VALIDITY AND RELIABILITY OF SHIFT WORK DISORDER QUESTIONNAIRE AMONG INDONESIAN FEMALE NURSES

Nurses on shift work experience several symptoms such as excessive sleep, insomnia, feeling tired and fatigue. This situation could be inimical to health, and lead to the conditions known as shift work disorder (SWD). A tool is needed to measure shift work disorder among shift work nurses. It can be used to understand the ailment, and support strategies to prevent it. The aim of this study was to adapt SWD questionnaire for use in Bahasa. The study was a cross-sectional study among 201 female nurses who worked on shift duties at public hospital from March to April 2020. The questionnaires were self-administered via an online platform. SWD questionnaire was measured using three questions from previous study. It was used to measure sleep disorder related to work schedule. Permission to use this questionnaire was granted by original author. The process of translation and adaptation SWD questionnaire based on WHO studies. Cronbach alpha was used to measure internal consistency reliability. Exploratory factor analysis (EFA) using principal axis factor to examine construct validity. Confirmatory factor analysis (CFA) was used to assess the structural model fit of SWD. The cronbach alpha for SWD questionnaire was 0.834, which indicated adequate reliability. All of the items in SWD questionnaire had factor loading greater than 0.32, and the CR and AVE of SWD questionnaire were 0.951 and 0.751, which indicated good convergent validity. This study validates the psychometric properties of SWD questionnaire among Indonesia Female Nurses, including translation, validity, and reliability.

Health Problems among Nurses Due to Flexible Working Conditions

Sleepiness and sleeplessness are symptoms of shift work disorder (SWD), a sleep disorder caused by a person's work schedule. Understanding the mechanisms underlying shift work-related health concerns may be necessary when scheduling shifts, establishing employment routines, providing clinical care, and selecting employees. In today's workplace, stress has become the most influential element impacting individual efficacy and satisfaction. In this environment, occupational stress is becoming increasingly prevalent in the nursing profession. Nurses in today's healthcare system encounter several obstacles. These difficulties develop as a result of issues at the organizational, state, and national levels. It is critical for nurses to first recognize and comprehend every potential difficulty they may confront to deal with them effectively. Not only should they be recognized and understood, but methods to minimize them should also be sought.

P014 Shift work disorder and the prevalence of help seeking behaviours for sleep concerns in Australia

Introduction Shift work disorder is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help-seeking behaviours for sleep in shift workers is limited. Methods As a part of a national sleep health survey, data were collected on the help-seeking behaviours for sleep problems in an online sample of Australian individuals on non-standard work schedules (n=448). Of the sample of non-standard workers, 10.5% (n=41) met the criteria for probable shift work disorder (pSWD). Results Non-standard workers with pSWD did not seek help for sleep problems at higher rates than workers without SWD (p = .979). General practitioners were the most reported healthcare professional sought out for sleep problems of individuals with pSWD. Self-management was common in workers with pSWD, with a high self-reported prevalence of alcohol use (31.7%) as a sleep management strategy, and caffeine consumption (76.9%) as a sleepiness management strategy. The majority of individuals with pSWD reported the mentality of ‘accept it and keep going’ as a sleepiness management strategy, highlighting a potential barrier to help-seeking behaviour in workers with pSWD. Discussion These findings provide novel insight into the help-seeking behaviours of individuals with pSWD. There is a need for further research to understand why individuals at risk for shift work disorder are not actively seeking help, and to develop health promotion and intervention strategies to improve engagement with healthcare professionals.

P052 Mental health predictors for shift work disorder in paramedics during their early career

Introduction Shift work disorder (SWD) involves excessive sleepiness and/or insomnia and is associated with poor health outcomes in those affected. This study assessed the prevalence of and risk factors for SWD during the first six-months of paramedics’ careers. Furthermore, the study explored potential mediators in the relationship between mental health and SWD risk. Methods Recruit paramedics’ (n=101) SWD risk (SWD-Screening Questionnaire) was assessed at baseline (i.e., before shift work) and at six-months after engaging in shift work as a graduate paramedic. Logistic regression models assessed whether baseline depression (Patient Health Questionnaire-9) and baseline anxiety (Generalised Anxiety Disorder Questionnaire-7) predicted a high risk for SWD at six-months. Lavaan path analysis was used to assess whether shift and sleep variables, created from participants’ sleep and work diaries, mediated the relationship between mental health and SWD risk. Results After six-months of emergency work 21.5% of paramedics were high risk for SWD. Baseline depression predicted 1.28-times greater odds for SWD at six-months. Shift and sleep variables were not mediators in the relationship between baseline mental health and subsequent SWD risk. Baseline depression was independently associated with increased sleepiness levels following paramedics’ major sleep periods across all work conditions (nightshift, workdays, and non-workdays) at six-months. Depression levels before shift work also predicted a greater perceived workload on nightshifts. Conclusions Depression symptoms before starting shift work are a modifiable risk factor for SWD. Moreover, the first six-months of paramedics’ careers is a critical period for implementing preventative measures for SWD, including interventions to decrease depression symptoms.

Circadian Rhythm Disorders

Circadian rhythm disorders are a group of sleep conditions that involve a misalignment of an individual’s internal timekeeping system with that of one’s desired sleep-wake time. This desynchrony can compromise sleep health as well as the functioning of other organ system, and significantly diminish one’s quality of life. There are six well-defined circadian rhythm disorders that can be classified as either intrinsic or extrinsic, based on the underlying factors that contribute to the condition. Intrinsic circadian disorders include the following: 1) advanced sleep-wake phase disorder, 2) delayed sleep-wake phase disorder, 3) irregular sleep-wake rhythm disorder, and 4) non-24-hour sleep-wake rhythm disorder. The two circadian disorders caused by external factors include 1) shift work disorder, and 2) jet lag disorder, both of which are due to behaviorally mediated misalignments of circadian system. This chapter serves to summarize these disorders, guide clinicians towards screening and evaluation of these conditions, and introduce basic treatment strategies that can be applied by non-sleep medicine clinicians.

Psychosocial Features of Shift Work Disorder

To better understand Shift Work Disorder (SWD), this study investigates insomnia, sleepiness, and psychosocial features of night workers. The study compares night workers with or without SWD to day workers with or without insomnia. Seventy-nine night workers and 40 day workers underwent diagnostic interviews for sleep disorders and for psychopathologies. They completed questionnaires and a sleep diary for 14 days. The design was observatory upon two factors: Work schedule (night, day work) and sleep (good sleep, SWD/insomnia). Two-way ANCOVAs were conducted on psychosocial variables, and effect size were calculated. The clinical approach chosen led to distinct groups of workers. Night workers slept several periods (main sleep period after work, naps, nights on days off). High total wake time and low total sleep time characterized sleep in SWD. Most night workers with SWD still complained of sleepiness after main sleep. Cognitive activation distinguished groups of night workers. All other differences in psychosocial variables between night workers groups were similar to, but smaller than, the ones between day workers. The evaluation of SWD should consider all sleep periods of night workers with particular attention to self-reported total wake time, state sleepiness, and level of cognitive activation.

518 Preliminary report on the efficacy of behavioral therapy for insomnia in shift work disorder: a randomized control trial

Introduction Around 33% of shift workers suffer from shift work disorder (SWD). SWD includes insomnia and sleepiness related to the atypical work schedule. Most SWD treatments rely on light therapy or pharmacology. Few studies explored CBT-I efficacy for insomnia in shift work and reported promising results. The study aims to evaluate the efficacity of a behavioral therapy for insomnia adapted for SWD (BT-SWD). Methods Forty-three night shift workers meeting SWD criteria were recruited (mean age = 34 years old; 77% women) and randomized to either BT-SWD or waiting list control group. Eight participants dropped-out while waiting. Before and after treatment, participants completed questionnaires (ESS, ISI, STAI and BDI-II) and sleep diaries throughout the experimentation. BT-SWD involves sleep restriction therapy and stimulus control for insomnia as well as fixed sleep periods in the dark for shift workers. BT-SWD has been applied to night sleep, day sleep, and naps in this order. It consists of 6 sessions of 50 minutes delivered on 8 weeks. A mixed MANOVA was conducted on questionnaires scores with group (treatment or waitlist) as the between-subject factor and time as the within subject factor. Results A multivariate interaction effect was significant, F(6,21) = 8.24, p<.001. A univariate interaction effect was observed for the BDI-II (p=.042), the trait scale of the STAI (p=.021) and the ISI, both for night sleep (p=.027) and day sleep (p<.001), indicating that the scores of participants in the treatement group lowered significantly more than those of participants on the waiting group. The treatment group had a significantly less severe insomnia, both for day sleep during night work (p<.001), and night sleep during days off (p<.001). There was no significant difference between the control and the treatment group on sleepiness levels. Conclusion BT-SWD is effective at reducing insomnia severity as well as levels of trait anxiety and depression. Results are more equivocal for sleepiness. The waiting list control group design used has led to an important attrition in the context of shift work. Further analyses are needed to determine the BT-SWD efficacy on sleep variables. Support (if any) The study was supported by a CIHR grant (#110254) awarded to the first author