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Context of Practice 7: Application of Research in Clinical Settings

Introduction to Systematic Review Literature

All around the world, the workforce is involved in working in shifts. Even in the healthcare system, shift work is regarded as very necessary so as to make sure the care is provided to the patients all the time in the residential and hospital facility (Ferri et al., 2016). Scheduling and rotating are the key features of working in shift and nurses are the main healthcare providers who are locked into plans to deliver care 24 hours which involves working at night also. Working in shift and mainly at night especially, disrupts the circadian rhythm of the body. Because of this, sleep alterations occur and biological functions are disturbed in the nurses which ultimately affects the psychological and physical well-being and often results in undesirable work performances. It was also identified that nurses have problems in waking and sleeping. Some nurses also complain about gastrointestinal disorders and have been found out that they are more vulnerable to cardiovascular diseases. They also face insomnia, fatigue and excessive sleepiness in the day (Ferri et al., 2016). New nurses might struggle with all these problems while they are stuck in the loop of shift rotation. Many nurses complain that they don’t even get time to have a meal or some tea as they are always working. They also mention having an irregular sleeping pattern and also say that they can't go back to sleep after working in a late-night shift. While working on different shifts they criticize the fact that their mentor is not present on the same shift as them and therefore they face the problem because of it (Wong et al., 2018).

For the systematic review literature, PICO approach was utilized to make the review question. PICO here stands for population, intervention, context and outcomes. Therefore, the PICO question of this review literature is the perception of new graduate nurses while struggling with shift rotation. The population here refers to the new graduate nurses, intervention is shift rotation, context is struggling and the outcome is the perception of the newly graduated nurses. This framework provides the most dependable and valid tool which aids in organizing and focusing the literature search (Methley, Campbell, Chew-Graham, McNally & Cheraghi-Sohi, 2014).

Method

Eligibility criteria

Only those researches and study were considered that was performed in the English language in this systematic review. The studies from 2013 to 2018 were selected for the review. This regarded time slot was utilized so that only recent information could be included in the systematic review.

Information sources

The databases which were selected for the systematic review include EMBASE, CINAHL and MEDLINE. Google scholar was also utilized for the same work. The data was searched for the articles from only 2013 to 2018 to get some relevant literature for the systematic review. 

Search

The search was performed by using keywords and Boolean operators. The keywords help in easy identification of the studies which are desired at others is filtered out. Only studies which have full body text were considered for the systematic review. The various keywords that were used for the given study were: New graduate nurse, fresh nursing students, new registered nurse, inexperienced nurse, struggling, problems, troubles, shift rotation, shifts, night shift, day shift. The Boolean operator was also effective in finding the papers. The keywords were used in combinations to get the relevant literature from the database. The various Boolean operators which were used were AND and OR. The combinations which were used were new graduate nurses AND struggling OR shift rotation, fresh nursing students AND struggling OR shift rotation, inexperience nurse AND struggling OR shift rotation, new graduate nurses AND problem OR shift rotation, new graduate nurses AND struggling OR night shift, fresh nursing student AND problem OR shift rotation, inexperience nurse AND problem OR shift rotation.

S. no

Author and year

Methodology

Participants

Key findings

1.

Saksvik‐Lehouillier et al., 2013

The sample for their study was taken 905 newly registered and graduated nurses. Many of them were working in rotating 3 shift schedules. Data was collected by sending envelopes consisting of a questionnaire by postal service. The questionnaire includes instruments to measure tolerance work of the shift, their personality, their working schedule and factors of their lifestyle. Data analysis was performed with the help of a statistical program that is, PASW, version 17.

905 new nursing graduates were taken for the study.

In this study, it was found out that, in new nurses, flexibility was negatively related to shift work tolerance. Effect of caffeine consumption was found out to be positive in newly registered nurses.

2.

Gifkins, Johnston& Loudoun,2018

The study makes use of constructive framework so as to explore the experiences of the individuals. The open-ended approach was utilized. A descriptive recording was taken from newly registered nurses in which they stated about their day-to-day lives. There were in total 9 inexperienced nurses who have worked less than a year in shifts. Data was collected via interviews. A protocol for research having open-ended questions was made which included questions about their lives, the shifts and eating pattern. Data analysis was done and results were analyzed.

9 nurses who were inexperienced were taken for the study. 

Inexperienced nurses stated that they feel more craving for snacks and food while they are working especially in the night shift. They believed that their diet has been altered since the starting of the work. They described their eating pattern is not healthy considering their food timing. New nurses consume more caffeine particularly in the night shift so as to boost their energy and avoid fatigue and tiredness. They prepare for their shift to prevent fatigue. It was also found out that they do not undertake self-care strategies. New nurses described that they don’t consume enough water and other fluids.

3.

Wong et al., 2018

The study was done by collecting data by taking interviews. Questions were asked about their workload, working situation and many more topics.

8 new nursing graduates were taken for the study.

The subjects in the study experienced a lot of workloads. Most of them mentioned that they do overtime in multiple shifts. Some of them have insomnia which is linked to their shift time in the night. They also complained about having to work in a different shift from their mentors.

4.

Magnaye,Joyo, Magsino& Mendoza,2018)

The data was collected via a questionnaire. There were a total of 46 new nurses. Then the data was analyzed.

46 newly graduated nurses were taken for the study.

It was found out that rotational shifting and scheduling affect work performance in a negative way. The weighted mean was found out to be 3.35 and was given 6th rank out of 9 factors which impact the performance of the work.

Table 1: Findings of the studies

S.no

Questions

Saksvik‐Lehouillier et al., 2013

Gifkins, Johnston& Loudoun,2018

Wong et al., 2018

Magnaye,Joyo, Magsino& Mendoza,2018)

1.

Was there a clear statement of the aims of the research?

NO

YES

YES

YES

2.

Is a qualitative methodology appropriate?

YES

YES

CAN’T TELL

YES

3.

Was the research design appropriate to address the aims of the research?

YES

YES

NO

YES

4.

Was the recruitment strategy appropriate to the aims of the research?

YES

YES

NO

YES

5.

Was the data collected in a way that addressed the research issue?

YES

YES

CAN’T TELL

YES

6.

Has the relationship between researcher and participants been adequately considered?

YES

YES

CAN’T TELL

YES

7.

Have ethical issues been taken into consideration?

YES

YES

YES

NO

8.

Was the data analysis sufficiently rigorous?

YES

YES

CAN’T TELL

CAN’T TELL

9.

Is there a clear statement of findings?

CAN’T TELL

YES

YES

NO

10.

How valuable is the research?

The research was valuable as it can tell about work shift tolerance between the rotating shifts in newly graduated nurses.

The findings are very valuable as they focused our attention on the issues in the workplaces shifts. They stated the perception of inexperienced nurses.

The research was not that valuable as more participants should be considered for the study.

The research was not valuable as more description could be given about the findings rather than giving them some ranks.

Table 1: CASP qualitative questions checklists

Paper 1: In the paper of Saksvik‐Lehouillier et al., it was founded that in newly registered nurse the flexibility was affected negatively because of the shift work tolerance. In the paper, it was suggested that it might happen because nurses are new to the night shift and may experience more than usual negative impacts of working in shifts. It was also determined that the number of work hours is associated negatively with overall shiftwork tolerance. The same result was obtained for the consumption of caffeine in newly registered nurses (Saksvik‐Lehouillier et al., 2013).

Paper 2: In the paper of Gifkins, Johnston& Loudoun, they found out that nurses have a major craving for food and snacks while they are on shifts and particularly on their night shifts. The diets of the nurses have changed since they joined the hospital facility as a nurse. The eating pattern was not healthy considering their timings. For night shifts, inexperienced nurses intake large amounts of caffeine. The reason provided by them was to boost their energy for working and so that they don't feel fatigued or tiredness. For self-care, new nurses plan out their activities, especially for the night shift. Inexperienced nurses also stated to be involved in fewer self-care activities. It was reported that new nurses don't take much fluids and water while they are working in the shifts.

Paper 3: In the study conducted by Wong et al., it was founded that new nurses have to bear a high level of workload. The nurses stated that very frequently miss their food and even do overtime which lasts for 15-90 minutes in most of the shifts. Many of the nurses involved in the study were developed insomnia. The study also mentioned that new nurses preferred to work under the guidance of their mentors but due to different shift timings, it could not be made possible.

Paper 4: In the study conducted by Magnaye, Joyo, Magsino& Mendoza, the researchers found out about the mean score of rotational shifting and scheduling and how much it affects the performance of the work done by nursing graduate. The mean that was obtained was 3.35. There are three rotations in day shift between nurses. They were 7 AM to 3 PM, 6 AM to 2 PM and 3 PM to 11 PM. The night shifts were from 11 PM to 7 AM and from 10 PM to 6 AM. It was also recorded, nurses felt more awake in the morning one. They state that rotating shift disturbs the body’s circadian rhythm. Day shift demands more inputs in the performances.

Conclusion on Systematic Review Literature

It can be concluded that new graduate nurses might have to struggle with the rotation of the shift as it can be seen in the articles that have been reviewed in this systematic review literature. There are various implications for their physical and mental wellbeing. With that, they develop chronic diseases as rotational shifts disrupt their body’s circadian rhythm. They may also experience insomnia and a lot of workloads. The pieces of literature which have been reviewed in the study also suggested the same. That they might not be flexible with shift work and also can start the intake of more caffeine than usual. They might also not eat well or can’t manage self-care. Besides this, they might also don’t complete the requirement of the fluids and water in their body. With rotational shifts, they even develop insomnia and might miss taking their meals. Shift rotation can also negatively affect their work performance. Therefore, shift rotation could be a reason for newly graduated nurses stress.

References for Systematic Review Literature

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: Comparison between rotating night shifts and day shifts. Risk Management and Healthcare Policy, 9, 203–211. https://doi.org/10.2147/RMHP.S115326

Gifkins, J., Johnston, A., & Loudoun, R. (2018). The impact of shift work on eating patterns and self-care strategies utilised by experienced and inexperienced nurses. Chronobiology International, 35(6), 811-820.

Magnaye, B. P., Joyo, J. M., Magsino, A. D., & Mendoza, K. S. (2018). Work performance of nursing graduates from one academic institution in the Philippines.Asia Pacific Journal of Education, Arts and Sciences, 5(4), 10-20

Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., &Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Services Research14(1), 579.

Saksvik‐Lehouillier, I., Bjorvatn, B., Hetland, H., Sandal, G. M., Moen, B. E., Magerøy, N., ... &Pallesen, S. (2013). Individual, situational and lifestyle factors related to shift work tolerance among nurses who are new to and experienced in night work. Journal of Advanced Nursing, 69(5), 1136-1146.

Wong, S. W. J., Che, W. S. W., Cheng, M. T. C., Cheung, C. K., Cheung, T. Y. J., Lee, K. Y., & Yip, S. L. (2018). Challenges of fresh nursing graduates during their transition period. Journal of Nursing Education and Practice, 8(6), 30-37.

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