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Effect of a Workplace Walking Initiative to Decrease Telehealth Nurses' Fatigue Georgia College Knowledge Box Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects School of Nursing Winter 12-14-2014 Effect of a Workplace Walking Initiative to Decrease Telehealth Nurses' Fatigue Rae Ann Heissenbuttel Geoorgia College, [email protected] Follow this and additional works at: https://kb.gcsu.edu/dnp Part of the Nursing Commons Recommended Citation Heissenbuttel, Rae Ann, "Effect of a Workplace Walking Initiative to Decrease Telehealth Nurses' Fatigue" (2014). Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects. 17. https://kb.gcsu.edu/dnp/17 This Thesis is brought to you for free and open access by the School of Nursing at Knowledge Box. It has been accepted for inclusion in Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects by an authorized administrator of Knowledge Box. Running Header: EFFECT OF WALKING ON NURSES FATIGUE Effect of a Workplace Walking Initiative on Telehealth Nurses’ Fatigue Rae Ann Heissenbuttel Georgia College & State University EFFECT OF WALKING ON NURSES FATIGUE 2 Effect of a Workplace Walking Initiative on Telehealth Nurses’ Fatigue Rae Ann Heissenbuttel Georgia College and State University Dedication Without the support and love of my family- Dave, Parker, Katie, and Peter the completion of this project and other degree requirements for my DNP would not have been possible. Thank you for all the understanding of missed soccer games, football games, volleyball matches, and miscellaneous school events over the last two years. Also, love and gratitude to my parents- Ron and Laura and to my sister Lee, for all of their support and encouragement through the years of my continued education. Also, a quick thank you to all of my close friends- Meg, Amy, Nancy, and Mary Kathryn for always staying by my side. EFFECT OF WALKING ON NURSES FATIGUE 3 Acknowledgement I would like to acknowledge the contribution of several key individuals and organizations in ensuring this project came to fruition. To begin with, I would like to thank my Project Chair, Dr. Susan Steele for all of her guidance, knowledge, and support throughout completing each process of this project. Followed by the continued support and knowledge of my committee members, Dr. Leslie Moore and Dr. Michael Horowitz. Also, I would like to acknowledge Optum for allowing me the time and support to complete my DNP Project, largely in part to Greg Mudge. I would also like to acknowledge Optum for approving the use of the SF-36 Survey for use in this scholarly project and Pam Bartley for her assistance in using the tool. I would also like to acknowledge the American Heart Association for developing and supporting the use of their Workplace Walking Initiative. EFFECT OF WALKING ON NURSES FATIGUE 4 Table of Contents Dedication………………………………………………………………………………….. 2 Acknowledgement…………………………………………………………………………. 3 Abstract…………………………………………………………………………………….. 8 Problem Statement…………………………………………………………………………. 9 Clinical Questions…………………………………………………………………………. 10 Current Workplace Situation………………………………………………………………. 10 Theoretical Framework……………………………………………………………………. 11 Review of Literature……………………………………………………………………….. 12 Fatigue……………………………………………………………………………… 12 Fatigue Classification………………………………………………………………. 13 Acute & Chronic Fatigue…………………………………………………... 13 Mental & Physical Fatigue…………………………………………………. 13 Fatigue in Healthcare Workers…………………………………………………………….. 14 Fatigue in Nurses…………………………………………………………………………... 15 Fatigue Counter Measures…………………………………………………………………. 16 Fatigue in Call Center Employees…………………………………………………………. 17 Exercise and Fatigue……………………………………………………………………….. 18 Health Consequences of Sedentary Work…………………………………………………. 18 Workplace Wellness Initiatives……………………………………………………………. 19 Methods……………………………………………………………………………………. 20 Design……………………………………………………………………………………… 20 Instruments…………………………………………………………………………………. 21 EFFECT OF WALKING ON NURSES FATIGUE 5 SF-36 Assessment………………………………………………………………….. 21 Fatigue Assessment Scale………………………………………………………….. 22 Fatigue Severity Scale……………………………………………………………… 23 Congruence of Organizations Strategic Plan to Project……………………………………. 23 IRB Approval………………………………………………………………………………. 24 Clinical Questions………………………………………………………………………….. 24 Project Aims……………………………………………………………………………….. 24 Project Description………………………………………………………………………… 25 Recruitment………………………………………………………………………………… 25 Inclusion/Exclusion Criteria……………………………………………………………….. 25 Informed Consent and Confidentiality…………………………………………………….. 26 Project Intervention………………………………………………………………………… 26 Data Analysis………………………………………………………………………………. 27 Instruments…………………………………………………………………………………. 27 Results……………………………………………………………………………………… 28 Sample Characteristics…………………………………………………………………….. 28 Demographics………………………………………………………………………. 28 Body Weight ………………………………………………………………………. 29 Physical Activity…………………………………………………………………… 29 Walking Log Data………………………………………………………………………….. 29 Outcomes…………………………………………………………………………………… 30 Clinical Question 1………………………………………………………………… 30 Clinical Question 2………………………………………………………………… 31 EFFECT OF WALKING ON NURSES FATIGUE 6 Clinical Question 3………………………………………………………………… 32 Clinical Question 4…………………………………………………………………. 33 Discussion………………………………………………………………………………….. 35 Analysis of Results…………………………………………………………………………. 35 Limitations of the Study……………………………………………………………………. 36 Implications for Practice…………………………………………………………………… 37 Future for Research………………………………………………………………………… 38 References………………………………………………………………………………….. 39 Table 1……………………………………………………………………………………… 49 Table 2……………………………………………………………………………………… 51 Table 3……………………………………………………………………………………… 52 Table 4……………………………………………………………………………………… 53 Table 5……………………………………………………………………………………… 54 Table 6……………………………………………………………………………………… 55 Table 7……………………………………………………………………………………… 56 Table 8……………………………………………………………………………………… 67 Table 9……………………………………………………………………………………… 71 Table 10…………………………………………………………………………………….. 76 Figure 1…………………………………………………………………………………….. 77 Figure 2…………………………………………………………………………………….. 78 Appendix A………………………………………………………………………………… 79 Appendix B………………………………………………………………………………… 81 Appendix C………………………………………………………………………………… 84 EFFECT OF WALKING ON NURSES FATIGUE 7 Appendix D………………………………………………………………………………… 85 Appendix E…………………………………………………………………………………. 86 Appendix F…………………………………………………………………………………. 87 EFFECT OF WALKING ON NURSES FATIGUE 8 Abstract Background: Fatigue has been a common problem in the nursing profession. To date, most of the research regarding nurse fatigue has focused on nurses working in hospitals. Minimal research has been completed examining fatigue among nurses working in the telehealth environment and the effects of an evidence-based workplace initiative to decrease fatigue. Aim: The aim of this translational project was to describe the overall self-reported health and fatigue for a group of telehealth nurses and to evaluate the effectiveness of the American Heart Association’s (AHA) walking program in improving overall health status and decreasing fatigue in telehealth nurses. Methods: The project evaluated a sample of 49 telehealth nurses’ health status and fatigue before and after the implementation of the AHA’s workplace walking program. The participants were asked to walk three times a week for at least 20 minutes, logging the date, time, and distance walked using a pedometer. The project participants overall health status and fatigue were measured using the SF-36 Questionnaire, Fatigue Assessment Scale (FAS), and the Fatigue Severity Scale pre- and post-implementation of the walking program. Results: The study did demonstrate that a walking program can be an effective countermeasure for fatigue. The study demonstrated an impact on total fatigue, along with the number of minutes walked effected fatigue and fatigue exhibited a decrease over the 4 week walking time period. Implications: Nurses working in the telehealth role experience very different sources of work- related fatigue, including prolonged sitting and computer work. Fatigue Counter Measurement Programs in nursing, such as this walking initiative need to be developed and implemented for nurses working in the call center work environment. EFFECT OF WALKING ON NURSES FATIGUE 9 Effect of a Workplace Walking Initiative on Telehealth Nurses’ Fatigue Telehealth nursing can be defined as nurses who deliver healthcare services and provide healthcare (National Council of State Boards of Nursing, 1997). Telehealth nurses perform core nursing job functions telephonically, versus physically being with the client. Nurses deliver nursing assessments, patient triage, and patient education through the phone. Telehealth nurses try to decrease overall medical costs through increased patient education and health promotion programs. Nurses working in telehealth began to proliferate in the United States in the 1980’s and became more utilized in the 1990’s in response to escalating healthcare costs (Turner, Bentley, Hodgson, Collard, Drimalis, Rabune, & Wilson, 2002). Many of the large insurance companies started using telehealth nursing advice nurses in the early 1980’s and the role has now involved to include case management, wellness programs, and high cost disease management programs. This study evaluated nurses working in telehealth, employed by an insurance carrier with an office in Atlanta, Georgia and Tampa, Florida. Problem Statement Fatigue due to insufficient sleep or impaired sleep is a common problem in nursing (Hughes & Rogers, 2004,
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