BACKGROUND: Although some studies have detailed consequences of shift work in nurses concerning general health, fatigue, sleepiness, or medical errors, only one study has been carried out in Italian healthcare comparing the effects of sleepiness and fatigue associated to shift work to the attentional performance of nurses. In this pilot study, we showed that night shifts are associated with significant greater sleepiness and tiredness, and worsened attentional performance (Di Muzio et al., 2019).
AIMS: The aim of the project will be to extend and replicate findings of our pilot study and assess the levels of psychomotor vigilance fatigue and sleepiness across nursing 8-h rapidly rotating work shifts, in order to highlight a potential level of risk associated with a specific work shift. This evaluation will be performed using a within-subject design and using the Psychomotor Vigilance Task (PVT), which is the most recognized measure of sustained vigilance. We will also evaluate if differences in attentional performance are modulated by the presence/absence of sleep disorders, and by age and years on the job.
According to our hypothesis, differences between different shifts will be associated to the presence of sleep disorders, as assessed by the Pittsburgh Sleep Quality Index (PSQI).
METHODS Morning, afternoon, and night shifts will be compared with respect the presence of tiredness, sleepiness, and performance at the Psychomotor Vigilance Task (PVT) in a sample of 80 nurses working in 8-h rapidly rotating pattern. Subsequently, a within-subject Analysis of Covariance (ANCOVA), Gender x Shift (M vs. A vs. N), Analysis of Covariance (ANCOVA), considering Age and Years on the job as covariates, will assess the effect of shifts on the sustained attention. Finally, the sample will be divided as a function of the presence/absence of sleep problems as measured by the PSQI, and the effect of shift will be separately evaluated in the two groups.
The night shift, with its overnight duty hours, is a prominent feature of health care providers and a necessary part of a 24-hour healthcare institution. During clinical cares, time pressure and increasing fatigue have additive negative effects, such as in reducing alertness and enhancing the risk for errors in clinical judgment, in administration of medications, in decision making and new or unfamiliar professional manoeuvres that require complex cognitive skills.
Prolonged work shifts, or night shifts, lead to a poor quantity/quality of sleep. Medication errors and, more in general, performance is mainly compromised by the altered sleep-wake rhythm. Tiredness, as a consequence of insufficient or poor quality sleep over a prolonged period, can lead to difficulty in attention and concentration, reduced motivation, irritability, misperception, memory lapses, decreased reaction times, loss of empathy and errors of judgment.
Since in a previous study with a small sample of italian nurses we have demonstrated that night shifts are associated with significant greater sleepiness and tiredness, and worsened attentional performance, it is mandatory to extend the findings of our pilot study and specifically address the issue of moderating factors.
The originality of the current project is represented by the large sample and by the evaluation of the moderating effects of (A) presence/absence of sleep disorders; (B9 age; (C) years on the job.
In our opinion, this project will allow to consolidate our knowledge of the factors affecting sleepiness and decreased performanc ein night shifts, paving the way to new projects directly aimed to develop specific countermeasures.
Concerning developing adequate countermeasures, we think that the core issue is represented by continuous monitoring of sleep-wake schedules in nurses and, in general, in medical personnel. Actigraphy may be considered as a useful tool for estimating sleep measures and trigger appropriate countermeasures when a sleep disorder or an altered sleep-wake schedule is suspected. Not alternatively, healthcare should consider the possibility to introduce a behavioral measure for monitoring sleepiness during night shifts. Finally, we think that the most crucial change in nursing practice should consider effective treatments for reducing sleepiness associated with night shifts. For this reason, we plan, as a future continuation of the current project to introduce an exposition to bright light at the start of the night shift, aiming to reduce sleepiness at the levels of morning and afternoon shifts.