Fatigue is a subjective symptom of malaise that results in aversion to activity. It is a poorly defined feeling, and to delineate the symptom, one needs to undertake a very careful probing. To identify pointers to a specific diagnosis, a careful inquiry into the complaints may reveal complaints, such as, fatigue, tiredness, exhaustion, burn-out, or drained. This may indicate lack of energy that may be due to lack of motivation or sleepiness. Surveys report that almost 5% to 20% of the general population suffers from persistent and troublesome fatigue.
To the medical community, especially nursing, fatigue as a syndrome throws a difficult challenge. Fatigue, as a subjective symptom, may or may not be associated with positive diagnostic findings. Fatigue, thus, can be defined as a syndrome of severe subjective weakness that is the expression of mental or physical tiredness, exacerbated by minimal exertion and unexplained by a conventional medical diagnosis. Although subjective fatigue is normally distributed in the population, the troublesome and persistent fatigue can be attempted to be measured by persistence.
It is reported to be twice as common in women, but age or occupation has little role to play in its incidence. The patients usually regard fatigue as important symptom since this is disabling. The healthcare providers generally regard this as unimportant since it is nonspecific diagnostically. In this work, this writer shall focus on the topic of fatigue from different aspects to analyze its importance in clinical nursing practice. Model Case: The patient was diabetic for long. He is being treated with antidiabetic medications.
Along with that, he has hypertensive cardiovascular disease and chronic dyslipidaemia. He is on lifestyle modification regime with drug therapy. He is a frequent visitor to the hospital with different indications, and this time, he has been admitted with community-acquired pneumonia. Perhaps his diabetes and chronic obstructive pulmonary disease predisposes him to have frequent attacks of infection. It is doubtful whether he, at all, is following the physicians’ instructions, especially those related to risk-factor modifications when he is outside the hospital.
This is my third encounter with this patient in the clinical area during my tenure as a nurse in clinical placement. A tight glucose control and antibiotic treatment has brought down the severity of the infection, and his clinical parameters are showing improvement. Despite the fact that he is in the phase of convalescence, he is showing resistance to move out of the bed, and it is apparent that his activities of daily living are, against expectation, yet dependent on nurses.
A conversational probe into the patient’s status clearly demonstrated a state of inability to comply with instructions while the clinical parameters were within the acceptable limits of normalcy. When asked to come out of bed and walk down the corridor, he expresses utter inability, and he thinks his condition is due to something else yet unexplored by the physicians. He says, “I just can’t move. ” There are several other occasions in the practice of any nurse in the clinical area where patients have unusual delay in recovery or unexpected poor outcomes despite perfect management of their clinical conditions.
A pure case of incidental and unpredictable fatigue might actually result from any clinical condition being managed in the hospital-based practice or at home, and for the patients, this happens to be an unresolved issue, and for the managing nurses, this can be alarming since in the face of absence of any demonstrable etiology, this remains a condition that is extremely tedious and difficult to manage.