title: Fatigue in adults with post-infectious fatigue syndrome: a qualitative content analysis.
abstract: BACKGROUND
  Fatigue is a major problem among individuals with post-infectious fatigue syndrome (PIFS), also known as chronic fatigue syndrome or myalgic encephalomyelitis. It is a complex phenomenon that varies across illnesses. From a nursing perspective, knowledge and understanding of fatigue in this illness is limited. Nurses lack confidence in caring for these patients and devalue their professional role. The aim of this study was to explore in-depth the experiences of fatigue among individuals with PIFS. A detailed description of the phenomenon of fatigue is presented. Increased knowledge would likely contribute to more confident nurses and improved nursing care.
  
  
  METHODS
  A qualitative study with open interviews was employed. In-depth interviews with patients were fully transcribed and underwent a qualitative content analysis. A maximum variation sample of 26 affected adults between 26-59 years old was recruited from a population diagnosed at a fatigue outpatient clinic.
  
  
  RESULTS
  The fatigue was a post-exertional, multidimensional, fluctuating phenomenon with varying degrees of severity and several distinct characteristics and was accompanied by concomitant symptoms. Fatigue was perceived to be an all-pervasive complex experience that substantially reduced the ability to function personally or professionally. A range of trigger mechanisms evoked or worsened the fatigue, but the affected were not always aware of what triggered it. There was an excessive increase in fatigue in response to even minor activities. An increase in fatigue resulted in the exacerbation of other concomitant symptoms. The term fatigue does not capture the participants' experiences, which are accompanied by a considerable symptom burden that contributes to the illness experience and the severe disability.
  
  
  CONCLUSIONS
  Although some aspects of the fatigue experience have been reported previously, more were added in our study, such as the dimension of awakening fatigue and the characteristic beyond time, when time passes unnoticed. We also identified trigger mechanisms such as emotional, neurological, social, financial, and pressure on oneself or from others. This in-depth exploration of fatigue in PIFS provides an overview of the dimensions, characteristics, and trigger mechanisms of fatigue, thus making better clinical observations, early recognition, improved communication with patients and more appropriate nursing interventions possible.
authors.affiliation: Department of Nursing Science, Institute of Health and Society, University of Oslo, P.O.B. 1130, Blindern, 0318 Oslo Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Stormorken
authors.affiliation: Center for Community Research, DePaul University, 990 W. Fullerton Ave, Suite 3100, Chicago, Illinois 60614 USA.
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Jason
authors.affiliation: Department of Nursing Science, Institute of Health and Society, University of Oslo, P.O.B. 1130, Blindern, 0318 Oslo Norway.
authors.forename: Marit
authors.initials: M
authors.lastname: Kirkevold
keywords: Adult patients; Fatigue; In-depth interview; Myalgic encephalomyelitis chronic fatigue syndrome; Nursing qualitative research; Patient experiences; Post-infectious fatigue syndrome; Qualitative research