nursing research
TRANSCRIPT
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.