What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review

Aim: To synthesize existing research to determine if nurses who work shifts have poorer psychological functioning and resilience than nurses who do not work shifts. Background: Research exploring the impact of shift work on the psychological functioning and resilience of nurses is limited compared with research investigating the impact of shifts on physical outcomes. Design: Integrative literature review. Data Sources: Relevant databases were searched from January 1995-August 2016 using the combination of keywords: nurse, shift work; rotating roster; night shift; resilient; hardiness; coping; well-being; burnout; mental health; occupational stress; compassion fatigue; compassion satisfaction; stress; anxiety; depression. Review Methods: Two authors independently performed the integrative review processes proposed by Whittemore and Knafl and a quality assessment using the mixed-methods appraisal tool by Pluye et al. Results: A total of 37 articles were included in the review (32 quantitative, 4 qualitative and 1 mixed-methods). Approximately half of the studies directly compared nurse shift workers with non-shift workers. Findings were grouped according to the following main outcomes: (1) general psychological well-being/quality of life; (2) Job satisfaction/burnout; (3) Depression, anxiety and stress; and (4) Resilience/coping. We did not find definitive evidence that shift work is associated with poorer psychological functioning in nurses. Overall, the findings suggest that the impact of shift work on nurse psychological functioning is dependent on several contextual and individual factors. Conclusion: More studies are required which directly compare the psychological outcomes and resilience of nurse shift workers with non-shift workers

Effects of circadian disruption on physiology and pathology: from bench to clinic (and back)

Nested within the hypothalamus, the suprachiasmatic nuclei (SCN) represent a central biological clock that regulates daily and circadian (i.e., close to 24 h) rhythms in mammals. Besides the SCN, a number of peripheral oscillators throughout the body control local rhythms and are usually kept in pace by the central clock. In order to represent an adaptive value, circadian rhythms must be entrained by environmental signals or zeitgebers, the main one being the daily light?dark (LD) cycle. The SCN adopt a stable phase relationship with the LD cycle that, when challenged, results in abrupt or chronic changes in overt rhythms and, in turn, in physiological, behavioral, and metabolic variables. Changes in entrainment, both acute and chronic, may have severe consequences in human performance and pathological outcome. Indeed, animal models of desynchronization have become a useful tool to understand such changes and to evaluate potential treatments in human subjects. Here we review a number of alterations in circadian entrainment, including jet lag, social jet lag (i.e., desynchronization between body rhythms and normal time schedules), shift work, and exposure to nocturnal light, both in human subjects and in laboratory animals. Finally, we focus on the health consequences related to circadian/entrainment disorders and propose a number of approaches for the management of circadian desynchronization.Fil: Chiesa, Juan José. Universidad Nacional de Quilmes. Departamento de Ciencia y Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Duhart, José Manuel. Universidad Nacional de Quilmes. Departamento de Ciencia y Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Casiraghi, Leandro Pablo. Universidad Nacional de Quilmes. Departamento de Ciencia y Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Paladino, Natalia. Universidad Nacional de Quilmes. Departamento de Ciencia y Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bussi, Ivana Leda. Universidad Nacional de Quilmes. Departamento de Ciencia y Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Golombek, Diego Andrés. Universidad Nacional de Quilmes. Departamento de Ciencia y Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

The shiftworking influence on nursing personnel

Shiftworking is a common characteristic of modern societies. At present nearly one-fifth of the total global work force works in shifts and at the same time 19% of EU’s workforce work night shift. Continuity, rotation and scheduling are the main characteristics of shiftworking. Healthcare personnel and nurses provide and are responsible for healthcare services on 24 hour basis. Shiftworkers tend to experience problems in four main areas caused by the desychronization of endogenous physiological system, the circadian rhythms. The first relates to increased fatigue and sleepiness caused by the decreased amount of sleep which results in a cumulative sleep debt when trying to sleep during the day. The second relates to their health; shiftworkers tend to suffer from poorer general health, physiological and psychological, including an increase in gastrointestinal and cardiovascular problems, neurotisicm and burn-out. The third area of concern relates to their family and social life. Shiftworkers tend to suffer from poorer family and social relationships because their working hours often coincident with societal and family obligations. The fourth area concerns the satisfaction and performance from workplace. The aim of this study was to investigate the burden experienced by nursing personnel working irregular shift system in Greece and the promotion of a theoretical frame of designing shiftwork system less health damaging. The instrument used for the data collection is the scales of Standard Shiftwork Index questionnaire completed by nurses and medical auxiliaries working a) irregular shift system concluding night shifts and b) permanently morning shifts. The study was carried out from November 2006 to November 2007 and conducted at three general hospitals of Athens. The study has documented the working conditions concerned the rotating shift system. The results showed that bachelor degree nurses reported lesser job satisfaction. Female nurses and nurses diagnosed with chronic disease reported higher scores in the SSI scales. The divorced/widow nurses had higher score in the chronic fatigue scale and the employes with more than three persons under their consideration reported greater sleep problems. Personnel working rotating shift system reported greater score in the chronic fatigue and the languidity scale and lesser score in the scale which measures the amount of time the shift system leaves compared to those working permantly morning shifts. The basic conclusion of this study is the recognition of the need for more explanation of the consequences of the rotating shift system in clinical basis and the adoption of the shift system with lesser implications on physical, psychological health and family/social life. Finally, it is regarded as necessary the shiftworkers to be informed and educated on the implications of the shifts in order to use the appropriate coping strategies.Η εργασία με βάρδιες αποτελεί καθημερινό χαρακτηριστικό των σύγχρονων κοινωνιών δεδομένου ότι το 1/5 του συνολικού εργαζόμενου δυναμικού παγκοσμίως εργάζεται με βάρδιες καθώς και η νυχτερινή εργασία αφορά το 19% των εργαζομένων της Ευρωπαϊκής Ένωσης. Τα κύρια χαρακτηριστικά της εργασίας με βάρδιες είναι η συνέχεια, η εναλλαγή των βαρδιών και ο προγραμματισμός. Οι επαγγελματίες υγείας, και συγκεκριμένα το νοσηλευτικό προσωπικό, παρέχουν τις υπηρεσίες τους και έχουν την ευθύνη για την παροχή φροντίδας υγείας επί 24ώρου βάσεως. Οι εργαζόμενοι με βάρδιες αντιμετωπίζουν προβλήματα σε διάφορα επίπεδα λόγω αποσυγχρονισμού της εσωτερικής φυσιολογίας του οργανισμού, των κιρκάδιων ρυθμών. Σε πρώτο επίπεδο, η εργασία με βάρδιες, συμπεριλαμβανομένης της νυχτερινής εργασίας, σχετίζεται με αυξημένη κούραση και υπνηλία. Αυτό σχετίζεται με την οφειλή του οργανισμού σε ύπνο, η οποία συσσωρεύεται από τη μη ικανοποιητική ποιότητα ύπνου, όταν ο εργαζόμενος προσπαθεί να κοιμηθεί κατά τη διάρκεια της ημέρας. Σε δεύτερο επίπεδο, οι εργαζόμενοι με βάρδιες παρουσιάζουν χαμηλότερο επίπεδο υγείας, σωματικής και ψυχικής, και ιδιαίτερα παρατηρείται μια αύξηση συμπτωμάτων από το γαστρεντερικό και καρδιολογικό σύστημα καθώς και αυξημένα επίπεδα νευρωτισμού και συναισθηματικής εξουθένωσης. Το τρίτο επίπεδο αφορά στην οικογενειακή και κοινωνική τους ζωή. Οι εργαζόμενοι μα βάρδιες έχουν λιγότερες οικογενειακές και κοινωνικές συναναστροφές, λόγω του ότι οι ώρες εργασίας τους συχνά συμπίπτουν με τις οικογενειακές και κοινωνικές υποχρεώσεις. Το τέταρτο επίπεδο είναι η ικανοποίηση από τον χώρο εργασίας και ο βαθμός απόδοσής τους. Ο σκοπός της παρούσας μελέτης ήταν η διερεύνηση της επιβάρυνσης του νοσηλευτικού προσωπικού που εργάζεται με μη τακτικό κυκλικό εναλλασσόμενο ωράριο στη χώρα μας, και η μελέτη ενός θεωρητικού πλαισίου έτσι ώστε να σχεδιαστούν προγράμματα κυκλικού ωραρίου που δεν θα είναι επιβαρυντικά για το νοσηλευτικό προσωπικό και θα συμβάλλουν στην πρόληψη προβλημάτων υγείας που ενδεχομένως προκύπτουν από το κυκλικό ωράριο. Για τη συλλογή των δεδομένων χρησιμοποιήθηκαν οι κλίμακες του ερωτηματολογίου Standard Shiftwork Index, το οποίο συμπληρώθηκε από α) νοσηλευτικό και παραϊατρικό προσωπικό που ακολουθούσε κυκλικό εναλλασσόμενο ωράριο με ή χωρίς νυχτερινές βάρδιες και β) προσωπικό που εργάζονταν μόνιμα πρωινό ωράριο. Η μελέτη πραγματοποιήθηκε σε τρία γενικά νοσηλευτικά ιδρύματα της Αττικής από το Νοέμβριο του 2006 μέχρι το Νοέμβριο του 2007. Στην μελέτη δόθηκε μια τεκμηριωμένη εικόνα των συνθηκών εργασίας όσον αφορά στο εναλλασσόμενο κυκλικό ωράριο. Τα αποτελέσματα που προέκυψαν από τα δεδομένα που συλλέχθησαν έδειξαν ότι μικρότερη ικανοποίηση από την εργασία δηλώνουν οι εργαζόμενοι Πανεπιστημιακής εκπαίδευσης. Οι νοσηλεύτριες και οι εργαζόμενοι με βάρδιες που πάσχουν από κάποια χρόνια νόσο αναφέρουν περισσότερα προβλήματα στις περισσότερες κλίμακες του Standard Shiftwork Index. Επιπλέον, όσοι εργαζόμενοι που ήταν σε διάσταση ή χήροι είχαν μεγαλύτερη βαθμολογία στην κλίμακα για τη χρόνια κόπωση και όσοι ήταν παντρεμένοι και είχαν υπό την επίβλεψή τους πάνω από τρία άτομα αντιμετώπιζαν περισσότερα προβλήματα ύπνου. Κατά την σύγκριση μεταξύ των δύο ομάδων εργαζομένων, κυκλικό vs ημερήσιο ωράριο, προέκυψε ότι μεγαλύτερη βαθμολογία στην κλίμακα για την χρόνια κόπωση και την νωθρότητα και μικρότερη βαθμολογία στην ικανοποίηση από το χρόνο που αφήνει το σύστημα βαρδιών δηλώνουν όσοι εργαζόμενοι ακολουθούν κυκλικό ωράριο. Το βασικότερο συμπέρασμα της παρούσας μελέτης είναι η αναγνώριση της ανάγκης για περαιτέρω διερεύνηση των επιπτώσεων του εναλλασσόμενου ωραρίου σε κλινικό επίπεδο στους εργαζόμενους και υιοθέτηση του καταλληλότερου συστήματος βαρδιών που θα προκαλεί όσο το δυνατόν λιγότερη διαταραχή σε σωματικό, ψυχικό και κοινωνικο/οικογενειακό επίπεδο. Κρίνεται απαραίτητη η ενημέρωση των εργαζομένων σχετικά με τις πιθανές επιπλοκές των βαρδιών προκειμένου να βρίσκουν τους μηχανισμούς άμυνας και αντιμετώπισης των επιπτώσεων

Cardiac Rehabilitation After Open Heart Surgery: A Narrative Systematic Review

Background: Postoperative cardiac rehabilitation (CR) programs are increasingly recommended by clinicians, but only a minority of patients who have undergone open heart surgery participate in such programs. Participation rates in postoperative CR, if anything, appear to be declining. This systematic review examines the effectiveness of post-operative CR and reveals possible participation barriers. Methods: A search of two scholarly databases for primary research papers published in the last decade examining the impact of post-operative CR was conducted and the resultant papers reviewed. Results: The 21 resulting studies revealed physiological functioning improvement and a reduction in mortality and readmission rates, while highlighting an enhancement in mental status. Some of the studies recognized the need for nutritional support and suggested that age, gender, access to CR centers, and socioeconomic variables impact participation in CR. Conclusions: Post-operative CR participation rates continue to decline despite increasing evidence of the value of the approach

Bridging Gaps in Holistic Rehabilitation After Critical Illness: A Systematic Review

Background: Holistic care in the Intensive Care Unit (ICU) addresses the full spectrum of patient needs—physical, emotional, psychological, social, spiritual, and environmental—to support recovery and improve long-term outcomes after critical illness. Objective: This systematic review aimed to synthesize evidence on the effectiveness of holistic care interventions across these six dimensions of wellness in adult ICU patients. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted following PRISMA guidelines. The SPICE framework was used to define the scope (Setting: ICU; Perspective: patients; Intervention: holistic care; Comparison: standard care; Evaluation: multi-dimensional outcomes). Studies published in English between 1999 and 2024 were included. Methodological quality was appraised using Joanna Briggs Institute (JBI) tools. Results: Seven studies, comprising randomized controlled trials, observational, and mixed-methods designs, met the inclusion criteria. The interventions were diverse, encompassing corporeal rehabilitation, spiritual care toolkits, reflexology, early physical therapy, patient diaries, and family involvement. A narrative synthesis of these heterogeneous studies suggested potential benefits and high acceptability for various patient-centered outcomes. Conclusions: The limited but promising evidence indicates that holistic care interventions may contribute positively to ICU patient recovery. The findings underscore the need for more robust, high-quality research to conclusively determine their efficacy and support their integration into standard critical care practice

Evaluation of bone metabolism in critically ill patients using CTx and PINP

Background. Prolonged immobilization, nutritional and vitamin D deficiency, and specific drug administration may lead to significant bone resorption. Methods and Patients. We prospectively evaluated critically ill patients admitted to the ICU for at least 10 days. Demographics, APACHE II, SOFA scores, length of stay (LOS), and drug administration were recorded. Blood collections were performed at baseline and on a weekly basis for five consecutive weeks. Serum levels of PINP, β-CTx, iPTH, and 25(OH)vitamin D were measured at each time-point. Results. We enrolled 28 patients of mean age 67.4 ± 2.3 years, mean APACHE II 22.2 ± 0.9, SOFA 10.1 ± 0.6, and LOS 31.6 ± 5.7 days. Nineteen patients were receiving low molecular weight heparin, 17 nor-epinephrine and low dose hydrocortisone, 18 transfusions, and 3 phenytoin. 25(OH)vitamin D serum levels were very low in all patients at all time-points; iPTH serum levels were increased at baseline tending to normalize on 5th week; β-CTx serum levels were significantly increased compared to baseline on 2nd week (peak values), whereas PINP levels were increased significantly after the 4th week. Conclusions. Our data show that critically ill patients had a pattern of hypovitaminosis D, increased iPTH, hypocalcaemia, and BTMs compatible with altered bone metabolism. © 2016 Alexandra Gavala et al

Sleep Disturbance in Nursing Personnel Working Shifts

Objective: The aim of the present study was to explore the factors that are associated with sleep disturbance in nursing personnel working irregular shifts. Methods: A cross-sectional survey was carried out. The Standard Shiftwork Index was used for data collection, which was completed by 365 nurses and nurse assistants working shifts including nights. Results: Female nurses and nurses with elevated levels of chronic fatigue were found with greater sleep disturbance between all shifts. Sleep disturbance between most shifts was greater in participants with more than 18 years of working experience and those having family members to look after. No differences were observed in family status, professional training, or circadian characteristics. Conclusion: Our results suggest that demographics, working characteristics, and family structure are associated with sleep disturbance between shifts in nursing personnel. The modification of shift schedules according to individual needs and preferences is necessary for the reduction of sleeping problems. © 2013 Wiley Periodicals, Inc