Impact of Shift Work on the Health and Safety of Nurses and Patients

Learning from disaster: patient safety and the role of oncology nurses

When the Oncology Nursing Society (ONS) was almost exactly half its present age, in November 1994, a Boston Globe health columnist named Betsy Lehman was admitted to the Dana-Farber Cancer Institute in Boston, Massachusetts, to receive an investigational regimen for breast cancer. Her treatment ended in disaster. In one of the most notorious patient safety failures of modern times, Lehman was given severe overdoses of cyclophosphamide during a four-day period. On each of those four days, nurses, physicians, and pharmacists at Dana-Farber failed to notice that Lehman was receiving doses four times greater than the intended amount (Aspden, Wolcott, Bootman, & Cronenwett, 2007). Lehman died of cyclophosphamide toxicity on December 3, 1994.
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The role of career counselling in supporting career well-being of nurses

The phenomenon of occupational and career burnout in nurses has received recent attention from academia, the media, and health care practitioners. Research surrounding career burnout often adopts a health perspective and focuses on the psychological well-being of nurses. While acknowledging the vital importance of a health perspective, this article contends that the ability to cultivate a sense of career well-being may act as an antidote to the occupational and career burnout in the nursing profession. To examine the relationship between career burnout and career well-being in nurses, the article explores the many ways career counsellors can be of service to clients in the nursing profession, improving clients’ career well-being via the enhancement of effective coping skills. In particular, the phenomenon of career burnout and its related issues and factors in nurses are identified and analysed. Guided by key tenets from career development theoretical approaches, counselling interventions are proposed to address the unique occupational burnout issue in the nursing profession, aiming to further the career well-being of nurses.

Empowering a healthy practice environment

This article provides frontline nurses a tool kit so they can advocate a healthy practice environment. The healthy nurse, healthy work hours, job satisfaction, adequate sleep, power naps at work, and balancing family/work are discussed. The overweight nurse, nurse fatigue, compassion fatigue, shift work sleep disorder, and role strain are discussed as barriers to a healthy practice environment. Case reports with analysis and recommendations are discussed to overcome these barriers. Resources are presented for frontline nurses to develop a tool kit for transforming their environment to a healthy practice environment and to empower them to become healthy nurses.

[Risk factors for deliberate self-extubation]

PURPOSE

This study was conducted to analyze intubation survival rates according to characteristics and to identify the risk factors affecting deliberate self-extubation.

METHODS

Data were collected from patients' electronic medical reports from one hospital in B city. Participants were 450 patients with endotracheal intubation being treated in intensive care units. The collected data were analyzed using Kaplan-Meier estimation, Log rank test, and Cox's proportional hazards model.

RESULTS

Over 15 months thirty-two (7.1%) of the 450 intubation patients intentionally extubated themselves. The patients who had experienced high level of consciousness, agitation. use of sedative, application of restraints, and day and night shift had significantly lower intubation survival rates. Risk factors for deliberate self-extubation were age (60 years and over), unit (neurological intensive care), level of consciousness (higher), agitation, application of restraints, shift (night), and nurse-to-patient ratio (one nurse caring for two or more patients).

CONCLUSION

Appropriate use of sedative drugs, effective treatment to reduce agitation, sufficient nurse-to-patient ratio, and no restraints for patients should be the focus to diminish the number of deliberate self-extubations.

An integrative review: fatigue among nurses in acute care settings

OBJECTIVE

The aim of this study was to examine current research related to nurse fatigue and identify effective prevention strategies.

BACKGROUND

Work-related fatigue negatively affects patient safety and nurses' well-being and increases employer costs. Preventing fatigue and minimizing its negative consequences require knowledge of the contributing factors if effective interventions are to be designed and implemented.

METHODS

This review targeted original research (2002-2013) examining fatigue among nurses working in acute care settings.

RESULTS

Nurses experience high rates of fatigue. Shifts longer than 12 hours contribute to increased fatigue and errors, but the evidence was inconsistent with regard to age and fatigue level. Individual lifestyle, unit culture, and organization policies influence the prevalence and intensity of work-related fatigue.

CONCLUSIONS

Preventing work-related fatigue requires multifaceted approaches involving the organization, the clinical unit, and the individual.

Experience and limited lighting may affect sleepiness of tunnel workers

Background

Working on shifts, especially on a night shift, influences the endogenous sleep regulation system leading to diminished sleep time and increased somnolence. We attempted to evaluate the impact of shifts on sleepiness and correlate the sleepiness score to the experience in a shift schedule.

Materials and methods

This cross-sectional study consists of 42 male and 2 female workers involved in a tunnel construction. They underwent spirometry, pulse oximetry and were asked to complete the Epworth Sleepiness Scale questionnaire.

Results

Statistical analysis revealed that workers of lower Epworth had a mean age of 43.6 years, compared to the mean age of 36.4 years of workers with higher Epworth. Furthermore, workers of lower Epworth were characterized by a mean number of shift years equal to 14.8, while those of higher Epworth possessed a mean number of shift years equal to 8. The shift schedule did not reveal any statistically significant correlation.

Conclusions

Workers employed for a longer time had diminished sleepiness. However, there is no relationship between night shifts and sleepiness, possibly because of exposure to artificial lighting in the construction site.

Some health effects of aircraft noise with special reference to shift work

BACKGROUND

Aircraft noise is an environmental stressor. A positive relationship exists between noise and high blood pressure. Shift work is an additional hazardous working condition with negative effect on the behavior attitude of workers.

OBJECTIVE

This study aimed at investigating some health hazards for shift work on workers at Cairo International Airport (CIA), Egypt, as a strategic work place, with more than one stressor.

SUBJECTS AND METHODS

Assessment of noise effects were carried out in four working sites at the airport besides control sites. The average noise level in the exposure sites was 106.5 dB compared with 54 dB at the control sites. The study comprised a group of 200 male workers exposed to aircraft noise and 110 male workers not exposed to noise as control group. All workers had full general medical examination after filling specially formulated questionnaire. Hearing impairment, raised blood pressure, headaches, disturbed sleep, and symptoms of anxiety were more prominent among the exposed workers than the control. Symptoms of upper respiratory tract were reported among night shifters of both groups with high tendency for smoking. Thus, night-shift workers at CIA work under more than one stressor. Hypertension and smoking might act as intermediate factors on the causal pathway of complaints, making aircraft noise and night shift acting as two synergistic stressors. Airport workers are in need for aggressive hearing conservation programs. Organization of the working hours schedule is mandatory to avoid excessive noise exposure.

The influence of shift work on cognitive functions and oxidative stress

Shift work influences health, performance, activity, and social relationships, and it causes impairment in cognitive functions. In this study, we investigated the effects of shift work on participants' cognitive functions in terms of memory, attention, and learning, and we measured the effects on oxidative stress. Additionally, we investigated whether there were significant relationships between cognitive functions and whole blood oxidant/antioxidant status of participants. A total of 90 health care workers participated in the study, of whom 45 subjects were night-shift workers. Neuropsychological tests were administered to the participants to assess cognitive function, and blood samples were taken to detect total antioxidant capacity and total oxidant status at 08:00. Differences in anxiety, depression, and chronotype characteristics between shift work groups were not significant. Shift workers achieved significantly lower scores on verbal memory, attention-concentration, and the digit span forward sub-scales of the Wechsler Memory Scale-Revised (WMS-R), as well as on the immediate memory and total learning sub-scales of the Auditory Verbal Learning Test (AVLT). Oxidative stress parameters were significantly associated with some types of cognitive function, including attention-concentration, recognition, and long-term memory. These findings suggest that night shift work may result in significantly poorer cognitive performance, particularly working memory.

Chronotype modulates sleep duration, sleep quality, and social jet lag in shift-workers

This study explores chronotype-dependent tolerance to the demands of working morning, evening, and night shifts in terms of social jet lag, sleep duration, and sleep disturbance. A total of 238 shift-workers were chronotyped with the Munich ChronoType Questionnaire for shift-workers (MCTQ(Shift)), which collects information about shift-dependent sleep duration and sleep timing. Additionally, 94 shift-workers also completed those items of the Sleep Questionnaire from the Standard Shift-Work Index (SSI) that assess sleep disturbances. Although all participants worked morning, evening, and night shifts, subsamples differed in rotation direction and speed. Sleep duration, social jet lag, and sleep disturbance were all significantly modulated by the interaction of chronotype and shift (mixed-model ANOVAs). Earlier chronotypes showed shortened sleep duration during night shifts, high social jet lag, as well as higher levels of sleep disturbance. A similar pattern was observed for later chronotypes during early shifts. Age itself only influenced sleep duration and quality per se, without showing interactions with shifts. We found that workers slept longer in fast, rotating shift schedules. Since chronotype changes with age, investigations on sleep behavior and circadian misalignment in shift-workers have to consider chronotype to fully understand interindividual and intraindividual variability, especially in view of the current demographic changes. Given the impact of sleep on health, our results stress the importance of chronotype both in understanding the effects of shift-work on sleep and in devising solutions to reduce shift-work-related health problems.

Influences of the circadian clock on neuronal susceptibility to excitotoxicity

Stroke is the third leading cause of death and the primary cause of morbidity in the United States, thus posing an enormous burden on the healthcare system. The factors that determine the risk of an individual toward precipitation of an ischemic event possess a strong circadian component as does the ischemic event itself. This predictability provided a window of opportunity toward the development of chronopharmaceuticals which provided much better clinical outcomes. Experiments from our lab showed for the first time that neuronal susceptibility to ischemic events follows a circadian pattern; hippocampal neurons being most susceptible to an ischemic insult occurring during peak activity in a rodent model of global cerebral ischemia. We also demonstrated that the SCN2.2 cells (like their in vivo counterpart) are resistant to excitotoxicity by glutamate and that this was dependent on activation of ERK signaling. We are currently working on elucidating the complete neuroprotective pathway that provides a barricade against glutamate toxicity in the SCN2.2 cells. Our future experiments will be engaged in hijacking the neuroprotective mechanism in the SCN2.2 cells and applying it to glutamate-susceptible entities in an effort to prevent their death in the presence of excitotoxicity. Despite the advancement in chronopharmaceuticals, optimal clinical outcome with minimal adverse events are difficult to come by at an affordable price. Superior treatment options require a better understanding of molecular mechanisms that define the disease, including the role of the circadian clock.

Nurses aged over 50 years and their experiences of shift work

AIM

The Late Career Nurse project examined views and characteristics of nurses working in New Zealand who were born before 1960. This paper focuses on the experiences of such nurses who undertake shift work.

BACKGROUND

The mean age of registered nurses in New Zealand has been rising steadily, and 40% are now aged 50 years or over. While there is substantial literature on the phenomenon and consequences of the ageing nursing workforce, little is known of the particular experiences of nurses aged over 50 years who work shifts.

METHOD

An anonymous online survey was emailed to eligible nurse New Zealand Nurses Organisation members aged over 50 years in February 2012. Quantitative and qualitative analyses of the 3273 responses received were undertaken.

RESULT

Over 45% of respondents worked shifts or flexible hours. While shift work suited many, others noted deleterious effects on family and social relationships, physical and mental health (notably sleep patterns and fatigue), and decreasing tolerance for shift work as they age. Poor scheduling practices were particularly detrimental.

CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT

Worldwide, workforce ageing means strategies are required to retain older nurses in the workforce. Improved scheduling practices including increasing access to flexible and part time work hours, and development of resources on coping with shift work are recommended.

Tai Chi Improves Sleep Quality in Healthy Adults and Patients with Chronic Conditions: A Systematic Review and Meta-analysis

BACKGROUND

Physical activity and exercise appear to improve sleep quality. However, the quantitative effects of Tai Chi on sleep quality in the adult population have rarely been examined. We conducted a systematic review and meta-analysis evaluating the effects of Tai Chi on sleep quality in healthy adults and disease populations.

METHODS

Medline, Cochrane Central databases, and review of references were searched through July 31, 2013. English-language studies of all designs evaluating Tai Chi's effect on sleep outcomes in adults were examined. Data were extracted and verified by 2 reviewers. Extracted information included study setting and design, population characteristics, type and duration of interventions, outcomes, risk of bias and main results. Random effect models meta-analysis was used to assess the magnitude of treatment effect when at least 3 trials reported on the same sleep outcomes.

RESULTS

Eleven studies (9 randomized and 2 non-randomized trials) totaling 994 subjects published between 2004 and 2012 were identified. All studies except one reported Pittsburg Sleep Quality Index. Nine randomized trials reported that 1.5 to 3 hour each week for a duration of 6 to 24 weeks of Tai Chi significantly improved sleep quality (Effect Size, 0.89; 95% confidence interval [CI], 0.28 to 1.50), in community-dwelling healthy participants and in patients with chronic conditions. Improvement in health outcomes including physical performance, pain reduction, and psychological well-being occurred in the Tai Chi group compared with various controls.

LIMITATIONS

Studies were heterogeneous and some trials were lacking in methodological rigor.

CONCLUSIONS

Tai Chi significantly improved sleep quality in both healthy adults and patients with chronic health conditions, which suggests that Tai Chi may be considered as an alternative behavioral therapy in the treatment of insomnia. High-quality, well-controlled randomized trials are needed to better inform clinical decisions.

Examination of Attention Level in Nurses Working Night Shifts in terms of the Relationship between Electrodermal Activity and Sex Hormones

INTRODUCTION

Electrodermal activity (EDA) is an electrical activity of eccrine sweat gland stimulated by the sympathetic nervous system. Skin conductance level (SCL) is measured with EDA. SCL and sweat gland activity increase in emotional situations, such as high activation, attention or stress. In this study, we investigated whether working in shifts affects attention level of nurses with EDA and explored the relationship between EDA and sex hormones.

METHOD

The study was carried out on nurses working night shifts (16.00-08.00 h) (n=22) and nurses working without a shift (08.00-16.00 h) (n=20). Firstly, The Epworth Sleepiness Scale which evaluates a person's daytime sleepiness was applied to the subjects. For EDA measurement, Ag/AgCl electrodes were put on two fingers of their dominant hand. SCL was measured via MP30 system and GSR connection. The blood samples were analyzed for cortisol and ACTH hormone levels to investigate the changes in sleep and circadian rhythm.

RESULT

It was found that there was no statistically significant difference in skin conductance levels between the groups. Moreover, in the comparison of hormone values between the groups, the cortisol levels in night shift nurses were higher than in those working without a shift.

CONCLUSION

Night shift had no significant effect on the attention levels in the nurses. This situation is thought to be related to the fact that the nurses responsible for the night service raise their attention level to the highest point. The reason for higher level of cortisol in nurses working shifts may reflect that cortisol has no effect on the breadth of attention but reflects a high level of stress.

The effect of shift length on fatigue and cognitive performance in air medical providers

OBJECTIVE

To employ a battery of previously validated surveys and neuropsychological tests to compare changes in fatigue and cognitive abilities of air medical providers after 12- and 24-hour shifts.

METHODS

A convenience sample of 34 flight nurses and flight paramedics employed by one air medical service completed the Pittsburgh Sleep Quality Index (PSQI) and the Chalder Fatigue Questionnaire (CFQ) to determine fatigue before and after 12-hour (n = 16) and 24-hour (n = 19) shifts. A battery of neuropsychological tests, including the University of Southern California Repeatable Episodic Memory Test (USC-REMT), Paced Auditory Serial Addition Test (PASAT), Trail Making Test (TMT), and Stroop Color-Word Test were administered before and after the shift to measure changes in cognition. We compared the change in scores stratified by shift length using t-tests, Wilcoxon signed-rank test, and Fisher's exact test.

RESULTS

Participants in the 12- and 24-hour shift groups were aged 36 ± 8 years (12-hour shifts) and 39 ± 6 years (24-hour shifts) (mean ± standard deviation) and were preponderantly male (62% 12-hour shifts; 63%, 24 hour shifts). The PSQI scores identified 50% of both 12-hour and 24-hour shift subjects as having poor sleep quality. Preshift fatigue was described as a median 2/10 (interquartile range [IQR] = 2-4) and fatigue declined by the end of the shift to a median 1/10 [IQR = 1-2], p = 0.006. Providers averaged 6.8 hours of sleep during 24-hour shifts and 1 hour of sleep during 12-hour shifts. Changes in cognitive scores did not differ between groups.

CONCLUSIONS

This study identified no changes in cognitive performance following 12- and 24-hour shifts in air medical providers. This suggests that 24-hour shifts in an air medical service with low to moderate utilization do not have a detrimental effect on cognition as measured by this test battery, and are comparable to 12-hour shifts in terms of impact on cognitive function.

Feasibility of the use of a reliable and valid central venous catheter blood draw bundle checklist

The primary objective of this study was to test the feasibility of creating a central venous catheter blood draw bundle checklist to ensure adherence to the evidence-based blood draw procedure. This study included establishing checklist reliability and validity and periodic observations in 2 inpatient pediatric oncology units. The findings provided support for the reliability and validity of this checklist based on content validity, test-retest reliability, interrater agreement, and internal consistency and reinforced the need for periodic observations to ensure consistency in proper central venous catheter blood draw procedures.

Work/life balance and health: the Nurses and Midwives e-cohort Study

BACKGROUND

Nursing and midwifery are demanding professions. Efforts to understand the health consequences and workforce needs of these professions are urgently needed. Using a novel electronic approach, the Nurses and Midwives e-cohort Study (NMeS) aims to investigate longitudinally Australian and New Zealand nurses' and midwives' work/life balance and health. This paper describes NMeS participation; provides key baseline demographic, workforce and health indicators; compares these baseline descriptions with external norms; and assesses the feasibility of the electronic approach.

METHODS

From 1 April 2006 to 31 March 2008, nurses in Australia and New Zealand, and midwives in Australia were invited to participate. Potential participants were directed to a purpose-built NMeS Internet site, where study information was provided and consent sought. Once obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited.

RESULTS

Overall, 7633 (2.3%) eligible nurses and midwives participated (6308 from Australia and 1325 from New Zealand) from a total pool of 334,400. Age, gender, occupational and health profiles were similar between countries and to national figures. However, some differences were noted; for instance, Queensland participants were over-represented, while Victorian and South Australian participants were under-represented, and 28.2% of Australians were in high strain positions compared with 18.8% of New Zealanders.

CONCLUSIONS

Using an internationally novel web-based approach, a large cohort, which appears generally similar to population norms, has been established. Provided participant retention is adequate, the NMeS will provide insight into understanding the drivers of nurses' and midwives' workforce retention and work-related factors associated with their health.

Sleep variability, health-related practices, and inflammatory markers in a community dwelling sample of older adults

OBJECTIVE

To explore relationships between wake- and sleep-related health behaviors and circulating concentrations of inflammatory markers (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) in a cohort of community dwelling older adults. Low-grade chronic inflammation is an important risk factor for age-related morbidity. Health behaviors, including average aggregate measures of sleep, have been linked to increased inflammation in older adults. Variability in sleep timing may also be associated with increased inflammation.

METHOD

Participants were community dwelling older adults ≥ 60 years (n = 222: 39 bereaved, 55 caregivers, 52 with insomnia, and 76 good sleepers). Mean values and intraindividual variability in sleep, as well as caffeine and alcohol use, exercise, and daytime napping, were assessed by sleep diaries. Blood samples were obtained in the morning.

RESULTS

Several interactions were noted between sleep behaviors, inflammatory markers, and participant group. Greater variability in wake time and time in bed was associated with higher IL-6 among good sleepers relative to caregivers and older adults with insomnia. Good sleepers who consumed moderate amounts of alcohol had the lowest concentrations of IL-6 compared with the other three groups who consumed alcohol. Insomnia subjects, but not good sleepers, showed increased concentrations of IL-6 associated with caffeine use. Caregivers showed increased concentrations of TNF-α with alcohol use relative to good sleepers. Greater variability in bedtime, later wake times, and longer time in bed was associated with higher TNF-α regardless of group.

CONCLUSIONS

Moderation and regularity in the practice of certain health behaviors, including sleep practices, were associated with lower plasma levels of inflammatory markers in older adults. Life circumstances and specific sleep disorders may modify these associations.

Using blue-green light at night and blue-blockers during the day to improves adaptation to night work: a pilot study

BACKGROUND

Bright light at night paired with darkness during the day seem to facilitate adaptation to night work. Considering the biological clock sensitive to short wavelengths, we investigated the possibility of adaptation in shift workers exposed to blue-green light at night, combined with using blue-blockers during the day.

METHODS

Four sawmill shift workers were evaluated during two weeks of night shifts (control and experimental) and one week of day shifts. Throughout the experimental week, ambient light (approximately 130 lx) was supplemented with blue-green light (200 lx) from 00:00 h to: 05:00 h on Monday and Tuesday, 06:00 h on Wednesday and 07:00 h on Thursday. Blue-blockers had to be worn outside from the end of the night shift until 16:00 h. For circadian assessment, salivary melatonin profiles were obtained between 00:00 h and 08:00 h, before and after 4 experimental night shifts. Sleep was continuously monitored with actigraphy and subjective vigilance was measured at the beginning, the middle and the end of each night and day shifts. The error percentage in wood board classification was used as an index of performance.

RESULTS

Through experimental week, melatonin profiles of 3 participants have shifted by at least 2 hours. Improvements were observed in sleep parameters and subjective vigilance from the third night (Wednesday) as performance increased on the fourth night (Thursday) from 5.14% to 1.36% of errors (p=0.04).

CONCLUSIONS

Strategic exposure to short wavelengths at night, and/or daytime use of blue-blocker glasses, seemed to improve sleep, vigilance and performance.

Associations between work schedule characteristics and occupational injury and illness

BACKGROUND

Nurses often endure working irregular day, night and evening shifts as well as mandatory overtime (i.e. employer-imposed work time in excess of one's assigned schedule). While these work characteristics are examined as potential risks for nurses' safety and health, it is not clear whether negative health impacts occur simply because of working long hours or in combination with other mechanisms.

AIM

This study investigates how these work characteristics are associated with nurses' work-related injury and illness over and above long work hours.

METHODS

In this cross-sectional study, questionnaire data were collected from a sample of 655 registered nurses in the Philippines. Multiple logistic regression was used to assess associations of shift work and mandatory overtime with four work-related health outcomes.

RESULTS

After weekly work hours, shift length and demographic variables were accounted for, non-day shifts were associated with work-related injury [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.07, 2.24] and work-related illness (OR = 1.48; 95% CI: 1.02, 2.16). Also, frequency of working mandatory overtime was associated with work-related injury (OR = 1.22; 95% CI: 1.06, 1.41), work-related illness (OR = 1.19; 95% CI: 1.04, 1.37) and missing more than 2 days of work because of a work-related injury or illness (OR = 1.25; 95% CI: 1.08, 1.44).

CONCLUSIONS

These findings suggest that non-day shifts and mandatory overtime may negatively impact nurses' health independent of working long hours. Mechanisms through which these work characteristics affect health, such as circadian rhythm disturbance, nurse-to-patient ratios and work-family conflict, should be examined in future studies.

Infant births during the internal night are at increased risk for operative delivery and NICU admission

PURPOSE

The purpose of the present study was to compare neonatal morbidity between night and the rest of day and investigate potential differences of birth outcomes during the internal night.

METHODS

We conducted a retrospective study based on maternal and neonatal data of period 2004-2007, enrolling exclusively spontaneous deliveries of term (≥ 37 weeks), singleton pregnancies with cephalic presentation that were in labor. Time of day was divided into the night-shift period, from 11.00 p.m. to 7.00 a.m. (period 1) and the rest-of-day period, from 7.00 a.m. to 11.00 p.m. (period 2). The night-shift period was further sub-divided into period 1a (11.00 p.m.-3.00 a.m.) and period 1b (3.00 a.m.-7.00 a.m.). Epidemiological and obstetric characteristics as well as neonatal outcomes were initially compared between periods 1 and 2 and thereafter between sub-periods 1a and 1b.

RESULTS

There were 3,055 cases with complete data meeting our inclusion criteria, of which 871 (28.5%) were delivered during period 1 and 2,184 (71.5%) during period 2. Furthermore, 51.3% of night-born infants were delivered during period 1a and the remaining 48.7% during period 1b. All examined parameters were not significantly different between periods 1 and 2. Analyzing night internally, the rate of emergent CS was significantly higher for period 1a (13.2%), compared with period 1b (4%). Furthermore, incidence of NICU admission was significantly higher for the first half of the night-shift period (2.7%) compared to the relative of the second half (0.5%).

CONCLUSIONS

Neonatal morbidity was comparable between night-shift and rest-of-day periods, but the rates of emergent CS and NICU admission were significantly increased in the first half of the night-shift period (11.00 p.m.-3.00 a.m.).

Sleep quality and quality of life in female shift-working nurses

AIM

This paper is a report of a study of the factors that influence sleep quality and quality of life among shift-working nurses and the relationship between their sleep quality and quality of life.

BACKGROUND

Although shift-working nurses strive to adapt their life schedules to shift rotations, they tend to suffer from severe sleep disturbances and increased rates of cancer, cardiovascular diseases, digestive disease and irregular menstrual cycles. Poor sleep is also associated with medical errors and occupational injuries.

METHODS

A cross-sectional study was conducted in 2008 with a convenience sample of 435 female nurses from five regional hospitals in Taiwan. Data were collected on sleep quality and quality of life using the Pittsburgh Sleep Quality Index and World Health Organization Quality of Life Instrument-BREF Taiwan version respectively. Data were analysed using descriptive statistics, independent t-tests, analysis of variance and Pearson correlations.

FINDINGS

The majority of female shift workers (57%) had global sleep-quality scores > or = 5, indicating poor sleep and all mean scores in four domains of the quality-of-life measure were statistically significantly lower than those of females in Taiwan's general population. Scores for poor sleep quality and quality of life were related to premenstrual dysphoria, occupational injury, illness and medication use. In addition, the associations between scores on the sleep-quality and quality-of-life scales were statistically significantly inversely correlated.

CONCLUSION

Advice should be included in both undergraduate programmes and continuing education to help nurses to recognize and improve their own sleep quality and life quality managers should create a supportive environment to encourage shift-working nurses to engage in healthy behaviours.

Insecurity and shiftwork as characteristics of negative work environment: psychosocial and behavioural mediators

AIM

This paper is a report of an investigation into whether insecure work contract and shiftwork are associated with reduced wellbeing indicators, such as psychological distress, low job involvement and low work ability.

BACKGROUND

Insecure work contracts and shiftwork have repeatedly been found to contribute to the development and continuation of negative outcomes among healthcare professionals. In particular, nurses are generally considered as being at high risk of work-related stress and reduced wellbeing.

METHODS

Cross-sectional survey data from the Finnish Health Care Professional Study collected in 2006 were used. The random sample of Finnish Registered Nurses comprised 2100 women and men aged 22-65 years. Information on the work contract and shiftwork were self-reported. The wellbeing indicators used were psychological distress (GHQ-12), work ability and job involvement. Psychosocial work characteristics were measured using the Job Content Questionnaire and an organizational justice scale.

RESULTS

Variance and linear regression analyses showed that insecure work contract was associated with lower work ability and job involvement. Shiftwork was related to psychological distress, low job involvement and low work ability. Support for a mediating role of job demands and job control and a moderating role of relational justice was obtained.

CONCLUSION

To reduce the negative effects of environmental stressors, such as insecure work contract and shiftwork, it may be better to focus on improving psychosocial work characteristics than on nurses' health-related behaviour.

Self-reported gastrointestinal and cardiovascular symptoms in female Turkish nurses

AIM

This study aimed to determine the prevalence of gastrointestinal and cardiovascular symptoms and to compare working conditions and lifestyle characteristics among nurses.

BACKGROUND

Gastrointestinal and cardiovascular disorders are important health problems in nurses. Although many epidemiologic studies have researched nurses' health problems, few have focused on their cardiovascular and gastrointestinal symptoms.

METHODS

A cross-sectional design was used with a sample of 400 nurses from a medical faculty hospital in northwestern Turkey. Data were collected using the Physical Health Questionnaire of the Standard Shift Work Index.

RESULTS

The nurses worked different shifts and provided direct patient care in four different clinical areas in the hospital. There were statistically significant differences in age, educational status, marital status, work years, weekly working hours and type of work shift among nurses in different units. The mean gastrointestinal symptoms subscale score was 17.7 [standard deviation (SD) = 3.2] and the mean cardiovascular symptoms subscale score was 14.4 (SD = 3.7). Compared with results in similar studies, the nurses' gastrointestinal and cardiovascular symptoms scores in our study are quite high. The regression model shows that gastrointestinal symptoms are most prevalent in the 20-30-year-old age group [odds ratio (OR) = 13.90] and the cigarette-smoking group (OR = 8.52). The most important factors affecting the prevalence of cardiovascular symptoms are marital status (OR = 2.41) and smoking (OR = 2.31).

CONCLUSION

The findings might help occupational health nurses and other occupational health-care personnel in assessing high-risk nurses who could benefit from interventions aimed at minimizing gastrointestinal and cardiovascular disorders.

The association between shift duty and abnormal eating behavior among nurses working in a major hospital: a cross-sectional study

BACKGROUND

Shift work induces stress, disturbs family life and interrupts regular meal schedules. Few studies have addressed the association between shift duties and abnormal eating behavior among hospital nurses.

OBJECTIVES AND DESIGN

We tested the hypothesis that shift duties were independent predictors of abnormal eating. Self-administered surveys consisting of socio-demographic data, working pattern, Perceived Organizational Support (POS) questionnaire and the patterns of eating style identified by the Dutch Eating Behavior Questionnaires (DEBQ) were used.

SETTINGS

One major acute hospital in one Territory of Hong Kong.

PARTICIPANTS

All 662 nurses who worked on a full-time basis in this hospital were invited to join the study and among them, 378 completed surveys were collected with a response rate of 57.1%. The average age was 37.2 years, and 91.5% were female. 67.3 were registered nurses, 17.9% enrolled nurses; and 14.5% were ranked nursing officers or above. 39.1% worked in acute settings (medical wards, intensive care units and emergency departments), and 62.1% of respondents had at least 11 years of clinical experience and 76.2% of respondents had shift duties with 81.9% having at least four shift duties per month. Only 66.7% of respondents had normal body mass index (BMI 18.5-22.9 kg/m2).

METHODS

Three binary logistic regression analyses were conducted with abnormal emotional, external and restraint DEBQ as outcome variables, respectively. We controlled for age, gender, marital status, work setting (acute vs. non-acute), years of clinical experience, the frequency of shift duties, body mass index, perception of body weight changes in the past 6 months, self-perception of recent overeating and POS.

RESULTS

The proportions of participants having abnormal emotional, external and restraint DEBQ scores were 66.4%, 61.4% and 64.0%, respectively. From multiple regression analysis, nurses having 4 or more shift duties per month were more likely to present with abnormal emotional (adjusted odds ratio aOR 2.91, 95% C.I. 1.57-5.42, p=0.001) and restraint (aOR 3.35, 95% C.I. 1.76-6.38, p<0.001) DEBS scores.

CONCLUSIONS

Shift duties were positively associated with abnormal eating behavior among nurses working in hospitals. More health promotional initiatives should be targeted towards hospital nurses whose duties require frequent night shifts to enhance healthy eating.

Subjective and objective sleep and sleepiness among tunnel workers in an extreme and isolated environment: 10-h shifts, 21-day working period, at 78 degrees north

OBJECTIVES

The aim of this study was to examine the effects of extended work hours (10 h on, 14 h off for 21 days) on sleep and sleepiness in an extreme and isolated environment in the far north (Spitsbergen, 78 degrees north). We wanted to examine whether sleep duration, sleepiness and other parameters changed over the 3-week working period and whether the parameters differed between day and night shifts.

METHODS

The work consisted of tunnel construction in Svea, Spitsbergen. The participants worked alternate fixed day shift (06:00-16:00) or fixed night shift (18:00-04:00) for a 21-day work period in a counterbalanced, crossover design. The participants were 25 male workers (age 24-60 years). We used subjective and objective measures of sleep (diary and actigraphy) and a subjective daytime sleepiness and function questionnaire.

RESULTS

The workers had a high sleep efficiency measured both subjectively and objectively. This did not change across days or between day and night shifts. Total sleep time was significantly shorter (about (1/2) to 1h) during the day shift period than during the night shift period, as measured both subjectively and objectively, but did not differ across days. Subjective ratings of sleepiness did not differ between shifts.

CONCLUSIONS

There were few differences between the day and night shift periods and across the 21-day working period, as measured both subjectively and objectively. The subjects experienced few problems and seemed to adapt easily to their work schedule. This contrasts with what is usually the case in more conventional shift work situations, where workers do not adapt well, as measured by sleepiness and various sleep parameters.

Sleepiness in critical care nurses: results of a pilot study

BACKGROUND

Sleep deprivation, compounded by circadian disruptions, is a common problem in health care workers. Sleepiness in nurses has important implications for patients as well as nurses' own safety.

OBJECTIVE

The objective of the study was to assess comprehensively sleepiness levels in post-night-shift nurses.

METHODS

Post-night-shift nurses in the ICU and on general floors (medicine and surgery) were assessed using subjective (Epworth Sleepiness Scale [ESS]) and objective (Mean Sleep Latency Test [MSLT]) measures.

RESULTS

ESS was abnormal (>8) in 7 of 10 ICU nurses compared with 2 of 10 floor nurses (P < .005), and mean ESS score was also higher (8.7 +/- 3.9 vs. 5.6 +/- 2.1, respectively; P = 0.042). MSLT values for the first nap period were in the pathologic range in the ICU nurses compared with the floor nurses (4.65 +/- 5.5 vs. 10.85 +/- 7.4 minutes, respectively; P < .05).

CONCLUSIONS

Post-night-shift RNs working in the ICU have a pathologic degree of sleepiness.

Psychological, lifestyle and coping contributors to chronic fatigue in shift-worker nurses

AIM

This paper is a report of a study to assess the following in shift-worker nurses: (1) the relationships amongst chronic fatigue and psychological variables including anxiety, mood and locus of control; (2) the relationships amongst chronic fatigue and a number of lifestyle factors such as shiftwork, sleep and exercise; and (3) various coping behaviours that best predict chronic fatigue.

BACKGROUND

In the shift-working population, individual psychological, lifestyle and coping differences influence fatigue levels. However, some of these factors are somewhat unexplored and their relative contribution to fatigue remains poorly understood. Methods. An exploratory design was adopted with 111 eldercare shift-worker nurses. Data were collected during 2006. Nurses completed self-administered questionnaires examining fatigue, anxiety, mood disturbance, locus of control, sleep, work, lifestyle and coping characteristics.

FINDINGS

Multiple regressions showed that mood disturbance, locus of control and trait anxiety are statistically significant predictors of chronic fatigue. Poor sleep quality was the lifestyle factor which most strongly contributed to fatigue. Other lifestyle predictors included higher workload perception, lack of exercise and the non-availability of support. Whilst problem-focused coping behaviours were not associated with fatigue, coping by using alcohol, letting emotions out and avoiding the situation significantly predicted chronic fatigue.

CONCLUSION

The challenge for improving the fatigue outcomes requires further investigation of the profile of a nurse who is at a high risk of fatigue, and then integrating this profile into a fatigue management programme which considers relative contributions of the psychological, lifestyle and coping factors.