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.     

实行夜班加强辅助班与护理住院总值班对妇产科夜班护士压力的影响

目的 探讨通过实行夜班加强辅助班及护理二线住院总查房制度,对减轻妇产科夜班护士压力的影响.方法 通过对夜班实行加强辅助班及开展夜间护理住院总值班制度,实施前后采用护士工作压力量表对48名一线夜班护士进行的压力状态比较.结果 实施后护士在患者护理方面、工作量及时间分配方面、护理专业及工作方面的压力得分分别为（1.91±0.32）,（1.73±0.48）,（1.48±0.61）分,均低于实施前的（3.35±0.76）,（3.35±0.47）,（2.92±0.67）分,差异具有统计学意义（t值分别为2.44,2.35,2.25;P ＜0.05）,管理及人际关系方面的问题、工作环境及资源方面实施前后比较,差异无统计学意义（P＞0.05）;在实施加强班和护理住院总值班后,夜班护士前5位压力源均减轻,与实施前比较差异均有统计学意义（P＜0.01）.结论 通过实行夜班加强辅助班和护理总值班制度,减轻了妇产科一线夜班护士的压力,保障了护理质量安全.     

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.     

An investigation into primary nursing and its effect upon the nursing attitudes about and administration of prn night sedation

This study aims to explore the administration of pm night sedation by qualified night nurses on primary nursing and team nursing wards using a quasi-experimental design. The purpose of the study was to examine the attitudes of qualified nurses ( n =20) about sleep problems in hospital and sleep medication and compare these attitudes with behaviour (the administration of pm night sedation) reporting any differences between wards using team and primary nursing philosophies of care. Ten nurses from team nursing wards and 10 nurses from primary nursing wards were interviewed about the amount of night sedation they had administered during one night shift. This was followed by a questionnaire aimed at examining their attitudes about sleep and night sedation using several visual analogue scales. Findings proved to be significant in that results confirmed that team nurses gave out almost three times as much pm night sedation as nurses on primary nursing wards and held attitudes that closely correlated with more of a 'medical model' approach such as an emphasis on the advantages of night sedation and the need for its continued use in the clinical area.     

二级医院夜班护士睡眠质量现状与影响因素的调查分析

目的了解二级医院夜班护士的睡眠质量及影响因素,为制订管理对策提供依据。方法采用匹兹堡睡眠质量昔表对淮安市8所二级医院581名夜班护士进行调查。结果夜班护士匹兹堡睡眠质量得分高于国内正常成人（P〈0．01）;44．92％的夜班护士存在睡眠障碍;夜班护士睡眠质昔的影响因素为科室和有无二线班（P〈0．O1或P〈0．05）。结论准安市二级医院夜班护士睡眠问题比较突出,应引起社会、有关管理层及护士自身的重视,建议从社会、医院、护士自身方面采取相应的对策。     

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。     

A computer-aided comparative study of progressive alertness changes in nurses working two different night-shift rotas

Two groups of nurses were investigated during the course of two different types of night-shift rota The purpose was to define, if possible, the optimum shift pattern for hospital night staff The mental alertness of two groups of nurses was assessed, both subjectively and objectively, at the beginning and end of each night-shift of a set of nights being worked Alertness was assessed subjectively by means of a visual analogue scale, and objectively by means of a computer generated test, the unprepared simple reaction time task One group worked permanent nights and the other rapidly rotating nights Subjectively the nurses felt they were more alert at the beginning than at the end of a night-shift, and also at the beginning of a span of nights than at the end With computer testing, performance was broadly worse at the beginning of a shift than at the end It was worse at the beginning of a span of nights, improving to a peak at around the fourth day, and then in the case of permanent nights, remaining about the same or deteriorating slightly towards the end of the span The improvement by day 4 could be a practice effect or it may be that it takes this long to adjust to the new pattern of working as some authors have described Debate centres around whether nurses should cease working nights just as they have become accustomed to them as in the rapid rotation, or continue for longer to gain benefit from this acclimatization as in permanent nights     

肿瘤科护士睡眠质量的调查

目的 探讨专科医院肿瘤科护士睡眠质量现状,分析影响某专科医院肿瘤科护士睡眠质量的因素.方法 采用匹兹堡睡眠质量指数（PSQI）量表对108名肿瘤科护士睡眠质量进行调查及相关分析.结果 肿瘤科护士PSQI得分明显高于国内正常成人组,除睡眠质量与睡眠时间外,总分及其他5个成分得分差异均有统计学意义（P＜0.01）;46.3%的肿瘤科护士睡眠质量差,PSQI总分＞7分;不同职称、工龄、夜班频数肿瘤科护士睡眠质量差异有统计学意义（P＜0.05）;不同科室、年龄、学历、婚姻状况肿瘤科护士睡眠质量差异无统计学意义（P＞0.05）.结论 肿瘤科护士睡眠质量差,职称、工龄、夜班频数是肿瘤科护士睡眠质量的影响因素.     

Overnight duty impairs behaviour, awake activity and sleep in medical doctors.

BACKGROUND: The impact of prolonged work cycles among senior doctors remains disputed. We evaluated the effects of overnight duty on awake activity and sleep quality in senior doctors in emergency medical specialties. METHODS: Thirty-six healthy doctors were monitored during a 2-week period including three separate 84 h on-call cycles. An on-call cycle consisted of the night and the day before night duty; the night duty itself and the subsequent 2 days and nights after night duty. The first day after night duty could either be worked or not. Actigraphy was used to measure physical activity and to evaluate sleep duration and quality. A standardized questionnaire was used to assess daytime performance and night sleep quality. RESULTS: Night actigraphy demonstrated that on-call work induced a significant reduction in sleep duration that was not recovered during the subsequent two nights. Sleep during the night duty itself was fragmented and of poor quality. Awake activity was significantly impaired on the day after night duty. Although subjectively night sleep quality did not differ between the nights before and after night duty, all subjective daytime parameters were impaired the day after night duty, and mood, fatigue and concentration remained altered on the second day. Working the day after night duty impaired objective measurements of daytime activity and sleep quality during the subsequent two nights. CONCLUSIONS: On-call night work in acute specialties induces sleep debt associated with prolonged impairment of awake activity, sleep quality and performance. Not working the following day after an on-call night allows partial recovery of sleep quality to begin.     

Effects of rotating night shifts: literature review

AIM: This paper reports a review examining the concept of sleep and its antithesis of fatigue, and considers the evidence on nurses' ability to cope with the demands of continually changing hours of work, their safety, and the impact any manifestations of sleep disruption may have on the care of their patients. While many aspects of this paper may apply to nursing in general, special consideration is given to nurses in the critical care environment. BACKGROUND: Night duty rotations are common practice in nursing, and particularly in specialist units. It is essential that nurses working in these environments are able to maintain careful and astute observation of their vulnerable patients, and concern arises when they may be unable to do so. Research suggests that fatigue can negatively affect nurses' health, quality of performance, safety and thus patient care, and that the effects of fatigue may be exacerbated for nurses over 40 years of age. METHOD: The literature was examined for the 10-year period up to December 2003. The databases searched were Ovid, Proquest, Blackwell Science, EBSCO Online, Australian Health Review and WebSPIRS, using the keywords of, shiftwork, rosters, intensive care, fatigue, sleep deprivation and sleep studies. FINDINGS: There is consensus amongst researchers on the adverse psychological and physiological effects of night rotations on nurses when compared with their permanent night duty peers, particularly for those over 40 years of age. Evidence also suggests that the effects of fatigue on nurse performance may negatively affect the quality of patient care. CONCLUSIONS: The literature reinforces concerns about the adverse relationship between fatigue and performance in the workplace. Optimal standards for patient care may be difficult to achieve for more mature nurses, who may suffer from sleep deprivation and health problems associated with rotational night work and disrupted physiological rhythms.     

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.     

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。     

Rotating Shiftwork Schedules: Can We Enhance Physician Adaptation to Night Shifts?

Objectives : To evaluate the effectiveness of a broad, literature-based night shiftwork intervention for enhancement of emergency physicians' (EPs') adaptation to night rotations. Methods : A prospective, double-blind, active placebo-controlled study was conducted on 6 attending physicians in a university hospital ED. Three data sets were collected under the following conditions: baseline, after active placebo intervention, and after experimental intervention. In each condition, data were collected when the physicians worked both night and day shifts. Measurements included ambulatory polysomnographic recordings of the main sleep periods, objective performance tests administered several times during the subjects' shifts, and daily subjective ratings of the subjects' sleep, moods, and intervention use. Results : The subjects slept an average of 5 hr 42 min across all conditions. After night shifts, the subjects slept significantly less than they did after day shifts (5 hr 13 min vs 6 hr 20 min; p < 0.05). The physicians' vigilance reaction times and times for intubation of a mannequin were significantly slower during night shifts than they were during day shifts (p = 0.007 and p < 0.04, respectively), but performances on ECG analysis did not significantly differ between night and day shifts. Mood ratings were significantly more negative during night shifts than they were during day shifts (more sluggish p < 0.04, less motivated p < 0.03, and less clear thinking p < 0.04). The strategies in the experimental intervention were used 85% of the time according to logbook entries. The experimental and active placebo interventions did not significantly improve the physician's performance, or mood on the night shift, although the subjects slept more after both interventions. Conclusions : Although the experimental intervention was successfully implemented, it failed to significantly improve attending physicians' sleep, performance, or mood on night shifts. A decrease in speed of intubation, vigilance reaction times, and subjective alertness was evident each time the physicians rotated through the night shift. These findings plus the limited sleep across all conditions and shifts suggest that circadian-mediated disruptions of waking neurobehavioral functions and sleep deprivation are problems in EPs.     

Work-related fatigue and recovery: the contribution of age, domestic responsibilities and shiftwork

AIM: This paper reports a study of the relationship between age, domestic responsibilities (being partnered and having dependents), recovery from shiftwork-related fatigue and the evolution of maladaptive health outcomes among full-time working female nurses. BACKGROUND: Several studies have suggested that full-time working women with family responsibilities are at greater risk of developing work-related fatigue problems than single women without these responsibilities. METHOD: A questionnaire was distributed in 2004 to 2400 nurses at two hospitals in Australia, and 1280 responses were obtained (response rate 54%). The data from a purposive sample of 846 full-time working nurses are reported here. FINDINGS: Domestic responsibilities were not related to differences in fatigue and recovery. Our results suggested that for full-time shiftworking nurses, being part of a family structure, may actually be protective against the development of maladaptive fatigue. The most important factor determining maladaptive fatigue outcome was shift pattern worked, particularly rotation including night duty. The effect of age was equivocal. The youngest age group reported the highest fatigue and poorest recovery compared to the oldest group, who reported the best characteristics. However, this latter group may represent a particularly well-adapted 'survivor cohort'. The relationship between age and fatigue was partly confounded by older, experienced, nurses with greater job responsibilities, working fewer multiple shifts including night duty. In general, increasing age was not associated with poorer recovery or higher maladaptive fatigue. CONCLUSIONS: Unpredictable internal shift rotations, including night duty, which are traditional and typical in nursing, are inimical to maintaining nurses' health. More creative approaches to rostering for nurses working multiple shifts are a necessary step towards reducing wastage from the profession due to chronic work-related fatigue. Younger nurses in particular, may need more support than is currently recognized if they are to be retained within the profession.     

2种排班模式护理人员满意度分析

目的 探讨护理人员对2种排班模式的满意度。方法 在同一病区对30名护理人员不同时期分别实施AN(A指日班,N指夜班)连续性排班结合周夜班(周夜班组)和AN连续性排班结合轮夜班(轮夜班组)各8个月。比较2组护理人员满意度。 结果 护理人员满意度得分均低于最低标准。周夜班组工作被称赞和认可、福利待遇得分高于轮夜班组,轮夜班组家庭和工作的平衡、排班得分高于周夜班组。 结论 AN连续性排班结合周夜班与AN连续性排班结合轮夜班的排班模式护理人员满意度均低,2种排班模式各有优势。     

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（8 h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、李氏疲倦量表（Lee's Fatigue Scale）进行调查,使用活动记录仪实施客观测量。 结果 护士昼夜活动节律相关指数中静息-活动周期（r24）和昼夜节律整体偏低,8 h轮班制护士总睡眠时间明显低于12 h轮班制护士,差异有统计学意义（P<0.001）。8 h轮班制护士在值夜班前的疲倦程度比12 h轮班制护士高,但12 h轮班制护士在值夜班后的疲倦程度比8 h轮班制护士高,差异有统计学意义（P<0.001）。多元线性回归分析显示,昼夜活动节律指标中的工作时活动水平、总睡眠时间、静息-活动周期（r24）是工作后疲倦度的显著预测因子,尤其是ICU12 h轮班制护士。 结论 通过昼夜活动节律相关指标与工作前后疲倦度相关性探讨,有助于护理管理者了解护士工作状态,为改善ICU护士轮班方式、限定夜班数量及量化工作负荷提供依据。     

Striking the balance: night care versus the facilitation of good sleep

This article presents the key findings from an extensive research project aiming to identify the determinants of poor sleep in care homes. A mixed methods study was conducted in 10 care homes in South East England. This included 2-week daily diaries completed by 145 older residents and interviews with 50 care-home staff. This research demonstrated that the regular surveillance by qualified nurses and care assistants at night seriously impedes the quality of sleep experienced by older people living in care homes. However, nurses and social care workers have a duty of care, which would not be fulfilled if regular checks were not undertaken at night. There is a need for care-home staff to strike a balance between enabling older people living in care homes to have a good night's sleep and adhering to their own professional duty of care.     

Night shift: can a homeopathic remedy alleviate shift lag?

Night shift nurses are subject to shift lag or circadian dysrhythmia, which may result in physical and mental symptoms ranging from fatigue, irritability, depression, and apathy to gastrointestinal, cardiovascular, and sleep disorders. This study investigated the effect a homeopathic remedy No-Shift-Lag had on the night shift nurses in an intensive care unit. The study was a randomized, double-blind, placebo-controlled, crossover trial. The measures included an objective computer-based vigilance test and a series of subjective questionnaires.     

设立儿科夜班护理二线值班对缓解一线护士压力的效果分析

目的了解设立护理二线值班对一线夜班护士压力的缓解情况。方法采用自设问卷,对64名儿科夜班护士进行调查。结果夜班中设立护理二线值班对一线夜班护士来源于环境和个人自身素质的压力起到了明显的缓解作用;对来源于患儿及护理工作本身的压力缓解作用不明显。结论夜班中设立护理二线值班能够缓解一线夜班护士在工作环境和自身素质方面的压力,该制度有一定应用推广价值。     

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.