School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
Chronobiol Int. 2022 Apr;39(4):557-568. doi: 10.1080/07420528.2021.2005082. Epub 2021 Dec 14.
Female nurses working rotating shifts must change their daily routines often, which affects their biological circadian rhythms and could cause sleep disorders and fatigue. The objective of this study was to compare the sleep-wake rhythms, sleep quality, and fatigue of female nurses working rotating shifts and fixed day shifts and to analyze the factors that influence their fatigue. Participants comprised a shift worker group of 101 nurses and a day worker group of 76 nurses. Following the collection of basic information of the nurses and their scores in the various constructs of the Pittsburg Sleep Quality Index (PSQI) and the Checklist Individual Strength (CIS) questionnaire, each nurse wore an actigraph for seven consecutive days to collect for analysis the sleep-wake rhythm parameter dichotomy index (I < O) and durations of continuous sleep and wake. Multivariable linear regression was then used to determine whether the influence of various variables on fatigue differed between the two groups. Results revealed that the sleep-wake rhythm parameter I < O of the day worker group was significantly higher than that of the shift worker group ( = 5.08, < .001). The shift worker group exhibited significantly higher PSQI global scores ( = -2.00, = .047), longer total sleep time ( = 2.07, = .040), poorer habitual sleep efficiency ( = -3.06, = .003), and greater use of sleeping medication ( = -2.90, = .004) than did the day worker group. Multivariable linear regression was performed to analyze the important predictors of the CIS score in the two groups with body mass index, age, work experience, marital status, educational background, department of employment, shift type at the time of recruitment, sleep-wake rhythm parameter I < O, and quality of sleep as independent variables. Results indicated that in the shift worker group, the overall explanatory power () of the multivariable linear regression model was 22.9% (F = 3.01, = .003), and only the PSQI global score (β = 0.33, = .003) influenced the CIS score. In the day worker group, the various variables did not influence the CIS score in the multivariable linear regression model. Although the female nurses working rotating shifts spent more time in bed, their sleep-wake rhythms and sleep quality were poorer than those of the day worker group. Furthermore, the sleep quality of female nurses in the shift worker group had a significant impact on their fatigue. In other words, for female nurses who must work rotating shifts, sleep quality determines whether fatigue can be reduced. The shift-working nurses themselves should implement sleep management, such as avoiding disruptions to their sleep-wake rhythm and improving sleep quality, which should be effective strategies to reduce fatigue.
女性倒班护士经常改变日常生活规律，这会影响其生理昼夜节律，导致睡眠障碍和疲劳。本研究旨在比较倒班和固定白班护士的睡眠-觉醒节律、睡眠质量和疲劳程度，并分析影响其疲劳的因素。研究对象包括 101 名倒班护士和 76 名白班护士。收集护士的基本信息和匹兹堡睡眠质量指数（PSQI）和个体力量检查表（CIS）问卷的各项得分后，每位护士连续 7 天佩戴活动记录仪，以分析睡眠-觉醒节律参数二分指数（I<O）和连续睡眠和觉醒的持续时间。然后，采用多变量线性回归来确定两组之间不同变量对疲劳的影响是否存在差异。结果显示，白班护士的睡眠-觉醒节律参数 I<O 显著高于倒班护士（ =5.08， <.001）。倒班护士的 PSQI 总分（ =-2.00， =.047）、总睡眠时间（ =2.07， =.040）、习惯性睡眠效率（ =-3.06， =.003）和睡眠药物使用（ =-2.90， =.004）均显著高于白班护士。采用多变量线性回归分析两组的 CIS 评分重要预测因子，以体重指数、年龄、工作经验、婚姻状况、教育背景、就业部门、招聘时的班次类型、睡眠-觉醒节律参数 I<O 和睡眠质量为自变量。结果表明，在倒班护士组，多变量线性回归模型的总解释力（ ）为 22.9%（F=3.01， =.003），只有 PSQI 总分（β=0.33， =.003）影响 CIS 评分。在白班护士组，多变量线性回归模型中没有变量影响 CIS 评分。尽管倒班的女性护士在床上的时间更多，但她们的睡眠-觉醒节律和睡眠质量比白班护士差。此外，倒班护士组的睡眠质量对其疲劳有显著影响。换句话说，对于必须倒班的女性护士来说，睡眠质量决定了疲劳是否可以减轻。倒班护士本身应实施睡眠管理，如避免打乱睡眠-觉醒节律和改善睡眠质量，这应是减轻疲劳的有效策略。
