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Zhang Y, Murphy J, Lammers-van der Holst HM, Barger LK, Lai YJ, Duffy JF. Interventions to improve the sleep of nurses: A systematic review. Res Nurs Health 2023; 46:462-484. [PMID: 37710916 PMCID: PMC10539041 DOI: 10.1002/nur.22337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
Nurses are at a high risk for short sleep duration and poor sleep quality due to irregular work schedules and high occupational stress. Considering the effect of nurses' sleep on the safety and health of themselves and their patients, it is important to promote healthy sleep for nurses. We sought to synthesize the published experimental and quasi-experimental studies that address interventions to improve sleep in nurses. A systematic search was conducted for studies published in English up until May 15, 2023, using the databases PubMed, CINAHL, Academic Search Ultimate, and PsycINFO. In total, 38 articles were included, covering 22 experimental and 16 quasi-experimental studies with sample sizes ranging from 9 to 207. Studies were assessed using the Cochrane Risk of Bias tool and considered as low to medium quality. Thirty-six of the 38 studies reported positive findings for at least one sleep outcome. Intervention types included aroma therapy, dietary supplements, cognitive behavioral therapy, light therapy, mind-body therapy, sleep education, exercise, napping, shift schedule modification, and multicomponent intervention, all of which showed moderate effectiveness in promoting sleep outcomes of nurses. Comparing and contrasting studies on specific interventions for improving sleep in nurses is sparse and often equivocal. With the variations of research methodology and outcome measures, it is difficult to make a conclusion about each intervention's effectiveness on specific sleep outcomes. Additional high-quality research, including randomized controlled trials, is needed to evaluate strategies for improving sleep in this unique, safety-sensitive occupational group.
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Affiliation(s)
- Yuan Zhang
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | - Jennifer Murphy
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | | | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115
| | - Yun-Ju Lai
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | - Jeanne F. Duffy
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115
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2
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Abstract
An integrative review of 21 studies found mixed results on the associations of work schedule and nurse fatigue. Suggestions for nurse leaders include monitoring fatigue in shift workers, ensuring supportive work design, promoting a healthy lifestyle, and implementing scheduling interventions.
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Affiliation(s)
- Melita Peršolja
- Melita Peršolja is an associate professor, Vipava Unit of Faculty of Health Sciences at the University of Primorska, Slovenia
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3
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Asadpoordezaki Z, Coogan AN, Henley BM. Chronobiology of Parkinson's disease: Past, present and future. Eur J Neurosci 2023; 57:178-200. [PMID: 36342744 PMCID: PMC10099399 DOI: 10.1111/ejn.15859] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Parkinson's disease is a neurodegenerative disorder predominately affecting midbrain dopaminergic neurons that results in a broad range of motor and non-motor symptoms. Sleep complaints are among the most common non-motor symptoms, even in the prodromal period. Sleep alterations in Parkinson's disease patients may be associated with dysregulation of circadian rhythms, intrinsic 24-h cycles that control essential physiological functions, or with side effects from levodopa medication and physical and mental health challenges. The impact of circadian dysregulation on sleep disturbances in Parkinson's disease is not fully understood; as such, we review the systems, cellular and molecular mechanisms that may underlie circadian perturbations in Parkinson's disease. We also discuss the potential benefits of chronobiology-based personalized medicine in the management of Parkinson's disease both in terms of behavioural and pharmacological interventions. We propose that a fuller understanding of circadian clock function may shed important new light on the aetiology and symptomatology of the disease and may allow for improvements in the quality of life for the millions of people with Parkinson's disease.
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Affiliation(s)
- Ziba Asadpoordezaki
- Department of Psychology, Maynooth University, Maynooth, Co Kildare, Ireland.,Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Maynooth, Co Kildare, Ireland.,Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Beverley M Henley
- Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
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4
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Vladič M, Kren A. Sleep deprivation and burnout syndrome among pre-hospital emergency medical service employees in Slovenia. OBZORNIK ZDRAVSTVENE NEGE 2021. [DOI: 10.14528/snr.2021.55.4.3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Sleep deprivation and burnout are common in employees who work in shifts, night shifts, overtime as well as those who work under stressful and unpredictable circumstances. The purpose of the study was to explore the quality of sleep, determine burnout level components and investigate the level of these components and their impact on the quality of sleep among employees in pre-hospital emergency medical services.Methods: A quantitative non-experimental research method was used. Data were collected using a standardized Pittsburgh sleep quality index questionnaire and a standardized Maslach burnout inventory questionnaire. The survey was completed by 204 healthcare professionals. Data were analyzed with univariate and bivariate statistics.Results: The average Pittsburgh Sleep Quality Index score was 4.97, s = 3.23. Poorer quality of sleep is exhibited by female respondents (57.4 %), respondents who are employed in more overloaded pre-hospital emergency service units (52.3 %) and those who work 24 hours or more (67.7 %). Overall, 17.6 % respondents exhibited high emotional exhaustion, 32.8 % exhibited high depersonalization and 9.3 % exhibited low personal accomplishment. A weak correlation was present between sleep quality and emotional exhaustion (r = 0.381, p < 0.01), depersonalization (r = 0.293, p < 0.01) and personal accomplishment (r = 0.368, p < 0.01).Discussion and conclusion: Healthcare professionals represent a vulnerable group that is subject to poor sleep quality and burnout syndrome, therefore, the need for empowering them in terms of proper sleep hygiene and burnout prevention is indicated.
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Cavalheiri JC, Pascotto CR, Tonini NS, Vieira AP, Ferreto LED, Follador FAC. Sleep quality and common mental disorder in the hospital Nursing team. Rev Lat Am Enfermagem 2021; 29:e3444. [PMID: 34468620 PMCID: PMC8432590 DOI: 10.1590/1518-8345.4280.3444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
Objective: to determine the prevalence of sleep quality and common mental disorder in
Nursing professionals and factors associated with sleep change. Method: a cross-sectional, analytical and quantitative study developed with 196
Nursing professionals of a public hospital and a mixed one. Data was
collected by means of an instrument of sociodemographic characterization, by
the Self-Report Questionnaire 20 and Pittsburgh Sleep Quality Index and were
analyzed by descriptive and inferential statistics to identify possible
factors associated with sleep changes. Results: sleep changes were identified among the Nursing professionals with a
frequency of 76.5% (70.4-82.1). Sleep quality was classified as poor in
41.8% (41.8-55.6) and sleep disorder in 27.6%. (21.4-34.2). The prevalence
of common mental disorder was identified in 36.7% (30.1-43.9). The main
factor for poor sleep quality was the presence of common mental disorder
(Odds Ratio: 5.15; p<0.001). Conclusion: sleep changes were prevalent and the characteristics of the work environment
and the presence of mental disorder showed relevance in the changes.
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Affiliation(s)
| | | | | | - Ana Paula Vieira
- Universidade Estadual do Oeste do Paraná, Francisco Beltrão, PR, Brazil
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6
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The relationship between sensory stimuli and the physical environment in complex healthcare settings: A systematic literature review. Intensive Crit Care Nurs 2021; 67:103111. [PMID: 34247937 DOI: 10.1016/j.iccn.2021.103111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/28/2021] [Accepted: 05/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This systematic review presented the current status of literature on the outcomes resulted from sensory stimuli in critical care environments as well as the environmental interventions that can improve or impede the impact of such sensory stimuli. METHODS Articles found through a systematic search of PsycINFO, Web of Science, and PubMed databases, in combination with a hand search, were reviewed for eligibility by two independent coders. Reporting and quality appraisals were based on PRISMA and MMAT guidelines. RESULTS Out of 1118 articles found, and only 30 were eligible. Final articles were comprised of issues related to noise, lighting, and temperature. Identified sensory stimuli resulted in psychological and physiological outcomes among both patients and staff. Examples include impacts on stress, delirium, sleep disturbances, poor performance and communication. The environmental factors that influence sensory stimuli included layout, room size, artificial lighting, presence of windows and acoustical interventions. CONCLUSION Literature on the impact of sensory stimuli on staff is scarce compared to patients. Studies on environmental interventions are inadequate and lack structure. The physical environment can impact the patient and staff outcome resulting from noise, lighting, and temperature. When applied strategically, sensory stimuli can result in positive outcomes among patients and staff.
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Stefani O, Cajochen C. Should We Re-think Regulations and Standards for Lighting at Workplaces? A Practice Review on Existing Lighting Recommendations. Front Psychiatry 2021; 12:652161. [PMID: 34054611 PMCID: PMC8155670 DOI: 10.3389/fpsyt.2021.652161] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Nowadays lighting projects often include temporal variations of the light, both spectrally and in terms of intensity to consider non-visual effects of light on people. However, as of today there are no specific regulations. Compliance with common lighting standards that address visual aspects of light, often means that only little non-visually effective light reaches the eye. In this practice review we confront existing regulations and standards on visual lighting aspects with new recommendations on non-visual aspects and highlight conflicts among them. We conclude with lighting recommendations that address both aspects.
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Affiliation(s)
- Oliver Stefani
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Basel, Switzerland
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8
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Alfonsi V, Scarpelli S, Gorgoni M, Pazzaglia M, Giannini AM, De Gennaro L. Sleep-Related Problems in Night Shift Nurses: Towards an Individualized Interventional Practice. Front Hum Neurosci 2021; 15:644570. [PMID: 33796014 PMCID: PMC8007770 DOI: 10.3389/fnhum.2021.644570] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/22/2021] [Indexed: 02/05/2023] Open
Abstract
Rotating shifts (mostly 8- or 12-h) are common among nurses to ensure continuity of care. This scheduling system encompasses several adverse health and performance consequences. One of the most injurious effects of night-time shift work is the deterioration of sleep patterns due to both circadian rhythm disruption and increased sleep homeostatic pressure. Sleep problems lead to secondary effects on other aspects of wellbeing and cognitive functioning, increasing the risk of errors and workplace accidents. A wide range of interventions has been proposed to improve the sleep quality of nurses and promote an increase in attention levels. In recent years, particular attention has been paid to individual and environmental factors mediating the subjective ability to cope with sleep deprivation during the night shift. Given the predictive role of these factors on the negative impact of a night shift, an individualized intervention could represent an effective countermeasure by ensuring suitable management of shift schedules. Therefore, the aims of this mini-review are to: (a) provide an updated overview of the literature on sleep problems in night shift nurses and their adverse consequences; and (b) critically analyze the psychosocial factors that mediate the negative impact of shift work with the ultimate goal of defining an effective countermeasure based on an individualized approach.
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Affiliation(s)
- Valentina Alfonsi
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Mariella Pazzaglia
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Luigi De Gennaro
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
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9
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Crowther ME, Ferguson SA, Vincent GE, Reynolds AC. Non-Pharmacological Interventions to Improve Chronic Disease Risk Factors and Sleep in Shift Workers: A Systematic Review and Meta-Analysis. Clocks Sleep 2021; 3:132-178. [PMID: 33525534 PMCID: PMC7930959 DOI: 10.3390/clockssleep3010009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Shift work is associated with adverse chronic health outcomes. Addressing chronic disease risk factors including biomedical risk factors, behavioural risk factors, as well as sleep and perceived health status, affords an opportunity to improve health outcomes in shift workers. The present study aimed to conduct a systematic review, qualitative synthesis, and meta-analysis of non-pharmacological interventions targeting chronic disease risk factors, including sleep, in shift workers. A total of 8465 records were retrieved; 65 publications were eligible for inclusion in qualitative analysis. Random-effects meta-analysis were conducted for eight eligible health outcomes, including a total of thirty-nine studies. Interventions resulted in increased objective sleep duration (Hedges' g = 0.73; CI: 0.36, 1.10, k = 16), improved objective sleep efficiency (Hedges' g = 0.48; CI: 0.20, 0.76, k = 10) and a small increase in both subjective sleep duration (Hedges' g = 0.11; CI: -0.04, 0.27, k = 19) and sleep quality (Hedges' g = 0.11; CI: -0.11, 0.33, k = 21). Interventions also improved perceived health status (Hedges' g = 0.20; CI: -0.05, 0.46, k = 8), decreased systolic (Hedges' g = 0.26; CI: -0.54, 0.02, k = 7) and diastolic (Hedges' g = 0.06; CI: -0.23, 0.36, k = 7) blood pressure, and reduced body mass index (Hedges' g = -0.04; CI: -0.37, 0.29, k = 9). The current study suggests interventions may improve chronic disease risk factors and sleep in shift workers; however, this could only be objectively assessed for a limited number of risk factor endpoints. Future interventions could explore the impact of non-pharmacological interventions on a broader range of chronic disease risk factors to better characterise targets for improved health outcomes in shift workers.
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Affiliation(s)
- Meagan E Crowther
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Sally A Ferguson
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Grace E Vincent
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health (AISH): A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
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10
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Chang W, Peng Y. Meta-analysis of differences in sleep quality based on actigraphs between day and night shift workers and the moderating effect of age. J Occup Health 2021; 63:e12262. [PMID: 34392580 PMCID: PMC8364763 DOI: 10.1002/1348-9585.12262] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study was to conduct a meta-analysis of studies that used actigraphs to compare the influence of day and night shifts on the sleep quality of workers as well as examine the moderating effect of age. METHODS Databases including PubMed, CINAHL, the Cochrane Library, MEDLINE, and EBSCOhost were searched for relevant studies published in English between January 1st, 2000 and April 30st, 2021. Our main targets were studies that used actigraphs to assess the sleep quality of night shift workers. This meta-analysis included 12 papers and was performed using Comprehensive Meta-Analysis (CMA) Version 3.0. Effect sizes were displayed in a forest plot using standardized mean difference (SMD) and 95% confidence intervals (CI). RESULTS Among the sleep quality indices of the day and night shift workers, no significant difference existed in terms of sleep efficiency (SE) (SMD = 0.27, 95% CI: -0.03-0.57), whereas night shift workers presented longer sleep-onset latency (SOL) (SMD = 0.62, 95% CI: 0.15-1.08), greater wake after sleep onset (WASO) (SMD = 0.41, 95% CI: 0.12-0.70), and longer total sleep time (TST) (SMD = 0.85, 95% CI: 0.32-1.39) than did day shift workers. The differences between the day and night shift workers in SOL, WASO, and TST did not vary with age. CONCLUSIONS Among the sleep quality indices, night shift workers presented longer SOL and greater WASO than did day shift workers. However, night shift workers could regulate their rest time and had adequate TST; thus, their SE was not different from that of day shift workers.
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Affiliation(s)
- Wen‐Pei Chang
- School of Nursing, College of NursingTaipei Medical UniversityTaipeiTaiwan
- Department of NursingTaipei Medical University‐Shuang Ho HospitalMinistry of Health and WelfareNew Taipei CityTaiwan
| | - Yu‐Xuan Peng
- Nurse in the Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
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11
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Harrison EM, Schmied EA, Yablonsky AM, Glickman GL. Implementation of interventions designed to promote healthy sleep and circadian rhythms in shiftworkers. Chronobiol Int 2020; 38:467-479. [PMID: 33327802 DOI: 10.1080/07420528.2020.1845190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Shiftwork is a significant risk factor for a host of negative health and safety outcomes, which have been at least partly attributed to disturbances of the circadian timing system. As a result, an entire sub-field of chronobiology has been devoted to developing and evaluating countermeasures for circadian misalignment, sleep disruption, fatigue, and other issues associated with shiftwork. Much of this research takes place under highly controlled laboratory conditions due to the necessity of accurately characterizing individual rhythms, both for intervention design and assessment of efficacy. Applied studies of interventions for shiftworkers are, by their nature, more complicated, often demonstrating less consistent findings. While this, in part, reflects execution under less rigorously controlled conditions, it may also stem from variability in implementation approaches. A systematic review of published studies (through May 2017) of interventions designed to enhance circadian health in shiftworkers was conducted to determine the frequency and quality of the assessment of implementation as well as barriers and enablers to implementation. A search of PubMed, PsychINFO, Web of Science, and CINAHL databases yielded a total of 5368 unique references. After a title and abstract screen, 323 proceeded to full-text review; 68 of those met final criteria for data extraction. Implementation was assessed to some degree in 60.3% of those 68 articles. Where it was assessed, the mean quality score on a scale from 1 to 5 (1 = very little, 3 = moderate, 5 = very in-depth) was 2.56. One or more enablers were identified in just 17 of the 68 studies (25.0%), and barriers in just 18 (26.5%). Implementation of these interventions is a critical but seldom-acknowledged component of their uptake and effectiveness, and we highly recommend that future shiftworker intervention research make an effort to incorporate formalized assessments of implementation and/or hybrid effectiveness-implementation approaches.
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Affiliation(s)
- Elizabeth M Harrison
- Center for Circadian Biology, University of California San Diego, La Jolla, CA, USA.,Leidos, Inc., San Diego, CA, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, USA
| | - Emily A Schmied
- Leidos, Inc., San Diego, CA, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, USA.,School of Public Health, San Diego State University, San Diego, CA, USA
| | - Abigail M Yablonsky
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, USA.,Directorate for Professional Education, Naval Medical Center San Diego, San Diego, CA, USA
| | - Gena L Glickman
- Center for Circadian Biology, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry and Neuroscience, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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12
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van Woerkom M. A quasi-experimental study into the effects of naps and therapy glasses on fatigue and well-being. J Nurs Manag 2020; 29:562-571. [PMID: 33029828 PMCID: PMC8247279 DOI: 10.1111/jonm.13172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
Aim To investigate the effects of a napping facility and therapy glasses on fatigue and well‐being at the end of the night shift. Background Night shift work has adverse effects on fatigue and well‐being. Methods A quasi‐experimental study was conducted, and data were collected on 243 night shifts of 95 nurses who had either access to a napping facility, therapy glasses, both facilities or no facilities. Multilevel analyses were conducted to predict fatigue and well‐being. Results Night shifts of nurses having access to both facilities were associated with less fatigue and more well‐being. The use of therapy glasses related negatively to fatigue and positively to well‐being. The use of the napping facility was not associated with fatigue and well‐being. However, having slept while napping and sleeping time during napping were negatively associated with fatigue and positively associated with well‐being. Conclusion Therapy glasses and sleeping in a napping facility can be effective interventions in reducing the adverse effects of night shift work. Implications for Nursing Management Therapy glasses seem an effective investment to facilitate the well‐being of nurses. To enhance sleeping during napping, it is worthwhile to let nurses get accustomed to the napping facility and customize settings to personal preferences.
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Affiliation(s)
- Marianne van Woerkom
- Department of Human Resource Studies, Tilburg University, Tilburg, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
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13
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Improving fatigue risk management in healthcare: A scoping review of sleep-related/ fatigue-management interventions for nurses and midwives (reprint). Int J Nurs Stud 2020; 112:103745. [PMID: 32847675 DOI: 10.1016/j.ijnurstu.2020.103745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Nurses and midwives make up almost 50% of the global healthcare shift working workforce. Shift work interferes with sleep and causes fatigue with adverse effects for nurses' and midwives' health, as well as on patient safety and care. Where other safety-critical sectors have developed Fatigue Risk Management Systems, healthcare is behind the curve; with published literature only focussing on the evaluation of discreet sleep-related/fatigue-management interventions. Little is known, however, about which interventions have been evaluated for nurses and midwives. Our review is a critical first step to building the evidence-base for healthcare organisations seeking to address this important operational issue. OBJECTIVES We address two questions: (1) what sleep-related/fatigue-management interventions have been assessed in nurses and midwives and what is their evidence-base? and (2) what measures are used by researchers to assess intervention effectiveness? DESIGN AND DATA SOURCES The following databases were searched in November, 2018 with no limit on publication dates: MEDLINE, PsychINFO and CINAHL. REVIEW METHODS We included: (1) studies conducted in adult samples of nurses and/or midwives that had evaluated a sleep-related/fatigue-management intervention; and (2) studies that reported intervention effects on fatigue, sleep, or performance at work, and on measures of attention or cognitive performance (as they relate to the impact of shift working on patient safety/care). RESULTS The search identified 798 potentially relevant articles, out of which 32 met our inclusion criteria. There were 8619 participants across the included studies and all were nurses (88.6% female). We did not find any studies conducted in midwives nor any studies conducted in the UK, with most studies conducted in the US, Italy and Taiwan. There was heterogeneity both in terms of the interventions evaluated and the measures used to assess effectiveness. Napping could be beneficial but there was wide variation regarding nap duration and timing, and we need to understand more about barriers to implementation. Longer shifts, shift patterns including nights, and inadequate recovery time between shifts (quick returns) were associated with poorer sleep, increased sleepiness and increased levels of fatigue. Light exposure and/or light attenuation interventions showed promise but the literature was dominated by small, potentially unrepresentative samples. CONCLUSIONS The literature related to sleep-related/fatigue-management interventions for nurses and midwives is fragmented and lacks cohesion. Further empirical work is warranted with a view to developing comprehensive Fatigue Risk Management Systems to protect against fatigue in nurses, midwives, and other shift working healthcare staff.
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14
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Querstret D, O'Brien K, Skene DJ, Maben J. Improving fatigue risk management in healthcare: A systematic scoping review of sleep-related/fatigue-management interventions for nurses and midwives. Int J Nurs Stud 2019; 106:103513. [PMID: 32283414 DOI: 10.1016/j.ijnurstu.2019.103513] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 12/04/2019] [Accepted: 12/24/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Nurses and midwives make up almost 50% of the global healthcare shift working workforce. Shift work interferes with sleep and causes fatigue with adverse effects for nurses' and midwives' health, as well as on patient safety and care. Where other safety-critical sectors have developed Fatigue Risk Management Systems, healthcare is behind the curve; with published literature only focussing on the evaluation of discreet sleep-related/fatigue-management interventions. Little is known, however, about which interventions have been evaluated for nurses and midwives. Our review is a critical first step to building the evidence-base for healthcare organisations seeking to address this important operational issue. OBJECTIVES We address two questions: (1) what sleep-related/fatigue-management interventions have been assessed in nurses and midwives and what is their evidence-base? and (2) what measures are used by researchers to assess intervention effectiveness? DESIGN AND DATA SOURCES The following databases were searched in November, 2018 with no limit on publication dates: MEDLINE, PsychINFO and CINAHL. REVIEW METHODS We included: (1) studies conducted in adult samples of nurses and/or midwives that had evaluated a sleep-related/fatigue-management intervention; and (2) studies that reported intervention effects on fatigue, sleep, or performance at work, and on measures of attention or cognitive performance (as they relate to the impact of shift working on patient safety/care). RESULTS The search identified 798 potentially relevant articles, out of which 32 met our inclusion criteria. There were 8619 participants across the included studies and all were nurses (88.6% female). We did not find any studies conducted in midwives nor any studies conducted in the UK, with most studies conducted in the US, Italy and Taiwan. There was heterogeneity both in terms of the interventions evaluated and the measures used to assess effectiveness. Napping could be beneficial but there was wide variation regarding nap duration and timing, and we need to understand more about barriers to implementation. Longer shifts, shift patterns including nights, and inadequate recovery time between shifts (quick returns) were associated with poorer sleep, increased sleepiness and increased levels of fatigue. Light exposure and/or light attenuation interventions showed promise but the literature was dominated by small, potentially unrepresentative samples. CONCLUSIONS The literature related to sleep-related/fatigue-management interventions for nurses and midwives is fragmented and lacks cohesion. Further empirical work is warranted with a view to developing comprehensive Fatigue Risk Management Systems to protect against fatigue in nurses, midwives, and other shift working healthcare staff.
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Affiliation(s)
- Dawn Querstret
- Faculty of Sport, Health and Applied Science, St Mary's University, London TW1 4SX, UK.
| | - Katie O'Brien
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7YH, UK
| | - Debra J Skene
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7YH, UK
| | - Jill Maben
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7YH, UK
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15
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Feldstudie zu verschiedenen Lichtsituationen mit steuerbarem Blauanteil bei industrieller Spätschicht. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-00229-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Golmohammadi R, Darvishi E. The combined effects of occupational exposure to noise and other risk factors - a systematic review. Noise Health 2019; 21:125-141. [PMID: 32719300 PMCID: PMC7650855 DOI: 10.4103/nah.nah_4_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Noise-induced health effects exacerbate by many other risk factors. This systematic review aims at shedding light on the combined effects of co-exposure to occupational noise and other factors. MATERIAL AND METHODS A literature search in Web of Science, Scopus, PubMed, Science Direct, and Google Scholar, with appropriate keywords on combined effects of occupational noise, and co-exposure to noise and other factors, revealed 7928 articles which were screened by two researchers. A total of 775 articles were reviewed in full text. We found 149 articles that were relevant and had sufficient quality for analysis. RESULTS We identified 16 risk factors that exacerbate occupational noise-induced health effects. These factors were classified into four groups: chemical (carbon monoxide (CO), solvents, heavy metals, and other chemicals), physical (lighting, heat, vibration, and cold), personal (age, gender, genetics, smoking, medication, contextual diseases) and occupational (workload and shift work). Hearing loss, hypertension, reduced performance, and cardiovascular strains, are the most important risk factors combined effects due to concurrent exposure to noise and other risk factors. CONCLUSION Evidences of combined effects of solvents, vibration, heavy metals, CO, smoking, chemicals, aging, heat, and shiftwork were respectively stronger than for other factors. Most of the studies have investigated only the combined effects of risk factors on hearing, and the evidence for non-auditory effects is still limited, and more studies are warranted. Therefore, in the Hearing Conservation Programs, besides noise, aggravating factors of noise effects should also be taken into account.
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Affiliation(s)
- Rostam Golmohammadi
- Center of Excellence for Occupational Health, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ebrahim Darvishi
- Department of Occupational Health Engineering, Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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17
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Griepentrog JE, Labiner HE, Gunn SR, Rosengart MR. Bright environmental light improves the sleepiness of nightshift ICU nurses. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:295. [PMID: 30424793 PMCID: PMC6234544 DOI: 10.1186/s13054-018-2233-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/15/2018] [Indexed: 12/21/2022]
Abstract
Background Shift work can disturb circadian homeostasis and result in fatigue, excessive sleepiness, and reduced quality of life. Light therapy has been shown to impart positive effects in night shift workers. We sought to determine whether or not prolonged exposure to bright light during a night shift reduces sleepiness and enhances psychomotor performance among ICU nurses. Methods This is a single-center randomized, crossover clinical trial at a surgical trauma ICU. ICU nurses working a night shift were exposed to a 10-h period of high illuminance (1500–2000 lx) white light compared to standard ambient fluorescent lighting of the hospital. They then completed the Stanford Sleepiness Scale and the Psychomotor Vigilance Test. The primary and secondary endpoints were analyzed using the paired t test. A p value <0.05 was considered significant. Results A total of 43 matched pairs completed both lighting exposures and were analyzed. When exposed to high illuminance lighting subjects experienced reduced sleepiness scores on the Stanford Sleepiness Scale than when exposed to standard hospital lighting: mean (sem) 2.6 (0.2) vs. 3.0 (0.2), p = 0.03. However, they committed more psychomotor errors: 2.3 (0.2) vs. 1.7 (0.2), p = 0.03. Conclusions A bright lighting environment for ICU nurses working the night shift reduces sleepiness but increases the number of psychomotor errors. Trial registration ClinicalTrials.gov, NCT03331822. Retrospectively registered on 6 November 2017.
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Affiliation(s)
- John E Griepentrog
- Department of Surgery, University of Pittsburgh, 200 Lothrop Street - Suite F1266.1, Pittsburgh, PA, 15213, USA
| | - Hanna E Labiner
- Department of Surgery, University of Pittsburgh, 200 Lothrop Street - Suite F1266.1, Pittsburgh, PA, 15213, USA
| | - Scott R Gunn
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh, 200 Lothrop Street - Suite F1266.1, Pittsburgh, PA, 15213, USA. .,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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18
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Sun Q, Ji X, Zhou W, Liu J. Sleep problems in shift nurses: A brief review and recommendations at both individual and institutional levels. J Nurs Manag 2018; 27:10-18. [PMID: 30171641 DOI: 10.1111/jonm.12656] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022]
Abstract
AIMS The purposes of this article are (a) to review briefly the current literature on shift nurses' sleep patterns, sleep quality, and the existing interventions implemented in nursing settings; and (b) to propose solutions that target individual nurses, nurse managers, and health care organisations to improve sleep health in shift nurses. BACKGROUND Sleep problems among shift nurses have been recognized increasingly as a significant issue at both the individual and organisational levels. However, the solutions are not well known. DESIGN Narrative review. METHODS A literature search was conducted using the following databases: CINAHL, PubMed, Embase, and Google Scholar from 1986 to 2016, to include original papers that reported studies on shift nurses' sleep problems and interventions. RESULTS Thirteen papers were included in this review, which all indicated associations between shift nurses' sleep problems and current intervention practices. Despite the higher prevalence of sleep problems in shift nurses compared to the general population, current interventional practices only focus on bright-light exposure, nap breaks, shift schedule rearrangement, and behavioural interventions. CONCLUSIONS To address shift nurses' poor sleep quality, we proposed two levels of approach for consideration-the individual level and the management/institutional level. The recommendations include: improving sleep hygiene; providing a low-stimulation sleep environment; conducting rigorous intervention studies to evaluate the effectiveness of a variety of therapies to deal with shift nurses' sleep disturbances; increasing awareness of sleep health of shift nurses; establishing a flexible rotating work schedule; and putting in place policies such as a 15-30 min nap break, social support, and a suitable working environment. IMPLICATIONS FOR NURSING MANAGEMENT With better awareness and understanding of shift nurses' sleep behaviours, effective interventions can be employed to improve shift nurses' sleep patterns and sleep quality to promote better emotional and health outcomes.
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Affiliation(s)
- Qiuzi Sun
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Nursing Administration, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaopeng Ji
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,School of Nursing, University of Delaware, Newark, Delaware
| | - Wenqin Zhou
- Department of Nursing Administration, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianghong Liu
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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19
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20
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Jensen HI, Larsen JW, Thomsen TD. The impact of shift work on intensive care nurses' lives outside work: A cross-sectional study. J Clin Nurs 2017; 27:e703-e709. [PMID: 29193498 DOI: 10.1111/jocn.14197] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine how shift work affects intensive care nurses' lives outside work. BACKGROUND Shift work is unavoidable for many nurses. When attempting to minimise negative effects of shift work, it is important to identify areas which affect nurses working shifts. DESIGN A cross-sectional study. METHODS A questionnaire survey among Danish intensive care nurses concerning experiences with shift work and family life, spare time activities, sleep and health. RESULTS A total of 114 nurses (88%) participated. Shift work was found to influence the opportunities for spare time activities, and about 25% of both evening- and night-shift groups found that working shifts sometimes led to social isolation. A total of 58% of nurses working evening shifts sometimes to very often experienced having trouble falling asleep when working shifts. Night-shift workers had a higher percentage of physical and mental symptoms when working shifts compared with evening-shift workers, with mood swings and headaches being the most common. The median score for thriving on working shifts was 8 (IQR 5-9) for evening-shift workers and 8 (IQR 7-9) for night-shift workers (scale 0-10 with 10 being the highest level of thriving). CONCLUSION Shift workers reported that working shifts had a negative impact on life outside work. Opportunities for participating in spare time activities and difficulties falling asleep after shifts were the main issues for evening-shift workers, whereas physical symptoms such as headaches and mood swings were more dominant among night-shift workers. Despite the negative effects, the participants generally thrived on working shifts. RELEVANCE TO CLINICAL PRACTICE By identifying modifiable areas which negatively influence life outside work when working shifts, it will be possible subsequently to plan interventions aimed at decreasing the negative effects. Interventions may include nurses having increased influence on their work schedules and education in sleep hygiene and dietary habits.
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Affiliation(s)
- Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, Kolding, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Jette West Larsen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, Kolding, Denmark
| | - Tina Damgaard Thomsen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, Kolding, Denmark
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21
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Affiliation(s)
- Skip G Morelock
- Skip G. Morelock is the manager of compliance and quality at the University of Texas Southwestern Medical Center in Dallas, Tex
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