Study: Mental fatigue, missed perioperative care linked

Editor's Note

A July 16 study published in BMC Research Notes found that mental fatigue among perioperative nurses is significantly associated with increased rates of missed perioperative nursing care. 

This cross-sectional study surveyed 385 operating room nurses working in university-affiliated hospitals in East Azerbaijan, Iran. Participants met inclusion criteria related to experience, education, and active clinical roles, and were excluded if they reported diagnosed mental illness or antidepressant use. Researchers used validated Persian versions of Johansson’s mental fatigue questionnaire and Kalisch’s MISSCARE Survey (Section A) to measure psychological fatigue and frequency of missed care. Data were analyzed using non-parametric tests, correlation analysis, and quantile regression.

Key results include:

• 9% of participants experienced some level of mental fatigue.
• The mean mental fatigue score among OR nurses was 15 ± 5.44, indicating mild fatigue.
• The average missed care score was 03 ± 10.70 out of 128, reflecting a moderate level of missed care.
• The most frequently missed care domain was preoperative preparation (mean: 35.9), followed by safety and communication. The least missed domain was wound closure (mean: 11.3).
• Women reported significantly more missed care than men (p < 0.001).
• A statistically significant positive correlation was found between mental fatigue and missed care (Spearman’s r = 0.319, p < 0.001).
• Quantile regression confirmed that both gender and mental fatigue were independently associated with missed perioperative care after adjusting for other variables.

Authors describe the level of missed care reported as "alarming" and emphasize that high omission rates in preparation, safety, and communication likely reflect workflow challenges unique to the operating room. They reference existing literature linking fatigue with poor clinical performance and call for practical interventions such as fatigue monitoring, shift restructuring, rest breaks, and resilience training.