The Effect of Shift Directions of Clinical Nurses on the circadian Rhythm / 기본간호학회지

ABSTRACT

The circadian system represents a temporal order which is mediated by the mutual coupling of oscillators and by the synchronizing effects of zeitgebers. It is known that well-being of man depends partly on the maintenance of this order, and that repeated or long lasting disturbances to it such as shift work will cause harmful effects. This study was a quasi-experimental study to test the effect of shift directions for the clinical nurses on the circadian rhythm. Fourteen nurses working at the general units of Y hospital were selected according to the established criteria. Fourteen subjects were assigned to a weekly shift but the directions of shift work were phase delay first and then phase advance or vice versa. Oral temperature, total sleeping time, frequency of sleep-wake cycle, fatigue, mental performance, and physical symptom were measured during these days except holidays. The data collection period was from April 26, 1993 to July 3, 1993. MANOVA and Wilcoxon signed rank test were used for statistical analysis. The results are summarized as follows. 1. Having worked on evening and night shifts in either phase delay or phase advance schedules, temperature rhythms of shift workers were gradually adapted to the new sleep-wake cycles. A complete adaptation to work on the night shift was achieved the sixth day of the night shift in the phase delay schedule compared to the partial adaptation to the work on the night shift in the phase advance schedule. Accordingly, by putting evening shift between day and night shifts, it will be possible for circadian rhythm to adapt easily to the night shift. 2. There were differences in the total sleeping time, frequency of sleep-wake cycle, fatigue, and physical symptom except for mental performance between night shift and day, evening shift. This indicates further that shift workers working on the night shift have a hard time adapting to the shift work compared to the other shifts. 3. Evaluating all the acrophases of temperature rhythm either in phase delay or phase advance schedules, it was shown that night to evening shift in the phase advance schedule revealed the smallest phase move. Also phase advance schedule showed poorer adaptation to shift work than phase delay schedule in connection with total sleeping time, frequency of sleep-wake cycle, fatigue, mental performance, and physical symptom. It is suggested, taken together, these findings reflect that phase delay schedule facilitated the degree of adjustment to the shift work compared to the phase advance schedule.