Shift work--problems and its impact on female nurses in Udaipur, Rajasthan India

Influence of shift work on sleep quality and circadian patterns of heart rate variability among nurses

Background

Shift work implementation is essential for providing continuous patient care in hospitals. However, working in shifts on a routine basis may disrupt the circadian pattern and alter the sleep-wakefulness cycle in nurses. Stress due to shift work can influence the adaptability of the cardiovascular system, produce psychophysiological strain and deteriorate work performance in female nurses.

Objective

This study investigated the effect of morning and night shift work on sleep quality and circadian patterns governing heart rate variability (HRV) in female nurses working in a tertiary care hospital.

Methods

Thirty-eight healthy female nurses were recruited. Frequency and time domain parameters of HRV were recorded as markers of cardiac autonomic function. A student t-test was used to investigate differences in HRV between morning and night shift workers. Mann-Whitney non-parametric test was applied for the difference between Pittsburgh Sleep Quality Index (PSQI) scores in the two groups.

Results

Standard deviation of the normal-to-normal interval (SDNN) (msec), total power (ms2) and high-frequency (HF) band power (ms2) were significantly reduced in night shift nurses than in morning shift nurses. The low-frequency (LF)/HF ratio was significantly increased in night shift nurses. The differences in standard deviation of the averages of NN intervals (SDaNN) (msec), root mean square of successive differences between adjacent NN intervals (RMSSD), mean NN, very low-frequency (VLF) band power (ms2) and LF band power (ms2) were not statistically significant. The global PSQI score was significantly higher among night shift workers than in morning shifts.

Conclusion

Inadequate sleep can disrupt the body's ability to regulate heart rhythm and increase the risk of cardiovascular diseases and mortality. The research suggests a propensity for autonomic imbalance in night shift workers when compared to their counterparts on morning shifts.

Human resource shortage in India's health sector: a scoping review of the current landscape

BACKGROUND

For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage.

METHODS

A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the "descriptive-analytical" method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems.

RESULTS

A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies (n = 27) whereas 69.3% of studies (n = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India.

CONCLUSION

There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.

Differences in nutritional profile by chronotype among 12-h day shift and night shift nurses

Acute care nurses may suffer substantial fatigue if working night shift or if assigned a shift contrasting their preferred sleep-wake patterns, called chronotype. Nurses are at higher risk for diet-related, metabolic diseases compared to other healthcare professionals. Yet, the impact of preferred chronotype and mismatch to assigned shift on nutritional intake and risk for metabolic disease among acute care nurses is unclear. This observational study analyzed dietary data from 52 acute care nurses. Participants completed the revised morningness-eveningness questionnaire which gives a total score between 4 and 26. Lower scores (<12) were flagged as evening type (E-type), higher scores (>17) defined as morning type (M-type), and scores between 12 and 17 were categorized as neither types (N-type). N-type participants were considered chronotype matched when assigned to either shift, whereas E-types were only considered matched if assigned to night shift, and M-types matched only if assigned to day shift. Participants also recorded all dietary intake for 7 d (reflecting a typical workweek) in the MyFitnessPal phone application. Findings indicated that eveningness nurses had markers of MetS, including a significantly larger body mass index and waist circumference than N-types (p < 0.05). E-types also consumed, on average, more calories than other chronotypes (m = 1833.7 kcal), although this was not a statistically significant finding. Mismatched day (n = 7, 13.4%) and night (n = 5, 9.6%) nurses in our sample consumed, on average, more calories (m = 1935.1 kcal, m = 1981.2 kcal, respectively) than matched day (n = 24, 46.2%, m = 1642.6 kcal) or night (n = 16, 30.8%, m = 1599.1 kcal) nurses, although this finding was not statistically significant. Mismatched day nurses consumed significantly less fiber than day matched nurses (median = 10.9 g versus median = 18.5 g, p = 0.04), while night mismatched consumed significantly more fiber compared to night matched (median = 21 g versus median = 12.2 g, p = 0.05) nurses. Participant diets overall did not follow recommendations by the United States Department of Agriculture (USDA), who consumed a higher percentage of calories from saturated fats and a smaller percentage of calories from fiber, habits which increase risk for metabolic syndrome. Further research surrounding nutritional pathways utilizing larger samples is needed to uncover relationships with metabolic syndrome especially for eveningness-type nurses or if working a shift mismatched with preferred chronotype.

Nurses' experiences and preferences around shift patterns: A scoping review

Objective

To explore the evidence on nurses’ experiences and preferences around shift patterns in the international literature.

Data sources

Electronic databases (CINHAL, MEDLINE and Scopus) were searched to identify primary studies up to April 2021.

Methods

Papers reporting qualitative or quantitative studies exploring the subjective experience and/or preferences of nurses around shift patterns were considered, with no restrictions on methods, date or setting. Key study features were extracted including setting, design and results. Findings were organised thematically by key features of shift work.

Results

30 relevant papers were published between 1993 and 2021. They contained mostly qualitative studies where nurses reflected on their experience and preferences around shift patterns. The studies reported on three major aspects of shift work: shift work per se (i.e. the mere fact of working shift), shift length, and time of shift. Across all three aspects of shift work, nurses strive to deliver high quality of care despite facing intense working conditions, experiencing physical and mental fatigue or exhaustion. Preference for or adaptation to a specific shift pattern is facilitated when nurses are consulted before its implementation or have a certain autonomy to self-roster. Days off work tend to mitigate the adverse effects of working (short, long, early or night) shifts. How shift work and patterns impact on experiences and preferences seems to also vary according to nurses’ personal characteristics and circumstances (e.g. age, caring responsibilities, years of experience).

Conclusions

Shift patterns are often organised in ways that are detrimental to nurses’ health and wellbeing, their job performance, and the patient care they provide. Further research should explore the extent to which nurses’ preferences are considered when choosing or being imposed shift work patterns. Research should also strive to better describe and address the constraints nurses face when it comes to choice around shift patterns.

Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review

Shift workers often experience reduced sleep quality, duration and/or excessive sleepiness due to the imposed conflict between work and their circadian system. About 20-30% of shift workers experience prominent insomnia symptoms and excessive daytime sleepiness consistent with the circadian rhythm sleep disorder known as shift work disorder. Individual factors may influence this vulnerability to shift work disorder or sleep-related impairment associated with shift work. This paper was registered with Prospero and was conducted using recommended standards for systematic reviews and meta-analyses. Published literature that measured sleep-related impairment associated with shift work including reduced sleep quality and duration and increased daytime sleepiness amongst healthcare shift workers and explored characteristics associated with individual variability were reviewed. Fifty-eight studies were included. Older age, morning-type, circadian flexibility, being married or having children, increased caffeine intake, higher scores on neuroticism and lower on hardiness were related to a higher risk of sleep-related impairment in response to shift work, whereas physical activity was a protective factor. The review highlights the diverse range of measurement tools used to evaluate the impact of shift work on sleep. Use of standardised and validated tools would enable cross-study comparisons. Longitudinal studies are required to establish causal relationships between individual factors and the development of shift work disorder.

Night Shift Work and Its Health Effects on Nurses

The purpose of this research was to study night shift work and its health effects on nurses. This was a quantitative study using descriptive design; it also incorporated three qualitative open-ended questions to complement the study. The data were collected using Survey Monkey, with an Internet-based confidential data collection tool. The population of relevance to this study was nurses employed in hospital settings in the United States. E-mail addresses and Facebook were used to recruit participants. Results indicated that there is an increased risk of sleep deprivation, family stressors, and mood changes because of working the night shift. Rotating shifts were mentioned as a major concern for night shift nurses. Respondents agreed that complaints about fatigue and fatigue-related illnesses in night shift workers were ignored. There was also a general perception among nurses working the night shift that sleep deprivation leads to negative health consequences including obesity; however, they were not as high a concern as rotating shifts or fatigue.

Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial

OBJECTIVE

To compare the efficacy of experimental auriculotherapy and placebo auriculotherapy with sham points for the treatment of stress in nurses of a charity hospital in São Paulo.

METHOD

Randomized, single-blind, controlled trial. The sample consisted of 168 nurses with medium and high stress levels according to the List of Stress Symptoms (LSS). The participants were randomized to three groups: Auriculotherapy (G1), Placebo (G2) and Control (G3). Groups 1 and 2 received 12 sessions, twice a week. The points used in Group 1 were: Shenmen and Brainstem; in Group 2 the points were: External Ear and Face Area. The three groups were evaluated at baseline, after eight sessions, 12 sessions and in a follow-up (after 15 days).

RESULTS

Group 1 achieved a 43% reduction and a 1.81 Cohen d index (high effect), presenting statistical difference after eight sessions, maintained in the follow-up evaluation (p <0.001), according to Analysis of Variance. Group 2 achieved a 26% reduction, with Cohen's d index of 0.86 (great effect), achieving a difference after 12 sessions (p<0.001), maintained in the follow-up (p <0.05). The G3 did not present stress reduction.

CONCLUSION

Experimental auriculotherapy achieved greater stress reduction among nurses, but there was no statistical difference between the two intervention groups. Brazilian Registry of Clinical Trials: RBR-req2792.

Relationship Between Shift Work and Personality Traits of Nurses and Their Coping Strategies

BACKGROUND & OBJECTIVE

Because of social progress, population growth, industrialization, and the requirements of some jobs, a significant percentage of employees are working in shifts. Shift work is considered a threat to health that could have unfavorable effects on various aspects of human life. This study investigated the relationship between shift work and the personality traits of nurses and their coping strategies in a selection of non-governmental hospitals in Tehran in 2014.

METHODS

This applied cross-sectional descriptive research employed the Standard Shift work Index and Eysenck Personality Questionnaire (EPQ) which, after confirmation of its validity and reliability (Cronbach's alpha 0.73), were distributed among 305 nurses from 6 non-governmental hospitals in Tehran selected through cluster random sampling. Data was analyzed in two statistical levels: descriptive and inferential.

RESULTS

Results revealed that 43.6% of the nurses participating in the study were introverted and 56.4% were extroverted. There are significant relationships between age and physical health (P=0.008), sex and physical health (P=0.015), educational level and physical health (P=0.014), sex and cognitive, somatic anxiety (P=0.006), age and social-family status (P=0.001), marital status and social-family status (P=0.001), having a second job and social-family status (P=0.001), educational level and sleep and fatigue (P=0.002), work experience and coping strategies (P=0.044), and sleep and fatigue and personality traits (P=0.032).

CONCLUSION

Complying with the standards of working hours for nurses and avoiding overtime when scheduling, especially for nurses with more work experience, can prevent the severe complications of shift work, enhance health, and ultimately enhance the quality of care. By improving the physical, psychological, and social health of nurses, the quality of patient care can be expected to improve, too.

Understanding the health behaviors of India’s information technology and business process outsourcing employees

Purpose

– The purpose of this paper is to investigate the behaviors of India’s information technology (IT) and business process outsourcing (BPO) employees in relation to diet, exercise, sleep, stress, and social habits.

Design/methodology/approach

– This was a qualitative research study, using in-depth, semi-structured interviews. Descriptive data were collected from a two-stage purposive sample of 28 IT-BPO employees from three IT companies and two BPOs in Bangalore, India.

Findings

– The majority of interviewees reported having an unhealthy diet and/or sedentary lifestyle. Lack of time due to demanding work schedules was the largest barrier to diet and exercise. Call-centers were described as a social environment with a young workforce.

Research limitations/implications

– Given the qualitative study design and limited sampling frame, results may not be generalizable. However, the qualitative data suggests that India’s young IT-BPO employees may be at greater risk of lifestyle-related diseases than the general population. The data also suggests that interventions incorporating social influence may be a promising solution, particularly at international call centers.

Originality/value

– There is a lack of literature on the lifestyle of IT-BPO employees in India. The results from this study provide qualitative insight on the motives for health behaviors of IT-BPO employees, as well as the barriers and facilitators for leading a healthy lifestyle in this industry. The findings provide the framework for future workplace wellness interventions.