NK1

 

Research NK1

 

Provide a synopsis of one completed institutional review board-approved (IRB-approved) nursing research study.

 

 

Study overview

  • Title of study
  • IRB approval date and type of review (i.e., full board, expedited, exempt)
  • Study start date
  • Study completed date

 

Research team

  • Nurse(s) at the organization who is (are) the principal investigator(s) (PI), co-PI, or the site PI involved in the conduct of the study
  • Other key personnel on research team

 

Study aim(s)

  • Study purpose, what new knowledge will be generated, or both

 

Significance of the literature review (two pages maximum)

  • Key references to support the significance
  • Why the study is important to nursing (e.g., the patient experience of care, patient or health outcomes, cost of care, nursing practice).
  • What is currently known about the topic if an intervention study, what evidence supports the intervention or innovation.
  • Summarize the gap in current knowledge about the topic being addressed by the study.

 

Innovation

  • How the study will produce actionable information for nursing

 

Study design

  • Describe the study design: Qualitative, quantitative (descriptive, correlational, quasi-experimental, experimental, or other).
  • Research questions(s), hypothesis, or both

 

Sample description

  • Type of sample (e.g. convenience, cohort, random)
  • Inclusion and exclusion criteria
  • Sample size

 

Location of study (within the applicant organization)

  • Hospital, units(s) ambulatory care area(s) that apply

 

Study procedures

  • Procedures from initial screening through end of contact with subjects
  • Data collection methods

 

Results

  • Results of data analysis (description of sample characteristics and analysis for research questions or hypotheses)

 

Discussion

  • Discussion and interpretation of the findings
  • Implications of the findings and recommendations to the organization

 

Study Overview
Title of study: Self-Care Habits of the Night Shift Nurse

 

Introduction: Research has demonstrated that night shift work can lead to a variety of negative health outcomes such as depression, insomnia and obesity (Hai, Xiaohong & Chunmeng, 2016). The negative health effects of night shift work may be mitigated by engaging in a variety of health-promoting activities. This survey was conducted to provide a baseline assessment of Greenwich Hospital nurses’ beliefs about and current implementation of self-care strategies, and their impact on health outcomes.

 

Research Question
To what extent do night-shift nurses engage in evidence-based self-care habits?
What are self-care habits moderated by a variety of co-variates including staffing levels, unit culture and years of experience?

 

  • IRB approval date and type of review (i.e., full board, expedited, exempt)

IRB approval date: February 14, 2017 Exemption 2, Anonymous Survey; Approval by letter)
Study start date: March 12, 2017
Study completed date: June 6, 2017

 

Research team

  • Nurse(s) at the organization who is (are) the principal investigator(s) (PI), co-PI, or the site PI involved in the conduct of the study:

Gina Trovato, MSN, RN, CRN, Principal Investigator

 

  • Other key personnel on research team:

The Greenwich Hospital Professional Governance Night Shift Council members

 

Study aim(s)

  • Study purpose, what new knowledge will be generated, or both:

Nurses who perceive greater support for self-care will be more likely to engage in self-care behavior.

 

Significance of the literature review (two pages maximum)

  • Key references to support the significance:

Night shift workers experience challenges in many aspects of their personal and professional lives, such as fatigue, car accidents, exercise avoidance, unhealthful eating habits and lack of involvement in professional development opportunities. In a study of night shift workers in Brazil, 80% of nurses surveyed (n=50) reported that their physical health problems and/or emotional stressors interfered with their daily social activities. Many of these nurses also reported that their level of sleep deprivation interfered with their ability to deliver high-quality nursing care. (Lessa Cordeiro, da Silva,Cunha da Silva, da Silva, Galdino Alves & Rodrigues da Silva, 2017).

 

Others have documented the impact of shift work on weight (Williams, 2017). Apellido (2019), in a study of 24 night shift nurses, found a small but statistically significant relationship between sleep deprivation and body mass index (BMI). Nurses who slept poorly between shifts were more likely to have a high BMI.

 

Night shift work also has an impact on mood. Hai, Xiaohong & Chunmeng (2016) found that night shift nurses experience more anxiety and report higher levels of depression than day shift nurses. The increase in psychological symptoms experienced by these nurses was associated with lower levels of social support. Simply put, it may be more difficult for night shift nurses to find social support outside of work due to their unique work and sleep schedules. This lack of support can increase their risk for anxiety and depression.

 

Night nurses frequently do not take their breaks, and they normalize this practice, which is disregarded as a safety issue (Geiger-Brown et al., 2016). This may sometimes be because nurses feel this practice is not supported by management; research demonstrates the important role of administrators in promoting a culture of safety, particularly on night shift (Weaver, Lindgren, Cadmus, Flynn & Thomas-Hawkins, 2017).

 

  • Why the study is important to nursing (e.g., the patient experience of care, patient or health outcomes, cost of care, nursing practice).

This study is important to nursing to improve nurses’ health and improve the nurse work environment. Improving the self-care of nurses who work the night shift is a priority.

 

  • What is currently known about the topic if an intervention study, what evidence supports the intervention or innovation.

Night shift nurses do not routinely take a break during their shift, and many night nurses report feeling tired during their shift or when driving a car after their shift. It is known that a lack of self-care is associated with poor health outcomes for shift workers worldwide (Agosti, Andersson, Ejlertsson & Janlöv, 2015). The impact of shift work can also be felt by hospitals, as night shift workers are more likely to experience absence due to illness and to retire early (Åkerstedt, Ingre, Eriksen, 2003; Josefsson, Sonde, Winblad, Robins-Wahlin, 2007).

 

While the impact of poor self-care activities on night shift workers is well documented, what is less known is how perceptions of administrative support shape night shift workers’ decision making around self-care activities. It is important to know whether nurses participate in self-care activities and how nurses perceive support to engage in these behaviors. This study documented nurses’ current level of engagement in self-care activities. The study also aimed to document the role of perceived support on night shift nurses’ level of engagement in self-care behavior. This second area remains largely unexplored in the literature.

 

  • Summarize the gap in current knowledge about the topic being addressed by the study.

Night shift nurses do not routinely take a break during their shift, and many night nurses report feeling tired during their shift or when driving a car after their shift. It is important to know whether nurses participate in self-care activities and whether their work environment affects this.

 

Innovation

  • How the study will produce actionable information for nursing

The study gained information about night shift nurses and their self-care habits. Nursing will be able to make recommendations for night shift nurses based on the results. Recommendations to improve the work environment so nurses can practice better self-care may include making healthier food options available during their shift; encouraging breaks off the unit or in a calm, peaceful breakroom environment designed to re-energize themselves; and support from leadership (night supervisor) when making rounds.

 

Study design

  • Describe the study design: Qualitative, quantitative (descriptive, correlational, quasi-experimental, experimental, or other).

Descriptive correlational study.

 

  • Research questions(s), hypothesis, or both

To what extent do night-shift nurses engage in evidence-based self-care habits? What are self-care habits moderated by a variety of co-variates including staffing levels, unit culture and years of experience?

 

  • Hypothesis

Nurses who perceive greater support for self-care will be more likely to engage in self-care behavior.

 

Sample description

  • Type of sample (e.g. convenience, cohort, random)
  • Inclusion and exclusion criteria
  • Sample size

 

A total of 145 surveys were distributed to all nurses on all hospital units that function at night; 106 surveys were completed, for a 73% response rate. These nurses represented 11 units throughout Greenwich Hospital.

 

Location of study (within the applicant organization)

  • Hospital, units(s) ambulatory care area(s) that apply

Greenwich Hospital inpatient units where nurses work the night shift (Medicine, Surgery, Medical Oncology, Intermediate Care, Pediatrics, Maternity, Labor and Delivery, NICU and MSICU).

 

Study procedures

  • Procedures from initial screening through end of contact with subjects

Subjects were invited to participate in this de-identified, anonymous survey. There were no repercussions for nurses who chose not to participate.

 

  • Data collection methods

For the purposes of this research, all night shift nurses were invited to participate in a survey asking about fatigue and health promotion activities developed from the literature (i.e., sleep, work breaks, driving, diet, physical activity, professional life and personal life). In addition to the sample questions, nurses were asked to complete the Chalder Fatigue Scale, an 11-item, valid and reliable Likert scale asking about various aspects of fatigue. The survey was distributed to these nurses, and those who chose to participate returned their surveys to secure drop boxes. The survey took no more than 20 minutes to complete. All surveys were anonymous, and no personally identifying information was collected. 

 

Results

  • Results of data analysis (description of sample characteristics and analysis for research questions or hypotheses)

The data were entered into SPSS and analyzed using SPSS 26.0. Descriptive statistics were used to describe sample characteristics, and correlation analyses were run to determine the associations among variables. The sample included night shift nurses (n=106, 73.1% response rate), composed primarily of females (94.5%) 20-40 years of age (68.1%).

 

Over 70% of nurses reported “rarely” or “never” taking a break during their 12-hour shift.  Contributing factors included being too busy with patient assignment (79%), other nurses being too busy (29%), not enough staff (28%), timing interference with nursing assistant breaks (17%) and other (15%). 

 

Approximately 36% of nurses reported having an adequate breakroom, whereas roughly 38% reported the opposite. The availability of an adequate breakroom increases the chance that nurses will take a break (r=0.201, p<0.05) and, as a result, feel weak less than usual (r=0.220, p<0.01). In addition, nurses are more likely to take breaks if the unit culture is supportive of their doing so (r = 0.432, p<0.01). 

 

A supportive unit culture also decreases the frequency of nurses reporting their eyes closing during their drive home (r = -0.203, p<0.05). When management is knowledgeable about the effects of night shift, nurses take a break at night more often (r=0.203, p<0.05). Taking a break also correlates with more frequent reports of uninterrupted sleep (r=0.237, p<0.05), feeling less than usually sleepy (r = 0.278, p<0.01), having less than usual difficulty concentrating (r=0.207, p <0.05) and less frequently employing strategies to stay awake while driving (r=-0.225, p<0.05). Nurses also reported feeling more awake during their drive home if they napped during their break at work (r=0.602, p<0.01). 

 

Table 1: Correlates of taking a break on night shift (n=106)

 

 

Pearson’s r

p-value

Perceived adequacy of the breakroom

0.201

<.05

Supportive unit culture

0.432

<.01

Management is knowledgeable about the effects of night shift

0.203

<.05

 

Table 2: Correlation between the likelihood of taking a break on health outcomes (n=106)

 

 

Pearson’s r

p-value

Uninterrupted sleep

0.237

<.05

Feeling less sleepy

0.278

<.05

Number of strategies used to stay awake while driving

-0.225

<.05

Less than usual difficulty concentrating

0.207

<.05

 

Discussion

  • Discussion and interpretation of the findings

While all areas of self-care were assessed, the most significant finding was that more than 80% of night nurses rarely or never take a break and do not document this omission. However, this study also supports previous research that demonstrates the impact of taking breaks on important health outcomes for nurses.

 

  • Implications of the findings and recommendations to the organization

 

Enhanced awareness of night nurse self-care habits and an understanding of the reasons for omitting breaks creates an opportunity to implement self-care education and interventions such as break scheduling. Results from this preliminary study may serve as the foundation for an intervention study examining the impact of targeted interventions to change nurse engagement in health promotion activities.


Certainly this study underscores the importance of unit culture in supporting and promoting taking breaks on night shift. When nurses believe that taking breaks is supported, they are more likely to do so. Managers may need to be clear and explicit in their support for this practice and encourage nurses to take breaks regularly. Nurse managers support nurses to take breaks by the clinical coordinator or charge nurse assigning nurses breaks at set times during their shift and designating nurses to cover each other’s assignment when on break.

 

As Greenwich Hospital undergoes renovation, nurse managers and clinical nurses play a major role in communicating architectural features to be incorporated into design plans. When nursing units are redesigned, enhanced breakrooms are important to accommodate the unique needs of night shift nurses. Unit practice councils have discussed essential features of breakrooms, such as soft colors for the walls, mood lighting, calm wall art of nature scenes, lounge chair and plants.

 

Recognizing the need to create a culture of self-care, Anna Cerra, DNP, MSN, MSHA, RN, SVP Patient Care Services/Chief Nursing Officer, has supported hospital-wide initiatives to promote self-care activities. Managers have invited Laura Flahive, Yale New Haven Health System Health Coach, to staff meetings to speak about self-care and have offered time on units for her to meet with staff members. The Caritas Cart has been instrumental in providing self-care such as centering exercise with the Tibetan singing bowl, affirmation cards, tea and essential oils. This is brought to the unit when nurses are working so they can pause and relax for a few moments during their shift.

 

Initiatives such as the Caritas Cart are effective for night shift nurses. Chang, Lin & Chang (2017), for example, found that aromatherapy massage could improve night shift nurses’ quality of sleep. This evidence supports the expansion of these self-care activities across shifts. The renovation of the cafeteria provided an opportunity for night shift nurses to request that healthy food be made available during their shift. The cafeteria had been closed during the night shift; following the renovation, it is open with fresh foods and soups using a grab and go model in which fresh foods are available for nurses and staff members.

 

References:

 

Apellido, R. (2019). Night Shift Work and Weight Gain Among Female Filipino Nurses. Journal of the New York State Nurses Association, 46(2), 12–25.

 

Chang, Y. Y., Lin, C. L., & Chang, L. Y. (2017). The Effects of Aromatherapy Massage on Sleep Quality of Nurses on Monthly Rotating Night Shifts. Evidence-Based Complementary & Alternative Medicine (ECAM), 2017, 1–8

 

Geiger-Brown, J., Sagherian, K., Shijun Zhu, Wieroniey, M. A., Blair, L., Warren, J., … Szeles, R. (2016). Napping on the Night Shift: A Two-Hospital Implementation Project. AJN American Journal of Nursing, 116(5), 26–34.

 

Hai Zou, Xiaohong Lan, & Chunmeng Li. (2016). Relationship among Anxiety, Depression, Social and Self-Efficacy in Night-Shift Nurse. International Medical Journal, 23(3), 275–278.

 

Lessa Cordeiro, E., da Silva, T. M., Cunha da Silva, E., da Silva, J. E., Galdino Alves, R. F., & Rodrigues da Silva, L. S. (2017). Lifestyle and Health of the Nurse That Works the Night Shift. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 11(9), 3369–3375.

 

Weaver, S. H., Lindgren, T. G., Cadmus, E., Flynn, L., & Thomas-Hawkins, C. (2017). Report From the Night Shift: How Administrative Supervisors Achieve Nurse and Patient Safety. Nursing Administration Quarterly, 41(4), 328–336.

 

Williams, G. M. (2017). Obesity Among Night Shift Nurses: Time to Intervene. American Journal of Public Health, 107(1), 41–42