European Journal of Scientific ResearchISSN 1450-216X Vol.23 No.1 (2008), pp.70-86© EuroJournals Publishing, Inc. 2008http://www.eurojournals.com/ejsr.htm

Effect of Night Shift on Nurses Working in Intensive Care Unitsat Jordan University HospitalRaghad Hussein AbdalkaderLecturer at Maternal and child health nursing department, Faculty of NursingThe University of Jordan, Amman, JordanE-mail: raghadabdlkader@yahoo.comFerial Ahmed HayajnehAssistant Dean for Training, Assistant Professor, Clinical Nursing DepartmentFaculty of Nursing, The University of Jordan, Amman, JordanE-mail: drferial@yahoo.comAbstractThis descriptive exploratory study was conducted to describe the effect of nightshift on Jordanian nurses at critical care units. A convenience sample of Jordanian nursesworking at six critical care units in a teaching hospital (N=100) were studied using astructured questionnaire developed by Sizeni Madide(2003) that describe the effect of nightshift among nurses working in critical care units. The findings showed that female nurseshad a significant difference on sufficient sleep, and interpersonal conflicts. In addition, theresults indicated that nurses experience health problem and their work performanceaffected by the night shift. The study findings indicated that night shift affect critical carenurses well being. Consequently, this study emphasizes and urges the need to design propernursing manager interventions that help nurses to improve nursing care quality.Keywords: Night shift, critical care units, Jordanian nurses, circadian rhythms.1. IntroductionShift work is a reality for about 25% of North America working population. Interest in the effect ofshift work on people; have developed because many experts have blamed rotating shifts for humanerror connected to a number of accidents and catastrophes related to disturbance of circadian rhythmswhich result in an increased risk of accidents and injury. (Coffey, Skipper, & Jung, 1998).The international council of nursing (ICN) recognizes that many health care providers' servicesare accessible on twenty-four hour basis, making shift work a necessity, at the same time ICN is veryconcerned that shift work may have a negative impact on the individual's health, ability to function,thus affecting the services provided.Nurses as health care providers are obliged to work during the day and during the night to caterfor the needs of sick people. While Intensive care nurses were vulnerable to a stressful environment

because of the complex nature of patient’s health problems that requiring an extensive use of verysophisticated technology.Furthermore, few researchers' studies the effect of night on critical care nurses for exampleMathew and Campbell (1990) stated that Nurses turnover is expensive. It affects the safety andEffect of Night Shift on Nurses Working In Intensive Care Units at Jordan University Hospital 71effectiveness of service in Intensive Care Units. And they hypothesized that frequent night duty is amajor factor influencing turnover therefore they conduct a study on thirty (30) nurses, who choose toleave intensive care unit within last eight month, The results of the study support the hypothesis andthey found that 50% of the staff left intensive care unit, because of general dissatisfaction with avariety of aspects of their job, specifically night duty.Furthermore, in examining the influence of day, afternoon, night and rotating shifts on jobperformance and stress on nurses, found that job performances and satisfaction was less on a rotatingroster than on a fixed roster. Although there has been a move towards studies of nursing turnover, thereis still a general absence of research that attempts to associate perceptions of night duty with jobsatisfaction and ultimately staff turnover.(Ohida, "et al". 2001)The literature revealed that there is various effect of night shift on workers, night work haveimplications for the entire living sphere of mankind, thus health hazards and stresses of work itself, aswell as intervening factors from outside the working life may influence, and impair the state of health.Literature agrees that the effect of night is due to disruptions in circadian rhythms. They also state thatthese effects are associated with phase shifting in sleep and wakefulness cycles, and cause interferenceswith daily routine at work and in family and social life. Effect of night on nurses particularlyhighlighted, but few studies examine that effect on intensive care nurses and the consequences oncritical patient and quality of care.Night shift term defined as work performed after 6pm and before 6am the next day, therefore,the activity at night will be out of phase with the circadian body temperature and other coupledrhythms. In addition, because individual biological rhythms, re-entrain to a time shift at different rates,each time the work schedule rotates, for a period of time after the time shift, the circadian system willbe in a desynchronized state. This disorientation can lead health, psychosocial effect such as feeling offatigue and disorientation.Conceptual definition of effect is: a change from original status. This study defines it as thechange in health, psychological, and social status of nurses after working at night shift

Jordan university hospital is a health institution in Amman-Al Jubaiha, it includes 650 beds.6critical care units, and nurses take turns working the three shifts. Nurses might work in the evening, inthe middle of the night, or morning, their shift; the morning shift 7hours, evening shift 7hours, andnight shift is 10 hours. Furthermore nurses at Jordan provide continuous service personnel on twentyfourhour basis for the provision of health. Therefore they susceptible to all hazards mention before2. Previous Researchliterature has devoted much attention to the effect of night shift on the entire living sphere of mankind,particularly nursing as profession had a lot of studies describe the effect of their working against thephysiological nature of the human being which affects their health, psychology, and social life, thisphysiological nature created by Allah which is circadian rhythm, confirmation to this, Allah says in theholly Quran "and made the night as a covering, and made the day as means of subsistence".Circadian rhythm is determined by nucleus suprachiasmaticus in the hypothalamus. Thisstructure regulates the physiology and psychology functions of the body such as temperature. Reachingits maximum at five pm and its minimum at five am. This basic principle underlying the rhythmvariation is catabolism and readiness for action during the day, and anabolism and rest during the night.(Akerstedt, 1996).According to Pheasant, 1999, the word circadian comes from the Latin" circa dies" whichmeans "about a day". Circadian rhythms are partly driven by the internal body clocks and partlysynchronized to external world by cues known as zeitgebers (German: ziet, time; geber, giver). Theserhythms are coordinated to allow for high activity during the day and low activity at night. Normallythe body uses cues from its processes and from the environment such as clock time, social activities,the light/ dark cycle, and meal times to keep the various rhythms on track.72 Raghad Hussein Abdalkader and Ferial Ahmed HayajnehThe problem with a night shift working is that, the human race is diurnal, who are functionsduring day time. Night workers report a number of health problems. (Crofts.1999). Therefore thesenegative effects have consequences not just for individual, but also for work place, as decreasedalertness and reduced job performance that could endanger human lives and affect the quality of care atintensive care unit. (Koller 1996; Brown & Erkes, 1998).Moreover Lushington and Dawson (1997) stated that Night shift has physical and social effectson the life of an individual including nurses, the long hours that they work interfere with their health

and their safety. Night work can even be more negative impact for female nurses who also have familyresponsibilities such as pregnancy and child rearing.Studies show that shift workers accident rates are more than day workers. Thus the findings donot conclusively indicate that night shift workers are more prone to accidents. There are alsodiscrepancies with research on this issue because of the fact that working conditions are not the sameon different shifts. For example, the nature of workload, the backup system available, and the amountof supervision can make comparisons inaccurate. Nonetheless, lack of sleep heightens the decline inperformance. Research has shown that the optimum mental performance level for workers occursbetween 2-4pm, maximum general awareness is between 1-7pm. Performance levels are lowestbetween 3:30-5:30am (Coffey, Skipper, & Jung, 1998).Furthermore, a retrospective study on error rates by time of day was conducted, under threecontinuous three shift schedules, they document error from the recording between 1921-1931.Thisstudy revealed that the numbers of error over175.000 was against the time of the day. The highestnumber of errors occurred between around 3am. (MOSER R,DUBRAVEC M,2001, ScottA,Kittaning,2001).Moreover, a survey study was conducted, by applying a questionnaire consisting mainly ofitems concerning sleep disorders, on night shift work related problems and work performance onyoung female nurses in 11 hospitals in Japan. Subjects were 620 female nurses average age 23.9. Theresult indicated significant association between working on night shift and use of alcoholic beveragesto help induce sleep. Moreover, average hours of sleep were significantly associated with three relatedsleep items: subjective sleep quality, difficulty in getting to sleep and daytime drowsiness. (Ohida,"et.al", 2001).In Japan the health and safety association published the results of medical examination of thecountry salaried employees. This report includes the result of 600,000 employees in health and hygienesector. Nurses who work rotating shifts had complaints concerning fatigue and this was highest in thenight shift, followed by evening then morning shift. The symptoms reported by night shift nursesinclude sleepiness, sadness, and difficulty concentrating, with numerous complaints about cumulatedfatigue and disturbed social life. (Ohida, "et.al", 2001; Behar, "et al", 1999)While across sectional study in Germany used a standardized questionnaire of thirteen items onsleeping disturbances and fatigue symptoms on sample size 3332 nurses on the effect of night shiftthey found that night shift is associated to sleeping disturbances off duty but not to fatigue symptoms

on duty. They conclude that fatigue is primarily related to quickly alteration work schedules but not tothe fact of day shift or night shift. Also night shift is correlated to sleeping disturbance but it is unclearif night shift leads to fatigue symptoms ((Behar, et al, 1990; Mckenzie,J 2001).Costa (2001) indicates that women can be more vulnerable to shift- work in relation to boththeir more complex circadian and infradian (menstrual) hormonal rhythms and extra demands relatedto family life. This includes disorders such as menstrual pains abortion interference with fetaldevelopment, premature and low birth weight.Moreover exposure to light at night may increase the risk of breast cancer by up to 60%. Lightsuppresses the normal nocturnal production of melatonin by pineal gland, which in turn could increase ofestrogen by the ovaries. (Davis, "et al" 2001; Horowitz, "et al" 2001). Also retrospective study wasconducted on 763 women with breast cancer, and 741 women without the disease, found that womenwho regularly worked night shift for three years or less were about 40% more likely to have breastcancer than women who did not work such shifts. Women who worked at night for more than threeEffect of Night Shift on Nurses Working In Intensive Care Units at Jordan University Hospital 73years were 60% more likely to develop breast cancer. Furthermore another longitudinal study on78,000 nurses from 1988- 1998.it found that nurses who worked rotating night shifts at least threetimes a month for one to 29years were about 8% more likely to develop breast cancer. For those whoworked the shifts for more than 30 years, the relative risk of breast cancer went up by 36 %.(laden,"et al" 2001)The nurse's health study found that women who worked night shifts at least three times permonth for 15 years or more had a35% greater risk for intestinal cancer, including 41% greater risk ofright colon cancer, 22% greater risk of left colon cancer, and 51% greater risk of rectal cancer thanwomen never worked rotating night shifts. (Brigham and women's hospital, 2003)Lipkin, et al (1998) stated that shift workers are more likely to suffer cardiovascular anddigestive disorders. Shift workers also experience headaches, muscle pain respiratory infection andgeneral malaise these in turn result in higher rates of absenteeism employee turnover and higher costsassociated with recruiting and training replacement employees. Nonetheless, Steeland, and Fine.(1998) studied the effects of shift on worker who do not rotate, to determine whether current shift orrecent change in shift was a risk factor for ischemic heart disease, they conduct a nested case controlstudy of heart disease death at work within a cohort of 21,000men.they found that there was little

evidence of any difference in heart disease risk by current shift. there was some indication that recentchange from afternoon or night shift to day shift had a protective effect initially which decrease overtime on the other hand no corresponding negative was found for change from first to second third, butanalysis were limited by small number of worker on night shift.Sleep is one of the main reasons why irregular hours cause ailments and disorders extendedwaking leads to tiredness and reduced functional capacity. After the first 24 hours without sleep thefunctional capacity may be halved and after two sleepless days, the functional capacity is at its lowestand risk of falling asleep is ever present. With prolonged exposure, the individual cannot manage tokeep awake, and can't make complex decisions which require thinking (Akerstedt, 1996). Nonethelessnon experimental research design conducted to examine the effect of sleep on short term memory recallin day shift versus night shift nurses Revealed that there is no effect of lack of sleep on cognitiveprocess of short-term memory recall. (Allen C (, 1999)A study was conducted in 2002 found that men who worked an evening or rotating shift weremore likely to report stress, relationship problems and feeling little control over their life. As well, 45percent of men working an evening shift were daily smokers, compared with 27 percent of daytimeworker sand men working an evening rotating or irregular shift had higher odds of reporting adiagnosis of a chronic condition (they reported back problems ulcers, heart conditions, and high bloodpressure) in the next four years than their male daytime counterparts or women with anon standardschedule. (CBC news online staff, 2002)Also job performance and job related stress of nurses was examined on 463nurses workingrotating shift. The study revealed that the overall job performance was highest for nurses on day shiftfollowed by the night, afternoon, and rotating shifts. Rotating shift nurses experienced the most jobrelated stress, followed in turn by the afternoon day and night shift nurses. (Coffey, "et al",1998)A study conducted to examine shift related differences in chronic fatigue and the contributionof sleep quality anxiety and depression to chronic fatigue among a random sample (142) of femalecritical care nurses. Twenty three percent of this sample met the criteria for clinical depression, day andnight nurses did not differ in their reports of chronic fatigue. Night nurses reported more depressionand poorer sleep quality, depression and anxiety, depression and sleep quality were the most relevant

to the explanation of chronic fatigue. This study suggests the need for studies of strategies to promotesleep and improve mood in critical care nurses. (PERKINS, 2001). Moreover effects of shift work onmood changes were studied on 1608 Japanese female nurses, working on rotating shift schedules,revealed that there were prominent changes of subjective fatigue, activity and confusion were observedespecially when shift changes occurred. However the mood changes were observed even afteradjusting for the effect of sleep hours, indicating that irregular sleep pattern is not the only cause thataffects mood. (Hartel C. 2000)74 Raghad Hussein Abdalkader and Ferial Ahmed HayajnehAbout the prevalence of extended work periods and their effects on patient safety. Logbookscompleted by 393 hospital staff nurses revealed that participants usually worked longer than scheduledand that approximately 40 percent of the 5,317 work shifts they logged exceeded twelve hours. Therisks of making an error were significantly increased when work shifts were longer than twelve hours,when nurses worked overtime, or when they worked more than forty hours per week (Rogers, "et al".2004).PurposeThe main purpose of the study is to describe the effects of night shift on nurses and to evaluate theimpact of these on the health and well-being at intensive care nurses, in an attempt to provideapplicable recommendation to decrease stress produced by working conditions, and promote the bestpatient care.SignificanceThe current study may help both nurses and administrators to understand some of the underlyingeffects of night shift on nurses, and their impact on nurse’s life, clinical practices. The study will helpthe manager by giving them direction as to what steps should be taken to protect nurses fromoccupational stress that caused by night shift in attempt to decrease nurses turnover, which negativelyaffect safety and effectiveness of services provided in intensive care units, and in the other hand it iscost expenditure through advertising interviewing and orientating new hired nurses. Furthermore it issignificant for nurses because it will improve their quality of life and coping with night shift.Study finding may also provide a knowledge base for further research that addressed afterstudying all aspects of nurses work shift and its relationship with other factors in the clinical and otherworld environment.

3. Research QuestionsQ1. What are the effects of night shift on health aspect among intensive care units nursesaccording to the gender?Q2. What are the effects of night shift on psychosocial aspect among intensive care unitsnurses according gender and civil status?Q3. What are the effects of night shift on work performance among intensive care nurses?Q4. What are the effects of monthly night shift schedule on health aspect on nurses inintensive care unit?4. Research Methods4.1. DesignThis research design is of descriptive exploratory design, it describes the Phenomenon as it exists inthe current time; it is more practical in the implementation, economical in cost, and easy to manage.The study utilizes the data to recognize the level of knowledge and attitudes of the nurse toward nightshift work, therefore the study is designed to describe the effect of night shift on nurses.4.2. Population and SampleThe study population consist of all staff nurses and practical nurses in critical care units at JordanUniversity Hospital, so these are the target population. Sample inclusion criteria is intensive carenurses who are working shift schedule, exclusion criteria is nurses fixed at morning shift such as headnurses and aid nurses. For the purpose of sample size determination the convenience sample of 100Effect of Night Shift on Nurses Working In Intensive Care Units at Jordan University Hospital 75nurses (staff and practical) were chosen, from the six units along three weeks duration, Selecting aconvenience sample willlimit the extent of generalization, it is inexpensive and accessible, and theyusually require less time to acquire than other types of samples.4.3. SettingThis study was conducted at the Jordan University Hospital at six critical care units; Surgical intensivecare unit SICU(1st floor), Surgical intensive care unit SICU(3rd floor), Coronary care unit CCU,Medical care unit MICU, Neurology intermittent care unite NICU, Pediatric care unit PICU.Jordan University Hospital is a major teaching hospital in Amman, it includes 650 beds total,eight floors, six critical care units that contains 41 beds, and nurses take turns working the three shifts.There shift-work schedule not typical three shift system, the morning shifts 8 hour, the evening shift is7 hours, and night shift is 10 hours duration .each Intensive Care Unit capacity is 6 to 8 beds ingeneral, the system of all the units are opened system except C.C.U, which is a closed system, singlerooms.4.4. Data Collection and Instrument

Participation in the study is voluntary and based on the nurses ability to give an informed consent, alldata and information’s gathered will be strictly confidential and will not be accessed by any otherwithout prior permission from the participants, moreover, the participant has the right to withdrew atany time if he can not complete the questionnaire.To study the Effect of night shift on nurses, a questionnaire was developed by Sizeni Madidewho is a master science student graduated from Lule University of Technology in Sweden, thisquestionnaire obtained from his thesis, Reliability and alidity of this questionnaire is not known relatedto miscommunication between me and the author, instructors, and University Dean, despite frequent Emails,that may be related to language barriers.Therefore face validity for the questionnaire was done by 4 experts-nursing- researchers: DrFathieh, Dr Amal, Dr Ferial, at University of Jordan and Mona alekue(R.N Master degree in nursing)from Al Hussien Centerfor cancer. Internal consistency reliability “Cronbachs alpha coefficient”calculated as the most approach to estimate internal consistency which based on interrelation of allitems in the scale.4.5. ProcedureData collections were along three weeks duration, two inter raters were involved in data collectionprocess. First of all, a list of the six unit's staff and practical nurses names were got. Then started todistribute the questionnaires in the three shifts, and collect it by hand when they finish. This studyapproved from Jordan University Hospital by applying a proposal about the study to the Dean ofNursing in the University, in turn they facilitate the approval, also an e-mail had sent to take thepermission from the authors to use his questionnaire4.6. Data AnalysisDescriptive statistics will be computed using the statistical package for the social Science / personalcomputer (SPSS / version12), data analysis will include descriptive statistics to describe the studysample via mean, median, range, and frequency. Cross tabulation and mean test will be used to studyeffect of night shift on health aspect among nurses, according to gender. Tow way ANOVA will beused to study the effect on psychosocial aspect among intensive care nurses according to gender andcivil status. Descriptive statistics via means and standard deviations will be used to describe the effecton work performance.76 Raghad Hussein Abdalkader and Ferial Ahmed Hayajneh

5. The results of research questionsIn order to meet the demand for an improved efficiency of dealing with the extended hours of work insome industries, there has been an increasing drive towards the use of shift- workers. The main purposeof this descriptive study was to identify the effects of night shift on Jordanian nurses working in criticalcare units.5.1. Sample characteristicOne hundred questionnaires were distributed to critical care nurses in Jordan university hospital. Theoverall return rate (response rate) of the questionnaires was 100%. The sample consisted of eightyseven registered nurses (87%) and eleven (11%) practical nurses. Moreover the largest number of nurserespondents were single (71%) and in the age range from 21 years to 30 years old. Nearly half of themfemale nurses (56%) and (44%) male. Regarding sample distribution among the six units: 26% ofsample from surgical intensive care unit SICU first floor. (17%) seventeen percent from coronary careunit, (20%) twenty percent from medical intensive care unit, (10%) ten percent from Neuro Intensivecare unit and nine percent (9%) from surgical intensive care unit (third floor) see table 1.Table 1: Sample Characteristics5.2. Results of Q1 The influence of genderThe influence of gender has its own highlights in this study. Male regardless of marital statusrespondents requested to work on a day shift. This is probably due to fact that they need to be withtheir families or their young age. The married male nurse regarded night shift as strenuous, this was incontract to the suggestion made by the unmarried male nurse. Who regarded night shift as comfortableand had enough energy to perform his duties, but did not have enough sleep when on night shift. thyneeded to induce sleep by reading. Night shift affected the social life of male nurses but did notseriously affect their health. However, they complained about feet ailments. This could be associatedwith theatre work, where there is a lot of static standing. Rotating shifts can be very strenuous for afemale nurse with children and other family responsibilities. For these nurses other patterns of shiftschedules are not only strenuous but also dangerous since they involve transport problems. Travelingor driving at night Crofts L (1999)), in his study, he strongly endorsed the need to take intoconsideration nurses scheduler for shift work. he argue that the personal, socio-cultural and

environmental perspective of the nurse need to be given attention by the various stake holders involvedwith rostering. Night shift is not suitable for life style for both married and unmarried nurses.Effect of Night Shift on Nurses Working In Intensive Care Units at Jordan University Hospital 775.3. 1. Results of Q2: the effects of night shift on psychosocial aspect.It is important to note that even though nurses make a request to work on a night shift, they still regardit as being strenuous. This study examined concentration as one of the psychological concepts of nightshift, any shifts revealed that 28% of respondent felt that their concentration is law, 64% felt that theirconcentration is normal, and 8% felt that is almost high even on night shift. The nurses experiencephysical and mental workload since their job involves standing, walking, bending, lifting and makingdecisions about patient care and other administrative work. All this leads to exhaustion, which disturbsconcentration. This means that a tired person is unable to think clearly. The study by Allen C (1999),examined whether nurses can work a 12-hour working system, the results concluded that the systemhad less significant physical workload but greater mental workload. 78% of nurses whose age less than30 year, have night shift effect on psychosocial aspect, 56% of them are female and 43% male.5.3.2. Effects of night shift on social lifeSome of the problems of night shift and the dislike of this shift emanate form the social difficultiesencountered by nurses. Adaptation to night shift could be influenced by the social status of theindividual within the community. For instance, the marital status, family needs, societal values and thelifestyle of the individual within the community influence the nurses attitude towards night shift. Nightshift causes an imbalance between desired lifestyle and work, women have a major role to play in thedomestic life and they compromise their sleep to undertake the domestic chores such as care to theirchildren and family chores. To find out whether night shift affects the social aspect of nurses or not,see table (2), 60% of respondents stated that their social life is sometimes affected, 33% stated thatalways their social life is affected that is mean 93% of the nurses are affected and 7% not affected. Theaspect of social life involves nurses families, work relationships and other social groups.Table 2: Social life78 Raghad Hussein Abdalkader and Ferial Ahmed Hayajneh5.4. Results of Q3 the effects of night shift on the Work performance

Nurses regarded the time of 10 hours allocated for night shift is too long (see figure 2: caouses ofcomplain). 78% of nurses feel that night shift has a heavier workload than the day shift, neverthelesstheir present shift either morning, evening or night. They attribute this to the fact that there are fewernurses working at night, 73% of nurses revealed that the ratio of nurses to patient is not appropriate.The temporary supporting night nurses not as competent as permanent staff to deal with peculiarproblems encountered in specialized units. This makes it necessary for night nurses to work extra hardto keep their sections functioning to the desired health care standards. The workload of the night nursesis dependent on the intake of patients during a particular day. Management is facing a problem of anunpredictable patient influx on each day.Figure 2: Causes of complainThe results revealed that 64% of nurses sometimes increase the conflict at their Work(see figure3 the effect of complain). Poor attitudes could irritate patients, lead to conflicts between staff andpatients and even among staff. There will also be a low motivation towards work and errors inadministering health care. Performance goes along with motivation, which is the drive towardsproductivity. Productivity is essential to save human lives health care.Effect of Night Shift on Nurses Working In Intensive Care Units at Jordan University Hospital 79Figure 3: Effect of complain5.5. Results of Q4: The effects of night shift on health status of the night workersRegarding health status of the respondents during night shift (see figure 1), 74% of the nurses felt thattheir health is affected, 26% had no health problems and11% did not know whether night shift affectthem or not. Amongst the respondents, 61% are troubled by frequent headaches, 49% by backache,36% by persistent tiredness, and44% by insomnia and 23%suffered from feet ailments. The prevalenceof these ailments indicates that health risks exist with shift work and night shift as stated in literature.Sleep problem dominated in ailments of all age groups of the respondents.Another health relatedproblem was that of exposure to occupational injuries and diseases. The results show that 56% of therespondents sustained either a needle stick injury NSI or a back injury. 50% of respondents indicatethat the incidents occur on night shift. NSI can occur if the nurse is too busy, drowsy or tired where sheis likely to loose concentration and cause an accident. NSI predisposes nurses to infections such asHuman Immune Virus (HIV), Acquires Immune Deficiency Syndrome (AIDS), Hepatitis B, and other

viral infections. Lack of knowledge and skill exposes nurses to such harmful conditions and otherhazards such as back injury. In general, backache can result from exposure to psychological hazards.According to previous studies stress is a psychological problem which manifest itself with aches andpains of neck or back pain depending on the biological structure of the person. Orientation of newlyemployed nurses and in-service training, and procedure manuals are tools that assist managers ineducating and development of staff thus reducing hazards. According to Lipkin et al.(1998), nursesform a high-risk group for the chronic fatigue syndrome possibly due to occupational stressors, such asexposure to viruses and stressful shift work that interfere with their biological rhythm. Finally 63% ofnurses demonstrate a problem during C shift that does not occur usually, with monthly C shift pattern.Health problem nurses usually experience to night shift80 Raghad Hussein Abdalkader and Ferial Ahmed HayajnehHealth problem nurses usually experience to night shift

Health problem nurses usuallyexperience to night shiftfrequent headachesbackachepersistent tirednessfeet ailmentsloss of sleepmuscular strainothers00.10.20.30.40.50.6Mean5.5.1. Problems of night shiftThere is a diversity of problem encountered by nurses in a normal working situation. Some of thesemay be physical, physiological, psychosocial and social. Night work intensifies problems since theindividual is working when the body clocks is naturally telling the majority of the people to rest.

Problems vary with each individual since the biological structure is different. The findings revealedthat 57% of nurses have experienced a problems to fall a sleep. and most of nurses 92% of samplestated that night shift doesn’t suit their life style(see figure 2). Furthermore 94% stated that night shiftis uncomfortable and doesn’t pay better salary. 5.5.2. The influence of circadian rhythm on the nightworkers As previously, mentioned differences in the circadian rhythm make other people to be at theirpeak in the evening and some to reach their peak in the morning Meckenzie J(2001) The study alsoexamined if nurses felt more energetic when working on night shift. The results showed that 67% ofthe nurses did not feel energetic. Tiredness may be due to insomnia, changes in sleeping patterns,variations in length of shift periods, and circadian rhythms. The fact that about 20% of the respondentsexperienced persistent tiredness implies that their performance could be impaired. This inefficiency inperformance could have deleterious consequences on the health care of patients.5.5.2. The influence of circadian rhythm on the night workersAs previously, mentioned differences in the circadian rhythm make other people to be at their peak inthe evening and some to reach their peak in the morning Meckenzie J(2001) The study also examinedif nurses felt more energetic when working on night shift. The results showed that 67% of the nursesdid not feel energetic. Tiredness may be due to insomnia, changes in sleeping patterns, variations inlength of shift periods, and circadian rhythms. The fact that about 20% of the respondents experiencedpersistent tiredness implies that their performance could be impaired. This inefficiency in performancecould have deleterious consequences on the health care of patients.Effect of Night Shift on Nurses Working In Intensive Care Units at Jordan University Hospital 815.5.3. Sufficient sleepThe major problem faced by night shift workers is the lack of sleep or insomnia (table 3). 72 % of therespondents working on day shift indicated that they do not get enough sleep when on night shift.Among the whole group of respondents, 49% sleep for less than 5 hours, another 44% of respondentssleep for 6 to 7 hours. Among day and night nurses of all age groups, only 7% sleeps for eight hours ormore, after night shift. The data obtained from the survey showed that 75% of the nurses have a

problem with falling asleep after night shift, implying that 23% did not have a problem. Insomnia is aprevalent ailment that affects all categories of nurses who participated in this survey. Yamanchi h, etal,2001), have noted differences in the biological make-up of individuals. These differences can createdifficulties for some people when they are expected to adjust from a diurnal working schedule toworking on a night schedule. This is in line with suggestions by some nurses who have no problemswith working on a night shift. They indicated that they were more energetic when they work on nightshift. This evidence collaborates that of Rodgers et al., 1986 who pointed out that some people are“evening types” whereas others are “morning types”. Preferences towards shifts have an influence oneach individual towards adaptation to night shift.Sleep is a major concern since it affects the health and the performance of nurses who aredealing with human lives. The health care workers in this study have indicated that they are exposed tosuch hazards and mistakes. Any mistake or accident resulting from fatigue or stress can cost a life ofthe next person, resulting in law suites and claims from patients.Table 3: Effect on sleep6 %94 %694YesNois night shift comfortable42 %57 %4257YesNo. After night shift work doyou experience any problemto fall a sleep?49 %44 %7 %49447Less than 5h6hrs_8hrsMore than

8hrsHow many hours do yousleep after night duty72%28 %7228YesNoget enough sleep after nightduty?5.5.4. Strategies to induce sleepAn important factor to note is that 54% of respondents use some form of strategy to induce sleep (chart1). The respondents, who indicated that they have no sleeping problems when on night shift, have touse some form of strategy to induce sleep as well. Several options to induce sleep were mentioned andthese included the use of beverages, reading and music. From the medical point of view, continuedintake of medication or sleeping tablets affects the physiological and psychosocial well-being of theindividual. It is not advisable to take medication without consultation with the medical doctor. Animportant fact to remember is that induced sleep is not restful and tablets can be habit forming.82 Raghad Hussein Abdalkader and Ferial Ahmed HayajnehChart 1: Ways in which nurses induce sleep

6. Summary and ConclusionStudy shows that all age groups are subject to exposure to physiological and psychological hazardsbrought about by night shift as indicated in their subjective response. The recent developmentsregarding shift work is aimed towards improvement of health of shift workers, the physical andpsychosocial well being as stated by International Labor Office ILO. ILO has highlighted thatrecommendation should be relevant to specific groups and work systems. Noted is that each sector hasits own specific needs, especially health sector as it deals with patient care. The night shift worker is aman at odds with his own body rhythms as stated in Pheasnt,(1991) when managers are planning shiftschedules should be aware of these biological rhythms as explained by other research's. Literature hasexplained that there is no perfect schedule; the main factor is consideration of the inputs from theparticipants in shift work. Shift work environment should be comfortable, safe and free from hazardssuch long hours at work. Further studies are required to find out the extent of night shift effect.Management will benefits with further research in this area. The purpose of this study to describe

hazards affecting nurses working on night shift and to make recommendations based on the finding.7. RecommendationsThe findings of this study suggest that it may valuable to replicate this study with larger and moreheterogeneous randomly selected sample and well-defined valid instrument that fit and sensitive toJordanian culture Assessment of advantages and disadvantages of shift system should be done based onobjective criteria. Adjustment of physiological function to night work, level of well being, healthproblems, and disturbances in personal life, accident rate and performance efficiency, are all taken intoconsideration in shift work design.Upon the study findings, I recommended that nurses need a continuous medical screen. Thatsupported by International Labor Office (1990), which was adopted that permanent and rotating nightworkers are generally a population at risk and are to be included in medical screening, and should begiven special attention as they are exposed to work load and extended working hours.Effect of Night Shift on Nurses Working In Intensive Care Units at Jordan University Hospital 83Other recommendation to managers include, appropriate health services for nightand shiftworkers, first aid facilities, option to transfer to day work for health reasons,measures for women onnight shifts, and special maternity protection.Schedule planners should avoid quick change over fromnight to day on the same day or from morning to night. Every shift system should include some freeweekend with at least 2 successive full days off. Time of recovery, and rest breaks must be consideredschedule to be regular and predictable.However, managers must have responsibilities toward nurses, like to let nurses have a freedomof choice regarding shifts, and to formulate strategies to assist the nurses who find it difficult to workat night, identify the existing occupational hazards that affecting nurses, and they will be able toforecast on possible strategies that can help to reduce hazards in hospitals.Considerations of nurses needs for a particular shift and involvement is important formotivation and acceptance of shift schedules and work. Motivation could improve adaptation of thenurses to awkward hours of night shift.It can not be possible to meet all the needs of different nurses when planning Schedules, on thecontrary, it is possible to make adaptations that can reduce the strain of the long hours worked on nightshift.Other recommendations is encouraged to provide a psychologically supportive environment to

the nurses. Rest room should be provided to relieve psychological stressors. Music, reading materials,and games provide relaxation to nurses.The comfort of the environment and the furniture used for resting is essential and conductive tocomplete rest. Those who feel tired can benefit from a separate resting area at the Cafeteria or the workarea.Tips are recommended for shift workers, to be in health and good mannerSleepingPlan your sleeping time, keeping a steady schedule. Make and keep rules, train your children’s not todisturb you when you are sleeping. Do not work too many nights in arrow. At least, not more than four.Develop a good sleeping environment, have a dark cool, and comfortable room, black out light withheavy curtains. Eye-shades and ear–plugs can be used by those who are comfortable wearing them,turn telephone volume to off. If under stress, relax before going to bed, light exercise is one of that.DigestionCare about what you eat and drink, choose light healthy meals before going to bed. Avoid heavy,gassy, greasy or fatty meals during night shift. Avoid coffee or caffeine at least four hours before goingto bed Herbal tees and warm milk are good before bed. Avoid using intoxicants or sleeping pills to get84 Raghad Hussein Abdalkader and Ferial Ahmed Hayajnehin sleep, except in most unusual circumstances; the sleep architecture is altered thus sleep is less restfuland you may be hung over poor performance at workSocialDo not lose your connection with your family life, do not forget that your family is for whom you do it,and do not lose your spouse or significant other. Grocery shopping at off peak hours will be of benefits.Finally of recommendations, identifying effect of night shift on circadian rhythm among nursesworking in critical care units can contribute to critical care nursing curriculum that can addresspsychological and physiological needs of nurses, which ultimately reduce stress level from night shiftand improve the quality of nursing care.Effect of Night Shift on Nurses Working In Intensive Care Units at Jordan University Hospital 85References[1] Akerstedt T(1996-). Subjective and objective sleepiness in the active individual. InternationalJournal of Neuro Sience. 52: 29-37.[2] Allen C. (1999). Summary of the Croet Seminar: Shift work. retrive form Oregon Health andScience University, in March/10/2004 Web site

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