Relationship between Sleep and Subjective Fatigue in Rotating Shift Nurses: Validation Using a Wearable Device

Yuko Yoshida,Naotaka Sugimura,Naomi Sumi,Rika Yano,Fumie Nemoto

doi:10.4236/ojn.2018.84023

Yuko Yoshida, Naotaka Sugimura + Show 3 more

Open Access

https://doi.org/10.4236/ojn.2018.84023

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Abstract

The objective of this study was to determine if sleep indicators are associated with subjective fatigue in nurses working in a rotating, two-shift system with a 16-hour night shift, using the wearable device Fitbit One. Subjective fatigue was evaluated using the Subjective Fatigue Symptom Questionnaire (SFSQ), a rating scale developed by the Working Group for Occupational Fatigue of the Japan Society for Occupational Health. Subjects were asked to continuously wear a Fitbit One to obtain the following data: time in bed (TIB), deep sleep time, length and frequency of nighttime awakening, sleep efficiency, waking time, and bed time. Nurses had a mean age and standard deviation of 33.2 ± 7.5 years and had worked as nurses for 9.8 ± 6.2 years on average. Eight nurses were in their 20s (42.1%), 5 in their 30s (26.3%), and 6 in their 40s (31.6%). All participants were female. Participants’ SFSQ scores calculated from the 9 evenings in the study period were averaged to establish a threshold for categorizing high-fatigue (HF) and low-fatigue (LF) groups. No significant differences were found between HF and LF nurses in terms of TIB, deep sleep time, nighttime awakening time or frequency, or sleep efficiency on any type of day (as classified by shift, day off, etc.). Nurses in both groups woke up significantly later on days off and on pre-night-shift days than on day-shift days. These results demonstrate the variation in sleep patterns of nurses on a rotating, two-shift system between day-shift and night-shift days.

Highlights

Excessive fatigue causes nurses to develop health problems, but it negatively impacts the safety of medical care by reducing their work efficiency and making them more prone to making medical errors
Nurses in both groups woke up significantly later on days off and on pre-night-shift days than on day-shift days. These results demonstrate the variation in sleep patterns of nurses on a rotating, two-shift system between day-shift and night-shift days
We investigated the associations between subjective fatigue and sleep indicators measured using this wearable device in rotating shift nurses, in an effort for these findings to serve as a basic reference for a potential simple method to identify early warning signs of fatigue in nurses

Summary

Introduction

Excessive fatigue causes nurses to develop health problems, but it negatively impacts the safety of medical care by reducing their work efficiency and making them more prone to making medical errors. Nurses who work in a rotating shift system may be required to work at night when they would normally be asleep. Night shifts place nurses under mental and physical stress that exceed those experienced when working during the day. In Japan, an increasing proportion of hospital wards operate under a rotating two-shift system, characterized by a long night-shift (of greater than 8 hours). The system was introduced to chronic wards that focused mostly on long-term medical care, but this trend has spread to acute and advanced wards. More than half of rotating two-shift systems incorporate a night shift of 16 hours or more [2]

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