Nurses often schedule themselves or are asked to work extra shifts. Twelve hour
ID: 126548 • Letter: N
Question
Nurses often schedule themselves or are asked to work extra shifts. Twelve hour shifts have become very popular in healthcare institutions. These factors, along with other professional and personal factors, can contribute to sleep deprivation, and can affect the nurse’s health, as well as their ability to perform safe patient care. Read the following article: Eanes, L. (2015). The potential effects of sleep loss on a nurse's health. American Journal of Nursing, 115(4), 34-40. doi:10.1097/01.NAJ.0000463025.42388.10 Initial Discussion Post: You are working with a new RN who has been employed on your unit for two months. She has recently begun course work for an advanced degree, and has been offering to work extra shifts to pay her tuition. Identify one (1) acute and one (1) chronic effect of sleep loss that could impact the RN’s health, and describe precautions you would suggest to prevent the problems. Identify a suggestion you would make to the unit manager regarding this issue.
Explanation / Answer
ACUTE EFFECTS OF SLEEP LOSS
One acute effect of sleep loss that could impact the RN's health is her loss of memory and inability to learn new things.Failure to adhere to the needs for both adequate and appropriately timed sleep can result in an overall decline in the ability to learn, remember, use sound judgment, and perform tasks safely.
Memory and learning. The consequences of insufficient sleep go beyond just daytime sleepiness and fatigue. Over the short term, sleep loss-even as little as one hour per sleep period-can result in memory deficits, cognitive impairment, and reduced attentiveness. There is considerable evidence that sleep, learning, and memory are interrelated. While the acquisition of knowledge and recall occur when people are awake, those getting insufficient sleep are often unable to focus effectively, filter distractions, and learn new information. There is little research on how sleep loss affects learning among nurses, but according to Geiger-Brown, sleep-deprived nurses have displayed the reduced ability to learn such new information as pertinent facts regarding patient assignments or training in the use of new equipment.
There is mounting evidence that sleep affects not only the acquisition of new information but also the stabilization of learning through the strengthening of neuronal connections. In other words, during sleep, information obtained during wakefulness is consolidated or preserved as long-term memories, and without sufficient sleep, it's more difficult to recall or retrieve newly acquired knowledge.
Performance and judgment. A survey of 3,604 postgraduate medical residents working in a variety of specialties and hospitals indicated that sleeping five or fewer hours per night was associated with the following events:
* medical errors
* adverse patient outcomes
* being named in malpractice suits
* serious accidents or injuries
* conflict with colleagues
* increased use of alcohol
* use of medications to stay awake
* noticeable weight change
* working in an impaired condition
Motor vehicular injuries and sleep loss. Fatigue, increased sleepiness, diminished ability to selectively process and retain information, slowed reaction time, and reduced vigilance can increase the risk of human error, the consequences of which can be costly in terms of personal health and well-being.
Musculoskeletal injuries and sleep loss. Of the 4,614 RNs who responded to the 2011 ANA Health and Safety Survey, 53% reported working mandatory and unplanned overtime, 55% said they worked more than 40 hours per week, and 62% reported having disabling work-related musculoskeletal injuries.23 While it is well established that musculoskeletal injuries are a significant cause of morbidity among nurses, to date, only a small number of nursing studies have explored the relationship between this type of injury and extended work hours, sleepiness, and fatigue. Of the studies that explored these relationships and controlled for extraneous variables, such as physical demands, findings suggest a positive correlation
CHRONIC EFFECTS OF SLEEP LOSS
Obesity and sleep loss. In addition to poor dietary habits, increased caloric intake, and lack of exercise, sleep loss is now considered a potential risk factor for obesity.
Diabetes and sleep loss. Over the past three decades, there has been an observable decline among Americans in average sleep times and an alarming rise in diabetes. While obesity is a major risk factor for type 2 diabetes, researchers now believe chronic partial sleep restriction may impair glucose metabolism, thereby increasing the risk of diabetes independent of changes in BMI. Multiple laboratory studies have shown a causal effect between chronic sleep loss and measurable changes in glucose metabolism, hormone levels, and autonomic system response, any of which may contribute to obesity, visceral fat accumulation, and diabetes
Cardiovascular risk. Chronic partial sleep restriction has been shown to increase cardiovascular morbidity and mortality,42 but as with obesity and diabetes, the pathways underlying the connection between chronic partial sleep restriction and increased cardiovascular risk are unclear.
Cancer risk. The scientific community has long accepted that sleep is needed to regulate cellular activity and repair damaged DNA.
Suggestion for a good sleep
1. Establish a bedtime routine, and stick to it. Each night, follow the same pattern before going to sleep — such as brushing your teeth, washing your face, taking a warm bath and winding down with a book — to train your body that it’s time to sleep. Figure out what helps you to relax if you’re not sleepy so you can get some rest more quickly.
2. Hang blackout curtains in your room. Get uninterrupted sleep by blocking light and sound from your bedroom with these curtains, designed to keep the room darker and quieter both day and night. Don’t have time to buy blackout curtains. Draping a heavy blanket over your window can also help.
3. Keep your room cool, if possible. While you may not always be able to keep the temperature in your apartment down during a particularly hot summer, you’ll sleep better if your bedroom stays cooler so you don’t get overheated and wake up.
4. Turn off your phone. Friends and family may be unaware of your work schedule and call you in the morning when you’re trying to sleep. Prevent interruptions by silencing or unplugging your landline and setting your cell phone to “do not disturb” or turning it off entirely.
5. Avoid caffeine at least a few hours before bedtime. You may rely on an energy drink or soda to keep you awake when 3 a.m. rolls around, but caffeine can cause insomnia as well as headaches and dizziness, according to the National Sleep Foundation. If you must drink a caffeinated beverage during your shift, do so as early as possible so you don’t keep yourself awake later when you’re trying to go to sleep.
6. Get some exercise during your shift. If you are spending most of your shift sitting at a desk, make sure to get up when you can and move around a bit. Even taking a quick walk outside — or, if that’s not an option, around the building a few times — can keep you alert and also help your body to feel tired once you’re ready to sleep.
7. Let others know your schedule so they can help you get some sleep. You’ll inevitably encounter interruptions, like someone knocking or ringing the doorbell while you’re sleeping, but you can minimize these by telling friends, neighbors, colleagues and family your schedule. Make sure they know that you won’t be answering the door or the phone between certain hours — and then stick to that. If you take phone calls during the time you’re normally sleeping, friends will assume your schedule has changed or that they can talk to you during that time.
8. Use the bathroom and avoid drinking too much liquid right before bed. If you have to wake up to use the bathroom a few hours after getting home from your shift, it can be hard to fall back asleep. Minimize the chance of this happening by drinking less about an hour before your shift ends and using the restroom when you leave or right when you get home.
9. Wear dark sunglasses on your drive home. The National Sleep Foundation recommends putting sunglasses on if you leave work at dawn to avoid disrupting your body’s Circadian rhythm. It can be hard to fall asleep when it’s light outside, so trick your body into believing it’s still nighttime with dark glasses.
10. Keep your room quiet with a sound machine. It’s not just for babies: White noise can block outside traffic noises, sounds from your children or spouse and even the clatter from the kitchen if someone else is home. Choose one with several sounds so you can find one that works best for you.
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