Dimensions of Fatigue as Predictors of Performance: A Structural Equation Modeling Approach Among Registered Nurses

Abstract

OCCUPATIONAL APPLICATIONS This study developed and evaluated a quantitative model relating dimensions of occupational fatigue and performance among registered nurses. Fatigue is a likely contributing factor to medical errors, with implications for both patient and provider safety. Thus, there is an ongoing need to further understand, define, and quantify the effects of fatigue on performance in healthcare workers, particularly nurses. The final model developed here supports existing evidence that mental and physical fatigue are distinct dimensions that contribute to a separate construct—total fatigue. Further, mental and physical fatigue dimensions had both direct and indirect effects on perceptions of mental and physical performance in this population. This model can be used by practitioners to evaluate fatigue interventions and estimate potential changes in perceived performance based on subjective measures of performance. TECHNICAL ABSTRACT Background: While fatigue has been linked to performance decrements in nurses, relationships between dimensions of fatigue and the effects of fatigue on performance have not been fully defined. Purpose: A quantitative model was developed here to relate mental and physical dimensions of fatigue to total fatigue and to evaluate direct and indirect effects of dimensions of fatigue on dimensions of performance. Methods: Data from a previous survey of registered nurses were used to estimate the model using structural equation modeling. Initial hypothesized and alternate models were evaluated for fit, and a final model was cross-validated with a subset of the sample. Results: All models had adequate fit to the data. Pathways in the initial and validation models indicated that total fatigue does exist as a construct and is directly affected by mental and physical fatigue. Direct effects were found between mental fatigue and mental performance and between physical fatigue and physical performance. Total fatigue, however, did not play a mediating role in the relationship between dimensions of fatigue and performance. Conclusions: The final model provides quantitative estimates of the strength of relationships between perceived dimensions of occupational fatigue and performance in registered nurses, and it can be used to guide the development and evaluation of fatigue interventions.