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.
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
25. Åkerstedt T. Shift work and disturbed sleep/wakefulness. Occupational Medicine. 2003; 53(2):89–94. https://doi.org/10.1093/occmed/kqg046.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
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.
Table 1.
Comparison of Nurses' General and Career Characteristics (N=100)
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† |
---|---|---|---|---|---|
M± SD | M± SD | ||||
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 |
Table 3.
Comparison of Neurocognitive Function between Shift Nurse and Non-shift Nurse (N=100)
Table 4.
Comparison of Neurocognitive Function with Sub Category between Shift Nurse and Non-shift Nurse (N=100)
Table 5.
Correlations of Sleep Quality, Fatigue, and Neurocognitive Function of the Shift Nurses Who were Bad Sleepers (N=40)