Importance: The effects of fast-rotating backward-shift work on subjective and objective measures of sleep-wake quality, daytime attention, and tiredness of healthcare workers have not yet been established.
Objective: To investigate the effect of shift rotation direction on tiredness, sleepiness, and sustained attention among nurses working forward and backward-rotation shifts.
Design: Data will be collected in 128 nurses from five Italian hospitals who are working forward or backward-rotation shifts after three-shift systems (morning, afternoon, and night).
Setting: Five mid-sized hospitals in Italy.
Participants: The participants will comprise 128 nurses of whom 64 have a forward-rotating schedule (i.e., morning to afternoon to night), and 64 have a backward-rotating schedule (i.e., afternoon to morning to night).
Main Outcomes and Measures: Sleep data will be collected using the Karolinska Sleepiness Scale and Pittsburgh Sleep Quality Index. Sustained attention will be measured using the Psychomotor Vigilance Task. Tiredness will be evaluated using the Tiredness Symptom Scale.
Relevance: Direction of shift rotation model is susceptible to negatively affect health and cognitive performance. Our project is aimed to demonstarate how forward rotation may be more beneficial than backward rotation for several measured performance attentional outcomes, tiredness, and sleepiness.
Within this framework, optimization of shift rotations may be implemented to decrease the combination of the negative effects of shift work and reduce the potential risk of medical errors in healthcare systems.
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.
In previous studies, we have demonstrated that (A) night shifts are associated with significant greater sleepiness and tiredness, and worsened attentional performance, and (B) the presence of a poor sleep quality as moderating factor. In the current project, we will investigate on the specific effect of the direction of rotation.
The originality of the current project is represented by the large sample and by the behavioral evaluation of the effects of increased sleepiness.
In our opinion, this project will allow to consolidate our knowledge of the factors affecting sleepiness and decreased performanc in night shifts, paving the way to new projects directly aimed to develop specific countermeasures.
Concerning developing adequate countermeasures, 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. Directly consequence of the current project, if it will confirm the hypothesis, changes in the direction of rotating shifts can be implemented without additional costs