THE IMPACT OF 12-HOUR WORK SHIFT ON THE PSYCHOLOGICAL

HEALTH OF 3RD YEAR NURSING STUDENTS IN COLEGIO DE STA.

LOURDES OF LEYTE FOUNDATION, INC.

A Research Proposal

Presented to

The Nursing Department

Colegio de Sta. Lourdes of Leyte Foundation, Inc.

Tabontabon, Leyte

In Partial Fulfillment

of the Requirements for the course

BACHELOR OF SCIENCE IN NURSING

LATINA, JUDY D.

LOPEZ, JUMYLENE LEX A.

MABALHIN, HANNA MAE D.

MAHAIT, CARL ANGELO Z.

MARGALLO, AUBREY SHENELL S.

 TABLE OF CONTENTS

Cover Page...............................................................................................................
Table of Contents ....................................................................................................
Chapter I: INTRODUCTION
Background of the Study ........................................................................................
Statement of the Problem .......................................................................................
Research Hypothesis ...............................................................................................
Significance of the Study.........................................................................................
Scope and Delimitation ..........................................................................................
Theoretical Framework............................................................................................
Conceptual Framework............................................................................................
Definition of Terms ................................................................................................
Chapter II: REVIEW OF RELATED LITERATURE
Conceptual Literature
Related Studies
Chapter III: METHODOLOGY
Research Design
Research Locale.......................................................................................................
Research Design .....................................................................................................
Respondents of the Study .......................................................................................
Research Instrument ...............................................................................................
Data Analysis ..........................................................................................................
REFERENCES..................................................................................................................
APPENDICES ...................................................................................................................
Appendix A. Survey Questionnaire ........................................................................
 Chapter 1

Introduction

This chapter discusses the background of the study, the statement of the problem,

the significance of the study, the study’s scope and delimitations, the theoretical and

conceptual frameworks, and definition of terms used.

Background of the Study

In the past two decades, many changes have been implemented in healthcare

working systems. One of these changes has been the assimilation of shift-work systems

and flexibility in work schedules. The need for 24-hour care makes healthcare

professionals work with different shift systems, such as 8 h, 9 h, 10 h or 12 hour shifts.

However, the common shiftwork systems divided a 24 h day in two (12 h) or three (8 h)

shifts. This requires the staff to be adaptable to the various forms of shift work schedules.

The 12-hour shift is one of hospital-based nurses' most common shifts. The

typical nurse’s schedule in the hospital setting is either 7 am to 7 pm or 7 pm to 7 am.

Nurses in hospitals worldwide work shifts to provide patient care across 24 hours of the

day. Due to worldwide nursing shortages and difficulty retaining staff (both registered

nurses and nursing assistants) working in hospitals has been adopted widely.

In the Philippines, the Department of Health has set forth a review on the

Department Circular 2013-0423 that aims to assess the 8-hour and 12-hour shifting

schedule for nurses and their effects on health workers. It sets one’s sight into gathering
data or feedback on the effect of 8-hour and 12-hour shifts on the productivity, safety,

and well-being of nurses and patients in DOH-licensed hospitals (DOH, 2023).

The effects of shiftwork have been extensively researched and reported. They

include negative effects on social and domestic activities (Fischer et al., 1993) and long

term effects on physical and psychophysiological health (Åkerstedt, 1990, Waterhouse

et al., 1993). Also likely to be important is disruption to the sleep–wake cycle (Tepas and

Mahan, 1989), leading to reductions in alertness and performance, which not only has

immediate implications for occupational health and safety (Folkard, 1990, Åkerstedt,

1991), but is also often repeated many times, resulting in more chronic sleep loss, and

therefore cumulative effects, with serious long term implications (Tepas and Mahan,

1989).

The key drivers for introducing 12 h shifts have been seen as potential financial

savings, a positive impact on recruitment and retention and improved continuity of care

(National Nursing Research Unit, 2013, NHS Evidence, 2010). The motivation for

change can initially be associated with nursing staff shortages in the 1990s, staff

preference linked to greater employee friendly initiatives and more recently to austerity

pressures. The financial saving has been assessed at around £3 m per year for an average

sized UK district general hospital, based on one case study site (NHS Evidence, 2010).

Concerns have been raised that longer shifts may have a negative impact on patients,

workers themselves and the organisation of care (Hughes, 2008). Increasing concern has

been raised in the past few years in respect of the impact on patient safety and that cost

savings are the primary driver (Royal College of Nursing, 2012), with calls for review of

the shift pattern in both the USA (Geiger-Brown and Trinkoff, 2010) and UK (Calkin,
2013). In New Zealand, collective agreements have been drawn up between employers

and unions which recommend that 10 and 12 h shifts are not implemented as a standard

rostering pattern primarily to protect nurses from harm resulting from shift work and the

way work is organised (New Zealand Nurses Association, 2012).

This compression of the working week is favorable for many employees as it

leads to longer periods off, and therefore increased opportunities for social and domestic

interaction and leisure time (Smith et al., 1998). Twelve-hour shifts have also been noted

to lead to a reduction in total commuting time (Gillberg, 1998). Decreases in absence due

to sickness, increases in productivity, and increases in satisfaction with work and

rostering practices have also been reported (Wedderburn, 1996, Baker et al., 2003). The

potential disadvantages of 12-h shift systems have also been examined: predominantly

these are the increased potential for fatigue, reduced performance and increased accident

risk (Johnston et al., 1989, Rosa, 1995). These disadvantages have been noted to be of

particular importance for 12-h night shifts (Smith et al., 1998, Rosa, 1995), and toward

the end of a 12-h shift (Rosa and Colligan, 1988, Ugrovics and Wright, 1990, Folkard,

1997), particularly when the job is monotonous or if it involves continuous heavy

physical work (Tepas, 1985). Other studies have concluded that the first 12-h shift after a

period of rest days is particularly susceptible to fatigue (Johnston et al., 1989). Few

studies, however, have systematically investigated the effects of 12-h shifts on sleep and

fatigue in the field, and in particular, the implications for effects on performance.

When considering the negative impacts of shift work on workers’ health, fatigue

and sleepiness are the most common complaints among staff. Job performance, lack of

psychosocial well-being, and job dissatisfaction have also been well-reported in the
literature. Community-based studies of fatigue demonstrate the prevalence of fatigue in

primary care studies, which is defined as loss of energy and tiredness among workers

ranging from 10% to 45%. This prevalence is associated with a lack of physical activity

and psychosocial variables such as depression, anxiety, and psychological problems. The

data of NHANES (National Health and Nutrition Examination Survey), indicates that

female respondents suffered from fatigue at 20.4%, which is higher than that suffered by

male respondents at 14.3%. This finding points to a higher risk among women than men

at 1.5 times more risk. Therefore, fatigue is considered as a symptom resulting from shift

work, which has an impact on health. It has a significant effect on the levels of alertness,

concentration, judgment, mood, and performance which might also be a reason for the

increased risk of injury and medical errors. Moreover, fatigue also impairs memory,

problem-solving, and decision-making abilities which is an indication that such shift

work has a psychological effect on workers.

This research study will describe the impact of 12-hour shift work on the

psychological health of 3rd-year student nurses in Colegio de Sta. Lourdes of Leyte

Foundation, Inc. From the findings of the study, recommendations can be formulated.

Research Hypothesis

Hypothesis is a statement to be proven. In this current study, the research

hypothesis is stated as: 12-hour work shift in hospitals has a significant relationship on

the psychological health of 3rd year student nurses in Colegio de Sta. Lourdes of Leyte

Foundation, Inc.

SIGNIFICANCE OF THE STUDY

 The results of this study can benefit the following:

Nursing Students: Understanding the psychological impact of 12-hour shift work

can help students anticipate and navigate potential challenges, allowing them to

proactively protect and promote their mental well-being. The study's findings can also

inform the development of support systems and interventions tailored to the unique needs

of nursing students working 12-hour shifts.

Healthcare Organizations: The study findings can enhance the overall well-

being and job satisfaction of their nursing students. This, in turn, can lead to decreased

turnover rates and improved patient care outcomes. Furthermore, the study contributes to

the growing body of research on work schedules and their impact on healthcare

professionals, helping to inform future policies and practices in the field.

Academic Institutions: Incorporating knowledge about the psychological impact

of 12-hour shift work can help educators prepare students for the realities of their future

profession and develop resilience and coping skills. It can also enhance discussions

around self-care practices and support services available to nursing students.

Healthcare Professionals. The insights gained can contribute to the existing

body of knowledge on shift work and its psychological effects, enabling better-informed

decision-making and improving the quality of future research studies in this area.

Patients and Healthcare Consumers: By addressing and promoting the

psychological well-being of nursing students working 12-hour shifts, their ability to

provide high-quality and safe patient care can be enhanced, leading to improved

healthcare outcomes and patient satisfaction.

Mental Health Professional: This study can enable mental health professionals

to better understand and address the specific stressors and psychological needs of nursing

students working 12-hour shift. They can tailor therapeutic interventions and provide

support services that specifically cater to this group, promoting to their mental health and

resilience.

Researchers. This study will be beneficial to the researchers for the data to be gathered

will serve as a source of accurate and useful information and take credit on the success of

the paper. The researchers will be of help to identify the impact of 12-hour work shift on

the psychological health of student nurses.

Future Researchers: This study will be beneficial to the future researchers because this

will serve as their guide and reference material for their future study.

SCOPE AND LIMITATION OF THE STUDY

This study will focus on the determination on the impact of 12-hour work shift

and psychological health at Colegio De Sta. Lourdes of Leyte Foundation, Inc. The data

collection will be conducted to randomly chosen third year nursing students in Colegio

De Sta. Lourdes of Leyte Foundation, Inc, within the year of 2024 through survey

questionnaire with the same questions provided. The study will be limited to the 3rd year

nursing students since the study aims to describe the impact of 12-hour work shift on the

psychological health of chosen respondents.

Theoretical Framework

This study is supported by The Transactional Model of Stress and Coping,

developed by Richard Lazarus and Susan Folkman (1984)

The Transactional Model of Stress and Coping framework allows for a

comprehensive understanding of the dynamic process of stress and coping in the context

of the duty and can inform interventions and support systems to promote better

psychological health among nursing students.

This suggests that stress is a result of the interaction between an individual and their

environment. According to this model, individuals appraise and interpret situations as

either stressful or not, and their coping strategies play a crucial role in determining their

psychological health outcomes.

Primary appraisal: Nursing students would engage in primary appraisal by

evaluating the significance and potential impact of the 12-hour hospital duty on their

well-being. This appraisal process involves assessing the demands, challenges, and

potential stressors associated with the duty.

Secondary appraisal: After the primary appraisal, nursing students would engage in

secondary appraisal by evaluating their coping resources and strategies. This appraisal

process involves assessing their perceived ability to cope with the demands and

challenges of the duty, as well as the availability of social support and resources.

Coping strategies: Nursing students would then use various coping strategies to

manage the stressors associated with the 12-hour hospital duty. Coping strategies can be

categorized as problem-focused (e.g., seeking support, time management) or emotion-

 focused (e.g., relaxation techniques, emotional expression). The effectiveness of these

coping strategies can influence the psychological health outcomes.

Psychological health outcomes: The psychological health outcomes can include

measures of stress, anxiety, depression, burnout, and overall well-being. These outcomes

are influenced by the appraisal of the duty, the coping strategies utilized, and the

individual's perception of their ability to manage the demands of the duty.

By using the Transactional Model of Stress and Coping as a theoretical framework,

researchers can examine how nursing students appraise the 12-hour hospital duty, the

coping strategies they employ, and how these factors relate to their psychological health

outcomes.

CONCEPTUAL FRAMEWORK

 Poorer mental health

outcomes
 Higher rates of
depressive symptoms
and anxiety
12-hour shift Psychological health
 Associated with
work
considerable impacts
on sleep
 Academic workload
 Unhealthy lifestyles
 Living far away from

DEFINITION OF TERMS

Nursing Students. This is also a group of people which has 12-hourk work shift

and acquire 12-hour work shift for their on-the-job training.

 Work Shift. It is a work schedule that falls outside the hours of 7 am and 6 pm12.

It is performed in rotations, meaning that different groups of workers take turns to cover

different periods of time during the day or night. Shift work can include overnight, early

morning, evening, or rotating shifts. Shift work is designed to provide service or make

use of all 24 hours of the day.

Psychological Health. It is the sum of how we think, feel, relate, and exist in our

day-to-day lives. Our thoughts, perceptions, emotions, motivations, interpersonal

relationships, and behaviors are a product of our experiences and the skills we have

developed to meet life’s challenges. Psychological health includes mental, emotional,

social, and spiritual dimensions.

Chapter II

Review of Related Literature

This chapter presents a critical review of conceptual literature related to the topic of the

research, and previous research done before, foreign and local, and how they relate to the

present study.

Conceptual Literature

Nurses are committed to meeting the diverse and often complex needs of people

with competence and compassion. While nursing is viewed as a “calling” by many

nurses, it is a demanding profession. During the course of their work, nurses encounter

physical, mental, emotional, and ethical challenges. Depending on the role and setting of

the nurse’s work, these may include incurring the risk of infection and physical or verbal

assault, meeting physical demands, managing and supporting the needs of multiple

patients with complex needs, having emotional conversations with patients and families,
and confronting challenging social and ethical issues. Nurses, particularly those who

work in communities and public health settings, may also face the stress of encountering

health inequities laid bare, such as hazardous housing and food insecurity. Nurses’ health

and well-being are affected by these stresses and demands of their work, and in turn, their

well-being affects their work, including increasing the risk of medical errors and

compromising patient safety and care (Melnyk et al., 2018). These can be associated with

the impacts of 12-hour work shift on the psychological health of healthcare workers more

so on student nurses.

Twelve-hour shifts arose in the 1970s and led to a change from the traditional

shift system with three 8-h shifts to a shift system with two long shifts. Twelve-hour

shifts were welcomed by many as an intervention that would bring value to healthcare

systems, nurses and their patients by reducing staffing costs; allowing a more efficient

organization of care throughout the day; increasing quality of care; improving nurse

recruitment and reducing staff turnover (Chiara Dall’Ora et al., 2022).

Long shifts appeared as a solution at a moment where nursing staff was in high

demand but in short supply, and maintaining safe staffing levels was challenging for

healthcare systems (Ganong WL et al., 1976). After their introduction in the late 70s’ in

the US, 12+ hour shifts increased steadily in the UK and several other countries in

Europe, but there was little if any robust evaluation of their impact (Nhs Evidence, 2010).

It is only recently that more rigorous studies using large samples and objective roster data

have started to shed light on the effect of long shifts (C. Dall’Ora et al., 2010). The

overall emerging picture points to a negative effect on nurses’ health and well-being

including sickness absence, burnout, and intention to leave their job (I. Rodriguez
Santana et al., 2020). Far from enabling staff to perform more productively, these long

shifts have also been associated with higher rates of errors and patient safety-related

outcomes (P. Griffiths et al., 2014). The hypothetical link between 12+ hour shifts and

jeopardized patient safety is the in shift fatigue increase (L.M. Barker and M.A.

Nussbaum, 2011). Since fatigue during the shift increases exponentially after the first 8

hours and accumulates over consecutive shifts and fatigue is linked to accidents and

performance impairments, the consequences for patient safety could be serious (K.A.

Honn et al., 2019).

In addition, the prevalence of 12-hour shift work has increased in various

industries, impacting the lives of a substantial portion of the workforce.

Psychological Impact of Extended Work Hours: Several studies have investigated the

psychological impact of extended work hours, specifically in the context of 12-hour

shifts. Shields et al. (2018) reported higher levels of job-related stress and burnout among

individuals engaged in prolonged work shifts. The extended work hours were linked to

increased feelings of fatigue, irritability, and a decline in overall mood (Caruso, 2014).

Review of Related Studies

According to a study entitled ‘The impact of 12-hour shift on nurses’ health,

wellbeing, and job satisfaction, a 12-hour shift work causes disturbance in sleep, stress,

fatigue, and anxiety. Furthermore, nurses in the recent studies highlighted that they were

dissatisfied with 12-hour shifts and reported high emotional exhaustion and intention to

leave their job.

 “The Effects of 12-Hour Shifts on Nurse Burnout and Job Satisfaction in Acute

Care Settings” implied that a positive correlation between the frequency of 12-hour shifts

and increased levels of burnout, particularly emotional exhaustion. However, job

satisfaction varied among nurses, with some expressing a preference for the longer shifts

due to increased days off.

In accordance with the study entitled “Impact of 12-Hour Nursing Shifts on

Mental Health: A Comparative Analysis of Day and Night Shifts” suggested that while

nurses on 12-hour night shifts experienced disruptions in sleep patterns and higher levels

of anxiety, those on day shifts reported increased stress related to workload and patient

care responsibilities. The study emphasized the need for tailored interventions

considering the specific challenges associated with different shift times.

Lastly, a study entitled “Employee Perspectives on the Psychological Effects of

12-Hour Shifts in a Hospital Setting”, provided valuable insights the subjective

experiences of hospital workers, shedding light on the diversity of psychological

responses to extended work hours.

Chapter III

Methodology

This chapter discusses the methods and procedures in the conduct of this study.

This will include the research design, the locale, the respondents, the research instrument,

gathering, processing, analysis and interpretation of data.

RESEARCH LOCALE
 The study will be conducted in Colegio De Sta. Lourdes Of Leyte Foundation

Incorporated located at Brgy. 1 Quezon Tabontabon Leyte.

The institution is owned and founded by. Dr. Rustico Balderian with the aim

of providing tertiary education to the people of Tabontabon and the surrounding area.

Known for its reputable educational offerings and scholarships opportunities, the

institution has become a sought-after destination for students across the region.

By selecting respondents from this school, who are currently complying to heir clinical

duty in the healthcare setting with 12 hour shifts, the study can gather firsthand

experiences and perceptions about the impact of these extended work hours. This will

enable the study to provide insights and recommendations for the improvement of shift

scheduling practices and the well-being of nursing staff in similar healthcare settings.
Respondents of the Study

The respondents of this study were the third-year nursing students of Colegio de Sta.

Lourdes of Leyte Foundation, Inc. The researchers considered the third- year nursing

students of CSSLFI for the reason, that they are in the critical period of transition for

nursing students. They are no longer beginners but are still developing their skills and

knowledge. This stage often involves transitioning from classroom learning to more

hands-on clinical experiences.

Data Analysis

Survey responses were presented using tables. Statistical analysis that are

employed will include frequency and percentage distributions, facilitated by the MS

Excel computer application. No statistical test of hypothesis was done on the data

collected since the research study is descriptive in nature.