Literature review sub title 4
Berger and Hobbs (2006), argued that modifying external factors such as diet and exercise, the amount of shifts worked consecutively, and the food and beverage intake patterns will reduce the negative health effects associated with shift work on nurses. Some of the main topics that the researchers focused on are:
1. Basis for biological rhythm
The circadian rhythm is affected for nurses working the shift work. The study mentions that the biological rhythm consists of the external rhythm which covers meal times, sleep times and social activities, and the internal rhythm which is the circadian rhythm. The fact that the circadian rhythm is affected with shift work nurses by the difference of night and day sleep time, their social activities and meal times are also affected. This makes it more difficult for them to adjust with their social life which in itself creates stress. Moreover, stress increases cortisol levels which is a hormone that regulates the amount of fat stored in the body which makes shift workers gain weight by increasing their BMI.
2. Physiologic effects of shift work
The study here is focused on the melatonin levels, cortisol levels and body temperature in shift workers. Researchers are
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They found that some nurses preferred to sleep during the day and do more activities during the day and had a difficult time functioning at night. These were the people that could not adapt easily during the shift work. Moreover, there were nurses who could function better during the night and be more alert and have their social activities during the night and slept during the day these nurses adapted very easily to shift work and preferred to work nights. The study found that nurses who who worked the shift work for more than fifteen years and could not adapt to shift work had a higher rate for divorce, increased rate for colorectal cancer, social isolation and substance
The negative impacts of shift work on workers’ health such as fatigue and sleep which are the main complain among the staff, job performance, psychosocial well-being, and job dissatisfaction have been
West, Ahern, Byrnes and Kwanten (2007) indicate that the new graduate nurses may have not worked full-time in the past; given that graduate nurses begin their career with a full-time job can lead to exhaustion. It was discovered that shift work leads to desynchronisation of physiologically determined circadian rhythms which has a major psychobiology effect and it is commonly perceived the effects of shift work contribute to graduate nurses attrition rate. The NGNs often have a high level of stress due to disturbed sleeping patterns, as they find to adaption to shift work or rotating work hours difficult. Eventually, it leads to feelings of lack of job satisfaction, exhaustion and spending of less time with their friends and family, which can eventually could lead to burnout (West et al., 2007).
Moreover, most shifts run into each other with day shifts extending into the night and night shifts extending into the day. This means that their circadian rhythms are distorted. Extended shift work for nurses eventually lead to them finding it difficult to adapt to normal life or any activities outside work.
It is problematic that healthcare professions work rotating shifts because this impedes on the ability of the human body to function properly. Rotating shifts means that everyday their shifts are at different times and different lengths of time. The human body needs to be in line with the environment and when the sun is up the body naturally is awake and alert and during night time the body goes dormant to sleep, this is called circadian rhythm. The body has a circadian clock and when this is disrupted this can lead to depression and anxiety. This can lead to exhaustion and irritation that can cause someone to make mistakes. This can also lead to sleep debt and cause insomnia that can affect the mental alertness. Sleep allows the body to fight
The authors of this article performed a search looking for only qualitative research articles that were based on the experiences of nurses at the time of shift change/nursing handoffs. One hundred and twenty-five qualitative articles between 1988 and 2012 met the initial inclusion criteria and 50 articles were evaluated and a final sample of 29 qualitative articles was analyzed and utilized for this study and included (Abraham, Kannampallil & Patel, 2013). Only articles that described nurse to nurse shift reporting was used.
Within the recent years, hospitals and medical facilities have been experiencing nursing shortages that necessitate more nurses to be present to compensate for the care needed to be given. This requires nurses to be dealt with imperative extended work hours along with their normal shifts with no denial or excuse accepted. Working extra hours are accompanied with negative effects that have an impact on the nurse, coworkers, and patients. A major concern that occurs with overtime is that nurses become fatigued or burnout. Fatigue that is experienced is a result of sleep deprivation from working overtime that is associated with arduousness neurobehavioral functioning
Throughout the years there has been more attention directed towards healthcare worker fatigue. More specifically, fatigue associated among night-shift nurses. The Joint Commission has found that lack of sleep from night shifts has contributed to increased errors, leading to poor patient outcomes (Gardner, Dubeck, 2016).
Fatigue and sleepiness, tendency to fall asleep, go hand in hand as nurses struggle to stay awake during long, consecutive, day or night shifts. For example, in the Staff Nurse Fatigue and Patient Safety Study, the number of nurses who reported an error or a near miss had less hours of sleep than the nurses who did not report an error or a near miss, and it was determined that there is a 3.4 percent chance of a nursing error when nurses get 6 hours of sleep or less in the prior 24 hours; another study found that the chances of making an error was three times higher when nurses worked more than 12.5 hours per shift (Rogers, 2008). In the Staff Nurse Fatigue and Patient Safety Study, over two thirds of the participants reported that they struggle to stay awake while working and 20 percent reported incidence of falling asleep during their shift (Rogers, 2008). Nurses also do not get adequate breaks while working long shifts, according to the Agency of Healthcare Research and Quality (AHRQ) less than 50% of work breaks for are away from patient care, which means nurses never truly get a chance to relax (Phillips, 2014). Not only is the patient safety at risk when nurses are fatigued, but the well being of nurses is at stake as well. While nurses are fatigued they are risking their
In hospital, admitted patient were taken care by health worker twenty-four hours a day. There were three different shifts scheduled; morning, evening and night, and nurses works for eight hours a shift to provide patient care. In the hospital, each shift with different patients and different nurses are challenging part for continuity of care. During shift change essential information exchange and duties should be carried out in order to provide patient’s safety, quality and efficiency. Even though busy shift, nurse have vital role for providing high quality care and patient safety. Specially, shift change many patient described as a “ghost town”. Nurses are exchanging needed information and not spending much time with patients. The hospital
Since the early days of nursing when nurses would work extended shifts and even lived on the wards where they worked, nurse fatigue has been a much discussed issue. During the late 1800s and into the early 1900s, workers spanning several industries fought for the eight hour work day and eventually won with the passage of the US Fair Labor Standards Act in 1938 (Miller, 2011). In the years since then, the extended shift has again become popular, particularly in the field of nursing. Though many nurses and organizations laud twelve hour shifts as beneficial to staffing needs and personal lives, the risks to patient and nurse safety must be considered.
Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in
Limited attention has been paid to the hours worked by nurses, or the effects of these hours on patient safety (Rogers, 2008). Even though most nurses favor 12- hour shifts and overtime, it is associated with difficulties staying awake during times of duty, reduced sleep times, and triple the risk of making an error (Rogers, 2008). The most significant risk of making an error occurred when nurses were scheduled to work 12.5 hours or more.
The fatigue associated with working the night shift was brought into the spotlight after an aircraft incident that occurred on June 10, 1990. British Airways flight 5390 had just departed from Birmingham International Airport when the aircraft experienced a rapid pressure loss due to the pilot’s windshield blowing out of the aircraft. This resulted in the pilot being sucked halfway out of the aircraft and another flight crew member grabbing the pilots belt and holding him from being sucked completely out while the copilot to take control of the aircraft and land it safely at a nearby airport. The official findings of the accident investigation linked the windshield blowout to the wrong size bolts being installed. The bolts were installed early in the morning hours and the fatigued shift maintenance manager who installed them didn’t recognize that they were the wrong bolts. He thought that the countersinking on the window was unusually large (Baron, 2009). This is just one example of mistakes made on night shift due to fatigue. Fatigue is a dangerous human factor that is present in the aircraft maintenance community.
It is my opinion that shift work is another potential hazard to me as an employee in the Healthcare Industry. It is my belief that employees on nightshift work or those working irregular hours may be more susceptible to errors and accidents, mainly due to fatigue or
24, 25In contrast, a study in Canada reported that nurses involved in the research ,were less likely to implicate self care activities. 26 While in another study, it was found that 90% of 8100 Canadian physicians were reported to be in good health unlike nurses .27 Little is known about the personal eating and physical activity pattern or obesity prevalence of the nursing workforce. Several studies have explored job-related factors, such as work related stress, job satisfaction, and shift patterns and their influence on the health of nurses. 28-30