A survey of the relationship between work schedule and its effect on the fatigue of rescue personnel in Isfahan with a standard method of CIS202.

CONTEXT: Fatigue is a factor that can have negative effects on family life, social relationship and work. Work schedule is one of the affective factors on personnel's fatigue in different jobs. In this study, the work schedule and its effect on rescue personnel in Isfahan are explored. AIMS: The purpose of this study was to investigate the relationship between work schedules and fatigue among rescue personnel. SETTINGS AND
DESIGN: This study is periodical and has been conducted on 72 employees of rescue personnel in Isfahan.
MATERIALS AND METHODS: Random sampling was done and the primary data that was collected through fatigue assessment questionnaire after being conducted as a pilot study on 10% of samples were collected to confirm the validity of this study. Finally, the data was given to SPSS11.5 software and were analyzed by descriptive statistics and linear digression.
RESULTS: The results showed that from the statistical point of view some parts of work schedules like work hours satisfaction, resting time and work order on total fatigue are effective in linear and inverse way but the item "predictibility of work conditions" does not have a meaningful relationship with total fatigue. Furthermore, the results showed that there is a meaningful and inverse relationship with work hours, resting time and work order with mental fatigue and also the work schedule has a meaningful, linear and inverse relation with mental fatigue and total fatigue.
CONCLUSIONS: By increasing the satisfaction of working hours, increasing resting time and also with an increase of work order the total fatigue of rescue personnel will decrease.

INTRODUCTION

Fatigue is a self-detecting situation that a person experiences, a continuing feeling of exhaustion and a decline of potentiality in body and mental operations.[1] In most cases, the strain is causing the fatigue. Usually, strain leads to stress and if stress gets high or continues for a long time it can lead to irrevocable changes.[2] Fatigue can be detected by these symptoms; languor and exhaustion, decline in body's ability, droop, lack of energy, incapability, sleepiness, low understanding, insufficient concentration, incompetency feeling and decrease of motivation that in a healthy person will vanish by sleeping and resting.[3]

Fatigue has multidimensional structure and many reasons and the stable and lasting mental feelings of exhaustion lead to weakness and lack of energy that cause a decrease of operational potentials.[4] Since fatigue is a complicated phenomenon, finding a comprehensive and deterministic definition for it, is difficult. The existence of different reasons in relation to creation of fatigue and the difficulties for investigation of its amount and intensity are some reasons that make this sign indescribable.[56]

Individuals can show specific behaviors in fatigue and sleepiness that these symptoms are easily recognizable in appearance such as eye, head, and face.[7]

Fatigue Symptoms are different from person to person, which is generally divided into two categories: Physical signs and symptoms associated with functional impairment. Physical symptoms are include drowsiness, irritability, depression, dizziness, loss of appetite, digestive problems, susceptibility to disease and dysfunction related symptoms include slowed reaction (physical reaction speed and the speed of thought), defects in response to stimuli, deficits in reasoning, judgment, and inability to concentrate, increase memory errors, including amnesia, loss of consciousness, loss of motivation.[8]

Fatigue in different work conditions is different in. Dijeck in his study concludes that about 20% of the participants have expressed a kind of fatigue, and other studies have reported 7–45% prevalence of fatigue.[9]

In the US the problems related to fatigue that leads to decline of performance and causes accidents have cost 18 million a year. Annually more than 1500 deaths, 100,000 accidents, 76,000 injuries happen due to sleepiness resulted from fatigue in highways.[10] In general, the drivers’ fatigue is the cause of 25% of the accidents as the main reason and 60% of road accidents leading to death or serious injuries.[7] Fatigue is a pretty rampant sign in an emergency ward.[11] In a study that Papp et al. conducted in five university health center in America, it was shown that lack of sleep and fatigue in resident doctors had significant effects on their personal lives, welfare, their relationship with their spouses and family and quitting personal and social activities and it also has affected their job functionality.[12] Sleep and fatigue management in work conditions have remained as a challenge.[1314] One of the effective factors on fatigue is work schedule.[15] Work schedule can affect the employees or workers through sleepiness or adaptability mechanism.[16] Rhythm disorders and lack of sleep can lead to the decline of alertness, operational malfunction and worsen of mental condition of a person.[17]

In December 2011, The Joint Commission published a Sentinel Event Alert dealing with healthcare worker fatigue and patient safety. They acknowledge the research to date linking extended-duration worked shifts, fatigue, and impaired performance and safety. The Joint Commission has suggested several actions to help mitigate the risks of fatigue that result from extended work hours. In December 2011, The Joint Commission published a Sentinel Event Alert dealing with healthcare worker fatigue and patient safety. They acknowledge the research to date linking extended-duration worked shifts, fatigue, and impaired performance and safety. The Joint Commission has suggested several actions to help mitigate the risks of fatigue that result from extended work hours.[18]

The IOM has published papers on patient and personal safety as they relate to resident duty hours. In its 2008 report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, the IOM cites prolonged wakefulness, shifts longer than 16 consecutive hours, the variability of shifts, and the volume and acuity of patient load as factors that increase the risk of harm to patients.[19]

Disruptions in circadian rhythm, fatigue, and sleep deprivation may affect the NNP's clinical performance during night and extend shifts, with specific impact on levels of alertness.[20]

Nursing research suggests that shift length impacts vigilance and safety.[2122]

Conducted descriptive, self-report studies and found statistically significant increases in errors and near errors when staff nurses worked shifts 12.5 h or longer. Trinkoff et al. found a significant relationship between nurse work schedules and patient mortality.[23]

Emergency personnel must have quickness, precision, alertness and a high focus so that they can do their duties well. One of the factors that may become a barrier in accomplished the personnel's mission is fatigue caused from non-standard schedule that result in the lack of focus, lack of alertness, increase in the possibility of error and consequently endangering injured people and emergency personnel. The effective factors and their impact should be assessed for finding an appropriate plan for this problem.

MATERIALS AND METHODS

This study is a cross-sectional study and was conducted in 1390 on rescue base personnel of Isfahan. 72 subjects participated in this study (confidence interval 95%, power of test 80%, estimated error 0.25, standard deviation 0.75). Samples were randomly taken. The variables included age, marital status, education, satisfaction of work hours, and predictability of duties, work order, rest, mental fatigue, physical activity, motivation and focus.

For the assessment of the relationship between work schedule and fatigue of the participants, we used work schedule questionnaires and fatigue questionnaires[24] that have been used in Ku and Smith study in 2006.

The questionnaire consisted of four main areas: 1 - Discipline, 2 - Satisfaction while working hours and working conditions, 3 - Recreation, 4 - predictability and It contains 23 questions. Fatigue questionnaire used in this study was CIS20R questionnaire, which was used in 57 studies.[25]

In order to check the validity of it, first the English version of the questionnaire was translated into Persian. Then comments of experts on communication, simplicity and intelligible were taken and to evaluate the reliability of them they were implemented in the final version. The translated questionnaires were distributed among 20% of samples (14 cases) and reliability of the questionnaire was assessed by Cronbach's alpha test of reliability in order to beat fatigue scale questionnaire schedule and they were 0.76 and 0.86, respectively. The questionnaire consisted of four main areas, including mental fatigue, concentration, motivation and physical activity, and 6-point Likert-scale questions were designed. Then the questionnaires were completed by the researcher and the participants. After completing the questionnaires, data was given to SPSS11.5 (SPSS Inc. Chicago.) software and were analyzed by descriptive statistics and linear regression analysis that was performed on the data, and the regression equations were obtained.

RESULTS

Results show that 25% of participants were single, and 75% were married. Education 26.4% of participant's diploma, 19.4% associate, 52.8% had a bachelor's degree. The age of participants ranged from 20 to 50 years, and the mean and standard deviation respectively 32.3 and 10.45 years, respectively.

After data collection, analysis and original questionnaire schedule, the mean and standard deviation of the scores of satisfaction with working hours is equivalent to 66.05 ± 27.1, predictability of schedule equal to 45.75 ± 8.5, rest of 50.10 ± 10.53 and working order of 60.05 ± 13.43 respectively.

The analysis of questionnaire fatigue in four main areas, the mean and standard deviation of scores for fatigue, mental equivalent of 49.4 ± 14.75, and focus is equivalent to 45.4 ± 10.7, motivation equivalent to 38.75 ± 12.75 and physical activity equivalent to 37.27 ± 13.11, respectively.

Then the relationship between the four main areas work schedule and the total score of fatigue was investigated. As shown in Table 1, regression equations and significance levels were obtained. The relationship between four main areas of fatigue and the final score of work schedule were determined [Table 2]. Next, the relationship between all domains of questionnaires was calculated based on simple linear regression [Table 3]. A simple linear regression analysis showed a significant relationship between work schedules and general fatigue (P < 0.001). And the estimated regression equation is equal to: (76.26–0.52 work schedules) [Figure 1].

Table 1

Relationship between main areas of fatigue questionnaire schedule and total fatigue scores

Table 2

Relationship between key areas of fatigue questionnaire and final score of schedule

Table 3

Relationship between key areas of the questionnaire fatigue and key areas questionnaire schedule

Figure 1

The relationship between the program of work and fatigue (P = 0.001)

DISCUSSION

The results of this study show that there is a significant and inverse relationship between the amount of satisfaction of work hours and fatigue and by increasing the satisfaction of work hours, the satisfaction also increases. There is also a significant and inverse relationship between the amount of rest and fatigue [Table 1] and based on the results in Table 3 there is a significant and inverse relationship between rest and mental fatigue. The results of a study by Ku and Smith on the staff of the locomotive which was carried out in 2010 showed that the work schedule, working hours and rest factors have the greatest impact on social welfare and fatigue.[24]

The results indicate that there is a significant and inverse relationship between mental fatigue and work schedule and work schedule and total fatigue, thereby by increasing the mental fatigue the total fatigue increase directly and positively. In a study that was conducted on nurses by Bonnet in 1989 their mental and physical fatigue was reported, and there was a significant relationship between workplace variables like shift hours and work hours.[25] Also, the results show that there is a significant and inverse relationship between work order and fatigue, that is, by increasing work order the total fatigue decreases.

There was no significant relationship between predictability and total fatigue [Table 1] predictability has only relationship with physical activity and does not have any relationships with the subsets of total fatigue. In a study conducted by Ku and Smith on locomotive personnel in 2010 they mentioned to the significance of predictability in work schedule, but they did not deal with the relationship between predictability and fatigue.[24]

In this study, there was a relationship between work order and focus, in a study conducted by Patterson and Yealy by using a fatigue questionnaire of CIS20R in 2010 the medical errors were related to the residents with fatigue, sleepiness and anxiety.[26] Also as the results of this study and a study conducted by Joffe MD, Mark D on emergency personnel's fatigue in the US, it was shown that the strategies for prevention of medical error can control and decrease fatigue and the managers of emergency ward must have policies and plans for controlling this fatigue.[11] A simple linear regression analysis showed a significant relationship between work schedules and general fatigue.[272829303132333435363738394041424344]

CONCLUSIONS

Generally in investigation of work schedule and total fatigue despite the lack of significance and relationship, the statistical relation resulted from the questionnaires indicate a significant, linear and Meanwhile, in order to reduce the risk of fatigue-related errors among employees should also pay attention to the working hours and rest factors such as the stability of the schedule of work and good working schedules and strategies to reduce fatigue causes promoting of awareness of job satisfaction and will reduce human errors.

This study was approved by the Medical School of Isfahan University, and thus, the authors of this study thank the university staff and all participants.

Financial support and sponsorship

This study funded by the Medical school of Isfahan University, Isfahan, Iran.

Conflicts of interest

There are no conflicts of interest.