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Fatigue Monitoring and Management across Different Industries

Article in Proceedings of the Human Factors and Ergonomics Society Annual Meeting · September 2016
DOI: 10.1177/1541931213601230

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 Proceedings of the Human Factors and Ergonomics Society 2016 Annual Meeting 993

Fatigue Monitoring and Management across Different Industries

Ranjana K. Mehta, Texas A&M University, College Station, TX, USA
S. Camille Peres, Texas A&M University, College Station, TX, USA
Linsey M. Steege, University of Wisconsin – Madison, Madison, WI, USA
Jim R. Potvin, Potvin Biomechanics Inc., Ontario, Canada
Mike Wahl, Definitions Health and Wellness, NL, Canada
Laura M. Stanley, Montana State University, MT, USA
Thomas E. Nesthus, FAA Civil Aerospace Medical Institute, OK, USA

Fatigue, often defined as a physiological state of reduced mental or physical performance

capability resulting from sleep loss, circadian phase, or workload (physical or cognitive), has
been implicated as a critical risk factor resulting in severe injuries and accidents. A great deal of
research has been done into the identification, measurement, and management of fatigue,
however it is still poorly understood. This may be due to the characteristics and variability of
work conditions across different industries; for example, fatigue in manufacturing is largely
related to physical demands, and in aviation fatigue is related to sleep and shift-work. This panel
will comprise of academics and practitioners across manufacturing, healthcare, transportation,
aviation, and oil and gas industries. Topics covered within each industry will include fatigue
causes and consequences, existing fatigue monitoring/management practices, barriers to fatigue
monitoring and management, and recommendations/discussions around improving the current
state.

INTRODUCTION PANELISTS

Fatigue may be defined as a physiological state of Occupational Fatigue in Nursing

reduced mental or physical performance capability
resulting from sleep loss or extended wakefulness,
circadian phase, or workload (mental and/or physical
activity) that can impair an operator’s alertness and
Copyright 2016 by Human Factors and Ergonomics Society. DOI 10.1177/1541931213601230
(Presenter: Linsey M. Steege, Ph.D., School of Nursing,
University of Wisconsin – Madison, Madison, WI)
Occupational fatigue in nursing is a

ability to work safely or perform safety related duties.
Fatigue is a multi-dimensional construct and can be
acute or chronic in nature (Mehta and Agnew, 2012;
Mehta and Parasuraman, 2014). Moreover, the interplay
between the various aspects of fatigue, such as sleep,
shift, or workload, can alter the severity of fatigue
outcomes. Adding to these challenges, factors such as
variability in work conditions, organizational safety
culture, worker profiles, and distinct barriers within each
industry increase the complexity and difficulty with
which fatigue can be monitored or managed. This panel
will focus on the similarities and dissimilarities across
industries on existing fatigue monitoring and
management and barriers to effective fatigue
management practices. The discussions, across the
different industries, may facilitate information
dissemination on existing practices and offer
opportunities for practitioners and academics to
deliberate on potential solutions for existing barriers to
effective fatigue management.
multidimensional (e.g., mental and physical fatigue) and
multistate (acute and chronic) construct that is associated
with negative outcomes for nurses, the patients they care
for, and healthcare organizations (Barker & Nussbaum,
2011; Smith-Miller, Shaw-Kokot, Curro, & Jones,
2014). Specifically, increased fatigue has been linked to
decreased nurse performance, health, and well-being
(e.g., Barker & Nussbaum, 2011; Geiger-Brown et al.,
2004; Smith-Miller et al., 2014); patient safety (e.g.,
Trinkoff et al., 2011); and nurse satisfaction and
retention (e.g., Josten, Ng, & Thierry, 2003). Sources of
fatigue in nurses span all components of the nursing
work system and include circadian demands (long work
hours and shift schedules), organizational culture,
psychosocial factors, time demands, design of the
physical environment, and task demands (Chen,
Daraiseh, Davis, & Pan, 2014; L. Steege & Dykstra,
2016; L. M. Steege, Drake, Olivas, & Mazza, 2015).
Multilevel Fatigue Risk Management Systems have not
been widely implemented in nursing work systems thus
far. Rather, existing guidelines and interventions have
Proceedings of the Human Factors and Ergonomics Society 2016 Annual Meeting
emphasized the joint responsibilities of individual nurses
and healthcare organizations to monitor and address
fatigue and associated risks ("Addressing Nurse Fatigue
to Promote Patient Safety and Health: Joint
Responsibilities of Registered Nurses and Employers to
Reduce Risks," 2014; Scott, Hofmeister, Rogness, &
Rogers, 2010).
Current recommendations and strategies for
addressing fatigue in practice include improving sleep
hygiene among individual nurses, and implementing rest
break policies, shift length and scheduling restrictions
and rides home for nurses in healthcare organizations
("Addressing Nurse Fatigue to Promote Patient Safety
and Health: Joint Responsibilities of Registered Nurses
and Employers to Reduce Risks," 2014). Effective
fatigue monitoring and management in nursing systems,
though, is limited by a lack of measures of nurse fatigue,
limited data to characterize multidimensional demands
during nursing work and predict fatigue risks, and a
professional culture in nursing that accepts fatigue as a
“part of the job” and resists accepting help or
acknowledging fatigue (L. Steege & Dykstra, Under
Review; L. Steege & Pinekenstein, In Press).
Future work is needed to: 1) Identify new strategies
to monitor work demands to predict fatigue and
associated risks in the context of nursing work systems,
2) Implement decision support tools to guide nursing
decision-makers in managing fatigue in the nursing work
force, and 3) Develop a safety culture related to fatigue
in nursing, beginning in nursing education programs and
spanning nursing workplaces and professional
organizations.
Taking the Blinders Off: Maturing Ergonomics from
Single Task Analyses to Quantifying Muscle Fatigue
from Whole Jobs
(Presenter: Jim R. Potvin & Michael W. Sonne, Potvin
Biomechanics Inc., Ontario, Canada)
In automotive manufacturing, fatigue is most often
considered to be a reduction in the force generating
capacity of muscles, or muscle groups, resulting from
repetitive work. Unfortunately, most current ergonomic
assessment tools tend to have tunnel vision, in that they
can only determine the acceptability of either a task with
a single effort (eg. biomechanics software), or a
‘monotask’ stereotypically performed on-then-off
repetitively over a work day (eg. ACGIH TLV for hand
activity). While there is a need for an ergonomic tool to
assess more complex sequences of different efforts, few
studies exist in the literature to facilitate an
understanding of how muscles fatigue and recover over
the course of such tasks. We conducted five studies,
994
with a total of 9 complex isometric effort time-histories
of either the handgrip muscles or thumb flexor muscle.
These data were used to develop and validate a modified
version of a three-compartment (rested, active and
fatigued motor units) model proposed by Xia & Frey-
Law (2008). The method shows promise for predicting
fatigue accumulation with a wide array of tasks, and we
will demonstrate its use within current digital human
modeling software, where full time-histories can be
simulated.
Physiology Based Approach to Fatigue – Working in
Remote Locations
(Presenter: Mike Wahl PhD(c), CK – Managing
Director, Definitions Health and Wellness)
After a number of high-profile disasters (most notably
the Ocean Ranger disaster and Piper Alpha in 1988 in
which 167 personnel lost their lives), oil and gas
industry companies as well as other organizations
working in remote locations are making every effort to
ensure that their accident rates are kept as low as
possible. The focus on ‘accident’ prevention is the main
driver for most Health, Safety and Environmental
(HS&E) programs. For most industrial accidents, there is
a causal chain of organization conditions and human
errors with Reason (1990) indicating that human-factors
causes can be attributed to 70-80% of accidents in high-
hazard industries.
Working in remote locations such as the offshore
drilling process is inherently dangerous, arduous and
socially isolating (Elliott 1985; Ulleberg and Rundo
1997). The environment is characterized by constant
noise and activity, and the employees live and work in a
restricted working location for a period of time without
any breaks. Most of the workforce is male, engaged in
blue and gray collar jobs, and there is a significant
portion of the population at risk for health and fatigue
related conditions. Consequently the working
environment in a remote location contains many
environmental and organizational factors that are
potential sources of fatigue, i.e. demands in an
individual’s environment that are perceived to be a threat
to the individual (Caplan et al, 1975). The combination
of heavy equipment, immense physical forces and
geological uncertainty with numerous personnel creates
an overall risk for fatigue related accident and incident.
Several studies on working in remote locations show
there is an association between job stress, strain and
health problems (Theorell and Karasek 1996; Ulleberg
and Rundo 1997). In the case of the offshore oil
industry, the fundamental nature of offshore operations
is unlikely to change in the short term and some aspects
Proceedings of the Human Factors and Ergonomics Society 2016 Annual Meeting
like geological uncertainty will always be present.
However, the focus on safety performance with respect
to fatigue management has typically been placed on
short-term management and policy rather than an overall
approach to reducing fatigue by addressing human
factors.
In years to come, shifts in industry structure (majors
versus independents), aging infrastructure, deep water
operations, new drilling and production technology,
more complex wells, and the turnover of the owner and
contractor operations workforce may affect company-
level and industry-wide HS&E performance
(Jablonowski 2006). Industry has long recognized the
risk associated with fatigue management; however, the
human factors underlying a physiology based approach
to fatigue mitigation, that considers individual and
occupational risk factors related to health status, is
novel. These factors include obesity status, age,
nutritional requirements, illnesses or chronic injuries,
mental stresses and anxiety. The examination of these
physiological variables, as they relate to workers in the
oil and gas industry, provides insights regarding
strategies that organizations can incorporate to address
fatigue which yield a measurable impact on safe
operations.
Fatigue Monitoring Technologies for Detecting
Driver Drowsiness
(Presenter: Laura M. Stanley, Associate Professor –
Mechanical & Industrial Engineering Department,
Montana State University)
This talk will provide a review of the technologies
and methodologies for detecting driver drowsiness.
Each year, the National Highway Traffic Safety
Administration (NHTSA) estimates that nearly 100,0000
vehicle crashes are attributed to driver drowsiness. As a
result, many technology developers are seeking ways to
prevent such crashes, with techniques centered upon
utilizing the driver’s: (1) vehicle-based performance
measures, (2) behavioral-based performance measures,
and (2) physiologically-based performance measures.
Specifically, many of these companies are using one or
more of the following metrics to establish their
algorithms for alerting the driver: percentage of eyelid
closure over time (PERCLOS), eyelid distance, eye
blink rate, blink speed, gaze direction, eye saccadic
movement, yawning, and head orientation. This talk
will discuss the pros and cons of such approaches,
barriers (e.g. balancing “false alarms” and “hits”), and
recommendations on how to improve driver alertness
technologies.
995
Fatigue Risk Management in Commercial Flight
Operations
(Presenter: Thomas E. Nesthus, Ph.D. FAA Civil
Aerospace Medical Institute, Oklahoma City, OK)
New fatigue mitigation approaches have been
recently implemented in commercial passenger flight
operations. Triggered by the Colgan Air accident near
Buffalo NY, regulations governing commercial pilot
flight and duty time limitations and rest requirements
were revised to incorporate aspects of fatigue mitigation,
sleep, and circadian rhythm science. In addition to 14
CFR part 117’s internal changes to improve fatigue
management, section 117.7 provides an optional process
for the authorization of flight operations that exceed the
limitations of other sections of the regulation.
Additionally, Congress enacted the Airline Safety and
Federal Aviation Administration Extension Act of 2010,
referred to as Public Law 111-216, requiring all part 121
certificate holders to develop and implement a Fatigue
Risk Management Plan designed to mitigate fatigue on a
day-to-day basis for flight operations falling within the
structure of the regulation. This presentation discusses
the critical consequences of fatigue, the risk factor
background, and sequence of regulation change. It also
describes how science has played a significant and
continued role in monitoring and managing flight crew
fatigue, even during extended long haul and ultra-long
range flight operations. Challenges remain for carriers to
support the scientific requirements for data acquisition
and analysis in validating their Fatigue Risk
Management System proposals, but the result of these
scientific evaluations advances our knowledge and
understanding of fatigue in aviation.
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