轮班制对ICU女护士昼夜活动节律与疲倦的影响

doi:10.3761/j.issn.0254-1769.2021.03.016

摘要/Abstract

摘要：

目的比较ICU女护士不同工作时长（8 h和12 h）昼夜活动节律相关指标与工作前后疲倦的差异,并分析疲倦程度的影响因素。方法采用便利抽样法选取北京市3所三级甲等综合医院228名ICU女护士,通过一般资料问卷、李氏疲倦量表（Lee's Fatigue Scale）进行调查,使用活动记录仪实施客观测量。结果护士昼夜活动节律相关指数中静息-活动周期（r24）和昼夜节律整体偏低,8 h轮班制护士总睡眠时间明显低于12 h轮班制护士,差异有统计学意义（P<0.001）。8 h轮班制护士在值夜班前的疲倦程度比12 h轮班制护士高,但12 h轮班制护士在值夜班后的疲倦程度比8 h轮班制护士高,差异有统计学意义（P<0.001）。多元线性回归分析显示,昼夜活动节律指标中的工作时活动水平、总睡眠时间、静息-活动周期（r24）是工作后疲倦度的显著预测因子,尤其是ICU12 h轮班制护士。结论通过昼夜活动节律相关指标与工作前后疲倦度相关性探讨,有助于护理管理者了解护士工作状态,为改善ICU护士轮班方式、限定夜班数量及量化工作负荷提供依据。

关键词: 监护室护士, 昼夜活动节律, 疲倦, 活动记录仪, 护理管理研究

Abstract:

Objective To compare the differences of circadian activity rhythms indexes and fatigue severity among female nurses（8-and 12-hour shift）in intensive care units（ICU）before and after their shift work;further more,to explore the influencing factors of fatigue. Methods A convenience sample of 228 female nurses from ICU of 3 hospitals in Beijing was involved. A demographic form and Lee's Fatigue Scale were included as measurements,and objective data was collected from motion sensor monitor（wrist actigraph）. Results The circadian rhythms indexes（r24 and circadian activity rhythms）among nurses in ICU were generally low. The total sleep time（TST） of the 8-hour shift nurse was significantly lower than that of the 12-hour shift nurse（P<0.001）. The 8-hour shift nurses had significantly higher fatigue severity before night shift,and 12-hour shift nurses had significantly higher fatigue after night shift（P<0.001）,with statistically significant differences. The circadian rhythms indexes of working activity level,TST and rest-activity cycles（r24） were significant predictors for fatigue severity after night shift work（P<0.05）,especially for 12-hours shift nurses in ICU. Conclusion By exploring the associations between circadian activity rhythms indexes and fatigue severity before and after work,it helps nursing managers understand the working status of nurses in ICU. It can also provide a basis for scheduling shift-work and quantifying workload.

Key words: Nurses in Intensive Care Unit, Circadian Activity Rhythms, Fatigue, Actigraph, Nursing Administration Research

张欣, 董婧琦, 徐舒慧, 李时雨. 轮班制对ICU女护士昼夜活动节律与疲倦的影响[J]. 中华护理杂志, 2021, 56(3): 409-414.

ZHANG Xin, DONG Jingqi, XU Shuhui, LI Shiyu. Associations between circadian activity rhythms and perceived fatigue before and after shift work among female nurses in intensive care units[J]. Chinese Journal of Nursing, 2021, 56(3): 409-414.

图/表 3

参考文献 41

[1]	Wright KP Jr, Bogan RK, Wyatt JK . Shift work and the assess-ment and management of shift work disorder(SWD)[J]. Sleep Med Rev, 2013,17(1):41-54.
[2]	Ganesan S, Magee M, Stone JE , et al. The impact of shift work on sleep,alertness and performance in healthcare workers[J]. Sci Rep, 2019,9:4635.
[3]	Goldstein AN, Walker MP . The role of sleep in emotional brain function[J]. Annu Rev Clin Psychol, 2014,10(1):679-708.
[4]	Eugene AR, Masiak J . The neuroprotective aspects of sleep[J]. MEDtube Sci, 2015,3(1):35-40.
[5]	Gómez-García T, Ruzafa-Martínez M, Fuentelsaz-Gallego C , et al. Nurses' sleep quality,work environment and quality of care in the Spanish National Health System:observational study among different shifts[J]. BMJ Open, 2016,6(8):e012073.
[6]	Bagheri Hosseinabadi M, Ebrahimi MH, Khanjani N , et al. The effects of amplitude and stability of circadian rhythm and occupational stress on burnout syndrome and job dissatis-faction among irregular shift working nurses[J]. J Clin Nurs, 2019,28(9/10):1868-1878.
[7]	Barker LM, Nussbaum MA . The effects of fatigue on perfor-mance in simulated nursing work[J]. Ergonomics, 2011,54(9):815-829.
[8]	Mc Call C , McCall WV. Comparison of actigraphy with polyso-mnography and sleep logs in depressed insomniacs[J]. J Sleep Res, 2012,21(1):122-127.
[9]	Shaker D, Samir A, Zyada F , et al. Impact of shift work on sleep problems,hormonal changes,and features of metabolic syndrome in a sample of Egyptian industrial workers[J]. Middle East Curr Psychiatry, 2018,25(2):91-97.
[10]	Ancoli-Israel S, Clopton P, Klauber MR , et al. Use of wrist activity for monitoring sleep/wake in demented nursing-home patients[J]. Sleep, 1997,20(1):24-27.
[11]	Greer TL, Trivedi MH . Exercise in the treatment of depression[J]. Curr Psychiatry Rep, 2009,11(6):466-472.
[12]	Lee SY, Grantham CH, Shelton S , et al. Does activity matter:an exploratory study among mothers with preterm infants?[J]. Arch Womens Ment Health, 2012,15(3):185-192.
[13]	Zhang X, Lee SY, Luo HH , et al. A prediction model of sleep disturbances among female nurses by using the BP-ANN[J]. J Nurs Manag, 2019,27(6):1123-1130.
[14]	Chang WP, Li HB . Differences in workday sleep fragmentation,rest-activity cycle,sleep quality,and activity level among nurses working different shifts[J]. Chronobiol Int, 2019,36(12):1761-1771.
[15]	Ortiz-Tudela E, Iurisci I, Beau J , et al. The circadian restacti-vity rhythm,a potential safety pharmacology endpoint of cancer chemotherapy[J]. Int J Cancer, 2014,134(11):2717-2725.
[16]	Ancoli-Israel S, Cole R, Alessi C , et al. The role of actigraphy in the study of sleep and circadian rhythms[J]. Sleep, 2003
	26(3):342-392.
[17]	Lam JC, Mahone EM, Mason TBA , et al. Defining the roles of actigraphy and parent logs for assessing sleep variables in preschool children[J]. Behav Sleep Med, 2011,9(3):184-193.
[18]	Lee KA, Hicks G, Nino-Murcia G . Validity and reliability of a scale to assess fatigue[J]. Psychiatry Res, 1991,36(3):291-298.
[19]	Tsai SY, Shun SC, Lai YH , et al. Psychometric evaluation of a Chinese version of the Lee Fatigue Scale-Short Form in women during pregnancy and postpartum[J]. Int J Nurs Stud, 2014,51(7):1027-1035.
[20]	胡良平, 李子建 . 医学统计学基础与典型错误辨析[M]. 北京: 军事医学科学出版社, 2003.
	Hu LP, Li ZJ. The basis of medical statistics and the differentiation of typical errors[M]. Beijing: Military Medical Science Press, 2003.
[21]	Ferreira LRC, de Martino MMF . Sleep patterns and fatigue of nursing students who work[J]. Rev Esc Enferm USP, 2012,46(5):1178-1183.
[22]	Boudreau P, Dumont GA, Boivin DB . Circadian adaptation to night shift work influences sleep,performance,mood and the autonomic modulation of the heart[J]. PLoS One, 2013,8(7):e70813.
[23]	Geiger-Brown J, Rogers VE, Trinkoff AM , et al. Sleep,sleepi-ness,fatigue,and performance of 12-hour-shift nurses[J]. Chrono-biol Int, 2012,29(2):211-219.
[24]	Erman MK, Seiden DJ, Yang R , et al. Efficacy and tolerability of armodafinil:effect on clinical condition late in the shift and overall functioning of patients with excessive sleepiness associated with shift work disorder[J]. J Occup Environ Med, 2011,53(12):1460-1465.
[25]	Slanger TE, Gross JV, Pinger A , et al. Person-directed,nonphar macological interventions for sleepiness at work and sleep disturbances caused by shift work[J]. Cochrane Database Syst Rev, 2016(8):D10641.
[26]	何叶, 顾晴, 吴楠 . 不同光照治疗方案对改善轮班工作者睡眠质量效果的系统评价[J]. 中华护理杂志, 2018,53(1):94-99.
	He Y, Gu Q, Wu N . Effectiveness of light therapy on sleep quality in shift workers:a systematic review[J]. Chin J Nurs, 2018,53(1):94-99.
[27]	Simões MRL , Marques FC,de Mattia Rocha A. Work in rota ting shifts and its effects on the daily life of grain processing workers[J]. Rev Latino-Am Enfermagem, 2010,18(6):1070-1075.
[28]	Folkard S . Do permanent night workers show circadian adjust ment? A review based on the endogenous melatonin rhythm[J]. Chronobiol Int, 2008,25(2/3):215-224.
[29]	谢立亚 . 轮班工作、昼夜节律改变与健康效应[J]. 中华预防医学杂志, 2014,48(9):756-757.
	Xie LY . Shift work,circadian rhythm changes and health effects[J]. Chin J Prev Med, 2014,48(9):756-757.
[30]	Burgess PA . Optimal shift duration and sequence:recommended approach for short-term emergency response activations for public health and emergency management[J]. Am J Public Heal, 2007,97(Supplement_1):S88-S92.
[31]	Hughes RG, Rogers AE . Are You Tired? Sleep deprivation compromises nurses'health-and jeopardizes patients[J]. Am J Nurs, 2004,104(3):36-38.
[32]	Magnavita N, Garbarino S . Sleep,health and wellness at work:a scoping review[J]. Int J Environ Res Public Heal, 2017,14(11):1347.
[33]	Suresh G, Horbar JD, Plsek P , et al. Voluntary anonymous re porting of medical errors for neonatal intensive care[J]. PEDIATRICS, 2004,113(6):1609-1618.
[34]	Sun QZ, Ji XP, Zhou WQ , et al. Sleep problems in shift nurses:a brief review and recommendations at both individual and institutional levels[J]. J Nurs Manag, 2019,27(1):10-18.
[35]	Camerino D, Conway PM, Sartori S , et al. Factors affecting work ability in day and shift-working nurses[J]. Chronobiol Int, 2008,25(2/3):425-442.
[36]	Weaver AL, Stutzman SE, Supnet C , et al. Sleep quality,but not quantity,is associated with self-perceived minor error rates among emergency department nurses[J]. Int Emerg Nurs, 2016,25:48-52.
[37]	吕永利, 耿力, 丁颖 . 经历不良事件后离职的低年资护士的感受及应对措施的质性研究[J]. 中华护理杂志, 2020,55(9):1320-1323.
	Lü Yongli, Geng L, Ding Y . A qualitative study on feelings and coping measures of junior nurses leaving after adverse events[J]. Chin J Nurs, 2020,55(9):1320-1323.
[38]	甘露, 张海燕, 尚文涵 , 等. 护士离职率现状及影响因素分析[J]. 中华护理杂志, 2020,55(2):198-203.
	Gan L, Zhang HY, Shang WH , et al. Nursing turnover rate and its influencing factors[J]. Chin J Nurs, 2020,55(2):198-203.
[39]	卢伟, 秦薇, 徐建鸣 , 等. 低年资护士离职原因的探讨[J]. 中华护理教育, 2016,13(11):859-862.
	Lu W, Qin W, Xu JM , et al. Factors affecting turnover of junior nurses:a qualitative study[J]. Chin J Nurs Educ, 2016,13(11):859-862.
[40]	Ancoli-Israel S, Klauber MR, Jones DW , et al. Variations in circadian rhythms of activity,sleep,and light exposure related to dementia in nursing-home patients[J]. Sleep, 1997,20(1):18-23.
[41]	Sookoian S, Gemma C, Fernández Gianotti T , et al. Effects of rotating shift work on biomarkers of metabolic syndrome and inflammation[J]. J Intern Med, 2007,261(3):285-292.