Keywords

1 Introduction

Accompanying with economic and technology improvement, in recent years, ageing society rapid development has became a global trend issue, especially for large dementia and bedridden elderly population growth, the extended care period. Elderly dependency ratio and nursing care career have obtained increasing attention, and increasing elderly nursing demand also bring out huge promising market opportunity and challenge. Comparing with previous elderly nursing care mode and care service focus (basic life care), nowadays and future elderly nursing care is paying more attention to long-term period, diversity and personal care service items owing to living quality improvement. In other words, long-term care and diversified care service supply for elder population become more and more important mainstream development direction, which could help nursing industry to go across current development bottleneck.

According to the international standard, China has stepped into Aging Society from 1999 with 126 million elder people over 60 years old (accounting for 10 % of total population). By the end of 2014, ministry of civil affairs of the People’s Republic of China reported that elderly population over 60 years old in China has been more than 200millions, 14.9 % of total population. China entered the Aged Society under the condition of weak pension consciousness and undeveloped economical reality, so in current social nursing facilities a large proportion of elders are disabled, semidisabled with high average nurse‐care level or the elders need daily medical care for a long‐term period. All those disabled and semi‐disabled elders need professional care by caregivers. So according to the elderly to caregiver ratio 3:1, the national needs 10 million caregivers in minimum. Hard and long time care works usually make some great effects on caregiver’s physical body situation or mental burder [1, 2, 3]. Due to high extensive work load but low salary and despise view for caregiver occupation, caregivers’ shortage reality become more and more serious for urban and rural nursing institutions. For this reason, it is very urgent to increase caregiver’s care work efficiency by skill training, more importantly is to get a good knowledge of caregiver’s body fatigue situation and mental burden during daily care work period and then develop corresponding feasible solutions.

As well know that fatigue situation produced by work process is a serious issue if it could not be recovered timely, which not only lead to working efficiency decrease, but also affect worker’s physical and psychological health, induce safety accident and even suicide and overwork death. Until now, some developed countries such as Europe, America and Japan are paying increasing attention to industrial fatigue investigation and study for ensuring worker’s occupational circumstance. However such conscious in China is very weak, therefore this work is aim to get a good knowledge of caregiver’s fatigue situation basically and put forward some effective measures and necessary assisted device as feedback to adjust to Chinese nursing house development. In this paper, 100 employees from four different nursing houses including day and night working shift were selected in random for sampling survey. And the fatigue situation was evaluated applying Japanese “subjective fatigue symptoms” (new edition of 2002) and “Tired body parts” questionnaires in field question-answer form. Collecting “subjective fatigue symptoms” questionnaire results were compared and analyzed before and after work, which showed that caregiver’s fatigue degree at the end of working day is more serious with larger scores than that of the beginning, especially caregiver in night shift displayed more fatigue in blurry vision and languidness. Along with longer care-work time, “waist” and “shoulders” were most complained tired body parts among all subjects. For quantifying caregiver’s body and mental fatigue by different care work contents during daily working period, “saliva test” was also conducted on 3 caregivers for continuous three days. It is found that different care content, work-shifts, caregiver’s experience years make different type of body and mental fatigue effects on caregivers to varying degrees. Consequently, we proposed some fatigue countermeasures and optimized work schedules after statistics analyzing fatigue characteristics correlation with care work schedule and caregiver’s experience years.

2 Methods

2.1 Investigation Subjects

100 caregivers from four different nursing houses including day and night working shift were selected as investigation subjects in random for sampling survey, and the subjects’ characteristic was summarized in Table 1. Six caregivers from the same nursing house were also employed to carry out continuous three days tracking studies of saliva test.

Table 1. Characteristic of investigated subjects
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2.2 Fatigue Evaluation Items and Form

Caregivers’ daily work fatigue situation was evaluated by applying Japanese “subjective fatigue symptoms” (new modified edition of 2002) and “Tired body parts” questionnaires in field survey. 25 question items were included in “subjective fatigue symptoms” and divided into five groups indicating five different type of fatigue characteristics/factors: (1) Drowsiness and dullness; (2) Uneasy feeling; (3) Illness situation; (4) Physical impairment/pain; (5) Fuzzy feeling, which listed in Table 1. And each item was given a mark/score by caregiver among five grade levels of “definitely no (1 point)”, “hardly no (2 point)”, “a little bit (3 point)”, “exactly yes (4 point)” and “strongly agree (5 point)” through question-answer form before and after working (total in two times for each subject). “Tired body parts investigation” questionnaire was comprised of 17 body parts (head, shoulders, back, arms, front arms, hands, thighs, knees and leg, feet) for evaluating accumulated body loading after care working, so caregiver only required to record the pain feeling body part with “Yes” (Table 2).

Table 2. Check-list of subjective symptoms of fatigue
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2.3 Data Collation and Disposal

All the questionnaire data was collected and disposed with IBM SPSS Statics 20 software. Firstly of all, each evaluation item of “subjective fatigue symptoms” questionnaire was calculated and indicated by mean and SD value in the group of 4 nursing facilities. Afterwards, fiver fatigue factors were summarized with sum scores of items included in each type (1*5 = 5 lowest mark; 5*5 = 25 full mark). Fatigue location evaluated by subjective “Tired body parts” sheets was also counted and sort in to a rank. In order to investigate fatigue condition difference of before/after care work and day/night work shift, average value of each item and factor type in “subjective fatigue symptoms” questionnaire were compared applying Wilcoxon (paired test). Furthermore, relationship between subject’s age or working experience and fatigue evaluation was also clarified by “Pearson correlation” analysis.

3 Results and Discussions

3.1 General Characteristics of “Subjective Fatigue Symptoms”

Table 3 listed 25 items of subjective fatigue symptoms (mean and SD values) for subjects’ before and after care work process. It is found that “Feel a pain in the back” complaint item and other physical impairment items included in Type4 (IV) showed a comparative high score before work shift among 4 nursing house facilities. Fatigue condition before work shift is deemed as fatigue accumulation state in subject’s body accompanied with long-term care-work occupation. Based on the subjective fatigue symptom investigation in current study, back pain was clarified as a serious puzzling issue for caregiver due to it was hardly recovered. Correspondingly, in the case of after work period, subjects’ complained about items of “Want to lie down”, “Feel stiffness in shoulder” and “Get tired in the legs” increased significantly except for “Feel a pain in the back” belonged to Type1 (I) and Type4 (IV). Fatigue factor types calculated by sum scores in respective type group were summarized in Table 4. It is obvious to note subject’s fatigue complaints after care work were mainly concentrated in “Physical impairment” and “Drowsiness/dullness” factors in those 4 nursing house facilities, following by “Fuzzy feeling”, “Illness condition” and “Uneasy feeling” factors.

Table 3. Facility comparison of fatigue level for 25 items between before and after work
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Table 4. Facility comparison of fatigue level in 5 factors between before and after work
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In Fig. 1, fatigue condition change evaluation were illustrated by respective item and type group. Care work loading on investigated subjects was clearly reflected by all positive score change among 25 complaint items respectively. Especially, complaint items of “Want to lie down”, “Get tied in the legs”, “Feel a pain in the back”, “Get tired in the wrist” and “Feel stiffness in shoulder” displayed obvious fatigue condition change during work. Through on-scene interview and observation for investigated caregivers’ care work process among four nursing house facilities, caregiver with big age and large numbers of turn-over care in wide work distribution were considered to be important reasons for complained items.

Fig. 1.
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The evaluation of fatigue condition change during care work

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3.2 Discussion of Work Shift Effect on “Subjective Fatigue Symptoms”

In Tables 5 and 6, day and night work shift fatigue level along with care work were compared by each complaint item and type factor respectively. All the subjects employed for work shift effect discussion on fatigue symptom were originated from No.1 facility with the same sample numbers. Comparing with day-work shift, night-work shift subjects showed more fatigue symptom such as “Give a yaw”, “Become drowsy” and “Want to lie down” in addition to “Feel a pain in the back” item before work. In general, fatigue symptoms included in Type1 (I)-“Drownsiness/dullness” displayed an obvious complaint total-points. Predetermined night shift working schedule for subjects was required to charge from 9:00 pm to 7:00am (+1day) in No.1 facility. Because night shift caregiver’s working period is just as the same with normal people’s regular bedtime, so as you can imagine, most of night shift subjects may presented a dullness state before work. According to subjects’ fatigue complaint items after care work, it is clearly to find that night shift caregiver suffered from a painful work period of physical (care work loading) and mental (sleep breaking) torture with a higher score in Type1 (I), Type3 (III) and Type5 (V) factors than day shift subjects except fatigue symptom score of Type4 (IV)-“Physical impairment”. Based on site survey results, it is found that most elders fall into sleep with sharp activities reduce during night period, and for caregiver their main work was to assist bedridden elder to turn-over and check sick elder’s body condition every 2 h. In other words, night shift subjects burdened less amount of care work than day shift, but they suffered from larger mental challenge as sleep broken, fear, loneliness and so on.

The comparison of subjects’ fatigue condition change during work between day and night shift was clarified in Fig. 2 combining detailed items change painting in Radar map and type factor summary bar. It is worthwhile to note that both day and night work shift subjects displayed the obvious fatigue symptom change in “Want to lie down” and “Feel stiffness in shoulder” items. Furthermore, work shift’s characteristics were also reflected on subjects’ different fatigue symptom factors, where day shift subjects’ fatigue complaints concentrated in Type4 (IV) because of heavier workload but night shift subjects’ fatigue mainly stated in Type1 (I) as the result of regular rest violation.

Table 5. Work shift comparison of fatigue level for 25 items before and after work
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Table 6. Work shift comparison of fatigue level in 5 factors between before and after work
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3.3 Fatigue Location Discussion by “Tired Body Part” Questionnaire

Figure 3(a) and (b) indicated the fatigue location rank of day work and work shift comparison respectively. It is obvious to obtain a general tired body part rank for 4 nursing house facilities (day shift) in total counting as: waist > shoulder > knee > arm > foot > head > back = hand/finger = thigh. Extraordinary, “waist pain” accounted for 80 % of subjects through one day-shift care work, which confirmed that accumulated fatigue of waist part was serious and urgent issue. When we took the same fatigue location rank to sort corresponding day/night shift complaint feedback from No.1 facility, similar rank trend in night shift subjective reply was also demonstrated. However, night shift subjects showed a general lower percentage of fatigue complaints on body parts than day shift one.

Fig. 2.
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Fatigue condition change during care work comparison between day and night shift

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Fig. 3.
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Tired body part rank summary

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3.4 Relationship Between Subjects’ Characteristic and Fatigue Symptom

The correlation between subjects’ fatigue symptom change and age or experience years was carried out by SPSS Pearson tests. The results did not showed correlation between subjects’ fatigue symptom change and age based on limited data collection from current study. On the other hand, experience year indicated low negative linear correlation (−0.402) with fatigue symptom of Type4 (IV) under the significance interval P < 0.05, which means that expert caregiver with longer occupational years could master better skill of care work with less body loading.

3.5 Saliva α-Amylase Assay Test Results

The information of two groups subjects employed in saliva α-Amylase assay were recorded in Table 7, in which yellow group charged with shower care job during 9:30am to 10:30am. As the talk interview with subjects, we found that most of caregivers complained of physical fatigue and high stress during shower care job. As well known that larger numbers of elders were not cooperative or move around during shower process, which may result in increased elder fell-down risk and requirement of physical power for caregiver. Saliva α-Amylase is a kind of indicator of subject’s fatigue and mental stress reflection. Figure 4 illustrated the average value of saliva tests for both two groups among three continuous observation days. It was found that either with or without shower care job both two groups subjects showed increased saliva α value along with increasing work duration time compared with first time measurement. Especially, saliva α value measured at 10:30am for the group charged with shower job manifested a large increase peak, which quantified shower care work loading on subject’s body. However, after the day rest period from 13:00 to 15:00, both two groups kept the similar saliva α value for the third saliva test (tested at 16:30) as 2 times of first test measurement value. In other words, shower care job fatigue loading could be recovered effectively by lunch rest period.

Table 7. Subjects’ information for saliva α-Amylase assay
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Fig. 4.
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Saliva α-Amylase assay results of two groups’ subjects during work shift

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4 Conclusions

In this research, Japanese “subjective fatigue symptoms” and “Tired body parts” questionnaire were employed to investigate caregiver’s fatigue situation in Chinese nursing house facility. As a conclusion, fatigue pattern characteristics of Type4-“Physical impairment” and Type1-“Drowness/dullness” were clarified for day shift and night shift caregiver respectively. Furthermore, fatigue body location rank was also demonstrated according to complaint counting from “tired body parts” with “waist pain” as top spot. Finally, physical body loading and mental stress caused by shower care job was quantitatively confirmed by salivaα-Amylase assay.

Combined caregivers’ nursing work interview and fatigue investigation feedback, some measures were proposed for improving the fatigue condition of Chinese elder nursing occupation as: (1) shower-assisted device application; (2) effective arrange of rest period during day shift; (3) optimize night shift work schedule by shift system with shorter work duration; (4) specific body exercise for tired body part recovery.