Effects of Accumulating Work Shifts on Performance-Based Fatigue Using Multiple Strength Measurements in Day and Night Shift Nurses and Aides

The effect of full-time culture on quality and safety of care – a literature review

Purpose

The purpose of this study is to increase knowledge and understanding of the relationship between full-time-culture and the outcome for quality and safety of care.

Design/methodology/approach

The paper is a literature review with a qualitatively oriented thematic analysis concerning quality or safety outcomes for patients, or patients and staff when introducing a full-time culture.

Findings

Identified factors that could have a positive or negative impact on quality and patient safety when introducing full-time culture were length of shift, fatigue/burnout, autonomy/empowerment and system/structure. Working shifts over 12 h or more than 40 h a week is associated with increased adverse events and errors, lower quality patient care, less attention to safety concerns and more care left undone. Long shifts give healthcare personnel more flexibility and better quality-time off, but there is also an association between long shifts and fatigue or burnout. Having a choice and flexibility around shift patterns is a predictor of increased wellbeing and health.

Originality/value

A major challenge across healthcare services is having enough qualified personnel to handle the increasing number of patients. One of the measures to get enough qualified personnel for the expected tasks is to increase the number of full-time employees and move towards a full-time culture. It is argued that full-time culture will have a positive effect on work environment, efficiency and quality due to a better allocation of work tasks, predictable work schedule, reduced sick leave, and continuity in treatment and care. There is limited research on how the introduction of full-time culture will affect the quality and safety for patients and staff, and few studies have been focusing on the relationship between longer shift, work schedule, and quality and safety of care.

The impact of repeated bouts of shiftwork on rapid strength and reaction time in career firefighters

The purpose of this study was to examine the influence of repeated bouts of shiftwork on lower extremity maximal and rapid strength and reaction time in career firefighters. Thirty-five firefighters (3 females; 34.3 ± 9.1 years) performed a psychomotor vigilance test (PVT) and reactive maximal isometric strength assessment prior to and following a full shift rotation (three 24-hr on-off shifts). Reaction time (RT), maximal, absolute and normalised rapid strength (50, 100, 150, 200 ms), and PVT measures were assessed on-site. Separate linear regression models were used to evaluate the POST-PRE change in variables adjusted for BMI, age, sleep, and call duration. Early (50 ms) absolute rapid strength was the only variable significantly reduced (-25.9%; p = 0.031) following the full shift rotation. Our findings indicate that early rapid strength may be a sensitive measure in detecting work-related fatigue, despite minimal changes in sleep between work and non-work nights and a low call duration. Practitioner summary: We examined the impact of repeated shiftwork on changes in reaction time and neuromuscular function. Early rapid strength was a sensitive, portable lab assessment that feasibly measured work-related fatigue in career firefighters. Interventions that mitigate work-related fatigue may be impactful at preventing falls and/or risk of musculoskeletal injury.

Multicomponent exercises to prevent and reduce back pain in elderly care nurses: a randomized controlled trial

Background

Sports science is making an important contribution to health services research and supports the development of tailored interventions, e.g., in nursing settings. Working in elderly care is associated with a high prevalence of low back pain (LBP). Due to the diverse requirements and high strains, multicomponent programs are essential to address all relevant factors. This randomized controlled trial investigated the effects of a tailored ten-week ergonomics and twelve-week strength training on lifting behavior, strength endurance, LBP, functional impairment and adherence.

Methods

n = 42 nurses were randomly assigned to the intervention (IG; n = 20) or control group (CG; n = 22). They were eligible for participation if they were active in residential care and if they provided written informed consent. Other employees were excluded. The data were collected at baseline, at ten weeks (after ergonomics training), at 22 weeks (after strength training), and at 34 weeks (follow-up). The analysis combined physical tests with questionnaires (Progressive Isoinertial Lifting Evaluation, PILE-Test; Biering-Sørensen-Test; Visual Analog Scale Pain, VAS; Oswestry Disability Index, ODI; self-developed questionnaire for adherence). Group differences were analyzed by Chi²-Tests, ANOVA, and Linear Mixed Models.

Results

The IG showed an improved lifting performance (PILE-Test; 95% CI 1.378–7.810, p = .006) and a reduced LBP compared to the CG (VAS; 95% CI − 1.987 to 0.034, p = .043) after ergonomics training (PILE-Test, F_(1,34) = 21.070, p < .001; VAS, F_(1,34) = 5.021, p = .032). The results showed no differences concerning the Biering-Sørensen-Test and the ODI. Positive adherence rates were observed.

Conclusions

This approach and the positive results are essential to derive specific recommendations for effective prevention. The study results can be completed in future research with additional strategies to reduce nurses’ burden further.

Trial registration

The trial was registered at DRKS.de (DRKS00015249, registration date: 05/09/2018).

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.

The Influence of Doing Shift Work on the Lifestyle Habits of Primary Care Nurses

Nurses’ lifestyle habits play a key role in promoting healthy lifestyles; although, they may not always be entirely healthy and can be influenced by working conditions. This paper aims to analyze the influence of doing shift work on nurses’ lifestyle habits. Participants (n = 219) were recruited from 27 primary health care centres in Spain. Data were collected on socio-demographic characteristics, working conditions and lifestyle behaviour, assessed by use of an adhoc questionnaire including validated measures. Descriptive analysis and logistic regression models were performed. A total of 95% of the nurses reported having an adequate diet; 45.2% did not engage in any type of physical activity; and 85.8% did not smoke, especially women. A total of 60.3% did shift work, especially the younger ones (80.8%; p < 0.001), these nurses being the ones with the worst food habits (81.8%). In contrast, nurses who did shift work, exercised more days a week (69.5%; p < 0.001). The dietary habits of the nurses were adequate. Low tobacco consumption and low adherence to physical activity were observed, especially among women. Shift work harmed eating habits and obesity rates, but was a protective factor in terms of adherence to physical exercise.

A Novel Physical Fatigue Assessment Method Utilizing Heart Rate Variability and Pulse Arrival Time towards Personalized Feedback with Wearable Sensors

This paper proposes a novel method for physical fatigue assessment that can be applied in wearable systems, by utilizing a set of real-time measurable cardiovascular parameters. Daylength measurements, including a morning test set, physical exercise during the day, and an afternoon test set were conducted on 16 healthy subjects (8 female and 8 male). To analyze cardiovascular parameters for physical fatigue assessment, electrocardiography, pulse wave and blood pressure were measured during the test sets. The fatigue assessment questionnaire score, reaction time, countermovement jump height and hand grip strength were also measured and used as reference parameters. This study demonstrates that (i) the compiled test battery can selectively assess the rested vs. physically-fatigued states; (ii) the obtained linear support-vector machine, trained using the heart rate variability based parameter (F-score 0.842, accuracy 0.813) and pulse arrival time based parameter (F-score 0.875, accuracy 0.875) shows a promising ability to classify between the physically mildly fatigued and significantly fatigued states. Despite the somewhat limited study group size, the results of the study are unique and provide a significant advancement on the existing physical fatigue assessment methods towards a personalized and continuous real-time fatigue monitoring system with wearable sensors.

Need for cognition moderates the impairment of decision making caused by nightshift work in nurses

The current study explores the effect of nightshift work on the decision-making competence and performance of the Iowa Gambling Task (IGT) and analyzes whether individual differences in the need for cognition (NFC) can moderate this effect. A total of 107 female nurses were recruited to complete the decision-making competence scale and IGT at two times, after a night shift and after a day shift. The results revealed that the IGT scores and decision-making competence of nurses after nightshift work significantly declined, and also that the decrease in decision-making competence was related to the nurses’ performance of the IGT. Additionally, the decreasing degree of IGT and decision-making competence scores of the high-NFC group were significantly lower than those of the low-NFC group after nightshift work. In can be concluded that the decrease in decision-making competence which was related with poor decision-making due to nightshift work. NFC moderated the effect of nightshift work on decision-making.

Relationship Between Working Conditions, Worker Outcomes, and Patient Care: A Theoretical Model for Frontline Health Care Workers

Despite the integral role that frontline health care workers play in providing care to older adults and those with chronic conditions and disabilities, few studies have examined the relationships between the working conditions endured by this workforce, the quality of the care they deliver, and the outcomes of patients for whom they care. Thus, the authors: (1) developed a novel conceptual framework that highlights these relationships and (2) performed a comprehensive search and analysis of the literature (PubMed, AgeLine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), JSTOR, Scopus, Web of Science) to assess the relationships proposed in the framework. A total of 31 studies were included. The results suggest that working conditions affect workers themselves, the care they deliver, and their patients' outcomes. Additional studies, as well as policy solutions, are needed to address the issues faced by this workforce in order to improve health care delivery.

Factors that Affecting Female Nurse Performance with Work Stress as an Intervening Variable in the Hospital of Dr. Tadjuddin Chalid Makassar

Background: Professional nurse job, long term rhythm of life that is irregular, and pressure of many aspects of live cause multiple role conflicts, sleep problem, affect the efficiency and quality of nurses performance. 12 hours shift rotation are very common in the world, but there is worries that develop about the effect of quality and safety of nurses and patient. Aim : To find out the direct and indirect effect of work family conflict, shift work, nutrition status, sleep quality on nurse performance through work stress as an intervening variable on female nurses at Hospital of Dr Tadjuddin Chalid Makassar. Methods : The type of this research used observational analytic with cross-sectional design to see the effect of work family conflict, shift work, nutrition status, and quality of sleep on nurse performance through work stress as an intervening variable on female nurses in the Hospital of Dr MTadjuddin Chalid Makassar. This research was conducted in February – June 2021 at Dr. Hospital. Tadjuddin Chalid Makassar. The sample of this research was female nurses who were married as many as 73 respondents, Data collection used questionnare, scale, microtoice, and secondary data. Data analysis used univariate analysis with SPSS program version 24 and multivariate analysis to find out the effect of two or more variables and to see the direct and indirect effect with handle the anther variable with used Path Analysis that was conducted with used SmartPLS program. Results : There is no direct effect of work family conflict on performance with a score p (0,462)>0,05 There is an indirect effect of work family conflict on performance through work stress with a score p (0,001) < 0,05. There is direct effect of work stress on performance with p-value (0,003) < 0,05. There is no direct and indirect effect of shift work on performance although it through work stress as intervening variable on nurse with p-value > 0,05. There is no direct and indirect effect of nutrition status on performance athought it through work stress as an intervening variable on nurse with p-value > 0,05.  There is direct effect of sleep quality on performance with p-value (0,007) < 0,05. However, there is no indirect offect of sleep quality on performance through work stress as intervening variable on female nurses in the Hospital of Dr Tadjuddin Chalid Makassar with p-value (0,983) > 0,05. Conclusion:There is no direct effect of work family conflict on performance, but there is an indirect effect of work family conflict on performance through work stress as variable intervening. There is no direct and indirect effect of nutrition status on performance athought it through work stress as intervening variable and there is direct effect of quality of life on performance but there is no indirect effect of quality of sleep on performance through work stress as intervenig variable on nurses in Hoospital of Dr Tadjuddin Chalid Makassar. Suggested on female nurses could manage their quality of sleep with rest first before doing the activity, so that when they work, they can work as optimal

The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study

BACKGROUND

Healthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied.

OBJECTIVE

To determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures.

DESIGN

A quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested).

SETTING

Participants were tested in a northwestern US university's nursing simulation laboratory.

PARTICIPANTS

A volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals.

METHODS

Simulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness.

RESULTS

In our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors.

CONCLUSIONS AND RELEVANCE

Nurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts-if any-on patient care. Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

Factors That Influence Nurse Staffing Levels in Acute Care Hospital Settings

PURPOSE

To identify which patient and hospital characteristics are related to nurse staffing levels in acute care hospital settings.

DESIGN

A cross-sectional design was used for this study.

METHODS

The sample comprised 1,004 patients across 10 hospitals in the Andalucian Health Care System (southern Spain) in 2015. The sampling was carried out in a stratified, consecutive manner on the basis of (a) hospital size by geographical location, (b) type of hospital unit, and (c) patients' sex and age group. Random criteria were used to select patients based on their user identification in the electronic health record system. The variables were grouped into two categories, patient and hospital characteristics. Multilevel linear regression models (MLMs) with random intercepts were used. Two models were fitted: the first was the null model, which contained no explanatory variables except the intercepts (fixed and random), and the second (explanatory) model included selected independent variables. Independent variables were allowed to enter the explanatory model if their univariate association with the nurse staffing level in the MLM was significant at p < .05.

RESULTS

Two hierarchical levels were established to control variance (patients and hospital). The model variables explained 63.4% of the variance at level 1 (patients) and 71.8% at level 2 (hospital). Statistically significant factors were the type of hospital unit (p = .002), shift (p < .001), and season (p < .001). None of the variables associated with patient characteristics obtained statistical significance in the model.

CONCLUSIONS

Nurse staffing levels were associated with hospital characteristics rather than patient characteristics.

CLINICAL RELEVANCE

This study provides evidence about factors that impact on nurse staffing levels in the settings studied. Further studies should determine the influence of patient characteristics in determining optimal nurse staffing levels.

Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis

BACKGROUND

Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety.

OBJECTIVES

To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times.

METHODS

We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables.

RESULTS

The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids.

CONCLUSION

Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.

The vicious circle between physical, psychological, and physiological characteristics of shift work in nurses: a multidimensional approach

PURPOSE

To compare physical, psychological, and physiological adaptations between rotating and morning shift health workers using objective and subjective approaches.

METHODS

Forty nurses [n = 20 morning shift (MS) group; n = 20 rotating shift (RS) group] were evaluated for anthropometry, body composition, and handgrip strength. Quality of life, depression, fatigue, daytime sleepiness, and sleep quality were assessed with SF-36, Zung Self-Rating Depression Scale (SDS), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and triaxial accelerometers. Sleep-related data were monitored with sleep actigraphy. Salivary melatonin levels were analyzed before/after sleep, and blood lipid profiles were measured the following morning.

RESULTS

The RS group had higher mean BMI and total and abdominal fat and scored lower in the SF-36 (p < 0.01). All nurses showed reduced physical activity levels, which, in the RS group, were negatively correlated with FSS (p = 0.033) and SDS scores (p = 0.025). Poor sleep was revealed in 53% of nurses. The RS group had worse sleep quality by PSQI than the MS group (p = 0.045). PSQI scores were inversely related to SF-36 scores and positively correlated with FSS, BMI, waist circumference, and body fat (p < 0.05).

CONCLUSION

RS nurses showed increased body mass and total and abdominal fat along with decreased quality of life and sleep quality compared to MS counterparts. A strong relationship was found between physical, psychological, and physiological domains. Further studies should consider workplace interventions to prevent obesity, promote physical activity, and manage poor sleeping patterns in nurses.

Effect of shift work in intensive care on attention disorder in nurses

AIM

The purpose of this study was to determine the level of attention between shifts and to make recommendations about the regulation of shifts.

METHODS

The researchers applied the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI) and Stroop color word interaction test (SCWI) in 72 intensive care workers working in different shifts.

RESULT

The study included a total of 72 participants, including 30 (43.3%) females and 42 (58.3%) males. There were statistically significant differences between the groups in the sub-items of the HAM-D and SCWI test (Table 3). There was a significant elongation in the night-shift employees at all times within the SCWI sub-items. A significant height in the number of errors and corrections in the cards applied in the continuation of the test was also determined in the night-shift group.

CONCLUSION

This study revealed a significant decrease in the level of attention in the night-shift compared with the day-shift. This increase in attention deficit may also be a preventable cause of increased mortality in the night-shift.

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.

Fatigue and the Female Nurse: A Narrative Review of the Current State of Research and Future Directions

Background: The female nurse exhibits a multitude of personal and environmental characteristics that renders this population especially prone to fatigue. The consequences of fatigue in nurses are widespread and impactful at the personal, organizational, and societal levels. These include high injury rates and burnout in the nurse and poor patient and organizational outcomes. Objective: This article discusses the implications of fatigue in female nurses, including the impacts of fatigue across multiple entities (e.g., worker, patient, organization). It also reviews the current state of the research, including recent work on nurse fatigue and work schedule characteristics, and key areas for future work that would help empirically establish approaches to counter the detrimental and widespread effects of fatigue. Method: A narrative literature review was conducted resulting from an analysis of the literature limited to peer-reviewed studies. Results: A confluence of factors combines to elevate the prevalence and risk of fatigue in the female nurse. Numerous measures have established that performance-based fatigue results from nursing work schedules in nurses. Data also demonstrate that fatigue accumulates across successive shifts. Recent evidence supports the use of objective fatigue measures, including psychomotor reaction time and muscle function-related variables. Current gaps in the literature are delineated in the text. Conclusions: Strategic and well-designed research studies, as well as recent technological advances in fatigue tracking tools have the potential to help workers, administrators, and organizations develop fatigue management programs that could reduce the heavy burdens of fatigue on a multitude of health, safety, and economical outcomes.

Impact of night shift rotations on nursing performance and patient safety: A cross-sectional study

Aim

Hospitals operate on a 24‐hr basis, with shiftwork being unavoidable for most nurses. This study aims to explore the impact of night shiftwork rotations on nurses' physiological status, work performance and patient safety concerns among nurses in public hospitals.

Design

A descriptive predictive correlational design using a self‐administered questionnaire.

Methods

Electronic and printable survey questionnaires were distrusted among nurses working in public hospitals in multiple regions of Saudi Arabia. The study recruited 1,256 nurses from different nationalities, hospital work units and work experience.

Results

A large proportion of nurses on night shiftwork encountered patient safety issues (85.7%) and physiological consequences (93.6%). Counselling sessions and programmes to support at‐risk nurses are recommended.

A quasi-experimental study into the effects of naps and therapy glasses on fatigue and well-being

Aim

To investigate the effects of a napping facility and therapy glasses on fatigue and well‐being at the end of the night shift.

Background

Night shift work has adverse effects on fatigue and well‐being.

Methods

A quasi‐experimental study was conducted, and data were collected on 243 night shifts of 95 nurses who had either access to a napping facility, therapy glasses, both facilities or no facilities. Multilevel analyses were conducted to predict fatigue and well‐being.

Results

Night shifts of nurses having access to both facilities were associated with less fatigue and more well‐being. The use of therapy glasses related negatively to fatigue and positively to well‐being. The use of the napping facility was not associated with fatigue and well‐being. However, having slept while napping and sleeping time during napping were negatively associated with fatigue and positively associated with well‐being.

Conclusion

Therapy glasses and sleeping in a napping facility can be effective interventions in reducing the adverse effects of night shift work.

Implications for Nursing Management

Therapy glasses seem an effective investment to facilitate the well‐being of nurses. To enhance sleeping during napping, it is worthwhile to let nurses get accustomed to the napping facility and customize settings to personal preferences.

How the Lagged and Accumulated Effects of Stress, Coping, and Tasks Affect Mood and Fatigue during Nurses' Shifts

Nurses experience significant stress and emotional exhaustion, leading to burnout and fatigue. This study assessed how the nurses' mood and fatigue evolves during their shifts, and the temporal factors that influence these phenomena. Performing a two-level design with repeated measures with moments nested into a person level, a random sample of 96 nurses was recruited. The ecological momentary assessment of demand, control, effort, reward, coping, and nursing tasks were measured in order to predict mood and fatigue, studying their current, lagged, and accumulated effects. The results show that: (1) Mood appeared to be explained by effort, by the negative lagged effect of reward, and by the accumulated effort, each following a quadratic trend, and it was influenced by previously executing a direct care task. By contrast, fatigue was explained by the current and lagged effect of effort, by the lagged effect of reward, and by the accumulated effort, again following quadratic trends. (2) Mood was also explained by problem-focused and emotion-focused coping strategies, indicative of negative mood, and by support-seeking and refusal coping strategies. (3) Fatigue was also associated with direct care and the prior effect of documentation and communication tasks. We can conclude that mood and fatigue do not depend on a single factor, such as workload, but rather on the evolution and distribution of the nursing tasks, as well as on the stress during a shift and how it is handled. The evening and night shifts seem to provoke more fatigue than the other work shifts when approaching the last third of the shift. These data show the need to plan the tasks within a shift to avoid unfinished or delayed care during the shift, and to minimize accumulated negative effects.

Cole-impedance parameters representing biceps tissue bioimpedance in healthy adults and their alterations following eccentric exercise

The purpose of this study is to identify if participation in an eccentric exercise protocol altered the Cole-impedance model parameters that represent localized bicep tissue bioimpedance. This supports continued efforts to identify which features of tissue bioimpedance may be effective markers to non-invasively identify skeletal muscle damage. Here, the Cole-impedance model parameters that best fit the localized electrical impedance of exercised (using an eccentric stimulus) and unexercised biceps of 6 participants (collected before, immediately after and at 24 h, 48 h, 72 h and 96 h) are determined using a numerical optimization technique. Statistical tests comparing the pre-exercise and post-exercise model parameters report significant decreases in R ∞ and R 1 with significant increases in C at 72 h and 96 h post-exercise for exercised biceps (aligning with noted periods of peak swelling). These changes in R ∞ , R 1 , and C were not observed in the unexercised biceps. These results support that the C parameter of the Cole-impedance model fit to bioimpedance data may be a suitable marker for identifying skeletal muscle damage.

Energy Expenditure and Changes in Body Composition during Submarine Deployment-An Observational Study "DasBoost 2-2017"

The present study was designed to objectively assess the effects of 3-months submarine deployment on behavioural and metabolic determinants of metabolic health. In 13 healthy, non-obese volunteers, we using stable isotope dilution, and plasma and urinary biochemistry to characterize metabolic health before and after a 3-month submarine deployment. Volunteers worked in 6-h shifts. After deployment, we observed reduced fat-free mass (mean ± SD, -4.1 ± 3.3 kg, p = 0.003) and increased adiposity (21.9 ± 3.2% fat mass to 24.4 ± 4.7%, p = 0.01). Changes in fat-free mass were positively associated with physical activity (+0.8 kg per 0.1 increase in PAL, p = 0.03). The average physical activity level was 1.64 ± 0.26 and total energy expenditure during deployment was 2937 ± 498 kcal/d, while energy intake was 3158 ± 786 kcal/d. Fasting glucose (p = 0.03), and triglycerides (p = 0.01) declined, whereas fasting free fatty acids increased (p = 0.04). Plasma vitamin D and B12 concentrations decreased (-14%, p = 0.04, and -44%, p = 0.001, respectively), and plasma calcium, and magnesium increased (+51%, p = 0.01, and +5%, p = 0.02). Haemoglobin was unchanged, but haematocrit decreased (-2.2 ± 2.1%, p = 0.005). In conclusion, submarine deployment impairs fat-free mass maintenance and promotes adiposity. High physical activity may prevent the decline in fat-free mass. Our study confirms the need to counteract Vitamin D and B12 deficiencies, and suggests impairments in erythrocyte metabolism.

Energy Expenditure and Changes in Body Composition during Submarine Deployment-An Observational Study "DasBoost 2-2017"

The present study was designed to objectively assess the effects of 3-months submarine deployment on behavioural and metabolic determinants of metabolic health. In 13 healthy, non-obese volunteers, we using stable isotope dilution, and plasma and urinary biochemistry to characterize metabolic health before and after a 3-month submarine deployment. Volunteers worked in 6-h shifts. After deployment, we observed reduced fat-free mass (mean ± SD, −4.1 ± 3.3 kg, p = 0.003) and increased adiposity (21.9 ± 3.2% fat mass to 24.4 ± 4.7%, p = 0.01). Changes in fat-free mass were positively associated with physical activity (+0.8 kg per 0.1 increase in PAL, p = 0.03). The average physical activity level was 1.64 ± 0.26 and total energy expenditure during deployment was 2937 ± 498 kcal/d, while energy intake was 3158 ± 786 kcal/d. Fasting glucose (p = 0.03), and triglycerides (p = 0.01) declined, whereas fasting free fatty acids increased (p = 0.04). Plasma vitamin D and B12 concentrations decreased (−14%, p = 0.04, and −44%, p = 0.001, respectively), and plasma calcium, and magnesium increased (+51%, p = 0.01, and +5%, p = 0.02). Haemoglobin was unchanged, but haematocrit decreased (−2.2 ± 2.1%, p = 0.005). In conclusion, submarine deployment impairs fat-free mass maintenance and promotes adiposity. High physical activity may prevent the decline in fat-free mass. Our study confirms the need to counteract Vitamin D and B12 deficiencies, and suggests impairments in erythrocyte metabolism.

Sleep in the United States Military

The military lifestyle often includes continuous operations whether in training or deployed environments. These stressful environments present unique challenges for service members attempting to achieve consolidated, restorative sleep. The significant mental and physical derangements caused by degraded metabolic, cardiovascular, skeletomuscular, and cognitive health often result from insufficient sleep and/or circadian misalignment. Insufficient sleep and resulting fatigue compromises personal safety, mission success, and even national security. In the long-term, chronic insufficient sleep and circadian rhythm disorders have been associated with other sleep disorders (e.g., insomnia, obstructive sleep apnea, and parasomnias). Other physiologic and psychologic diagnoses such as post-traumatic stress disorder, cardiovascular disease, and dementia have also been associated with chronic, insufficient sleep. Increased co-morbidity and mortality are compounded by traumatic brain injury resulting from blunt trauma, blast exposure, and highly physically demanding tasks under load. We present the current state of science in human and animal models specific to service members during- and post-military career. We focus on mission requirements of night shift work, sustained operations, and rapid re-entrainment to time zones. We then propose targeted pharmacological and non-pharmacological countermeasures to optimize performance that are mission- and symptom-specific. We recognize a critical gap in research involving service members, but provide tailored interventions for military health care providers based on the large body of research in health care and public service workers.

Does work-induced fatigue accumulate across three compressed 12 hour shifts in hospital nurses and aides?

Fatigue-related impairments in the nursing workforce contribute to a multitude of health, safety, and economic consequences at the individual, organizational and societal levels. Long and compressed work schedules are commonly worked in the healthcare industry, but more research is needed to understand the cumulative effects of multiple work shifts on physiology-based performance outcomes in nurses. The purpose of this study was to compare the effects of a single nursing work shift versus three compressed (one every 24 hours) 12 hour shifts on performance-based fatigue in nurses and aides. Twenty-six fulltime hospital working nurses and aides (age = 36.1 ± 13.3 years) reported to the lab for testing before, immediately after working a single 12 hour shift, and after working three 12 hour shifts in a 72 hour period. Outcome measures included vigilance-based reaction time, lapses of attention, and muscle function assessments (lower and upper body muscle strength, explosive strength and vertical jump performance). All variables except hand grip strength showed a significant decline following the three work shifts. The psychomotor vigilance reaction time and lapses of attention variables also generally showed a significant decline from the end of shift one to the end of shift three, indicting an accumulation of fatigue in these metrics with increasing number of shifts worked. Muscle function variables responded early in the duty cycle, showing a significant decline after a single work shift, but did no further decline by the end of the third shift. These findings use objective measures to substantiate that fatigue impairments occur from working a single 12 hour shift, and in several instances, increase further with more successive work shifts. Caution should be employed by personnel and administrators with work schedules involving multiple compressed 12 hour shifts. Fatigue management strategies may be used to improve risks and consequences from fatigue-related mishaps, and this study reports several variables that appear sensitive to identifying and tracking fatigue in this population.

Shift-work nurses' work environments and health-promoting behaviours in relation to sleep disturbance: A cross-sectional secondary data analysis

AIMS AND OBJECTIVES

To examine the association of nursing work environments and health-promoting behaviours with shift-work nurses' sleep disturbance.

BACKGROUND

Shift-work nurses reportedly have sleep problems, which affect their sleep quality and quantity. Given the high risk of developing performance decrements and medication errors in sleep-disturbed nurses, factors related to sleep disturbance among shift-work nurses should be investigated.

DESIGN

A cross-sectional secondary data analysis.

METHODS

Our study analysed data from 339 nurses who had been involved in rotating shift work including night shifts for more than 6 months. To examine associations of nursing work environments and health-promoting behaviours with sleep disturbance, multiple linear regression models were generated. This study is reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guideline.

RESULTS

Nurses with more collegial relations with physicians were significantly less likely to have high levels of sleep disturbance (B = -4.01, p = 0.04). Those with higher levels of sleep disturbance were significantly more likely to report less stress management (B = -9.56, p < 0.01) and higher health responsibility (B = 9.30, p < 0.01).

CONCLUSIONS

To alleviate shift-work nurses' sleep disturbance, organisational supports for collaborative relations with physician and increased healthcare accessibility are needed. Individual nurses should develop healthy lifestyles to reduce occupational stress and alleviate sleep disorders.

RELEVANCE TO CLINICAL PRACTICE

To improve shift-work nurses' sleep, collegial relations with physicians and healthy lifestyles should be promoted.

Time course of recovery after two successive night shifts: A diary study among Austrian nurses

AIM

To explore how nurses recover from night shift work during periods off duty.

BACKGROUND

Given the large number of affected individuals globally, detrimental health outcomes of night shift work are an important public health issue. Sufficient recovery opportunities are essential to prevent prolonged fatigue associated with demanding tasks and high workload as experienced in nurses working long shifts during the night.

METHOD

Nurses (n = 53, 96% females) who worked in two public nursing homes in Austria completed a 5-day diary to collect data on well-being conceptualized by fatigue, distress and vigour.

RESULTS

Nurses experienced worse well-being post night shift days than during rest days. Well-being improved from post night shift day 2 to the following rest day 1 and continued improvement from rest day 1 to rest day 2.

CONCLUSIONS

Nurses who work at nights are at risk for experiencing prolonged fatigue. Our results suggest that after two consecutive 12-hr night shifts full recovery needs at least three days off work.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies for maintaining nurses' good health and caring attitudes as well as vigilance for patient safety should include fatigue management plans and optimised schedules for night shift work.