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

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

The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of “Institute for Healthcare Improvement Ventilator Bundle”, i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle’s compliance should be the gold standard combination

The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of “Institute for Healthcare Improvement Ventilator Bundle”, i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle’s compliance should be the gold standard combination

Influence of Shiftwork on Greek Nursing Personnel

Background: The aim of this study was to investigate the burden experienced by nursing personnel working irregular shifts in Greece and to conduct the first test of a Greek version of the Standard Shiftwork Index (SSI). Methods: A cross-sectional survey was carried out. The SSI was completed by 365 nurses and nursing assistants working shifts, including nights. Results: Female nursing personnel and those suffering from a chronic disease were most affected by working rotating shifts as they had elevated scores on the majority of the SSI scales, such as sleep, chronic fatigue, digestive and cardiovascular problems, general health questionnaire, cognitive and somatic anxiety, shift time satisfaction, engagement and disengagement strategies, languidity, flexibility, and neurotisicm. Nurses with longer working experience and those with family responsibilities also scored higher on some of the SSI scales, such as the sleep, shift time satisfaction, social and domestic disruption, disengagement strategies, morningness, and languidity scales. Conclusion: Shiftwork affects female nurses, those with chronic disease, older age, and domestic responsibilities more severely. Therefore management should take these factors into account when designing work schedules to alleviate the burden caused by shiftwork

Avascular necrosis of the femoral head: Evaluation of hyperbaric oxygen therapy and quality of life.

INTRODUCTION: The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive (e.g., core decompression) and non-invasive methods (e.g., hyperbaric oxygen therapy - HBO2). The purpose of the present study is to evaluate the effect of HBO2 on the quality of life (QoL) of patients with AVNFH. METHODS: This was a prospective observational non-controlled study of patients with AVNFH treated by HBO2. It was conducted, with the use of Steinberg scale, on 73 patients with AVNFH Stage I or II who were treated with HBO2. Patients’ QoL was assessed with EuroQol-5D-5L (EQ), Harris Hip Score (mHHS), MAHORN (MHOT), and VAS, in three different phases: before HBO2; after the completion of the first phase (20 HBO2 sessions, up to two months); and after the completion of the second phase (20 HBO2 sessions, up to two months after the first phase). A reassessment was made on the completion of each phase. Ratings were also made after the completion of each phase, over the first five months of follow-up. RESULTS: All 73 patients (67.1% males, 32.9% females, mean age: 40.34, SD ±± 9.99) participated in the study. Steinberg scale, mean EQ (F (1, 57) = 25.18, η2 = .306 and F (1, 43) = 43.402, η2 = .502); mHHS (F (1, 61) = 67.13, η2 = .524) and F (1, 43) = 31.84, η2 = .425); MHOT (F (1, 61) = 11.68, η2 = .161) and F (1, 43) = 98.01, η2 = .695); and VAS (F (1, 53) = 24.11, η2 = .313) and F (1, 39) = 45.61, η2 = .539), improved between the first and second measurements and between the second and third measurement accordingly (p < .01). CONCLUSION: HBO2 treatment does not induce alteration of quality of life and is well tolerated and accepted by patients

Light affects heart rate's 24-h rhythmicity in intensive care unit patients: An observational study

Muurlink, OT ORCiD: 0000-0002-8251-9521Background: Intensive care unit (ICU) patients experience two affronts to normal 24-h rhythms: largely internal events such as medication and external factors such as light, noise and nursing interventions. Aims and objectives: We investigated the impact of light variance within an ICU on 24-h rhythmicity of three key physiological parameters: heart rate (HR), mean arterial blood pressure (MAP) and body temperature (BT) in this patient population. Design: Patients were assigned to beds either in the ‘light’ or ‘dark’ side within a single ICU. An actigraph continuously recorded light intensity for a 24–72-h period. Methods: Measurements of HR, MAP and BT were recorded every 30 min. Results: HR, MAP and BT did not follow 24-h rhythmicity in all patients. Higher light exposure in the Light Side of the ICU (122·3 versus 50·6 lx) was related to higher HR (89·4 versus 79·8 bpm), which may translate to clinically relevant outcomes in a larger sample. Duration of stay, the one clinical outcome measured in this study, showed no significant variation between the groups (p = 0·147). Conclusions: ICU patients are exposed to varying light intensities depending on bed positioning relative to natural sunlight, affecting the 24-h rhythm of HR. Larger, well-controlled studies also investigating the effect of relevant light intensity are indicated. Relevance to clinical practice: Light is a variable that can be manipulated in the constrained environment of an ICU, thus offering an avenue for relatively unobtrusive interventions. © 2019 British Association of Critical Care Nurse

Saliva cortisol levels and physiological parameter fluctuations in mild traumatic brain injury patients compared to controls

Background: Evidence suggests that fluctuations of cortisol and physiological parameters can emerge during the course of mild Traumatic Brain Injury (mTBI). Objective: To investigate fluctuations of cortisol and physiological parameters during the acute phase of mTBI in hospitalized patients. Methods: 30 participants (19 patients with mTBI and 11 controls) were examined for saliva cortisol dynamics, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and body temperature (BT) fluctuations for four consecutive days. Also, the participants completed the Athens Insomnia Scale and Epworth Sleepiness Scales, in order to check for sleep problems. Results: Patients showed elevated levels of cortisol relative to controls (peak at 8 am and lowest levels at 12 am), as well as for most physiological parameters. MAP was significantly higher for patients throughout the measurement period, and BT was elevated for patients relative to controls at almost all measurements of the first and second day. Mean HR tended to track at non-significantly higher levels for the mTBI group. Patients’ sleepiness and insomnia values (ESS and AIS) were initially significantly higher relative to controls but the difference dissipated by day 4. Conclusion: The increase in absolute values of cortisol and physiological parameters measurements, indicates that in the acute phase of mTBI, a stressful process is activated which may affect sleep quality as well. Supplemental data for this article is available online at at doi: 10.1080/00207454.2021.1951264