The effectiveness of an individualized sleep and shift work education and coaching program to manage shift work disorder in nurses: a randomized controlled trial

Abstract

Study objectives: While insomnia and sleepiness symptoms are common in shift workers, 20%-30% experience more severe symptoms and meet the criteria for shift work disorder (SWD). SWD can lead to impairments in cognitive function, physical and mental health, and reduced productivity and increased risk of workplace injury. The aim of this study was to deliver and evaluate a shift work individual management coaching program, focusing on sleep education, promoting good sleep hygiene, and providing individualized behavioral strategies to cope with shift schedules.

Methods: A clustered randomized controlled trial of sleep education and sleep disorders screening was undertaken, based on hospital wards at a tertiary hospital in Melbourne, Australia. Participants identified as high risk for SWD underwent one of two 8-week programs, a shift work individualized management program, or an active control. The primary outcome was ward-based sick leave. Secondary outcomes were SWD risk, sleep hygiene, insomnia, depression, and anxiety. A total of 149 nurses, across 16 wards (96% female, 34.66 ± 11.99 years) completed both baseline and follow-up questionnaires (23.9% were high risk SWD).

Results: There was no significant reduction in sick leave between intervention and control wards (mean difference = 1.2 days, P = .063). Improvements were seen in insomnia (P < .0001) and depression (intervention, P ≤ .0001, control, P = .023) in both groups, but were not significantly different between programs. Anxiety (P = .001. control P = .079) and Functional Outcomes of Sleep Questionnaire 10 (P = .001 control P = .056) improved only for the intervention.

Conclusions: This SWD intervention trial did not reduce sick leave compared to the active control but there was an improvement. Improvements in sleep hygiene, insomnia, depression, and anxiety severity were seen for both groups. Future intervention trials should consider including both sleep and mental health interventions, strategies to avoid between group contamination and the duration of programs for optimal behavioral modification.

Clinical trial registration: Registry: Australian New Zealand Clinical Trials Registry; Name: Sleep Health Management for Healthcare Workers; URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12616000369426; Identifier: ACTRN12616000369426.

Citation: Booker LA, Sletten TL, Barnes M, et al. The effectiveness of an individualized sleep and shift work education and coaching program to manage shift work disorder in nurses: a randomized controlled trial. J Clin Sleep Med. 2022;18(4):1035-1045.

Keywords: anxiety; circadian rhythm; depression; insomnia; nurses; shift work disorder; sleep.