Nils Magerøy

Shift Work Disorder in Nurses – Assessment, Prevalence and Related Health Problems

Background This study investigates the prevalence of symptoms of shift work disorder in a sample of nurses, and its association to individual, health and work variables. Methodology/Principal Findings We investigated three different shift work disorder assessment procedures all based on current diagnostic criteria and employing symptom based questions. Crude and adjusted logistic regression analyses were performed with symptoms of shift work disorder as the dependent variable. Participants (n = 1968) reported age, gender, work schedule, commuting time, weekly work hours, children in household, number of nights and number of shifts separated by less than 11 hours worked the last year, use of bright light therapy, melatonin and sleep medication, and completed the Bergen Insomnia Scale, Epworth Sleepiness Scale, Global Sleep Assessment Questionnaire, Diurnal Scale, Revised Circadian Type Inventory, Dispositional Resilience (Hardiness) Scale – Revised, Fatigue Questionnaire, questions about alcohol and caffeine consumption, as well as the Hospital Anxiety and Depression Scale. Conclusions/Significance Prevalence rates of symptoms of shift work disorder varied from 32.4–37.6% depending on the assessment method and from 4.8–44.3% depending on the work schedule. Associations were found between symptoms of shift work disorder and age, gender, circadian type, night work, number of shifts separated by less than 11 hours and number of nights worked the last year, insomnia and anxiety. The different assessment procedures yielded similar results (prevalence and logistic regression analyses). The prevalence of symptoms indicative of shift work disorder was high. We argue that three symptom-based questions used in the present study adequately assess shift work disorder in epidemiological studies.

Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study

BackgroundDespite considerable knowledge about musculoskeletal disorders (MSD) and physical, psychosocial and individual risk factors there is limited knowledge about physical activity as a factor in preventing MSD. In addition, studies of physical activity are often limited to either leisure activity or physical activity at work. Studies among military personnel on the association between physical activity at work and at leisure and MSD are lacking. This study was conducted to find the prevalence of MSD among personnel in the Royal Norwegian Navy and to assess the association between physical activity at work and at leisure and MSD.MethodsA questionnaire about musculoskeletal disorders, physical activity and background data (employment status, age, gender, body mass index, smoking, education and physical stressors) was completed by 2265 workers (58%) 18 to 70 years old in the Royal Norwegian Navy. Multiple logistic regression with 95% confidence intervals was used to assess the relationship between physical activity and musculoskeletal disorders.ResultsA total of 32% of the workers reported musculoskeletal disorders often or very often in one or more parts of the body in the past year. The most common musculoskeletal disorders were in the lower back (15% often or very often), shoulders (12% often or very often) and neck (11% often or very often). After adjustment for confounders, physical activity was inversely associated with musculoskeletal disorders for all body sites except elbows, knees and feet.ConclusionThe one-year prevalence of musculoskeletal disorders among workers in the Royal Norwegian Navy was rather low. A physically active lifestyle both at work and at leisure was associated with fewer musculoskeletal disorders among personnel in the Royal Norwegian Navy. Prospective studies are necessary to confirm the cause and effect in this association.

Exposure to bullying behaviors as a predictor of mental health problems among Norwegian nurses: Results from the prospective SUSSH-survey

BACKGROUND The relationship between workplace bullying and mental health problems are well documented in previous cross-sectional studies, but knowledge on how this relationship develops over time is still scarce. OBJECTIVES The aim of this study was to explore the prospective relationship between exposure to bullying behaviors at baseline, and increased symptoms of mental health problems (anxiety, depression, fatigue) one year later. Furthermore, the reverse relationship was investigated. DESIGN This is a prospective longitudinal study, where members of the Norwegian Nurses Organization answered identical questions regarding workplace bullying and mental health problems, at baseline (2008-2009) and follow-up (2010). PARTICIPANTS Altogether, 1582 nurses completed both questionnaires. RESULTS Hierarchical regression analyses indicated that exposure to bullying behaviors at baseline predicted subsequent increased symptoms of anxiety and fatigue, after adjusting for baseline symptoms of anxiety and fatigue respectively, age, gender, night work and job demands. Moreover, symptoms of anxiety, depression and fatigue at baseline predicted increased exposure to bullying behaviors one year later, after adjusting for exposure to bullying behaviors at baseline, age, gender, night work and job demands. CONCLUSION In this study we find support for a reciprocal relationship between exposure to bullying behaviors and symptoms of anxiety and fatigue, respectively. Thus, the results may indicate a vicious circle where workplace bullying and mental health problems mutually affect each other negatively.

Personality factors related to shift work tolerance in two- and three-shift workers

This study aimed to investigate whether different personality variables were associated with shift work tolerance, and whether these potential associations were moderated by various types of shift work. The sample comprised 1505 nurses who worked either two or three rotating shifts. Personality traits were measured in terms of morningness, flexibility, languidity and hardiness. Morningness reflects the tendency to be alert relatively early in the morning and sleepy relatively early in the evening. Flexibility denotes the ability to both work and sleep at odd times of the day, while languidity concerns the tendency to become tired/sleepy when cutting down on sleep. Hardiness relates to resilience to stressful life events. The dependent variables in this study comprised of measures of insomnia, sleepiness, depression and anxiety. Hierarchical regression analyses, which controlled for demographic variables and work load, revealed that Morningness was significantly and negatively related to insomnia. The Morningness by Shift type interaction was overall significant for depressive symptoms. Morningness was near significantly associated with lower levels of depressive symptoms in three-shift workers, but unrelated to depressive symptoms in two-shift workers. Flexibility was associated with higher levels of depressive symptoms. Flexibility by Shift type interaction was significant for insomnia, indicating that flexibility was negatively associated with insomnia for three-shift workers and unrelated with insomnia for two-shift workers. Languidity was associated with higher levels of sleepiness, depressive and anxiety symptoms. Hardiness was associated with lower levels of all four dependent variables.

Workplace bullying and subsequent health problems

BACKGROUND Cross-sectional studies demonstrate that exposure to bullying in the workplace is positively correlated with self-reported health problems. However, these studies do not provide a basis to draw conclusions on the extent to which bullying leads to increased health problems or whether health problems increase the risk of being bullied. To provide better indications of a causal relationship, knowledge from prospective studies on the association between bullying in the workplace and health outcomes is therefore summarised. MATERIAL AND METHOD We conducted a systematic literature review of original articles from central literature databases on longitudinal associations between bullying in the workplace and health. Average associations between bullying and health outcomes are calculated using meta-analysis. RESULTS A consistent finding across the studies is that exposure to bullying is significantly positively related to mental health problems (OR =1.68; 95% KI 1.35-2.09) and somatic symptoms (OR = 1.77; 95% KI 1.41-2.22) over time. Mental health problems are also associated with subsequent exposure to bullying (OR = 1.74; 95% KI 1.44-2.12). INTERPRETATION Bullying is positively related to mental health problems and somatic symptoms. The association between mental health problems and subsequent bullying indicates a self-reinforcing process between mental health and bullying. The methodological quality of the studies that were conducted is relatively sound. However, based on the existing knowledge base there are no grounds for conclusions regarding an unambiguous causal relationship between bullying and health.

Shift-related sleep problems vary according to work schedule

Objectives Shift-related sleep and sleepiness problems may be due to characteristics of both shifts (ie, day, evening and night shifts) and work schedules (ie, permanent vs rotational schedules). The Bergen Shift Work Sleep Questionnaire (BSWSQ) was used to investigate associations between shift-related sleep problems and work schedules. Methods 1586 nurses completed the BSWSQ. Participants who, in relation to a shift, ‘often’ or ‘always’ experienced both a sleep problem and a tiredness/sleepiness problem were defined as having shift-related insomnia (separate for day, evening and night shifts and rest-days). Logistic regression analyses were conducted for day, evening, night, and rest-day insomnia with participants on both permanent and rotational schedules. Results Shift-related insomnia differed between the work schedules. The evening shift insomnia was more prevalent in the two-shift rotation schedule than the three-shift rotation schedule (29.8% and 19.8%, respectively). Night shift insomnia showed higher frequencies among three-shift rotation workers compared with permanent night workers (67.7% and 41.7%, respectively). Rest-day insomnia was more prevalent among permanent night workers compared with two- and three-shift rotations (11.4% compared with 4.2% and 3.6%, respectively). Conclusions The prevalences of shift-related insomnia differed between the work schedules with higher frequencies for three-shift rotations and night shifts. However, sleep problems were present in all shifts and schedules. This suggests that both shifts and work schedules should be considered in the study of shift work-related sleep problems.

Predictors of shift work disorder among nurses: a longitudinal study

BACKGROUND Shift work is associated with sleep problems and impaired health. The main aim of the present study was to explore predictors of developing shift work disorder (SWD) among Norwegian nurses using a longitudinal design. METHODS A total of 1533 nurses participating in a survey on shift work, sleep and health responded to questionnaires at baseline and at follow-up about two years later. SWD was defined as problems of excessive sleepiness and/or complaints of insomnia related to the work schedule. RESULTS AND CONCLUSIONS There was a significant reduction (p < 0.001) in the prevalence of SWD from baseline to follow-up, from 35.7% to 28.6%. Logistic regression analyses showed significant risks of having SWD at follow-up and the following variables measured at baseline: number of nights worked the last year (OR = 1.01, 95% CI = 1.01-1.02), having SWD (OR = 5.19, 95% CI = 3.74-7.20), composite score on the Epworth Sleepiness Scale (OR = 1.08, 95% CI = 1.04-1.13), use of melatonin (OR = 4.20, 95% CI = 1.33-13.33), use of bright light therapy (OR = 3.10, 95% CI 1.14-8.39), and symptoms of depression measured by the Hospital Anxiety and Depression Scale (OR = 1.07, 95% CI = 1.00-1.14). In addition, leaving night work between baseline and follow-up was associated with a significantly reduced risk of SWD at follow-up (OR = 0.12, 95% CI = 0.07-0.22).

Coping styles relate to health and work environment of Norwegian and Dutch hospital nurses: A comparative study

Nurses exposed to high nursing stress report no health complaints as long as they have high coping abilities. The purpose of this study was to investigate coping styles in relation to the health status and work environment of Norwegian and Dutch hospital nurses. This comparative study included a random sample of 5400 Norwegian nurses and a convenience sample of 588 Dutch nurses. Coping, health, and work environment were assessed by questionnaire in both samples and associations were investigated bivariately and multivariately. We found that active problem-solving coping was associated with the health and work environment of Norwegian nurses but not with the health and work environment of Dutch. Passive coping (avoiding problems or waiting to see what happens) was found to relate to poor general health, poor mental health, low job control, and low job support in both Norwegian and Dutch nurses. Improvements in the nursing work environment may not only result in better mental health, but may also reduce passive coping.

Association of psychosocial factors and bullying at individual and department levels among naval military personnel

OBJECTIVE We studied the associations between bullying at work and psychosocial factors both at the individual and at the department levels. METHODS The data were collected in a cross-sectional study from a questionnaire sent by mail in 2002 to all military personnel in the Royal Norwegian Navy as part of a general work and health study. Self-experienced and observed bullying as well as scores for psychosocial scales using the General Nordic Questionnaire for Psychological and Social Factors at Work were calculated both for the individuals (n=1604) and as a mean for each Navy department (n=97). RESULTS Low scores on the fair leadership, innovative climate, and inequality scales were associated with high occurrence of bullying at the individual level in a backward stepwise multivariate logistic regression, which means that lack of fair leadership and innovative climate and unequal treatment were associated with high occurrence of bullying. At the department level, the three scales were similarly significantly associated with percentage observed bullying when analyzed separately. A low score on the fair leadership scale and lower departmental mean age were associated with high percentage observed bullying in a stepwise multiple linear regression analysis. Repeating the analyses excluding those being bullied did not change the estimates markedly. CONCLUSION Our findings indicate that the work environment as perceived by the individual and at the department level is related to the occurrence of bullying.

Personality factors predicting changes in shift work tolerance: A longitudinal study among nurses working rotating shifts

Abstract The aim of the present study was to investigate the relationship between personality factors (hardiness, morningness, flexibility, and languidity) and longitudinal changes on different measures of shift work tolerance (fatigue, sleepiness, anxiety and depression) over one year among nurses working rotating shifts. A total of 642 female Norwegian nurses working in a rotating three-shift schedule participated in the study. The cohort was established by age-stratified selection among members of the Norwegian Nurses Association in 2008. Questionnaires were administered in 2008/2009 (T1) and in 2009/2010 (T2). The results showed that hardiness was negatively related to fatigue, anxiety and depression at T2 when controlling for the scores on these constructs at T1. Morningness was not related to any indicators of shift work tolerance at T2 when controlling for shift work tolerance at T1. Flexibility was negatively related to anxiety at T2 when controlling for anxiety at T1. Languidity was positively related to sleepiness and fatigue at T2 when controlling for sleepiness and fatigue at T1. The findings indicate that personality factors, especially hardiness, can predict changes related to shift work tolerance over a period of one year.