Dissertations / Theses on the topic 'Night nurses'

Nurses are largely unaware of the problems of night-shift-nurse sleepiness and available strategies to manage night-shift sleepiness. The purpose of this project was to examine nurses' self-perception, awareness of sleepiness, and current strategies to manage this problem in the emergency medicine department of a major academic hospital in the western United States. The validated de-identified Karolinska Sleepiness Scale (KSS) was used to measure the prevalence and intensity of night shift nurses' sleepiness prior to the development of an educational program on strategies to manage sleepiness. Of the 164 registered nurses surveyed, 72 (43.9%) reported sleepiness greater than 7 on the KSS. An educational program was developed and evaluated by a panel of 6 experts who were selected on their clinical, educational, quality improvement, and research in sleep studies. Expert reviews indicated that the education program was 100% relevant, appropriate, and understandable, and provided adequate information on the topic with no recommended changes. The education program was presented to 16 night shift nurses with a pre/posttest survey completed by 14 nurses. Results indicated that participating nurses increased their knowledge of managing strategies for sleepiness from 69% (agree or strongly agree) preintervention to 92% postintervention. Postintervention, there was a 50% increase in the number of nurses who reported benefits from the education intervention. The findings of this project contribute to positive social change by improving nurses' health and quality patient care by advancing nurses' awareness of night shift sleepiness and countermeasure management strategies.

The research problem is the increasing numbers of overweight and obese nurses working the night shift. Study on overweight and obesity among female Filipino nurses has not been conducted. It was important to conduct a research study among female Filipino nurses to find out if there are statistically significant associations between night shift work and weight gain. The purpose of this correlational and cross-sectional study was to determine if there are statistically significant associations between insufficient sleep, abnormal eating patterns, working 12-hour shifts, years of working night shift, age, stress, marital status, nursing units, decreased physical activity, and level of weight gain among female Filipino nurses working the night shift in the hospital. The theoretical base of this study was the locate evidence, evaluate evidence, assess evidence, and informed decision model. The survey questionnaire was constructed and an online survey through Survey Monkey was used to access nurses via a convenience sampling. Data were analyzed using Spearman correlation, multiple regression, and ANOVA. According to study findings, there were significant associations between insufficient sleep, abnormal eating patterns, marital status, 12-hour shifts, number of years working on night shift, and increased in body mass index. The implications for social change include information that nurses can use to better understand the negative implications of night shift work on health. At the organizational level, this study provides information for administrators and nursing leaders that might facilitate change in policies by improving working conditions for nurses.

The night shift environment in acute care nursing is a unique and poorly understood entity. Retention of experienced nurses on the night shift is vital to the provision of quality care and the nurturing of new nurses. The goal of this phenomenological study was to elicit a description of the lived experience of experienced night shift nurses with the goal of gleaning information that would improve the work environment on the night shift. Five experienced night shift RNs participated in self-directed interviews, responding to the question, "Can you please share your experiences as an RN working the night shift?" The interview data were analyzed using Giorgi's phenomenological method to arrive at a typical and essential structure of the experience. The results revealed negative and positive aspects of working a night shift schedule. Negative aspects of night shift nursing included a feeling of being misunderstood and undervalued professionally and personally. Inadequate resources, on the night shift, was also identified as a barrier to nurse satisfaction, and negatively influencing the provision of quality nursing care and quality orientation of new nurses. Negative physiologic influences of night shift centered around poor quality and quantity of sleep. While these negative influences were consistently presented by all participants, so were the positive aspects of night shift nursing. The participants of this study were strongly invested in the teamwork they experienced within their night shift work environment. Interdependent team spirit was found to have arisen in response to the lack of resources experienced by these nurses. This teamwork, along with the other positive aspects, such as autonomous practice and positive effects on personal time, were seen as incentives for these experienced nurses to continue nursing on the night shift. Nursing administration may be able to utilize the information gleaned from this study to optimize the night shift work environment, and subsequently, increase retention of the experienced nurse. Further research is needed to clarify: the needs of experienced nurses in varying clinical settings, the needs of inexperienced night shift nurses, and the representativeness of the data found in this study to larger numbers of nurses.

This study shows the investigation of physical activeness among the nurses whowork in night shifts in hospitals and motivates them to do physical activities in theform of gamification in their working place. A qualitative approach is applied forgathering the data in the form of interviewing nurses to inquiry the problems andtried to find out the real opinions and scenarios related with physical inactivenessbased on the nurse’s interpretation. Working-time, working-loads, leisure-time,behaviors towards physical activity, laziness, less knowledge about voluntarymovements are coming out from the findings of this study. This paper suggests someactions such as walking, doing physical exercises, playing games etc. to encouragenurses to do more physical activities in a fun way in the workplace. A fun game,called ‘Healthy steps’ is designed based on the suggested actions in the form ofgamification is presented in this paper to promote physical activity at workplace andto encourage the nurses to participate lo lead a healthy lifestyle.
Denna studie visar undersökningen av fysisk aktivitet bland sjuksköterskorna somarbetar på nattskift på sjukhus och motiverar dem att göra fysiska aktiviteter i formav gamification på sin arbetsplats. En kvalitativ metod tillämpas för att samla in datai form av intervjuande sjuksköterskor för att undersöka problemen och försökte tareda på de verkliga åsikterna och scenarierna relaterade till fysisk inaktivitet baseratpå sjuksköterskans tolkning. Arbetstid, arbetsbelastning, fritid, beteende mot fysiskaktivitet, lathet, mindre kunskap om frivilliga rörelser kommer fram från resultatenfrån denna studie. Denna uppsats föreslår några åtgärder som att gå, göra fysiskaövningar, spela spel etc. för att uppmuntra sjuksköterskor att göra mer fysiskaaktiviteter på ett roligt sätt på arbetsplatsen. Ett roligt spel, kallat ‘Healthy steps’ ärutformat baserat på de föreslagna åtgärderna i form av gamification, presenteras idenna uppsats för att främja fysisk aktivitet på arbetsplatsen och för att uppmuntrasjuksköterskorna att delta för att leva en hälsosam livsstil.

Dirbantieji naktinį darbą pirmiausia susiduria su šoko sukėlimu organizmui. Kadangi kūnas yra įpratęs „gyventi“ pagal tam tikrą ritmą, kitaip vadinamą cirkadiniu ritmu, nuolatiniai ar dažnai pasikartojantys nukrypimai nuo jo gali sukelti sveikatos sutrikimų, kurie ilgainiui gali pereiti į rimtas ligas ar sutrikimus. Darbo tikslas ir yra ištirti ir įvertinti slaugytojų sveikatos problemų sąsajas su naktiniu darbu. Baigiamajame magistro darbe atliekamas sveikatos nusiskundimų palyginimas tarp slaugytojų dirbančiųjų naktinį darbą ir nedirbančiųjų naktinio darbo. Gauti rezultatai parodo reikšmingus skirtumus tarp šių grupių subjektyvaus savo sveikatos bei psichologinės sveikatos vertinimų. Naktinį darbą dirbančioms slaugytojoms padidėja rizika susirgti tam tikromis ligomis.
Night workers first encounters with a shock inducing body. Since the body is accustomed to live according to a certain rhythm, known as the circadian rhythm, persistent or frequently recurring deviations from it can cause health problems, which may eventually move on to serious diseases or disorders. The aim is to explore and evaluate nursing and health issues with night work. The master thesis is performed in health complaints comparison between nurses who works at night and and the ones who doesn't work at night. The obtained results show significant differences between the groups in their subjective health and psychological health assessments. Nurses working night work has increased risk of developing certain diseases.

Magister Curationis - MCur
Clinical learning experiences form an integral part of the 2nd and 3rd year learner nurses' training, because it is in the clinical placement that nurses should acquire the knowledge, skills and values that are necessary for professional practice competency. Nurses who are working night shift routinely feel deserted and left out of the information sphere. In most cases, these nurses find themselves in situations of staff shortages, diminished resources and reduced managerial direction. This situation is leading to demotivation. Maslow’s theory in relation to the hierarchy of human needs is regarded as the basic motivators of human activity. Maslow’s theoretical framework of the hierarchy of basic human needs was employed to compare the motivational needs of 2nd and 3rd year learner nurses who were working either night or day shift at the time of data collection. The purpose of the study was to compare the motivational needs of 2nd and 3rd year learner nurses who were working day and / or night shift. The researcher followed a quantitative, descriptive and comparative survey design with a sample of the population. A sample of 2nd year (n = 103) and 3rd year learner nurses (n = 103) was drawn from each group and a 100 fully completed questionnaires were submitted by each group. The researcher gathered the data with the assistance of a self-administered questionnaire that comprised primarily of closed-ended questions and a 5-point Likert scale was employed to capture their responses. The researcher used a structured questionnaire to explore the perceptions of the 2nd and 3rd year learner nurses about their needs to acquire motivation in the workplace in the context of Maslow’s hierarchy of needs. The researcher used descriptive and inferential statistics to analyse the data. Data was plotted and expressed by means of frequency tables. Descriptive statistical analysis and associations between various variables were completed by using parametric tests. The findings of the study were related to Maslow’s hierarchy of needs; i.e. the physiological, safety, social, self-esteem and self-actualisation needs to motivate the 2nd and 3rd year learner nurses during day and night shift. The findings include significant differences between the needs of 2nd and 3rd year respondents in relation to working day and night shift at the health service institutions in the Western Cape Province. In Item 27, the perceived needs of the 2nd and 3rd year respondents to be placed in their units of preference during night shift varied between never to sometimes. The 2nd year respondents (n = 74, 74.0%) and (n = 74, 76.8%) of 3rd year respondents on night shift experienced their need to be placed in a unit of preference to be considered. From the descriptive statistics (Tables 4.15 – 4.220), it was evident that the 2nd year respondents did neither have the highest nor lowest mean values across the study; the observation for the 3rd year respondents was similar. The mean values of night shift respondents mostly scored lower than the day shift mean values. The inferential statistics indicated significant differences between 2nd and 3rd year day shift respondents and between 2nd and 3rd year night shift respondents with night shift depicting more significant differences than day shift. That confirmed that both 2nd and 3rd year learner nurses’ motivational needs of night shift respondents were more pronounced than the needs of day shift respondents. Emerging from this research, recommendations were formulated for clinical educators, nurse educators, unit managers and professional nurses in accordance with Maslow's hierarchy of needs with the purpose of meeting the motivational needs of the 2nd and 3rd year learner nurses at the health service institutions in the Western Cape Province. Validity and reliability principles were applied during the entire research process. The reliability and validity of the research instrument was determined by applying Cronbach's alpha test. The Cronbach alpha coefficients were 0.93 and 0.93 for the day and night shift respondents respectively. Those values were above 70% and close to 100%, which indicated that the questionnaire had been a reliable research instrument. All coefficients of the pilot study were above 70% which indicated that the instrument was consistent and reliable. The reliability of the questions were tested for content and face validity. The researcher observed ethical considerations during the entire research process. Ethical considerations of beneficence, avoiding undue intrusion, the right to privacy, confidentiality, fair treatment, respect for the respondents, the right to freedom and the right to withdraw from the study at any stage, informed consent and protecting respondents from any harm were adhered to. The respondents provided written consent that acknowledged those ethical principles.

Operationssjukvård krävs under natten för att säkerställa vården och hjälpa patienter inom rimlig tid.  Operationssjuksköterskan i operationsteamet arbetar tillsammans med opererande läkare med det kirurgiska tillvägagångssättet, samt ansvarar för patientens perioperativa vård. Syftet med denna intervjustudie var att belysa operationssjuksköterskornas upplevelser av att arbeta nattskift på en operationsavdelning. Halvstrukturerade intervjuer genomfördes med sex operationssjuksköterskor på ett medelstort sjukhus i Sverige, och efter en kvalitativ innehållsanalys av materialet framkom sex kategorier; Nattens ryggrad – teamarbetet, Natten – vårdandets tid, På Natten – alltid redo, Natten blir till dag, Natten – tidens tand samt Nattens charm. Studiens resultat speglade operationssjuksköterskornas upplevelser av att teamarbetet utgjorde grunden för ett patientsäkert arbete under nattskiftet samt att operationssjuksköterskorna fick en förbättrad möjlighet att fokusera på omvårdnaden och kommunikationen med patienten under natten. Det krävdes även konstant handlingsberedskap inför oväntade situationer, och arbetet under natten var under förändring då fler av dagskiftets operationer sköts över till natten. Operationssjuksköterskorna upplevde även att arbetet under natten blev svårare då de blev äldre, men att arbetet under nattskift ändå upplevdes som roligare än dagskiftet. Således kunde det tolkas att nattskiftet hade en inverkan på operationssjuksköterskornas arbete, då arbetet kunde vara fysiskt och psykiskt ansträngande vilket även kunde ha en inverkan på patientsäkerheten. Nattskiftets speciella karaktär och med ett närmare teamarbete resulterande ändå i att arbetet utfördes med kvalitet samt att operationssjuksköterskorna upplevde arbetet som roligare, vilket fick dem att välja att fortsätta arbeta nattskift.

Syftet med denna studie var att beskriva sjuksköterskors upplevelser av att arbeta i hemsjukvården och därmed få ökad kunskap och kännedom om villkoren för nattarbete. Studien hade en kvalitativ deskriptiv design och fjorton sjuksköterskor besvarade frågeformulären. Materialet analyserades med hjälp av innehållsanalys. Resultatet utmynnade från ett tema med följande kategorier, nattarbete ett val av praktiska skäl, vidgat perspektiv ger arbetstillfredsställelse och insikten om arbetets komplexitet ger en känsla av otillfredsställelse. Majoriteten av sjuksköterskorna valde att arbeta inom nattpatrullen för att tjäna extra pengar, samt på grund av närheten till arbetet. Samtliga sjuksköterskor påtalade vikten av att ha tillräckligt med tid vid hembesöken. Flertalet män ansåg dock sin kompetens för hög för de arbetsuppgifter de utförde i hemsjukvården. Att de sedan valt att fortsätta arbeta inom nattpatrullen berodde på att de upplevde arbetet som självständigt, fritt och stimulerande. Sjuksköterskorna påpekade att de inte kände sig delaktiga i beslut. Flera påtalade att cheferna inte hade någon förståelse för deras arbetsvillkor. Behovet av hemsjukvård ökar och mer personal kommer att behövas. Att rekrytera och behålla sjuksköterskor inom hemsjukvården är en utmaning. Det är därför av vikt att ta reda på hur vårdpersonal upplever sina arbetsvillkor och vad som kan locka fler att arbeta inom hemsjukvården.
The purpose of this study was to describe nurses' experiences of working in home health care and thus enhance the understanding and knowledge of the conditions of night work. The study had a qualitative descriptive design and fourteen nurses answered the questionnaires. The material was analysed using content analysis. The analysis resulted from a theme with the following categories: night work as a choice for practical reasons, broader perspective gives job satisfaction and the recognition of the complexity of the work gives a sense of dissatisfaction. The majority of the nurses chose to work in night patrol to earn extra money, as well as the close proximity to their work. All the nurses emphasised the importance of having enough time at home visits. Most men, however, considered their skills too advanced for the tasks they performed in home nursing. That they then chose to remain with the night patrol was because they experienced their work as independent, free and stimulating. The nurses said that they felt left out when it came to decisions. Several complained that the managers had no understanding of their working conditions. The need for home care will increase and more staff will be needed. To recruit and retain nurses within home care is a challenge. It is therefore important to find out how health professionals perceive their working conditions and discover what might attract more people to work in home health care.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-11-23T17:13:54Z No. of bitstreams: 1 Beloní Gabe Leal_.pdf: 2118279 bytes, checksum: 946f5888dcf7ac8a1ed76613ae36b86b (MD5)
Made available in DSpace on 2015-11-23T17:13:54Z (GMT). No. of bitstreams: 1 Beloní Gabe Leal_.pdf: 2118279 bytes, checksum: 946f5888dcf7ac8a1ed76613ae36b86b (MD5) Previous issue date: 2015-09-30
Nenhuma
Este estudo aborda as representações sociais (RS) de saúde e doença na perspectiva dos profissionais de enfermagem que trabalham no turno da noite. As RS refletem o modo como indivíduos, grupos e sujeitos sociais constroem seu conhecimento a partir de sua inscrição social e cultural. O objetivo foi elaborar ações de educação em saúde, para os profissionais de enfermagem do turno da noite, a partir de suas representações sociais de saúde e doença, relacionadas ao trabalho noturno. O estudo foi realizado à luz das RS, com base na teoria do núcleo central. O campo de estudo foi uma instituição hospitalar da rede privada, localizada em Porto Alegre/RS. Participaram 100 profissionais de enfermagem que exercem atividades no turno da noite. A coleta deu-se por meio de questionário com questões estímulos. Para a análise das evocações, utilizou-se o software Ensemble de Programmes Permettant l’Analyse des Evocations. Seguiu-se a Resolução nº. 466/2012. As RS dos profissionais de enfermagem do noturno acerca do pré-plantão foram constituídas por atributos que representam a necessidade de organização prévia, bem antes de iniciar a jornada de trabalho. Também evocaram o esforço para superar o cansaço e a sonolência, exigindo um ritmo de alerta e maior concentração no trabalho. No pós-plantão emergiram evocações relacionadas ao cansaço, ao sono e à necessidade de descanso, representando a longa jornada de trabalho noturno com 12 horas consecutivas. As RS do plantão noturno, relacionadas à saúde foram constituídas por vocábulos como alimentação, dores, insônia, obesidade, sedentarismo e sono, que indicam o plantão noturno como espaço de “não saúde”. As RS relacionadas à doença foram constituídas pelas evocações: dores, ansiedade, depressão, insônia, hipertensão, obesidade e varizes. Esse mesmo grupo evoca vocábulos que representam a preocupação em prevenir essas doenças ou outras e suas causas. As RS do plantão noturno relacionadas à vida social e familiar foram constituídas por evocações que determinaram a falta de tempo, a ausência e a saudade, apontando que o trabalho à noite pode dificultar as relações sociais e familiares, com desencontros, ausências em comemorações e em momentos de lazer junto com a família. As RS dos profissionais de enfermagem acerca do pré e pós-plantão noturno relacionadas à sua saúde, à doença e à sua vida social guiaram e respaldaram a proposta de intervenção deste estudo, pautada nos princípios de educação em saúde e de promoção da saúde. Ações de educação em saúde foram constituídas em três dimensões do cuidado: elaboradas para os profissionais de enfermagem, para a gestão assistencial e para a instituição. Considera-se que o conjunto de ações de educação em saúde pode contribuir para a qualificação das condições do trabalho noturno dos profissionais de enfermagem.
This essay will discuss the social representations (SR) of health and illness on the perspective of nurses that work on the night shift. The SR reflect the way individuals, groups and social personas make up their knowledgement by taking as reference their own social and cultural contexts. The objective of this essay was to create actions on health education for nurses that work in the night shift, taking as a starting point their social representations on night shift work schedule.The study was focused on SR and based on the central nucleus theory. A private hospital located in Porto Alegre/RS was used as field of study. One hundred nurse professionals from the night shift took part of the study. A questionnaire containing stimulus questions was used for data collection. The software Ensemble de Programmes Permettant l’Analyse des Evocations was used to analyse the evoked words. The essay was done in conformity with the Resolution 446/2012. Night shift nurses’ SR concerning the moment before their duties were constituted by attributes that represent their necessity of previous organization. The effort to keep themselves awake and rested was evoked as well, once their shift requires them to be much more aware and concentrated on their tasks than those of the morning shift. The participants also claimed about being tired, sleepy and needed of resting on the post shift period, reflections of their working journey of 12 hours in a roll. The night shift SR related to health were composed by words such as: food, pain, insomnia, obesity, sedentary lifestyle and sleepiness – what points the night shift as a non healthy environment. The SR related to illness were composed by the words: pain, anxiety, depression, insomnia, hypertension, obesity and varicose veins. This same group evokes words that represent their worrying on preventing those illness or similar ones and its causes. The SR related to their personal lives were composed by evocations such as lack of time, absence and longing, what points the night shift as an obstacle for the maintenance of social and parental relationships, once night shift workers can’t always be present on family’s parties and friends hangouts. The SR related to the period before and after the night shift, to workers’ health, to illness and to workers’ personal lives, guided and endorsed this study’s intervention proposal, based on health education and health promotion principles. Health education actions were composed based on three caring dimensions: towards the nurses, towards the care management and towards the institution. A series of actions of health education can contribute for the better qualification of night shift workers environment.

Bakgrund: Det förekommer stora nutritionsproblem på äldreboenden i Sverige och andra delar av världen. Sjukdom och åldrande är riskfaktorer för näringsmässiga störningar. Undernäring hos äldre är associerad med ökad dödlighet och sjuklighet samt en ökad risk för trycksårsutveckling och infektioner. Socialstyrelsen har utfärdat en rekommendation angående nattfastans längd för att motverka undernäring och dess komplikationer, samt för att öka energi- och näringsintaget hos vårdtagarna. Syfte: Att belysa nattfastan på äldreboenden i en stad i södra Sverige samt undersöka kunskap och attityder om nattfasta hos omvårdnadspersonalen på äldreboenden. Metod: Deskriptiv enkätundersökning med kvantitativ ansats. Studien gjordes på tolv äldreboenden där 167 informanter deltog. Urvalet bestod av omvårdnadspersonal från utvalda äldreboenden i en stad i södra Sverige. Datan analyserades i IBM SPSS Statistics version 22 och redovisades i deskriptiv statistik. Resultat: Majoriteten av informanterna hade vetskap om att Socialstyrelsen utfärdat en rekommendation gällande nattfasta. Dock var det knappt hälften som visste hur många timmar nattfastan ej bör överstiga. De flesta informanter uppgav att de erbjöd både förfrukost och ett extra mål på kvällen, men få vårdtagare nyttjar dessa mål. Slutsats: Många vårdtagare riskerar en alltför lång nattfasta då det är få som nyttjar de extra mål som erbjuds. Det är betydelsefullt att undervisa omvårdnadspersonal om de regelverk och rekommendationer som finns samt bedriva undervisning om nutritionsfrågor. Sjuksköterskan är ansvarig att se till att den kompetens som behövs finns.
Background: There are major nutrition problems in nursing homes in Sweden and other parts of the world. Illness and aging are risk factors for nutritional disorders. Malnutrition in the elderly is associated with increased morbidity and mortality and an increased risk of pressure ulceration and infection. The Swedish National Board has issued a recommendation regarding the length of night fasting to counter malnutrition and its complications and to increase energy and nutrient intake in the care recipients. Objective: To highlight the night fasting in nursing homes in a city in southern Sweden, and examine knowledge and attitudes about the night fasting in nursing staff in nursing homes. Method: Descriptive survey with quantitative approach. The study was done on twelve nursing homes where 167 informants participated. The sample consisted of nursing staff from selected nursing homes in a town in southern Sweden. The data were analysed in IBM SPSS Statistics version 22 and presented in descriptive statistics. Results: The majority of respondents had knowledge that the Swedish National Board issued a recommendation concerning night fasting. However, it was only nearly half who knew how many hours the night fasting should not exceed. Most informants stated that they offered both pre-breakfast and an extra meal in the evening, but few residents utilize these meals. Conclusion: Many residents run the risk of a long night fasting when there are few residents who use the additional snacks that offers. It is important to educate nursing staff on the rules and recommendations that exist and provide education on nutritional issues. The nurse is responsible to ensure that the skills needed are available.

Thesis (M.A.)--Northern Kentucky University, 2008.
Made available through ProQuest. Publication number: AAT 1457014. ProQuest document ID: 1594487381. Includes bibliographical references (p. 49-50)

碩士
高雄醫學大學
醫學研究所碩士班
94
Objective：The main purpose of this study is to examine the impact of night-shift task on the health of reproductive system, such as menstrual cycle, and sex ratio of birth outcome among the female nurses. Method ：The study subjects were female nurses who were 20-45 years old and lived in Kaohsiung metropolitan. All the study nurses were asked by questionnaire about their time-shift working status, status of menstruation, quality of sleep, lives birth, and reproductive system. Data were analyzed by Statistical Package for Social Science (SPSS). Results：Compared to day-shift nurses, night-shift nurses had a higher opportunity to have irregular menstruation cycles and premature babies (p<0.05). The averaged sex ratio among the study nurses’ babies was 0.9. The sex ratio among the night-shift nurses’ babies was 1.008, which was significantly higher than that in day-shift nurses’ babies (0.67). Conclusion：Night-shift task can cause female nurses to have irregular menstruation and premature babies. In addition, night-shift nurses have more chances to have male babies than day-shift nurses. Key words：Nurse, night-shift task, sex ratio, birth outcome

Recently, there has been increasing recognition of the threat of fatigue on safety. Nursing has been slow to recognize this threat. Workplace napping is a fatigue management strategy that is used in some nursing workplaces, although often hidden. This feminist interpretive phenomenological study explored the lived experience of night shift fatigue and the use of workplace napping among critical care nurses. An understanding of the meaning of night shift fatigue, the concern for safety as embodied by fear, was illuminated by exploring the phenomenological commonalities within the nurses’ historical, social and cultural world. Five main themes were identified within this overarching understanding. There is a need to recognize oppressive constraints, and share the responsibility for managing fatigue among individuals, professions and organizations. In education, practice and research, nurses must be supported through validated evidence-informed strategies to manage what is a normal consequence of shift work, thus leading to enhanced safety for both the patient and nurse.

碩士
國立臺灣大學
健康政策與管理研究所
104
Background and objective: Existing epidemiologic evidences show that shift work and night work are associated with increased health risks, including sleep disorders, metabolic diseases, cardiovascular or cerebrovascular diseases and depression. In Taiwan, long working hours and shift work are common among health care workers. In this occupational group, diseases associated with overwork problems have been a public health issue. The labor authority of Taiwan has taken measures to regulate working hours in attempt to safeguard occupational health of health care workers. Since January 1 of 2014, nurses are no longer exempted from working hour regulations of the Labor Standard Act. This study was conducted to compare with international regulations of shift work and night work, and to explore the patterns of shift work and night work status as well as hospital management concerning shift work and night work among nurses working in hospitals of Taipei City and New Taipei. Nurses’ perceived health impacts associated with night work and shift work and their attitudes toward organizational policies and governmental policies were examined. Methods: Literature review and in-depth interviews were conducted. In interview study, study subjects were female nurses in hospitals of the Taipei city or New Taipei city, with work tenure of 1 year or longer. Those who were pregnant or had given birth within a year were excluded. A total of 23 nurses were interviewed during the study period from November 2015 to December 2016. Results: Comparions with international regulations indicated that regulations on shift work and night work of Western countries are more comprehensive as compared to that of Taiwan. Results from interviews with nurses suggested that violations of the Labor Standards Law were commonplace, but many nurses chose to tolerate unlawful practices due to unbalance labor relation. Several nurses did not even know their rights had been infringed. Conclusion and recommendation: Labor authority should pay attention to the safety and health risks with night work and shift work. We suggest that regulations should be revised and guidelines should be promulgated to help workers to better adapt to night and shift work. In addition, labor right and occupational health education should be provided, and labor inspection should be forcefully implemented with sufficient level of punishment to truly safeguard the labor and health rights of working people in Taiwan.

Sleep disruption, like that experienced by long-term rotating shift workers, is a physiological stressor which causes a variety of adverse physical, psychological and cognitive symptoms. Some cognitive symptoms are thought to be mediated by the direct effect of stress hormones on the hippocampus. Regardless of its source, stress provokes endocrine responses in the body that affect the hypothalamic-pituitary-adrenal (HPA) axis. Whereas acute activation of the HPA axis adaptively activates the body’s stress response by increasing cortisol production, prolonged or repeated activation is detrimental to health due to dysregulation of the HPA axis. Cortisol affects the hippocampus, which has a high concentration of glucocorticoid receptors and plays a prominent role in the down-regulation of the HPA axis. Overstimulation of glucocortioid receptors can cause hippocampal atrophy and related cognitive deficits. Research has found that air crew with inadequate recovery time between outbound, transmeridian long-haul flights showed performance decrements on cognitive tasks, reduced hippocampal volumes and increased cortisol levels. The current study aimed to investigate whether work-related sleep disruption caused similar effects among rotating shift-workers from outside the flight industry. Twelve long-term female rotating shift-workers (nurses) and 17 day working female control participants (nurses and others) participated in the study. Analyses of the sleep health, cognitive (memory, attention, visual-spatial skills), endocrine (salivary cortisol), magnetic resonance imaging (MRI) and spectroscopy (MRS) data of these participants showed few differences between groups in cognitive performance, volumetric MRI or MRS. Shift workers reported less sleep over a fortnight, higher levels of fatigue and lower levels of vigor compared to controls. Cortisol rhythm changes including earlier morning rise and peak attenuation were apparent in shift workers. The results are interpreted in terms of age differences between the groups and the existence of a 'healthy worker' effect in the shift workers.

RESUMO - Ao longo das últimas décadas, a temática do trabalho por turnos com trabalho noturno tem levantado algumas preocupações por parte dos enfermeiros relativamente ao impacto na sua saúde (física e mental), qualidade de vida e consequentemente à possibilidade deste tipo de horário laboral contribuir para a prática da automedicação. Objetivo: Avaliar o impacto do trabalho por turnos com trabalho noturno na saúde (física e mental), qualidade de vida e automedicação dos enfermeiros de três serviços de um Hospital Central. Tipo de estudo: Foi efetuado um estudo observacional, transversal e com uma componente descritiva e uma componente analítica, comparando a qualidade de vida, o estado de saúde e a automedicação dos enfermeiros que trabalhavam por turnos dos que tinham horário fixo. Utilizaram-se os seguintes testes estatísticos: coeficiente de Pearson (r), teste de U de Mann-Whitney, teste Qui-quadrado e teste Exato de Fisher. E um nível de significância de 5%. Amostra: A amostra é de conveniência, constituída por enfermeiros de três serviços de um hospital Central da região de Lisboa, que concordaram em participar no estudo (n=51). Dos 51 profissionais que aderiram ao estudo, 37 exerciam em horário fixo e diurno e 14 em horário por turnos com trabalho noturno. Instrumento de recolha de dados: Os instrumentos de colheita de dados utilizados foram: EPTT (Estudo Padronizado do Trabalho por Turnos), traduzido e adaptado para a versão portuguesa por Carlos Silva (1995) e Whoqol-bref, questionário de avaliação da qualidade de vida desenvolvido pela OMS, traduzido e adaptado para a versão portuguesa por Canavarro et al (2006). Resultados: No que concerne às caraterísticas sociodemográficas da amostra estudada, verificou-se que apesar do trabalho por turnos com trabalho noturno ser mais frequente nos homens, não se obtiveram diferenças estatisticamente significativas (Teste Exato de Fisher; p=0,120). Relativamente ao estado civil verificou-se que o trabalho por turnos era mais frequente nos enfermeiros solteiros, separados ou viúvos (19/22; 86,4%) do que nos casados ou união de facto (18/29; 62,1%) (Teste Exato de Fisher; p=0,052). Maior proporção de enfermeiros que trabalhavam em horário diurno fixo tinham filhos a cargo e essa diferença era significativa quando comparada com a proporção de enfermeiros que trabalhavam por turnos. 10 Relativamente à análise do estado de saúde (físico e mental) e qualidade de vida dos enfermeiros verificou-se que os enfermeiros que trabalhavam por turnos com trabalho noturno referiram um efeito mais negativo na saúde e qualidade de vida comparativamente aos enfermeiros com horário fixo, mas não se verificou diferença estatisticamente significativa (Teste Exato de Fisher; p= 0,141). No que respeita à avaliação das perturbações de saúde física, psicológica, sociofamiliar e do sono verificou-se que, tanto os trabalhadores com horário fixo e diurno, como os trabalhadores com horário por turnos com trabalho noturno, apresentaram valores de score entre 22 e 27 (numa escala de 0 a 100) nos domínios de avaliação física, psicológica, social e ambiental, mas não havia diferença estatisticamente significativa entre os dois grupos (teste U de Mann- Whitney: p= 0,849; 0,983; 0,399; 0,340 respetivamente). Verificou-se também que não existia uma associação significativa entre o trabalho por turnos com trabalho noturno e a dificuldade em adormecer, em comparação com os trabalhadores com horário fixo e diurno (Teste qui-quadrado de Pearson; p=0,588). A automedicação apresentou uma prevalência de 35,7% nos trabalhadores com horário fixo e diurno, contrapondo com 24,3% nos trabalhadores com trabalho rotativo e noturno, sem diferença estatisticamente significativa (teste qui-quadrado, p=0,316). Também não houve diferenças com significado estatístico no consumo de psicofármacos e analgésicos (teste exato de Fisher, p= 0,619; p=0,170, respetivamente). Neste estudo, não se verificou qualquer diferença com significado estatístico no que respeita à qualidade de vida, estado de saúde físico e mental e automedicação entre enfermeiros que trabalham por turnos com horário noturno e enfermeiros com horário fixo. Contudo, uma das grandes limitações deste estudo é a dimensão da própria amostra, pelo que outros estudos com amostras de maiores dimensões deverão ser realizados.
ABSTRACT - Over the last decades, the issue of night shift work has raised some concerns on the part of nurses regarding the impact on their health (physical and mental), quality of life and consequently the possibility of Practice of self-medication. Objective: To evaluate the impact of shift work with night work on health (physical and mental), quality of life and self-medication of nurses from three services of a Central Hospital. Type of study: An observational, cross-sectional study with a descriptive component and an analytical component was carried out, comparing the quality of life, health status and self-medication of nurses who worked in shifts of those who had a fixed schedule. The following statistical tests were used: Pearson's coefficient (r), Mann-Whitney U test, Chi-square test and Fisher's exact test. And a significance level of 5%. Sample: The sample is of convenience, consisting of nurses from three services of a central hospital in the Lisbon region, who agreed to participate in the study (n = 51). Of the 51 professionals who joined the study, 37 worked in fixed and daytime hours and 14 in shift hours with night work. Data collection instrument: Data collection instruments used were: EPTT (Standardized Study of Shift Work), translated and adapted to the Portuguese version by Carlos Silva (1995) and Whoqol-bref, quality of life assessment questionnaire Developed by WHO, translated and adapted to the Portuguese version by Canavarro et al (2006). Results: As regards the sociodemographic characteristics of the sample studied, it was verified that although night shift work was more frequent in men, no statistically significant differences were obtained (Fisher's exact test, p = 0.120). Concerning marital status, it was found that shift work was more frequent in single, separated or widowed nurses (19/22, 86.4%) than married or de facto union (18/29, 62.1%), (Fisher's Exact Test, p = 0.052). A higher proportion of nurses working at fixed daytime had dependent children, and this difference was significant when compared to the proportion of nurses who worked in shifts. Regarding the analysis of the health status (physical and mental) and quality of life of the nurses, it was verified that the nurses who worked in shifts with night work reported a more negative effect on health and quality of life compared to nurses with fixed schedule, but There was no statistically significant difference (Fisher's Exact Test, p = 0.141). 8 Regarding the evaluation of physical, psychological, socio-familial and sleep disorders, it was found that both fixed and daytime workers and shift workers with night work presented score values between 22 and 27 (On a scale of 0 to 100) in the physical, psychological, social, and environmental assessment domains, but there was no statistically significant difference between the two groups (Mann-Whitney U test: p = 0.849, 0.983, 0.399, 0.340 respectively). It was also found that there was no significant association between shift work with night work and difficulty falling asleep compared to workers with fixed and daytime schedules (Pearson's chi-square test, p = 0.588). Self-medication presented a prevalence of 35.7% in workers with fixed and daytime hours, compared with 24.3% in workers with rotational and nocturnal work, with no statistically significant difference (chi-square test, p = 0.316). There were also no statistically significant differences in the consumption of psychoactive drugs and analgesics (Fisher's exact test, p = 0.619, p = 0.170, respectively). In this study, there was no statistically significant difference in quality of life, physical and mental health status and self-medication among night shift nurses and fixed-time nurses. However, one of the major limitations of this study is the size of the sample itself, so further studies with larger samples should be performed.