Stressful situations reduce the ability to process complex information. They make us more likely to pursue a familiar course of action, or something we are good at, even if it is unwise. Situations where we are fatigued diminish our ability to physically react and perform.
When exposed to stress, the ability to perform complex analytical tasks falls. We show a preference for “implicit memory and well-rehearsed tasks”.[i] This behaviour was evident in the repeated attempts to deliver vaginally in a situation where this was clearly inappropriate, the unwillingness to transfer to a different care setting or the reluctance to open a third theatre. In an emergency with high stress responses, there was a tendency to revert to behaviours which were well practised leading to a failure to analyse a problem fully and respond appropriately.
Fatigue is well recognised as having similar deleterious effects to stress on both cognition and manual dexterity. Not having slept for 18 hours reduces reaction times to those of someone who has a blood alcohol level of the legal driving limit.[ii] Disconcertingly, where staff expressed concerns that they were tired, no mention of this was made in any action plans.
Stress and fatigue may be caused by the workload or complexity of cases being dealt with, or may be attributable to workforce issues which the trust/board needs to address.
[i] Sandi C. Stress and cognition. WIREs Cognitive Science 2013;4(3):245–61.
[ii] Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med 2000;57(10):649–55.