Systematic review of shift work and nurses' health

Job satisfaction in midwives working in labour ward: A systematic review with meta-analysis

PROBLEM

There is little documented evidence of job satisfaction in midwives who work in birthing rooms.

BACKGROUND

Job satisfaction in midwives who work in birthing rooms may have changed in recent decades due to the medicalization of maternal health.

AIM

To analyse job satisfaction levels among midwives working in birthing rooms.

METHODS

We searched Web of Science, SCOPUS, MEDLINE, CUIDEN and CINAHL for observational and mixed method studies. The literature search was carried out from September to October 2022.

FINDINGS

A total of 13 studies were included in the systematic review. A meta-analysis of the variable "midwives' job satisfaction" was performed on 12 of the studies. Midwives rated their job satisfaction positively: DME, CI (95%) = 1.24 [0.78, 1.69]. Subgroup 1: DME, CI (95%) = 2.41 [2.05, 2.76]); Subgroup 2: DME, CI (95%) = 0.76 [0.65, 0.86]; subgroup 3: DME, CI (95%) = 1.11 [0.95, 1.27]; subgroup 4: DME, CI (95%) = 0.10 [-0.11, 0.31].

DISCUSSION

Although midwives show high levels of satisfaction, the heterogeneity of instruments, lack of specificity and limited number of studies found restrict the outcomes.

CONCLUSION

There are no specific measurement instruments for assessing job satisfaction among midwives working in labour wards, so it is possible that these data do not correspond to reality as they do not take into account specific professional aspects within this field of practice.

More Than Just a Pain in the Back: Pain Among American Nurses and Its Relationship to Modifiable Work Factors and Work Performance

Nursing is a profession with high rates of workplace injuries, hazards, and turnover. Improving the health and safety of nurses at work is vital to retain and grow the workforce to meet future demands. The purpose of this study was to describe the breadth of pain among American nurses and explore the relationships between this pain and modifiable work factors and perceived work performance. We used a cross-sectional descriptive design of 2312 nurses from across the United States. Nurses completed a survey containing questions about demographics, the presence of pain in the past week, the number of pain sites, pain locations, severity, and the impact on work performance. The median number of pain locations reported was 2, back pain was the most reported pain site, and average pain severity ranged from 4 to 5. Significant modifiable work factors associated with pain were average patient load and shift length. Many participants indicated that their pain impacted work performance, while a smaller proportion acknowledged that their pain impacted patient care. Pain among nurses spans multiple locations, is moderately severe, and impacts work performance. Addressing related modifiable work factors may decrease pain and the impact on the health, safety, and work performance of the nursing workforce.

Awareness, support, and opinions of healthy food and drink policies: a survey of staff and visitors in New Zealand healthcare organisations

BACKGROUND

In 2016, a voluntary National Healthy Food and Drink Policy (hereafter, "the Policy") was released to encourage public hospitals in New Zealand to provide food and drink options in line with national dietary guidelines. Five years later, eight (of 20) organisations had adopted it, with several preferring to retain or update their own institutional-level version. This study assessed staff and visitors' awareness and support for and against the Policy, and collected feedback on perceived food environment changes since implementation of the Policy.

METHODS

Cross-sectional electronic and paper-based survey conducted from June 2021 to August 2022. Descriptive statistics were used to present quantitative findings. Free-text responses were analysed following a general inductive approach. Qualitative and quantitative findings were compared by level of implementation of the Policy, and by ethnicity and financial security of participants.

RESULTS

Data were collected from 2,526 staff and 261 visitors in 19 healthcare organisations. 80% of staff and 56% of visitors were aware of the Policy. Both staff and visitors generally supported the Policy, irrespective of whether they were aware of it or not, with most agreeing that "Hospitals should be good role models." Among staff who opposed the Policy, the most common reason for doing so was freedom of choice. The Policy had a greater impact, positive and negative, on Māori and Pacific staff, due to more frequent purchasing onsite. Most staff noticed differences in the food and drinks available since Policy implementation. There was positive feedback about the variety of options available in some hospitals, but overall 40% of free text comments mentioned limited choice. 74% of staff reported that food and drinks were more expensive. Low-income staff/visitors and shift workers were particularly impacted by reduced choice and higher prices for healthy options.

CONCLUSIONS

The Policy led to notable changes in the healthiness of foods and drinks available in NZ hospitals but this was accompanied by a perception of reduced value and choice. While generally well supported, the findings indicate opportunities to improve implementation of food and drink policies (e.g. providing more healthy food choices, better engagement with staff, and keeping prices of healthy options low) and confirm that the Policy could be expanded to other public workplaces.

Relationship between social jetlag and body mass index in nurses working shift schedules: a cross-sectional study

This study aimed to explore the relationship between shift-working nurses' social jetlag and body mass index (BMI) and provide a theoretical basis for nursing managers to develop appropriate health interventions. Shift work is unavoidable in nursing and is associated with circadian rhythm disorders. Social jetlag is prevalent in shift-working nurses and is associated with adverse health outcomes (particularly metabolism-related indicators). BMI is a significant metabolic indicator, and research has demonstrated its effectiveness in predicting the formation of metabolic syndrome. The relationship between social jetlag and BMI can be explained by considering physiological, psychological, and behavioral factors. However, most studies on social jetlag and health status are focused on non-shift nurse populations, with fewer studies on shift workers. Five tertiary hospitals located at similar latitudes in Southwest China were selected for the study. We surveyed 429 shift-working nurses using sociodemographic data, the Munich Chronotype Questionnaire for Shift Workers, and BMI. The restricted cubic spline model was used to analyze the relationship between social jetlag and BMI among shift-working nurses, and segmented linear regression was performed around the inflection point using multiple linear regression analysis. The results revealed that social jetlag (82.0 [85.0] min) was experienced by 64.6% of the shift-working nurses. After controlling for confounding variables, the model with seven knots had the lowest accepted Akaike information criterion value, and there was a U-shaped relationship between shift-working nurses' BMI and social jetlag in this model; its inflection (lowest) point of 20.7 was considered the cut-off point. Segmented regression showed that for BMI < 20.7, BMI was significantly negative with standardized social jetlag; whereas with BMI > 20.7, BMI was significantly positive with standardized social jetlag. BMI has a U-shaped relationship with social jetlag, and attention should be paid to overweight or underweight shift-working nurses to detect early circadian rhythm disorder. Shift-working nurses with high social jetlag tended to have higher/lower BMI, which should be further investigated in the future, to minimize metabolic diseases among them.

Adverse Associations of Long-Term Exposure to PM2.5 and Its Components with Platelet Traits among Subway Shift-Workers without Air Purifier Use

Air purifier use, shift work, and long-term exposure to fine particulate matter (PM2.5) are linked to platelet abnormality. However, the role of air purifier use and shift work in the individual or joint associations of PM2.5 and its components with platelet indices are largely unknown. A total of 8772 participants were recruited from a population of subway workers in China. PM2.5 and its component data were obtained from the Tracking Air Pollution in China dataset. The role of air purifier use and shift work in the association between PM2.5 and its components and platelet indices were analyzed. Among shift workers without air purifier use, positive associations of PM2.5 and each component in PM2.5 with the mean platelet volume (MPV) or platelet counts (PLT) were observed, whereas negative associations of PM2.5 and each component in PM2.5 with the platelet distribution width (PDW) were observed. Furthermore, estimated changes (95%CIs) in PLT, MPV, and PDW in response to each 10th percentile increment in the mixture of PM2.5 and its components were 0.8657 (0.2496, 1.4819), 0.0192 (0.0054, 0.0329), and -0.0648 (-0.0945, -0.0351), respectively, and sulfate in PM2.5 was the major contributor to those associations. Long-term exposure to PM2.5 and its components was related to increased platelet disorders among shift workers without air purifier use, and those associations were mainly attributed to sulfate in PM2.5.

The Effect of Self-Acupressure on Sleep Quality and Fatigue in Nurses: A Sham-Controlled Study

This study was conducted to determine the effects of self-acupressure on sleep quality and fatigue in nurses working in medical clinics. A total of 64 nurses (n = 32 acupressure, n = 32 sham acupressure) participated in this prospective, 2-arm (1:1) study with an experimental design. In the study, both groups used the pressure points they were taught while performing self-acupressure 3 times per week for 4 weeks. After the intervention, the total mean score average of the acupressure group on the Pittsburg Sleep Quality Index and Fatigue Severity Scale was significantly lower than that of the sham acupressure group (P < .05). Self-acupressure is a noninvasive, easy-to-use, safe, and efficient complementary and integrated technique that nurses can use to improve their sleep quality and manage fatigue.

Mixed shift rotations, sleep, burnout and well-being in professions similar to radiographers: A systematic review

INTRODUCTION

Delivering 24 h healthcare requires rotational shift work from doctors and the medical imaging team, while contributing to safe and timely care of patients. Additional service pressure and staff shortfall leads to workload pressures, adjusted shift patterns and risk of burnout. Evidence should be sought to the effects of this work on staff.

METHODS

This systematic review followed PRISMA reporting guidelines, using a convergent mixed methods approach according to Guidance from Joanna Briggs International. Quantitative trends and results were qualified in order to thematically analyse in conjunction with qualitative data and discussed together in context. Following initial searching, returned articles were screened by title and abstract. A team of 3 reviewers undertook blinded critical appraisal of those suitable, with quality assurance from a 4th team member. Papers passing a threshold of 75% on JBI appraisal tools were accepted for synthesis. Data extraction of appropriate articles retrieved was undertaken in parallel.

RESULTS

Following screening and critical appraisal, 13 studies were returned focusing exclusively on Non Consultant Doctors. No studies investigated diagnostic radiographers. 85% (n = 11) reported negative association between shift work and the three themes of sleep/fatigue, burnout and wellbeing: including after the introduction of shift pattern control or adjusted shift patterns. The remainder showed no change, or any improvement nullified by countermeasures to maintain service delivery.

CONCLUSION

Current working practices and shift plans in the target population showed detrimental effects on the participants - this can be suggested that Diagnostic Radiographers may suffer fatigue, burnout and poor mental health from stretched shift working patterns.

IMPLICATIONS FOR PRACTICE

Further study into the effects of shift work on Diagnostic Radiographers and other allied health professionals is indicated - relating to the above themes in the context of errors and patient safety. Additional research into Non Consultant Doctors, shift work effects and the context of wider service delivery required; with suitable interventions and education to maximise understanding of legal working practices, monitoring and self-management of symptoms.

Sleep quality according to chronotype in nurses working 8-hour shifts

BACKGROUND

To date, studies have been focused on sleep disturbances of nurses working during night shifts. There is a lack of understanding regarding the sleep quality of nurses working in the rapid rotation system for each type of shift work.

AIMS

To determine the relationship between chronotype and sleep quality according to shift type (i.e. day, evening and night shifts) in nurses working 8-hour rotating shifts.

METHODS

A cross-sectional, descriptive study was conducted from two tertiary hospitals in South Korea from December 2021 to September 2022, including nurses working 8-hour rotating shifts (N = 74). They completed questionnaires to measure general, occupational and sleep-related characteristics, chronotype, insomnia severity and daytime sleepiness. Additionally, sleep parameters were collected from actigraphy and sleep diaries for 7 days.

RESULTS

A total of 64% of nurses had an evening chronotype and 37% of nurses had an intermediate chronotype. Nurses had significantly less total sleep time and worsened sleep latency and efficiency during the day shift compared to other shift types. Compared to nurses with an intermediate chronotype, those with an evening chronotype had poorer sleep quality during day shift work.

CONCLUSIONS

Strategies to enhance nurses' sleep quality during day shifts should consider a two-level approach: individual approaches, such as improving sleep hygiene, and administrative approaches, such as establishing a chronotype-based shift system for scheduling.

Sleep quality and the need for recovery among nurses working irregular shifts: A cross-sectional study

BACKGROUND

Shift work affects the mental and physical health of nurses, yet the effect of working irregular shifts on sleep and its association with the need for recovery is under-explored.

OBJECTIVE

The purpose of this study was to investigate the sleep quality of nurses working irregular shifts, including night shifts, and to determine whether sleep quality is associated with the need for recovery.

METHODS

This cross-sectional study included 405 nurses working irregular shifts. Data were collected using an online questionnaire that included sociodemographic characteristics, the Sleep-Wake Experience List, sleep problems, sleep duration, and the Need for Recovery scale. Data analyses included descriptive statistics, chi-square tests, t-tests, logistic and multiple linear regressions.

RESULTS

Nurses who worked irregular shifts had poor sleep quality. Those who also worked night shifts, had significantly poorer sleep quality and experienced more difficulties in daily functioning than those who did not work night shifts. Sleep quality was significantly associated with the need for recovery and this remained so after controlling for confounding variables (β= .554, p = .001).

CONCLUSION

The findings indicate that in nurses who work irregular shifts, the sleep quality is low. In this group, the sleep quality in nurses who work night shifts is lower than in nurses who do not work night shifts. Furthermore, better sleep quality was associated with lower need for recovery. These findings suggest that improving sleep quality in nurses working irregular shifts may lower their need for recovery, which may improve health, and reduce burnout and sickness absence.

A Wake-Up Call to Address Nurse Fatigue

Research exploring differences in fatigue and sleep quality between day- and night-shift nurses highlights the urgent need for action to mitigate nurse fatigue. Nurses need to prioritize their sleep, and nurse leaders must take proactive measures such as providing education for all doing shiftwork, ensuring completion of job requirements during the shift, and creating a culture where nurses take their scheduled breaks.

Strategies that nurses working irregular night shifts use to improve sleep quality: A qualitative study among good and poor sleepers

AIMS

To assess the sleep strategies that nurses working irregular night shifts use to improve their sleep quality, and to compare the strategies of good and poor sleepers to determine whether the differences between the two groups could provide insights into possible effective strategies.

DESIGN

A qualitative descriptive study.

METHODS

The study was conducted from September 2019 to January 2020. Thirty-four nurses working irregular night shifts participated; 17 were classified as good sleepers and 17 as poor sleepers based on the Sleep-Wake Experience List, a validated self-report instrument that measures one's sleep quality. Interviews were conducted using open questions to explore strategies around the night-shift set. The interviews were analysed using thematic analysis.

FINDINGS

Both groups described similar and different strategies that help them work and sleep well during and after night shifts. However, good sleepers mentioned a greater number of strategies and seemed to have thought about them more than poor sleepers. The most common strategies were having a clear structure, being organized-especially regarding sleeping time-maintaining a daily routine and adjusting their sleep environment.

CONCLUSION

Healthcare institutions should consider offering education and training programs aimed at empowering nurses who work irregular night shifts. These programs should provide nurses with various sleep strategies to enhance their sleep quality and overall well-being.

IMPLICATIONS FOR THE PROFESSION

Nurses working irregular night shifts can possibly enhance their sleep quality by making personalized plans, for example, including a clear day structure, or an optimized sleep environment.

IMPACT

The study focused on how nurses working night shifts could possibly enhance their sleep quality. The findings highlight the importance of providing nurses with diverse sleep strategies to improve sleep quality, helping them to identify what works best for them and consistently apply these strategies.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research guidelines were followed.

PATIENT OR PUBLIC CONTRIBUTION

Nurses working irregular night shifts at Maastricht University Medical Center in Maastricht, the Netherlands, who agreed to participate in the study, engaged in a discussion to assess the relevance of sleep quality to their work. They were also encouraged to share their perspectives during the interviews.

Relationship Between Sleep Problems and Memory Impairment Among Nurses

BACKGROUND

Sleep problems are common among nurses and can lead to various health problems. Further, the relationship between multiple sleep problems and memory impairment in clinical nurses remains unknown. Therefore, in this study, we aimed to explore the relationship between sleep problems and memory impairment among nurses.

METHODS

Multistage cluster-stratified random sampling was performed from tertiary hospitals in Shandong, China. Overall, a total of 1833 nurses were included in the final analysis. The Chinese version of the Pittsburgh Sleep Quality Index and prospective and retrospective memory questionnaire were administered to the participants.

RESULTS

The sleep quality of the nurses decreased during the normal epidemic prevention and control period compared with that before the epidemic in terms of sleep duration, sleep efficiency, and sleep disturbances. Nurses who reported cumulative or specific sleep problems (e.g., high sleep latency, sleep disturbances, and daytime dysfunction) and those in the "daily disturbances" and "poor sleep quality" groups had a higher risk of memory impairment than the others.

CONCLUSION

Sleep problems might be important for memory impairment among nurses. These findings may help identify nurses at considerable risk of memory impairment in clinical practice.

Prevalence and bidirectional association of sleep quality and gut health among Chinese midwives: a large population, multi-center cross-sectional study

Background

Shift work can disrupt sleep quality and gut health. Nurses and midwives constitute approximately half of the global healthcare shift-working workforce. Our previous study revealed that most midwives were experiencing suboptimal health conditions, characterized by poor sleep quality and a high prevalence of gastrointestinal diseases. The gut-brain axis theory highlights the potential interplay between sleep quality and gut health. However, limited research focuses on this relationship among midwives.

Methods

A cross-sectional survey included 2041 midwives from 87 Chinese hospitals between March and October 2023. Participants completed standardized questionnaires assessing sleep quality, gut health, depression, anxiety, and work stress. Binary logistic regression analyzed factors associated with poor sleep, and multiple linear regression examined the influence of sleep quality on gut health.

Results

Over 60% of midwives reported poor sleep, with many experiencing gastrointestinal disorders. We observed a bidirectional relationship between sleep quality and gut health among midwives. After multivariable adjustments, midwives with higher gut health scores were more likely to experience poor sleep quality (odds ratio = 1.042, 95% confidence interval = 1.03-1.054). Conversely, midwives with higher sleep quality scores were also more likely to have poor gut health (β = 0.222, 95% confidence interval = 0.529-0.797). These associations remained robust across sensitivity analyses. Furthermore, depression, anxiety, and work stress significantly affected both sleep quality and gut health among midwives.

Conclusion

This study enhances our understanding of the intricate relationship between sleep quality and gut health among midwives. Poor gut health was associated with a higher risk of poor sleep, and vice versa. To improve the overall wellbeing of midwives, the findings emphasize the importance of addressing poor sleep quality and promoting gut health through maintaining a healthy diet, lifestyle, and good mental health. Further studies are needed to confirm our findings and clarify the underlying mechanisms.

Prevalence of dyslipidaemia within Polish nurses. Cross-sectional study - single and multiple linear regression models and ROC analysis

BACKGROUND

Maintaining good health is vital not only for own well-being, but also to ensure high-quality patient care. The aim of this study was to evaluate the prevalence of dyslipidaemia and to determine the factors responsible for the development of this disorder among Polish nurses. Lipid profile disorders are the most prevalent and challenging risk factors for the development of cardiovascular disease. Nurses have significant potential and play a crucial role in providing care and treatment services.

METHODS

This cross-sectional study involved nurses and included measurements of body weight composition (Tanita MC-980), body mass index, waist circumference, blood pressure (Welch Allyn 4200B), lipid profile, and fasting blood glucose (CardioChek PA).

RESULTS

The results revealed that more than half of the nurses (60.09%) were overweight or obese, with 57.28% exhibiting elevated blood pressure, 32.25% having fasting glucose levels, and 69.14% experiencing dyslipidaemia. Multiple model evaluation using ROC curves demonstrated that multiple models accurately predicted hypercholesterolemia (AUC = 0.715), elevated LDL (AUC = 0.727), and elevated TC (AUC = 0.723) among Polish nurses.

CONCLUSION

Comprehensive education programmes should be implemented that include the latest advances in cardiovascular disease prevention. Regular check-ups, as well as the promotion and availability of healthy food in hospital canteens, are essential.

The relationship between quick return shift schedules and burnout among nurses: A prospective repeated measures multi-source study

BACKGROUND

In today's world, essential health care services are expected round the clock, leading to distinct shift work requirements. A notable aspect is the "quick return," where the rest interval between nursing shifts is <11 h. Preliminary research suggests a potential association between quick return schedules, diminished sleep quality, and possible nurse burnout. Yet, the motivation of nurses could potentially moderate this relationship.

OBJECTIVE

To examine a moderated-mediation model, whereby sleep duration and nurse's motivation act together to mediate the link between quick return schedules and nurse's burnout.

DESIGN

A prospective repeated measures (4-5 nursing shifts per nurse) multi-source (self-report and objective measures) study.

SETTING

Internal and surgical departments across one large and one medium scale teaching hospitals in Israel.

PARTICIPANTS

Registered nurses who provide direct patient care (n = 79) across 369 shifts.

METHODS

Nurses completed a questionnaire containing personal information and information regarding their shifts during the study week. They wore an accelerometer (a wrist worn device that monitors and records an individual's activity level) during a work-week to objectively determine their sleep duration, completed a motivation questionnaire at the beginning of each shift, and completed a burnout questionnaire at the end of the week. Mixed-model regression analysis was used to test a moderated-mediation model following Hayes' recommendations, whereby the joint effect of sleep duration and motivation mediates the link between quick return schedules and burnout.

RESULTS

The moderated-mediation model was supported. Quick return schedules were negatively statistically significantly associated with sleep duration (b = -126.54, SE = 20.85, p < 0.001); so that more frequent quick return schedules were related to shorter sleep duration. However, no direct correlation was observed between sleep duration and burnout (p = 0.171). A statistically significant interaction was observed between sleep duration and motivation (b = 0.00, SE = 0.00, p < 0.001) concerning burnout. Thus, nurses with lower motivation were prone to experiencing higher levels of burnout with shorter sleep duration compared to nurses with higher motivation.

CONCLUSIONS

The mediating role of sleep duration, moderated by motivation, plays a role in the connection between quick return schedules and burnout. This indicates that nurses can sustain their work motivation even within the demands of quick return schedules, consequently mitigating burnout levels. To prioritize employees' well-being, organizations should adopt shift work structures that minimize quick return schedules and extend nurses' sleep duration. Consequently, managers must employ strategies to enhance nurses' motivation when addressing scenarios that necessitate quick return schedules.

Stress begets stress: The moderating role of childhood adversity in the relationship between job stress and sleep quality among nurses

BACKGROUND

Nurses exhibit considerable variations in sleep quality and experience high job stress levels. Distal factors, such as childhood adversity, and proximal factors, both influence sleep quality. We investigated the moderating role of childhood adversity with job stress and sleep quality, and whether this aligns with the stress-sensitization or stress-amplification models.

METHODS

The impact of job stressors' total score and its dimensions on sleep quality was analyzed using traditional linear regression models and the extreme gradient boosting machine learning algorithm. The hierarchical regression examined the moderating role of childhood adversity in the relationship between job stress and sleep quality. An interactive tool was used to visualize the results.

RESULTS

Among the dimensions of job stress, "time allocation and workload" strongly correlated with sleep quality, followed by "nursing profession and work problems," "patient care issues," "management and interpersonal problems," and "working environment and equipment problems." The moderating role of childhood adversity in the relationship between different dimensions of job stressors (except working environment and equipment problems) and sleep quality aligns with the stress-sensitization model.

LIMITATIONS

This study was susceptible to recall bias and objective sleep data were unavailable. Cross-sectional study design was used, thus limiting causal inferences. Finally, the moderating effect of childhood adversity on subsequent stress among nurses remains unclear.

CONCLUSION

Childhood adversity and job stress were integrated into a stress-sensitization model, providing a nuanced and specific examination of sleep quality. Healthcare policymakers should focus on job stress and childhood adversity, improve nurses' sleep quality, and ultimately benefit patient care and outcomes.

Circadian Rhythms Characteristics of Nurses Providing Direct Patient Care: An Observational Study

Background

In today's modern world, longer working hours, shift work, and working at night have become major causes of the disruption of our natural circadian rhythms. This study aimed to investigate the effects of the type of shift work (rotating vs. fixed day), duty period (on-duty vs. off-duty), and working period within each shift (nighttime vs. daytime) on the circadian rhythm characteristics of nurses who provide direct patient care.

Methods

This cross-sectional study used a purposive sampling method. Cosinor analysis was applied to analyze the actigraphy data of nurses providing direct patient care for seven consecutive days. The linear mixed effects model was then used to determine any variances between shift type, duty period, and working period within each shift for the nurses.

Results

The mesor value did not differ according to nurses' shift type, duty period, and working period within each shift. The amplitude was statistically higher in on-duty nurses and in daytime working hours. The acrophase was significantly delayed in nighttime working hours. As well as nurses in rotating shift had experience.

Conclusion

Our findings revealed that the peak activity of nurses occurs significantly later at night while working and nurses working during nighttime hours may have a weaker or less distinct circadian rhythm. Thus, this study suggests that limits be placed on the number of rotating nighttime shifts for nurses.

Sleep quality, sleep duration, and sleep disturbances among hospital night workers: a prospective cohort study

PURPOSE

This study aimed to assess among hospital night workers (i) to what extent sleep quality, sleep duration and sleep disturbances overlap, and (ii) associations between sociodemographic factors, lifestyle factors and work characteristics and sleep components.

METHODS

Data were used from 467 hospital night workers participating in the Klokwerk + study, a prospective cohort study with two measurements. Sleep quality was measured by the Pittsburgh Sleep Quality Index, sleep duration and sleep disturbances were measured by the Medical Outcomes Study Sleep Scale. The overlap between the three sleep measures was visualized with a Venn diagram and the proportions of overlap was calculated. Associations between independent variables (sociodemographic factors, lifestyle factors and work characteristics) and the three sleep outcomes were estimated using between-within Poisson regression models.

RESULTS

About 50% of the hospital night workers had at least one poor sleep outcome. Overlap in poor sleep outcomes was apparent for 36.8% of these workers, while the majority had a poor outcome in one of the sleep components only (63.1%). Former smoking had a significant association with poor sleep quality. For most independent variables no associations with poor sleep outcomes were observed.

CONCLUSION

Our findings suggest that sleep quality, sleep duration and sleep disturbances are separate entities and should be studied separately. Lifestyle factors and work characteristics were generally not associated with poor sleep. Since these factors can have an acute effect on sleep, future research should consider ecological momentary assessment to examine how exposure and outcomes (co)vary within-persons, over time, and across contexts. Trial registration Netherlands Trial Register trial number NL56022.041.16.

Prevalence and associated factors of secondary traumatic stress in emergency nurses: a systematic review and meta-analysis

Background: Nurses in emergency departments are at a high risk of experiencing secondary traumatic stress because of their frequent exposure to trauma patients and high-stress environments.Objective: This systematic review and meta-analysis aimed to determine the overall prevalence of secondary traumatic stress among emergency nurses and to identify the contributing factors.Method: We conducted a systematic search for cross-sectional studies in databases such as PubMed, Web of Science, Embase, CINAHL, Wanfang Database, and China National Knowledge Internet up to October 21, 2023. The Joanna Briggs Institute's appraisal checklists for prevalence and analytical cross-sectional studies were used for quality assessment. Heterogeneity among studies was assessed using Cochrane's Q test and the I2 statistic. A random effects model was applied to estimate the pooled prevalence of secondary traumatic stress, and subgroup analyses were performed to explore sources of heterogeneity. Descriptive analysis summarized the associated factors.Results: Out of 345 articles retrieved, 14 met the inclusion criteria, with 11 reporting secondary traumatic stress prevalence. The pooled prevalence of secondary traumatic stress among emergency nurses was 65% (95% CI: 58%-73%). Subgroup analyses indicated the highest prevalence in Asia (74%, 95% CI: 72%-77%), followed by North America (59%, 95% CI: 49%-72%) and Europe (53%, 95% CI: 29%-95%). Nine studies identified associated factors, including personal, work-related, and social factors. In the subgroup of divided by recruitment period, emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%-78%).Conclusions: Secondary traumatic stress prevalence is notably high among emergency department nurses, with significant regional variations and period differences. The factors affecting secondary traumatic stress also varied across studies. Future research should focus on improving research designs and sample sizes to pinpoint risk factors and develop prevention strategies.Registration: PROSPERO CRD42022301167.

Night shift work was associated with functional outcomes in acute ischemic stroke patients treated with endovascular thrombectomy

Objective

This study aimed to explore the impact of late night shift work on the functional outcomes of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT).

Methods

Consecutive AIS patients who underwent EVT between June 2019 and June 2021 were enrolled and divided into non-night shift work and night shift work groups based on their occupational histories. The primary outcome was the modified Rankin Scale score defined 3-month functional outcome. The secondary outcomes were 3-month mortality, symptomatic intracerebral hemorrhage (sICH), ICH and early recanalization.

Results

A total of 285 patients were enrolled, 35 patients (12.3%) were night shift workers, who were younger (P < 0.001) and had a significantly higher prevalence of smoking (P < 0.001), hyperlipidemia (P = 0.002), coronary heart disease (P = 0.031), and atrial fibrillation (P < 0.001). The 3-month favorable outcomes were achieved in 44.8% and 25.7% of patients in the non-night shift work and night shift work groups, respectively (adjusted odds ratio [OR]: 0.24, 95% CI: 0.10-0.57; adjusted P = 0.001). No difference was found in 3-month mortality (adjusted OR: 0.43; 95% CI: 0.14-1.25, adjusted P = 0.121), rates of ICH (adjusted OR: 0.73; 95% CI: 0.33-1.60; adjusted P = 0.430), sICH (adjusted OR: 0.75; 95% CI: 0.34-1.67; adjusted P = 0.487), or early successful recanalization (adjusted OR: 0.42; 95% CI: 0.12-1.56; adjusted P = 0.197). These results were consistent after PSM analysis.

Conclusion

Our findings suggest that late night shift work is significantly associated with unfavorable outcomes in patients with AIS after EVT.

The effect of circadian on the productivity of nurses with the mediating role of quality of work life

BACKGROUND

Circadian rhythms, as an integral part of daily life, govern the scheduling, management, and coordination of living organisms. Given the irregular nature of shift patterns in nurses' work schedules, investigating their implications is paramount to increasing Quality of Work Life (QWL) and productivity. The study aimed to investigate the impact of circadian rhythm on the efficiency of nurses working in hospitals in Qazvin, Iran, with QWL serving as a mediating variable.

METHODS

This study employed a descriptive-analytical research design, utilizing cross-sectional data collected in 2022-2023 based on the implementation of Structural Equation Modeling (SEM). The number of participants was 378 nurses. The data were obtained by administering a questionnaire and various tools, organized into four sections: demographic information, the Circadian Questionnaire, the Quality of Work Life Questionnaire, and the Nurses' Efficiency Questionnaire. The collected data were subsequently analyzed using SEM techniques within the R software.

RESULTS

The findings demonstrated statistically significant variations in mean scores about gender and efficiency (p = 0.008), marital status and efficiency (p = 0.000), and employment type and efficiency (p = 0.002) among the study participants. There was a significant association between shift patterns and QWL (p = 0.004). Expressly, the confirmed results indicated a direct impact of circadian on QWL (with a path coefficient of 0.013), as well as an indirect impact on efficiency mediated by the variable QWL (with a path coefficient of 0.037) (p < 0.05).

CONCLUSION

Due to the critical role of nurses in the healthcare system, implementing strategies that promote their efficiency is paramount. Therefore, managers can create an environment that enhances nurses' productivity by improving methods that positively impact their QWL.

Circadian rhythm and sleep disruptions in relation to prenatal stress and depression symptoms

Circadian rhythm and sleep are related to health, but there is little data on the relationship between the sleep/wake rhythm and mood at different stages of pregnancy. The aim of this prospective, longitudinal study was to investigate the associations of circadian rhythm and sleep disruptions with stress and depression among women in early and late pregnancy. The participants were 26 pregnant women. Objective and subjective estimations of circadian rhythm and sleep were administered, namely actigraphy and the Biological Rhythms Interview of Assessment in Neuropsychiatry in the form of a questionnaire. The Perceived Stress Scale and the Edinburgh Postnatal Depression Scale were also used. Subjectively perceived circadian rhythm disruptions were positively related to stress. Tendency to maintain a regular rhythm of sleep and activity in early pregnancy and subjectively perceived disruptions of circadian rhythms in late pregnancy were positively associated with prenatal depression in late pregnancy. Sleep fragmentation and long time spent in bed at night in early pregnancy were positively associated with stress and depression in late pregnancy. The results suggest the importance of flexibility and the ability to adapt one's circadian activities to the demands of the situation of pregnancy-related changes in lifestyle. They also indicate the significance of good-quality uninterrupted night sleep in early pregnancy.

Effects of grit, calling, and resilience on the retention intention of general hospital nurses

AIM

This study aimed to determine the influence of personal factors such as grit, calling, and resilience on nurses' retention intention in South Korean general hospitals.

BACKGROUND

The global shortage and high turnover rate of nurses have become significant concerns with no clear solutions for increasing retention.

INTRODUCTION

Determining the factors related to the f general hospital nurses and retention intention is important for solving the problem of inadequate nursing personnel and improving the quality of nursing services.

METHODS

This study was a descriptive survey of 221 nurses working at a general hospital in South Korea from July 2021 to February 2022. Data were collected using self-reported online questionnaires, with measurement tools focusing on grit, calling, resilience, and retention intention. The STROBE checklist was used for reporting this study.

RESULTS

The average retention intention score was 5.35 ± 1.52 out of 8 points. Significant correlations were found between retention intention and grit, calling, and resilience. The factors influencing retention intention were job satisfaction, calling, marital status, and total career length, explaining 31.9% of the variance.

CONCLUSIONS

To enhance nurses' intention to remain at general hospitals, their job satisfaction and sense of a calling should be improved. Further research should be conducted to identify factors that influence retention intention, particularly among groups with low job retention, with consideration of individual characteristics that might affect retention intention.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Increasing nurses' retention intention would alleviate the nursing shortage, help hospitals retain competent nurses, reduce turnover-related costs, and improve organizational efficiency. Resolving the nursing shortage is critical for improving patient safety and nursing service quality at general hospitals.

The association between chronotype, sleep quality and medication errors among critical care nurses

Medication administration errors could result in severe complications in critical care units. This study investigated an association between chronotype, sleep quality and medication errors among essential nurses of care in Qazvin teaching hospitals in Iran. In this multicenter, cross-sectional study, all registered nurses of critical care units of Qazvin teaching hospitals were recruited. Data were collected through anonymous questionnaires, including socio-demographic data, Morning-Evening Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and medication errors data. Data were analyzed with SPSS v.24 by using the Chi-square test, Mann-Whitney U test, and logistic regression analysis. P values less than 0.05 were considered significant. The mean age and work experience were 33.12 ± 6.74 and 9.11 ± 5.96, respectively. One hundred sixty-six nurses (96%) have been working in rotating shifts. Nurses with intermediate chronotypes were predominant (n = 122; 70.5%). The majority of nurses (68.2%) had poor sleep quality (n = 118). Logistic regression analysis showed eveningness chronotype was associated with 4.743 fold increased risk of medication error (P < 0.033). No association was found between medication error and sleep quality (p < 0.95). There was no significant relationship between chronotype and sleep quality (P < 0.257). Our study showed that nurses with eveningness chronotype make more medication errors; therefore, considering the individual circadian preference before deciding on their shift timing assignment will be an important issue in reducing nurses' medication errors and improving patient safety in critical care units.

Influence of shift work on periodontitis according to the occupation group

This study aimed to investigate the effects of shift work on periodontal disease in blue-and white-collar workers and to examine the interaction effects between occupation and work patterns. Data were collected from the Korea National Health and Nutrition Examination Survey conducted by the Korean Ministry of Health and Welfare for a total of nine years from 2007 to 2015. Participants with missing outcome variables were excluded from the analysis and a total of 32,336 participants were included in the final analysis. Univariable odds ratios (OR) were calculated using a logistic regression model with 95% confidence interval (CI). A multivariable logistic regression analysis was performed using the backward elimination method. The CONTRAST statement was used to analyze the interaction effect between occupation and work patterns. Multivariable logistic regression analysis revealed that interaction effects are present between the terms, occupational type and work pattern. Crude OR of shift work for periodontitis was 1.269 [CI 1.213-1.327, P < 0.05]. However, following adjustment for multiple confounding factors and the interaction effect term considered, this OR (1.269) increased to 1.381 [CI 1.253-1.523] in white-collar group while it decreased to 1.198 [1.119-1.283] in blue-collar. Crude OR of blue-collar (OR = 3.123, CI 2.972-3.281, P < 0.05) decreased to 1.151 [CI 1.049-1.262] when interaction effect to the shift work was considered. Shift work pattern increases the risk for periodontitis and this adverse effect is greater when white-collar workers are engaged comparing to blue-collar. The result of this study suggests that 24/7 lifestyle of the modern society poses health risks to the relevant people and the potential harm can be greater to white-collar workers.

Correlation Among Workplace Burnout, Resilience, and Well-Being in Nursing Staff: A Cross-Sectional Study in Taiwan

BACKGROUND

Because nurses often work in medical environments characterized by high workloads and high levels of stress and pressure, they are particularly vulnerable to workplace burnout and their well-being may suffer. Related studies on burnout, resilience, and well-being have focused primarily on teachers, social workers, and students, with few studies addressing the situation faced by nursing staff. It is important to understand the factors affecting the well-being of nursing staff.

PURPOSE

This study explores the status quo and correlations among nursing-staff demographic characteristics, workplace burnout, well-being-related resilience, and the predictive factors of well-being in nurses.

METHODS

A cross-sectional, descriptive, correlational research design and purposive sampling were used in this study. Nursing staff who had worked for more than 6 months at a medical center in central Taiwan were recruited as participants, with data from 289 participants collected. A structured questionnaire was used to collect data on demographic characteristics, workplace burnout, resilience, and well-being.

RESULTS

The average scores for workplace burnout, resilience, and well-being were 40.40/(0- to 100-point scale), 26.79/(10- to 50-point scale), and 43.25/(24- to 96-point scale), respectively. The result of the regression analysis explained about 51.6% of the variance in well-being. Furthermore, resilience (28.4%), self-perceived health (14.3%), workplace burnout (4.5%), exercise frequency (1.8%), job title (1.2%), interpersonal pressure relief resilience (0.9%), and marital status (0.5%) were other important predictive factors of well-being in the participants.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Medical institutions should provide appropriate resilience-enhancing countermeasures to reduce workplace burnout as well as pay greater attention to the exercise frequency, self-perceived health, job title, and marital status of their nurses to help them achieve physical, mental, and overall well-being.

Both short and long sleep durations are associated with type 2 diabetes, independent from traditional lifestyle risk factors-The Maastricht Study

OBJECTIVES

This study examined the cross-sectional association between sleep duration, prediabetes, and type 2 diabetes, and its independence from the traditional lifestyle risk factors diet, physical activity, smoking behavior, and alcohol consumption.

METHODS

Cross-sectional data from 5561 people aged 40-75 years recruited into The Maastricht Study between 2010 and 2018 were used (1:1 female:male and mean age: 60.1 years [standard deviation: 8.6]). Sleep duration was operationalized as in-bed time, algorithmically derived from activPAL3 accelerometer data (median 7 nights, IQR 1). Glucose metabolism status was determined with an oral glucose tolerance test. Multinomial logistic regression was used to assess the association of sleep duration as restricted cubic spline with prediabetes and type 2 diabetes. We adjusted for sex, age, educational level, the use of sleep medication or antidepressants, and the following lifestyle risk factors: diet quality, physical activity, smoking behavior, and alcohol consumption.

RESULTS

A U-shaped association between sleep duration and type 2 diabetes was found. Compared to those with a sleep duration of 8 hours, participants with a sleep duration of 5 and 12 hours had higher odds of type 2 diabetes (OR: 2.9 [95% CI 1.9 to 4.4] and OR 3.2 [2.0 to 5.2], respectively). This association remained after further adjustment for the lifestyle risk factors (OR: 2.6 [1.7 to 4.1] and OR 1.8 [1.1 to 3.1]). No such association was observed between sleep duration and prediabetes.

CONCLUSIONS

Both short and long sleep durations are associated positively and independently of lifestyle and cardiovascular risk factors with type 2 diabetes, but not with prediabetes.

Interventions to improve the sleep of nurses: A systematic review

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.

Nature of the work correlated to overweight and obesity for nurses: A 10-year hospital-based cohort study

BACKGROUND

Nurses are a high-risk group for overweight and obesity due to high stress, low-labor medical work, irregular diet, and lack of exercise. There is scarce information on relationship between job characteristics and overweight and obesity among nurses. This study aimed to answer the question. Does the nature of the work including job position, seniority relate to overweight and obesity among nurses? Their incidence was also investigated.

METHODS

We conducted a retrospective cohort study of nurses who underwent annual checkups during 2007 to 2016 in a medical center. Overweight was defined as a body mass index between 24 and 27 kg/m 2 . Obesity was defined as a body mass index higher than 27 kg/m 2 . We calculated the prevalence and incidence of overweight and obesity and estimated relative risks using logistic regression.

RESULTS

Overall, 4253 participants were enrolled for the incidence of overweight and obesity. We found that junior staff, administrative directors, working in intensive care units, and old age had a high possibility of overweight. Junior staff, administrative directors, old age, and male sex tend to be obesity. Overweight and obesity occurred rapidly in the first 2 years of their career.

CONCLUSION

Our findings suggest that policies should be set up to achieve the goal of workplace health promotion. Health plans focusing on these factors may help nurses avoid obesity and overweight. The director of the hospital should keep track of the health checkup database to confirm the benefits of its long-term implementation.

Evaluation of medication errors in nursing during the COVID-19 pandemic and their relationship with shift work at teaching hospitals: a cross-sectional study in Iran

Introduction

Medication errors in nursing negatively affect the quality of the provided health-treatment services and society's mentality about the health system, threatening the patient's life. Therefore, this study evaluates medication errors in nursing during the COVID-19 pandemic and their relationship with shift work at teaching hospitals.

Materials and methods

All the nurses working at teaching hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences (southwest of Iran) comprised the statistical population of this research (260 participants). Data were collected using three questionnaires: a demographic characteristics questionnaire, a medication error questionnaire, and the standard Circadian Type Inventory (CTI) for a normal physiological cycle.

Results

At least one medication error was observed in 83.1% of nurses during their work span. A medication error was found in 36.2% of nurses during the COVID-19 pandemic (over the past year). Most medication errors (65.8%) occurred during the night shift. A significant relationship was detected between medication errors and shift work. Medicating one patient's drug to another (28.84%) and giving the wrong dose of drugs (27.69) were the most common types of medication errors. The utmost medication error was reported in emergency wards. The fear of reporting (with an average of 33.06) was the most important reason for not reporting medication errors (p < 0.01).

Discussion and conclusion

Most nurses experienced a history of medication errors, which were increased by shift work and the COVID-19 pandemic. Necessary plans are recommended to reduce the fatigue and anxiety of nurses and prevent their burnout, particularly in critical situations. Efforts to identify risky areas, setting up reporting systems and error reduction strategies can help to develop preventive medicine. On the other hand, since the quality of people's lives is considered the standard of countries' superiority, by clarifying medical errors, a higher level of health, satisfaction and safety of patients will be provided.

Examining the relationship between long working hours and the use of prescription sedatives among U.S. workers

OBJECTIVES

The prevalence of long working hours has been accompanied by a corresponding rise in sleep disorders. Sedative-hypnotic agents (SHAs), have been reported as the second most commonly misused drug class in the U.S. The key objective of this study was to examine the relationship between working hours on the use of sleep aids and medications with sedative properties.

METHODS

The 2010-2019 Medical Expenditure Panel Survey data was utilized. SHAs and medications with sedative related properties (MSRPs) were identified. Furthermore, we employed different regression models ranging from multivariable linear regression, Tobit regression, Heckman regression, and multivariable logistic regression, to ensure consistency, robustness, and reliability of associations.

RESULTS

Overall, a sample of 81,518 observations of full-time workers was analyzed. Working 56hours or more per week was significantly associated (p < 0.05) with an increased odds of using SHAs and MSRPs by 13% (Adjusted Odds Ratio, aOR =1.13, 95% Confidence Interval, CI=1.01:1.26) and 9% (aOR=1.09, 95% CI=1.03:1.16), respectively more than that among those who worked fewer hours. Females in our study had a higher likelihood (aOR=1.11, 95% CI=1.05:1.19) of using SHAs when compared to males. Also, professional services had the highest likelihood (aOR=1.31, 95% CI=1.14:1.50) of using SHAs.

CONCLUSION

We found that long working hours were significantly associated with an elevated use of SHAs and MSRPs among U.S. workers. Specifically, female workers and individuals working in professional services had the highest likelihood of using sleep medications.

Factors contributing to patient safety during triage process in the emergency department: A systematic review

BACKGROUND

Triage is a dynamic environment in which large numbers of people can present. It presents a vulnerable assessment point, as a triage nurse must assess a patient's urgency level and analyse their health status and expected resource needs. Given the critical nature of triage, it is necessary to understand the factors contributing to patient safety.

OBJECTIVES

To identify and examine the factors contributing to patient safety during the triage process.

METHODS

A systematic review of the literature was undertaken, and a thematic analysis of the factors contributing to patient safety during the triage process. PubMed, CINAHL, Web of Sciences, Science Direct, SAGE, EMBASE and reference lists of relevant studies published in English until March 2022 were searched for relevant studies. The search protocol has been registered at the PROSPERO (CRD42019146616), and the review was conducted using the PRISMA criteria.

RESULTS

Out of 5366 records, we included 11 papers for thematic synthesis. Identified factors contributing to patient safety in triage are related to the emergency's work environment, such as patient assessment, high workload, frequent interruptions and staffing, and personal factors such as nurse traits, experience, knowledge, triage fatigue and work schedule.

CONCLUSIONS

This review shows that patient safety is influenced by the attitude, capabilities and experiences of triage nurses, the time when nurses can dedicate themselves to the patient and triage the patient without disruption. It is necessary to raise awareness among nursing administrators and healthcare professionals to provide a safe triage environment for patients.

RELEVANCE TO CLINICAL PRACTICE

This review highlights the evidence on the factors contributing to patient safety in the triage process. Further research is needed for this cohort of triage nurses in the emergency department concerning ensuring patient safety.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required to design or undertake this review.

Associations of chronotype and insomnia with menstrual problems in newly employed nurses at university hospitals in the Republic of Korea

Background

Dysmenorrhea and menstrual cycle changes occur in women working shifts. Circadian rhythm disruption and sleep disturbances associated with shift work leads to health problems. We identified chronotypes and the occurrence of insomnia among newly employed university hospital nurses and investigated the association of these factors with menstrual problems.

Methods

We conducted pre-placement health examinations for shift workers using self-reported questionnaires between 2018 and 2020. A total of 463 nurses were included in the study. Sociodemographic data, shift work experience, and information on insomnia were collected from health examination data. In addition, details regarding chronotype, dysmenorrhea, irregular and abnormal menstrual cycles, amenorrhea, and contraceptive use were obtained from the questionnaire. Multiple logistic regression analysis was performed to study the association between chronotype, insomnia, and menstrual problems after controlling for age, body mass index, contraceptive use, amenorrhea, and prior shift work.

Results

The prevalence rates of dysmenorrhea, irregular menstrual cycles, and longer menstrual cycles were 23.8%, 14.9%, and 4.1%, respectively. The risk of dysmenorrhea increased in the evening-type (odds ratio [OR]: 3.209; 95% confidence interval [CI]: 1.685-6.113) and those with insomnia (OR: 1.871; 95% CI: 1.074-3.261). Additionally, the risk of an irregular menstrual cycle (OR: 2.698; 95% CI: 1.167-6.237) increased in the evening-type, and the risk of a longer menstrual cycle (OR: 4.008; 95% CI: 1.354-11.864) increased in individuals with insomnia.

Conclusions

Our findings suggest that dysmenorrhea is promoted in the evening-type and insomnia individuals. There may be an increased risk of irregular menstrual cycles among evening-type nurses and an increased risk of longer menstrual cycles among those with insomnia. Therefore, factors such as evening-type and insomnia should be considered for the prevention of menstrual problems in women performing shift work.

Patterns of smartphone usage associated with depressive symptoms in nursing students

Introduction

Rather than focusing on the activities that the smartphone has been used for, the existing literature frequently focuses on the association between problematic use of smartphone independent of the content of use (self-reported) and depressive symptoms in youth. This study aims to explore patterns of smartphone usage and the association with depressive symptoms in nursing students.

Methods

This cross-sectional study of nursing freshmen (n = 1, 716) was conducted between October and November 2018. Participants were recruited from three Chinese public medical universities using stratified cluster sampling. Self-rated frequency of 12 different smartphone activities over the preceding week was evaluated. Depressive symptoms were assessed by using the Patient Health Questionnaire-9 (PHQ-9).

Results

Of the 1,716 students recruited, 1,424 (83.0%) were girls, and the mean [SD] age was 18.90 [1.39] years. Using principal component analysis (PCA), two typical usage patterns were indicated. The "entertainment pattern" factor included a high frequency of streaming images or videos, searching for information, chatting online, online shopping, downloading, reading online, checking social media sites, taking pictures or videos, and playing games. The "communication pattern" had a high frequency of emailing, texting, and calling. Using logistic regression models, the association between smartphone usage patterns and depressive symptoms was tested. The "communication pattern" was significantly associated with a 53% increase in the odds of moderate and above depressive symptoms (AOR = 1.529; 95% CI = 1.286-1.818; p < 0.001), controlling for a set of socio-demographic and smartphone use covariates.

Discussion

This study provides insights into how the patterns of smartphone usage are associated with the severity of depressive symptoms in nursing students. It indicates that it may primarily be how we use our smartphones rather than how much we use them that poses a risk for depression.

Factors Affecting Nurse Retention Intention: With a Focus on Shift Nurses in South Korea

This study aims to investigate the factors affecting shift nurses' retention to solve the nurse shortage problem. The independent variables were general characteristics, stress response, work-life balance, and grit. The subjects for the study were 214 nurses working in three shifts at three general hospitals in Korea. Data were collected from 1 to 31 August 2022. We used structured tools such as the Nurses' Retention Index, Stress Response Inventory, Work-Life Balance Scale, and Clinical Nurse's Grit Scale. Data analysis was conducted using descriptive statistics, independent sample t-test, one-way variance analysis, Pearson correlation analysis, and hierarchical multiple regression analysis. Age, job satisfaction, and grit were factors that had a significant impact on retention intention. Grit had the greatest impact on retention intention. Additionally, retention intention increased in those aged from 30 to 40 years as compared with those under the age of 30. It is necessary to develop and implement a program that can improve grit to enhance the retention intention of shift nurses. Additionally, it is necessary to actively seek measures to reduce dissatisfaction with nursing jobs, increase satisfaction, and manage human resources considering the characteristics of age groups.

Salivary Biomarkers Analysis and Neurobehavioral Assessment in Nurses Working Rotation Shifts: A Pilot Study

Currently, about one in five workers is employed in night shift work in Europe. Shift work including nighttime hours is essential in several activities, especially the healthcare sector. Importantly, night working may be associated with the occurrence of sleep disorders or work-related stress, both potentially augmenting the risk of errors and accidents at work. This study aims to examine the presence of neurobehavioral alterations that can be a consequence of shift working and concurrent misalignment of the sleep times and circadian rhythms. Nurses (n = 102) employed at a University Hospital located in North-Eastern Sicily, Italy, voluntarily participated in this pilot study. During medical surveillance, morning and evening salivary samples were collected, and seven psychodiagnostics questionnaires were administered to all the subjects. On one hand, the salivary levels of stress-related biomarkers (cortisol and alpha-amylase) and a circadian biomarker (melatonin) were evaluated. On the other hand, several neurobehavioral features were assessed, including depression, anxiety, work-related, and sleep issues. Interestingly, a positive relationship between salivary morning cortisol and depression scale, as well as a negative relationship between salivary morning alpha-amylase and work ability scale, were observed. Based on these results, the integration of subjective questionnaire outcomes and objective salivary biomarker quantification can help to identify workers with increased susceptibility to developing neurobehavioral alterations. This approach may contribute to ameliorating preventive strategies towards sensitive categories, such as nurses working rotation shifts.

Social jet lag and (changes in) glycemic and metabolic control in people with type 2 diabetes

OBJECTIVE

Social jet lag, i.e., the discordance among social and biological rhythms, is associated with poor metabolic control. This study aimed to assess cross-sectional and longitudinal associations among social jet lag and glycemic and metabolic control in people with type 2 diabetes.

METHODS

In a prospective cohort (N = 990) with type 2 diabetes, social jet lag was measured at baseline using daily diaries and was categorized (high, moderate, or low). Metabolic outcomes were assessed at baseline and at 1 and 2 years of follow-up. Associations among social jet lag and glycemic and metabolic control were analyzed using linear regression and linear mixed models adjusted for confounding factors. Analyses were stratified for work status (retired vs. working; p value for interaction = 0.007 for glycated hemoglobin [HbA1c]).

RESULTS

In working people, a cross-sectional association between high social jet lag and HbA1c (1.87 mmol/mol [95% CI: 0.75 to 2.99]) and blood pressure (5.81 mm Hg [95% CI: 4.04 to 7.59]) was observed. For retired people, high social jet lag was negatively associated with HbA1c (-1.58 mmol/mol [95% CI: -2.54 to -0.62]), glucose (-0.19 mmoL/L [95% CI:-0.36 to -0.01]), and blood pressure (-3.70 mm Hg [95% CI: -5.36 to -2.04]), and the association with BMI was positive (1.12 kg/m² [95% CI: 0.74 to 1.51]). Prospective associations had the same direction as cross-sectional findings but were nonsignificant for working or retired people.

CONCLUSIONS

Social jet lag was cross-sectionally, but not prospectively, associated with glycemic and metabolic markers. Interaction with work status was present, and directions of the associations were generally detrimental in the working population, whereas higher social jet lag was associated with improved glycemic and metabolic control for retired people.

Associations between circadian disruption and cardiometabolic disease risk: A review

The human circadian system plays a vital role in many physiological processes, and circadian rhythms are found in virtually all tissues and organs. The disruption of circadian rhythms may lead to adverse health outcomes. Evidence from recent population-based studies was reviewed because they represent real-world behavior and can be useful in developing future studies to reduce the risk of adverse health conditions, including cardiovascular diseases, obesity, and diabetes mellitus, which may occur because of circadian disruption. An electronic search in PubMed and Web of Science (2012-2022) was performed. Selected articles were based on specific inclusion and exclusion criteria. Five factors that may disrupt circadian rhythm alignment are discussed: shift work, late chronotype, late sleep timing, sleep irregularity, and late meal timing. Evidence from observational studies of these circadian disruptors suggests potential detrimental effects on cardiometabolic health, including higher BMI/obesity, higher blood pressure, greater dyslipidemia, greater inflammation, and diabetes. Future research should identify the specific underlying pathways in order to mitigate the health consequences of shift work. Furthermore, optimal sleep and mealtimes for metabolic health can be explored in intervention studies. Lastly, it is important that the timing of external environmental cues (such as light) and behaviors that influence circadian rhythms are managed.

Work as a social risk factor in pregnancy: A systematic review of screening practices related to working conditions and family leave among pregnant adults

BACKGROUND

Paid family leave and working conditions are components of employment quality-a key social determinant of health across the life course, particularly during pregnancy. Increased research on prenatal social risk screening has not extended to employment quality. The objective of this systematic review was to identify prenatal screening practices and interventions in health care settings that address employment and working conditions as social risk factors among pregnant adults and to describe their properties and key findings.

METHOD

We searched MEDLINE, PsychINFO, SocINDEX, EMBASE, and the SIREN Evidence and Resource Library for studies published through February 14, 2022. We selected multiple search terms related to four domains: (1) employment or working conditions; (2) screening; (3) health care settings; and (4) pregnancy or maternal health.

RESULTS

Of the 2317 unique titles and abstracts that were potentially relevant, eight articles met all inclusion criteria and focused on pregnant populations. The content of identified screening practices varied substantially, highlighting the multiple ways employment is conceptualized as a potential risk factor. Few studies included multidimensional measures of employment to assess working conditions, which may be particularly relevant during pregnancy.

CONCLUSIONS

Our review suggests that screening for employment as a social risk factor does not regularly occur in prenatal care. Although pragmatic properties of the screening tools we assessed are promising, tools seldom examine the multidimensional nature of work. Understanding the principal intent of screening for employment prenatally could provide greater opportunity to collect and interpret contextual factors that influence how both providers and patients respond to social risk.

Pregnant nurses' experiences of working shifts: a qualitative systematic review protocol

OBJECTIVE

The proposed systematic review will synthesize the experiences of nurses working in any shifts during pregnancy.

INTRODUCTION

Nurses are among the most burdened health care workers and are at risk of diseases of the circulatory system due to prolonged standing. For pregnant nurses, this could reduce blood circulation and blood flow to the uterus and placenta. Contributing factors include long working hours and frequent heavy lifting, which may induce uterine contractions and premature birth; irregular shifts, which exacerbate fatigue; and high levels of psychosocial stress. There is no qualitative evidence as to what nurses are experiencing while working shifts when pregnant. This review will evaluate and integrate the current available findings related to the experience of shift-working nurses who are pregnant.

INCLUSION CRITERIA

This review will include qualitative studies focusing on the experience of shift work among pregnant nurses. No language or date limits will be applied. All types of pregnancy among nurses will be included.

METHODS

The databases to be searched will include CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycINFO (EBSCOhost), and Igaku Chuo Zasshi (the Japan Medical Abstracts Society). Sources of gray literature will include MedNar and DANS, as well as the websites of the American Nurses Association and the Japanese Nursing Association. Study selection, critical appraisal, data extraction, and data synthesis will be performed independently by 2 reviewers. The synthesized findings will be graded according to the ConQual approach for establishing confidence in findings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022309674.

Circadian rhythms in the blood-brain barrier: impact on neurological disorders and stress responses

Circadian disruption has become more prevalent in society due to the increase in shift work, sleep disruption, blue light exposure, and travel via different time zones. The circadian rhythm is a timed transcription-translation feedback loop with positive regulators, BMAL1 and CLOCK, that interact with negative regulators, CRY and PER, to regulate both the central and peripheral clocks. This review highlights the functions of the circadian rhythm, specifically in the blood-brain barrier (BBB), during both healthy and pathological states. The BBB is a highly selective dynamic interface composed of CNS endothelial cells, astrocytes, pericytes, neurons, and microglia that form the neurovascular unit (NVU). Circadian rhythms modulate BBB integrity through regulating oscillations of tight junction proteins, assisting in functions of the NVU, and modulating transporter functions. Circadian disruptions within the BBB have been observed in stress responses and several neurological disorders, including brain metastasis, epilepsy, Alzheimer's disease, and Parkinson's disease. Further understanding of these interactions may facilitate the development of improved treatment options and preventative measures.

Mobile app for personalized sleep–wake management for shift workers: A user testing trial

Objective

Development of personalized sleep–wake management tools is critical to improving sleep and functional outcomes for shift workers. The objective of the current study was to test the performance, engagement and usability of a mobile app ( SleepSync) for personalized sleep–wake management in shift workers that aid behavioural change and provide practical advice by providing personalized sleep scheduling recommendations and education.

Methods

Shift workers ( n = 27; 20 healthcare and 7 from other industries) trialled the mobile app for two weeks to determine performance, engagement and usability. Primary outcomes were self-reported total sleep time, ability to fall asleep, sleep quality and perception of overall recovery on days off. Secondary performance outcomes included sleep disturbances (insomnia and sleep hygiene symptoms, and sleep-related impairments) and mood (anxiety, stress and depression) pre- and post-app use. Satisfaction with schedule management, integration into daily routine and influence on behaviour were used to determine engagement, while the usability was assessed for functionality and ease of use of features.

Results

Total sleep time ( P = .04), ability to fall asleep ( P < .001), quality of sleep ( P = .001), insomnia ( P = .02), sleep hygiene ( P = .01), sleep-related impairments ( P = .001), anxiety ( P = .001), and stress ( P = .006) were all improved, with non-significant improvements in recovery on days off ( P = .19) and depression ( P = .07). All measures of engagement and usability were scored positively by the majority of users.

Conclusions

This pilot trial provides preliminary evidence of the positive impact of the SleepSync app in improving sleep and mood outcomes in shift workers, and warrants confirmation in a larger controlled trial.

Circadian regulation of genetic and hormonal risk factors of cardiovascular disease in women

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. However, sex differences can impact differently the etiology and outcome of cardiovascular disease when comparing men and women. Women have unique genetic and hormonal risk factors that can be associated with the development of cardiovascular diseases. Furthermore, certain phenotypes of cardiovascular diseases are more prevalent to women. Molecular clocks control circadian rhythms of different physiological systems in our body, including the cardiovascular system. Increased evidence in recent years points to a link between cardiovascular disease and regulation by circadian rhythms. However, the difference between circadian regulation of cardiovascular disease in women and men is poorly understood. In this review, we highlight the recent advances in circadian-regulated cardiovascular diseases with a specific focus on the pathogenesis of heart disease in women. Understanding circadian-regulated pathways and sex-specific differences between men and women may contribute to better diagnosis and development of sex-targeted interventions to better treat cardiovascular diseases.

Investigating the effectiveness of employing clinical faculty members in the shift work system during the Covid-19 pandemic in Iran: A cross-sectional study

Introduction

Having an accurate attitude about shift work and choosing the right people to work in the shift work system increases organizational productivity and improves the employees' life quality. Consequently, the current research investigates the effectiveness of employing clinical faculty members in the shift work system during the Covid-19 pandemic.

Materials and Methods

In this descriptive study, 71 Iranian clinical faculty members with a history of shift work (night shift) during the Covid-19 pandemic participated. Circadian Type Inventory (CTI) was used to collect data.

Results

Based on the results of this research (Flexible/Rigid = Mean ± SD = 2.47 ± 18.17) and (Languid/Vigorous = Mean ± SD = 2.89 ± 15.35) which revealed that although clinical faculty members in normal conditions can overcome the feeling of sleepiness due to lack of sleep, they are not flexible and cannot work in the shift work system with the ability to stay awake at unusual times of the day or night. Pearson's correlation coefficient test also showed that as the value of the Languid/Vigorous component increases, the value of the Flexible/Rigid component also increases (r = 0.410). Likewise, there was no significant relationship between the main research variables and demographic characteristics.

Discussion and Conclusion

Clinical faculty members who are simultaneously responsible for the duties of teaching students, research, and treating patients, if they are employed in a shift work system, especially during the pandemic, it may lead to a decrease in the quality of teaching, lack of motivation in research and indifference toward students' affairs, reducing flexibility, inability to update what they have learned in the professional world, increasing medical errors and also reducing their ability to manage the class. Consequently, it is suggested to avoid using them in the shift work systems as much as possible.

Analysis and mapping of global research publications on shift work (2012-2021)

BACKGROUND

The main objective of the study was to identify research trends, collaboration patterns, and the most impactful publications in the field of shift work.

METHODS

Documents published in scientific journals indexed in the Scopus database on shift work were retrieved and analyzed using the title/abstract search methodology. The study period was from January 1st, 2012, to December 31st, 2021.

RESULTS

Two thousand three hundred twenty-eight documents were retrieved with an h-index of 71 and an average number of 4.5 authors per document. The cumulative number of publications showed a linear growth pattern, while that of citations showed an exponential pattern. The most frequent author keywords, excluding keywords related to shift work, were sleep, fatigue, and nursing. The average annual growth rate was 4.3, and the average doubling time was 3.2. No significant correlation was found between the number of publications and national income among prolific countries. Cross-country research collaboration was weak while the degree of author-author collaboration was relatively high. The Chronobiology International journal was the most prolific, while Harvard University was the most active institution in the field of shift work.

CONCLUSIONS

Given the volume and the negative health impact of shift work, better human resource management is needed to create safer and healthier working schedules.

Association of psychological symptoms with job burnout and occupational stress among coal miners in Xinjiang, China: A cross-sectional study

Objective

The study aimed to investigate the influencing factors of psychological symptoms in relation to job burnout and occupational stress among coal miners in Xinjiang, so as to provide data support for enterprises in an effort to help them identify internal psychological risk factors and improve the mental health of coal miners.

Methods

A cross-sectional study was carried out. A total of 12 coal mines were selected using the stratified cluster random sampling method and 4,109 coal miners were investigated by means of online electronic questionnaires. The Symptoms Check List-90 (SCL-90), Chinese Maslach Burnout Inventory (CMBI), and Job Demand-Control (JDC) model were respectively used to measure the status of psychological symptoms, job burnout, and occupational stress among coal miners. The mediation analysis was performed through structural equation modeling (SEM) by using Analysis of Moment Structure (AMOS).

Results

The prevalence of psychological symptoms was higher in the occupational stress group than in the non-occupational stress group, and increased with job burnout (P < 0.05). The multivariate logistic regression analysis results showed that mild (OR = 1.401, 95% CL: 1.165, 1.685), moderate (OR = 2.190, 95% CL: 1.795, 2.672), or severe levels of burnout (OR = 6.102, 95% CL: 3.481, 10.694) and occupational stress (OR = 1.462, 95% CL: 1.272, 1.679) were risk factors for psychological symptoms in coal miners. The results of structural equation modeling indicated that occupational stress (β = 0.11, P = 0.002) and job burnout (β = 0.46, P = 0.002) had significant positive direct effects on psychological symptoms, and job burnout was an intermediate variable between occupational stress and psychological symptoms.

Conclusion

High levels of job burnout and occupational stress were risk factors for psychological symptoms. Both occupational stress and job burnout had direct effects on psychological symptoms, and occupational stress could also have an indirect effect on coal miners' psychological symptoms through the intermediate variable of job burnout.

What do we know about the effect of night-shift work on cardiovascular risk factors? An umbrella review

Objective

To evaluate the existing evidence on the effect of night-shift work and its subtypes (permanent and rotating) on cardiovascular risk factors: diabetes, lipid disorders, being overweight, hypertension, smoking habits, sedentariness, and occupational psychosocial stressors.

Method

A Web of Sciences and Cochrane review library search was conducted to identify systematic reviews with or without meta-analysis dealing with the quantification of the link between night-shift work and the studied cardiovascular risk factors in working populations. We used the AMSTAR 2 to evaluate the quality of each review. The main results of the included systematic reviews were compiled in a summary structured around the different cardiovascular risk factors.

Results

After selection, 33 systematic reviews were included: nine for diabetes, four for lipid disorders, nine for being overweight, four for hypertension, two for smoking habits, three for occupational psychosocial stressors and two for sedentariness. The results confirmed an excess risk of diabetes of about 10% regardless of the type of night work. A stated excess risk of being overweight at around 25% was also highlighted for shift workers overall, which could reach 38% among night-shift workers. An increased risk of obesity, estimated at 5% for night-shift workers and at 18% for rotating shift workers, was observed. An excess risk of hypertension was estimated at around 30% when considering the broad definition of shift work and when night periods were included in rotating shifts. The literature provided inconsistent results for the link between lipid disorders and night-shift work. Shift workers appeared to be more likely to smoke. The link between shift work and occupational psychosocial stressors was scarcely explored in the available studies. Sedentariness was scarcely considered in systematic reviews, which prevents any firm conclusions.

Conclusion

The consequences of night work in terms of diabetes, being overweight/obesity and hypertension are established. Monitoring of these cardiovascular risk factors for these night-shift workers could be implemented by practitioners. In contrast, the links with lipid disorders, sedentariness, smoking habits, and occupational psychosocial stressors warrant further investigation.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021275212, PROSPERO (ID CRD42021275212).

Shift Work and Early Arterial Stiffness: A Systematic Review

Shift work is a way of organizing rotating schedules throughout the day. This can include 1-3 shifts for the same person on a rotational basis with other workers. Schedules that include night work have been associated with cardiovascular risk, mainly due to circadian misalignment. This systematic review sought to determine whether shift work is a risk factor for increased arterial stiffness. A systematic review of different databases was performed, using the following keywords: work shift, night work, arteriosclerosis, vascular stiffness, arterial stiffness, pulse wave velocity, and their Medical Subject Headings. We selected and analyzed 11 articles regarding pulse wave velocity as an indicator of arterial stiffness. Two studies identified higher levels of arterial stiffness in shift workers compared to day workers, while two studies found the opposite. In addition, four studies found no differences in arterial stiffness between shifts, two studies associated shorter sleep duration with arterial stiffness, and one study observed that physical activity could prevent adverse cardiovascular outcomes in shift workers. The findings are heterogeneous and preclude any robust conclusions. However, the present review points to the need for further studies to investigate arterial stiffness in shift workers, with greater control for confounding factors and longitudinal design.