Clinician Fatigue-centred Behaviours
No examination of clinical frameworks would be complete without an exploration of the models of behaviour for which clinicians should hold themselves accountable.
Fatigue mitigation behaviours:
Fatigue mitigation behaviours point to in-work behaviours and out-of-work behaviours.
Out of work behaviours alude to the fact that we are required, as much as is reasonably possible, to engage in lifestyles and choices that do not compromise our ability to arrive at work rested and able to complete a full day's work in a low-risk physical and cognitive manner.
Life events sometimes conspire against us.
IM SAFE is the acronym that relates to this.
If you find yourself affected by any one of these:
Then it is probably safer to stay at home.
Call it a Registration Preservation Day.
Fatigue restoration behaviours:
Once fatigue has a hold of you, whether it is on call, night duty, late-early-late-earlies, then restoration must take place.
Only sleep cures fatigue due to sleep deprivation.
There is a way that you can calculate your sleep debt.
People on average require 7.3 hours of sleep per night.
If, on a late-early you only get 5 hours, then your sleep debt is 2.3 hours.
If on the following night you are called in and you get only four hours sleep, then your sleep debt climbs to 5.6 hours.
In order to correct this, you have to sleep an extra 5.6 hours, probably spread over a few nights, until your sleep debt is corrected.
Exactly the same summative mathematics applies to interrupted sleep if you have an unwell infant or a personal crisis at home.
Further, there are two types of fatigue:
Physical fatigue from physical effort, and mental fatigue.
Restoration from physical fatigue commences as soon as you stop your effort and rest.
Unfortunately, restoration of mental fatigue only starts to occur two hours after removal from the compassionate environment.
Which is why you never get to sleep until 01:30 AM if you have worked until 23:00 PM.
Sure, the unenlightened mathematics says you can get to sleep as soon as you get home.
The reality, as you know and can see, is that it never happens. Worse, you get to work 20 hours out of 29 all on 5 hours sleep.
Fatigue accountability behaviours:
Being aware of the risks of fatigue means being accountable for your own behaviours around fatigue.
This means flagging your own fatigue to others if you become fatigued, and taking pro-active measures to manage your own fatigue.
Fatigue may erode team cohesion by lowering thresholds for conflict, and providing easy pickings for others to focus on seemingly eratic behaviours and coping mechanisms.
As highlighted in the poem 'Ouch', others may not appreciate the distress a fatigued person is in, simply because of the perspectival nature of feeling, and because of the 'unknowns' that magnify your self-centric feelings.
Is there a way to counter these accerbations?
Further research needed.
In the meantime, see above.
Fatigue-related performance measures:
Everyone likes being held accountable for their actions, right?
Well, we like being held accountable for our positive behaviours and outcomes!
But what about our negative ones?
If I could do better, I want to know how.
It's a two way street.
In the meantime, fatigue restoration optimises clinical performance.