36.607 position:50% align:middle I even think about the differences that exist within one organization between different units. 00:12:36.607 --> 00:12:41.952 position:50% align:middle So these variations can make it impossible to prescribe one way to institute fatigue risk management 00:12:41.952 --> 00:12:43.372 position:50% align:middle throughout the country. 00:12:43.372 --> 00:12:46.982 position:50% align:middle Individual differences exist among workers. 00:12:46.982 --> 00:12:52.501 position:50% align:middle So there are biological differences that are noted among individuals that are related to sleep. 00:12:52.501 --> 00:12:55.590 position:50% align:middle I like to use the example of sleep preferences. 00:13:00.548 --> 00:13:00.918 position:50% align:middle We all know those people who like to wake up really early or those people who like to sleep in 00:13:00.918 --> 00:13:02.021 position:50% align:middle and stay up really late. 00:13:02.021 --> 00:13:07.731 position:50% align:middle Those are preferred sleep times that can have a genetic origin to them. 00:13:07.731 --> 00:13:14.388 position:50% align:middle So we can imagine how workers that have those different sleep preferences that can intersect with their work 00:13:14.388 --> 00:13:17.767 position:50% align:middle time and maybe cause some disruption to their sleep. 00:13:17.767 --> 00:13:23.130 position:50% align:middle Social factors can also influence sleep for individuals, factors including gender norms, 00:13:23.130 --> 00:13:25.441 position:50% align:middle racial and ethnic discrimination. 00:13:25.441 --> 00:13:29.980 position:50% align:middle Limited staffing resources, as we are seeing with the coronavirus pandemic, 00:13:29.980 --> 00:13:32.273 position:50% align:middle we cannot control who shows up at the hospital. 00:13:32.273 --> 00:13:34.273 position:50% align:middle When patients need us, they need us. 00:13:34.273 --> 00:13:37.836 position:50% align:middle And these patient numbers and workforce numbers can really ebb and flow. 00:13:37.836 --> 00:13:42.790 position:50% align:middle This can make managing the workload challenging, but it can also be for the reason for controlling 00:13:42.790 --> 00:13:46.259 position:50% align:middle the other factors that contribute to fatigue. 00:13:46.259 --> 00:13:49.683 position:50% align:middle There's a lot of heterogeneity in the research. 00:13:49.683 --> 00:13:54.343 position:50% align:middle There are multiple placements to institute change and this is reflected in the literature. 00:13:54.343 --> 00:13:58.513 position:50% align:middle In addition, study outcomes are measured in a variety of ways. 00:13:58.513 --> 00:14:03.934 position:50% align:middle So regardless though overall, the reviews of literature indicate interventions 00:14:03.934 --> 00:14:07.281 position:50% align:middle do improve worker sleep and fatigue levels. 00:14:07.281 --> 00:14:10.098 position:50% align:middle Fatigue is not always easy to measure. 00:14:10.098 --> 00:14:13.073 position:50% align:middle There are multiple ways to measure sleep and fatigue. 00:14:13.073 --> 00:14:19.447 position:50% align:middle Some are self-reported surveys, but one needs to know what type of measure is desired. 00:14:19.447 --> 00:14:24.651 position:50% align:middle So are you wanting to measure sleepiness right now, are you wanting to measure at the end of a shift, 00:14:24.651 --> 00:14:27.100 position:50% align:middle are you wanting to measure fatigue in between shifts? 00:14:27.100 --> 00:14:31.658 position:50% align:middle So it can be really difficult to find a tool for measurement. 00:14:31.658 --> 00:14:38.584 position:50% align:middle Some devices do exist on the market to help monitor for fatigue, but they may not be feasible in nursing. 00:14:38.584 --> 00:14:46.014 position:50% align:middle The data sources for contributing factors, there are multiple sources for tracking things 00:14:46.014 --> 00:14:51.199 position:50% align:middle like shift length, staffing and patient acuity, and other factors that contribute to fatigue, 00:14:51.199 --> 00:14:58.404 position:50% align:middle but these data sources are often not in one central data collection tool, making it a challenge to assess 00:14:58.404 --> 00:15:01.536 position:50% align:middle the status of the unit and/or individual nurses. 00:15:01.536 --> 00:15:06.885 position:50% align:middle The lack of consideration of sleep and adverse event root cause analyses. 00:15:06.885 --> 00:15:10.742 position:50% align:middle So oftentimes in healthcare, worker sleepiness and fatigue 00:15:11.485 --> 00:15:13.806 position:50% align:middle are not always a consideration in root cause analyses. 00:15:13.806 --> 00:15:19.299 position:50% align:middle My conversations with healthcare providers, management and risk management indicate that 00:15:19.299 --> 00:15:24.615 position:50% align:middle the time of an adverse event is often noted, but further investigation into, like, 00:15:24.615 --> 00:15:26.645 position:50% align:middle a worker schedule leading up to the event. 00:15:26.645 --> 00:15:31.942 position:50% align:middle So were they working on their third or fourth night shift, whether worker's having sleep issues, 00:15:31.942 --> 00:15:35.908 position:50% align:middle and whether they have fatigue at the time of the event is not investigated. 00:15:35.908 --> 00:15:41.873 position:50% align:middle So understandably this may cause a worker to feel culpable, they may not want to admit to fatigue 00:15:41.873 --> 00:15:46.202 position:50% align:middle which is why culture change is so vital, but it also prevents us from really seeing where 00:15:46.202 --> 00:15:52.899 position:50% align:middle there's difficulties in the system such as, like, the scheduling issues. 00:15:52.899 --> 00:15:54.922 position:50% align:middle Addressing barriers. 00:15:54.922 --> 00:16:01.053 position:50% align:middle So with that heterogeneity and practice settings and research, this is where I really see 00:16:01.053 --> 00:16:02.247 position:50% align:middle nursing can shine. 00:16:02.247 --> 00:16:07.469 position:50% align:middle I see that nursing leadership, shared leadership systems within the hospitals, 00:16:07.469 --> 00:16:10.827 position:50% align:middle hospital-based DMPs, they can all come together with our scientists 00:16:10.827 --> 00:16:14.735 position:50% align:middle to develop evidence-based programs that can really make a difference. 00:16:14.735 --> 00:16:19.929 position:50% align:middle There are plenty of resources and recommendations, but each unit in an organization will have to find what 00:16:19.929 --> 00:16:21.433 position:50% align:middle would work for them. 00:16:21.433 --> 00:16:26.277 position:50% align:middle Individual differences, educating workers on the risks and some of the ways 00:16:26.277 --> 00:16:28.925 position:50% align:middle we can differ can be helpful. 00:16:28.925 --> 00:16:33.154 position:50% align:middle It can allow workers to make informed decisions regarding their work and their health. 00:16:33.154 --> 00:16:37.349 position:50% align:middle Anecdotally, I can tell you, when I speak to students and workers about sleep, 00:16:37.349 --> 00:16:40.698 position:50% align:middle they know they're tired, they think it's just part of the job. 00:16:40.698 --> 00:16:44.989 position:50% align:middle But they are often really surprised by how sleep contributes to health. 00:16:44.989 --> 00:16:46.291 position:50% align:middle And it really... 00:16:46.291 --> 00:16:52.187 position:50% align:middle Hearing about that really encourages them to kind of think about ways that they can improve their sleep. 00:16:52.187 --> 00:16:57.381 position:50% align:middle In addition, I think that having a buddy system in place can be really helpful so that nurses can help 00:16:57.381 --> 00:17:00.237 position:50% align:middle support each other and be accountable for each other. 00:17:00.237 --> 00:17:02.705 position:50% align:middle Limited staffing resources. 00:17:02.705 --> 00:17:04.945 position:50% align:middle I cannot pretend to be an expert on this. 00:17:04.945 --> 00:17:09.465 position:50% align:middle I know that this has been an issue in healthcare for many years and certainly, 00:17:09.465 --> 00:17:13.313 position:50% align:middle there are experts on this topic that can speak better of this than I can. 00:17:13.313 --> 00:17:20.149 position:50% align:middle But I will point you to NCSBN had a recent policy brief that they published that was related to academic 00:17:20.149 --> 00:17:23.731 position:50% align:middle practice partnerships during the time of COVID-19. 00:17:23.731 --> 00:17:28.004 position:50% align:middle In addition to that, I would also say that dedicated education units 00:17:28.004 --> 00:17:33.458 position:50% align:middle are an opportunity that can foster relationships with nursing students in an effort to hire them 00:17:33.458 --> 00:17:39.763 position:50% align:middle after graduation as nurses on the unit that they've been working with during their schooling. 00:17:39.763 --> 00:17:42.728 position:50% align:middle Fatigue is not always easy to measure. 00:17:42.728 --> 00:17:48.778 position:50% align:middle There are self-report surveys such as the Epworth Sleepiness Scale as well as short cognitive tests. 00:17:48.778 --> 00:17:53.928 position:50% align:middle Again it is best to carefully review what is being measured to determine the best measurement tool 00:17:53.928 --> 00:17:55.459 position:50% align:middle to suit your needs. 00:17:55.459 --> 00:18:00.128 position:50% align:middle Data sources for contributing fatigue, this disjointed system. 00:18:00.128 --> 00:18:05.057 position:50% align:middle There are predictive model products on the market which attempt to bring some of the multiple 00:18:05.057 --> 00:18:06.765 position:50% align:middle data sources together. 00:18:06.765 --> 00:18:13.164 position:50% align:middle There's also some current research looking at how the brain systems that exist together and measure those 00:18:13.164 --> 00:18:17.734 position:50% align:middle to predict fatigue with the nurses on the unit without having to buy a specific product. 00:18:17.734 --> 00:18:22.698 position:50% align:middle But I think this will be a part of fatigue risk management we really want to watch. 00:18:22.698 --> 00:18:27.338 position:50% align:middle Sleep and fatigue, that lacking of reporting in adverse events. 00:18:27.338 --> 00:18:33.401 position:50% align:middle So the systems need to be inclusive of organizations and workers where there is a joint effort to change 00:18:33.401 --> 00:18:35.655 position:50% align:middle the culture surrounding sleep and fatigue. 00:18:35.655 --> 00:18:37.789 position:50% align:middle So future research. 00:18:37.789 --> 00:18:43.536 position:50% align:middle Although poor sleep and fatigue has been a known issue for many years, the research is really burgeoning 00:18:43.536 --> 00:18:47.964 position:50% align:middle and we feel it's really bright for future opportunities in research. 00:18:47.964 --> 00:18:53.748 position:50% align:middle The culture change, we know from other industries that the culture change helps to promote sleep 00:18:53.748 --> 00:18:55.328 position:50% align:middle and fatigue mitigation. 00:18:55.328 --> 00:19:00.367 position:50% align:middle But the most effective methods for changing this culture in healthcare is unclear. 00:19:00.367 --> 00:19:04.656 position:50% align:middle So how can medicine, nursing, and other healthcare practitioners come together 00:19:04.656 --> 00:19:07.525 position:50% align:middle with hospital leadership to change this culture? 00:19:07.525 --> 00:19:11.599 position:50% align:middle They are some of the questions that still need to be investigated. 00:19:11.599 --> 00:19:16.985 position:50% align:middle As mentioned, predictive models in fatigue detection, and counter strategies are both active 00:19:16.985 --> 00:19:19.590 position:50% align:middle fields of research and things to watch. 00:19:19.590 --> 00:19:26.735 position:50% align:middle Education, NIOSH does have an education program targeting nurses on their website. 00:19:26.735 --> 00:19:32.007 position:50% align:middle It is free to use and we have a study that we're ready to launch with the hopes of recruiting nurses 00:19:32.007 --> 00:19:33.655 position:50% align:middle in the fall of 2021. 00:19:33.655 --> 00:19:38.688 position:50% align:middle Our study purpose is to evaluate the effectiveness of the training on sleep and well-being. 00:19:38.688 --> 00:19:43.288 position:50% align:middle That being said, this is one of the only free education tools available on the market. 00:19:43.288 --> 00:19:49.673 position:50% align:middle There may be training and education programs within organizations, but research is really lacking 00:19:49.673 --> 00:19:53.009 position:50% align:middle on the best method for providing this type of training. 00:19:53.009 --> 00:19:57.368 position:50% align:middle Individual differences, specifically we need to better understand 00:19:57.368 --> 00:20:03.410 position:50% align:middle how the social and environmental influence on individual's sleep, how this all intersects with 00:20:03.410 --> 00:20:09.224 position:50% align:middle shift work and health, and the effectiveness of a full risk management program. 00:20:09.224 --> 00:20:13.000 position:50% align:middle There is enough evidence for recommendations for fatigue risk management, 00:20:13.000 --> 00:20:16.870 position:50% align:middle but we need to better understand how these recommendations can be incorporated 00:20:16.870 --> 00:20:19.641 position:50% align:middle into various practice settings. 00:20:19.641 --> 00:20:23.716 position:50% align:middle So with that, I would like to say thank you again for attending. 00:20:23.716 --> 00:20:29.361 position:50% align:middle A special thank you to Mary Anne, Nancy, and others at NCSBN for inviting me to speak today. 00:20:29.361 --> 00:20:34.342 position:50% align:middle Certainly, if anyone has questions after the conference, please feel free to contact me. 00:20:34.342 --> 00:20:35.774 position:50% align:middle Thank you. 00:20:58.400 --> 00:21:00.386 position:50% align:middle Thanks for joining me today. 00:21:00.386 --> 00:21:02.337 position:50% align:middle I'm so excited to be here. 00:21:02.337 --> 00:21:06.436 position:50% align:middle I mean, to be one of three researchers to be talking about sleep and fatigue, 00:21:06.436 --> 00:21:12.513 position:50% align:middle that tells me that there's such a great interest, tells me that it's moving the research forward. 00:21:12.513 --> 00:21:20.561 position:50% align:middle Certainly, the topics that Dr. Witkoski-Stimpfel and Dr. Farag spoke to really did address 00:21:20.561 --> 00:21:23.907 position:50% align:middle some of the barriers I discussed and some of the places we need more research. 00:21:23.907 --> 00:21:29.907 position:50% align:middle So such an exciting day and I can also see from the Q&A that there's great interest in this. 00:21:29.907 --> 00:21:32.269 position:50% align:middle So thank you all for joining us. 00:21:32.269 --> 00:21:36.726 position:50% align:middle While we're waiting, I just want to say that if anybody has 00:21:36.726 --> 00:21:41.326 position:50% align:middle any kind of questions, any comments, you just want to talk about sleep, happy to do that. 00:21:41.326 --> 00:21:47.365 position:50% align:middle Just email me and I would love to talk to you, beverly.hittle@uc.edu. 00:21:47.365 --> 00:21:55.039 position:50% align:middle And while we're waiting, I also want to acknowledge... I saw Dr. Trinkoff is on the call, who really, 00:21:55.039 --> 00:21:59.441 position:50% align:middle you'll probably see her name in some of our... in the other three...myself and the other two 00:21:59.441 --> 00:22:04.429 position:50% align:middle presentations as somebody who has been doing this type of research for a while 00:22:04.429 --> 00:22:05.616 position:50% align:middle and really has paved the way for us. 00:22:05.616 --> 00:22:08.920 position:50% align:middle So thanks for being here, very exciting to see you here too. 00:22:08.920 --> 00:22:14.409 position:50% align:middle So let me see if there's any questions. 00:22:20.370 --> 00:22:25.956 position:50% align:middle So I also saw earlier that Dr. Trinkoff had put something in here about the NIOSH. 00:22:25.956 --> 00:22:29.281 position:50% align:middle She put the link for the NIOSH training. 00:22:29.281 --> 00:22:36.350 position:50% align:middle So please encourage individuals that you know working in the hospital setting to take the training. 00:22:36.350 --> 00:22:41.181 position:50% align:middle I have found that students that I've spoken to, particularly new grads, like, 00:22:41.181 --> 00:22:44.621 position:50% align:middle they just...there's a lot of this information that seems really new to them. 00:22:44.621 --> 00:22:49.791 position:50% align:middle Although sleep is something that is becoming more prevalent, sleep knowledge is becoming more prevalent 00:22:49.791 --> 00:22:56.650 position:50% align:middle within society, with people wearing their trackers and stuff, I still think that there's a room for this, 00:22:56.650 --> 00:23:04.382 position:50% align:middle for workers to be educated on because it's not always intuitive to know how to sleep when you're 00:23:04.382 --> 00:23:05.698 position:50% align:middle working night shift. 00:23:05.698 --> 00:23:12.826 position:50% align:middle We can read about sleep education for the general population, but when working shift work, 00:23:12.826 --> 00:23:19.111 position:50% align:middle it might take some specialized, you know, specific ways to kind of adjust your sleep. 00:23:20.327 --> 00:23:22.453 position:50% align:middle Well, thank you everybody for attending. 00:23:22.453 --> 00:23:24.755 position:50% align:middle Feel free to contact me if you have any questions. 00:23:24.755 --> 00:23:26.032 position:50% align:middle Have a good day.