Using pharmacological aids to improve waking function and sleep while working at night

Non-refreshing or insufficient sleep, and impaired alertness on the job, are two nearly universal consequences of night work. The effects of drugs upon the sleep and alertness of night workers has only recently been studied and much work remains to be done. To date, it is clear that sleep during the day can be improved with sedative-hypnotic compounds, particularly the benzodiazepines. Despite improvement in sleep, alertness at night is improved only mildly, if at all, with short-acting sleeping agents and can be further impaired with long-acting drugs. The limited research examining alertness and performance during night shift hours after administration of CNS stimulants suggests significant benefits. The judicious use of CNS stimulants in this way needs further exploration. Precise pharmacological manipulation of the endogenous sleep/wake rhythm is primarily theoretical at this time but should be pursued.     

The many meanings of sleep

Reductions in sleep are concomitant with night shift work. Data are presented showing that these robust differences in sleep are even present in experienced permanent night shift workers who most prefer to work nights. A model is presented which relates these reductions to chronic sleep deprivation. This, in turn, may be associated with performance decrements, and lead to accidents and illness. Better work schedule selection, worker training programs, and preventive medical action are unproven but promising approaches to overturning this model.     

Ten-hour days and eight-hour nights: Can the Ottawa Shift System reduce the problems of shiftwork?

Most research on condensed working weeks has concentrated either on daywork only or on 12-h shifts. The Police Force in Ottawa, Canada, have been reporting positive experiences with a shift system which retains an 8-h night shift but which extends the day shifts to 10-h, thus enabling a 6-day rest period following night shifts. In the present study, the effects on well-being, personal, social and work disruption, alertness and sleep were evaluated when the same system was adopted by a police force in the UK. A survey was conducted at four police stations prior to the change and again 6 months after the change. Two of the stations did not change to the Ottawa system and hence formed a control group. The stations originally worked 8-h shifts with blocks of seven consecutive shifts. The results suggest that, in contrast to the control group the 'Ottawa' group experienced a significant improvement in well-being, a significant reduction in personal, social and work disruption, and a significant increase in average sleep duration over a shift cycle. Self-rated alertness at the end of shifts was no worse under the Ottawa system. However, the values were still very low at the end of the night shift and, with an average sleep duration between night shifts of only 6-4-h it suggests that the block of seven nights in the Ottawa system may need review.     

The after-effects of a prolonged period of day-sleep on subjective sleep quality

The effects of day-sleep on the quality ofsleep are not restricted to the night-work period itself. Effects can be measured during night-sleep in the period following night-work. A study on these after-effects, using a self-report instrument to measure sleep quality, is described. A total of N=7O operators wcrc observed over five consecutive undisturbed nights after a working period of seven morning shifts (N= 35) and after a working period of seven night-shifts (N= 35). The quality of sleep during the third night after the night-shift period was still significantly worse than the third night after the rnorning-shift period. No differential (after-)effects were observed with respect to differences in sleep duration.     

Is there an optimum number of night shifts? Relationship between sleep, health and well-being

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health: i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.     

Is there an optimum number of night shifts? Relationship between sleep, health and well-being

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.     

Is there an optimum number of night shifts? Relationship between sleep,health and well-being

Abstract

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health: i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.     

Stress states in nuclear operators under conditions of shiftwork

This study examined the stress states experienced by nuclear power operators at work under an existing shift system, time-on-shift effects and the manner in which these states may be moderated by achievement motivation and a sense of coherence. The results show an incidence of stress states during evening shifts and night-shifts in the operators, which are primarily characterized by increased distraction as well as by enhanced sleepiness and low irritability. The night-shift was found to be the most problematic one in terms of increased sleepiness and distractibility, and reduced alertness. An abrupt fall in alertness during the evening shift and a considerably increased distractibility at its end was observed. These facts, as well as the lack of recuperation from daily domestic activities and caring for children at the start of the shift, suggest that besides the night duty, the evening one also constitutes a serious challenge to operational safety at this nuclear facility. Correlations found between personality characteristics and sleepiness, distractibility and irritability, indicate personal resources as important modifiers of stress states. A narrowing in the effects of motivation and sense of coherence was found in the evening shifts and night-shifts. The results have practical implications for intentional modifications of personal resources at nuclear facilities.     

Stress states in nuclear operators under conditions of shiftwork

Abstract

This study examined the stress states experienced by nuclear power operators at work under an existing shift system, time-on-shift effects and the manner in which these states may be moderated by achievement motivation and a sense of coherence. The results show an incidence of stress states during evening shifts and night-shifts in the operators, which are primarily characterized by increased distraction as well as by enhanced sleepiness and low irritability. The night-shift was found to be the most problematic one in terms of increased sleepiness and distractibility, and reduced alertness. An abrupt fall in alertness during the evening shift and a considerably increased distractibility at its end were observed. These facts, as well as the lack of recuperation from daily domestic activities and caring for children at the start of the shift, suggest that besides the night duty, the evening one also constitutes a serious challenge to operational safety at this nuclear facility. Correlations found between personality characteristics and sleepiness, distractibility and irritability, indicate personal resources as important modifiers of stress states. A narrowing in the effects of motivation and sense of coherence was found in the evening shifts and night-shifts. The results have practical implications for intentional modifications of personal resources at nuclear facilities.     

Dealing with shift work: Physical fitness, temperature, and napping

This paper reviews the effects of generally controllable factors such as physical conditioning, ambient temperature, and amount of prior sleep in adjustment to night work periods and shift work. One can expect a 5-10% decline in capacity for work in nocturnal work periods as compared to daytime work periods. This decreased capacity would dissipate if workers maintained a consistent sleep-wake routine for 8-16 days after moving to a new shift. Proven means for accelerating this adaptation are currently not available. The ability to perform work also declines as the length of the work period increases but depending upon individual tasks. Physical conditioning improves mood and general well-being, but no strong evidence currently indicates that conditioning increases tolerance or adjustment to shift work.

Increased ambient temperature increases the stress of work, although studies do not address heat as a factor in adjustment to shift work. While lower nocturnal temperature would be assumed to reduce heat stress during night shifts, supporting data does not exist. Studies have not addressed the negative consequences of cold stress or of rotating from night to day shifts with added heat stress.

The proper use of short sleep periods either as preparation for or as a response to a shift change can ameliorate some effects of shift rotation. Data indicate that performance on 'graveyard' shifts can be maintained close to baseline levels following true prophylactic naps while performance may decline by up to 30% when such naps are not taken. While there is evidence that naps or even rest periods without sleep are beneficial in improving mood in normal young adults, these data do not apply to 'replacement' naps. Studies of interjected naps imply that such naps do reduce sleep debt but do not imply that such naps are more beneficial than longer sleep periods. Naps appear to be most advantageous when the accumulated sleep debt is least.     

A new quantitative method for assessing sleepiness: The alpha attenuation test

Abstract

Sleepiness interferes with the ability of night-workers and shiftworkers to safely and effectively perform their jobs, and has been increasingly recognized as a major cause of industrial and transportation accidents. Current methods for the assessment of physiological sleepiness levels, such as the Multiple Sleep Latency Test (MSLT) have several limitations and are particularly impractical in field or occupational studies. In this study, the effectiveness of the Alpha Attenuation Test (AAT) for the quantification of sleepiness has been evaluated and compared to the MSLT during a 40-h sleep deprivation protocol. The AAT, a 12-min eye closed/open protocol, is a quantitative method based on the fact that EEG alpha (8-12 Hz) activity tends to increase with eyes open as individuals get sleepier, while it decreases with eyes closed. In this validation study, the AAT proved to be a sensitive measure of sleepiness induced by sleep deprivation, and it also correlated well with the MSLT. Relative to the MSLT, the AAT has the advantages of being objective, minimally intrusive, and more practical especially in industrial or field studies.     

The next step for physician executives?

The next step for career growth for many physician executives will be the top leadership role in a health care organization. The availability of such positions for physicians has been limited in the past but could very well open in the future. As physicians, administrators, and boards begin to trust each other more and form meaningful partnerships, the potential for physician CEOs increases. In 1997, the Physician Executive Management Center conducted surveys of physicians serving in CEO roles in hospitals and group practices throughout the country. We compared the results with earlier surveys we had conducted since 1986. This article reports the significant findings of these surveys on areas such as employment contracts, job duties, skills and talents, and remuneration.     

Lonely at the top and loving it: physicians as CEOs

As little as five years ago, most hospital board members scoffed at the idea of hiring physicians as chief executive officers or chief operating officers. Physicians, they maintained, belonged at the bedside, not in the board room. For the most part, physicians didn't take issue with this thinking. Profit and loss statements, strategic planning, and other CEO duties were alien. Besides, being a "suit" was unconscionable, a total fall from the true grace of medicine: patient care. Dramatic changes in health care have wrought dramatic changes in the mindsets of both board members and physicians. Today, both sides have developed a new perspective on physicians in top hospital administrative positions. In this article, the author reports on the experiences of physician executives who have made the trip to the top.     

Provider satisfaction: an analysis based on expectation

Provider organizations will need to be in closer touch with their medical staffs in order to successfully anticipate and react to the many changes that lie ahead in the financing and delivery of health care services. This will mean understanding both physicians feelings and expectations. If you were asked today how satisfied your physicians are with your HMO, what would be your reply? How would you know? This staff-model HMO conducted a formal survey of its physicians to determine their expectations of the organization and their level of satisfaction with their work and environment. Such a tool is recommended for others interested in maintaining good relations with their physicians.     

When Conscientiousness Isn’t Enough: Emotional Exhaustion and Performance Among Call Center Customer Service Representatives

The authors examined the relationship of the interaction between emotional exhaustion and conscientiousness with objectively-measured call volume performance and subjectively-measured service quality ratings among 92 call center customer service representatives (CSR’s) of a financial services institution. Results supported the interactive effects on call volume but not service quality. Specifically, the relationship between emotional exhaustion and call volume was stronger among high- than low-conscientiousness CSR’s. Among CSR’s reporting low levels of emotional exhaustion, those high in conscientiousness achieved higher call volumes than those low in conscientiousness. In contrast, among CSR’s reporting high levels of emotional exhaustion, those high in conscientiousness achieved lower call volumes than those low in conscientiousness. Implications for both the personality and stress literatures are discussed. Practical implications for human resources managers also are offered.     

Proactive coping with job insecurity: Is it always beneficial to well-being?

With reference to conservation of resources theory, the authors explored the role of proactive coping in relation to both positive and negative aspects of employee well-being (happiness and depression) when confronted with job insecurity. The authors investigated if coping efficiency improves when employees are highly committed to work, that is, when they have a high level of work involvement. Results of tests with samples of 162 Austrian and 444 Taiwanese employees revealed that, overall, proactive coping was positively related to employee well-being if the perception of job insecurity was low. However, in the case of high job insecurity, the beneficial effect of proactive coping was present only among employees with high work involvement. The interaction was significant for feelings of depression in the Austrian sample and for feelings of happiness in the Taiwanese sample. The findings suggest that if a person experiences job insecurity, the efficiency of proactive coping might depend on the person's work-related attitudes and beliefs, such as work involvement, that serve as coping resources.     

Effects of sleep inertia on cognitive performance following a 1-hour nap

Abstract

This study investigated the effects of a 1-h nap on subsequent performance in spatial memory (SM) and logical reasoning (LR) tasks. The objective was to evaluate the duration of the effects of sleep inertia (SI). The performance was measured in two independent groups of subjects. The 1-h nap took place at 00:00 h in group 1 and at 03:00 h in group 2. In each task, the experimental design comprised one no-nap condition in which subjects had no sleep before the night tests, and a nap condition that comprised the 1-h nap followed by the test sessions. To measure the duration of SI effects, the subjects were tested in two 30-min sessions and the data in each session were analysed in sub-units of time of 3 min each. In each task the results showed no effects on accuracy, and no circadian effects of napping were found. In each task, analyses of pooled data of the two groups showed that the performance in the 1-h nap condition exhibited significant reductions of speed immediately following awakening, when compared with no-nap, reflecting SI effects. In SM, the slowing lasted 24 min, and 27 min in LR. Practical implications of the results are discussed.     

Effects of sleep inertia on cognitive performance following a 1-hour nap

This study investigated the effects of a 1-h nap on subsequent performance in spatial memory (SM) and logical reasoning (LR) tasks. The objective was to evaluate the duration of the effects of sleep inertia (SI). The performance was measured in two independent groups of subjects. The 1-h nap took place at 00:00 h in group 1 and at 03:00 h in group 2. In each task, the experimental design comprised one no-nap condition in which subjects had no sleep before the night tests, and a nap condition that comprised the 1-h nap followed by the test sessions. To measure the duration of SI effects, the subjects were tested in two 30-min sessions and the data in each session were analysed in sub-units of time of 3 min each. In each task the results showed no effects on accuracy, and no circadian effects of napping were found. In each task, analyses of pooled data of the two groups showed that the performance in the 1-h nap condition exhibited significant reductions of speed immediately following awakening, when compared with no-nap, reflecting SI effects. In SM, the slowing lasted 24 min, and 27 min in LR. Practical implications of the results are discussed.     

Group Emotions: Cutting the Gordian Knots Concerning Terms,Levels of Analysis,and Processes

Abstract

Research has established that groups are pervaded by feelings. But group emotion research within organizational science has suffered in recent years from a lack of terminological clarity, from a narrow focus on small groups, and from an overemphasis on micro-processes of emotion transmission. We address those problems by reviewing and systematically integrating relevant work conducted not only in organizational science, but also in psychology and sociology. We offer a definition of group emotions and sort the conceptual space along four dimensions: group emotion responses, recognition, regulation, and reiteration. We provide evidence that group emotions occur at all levels of analysis, including levels beyond small work groups. The accounts of group emotion emergence at higher levels of analysis differ substantially between organizational science, psychology, and sociology. We review these accounts—emergence through inclination, interaction, institutionalization, or identification—and then synthesize them into one parsimonious model. The consequences of different group emotions are reviewed and further constructs (including emotional aperture, group emotional intelligence, emotional culture, and emotional climate) are discussed. We end with a call for future research on several neglected group emotion topics including the study of discrete shared emotions, emotions at multiple levels, the effects of social network patterns, and effects on group functioning.     

Senior physician slowdown-problem or opportunity?

Examine a plan for physician slowdown or relief of call and learn how it can extend the professional lives of experienced physicians at a time when practices are facing a physician shortage.