The impact of long work hours and shift work on cognitive errors in nurses

Impact of fly-in fly-out work on health behaviours and affective states: A daily diary study

Our knowledge about the role of fly-in fly-out (FIFO) work-related factors on the well-being of workers across the FIFO work cycle is limited. This study examined the within-person effects of job demand and control on psychological states and health behaviours. The study employed a daily diary design, with 23 FIFO workers in the Australian mining industry completing a daily diary survey for 28 consecutive days across on-shift and off-shift periods. Multilevel analyses showed FIFO workers experienced higher positive affect and enjoyed better sleep quality, but consumed more alcohol, during off-shift days as compared to on-shift days. Within-person variability in daily demand (workload) was associated with higher anxious affect, whereas job control predicted lower anxious and depressed affects, higher positive affect, more alcohol consumption, and more physical activity. The within-person effect of demand on anxious affect was moderated by job control such that those who generally had more control over their jobs had a smaller effect of demand on anxiety than those with less control. Results suggest potentially modifiable aspects of FIFO work-particularly job control-may help alleviate the impact of workload on poorer health behaviours and mood.

An examination of the usefulness of a quantitative appraisal method in nursing human resource management in primary hospital operating rooms: An example of integrated collaborative scheduling

In recent years, China medical and health services have made great development. However, the management of nursing human resources in operating room of primary hospitals still faces a series of challenges. In the nursing work of operating room, high-quality nursing human resource management is important for improving the efficiency of operating room and ensuring the safety of patients. From January 2022 to December 2022, comprehensive collaborative scheduling and quantitative scoring evaluation methods were carried out in our hospital, and relevant data were collected. The flexible scheduling combined quantitative scoring performance appraisal system and the traditional scheduling plus average distribution performance appraisal system were statistically analyzed and compared in terms of annual surgical cases, annual overtime hours, annual back work hours, annual compensatory rest hours, and average daily working hours. This study was based on 30 medical staff (27 females and 3 males) in the operating room of a primary hospital. The annual operation volume increased by 387 cases compared with before, and the attitudes of patients to the service attitude and preoperative waiting time were significantly improved, reaching more than 95%. In addition, in the survey of surgeons, it was found that their satisfaction with preoperative preparation and operation time was significantly higher than that of the traditional scheduling method, and reached more than 95%. In the survey of nursing staff, it was found that the satisfaction with the traditional scheduling method was about 80%, and the satisfaction directly reached 100% after the comprehensive collaborative scheduling system. Based on the above survey, the satisfaction of nurses, doctors and patients with the new comprehensive collaborative scheduling system has improved compared with before. After the implementation of the comprehensive collaborative scheduling system, the annual surgical volume has increased significantly, and the average daily working hours of nursing staff have decreased. Comprehensive collaborative scheduling is an effective method of nursing human resource management in operating room, which can effectively improve the work efficiency of nurses and the satisfaction of patients, doctors and nurses. In practice, this method needs to be continuously explored and refined to adapt to different application scenarios and requirements.

Relationship between shift work, night work, and headache and migraine risk: A meta-analysis of observational studies

BACKGROUND

To date, there is insufficient research on whether shift work and night work increase the risk of experiencing headaches and migraines.

OBJECTIVES

This study aimed to evaluate the potential association between shift work, night shift work, and headache/migraine.

METHODS

We conducted a thorough search of the PubMed, Embase, and Web of Science databases up until October 2023 to identify relevant studies. Our inclusion criteria focused on observational studies that investigated the association between shift work exposure and headache/migraine outcomes. We extracted adjusted risk estimates from each study and calculated pooled odds ratios using either fixed or random-effects models. Our methodology followed the Meta-Analysis Group guidelines for observational studies in epidemiology. To ensure accuracy and consistency, two investigators independently reviewed the retrieved records and extracted data based on the predefined inclusion criteria.

RESULTS

This meta-analysis included a total of seven studies involving 422,869 participants. The pooled analysis revealed a significant association between shift work and an increased risk of headaches (HR = 1.32, 95% CI: 1.15-1.52, P < 0.001). Specifically, individuals working night shifts had a 44% higher risk of developing headaches (HR = 1.44, 95% CI: 1.09-1.90, P = 0.011). Furthermore, shift work was also found to be associated with a higher incidence of migraines (HR = 1.63, 95% CI: 1.27-2.08, P < 0.001). Interestingly, night shift work was associated with a decreased incidence of migraines (HR = 0.74, 95% CI: 0.57-0.96, P = 0.024).

CONCLUSION

Our study found a noteworthy association between shift work/night work and the occurrence of headaches and migraines. However, it is important to note that our study does not establish a causal relationship. Future research should investigate potential common vulnerability factors, such as genetics or health behaviors. This knowledge can help inform the implementation of preventive measures and interventions to mitigate the health risks associated with shift work.

Effects of working conditions on the perception of night work safety and health effects on nurses

AIM

To examine night working conditions by shift work type and identify the effects of night working conditions on nurses' perceptions of shift work safety and health effects.

BACKGROUND

Night work is the main factor affecting nurses' health. However, the safety of night working conditions has not been sufficiently examined in previous studies.

METHODS

This study used a cross-sectional research design and an online survey using a tool released by the Australian Manufacturing Workers' Union, and the responses of 348 shift work nurses in Korea were analyzed. Logistic regression analysis was used to examine the effects of shift work conditions on the perceived safety of night work and health effects. The STROBE reporting guidelines were utilized, and data were collected from December 1 to December 31, 2021.

RESULTS

The adjusted logistic regression analysis showed that perceived threat to safety and the health effects of shift work were not significant according to shift type. However, night-shift-work nurses who worked alone (P = 0.003), lacked an emergency recovery system (P = 0.026), and had difficulty commuting perceived a threat to their health (P = 0.007). Additionally, nurses who experienced loss of concentration (P = 0.006) and inadequate rest time (P < 0.001) perceived the health effects of shift work.

DISCUSSION

Urgent monitoring of night work conditions is necessary for the 2-shift work type. Nurses must work night shifts together and an emergency system should be established for their safety.

CONCLUSION

Night work conditions should be improved to prevent the hazards of night work and its negative health effects on nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study suggests the necessity of a policy to enhance night work safety, including emergency coping systems and sufficient inter-shift rest time.

Leisure crafting and work engagement among Chinese ICU nurses: The multiple mediation effect of recovery experience and humanistic care ability

AIMS

Based on the conservation of resources theory, this study explored the intermediary role of intensive care unit (ICU) nurses' recovery experience and humanistic care ability between leisure crafting and work engagement.

BACKGROUND

As the ICU is an important life-saving department, the level of work engagement of nurses directly affect the quality of life and health outcomes of patients. Actively seeking countermeasures to improve the work engagement level of ICU nurses is of great significance to enhancing the nursing quality of the ICU. According to the theory of resource conservation, the resources owned by individuals are limited and must be replenished promptly and effectively to maintain relatively stable physical, mental, and working states. Therefore, determining ways for ICU nurses to supplement the consumed resources effectively and efficiently in a limited time to maintain a high level of work engagement is the main concern of this study.

METHODS

In this cross-sectional study from January 2023 to March 2023, 478 ICU nurses were recruited by convenience sampling. The survey tools included the Leisure Crafting Scale, the Utrecht Work Engagement Scale-9, the Caring Ability Inventory, and the Recovery Experience Questionnaire. Descriptive data and Pearson correlation coefficients were analyzed via SPSS 26.0 (IBM Corp.). PROCESS v4.0 (by Andrew F. Hayes) Macro Model 6 was applied to analyze the serial multiple mediator models. We used the STROBE checklist to report the results.

RESULTS

First, the results showed that leisure crafting, humanistic care ability, and recovery experience were positively correlated with work engagement. Second, recovery experience and humanistic care ability played a partially mediating role between leisure crafting and work engagement, respectively. Third, recovery experience and humanistic care ability also had a serial mediation effect between leisure crafting and work engagement.

CONCLUSION

The findings of the study indicated that improving nurses' active control of leisure time may have particularly positive effects on ICU nurses' work engagement through increasing recovery experience and humanistic care ability.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Administrators can formulate intervention measures to improve the leisure crafting level of ICU nurses, promote work-life balance, which enhances recovery and supports engagement with patient-focused humanistic care, and have a positive impact on the work engagement of ICU nurses.

Psychosocial ergonomics of the workplace of medical staff during the COVID-19 pandemic in three risk's dimensions: working hours, violence and the use of psychoactive drugs-a prospective pilot study

Introduction

Workplace ergonomics should also be considered in the context of psychosocial factors affecting the worker, which have a real impact on occupational risk. The present study examined psychosocial risk factors in medical personnel in three domains: working hours, violence and substance abuse.

Methods

The purpose of the present study is to assess the current state of psychosocial ergonomics of medical personnels by measuring occupational risks in the domains of: working hours, violence and psychoactive substance abuse. The survey is consisted of two parts: socio-demographic information of participants and participants' assements of psychosocial risk factors.

Results

In more than half of the respondents (52%), increased risk was identified in the domain of working hours. Nearly half of the respondents (49.6%) have an identified high risk in the domain of violence, and more than half of the respondents (52%) are at high risk in the domain of psychoactive substance abuse.

Discussion

Our findings show that the present psychosocial ergonomics of the Polish health system must be improved. The COVID-19 pandemic has been a compelling test to assess the current state. Our findings highlighted the fact that HCWs often worked overtime and that many cases of workplace violence and substance abuse were reported.

Barriers and Facilitators of Diet, Physical Activity Levels, and Sleep Among Nursing Undergraduates and Early-Career Nurses: A Qualitative Descriptive Study

PURPOSE

Mechanisms leading to burnout, associated with high turnover in nursing, may start as early as in nursing school. Given health habits (e.g., diet, physical activity, and sleep) can exacerbate or lessen the impact of burnout, this study examined current barriers and facilitators to healthy diet, physical activity levels, and sleep among nursing undergraduates (UGs) and early-career nurses (ECNs).

RESEARCH DESIGN

Qualitative descriptive study.

SAMPLE

25 nursing UGs and 25 ECNs (within 3 years of graduation) from a Southeastern college of nursing.

DATA COLLECTION AND ANALYSIS

After development of theory-informed interview guides, participants conducted interviews either in-person or by phone, which were audio-recorded and transcribed. Braun and Clarke's six-step thematic analysis was used to analyze the transcripts.

RESULTS

All but one (aged 54) UG was in their early 20s and ECNs were in their early to mid-20s. Most participants were white, females. Time and stress were the strongest barriers among UGs and ECNs for adherence to healthy diet, physical activity, although stress did act as a facilitator for physical activity in a subset of both UGs and ECNs. Shiftwork was a common barrier to healthy behaviors among ECNs.

CONCLUSION

The fact that the more common and stronger barriers to healthier behaviors among UGs and ECNs were the same give credence to the idea that processes associated with burnout begin during or before nursing education and are persistent.

Health and related behaviours of fly-in fly-out workers in the mining industry in Australia: a cross-sectional study

BACKGROUND

Fly-In Fly-Out (FIFO), which entails travelling mostly from the urban areas to stay and work in remote areas for designated periods and travel back home to spend designated days of leave, has become a common work arrangement in the mining sector globally. This study examined the mental and physical health of FIFO workers and described their health-related behaviours during on-and off-shift periods.

METHODS

A cross-sectional study was conducted with FIFO workers (N = 216) in the mining industry in Australia who completed an online survey. Paired t-test and McNemer's analysis examined the differences in health-related behaviours during workers' on-and off-shift days. Logistic regression examined the predictors of physical health and psychological distress status of FIFO workers.

RESULTS

Workers reported longer sleep duration (7.5 ± 1.5 h vs 6.3 ± 1.2 h, p < 0.001) and better sleep quality (78.2% vs 46.3%, p < 0.001) during off-shift nights than on on-shift nights. Smoking prevalence was 26.4%, and workers reported smoking a similar number of cigarettes per day during on-and off-shift days. Most workers reported drinking alcohol (86.1%) and more often at risky levels during off-shift than on-shift days (57.9% vs 34.3%, p < 0.001). Fruits and vegetable consumption was low but with higher vegetable intake during off-shift days (2.8 ± 1.4 vs 2.3 ± 1.3 serves, p < 0.001). Workers had good physical health status (91.2%), but 71.4% were overweight/obese and 33.4% indicated high levels of psychological distress. Working on long shifts (OR 6.63, 95% CI 1.84-23.91) and smoking (OR 7.17, 95% CI 2.67-19.26) were linked to high psychological distress.

CONCLUSIONS

The prevalence of psychological distress and risky health behaviours was high. Interventions should aim to reduce psychological distress and support multiple behaviour changes, considering FIFO work-related characteristics including long shift hours.

Work Organization Factors Associated With Nurses' Stress, Sleep, and Performance: A Pre-pandemic Analysis

Background

The COVID-19 pandemic put extreme stress on an already strained healthcare workforce. Suboptimal work organization, exacerbated by the pandemic, is associated with poor worker, patient, and organizational outcomes. However, there are limited qualitative studies exploring how the interconnections of work organization factors related to shift work, sleep, and work stress influence registered nurses and their work performance in the United States.

Purpose

We sought to understand how nurses perceive work organization factors that impact their performance. Knowledge in this area could direct efforts to implement policies and design tailored interventions to support nurses in the post-pandemic period.

Methods

We used a qualitative descriptive design with the Work, Stress, and Health framework as an overarching guide to understand the interconnectedness of work organization factors, work stress, and outcomes. Participants were randomly assigned to one of two anonymous, asynchronous virtual focus groups (i.e., threaded discussion boards) in 2019. Registered nurses (N = 23) working across the United States were recruited and engaged until data saturation was achieved. Directed content analysis was used to analyze the data.

Results

Findings aligned with the Work, Stress, and Health framework and revealed three themes: (1) "Our Voice Should Matter" (nurses' desire to have their voices heard in staffing policies); (2) "Tired But Wired" (the harmful cycle of work stress, rumination, and poor sleep); and (3) "We're Only Human" (nurses' physical, emotional, and mental exhaustion linked to critical performance impairments).

Conclusion

These findings underscore that high work stress and poor sleep were present before the pandemic and impacted nurses' perceptions of their performance. As leaders look forward to recovery and work redesign efforts, these findings can guide decision-making and resource allocation for optimal nurse, patient, and organization outcomes.

Effects of 90 Min Napping on Fatigue and Associated Environmental Factors among Nurses Working Long Night Shifts: A Longitudinal Observational Study

For nurses working long night shifts, it is imperative that they have the ability to take naps to reduce fatigue, and that an appropriate environment is prepared where such naps can be taken. We verified the effects of 90 min napping on fatigue and the associated factors among nurses working 16-h night shifts. We investigated 196-night shifts among 49 nurses for one month. Wearable devices, data logging devices, and questionnaires were used to assess nap parameters, fatigue, and environmental factors such as the napping environment, ways of spending breaks, and working environment. Nurses who nap at least 90 min on most night shifts had more nursing experience. Multivariable logistic regression analysis showed that the environmental factors significantly associated with total nap duration (TND) ≥ 90 min were noise, time spent on electronic devices such as cellphones and tablets during breaks, and nap break duration. The night shifts with TND ≥ 90 min showed lower drowsiness after nap breaks and less fatigue at the end of night shift compared to those with TND < 90 min. Nurses and nursing managers should recognize the importance of napping and make adjustments to nap for at least 90 min during long night shifts.

Because they're worth it? A discussion paper on the value of 12-h shifts for hospital nursing

The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses' wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses.

Effect of shift work on fatigue, reaction time and accuracy of nurses in the department of neurology: A cross-sectional observational study

AIMS

The purpose of our study was mainly to explore the effect of different shift work on cognitive and executive performance in a real clinical environment among nurses from China.

BACKGROUND

Working in shifts can disrupt circadian rhythm, resulting in reduced sleep duration, which can have a detrimental effect on cognitive function. To provide continuous service for patient care, shift work is often a special requirement for nurses. The Stroop test can be used to measure selective attention and reaction time during executive function. However, there have been limited studies about the effect of shift work on the cognitive performance of nurses by Stroop tests. Additionally, no study has been conducted in nurses working in shifts from China.

METHODS

Registered nurses in general ward, Department of Neurology, from West China Hospital of Sichuan University, were eligible and consecutively included if they were simultaneously responsible for the day, evening and night shifts on the shift work schedule. A fatigue questionnaire and Stroop tests were performed for each subject separately before and after three working shifts (morning, evening and night shift) to measure changes in fatigue, reaction time and accuracy.

RESULTS

Eighteen registered nurses (4 males and 14 females) were included in our study, with a median age of 25 years old. The fatigue degree was significantly increased after day and evening shifts (p=0.015 and <0.001, respectively). Compared with those in the preshifts, the reaction time in the neutral task and incongruent task was significantly quicker after the day shift (p=0.001, p<0.001) and night shift (p=0.008, 0.019). In contrast, the reaction time after the evening shift was mildly increased, although without significance. There was no significant difference in accuracy among the three different working shifts. In addition, there was a negative correlation between the fatigue score and reaction time on the incongruent task in the Stroop test before the day shift (r=-0.542, p=0.020). The fatigue score in the postday shift was found to be inversely related to working hours in the daytime (r=-0.500, p=0.034).

CONCLUSIONS

Our study showed that increased fatigue was found in nurses after day and evening shifts, and shift work can affect the reaction time after the evening shift. However, there was no significant difference in accuracy and a high level of attention could be maintained among the three working shifts, suggesting a highly developed sense of responsibility in our nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

In addition to focusing on the common adverse effects of evening or night shifts on nurses, fatigue in the day shift should be paid special attention to by the leadership in the nursing management. Also, nurse managers can implement specific strategies to reduce fatigue after the day shift by shortening the working hours in the daytime appropriately, setting rest periods in the day shift or dividing nurses into morning and afternoon shifts.

Effect of Shift Work on Cognitive Function in Chinese Coal Mine Workers: A Resting-State fNIRS Study

Aim: Pilot study to examine the impact of shift work on cognitive function in Chinese coal mine workers. Background: Shift work is commonly used in modern industries such as the coal industry, and there is growing concern over the impact that shift work has on miners’ work performance and personal well-being. Method: A total of 54 miners working three shifts (17 in morning shift, 18 in afternoon, and 19 in night shift) participated in this exploratory study. A resting-state fNIRS functional connectivity method was conducted to assess the cognitive ability before and after the work shift. Results: Results showed significant differences in cognitive ability between before and after the work shifts among the three-shift workers. The brain functional connectivity was reduced ranking as the night, afternoon, and morning shifts. Decreased brain functional connectivity at the end of the working shift was found compared with before in the morning and afternoon shifts. Opposite results were obtained during the night shift. The resting-state functional brain networks in the prefrontal cortex of all groups exhibited small-world properties. Significant differences in betweenness centrality and nodal local efficiency were found in the prefrontal cortex in the morning and night shifts. Conclusions: The current findings provide new insights regarding the effect of shift work on the cognitive ability of Chinese coal mine workers from the view of brain science.

The Impact of Rotating Night Shift Work and Daytime Recharge on Cognitive Performance Among Retired Nurses

Introduction

The exact relationship between long-term shift work (SW) and cognitive impairment (CI) has been poorly understood. The effects of the long-term rotating night SW (RNSW) combining daytime recharge (DTR) on cognitive function were investigated.

Methods

A total 920 retired nurses and 656 retired female teachers aged ≥50 years were analyzed. Participants who worked at least once per week for 8 hat night for more than 1 year were defined as the SW group, and those without a regular nighttime shift were defined as the control group. The associations among duration, frequency, and DTR of RNSW, and neuropsychological assessments were ascertained by regression models.

Results

Participants with RNSW had a significantly higher proportion of mild CI (MCI), both amnestic MCI (aMCI) (14.4% in 11–20 years, p &lt; 0.05, and 17.8% in &gt; 20 years, p &lt; 0.001) and non-amnestic MCI (naMCI) (8.1% in 11–20 years, p &lt; 0.05), as well as dementia (1.5% in 1–10 years, and 11.7% in &gt; 20 years, p &lt; 0.05) compared to controls (8.4% with aMCI, 4.4% with naMCI, and 7.0% with dementia, respectively). There were significant negative relationships between general times of night SW and scores of Mini-Mental State Examination (MMSE) (R squared = 0.01, p = 0.0014) and Montreal Cognitive Assessment (MoCA) (R squared = 0.01, p = 0.0054). Participants with ≥1 h of DTR and ≥ 11 years of RNSW were about 2-fold more likely to experience MCI compared with the subjects in the control group, especially with 3–5 h (odds ratio [OR]: 2.35; 95% confidence interval: 1.49–3.68, p &lt; 0.001).

Conclusion

The long-term RNSW was associated with a higher risk of CI, especially aMCI and dementia, and the problem cannot be improved by DTR.

Comparison of 12-Hour Biweekly Versus 6-Hour Weekly Shifts on Fatigue in Student Nurses

BACKGROUND

Some challenges affecting student nurse learning include student fatigue, clinical recovery time, and hindered clinical experiences due to students experiencing long clinical shifts.

AIM

The aim of this study was to evaluate the differences between 12-hour biweekly and 6-hour weekly shifts on student nurse fatigue.

METHODS

A descriptive research design was used with second-year nursing students (N = 80) upon completion of their clinical rotations of four distinct cohorts during 2019-2020. All students in these cohorts were invited to complete the Occupational Fatigue Exhaustion Recovery (OFER15) online survey, developed and validated to assess the full spectrum of fatigue.

RESULTS

There were no statistically significant differences in acute fatigue, chronic fatigue, or the inter-shift recovery subscale for the 6-hour and 12-hour clinical groups. Student nurses, like registered nurses, would likely prefer to choose between a 6-hour and 12-hour clinical shift depending on their individual circumstances. In the parameters of this study, there was no statistical significance in shift length and student nurse fatigue.

LINKING EVIDENCE TO ACTION

Student nurse fatigue levels can affect learning inside and outside of nursing clinical experiences. In this study, no statistical significances were found between 6-hour and 12-hour clinical experiences in second-year nursing students. Offering both the 6-hour and 12-hour clinical experiences provides flexibility for students, clinical sites, and the school of nursing.

Workplace Cognitive Failure among Nurses during the COVID-19 Pandemic

Numerous studies provide evidence of the physical and emotional strain experienced by nurses during the COVID-19 pandemic. However, little is known regarding the impact of this occupational strain on nurses’ cognitive function at work. The aim of this study was to identify factors associated with workplace cognitive failure in a sample of U.S. nurses during the COVID-19 pandemic. An online questionnaire was administered in May 2020 to Michigan nurses statewide via three nursing organizations (n = 695 respondents). Path analysis was conducted to test the parallel effects of frequency of contact with COVID patients and personal protective equipment (PPE) supply on workplace cognitive failure scores. Mediation effects of stress, sleep quality, secondary trauma, and work-related exhaustion were examined for each exposure. Results revealed significant indirect effects of all mediators except sleep quality of contact with COVID patients (cumulative indirect effect = 1.30, z = 6.33, p < 0.001) and PPE (cumulative indirect effect = −2.10, z = −5.22, p < 0.001) on cognitive failure. However, 58% of the PPE effect was direct. To reduce the risk of cognitive failure, healthcare organizations need to provide nurses with protective equipment and work environments that allow nurses to strengthen their resilience to extreme working conditions.

Health and well-being of rotation workers in the mining, offshore oil and gas, and construction industry: a systematic review

Introduction

Rotation work, characterised by travelling long distances to work in isolated areas where workers typically rotate consecutive days working and living on-site with periods at home, is increasingly used in the resources and construction sectors globally. Such employment practices may have an impact on workers’ health and well-being. This systematic review explores the impact rotation work has on mental and physical outcomes in rotation workers in the resources and construction sectors.

Method

The PubMed, Medline, EMBASE, CINAHL, PsycINFO, and Scopus databases were systematically searched on 1 May 2020 to identify quantitative, qualitative and mixed-method studies addressing the health of rotation workers published in peer-reviewed journals. Findings from the studies were summarised narratively.

Results

Of 6268 studies retrieved, 90 studies were included in the review. Studies suggested higher prevalence of psychological distress in onshore rotation workers and higher overweight/obesity rates among rotation workers as compared with the general population. We found more sleep problems and higher levels of smoking during work periods compared with off-site days; and higher alcohol intake during off-site days compared with on-site days. Workers generally perceived their physical health status as good. High-perceived job demands (such as workload, repetitive work) were associated with mental distress and exhaustion, sleep problems and perceived poor physical health status, while high-perceived job resources (such as job clarity/control, support) were associated with low mental distress and exhaustion, less smoking and alcohol intake, and better sleep.

Conclusion

Rotation work is associated with several poorer health behaviours and outcomes, such as sleep problems, smoking, alcohol consumption and overweight/obesity. Interventions needed to improve rotation workers’ health should include maximising available job resources and reducing job demands. Further longitudinal studies are needed to explore the long-term health effects of rotation work and the short-term contextual effects of the different aspects of rotation work.

Sleep, fatigue and alertness during working hours among rotating-shift nurses in Korea: An observational study

AIMS

To determine the effects of sleep parameters and fatigue on the decline in alertness of nurses across shifts.

BACKGROUND

Shift work can lead to nurse fatigue owing to insufficient sleep and inadequate recovery time between shifts. Nurse fatigue has adverse effects on alertness and can affect provision of quality care.

METHODS

An observational study using wrist actigraphs was conducted from 2019 to 2020. Participants were 82 rotating-shift nurses who provided direct nursing care in acute hospitals in South Korea. They wore actigraphs for 14 days to measure sleep parameters and predict hourly alertness and reported subjective fatigue before and after every shift.

RESULTS

Nurses demonstrated shorter sleep hours, lower sleep efficiency and longer sleep latency before night shifts compared with other shifts. Fatigue was the highest before day shifts. Sleep parameters and fatigue significantly affected the steep decline in alertness in participants with alertness scores below 70.

CONCLUSIONS

Sleep parameters and fatigue level contributed to the differences in decline in alertness across shifts.

IMPLICATION FOR NURSING MANAGEMENT

Findings inform nurse managers, administrators to develop interventions to reduce fatigue, improve sleep quantity and quality and increase alertness among rotating-shift nurses. Management, institutional and individual factors should be considered when developing interventions.

Sleep quality and work among nursing vocational students

OBJECTIVES

to analyze quality of sleep among students of technical courses in nursing according to the exercise of work activity.

METHODS

a cross-sectional and analytical research, with 213 students from Paraná. Characterization data and the Pittsburg Sleep Quality Index were collected between March and June 2020 and analyzed descriptively and inferentially.

RESULTS

quality of poor sleep was 76.5% among those who work and 75.3% among those who do not work. Difficulty in reconciling personal and academic life (p=0.016;adjOR:3.450) and indicating anxiety due to school activities (p=0.017;adjOR:3.236) increased the chances of poor sleep quality among working students. Satisfaction with health reduced the chances of poor sleep quality, regardless of exercising work activity (p=0.002;adjOR:0.210) or not (p=0.008;adjOR:0.215).

CONCLUSIONS

students who performed work activities have worse sleep quality due to anxiety and the multiple activities to be reconciled with the study.

Impact of Shift Work and Long Working Hours on Worker Cognitive Functions: Current Evidence and Future Research Needs

Particular working conditions and/or organization of working time may cause important sleep disturbances that have been proposed to be predictive of cognitive decline. In this regard, circadian rhythm misalignment induced by exposure to night work or long working hours would be responsible for cognitive impairment. Nevertheless, evidence supporting this correlation is limited and several issues still need to be elucidated. In this regard, we conducted a systematic review to evaluate the association between shift/night work and cognitive impairment and address its main determinants. Information provided by the reviewed studies suggested that night work might have serious immediate negative effects especially on cognitive domains related to attention, memory and response inhibition. Furthermore, cognitive performance would progressively worsen over consecutive night shifts or following exposure to very long work shifts. Otherwise, conflicting results emerged regarding the possible etiological role that night work chronic exposure would have on cognitive impairment. Therefore, circadian rhythm desynchronization, lack of sleep and fatigue resulting from night work may negatively impact worker’s cognitive efficiency. However, in light of the considerable methodological variability of the reviewed studies, we proposed to develop a standardized research and evaluation strategy in order to obtain a better and comprehensive understanding of this topic.

Registered nurses' perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study

BACKGROUND

Registered nurse has a vital role in delivering healthcare services to individual, family and community. One of the main challenges that health system facing globally is the shortage of nursing workforce. Vanuatu as a Pacific county is also facing the shortage issue and the impact on the registered nurses' performance.

METHODS

A qualitative study was used to collect data from 25 registered nurses in three randomly selected hospitals in Vanuatu between 4th to 14th September, 2020. A semi-structured open-ended questionnaire was used to collect data using face-to-face in-depth interviews. The data were transcribed and analyzed using thematic analysis process.

RESULTS

Four themes were identified including; Difficult working conditions, Reinforcing factors and Perceived risks. Sub themes for difficult working condition were heavy workload, lack of workforce and unusual working hours. Sub themes for reinforcing factors were lack of support, lack of opportunities and advancement in nursing practice. Sub themes for perceived risks were stress, physical and mental risk, and social and family risks.

CONCLUSION

This study has identify factors affected shortage of current nursing workforce and the impact it has on registered nurses. Broad themes and sub-themes were identified which highlighted the impact of nursing shortage to registered nurses and the effects on their performance which includes stress or moral distress from work overload and lengthy hours shift which impact the nurses' physical, psychological, social, and family relationship, and lack of leadership support. The findings can be helpful to policy makers at the decision-making level to resolve the nursing workforce shortage and its effects in the future by refining and developing relevant policies that will address and strengthen the nursing workforce to meet the demand and improve delivery of quality health services to all individual.

The Association Between Cognitive Medical Errors and Their Contributing Organizational and Individual Factors

BACKGROUND

Examining cognitive medical errors (MEs) and their contributing factors is vital in health systems research, as it provides baseline data that can be used to develop appropriate interventions to prevent and/or minimize errors. The primary aim of this study was to investigate the association between cognitive MEs and hospitals' organizational factors and the individual psychological and functional factors.

METHODS

This cross-sectional study was conducted in three main hospitals in Northern Jordan. A proportional sampling technique was employed to decide the number of participants from each hospital. Data from physicians and nurses (n=400) were collected using a self-administered questionnaire, which was developed based on pertinent literature review. Exploratory and confirmatory factor analyses were conducted to validate the study instrument. The relationships between the variables were analyzed through structural equation modeling (SEM) using AMOS. Multi-group analysis was also performed to examine the differences in the participants' perceptions towards the respective variables between the three selected hospitals.

RESULTS

Our results showed a non-significant negative association between MEs and hospital organizational factors. Also, the SEM analysis showed a positive significant correlation between MEs and psychological and functional factors, whereby excessive workload, complexity of tasks, stress, sleep deprivation, and fatigue were found to be predictors of MEs occurrence. In comparison to the results from the university hospital, the multi-group analysis results from the governmental public hospital and the private hospital showed a significant impact of psychological and functional factors on MEs.

CONCLUSION

To reduce the occurrence of MEs in hospitals, there is a need to enhance organizational safety culture. Efforts should be directed at both organizational and individual levels. Also, it is essential that health decision makers develop strategies to reduce work-related stress and improve healthcare staff well-being, as work stress may cause cognitive impairments among healthcare workers and hence threaten patients' safety.

Effect of shift work on working memory, attention and response time in nurses

Objective. The present study aimed to investigate the relationship between shift work and cognitive performance in nurses. Methods. The present before-after study included 35 female nurses 25-40 years old with similar mental and physical workload. Working memory, response time and attention were assessed using Wechsler and Stroop tests. The variables were measured at the beginning and the end of three working shifts (morning, afternoon and night). An interval of 3 days was considered for performing an after-shift test to eliminate the learning effect. Data were analyzed using repeated-measures analysis of variance (ANOVA). Results. At the end of all three shifts, nurses' working memory (p = 0.039) and interference score (p = 0.04) were significantly decreased, but their response time was not significantly affected during a shift. The decrease in working memory after the night shift was significantly higher than after the morning and evening shifts (p < 0.001). Conclusion. The results of this study showed that shift work can affect some aspects of cognitive function (working memory and attention) in nurses, and this effect was more prominent after a night shift.

Creating safety in care: Student nurses' perspectives

Nursing is often hazardous work. Promoting safety and care requires nurses to apply knowledge, skill and creativity in patient encounters. Nurses' risk exposures are well documented, with research on student nurses' safety more limited. We studied final-year nursing students' risk perceptions using questionnaire-based vignettes involving four patient presentations on patient aggression, manipulating patient and resource risk factors. We found student nurses were most likely to ask for help and wait when managing high-risk patient aggression scenarios. Student nurses placed most importance on their own safety and patient condition in making decisions. Resource risk significantly interacted with gender, with male nurses more likely to seek help when risks were high. There is need to improve student nurse training on managing patient aggression by promoting creative approaches to problem solving and critical thinking using simulation techniques to enhance situation awareness and translate knowledge to practice.

Vigilance and sleepiness in nurses working 12-hr shifts and their coping strategies

AIM

To describe the progression of vigilance and sleepiness over the shift and the coping strategies of nurses working 12-hr day or night shifts.

BACKGROUND

The spread of 12-hr shift work in nursing raises the question of whether sufficient vigilance can be maintained to ensure quality of care.

METHOD

18 nurses working 12-hr shifts filled out a Karolinska Sleepiness Scale questionnaire and a Brief Psychomotor Vigilance Test, at the beginning of the shift and then every 3 hr. Coping strategies and quality of care were assessed on self-administered questionnaires, filled out at 3 hr, 6 hr, 9 hr and 12 hr after the start of the shift.

RESULTS

The present investigation did not show significantly excessive sleepiness or vigilance impairment or poor self-perception of quality of work during 12-hr nursing work shifts, although Psychomotor Vigilance Test results gradually deteriorated slightly over duty time (from start to end of shift). Certain coping strategies were preferred such as 'having a nap' later in the night shift.

CONCLUSION

Attention needs to be paid to the health status of nurses working 12-hr shifts, with regular medical monitoring by the occupational health service.

IMPLICATIONS FOR NURSING MANAGEMENT

Coping strategies to maintain sufficient vigilance to ensure quality of care should be facilitated.

Health-related quality of life in pilots of a Chinese commercial airline

Health-related quality of life (HRQOL) is currently an important issue in the medical industry. However, data on HRQOL in commercial airline pilots are lacking. This study aimed to investigate HRQOL and its related factors in a sample of commercial pilots. A purposive sample of 373 participants was recruited from a Chinese Commercial Airline. The median (IQR) score for physical health, psychological health and social relationship were 64.3 (75-53.6), 62.5 (70.8-54.2) and 75 (75-58.3), respectively. The mean (SD) score for Environment was 62.2 (16). After controlling for demographics, the multiple linear regression analyses showed that physical activity, fruit intake and vegetable intake were positively correlated with HRQOL score (p < .05), while time-zone flights, smoking, alcohol drinking and being dyslipidemic showed a negative correlation with HRQOL score (p < .05). Healthcare providers should consider time-zone flights, behavioral factors and dyslipidemia when planning related health promotion and disease prevention programs for commercial pilots in the future.

The Moderating Role of Work-Related Rumination in Nurses’ Sleep Quality Trajectory During Morning Shift Work

Abstract. This diary study investigated nurses’ recovery after transitioning to morning shift work (i.e., their short-term adaptation to shift work) by examining the change trajectory of sleep quality over the course of five consecutive morning shifts. Results of latent growth analyses ( N = 132) showed that nurses’ sleep quality started at low levels and increased rapidly in the beginning until it stabilized toward the end of the shift work period. Moreover, work-related rumination moderated the sleep quality trajectory. When rumination was low, nurses’ sleep quality showed a quadratic trajectory, whereas when rumination was high, sleep quality showed a flatter and linear trajectory, suggesting that rumination impedes recovery after the transition and adaptation to morning shift work.

Mitigating the Adverse Effects of 12-Hour Shifts: Nursing Leaders' Perspectives

OBJECTIVE

The purpose of this study was to explore perspectives of nurse leaders regarding strategies to mitigate the job demands of 12-hour shift work and learn their views regarding the role of breaks in offsetting the cognitive and physical demands of acute care nurses working 12-hour shifts.

BACKGROUND

The strain of long shifts can result in adverse outcomes for nurses, organizations, and patients.

METHODS

A modified, 3-round, e-Delphi solicited input from nurse leaders. First, qualitative information about support and resources to mitigate the adverse effects of 12-hour shifts was collected, and then 2 subsequent rounds used consensus identification and item ranking to develop recommendations.

RESULTS

Findings reinforce that job demands of 12-hour shifts can be mitigated via staffing practices, quiet break spaces, and the opportunity to work with familiar patients.

CONCLUSIONS

Recommendations from this work may enhance patient safety, positive organizational outcomes, and a resilient and sustainable nursing workforce.

Impact of nurse's worked hours on medication administration near-miss error alerts

Long working hours have been shown to negatively impact adverse events in health care. In this study, a retrospective correlational design was used to evaluate the relationship between working hours and near-miss medication error alerts. During a two-year period, 5372 nurses triggered 420,706 near-miss alerts on 9, 285, 786 medication administrations. Nurses who worked 60 h or more in a week yielded an average near-miss rate of 4.0% compared to 3.0% (p <.001) for nurses who did not. Nurses working extended hours had a significantly increased risk of triggering a near-miss alert compared to those not working extended hours.

Subjective and objective sleep among air ambulance personnel

The present study aimed to investigate the effects of shift work on sleep among pilots and Helicopter Emergency Medical Service crew members (HCM) in the Norwegian Air Ambulance. Sleep was assessed by diaries and actigraphy during a workweek (24 h duty for 7 consecutive days) in the winter season and a workweek during the summer season in pilots and HCM (N = 50). Additionally, differences in sleep were studied between the week before work, the workweek, and the week after work in both seasons. Results indicated that bedtime was later (p <.001) and time spent in bed (p <.05) was shorter during the summer, compared to the winter, season. The workers delayed the sleep period in the workweek, compared to the week before (winter: p <.001, summer: p <.001) and the week after (winter: p <.05-.001, summer: p <.001). They spent more time in bed during the workweek, compared to the week before (winter: p <.001, summer: p <.01) and after (winter: p <.001, summer: p =.37). Further, the workers had longer wake after sleep onset during the workweek, compared to the week before (winter: p <.001, summer: p <.01) and the week after (winter: p <.01, summer: p <.01). Finally, the workers had lower sleep efficiency during the workweek recorded by actigraphy compared to the week before (winter: p <.01, summer: p <.001) and the week after (winter: p <.01, summer: p <.001). According to the sleep diaries the total sleep time was 7:17 h in the winter and 7:03 h in the summer season. Overall, the sleep was somewhat affected during the workweek, with delayed sleep period, longer wake after sleep onset, and lower sleep efficiency compared to when off work. However, the workers spent more time in bed during the workweek compared to the weeks off, and they obtained over 7 h of sleep in both workweeks. Our findings suggest that the pilots and the HCM sleep well during the workweek, although it affected their sleep to some extent.

Shift work and hospital employees: A descriptive multi-site study

BACKGROUND

Hospitals staff with 12-hour and other shift work patterns to account for daily and seasonal workload requirements. Research in healthcare and industries requiring shift work suggests there may be negative health consequences to the workers related to fatigue and other factors. Due to the 24/7 nature of healthcare, it is important to understand the impact of shift work on employees.

OBJECTIVES

The objectives of this study were to investigate how shift work impacts satisfaction with time for social and home activities, based on the Social and Domestic Survey, and chronic fatigue. In addition, an exploration of drowsy driving was undertaken.

DESIGN AND SETTING

This study was a multi-site, descriptive survey study, conducted in 4 acute care hospitals in one metropolitan area in the central United States.

PARTICIPANTS

Participants included healthcare workers in five 24/7 departments: nursing, respiratory therapy, laboratory, radiology and pharmacy.

METHODS

Measures included demographics, work characteristics, and scales including the: Social and Domestic Survey, Circadian Type Inventory, and Chronic Fatigue Scale along with data regarding drowsy driving and automobile accidents/near misses. Data were analyzed using descriptive statistics for sample characteristics. An exploratory factor analysis was conducted on the Social and Domestic Survey. Group differences were tested using Mann-Whitney U tests and regression analyses.

RESULTS

The sample included 1563 subjects (24% RR). The mean age was 40 years. Nursing comprised 77% of the sample, 88% were female, 85% were in a direct patient care role, 67% worked day shift, and 49% worked 12-hour shifts. Pay was important for working night shift, but home life was important for day shift. Night shift (p<0.001) and 12-hour shift workers (p<0.001) had higher chronic fatigue. However, after controlling for other factors, working night shift remained a significant predictor of chronic fatigue and lower satisfaction with time for daily tasks and family/social life, whereas working 12-hour shifts predicted higher satisfaction with daily tasks and periodic life activities. Thirty-five percent of workers reported altering their driving behavior at least half the time due to drowsy driving and 19% had an automobile accident or near miss due to drowsy driving.

CONCLUSIONS

Findings suggest that night and long shifts can have negative effects on fatigue, family, and social life. Drowsy driving and accidents/near misses frequently occur due to drowsy driving. Leaders should continue to study the 24/7 work environment and test measures to improve the safety of shift workers.

The effectiveness of bright light exposure in shift-worker nurses: A systematic review and meta-analysis

Bright light exposure is as one of the non-pharmacological measures to sleep management in shift-worker. This study was conducted to determine the effectiveness of bright light exposure in shift-worker nurses. We performed a systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and using existing literature in the following databases: Cochrane Library, Embase, PubMed, Scopus, Web of Science, to examine any eligible and relevant interventional (randomized controlled trial, experimental and quasi-experimental studies) which were published by December 31, 2018. The obtained documents were analyzed using Stata 14.1 and Cochrane Collaboration's RevMan 5.3. Five studies met eligibility criteria. Results from fixed-effect meta-analysis of the included studies revealed that the exposure could decrease the sleepiness levels, complaints related to shift-work, insomnia and increased the psychomotor error (95% confidence interval (CI): -0.87,-0.43, p=0.000, I²=98.6%), alertness and daytime sleep duration following night shifts (95% CI: 0.08,0.99, p=0.000, I²=92.7%). However, in the random effects model, none of them were statistically significant. Although the results of fixed-effect are in favor of beneficial effects of bright light exposure in shift-worker nurses, the random effects could not approve these findings. Maybe because of either large heterogeneity or insufficiency of the number of studies. Besides, because of the low number of studies, it was impossible to deal with high amount of heterogeneity using subgroup analysis or meta-regression. So the controversy on this topic continues to persist, which highlights the need for more well-designed randomized control trials with larger sample sizes in the future.

"It is really so exhausting": Exploring intensive care nurses' perceptions of 24-hour long shifts

AIM AND OBJECTIVES

To explore the perceptions and experiences of Cambodian ICU registered nurses regarding their working 24-hr shifts.

BACKGROUND

In Europe and the USA, nurses are moving to a 12-hr shift, and numerous studies have revealed the positive and negative effects of these. However, lesser known is the impact of 24-hr nursing shifts on care quality, and health and safety. In Cambodia, 100% of nurses are rostered for these in their shift patterns, but until this study no research had been conducted on such shifts.

DESIGN

A qualitative descriptive study.

METHOD

Three focus group discussions were conducted with 30 registered nurses in July 2019, ten in each group, from three intensive care units of three hospitals in Cambodia. Data saturation was obtained. Data were analysed using content analysis, and the COREQ was applied for reporting this study.

FINDINGS

The ICU nurses' perspectives revealed significant and unacceptable effects of working shifts of ~25-hr length, taking into account staff handover. Two major themes arose: It is so exhausting and Compromised hospital care. Alarmingly, participants worked on average 72 hr per week, were exhausted, and nursed between 6 and 10 critically ill patients per shift.

CONCLUSION

To our knowledge this is the first study on nurses working 24-hr shifts, revealing unacceptable, high risks for the health and safety of nurses and patients, with nursing activities left undone, and a lack of quality care.

RELEVANCE TO CLINICAL PRACTICE

Improving nurse and patient health and safety, and quality of care requires hospital leaders to work with government and nursing organisations to develop better shift strategies. Resources need to be provided so that: nurses can work a maximum 12-hr shifts; the ratio of nurses to patients is improved; and nurses can have decent break times. This has major implications, for not only practice, but also management, administration, budgets and education.

Shift work sleep disorder and job stress in shift nurses: implications for preventive interventions

BACKGROUND

A growing literature has revealed a relationship between shift-work, including night-shift, and the disturbance of sleep-wake cycle, leading to insomnia and/or increased daytime sleepiness in shift nurses; recent findings showed an association between shift work sleep disorders and distress, work accidents, decreased job performance and, consequently, lower quality of health service provision and lower standards of care.

OBJECTIVES

To analyze across the gender how shift nurses experience shift work sleep disorders and job stress.

METHODS

A cross-sectional study was performed following the STROBE Statement. The Italian version of the Job Content Questionnaire, the Bergen Insomnia Scale and the Epworth Sleepiness Scale were administered to the registered nurses employed in three Departments of General Practice and Elderly Care Medicine.

RESULTS

No significant association was found between high job strain and insomnia and daytime sleepiness. Significantly more women than men experienced high job strain, insomnia and daytime sleepiness; among women the level of social support was significantly and negatively associated with insomnia and daytime sleepiness.

CONCLUSIONS

The findings of this study suggest that interventions aimed to prevent shift work sleep disorder and job stress in shift-nurses should incorporate the assessment of social support across the gender. Moreover, longitudinal studies are required to evaluate the effectiveness of interventions targeted on social support to minimize the occurrence of insomnia and daytime sleepiness in shift nurses.

Occupational stress and cognitive failure of nurses and associations with self-reported adverse events: A national cross-sectional survey

AIM

To determine correlations for nurse self-reported occupational stress, prevalence of cognitive failure (CF), and adverse events.

DESIGN

Cross-sectional nationwide survey.

METHODS

Tertiary-level public hospitals (N = 115) from 13 provinces in Iran were recruited and 2,895 nurses surveyed (August 2016-December 2017). Participants' self-reported demographic information, occupational stress, CF, and frequency of adverse events were analysed using chi-square, t tests, and binary logistic regression.

RESULTS

This study showed that 29.1% of nurses had experienced adverse events in the past six months. Significant predictors for reported adverse events from logistic regression were 'Role stressors', 'Interpersonal relations stressors', and 'Action', while 'Working environment stressors' was protective for reported adverse events. Demographic predictors of adverse events were longer work hours and male gender, while those working in critical care units, general wards, and other wards had higher reported adverse events than for emergency wards.

CONCLUSIONS

Occupational stress and CF are associated with the reporting of adverse events. Further research is needed to assess interventions to address occupational stress and CF to reduce adverse events.

IMPACT

Adverse events compromise patient safety, lead to increased healthcare costs, and impact nursing staff. Higher self-reported adverse events were associated with higher reported stressors and CF. Understanding the factors that influence occupational stress, CF, and adverse events will support quality patient care and safety.

Night-shift nurses and drowsy driving: A qualitative study

BACKGROUND

Drowsy driving following the night shift is persistent among nurses resulting in elevated rates of vehicle crashes and crash-related injuries and deaths. While considerable effort has been dedicated to the development of countermeasures, implementation of these countermeasures in nursing has lagged behind other shift work oriented industries. Developing effective countermeasures for drowsy driving in nurses requires a thorough characterization of nurse's perceptions of drowsy driving and potential mitigations.

OBJECTIVE

The objective of this research was to elicit night shift nurses' perceptions of drowsy driving, countermeasures, and educational and technological interventions.

DESIGN

Perceptions were elicited through a semi-structured interview protocol. The protocol design was driven by previously identified research gaps. Questions focused on four topics: perceptions of drowsy driving, current practices and methods to mitigate drowsiness during the shift and commute, preferences and expectations for training on drowsiness management, and, preferences and expectations for technological mitigations.

SETTING

The data collection took place at a large urban hospital in Texas, USA.

PARTICIPANTS

Thirty night-shift nurses were recruited with voluntary sampling. No nurses declined to participate after initially consenting. The participants were male and female nurses who currently worked a 12 hour night shift. The nurses had between 1 and more than 20 years of experience and worked in a variety of units.

METHOD

The interview recordings were transcribed by the research team and entered into a qualitative data analysis software. Transcripts were analyzed by two independent coders with a grounded theory approach to identify common themes and subthemes across participants.

FINDINGS

Feelings of drowsiness typically manifested immediately following the shift or during the post work commute. Nurses responded to drowsiness by engaging in multiple ineffective countermeasures (e.g., listening to music) and effective countermeasures (e.g., naps) were used sparingly. Experiences and mitigation methods traversed through the nurses' social network although they did not always alter behavior. Nurses were uncertain but enthusiastic about educational and technological interventions preferring practical training and auditory interactive alerts.

CONCLUSIONS

The findings suggest a strong need for real time drowsiness interventions during or immediately prior to nurses' post work commutes. Nurses' enthusiasm for training and technology to prevent drowsy driving suggests high levels of readiness and acceptance for such interventions. Future work should focus on the development and implementation of practical training and technological interventions for drowsy driving in nurses.

Nurse staffing models in medical-surgical units of acute care settings: A cross-sectional study

BACKGROUND

Nurse staffing models have been developed across different countries to address nursing shortages and improve quality of nursing care. However, there is no published study that describes nurse staffing models in Ethiopian hospitals.

AIMS

To describe the existing staffing models for nursing practice in acute care units of two hospitals (one public and one private) in Ethiopia.

METHODS

A cross-sectional study was conducted from July to December 2018. A self-administered questionnaire was used to collect data such as shift patterns, hours worked, and number of patients cared for per shift. Unit-level data on nurse staffing were collected using a checklist developed specifically for this study.

RESULTS

Fifty-nine percent (59.9%) of participants reported that they worked six or seven days per week. On average, they worked 50 hours per week and 12% working over 60 hours per week. The number of patients they provided care for during their last shift ranged from four to 45 with an average of 13 patients.

CONCLUSION

This study demonstrates that nurses working in acute care settings in Ethiopia are typically working more than 40 hours per week and caring for many patients per shift, which has the potential to impact patient safety.

Effects of Nocturnal Sleep Quality on Diurnal Cortisol Profiles and Attention in Nurses: A Cross-Sectional Study

Objective:

Low sleep quality (LSQ) activates the hypothalamic–pituitary–adrenal (HPA) axis and is related to arousal. Nursing staff, who work in shifts, tend to exhibit LSQ, which affects the level of vigor after awakening. This study investigated the effects of nocturnal sleep quality on diurnal cortisol profiles and sustained attention in day-shift nurses.

Method:

This study adopted a prospective cross-sectional design. Participants were recruited from a university-affiliated hospital in northern Taiwan. In the initial stage of this study, the Chinese Pittsburgh Sleep Quality Index (PSQI) Questionnaire was administered to 199 participants to categorize them as either LSQ (PSQI > 5) or high sleep quality (HSQ; PSQI ≤ 5). Participants were then randomly sampled from the two groups. Nocturnal sleep data and four diurnal saliva samples were collected for each participant. Sustained attention was measured before they started work. A total of 32 and 29 participants in the HSQ and LSQ groups, respectively, completed the data collection process.

Results:

Compared with the HSQ group, the LSQ group exhibited earlier wake-up times ( p = .02), a flatter cortisol awakening response (CAR) slope ( p < .01), a flatter morning-to-evening slope ( p < .01), and prolonged reaction speed and mean reaction time before starting work ( p < .01).

Conclusion:

Compared with the HSQ group, the LSQ group exhibited impaired HPA-axis regulation, with a flatter CAR and diurnal cortisol slope and poor sustained attention in the morning. Nursing staff are advised to achieve HSQ to improve attention and performance levels and maintain optimum work safety.

Association between sleep and fatigue in nurses who are engaged in 16 h night shifts in Japan: Assessment using actigraphy

AIM

To determine the association between sleep and fatigue in nurses who are working in a two-shift system, including 16 h night shifts.

METHODS

Sixty-one nurses were assessed on their sleeping and napping over 9 days, using actigraphy and a sleep diary. Work-related feelings of fatigue were measured by using the "Jikaku-sho shirabe" questionnaire and the Cumulative Fatigue Symptoms Index.

RESULTS

The main night-time sleep started after 00:00 hours in half of the participants and the average start and end times were significantly delayed among the participants in their 20s, compared to those in their 40s . Although ~90% of the participants napped during and/or after a night shift, only 50.8% napped for >2 h during their shift and 32.8% napped in the morning after a night shift. In the high-fatigue group, significantly more nurses went to sleep after 00:25 hours than before 00:26 hours the night after a night shift. Furthermore, those nurses who napped for >2 h during their night shift exhibited a significantly lower rate of some cumulative fatigue symptoms, compared to those who did not. In addition, a combination of napping in the morning after a night shift and beginning the following night-time sleep before 00:26 hours were associated with a significant decrease in fatigue symptoms.

CONCLUSIONS

Naps at an appropriate time and of an appropriate duration, along with the practice of beginning the night-time sleep early after a night shift, might relieve cumulative mental fatigue in nurses who are working 16 h night shifts.