A review study on impact of shiftwork on health

 

Donode Manju Indrakumar1*, Dr. Sonam Bhasin2

1 PhD Scholar,Calorx Teacher's University, Ahmedabad, Gujarat, India

Email: manjudonode113@gmail.com

2 PhD Guide,Dept. of Home Science, Calorx Teacher's University, Ahmedabad, Gujarat, India

Abstract - Shift work is a prevalent practice in various industries, essential for maintaining continuous operations and services. However, an increasing body of research indicates that shift work can have significant adverse effects on workers' health. This review examines the current literature on the impact of shift work on physical and mental health outcomes. The findings suggest a strong association between shift work and increased risks of cardiovascular disease, gastrointestinal disorders, metabolic syndrome, sleep disturbances, and mental health issues such as depression and anxiety. The review also explores the mechanisms underlying these health effects and discusses potential interventions to mitigate the negative consequences of shift work.

Keywords: Shiftwork, Impact Health

INTRODUCTION

Shift work, defined as any work schedule that falls outside the traditional 9-to-5 workday, is integral to modern economies, particularly in sectors such as healthcare, manufacturing, transportation, and emergency services. While shift work enables round-the-clock service delivery and operational efficiency, it disrupts the natural circadian rhythm of workers, leading to various health complications. This review aims to synthesize existing research on the health impacts of shift work, with a focus on understanding the breadth and depth of these effects. By examining both physiological and psychological outcomes, this review seeks to provide a comprehensive overview of how shift work influences health and to identify potential strategies for mitigating its adverse impacts.

WORK-LIFE BALANCE

Striking a balance between work and personal life is essential for employees in any field, but especially for shift workers. Definitions of work-life balance (WLB) can vary widely and be difficult to pin down due to the myriad of factors that can impact it. Some people believe in "working to live" and view work as an objective, while others think about "living to work" and put work at the centre of their lives (Delecta, 2011, p. 187). Various definitions are provided in the table found in Appendix 1. A lot of people take Clark's (2000) concept of work-life balance—or work-family balance, as other authors call it—as gospel. "Satisfaction and good functioning at work and at home with a minimum of role conflict." According to Clark (2000), p. 751. Nonetheless, there are definitions that put more weight on the notion that individuals have to find a balance between their various responsibilities, both at work and outside of it, if they want to be happy (Kalliath & Brough, 2008). According to these several definitions, work-life balance (WLB) is the chance and challenge of reducing the negative social and physical impacts of work on workers' well-being while establishing a balance between non-work responsibilities and duties and obligations. Two studies (Albertsen et al., 2014; Lockwood, 2003) found that a strong WLB promotes commitment, productivity, and decreases turnover. In view of the negative consequences of insufficient WLB, this idea stands out as the key variable in this research (Albertsen et al., 2014).

SHIFT WORK & SCHEDULES

Multiple factors, including "individual, family, work & organisation, and the social environment" (Delecta, 2011, p. 187), constitute what is often known as work-life balance (WLB). There are a lot of variables that influence work-life balance, according to some research. These include gender, age, marital status, number of children, hours worked, degree of workplace engagement, commitment fulfilment, and corporate support (Sturges & Guest, 2004). It is believed that these elements might serve as potential controllers. Or, as stated by Greenhaus et al. (2003), p. 513, WLB may instead be categorised into "time balance, involvement balance, and satisfaction balance." There are three main types of work-family conflicts, as stated by Wöhrmann et al. (2020): (1) time-based disagreements, (2) strain-based conflicts, and (3) conduct-based conflicts. For the purpose of this research, work-life balance (WLB) will be divided into three groups: (1) time-based conflicts; (2) involvement-based conflicts; and (3) satisfaction-based conflicts. This is an amalgamation of the differences highlighted by Wöhrmann et al. (2020) and Greenhaus et al. (2003). You may find a summary of this in Appendix 2. Last but not least, research (Kamphuis, 2018) found that employees reporting higher levels of work-life conflict were more likely to skip work.

DIFFERENT SHIFT WORK SCHEDULES IN PUBLIC HEALTHCARE

In the public healthcare sector, there are many shift work patterns that are used. Schedules may be highly chaotic and difficult to categorise into any one kind of shift schedule, but they can also be quite organised and predictable, following a set pattern of shifts called rotation. Shift systems for extended operations, two-shift, regular and irregular three-shift, permanent night work, and others are defined by Sallinen and Kecklund (2010). One of the most prevalent types of shift arrangements in the healthcare sector is the two-shift schedule, which entails permanently assigning certain employees to work night shifts and others to work day shifts (alternating between morning and evening hours). Researchers Sallinen and Kecklund (2010) tallied up all the necessities for every shift plan. More so, "shift systems can be distinguished by the direction of shift rotation involved when the worker changes from one block of shifts to the next." (Tucker et al., 2000, p. 678). Therefore, it's not just the quantity of shifts that matters, but also their order, or rotation. The public health field does not normally use a shift system where employees are constantly swapped out. Nevertheless, these shift rotations could still be considered in cases with unpredictable schedules (Klein Hesselink et al., 2010). "Collective schedules" refer to more rigorous rotation plans implemented for teams of employees, while "individual schedules" are more adaptable and tailored to the needs of specific individuals (Knauth, 1993).

GENERAL EFFECT OF SHIFT WORK ON EMPLOYEES

One may make the case that, on the whole, workers are more negatively affected by shift work than positively. Tiredness, social life, and physical and mental health are some of the many influenced factors that several authors have discussed (Åkerstedt, 2003; Folkard & Tucker, 2003; Harrington, 2001; Sallinen & Kecklund, 2010). The research on the effects of shift work patterns on work-life balance will address each of these issues separately because of their significance. The intricacy of the subject makes it impossible for this overview to include everything. Since shift workers are unable to participate in as many family and social activities (such going to a sporting or religious event), shift employment affects workers' social and familial life, according to research. According to Harrington (2001, p. 69), this is why shift work is associated with social exclusion. Working shifts may lead to less sleep for workers, which in turn impacts their leisure time or causes a "disturbed social life" (Åkerstedt, 2003; Folkard & Tucker, 2003, p. 99), according to some authors. Schedule flexibility may be an advantage of shift work, but the drawbacks become more apparent when taking into account responsibilities connected to children and marriage (Harrington, 2001).
Åkerstedt (2003), Folkard & Tucker (2003), Harrington (2001), Sallinen & Kecklund (2010), and "impaired health" (Folkard & Tucker, 2003, p. 99) are some of the negative effects of shift work on employees' health outcomes. The risks of cardiovascular and gastrointestinal illnesses, anxiety, depression, and pregnancy are increased among shift workers, according to research (Åkerstedt et al., 2002; Harrington, 2001). People who work shifts have "disrupted circadian rhythms," say Folkard and Tucker (2003, p. 99). Last but not least, gender is another factor that influences the effects of shift work on employees. Åkerstedt et al. found that shift employment was more common among women compared to men. two years ago. Rigid work schedules seem to have a greater detrimental effect on women than men, they explain. Eby et al. (2005) found that employees' "productivity, job satisfaction, and work schedule satisfaction" increased when they had more leeway to decide when and how they worked. This is because employees reported higher levels of satisfaction when given more leeway to plan their workdays around their own needs.
Remember that there may be discrepancies between the perceived and objective timelines when it comes to shift work schedules. Objective schedules are work plans that provide unbiased data, such the gap between real and expected labour hours. Some employees may find working 12 hours straight, or even overnights or weekends, more difficult than others, hence shift schedules may also be seen as perceived schedules. One kind of scheduling justice is distributional justice; another is procedural justice; a third is informational justice; and a fourth is interpersonal justice (Uhde et al., 2020). Politeness, culture, and the subjective fairness of rules and processes are all kinds of justice. Based on these kinds of justice and perceived fairness, it is "important to not only consider the objective quality of the resulting shift schedule (i.e. from the economic or legal point of view), but also the subjective experiences of the people involved," as stated by Uhde et al. (2020, p. 10). We will consider this background later on, when we are collecting data and developing our technique, when we will be looking at how shift workers perceive their schedules alongside the "facts" of shift work.

EFFECT OF SHIFT WORK ON WLB

The relationship between shift work and work-life balance has been the topic of many insightful systematic reviews of the relevant research. Review articles (Albertsen et al., 2008; Eby et al., 2005; Iskra-Golec et al., 2017; Van Amelsvoort et al., 2004; Williams, 2008; Wirtz et al., 2011; Wöhrmann et al., 2020) provide a solid summary of the current research status (see Appendix 3). Employee views are significant since this research focused on particular elements of shift work rather than shift work itself, which is complex and calls for greater inquiry. So yet, this has not been mentioned in any reviews.
Research on shift work and work-life balance is complex and important. One study, by Van Amelsvoort et al. (2004), found that HR policies and companies should prioritise the "interplay of working hours and work-life balance" (Holly & Mohnen, 2012, p. 2). More studies on the topic of work-family ties among shift workers are clearly required (Iskra-Golec et al., 2017). They found that shift work negatively affects many things, including marital communication, but that shift employment positively affects childcare and taking shift preferences into account when parents' schedules are complementary. The impact of variables and work patterns on WLB is examined in Williams' (2008) study. Regular night and evening schedules, split hours, rotating shifts, irregular shifts, casual or on-call positions, and so on were all considered shift work in this research. A "self-perceived notion," work-life balance (WLB) is what the research found."Shift schedules are connected to WLB satisfaction through a complex interaction of hours worked, self-perception, and general feelings of well-being" (p. 15). I am worried that the results of this study, which were done in 2008 in Canada, may have the same negative effect in 2021 in Germany.
Wöhrmann et al. (2020) provides a synopsis of current research on three distinct issues:(1) shift work;(2) work-family conflict; and(3) the effect of shift work on work-family conflict. Studies like Williams (2008), Van Amelsvoort et al. (2004), and Albertsen et al. (2008) have more out-of-date conclusions since this one came out in 2020, a year ago.
Finding a happy medium between work and personal life when working shifts could be unpredictable is no easy task (Wöhrmann et al., 2020). Employees' social and family life may be severely impacted by shift work and irregular schedules, contrary to common notion, according to a review of the effects of shift work on work-family conflict. Further, studies have shown that shift work is associated with increased work-family conflicts, while no such association has been found between family and work conflicts (Wöhrmann et al., 2020). More studies are looking at how shift work negatively impacts WLB (work-life balance). Albertsen et al. (2014), Arlinghaus & Nachreiner (2016), Dall'Ora et al. (2016), Greubel et al. (2016), and Wirtz et al. (2011) found that working long hours or on Sundays results in low levels of WLB. Many people who work shifts feel guilty about the time they miss out on spending with their loved ones (Eby et al., 2005).
WHAT FACTORS IMPACT PUBLIC HEALTH CARE SHIFT WORK SCHEDULES
When assessing the public healthcare system's shift work arrangement, experts have pointed out a number of factors that must be considered. Drawing on information from previous studies, Appendix 4 provides a more detailed, though still incomplete, overview of the factors influencing shift work schedules. This table includes all of the factors and effects of shift work based on the studies that referenced them. Considerations like the "number of successive night shifts, the length of the night shifts and the provision of breaks within them" (Folkard & Tucker, 2003, p. 99) are necessary for assessing the shift system's risk. Some other factors that have been mentioned in previous studies by Åkerstedt (2003), Klein Hesselink et al. (2010), Knauth & Hornberger (2003), Sallinen & Kecklund (2010), Wöhrmann et al. (2020), and others are the following: the maximum number of consecutive shifts, the direction and speed of shift rotation, the sequence of shifts, the duration of a shift, the time off between shifts, the start and end times of shifts, and whether they are nights or weekends.
The variables were included as research variables because, as this summary shows, the study by Härmä et al. (2015) provides the most comprehensive evaluation of factors. According to Härmä et al. (2015), there are 29 aspects of working time patterns. These include the duration and intensity of working hours, the diversity of start and finish times, and the social aspects of working hours.

SLEEP DEPRIVATION AND WORKPLACE FATIGUE

In most cases, disruptions to the quality, quantity, or duration of sleep lead to sleep deprivation. Daytime sleepiness, reduced sleep enrichment, and loss of restorative sleep are the most typical symptoms of sleep deprivation (Waters & Bucks, 2011). Panjwani, Ray, Chatterjee, Bhaumik, & Kumar (2010) found that the quantity and quality of sleep a person gets at night correlates with their degree of alertness throughout the day. The effects of sleep deprivation may be mitigated if adults get the recommended 8 to 9 hours of quality sleep nightly. To compensate for sleep loss, which is a collective phenomena, one must increase the amount of time spent sleeping and the quality of that sleep (Tewari, Soliz, Billota, Garg, & Singh, 2011). The current demands of the nursing profession make this impractical in many cases. Furthermore, the duration of awake time increases in proportion to the degree of fatigue. People often experience mid-day and mid-night fatigue and a lack of energy as a result of disruptions to their internal circadian rhythm (Geiger- Brown et al., 2014). Sleep deprivation might endanger not just the individual but also the public. Fatigue from not getting enough sleep impacts one's physical and mental skills, which are necessary for doing even the most basic tasks. Among the most often acknowledged consequences of sleep deprivation and fatigue include delays in reaction time, low motivation, difficulties focussing, diminished attention, poor coordination, poor judgement, and issues processing information and memory. Workplace exhaustion is a major problem in modern industrialised nations because of longer work hours, more demanding operations, cumulative sleep loss, and circadian rhythm irregularities, which are common in many industries (Sadeghniiat-Haghighi & Yazdi, 2015). Companies that operate around the clock have been accused of posing a safety concern due to employees' lack of sleep and occupational weariness. Workplace exhaustion is defined by Steege and Pinekenstein (2016) as a multi-faceted condition that hinders normal cognitive and physical functioning. It happens when workers' schedules, the conditions in which they work, and the tasks they are required to do put them under undue stress. No matter how much training, knowledge, or experience you have, you will eventually tire out. Those who work in transit, industrial shifts, flying trans-meridian routes, the armed forces, and healthcare all deal with sleep loss and exhaustion to varied degrees (Panjwani et al., 2010). Aside from drug-induced weariness, workers experiencing similar shifts have reported varying degrees of tiredness (Autumn, Monica, Jitendra, & Bharat, 2016). In the US alone, occupational fatigue costs an estimated $18 billion per year (Sadeghniiat-Haghighi & Yazdi, 2015). Indeed, studies conducted during the 1990s have shown that nighttime operator errors result in double the amount of rework, worse productivity and quality, and higher product prices (Van Reeth, 1998).

the effects of sleep deprivation and fatigue in night shift nursing

The idea of healthcare professionals putting in more hours has been floating about for some time. Reinke, Ozbay, Dieperink, & Tulleken (2014) found that night shifts may have a detrimental effect on functioning and performance, particularly for healthcare workers who are permitted to work longer hours. Carers must remain alert and observant despite the effects of fatigue if healthcare is to be provided safely and effectively (Dubeck, 2014). When it comes to helping people, few occupations are as taxing and challenging as nursing. Responsibility and accountability in healthcare delivery need high levels of emotional stability, cognitive functioning, and performance (Wali, Qutah, Abushanab, Basamh, Abushanab, & Krayem, 2013). Efforts to improve diagnostic tools and treatment alternatives have not eliminated quality of care inequalities (Reinke et al., 2014). According to Hans et al. (2014), it is now well acknowledged that nursing fatigue poses a danger to both the safety of nurses and their patients. Numerous studies have shown that working night shifts or lengthy hours may lead to fatigue and poor sleep quality. There is a potential for hazardous nursing practice because to the anticipated decrease in consciousness with length of wakefulness (Berger & Hobbs, 2006). Overnight shifts and 12-hour shifts are common for American nurses, who provide direct care to patients. Nearly two-thirds of the 23,000 nurses who took part in the study's cross-sectional analysis worked 12-hour shifts or longer, found Stimpfel, Sloane, and Aiken (2012). Another interesting fact is that 1,617,200 registered nurses work in healthcare facilities throughout the nation (American Nurses Association, 2011). Medical errors are three times more likely to occur in shifts when nurses work 12.5 hours or longer, according to survey study by Domen et al. (2015). The Occupational Safety and Health Administration (2013) warns that workers should not be required to remain alert for more than eight hours at a time. The Joint Commission used data on shift lengths in a 2011 study that argued for the need of reducing fatigue among healthcare professionals. Although chronic fatigue is associated with both working and sleep hours, it has no effect on or correlation with nurses' cognitive performance, according to Barker and Nussbaum (2011) (Martin, 2015). For nurses, factors related to weariness on the job include physiological and psychological exhaustion, lack of recovery time between shifts, job satisfaction and professional satisfaction, self-harm, and job contentment; for patients, factors linked to fatigue include medical errors and potential medical errors (Martin, 2015). Reinke et al. (2014) found that nurses' inadequacy in handling unexpected work patterns might put patients at risk due to lapses in judgement or carelessness. Additionally, research has shown that sleep-related fatigue negatively affects patient outcomes and performance (Domen et al., 2015). Researchers found that night shift weariness was a factor in needlestick injuries among medical trainees and nurses. Nurses who don't get enough sleep are more likely to have impaired cognitive function, which means they could hurt their patients in addition to being less productive at work. Lack of empathy and an increased risk of burnout and depression further lower the quality of care that nurses provide (Fallis, McMillan, & Edwards, 2011). There are many different aspects of health care that contribute to patient safety, including the safe use and administration of medications.

FATIGUE MANAGEMENT APPROACHES

Both working-age people and those seeking primary care often report feeling chronically and generally exhausted. Chronic fatigue affects 0.42–2.6 percent of the population, whereas 3.6% of working-age adults report experiencing occupational weariness (Ali et al., 2014). Worker training to identify and treat symptoms of fatigue and chronic exhaustion is crucial for safe-sensitive industries because of the underappreciated harmful effects of fatigue on workplace performance and productivity (Ali et al., 2014).
Due to the persuasive consequences of workplace tiredness, several businesses have instituted processes to decrease the likelihood of mistakes, injuries, and accidents that may result from long work hours, irregular work schedules, or prolonged working hours. Workplace design and technology upgrades, education and training, legislation limiting maximum hours worked, impervious scheduling, methods to prevent and manage tiredness both during and between shifts, and studies on the topic of fatigue management are common examples of such tactics (Scott et al., 2010). Large businesses are more receptive to applying methods that reduce the risk of fatigue while working since research has shown a correlation between this and increased productivity. Methods for lowering the probability of fatigue, systems for reporting fatigue, training programs for employees, supervisors, and executives, investigations into instances of fatigue, and maintenance and sleep disorder screening programs are all part of the arsenal of tools used to manage the risk of fatigue (Randolph, 2015).
INDIAN HEALTH SCENARIO
With 17% of the world's total population, India easily qualifies as the second most populous country. India's economy has grown rapidly since liberalisation and structural adjustment measures were implemented, even if concerns about inequality and poverty have persisted. Over the last few years, the nation's economy has grown at an average pace of over 8%, making it one of the world's fastest-growing economies. Emerging infectious diseases and antibiotic resistance, changing demographics and the environment, health-related behavioural issues, and the increasing focus on non-communicable diseases are all new public health challenges. However, the country has made commendable strides in other health-related domains, and these accomplishments are worthy of praise. some of these goals include eradicating smallpox, decreasing baby and maternal mortality, and increasing life expectancy.

PUBLIC HEALTH SECTOR

In terms of public health, we may think of the federal government, state governments, and even certain local and regional organisations. The Ministry of Health and Family Welfare is in charge of the health system within the federal government. There is a very consistent administrative structure that all of the state governments follow. District hospitals and hospital operations are overseen by a District Medical Superintendent, whereas rural non-hospital tasks are overseen by a Chief Medical Officer/District Health Officer. In both big and small towns, the health program hierarchy of the various municipalities are varied. There is a wide variety of healthcare institutions within the realm of public health. There are a small number of specialised hospitals for conditions including leprosy, tuberculosis, and mental health, but the vast bulk of healthcare is provided by district, civil, cottage, rural, teaching, non-teaching, and maternity facilities.
Depending on the population, large cities may have a number of state-run hospitals, some of which are teaching hospitals. In addition, there are hospitals and clinics run by regional organisations. A variety of in-and out-of-hours services are provided by the district's primary health care delivery system, which includes community health centres (CHCs), primary health centres (PHCs), and sub centres (SCs). With 30 inpatient beds and a variety of programs, each CHC should be able to help 100,000 people. The inpatient and outpatient services offered by city and civil hospitals serve as primary, secondary, and tertiary care institutions, respectively. The network of municipal corporations in urban areas is responsible for providing for the health requirements of the population via facilities such as Urban Family Welfare Centres (UFWC), Health Posts (which serve about 1.5 lakh people), and Post Partum Centres. (The 2005-2006 Academic Year of Nursing).
CONCLUSION
The review highlights the significant health risks associated with shift work, emphasizing the need for awareness and intervention strategies to protect workers. Health issues such as cardiovascular disease, metabolic disorders, gastrointestinal problems, and mental health challenges are prevalent among shift workers. Understanding the mechanisms behind these health effects is crucial for developing effective interventions. Employers, policymakers, and healthcare providers must collaborate to implement evidence-based strategies, such as optimizing shift schedules, promoting healthy lifestyle practices, and providing access to medical care, to mitigate the negative health impacts of shift work. Future research should focus on long-term studies and intervention trials to further elucidate the relationship between shift work and health and to refine strategies for improving worker well-being.
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