Effect of the first night shift period on sleep in young nurse students

Emission rate of carbon dioxide while sleeping

Humans emit carbon dioxide (CO₂ ) as a product of their metabolism. Its concentration in buildings is used as a marker of ventilation rate (VR) and degree of mixing of supply air, and indoor air quality (IAQ). The CO₂ emission rate (CER) may be used to estimate the ventilation rate. Many studies have measured CERs from subjects who were awake but little data are available from sleeping subjects and the present publication was intended to reduce this gap in knowledge. Seven females (29 ± 5 years old; BMI: 22.2 ± 0.8 kg/m² ) and four males (27 ± 1 years old; BMI: 20.5 ± 1.5 kg/m² ) slept for four consecutive nights in a specially constructed capsule at two temperatures (24 and 28°C) and two VRs that maintained CO₂  levels at ca. 800 ppm and 1700 ppm simulating sleeping conditions reported in the literature. The order of exposure was balanced, and the first night was for adaptation. Their physiological responses, including heart rate, pNN_50, core body temperature, and skin temperature, were measured as well as sleep quality, and subjective responses were collected each evening and morning. Measured steady-state CO₂ concentrations during sleep were used to estimate CERs with a mass-balance equation. The average CER was 11.0 ± 1.4 L/h per person and was 8% higher for males than for females (P < 0.05). Increasing the temperature or decreasing IAQ by decreasing VR had no effects on measured CERs and caused no observable differences in physiological responses. We also calculated CERs for sleeping subjects using the published data on sleep energy expenditure (SEE) and Respiratory Quotient (RQ), and our measured CERs confirmed both these calculations and the CERs predicted using the equations provided by ASHRAE Standard 62.1, ASHRAE Handbook, and ASTM D6245-18. The present results provide a valuable and helpful reference for the design and control of bedroom ventilation but require confirmation and extension to other age groups and populations.

Sleep-Related Problems in Night Shift Nurses: Towards an Individualized Interventional Practice

Rotating shifts (mostly 8- or 12-h) are common among nurses to ensure continuity of care. This scheduling system encompasses several adverse health and performance consequences. One of the most injurious effects of night-time shift work is the deterioration of sleep patterns due to both circadian rhythm disruption and increased sleep homeostatic pressure. Sleep problems lead to secondary effects on other aspects of wellbeing and cognitive functioning, increasing the risk of errors and workplace accidents. A wide range of interventions has been proposed to improve the sleep quality of nurses and promote an increase in attention levels. In recent years, particular attention has been paid to individual and environmental factors mediating the subjective ability to cope with sleep deprivation during the night shift. Given the predictive role of these factors on the negative impact of a night shift, an individualized intervention could represent an effective countermeasure by ensuring suitable management of shift schedules. Therefore, the aims of this mini-review are to: (a) provide an updated overview of the literature on sleep problems in night shift nurses and their adverse consequences; and (b) critically analyze the psychosocial factors that mediate the negative impact of shift work with the ultimate goal of defining an effective countermeasure based on an individualized approach.

Experimental study on sleep quality affected by carbon dioxide concentration

This study comprehensively investigated the impact of indoor carbon dioxide (CO₂ ) concentration on sleep quality. Three experimental conditions (800, 1900, 3000 ppm) were created in chambers decorated as bedroom and other environmental parameters that may influence the sleep quality were under strict control. Sleep quality of 12 subjects (6 men and 6 women) was monitored for 54 consecutive days through sleep quality questionnaire and physiological measures. Both subjective and physiological results showed that sleep quality decreased significantly with the increase of CO₂ concentration, and the comprehensive questionnaire score at 3000 ppm was only 80.8% of that at 800 ppm. A linear positive correlation was found between sleep onset latency (SOL) and CO₂ concentration, while a linear negative correlation occurred between slow-wave sleep (SWS) and CO₂ concentration. In addition, in the same sleep environment, men had higher subjective questionnaire scores after wake-up, longer SWS and shorter SOL, which lead to a better sleep quality compared with women, and there was a significant gender difference in sleep quality at 800 ppm (P < .05).

Night shifts as a learning experience among nursing students across Europe: Findings from a cross-sectional survey

BACKGROUND

Organising clinical placements during nights has been reported as an additional opportunity to introduce students to the whole picture of their future responsibilities. However, studies in this field are still lacking.

OBJECTIVES

To describe and compare (a) the night shift experience of nursing students across Europe, (b) the patient-related problems that they face during night shifts, (c) the night care activities nursing students are called to perform, and (d) the perceived effects of night shift work on learning outcomes.

DESIGN

A cross-sectional study, 2016.

SETTINGS

Five European countries: Czech Republic, Italy, Poland, Portugal, and Slovakia.

PARTICIPANTS

Nursing students from nine Bachelor of Nursing Science degree programmes attending night shifts during their study period and who were willing to participate were included. A total of 907 out of 1347 (67.3%) eligible students participated.

METHODS

Questionnaire based on the available literature, translated into five languages.

RESULTS

The duration of the night shift was from an average of 9.8 (CI 95% 9.6-10.0) in Italy to 11.9 (CI 95% 11.7-12.0) in the Czech Republic. Students faced mainly patients' pain without statistical differences across countries (at the overall level, 717 out of 907; 79%; p = .318). However, significant differences in the tasks performed during nights emerged: Polish students reported being more involved in performing basic nursing care (72; 93.5%) as compared to other countries (e.g., Portuguese students 337; 84.9%), (p = .02). Overall, an average of 28.9% of the night shift time was reported to be free of commitments, with higher values among Polish (38%, CI 95% 33.6-42.3) and Slovakian students (33.4%, CI 95% 30.6-36.3) and lower values among Czech Republic students (20.4%, CI 95% 17.6-23.2) (p .001). Boredom and satisfaction were reported as the main feelings during night shifts, with significant differences (p .001) across countries. Students reported significant different effects (p .001) of night shifts on their understanding of a nurse's role (from 5.2 out of 10 in Poland to 6.5 in the Czech Republic), on the understanding of the continuity of nursing care (from 5.2 in Poland to 6.7 in Italy), and on having a relationship with the clinical mentors (from 2.7 and 4.2 in Poland and the Czech Republic, respectively, to 6.9 in Italy).

CONCLUSIONS

Night shifts can be both a valuable and a non-valuable learning experience, suggesting the need to carefully plan and assess their effectiveness at the unit level.

A sleep intervention study comparing effects of sleep restriction and fragmentation on sleep and vigilance and the need for recovery

PURPOSE

Sleep deprivation is present not only in sleep disorders but also in numerous high demanding jobs and negatively affects cognition, performance and health. We developed a study design to distinguish the effects and need for recovery of two short-term disturbances - intermittent sleep fragmentation and partial sleep restriction.

METHODS

The randomized within-subjects design contained two weeks each with a baseline night, an intervention night of either sleep deprivation (5 h) or sleep fragmentation (light on every hour) and two undisturbed recovery nights. Twenty healthy male participants (mean age: 39.9 ± 7.4 years, mean BMI: 25.5 ± 2.2 kg/m²) underwent polysomnography, a psychomotor vigilance task (PVT), and subjective questions on well-being and sleep efficiency.

RESULTS

Percentage-wise, the restriction night had significant less wake times, less light sleep (stage 1), less REM sleep, but more deep sleep (stage 3) than the fragmentation night. The restriction week displayed a significant recovery effect regarding these sleep stages. The sleep fragmentation week presented a significant recovery effect regarding sleep onset times. PVT performance showed only a slight recovery effect after sleep restriction. Subjective sleep quality was reduced after both interventions with a significant recovery effect during restriction week only.

CONCLUSIONS

Short-term sleep restriction presented as a stronger sleep disturbance than short-term intermittent sleep fragmentation, including a stronger need for recovery. Already a one night sleep deprivation had an effect beyond two recovery days. The PVT was not sensitive enough to reveal significant changes. Next, autonomic parameters as possible biomarkers will be investigated.

Sleep Applications to Assess Sleep Quality

This article highlights the potential uses that smartphone applications may have for helping those with sleep problems. Applications in smartphones offer the promised possibility of detection of sleep. From the author's own experience, one can also conclude that sleep applications are approximately as good as polysomnography in detection of sleep time, similar to the conventional wearable actimeters. In the future, sleep applications will help to further enhance awareness of sleep health and to distinguish those who actually poorly and only briefly sleep from those who suffer more likely from paradox insomnia.

Comparison of Differing Clinical Schedules for Nursing Students

Maximizing student clinical schedules involves a range of nurse educator activities including scheduling, placement, and learning activity construction. The purpose of this study was to compare opportunities for students to develop their psychomotor skills on the clinical unit and perceptions of clinical experiences across 6-hour day, 6-hour evening, and 12-hour day schedules in an acute care setting. The main finding was that 12-hour schedules provided an overall significantly higher rate of skill opportunities than either of the other 6-hour schedules.