Received: 2 September 2018 | Revised: 24 November 2018 | Accepted: 6 January 2019

DOI: 10.1111/ppc.12354

ORIGINAL ARTICLE

Psychosocial correlates of work‐related fatigue among

Jordanian emergency department nurses

Khaldoun M. Ismail RN, MSN1 | Malakeh Z. Malak RN, CNS, PhD2 |

3,4
Rasmieh M. Alamer RN, PhD

1
Department of Adult Health Nursing, Najran
University, Najran, Saudi Arabia Abstract
2
Department of Community Health Nursing, Purpose: This study purposed to assess the psychosocial correlates of work‐related
Faculty of Nursing, Al‐Zaytoonah University of
fatigue among Jordanian emergency department nurses.
Jordan, Amman, Jordan
3
Department of Psychiatric Health Nursing, Design and Methods: A cross‐sectional study was conducted among Jordanian
Faculty of Nursing, Isra University, Amman, emergency nurses (n = 220). Measures included Occupational Fatigue Exhaustion/
Jordan
4
Recovery Scale (OFER15) and Copenhagen Psychosocial Questionnaire version Two
Adjunct Fellow, Western Sydney University,
School of Nursing and Midwifery, Sydney, (COPSOQ II).
NSW, Australia
Findings: The psychosocial factors correlated with all types of work‐related fatigue
Correspondence (acute, chronic, and inter‐shift [recovery]) were quantitative demands, work‐family
Malakeh. Z. Malak, Department of Community
conflict, sexual harassment, threats of violence, physical violence, and bullying.
Health Nursing, Faculty of Nursing,
Al‐Zaytoonah University of Jordan, P.O. Box Importantly, quantitative demands and sexual harassment were the main predictors
130, Amman 11733, Jordan.
of all types of work‐related fatigue.
Email: malakehmalak@yahoo.com
Practice Implications: The psychosocial correlated factors should be considered
when developing interventions to minimize work‐related fatigue phenomenon. This
would lead to a more positive working environment which will promote safe
nursing care.

KEYWORDS
acute fatigue, chronic fatigue, intershift fatigue, psychosocial factors, work‐related fatigue

1 | INTRODUCTION acute fatigue in addition to insufficient recovery between work shifts

Work‐related fatigue is one of the most common phenomena among
shift workers, particularly nurses. It is defined as a mental or physical
exhaustion that stops a person from being able to function normally
as a result of prolonged periods of physical and/or mental exertion
without enough time to rest and recover.1,2
Work‐related fatigue can be classified into three distinct types:
acute fatigue, chronic fatigue, and inter‐shift (recovery) fatigue.3 Yet,
acute and chronic work‐related fatigue overlaps.1
Acute work‐related fatigue is defined as a feeling of lack of
energy as a direct consequence of previous work activities and it can
be considered as a human protective response to work demands.4
Whereas chronic work‐related fatigue results from high levels of
which persists even on rest days and holidays.5 Moreover, compared
with acute fatigue, chronic fatigue is correlated with more negative
consequences on worker’s health, well‐being, and work perfor-
mance.6 The third type is inter‐shift (recovery) work‐related fatigue
that exists when nurses do not feel recovered from a previous shift at
the start of the next shift.7
Work‐related fatigue affects all nurses, regardless of where they
work. Raftopoulos et al8 found that 91.9% of nurses complained of
working fatigue with a higher level among female nurses. Jones et al9
found that 46.2% of French registered nurses and 52.1% of aid
nurses reported having working fatigue. Furthermore, Bolandianbaf-
ghi et al10 reported that the average score of working fatigue in
nurses was 45.3%.

486 | © 2019 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/ppc Perspect Psychiatr Care. 2019;55:486–493.
ISMAIL ET AL. | 487

Work‐related fatigue is multidimensional in both its manifesta- 2.1 | Measurement methods

tions and causes. To illustrate, the literature reported that the
Self‐administered structured questionnaires were, it consists of the
etiology of work‐related fatigue is associated with various physiolo-
following instruments: basic sociodemographic data questionnaire,
gical and psychological difficulties.1,11
Occupational Fatigue Exhaustion/Recovery Scale (OFER15), and
There are many negative consequences of work‐related fatigue
Copenhagen Psychosocial Questionnaire version Two (COPSOQ II).
that impact on the patients, nurses, and health organizations.12 It
can negatively impact on quality of care, client satisfaction, and
• Basic sociodemographic data questionnaire: includes sex, age, marital
patients’ outcomes and nurses’ safety.13,14 Its manifestations on
status, level of education, years of experience, and income.
nurses can be mirrored in a combination of physical (eg, sleepiness)
• OFER15: this scale, developed by Winwood et al23 is composed
and psychological features (eg, compassion fatigue and emotional
of 15 items distributed on three subscales (acute fatigue,
exhaustion.,15 In addition, work‐related fatigue may lead to
chronic fatigue, and inter‐shift [recovery]). Each subscale
interpersonal consequences including decreased quality of commu-
consists of five items. Each item is rated with 7 points on Likert
nications with colleagues and patients.16 It also leads to physiolo-
scale from “0” (strongly disagree) to “6” (strongly agree). The
gical consequences including nurse injuries and adverse health
items that were numbered with 9, 10, 11, 13, and 15 should be
outcomes like smoking, overweight and obesity, musculoskeletal
scored reversely. The sum of each subscale is divided by 30 and
problems, cardiovascular diseases, and diabetes mellitus.11,12,17 Of
multiplied by 100 to produce comparable scores between 0 and
note, it is reported that 38% of nurses make medical errors related
100.23 Among the three subscales, the highest one indicates the
to fatigue.18 Nurses’ fatigue was one of the top three causes of drug
dominant type of work‐related fatigue. This scale has been
errors identified by nurses which in turn influence directly the
tested in different populations and has strong psychometric
patients’ safety.19
properties.6 The OFER’s scale demonstrated high construct and
Overall, a wide range of literature examined the factors that
face validity.24 This scale and its three subscales showed good
affect nurses' workday, but a few studied work‐related fatigue among
internal consistency reliability with Cronbach’s ɑ of the total
emergency nurses.11,20–22 Of note, in Jordan, there is a dearth of data
scale greater than 0.84. In addition, its subscale produces
that assessed the relationship between psychosocial work stressors
Cronbach’s ɑ of 0.82 for acute fatigue, 0.93 for chronic fatigue,
and work‐related fatigue among emergency departments (EDs)
and 0.75 for inter‐shift fatigue.6 The Arabic version of the
nurses.
OFER15 was used in this study.
This study purposed to assess the psychosocial correlates of
• COPSOQ II: it was developed by the National Research Centre for
work‐related fatigue among ED nurses in Jordan. The specific
the Working Environment, Denmark.25 The short version of the
research questions that guided the current study were: (1) what is
questionnaire was used in this study. The COPSOQ II short
the relationship between psychosocial factors and work‐related
version measured 23 psychosocial factors with a total of 40
fatigue among ED nurses; and (2) what are the predictors of work‐
questions. Most of the questions were rated based on five
related fatigue among ED nurses?
response options except job satisfaction and work‐family conflict
that were rated on four options. The scoring system of COPSOQ
II is very simple. For the questions with five response format, the
2 | METHODS scores are rated as 0, 1, 2, 3, and 4. To measure the total score of
each factor, we can add the two scores of two questions, and it
A cross‐sectional, descriptive correlational design was used to will be within 0 to 8. For the questions with four response format,
conduct this study. the scores were rated as 0, 1, 2, and 3. To measure the total score
The population of this study included ED nurses at hospitals in of each factor, the two scores of two questions can be added, and
Jordan. All ED nurses who met the inclusion criteria in the selected it will be within 0 to 6. This tool is valid and reliable. The
hospitals from different health sectors were invited to participate. COPSOQ II has a high internal consistency, where Cronbach’s ɑ
The sampling size was obtained using G*‐Power 3.0.10 (Heinrich‐ coefficient was above 0.70 for most of the subscales or factors.25
Heine University, Germany) program with a medium effect size of This tool was translated into Arabic, and content validity index
0.11, a power of 0.85, and 0.05 level of significance with 13 and reliability were assessed. The Cronbach ɑ for the total scale
predictors. According to regression, a total sample of 192 partici- was 0.84.
pants was needed. Keep in mind that 220 participants were recruited
for this study to allow for dropout.
2.2 | Ethical considerations
The inclusion criteria included the nurses who (1) were full‐time
workers, (2) had at least 1 year of experience in ED, and (3) were In this study, the ethical codes adopted from the Human Sciences
willing to participate in the study. The exclusion criteria included Research Council adhered to all steps of this study. These ethical
the subjects who reported having physical or psychological principles include respect and protection, transparency, scientific and
problems. academic professionalism, and accountability.26
488 | ISMAIL
The approval to conduct this study was obtained from the
Institutional Review Board (IRB) of Al‐Zaytoonah University of
Jordan represented by the dean of graduate studies, in addition to
the IRB’s of the selected hospitals. Moreover, permission to conduct
this study was obtained from the managers of each selected
hospitals.
Concerning participants, each participant received a question-
naire attached with a consent form. Confidentiality and anonymity of
the participants were assured by instructing them after filling the
questionnaire, to put it inside the envelope without mentioning their
names and close it. Moreover, it was also made clear that
participation was voluntary and they could withdraw from the study
at any time without any harmful effects on the participants. In
addition, there would be no direct benefit or reward because of their
participation.
2.3 | Data collection procedure
After obtaining the ethical approval from IRB of the Al‐Zaytoonah
University of Jordan, permission letters were sent to the selected
hospitals’ managers and the IRB’s of each sector attached with the
proposal of the study. After that, a numbered questionnaire was
distributed to ED in‐charges (nurse manager) in each selected
hospital to assign it to the emergency team who met the eligibility
criteria. Each questionnaire attached by a consent form, the purpose
of the study, participation instructions’ paper, and an empty
envelope. After 1 week, the envelopes with filled questionnaires
from each participating hospital were collected. However, in some
cases, the investigator distributed the questionnaire to the partici-
pants individually after explaining the purpose of the study as well as
their rights.
2.4 | Statistical analysis
All data were entered and analyzed using the Statistical Package for
Social Sciences, version 23.0 (IBM Corporation, Armonk, NY). The
variables related to sociodemographic characteristics and work‐
related fatigue were described using the descriptive statistics
including frequency, percentage, mean, and standard deviation.
Pearson’s correlation was used to examine the relationships between
the independent variables (psychosocial factors) and the dependent
variables (acute fatigue, chronic fatigue, and inter‐shift [recovery]).
Furthermore, a multiple linear regression was used to detect the
main predictors of work‐related fatigue. The findings were significant
at P < 0.05.
3 | RES U LTS
3.1 | Sample characteristics and levels of work‐
related fatigue
A total of 220 participants were invited and agreed to participate in
the present study with a response rate of 100%. The participants
ET AL.
mean age was 28.54 (SD = 3.78). More than half of the sample was
males (63.6%). In all, 52.3% were married, 43.6% single, 3.2%
divorced, and 0.9% widowed. The majority of the sample (82.3%) had
a bachelor degree. The mean years of work experience was 5.47
(SD = 3.91). Moreover, the participants’ income mean was 496.04
JOD (SD = 151.16).
Acute work‐related fatigue had the highest average score
(mean = 61.63; SD = 27.17), followed by chronic fatigue (mean =
57.18; SD = 17.41), then intershift (recovery) fatigue (mean = 56.25;
SD = 17.39).
3.2 | Correlations with work‐related fatigue
The correlations between work‐related fatigue and psychosocial
factors are presented in Table 1. Regarding acute fatigue, the results
revealed that there was a negative relationship between acute
fatigue and commitment to workplace (r220 = −0.18; P < 0.01),
predictability (r220 = −0.23; P < 0.01), recognition (r220 = −0.30;
P < 0.01), social support of supervisor (r220 = −0.21; P < 0.01), job
satisfaction (r220 = −0.34; P < 0.01), trust in management
(r220 = −0.21; P < 0.01), and justice (r220 = −0.30; P < 0.01), respec-
tively. On the contrary, acute fatigue was positively correlated with
quantitative demands (r220 = 0.46; P < 0.01), work‐family conflict
(r220 = 0.44; P < 0.01), stress (r220 = 0.21; P < 0.01), sexual harassment
(r220 = 0.52; P < 0.01), threats of violence (r220 = 0.17; P = 0.01),
physical violence (r220 = 0.36; P < 0.01), and bullying (r220 = 0.20;
P < 0.01), respectively.
Concerning chronic fatigue, the results revealed that there was a
negative relationship between chronic fatigue and trust in manage-
ment (r220 = −0.16; P < 0.05). On the contrary, chronic fatigue was
positively correlated with quantitative demands (r220 = 0.27;
P < 0.01), role clarity (r220 = 0.14; P < 0.05), work‐family conflict
(r220 = 0.15; P < 0.01) and self‐rated health (r220 = 0.23; P < 0.01),
sexual harassment (r220 = 0.41; P < 0.01), threats of violence
(r220 = 0.18; P < 0.01), physical violence (r220 = 0.26; P < 0.01), and
bullying (r220 = 0.15; P < 0.05), respectively.
Intershift (recovery) was negatively correlated with job satisfac-
tion (r220 = −0.16; P < 0.05), and burnout (r220 = −0.14; P < 0.05). On
the contrary, there was a positive relationship between intershift
(recovery) and quantitative demands (r220 = 0.24; P < 0.01), work‐
family conflict (r220 = 0.15; P < 0.05), self‐rated health (r220 = 0.21;
P < 0.01), sexual harassment (r220 = 0.36; P < 0.01), threats of violence
(r220 = 0.20; P < 0.01), physical violence (r220 = 0.28; P < 0.01), and
bullying (r220 = 0.16; P < 0.05), respectively. However, the psychoso-
cial factors correlated with all types of work‐related fatigue were
quantitative demands, work‐family conflict, sexual harassment,
threats of violence, physical violence, and bullying.
3.3 | Predictors of work‐related fatigue
Multiple linear regression analysis was used to examine the
significant predictors of work‐related fatigue. As shown in Table 2,
the variables that entered in the models as predictors of the acute
ISMAIL ET AL. | 489

T A B L E 1 Correlation between psychosocial factors and work‐related fatigue

Work‐related fatigue
Acute fatigue Chronic fatigue Intershift (recovery)

Factors r P r P r P
Quantitative demands 0.46 0.000** 0.27 0.000** 0.24 0.000**
Work pace −0.02 0.827 −0.00 0.979 −0.08 0.261
Emotional demand 0.12 0.082 0.03 0.625 0.01 0.913
Decision latitude −0.10 0.128 0.02 0.761 −0.03 0.650
Skill discretion −0.04 0.486 0.01 0.945 −0.04 0.518
Meaningfulness of work 0.05 0.408 −0.02 0.781 0.03 0.690
Commitment to workplace −0.18 0.009** −0.05 0.470 −0.03 0.591
Predictability −0.23 0.001** −0.08 0.269 −0.04 0.512
Recognition −0.30 0.000** −0.04 0.565 −0.05 0.510
Role clarity 0.09 0.170 0.14 0.034* 0.05 0.464
Quality of leadership −0.10 0.125 0.10 0.126 0.01 0.862
Social support of supervisor −0.21 0.001** −0.02 0.725 0.01 0.887
Job satisfaction −0.34 0.000** −0.13 0.057 −0.16 0.015*
Work‐family conflict 0.44 0.000** 0.15 0.022* 0.15 0.028*
Trust in management −0.21 0.001** −0.16 0.016* 0.00 0.977
Justice −0.30 0.000** 0.13 0.059 0.05 0.431
Self‐rated health 0.01 0.944 0.23 0.001** 0.21 0.002**
Burnout 0.05 0.488 −0.05 0.488 −0.14 0.044*
Stress 0.21 0.002** 0.06 0.366 −0.05 0.484
Sexual harassment 0.52 0.000** 0.41 0.000** 0.36 0.000**
Threats of violence 0.17 0.010* 0.18 0.007** 0.20 0.003**
Physical violence 0.36 0.000** 0.26 0.000** 0.28 0.000**
Bullying 0.20 0.003** 0.15 0.026* 0.16 0.017*
*Significant at the 0.05 level.
**Significant at the 0.01 level.

T A B L E 2 Predictors of acute fatigue among emergency department nurses (n = 220)

Predictors b B t P‐value 95% CI
**
Quantitative demands 3.65 0.20 4.16 0.000 2.14‐4.75
Commitment to workplace 0.25 0.02 0.34 0.730 −1.18‐1.68
Predictability 0.25 0.02 0.27 0.783 −1.52‐2.01
Recognition −0.85 −0.07 −1.02 0.310 −2.49‐0.79
Social support from supervisor −0.06 −0.01 −0.08 0.935 −1.61‐1.80
Job satisfaction 0.72 0.02 0.37 0.716 −3.15‐4.58
Work‐family conflict 4.50 0.25 4.79 0.000** 2.64‐6.34
Trust in management −0.04 −0.00 −0.05 0.960 −1.66‐1.58
Justice −1.14 ‐0.08 −1.48 0.141 −2.66‐0.38
Stress 1.29 0.08 1.63 0.105 −0.27‐2.85
Sexual harassment 4.87 0.27 4.52 0.000** 2.86‐6.86
Threats of violence 0.79 0.03 0.73 0.464 −0.77‐2.34
Physical violence 1.91 0.12 1.63 0.104 0.25‐3.39
Bullying 1.00 0.04 0.86 0.393 −0.20‐2.20
Abbreviations: b, unstandardized β; B, standardized β; CI, confidence interval.
490 | ISMAIL ET AL.

T A B L E 3 Predictors of chronic fatigue among emergency T A B L E 4 Predictors of intershift (recovery) among emergency
department nurses (n = 220) department nurses (n = 220)
Predictors b B t P‐value 95% CI Predictors b B t P‐value 95% CI
** *
Quantitative demands 1.68 0.18 2.62 0.009 0.40‐3.12 Quantitative demands 1.39 0.15 2.22 0.027 0.18‐2.58
Role clarity 1.19 0.13 2.09 0.038* 0.06‐2.32 Job satisfaction −0.67 −0.03 −0.46 0.644 −3.55‐2.20
Work‐family conflict 0.68 0.06 0.99 0.319 −0.66‐2.02 Work‐family conflict 0.99 0.08 1.29 0.197 −0.51‐2.50
Trust in management −1.14 −0.12 −1.86 0.063 −2.34‐0.06 Self‐rated health 3.49 0.22 3.51 0.001** 1.53‐5.46
Self‐rated health 3.59 0.23 3.73 0.000 **
1.69‐5.49 Burnout −0.95 −0.09 −1.43 0.154 −2.27‐0.36
Sexual harassment 2.59 0.22 3.01 0.003** 1.27‐3.90 Sexual harassment 1.83 0.15 2.06 0.040* 0.24‐3.41
Threats of violence 0.49 0.03 0.58 0.563 −0.47‐1.45 Threats of violence 0.60 0.04 0.65 0.511 −0.58‐1.78
*
Physical violence 1.19 0.08 1.25 0.210 0.15‐2.21 Physical violence 2.36 0.17 2.44 0.016 1.16‐3.55
Bullying 0.89 0.06 0.97 0.329 −0.67‐2.45 Bullying 0.16 0.01 0.17 0.863 −0.18‐0.50
Abbreviations: b, unstandardized β; B, standardized β; CI, confidence Abbreviations: b, unstandardized β; B, standardized β; CI, confidence
interval. interval.

fatigue were quantitative demands, commitment to workplace,
predictability, recognition, social support of supervisor, job satisfac-
tion, trust in management, justice, sexual harassment, threats of
violence, physical violence, bullying, work‐family conflict, and stress.
The full model that contained all predictors of acute fatigue was
statistically significant (F14,217 = 15.62; P < 0.001; R = 0.77; R2 = 0.60;
adjusted R2 = 0.56). This indicated that 56.0% of the variance in acute
fatigue was explained by the whole model. The significant predictors
of acute fatigue were quantitative demands (B = 0.20; P < 0.001),
work‐family conflict (B = 0.25; P < 0.001), and sexual harassment
(B = 0.27; P < 0.001). However, the work‐family conflict had the
strongest relationship with acute fatigue.
As shown in Table 3, the variables that entered the models as
predictors of the chronic fatigue were quantitative demand, trust in
management, sexual harassment, threats of violence, physical violence,
bullying, role clarity, work‐family conflict, and self‐rated health. The
full model that contained all predictors of chronic fatigue was
statistically significant (F9,219 = 7.93; P < 0.001; R = 0.56; R2 = 0.32;
adjusted R2 = 0.28). This indicated that 28.0% of the variance in
chronic fatigue was explained by the whole model. The significant
predictors of chronic fatigue were quantitative demands (B = −0.18;
P < 0.01), role clarity (B = 0.13; P = 0.038), self‐rated health (B = 0.23;
P < 0.001), and sexual harassment (B = 0.22; P < 0.01). However, self‐
rated health had the strongest relationship with chronic fatigue.
As shown in Table 4, the variables that entered the model as
predictors of the intershift (recovery) were quantitative demand, job
satisfaction, work‐family conflict, self‐rated health, burnout, sexual
harassment, threats of violence, physical violence, and bullying. The
full model that contained all predictors of intershift (recovery) was
statistically significant (F9,219 = 6.66; P < 0.001; R = 0.54; R2 = 0.30;
adjusted R2 = 0.25). This indicated that 25.0% of the variance in
intershift (recovery) fatigue was explained by the whole model. The
significant predictors of intershift (recovery) were quantitative
demands (B = 0.15; P = 0.027), self‐rated health (B = 0.22; P < 0.01),
sexual harassment (B = 0.15; P = 0.040), and physical violence
(B = 0.17; P = 0.016). However, self‐rated health had the strongest
relationship with intershift (recovery).
Overall, quantitative demands and sexual harassment were the
main predictors for all types of work‐related fatigue.
4 | D I S C U SS I O N
Concerning psychosocial factors and work‐related fatigue, this study
revealed that quantitative demands had a positive correlation with
work‐related fatigue (acute, chronic, and inter‐shift [recovery]).
These results are in line with previous studies.8,11,27–29 Therefore,
it is important to monitor nurses work quantitative demands and to
analyze work roles and job description.
The current study found that there was a negative relationship
between acute fatigue and commitment to the workplace, predict-
ability, recognition, social support from supervisor, and justice. These
findings are supported by a previous study.30 Parhizi et al29 found
that there was a negative relationship between nurses’ fatigue and
predictability (skill discretion), recognition (rewards), and social
support from the supervisor. Furthermore, other previous studies
have been documented that nurses who received greater rewards
and support from the supervisor during work have lower levels of
fatigue.9,27 Hence, these factors should be considered to understand
the related factors of acute fatigue among ED nurses.
The study findings also indicated that there was a positive
relationship between role clarity and chronic fatigue, which is
inconsistent with a previous study.30 The mentioned study indicated
that there was a negative relationship between role clarity and
chronic fatigue.30 These results might be interpreted as a lack of
awareness about how nurses’ roles contribute to protection from
chronic fatigue. However, we believe that a lack of role clarity is an
important factor affecting chronic fatigue, and would, in turn,
increase the levels of quantitative demands.
Furthermore, this study indicated that job satisfaction was
negatively correlated with acute fatigue and inter‐shift (recovery).
These results are consistent with a previous study28 which found that
greater job satisfaction among nurses resulted in lower acute fatigue
and inter‐shift (recovery) fatigue levels. On the contrary, a previous
ISMAIL ET AL.
study claimed that job satisfaction was positively correlated with
30
acute fatigue and negatively correlated with inter‐shift (recovery).
Therefore, improving ED nurses’ job satisfaction could minimize
work‐related fatigue as well as the quality of care.
This study demonstrated that there was no relationship between
job satisfaction and chronic fatigue, which is inconsistent with a
previous study that revealed that job satisfaction negatively
correlated with chronic fatigue.31 Therefore, improving ED nurses’
job satisfaction could minimize work‐related fatigue as well as the
quality of care.
Work‐family conflicts are frequently reported among workers.
These conflicts are associated with time strains, loss of work or
family activities, and transferring stress from work to home. This
could lead to physical and mental health problems including
32
fatigue. This study revealed that work‐family conflict associated
positively with work‐related fatigue (acute, chronic fatigue and inter‐
shift [recovery]). These results are consistent with our results in
which it was found that the work‐family conflict was increasingly
correlated with acute and chronic fatigue, while it was negatively
correlated with inter‐shift recovery.30
It has been documented that the greater level of nurses’ trust in
management was correlated with lower fatigue level.30 These study
findings found that trust in management had a negative relationship
with acute and chronic fatigue. These results support the role of
managers in promoting nurses’ health. The managers should build
trust relationships and communicate effectively with their team and
healthcare institutions.
The results of the current study revealed that self‐rated health
had a positive relationship with chronic and inter‐shift (recovery),
which is partially similar to Liu et al3 study. This study indicated that
self‐rated health positively correlated with the level of chronic
fatigue, however negatively correlated with inter‐shift (recovery).
Another study has documented that there were different relation-
ships between self‐rated health and chronic and inter‐shift (recov-
ery). Self‐rated health was negatively correlated with chronic fatigue
30
and positively with inter‐shift recovery. Therefore, health promo-
tion activities should be encouraged among ED nurses to enhance
their health status.
The study findings indicated that burnout was negatively
correlated with inter‐shift (recovery), whereas a greater burnout
level results in lower recovery level between shifts. However, recent
evidence indicated that burnout levels were increasingly correlated
with work‐related fatigue.27,30 Therefore, developing strategies to
enhance the nursing work environment, which in turn could minimize
the burnout level is paramount.
The study revealed that there was a positive relationship
between stress and acute fatigue. These results are consistent
with a previous study,30 which demonstrated that stress during
work could increase the nurses’ work‐related fatigue. Another
study conducted by Doerr et al33 showed that there was a
reciprocal correlation between stress and acute fatigue in daily
life events. In stressful times, the levels of fatigue are elevated.
Therefore, stress management programs among ED nurses should
| 491
be implemented and should cover the mutual influence of stress
and fatigue. 33
The current study revealed that offensive behaviors (sexual
harassment, threats of violence, physical violence, and bullying) had
positive relationships with work‐related fatigue (acute, chronic
fatigue, and inter‐shift [recovery]). Findings are partially similar to a
previous study30 indicating that acute and chronic fatigue positively
correlated with threats of violence, physical violence, and bullying.
However, inter‐shift (recovery) was negatively correlated with the
same offensive behaviors. On the contrary, there was no significant
relationship between sexual harassment and work‐related fatigue.
These results assure the need for the safe work environment to
protect the ED nurses from these offensive behaviors to promote
quality of nursing care.
The multiple linear regression among the psychosocial factors
showed the predictors of work‐related fatigue among ED nurses in
Jordan. Concerning acute fatigue, the main predictors were
quantitative demands, work‐family conflicts, and sexual harassment.
In addition to that work‐family conflicts were the strongest predictor.
The main predictors of chronic fatigue were quantitative demands,
role clarity, self‐rated health, and sexual harassment, however, self‐
rated health was the strongest predictor. Furthermore, the pre-
dictors of intershift (recovery) included quantitative demands, self‐
rated health, sexual harassment, and physical violence. Keep in mind
that self‐rated health was the strongest predictor.
Overall, quantitative demands and sexual harassment were the
main predictors of all types of work‐related fatigue. A recent study
conducted by Abdul‐Rahman et al30 reported similar results. The
work‐family conflicts were the significant predictor of acute fatigue.
However, chronic fatigue can be predicted by self‐rated health, work‐
family conflict, and role clarity. Moreover, work‐family conflict, self‐
rated health, and physical violence were the predictors of intershift
(recovery). Previous literature has documented that job quantitative
demands were the main predictors of acute fatigue.34 These results
could be explained by the fact that fatigue is triggered when the
number of workloads, circumstances, and tasks exceed the nurses’
resources. Furthermore, the inconsistent results with previous
literature could be related to different definitions and tools that
were used for assessing work‐related fatigue. In addition to cultural
factors whereby nurses feel shy to talk about their experiences in the
work context and the demographic attributes of the participating
subjects in the study.
The limitations underlying this study include the design of the
study, cross‐sectional, descriptive correlational, which cannot predict
precisely the effects of independent variables. Also, the sample was a
convenience, which limits the generalizability of the findings.
4.1 | Practice implication
The findings of this study could be used as baseline information for
healthcare professionals to develop preventive strategies and
health promotion programs against adverse psychosocial work
factors for emergency nurses. For example, establishing measures
492 | ISMAIL
to reduce the work demands and work overload through many
strategies. These strategies could include, increasing the nursing
personnel ratio, providing rewards, changing and rotating shifts
between nurses, and state naps (about 20 minutes) or meal breaks
within the night shifts or long shifts. Moreover, enforcing positive
self‐management strategies and activities should be promoted. In
addition to that, policymakers should work toward including
activities such as stress management and adaptation, self‐care
approaches (eg, relaxation techniques, meditation, and distraction),
and problem‐solving methods. Also, findings obtained from this
study could draw the attention of policymakers to control and
manage work‐related fatigue by developing policies that improve
emergency nurses’ health and enhance patients’ safety and
healthcare quality as a whole.
5 | CONC LU SION S
Work‐related fatigue is a multifactorial phenomenon that can be
influenced by many factors. Jordanian ED nurses had high levels of
work‐related fatigue, particularly, acute fatigue. Quantitative de-
mand, work‐family conflict, sexual harassment, threats of violence,
physical violence, and bullying had significant correlations with all
types of work‐related fatigue.
The main predictors of acute fatigue were quantitative demands,
and sexual harassment, in addition to work‐family conflicts, while
quantitative demands, role clarity, and sexual harassment, and self‐
rated health were the main predictors of chronic fatigue. Moreover,
the main predictors of intershift (recovery) were years of experience,
quantitative demands, self‐rated health, sexual harassment, and
physical violence. However, quantitative demands and sexual
harassment were the main predictors of all types of work‐related
fatigue.
These factors should be considered when establishing and
developing interventions and strategies to minimize work‐related
fatigue phenomenon among ED nurses. Also, future studies could be
conducted to assess other factors effect on ED nurses’ work.
CO NFLICT OF I NTERE STS
The authors declare that there are no conflict of interests.
OR CID
Malakeh Z. Malak http://orcid.org/0000-0002-2412-2999
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How to cite this article: Ismail KM, Malak MZ, Alamer RM.
Psychosocial correlates of work‐related fatigue among
Jordanian emergency department nurses. Perspect Psychiatr
Care. 2019;55:486‐493. https://doi.org/10.1111/ppc.12354