Registered nurses (RNs) comprise one of the largest safety-sensitive groups of workers in the US, and frequently work shiftwork and long work hours, resulting in both acute and chronic sleep deprivation. Nursing work requires the ability to detect subtle changes in patients'condition, and continuous cognitive effort to organize and reorganize priorities to accommodate patients'fluctuating status amidst interruptions. Sleep deprivation produces lapses of attention that can interfere with needed vigilance. It also increases risk to the nurse for drowsy driving, work-related accidents and injuries, and for developing chronic illnesses such as metabolic disorder and cardiovascular disease. Other 24/7 industries have tackled the problem of sleep deprivation and loss of alertness on the job and found some effective solutions, but these have not been tried in hospital nursing. Our long term objective is to translate laboratory and workplace fatigue-risk reduction interventions that have shown efficacy in other settings into effective prevention practices for hospital nurses. The first study aim is to pilot test an individual and nursing unit-level intervention to increase the duration and quality of sleep that nurses achieve, improve their alertness and neurobehavioral functioning, and reduce fatigue-producing schedules. A second study aim is to assess barriers, fidelity, and maintenance of change over time by conducting a rigorous process evaluation of the intervention implementation. We will conduct this pilot in two hospitals (4 units per hospital, 160 nurses total) using a group randomized design with randomization at the nursing unit level, and collect baseline, 3 month, and 6 month outcomes. The actual intervention consists of: (1) online screening and referral for sleep disorders, (2) online training for coping with long work hours and shiftwork, including sleep strategies, (3) fatigue risk management software and consultation with industry chronobiologist for managers, and (4) modification of napping policies for night shift nurses. Because there are numerous causes of sleep deprivation a multifaceted approach will be more effective than any single intervention. We hypothesize that with this intervention we will see (1) increased total sleep time per week, (2) higher subjective sleep quality, (2) faster reaction times and reduced variability in performance vigilance tests, (4) lower levels of sleepiness during work, (5) lower fatigue risk scores in night shift nurses, and (6) lower intershift fatigue scores, reflecting that nurses now feel recovered from the previous shift at the time they start their current shift. Because this is a pilot, we will focus on both outcomes and the processes to achieve them, with a heavy emphasis on documenting barriers, facilitators, intervention fidelity, to assess feasibility of a larger study.

Public Health Relevance

Registered nurses (RNs) comprise one of the largest safety-sensitive groups of workers in the US, and frequently work shiftwork and long work hours, resulting in both acute and chronic sleep deprivation. Sleep deprivation produces lapses of attention that can interfere with needed vigilance as well as increasing risk to the nurse for drowsy driving, work-related accidents and injuries, and chronic illnesses such as metabolic disorder and cardiovascular disease. This pilot study tests an individual and nursing-unit level intervention to increase the duration and quality of sleep that individual nurses achieve, improve their alertness and neurobehavioral functioning, and reduce fatigue-producing schedules.

Agency
National Institute of Health (NIH)
Institute
National Institute for Occupational Safety and Health (NIOSH)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21OH009979-02
Application #
8326459
Study Section
Safety and Occupational Health Study Section (SOH)
Program Officer
Frederick, Linda J
Project Start
2011-09-01
Project End
2014-08-31
Budget Start
2012-09-01
Budget End
2014-08-31
Support Year
2
Fiscal Year
2012
Total Cost
$161,162
Indirect Cost
$33,256
Name
University of Maryland Baltimore
Department
Psychology
Type
Schools of Nursing
DUNS #
188435911
City
Baltimore
State
MD
Country
United States
Zip Code
21201