Effects of Sleep Deprivation on the Cognitive Performance of Nurses Working in Shift

The mediating role of sleep quality between pre-sleep portable media device use and nursing performance

The prevalence of portable media device (PMD) use has proliferated, potentially causing serious problems, particularly in critical situations. The main aim of the present study was to investigate the relationship between pre-sleep PMD use and cognitive performance, as well as the mediating effects of sleep quality among nurses. A cross-sectional study was designed, with 200 registered nurses voluntarily participating. The average time spent on PMDs was self-reported. The Pittsburgh Sleep Quality Index, the epworth sleepiness scale, the Occupational cognitive failures questionnaire, and the Nursing Errors Questionnaire were used to collect data. Correlation analyses and structural equation modeling were conducted. Significant relationships were found between pre-sleep PMD use and all variables of interest. Sleep quality was significantly related to daytime sleepiness and occupational cognitive failures, mediating the effect of pre-sleep PMD use on these two variables. Problematic use of PMDs at bedtime may be considered an unsafe act for healthcare workers. Healthcare providers should be aware of the potential risks induced by excessive PMD use. Creating a culture of proper smartphone use is crucial for overcoming these challenges.

The Relationship Between Poor Sleep and Memory Impairment Among Shift Nurses in China: A Cross-Sectional Study

Purpose

Many shift nurses experience poor sleep quality, and the effect on nurses' cognitive function remains unclear. The study aims to investigate sleep status and explore its association with cognitive function.

Methods

This descriptive cross-sectional study was conducted in a tertiary care hospital in Fujian, China between March and September 2022. By convenience sampling method, 588 shift nurses participated in this study. The Pittsburgh Sleep Quality Index (PSQI) and Bergen Shift Work Sleep Questionnaire (BSWSQ) were used to assess sleep quality, while the Chinese version of Ascertain Dementia-8 (AD-8) was used to evaluate cognitive function. A PSQI score ≤7 is classified as good sleep quality, and a score >7 indicates poor sleep quality. An AD-8 score≥ 2 is considered indicative of memory impairment. Multivariate logistic regression analysis was conducted to explore the association between sleep status and memory impairment.

Results

A total of 310 (52.6%) participants presented poor sleep quality. Among them, 52.2% of participants had day shift-related sleep problems, 45.9% had evening shift-related sleep problems, 61.9% had night shift-related sleep problems, and 15.0% reported rest-day/vacation-related sleep problems. The prevalence of poor sleep quality and each shift-related sleep problem in the memory impairment group were higher than in the normal memory group (P<0.05). Multivariate logistic regression analysis indicated that poor sleep quality (OR=2.073, 95% CI: 1.398~3.072), evening shift-related sleep problems (OR=1.707, 95% CI: 1.028~2.835), night shift-related sleep problems (OR=1.859, 95% CI:1.104~3.129), and rest-day/vacation-related sleep problems (OR=2.069, 95% CI:1.170~3.659) was significantly associated with memory impairment.

Conclusion

This study highlights the prevalence of poor sleep quality among clinical nurses and identifies poor sleep quality and shift-related sleep problems (excluding day shift) as risk factors for memory impairment. Nurse managers should prioritize sleep quality and focus on cognitive function to enhance nurses' occupational health.

How Shift Nurses' Presenteeism is Related to Insomnia and Care Left Undone: A Cross-Sectional Study Using Generalised Structural Equation Modelling

AIM

To examine the association between nurses' insomnia, presenteeism and care left undone and explore the mediating effect of presenteeism on the relationship between insomnia and care left undone among nurses in acute care hospitals, applying a dynamic model of presenteeism and absenteeism.

DESIGN

A cross-sectional design.

METHODS

A secondary data analysis was conducted using online survey data collected in January 2023. Participants were 1154 registered nurses who provided direct nursing care to patients in tertiary or general hospitals (hospitals with 300 or more beds) in South Korea. Poisson regression analysis was used to examine the association between nurses' insomnia, presenteeism and care left undone. Generalised structural equation modelling was performed to examine the mediating effect of presenteeism on the relationship between insomnia and care left undone.

RESULTS

The prevalence of insomnia was 15.3%. More than half of the participants (63.7%) reported experiencing presenteeism in the past 4 weeks. All reported at least one nursing care left undone during their last shift. Insomnia and presenteeism were positively associated with care left undone, and presenteeism mediated the relationship between insomnia and care left undone among nurses in acute care hospitals.

CONCLUSION

Nurses experienced insomnia and presenteeism, related to higher rates of care left undone. Nurses' insomnia had a direct effect on care left undone and an indirect effect through presenteeism.

IMPLICATIONS FOR THE PROFESSION

Nurse managers and administrators need to make greater efforts to reduce insomnia and presenteeism among nurses, thereby reducing care left undone and improving patient safety in acute care settings.

IMPACT

Nurse managers and administrators should consider proactive interventions to address nurses' insomnia and foster a workplace with healthy systems and culture to reduce sleep disturbance and presenteeism, which can effectively decrease care left undone.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Resting-state electroencephalography (EEG) microstates of healthy individuals following mild sleep deprivation

Mild sleep deprivation is widespread in many societies worldwide. Electroencephalography (EEG) microstate analysis provides information on spatial and temporal characteristics of resting brain network, serving as an indicator of neurophysiological activities at rest. This study seeks to investigate potential neural markers in EEG following mild sleep deprivation of a single night using EEG microstate analysis. Six-minute resting EEG was conducted on thirty healthy adults within 6 hours of waking in the morning and after at least 18 h of sleep deprivation. Translated and validated Malay language Karolinska Sleepiness Scale was used to assess the participants' degree of sleepiness. Microstate characteristics analysis was conducted on the final 24 subjects based on four standard microstate maps. Microstate C shows a significant increase in mean duration, coverage and occurrence, while microstate D has significantly higher occurrence after sleep deprivation. This study demonstrates notable changes in resting state EEG microstates following mild sleep deprivation. Present findings deepen our understanding of the brain's spatiotemporal dynamics under this condition and suggest the potential utility of neural markers in this domain as components of composite markers for sleep deprivation.

Sleep Deprivation and Fatigue among Nurses Working Consecutive Night Shifts: A Prospective Observational Study

PURPOSE

This study aimed to identify changes in sleep patterns and fatigue levels during consecutive night shifts among shift nurses and to determine the association between sleep parameters and increased fatigue levels during work.

METHODS

This prospective observational study employing ecological momentary assessments was conducted using data collected from 98 shift nurses working in Korean hospitals between June 2019 and February 2021. The sleep patterns were recorded using actigraphy. The participants reported their fatigue levels at the beginning and end of each night shift in real time via a mobile link. Linear mixed models were used for the analysis.

RESULTS

Nurses spent significantly less time in bed and had shorter sleep durations during consecutive night shifts than on off-duty days, whereas their wake times after sleep onset were much longer on off-duty days than on on-duty days. Fatigue levels were higher on the second and third night-shift days than on the first night-shift days. A shorter time spent in bed and asleep was associated with a greater increase in fatigue levels at the end of the shift than at the beginning.

CONCLUSION

Nurses experience significant sleep deprivation during consecutive night shifts compared with off-duty days, and this sleep shortage is associated with a considerable increase in fatigue levels at the end of shifts. Nurse managers and administrators must ensure sufficient intershift recovery time during consecutive night shifts to increase the time spent in bed and sleeping.

Are there effects of light exposure on daytime sleep for rotating shift nurses after night shift?: an EEG power analysis

Introduction

Night-shift workers often face various health issues stemming from circadian rhythm shift and the consequent poor sleep quality. We aimed to study nurses working night shifts, evaluate the electroencephalogram (EEG) pattern of daytime sleep, and explore possible pattern changes due to ambient light exposure (30 lux) compared to dim conditions (<5 lux) during daytime sleep.

Moethods

The study involved 31 participants who worked night shifts and 24 healthy adults who had never worked night shifts. The sleep macro and microstructures were analyzed, and electrophysiological activity was compared (1) between nighttime sleep and daytime sleep with dim light and (2) between daytime sleep with dim and 30 lux light conditions.

Results

The daytime sleep group showed lower slow or delta wave power during non-rapid eye movement (NREM) sleep than the nighttime sleep group. During daytime sleep, lower sigma wave power in N2 sleep was observed under light exposure compared to no light exposure. Moreover, during daytime sleep, lower slow wave power in N3 sleep in the last cycle was observed under light exposure compared to no light exposure.

Discussion

Our study demonstrated that night shift work and subsequent circadian misalignment strongly affect sleep quality and decrease slow and delta wave activities in NREM sleep. We also observed that light exposure during daytime sleep could additionally decrease N2 sleep spindle activity and N3 waves in the last sleep cycle.

The effect of a mindfulness intervention (MI) on sleep disturbance (SD) among nurses

Sleep disturbance (SD) makes it difficult for nurses in intensive care units (ICUs) to perform activities that require focused and continual concentration, which raises the risk of medical errors, health issues, loss of sleep, and patient care mistakes. The mindfulness intervention (MI) was created to give participants the capacity to approach their own emotions with non-judgmental awareness and to become more conscious of their thoughts and feelings, and it reduced psychological symptoms. This study examined the effect of MI on SD among nurses. A randomized control trail (RCT) was conducted and recruited 100 nurses from intensive care and medical-surgical units from three hospitals located at the northern and middle regions of Jordan. Bivariate analysis including independent T-test and multiple linear regressions were used to study the differences between the interventional group (MI) and the comparison group (watching mindfulness videos) in terms of the impact on the SD. Nurses reported significant and high levels of SD. MI significantly reduced the level of SD and improved sleep quality among nurses. MI should be integrated into nursing competences to combat the negative impacts of poor sleep quality on nurses and organizational-sensitive outcomes.

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.

The Association between Working Hours with Vigilance and Executive Function of Intensive Care Unit Nurses

Background

Vigilance and executive functions are integral to nursing practice. Prolonged working hours are associated with heightened fatigue and increased nursing errors. However, the impact of work duration on the vigilance and executive function of ICU nurses remains unexplored.

Objective

This study aims to elucidate the association between ICU nurses' working hours, vigilance, and executive function.

Design

A cross-sectional study. Setting. Intensive care medicine department of a tertiary hospital in Zhengzhou, China. Participants. A total of 51 registered nurses who participated in 12 h shifts in the ICU completed the survey.

Methods

E-prime software was employed to develop four test tasks to measure the vigilance and executive functioning of ICU nurses. The test was performed before the start of the shift and after 4, 8, and 12 h.

Results

The analysis revealed no statistically significant differences in the response time of vigilance for ICU nurses across shifts (p=0.503) or working hours (p=0.078). However, a significant difference existed in lapses across working hours (p=0.005), significantly increasing after 8 and 12 h. The analysis indicated a significant difference in Flanker effect size across different working hours (p=0.035). The analysis revealed no significant differences in the switch cost (p=0.200) or response accuracy (p=0.479) of the task switching across working hours. The response accuracy for the 2-back task differed significantly (p=0.003) across working hours.

Conclusion

Limited evidence demonstrated that vigilance and specific aspects of executive functioning (inhibitory control and working memory) of ICU nurses were negatively correlated with the duration of their work in a real clinical setting. Furthermore, no vigilance and executive function differences were identified between day and night shifts. Implications for Nursing Management. Nursing administrators should reconsider scheduling 12 h shifts, shortening shifts, or implementing short rest periods to reduce fatigue and cognitive load. In addition, flexible scheduling and rationalizing the order of work may help reduce the possible risks associated with prolonged work.

Workers' whole day workload and next day cognitive performance

Workload experienced over the whole day, not just work periods, may impact worker cognitive performance. We hypothesized that experiencing greater than typical whole day workload would be associated with lower visual processing speed and lower sustained attention ability, on the next day. To test this, we used dynamic structural equation modeling to analyze data from 56 workers with type 1 diabetes. For a two-week period, on smartphones they answered questions about whole day workload at the end of each day, and completed cognitive tests 5 or 6 times throughout each day. Repeated smartphone cognitive tests were used, instead of traditional one- time cognitive assessment in the laboratory, to increase the ecological validity of the cognitive tests. Examples of reported occupations in our sample included housekeeper, teacher, physician, and cashier. On workdays, the mean number of work hours reported was 6.58 (SD 3.5). At the within-person level, greater whole day workload predicted decreased mean processing speed the next day (standardized estimate=-0.10, 95% CI -0.18 to -0.01) using a random intercept model; the relationship was not significant and only demonstrated a tendency toward the expected effect (standardized estimate= -0.07, 95% CI -0.15 to 0.01) in a model with a random intercept and a random regression slope. Whole day workload was not found to be associated with next-day mean sustained attention ability. Study results suggested that just one day of greater than average workload could impact next day processing speed, but future studies with larger sample sizes are needed to corroborate this finding.

Electrophysiological Mechanism of Attention of Sleep Deprivation: Evidence From Event-Related Potentials (ERP) Data

INTRODUCTION

The purpose of this study is to investigate the effects of sleep deprivation on individual attentional function and related electrophysiological mechanisms.

METHODS

Twenty healthy men who were deprived of sleep for 24 h were evaluated by selective attention test, persistent attention test, and event-related potentials (ERP) experiment.

RESULTS

After 24 h of sleep deprivation, the subjects' selective attention decreased, mainly manifested as prolonged response time, decreased motion stability, increased rate of neglect error, decreased sustained attention, prolonged latency of P300 at Cz (p=0.001), and decreased amplitude (p=0.000).

CONCLUSION

After 24 h of sleep deprivation, the attentional ability decreased significantly, and behavioral and ERP indicators showed certain changes.

Overtime and alertness of rotating-shift nurses: An observational study using ecological momentary assessment

AIMS AND OBJECTIVES

This study aimed to determine the effect of overtime on alertness at work among rotating-shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts.

BACKGROUND

Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work.

DESIGN

A prospective observational study was employed. The study followed STROBE checklist for observational studies.

METHODS

Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real-time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed-effect models were employed to investigate the association between overtime and alertness.

RESULTS

A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous-day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous-day overtime hours and consecutive overtime days in all shifts.

CONCLUSIONS

The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty.

RELEVANCE TO CLINICAL PRACTICE

Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

Preventive Effects of a Single Bout of Exercise on Memory and Attention following One Night of Sleep Loss in Sports Students: Results of a Randomized Controlled Study

Sleep loss is a severe problem in night-shift workers. It causes fatigue and a decrease in awareness that may be counter-acted by exercise. This randomized controlled study of 22 university students investigated the effects of exercise to prevent loss of cognitive and physical performance following sleep deprivation. We compared a single bout of 20 min circuit training to control in an experimental setting of overnight sleep loss. Outcomes included memory, cognitive tasks, and physical parameters. The occurrence of false memories was considered the main outcome. Exercise did not exert significant effects on false memories (p = 0.456). We could detect a trend to significance (p < 0.01) assessing cognitive dimensions, i.e., selective and sustained attention, and visual scanning speed. This revealed strong effects of exercise on attention (p = 0.091; Cohen’s d = 0.76; ∆14%), cognitive performance, performance speed, and perceived sleepiness (p = 0.008; d = 0.60; ∆2.4 cm VAS). This study failed to show the effects of exercise on memory function. Still, the observed effects on attention and consciousness could be considered clinically relevant, as these results encourage further research to determine its practicability and meaningfulness among night-shift workers.

Altered dynamic brain activity and its association with memory decline after night shift-related sleep deprivation in nurses

AIMS AND OBJECTIVES

To investigate, for the first time, aberrant time-varying local brain activity in nurses following night shift-related sleep deprivation (SD) and its association with memory decline.

BACKGROUND

Prior studies have elucidated alterations in static local brain activity resulting from SD in the occupations outside medical profession.

DESIGN

A longitudinal study followed the STROBE recommendations.

METHODS

Twenty female nurses underwent resting-state functional magnetic resonance imaging and memory function assessment (by Complex Figure Test (CFT) and the California Verbal Learning Test, Second Edition (CVLT-II)) twice, once in a rested wakefulness (RW) state and another after SD. By combining the sliding-window approach and amplitude of low-frequency fluctuation (ALFF) analysis, the dynamic ALFF (dALFF) variability was calculated to reflect the characteristics of dynamic local brain activity.

RESULTS

Poor performance on the CFT and CVLT-II was observed in nurses with night shift-related SD. Reduced dALFF variability was found in a set of cognition-related brain regions (including the medial/middle/superior frontal gyrus, anterior/posterior cingulate gyrus, precuneus, angular gyrus, orbitofrontal and subgenual areas, and posterior cerebellum lobe), while increased dALFF variability was observed in the somatosensory-related, visual and auditory regions. SD-related dALFF variability alterations correlated with changes in subjects' performance on the CFT and CVLT-II.

CONCLUSIONS

Night shift-related SD disturbed dynamic brain activity in high cognitive regions and induced compensatory reactions in primary perceptual cortex. Identifying dALFF variability abnormalities may broaden our understanding of neural substrates underlying SD-related cognitive alterations, especially memory dysfunction.

RELEVANCE TO CLINICAL PRACTICE

Night shift-related SD is as an important occupational hazard affecting brain function in nurses. The effective countermeasure addressing the adverse outcomes of SD should be advocated for nurses.

PATIENT OR PUBLIC CONTRIBUTION

Patients or public were not involved in the design and implementation of the study or the analysis and interpretation of the data.

Effect of shift work on fatigue, reaction time and accuracy of nurses in the department of neurology: A cross-sectional observational study

AIMS

The purpose of our study was mainly to explore the effect of different shift work on cognitive and executive performance in a real clinical environment among nurses from China.

BACKGROUND

Working in shifts can disrupt circadian rhythm, resulting in reduced sleep duration, which can have a detrimental effect on cognitive function. To provide continuous service for patient care, shift work is often a special requirement for nurses. The Stroop test can be used to measure selective attention and reaction time during executive function. However, there have been limited studies about the effect of shift work on the cognitive performance of nurses by Stroop tests. Additionally, no study has been conducted in nurses working in shifts from China.

METHODS

Registered nurses in general ward, Department of Neurology, from West China Hospital of Sichuan University, were eligible and consecutively included if they were simultaneously responsible for the day, evening and night shifts on the shift work schedule. A fatigue questionnaire and Stroop tests were performed for each subject separately before and after three working shifts (morning, evening and night shift) to measure changes in fatigue, reaction time and accuracy.

RESULTS

Eighteen registered nurses (4 males and 14 females) were included in our study, with a median age of 25 years old. The fatigue degree was significantly increased after day and evening shifts (p=0.015 and <0.001, respectively). Compared with those in the preshifts, the reaction time in the neutral task and incongruent task was significantly quicker after the day shift (p=0.001, p<0.001) and night shift (p=0.008, 0.019). In contrast, the reaction time after the evening shift was mildly increased, although without significance. There was no significant difference in accuracy among the three different working shifts. In addition, there was a negative correlation between the fatigue score and reaction time on the incongruent task in the Stroop test before the day shift (r=-0.542, p=0.020). The fatigue score in the postday shift was found to be inversely related to working hours in the daytime (r=-0.500, p=0.034).

CONCLUSIONS

Our study showed that increased fatigue was found in nurses after day and evening shifts, and shift work can affect the reaction time after the evening shift. However, there was no significant difference in accuracy and a high level of attention could be maintained among the three working shifts, suggesting a highly developed sense of responsibility in our nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

In addition to focusing on the common adverse effects of evening or night shifts on nurses, fatigue in the day shift should be paid special attention to by the leadership in the nursing management. Also, nurse managers can implement specific strategies to reduce fatigue after the day shift by shortening the working hours in the daytime appropriately, setting rest periods in the day shift or dividing nurses into morning and afternoon shifts.

Effect of Shift Work on Cognitive Function in Chinese Coal Mine Workers: A Resting-State fNIRS Study

Aim: Pilot study to examine the impact of shift work on cognitive function in Chinese coal mine workers. Background: Shift work is commonly used in modern industries such as the coal industry, and there is growing concern over the impact that shift work has on miners’ work performance and personal well-being. Method: A total of 54 miners working three shifts (17 in morning shift, 18 in afternoon, and 19 in night shift) participated in this exploratory study. A resting-state fNIRS functional connectivity method was conducted to assess the cognitive ability before and after the work shift. Results: Results showed significant differences in cognitive ability between before and after the work shifts among the three-shift workers. The brain functional connectivity was reduced ranking as the night, afternoon, and morning shifts. Decreased brain functional connectivity at the end of the working shift was found compared with before in the morning and afternoon shifts. Opposite results were obtained during the night shift. The resting-state functional brain networks in the prefrontal cortex of all groups exhibited small-world properties. Significant differences in betweenness centrality and nodal local efficiency were found in the prefrontal cortex in the morning and night shifts. Conclusions: The current findings provide new insights regarding the effect of shift work on the cognitive ability of Chinese coal mine workers from the view of brain science.

Effect of sleep on alertness at work among fixed night shift nurses: A prospective observational study

AIMS

To identify patterns of declining alertness at work among fixed night shift nurses using an objective measure and to determine the effect of sleep parameters on the decline in alertness at work.

DESIGN

A prospective observational study.

METHODS

Data were collected from 65 fixed night shift nurses who provided direct nursing care for patients in Korean hospitals between September 2020 and March 2021. Participants wore an actigraph for 14 days on their non-dominant hand to measure sleep parameters and predict their hourly alertness scores. They completed an online survey to provide their demographic information. Mixed-effect models were employed to determine the association between sleep parameters and the decline in alertness.

RESULTS

The alertness scores of fixed night shift nurses constantly dropped every working hour. Scores dropped below 20% after 4 h from the beginning of the shift and below 30% after 6 h. Increased minutes in bed, minutes asleep and sleep efficiency reduced the risk of decreased alertness scores below 70. Increased sleep latency was associated with an increased risk of alertness scores dropping below 70.

CONCLUSION

The alertness of fixed night shift nurses drops steeply during regular hours and remains low during overtime. Sleep parameters contribute to the decline in alertness at work among fixed night shift nurses.

IMPACT

This study identified patterns of decline in alertness among fixed night shift nurses and the contributing factors for this decline, using an objective measure. The findings have important implications for the development of future interventions to improve the sleep hygiene of fixed night shift nurses to enhance their alertness at work.

Workplace Cognitive Failure among Nurses during the COVID-19 Pandemic

Numerous studies provide evidence of the physical and emotional strain experienced by nurses during the COVID-19 pandemic. However, little is known regarding the impact of this occupational strain on nurses’ cognitive function at work. The aim of this study was to identify factors associated with workplace cognitive failure in a sample of U.S. nurses during the COVID-19 pandemic. An online questionnaire was administered in May 2020 to Michigan nurses statewide via three nursing organizations (n = 695 respondents). Path analysis was conducted to test the parallel effects of frequency of contact with COVID patients and personal protective equipment (PPE) supply on workplace cognitive failure scores. Mediation effects of stress, sleep quality, secondary trauma, and work-related exhaustion were examined for each exposure. Results revealed significant indirect effects of all mediators except sleep quality of contact with COVID patients (cumulative indirect effect = 1.30, z = 6.33, p < 0.001) and PPE (cumulative indirect effect = −2.10, z = −5.22, p < 0.001) on cognitive failure. However, 58% of the PPE effect was direct. To reduce the risk of cognitive failure, healthcare organizations need to provide nurses with protective equipment and work environments that allow nurses to strengthen their resilience to extreme working conditions.

Evaluation of sleep quality among nursing faculty: Application of the Pittsburgh Sleep Quality Index-A descriptive correlational study

AIM

The aim of this study was to describe the overall sleep quality, sleep patterns and severity of sleep difficulties among nursing faculty using the Pittsburgh Sleep Quality Index (PSQI).

DESIGN

Cross-sectional descriptive and correlational study.

METHODS

A survey of faculty recruited from Texas Board of Nursing approved colleges/schools was used. A purposive, convenience sample of 105 faculty completed the PSQI, a reliable and valid instrument, in an online setting. Data was collected from January 2019 through April 2019.

RESULTS

Nursing faculty reported sleep difficulty across all components, with more problems in sleep latency, sleep disturbances and subjective sleep quality. Overall, 70.5% of participants were reportedly "poor" sleepers, a salient finding. Faculty experienced poor sleep quality across all academic ranks and age groups. Sleep latency and subjective sleep quality were components that presented higher in severity for the youngest faculty.

Impact of Shift Work and Long Working Hours on Worker Cognitive Functions: Current Evidence and Future Research Needs

Particular working conditions and/or organization of working time may cause important sleep disturbances that have been proposed to be predictive of cognitive decline. In this regard, circadian rhythm misalignment induced by exposure to night work or long working hours would be responsible for cognitive impairment. Nevertheless, evidence supporting this correlation is limited and several issues still need to be elucidated. In this regard, we conducted a systematic review to evaluate the association between shift/night work and cognitive impairment and address its main determinants. Information provided by the reviewed studies suggested that night work might have serious immediate negative effects especially on cognitive domains related to attention, memory and response inhibition. Furthermore, cognitive performance would progressively worsen over consecutive night shifts or following exposure to very long work shifts. Otherwise, conflicting results emerged regarding the possible etiological role that night work chronic exposure would have on cognitive impairment. Therefore, circadian rhythm desynchronization, lack of sleep and fatigue resulting from night work may negatively impact worker’s cognitive efficiency. However, in light of the considerable methodological variability of the reviewed studies, we proposed to develop a standardized research and evaluation strategy in order to obtain a better and comprehensive understanding of this topic.

Sleep-Related Problems in Night Shift Nurses: Towards an Individualized Interventional Practice

Rotating shifts (mostly 8- or 12-h) are common among nurses to ensure continuity of care. This scheduling system encompasses several adverse health and performance consequences. One of the most injurious effects of night-time shift work is the deterioration of sleep patterns due to both circadian rhythm disruption and increased sleep homeostatic pressure. Sleep problems lead to secondary effects on other aspects of wellbeing and cognitive functioning, increasing the risk of errors and workplace accidents. A wide range of interventions has been proposed to improve the sleep quality of nurses and promote an increase in attention levels. In recent years, particular attention has been paid to individual and environmental factors mediating the subjective ability to cope with sleep deprivation during the night shift. Given the predictive role of these factors on the negative impact of a night shift, an individualized intervention could represent an effective countermeasure by ensuring suitable management of shift schedules. Therefore, the aims of this mini-review are to: (a) provide an updated overview of the literature on sleep problems in night shift nurses and their adverse consequences; and (b) critically analyze the psychosocial factors that mediate the negative impact of shift work with the ultimate goal of defining an effective countermeasure based on an individualized approach.

The association between nurses' moral distress and sleep quality and their influencing factor in private and public hospitals in Iran

BACKGROUND

Nurses in their workplace, for a variety of reasons, always face moral distress that is an underlying issue in the nursing profession, which can lead to problems such as reduced quality and quantity of care and sleep disorder. Besides, given the increased privatization of hospitals, this study aimed to explore the association between nurses' moral distress and sleep quality and its comparison among nurses in private and public hospitals.

MATERIALS AND METHODS

This was a descriptive-analytical study involving 150 nurses working in Ilam Province hospitals. Sampling conducted using a multistage random sampling method. Data were collected through the questionnaire of sociodemographic characteristics, the Corley's Moral Distress Scale, and the Pittsburgh Sleep Quality Index. Data were analyzed using SPSS software version 22. Descriptive statistics such as frequency, mean, ANOVA, independent t-test, multiple linear regression, and Pearson correlation coefficient at the significant level of P < 0.05 were calculated.

RESULTS

The analysis revealed that moral distress was positively associated with sleep quality. Furthermore, the scores of nurses' moral distress and sleep quality were different in private and public hospitals, so that the level of moral distress in the public hospital and sleep quality in the private hospital was higher and lower, respectively, but the difference was not statistically significant. Moreover, sleep quality, and the type of employment was the most important predicting variables of moral stress (B = 1.86) and sleep quality (B = 2.39), respectively.

CONCLUSION

According to the study results, a positive and significant association was found between moral distress and nurses' sleep quality. It is recommended that appropriate strategies and training program be formulated by the health-care system to increase nurses' ability to combat moral distress adverse effects.

Poor Sleep Hygiene is Associated with Decreased Discrimination and Inattention on Continuous Performance Task in Doctor of Physical Therapy Students: A Cross-sectional Study

Introduction

Reduced sleep quality impairs learning, memory formation, attention, and executive function ability. Poor sleep quality or sleep hygiene has been shown to impair academic performance of undergraduate and medical students. The purpose of this study was to examine the association between sleep quality, sleep hygiene, and cognitive performance in Doctor of Physical Therapy (DPT) students.

Methods

Fifty DPT students at the University of Kansas Medical Center completed the Pittsburgh Sleep Quality Index (PSQI) and the Sleep Hygiene Index (SHI). Cognitive performance was assessed using the Continuous Performance Test (CPT) which is a test of sustained attention and the Trail-Making Task (TMT) to assess executive functioning. An actigraph was worn for one week to objectively characterize sleep outcomes. Spearman's correlations were performed to assess the association between self-report sleep quality, sleep hygiene, and outcomes on the cognitive tasks. Post-hoc Mann-Whitney and Kruskal-Wallis tests were conducted to examine group differences between sleep outcomes and cognitive performance for demographic variable categories.

Results

Twenty-three students (46%) reported poor sleep quality, and 27 participants (54%) had objectively-reported poor sleep quality. There was a significant positive correlation between SHI and Detectability (r_s= 0.297, p= 0.036) and Omissions (r_s=.343, p=0.015). There were group differences between sex and number of pets on the CPT outcomes, and there was a significant group difference between the number of drinks/week categories on the SHI.

Discussion and Conclusions

About half of the participants were identified as having poor sleep quality. Poorer sleep hygiene was associated with poorer discrimination and inattention, which could potentially impact the students' academic and clinical performance as well as their health and wellbeing. Also, certain demographic variables may modulate the results.

Predicting motor skill learning in older adults using visuospatial performance

Between-group comparisons of older and younger adults suggest that motor learning decreases with advancing age. However, such comparisons do not necessarily account for group differences in cognitive function, despite the co-occurrence of aging and cognitive decline. As such, cognitive differences may explain the observed age effects on motor learning. Recent work has shown that the extent to which a motor task is learned is related to visuospatial function in adults over age 65. The current study tested whether this relationship is replicable across a wider age range and with a brief, widely available cognitive test. Thirty-three adults (aged 39-89 years old) completed the Montreal Cognitive Assessment (MoCA) prior to practicing a functional upper extremity motor task; performance on the motor task was assessed 24 hours later to quantify learning. Backward elimination stepwise linear regression identified which cognitive domains significantly predicted retention. Consistent with previous findings, only the Visuospatial/Executive subtest score predicted change in performance 24 hours later, even when accounting for participant age. Thus, the age-related declines in motor learning that have been reported previously may be explained in part by deficits in visuospatial function that can occur with advancing age.

Interaction Between Circadian Rhythms, Energy Metabolism, and Cognitive Function

The interaction between meal timing and light regulates circadian rhythms in mammals and not only determines the sleep-wake pattern but also the activity of the endocrine system. Related with that, the necessity to fulfill energy needs is a driving force that requires the participation of cognitive skills whose performance has been shown to undergo circadian variations. These facts have led to the concept that cognition and feeding behaviour can be analysed from a chronobiological perspective. In this context, research carried out during the last two decades has evidenced the link between feeding behaviour/nutritional habits and cognitive processes, and has highlighted the impact of circadian disorders on cognitive decline. All that has allowed hypothesizing a tight relationship between nutritional factors, chronobiology, and cognition. In this connection, experimental diets containing elevated amounts of fat and sugar (high-fat diets; HFDs) have been shown to alter in rodents the circadian distribution of meals, and to have a negative impact on cognition and motivational aspects of behaviour that disappear when animals are forced to adhere to a standard temporal eating pattern. In this review, we will present relevant studies focussing on the effect of HFDs on cognitive aspects of behaviour, paying particular attention to the influence that chronobiological alterations caused by these diets may have on hippocampaldependent cognition.

Hydrogen Sulfide Prevents Sleep Deprivation-Induced Hippocampal Damage by Upregulation of Sirt1 in the Hippocampus

Sleep deprivation (SD) induces hippocampal damage. Hydrogen sulfide (H₂S) is a neuronal protective factor. Silence information regulating factor 1 (Sirt1) plays an important role in neuroprotection. Therefore, this study was aimed at exploring whether H₂S meliorates SD-induced hippocampal damage and whether Sirt1 mediates this protective role of H₂S. We found that sodium hydrosulfide (NaHS, a donor of H₂S) alleviated SD-generated hippocampal oxidative stress, including increases in the activation of SOD and the level of GSH as well as a decrease in the level of MDA. Meanwhile, we found that NaHS reduced SD-exerted hippocampal endoplasmic reticulum (ER) Stress, including downregulations of GRP78, CHOP, and cleaved-caspase-12 expression. Moreover, NaHS reduced the apoptosis in the SD-exposed hippocampus, and this included decreases in the number of apoptotic cells and the activation of caspase-3, downregulation of Bax expression, and upregulation of Bcl-2 expression. NaHS upregulated the expression of Sirt1 in the hippocampus of SD-exposed rats. Furthermore, Sirtinol, the inhibitor of Sirt1, abrogated the protection of NaHS against SD-exerted hippocampal oxidative stress, ER stress, and apoptosis. These results suggested that H₂S alleviates SD-induced hippocampal damage by upregulation of hippocampal Sirt1.

Shimian granules improve sleep, mood and performance of shift nurses in association changes in melatonin and cytokine biomarkers: a randomized, double-blind, placebo-controlled pilot study

Shift nurses are prone to sleep problems and impaired nighttime alertness, with risk for reduced health status plus decreased performance, handling errors, and workplace accidents. Attention to and improvements in the situation of shift nurses are urgent. Shimian granules (SMG), an improved formula of Jieyuanshen with liver qingre and yangxin tranquilizing effects, for more than a decade has been used in China as a herbal treatment of sleep disorders in clinical practice. However, clinical data on SMG have rarely been reported. This double-blinded, randomized, placebo-controlled, pilot clinical trial (ChiCTR-IOR-17013031) aimed to explore whether Shimian granules (SMG) improves sleep and affective state in shift nurses and in association with changes in concentrations of salivary cytokines. Fifty-three rotating-shift female nurses with a Pittsburgh Sleep Quality Index (PSQI) score ≥8 were orally treated with 10.0 g SMG or placebo 2 times daily (30 min after breakfast and 30 min before bed) for 1 month. The Insomnia Severity Index (ISI), a psychomotor vigilance task, Hospital Anxiety and Depression Scale (HADS-A/HADS-D), and levels of four salivary cytokines were evaluated by single time-of-day sampling at baseline and after 1 month of treatment. Significantly lower ISI, HADS, HADS-A, and HADS-D scores, but higher 1/mean reaction time (1/mRT) score, were found in shift nurses treated with SMG than in those who received placebo, and these effects were associated with changes in salivary melatonin, TNF, IL-1β, and IL-6 levels. These latter findings suggest melatonin, TNF, and IL-6 levels may be suitable biomarkers of ISI score in shift nurses, whereas TNF level may be a suitable biomarker of 1/mRT score and IL-6 level a suitable biomarker of HADS score in response to SMG treatment. The results of this pilot study suggest SMG can effectively improve sleep, alertness, plus anxiety and depression symptoms in shift nurses in association with changes in salivary cytokine levels. The results of this study provide an experimental basis for the evaluation of traditional Chinese medicines for the treatment of insomnia and underlying mechanisms of their actions that require detailed future exploration.

Circadian Rhythms: Will It Revolutionise the Management of Diseases?

The Nobel Prize for Medicine in 2017 was awarded to Michael Young, Michael Rosbash and Jeffrey Hall for their discoveries into the molecular mechanisms controlling circadian rhythms (CR). The aims of this paper were to present the mechanisms behind the CRs and discuss the impact this could have on human health. We argued that further research in this field has the potential to revolutionise healthcare through understanding the influence on the pathogenesis of disease, including in cardiovascular, mental and neurological health, as well as influence on cognitive function. The research has shown that intrinsic CRs have physiological and biochemical influences on the body, which may affect the efficiency of drug absorption due to the altered activity of enzymes. There is strong data to suggest CR disturbances, due to either shift work, sleep disorders or frequent travel between time zones, has negative impact on health. This article aims to summarise the extent of this impact and analyse CRs as a potential therapeutic target, as well as describing the pathophysiology and mechanisms driving the course of disease among people with CR disorders. These new discoveries may revolutionise the way in which treatment is provided in the future with more focus on lifestyle changes to provide treatment and more optimal precision medicine. Pharmaceutical companies and healthcare staff must consider the significant message provided from this data and use the information to optimise drug delivery and treatment provision. The facts of CRs role in healthcare can no longer be ignored.

Psychological Impact of Shift Work

PURPOSE OF REVIEW

Technology and globalization have been central forces driving the need for shift work. This review examines recent scientific developments that inform our understanding of how psychological process contribute to and are impacted by shift work.

RECENT FINDINGS

Nascent research is beginning to expand beyond circadian misalignment to elucidate the phenomenology of shift work and the associated psychological impairments. Psychological processes and their interaction with biology are considered in the pathophysiology of shift work sleep disorder. Additionally, a review of the adverse consequences of shift work in the cognitive, emotional, and psychosocial domains are reviewed and discussed.

SUMMARY

The phenomenology of shift work encompasses multiple domains of biopsychosocial functioning. As such, interventions to reduce the adverse impact of shift work may benefit from an integrated approach.