Research Critique

Research Critique

In this article, James et al. (2021) conducted quasi-experimental quantitative research to investigate the impact of three consecutive 12-hour shifts on cognition, drowsiness, and nursing performance domains in day and night shift nurses in this publication. Such a design seeks to establish a cause-and-effect association between an independent and dependent variable. In this study, the independent variable was 12-hour shifts whereas dependent elements were cognition, sleepiness, and nursing performance. The primary issue being studied was fatigue from long shifts, linked to a greater risk of medical errors, declined care quality, and occupational injury in nurses. Nursing is a complex and multidimensional profession, and shiftwork-related exhaustion affects some nursing undertakings and nurses more than others. When nurses work overtime or extended shifts, the risk of making a mistake increases linked to sleep disturbances and deprivation. Furthermore, it predisposes them to burnout and reduced job performance, leading to patient dissatisfaction. Despite these disadvantages, long, consecutive shifts have become common due to their perceived convenience, continuity of care, and administrative flexibility. 

James et al. (2021) reviewed other studies in this area, which have explored the effects of sleep or fatigue on nursing performance. They also reviewed research articles on the influences of consecutive 12-hour shifts on various measures of shiftwork-related fatigue, such as muscle strength, sustained attention, forecasted cognitive effectiveness, and subjective sleepiness. These studies are relevant since they offer self-reported knowledge illustrating that nurses working 12-hour shifts experience more fatigue or sleepiness than those working 8-hour shifts. Others link 12-hour shifts to poorer patient care quality and safety. Most of the studies are current, predominantly being from 2026 to 2019. However, none of them have specifically assessed shiftwork-related exhaustion from consecutive shifts. Likewise, they have not investigated the relationship between sleepiness, cognitive effectiveness, sustained attention, and nursing performance. Equally, the inquiries have contradictory findings, making it difficult to measure what metrics may be relevant to boost patient care. This lack of completeness creates a gap in the literature, which James et al. (2021) attempted to fill with the current study.

The investigators targeted all registered nurses involved in direct patient care and worked 12-hour day or night shifts. They enlisted them into team sets based on the shift category they worked from November 2018 to March 2020 through a flier, a social media post, and word-of-mouth from two urban hospitals in the northwestern United States (James et al., 2021). The researchers envisioned obtaining a sample of around 100 nurses based on the findings of conservative power analysis of medium-sized effect at 80% power. They anticipated that 90 nurses would be adequate to express between-subjects effects, and 40 individuals would be enough to record between-within interactions assuming r = 0.40 between recurring measures (James et al., 2021). Of the 113 recruited nurses, 19 withdrew due to scheduling difficulties leaving a final sample of 94 caregivers.

James et al. (2021) collected data through tests, a Qualtrics survey, and observation. In particular, the researchers used the Creighton Competency and Evaluation Inventory to score nursing performance in the simulated setting. Likewise, they utilized the Psychomotor Vigilance test to record momentary constant attention, the Karolinska Sleepiness Scale to measure subjective sleepiness, and the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTETM) to compute forecasted cognitive effectiveness from ReadibandTM wrist actigraphs (James et al., 2021). The study found that nurses performed well in clinical simulation tasks irrespective of the exhaustion they amassed from consecutive shifts, and they were similar for almost all forms of nursing performance. Equally, the study established that night nurse were slightly worse than day nurses regarding communication skills. Nevertheless, this variance was minor, and the researchers eliminated it when controlling for projected cognitive effectiveness. Third, quantifiable changes in sustained attention and subjective sleepiness from succeeding shifts did not convert into variations of any performance domain. Finally, it was evident that more tangible and low-level variables had a superior interindividual discrepancy than more abstract and high-level elements, such as communication. 

Overall, the study results indicate that nurses on 12-hour consecutive shifts typically sustain their capacities despite quantifiable fluctuations in cognition and sleepiness. These findings support the acceptability of these 12-hour day and night shifts on diverse patient care elements. Based on this evidence, clinicians can consider changes in communication skills and expected cognitive efficacy as possible realms of focus to mitigate the effects of exhaustion on nursing performance and patient care (James et al., 2021). Furthermore, they should consider the significance of distinguishing, assessing, and controlling variables regarding shift attributes.

Nevertheless, it is vital to deliberate these findings in light of various limitations. The researchers scored nursing performance during clinical simulations as a proxy for general nursing performance. Consequently, the article’s results may not translate directly to actual patient care outcomes (James et al., 2021). Likewise, the discoveries did not capture omission and mistakes in performance since the participants performed well, and the Creighton Competency Evaluation Instrument was developed originally for nursing learners. Furthermore, the study sample was demographically characteristic of its local area, which was substantially less diverse than the approximation of the United States in general. Finally, the quasi-experiment design did not randomize subjects into shift kinds. Therefore, the results reflected only the sampled day and night nurses’ attributes instead of the exact effect of shift forms on exhaustion and nursing performance (James et al., 2021). Future research is essential to delineate the precise influences of shift lengths, rotation types, and the number of consecutive and non-consecutive shifts to shiftwork-related weariness and its effect on nursing performance.

References

James, L., Elkins-Brown, N., Wilson, M., James, S. M., Dotson, E., Edwards, C. D., & Butterfield, P. (2021). The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study. International Journal of Nursing Studies, 123, 1-12. https://doi.org/10.1016/j.ijnurstu.2021.104041