Shift nurses’ social jetlag,anxiety, and premenstrual symptoms: A cross-sectional study

BackgroundAlthough rotating shifts are essential for nurses to ensure optimal patient care, rotating shifts expose them to an imbalanced circadian rhythm. Shift work leads to nurses experiencing diminished sleep quality, which affects their wakefulness and judgment, curtails work performance, and affects care quality.AimTo investigate the relationship among social jetlag, anxiety, and premenstrual symptoms in nurses working in 8-hour rotating shiftsMethodsParticipants were 194 shift-working nurses in three South Korean university hospitals from March 21 to April 2 in 2021. Chronotype and social jetlag were assessed using the Munich Chronotype Questionnaire for Shift Workers. Anxiety was measured with the State-Trait Anxiety Inventory X-1. Premenstrual symptoms were measured using the Shortened Premenstrual Assessment Form. This cross-sectional study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.FindingsAmong participants, the mean overall social jetlag was 3 hours 45 minutes. Hierarchical regression analysis revealed that social jetlag (on evening shift) and anxiety significantly influenced nurses’ premenstrual symptoms. Moreover, individuals’ chronotype and preference to work the night shift were identified as predictors of premenstrual symptoms.DiscussionNurses working on shifts are bound to experience greater social jetlag compared with the general population and are at an elevated risk of deteriorated quality of life. Nursing managers should consider individuals’ chronotypes and social jetlag when establishing shift schedules and identify strategies that relieve anxiety in nurses working in rotating shifts.ConclusionSocial jetlag and anxiety adversely affect premenstrual symptoms in female nurses working in 8-hour rotating shifts.     

Sleep quality and morningness–eveningness of shift nurses

Aim and objective. The aim of the study was to analyse, while controlling for identified covariates, the effects of morningness–eveningness on sleep quality for shift nurses. Background. Shift nurses had greater difficulty falling asleep or staying asleep, thus resulting in higher rates of retiring from hospital. Existing research has addressed the effects of manpower demand and personal preferences on shift assignment; however, the concept of endogenous rhythms is rarely considered. Methods. This analysis included 137 nurses between the ages of 21–58. Nurses completed the Horne and Ostberg questionnaire to assess morningness‐eveningness and the Pittsburgh Sleep Quality Index (PSQI) questionnaire to measure self‐reported sleep quality over the last month. The 18‐point Chinese version had a Cronbach's reliability coefficient of 0·79 overall and 0·86 respectively. This study analysed correlates of sleep quality by comparing the groups with better or worse sleep quality according to the median of PSQI. Univariate and multivariate analyses were used for the risk factors of worse sleep quality. Results. The result showed that the strongest predictor of sleep quality was morningness–eveningness not the shift schedule or shift pattern for nurses under controlling the variable of age. Greater age and longer years employed in nursing significantly decreased the risk of worse sleep quality. The confounding age factor was properly controlled; evening types working on changing shifts had higher risk of poor sleep quality compared to morning types. Conclusions. Morningness–eveningness was the strongest predictor of sleep quality under controlling the variable of age in shift nurses. Implications for clinical practice. Our results suggested that determining if nurses were attributed to morning or evening types is an important sleep issue before deciding the shift assignment.     

Self-assessed quality of sleep, occupational health, working environment, illness experience and job satisfaction of female nurses working different combination of shifts

AIM: The aim of this study was to describe and compare the self-assessed quality of sleep, occupational health, working environment, illness experience and job satisfaction among female nurses working different combinations of shifts. BACKGROUND: Evidence from several studies indicates that there is an association between the disruption of the circadian cycle caused by shift work and adverse health effects. METHODS: A cross-sectional design was used with a sample of 348 nurses drawn from the registry of the Icelandic Nurses' Association, representing 17% of the workforce of Icelandic nurses. A self-administered questionnaire, measuring occupational health, quality of sleep, the illness experience, job satisfaction and working environment was used. Data were analysed according to type of shift (days only, rotating days/evenings, rotating days/evenings/nights) by use of analysis of variance and chi-square. RESULTS: No difference was found between participants based on type of shift with regard to the illness experience, job satisfaction and quality of sleep. Nurses working rotating day/evening/night shifts reported a longer working day, more stressful environmental risk factors, more strenuous work and that they were less able to control their work-pace. In general, the nurses reported low severity of symptoms; however, nurses working rotating days/evenings shifts experienced more severe gastrointestinal and musculoskeletal symptoms when compared with others. This was explained by the short rest period provided for between evening and morning shifts. CONCLUSIONS: In general Icelandic nurses are satisfied with their work and their shift assignment does not seem to pathologically disrupt their circadian cycle. Nevertheless, nursing directors are advised to look more closely at the organization of nurses' work during night shifts, as well as the rest period for nurses changing from evening to day shifts.     

ICU护士工作反应时间现况及影响因素分析

目的 :比较可反映工作执行力的客观指标反应时间在ICU护士白、夜班上班前和下班后之间的差异及其影响因素。方法 :采用便利抽样法选取2家医院6个ICU的118名护士,通过自设一般资料问卷进行调查,使用精神运动警觉测试仪器实施测量。结果 :护士下班后(白班后为296.75 ms,夜班后为310.25 ms)反应时间均长于上班前(白班前为290.64 ms,夜班前为288.44 ms),夜班后(310.25 ms)长于白班后(296.75 ms),差异有统计学意义(P<0.05)。存在睡眠障碍的护士,夜班前(299.64 ms)及夜班后(363.33 ms)的反应时间均长于无睡眠障碍组(夜班前为285.56 ms,夜班后为306.40 ms)(P<0.05)。性别、孩子个数、医院工作年限、日工作时长、摄入咖啡因饮料、摄入甜品会对ICU护士上班前后反应时间产生不同程度的影响。结论 :建议护理管理者合理运用反应时间指标改善排班方法,识别其保护因素和危险因素,提高ICU护士工作执行能力。     

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

Aim

Pilot study to examine the impact of long work hours and shift work on cognitive errors in nurses.

Background

Twelve‐hour shifts are more commonly used in hospital settings and there is growing concern over the impact that extended and irregular work hours have on nurses’ well‐being and performance.

Method

Twenty‐eight nurses working different shifts (8‐hr days and 12‐hr rotation) participated in this study. Nurses were assessed at the beginning of four consecutive shifts using actigraphy, a sleep diary and an after work questionnaire.

Results

Nurses working 12‐hr rotations had less total sleep time and less sleep efficiency than 8‐hr day nurses. Twelve‐hour rotation nurses also napped more than their counterparts. There were no differences between the two groups with respect to cognitive errors.

Conclusions

Twelve‐hour rotations have a negative effect on nurses’ sleep patterns. There is no evidence indicating 12‐hr rotations increased errors.

Implications for nursing management

Nurse managers can implement specific strategies, such as greater shift work flexibility and designated quiet time, to reduce the effects of disturbed sleep patterns in nurses.     

Rotating shift-related changes in hormone levels in intensive care unit nurses

Title.  Rotating shift-related changes in hormone levels in intensive care unit nurses.
Aim.  This paper is a report of a study to investigate if an irregular rotating shift system, including night shifts, can cause changes to the secretion of hormones in nurses.
Method.  In 2006, 32 healthy intensive care unit nurses completed the Standard Shiftwork Index (SSI) and blood samples were collected from each participant at the beginning and end of each shift. Change in hormone levels between the beginning and end of morning shifts were examined and compared between nurses on morning only and rotating shifts. Correlations between change in hormone concentrations and scores from the SSI are presented.
Results.  The mean reduction of cortisol level between the two measurements was statistically significantly greater for the 'rotating' than 'morning' shift group ( P  = 0·032). There were no statistically significant differences between the two groups in overall mean change from the first to the second measurement of prolactin, triiodothyronine and thyroid-stimulating hormone. Levels of thyroxine increased statistically significantly in the 'rotating' group ( P  = 0·049) but not in the 'morning' group. The morningness scale score was greater for the 'rotating' group, while greater job satisfaction levels were found in the 'morning' group. Statistically significant correlations were found between thyroid-stimulating hormone, triiodothyronine, thyroxine and prolactin changes and specific scales of the SSI questionnaire.
Conclusion.  Ergonomic shift schedules sympathetic to the body clock and nurses' preferences should be adopted to mitigate the adverse effects on health.     

Insomnia,anxiety, and heart rate variability among nurses working different shift systems in Taiwan

This cross‐sectional comparative study investigated the levels of insomnia, anxiety, and heart rate variability of nurses members working different shift systems. One hundred and twenty‐four participants were recruited from members of the nurses of two Taiwanese hospitals. Data were collected using the Chinese versions of the Athens Insomnia Scale and Beck Anxiety Scale questionnaires and electrocardiograms recorded immediately upon completion of each participant's work shift. A binary logistic regression model was used for analysis. Insomnia, anxiety, and abnormal parasympathetic activity were more acute in nurses who worked a rotating shift than in those performing day or night shift work. Logistic regression analysis showed that age significantly increased the incidence and level of insomnia. Age, years of service, and nurses’ status as a parent significantly intensified incidences of anxiety and abnormal parasympathetic activity. Rotating shift work is one of the main factors causing adverse effects on the physical and psychological health of nurses; therefore, when a shift work system cannot be avoided, a practice of day and night shifts for nurses is preferable to rotating shifts.     

Patterns and correlates of benzodiazepine use in nurses: A nationwide,population‐based study

In the present study, we examined patterns of benzodiazepine (BZD) use in nurses, and compared the characteristics of frequent users with those of infrequent users. Data on all nurses enrolled in the study were derived from the reimbursement claim records in Taiwan's National Health Insurance Research Database for the period 2004–2008. The case group comprised 33 588 nurses with BZD use, and the control group was exactly matched to each case according to age and sex. The patterns of occasional, frequent, and daily BZD use demonstrated an increasing trend from 2004 to 2008. This trend was observed for most of the BZD with a short or intermediate half‐life. Older nurses (>45 years) and those with greater experience (≥5 years) were more likely to use BZD frequently. Moreover, the risk of frequent BZD use increased significantly when nurses exhibited comorbid depression (adjusted odds ratio (aOR): 2.58), anxiety (aOR: 1.78), or sleep disorders (aOR: 2.29) compared with infrequent BZD use. The results indicated that nurses with BZD use had comorbidities of anxiety, depression, and sleep disorders. The increasing trend of patterns of BZD use and its association with sleep disorders, depression, and anxiety can be used as references for stress and sleep management in nurses.     

Mismatch of Sleep and Work Timing and Risk of Type 2 Diabetes

OBJECTIVE

To examine whether a mismatch between chronotype (i.e., preferred sleep timing) and work schedule is associated with type 2 diabetes risk.

RESEARCH DESIGN AND METHODS

In the Nurses’ Health Study 2, we followed 64,615 women from 2005 to 2011. Newly developed type 2 diabetes was the outcome measure (n = 1,452). A question on diurnal preference ascertained chronotype in 2009; rotating night shift work exposure was assessed regularly since 1989.

RESULTS

Compared with intermediate chronotypes, early chronotypes had a slightly decreased diabetes risk after multivariable adjustment (odds ratio 0.87 [95% CI 0.77–0.98]), whereas no significant association was observed for late chronotypes (1.04 [0.89–1.21]). Among early chronotypes, risk of type 2 diabetes was modestly reduced when working daytime schedules (0.81 [0.63–1.04]) and remained similarly reduced in women working <10 years of rotating night shifts (0.84 [0.72–0.98]). After ≥10 years of shift work exposure, early chronotypes had a nonsignificant elevated diabetes risk (1.15 [0.81–1.63], P_trend = 0.014). By contrast, among late chronotypes, the significantly increased diabetes risk observed among day workers (1.51 [1.13–2.02]) appeared largely attenuated if their work schedules included night shifts (<10 years: 0.93 [0.76–1.13]; ≥10 years: 0.87 [0.56–1.34]; P_trend = 0.14). The interaction between chronotype and shift work exposure was significant (P_interaction = 0.0004). Analyses restricting to incident cases revealed similar patterns.

CONCLUSIONS

In early chronotypes, type 2 diabetes risk increased with increasing duration of shift work exposure, whereas late types had the highest diabetes risk working daytime schedules. These data add to the growing body of evidence that workers could benefit from shift schedules minimizing interference with chronotype-dependent sleep timing.     

Self-reported sleep and health among Norwegian hospital nurses in intensive care units

Aim and background: Shift work, and especially night work, is associated with poor health. Nurses, work a variety of work schedules including night work. So far, few studies have specifically investigated sleep and health among intensive care nurses. Design and methods: We investigated sleep, sleepiness, fatigue, subjective health complaints, anxiety and depression in 150 intensive care nurses (convenience sample representing a response rate of 56·2%). The nurses worked at two major University hospitals in Norway and answered a questionnaire survey. Results: The intensive care nurses reported poorer sleep, more sleepiness, more fatigue, more anxiety and more depression compared to normative data. Poor sleep was reported by 70% and excessive sleepiness by 25% of the nurses; however, the design of the study did not allow us to determine the causes underlying these findings. Multiple linear regression analyses showed that age was positively associated with sleep problems, fatigue, subjective health complaints and anxiety and depression. In contrast, shift work experience was negatively associated with sleep problems, suggesting better coping with shift work over time. Conclusions: Nurses working in intensive care units reported poorer sleep, more sleepiness, more fatigue, more anxiety and more depression compared to Norwegian norm groups. Age was positively related to these complaints, whereas shift work experience was negatively related to poor sleep. More studies are needed on strategies to improve sleep and health in nurses.     

The Impact of Shift Work on Brazilian Train Drivers with Different Chronotypes: A Comparative Analysis through Objective and Subjective Criteria

Objective

The aim of this study was to compare sleep pattern, tiredness sensation and quality of life between different chronotypes in train drivers from a Brazilian transportation company.

Subjects and Methods

Ninety-one train drivers, working a rotary work schedule including night shift, were divided into three groups according to their chronotype (morning types, intermediate or evening types) and were assessed for their sleep and quality of life, as characterized by a subjective questionnaire and the Psychomotor Vigilance Task (PVT), applied before and immediately after the night shift. The pattern of activity and rest was measured for 10 days by actigraphy, and the chronotype was determined through the Morningness-Eveningness Questionnaire.

Results

Forty-one (45.1s%) individuals were classified as morning type, 44 (48.4s%) were classified as intermediate and 6 (6.6s%) as evening type. The evening types had a tendency to remain awake for a longer period of time before the night shift (p = 0.05) and scored worse overall for quality of life compared to morning types (p = 0.11). There was no significant difference between the groups regarding variability in the PVT performance, even when covaried by the period of waking time before the test. There was no significant difference either in feelings of fatigue before and after starting the shift.

Conclusion

Although the evening type number was small, evening type individuals scored worse relative to sleep and quality of life than morning type individuals.Key Words: Chronotype, Fatigue, Shift work, Psychomotor Vigilance Task, Actigraphy     

The effects of extended workdays on fatigue, health, performance and satisfaction in nursing

BACKGROUND: Several authors have claimed that 12-hour shifts in nursing are better for both employees and patient care. However, although the research has found positive effects on satisfaction with working hours and free time, the effects on employee fatigue, health and performance have mostly been neutral or negative. AIM: Work schedules should preferably be beneficial for satisfaction, fatigue, health and performance. This study therefore investigated whether shifts that are extended only slightly can combine the positive effects of the 12-hour shift with the positive effects of the 8-hour shift. The study investigated the effects of 9-hour shifts. METHOD: A total of 134 nurses from three nursing homes in the Netherlands completed a questionnaire on fatigue, health, performance and satisfaction. One group worked 8-hour shifts, and the other worked 9-hour shifts. RESULTS: Nurses who worked 9-hour shifts were on average more fatigued, had more health complaints, and were less satisfied with their working hours and free time than those who worked 8-hour shifts. Their performance was slightly poorer. About 70% to 80% of the 8- and 9-hour nurses preferred to work a maximum of 8 hours during morning/early and afternoon/late shifts. CONCLUSIONS: The 9-hour shift seemed to combine the negative aspects of the 12-hour shift with the negative aspects of the 8-hour shift. It is suggested that the 9-hour shift had more negative effects than the 12-hour shift because: (1) nurses could not choose what shift length they worked; (2) many worked part-time; and (3) they already had many days off. It is also suggested that increases in workload since the 1980s make current extended shifts in nursing more fatiguing.     

Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units

AimTo assess 12-h shift Intensive Care Unit (ICU) nurses' fatigue and identify the associated demographic factors.BackgroundLiterature reveals inconsistencies as to whether 12-h shifts decrease or increase nurse fatigue levels.MethodsA cross-sectional survey of 67 ICU nurses working 12-h shifts was undertaken to determine their fatigue levels in two hospitals. The Occupational Fatigue Exhaustion/Recovery Scale (OFER), Spearman's correlation, ANOVA, t-tests, and Chi-Square were used for analyses.Results57 out of 67 participants experienced low to moderate chronic fatigue; 36 of those exhibited low to moderate acute fatigue levels; 46 reported low to moderate inter-shift fatigue. Age (ρ = 0.03, r² = −0.28), number of family dependents (ρ = 0.03, r² = −0.27), and years of nursing experience (ρ = 0.03, r² = −0.27) were moderately negatively correlated with acute fatigue, while frequency of exercise per week (ρ = 0.01, r² = −0.31) was moderately negatively correlated with chronic fatigue. Hospital A had higher chronic fatigue levels than Hospital B. Age (ρ < 0.01), age group (ρ = 0.03), shift schedule (ρ = 0.02), and nursing experience (ρ = 0.03) were significantly related to the difference in chronic fatigue levels between the two hospitals.ConclusionsMore than half of the 12-h shift ICU nurses studied in both hospitals had low to moderate fatigue levels. Age, number of family dependents, years of nursing experience, and frequency of exercise per week were identified as key factors associated with fatigue. The difference in chronic fatigue levels between hospitals suggests that implementing more support for younger and/or less experienced nurses, better strategies for retaining more experienced nurses, and fewer rotating shifts could help reduce fatigue.     

综合干预对手术锐器伤护士睡眠质量及焦虑的影响

目的探讨综合干预对改善手术锐器伤护士睡眠质量及焦虑负性情绪的有效性。方法便利抽样选取2014年1月至2016年3月上海市某三级甲等医院手术室发生锐器伤护士35名,采用阿森斯失眠量表(Athens insomnia scale,AIS)、焦虑自评量表(self-rating anxiety scale,SAS)评定其睡眠质量及焦虑水平,将AIS总分6分存在失眠合并轻、中度焦虑(SAS评分≥50~69分)的29名护士作为研究对象,给予睡眠认知及行为干预、支持性心理干预等综合干预3个月。比较干预前后护士的睡眠进程各参数、焦虑水平等指标。结果手术室护士发生锐器伤后失眠发生率高达82.6%;SAS总分为(64.98±8.13)分,与常模比较差异有统计学意义(P0.01);经3个月综合干预后护士觉醒时间缩短,觉醒次数减少,睡眠效率和睡眠维持率提高,SAS评分降低,与干预前比较差异均有统计学意义(均P0.01)。结论以睡眠认知及行为干预、支持性心理干预、提高护士应对工作压力的能力等为目的的综合干预,可有效提高手术锐器伤后护士的睡眠质量,改善其焦虑负性情绪。     

Short sleep duration and high exposure to quick returns are associated with impaired everyday memory in shift workers

PurposeTo 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.MethodsIn 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.FindingsHigh 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.DiscussionFrequent insufficient time for rest between shifts as well as short sleep was associated with poorer everyday memory.     

两种轮班制下护士睡眠质量现状调查

目的 探讨两种轮班制下护士睡眠质量现状,为护理管理者安排班次提供依据.方法 对某三级甲等医院79名8h轮班制护士及71名非8h轮班制护士进行睡眠质量调查.结果 8 h轮班制与非8h轮班制护理人员睡眠障碍者分别为54名(68.35％)和57名(80.28％);睡眠质量得分分别为(27.51-6.89)分和(28.65±6.56)分,均高于国内常模(P＜0.01);非8h轮班制护士觉醒不足因子得分高于8h轮班制护士(P＜0.05).结论 两种轮班制下护士睡眠障碍情况严重,管理者应积极探索新的轮班方式以改善护士睡眠质量,保障护士身心健康,提高护理质量.     

Effect of working consecutive night shifts on sleep time,prior wakefulness,perceived levels of fatigue and performance on a psychometric test in emergency registrars

Objective: To evaluate the effect of working consecutive night shifts on sleep time, prior wakefulness, perceived levels of fatigue and psychomotor performance in a group of Australian emergency registrars. Methods: A prospective observational study with a repeated within‐subjects component was conducted. Sleep time was determined using sleep diaries and activity monitors. Subjective fatigue levels and reciprocal reaction times were evaluated before and after day and night shifts. Results: A total of 11 registrars participated in the study with 120 shifts analysed. Sleep time was found to be similar during consecutive night and day shifts. The mean number of hours spent awake before the end of a night shift was 14.33. Subjective fatigue scores were worst at the end of a night shift. There was no difference in reciprocal reaction time between the end of night shift and the start of day shift. Conclusions: Registrars sleep a similar amount of time surrounding night and day shifts. Despite reporting the highest levels of fatigue at the end of a night shift, there is no significant difference in reaction times at the end of night shift compared with the beginning of day shift. This correlates with the finding that at the end of night shift the registrars have been awake for less than 16 h, which is the point at which psychomotor performance is expected to decline.     

Trajectories of fatigue in family caregivers of patients undergoing radiation therapy for prostate cancer

Predictors of and trajectories for evening and morning fatigue were evaluated in family caregivers of oncology patients using hierarchical linear modeling. Evening fatigue trajectory fit a quadratic model. Predictors included baseline sleep disturbances in family caregivers and baseline evening fatigue in patients. Morning fatigue trajectory fit a linear model. Predictors were baseline trait anxiety, levels of perceived family support, and baseline morning fatigue in patients. Findings suggest considerable inter‐individual variability in the trajectories of evening and morning fatigue. Evaluating family caregivers for sleep disturbance, anxiety, and poor family support, as well as high levels of patient fatigue, could identify those family caregivers at highest risk for sustained fatigue trajectories. © 2008 Wiley Periodicals, Inc. Res Nurs Health 32:125–139, 2009     

Impact of shift work on the health and safety of nurses and patients

Shift work generally is defined as work hours that are scheduled outside of daylight. Shift work disrupts the synchronous relationship between the body's internal clock and the environment. The disruption often results in problems such as sleep disturbances, increased accidents and injuries, and social isolation. Physiologic effects include changes in rhythms of core temperature, various hormonal levels, immune functioning, and activity-rest cycles. Adaptation to shift work is promoted by reentrainment of the internally regulated functions and adjustment of activity-rest and social patterns. Nurses working various shifts can improve shift-work tolerance when they understand and adopt counter measures to reduce the feelings of jet lag. By learning how to adjust internal rhythms to the same phase as working time, nurses can improve daytime sleep and family functioning and reduce sleepiness and work-related errors. Modifying external factors such as the direction of the rotation pattern, the number of consecutive night shifts worked, and food and beverage intake patterns can help to reduce the negative health effects of shift work. Nurses can adopt counter measures such as power napping, eliminating overtime on 12-hour shifts, and completing challenging tasks before 4 am to reduce patient care errors.