The Effects of Night Shift and day Shift on Patient Care on Secondary Hospitals: An Input to Effective Nursing Care

1.1 Introduction

1.2 Background of the Study

- All about research problem

-personal experiences of the researcher

-information on what the research all about

-statistical figures and information

-Purpose of research

o Review of Related Literature

Local Lit. – books, magazines, articles, published materials ( Cited the year and the Name of publication)

Foreign Lit. – Reading from books, magazines, articles and other published materials ( Cited surname and year)

o Synthesis

-Compare your study with the lit. And studies you have reviewed

-Cite the similarities, uniqueness, differences

1.3 Conceptual Framework

-Discuss some theories and models that are the basis of the research

-the basis of the Statement of the Problem

1.4 Research Paradigm

-Must answer the question, How would you do about the research?

1.5 Statement of the Problem

Questions Stated in statement form

Q1 – Who is your respondents?

Q2 – How respondents are affected by the issue raised in the research

Q3 – Significant relationship or difference

1.6 Hypothesis

-Tentative expalanation about the phenomena

CHAPTER ll

Methodology

2.1 Research Design

-describes the plan of the researcher

1. Descriptive (By doing an observation)

2. Experimental (it has Intervention)

3. Quasi-experimental

2.2 Sample and Sampling technique

2.3 Research Instruments

-Questionnaires

-interview

-Documentary analysis

2.4 Data Gathering Procedure

-Narrates the procedure adopted by the researchers in completing the study

-from questionnaires, conceptualization, distribution and retrieval

-includes validation procedure

2.5 Statistical Treatment

-included are statistical treatment that will answer SOP#3

-help the researcher analyze and interpret

SOP#1 Frequency/Percentage

SOP#2 Weighted mean Distribution

SOP#3 Pearson R, Moment Correlation, chi square, t-test,ANOVA

The Effects of Night Shift and day Shift on Patient Care in a

Secondary Hospital: An Input to Effective Nursing Care

2009-2010

Presented to the faculty of Olivarez College in Partial Fulfillment for the

Degree of Bachelor of Science in Nursing

Atienza, Maria Anna A.

Emes, May Jennifer V.

Silvestre, Mary Shirani V.

Vivo, Kahmille Z.

1.1 Introduction

Nurses today have a broad scope of responsibility as health care providers that

require them, under some circumstances, to exercise independent professional

judgment.

Nurses as health care providers are obliged to work during the day and during

the night on a twenty-four hour basis, seven days a week to cater for the needs

of sick people. Some nurses are lucky to work during the normal/regular shift;

others have no choice but to take on the night shift. This is a reality for one third

of all nurses in a hospital with a rotating eight-hour shift.

Many studies have hypothesized that frequent night duty has an adverse effect

on nurses’ performance given the disruption in sleeping patterns coupled by

exposure to a stressful work environment, compare to nurses who work during

the day. There are implications for the entire living sphere of mankind, thus

health hazards and stresses of work itself, as well as intervening factors from

outside the working life may influence, and impair the state of health.

In is generally accepted in the literature that night work causes disruptions in

circadian rhythms. The literature further document that disruptions in circadian

rhythms are often associated with phase shifting in sleep and wakefulness

cycles, and cause interferences with daily routine at work and in family and

social life.

However, it is an accepted fact nurses as health care providers are bound to do

shift work. Nurses have no choice but to do the night shift at some point. This, for

most nurses, is an unwelcome imposition on a normal life. Studies have shown

that shift work can have a negative impact on among others, work performance,

quality of patient care and psychosocial and health aspects. While the negative

effects of shift work have direct and immediate effects on nurses, if left

unaddressed, this will ultimately adversely affect the health care system and may

even endanger human lives.

1.2 Background of the Study

The focus of this research is to evaluate the effects of shift schedule in terms of

patient care in general and determine if there is a significant difference in terms

of quality of patient between nurses working on the day shift vis-à-vis those

working on the night shift. The assumption is that there is a significant difference

in terms of quality of patient care between the two shifts and that identifying and

determining the factors contributing to the perceived difference in terms of quality

of patient care will help hospital administrators/management come up with

appropriate, specific and directed interventions to address the perceived gap.

The study will be conducted in Olivarez General Hospital, Parañaque City. The

research shall involve the registered nurses of the said secondary hospital, half

of which are doing the day shift with the other half doing the night shift, who will

be asked to respond to a questionnaire covering a range of topics and issues.

The nurses who will be asked to answer the questionnaire work in the different

units of the hospital as determined by the needs of the secondary hospital and

based on the professional qualifications of the individual nurses.

Given the above workforce and their assignment to different shift work schedules

as well as exposure to different levels of occupational stress and hazards within

the clinical environment, it is necessary to conduct this research to determine the

impact of shift work (day shift and night shift) on nurses and how this in turn

affects on the quality of patient care in general. This study is expected to identify

and determine possible changes and prescriptions as to the steps and measures

that should be taken by hospital administrators to ensure the welfare of nurses as

well as the patients in their care by ensuring that there will be no significant

difference in terms of the quality of patient care during both the day shift and the

night shift.

Objective/Aim of the Study

The study aims, in general: (1) To obtain basic information about the shift work

organization/schedule within the secondary hospital; (2) To identify the factors

which have a direct effect on nurses’ performance; (3) To identify the factors

which have a direct effect on the quality of patient care; (4) To differentiate the

effects of night shift and day shift on nurses’ performance, particularly on the

quality of care; (5) To evaluate the impact of shift work (night shift and day shift)

on the physical and psychosocial aspect of the nurses’ lives; and (6) To

recommend certain policy changes to hospital administrators, including

ergonomically designed shift schedules based on the identified problems in order

to close the gap on the perceived difference between the quality of patient care

between the day shift and the night shift.

Review of Related Literature and Studies

Foreign Literature

Nurses develop within the profession of nursing as it exists during periods

of nurse’s education and training and their work in nursing. It is a social

expectation that nurses move their profession to a developmental level that

meets both the needs of the members of society for effective and efficient

nursing (Orem 1995)

Night shift nurses should have to spend a day or two working during the

waking hours. This would likely make them see how much different it is to work

when all the doctors round and all the orders are written, and the majority of

procedures are done. Day shifts are rarely quiet or without excitement of some

sort. Most visitors come during the day, we serve all the meals, and most

importantly we have to see management. (Kelton 2009)

Night shift workers have many inherent risks, some of the most serious

problem of night workers are frequent sleep disturbances, absenteeism,

accidents, errors, injuries, and facilities. Other symptoms include insomnia,

disrupted sleep disturbances, reduced performance, difficulty with personal

relationship, irritability and depressed moods (Martin 1998)

Potential side effects of sleep deprivation like headaches, fatigue and

depression may make them unsafe for the people operating heavy machinery,

driving trucks or wielding a surgeon’s knife. Night-shift workers maybe more alert,

but what happens when they then try to sleep during the day? They might not

sleep at all, and sleeplessness has its perils. Studies show that one night’s loss

of sleep results in a 30 percent drop in cognitive performance, raising to 60

percent after two nights. To what degree drugs or environment can compensate

for this deficit, and for how long, remains to seem. According to (Beitz 2004)

Local Literature

Working night shift is harder that working during the day because it is

more tiring to lack of sleep. Even it has the same working hours you still cannot

get enough tiring to lack of sleep. Even it has the same working hours you still

cannot get enough sleep to regain the energy you lost. You can sleep for only 4

to 6 hours during the day, which is not enough, compared to morning shift

workers who can have a goodnight sleep for about 6 to 10 hours.

When you go home after work at a night shift which is usually at around 8

to 10am, you’ll often have a hard time to sleep maybe because of the

environment or because you’re thinking that you don’t want to miss the things

that can happen during the day like talking to your family and friends, watching

the television or even hanging out somewhere.

When the day ends, you’ll then start preparing yourself for work. If you are

already in your work place, you’ll soon fell sleepy and tired which causes difficulty

concentrating and loss appetite. (Ocampo 2006)

In today’s wired world, many of us work all hours of the day or night, which

affects our well-being and safety. Fatigue among shift workers is an

internationally recognized problem across multiple industries. Night workers are

just as likely as day workers to perform tasks requiring attention to detail,

reasoning, decision-making, and other mental skills. Many night workers don’t fit

the stereotype of the shift worker. Think of actors, musicians, television news

anchors, computer programmers, doctors on call, nurses, diplomats, business

executives, and just about anyone who works long or irregular hours. A night

worker, even one who has slept reasonably well, is no more alert between 2 AM

and 8 AM than a day worker who has slept only 4 hours per night, 2 nights in a

row. (Isidro 2004)

1.3 Theoretical Framework

Figure 1.

The figure shows the comparison of Day shift Nurses and Night shift Nurses on

terms of Core, Care and Cure factors based on the Nursing Theory of Lydia Hall.

NURSE

Night ShiftDay Shift

Care( Hands on bodily care)

Core (Establishing Rapport)

Cure (Assisting in Medical Procedures)

More effective functional skills in providing quality care, core and cure to the patient

Care( Hands on bodily care)

Core (Establishing Rapport)

Cure (Assisting in Medical Procedures)

Inappropriate functional skills in providing quality care, core and cure to the patient

1.4 Research Paradigm

Profile:-Age

-Gender-Area of

assignment-Civil Status

Day Shift on Patient Care

Night Shift on Patient Care

Effective Nursing Care

1.5 Statement of the Problem

1. This study sought to answer the effects of night shift and day shift on patient care

in the following questions:

1.1Age

1.2Gender

1.3Area of assignment

1.4Civil Status

2. To what extent does night shift duty affect patient care in terms of:

2.1 Therapeutic communication

2.2 Vital signs taking

2.3 Medication administration

2.4 Therapeutic touch

2.5 Charting and documentation

3. To what extent does day shift duty affect patient care in terms of:

3.1 Therapeutic communication

3.2 Vital signs taking

3.3 Medication administration

3.4 Therapeutic touch

3.5 Charting and documentation

4. Is there a significant difference between the care given during night shift and day?

5. Based on the result of the study, what nursing care on the night shift and day shift

can be improved?

1.6 Hypothesis

At 0.05 level of significance, the following hypothesis will be answered:

1. There is no significant difference in patient care during night shift when grouped

according to profile variable in number 1.

2. There is no significant difference in patient care during day shift when grouped

according to profile variable in number 1.

Scope and Delimitation

This study is limited to the night shift and day shift duty nurses in secondary

hospital. The nurses who are working in night shift start their work at 10:00 p.m. to 6:00

a.m. The nurses who are working in day shift start their work at 6:00 a.m. to 2:00 p.m.

This was composed of nurses in Olivarez General Hospital particularly nurses in the

ward because they have more interaction with the patient.

1.7 Significance of the Study

1. Patients

This would be the way to address the nurses that they would be more

carrying and have a good relationship with their patient/client.

2. Nurses

Help them to understand the effects of night shift and day shift on the patient

care and also to measure the affectivity of nursing care given to them.

3. Hospital Administrators

Help them understand the consequences of night shift and day shift that will

affect the quality, safety and effectiveness of patient care

4. Future Researchers

Researchers hope that this research will be a good example for them to be

guided for future work

1.8 Definition of Terms

The fllowing terms were defined in terms of their operational meanings in the

study:

Circadian rhythms – for this study, it refers to roughly 24 hour cycle in the

physiological processes of living beings

Day shift – for this study, it refers to scheduled to work during the daytime at 6:00

a.m. until 2:00 p.m.

Effective – refers to the ability of the nurse to do his/ her duty in an appropriate

manner

Hospital – A place devoted primarily to the maintenance and operation of

facilities for diagnostic, treatment and care of individuals suffering from

different illness or disease.

Nursing Care – for this study, it refers to care by a skilled nurse; the work of

caring for the sick or injured.

Night Shift – for this study, it refers to work performed after 10:00 p.m. and before

6am the next day, it is scheduled to work during the nighttime,

Patient – the person who receives care

Psychological – Defined as how a nurse affects the mind of their patients.

Secondary Hospitals – health facilities either privately owned or government

operated such as infirmaries, municipal and district hospitals and out patient

departments of provincial hospitals. Secondary hospitals are capable of

performing minor surgeries and perform simple laboratory examinations.

Shift – for this study, it refers to changing of position or direction

CHAPTER 2

METHODOLOGY

This chapter is composed of the following: a) Research Design; b) Sample and

Sampling Technique; c) Research Instrument; d) Data Gathering Procedure/Technique;

and e) Statistical Treatment of Data.

2.1 Research Design

For the purpose of evaluating the effects of the work shift (night shift and day

shift) on patient care in a secondary hospital, the researchers will utilize a

combination of a review of literature and an analysis of the results of the formal

survey conducted through a questionnaire that includes demographic, behavioral

and psychosocial variables relevant to the research. Thus, the research design is

both experimental and descriptive. This study shall also utilize the data gathered

through the answers provided by the respondents in the questionnaire to

recognize and evaluate the behaviors, attitudes and responses of the nurses

toward their work shift, whether it is at day or night. The study therefore is

designed to describe the effect of night shift and day shift on patient care. This

alternative explanation is shown in the illustration below:

Day Shift

Night Shift

Patient Care

2.2 Sample and Sampling Technique

For the purpose of the research, the study population shall be all staff nurses and

practical nurses in the secondary hospital. The representative sample inclusion

criteria are nurses who are working rotating shift schedule as they work in both

shifts.

The random sampling technique shall be used by the researchers for the study

as this shall provide an accurate view of the population, provided that there will

be no bias in the selection process.

2.3 Research Instrument

The research instrument that will be utilized by the researchers for the study shall

be a structured questionnaire. A questionnaire consisting of ____ questions shall

be administered to nurses working in different units and shifts as shown in

Appendix 1. The questionnaire is divided into four major parts, namely; 1)

Respondent Profile; 2) Occupational Information; 3) Work performance and

Patient Care; 4) Psychosocial Aspect; 5) Health Aspect; and 6) Hospital

Administration. The respondents will be asked to fill in the questionnaires at their

convenience but limited to a period of five (7) days.

2.4 Data Gathering Procedure/Technique

The data gathering procedure/technique to be used in the study shall be random

selection of respondents included in the representative sample. The

questionnaires shall be given to the randomly selected respondents belonging to

the representative sample and shall collected after a period of seven (7) days, at

most, from the time that the questionnaire was given. This shall give the

respondents enough time to submit thoughtful answers since ample time has

been provided them to reflect on their answers. Further, since the study will be

surveying a homogenous group, the utilization of the questionnaire as a data

gathering technique is appropriate and is less costly to undertake.

After the questionnaire has been gathered, an analysis of the documents

gathered shall be undertaken. If applicable, necessary and practicable,

unobtrusive methods of gathering data such as observations shall also be

undertaken.

2.5 Statistical Treatment of Data

To aid the researchers interpret the data gathered in an unbiased manner, the

one-way analysis of variance (ANOVA) shall be used to test for differences

among the two independent groups, the first group are the nurses working on the

day shift while the second are the nurses working on the night shift. A one-way

ANOVA is used to test for differences among two or more independent groups.

Both groups will then be evaluated based on their responses to the

questionnaires. A one-way ANOVA can be used to evaluate the effects of work

shifts (day shift and night shift) on patient care.