12-hour Shifts Research Articles

Nurses Turnover, Retention and Quality of Care Not Going Away, but Solutions Exist

Nursing is a challenging profession mentally, emotionally and physically. Nurses work in a fast-paced environment, providing patient care, assuring family members and keeping up with the newest techniques and procedures. Because of the stress involved in nursing, many healthcare organizations have a high rate of nurse turnover. Nurse turnover is a global concern that is both costly for healthcare organizations, and in the context of the work environment, affects quality and safety, he nursing shortage is a problem that is being experienced worldwide. It is a problem that could have a serious impact on providing quality healthcare. Understanding the reasons why nurses leave their place of employment are important. Reasons of nurse’s turnover are identified in existing surveys but the action must be implemented before nurses decide to leave. A happy, competent and skilled nurse can contribute to a positive patient experience. Long shift hours, double duties, over burden, mismanaged nurse patient ratio is a leading cause of nurse’s turnover.

Length of Clinical Shift on Quality of Care, Learning Outcomes, and Satisfaction in Prelicensure Nursing Programs

Some schools and nursing care organizations have implemented 12-hour shifts for students' clinical experiences. The aim of this review was to identify how student 12-hour shifts compared to shifts of less than 12 hours influence patient safety, care quality, learning outcomes, and student, faculty, and staff satisfaction. Searches for academic literature using electronic databases resulted in 13 primary research articles covering the period between 1982 and 2018. During longer clinical shifts, no change in patient safety events occurred. Students and clinical staff perceived care quality was maintained or influenced positively. Faculty were undecided or minimally did not believe care quality improved. While students perceived meeting learning outcomes, faculty perceptions were divided. Students were satisfied with longer shifts; however, the satisfaction of faculty and clinical staff was mixed. Within realms of patient safety, care quality, learning outcomes, and student, faculty, and clinical staff satisfaction, research has been insufficient and inconclusive regarding 12-hour student shifts.

Promoting Parent Partnership in Developmentally Supportive Care for Infants in the Pediatric Cardiac Intensive Care Unit.

Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress. This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery. The Care Partnership Pyramid was created by a multidisciplinary team and incorporated feedback from nurses and parents. Three Plan-Do-Study-Act (PDSA) cycles tested its impact on parent partnership in care. Information about developmentally supportive care provided by parents during each 12-hour shift was extracted from nursing documentation. A staff survey evaluated perceptions of the tool and informed modifications. Changes in parent partnership during PDSA 1 did not reach statistical significance. Staff perceived that the tool was generally useful for the patient/family but was sometimes overlooked, prompting its inclusion in the daily goals checklist. For PDSA 2 and 3, parents were more often observed participating in rounds, asking appropriate questions, providing environmental comfort, assisting with the daily care routine, and changing diapers. Use of a bedside visual tool may lead to increased parent partnership in care for infants after cardiac surgery. Future projects are needed to examine the impact of bedside care partnership interventions on parent preparedness, family well-being, and infant outcomes.

Study protocol for a prospective randomised double-blind placebo-controlled clinical trial investigating a Better Outcome with Melatonin compared to Placebo Administered to normalize sleep–wake cycle and treat hypoactive ICU Delirium: the Basel BOMP-AID study

IntroductionDelirium is frequently observed in the intensive care unit (ICU) population, in particular. Until today, there is no evidence for any reliable pharmacological intervention to treat delirium. The Basel BOMP-AID...

Evaluation of the carcinogenic risk of chemicals landfill of municipal solid waste

The paper assesses the carcinogenic risks from emissions of solid municipal waste landfill for the case when the residential development zone potentially falls within the boundaries of the sanitary protection zone, as well as for the normal situation when the employee of the landfill is on its territory for 8-hour shift.

Fatigue in Aeromedicine: A Validity Study of the Flight Risk Assessment

ABSTRACT Objective: A validation study was conducted on the Flight Risk Assessment (FRA), a unique self-report fatigue measure for flight medics on duty. Background: Air medical professionals face unique challenges above and beyond the difficulty of working in a hospital setting or prehospital ground medicine. Providers frequently work multiple 24-hour shifts, resulting in circadian rhythm disturbance and cumulative sleep loss. The plane environment and the effects of flight are also contributory to fatigue; however, air medics must engage in emergent, time-sensitive, life-saving procedures despite these challenging circumstances. Although the aeromedical industry has rapidly expanded in the past several decades, the field of flight medicine lacks validated tools to evaluate fatigue levels, and many companies rely on flight providers’ recognition of fatigue to prevent work-related mistakes. Method: To establish construct validity, scores on the FRA were compared to scores on the Psychomotor Vigilance Test (PVT), an objective measure of fatigue. Results: The results indicate that a total of five questions on the FRA was significantly and strongly correlated with mean reaction time on the PVT (r = .60, p = .001). Perceived fitness for duty was poorly correlated with fatigue levels as measured by the FRA (r < .01) suggesting medics may have difficulty recognizing when they are fatigued and fit for duty. Conclusion: The air medical industry is rapidly expanding, and valid and reliable measures are indicated to assess fatigue levels among providers. Initial findings suggest the FRA is an efficient tool to objectively measure the fatigue levels of air medics through a self-report measure.

Influence of Demographic Characteristics and Muscle Strength on the Occupational Fatigue Exhaustion Recovery Scale in Career Firefighters.

Little is known regarding how individual characteristics and changes in muscle strength across a shift cycle are associated with the Occupational Fatigue Exhaustion Recovery scale in career firefighters. Thirty-two career firefighters completed lower body maximal strength testing prior to and following three 24-hour on-off shifts. Demographic data were collected prior to the first shift and the OFER15 questionnaire was completed following the last shift. Increased age was associated with greater acute and chronic fatigue and poorer recovery. A positive percent change in strength following a shift cycle was related to better recovery. Age was the only significant predictor of acute and chronic fatigue, while age and the change in strength were significant predictors of inter-shift recovery. Increased age influences all dimensions of work-related fatigue, with changes in muscle strength influencing inter-shift recovery in career firefighters.

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study.

Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores. During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores. Overall, total daily EHR usage time (median time [hh:mm] [25th, 75th percentile]) was 2:10 (1:31, 3:08). For all hours (8 a.m.-8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric Risk of Mortality 3 (PRISM3) scores. For regular hours (8 a.m.-7 p.m.), no strong association was noted between total EHR, chart review, and documentation times and patient census, PIM2, or PRISM3 scores. When patient census was higher, the odds of EHR after-hour usage (7 p.m.-8 a.m.) was higher (OR 1.262 [1.135, 1.403], p < 0.0001), but there were no increased odds with PIM2 (OR 1.090 [0.956, 1.242], p = 0.20) and PRISM3 (OR 1.010 [0.984, 1.036], p = 0.47) scores. A subset of physicians spent less time performing EHR-related tasks when patient census and admission mortality scores were elevated. We performed a novel evaluation of physician EHR workflow in our PICU. Our pediatric critical care physicians spend approximately 2 hours (out of an expected 10-hour shift) each service day using the EHR, but there was no strong or consistent association between EHR usage and patient census or mortality scores. Future larger scale studies are needed to ensure validity of these results.

Scheduling of Physicians with Time-Varying Productivity Levels in Emergency Departments

Emergency department (ED) overcrowding and long patient wait times have been studied extensively in the literature due to its relevance. We propose a novel approach to assign physicians to shifts such that ED wait times are reduced without adding new physicians. In particular, we extend the physician rostering problem by including the heterogeneity between emergency physicians with regard to their productivity levels (measured as patient-per-hour rate) and by including the stochastic nature of patient arrivals and physician productivity. We formulate the physician rostering problem as a two-stage stochastic program and solve it with a sample average approximation and the L-shaped method. To formulate the problem, we perform a data analysis to investigate the major drivers of physician productivity levels using patient visit data from our partner ED, and find that it is sufficient to only consider individual physicians and the shift hour in which they are scheduled to provide emergency care. In particular, the workload and occupancy levels in the ED have a significant impact on physician productivity levels but the magnitude of this impact is minor. A simulation study calibrated using real data shows that the new scheduling from our formulation can reduce patient wait times by as much as 20%, compared to the current scheduling at our study ED. We also demonstrate how to incorporate physician preference in scheduling through physician clustering based on their productivity levels. Our simulation results show that EDs can receive almost full benefit even when the number of clusters is fairly small.

Rotating night shift work and non-alcoholic fatty liver disease among steelworkers in China: a cross-sectional survey

ObjectivesIn a 24/7 society, the negative metabolic effects of rotating night shift work have been increasingly explored. This study aimed to examine the association between rotating night shift work and...

Non-interventional study evaluating exposure to inhaled, low-dose methoxyflurane experienced by hospital emergency department personnel in France

ObjectivesLow-dose methoxyflurane is a non-opioid, inhaled analgesic administered via the Penthrox inhaler and was recently licensed in Europe for emergency relief of moderate-to-severe trauma-associated pain in conscious adults. This non-interventional...

Study of determinants in deaths occurring in an Italian teaching hospital during a year.

The main source of mortality data is the death certificate. The forms must be filled in correctly because inaccuracy can lead to the misallocation of resources in health care programs and research. The main purpose was to verify the existence of any relationships and/or correlations between the deaths of the Polyclinic of Bari and some specific elements by carrying out a "risk adjusted" analysis that represents a real indicator of the quality of care. All death records of patients who died in the Bari Polyclinic (over 1.500 beds) in 2017 (1.005 patients) were analysed. For each card, the corresponding medical records have been evaluated. The main causes of death are cardiovascular and neoplastic diseases, in line with statistics carried out on a national basis. Infectious and parasitic diseases represent the third cause of death with a discrepancy with the national average mainly due to the high incidence of nosocomial infections in European hospitals. There were no statistically significant differences in the frequency of deaths per shift and per ward. Patients suffering from infectious and digestive system diseases are more at risk of dying in the afternoon. An increased risk of death in the last hours of the night shift has been demonstrated. These findings indicate the need to adopt, in case of adverse events due to changes in the quality of care, the necessary barriers to prevent the occurrence of active or latent errors against patients exposed to this risk.

The Comorbidity of Musculoskeletal Disorders and Depression: Associations with Working Conditions Among Hospital Nurses.

Background: Musculoskeletal disorders (MSDs) are the leading cause of pain and disability among nurses and are frequently accompanied by depression. However, the association between the comorbidity of MSDs and depression and working conditions has not been studied, which was the aim of this study. Methods: In 2015, all nurses (n = 1,102) employed at a community hospital in the Northeast United States were invited to participate in this cross-sectional study. A survey was distributed in which participants were asked to report on MSDs, depressive symptoms, as well as subjective working conditions assessed including physical demands, psychological demands, decision authority, social support, and work-family conflict. Findings: 397 nurses responded (36%), and the prevalence of the comorbidity of MSDs and depression was 14.5%. Poisson regression (PR) models suggested that work-family conflict was associated with increased risk of the comorbidity (PR = 2.18; 95% confidence interval [CI] = 1.33-3.58), as was 8-hour night shift (PR = 2.77; 95% CI = [1.22, 6.31]) or 12-hour day shift (PR = 2.20; 95% CI = [1.07, 4.50]). Other working conditions were not directly associated with the comorbidity. Conclusions/Application to Practice: The comorbidity of MSDs and depression is prevalent among hospital nurses, and work-family conflict and working night shift or longer shifts were significantly associated with this. Effective workplace programs are needed to address nurses' working conditions to reduce their work-family conflict, thereby improving their musculoskeletal and mental health.

Helmet-CAM: Strategically Minimizing Exposures to Respirable Dust Through Video Exposure Monitoring.

Exposure to respirable crystalline silica (RCS) remains a serious health hazard to the US mining workforce who are potentially exposed as various ore bodies are drilled, blasted, hauled by truck, crushed, screened, and transported to their destinations. The current Mine Safety and Health Administration (MSHA) permissible exposure limit (PEL) for RCS remains at approximately 100 μg/m3, but it is noteworthy that the Occupational Safety and Health Administration (OSHA) has lowered its PEL to 50 μg/ m3 (with enforcement dates staggered through 2022 for various sectors), and the National Institute for Occupational Safety and Health (NIOSH) has held a 50 μg/m3 recommended standard since 1976. To examine a method for reducing RCS exposure using a NIOSH-developed video exposure monitoring (VEM) technology (referred to as Helmet-CAM), video and respirable dust concentration data were collected on eighty miners across seven unique mining sites. The data was then collated and partitioned using a thresholding scheme to determine exposures that were in excess of ten times the mean exposure for that worker. Focusing on these short duration, high magnitude exposures can provide insight to implement controls and interventions that can dramatically lower the employee's overall average exposure. In 19 of the 80 cases analyzed, it was found that exposure could be significantly lowered by 20% or more by reducing exposures that occur during just 10 min of work per 8-hour shift. This approach provides a method to quickly analyze and determine which activities are creating the greatest health concerns. In most cases, once identified, focused control technologies or behavioral modifications can be applied to those tasks.

Occupational exposure to particulate matter from air pollution in the outdoor workplaces in Almaty during the cold season.

BackgroundA large fraction of population in Almaty and other Kazakhstan cities is employed in the outdoor jobs and likely exposed to high levels of particulate matter (PM) during the cold season. The magnitude of such occupational exposure remains unknown; therefore, the aim was to quantify the levels of exposure to PM10 in the outdoor workplaces in Almaty in order to guide future interventions of primary prevention.MethodsOutdoor security non-smoking guards (N = 12) wore TSI DustTrack AM520 aerosol monitors with a 10-μm impactor for 8 hours of outdoor shift. Ten samples (k = 10) from each worker were obtained for the cold season (November-March) from various locations across Almaty. Total sampling time was 57600 minutes. We compared normalized time-weighted average (TWA) concentrations for 8-hour shifts within and between workers using analysis of variance (ANOVA) and assessed compliance with environmental exposure limit (EEL) (0.060 mg/m3) via exceedance (γ) and probability of overexposure (θ).ResultsPM10 TWA ranged from 0.050 to 2.075 mg/m3 with the geometric mean 0.366 and median 0.352 mg/m3. PM10 TWA distribution was left-skewed with large variation. The fold-range of within-person variability, containing 95% of the exposure concentration (wR0.95) was 13, whereas between-person fold-range (bR0.95) was 3. However, between-person variance exceeded the one within with F-ratio 2.797 (p = 0.003) with statistical power 97% at α = 0.05. Only two of 120 samples had TWA below EEL, yielding γ = 0.995 and θ = 1.ConclusionsOutdoor workers in polluted cities like Almaty are exposed to very high levels of PM10 during the cold season. Urgent action should be taken to regulate such occupational exposure and to raise awareness of workers and employers on hazards associated with it.

Hospital and Shift Work Influences on Nurses' Dietary Behaviors: A Qualitative Study.

Background: Nurses working in hospitals face unique influences on their workplace dietary behaviors, but little is known about what nurses experience as dietary influencers in the hospital setting. Understanding these influences is paramount in developing effective programs that target healthy workplace eating. This study aimed to explore hospital shift nurses' experiences and perceptions of influences on making healthy nutritional choices while at work. Methods: This qualitative, descriptive study was guided by the Theoretical Domains Framework and analyzed using thematic analysis. Twenty-one Registered Nurses working 10- to 12-hour shifts in hospitals in South Carolina, USA, in 2018 were interviewed individually or in focus groups about their workplace dietary behaviors and influences. Findings: Framework constructs most relevant to hospital shift nurses included (a) environmental context and resources; (b) social/professional role and identity; (c) memory, attention, and decision processes; (d) social influences; (e) emotion; and (f) behavioral regulation. In addition, four major themes emerged: (a) Nursing roles and responsibilities restrict freedom of movement and minimize individual control over dietary practices; (b) The hospital food environment is oppressively unhealthy; (c) Free food is currency and influences consumption; and (d) Shift work is a major barrier to healthy eating. Conclusions/Applications to Practice: To achieve healthy eating practices in the workplace, hospital shift nurses need supportive systems, policies, and interventions that target and reduce the barriers inherent in hospital-based nursing shift work. To improve hospital shift nurses' workplace dietary behaviors, these findings should inform hospital food policies, workplace wellness programs, administrative practices, and staff education.

Nap breaks formalised for staff on 12-hour shifts

Nap breaks formalised for staff on 12-hour shifts

12-hour shifts: why nurses so often see them as key to their work-life balance

12-hour shifts: why nurses so often see them as key to their work-life balance

The impact of shift work on nutritional status of police officers

The aim of this study was to show the extent of the influence of the shift work on nutritional status and physical activity of police officers. The research included 130 healthy police officers. The respondents were divided into two groups. The first group included 82 officers who were working the first shift. The second group included 48 officers who were working the 12hour shift. The study used customized questionnaire consisting of questions regarding leisure-time physical activity, self-report lifestyle activity level, body height, body mass, and derived body mass index (BMI). The ANOVA analysis showed that the first shift had significantly lower BMI (2.57 kg/m2 , p = 0.004) than the 12-hour shift. The results showed that physical activity is strongly associated with lower values of BMI in both groups (p < 0.01). Regarding the correlation between age and years of service, only the 12-hour shift showed coherency (p < 0.01). Although there was no difference in the level of physical activity between police officers from different shifts, declines in physical activity were associated with higher values of BMI.

The training and practice of crew resource management: an in vivo study of the UK National Police Air Service

The UK National Police Air Service (NPAS) provides tactical air support to the police forces of England and Wales. Uniquely, crews are composed of civilian pilots and police officers [tactical flight officers (TFOs)]. Providing tactical air support makes big demands of pilots and TFOs. Threats include aerial hazards, marginal weather, no-notice re-tasking, malfunctions, attacks launched from the ground, a 12-hour shift and irregular meals. Mindful of the need to create flight-deck teams that are resilient, resourceful and, above all, effective, the NPAS jointly trains its pilots and TFOs in crew resource management (CRM). Behaviours trained in CRM ground-schools (such as methodical skepticism, mindfulness and canvassing) were observed on the flight-deck and were seen to impact performance. Joint training of pilots and TFOs in CRM, to the extent that it improves understanding and communication, may improve teamworking. Operators that separately train pilots and cabin crew in CRM should consider joint training. Further, operators should broaden the CRM training catchment to include dispatchers, engineers and other safety-critical personnel. Widening the catchment would acknowledge the systemic character of aviation (Harris and Stanton, 2010; Bennett 2019c). Further, it would acknowledge the Civil Aviation Authority's (2016) exhortation to improve inter-profession coordination. It is recommended that more inductive, in vivo studies of the flight-deck be conducted.