Decreased hydration status of emergency department physicians and nurses by the end of their shift

The Effect of Shift Working on Dietary Patterns of Healthcare Practitioners during the COVID-19 Pandemic: A Cross-Sectional Study

Background and Objectives: Health professionals' working schedules often do not allow them to follow a balanced way of life, and the nature of their work can affect their weight and eating habits. The aim of the present study is to shed some light on the impact of night shift working on the dietary practices of healthcare practitioners in Greece. Materials and Methods: This was a cross-sectional study. With the use of an administered questionnaire several parameters were assessed, including anthropometric characteristics, weight history, as well as nutritional habits of the same group of participants during night shifts and when at regular working hours. Moreover, nutritional beliefs of the subjects were recorded, as well as the level of adherence to the Mediterranean diet. Results: It was observed that in all food groups, including water, used to compare the nutritional patterns of the participants during night shifts and when working regular hours, statistical differences were noted (p = 0.001). Furthermore, the participants who reported a higher adherence to the Mediterranean diet and self-reported healthier nutritional habits, had a statistically lower weight compared to the participants that rarely followed the specific model or reported unhealthier eating routine (p = 0.010 and p = 0.015, respectively). Conclusions: We conclude that shift-working healthcare professionals are associated with disturbed eating behaviours leading to the high consumption of unhealthy food. The implementation of interventions that will concentrate on educating health workers on balanced nutrition and improving physical environment (i.e., food availability, healthier food choices) seems to be of great importance.

Determinants of fatigue in emergency department clinicians who wear personal protective equipment

OBJECTIVE

To determine the independent predictors for clinician fatigue and decline in cognitive function following a shift in the ED during early stages of the COVID-19 pandemic.

METHODS

This was a prospective, quasi-experimental study conducted in a metropolitan adult tertiary-referral hospital ED over 20 weeks in 2021. The participants were ED doctors and nurses working clinical shifts in an ED isolation area or high-risk zone (HRZ) with stringent personal protective equipment (PPE). The participants' objective and subjective fatigue was measured by the Samn-Perelli fatigue score and a psychomotor vigilance 'smart game' score, respectively. Postural signs/symptoms and urine specific gravity (SG) were measured as markers of dehydration.

RESULTS

Sixty-three participants provided data for 263 shifts. Median (interquartile range) age was 33 (28-38) years, 73% were female. Worsening fatigue score was associated with working afternoon shifts (afternoon vs day, adjusted odds ratio [aOR] 5.16 [95% confidence interval (CI) 1.32-20.02]) and in non-HRZ locations (HRZ vs non-HRZ, aOR 0.23 [95% CI 0.06-0.87]). Worsening cognitive function (game score) was associated with new onset postural symptoms (new vs no symptoms, aOR 4.14 [95% CI 1.34-12.51]) and afternoon shifts (afternoon vs day, aOR 3.13 [95% CI 1.16-8.44]). Working in the HRZ was not associated with declining cognitive function. Thirty-four (37%) of the 92 participants had an end of shift urine SG >1.030.

CONCLUSION

Working afternoon shifts was associated with fatigue. There was no association between HRZ allocation and fatigue, but our study was limited by a low COVID workload and fluctuating PPE requirements in the non-HRZs. Workplace interventions that target the prevention of fatigue in ED clinicians working afternoon shifts should be prioritised.

A systematic review of measurement methods used to estimate fluid and beverage intake in free-living, working-age adults

BACKGROUND

Beverage intake in employees is important to quantify due to the potential of dehydration to increase the risk of errors and reduced work performance. This systematic review aimed to (1) characterise existing fluid intake measurement tools used in the workplace setting or among free-living, healthy adults of working age and (2) report the current validation status of available assessment tools for use in a UK setting.

METHODS

Three electronic databases were searched for publications measuring beverage intake using a defined tool or method. Additional studies were identified by hand from trial registers, grey literature and reference lists. Eligibility was determined using predefined inclusion/exclusion criteria. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology framework. Narrative synthesis was performed.

RESULTS

The review identified 105 studies. The most frequently reported beverage assessment methods were total diet diaries/records (n = 22), fluid specific diaries/records (n = 18), food and fluid frequency questionnaires (n = 17), beverage-specific frequency questionnaires (n = 23) and diet recalls (n = 11). General dietary measurement tools (measuring beverages as part of total diet) were used in 60 studies, and 45 studies used a beverage-specific tool. This review identified 18 distinct dietary assessment tools, of which 6 were fluid/beverage specific. Twelve tools published relative validity for a beverage-related variable and seven tools for total daily fluid intake (from whole diet or from beverages only).

CONCLUSIONS

Several fluid intake assessment tools were identified; however, few have been fully evaluated for total beverage intake, and none in a UK working population.

Hydration and meal habits of physicians and medical learners: a literature review

PURPOSE

Nutrition and hydration are important components of physician and medical learner well-being; meal-skipping and insufficient hydration are known to negatively impact cognition. Existing data on these phenomena are sparse and rarely considered together; furthermore, there is a lack of literature on interventions to address these problems. We therefore aimed to characterize existing literature on this topic.

METHODS

We conducted a literature review of existing literature on the prevalence of and reasons for meal-skipping and insufficient hydration in physicians and medical learners.

RESULTS

Reported prevalences varied widely, as did the ways in which the data were collected. Reasons for meal-skipping and insufficient hydration are less studied, but a lack of time is the most commonly reported reason, among a variety of other barriers.

CONCLUSION

Further research is required to better characterize the prevalences and reasons for meal-skipping in physicians and medical learners. By consolidating the state of current knowledge on this topic in this work, we establish the groundwork for future studies and allow intervention studies to be based on a broader data set.

The Seniority Swoop: Young Nurse Burnout, Violence, and Turnover Intention in an 11-Hospital Sample

We sought to understand whether nurses aged 20 to 29 years burnout and intend to turnover in higher proportions than more senior nurses, and if so, why. Guided by Maslow's hierarchy, we used brief inventories to assess hospital-based bedside nurses at 11 hospitals in Pennsylvania and Rhode Island (n = 3549/9520) prior to the pandemic. In a second study, we compared scheduling policies, bargaining, and Magnet status to see whether these variables predicted worsened burnout rates in young nurses. In a pattern that appears like a swooping line when graphed, nurses aged 20 to 29 years reported higher burnout and intention to leave than more senior nurses. They also reported being punched, bitten, spit on, kicked, or otherwise physically struck more often, worked more long shifts, worked more nights, and reported more dehydration and poorer sleep. Notably, age alone was not a strong predictor of turnover until burnout was added to the model, indicating that there is no inherent millennial trait resulting in higher turnover. Instead, preventing and addressing burnout is key to retention. When comparing hospital characteristics, only scheduling perks for senior nurses predicted the seniority swoop pattern. We offer 9 recommendations to reduce burnout and turnover in young nurses.

Female nurses have a higher prevalence of urinary tract symptoms and infection than other occupations in dialysis units

Introduction:

Urinary tract symptoms and infection have been associated with occupational factors that impact hydration habits particularly in women. We compared self-reported urinary symptoms and infection and hydration habits between nurses and other occupations in dialysis units.

Methods:

Cross-sectional study. Participants worked in five nephrology centers in Brazil and answered an online questionnaire comprising questions regarding urinary tract symptoms and infection episodes in the preceding year; data on usual daily beverage intake, urine frequency, and urine color according to a urine color chart were also collected, as well as perceptions of water access and toilet adequacy at work.

Results:

We included 133 women (age=36.9±9.5 years). The self-reported usual daily beverage intake was 6.6±2.9 cups/day (~1320 mL), daily urine frequency was 5.4±2.1, and urine color chart score: 3.0±1.2. Nurses (N=66/49.6%) reported higher prevalence of burning sensation (50 versus 27%; P<0.001), urinary urgency (42 versus 21%; P<0.001), and infection (42% versus 25%; P=0.04) as well as lower liquid intake (6.0±2.6 versus 7.3±3.0 cups/day; P=0.01) than controls. Forty four percent of nurses reported being able to drink when thirsty "always" and "most of the time" versus 93% of the control group.

Conclusion:

Dialysis female nurses reported lower beverage intake and higher prevalence of symptoms and infection than other occupations in the same environment. Interventions to improve hydration can potentially decrease urinary problems in this population.

The Health of Health Care Professionals

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

Thirst at Work Implies More Than Just Inadequate Facilities for Breaks

Early signs of dehydration, such as headaches, are not unusual in the working population. Even slight deficiencies of water intake may have negative effects on both health and performance. However, little is known about work-related fluid intake. We expect the daily experience of interruptions to distract from perceived thirst, resulting in reduced daily fluid intake. This effect may be more pronounced when the workload is generally less predictable due to the assignment of tasks that are beyond the definition of the worker's professional role (unreasonable tasks). Data were gathered from 29 female service employees across five workdays. Multilevel analyses revealed daily work interruptions to be negatively associated with fluid intake, especially when there were frequent unreasonable task-assignments. Results suggest that interruptions at work might reduce daily fluid intake. However, adequate allocation of tasks by managers can protect employees against insufficient drinking.

Nutra-ergonomics: influence of nutrition on physical employment standards and the health of workers

The importance of ergonomics across several scientific domains, including biomechanics, psychology, sociology, and physiology, have been extensively explored. However, the role of other factors that may influence the health and productivity of workers, such as nutrition, is generally overlooked. Nutra-ergonomics describes the interface between workers, their work environment, and performance in relation to their nutritional status. It considers nutrition to be an integral part of a safe and productive workplace that encompasses physical and mental health as well as the long-term wellbeing of workers. This review explores the knowledge, awareness, and common practices of nutrition, hydration, stimulants, and fortified product use employed prior to physical employment standards testing and within the workplace. The influence of these nutra-ergonomic strategies on physical employment standards, worker safety, and performance will be examined. Further, the roles, responsibilities, and implications for the applicant, worker, and the employer will be discussed within the context of nutra-ergonomics, with reference to the provision and sustainability of an environment conducive to optimize worker health and wellbeing. Beyond physical employment standards, workplace productivity, and performance, the influence of extended or chronic desynchronization (irregular or shift work) in the work schedule on metabolism and long-term health, including risk of developing chronic and complex diseases, is discussed. Finally, practical nutra-ergonomic strategies and recommendations for the applicant, worker, and employer alike will be provided to enhance the short- and long-term safety, performance, health, and wellbeing of workers.