NSG/456 Week 1: Research Question, sample paper

Thirty Minutes at 0300: Turning Night-Shift Fatigue on a Medical-Surgical Unit Into an Answerable Research Question About Scheduled Naps

[Student Name]

University of Phoenix

NSG/456: Research Outcomes Management for the Practicing Nurse

Week 1 Assignment

[Instructor Name]

[Date]

The unit, its staff and its data are a composite written for a model paper.

At about 0300 on most nights, the medication room on my unit goes quiet in a particular way. Nurses who have been moving steadily since 1900 slow down, reread labels twice and ask each other to double-check doses they would check alone at 2100. Everyone on nights knows the feeling, and almost no one talks about it as a safety issue. This paper turns that shared experience into a research question that a study could answer. A problem that everyone on a unit feels is not yet a question anyone can study; the work of this week is closing that distance.

The Clinical Problem

Fatigue among nurses who work long shifts is well documented. Rogers et al. (2004) analyzed logbooks kept by 393 hospital staff nurses and found that about 40% of the 5,317 shifts they recorded lasted longer than twelve hours. Errors became significantly more likely when shifts lasted more than twelve hours, when nurses worked overtime and when their total hours passed forty across a week. Those findings concern shift length, which my unit cannot easily change, since it staffs 12-hour shifts by design. What a unit can change is what happens inside the shift.

One option is a planned nap. Other safety-sensitive industries, including aviation, have used brief planned rest periods to reduce fatigue during long duty periods. In nursing, the idea is controversial, and many units treat sleeping at work as a disciplinary matter. That combination, a plausible intervention that practice has not adopted, is a good place for a research question.

What Is Already Known

A randomized trial in an academic emergency department assigned 49 physicians and nurses working three consecutive night shifts either to a 40-minute nap opportunity at 0300 or to no nap (Smith-Coggins et al., 2006). At the end of the shift, the nap group reported less fatigue and sleepiness and showed fewer lapses on a vigilance test, although memory was briefly worse just after waking. A later implementation project on six nursing units in two hospitals offered nurses a 30-minute nap during the night shift; only one unit fully implemented it, largely because nurse managers did not approve, but nurses on that unit took 153 naps, most reported light or deep sleep and they rated naps as helpful (Geiger-Brown et al., 2016).

Neither study measured patient safety outcomes on inpatient units, and neither followed staff nurses on medical-surgical units, where workload at night differs from the emergency department. That is the gap my question addresses.

Naming the Variables and Population

The independent variable is a scheduled nap opportunity: a protected 30-minute period between 0200 and 0400, with coverage arranged by the charge nurse, in a quiet room with a recliner. The comparison is usual practice, in which nurses take breaks but do not nap.

The dependent variables need to be measurable. The primary outcome is self-reported sleepiness at 0600, measured with the Karolinska Sleepiness Scale. The secondary outcome is medication errors and near misses reported through the hospital's event system during the study period. Self-reported sleepiness is the more sensitive measure; errors and near misses matter more but are rarer and underreported.

The population is registered nurses working 12-hour night shifts on adult medical-surgical units. Nurses in intensive care, the emergency department and float pools are excluded, because their work patterns differ.

Three Drafts of the Question

Draft 1: Do naps help night-shift nurses? This is a question about the idea, not a study. It has no population, no defined intervention and no measurable outcome.

Draft 2: Does napping reduce errors among nurses? This adds an outcome, but errors are rare, "napping" is undefined and the population is unclear.

Draft 3: Among registered nurses working 12-hour night shifts on adult medical-surgical units, is a scheduled 30-minute nap opportunity during the shift, compared with usual breaks without a nap, associated with lower self-reported sleepiness at the end of the shift and fewer reported medication errors and near misses?

The third draft names the population, the intervention, the comparison and two measurable outcomes. It uses the phrase "associated with," which fits a study in which the unit, rather than each nurse, might be assigned to the intervention. If a randomized design proves possible, the question could be restated to ask whether the nap reduces sleepiness.

The Hypothesis

Directional hypothesis: nurses offered a scheduled 30-minute nap opportunity will report lower sleepiness at 0600 than nurses on the same kind of unit without the opportunity. A secondary hypothesis predicts fewer medication errors and near misses on units with the nap opportunity, although the study may not have enough events to test it with confidence.

Is the Question Feasible?

A good question is one a real study could answer with the time and resources available. This one passes that test for three reasons. First, the population is at hand: my unit and a similar unit in the same hospital employ about 60 nurses who work nights, enough to recruit a useful sample over a few months. Second, both outcomes can be measured without new equipment. The Karolinska scale takes seconds to complete, and event reports are already collected by the hospital's patient safety office. Third, the intervention costs little: an unused family consultation room and a recliner exist on my unit, and the charge nurse already assigns break coverage. The main obstacle is permission. A study cannot begin until nursing leadership agrees to protect nap time, and the implementation project described above suggests that this agreement is harder to obtain than any of the data.

Why the Question Matters

The question matters to patients, because tired nurses make more errors, and to nurses, because drowsy driving after night shifts is a real risk. It also matters to managers, who in the implementation project were the main barrier to napping. A well-designed local study would give them evidence from their own setting rather than from an emergency department in another state.

Conclusion

A shared experience at 0300 became a research question with a population, an intervention, a comparison and measurable outcomes. Week 2 will ask what ethical protections a study of this question would need, which matters because the participants would be the researcher's own colleagues and one outcome is their errors.

References

Geiger-Brown, J., Sagherian, K., Zhu, S., Wieroniey, M. A., Blair, L., Warren, J., Hinds, P. S., & Szeles, R. (2016). Napping on the night shift: A two-hospital implementation project. American Journal of Nursing, 116(5), 26-33. https://doi.org/10.1097/01.NAJ.0000482953.88608.80

Rogers, A. E., Hwang, W.-T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212. https://doi.org/10.1377/hlthaff.23.4.202

Smith-Coggins, R., Howard, S. K., Mac, D. T., Wang, C., Kwan, S., Rosekind, M. R., Sowb, Y., Balise, R., Levis, J., & Gaba, D. M. (2006). Improving alertness and performance in emergency department physicians and nurses: The use of planned naps. Annals of Emergency Medicine, 48(5), 596-604. https://doi.org/10.1016/j.annemergmed.2006.02.005