Orientador: Milva Maria Figueiredo De Martino / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T23:21:59Z (GMT). No. of bitstreams: 1 Carmona_LucianeRuiz_D.pdf: 4020231 bytes, checksum: 3a495b39346f1f0920874ed134289dec (MD5) Previous issue date: 2011 / Resumo: Introdução: Devido à crescente industrialização da sociedade, torna-se cada vez mais comum o trabalho em turnos, bem como o desenvolvimento do trabalho noturno, porém com pronunciado efeito negativo no sono, desempenho e saúde. Objetivo: Investigar os padrões do ciclo vigília-sono e a ritmicidade circadiana da temperatura corporal periférica, através das medidas tomadas no punho, do estudante de enfermagem do período diurno que trabalha no turno noturno. Método: Estudo longitudinal descritivo, com enfoque quantitativo, em que participaram 27 sujeitos adultos, auxiliares e técnicos de enfermagem que trabalhavam no turno noturno, e que eram alunos do curso de graduação em Enfermagem de uma faculdade particular do interior paulista, no período diurno. Foram utilizados os seguintes instrumentos: Ficha de Identificação, Questionário de Indivíduos Matutinos e Vespertinos (HO), Questionário de Sonolência de Epworth, Diário de Sono, durante 32 dias, divididos em período letivo e férias, e um termistor (Thermochron iButton®) no punho da mão não dominante, para verificação de temperatura do punho a cada 30 minutos. Resultados: Quanto ao ajuste dos dados de temperatura do punho a uma curva cosseno, com um período de 24 horas, foi verificada ritmicidade significante em 35,3% dos sujeitos no período letivo e em 93,7% dos sujeitos no período de férias, além da existência de ritmos diferentes de 24 horas, como de 12 e 16 horas. A média da amplitude rítmica da temperatura do punho foi menor no período letivo quando comparado ao período de férias. Houve diferença estatisticamente significativa no horário em que ocorreu a acrofase, quando comparado o período letivo sem trabalho e com trabalho (p<0,0001), período de férias sem trabalho e férias com trabalho (p<0,0001). Quanto ao tempo de sono, no período de férias, foi maior quando comparado ao letivo, assim como nos dias sem trabalho e nos dias em que não dormiram imediatamente após o trabalho noturno. Verificou-se diferença significativa quando comparado o tempo de sono no período de férias sem trabalho (8:34h) e período letivo sem trabalho (7:24h), com p<0,0001, e ainda nas férias com trabalho (5:11h) e letivo com trabalho (4:19h), com p=0,0496. Quanto à Meia Fase do Sono (MFS), houve diferença estatisticamente significativa entre os períodos letivo e férias com e sem trabalho. Os sujeitos apresentaram escores de sonolência entre 7,2 e 15,9, com média de 11,4, caracterizando prevalência de sonolência diurna excessiva. Conclusão: Verificou-se redução das horas de sono do estudante trabalhador noturno, devido a necessidade de frequentar as aulas no período matutino. Observou-se a presença de ritmos diferentes de 24 horas, especialmente durante o período letivo, e o deslocamento de fase da temperatura do punho, de acordo com a jornada de trabalho/estudo, com oposição de fase nos dias com trabalho quando comparado aos dias sem trabalho noturno. A maior potência espectral foi verificada no ritmo de 24 horas, tanto no período letivo como durante as férias, confirmando a hipótese de que a região do punho apresenta expressão rítmica bem definida e robusta. Os achados reforçam a ideia de que o estudo favorece o estabelecimento de rotina, porém pouco influencia no deslocamento da temperatura corporal, que demonstrou ser fortemente influenciada pelo trabalho noturno. Semelhantemente à acrofase, a meia fase do sono apresentou grande diversidade nos horários de ocorrência, porém com relação de fase mantida entre os ritmos, nos diferentes momentos do estudo / Abstract: Introduction: Due to the increasing industrialization of society, the work in shifts is becoming increasingly common, as well as the development of night work, although with a pronounced negative effect on the workers sleep, performance and health. Objective: to investigate the patterns of sleep-wake cycle and the circadian rhythmicity of peripheral body temperature, through measures taken at the wrist of nursing students who studies during the day and works on the night shift. Methods: longitudinal descriptive study, with a quantitative approach, involving 27 adult subjects, nursing assistants and technicians who worked in the night shift and were students of undergraduate nursing of a private college in São Paulo State, during the daytime. The following instruments were used: Identification Form, Morningness Eveningness Questionnaire of Horne and Östberg, Sleepiness Questionnaire Epworth, Sleep Diary, for 32 days, divided into school term and school vacations, and a thermistor (Thermochron iButton) on the non-dominant hand wrist to check the temperature of the wrist every 30 minutes. Results: The adjustment of the temperature data of the wrist to a cosine curve, within a 24-hour period, a significant rhythmicity was verified in 35.3% of subjects in the school term and 93.7% of subjects in the vacation period, apart from the existence of different rhythms of the 24 hours such as 12 and 16 hours. The average amplitude of the wrist temperature rhythm was lower in the scholl term when compared to the vacation period. There was a statistically significant difference in the time that the acrophase occurred, when comparing the school term on the days-off and on working days (p<0.0001), school vacation on the days-off and working days (p<0.0001). The sleep time during the school vacation was higher when compared to the school term, as well as on the days off and on the days when the subjects didn't sleep immediately after work. There was a significant difference when comparing the sleep time on the vacation period and days off (8:34) and school term and days off (7:24), p<0.0001, and also on vacation on working days (5:11) and school term on working days (4:19), p=0.0496. The Middle Phase of Sleep (MPS) there was a statistically significant difference between the school and vacation periods on working days and days off. The subjects presented EDS scores between 7.2 and 15.9, averaging 11.4, characterizing the prevalence of excessive daytime sleepiness. Conclusion: It was verified an intensification of the 14 reduction of hours of sleep of the night working student, because of the need to attend classes in the morning. The presence of rhythms different than 24 hours, was observed especially during the school term, and the phase transfer of the wrist temperature, according to the period of work/study, with phase opposition on working days when compared to days off. The greatest spectral power was observed in the 24-hour rhythm, either during school term or vacation, confirming the hypothesis that the region of the wrist shows a well-defined and robust rhythmic expression. The findings reinforce the idea that the study favors the establishment of routine, but has little influence in displacing the body temperature, wich proved to be strongly influenced by the night shift work. Similar to the acrophase, the MPS showed great diversity in times of occurrence, but with a phase relation maintained between the rhythms on the different times of study / Doutorado / Enfermagem e Trabalho / Doutor em Enfermagem

Sammanfattning Bakgrund: Undersköterskor är en stor yrkesgrupp men många är sjukskrivna, ofta relaterat till stress. Att arbeta natt, vilket många undersköterskor gör, är ytterligare en faktor som kan ge upphov till arbetsrelaterad stress. Nattarbetet medför även andra hälsorisker, exempelvis depression, övervikt och kardiovaskulära sjukdomar. Få studier går att finna gällande undersköterskor och nattarbete. Syftet: Syftet var att undersöka hur nattarbetande undersköterskor upplever nattarbetet och på vilket sätt nattarbetet påverkar deras hälsa. Metod: Studien är en kvalitativ intervjustudie med en induktiv ansats. För rekrytering av deltagare användes snöbollsprincipen. Deltagarna intervjuades via telefon och spelades in. Datamaterialet bearbetades genom kvalitativ innehållsanalys.  Resultat: Undersköterskorna upplevde att det var lugnare att jobba nattpass än dag – och kvällspass. Det var extra viktigt med bra samarbete. Nattarbetet var skört när någonting extra, akut, inträffade. De upplevde att de fick försämrad sömn och blev trötta av att arbeta natt. De åt på ett annat sätt än om de enbart arbetade dag- eller kvällspass. Något som ansågs som positivt var att nattarbetet kunde bidra till längre ledigheter vilket uppfattades öka livskvaliteten. Slutsats: De flesta undersköterskor upplevde nattarbetet positivt trots att det påverkade deras hälsa negativt. Fler nattarbetande undersköterskor behövs. Kunskap om undersköterskors sömn och matvanor i förhållande till nattarbete, samt hur nattarbetande undersköterskor upplever sin arbetsmiljö, är viktigt för att motivera förebyggande åtgärder i form av exempelvis medicinska kontroller och utbildning. / Abstract Background: Many assistant nurses are on sick leave due to stress. Some need to work at night, which can be a stress factor. Night shift workers also tend to have problems with obesity and depression. There are few studies about assistant nurses and night shift work. Aim: The aim was to investigate how assistant nurses experience night work and their health. Method: A qualitative interview study with an inductive approach. The snowball principle was used to recruit participants. Data were analyzed through qualitative content analysis approach. Results: Assistant nurses reported that it was calmer to work at night and that cooperation was even more important compared with day or evening- shifts. Working conditions were fragile if something urgent happened. Participants suffered from lack of sleep and had a change in eating habits due to the night- shift work. Night shifts resulted in longer periods of free time which increased quality of life. Conclusion: Most assistant nurses experienced positive experiences of night shift-work, even though it had a negative effect on their health. More night-working assistant nurses are needed. Knowledge about sleep and eating habits, as well as work environment during night shifts, is important to motivate preventive measures, for example medical check-ups and education.

Objective: To evaluate the association between shift work and blood pressure, pre-hypertension and hypertension in nursing personnel of a large general hospital. Methods: In a cross-sectional survey, 493 nurses, nurse technicians and assistants, were selected at random in a large general hospital. Hypertension was diagnosed by the mean of four automatic blood pressure readings>= 140/90 mmHg or use of blood pressure lowering agents, and pre-hypertension by systolic blood pressure>= 120-139 or diastolic blood pressure>= 80-89 mmHg. Risk factors for hypertension were evaluated by a standardized questionnaire and anthropometric measurements. The association between turns of work, defined as day or night, and by the combination of turns, and blood pressure, pre-hypertension and hypertension was explored in bivariate and multivariate analyses, controlling for risk factors for hypertension by covariance analysis and modified regression Poisson. Results: The mean age of the participants was 34.3 ± 9.4 years and 88.2% were women. Night shift workers were older, more frequently married or divorced, and less educated. The prevalence of hypertension in the whole sample was 16%, and 28% had pre-hypertension. Blood pressure (after adjustment for confounding) was not different in day and night shift workers. The prevalence of hypertension and pre-hypertension by shift work (day/night and combination of turns) was not different in the bivariate analysis and after adjustment for confounding (all risk ratios = 1.0). Conclusion: Night shift work is not associated with blood pressure, hypertension and pre-hypertension in nurses and nurses assistants working in a large general hospital.

Objective: To evaluate the association between shift work and blood pressure, pre-hypertension and hypertension in nursing personnel of a large general hospital. Methods: In a cross-sectional survey, 493 nurses, nurse technicians and assistants, were selected at random in a large general hospital. Hypertension was diagnosed by the mean of four automatic blood pressure readings>= 140/90 mmHg or use of blood pressure lowering agents, and pre-hypertension by systolic blood pressure>= 120-139 or diastolic blood pressure>= 80-89 mmHg. Risk factors for hypertension were evaluated by a standardized questionnaire and anthropometric measurements. The association between turns of work, defined as day or night, and by the combination of turns, and blood pressure, pre-hypertension and hypertension was explored in bivariate and multivariate analyses, controlling for risk factors for hypertension by covariance analysis and modified regression Poisson. Results: The mean age of the participants was 34.3 ± 9.4 years and 88.2% were women. Night shift workers were older, more frequently married or divorced, and less educated. The prevalence of hypertension in the whole sample was 16%, and 28% had pre-hypertension. Blood pressure (after adjustment for confounding) was not different in day and night shift workers. The prevalence of hypertension and pre-hypertension by shift work (day/night and combination of turns) was not different in the bivariate analysis and after adjustment for confounding (all risk ratios = 1.0). Conclusion: Night shift work is not associated with blood pressure, hypertension and pre-hypertension in nurses and nurses assistants working in a large general hospital.

Objective: To evaluate the association between shift work and blood pressure, pre-hypertension and hypertension in nursing personnel of a large general hospital. Methods: In a cross-sectional survey, 493 nurses, nurse technicians and assistants, were selected at random in a large general hospital. Hypertension was diagnosed by the mean of four automatic blood pressure readings>= 140/90 mmHg or use of blood pressure lowering agents, and pre-hypertension by systolic blood pressure>= 120-139 or diastolic blood pressure>= 80-89 mmHg. Risk factors for hypertension were evaluated by a standardized questionnaire and anthropometric measurements. The association between turns of work, defined as day or night, and by the combination of turns, and blood pressure, pre-hypertension and hypertension was explored in bivariate and multivariate analyses, controlling for risk factors for hypertension by covariance analysis and modified regression Poisson. Results: The mean age of the participants was 34.3 ± 9.4 years and 88.2% were women. Night shift workers were older, more frequently married or divorced, and less educated. The prevalence of hypertension in the whole sample was 16%, and 28% had pre-hypertension. Blood pressure (after adjustment for confounding) was not different in day and night shift workers. The prevalence of hypertension and pre-hypertension by shift work (day/night and combination of turns) was not different in the bivariate analysis and after adjustment for confounding (all risk ratios = 1.0). Conclusion: Night shift work is not associated with blood pressure, hypertension and pre-hypertension in nurses and nurses assistants working in a large general hospital.

The research problem is the increasing numbers of overweight and obese nurses working the night shift. Study on overweight and obesity among female Filipino nurses has not been conducted. It was important to conduct a research study among female Filipino nurses to find out if there are statistically significant associations between night shift work and weight gain. The purpose of this correlational and cross-sectional study was to determine if there are statistically significant associations between insufficient sleep, abnormal eating patterns, working 12-hour shifts, years of working night shift, age, stress, marital status, nursing units, decreased physical activity, and level of weight gain among female Filipino nurses working the night shift in the hospital. The theoretical base of this study was the locate evidence, evaluate evidence, assess evidence, and informed decision model. The survey questionnaire was constructed and an online survey through Survey Monkey was used to access nurses via a convenience sampling. Data were analyzed using Spearman correlation, multiple regression, and ANOVA. According to study findings, there were significant associations between insufficient sleep, abnormal eating patterns, marital status, 12-hour shifts, number of years working on night shift, and increased in body mass index. The implications for social change include information that nurses can use to better understand the negative implications of night shift work on health. At the organizational level, this study provides information for administrators and nursing leaders that might facilitate change in policies by improving working conditions for nurses.