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
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The reported prevalence of aircrew fatigue and the contributing factors within the South African aviation industry
- Authors: Blair, Dylan Ross
- Date: 2022-10-14
- Subjects: Fatigue , Flight crews , Fatigue in the workplace , Sleep deprivation , Sleep-wake cycle , Air travel Safety measures , Airlines South Africa
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/362762 , vital:65360
- Description: Fatigue in aviation results from the complex interaction of various factors (both work and non-work-related) that are important to understand when attempting to manage it. Managing fatigue effectively is important given that it has and continues to influence crew wellness and aviation safety. One of the ways of managing fatigue is through appropriately designed Flight Time Limitations (FTLs) however; in South Africa there have been calls from the unions and the crew to update these in line with the latest science and operational demands and insights. Doing this requires the generation of context specific data, which this thesis aimed to provide as an initial step. Firstly, this study aimed to explore the reported prevalence of fatigue across the South African aviation industry. Secondly, it elucidated what factors (both work and non-work related) crew perceived contributed to fatigue and lastly, the crew‟s perceptions regarding the current FTLs were explored. Methods: To realize the aims of the study, an online survey was developed using existing literature initially, and through consulting with and getting information from aviation industry stakeholders and other experts in the field of aviation and fatigue. This consultation (which occurred over a number of iterations of the survey) ensured that there was a balance between the scientific and the actual operational perspectives on how best to explore crew perceptions around fatigue. The finalized survey was divided into five parts: part one was consent to participate; part two included questions pertaining to the participants‟ demographic information; part three included questions pertaining to the crews‟ perceptions around fatigue (its prevalence, its impact on safety and how it affected crew); part four explored crew‟s perceptions on fatigue contributory factors, both work and non-work related; finally part five included questions pertaining to crew perceptions about the current South African FTLs, specifically their concerns, suggestions for improvement and any aspects they considered as fatigue mitigating. The survey was made available via the South African Civil Aviation Authority‟s (SACAA) website as well as via the industry stakeholder‟s networks that encouraged all crew across the different sectors of the industry to participate. All numerical data collected were analysed descriptively through inferential statistics, while the qualitative data were analysed using thematic analysis. Results: 194 participants completed the survey, 167 were from cockpit and 27 were from the cabin crew. The results of the study highlight that there is a high perceived prevalence of fatigue. The crew also recognized that fatigue is a significant safety risk, but less indicated that fatigue interfered with their ability to do their duties. Crew reported that the length of duties, number of sectors flown, insufficient sleep at night, early sign-on‟s, late sign-offs, working too many consecutive days in a row, inadequate or irregular sleep before and during periods of duty, night flying, bad weather, severe turbulence, having young children or dependents to look after, financial stress, extended commuting to get to and from work, and poor diet were some of the work and non-work-related contributory factors to fatigue. In line with these findings, questions around the perceived concerns about the current FTLs revealed that crew were concerned about unclear definitions of the civil aviation regulations (CARs), the lack of control of disruptive rostering schedules, periods of high workload due to the number of sectors flown per duty, the length of duty periods and effects of being on standby duty, inadequate rest between duties and strings of duty. The crew also had concerns regarding the Flight Duty Periods (FDPs) where the crew were concerned with the flying limits being used as targets by the operators, a lack of science applied to the FDPs, and that the current FDPs are outdated. The recommendations included limiting disruptive rostering schedules by altering standby provisions for the crew, instilling a block roster schedule, disallowing double signing on and off on the same day, and reducing split shifts. The crew also recommended adjusting duty durations by adjusting daily and monthly limits, tapering duty lengths, but also limiting discretionary extensions. Increasing rest provision was another recommendation suggested by the crew and included increasing the number of rest days off as well as the minimum hours of rest between duties needs to be increased. The fatigue mitigating aspects were minimal if any. Conclusion: Overall the study revealed that there is a high perceived prevalence of fatigue within this sample of the South African aviation industry and that the concerns outlined by crew around the contributory factors to fatigue are consistent with previous research, but also reflect the unique operating context of South Africa. This study serves as a base from which to explore more specific areas of the crew working time that are disruptive to sleep. This may help operator‟s roster duties in a more predictable way to limit the incidence of fatigue, while also offering the opportunity for the regulator and other stakeholders to focus their efforts on how to better design the current FTLs to limit the prevalence and risks associated with crew fatigue. , Thesis (MSc) -- Human Kinetics and Ergonomics, 2022
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