IN
DEGREE PROJECT MEDICAL ENGINEERING, SECOND CYCLE, 30 CREDITS
,
STOCKHOLM SWEDEN 2020
Promotion of Physical Activities of
Night Shift Nurses with
Gamification
A Study of Investigating of Physical Activity
among Night Shift Nurses and Promoting
Gamification
TANMINA AZAD
KTH ROYAL INSTITUTE OF TECHNOLOGY
TRITA TRITA-CBH-GRU-2020:296
Promotion of Physical Activities of Night
Shift Nurses with Gamification
-A Study of Investigating of Physical Activity among Night Shift Nurses and Promoting
GamificationTANMINA AZAD
Master’s in Medical Engineering
Date: December 18, 2020
Supervisor: Maksims Kornevs Examiner: Sebastiaan Meijer TRITA-CBH-GRU-2020:296
School of Engineering Sciences in Chemistry, Biotechnology and Health Swedish titel: Främjande av Fysiska Aktiviteter
Acknowledgement
I would like to acknowledge everyone who played a role in my academic accomplishments.
I would likely to say thank you to my supervisor and the examinees, who has provided advice and guidelines the research process,
I would like to say thank to the participants of the interview for their contributions and my groupmate for helping me to carry the study.
Abstract
This study shows the investigation of physical activeness among the nurses who work in night shifts in hospitals and motivates them to do physical activities in the form of gamification in their working place. A qualitative approach is applied for gathering the data in the form of interviewing nurses to inquiry the problems and tried to find out the real opinions and scenarios related with physical inactiveness based on the nurse’s interpretation. Working-time, working-loads, leisure-time, behaviors towards physical activity, laziness, less knowledge about voluntary movements are coming out from the findings of this study. This paper suggests some actions such as walking, doing physical exercises, playing games etc. to encourage nurses to do more physical activities in a fun way in the workplace. A fun game, called ‘Healthy steps’ is designed based on the suggested actions in the form of gamification is presented in this paper to promote physical activity at workplace and to encourage the nurses to participate lo lead a healthy lifestyle.
Key words: Shiftwork, Physical activity, Schedule, Gamification
Sammanfattning
Denna studie visar undersökningen av fysisk aktivitet bland sjuksköterskorna som arbetar på nattskift på sjukhus och motiverar dem att göra fysiska aktiviteter i form av gamification på sin arbetsplats. En kvalitativ metod tillämpas för att samla in data i form av intervjuande sjuksköterskor för att undersöka problemen och försökte ta reda på de verkliga åsikterna och scenarierna relaterade till fysisk inaktivitet baserat på sjuksköterskans tolkning. Arbetstid, arbetsbelastning, fritid, beteende mot fysisk aktivitet, lathet, mindre kunskap om frivilliga rörelser kommer fram från resultaten från denna studie. Denna uppsats föreslår några åtgärder som att gå, göra fysiska övningar, spela spel etc. för att uppmuntra sjuksköterskor att göra mer fysiska aktiviteter på ett roligt sätt på arbetsplatsen. Ett roligt spel, kallat ‘Healthy steps’ är utformat baserat på de föreslagna åtgärderna i form av gamification, presenteras i denna uppsats för att främja fysisk aktivitet på arbetsplatsen och för att uppmuntra sjuksköterskorna att delta för att leva en hälsosam livsstil.
Table of Contents
Chapter 1 ... 1
Introduction ... 1
1.1 Introduction of the context ... 1
1.2 Need for this research ... 3
1.3Aim ... 4 1.4 Research questions ... 4 Chapter 2 ... 6 Background ... 6 2.1 Literature review ... 6 2.2 Gamification in general ... 10 Chapter 3 ... 14 Methodology ... 14 3.1 Qualitative approach ... 14
3.2 Preparation before the first Interview ... 16
3.3 Data and the participants ... 17
3.3.1 Table of participants ... 17
3.4 Data collection ... 19
3.5 Data analysis ... 19
3.6 The process of generating actions, clustering, filtering, selecting for gamification design .. 22
Chapter 4 ... 25
Findings ... 25
4.1 Result ... 25
4.2 The process designing gamification from actions, clustering filtering selecting. ... 27
Chapter 5 ... 31
Discussion ... 31
5.1 Limitation of this study ... 31
5.2 Recommendations and Findings ... 32
5.3 Suggested actions ... 34
5.4 The designing game ... 36
Chapter 6 ... 39
Conclusion ... 39
References ... 40
Definition of concepts
Shift refers to hours of study in which a worker or a group of workers is scheduled
to work in the workplace (Madide S, 2003).
Shift work definition varies from country to country, state to state. Generally, shift
work duration is 07:00 to 09:00 hours depending on different organizations (Konz, 1990), Kogi, (2001) defines shift work as working other than daytime hours, and night work means work performed after 18:00 and before =6:00 hours, the next day. (Maddie S, 2003)
Night work in terms of section 17 (1) of the Basic Conditions of Employment Act,
1997, night work means work performed after 18:00 and before 06:00 hours, the next day (www.workinfo.com), (Madide, 2003).
Shift organization refers to the allocation and arrangement of shifts to keep the
production going 24 hours (Kroemer, 1992).
Ergonomics is the study of work. More specially ergonomics is the science of
designing the job to fit the worker, rather than physically forcing the worker’s body to fit the job. (Maddie, 2003). Ergonomics draws several scientific disciplines, including physiology, arthrometry, industrial hygiene, and kinesiology (Madide S.
2003).
Ergonomics involves the application of scientific information concerning human
beings to the design of objects, systems, and environments for human use (Madide
S. 2003).
Physical Activity WHO defines physical activity as any bodily movement produced
including during leisure time, for transport to get to and form places, or as part of a person’s work. Both moderate-and vigorous -intensity physical activity improves health (https://www.who.int/news-room/fact-sheets/detail/physical-activity)
(WHO, 2020).
Gamification is a medium which increases an individuals’ such as consumers,
1
Chapter 1
Introduction 1.1 Introduction of the context
In today’s world, shift works become a common practice to run the activities and services among industry, healthcare, or any other types of organization. In Sweden, 8% people have fixed hours outside the normal range, 27% people have irregular working hours, 4% people have to work on shift schedules (Madide S. 2003). All these three shifts - morning, evening, night might have the same pattern of activities and working guidelines. But in terms of timing, duration, and the nature of the shifts the activities of workers such as nurses or health-care workers can be varied. In the healthcare field, there is a need of rotating shift works to run 24 hours of services. Human-job interface or work-design ergonomics is about work schedule and work content (Amalberti T. 2012). Hhospitals are very busy place and daily works are hampered by different factors like work-schedule, over-duty, etc. These factors make worker performances poor and have a negative effect in their physical health and mental health.
2 shifts because of the rush working hours. During the night shift, the nurses have to do a less physical activity because of the nature of the time and tasks. Different research sources have shown that the shift works, especially in the night shift, nurses face different kinds of problems such as fatigue, sleeping problems, depression, stress, and behavior problems. The reason behind these problems can be the nature of the timing and the tasks and a lack of physical activity. Generally, it is seen that the impact of health-related problems of night-shift worker is more than a day-shift worker (Maddie, 2003).
So, we can suggest some solutions to imply some physical activities to create a good working environment and to ensure good health and wellbeing of the nurses who work in night shifts. Beside their occupational physical activity, we can advise them to do some physical activities in their leisure time to activate themselves to ensure their safety in workplaces.
To achieve it, the author proposes the use of gamification. Gamification is an effective tool to change a behavior of people by introducing game elements in daily work routines (Koivisto & Hamari, 2019). Gamification has been proven an effective way to promote physical activities which using traditional elements like scores and leadership boards into advanced solutions like using Pokémon Go types games to encourage extra physical activity.
3
1.2 Need for this research
Most authors observed that the fatigue related to night shifts can increase the risk of human errors and injuries and can negatively affect the quality of patient care. Moreover, fatigue reduces performance and job satisfaction, absence due to sickness, absenteeism, turnover, and job attrition and often induces use of psychotropic drugs (Ferri et al., 2016). Fatigue remains the major source of nurse’s errors in administering medication. A study by Jamal and Baba mentioned that the rotating shift nurses showed a lower degree of job satisfaction. In a Greek nursing sample study, the levels of job satisfaction measured by the ‘Index of Work Satisfaction’ appeared to relate to shift work. Decreased job satisfaction for nurses is strongly associated with increased job stress. Health professionals who worked night shifts showed more psychological and mental health problems than day workers such as irritability, somatization, obsessive–compulsive disorder, interpersonal sensitivity, anxiety, altered mood, and paranoid disorders which were significantly higher. In some studies, the relative risk of cardiovascular diseases in night shift workers was higher than the day workers (Ferri et al., 2016).
4 Due to the many health-related consequences associated with shift work, several attempts have been made to create ergonomic advice on what factors constitute a good shift schedule, but the evidence is rather weak. Most studies have been carried out with highly specific populations, and representative shift work studies are rare (Åkerstedt, 2017).
1.3Aim
The aim of the research is to establish and assess the problems and experiences associated with nurses during night-shifts due to physical inactiveness and suggesting promoting physical activity through gamification.
1.4 Research questions
· What is the rate of physical activeness in night shifts- low/ medium/ high?? · What are the reasons for physical inactiveness?
· How gamification can be helpful to be active in the nightshifts?
1.5 Structure of the thesis
5 discussion will be presented with the connections of previous sections. In the last section, the reader will find the conclusion.
6
Chapter 2
Background
2.1 Literature review
In the Digest for Conditions of work, (1990) ILO states the reasons for working time arrangements. The underlying causes of changes in the working time practices were, the renewed interest in flexibility for working time, derives from both social and economic change. Modern workforce prefers opportunities for choices about work. Workers and consumers may prefer that services be available for longer periods. Young workers, the workers with family responsibilities and older workers may have different concerns, but all have an interest in some forms of working time flexibility. These can be educational leave, shorter or more flexible hours or phase retirement. They also may have new needs for protection, as in the case of many part-times workers (Madide S. 2003). On the other hand, organizations need to run operations 24 hours to deliver services. Several organizations concern different shifts to keep running the working wheel. They prefer different shifts to operate 24 hours services such as morning, day, or night shifts (Madide S. 2003).
7 or day and night shifts are the common working shifts in the most continuous running system. There is also often seen two twelve-hour shifts in which shifts length may be different such as 8 hours or 12 hours. In the 12 hours shift system, employees have a long time to pass with their family or enjoy a longer leisure time. But on the other side, there is an argument against this long shift that working alone shift especially at night, may be caused a higher risk of safety because of fatigue problem combined with insufficient movements, workloads (Madide S. 2003).
In Europe and America, there are 20% workers engaged in night shifts (Ferri P. 2016). As earlier mentioned, shift work is considered necessary to ensure continuity of care in hospitals and residential facilities in the field of healthcare (Ferri P. 2016). Rotating and scheduling are the main characteristics of shift work and nurses are largely locked into schedules that provide 24-hour care and include night shift work (Ferri P. 2016). Shift work, and night shift, in one of the most frequent reasons for the disruption of circadian rhythms, causing significant alternations of sleep and biological functions, which, in turn, can affect the physical rhythms and psychological well-being and negatively condition work performance (Ferri P. 2016).
A majority number of studies have been carried out to analyse the impact shift work on the physical health of workers (Ferri P. 2016). Some authors identified in the studies that a maladaptation syndrome related to shift work, characterized by impaired sleeping, gastrointestinal disorders (Ferri P. 2016).
8 was noticeably poorer than that of a day and no night-rotating workers, have been found in most of the studies (Ferri P. 2016). Sleep disturbance which occurs in shift work is strongly linked to chronic fatigue has found from a Greek study (Ferri P. 2016). The symptoms of fatigue, including “ sleepiness and lack of energy”, “impaired concentration”, and “feelings of discomfort,” were more severe in the nurses who worked night shifts than others who worked during the day.
Shift workers are often referred to as an ‘at risk group’ because the rates of cardiovascular disease, diabetes and metabolic syndrome are higher in shift workers than in those who only work during the day (Boggild H. 1999). A study conducted by Torquate L. (2008), mentioned that the risks of cardiovascular events and coronary heart disease morality were 17 and 26% higher, respectively, in shift workers than in non-shift workers. Furthermore, there was a dose-response relationship, with a 7% increased risk of cardiovascular disease for every additional 5 years of shift work (Torquati L. 2018). A study showed data from a prospective cohort study of 74,862 nurses which mentioned that cardiovascular disease and all-cause mortality are significantly higher in nurses who have worked night shifts for more than 5 years, than in those who never worked night shifts (Gu F. 2015).
9 time is a major barrier to the maintenance of regular leisure time physical activity in shift workers (Atkinson G. 2008). Therefore, insufficient levels of physical activity have been identified as one of the potentials mechanisms which link shift work with adverse health outcomes (Hulsegge G. 2017).
There is, however, little evidence that shift workers are less active than those who regularly work only during the day (Hulsegge G. 2017). For example, objective measures of activity in two Danish cohorts show no differences in leisure-time physical activity between shift and non-shift workers (Hulsegge G. 2017). In contrast, accelerometer data from the US NHANES study show that, in terms of overall physical activity, rotating shift workers do more light intensity physical activity than daytime workers (Hulsegge G. 2017). However, in that study, both evening and night shift workers recorded fewer bouts of work-related moderate-vigorous physical activity than those who worked during the day (Loprinzi PD. 2015). Patterns of physical activity in shift workers are therefore complex and may be further clouded by long periods of sitting time in some occupational groups (Loprinzi PD. 2015). Moreover, differences in how shift works accumulate physical activity while at work and in leisure time, on days when they are working at night, during the day, or on non-workdays are large unexplored (Tracy L. 2019).
10 In one study, conducted in Brazil the researchers found a very low level of physical activity among nursing students (Cilar L. 2016). In Thailand, one third of the students did not do physical activities regularly (Cilar L. 2016. A study in Hong Kong showed higher physical activity in male nursing students compared to female nursing students (Cilar L. 2016). A study from US, showed that the full-time nursing students are more physically active than part-time nursing students (Cilar L. 2016). Nursing students in the UK did not meet the recommended physical activity guidelines of the WHO (World Health Organization) (Cilar L. 2016). The main obstacles for nursing students to carry out physical activity are lack of free time, physical effort, lack of energy, busy work schedule, mental effort, and busy learning schedule (Cilar L. 2016).
In a survey carried out in Slovenia between 2011 and 2013 among nursing students, the authors showed a noticeable reduced physical activity compared to the students who study in other faculties (Cilar L. 2016). (Cilar,2016). Reduced physical activity causes poor health among students and increases risk of stress, cardiovascular disease, hypertension, early death, sleep disorders, and (Cilar L. 2016). (Cilar, 2016). The studies also show a connection between physical and mental health. Reduced physical activity also affects the mental state and the emergence of mental disorders such as depression and anxiety (Cilar L. 2016).
2.2 Gamification in general
11 play, fun, challenges, rules, transparency, and rewards, can be addressed to almost any real-world problem (Pedro P. et, al. 2014).
13 experience (Pedro P. et, al. 2014). These elements are also applicable for health-related gamification solutions (Pedro P. et, al. 2014).
14
Chapter 3
Methodology
This part is set out the methodical approach undertaken to investigate and discover an individual’s personal experiences of physical activeness while working in a night-shift environment. This part will represent the purpose of this research and the methodological approach adopted. It will show the sample which was selected and the method which is used for the data collection besides the process of data analysis. In this part two interviews have done. This part also describes the process of making actions, how the actions are generating, clustering, and selecting for the further gamification design.
3.1 Qualitative approach
For this study, a qualitative approach was chosen as a research method for carrying out the purpose. Qualitative approach is used for collecting and analyzing nonnumerical data to understand concepts, opinions, or experiences. (Conroy, 2010). This approach is used in this study to gather in-depth insights of problems which are indicated in literature. It will help to give information based on real-life experiences in support of theoretical literature.
For the literature studies, the author applied some strategies to find the right and related materials to carry out the work and finding the research questions. The papers were collected from different sources.
The sources name: 1. Springer
15 The keywords for searching related papers:
• Health-care system • Shifts • Nurse’s well-being • Night shifts • Physical activity • Gamification
• Effects of night shifts • Safety, Ergonomics
At first 87 papers were found from the mentioned sources. Then found some of the paper are same and some papers cannot have permission to access full text. So, the duplications and the non-access papers were filtered out. Then finalize the rest of the related papers according to the selection criteria.
The selection criteria:
• Peer-reviewed • Full paper
• Effect reported on shifts, working in specially in nights, • Clearly described nightshift workers health-conditions • Physical activities among night shifts workers
16
3.2 Preparation before the first Interview
For this study semi-structured interviews were chosen to carry out the research progress. Doing the qualitative interviews, which helped to acquire the first based findings from the literature. The interview questions were formulated based on the literature reviews and the questions were basically adopted to find out the answers to the research questions for this study. To get a lot of qualitative data from the interviews, five questions were formulated.
The five questions on Physical Activities are:
1. Do you feel any physical inactiveness during work-shifts in nights and if yes, then to what extent do you feel it? low, mild, or high.
2. Are the physical movements during night shifts less than the day or other shifts? 3. Are there any factors or reasons for physical inactiveness during night shifts? 4. Do you feel any types of laziness, sleep, or health-related problems or mental problems by working night-shift duty?
5. Do you feel is it important to do physical activities during work and why? Is there any necessity to promote something fun or game related to be energized and active during night shifts? If yes, what extent?
17 the recording the interview was informed among the participants before starting of the interview.
This process of interviews allowed the participants to elaborate and provide information with more flexibility as they know the working environments very well and they were familiar with the working related issues. Interviewing these people can help to obtain the data which can be related with the literature analysis. (Conroy ,2010). Before starting the interviews telling participants the summary of the research of the thesis to familiarize them with the topics.
3.3 Data and the participants
The ideas behind a specific sampling approach very significantly, and reflect the purposes and questions directing the study (Conroy, 2010). In choosing the sample of participants for this study a purposive sampling method was used to carry the process. Criterion sampling is a type of purposive sampling in which study respondents must meet a predetermined standard for them to take part in a study (Moser & Korsten’s, 2018). The researcher set a standard about selection of participants.
The inclusion criterion was based on the nurses who are currently working more than 5 years in hospitals, private hospitals, home care, and have experienced in working in three rotating shifts such as morning, day and night, and the age limit between 25-40 years. After conducting these criteria, 10 candidates were selected as participants.
3.3.1 Table of participants
18 Participants Id used in
interview serial
Duration in minutes
Intern nurse Participant 1 42 Junior nurse Participant 2 39 Senior nurse Participant 3 45 Assistant nurse Participant 4 50 Assistant nurse Participant 5 48 Assistant nurse Participant 6 51 Assistant nurse Participant 7 50
Assistant nurse Participant 8 41
Assistant nurse Participant 9 40
Assistant nurse Participant 10 47
19
3.4 Data collection
Data collection was taken place by calling each participant’s phone at their suggested appointed time. A mobile phone was used to record all the interviews and took some important notes on the paper while listening close to the sound of expressions on different questions.
3.5 Data analysis
Thematic analysis is a method of analyzing qualitative data for any qualitative approach. It is used as a text like as interview transcript texts. The researcher closely examines the data to identify common themes – topics, ideas, and patterns of meaning that come up repeatedly (Braun V. & Clarke V. 2012).
Virginia Braun and Victoria Clarke (2012) developed this process for psychological research. It is a flexible method that can be adapted to many kinds of research (Braun V., & Clarke V. 2012).
Thematic analysis is a good approach to research where you are trying to find out something about people’s views, opinions, knowledge, experiences, or values from a set of qualitative data such as interviews, transcript texts etc. (Braun V., & Clarke V. 2012).
This thematic approach is a good, applied approach to the researcher who wants to know the views and experiences of the persons about different topics.
20 can help the researchers to obtain more knowledge of understanding by listening repeatedly and reading transcribed interviews.
Familiarization
In this step, the author collected the interview answers because of information which was needed in the research questions. the author familiarized with the datas and overviewed them before starting and analyzing the individual terms.
For this transcription method verbatim transcription was applied with the help of a mobile app named transcribe. This helped a lot to take a deep concentration and took different important notes based on the conversations by playing several occasions.
Coding
In this coding step, different quotes and phrases were highlighted from the conversations from different participants which had drawn important attention for different codes. The codes represent the feelings, expression of the answers to the interview questions asked during interviews. In this method, the author went through all the transcripts of every participant and highlighted everything that jumps out as relevant or potentially important. Reviewing the interviews extracted codes one after one and added them. Finishing and observing all the texts, all the data were collected and identified by codes. These codes allowed the author to gain a condensed overview of the main highlights and potential meanings that were extracted from the data.
21
Generating themes
In this step, the author looked over the codes that had been created before, identified patterns among them and tried to come up with themes related with physical activities issues such as shift-handling, voluntary movements during work, insufficient movements, working patterns etc. The themes were the collection of different groups of codes that were used to identify and reflect the potential meanings of the research questions. It helped the author to observe the main findings which were needed to work with this study.
The example of generating themes can be found on Appendix section.
Reviewing and finalize the themes.
In this part all the themes were reviewed again and selected most relevant themes according to the study.
Defining and naming themes
This is the last step of the themes analysis process where author had to review the themes again and had to name the themes according to the right placement of participant’s expression with the relevant facts and define them to match the statements of participants. From the naming themes, the main points were presented in findings section. See findings part.
22 modify the research purpose that had already discussed (Sarantakos, 1998). The result of this part was discussed in the result part.
3.6 The process of generating actions, clustering, filtering, selecting for gamification design
In this step, the author tried to generate some actions or concepts based on the previous interview session. For generating the actions, the authors at first tried to find out the problems from the findings of the first method part, and then tried to look out some actions which can be suitable for different arising problems. The author tried to find out the actions from different sources such as online, literature reviews, by own experiences and last of all taking a second interviews about the actions with the same nurses again.
For generating concepts, Brainstorming, Clustering, Filtering, and selection by pattern.
Brainstorming
23
Clustering
After brainstorming the author drawn a cluster based on the actions which will help nurses to be active in the workplace. Then the writer created concepts which contain the actions. The cluster was drawn to combining all the actions based on similar nature or pattern among the actions and divided them into four different concepts. Each concept presents similar actions which are different from each-other categories. The clustering can be found at chapter four. The cluster drawing was made for giving a summarize picture about concepts of actions to the nurses in the interviews to having their feedbacks as good/better/not so good comments.
Interview
In this step, the interview was done by phone call as before. This time the actions or ideas and the cluster drawing were written in a one-word file and sent to them before the schedule of interview time. The file was sent by email. In this interview, the same number and same number of participants were participated by contacted with private contacts with the author. The same participants were chosen because they already knew the thesis aim and, they had the previous knowledge about the research questions and the problems. So, it was easy to tell them the actions and concepts with them for their suggestions, the interview was done over phone and lasted about 30-45 minutes. The nurses chose the interview time according to their will. The interview was about their suggestion based on the actions. The interview recorded the same way as the previous was done. They gave the feedback of the actions in the form of good, better, or not so good according to their prospects. The author asked the participants about each action and then he or she requested to see the cluster drawing to generate concepts for gamification by saying good, better, or not so good and gave suggestions.
24
Filtering
After the interview, the author filtered the actions from the four concepts by discussing with the nurses. The writer filtered them based on the most related and common suggestions about concepts were coming from nurses during the second time interviews which were same pattern among them.
See appendix part.
25
Chapter 4
Findings
4.1 Result
This part is a presentation of main themes and drawing the findings which are coming out from the interview process and the data analysis part. These main themes that raised from the data analysis because of an individual were: the pattern of working tasks, the design of working schedule, mentally affected, the unspoken way or approach of work, lack of motivations, unwillingness of voluntary movement, inspirations towards being healthy. They are all themes connected to each-other which are related with the research study that show the needs of the stated problem earlier in the study section and have an impact on an individual’s working life as well as personal life.
• All the participants stated that there were less voluntary physical activities in night shifts except working activities in the workplace All stated that they were doing a lot of working tasks in night shifts.
● Participants 2,3,5,7, 8,9 and 10 acknowledged that they did not do any extra physical movements except works in the night shifts.
• Participants 2,1,5, 8 stated that the working pattern in night shift was of the reason of not doing voluntary physical movements.
26 • All Participants 1, 2,4,5,7,8,9 and 10 stated that their poor behavior approach about physical activities in workplace during work. They knew the importance but naturally they did not do it. They usually sit and talk to each-other when they were free or in break time. But not intentionally moving except the working movements.
• Majority of the participants like the idea of voluntary physical activities in the working place but they were not sure about how it will be implied due to workloads, business of the shifts, improper and insufficient space etc.
• Participants 2,3,4,7, 9 pointed out that organizational design of their working styles and environment can be the reason of not doing physical activities • All the participants stated that sometimes the workloads were so heavy that
they could not do able any other activities.
• Confusions about implying any fun activities such as Pokémon go or other types of games
27
4.2 The process designing gamification from actions, clustering filtering selecting.
Suggested actions
These are the general actions which had been discussed in the interviews. They are: walking for a Coffee break, nurses are encouraged to walk more often in the working place, can play a common game as Pokémon Go with group, walking outside, stretching, taking a pause or standing up for few seconds, nurses can play hide and seek type game with team, using stairs or elevator, to take different exercises before starting the work, each nurse can give 5 motivational quotes by written in paper, to other five nurses by walking, playing alone Pokémon go, the nurse’s team can play a common game, the game is about how fast they walk.
Cluster drawing of summarize the actions in form of concepts
28 After reviewing the suggestions and comments about the concepts of the cluster drawings from the nurses, a gamification was designed below. See appendix part.
Promoting physical activeness among nurses through Gamification
Walking inside the workplace
Body / physical movements
Walking for a Coffee break reak
Nurses are encouraged to walk more often in the working place The game is about using stairs or elevator
each nurse can give 5 motivational quotes by written in paper to other five nurses by walking
Walking outside of the workplace
taking a pause or standing up for few seconds hide and seek type game with team
Pokémon Go Stretching
Walking outside for 5 mins with group
to take different exercises before starting the work
29
Game-design based on the concept ‘Walking inside the workplace’
After reviewing all the actions based on their close patterns, the author decided to create a game. The most matched and common pattern among the actions was walking coming from the interviews. So, the author tried to create a game based on the summery of different actions stated above related with walking.
This game is called ‘Healthy Steps’.
This game can be played by individual or in group. Duration: not stated
The game is about walking in the workplace. When the nurses have no work or they are sitting idly, they can play this game. For this game, the head of the nurses write 3 healthy walking activities and put in on the board in the working station. Each nightshift, the nurses are requested to look on this board and try to play the game in their suitable times. The 5 activities have different points. Each activity has points and each complete activity will give points. Then the participant’s point will be counted and will awarded as a Health steps winner among the nurses and his or her name will be put on the winner board list through the day.
Now the game. The tasks or activities are: • Walking 5 minutes contains 5 points
• Using stairs instead of walking, each floor contains 10 points • Walking one department from other department, contain 5 points
30 mobile. So, they cannot forget about it. Each participant can store hid or her points in their mobile and send it to the head nurse or telling the head nurse by directly. Then the head nurse compares the points and tell the who the winner. The head nurse will send virtual flowers and winning wish to the winner through an email or sending sms to his or her mobile. And lastly the head nurse will write the winner’s name on the top list of the board in the working station. So, other nurses can see the name and get motivate to do better for the next time.
31
Chapter 5
Discussion 5.1 Limitation of this study
The applying method for data collection is a good way to point out the problems. This interview gives the opportunity to look after the real scenario based on the nurse’s experiences and their thoughts about physical activities.
There are limitations of this method that there is no quantitative data to be presented to visualize the situation numerically.
The other limitation is less selection of participants for the interviews. The participants were selected based on personal contact with the author and his groupmate so there were less people to be interviewed. So, there were limited experiences to contact the nurses in a vast process to perform the interview. Less participants result in less source of information and less variation of acquiring results. It will be more effective if the interviews will be held among many nurses along with the organization management members in different hospitals. The other possible reason for this smaller number of nurses is because of the Corona pandemic. The nurses and the hospitals are also now busy for this situation.
32
5.2 Recommendations and Findings
The participants were suggested some suggestions based on the interview conversations and they thought that these will have helped them in that case. The suggestions were.
● For avoiding sitting idly, it is suggested that they can stand up after each hour and stretched their hands, legs for a few minutes.
● The authority can introduce a voluntary movement sin their working schedule for every worker to keep them energized and encourage them to do some physical movements. They can design a good plan of activities in the form of gamification to encourage them to change their behavior approach to be active in the work.
● The authorities can arrange a checklist for behavior approach towards physical activities.
33
This research shows different points of views related to physical inactivity in night shift nurses. The important points are basically arising based on the reactions of the nurses during interviews related with work, working design, behavior approach, less awareness of physiological well-being and so on.
The author wanted to find out if the nurses are doing normally enough physical activities which means voluntary movements during night shifts except working based on literature findings. To what extent they were physically active in night shifts and if they have any physiological problem including sleeping problem, fatigue. For this purpose, the research questions are made.
The author also found some factors after conducting the interviews which raise the needs of promoting good solutions to overcome the actors behind the physical inactiveness. These factors could be the barriers for the well-being of nurses working in night shifts which were listed in the earlier part of the findings of the research. The factors such as time, duties, the time of year, ways of thinking towards voluntary physical activities, inspiration, poor work schedule, sitting idly, laziness.
34 The timing of the shift basically night shift is itself a factor for less voluntary physical activity is coming out from the research. In this shift, there is less chance to go outside and take a break to take some fresh air during working gaps. The nurses could not manage themselves or feel any motivation to do voluntary movements except work. Outdoor activities are not possible, in that case they can walk in the corridor or use the stairs instead of using the elevator for free style exercising to reduce idleness in the work. This behavior change can help them a lot.
Shift work has been thought to restrict participation in leisure time activities, but the knowledge about physical activity in rotating night shift nurses has been limited so far. The author tried to find out the connection between the leisure-time physical activity among nurses using based on the interview discussions. The research showed that based on the similar expressions of the participants that they were not doing so much fun type physical movements in their leisure time.
5.3 Suggested actions
35 it is not possible for the nature of the time and the shifts. They are passing their free time or leisure time without doing any healthy movement. The author has experienced these things quite a lot. The author and the other colleagues are talking or sitting idly or looking into their mobiles or also time passing in front of the computer sometimes more than an hour while all the patients and older people are sleeping or there are no specific prescribed working tasks.
In this paper the mentioned suggested actions can be effective for the nurses who work in the hospital. All the actions are not like something the nurse must do forcefully. The suggested actions are like something to change their behaviour towards voluntary movements in a healthy way without taking extra stress.
There is one example:
One suggested action is drinking coffee. Usually in Sweden , coffee breaks are very popular. Going for a coffee break , the person must walk certain steps. If this walking for coffee is designed in a fun form like gamification, it will encourage the person to do it quite several times and it will become a healthy behaviour. So, there is no extra effort needed but the need is to change the behaviour to do things like this in a fun way.
36 Some of the nurses also mentioned that the free time or leisure time can be varied sometimes due to emergencies or other issues. So, it will be difficult to do such actions during this time.
Three nurses mentioned that, for working load and timing issues, they used elevators to easy access. So, sometimes using stairs instead of elevators cannot be an effective way to do at work.
Some of the nurses mentioned confusion about implementation of these actions After all the interviews, there are some important points coming out which are needed to be discussed in further studies in future.
• Engagement of participation with groups • Effective way to use the leisure time • Timing management
• The cooperation among other nurses to continue the tasks • Can be obstacles to do the working tasks
• Difficult to do in an emergency time, over-workload
These things needed to be considered for further studies. It needs a deep study to find the opportunities and threats and how to cope up the situation.
5.4 The designing game
37 All the participants played well and there were winners each day. The participants felt quite excited because of the competition and they were excited at the end of each night and week when the head nurse wrote the winner's name on the chart-board. The participants who took part in the game were between 25 to 35 ages. After the game the author asked them if they felt any health-related complications during these three weeks. Most of them say ‘no’ complications.
After all, the participants though it is a fun way to motivate themselves to change their behaviour to do physical activities during workplace based on their regular working styles. This game was played in an older-care home. So, the real scenario can be differed from hospitals.
Nurses can play the mentioned designed game in their workplace. Through this game, it will help them to change their behavior and engaging themselves in a fun activity in a positive way. The winning mind led the nurses to take part in the game again and again. The game can have a positive impact on their daily working lifestyles, and it can change their physical activities in a fun way. The game is designed based on their daily behaviors in this way that they can do it normally without any complexity. The gamification is a way to engage themselves in a fun way with linking their physical movements in terms of positive health-outcomes. It is promoting the physical activities in the working place and enhancing the healthy-lifestyle habits.
38
5.5 Future work
This study reflects some facts which can be done in future investigations related to this area.
● A numerical comparison among three shifts nurse’s total physical activity including voluntary movement.
● The ergonomic view of designing a good schedule.
● A comparison of thinking between the authority who are responsible for planning, designing the schedules, tasks, and the different shift nurses.
● Designing and including a good fun activity when planning a better working
environment for the employees in the health-care system.
39
Chapter 6
Conclusion
Nurses play a key role in the health-care system all over the world and their safety in the working environment cannot be ignored to deliver a good service among the patients. The findings pointed to the need of considering the working conditions in developing an effective workplace by implementing some given suggestions such as free style exercising, and gamification to improve their lifestyle. In order to implement the gamification, it is needed to draw an attention to all the participants and require the user’s feedback regarding how they think, how they behave, and they act and how they play the game frequently in the long run.
40
References
Åkerstedt T., & Kecklund, G. (2017). What work schedule characteristics
constitute a problem to the individual? A representative study of Swedish shift workers. Applied Ergonomics, 59, 320–325.
Alm, H., & Woltjer, R. (2010). Patient safety investigation through the lens of FRAM. Human Factors: A System View of Human, Technology and
Organisation. Maastricht, The Netherlands: Shaker Publishing, 53–65.
Amalberti, R., Auroy, Y., Berwick, D., & Barach, P. (2005). Five system barriers to achieving ultrasafe health care. Annals of Internal Medicine, 142(9), 756– 764.
Amalberti, R., & Hourlier, S. (2016). Human error reduction strategies in health care. In Handbook of human factors and ergonomics in health care and patient
safety (pp. 414–429). CRC Press.
Atkinson G. 2008. Exercise, energy balance and shift worker . Sports medicine
(Auckland, NZ).
Bion, J. F., Abrusci, T., & Hibbert, P. (2010). Human factors in the management of the critically ill patient. British Journal of Anaesthesia, 105(1), 26–33.
Borglid H, Knutsson A. (1999). Shift work, risk factors and cardiovascular disease.
Scand J Work Environ Health.
Brännmark, M., & Holden, R. J. (2013). Packages of participation: Swedish employees’ experience of lean depends on how they are involved. IIE
Transactions on Occupational Ergonomics and Human Factors, 1(2), 93–
41 Bridger, R. (2017). Introduction to Human Factors and Ergonomics (4th Edition).
CRC Press.
Braun, V., & Clarke, V. (2012). Thematic analysis. In H. Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, & K. J. Sher (Eds.), APA handbooks in psychology®. APA handbook of research methods in psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological (p. 57–71). American Psychological Association.
Buckle, P., Clarkson, P. J., Coleman, R., Ward, J., & Anderson, J. (2006). Patient safety, systems design and ergonomics. Applied Ergonomics, 37(4), 491–500.
Carayon, P. (2012). Human factors and ergonomics in health care and patient safety. Handbook of Human Factors and Ergonomics in Health Care and
Patient Safety, 3–16.
Carayon, P., Xie, A., & Kianfar, S. (2014). Human factors and ergonomics as a patient safety practice. BMJ Quality & Safety, 23(3), 196–205.
Carthey, J., Walker, S., Deelchand, V., Vincent, C., & Griffiths, W. H. (2011). Breaking the rules: understanding non-compliance with policies and
guidelines. Bmj, 343.
Catchpole, K. (2013). Spreading human factors expertise in healthcare: untangling
the knots in people and systems. BMJ Publishing Group Ltd.
Catchpole, K. (2013b). Toward the modelling of safety violations in healthcare systems. BMJ Quality & Safety, 22(9), 705–709.
42 588.
Catchpole, K., & Russ, S. (2015). The problem with checklists. BMJ Quality &
Safety, 24(9), 545–549.
Cilar, L., Preložnik, N., Štiglic, G., Vrbnjak, D., Pajnkihar, M. (2016). Physical activity among nursing students.
Conroy, M. (2010). A Qualitative Study of the Psychological Impact of
Unemployment on Individuals.
Cook, R. (2013). The Systems View of Safety. Ödegård, S.(Red.) Patientsäkerhet:
Teori Och Praktik. Stockholm: Liber. Ss, 142–147.
Cook, R. I. (2004). Operating at the sharp end: the human factors of complex technical work and its implications for patient safety. Surgical Patient Safety:
Essential Information for Surgeons in Today’s Environment, 2.
Cook, R. I. (2013). Assessing the Impact of Technology on Patient Safety.
Ödegård, S.(Red.) Patientsäkerhet: Teori Och Praktik. Stockholm: Liber. Ss.
Cook, R. I., & Nemeth, C. P. (2010). “Those found responsible have been sacked”: some observations on the usefulness of error. Cognition, Technology & Work,
12(2), 87–93.
Cook, R., & Rasmussen, J. (2005). “Going solid”: a model of system dynamics and consequences for patient safety. BMJ Quality & Safety, 14(2), 130–134.
Cvach, M. (2012). Monitor alarm fatigue: an integrative review. Biomedical
Instrumentation & Technology, 46(4), 268–277.
43 scoping review. BMC Health Services Research, 13(1), 175.
Dekker, S. (2011). The criminalization of human error in aviation and healthcare: A review. Safety Science, 49(2), 121–127.
Dekker, S. (2012). Complexity, signal detection, and the application of
ergonomics: Reflections on a healthcare case study. Applied Ergonomics,
43(3), 468–472.
Drews, F. A. (2016). Human error in health care. In Handbook of human factors
and ergonomics in health care and patient safety (pp. 352–369). CRC Press.
Dul, J., Bruder, R., Buckle, P., Carayon, P., Falzon, P., Marras, W. S., Wilson, J. R., & van der Doelen, B. (2012). A strategy for human factors/ergonomics: developing the discipline and profession. Ergonomics, 55(4), 377–395. Eklund, J. (2003). An extended framework for humans, technology and
organization in interaction. Human Factors in Organizational Design and
Management-VII. Re-Designing Work and Macroergonomics-Future
Perspectives and Challenges. IEA Press, Santa Monica, California, 47–54.
Ferri, P., Guadi, M., Marcheselli, L., Balduzzi, S., Magnani, D., & Di Lorenzo, R. (2016). The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts. Risk Management and Healthcare Policy, 9, 203.
Flahr, H., Brown, W. J., & Kolbe-Alexander, T. L. (2018). A systematic review of physical activity-based interventions in shift workers. Preventive Medicine
Reports, 10, 323–331.
Flin, R., & Yule, S. (2004). Leadership for safety: industrial experience. BMJ
44 Gopher, D., & Donchin, Y. (2011). Embedded risks and challenges of modern
health care and the urgent call for proactive human factors. Handbook of
Human Factors and Ergonomics in Health Care and Patient Safety, 27–42.
Gurses, A. P., Ozok, A. A., & Pronovost, P. J. (2012). Time to accelerate
integration of human factors and ergonomics in patient safety. BMJ Quality &
Safety, 21(4), 347–351.
Gurses, A. P., Winters, B. D., Pennathur, P. R., Carayon, P., & Pronovost, P. J. (2016). Human factors and ergonomics in intensive care units. In Handbook of
human factors and ergonomics in health care and patient safety (pp. 722–
737). CRC Press.
Gu F, et al. (2015). Total and cause-specific mortality of U.S nurses working rotating night shifts.
Hales, B. M., & Pronovost, P. J. (2006). The checklist—a tool for error
management and performance improvement. Journal of Critical Care, 21(3), 231–235.
Herrera, I. A., & Woltjer, R. (2010). Comparing a multi-linear (STEP) and systemic (FRAM) method for accident analysis. Reliability Engineering &
System Safety, 95(12), 1269–1275.
Hoffmann, A., Christmann, C. A., & Bleser, G. (2017). Gamification in stress management apps: a critical app review. JMIR Serious Games, 5(2), e13. Hollnagel, E. (2012). Coping with complexity: past, present and future. Cognition,
Technology & Work, 14(3), 199–205.
45 2226–2231.
Hulsegga G. et al (2017) . Shift workers have similar leisure-time physics activity levels as day workers but are more sedentary at work. Sand J Work Environ
health.
James P. Keller, J. (2014). ECRI Institute’s TOP 10 Patient Safety Concerns for
Healthcare Organizations. file:///C:/Users/ASUS/Downloads/ECRI Institute s
TOP 10. Patient Safety Concerns for Healthcare Organizations. Inadequate reprocessing of endoscopes and surgical instruments_.pdf
Jöhnk, A., & Karlsson, H. (2016). Patient safety and the work environment.
https://www.nhsconfed.org/-/media/Confederation/Files/public-
access/European-Office/Patient-safety-and-the-work-environment---SALAR.pdf?la=en&hash=669D6559EF2C898A8A7B4387EDC32AC516278 073
Joshi, R., van Pul, C., Atallah, L., Feijs, L., Van Huffel, S., & Andriessen, P. (2016). Pattern discovery in critical alarms originating from neonates under intensive care. Physiological Measurement, 37(4), 564.
Keller Jr, J. P. (2012). Clinical alarm hazards: a “top ten” health technology safety concern. Journal of Electrocardiology, 45(6), 588–591.
Koivisto, J., & Hamari, J. (2019). Gamification of physical activity: A systematic literature review of comparison studies. 3rd International GamiFIN
Conference, GamiFIN 2019.
46 Leveson, N. (1995). Medical devices: The therac-25. Appendix of: Safeware:
System Safety and Computers.
Levine, A. C., Adusumilli, J., & Landrigan, C. P. (2010). Effects of reducing or eliminating resident work shifts over 16 hours: a systematic review. Sleep,
33(8), 1043–1053.
Lelihan, D. (2012). Health Games. A Key Component for the Evolution of Wellness Programs. Games for Health Journal 1(3), 233-235 (2012). Loder, E. (2009). Migraine with aura and increased risk of ischaemic stroke.
British Medical Journal Publishing Group.
Loef, B., Hulsegge, G., Wendel-Vos, G. C. W., Verschuren, W. M. M., Vermeulen, R. C. H., Bakker, M. F., van der Beek, A. J., & Proper, K. I. (2017). Non-occupational physical activity levels of shift workers compared with non-shift workers. Occupational and Environmental Medicine, 74(5), 328–335. https://doi.org/10.1136/oemed-2016-103878.
Loprinzi PD. (2015). The effects of shift work on free-living physical activity and sedentary behaviour.
Madide, S. (2003). Effects of night shift schedules on nurses working in a private
hospital in South Africa.
Martin, J. L., Norris, B. J., Murphy, E., & Crowe, J. A. (2008). Medical device development: The challenge for ergonomics. Applied Ergonomics, 39(3), 271– 283.
47 Stockholm, Sweden. BMC Health Services Research, 12(1), 1–13.
Moser, A., & Korstjens, I. (2018). Series: Practical guidance to qualitative
research. Part 3: Sampling, data collection and analysis. The European journal of general practice.
Ohashi, K., Dalleur, O., Dykes, P. C., & Bates, D. W. (2014). Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug
Safety, 37(12), 1011–1020.
Pedro Pereira, Emília Duarte, Francisco Rebelo, Paulo Noriega. (2014). A review of gamification on health-related contexts.
Patterson, E. S., Cook, R. I., & Render, M. L. (2002). Improving patient safety by identifying side effects from introducing bar coding in medication
administration. Journal of the American Medical Informatics Association,
9(5), 540–553.
Pennathur, P. R., Thompson, D., Abernathy III, J. H., Martinez, E. A., Pronovost, P. J., Kim, G. R., Bauer, L. C., Lubomski, L. H., Marsteller, J. A., & Gurses, A. P. (2013). Technologies in the wild (TiW): human factors implications for patient safety in the cardiovascular operating room. Ergonomics, 56(2), 205– 219.
Peplonska, B., Bukowska, A., & Sobala, W. (2014). Rotating night shift work and physical activity of nurses and midwives in the cross-sectional study in Ł ódź, Poland. Chronobiology International, 31(10), 1152–1159.
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., Sexton, B., Hyzy, R., Welsh, R., & Roth, G. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England
48 Raymer, K. E., Bergström, J., & Nyce, J. M. (2012). Anaesthesia monitor alarms: a
theory-driven approach. Ergonomics, 55(12), 1487–1501.
Rogers, A. E. (2016). Health-Care Work Schedules. In Handbook of human factors
and ergonomics in health care and patient safety (pp. 228–243). CRC Press.
Rollenhagen, C. (2010). Can focus on safety culture become an excuse for not rethinking design of technology? Safety Science, 48(2), 268–278.
Rosness, R., Grøtan, T. O., Guttormsen, G., Herrera, I., Steiro, T., Størseth, F., & Wærø, I. (2010). Organizational accidents and Resilient Organizations: Six
Perspectives. Revison 2. Sintef Technology and Society: Trondheim.
Russ, A. L., Fairbanks, R. J., Karsh, B.-T., Militello, L. G., Saleem, J. J., & Wears, R. L. (2013). The science of human factors: separating fact from fiction. BMJ
Quality & Safety, 22(10), 802–808.
Schaeffer, N. E. (2012). The role of human factors in the design and development
of an insulin pump. SAGE Publications.
Sharples, S., Martin, J., Lang, A., Craven, M., O’Neill, S., & Barnett, J. (2012). Medical device design in context: A model of user–device interaction and consequences. Displays, 33(4–5), 221–232.
Sizeni Madidi (2003). Effectes of Night Shift scheduels on Nurses Working in a Provate Hospital in South Africa. A project report submitted in partial
filfillment of the requirement for the Masters of science degree in Ergonomics.
Shekelle, P. G., Pronovost, P. J., Wachter, R. M., McDonald, K. M., Schoelles, K., Dy, S. M., Shojania, K., Reston, J. T., Adams, A. S., & Angood, P. B. (2013). The top patient safety strategies that can be encouraged for adoption now.
49
The Management System for Nuclear Installations (Issue GS-G-3.5). (2009).
INTERNATIONAL ATOMIC ENERGY AGENCY.
https://www.iaea.org/publications/8090/the-management-system-for-nuclear-installations.
Torquati L. et al. (2018). Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose-response relationship. Scan J Work Environ Health.
Wears, R. L., Cook, R. I., & Perry, S. J. (2006). Automation, interaction, complexity, and failure: A case study. Reliability Engineering & System
Safety, 91(12), 1494–1501.
Wears, R. L., Perry, S. J., & Patterson, E. S. (2016). Handoffs and Transitions of Care. In Handbook of Human Factors and Ergonomics in Health Care and
Patient Safety (pp. 192–201). CRC Press.
Weigl, M., Hornung, S., Angerer, P., Siegrist, J., & Glaser, J. (2013). The effects of improving hospital physicians working conditions on patient care: a
prospective, controlled intervention study. BMC Health Services Research,
13(1), 401.
Williams, E. S., Halbesleben, J. R. B., Manwell, L. B., McMurray, J. E., Rabatin, J., Rashid, A., & Linzer, M. (2012). The effect of workplace health care worker stress and burnout on patient outcomes. Handbook of Human Factors
and Ergonomics in Health Care and Patient Safety, 2, 119–131.
Woods, D. D. (2010a). CLUMSY USE OF TECHNOLOGY. In Behind human
error. Ashgate Publishing, Ltd.
50 TECHNOLOGY. In Behind human error. Ashgate Publishing, Ltd.
Zayas-Cabán, T., & Valdez, R. S. (2016). Human factors and ergonomics in home care. In Handbook of human factors and ergonomics in health care and patient
51
Appendix
First part
Interview for the research project purpose Author:
Participant’s name: Position of work: Gender
Abstract of Physical activeness
52 Most authors observed that the fatigue related to night shifts can increase the risk of human errors and injuries and can negatively affect the quality of patient care.26 Moreover, fatigue reduces performance and job satisfaction, absence due to
sickness, absenteeism, turnover, and job attrition and often induces use of
psychotropic drugs. So, we can suggest some solutions based on gamification to imply some physical activities to create a good working environment and to reduce the stress to ensure the good health and well-being of the nurses who work in nightshifts. Beside their occupational physical activity, we can advise them to do some physical activities in their leisure time to activate themselves and keep them stress-free to ensure their safety in workplaces.
Questions on Physical Activities
1. Do you feel any physical inactiveness during work-shifts in nights and if yes, then to what extent do you feel it? low, mild, or high.
2. Are the physical movements during night shifts less than the day or other shifts? 3. Are there any factors or reasons for physical inactiveness during night shifts? 4. Do you feel any types of laziness, sleep, or health-related problems or mental problems by working night-shift duty?
5. Do you feel is it important to do physical activities during work and why? Is there any necessity to promote something fun or game related to be energized and active during night shifts? If yes, what extent?
Comments or
suggestions………
53
Example of thematic analysis
Coding qualitative data
The author coloured the keywords in different colour for coding from each interviewer’s speech. In the above mentioned one of the examples of how the author did it.
After finding the codes from the interviewer’s speech, the author tried to match up the codes with their similarities from each participant’s speech. A then organized and combined them and making themes based on that. There is an example below how the author did it.
Turning code into themes and naming themes
Codes Themes
• Less movement
• Average movement
• Confusion about movements
• Acknowledgement of physical
activity in night shift Interview extract
codes ”Personally, I think that there is a variation
among shifts. I think the atmosphere and the environment matters a lot. I can say, it depends on the workload but it’s probably less
movement average in night”. But I am not sure it feels same or not, for the other people also”.
54
• Workload
• Different atmosphere and environment
• Variation of shifts
• Nature of tasks based on different
55
Second part of the interview
Interview for the research project purpose Author: Tanmina Azad
Participant’s name: Position of work: Gender
Actions can be taken.
Bad behaviors Actions that can be used in a fun way
Sitting longer time on a chair, sitting longer
time in front of computer • Keeping silent for 5 or 10 seconds in between works, taking a pause or standing up for few seconds while working in front of computer. Each standing time is awarded 1 point and for stretching they will get bonus points.
Leisure time, doing nothing so much productive, doing talking, seeing mobile, talking each-other, being lazy
● The nurse’s team can play a common game. The game is about how fast they walk one patient to other while rounding in a floor. The faster nurse will be called the Fastest walker and get 10 points.
56
● Walking with group of people. Each day one of the member of the ream record how long they walk. He or she will record the time of walking. Then after 1 week all the team’s time will compare and will announce the winner team and will be listed on the leaderboard.
● Pokémon go can be played alone or in teams in the leisure time.
● The nurse’s team can play a common game as Pokémon Go. They can join using a code where each nurse can join when they are free and play games and see who will win in free times at work without presenting physically at the same place at the same time.
● Walking for a Coffee break. Each coffee break is awarded for 5 points. After counting the whole week points then the nurses will categorize the level of Coffee-lover and make a list of them and then put them in on the chart in the coffee place.
● Nurses can play hide and seek type game with team. The highest finding member can get 5 points and will be lead next time when they will again play.
●
Less interested of being active or energized in workplace
● During the working time, each nurse can give 5 motivational quotes by written in paper to other five nurses by walking. They can do it when they are passing the corridor,
