AbstractFatigue presents as an all-pervasive challenge to anyone who is engaged in shift work. While this affects all nurses, those who work on night duty have been shown to have the greatest risk of fatigue and cognitive impairment thus potentially posing a higher safety risk to themselves, the patients under their care and the wider community as nurses make their way home driving while drowsy. Show Despite robust evidence revealing the positive attributes of increased working abilities from napping on night duty, and the overall agreement by nurse managers and organisations, this practice has been slow to be introduced into nursing. Research revealed that 55 per cent of nurse managers felt the greatest barrier to implementation was the lack of policy and supervision around this practice. This discussion paper challenges nurses, managers and organisations to take note of current research, ACORN guidelines and work health and safety guidelines and start to change thinking and culture by looking at napping on night duty as a ‘safety’ implementation for staff, patients and the wider community. Policies and procedures should be developed and further research should be conducted into length and type of naps and subsequent positive and/or negative effects that may be reported by staff and health care facilities. Recommended Citation Gamble,
Jennifer and Foran, Paula (2021) "Asleep on the job: Can night shift napping provide greater safety for both staff and patients?," Journal of Perioperative Nursing: Vol. 34 : Iss. 1 , Article 6. DOWNLOADS Since March 04, 2021 COinS What do doctors, nurses, firefighters, truck drivers, and air traffic controllers all have in common? Many of them work night shifts. Whether someone is an early riser or a night owl, working night shifts can be challenging. We have compiled some tips to help people cope with working into the late and early hours of the day. Share on PinterestHealthcare professionals often have to work night shifts and have long duty hours. Image Source/Getty Images Due to our modern 24-hour society, nearly 15 million people in the United States work full-time night shifts, evening shifts, rotational shifts, or other such irregular schedules. What is more, a poll by American analytics company Gallup showed that almost 4 in 10 adults said they work at least 50 hours every week. According to the National Sleep Foundation, there is a link between shift work and long working hours and several health issues. These include an increased risk of metabolic problems, heart disease, gastrointestinal difficulties, obesity, and certain cancers. A study published by the American Association for Cancer Research found that for every 5 years of night shift work, the risk of breast cancer rises by 3.3%. Night shift work may also interfere with the body’s ability to repair DNA damage from normal cellular processes. The suppression of melatonin — the hormone responsible for regulating the internal body clock — may play a role. People need to work through the night for numerous reasons. Finding ways to cope can be the difference between living a healthy existence and being subjected to the many elevated health and safety risks during night shifts. Here are Medical News Today‘s coping strategies for working after dark. Some people can work at night without issue, while others experience sleep deprivation and fatigue. This is because humans are designed to sleep at nighttime. The body is controlled by an internal body clock, or circadian pacemaker, located in the suprachiasmatic nucleus (SCN) of the hypothalamus. The SCN generates circadian rhythms, which regulate behavioral and physiological processes in the body, including alertness, sleep, temperature control, and hormone production. Circadian rhythms run in 24-hour cycles and are significantly influenced by the natural light and dark cycles. Many bodily processes that are active in the daytime slow down at night to prepare for sleep. At night, the circadian pacemaker releases the sleep hormone melatonin from the pineal gland, which causes the body to feel less alert and raises the desire to sleep. Night shifts cause the body to battle against its natural rhythms by trying to be alert when programmed to be sleeping. Similarly, when you go home after a night shift, the cues from your internal body clock and daytime light exposure tell you to be awake and active. Adults need between 7–9 hours of sleep to function at their best. If people sleep for under that amount, they will incur “sleep debt.” The only way to pay back sleep debt is to catch up on missed sleep, which has to occur as soon as possible. Working at night involves successfully managing sleep during the day — that is, to keep sleep debt to a minimum — and fatigue during the night. Daytime sleep can be lighter, shorter, and of poorer quality than sleep at night due to light, noise, and temperature. Try these steps to keep sleep in check and make the environment more favorable for sleep.
After the last shift in a block of night shifts, remember that the more days in a row a person has been working through the night, the more sleep debt they will likely have accrued. Repaying some of the sleep debt as quickly as possible will help individuals recover sooner. Exposure to light triggers chemical events in the circadian pacemaker that affects your sleep and wake cycles. For example, the body releases melatonin as it gets dark in the evening to instigate drowsiness. By morning light, the body suppresses melatonin and elevates cortisol levels to make the body feel more awake. Artificial light can affect the circadian pacemaker in the same way as sunlight, and timed exposure to bright light can help alter the body’s sleep cycle. During night shifts, people can try to “trick” their body into an alert state with exposure to bright light and promote sleep by suppressing light exposure after their shift. Research has shown that night-shift workers who were exposed to bright light during their shift and wore sunglasses on the way home to suppress light drifted off to sleep quicker and slept for longer after their shift than people who received no bright light exposure. Furthermore, another study found that intermittent exposure to bright light is almost as effective as continual exposure. People should beware of exposure to blue light emitted from digital devices, such as a smartphone, tablet, or television, before bed after a night shift. Research suggests that blue light knocks the circadian rhythm off-kilter, which signals to the brain that it is daytime, resulting in poorer sleep quality . Ways to control exposure to light include:
Keeping the bedroom dark will help keep the body in sleep mode until it is time to wake up and begin the day. When the typical daily rhythm is off-balance, so too is metabolism. Night shift workers are more likely to experience metabolic syndrome and have a 23% increased risk of becoming overweight or obese due to poor diet and the disruption of the body clock. Planning meals can help people stay alert during working hours and be more relaxed for sleep. People could try to consider the following:
Accessing the grocery store and adequate facilities to prepare food can be challenging for night workers. People should be prepared and take food to work to ensure they eat properly and stay alert. Taking a nap can become an essential element of working safely overnight. While a short nap before starting a shift can help combat fatigue, a nap during your break may be vital for maintaining alertness and remaining vigilant. A nap midway through the day has been shown to boost and restore brainpower. Even naps 20–45 minutes long prove beneficial for shift workers to counteract fatigue. Ideally, night-shift naps should not exceed 45 minutes. Sleep comprises different stages, completing in cycles of between 90–100 minutes. One sleep cycle runs from light sleep to deep sleep. People should be aware of how long they nap to ensure they do not wake up during deep sleep. Waking from deep sleep is associated with greater sleep inertia, meaning that it takes longer to feel alert and not feel refreshed. Caffeine is a stimulant. When used carefully, a daily dose of coffee can help a person remain alert throughout a shift. However, improper use can cause gastrointestinal upsets and muscle shakes. Most people take a huge dose of coffee at the start of their shift to jump-start their day. However, research suggests shift workers take a different approach to maximize the effects of caffeine. Workers that consumed smaller — equivalent to quarters of cups of coffee — and more frequent doses of caffeine throughout their day experienced enhanced wakefulness, performed better on cognitive tests, and had fewer accidental naps than those who had had no caffeine. Some evidence suggests that the effects of caffeine kick in after around 20 minutes and that a small dose of caffeine before a nap can counter the sleep inertia people may experience after waking. People should stop consuming caffeine around 6 hours before their bedtime to ensure that the stimulant does not affect sleep. Every person is different, so finding the right combination of techniques that suit an individual best may take time. Applying some of the above strategies may help people on their way to coping better with working at night and ensuring the right amount of sleep to function properly. |