Sleep is a basic human need” (Maslow 1970, p.92), we all have at least unclear belief of what sleep is, and as a human being we require different types and depth of sleep in different amount and at various time over the day. On the other hand, the quality of sleep is important than the quantity of sleep.

The International Council of Nursing recognizes that many health care providers’ services are accessible on twenty-four hour basis, making shift work a necessity, at the same time ICN is very concerned that shift work may have a negative impact on the individual’s health, ability to function, thus affecting the services provided, (ICN, 1899-2010).

Rotating shifts have been associated with more sleep disturbances, digestive problems, fatigue and alcohol intake, along with less satisfactory psychological health and work performance. Nurses on rotating shifts were found to take more sick days and to give more serious reasons for these sick days relative to fixed shift workers, (ICN, 1899-2010).Sleep obtained during the day or at irregular times is of poorer quality than that obtained during normal nighttime sleep. Chronically limited sleep patterns and the subsequent sleep balance that accumulates over time may be most persistent in such professions as health care delivery that functions 24 hours a day, 7 days a week. (Kawada T. & Suzuki S., 2002) found that rotating shift work affects the amount of sleep, but not the rate of errors among workers on a three-shift schedule.”Reduction in the amount of sleep predisposes individuals to sleep deprivation, resulting in poor psychomotor performance,” and “Nurses who work the night shift may be particularly subject to sleep deprivation because of irregularity of sleep hours and disruptions in the circadian cycle. Poor psychomotor performance has been associated with an increase in error, which can be translated into an unsafe work environment. The identification of sleep deprivation in nurses is essential for maintaining safe working conditions.” (Johnson, science daily, 2007).The implication of this study may help both nurses and administrators to understand some of the underlying effects of rotation shift on nurses’ sleep patterns. Our study findings may also provide a knowledge base for further research that addressed after studying all aspects of nurses work shift and its relationship with other factors in the clinical and other world environment.

Purpose of the Study

The purpose of the study is to explore the sleep patterns of the hospital nurses who are working rotating shifts in the Intensive Care Unit in the Salmaniya Medical Complex.

Objectives

At the end of this project we aim to; (a) to evaluate sleep patterns among Intensive care unit nurses who are doing shift rotation. (b) to identify number of sleeping hours among these nurses. (c) to assess the effect of shift rotation on the quality of sleep (d) to discover when these nurses are going to sleep after their shift.

Problem Statement

Research Question

What is the relationship between the shift work rotation and sleep deprivation among nurses who are working in Intensive Care Unit?

Hypothesis

There is a positive relationship between rotating shift work and sleep deprivation among Nurses in the Intensive Care Unit.

Definitions of Terms

A. Dictionary Definitions:

1) Shift work:

Is an employment practice designed to make use of the 24 hours of the clock, rather than a standard working day. The “three-shift system” is the most common pattern, with “first” from 6:00 a.m. to 2:00 p.m., “second” from 2:00 p.m. to 10:00 p.m., and a “third” (or “night”) shift from 10:00 p.m. to 6:00 a.m. This is generally worked over a five-day week; to provide coverage 24/7, employees have their days off (“weekends”) on different days.

All of the shifts have desirable and less desirable qualities. First shift has very early starts, so time in the evening is heavily cut short. The second shift (or “swing shift”) occupies the times during which many people finish work and socialize. The third shift creates a situation in which the employee must sleep during the day. (Wikipedia, the free encyclopedia, 2007)

2) Sleep deprivation:

A sleep disorder characterized by having too little sleep can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss. (Wikipedia, the free encyclopedia, 2008)

3) Nurses:

A person who is qualified in the art and science of nursing and meet certain prescribed standards of education and clinical competency.(Barbara F. 2003) Nurses work in a large variety of specialties where they work independently and as part of a team to assess, plan, implement and evaluate care.

4) ICU:

An intensive care unit (ICU) is a specialized department used in many countries’ hospital that provides intensive care unit. Many hospitals also have designated intensive care areas for certain specialties of medicine, as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized. (Wikipedia, the free encyclopedia, 2007)

B. Operational Definitions:

Sleep deprivation among ICU nurses who are doing shift work

ICU Nurses in Bahrain are qualified nurses who have the ability to take immediate actions in the critical situations. Special programs are conducted in order to strengthen and reinforce their skills and capabilities in immediate decision-making. These nurses are doing shift duties of the 24 hours of the clock divided into three shifts ,morning ,evening and night 8 hours each shift. This rotation of shifts will affect on their sleep habits and we will measure the effect of shift rotation on sleep patterns by using questionnaire.

Limitations

“Limitations are uncontrolled variables that may affect study result and limit the generalizability of findings……. The researcher should openly acknowledge the limitation of a study, as much as possible, before data are collected. Other limitations may occur while the study is in progress (such as malfunctions of equipment and subject dropout).The limitations must be taken into consideration when the conclusions of a study are formulated and when recommendations are made for future research.” (Nieswiadomy, 2008,p.47)

There will be a several limitaions in conducting our research project and it will be identified after collection of the data.

Literature review

There were numbers of literature reviews related to our topic. First study is (Geiger-Brawn, 2008).The study done on 2,273 registered nurses who are working shift duty. He measured the sleep of the nurses by two items “my sleep was restless” and “I got less sleep than I thought I should “.The result was the worse schedule (shift rotation) the worse the sleep for most nurses.”Inadequate sleep has both short-term (needle stick injuries and musculoskeletal disorders) and long-term (cardiovascular and metabolic diseases) health consequences for nurses, and possibly for the patients that they serve,” said Dr. Geiger-Brown. “Adequate sleep is critical to providing quality patient care.”

The second study (Muecke, 2005,50(4)) was Integrative literature reviews and meta-analyses were used, the literature was examined for the 10-year period up to December 2003. The aims of this paper reports a review examining the concept of sleep and its antithesis of fatigue, and considers the evidence on nurses’ ability to cope with the demands of continually changing hours of work, their safety, and the impact any manifestations of sleep disruption may have on the care of their patients. While many aspects of this paper may apply to nursing in general, special consideration is given to nurses in the critical care environment. The results concluded what is already known about this topic

• There is an adverse relationship between fatigue and quality of performance.

• Older nurses, specifically those over 40 years of age may exhibit inferior performance skills compared with those of younger night workers.

• Fatigue has been implicated in some of the world’s worst disasters.

What this paper adds

• Disrupted body rhythms caused by shift work lead to major physiological and psychological effects for nurses that may affect patient safety and the quality of care

Provided.

Third study was a comparative study (HannaAdmi, 2008) Self-administered questionnaire that included items on demographics; health history and complaints; and sleep habits and disorders were used to carry out this study.

The goal of this study was to find out and describe the health complaints and sleep patterns among hospital nurses who are working in rotating shifts and to examine the effect of the shift work on nurses’ absenteeism and patient safety. Also there were specific objectives for this study. These objectives were: A) to compare subjective medical complaints and sleep disorders between female and male nurses, daytime and shift nurses and between adaptive and non adaptive shift nurses, B) to identify the scope of non adaptive shift nurses and C) to compare the rates of the absenteeism, clinical errors and adverse incidents between adaptive and non adaptive shift work nurses.

In this study, there were 738 hospital nurses in a major teaching hospital in northern Israel were investigated during the year 2003. The sample comprised all nurses who are working only daytime shifts or rotating shifts. A total of 688 (93.2%) nurses completed all the self administered questionnaire data, including 589(85.6%) females and 99 (14.4%) males. Of the total sample, 195 (175 females and 20 males) nurses worked only daytime and 493(414 females and 79 males) nurses worked flexible rotating shift in accordance with the units’ and nurses needs.

The result of this study appears that gender, age and weight are more significant factors than shift work in determining the well-being of nurses. Moreover, nurses who are non-adaptive to the shift work based on their complaints about sleep were found working effectively and safely as their colleagues in terms of absenteeism from their work and involvement in the professional errors and accidents. So, in conclusion of this study, there were two findings. The first one was that females who works on shift complains significantly more about sleep problems than males who are working shift work. The second finding was that although the researchers found high rates of non-adaptive shift work nurses, they did not find a more adverse impact on their health, absenteeism rates or performance (reported errors and incidents) compared to their adaptive and daytime shift colleagues. In another meaning, shift work by itself was not a risk factor for nurses’ health and organizational outcomes.

The fourth study (Chan, 2008,18).this was conducted in two local hospitals in Hong Kong during the period 2005-2006. A self – report questioner completed by nurses (n=163). The purpose of the study was to explore nurses perceived sleep quality and examine factors that contribute to insufficient sleep quality. The data were analysis by SPSS 12.0(SPSS Inc., Chicago, IL, USA).The result analyzed with descriptive statistics. In the study 72% of nurses self reported as getting insufficient sleep. The result was compared with the results of study by Karacan et al. (1986) and Lack et al. (1988),which showed only 6.5% and 27.8% subjects self-reporting as getting insufficient sleep, which indicate that insufficient sleep is a major issue for rotation shift nurses in Hong Kong and that problem is quite serious. The study showed that more than 70% of shift working nurses had insufficient sleep and indication levels were higher.

Methodology

Research Design

We have selected descriptive exploratory research design; it is more practical in the implementation, economical in cost, and easy to manage. The study is designed to describe the effect of shift work rotation on nurses’ sleep patterns.

Sample Design and Size

The sample will include staff nurses working in ICU with an experience of at least five years, because they have experienced enough shift rotation. A total of hundred ICU nurses will be selected. Out of them, seventy five are working in main ICU Department, and twenty five in 52 B ICU. Their ages should be within a range of 25 to 45 years old as sleep patterns is also affected by age. The study will be conducted within a period of one month; questionnaire will be distributed for data collection and will be carried out within one week during morning, evening, and night shift duties. The subjects’ rights will be protected through a written consent which will guarantee their confidentiality and anonymity.

Pilot Study

We are going to conduct a pilot study for twenty ICU nurses; fifteen from the main ICU and five from 52B ICU. This study will be done to identify the time that would be consumed and to measure the validity and reliability of the instrument which will be used.

Data Collection Procedure

Ethical approval for the study will be obtained from the Chief Executive Nurses of the Salmaniya Medical Complex and to the incharge of the Intensive Care Unit department in order to get a written legal permission that allow us to conduct the study. Participation in the study is voluntary and based on the nurses ability to give an informed consent, all data and information’s gathered will be strictly confidential and will not be accessed by any other without permission from the participants, moreover, the participant has the right to withdrew at any time if she/he cannot complete the questionnaire. We had developed a19 item questionnaire, we are going to do a pilot study to pretest the developed questionnaire regarding reliability and validity. After that, all of us as researchers will take the responsibility to distribute the research questionnaires to all the participants (total number is 100 samples) that had been selected randomly in the ICU of SMC by using computer in selecting staff CPR numbers. Code numbers will be placed on the margins of the questionnaire in order to maintain anonymity and confidentiality of all the participants and to facilitate data analysis procedure. The purposes of the study will be explained for them. Participant’s rights’ to withdraw at any time if they wish to discontinue, and their rights’ to know the result of the study are reserved, we are going to list our e-mails to answer their concerns. They will be informed also about the time of publishing the results of the study.

Instruments

This study will be conducted through a 19 item questionnaire that we had developed with consideration of stability reliability which means consistency of the questionnaire over the study time. In addition to that we had considered the validity of the questionnaire that means the ability to gather the data it is intended to gather through checking the content validity and the face validity.

Data Analysis

Descriptive statistics will be computed using the statistical package for the Social Science/Personal computer; data analysis will include descriptive statistics to describe the study sample via mean, median, range, and frequency we use this method as it fast, easy and accurate. Crosstabulation and mean will be used to study effect of shift rotation on nurses sleep patterns.