Research Proposal –Effect of Night Shift on Nurses Performance

Introduction

This research proposal centers on the investigation of the impact of working in night shifts on the performance of the nurses. The influence is not only limited to performance but sleep deprivation also leads to other mental and physical health related concerns. In this study, these aspects are considered and examined in the light of previous research work and the findings of this research.

Purpose or Rationale of this Research Study 

The examination of some of the existing work on the study topic has provided an overall understanding of the issues related to it. One existing research sheds light on the poor performance and higher thyrotropin levels while anxiety level was also found to be higher in on-duty night shift nurses (Chang, et al., 2014). In addition to this research work, another research focusing on the impact of fatigue which is a byproduct of sleep deprivation suggested that fatigue can directly impact the quality of healthcare provided by nurses in acute care settings. Also, an increased number of errors were recorded in fatigued nurses (Smith-Miller, et al., 2014).

These researches along with the reviewed research work presented in the literature review section led to the identification of a research idea that utilizes primary source of data collection and investigates the underlying aspects of performance and nurses working in night shift.

Problem Statement

The problems surrounding the research topic are the lack of empirical evidence to support the claim that night shifts have a negative impact on the performance of nurses while there are researches that have provided primary source of data suggesting that performance remains unaffected from sleep disruption (Reinke, et al., 2015). Also, there are a very small number of researches that have investigated the topic as a whole from both qualitative and quantitative aspects providing a clear and concise outcome. The aspects related to the study topic that are still unearthed needs to be examined and analyzed for a better understanding of features regarding performance of nurses.

Theoretical Framework

The theoretical framework identified for this research is based on the investigation of independent variables like job satisfaction, physical and psychological symptoms related to stress on the basis of which dependent variables like disrupted circadian rhythm and its effect on nurses which leads to sleep disorder will be examined. This provides a clear direction to the research without any flaws and disruptive factors and hence represents an optimum framework for this research.

Research Questions

The research questions formulated for this research are as follows:

Q₁: Does working night shift affect the work quality and physical health of nurses in a general hospital? (For Qualitative analysis)

Q₂: What are the factors that affect the work quality and physical health of nurses working night shift in a general hospital? (For Quantitative analysis)

Research Hypothesis

The hypothesis derived for this research study is of Causal; and Cause and effect nature that is identifying the cause of changes in a variable or analyzing the effect of one variable over another. The designed hypothesis is as follows:

H₀: Working in night shift affects the work quality and physical health of nurses in a general hospital.

H₁: Working in night shift affects the job satisfaction, physical and psychological symptoms related to stress leading to disrupted circadian rhythm and sleep disorders in nurses.

H₂: Working in night shift does not affect the work quality and physical health of nurses in a general hospital.

Literature Review

In this section, a literature review is conduced and presented of the selected articles related to the study topic but first of all, the selection criteria is provided on the basis of which the research studies have been selected.  

Selection Criteria for Research Articles

The research studies have been selected on the basis of the following criterion;

• Research paper must not be published before 2005 while the most recent and relevant research studies are preferred over the older ones.
• Research study is related to the study topic fully and does not merely touch the topic under the microscope in this research.  

Review of the Selected Articles

A research conducted by Sandy Mueke on the topic of fatigue and its association with the concept of sleep disruption has provided some solid ground for the investigation of the research topic in details. The study has reviewed a number of research articles and has suggested that there is a serious connection that is present between the psychological heath of nurses and night shifts. Also, there is a dependency between physiological aspects as well when considering the overall health of nurses working in nigh rotations. The study focused on Australian Healthcare system and concluded that the psychological and physiological well-being of nurses was effected when undergoing night rotations while the impact was more severe on nurse over the age of 40 while this also has a direct effect on the performance of these nurses leading to decline in the quality of healthcare provided to the patients (Muecke, 2005).

Another research work has provided evidence related to the negative impact of Night shifts and has suggested that the night shift workers have been found to be sleep deprived more often along with issues like sleepiness, misalignment of circadian rhythms and below average performance quality while the study also suggested that night shift napping actually improved the performance of workers in night shift and improved their overall physical health (Ruggiero, and Redeker, 2014). In addition to it, a research study investigating the chronic diseases prevalence and circadian strain imposed due to lack of sleep at night in night shift nurses also provided similar sort of evidence. The study concluded that there is a serious association between cardiovascular diseases and night shift workers who have been working in such shifts for over 5 years (Gu, et al., 2015). 

On the contrary, a piece of research focusing on the performance of nurses working in night shift and their psychometric performance and vigilance as well has provided different results. The outcome of this research study suggests that there is not much difference when considering ICU nurses and their performance in night shifts while decision making ability also remained similar in day as well as night (Reinke, et al., 2015). The literature reviewed in this section provides a mixed outcome in terms of the study topic and a gap has been identified in empirical studies on the research issue.

Methodology

On the basis of the above provided research questions and hypothesis, a research methodology has been designed that would assist the researcher in the investigation and identification of the study topic as research methodologies and techniques play a vital role in the successful completion and in the achievement of desired results (Kothari, 2004).  

Variables in the Study

The independent and dependent variables formulated for this research study are as follows: 

• Independent variables: Job satisfaction, physical and psychological symptoms related to stress.
• Dependent variables: Disrupted circadian rhythm affects nurses which lead to a sleep disorder.

Study Design 

The study would utilize a mixed methodology for the collection of primary data. Both quantitative and qualitative methods will be implemented and cross-sectional study design with confirmatory approach is selected as it would provide the data of the selected group at that given time while semi structured interviews would allow the researcher to look into the related aspects in the past of the participants eradicating the notion of impact of past experiences.

Data Collection and Sample Population

The procedure formulated for data collection is questionnaires and interviews of the selected participants. In order to diversify the outcome, a total of 20 to 30 participants will be selected from different backgrounds and cultures that comply with the inclusion and exclusion criteria provided in the blow paper in details. Number of participants might also increase given the time and opportunity at the time of conduction of study. All participants will first need to sign the consent and then the questionnaires will be provided to the participants online through email or in hard copy format depending upon the feasibility. Once questionnaires are filled then a semi structured interview will be conducted which would allow the participant to discuss the question topic related aspects giving an insight to the researcher regarding the notion behind the provided answers by the participant. Interviews will be conducted on video calls on Skype or in person. Time and date of interview will be confirmed at least 48 hours prior to the interview to avoid any inconvenience.

Questionnaire and interview questions will be finalized after an extensive and in-depth review of literature on the research topic and also after analysis of procedure to formulate intriguing questions. The main focus of the data collection tools would remain close to the aspects related to job satisfaction, physical and psychological symptoms related to stress and its impact on disrupted circadian rhythm in nurses and also sleep disorders. 

Inclusion and Exclusion Criteria 

The inclusion and exclusion criteria designed for the selection of participants of this research study for the purpose of data collection is as follows and only those participants will be selected who complied with both the criterions in a complete manner. Also, the implementation of this criterion on all participants will be insured by the researcher.

Inclusion Criterion

• The participant must be in association to a healthcare institution as a nurse for at least 12 months or must have worked as nurse for at least 3 years since 2012 in some form. 
• The participant agrees or consents with the utilization of provided data for the conduction of the study and has no ethical issues with the topic or conduction of this research.
• The participant is aged over 24 to have better understanding of nursing practices and has at least gained some relevant degree or diploma or education to nursing.

Exclusion Criterion

• The participant does not fulfill inclusion criterion in an appropriate manner.
• The participant is unavailable to give interview or has twice skipped the interview causing delay in the study.
• The participant has not filled the formulated questionnaire after at least two reminders or is not willing to coordinate with the researcher in this regard.

Ethical Considerations

All the ethical and legal aspects will be considered in detail. The Helsinki declaration will also be kept under consideration while no sort of discrimination will be tolerated in any case. It will be assured that no discrimination is observed in participant selection or during the conduction of the study as a whole. Consent of the participants will be taken prior to induction into the study and all personal contact details will be kept confidential. 

Data Analysis Technique

Mixed approach has been selected for data analysis in this study. Data collected from questionnaires having the Likert Scale technique analyzed quantitatively utilizing simple mathematical calculations and will be presented in percentage form. While qualitative analysis will be conducted on the answers provided through semi structured interview. This format of analysis will unearth the underlying notion behind the answers provided by the participants of the study which usually go unnoticed in other formats of analysis.

Outcome and Impact on Nursing

In this section of this research proposal, the expected outcomes, the assumptions and the impact of the conduction of this research study on the field of nursing are examined. These aspects are vital in terms of clarity of the goals of the research and what would be achieved through the research (Kothari, 2004). 

Assumptions of this Study

It is assumed that the null hypothesis will be evidently found positive in this research. The hypothesis that working night shift affects the work quality and physical health of nurses in a general hospital and that working night shift affects the job satisfaction, physical and psychological symptoms related to stress leading to disrupted circadian rhythm and sleep disorders in nurses is assumed to be true however it is the evidence based on the findings of this research that would prove this assumption to be true or false.

Expected Outcome of the Research

The expected outcome of this research is that a clear-cut evidence would be found suggesting that there is a connection between nurse shift timings that is night shift timings with sleep deprivation, poorer physical and mental health aspects along with disrupted circadian rhythm while all this leading to increased errors and lower work quality and hence effecting the performance of nurses. It is expected that profound evidence will be found through this research to support the above provided assumptions and the null hypothesis.

Impact of this Research Study

This research study would impact the field of nursing in an insightful manner. It would ask questions that have been surrounding the healthcare systems for years but have not been answered until now. It would highlight the performance and health related issues of nurses working in night shifts and will provide an opportunity to policy makers to improve the job satisfaction and other identified aspects by addressing unearthed concerns. For instance, special bonus for night shift workers, and improved health benefits specifically related to sleep disorders, stress, depression, anxiety and cardiovascular diseases along with any other mental or physical health condition found to be associated with nigh shift nurses through this study. In the end, this research proposal presents a great opportunity for improvements in the healthcare system through enhancement of policies towards better job satisfaction and improved performance of nurses.  

References

Chang, Y. S., Chen, H. L., Wu, Y. H., Hsu, C. Y., Liu, C. K., & Hsu, C. (2014). Rotating night shifts too quickly may cause anxiety and decreased attentional performance, and impact prolactin levels during the subsequent day: a case control study. BMC psychiatry, 14(1), 218. 

Gu, F., Han, J., Laden, F., Pan, A., Caporaso, N. E., Stampfer, M. J., …& Speizer, F. E. (2015). Total and cause-specific mortality of US nurses working rotating night shifts. American journal of preventive medicine, 48(3), 241-252. 

Kothari, C. R. (2004). Research methodology: Methods and techniques. New Age International. 

Muecke, S. (2005). Effects of rotating night shifts: literature review. Journal of advanced nursing, 50(4), 433-439. 

Reinke, L., Özbay, Y., Dieperink, W., & Tulleken, J. E. (2015). The effect of chronotype on sleepiness, fatigue, and psychomotor vigilance of ICU nurses during the night shift. Intensive care medicine, 41(4), 657-666. 

Ruggiero, J. S., &Redeker, N. S. (2014). Effects of napping on sleepiness and sleep-related performance deficits in night-shift workers: a systematic review. Biological research for nursing, 16(2), 134-142. 

Smith-Miller, C. A., Shaw-Kokot, J., Curro, B., & Jones, C. B. (2014). An integrative review: fatigue among nurses in acute care settings. Journal of Nursing Administration, 44(9), 487-494.