From the Journal of Clinical Nursing. a literature review by Annabel Matheson et al examining the impact of shiftwork on the lives of nurses.
118 studies were reviewed. 109 from peer-reviewed journal, 3 from expert journals, 2 from reports and 4 were from book chapters.
The results were categorised under the themes of physical health, sleep and psychosocial health.
Shiftwork has been investigated from a variety of perspectives within the literature. There are two approaches from which shiftwork research mainly derives: personal and organisational. Most of the personal research examines the experience and effects of shiftwork on individuals from a variety of perspectives such as sleep, coping and health through means of questionnaires, hormone testing, sleep testing and reaction time tests.
The literature describes a series of symptoms often grouped as shiftwork syndrome: “a disruption of the circadian sleep/wake cycle. resulting in insomnia, excessive sleepiness and fatigue”.
There are some conflicting results amongst studies, but there does seem to be growing evidence that shiftwork that disrupts the circadian rhythms is probably carcinogenic to humans. This is thought to be related to the effects of melatonin suppression due to night time light exposure.
There have been studies that report a strong association with shiftwork and elevated prostate specific antigen levels in males and an increased risk of breast cancer amongst women.
Recent research on mechanisms of breast cancer and shiftwork has focussed on the role of melatonin and the impact that night shift has on preventing the rise of this hormone while working. The study postulated that the disruption caused by night shift in the normal rise of melatonin which occurs at night results in higher levels of other reproductive hormones, and this may increase the risk of breast cancer. The authors also theorised that male shiftworkers may also be at a higher risk of prostate cancer due to the same mechanism of increased reproductive hormones. Others have also reported greater risk of breast cancer for those working rotating shifts including night shifts particularly when they are worked over an extended period of time.
Gastrointestinal disturbances with symptoms ranging from dyspepsia, gastritis, colitis to indigestion, irregularity in bowel movements and appetite disturbances.
This may be due in part to circadian rhythm disruption effecting gastric secretions.
Research has also found that shift work may impair glucose metabolism particularly in middle-aged workers.
Sleep quantity and quality.
It has been established that shiftwork affects sleep quality and quantity.
Global sleep quality among permanent night shift nurses was significantly poorer than that of the day shift workers in one study, yet there was no association reported with shift systems in another. Poor sleep quality, higher work- load perception, lack of exercise and lack of support were associated with fatigue in an Australian study of aged-care nurses. Some shiftworker control over scheduling was trialled to attempt to increase sleep quality, however, no change in sleep quality was reported. Chronotype (whether someone is naturally an ‘early bird’ or a ‘late owl’) has also been linked to sleep quality on different shifts, rather than shift schedule, in contrast with other studies.
The impact on sleep quality due to the need for nurses to complete ‘domestic’ and other care duties is also acknowledged in the literature. As is its impact on family life.
One study found improved length of sleep periods amongst staff exposed to a very bright light during the night shift in order to suppress melatonin secretion (although this would seem to come at a cost – see above).
Two studies showed increased ‘domestic disruption’ amongst shiftworkers with children (particularly when the shiftworker is female) which can negatively affect their feelings about their work.
In one study, 53% of participants were unhappy or very unhappy with their partners’ shiftwork, and a third of all respondents had tried to persuade their partners to change their working hours. This type of research is rare in the body of shiftwork literature, although some research has explored whether partner sup- port helps a worker to better tolerate shiftwork.
Increased smoking and alcohol consumption has been reported as one negative coping strategy for shiftworkers.
More postitive coping multipliers included physical fitness, and a strong family support network.
In discussing these issues the authors note:
In the context of the physical effects, increasing the frequency of check-ups related to breast screening and cardiovascular disease is warranted from the increased risks of shiftwork, particularly for women, as overwhelmingly the Australian nursing workforce is female, consisting of 90% of the 205,600 Australian registered nurses in the health workforce in 2011.
Poorer sleep quality and quantity have been reported. The resulting effects included mental tiredness, exhaustion, altered mood and chronic fatigue. As nurses’ patient care responsibilities require a high level of vigilance, getting as much good-quality sleep as possible is imperative to providing excellent quality care over the 24-hour period.
The psychosocial effects of shiftwork include problems with social disruption, balancing work/family and personal needs. These effects have implications for the emotional and social welfare of nurses whose work requires that they have the capacity to maintain compassion and sensitivity for the people in their care.These findings are relevant to individual nurses but also have relevance for education, service provision and research. A marked lack of attention to the best ways to manage shiftwork and to maintain good health among the nursing work- force suggests a need for increased workplace and professional awareness of the issues this research has raised.
In conclusion Annabel worries that despite the now substantial literature describing the effects of shiftwork on physical health and wellbeing, few studies have been published in nursing journals to inform nurses of the issues.
As there are significant differences in the types and structures of shiftwork that nurses perform, more research, discussion and reflection needs to be done on this important topic.
Reference: The impact of shiftwork on health: a literature review – Matheson – 2014 – Journal of Clinical Nursing – Wiley Online Library [Internet]. [cited 2014 Dec 12]. Available from: http://onlinelibrary.wiley.com/doi/10.1111/jocn.12524/abstract