Development And Validation Of A Clinical Prediction Model For Shift Work Sleep Disorder Among Chinese Nurses

Objective: Guided by the Newman system model,the Walker and Avant conceptual analysis method was used to analyze the concept of shift word sleep disorder in nurses,and to analyze the prerequisites,influencing factors,adverse consequences,and evaluation tools of shift work sleep disorder,and to investigate the influencing factors of shift work sleep disorder in the follow-up research.Provide guidance on the selection of assessment tools;through a cross-sectional study,the adverse effects of shift work as an environmental stressor on nurses’ sleep and health were identified.To build a prediction model for nurses’ shift work sleep disorder,which can be used for early assessment and early diagnosis of whether shift nurses have sleep disorders and the probability of their occurrence.Methods: mixed methods.Part one: Shift work sleep disorder: a concept analysisIn this study,the Walker and Avant concept analysis methods were used to systematically search the literature related to shift work sleep disorder.The search databases included: Pub Med,Embase,Web of Science,CNKI,Wanfang,and CBM databases.Retrieval time limit: database construction-April 2021.Through literature analysis,the preconditions,attribute characteristics,influencing factors,adverse consequences,and commonly used assessment tools of shift work sleep disorder were systematically sorted out.And applying qualitative research methods,typical cases,related cases,critical cases,and opposite cases were formed by interviewing shift nurses in different departments.To provide the basis for the design of influencing factors and the selection of questionnaires in the follow-up investigation and research,and to let nurses understand the characteristics of shift work sleep disorder in reality through case studies,and to understand how the influencing factors affect sleep disorders of nurses in the follow-up research through interviews.Part two: Association between night shift and sleep quality and health among Chinese nurses: a cross-sectional studyFrom March to June 2020,by the shift work sleep disorder conceptual analysis,based on the data of the nurses’ health cohort in Shengjing Hospital in 2019,through the "SO JUMP" network platform,the general information questionnaire,Pittsburgh Sleep Quality Index(PSQI)and The Cornell Health Index(CMI)is made into an online questionnaire,and nurses fill in the questionnaire on the mobile terminal through the network link.After collecting and arranging the data,the chi-square test was used for categorical variables,and the independent samples t test was used for continuous variables to analyze the statistical differences between the shift and non-shift nurses.The effects of shift work on nurses’ sleep and health were analyzed by an adjusted linear regression model.Part three: Development and validation of a clinical prediction model for shift work sleep disorder among Chinese nursesFrom February to May 2021,a cross-sectional survey was adopted,with the healthy cohort of nurses at a Grade A tertiary hospital as the research object,and guided by the first part of the review of the attributes,influencing factors and commonly used measurement tools of shift sleep disorders,the design Questionnaires that comprehensively reflect the influencing factors and outcome indicators of shift work sleep disorders among nurses,including: General Information Questionnaire,Generalized Anxiety Disorder Scale,Depression Module in Patient Health Questionnaire,Occupational Stress Assessment,Family Support Assessment,Sleep Hygiene Assessment,Outcome Main applications of indicators: Insomnia Severity Index Scale,Epworth Sleepiness Scale for evaluation.The above-mentioned questionnaires are made online through the "SO JUMP" network platform,and the nurses fill in the questionnaires through the mobile phone.The included shift nurses were randomly divided into training set population and validation set population according to the ratio of 2:1.In the training set population,the risk factors of nurses’ shift sleep disorder were analyzed by univariate logistic regression model,and the multivariate logistic regression model was used to screen the predictors and establish a visual nomogram.The developed prediction model is evaluated and verified by calculating the discrimination,calibration,and clinical validity of the prediction model constructed by the training set population and the validation set population.Results:Part one: After a systematic search,54 articles were screened and included in the study.Through literature analysis,the prerequisite for shift work sleep disorder is to engage in work related to shift work;4 attributes include: mismatch of internal/external circadian rhythms,impaired sleep,multi-dimensional health problems,and dynamic changes in symptoms;influencing factors mainly include: :Risk factors related to shift work such as night shift length,shift type,interval time,physical and mental health,poor lifestyle and sleep hygiene,personal factors such as family support,presence of minor children,etc.;adverse consequences include:physical and mental health Impact,impact on family/social adaptation,impact on job performance/safety/satisfaction;commonly used measurement tools include:Pittsburgh Sleep Quality Index,Insomnia Severity Index,Epworth Sleepiness Scale,etc.Through interviews with shift nurses in different departments,typical cases,boundary cases,related cases,and opposite cases were constructed according to the attributes of shift sleep disorders.Part two: A total of 3206 nurses were included in this study,including 1289 day shift nurses and 1917 night shift nurses.Night shift nurses had worse sleep quality than day shift nurses(55.14% VS 45.23%,p < 0.05),and had more physical health problems(20.71% VS 17.61%,p < 0.05).Shift work was significantly positively associated with poor nurse sleep quality(? = 0.96,95% CI = 0.67～1.26)and poor health(? =2.01,95% CI = 0.15 ～ 3.88).Night shift was significantly associated with other domains of the PSQI and physical health,except for sleep medication(? = 0.02,95%CI =-0.01～0.05)and mental health(? = 0.38,95%CI =-0.27～1.03).Further analysis found that day-shift nurses once participated in shift work longer than night-shift nurses,and night-shift nurses were relatively young and had high professional titles;night-shift nurses were more likely to experience daytime sleepiness,sleep disturbance,difficulty falling asleep,low sleep efficiency,and lack of energy during the day than day-shift nurses.Health effects revolve around:cardiovascular system,digestive and genitourinary systems,fatigue,lack of perception of mental health problems.It is suggested that we should pay attention to the impact of shift work on nurses’ occupational health,and develop diagnostic tools such as predictive models for early detection and early diagnosis of sleep disorders in shift-shift nurses,so as to promote nurses’ occupational health.Part three: A total of 1239 shift nurses were included in this study,including 660(53.27%)nurses with shift sleep disorders and 579(46.73%)nurses with non-shift sleep disorders.According to whether there is shift sleep disorder,the two groups are divided into groups,and the analysis shows that the two groups have statistics in terms of marital status,age,whether there are children,professional title,whether to shift quickly,whether there is a chance to take a nap,the length of nap,the number of night shifts per month,and the number of night shift nurses.Differences: According to the random grouping principle of 2:1 ratio,the shift nurses were divided into training set population and validation set population,which were 843(2/3)shift nurses and 396(1/3)shift nurses,respectively.For the variables with statistical differences between the nurses in the shift sleep disorder group and the non-shift sleep disorder group,a univariate Logistic regression analysis was performed item by item in the training set population.The number of night shifts and the number of night shift nurses were the independent influencing factors of shift sleep disorders among nurses;the multivariate logistic regression analysis of the variables with differences in univariate analysis showed that the number of night shift nurses was greater than or equal to 3(OR: 0.57,95% CI: 0.41～0.78)and family support(OR: 0.97,95% CI:0.95 ～ 0.99)were protective factors for nurses’ shift-shift sleep disorder.Sleep hygiene(OR: 1.12,95% CI: 1.06～1.18),depression(OR:3.34,95% CI: 2.31～4.82),high workload(OR: 2.05,95% CI: 1.26 ～ 3.33)were risk factors.In addition,according to the research results and expert recommendations of the second part,the monthly night shift number is incorporated into the establishment of the forecasting model.Using R software to draw a nomographic model for predicting nurses’ shift-shift sleep disorders.By analyzing the validation set population and the training set population to evaluate and verify the model’s discrimination,calibration,and clinical effectiveness,it was found that the area under the ROC curve of the training set and validation set AUC values were 0.759 and 0.752,respectively,suggesting that the developed nurses sleep during shift work.The performance of the disorder prediction model was excellent,and it could well distinguish whether the shift nurses had sleep disorders.Calibration plots plotted on the training and validation sets show that the model’s predicted risk of shift sleep disorder is highly consistent with the actual risk.Clinical decision curve analysis showed that the model could benefit the population as a whole.Conclusion:1.This study conducted a conceptual analysis of shift sleep disorder,and systematically analyzed the prerequisites,influencing factors,adverse consequences,attributes,and commonly used measurement tools of shift sleep disorder.The analysis of the influencing factors,adverse consequences and measurement tools of shift work sleep disorder can provide theoretical guidance for the later research on the impact of shift work on nurses’ sleep and health and the prediction model of nurse shift sleep disorder,especially for the comprehensive design and investigation of the risk of shift work sleep disorder in nurses.Factors,screening predictors,and scientific measurement of outcome variables will play a theoretical guiding role.2.According to the theoretical guidance of Newman’s system model about stressors breaking through the body’s resistance line and causing poor health.Through a cross-sectional study,it was verified that shift work as a risk factor for environmental exposure has adverse effects on nurses’ sleep and health.Risk factors for the impact of shift work on nurses’ sleep and health should be identified,and an assessment tool should be constructed for nurses’ regular assessment,so as to promote nurses’ protection against the hazards of shift work and improve occupational health.3.By investigating and screening the independent risk factors of shift sleep disorder in nurses,a clinical prediction model for shift sleep disorder in nurses is constructed,which can be used for nurses to regularly self-assess the probability of shift sleep disorder,so as to detect and prevent the occurrence of shift sleep disorder early.Through the results of this study,the enlightenment for nursing managers is that they should rationally allocate nurses’ human resources,increase the number of night-shift nurses,and reduce workload through scientific shift scheduling,so as to ensure that nurses get adequate rest during night shifts.And pay attention to provide psychological support,such as mental health education,in order to reduce the occurrence of sleep disorders in nurses working shift;shift nurses should also actively seek family support,develop good sleep habits,improve sleep hygiene.In order to improve the occupational health of shift nurses,ensure the quality of nursing and patient safety.