Night Shift Nursing Stress - Research Paper Example

Night Shift Nursing Stress The history of nursing has necessitated the need for nurses to work night shifts in many environments to accomplish the objective of continuity of patient care. As humans are biologically designed to be awake during the day and sleep at night, there has been growing concern and interest over the years about how circadian rhythm disruption may increase the risk of adverse health effects in the night shift nurse. This literature review examines many different research modalities conducted, including: cross-sectional studies, questionnaires, interviews, self-observation by diary, and outside observation to determine a correlation. The paper discusses the research findings indicating that night shift work exacerbates stress because it is positively correlated with adverse health effects, including sleep, physiological, and psychological disorders. In addition, considerations and recommendations to the nurse to alleviate the associated stress, as well as promote adaptability and tolerance for the night shift routine, both at work and home, are discussed. Night Shift Nursing Stress I. Introduction Continuity of patient care requires that health care providers be available to work night shift. According to Blachowicz and Letizia (2006), “Nursing is among the many professions affected by the requirement to work outside of normal daytime hours. While benefits exist, nurses face significant challenges when they work alternate shifts” (p. 274). Over the years, concern and interest have resulted in studies conducted to determine the health risks and effects of night shift work on the nurse. As humans are naturally designed to be awake during the day and sleep at night, working nights disrupts the circadian rhythm, or internal clock. Night shift work exacerbates stress because it is positively correlated with adverse health effects, including sleep, physiological, and psychological disorders.  This paper highlights some of the most common occupational health risks and disorders associated with working nights. In addition, considerations and recommendations to help alleviate the associated stress will be discussed. II. Effects on Sleep Working night shifts is a necessary part of a nurse’s job description. However, working night shifts for long periods can have a detrimental effect on sleep, resulting in fatigue and other adverse consequences. Happell et al. (2013, p. 642) report that working night shifts resulted in physical stress and exhaustion for nurses because they could not get an adequate amount of sleep. This shows that night shifts can disturb the physiological working of the body. A. Sleep Deprivation and Fatigue The unique physical work environment contributes to disturbances in the normal sleep patterns of nurses. It is reported by Muecke (2005, p. 435) that when nurses work night shifts in artificially lit hospital environments, the natural release of the hormone melatonin is suppressed. This hormone induces sleep in the body and when its release is inhibited by the presence of light, the nurses become deprived of natural sleep patterns. In addition, Smith and Eastman (2012, p. 112) explain that the best sleep quality is achieved a few hours prior to waking. Hence, due to night shifts, nurses become deprived of this high quality sleep and accumulate increasing amounts of cumulative sleep debt (Muecke, 2005, p. 435). This indicates that sleep lost during night shifts cannot be compensated by sleeping during the day. Night shift work also adversely affects fitness levels of nurses. It is argued by Persson and Martensson (2006, p. 415) that nurses who work night shifts have lower energy intake than day shift workers. Furthermore, Monk et al. (2013, p. 207) argue that nurses who have retired from shift work may continue to suffer from poor sleep compared to people who only worked day shifts. This shows that working night shifts disturbs sleep patterns and has long-term consequences for health and quality of life. B. Poor Job Performance In addition to sleep deprivation, working night shifts can also adversely affect the job performance of nurses. As stated previously, the hormone melatonin is released in the body at night to induce sleep. However, the needs of patient care and administering treatment require nurses to guard against the onset of sleep to remain mentally alert and attentive. Unfortunately, despite these efforts, the mental alertness and motor responses of nurses working night shifts are compromised. Nurses become unable to perform their duties and interpret care situations with the responsiveness that is required. Research by Alspach (2008, p. 13) shows that sleep deprivation caused by working night shifts can lead to poor cognitive performance in several areas. In addition, Muecke (2005, p. 437) argues that working night shifts was a major reason for reduced levels of mental alertness and job performance. According to Muecke (2005), “The implications of fatigued nurses working in any patient care area are undoubtedly important, but the effects of impaired nurse performance in the critical care environment can be more profound” (p. 437). Such effects were particularly prominent in mature nurses who are defined by Reilly, Waterhouse and Atkinson (1997, p. 815) as older nurses above the age of 49. Persson and Martensson (2006, p. 416) report that the need to stay alert during night shifts causes some nurses to change their diet and eating habits, with consequences for their health. These research findings explain that sleep deprivation through night shift work leads to poor job performance which can put the life of the patient at serious risk. C. Safety Risks When nurses working night shifts are deprived of sleep and their performance declines, it can lead to greater safety risks to the safety and well-being of the nurses as well as their patients. This is shown by the work of Alspach (2008, p. 13) who states that motor skills and information processing capacities of nurses suffer due to sleep deprivation. Being deprived of sleep for more than 24 hours can result in loss of psychomotor performance similar to someone with more than the legal blood alcohol content. Nurses become more likely to suffer from road accidents while driving home after completing their night shift. Patients also come under increased risk when nurses are deprived of sleep. When nurses suffer from reduced mental alertness and responsiveness, they become less able to deliver the promised level of care and attention to their patients. The risk of medication error and harm increases when the alertness and attentiveness of nurses are compromised. Alspach (2008) identifies some of these medication errors (p. 14). These include errors in reading and interpreting medical data and reports of the patient, including readings displayed on medical equipment. The motor skills can also be compromised which can result in incorrect handling of medical equipment and of the patient while assisting them in various personal tasks. Efinger, Nelson, and Starr (1995, p. 318) argue that shiftwork can result in poor job performance as well as reduced levels of patient satisfaction and quality of care. Accidents and injuries also become more common with night shift workers. Johnson, Brown, and Weaver (2010, p.147) also found an inverse relationship between sleep duration and psychomotor performance. Keller (2009, p. 498) argues that the trend of extended shift hours that go up to even 16 hours per shift are detrimental to the welfare of nurses and patients because they increase fatigue among nurses. As a result, the likelihood of medication errors and health care errors increases. These research findings show that extended sleep deprivation increases safety risks for nurses as well as patients because reduced alertness and psychomotor performance can lead nurses to making incorrect diagnoses and administering wrong medication detrimental to the patient. III. Physiological Effects A. Cardiovascular disorders Nurses who work night shifts become exposed to the risk of physiological disorders that can have a deep impact on their overall health and well-being. It is argued by Blachowicz and Letizia (2006, p. 276) that nurses who work night shifts attempt to overcome the effects of fatigue through the consumption of stimulants that are rich in sodium and fats which increases the risk of high blood pressure and other cardiovascular disorders. Alspach (2008) also states that working night shifts contributes to increased risk of cardiovascular diseases and some types of cancer (p. 13). The risk of cardiovascular diseases and high blood pressure among nigh shift workers has also been documented by Muecke (2005) in the following words: The circadian pattern of lowering of blood pressure and heart rate at night may result in a higher incidence of ischaemic heart disease in nightworkers. Harrington (2001) concurs and describes Scandinavian studies that support this observation. These studies suggest that the propensity for cardiovascular pathology amongst shiftworkers is not only related to circadian disruption, but also to stress and a poor diet and exercise regime that may be associated with the social upheaval linked with irregular working hours. (p. 436) These findings provide ample evidence to argue that night shift nurses are at an increased risk of cardiovascular complications due to their peculiar work patterns. B. Gastrointestinal Disorders In addition to cardiovascular disorders, night shift nurses are also likely to be at greater risk of suffering from various gastrointestinal disorders including ulcers, nausea, diarrhea and constipation. Alspach (2008) has argued that sleep deprivation among nurses who work night shifts can contribute to nausea which could also affect their job performance (p. 17). Muecke (2005, p. 436) also reports that nurses who work night shifts are at greater risk for gastrointestinal problems because of their eating patterns. According to Muecke (2005, p. 436) the irregular eating schedules of night shift nurses do not coincide with the natural process of the body by which digestive enzymes are released. In fact, Muecke (2005, p. 436) reports that the risk of such gastrointestinal disorders increases by up to six times among night shift nurses. Thus, the research shows that night shift nurses are likely to experience disorders such as ulcers, nausea, diarrhea and constipation. C. Metabolic Disorders Disruptions to the natural digestive and sleep cycles of the body can also take a toll on the metabolic functions of the body, thereby resulting in varied effects of eating disorders. In order to stay awake during the night shift hours, nurses avoid consuming large meals and instead prefer to have fast food and caffeinated drinks to pull through the night. This increases the consumption of unhealthy foods that are high in fats, oils, sodium and caffeine (Blachowicz and Letizia, 2006, p. 276). Persson and Martensson (2006, p. 417) explain various instances through which night shift nurses attempt to cope with the pressures of night shift work. Their results reveal that preference for fast food over more nutritious food due to less time is a common occurrence among night shift workers. Many nurses also demonstrated an increased desire to consume junk food when they see their colleagues consuming it. However, a desire to maintain a healthy diet for good digestion was just as common among the night shift nurses (Persson and Martensson , 2013, p. 417). A further consequence of unhealthy eating habits and irregular meal patterns is the onset of obesity through rapid weight gain. Marquezea et al. (2012, p. 2047) support this view by arguing that working at night shifts is an important factor contributing to overweight and obesity among nurses. Marquezea et al. (2012) state, “However, as we have mentioned, working at night leads to a greater increase in BMI than the day work” (p. 2047). Hence, it appears that nurses who work night shifts become increasingly disposed towards obesity due to unhealthy eating habits and the resulting metabolic disorders. D. Endocrine Disorders Disruptions to the sleep and digestive patterns can also contribute to various endocrine disorders because the hormonal cycles are affected negatively. Alspach (2008) states that nurses who work night shifts are likely to experience “possible enhanced risk of cardiovascular diseases, insulin resistance, diabetes, and certain cancers” (p. 13). In fact, Muecke (2005, p. 436) reports a study by Perkins (2001) where it is proposed that nurses who already suffer from diabetes should avoid working night shifts as it could exacerbate their condition. Persson and Martensson (2006, p. 415) draw a link between poor dietary habits and diabetes among night shift nurses and argue that poor food choices can lead to obesity and, consequently, diabetes among night shift nurses. However, it is interesting to note that Marquezea et al. (2012, p. 2045) have found that night shift workers do not suffer from diabetes. Although the research is not unanimous, most findings support the view that disturbed circadian rhythms can lead to endocrine disorders in night shift nurses. IV. Psychological effects A. Mild Psychiatric Disorders Night shift working among nurses is also known to contribute to mild psychological disorders (MSD) in the form of anxiety and depression. Other factors such as age and gender also moderate the effect of night shifts; however, it is important to explore the impact of extensive periods of night shift work on the psychological well-being of nursing professionals. Diniz et al. (2012, p. 2887) have shown the relationship between minor psychiatric disorders and night shift work. They draw a relationship between night shift work and stress in the following words: In the context of work-health relationships, the permanence in night shifts, due to some advantageous features related to income or conciliation with diurnal domestic work, amongst others [23] would lead to the worker’s mental strain, resulting from an unequal correlation of forces [6] in that workers have to deal with harmful aspects of work in health and wellbeing. (p. 2891) Diniz et al. (2012, p. 2891) explain that psychiatric disorders such as anxiety, fatigue or mental fatigue can be experienced by nurses because they continuously suppress the natural signals of the body for food and rest which results in mental strain and more serious complications such as minor psychiatric disorders. Nurses at times cannot adapt to the night shift schedule even after spending years in the same shift. This produces another kind of strain with its own kind of psychiatric conditions. Alspach (2008, p. 13) also upholds the view that night shift nurses are prone to developing psychological conditions. While Alspach (2008, p. 13) does not categorically state these conditions as anxiety and depression, he finds considerable similarity between the symptoms demonstrated by night shift nurses and those suffering from depression or anxiety. Hence, it may be stated that research evidence establishes a link between night shift work and psychiatric disorders among nurses. B. Alcohol and Other Substance Abuse The mental strain and psychological pressures associated with night shift work can also push nurses to engage in alcohol and other forms of substance abuse, including smoking, which contributes to poor health. Diniz et al. (2012, p. 2890) report greater incidence of smoking among night shift workers compared with day shift nurses. While 23.5% of the day shift nurses surveyed reported smoking habits, the percentage of night shift nurses who took up smoking was 53.6%. In another study, Trinkoff and Storr (1998) reported that nurses who worked night shifts were at the greatest risk of high alcohol consumption and smoking. Rotating shift nurses were also at an increased risk but less than night shift nurses. Family and home demands were also a contributing factor in determining substance use among women nurses. This proves that nurses are in great risk of compromising their health if they take to substance abuse to cope with the pressures of working night shifts. C. Family and Social Dysfunction Sleep deprivation due to night shift nursing can prevent nurses from spending sufficient time with their family. Muecke (2005, p. 437) also explains that working shifts disrupts the family and social life of nurses. He further explains that disruption of social life can contribute to a negative lifestyle and its associated health risks. Persson and Martensson (2006, p. 421) explain that family commitments often prevent nurses from following a balanced and healthy lifestyle. They also state that irregular working hours prevent nurses from participating in social events held during weekdays; although they could search for opportunities to socialize with colleagues who worked similar shifts. Smith and Eastman (2012, p. 112) report that nurses do not prefer evening shifts because these interfere with family and social events. Diniz et al. (2012, p. 2891) also report that the family and social lives of night shift nurses suffer because their schedules do not match with those of family and neighbors. They further state that the emotional stability of night shift nurses is also compromised. Hence, it may be argued that nurses suffer not only physically and professionally, but their social life also becomes misbalanced because of peculiar work schedules. V. Conclusion On the basis of the research that has been reviewed in the foregoing sections, it can be concluded that night shift work exacerbates stress because it is positively correlated with adverse health effects, including sleep, physiological, and psychological disorders. This can affect not only the well-being and health or nurses but also the safety of the patients under their care. There is a need to increase awareness of these effects among night shift nurses and hospital administrators so that they may develop appropriate support systems to ensure the well-being and professional competence of nurses. Through these means, the quality of care delivered to patients can also be ensured. Some of these interventions can be made by nurses independently, for example healthy eating and sleeping habits, while others require cooperation from hospital management, for example, balanced shift schedules. Most importantly, nurses should assume responsibility for initiating positive changes in their lifestyles to maintain their health and professional competence. References Alspach, G. (2008). Napping on the Night Shift: Slacker or Savior?. Critical Care Nurse, 28(6), 12-19. Retrieved from http://vlib.excelsior.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=35453406&site=eds-live&scope=site Blachowicz, E., & Letizia, M. (2006). Best Practice. The challenges of shift work. MEDSURG Nursing, 15(5), 274-280. Retrieved from http://vlib.excelsior.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009315093&site=eds-live&scope=site Diniz, T. B., Silva-Costa, A., Griep, R. H., & Rotenberg, L. (2012). Minor psychiatric disorders among nursing workers-is there an association with current or former night work?. Work, 412887-2892. Retrieved from http://vlib.excelsior.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011465581&site=eds-live&scope=site Efinger, J., Nelson, Lucille C., & Walsh Starr, Julia M. (1995). Understanding Circadian Rhythms: A Holistic Approach to Nurses and Shift Work. Journal of Holistic Nursing, 13:306. doi:10.1177/089801019501300403 Happell, B., Dwyer, T., Reid-Searl, K., Burke, K. J., Caperchione, C. M., & Gaskin, C. J. (2013). Nurses and stress: recognizing causes and seeking solutions. Journal Of Nursing Management, 21(4), 638-647. doi:10.1111/jonm.12037 Johnson, A., Brown, K., & Weaver, M. (2010). Sleep deprivation and psychomotor performance among night-shift nurses. AAOHN Journal, 58(4), 147-154. doi:10.3928/08910162-20100316-02 Keller, S. (2009). Effects of extended work shifts and shift work on patient safety, productivitiy, and employee health. AAOHN Journal, 57(12), 497-502. doi:10.3928/08910162-20091116-01 Marquezea, E., Lemos, L., Soares, N., Lorenzi-Filhob, G., & Morenoa, C. C. (2012). Weight gain in relation to night work among nurses. Work, 412043-2048. Retrieved from http://vlib.excelsior.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011465691&site=eds-live&scope=site Monk, T.H. Buysse, D. J., Billy, B. D., Fletcher, M. E., Kennedy, K. S., Begley, A. E., &…Beach, S. R. (2013). Shiftworkers report worse sleep than day workers, even in retirement. Journal Of Sleep Research, 22(2), 201-208. doi:10.1111/jsr.12003 Muecke, S. (2005). Effects of rotating night shifts: literature review. Journal Of Advanced Nursing, 50(4), 433-439. doi:10.1111/j.1365-2648.2005.03409.x Perkins, L. (2001). Is the night shift worth the risk? RN, 64(8), 65-66. ISSN: 0033-7021 Persson, M., & Martensson, J. (2006). Situations influencing habits in diet and exercise among nurses working night shift. Journal Of Nursing Management, 14(5), 414-423. doi:10.1111/j.1365-2934.2006.00601.x Reilly, T., Waterhouse, J., & Atkinson, G. (1997). Aging, rhythms of physical performance, and adjustment to changes in the sleep activity cycle. Occupational and Environmental Medicine 54(11), 812–816. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1128953/ Smith, M. R., & Eastman, C. I. (2012). Shift work: health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment. Nature & Science Of Sleep, 4111-132. doi:10.2147/NSS.S10372 Trinkoff, A. M., & Storr, C. L. (1998). Work schedule characteristics and substance use in nurses. American Journal of Industrial Medicine, 3(3), 266-271. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9698996 Read More