The Impact of Long Working Shifts on Healthcare Executives
There have been various changes in the technology in the field of medical science. The improvement in technology has resulted to improvement in the health services and introduction o several devices in cost effective manner. Health care executives are affected negatively due to prolonged and rotation in the work shifts. Change in the work shift especially night shifts has resulted to issues of depression, insomnia, fatigue and sleep disorder. It is the main reason that affects the quality of working and occurrence of accidents at the workplace (Akerstedt & Kecklund, 2017). The employees feel the problem of burnout and fatigue which is influencing the productivity and quality for services at the healthcare institutions.
The introduction of the computer assisted technologies has lead to improvement in the equipments and betterment of the health services. The issue of sleep disorder and other health related issues are measured and mitigated with the use of various devices invented over a period of time. One such device is wrist band that is used to measure the sleep of an individual that is considered to be an evolutionary change in the healthcare sector. This device helps to measure the issues related to the sleep and measure its extent as sleep is an important factor that affected the performance of the healthcare executives in this sector (Ogeil, et al., 2018).
The literature review is aimed to critically evaluate and synthesize the existing studies on sleep measuring devices used by healthcare professionals. This review will analyze the overview of the issues due to long working shifts and rotation in shifts and severity of sleep disorder that has resulted to the need of its measurement. There is a use of the device named Actigraph also termed as Actimetry sensor for measurement of the sleep among the individuals (de Zambotti, Baker & Colrain, 2015). Thereafter, the literature review analyses the traditional and advanced methods of measuring sleep and access the studies for the justification of the device and its accuracy to provide recommendations to identify the potential improvements in the area of study.
In the words of Ferri, et al., (2016), working in shifts is necessity for continuous care in healthcare sector. Night shift is considered to be one of the most frequent reasons for affecting the routine life that results to alteration in the biological functions and sleep. It has resulted to impact the physical and psychological health of the employee and negatively impact work performance. The issues arise due to sleep disorder are sleepiness, insomnia, anxiety and fatigue. There are several other issues such as work pressure, long working hours and operating under unhealthy conditions that affect the productivity and work efficiency of the healthcare employees. The issues on health arise due to the resynchronization of the endogenous physiological system, physiological system, the circadian rhythms physical and psychological problems due to the issues of fatigue and problems associated with disruption on social life (Lee, Byun, Keill, Dinkel, & Seo, 2018). In addition to this, it is also identified that the consistency of the sleep deprivation is highly associated with the rise in the chronic fatigue that affects the alertness of the person. It is a known fact that the workers working in the healthcare sector are required to be alert and accurate at the time of shift, as negligence leads to arising severe consequences to the health of the patients (de Zambotti, et al., 2015).
Computer-Assisted Technologies and Sleep Measurement Devices
Ogeil, et al., (2018) indicates that poor sleep have immediate impact on the body, human body also fails to rejuvenate in short sleep and body clock is disturbed due to frequent change in work shift. There is also maladaptation syndrome related to shift work that leads to gastrointestinal disorder and increases the risk of cardiovascular diseases. It is identified that shift work disorder is also an issue that results in alteration of the circadian rhythm related to sleep and wake, excessive fatigue and sleepiness and leads to deprived quality of the sleep. At the same time, it is also considered as the main reason for the deprived performance at the workplace and feeling of discomfort at the time of working at the hospitals. The employees face it challenging to work continuously and there is the occurrence of accidents due to sleep disorder in nursing staff (Marino, et al., 2013). The nurses that work in the day shifts are when compared with those working in rotational and only night shifts lead to the result that the employees that are working in rotational shifts are facing more issues in comparison to those working in the night shifts. On the other side, the nurses that work in day shifts are having no issues of laziness, fatigue and impaired concentration (Jeon, & Finkelstein, 2015).
According to Mantua, et al., (2016) the analysis of the health issues has resulted to focus towards deep study and identify the solution to the problem. The most popular approach to the identification of sleep related issues is the gold standard that leads to measuring a person’s sleep. Polysomnography is the approach that is applied that empowers a number of collective efforts to measure sleep. The approach involves surface electrodes, physiologic parameters of sleep it also includes brain dynamics of electroncephalography. In addition to this, this also records the movements of the eyes, muscle activity, respiratory function and heart physiology. The approach consists of measuring the brain, breathing, limb movements and body position analysis for better and accurate results.
As per the views of Marino, et al., (2013), consumer sleep tracking devices are evaluated on large scale to measure the effectiveness and accuracy of the devices. The study indicates that the actigraphy provides an overall high accuracy and reliable results. While comparing the approach with Polysomnography, it is identified that Polysomnography is an accurate and more relaiable approach among all the available tools that are used for measuring sleep. Polysomnography is a laboratory based approach that measures sleep under surveillance of large number of devices with expert team that continuously supervise and evaluate the sleep. For the distinctive feature of the sleep, the clinicians try to measure the binary presence of sleep and waking through the wrist movements. It facilitates in an inexpensive support to large-scale population research without disruption sleep. At the same time, Lee, et al., (2018) depicts that the results of wearable devices are having great accuracy that provides better results without affecting the routine life of the individuals in a cost effective manner. In contrast to this, Jeon, & Finkelstein, (2015) identified that the accuracy of the sleep detection devices are not as per the committed level and the results revealed by the devices vary widely. At the same time, there were no evidences available for the accuracy of the sleep measuring tool that justify results provided by these devices and manage sleep disturbance in practical life.
Traditional and Advanced Methods of Measuring Sleep
Ferri, et al., (2016) stated that on comparing this approach with the actigraphy, which is an approach that is a non-invasive approach that monitors the rest cycle or records the motions with the help of an actimetry sensor. In this activity, it is needed to wear a device over a period of time and the movements are recorded in a wrist watch like machine that records the movements until and unless the user exposed to light. This data is transferred to the computer for identifying the sleep of the user. In some of the technology updated tools, this device provides real-time updates and consolidated results of the period of analysis. It is also a concern that the actigraphy might overestimate sleep and on the other side underestimate the wake time as the beginning of sleep period are recorded in a special manner (Lee, et al., 2017). In actigraphy, the immobility of the individual is considered as the beginning of the sleep period whereas PSG is more advanced as it also considers the changes in the brain electrical activity patterns marked sets of sleep.
In the past few years, there are positive technological improvements in the actimetry sensor that has resulted in improvement in results and accuracy of the device. In addition, the approach is now considering the high memory storage, three-axis accelerometer sensors, high sampling rate. There is also use of the heart rate, blood circulation and its atomized synchronization with the Smartphones leads to improvement in the results of the device (Conrad, Karlik, Lewandowski Holley, Wilson, & Koh, 2017). Also, the device is to be placed on the wrist of non-dominant hand for measurement of sleep and sensitivity to normal and monitors heart rate automatically.
There are some of the shortcomings of PSG that include the need of the individual to spend time in a lab and at the same time, pre-identified situation with the brain for the upcoming event sometimes results to affect the sleep which may lead to influence the results. In addition to this, expensiveness, time consumption for both the evaluators and individuals is a little impractical approach to spend a long period of time in the laboratory. These are factors that affect the use of the method. At the same time, lack of home recording and its limited availability has resulted in new methods to objectively evaluation of sleep (Mantua, et al., 2016). Although, there are some lacking areas associated with the PSG still it is a widely accepted and more accurate approach to measure sleep.
Comparison of Actigraphy and Polysomnography in Sleep Measurement
The primary advantage of the actimetry sensor is the low cost, the prices of the devices are affordable in past few years that lead to more popularity and its easiness to use is the added benefit over the other approaches to measuring sleep. Since the device can be worn on the wrist it can be used for a long period of time which provide exhaustive picture of the sleep time or cycle. The best feature of actigraphy is no requirement of support and also it does not affect normal working life in comparison to so it is more preferred approach over PSG due to providing the natural environment and easy use (Lee, et al., 2017).
The limitations of the study is that this only considers the gathering of the data by the use of secondary method so there might be a possibility that the information related to the current scenario is not resent in a real manner. In addition to this, limited sample collection from the respondents and evaluations of the specific 5-6 wrist bands is also limitation of the study that might affects the outcomes of the literature review.
With the innovation and technology improvements in the actimetry sensor that has to lead to overcome the use of the device on a wide range of the users. In addition to this, the introduction of the fitness bands monitors the health of the people is a revolutionary change in the technology that has negatively impacted the use of PSG for the evaluation of the sleep disorder. The core advantage of the approach is the cost-effectiveness and its data transfer facility that helps the user to transfer the data (Mantua, et al., 2016). The overall analysis on the basis of the various factors such as price, comfort, appropriateness and accuracy of the results indicates that PSG is a better approach in comparison to actigraphy in terms of accuracy. On the other side, actimetry sensor-based approach is having just one issue that is accurate and this method is far better than the PSG on other factors (Conrad, et al., 2017).
The involvement of the new technologies has improved and establishes benchmarks in the accuracy of the devices. The devices are improved over time and as a result, the changes occurred are meant for the recording the heartbeat, blood pressure, walk record, body temperature and sleep. These devices are now connected with Smartphones and will transfer the data and simulation to the devices for long time comparison of the data and its evaluation (Lee, et al., 2018). It is also recommended that the various devices used to measure sleep are needed with supporting evidence for the accuracy of the results so that it will be helpful for the nurses and population to identify the issues and take necessary steps to overcome the same.
Improvements in Actigraphy Sensors
Conclusion:
From the above discussion, the literature review analyses the impact of the changes in the working shifts leads to several types of issues on the health of the nurses and other persons working in this sector. The issues include sleepiness, anxiety, depression, fatigue and burnout along with several other health issues. The review also compares the two approaches to measure the sleep among the healthcare professional which are Polysomnography and actigraphy. It evaluates the benefit and the shortcomings of both the approaches where it is analyzed that PSG is still a better and accurate method for measuring sleep. It is also concluded that there are several technological changes that lead to accuracy and cost-effectiveness in measuring sleep with the help actimetry sensor. Some of the identified research gaps were lack of covering the whole population, comparison of limited actigraphy machines and lack of proper evidences for majority of devices. At last, it is recommended that the use of the actimetry sensor is easy and cost effective which is improving day by day and soon it will be completely replaced by fit bands that will help to measure the sleep and help the nurses to take appropriate measures to overcome the issues related to sleep.
References:
Akerstedt, T., & Kecklund, G. (2017) What work schedule characteristics constitute a problem to the individual? A representative study of Swedish shift workers. Applied ergonomics, 59, pp. 320-325.
Conrad, N., Karlik, J., Lewandowski Holley, A., Wilson, A. C., & Koh, J. (2017) A Narrative Review: Actigraphy as an Objective Assessment of Perioperative Sleep and Activity in Pediatric Patients, Children, 4(4), pp. 26.
de Zambotti, M., Baker, F. C., & Colrain, I. M. (2015) Validation of sleep-tracking technology compared with polysomnography in adolescents. Sleep, 38(9), 1461-1468.
Ferri, P., Guadi, M., Marcheselli, L., Balduzzi, S., Magnani, D., & Di Lorenzo, R. (2016) The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts, Risk management and healthcare policy, 9, pp. 203.
Jeon, L., & Finkelstein, J. (2015) Consumer sleep tracking devices: a critical review. Digital Healthcare Empowering Europeans: Proceedings of MIE2015, 210, pp. 458.
Lee, H. A., Lee, H. J., Moon, J. H., Lee, T., Kim, M. G., In, H., & Kim, L. (2017) Comparison of wearable activity tracker with actigraphy for sleep evaluation and circadian rest-activity rhythm measurement in healthy young adults, Psychiatry investigation, 14(2), pp. 179-185.
Lee, J. M., Byun, W., Keill, A., Dinkel, D., & Seo, Y. (2018) Comparison of Wearable Trackers’ Ability to Estimate Sleep, International journal of environmental research and public health, 15(6), pp. 1265.
Mantua, J., Gravel, N., & Spencer, R. (2016) Reliability of sleep measures from four personal health monitoring devices compared to research-based actigraphy and polysomnography, Sensors, 16(5), pp. 646.
Marino, M., Li, Y., Rueschman, M. N., Winkelman, J. W., Ellenbogen, J. M., Solet, J. M., … & Buxton, O. M. (2013) Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography, Sleep, 36(11), pp. 1747-1755.
Ogeil, R. P., Barger, L. K., Lockley, S. W., O’Brien, C. S., Sullivan, J. P., Qadri, S., & Rajaratnam, S. M. (2018) Cross-sectional analysis of sleep-promoting and wake-promoting drug use on health, fatigue-related error, and near-crashes in police officers, BMJ open, 8(9), e022041.
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