On-shift and daily variations in self-report and performance measures in rotating-shift and permanent night nurses

Abstract

An intensive study was conducted of the influence of type of shift system, type of shift, and time-into-shift on a battery of on-shift and daily measures obtained from 61 female nurses over a 28-day period. Thirty-two rotating-shift nurses and 28 permanent night nurses recorded data on a hand-held computer at the start and end of each day, and every 2-h during their shifts. The measures included a sleep diary, self-ratings of mood, workload, and personal disruption, and two cognitive performance tasks. These results suggest that the permanent night nurses were no worse off and for some measures were actually better off than the rotating-shift nurses after controlling for differences in age and shiftwork experience; the night-shift was problematic for the rotating-shift nurses but so was the early shift; mood deteriorated and reaction time got slower over the course of the night-shift but extra long responses (which may correspond to lapses of attention) and rated workload were lower on the night-shift. The relatively large number of consecutive night-shifts worked by the rotating-shift nurses, the uneven distribution of workload between shifts, and the long night-shift may have contributed to these results.     

A 14-h night-shift in the control room of a fire brigade

Abstract

All 29 operators in the control room of a fire brigade performed test sessions during work and leisure time at 2-h intervals on a day with a 14-h night-shift, a day off and a day with a 10-h morning shift. The test sessions consisted of a visual search choice reaction time test and two Sternberg memory search tests (1 or 5 letters had to be memorized). Furthermore, the operators recorded their oral temperature and their subjective alertness before each test session. The subject also kept a diary of work and sleep times for 14 days. The circadian rhythm of body temperature was hardly changed by a single night-shift. Parallel to the body temperature, the subjective alertness fell significantly during the night-shift reaching a minimum value at 06:00 h. The mean reaction times increased non-significantly at the end of the night-shift and the results of the two Sternberg memory search tests showed no significant trends. The sleep of the operators after the night-shift was on average reduced to 5 hs 34 min. The results of subjective rating of alertness and reaction time test are interpreted as effects of the combined influences of circadian rhythmicity, sleep loss and time on professional task. Most results support the conclusion that a 14-h night-shift without extensive breaks is not acceptable.     

On-shift and daily variations in self-report and performance measures in rotating-shift and permanent night nurses

An intensive study was conducted of the influence of type of shift system, type of shift, and time-into-shift on a battery of on-shift and daily measures obtained from 61 female nurses over a 28-day period. Thirty-two rotating-shift nurses and 28 permanent night nurses recorded data on a hand-held computer at the start and end of each day, and every 2-h during their shifts. The measures included a sleep diary, self-ratings of mood, workload, and personal disruption, and two cognitive performance tasks. These results suggest that the permanent night nurses were no worse off and for some measures were actually better off than the rotating-shift nurses after controlling for differences in age and shiftwork experience; the night-shift was problematic for the rotating-shift nurses but so was the early shift; mood deteriorated and reaction time got slower over the course of the night-shift but extra long responses (which may correspond to lapses of attention) and rated workload were lower on the night-shift. The relatively large number of consecutive night-shifts worked by the rotating-shift nurses, the uneven distribution of workload between shifts, and the long night-shift may have contributed to these results.     

Modification of shiftwork effects by chemical workplace exposure

Abstract

Possible chronotoxic effects were the reason to study chemical workplace exposure under the special condition of shiftwork. Eight shiftworkers occupationally exposed to acetone vapours and eight controls were investigated during fast-rotated shiftwork. The mean concentration of acetone during the shifts was close to 1000 ppm (2400 mg/m³). Data on well-being and acute symptoms, but not on performance, indicate that the exposure contributed mainly in an additive way to the negative effects of shiftwork. As a consequence, the exposed shiftworkers revealed enhanced impairments during the night-shift.     

A 14-h night-shift in the control room of a fire brigade

All 29 operators in the control room of a fire brigade performed test sessions during work and leisure time at 2-h intervals on a day with a 14-h night-shift, a day off and a day with a 10-h morning shift. The test sessions consisted of a visual search choice reaction time test and two Sternberg memory search tests (1 or 5 letters had to be memorized). Furthermore, the operators recorded their oral temperature and their subjective alertness before each test session. The subject also kept a diary of work and sleep times for 14 days. The circadian rhythm of body temperature was hardly changed by a single night-shift. Parallel to the body temperature, the subjective alertness fell significantly during the night-shift reaching a minimum value at 06:00 h. The mean reaction times increased non-significantly at the end of the night-shift and the results of the two Sternberg memory search tests showed no significant trends. The sleep of the operators after the night-shift was on average reduced to 5 hs 34 min. The results of subjective rating of alertness and reaction time test are interpreted as effects of the combined influences of circadian rhythmicity, sleep loss and time on professional task. Most results support the conclusion that a 14-h night-shift without extensive breaks is not acceptable.     

Psychophysical conditions and hormonal secretion in nurses on a rapidly rotating shift schedule and exposed to bright light during night work

Abstract

The psychophysical conditions of 15 young female nurses, working in a rapidly-rotating shift system (2-2-2-2), modified according to some psychophysiological criteria, and exposed to short period (4 × 20 min) of bright light (2350 Lux) during their night duty, were studied in order to evaluate their adaptation to night work and to test a possible positive effect on it of bright light. Subjective evaluations of work load and psychophysical conditions, performance measures, hormonal excretion (cortisol, 6-sulphatoxymelatonin and catecholamines), oral temperature and activity-sleep logs were taken during the shiftwork cycle, comprising one morning, one afternoon and two consecutive nights under normal and bright light. The results showed that this rapidly-rotating shift system had little effect upon the normal circadian rhythms of the body. Moreover, the lengthening of the night shift to 10 h can be considered to be acceptable, provided that work load is reduced and there are sufficient rest pauses available. On the other hand, the reduction to 7 h of the length of the day shifts and delayed start of the morning shift to 07:00 h appeared to be convenient both in relation to the work load and sleep duration. Some positive effects of bright light upon psychophysical conditions and performance efficiency were noted, while hormonal excretion and body temperature did not show any effect of bright light; in particular, melatonin excretion was not suppressed appreciably by the bright light used.     

Interactive effect of individual factors on nurses' health and sleep

Abstract

There is a tendency in studies concerning individual diferences in shiftwork tolerance to analyse the moderating effect of individual factors separately as if they acted independently. The aim of this study was to examine the interactive effect of individual factors (i.e. morningness, flexibility, languidity, neuroticism, extroversion) on nurses' health and sleep. A hundred female nurses (mean age 25.9 years, SD = 3.7 years) working a 2 × 12-h shift system were chosen from a larger study conducted among Intensive Care Unit staff. All subjects completed the Standard Shiftwork Index. Multiple regression analyses show that interactions of neuroticism and other factors (languidity, morningness) predict the majority of health and sleep complaints rather than neuroticism itself. Correlation analyses revealed that the interaction of neuroticism and languidity correlates higher with some indices of impaired health and sleep disturbances than when these factors are taken separately. The contribution of flexibility together with extroversion in interactions with neuroticism, and with neuroticism and languidity weaken the relations of languidity and neuroticism with health and sleep indices. The results show that some individual features tend to strengthen or counteract one another in relation to symptoms of shiftwork intolerance.     

Psychophysical conditions and hormonal secretion in nurses on a rapidly rotating shift schedule and exposed to bright light during night work

The psychophysical conditions of 15 young female nurses, working in a rapidly-rotating shift system (2-2-2-2), modified according to some psychophysiological criteria, and exposed to short period (4 × 20 min) of bright light (2350 Lux) during their night duty, were studied in order to evaluate their adaptation to night work and to test a possible positive effect on it of bright light. Subjective evaluations of work load and psychophysical conditions, performance measures, hormonal excretion (cortisol, 6-sulphatoxymelatonin and catecholamines), oral temperature and activity-sleep logs were taken during the shiftwork cycle, comprising one morning, one afternoon and two consecutive nights under normal and bright light. The results showed that this rapidly-rotating shift system had little effect upon the normal circadian rhythms of the body. Moreover, the lengthening of the night shift to 10 h can be considered to be acceptable, provided that work load is reduced and there are sufficient rest pauses available. On the other hand, the reduction to 7 h of the length of the day shifts and delayed start of the morning shift to 07:00 h appeared to be convenient both in relation to the work load and sleep duration. Some positive effects of bright light upon psychophysical conditions and performance efficiency were noted, while hormonal excretion and body temperature did not show any effect of bright light; in particular, melatonin excretion was not suppressed appreciably by the bright light used.     

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.     

A 14-h night-shift in the control room of a fire brigade

All 29 operators in the control room of a fire brigade performed test sessions during work and leisure time at 2-h intervals on a day with a 14-h night-shift, a day off and a day with a 10-h morning shift. The test sessions consisted of a visual search choice reaction time test and two Sternberg memory search tests (1 or 5 letters had to be memorized). Furthermore, the operators recorded their oral temperature and their subjective alertness before each test session. The subject also kept a diary of work and sleep times for 14 days. The circadian rhythm of body temperature was hardly changed by a single night-shift. Parallel to the body temperature, the subjective alertness fell significantly during the night-shift reaching a minimum value at 06:00 h. The mean reaction times increased non-significantly at the end of the night-shift and the results of the two Sternberg memory search tests showed no significant trends. The sleep of the operators after the night-shift was on average reduced to 5 hs 34 min. The results of subjective rating of alertness and reaction time test are interpreted as effects of the combined influences of circadian rhythmicity, sleep loss and time on professional task. Most results support the conclusion that a 14-h night-shift without extensive breaks is not acceptable.     

Appropriate use of bright light promotes a durable adaptation to night-shifts and accelerates readjustment during recovery after a period of night-shifts

Abstract

The present study examines the stability of bright light circadian readjustment during two consecutive dim light night-work periods and circadian synchronization during the recovery after a night-shift period. A sample of 10 subjects was divided into 2 groups (control group: 6 subjects; experimental group: 4 subjects). All subjects worked during 5 days, between 23:00 and 07:00 h and then went to sleep. Subjects received 2500-3000 lux between 02:00 and 05:00 h during 5 days for the control group and 3 days for the experimental group. During recovery after the night-shift periods, three cycles of bright light were administered at two different times: 12:00-15:00 h for two of six subjects from the control group and 10:00-13:00 h for all subjects (4) of the experimental group. By the fifth cycle of night-work the maximum of urinary aMT6s excretion that occurs at 05:00 h in the baseline condition was shifted to 12:00 h for the control and experimental groups (delay in hours: 7±1.6 (control); 7±1 (experimental)). This result suggests that three cycles of bright light are sufficient to induce a significant phase delay and that this delay remained stable when night-work proceeded under dim light. The phase delay of the circadian aMT6s excretion by exposure to bright light was accompanied by an improvement of the quality of day sleep and level of cognitive and psychomotor performances for control and experimental groups. No significant difference was observed in the two groups for daytime sleep and nocturnal performance. The two bright light periods used during the three days of recovery induced a complete synchronization in five of six subjects. One subject showed a partial synchronization probably because he remained at the laboratory under dim light during the day and had few family and social contacts.     

Interactive effect of individual factors on nurses' health and sleep

There is a tendency in studies concerning individual diferences in shiftwork tolerance to analyse the moderating effect of individual factors separately as if they acted independently. The aim of this study was to examine the interactive effect of individual factors (i.e. morningness, flexibility, languidity, neuroticism, extroversion) on nurses' health and sleep. A hundred female nurses (mean age 25.9 years, SD = 3.7 years) working a 2 × 12-h shift system were chosen from a larger study conducted among Intensive Care Unit staff. All subjects completed the Standard Shiftwork Index. Multiple regression analyses show that interactions of neuroticism and other factors (languidity, morningness) predict the majority of health and sleep complaints rather than neuroticism itself. Correlation analyses revealed that the interaction of neuroticism and languidity correlates higher with some indices of impaired health and sleep disturbances than when these factors are taken separately. The contribution of flexibility together with extroversion in interactions with neuroticism, and with neuroticism and languidity weaken the relations of languidity and neuroticism with health and sleep indices. The results show that some individual features tend to strengthen or counteract one another in relation to symptoms of shiftwork intolerance.     

Sleep hygiene practices and sleep duration in rotating-shift shiftworkers

Abstract

Alcohol, caffeine and tobacco intake, exercise, activities on going to bed, and sleep-enhancing measures were assessed in 72 rotating-shift shiftworkers to determine whether these variables differ following day shifts and night-shifts, and which are related to sleep duration. Only alcohol intake and exercise prior to sleep, and feeling drowsy when retiring, differed following the night-shift. Workers generally followed recommendations concerning alcohol intake, sleeping immediately on retiring, and exercising, but acted contrary to recommendations concerning caffeine and nicotine intake. The only behaviour clearly associated with poor sleep was smoking, which reduced sleep duration.     

Shiftwork effects in nuclear power workers: A field study using portable computers

Abstract

This field study of nuclear power shiftworkers reports the use of hand-held computers to record alertness levels, cognitive task performance and workload ratings. Subjective ratings and performance tasks (Search and Memory-5 (SAM-5); Choice Reaction Time (CRT) were completed on the computers at 2-h intervals during selected shifts in the work schedule by maintenance crews and reactor operators. Sleep duration and quality data were also obtained during the 35-day shift cycle. Workload remained relatively stable across shifts. The night-shift was associated with shorter sleep durations and poorer sleep quality. Significantly lower levels of alertness and poorer perforniance for components of the performance tasks were also observed on the night-shift. Tinic-on-shift effects on alertness were evident, where by for the night-shift, especially, alertness dropped dramatically during the early hours. Components of SAM-5 performance showed differential time-on-shift patterning relative to each shift whereas CRT was unresponsive to time-on-shift effects. Significant variations were observed in alertness and performance components during the 12-h night-shift. Perhaps paradoxically, performance on the 12-h night-shift appeared to improve rather than deteriorate during the early-hour period that was associated with the greatest drop in alertness. This was suggestive of extra effort expenditure during this critical period.     

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.     

Changes in the structure of health complaints as related to shiftwork exposure

Abstract

Factor analyses of health complaints in groups with different length of shiftwork exposure show that the structure of these complaints changes with increasing shift experience, indicating the emergence of a shift-specific pattern of health complaints. After about 15 years of shiftwork, complaints related to disturbances of circadian-controlled functions can be found in the first factor whereas other complaints have their dominant loadings on a separate factor, representing general, non-shift-specific impairments. The results indicate that in this way shift-specific components of health impairment can be separated from other non-shift related components.     

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.     

Health, well-being and burnout of ICU nurses on 12- and 8-h shifts

It is generally agreed that some features of shift systems can influence the extent of well-being and health problems experienced by the workers involved. Extended working days (9-12 h) have been found to aggravate some problems associated with shiftwork, especially when the work is mentally and emotionally demanding. The aim of the study was to compare measures of health, sleep, psychological and social well-being, job satisfaction and burnout of ICU nurses on 12- and 8-h shifts. The groups of subjects were matced for age, length of shiftwork experience, marital status and number of hours worked. the 12-h shift nurses, when compared to their 8-h shift colleagues, experienced more chronic fatigue, cognitive anxiety, sleep disturbance and emotional exhaustion. Job satisfaction seems to be independent of the shift duration. The nurses on 12-h shifts reported less social and domestic disruption than those on 8-h shifts. The 12-h shift nurses showed worse indices of health, well-being and burnout tan the 8-h shift nurses. It is suggested that this may be associated with their longer daily exposure to the stress of work. The increased number of rest days of 12-h shift nurses seems tobe insufficient to dissipate the adverse health and well-being effects that built up over their longer shifts.     

Psychophysical conditions of air traffic controllers evaluated by the standard shiftwork index

Abstract

In the ambit of a large epidemiological survey on the Italian population of air traffic controllers, an evaluation of their health conditions was carried out using the Standard Shiftwork Index (SSI). The study took into consideration 572 male air traffic controllers, aged between 23 and 59 years, of whom 301 were engaged in three large Regional Centres, 189 in thirteen Airport Towers and 82. formerly active controllers, were working in administrative offices. The former controllers showed worse health levels, in particular minor psychological disorders and chronic fatigue. Sixteen of them had been transferred to administrative jobs because of health impairment, owing to severe diseases of the nervous, gastrointestinal and cardiovascular systems. Such disorders, and musculoskeletal ones, were mostly reported by the active controllers. The controllers engaged in Regional Centres showed more sleep disturbances than those engaged in towers. Beside age, some personal characteristics appeared to influence health and well-being. Neuroticism was correlated with chronic fatigue, digestive and cardiovascular complaints, minor psychological disorders, cognitive and somatic anxiety. On the other hand, morningness was correlated negatively with sleep disturbances on morning shift, and positively with sleep duration both on morning shift and rest days.     

Shiftwork locus of control: Scale development

Abstract

Shiftwork is a significant feature of occupational life for many people. It can have disruptive effects on sleep, health, social activity and performance. It is likely that beliefs about personal control will influence the individual-shiftwork relationship. This paper has two aims; first, to put forward the thesis that shiftwork-specific personal control expectancies may moderate the disruptive impact of shiftwork, and second, to report the development and preliminary validation of a shiftwork-specific locus of control scale. The scale demonstrated satisfactory psychominary qualities in terms of factor structure, internal reliability, construct validity and test-retest reliability. Variables associated with better coping with shiftwork such as alertness, flexibility of sleeping habits and the structured use of time correlated positively with shiftwork locus of control. In contrast, shiftwork locus of control was found to be inversely related to shiftwork problems such as sleep disturbance, poor mental well-being and work stress.