Investigating Relationship between Sleep Deprivation, Drowsy Driving Episodes and Accidents among the Night Shift Hospital Nurses - Coursework Example

Investigating relationship between sleep deprivation, drowsy driving episodes and accidents among the night shift hospital nurses (Registered nurses) Abstract Studies have revealed that hospital staff nurses working on night shifts are more likely to cause accidents due to drowsy driving after completing their night shift. Previous studies have focused on the medical errors caused by hospital staff nurses on night shifts with recommendations focusing on the need for napping during the night shift. The focus of this study is on the ability of hospital staff nurses to remain alert when driving home from night shifts and describing episodes of drowsy driving and accidents that occur due to sleep deprivation. Two samples of random registered nurses will form the study sample. A total of 895 full time registered nurses will complete logbooks for 4 weeks providing data related to the number of hours they worked, the duration of sleep and episodes of drowsy driving. Descriptive statistics will be used for to analyze the data collected from the two samples in order to deduce answers to the research questions. Description Studies have revealed that more than 100,000 accidents, 50,000 severe and minor injuries and more than 2000 deaths are reported every year due to the tendency of people sleeping while driving on roadways1. This is one of the major causes of injuries and deaths among the hospital staff nurses that work on night shifts. The increased number of accidents due to drowsy driving occurs due to the fatigue experienced by nurses due to long hours of work at night without enough time for short naps in between their work schedules. The fatigue-related accidents involve one vehicle driven by nurses from a night duty2. These types of accidents occur when vehicles are at high speeds and they tend to be serious than many other road crashes. The driver is less likely to take an immediate action to prevent the accident because he/she is usually alone behind the wheel. Hence, the probability of avoiding the crash is minimal since once the driver sleeps on the wheel the next experience is fatal injury or death. According to a report released by the National Highway Traffic Safety Administration in 2011, more than 40% of 200 105 million adult drivers admitted to have fallen asleep while driving on the highway which shows that drowsy driving is common across the board3. Additionally, the poll conducted by the Sleep in America organization in 2005 revealed that more than sixty five percent of the participants had once fallen asleep while driving at more than 57mph or even higher on roadways4. Shockingly, the poll revealed that more than 10 million adult drivers had been involved in fatigue or sleep related motor vehicle crash in the United States. A more recent study revealed that severe to moderate drowsiness accounted for 25% and 23% of near cashes and actual crashes on roadways 5. The prevalence rate of fatigue-related crashes resulting from sleep deprivation is higher among full time employed individuals particularly those working for more than 50 hours per week night shifts. Individuals working on night shifts are more prone to fatigue-related accidents because their sleep cycle is disrupted during the night and the recurrence of sleep tends to be early in the morning when the mind relaxes from the many duties performed during the night shifts. Several studies have surprisingly revealed that the rates of motor vehicle crashes among the medical residents are higher than expected. For example, statistics have revealed that during residency the likelihood of motor vehicle crashes is 8 times higher than before residency (19.5% vs 4.2%). Statistics have also revealed that the risk of near motor vehicle crash or actual motor vehicle crash (OR=5.8 or OR=2.4 is higher among the residents that work for more than 20 hours as compared to the residents that work for less than 20 hours6. It is estimated that the likelihood for a motor vehicle crash increases by 9.5% when a night shift for a resident or hospital staff nurses is extended by one month. It is important to note that the data on motor vehicle crashes due to sleep deprivation and drowsy driving is not only limited to one medical filed such as hospital staff nurses but it cuts across all medical specialties and subspecialties7. For example, anesthesia and emergency medicine residents have also reported more than 18% of actual or near motor vehicle crashes due to drowsy driving. The most probable time for motor vehicle crashes among the hospital staff nurses is between 8:00 am and 9:00 am when the hospital staff nurses drive home after a call. These occur in both no traffic and moderate traffic. During a training program with pediatric residents, more than 45% of the participants surveyed in a medical center located in a large university admitted to have fallen asleep at a stop light only to be awakened by the incoming traffic8. More than 50% of the participants that took place in the same survey revealed that they had experienced episodes of drowsy driving not necessarily at a stop light. 77% of anesthesiology residents and 65% of emergency medicine residents reported episodes of miss crashes or near cashes related to drowsy driving due to sleep deprivation. This further cement the argument that episodes of motor vehicle crashes or near crashes are not limited to only one medical field but it extends to all other medical fields. Periods of being awake for more than 18 consecutive hours are associated with drowsy driving because it produces deficits of cognitive performance. Laboratory studies have revealed that the deficit in cognitive performance caused by sleep deprivation of up to 19 consecutive hours is the same as the deficit in cognitive performance caused by 0.05% alcohol concentration in the blood9. This means that a hospital staff nurse that stays awake for 24 consecutive hours experiences a deficit in cognitive performance equal to a 0.1% concentration of alcohol in the blood. In most American states, this level of impairment exceeds the widely acceptable legal standards required of a driver. A study conducted by Arendt and colleagues revealed that more than 30 consecutive hours of wakefulness produced many instances of cognitive impairments, decreased rates of vigilance, attention lapses, and accidents 10. Hospital staff nurses that worked for more than 30 consecutive hours were found to experience lengthened reaction times, performance impairment along the roadways, and speed and lane variability of up to 30%. Findings also revealed that the level of impairment caused by prolonged periods of staying awake among the registered nurses could not be judged accurately. With more than 60% of healthcare providers in the United States being registered nurses employed to work on rotating or night shifts, it is clear that most of the registered nurses are prone to motor vehicle crashes. Most registered nurses find themselves working on scheduled shifts of up to 12 hours with others working on unanticipated shifts of up to 16 to 18 hours. In many other instances, registered nurses also wok on mandatory overtime shifts thus increasing their periods of staying awake. This in turn affects their psychomotor and cognitive performance not only in the job place but also along the roadway when driving home from scheduled night shifts11. As stated there above, information regarding the extent to which long hours of working during night shifts affects the driving ability of hospital staff nurses is lacking because most studies have focused on the cognitive performance of hospital staff nurses in the healthcare setting rather than outside the healthcare setting. However, in one study conducted by Novak and Auvil-Novak established that more than 90% of nurses in the intensive care units had experienced episodes of drowsy driving and thus had injuries related to automobile crashes when commuting from work early in the morning12. A few other studies have also revealed that nurses on night shifts were more likely to experience episodes of drowsy driving than nurses that work on rotating, evening and day shifts. In undertaking the current research study, findings from previous studies will also be incorporated to set the foundation for determining the relationship between sleep deprivation, drowsy driving and accidents caused by hospital nurses on night shifts. For example, the current duration for sleep deprivation that cause drowsy driving will be compared to the duration of sleep deprivation applied in other studies. The current level of cognitive impairment caused by sleep deprivation that result into near or missed or real motor vehicle crash will be compared to that utilized in other few studied conducted in the same field. The purpose is to ensure that the current study generates results that can be used to inform the practice of nursing and help change the current nursing practice where nurses are put on mandatory overtime without taking into consideration the periods of wakefulness among the nurses. Methodology As mentioned there above, the data used for this study will be collected from 2 samples of registered nurses that will be randomly selected. In total, 895 nurses will be included in the study sample. In order to ensure the participants meet the minimum criteria of being registered nurses (RNs), the American Nurses Association membership roaster will be used as the leading guide towards the selection of 393 registered nurses. Additionally, the remaining 502 Registered nurses will be selected randomly from the American Association of Critical Care Nurses (AACN) membership roaster13. Procedure The procedure for participants’ selection will follow a set laid down criteria. A random sample comprising of 4000 ANA members will be served with cover letters detailing the eligibility and study criteria. A demographic questionnaire will also accompany the cover letter mailed to the sample selected. After a period of 2 months, another random sample consisting 5000 AACN members will also be served with a demographic questionnaires and cover letters detailing the eligibility and study criteria. The purpose for this is to ensure that a large number of participants are reached from where the study sample will be selected among those that will return well filled demographic questionnaires to the research center. After the demographic questionnaires are evaluated and eligibility criteria approved, the selected subjects will be served with two log books each in which the details for completing the log books will be issued to more than 895 ANA registered nurses and 1000 AACN members. This will include hospital staff nurses that are unit based or working full time. Out of the 895 ANA issued with two log books, a sample of 393 ANA members will be selected following the evaluation of correctly filled and completed log books. Those that will return only one log book will not be selected into the final study sample. Similarly, out of the sample of 1000 subjects of AACN, 502 study subjects will be selected into the final sample for this study purposes. Finally, a final sample of 895 of hospital staff nurses in direct care duties will be include into the study sample out of a range of many other nurses left out due to the failure of meeting the eligibility and study criteria. Nurses in advanced practice or administrative positions or those in specialized roles will not be included in the study. Participants As mentioned in the sections above, the total study sample will consist of 895 subjects. This will comprise 393 registered nurses from ANA membership and 502 registered nurses from AACN membership. In terms of age, the participants’ ages will fall between 40-45 years, an age where the hospital staff nurses have gathered enough experience and able to narrate what affects their performance positively or negatively. The mean age of the participants will be 44.8 years. The participants will also be full time employees. The definition of full time employees means that the participants will be working for a minimum of 35 hours per week and drawn from large hospitals with more than 350 beds as well as medium size hospitals with more than 300 beds. Instruments The main instruments used in this study will be logbooks. The participants will be required to complete and fill the log books on a daily basis. The information or data to be collected using the log books include the amount of hours worked by a hospital staff nurse both actual and scheduled hours, the patterns of wakefulness and sleepiness, and sleep and drowsiness episodes while driving on roadways. Nurses will not be required to complete or fill this information when they are on days off. The other instrument is the demographic questionnaire which hospital staff nurses in the study sample will be required to complete and return back as explained above. Analysis Data will be collected from logbooks and demographic questionnaires. Frequency tables and descriptive statistics will then be used to summarize the data obtained from the log books and demographic questionnaires14. A night shift will be categorized as the shift that lasted from 10p.m to 8 am. Any other shift will be categorized as a non-night shift. The night shift will therefore last between 8 to 10 hours. The daily reports completed by nurses will provide information about when the nurses napped, went to bed and woke from bed. This will be calculated to give the figure for the duration the nurses slept. For purposes of analysis, drowsy driving, total duration of sleep, and the hours worked will be taken as the variables of interest in this study15. A question such as “did you experience difficulties staying awake today at work” will be used to measure the level of drowsiness experienced by the hospital staff nurses. In order to measure the extent to which different nurses experienced episodes of drowsy driving, the study subjects will be required to answer the question “did you experience moments of drowsiness when you were driving home after your night shift?” In order to accurately determine when episodes of drowsy driving occurred, participants will be required to record and report when they were released by their fellow colleagues after the end of their night shifts. The frequency and trend of actual motor vehicle or near motor vehicle crash will be assessed by providing the answer to the question “Did you get involved in a near accident or real accident on your way home from work?. The relationship between shift duration with drowsy driving probability, sleep episodes and drowsiness while driving home will be examined by conducting a univariate analysis. The total time slept by the participants will be estimated using the Generalized Estimating Equation (GEE)16. Using an interval of 95% confidence and ORs, the association magnitude between the total time slept by a participants and occurrence of drowsy driving episodes will also be established17 . The purpose of the multivariate analysis is to examine the association between work hours and drowsy driving episodes while producing more control for demographic variables such as years of experience, age and marital status of the registered nurses18. Ethics Ethics is an important factor that will be taken into consideration when conducting the study. One of the ethical issues that will be observed when conducting the study will be confidentiality of information provided by the participants. Even though the information gathered in this study will not be sensitive as to damage the reputation or the image of participants when exposed, the aspect of confidentiality will still be observed in order to enhance the relationship between the participants and the researchers for future reference or future studies. The autonomy of the participants to participate or not to participate in the study will also be taken into consideration. References 1. Scott, l, et al., The relationship between nurse work schedules, sleep duration, and drowsy driving. SLEEP 2007; 30(12):1801-1807. 2. Novak, R, Auvil-Novak., Focus group evaluation of night nurse shift work difficulties and coping strategies. Chronobiol Int. 1996;13:457–463 3. National Highway Traffic Safety Administration, Washington: US Department of Transportation, The impact of driver inattention on near-crash/crash risk, DOT HS 810 594, 2005. 4. National Sleep Foundation, Sleep in America poll. Online journal 2005, http://www.sleepfoundation.org/site/c.huIXKjM0IxF/b.2419039/k.14E4/2005_Sleep_in_America_Poll.htm 5. Gold, et al., Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. Am J Public Health, 2004, 82:1011–1014 6. Stutts, J, Vaughn, B., Why do people have drowsy driving crashes? Input from drivers who just did. Washington: AAA Foundation for Traffic Safety; 1999. 7. Horne, J, and Reyner, L., Vehicle accidents related to sleep: a review, Occup Med. 2003; 56:289–294 8. Arendt J, Owens, J, Crouch, M, Stahl, J, and Carskadon, M., Neurobehavioral performance of residents after heavy night calls vs after alcohol ingestion. JAMA; 294:1025–1033, 2005. 9. Philip, P, Sagaspe, P, and Tailed, J, et al., Fatigue, sleepiness, and performance in simulated versus real driving conditions. Sleep. 2005; 28:1511–1516 16. Brown, I., Driver fatigue. Hum Factors. 1994; 36:298–314 17. McCartt, A, Rohrbaugh, J, Hammer, M., Factors associated with falling asleep at the wheel among long-distance truck drivers. Accid Anal Prev. 2000; 32:493–504 Read More