SleepDeprivationPODDelta

Running head: SLEEP DEPRIVATION POD DELTA 1
Sleep Deprivation POD Delta
Deyanira Martinez, Niani Conerly, Jonathan Foster, Allyson Derrick, Lisa Burks
Patty Hanks Shelton School of Nursing
Community and Public Health
Tammie Coffman, RN, MSN, OCN-C
December 2, 2014

SLEEP DEPRIVATION POD DELTA 2
Sleep Deprivation POD Delta
Community Defined
The World Health Organization includes the definition of Community as: “A group of
people, often living in a defined geographical area, which may share a common culture, values
and norms, and are arranged in a social structure according to relationships which the community
has developed over a period of time. Members of a community gain their personal and social
identity by sharing common beliefs, values and norms which have been developed by the
community in the past and may be modified in the future” (Lancaster & Stanhope, 2014)
People
Nurses comprise the single largest component of hospital staff, are the primary providers
of hospital patient care, and deliver most of the nation’s long-term care (Rogers, 2006).
According to Healthy People 2020, “poor sleep health is a common problem with 25% of U.S.
adults reporting insufficient sleep or rest at least 15 out of every 30 days”. In a study that
analyzed the variables related to sleep deprivation 45% stated that they experienced insufficient
sleep prior to beginning the shift (Silva-Costa, Griep, Fischer, Rotenberg, 2012).
Place
The United States is one of the fastest growing countries and has one of the most
advanced health care systems in the world. Currently, the United States of America has a
population of 319,362,407 residents and counting (U.S. Census Bureau, 2014). Out of the
growing population nurses make up a large percentage in the community. Nursing is the nation’s
largest healthcare profession, with more than 3.1 million registered nurses (Rogers, 2006).
Function

It is important as health-care professionals in the workforce to be educated on the risks
associated with sleep deprivation. Becoming aware of this issue will significantly reduce
medical errors and provide a better patient outcome. Normally, a nurse is able to take on a full
load of patients while simultaneously having the capacity to integrate and apply skills, utilize
knowledge, and make swift decisions regarding particular nursing tasks (Hye-Won & Mi-Ran,
2014). Consequently, it is necessary to precisely confirm the level of nursing competency to
determine the effectiveness of patient care (Hye-Won & Mi-Ran, 2014).
Sleep, like nutrition, is a physical necessity. It is a critical component of health and
needed for optimal performance in the work environment (Sleep Health, 2014). Fatigue and
sleep-deprivation both influence basic patterns of behavior that can negatively affect nursing care
and interpersonal relationships with the patients (Sleep Health, 2014). The lack of sleep can
reduce productivity and significantly increase the chance for medical errors that can be
detrimental to the health of the patient (Sleep Health, 2014). According to Healthy People 2020,
“Adequate sleep is necessary to fight off infection, support the metabolism of the body, and work
effectively and safely”.
Community as a Client
The community we are looking at is night shift nurses/new night shift nurses. The
problem we are focusing on is sleep deprivation among night shift nurses. Studies have reported
that fatigue due to inadequate or impaired sleep is a common problem among nurses (Hasson &
Gustavasson 2010). Not only is sleep deprivation a problem among night shift nurses, but
studies also show nurses develop sleeping pattern problems when asked to work nights and days
(Hasson & Gustavasson 2010). Impaired sleep seems to be a frequent problem, especially
among women. “Sleep in America Poll, showed 60% of the women stated that they only get a

good nights sleep a few nights per week or less”. As many as 46% stated that they experienced
sleep problems every night (Hasson & Gustavsson 2010). It is important for the nurses to get an
adequate amount of sleep because mistakes due to the lack of sleep are a growing epidemic
among nurses.
Sleep deprivation has been associated with poor psychomotor performance, poor decision
making, slowed reaction time, irritability, periods of micro-sleep, ineffective communication,
and lethargy (AAOHN Journal 2010). Not only would more sleep benefit the nurses by cutting
their mistakes and boost their immune system, but also most importantly it helps the patient
because you don’t have a fatigued, poorly focused nurse providing care.
Community Health
Community Health is defined as, “the meeting of collective needs by identifying
problems and managing behaviors within the community itself and between the community and
the larger society” (Lancaster & Stanhope, 2014). This definition focuses on the overall goal of
Community Health, along with status, structure, and process. The use of all three dimensions is
an effort to broaden the definition of Community Health and focus on the notion that “the earlier
in the causal process interventions occur, the greater the likelihood of improved health”
(Lancaster & Stanhope, 2014).
Status
Status in Community Health involves the biological, emotional, and social aspects of
Nursing outside of the hospital atmosphere. Using the biological status standpoint, the number
of work related incidents in the hospital affect the interactions in the community as well. In the
American Journal of Nursing November 2014 edition, Implementing Evidence-Based Medication
Safety Interventions on a Progressive Care Unit, a survey was held to find out the top 5 reasons

for medication errors in the hospital setting. Fatigue was the 4th and 5th most common reason
nurses said their medication errors occurred pre-intervention ranking at 22.6% and 26.6%. Post-
intervention, Fatigue was listed as 5th most common reason ranking at 22.7% (Williams, 2014).
The emotional part of health status is often measured by consumer satisfaction; however, it is
clear that no patient is satisfied with receiving the wrong medication, the wrong dose, or the
wrong time, due to a nurse’s lack of sleep. In this case, the social aspect of health status focuses
on the functional level of the nurse when he/she is working under sleep-deprived conditions. As
discussed throughout this document, the functionality of a tired nurse is hindered greatly in ways
more likely than not, harm the patient. Overall, the status, or outcome, of sleep-deprived nurses
is not good, and should be addressed in the hospital, community facilities, and at a personal level
as well.
Structure
Community Health focuses on not only the issue at hand, but also ways to treat this
growing problem. Structure compares the services at hand, and the problems at hand when these
resources are not utilized. Specific resources aimed to educate and guide nurses will be further
talked about later in the document; however, it is important to use the data already in place to
help guide planned treatment. Understanding the types of errors that occur under specific
circumstances can help the education department when it comes time to teach nurses how to
better their sleep habits. The problem aspect of structure is concerning in that often times “it is
the false belief that simply providing health care improves health” (Lancaster & Stanhope, 2014,
p. 401). In our case of sleep deprivation, just providing the knowledge and tools needed to
practice healthy sleep, does not mean that healthy sleep will be made a priority to the practicing
nurses on shift. Structure in the community also has to do with the community demographics,

race, and education level. Being aware of their relationship to the care being provided is
important in prior knowledge of the importance of sleep, as well as ways to cope with bouts of
deprived sleep.
Process
Community Health views the process aspect as overall problem solving; looking at how
the nurse and the community agree to work together to provide overall wellness to others. It is
the job of the nurse to direct this care. Lancaster and Stanhope’s Public Health Nursing textbook
states that, “once change is indicated, then the community must define and make available the
resources for the change to occur” (Lancaster & Stanhope, 2014, p. 401). In the aspect of sleep
deprivation in nurses, the literature data has made evident that fatigue and work related errors is
a growing problem. Now it is up to active nurses and their community to decide if the health of
their patient’s is worth solving this issue.
Competence
The last aspect of Community Health is similar to a summary of parts talked about above.
Community competence states that if a community is working as it should, in a healthy manner,
they “are able to collaborate effectively in identifying the problems and needs of the community;
can achieve a working consensus on goals and priorities; can agree on ways and means to
implement the agreed-on goals; and can collaborate effectively in the required actions”
(Lancaster & Stanhope, 2014, p. 401). The way a community goes about performing these tasks,
depends on the resources available, and the effort put into the health of the community.
Partnerships
The ultimate goal is to be able to reduce risks from nurses due to sleep deprivation, create
and sustain a network of safety, and maintain a conducive work environment. “Both nurses and

employers have an ethical responsibility to carefully consider the need for adequate sleep when
deciding whether to offer or accept work assignments” (ANA Board of Directors, 2014). One of
the organizations that is striving to alleviate the issue of sleep deprivation in the nursing field is
the American Nurses Association. The American Nurses Association Board of Directors,
beginning September 10, 2014, made a revised position statement addressing nurse fatigue
associated with shift work (ANA Board of Directors, 2014). The National Sleep Foundation
describes a “shift worker” as anyone that works beyond the typical hours of nine to five
(National sleep foundation, 2014). According to the Bureau of Labor Statistics, millions of
Americans are considered shift workers, including nurses (National sleep foundation, 2014).
According to this position statement it is the collaborative responsibility of the nurses and
the employers to understand the risks associated with sleep deprivation and to also ensure the
safety of patient’s lives (ANA Board of Directors, 2014). It is the nurse’s obligation to arrive to
work well rested, remain alert at work, and to promote health promoting behaviors throughout
the work environment that will decrease the risk of errors (ANA Board of Directors, 2014). The
nurse’s responsibility may even entail rejecting work assignments in order to allow enough time
to attain a sufficient amount of sleep (ANA Board of Directors, 2014). The American Nurses
Association suggests that the nurse participate with employers regarding a work schedule that
will best meet his or her needs (ANA Board of Directors, 2014).
The responsibility of the employer is to make an official policy that allows nurses
opportunities to accept or decline work assignments without being penalized while
simultaneously maintaining adequate staffing. Most importantly, employers need to promote a
safe environment that ensures the best patient outcome (ANA Board of Directors, 2014).
Requiring periodic audits can ensure that these specific policies are being followed adequately

(ANA Board of Directors, 2014). It is vital that the nurse know their own limitations and decline
any additional work shifts or overtime that will contribute to additional fatigue.
The National Sleep Foundation suggests that shift workers that are sleep deprived are
very limited to the amount of pharmacological and behavioral treatments, but they do offer
coping strategies that can maintain alertness in the work environment (National sleep foundation,
2014). These strategies include: taking short periodic nap breaks throughout the shift, drinking
caffeinated beverages, and completing the most complicated tasks at the beginning of the shift
(National sleep foundation, 2014). Additional recommendations include improving wellness by
eating a well-balanced diet, exercising and managing stress, as well as getting seven to nine
hours of sleep the night prior to coming to work (ANA Board of Directors, 2014). Nurses and
employers can collectively reach out to these organizations for additional advice on how to
reduce medical errors and learn about other effective coping mechanisms.
Data
Nurses who are experiencing sleep deprivation are at risk for disrupting their patients and
their own safety. This is evidenced by nurses that are working night shift “are less alert and
more likely to struggle to stay awake during the latter half of the shift than are nurses working
permanent day or evening shifts” (Fallis, McMillan, & Edwards, 2011). There are many effects
that can inhibit the person experiencing fatigue, such as: slowed reaction time, attention lapses,
less attention to detail, compromised problem-solving, impaired psychomotor skills, reduced
coordination, and finally more errors of omission (Stokowski, 2012). At this point, nurses
experiencing fatigue become a hazard to themselves and the patients in their care.
The data suggests that the sleep deprivation problem lays in nurses who are trying to
switch their schedules in order to work night shift, or who have to switch their sleep schedules

multiple times during the week (Salisbury, 2011). Since working during the nighttime hours is
not a natural schedule for our bodies to take on, many nurses may find that it is difficult and
tiresome to switch their sleeping schedules. “If a person tries to sleep during the declining phase
of melatonin secretion, sleep can be shorter with more awakenings” (Stokowski, 2012).
Stokowski relays just one of the any barriers to nurses trying to switch their sleep schedule.
Since melatonin production is related to the amount of light taken in, it is difficult to convince
one’s body to go to sleep when their circadian clock is on the downslide of melatonin
production. “As many as 25% of hospital nurses go without sleep for at least 24 hours in order
to adjust to working on the night shift, which, in fact, is the least effective strategy for adapting
their internal, circadian clocks to a night-time schedule” (Vize, 2011). This would become even
more of a danger because they are going way past time without any sleep. The Vanderbilt study
(Salisbury, 2011) conducted DNA testing as part of their research. This was done in order to
determine “the extent to which their circadian clocks influenced their adaptation”. The results
showed that there are different chronotypes -- whether they are early or late risers. This is an
interesting beginning to understanding why some nurses may be better suited for working night
shift than others. One gene, PER3, appear to have a major impact on the effectiveness of the no
sleep strategy. “Individuals with one variant of this genotype appear to respond more poorly
than average to this strategy while those with the other genotype appear to respond better than
average” (Salisbury, 2011).
This becomes a problem when it affects their cognitive and physical abilities. Many
errors may occur during this time that are related to care and medication administration.
Stokowski concluded that, “a survey of critical care nurses found that 26% had experienced

personal work injuries or near injuries, 16% had been involved in patient safety incidents, and
20% had accidents or near accidents on the drive home—all believed to be related to fatigue.”
Methods to obtain data related to sleep deprivation in nurses working the night shift
primarily include secondary analysis of data previously collected. This is evidenced by the use
of the primary resources, such as the Vanderbilt study conducted by David Salisbury. In another
study, like the one from American Journal of Nursing November 2014 issue, “Implementing
Evidence-Based Medication Safety Interventions on a Progressive Care Unit,” surveys and
questionnaires were completed to gather nurses’ inputs about the cause of medication errors.
Community Nursing Diagnosis
To address the growing problem of Nurses continuing to work despite their lack of sleep,
a Community Nursing Diagnosis has been formulated to address this issue, and will later be
broken up into goals and outcomes, interventions, and evaluation. The Nursing Diagnosis of,
Sleep Deprivation among night shift Nurses related to disturbed sleep pattern as evidenced by
increased medical errors, encompasses the population, the problem, and the result. Not only is it
detrimental to a Nurse’s overall health, but the lack of sleep causes potentially deadly mistakes
for patients as well.
Planning
Individuals working nights and rotating shifts rarely obtain optimal amounts of sleep. In
fact, an early objective study showed that night shift workers obtain 1 to 4 hours less sleep than
normal when they were working nights (Rogers, 2006). In order to improve the quality of care
and prevent medical errors that could be life threatening, there are several practices that should
be employed by the nurse who struggles with sleep deprivation (Bixby, 2008). When working a
shift that increases the odds of sleep deprivation, eating properly will aid in maintaining health.

Ensuring that a well-balanced diet is taken into account by the professional before to beginning
of the shift can aid in proper cognitive function and lead to a safe and effective shift.
Family support is also important to managing shift work. “Night shifts cause disruption
to personal and family lives and may result in higher levels of stress”, says Hungs. The nurses’
family members and friends need to be aware and understanding that your day is like their night
shift (Bixby, 2008). They need to understand that you need quiet sleep to be well rested in order
to provide the best care to each patient. It may be necessary to establish household rules so that
proper sleep health can be maintained (Bixby, 2006).
Often caffeine might seem like a solution to tiredness, but according to research in the
May issue of the journal SLEEP, “caffeine should be consumed in moderation”. The researchers
who conducted the study suggest that night shift workers who need to stay alert should consider
taking frequently low doses of caffeine (Bixby, 2006). “While there is no perfect substitute for
sleep, our results point the way toward a much better method for using caffeine in order to
maintain optimal vigilance and attention, particularly when someone has to remain awake longer
than the traditional 16 hour wake episode”, said James Wyatt, PhD, sleep researcher at Rush
University Medical Center in Chicago and lead author on the study, in a press release (Bixby,
2006).
In order to reduce the risk of medical errors while increasing the overall workplace
productivity and profitability, managers can also take the following actions to improve the
quality of care by educating their employees about the relationship between sleeplessness and
workplace accidents, lack of productivity and personal health (Massey, 2012). They can also
educate employees on sleep hygiene that can be used to help ensure proper sleep and monitor the
number of errors in order to emphasize to the employee how the lack of sleep can affect

judgment and decision-making (Massey, 2012). The manager can make suggestions for
employees suspected of suffering from sleep deprivation to keep a "sleep log" to identify if they
are experiencing a lack of sleep quantity or quality (Massey, 2012). By encouraging employees
not to overwork or rewarding long working hours only for the sake of working can significantly
decrease the number of nights in a row that employees are assigned to work and ensure proper
lighting for those engaged in shift work to promote wakefulness (Massey, 2012).
Sleeplessness and fatigue can be costly and potentially result in severe cases of injury and
death of patients and employees. Research in the field of sleep deprivation and what to do about
it indicates managers should take action now to avoid potentially catastrophic consequences
(Massey, 2012). Sleep deprivation needs to be included as part of any company's health and
safety considerations, as it can result in higher levels of company profitability but more
importantly, it helps protect the health of their fellow employees and the community as a whole
(Massey, 2012).
Implementation
Nurses need optimal alertness and psychomotor ability to perform their duties. In a study
among night shift nurses, 75.9% of nurses used caffeine to stay awake, which is considered
acceptable if only moderate amounts are consumed (AAOHN, 2010). There is data that
contributes to the idea of napping during their shift, “to improve performance, reduce fatigue,
and increase vigilance for individuals working extended hours or during night shift” (Fallis,
McMillan, & Edwards, 2011). The majority of sleep-deprived nurses claim to have only slept
approximately less than 5 hours in a 24-hour period. Earlier studies reported that sleep
restrictions of 5 hours or less, results in a lower psychomotor performance (Fallis, McMillan, &
Edwards, 2011). “Restorative napping, defined as a purposeful, brief sleep period, has been

identified as a potential strategy to improve performance, reduce fatigue, and increase vigilance
for individuals working extended hours or during the night shift” (Critical Care Nurse Online,
2012). When workers are allowed to nap, it shows that memory and vigilance are improved. In
a study of a planned nap for emergency department physicians and nurses, Smith-Coggins and
colleagues reported that participants had fewer performance lapses, and reported more intense
focus, less fatigue, and less sleepiness during their shift (Critical Care Nurse Online, 2011).
Studies will also show that halfway through a shift, between 2 A.M. and 3 A.M., a 30-minute
nap showed vast improvements on subjective and objective measures of alertness in hospital
workers (Critical Care Nurses Online, 2011). Having an extremely focused and alert nurse
benefits the patients significantly. Not only is the nurse more aware of the patient’s needs in
general, but also it reduces the risk of medical errors. However, the risk for errors increases due
to the sleep deprivation and lack of focus of the night shift nurse.
Evaluation
There are many different strategies that are suggested throughout the research. Many
theories or methods depend on the individual nurses’ preferences. These strategies can include
napping during the shift, maintaining the nighttime schedule on days off, controlling exposure to
light, depending on whether you are trying to sleep or not, and avoiding nicotine and caffeine
before sleeping. Sleep aids may be helpful, however some may experience fatigue upon waking
while under the influence of the sleep aids.
Napping is preferred by some nurses, but not by others. A study conducted of critical
care night-shift nurses, with an average of 17 years of experience, reported that 77% of the
participants who napped regularly reported benefits of napping. They felt refreshed, energized,
and alert. The other 23%, who did not nap regularly, reported feeling disoriented and tired

(Fallis, McMillan, & Edwards, 2011). Napping may not always be reasonable on a shift due to
the workload a limited amount of staff. Fallis reported additional contributing factors such as:
unstable patients, not being in a comfortable place to nap, and being too busy as reasons why
nurses are unable to nap at work.
Nurses may find that they are not able to get a sufficient amount of sleep to do their jobs
efficiently. A sleep diary might help to record any themes or recurring patterns in their sleep
schedule. Using their available resources, will deliver numerous strategies to aid in the battle the
fatigue and sleep-deprivation among night-shift nurses.

References
Fallis, W. M., McMillan, D. E., & Edwards, M. P. (2011). Napping during night shift:
Practices, preferences, and perceptions of critical care and emergency
department nurses. Critical Care Nurse, 31(2), e1-e11. doi:10.4037/ccn2011710.
Hasson, D., & Gustavsson, P. (2010). Declining Sleep Quality among Nurses: A
Population-Based Four-Year Longitudinal Study on the Transition from Nursing
Education to Working Life. Plos ONE, 5(12), 1-6. doi:10.1371/journal.pone.0014265
Hye-Won, K., & Mi-Ran, K. (2014). Nursing Competency as Experienced by Hospital
Nurses in a Clinical Nursing Unit. International Journal Of Bio-Science &
Bio-Technology, 6(4), 235-244. doi:10.14257/ijbsbt.2014.6.4.22
Lancaster, J., & Stanhope, M. (2014). Public Health Nursing: Population-Centered
Health Care in the Community. Maryland Heights, Missouri, United States of
America: Elsevier Mosby
Massey, T. (2012). The risks of falling asleep on the job. Occupational Health, 64(11),
18-19.
Nursing Fact Sheet. (n.d.). Retrieved November 13, 2014.
Salisbury, D. (2011, April 14). Sleep strategy used by night nurses throws off their
circadian clocks. Retrieved from
http://news.vanderbilt.edu/2011/04/nurse-sleep-circadian-clocks/.
Shift Work and Sleep. (2014). Retrieved from http://sleepfoundation.org/sleep-
topics/shift-work-and-sleep (n.d.). Retrieved December 2, 2014, from
http://www.nursingworld.org/Addressing Nurse-Fatigue-ANA-Position-Statement.pdf

Sleep Health. (2014). Retrieved from
http://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health
Stokowski, L. A. (2012). Help Me Make it Through the Night(shift). Ohio Nurses
Review, 87(2), 12-16.
Vize, E. (2011). Sleep tight. World Of Irish Nursing & Midwifery, 19(5), 53
Williams, DNP, APRN, FNP-C, T., et. al. (2014). Implementing Evidence-Based Medication
Safety Interventions on a Progressive Care Unit. American Nursing Journal. Vol. 114,
No. 11

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