Association of Sleep and Fatigue With Decision Regret Among Critical Care Nurses

Abstract

Background The effects of inadequate sleep on clinical decisions may be important for patients in critical care units, who are often more vulnerable than patients in other units. Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome. Objectives To examine the association between selected sleep variables, impairment due to fatigue, and clinical-decision self-efficacy and regret among critical care nurses. Decision regret was the primary outcome variable. Methods A nonexperimental, descriptive design and extant measures were used to obtain data from a random sample of full-time nurses. Binary logistic regression models were used to examine the association between sleep variables, fatigue, and clinical-decision self-efficacy and regret. The discrimination of the models was compared with the C statistic, the area under the receiver operating characteristic curve. Results A total of 605 nurses returned the questionnaires (17% response rate). Among these, decision regret was reported by 157 of 546 (29%). Nurses with decision regret reported more fatigue, more daytime sleepiness, less intershift recovery, and worse sleep quality than did nurses without decision regret. Being male, working a 12-hour shift, and clinical-decision satisfaction were significantly associated with decision regret (C statistic, 0.719; SE, 0.024). Conclusion Nurses who experience impairments due to fatigue, loss of sleep, and inability to recover between shifts are more likely than unimpaired nurses to report decision regret.

Sleep quality, level of daytime sleepiness and fatigue among working nursing students

“…Zabrinjavajući nalaz u ovoj studiji jeste da je 56,6% studenata koji rade u smenskom rasporedu prijavilo nenameravane epizode spavanja tokom noćne smene, što je značajno veća prevalencija u odnosu na one koje prijavljuju druge studije [33,34]. Ispitanici u našoj studiji sa višim skorovima prekomerne dnevne pospanosti i umora imali su statistički značajno veći broj nenameravanih epizoda spavanja na poslu, što ih potencijalno dovodi u veći rizik od činjenja grešaka i povređivanja, o čemu ukazuje više studija [33,35,36].…”

“…Zaposleni studenti, koji su prema prosečnom PSQI "dobri spavači", nisu ispoljavali prekomernu dnevnu pospanost i simptome umora, za razliku od onih koji spadaju u grupu "loših spavača". Značajna povezanost između kvaliteta spavanja, dnevne pospanosti i težine umora kod sestara i studenata sestrinstva potvrđena je i u studijima drugih autora [4,11,23,34,36].…”

Sleep deprivation in nursing students: The negative impact for quality and safety

“…Historic studies as well as more recent research have confirmed sleep loss negatively affects performance of cognitive tasks, indicating slower reaction times and poor decisionmaking, as well as cardiac, metabolic, and gastrointestinal issues [5][6][7] while the sleep-deprived persons do not realize the extent to which they are affected or the long term impact to health. [3,8] College students, in particular, experience the pressing need to work and maintain social lives while balancing extensive class and study time.…”

“…[16][17][18] Lockley, Barger, Ayas, Rothschild, Czeisler, and Landrigan's and Scott et al's studies found that nurses working 12.5 hours or more made significantly more errors and had an increased risk for needle stick injury, hepatitis, HIV, and blood borne illness and regretted some clinical decisions. [7,19] Scott et al found that nurses working the night shift, those working 12-hours or greater, or were males had the most decision regret. [7] Lockley et al also found that physicians working consecutive 24-hour shifts made more serious errors, attention failures, had more needle stick injuries, and doubled their risk of having a motor vehicle accident.…”

Recent Advances in Multidisciplinary Critical Care

“…It is, however, also well known that there is a positive correlation between critical care nurses' shift length and the rate of medical errors. 96 As in situ simulation has been proposed as an innovative approach to investigate quality of care topics, Calhoun et al 97 explored its use to study the relationship between critical care nurses' time spent on the current shift and the efficient, accurate completion of tasks in a pediatric ICU. As such, 28 nurses performed in 3 assessments during a standard 12-hour shift using a high-fidelity pediatric simulator.…”