The effects of fatigue on performance in simulated nursing work

Fatigue is associated with increased rates of medical errors and healthcare worker injuries, yet existing research in this sector has not considered multiple dimensions of fatigue simultaneously. This study evaluated hypothesised causal relationships between mental and physical fatigue and performance. High and low levels of mental and physical fatigue were induced in 16 participants during simulated nursing work tasks in a laboratory setting. Task-induced changes in fatigue dimensions were quantified using both subjective and objective measures, as were changes in performance on physical and mental tasks. Completing the simulated work tasks increased total fatigue, mental fatigue and physical fatigue in all experimental conditions. Higher physical fatigue adversely affected measures of physical and mental performance, whereas higher mental fatigue had a positive effect on one measure of mental performance. Overall, these results suggest causal effects between manipulated levels of mental and physical fatigue and task-induced changes in mental and physical performance.

Statement of Relevance: Nurse fatigue and performance has implications for patient and provider safety. Results from this study demonstrate the importance of a multidimensional view of fatigue in understanding the causal relationships between fatigue and performance. The findings can guide future work aimed at predicting fatigue-related performance decrements and designing interventions.     

Stress reactions to computer‐interactive tasks as a function of task structure and individual differences

The resurgence of interest in occupational stress has resulted in an emphasis on identifying work conditions that are potentially causal in generating stress reactions and psychological disorders among workers. Although a considerable knowledge base related to this topic has evolved, relatively little is known regarding the impact of computer technology on incidence of job stress. This issue is especially important for older workers, given the increased use of computers in most occupations, the aging of the workforce, and the changes in cognitive and physiological capacities that occur with increased age. The study reported in this article was concerned with developing a methodology to evaluate stress for computer‐interactive tasks as a function of the mental workload of the task and the age of the individual. Sixty‐five women ranging in age from 25 to 70 years performed three computer‐interactive tasks that varied as a function of information processing complexity and pacing requirements. The methodology encompassed physiological, subjective, and performance measures. Results indicated differences in sensitivity among the measures as a function of task and age. The data also indicated age differences in stress reactions and performance. The findings are discussed in terms of the suitability of computer tasks for older people.     

Effects of different physical workload parameters on mental workload and performance

The design and evaluation of an occupational task should include an assessment of mental workload, since excessive levels of mental workload can cause errors or delayed information processing. Physically demanding work that is performed concurrently with a cognitive task may impact mental workload by impairing mental processing or decreasing performance. The primary objective of this study was to determine whether there is a differential effect of various types of physical activity on both mental workload and cognitive performance. Objective and subjective assessment tools (heart rate variability and visual analog scale) were used as indicators of mental workload, while correct responses during an arithmetic task reflected levels of performance. Thirty participants (ages 18-24 years) performed a combination of tasks inducing both physical and mental workload. Type of physical effort, frequency of movement, and force exertion level were manipulated to alter the workload associated with the physical activity. Changes in subjective ratings generally corresponded to changes in both performance on the arithmetic task and objective mental workload assessment. Some discrepancies occurred at the highest physical force exertion level as participants perceived an increase in effort to maintain the same level of performance. Further research is needed to determine the force exertion threshold, beyond which the physical effort required interferes with mental workload and/or cognitive performance.

Relevance to industry

Technological advancements have increased the requirement for many workers to execute cognitive tasks concurrently with physical activity. When designing and evaluating such situations it is important to determine the interactive effects of these activities. A simple, uni-dimensional tool is suggested as a screening tool to identify situations requiring excessive or increased mental workload that many degrade performance or place additional stress on the individual.     

On the relationship between subjective and objective measures of fatigue

Objective: Objective and subjective methods have been used in the past to assess workplace fatigue, but little is known about correlations between them. We examine correlations between subjective and objective measures, including measures collected in a workplace scenario. Methods: 15 young and 17 older participants were assessed before and after work with four types of fatigue measure: objective physical (posturography), objective mental (psychomotor vigilance task), subjective physical and mental (self-assessment), objective and subjective realistic (oculomotor behaviour, observer-rated facial expression, typing performance). Results: Pre- and post-test scores were analysed with an ANOVA, significant differences were submitted to a factor analysis. It yielded three factors: one representing posturography, the second self-rated mental and physical fatigue and the third observer-rated facial expression. Conclusions: Results advocate the existence of three independent fatigue components: Objective physical fatigue, introspective and extrospective fatigue.

Practitioner Summary: This study analyses correlations between different subjective and objective fatigue markers to better understand the complex nature of workplace fatigue. Measurements were conducted directly at the workplace. Results reveal that fatigue comprises three independent fatigue components: Objective physical fatigue, introspective and extrospective fatigue.     

Prediction of development of fatigue during a simulated ambulance work task from physical performance tests

The aims of this study were (1) to identify which physical performance tests could best explain the development of fatigue during a simulated ambulance work task, (2) to investigate the effect of height and weight and (3) to investigate in what respects these findings differ between female and male ambulance personnel. Forty-eight male and 17 female ambulance personnel completed a test battery assessing cardio-respiratory capacity, muscular strength and endurance, and co-ordination. The subjects also completed a simulated ambulance work task -- carrying a loaded stretcher. The work task was evaluated by development of fatigue. Univariate and multiple regression analyses were used to investigate to what extent the tests in the test battery were able to explain the variance of developed fatigue. The explained variance was higher for female than for male ambulance personnel (time > 70% of HRpeak: R2 = 0.75 vs 0.10, accumulated lactate: R2 = 0.62 vs 0.42, perceived exertion: R2 = 0.75 vs 0.10). Significant predictors in the models were VO2max, isometric back endurance, one-leg rising, isokinetic knee flexion and shoulder extension strength. Height, but not weight, could further explain the variance. The high physical strain during carrying the loaded stretcher implies the importance of investigating whether improved performance, matching the occupational demands, could decrease the development of fatigue during strenuous tasks.     

Vessel motion thresholds for maintaining physical and cognitive performance: a study of naval personnel at sea

Methods and results are reported from a study of ships companies' exposure to low-frequency motions on three vessels of the Royal Navy. The aim of the study was to investigate relationships between deck accelerations and the incidence of problems such as difficulties with physical tasks, cognitive activities, motion sickness, and work effort. Ship motions were recorded continuously during sea patrols of 10-14 days. The data collected from the three vessels comprised 105 days of ship motions over 12 patrols, with 779 associated daily diaries from 78 participants. Problems most strongly associated with vessel motions were related to the difficulties with physical tasks. Some cognitive aspects of task performance and motion sickness were associated with vertical acceleration magnitudes, but the correlations were less strong than with physical tasks. Practitioner Summary: Little is known about the severity of ship motions that degrade physical and mental performance. The paper offers preliminary estimates of the motion threshold values below which the performance will not be degraded by motion.     

Identification and analyses of job difficulty dimensions An empirical study

A study was conducted to identify what job incumbent's interpret as dimensions of job difficulty. In this study job difficulty is defined as a job activity that requires significant physical and/or mental effort to complete. First, interviews, card sorting, and categorization procedures were used with randomly selected staff nurses in three hospitals to develop an occupation specific job difficulty composite scale. The scale was then administered to 130 medical-surgical staff nurses. Factor analysis revealed three job difficulty dimensions for nurses—overload, conflict, head nurse practices, Second, ANOVA and stepwise multiple regression were used to examine the relationships between the factor analytically derived dimensions and satisfaction, commitment, job tension, and performance ratings. It was determined that the various dimensions were differentially related to the various outcome measures.     

On the investigation of the neurophysiological correlates of knowledge worker mental fatigue using the EEG signal

Technological trends and advances in automation have underscored the importance of task performance of certain jobs requiring mental functions such as information processing and decision analyses. Most experts agree that such work environments produce increased mental activities, with profound implications for mental fatigue and stress. Consequently, productivity measurement and improvement for white collar or ‘knowledge worker’ occupations remains a major challenge and concern. This investigation defines an experimental approach that examines the neurophysiological correlates of white collar worker mental fatigue using the EEG signal. A 6 h laboratory experiment was conducted to simulate work output. The methods of assessing fatigue employed were mental tests and physiological measurements. The experiment involved reading of standardized texts, finding solutions to arithmetic-logical problems and a combination of both task types. Two primary performance measures were obtained, work output and brain waves. Fast Fourier transform and correlation analyses are used to quantify the relationship between certain brain waves and mental fatigue. This research is a major step towards the development of a model that explores the relationship between mental fatigue and factors associated with output performance, optimal recuperation periods and related variables. Such a model would be useful in human reliability prediction based on task parameters and worker profiles.     

Effects of precision demands and mental pressure on muscle activation and hand forces in computer mouse tasks

The objective of the present study was to gain insight into the effects of precision demands and mental pressure on the load of the upper extremity. Two computer mouse tasks were used: an aiming and a tracking task. Upper extremity loading was operationalized as the myo-electric activity of the wrist flexor and extensor and of the trapezius descendens muscles and the applied grip- and click-forces on the computer mouse. Performance measures, reflecting the accuracy in both tasks and the clicking rate in the aiming task, indicated that the levels of the independent variables resulted in distinguishable levels of accuracy and work pace. Precision demands had a small effect on upper extremity loading with a significant increase in the EMG-amplitudes (21%) of the wrist flexors during the aiming tasks. Precision had large effects on performance. Mental pressure had substantial effects on EMG-amplitudes with an increase of 22% in the trapezius when tracking and increases of 41% in the trapezius and 45% and 140% in the wrist extensors and flexors, respectively, when aiming. During aiming, grip- and click-forces increased by 51% and 40% respectively. Mental pressure had small effects on accuracy but large effects on tempo during aiming. Precision demands and mental pressure in aiming and tracking tasks with a computer mouse were found to coincide with increased muscle activity in some upper extremity muscles and increased force exertion on the computer mouse. Mental pressure caused significant effects on these parameters more often than precision demands. Precision and mental pressure were found to have effects on performance, with precision effects being significant for all performance measures studied and mental pressure effects for some of them. The results of this study suggest that precision demands and mental pressure increase upper extremity load, with mental pressure effects being larger than precision effects. The possible role of precision demands as an indirect mental stressor in working conditions is discussed.     

The effect of work-rest schedules and type of task on the discomfort and performance of VDT users

Consideration of the literature survey indicates that video display terminal (VDT) operators tend to have a high incidence of musculoskeletal problems, visual fatigue, and job stress. Although a number of ergonomic improvements in workstation design and work environment can help to reduce these problems, a proper work-rest schedule deserves consideration since it is easily applicable and inexpensive. The objective of this study was to compare the work-rest schedules for VDT operators considering data entry and mental arithmetic tasks. An experiment was conducted with 10 male college students as participants. The methodology included a discomfort questionnaire and performance measures. The independent variables were the work-rest schedule (60-minute work/10-minute rest, 30-minute work/5-minute rest, and 15-minute work/micro breaks) and the type of task (data entry and a mental arithmetic task). The results were analysed using multiple analysis of variance followed by separate analyses. The 15/micro schedule resulted in significantly lower discomfort in the neck, lower back, and chest than the other schedules for data entry task. The 30/5 schedule followed by 15/micro schedule resulted in the lowest eyestrain and blurred vision. Discomfort in the elbow and arm was the lowest with the 15/micro schedule for the mental arithmetic task. The 15/micro schedule resulted in the highest speed, accuracy, and performance for both of the tasks, compared with the 60/10 and 30/5 schedules. The data entry task resulted in significantly increased speed, accuracy, and performance, and lower shoulder and chest discomfort than the mental arithmetic task.     

Prediction of development of fatigue during a simulated ambulance work task from physical performance tests

The aims of this study were (1) to identify which physical performance tests could best explain the development of fatigue during a simulated ambulance work task, (2) to investigate the effect of height and weight and (3) to investigate in what respects these findings differ between female and male ambulance personnel. Forty-eight male and 17 female ambulance personnel completed a test battery assessing cardio-respiratory capacity, muscular strength and endurance, and co-ordination. The subjects also completed a simulated ambulance work task — carrying a loaded stretcher. The work task was evaluated by development of fatigue. Univariate and multiple regression analyses were used to investigate to what extent the tests in the test battery were able to explain the variance of developed fatigue. The explained variance was higher for female than for male ambulance personnel (time > 70% of HR_peak: R² = 0.75 vs 0.10, accumulated lactate: R² = 0.62 vs 0.42, perceived exertion: R² = 0.75 vs 0.10). Significant predictors in the models were VO₂max, isometric back endurance, one-leg rising, isokinetic knee flexion and shoulder extension strength. Height, but not weight, could further explain the variance. The high physical strain during carrying the loaded stretcher implies the importance of investigating whether improved performance, matching the occupational demands, could decrease the development of fatigue during strenuous tasks.     

Assessment and monitoring of mental workload in subway train operations using physiological,subjective, and performance measures

Subway train operation is a complex, sociotechnical system that involves a variety of cognitively demanding tasks. The train operators are responsible for continuously monitoring the surrounding environment, maintaining awareness, processing information, and making decisions under risk. The resulting mental strain on operators can negatively affect their performance and the interaction of the human–machine system. The objective of this study was to evaluate if physiological, subjective, and performance measures could identify the level of mental workloads arising from routine and nonroutine operations in the subway system. A total of 11 subway train operators underwent different driving scenarios in a high‐fidelity simulator. The simulated tasks were divided into two categories: routine operations (preparing to drive and driving between stations without interruptions or emergencies) and nonroutine operation (responding to a tunnel fire, dealing with a high density of passengers, encountering a passenger/technician on the track, and responding to train failure). The mental workload was monitored and evaluated in these tasks using an electrocardiogram, subjective self‐rating scales, and driving performance. Both heart rate variability and performance measures (including reaction time and error rate) detected mental workload variations in the different operations. On the other hand, the subjective ratings (including NASA‐TLX) assessed the overall mental workload associated with a task, without explaining the mental demand variations within the task over time. Subway train drivers experienced different levels of mental workload during routine and nonroutine driving conditions. The findings of this study can be used to extract mental workload limits to optimize workload levels during train operations.     

The effect of work-rest schedules and type of task on the discomfort and performance of VDT users

Consideration of the literature survey indicates that video display terminal (VDT) operators tend to have a high incidence of musculoskeletal problems, visual fatigue, and job stress. Although a number of ergonomic improvements in workstation design and work environment can help to reduce these problems, a proper work-rest schedule deserves consideration since it is easily applicable and inexpensive. The objective of this study was to compare the work-rest schedules for VDT operators considering data entry and mental arithmetic tasks. An experiment was conducted with 10 male college students as participants. The methodology included a discomfort questionnaire and performance measures. The independent variables were the work-rest schedule (60-minute work/10-minute rest, 30-minute work/5-minute rest, and 15-minute work/micro breaks) and the type of task (data entry and a mental arithmetic task). The results were analysed using multiple analysis of variance followed by separate analyses. The 15/micro schedule resulted in significantly lower discomfort in the neck, lower back, and chest than the other schedules for data entry task. The 30/5 schedule followed by 15/micro schedule resulted in the lowest eyestrain and blurred vision. Discomfort in the elbow and arm was the lowest with the 15/micro schedule for the mental arithmetic task. The 15/micro schedule resulted in the highest speed, accuracy, and performance for both of the tasks, compared with the 60/10 and 30/5 schedules. The data entry task resulted in significantly increased speed, accuracy, and performance, and lower shoulder and chest discomfort than the mental arithmetic task.     

Fatigue assessment of construction equipment operators using a sweat lactate biosensor

This study investigated the accuracy and usefulness of a sweat-based biosensor for measuring the fatigue levels of construction equipment operators. Specifically, the paper first elaborated on the suitability of selecting sweat lactate as a biomarker for measuring combined fatigue (i.e., a combination of physical and mental fatigue) that construction equipment operators often experience. Then, the mechanism of a sweat-based sensor was explained. An experiment was then presented in which the sweat lactate levels of five subjects engaged in simulated equipment operating tasks were measured. The reliability of the sweat-based lactate sensor was also evaluated by conducting a between-day test-retest experiment. The lactate measurements of the sweat sensor were compared to measurements of blood lactate to assess the accuracy of the sweat sensor. The Fatigue Assessment Scale, a subjective fatigue method, validated sweat lactate as a fatigue assessment biomarker. Analytical results indicate that the lactate measurements from the sweat-based sensor do reflect the fatigue level of equipment operators, and the device has good reliability for measuring sweat lactate concentration.     

Perceived fatigue after mental work: an experimental evaluation of a fatigue inventory

The aim of this study was to investigate the perceived fatigue after mental work and to test the Swedish Occupational Fatigue Inventory (SOFI). Twenty male and 20 female participants worked with proof reading (2 x 90 min) and a vigilance task (2 x 60 min). After each task session, perceived fatigue was rated with the SOFI and Borg's CR10O-scale. In addition, physiological reactions were registered; blood pressure, heart rate, heart rate variability and muscle activity in corrugator supercilii, as well as measures of performance: reaction time, number of pages read and number of proof errors found, number of detected signals. As expected, the highest ratings were obtained on Lack of energy, Lack of motivation and Sleepiness, particularly after the vigilance task. High ratings after both work tasks were also found on the CR10-scale. Men and women did not differ significantly with respect to their ratings. No clear-cut physiological reactions were found to correlate with ratings of fatigue. The results indicate the validity of the mental dimension of the SOFI.     

Effect of job rotation on work demands, workload, and recovery of refuse truck drivers and collectors

Job rotation is often advocated to reduce workload, but its efficacy has seldom been investigated. The aim of this study is to compare the work demands, workload, and recovery among truck driving, refuse collecting, and rotating between these two jobs, between days and during the day. Three teams of 3 employees each participated in this study. Work demands were assessed by systematic observation of tasks and activities. Workload was quantified by means of heart rate, oxygen uptake, subjective ratings, and urinary excretion rates of catecholamines. Recovery was quantified by excretion rates of catecholamines after work. Job rotation between driving and collecting is an effective measure to reduce physical workload as compared with collecting only and to decrease mental workload as compared with driving only. However, job rotation resulted in increased physical workload as compared with driving only. Job rotation did not increase mental workload as compared with collecting only. No effects were seen on recovery. No differences were found between rotating between days and during the day. Actual or potential applications of this research include the recommendation that before job rotation is introduced, its efficacy be determined in terms of well-chosen workload measures because a reduction in work demands does not directly imply a reduction in workload. Therefore, job rotation might be less effective than expected.     

Perceived fatigue after mental work: an experimental evaluation of a fatigue inventory

The aim of this study was to investigate the perceived fatigue after mental work and to test the Swedish Occupational Fatigue Inventory (SOFI). Twenty male and 20 female participants worked with proof reading (2x90 min) and a vigilance task (2x60 min). After each task session, perceived fatigue was rated with the SOFI and Borg's CR10-scale. In addition, physiological reactions were registered; blood pressure, heart rate, heart rate variability and muscle activity in corrugator supercilii, as well as measures of performance: reaction time, number of pages read and number of proof errors found, number of detected signals. As expected, the highest ratings were obtained on Lack of energy, Lack of motivation and Sleepiness, particularly after the vigilance task. High ratings after both work tasks were also found on the CR10-scale. Men and women did not differ significantly with respect to their ratings. No clear-cut physiological reactions were found to correlate with ratings of fatigue. The results indicate the validity of the mental dimension of the SOFI.     

An ergonomics study of thumb movements on smartphone touch screen

This study investigated the relationships between thumb muscle activity and thumb operating tasks on a smartphone touch screen with one-hand posture. Six muscles in the right thumb and forearm were targeted in this study, namely adductor pollicis, flexor pollicis brevis, abductor pollicis brevis (APB), abductor pollicis longus, first dorsal interosseous (FDI) and extensor digitorum. The performance measures showed that the thumb developed fatigue rapidly when tapping on smaller buttons (diameter: 9 mm compared with 3 mm), and moved more slowly in flexion–extension than in adduction–abduction orientation. Meanwhile, the electromyography and perceived exertion values of FDI significantly increased in small button and flexion–extension tasks, while those of APB were greater in the adduction–abduction task. This study reveals that muscle effort among thumb muscles on a touch screen smartphone varies according to the task, and suggests that the use of small touch buttons should be minimised for better thumb performance.