The effects of different shift patterns on nurses’ sleep-wake behaviours in selected, private healthcare facilities
- Authors: Bell, Emma Catherine
- Date: 2023-10-13
- Subjects: Fatigue , Fatigue in the workplace , Sleep deprivation , Sleep-wake cycle , Shift systems , Nurses , Health facilities, Proprietary
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/424219 , vital:72134
- Description: Nurses are required to work shifts to provide 24-hour care, in which they complete physically and mentally demanding tasks. The length and type of shifts, particularly night shifts interfere with the natural sleep-wake behaviours, leading to extended wakefulness and overall reduced sleep, and increase the likelihood of sleepiness during subsequent shifts. This can in turn affected various cognitive processes such attention, vigilance and alertness, which are necessary during the care process. Sleepiness as a result of working shifts has also been associated with an increased risk accidents and error during the delivery of care. Given the unique demands and ways in which workplaces are structured, each context arranges its shifts in unique ways and thus, in order to determine how to manage the effects of shift work, it is important to understand how it affects self-reported fatigue and sleep, of, in this case, nurses. While there has been extensive research on this in the global north, to date, there has been limited research aimed at examining the effects of shift work on nurses’ sleep-wake behaviours and fatigue in the South African context. Therefore, the aim of this study is to characterise shift arrangements in selected private facilities and explore its effects on private healthcare nurses. This study adopted a cross-sectional, survey design using an amended version of Standard Shiftwork Index. The questionnaire included demographic and shift details and explored the impact of the shift systems on nurse sleep-wake behaviours and disturbances and fatigue and workload. It was distributed among shift working nurses registered with the South African Nursing Council across three selected, private, healthcare facilities in the Eastern Cape, over a two-month period. The responses were analysed with descriptive and inferential statistics, with open-ended questions analysed using a thematic analysis. A total of 51 nurses completed the survey. Nurses worked 12-hour shifts which included night shifts and day shifts with fixed start and end times. Over time was commonly reported and generally, nurses reported having very little control over their shift arrangements. Overall, nurses slept less than what they reported they needed on duty days, with nurses working both day and night shifts reporting to sleep less than the globally recommended required sleep. This was compensated for by longer sleep durations during days off. The data collection revealed that three different shift arrangements were in use, including permanent day shifts, permanent night shifts and rotating shift work including nights, with permanent night nurses working significantly more consecutive shifts (seven) than the other two shift types and having significantly more days off (seven) as well. While there were no significant differences in self-reported sleep across the three shift types, permanent night nurses were found to have the shortest sleep. During days off, rotating nurse reported significantly longer sleep times compared to day shift workers which may point to the need to catch up from sleep debt. Rotating nurses experienced the greater total disturbances to their sleep than permanent day and permanent night shift nurses. While not statistically significant, it may point to the fact that rotating shift workers could not obtain regularly timed sleep (due to having to change their schedules) compared to permanent day and night nurses. Workload (physical, emotional, mental and time pressure) did not differ between the shifts (day or night) or the shift types, but did reflect a heavier workload, possibly due to the data collection occurring during the 5th wave of the COVID 19 pandemic. This study highlights that nurses in private healthcare facilities are working extended hours which were associated with reduced total sleep, irrespective of the nature of the shift, with rotating shift nurses experiencing some degree of greater disturbances to their sleep. The number, duration speed and direction of the shifts of rotating nurses needs to be explored further, whilst also exploring the influence of individual factors on sleep-wake behaviours of nurses. It may be beneficial for the healthcare facilities to implement fatigue management strategies to mitigate the negative impacts of shift work, given the impact that this may impact the delivery of care. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2023
- Full Text:
- Date Issued: 2023-10-13
Validation of an assessment tool for mental fatigue applied to rotational shift work
- Authors: Huysamen, Kirsten Christina
- Date: 2014
- Subjects: Mental fatigue , Shift systems , Performance , Motor ability , Memory
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:5154 , http://hdl.handle.net/10962/d1013551
- Description: Mental fatigue has been proven to be highly prominent during shift work, due to long, irregular working hours and disruption of the circadian rhythm. Measuring mental fatigue has been a challenge for many years, where commonly cognitive test tasks are used to assess mental fatigue. Moreover, these test tasks do not isolate where fatigue is occurring during human information processing. The human information processing system consists of four core stages, each of which requires numerous cognitive functions in order to process information. The Human Kinetics and Ergonomics Department at Rhodes University has developed six cognitive test tasks where each isolates a cognitive function: an accommodation test task, a visual detection test task, a reading test task, a memory test task, a tapping test task and a neural control test task. The cognitive functions include: eye accommodation, visual discrimination, visual pattern recognition, memory duration, motor programming and peripheral neural control. General task-related effect can also be examined for each of these cognitive test tasks which include choice reaction time, visual detection, reading performance, short-term memory, motor control and tracking performance. Additionally, a simple reaction time test task has been developed to analyse simple reaction time. This test task does not isolate a cognitive function. One or more parameters can be examined for each cognitive function and task-related effect. The first aim of this study was to validate numerous cognitive test tasks for mental fatigue in a simulated shift work laboratory setting. The second aim was to assess the validated cognitive test tasks in Phase 1 in a field-based rotational shift work setting. Parameters revealing sensitivity to mental fatigue would be validated for mental fatigue applied to rotational shift work and would be inserted into an assessment tool. In the laboratory setting, the seven cognitive test tasks were examined on four different types of shift work regimes. The first regime was a standard eight-hour shift work system, and the other three were non-conventional shift work regimes. Participants (n = 12 per regime) were required to complete one day shift followed by four night shifts, where testing occurred before and after each shift and four times within each shift. The cognitive test tasks revealing sensitivity to fatigue included: visual detection test task, reading test task, memory test task, tapping test task, neural control test task and simple reaction time test task. The testing of Phase 2 was conducted in three different companies, where each performed a different type of rotational shift work. The six cognitive test tasks validated for mental fatigue in Phase 1 were tested before and after work for each shift type within the rotational shift work system adopted by each company. Company A (n = 18) and Company B (n = 24) performed two-shift rotational shift work systems, where the shift length of Company A was 12-hours and the shift length of Company B was irregular hours. Company C (n = 21) performed an eight-hour three-shift rotational shift work system. Nine parameters revealed fatiguing effects and were inserted into the assessment tool, five of which provided information on a specific cognitive function: error rate for visual discrimination, processing time for visual pattern recognition, error rate for visual pattern recognition, impact of rehearsal time on memory recall rate for memory duration and the high-precision condition for motor programming time. The remaining four parameters provided information on general task-related effects: reading speed for reading performance, recall rate for short-term memory, reaction time for motor control and simple reaction time. Therefore, an assessment tool comprising nine parameters was validated for mental fatigue applied to rotational shift work, where five of the parameters were able to isolate exactly where fatigue was occurring during human information processing and the other four parameters were able to assess fatigue occurring throughout the human information processing chain.
- Full Text:
- Date Issued: 2014
The effects of booster breaks during a sedentary night shift on physiological, psychomotor, psycho-physiological, and cognitive performance over a 3 night shift habituation phase
- Authors: Lombard, Wesley Ross
- Date: 2010
- Subjects: Night work , Shift systems , Performance , Exercise , Exercise -- Physiological aspects , Exercise -- Psychological aspects , Cognition -- Effect of exercise on , Motor ability
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:5116 , http://hdl.handle.net/10962/d1005194 , Night work , Shift systems , Performance , Exercise , Exercise -- Physiological aspects , Exercise -- Psychological aspects , Cognition -- Effect of exercise on , Motor ability
- Description: Despite extensive research into shift work, workers working under rotating shift conditions are still plagued by the effects of the desynchronisation resulting from working against their natural circadian rhythms. Additionally, modern industries are shifting towards tasks requiring greater cognitive demand with less manual labour incorporated into the tasks. Research into operator based tasks, and hence those of a sedentary cognitive base both during day and night shifts, has been focusing on the effectiveness of the standard rest/break schedule. Research indicating that the standard rest break schedule is often ineffective in eliminating operator discomfort and performance deterioration, with these affects argued to be more pronounced during a night shift schedule. Therefore current research set out to investigate alternative rest break schedules, incorporating a short bout of physical activity and stretching exercises which are proposed to enhance performance and subjective mood, while eliminating operator discomfort for sedentary based cognitive tasks. Three conditions were tested during a three day habituation shift cycle within a laboratory, incorporating two night shift groups (control and experimental) and a control day shift group. Twelve subjects made up each group, with the two night shift groups completing the shift schedule together. The control groups followed a typical 8 hour shift schedule while the experimental group performed a booster break (exercise and stretches) activity for 7.5 minutes every hour during the night shift schedule. Over the course of the shift, subjects completed a battery of six tests providing data on physiological measurements (heart rate and temperature), performance criteria (reaction time responses, memory and neurobiological) and subjective measures. Responses obtained for all the different parameters measured indicated a strong circadian influence for the majority of the variables, indicating the course of natural down regulation within physiological and performance criteria over the night shift. The booster break significantly improved reaction time performance, subjective ratings and resulted in a high sustainable activity level. Day shift comparisons indicating that within subjective measures and reaction time performance, the booster break resulted in similar responses to those of the day shift workers, while the control night shift groups reported significantly lowers results. Additionally, the booster break had positive influences during the circadian nadir, significantly improving parameters of performance and subjective ratings of sleepiness. The results of this study indicating which variables are strong predictors and indicators of the oscillations in performance and subjective ratings due to the circadian changes. The booster break interventions had positive effects on subjective ratings and reaction time performance, while also being argued to decrease the burden placed on the cardiac system as a result of increased sympathetic tone during the night shift, while additionally resulting in similar responses to those of day shift workers. Further studies are required, however, to provide conclusive evidence particularly within a working situation over a longer shift schedule.
- Full Text:
- Date Issued: 2010
The impact of a one-hour self-selected nap opportunity on physiological and performance variables during a simulated night shift
- Authors: Davy, Jonathan Patrick
- Date: 2010
- Subjects: Night work , Naps (sleep) in the workplace , Naps (sleep) in the workplace -- Case studies , Shift systems
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:5123 , http://hdl.handle.net/10962/d1005201 , Night work , Naps (sleep) in the workplace , Naps (sleep) in the workplace -- Case studies , Shift systems
- Description: Napping has been explored extensively as a means of counteracting the negative effects associated with shift work. A significant amount of this research has focused on the implementation of scheduled naps, with few studies considering flexible nap schemes. The current study therefore aimed to assess the effects of a flexible nap opportunity on the physiological, cognitive, performance, neurophysiological and subjective responses of a group of non shift workers over the course of a three-day simulated night shift regime. Additional foci were the effects of the nap condition on the extent of the circadian adaptation of the subjects to the irregular work schedule and the circadian-related influences associated with being awake during the night. 36 subjects – 18 males and 18 females – were recruited to participate in the current study. The data collection spanned twelve days, during which four, three-day long shift cycles were set up: three night shift cycles and one day shift cycle. During each night shift cycle, three separate experimental conditions were staggered, namely the nap condition, the no nap condition and a booster break condition (a collaborative study that completed the setup). The day shift served as a further comparison. Each cycle comprised of 12 subjects, which meant there were four subjects per condition during each cycle. The shifts were 8 hours in duration, with the no nap group following a standard break schedule evinced in industry. The three breaks taken during the shifts amounted to a total time of 1 hour. The nap group was afforded a 1 hour flexible nap opportunity between 00h00 and 03h00 with no other breaks. Therefore, both conditions had the same amount of work time. During the shifts, subjects performed two simple, low arousal tasks (beading and packing) and completed a test battery roughly every two hours which was comprised of physiological, performance, neurophysiological and subjective measures. It was found that the inclusion of the nap opportunity significantly improved output performance and response time during a low precision, modified Fitts tapping task over the course of three night shifts, relative to no napping. Physiologically, napping resulted in higher heart rate frequency measures by the end of the shifts, which were also accompanied by significant reductions in subjective sleepiness ratings during all iii the night shifts. The nap group’s responses in this case, did not differ significantly from those of the day shift. Both simple reaction time and memory performances improved as a result of the nap inclusion, but only during the third night shift. The majority of the measures included in the research also depicted the effects of the circadian rhythm, which was indicative of the pronounced effect that this natural biological down regulation has on performance during the night. Napping reduced the severity of these effects during beading performance and measures of subjective sleepiness. With regard to habituation, the nap opportunity also resulted in positive changes in the responses of beading performance, high precision response time, simple reaction time and both subjective sleepiness measures, relative to no napping. Sleep diary responses indicated that although sleep length and quality during the day were significantly reduced for both night-time conditions, recovery sleep (length and quality) for the nap group did not differ significantly from the no nap group. The findings of this research indicate that the inclusion of a flexible napping opportunity during the night shift had positive effects on some physiological, performance and subjective responses, and that this intervention is as beneficial as scheduled napping. Specifically, napping resulted in a significantly higher output during the beading task, relative to the no nap group despite the duration of work time being the same. As such the introduction of a flexible, self-selected nap opportunity is a practical, effective and individual-specific means of alleviating the negative effects of shift work, while improving certain performance parameters. Therefore, industries should consider its inclusion in their fatigue management programs. However, contextspecific considerations must be made, with regard work scheduling, individual differences and task demands when implementing such an intervention. This will ensure that its introduction will be well received and in time, lessen the health and work-related decrements associated with shift work.
- Full Text:
- Date Issued: 2010
The effects of night work and task diversification on efficiency of performance
- Authors: Munton, Lynne Kerry
- Date: 1998
- Subjects: Night work -- Evaluation , Shift systems , Performance
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:5175 , http://hdl.handle.net/10962/d1018253
- Description: This study investigated the effects of night work on performance efficiency. Night work is generally acknowledged to impair performance, yet much research has contradicted this assertion. The feasibility of including brief periods of physical activity to stimulate arousal within mentally demanding work shifts was also evaluated. Thirty six postgraduate volunteers were assigned to either the cognitive tasks (CT) or cognitive and motor tasks (CMT) group. All subjects performed three psycho-motor tests, using the Vienna Test System, at midday and midnight. The CMT group performed a short cycling activity before each test. Heart rate responses served as physiological measures, the Perceived Strain Scale was used to quantify individual perceptions of strain and performance efficiency was assessed in terms of speed and accuracy. Although several trends were apparent, no significant differences (p < 0.05) were revealed with respect to the three performance variables between the midday and midnight test sessions, or between the CT and CMT subjects, other than the higher heart rates recorded in the CMT group. In summary, neither time of day nor physical activity were found to affect performance within the controlled environment of this study.
- Full Text:
- Date Issued: 1998