Educating Nurses on Shift Work Risks and Risk Reduction Strategies

Abstract

Background:  Continuous attendance over the ill and injured is at the very heart of nursing, and shiftwork in nursing is therefore prevalent worldwide.   A substantial body of evidence links shiftwork with increased risk of illness, injuries, and accidents (Matheson, O’Brien, & Reid, 2014; National Institute of Occupational Safety and Health, 2015).  Health impairments linked to shiftwork include cardiovascular disease, diabetes, cancer, and other ailments (Gan et al., 2015; Koh, 2010; Lin et al., 2015).   Occupational injuries are also heightened in shift workers, specifically including nurses (DeCastro et al., 2010).   Extensive evidence also supports psychosocial harm to shift workers, including low quality of life scores (Perrucci et al., 2007; Shao, Chou, Yeh, & Tzeng, 2010).  Shiftwork hazards unfortunately extend to an increased risk of errors, including nursing medication errors (Suzuki, Ohida, Kaneita, Yokoyama & Uchiyama, 2005).   As early as 1992 Gold found a high incidence of nurses falling asleep during work hours, and this finding has subsequently been replicated in the literature (Muecke, 2005) with obvious implications for patient safety.  In a 2004 report for the Institute of Medicine, Rogers summarized the literature indicating risks to patients in terms of procedural and medication errors resulting from diminished attentiveness, cognitive decline, delayed reaction times, impaired memory, loss of physical strength, and other problems associated with shift work and fatigue.

A number of strategies have been advanced to reduce risks of shift work.  Primary among these interventions is alteration of sleep behaviors and efforts to improve circadian rhythm adaptation (Matheson, O’Brien, & Reid, 2014).    Shift workers underestimate the importance of adequate quantity and quality of sleep, and consistently sleep less than daytime workers (Tucker, Folkard, Ansiau & Marquie, 2010).  Increasing awareness of needs for rest has been shown to have a positive impact in countering fatigue among nurses (Scott, Hofmeister, Rogness & Rogers, 2010).   In addition to securing adequate sleep, useful interventions may include dietary modifications, controlled light exposure, timing of exercise, naps, and judicious use of medications (Neil-Sztramko, Pahwa, Demers, & Gotay, 2014).   Workplace adjustments have also been found to be important.  Creating a workplace culture which promotes safety includes policies which support best scheduling practices, periodic fatigue assessments, no-blame reporting, and frequent breaks (Caruso, 2015). 

Nurses may lack awareness of the hazards of shift work, and training to facilitate behaviors thought to mitigate risk.  Worker education regarding risks has been recommended to foster improved adaptation practices (Caruso, 2015).  Shao, Chou, Yeh, & Tzeng, (2010) concluded their recent study of 435 nurses with a recommendation for  provision of shift work educational programs to undergraduate and working nurses.  Suzuki et al. (2005) also concluded their study of occupational errors and accidents in shift working nurses with a recommendation for provision of sleep hygiene advice and other health promotion measures.  Best practices for improving awareness of risks for nurses are not known.  No reports have been located regarding use of a self-directed multimedia educational module to inform nurses of shift work hazard.  Learning via an online platform has been shown to be effective across other broad areas of study (Bell & Federman, 2013).

Purpose:   The proposed presentation provides evidence of the need for interventions to better educate nurses about shift work risk and risk reduction.  A web-based multimedia educational module was designed, implemented, and evaluated.  The primary objective of the study was to determine whether this educational program would impact nurses' knowledge of shift work and perception of shift work risks.   Additionally, the study sought to determine whether the information presented would influence nurses' intention to change behavior to reduce risk.

Methods: A multimedia online educational module was created by the researcher.  The program was interactive, self-directed and required less than one hour to complete.  A single group convenience sample of 39 hospital based registered nurses participated in a brief assessment of knowledge before and after completion of the program.  Participants were also asked to rate their perception of shift work risk.  Likelihood of behavior change associated with risk reduction was assessed pre and post intervention.

Results:   A paired-samples t-test was conducted to compare pre and post intervention knowledge of shift work risks.  There was a significant difference in the scores pre-intervention and post intervention with t(38) = 4.61 (p<0.0001).   Additional paired samples t-tests were conducted to compare pre and post intervention perception of risk.  These analyses indicated that the nurses' perception of risk differed significantly after completing the educational module.  A final set of paired samples t-tests compared pre and post intervention scores on the nurses' likelihood of behavioral change, with a significant difference demonstrated post intervention. 

Conclusion:   Paired samples t-test analysis demonstrated significant increase in participants' knowledge of shift work hazard post intervention.  Perception of risk and likelihood of behavior change were significantly increased from pre to post intervention.  The findings of this study indicate that completion of a short online educational presentation allowed nurses to increase knowledge of hazards associated with shift work. Moreover, nurses demonstrated enhanced awareness of risk and increased likelihood of behavioral change.