Creation of a Conceptual Framework to Investigate Hospital Nurse Fatigue and Adverse Patient Outcomes

Tuesday, 31 July 2012: 11:10 AM

Diane A. Drake, PhD, RN
Nursing Administration, Mission Hospital, Mission Viejo, CA
Michele Luna
Quality Department, Mission Hospital, Mission Viejo, CA

Learning Objective 1: Describe the methods used to create a conceptual framework to investigate hospital nurse fatigue and adverse patient outcomes.

Learning Objective 2: Identify opportunities to conceptualize hospital nursing research and practice outcomes.

Purpose: The purpose of this presentation is to describe methods used to create a conceptual framework to guide the investigation of hospital nursing practice and adverse patient outcomes. 

Methods: A professional collaboration between the hospital nurse quality manager and nurse research scientist allowed for discussion of experiential knowledge and inception of the idea to investigate nurse fatigue and adverse patient outcomes. Clarification of concepts was necessary to describe “what is really going on” related to nurse fatigue and adverse patient outcomes. Review of related literature, identification of fatigue types, and further discussions to refine definitions of fatigue, hospital nursing, and adverse patient outcomes was accomplished over many months. Interview of nurses who had published and researchers who had investigated nurse fatigue supported the need to create a diagram of nurse fatigue concepts and relationships. A study team of hospital nurses reviewed selected articles related to fatigue and adverse patient outcomes and agreed upon major concepts for investigation.

Results: Four study concepts were selected by the study team: hospital nurse, hospital unit, fatigue types (mental, physical and emotional), and adverse patient outcomes.  The conceptual framework was used to create the necessary strategy to apply empirical methods over three phases of research to: 1) design and administration of a survey, Hospital Nurse Force and Fatigue Study, to test the prevalence and types of hospital nurse fatigue, 2) test the effect of interrelated hospital and nurse variables on fatigue and adverse patient outcomes, 3) test interventions to mitigate or prevent hospital nurse fatigue and related adverse patient outcomes.

Conclusion: The process of creating a conceptual framework can help clarify that adequate and correct assumptions are made to enable meaningful results of investigations. Experiential knowledge and discussion of methods used to create conceptual frameworks for nursing research are critical to advance nursing science in the hospital.