Sleep quality and responses to insufficient sleep in women on different work shifts

1. The aim of this study was to examine degrees of cognitive behavioural effects of fatigue, mood changes and somatic responses to sleep loss in women with and without sufficient sleep, and to explore possible links between effects of sleep loss and specific sleep disturbances in selected groups. 2. A total 156 women working in a casualty department on different work shifts responded to a questionnaire which measured sleep quality, strain and symptoms related to working conditions, as well as effects of sleep loss. 3. About 40% of the women had perceived insufficient sleep during the last 6 months. They perceived significantly worse sleep quality and a higher degree of strain according to working conditions than the others. Palpitation and dysphoria as effects of sleep loss were independently predicted by sleep quality. Dysphoria was also predicted by difficulty in falling asleep. Cognitive behavioural effects of fatigue was predicted by disturbed sleep. Palpitation effects led to a 10-fold increase in the probability of cognitive behavioural effects of fatigue. The effects were most prominent among women suffering from gastrointestinal problems of long duration and chronic pain. 4. Responses to reduced sleep quality in women constitute a form of stress, with sympathetic activation, increased susceptibility to infection, moderate cognitive impairment, mood changes and somatic distress.     

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.     

Factors associated with perceived sleep quality of nurses working on rotating shifts

Aims. To explore nurses’ perceived sleep quality and examine factors that contribute to insufficient sleep quality. Background. Shift work is an important source of disturbances in the health and well‐being of nurses. However, nursing services must be available on a 24‐hour basis, making shift work a necessity. Sleep disorders tend to occur among nurses typically working on a rotating schedule. Although many studies related to nurses’ sleep quality have been carried out in the West, few have investigated factors linked to nurses’ sleep quality in Hong Kong. Design. A cross‐sectional study. Method. The study was conducted during the period November 2005–June 2006 in two local hospitals in Hong Kong. Nurses (n = 163) completed a self‐reported questionnaire. Demographic data and information on health status, strain and symptom levels and perceived sleep quality were collected. Results. More than 70% of the nurses reported having insufficient sleep and strain and symptom levels were higher in this group. Older age, perceived poor sleep status, gastrointestinal symptoms and higher strain and symptom levels were risk factors that contributed to insufficient sleep. Conclusions. Evaluation of internal stressors and modification of shift work schedules are important areas of future research; these should aim at finding the best compromise between productivity and employees’ sleep quality, health and performance. Relevance to clinical practice. Healthcare workers’ job task analysis, the evaluation of internal stressors and the modification of shift work schedules are important areas of future research and should result in the best compromise between productivity and employees’ sleep quality, health and performance.     

Effects of sleep loss in men and women with insufficient sleep suffering from chronic disease: a model for supportive nursing care

This study evaluated self-reported subjective health and effects of sleep loss according to perceived interfering cognitive anxiety related to falling asleep in patients with and without insufficient sleep and gender differences in these aspects 5 years after coronary artery bypass graft and transluminal coronary angioplasty. A total of 145 patients, five years after intervention, responded to a mailed questionnaire. Nearly 60% had severe combined sleep disturbances; 35.9% of these had complained of insufficient sleep and 15% also perceived difficulty falling asleep related to cognitive anxiety. Measurable gender differences were small. A theoretical framework is presented which can increase understanding among nurses, patients and their relatives concerning the quality and quantity of sleep and sleep loss related to quality of life. These results suggest that there are significant relationships between sleep quality, resilience to stress and coping strategy in patients with a chronic disease, indicating the need for more individualised supportive nursing care.     

Cognitive Performance Following Modafinil versus Placebo in Sleep-deprived Emergency Physicians: A Double-blind Randomized Crossover Study

Objectives: Modafinil has recently been approved for the treatment of shift work sleep disorder, making it potentially available for shift-working emergency physicians. The authors' objectives were to determine whether modafinil improved cognitive performance of emergency physicians following overnight shifts and to record symptoms and subjective evaluations of the effect of modafinil on the participants.
Methods: This was a randomized, double-blind, placebo-controlled crossover study that followed CONSORT guidelines. Participants were assigned to one of two study groups, with study sessions occurring at least seven weeks apart, and received either modafinil or placebo depending on their random allocation. Testing after night shifts included a coding task and an AX version of the Continuous Performance Task, both of which test cognitive function. Participants also completed visual analog scales for three subjective outcomes, and symptoms were elicited.
Results: Modafinil facilitated performance on long interstimulus-interval AX trials ( F [1, 23] = 6.65, p = 0.1) and marginally reduced errors on AY trials in the Continuous Performance Task (F [1, 23] = 3.59, p = 0.07), suggesting facilitation of sustained attention, cognitive control, and working memory. Additionally, modafinil, compared with placebo, facilitated performance on the coding task at the first session. Subjective data from visual analog scales confirmed that modafinil increased perceived alertness during the simulated patient care sessions but worsened sleep onset when opportunities for sleep arose.
Conclusions: Modafinil increased certain aspects of cognitive function and subjectively improved participants' ability to attend post–night-shift didactic sessions but made it more difficult for participants to fall asleep when opportunities for sleep arose.     

Disentangling the effects of psychological and physical work demands on sleep, recovery and maladaptive chronic stress outcomes within a large sample of Australian nurses

AIM: This paper reports a study to determine if different types of work strain experienced by nurses, particularly those of an essentially psychological nature, such as emotional demand, mental effort and problems with peers and/or supervisors, have a differential impact on sleep quality and overall recovery from work strain, compared with physical work strains, and lead to higher maladaptive chronic fatigue outcomes. BACKGROUND: Various studies have shown that the dominant work-demand strain associated with nursing work can vary between different areas of nursing. For example, whereas emotional strain is reported to be the principal strain associated with work in areas such as oncology, haematology and renal units, medical and surgical unit nurses report work pace and staffing issues as the dominant work strain. Purely physical strain seems to be less commonly reported as a concern. METHOD: A large sample (n = 760) of Australian nurses working in a large metropolitan hospital completed questionnaires on their work demands, sleep quality, fatigue, and recovery between shifts in January 2004. FINDINGS: A high work pace exacerbates the psychological rather than the physical strain demands of nursing. Psychological strain affects sleep quality and impairs recovery from overall work strain between shifts. This combination is highly predictive of serious maladaptive stress/fatigue outcomes among nurses. CONCLUSION: Coping with psychological stressors adequately is an important requirement for nurses in order to avoid adverse health effects and maintain a long-term career in nursing. Appropriate training of undergraduate nursing students in managing the stresses they are likely to encounter would seem to be an essential requirement for the 21st century. Such training might constitute an important long-term component in overcoming the chronic nurse shortages evident in many countries.     

Self-reported subjective sleep quality and fatigue in patients with peritoneal dialysis treatment at home

The aim of this study was to describe habitual sleep, daytime symptoms, sleep-disturbing factors, current sleep during 1 week and fatigue in patients with peritoneal dialysis treatment at home and also discover predictions for sleep quality outcome. The knowledge should increase possibilities for supportive nursing health care. Fifty-five patients answered two mailed questionnaires and filled in a sleep diary. Of these, 60% had moderate, persistent sleep problems combined with daytime symptoms. Nocturnal awakenings with difficulties falling asleep again and a sleep duration predicted as 57% of sleep quality. Nocturnal pruritus and 'difficulties finding a comfortable sleeping position' were significant sleep-disturbing factors. Sleep quality predictors means progress in knowledge about the complexity of the situation for peritoneal dialysis patients. Poor sleep, daytime symptoms, sleep-disturbing factors and chronic fatigue need to be enlightened, especially for the nephrology nurses who are in a unique position to give supportive nursing health care.     

心内科住院病人睡眠质量分析与护理干预

目的:了解心内科老年住院病人睡眠质量,分析睡眠障碍原因,探讨改善睡眠障碍的有效措施。方法:对97例病人采取一对一访谈式调查,了解其睡眠质量和睡眠障碍症状,包括病人上床时间、入睡所需时间、夜醒次数、再次入睡所需时间、晨醒时间等。分析影响睡眠的因素(包括疾病因素、环境因素、心理因素及其他因素),予针对性护理。护理干预后3、7d再次对病人进行睡眠质量评价。结果:心内科住院老年病人睡眠障碍症状主要为早醒(40.2%)、入睡困难(35.1%)、夜醒、醒后入睡困难等。主要原因依次为疾病因素、心理因素、环境因素、其他因素。护理干预后均有不同程度改善。结论:疾病因素和心理因素是影响心内科老年住院病人睡眠质量的主要因素,通过实施针对性护理干预,可以有效提高病人睡眠质量,促进病人早日康复。     

Effects of work organization on the mental health of nursing staff

A survey was carried out among a sample of 973 nurses in hospitals in the Valencian Community (Spain). The aim was to study the relation between work organization, sociodemographic and professional factors and the mental health of nursing staff. The information was collected by means of a questionnaire. Three indicators were used to study mental health: fatigue, sleep disturbance and psychological or psychosomatic indicators of mental suffering. Work organization affected the mental health of workers with varying impact according to the mental health indicator under consideration. Dissatisfaction due to work schedule, psychological and mental load increased the risk of showing signs of fatigue, with a prevalence odds ratio (POR) of 2.15, 2.00, 1.86, respectively, along with the risk of psychological symptoms with a POR of 2.36, 1.80, 2.10, respectively. Permanent night shifts or rotating night shifts increased the risk of sleep disturbance with a POR of 2.00 and 1.34 respectively.     

Lifestyle practices and nocturnal sleep in midlife women with and without insomnia

Relationships between common lifestyle practices important to sleep hygiene (e.g., smoking cigarettes, drinking alcohol, ingesting caffeine, exercising, bed times, getting-up times) and nocturnal sleep have not been documented for women with insomnia in their home environments. This community-based sample of 121 women, ages 40 to 55 years, included 92 women who had experienced insomnia for at least 3 months and 29 women with good-quality sleep. Women recorded lifestyle practices and sleep perceptions (time to fall asleep, awakenings during sleep, feeling rested after sleeping, and overall sleep quality) in diaries while undergoing 6 nights of somnographic sleep monitoring at home. Compared to women with good-quality sleep, women with insomnia reported greater night-to-night variation in perceived sleep variables, poorer overall sleep quality (M = 2.8, SD = 0.7 vs. M = 1.9, SD = 0.5, P < 0.05), and longer times to fall asleep (M = 25 min, SD = 14.2 vs. M= 12.9 min, SD = 5.8, P < 0.05). Correlations between mean individual lifestyle practice scores and mean perceived or somnographic sleep variables were low, ranging from 0 to 0.20. An aggregated sleep hygiene practice score was not associated with either perceived or somnographic sleep variables. Regression analysis using dummy variables showed that combinations of alcohol, caffeine, exercise, smoking, and history of physical disease explained 9% to 19% of variance in perceived or somnographic sleep variables. Lifestyle practices, and combinations thereof, do warrant consideration when assessing or treating insomnia, but these data fail to support a dominant relationship between lifestyle practices and either perceived or somnographic sleep variables.     

儿童及青少年失眠的临床特征及治疗研究概况

儿童及青少年是生命历程的关键阶段,许多有助于确定当前和未来健康结果的行为模式在此间得以确立,儿童及青少年精神卫生保健至关重要。儿童及青少年失眠受青春期生理发育、学校及家庭等社会环境、心理行为等多种因素影响,囊括了入睡困难、睡眠时间不足、睡眠质量差和日间困倦等一系列症状,明显影响其精神状态和生活学习质量。儿童及青少年失眠的治疗方法以睡眠卫生教育、认知行为治疗和正念冥想等综合治疗为主。笔者从失眠的相关成因、症状和治疗方法3个方面对儿童及青少年失眠作一综述,为其临床诊疗提供参考。     

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.     

Night Shifts in Emergency Medicine: The American Board of Emergency Medicine Longitudinal Study of Emergency Physicians

Background

Night shift work is an integral component of the practice of emergency medicine (EM). Previous studies have demonstrated the challenges of night shift work to health and well being among health care providers.

Objective

This study was undertaken to describe the self-reported experience of emergency physicians regarding night shift work with respect to quality of life and career satisfaction.

Methods

The 2008 American Board of Emergency Medicine (ABEM) Longitudinal Study of Emergency Physicians (LSEP) was administered by mail to 1003 ABEM diplomates.

Results

Among 819 participants in the 2008 LSEP Physician Survey, most participants responded that night shift work negatively influenced job satisfaction with a moderate or major negative influence (58%; n = 467/800). Forty-three percent of participants indicated that night shifts had caused them to think about leaving EM (n = 344/809). Most participants responded that working night shifts has had mild negative effects (51%; n = 407/800) or major negative effects (9%; n = 68) on their health. Respondents were asked to describe how working night shifts has affected their health. Common themes included fatigue (36%), poor quality of sleep (35%), mood decrement/irritability (29%), and health maintenance challenges (19%). Among participants in the 2008 LSEP Retired Physician Survey, night shifts were a factor in the decision to retire for 56% of participants.

Conclusions

Emergency physicians report negative impacts of night shift work, including fatigue, poor quality of sleep, mood decrement, irritability, and health challenges. Night shifts have a negative influence on job satisfaction and can be a factor in the decision to retire.     

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.     

Comparison of nurse, system and quality patient care outcomes in 8-hour and 12-hour shifts

BACKGROUND: Many nurses desire 12-hour shifts. However, there are concerns about implementation. OBJECTIVE: We sought to compare the effects of 8- and 12-hour shifts on nurse, system, and quality patient care outcomes. METHODS: We used a cross-sectional design with data collected from multiple sources in 2003-2004, including a nurse survey and administrative and patient records. We studied hospital nurses and patients in general adult wards, with outcomes including burnout, job satisfaction, scheduling satisfaction, preferences, intention to stay, and employee safety. System outcomes included recruitment and turnover, staffing, absenteeism, and related costs. A variety of quality patient care outcomes were measured from the 3 different types of data. RESULTS: Thirteen New York City hospitals participated; 805 surveys were examined from 99 nursing units (response rate 42%). Compared with nurses working 8-hour shifts, those working 12-hour shifts were on average more satisfied with their jobs, experienced less emotional exhaustion, 10 times more likely to be satisfied with schedules, 2 times as likely to perceive 12-hour schedules as important, and 58% less likely to report missing shifts; units with 12-hour shifts had lower vacancy rates and weeks to fill the position (all P values < or =0.05). There were no differences in patient outcomes. CONCLUSIONS: Nurses working 12-hour shifts were more satisfied. There were no differences in quality outcomes. Flexibility and choice in shift length are important elements in a positive nurse work environment. This study represents an innovative attempt by a labor-management bargaining group to make an evidence-based decision. We encourage others to conduct similar studies.     

Work schedule flexibility is associated with emotional exhaustion among registered nurses in Swiss hospitals: A cross-sectional study

BackgroundEmotional exhaustion among healthcare workers is a widely investigated, well-recognized problem, the incidence of which has recently been linked to work environment factors, particularly work/family conflict. However, another environmental feature that may be equally influential, but that is more amenable to nurse manager action, remains less recognized: shift schedule flexibility.ObjectivesThis study’s main purposes were to assess variations in work schedule flexibility between Swiss acute care hospital units, and to investigate associations between psychosocial work environment (e.g. work schedule flexibility) and self-reported emotional exhaustion among registered nurses.MethodsThis is a secondary analysis of data collected for the multi-center observational cross-sectional Match^RN study, which included a national sample of 23 hospitals and 1833 registered nurses across Switzerland.ResultsOverall, self-reported work schedule flexibility among registered nurses was limited: 32% of participants reported little or no influence in planning their own shifts. Work schedule flexibility (β −0.11; CI −0.16; −0.06) and perceived nurse manager ability (β −0.30; CI −0.49; −0.10) were negatively related to self-reported emotional exhaustion. Work-family conflict (β 0.39; CI 0.33; 0.45) was positively correlated to emotional exhaustion.ConclusionsThe study results indicate that managerial efforts to improve working environments, including special efforts to improve work schedule flexibility, might play an important role in promoting nurses’ emotional health.     

心脏介入术后患者失眠原因调查分析及对策

目的探讨心脏介入术后失眠的原因及护理对策。方法采用自行设计的心脏介入术后睡眠情况调查表,对124例行心脏介入术患者术后睡眠状况进行问卷调查。结果92%的患者术后第1天出现失眠,以经皮冠状动脉腔内成型术(PTCA)患者为主(96%)。入睡困难和睡眠维持障碍(早醒伴再入睡困难)是最常见的症状。失眠的原因依次为:肢体制动、腰背酸痛、排尿困难、环境因素、精神心理因素。结论采取有效的护理对策能提高心脏介入术患者术后的睡眠质量。     

Occupational class, psychosocial stress and morbidity

The association between stress and morbidity was studied in an industrial population, which consisted of both white-collar and blue-collar workers (n = 902). Information about living and working conditions, health behaviour, mental well-being and morbidity were obtained by questionnaires, interviews, clinical examinations, and physiological and biochemical measurements. The same cohort was re-examined after five and ten years. Comparison of occupational classes showed consistently that living and working conditions, psychosocial stress, and health and sickness behaviour were more deleterious among blue-collar workers and their morbidity and mortality rates were higher than among white-collar workers. The effect of stress on health was examined both cross-sectionally and longitudinally. Psychosocial stressors at work were related to mental strain, perceived health, and absenteeism. Stress symptoms were strongly associated with perceived health, locomotor symptoms, smoking, drinking, and absenteeism. None of the stress indicators were related to blood pressure. In the follow-up the baseline indicators of stress predicted future chronic illness and angina pectoris, but not hypertension or myocardial infarction. Blood pressure changes were not related to psychosocial factors. Stress did not predict mortality in the ten year follow-up. The study suggests that psychosocial stress is mostly related and may be causally linked to such indicators of morbidity as perceived health, bodily symptoms and sickness behaviour. The aetiological contribution of stress to biologically defined morbidity may be weak.