Martin.K & ChenEd.

D(1986),stated that the Psychological and other factors are examined

individually and collectively in relation to self perceived chronic fatigue among a national
sample of adults. It is found that the lifestyle variable physical activity and such psychological
variables as self- reported depression, anxiety, and emotional stress are highly associated with
fatigue and are independently predictive of it.

Gerald P.Krueger(1989),stated that, the Physiological and Psychological stressors associated

with sustained work, fatigue and sleep loss affect worker performance. This review describes
findings relating to sustained work stresses commonly found in our advancing technological
world. Researchers report decrements in sustained performance as a function of fatigue,
especially during and following one or more nights of complete sleep loss, or longer periods of
reduced or fragmented sleep. Sleep loss appears to result in reduced reaction time, decreased
vigilance, perceptual and cognitive distortions and changes in affect.

A.David & A.Pelosi(1990), stated that that to determine the prevalence and associations of
symptoms of fatigue.

Meijman(1991), stated that the acute fatigue is a normal phenomenon that disappears after a
period of rest, when tasks are switched, or when particular compensation strategies are used.In
prolonged fatigue is not easily reversible in the short term and is not easily reversible in the short
term and is not task specific the compensating mechanisms that are useful in reducing acute
fatigue are no longer effective.

Joinson(1992), stated that the study of burnout in nurses who worked in an emergency
department .The researcher identified behaviors that were characteristic of compassion of fatigue
including chronic fatigue, irritability, dread going to work aggravation of physical ailments, and
a lack of joy in life.

Pascal.J(1992), stated that to identify the prevalence, psychiatric comorbidity, illness behavior
and outcome of patients with a presenting complaint of fatigue in a primary care setting.

L.Ridsdale(1993), stated that to describe the characteristics of patients attending their general
practitioner and complaining of fatigue or being “tired all the time”.

1
T.Pawlikowska&T.Chalder(1994), stated that to determine the prevalence of fatigue in the
general population and the factors associated with fatigue. Fatigue is distributed as a continuous
variable in the community and is closely associated with psychological morbidity.

JanH.M.M Vercoulen&Gijs Bleijenberg(1994), stated that the absence of laboratory tests and
clear criteria to identify homogeneous(sub) groups in patients presenting with unexplained
fatigue ,and to assess clinical status and disability in the patients, calls for further assessments
methods. In the present study, a multi-dimensional approach to the assessment of chronic fatigue
syndrome is evaluated.

Rogar R.Rosa (1995), stated that, studies of overtime have pointed to fatigue has been measured
more directly in studies of scheduled long work shifts, and significant loss of sleep and increases
in subjective sleepiness have been reported. Factors which could compound the fatiguing effects
of extended work shifts, such as workload, noise, chemical exposure, or duties and
responsibilities outside of the workplace, rarely have been studied systematically. It is concluded
that extended work shifts schedules should be instituted cautiously and evaluated carefully, with
appropriate attention given to workload, job rotation, rest breaks commuting time, and social or
domestic responsibilities.

Kristal-Boneh(1996), stated that, the prevalence of fatigue and its association with occupational
conditions and health- related habits in3785 industrial employees of 6 industrials sectors to
define modifiable factors. The factors examined included of employees workstations and health
related habits. Accidents were significantly more frequent in those workers with fatigue
complaints of fatigue during and after work, an ergonomic evaluation.

HickieI.B & HookerA.W(1996), stated that to determine the prevalence and socio demograohic
and psychiatric correlates of prolonged fatigue syndromes among patients in primary care.

Meijman & Schaufeli(1996), stated that the prolonged fatigue manifests itself in inefficient
action patterns; declining interest ,involvement and commitment reduced concentration and
motivation and negative emotions. Moreover prolonged fatigue may affect the individual’s
performance and functioning in the occupational as well as in the home setting. The Maastricht
cohort study focuses on prolonged fatigue among employees we simply use of the term fatigue.

2
G.E.Hardy&D.A.Shapiro(1997), stated that, the aims of this study were to obtain a systematic
estimate levels of fatigue in representative samples of the major occupational of health care
workers, to examine the relationship b/w fatigue and mental health, to test the fatigue arises from
a combination of poor mental health &high job stress.

Gentry et al(1997), stated that the ARP is designed to help professionals use strategies to
address and resolve the symptoms and the cause of compassion fatigue while helping developing
an integrated individual self care discipline that enhances future resiliency.

Abigail Shefer et al(1997), stated that the objective was to determine if a cluster of chronic
fatigue syndrome like illness had occurred among employees in two large state office buildings
in northern California,and to identify risk factors for and features of fatiguing illness in this
population.

Schroer (1997), stated that the official diagonostic label that includes chronic job stress, over
strain, and burnout-mental states that involve prolonged fatigue may lead to sick leave and work
disability, it is not only a pressing social problem but also an economic problem urging for
preventive action.

Dr.Janneke Van Mens-Verhulst (1998), stated that this study examines factors differentiating
women &men who suffer from fatigue. It is based on diaries kept by Dutch citizens over a 21-
day period b/w1987-88.The majority of those with persistent fatigue complaints (PFs) were
male, middle- aged, lower-educated and unemployed, and they had more psychological and
psycho-social problems than the incidental fatigue suffers(IFs).Factors differentiating the PFs
from the IFs are not the same for both sexes. Moreover, on a number of social-demographic
variables PF men and women differed less from each other than IF men & women. Future
research should focus on the gender-specificity of the factors that lead to the development of
persistent fatigue.

N.K Park et al(1998), stated that the purpose of obtaining reference materials for the prevention
and management of mental health promoting in industrial workers, this survey was investigated
the relationship b/w subjective fatigue symptoms and its related factors such as demographic, job
and health related variables.

3
James C. Findley(1998), stated that Chronic fatigue syndrome is characterized by debilitating
fatigue and a variety of somatic symptoms.Few studies have examined psychological aspects of
CFS. In the present study self efficacy is shown to be a significant predictor of CFS symptoms
beyond the varients accounted for by demographic variables and distress.

Jon Havard Loge & Stein Kaasa (1998), stated that the population norms for interpretation of
fatigue measurements have been lacking, and the sociodemographic associations of fatigue are
purely documented. A random sample of 3500 Norwegians, aged 19-80 years, was there for
investigated. A mailed questionnaire (11) items in which the sum score of the responses is
designated as total fatigue in which the sum score of the responses is designated as total
fatigue.67% of those receiving the questionnaire responded. Women were more fatigued than
men and 11.4% reported substantial fatigue lasting 6 months or longer.

Leonard A et al(1998), stated that the present study assessed the prevalence of chronic fatigue
syndrome in a sample of nurses. There is a paucity of studies on the prevalence of CFS in
healthcare professionals. That nurses might represent a high risk group for this illness, possibly
due to occupational stressors such as exposure to viruses in the work setting, stressful shift work
that is disruptive to biologic rhythms, or to other possible stressors in the work
settings.(eg:accidents).

I.J Mert Kant (1998), stated that the study on Fatigue at Work was started in the Netherlands.
The Maastricht Cohort Study was set up to examine the psychological risk factors in etiology
and natural course of prolonged fatigue among employees, to gain insight into the prevalence
and incidence of prolonged fatigue and to investigate the effectiveness of different treatments of
fatigue. The general objective of the study is to develop preventive measures and actions that can
be used in the workplace.

Bultmann et al (1998), stated that the Maastricht cohort study is part of the Netherlands
concerted research action on Fatigue at Work granted by the Netherlands Organization for
Scientific Research.This multidisciplinary 6 year national research program was initiated in 1996
and includes medical and psychological research on acute and prolonged fatigue among
employees.

4
Zohar & Dov(1999), stated that the effect of occupational hassles on negative mood and effort
exertion. Using pooled-time series analysis on daily records of a sample of military jump masters
(parachute trainers), it was shown that hassles severity predicted end of day mood, fatigue and
subjective workload. Author indicated that, despite their transient nature, daily hassles at work
constitute a significant factor whose effect has been overlooked by available methods of
occupational stress.

Anna Beurskens & Ute Bultmann (2000), stated that to evaluate the validity of the checklist
individual strength questionnaire in the working population. These 20 items self reported
questionnaire has often been used in patients with chronic fatigue. To date, no research has
focused on the validity of the CIS in occupational groups.

Ute Bultmann et al(2000), stated that in the Netherlands, a large-scale prospective cohort study
was started on prolonged fatigue in the working population. The 1st issue that had to be
addressed was the determination of a cutoff point for fatigue for use in the working population
.Fatigue is measured with the checklist individual strength(CIS),a 20-item self-report
questionnaire .This article demonstrates the process of decision making in the determination of
the cutoff point.

Elizabeth Ahsberg(2000), stated that perceived fatigue related to work has often been measured
in one dimension. The main purpose of the present study was to validate a purposed five-factor
model of perceived fatigue in a new sample.597 persons, employed in five occupations with
different types of workloads rated their fatigue after work. The results suggest a slightly revised
model for perceived fatigue, still with the five dimensions; Lack of energy, Physical exertion,
Physical discomfort, Lack of motivation and Sleepiness.

Kalimo et al(2000), stated that sleep disorders and daytime fatigue are common health problems
in middle-aged and elderly populations, and they vary greatly between occupational groups there
is wide spread evidence that working hours and job stress may explain these differences. In this
study the relationship of job demands and job control to sleep disorders was investigated. The
main effects of job demands and job control on insomnia, sleep deprivation and day time fatigue
were highly significant.

5
Elizabeth Ahsberg & Goran Kecklund(2000), stated that the purpose of the present study was
to study the effects of shift work on different dimensions of perceived fatigue as well as to study
if fatigue changes over an entire shift cycle, using the (SOFI).Longer reaction times coincided
with increasing ratings of the mental aspects of fatigue. Sleepiness is well known in shift work.
Fatigue tends to acculate during night shifts.

BultmannUte(2001), stated that the differences in fatigue and psychological distress across
occupations were examined among 8521 employees participating in the Maastricht cohort study
of “Fatigue at Work”. Although “occupation” seems to be an easy entry for intervention,
focusing on the occupation exclusively to prevent, or at least reduce, fatigue and psychological
distress may be in adequate .Further research, including a longitudinal analysis, is required to
elucidate the complex relation between occupation, psychosocial risk factors, and fatigue and
psychological distress.

Kate Sparks&Brian Faragher(2001), stated that over the last 40 years, major changes have
taken place in the work place. The workforce itself is also diversifying, with an increase in
female participation, a growing number of dual-earner couples and older workers. The present
paper discusses the impact of these workplace transitions on employee well- being. We focus on
four issues that are current concerns for organizations and the workforce; job insecurity, work
hours, control at work, and managerial style.

SarojParasuraman&ClaireA.Simmers(2001), stated that the study examined the impact of

worker and family role characteristics on work-family conflict and indicators of psychological
well-being among self-employed and organizationally employed women and men. Self-
employed persons enjoy greater autonomy and schedule flexibility at work, and report higher
levels of job involvement and job satisfaction than those employed in organizations.

UteBultmann&IjmertKant(2002), stated that the purpose of this study were:1) To explore the
relationship between fatigue and psychological distress in the working population;2)To examine
associations with demographic and health factors; and 3)To determine the prevalence of fatigue
and psychological distress. Fatigue was fairly well associated with psychological distress. The
results indicate that fatigue and psychological distress are common in the working population.

6
Although closely associated ,there is some evidence suggesting that fatigue and psychological
distress are different conditions, which can be measured independently.

W.Cullen,Y.Kearney&G.Bury(2002), stated that to determine prevalence of fatigue as an

unsolicited symptom during general practice consultations. The prevalence of fatigue reported in
this study is over three times higher than that reported in earlier work. Doctor characteristics
appear to be as important as patient characteristics in determining fatigue.

N.W Van Yperan&O.J(2002), stated that the present study tested depositional goal orientation
as an explanation for variation in responses to high job demands. Survey data from 322
university employees demonstrated that job demands were positively related to fatigue, for all
combinations of goal orientation. the managerial implications of these findings are discussed.

D.C.L Mohren(2002), stated that the objectives of this study are discuss possible mechanisms
through which the work schedule-particularly “shift work”, which includes nighttime work-
might influence the risk of contracting common infections. Compare the demographic and
behavioral features of day workers and shift workers. Contrast the prevalence of common
infections in they and shift workers, adjusting for type of work. Self-Administered questionnaire
data from the Maastricht cohort study on “Fatigue at Work” were used.

Bultmann Ute et al(2002), stated that the study examined potentially modifiable lifestyle factors
for the onset of fatigue and psychological distress after 1-year follow-up among 8833 employees
who participated in the prospective Maastricht cohort study of “Fatigue at Work”. To prevent or
at least reduce the risk of developing fatigue and psychological distress in the working
population.

Ute Bultmann & I. J Kant (2002), stated that to examine the associations between psychosocial
work characteristics and fatigue in employees in the Maastricht cohort study. A second objective
was to compare the relationships for fatigue versus psychological distress with these
psychosocial work characteristics.

Nicole Jansen & I. J MertKant(2002), stated that this study examined the concept of need for
recovery, that is the need to recuperate from work-induced fatigue, experienced after a day of
work. The study explored the relationship between need for recovery from work, prolonged

7
fatigue, and psychological distress in the working population. Although need for recovery,
fatigue, and psychological distress were frequently comorbid, they also clearly occurred as
separate entities.

Figley (2002), stated that compassion fatigue as a state of tension and preoccupation with the
individual or cumulative traumas of clients. The phenomenon of compassion fatigue emerges
suddenly and without warning and includes a sense of helplessness and confusion.

Torbjorn&PeeterFredlund(2002), stated that to study the relation between work and

background factors on the one hand and disturbed sleep and fatigue on the other. Work stress,
shift work, and physical workload interfere with sleep and are related to fatigue.

L.G.P.M Van Amelsvoort&I.J Kant(2002), stated that the objective of this study was to assess
the predictive value of fatigue of work disability on medical grounds within the framework of a
large prospective cohort study.

Michael Sharpe & David Wilks(2002), stated that fatigue can refer to a subjective symptom of
malaise and aversion to activity or to objectively impaired performance. It has both physical and
mental aspects. The symptom of fatigue is a poorly defined feeling, and careful inquiry, is
needed to clarify complaints of “fatigue,” “tiredness,”or “exhaustion” and to distinguish lack of
energy from loss of motivation or sleepiness, which may be pointers to specific diagnoses.

T.Akerstedt & A.Knutsson(2002), stated that to investigate which variables(related to work,

lifestyle, or background) are related to the tendency to fall asleep unintentionally, either during
work hours, or during leisure time.

Mohren,Danielle & Jansen(2002), stated that discuss possible mechanisms through which the
work schedule particularly shift work which includes night time work might influence the risk of
contracting common infections. Compare the demographic and behavioral features of day
workers and shift workers. Contrast the prevalence of common infections in day and shift
worker, adjusting for type of work. This study examined the prevalence of common infections
among employees in different work schedules. Self Administered questionnaire dat from the
Maastricht cohort study on “Fatigue At Work” were used.

8
M.J.H Huibers et al (2003), stated that the persistent fatigue among employees, burnout, and
Chronic Fatigue Syndrome(CFS)are three fatigue conditions that share some characteristic in
theory. However, these conditions have not been compared in empirical research, despite
conceptual similarities. Fatigue employees shared many important characteristics with CFS
patients, regardless of burnout status, and many fatigued employees met CFS criteria.

G.M.H Swaen et al(2003), stated that to determine whether fatigue and need for recovery are
risk factors for being injured in an occupational accident. Fatigue and need for recovery were
found to be independent risk factors for being injured in an occupational accident. This means
that in the push back of occupational accidents, fatigue, and even more importantly need for
recovery, need special attention.

J.DeVries,H.JMichielsen&G.LVanHeck(2003), stated that to compare the psychometric

qualities of six fatigue questionnaires in a sample of working persons. All the questionnaires
were unidimentional and had good reliability and validity. The FAS was the most promising
fatigue measure.

N.W.H Jansen et al(2003), stated that to describe the prevalence of fatigue among employees in
different work schedules(day work, three-shift, five-shift, and irregular shift work);To
investigate whether different work schedules are related to increasing fatigue overtime, while
taking into account job title and job characteristics; and To study fatigue among shift workers
changing to day work.

F.J.H Van Dijk et al(2003), stated that the fatigue is a common complaint in the working
population. Approximately 20% of the working population report symptoms that fall under the
concept of fatigue. At first sight, the presence of fatigue in a working population does not give
much reason for concern from an occupational health perspective. After work has been done,
some fatigue may be expected and this fatigue is compensated for by social and financial
rewards .Occupational health interest in fatigue arises from the adverse consequences that are
attributed to fatigue in the more serious acute or chronic forms, and when there is insufficient
opportunity to for workers to recover.

I.JKant&U.Bultmann(2003), stated that in 1998, a large scale prospective cohort study of

prolonged fatigue in the working population was started in the Netherland. The ultimate goal of

9
this Maastricht cohort study was to identify risk factors involved in the aetiology and natural
course of prolonged fatigue in the working population and to develop preventive measures and
treatments that can be used in occupational health settings.

Nicole Jansen & I.J Mert Kant (2003), stated that in this paper working hours, patterns and
work schedules of employees were evaluated in terms of need for recovery from work. Self-
administered questionnaire data from employees of the Maastricht Cohort study on Fatigue at
Work were used.

Pascal M.L et al(2003),stated that the aims of this study were to examine (a)whether employees
with a chronic disease report more fatigue than employees without a chronic disease, (b)whether
number or type of chronic disease is related to fatigue, and (c)whether differences in fatigue level
in various type of chronic disease are related to psychological distress.

N. Janssen & I.J Kant (2003), stated that to investigate whether there is a relationship between
fatigue and sickness absence. Two additional hypotheses were based on theoretical distinction
between involuntary, health related absence and voluntary, attitudinal absence. Fatigue was
associated with short term but particularly with long term sickness absence. Fatigue as measured
with the Checklist Individual Strength can be used as a screening instrument to assess the
likelihood of sickness absence in the short term.

J.LHossain et al(2003), stated that about 20-25%of the population in primary healthcare settings
complaints of chronic fatigue but this symptom has been under emphasized compared with
sleepiness in clinical practice. Shift workers are particularly vulnerable because of various
fatigue-related personal &public morbidity and mortality.

Helen.J.Michielsen et al (2003), stated that the main aim of this study was to examine the
dimensionality and psychometric qualities of a new 10-item fatigue measure, the Fatigue
Assessment Scale(FAS).As per of a longitudinal study, the respondents, all workers with at least
20 working hours per week, completed the FAS, four related fatigue measures, a depression
questionnaire, and an emotional stability.

Murtagh J(2003),stated that the fatigue or excessive tiredness of body or mind is a common
presenting problem in general practice. This article provides a diagnostic model for the diagnosis

10
of fatigue in general practice. Fatigue is interchangeable with terms such as tiredness, weariness,
loss of energy, listlessness and exhaustion. It can be a difficult and frustrating symptom for the
general practitioner evaluate.

H Andrea & I.J Kant(2003), stated that the study associations between characteristics of
employees active at work and making a fatigue related to visit to the general practitioner or
occupational physician in terms of fatigue, physical health problem, mental health problems,
psychosocial work characteristics and attributions of their fatigue complaints.

M.Van Veldhovan & S Broersen(2003), stated that “the need for recovery scale” is suggested
as an operationalisation for the measurement of (early symptoms of ) fatigue at work.
Correlations with other relevant measurement scales on fatigue at work are presented to validate
the operationalisation claim as are early results on predictive validity. A study is presented that
further investigates the measurement quality and validity of the scale. The data used in this study
were collected by Occupational Health Services for 68775 workers during the period 1996-
2000.Comparing the measurement quality of subgroups differing in terms of age class, sex, and
education level, the general applicability of the scale was shown.

Edith J.C,Josten&Julie(2003), stated that the work schedules should preferably be beneficial
for satisfaction, fatigue, health, and performance. This study therefore investigated whether shifts
that are extended only slightly can combine the positive effects of the 12 hour shift with the
positive effects of the 8 hour shift. The study investigated the effects of 9 hour shifts.

Prof.DrewDawson&KirstyM.CCullough (2004), stated that fatigue has increasingly been

viewed by society as a safety hazard. This has lead to increased regulation of fatigue by
governments. The most common control process has been compliance with prescriptive rule sets.
This review presents a conceptual basis for managing the first two levels of an error trajectory
for fatigue. The concept is based upon a prior sleep/wake model, which determines fatigue risk
thresholds by the amount of sleep individuals have acquired in the prior 24 & 48 hours.

Roach,Gregory et al(2004), stated that the objectives of the current paper were to describe the
background and conceptual basis of (FAID),present FAID-based predictions for four of the
scenarios and discuss the advantages of &possible improvements to, FAID.

11
Marcus J.H. Huibers et al(2004), stated that fatigue is a common complaint that may lead to a
long-term sick leave and work disability. To assess the efficacy of cognitive-behavioral therapy
by general practitioners for unexplained, persistent fatigue among employees. Fatigue can best
be understood as a continuum, ranging from mild complaints frequently seen in the community
to severe, disabling fatigue such as chronic fatigue syndrome .When fatigue becomes severe and
persistent, it may lead long-term sick leave and work disability.

Mogens Agervold&Eva Gemzoe Mikkelsen (2004), stated that the objectives of this study
were therefore, first, to investigate relationships between bullying and other psychosocial work
environment factors within a particular organizational setting and second, to investigate if bullied
employees reported higher levels of stress than non bullied employees. They suggest that
management style may directly or indirectly have contributed to a higher level of bullying. Also,
bullied employees reported significantly more symptoms of psychological stress and mental
fatigue than non-bullied employees.

Ludovic Van Amelsvoort(2004), stated that the aim of the present study was to investigate
whether the direction of shift rotation was related to the need for recovery, fatigue, sleep quality,
work family conflict, and leisure time among three-shift workers. Optimization of shift work
schedules, in terms of shift rotation, seems a promising method for decreasing the negative
impact accompanying shift work. Future studies should investigate whether these findings for
three-shift workers are applicable to other shift work schedules as well. Furthermore, this study
clearly illustrates the existence of secondary selection processes among shift workers and thereby
emphasizes the complexity of valid shift work research.

Janssen&Nathalie (2004), stated that little is known about the natural course of fatigue among
employees. An adequate understanding of its development and risk factors is important to
prevent chronic health complaints and absenteeism. This longitudinal study investigated
associations between positive changes in perceived work characteristics and changes in fatigue
by performing hierarchical regression analysis.

T.Akerstedt&A.Knutsson(2004), stated that the study examined the multivariate

relationship between mental fatigue and different work-related(work load, work hours) and
background/life style factors, as well as disturbed sleep. Disturbed sleep is an important predictor

12
of fatigue, apparently stronger than previously well-established predictors such as work load,
female gender, lack of exercise, etc.

Beckers et al (2004), stated that sought to better understand the relationship between overtime
and mental fatigue by taking into account work motivation and the quality of overtime work and
studying theoretically derived subgroups. Moderate overtime is common among Dutch workers,
who seem to be happy workers with attractive jobs rather than fatigued employees

Helen J. Michielsen et al (2004), stated that this paper reports on two studies. The goal of the
study is to examine the dimensionality of existing fatigue scales. The aims of study were to
construct a new self- report fatigue instrument and to examine its psychometric qualities. Fatigue
is unidimentional.

Gerard M.H et al(2004), stated that the aim of this study was to prospectively investigate the
effect of potential workplace closure , an externally attributed form of job insecurity, on fatigue
and psychological distress. In April 1999’the Minister responsible announced that a
governmental agency would close down one of its two locations. Baseline data from the
employees were available before the closure announcement because they were enrolled in the
Maastricht Cohort Study on “Fatigue at Work.”

Medland et al(2004), stated that Burnout results from prolonged high levels of stress at work
and, if not addressed, contributes to healthcare providers leaving the workplace.

M.J.H Huibers&I.JKant (2004), stated that to determine the prevalence of chronic fatigue
syndrome (CFS)-like caseness in the working population .Using data from the prospective
Maastricht cohort study on fatigue at work the prevalence and incidents of CFS – like cases
were determined among 5499 employees who responded to the follow up assessment 3 years and
8 months after baseline.

Papp & Klara (2004), stated that to identify and model the effects of sleep loss and fatigue on
resident-physicians professional lives and personal well-being .More residents perceived that
sleep loss and fatigue had major impact on their personal lives during residency, leaving many
personal and social activities and meaningful personal pleasures deferred or postponed.

13
Marcus J.H Huibers(2004), stated that the main objective of this study was to identify
predictors of fatigue caseness, work resumption and chronic fatigue syndrome (CFS) like
caseness in a sample of fatigued employees on sick leave.

Marcus J H Huibers et al(2004), stated that to identify risk factors of the development of the
chronic fatigue syndrome (CFS),the persistence or recurrence of fatigue in a large sample of
fatigued employees.

Huibers et al(2004), stated that the serious adverse consequences of unexplained fatigue,it is
important to identify factors that determine the prognosis of unexplained fatigue and the onset of
long term sickness absence in fatigued employees.

A.J Dittner&R.G Brown(2004), stated that fatigue is a common feature of physical and and
neurological disease as well as psychiatric disorders, often reported amongst patients most
severe and distressing symptoms. A large number of scales have been developed attempting to
measure the nature,severity and impact of fatigue in a range of clinical populations. The aim of
the present review is to guide the clinician and researcher in choosing a scale to suit their needs.

Drew Dawson(2005), stated that while there is little doubt that physicians-in-training work long
hours and experience chronic sleep restriction over many years ,the consequences remain
unclear. There is not yet a significant body of evidence-based data clearly delineating the
relationship between work patterns,sleep duration, and patient safety or practitioner well being.
The limitations of and contradictions among individual studies, it is possible to look for
converging evidence or broad themes from this body of work. From these perspective, there
appears to be a small but significant group of studies for which restricted working hours were
associated with self-reported improvements in variables that broadly reflect “quality of life
issues”

Drew Dawson & Kirsty M.C Culloch(2005), stated that fatigue has increasingly been viewed
by society as a safety hazard. This has lead to increased regulation of fatigue by governments.
This review presents a conceptual basis for managing the first two levels of an error trajectory
for fatigue. The concept is based upon a prior sleep/wake model, which determines fatigue risk
thresholds by the amount of sleep individuals have acquired in the prior 24 & 48 hours.

14
Kang JW & Hong YS(2005), stated that the aim of this study were to investigate the factors
affecting the fatigue and stress in male manufacturing workers. Fatigue and stress were
positively correlated, but the job characteristics need to be considered individually for the
intervention and prevention of fatigue and stress.

Sandy Muecke(2005), stated that this paper reports a review examining the concept of sleep and
its antithesis of fatigue, and considers the evidence on nurses ability to cope with the demands of
continually changing hours of work ,their safety ,and the impact any manifestations of sleep
disruption may have on the care of their patients.While many aspects of this paper may apply to
nursing in general, special consideration is given to nurses in the critical care environment.

Winwood et al (2005), stated that various empirical studies link persistent failure to recover
from acute fatigue to the evolution of chronic fatigue. However, existing fatigue measurement
scales do not tend to distinguish b/w acute and chronic fatigue elements well, and none include a
measure of effective recovery from fatigue. These studies confirm the mediating role of inter
shift-shift recovery in the evolution of adaptive end-of-shift fatigue states to maladaptive
persistent fatigue traits. The OFER scale is suggested as a a potentially valuable new tool for use
in work related fatigue research.

Friese(2005), stated that showed the value of building and strengthening work environments to
limit burnout and compassion fatigue.

Kathlyn E.Fletcher et al (2005), stated that to summarize the literature regarding the effect of
interventions to reduce resident work hours on resident work hours on residents education and
quality of life. The long term impact of reducing resident work hours on education remains
unknown. These study included that assessed a system change designed to counteract the effects
of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to
residents; and were conducted in the United States.

R.Cairns&M.Hotopf(2005), stated that to perform a systematic review of studies describing the

prognosis of chronic fatigue (CF) and chronic fatigue syndrome (CFS) and to identify
occupational outcomes from such studies.

15
Anna Dahlgren,Goran Kecklund & Torbjorn Akerstedt(2005), stated that the aim of the
study was to relate different levels of work stress to measures of sleep and the diurnal pattern of
salivary cortisol and subjective sleepiness.

Adams et al(2006), stated that the article highlights the factors analysed and indicated that the
compassion fatigue(CF) scale measured multiple dimensions, which measures increasing ability
of professionals meet the emotional needs of their clients which results in stressful environment
without experiencing (CF) compassion fatigue.

Jodi M. Jacobson (2006), stated that the employee assistance (EA) field has not received
adequate attention with regard to the study of these negative effects, such as compassion fatigue.
This paper highlights results from a national research study of members of the Employee
Assistance Professionals Association who were assessed for risk for compassion fatigue and
burnout, as well as potential for compassion satisfaction.

Jianhua Shen et al(2006), stated that the shift work is a ubiquitous phenomenon and its adverse
effects on workers physical and mental health have been documented. In the sleep literature.
Differentiating between the symptoms of fatigue and sleepiness, and developing appropriate
objective measures, have become very important endeavors. From such research, fatigue and
sleepiness have been shown to be distinct and independent phenomena. However, it is not known
whether shift work differentially affects fatigue and sleepiness.

M.C Holm(2006), stated that Compassion Fatigue results from giving high levels of energy and
compassion over a prolonged period to those who are suffering, often without experiencing the
positive outcomes of seeing patients improve.

Peter C.Winwood(2006), stated that this paper reports a study of the relationship between age,
domestic, responsibilities, recovery from shift work related fatigue and the evolution of
maladaptive health outcomes among full-time working female nurses.

Abendroth,Maryann&Flannery(2006), stated that there is a growing interest in the clinical

phenomenon of compassion fatigue and its impact on healthcare providers, however, its impact
on hospice nurses is basically unknown. This study investigated the prevalence and the
relationships between nurse characteristics and compassion fatigue risk.

16
Scott,Linda&Hwang(2006), stated that this study describes fatigue and stress among a random
sample of full time hospital staff nurses who provide care for aging family members, compares
the results to nurses with and without children younger than 18 years living at home,examines
differences in sleep duration ,and explores the effects on work performance by care giving status
during a week period.

Fehmidah Munir et al(2007), stated that this study examined specific psychosocial factors
associated with psychological and health-related distress amongst employees reporting reporting
different chronic illnesses. To enable individuals to effectively manage both their illness and
their work without serious repercussions, it is important for both healthcare professionals and
employers alike, to improve the well-being of workers with chronic illness illness by supporting
and facilitating their efforts to overcome health-related limitations at work.

Ricci&JudithA.ScD(2007), stated that the objective of this study was to estimate fatigue
prevalence and associated health – related lost productive time(LPT) in US workers. Fatigue is
prevalent in US workforce. When occurring with other health conditions, it is associated with
significantly more condition specific (LPT).

S.S.Leone&M.J.H.Huibers(2007), stated that burnout and prolonged fatigue related but distinct
concepts that have seldom been empirically controlled. To examine similarities, overlap and
differences between burnout and prolonged fatigue. Burnout and prolonged fatigue plays a
central role. These two conditions come from different background: typically prolonged fatigue
comes from a medical background, while burnout comes from a psychological background.
Fatigue is a complex phenomenon.

Lore De Rave, Nicole W H Jansen & I. J Mert Kant (2007), stated that the aim of this study
was to examine the longitudinal relationship between transitions in work schedules, work hours
and overt time and changes in several self-reported health outcomes(general health, fatigue, need
for recovery, and psychological distress).In this study transitions in work time arrangements
were prospectively related to changes in several self-reported health outcomes. Substantial and
significant associations were found for transitions in work schedule and the incidence of
prolonged fatigue and the need for the recovery among men. Moreover transitions in work hours
affected the end for recovery among men, while they influenced general health and

17
psychological distress among women. These findings underline the need for interventions
addressing work time arrangements in order to reduce or prevent their impact on employee
health.

S.S Leone et al(2007), stated that to examine similarities, overlap and differences between
burnout and prolonged fatigue. Burnout and prolonged fatigue are related but distinct concepts
that have seldom been empirically compared.

Cho & Kwang-Hee (2007), stated that the administrative employees of government were
analyzed on their levels of fatigue symptoms to reveal the various factors related to them. The
survey items included subjects socio demographic and job related characteristics health related
behavior, degree of job demand job autonomy, social support in work, type A behavior pattern,
locus of control, sense of self-esteem and degree of fatigue.

Torbjorn Akerstedt&Goran Kecklund(2007), stated that disturbed and shortened sleep is

prospectively related to disease. One might also expert that sickness absence would be another
consequence but very little data seem to exist. The present study used 8300 individuals in a
national sample to obtain information on reports of disturbed sleep and fatigue 1 year and
merged this data on long term sickness absence 2 years later.

Cha K.T et al (2008), stated that a growing body of research has documented that occupational
stress is closely associated with increased risk of fatigue. This study was conducted in an effort
to assess the relationship of occupational stress to self-perceived fatigue among Korean white
collar employees. In logistic regression analysis, occupational stress was associated with an
increased risk of fatigue, and some domains of occupational stress had different effects on
fatigue by gender(job demand, job insecurity, and lack of reward for men, job demand, lack of
reward, and discomfort in occupational, which indicates that occupational stress may perform a
slightly different role in increasing the risk of fatigue by gender. This study suggest that
occupational stress is a determinant predictor of self perceived fatigue.

Glaister,Mark et al (2008), stated that the aim of this study was to evaluate the validity and
reliability of eight different approaches to quantify this parameter in tests of multiple-sprint
performance.

18
Hugo Westerlund et al(2008), stated that to examine secular trends in work-related sleep
disturbances and their association with sickness absence in the Swedish working population. Self
–reported sleep disturbances attributed to work-related causes were on the rise in Sweden and
were associated with medically-certified sickness absence. Most of this association seems to be
accounted for by depressive symptoms.

Saremi M,Khani Jazani R&Tassi P(2008), stated that the aim of this study was to investigate
the combined effects of work-related risk factors, age and shift work on fatigue. The field study
was performed based on questionnaire about the sleep characteristics, environmental work-place
exposure and fatigue level. Older workers are less able to adjust to night work especially if they
work in the noisy environments.

Karen Alkema et al (2008), stated that the purpose of this study was to investigate the
relationship between self-care, compassion fatigue, burnout, and compassion satisfaction among
HCPs. Respondents also reported the types of self-care activities in which they took part. Results
indicated a relationship between self care strategies and lower levels of burnout and compassion
fatigue, and higher levels of compassion satisfaction.

Iris Nijrolder et al(2008), stated that the fatigue is a common presenting symptom in primary
care and its course and outcomes often remain unclear, cohort studies among patients seeking
care for fatigue are scarce. We therefore aimed to investigate patterns in the course of fatigue and
relevant secondary outcomes in a large cohort of patients who sought care for a main symptom
of fatigue. This study suggests a longitudinal relationship between the severity of fatigue,
impaired functioning ,psychological symptoms ,and a poor sleep. Physicians should be aware
that a substantial proportion of patients seeking care for fatigue have these additional health and
psychosocial problems.

Rosenthal et al(2008), stated that fatigue, a common presenting symptom in primary care,
negatively impacts work performance, family life, and social relationships. The differential
diagnosis of fatigue includes lifestyle issuer, physical conditions, mental disorders and treatment
side effects. Fatigue can be classified as secondary to other medical conditions ,physiologic or
chronic. Scheduling regular follow-up visits rather than sporadic urgent appointments, is
recommended for effective long term management.

19
Annet H.De Lange et al(2009), stated that this prospective four-wave study examined (1)the
causal direction of the longitudinal reactions among job demands, job control, sleep quality, and
fatigue; and (2)the effects of stability and change in demand-control history on the development
of sleep quality and fatigue.

Torbjorn Akerstedt et al(2009), stated that work hours that displace sleep to the daytime and
work to the nighttime will interfere with the circadian and homeostatic regulation of sleep. Such
work hours will in several ways constitute a health problem with respect to sleep and fatigue The
term shift work is used to dente work schedules that divide 24 hour coverage. The teams can
alternative b/w early morning, afternoon, and night shifts or may, work a permanent shift.

Annet H.De Lange et al(2009), stated that this prospective four wave study examined the causal
direction of the longitudinal relations among job demands, job control, sleep quality and fatigue;
and the effects of stability and change in demand control history on the development of sleep
quality and fatigue.

Helene Andrea et al(2009), stated that anxiety and depression are prevalent among employees
and are associated with functional disability and work impairement. Study aims were to
determine incidence of subclinical anxiety and depression in a general working population and
identify the psychosocial work characteristics associated with the onset of subclinical anxiety
and depression.

Fu-Wei Wang et al(2009), stated that there has been increasing interest in the occupational
health of workers in small enterprises, especially in developing countries. This study examines
the association between psychosocial job characteristics and fatigue, attempts to identify risk
factors for fatigue among workers of small enterprises in southern Taiwan.

Kathleen.K,Ohlmann,MaryI.O,Sullivan&PhyllisBerryman(2009), stated that sleep plays an

important role in workers lives, allowing them to relax, restore, and revitalize their bodies,
minds, and emotions every 24 hours. Sleep repairs the physical body to improve and maintain
general health, consolidate learning and memory, and recharge the psychological batteries to
maintain emotional balance and well being. Regular exercise keeps muscles toned, improves
cardiovascular activity and reduces stress. However, neither diet nor exercise replaces the need
for help. With prolonged inadequate sleep, humans do not function well. They become accident

20
prone,are less productive, and experience increased fatigue and health problems. This article
discusses the importance of sleep, sleep events, health risks associated with inadequate sleep, and
health care professionals role in protecting employees and companies.

CarinaFourie et al (2010), stated that the research has three principal objectives, they are to
improve our understanding of the evolution of FRMS as an approach to managing fatigue, to
learn from the experiences of regulatory authorities and companies in countries that have
implemented FRMS, to provide the Department for Transport with recommendations on how
FRMS could be adopted in the UK.

Neu D et al (2010), stated that the lack of distinction in the clinical use of terms like fatigue and
sleepiness can potentially be associated with non restorative sleep (NRS) complaints, their
relationships are still poorly described. The purpose to use Rasch analysis-based method to study
the interrelations of fatigue, sleepiness and NRS.

Hugo Westerlund(2010), stated that to determine, using longitudinal analysis, if retirement is

followed by a change in the risk of incident chronic diseases, depressive symptoms, and fatigue.
Longitudinal modeling of repeat data showed that retirement did not change the risk of major
chronic diseases but was associated with a substantial reduction in mental and physical fatigue
and depressive symptoms, particularly among people with chronic fatigue diseases.

William Hamilton,Jessica Watson&Alison Round(2010), stated that fatigue is a normal part

of life,but it can also be a symptom of disease, including serious illnesses. It is a common
complaint in primary care, exceeded only by complaints of cough. Five to seven percent of
patients attending primary care have a primary complaint of fatigue, with this proportion being
remarkably consistent across Western countries. Precipitating factors for consultation can be
stressful life events for example, work disputes, family problems, bereavement, or financial
difficulties; or they can be illnesses such as respiratory tract infections.

Crystal Hooper MS & Elaine Reimels(2010), stated that today the proportion of acute patients
entering the health care system through emergency departments continues o grow, the number of
uninsured patients relying primarily on treatment in the emergency department is increasing and
patients average acuities are rising. At the same time support resources are constrained, while
reimbursement and reputation depends increasingly on publicly available measures of patient

21
satisfaction.It is important to understand the potential effect of these pressures on direct care
staff. This study explores the prevalence of compassion fatigue among emergency nurses and
nurses in other selected impatient specialties.

ElizabethA&Yoder MSN(2010), stated that compassion fatigue, trigger situations, and coping
strategies were investigated in hospital and home care nurses. The Professional Quality of Life
Scale measured compassion fatigue, compassion satisfaction, and burnout. Compassion Fatigue
scores were significantly different between nurses who worked 8-or 12 hour shifts.

Phillippa Gander et al (2011), stated that this paper focuses on the development of fatigue risk
management system(FRMS) in the transport sector. The evolution of regulatory frameworks is
traced, from unidimentional hours of service regulations through to frameworks that enable
multidimentional FRMS.

Siedine Knobloch & Hester C. Klopper(2010),stated that the compassion fatigue was first
introduced in relation to the study of burnout among nurses ,but it was never defined within this
context it has since been adopted as synonym for secondary traumatic stress disorder. The aim of
the study was to define compassion fatigue within nursing practice.

Sarah Sofianopoulos,Brett Williams&Frank Archer(2010), stated that the to identify the

literature available on prehospital providers regarding the effects of shift work on sleep. Shift
work can affect health and well-being on a variety of levels, both physiologically, affecting
aspects of work and personal life. Further research is warranted to prevent the issues of patient
safety,work-related fatigue and the cumulative effects of shift work.

AnnWilliamson et al (2011), stated that the objective of this review was to examine the
evidence for the link between fatigue and safety, especially in transport and occupational
settings. For the purposes of this review fatigue was defined as ‘a biological drive for
recuperative rest. ’The review examined the relationship between three major causes of fatigue-
sleep homeostasis factors, circadian influences and nature of tasks effects-safety outcomes, first
looking at accidents and injury and then at adverse effects on performance.

Drew Dawson et al (2011), stated that in recent years, theoretical models of the sleep and
circadian system developed in laboratory settings have been adapted to predict fatigue and by

22
inference, performance. This is typically done using the timing of prior sleep and waking or
working hours as the primary input and the time course of the predicted variables as the primary
output.

Thomas.J.Balkin et al(2011), stated that in this paper discussed the challenges and
opportunities for technological approaches to fatigue management, beginning with a discussion
of the “ideal” system, followed by some of the general issues and limitations of current
technologies. Finally, discussed the future directions in the next generation technology for
Fatigue Management.

Y.IranNoy et al(2011), stated that fatigue is regarded as a major contributor to workplace and
highway mobidity and mortality. While the scientific literature is replete with studies that can be
traced back more than a hundred years, much remains to be done to improve our knowledge of
and ability to elevate the consequences of fatigue.

JillianDorrian,Stuart.D.Baulk&DrewDawson(2011), stated that research suggests that less

than 5 h sleep in the 24 h prior to work and /or more than 16 h of wakefulness can significantly
increase the likelihood of fatigue-related impairment and error at work. While it is acknowledged
that reduced sleep, increased wakefulness, and longer work hours produce work-related
fatigue,few studies have examined the impact of workload on this relationship. This study
investigate fatigue in a large sample of Australian Rail Industry Employees.

William.J.Horrey et al(2011), stated that a Hopkinton Conference was organized to review and
discuss the state of knowledge in the area and to define future directions for research aimed at
preventing or mitigating the consequences of fatigue. In this paper some of the major outcomes
and recommendations from this process. These are organized into 5 topic areas :the link b/w
fatigue and safety, demographic issues in fatigue, modeling and predicting fatigue, technological
approaches to fatigue management , and organizational factors in fatigue management.

Lee Di Milla et al(2011), stated that this article reviews that literature pertaining to the
association between demographic variables (eg: age, sex, race, socio-economic status) with
fatigue, and when feasible ,accident risk. It also explores there potential influence and interaction
with some working arrangements, commute time, personality characteristics, and circadian
chronotype. Fatigue has been implicated in a range of impairements that can have detrimental

23
effects on individuals, and it is differentiality associated with conventional demographic
variables.

Williamson.et.al (2011), stated that concur that fatigue in both a physical and mental state,
defining fatigue as “a biological drive for recuperative rest”. Published literature reviews of
fatigue studies show some correlations of age and fatigue with time of day. Although it makes
sense anecdotally that natural circadian rhythms have an effect on fatigue and work performance,
research is unclear as to a direct link between circadian rhythms, performance, and safety
outcomes. More likely is that circadian rhythm plays a role in conjunction with other sleep-
related factors including time since waking, time since beginning work, rest break timing,
workload distribution, and the nature of the work being performed.

Anthony Sverre Wagstaff and Jenny-Anne Sigstad Lie (2011), stated that in order to devise
effective preventive strategies,it is important to study workplace stressors that might increase the
risk of workplace accidents both affecting workers themselves as well as causing harm to third
parties. The aim of this report is to provide a systematic, updated overview and scientific review
of empirical research regarding accidents in relation to long work hours and shift work, primarily
based on epidemiological studies.

S.UChauan Yuan&Ming Chih Chou(2011), stated that to compare the symptoms of fatigue
and physiological indices in nurses who work in shifts. It is clear that differing work schedules
result in differing levels of fatigue, with shift work attributing to higher levels than day work.

Gander et al(2011), stated that the inability to function at the desired level due to incomplete
recovery from the demands of prior work and other waking activities. Acute fatigue can occur
when there is inadequate time to rest and recover from a work period. Cumulative fatigue occurs
when there is insufficient recovery from acute fatigue over time. Recovery from fatigue ie;
restoration of function (particularly of cognitive function ) requires sufficient good quality sleep.

Nie,Shu-Fen,Chung&Min-Huey(2011), stated that this study reviewed the effect of shift

rotations on employee cortisol profile, sleep, quality, fatigue, and attention level.

Drew Dawson,Janine Chapman&Matthew J.W Thomas (2012), stated that in this review we
introduce the idea of a novel group of strategies for further reducing fatigue-related risk in the

24
workplace. Fatigue related risk is a workplace hazard. Fatigue-proofing as well as fatigue-
reduction strategies are useful, mixed methods are needed to harvest, develop and evaluate
effective strategies. The strategies can then be integrated into the formal safety management
system.

Lerman,Steven E.MD,Eskin,Evamaria M.D,Flower&David.J (2012), stated that fatigue is an

unsafe condition in the workplace. Like other risk factors, fatigue can be managed. Safety and
productivity in the workplace are intimately related to worker health. A workplace may have
chemical, physical, biological, and/or psychosocial hazards that have the potential to impact
physical and psychological well- being. Healthier employees result in fewer health claims, better
safety records, and greater productivity.

Lerman.et.al (2012), stated that a Fatigue Risk Management system that is similar to or part of
an organizations overall safety management system. Here an FRMS is defined as “a scientifically
based, data-driven addition or alternative to prescriptive hours of work limitations which
manages employee fatigue in a flexible manner appropriate to the level of risk exposure and the
nature of the operation”. The sleepiness refers only to the tendency to fall asleep, while fatigue is
the body’s natural reaction to sleep deprivation or physical and mental exertion. In other words, a
person can be fatigued not because of a lack of restorative sleep, but due to strenuous physical,
and/or mental work. Therefore state that recovery from fatigue could include rest that does not
involve sleeping.

KristenBell DeTienne et al (2012), stated that moral stress is an increasingly significant concept
in business ethics and the workplace environment. This study compares the impact of stress with
other job stressors on three important employee variables-fatigue, job satisfaction, and turnover
intensions by utilizing survey data from 305 customer contact employees of a financial
institutions call center. The resulted reveal that even after including the control variables in the
statistical models, moral stress remains a statistically significant predictor of increased employee
fatigue,decreased job satisfaction and turnover intentions.

Jodi M Jacobson (2012), stated that Employee Assistance Programme professionals provide a
majority of the mental health services to adults within the workplace. With increased traumatic
events at work, including workplace violence and natural disasters, employers are relying more

25
on their EAPs to provide crisis intervention .This study assessed the risk of compassion fatigue
and burnout and have high potential for compassion satisfaction.

Michiel AJ Kompier,Toon W.Taris and Marc Van Veldhoven(2012), stated that this study of
a large heterogeneous sample of 5210 day time employees was designed to shed more light on
the work effort-recovery mechanism by examining cross sectional relations between subjective
sleep quality and psychosocial work characteristics work related rumination fatigue after work
and affective well being at work and work pleasure.

UteBultmann et al(2012), stated that this study aims to examine whether sleep disturbances and
fatigue are independently related to the onset of register –based sickness absence of 3 weeks
during a 1-year follow-up in a representative sample of the Danish workforce and to determine if
possible associations are gender-specific. Sleep disturbances predicted risk of sickness absence
after adjustment for covariates, but lost statistical significance after further adjustment for
depressive symptoms. Fatigue was significantly related to future sickness absence, also when
adjusted for depressive symptoms and sleep disturbances.

Ossi Rahkonen et al(2012), stated that the aim of this study was to examine whether sleep
problems predict subsequent sickness absence among middle aged public sector employees.

Birowo Herusasongko et al(2012), stated that this research was conducted to study the effects
of environmental factors ie; heat stress, thermal comfort, and occupational noise and individual
factors of the workers ie; age work duration and nutrition status on occupational fatigue and
stress. Different level of fatigue was indicated on workers working in different work shifts, there
was no direct effects of heat stress and thermal comfort on occupational fatigue.

Ann Williamson and Rena Friswell (2013), stated that many workers are exposed to fatigue
risk that they would rarely encounter outside their job. This paper discusses the current state of
occupational fatigue research, providing a snapshot of the evidence on its causes and an
overview of occupational health and safety approaches to its management .Although our
understanding of the causes of occupational fatigue is improving, there is as yet little research
evaluating fatigue risk management system and counter measures.

26
 Briean C.Satterfield & Hans.P.A.Van Dongen (2013), stated that this review describes
the sleep-related neurobiology of fatigue; factors in the operational environment that contribute
to fatigue; and the effects of fatigue on cognitive performance that lead to errors, incidence, and
accidents. Occupational fatigue is of significant concern at the individual, organizational and
societal levels, and strategies have been developed to help successfully manage and mitigate
fatigue at each level.

Beatrice Hazzard(2013), stated that the purpose of this study is to describe

postanesthesia care unit nurses fatigue and link fatigue levels to work and non work related
factors. The study design is a pilot study using a descriptive correlation design. Participants used
a week 4 week daily dairy to record hours worked, breaks taken, and sleep patterns and
completed the Occupational Fatigue Exhaustion Recovery Scale.

Kronos (2014), stated that a new study shows exactly how H R teams can manage
fatigue and ensure workers don’t experience too much physical stress from lack of sleep. The
four factors, in order of influence on fatigue. They are the number of hours worked in a day,
number of consecutive days worked without more than 24 hours off, total hours worked in a
week, working mostly nights.

Alicia A.Thorp et al (2014), stated that to examine whether the introduction of

intermittent standing bouts during the workday using a height-adjustable workstation can
improve subjective level of fatigue, musculoskeletal discomfort and work productivity relative to
seated work.

Smith-Miller,CherylA,Shaw-Kokot&Julia(2014), stated that the aim of this study was

to examine current research related to nurse fatigue and identify effective prevention strategies.

C.A.M.Roelen et al(2014), stated that to investigate fatigue as prognostic risk marker

for identifying working employees at risk of long term sickness absence.

Christian Stahl & Elinor Edvardsson Stiwne(2014), stated that the aim of this study
was to analyze how different types of sick leave narratives were related to return to work ,job
mobility or continued sick leave for people sick listed with common mental disorders. Special

27
attention was paid to how the respondents described their contacts with employers and
rehabilitation professionals.

Corne A.R Willem Van Rhenen et al(2014), stated that prolonged fatigue adversely
affects an individual’s performance and functioning. The present study investigated the
prospective associations between prolonged fatigue and sickness absence during 1 year follow
up.

Jie Chen,Nancy M.Daraiseh&Kermit(2014), stated that this study identified the

nursing work activities that could be the primary sources of work related acute fatigue in US
hospital nurses. The study suggests that bedside care and walking standing other than manual
patient handling, contributed most to the level of acute fatigue.

Jie Chen,Kermit G Davis&Nancy(2014), stated that this study investigated the status of
acute fatigue chronic fatigue and inter shift recovery among 12 hour shift nurses and how they
differed by organizational and individual factors. An unhealthy fatigue recovery process was
found for nurses working a 12hour shift during the day.

Doreen J,Yamang Ross&Candace Burns(2014), stated that the long work hours and
irregular shifts are part of the nations 24 hour society and contribute to employee fatigue. Factors
affecting employee fatigue are circadian rhythm, sleep quality and quantity, individual health,
the environment and work tasks. Employee fatigue contributes to accidents and injuries and
affects occupational performance, safety ,health. These findings should be used by occupational
health nurses to address fatigue management and develop comprehensive fatigue management
programs.

Smith Miller,Cheryl A,Shaw Kokot&Julia(2014), stated that the aim of this study was
to examine current research related to nurse fatigue and identify effective prevention strategies.
Preventing work related fatigue requires multifaceted approaches involving the organization, the
clinical unit, and the individual

Ahmed H.Alighadir&Sami A.Gabr (2015), stated that this research work was
performed to examine whether different levels of physical activity and environmental and social

28
factors are associated with changes in adrenal hormones as markers of adrenal fatigue in Saudi
adult volunteers. A total of 160 Saudi adults aged 15-22 years were included in this study.

Kate Sheppard (2015), stated that unresolved compassion fatigue often causes physical
and emotional exhaustion, and can significantly impair job performance. It is also known to
cause increased absenteeism and even turnover among health care providers such as registered
nurses.

CorneRoelen et al (2015), stated that the prognostic models including age ,self rated
health and prior sickness absence have been found to predict high SA days and high SA episodes
during 1 year follow up. More predictors of high SA are needed to improve these SA prognostic
models. The purpose of this study was to investigate fatigue as new predictor in SA prognostic
models by using risk reclassification methods and measures.

Linsey M.Steege et al (2015), stated that to identify fatiguing tasks and develop a model
of sources of fatigue in nursing work. Registered nurses reported working in environments that
include physically and mentally fatiguing tasks. They identified factors related to work content
demands including, physical and mental task demands as well as time and multitasking demands,
as most frequently contributing to fatigue.

Linsey M.Steege&Jessica G.Dykstra (2016), stated that occupational fatigue in hospital

nurses is associated with increased nurse turnover, and decreased nurse health and patient safety.
The goal of this study was to explore the factors contributing to or preventing fatigue, and
barriers and facilitators to individual nurse coping in hospital work systems. It explore hospital
registered nurses perceptions of fatigue and coping at work. Factors that contribute to or prevent
fatigue span work system components.

Ruggiero&Jeanne (2016), stated that shift workers, particularly night workers, are prone
to disrupted circadian rhythms and sleep deprivation resulting in fatigue and sleepiness, thereby
endangering patient safety. Little is known about the sleep patterns of emergency nurses who
work highly variable around the clock schedules to meet the demands of fluctuating patient
census and acuities throughout the 24 hour period.

29
 Steege,Linsey,Pinekenstein&Barbara (2016), stated that addressing occupational
fatigue in nursing work systems and mitigating associated risks to nurses require strategic
management and high level decision making as well as daily management through operational
and tactical actions.

Knar Sagherian et al (2017), stated that hospital nurses are expected to maintain optimal
work performance; yet, fatigue can threaten safe practice and result in unfavorable patient
outcomes. This descriptive cross sectional study explored he association between fatigue, work
schedules and perceived work performance among nurses.

Leslie Tarnacki Cahri (2017), stated that the employees keep quiet about feeling
overworked and overwhelmed. It’s up to leaders, she says, to spot those fatigue workers and
address the issue before it gets out of hand .It’s a problem that’s more widespread than you might
think. One third of Australians do not take their allocated annual leave, according to the
Australian Institute. But keeping track of employees time-off entitlements and ensuring they take
adequate leave is not just good for staff well being and morale-it can also help boost business
productivity.

30
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