Day-shift Nurses Research Articles

Leveraging Nursing Assessment for Early Identification of Post Operative Gastrointestinal Dysfunction (POGD) in Patients Undergoing Colorectal Surgery.

Background: Postoperative gastrointestinal dysfunction (POGD) remains a common morbidity after gastrointestinal surgery. POGD is associated with delayed hospital recovery, increased length of stay, poor patient satisfaction and experience, and increased economic hardship. The I-FEED scoring system was created by a group of experts to address the lack of a consistent objective definition of POGD. However, the I-FEED tool needs clinical validation before it can be adopted into clinical practice. The scope of this phase 1 Quality Improvement initiative involves the feasibility of implementing percussion into the nursing workflow without additional burden. Methods: All gastrointestinal/colorectal surgical unit registered nurses underwent comprehensive training in abdominal percussion. This involved understanding the technique, its application in postoperative gastrointestinal dysfunction assessment, and its integration into the existing nursing documentation in the Electronic Health Record (EHR). After six months of education and practice, a six-question survey was sent to all inpatient GI surgical unit nurses about incorporating the percussion assessment into their routine workflow and documentation. Results: Responses were received from 91% of day-shift nurses and 76% of night-shift registered nurses. Overall, 95% of the nurses were confident in completing the abdominal percussion during their daily assessment. Conclusion: Nurses' effective use of the I-FEED tool may help improve patient outcomes after surgery. The tool could also be an effective instrument for the early identification of postoperative gastrointestinal dysfunction (POGD) in surgical patients.

Use of pain assessment tools and associated factors among nurses caring for hospitalized children in District Hospital in Rwanda


 
 
 INTRODUCTION: The majority of children will experience pain in their childhood. Nurses play a crucial role in caring for children in pain. Pain assessment tools aid nurses in providing effective care for these children. This study aimed to assess the use of pain assessment tools and associated factors among nurses caring for hospitalized children at a selected district hospital in Rwanda. METHOD: This descriptive cross-sectional study occurred at Kabgayi District Hospital in Southern Province, Rwanda. 153 nurses caring for children below 15 years were sampled. Pretested and validated questionnaires, in addition to patients' files, were used as data collection tools. Descriptive and inferential statistics were used to analyze the data.
 RESULTS: At Kabgayi District Hospital, the majority (60.4%) of nurses used pain assessment tools, mostly the verbal pain rating scale. More than eighty percent (83.8%) cited inadequate resources hindering tool utilization. A high workload for nurses made performing appropriate pain assessment procedures difficult. The use of pain assessment tools was associated with the nurses' working shifts (p=0.022). Day-shift nurses implemented tools more than their night-shift counterparts.
 CONCLUSION: The findings indicate that there are still barriers to the use of pain assessment tools among nurses caring for hospitalized children at Kabgayi District Hospital. Reducing a high workload for nurses will improve the effective use of pain assessment tools. Training for nurses in the form of continuing professional development (CPD) using other appropriate types of pain assessment tools, such as Face, Legs, Activity, Cry, Consolability (FLACC), and Wong-Baker Faces pain rating scale, should be enhanced.
 
 

Factors Associated with Work Fatigue among Nurses in South Tangerang City Public Hospital

Work fatigue is a pervasive issue that affects nursing care quality and patient safety in healthcare settings. This study examined the prevalence of work fatigue among nurses and its association with various factors, including age, body mass index (BMI), work tenure, and work shift. This study employed a cross-sectional quantitative approach and was conducted at the South Tangerang City Public Hospital from February to March 2023. A total of 85 nurses participated in this study. The Industrial Fatigue Research Committee (IFRC) instrument was used to measure work fatigue, encompassing general, mental, and physical domains. Workload-related symptoms were assessed using Likert scale-based responses, classifying the respondents into fatigue and non-fatigue groups. The results indicated that 55.3% of the nurses reported experiencing work fatigue. Significant associations were observed between work fatigue and several other factors. Older nurses demonstrated a lower prevalence of work fatigue (PR:0.579; 95% CI: 0.415–0.808), suggesting that age is a protective factor against fatigue. Conversely, nurses with non-normal BMI exhibited a higher prevalence of work fatigue (PR: 1.587; 95% CI: 1.100–2.291). A longer work tenure was associated with increased work fatigue (PR: 1.851, 95% CI: 1.298–2.639), possibly due to cumulative stress and physical demands. Furthermore, night-shift nurses experienced higher work fatigue (PR: 1.882, 95% CI: 1.302–2.721) than day-shift nurses, indicating the disruptive impact of irregular sleep patterns. These findings emphasize the need for healthcare organizations to address work fatigue among nurses. Strategies may include workload management, providing resources for emotional support, and promoting a healthy work environment. Addressing the specific vulnerabilities of younger nurses, individuals with non-normal BMI, and working night shifts is vital for mitigating work fatigue

Cortisol Awakening Response and Stress in Female Nurses on Monthly Shift Rotations: A Longitudinal Study.

The majority of shift nurses are female, there is still an expectation that they fulfil the traditional role of women in the family in Asia, often conflicting with shift work, increases stress, and affects cortisol secretion patterns. This study was to understand the changes in the cortisol awakening response (CAR) and work stress in nursing personnel working in different shifts. We recruited 41 female shift nurses. We administered the Taiwan Nurse Stress Checklist (NSC), and the nurses themselves collected saliva samples upon waking and 30 minutes after waking for three consecutive days at home. The saliva samples enabled us to analyze the increase in cortisol levels following waking (CARi) of nurses working different shifts (day, evening, and night). We then analyzed the data obtained using a hierarchical linear model (HLM). The results indicated that in terms of stress from the inability to complete personal tasks, the regression coefficients of night-shift nurses vs. day-shift nurses (B = 4.39, p < .001) and night-shift nurses vs. evening-shift nurses (B = 3.95, p < .001) were positive, which means that night-shift nurses were under significantly greater stress than day-shift and evening-shift nurses. With regard to CARi, the regression coefficients of night-shift nurses vs. day-shift nurses (B = −3.41, p < .001) and night-shift nurses vs. evening-shift nurses (B = −2.92, p < .01) were negative, which means that night-shift nurses have significantly lower CARi values than day-shift and evening-shift nurses. With regard to cortisol levels 30 minutes after waking, the regression coefficients of night-shift nurses vs. day-shift nurses (B = −3.88, p < .01) and night-shift nurses vs. evening-shift nurses (B = −3.31, p < .01) were negative, which means that night-shift nurses have significantly lower cortisol levels 30 minutes after waking than day-shift and evening-shift nurses. These results indicate that female night-shift nurses display the lowest CARi and cortisol levels 30 minutes after waking and are more negatively affected by being unable to complete personal tasks.

Nightshift Work and Nighttime Eating Are Associated With Higher Insulin and Leptin Levels in Hospital Nurses.

BackgroundCircadian misalignment between behaviors such as feeding and endogenous circadian rhythms, particularly in the context of shiftwork, is associated with poorer cardiometabolic health. We examined whether insulin and leptin levels differ between dayshift versus nightshift nurses, as well as explored whether the timing of food intake modulates these effects in nightshift workers.MethodsFemale nurses (N=18; 8 dayshift and 10 nightshift) completed daily diet records for 8 consecutive days. The nurses then completed a 24-h inpatient stay, during which blood specimens were collected every 3 h (beginning at 09:00) and meals were consumed at regular 3-h intervals (09:00, 12:00, 15:00, and 18:00). Specimens were analyzed for insulin and leptin levels, and generalized additive models were used to examine differences in mean insulin and leptin levels.ResultsMean insulin and leptin levels were higher in nightshift nurses by 11.6 ± 3.8 mU/L (p=0.003) and 7.4 ± 3.4 ng/ml (p=0.03), respectively, compared to dayshift nurses. In an exploratory subgroup analysis of nightshift nurses, predominately eating at night (21:00 – 06:00) was associated with significantly higher insulin and leptin levels than consuming most calories during the daytime (06:00 – 21:00).ConclusionsIn our study of hospital nurses, working the nightshift was associated with higher insulin and leptin levels, and these effects were driven by eating predominately at night. We conclude that although nightshift work may raise insulin and leptin levels, eating during the daytime may attenuate some of the negative effects of nightshift work on metabolic health.

Executive Performance Is Associated With Rest-Activity Rhythm in Nurses Working Rotating Shifts.

PurposeRest-activity rhythms (RAR) is one of the most fundamental biological patterns that influence basic physical and mental health, as well as working performance. Nowadays, with the utilization of actigraphy device in detecting and analyzing RAR objectively, evidence has confirmed that RAR could be interrupted by shift work. Nurses need to participate shift work in their daily routine. The aim of the present study is to identify the RAR of nurses working rotating shifts and find out the relationship between RAR and executive function.MethodsA total of 11 female nurses on day-shift (DS), 11 female nurses on rotating-shift (RS) were recruited. Demographic features, non-parametric variables of RAR as well as sleep variables according to actigraphy data, and a series of cognitive function evaluations during work time were collected.ResultsThe Student’s t-test comparison revealed that RS group nurses showed significant shorter total sleep time (TST), lower level of interdaily stability (IS) and relative amplitude (RA), as well as poorer executive performance compared with DS nurses. The linear regression analysis demonstrated that several aspects of executive performance such as choice reaction test (CRT) (reflecting attention and concentration) and trail making test (TMT) -B (reflecting cognitive flexibility) were associated with IS in RS group nurses.ConclusionThese results elucidated that RAR was disrupted for nurses working rotating shifts, and executive performance was associated with IS from day to day in nurses working rotating shifts.

Adapting Research to a Global Pandemic: A Fully Remote Actigraphy and Ecological Momentary Assessment Study.

Mandated social distancing practices and quarantines in response to COVID-19 have resulted in challenges for research on healthcare workers, such as hospital nurses. It remains unknown whether nursing studies utilizing complex methodology like sleep actigraphy and ecological momentary assessment (EMA) can be conducted remotely without compromising data quality. We aimed to (a) disseminate our remote study protocol for sleep actigraphy and EMA data from hospital nurses during COVID-19, (b) assess feasibility and acceptability of this approach for studies on hospital nurses, and (c) examine the reliability and ecological validity of sleep characteristics measured across 14 days. Using an online platform, we provided 86 outpatient nurses from a cancer hospital with detailed video/text instructions regarding the study and facilitated virtual study onboarding meetings. Feasibility was assessed by comparing adherence rates to a similar in-person study of nurses from the same hospital; acceptability was evaluated through content analysis of qualitative study feedback. Multilevel modeling was conducted to assess changes in sleep characteristics as a function of study day and daily stressful experiences. Adherence to EMA (91.8%) and actigraphy (97.9%) was high. EMA adherence was higher than the in-person study of inpatient day-shift nurses from the same hospital. Content analyses revealed primarily positive feedback, with 51.2% reporting "easy, clear, simple onboarding" and 16.3% reporting the website was "helpful." Six participants provided only negative feedback. Sleep characteristics did not change as a function of study day except for self-reported quality, which increased slightly during Week 1 and regressed toward baseline after that. A higher incidence of stressor days or higher stressor severity followed nights with shorter-than-usual time in bed or poorer-than-usual sleep quality, supporting the ecological validity for these methods of assessing sleep in nurses. Findings suggest that a fully remote study protocol for EMA and actigraphy studies in nursing yields robust feasibility, acceptability, reliability, and validity. Given the busy schedules of nurses, the convenience of this approach may be preferable to traditional in-person data collection. Lessons learned from COVID-19 may apply to improving nursing research postpandemic.

Subjective cognitive abilities correlate with poor sleep among day-shift and night-shift nurses.

Experimental studies have shown that sleep deprivation may lead to worse performance on cognitive tests. However, few studies have considered how sleep is associated with perceived cognitive performance in the daily lives of hospital nurses who require high cognitive abilities to deliver high-quality patient care. The current study examined the relationship between sleep and subjective cognition in nurses, and whether the relationship differed by work shift and workdays. Sixty in patient nurses working full-time (M=35years; 39day-shift nurses, 21 night-shift nurses) reported their sleep characteristics and daily subjective cognition using ecological momentary assessment for 14days. Concurrently, objective sleep characteristics were measured with a sleep actigraphy device for 14days. Using multilevel modelling, results indicated that at the within-person and between-person level, better sleep quality and higher sleep sufficiency were associated with better subjective cognition at the daily-level and on average. Moderation analyses indicated at the within-person level, better sleep quality and longer time in bed were associated with better next-day cognition; these associations were stronger for night-shift nurses compared with day-shift nurses. At the between-person level, better sleep quality and higher sleep sufficiency were also associated with better subjective cognition overall; these associations were significant for day-shift nurses, but not for night-shift nurses. The sleep-subjective cognition relationships were more apparent on workdays versus non-workdays. Findings suggest that sufficient sleep recovery is important for nurses' reports of daily and overall cognitive functioning. Night-shift nurses' subjective cognitive abilities may be more protected on days following better sleepquality and more sufficient sleep.

A multimodal analysis of physical activity, sleep, and work shift in nurses with wearable sensor data

Night shift workers are often associated with circadian misalignment and physical discomfort, which may lead to burnout and decreased work performance. Moreover, the irregular work hours can lead to significant negative health outcomes such as poor eating habits, smoking, and being sedentary more often. This paper uses commercial wearable sensors to explore correlates and differences in the level of physical activity, sleep, and circadian misalignment indicators among day shift nurses and night shift nurses. We identify which self-reported assessments of affect, life satisfaction, and sleep quality, are associated with physiological and behavioral signals captured by wearable sensors. The results using data collected from 113 nurses in a large hospital setting, over a period of 10 weeks, indicate that night shift nurses are more sedentary, and report lower levels of life satisfaction than day-shift nurses. Moreover, night shift nurses report poorer sleep quality, which may be correlated with challenges in their attempts to fall asleep on off-days.

Comparison of Psychological and Physiological Stress in NICU Nurses: Effects of Unit Design and Shift.

Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied. To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift. Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models. NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001). Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress. Strategies are needed for reducing stress in NICU nurses who work night shift.

Relationship among anxiety, depression, social and self-efficacy in night-shift nurses

Night shift disturbs normal circadian rhythm, thus leads to several psychological problems. We aim to investigate the anxiety, depression, social support and self-efficacy of night-shift nurses compared with day-shift nurses and explore the association between emotional status and social support as well as the combined influence of social support and self-efficacy on emotional status. We conducted this quantitative comparative study in a hospital from January 1, 2019 to August 31, 2020, using the Hospital Anxiety and Depression Scale (HADS), Perceived Social Support Scale (PSSS), and General Self-Efficacy Scale (GSES). The HADS-A and HADS-D scores were higher for the night-shift nurses than for the day-shift nurses (7.38 ± 3.228 vs. 5.81 ± 3.180 and 6.79 ± 3.444 vs. 5.43 ± 3.155, respectively, P &lt; 0.01). The family support, friend support, other support and total social support scores were lower for the night-shift nurses than for the day-shift nurses. In both groups, these scores were lower for nurses with suspected anxiety than for those without anxiety (61.16 ± 12.208 vs. 66.35 ± 9.976, P &lt; 0.01) and were lower for nurses with suspected depression than for those without depression (59.91± 11.606 vs. 66.77 ± 10.320, P &lt; 0.01). The item scores, total scores and total mean score for the night-shift nurses were significantly lower than those for the day-shift nurses (P &lt; 0.01). Social support and self-efficacy had noticeable regression effects on nurses’ anxiety and depression, and both variables had significant negative effects on anxiety and depression. This study suggests that night-shift nurses may have higher anxiety and depression than day-shift nurses. Nurses with suspected anxiety and depression nurses may have lower social support than those without anxiety and depression.

Better Night’s Sleep and Subjective Cognition: The Role of Day and Night Work Shifts

Previous research indicates poor sleep and cognitive functioning are associated. Studies have yet to consider the role of work shift on this relationship. The current study examined the sleep and subjective cognition relationship in nurses, and if this relationship differed for day- and night- shift nurses. Sixty-one nurses (M=35.39, SD=11.73; 39 day-, 22 night-shift) reported their nightly sleep characteristics and next-day subjective cognition (i.e., processing speed, memory, and mental focus) using ecological momentary assessments for 2 weeks. Multilevel models controlled for sociodemographic characteristics and decomposed the variance attributed by between- and within-person levels. At the within-person level, better sleep the previous night was associated with better subjective cognition the following day. This relationship was more apparent in night-shift nurses than in day-shift nurses, such that (a) longer sleep duration predicted better mental focus (B=1.62, p<.05) and (b) higher sleep quality predicted better memory (B=8.67, p<.001). At the between-person level, better sleep overall was associated with better subjective cognition across days. This association was more apparent in day-shift nurses than in night-shift nurses, such that (a) better sleep quality and sufficiency predicted faster processing speed (B=34.33; B=26.28; p<.001) and (b) better sleep quality and greater sleep sufficiency predicted better memory (B=30.94; B=23.09; p<.001). Findings suggest that sleep characteristics are associated with subjective cognition in nurses day-to-day and on average. Specific sleep characteristics associated with subjective cognition differ between day- and night-shift nurses, presumably due to differences in their sleep issues and perceived cognitive abilities.

Sleep health and predicted cognitive effectiveness of nurses working 12-hour shifts: an observational study

BackgroundDue to the 24hr nature of society, shift work has become an integral part of many industries. Within the literature there exists an abundance of evidence linking shift work-related sleep restriction and fatigue with errors, accidents, and adverse long-term health outcomes. ObjectiveThe study goal was to physiologically measure sleep patterns and predicted cognitive decline of nurses working both 12hr day and night shifts to address the growing concern about sleep restriction among healthcare workers. DesignThis study presents the results of a quasi-experimental, mixed between-within design where the sleep of 12hr day and night shift nurses was measured using ReadiBand wrist actigraphs. The between groups component was comprised of day v. night shift nurses. The within groups component was comprised of two separate measurement periods for each nurse—once for three consecutive days while they were working shifts (on duty) and once for three consecutive days off work (off duty). SettingParticipants wore the wrist actigraph at home and in the hospital, and were instructed to adhere to their regular sleep schedule. ParticipantsParticipants were recruited from two hospitals in Washington State (n=90). Participants were 48 night- and 42 day-shift nurses. All participants worked 12-hour shifts. MethodsSleep was measured using ReadiBand wrist actigraphs, which are licensed with the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTEtm) Alertness Score model, a biomathematical model that predicts cognitive effectiveness based on sleep/wake schedule. ReadiBands also calculate sleep quantity, sleep efficiency, and sleep latency. Results were analysed in SPSS (v26) through multilevel modelling. ResultsDifferences were observed in sleep quantity, efficiency, and latency based on shift type (day vs. night) and shift duty (on vs. off). The most extreme differences, however, were noted in cognitive effectiveness (SAFTEtm), whereby night shift nurses experienced substantial decline—frequently into the “high risk” zone—throughout their shifts compared to day shift nurses. ConclusionsThe present study identifies sleep characteristics that differ between day and night nurses working 12-hour shifts using objective measurements of sleep. Biomathematical modelling can offer a novel method to estimate hours of greatest cognitive decline, and have implications for policy around shift duration, timing, and overtime allocation.

1167 Nursing Perceptions of Sleep Assessment in the Intensive Care Unit

Abstract Introduction Sleep disruption in intensive care unit (ICU) patients is highly prevalent and may contribute to adverse clinical outcomes. Although clinical practice guidelines recommend routine assessment of sleep, surveys of ICU clinicians indicate that sleep assessment programs (SAP) are rarely implemented. The purpose of the current project was to characterize sleep-related perceptions, practices, and knowledge among ICU nurses, to identify barriers and facilitators of implementation of a systematic SAP. Methods A 29-item, paper-based survey was administered to all nurses (N=220) in a medical ICU at a 750-bed academic medical center and a mixed ICU in a 300-bed community hospital. Voluntary survey completion was conducted over four weeks. Descriptive statistics were employed. Results A total of 163 surveys were completed (74.1%). Participants were primarily female (n=135; 82.8%), day-shift nurses (n=83; 50.9%), with 2-5 years of ICU experience (n=70; 42.9%). Respondents said they sometimes (n=52; 31.9%), and often (n=52; 31.9%), assess sleep, and 76.1% (n=124) reported not assessing sleep formally in the last three shifts. Approximately half of the respondents (n=85; 52.1%) were not aware of clinical practice guideline recommendations for sleep in the ICU. Most nurses reported that their unit could benefit from a SAP (n=101; 62.0%) and that they should have a primary responsibility in ensuring that sleep is discussed daily (n=144; 88.3%). Conclusion Despite published guidelines recommending routine sleep assessment, ICU nurses report infrequent assessment and a lack of awareness of these guidelines. However, ICU nurses believe implementation of routine sleep assessments would be beneficial to patient care. This suggests that SAP implementation would be positively received by ICU nurses. Future studies evaluating knowledge and site-specific perceptions and practices, as well as nursing staff characteristics, can further guide implementation of SAPs in the ICU. Support

0225 Do Associations Between Daily Stress and Sleep Vary by Work Shift? A Within-Person Analysis in Nurses

Abstract Introduction Longitudinal studies have shown daily stress and sleep are bidirectionally associated. Nurses are particularly likely to experience sleep disturbances and high stress due to demanding work environments. Night shift work may be a unique stressor for nurses that exacerbates associations between stress and sleep. Using a within-person design, we examined the daily bidirectional associations between stress and sleep and moderation by nightly work shift (day/off shift vs. night shift) in a large sample of nurses. Methods Participants were 393 nurses (91% female; 77% white, mean age = 38.4 years) recruited from two hospitals. Participants completed 14 days of sleep diaries and actigraphy to assess total sleep time (TST) and sleep efficiency (SE). They simultaneously completed assessments of stress on the previous day (0 = “not at all” to 4 = “extremely”) and daily work schedule (day/off shift vs. night shift [work between 9pm-6am]). Results Results indicated greater daily stress was associated with shorter diary TST (b = -9.49, p&amp;lt;.0001) and actigraphy TST (b = -4.48, p&amp;lt;.01), as well as lower diary SE (b = -0.56, p&amp;lt;.001). When examining reverse pathways of sleep predicting next day stress, both diary TST (b = -0.0004, p&amp;lt;.0001) and actigraphy TST (b = -0.0002, p = .03) predicted higher next-day stress. Lower diary SE predicted higher next-day stress (b = -0.005, p&amp;lt;.001). Only the association between daily stress and nightly diary SE was moderated by daily work shift: only when nurses worked a day or off shift did they have a negative association between daily stress and diary SE (b = -0.68, p&amp;lt;.0001). Conclusion Daily stress and sleep disturbances occurred in a bidirectional fashion for night- and day-shift working nurses. Most associations were similar regardless of daily type of work shift. Objective and subjective short TST and low subjective SE may contribute to a cycle of increased stress and are prime targets for a tailored sleep intervention in nurses. More research is needed to develop interventions to address the unique sleep health challenges faced by nurses. Support NIAID R01AI128359-01

Effects of Nocturnal Sleep Quality on Diurnal Cortisol Profiles and Attention in Nurses: A Cross-Sectional Study.

Low sleep quality (LSQ) activates the hypothalamic-pituitary-adrenal (HPA) axis and is related to arousal. Nursing staff, who work in shifts, tend to exhibit LSQ, which affects the level of vigor after awakening. This study investigated the effects of nocturnal sleep quality on diurnal cortisol profiles and sustained attention in day-shift nurses. This study adopted a prospective cross-sectional design. Participants were recruited from a university-affiliated hospital in northern Taiwan. In the initial stage of this study, the Chinese Pittsburgh Sleep Quality Index (PSQI) Questionnaire was administered to 199 participants to categorize them as either LSQ (PSQI > 5) or high sleep quality (HSQ; PSQI ≤ 5). Participants were then randomly sampled from the two groups. Nocturnal sleep data and four diurnal saliva samples were collected for each participant. Sustained attention was measured before they started work. A total of 32 and 29 participants in the HSQ and LSQ groups, respectively, completed the data collection process. Compared with the HSQ group, the LSQ group exhibited earlier wake-up times (p = .02), a flatter cortisol awakening response (CAR) slope (p < .01), a flatter morning-to-evening slope (p < .01), and prolonged reaction speed and mean reaction time before starting work (p < .01). Compared with the HSQ group, the LSQ group exhibited impaired HPA-axis regulation, with a flatter CAR and diurnal cortisol slope and poor sustained attention in the morning. Nursing staff are advised to achieve HSQ to improve attention and performance levels and maintain optimum work safety.

0629 Social Jetlag and Sleep Disruption in Dayshift Nurses

0629 Social Jetlag and Sleep Disruption in Dayshift Nurses

Misaligned core body temperature rhythms impact cognitive performance of hospital shift work nurses.

Circadian rhythms greatly influence 24-h variation in cognition in nearly all organisms, including humans. Circadian clock impairment and sleep disruption are detrimental to hippocampus-dependent memory and negatively influence the acquisition and recall of learned behaviors. The circadian clock can become out of sync with the environment during circadian misalignment. Shift work represents a real-world model of circadian misalignment that can be studied for its physiological implications. The present study aimed to test the hypothesis that circadian misalignment disrupts vigilance and cognitive performance on occupationally relevant tasks using shift work as a model. As such, we sought to (1) explore the general effects of night- and day-shift worker schedules on sleep-wake parameters and core body temperature (CBT) phase, and (2) determine whether shift-type and CBT phase impact cognitive performance and vigilance at the end of a 12-h shift. We observed a sample of day-shift and night-shift hospital nurses over a 10-day period. At the end of three, consecutive, 12-h shifts (7 pm-7am or 7am-7 pm), participants completed a cognitive battery assessing vigilance, cognitive throughput, and medication calculation fluency (via an investigator developed and tested metric). Night-shift nurses exhibited significantly greater sleep fragmentation as well as a greater disparity between their wake-time and time of CBT minimum compared to day-shift nurses. Night-shift nurses exhibited significantly slower cognitive proficiency at the end of their shifts, even after adjustment for CBT phase. These results suggest that circadian disruption and reduced sleep quality both contribute to cognitive functioning and performance.

Functional Gastrointestinal Disorders Common Among Nurses With Poor Sleep Quality in Shanghai, China: A Pilot Study.

This study aimed to determine whether functional gastrointestinal disorders are more common among nurses with self-reported poor sleep. In total, 468 nurses working the day shift or rotating shifts completed two questionnaires: the questionnaire for irritable bowel syndrome (IBS) using Rome III criteria and the Pittsburgh Sleep Quality Index (PSQI). The prevalence of poor sleep was 41.04% (95% confidence interval, CI: [36.23, 45.85]), and poor sleep was significantly more common among rotating-shift nurses than among day-shift nurses (50.70% vs. 29.95%; p < .05). Among nurses with poor sleep, the prevalence of IBS and functional constipation was 35.15% (95% CI: [27.86, 42.44]) and 11.52% (95% CI: [6.65, 16.39]), respectively. After adjusting for age, work schedule, night pain, and psychological factors, IBS (odds ratio, OR: 1.88; 95% CI: [1.03, 2.49]) and functional constipation (OR: 1.77; 95% CI: [0.64, 2.57]) were significantly more common in nurses with poor sleep. We conclude that IBS and functional constipation are prevalent in nurses with poor sleep. Poor sleep was independently associated with IBS and functional constipation among nurses in Shanghai, China.

The correlation of serum concentration of copper and prevalence of depressive mood in psychiatric night shift nurses

Objective The aim of this study was to investigate the correlation of serum copper levels and mental health in psychiatric shift nurses. Methods The participants were divided into day shift nurses (control group,n=60) and night shift nurses (n=60) . The concentrations of trace mineral, serum biochemical levels, inflammatory and oxidative markers in blood samples of 120 shift nurses were measured. The depressive mood was measured with second edition of Chinese version of the Beck Depression Inventory,(BDI-Ⅱ) . Results The night shift nurses showed moderate-to-severe depression levels, which were significantly higher than those of the day shift nurses, 23.3% (14/60) and 11.7% (7/60) vs. 6.7% (4/60) and 1.7% (1/60) ,χ2=6.536, 4.82,P < 0.05. Night-shift nurses also had higher levels of serum copper, hs-CRP, IL-6, T-SOD and Cu-Zn SOD than the control group, (19.57±4.14) μmol/L vs. (18.03±3.20) μmol/L, 1.32 (0.78-1.89) mg/L vs.0.89(0.45-1.44) mg/L, 68.54 (51.43-96.78) ng/L vs. 56.39 (35.56-78.71) ng/L, (66.78± 14.72) kU/L vs. (47.32±17.84) kU/L, (54.22±14.91) kU/L vs. (48.17±17.23) kU/L,t=-3.133~-2.057,P < 0.01 or 0.05. BDI-Ⅱscores correlated positively with serum copper, hs-CRP, IL-6, T-SOD and Cu-Zn SOD,r=0.248-0.457, all P <0.01. In night shift group, multivariate regression analysis showed that serum copper, hs-CRP, IL-6 and T-SOD (β=0.097-5.340,P<0.01 or 0.05) were independently related factors influencing BDI-Ⅱ scores (R2 = 0.609,P = 0.000) . Conclusions Serum copper may serve as an evaluation index for depressive mood in psychiatric shift nurses, and serum copper concentrations in night shift nurses should be monitored regularly. Clinical Trial Registry Chinese Clinical Trial Registry, ChiCTR-OOC-14005540. Key words: Psychiatric; Night shift; Nurse; Depressive mood; Copper