A Pilot Study to Examine the Relationship Between Napping and Fatigue in Nurses Practicing on the Night Shift

Total sleep deprivation alters spontaneous brain activity in medical staff during routine clinical work: a resting-state functional MR imaging study

Objectives

To assess the effect of total sleep deprivation (TSD) on spontaneous brain activity in medical staff during routine clinical practice.

Methods

A total of 36 medical staff members underwent resting-state functional MRI (rs-fMRI) scans and neuropsychological tests twice, corresponding to rested wakefulness (RW) after normal sleep and 24 h of acute TSD. The rs-fMRI features, including the mean fractional amplitude of low-frequency fluctuation (mfALFF), z-score transformed regional homogeneity (zReHo), and functional connectivity (zFC), were compared between RW and TSD. Correlation coefficients between the change in altered rs-fMRI features and the change in altered scores of neuropsychological tests after TSD were calculated. Receiver operating characteristic (ROC) and logistic regression analyses were performed to evaluate the diagnostic efficacy of significantly altered rs-fMRI features in distinguishing between RW and TSD states.

Results

Brain regions, including right superior temporal gyrus, bilateral postcentral gyrus, left medial superior frontal gyrus, left middle temporal gyrus, right precentral gyrus, and left precuneus, showed significantly enhanced rs-fMRI features (mfALFF, zReHo, zFC) after TSD. Moreover, the changes in altered rs-fMRI features of the right superior temporal gyrus, bilateral postcentral gyrus, left middle temporal gyrus, and left precuneus were significantly correlated with the changes in several altered scores of neuropsychological tests. The combination of mfALFF (bilateral postcentral gyrus) and zFC (left medial superior frontal gyrus and left precuneus) showed the highest area under the curve (0.870) in distinguishing RW from TSD.

Conclusion

Spontaneous brain activity alterations occurred after TSD in routine clinical practice, which might explain the reduced performances of these participants in neurocognitive tests after TSD. These alterations might be potential imaging biomarkers for assessing the impact of TSD and distinguishing between RW and TSD states.

Association of intra-shift nap duration with heart rate variability in medical night shift workers

Napping during night shifts effectively reduces disease risk and improves work performance, but few studies have investigated the association between napping and physiological changes, particularly in off-duty daily lives. Changes in the autonomic nervous system precede diseases like cardiovascular disease, diabetes, and obesity. Heart rate variability is a good indicator of autonomic nervous system. This study aimed to investigate the link between night shift nap durations and heart rate variability indices in the daily lives of medical workers. As indicators of chronic and long-term alterations, the circadian patterns of heart rate variability indices were evaluated. We recruited 146 medical workers with regular night shifts and divided them into four groups based on their self-reported nap durations. Heart rate variability circadian parameters (midline-estimating statistic of rhythm, amplitude, and acrophase) were obtained by obtaining 24-h electrocardiogram on a day without night shifts, plotting the data of the heart rate variability indices as a function of time, and fitting them into periodic cosine curves. Using clinical scales, depression, anxiety, stress, fatigue, and sleepiness were assessed. Linear regression analysis revealed a positive relationship between 61-120-min naps and 24-h, daytime, and night-time heart rate variability indices, and the parasympathetic activity oscillation amplitude (indexed by high-frequency power, the square root of the mean of the sum of squares of differences between adjacent normal intervals, standard deviation of short-term R-R-interval variability) within one circadian cycle. This study indicated that napping for 61-120 min during night shifts could benefit medical workers' health, providing physiological evidence to promote nap management.

Considering the impact of shift working on health

Shift work is necessary for the provision of health services, especially in hospitals as it is the only way to provide continuous care to patients. Working at night is inconsistent with the body's biological clock and night shift working hugely disrupts the circadian and sleep wake cycles. In 2020, the World Health Organization classified night shift working as being a 'probable' class 2A carcinogen and a number of independent cohort studies of both night workers and shift workers have observed increased incidence of certain cancers. Altered sleep timing, food timing and light exposure typical for shift workers leads to an acute circadian disruption and misalignment of regulatory hormones. This straying from synchronisation has been shown to result in individuals being more vulnerable to a number of chronic health conditions. Night shift work disrupts the normal sleep-wake cycle, often leading to shortened sleep duration and excessive fatigue and the results of this are far reaching. This article will explore the full impact of shift working, questioning if current practices employed within the NHS should continue.

Nurses' perceptions of night shifts: A qualitative study

AIM

To describe the experiences and perceptions of emergency nurses regarding the shortening of night shifts and identify aspects of nurses' preferences for night shifts.

BACKGROUND

Shift work can be associated with distinct physical and psychological disadvantages for nurses, especially night nurses. Knowledge regarding the factors influencing their perceptions of night shifts is limited.

METHODS

A qualitative description design. Fifteen nurses from the emergency setting with 6 to 14 years of work experience participated in interviews. Semistructured interviews were conducted between November 2018 and March 2019. A thematic analysis was performed for the data analysis.

FINDINGS

The following three themes emerged: (1) maintaining quality within quantity, (2) maintaining comfort within busyness, and (3) buffering the gap between ideal and reality.

CONCLUSIONS

Considering work intensity and patient safety, nurses believe that an 8 h night shift is the most suitable length for the emergency department. Long shifts are probably more suitable for other departments with lower night workloads.

Did rest breaks help with acute fatigue among nursing staff on 12-h shifts during the COVID-19 pandemic? A cross-sectional study

AIM

This study aimed to explore whether 30-min rest breaks were as effective at lowering acute fatigue among 12-h shift hospital nursing staff who cared for patients with COVID-19 as among those who did not.

DESIGN

The study was cross-sectional in design.

METHODS

Data from the SAFE-CARE study collected online between May and June 2020 were used. A subsample (N = 338) comprised of nursing staff who reported working 12-h shifts, and providing direct patient care in hospitals was used in this study. Data on socio-demographics, work and rest breaks, and subjective measures of fatigue, psychological distress, sleep and health were used. Hierarchical multiple linear regression followed by stratified analyses was conducted to explore the relationships between rest breaks and acute fatigue among nursing staff groups with and without COVID-19 patient care.

RESULTS

The sample, on average, had high acute fatigue. Around 72% reported providing care to patients with COVID-19, and 71% reported taking rest breaks 'sometimes', 'often' or 'always'. In the group that cared for patients with COVID-19, there was no significant relationship between rest breaks and acute fatigue (p = .507). In the group that cared for patients hospitalized for other reasons, rest breaks were associated with lower acute fatigue (p = .010).

CONCLUSION

Our findings showed both the importance and inadequacy of rest breaks in reducing acute fatigue. The process of within-work recovery is complex, and routine rest breaks should be facilitated by nursing management on hospital units during and after the COVID-19 pandemic.

IMPACT

Rest breaks may present an effective strategy in lowering fatigue. Although rest breaks were not associated with less fatigue among staff caring for patients with COVID-19, other co-workers experienced some fatigue recovery. For frontline nursing staff, routine rest breaks are encouraged, and a systematic evaluation pertaining the sufficiency of rest breaks during high work demands in future research is needed.

Predicting nurse fatigue from measures of work demands

Fatigue arising from excessive work demands is a known safety challenge in hospital nurses. This study aimed to determine which measures of work demands during nursing work are most predictive of hospital nurse fatigue levels at the end of the work shift. Measures of work demands of registered nurses from two hospital units in the United States were collected from organizational data sources, wearable sensors, and questionnaires. Fatigue levels were measured at the start and end of each shift using the Brief Fatigue Inventory. Multilevel linear regression analysis was used to predict end of shift fatigue based on work demand variables. The best fit model included multiple variables from organizational data sources and a physical activity variable measured by a wearable sensor. Organizational data can be used to create dynamic measures of work demands as they occur and predict end of shift fatigue levels in hospital nurses.

Changes in Fatigue Levels and Sleep Measures of Hospital Nurses During Two 12-Hour Work Shifts

OBJECTIVE

The aims of this study were to explore nurses' fatigue levels and sleep measures during two 12-hour consecutive day shifts and examine the relationships between nurses' fatigue levels within shifts and their previous-night sleep characteristics.

BACKGROUND

Monitoring changes in fatigue and sleep is important to enable effective fatigue management.

METHODS

This was a descriptive, repeated-measures study. Data were collected using surveys and actigraphy 4 times during each consecutive shift (7:00 am-7:30 pm).

RESULTS

General fatigue levels started trending up 4 hours after the start of work; highest levels were reported at 7:30 pm. Fatigue levels accumulated across consecutive shifts. Subjective sleep quality was higher the night before the 2nd shift than the night before the 1st shift. Nurses' poor sleep the night before a shift was related to increased fatigue levels during the next shift.

CONCLUSION

It is important to consider when fatigue management interventions will be most effective and to consider previous-night's sleep when monitoring fatigue.

A quasi-experimental study into the effects of naps and therapy glasses on fatigue and well-being

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.