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

Quantity and quality of napping to mitigate fatigue and sleepiness among nurses working long night shifts: a prospective observational study

BACKGROUND

Napping during night shifts is a countermeasure against fatigue and sleepiness, which both impact patient safety. However, there is insufficient evidence on how nurses nap, especially concerning their napping quality. This study explored night-shift napping and its associated factors among nurses, considering napping quantity and quality, to mitigate fatigue and sleepiness.

METHODS

This month-long prospective observational study included 32 nurses working 16-h night shifts in a general ward. All nurses responded to questions on individual factors, while fatigue and sleepiness were checked four times during night shifts. Night-shift napping was measured using a wearable device and classified into six groups: time in bed [TIB] > 180 min and sleep efficiency [SE] ≥ 70%, TIB > 180 min and SE < 70%, TIB 120-180 min and SE ≥ 70%, TIB 120-180 min and SE < 70%, TIB < 120 min and SE ≥ 70%, and TIB < 120 min and SE < 70%.

RESULTS

Most nurses (81.2%) worked four night shifts per month, and 105 night shifts in which nurses intended to nap were analyzed. The two nap conditions (TIB 120-180 min and SE ≥ 70%, TIB > 180 min and SE ≥ 70%) were not worse than other nap conditions in fatigue and sleepiness at the end of the night shift and change in fatigue from the start to the end of the night shift. Sleep reactivity, pre-nap time on electronic devices, and prophylactic naps taken before the night shift were each the common factors related to napping for TIB ≥ 120 min and SE ≥ 70%.

CONCLUSIONS

Nurses working long night shifts should consider both sufficient napping quantity and good napping quality. We suggest aiming for a TIB of at least 120 min and a SE of at least 70% to mitigate fatigue and sleepiness at the end of a night shift. Assessing sleep reactivity, pre-nap time on electronic devices, and prophylactic naps may be useful in achieving both quantity and quality effectively. Nurses and their managers should have a better understanding of napping and consider strategically taking naps during night shifts.

Sleep quality and fatigue among nurses working in high-acuity clinical settings in Saudi Arabia: a cross-sectional study

BACKGROUND

Poor sleep quality is prevalent among nurses worldwide. Around two-thirds of nurses doing shift work are known to experience sleep problems and fatigue. Fatigue and sleep problems are linked to poor performance, impaired alertness, injuries, chronic diseases, compromised healthcare quality, and medical errors, all of which detrimentally impact nurses and threaten patients' safety. This area of research has received insufficient attention in Saudi Arabia; therefore, the purpose of this study was to examine the levels of sleep quality and perceived fatigue and their association among nurses working in acute care settings in comprehensive hospitals in Saudi Arabia.

METHODS

A descriptive cross-sectional study using the Pittsburgh Sleep Quality Index and Chalder Fatigue Scale. Data was obtained via an online questionnaire that was distributed to nurses using the QuestionPro platform through hospital administrators, social media (WhatsApp), and personal contact.

RESULTS

A total of 173 nurses completed the online survey. Most participants reported poor sleep quality (n = 127, 73.4%) and severe perceived fatigue (n = 156, 90.2%). Furthermore, the study revealed a significant correlation between the overall sleep disturbance and fatigue global scores (r = 0.57, P < 0.001), indicating that poor sleep quality was significantly associated with higher fatigue levels among the study sample.

CONCLUSIONS

The current study found a significant association between sleep quality and severe fatigue in nurses working in high acute care settings in Saudi Arabia. It is very clear from the results that nurses are experiencing poor sleep and severe fatigue, which in turn, will negatively impact the nurse's quality of life and patient safety.

Recovery from shift work

One fifth of today's workforce is engaged in shift work and exposed to various mental and physical health risks including shift work disorder. Efficiently recovering from shift work through physical and mental interventions allows us to mitigate negative effects on health, enables a better work-life balance and enhances our overall wellbeing. The aim of this review is to provide a state-of-the-art overview of the available literature. The role of sleep timing and naps, light therapy and psychotherapy, diet and exercise in recovery from shift work is presented here. We further review the impact of shift schedules and social support on post-shift unwinding.

Effects of 90 Min Napping on Fatigue and Associated Environmental Factors among Nurses Working Long Night Shifts: A Longitudinal Observational Study

For nurses working long night shifts, it is imperative that they have the ability to take naps to reduce fatigue, and that an appropriate environment is prepared where such naps can be taken. We verified the effects of 90 min napping on fatigue and the associated factors among nurses working 16-h night shifts. We investigated 196-night shifts among 49 nurses for one month. Wearable devices, data logging devices, and questionnaires were used to assess nap parameters, fatigue, and environmental factors such as the napping environment, ways of spending breaks, and working environment. Nurses who nap at least 90 min on most night shifts had more nursing experience. Multivariable logistic regression analysis showed that the environmental factors significantly associated with total nap duration (TND) ≥ 90 min were noise, time spent on electronic devices such as cellphones and tablets during breaks, and nap break duration. The night shifts with TND ≥ 90 min showed lower drowsiness after nap breaks and less fatigue at the end of night shift compared to those with TND < 90 min. Nurses and nursing managers should recognize the importance of napping and make adjustments to nap for at least 90 min during long night shifts.