Factors correlating with prolonged fatigue among emergency department nurses

Abstract

Background

Fatigue affects nurses negatively and leads to physical, cognitive and emotional problems that may influence nurses' quality of life. However, there is a lack of studies about prolonged fatigue and its relationship with socio-demographic characteristics and job-related psychosocial factors among nurses, especially emergency nurses, worldwide and in Jordan.

Aims

This study aims to assess the relationship between demographic factors, physical health, psychological distress and job-related psychosocial factors (psychological job demands, job control and social support) and prolonged fatigue among emergency department nurses in Jordan.

Methods

A descriptive correlational study using a convenience sample was used to recruit 153 emergency nurses. Physical health Questionnaire, General Health Questionnaire, Job Content Questionnaire and Checklist Individual Strength were used.

Results

The majority of emergency nurses experienced abnormally prolonged fatigue, moderate health, high psychological distress, high job demands and low job control and social support. Significant negative relationships were addressed between job control, social support and prolonged fatigue, whereas income had a negative weak relationship. Psychological distress and job demands had a positive weak relationship with prolonged fatigue. There was a significant positive weak relationship between psychological distress, job demands and prolonged fatigue. Job-related psychosocial factors (with exception of social support) and mental health were the predictors of prolonged fatigue.

Conclusions

Prolonged fatigue is a multidimensional phenomenon that can be affected by several factors such as job-related psychosocial factors and psychological health. These factors should be taken into consideration when testing and developing interventions to minimise prolonged fatigue among emergency nurses.

Keywords

physical health prolonged fatigue psychological distress psychosocial factors socio-demographic factors

Introduction

Fatigue is a significant problem and a major complaint of nurses (Maynardes et al., 2009; Vasconcelos et al., 2011). Nurses have found changes in healthcare increasingly stressful and demanding (Harris, 2013). They suffer from increasing workloads, which leads to many problems such as distress, burnout and fatigue (Laschinger and Fida, 2014).

The Registered Nurses Association of Ontario (2011) defines fatigue as a subjective feeling of tiredness that affects a person’s physical and mental state. It ranges from tiredness to exhaustion and creates undesirable conditions that interfere with a person's physical and cognitive ability to work within their normal capabilities. Prolonged fatigue is defined as fatigue that is subjectively expressed by a person for more than 2 weeks (Tang et al., 2016).

A previous review indicated that 19.0% of health workers were suffering from fatigue, heavy headedness, headaches, dizziness and problems with concentration (Magnavita, 2015). The prevalence of fatigue among nurses differs from one country to another and differs between female and male nurses (Vasconcelos et al., 2011; Raftopoulos et al., 2012; Hazzard et al., 2013; Ho et al., 2013; Zhou and Fang, 2015; Abdul Rahman et al., 2016; da Silva et al., 2016).

The emergency department (ED) is considered one of the most stressful environments that can cause physical and psychological distress to nurses who are facing many physically and mentally fatiguing duties (Steege et al., 2015). Furthermore, they are suffering more time pressure, physical demands and challenges in decision-making as a result of various regulations (Steege et al., 2015).

Fatigue affects nurses negatively and leads to many physical, cognitive and emotional problems that may influence quality of life, wellbeing, job satisfaction, job performance (Barker and Nussbaum, 2011; Barker et al., 2012; Pasupathy and Barker, 2012; Slocum-Goris et al., 2013) and personal safety (Tang et al., 2016). DaSilvaa et al. (2016) found that fatigue causes a decrease in workability, which is defined as workers’ ability to meet the physical, mental and social demands of a job. It may lead to many physical health problems (e.g. cancer, heart disease, diabetes, gastrointestinal disorders and obesity) (Levtak, et al., 2011) and mental health problems (e.g. anxiety and depression) (Drake et al., 2012; Letvak et al., 2011). The most prevalent health problems among nurses were work-related musculoskeletal disorders and injuries (Simon et al., 2008; Lelis et al., 2012) and mental health strain. Mental health disorders are characterised by depression that may arise from the mental workload presenting in the workplace (Mininel et al., 2011). Also, it has many negative effects on nurses' work performance (Aker and Biddle, 2011; Campbell et al., 2011). Hughes (2008) reported that nurses' fatigue has been correlated with medication errors, charting errors and medical decision errors.

Earlier studies documented that many factors affect prolonged fatigue among the general population and in industrial workers, such as socio-demographic characteristics, including age (being older), gender (being female) (Tang et al., 2016) and marital status (divorced or widowed individuals) (Friedberg et al., 2014). On the contrary, Smith-Miller et al. (2014) documented that many studies evaluated the correlation between nurses' characteristics in acute care settings including gender, age and educational level and fatigue; however, the results were inconsistent.

The psychological demands of emergency nursing practice are important factors of fatigue in ED nurses (Adriaennssens et al., 2011). Previous research showed a strong influence of job-related psychosocial factors on fatigue including low job control, lack of social support (Steege et al., 2015) and high psychological job demands (Parhizi et al., 2013; Han et al., 2014). Physical health, job control and social support negatively affect prolonged fatigue, but psychological distress and job demands positively affect prolonged fatigue in industrial workers (Tang et al., 2016).

There are many studies about work-related fatigue among nurses in acute-care settings (Han et al., 2014; Abdul Rahman et al., 2016). However, prolonged fatigue has been only studied in industrial workers (Tang et al., 2016), the general population (Friedberg et al., 2015) and the elderly (Avlund et al., 2003; Cheng et al., 2008). Therefore, there is a lack of studies about prolonged fatigue and its relationship with socio-demographic characteristics and job-related psychosocial factors among nurses, especially emergency nurses, worldwide and in Jordan. So, the results of this study could provide baseline information about the level of prolonged fatigue and significant factors influencing prolonged fatigue among ED nurses in Jordan, which may help enable nurses to better identify and handle prolonged fatigue in its early stages. The results of the study may be essential for policymakers, administrators, healthcare professionals and researchers to develop and implement strategies, in addition to comprehensive health-promotion programmes. These programmes should focus on improving influencing factors to reduce prolonged fatigue, improve nurses' health and enhance their productivity. Also, monitoring prolonged real-time workplace fatigue for nurses by wearing special devices could help address the problem. Furthermore, developing new decision-making tools that combine these data and give analysis for prolonged fatigue management in collaboration with healthcare professionals and policy makers is necessary (Steege and Pinekenstein, 2016).

Thus, the purpose of this study was to assess the relationship between demographic factors, physical health, psychological distress and job-related psychosocial factors (psychological job demands, job control and social support) and prolonged fatigue among ED nurses in Jordan. Furthermore, this study was guided by the following questions:

What are the levels of prolonged fatigue, physical health, psychological distress and job-related psychosocial subscales among ED nurses?

What are the relationships between demographic factors, physical health, psychological distress, job-related psychosocial factors (psychological job demands, job control and social support) and prolonged fatigue among ED nurses?

What are the predictors, including demographic, physical health, psychological distress and job-related psychosocial factors, of prolonged fatigue among ED nurses?

Methods

Design, population, sampling and setting

A cross-sectional, descriptive correlational design was used to conduct this study. The population under study was all nurses enrolled in the EDs of hospitals of the Amman Governorate, which is the capital of Jordan and the largest city in the country. Jordanian hospitals are a stressful environment for ED nurses, involving overcrowding, shortages of staff and shift work (Jonsson and Halabi, 2006; Hamaideh and Ammouri, 2011), which exposes nurses to prolonged fatigue.

The total number of ED nurses reached about 210 in the three participating hospitals; however, 180 were eligible for participation. A convenience sampling method was used to recruit 153 ED nurses. For the purpose of estimating adequate sample size, G* power version 3.0.10 was used, with p = 0.80, α = 0.05, effect size r = 0.15 and 11 predictors. The necessary sample size was 123; to cover the drop out of any subjects an additional 30 nurses were added to give a total of 153. The inclusion criteria included ED nurses who had 1 year’s experience or more in the ED and were willing to participate in the study. A total of three hospitals were selected (one from the government sector, one military-affiliated hospital and one from the private sector).

Measurements

A self-administered structured questionnaire was developed after reviewing the relevant literature about the preferable tools for measuring prolonged fatigue and correlating factors. This questionnaire consisted of the following instruments:

Basic socio-demographic data questionnaire. This was developed by the researchers based on the previous literature. It includes age, gender, marital status, educational level, years of experience and income.

Physical health questionnaire. This was adopted from Tang et al. (2016) who developed the questionnaire to assess the physical health of participants. It includes two questions about perceived physical health and whether the individuals exercised regularly. Perceived physical health was measured by the following question: ‘How would you rate your physical health at the present time?’ with a response on a five-point Likert scale ranging from ‘1 = very poor’ to ‘5 = excellent’. Performing exercise was measured by the following question: ‘Do you do a moderate level of exercise for at least 30 minutes every day?’ with a response on a five-point Likert scale ranging from ‘1 = never’ to ‘5 = always’. The sum of the weighted-item scores of the two questions indicate the level of physical health and high, moderate and low score values were obtained from the median cut-off point.

General Health Questionnaire. This was developed by Goldberg and Williams (1988) and used to assess psychological distress. It consists of 12 items rated based on a four-point Likert scale ranging from zero to three. The sum of weighted-item scores was calculated. Goldberg's original scoring method was used in this study. The response categories in this method was scored as 0, 0, 1 and 1 respectively, whereas the values 0 and 1 are recorded as 0 and the values 2 and 3 are recorded as 1. This gives scores ranging from 0 to 12. A score greater than or equal to 2 indicates an individual would experience psychological distress. It is valid and reliable. The Cronbach’s alpha coefficient for this tool was 0.93 (Kashyap and Singh, 2017).

Job Content Questionnaire (JCQ). This was developed by Karasek et al. (1998) to determine the psychosocial characteristics of a job. It consists of the three best-known scales: (a) decision latitude or job control (nine items), (b) psychological job demands (five items) and (c) social support at work (eight items). These scales are rated based on a four-point Likert scale. The scoring of each scale was performed according the McMaster University Staff Association manual (2004) and dichotomised by the median cut-off point to obtain ‘high ≥ median score’ and ‘low median score’ values for each scale. This tool is valid and reliable. The Cronbach’s alpha coefficient for decision latitude was 0.70, 0.72 for psychological job demands and 0.86 for social support scale (Nehzat et al., 2014).

Checklist Individual Strength (CIS20-R). This was developed by Vercoulen et al. (1994) to assess physical and mental fatigue in the past 2 weeks. It is composed of four subscales with 20 items: a subjective feeling of fatigue (eight items), concentration (five items), motivation (four items) and physical activity (three items). For delimitating research purposes, only the subscale of subjective fatigue was adopted to measure the level of prolonged fatigue. The subscale was rated based on a seven-point Likert scale ranging from one to seven. The score of the total subscale ranges from eight to 56. A score of 27 or higher indicates an abnormal fatigue and a score of 37 or higher reflects severe fatigue. This subscale is applicable for measuring fatigue among working people in different cultures (Makowiec-Dabrowska and Koszada-Wlodarczyk, 2006). The subjective fatigue subscale was found to be valid and reliable. Its Cronbach’s alpha coefficient ranged from 0.90 to 0.96 (De Vries et al., 2003).

The questionnaire was in English although for cultural considerations, it was pilot tested on a group of ED nurses (N = 15) who were not included in the study but possessed the same inclusion criteria. The pilot study confirmed the questions were clear and there was no need for any language translation; the nurses understood the questions and the instrument. The pilot study also confirmed the anticipated amount of time needed by the respondents to complete the survey was correct; the questionnaire took an average of 15–20 minutes to complete. Internal consistency was used to ascertain the reliability of the instrument. Cronbach's Alpha obtained from the pilot data for each instrument was: physical health = 0.90, psychological distress = 0.80, the JCQ = 0.82, job demands = 0.88, job control = 0.79, social support = 0.87 and subjective feeling of fatigue subscale in CIS20-R = 0.81. Also, for preferable results, Cronbach's Alpha test was run on study data, which reflects good reliable results. Although the subjective feeling of fatigue subscale in CIS20-R was not used previously to measure prolonged fatigue in nurses, these results confirmed it has good psychometric properties, thus it could be used in the context of hospital nursing and in our culture to assess prolonged fatigue.

Data collection procedure

After receiving ethical approval and permission to have access to nurses and obtaining informed consent from participants, arrangements were made for a questionnaire to be completed by the selected ED nurses who met the eligibility criteria. All units in the ED were chosen because it was important to control the setting for administering questionnaires, so participants would not have an opportunity to take a second questionnaire form. Initially, the objectives and the content of the questionnaire were explained to the whole group of nurses in each ED unit; this questionnaire was then directly administered to them and collected after 1 week to allow nurses to participate in the study. The questionnaires were distributed until the required number of participants was reached.

Ethical considerations

Ethical codes were adhered to in all stages of the study. Institutional review board permission was obtained from the selected hospitals. The nurses were also given a cover letter before the questionnaire, containing a written description of the purpose and the nature of the study. The assurance of anonymity and confidentiality was addressed prior to the request for participation. Informed consent was obtained from the participants. In addition, nurses were reassured that their participation in the study was voluntary. All subjects were informed they could withdraw from the study at any time if they wished not to participate by returning the unanswered questionnaire during the data collection phase.

Data analysis

The Statistical Package for Social Sciences (SPSS) version 23 was used to compute all data in this study. Descriptive statistics (means, standard deviations, frequencies and percentages) were used to describe the variables. The correlation tests (Pearson's and Point-biserial) were used to examine the relationships between study variables. Furthermore, multiple linear regression analysis was used to look at the combined effect of predictors (demographic characteristics, physical health, psychological distress and job-related psychosocial factors) on prolonged fatigue and to determine the best predictors for it. The significance level was tested at the alpha level of ≤0.05.

Results

A total of 153 nurses participated in the study. All nurses answered all questionnaires and questions, so there were no missing data. Analysis of the distribution of participants according to their health sector showed that 43.1% were from military-affiliated hospitals, 25.5% were from public hospitals and 31.4% were from private hospitals. Analysis of the demographic data revealed the majority of the sample were males (66.0%). The subjects' age ranged from 23–50 years, with the majority between 23–30 years (61.4%). More than half of nurses were married (52.9%). Analysis of educational level revealed that more than two-thirds of participants were graduates with a bachelor’s degree (79.8%). The majority of the study sample had 1–5 years of work experience (45.1%), 34.0% had 5–10 years, 17.6% 10–15 years and 3.3% had more than 15 years. The sample income ranged between 250–1000 Jordanian dinar (JOD), with the majority between 250–500 JOD (59.5%) (Table 1).

Table 1.

Demographic characteristics of the study population (N = 153).

Characteristics	Frequency	Percent (%)
Age
23–29 years	94	61.4
30–39 years	56	36.6
40–50 years	3	2.0
Gender
Male	101	66.0
Female	52	34.0
Marital status
Single	68	44.4
Married	81	52.9
Divorced	3	2.0
Widowed	1	0.7
Educational level
Diploma	23	15.0
Bachelor’s degree	122	79.8
Higher education	8	5.2
Years of experience
1–5 years	69	45.1
5–10 years	52	34.0
10–15 years	27	17.6
>15 years	5	3.3
Income per month
250–500 JOD	91	59.5
500–750 JOD	58	37.9
750–1000 JOD	2	1.3
>1000 JOD	2	1.3

JOD: Jordanian dinar.

Table 2 shows the levels of participants’ prolonged fatigue, physical health, psychological distress and job-related psychosocial factors (job control, job demands and social support). The results indicated the majority of ED nurses had abnormal prolonged fatigue (Mean = 31.8, SD = 6.2), moderate physical health (Mean = 5.3, SD = 1.5), high psychological distress (Mean = 4.7, SD = 3.1), high job demands (Mean = 33.8, SD = 6.2) and low job control (Mean = 60.9, SD = 9.0) and social support (Mean = 20.6, SD = 5.2).

Table 2.

Levels of participant’s prolonged fatigue, physical health, psychological distress, and job-related psychosocial factors (N = 153).

Variable	Possible range	Actual range	M (SD)
Prolonged fatigue	8–56	14–50	31.8 (6.2)
Physical health	2–10	2–10	5.3 (1.5)
Psychological distress	0–12	0–11	4.7 (3.1)
Job-related psychosocial factors subscales
Job control	24–96	42–80	60.9 (9.0)
Job demand	12–48	20–48	33.8 (6.2)
Social support	8–32	8–32	20.6 (5.2)

M: mean; SD: standard deviation.

Results of Pearson (r) and Point-biserial (r p.b) correlations are indicated in Table 3. Pearson's correlation was performed to assess the relationship between physical health, psychological distress, job-related factors and prolonged fatigue among ED nurses. The results showed a statistically significant positive weak relationship between psychological distress and prolonged fatigue (r ₍₁₅₁₎ = 0.18; p < 0.05). Furthermore, there was a statistically significant relationship between all subscales of job-related psychosocial factors and prolonged fatigue. Job demands had a statistically significant positive weak relationship with prolonged fatigue (r ₍₁₅₁₎ = 0.23; p < 0.01). However, job control and social support were associated negatively with prolonged fatigue (r ₍₁₅₁₎ = −0.31; p ≤ 0.01, r ₍₁₅₁₎ = −0.26; p < 0.01).

Table 3.

Correlation between associating factors and prolonged fatigue (N = 153).

Variables	r	p
Physical health	0.00	0.995
Psychological distress	0.18	0.030*
Job control	−0.31	0.000**
Job demand	0.23	0.005**
Social support	−0.26	0.001**
	r p.b	p
Age	−0.05	0.571
Gender	0.07	0.378
Marital status	−0.06	0.478
Educational level	−0.02	0.785
Years of experience	−0.06	0.490
Income per month	−0.17	0.038*

*Significant at the 0.05 level; **significant at the 0.01 level.

The Point-biserial test was conducted to examine the relationship between age, gender, educational level, marital status, years of experience, income per month and prolonged fatigue. The results showed a statistically significant negative weak relationship between income and prolonged fatigue (r ₍₁₅₁₎ = −0.17; p < 0.05). There was no significant relationship between other variables and prolonged fatigue.

As shown in Table 4, multiple linear regression analysis was used to examine the significant predictors of prolonged fatigue. The variables that entered the models as predictors of the prolonged fatigue were income, psychological distress and job-related psychosocial factors (job control, job demands and social support). Regarding prolonged fatigue, the full model containing all predictors was statistically significant (F _{(5, 147)} = 9.00; p < 0.001; R = 0.48; R²= 0.23; adjusted R²= 0.21). This indicated that 21.0% of the variance in prolonged fatigue was explained by the whole model. The significant predictors of prolonged fatigue were psychological distress (B = 0.18; p = 0.016), job control (B = −0.30; p < 0.001) and job demands (B = 0.21; p < 0.01). However, job control had the strongest relationship with prolonged fatigue (part²= 0.0761).

Table 4.

Predictors of prolonged fatigue among ED nurses (N = 153).

Predictors	b	B	t	p value	95% CI
Income per month	−1.48	−0.14	−1.93	0.056	−3.00–0.04
Psychological distress	0.37	0.18	2.44	0.016	0.07–0.67
Job control	−0.21	−0.30	−3.82	0.000	−0.32– −0.01
Job demand	0.21	0.21	2.77	0.006	0.06–0.36
Social support	−0.17	−0.14	−1.73	0.085	−0.36–0.02

b: unstandardised beta; B: standardised beta; CI: confidence interval.

Discussion

This is one of the first studies addressing prolonged fatigue among nurses, especially those working in an ED. The findings of this study indicated the level of prolonged fatigue among ED nurses reflected abnormal fatigue. This result is higher than that documented in a previous study among industrial workers (Tang et al., 2016) and the working population. This result supports the evidence that nurses had a high level of fatigue when compared with other working personnel (Ho et al., 2013). The new trends in nursing related to the work environment, including working 12-hour shifts (Dickson and Witkoski, 2010) and overcrowding and large numbers of patients that could lead to fatigue (Bae, 2012). Furthermore, ED nurses need to plan and implement the interventions that maintain the quality of care, organise work and adapt to the available resources in providing care and related to the seriousness of a patient's clinical symptoms (dos Santos et al., 2013), which could raise the level of prolonged fatigue.

The current study revealed that ED nurses had moderate physical health, which is consistent with previous research findings that have found that nurses had low to moderate levels of physical health and fitness (Albert et al., 2014; Klainin-Yobas et al., 2015). Physical health is considered one of the health behaviours and there is great importance for nurses to achieve wellness and optimal health and stay in the workforce (Albert et al., 2014). It had been revealed that despite the knowledge nurses have about health behaviours, they did not necessarily apply them to their own lifestyle (Malik et al., 2011). Therefore, health promotion activities should be encouraged for nurses.

It has been documented that work stress greatly affects the health of workers such as nurses, doctors and psychologists (Okwaraji and Aguwa, 2014). This study revealed that ED nurses experienced psychological distress, which is consistent with previous studies (Okwaraji and Aguwa, 2014; Vasconcelos et al., 2012). It indicated that psychological distress might be related to work-related stress, which emerges when nurses spend most of their time, energy and effort on their work for a long period without taking time to rest and relax physically or emotionally (Ibikunle at al., 2012; Thorsen et al., 2011).

It had been reported that low physical and psychological wellbeing among nurses could affect their job satisfaction, organisational loyalty and commitment and intention to leave the profession (Javed et al., 2014). This may also lead to both physical and behavioural problems such as stress, depression, anxiety, irritability, headache and insomnia (Abdulla et al., 2011; Bayram et al., 2010; Gao et al., 2011).

Regarding the levels of job-related psychosocial factors, this study documented that the job-demand level was higher and the control and social support levels were lower than previous studies among Chinese nurses (Fang et al., 2008) and among industrial workers (Tang et al., 2016). This could be related to the work environment among ED nurses, which is considered stressful, as they experience more pressure, physical demands and challenges in decision making as a result of various regulations and laws (Steege et al., 2015).

The study revealed there was a negative relationship between income and prolonged fatigue, in which low income increases the level of prolonged fatigue. This result is consistent with previous studies (Ho et al., 2013; Jones et al., 2015; Raftopouloset et al., 2012; Rose et al., 2017). This might be related to ED nurses' dissatisfaction with employee benefits, including a low monthly income or salary, which could cause prolonged fatigue as a result of thinking of ways to cover their expenses (Dall et al., 2009; Mark et al., 2009).

It has been documented that the risk of fatigue decreases with good physical health (Abd-Elfatah et al., 2015). However, this study found there was no relationship between physical health and prolonged fatigue. The relationship between physical health and prolonged fatigue is seldom studied. However, this study result is inconsistent with a previous study conducted by Tang et al. (2016) that revealed a negative relationship between physical health and prolonged fatigue among industrial workers. Therefore, graded exercise therapy is regarded as an effective rehabilitation strategy for fatigue (Clark et al., 2016).

The study findings indicated a positive relationship between psychological distress and prolonged fatigue. This is consistent with previous studies (Adriaennssens et al., 2011; Rose et al., 2017; Tang et al., 2016). It could be related to work environment, which leads to increased stress for employees (Fries, 2009) and the nature of ED nurses' work, which is stressful and requires more concentration to deal with many patients at the same time. Therefore, perceived psychological distress should be considered when trying to understand the related factors of prolonged fatigue among ED nurses.

Multiple linear regression among the influencing factors showed predictors of prolonged fatigue. Job demands, job control and psychological distress were the main predictors of prolonged fatigue. However, job control represented the largest influence compared with job demands and psychological distress. A previous study conducted by Tang et al. (2016) revealed that job demands, job control and psychological distress were the main predictors of prolonged fatigue among industrial workers. However, psychological distress had the largest influence compared with job-related psychosocial factors. Zhou and Fang (2015) indicated that job control and job demands were important predictors of fatigue. A Belgian study found that job demands were the most significant predictor and had the most significant effect on persistent fatigue (Vanroelen et al., 2010). On the contrary, Fang et al. (2008) documented that job demands were the main predictor of chronic fatigue among Chinese nurses. The inconsistent results from the literature might be due to different definitions and tools for assessing fatigue and prolonged fatigue, and whether physical and psychological conditions were considered in the research.

The results of this study supported that the subjective feeling of fatigue subscale in CIS20-R is a good and reliable instrument to measure prolonged fatigue in nurses. This is the first publication about the use of CIS20-R in nurses. Hence, it is necessary for healthcare professionals and policy makers to use this subscale as it could be helpful in a nursing context among other things.

The health status of ED nurses is of great importance if successful healthcare delivery, including physical health, psychological distress and psychosocial job-related factors, is to be achieved. The present study could help establish the measures that assist healthcare professionals, employers and nursing managers create and test interventions that aim to assess and minimise prolonged fatigue among ED nurses, taking all factors into consideration. The psychological status of ED nurses should be considered when developing health-promoting programmes to alleviate the level of prolonged fatigue and prevent ED nurses from experiencing prolonged fatigue. Moreover, positive self-care strategies and healthy rituals to cope with prolonged fatigue should be enforced. A commitment to self-care activities including adequate exercise and stress reduction should be promoted.

The findings of this study could inform policy makers when formulating policies that enhance ED nurses' mental health and job control and decrease job demands to minimise levels of prolonged fatigue. Moreover, adopting the use of CIS20-R in nurses to measure prolonged fatigue in future studies might be necessary and helpful.

Limitations

The limitations underlying this study included: (a) the sample was convenience, which limits generalisation of the findings; (b) the design was cross-sectional, which did not predict the effect of independent and dependent variables; and (c) the study was confined to the hospitals in the Amman Governorate in Jordan.

Conclusions

Prolonged fatigue is a multidimensional phenomenon that is affected by several factors. This study indicated that most ED nurses experienced abnormally prolonged fatigue, moderate physical health, high psychological distress, high job demands and low job control and social support. Income, job control and social support had negative relationships with prolonged fatigue, although the relationship with income was weak. Psychological distress and job demands had a positive weak relationship with prolonged fatigue. The main predictors of prolonged fatigue were psychological distress, job demands and job control. Job control was the strongest predictor. These factors should be taken into consideration when testing and developing healthcare strategies and interventions to minimise prolonged fatigue among ED nurses. Furthermore, this study could help develop future research, which should focus on evaluating interventions and strategies designed to minimise prolonged fatigue based on the correlated factors and studying the consequences of prolonged fatigue on ED nurses.

Key points for policy, practice and/or research

Prolonged fatigue is a multidimensional phenomenon that could be affected by several factors.

The majority of emergency nurses had an abnormal level of prolonged fatigue.

Income, job control, and social support had negative relationships with prolonged fatigue.

Psychological distress and job demands had a positive weak relationship with prolonged fatigue.

The related factors should be taken into consideration when developing health care strategies and interventions to minimize prolonged fatigue among emergency nurses.

Supplemental Material

JRN880309 Supplemental Material - Supplemental material for Factors correlating with prolonged fatigue among emergency department nurses

Supplemental material, JRN880309 Supplemental Material for Factors correlating with prolonged fatigue among emergency department nurses by Ashraf M Al-Abdallah and Malakeh Z Malak in Journal of Research in Nursing

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics

Ethical approval was received from the institutional ethics committee of Al-Zaytoonah University of Jordan and selected hospitals. This study was approved by the ethics committees of the Jordan Ministry of Health, Jordanian Royal Medical Services, and the private hospital. The identification numbers are MOH REC 170099, 6147, and 2725/2017/1.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Ashraf M Al-Abdallah has a Master degree in Adult Health Nursing from the Faculty of Nursing at Al-Zaytoonah University of Jordan, Jordan. He is head nurse of the Intensive Care Unit at Shmaisani hospital, Jordan. His research interests are concerned with topics related to critical care and adult health.

Malakeh Z Malak has a PhD in Community Health Nursing from the Faculty of Nursing at Alexandria University, Egypt. She is an Associate Professor at the AL-Zaytoonah University of Jordan where she is working as a researcher in addition to her academic position. Her interests are concerned with topics related to community health nursing, health promotions for individuals, families, and community as a whole.

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