Sleep Health in Healthcare Provider
Autumn Joyce
Lunelle Pierre
Kassandra Malivert
New York City College of Technology
Due: December 5, 2012
The Healthy People 2020 topic that will be discussed is sleep health in healthcare professionals. Poor sleep health is a common problem with twenty five percent of the U.S. adults reporting insufficient sleep or rest at least 15 out of every 30 days. According to Healthy People 2020, “the goal is to increase public knowledge of how adequate sleep and treatment of sleep disorders improve health, productivity, wellness, quality of life and safety on roads and in the workplace. Sleep health is a topic of choice because sleep is a critical determinant of health and well-being. Sleep is a basic requirement for infants, children and adolescent health and development. Untreated sleep loss and disorders impact basic patterns of behavior that negatively affect family health and interpersonal relationships. Productivity can be significantly reduced and their is an increased risk for medical errors, motor vehicle and industrial accidents.
Being a health care provider can be very difficult. The expectation is to work many hours to provide care for patients without any regards for the healthcare provider. Many times, you are not able to use the restroom which can lead to kidney infections and UTI, you do not have time to eat which can cause decreased energy and mood changes, you do not have time for a quick break at times to clear your head. All these factors can lead to frustration with yourself and others around you. Poor sleep can lead to heart disease, increased blood pressure, obesity, diabetes which all causes mortality. Adequate sleep is necessary to fight off infections,support the metabolism of sugar to prevent diabetes, perform well in school and work effectively and safely.
In 2008, the CDC conducted a survey called the Behavioral Risk Factor Surveillance System (BRFSS) survey. The survey included a core question regarding perceived insufficient rest or sleep in 2008 and an optional module of four questions on sleep behavior in 2009. Results shows that among 74,571 adults respondents in 12 states, 35.3% reported less than seven hours of sleep during a typical 24 hour period, 37.9% reported unintentionally falling asleep during the day at least once in the preceding month, and 4.7% reported nodding off or falling asleep while driving at least once in the preceding month. The National Sleep Foundation reports about 20% of Americans average less than six hours of sleep per night and the number of Americans who report getting eight hours of sleep or more has decreased.
Lack of sleep affects an individual both physically and mentally. Health professionals with poor quality of sleep are at risk for patient medication errors and poor patient outcomes. Nurses often work extended hours or night shifts that put them at risk for sleep loss and/or sleep deprivation. Negotiation of each nurses’ schedule involves delicate balance as unit staffing needs are matched to nurses’ desired schedules (Geiger-Brown & Trinkoff, 2010). The need to provide 24/7 patient care means that nurses must staff for 8 or 12 hour shifts. Many nurses work outside the 9:00-5:00PM work day or office hours. Extended shift (those past 8 hours) and overtime due to unplanned staff illnesses or increased hospital admissions can result in increased fatigue and sleep deprivation (Geiger-Brown & Trinkoff, 2010). It is clear that differing work schedules result in differing levels of fatigue, with shift work attributing to higher levels than day work (Yuan, Chou, Chen, Lin, Chen, Liu & Kuo, (2011). Sleep deprivation is defined as a sufficient lack of restorative sleep over a cumulative period so as to cause physical or psychiatric symptoms (Stedman, 2006).
Studies related to fatigue and sleepiness indicates that adults require 6 to 10 hours of sleep in a 24-hour period. However, our society expects performance and productivity on a 24-hour basis. The need for round the-clock operations in the USA, including healthcare, often assumes precedence over the basic physiologic principles governing sleep and wakefulness (Owens, 2009). Several studies have established that impaired sleep is a common problem among nurses. Overworked, fatigued and stressed nurses are at a higher risk of making mistakes that threaten patient safety as well as their own health (Hasson & Gustavsson, 2010). Shift work, and particularly working night shift, is recognized as a source of stress for nurses (Fallis, McMillan, & Edwards, 2011). For nurses working either 8 or 12-hour shifts, sleep deprivation increases the risk for patient errors, near misses, sentinel events, and personal injuries on shift and while driving home (Fallis et aI., 2011). To further compound this issue, most healthcare professionals, including nurses, typically receive little or no formal education about normal sleep or the essential role of sleep in maintaining adequate performance.
Other concerns related to sleep loss involve effects on the immune and cardiovascular systems. A decrease in the immune system is often associated with infectious diseases. Lack of quality sleep and cardiovascular regulation are closely related and they affect both young and old person. Constant changes due to sleep loss could increase the risk of cardiovascular disease (Vaara & Koivu, 2010).
Studies have reported that the effects of going without sleep for as long as 24 hours are similar to drinking two to three alcoholic beverages. (Falleti, Maruff, Collie, Darby, & McStephen, 2003). Sleep loss substantially impairs physical, cognitive, and emotional function and failure to adhere to the needs for adequate amounts of and appropriately timed sleep results in an increase in sleepiness, fatigue, and a decline in waking function (Owens, 2007). The only sure way for people to overcome sleep deprivation, thus increasing sleep health, is to increase continuous sleep time. One possible option to aid in the fight against sleep deprivation and to increase alertness may be the recommendation of scheduled naps during an individual’s shift. Studies suggest that naps of 20 minutes may be beneficial in combating fatigue and increasing mental acuity in night-shift nurses (Hayashi, Chikazawa, & Hori, 2004). Other strategies include the limitation of stimulants, such as caffeine and to have available an environment that is dark, cool and quiet during nap time.
Sleep health in healthcare professionals have become a major issue. As healthcare providers, we only think about the wellbeing of our patients and do everything in our power to make them heal. We need to start thinking about our health as well. Healthcare providers work long hours and different shifts to provide care for our patients. Are we really providing the best care? According to “Shift work in Nursing: Is it Really a Risk Factor for Nurses Health and patients’ Safety” by Hanna Admi, Orna Tzischinsky, Rachel Epstein, Paula Herer and Peretz Lavie, most nurses who are working at hospital setting are older female nurses who have been a long time. They are expected to carry out good quality care and make sure that their patients are kept safe. With their health declining and lack of sleep for about 24 hours, there are major health risks for the nurses and the patients. The article states policymakers should help healthcare provider by adjusting shift rotations in order to avoid the effects that Healthcare providers and sleep deprivation will have on patient care.
Four recommended solutions that health care providers especially nurses, need to take in order to get better sleep habits and stay healthy are sleep, cutting back on work time, change of shift and taking 15-20mins of “power nap” on their break time. As healthcare providers it is hard not to work those long hours. Many healthcare providers do not go home to rest after working night shift. According to Focus on prehospital providers, rather than sleeping, healthcare providers take of other personal errands. Cutting back on work time can provide more hours for sleep. Sleep can improve the quality of life and better long term health in health care professionals. Another showed that taking a power nap for 15- 20 mins can make the nurse sharper and more alert. Some hospitals have a quiet, dark room set apart for nurses to take naps on their break time.
Community Health nurses have the responsibility of teaching and educating nurses and other health care providers on how importance of sleep health. They can conduct more studies on how power napping for 20mins can make the healthcare provider more rejuvenated after a couple of hours of work . The nurse should find out ways to reach hospitals about adjustment to shifts by handing out pamphlets, partnering with clinics and being a spokesperson for healthcare providers.
Reference
Healthy People.gov. 2012. Sleep Health. Accessed at
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=38 on November 25,2012.
Centers for Disease Control and Infection (CDC). 2011. Unhealthy Sleep-Related Behaviors-12 states, 2009. Accessed at http://www.cdc.gov/mmwr/pdf/wk/mm6008.pdf on November 25,2012.
Samaritan Regional Health System (2012). Sleep Statistics. Accessed at
http://www.samaritanhospital.org/departments-services/sleep-center/sleep-statistics on December 2, 2012
Chen, M.C., Liu, H.H., & Kuo, H.W. (2011). Influences of shift work on fatigue among nurses. Journal of Nursing Management, 19(3): 339-345. doi 10.1111/j.1365-2834.2010.01173x
Falleti, M.G., Maruff, P., Cillie, A., Darby, D.G., McStephen, M. (2003). Qualitative similarities in cognitive impairment associated with 24h of sustained wakefulness and a blood alcohol concentration of 0.05%. Journal ofSleep Research, 12, 265-274.
Fallis, W.M., McMillan, D.E., & Edwards M.P. (2011). Napping during night shift: practices preference,Perceptions of critical care and emergency department nurses. American Association ofCritical-Care Nurses 2011 ;31 :e1=e11. doi: 10.4037/ccn2011710
Geiger-Brown, J., & Trinkoff, A. (2010). Is it time to pull the plug on 12-hour shifts? Part 1. Journal of Nursing Administration, 40(3): 100-102.
Yuan, S.C., Chou, M.C., Chen, C.J., Lin, Y.J., Owens, J.A. (2009). Sleep loss and fatigue in healthcare professionals. Journal of Perinatal and Neonatal Nursing, 21(2).92-100. doi: 10.1097/01JPN.0000270624.64584.9d
Admi, H., Tzischinsky, O., Epstein, R., Herer, P., & Lavie, P. (2008). Shift work in nursing: is it really a risk factor for nurses’ health and patients’ safety?. Nursing Economic$, 26(4), 250-257.
