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Durkin AC, Richards AJ. Sleep quality and the intention to modify sleep behaviors among night-shift nurses. Nursing 2024; 54:54-58. [PMID: 38386454 DOI: 10.1097/01.nurse.0001006268.77409.dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE To explore the relationship between sleep quality and intent to change sleep behaviors among night-shift nurses. METHODS Full-time night-shift nurses in a hospital setting completed a cross-sectional online survey including demographics, Snoring, Tiredness during daytime, Observed apnea, and High Blood Pressure (STOP) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Intention to Change Behavior Scale (ICBS). The relationship between PSQI and ICBS scores was tested using Spearman's rho correlation coefficient. RESULTS Most participants reported poor sleep and did not engage in health behaviors that promote good sleep. There was a weak, positive relationship between PSQI and ICBS scores. Those who reported poor sleep quality indicated a high intent to improve sleep. CONCLUSION These findings support the need for night-shift nurses to prioritize enhancing their sleep quality by advocating for policy and practice improvements. The findings also highlight the importance of support from nurse leaders, educators, and researchers to raise awareness and implement holistic strategies for better sleep health.
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Affiliation(s)
- Adelaide Caroci Durkin
- Adelaide Durkin is an associate professor at Kettering College in Kettering, Ohio. Andrew Richards is an associate professor at Southern Adventist University in Collegedale, Tenn
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A Scoping Review of Sleep Education and Training for Nurses. Int J Nurs Stud 2023; 142:104468. [PMID: 37080122 PMCID: PMC10180237 DOI: 10.1016/j.ijnurstu.2023.104468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Shift work and resulting sleep impairment among nurses can increase their risk for poor health outcomes, occupational injuries, and errors due to sleep deficiencies. While sleep education and training for nurses has been recommended as part of a larger fatigue risk management system, little is known about training programs designed specifically for nurses. OBJECTIVE Investigate the literature for current sleep education or training programs specifically for shift working nurses, with intent to assess training content, delivery characteristics, and outcome measures. DESIGN A scoping review conducted October 2020 through September 2021. METHODS The bibliographic databases Cumulative Index of Nursing and Allied Health (CINAHL), Scopus, PubMed, and NIOSHTIC-2 were searched using words such as "nurse," "sleep hygiene," "shift work," and "education". Studies were included if they: 1) were original research; 2) discussed sleep education, training, or sleep hygiene interventions; 3) included a study population of nurses engaging in shift work; 4) focused on sleep as a primary study measure; 5) were written in English language; and 6) were published in 2000 or later. RESULTS Search results included 17,237 articles. After duplicates were removed, 14,620 articles were screened. Nine articles were found to meet established criteria. All studies included sleep hygiene content in the training programs, with five studies adding psychological and/or behavior change motivation training to support change in nurse sleep habits. Three studies added specific training for nurses and for managers. Delivery modes included in-person training of various lengths and frequency, mobile phone application with daily engagement, an online self-guided presentation, and daily reading material coupled with audio training. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were the outcome measures most frequently used. Although studies demonstrated improved sleep measures, most were pilot studies testing feasibility. CONCLUSION Although there is a paucity of studies focused on sleep education and training for shift working nurses, we found the inclusion of sleep hygiene content was the only common characteristic of all nine studies. The variability in training content, delivery methods, and outcome measures suggests further research is needed on what constitutes effective sleep education and training for nurses.
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Jelmini JD, Ross J, Whitehurst LN, Heebner NR. The effect of extended shift work on autonomic function in occupational settings: A systematic review and meta-analysis. J Occup Health 2023; 65:e12409. [PMID: 37287085 PMCID: PMC10247865 DOI: 10.1002/1348-9585.12409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE To examine the effect of 24-h shift work on autonomic nervous system function via heart rate variability (HRV) methodologies. METHODS Electronic databases (indexed in either PubMed, MEDLINE, CINAHL, SPORTDiscus, or OpenDissertations) were searched from January 1964 to March 2023. A modified Downs and Black checklist was used for assessing methodological quality and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Study design, study population, study sample, shift work description, and assessment of HRV metrics and methods were extracted from each study. FINDINGS A total of 58 478 study articles were identified, of which 12 articles met inclusion criteria. Sample sizes varied from eight to 60 participants, with the ratio of low- to high-frequency HRV (LF/HF) as the most common frequency-domain variable reported. Of the nine included studies that observed LF/HF, three (33.3%) demonstrated a significant increase after 24-h shift work. Moreover, of the five studies that reported HF, two (40%) noted a significant decrease after 24-h shift work. When observing risk of bias, two (16.6%) studies were low quality, five (41.7%) were moderate quality, and five (41.7%) were high quality. INTERPRETATION There were inconsistent findings demonstrating an effect of 24-h shift work on autonomic function, with a suggested shift away from parasympathetic dominance. Discrepancies in HRV methodologies, such as the duration of recordings and hardware used for measurement, may have contributed to the disparity in findings. In addition, differences in roles and responsibilities across occupations may explain the incongruence in findings across studies.
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Affiliation(s)
- Jacob D. Jelmini
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
| | - Jeremy Ross
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
| | | | - Nicholas R. Heebner
- College of Health Sciences, Sports Medicine Research InstituteUniversity of KentuckyLexingtonKentuckyUSA
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Keller E, Hittle BM, Smith CR. Tiredness Takes Its Toll: An Integrative Review on Sleep and Occupational Outcomes for Long-Term Care Workers. J Gerontol Nurs 2023; 49:27-33. [PMID: 36594911 DOI: 10.3928/00989134-20221206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Poor sleep quality and duration among health care professionals have negative impacts on worker safety, work readiness, and well-being. However, the consequences of impaired sleep among long-term care (LTC) workers remain understudied. The current integrative review sought to explore associations between sleep and occupational outcomes in LTC workers. Multiple database searches yielded 1,543 articles; nine articles met inclusion criteria. Results synthesized from included articles revealed sleep-associated occupational outcomes across three themes, Burnout/Fatigue, Mental and Physical Health, and Well-Being, which may affect performance measures and predict injuries/errors. Exploring outcomes of poor sleep quality and duration among LTC workers has highlighted the needs of this population and may inform future intervention development. LTC organizations should consider implementing strategies to better support the sleep quality of their workforce. In addition, further research is needed to explore how impaired sleep contributes to negative worker outcomes and patient care quality. [Journal of Gerontological Nursing, 49(1), 27-33.].
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Varner K, Hittle BM, Martsolf D, Plano Clark VL, Gillespie GL, Reutman S. Qualitative Findings for Supporting Newly Graduated Nurse and Teacher Sleep During Their First Year. Workplace Health Saf 2022; 70:556-565. [PMID: 36000700 DOI: 10.1177/21650799221116598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New graduate role transition for nurses and teachers is stressful. Poor adaptation may manifest as insomnia, which has implications for the new professionals, their employers, and the public served. This study examines factors that impact new graduate sleep, with the aim of identifying perceived helps and hindrances to sleep-during-transition. METHODS Targeted content analysis of transcripts from a larger longitudinal mixed methods study comparing new graduate sleep during their first year of practice. Study participants (N = 21) answered questions in the final interview regarding the most positive and negative impact(s) on sleep during the transition year. Transcripts were analyzed and compared based on the new graduate sleep typology (i.e., Got Better, Got Worse, Stayed Varied) which emerged from the parent study. FINDINGS Most participants, regardless of sleep type, identified a person/group as most positively impacting sleep. They identified work thoughts, stress/anxiety, people, work hours/sleep schedules, and environmental factors as negatively impacting sleep. Work thoughts and stress/anxiety were mentioned together and most frequently by participants in all three sleep types. CONCLUSION/APPLICATIONS TO PRACTICE This study provided insight into new graduate nurse and teacher sleep during transition. Support persons and/or groups may be essential regardless of sleep type. Thought management/stress mitigation strategies and good sleep hygiene may also improve the sleep experiences of these new professionals. Occupational health nurses can support sleep-during-transition among new nurses and teachers by acting as sleep advocates. They may also identify a need for medical intervention and/or sleep specialists and should promote fatigue risk mitigating policies.
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Jabaley T, Bagley J, Beardslee B, Hammer MJ. Ambulatory Oncology Nurses Weigh in About 12-Hour Shifts. J Nurs Adm 2022; 52:491-497. [PMID: 35994604 DOI: 10.1097/nna.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies conducted in hospital settings have associated negative clinical outcomes with 12-hour shifts. Despite this, 12-hour shifts are common in nursing and popular among nurses. Little is known about outcomes associated with 12-hour shifts in ambulatory care settings. OBJECTIVE A mixed-methods, quality improvement project was conducted in a large, ambulatory cancer center to evaluate oncology nursing staff perspectives on 12-hour shift work. METHODS One hundred ambulatory oncology nurses completed surveys and 11 participated in focus group interviews. FINDINGS Nurses expressed predominately positive perspectives about 12-hour shift work in ambulatory oncology care. CONCLUSIONS Ambulatory oncology nurses perceived benefits to quality, safety, and satisfaction for both nurses and patients related to 12-hour shifts. Further evaluation of patient, nurse, and organizational outcomes unique to ambulatory settings is essential for nurse executives in formulating data-driven staffing plans. The incorporation of 12-hour shifts should be considered.
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Affiliation(s)
- Terri Jabaley
- Author Affiliations: Clinical Inquiry Specialist (Dr Jabaley), Associate Chief Nurse (Ms Bagley), Oncology Nurse Navigator (Mr Beardslee), and Director (Dr Hammer), The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts
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Hittle BM, Norrell RM, Omololu SO, Gresham-Ulrich M. Retirement Center Worker Sleep Health Assessment During the COVID-19 Pandemic. Workplace Health Saf 2022; 70:268-277. [PMID: 35112602 DOI: 10.1177/21650799211054863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sleep health disturbances can increase risks for workplace injury, error, and poor worker health. Essential workers have reported sleep disturbances since the COVID-19 pandemic onset, which may jeopardize their health and safety. The aims of this project were to assess sleep health among Continuing Care Retirement Community (CCRC) workers, examine potential differences between worker types, and describe the self-perceived impact of COVID-19 on workers' workload and sleep. METHODS Through an academic-practice partnership, this needs assessment used a cross-sectional design that collected self-report data during fall 2020 from CCRC workers. Guided by the Workplace Health Model, survey questions included work characteristics, sleep health, and COVID-19 impact on sleep and workload. FINDINGS Ninety-four respondents completed the survey across multiple departments. Respondents (n = 34, 36.2%) reported sleeping below recommended hours on workdays. The majority scored above the population mean on Patient-Reported Outcomes Measurement (PROMIS) measures of sleep disturbance (n = 52, 55.3%), sleep-related impairment (n = 49, 52.1%), and fatigue (n = 49, 52.1%). Differences in workday total sleep time and fatigue were noted among shift workers versus nonshift workers, with shift workers reporting less sleep and more fatigue. Shorter sleep duration was noted among respondents working shifts 10 or more hours compared with those working 8 hours. Pandemic-related workload increase was reported by 22.3% (n = 21) of respondents, with 17% (n = 16) noting more than one type of workload change. Since COVID-19 onset, 36.2% (n = 34) reported no sleep changes and 35.1% (n = 33) reported sleeping less. A medium, positive relationship was found between increased changes in work due to COVID-19 and increased difficulties sleeping (r = .41, n = 73, p = .000). CONCLUSION/APPLICATION TO PRACTICE Proper sleep health is essential to workplace safety and worker health. By assessing sleep health during a crisis, occupational health nurses can identify opportunities to support worker health and safety, through sleep education, monitoring for sleepiness and fatigue, ensuring countermeasures are available (e.g., caffeine), and assessing for opportunities to change organizational policies.
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Need for cognition moderates the impairment of decision making caused by nightshift work in nurses. Sci Rep 2022; 12:1756. [PMID: 35110674 PMCID: PMC8810797 DOI: 10.1038/s41598-022-05843-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/05/2022] [Indexed: 11/26/2022] Open
Abstract
The current study explores the effect of nightshift work on the decision-making competence and performance of the Iowa Gambling Task (IGT) and analyzes whether individual differences in the need for cognition (NFC) can moderate this effect. A total of 107 female nurses were recruited to complete the decision-making competence scale and IGT at two times, after a night shift and after a day shift. The results revealed that the IGT scores and decision-making competence of nurses after nightshift work significantly declined, and also that the decrease in decision-making competence was related to the nurses’ performance of the IGT. Additionally, the decreasing degree of IGT and decision-making competence scores of the high-NFC group were significantly lower than those of the low-NFC group after nightshift work. In can be concluded that the decrease in decision-making competence which was related with poor decision-making due to nightshift work. NFC moderated the effect of nightshift work on decision-making.
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Sprajcer M, Thomas MJW, Sargent C, Crowther ME, Boivin DB, Wong IS, Smiley A, Dawson D. How effective are Fatigue Risk Management Systems (FRMS)? A review. ACCIDENT; ANALYSIS AND PREVENTION 2022; 165:106398. [PMID: 34756484 PMCID: PMC8806333 DOI: 10.1016/j.aap.2021.106398] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Fatigue Risk Management Systems (FRMS) are a data-driven set of management practices for identifying and managing fatigue-related safety risks. This approach also considers sleep and work time, and is based on ongoing risk assessment and monitoring. This narrative review addresses the effectiveness of FRMS, as well as barriers and enablers in the implementation of FRMS. Furthermore, this review draws on the literature to provide evidence-based policy guidance regarding FRMS implementation. METHODS Seven databases were drawn on to identify relevant peer-reviewed literature. Relevant grey literature was also reviewed based on the authors' experience in the area. In total, 2129 records were screened based on the search strategy, with 231 included in the final review. RESULTS Few studies provide an evidence-base for the effectiveness of FRMS as a whole. However, FRMS components (e.g., bio-mathematical models, self-report measures, performance monitoring) have improved key safety and fatigue metrics. This suggests FRMS as a whole are likely to have positive safety outcomes. Key enablers of successful implementation of FRMS include organisational and worker commitment, workplace culture, and training. CONCLUSIONS While FRMS are likely to be effective, in organisations where safety cultures are insufficiently mature and resources are less available, these systems may be challenging to implement successfully. We propose regulatory bodies consider a hybrid model of FRMS, where organisations could choose to align with tight hours of work (compliance) controls. Alternatively, where organisational flexibility is desired, a risk-based approach to fatigue management could be implemented.
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Affiliation(s)
| | | | | | | | - Diane B Boivin
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Imelda S Wong
- Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health, USA
| | | | - Drew Dawson
- Appleton Institute, CQUniversity, Adelaide, Australia
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Tabur A, Choudhury A, Emhan A, Mengenci C, Asan O. Clinicians’ Social Support, Job Stress, and Intent to Leave Healthcare during COVID-19. Healthcare (Basel) 2022; 10:healthcare10020229. [PMID: 35206844 PMCID: PMC8872505 DOI: 10.3390/healthcare10020229] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 12/07/2022] Open
Abstract
The onset of COVID-19 has escalated healthcare workers’ psychological distress. Multiple factors, including prolonged exposure to COVID-19 patients, irregular working hours, and workload, have substantially contributed to stress and burnout among healthcare workers. To explore the impact of COVID-19 on healthcare workers, our study compares the job stress, social support, and intention to leave the job among healthcare workers working in a pandemic (HP) and a non-pandemic hospital (HNP) in Turkey during the pandemic. The cross-sectional, paper-based survey involved 403 healthcare workers including physicians, registered nurses, health technicians, and auxiliary staff across two hospitals from 1 September 2020 to 31 November 2020. The findings indicate a significant impact of ‘Job stress’ on ‘Intent to leave’ job among participants in the HP. We noted that ‘intent to leave’ and ‘job stress’ were significantly higher among the HP healthcare workers than those working in the HNP, respectively. However, workers’ ‘social support’ was significantly lower in the HP. Healthcare workers, during COVID-19, face several hurdles such as job stress, reduced social support, and excessive workload, all of which are potential factors influencing a care provider’s intent to leave the job.
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Affiliation(s)
- Ayhan Tabur
- Emergency Department, Gazi Yaşargil Training and Research Hospital, Diyarbakir 21070, Turkey;
| | - Avishek Choudhury
- Stevens Institute of Technology, School of Systems and Enterprises, Hoboken, NJ 07030, USA;
| | - Abdurrahim Emhan
- Collage of Business Administration, University of Central Florida, Orlando, FL 32816, USA;
| | - Cengiz Mengenci
- Department of Quality, Bower Hospital, Diyarbakir 21100, Turkey;
| | - Onur Asan
- Stevens Institute of Technology, School of Systems and Enterprises, Hoboken, NJ 07030, USA;
- Correspondence: ; Tel.: +1-(201)-216-5514
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Naylor J, Gillespie GL, Betcher C, Orr CE. Cost Analysis of Providing Overtime to Current Nurses Versus Hiring a Dedicated Nurse for COVID-19 Management in a Processing Plant. Workplace Health Saf 2022; 70:24-30. [PMID: 35037511 DOI: 10.1177/21650799211027868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND U.S. meat and poultry processing workers experienced a disproportionate burden of COVID-19 illness following the declaration of the COVID-19 pandemic. Managing prevention and surveillance activities for COVID-19 prevention required additional work for occupational health nurses. The purpose of this project was to conduct a cost analysis for two staffing options to address the increased workload for occupational health nurses. METHODS An economic quality improvement design was used for this study. The project was performed at a meat and poultry processing plant with 1,800 employees and six occupational health nurses. Two staffing options were considered. Option 1 was to continue to pay current occupational health nurses overtime, and Option 2 was to hire a COVID-dedicated nurse to manage the increased workload. A cost analysis was conducted for wages per hour plus benefits at three time points: 3 months, 1 year, and 3 years. FINDINGS Costs for Option 1 (continuing overtime) at 3 months, 1 year, and 3 years were estimated at US$27,370, US$109,517, and US$328,550, respectively. Costs for Option 2 (hiring a COVID-dedicated nurse) at 3 months, 1 year, and 3 years were estimated at US$44,279, US$94,979, and US$230,179, respectively. CONCLUSIONS/APPLICATION TO PRACTICE Hiring a dedicated COVID nurse would save the processing plant extensive salary costs by Year 3. Reducing overtime had the potential to decrease the COVID-19-related workload and potential experiences of fatigue and burnout in occupational health nurses.
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Chen YJ, Lin KP. Association Among Work Characteristics, Role Transition, and Job Burnout in Nurse Practitioners in Taiwan. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221081403. [PMID: 35274551 PMCID: PMC8921748 DOI: 10.1177/00469580221081403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Workplace burnout is common among nurse practitioners (NPs) and often occurs during role transition from a registered nurse to an NP. This study aimed to explore the predictors of job burnout in nurse practitioners (NPs). A quantitative cross-sectional design was conducted on 361 convenience sample of NPs from four hospitals in central Taiwan. Data on the demographic and working characteristics (hospital grade, years of experience as an RN and NP, practice setting, working shifts, working hours, average number of patients take care, salary, and performance bonus), Chinese version of the Nurse Practitioner Role Transition Scale, and Occupational Burnout Inventory were used. The enrolled NPs showed medium-level role transition scores (mean = 65.73, SD = 9.59), and the prevalence of personal burnout, client-related burnout, and over-commitment was 51.2%, 19.4%, and 49.9%, respectively. Role transition, hospital grade, practice setting, working hours, and number of patients take care were significant predictors of personal burnout, client-related burnout, and over-commitment after adjusting for cofounding variables, possibly explaining 52.8%, 42.1%, and 36.3% of variance, respectively. Hospital administrators should provide necessary assistance to help NPs transition to new role and ensure a positive work environment and reasonable workload so as to prevent the impact of job burnout on NPs.
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Affiliation(s)
- Yi Ju Chen
- Division of Orthopedics, Everan Hospital, Taichung, Taiwan
| | - Kuan Pin Lin
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
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Dugan AG, Decker RE, Zhang Y, Lombardi CM, Garza JL, Laguerre RA, Suleiman AO, Namazi S, Cavallari JM. Precarious Work Schedules and Sleep: A Study of Unionized Full-Time Workers. OCCUPATIONAL HEALTH SCIENCE 2022; 6:247-277. [PMID: 35372671 PMCID: PMC8962924 DOI: 10.1007/s41542-022-00114-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
Unlike precarious employment which is temporary and insecure, with inadequate pay, benefits, and legal protections, precarious work schedules can affect workers with permanent full-time jobs in sectors where employment has historically been secure, well-compensated, and even unionized. Precarious work schedules - characterized by long shifts, non-daytime hours, intensity and unsocial work hours - are increasingly prevalent. Relations between precarious work schedules and poor health are not well understood, and less is known about how to attenuate this relation. We examined the indirect effects of precarious work schedules on fatigue and depressive symptoms through sleep quantity. Two moderators - schedule flexibility and sleep quality - were examined as buffers of these associations. Workers from the Departments of Correction and Transportation in a northeast state (N = 222) took surveys and reported on demographics, work schedule characteristics, schedule flexibility, sleep quality and quantity, fatigue, and depressive symptoms. Results revealed that precarious work schedules had indirect effects on fatigue and depressive symptoms through sleep quantity. Schedule flexibility moderated the relation between precarious work schedules and sleep quantity, such that workers with greater schedule flexibility had more hours of sleep. Sleep quality moderated the association between sleep quantity and fatigue and depressive symptoms, such that workers reported greater fatigue and depressive symptoms when they had poorer sleep quality. Findings have direct applicability for developing initiatives that enhance Total Worker Health® through individual and organizational changes. Supplementary Information The online version contains supplementary material available at 10.1007/s41542-022-00114-y.
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Affiliation(s)
- Alicia G Dugan
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030 USA
| | - Ragan E Decker
- Society for Human Resource Management, 1800 Duke Street, Alexandria, VA 22314 USA
| | - Yuan Zhang
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, 113 Wilder Street, Lowell, MA 01854-5126 USA
| | - Caitlin M Lombardi
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT 06269 USA
| | - Jennifer L Garza
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030 USA
| | - Rick A Laguerre
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269 USA
| | - Adekemi O Suleiman
- Department of Public Health Sciences, University of Connecticut School of Medicine, 195 Farmington Ave, Farmington, CT 06030 USA
| | - Sara Namazi
- Department of Health Sciences, Springfield College, 468 Alden St, Springfield, MA 01109 USA
| | - Jennifer M Cavallari
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030 USA.,Department of Public Health Sciences, University of Connecticut School of Medicine, 195 Farmington Ave, Farmington, CT 06030 USA
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AORN Position Statement on Perioperative Safe Staffing and On‐Call Practices. AORN J 2021. [DOI: 10.1002/aorn.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Min A, Hong HC, Son S, Lee TH. Alertness during working hours among eight-hour rotating-shift nurses: An observational study. J Nurs Scholarsh 2021; 54:403-410. [PMID: 34791773 DOI: 10.1111/jnu.12743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to identify the patterns of the decline in the alertness of rotating-shift nurses during working hours across different shift types (day, evening, and night) using an objective measure. DESIGN An observational study using ReadiBand wrist actigraphs was conducted. METHODS Data were collected from June 2019 to February 2020. Participants were rotating-shift nurses (N = 82) who provided direct nursing care for patients in acute care hospitals in South Korea. Nurses wore actigraphs continuously for 14 days on their non-dominant hand to identify sleep-wake cycles and predict their alertness scores hourly. All participants completed a sleep diary. FINDINGS Nurses working during night shifts had lower average alertness scores (mean = 77.12) than nurses working during day (mean = 79.05) and evening (mean = 91.21). Overall, alertness showed a declining trend and the specific patterns of decline differed across shifts. Participants with alertness scores less than 70 or 80 demonstrated a significant decline in alertness across all shifts. CONCLUSIONS Distinct patterns of decline in alertness per nursing shift were revealed. Each shift feature should be considered when developing interventions to increase nurses' alertness, promote high-quality care provision, and ensure patient safety. CLINICAL RELEVANCE The implementation of interventions to increase alertness among shift nurses is needed at the organizational level, and the cooperation of nursing managers and administrators is required.
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Affiliation(s)
- Ari Min
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Sungtaek Son
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Tae Hee Lee
- Department of Applied Statistics, Yonsei University, Seoul, South Korea
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Cochran KR, Letvak SA, McCoy TP, Bacon C, Karper WB. Can Nurses Self-Assess Fatigue?: Implications for Nurse Leaders. J Nurs Adm 2021; 51:507-512. [PMID: 34519698 DOI: 10.1097/nna.0000000000001055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were to describe nurses' self-perceptions of fatigue and to examine nurses' acceptance of specific fatigue countermeasures. BACKGROUND The work of nurses places them at a high risk of fatigue. Evidence suggests 75% to 80% of nurses in the United States experience high levels of fatigue. METHODS This descriptive, cross-sectional correlational study surveyed 279 nurses. RESULTS Results suggest that almost half of nurses (46%) are not able to accurately self-assess fatigue. Nurses expressed acceptance of several workplace fatigue reduction strategies. CONCLUSIONS It may be unrealistic to expect nurses to self-assess fatigue levels and make decisions about their ability to safely provide patient care. Reliable methods for assessing fatigue in the workplace are needed. Several strategies exist that may be used to alleviate fatigue, and many were acceptable to nurses. Nurse leaders are well positioned to implement changes that impact the occurrence of nurse fatigue and thereby the quality of patient care.
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Affiliation(s)
- Karen R Cochran
- Author Affiliations : Grant Specialist (Dr Cochran), School of Nursing, Western Carolina University, Asheville, North Carolina; and Professor (Dr Letvak), Clinical Professor (Dr McCoy), and Assistant Professor (Dr Bacon), School of Nursing, and Associate Professor (Dr Karper), Department of Kinesiology, University of North Carolina at Greensboro
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Min A, Hong HC, Son S, Lee T. Sleep, fatigue and alertness during working hours among rotating-shift nurses in Korea: An observational study. J Nurs Manag 2021; 29:2647-2657. [PMID: 34351017 DOI: 10.1111/jonm.13446] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/22/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
AIMS To determine the effects of sleep parameters and fatigue on the decline in alertness of nurses across shifts. BACKGROUND Shift work can lead to nurse fatigue owing to insufficient sleep and inadequate recovery time between shifts. Nurse fatigue has adverse effects on alertness and can affect provision of quality care. METHODS An observational study using wrist actigraphs was conducted from 2019 to 2020. Participants were 82 rotating-shift nurses who provided direct nursing care in acute hospitals in South Korea. They wore actigraphs for 14 days to measure sleep parameters and predict hourly alertness and reported subjective fatigue before and after every shift. RESULTS Nurses demonstrated shorter sleep hours, lower sleep efficiency and longer sleep latency before night shifts compared with other shifts. Fatigue was the highest before day shifts. Sleep parameters and fatigue significantly affected the steep decline in alertness in participants with alertness scores below 70. CONCLUSIONS Sleep parameters and fatigue level contributed to the differences in decline in alertness across shifts. IMPLICATION FOR NURSING MANAGEMENT Findings inform nurse managers, administrators to develop interventions to reduce fatigue, improve sleep quantity and quality and increase alertness among rotating-shift nurses. Management, institutional and individual factors should be considered when developing interventions.
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Affiliation(s)
- Ari Min
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Sungtaek Son
- Clinical Development Division, Celltrion Inc., Incheon, South Korea
| | - Taehee Lee
- Department of Applied Statistics, Yonsei University, Seoul, South Korea
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Smith A, McDonald AD, Sasangohar F. The Impact of Commutes, Work Schedules, and Sleep on Near-Crashes during Nurses' Post Shift-Work Commutes: A Naturalistic Driving Study. IISE Trans Occup Ergon Hum Factors 2021; 9:13-22. [PMID: 34157964 DOI: 10.1080/24725838.2021.1945708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OCCUPATIONAL APPLICATIONSDriving and survey data were collected from nurses following the night-shift and analyzed with logistic regression and frequency analysis. The analyses showed that prior near-crashes and drive length contributed significantly to near-crashes. The frequency analysis showed that most near-crashes occurred on major roadways, including principal arterials, major collectors, and interstates, within the first 15 minutes of the drive. These results highlight the urgent need for countermeasures to prevent drowsy driving incidents among night-shift nurses. Specifically, nurses and hospital systems should focus on countermeasures that encourage taking a break on the post work commute and those that can intervene during the drive. This may include the use of educational programs to teach nurses the importance of adequate rest or taking a break to sleep during their drive home, or technology that can recognize drowsiness and alert nurses of their drowsiness levels, prompting them to take a break.
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Affiliation(s)
- Alec Smith
- Wm' Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Anthony D McDonald
- Wm' Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
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Fatigue and Vigilance-Related Factors in Family Caregivers of Patients With Advanced Cancer: A Cross-sectional Study. Cancer Nurs 2021; 45:E621-E627. [PMID: 33813529 DOI: 10.1097/ncc.0000000000000944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Family caregivers (FCs) commonly experience fatigue during caregiving. The factors of fatigue in the FCs of patients with advanced cancer have not yet been investigated in Taiwan. OBJECTIVE This study investigated potential predictors of fatigue in the FCs of patients with advanced cancer. METHODS A descriptive, cross-sectional study was conducted on 184 FCs. Data were collected using the Checklist Individual Strength and the palm-based psychomotor vigilance test. A linear regression model was the main statistical method for identifying the factors predictive of fatigue in FCs. RESULTS Subjective and objective measurements revealed that 95% of the FCs had fatigue and poor vigilance. Those who spent more time each day on caregiving tasks, had no religious beliefs, had a full- or part-time job, and had a greater caregiver burden experienced greater fatigue. CONCLUSIONS Fatigue and poor vigilance were common in the Taiwanese FCs of patients with advanced cancer. Family caregivers with risk factors for fatigue must be identified and given access to resources for assistance. IMPLICATION FOR PRACTICE Healthcare providers must proactively assess FCs for fatigue and vigilance status and provide interventions appropriate for individual needs.
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Min A, Kang M, Hong HC. Sickness Presenteeism in Shift and Non-Shift Nurses: Using the Fifth Korean Working Conditions Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063236. [PMID: 33800982 PMCID: PMC8004057 DOI: 10.3390/ijerph18063236] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023]
Abstract
Nurses have reported higher rates of sickness presenteeism than other workers, which is particularly problematic because this problem is linked to care quality and patient safety. This secondary data analysis study aimed to identify the prevalence of sickness presenteeism and explore related factors among shift and non-shift nurses using the Fifth Korean Working Conditions Survey. A total of 272 nurses in Korean hospitals were included. The survey included questions on working conditions, health status, and sickness presenteeism. A multivariate logistic regression was used to identify associated factors of sickness presenteeism. Overall, 21.8% of the participants reported experiencing sickness presenteeism; shift nurses experienced more sickness presenteeism than non-shift nurses. Sickness presenteeism was greater in shift nurses who did not have rest breaks during work and in nurses who experienced quick return. Additionally, the odds of sickness presenteeism were approximately four times greater in shift nurses who experienced sleep disturbance and about four times higher in shift nurses who experienced health problems. Among non-shift nurses, the odds of sickness presenteeism were about 15 times greater in those who worked ≥53 h per week. Nurse managers and administrators should prevent sickness presenteeism in hospital nurses to provide quality care and enhance productivity.
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Affiliation(s)
- Ari Min
- Department of Nursing, Chung-Ang University, Seoul 06974, Korea; (A.M.); (H.C.H.)
| | - Minkyung Kang
- College of Nursing, Keimyung University, Daegu 42601, Korea
- Correspondence: ; Tel.: +82-53-258-7657
| | - Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul 06974, Korea; (A.M.); (H.C.H.)
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Jeong YM, Min A. Depression, Help‐Seeking Attitude, Sleep Quality, and Missed Nursing Care Among Nurses in Korean Hospitals: A Cross‐Sectional Study. J Nurs Scholarsh 2021; 54:135. [DOI: 10.1111/jnu.12647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Yoo Mi Jeong
- Assistant Professor College of Nursing Dankook University South Korea
| | - Ari Min
- Assistant Professor Department of Nursing Chung‐Ang University South Korea
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Chang W, Peng Y. Meta-analysis of differences in sleep quality based on actigraphs between day and night shift workers and the moderating effect of age. J Occup Health 2021; 63:e12262. [PMID: 34392580 PMCID: PMC8364763 DOI: 10.1002/1348-9585.12262] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study was to conduct a meta-analysis of studies that used actigraphs to compare the influence of day and night shifts on the sleep quality of workers as well as examine the moderating effect of age. METHODS Databases including PubMed, CINAHL, the Cochrane Library, MEDLINE, and EBSCOhost were searched for relevant studies published in English between January 1st, 2000 and April 30st, 2021. Our main targets were studies that used actigraphs to assess the sleep quality of night shift workers. This meta-analysis included 12 papers and was performed using Comprehensive Meta-Analysis (CMA) Version 3.0. Effect sizes were displayed in a forest plot using standardized mean difference (SMD) and 95% confidence intervals (CI). RESULTS Among the sleep quality indices of the day and night shift workers, no significant difference existed in terms of sleep efficiency (SE) (SMD = 0.27, 95% CI: -0.03-0.57), whereas night shift workers presented longer sleep-onset latency (SOL) (SMD = 0.62, 95% CI: 0.15-1.08), greater wake after sleep onset (WASO) (SMD = 0.41, 95% CI: 0.12-0.70), and longer total sleep time (TST) (SMD = 0.85, 95% CI: 0.32-1.39) than did day shift workers. The differences between the day and night shift workers in SOL, WASO, and TST did not vary with age. CONCLUSIONS Among the sleep quality indices, night shift workers presented longer SOL and greater WASO than did day shift workers. However, night shift workers could regulate their rest time and had adequate TST; thus, their SE was not different from that of day shift workers.
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Affiliation(s)
- Wen‐Pei Chang
- School of Nursing, College of NursingTaipei Medical UniversityTaipeiTaiwan
- Department of NursingTaipei Medical University‐Shuang Ho HospitalMinistry of Health and WelfareNew Taipei CityTaiwan
| | - Yu‐Xuan Peng
- Nurse in the Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
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Cho H, Han K, Ryu E, Choi E. Work Schedule Characteristics, Missed Nursing Care, and Organizational Commitment Among Hospital Nurses in Korea. J Nurs Scholarsh 2020; 53:106-114. [PMID: 33249723 DOI: 10.1111/jnu.12612] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE This study describes Korean nurses' work schedule characteristics and identifies their components to investigate associations of work schedule components with missed nursing care and organizational commitment. DESIGN This cross-sectional secondary analysis used survey data of 1,057 nurses in 111 units at six hospitals in South Korea. Data were collected between April 2017 and March 2018. METHODS A self-administered survey, including seven work schedule characteristic items, the Korean version of the MISSCARE Survey, and the Korean version of the Organizational Commitment Questionnaire, was employed. To construct independent components of work schedule characteristics, a principal component analysis was performed. The associations of work schedule components with missed nursing care and organizational commitment were analyzed using multiple linear regression models with generalized estimating equation methods. FINDINGS The average number of daily work hours was 9.7. Nearly half of the study population worked while sick once or more per month. The two components of nurses' work schedule characteristics were "long work hours" and "lack of rest," and these components showed variations between units. Unhealthy work schedule components were linked to frequently missed nursing care and decreased organizational commitment. CONCLUSIONS This study showed that proper work hours and adequate rest are important to reduce missed nursing care tasks and enhance organizational commitment, both of which are critical for better patient care and organizational outcomes. CLINICAL RELEVANCE Healthcare organizations should provide adequate nursing staff and assign reasonable workloads. Furthermore, hospitals should periodically monitor the work schedule characteristics of nurses and actively intervene in cases of scheduling issues to resolve them.
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Affiliation(s)
- Hyeonmi Cho
- Beta Eta-at-Large, PhD Student, University of Wisconsin-Madison, School of Nursing, WI, USA
| | - Kihye Han
- Lambda Alpha-at-Large, Associate Professor, Chung-Ang University College of Nursing, Seoul, Republic of Korea
| | - Eunjung Ryu
- Professor, Chung-Ang University College of Nursing, Seoul, Republic of Korea
| | - Eunsook Choi
- Unit Manager, National Cancer Center Department of Nursing, Gyeonggi-do, Republic of Korea
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Gerace A, Rigney G. Considering the relationship between sleep and empathy and compassion in mental health nurses: It's time. Int J Ment Health Nurs 2020; 29:1002-1010. [PMID: 32406147 DOI: 10.1111/inm.12734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/30/2022]
Abstract
Sleep plays a critical role in overall health, well-being, and daytime functioning. Provision of 24-hour care means that nurses undertake shift work and therefore have been found to commonly not get the recommended amount of sleep, resulting in sleep deprivation. Research to date has focused on how sleep deprivation impacts their cognitive performance (e.g., reaction time, memory consolidation); however, less considered is how nurses' sleep impacts on their ability to understand and provide emotional care to consumers. In this paper, we examine how sleep may influence nurses' ability to empathize and provide compassionate care, both of which are fundamental aspects of their work. We begin by considering the unique challenges nurses face as shift workers and the impact of sleep on physical and psychological functioning. We examine how empathy and compassion drive nurses' attempts to understand consumers' perspectives and experiences and motivate them to want to help those in their care. Work directly investigating the relationship between sleep and these processes indicates emotional recognition and experience are hampered by poor sleep, with greater compassion towards oneself or from others associated with better sleep. Much of this work has, however, been conducted outside of the nursing or health professional space. We discuss issues that need to be addressed in order to move understanding forward regarding how sleep impacts on mental health nurses' empathy and compassion, as well as how an understanding of the sleep-empathy/compassion link should be an important priority for nurse education and well-being.
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Affiliation(s)
- Adam Gerace
- School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia
| | - Gabrielle Rigney
- School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia
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Westley JA, Peterson J, Fort D, Burton J, List R. Impact of nurse's worked hours on medication administration near-miss error alerts. Chronobiol Int 2020; 37:1373-1376. [PMID: 32835534 DOI: 10.1080/07420528.2020.1811295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Long working hours have been shown to negatively impact adverse events in health care. In this study, a retrospective correlational design was used to evaluate the relationship between working hours and near-miss medication error alerts. During a two-year period, 5372 nurses triggered 420,706 near-miss alerts on 9, 285, 786 medication administrations. Nurses who worked 60 h or more in a week yielded an average near-miss rate of 4.0% compared to 3.0% (p <.001) for nurses who did not. Nurses working extended hours had a significantly increased risk of triggering a near-miss alert compared to those not working extended hours.
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Affiliation(s)
| | - Jessica Peterson
- Nursing Education & Research, Ochsner Health, New Orleans, LA, USA
| | - Daniel Fort
- Center for Outcomes & Health Services Research, Ochsner Health, New Orleans, LA, USA
| | - Jeffrey Burton
- Center for Outcomes & Health Services Research, Ochsner Health, New Orleans, LA, USA
| | - Robert List
- Staffing Resource Center, Ochsner Health, New Orleans, LA, USA
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Ballesio A, Lombardo C, Lucidi F, Violani C. Caring for the carers: Advice for dealing with sleep problems of hospital staff during the COVID-19 outbreak. J Sleep Res 2020; 30:e13096. [PMID: 32515084 PMCID: PMC7300547 DOI: 10.1111/jsr.13096] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/26/2022]
Abstract
Hospital staff are at the frontline in the COVID‐19 outbreak. The stressors they experience may induce sleep problems in a population already at risk. Sleep deprivation, long shifts and insomnia in hospital staff have been associated with individual, organizational and public health hazards. These include increased risk of mental and somatic disorders, altered immune responses, medical errors, misunderstandings, drowsy driving and burnout. In March 2020, the World Health Organization called for providing access to mental health and counselling for health professionals involved in the COVID‐19 outbreak. To answer this call, we propose practical advice for the management of sleep problems (sleep deprivation, insomnia and shift work) that can be included in supportive interventions. The advice is based on psychobiological principles of sleep regulation and on guidelines for the treatment of insomnia and was implemented within an initiative offering psychological support to the staff of three university hospitals in Rome.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Caterina Lombardo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabio Lucidi
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Cristiano Violani
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Okoli CTC, Seng S, Otachi JK, Higgins JT, Lawrence J, Lykins A, Bryant E. A cross-sectional examination of factors associated with compassion satisfaction and compassion fatigue across healthcare workers in an academic medical centre. Int J Ment Health Nurs 2020; 29:476-487. [PMID: 31808600 DOI: 10.1111/inm.12682] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 12/30/2022]
Abstract
Compassion satisfaction (CS) among healthcare professionals is a sense of gratification derived from caring for their suffering patients. In contrast, compassion fatigue, often a consequence of burnout (BO) and secondary traumatic stress (STS), is detrimental to healthcare professionals' productivity and patient care. While several studies have examined CS, BO, and STS among healthcare professionals, the majority have assessed samples in specific disciplines. However, the comparative differences in these factors by discipline or work setting are not well known. The aims of this study were to examine the differences in CS, BO, and STS by discipline and work setting, and to assess demographic, work-related, and behavioural factors associated with these outcomes. An electronic survey was administered (N = 764) at a large academic medical centre in the southeast United States. Questions elicited demographic variables, work-related factors, behavioural/lifestyle factors, experience with workplace violence, and the Professional Quality of Life Scale. Findings of the study determined that the rates of CS, BO, and STS vary across healthcare disciplines and work settings. Demographic, work-related, behavioural, and work setting (i.e., experience of workplace violence) factors were differentially associated with experiences of CS, BO, and STS. The results of the study suggest two potential areas for research, specifically workplace violence and sleep quality as a means of further understanding reduced CS and increased BO and STS among healthcare workers. These findings have important implications for future research and policy interventions to enhance healthcare workers' health and safety.
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Affiliation(s)
| | - Sarret Seng
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Janet K Otachi
- University of Kentucky College of Social Work, Lexington, Kentucky, USA
| | - Jacob T Higgins
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
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Hittle BM, Caruso CC, Jones HJ, Bhattacharya A, Lambert J, Gillespie GL. Nurse Health: The Influence of Chronotype and Shift Timing. West J Nurs Res 2020; 42:1031-1041. [PMID: 32419655 DOI: 10.1177/0193945920916802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Extreme chronotype and circadian disrupting work hours may increase nurse disease risks. This national, cross-sectional study of nurses (N = 527) had three hypotheses. When chronotype and shift times are incongruent, nurses will experience increased likelihood of (1) obesity, (2) cardiovascular disease/risk factors, and (3) obesity or cardiovascular disease/risk factors when theoretically linked variables exist. Chronotype mismatched nurses' (n = 206) average sleep (6.1 hours, SD = 1.2) fell below 7-9 hours/24-hours sleep recommendations. Proportion of male nurses was significantly higher chronotype mismatched (12.3%) than matched (6.3%). Analyses found no direct relationship between chronotype match/mismatch with outcome variables. Exploratory interaction analysis demonstrated nurses with mismatched chronotype and above average sleep quality had an estimated 3.51 times the adjusted odds (95% CI 1.52,8.17; p = .003) of being obese. Although mechanism is unclear, this suggests sleep quality may be intricately associated with obesity. Further research is needed to inform nurses on health risks from disrupted sleep, chronotypes, and shift work.
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Affiliation(s)
| | - Claire C Caruso
- National Institute for Occupational Safety and Health, Division of Science Integration, Cincinnati, OH
| | - Holly J Jones
- College of Nursing, University of Cincinnati, Cincinnati, OH
| | | | - Joshua Lambert
- College of Nursing, University of Cincinnati, Cincinnati, OH
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Night-shift nurses and drowsy driving: A qualitative study. Int J Nurs Stud 2020; 112:103600. [PMID: 32703687 DOI: 10.1016/j.ijnurstu.2020.103600] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Drowsy driving following the night shift is persistent among nurses resulting in elevated rates of vehicle crashes and crash-related injuries and deaths. While considerable effort has been dedicated to the development of countermeasures, implementation of these countermeasures in nursing has lagged behind other shift work oriented industries. Developing effective countermeasures for drowsy driving in nurses requires a thorough characterization of nurse's perceptions of drowsy driving and potential mitigations. OBJECTIVE The objective of this research was to elicit night shift nurses' perceptions of drowsy driving, countermeasures, and educational and technological interventions. DESIGN Perceptions were elicited through a semi-structured interview protocol. The protocol design was driven by previously identified research gaps. Questions focused on four topics: perceptions of drowsy driving, current practices and methods to mitigate drowsiness during the shift and commute, preferences and expectations for training on drowsiness management, and, preferences and expectations for technological mitigations. SETTING The data collection took place at a large urban hospital in Texas, USA. PARTICIPANTS Thirty night-shift nurses were recruited with voluntary sampling. No nurses declined to participate after initially consenting. The participants were male and female nurses who currently worked a 12 hour night shift. The nurses had between 1 and more than 20 years of experience and worked in a variety of units. METHOD The interview recordings were transcribed by the research team and entered into a qualitative data analysis software. Transcripts were analyzed by two independent coders with a grounded theory approach to identify common themes and subthemes across participants. FINDINGS Feelings of drowsiness typically manifested immediately following the shift or during the post work commute. Nurses responded to drowsiness by engaging in multiple ineffective countermeasures (e.g., listening to music) and effective countermeasures (e.g., naps) were used sparingly. Experiences and mitigation methods traversed through the nurses' social network although they did not always alter behavior. Nurses were uncertain but enthusiastic about educational and technological interventions preferring practical training and auditory interactive alerts. CONCLUSIONS The findings suggest a strong need for real time drowsiness interventions during or immediately prior to nurses' post work commutes. Nurses' enthusiasm for training and technology to prevent drowsy driving suggests high levels of readiness and acceptance for such interventions. Future work should focus on the development and implementation of practical training and technological interventions for drowsy driving in nurses.
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Kyle E, Spruce L. Clinical Issues—November 2019. AORN J 2019; 110:536-546. [DOI: 10.1002/aorn.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Association of Working Hours and Patient Safety Competencies with Adverse Nurse Outcomes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214083. [PMID: 31652889 PMCID: PMC6862320 DOI: 10.3390/ijerph16214083] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022]
Abstract
The environment of health organizations can determine healthcare quality and patient safety. Longer working hours can be associated with nurses’ health status and care quality, as well as work-related hazards. However, little is known about the association of hospital nurses’ working hours and patient safety competencies with adverse nurse outcomes. In this cross-sectional descriptive study, convenience sampling was employed to recruit 380 nurses from three tertiary care hospitals in South Korea. Data were collected using structured questionnaires from May to June 2016. Hierarchical linear regression analysis was used to identify the association of working hours and patient competencies with adverse nurse outcomes among 364 participants selected for analysis. Most nurses worked over 40 h/week. Working hours (β = 0.202, p < 0.001) had the strongest association with adverse nurse outcomes. Low perceived patient safety competencies (β = −0.179, p = 0.001) and frequently reporting patient safety accidents (β = 0.146, p = 0.018) were also correlated with adverse nurse outcomes. Nursing leaders should encourage work cultures where working overtime is discouraged and patient safety competencies are prioritized. Further, healthcare managers must formulate policies that secure nurses’ rights. The potential association of overtime with nurse and patient outcomes needs further exploration.
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Policy brief: Nurse fatigue, sleep, and health, and ensuring patient and public safety. Nurs Outlook 2019; 67:615-619. [PMID: 31582105 DOI: 10.1016/j.outlook.2019.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Dowdell EB, Clayton BQ. Interrupted sleep: College students sleeping with technology. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:640-646. [PMID: 30365360 DOI: 10.1080/07448481.2018.1499655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/22/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
Objective: To examine the influence of cell phones and sleep quality among college students and the prevalence of sleep texting. Participants: Participants were 372 college students at two mid-size universities in 2013. Methods: A survey was used to ask about cell phone use during sleep and sleep quality. Students were asked about hours of sleep, both on a school night, and over the weekend in addition to location of cell phone. Results: A quarter of the sample (25.6%) reported sleep texting behavior along with poor sleep quality and the cell phone influencing their sleep (p < .05). Students that sleep text were more likely to report sleep interruption (p < .000), to place their phone in bed with them (p < .000), have no memory of texting (72%) or what they texted (25%). Conclusions: Sleep texting and its influence on poor sleep habits is a growing trend in a college student population.
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Affiliation(s)
- Elizabeth B Dowdell
- M. Louise Fitzpatrick College of Nursing , Villanova University , Villanova , Pennsylvania , USA
| | - Brianne Q Clayton
- M. Louise Fitzpatrick College of Nursing , Villanova University , Villanova , Pennsylvania , USA
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Sleep duration is associated with depressive symptoms among expatriate nurses. J Affect Disord 2019; 257:658-661. [PMID: 31377601 DOI: 10.1016/j.jad.2019.07.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/06/2019] [Accepted: 07/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is limited data on sleep and its impact on mental health among expatriate nurses in Saudi Arabia. This study aimed to assess the association between sleep duration and symptoms of depression among expatriate nurses. METHODS Nurses in government healthcare facilities in Al-Qassim, Saudi Arabia responded to an electronic survey (n = 977) on demography, lifestyle, job features, and symptoms of depression (Depression Anxiety Stress Scale 21). Binary and multinomial logistic regression, respectively, assessed the adjusted associations of daily sleep hours (≤5, 6-7, ≥8) with having any (no, yes) or degree of symptoms (no, mild to moderate, and severe to extremely severe). RESULTS There was a dose-response relationship between sleep hours and depressive symptoms (any as well as degree) (p-values for trend <0.05). For nurses who slept 6-7 h, the odds ratio (OR) of having any symptoms of depression was 1.6 (95% CI: 1.2 - 2.2), 'mild to moderate' symptoms 1.5 (95% CI: 1.1 - 2.2), and 'severe to extremely severe' symptoms 1.9 (95% CI: 1.1 - 3.4). For nurses who slept ≤5 h, the OR of having any symptoms was 2.1 (95% CI: 1.4-3.3), 'mild to moderate' symptoms 1.7 (95% CI: 1.0-2.6), and 'severe to extremely severe' symptoms 4.2 (95% CI: 2.2-8.1) (reference group ≥ 8 h). LIMITATIONS The sleep data pertained to duration only and not to sleep quality. CONCLUSION There was a strong association between sleep duration and symptoms of depression among expatriate nurses.
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Wingler D, Keys Y. Understanding the impact of the physical health care environment on nurse fatigue. J Nurs Manag 2019; 27:1712-1721. [PMID: 31487085 DOI: 10.1111/jonm.12862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/20/2019] [Accepted: 08/31/2019] [Indexed: 11/30/2022]
Abstract
AIM(S) The purpose of this study was to investigate factors in the physical health care environment (PHE) contributing to nurse fatigue. BACKGROUND Nurses experience high levels of physical, mental and overall fatigue related to the physically demanding and mentally complex nature of bedside care. METHOD(S) This study used secondary data analysis of a 2017 focus group session, which explored: (a) challenges nursing professionals face while delivering care, (b) the effect of nurse fatigue on care delivery and (c) system factors that can either reduce or contribute to nurse fatigue. Eleven volunteers from a health care design focused nursing organisation participated in the focus group. RESULTS Twenty-seven design elements across four environmental categories were identified in this study as impacting fatigue. The effects of fatigue were found to have implications at the individual level (nurse and patient), the organisational level and the profession at large. Fatigue effects were found to be cumulative. CONCLUSION(S) Findings suggest that the PHE can have a substantial impact on nurse fatigue and contribute to profound effects with patient and staff safety implications. IMPLICATIONS FOR NURSING MANAGEMENT This study provides nursing managers, hospital administrators, nurses and designers with evidence for utilizing the PHE to mitigate and prevent nurse fatigue.
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Affiliation(s)
- Deborah Wingler
- School of Architecture, The Center for Health Facilities Design and Testing, Clemson University, Clemson, South Carolina
| | - Yolanda Keys
- College of Nursing and Health Sciences, Texas A&M University, Corpus Christi, Texas
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Gill FJ, Lin F, Massey D, Wilson L, Greenwood M, Skylas K, Woodard M, Tembo A, Mitchell M, Gullick J. Development of a position statement for Australian critical care nurse education. Aust Crit Care 2019; 32:346-350. [DOI: 10.1016/j.aucc.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/22/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022] Open
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Stimpfel AW, Fletcher J, Kovner CT. A comparison of scheduling, work hours, overtime, and work preferences across four cohorts of newly licensed Registered Nurses. J Adv Nurs 2019; 75:1902-1910. [DOI: 10.1111/jan.13972] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/14/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jason Fletcher
- Rory Meyers College of Nursing New York University New York New York
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Imes CC, Chasens ER. Rotating Shifts Negatively Impacts Health and Wellness Among Intensive Care Nurses. Workplace Health Saf 2019; 67:241-249. [PMID: 30827198 PMCID: PMC10478161 DOI: 10.1177/2165079918820866] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
The impact of shift work on sleep and health has been examined in the past, but most studies utilized cross-sectional designs relying on between-subject differences. The purpose this study was to examine the within-subject differences in self-report measures of health and wellness among a group of nurses engaged in rotating shifts. Patient-Reported Outcomes Measurement Information System (PROMIS) measures, collected post-day and post-night shift, were used to assess health, sleep disturbances and sleep-related impairment, fatigue, emotional distress (anger), satisfaction with social roles outside of work, and applied cognitive abilities. Among the sample of 23 White, mostly female (91.3%) nurses, all PROMIS measures were worse indicting lower health and wellness after working night shifts compare to after working day shifts ( p values from .167 to < .001). During both time points of assessment, sleep-related impairment was highly correlated with greater emotional distress, greater fatigue, and worse memory and concentration. Study findings support prior studies that shift work can negatively impact health and wellness.
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Affiliation(s)
- Christopher C. Imes
- University of Pittsburgh School of Nursing, Department of Acute and Tertiary Care
| | - Eileen R. Chasens
- University of Pittsburgh School of Nursing, Department of Health & Community Systems
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Younan L, Clinton M, Fares S, Jardali FE, Samaha H. The relationship between work-related musculoskeletal disorders, chronic occupational fatigue, and work organization: A multi-hospital cross-sectional study. J Adv Nurs 2019; 75:1667-1677. [DOI: 10.1111/jan.13952] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/31/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Lina Younan
- Hariri School of Nursing; American University of Beirut; Beirut Lebanon
| | - Michael Clinton
- Hariri School of Nursing; American University of Beirut; Beirut Lebanon
| | - Souha Fares
- Hariri School of Nursing; American University of Beirut; Beirut Lebanon
| | - Fadi El Jardali
- Department of Health Management & Policy; American University of Beirut; Beirut Lebanon
| | - Helen Samaha
- Academic and Administrative Nursing Affairs; Order of Nurses in Lebanon; Beirut Lebanon
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Lim S, Han K, Cho H, Baek H. Shift-work nurses' work environments and health-promoting behaviours in relation to sleep disturbance: A cross-sectional secondary data analysis. J Clin Nurs 2019; 28:1538-1545. [PMID: 30589981 DOI: 10.1111/jocn.14769] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 11/06/2018] [Accepted: 12/05/2018] [Indexed: 01/29/2023]
Abstract
AIMS AND OBJECTIVES To examine the association of nursing work environments and health-promoting behaviours with shift-work nurses' sleep disturbance. BACKGROUND Shift-work nurses reportedly have sleep problems, which affect their sleep quality and quantity. Given the high risk of developing performance decrements and medication errors in sleep-disturbed nurses, factors related to sleep disturbance among shift-work nurses should be investigated. DESIGN A cross-sectional secondary data analysis. METHODS Our study analysed data from 339 nurses who had been involved in rotating shift work including night shifts for more than 6 months. To examine associations of nursing work environments and health-promoting behaviours with sleep disturbance, multiple linear regression models were generated. This study is reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guideline. RESULTS Nurses with more collegial relations with physicians were significantly less likely to have high levels of sleep disturbance (B = -4.01, p = 0.04). Those with higher levels of sleep disturbance were significantly more likely to report less stress management (B = -9.56, p < 0.01) and higher health responsibility (B = 9.30, p < 0.01). CONCLUSIONS To alleviate shift-work nurses' sleep disturbance, organisational supports for collaborative relations with physician and increased healthcare accessibility are needed. Individual nurses should develop healthy lifestyles to reduce occupational stress and alleviate sleep disorders. RELEVANCE TO CLINICAL PRACTICE To improve shift-work nurses' sleep, collegial relations with physicians and healthy lifestyles should be promoted.
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Affiliation(s)
- Sungju Lim
- University of Texas at Austin School of Nursing, Austin, Texas
| | - Kihye Han
- Chung-Ang University College of Nursing, Seoul, South Korea
| | - Hyeonmi Cho
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin
| | - Hyang Baek
- Chung-Ang University Graduate School Department of Nursing, Seoul, South Korea
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Li H, Shao Y, Xing Z, Li Y, Wang S, Zhang M, Ying J, Shi Y, Sun J. Napping on night-shifts among nursing staff: A mixed-methods systematic review. J Adv Nurs 2018; 75:291-312. [DOI: 10.1111/jan.13859] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/05/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Huanhuan Li
- Basic Nursing Department; School of Nursing; Jilin University; Changchun Jilin China
| | - Yanping Shao
- Department of Obstetrics and Gynecology; The Second Hospital of Jilin University; Changchun Jilin China
| | - Zhuangjie Xing
- Basic Nursing Department; School of Nursing; Jilin University; Changchun Jilin China
| | - Yuan Li
- Basic Nursing Department; School of Nursing; Jilin University; Changchun Jilin China
| | - Shouqi Wang
- Basic Nursing Department; School of Nursing; Jilin University; Changchun Jilin China
| | - Meiling Zhang
- Basic Nursing Department; School of Nursing; Jilin University; Changchun Jilin China
| | - Jie Ying
- Basic Nursing Department; School of Nursing; Jilin University; Changchun Jilin China
| | - Ying Shi
- Basic Nursing Department; School of Nursing; Jilin University; Changchun Jilin China
| | - Jiao Sun
- Basic Nursing Department; School of Nursing; Jilin University; Changchun Jilin China
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Cho H, Han K. Associations Among Nursing Work Environment and Health-Promoting Behaviors of Nurses and Nursing Performance Quality: A Multilevel Modeling Approach. J Nurs Scholarsh 2018; 50:403-410. [DOI: 10.1111/jnu.12390] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hyeonmi Cho
- Research Assistant; Chung-Ang University Graduate School Department of Nursing; Seoul South Korea
| | - Kihye Han
- Lambda Alpha-at-Large , Associate Professor; Chung-Ang University Red Cross College of Nursing; Seoul South Korea
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