Circadian rhythm, shiftwork and you!

Chronobiological knowledge is increasing and the relationship between this knowledge and shiftwork is becoming clearer. This, in turn, is highlighting a need to facilitate a mix of permanent (day, evening and night) and rotational shift systems within individual wards or units. Is it perhaps time to allow greater flexibility in how individual nurses deal with the profession's need to care for patients throughout the 24 hour period? This review will focus on the 24 hour day-night or circadian rhythms and the consequences of the disruption of these rhythms as nurses undertake shiftwork and other activities which demand efficient functioning at times when an individual's circadian rhythms are expecting them to be at rest. As disruption of these rhythms is essentially unavoidable when 24 hour care is required, the choice becomes one of determining a preference for tolerable rhythm desynchrony and shorter more frequently occurring episodes of night work, or some degree of rhythm synchrony and adaptation during slightly longer but less frequent episodes of rhythm disruption.     

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.     

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.     

A study of female nurses combining partner and parent roles with working a continuous three-shift roster: the impact on sleep,fatigue and stress

This study of female nurses working a continuous 3-shift roster found that the average sleep duration per 24-hours across the roster is almost one hour less for nurses who combine shiftwork, partner and parent roles. In particular, they are not free to use the later starting afternoon shift as an opportunity to repay the sleep debt incurred on night shift. The results show an interaction between work and family roles resulting in chronic fatigue that is a risk factor especially when combined with the acute fatigue associated with night work. The sleep record data is supported by interview data which highlight shiftwork as a stressor that reduces the opportunity for participation in social and leisure activities by all three of the groups studied: single, partnered and partnered with children. The strain of shiftwork on personal and social relationships reduces the resources available for coping with the emotional and physical stressors encountered by nurses in their work and family roles.     

Industrial workers on a rotating shift pattern: adaptation and injury status.

Over 11 million Americans work some type of shift pattern. Numerous health and safety issues result when workers follow a rotating shift schedule. Over 5 million work-related injuries occur annually in the United States at a cost of almost $48 billion. Disrupted circadian rhythms and fatigue from rotating shifts have been implicated as a cause of traumatic injuries. This study revealed that factors related to circadian type, effects of the work environment, and coping styles explained over 51% of the variance in adaptation scores for this group of rotating shiftworkers. Adaptation levels were not significantly different for the injured and non-injured groups of shiftworkers. Findings of this research suggest that education on the effects of circadian rhythm disruption and more effective ways of coping may be justified. Also, additional research related to adaptation and injuries is needed.     

夜班护士睡眠质量的质性研究

目的:了解夜班护士睡眠质量状况,分析影响睡眠质量的因素,为提高夜班护士工作质量提供依据。方法:以质性研究中的现象学方法为指导,采用开放式访谈法,深入访问某医院上夜班的10名护士。结果:通过分析﹑归纳﹑比较得出影响夜班护士睡眠质量的主要因素有:不固定的睡眠时间使睡眠失去昼夜节律,夜班后睡眠质量差,夜班后睡眠时间不能保障。结论:通过对夜班护士睡眠质量的分析,夜班护士在固定的时间持续上夜班,形成新的睡眠节律,可提高病区夜间护理质量,同时可解决夜班护士睡眠质量问题。     

Exercise,diet, and sleep habits of nurses working full-time during the COVID-19 pandemic: An observational study

BackgroundHealthy diet, exercise, and sleep practices may mitigate stress and prevent illness. However, lifestyle behaviors of acute care nurses working during stressful COVID-19 surges are unclear.PurposeTo quantify sleep, diet, and exercise practices of 12-hour acute care nurses working day or night shift during COVID-19-related surges.MethodsNurses across 10 hospitals in the United States wore wrist actigraphs and pedometers to quantify sleep and steps and completed electronic diaries documenting diet over 7-days.FindingsParticipant average sleep quantity did not meet national recommendations; night shift nurses (n = 23) slept significantly less before on-duty days when compared to day shift nurses (n = 34). Proportionally more night shift nurses did not meet daily step recommendations. Diet quality was low on average among participants.DiscussionNurses, especially those on night shift, may require resources to support healthy sleep hygiene, physical activity practices, and diet quality to mitigate stressful work environments.     

轮班制对ICU女护士昼夜活动节律与疲倦的影响

目的 比较ICU女护士不同工作时长(8h和12 h)昼夜活动节律相关指标与工作前后疲倦的差异,并分析疲倦程度的影响因素.方法 采用便利抽样法选取北京市3所三级甲等综合医院228名ICU女护士,通过一般资料问卷、李氏疲倦量袁(Lee's Fatigue Scale)进行调查,使用活动记录仪实施客观测量.结果 护士昼夜活动...     

How to use light and dark to produce circadian adaptation to night shift work.

The circadian rhythms of night shift workers do not usually adjust to their unusual work and sleep schedules, reducing their quality of life and producing potentially dangerous health and safety problems. This paper reviews field studies of simulated night work in which shifted light-dark cycles were constructed with artificial bright or medium-intensity light to produce circadian adaptation, ie the shifting of circadian rhythms to align with night work and day sleep schedules. By using these studies we describe fundamental principles of human circadian rhythms relevant to producing circadian adaptation to night shift work at a level designed for the reader with only a basic knowledge of circadian rhythms. These principles should enable the reader to start designing work/sleep-light/dark schedules for producing circadian adaptation in night shift workers. One specific schedule is presented as an example. Finally, we discuss phase-response curves to light and clarify common misconceptions about the production of circadian rhythm phase shifts.     

Nurses and shift work: effects on job performance and job-related stress

The purpose of this research was to examine the influence of day, afternoon, night and rotating shift schedules on the job performance and job-related stress of nurses. Registered nurses from five hospitals (n = 463) were surveyed using a structured questionnaire which measured both job performance and job-related stress. Analysis of data indicated that both the nurses' job performance and their job-related stress were related to the type of shift they worked. Overall job performance was highest for the nurses on the day shift, followed by the night, afternoon, and rotating shifts. Rotating shift nurses experienced the most job-related stress, followed in turn by the afternoon, day, and night shift nurses. The findings are interpreted within a conceptual framework which examines the social organization of work in the hospital by shift and the effects of shift work on biological rhythm synchronization.     

供给特定营养素提高夜班护士工作质量的研究

目的 改善频繁夜班对护士身心健康的影响,进一步稳定护理队伍,全面提高护理质量.方法 随机选择临床科室夜班护士60例,分为实验组、对照组各30例,实验组在夜班同定时间段内提供咖啡,对照组夜班期间则不供给;根据康奈尔医学指数(CMI)和特质应对方式问卷,结合本项目需要设计调查表进行问卷调查,并测定肾上腺皮质醇及血糖浓度.结果 实验组兴奋性增强,积极性增高,有消除困倦作用而不影响下班后睡眠,肾上腺皮质醇浓度和血糖浓度上升明显,与对照组比较差异均有统计学意义.结论 通过供给特定营养素,能人为干预、消除夜班护士困倦疲劳状态,降低护理事故发生率,提高护理质量.     

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.     

综合医院护士心理健康与社会支持及应对方式的相关性研究

目的 了解综合医院护士群体心理健康状况及与社会支持、应对方式的相关性.方法 采用整群抽样的方法,抽取3所综合医院756名护士,利用症状自评量表(SCL-90)、社会支持量表(SSRS)及应对方式量表(SCSQ)进行问卷调查,并对结果进行分析.结果 护士的心理健康水平欠佳,阳性检出率达到37.04%;护士长和普通护士在躯体化因子方面比较差异有统计学意义;夜班护士与白班护士在躯体化、抑郁、恐怖症状因子方面比较,差异有统计学意义;社会支持、应对方式与心理健康水平有相关性.结论 医院管理者应该注重护士的心理健康问题,同时予以积极的社会支持和应对方式指导,以提高护士整体的心理健康水平.     

综合医院护士心理健康与社会支持及应对方式的相关性研究

目的了解综合医院护士群体心理健康状况及与社会支持、应对方式的相关性。方法采用整群抽样的方法，抽取3所综合医院756名护士，利用症状自评量表（SCL-90）、社会支持量表（SSRS）及应对方式量表（SCSQ）进行问卷调查，并对结果进行分析。结果护士的心理健康水平欠佳，阳性检出率达到37．04％；护士长和普通护士在躯体化因子方面比较差异有统计学意义；夜班护士与白班护士在躯体化、抑郁、恐怖症状因子方面比较，差异有统计学意义；社会支持、应对方式与心理健康水平有相关性。结论医院管理者应该注重护士的心理健康问题，同时予以积极的社会支持和应对方式指导。以提高护士整体的心理健康水平。     

An ergonomic approach to stress

The relationships between psychology and ergonomics centre around the concept of stress. This paper outlines the concept that stress is a mismatch between the demands made on an individual and his ability to cope. The nature and theories of stress are reviewed and sources of stress in the nursing profession are analysed. Coping is recognized as a way of reducing the actual or perceived stresses. However, a common method of coping is to disguise the symptoms by taking therapeutic drugs, tobacco or alcohol. It is argued that these methods are a maladaptation since in themselves they can cause illness and death. Evidence of smoking habits in relation to perceived stress in the nursing profession is given. It is concluded that a direct action approach to reduce workplace (organizational) stressors can be achieved by an ergonomic approach to the problem, and that this, if successful, will obviate the need to resort to unhealthy coping mechanisms. Suggestions are put forward as to how some of the major recognised sources of stress in the nursing profession can be analysed and removed by applying ergonomic methods. Shift working is seen by many nurses as a particular stressor. The relationships between lighting quality and circadian rhythm control are discussed as a further example of how an ergonomic solution might be sought.     

护士长工作疲溃感与工作压力源及应对方式的相关研究

目的探讨护士长工作疲溃感、工作压力源及应对方式的水平及其之间的关系.方法采用问卷调查法,调查了广州市5家三级甲等综合医院的200名护士长的工作疲渍感、工作压力源、应对方式及其之间的相互关系.结果护士长的工作压力为中等水平,其首要工作压力为工作量与时间分配方面,最大压力源为非护理性工作太多;护士长情绪疲溃感与工作无成就感均为高度,工作冷漠感为中度;护士长的工作压力与情绪疲溃感和工作冷漠感呈正相关,与工作无成就感不相关;应对方式对护士长工作疲溃感有影响,积极应对有助于降低护士长的工作无成就感,消极应对可以加重情绪疲溃感和工作冷漠感的产生.结论护士长的工作疲溃感严重,并受工作压力及应对方式影响,建议关注护士长工作压力的主要影响因素及减轻护士长的非护理性工作,加强对护士长管理知识、心理知识及专业知识的培训,提高其积极应对技巧.     

Stress and coping of Canadian rural nurses caring for trauma patients who are transferred out

INTRODUCTION: The present study investigated acute stress and coping among rural nurses who work with transfer trauma patients. METHODS: Nineteen rural nurses ages 34 to 53 years participated in 4 focus groups. Each group was asked to identify a specific stressful situation involving transfer of trauma/accident patients and to share their experience of the situation. RESULTS: Stressful situations encountered included system problems (EG, lack of resources; time pressures), lack of communication, visual impact, and professional discord. Coping responses included efforts to alter the problem (problem-focused coping) and efforts to control emotions (emotion-focused coping). Social support coping was identified as the most helpful way of coping with trauma. DISCUSSION: Overall the findings suggest that rural nurses face unique stressors not identified in the nursing literature, which most often reflects urban settings.     

Strategies used by burns nurses to cope with the infliction of pain on patients

The infliction of pain on patients is part of the daily routine for many nurses, particularly those who work in burns units, but there has been little help available for nurses to develop useful ways of coping with such circumstances. Few researchers have considered how the ways that nurses manage their feelings about pain may provide insights into the reasons why available pain control methods have not been fully practiced. The aim of this study was to identify the range of coping strategies used by nurses when conducting painful procedures. Nurses working in five burns units were interviewed about their feelings when it was necessary for them to inflict pain on patients in the course of giving patient care. Content analysis was used to identify the kinds of coping strategies used by nurses to manage their feelings about such situations. Fourteen kinds of strategy were identified and were then grouped into four categories: (i) distancing oneself from the patient's pain; (ii) engaging with the patient's pain; (iii) seeking social support and (iv) reconstructing the nurse's core role. The use of each of these categories of coping have implications for both the management of patient's pain and the nurse's emotional well-being. While distancing oneself from the patient's pain was the most prevalent way for nurses to cope with their feelings about causing pain to patients, all types of coping strategies had their advantages. It is possible that combinations of various strategies may be the most effective way for nurses to deal with their patients' pain.     

Determinants of shift-work adjustment for nursing staff: the critical experience of partners.

Levels of congruence between shift workers and their partners on experiences of shift work are rarely addressed. Partners, however, might be a potential source for validation of shift-work issues in terms of their understanding of these issues and might have an impact on the shift workers' experience of support or personal disruption. Participants consisted of 59 hospital shift-working nurses (55 women, 4 men) and their 59 partners. Two parallel versions of a previous questionnaire (Smith & Folkard, 1993a, 1993b) were used to obtain subjective data from workers and their partners on perceptions of the workers' experience of sleep flexibility and chronotype and lifestyle factors (sleep/fatigue, health/stress, and social/family) relating to tolerance across three shift types: day, evening, and night. All participants provided information on ideal shift choice and ratings of their own personal disruption and family, communication, and relationship issues. Results indicate that shift workers and their partners are congruent in their perceptions of the impact of shift work on the worker in all three lifestyle factors relating to tolerance across the three shift types. Shift workers experience more health/stress and social/family problems on the evening shift; this is related to their partners' increased sense of personal disruption. Similarly, when partners report the perceived impact of shift work on these same dimensions, it is associated with shift workers' heightened sense of personal disruption. Fewer sleep/fatigue and health/stress problems on the night shift are related to greater sleep flexibility, and evening types experience increased sleep/fatigue problems on the day shift. Social measures (particularly the personal disruption of the partner) rather than biological measures are the greatest predictors of shift workers' personal disruption. Findings are supported by qualitative data. It appears that the partner's understanding and own sense of disruption is critical to the experience of the shift worker regarding coping and predictability of tolerance.     

海岛地区女护士群体总体幸福感与特质应对方式的相关分析

目的 探讨海岛地区女护士总体幸福感与特质应对方式的关系.方法 对379名女护士分别采用总体幸福感量表和特质应对方式量表进行测量,分析女护士的总体幸福感及应对方式.结果 女护士的总体幸福感良好,不同年龄、工作年限女护士的总体幸福感和消极应对方式比较,差异有统计学意义;总体幸福感与特质应对方式存在相关性,与积极应对方式呈正相关,与消极应对方式呈负相关.逐步回归分析表明特质应对方式、年龄、工作年限对主观幸福感有显著影响.结论 海岛地区女护士的总体幸福感与特质应对方式密切相关,积极应对方式有助于提高护士的幸福感.