Introduction: Entering working life as a new nurse is stressful and often an introduction to shiftwork,
which has been associated with impaired sleep and recovery. In a randomized controlled
trial, we previously examined the effects of a proactive ‘sleep and recovery intervention’
for new nurses showing preventive effects on somatic symptoms, decreased burnout and
fatigue symptoms but no significant effects on sleep ratings. The aim of this study
was to examine the effects of the intervention on day-to-day sleep, detachment and
stress.
Methods: 209 new nurses were recruited at eight Swedish hospitals and randomly assigned into
an intervention or control group (Clinical Trial NCT04246736). The intervention included
three 2,5h group sessions, with psychoeducation on strategies enhancing sleep and
recovery, based on cognitive behavioral therapy techniques modified for shiftworkers.
A subsample of participants (64 in the intervention group, 74 in the control group)
wore an actigraph and filled in a diary for one week before (baseline) and after (follow
up) the intervention. The diary contained questions from the Karolinska Sleep Diary;
sleep quality index, anxiousness at bedtime, questions about detachment (difficulties
stopping thinking about work during free time), satisfaction with leisure time and
feeling tense. Sleepiness (Karolinska Sleepiness Scale) and stress were rated during
the day. Regression analysis estimated the effect of treatment on outcomes, controlling
for baseline scores.
Results: The mean age was 27 years (SD=5.2), 86% were women with an average of 3.1 months
(SD=2.5) experience in the profession. Measures during days off showed that at follow
up, the intervention group reported significantly less problems with detachment (-0.59,
95% CI -0.87- -0.3) and exhibited -3.39 percentage points less fragmented sleep (95%
CI -6.76- -0.02). A significant interaction indicated that those who had more problems
detaching at baseline also had a greater benefit of treatment (-0.41, 95% CI -0.7
- -0.13, t = -2.9, p = 0.004). The intervention had no significant effect on other measures of sleep,
satisfaction with leisure time or feeling tense during days off. Measures during workdays
showed that at follow-up, the intervention group reported less problems with detachment
(-0.47, 95% CI -0.76- -0.17), felt less tense (-0.25, 95% CI -0.48- -0.03) and reported
higher satisfaction with their leisure time (-0.22, 95% CI -0.43- -0.01). The intervention
did not affect sleep outcomes during workdays. There were no significant effects on
sleepiness or stress ratings either during workdays or days off.
Conclusion: Results were promising showing that detachment was improved during workdays and days
off, indicating that the intervention could promote better conditions for sleep and
recovery for new nurses. Sleep was only improved during days off, which might indicate
that organisational factors affect the use of sleep-improvement strategies during
workdays. This should be examined further in future studies. Support: AFA Insurance
(150024).
