Sleep, Mindfulness, and Shift-Level Safety Performance in Perianesthesia Nurses: A Prospective Repeated-Measures Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 300
- 试验地点
- 1
- 主要终点
- Shift-Level Perianesthesia Safety Deviation Rate
研究概览
简要总结
Perianesthesia (preoperative and postanesthesia care unit, PACU) nurses work rotating, often extended shifts that can disrupt sleep and increase fatigue, both of which are recognized threats to patient safety in high-acuity perioperative settings. Mindfulness, a trait-like capacity for present-moment, non-judgmental awareness, has been proposed as a psychological resource that may help nurses regulate attention and buffer the effects of sleep loss and fatigue on clinical performance. However, little is known about how sleep quality and quantity, shift-level fatigue, and mindfulness jointly relate to the day-to-day safety performance of perianesthesia nurses.
This prospective, repeated-measures, single-center study examines the relationships among sleep, mindfulness, and shift-level safety performance among nurses working in the perianesthesia/PACU care areas of Ağrı Training and Research Hospital. Approximately 25 to 40 perianesthesia nurses will be followed across 8 to 12 of their own shifts each, with a target of 250 to 300 evaluable shift-level observations. At baseline, nurses will complete a demographic form together with the Pittsburgh Sleep Quality Index (B-PSQI) and the Mindful Attention Awareness Scale (MAAS). Before each observed shift, nurses will complete a brief pre-shift sleep and sleepiness diary; after each shift they will complete a post-shift acute-fatigue and shift-characteristics form. For each observed shift, trained researchers will use a researcher-developed Perianesthesia Safety Process Observation Form to document adherence to, and deviations from, applicable safety-critical care processes.
The primary outcome is the Shift-Level Perianesthesia Safety Deviation Rate, defined as the number of observed safety-process deviations divided by the number of applicable safety processes for that shift. Secondary outcomes include post-shift acute fatigue, the occurrence of near-miss events, and exploratory analyses of whether trait mindfulness moderates the associations between sleep/fatigue and safety performance. No patients are directly enrolled as research subjects; only nurses and their shifts are observed. Findings are expected to inform strategies to support nurse sleep, wellbeing, and safety-critical performance in perianesthesia settings.
详细描述
Background and Rationale Sleep deprivation and shift work are established threats to human performance, attention, and decision-making, and nurses working rotating or extended shifts in high-acuity perioperative environments are particularly vulnerable to their effects. Perianesthesia nurses, who care for patients before and immediately after anesthesia and surgery, must perform frequent, time-critical, safety-critical tasks such as airway monitoring, medication verification, hemodynamic surveillance, and handoff communication, often under conditions of high cognitive load and interruption. Impaired sleep and accumulated fatigue have been associated in the broader nursing literature with increased rates of near-miss events, procedural deviations, and medication administration errors, but the specific relationship between sleep, fatigue, and shift-level safety performance has not been well characterized within perianesthesia/PACU nursing.
Mindfulness, defined as the capacity to sustain present-moment, non-judgmental awareness of one's internal state and surroundings, has been studied as a psychological trait that may protect against the performance-degrading effects of stress and fatigue. Nurses with higher trait mindfulness may be better able to notice early signs of fatigue-related lapses in attention and to compensate for them during safety-critical tasks. To date, however, few studies have examined whether trait mindfulness moderates the relationship between sleep/fatigue and observed safety performance at the shift level in perianesthesia nursing.
Conceptual Model This study is guided by a conceptual model in which shift-level and person-level sleep parameters (habitual sleep quality, pre-shift sleep duration, and pre-shift sleepiness) and post-shift acute fatigue are hypothesized to be associated with a higher rate of observed safety-process deviations during the shift. Trait mindfulness, measured once at baseline, is hypothesized to act as a moderator that attenuates (buffers) the strength of the sleep-safety and fatigue-safety associations. Because shifts are nested within nurses, and because the same nurse's shifts are likely to be correlated with one another, the design and analysis explicitly account for this nested (multilevel) structure.
Aims and Research Questions
The study addresses the following research questions:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Nurse-Level Inclusion Criteria:
- •Registered nurse currently working in the perianesthesia/PACU care areas of the study hospital
- •Willing and available to be followed across multiple of the nurse's own shifts during the study period
- •Willing to provide written informed consent
- •Nurse-Level
排除标准
- •Not directly involved in bedside perianesthesia/PACU patient care during the observation period (e.g., purely administrative role)
- •Unwilling or unable to complete the baseline and per-shift study instruments
- •Shift-Level Inclusion Criteria:
- •Regularly scheduled perianesthesia/PACU shift of a participating nurse occurring during the study period
- •At least one applicable safety-critical care process occurs during the shift
- •Shift-Level Exclusion Criteria:
- •Shift is shortened, cancelled, or substantially altered such that planned pre-shift/post-shift data collection and safety-process observation cannot be completed
- •Study observer is unavailable to complete the safety-process observation for that shift
研究组 & 干预措施
Perianesthesia/PACU Nurses and Observed Shifts
Registered nurses working in the perianesthesia/PACU care areas of Ağrı Training and Research Hospital, followed prospectively across multiple of their own regularly scheduled shifts. For each nurse, baseline sleep quality (B-PSQI) and trait mindfulness (MAAS) are assessed once; for each observed shift, pre-shift sleep/sleepiness, post-shift acute fatigue, and researcher-observed safety-process adherence are recorded. There is no experimental intervention; nurses continue their usual clinical duties.
干预措施: Sleep, Mindfulness, and Shift-Level Safety Observation Toolkit (Other)
结局指标
主要结局
Shift-Level Perianesthesia Safety Deviation Rate
时间窗: Assessed once per observed shift, over the course of each nurse's participation in the study (approximately 8-12 shifts per nurse across the study period, up to approximately 6 months).
For each observed shift, the number of observed deviations from applicable safety-critical perianesthesia care processes (documented via the researcher-developed Perianesthesia Safety Process Observation Form), divided by the number of applicable safety-critical processes for that shift.
次要结局
- Post-Shift Acute Fatigue(Assessed once per observed shift, immediately at the end of the shift, over the course of each nurse's participation in the study (approximately 8-12 shifts per nurse, up to approximately 6 months).)
- Occurrence of Near-Miss Events(Assessed once per observed shift, over the course of each nurse's participation in the study (approximately 8-12 shifts per nurse, up to approximately 6 months).)
- Moderating Effect of Trait Mindfulness on the Sleep/Fatigue-Safety Association(Baseline MAAS assessed once at enrollment; sleep, fatigue, and safety deviation rate assessed once per observed shift over the course of each nurse's participation in the study (approximately 8-12 shifts per nurse, up to approximately 6 months).)
研究者
Volkan Gokmen
Dr.
Agri Ibrahim Cecen University