The experience of sleep disturbance of shift-work nurses in Hong Kong

1. The experience of sleep disturbance of shift-work nurses in Hong Kong Kwong Chung Man, Cheung King Yee, Ng Kit Yee, Janice Cheung Joyce Chong,

2. Preview • Introduction • Literature Review • Aims of the Research • Research Design & Data Collection • Data Analysis & Result • Implication & Discussion • Limitation and Suggestion

3. Introduction Kwong Chung Man

4. 迫自己入睡係一件痛苦嘅事!!!

5. Lapses in attention and inability to stay focused Reduced motivation Compromised problem-solving Confusion or bewilderment Irritability or hostility Unusual tenseness or anxiety Memory lapses (particularly in short-term memory) Impaired communication Diminished reaction time Faulty information processing and judgment Slowed information processing Diminished ability to detect and recognize the significance of subtle changes in a patient’s health Inability to deal with the unexpected Indifference and loss of empathy (Hughes & Rogers, 2004) Results of Sleep Deprivation

6. Factors influencing health of workers and tolerance to shift work (Giovanni Costa, 2003) • Shift and night work are a well recognized risk factors for health and well-being • 20–30% of shift work workers have severe sleep problems, that force them to quit • ~10% do not complain at all during their shift work working life

7. Shift work impact on health • Perturbing the psychophysical homeostasis (circadian rhythms, sleeping and eating hours), • Decreasing vigilance and performance (errors, accidents), • Hampering family and social relations • A recognized risk factor for gastrointestinal, psychoneurotic and cardiovascular disorders

8. Dose shift work lead to poorer health habits: A comparison between women who had always done shift work with those who had never done shift work (Kivimaki & Kuisma, 2001) • Questionnaire to 2795 female nurses • Compare 506 shift worker with 183 day workers • Shift work was not associated with alcohol intake or sedentary lifestyle • Shift work in nurses increases smoking and being overweight to a degree that contributes to health problems

9. Sleep quality and responses to insufficient sleep in women on different work shifts (Edéll-Gustafsson, 2002) • Questionnaire to 156 women working in hospitals • The prevalence of insufficient sleep was 40% • Palpitation, increase susceptibility to infection, cognitive behavioral effects of fatigue, dysphoria, somatic distress • Negative responses were related to rotating work shifts • Negative responses were related to self-rated sleep quality

10. Research Question The experience of sleep disturbance of shift-work nurses in Hong Kong

11. Aims of the Research • To promote shift-work nurses’ health and well-being by knowing more about • the experience of sleep disturbance • the impacts of sleep disturbance • the perceived causes of sleep disturbance • the copings of sleep disturbance

12. Research Design & Data Collection Cheung King Yee

13. Sampling method Purposive sampling The sample units are chosen ‘purposively’ for having particular features or characteristics which will enable detailed exploration and understanding of the central themes and puzzles which the researchers wishes to study

14. Selection criteria • Symbolic representation • shift-work nurses • with sleep disturbance experience • working in Hong Kong • Diversity • specialty • working experience • night shift (frequency and length)

15. Sample size • Seven samples • all female nurses (1 Nursing Officer and 6 Registered Nurses) • aged between 25 – 45 • 3 married and 4 single • working at acute hospital setting (2 in private hospital and 5 in public hospital)

16. Sample matrix

17. Semi-structured interviewingDemographic information Specialty: Medical Surgical A&E paediatric psychiatric Orthopaedic Intensive care unit Others (please specify) ______ Working experience (Shift) : ______ (years) How many night shift per month ______ How many working hours per night shift ______

18. Interview Guide • 請用1-10分 (最差1分, 最好10分) 評估你最近一個月的睡眠質素 • 你睡得唔好的經驗係點樣 • 睡得唔好對你有何影響 • 睡得唔好的原因是什麼 • 嘗試過什麼令你睡得好些 • 需要有何改變可以令你睡得好些

19. Qualitative Data Collection • Before the interview • Informed consent • Aims of research • Confidentiality • Right to withdraw • Seeking permission to record the data by audio-recording or note-taking • Length of interview around 15 to 20 minutes • Making appointment • Date / Time (on duty / off duty) • Location (working area / home / restaurant) • Means (face to face / over the telephone)

20. Interview process Listen Interviewer Interviewee Skills Response

21. After the interview • Appreciation • Reconfirming about the confidentiality • Raw data management

22. Data Analysis & Result Ng Kit Yee

23. Data analysis • Thematic analysis • Typologies • Experience of sleep disturbance • Perceived causes of sleep disturbance • Impacts of sleep disturbance • Coping of sleep disturbance • Desires for improving sleep disturbance

24. Thematic chart (2) Perceived causes (1) Experience of sleep disturbance (3) Impacts Sleep Disturbance (5) Desires for changes (4) Coping RESULT

25. 1.1Difficulty initiating sleep 1.2 Difficulty maintaining sleep 1.3 Early morning wakening 1.4 Nonrestorative sleep 1.5 Shallow sleep 1.6 Nightmare 1.7 Hopelessness/helplessness Typologies—(1) Experience of sleep disturbance

26. 1.1Difficulty initiating sleep PA同A/N難入睡 輾轉反側 個腦不停諗嘢 好難瞓得著，好難先瞓得著，好耐先瞓得著 Typologies—(1) Experience of sleep disturbance Sleep Disturbance

27. Typologies–(2) Perceived causes of sleep disturbance 2.1 Physiological 2.2 Psychological / cognitive 2.3 Work stress 2.4 Other stress

28. 2.2 Psychological / Cognitive Responsible personality Self reflection Hypnotic dependency Emotional upset Strange environment Typologies–(2) Perceived causes of sleep disturbance

29. 2.2 Psychological / Cognitive Responsibility personality 當個人越有責任心，就有壓力要自己做好D。 在自己能力範圍內就要做好D。 Technical在工作上handle得無問題，但依然stress，應該係咁 。 Typologies–(2) Perceived causes of sleep disturbance

30. 2.2 Psychological / Cognitive Self reflection 擔心自己做漏嘢可能自己有好多unfinished嘅business啦 但係完全冇壓力呢，我又覺得做人冇乜目的呢， 工作上嘅反思，每個人都想自己做得好啲就會常常反思， Typologies–(2) Perceived causes of sleep disturbance

31. 2.3 Work stress Job nature Shift duty Interpersonal relationship (Job related) Typologies–(2) Perceived causes of sleep disturbance

32. 2.3 Work stress Job nature 心情未ready去瞓覺 工作太過繁忙, 有時出事, 擔心明日怎樣同上司交待及根著要點樣處理 工作上一定有壓力啦 Typologies–(2) Perceived causes of sleep disturbance

33. 2.3 Work stress Shift duty Sleeping day夜晚冇睡意,夜.遲D先想瞓 返A好驚會起唔到身 多數PA會食[安眠藥]，AP就多數唔食，所以唔多唔少係壓力嘅問題嘅 PA Shift 返到屋企會諗吓自己有冇做漏嘢 Typologies–(2) Perceived causes of sleep disturbance Sleep Disturbance

34. Typologies–(3) Impacts of sleep disturbance 3.1 Biological 3.2 Psychological 3.3 Social

35. Typologies–(3) Impacts of sleep disturbance • 3.2 Psychological • Decrease concentration • Decrease motivation/ volition • Affecting creative and innovative ability • Money buying off stress • Dysphoria • Fear of making mistake in work • Learning ability • Poor money management • Mental fatigue

36. 3.2 Psychological Decrease concentration 唔夠呀, 第日返工時精神會好唔集中 Decrease motivation/ volition 我就好想去做運動，但係有時就變咗，err，我會冇咁主動力去做囉 做嘢冇乜推動力, 做事馬虎咗 Typologies–(3) Impacts of sleep disturbance

37. 3.2 Psychological Affecting creative and innovative ability …如果夠瞓就可以係思想上同生活上創啲新路出哩，可以create啲嘢出哩，…唯有用番一貫的方法做嘢，無辦法creative Money buying off stress 因為想令到情緒回復，會用錢令到自己情緒回復，包括食好嘢、着靚衫、去啲高尚地方 Typologies–(3) Impacts of sleep disturbance

38. 3.3 social Affect social life Affect parenting quality Affect spouse sleep Withdrawal Typologies–(3) Impacts of sleep disturbance

39. 3.3 social Affect social life 同埋唔哂輪班，星期六、日放假，可以同番現實生活嘅人有啲關係，譬如節日感覺，個啲都係自己life cycle嘅一種緩和，大圍氣候幫助到，輪班就唔係，輪班就脫離這種大圍氣候 Typologies–(3) Impacts of sleep disturbance

40. 3.3 social Affect parenting quality 成日有遺憾係自己啲仔女，無好好、又唔夠精神教佢，成日唯有因為自己的能力有限，陪住佢做嘅嘢，就係帶佢食好嘢、睇吓戲，因為自己唔哂點參與。因為太攰嗎。 因為有遺憾，細路仔啲成長期過咗就無 Typologies–(3) Impacts of sleep disturbance Sleep Disturbance

41. 4.1 Adaptive 4.2 Maladaptive Typologies—(4) Coping of sleep disturbance

42. 4.1 Adaptive Alternative therapy Life-style modification Cognitive adjustment Try to complete all daily task Self hypnosis Change life view Set priority in thinking Typologies—(4) Coping of sleep disturbance

43. 4.2 Maladaptive Habitual use of self medicated hypnotic in A/N and P/A shift 食安眠藥啦，安眠藥我係近…近呢一年我…食多咗非常有效嘅，簡直有上癮嘅，因為瞓得好舒服嘅 會連續晚晚都食，但係當我知道自己晚晚都食嗰輪呢，我就會真係停一停嘅啦，因為知自己唔好再依賴佢咁多，咁我會又再食少啲啦，盡量唔食啦，又用返我嘅平時方法多數PA會食，AP就多數唔食 Typologies—(4) Coping of sleep disturbance Sleep Disturbance

44. Typologies–(5) Desires for changes of sleep disturbance 5.1 Personal factors related 5.2 Work related

45. 5.1 Personal factors related Be more smart Better time management Set priority in thinking Relaxation Not depend on hypnotic Be more optimistic Typologies–(5) Desires for changes of sleep disturbance

46. 5.1 Personal factors related Be more smart 無食藥就精神好少少同埋記性比較好 即係唔夠瞓就會無咁醒(笑)，夠瞓梗係會醒啲啦 Better time management 希望時間控制技巧會有所改善, 現在我會嘗試將Ｄ提早做, 等唔好咁迫 Set priority in thinking 開始要分priority，要分緊要同唔緊要 Typologies–(5) Desires for changes of sleep disturbance

47. 5.1 Personal factors related Relaxation 我諗都係要自己學識放鬆個人 迫自己入睡係一件痛苦嘅事 Not depend on hypnotic 唔使食毒藥 Be more optimistic 就算別人態度唔好, 都要叫自己退一步唸一唸, 以減少Ｄ磨擦, 希望可以好開心地放工 Typologies–(5) Desires for changes of sleep disturbance

48. 5.2 Worked related No need to work 咁梗係放假 No night shift 如果可以唔需要返night shift就好啦 Typologies–(5) Desires for changes of sleep disturbance Sleep Disturbance

49. Result • Perceived Cause Job Nature + Personality Shift Work

50. Impact Result • Perceived Cause Coping: Adaptive + Mal-adaptive Biological Psychological