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. 2020 Aug 29;40(4):625–635. doi: 10.1007/s11596-020-2226-9

Prevalence and Influencing Factors on Fatigue of First-line Nurses Combating with COVID-19 in China: A Descriptive Cross-Sectional Study

Yu-xin Zhan 1,#, Shi-yu Zhao 2,#, Jiao Yuan 3, Huan Liu 4, Yun-fang Liu 1, Ling-li Gui 5, Hong Zheng 6, Ya-min Zhou 7, Li-hua Qiu 8, Jiao-hong Chen 9, Jiao-hua Yu 1,✉, Su-yun Li 1,✉
PMCID: PMC7412774  PMID: 32767264

Abstract

Nurses’ work-related fatigue has been recognized as a threat to nurse health and patient safety. The aim of this study was to assess the prevalence of fatigue among first-line nurses combating with COVID-19 in Wuhan, China, and to analyze its influencing factors on fatigue. A multi-center, descriptive, cross-sectional design with a convenience sample was used. The statistical population consisted of the first-line nurses in 7 tertiary general hospitals from March 3, 2020 to March 10, 2020 in Wuhan of China. A total of 2667 samples from 2768 contacted participants completed the investgation, with a response rate of 96.35%. Social-demographic questionnaire, work-related questionnaire, Fatigue Scale-14, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Chinese Perceived Stress Scale were used to conduct online survey. The descriptive statistic of nurses’ social-demographic characteristics was conducted, and the related variables of work, anxiety, depression, perceived stress and fatigue were analyzed by t-tests, nonparametric test and Pearson’s correlation analysis. The significant factors which resulted in nurses’ fatigue were further analyzed by multiple linear regression analysis. The median score for the first-line nurses’ fatigue in Wuhan was 4 (2, 8). The median score of physical and mental fatigue of them was 3 (1, 6) and 1 (0, 3) respectively. According to the scoring criteria, 35.06% nurses (n=935) of all participants were in the fatigue status, their median score of fatigue was 10 (8, 11), and the median score of physical and mental fatigue of them was 7 (5, 8) and 3 (2, 4) respectively. Multiple linear regression analysis revealed the participants in the risk groups of anxiety, depression and perceived stress had higher scores on physical and mental fatigue and the statistically significant positive correlation was observed between the variables and nurses’ fatigue, the frequency of exercise and nurses’ fatigue had a statistically significant negative correlation, and average daily working hours had a significantly positive correlation with nurses’ fatigue, and the frequency of weekly night shift had a low positive correlation with nurses’ fatigue (P<0.01). There was a moderate level of fatigue among the first-line nurses fighting against COVID-19 pandemic in Wuhan, China. Government and health authorities need to formulate and take effective intervention strategies according to the relevant risk factors, and undertake preventive measures aimed at reducing health hazards due to increased work-related fatigue among first-line nurses, and to enhance their health status and provide a safe occupational environment worldwide. Promoting both medical and nursing safety while combating with the pandemic currently is warranted.

Key words: COVID-19, pandemic, Chinese nurses, fatigue, anxiety, depression, perceived stress, cross-sectional study

Acknowledgement

Authors acknowledge all participants who responded to the surveys and the nursing administrators for the cooperation with their effort and time in conducting the present study.

Conflict of Interest Statement

The authors declare that there is no conflict of interest regarding the publication of this article.

Footnotes

The authors contributed equally to this work.

Contributor Information

Yu-xin Zhan, Email: 0109-kitty@163.com.

Shi-yu Zhao, Email: 648202059@qq.com.

Jiao-hua Yu, Email: yujiaohua2008@126.com.

Su-yun Li, Email: lisuyun0503@163.com.

References

  • 1.Aaronson LS, Teel CS, Cassmeyer V, et al. Defining and Measuring Fatigue. J Nurs Scholarship. 1999;31(1):45–50. doi: 10.1111/j.1547-5069.1999.tb00420.x. [DOI] [PubMed] [Google Scholar]
  • 2.Smith-Miller CA, Shaw-Kokot J, Curro B, et al. An Integrative Review Fatigue Among Nurses in Acute Care Settings. J Nurs Admin. 2014;44(9):487–494. doi: 10.1097/NNA.0000000000000104. [DOI] [PubMed] [Google Scholar]
  • 3.Steege LM, Dykstra JG. A macroergonomic perspective on fatigue and coping in the hospital nurse work system. Appl Ergon. 2016;54:19–26. doi: 10.1016/j.apergo.2015.11.006. [DOI] [PubMed] [Google Scholar]
  • 4.Kahriman İ, Öztürk H. Evaluating medical errors made by nurses during their diagnosis, treatment and care practices. J Clin Nurs. 2016;25(19–20):2884–2894. doi: 10.1111/jocn.13341. [DOI] [PubMed] [Google Scholar]
  • 5.Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumoma. N Engl J Med. 2020;382(13):1199–1207. doi: 10.1056/NEJMoa2001316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Organization WH. Coronavirus disease 2019 (COVID-19). Situation Report-50. https://www.who.int/docs/defaultsource/coronaviruse/situation-reports/20200310-sitrep-50-covid-19.pdf?sfvrsn=55e904fb_2
  • 7.Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Jones G, Hocine M, Jérôme S, et al. Demographic and occupational predictors of stress and fatigue in French intensive-care registered nurses and nurse’s aides: A cross-sectional study. Int J Nurs Study. 2014;52(1):250–259. doi: 10.1016/j.ijnurstu.2014.07.015. [DOI] [PubMed] [Google Scholar]
  • 9.Samaha E, Lal S, Samaha N, et al. Psychological, lifestyle and coping contributors to chronic fatigue in shift-worker nurses. J Adv Nurs. 2007;59(1):221–232. doi: 10.1111/j.1365-2648.2007.04338.x. [DOI] [PubMed] [Google Scholar]
  • 10.Kawano Y. Association of Job-related Stress Factors with Psychological and Somatic Symptoms among Japanese Hospital Nurses: Effect of Departmental Environment in Acute Care Hospitals. J Occup Health. 2008;50(1):79–85. doi: 10.1539/joh.50.79. [DOI] [PubMed] [Google Scholar]
  • 11.Maunder R, Hunter J, Vincent L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003;168(10):1245–1251. [PMC free article] [PubMed] [Google Scholar]
  • 12.Bai Y, Lin CC, Lin CY, et al. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004;55(9):1055–1057. doi: 10.1176/appi.ps.55.9.1055. [DOI] [PubMed] [Google Scholar]
  • 13.Lee AM, Wong JG, McAlonan GM, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry. 2007;52(4):233–240. doi: 10.1177/070674370705200405. [DOI] [PubMed] [Google Scholar]
  • 14.Lee ML, Chen CJ, Su IJ, et al. Severe acute respiratory syndrome—Taiwan, 2003. MMWR Morb Mortal Wkly Rep. 2003;52(20):461–466. [PubMed] [Google Scholar]
  • 15.Liu C, Wang H, Zhou L, et al. Sources and symptoms of stress among nurses in the first Chinese anti-Ebola medical team during the Sierra Leone aid mission: A qualitative study. Int J Nurs Sci. 2019;6(2):187–191. doi: 10.1016/j.ijnss.2019.03.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Lehmann M, Bruenahl CA, Löwe B, et al. Ebola and Psychological Stress of Health Care Professionals. Emerg Infect Dis. 2015;21(5):913–914. doi: 10.3201/eid2105.141988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Taylor-East R, Grech A, Gatt C. The mental health of newly graduated doctors in Malta. Psychiatr Danub. 2013;25(2):250–255. [PubMed] [Google Scholar]
  • 18.Morriss RK, Wearden AJ, Mullis R. Exploring the validity of the Chalder Fatigue scale in chronic fatigue syndrome. J Psychosom Res. 1998;45(5):411–417. doi: 10.1016/S0022-3999(98)00022-1. [DOI] [PubMed] [Google Scholar]
  • 19.Spitzer RL, Kroenke K, Williams JBW, et al. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092. [DOI] [PubMed] [Google Scholar]
  • 20.Schalet BD, Cook KF, Choi SW, et al. Establishing a common metric for self-reported anxiety: Linking the MASQ, PANAS, and GAD-7 to PROMIS Anxiety. J Anxiety Disord. 2014;28(1):88–96. doi: 10.1016/j.janxdis.2013.11.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.He XY, Li CB, Qian J, et al. Reliability and validity of a generalized anxiety scale in general hospital outpatients. Shanghai Arch Psychiatry. 2010;22(4):200–203. [Google Scholar]
  • 22.Manea L, Gilbody S, Mcmillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry. 2015;37(1):67–75. doi: 10.1016/j.genhosppsych.2014.09.009. [DOI] [PubMed] [Google Scholar]
  • 23.Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a Brief Depression Severity Measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Bian CD, He XY, Qian J, et al. Study on the application of depression symptom cluster scale of patient health questionnaire in general hospitals. J Tongji Univ (Med Sci) (Chinese) 2009;30(5):136–140. [Google Scholar]
  • 25.Yang TZ, Huang HT. An epidemiological study on the psychological stress of urban residents in social transformation. Chin J Epidemiol (Chinese) 2003;24(9):760–764. [PubMed] [Google Scholar]
  • 26.Shen J, Yu H, Zhang Y, et al. Professional quality of life: A cross-sectional survey among Chinese clinical nurses. Nurs Health Sci. 2015;17(4):507–515. doi: 10.1111/nhs.12228. [DOI] [PubMed] [Google Scholar]
  • 27.Dyrbye LN, Shanafelt TD, Johnson PO, et al. A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses. BMC Nurs. 2019;18:57–65. doi: 10.1186/s12912-019-0382-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Zdanowicz T, Turowski K, Celej-Szuster J, et al. Insomnia, Sleepiness, and Fatigue Among Polish Nurses. Workplace Health Saf. 2020;68(6):272–278. doi: 10.1177/2165079920901534. [DOI] [PubMed] [Google Scholar]
  • 29.Ferri P, Guadi M, Marcheselli L, et al. The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts. Risk Manag Healthc Policy. 2016;14(9):203–211. doi: 10.2147/RMHP.S115326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Sagherian K, Clinton ME, Huijer AS, et al. Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses. Workplace Health Saf. 2017;65(7):304–312. doi: 10.1177/2165079916665398. [DOI] [PubMed] [Google Scholar]
  • 31.Atkinson PG, Fullick S, Grindey C, et al. Exercise, Energy Balance and the Shift Worker. Sports Med. 2008;38(8):671–685. doi: 10.2165/00007256-200838080-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Xu MC, Zhang Y. Investigation on the psychological status of the first clinical first-line support nurses against novel coronavirus pneumonie. Chin Nurs Res (Chinese) 2020;34(3):368–370. [Google Scholar]
  • 33.Li CS, Mi YY, Chu J, et al. Investigation and analysis of novel coronavirus first-line caregivers with post-traumatic stress disorder. J Nurses Training (Chinese) 2020;35(07):615–618. [Google Scholar]
  • 34.Jiang X, Tan X. Investigation on the mental health status of first line nurses during the outbreak of COVID-19. J Nurs Sci (Chinese) 2020;35(07):75–77. [Google Scholar]
  • 35.Çelik S, Taşdemir N, Kurt A, et al. Fatigue in Intensive Care Nurses and Related Factors. Int J Occup Environ Med. 2017;88(4):199–206. doi: 10.15171/ijoem.2017.1137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Jones G, Hocine M, Salomon J, et al. Demographic and occupational predictors of stress and fatigue in French intensive-care registered nurses and nurses’ aides: A cross-sectional study. Int J Nurs Stud. 2015;52(1):250–259. doi: 10.1016/j.ijnurstu.2014.07.015. [DOI] [PubMed] [Google Scholar]
  • 37.Qasim AM, Loai AS, Omar AO. Fatigue, burnout, work environment, workload and perceived patient safety culture among critical care nurses. Br J Nurs. 2020;29(1):28–34. doi: 10.12968/bjon.2020.29.1.28. [DOI] [PubMed] [Google Scholar]
  • 38.Pasupathy KS, Barker LM. Impact of fatigue on performance in registered nurses: Data mining and implications for practice. J Healthc Qual. 2011;34(5):22–30. doi: 10.1111/j.1945-1474.2011.00157.x. [DOI] [PubMed] [Google Scholar]
  • 39.Steege L, Pinekenstein B, Rainbow J, et al. Addressing occupational fatigue in nurses: current state of fatigue risk management in hospitals, part 1. J Nurs Adm. 2017;46(4):426–433. doi: 10.1097/NNA.0000000000000509. [DOI] [PubMed] [Google Scholar]

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