Abstract
Background: fatigue is a concept that has different meanings in different areas and especially in nursing. By understanding of this concept, the nurses can manage their patients with fatigue and plan appropriate care for patients that will lead to effective nursing interventions and the desirable outcomes.
Purpose: to clarify and analyze the concept fatigue in order to achieve clear understanding as part of Theoretical Foundation for Nursing NUR701 course requirement.
Method: Using various resources, such as CINAHL, PUP MED, MEDLINE via
BSCO library and Google. Searching was limited to English language, fatigue, and full texts articles.
Conclusion: fatigue is a common, a universally experienced concept that a nurse must understand and clarify it correctly, because it is one of the most common problems associated with all health-related disorders, therefore more understanding and clarifying of fatigue will have implications for clinical nursing practice, and for developing effective nursing interventions that help patients to manage their fatigue effectively.
Keywords: fatigue, Nursing, Concept Analysis
Purpose of the analysis
‘Fatigue is a universally experienced concept and yet no universal definition is evident in the literature’ (Trendall, 2000). It is important for nurses to understand this concept, because they are communicating and providing direct care for their patients, they are playing an important role for managing fatigue and to plan appropriate care which then nursing intervention will be applied that depends on clear understanding of the concept fatigue.
This concept analysis aims to identify the feature that are important to the concept of fatigue and to differentiate between its conversational and its nursing usage by the plan proposed by Walker and Avant (1995) (Ream and Richardson, (1996)). Accordingly, all definitions are recognized, model and additional cases are created, identify antecedence that influence the fatigue and possible consequences are defined.
Background
Concept analysis is a method of clarifying, exploring, understanding and defining a particular idea or phenomenon, through breaking it into pieces and then re-gather it in a way that demonstrate our notion of it. Fatigue is one of those concepts that we are frequently appointment it, as well as, it absolute in the life, in the work, in the relations, and even in the person’s self. I have chosen this concept, because I am working in maternity wards in King Abdullah University Hospital where women felt fatigue after childbirth. Therefore, I must understand and achieve clear and comprehensive information about this concept. This information includes the different meanings of fatigue in different areas and especially in nursing, the characteristics and synonyms (similarities) of fatigue and the antecedence and consequences of fatigue. By understanding this concept, I can manage my patients with fatigue and plan appropriate care for patients and this will lead to effective nursing interventions and the desirable outcomes.
Introduction and Significance
Fatigue is a common symptom that maybe faced by a healthy person, a person with an acute or chronic disease, or a person undertaking therapeutic treatment (Mei Fu, 2001). Fatigue is an individual and multi-attribute concept with many manner of expressions physical, cognitive, and effective (Mei Fu , 2001 ).It can influence the patients feeling of wellbeing, their capacity to do daily activities, the correlation with family and friends and their capacity to manage with the disease as well as to combat the care (Godino , 2006).
Fatigue is a usual in the public population and a common complaint among general application attenders and more common among women than men (David, 1990). It is a very frequent compliant for individual who live with long-standing illness including those with renal failure who need continuance hemodialysis (McCan, 2000).
The goal of this paper is to elucidate and analyze the concept fatigue in order to reach comprehensible understanding.
Uses of the Concept Fatigue
As many concepts the meaning and uses of the word fatigue is not clear (Ream and Richardson, 1996).
There are many definitions of fatigue I will mention some of them:
A dictionary definition refers to fatigue as meaning ‘lassitude or weariness resulting from either bodily or mental exertion’ (A gnes, 1999).
According to Oxford English Dictionary, ‘Extreme tiredness resulting from mental or physical exertion or illness’ (Oxford English Dictionary, (2015)).
‘Reduce the efficiency of (a muscle or organ) by prolonged activity’ (Oxford English Dictionary, (2015)).
Fatigue is sense of weakness or loss of energy that patients describe in various ways: ‘I can hardly get through the day’ (Barbra Bates, (1996)).
Fatigue defined as ‘an overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level’ (NANDA, 2001).
Fatigue is a word defined by many disciplines according to the needs of each estate (Ream and Richardson, 1996):
To a physiologist: fatigue considered as decreased in the capacity to perform work.
A pathologist: may show fatigue as measure of a neuromuscular or metabolic disorder.
To a psychologist: fatigue may be an indication of depression linked with decreased stimulation to engage in mental and physical activities (Mei Fu, 2001).
Fatigue is an individual, discomfort sign, which include total body feeling varying from tiredness to exhaustion, generating an un-relenting general state, which impedes with person capacity to task to their normal ability (Ream and Richardson, 1996).
From a nursing viewpoint , fatigue is conceptualized as an inability to ongoing in whatever condition people find themselves (Srivastava , 1986) and is often report as not having sufficient energy to do what they want to do (Schaefer , 1993 ).
Fatigue defined by engineers as an action of ongoing, indefinite internal systemic changes in a material subjected to restate loading (Lee, 2004).
Fatigue is a phenomenon, which occurred the illness and healthy individuals or may occur under therapeutic regime (Mei Fu, 2001).
Fatigue in my word:
As we have noticed, there were no universal definition in the literature, but all definitions share some characteristics:
Fatigue follows excessive exertion.
Fatigue is a universal symptom.
Fatigue may be physical, mental, or emotional.
In medical and nursing definitions, they mention the subjective character of fatigue, but in Dictionary, definition did not introduce the subjective nature of symptom of fatigue.
Fatigue has range in severity and differ from person to person according to her/his personality, illness, causes, age.
Defining characteristics of fatigue
According to NANDA (Mei Fu, 2001), defining characteristics of fatigue are:
1) Incapacity to reinstate energy.
2) Deficiency of energy or incapacity to keep usual degree of physical activity.
3) Tired.
4) Verbalization of an unrelenting and enormous deficiency of energy.
5) Incapacity to keep usual pattern.
6) Lethargic or listless.
7) Elevated in physical complaints.
8) Recognize need for extra energy to achieve pattern duty.
9) Agreement attention.
10) Disinterest in surroundings, introspection.
11) Feelings of quilt for not keeping up with responsibilities.
12) Compromised libido.
13) Drowsiness.
According to (Piper et al, (1998)), characteristics of fatigue are:
1. Suffering or level of fatigue.
2. Describes fatigue as unpleasant, disastrous, negative, or abnormal.
3. Obstruct with socialization.
4. Impede with enjoyable tasks.
5. Obstruct with sexual tasks.
6. Describes self as frail, exhausted, unenergetic, listless, or sleepy.
7. Describes self as unhappiness.
8. powerless to focus.
9. impotent to remember.
10. ineffectual to think clearly.
11. Impede with work/school.
12. Describes self as angry and / or stiffen.
According to Schwartz et al (Mei Fu, 2001), characteristics of fatigue are:
1. Causes frequent trouble even after sleep.
2. Lower stimulus.
3. Aggravate by tension, depression.
4. Easily fatigued.
5. Predates other trouble.
6. Most incapacitate symptom.
7. Impede with or stop physical work.
8. Obstruct with work/socialization.
9. Impede with carrying out other tasks/duties.
10. Difficulty focusing.
11. Reduce by resting or sleeping.
12. Drowsiness.
13. Aggravate by daily activities.
14. Aggravate other symptoms.
15. Prolonged after exercise.
16. Differs in quality and extremity.
Defining attributes
Defining attributes are those ‘characteristics of a concept which appear over and over again’ when the concept is defined or described (Walker, 1995).
Ream and Richardson conceptualized fatigue as a multidimensional and compound concept with other attributes (Ream and Richardson, (1996)). They identified the following attributes of fatigue:
1. A total body notion and experience, encompassing physical, cognitive, and emotional aspect.
2. An odious and discomfort experience that causes distress a longstanding and implacable phenomenon.
3. A subjective experience rely on an individual’s recognition.
Measurement of fatigue
Researchers have trying to measure fatigue by assessing observable Phenomenon, such as changes in adenosine triphosphate, serum lactate, PH levels and Physical ability/strength (Piper et al) (Mei Fu , 2001 ) .
Self-report tools that measure an individual’s subjective recognition of fatigue are important to the understanding of the phenomenon (Mei Fu, 2001) .Many measures to assess the subjective aspect of fatigue exist (Tiesinga L, et al) (Mei Fu, 2001).
The Piper Fatigue Scale (PFS) developed to measure subjective dimensions of fatigue based on Piper’s theoretical framework of fatigue (Trendall, 2001). Visual Analogue Scale for Fatigue (VAS-F), (Leek A, et al 1991) (Dittner, 2004). It designed to be a simple and quick measure of fatigue and energy levels for patients in the general medical population. Tiredness and weakness are most often words used synonymously with fatigue in the nursing literature (Ream and Richardson, 1996). However, they should not used interchangeably with fatigue because tiredness and weakness do have distinct properties (Ream and Richardson, 1996).
Antecedence
Antecedence defined as ‘a thing that existed before or precedes another’ (Oxford English Dictionary, (2015)).
According to Ream and Richardson, fatigue has two antecedence (Ream and Richardson, 1996):
First one: Are physical or psychological changes.
Physical changes: include the effect of disease or the side effect of treatment, such as chemotherapy.
‘ A number of physiological disorders are associated with fatigue including: malnutrition, anemia, uremia, and other chronic illnesses such as cancer, rheumatoid arthritis, multiple sclerosis, human immunodeficiency virus (HIV) infection, systemic lupus erythematosus and renal disease ‘ (Cardenas and Kutner 1982, Krupp et al.1989, Blesch et al.1991, Crosby 1991, Darko et al. 1992), as cited by (McCan , 2000).
While psychological changes include depression and anxiety, which characterized by low energy and decreased of activity level (Nail et al, 1987) as cited by (Ream and Richardson, 1996).
Second one: is the individual have to be cognitively aware to express and evaluate his feelings of fatigue. ‘ Variables which have been identified as aggravating fatigue include: medications and treatment, over exertion, sleep quality and quantity, emotional stresses, environmental factors, lack of social support, age, nutritional status, disease activity ‘ (Tack, 1990) as cited by (Ream and Richardson , 1996).
Consequences
Consequences include the conditions that happened after the occurrence of concept (Goldberg, 2005).
Fatigue affects both mental and physical abilities. Physically such as: decreased in daily activity livings (which may guide to reduction of muscle tone and strength), decreased performance and physical complaints (Ream and Richardson, 1996) (Goldberg, 2005) (Fawccet, 1999).
Mentally affect includes impaired thought process, irritability, loss of concentration and short-term memory and difficult to make a decision, in ability to cope, poor motivation (Hubsky and Sears, 1992 Nail et al 1987, Voith et al, 1989) as cited by (Ream and Richardson, 1996).
These physical and mental components have an outcome upon individual’s general quality of life (Ream and Richardson, 1996).
The way in which fatigue may effect on your life commonly includes the following trouble (Goldberg, 2005):
1. Difficulty with everyday tasks, even small ones.
2. Sensation of no energy, feeling withdraw.
3. Feeling of having no power to do anything.
4. Having problems thinking, making decisions, and remembering things.
5. Dizziness or light-headedness.
6. Difficulty in sleeping.
7. Loss of sex drive.
8. Feeling more emotional than usual.
9. Cutting down on social activities, which can lead to feeling, isolated.
Model case
Ms X, was married women, has a two-year-old daughter. Worked in ICU in Arab Medical Center Hospital that is closed unit need more work as intensive care unit, and she was a master degree student, usually attend to her university at 8:00 am, and in some days, she attend to her work (C shift) at 10 pm to 8am next day. Then returned to take lectures in her university. Before two weeks, the effort was too much and she had a lot assignments, and her daughter was missed me because a long time of being away from her. These factors made her exhausted and she cannot do her responsibilities. She had lack of energy, tired, unable to maintain her usual activity, She couldn’t concentrate or even remember what needs doing and how, she has no energy to do anything, lethargy, and she want to leave her university and her work, . It was so frustrating and worrying to be like this. All she want to set in her home and shut her eyes and sleep.
Analysis: according to this case, fatigue occurred including all attribute. In addition, it occur when her responsibilities increase and she became unable to do all of them.
Conclusion
Fatigue is a common, a universally experienced concept that a nurse must understand and clarify this concept, because fatigue is one of the most familiar trouble associated with all health-related problem, therefore more understanding and clarifying of fatigue will have implications
for clinical nursing practice, and for developing effective nursing interventions to help patients to control their fatigue effectively.
