Evening Shifts Research Articles

Social jetlag, a novel predictor for high cardiovascular risk in blue-collar workers following permanent atypical work schedules.

SummaryCardiovascular diseases cause >4 million deaths each year in Europe alone. Preventive approaches that do not only consider individual risk factors but their interaction, such as the Systematic COronary Risk Evaluation (SCORE), are recommended by European guidelines. Increased cardiovascular risk is associated with shift‐work, surely interacting with the concurrent conditions: disruption of sleep, unhealthy behaviours, and circadian misalignment. Social jetlag (SJL) has been proposed as a way to quantify circadian misalignment. We therefore investigated the association between SJL and cardiovascular health in a cross‐sectional observational study involving blue‐collar workers, who either worked permanent morning, evening, or night shifts. Sociodemographic, health and productivity data were collected through questionnaires. Blood pressure and cholesterol were measured and the cardiovascular risk was estimated according to the relative risk SCORE chart. Bivariate analysis was performed according to the cardiovascular risk and the relationship between SJL and high cardiovascular risk was analysed through logistic regression. Cumulative models were performed, adjusted for various confounding factors. After 49 exclusions, the final sample comprised 301 workers (56% males; aged <40 years, 73%). Mean standard deviation (SD) SJL was 1:57 (1:38) hr (59.4% ≤2 hr). Cardiovascular risk was high in 20% of the sample. Multivariate analysis revealed SJL to be an independent risk factor for high cardiovascular risk. Each additional hour of SJL increased this risk by >30% (odds ratio 1.31, 95% confidence interval 1.02–1.68). This is the first study indicating that SJL potentially increases cardiovascular risk, and suggests that sleep and individual circadian qualities are critical in preventing negative health impacts of shift‐work.

285 Pilot field study of Ambulatory Sleep-Staging in Shift-Working Air Traffic Controllers

Abstract Introduction The simplicity of wrist actigraphy for sleep-wake monitoring in the field contributes to its ubiquity in shift-work research. However, devices based solely on recording activity levels are generally not suitable to quantify sleep architecture. This is a limitation as quantifying changes in sleep stages caused by circadian misalignment is important to better assess the consequences of sleep-wake disruption in shift-working populations. This pilot study was conducted to evaluate whether sleep stages vary with respect to different shift types. Methods Six male air traffic controllers aged 48.5±8.4 years (mean±SD) completed the protocol which entailed two ~9-day periods, each with up to 6 workdays. Schedules comprised 1 or 2 early night shifts (19:30–03:30h), followed by an evening shift (15:00–23:00h), day shift (09:00–17:00h), morning shift (06:30–14:30h), and 1 or 2 full night shifts (23:00–7:00h). A portable sleep-staging device (Somno-Art, Paris, France) that monitored activity levels and heart rate was worn on the non-dominant forearm during bedtime and produced estimates of REM and NREM sleep stages with a proprietary algorithm. Total sleep time (TST) and sleep stages were assessed per shift type with mixed-effects models. Results Final analyses were based on 70 sleep periods preceding workdays, standardized to 24 h to account for the different intervals between consecutive shifts. Analyses revealed significant effects of shift type for TST (p=.016), stages N1 (p=.010) and N2 (p=.043), but none for N3 (p=.055) or REM (p=.117) sleep. TST and stage N1 sleep prior to night shifts was shorter than for day, evening, or early night shifts (all p&amp;lt;.05). Participants obtained less stage N2 sleep prior to night shifts than days shifts (p=.049). Conclusion This pilot study suggests variations in TST across shifts were predominantly due to differences in light sleep stages, whereas no significant differences in N3 and REM sleep were observed. Thus, while TST was reduced for night shifts, participants obtained similar durations of the most recuperative stages. These findings highlight the importance of refined monitoring of sleep in field research involving shift-work. Support (if any) Project funded by NAV Canada. Devices lent by the Somno-Art company. A.K. received a postdoctoral fellowship from the Fonds de Recherche en Santé du Québec (FRQS).

Disjunction, tension and dissonance within nursing pain care provision for the older hospitalized person: A focused ethnographic insight.

This study presents an ethnographic insight into the older hospitalized persons' experiences on how nurses provide pain care provision. The older persons' perceptions of culturally mediated barriers and facilitators are presented. Focused ethnography. Multi-site across eight acute care units within two tertiary referral hospitals on the east coast of Australia collected over a one-year period from 2014 to 2015. Semi-structured interviews (n=12) of older persons (11hr). Twenty-three (23) semi-structured interviews with nine (9) registered nurses (12hr 38min). Participant observation (1,041hr) during day, night and evening shifts. The older person experienced disjunction within pain assessment by the reliance of nurses on objective measurement gained during functional task completion. Tension emerged during pain management when the older person was not included and/or options provided were not deemed effective. For some older persons this meant they undertook a decision to exclude their nurse from involvement in pain management. A thread woven throughout was a lack of communication, continuity of care and input from the older person. This study has implications for the provision of nursing care of the older hospitalized person. Dissonance within pain care provision for the older person occurs during episodes of missed pain care. Understanding and insight is gained into aspects of missed communication opportunities between nurses and the experiences of missed pain care of the older person.

309 Food consumption and meal timing in hospital nurses with shift work: A preliminary study

Abstract Introduction One of the important nonphotic zeitgebers is food consumption. The timing of food consumption in relation to melatonin onset has been reported to be associated with fat proportion and BMI. Irregular meal timing along with irregular sleep schedules due to shift work would increase the metabolism problem as well as influencing sleep problems. The aim of the study is to evaluate the meal timing and food consumption in shift workers. Methods The nurses with 3-rapid rotating shifts were enrolled to keep food diaries for two weeks including all three shift schedules. They filled out a morningness-eveningness questionnaire. They wore actigraphy to monitor sleep-wake patterns with a daily sleep diary. The timing and the frequencies of meal/snack and caffeine consumption during each shift and day-off were reviewed. The calorie from each food was calculated depending on the nutritional information on the internet. Results 13 female nurses were screened and 6 finished the study. The mean age is 29.4±7.69 years and the mean body mass index was 20.2±1.1kg/m2. Average frequencies of meals are 2.59±0.49, 1.66±0.75, 1.93±0.41, 2.09±0.96 times per day, and average frequencies of snack consumption are 1.37±0.9, 1.07±0.74, 0.75±0.82, 0.96±0.79 times per day for the morning, evening, night, and the day off, respectively. Total calorie consumed are 1662.5±564.8, 1380.8 ± 940.3, 1596.8±838.1, 1505.8±706.9 kcals in the same order. Caffeine consumption was 0.29±0.46, 0.4±0.48, 0.72±0.65, 0.46±0.54 cups per day in the same order. One subject with morning type showed a relatively regular meal schedule throughout the shifts. The timing for main calorie consumption seemed to show delayed on evening and night shifts than morning shift although total calorie consumption was similar between each shift. Conclusion Although this is a preliminary study with a small number of subjects, it showed shift worker nurses have an inconsistent number of meals and calorie intake depending on their shifts. Caffeine consumption is very lower than expected. The subject with morning chronotype seemed to keep relatively regular meal timing throughout the shifts, suggesting chronotype influences meal timing in shift workers. Support (if any) This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No.2019R1A2C1090643).

296 Sex differences in sleep and wakefulness of police officers working shifts: evidence from a field study

Abstract Introduction National reports of work-related injuries found the excess risk of work injury attributed to shift work to be significantly higher among women. The Working Time Society (WTS) concluded that male sex is one of the few factors that is “consistently associated with perceived or actual shift work tolerance”. However, it is unclear if physiological parameters are involved. Laboratory-controlled studies report sex differences in circadian rhythms (body temperature, melatonin). In sleep deprivation protocols, alertness and cognitive performances were affected by sex, menstrual cycle phase and hormonal contraceptives [HC] use. Nevertheless, field studies that compare male and female shift workers are scarce. Methods An observational study including 76 police officers working on patrol: 56 males and 20 females (11 using [HC], 6 not using [non-HC] and 3 with unknown use of hormonal contraception) aged 32.0 ± 5.3 years. Participants were followed throughout a month-long work cycle (1,457 morning, evening, night, or other shifts, plus rest days). They filled out time-stamped questionnaires (Samn-Perelli, KSS, Visual Analogue Scales, ~5/day; sleep and work-related information, ~1–2/day), completed 5-min Psychomotor Vigilance Tasks (PVT, ~2/day), and wore an actigraph to collect activity data. Linear mixed-effects models were used to analyze the effects of group, time awake and time-of-day on fatigue, sleepiness, alertness, mood and PVT measures. Results Self-reported measures and psychomotor performance significantly varied with time awake and time-of-day. Fatigue and sleepiness levels were significantly higher among female compared to male police officers, both with time awake and across the 24-h day. These variations were similar between non-HC females and the other groups. Compared to males, HC females were more fatigued and less alert, both with time awake and across the 24-h day, and sleepier with time awake. Having children at home did not explain these differences. Conclusion The results of this study expand our knowledge on the sex differences in the sleep and circadian physiology and demonstrate a critical effect of HC on women fatigue, sleepiness and alertness when working shifts. Sex and hormonal parameters must be considered in occupational medicine as well as in future laboratory and field studies on shift workers and circadian rhythms. Support (if any) IRSST, FRQS.

288 Chronotype-dependent impact of napping on sleep behavior in rotating shift workers

Abstract Introduction Rotating shift work is known to adversely impact sleep. Napping is one of the strategies that workers can use to mitigate the effect of shift work on their sleep. In this study, we investigated the effect of chronotype on napping behavior in police officers involved in rotating shift work. Methods Actigraphy-based sleep measures and chronotype information was available from 74 police officers (20 women and 54 men; age [mean ± SD]: 32 ± 5.4 years) that participated in a 35-day field study during which they worked morning, evening, and night shifts. A generalized linear mixed model was used to assess the effect of shift type, chronotype, and their interaction on the likelihood to take a nap, adjusted for relevant covariates. In addition, linear mixed models were used to determine the effect of shift type, chronotype, and their interaction on sleep duration with and without taking into account napping duration. Results The likelihood to take a nap was influenced by an interaction between shift type and chronotype (χ2(2) = 11.2, p = 0.004). Earlier chronotype was linked to a lower likelihood to take naps during days with morning shifts and a higher likelihood during days with night shifts. Napping modulated the effect of shift type and chronotype on daily sleep duration, most notably during night shifts: while chronotype was associated with the duration of the main sleep period during night shifts, with the main sleep period being 1.7 h [95% C.I.: 0.6 – 2.8] shorter in the earliest chronotypes compared to the latest chronotypes, this effect was attenuated and no longer significant when napping duration was taken into account (difference in total sleep duration in latest chronotypes vs earliest chronotypes during nights shifts: 0.9 [−0.1 to 1.9] h). Conclusion Napping attenuates the chronotype-dependent effect of atypical work schedules on sleep duration in this population of shift-working police officers. These findings highlight the need to take into account chronotype when assessing the effect of shift work on sleep behavior. Support (if any) The Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRRST) and Fonds de Recherche du Québec–Santé (FRQS).

RESEARCH SUMMARY OF CURRENT SITUATION OF NURSES’ ADHERENCE IN ROUTINE HAND HYGIENE IN THE SURGICAL DEPARTMENTS OF GIA DINH PEOPLE’S HOSPITAL IN 2019 AND SOME INFLUENCING FACTORS

The cross-sectional descriptive study was conducted in 04 months, using quantitative data combined with qualitative information. Quantitative data was collected using a non-participating observation method, using a checklist. We observed 498 opportunities to wash hands. Qualitative information was collected from 02 in- depth interviews with experts and 03 group discussions. Data were entered and analyzed by Exel, Epidata and SPSS 18 software.&#x0D; The rate of compliance of nurses was 78.1. The chance of doing the right thing and completing the 6 steps is 71.9%. Practice of routine hand hygiene of nursing varies with working time, the highest was in the morning shift, lowest was evening shift. Factors that positively influenced the compliance are management and attention of the hospital leaders and the Department of Infection controls, regulations, circulars, training documents and guidelines; there is regular inspection and supervision and post-supervision feedback. Factors that adversely affect routine hand hygiene compliance are work overload, provision of unsanitary hand washing water and wash basins; the hospital has no regulations on specific rewards and penalties.

Analyzing the effects of the new labor law on outpatient nurse scheduling with law-fitting modeling and case studies

New labor laws that include additional legal requirements or amendments occasionally come into effect, and these new laws may also bring about challenges to common hospital operations such as outpatient nurse scheduling. This research thus examines changes in Taiwan’s new labor law that might affect this scheduling problem. A binary goal programming (BGP) model appropriate to this new law is established. In order to investigate how those changes (i.e., in rest time between working days, rest time between shifts, and total maximum weekly working hours) affect scheduling decisions, we apply the model to a case in a hospital currently utilizing a different model that fits the old law and find effective concessions made to the new legislation (e.g., the tension caused by the additional overtime evening shifts during scheduling can be mitigated). The comparisons indicate that the new law does seriously affect scheduling in terms of daily work patterns, number of working days, nursing workload, and related issues. Insights are gained, showing that associated changes in the law likewise affect the human resources (HR) setting of the hospital, with a critical trade-off between reductions in full-time nurses and reductions in part-time nurses. For further model applications, a larger empirical case facing similar migration problems and another anticipated virtual problem whose size is sufficiently large in practice are also solved efficiently. Given the lack of related topics analyzing these effects on nurse scheduling, this study offers several potentially worthwhile directions for future research (e.g., another different investigation under a common law system).

Differences in Clinical Indicators of Diabetes, Hypertension, and Dyslipidemia Among Workers Who Worked Long Hours and Shift Work.

Many studies have reported an association between overwork, shift work, and chronic disease. However, there is little research on the influence of working hours and shift work and management of chronic diseases. The objective of this retrospective study was to examine the association between working hours, shift work type in workers with hypertension, diabetes, and dyslipidemia. Among 18,513 hourly wageworkers from the Korea National Health and Nutrition Examination Survey, 4,313 with hypertension, diabetes, and hyperlipidemia were selected. An analysis of covariance with general linear modeling was used to estimate group differences in clinical indices of chronic diseases according to weekly working hours and types of shift work, both unadjusted and adjusted for gender, age, education, marital status, household income, and medication usage. Clinical indicators were worse in workers with diabetes (differences in HbA1c = 0.15%; fasting blood glucose = 4.84 mg/dL), hypertension (differences in diastolic blood pressure = 1.2 mmHg), or dyslipidemia (differences in total cholesterol = 3.3 mg/dL) who worked for more than 40 hours/week compared with workers who worked less than 40 hours per week. Clinical indicators in workers with diabetes and hypertension were worse in shift workers, including evening and night shifts, relative to those who did not work shiftwork. Working more than 40 hours per week and shift work were negatively associated with adverse clinical indicators among workers with chronic diseases. To improve the health of workers with chronic diseases, these findings suggest that adjustment of working hours and shift work may be warranted.

A Time and Motion Analysis of Nursing Workload and Electronic Health Record Use in the Emergency Department

IntroductionThe use of an electronic health record may create unanticipated consequences for emergency care delivery. We sought to describe emergency department nursing task distribution and the use of the electronic health record. MethodsThis was a prospective observational study of nurses in the emergency department using a time-and-motion methodology. Three trained research assistants conducted 1:1 observations between March and September 2019. Nurse tasks were classified into 6 established categories: electronic health record, direct/indirect patient care, communication, personal time, and other. Nurses’ perceived workload was assessed using the National Aeronautics and Space Administration (NASA) Task Load Index. ResultsTwenty-three observations were conducted over 46 hours. Overall, nurses spent 27% of their time on electronic health record tasks, 25% on direct patient care, 17% on personal time, 15% on indirect patient care, and 6% on communication. During morning (7 am-12 pm) and afternoon shifts (12 pm-3 pm), the use of the health record was the most commonly performed task, whereas indirect patient care was the task most performed during evening shifts (3 pm-12 pm). Using the National Aeronautics and Space Administration (NASA) Task Load Index, nurses reported an increase in mental demand and effort during afternoon shifts compared with morning shifts. DiscussionWe observed that emergency nurses spent more time using the electronic health record as compared to other tasks. Increased usability of the electronic health record, particularly during high occupancy periods, may be a target for improvement.

Does Public Reporting of Staffing Ratios and Nursing Home Compare Ratings Matter?

ObjectivePublic reporting is a policy to improve quality and increase data transparency. The objective was to examine the association between publicly available staffing ratios and the Five-Star Quality Ratings from Nursing Home Compare over time. DesignPanel data analysis. Setting and ParticipantsAbout 146 nursing homes with complete quarterly data in New Jersey between January 1, 2012, and December 31, 2019. MethodsUsing data from the State of New Jersey Department of Health and Nursing Home Compare, staff-to-resident ratios were trended for registered nurses, licensed practical nurses, and certified nursing assistants by shift and over time. Panel data analysis was used to test the association between the ratios and the ratings. ResultsCompared to 2012, staffing ratios improved slightly for licensed practical nurses but not for registered nurses or certified nursing assistants in 2019 (P < .001). The number of residents assigned doubled at night for all personnel. During the day and evening shifts, registered nurse staffing was significantly associated with the Nursing Home Compare staffing rating (P < .01) but not the overall rating. Conclusions and ImplicationsDecreasing the number of residents assigned to a registered nurse in NHs results in an increase in staffing ratings. Mandatory public reporting holds nursing homes accountable for quality outcomes but does not improve staffing ratios. Quality resident care is the cumulative result of multiple measures inclusive of staffing; therefore, administrators should continue to focus on improving quality in NHs, which may improve staffing ratios across shifts.

Investigating shift work disorder among workers of Hamadan Glass Factory in 2017

Introduction: Shift work is an occupational stressor that influences some workforce. The present study examined shift work disorders among people who work in Hamadan Glass Factory. Materials and Methods: Participants included 210 workers (130 shift workers and 80 day-workers) of Hamadan Glass Factory. The survey of shift workers (SOS) was used to collect information on respondents’ demographic background, gastrointestinal, cardiovascular, psychological disorders, sleep-related problems, musculoskeletal disorders, and adverse effects of shift work on individual, family, and social life. Other information was obtained by studying participating workers’ medical records in the same year. Data were analyzed using SPSS 16. Results: The results indicated significant relationships between shift work and variables such as sleeplessness, sleep quality and quantity, stomachache, and diet. Concerning background variables (age, work experience, and marital status), the results of the Kruskal-Wallis test showed a significant relationship between age and musculoskeletal, cardiovascular, and gastrointestinal disorders. Moreover, the results of the Fisher test demonstrated a significant association between work experience and social problems; but none of these background variables were connected with sleep disorders. Considering the effect of shift work (morning, evening, and night) on personal, family, social life, and alertness, chi-square results revealed significance among the three shift-work types. Incidence was higher in night shifts than in morning and evening shifts. Conclusion: The findings showed that shift work is more likely to lead to sleep disorders and gastrointestinal diseases, risk of diabetes, infectious diseases, musculoskeletal and cardiovascular disorders than day-work. Shift workers encounter more social problems than novice shift workers.

Efficacy of intermittent exposure to bright light for treating maladaptation to night work on a counterclockwise shift work rotation.

Objectives:Rotating shift work is associated with adverse outcomes due to circadian misalignment, sleep curtailment, work-family conflicts, and other factors. We tested a bright light countermeasure to enhance circadian adaptation on a counterclockwise rotation schedule.Methods:Twenty-nine adults (aged 20–40 years; 15 women) participated in a 4-week laboratory simulation with weekly counterclockwise transitions from day, to night, to evening, to day shifts. Each week consisted of five 8-hour workdays including psychomotor vigilance tests, two days off, designated 8-hour sleep episodes every day, and an assessment of circadian melatonin secretion. Participants were randomized to a treatment group (N=14), receiving intermittent bright light during work designed to facilitate circadian adaptation, or a control group (N=15) working in indoor light. Adaptation was measured by how much of the melatonin secretion episode overlapped with scheduled sleep timing.Results:On the last night shift, there was a greater overlap between melatonin secretion and scheduled sleep time in the treatment group [mean 4.90, standard deviation (SD) 2.8 hours] compared to the control group (2.62, SD 2.8 hours; P=0.002), with night shift adaptation strongly influenced by baseline melatonin timing (r2= -0.71, P=0.01). While the control group exhibited cognitive deficits on the last night shift, the treatment group’s cognitive deficits on the last night and evening shifts were minimized.Conclusions:In this laboratory setting, intermittent bright light during work hours enhanced adaptation to night work and subsequent readaptation to evening and day work. Light regimens scheduled to shift circadian timing should be tested in actual shift workers on counterclockwise schedules as a workplace intervention.

Lessons learned from reviewing a hospital\u2019s disaster response to the hydrofluoric acid leak in Gumi city in 2012

BackgroundThis study analyzed the characteristics of hydrogen fluoride-exposed patients (HFEPs) treated in the emergency department (ED) of a local university hospital, and reviewed the hospital’s disaster response according to space, staff, supplies, and systems (4Ss).MethodsThis retrospective observational chart review and descriptive study included 199 HFEPs among 2588 total ED patients who visited a local university emergency medical center for treatment between September 27, 2012 and October 20, 2012, following a hydrofluoric acid leak at the Hube Globe factory in Gumi City, Republic of Korea. Descriptive results concerning the 4Ss were obtained by interviewing ED specialist staff physicians on duty during the study period. In accordance with American Burn Association criteria, patients requiring burn center referral were assigned to the major burn group (MBG) as severe condition.ResultsDuring the acute phase (within 8 h after leak initiation), there were 43 patients in the ED, which was staffed with 3 doctors and 3 nurses, without 4S resources. Of these 43 patients, there were 8 HFEPs (100%) in the MBG and 0 in the non-MBG (NMBG). During the subacute phase (24 h after the acute phase), there were 262 patients in the ED including 167 HFEPs, of whom 45 (26.95%) were in the MBG and 122 (73.05%) were in the NMBG. The ED was then staffed with 6 doctors (3 on day shift and 3 on night shift) and 10 nurses (3 on day shift, 4 on evening shift, and 3 on night shift), and no 4S resources were available. Throughout the study period, no 4Ss were available. First, there was no expansion of ED space or secured disaster reserve beds. Second, there was no increase in manpower with duty time adjustments or duty relocation for ED working personnel. Third, there was no logistics reinforcement (e.g., antidote or personal protective equipment). Fourth, there were no disaster-related measures for the administration department, decontamination zone setup, safety diagnostic testing, or designated disaster triage implementation.ConclusionsThe hospital’s disaster response was insufficient for all aspects of the 4Ss. Detailed guidance concerning a hospital disaster management plan is required.

COVID-19 pandemic impact on sleep habits, chronotype, and health-related quality of life among high school students: a longitudinal study.

The COVID-19 pandemic has challenged the population of affected areas in multiple dimensions. Adolescents have been especially affected with school closure and home confinement. The impact of the pandemic on sleep habits and quality of sleep and quality of life among adolescents has not been adequately characterized. We hypothesized that the COVID-19 pandemic has induced an evening shift of the daily rhythm among adolescents and adversely affected sleep quality and quality of life of high school students. Students were questioned about their usual bed and wake-up times and answered the Pittsburgh Sleep Quality Index Questionnaire, the Epworth Sleepiness Scale, the Horne-Osteberg Morningness-Eveningness Questionnaire, and the World Health Organization Quality of Life Questionnaire-abbreviated version before and during the pandemic. Ninety-four students (64% females, aged 15 ± 1 years) participated in both phases of the study. Students delayed bed and wake-up times by 1.5 (0.5-2.0) and 2.0 (1.5-2.5) hours, respectively. Chronotype (per the Morningness-Eveningness Questionnaire) shifted toward eveningness during the pandemic. Sleep duration increased and quality of sleep (per the Pittsburgh Sleep Quality Index) improved only among those students with shorter sleep duration before the pandemic. During the pandemic, the physical and psychological domains of the World Health Organization Quality of Life Questionnaire worsened but the environmental domain improved as compared with the study before the pandemic. High school students have delayed bed and wake-up times and shifted chronotype toward eveningness during the COVID-19 pandemic. The worsening of the physical and psychological World Health Organization Quality of Life Questionnaire domains and improvement in the environmental domain highlight the conflicting experiences that high school students are facing during the COVID-19 pandemic.

The self-reported causes of sleepiness in shift-working tram and truck drivers

Identifying the causes of sleepiness in various safety-critical work environments is necessary for implementing more efficient fatigue management strategies. In transportation, little is known about drivers’ own perceptions of these causes. Therefore, we instructed shift-working tram (n = 23) and long-haul truck drivers (n = 52) to report at the end of their shifts what made them sleepy if they felt so. These self-reports, measured on-duty sleepiness, and sleep amounts were recorded on every shift over a period of 2–3 weeks per driver. The causes of sleepiness were queried with smartphone applications and sleep logs. Sleepiness was measured with the Karolinska Sleepiness Scale (KSS) and sleep with wrist-worn actigraphs. Data were analyzed using generalized estimating equations. Sleep loss and insufficient rest breaks were commonly reported as causing sleepiness among the tram drivers, whereas time of day and sleep loss were the leading causes among the truck drivers. Other causes, such as traffic or cabin conditions, were not frequently mentioned. During morning, day, and evening shifts, the truck drivers were less likely to report insufficient rest breaks as causing sleepiness than the tram drivers. Similarly, during morning shifts, the truck drivers were less likely to attribute their sleepiness to sleep loss. In shifts with drives reporting severe sleepiness (KSS ≥ 7 at least once, 18–21% of shifts), sleep loss was significantly reported as causing sleepiness among both groups. Reporting insufficient rest breaks was associated with severe sleepiness among the tram drivers, whereas time of day showed the same among the truck drivers. The results highlight the need for addressing sleep-related fatigue in transportation and provide directions for future research with regard to secondary causes of sleepiness.

Barriers to and facilitators of nursing students’ adjustment to internship: A qualitative content analysis

BackgroundIdentifying factors affecting nursing students’ adjustment to the internship conditions can enable nursing officials to make important decisions that can help students benefit more from their internship period according to expected goals. ObjectivesThe present study was conducted to explain the facilitating and inhibiting factors of nursing students' adjustment to the internship. DesignThe qualitative content analysis approach was used. SettingThe present study was conducted at a nursing and midwifery school affiliated with a large metropolitan medical university in northern Iran. ParticipantsA total of 17 final-year nursing students who did morning shifts during the week and a day-long (morning and evening) shift per week, were selected through purposive sampling with maximum variation. MethodsData were collected over 17 months through face-to-face semi-structured interviews, then carefully transcribed and analyzed using Graneheim & Lundman qualitative content analysis approach. ResultsSupport systems, the internship structure and its setting, and personal and professional factors were the three themes identified as facilitators and barriers of adjustment. ConclusionAccording to the results, factors affecting students' adjustment to internship manifest their effect over a continuum, in the form of adequate/poor support, high/low self-efficacy, and appropriate/inappropriate internship structure and setting. Moreover, support systems are among the most important factors affecting nursing students' adjustment to the internship. Furthermore, the role of hospital staff in accepting or rejecting the conditions and issues that participants face during their internship is very important.

Drug modification by nurses in Norwegian nursing homes: A cross-sectional study

Crushing and dividing pills among older patients in nursing homes appears to be a common yet not harmless practice. Because few updates exist regarding the role of nurses and their dispensing of drugs in nursing homes, this study sought to describe the occurrence, methods, and causes of nurses’ drug modification and to examine possible factors associated with drug modification in this context. A cross-sectional study of 273 dispensing episodes of solid oral drugs made by nurses, were observed during day and evening shifts. Modifications were made in 20.5% of the dispensing episodes, including 80.4% where alterations were made by crushing and 19.6% where alterations were made dividing. The most commonly reported reasons for modification were ‘swallowing difficulties’ (53.6%) and ‘lack of understanding by the patient’ (19.6%). The logistic regression analysis showed a significant association between the occurrence of drug modification and both cognitive impairment and administration method.

Unscheduled Revisits after Diagnosis of Abdominal Pain at Emergency Department, Mukdahan Hospital

Background: Abdominal pain is a common complaint for patients revisiting the Emergency Department (ED). Evaluating the cause of the revisit can improve the quality of ED patient care. Objective: We aimed to analyzed unscheduled revisits after diagnosis of abdominal pain at emergency department. Materials and Methods: In order to determine the characteristics of their abdominal pain and the causes for the revisits, the charts of 90 patients were reviewed. These patients had experienced acute abdominal pain and had returned to the Emergency Department within 48 hours after their initial treatment during the period between January 2019 and December 2019. Results: During that time period, 44,000 patients visited the ED. Of these, 90 patients (0.2%) with acute abdominal pain or related symptoms had revisited the ED within the following 48 hours. Most of these patients had been 20 to 60 years of age and had had no co-morbid diseases. Almost half of patient revisits had occurred during the evening shift (45.6%). There were 74% of these patients, who had been admitted to hospital for observation or for procedures. No in-hospital mortality was reported for this study. The signs and symptoms of abdominal pain in these patients had not been specific. The factors, which most often contributed to the ED revisits, had been inappropriate consultations and inappropriate discharges or advises. Conclusion: The majority of the acute abdominal pain patients, who revisited the ED within 48 hours, had been admitted. The most common cause of revisits had been inappropriate consultations and inappropriate discharges. Improving ED patient care can be managed by contributing to effective consultations and to establishing an effective discharge system for the ED. Keywords: Revisits, Emergency medicine department, Acute abdominal pain

The relationship between chronotype and sleep behavior during rotating shift work: a field study.

Shift work, an essential part of our 24/7 society, inevitably leads to displacement of the habitual sleep period and thereby to misalignment of the internal circadian timing system with the rest-activity cycle and the environment. How interindividual differences in circadian organization affect sleep duration and timing during rotating shift work is not fully understood. The objective of this study was to assess the effect of chronotype, shift type, and their interaction on actigraphy-based sleep behavior in 74 police officers (20 women and 54 men; age [mean ± SD]: 32.1 ± 5.4 years) involved in rotating shift work throughout a 28- to 35-day work cycle consisting of morning, evening, and night shifts. Using linear mixed modeling, we found that chronotype was associated with sleep duration depending on the shift type: increasing morningness was correlated with longer sleep duration during series of consecutive morning shifts, while increasing eveningness was correlated with longer sleep duration during series of evening shifts. During series of night shifts, increasing eveningness was associated with a longer duration of the main sleep episode, but this relationship was attenuated and no longer significant when naps were taken into account due to increased napping in morning chronotypes during series of night shifts. Providing a detailed within-subject characterization of sleep behavior across a complete work cycle consisting of morning, evening, and night shifts, this study advances the understanding of the relationship between chronotype and sleep in rotating shift workers and supports the implementation of work schedules that take into account chronobiological principles.