Investigating the Effect of a Fatigue Management Program on Daytime Alertness among Emergency Nurses: An Interventional Study
Abstract
Background and Objective: Shift work can lead to irregular circadian rhythms, sleep loss, and fatigue. This study aimed to determine the effect of a fatigue management program on the alertness of emergency nurses.
Materials and Methods: This quasi-experimental study was conducted among emergency nurses at an educational hospital in Mashhad City, Iran. All participants completed the Depression, Anxiety, and Stress Scale (DASS), the Karolinska Sleepiness Scale (KSS), and the Swedish Occupational Fatigue Inventory (SOFI), and underwent the Psy-chomotor Vigilance Test (PVT) before and after the intervention. The intervention included optimizing the shift sched-ule to a fast-rotating clockwise system with one day off after each night shift. In a one-day pre-intervention workshop, nurses were trained to take 2-hour naps during the night shift and to drink coffee at a recommended dose equivalent to 50-150 mg of caffeine. Environmental light exposure was optimized using an adjustable light box. Data were analysed using SPSS software.
Results: The study cohort comprised 25 participants, with a mean age of 30.88 ± 5.75 years, of whom 16(64%) were men. Two dimensions of SOFI (indifferent and uninterested) showed a significant improvement after the intervention (P = 0.027 and P = 0.016, respectively). The mean reaction time on the PVT did not differ significantly before and after the intervention (P = 0.70).
Conclusion: Optimizing the shift schedule and implementing a fatigue management program alone did not significantly improve alertness. Other contributing factors, such as sleep-wake behavior on non-working days, second-job status, and personal habits, should also be addressed.
2. Vicente De Carvalho JS, Oliveira I, Rosa R, et al. Sleep quality and quality of life in physicians and nurses working at a Central Hospital. Eur Respir J 2018; 52: PA4372.
3. Afshari Saleh L, Rezaei Ardani A, Rafeemanesh E, et al. Assessment of the Relationship between Sleep Disorders and Circadian Type in Nurses with Shift and Daytime Work. J Sleep Sci 2020; 5: 13-9.
4. Peplonska B, Kaluzny P, Trafalska E. Rotating night shift work and nutrition of nurses and midwives. Chronobiol Int 2019; 36: 945-54.
5. Jackson ER, Shanafelt TD, Hasan O, et al. Burnout and Alcohol Abuse/Dependence Among U.S. Medical Students. Acad Med 2016; 91: 1251-6.
6. Dinges DF, Kribbs NB. Performing while sleepy: Effects of experimentally-induced sleepiness. In: Monk TH, Editor. Sleep, sleepiness and performance. Human performance and cognition. England, United Kingdom: John Wiley & Sons; 1991. p. 97-128.
7. Thompson-Burdine J, Barrett M, Matusko N, et al. Compassion Fatigue: The Cost of Caring and the Critical Need to Promote Wellness in Medical School Education. J Am Coll Surg 2017; 225: e42.
8. Barker LM, Nussbaum MA. Fatigue, performance and the work environment: a survey of registered nurses. J Adv Nurs 2011; 67: 1370-82.
9. Akerstedt T, Anund A, Axelsson J, et al. Subjective sleepiness is a sensitive indicator of insufficient sleep and impaired waking function. J Sleep Res 2014; 23: 240-52.
10. Fabreau G, Elliott M, Khanna S, et al. Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle. BMC Med Educ 2013; 13: 115.
11. Dashti S, Faradmal J, Soheili Zad M, et al. Survey of factors associated with burnout among health care staffs in Hamadan County in year 2012. Pajouhan Sci J 2014; 13: 1-8. [In Persian].
12. Rogers AE, Hwang WT, Scott LD, et al. The working hours of hospital staff nurses and patient safety. Health Aff (Millwood) 2004; 23: 202-12.
13. Di Muzio M, Reda F, Diella G, et al. Not only a Problem of Fatigue and Sleepiness: Changes in Psychomotor Performance in Italian Nurses across 8-h Rapidly Rotating Shifts. J Clin Med 2019; 8: 47.
14. Javadpour F, Keshavarzi S, Choobineh A, et al. Validity and reliability of the Swedish Occupational Fatigue Inventory (SOFI-20) among Iranian working population. Iran J Ergon 2015; 3: 50-8. [In Persian].
15. Yarmohammadi H, Poursadeghiyan M, Rahmani N, et al. Work-Related Fatigue and the Effective Factors in the Iranian Nurses. Arch Hyg Sci 2018; 7: 32-8.
16. Shahid A, Wilkinson K, Marcu S, et al. Karolinska Sleepiness Scale (KSS). In: Shahid A, Wilkinson K, Marcu S, Shapiro CM, Editors. STOP, THAT and One Hundred Other Sleep Scales. New York, NY: Springer 2012. p. 209-10.
17. Choobineh A, Javadpour F, Azmoon H, et al. The prevalence of fatigue, sleepiness, and sleep disorders among petrochemical employees in Iran. Fatigue: Biomed Health Behav 2018; 6: 153-62.
18. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33: 335-43.
19. Sahebi A, Asghari M, Salari R. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. J Iran Psychol 2005; 1. [In Persian].
20. Lamond N, Dawson D, Roach GD. Fatigue assessment in the field: validation of a hand-held electronic psychomotor vigilance task. Aviat Space Environ Med 2005; 76: 486-9.
21. Drummond SP, Bischoff-Grethe A, Dinges DF, et al. The neural basis of the psychomotor vigilance task. Sleep 2005; 28: 1059-68.
22. Thomann J, Baumann CR, Landolt HP, et al. Psychomotor vigilance task demonstrates impaired vigilance in disorders with excessive daytime sleepiness. J Clin Sleep Med 2014; 10: 1019-24.
23. Abad VC, Guilleminault C. Polysomnographic Evaluation of Sleep Disorders. In: Aminoff MJ, Editor. Aminoff's Electrodiagnosis in Clinical Neurology (Sixth Edition). Philadelphia, PA: W.B. Saunders; 2012. p. 727-62.
24. Basner M, Mollicone D, Dinges DF. Validity and Sensitivity of a Brief Psychomotor Vigilance Test (PVT-B) to Total and Partial Sleep Deprivation. Acta Astronaut 2011; 69: 949-59.
25. Dorrian J, Basner M, Dinges D, et al. Sleep Deprivation. In: Kryger MH, Roth T, Dement WC, Editors. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Saunders Company; 2017. p. 49-56.
26. Tanaka K, Takahashi M, Tanaka M, et al. Brief morning exposure to bright light improves subjective symptoms and performance in nurses with rapidly rotating shifts. J Occup Health 2011; 53: 258-66.
27. Zamanian Z, Kakooei H, Ayattollahi SM, et al. Effect of bright light on shift work nurses in hospitals. Pak J Biol Sci 2010; 13: 431-6.
28. Wright KP, Jr., Badia P, Myers BL, et al. Combination of bright light and caffeine as a countermeasure for impaired alertness and performance during extended sleep deprivation. J Sleep Res 1997; 6: 26-35.
29. Wright KP, Jr., Badia P, Myers BL, et al. Caffeine and light effects on nighttime melatonin and temperature levels in sleep-deprived humans. Brain Res 1997; 747: 78-84.
30. Smith-Coggins R, Howard SK, Mac DT, et al. Improving alertness and performance in emergency department physicians and nurses: the use of planned naps. Ann Emerg Med 2006; 48: 596-604, .e1-3.
31. Borges F, Fischer F, Rotenberg L, et al. Effects of Naps at Work on the Sleepiness of 12-Hour Night Shift Nursing Personnel. Sleep Sci 2009; 2: 24-9.
32. Saadat S, Sadeghian F, Fayaz M. Sleepiness and Fatigue among Night - Shift Nurses with Three - Hour Nap and Day - Shift Nurses. Int J Health Stud 2016; 2: 1-4.
33. Zion N, Shochat T. Let them sleep: The effects of a scheduled nap during the night shift on sleepiness and cognition in hospital nurses. J Adv Nurs 2019; 75: 2603-15.
34. Han K, Hwang H, Lim E, et al. Scheduled Naps Improve Drowsiness and Quality of Nursing Care among 12-Hour Shift Nurses. Int J Environ Res Public Health 2021, 18, 891.
| Files | ||
| Issue | Vol 8 No 3-4 (2023): Summer-Autumn | |
| Section | Original Article(s) | |
| Keywords | ||
| Fatigue; Psychomotor performance; Shift work schedule; Circadian rhythm sleep disorder | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |


