Self-reported sleep and health among Norwegian hospital nurses in intensive care units

Light at night exposure and risk of breast cancer: a meta-analysis of observational studies

Objective

The aim of this meta-analysis is to evaluate the impact of light at night (LAN) exposure on the risk of breast cancer across varying factors.

Method

We conducted a systematic search of literature up to July 15, 2023, including PubMed, Cochrane Library, and Embase databases, using keywords related to breast cancer and LAN exposure. Cohort study and case-control study literature on night light exposure and breast cancer risk were included. Statistical analyses were performed using Stata software version 17.0. To address heterogeneity among different studies, we employed a random-effects model for analysis and assessed publication bias using funnel plots and Egger's test.

Results

We included 13 case-control and 8 cohort studies with 734,372 participants worldwide. In the Newcastle-Ottawa Scale (NOS) assessments, the average score was 7.43 (ranging from 5 to 9). The overall meta-analysis demonstrated a significant association between exposure to LAN and risk of breast cancer (RR = 1.12; 95% CI: 1.06-1.17; I2 = 31.3%, p < 0.001). In the subgroup analysis, the results of the analysis for study types (case-control studies: RR = 1.16; 95% CI: 1.06-1.27; I2 = 40.4%, p = 0.001; cohort studies: RR = 1.08; 95% CI: 1.04-1.14; I2 = 0.0%, p < 0.001) and the results for light exposure types (outdoor LAN: RR = 1.07; 95% CI: 1.02-1.13; I2 = 30.9%, p = 0.004) are presented. In the analysis conducted for continents, the highest breast cancer risk was observed in the Asian population (Asian: RR = 1.24; 95% CI: 1.15-1.34; I2 = 0.0%, p < 0.001) and in the analysis of estrogen receptor status (ER+: RR = 1.10; 95% CI: 1.03-1.18; I2 = 17.0%, p = 0.005;). We also conducted an analysis on menopausal status and various lifestyles but did not find any statistically significant findings.

Conclusion

Our study demonstrates that LAN exposure is associated with an increased risk of breast cancer, particularly in the Asian population. Among the existing hypotheses, the idea that LAN exposure leads to a decrease in melatonin is widely accepted. However, until the mechanism of this effect is clearly elucidated, it is not recommended to take melatonin supplements for breast cancer prevention without medical advice. We hope to conduct more high-quality research, especially concerning the investigation of other environmental confounding factors, to further advance this field.

The association between chronotype, sleep quality and medication errors among critical care nurses

Medication administration errors could result in severe complications in critical care units. This study investigated an association between chronotype, sleep quality and medication errors among essential nurses of care in Qazvin teaching hospitals in Iran. In this multicenter, cross-sectional study, all registered nurses of critical care units of Qazvin teaching hospitals were recruited. Data were collected through anonymous questionnaires, including socio-demographic data, Morning-Evening Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and medication errors data. Data were analyzed with SPSS v.24 by using the Chi-square test, Mann-Whitney U test, and logistic regression analysis. P values less than 0.05 were considered significant. The mean age and work experience were 33.12 ± 6.74 and 9.11 ± 5.96, respectively. One hundred sixty-six nurses (96%) have been working in rotating shifts. Nurses with intermediate chronotypes were predominant (n = 122; 70.5%). The majority of nurses (68.2%) had poor sleep quality (n = 118). Logistic regression analysis showed eveningness chronotype was associated with 4.743 fold increased risk of medication error (P < 0.033). No association was found between medication error and sleep quality (p < 0.95). There was no significant relationship between chronotype and sleep quality (P < 0.257). Our study showed that nurses with eveningness chronotype make more medication errors; therefore, considering the individual circadian preference before deciding on their shift timing assignment will be an important issue in reducing nurses' medication errors and improving patient safety in critical care units.

Insomnia in cancer patients - A survey of health-care professionals' views and current practice in Romania

BACKGROUND

Changes in the quality of sleep are reported often in cancer patients and have a major impact on general health. However, insomnia tends to be insufficiently evaluated and managed.

AIM

The aim of the study was to analyze the perception of clinical staff working in oncology units regarding patients' sleep disorders. Furthermore, we assessed the prevalence of insomnia in this category of professionals.

MATERIALS AND METHODS

The study was cross sectional and used a descriptive and correlational design. Clinical personnel working in oncology departments were invited to complete a questionnaire regarding sleep problems in patients, and optionally, the Pittsburgh sleep quality index questionnaire was administered. Correlations between age, profession, experience, and their responses were statistically analyzed.

RESULTS

We gathered 101 responses, with 63.4% coming from doctors. With one exception, all professionals observed changes in sleep patterns in patients, but less than a third were actively looking for these problems and only three health professionals used questionnaires. No significant differences in answers were noted based on age, profession, or experience. Regarding professionals, 45.6% of them had impaired sleep based on the Pittsburgh questionnaire results.

CONCLUSION

Oncology staff are aware of the existence and impact of sleep problems, but active assessment for sleep problems is low. There is a relative high prevalence of poor sleep quality among oncology staff. In order to improve the well-being of patients, the quality of sleep should be documented as part of the care plan. The existence of guidelines is desirable.

The Relationship between Working Night Shifts and Depression among Nurses: A Systematic Review and Meta-Analysis

BACKGROUND

For many years, occupational physicians have debated whether there is a link between working the night shift and depression and other co-occurring mental health issues, with an emphasis on work-related, biological, individual, and environmental factors. We performed this systematic review and meta-analysis to estimate the overall association between sleep deprivation and depression among nurses working night shifts.

METHODS

A systematic search was carried out across the electronic databases PubMed, Scopus, and Web of Science from inception to 30 September 2022, for studies that reported a relationship between estimated night shift work and depression in nurses. The outcomes were measured using the odds ratio (OR) and matching 95% confidence interval (CI). The I² statistic was used to assess heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation technique was used to evaluate the quality of the evidence, and the Newcastle-Ottawa Scale was utilized to assess the methodological quality of each of the included studies. We determined the overall relationship between working nights and the onset of depression.

RESULTS

A total of 20 studies were included in the systematic review. Furthermore, 8 studies were included in the meta-analysis due to their common use of the OR as an effect measure. The 8 studies gave an overall estimate indicating a statistically significant association between night shift work and depression among nurses (OR = 1.49 95% CI: 1.26, 1.76). The prediction interval for the overall estimate was (0.995, 2.231). This implies that the true OR in a future study would most likely fall within this range, with a 95% certainty.

CONCLUSIONS

The outcome of this systematic review and meta-analysis showed a significant association between night shift work, the circadian and sleep disruption it causes, and the risk of depression in nurses. This demonstrates that nurses who work night shifts are at risk of developing depression.

Work Organization Factors Associated With Nurses' Stress, Sleep, and Performance: A Pre-pandemic Analysis

Background

The COVID-19 pandemic put extreme stress on an already strained healthcare workforce. Suboptimal work organization, exacerbated by the pandemic, is associated with poor worker, patient, and organizational outcomes. However, there are limited qualitative studies exploring how the interconnections of work organization factors related to shift work, sleep, and work stress influence registered nurses and their work performance in the United States.

Purpose

We sought to understand how nurses perceive work organization factors that impact their performance. Knowledge in this area could direct efforts to implement policies and design tailored interventions to support nurses in the post-pandemic period.

Methods

We used a qualitative descriptive design with the Work, Stress, and Health framework as an overarching guide to understand the interconnectedness of work organization factors, work stress, and outcomes. Participants were randomly assigned to one of two anonymous, asynchronous virtual focus groups (i.e., threaded discussion boards) in 2019. Registered nurses (N = 23) working across the United States were recruited and engaged until data saturation was achieved. Directed content analysis was used to analyze the data.

Results

Findings aligned with the Work, Stress, and Health framework and revealed three themes: (1) "Our Voice Should Matter" (nurses' desire to have their voices heard in staffing policies); (2) "Tired But Wired" (the harmful cycle of work stress, rumination, and poor sleep); and (3) "We're Only Human" (nurses' physical, emotional, and mental exhaustion linked to critical performance impairments).

Conclusion

These findings underscore that high work stress and poor sleep were present before the pandemic and impacted nurses' perceptions of their performance. As leaders look forward to recovery and work redesign efforts, these findings can guide decision-making and resource allocation for optimal nurse, patient, and organization outcomes.

Post-Work Recovery from Fatigue and Sleep Episodes among Nurses Who Are Engaged in 16-Hour Night Shifts: A Prospective Observational Study

Poor recovery from fatigue among shift-working nurses can cause a transition from acute to chronic fatigue. We aimed to clarify the relationship between nurses' recovery from fatigue and sleep episodes after 16 h night shifts while considering age. This prospective study included 62 nurses who worked 16 h night shifts. Fatigue was assessed by a questionnaire before, during, and after the night shift, and the morning following the night shift. Sleep episodes were continuously measured using a wearable device. We performed a hierarchical cluster analysis of multivariate sleep parameters in first and main sleep episodes after night shifts. A linear mixed model was used to estimate the difference between clusters in recovery from fatigue after the night shift, considering age. The participants were classified into a high sleep quality group (HSQG) and low sleep quality group (LSQG) in sleep episodes after the night shift. There was a significant main effect of clusters, and HSQG was significantly more effective than LSQG in recovering from fatigue. However, no main effects of age or interaction were observed. The quality of first and main sleep episodes at home was associated with recovery from the night shift to the next day, regardless of age.

[Prevalence of sleep disturbance in intensive care nurses: a post hoc analysis of a cross-sectional study]

Background

Intensive care nurses have irregular and unusual working hours due to shift work, which can disrupt the natural light-dark rhythm and thus increase the risk for sleep disorders.

Aim of the work

The aim of this post hoc analysis was to investigate the prevalence of self-reported sleep problems and associated factors among intensive care nurses working in Germany.

Methods

This analysis was a post hoc analysis of a cross-sectional study, which was performed as an online survey. Collected data were sociodemographic, work-related and health-related data. These data were used to calculate the prevalence and respective 95% confidence intervals (95% CI) of sleep problems. Factors associated with sleep problems were identified using the χ2-test, Fisher's exact test, and logistic regression analysis.

Results

The link to the online survey was accessed 1163 times and 490 intensive care nurses participated in the survey. A total of 432 intensive care nurses were included in this analysis, of whom 82.87% were women. A total of 57.64% (95% CI: 52.83-62.35%) reported sleep problems. Significantly associated with sleep problems were age (50-59 years odds ratio [OR]: 2.05, 95% CI: 1.00-4.21, p = 0.047 vs. 20-29 years) and living in a family (OR: 0.50, 95% CI: 0.27-0.93, p = 0.029 vs. single/living alone). In addition, depression (OR: 1.09, 95% CI: 1.06-1.12, p ≤ 0.001), anxiety (OR: 1.10, 95% CI: 1.06-1.14, p ≤ 0.001) and stress (OR: 1.09, 95% CI: 1.06-1.12, p ≤ 0.001) levels were significantly associated with sleep problems.

Conclusion

Sleep problems were present in one out of every two participating intensive care nurses and in particular mental health was associated with sleep problems.

Sleep quality and the associated factors among in-hospital nursing assistants in general hospital: A cross-sectional study

Background

Sleep quality and the associated factors in professional nurses have been extensively investigated. However, as an important part of the workforce in hospitals, sleep quality and influencing factors among in-hospital nursing assistants is rarely investigated.

Aim

This study aimed to assess the sleep quality and the associated factors of in-hospital nursing assistants in general hospital.

Methods

A cross-sectional survey study was conducted in a tertiary general hospital. Data were collected from 187 in-hospital nursing assistants using convenience sampling from June to July 2018. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate participants’ sleep quality. A multiple linear regression was performed to identify associated factors with sleep quality.

Results

This study revealed a mean PSQI score of 5.96 ± 3.64 among all participants, of which 62.3% (114/187) participants suffered from impaired sleep quality. In-hospital nursing assistants with significant medical condition, low monthly income, irregular diet and high family burden reported more worse sleep quality.

Conclusion

The study showed that poor sleep quality is a highly prevalent issue among Chinese in-hospital nursing assistants in general hospital. Measures to enhance nursing assistants’ wellbeing status (health and burden) and improve their salary (monthly income) are recommended.

Prevalence of depression and depressive symptoms among intensive care nurses: A meta-analysis

BACKGROUND

Nurses in intensive care units (ICUs) experience more stressful workplace conditions, making them more vulnerable to high levels of depression compared with those working in other healthcare settings.

OBJECTIVES

This meta-analysis aimed to estimate the pooled prevalence of depression in ICU nurses.

METHODS

A systematic search was conducted in Medline, EMBASE, CINHO, and Web of Science databases. Studies that reported depression among ICU nurses measured by a validated tool were synthesized using a random-effects model. Differences in prevalence of depression by study-level characteristics were estimated using sub-group analysis. Heterogeneity was investigated using standard Chi-squared tests and the I² statistic.

RESULTS

Data were extracted from 19 cross-sectional studies (2003-2020) from 11 countries involving 7196 ICU nurses. The overall pooled prevalence of depression or depressive symptoms among ICU nurses was 24.99% (95% CI, 17.9%-32.7%) with high between-study heterogeneity (χ²  = 812, τ²  = 0.03, I²  = 98%, P < .01).

CONCLUSION

Depression appears to be common among ICU nurses. Considering its negative impact on the quality of life of staff, patient care, and the overall critical care work environment, effective interventions should be designed and implemented to improve psychological health in this population.

RELEVANCE TO CLINICAL PRACTICE

Findings of this review indicate that regular screening for depressive symptoms might be helpful, and access to professional help and supportive care should be provided if necessary.

Strategies for Coping With Stress Used by Nurses in Poland and Belarus During the COVID-19 Pandemic

INTRODUCTION

Stress is an inseparable element of nurses' work. It is also the cause of wellbeing disorders and the source of various diseases. The wellbeing and health of nurses has a direct impact on the quality of care and health outcomes for patients. An appropriate stress coping strategy can reduce the impact of stress and mitigate its negative consequences. The COVID-19 pandemic, especially in its initial period, was a source of enormous additional stress for nurses. In Poland and Belarus: two neighboring countries with common history and similar culture, the authorities took a completely different approach to fighting the COVID-19 pandemic.

AIM

The purpose of this study was to investigate and compare how nurses in Poland and Belarus cope with stress during the COVID-19 pandemic.

MATERIALS AND METHOD

The cross-sectional study was conducted among 284 nurses working in hospital in Bialystok, Poland (158) and in Grodno, Belarus (126). Mini-Cope inventory - the polish adaptation of Carver's BriefCope was used for measuring coping with stress.

RESULTS

Only 17.5% of Belarusian nurses were tested for the presence of the virus and only 4.8% were infected, while in Poland it was 50.6 and 31.0%, respectively. The most frequent used coping strategies were active strategies (active coping, planning) and the least-used were avoidance strategies (behavioral disengagement, substance use) in both countries. Polish nurses significantly more often than Belorussian used support-seeking/emotion-oriented strategies, as well as avoidance strategies. No differences were found for active coping strategies between the both groups. Contact with a patient infected with the SARS-CoV2 virus did not influence the choice of stress coping strategies by nurses in both countries. Staying in quarantine or home isolation favored more active coping strategies, especially in the case of Belarusian nurses. Taking a SARS-CoV-2 test did not statistically differentiate the choice of coping strategies in the Belarusian group. In the Polish group, nurses with a positive SARS-CoV-2 test result used both use of instrumental support and use of emotional support strategies less frequently. SARS-CoV-2 virus infection did not statistically differentiated how stressful situations were handled in Polish group.

CONCLUSIONS

Polish and Belorussian nurses used similar strategies to cope with stress in the face of the COVID-19 pandemic. The social and demographic differences between Polish and Belorussian nurses differentiated the choice of coping strategies among the respondents to a greater extent than the completely different approach of the media and authorities to the COVID-19 pandemic in the two countries. The threat of the COVID-19 pandemic does not affect the choice of stress coping strategies by nurses in Poland and Belarus. Being in quarantine or home isolation favored the use of active coping strategies among Belorussian nurses. Polish nurses, on the other hand, were more likely to turn to religion after being quarantined.

Importance of testing the internal consistency and construct validity of the Pittsburgh Sleep Quality Index (PSQI) in study groups of day and night shift workers: Example of a sample of long-haul truck drivers in South Africa

Irregular work times promote inconsistent completion of the Pittsburgh Sleep Quality Index (PSQI) among shift workers. We aimed to demonstrate the importance of testing the internal consistency and construct validity of the PSQI and of the Epworth Sleepiness Scale (ESS) by presenting the methodology in a sample of long-haul truckers in South Africa. Internal consistency of the questionnaires was assessed by Cronbach's alpha (defined as raw alpha≥0.70), and construct validity by factor analysis. 302 participants (49.3%) reported at least one night shift/week. Overall, the PSQI and ESS's alpha were 0.42 and 0.85, respectively. The factors explained 19.6% of 57.0% of the variance. The PSQI's alpha was 0.46 in night shift workers and 0.38 in non-night shift workers. In this occupational group, the PSQI must be used with caution. Testing the internal consistency and construct validity among the assessed population seems necessary. Sleep questionnaires adapted to shift workers should be preferred.

Sleep medication and melatonin use among Norwegian nurses - A cross-sectional study

Aim

To estimate the prevalence of sleep medication and melatonin use among nurses and to assess if factors related to work, sleep or mental health, were associated with such use.

Design

A cross‐sectional study.

Methods

A questionnaire survey including 2,798 Norwegian nurses. Associations were estimated using a modified Poisson regression model.

Results

In total, 7.5%, 4.6% and 2.0% of the nurses included in the present study reported prescribed sleep medication, over‐the‐counter sleep medication or melatonin use in the last year, respectively. Short sleep duration, sleep problems and psychological conditions were strongly associated with both prescribed and over‐the‐counter sleep medication use. Nurses who worked more than 60 night shifts in the last year were at increased risk of sleep medication use.

Sleep complaints in former and current night shift workers: findings from two cross-sectional studies in Austria

Sleep impairment is highly prevalent in night shift workers, but evidence on the association of former night shift work (NSW) and its metrics (duration and frequency) in relation to sleep complaints is lacking. We evaluated the association of former and current NSW with chronic insomnia or circadian rhythm sleep disorder in a sample of the general worker (GW) population and in hospital workers (HW) in Austria. Information on sleep, NSW history, sociodemographic, and lifestyle factors was collected through an online cross-sectional survey in a representative sample of GW (N= 1,004) and a sample of HW (N= 799) between 2017 and 2019. Multi-variable adjusted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for various measures of sleep (including chronic insomnia, daytime sleepiness, sleep duration, napping habits) and doctor-diagnosed chronic insomnia across NSW exposure (never night shift work; ever; ever/former; ever/current) and related metrics (cumulative duration, average frequency), compared to never NSW. Effect modification by chronotype and daytime napping was investigated. Former NSW was associated with higher odds of chronic insomnia in both samples (GW: OR = 2.28, 95% CI = 1.07-4.83; HW: OR = 1.17, 95% CI = 0.60-2.27). Chronic insomnia odds tended to increase among current night shift workers (HW: OR = 1.50, 95% CI = 0.79-2.83), compared to day workers. Higher NSW frequency (shifts/month) was associated with higher chronic insomnia odds in former night shift workers in both samples (GW: OR_{per shift/month} = 1.06, 95% CI = 1.00-1.12; HW: OR_{per shift/month} = 1.12, 95% CI = 1.00-1.25). Former NSW was also associated with increased daytime sleepiness among GW (OR = 2.26, 95% CI 1.28-3.99). Associations were more pronounced among early chronotypes and participants who reported no daytime naps. Our results suggest that NSW is associated with chronic insomnia even in the years after cessation of involvement in working it.

Relationships Between Sleep Problems and Stress Coping Strategies Adopted by Nurses Including Socio-Occupational Factors

Introduction: The health of nurses has a direct impact on the quality of care and health outcomes for patients. The length and quality of sleep as well as the intensity of perceived stress have an impact on the health of nurses. An appropriate stress coping strategy can reduce the impact of stress and mitigate its negative consequences. Aim: The purpose of this study was to investigate relationships between excessive sleepiness and insomnia in interaction with selected socio-occupational factors and stress coping strategies among nurses. Material and Method: The cross-sectional study was conducted among 448 nurses working in hospitals in Podlasie Province in Poland. Mini-Cope inventory - the polish adaptation of Carver's BriefCope was used for measuring coping with stress. Sleep problems were assessed using the Athens Insomnia Scale and the Epworth Sleepiness Scale. Results: The most frequent used coping strategies were active strategies (active coping, planning). The least-used were avoidant strategies (behavioral disengagement, substance use). Excessive sleepiness affected 38% of surveyed, while insomnia 33%. Excessive sleepiness was most strongly related with behavioural disengagement (R ² = 18.6%), substance use (R ² = 17.5%), humour (R ² = 13.8%) and denial (R ² = 12.0%) while insomnia with substance use (R ² = 17.5%) and self-blame (R ² = 15.9%). Nurses with tertiary education experiencing sleep problems less frequently used the strategy of humour, behavioural disengagement, substance use and religion than with lower education. Nurses working in interventional wards experiencing excessive sleepiness used the strategy of humour, religion and positive reframing less often than those working in other wards while those suffering from insomnia used the strategy of humour more often than those working in other wards. Conclusions: The implementation of avoidant and support-seeking and emotion-oriented stress coping strategies by nurses were associated with the sleep problems. Tertiary education discourages nurses with sleep problems from using avoidant coping strategies and devoting themselves to religion. Education and improvement of the quality of sleep may prevent nurses from resorting to stress coping strategies that have a detrimental effect on their health and well-being.

The Association Between Shift Work And Affective Disorders: A Systematic Review

Atypical working time patterns are known to be associated with adverse physical health consequences. The impact of chronic exposure to shift work on psychological wellbeing and mental health is also reported, but not fully appreciated. We conducted a systematic review of the literature on the association between shift work and affective disorders using the electronic databases Medline, PsycINFO, Embase, Web of Science and Google Scholar. Data extracted included detailed characteristics of shift work, the affective disorders under study, and the population targeted. Some 25 extracted articles satisfied all inclusion and exclusion criteria. Findings of these articles reveal shift work is associated with increases in depressive symptoms (12 studies), anxiety (2 studies), and depression and anxiety (7 studies). Only three studies found no association between shift work and depression. The findings of this review suggest that shift work increases the symptoms of depression and anxiety.

Prevalence of Poor Sleep Quality in Nursing Staff: A Meta-Analysis of Observational Studies

Objective: Poor sleep quality is common in nursing staff. This meta-analysis aimed to examine the pooled prevalence of poor sleep quality in nursing staff. Methods: A systematic search in PubMed, EMBASE, PsycINFO, and Web of Science databases was performed. Studies that reported sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) were synthesized using a random-effects model. Results: Fifty-three studies were analyzed. The pooled prevalence of poor sleep quality was 61.0% (95% CI: 55.8-66.1%). The pooled total PSQI score was 7.13 ± 0.18 (95% CI: 6.78-7.50). The pooled component scores were 1.47 ± 0.20 (95% CI of mean score: 1.08-1.85) in sleep latency, 0.91 ± 0.15 (95% CI of mean score: 0.61-1.21) in sleep duration, 1.59 ± 0.13 (95% CI of mean score: 1.35-1.84) in overall sleep disturbances, 0.33 ± 0.18 (95% CI of mean score: 0-0.67) in sleeping medication, 1.21 ± 1.20 (95% CI of mean score: 0.83-1.60) in daytime dysfunction, 1.39 ± 0.14 (95% CI of mean score: 1.11-1.67) in subjective sleep quality, and 0.66 ± 0.11 (95% CI of mean score: 0.44-0.87) in habitual sleep efficiency. Subgroup and meta-regression analyses found that PSQI cutoff values, mean age, body mass index (BMI), sample size, study quality, and work experience moderated the prevalence of poor sleep quality. Conclusions: Poor sleep quality appears to be common in nursing staff. Considering its negative impact on health, effective measures should be taken to improve poor sleep quality in this population. Longitudinal studies should be conducted to examine the contributing factors of nurses' poor sleep quality.

Evaluation of the correlation between job stress and sleep quality in community nurses

Chronic sleep deprivation may worsen many medical and mental health conditions, causing difficulty in the ability to function at work. Job stress may be a factor that directly correlates with the poorer sleep quality of nurses from different departments in a general hospital. However, epidemiological evaluations of sleep problems among community nurses in China are scarce, and an association between sleep problems and occupational stress has not been investigated. This study investigated the association between nurses' job stress and sleep quality in a community hospital in China. This cross-sectional study was conducted from September to November 2017 and involved 180 nurses who had worked for more than 1 year in 12 community hospitals. The Job Stress Questionnaire was administered to evaluate occupational stress. The Pittsburgh Sleep Quality Index was used to evaluate sleep disorder status. Logistic regression was performed to investigate the association between job stress and sleep disorder among these community nurses in China. For the 155 nurses who completed the study, the job stress score was 58 ± 18, and 72 nurses (46%) had a Pittsburgh Sleep Quality Index (PSQI > 7). The type of nurse contract and total job stress scores were related to sleep disturbances within the previous month. The job stress scores were negatively associated with sleep quality; in other words, the higher the job stress scores were, the worse the quality of sleep. The logistic regression analysis showed that the type of nurse contract and self-reported job stress were significant factors affecting sleep quality. Sleep disturbances in nurses were highly associated with job difficulty factor, doctor-patient relationships, psychosomatic state, environment or events, promotion or competition and total pressure scores. Sleep problems were prevalent among clinical nurses in community hospitals in China. Occupational stress negatively affects sleep quality in Chinese community nurses; the higher the stress is, the worse the sleep quality.

Insomnia Symptoms and Mood Disturbances in Shift Workers with Different Chronotypes and Working Schedules

Background and Purpose

Shift workers frequently suffer from insomnia and mood disturbances, but little is known about the relationships of these conditions with the chronotypes and different working schedules of shift workers. We hypothesized that different shift-work schedules are associated with different severities of sleep and mood disturbances, and that the individual chronotype plays a role in sleep disturbances in shift workers.

Methods

This study enrolled 276 participants, comprising 77 nurses working in a three-shift schedule (3S, 27.9%), 60 firefighters working in a 24-h-every-other-day shift schedule (EOD, 21.7%), and 139 day workers (DW, 50.4%). All of the participants completed the following questionnaires to assess their sleep disturbances, mood, and chronotype: Insomnia Severity Index (ISI), Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale, and Morningness-Eveningness Questionnaire.

Results

ISI questionnaires were worse in both shift workers compare to DW, 35.1% of 3S, 23% of EOD had clinically significant insomnia (ISI score >14). Depressive mood and anxiety symptom were significantly worse in 3S compare to EOD. The sleep disturbance by ISI score had significant correlations with depressive mood and anxiety symptoms for both EOD and 3S (EOD: rho=0.57, rho=0.57, 3S: rho=0.37, rho=0.33 respectively). Chronotype type in shift workers had no significant correlation with sleep disturbance, depressive mood, nor anxiety symptom. However, after adjustment, the eveningness chronotype have relationship to the depressive mood in shift workers.

Conclusions

Sleep disturbances are more frequent in shift workers than DW. Depressive mood and anxiety symptoms were frequently reported in 3S, then EOD. Different shift schedules cab be a determinant of depressive mood and anxiety symptom.

Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units

AIM

To assess 12-h shift Intensive Care Unit (ICU) nurses' fatigue and identify the associated demographic factors.

BACKGROUND

Literature reveals inconsistencies as to whether 12-h shifts decrease or increase nurse fatigue levels.

METHODS

A cross-sectional survey of 67 ICU nurses working 12-h shifts was undertaken to determine their fatigue levels in two hospitals. The Occupational Fatigue Exhaustion/Recovery Scale (OFER), Spearman's correlation, ANOVA, t-tests, and Chi-Square were used for analyses.

RESULTS

57 out of 67 participants experienced low to moderate chronic fatigue; 36 of those exhibited low to moderate acute fatigue levels; 46 reported low to moderate inter-shift fatigue. Age (ρ = 0.03, r² = -0.28), number of family dependents (ρ = 0.03, r² = -0.27), and years of nursing experience (ρ = 0.03, r² = -0.27) were moderately negatively correlated with acute fatigue, while frequency of exercise per week (ρ = 0.01, r² = -0.31) was moderately negatively correlated with chronic fatigue. Hospital A had higher chronic fatigue levels than Hospital B. Age (ρ < 0.01), age group (ρ = 0.03), shift schedule (ρ = 0.02), and nursing experience (ρ = 0.03) were significantly related to the difference in chronic fatigue levels between the two hospitals.

CONCLUSIONS

More than half of the 12-h shift ICU nurses studied in both hospitals had low to moderate fatigue levels. Age, number of family dependents, years of nursing experience, and frequency of exercise per week were identified as key factors associated with fatigue. The difference in chronic fatigue levels between hospitals suggests that implementing more support for younger and/or less experienced nurses, better strategies for retaining more experienced nurses, and fewer rotating shifts could help reduce fatigue.

Sleep disturbances and related factors among nurses

The aim of this study was to describe patterns and potential risk factors for sleep disturbances, including that of sleep apnea, among Thai registered nurses. A descriptive, cross-sectional design was implemented. A sample of 233 registered nurses was recruited from 10 nursing departments from a tertiary hospital. Participants completed a one-time, self-report questionnaire and a 1 week-long sleep diary. Descriptive and logistic regression statistics were used for the analysis. Approximately 76% of nurses slept less than 7 h, 12.3% had difficulty initiating sleep, and 5% had difficulty maintaining sleep. Short sleep duration was prevalent, and night shift work schedules that exceeded 10 episodes/month were perceived as contributing to difficulties with initiating sleep. After excluding males from the analysis, the risk for depression related to short sleep duration becomes statistically significant. Organizational policies for registered nurses' shift work should include effective management of night shift assignments, as well as interventional strategies and policy directions, to promote sleep quality and mental health to ensure nurse well-being and patient safety.

An Investigation of Associations Between Management and Feather Damage in Canadian Laying Hens Housed in Furnished Cages

Feather pecking is a continuous welfare challenge in the housing of egg-laying hens. Canada is currently making the transition from conventional cages to alternative housing systems. However, feather damage (FD) among laying hens due to feather pecking remains a welfare concern. An explorative approach was taken to assess bird, housing, and management associations with FD in Canadian laying hens housed in alternative systems. A questionnaire focused on housing and management practices was administered to 122 laying farms across Canada in autumn of 2017 (response rate of 52.5%), yielding information on a subset of 26 flocks housed in furnished cages. Additionally, a three-point feather cover scoring system was developed to estimate the prevalence of FD. Farmers assessed FD by sampling 50 birds per flock. Linear regression modeling was applied to explain FD as a function of 6 variables (out of an available 54). Of the 6 modeled variables, "increased age", "brown feather colour", "midnight feeding", and "no scratch area" were associated with higher levels of FD at farm level (R² = 0.77). The results indicated that FD resulting from feather pecking is a multifactorial problem, and supported existing evidence that FD increases as birds age. These results also suggested that "feather colour", "midnight feeding", and "access to (or lack of) a scratch area or additional substrate" play a role in FD prevalence in furnished cages.

Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review

Shift workers often experience reduced sleep quality, duration and/or excessive sleepiness due to the imposed conflict between work and their circadian system. About 20-30% of shift workers experience prominent insomnia symptoms and excessive daytime sleepiness consistent with the circadian rhythm sleep disorder known as shift work disorder. Individual factors may influence this vulnerability to shift work disorder or sleep-related impairment associated with shift work. This paper was registered with Prospero and was conducted using recommended standards for systematic reviews and meta-analyses. Published literature that measured sleep-related impairment associated with shift work including reduced sleep quality and duration and increased daytime sleepiness amongst healthcare shift workers and explored characteristics associated with individual variability were reviewed. Fifty-eight studies were included. Older age, morning-type, circadian flexibility, being married or having children, increased caffeine intake, higher scores on neuroticism and lower on hardiness were related to a higher risk of sleep-related impairment in response to shift work, whereas physical activity was a protective factor. The review highlights the diverse range of measurement tools used to evaluate the impact of shift work on sleep. Use of standardised and validated tools would enable cross-study comparisons. Longitudinal studies are required to establish causal relationships between individual factors and the development of shift work disorder.

Reciprocal relations between care-related emotional burden and sleep problems in healthcare professionals: a multicentre international cohort study

OBJECTIVE

To determine whether there are reciprocal relations between care-related regret and insomnia severity among healthcare professionals, and whether the use of different coping strategies influences these associations.

METHODS

This is a multicentre international cohort study of 151 healthcare professionals working in acute care hospitals and clinics (87.4% female; mean age=30.4±8.0 years, 27.2% physicians, 48.3% nurses and 24.5% other professions) between 2014 and 2017. Weekly measures of regret intensity, number of regrets, and use of coping strategies (Regret Coping Scale) and sleep problems (Insomnia Severity Index) were assessed using a web survey.

RESULTS

The associations between regret and insomnia severity were bidirectional. In a given week, regret intensity (b_{regret intensity→sleep}=0.26, 95% credible interval (CI) (0.14 to 0.40)) and number of regrets (b_{number of regrets→sleep}=0.43, 95% CI (0.07 to 0.53)) were significantly associated with increased insomnia severity the following week. Conversely, insomnia severity in a given week was significantly associated with higher regret intensity (b_{sleep→regret intensity}=0.14, 95% CI (0.11 to 0.30)) and more regrets (b_{sleep→number of regrets}=0.04, 95% CI (0.02 to 0.06)) the week after. The effects of regret on insomnia severity were much stronger than those in the opposite direction. The use of coping strategies, especially if they were maladaptive, modified the strength of these cross-lagged associations.

CONCLUSIONS

The present study showed that care-related regret and sleep problems are closely intertwined among healthcare professionals. Given the high prevalence of these issues, our findings call for the implementation of interventions that are specifically designed to help healthcare professionals to reduce their use of maladaptive coping strategies.

Short sleep duration among Thai nurses: Influences on fatigue, daytime sleepiness, and occupational errors

OBJECTIVES

This study was conducted to: 1) describe sleep duration, fatigue, daytime sleepiness, and occupational errors among Thai nurses and 2) explore the influence of sleep duration on fatigue, daytime sleepiness, and occupational errors.

METHODS

A cross-sectional design was implemented. A convenience sample of 233 full-time nurses with at least one year of work experience was recruited to participate in the study. Data were collected using self-reported questionnaires and 1-week sleep diaries. Descriptive and logistic regression statistics were performed using SPSS software.

RESULTS

The mean total sleep time was 6.2 hours. Of the total participants, 75.9% (n=167) experienced short sleep duration, 38.2% (n=84) experienced fatigue, and 49.5% (n=109) experienced excessive daytime sleepiness. Occupational errors were reported by 11.7% (n=25). Medication errors, incorrectly performed procedures, and needle stick injuries were reported by 6.5% (n=13), 5.6% (n=12), and 4.7% (n=10), respectively, of participants performing the associated activities. The "Short Sleep Duration" group experienced more fatigue (p=.044) and excessive daytime sleepiness (p=.001) compared with the "Adequate Sleep Duration" group. Although occupational errors were more common in the "Short Sleep Duration" group, the difference between the two groups did not reach the level of statistical significance. Multivariable logistic regression analysis found that short sleep duration was a statistically significant risk factor for excessive daytime sleepiness (OR=2.47, 95% CI=1.18-5.19).

CONCLUSIONS

The majority of registered nurses experience short sleep duration. Short sleep duration increased the risk of excessive daytime sleepiness but not fatigue or occupational errors. Adequate night-time sleep is paramount for preventing daytime sleepiness and achieving optimal work performance.

Impact of CAre-related Regret Upon Sleep (ICARUS) cohort study: protocol of a 3-year multicentre, international, prospective cohort study of novice healthcare professionals

INTRODUCTION

Healthcare professionals are particularly at risk of developing numerous physical and psychological health problems. The experiences of emotional burden associated with providing healthcare, notably care-related regret, have been associated with these health problems, but only using cross-sectional data so far. Evidence of a causal impact of regret has not been assessed. The Impact of CAre-related Regret Upon Sleep (ICARUS) study is the first prospective and international cohort study established to examine how newly practising healthcare professionals adapt to their challenging job by assessing the impact of care-related regret on sleep and job quitting.

METHOD AND ANALYSIS

The ICARUS cohort study will include newly practising healthcare professionals working in acute care hospitals and clinics recruited between May 2017 and November 2019. Data collection, which will begin as soon as the participant starts working with patients, will consist of a 1-year weekly assessment using a secure web survey. Follow-up data will be collected at 6, 12, 18 and 24 months after the end of the first year. We will collect detailed information on the experience of care-related regret (ie, highest regret intensity, accumulation of regrets and coping strategies related to regrets), sleep problems and job quitting. Moreover, quality of life, health status and burnout will be assessed during the follow-up. Several confounders factors, including sociodemographic characteristics, personality, night shifts and work environment characteristics, will be assessed.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of Geneva Canton, Switzerland (CCER2016-02041), the Ethics Committee of London South Bank University (HSCSEP/17/06) and the University Research Ethics Committee of Bedfordshire (UREC106). Other study centres deemed local ethical approval unnecessary since the main ethics committee (Geneva) had already accepted the project. Results will be published in relevant scientific journals and be disseminated in international conferences. Fully anonymised data and questionnaires will be freely accessible to everyone (scientists and general public).

Fatigue in Intensive Care Nurses and Related Factors

BACKGROUND

Fatigue negatively affects the performance of intensive care nurses. Factors contributing to the fatigue experienced by nurses include lifestyle, psychological status, work organization and sleep problems.

OBJECTIVE

To determine the level of fatigue among nurses working in intensive care units and the related factors.

METHODS

This descriptive study was conducted with 102 nurses working in intensive care units in the West Black Sea Region of Turkey. Data were collected between February and May 2014 using a personal information form, the Visual Analogue Scale for Fatigue (VAS-F), the Hospital Anxiety and Depression Scale and the Pittsburg Sleep Quality Index.

RESULTS

The intensive care nurses in the study were found to be experiencing fatigue. Significant correlations were observed between scores on the VAS-F Fatigue and anxiety (p=0.01), depression (p=0.002), and sleep quality (p<0.001).

CONCLUSION

Anxiety, depression and quality of sleep were significantly affected by the intensive care nurses' levels of fatigue. These results can be of benefit in taking measures which may be used to reduce fatigue in nurses, especially the fatigue related to work organization and social life.

Sleep disturbances among Chinese clinical nurses in general hospitals and its influencing factors

BACKGROUND

This study aimed to determine the prevalence of sleep disturbances among clinical nurses in general hospitals in Mainland China, and identify its associate factors.

METHODS

Using a cross-sectional design, a total of 5012 clinical nurses selected by random cluster sampling completed the survey on the Pittsburgh Sleep Quality Index (PSQI), measures of quality of life indexed by the Medical Outcomes Study 12-item Short-Form Health Survey, occupational stress evaluated by the Job Content Questionnaire, lifestyle and sociodemographic details.

RESULTS

The average PSQI score of 4951 subjects was 7.32 ± 3.24, including 3163 subjects with PSQI ≥5, accounting for 63.9%. Multivariate Logistic regression analysis showed that the risk factors for sleep disturbances in nurses were female gender, the Emergency department and ICU, many years of service, high night shift frequency, professional status: primary and intermediate, employment status: temporary, poor quality of life: poor mental health, low perceived health, high occupational stress (high psychological demand, low job control and low workplace social support).

CONCLUSIONS

Sleep disturbances are highly prevalent among clinical nurses in general hospitals in Mainland China. Many of the factors listed above were associated with the prevalence of sleep disturbances in nurses, and occupational stress plays an important role in the development of sleep disturbances in Chinese clinical nurses.

Self-Rated Health and Sick Leave among Nurses and Physicians: The Role of Regret and Coping Strategies in Difficult Care-Related Situations

Moral distress - such as feeling strong regret over difficult patient situations - is common among nurses and physicians. Regret intensity, as well as the coping strategies used to manage regrets, may also influence the health and sickness absence of healthcare professionals. The objective of this study was to determine if the experience of regret related to difficult care-related situations is associated with poor health and sick leave and if coping strategies mediate these associations. Two cross-sectional surveys were conducted in Switzerland (Geneva, 2011 and Zurich, 2014). Outcomes were self-rated health (SRH) and sick leave in the last 6 months. We examined the associations of regret intensity with the most important care-related regret, number of recent care-related regrets, and coping strategies, using regressions models. Among 775 respondents, most reported very good SRH and 9.7% indicated absence from work during four working days or more. Intensity of the most important regret was associated with poor SRH among nurses and physicians, and with higher sick leave among nurses. Maladaptive emotion-focused strategies were associated with poor SRH among nurses, whereas adaptive emotion-focused strategies were positively associated with higher SRH and lower sick leave among physicians. Because care-related regret is an integral part of clinical practice in acute care hospitals, helping physicians and, especially, nurses to learn how to deal with negative events may yield beneficial consequences at the individual, patient care, and institutional level.

Depression in Registered Nurses: A State of the Science

Registered nurses suffer from depression at almost twice the rate of individuals in other professions. Major depression affects both employees and organizations. Depression is linked to increases in work absenteeism, short-term disability, and decreased productivity and presenteeism. Depression experienced by registered nurses may not be fully preventable, but realizing its presence and prevalence in the workplace is of vital importance. It is essential that we have a healthy, vibrant, and present registered nurse workforce to ensure that quality patient outcomes are achieved. This review of 36 articles assesses the current state of the science related to depression in registered nurses so that occupational health nurses can create pathways and work environments for better mental health for registered nurses.

The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts

BACKGROUND

Shift work is considered necessary to ensure continuity of care in hospitals and residential facilities. In particular, the night shift is one of the most frequent reasons for the disruption of circadian rhythms, causing significant alterations of sleep and biological functions that can affect physical and psychological well-being and negatively impact work performance.

OBJECTIVES

The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction.

METHODS

This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in 17 wards of a general hospital and a residential facility of a northern Italian city. This study involved 213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data collection was the "Standard Shift Work Index," validated in Italian. Data were statistically analyzed.

RESULTS

The response rate was 86%. The nurses engaged in rotating night shifts were statistically significantly younger, more frequently single, and had Bachelors and Masters degrees in nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in comparison with the day shift workers, in a statistically significant way.

CONCLUSION

Our results suggest that nurses with rotating night schedule need special attention due to the higher risk for both job dissatisfaction and undesirable health effects.

Sleep disturbances in nurses enrolled in part-time studies

Aim. The aim of this study was to assess the prevalence of sleep disorders among nurses enrolled in part-time studies and to identify the key factors affecting the sleep quality. Material and methods. The study was conducted on part-time student-nurses majoring in nursing. Sleep disorders were described using the Athens Insomnia Scale and the FIRST scale, as well as the author’s questionnaire. Data were analysed using Mann-Whitney U tests, ANOVA, Kruskal-Wallis and appropriate post-hoc tests. A significance criterion of P<0.05 was used throughout the study. Results. Sleep disorders were found in most student nurses – almost a half of them were at-risk of insomnia due to inadequate sleep hygiene. The main factors affecting sleep included nurses’ anxiety about their academic performance, stress, workload and shift work. Lack of sleep affected work performance the following day, leading to fatigue, increased daytime sleepiness, deterioration of concentration and irritability. Conclusion. Some individuals may not be aware about the relationship between one’s lifestyle and sleep quality which contributes to poor sleep quality and deteriorates one’s functioning during the day. In turn, this may lead to lower nursing care quality and it may also put additional strain on home chores.

Healthcare-Related Regret among Nurses and Physicians Is Associated with Self-Rated Insomnia Severity: A Cross-Sectional Study

To examine the association between healthcare-related regrets and sleep difficulties among nurses and physicians, we surveyed 240 nurses and 220 physicians at the University Hospitals of Geneva. Regret intensity and regret coping were measured using validated scales. Sleep difficulties were measured using the Insomnia Severity Index (ISI), and an additional question assessed the frequency of sleeping pill use. After controlling for sex, profession, years of experience, rate of employment, and depression as well as for all other regret-related variables, the following variables remained significantly associated with self-rated severity of insomnia: regret intensity (slope = 1.32, p = 0.007, 95%CI: [0.36; 2.29], std. coefficient = 0.16) and maladaptive (e.g., rumination) emotion-focused coping (slope = 1.57, p = 0.002, 95%CI: [0.60; 2.55], std. coefficient = 0.17) remained significant predictors of self-rated insomnia severity. If these cross-sectional associations represent causal effects, the development of regret-management programs may represent a promising approach to mitigating sleep difficulties of healthcare professionals.

Shift work disorder, depression, and anxiety in the transition to rotating shifts: the role of sleep reactivity

AIM

The aim of this study is to investigate premorbid sleep reactivity as a vulnerability to incident shift work disorder (SWD), and related changes in depression as well as anxiety following a transition to a rotating shifts work schedule.

METHODS

This is a longitudinal study with two waves of data collection. The community-based sample included normal sleeping non-shift workers (N = 96; 62.5% female; 47.9 ± 13.3 years) without a lifetime history of insomnia or baseline excessive daytime sleepiness who transitioned to rotating shift work one year later. Participants reported demographic characteristics, trait sleep reactivity on the Ford Insomnia Response to Stress Test, depression symptoms on the Quick Inventory of Depression Symptomatology, and anxiety symptoms on the Beck Anxiety Inventory. SWD was determined based on significant sleep disturbance and/or excessive sleepiness in the context of working in a rotating-shift schedule.

RESULTS

Analyses revealed that the odds were over five times greater for highly sleep-reactive individuals to develop SWD after transitioning to rotating shifts (OR = 5.59, p = 0.04). Nearly 90% of participants who suffered from SWD were accurately identified as high risk at one year before disease onset. Furthermore, individuals who developed SWD reported greater increases in symptoms of depression and anxiety. Finally, analyses revealed significant indirect effects wherein high sleep reactivity increased risk for SWD, which led to greater severity of anxiety and depression symptoms.

CONCLUSIONS

The Ford Insomnia Response to Stress Test (FIRST) accurately identifies a focused target population in which the premorbid psychobiological processes complicit in SWD onset and progression, as well as shift work-related depression and anxiety changes, can be better investigated, thus improving future preventative efforts.

Predictors of shift work disorder among nurses: a longitudinal study

BACKGROUND

Shift work is associated with sleep problems and impaired health. The main aim of the present study was to explore predictors of developing shift work disorder (SWD) among Norwegian nurses using a longitudinal design.

METHODS

A total of 1533 nurses participating in a survey on shift work, sleep and health responded to questionnaires at baseline and at follow-up about two years later. SWD was defined as problems of excessive sleepiness and/or complaints of insomnia related to the work schedule.

RESULTS AND CONCLUSIONS

There was a significant reduction (p < 0.001) in the prevalence of SWD from baseline to follow-up, from 35.7% to 28.6%. Logistic regression analyses showed significant risks of having SWD at follow-up and the following variables measured at baseline: number of nights worked the last year (OR = 1.01, 95% CI = 1.01-1.02), having SWD (OR = 5.19, 95% CI = 3.74-7.20), composite score on the Epworth Sleepiness Scale (OR = 1.08, 95% CI = 1.04-1.13), use of melatonin (OR = 4.20, 95% CI = 1.33-13.33), use of bright light therapy (OR = 3.10, 95% CI 1.14-8.39), and symptoms of depression measured by the Hospital Anxiety and Depression Scale (OR = 1.07, 95% CI = 1.00-1.14). In addition, leaving night work between baseline and follow-up was associated with a significantly reduced risk of SWD at follow-up (OR = 0.12, 95% CI = 0.07-0.22).

Insomnia, excessive sleepiness, excessive fatigue, anxiety, depression and shift work disorder in nurses having less than 11 hours in-between shifts

Study objective

To assess if less than 11 hours off work between work shifts (quick returns) was related to insomnia, sleepiness, fatigue, anxiety, depression and shift work disorder among nurses.

Methods

A questionnaire including established instruments measuring insomnia (Bergen Insomnia Scale), sleepiness (Epworth Sleepiness Scale), fatigue (Fatigue Questionnaire), anxiety/depression (Hospital Anxiety and Depression Scale) and shift work disorder was administered. Among the 1990 Norwegian nurses who participated in the study; 264 nurses had no quick returns, 724 had 1–30 quick returns and 892 had more than 30 quick returns during the past year. 110 nurses did not report the number of quick returns during the past year. The prevalence of insomnia, excessive sleepiness, excessive fatigue, anxiety, depression and shift work disorder was calculated within the three groups of nurses. Crude and adjusted logistic regression analyses were performed to assess the relation between quick returns and such complaints.

Results

We found a significant positive association between quick returns and insomnia, excessive sleepiness, excessive fatigue and shift work disorder. Anxiety and depression were not related to working quick returns.

Conclusions

There is a health hazard associated with quick returns. Further research should aim to investigate if workplace strategies aimed at reducing the number of quick returns may reduce complaints among workers.