Differences in Sleep, Fatigue, and Neurocognitive Function between Shift Nurses and Non-shift Nurses

Yoo Jin Jung; Seung Wan Kang

doi:10.7475/kjan.2017.29.2.190

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Jung and Kang: Differences in Sleep, Fatigue, and Neurocognitive Function between Shift Nurses and Non-shift Nurses

Original Article

Korean J Adult Nurs 2017;29(2):190-199.

Published online: 9 April 2017

DOI: https://doi.org/10.7475/kjan.2017.29.2.190

Differences in Sleep, Fatigue, and Neurocognitive Function between Shift Nurses and Non-shift Nurses

Yoo Jin Jung, MSN, RN¹, Seung Wan Kang, Ph.D., M.D.^2,

¹Nurse, Samsung Medical Center, Seoul, Korea

²Assistant Professor, College of Nursing • Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: Kang, Seung Wan College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8824, Fax: +82-2-745-7422, E-mail: drdemian@snu.ac.kr

- This manuscript is revision of the first author's thesis from Seoul National University.

Received 26 February 20175 April 2017 Accepted 25 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to investigate the differences in sleep, fatigue, and neurocognitive function between shift nurses and non-shift nurses.

Methods

A cross-sectional descriptive study design was used. A total of 100 nurses participated in the study. 50 were shift nurses and the remaining 50 were non-shift nurses. The Pittsburgh Sleep Quality Index, Fatigue Severity Scale, and a computerized neurocognitive function test (CNS Vital Signs-VS4) were administered to the subjects to assess verbal and visual memory, processing speed, reaction time, and simple attention. After the last night shift, the shift nurse conducted the study at around 8:00 am and the non-shift nurse participated after work.

Results

Compared to non-shift nurses, shift nurses had a significantly lower sleep quality (p=.002) and higher fatigue (p=.001) and achieved significantly lower scores on verbal memory (p=.001), processing speed (p=.003), and reaction time (p=.018). There were significant correlations between sleep quality and processing speed (p=.042), and reaction time (p=.015) of shift nurses who were bad sleepers.

Conclusion

This study findings suggest shift work could interfere with cognitive function. Personal and organizational programs should be developed to support their sleep and neurocognitive function.

Keywords: Shift work, Nurses, Sleep, Fatigue, Cognition

REFERENCES

1. Edéll-Gustafsson UM, Kritz EI, Bogren IK. Self reported sleep quality, strain and health in relation to perceived working conditions in females. Scandinavian Journal of Caring Sciences. 2002; 16(2):179–87. https://doi.org/10.1046/j.1471-6712.2002.00078.x.

2. Han KS, Park EY, Park YH, Lim HS, Lee EM, Kim L, et al. Factors influencing sleep quality in clinical nurses. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2011; 20(2):121–31. https://doi.org/10.12934/jkpmhn.2011.20.2.121.

3. Harris A, Waage S, Ursin H, Hansenå M, Bjorvatn B, Eriksen HR. Cortisol, reaction time test and health among offshore shift workers. Psychoneuroendocrinology. 2010; 35(9):1339–47. https://doi.org/10.1016/j.psyneuen.2010.03.006.

4. Kunert K, King ML, Kolkhorst FW. Fatigue and sleep quality in nurses. Journal of Psychosocial Nursing and Mental Health Services. 2007; 45(8):30–7.

5. Moon IO, Lee YJ. Factors influencing fatigue, physical health status and negative affectivity in shift-working nurses. Womens' Studies Forum. 2015; 25(3):45–68.

6. Lee KS, Kwon IS, Cho YC. Relationships between quality of sleep and job stress among nurses in a university hospital. Journal of the Korea Academia-Industrial cooperation Society. 2011; 12(8):3523–31. https://doi.org/10.5762/KAIS.2011.12.8.3523.

7. Yi YH, Choi SJ. Association of sleep characteristics with medi-cation errors for shift work nurses in intensive care units. Journal of Korean Academy of Fundamentals of Nursing. 2014; 21(4):403–12. https://doi.org/10.7739/jkafn.2014.21.4.403.

8. Kim MS, Kim JR, Park KS, Kang YS, Choe MSP. Associations between sleep quality, daytime sleepiness, with perceived errors during nursing work among hospital nurses. Journal of Agricultural Medicine and Community Health. 2013; 38(4):229–42. https://doi.org/10.5393/jamch.2013.38.4.229.

9. Rouch I, Wild P, Ansiau D, Marquié JC. Shiftwork experience, age and cognitive performance. Ergonomics. 2005; 48(10):1282–93. https://doi.org/10.1080/00140130500241670.

10. Lee JT, Lee KJ, Park JB, Lee KW, Jang KY. The relations between shiftwork and sleep disturbance in a university hospital nurses. Korean Journal of Occupational and Environmental Medicine. 2007; 19(3):223–30.

11. Suzuki K, Ohida T, Kaneita Y, Yokoyama E, Miyake T, Harano S, et al. Mental health status, shift work, and occupational acci-dents among hospital nurses in Japan. Journal of Occupational Health. 2004; 46(6):448–54. https://doi.org/10.1539/joh.46.448.

12. Curcio G, Ferrara M, De Gennaro L. Sleep loss, learning ca-pacity and academic performance. Sleep Medicine Reviews. 2006; 10(5):323–37. https://doi.org/10.1016/j.smrv.2005.11.001.

13. Åkerstedt T, Wright KP. Sleep loss and fatigue in shift work and shift work disorder. Sleep Medicine Clinics. 2009; 4(2):257–71. https://doi.org/10.1016/j.jsmc.2009.03.001.

14. Shin SW, Kim SH. Influence of health-promoting behaviors on quality of sleep in rotating-shift nurses. Journal of Korean Academy of Fundamentals of Nursing. 2014; 21(2):123–30. https://doi.org/10.7739/jkafn.2014.21.2.123.

15. Lin SH, Liao WC, Chen MY, Fan JY. The impact of shift work on nurses' job stress, sleep quality and self perceived health status. Journal of Nursing Management. 2014; 22(5):604–12. https://doi.org/10.1111/jonm.12020.

16. Dorrian J, Tolley C, Lamond N, van den Heuvel C, Pincombe J, Rogers AE, et al. Sleep and errors in a group of Australian hospital nurses at work and during the commute. Applied Ergonomics. 2008; 39(5):605–13. https://doi.org/10.1016/j.apergo.2008.01.012.

17. Machi MS, Staum M, Callaway CW, Moore C, Jeong K, Suya-ma J, et al. The relationship between shift work, sleep, and cognition in career emergency physicians. Academic Emergency Medicine. 2012; 19(1):85–91. https://doi.org/10.1111/j.1553-2712.2011.01254.x.

18. Rollinson DC, Rathlev NK, Moss M, Killiany R, Sassower KC, Auerbach S, et al. The effects of consecutive night shifts on neuropsychological performance of interns in the emergency department: a pilot study. Annals of Emergency Medicine. 2003; 41(3):400–6. https://doi.org/10.1067/mem.2003.77.

19. Kim HJ, Lee JH, Choi KG, Park KD, Chung EJ, Kim EJ, et al. Effects of sleep deprivation on attention and working memory in medical residents and interns. Journal of Korean Sleep Research Society. 2006; 3(2):85–92. https://doi.org/10.13078/jksrs.06015.

20. Özdemir PG, Selvi Y, Özkol H, Aydin A, Tülüce Y, Boysan M, et al. The influence of shift work on cognitive functions and ox-idative stress. Psychiatry Research. 2013; 210(3):1219–25. https://doi.org/10.1016/j.psychres.2013.09.022.

21. San Chang Y, Wu YH, Hsu CY, Tang SH, Yang LL, Su SF. Impairment of perceptual and motor abilities at the end of a night shift is greater in nurses working fast rotating shifts. Sleep Medicine. 2011; 12(9):866–9. https://doi.org/10.1016/j.sleep.2011.03.018.

22. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research. 1989; 28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4.

23. Krupp LB, LaRocca NG, Muir Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology. 1989; 46(10):1121–3. https://doi.org/10.1001/archneur.1989.00520460115022.

24. Gualtieri CT, Johnson LG. Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Archives of Clinical Neuropsychology. 2006; 21(7):623–43. https://doi.org/10.1016/j.acn.2006.05.007.

25. Åkerstedt T. Shift work and disturbed sleep/wakefulness. Occupational Medicine. 2003; 53(2):89–94. https://doi.org/10.1093/occmed/kqg046.

26. Garde AH, Hansenå M, Hansen J. Sleep length and quality, sleepiness and urinary melatonin among healthy Danish nurses with shift work during work and leisure time. International Archives of Occupational and Environmental Health. 2009; 82(10):1219–28. https://doi.org/10.1007/s00420-009-0419-4.

27. Hong EJ, Choi Kwon S. Effects of sleep and fatigue on soldiers health promoting behaviors in Korean army. Korean Journal of Adult Nursing. 2016; 28(1):106–15. https://doi.org/10.7475/kjan.2016.28.1.106.

28. Kleinman L, Zodet MW, Hakim Z, Aledort J, Barker C, Chan K, et al. Psychometric evaluation of the fatigue severity scale for use in chronic hepatitis C. Quality of Life Research. 2000; 9(5):499–508. https://doi.org/10.1023/A:1008960710415.

29. Kazemi R, Haidarimoghadam R, Motamedzadeh M, Golmo-hammadi R, Soltanian A, Zoghipayar MR. Effects of shift work on cognitive performance, sleep quality, and sleepiness among petrochemical control room operators. Journal of Circadian Rhythms. 2016; 14(1):1–8. https://doi.org/10.5334/jcr.134.

30. Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005; 25(1):117–29. https://doi.org/10.1055/s-2005-867080.

Table 1.

Comparison of Nurses' General and Career Characteristics (N=100)

Characteristics	Categories	Shift nurse (n=50)	Non-shift nurse (n=50)	x² or t	p
Characteristics	Categories	n (%) or M± SD	n (%) or M± SD	x² or t	p
Gender	Male	5 (10.0)	0 (0.0)	5.26	.056
Gender	Female	45 (90.0)	50 (100.0)
Age (year)	20~29	31 (62.0)	10 (20.0)	-5.62	.001
	30~39	18 (36.0)	37 (74.0)
	≥40	1 (2.0)	3 (6.0)
		29.1±3.8	34.7±4.6
Educational level	Diploma	1 (2.0)	3 (6.0)	3.15	.235
	Bachelor	44 (88.0)	37 (74.0)
	≥ Master	10 (10.0)	10 (20.0)
Intake of caffeinated drink	Never	5 (10.0)	7 (14.0)	2.67	.422
	Once/day	27 (54.0)	21 (42.0)
	2~3 times/day	17 (34.0)	22 (44.0)
	≥4 times/day	1 (2.0)	0 (0.0)
Alcohol intake	Never	15 (30.0)	17 (34.0)	1.81	.771
	＜4 times/month	11 (22.0)	10 (20.0)
	Once/week	7 (14.0)	9 (18.0)
	2~3 times/week	9 (18.0)	10 (20.0)
	≥4 times/week	8 (16.0)	4 (8.0)
Experience of nursing practice (year)	＜5	17 (34.0)	10 (20.0)	-1.16	.249
	5~10	29 (58.0)	34 (68.0)
	11~15	3 (6.0)	5 (10.0)
	＞15	1 (2.0)	1 (2.0)
		5.79±3.37	6.55±3.20
Frequency of night duty	Never	0 (0.0)	50 (100.0)	125.56	.001
	＜3/month	0 (0.0)
	3~4 times/month	1 (2.0)
	5~6 times/month	16 (32.0)
	7~8 times/month	31 (62.0)
	≥9 times/month	2 (4.0)

Table 2.

Comparison of Sleep Quality and Fatigue between Shift Nurse and Non-shift Nurse (N=100)

Variables	Categories	Shift nurse (n=50)	Non-shift nurse (n=50)	F	p^†
Variables	Categories	M± SD	M± SD	F	p^†
Sleep quality	PSQI score	7.46±3.59	5.52±2.81	9.71	.002
	Overall sleep quality	1.60±0.07	1.18±0.56	17.13	.001
	Sleep latency	1.78±0.95	1.08±0.94	18.59	.001
	Sleep duration	0.86±1.07	1.08±0.92	0.45	.506
	Sleep efficiency	0.68±1.09	0.40±0.73	0.76	.385
	Sleep disturbance	1.12±0.52	1.04±0.53	2.45	.121
	Day dysfunction due to sleepiness	1.42±0.93	0.74±0.88	7.58	.007
	Need medications to sleep	0	0
Fatigue	Fatigue severity scale	4.44±0.93	3.59±0.92	21.97	.001

^† Analyzed by ANCOVA for age difference.

Table 3.

Comparison of Neurocognitive Function between Shift Nurse and Non-shift Nurse (N=100)

Variables	Shift nurse (n=50)	Non-shift nurse (n=50)	t	p
Variables	M± SD	M± SD	t	p
Verbal memory	82.46±28.24	100.38±20.75	-3.62	.001
Visual memory	97.10±19.71	104.08±16.93	-1.90	.060
Processing speed	109.26±17.96	119.84±17.05	-3.02	.003
Reaction time	90.02±26.58	100.22±13.67	-2.41	.018
Simple attention	71.68±17.40	94.14±38.25	-1.96	.054

Table 4.

Comparison of Neurocognitive Function with Sub Category between Shift Nurse and Non-shift Nurse (N=100)

Variables	Categories	Shift nurse (n=50)	Non-shift nurse (n=50)	t	p
Variables	Categories	M± SD	M± SD	t	p
Verbal memory	Correct hits immediate	94.08±23.06	103.22±16.56	-2.28	.025
	Correct passes immediate	98.44±24.35	99.28±14.25	-0.21	.834
	Correct hits delay	75.48±35.89	97.96±26.67	-3.56	.001
	Correct passes delay	97.72±25.39	100.86±13.89	-0.77	.445
Processing speed	Correct response	110.74±18.19	120.36±17.10	-2.73	.008
Processing speed	Errors	94.84±15.48	97.14±12.38	-0.82	.414
Reaction time	Simple reaction time	69.47±39.30	86.59±10.36	-2.83	.007
	Complex reaction time correct	85.96±22.97	95.44±15.98	-2.40	.018
	Stroop commission errors	78.08±59.98	87.40±25.48	-1.01	.314

Table 5.

Correlations of Sleep Quality, Fatigue, and Neurocognitive Function of the Shift Nurses Who were Bad Sleepers (N=40)

Variables	Sleep quality	Fatigue	Neurocognitive function
	Sleep quality	Fatigue	Verbal memory	Visual memory	Processing speed	Reaction time	Simple attention
	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Sleep quality	1
Fatigue	0.57 (＜.001)	1
Verbal memory	-0.05 (.762)	-0.04 (.818)	1
Visual memory	-0.26 (.110)	-0.15 (.353)	0.49 (.001)	1
Processing speed	-0.32 (.042)	-0.26 (.102)	0.17 (.291)	0.41 (.009)	1
Reaction time	-0.34 (.015)	-0.09 (.584)	0.15 (.348)	0.24 (.145)	0.59 (＜.001)	1
Simple attention	-0.16 (.329)	-0.03 (.849)	0.25 (.127)	0.43 (.007)	0.53 (.001)	0.58 (＜.001)	1

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