College of Nursing, Washington State University, Spokane, WA, USA.
Sleep and Performance Research Center and Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
Accid Anal Prev. 2019 May;126:43-46. doi: 10.1016/j.aap.2017.09.023. Epub 2017 Oct 5.
Hospitals are around-the-clock operations and nurses are required to care for patients night and day. The nursing shortage and desire for a more balanced work-to-home life has popularized 12-h shifts for nurses. The present study investigated sleep/wake cycles and fatigue levels in 22 nurses working 12-h shifts, comparing day versus night shifts. Nurses (11day shift and 11 night shift) were recruited from a suburban acute-care medical center. Participants wore a wrist activity monitor and kept a diary to track their sleep/wake cycles for 2 weeks. They also completed a fatigue test battery, which included the Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale (KSS), at the beginning, middle and end of 4 duty shifts. Daily sleep duration was 7.1h on average. No overall difference in mean daily sleep duration was found between nurses working day shifts versus night shifts. Objective performance on the PVT remained relatively good and stable at the start, middle, and end of duty shifts in day shift workers, but gradually degraded across duty time in night shift workers. Compared to day shift workers, night shift workers also exhibited more performance variability among measurement days and between participants at each testing time point. The same pattern was observed for subjective sleepiness on the KSS. However, congruence between objective and subjective measures of fatigue was poor. Our findings suggest a need for organizations to evaluate practices and policies to mitigate the inevitable fatigue that occurs during long night shifts, in order to improve patient and healthcare worker safety. Examination of alternative shift lengths or sanctioned workplace napping may be strategies to consider.
医院是 24 小时运营的，护士需要日夜照顾病人。由于护理人员短缺以及对工作与家庭生活更平衡的渴望，12 小时轮班制在护士中流行起来。本研究比较了白班和夜班，调查了 22 名轮班工作 12 小时的护士的睡眠/觉醒周期和疲劳程度。从一家郊区急症医疗中心招募了护士（11 名白班和 11 名夜班）。参与者佩戴腕部活动监测器并记录日记，以记录他们 2 周的睡眠/觉醒周期。他们还在 4 个值班班次的开始、中间和结束时完成了疲劳测试电池，包括精神运动警觉测试（PVT）和 Karolinska 嗜睡量表（KSS）。平均每天睡眠时间为 7.1 小时。白班和夜班护士的平均每日睡眠时间没有总体差异。在白班工人的值班开始、中间和结束时，PVT 的客观表现相对较好且稳定，但在夜班工人的值班时间内逐渐恶化。与白班工人相比，夜班工人在测量日之间以及每个测试时间点的参与者之间的表现也更具变异性。在 KSS 上的主观嗜睡也观察到了相同的模式。然而，疲劳的客观和主观测量之间的一致性很差。我们的研究结果表明，组织需要评估实践和政策，以减轻长时间夜班不可避免的疲劳，从而提高患者和医护人员的安全。可以考虑检查替代轮班时间或规定的工作场所午睡。
