Industrial and economic requirements impose many work organizations in terms of rhythms and schedules. Currently, shift work affects 15% to 20% of the working population in developed countries [1] [2] [3]. However, all the impacts on the health of an employee in flexible hours and night shifts are still not yet fully understood [2].

The consequences of shift work on health, psychological balance, and socio-family life are numerous: sleep problems, vigilance, mood, cardiovascular disease, cancer, weight gain, metabolic and digestive problems, menstrual cycle disturbance, the procedures for pregnancy, occupational and traffic accidents [4]

From a point of view of regulation, the shift and/or night work of nurses is not specifically described. It is incorporated into the general legislation on night work, defined as a paid activity performed between 8 p.m. and 5 a.m. (art. 106 of the Congolese Labor Code) [5].

The notion of permanence of services and particularly medical care has full significance in a hospital environment. The nurses take turns in shifts: the day shifts give way to the night shift in the evening, after a period of 15 to 30 minutes of transmission and the reverse occurs in the morning. Night work is carried out in a fixed position or in alternating day/night mode. Nurses on shift schedules are also victims of disparities in the management of their working time towards day nurses: on night shifts, they work 12 hours a night while a day lasts on average 8 hours. On the other hand, the organization of working time in three shifts implies overlaps between the shifts.

In the United States, Europe and Asia, sleep problems caused by shift or night work in hospitals have been reported to affect work performance on most nurses [6] [7] [8] [9] [10]. However, in sub-Saharan Africa, few or none of surveys has been done on the relationship between shift or night work and nursing profession. Thus, we carried out this work in Pointe-Noire, Congo, at the Loandjili General Hospital (LGH), aiming to describe the impact of shift work on nurses’ health and quality of life.

The realization of this study was confronted with certain limits in particular the mismatch on the real number of nurses working at the Loandjili General Hospital. The documents received by the nursing directorate and human resources departments did not provide data. The study retained as the total number of nurses, that provided by the Nursing Department which is the user of resources made available. Besides this, local or African bibliographic references on the matter are rare or almost non-existent despite the Medline search strategy. Comparisons were only made with American, European and Asian references, notwithstanding the significant differences in lifestyles.

Our study has found a relatively young population of shift nurses; the average age was 35.68 years. Gold and al, in his work had an average age compared to ours (35 years) in the group of shift nurses [6]. On the other hand, Shen et al., who studied effects of shift work in a general population of employees, has found an average age of 42.1 years among shift employees [13]. This difference in average age between the general population and that of nurses can be explained by the fact that the option of working nights or alternating hours in hospitals often depends on seniority. Young nurses are generally assigned to rotating shifts and older nurses to day shifts.

On this point, many studies show a better tolerance of shift work among young employees than among older ones [7] [14] [15] [16].

The female predominance in both groups only confirms the feminization of the nursing profession. In this regard, the literature shows that women complain much more than men about troubles linked to shift work [14] [15].

Data from the literature show a better adaptation to shift work among single people than among employees living together as a couple. In the latter, partner labor is often a source of secondary complications [17] [18].

There is little longitudinal data on the effect of tenure. However, some studies show an increase in the relative risk of developing a cardiovascular disease beyond 5 years of sentant in shift work [1] [4], an irreversibility of sleep problems linked to shift work beyond 20 years. years and an increased risk of developing breast cancer among nurses who have practised 20 years or more in a rotating system compared to nurses who have worked only daytime all their lives [4].

In our series, we have found sleep disturbances among LGH nurses on shift schedules with very significant differences compared to nurses of the day. These disturbances included average sleep duration, sleep quality, sleep depth, sleep efficiency, sleep satisfaction and excessive daytime sleepiness. In the literature, studies have also found a decrease in the average sleep time among employees shifted for 1 - 2 hours compared to the sleep time of day employees [19] [20] [21] [22]. On the other hand, some series do not find a significant difference between the average duration of sleep among shift and/or night employee and that of day employees: 6.61 ± 1.5 vs 6.8 ± 1.2 for Drake and al [23] and 5.9 ± 1.2 vs 6 ± 0.9 for Ohida et al. [24].

Regarding the quality of sleep, Pilcher et al. [19] found frequencies quite close to ours in young Japanese nurses: 42% and 7%. In addition, Gold et al. [6] noticed poor quality of sleep in 52.1% of nurses on rotating schedules and in 27.8% of day nurses.

The authors are unanimous on the fact that the sleep of the shift employee is deeply disturbed concerning its efficiency, depth and satisfaction [11] [14] [18] [24] [25].

Regarding excessive daytime sleepiness, studies have also found an increased risk of excessive daytime sleepiness for shift and/or night employees [7] [8] [26] [27]. This would be attributable to the long duration of duties and to an almost chronic debt of sleep.

As in our series, Gold et al. [6] also notice that nurses on alternating schedules consume much more sleeping pills (27.7%) than their colleagues who work only daytime (16.5%).

Overall, we noticed as a function of the adopted shift work rhythm, sleep is disturbed quantitatively and qualitatively [4] [18] [24] in the same way. The differences observed may be due to the type of epidemiological studies chosen.

Several studies [1] [13] [14] [18] [25] [28] show that chronic fatigue is one of the most common complaints among shift employees. It is often notified after a night shift. However, its assessment objectively is still difficult to measure.

Shift work can be a potential stressful element due to sleep deprivation, long working hours, chronic tiredness and the rupture of social and family contacts it generates. A study carried out on 286 Finnish nurses also found more symptoms of stress in employees at alternating pace [17].

Mood problems such as depression, anxiety and irritability represent short-term health effects of shift work [28]. It is certain that insufficiently restful sleep is an important cause, but some authors invoke the role of certain character traits (such as introvert character) and job satisfaction [17].

A review of the literature found frequencies of appetite disturbances from 35% to 75% among shift employees and 50% among night employees [25]. Appetite disturbances in shift employees arise from changing normal meal times, difficulty having hot food at night, and inability to have social contact during the meal with family or friends. Sleep problems also play an important role [4] [18] [25].

Shift or night employees are frequently out of step with their society, and have to face great challenges in their social life because the majority of family and social activities are arranged in accordance with the orientation of the rhythm of the general people’s day. Therefore, shift work can lead to social marginalization due to the discrepancy between the little free time they have and the compound organization of social activities. This time pressure is a constant problem for those who have heavy family responsibility and can therefore have a negative influence on marital relationships, parenting and child rearing.

Shift work has become unavoidable in the operation of any hospital center. This way of working generates or is likely to make worse various health problems well known nowadays. Sleep problems, stress and appetite disturbances occupy a considerable place in the nursing population of Loandjili General Hospital. Its disturbances on the socio-family life of employees exposed to this type of rhythm are not the least. Thus, in order to prevent health and socio-family life problems linked to shift work, it should be put in place a careful monitoring of occupational physicians integrated into a medical care network including treating physicians, occupational psychologists and specialized sleep centers to control the inherent morbidity to extrinsic disturbances of the circadian rhythm.

The authors declare no conflict of interest in relation to this article.

Ebatetou, E.A., Atipo-Galloye, P. and Moukassa, D. (2021) Shift Work: Impact on Nurses’ Health and Quality Life in Pointe-Noire (Congo). Open Journal of Epidemiology, 11, 16-30. https://doi.org/10.4236/ojepi.2021.111002

SURVEY FORM

Date: __________________ Inclusion Number __________

1) General Information

Service __________________________________________________

Age __________

Number of children: __________

Grade: _________________

Fonction: _________________

Senority: __________

2) Personal medical history (Pre shift work)

Which one: ____________________

3) Shift work information

Senority: __________

Number of teams: __________

4) Informations on the health effects of shift work

a) Sleep and vigilance

i) n the previous months, at what time on average did you go to bed (light off) __________

ii) In the previous months, on average, how long did it take you to fall asleep? __________

iii) In the previous months, on average, what time did you get up? __________

iv) In the past few months, based on your job type, how many hours of actual sleep per night, on average, did you get? (this number of hours may be different from the number of hours spent in bed) __________

v) In the past few months, has your sleep been:

• Good

• Fearly good

• Bad

• Fearly bad

vi) In the past months, has your sleep depth been:

• Good

• Fearly good

• Bad

• Fearly bad

vii) During the past months, has your sleep efficiency (its restful nature) been:

• Good

• Fearly good

• Bad

• Fearly bad

viii) Overall, how satisfied are you with your primary sleep in recent months?

• Good

• Fearly good

• Bad

• Fearly bad

ix) In the past months, how would you rate your desire to sleep at bedtime?

• Very strong

• Strong

• Very weak

• Weak

x) In the past few months, how often have you taken medication to help you sleep?

• Never

• Less than 1 time per month

• 1 to 2 times per month

• 3 or more times per month

b) Activities and general status

i) In the past few months, have you ever felt fatigued outside of work??

• Always

• Often

• Sometimes

• Rarely

• Never

ii) In the previous months and outside of your working hours, you have been feeling:

• Not at all energetic

• Energetic

• Very energetic

iii) In the previous months and outside of your working hours, you have been feeling

• Not stressed at all

• Stressed

• Very stressed

iv) In the previous months, you would say your general mood was:

• Very bad

• Bad

• Good

• Very good

v) In general, in the previous months, have you noticed any occurrence of:

•

5) Information on the risk of workplace accidents

In the past months, during your working hours, have you been the victim of an accident at work: yes no If yes, have you been the victim of an accident at work: __________

6) Information on social life

a) Over the past few months, outside of work hours, how much free time do you feel you have at home?

• Insufficient

• Sufficient

b) During the previous months, outside of your working hours, how much time do you feel you have for real leisure activities?

• Insufficient

• Sufficient

EPWORTH SLEEPINESS SCALE

Instructions: How likely are you to doze off or fall asleep in the following situations, apart from a simple feeling of fatigue?

Even if you haven’t found yourself in such circumstances recently, imagine your reaction.

Use the following scale to choose the most appropriate number for each situation.

0 = no risk of dozing off

1 = small chance of dozing off

2 = average possibility of dozing off

3 = great chance of dozing off

Situations: 0 1 2 3

v

While watching television

Thank you for your cooperation