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.     

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。     

87例护理差错高发因素分析及防范对策

目的探讨87例护理差错的特点及规律,以降低护理差错发生率。方法回顾性分析2001~2004年87例差错的情况,分别对护理人员结构、新到本院工作的护士首次发生差错的时间、临近换班时段的差错进行分析。结果87例护理差错涉及护理人员广泛,覆盖率为57.4%。各级人员差错发生率由高至低排序为:护师82.4%,护士78.1%,主管护师62.5%,助理护士25%。新到本院工作1年内的护士差错率达64.4%(56例)。4个护理班次换班前2h差错率为33.3%(39例)。结论护理队伍不稳定,岗前培训欠缺,工作高峰时段人员不足,责任心不强是发生差错的主要原因。建立科学的管理制度,改革排班方法,推行“双人值班制”;规范岗前培训,加强护士责任感,加强法律意识的培养,是护理安全的关键。     

Near-miss errors in laboratory blood test requests by interns

BACKGROUND: Human errors have proven to be one of the most formidable patient care challenges in acute hospital setting. AIM: To evaluate the at-risk period for near-miss errors in laboratory blood test requests, in an acute medical hospital. DESIGN: Hospital-based retrospective analysis. METHODS: We reviewed the database of voluntary reports for near-miss errors for laboratory blood test requests by 104 medical residents in their first postgraduate year (interns), over a 2-year period (October 2002 to September 2004). To identify patterns and causal factors we analysed the reports with respect to months of working experience, work hours, and work shifts of an extended duration. RESULTS: There were 52 near-miss events among patients cared for by the medical service (20 male patients, 32 females, mean age 72.6 +/- 9.7 years). The overall incidence of near-miss events when interns practiced during the first month of training vs. subsequent months was 1.6 (95%CI 0.77-2.9) vs. 0.6 (95%CI 0.44-0.83) cases per 100 intern-days at risk. The odds ratio for a near-miss event during the first month of intern training vs. subsequent months was 2.64 (95%CI 1.29-5.38). With respect to the interns' on-call shift schedule, one half of the near-miss episodes occurred during an intern's on-call days and another half of them during an extended on-call shift; none of the events occurred during a standard working shift. These events peaked in frequency when on-call interns had worked for 12-20 h. DISCUSSION: The first month of internship represents an error-prone period. The best interventions to reduce near-miss errors by recently graduated medical interns should be the subject of further research.     

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 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.     

临床护理人员亚健康状况及相关因素的分析

目的 了解临床护士的亚健康状况,分析造成护士亚健康状况的相关因素.方法 采用亚健康筛选表、领悟社会支持量表、简易应对方式问卷、护士工作压力源量表,对136名临床护士进行调查.结果 本组有91.18%的护士处于亚健康状态,亚健康症状得分为(9.12±5.02),最常见的症状为疲劳,占79.41%;年龄、工作年限与护士亚健康状况得分呈正相关;社会支持总分、内支持、外支持以及积极应对均与护士的亚健康得分相关;护理专业及工作方面的压力、工作量及时间分配问题、工作环境及资源方面的问题、病人护理方面的问题以及管理及人际关系方面的问题均与护士的亚健康得分呈正相关.结论 护士群体亚健康状况的发生率较高,年龄越大、工作时间越长的护士亚健康状况越严重;护士的工作压力是影响亚健康的主要原因,社会支持能够改善护士的亚健康状况;管理者应重视维护护士的身心健康,以保证护理质量.     

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.     

护理差错110例分析及管理启示

目的:探讨护理差错发生的高危因素及防范措施,确定管理对策,减少临床护理差错事故的发生。方法:对发生的110例护理差错进行回顾分析。结果:发生差错者75人,与医嘱处理、核对、执行有关的差错发生率最高;工作年限1~5年及16年以上的护士出现差错的几率较高;上午、夜班时间差错率比中午和下午高。结论:护理管理者应重视工作程序和方法的改进,重视环节质量管理,重视新护士、实习护士的管理,关心、爱护、高年资护士,尤其是个人生活有波折者,实行弹性排班制,加强高危时段护士的人力管理。     

Testing Alertness of Emergency Physicians: A Novel Quantitative Measure of Alertness and Implications for Worker and Patient Care

BackgroundEstablishing practical solutions to manage fatigue in health care settings could reduce errors. Predictive Safety SRP Inc.’s AlertMeter is a 2-min cognitive assessment tool currently used in high-hazard industries to identify fatigued staff.ObjectiveNo prior study has attempted to address fatigue in emergency medicine (EM). We objectively assessed provider alertness to determine potential application of software-based fatigue recognition for risk reduction.MethodsIn a double-blind, prospective evaluation from July 1 to September 30, 2016, we applied the AlertMeter to EM residents at an academic level I trauma center. The tool was applied before and after shifts to evaluate alertness in three types of shifts: day, evening, and night. All residents were invited to participate—27 of 30 enrolled. Analysis of covariance (ANCOVA) was implemented to examine shift and completion effects on alertness score using baseline score as a covariate. Additionally, three separate ANCOVAs were conducted to examine alertness score differences between portion (start vs. end) and type of shift (day, evening, or night).ResultsResidents were significantly less alert at the completion of the evening shift. Scores at the end of the night shift were significantly lower than the start of the night shift.ConclusionsAlertness software can be reliably integrated into the emergency department. Alertness was lower at the end of the evening shift and end of the night shift. This work could have positive implications on shift and task scheduling and potentially reduce errors in patient care by quantifying providers’ fatigue and identifying areas for countermeasures.     

Nurses' experiences of working with trauma patients

AIM: To identify the issues relating to nursing care of trauma patients at St George Hospital in Sydney, Australia. METHOD: A series of nursing focus groups were conducted with nurses from the emergency department, high dependency surgical ward and several general surgical wards. The nurses were asked seven questions relating to their experience of working with trauma patients. RESULTS: The resulting data identified recurring themes, such as communication, education, documentation, pain management, workload and resources. CONCLUSION: It is hoped that the information from the focus groups will lead to an improvement in the communication between healthcare professionals as well as better co-ordination of patient care.     

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.     

责任制护理下实施晚间三级查房模式交班的效果

目的:评价责任制护理下实施晚间三级查房模式交班的效果。方法:实行晚间护士长、护理组长、责任护士参与的三级查房交班模式,制定各级护士交班职责,比较实施前后患者对护理工作满意度和护士对患者病情知晓情况。结果:实施后患者对护理服务满意度、护士对患者病情的知晓度均优于传统交班模式。结论:利用晚间三级查房模式交班,可快速提高护士的业务水平,提高护理质量。     

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.     

Reporting near-miss events in nursing homes

Since the Institute of Medicine report To Err Is Human was published in 1999, improving patient safety has become a major initiative for nurses working in all care settings. Nursing homes are a fertile environment for both a high frequency of adverse events to occur and a high number of institutional barriers to reporting them. This article outlines the barriers to reporting adverse events in nursing homes and provides support for why reporting near-miss events can serve as a means of reducing these barriers. It also provides recommendations and specific strategies for how to implement near-miss reporting systems in nursing homes such as policy changes, supportive leadership, and educating nurses about near-miss events. Further nursing research in this evolving area of patient safety is warranted.     

Critical analysis of an accident and emergency ward.

OBJECTIVES: To describe the work, both qualitatively and quantitatively, of an accident and emergency (A&E) ward, and discuss some of the advantages and disadvantages associated with this ward. METHODS: An observational study was carried out of all patients admitted to the A&E ward of Glasgow Royal Infirmary from 1 January 1992 to 31 December 1992. Epidemiological and management data were collected for all patients admitted. RESULTS: There were 2460 admissions, of which 69% were related to trauma and 45% to head injury; 47% of the patients had consumed alcohol before admission. Accidental trauma was the commonest reason for admission (57%), followed by assault (33%). Ninety two per cent of admissions stayed for less than 3 d, but 33% of the workload was spent on a small number of patients admitted for longer than 7 d. CONCLUSIONS: This A&E ward presents a significant workload, and some of its most serious problems lie with those patients who stay longer than 72 h. The safe and effective use of the ward depends upon it being well resourced, along with the department it serves.     

Reporting of near-miss events for transfusion medicine: improving transfusion safety

BACKGROUND: Half of the reported serious adverse events from transfusion are a consequence of medical error. A no-fault medical-event reporting system for transfusion medicine (MERS-TM) was developed to capture and analyze both near-miss and actual transfusion-related errors. STUDY DESIGN AND METHODS: A prospective audit of transfusion-related errors was performed to determine the ability of MERS-TM to identify the frequency and patterns of errors. RESULTS: Events and near-miss events (total, 819) were recorded for a period of 19 months (median, 51/month). No serious adverse patient outcome occurred, despite these events, with the transfusion of 17,465 units of RBCs. Sixty-one events (7.4%) were potentially life-threatening or could have led to permanent injury (severity Level 1). Of most concern were 3 samples collected from the wrong patient, 13 mislabeled samples, and 22 requests for blood for the wrong patient. Near-miss events were five times more frequent than actual transfusion errors, and 68 percent of errors were detected before blood was issued. Sixty-one percent of events originated from patient areas, 35 percent from the blood bank, and 4 percent from the blood supplier or other hospitals. Repeat collection was required for 1 of every 94 samples, and 1 in 346 requests for blood components was incorrect. Education of nurses and alterations to blood bank forms were not by themselves effective in reducing severe errors. An artifactual 50-percent reduction in the number of errors reported was noted during a 6-month period when two chief members of the event-reporting team were on temporary leave. CONCLUSION: The MERS-TM allowed the recognition and analysis of errors, determination of patterns of errors, and monitoring for changes in frequency after corrective action was implemented. Although no permanent injury resulted from the 819 events, innovative mechanisms must be designed to prevent these errors, instead of relying on faulty informal checks to capture errors after they occur.     

军队医院不同婚姻状况重症监护室聘用护士工作压力源的调查

[目的]调查分析军队医院ICU聘用护士工作压力源现状及其不同婚姻状况ICU聘用护士之间的差异。[方法]采用中国护士工作压力源量表对121名ICU聘用护士进行问卷调查。[结果]ICU聘用护士工作压力源5个维度得分中护理工作量及时间分配问题得分最高,其次是护理专业及工作方面的问题;在护士工作压力源条目排序中前5位依次是护士工作量大、经常倒班、上班的护士数量不够、担心工作中出现差错事故、护理病人病情过重;已婚ICU聘用护士工作压力显著高于未婚护士(P<0.05)。[结论]军队医院ICU聘用护士在工作量及时间分配问题方面压力最大,其工作压力源水平受婚姻状况影响。     

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.     

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