The Relationship BetweenInadequate Sleep andUnintentional Injury Group Two B: Amanda Anderson, Trina Cluny, Barbara MacDonald, Barbara Pernsky, Blake Webster MHST/NURS603 - Facilitating Inquiry Athabasca University Dr. M.Myer July 18, 2011
Objective This objective of this presentation is to showcase two studies conducted by Group Two B from the MHST/NURS603 - Facilitating Inquiry class. Following this presentation, students in the class will participate in a discussion forum to provide further insight into the research question. The members of Group Two B appreciate your engagement in reviewing the presentation and participating in the discussion forum. Your contribution will enhance our understanding of the research question and process.
Introduction:Research Process Two small studies were conducted, one qualitative and one quantitative. The sample for the qualitative study consisted of four students from Group Two B, leaving one student as principal investigator. The sample for the quantitative study consisted of all students (n=18) in the MHST/NURS603 - Facilitating Inquiry class The same research question was examined in both studies.
Introduction Sleep is essential to sustaining life. Inadequate sleep contributes to many healthissues and poorer health overall. Is there a relationship between inadequatesleep and unintentional injury? (National Sleep Foundation, 2011)
Introduction:Research Question Findings from two small studies—one qualitative and one quantitative, were used to examine the following research question: ―What are Athabasca University students’ perceptions about the relationship between inadequate sleep and unintentional injuries?‖
Literature Review A substantial body of research exists that links inadequate sleep and sleep problems to increased risk of unintentional injuries in children, adolescents and adults. Adequate sleep has several determinants. The degree of sleep efficiency, sleep quality, and refreshing sleep affects an individual’s ability to function the following day (Rosekind & Gregory, 2010).
Literature Review Sleep deprivation results in a decreased ability to respond quickly to stimuli, decreased attentiveness, and increased daytime sleepiness (Spengler, Browning, & Reed, 2004). Shift workers sleep an hour less per day on average when compared to daytime workers as a result of a disruption in the body’s circadian rhythms (Sleepdex, 2011).
Literature Review Sleep deprivation is the number one most common health complaint of shift workers as it negatively affects quality of life and job performance (Shields, 2003). Sleep deprivation is a major contributing factor in jeopardizing nurses’ psychomotor performance, and creates opportunity for unintentional injury to themselves, co- workers, and patients (Johnson, Brown, & Weaver, 2010).
Ethical Considerations Ethical approval for the studies was not obtained since this was an exercise in student understanding of the processes and application of qualitative and quantitative research methods. Participant information letters and consent forms were developed for both lab exercises to acknowledge the importance of informed consent and adherence to ethical guidelines in research studies involving human participants.
Qualitative Study:Theoretical Framework Utilizing a phenomenological approach each member of a focus group was asked to provide personal insight regarding sleep in an effort to understand their perception of sleep and its relationship to unintentional injuries.
Qualitative Study: MethodsResearch Design An on-line synchronous focus group was conducted with four of the Group two/B members acting as participants and one member acting as Principal Investigator. Focus groups can elicit information from multiple participants creating a picture of combined perspectives. Employing computer technology to conduct focus group sessions allows researchers to bring together participants with similar characteristics regardless of geographic location.
Qualitative Study: MethodsSampling All participants were students of Facilitating Inquiry (MHST/NURS603 at AU). Researchers & participants called Group Two/B which was chosen randomly by Professor Maggie Myers. All participants were health care professionals who have: Varying levels of experience with computers and online communication. Participants – different cultures , ages, different work experiences. Participants from across Canada – different time zones with one student traveling through Asia.
Qualitative Study: MethodsMeasures and Data Collection Data was collected from the four participants during a single on-line focus group session utilizing a Focus Group Interview Guide which was developed by all members of Group Two/B.
Qualitative Study: MethodsStudy Procedures A focus group meeting was scheduled via a chat room session on the Athabasca University (AU) web site created for the course Facilitating Inquiry, MHST/NURS603. The principal investigator facilitated dialogue between the participants. Verbatim transcripts were copied and pasted into a table format according to the order in which the questions were presented. Common themes were identified and grouped together to generate a single, composite response to each of the questions. Findings were validated as all participants participated in data analysis and assisted in writing the final report.
Qualitative Study: FindingsDefining Adequate Sleep Participants felt quality of sleep is more important than number of hours of sleep. All participants felt they did not get enough sleep. Reasons for lack of adequate sleep ranged from shift work, multiple responsibilities of work, master courses, age, family. All participants felt inadequate sleep negatively impacted them physically, emotionally, and spiritually.
Qualitative Study: FindingsInadequate Sleep & Unintentional Injury Participants related poor judgment and lack of mental awareness to inadequate sleep. One participant stated feeling ―at risk for injury as driving home after a night shift is dangerous‖.
Qualitative Study: FindingsPolices to Decrease Unintentional Injury Participants felt there should be guidelines aimed at reducing unintentional injuries related to inadequate sleep. Suggestions regarding who would be responsible for such policies included: unions, governments, nursing associations, workplace safety organizations.
Qualitative Study: DiscussionInterpretation of Results Participants noted that inadequate sleep: tends to negatively impact physical, emotional, and spiritual well-being. can contribute to making poor judgments and a lack of mental awareness. may increase the likelihood of unintentional injuries.
Qualitative Study: DiscussionLimitations of the Study Related to the nature of the lab group exercise and inexperienced researchers. Sample size was limited to four participants. Single session does not provide as much reliable data as multiple sessions. Online chat session did not allow for non-verbal interaction between the group members. There was inherent bias with the researchers acting as participants.
Quantitative Study:Theoretical Framework Utilizing the findings from the qualitative study, a descriptive quantitative study was designed to continue examining the relationship between inadequate sleep and unintentional injury.
Quantitative Study: MethodsResearch Design A 10-item likert survey was designed utilizing the results from a small qualitative study to determine the relationship between inadequate sleep and unintentional injury. Two of the questions allowed for participants to describe the unintentional injury or near miss that they experienced.
Quantitative Study: MethodsResearch Design A coding framework was designed assigning a value from 1-10 depending on the amount of agreement the subject indicated for each variable. Selecting the number 10 indicated the most agreement with the statement; 1 the least amount of agreement. If a question was left blank by the participant or the participant selected N/A a value of 0 was assigned.
Quantitative Study: MethodsSampling Convenience sampling was used for the study, with participants being all of the students enrolled in the Spring Session of the course MHST/NURS 603 (n=18) Participants were students completing graduate-level courses at Athabasca University (AU) with a variety of experiences. Specific demographic information was not collected as this was a learning exercise and ethical approval from AU’s REB was not sought.
Quantitative Study: MethodsMeasures and Data Collection Questionnaire contained 10 questions with multiple responses based on qualitative findings. Likert scale used with consistent numerical value (1 to 10) where: 1 = strongly disagree and 10 = strongly agree. Three questions solicited ―Yes‖ or ―No‖ responses.
Quantitative Study: MethodsStudy Procedures Questionnaire implemented through Survey Monkey participants were notified by email and a posting on AU discussion forum. participants had a two day window to complete survey. Findings analyzed with Survey Monkey and SPSS software.
Quantitative Study: Findings Defining Adequate Sleep 82.3% of participants rated ―based more on quality of sleep than quantity‖ between 8 and 10 on the Likert scale 39.3% of participants identified ―having at least 8-hours of undisturbed sleep‖ as a defining characteristic of adequate sleep on the same scale
Defining Adequate Sleep9080706050 40 30 20 10 0 Quality over Quantity At Least 8 Hours Feeling Rested
Do you get enough adequatesleep the majority of the time? 28% Yes 72% No
Quantitative Study: FindingsDefining Inadequate Sleep ―Being restless and disturbed several times‖ being identified by 82.4% of participants between 8 and 10 on the likert scale. ―Not feeling refreshed and rejuvenated‖ was another important indicator of inadequate sleep identified by 77.7% of participants on the same scale.
Defining Inadequate Sleep90807060 50 40 30 20 10 0 Being Restless/Disturbed Not Feeling Refreshed Not Defined by Specific # of Hours
Quantitative Study: FindingsUnintentional Injury & Sleep While only 16.7% of participants stated they experienced an unintentional injury in the past 12 months that they related to inadequate sleep… 16.7 Yes 83.3 No
Quantitative Study: FindingsUnintentional Injury & Sleep…when asked about ―near misses‖ 61.1% stated theyhad a near miss (of unintentional injury) in the past 12months. 38.9 61.1 Yes No
Quantitative Study: FindingsUnintentional Injury & Sleep 40% of participants identified near misses with medication administration to patients. 40% of participants identified near misses related to driving accidents. Other unintentional injuries/near misses identified included illness and minor injuries related to being less coordinated.
Quantitative Study: FindingsUnintentional Injury & Sleep Correlation between lack of sleep and reported occurrences of unintentional injury and/or near misses were examined using a two-tailed Spearman’s rho test. A significant relationship (correlation coefficient 0.565) was identified between experiencing a near miss of unintentional injury and belief that lack of sleep is linked to increased mistakes.
Quantitative Study: FindingsCorrelation between:Lack of Sleep, Unintentional Injuries, Near Misses A B C A. Lack of sleep is linked to increased mistakes & poor 1.00 0.565* 0.202 performance B. Experienced a near miss of unintentional injury 0.565* 1.00 0.306 C. Experienced an 0.202 0.306 1.00 unintentional injury *Correlation is significant at the 0.05 level (2-tailed)
Quantitative Study: DiscussionInterpretation of Results The study reflects the importance of quality sleep and feeling refreshed upon awakening in relation to one’s ability to perform and function the next day. Consistent with the literature, the findings from this quantitative study indicate a link between inadequate sleep to increased risk of unintentional injuries and near misses. Of particular concern is the rate of near misses associated with inadequate sleep with a statistically significant correlation demonstrated in this study.
Quantitative Study: DiscussionLimitations of the Study Related to the nature of the lab group exercise and inexperienced researchers. Sample size was limited to 18 participants. Response rate to the survey was likely falsely high, as all participants were encouraged to complete the survey as part of their course requirements There was inherent bias with the researchers acting as participants. Convenience sampling increases the potential for bias.
Implications of Both Studies Both qualitative and quantitative studies confirm the relationship between inadequate sleep and unintentional injury. The findings suggest the need for public awareness campaigns to inform about the relationship between inadequate sleep and unintentional injury. The findings draw attention to a need for the development of industry specific standards and public health policies that create supportive environments where adequate sleep is emphasized as a component of reducing the risk for unintentional injuries.
Conclusion Both of these small scale quantitative and qualitative research studies confirm a relationship of unintentional injury and inadequate sleep. The National Sleep Institute urges an investigation to create policies, identify and implement strategies to increase awareness and reduce unintentional injuries related to inadequate sleep. More-extensive research is warranted to build a stronger knowledge base and apply information and strategies to impact health outcomes within broader populations.
References Johnson, A. L., Brown, K., & Weaver, M. T. (2010). Sleep Deprivation and Psychomotor Performance Among Night-Shift Nurses. AAOHN: American Association of Occupational Health Nurses, 58(4), 147-154. National Sleep Foundation (2011) Retrieved from www.sleepfoundation.org/ Rosekind, M. R., & Gregory, K. B. (2010). Insomnia Risks and Costs: Health, Safety, and Quality of Life. The American Journal of Managed Care, 16(8), 617-626.
References Shields, M. (2003).The Health of Canada’s Shift Workers.Health Reports, 13(4), 21-25. Sleepdex. (2011, June).Sleep problems among shift workers. Retrieved from http://www.sleepdex.org/shiftwork.htm Spengler, S. E., Browning, S. R., & Reed, D. B. (2004). Sleep Deprivation and Injuries in Part- Time Kentucky Farmers: Impact of Self Reported Sleep Habits and Sleep Problems on Injury Risk. AAOHN: American Association of Occupational Health Nurses, 52(9), 373- 382.