International Journal of Nursing Studies ( IF 8.1 ) Pub Date : 2021-07-17 , DOI: 10.1016/j.ijnurstu.2021.104041 Lois James 1 , Nathaniel Elkins-Brown 2 , Marian Wilson 1 , Stephen M James 1 , Elizabeth Dotson 3 , Charles D Edwards 2 , Laura Wintersteen-Arleth 2 , Kevin Stevens 2 , Patricia Butterfield 4
Background
Healthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied.
Objective
To determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures.
Design
A quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested).
Setting
Participants were tested in a northwestern US university's nursing simulation laboratory.
Participants
A volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals.
Methods
Simulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness.
Results
In our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors.
Conclusions and Relevance
Nurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts—if any—on patient care.
Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.
中文翻译:
连续三班 12 小时轮班对白班和夜班护士认知、嗜睡和护理绩效领域的影响:一项准实验研究
背景
医疗保健系统广泛采用连续 12 小时的护士昼夜轮班制,但这些轮班对认知、嗜睡和护理绩效的影响仍未得到充分研究。
客观的
为了确定连续三个 12 小时轮班工作的护士认知和嗜睡的变化程度,量化这些变化对护理绩效不同方面的各自影响,并调查所有措施的个体差异。
设计
一项准实验性组内设计收集了 2018 年 11 月至 2020 年 3 月期间护士的数据。组间部分由白班护士与夜班护士组成,而组内部分由两个单独的测试阶段组成每位护士:在连续第三次轮班(疲劳)后立即安排一名护士,在连续三天下班(休息)后立即安排一名护士。
环境
参与者在美国西北部大学的护理模拟实验室接受了测试。
参与者
从当地两家医院招募了 94 名参与直接病人护理工作的 12 小时轮班的注册护士志愿者样本。
方法
模拟护理表现在七个不同的领域进行测量,并从 Creighton 能力和评估量表中得出一个总分,涵盖程序技能、评估、决策等较低和较高级别的结构。认知和嗜睡通过以下措施进行评估持续的注意力、预测的认知有效性和主观嗜睡。
结果
在我们的 94 名护士中,我们所有措施的个体差异从小到大不等。对于六个领域的表现和总分,各组或条件之间的平均值没有显着差异。对于第七个,夜间护士的沟通技巧低于日间护士,但这种影响很小。连续三班后,持续注意力和预测认知效果下降,主观嗜睡增加。与其他情况相比,疲劳的夜间护士的预测认知效率特别低,并且在控制其他预测因素时与沟通呈正相关。
结论和相关性
在连续三个轮班之后,护士在所有领域都保持了他们的表现水平。预测认知有效性的个体差异可以解释不同班次类型的沟通技能的表现差异,但不能解释其他领域的表现。沟通技巧和预测的认知有效性可能会让研究人员对夜班护士疲劳缓解策略的开发感兴趣,但我们的研究结果还表明,可能需要更敏感的绩效指标来捕捉长期连续轮班(如果有的话)的其他有意义的影响。病人护理。
Tweetable 摘要:连续三个 12 小时轮班对白班和夜班护士的认知、嗜睡和护理表现领域的影响:一项准实验研究。