Associations between night work and anxiety, depression, insomnia, sleepiness and fatigue in a sample of Norwegian nurses

Long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan: A national survey

BACKGROUND

Needlestick and sharps injuries are prevalent work-related injuries among nurses. Safety devices prevent only one-quarter of related injuries. More studies of modifiable risk factors are needed.

OBJECTIVES

To examine whether long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan.

DESIGN

Cross-sectional survey.

SETTINGS/PARTICIPANTS

This analysis included 19,386 full-time bedside nurses working in 104 hospitals across Taiwan.

METHODS

Participants filled out an anonymous questionnaire from July to September 2014. Chronic insomnia, needlestick injuries, and sharps injuries during the past year were each measured by a yes/no question. Multivariate logistic regression models were applied to examine the effects of long work hours and chronic insomnia on needlestick and sharps injuries, given with control for sex, marital status, educational level, age, years of practice, work unit, and hospital level in the model.

RESULTS

More than 70% of study nurses worked long hours during the previous week (>50h: 27.5%; 41-50h: 43.2%), and 15.5% of nurses reported chronic insomnia. The percentage of sharps injuries (38.8%) was higher than that for needlestick injuries (22.4%) during the previous year among nurses. After adjusting for potential confounders, logistic regression yielded significant results showing that those who worked 41 to 50h per week, >50h per week, and had chronic insomnia were 1.17 times (95% C.I.=1.04-1.32), 1.51 times (95% C.I.=1.32-1.72), and 1.45 times (95% C.I.=1.25-1.68) more likely to experience needlestick injuries, and 1.29 times (95% C.I.=1.17-1.42), 1.37 times (95% C.I.=1.23-1.53), and 1.56 times (95% C.I.=1.37-1.77) more likely to experience sharps injuries, respectively, than those who worked fewer hours and did not have insomnia.

CONCLUSIONS

This nationwide nurse survey showed that high rates of needlestick and sharps injuries persist in hospital nurses in Taiwan. The common problems of long work hours and chronic insomnia increase the risk of these injuries. We suggest that hospital managers follow regulations on work hours and optimize shift schedules for nurses to decrease related injuries.

Depression in Registered Nurses: A State of the Science

Registered nurses suffer from depression at almost twice the rate of individuals in other professions. Major depression affects both employees and organizations. Depression is linked to increases in work absenteeism, short-term disability, and decreased productivity and presenteeism. Depression experienced by registered nurses may not be fully preventable, but realizing its presence and prevalence in the workplace is of vital importance. It is essential that we have a healthy, vibrant, and present registered nurse workforce to ensure that quality patient outcomes are achieved. This review of 36 articles assesses the current state of the science related to depression in registered nurses so that occupational health nurses can create pathways and work environments for better mental health for registered nurses.

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

BACKGROUND

Shift work is considered necessary to ensure continuity of care in hospitals and residential facilities. In particular, the night shift is one of the most frequent reasons for the disruption of circadian rhythms, causing significant alterations of sleep and biological functions that can affect physical and psychological well-being and negatively impact work performance.

OBJECTIVES

The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction.

METHODS

This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in 17 wards of a general hospital and a residential facility of a northern Italian city. This study involved 213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data collection was the "Standard Shift Work Index," validated in Italian. Data were statistically analyzed.

RESULTS

The response rate was 86%. The nurses engaged in rotating night shifts were statistically significantly younger, more frequently single, and had Bachelors and Masters degrees in nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in comparison with the day shift workers, in a statistically significant way.

CONCLUSION

Our results suggest that nurses with rotating night schedule need special attention due to the higher risk for both job dissatisfaction and undesirable health effects.

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts

OBJECTIVE

The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work.

METHODS

This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns.

RESULTS

65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017).

CONCLUSIONS

Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers.

Anxiety levels in employees and students in psychiatric nursing

Introduction: Several research finding indicate that nursing care professionals are often faced with situations which may lead to anxiety. The aim of the present research was to determine the prevalence and typical signs of anxiety among nursing employees and nursing students in psychiatric settings. Methods: The Burns Anxiety Inventory was used as an assessment tool to measure anxiety. The research sample consisted of 242 participants. The data collected were processed by the descriptive statistics, Leveneʹs test, the ANOVA statistical test, the Welchʹs t-test, and the post hoc analysis. Pearsonʹs correlation coefficient was used to measure the strength of the association between the variables. Results: The results of the current study show that nearly half of the participants experience anxiety, but the differences were noted as regards their anxiety thoughts (p = 0.039). Anxiety feelings are more prevalent in female students (p = 0.046). Habitual smokers (p = 0.030) and casual smokers (p = 0.020) are more likely to develop anxious feelings and physical signs of anxiety. The anxiety signs are also more pronounced in the respondents with self-assessed lower economic status (p = 0.001) and poor self-rated health (p = 0.0001). Discussion and conclusion: The professionals and students in psychiatric nursing often encounter situations conducive to the development of anxiety. Further studies on the current topic are therefore recommended to design adequate educational programmes to timely recognise anxiety symptoms and to implement mutual and self-help measure.

Sleep disturbances in nurses enrolled in part-time studies

Aim. The aim of this study was to assess the prevalence of sleep disorders among nurses enrolled in part-time studies and to identify the key factors affecting the sleep quality. Material and methods. The study was conducted on part-time student-nurses majoring in nursing. Sleep disorders were described using the Athens Insomnia Scale and the FIRST scale, as well as the author’s questionnaire. Data were analysed using Mann-Whitney U tests, ANOVA, Kruskal-Wallis and appropriate post-hoc tests. A significance criterion of P<0.05 was used throughout the study. Results. Sleep disorders were found in most student nurses – almost a half of them were at-risk of insomnia due to inadequate sleep hygiene. The main factors affecting sleep included nurses’ anxiety about their academic performance, stress, workload and shift work. Lack of sleep affected work performance the following day, leading to fatigue, increased daytime sleepiness, deterioration of concentration and irritability. Conclusion. Some individuals may not be aware about the relationship between one’s lifestyle and sleep quality which contributes to poor sleep quality and deteriorates one’s functioning during the day. In turn, this may lead to lower nursing care quality and it may also put additional strain on home chores.

Fatigue and Vitamin D Status in Iranian Female Nurses

Introduction:

Given that nurses are among professions with frequent problems of fatigue, and given the nature of their profession that provides little exposure to sunlight and the subsequent deficiency of vitamin D, the present study examined the relation between fatigue and circulating vitamin D levels in female nurses working in Shahid Beheshti Hospital, Kashan, Iran in 2013.

Material and Methods:

This cross-sectional study was conducted in 200 female nurses working in Shahid Beheshti Hospital. To measure fatigue, fatigue questionnaire containing 9 questions eliciting the subject’s feeling in scales of 1 to 7, getting a possible score of 9 to 63, and Visual Analogue Scale in which nurses specified their fatigue in a band of zero to 10 were used. The 25-hydroxyvitamin D, which is the most important vitamin D metabolite, also was determined. The data was analyzed by SPSS-16. The Pearson’s correlation of coefficients, t-test, and multiple regression analysis were used in this study.

Results:

The mean fatigue score of nurses was 38.76±12.66 in questionnaire and 5.73±2.12 in Visual Analog Scale. The 89 per cent of nurses suffered from vitamin D deficiency, 9.5 percent of them had normal level and 1.5 per cent had toxicity level of vitamin D. There was a significant relationship between vitamin D level and fatigue scores (P<0.0001), and visual fatigue scores (P<0.0001). According to multivariate regression analysis, vitamin D level accounted for 13 per cent of the fatigue based on data on questionnaire and 18.6 per cent of fatigue according to Visual Analog Scale.

Conclusion:

High prevalence of fatigue among nurses could be attributed to vitamin D deficiency.

Comorbidity of poor sleep and primary headaches among nursing staff in north China

BACKGROUND

Sleep disorders and primary headaches are both more prevalent among nursing staff than in the general population. However, there have been no reports about the comorbidity of poor sleep and primary headaches among nursing staff.

METHODS

Stratified random cluster sampling was used to select 1102 nurses from various departments in three hospitals in north China. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The diagnosis of primary headaches including migraine, tension-type headache (TTH), and chronic daily headache (CDH) was based on the International Classification of Headache Disorders, 3rd edition (beta version) (ICHD-3-beta).

RESULTS

The response rate was 93 %. Among 1023 nurses, the prevalence of poor sleep was 56.7 %. Of these, 315 nurses (34.13 %) had poor sleep comorbid with primary headaches. The prevalence of poor sleep in the groups with CDH (82.1 %), migraine (78.9 %), and TTH (59.0 %) was significantly higher than that in the group without headaches (47.3 %) (all P < 0.05). Multivariate logistic regression revealed that rotating shifts and suffering headache were independent risk factors for poor sleep. Also, the 1-year prevalence of the three types of primary headache was significantly increased in the poor sleep group (migraine: 21.2 % vs. 7.2 %; TTH: 27.9 % vs. 24.9 %; CDH: 4.1 % vs. 1.1 %; P < 0.05). Compared with normal sleepers, nurses with poor sleep were 1.72 times more likely to have severe headache (OR: 1.72, 95 % CI: 1.14-2.57).

CONCLUSION

Comorbidity of poor sleep and primary headaches among nursing staff is common. Therefore, sleep quality should be carefully evaluated in nurses with primary headaches.

A systematic review of studies on the prevalence of insomnia in university students

OBJECTIVES

Many studies have shown that insomnia is a common problem among university students, but there are wide variations in the prevalence of insomnia. In this systematic review, we aimed to explore the prevalence of insomnia among university students using scientific and conclusive methods.

STUDY DESIGN

A systematic review is designed to analyze the studies reporting on prevalence of insomnia among university students.

METHODS

Systemic searches were conducted in PubMed, BioMed Central, EBSCO, ScienceDirect, Ovid LWW and Medline databases between January 2000 and July 2014, The Meta analyst software was used to calculate the prevalence rate of each study, the pooled means of prevalence rates and 95% CIs across studies were then calculated and presented.

RESULTS

Seven articles that met the inclusion and exclusion criteria were selected. The overall sample size in the current review was 16,478, with a minimum of 219 and a maximum of 10,322. The prevalence rates of the seven studies ranged between 9.4% (95%CI 8.8-10.0%) and 38.2% (95% CI 35.4-41.1%). Overall, the total students studied with a weighted mean prevalence of 18.5% (95% CI 11.2-28.8%), considerably higher than rates of 7.4% (95% CI 5.8-9.0%) reported in general population.

CONCLUSIONS

This review emphasized that insomnia prevalence in university students is considerably higher than that in general population, suggested that more attention should be paid to insomnia in university students.

[Stress, coping and presenteeism in nurses assisting critical and potentially critical patients]

OBJECTIVE

to verify the associations between stress, Coping and Presenteeism in nurses operating on direct assistance to critical and potentially critical patients.

METHOD

this is a descriptive, cross-sectional and quantitative study, conducted between March and April 2010 with 129 hospital nurses. The Inventory of stress in nurses, Occupational and Coping Questionnaire Range of Limitations at Work were used. For the analysis, the Kolmogorov-Smirnov test, correlation coefficient of Pearson and Spearman, Chi-square and T-test were applied.

RESULTS

it was observed that 66.7% of the nurses showed low stress, 87.6% use control strategies for coping stress and 4.84% had decrease in productivity. Direct and meaningful relationships between stress and lost productivity were found.

CONCLUSION

stress interferes with the daily life of nurses and impacts on productivity. Although the inability to test associations, the control strategy can minimize the stress, which consequently contributes to better productivity of nurses in the care of critical patients and potentially critical.

Predictors of shift work disorder among nurses: a longitudinal study

BACKGROUND

Shift work is associated with sleep problems and impaired health. The main aim of the present study was to explore predictors of developing shift work disorder (SWD) among Norwegian nurses using a longitudinal design.

METHODS

A total of 1533 nurses participating in a survey on shift work, sleep and health responded to questionnaires at baseline and at follow-up about two years later. SWD was defined as problems of excessive sleepiness and/or complaints of insomnia related to the work schedule.

RESULTS AND CONCLUSIONS

There was a significant reduction (p < 0.001) in the prevalence of SWD from baseline to follow-up, from 35.7% to 28.6%. Logistic regression analyses showed significant risks of having SWD at follow-up and the following variables measured at baseline: number of nights worked the last year (OR = 1.01, 95% CI = 1.01-1.02), having SWD (OR = 5.19, 95% CI = 3.74-7.20), composite score on the Epworth Sleepiness Scale (OR = 1.08, 95% CI = 1.04-1.13), use of melatonin (OR = 4.20, 95% CI = 1.33-13.33), use of bright light therapy (OR = 3.10, 95% CI 1.14-8.39), and symptoms of depression measured by the Hospital Anxiety and Depression Scale (OR = 1.07, 95% CI = 1.00-1.14). In addition, leaving night work between baseline and follow-up was associated with a significantly reduced risk of SWD at follow-up (OR = 0.12, 95% CI = 0.07-0.22).

Short rest periods between work shifts predict sleep and health problems in nurses at 1-year follow-up

OBJECTIVES

We investigated whether the number of work shifts separated by less than 11 hours (quick returns) at baseline (T1) could predict health problems in nurses at 1-year follow-up (T2).

METHODS

1224 nurses responded to a questionnaire-based survey in 2009 (T1) and 2010 (T2). Crude and adjusted logistic regression analyses were completed to assess the association between annual number of quick returns at T1 and the following outcome variables at T2: shift work disorder (SWD), excessive sleepiness (Epworth Sleepiness Scale), pathological fatigue (Chalder Fatigue Scale) and anxiety and depression (Hospital Anxiety and Depression Scale), while controlling for age, gender, the corresponding outcome variable at T1, number of night shifts at T1, change in number of quick returns and number of night shifts from T1 to T2.

RESULTS

The adjusted analyses showed that the annual number of quick returns at T1 predicted the occurrence of SWD (OR=1.01, 95% CI 1.00 to 1.01) and pathological fatigue (OR=1.01, 95% CI 1.00 to 1.01) at T2. A decreased number of quick returns from T1 to T2 entailed a reduced risk of pathological fatigue (OR=0.67, 95% CI 0.45 to 0.99) at T2. There was no association between quick returns at T1 and excessive sleepiness, anxiety or depression at T2 in the adjusted analyses.

CONCLUSIONS

This is the first longitudinal study investigating the associations between quick returns and future health problems. Quick returns increased the risk of SWD and pathological fatigue at 1-year follow-up. Reducing the number of quick returns from 1 year to the next was related to reduced risk of developing pathological fatigue.