Influence of rotating shifts and fixed night shifts on sleep quality of nurses of different ages: a systematic literature review and meta-analysis

Global prevalence of excessive daytime sleepiness among nurses: A systematic review and meta-analysis

BACKGROUND

Nurses face significant risks of excessive daytime sleepiness (EDS), which adversely affects workplace safety and productivity. Yet, the extent of EDS in this workforce remains inadequately characterized.

AIM

The aims of this systematic review were to assess the pooled prevalence of EDS among nurses.

METHODOLOGY

We systematically searched PubMed, Embase, Scopus, and ISI Web of Science for observational studies reporting the prevalence of EDS, as measured by the Epworth Sleepiness Scale (ESS), from database inception to May 1, 2024, with no language restrictions. Study quality was evaluated using JBI's critical appraisal tool. Pooled estimates were calculated through random-effects meta-analysis, with subgroup and meta-regression analyses assessing associations between EDS prevalence and study-level factors. Linear regression modeling was used to assess time trends. This study was registered with PROSPERO (CRD42024535109).

RESULTS

We included 36 unique studies encompassing 2677 nurses from 20 countries. EDS occurred in 14.0%-55.6% of nurses. The results of the meta-analysis showed a pooled prevalence of EDS of 32.2% (95% confidence interval [CI]: 28.5-36.1; I2 = 92.6). Prevalence estimate did not vary substantially in terms of study-level data (i.e., region, country income, pre/post covid era, hospital type, proportion of female nurse, average nursing experience, or proportion of married nurses). The prevalence of EDS in nurses has remained unchanged over time.

CONCLUSIONS

This meta-analysis identifies a high global prevalence of EDS among nurses, affecting nearly one-third of this workforce. The findings underscore the urgent need for targeted interventions to mitigate EDS across diverse geographic and economic contexts.

IMPLICATION FOR NURSING AND NURSING POLICY

This study highlights the pervasive issue of EDS among nurses worldwide, necessitating comprehensive strategies to address this challenge across all regions, income levels, hospital settings, and demographic groups.

Occupational Burnout and Insomnia in Relation to Psychological Resilience Among Greek Nurses in the Post-Pandemic Era

Recent studies indicate that nurses experienced high levels of occupational burnout and insomnia during and after the pandemic and highlight resilience as a crucial competence for overcoming adversity. The aim of this study was to assess occupational burnout, insomnia, and psychological resilience and to explore their interrelations among Greek nurses 14 months after the official ending of the pandemic which was declared in May 2023. The study was conducted online in July 2024 and included 380 nurses currently working in Greek hospitals, who completed the Copenhagen Burnout Inventory (CBI), the Athens Insomnia Scale (AIS), and the Brief Resilience Scale (BRS). Overall, 56.1% of the nurses exhibited insomnia symptoms and 46.8% displayed signs of occupational burnout. Low resilience scores were observed in 26.3%. Multiple regression analysis indicated that CBI explained 34.4% of the variance in the AIS scores, while an additional 3% was explained by the BRS. Mediation analysis revealed that resilience operates protectively as a negative mediator in the relationship between burnout and insomnia. In conclusion, one year after the end of the pandemic the levels of occupational burnout and insomnia among nurses remain high, whereas psychological resilience seems to be retained at moderate levels. Consequently, there is an urgent need to regularly monitor for risk of burnout and insomnia and to implement resilience-building strategies for nurses to combat burnout and improve insomnia symptoms.

Determinants of sleep quality and their impact on health outcomes: a cross-sectional study on night-shift nurses

Purpose

This study aimed to identify determinants of sleep quality and explore their adverse health outcomes among night-shift nurses in China.

Method

Through convenience sampling, this cross-sectional study enrolled a total of 711 night-shift nurses aged 20-55 years who completed questionnaires from which details regarding their sociodemographic characteristics, health-related indicators and sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) were extracted. A generalized linear regression analysis was then created to identify factors influencing sleep quality. Pearson correlation analysis was used to analyze the relationship between sleep quality and chronic fatigue.

Results

The prevalence rate of poor sleep quality among night-shift nurses reached as high as 90.1%. Our results showed that education level, years of working experience, quality of make-up sleep before and after night shifts, daily routine and diet were the primary factors affecting sleep quality (p < 0.01). Nurse fatigue had a significant positive correlation with subjective sleep quality, sleep latency, sleep duration, sleep disturbance, medications to sleep, daytime dysfunctions and global sleep quality (p < 0.01). However, nurse sleep efficiency had a significant negative correlation with fatigue (p < 0.01).

Conclusions

Higher education level, longer working years, worse quality of make-up sleep before and after night shifts, daily routine and daily diet were risk factors for poor sleep quality among nurses. Poor sleep among night-shift nurses is strongly correlated with chronic fatigue.

Sleep quality and hours of nurses according to shift type and schedule: A cross-sectional study

This study investigated the quality and duration of sleep among shift-working nurses. In this cross-sectional survey, nurses from eight units across two tertiary hospitals in South Korea's capital region participated. We collected data on sleep quality and duration from 117 nurses. We used the Mann-Whitney test, analysis of variance, or the Kruskal-Wallis test to analyze differences in sleep quality and duration across different shifts. The nurses generally reported low sleep quality, with sleep disturbances being the most common issue. The worst subjective sleep quality was associated with the night shift, while the shortest sleep duration was reported for the day shift. Nurses working two consecutive night shifts reported the poorest sleep quality and shortest sleep duration. The quality and duration of sleep for shift-working nurses varied depending on the shift type. There were also differences based on the arrangement of multiple consecutive shifts. The findings of this study suggest that planning for nurses' shift work should consider sleep quality and duration. Specifically, nurses working the night shift reported poor sleep quality and duration, indicating a need for strategies to ensure they get sufficient rest after their shifts.

Effects and implementation of an intervention to improve sleep, fatigue and recovery among healthcare workers with night shifts: A pre- and post-test study

BACKGROUND

Previous intervention studies among night workers mainly focused on single interventions and found inconclusive evidence for effectiveness. A comprehensive intervention approach that includes individual and environmental components has been argued as important. Gaining insight into contributing factors for the implementation of interventions for night workers and effectiveness is important to distinguish between theory and programme failure.

OBJECTIVES

To evaluate the effects and implementation of the PerfectFit@Night intervention to improve sleep, fatigue and recovery of night workers in healthcare, using the RE-AIM framework, which assesses reach, effectiveness, adoption, implementation and maintenance of interventions.

DESIGN

A prospective pre-post study design, with two measurements before and three and six months after the intervention.

SETTING

Twelve different departments of a university hospital in the Netherlands.

PARTICIPANTS

Healthcare workers working night shifts (n = 210).

METHODS

PerfectFit@Night consisted of environmental (provision of a powernap bed and healthy food, and workshop healthy rostering) and individual elements (e-learning and sleep coaching) and was implemented for three months in a phased manner. Questionnaires, logbooks and interview data were used. Effects of the intervention on sleep, fatigue and recovery were evaluated with mixed-effects models, and implementation factors of reach, adoption, implementation and maintenance were evaluated.

RESULTS

Night shift-related insomnia (-11 %-points, 95 % CI: -19 %, -4 % at three months), need for recovery (β: -2.45, 95 % CI: -4.86, -0.03 at six months) and fatigue (OR: 0.46, 95 % CI: 0.25, 0.86 at six months) decreased significantly after the intervention. No changes were found for subjective sleep quality and sleep duration. Barriers and facilitators for implementation were identified for each intervention element at individual (e.g., dietary preferences), organisational (e.g., responsibilities at work) and workplace levels (e.g., location of power nap bed), and for the intervention itself (e.g., useful information in e-learning). Although satisfaction was high and continuation was preferred, embedding of the intervention in the daily routine was limited. Facilitators for future implementation include a positive attitude towards the intervention, clear guidelines regarding intervention elements, appointment of night workers as ambassadors, and suitable conditions in terms of work demands and for the intervention elements.

CONCLUSIONS

The multi-faceted PerfectFit@Night intervention reduced insomnia, fatigue and need for recovery in night workers in healthcare. The most important facilitators to improve the implementation of PerfectFit@Night exist at the organisational level (e.g., positive attitude within the culture and suitable work demands). Combining effect and implementation evaluation is crucial to identify barriers and facilitators that hamper or enhance intervention effects.

TRIAL REGISTRATION

The study was registered in the Netherlands Trial Register on 17 January 2021 (trial number NL9224).

A Cross-Sectional Study of the Social Work Environment and Black Registered Nurses' Sleep

INTRODUCTION

Workplace experiences may place Black nurses at higher risk for poor sleep and adverse health outcomes. This study aimed to identify poor sleep prevalence and associations of workplace discrimination and workplace social capital with sleep.

METHODOLOGY

Descriptive statistics and multiple linear regression with exploratory analyses were conducted of cross sectional survey data from US Black nurses.

RESULTS

On average, 63 respondents reported sleeping 6.15 h, 45 min less daily than 6.9 h reported nationally for nurses. Ninety-percent of respondents reported poor sleep quality. While no direct significance was found, respondents reporting sleep quality changes had lower workplace social capital and higher workplace discrimination.

CONCLUSION

Black nurses may have higher prevalence of poor sleep than the larger nursing workforce. A potential relationship between decreased sleep quality and negative perceptions of the work environment may exist. Organizations should examine sleep and potential occupational health inequities among Black nurses when considering worker health.

Factors associated with sleep quality among Afghan healthcare workers

Background and Aims

Sleep is a complex physiological process during which the body and mind enter a period of rest. For a healthy lifestyle, different cohort groups can be affected in different ways. One such cohort is healthcare workers (HCWs)-an unexplored group in Afghanistan. Therefore, the present study examined the association between a range of sociodemographic factors including having night shift work and sleep quality among Afghan HCWs.

Methods

A cross-sectional survey was administered in January 2023 among HCWs (N = 342) in the Herat province of Afghanistan. The survey examined sleep quality and its association with a range of sociodemographic factors among HCWs. Logistic regression models were used to examine the association of sleep quality with sociodemographic characteristics among HCWs. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality among HCWs.

Results

A total of 342 HCWs participated in the present study with an age range of 18 to 60 years. The mean age of the participants was 28.90 years (SD ± 8.10). Just over half of the participants were male (50.3%). Of the 342 participants, 58.5% reported poor sleep quality. Being married status, having higher number of children, not being a doctor, having low economic status, working night shifts, and having a traumatic event occur during past month were among the main variables associated with sleep quality among Afghan HCWs. Multiple regression analysis indicated that having high income [negatively] (AOR = 4.132, p = 0.002), working night shifts [positively] (AOR = 0.288, p < 0.001), and having a traumatic event occur during past month [positively] (AOR = 0.504, p = 0.007) were significantly associated with sleep quality.

Conclusion

The study suggests the need for Afghan health employers to create a healthy work environment that prioritizes the well-being of their employees by limiting overtime hours, providing rest breaks during long shifts, and ensuring that HCWs have access to necessary resources for coping with work-related stressors. These policies would promote the overall health and well-being of the workforce and would likely lead to better patient care outcomes.

Altered coordination between sleep timing and cortisol profiles in night working female hospital employees

BACKGROUND

Cortisol typically peaks in the morning after waking up and declines throughout the day, reaching its lowest levels during nighttime sleep. Shift work can cause misalignment between cortisol levels and sleep-wake timing. We analyzed this misalignment in female shift workers focusing on the timing and extent of these changes.

METHODS

We conducted a cross-sectional study involving 68 shift workers (aged 37 ± 10 years) and 21 non-shift workers (aged 45 ± 10 years) from a hospital. Shift workers were monitored through two day shifts and three night shifts, whereas non-shift workers were monitored during two day shifts. Each participant collected six to eight saliva samples (depending on their shift type) and provided sleep timing information, which was recorded via polysomnography and sleep diaries. Generalized additive mixed models were used to estimate shift-specific differences in cortisol smooth curves. Summary measures calculated for the cortisol smooth curves included cortisol awakening response, peak-to-bed slope, and total output.

RESULTS

Between shift workers and non-shift workers, we observed similar diurnal cortisol profiles with a steep negative diurnal slope during day shifts. In shift workers on night shifts, a flattened U-shaped cortisol profile after the post-awakening maximum was observed, with a peak-to-bed slope close to zero. When comparing night to day shifts in the group of shift workers, mean cortisol levels were lower between 42 and 56 minutes and 1.8-11.9 hours after waking up, and higher between 14.9 and 22 hours after waking up.

CONCLUSION

Our findings indicate altered cortisol profiles in female hospital employees on night shifts. Specifically, cortisol levels were lower at night when higher levels would typically be necessary for work activities, and higher at bedtime after a night shift, when levels should normally be low.

Characterising Potential Subtypes and Influencing Factors of Sleep Quality in Psychiatric Nurses by Latent Profile Analysis

Background

Sleep is a crucial factor affecting an individual's physical and mental health. Psychiatric nurses work under high stress and load, and it is necessary to understand the sleep quality of psychiatric nurses and the influencing factors. However, individual-centred studies of psychiatric nurses' sleep are limited.

Aims

To explore the heterogeneity in sleep quality among psychiatric nurses, to identify the factors influencing different subtypes, and to provide targeted strategies and measures to improve their sleep quality.

Methods

From August to October 2022, 298 psychiatric nurses working in a mental health centre in Liaoning Province were selected as the participants. The study involved administering the following two questionnaires: the general information questionnaire and the Pittsburgh Sleep Quality Index (PSQI). Data analyses included latent profile analysis, Kruskal-Wallis H test, and multiple logistic regression.

Results

The prevalence of poor sleep quality (PSQI >5) among psychiatric nurses was 54.7%. The sleep quality of psychiatric nurses could be classified into the following three distinct profiles: good sleep quality, moderate sleep quality, and poor sleep quality. Nurses who were over 40 years of age, unmarried/divorced/separated/widowed, worked more than 40 hours per week, experienced significant life events in the past year, had poor nurse-patient relationships, and had chronic diseases were more likely to have poorer sleep quality.

Conclusions

There was significant heterogeneity in sleep quality among psychiatric nurses. Age, marital status, work schedule, total weekly working hours, night shifts, special life events, nurse-patient relationships, and chronic diseases were associated with their sleep quality. Implications. The heterogeneity and influencing factors of sleep quality in psychiatric nurses provided evidence for individualized interventions in the future. This trial is registered with ChiCTR2200062347.

Effects of work environments on satisfaction of nurses working for integrated care system in South Korea: a multisite cross-sectional investigation

BACKGROUND

Nurses' satisfaction has an impact on organizational and patient outcomes. Integrated care system in South Korea was established in 2015 to improve care quality and decrease caregiving burden. Since then, nurses' satisfaction has increased due to an increase in nursing staffing. However, besides nurse staffing, various work environments still affect nurse satisfaction.

METHODS

Individual online surveys were conducted with participants to determine their personal characteristics, work environments, and hospital characteristics. We used mixed-effects linear regression equation contained both fixed and random effects.

RESULTS

This study included 2,913 nurses from 119 hospitals. Their average job satisfaction was less than 6 points out of 10 points. Age, shift type, perceived workload, and delegation criteria were significant factors influencing nurses' satisfaction. There was no significant factor among hospital characteristics. The satisfaction level of nurses was high for no-night rotating shift, low perceived workload, and clear delegation criteria.

CONCLUSIONS

Nurses' satisfaction is affected by several work environmental factors. Low nurse satisfaction has a substantial impact on both patients and nurses. Therefore, nurse managers and hospitals should determine factors influencing their satisfaction and develop strategies to improve their satisfaction.

Sleep quality, sleep duration, and sleep disturbances among hospital night workers: a prospective cohort study

PURPOSE

This study aimed to assess among hospital night workers (i) to what extent sleep quality, sleep duration and sleep disturbances overlap, and (ii) associations between sociodemographic factors, lifestyle factors and work characteristics and sleep components.

METHODS

Data were used from 467 hospital night workers participating in the Klokwerk + study, a prospective cohort study with two measurements. Sleep quality was measured by the Pittsburgh Sleep Quality Index, sleep duration and sleep disturbances were measured by the Medical Outcomes Study Sleep Scale. The overlap between the three sleep measures was visualized with a Venn diagram and the proportions of overlap was calculated. Associations between independent variables (sociodemographic factors, lifestyle factors and work characteristics) and the three sleep outcomes were estimated using between-within Poisson regression models.

RESULTS

About 50% of the hospital night workers had at least one poor sleep outcome. Overlap in poor sleep outcomes was apparent for 36.8% of these workers, while the majority had a poor outcome in one of the sleep components only (63.1%). Former smoking had a significant association with poor sleep quality. For most independent variables no associations with poor sleep outcomes were observed.

CONCLUSION

Our findings suggest that sleep quality, sleep duration and sleep disturbances are separate entities and should be studied separately. Lifestyle factors and work characteristics were generally not associated with poor sleep. Since these factors can have an acute effect on sleep, future research should consider ecological momentary assessment to examine how exposure and outcomes (co)vary within-persons, over time, and across contexts. Trial registration Netherlands Trial Register trial number NL56022.041.16.

Sleep quality and the need for recovery among nurses working irregular shifts: A cross-sectional study

BACKGROUND

Shift work affects the mental and physical health of nurses, yet the effect of working irregular shifts on sleep and its association with the need for recovery is under-explored.

OBJECTIVE

The purpose of this study was to investigate the sleep quality of nurses working irregular shifts, including night shifts, and to determine whether sleep quality is associated with the need for recovery.

METHODS

This cross-sectional study included 405 nurses working irregular shifts. Data were collected using an online questionnaire that included sociodemographic characteristics, the Sleep-Wake Experience List, sleep problems, sleep duration, and the Need for Recovery scale. Data analyses included descriptive statistics, chi-square tests, t-tests, logistic and multiple linear regressions.

RESULTS

Nurses who worked irregular shifts had poor sleep quality. Those who also worked night shifts, had significantly poorer sleep quality and experienced more difficulties in daily functioning than those who did not work night shifts. Sleep quality was significantly associated with the need for recovery and this remained so after controlling for confounding variables (β= .554, p = .001).

CONCLUSION

The findings indicate that in nurses who work irregular shifts, the sleep quality is low. In this group, the sleep quality in nurses who work night shifts is lower than in nurses who do not work night shifts. Furthermore, better sleep quality was associated with lower need for recovery. These findings suggest that improving sleep quality in nurses working irregular shifts may lower their need for recovery, which may improve health, and reduce burnout and sickness absence.

Shift work characteristics and burnout among nurses: cross-sectional survey

BACKGROUND

Nurses working long shifts (≥12 h) experience higher levels of burnout. Yet other shift characteristics, including fixed versus rotating night work, weekly hours and breaks have not been considered. Choice over shift length may moderate the relationship; however, this has not been tested.

AIMS

To examine the association between shift work characteristics and burnout and exhaustion, and whether choice over shift length influences burnout and exhaustion.

METHODS

Cross-sectional online survey of nursing staff working in the UK and Ireland. We recruited two large National Health Service Trusts, through trade union membership, online/print nursing magazines and social media. We assessed associations using both univariable and multivariable generalized linear models.

RESULTS

We had 873 valid responses. Reports of inadequate staffing levels (odds ratio [OR] = 2.84; 95% confidence interval [CI] 2.08-3.90) and less choice over shift length (OR = 0.20; 95% CI 0.06-0.54) were associated with higher burnout in multivariable models. Similar associations were found for exhaustion, where rarely or never taking breaks was also a predictor (OR = 1.61; 95% CI 1.05-2.52). Nurses who worked long shifts had less choice than those working shifts of 8 h or less (66% of 12-h shift nurses versus 44% 8-h shift nurses reporting having no choice), but choice did not moderate the relationship between shift length and burnout and exhaustion.

CONCLUSIONS

The relationship between long shifts and increased burnout reported previously might have arisen from a lack of choice for those staff working long shifts. Whether limited choice for staff is intrinsically linked to long shifts is unclear.

Sleep disturbances and depressive symptoms of shift workers: Effects of shift schedules

This study explored sleep disturbances and depression among various types of shift workers (SWs) and non-SWs, focusing on work schedule diversity. We enrolled 6,654 adults (4,561 SWs, 2,093 non-SWs). Based on self-report questionnaires on work schedules, the participants were classified according to shift work type: non-shift work; and fixed evening, fixed night, regularly rotating, irregularly rotating, casual, and flexible shift work. All completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and short-term Center for Epidemiologic Studies-Depression scale (CES-D). SWs reported higher PSQI, ESS, ISI, and CES-D than non-SWs. Fixed SWs (fixed evenings and fixed nights) and true SWs (regularly and irregularly rotating SWs) scored higher on the PSQI, ISI, and CES-D than non-SWs. True SWs scored higher on the ESS than fixed SWs and non-SWs. Among fixed SWs, fixed night SWs scored higher on the PSQI and ISI than fixed evening SWs. Among true SWs, irregular SWs (irregularly rotating and casual SWs) scored higher on the PSQI, ISI, and CES-D compared to regularly rotating SWs. The PSQI, ESS, and ISI independently were associated with the CES-D of all SWs. We found an interaction between the ESS and the work schedule on the one hand, and the CES-D on the other, which was stronger in SWs than non-SWs. Fixed night and irregular shifts were linked with sleep disturbances. The depressive symptoms of SWs are associated with sleep problems. The effects of sleepiness on depression were more prominent in SWs than non-SWs.

The Effect of COVID-19 Fear in Patients and Clinical Nurses on Night Nursing Care

This study was conducted with the aim of determining the effect of fear of COVID-19 in patients and clinical nurses on night nursing care. This was a cross-sectional study. The research sample consisted of 604 patients and 270 clinical nurses selected by the convenience sampling method. Data were collected between August 2021 and July 2022 using a Patients' Information form, a Nurse's Information form, the Fear of COVID-19 scale, and the Night Nursing Care instrument. No significant difference was found between the total mean scores of the patients and the nurses on the Fear of COVID-19 scale or the Night Nursing Care instrument (rho = -0.017, p = .702; rho = -0.020, p = .741). It was found that patients' and nurses' fears of COVID-19 did not affect their perceptions of night nursing care.

Sociodemographic Aspects and Healthy Behaviors Associated With Perceived Life Satisfaction in Health Professionals

BACKGROUND

Life satisfaction is a determining factor for the improvement of mental and physical health. Health care workers are a vulnerable population to suffer alterations in the factors that affect life satisfaction. Determining the influence of these factors on quality of life is important for their proper management.

OBJECTIVE

To examine sociodemographic factors and healthy behaviors influencing life satisfaction in Peruvian professionals.

METHODS

A cross-sectional study was conducted with 506 health care workers, who had a mean age of 40.34 years (SD = 10.39). A sociodemographic questionnaire, sleep quality, physical activity, eating habits, and life satisfaction were used. A regression model was fitted with the life satisfaction variable as the dependent variable.

RESULTS

In multivariable analysis, age (β = -.938, P < .01) and perception of poor health status (β = -4.743, P < .001) were found to be associated with lower life satisfaction. On the other hand, higher university education level (β = 1.667, P < .001), absence of smoking (β = 3.202, P < .01), absence of depressive symptoms (β = 3.390, P < .001), interest in daily activities (β = 3.503, P < .05), good sleep quality (β = 1.027, P < .01), a high frequency of physical activity (β = 1.056, P < .01), and healthy eating are variables associated with higher life satisfaction.

CONCLUSION

Sociodemographic aspects such as age and the perception of poor health are associated with lower life satisfaction. On the other hand, healthy behaviors such as absence of smoking, absence of depressive symptoms, interest in daily activities, good quality of sleep, high frequency of physical activity, and a healthy diet were associated with higher life satisfaction.

Digital circadian and sleep health in individual hospital shift workers: A cross sectional telemonitoring study

BACKGROUND

Telemonitoring of circadian and sleep cycles could identify shift workers at increased risk of poor health, including cancer and cardiovascular diseases, thus supporting personalized prevention.

METHODS

The Circadiem cross-sectional study aimed at determining early warning signals of risk of health alteration in hospital nightshifters (NS) versus dayshifters (DS, alternating morning and afternoon shifts). Circadian rhythmicity in activity, sleep, and temperature was telemonitored on work and free days for one week. Participants wore a bluetooth low energy thoracic accelerometry and temperature sensor that was wirelessly connected to a GPRS gateway and a health data hub server. Hidden Markov modelling of activity quantified Rhythm Index, rest quality (probability, p1-1, of remaining at rest), and rest duration. Spectral analyses determined periods in body surface temperature and accelerometry. Parameters were compared and predictors of circadian and sleep disruption were identified by multivariate analyses using information criteria-based model selection. Clusters of individual shift work response profiles were recognized.

FINDINGS

Of 140 per-protocol participants (133 females), there were 63 NS and 77 DS. Both groups had similar median rest amount, yet NS had significantly worse median rest-activity Rhythm Index (0·38 [IQR, 0·29-0·47] vs. 0·69 [0·60-0·77], p<0·0001) and rest quality p1-1 (0·94 [0·94-0·95] vs 0·96 [0·94-0·97], p<0·0001) over the whole study week. Only 48% of the NS displayed a circadian period in temperature, as compared to 70% of the DS (p=0·026). Poor p1-1 was associated with nightshift work on both work (p<0·0001) and free days (p=0·0098). The number of years of past night work exposure predicted poor rest-activity Rhythm Index jointly with shift type, age and chronotype on workdays (p= 0·0074), and singly on free days (p=0·0005).

INTERPRETATION

A dedicated analysis toolbox of streamed data from a wearable device identified circadian and sleep rhythm markers, that constitute surrogate candidate endpoints of poor health risk in shift-workers.

FUNDING

French Agency for Food, Environmental and Occupational Health & Safety (EST-2014/1/064), University of Warwick, Medical Research Council (United Kingdom, MR/M013170), Cancer Research UK(C53561/A19933).

Self-Care in Nurses

The health of nurses impacts the care of patients in healthcare settings today both inside and outside of hospitals. Many papers are written about nurses' burnout, depression, poor physical and mental health, weight gain, unhealthy eating patterns, back injury, moral negativity, and lack of job satisfaction. However, little attention has been paid to self-care in nurses. The goal of this paper is to discuss the importance of nurses caring for themselves as they work under stressful conditions regularly. Job satisfaction is necessary for nurses to have a healthy work-life balance and a desire to go to work. There are evidence-based interventions that can make a difference in a nurse's quality of life that can be implemented independently or within the work setting. Suggestions made by researchers include working less than 40 hr/week in a clinical setting, working a consistent time of day without rotations, expressing emotions, taking time to exercise, participating in a support group, and incorporating a place designated as a sanctuary in the clinical setting. Personal ways to improve health include preparing healthy meals before working a shift, getting proper sleep, utilizing cognitive behavioral therapy, participating in mindfulness training, and practicing stress reduction techniques.

Executive Performance Is Associated With Rest-Activity Rhythm in Nurses Working Rotating Shifts

Purpose

Rest-activity rhythms (RAR) is one of the most fundamental biological patterns that influence basic physical and mental health, as well as working performance. Nowadays, with the utilization of actigraphy device in detecting and analyzing RAR objectively, evidence has confirmed that RAR could be interrupted by shift work. Nurses need to participate shift work in their daily routine. The aim of the present study is to identify the RAR of nurses working rotating shifts and find out the relationship between RAR and executive function.

Methods

A total of 11 female nurses on day-shift (DS), 11 female nurses on rotating-shift (RS) were recruited. Demographic features, non-parametric variables of RAR as well as sleep variables according to actigraphy data, and a series of cognitive function evaluations during work time were collected.

Results

The Student’s t-test comparison revealed that RS group nurses showed significant shorter total sleep time (TST), lower level of interdaily stability (IS) and relative amplitude (RA), as well as poorer executive performance compared with DS nurses. The linear regression analysis demonstrated that several aspects of executive performance such as choice reaction test (CRT) (reflecting attention and concentration) and trail making test (TMT) -B (reflecting cognitive flexibility) were associated with IS in RS group nurses.

Conclusion

These results elucidated that RAR was disrupted for nurses working rotating shifts, and executive performance was associated with IS from day to day in nurses working rotating shifts.