The Effect of Shift Work on Nurses' Psychological Health
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Running head: SHIFT WORK
The Effect of Shift Work on Nurses' Psychological health
NU7013 THEORY AND PRACTICE OF ENQUIRY METHODS FOR HEALTH CARE
The Effect of Shift Work on Nurses' Psychological health
NU7013 THEORY AND PRACTICE OF ENQUIRY METHODS FOR HEALTH CARE
1SHIFT WORK
Abstract:
Background: Nurses are exposed to various health problems because of the need to work in
night shifts or rotational shifts. This is associated with gastrointestinal problem, sleep
disturbance, psychological distress and poor cardiovascular health. Past research literature gives
in-depth discussion on the impact of sleep work on sleep quality and physical health. However,
effect of shift work on psychological health has not been adequately addressed in past research.
Aim: The aim of this literature review is to evaluate the consequences of shift work on
psychological health of nurses.
Search strategy: The search for article was done in EMBASE, Medline, PubMed, and Psych
INFO was used and in total, 12 research studies were found relevant to the research aim. The
data was thematically analyzed and three themes were identified. The three themes included
‘Shift work along does not predict risk of depression among nurses’, Shift work affects
psychological well-being and work performance of nurses’ and ‘Shift work affects coping skills
and personality traits of nurse and lead to poor quality of life’
Key findings:
The key findings from the study were that shift work leads to greater psychological
burden compared to day shifts. However, shift work alone does not predict risk of depression and
poor psychological state. This is influenced by poor sleep quality and duration of night shifts or
rotation shifts.
Conclusion: To conclude, the review proves that shift working has some effect of mental health
with the severity increasing with time and work environment.
Abstract:
Background: Nurses are exposed to various health problems because of the need to work in
night shifts or rotational shifts. This is associated with gastrointestinal problem, sleep
disturbance, psychological distress and poor cardiovascular health. Past research literature gives
in-depth discussion on the impact of sleep work on sleep quality and physical health. However,
effect of shift work on psychological health has not been adequately addressed in past research.
Aim: The aim of this literature review is to evaluate the consequences of shift work on
psychological health of nurses.
Search strategy: The search for article was done in EMBASE, Medline, PubMed, and Psych
INFO was used and in total, 12 research studies were found relevant to the research aim. The
data was thematically analyzed and three themes were identified. The three themes included
‘Shift work along does not predict risk of depression among nurses’, Shift work affects
psychological well-being and work performance of nurses’ and ‘Shift work affects coping skills
and personality traits of nurse and lead to poor quality of life’
Key findings:
The key findings from the study were that shift work leads to greater psychological
burden compared to day shifts. However, shift work alone does not predict risk of depression and
poor psychological state. This is influenced by poor sleep quality and duration of night shifts or
rotation shifts.
Conclusion: To conclude, the review proves that shift working has some effect of mental health
with the severity increasing with time and work environment.
2SHIFT WORK
Recommendation: It is recommended that clinical managers consider the study findings to
revise shift work patterns and implement programmes that help nurse to learn about sleep
hygiene and positive ways of coping with shift working.
Recommendation: It is recommended that clinical managers consider the study findings to
revise shift work patterns and implement programmes that help nurse to learn about sleep
hygiene and positive ways of coping with shift working.
3SHIFT WORK
Table of Contents
Introduction......................................................................................................................................4
Search strategy:................................................................................................................................6
Inclusion criteria:.........................................................................................................................7
Search findings:...........................................................................................................................7
Data analysis:...............................................................................................................................8
Themes.............................................................................................................................................9
Theme 1: Shift work along does not predict risk of depression among nurses...........................9
Theme 2: Shift work is associated with poor psychological well-being and work performance
of nurses.....................................................................................................................................12
Theme 3: Shift work affects coping skills and personality traits of nurse and lead to poor
quality of life..............................................................................................................................14
Conclusion:................................................................................................................................18
Systematic review protocol............................................................................................................20
References:....................................................................................................................................22
Appendix 1. Presenting your database search...........................................................................27
Appendix 2: PRISMA diagram to summarize search results:...................................................29
Appendix 3: Summary table......................................................................................................31
Table of Contents
Introduction......................................................................................................................................4
Search strategy:................................................................................................................................6
Inclusion criteria:.........................................................................................................................7
Search findings:...........................................................................................................................7
Data analysis:...............................................................................................................................8
Themes.............................................................................................................................................9
Theme 1: Shift work along does not predict risk of depression among nurses...........................9
Theme 2: Shift work is associated with poor psychological well-being and work performance
of nurses.....................................................................................................................................12
Theme 3: Shift work affects coping skills and personality traits of nurse and lead to poor
quality of life..............................................................................................................................14
Conclusion:................................................................................................................................18
Systematic review protocol............................................................................................................20
References:....................................................................................................................................22
Appendix 1. Presenting your database search...........................................................................27
Appendix 2: PRISMA diagram to summarize search results:...................................................29
Appendix 3: Summary table......................................................................................................31
4SHIFT WORK
Introduction
Working in the 21st century has no standard schedule now and there is lot of flexibility in
the work durations, with employees having to work on night shifts or extended hours to meet
consumer’s expectation. According to Kang et al. (2017), shift work is defined as the
arrangement of working hours in a way that team work workers need to work for extended hours
beyond their conventional office hours. The nursing workforce is one of the professional groups
who need to often engage in shift work and rotate between day and night shifts. The prevalence
of shift work among nurses is at 57% in UK (McDowall, Murphy and Anderson 2017). High
proportion of nurses is involved in shift work by working for straight shifts in the day or night
and rotating shift patterns. Some nurses tolerate shift working conditions. However, many nurse
experience serious problems due to exposure to shift working conditions such as family life,
sleep problems, tension, stress, gastrointestinal problems and interruption in food schedules
Khammar et al. (2017). This form of occupation stress can eventually affect nursing
performance.
Currently there is an increasing awareness on the detrimental impact of shift work on
nurse through the publication of large list of literatures that have explored the adverse effects of
shift work on nursing performance. Dahlgren et al. (2017) explains that shift work significantly
influences an individual’s circardian rhythm, as it is associated with sleep disturbance and
psychological symptoms like anxiety and irritation. Apart from sleep disturbance and fatigue,
Verma, Kishore and Gusain (2018) reported about poor psychological health in nurses working
in rotating night shifts. The cross-sectional study reported lower scores in job satisfaction and
psychological well-being of nurses. The study by Ferri et al. (2016) evaluated the influence of
shift working on the psychological and physical health of nurses and the study findings indicated
Introduction
Working in the 21st century has no standard schedule now and there is lot of flexibility in
the work durations, with employees having to work on night shifts or extended hours to meet
consumer’s expectation. According to Kang et al. (2017), shift work is defined as the
arrangement of working hours in a way that team work workers need to work for extended hours
beyond their conventional office hours. The nursing workforce is one of the professional groups
who need to often engage in shift work and rotate between day and night shifts. The prevalence
of shift work among nurses is at 57% in UK (McDowall, Murphy and Anderson 2017). High
proportion of nurses is involved in shift work by working for straight shifts in the day or night
and rotating shift patterns. Some nurses tolerate shift working conditions. However, many nurse
experience serious problems due to exposure to shift working conditions such as family life,
sleep problems, tension, stress, gastrointestinal problems and interruption in food schedules
Khammar et al. (2017). This form of occupation stress can eventually affect nursing
performance.
Currently there is an increasing awareness on the detrimental impact of shift work on
nurse through the publication of large list of literatures that have explored the adverse effects of
shift work on nursing performance. Dahlgren et al. (2017) explains that shift work significantly
influences an individual’s circardian rhythm, as it is associated with sleep disturbance and
psychological symptoms like anxiety and irritation. Apart from sleep disturbance and fatigue,
Verma, Kishore and Gusain (2018) reported about poor psychological health in nurses working
in rotating night shifts. The cross-sectional study reported lower scores in job satisfaction and
psychological well-being of nurses. The study by Ferri et al. (2016) evaluated the influence of
shift working on the psychological and physical health of nurses and the study findings indicated
5SHIFT WORK
that nurses who worked in rotating night shifts (RNS) suffered from frequent fatigue, distress,
anxiety and cardiovascular symptoms. However, the drawback in past literature is that the
relation between work and mental health has not been explored in detail. Although the topic od
shift work has been widely discussed and researched in past research, however these studies have
mainly highlighted relation between shift work and sleep quality. But, there is lack of studies that
have focused specifically on investigating the impact of shift work on psychological health.
Thus, this literature review is significant to separate findings related to effect of this working
pattern on psychological health and find out what could be done to improve psychological
health. The main rational for investigation about the effect of shift work on psychological and
mental health is that past research have paid less attention to mental outcomes due to rotating
shifts and findings from this research may help to prevent the rate of mental disorders highly
prevalent in nurses working in rotating shifts (Tajvar et al. 2015).
Thus, investigation about the severity of the issue in terms of mental health of nurse is
necessary as part of the duty to protect nurses from workplace hazard. This literature review will
help to systematically arrange the findings related to mental health outcomes of nurses due to
long shift hours and evaluate future consequences of the outcome for nurses.
The main of this literature review is to explore the effect of shift work on nurse’s
psychological health. The key objectives of the review are as follows:
To assess the impact of shift work and its nature on mental health outcomes of nurse’s.
To analyze the consequences of shift work on nurse’s psychological health and quality of
nursing care
that nurses who worked in rotating night shifts (RNS) suffered from frequent fatigue, distress,
anxiety and cardiovascular symptoms. However, the drawback in past literature is that the
relation between work and mental health has not been explored in detail. Although the topic od
shift work has been widely discussed and researched in past research, however these studies have
mainly highlighted relation between shift work and sleep quality. But, there is lack of studies that
have focused specifically on investigating the impact of shift work on psychological health.
Thus, this literature review is significant to separate findings related to effect of this working
pattern on psychological health and find out what could be done to improve psychological
health. The main rational for investigation about the effect of shift work on psychological and
mental health is that past research have paid less attention to mental outcomes due to rotating
shifts and findings from this research may help to prevent the rate of mental disorders highly
prevalent in nurses working in rotating shifts (Tajvar et al. 2015).
Thus, investigation about the severity of the issue in terms of mental health of nurse is
necessary as part of the duty to protect nurses from workplace hazard. This literature review will
help to systematically arrange the findings related to mental health outcomes of nurses due to
long shift hours and evaluate future consequences of the outcome for nurses.
The main of this literature review is to explore the effect of shift work on nurse’s
psychological health. The key objectives of the review are as follows:
To assess the impact of shift work and its nature on mental health outcomes of nurse’s.
To analyze the consequences of shift work on nurse’s psychological health and quality of
nursing care
6SHIFT WORK
To recommend strategies to resolve shift work related problems and improve health and
well-being for nurses in practice
Search strategy:
For developing a strong literature review, searching for information from valid and
relevant sources is critical (Youssef and Youssef 2016). To identify and retrieved relevant
literature that gives authentic and relevant information on the topic, databases such as the
EMBASE, Medline, PubMed, and Psych INFO were used for literature search. The process of
the literature search is completed in different steps that are identification, screening, eligibility
checking, and inclusion (Agger, Stephenson and Hasenkam 2017). For collecting information
regarding the chosen topic that is the influence of shift work on the psychological health of
nurses, an extensive search for literature has been conducted.
The given literature search was conducted on the 11th of November 2019 where search
limiters were applied to refine the search. Search limiters used for the given research included
articles published in the English language and peer-reviewed articles because search limiters
narrow the focus of search by way of well as we can retrieve information later from the
databases, and search is incomplete according to the values nominated. For effective literature
searching, identification of the keywords from the review question is essential as the keywords
or search strings help in identifying relevant, accurate and precise publications on the topic. The
search strings or keywords for the literature search are present reviews were identified as:
Concept one was incorporating keywords “shift work,” shift,” night shift work,” and
combined using the Boolean operator ‘OR.’
To recommend strategies to resolve shift work related problems and improve health and
well-being for nurses in practice
Search strategy:
For developing a strong literature review, searching for information from valid and
relevant sources is critical (Youssef and Youssef 2016). To identify and retrieved relevant
literature that gives authentic and relevant information on the topic, databases such as the
EMBASE, Medline, PubMed, and Psych INFO were used for literature search. The process of
the literature search is completed in different steps that are identification, screening, eligibility
checking, and inclusion (Agger, Stephenson and Hasenkam 2017). For collecting information
regarding the chosen topic that is the influence of shift work on the psychological health of
nurses, an extensive search for literature has been conducted.
The given literature search was conducted on the 11th of November 2019 where search
limiters were applied to refine the search. Search limiters used for the given research included
articles published in the English language and peer-reviewed articles because search limiters
narrow the focus of search by way of well as we can retrieve information later from the
databases, and search is incomplete according to the values nominated. For effective literature
searching, identification of the keywords from the review question is essential as the keywords
or search strings help in identifying relevant, accurate and precise publications on the topic. The
search strings or keywords for the literature search are present reviews were identified as:
Concept one was incorporating keywords “shift work,” shift,” night shift work,” and
combined using the Boolean operator ‘OR.’
7SHIFT WORK
Concept two identified as “nurse,” nurse practitioner,” qualified nurse,”,” and “registered
nurse” and combined using the Boolean operator ‘OR.’ Concept three consisting of
“psychological health,” mental health,” emotional health,” and “psychological wellbeing” search
strings and combined using the Boolean operator ‘OR.’ Concept four comprising “effects,”
impact,” consequences” and “outcomes” and combined using the Boolean operator ‘OR. The
summary of the concepts used and the number of hits obtained has been summarized in appendix
1. Medeiros and Teixeira (2016) state different authentic websites should be accessed to ensure
all the relevant information regarding the topic is found.
Inclusion criteria:
The World Health Organization (WHO) is a particular agency of the United Nations that
is disturbed by international public health. The WHO (www.who.int), The Department of Health
(health.gov.ie) and Ireland's Health Services (www.hse.ie) were accessed. In addition to this, the
manual research was conducted in which the “Irish health repository” named “Lenus” was
searched. The key inclusion criteria for article selection were as follows:
All the research articles must have nurse as the sample
The articles must be peer reviewed journal articles
The articles must be report about psychological or mental outcomes of nurses.
All articles must be published within the past 30 years.
Search findings:
After initial searches, 425 citations were retrieved from all databases, and their titles and
abstracts were screened. As the focused issue of the review is the effects of shift work on nurses’
psychological health, 302 citations were found to be irrelevant. For example, they addressed
Concept two identified as “nurse,” nurse practitioner,” qualified nurse,”,” and “registered
nurse” and combined using the Boolean operator ‘OR.’ Concept three consisting of
“psychological health,” mental health,” emotional health,” and “psychological wellbeing” search
strings and combined using the Boolean operator ‘OR.’ Concept four comprising “effects,”
impact,” consequences” and “outcomes” and combined using the Boolean operator ‘OR. The
summary of the concepts used and the number of hits obtained has been summarized in appendix
1. Medeiros and Teixeira (2016) state different authentic websites should be accessed to ensure
all the relevant information regarding the topic is found.
Inclusion criteria:
The World Health Organization (WHO) is a particular agency of the United Nations that
is disturbed by international public health. The WHO (www.who.int), The Department of Health
(health.gov.ie) and Ireland's Health Services (www.hse.ie) were accessed. In addition to this, the
manual research was conducted in which the “Irish health repository” named “Lenus” was
searched. The key inclusion criteria for article selection were as follows:
All the research articles must have nurse as the sample
The articles must be peer reviewed journal articles
The articles must be report about psychological or mental outcomes of nurses.
All articles must be published within the past 30 years.
Search findings:
After initial searches, 425 citations were retrieved from all databases, and their titles and
abstracts were screened. As the focused issue of the review is the effects of shift work on nurses’
psychological health, 302 citations were found to be irrelevant. For example, they addressed
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