Fatigue Management Strategies Research Articles

Perspective: Improving the understanding of sleep deprivation and strategies for fatigue management across the medical education continuum: a call to action.

Perspective: Improving the understanding of sleep deprivation and strategies for fatigue management across the medical education continuum: a call to action.

Exploring the usefulness of real-time digitally supported fatigue monitoring in fatigue management: Perspectives from occupational therapists and brain injury survivors

Introduction: Persistent fatigue after acquired brain injury (ABI) needs long-term self-management. Self-monitoring supports self-management and informs the use of fatigue management strategies. Using ecological momentary assessment to monitor fatigue offers a data-driven approach to managing fatigue. Aims: To explore the usefulness of self-monitoring fatigue in real-time, using ecological momentary assessment to support self-management, from the perspective of people with ABI and occupational therapists. Methods: People with ABI monitoried their fatigue by wearing a Fitbit and completing six surveys a day on their phone for 6 days. Think aloud and semi-structured interviews elicited views on self-monitoring and the data generated. Transcripts were analysed using reflexive thematic analysis. Results: Four themes were developed from people with ABI ( n = 9): (1) Attending to experience, (2) making sense of data, (3) the relationship between fatigue and activity, (4) implications for daily life. Three themes from occupational therapists ( n = 5): (1) Challenges of using of data, (2) perceived benefits of self-monitoring, (3) viewing data in relation to their understanding of fatigue. Conclusion: Data generated in real-time challenged perspectives on fatigue and fatigue management. These insights may help people with ABI and their clinicians to plan personalised strategies for fatigue management and evaluate its impact on daily living.

Analysis of Wavelet Coherence in Calf Agonist-Antagonist Muscles during Dynamic Fatigue.

Dynamic muscle fatigue during repetitive movements can lead to changes in communication between the central nervous system and peripheral muscles. This study investigated these changes by examining electromyogram (EMG) characteristics from agonist and antagonist muscles during a fatiguing task. Twenty-two healthy male university students (age: 22.92 ± 2.19 years) performed heel raises until fatigue. EMG signals from lateral gastrocnemius (GL) and tibialis anterior (TA) muscles were processed using synchrosqueezed wavelet transform (SST). Root mean square (RMS), mean frequency (MF), power across frequency ranges, wavelet coherence, and co-activation ratio were computed. During the initial 80% of the task, RMS and EMG power increased for both muscles, while MF declined. In the final 20%, GL parameters stabilized, but TA showed significant decreases. Beta and gamma intermuscular coherence increased upon reaching 60% of the task. Alpha coherence and co-activation ratio remained constant. Results suggest that the central nervous system adopts a differentiated control strategy for agonist and antagonist muscles during fatigue progression. Initially, a coordinated "common drive" mechanism enhances both muscle groups' activity. Later, despite continued increases in muscle activity, neural-muscular coupling remains stable. This asynchronous, differentiated control mechanism enhances our understanding of neuromuscular adaptations during fatigue, potentially contributing to the development of more targeted fatigue assessment and management strategies.

Evaluating cancer rehabilitation services: Insight from Australia and New Zealand

Background: Despite evidence supporting the benefits of rehabilitation for cancer survivors, the nature of cancer rehabilitation programs is inadequately described in Australia and New Zealand. This study provides insight into current service delivery and challenges for healthcare systems in implementation of cancer rehabilitation programs. Methods: A cross-sectional survey of directors of public and private rehabilitation services in hospital and ambulatory settings across Australia and New Zealand using the Australasian Rehabilitation Outcomes Centre (AROC) registry evaluated the current delivery of cancer rehabilitation programs, health professional workforce, core care components delivered, barriers and facilitators to service delivery, and unit/organisation-wide cancer rehabilitation activities. Descriptive statistics analyzed quantitative data, and qualitative analyses interpreted item responses. Results: Of the 300 services, 102 (34%) participants completed the survey. Most services provide non-dedicated cancer rehabilitation programs (n=63), led by rehabilitation physicians, followed by allied health. The common tumour streams referred included central nervous system (67%, n=56), haematological (59%, n=49), prostate (58%, n=48), and lung cancers (58%, n=48). Patients were frequently referred during post-treatment (87%, n=72) and treatment phases (66%, n=55). Core program components were multimodal exercises, fatigue management strategies, and management of medical complications and medications. The main barriers and facilitators toward the uptake of cancer rehabilitation programs were identified. Key activities in education, research, advocacy, and clinical practice improvement were also highlighted. Conclusions: The survey identified key barriers and facilitators for the implementation of cancer rehabilitation programs. Collaborative efforts of relevant stakeholders, clinicians, consumers, and policymakers need to address barriers to broader implementation of cancer rehabilitation services.

Correlation between Fatigue and Quality of Life in Adolescent Oncology Patients in Jordan

Background Adolescence represents a distinct and multifaceted developmental stage characterized by profound physical and cognitive transformations. Adolescents undergoing cancer treatment frequently have unique needs that remain unmet, leading to a notable decline in their quality of life. Cancer treatment often results in problems like fatigue, which affects patients' quality of life. Assessing quality of life and fatigue among adolescent cancer patients is essential for enhancing nursing care and improving outcomes. Objective This study aimed to investigate the correlation between fatigue and quality of life among adolescent cancer patients in Jordan. Methods A “cross-sectional” study was performed, with the participation of 127 Jordanian adolescent cancer patients, and data was collected through a nameless online survey of Jordanian adolescent cancer patients. The study commenced in February 2024 and concluded in June 2024. Demographic data and responses from two self-reported questionnaires—the Arabic versions of “Pediatric Quality of Life Inventory” “Multidimensional Fatigue Scale” and “Generic Core 4.0”—were collected. Descriptive statistics of means, frequencies, standard deviations, and percentages were used with demographics while inferential statistics were conducted using independent t-tests, Spearman's rank correlation coefficients, and Kruskal-Wallis tests in SPSS, version 26. Results Significant and potent correlations were found between various types of fatigue “general, sleep/rest, cognitive, and total” and quality of life “physical, emotional, social, school, psychosocial health”. Notably, the total fatigue scores showed a potent correlation with the total summary scores (r=0.946), with a p-value significant at the <0.001 level for all correlations, indicating that adolescents with cancer experienced high fatigue and low quality of life. Conclusion The study demonstrated a potent link between fatigue and quality of life. The study's outcomes can help enhance guidelines for routine evaluation of fatigue and quality of life by nurses and healthcare providers in adolescent cancer patients to implement and evaluate interventions aimed at reducing fatigue in patients, highlighting fatigue as a significant concern. Future research should explore interventions such as exercise, leisure activities, and sleep to alleviate fatigue. Longitudinal research is essential to assess fatigue at diverse times of the day and week; this could help develop tailored fatigue management strategies to augment the quality of life among adolescent oncology patients.

Fatigue Management in Advanced Prostate Cancer: Real-World Insights From Qualitative Interviews With Patients

BackgroundPatients with advanced prostate cancer (PC) commonly experience fatigue related to the disease itself and its treatment, which affects their quality of life. There are limited real-world data available on patients’ experiences of fatigue while receiving PC treatment and its management. Patients and MethodsThis was a cross-sectional, noninterventional qualitative study involving individual concept-elicitation interviews with patients in the United States. Patients with advanced PC aged ≥18 years who had experienced fatigue and were on androgen-deprivation therapy in combination with second-generation androgen receptor pathway inhibitors were interviewed and their experiences quantified. ResultsOf the 143 patients screened, 13 qualified and 11 completed the interview. Most patients used the term “fatigue” (n = 8) to describe their experiences of tiredness, exhaustion, lack of energy, and weakness. Most patients (n = 8) did not receive any form of educational support from their healthcare providers (HCPs), but some expressed an interest in receiving this support (pamphlets, n = 4; discussion with HCPs, n = 4; online resources, n = 3). Most patients (n = 9) self-discovered fatigue-management strategies over the course of their disease and treatment. Patients found that rigorous exercise (n = 5), regular naps (n = 2), increased rest (n = 3), and a healthy diet (n = 3) were the most effective approaches for managing their fatigue. ConclusionTools are needed to support HCPs with counseling patients with PC for effective management of disease- and treatment-related fatigue.

The impact of positive-pressure breathing apparatus on muscle fatigue of volunteer firefighter.

Muscle fatigue is one of the leading causes that contributes tremendously to injuries among volunteer firefighters in the workplace. The purpose of this study was to investigate the impact of positive-pressure breathing apparatus on muscle fatigue in the shoulder, back, and legs of volunteer firefighters. A total of 60 volunteer firefighters were recruited to perform a running task on a motorized treadmill in a controlled laboratory environment. Surface electromyography and rating of perceived exertion scores were collected from all participants every 60 seconds during the running task. Results show that the median frequency values for all measured muscle groups were significantly lower, and the rating of perceived exertion score was significantly higher after running with the positive-pressure breathing apparatus. Meanwhile, there were no significant differences in the median frequency values for the upper trapezius, erector spinae, and biceps femoris between the initial and final periods of running task without load. However, the median frequency values with load for gastrocnemius, rectus femoris, and tibialis anterior exhibited a greater downward trend compared to those without load. Additionally, using a breathing apparatus can cause asymmetric muscle fatigue in bilateral upper trapezius, erector spinae, gastrocnemius, and tibialis anterior muscles. The decreased performance due to muscle fatigue increases the risk of accidents, thereby posing a threat to the safety of volunteer firefighters. This study offers valuable insights into the effects of positive-pressure breathing apparatus on muscle fatigue among volunteer firefighters. These results may serve as a reference for developing improved fatigue management strategies and optimizing the design features of breathing apparatus.

Factors influencing fatigue of construction workers in hypoxic environments: A survey study

The number of construction projects at high altitude has continued to increase in recent years. Studies have shown that high-altitude environments pose significant challenges to construction workers and that hypoxia can cause cognitive and physical impairments. However, it remains unclear whether and how high-altitude exposure affects construction workers’ fatigue, which limits the effectiveness of occupational safety and health management in high-altitude projects. To address this concern, this cross-sectional study analyzed data from 646 workers at construction sites located at altitudes around 4000 m, aiming to identify factors contributing to fatigue. Using Bayesian network modeling, the study explored the interdependencies between shift conditions, sleep quality, work overload, and duration of high-altitude exposure on pre-service and work fatigue. The analysis revealed that sleep quality and shift patterns are primary predictors of pre-service fatigue, with work overload also playing a significant role. Pre-service fatigue emerged as a critical mediator for work fatigue, especially when combined with high workload. Notably, the duration of high-altitude exposure influenced both pre-service fatigue and work fatigue. These insights emphasize the need for comprehensive fatigue management strategies that consider individual and job-related factors to enhance safety outcomes. The study advocates for targeted fatigue monitoring and management practices, including pre-service training and real-time fatigue monitoring, to ensure the health and safety of workers in high-altitude construction environments.

Neuropsychology intervention for managing invisible symptoms of MS (NIMIS-MS) group: A pilot effectiveness and acceptability study

BackgroundPeople with MS (pwMS) commonly experience a range of hidden symptoms, including cognitive impairment, anxiety and depression, fatigue, pain, and sensory difficulties. These “invisible” symptoms can significantly impact wellbeing, relationships, employment and life goals. We developed a novel bespoke online group neuropsychological intervention combining psychoeducation and cognitive rehabilitation with an Acceptance and Commitment Therapy (ACT)-informed approach for pwMS in an acute tertiary hospital. This ‘Neuropsychological Intervention for Managing Invisible Symptoms’ in MS (NIMIS-MS) consisted of 6 sessions, each with a psychoeducation and ACT component. The content included psychoeducation around managing cognitive difficulties, fatigue, pain, sleep and other unpleasant sensations in MS with the general approach of understanding, monitoring, and recognising patterns and potential triggers. Specific cognitive rehabilitation and fatigue management strategies were introduced. The ACT-informed component focussed on three core ACT areas of the ‘Triflex’ of psychological flexibility (Harris, 2019): Being Present, Opening Up, and Doing What Matters. Methods118 pwMS attended the NIMIS-MS group intervention which was delivered 14 times in six-week blocks over an 18-month period. To evaluate the effectiveness and acceptability, participants completed measures of depression and anxiety (HADS), functional impairment (WSAS), Values- Progress (VQ) and Values- Obstruction (VQ), and Acceptance of MS (MSAS) pre and post NIMIs-MS group intervention. Qualitative feedback was obtained during focus groups after the final session and via online feedback questionnaires ResultsPre-post analysis showed that symptoms of depression and anxiety were significantly lower and acceptance of MS was significantly higher following completion of the NIMIS-MS group. Qualitative feedback showed that participants reported that they felt more equipped to manage the “invisible” symptoms of MS following completion of the group, and benefited from using ACT-based strategies and techniques. Participants highly valued the peer support that evolved during the NIMIS-MS groups. The online format was considered more accessible than in-person groups, due to less concerns of travel time, cost, fatigue, and comfort and infection. ConclusionEvaluation suggests that our novel NIMIS-MS groups is an acceptable, beneficial and feasible approach for providing neuropsychological interventions to individuals with MS.

Perspectives on fatigue management among veterans living with multiple sclerosis

BackgroundChronic fatigue is one of the most common, disabling, and least understood symptoms of many chronic health conditions including multiple sclerosis (MS). A multidisciplinary rehabilitative treatment approach is recommended for MS-related fatigue, but few people with MS have access to such treatment. In-person and telehealth cognitive behavioral therapy (CBT) for fatigue is an emerging acceptable and effective treatment for MS-related fatigue in civilians that has not been studied in Veterans with MS, a population that is more likely to be older, male, unemployed, and disabled. The present study aimed to understand how Veterans with MS (1) describe their fatigue and (2) manage their fatigue, and (3) perceive telehealth CBT for MS-related fatigue. MethodTwenty-four Veterans with MS completed semi-structured interviews and a brief survey. For descriptive purposes, the survey included questionnaires on demographics, fatigue, psychosocial functioning, depression, and pain. Thematic analysis with a combined deductive and inductive approach was used to analyze interview transcripts. ResultsThree themes emerged. First, “experience of MS fatigue as ‘one big tapestry’” described fatigue as deficits in physical and mental energy that were fluctuating and complex in their interaction with biological factors. Veterans described that MS fatigue negatively impacted daily activities of living, emotions, and cognitive functioning. Second, “managing MS fatigue through trial and error” revealed that Veterans expend significant time and effort learning and trialing fatigue management strategies based on their personal beliefs, military training/experiences, provider recommendations, and iterative learning. Most Veterans described energy management, relaxation, exercise, and adaptive thinking as helpful for managing fatigue. Interestingly, the helpfulness of medication for fatigue was highly variable, and none of the Veterans described medication as a standalone fatigue treatment. The third theme, “practicing flexibility with telehealth CBT for MS fatigue” revealed Veteran's enthusiasm about telehealth CBT for MS-related fatigue and highlighted the importance of flexible delivery to meet individual needs. ConclusionVeteran participants shared their experience of MS-related fatigue as well as management strategies that are consistent with previous research in civilians with MS fatigue. Notably, Veterans’ preference for flexible nonpharmacological intervention can inform adaptation of telehealth CBT for Veterans with MS fatigue.

A systematic mapping review of clinical guidelines for the management of fatigue in long-term physical health conditions

Purpose Despite a high prevalence of fatigue and its importance to patients, many people with long-term conditions do not receive fatigue management as part of their treatment. This review is aimed to identify clinical guidance for the management of fatigue in long-term physical health conditions. Methods A systematic mapping review was conducted in accordance with Social Care Institute for Excellence systematic review guidance. Bibliographic databases and guideline repositories were searched for clinical guidelines for long-term conditions, published between January 2008 and July 2018, with a search for updates conducted in May 2023. Data were extracted on the recommendations made for managing fatigue and, where cited, the underlying research evidence used to support these recommendations was also extracted. Results The review included 221 guidelines on 67 different long-term conditions. Only 30 (13.6%) of the guidelines contained recommendations for managing fatigue. These were categorised as clinical (e.g. conduct further investigations), pharmacological, behavioural (e.g. physical activity), psychological, nutritional, complementary, environmental, and multicomponent. The guidelines rated much of the evidence for fatigue management as fairly low quality, highlighting the need to develop and test fatigue-management strategies in high-quality trials. Conclusion This review highlights that management of fatigue is a very important neglected area in the clinical guidelines for managing long-term conditions.

Contributors to fatigue among nurses working in critical care units: A qualitative study.

Fatigue is a growing concern among nurses who provide care to unstable and critically ill patients in critical care wards. It has various negative consequences for both nurses and patients. To explore and describe contributors to fatigue among nurses working in critical care units. A qualitative content analysis. Participants were 21 nurses chosen using purposeful sampling. They were working in different critical care units at different hospitals in nine urban areas of Iran. Semi-structured interviews were used to collect data, and conventional content analysis was used to develop categories and subcategories. The analysis of data on the nurses' perspectives and experiences led to developing nine categories as contributors to fatigue: 'compassion fatigue', 'extensive network of interactions', 'sound and alarm fatigue', 'psychological tensions', 'managerial and organizational tensions', 'lack of motivation and incentives', 'individual characteristics of nurses', 'physical and mental pressure', and requirements of special care and situational complexity'. Understanding the factors that influence the experience of fatigue among nurses working in critical care units is essential for maintaining a reliable and high-quality health care environment within health care facilities. The experience of fatigue by critical care nurses can increase the possibility of practice errors, reduce patient safety and quality of care, and enhance staff burnout and turnover. Proactive policies should be formulated to assess nurses' fatigue levels and implement strategies for effective fatigue management. This approach aims to enhance both patient safety and job satisfaction in the workplace.

Night staff fatigue

Prior to the COVID-19 pandemic, burnout was reported to be prevalent among healthcare staff ( Lancet, 2019 ). Following the pandemic, there has been an increase in staff wellbeing awareness, and the emotional and physical strains felt by the healthcare workforce have been acknowledged and discussed. Associated fatigue risks increasing this burnout prevalence, especially among healthcare assistants that work at night, who are particularly susceptible to fatigue as a result of the opposing circadian rhythm demands (Geiger-Brown et al, 2019). Aim: This survey aimed to: identify what fatigue management strategies have been utilised among night staff in an acute NHS trust; examine the attitudes towards, and culture surrounding, power naps; identify the prevalence of associated risk for patients and staff wellbeing; and identify current barriers to fatigue management. This article aims to utilise the information gathered to make recommendations for optimising fatigue management among night staff within a hospital environment.

Fatigue Management Strategy for Shift Workers in the Air Traffic Control

Fatigue Management Strategy for Shift Workers in the Air Traffic Control

Prevalence, severity, and risk factors of cancer-related fatigue among working cancer survivors: a systematic review and meta-analysis.

The aim of this study is to evaluate the prevalence, severity, and risk factors of cancer-related fatigue among currently working cancer survivors. We searched the PubMed, Embase, Scopus, CINAHL, Cochrane Library, and ICHUSHI databases. The risk of bias was evaluated independently using the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS). A meta-analysis was conducted to determine the prevalence, severity, and related factors associated with cancer-related fatigue among currently working cancer survivors. Our meta-analysis included 18 studies and revealed that 42.2% of currently working cancer survivors experience cancer-related fatigue. The fatigue severity in this group was significantly higher than that in workers without cancer (absolute standardized mean difference (SMD) = 0.67), but lower than that in cancer survivors who had previously worked and were not currently working (absolute SMD = 0.72). Distress was identified as a potential risk factor for cancer-related fatigue in working cancer survivors (partial correlation coefficient = 0.38). The high prevalence of cancer-related fatigue among employed cancer survivors underscores the need for targeted workplace interventions and fatigue management strategies. While the severity of fatigue is less than that seen in non-working survivors, the comparison with the general working population highlights a significant health disparity. The association between distress and fatigue suggests the necessity for a holistic approach to fatigue management that considers both physical and mental factors in working cancer survivors. Our findings highlight the critical need for healthcare professionals and employers to monitor fatigue levels among working cancer survivors and offer appropriate support.

Developing offshore fatigue assessment application to measure fatigue among offshore workers in Malaysia

AbstractFatigue is a significant concern in the offshore oil and gas industry, posing risks to both resources and lives. This study aims to assess fatigue levels among daily trippers on offshore platforms and compare them across different job roles. The Offshore Fatigue Assessment Application (OFAA) was developed to measure fatigue in Malaysian offshore workers, focusing on alert response and lapses. A total of 51 participants were involved, with 31 in Crew A and 20 in Crew B. Based on the results, Crew A exhibited fatigue, with only 3 out of 12 data collection points showing an average reaction time (RT) below 500 ms, mainly during post‐work periods. Crew B also experienced fatigue, with only 1 out of 12 data collection points showing an average RT below 500 ms, occurring during mid‐work. While Crew B displayed fatigue during pre‐work and mid‐work, they generally maintained alertness during their sessions. Overall, Crew A consistently faced lapses in alertness, while Crew B showed fatigue during pre‐work and mid‐work but remained alert during their sessions. These findings highlight varying fatigue levels among offshore personnel, emphasizing the need for targeted fatigue management strategies in this industry.

Increased Confidence and Deeper Understanding of Fatigue Following Participation in Fatigue Education and Management Education in Systemic Sclerosis: A Mixed Methods Evaluation of a Virtual Intervention.

No fatigue-specific programs exist for people with systemic sclerosis (SSc) despite the burden of fatigue and negative impact on daily activities. This study used a convergent parallel mixed methods design to evaluate the impact of an adapted virtual intervention, Fatigue and Activity Management Education in Systemic Sclerosis (FAME-iSS), in the United States. Eighteen people with SSc participated in three separate six-week FAME-iSS programs. Participants completed the modified Fatigue Impact Scale (m-FIS), the Self-Efficacy for Performing Energy Conservation Strategies Assessment (SEPESCA), the Patient-Reported Outcomes Measurement Information System (PROMIS) Self-Efficacy for Managing Symptoms, and the Hospital Anxiety and Depression Scale (HADS) before, immediately after, and three months post intervention. Data were analyzed using descriptive and nonparametric inferential statistics. Participants' perceptions of the program and their use of fatigue management strategies were qualitatively analyzed using content analysis. Eighty-nine percent of participants were women with a mean ± SD age of 52.0 ± 11.6 years and a mean ± SD disease duration of 13.7 ± 14.5 years, and more than 70% had a college degree. Significant improvements were observed for self-efficacy on the PROMIS Self-Efficacy for Managing Symptoms (P = 0.002) and SEPESCA (P = 0.016) immediately post intervention, which continued to significantly improve up to the three-month follow-up (P = 0.006 and 0.035, respectively). Significant improvements were also observed for the m-FIS between baseline and the three-month follow-up (P = 0.029). Participants reported a deeper understanding of fatigue and that they liked sharing strategies and experiences with each other along with the facilitator, citing that "there was a power in our group because we had a common condition." FAME-iSS resulted in improvements in the impact of fatigue and self-efficacy for managing symptoms and performing energy conservation strategies. Feedback was positive, and the virtual format allowed for greater accessibility and sharing of strategies.

“I just want to stay here and sleep forever”: South African patients’ lived experiences of chronic fatigue in endometriosis

Chronic fatigue is a distressing symptom for endometriosis patients but is not widely investigated in the literature. Our aim was to explore patients’ lived experiences of chronic fatigue and how they make meaning of it. We analysed a subset of data from seven severely fatigued endometriosis patients, drawn from a broader qualitative study in South Africa, using an interpretive phenomenological analysis. Three superordinate themes and eight subordinate themes were developed. The three superordinate themes were powerlessness, which was a core aspect of the chronic fatigue experience among participants; struggle and anguish, as their lives had become a daily struggle resulting in feelings of despair and anger; and otherness, as they felt different from their peers due to the fatigue. The findings demonstrate the far-reaching effects that chronic fatigue has in the lives of endometriosis patients, including on their self-perception, and highlights the critical need for fatigue management strategies within treatment protocols.

Sleep and fatigue management strategies: How nurses, midwives and paramedics cope with their shift work schedules-a qualitative study.

To understand the benefits and challenges of shift work, and the coping strategies used by nurses, midwives and paramedics to manage the impact of shift work on sleep and fatigue from shift work. A single case study with embedded units. Twenty-seven participants were interviewed exploring their shift work experiences, coping strategies used to improve sleep, and what their recommendations are for improving shift work management. Interviews were completed between November and December 2022. Participants enjoyed the lifestyle, flexibility and financial rewards offered by working shift work. However, fatigue and sleep deprivation undermined these benefits, as it impacted their ability to enjoy social and family events. There were also concerns of long-term health consequences of shift work and delivery of care. Changes to rostering practices and sleep and shift work education were common recommendations. This study provides insights on how healthcare professionals manage sleep and fatigue due to shift work and the inadequate support. There is absence of adequate policies, processes and training at an organizational, academic and personal level on how to best manage sleep and fatigue when working shift work. Future research is needed to explore how to equip healthcare shift workers with the skills to successfully manage their schedules to mitigate the negative impact that poor sleep and fatigue has on the health and safety of themselves and their patients. Understanding the specific challenges of shift work and how workers manage their shift work schedules is critical for improving the health and safety of themselves and their patients. This study identified that there is insufficient training regarding sleep and shift work management strategies, potentially leading to occupational health and safety concerns. Further education and training to equip staff with the necessary information, training and guidance to staff on how to reduce fatigue risk is required. This study involved healthcare shift workers in semi-structured interviews. Data gathered from a previous survey that participants were involved in helped shape the interview topics and the study design.

Steps toward developing a comprehensive fatigue monitoring and mitigation solution: perspectives from a cohort of United States Naval Surface Force officers.

This study analyzed fatigue and its management in US Naval Surface Force warships, focusing on understanding current practices and barriers, and examining the influence of organizational and individual factors on managing chronic fatigue. Furthermore, this study explored the impact of organizational and individual factors on fatigue management. As part of a larger study, 154 naval officers (mean ± standard deviation; 31.5 ± 7.0 years; 8.8 ± 6.8 years of service; 125 male, and 29 female) completed a fatigue survey. The survey addressed (1) self-reported fatigue, (2) fatigue observed in others, (3) fatigue monitoring strategies, (4) fatigue mitigation strategies, and (5) barriers to fatigue mitigation. Logistic and ordinal regressions were performed to examine the effect of individual (i.e. sleep quality and years in military service) and organizational (i.e. ship-class) factors on fatigue outcomes. Fatigue was frequently experienced and observed by 23% and 54% of officers, respectively. Of note, officers often monitored fatigue reactively (i.e. 65% observed others nodding off and 55% observed behavioral impairments). Still, officers did not frequently implement fatigue mitigation strategies, citing few operationally feasible mitigation strategies (62.3%), being too busy (61.7%), and not having clear thresholds for action (48.7%). Fatigue management varies across organizational factors, which must be considered when further developing fatigue management strategies. Fatigue remains a critical concern aboard surface force ships and it may be better addressed through development of objective sleep and fatigue monitoring tools that could inform leadership decision-making.