Lengthy Shifts and Decision Fatigue in Out-of-Hours Primary Care: A Qualitative Study

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-03-13 DOI:10.1111/jep.70050

Mona Maier, Louisa Lawrie, Daniel Powell, Peter Murchie, Julia L. Allan

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引用次数: 0

Abstract

Rationale

Demands on healthcare workers are high: services are stretched, shifts are long and healthcare professionals (HCPs) regularly work lengthy periods without a break. Spending time continuously ‘on task’ changes decision-making in predictable ways, as described by the ‘decision fatigue’ phenomenon where decision-makers progressively shift towards making less cognitively effortful decisions as the time worked without a break increases. This phenomenon has been observed repeatedly in large quantitative observational studies, however, individual healthcare workers' experiences have not been explored.

Aims

This qualitative study aimed to explore general practitioners' (GPs) and advanced nurse practitioners' (ANPs) experiences of working for lengthy periods in an out-of-hours primary care service in the UK. This included exploration of self-perceived changes in decision-making throughout a work shift, and mitigating strategies used to avoid changes in decision-making over time.

Design

Semi-structured interviews were conducted online. An inductive thematic analysis was carried out to identify salient issues articulated by participants.

Setting and Participants

The interview sample (n = 10) comprised ANPs (n = 5) and GPs (n = 5) who regularly worked within the out-of-hours primary care service across a regional National Health Service (NHS) health board.

Results

HCPs (GPs and ANPs) provided insights into their experiences during lengthy shifts and the impact of prolonged periods of work on clinical decision-making. Four main themes were identified and developed: (1) HCPs are aware of decision fatigue effects over the course of a shift; (2) Multiple factors help and hinder stable decision-making quality; (3) HCPs deliberately use strategies to help keep the quality of their decision-making stable; and (4) HCPs are aware of contextual changes, likely related to the decision fatigue phenomenon.

Conclusions

The findings of this study underscore the intricate interplay of personal, social and systemic factors in decision-making quality and highlight HCPs' deliberate efforts to mitigate decision fatigue's effects in practice.

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超长轮班和非工作时间初级保健决策疲劳：一项定性研究

对卫生保健工作者的要求很高：服务紧张，轮班时间长，卫生保健专业人员（HCPs）经常长时间工作而不休息。正如“决策疲劳”现象所描述的那样，随着不间断工作时间的增加，决策者逐渐转向做出不那么费力的决策，从而以可预测的方式改变决策。这种现象在大量的定量观察性研究中被反复观察到，然而，个别医护人员的经历尚未被探索。目的：本定性研究旨在探讨全科医生（全科医生）和高级护士从业人员（ANPs）在英国非工作时间的初级保健服务中长时间工作的经验。这包括探索在整个工作班次中自我感知的决策变化，以及用于避免决策变化的缓解策略。设计半结构化访谈在网上进行。进行了归纳性专题分析，以确定与会者提出的突出问题。访谈样本（n = 10）包括护士（n = 5）和全科医生（n = 5），他们经常在区域国家卫生服务（NHS）卫生委员会的非工作时间初级保健服务中工作。结果HCPs （gp和ANPs）提供了他们在长时间轮班期间的经验以及长时间工作对临床决策的影响。确定并发展了四个主要主题：(1)HCPs意识到转变过程中的决策疲劳效应；(2)多种因素对稳定的决策质量既有帮助也有阻碍；(3)医疗服务提供者有意使用策略来保持其决策质量的稳定；(4) HCPs意识到情境变化，这可能与决策疲劳现象有关。结论本研究的结果强调了决策质量中个人、社会和系统因素的复杂相互作用，并强调了HCPs在实践中刻意减轻决策疲劳的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.