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Debets MPM, Tummers FHMP, Silkens MEWM, Huizinga CRH, Lombarts KMJMH, van der Bogt KEA. Doctors' alertness, contentedness and calmness before and after night shifts: a latent profile analysis. Hum Resour Health 2023; 21:68. [PMID: 37605244 PMCID: PMC10441714 DOI: 10.1186/s12960-023-00855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND While night shifts are crucial for patient care, they threaten doctors' well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate the adverse effects of night shifts. This study aimed to obtain more precise insight into doctors' feelings surrounding night shift by: identifying profiles based on doctors' alertness, contentedness and calmness scores before and after night shifts (research question (RQ) 1); assessing how doctors' pre- and post-shift profiles change (RQ2); and determining associations of doctors' demographics and shift circumstances with alertness, contentedness and calmness change (RQ3). METHODS Latent Profile Analysis using doctors' pre- and post-shift self-rated alertness, contentedness and calmness scores was employed to identify pre- and post-shift profiles (RQ1). A cross-tabulation revealed pre- and post-shift profile changes (RQ2). Multiple regressions determined associations of demographics (i.e. age, sex, specialty) and night shift circumstances (i.e. hours worked pre-call, hours awake pre-call, shift duration, number of consecutive shifts, total hours of sleep) with alertness, contentedness and calmness change (RQ3). RESULTS In total, 211 doctors participated with a mean age of 39.8 ± 10 years; 47.4% was male. The participants included consultants (46.4%) and trainees (53.6%) of the specialties surgery (64.5%) and obstetrics/gynaecology (35.5%). Three pre-shift (Indifferent, Ready, Engaged) and four post-shift profiles (Lethargic, Tired but satisfied, Excited, Mindful) were found. Most doctors changed from Ready to Tired but satisfied, with alertness reducing most. Age, specialty, sleep, shift duration and the number of consecutive shifts associated with alertness, contentedness and calmness changes. CONCLUSIONS The results provided nuanced insight into doctors' feelings before and after night shifts. Future research may assess whether specific subgroups benefit from tailored interventions.
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Affiliation(s)
- Maarten P M Debets
- Research Group Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Fokkedien H M P Tummers
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gyneacology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Milou E W M Silkens
- Department of Health Services Research and Management, City University of London, London, United Kingdom
| | - Coen R H Huizinga
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kiki M J M H Lombarts
- Research Group Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Koen E A van der Bogt
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
- University Vascular Centre Leiden, The Hague, The Netherlands
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Hamieh N, Airagnes G, Descatha A, Goldberg M, Limosin F, Roquelaure Y, Lemogne C, Zins M, Matta J. Atypical working hours are associated with tobacco, cannabis and alcohol use: longitudinal analyses from the CONSTANCES cohort. BMC Public Health 2022; 22:1834. [PMID: 36175874 PMCID: PMC9523930 DOI: 10.1186/s12889-022-14246-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study examined prospective associations between atypical working hours with subsequent tobacco, cannabis and alcohol use as well as sugar and fat consumption. METHODS In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use. Among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use when appropriate. RESULTS Working at night was associated with decreased smoking cessation and increased relapse in women [odds ratios (ORs) of 0.81 and 1.25], increased cannabis use in men [ORs from 1.46 to 1.54] and increased alcohol use [ORs from 1.12 to 1.14] in both men and women. Weekend work was associated with decreased smoking cessation in women [ORs from 0.89 to 0.90] and increased alcohol use in both men and women [ORs from 1.09 to 1.14]. Non-fixed hours were associated with decreased smoking cessation in women and increased relapse in men [ORs of 0.89 and 1.13] and increased alcohol use in both men and women [ORs from 1.12 to 1.19]. Overall, atypical working hours were associated with decreased sugar and fat consumption. CONCLUSIONS The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.
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Affiliation(s)
- Nadine Hamieh
- grid.7429.80000000121866389INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
| | - Guillaume Airagnes
- grid.7429.80000000121866389INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculty of Health, School of Medicine, Université Paris Cité, F-75006 Paris, France ,grid.414093.b0000 0001 2183 5849AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Centre Ambulatoire d’Addictologie, Hôpital européen Georges-Pompidou, F-75015 Paris, France
| | - Alexis Descatha
- grid.411147.60000 0004 0472 0283Poison Control Center, Academic Hospital CHU Angers, F-49000 Angers, France ,grid.7252.20000 0001 2248 3363Univ Angers, Centre Hospitalier Universitaire CHU Angers, Université de Rennes, INSERM, École des hautes études en santé publique, Institut de recherche en santé, environnement et travail Irset UMR_S 1085, F-49000 Angers, France ,grid.512756.20000 0004 0370 4759Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, USA
| | - Marcel Goldberg
- grid.7429.80000000121866389INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculty of Health, School of Medicine, Université Paris Cité, F-75006 Paris, France
| | - Frédéric Limosin
- grid.512035.0Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, F-75014 Paris, France ,grid.413885.30000 0000 9731 7223AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Service de psychiatrie et d’addictologie de l’adulte et du sujet âgé, Hôpital Corentin-Celton, F-912130 Issy-les-Moulineaux, France
| | - Yves Roquelaure
- grid.7252.20000 0001 2248 3363Univ Angers, Centre Hospitalier Universitaire CHU Angers, Université de Rennes, INSERM, École des hautes études en santé publique, Institut de recherche en santé, environnement et travail Irset UMR_S 1085, F-49000 Angers, France ,grid.7252.20000 0001 2248 3363University of Angers, Centre Hospitalier Universitaire d’Angers, Université de Rennes, Centre de consultations de pathologie professionnelle et santé au travail, F-49000 Angers, France
| | - Cédric Lemogne
- grid.512035.0Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, F-75014 Paris, France ,grid.411394.a0000 0001 2191 1995AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l’adulte, Hôpital Hôtel-Dieu, F-75004 Paris, France
| | - Marie Zins
- grid.7429.80000000121866389INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Faculty of Health, School of Medicine, Université Paris Cité, F-75006 Paris, France
| | - Joane Matta
- grid.7429.80000000121866389INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
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Patterson PD, Liszka MK, Mcilvaine QS, Nong L, Weaver MD, Turner RL, Platt TE, Opitz SE, Guyette FX, Martin-Gill C, Weiss LS, Buysse DJ, Callaway CW. Does the evidence support brief (≤30-mins), moderate (31-60-mins), or long duration naps (61+ mins) on the night shift? A systematic review. Sleep Med Rev 2021; 59:101509. [PMID: 34116386 DOI: 10.1016/j.smrv.2021.101509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/15/2022]
Abstract
We performed a systematic review of four databases to determine if the evidence supports a short or long duration nap during night shifts to mitigate fatigue, and/or improve health, safety, or performance for emergency services and public safety personnel (PROSPERO CRD42020156780). We focused on experimental research and evaluated the quality of evidence with the grading of recommendations, assessment, development, and evaluation (GRADE) framework. We used the Cochrane Collaboration's risk of bias tool to assess bias and reported findings using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Our search yielded n = 10,345 records and n = 44 were reviewed in full-text. Inter-rater agreement during screening was substantial (Kappa = 0.66). We retained n = 11 publications, reporting on n = 7 experimental studies with a cumulative sample size of n = 140. We identified wide variation in study design, napping interventions (i.e., timing, placement, and duration), and outcomes. We identified mixed findings comparing brief, moderate, and long duration naps on outcomes of interest. All seven studies presented serious risk of bias and the quality of evidence was rated as low. Based on the best available evidence, decisions regarding nap duration during night shift work should be based on time (post-nap) and outcome.
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Affiliation(s)
- P Daniel Patterson
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA; University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA.
| | - Mary K Liszka
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Quentin S Mcilvaine
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Lily Nong
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, MA, 02115, USA; Harvard Medical School, Division of Sleep Medicine, Boston, MA, 02115, USA
| | - Rose L Turner
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, PA, 15261, USA
| | - Thomas E Platt
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Samantha E Opitz
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Francis X Guyette
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Christian Martin-Gill
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Leonard S Weiss
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Daniel J Buysse
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, 15261, USA
| | - Clifton W Callaway
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
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Thun E, Waage S, Bjorvatn B, Moen BE, Vedaa Ø, Blytt KM, Pallesen S. Short sleep duration and high exposure to quick returns are associated with impaired everyday memory in shift workers. Nurs Outlook 2021; 69:293-301. [PMID: 33127075 DOI: 10.1016/j.outlook.2020.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/01/2020] [Accepted: 09/16/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the relationship between self-reported everyday memory problems the last month, and: (a) shift work schedule, (b) night shifts and quick returns worked the last year, and (c) sleep duration the last month. METHODS In all, 1,275 nurses completed the Everyday Memory Questionnaire - revised, and answered questions about shift work exposure and sleep duration. We performed multiple linear regression analyses with memory score as dependent variable, and the shift work exposure variables as well as sleep duration as predictors, while adjusting for potential confounders. FINDINGS High exposure to quick returns (β = .10, p < .05) and short sleep duration (β = .10, p < .05) were both positively associated with memory problems, whereas shift work schedule, long sleep duration, night shift exposure, and low and moderate exposure to quick returns were not. DISCUSSION Frequent insufficient time for rest between shifts as well as short sleep was associated with poorer everyday memory.
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Dobrowolska B, Zec A, Tosoratti J, Machul M, Pokorná A, Nascimento C, Ferrão S, Ziakova K, Solgajova A, Rybarova L, Achil I, Palese A. Night shifts as a learning experience among nursing students across Europe: Findings from a cross-sectional survey. Nurse Educ Today 2020; 90:104441. [PMID: 32416320 DOI: 10.1016/j.nedt.2020.104441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Organising clinical placements during nights has been reported as an additional opportunity to introduce students to the whole picture of their future responsibilities. However, studies in this field are still lacking. OBJECTIVES To describe and compare (a) the night shift experience of nursing students across Europe, (b) the patient-related problems that they face during night shifts, (c) the night care activities nursing students are called to perform, and (d) the perceived effects of night shift work on learning outcomes. DESIGN A cross-sectional study, 2016. SETTINGS Five European countries: Czech Republic, Italy, Poland, Portugal, and Slovakia. PARTICIPANTS Nursing students from nine Bachelor of Nursing Science degree programmes attending night shifts during their study period and who were willing to participate were included. A total of 907 out of 1347 (67.3%) eligible students participated. METHODS Questionnaire based on the available literature, translated into five languages. RESULTS The duration of the night shift was from an average of 9.8 (CI 95% 9.6-10.0) in Italy to 11.9 (CI 95% 11.7-12.0) in the Czech Republic. Students faced mainly patients' pain without statistical differences across countries (at the overall level, 717 out of 907; 79%; p = .318). However, significant differences in the tasks performed during nights emerged: Polish students reported being more involved in performing basic nursing care (72; 93.5%) as compared to other countries (e.g., Portuguese students 337; 84.9%), (p = .02). Overall, an average of 28.9% of the night shift time was reported to be free of commitments, with higher values among Polish (38%, CI 95% 33.6-42.3) and Slovakian students (33.4%, CI 95% 30.6-36.3) and lower values among Czech Republic students (20.4%, CI 95% 17.6-23.2) (p .001). Boredom and satisfaction were reported as the main feelings during night shifts, with significant differences (p .001) across countries. Students reported significant different effects (p .001) of night shifts on their understanding of a nurse's role (from 5.2 out of 10 in Poland to 6.5 in the Czech Republic), on the understanding of the continuity of nursing care (from 5.2 in Poland to 6.7 in Italy), and on having a relationship with the clinical mentors (from 2.7 and 4.2 in Poland and the Czech Republic, respectively, to 6.9 in Italy). CONCLUSIONS Night shifts can be both a valuable and a non-valuable learning experience, suggesting the need to carefully plan and assess their effectiveness at the unit level.
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Affiliation(s)
- Beata Dobrowolska
- Department of Development in Nursing, Faculty of Health Sciences, Medical University of Lublin, Staszica Street 4-6, 20-081 Lublin, Poland.
| | - Aleksandra Zec
- Department of Medical Sciences, University of Udine, Viale Ungheria, 20, 33100 Udine, Italy.
| | - Jessica Tosoratti
- Department of Medical Sciences, University of Udine, Viale Ungheria, 20, 33100 Udine, Italy.
| | - Michał Machul
- Department of Development in Nursing, Faculty of Health Sciences, Medical University of Lublin, Staszica Street 4-6, 20-081 Lublin, Poland.
| | - Andrea Pokorná
- Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University Kamenice 3, Brno, Czech Republic.
| | - Carla Nascimento
- Escola Superior de Enfermagem de Lisboa, Avenida Prof Egas Moniz, 1600-190 Lisboa, Portugal.
| | - Sónia Ferrão
- Escola Superior de Enfermagem de Lisboa, Avenida Prof Egas Moniz, 1600-190 Lisboa, Portugal.
| | - Katarina Ziakova
- Department of Nursing, Medical Faculty of Jessenius in Martin, Comenius University in Bratislava, Mala Hora 5, 03601 Martin, Slovakia.
| | - Andrea Solgajova
- Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Kraskova 1, 94974 Nitra, Slovakia.
| | - Lubica Rybarova
- Department of Midwifery, Faculty of Health Care, University of Prešov, Partizanska 1, 08001 Prešov, Slovakia.
| | - Illarj Achil
- Department of Medical Sciences, University of Udine, Viale Ungheria, 20, 33100 Udine, Italy.
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Viale Ungheria, 20, 33100 Udine, Italy.
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Palese A, Basso F, Del Negro E, Achil I, Ferraresi A, Morandini M, Moreale R, Mansutti I. When are night shifts effective for nursing student clinical learning? Findings from a mixed-method study design. Nurse Educ Today 2017; 52:15-21. [PMID: 28214665 DOI: 10.1016/j.nedt.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/15/2017] [Accepted: 02/03/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Some nursing programmes offer night shifts for students while others do not, mainly due to the lack of evidence regarding their effectiveness on clinical learning. OBJECTIVES The principal aims of the study were to describe nursing students' perceptions and to explore conditions influencing effectiveness on learning processes during night shifts. DESIGN An explanatory mixed-method study design composed of a cross-sectional study (primary method, first phase) followed by a descriptive phenomenological study design (secondary method, second phase) in 2015. SETTING Two bachelor of nursing degree programmes located in Northern Italy, three years in length and requiring night shifts for students starting in the second semester of the 1st year, were involved. PARTICIPANTS First phase: all nursing students ending their last clinical placement of the academic year attended were eligible; 352 out the 370 participated. Second phase: a purposeful sample of nine students among those included in the first phase and who attended the highest amount of night shifts were interviewed. METHODS First phase: a questionnaire composed of closed and open-ended questions was adopted; data was analyzed through descriptive statistical methods. Second phase: an open-ended face-to-face audio-recorded interview was adopted and data was analyzed through content analysis. RESULTS Findings from the quantitative phase, showed that students who attended night shifts reported satisfaction (44.7%) less frequently than those who attended only day shifts (55.9%). They also reported boredom (23.5%) significantly more often compared to day shift students (p=0001). Understanding of the nursing role and learning competence was significantly inferior among night shift students as compared to day shift students, while the perception of wasting time was significantly higher among night shift students compared to their counterparts. Night shift students performed nursing rounds (288; 98.2%), non-nursing tasks (247; 84.3%) and/or less often managed clinical problems (insomnia 37; 12.6% and disorientation/confusion 32; 10.9%). Findings from the qualitative phase showed night shifts are experienced by students as a "time potentially capable of generating clinical learning": learning is maximized when students play an active role, encounter patients' clinical problems and develop relationships with patients, caregivers and staff. CONCLUSIONS Night shifts remains ambiguous from the students' perspective and their introduction in nursing education should be approached with care, considering the learning aims expected by students in their clinical placements and the education of clinical mentors education who should be capable of effectively involving students in the process of night care by avoiding non-nursing tasks.
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Affiliation(s)
- Alvisa Palese
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Felix Basso
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Elena Del Negro
- Department of Surgery, San Daniele del Friuli Hospital, Italy.
| | - Illarj Achil
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Annamaria Ferraresi
- U.O. Formazione e Aggiornamento, Azienda Ospedaliero-Universitaria (AOU), Ferrara, Italy.
| | - Marzia Morandini
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Renzo Moreale
- Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Irene Mansutti
- Department of Medical and Biological Sciences, University of Udine, Italy.
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