Sleepy nurses: are we willing to accept the challenge today?

Mental Illnesses and Quality of Sleep Among Nurses Working at a Tertiary Hospital in Riyadh During the COVID-19 Pandemic

Objectives This study primarily aimed to estimate the prevalence of mental illnesses (depression, anxiety, and stress) along with the poor quality of sleep, with a secondary focus on determining whether there was an association between mental health and quality of sleep among nurses working at King Khalid University Hospital, Riyadh, Saudi Arabia, during the COVID-19 pandemic. Methods A cross-sectional study was conducted from June to December 2021 during the COVID-19 pandemic on 309 nurses from different departments at King Khalid University Hospital. Depression, anxiety, and stress were measured by the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21), and sleep quality was measured by the Pittsburg Sleep Quality Index (PSQI) via an online survey. Results The prevalence of depression, anxiety, and stress was 30.4%, 43.7%, and 16.5%, respectively, while 61.5% showed poor sleep quality. The association between poor quality of sleep and the other outcome variables of mental health (depression, anxiety, and stress) was highly significant (p<0.0001). Conclusion Nurses have reported an increased prevalence of depression, anxiety, stress, and poor quality of sleep during the COVID-19 pandemic, making them particularly vulnerable to mental illnesses and sleep difficulties in the event of future pandemics. There is a clear link between mental health issues and poor quality of sleep, necessitating the provision of psychological support for nurses. Enhancing sleep quality is recommended as a way to decrease the prevalence of mental health concerns.

Sleep Quality among Nurses during the First Year of Coronavirus Disease 2019

BACKGROUND: Nurses represent the largest section of the health-care workforce, and lack of sleep has an adverse influence on them, particularly during pandemics such as coronavirus disease 2019 (COVID-19). It causes not only health problem but also poor work results and an increased risk of medical errors. AIM: The goal of the study was to determine the prevalence of poor sleep quality among nurses during COVID-19 outbreaks. MATERIALS AND METHODS: A cross-sectional analysis was conducted among a group of nurses in the Al-Madinah region of Saudi Arabia at the National Guard Health Affairs in 2020 (1st year of the COVID-19 crisis). Data were collected using a validated questionnaire with two sections: Sociodemographic data such as age, nationality, family status, gender, and the Pittsburgh Sleep Quality Index. RESULTS: There were 238 nurses in the report. 37.8% of them were found to be between the ages of 31 and 35, while 24.4% were under the age of 30. The nurses were mostly female (84%). Sleep latency, sleep disruption, overall subjective sleep quality, and sleep length were the most widely identified sleep problems. Sixty-six percent of the nurses said they had a poor night’s sleep. None of the demographic variables analyzed had a significant relationship with overall sleep quality. CONCLUSION: Majority of nurses working at the National Guard Health Affairs and primary health-care centers in Al-Medina, Saudi Arabia, experience poor sleep quality, during the 1st year of COVID-19 crisis regardless of their demographic characteristics.

International Nursing: A Study of Sleep Quality Among Nurses and Its Correlation With Cognitive Factors

The objective of this study was to evaluate sleep quality and its relationship to cognitive factors among nurses. Sleep quality among nurses is an important issue, which requires more extensive study. Its correlation with cognitive ability has not been sufficiently considered. Five hundred forty nurses (66.3% female) working in 6 hospitals were selected as the sample of the study. Results show that nurses do not experience good quality of sleep. That is, 77.4% of the sample population of nurses have a poor quality of sleep, and nurses working the night shift have more sleep problems than other nurses. The results show that there is a relationship between dysfunctional beliefs and attitudes about sleep and metacognitive process and the quality of sleep, and that these variables can predict sleep quality. Based on the results of the study, it can be said that cognitive and metacognitive processes play an important role in sleep quality. Lack of sufficient sleep can create numerous problems for nurses and patients. Attention to the role of cognitive and metacognitive processes can help improve the sleep quality of nurses.

How safe staffing can improve emergency nursing: time to cut the Gordian knot

The phrase 'cut the Gordian knot' describes a bold and direct solution to a complicated problem. Nursing presence has been defined as nurses' ability to pay attention to patients and make them feel that their needs have been considered. In the emergency department (ED), nursing presence can be adversely affected by factors such as fatigue, workplace bullying, moral distress and inadequate staffing levels, which could lead to suboptimal patient outcomes and compromise the goals of nursing. Nursing presence is also important for nurses' job satisfaction and therefore for staff retention. This article explores the combined effects of fatigue, workplace bullying, moral distress and inadequate staffing levels on emergency nurses. To cut the Gordian knot it also provides recommendations for mitigating these issues in EDs through safe staffing decisions that consider patient acuity and skill mix.

Emotional Effects of the Duration, Efficiency, and Subjective Quality of Sleep in Healthcare Personnel

Considering that both sleep quality and duration are linked to psychological variables, this study analyzed the relationships between sleep components and emotional intelligence and the effects that sleep duration has on stress management and mood in a sample of nurses. The sample was made up of 1073 professionals. Data were collected by the Pittsburgh Sleep Quality Index and the Brief Emotional Intelligence Inventory for Senior Citizens. The results showed that the components of sleep quality were negatively related to stress management and mood. Furthermore, nurses who had short sleep patterns also had low moods and high stress levels. This study emphasizes the importance of subjective sleep quality as a necessary resource for professionals to manage stressful situations and mood and improve their relations with their patients and with each other.

Influencing Factors for Sleep Quality Among Shift-working Nurses: A Cross-Sectional Study in China Using 3-factor Pittsburgh Sleep Quality Index

PURPOSE

The aim of this study was to identify influencing factors for sleep quality among shift-working nurses based on a three-factor scoring model that included sleep efficacy, sleep quality and daily dysfunction.

METHODS

A cross-sectional survey of 513 nurses in a hospital in Shanghai, China, was conducted using a self-reported questionnaire. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed based on the three-factor PSQI model: Factor 1, sleep efficacy; Factor 2, sleep quality; Factor 3, daily disturbances.

RESULTS

After adjusting for age, marital status, and having children, multivariate logistic regression analysis showed that participants who had previous shift work experience which was at least 6 months ago, or were currently performing shift work were significantly more likely to have poor sleep quality (PSQI > 5) than those who had never done shift work (adjusted odds ratios of 3.943 and 3.975, respectively, both p < .001). Mean scores of the three individual factors increased significantly among nurses currently performing shift work compared with those who had never done shift work (Factor 1, β = 0.61, p < .001; Factor 2, β = 1.86, p < .001; Factor 3, β = 0.45, p = .002). Mean scores of Factor 2 and Factor 3 increased significantly among nurses with previous shift work experience compared with those who had never done shift work (Factor 2, β = 1.15, p = .003; Factor 3, β = 0.52, p = .005).

CONCLUSIONS

Performing current shift work and performing shift work previously were significantly associated with poor sleep quality. An appropriate arrangement and intervention strategies are needed in Chinese hospitals in order to improve sleep quality among shift-working nurses.

The Prevalence of Insomnia, Its Demographic Correlates, and Treatment in Nurses Working in Chinese Psychiatric and General Hospitals

PURPOSE

To determine the prevalence of insomnia and its socio-demographic correlates in Chinese nurses.

DESIGN AND METHODS

Up to 799 nurses were examined. Demographic data, total sleep time (TST), and insomnia were collected.

FINDINGS

The mean expected and actual TST were 8.3 ± 1.5 and 6.1 ± 1.1 hr, respectively. The prevalence of at least one type of reported sleep disturbance was 69.7%; the rates of difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were 54.6%, 54.7%, and 55.9%, respectively.

PRACTICE IMPLICATIONS

There is a large discrepancy of actual and expected sleep duration, and insomnia is common among nurses in China.

Certified Nursing Assistants Balancing Family Caregiving Roles: Health Care Utilization Among Double- and Triple-Duty Caregivers

PURPOSE OF THE STUDY

This study examines how certified nursing assistants (CNAs) balancing family caregiving roles-child care (double-duty child caregivers), elder care (double-duty elder caregivers), and both child and elder care (triple-duty caregivers)-utilize health care services relative to nonfamily caregiving counterparts (formal-only caregivers).

DESIGN AND METHODS

A sample of 884 CNAs from the Work, Family and Health Study was drawn on to assess the number of acute care (i.e., emergency room or urgent care facility) and other health care (i.e., outpatient treatment or counseling) visits made during the past 6 months.

RESULTS

Double-duty elder and triple-duty caregivers had higher acute care utilization rates than formal-only caregivers. CNAs with and without family caregiving roles had similar rates of other health care visits.

IMPLICATIONS

CNAs providing informal care for older adults have higher acute care visit rates. Given the increasing need for family caregivers and the vital importance of the health of the nursing workforce for the health of others, future research on how double- and triple-duty caregivers maintain their health amidst constant caregiving should be a priority.

Effect of diabetes mellitus on sleep quality

Diabetes mellitus (DM) is a highly prevalent condition affecting about 347 million people worldwide. In addition to its numerous clinical implications, DM also exerts a negative effect on patient’s sleep quality. Impaired sleep quality disrupts the adequate glycemic control regarded as corner stone in DM management and also lead to many deleterious effects causing a profound impact on health related quality of life. This article outlines various factors leading to impaired sleep quality among diabetics and delineates how individual factor influences sleep. The article also discusses potential interventions and lifestyle changes to promote healthy sleep among diabetics.

Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety

Background:

Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs.

Objectives:

To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone.

Methods:

Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries.

Results:

A total of 50% of nurses worked shifts of ≤8 hours, but 15% worked ≥12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13–1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10–1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09–1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51–1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23–1.42), and more care left undone (RR=1.29; 95% CI, 1.27–1.31).

Conclusions:

European registered nurses working shifts of ≥12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.

Evaluation of user interface and workflow design of a bedside nursing clinical decision support system

Background

Clinical decision support systems (CDSS) are important tools to improve health care outcomes and reduce preventable medical adverse events. However, the effectiveness and success of CDSS depend on their implementation context and usability in complex health care settings. As a result, usability design and validation, especially in real world clinical settings, are crucial aspects of successful CDSS implementations.

Objective

Our objective was to develop a novel CDSS to help frontline nurses better manage critical symptom changes in hospitalized patients, hence reducing preventable failure to rescue cases. A robust user interface and implementation strategy that fit into existing workflows was key for the success of the CDSS.

Methods

Guided by a formal usability evaluation framework, UFuRT (user, function, representation, and task analysis), we developed a high-level specification of the product that captures key usability requirements and is flexible to implement. We interviewed users of the proposed CDSS to identify requirements, listed functions, and operations the system must perform. We then designed visual and workflow representations of the product to perform the operations. The user interface and workflow design were evaluated via heuristic and end user performance evaluation. The heuristic evaluation was done after the first prototype, and its results were incorporated into the product before the end user evaluation was conducted. First, we recruited 4 evaluators with strong domain expertise to study the initial prototype. Heuristic violations were coded and rated for severity. Second, after development of the system, we assembled a panel of nurses, consisting of 3 licensed vocational nurses and 7 registered nurses, to evaluate the user interface and workflow via simulated use cases. We recorded whether each session was successfully completed and its completion time. Each nurse was asked to use the National Aeronautics and Space Administration (NASA) Task Load Index to self-evaluate the amount of cognitive and physical burden associated with using the device.

Results

A total of 83 heuristic violations were identified in the studies. The distribution of the heuristic violations and their average severity are reported. The nurse evaluators successfully completed all 30 sessions of the performance evaluations. All nurses were able to use the device after a single training session. On average, the nurses took 111 seconds (SD 30 seconds) to complete the simulated task. The NASA Task Load Index results indicated that the work overhead on the nurses was low. In fact, most of the burden measures were consistent with zero. The only potentially significant burden was temporal demand, which was consistent with the primary use case of the tool.

Conclusions

The evaluation has shown that our design was functional and met the requirements demanded by the nurses’ tight schedules and heavy workloads. The user interface embedded in the tool provided compelling utility to the nurse with minimal distraction.

The impact of shift work on nurses' job stress, sleep quality and self-perceived health status

AIM

The aim of this study was to describe the current state of nurses' shift work in Taiwan and how it affects nurses' stress, sleep quality and self-perceived health status.

BACKGROUND

To enable the provision of 24-hour patient care, nurses need to work various shifts. Long-term shift work significantly affects nurses' overall physical and mental health.

METHOD

Nurses from four Chiayi County district hospitals in Taiwan (n = 266) participated in this cross-sectional study from August to September 2010. Demographics, work schedule forms, a stress checklist, a sleep-quality measure and a health-status measure were used to collect data. Independent t-test, one-way anova, Pearson's r, and hierarchical regression were applied for analysis.

RESULTS

The results showed that regardless of the amount of shift work they performed, nurses reported moderate job stress, poor sleep quality and moderate self-perceived health. The following significant relationships were observed: job stress was inversely related to sleep quality, which was directly related to self-perceived health status.

CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT

Hospital managers need to ensure more healthy shift work scheduling in order to improve nurses' clinical performance and personal health status, thereby also improving the quality of patient care.

Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses

Nurses working 12-h shifts complain of fatigue and insufficient/poor-quality sleep. Objectively measured sleep times have not been often reported. This study describes sleep, sleepiness, fatigue, and neurobehavioral performance over three consecutive 12-h (day and night) shifts for hospital registered nurses. Sleep (actigraphy), sleepiness (Karolinska Sleepiness Scale [KSS]), and vigilance (Performance Vigilance Task [PVT]), were measured serially in 80 registered nurses (RNs). Occupational fatigue (Occupational Fatigue Exhaustion Recovery Scale [OFER]) was assessed at baseline. Sleep was short (mean 5.5 h) between shifts, with little difference between day shift (5.7 h) and night shift (5.4 h). Sleepiness scores were low overall (3 on a 1-9 scale, with higher score indicating greater sleepiness), with 45% of nurses having high level of sleepiness (score  > 7) on at least one shift. Nurses were progressively sleepier each shift, and night nurses were sleepier toward the end of the shift compared to the beginning. There was extensive caffeine use, presumably to preserve or improve alertness. Fatigue was high in one-third of nurses, with intershift fatigue (not feeling recovered from previous shift at the start of the next shift) being most prominent. There were no statistically significant differences in mean reaction time between day/night shift, consecutive work shift, and time into shift. Lapsing was traitlike, with rare (39% of sample), moderate (53%), and frequent (8%) lapsers. Nurses accrue a considerable sleep debt while working successive 12-h shifts with accompanying fatigue and sleepiness. Certain nurses appear more vulnerable to sleep loss than others, as measured by attention lapses.

Effects of Extended Work Shifts and Shift Work on Patient Safety, Productivity, and Employee Health

It is estimated 1.3 million health care errors occur each year and of those errors 48,000 to 98,000 result in the deaths of patients (Barger et al., 2006). Errors occur for a variety of reasons, including the effects of extended work hours and shift work. The need for around-the-clock staff coverage has resulted in creative ways to maintain quality patient care, keep health care errors or adverse events to a minimum, and still meet the needs of the organization. One way organizations have attempted to alleviate staff shortages is to create extended work shifts. Instead of the standard 8-hour shift, workers are now working 10, 12, 16, or more hours to provide continuous patient care. Although literature does support these staffing patterns, it cannot be denied that shifts beyond the traditional 8 hours increase staff fatigue, health care errors, and adverse events and outcomes and decrease alertness and productivity. This article includes a review of current literature on shift work, the definition of shift work, error rates and adverse outcomes related to shift work, health effects on shift workers, shift work effects on older workers, recommended optimal shift length, positive and negative effects of shift work on the shift worker, hazards associated with driving after extended shifts, and implications for occupational health nurses.

Fatigue and charting errors: the benefit of a reduced call schedule

THE EFFECTS OF FATIGUE caused by long work hours, working on call, and insufficient rest periods are often overlooked during reviews of perioperative documentation errors. THE RELATIONSHIP BETWEEN fatigue and nurse charting errors prior to and after implementation of a reduced call schedule was examined at a not-for-profit, Magnet community hospital. A SIGNIFICANT REDUCTION in nursing documentation errors was observed after the reduced call schedule was implemented, with the greatest reduction in errors seen among nurses working 12-hour or call shifts.