THE IMPACT OF WORKING NIGHT SHIFT ON THE PHYSICAL HEALTH AND

PERSONAL LIFE OF NURSES IN STA. ANA HOSPITAL (MANILA)

A Research Proposal

Submitted to

CEIS-CEU (Manila) Faculty

In Partial Fulfillment of the Requirements

in Practical Research 2

by

Maneja, Ella Mae A.

Moraleja, Tisha B.

Muralla, Tricia Emanuel Anne T. (L)

Palo, Marian Luisa M.

Ramos, Gieanne Angel V.

HSC-3

First Semester, SY 2019-2020

INTRODUCTION

Background of the study

People who are in the health care organizations often have to provide patient care

throughout the day. Working for long hours increases the risk of short sleep duration and effecting

one’s health. It may also lead to reduced performance in one’s job, obesity, injury, and other range

of chronic diseases.

Scientific evidence show that adequate sleep is a biological need just like the need for food

and drink. It’s critical to maintain life and good health and enables one to work safely (Everson,

2009). According to Luckhaupt, et al. (2010) the percentage of healthcare workers reporting 6

or less hours of sleep each day (a level considered too short by sleep experts) increased from 28%

to 32%.

As stated by Nightly Nurse (2019), registered nurses can work for about five 8-hours

days, four 10 hours days or even three 12 hour- days shifts per week. They may even perform

their jobs on weekends as part-time or full-time as needed depending on their designated

healthcare facilities in which they work.

Working within shorter time or duration is a lot favorable than laboring or overworking

long hours. Lampert (2016) claimed that nurses can spend much more of their time for other

activities after completing their shift hours. In addition to that, they can also have the time to relax

or meditate themselves, have time to explore or learn something outside their workplaces.

Working for long hours may affect the performance and the affability of a healthcare provider
especially nurses since they are the ones who mostly do the actions or interventions inside the

hospital. It can also lead to misunderstanding or miscommunication between nurses and their

patients and as confusions regarding their health records or care plan.

There are other aspects that may be affected when one works full time. According to

Ferri, Guadi, Marcheselli, Balduzzi, Magnani, and Di Lorenzo (2016) night- shift specifically is

one of the reasons for nurses’ sleeping disorders and undesirable changes in biological functions

which can negatively impact on their work performance. The lack of sleep which can have an

impact on the quality of service and care for the patients they attend to. Nurses working night-

shift experience health problems like fatigue, sleep problems, anxiety, and difficulties in

maintaining regular lifestyles.

With respect to the personal life of nurses, night-shift creates difficulties in family life

and tends to restrict nurses’ social and leisure activities. Women, especially mothers, have a role

to play at home such as doing household chores and taking care of their children and family. But

instead of being preoccupied with such things, they stay in bed and make-up for lost in order to

prepare sleep for the next shift. As nurses report for night- shift duty, an imbalance is created

between their normal lifestyle and work (Al-Ameri, 2017).

In considering some variables such as the civil status of the nurse and other demographic

characteristics, to ponder on further would be their “possible” psychosocial stress or social

inavailability in general. Ferri, et al. (2016) stated that one of the several factors that can negatively

affect a night shift nurse is their psychosocial stress. Psychosocial stress is caused by high forms

of external stressors like social threats, social exclusion, or the need to be affiliated with human

to human interaction (Dickerson and Kemeny, 2004; Panksepp, 2003; Tossani, 2013), which most

definitely are skills needed to be an efficient nurses. Nurses may often feel as though
there are not enough hours in the day to complete all their tasks. Nurses have to be good at time

management. When a patient is in urgent need of attention, nurses to-do-list can change rapidly.

The hectic pace of their job is one of the reasons why nurses get stressed out. Like normal human

beings, nurses, too, have personal lives.

In this study, the researchers will determine the effect of working night-shift to the physical

health and personal life of nurses, particularly those working in Sta. Ana Hospital (Manila).

Statement of the Problem

Main Problem

This research study aims to find out the impact of working night-shift to the physical health

and personal life of nurses in Sta. Ana Hospital (Manila) It will be conducted within the second

semester from june to march of school year 2019 to 2020.

Sub-problems

Specifically, the researchers will determine the answers to the following questions:

1. What is the impact of working night shift to the physical health of the nurses considering their

1.1 Age;

1.2 Sex;

1.3 Civil Status; and

1.4 Number of years in the service

2. What is the impact of working night-shift on the physical health of the sample?
3. What is the impact of working night-shift on the personal life of the sample?

4. How does the impact of working night-shift differ based on civil status?

5. How does the impact of working night-shift differ based on the number of years in the service?

Significance of the Study

The findings of this research may bring benefit to a number of people.

Nursing students. The finding of this study can give them an idea on what to expect when

they graduate and start working after passing the board exam.

Hospital Administrators. The research findings may encourage them to have the duration

of night-shift be lessened by frequent changes in rotation the shifts of individual nurses.

Researchers. This study related research serves as basis for for future related research

endeavors.

Scope and Delimitations of the Study

This research study focuses on the impact of working night-shift the physical health and

personal life of nurses in Sta. Ana Hospital in Manila. The data-gathering instrument is a survey

questionnaire.

This study will be conducted from June 2019 to March 2020

THEORETICAL AND CONCEPTUAL FRAMEWORK

Introduction

This chapter presents the theoretical framework which include the local and foreign related

literature and studies after the thorough and in-depth

search done by the researchers. This will also present conceptual framework, research paradigm,

and research hypothesis to fully understand the research to be done and lastly the definition of

terms for better comprehension of the study. This chapter is important to the readers and the

researchers to fully understand the variables under study.

Review of Related Literature

Foreign Literature

The Advantages and Disadvantages of Working Night Shifts

Shift-work particularly night-shift have possible advantages and disadvantages to the lives of

workers. They have to maintain their work-life balance and to face the pros and cons of their

work. Phillpott (2019) of CareerAddict listed 10 pros and cons of graveyard-shift, and these are

the following:

A.) Advantages

• There’s Less Traffic – people working during the day have higher percentage than people

working at night so the lesser the people, the lesser the traffic.
 • It's More Convenient – workers can do lots of errands during daytime after catching up

their sleep. They have an opportunity to see their loved ones more often, too.

• Get Paid More - working at night has a significant impact on workers’ lifestyle, and so it

can be difficult for companies to attract staff. As a result, most of them deal by offering more

money for the night-shift.

• Can Go Back To School - night shift makes it easier for them to attend classes and meet

tutors during the day.

• Provided with More Job Opportunities - possible to work another part-time job during the

day.

• There Are Fewer Meetings to Attend – most profession and work hold meetings during the

day so night-shift can save workers to a lot of time-consuming gatherings and etc.

• There’s Less Competition - there are fewer people working at night so this means that there

are fewer people to compete with, too.

• It’s Good for the Development of Individuals - Another benefit of fewer people being

around is that workers will have to double up on their responsibilities, allowing them to learn

new skills.

• More Time on Their Hands – familiarizing the schedule, can create time to attend to other

things besides work.

• There Are Fewer Disruptions - the night shift has fewer disruptions from micromanaging

bosses or difficult coworkers, meaning that they can relax, focus and pay more attention to their

work.
 B.) Disadvantages

• More Prone to Health Issues - human beings are not naturally nocturnal; our bodies are

programmed to rest at night. Altering this pattern can leave you feeling exhausted and moody,

while adjusting your sleep pattern can cause stress, an irregular heartbeat and even

cardiovascular complications for people with a weak heart. Reduced social interactions can also

negatively affect your mental health.

• It Can Be Boring – they’ll get to work in a quiet environment, both within and outside their

place of work.

• There’s a Reduced Access to Food - the night shift also disrupts their body’s eating

schedule.

• Take Lunch and Tea Breaks at Your Desk - staying at their desks limit their mobility, and

it can lead to long-term health complications.

• It Might Cause Family Friction - schedule will undoubtedly contradict their family’s

schedule.

• Difficulty in Sleep – their body clocks tend to change every shift and there are some

distractions in comprimising their sleep.

• It’s Not Very Safe - travelling to and from work expose them to many security threats, as

most crimes occur at night.

• The Weekends Become Meaningless - working at night affects their body’s ability to adjust

accordingly during weekends.

a hard time concentrating on their work.

• Won’t Have Access to Support Services - most departments are close at night, making it

difficult for them to access support services during their shift.

This article from Career Addict will be helpful to the present study as it entails some positive

and negative effects of graveyard-shift. Those effects can be applicable to nurses in Sta. Ana

Hospital because their line of work belongs to those professions with shift work.

You can Thrive on the Night Shift

In this article, a registered nurse proposed certain approach in which it helps Nurses to

sustain oneself in the hospital and other health facilities in which they can provide good and

quality health care for patients even they are working in Night shift. Strategies from creating

tricks in having a good sleep, avoiding stresses in working and having time for the family. These

strategies can help nurses work in satisfaction (Hunter, 2019).

Life Hacks: How to Cope with Night-shifts

Many professions include night-shift and they experienced different challenges. An article

from Medical News Today (2017) suggests five (5) coping strategies that night-shift workers

can do. These are the following: (a) Managing sleeping patterns, as they experience fatigue and

sleep deprivation because the human body is designed to sleep at night time. (b) Control of light

exposure, workers can help their body to keep alert by exposing themselves to light and after the

shift they can suppress the light exposure to help them sleep. (c) Watching diet, due to the poor

diet and body clock disruption, workers may experience poor metabolism that can result to

weight gain. (d) Taking a nap, this strategy can help maintain alertness and combat fatigue.
Lastly, (e) Use caffeine wisely, it is proven that it helps to be alert and awake but too much

intake may result to upset stomach and other complications. This literature is related to the

present study as this article suggests the different coping strategies that night-shift nurses in Sta.

Ana hospital can do before, during, and after their shift.

Shift work disorder in nurses- assessment, prevalence, and related health problems.

Flo, et al (2012) stated investigations regarding the prevalence of symptoms of shift work in

nurses and their association with the effect on their health and work performance. Putting into

consideration the age, gender, night work or number of shifts separated by 11 hours, and number

of nights worked last year, findings were symptoms of insomnia and anxiety. Relating it to this

study, these are important factors to take an overview of in terms of the physical health of nurses

varying also on their demographic characteristics.

Local Literature

Shift work research in the Philippines: current state and future directions

Different effects of shift work on a person’s health and well-being have been already shown

in several studies and articles. Recently, public awareness on shift work in the Philippines has

increased in the past ten years. Most of these employees are shift workers. Non-shift workers in

the industry are usually those with administrative positions (Lal 2010).

This article focuses on determining the current state of knowledge on shift work and its

effects on the Filipino workers and to define future studies in that tackles about shift work in the
local setting. In a rough and general sense, shift work is an employment practice that involves

different work schedules or shifts aside from the usual “standard“ day shift (e.g., 8 a.m. – 5

p.m.). It is a mode of scheduling hours of work to ensure continuity in the service or production

process (Kanterman 2008). Shift work system in the Philippines commonly implemented in the

manufacturing and services industries it is categorized as continuous, semi-continuous or

discontinuous. A continuous shift system operates around the clock without a daily or weekly

break and without public holidays. A semi-continuous shift work also operates around the clock

without a daily break and may also operate on public holidays but has breaks on certain days

such as weekends. On the other hand, a discontinuous shift work operates less than 24 hours a

day and therefore includes a daily break and usually a weekend break as well (Manigque et al.

1985). Usually, the shift time schedules are defined as follows:

• first shift : 6 a.m. to 2 p.m.

• second shift : 2 p.m. to 10 p.m.

• third shift or graveyard shift : 10 p.m. to 6 a.m.

However, there are still a lot of things to do locally to be able to assess how different the

shift work situation and the risk faced by the shift workers in the Philippines. There is still need

more detailed studies to be able to provide facts or evidence about the effects of shift work’s

effects and to be able to make applicable interventions to improve the worker’s health and

personal life.
Review of Related Studies

Foreign Studies

The Impact of Shift-work on the Psychological and Physical Health of Nurses in a

General Hospital: A Comparison Between Rotating Night-shifts and Day-shifts

According to Ferri, et al. (2016), this study discusses the different impacts to the body of

nurses, physically and psychologically, depending on their shift. Ferri, et al. (2016) highlighted

the negative impacts to nurses working at night. This study used Standard Shift-work Index or a

self report questionaire as their instrument for data collection. In contrary with the present study,

researchers will use survey questionaires as their data gathering instrument. In terms of the

participants of the study, 215 nurses working at night and 65 nurses work during the day in

different wards while the present study will only have 50 nurses in graveyard-shift at Sta. Ana

Hospital in Manila. The result of the foreign study is that eighty-six percent (86%) of the

participants have Bachelors and Masters degree and they are sort of younger than others. Those

participants experienced lower job satisfaction, sleeping problems, incessant fatigue, and some

cardiovascular symptoms. The results suggest that night-shift nurses need more attention than

day-shift nurses as they are more prone of having health problems and job dissatisfaction.

This foreign study is related to the present one because they discussed some physical health

problems of nurses at night. They also focused on the negative effects of graveyard shift which

is the main problem of the present study.

Night Shift Nursing (Katherine Pakieser-Reed)

This Book provides useful tips and practical tools that shows how the nurses make the

night shift. From their energizing fitness routines and nutritious food options to their sleep
patterns and how they balance family and personal relationships. Objective of this book is to

inform people what nurses account, situations/incidents may influence on their healthy diet. This

information is all over based in science yet it is accessible to all readers. Author presents the

different concept about sleep, fatigue, and health among shift workers in a relatable manner. It

also discusses the pros and cons of the third shift.

Katherine Pakieser-Reed, PhD, RN, the author of this book is the Director of the Center for

Nursing Professional Practice and Research at the University of Chicago Medical Center. Her

center is in charge for supporting nursing practice, ensuring that nurses have access to the

education and training for their roles and providing services that include the night staff.

In relation in our study, this book will be helpful for gathering information about the effects of

night shift in the physical health and personal life of nurses. We can use all the different pros

and cons of working night shift that has been discussed by this book.

Differences in health and well-being of night shift nurses versus day shift nurses.

This study conducted by Martin (2011) compared and examined variables of health and

well-being in a group of nurses who work night shift versus those who work the day shift. In

terms of age, night shift workers are younger than day shift workers and regarding their physical

health, night shift workers were reported to be more prone to problems like prominent gastric

symptoms, headache, high blood pressure, and sinusitis, as well as increase in sleeping tablet

consumption due to sleeping difficulties. To relate it with this study, these could be associated as

factors to be taken note of. If possible, factors as well that could affect the personal life of

nurses. Like the study conducted by Martin, this study will also be gathering information using

survey questionnaire.
Conceptual Framework

No related local studies were found but despite this factor, the researchers have gathered

information such as: night shift workers are more prone to health problems like sleep difficulties

and other psychological challenges, eating problems, increased substance intake, lessened

quality time for those with families, and frequent boredom.

A theory that would best support this study is the Modeling and Role-Modeling theory. The

theory was formulated by Erickson, et al. (1997), and is considered as a nursing philosophy. In

this theory, Irvin (1997) stated that there are commonalities and differences among people. These

serve as backbone for nurses to be aware of proper execution of their responsibilities as a

healthcare provider to their clients. To clarify, modeling involves the bettering of understanding

regarding the client world and role modeling is the nurses’ intervention and/or nurturance that

strongly requires acceptance. The modeling and role modeling theory will support the aims of this

study which are to seek information about the physical health and personal life of nurses in Sta.

Ana Hospital (Manila) along with the incorporation of night shift work as a variable.

Research Paradigm
 Physical
Working Health and
Night-shift Personal Life

Figure 1. A PC model on the Impact of Working Night-shift to the Physical Health and Personal

Life of Nurses in Sta. Ana Hospital (Manila).

Figure 1 shows the research paradigm of the study wherein the predictor variable is the shift-

work of nurses, particularly night-shift and the criterion variables are the physical health and

personal life of nurses. The researchers aim to determine the impact of PC model showing the

variables of the study. In the paradigm formulated, the relationship between the predictor variable

which includes the number of nurses and the particular time of their shift; and the criterion

variables which include the demographics of nurses such as age, sex, civil status, and duration of

career will be the basis of the result of the research.

Research Hypothesis

It states the actual expected relationship and is expressed affirmatively. According to the

related literature and studies that the researchers gathered, there are significant effects on the

physical health and personal life of nurses who work night shift.

Definition of terms

Anxiety - refers to a normal emotion that causes increased alertness, fear, and physical signs,

such as a rapid heart beat (Medical News, 2018) .

brain, 2017).

Chronic diseases - something that last 3 months or more, by the definition of the U.S.

National Center for Health Statistics (MedicineNet.com).

Family friction - conflict in family schedules.

Healthcare providers - defined as a doctor of medicine or osteopathy, podiatrist, dentist,

chiropractor, clinical psychologist, optometrist, nurse practitioner, nurse-midwife, or a clinical

social worker who is authorized to practice by the State and performing within the scope of their

practice as defined by State law, or a Christian Science practitioner (UC Berkely, 2019).

Insomnia - a sleep disorder that is characterized by difficulty falling and/or staying asleep

(WebMD.com).

CHAPTER III

METHODOLOGY
 This chapter presents on the discussion on methodology procedures. It includes the research

design, instrument for data collection and data analysis or statistical treatment of data.

Research design

The research is a non-experimental quantitative research. A survey questionnaire will be

utilized to gather data. The researchers aim to determine whether working night-shift has an

impact on the nurses physical health and personal life.

The sample

The population of nurses in Sta. Ana Hospital (Manila) is 182. To obtain the sample size, the

researchers will use Slovin’s formula. The sampling method used is convenience sampling as only

those nurses present during the graveyard shift period are taken as sample.

The Instrument of the Study

In the survey questionnaire, Likert scale will be used to gather information regarding the

impact of working night shift to the nurses physical health with “agree” or “disagree” as choices.

Semantic differential scale will be used to gather information regarding the impact of working

night shift to nurses personal life depending on their civil status.

Validity

The survey questionnaire will be presented to a research adviser, Dr. Imelda Bravo and a

research expert for validation. Recommendations will also be considered.

Reliability
 After the validation, the researchers will then proceed to pilot testing of the developed survey

questionnaire to 60 respondents from Mary Chiles Hospital in Manila. Once the pilot testing has

been done the Cronbach Alpha has been met, the researchers will now proceed to the

Procedures

The researchers will use survey questionnaire as a data gathering instrument which will then

be validated by a research adviser, Dr. Imelda Bravo and a research expert. After receiving their

evaluation or some recommendation, the next step would be the pilot testing which will be

conducted in Mary Chiles Hospital (Manila) and the Cronbach Alpha has been met the actual

survey will now be conducted.

Data Analysis

Inferential statistics will be used to interpret the gathered data with the utilization of a non-

parametric test, specifically Spearman’s rank order correlation coefficient. Spearman’s rank

order correlation coefficient will measure the association of the variables which are the physical

health and personal life of nurses from Sta. Ana Hospital (Manila).

References
Erickson, H.C., et al. (2013). Modeling and role modeling theory. Retrieved from

http://currentnursing.com/theory/modeling_and_role_modeling_theory.html

Ferri, P., Gaudi, M., Marcheselli, L., Balduzzi, S., Magani, D., & Di Lorenzo, R. (2016). The

impact of shift-work on the psychological and physical health of nurses in a general hospital:

A comparison between rotating night-shifts and day-shifts. Dovepress. Doi:

https://doi.org/10.2147/RMHP.S115326

Flo, E., Pallesen, S., Mageroy, N., Moen, B.E., Gronli, J., Norahus, I.H., & Bjonatn, B. (2012).

Shift work disorder in nurses - assesment, prevalence and related health probems. PLos

ONE. Doi: 10.371/journal.pone.0033981

Hunter, T. (2019). You can thrive on the night shift. Retrieved from

https://www.google.com/amp/s/scrubsmag.com/you-can-thrive-on-the-night-shift/amp/

Kuhne, J.P, Manalang, G., Mendoza, E., Aguila, M.E., Chua, R. B., & Gabud, R.S. (2012). Shift

work research in Philippines: Current state and future directions. Philippine Science Letters,

5 (1), 17-29.

Martin, R. (2011). Differences in health and well-being of night shift nurses versus day shift

nurses. Retrieved from https://search.proquest.com/docview/876606526?accountid=173015

Nightly Nurse (2019). How many hours do registered nurses work?. Retrieved from

https://www.nightlynurse.com/how-many-hours-registered-nurses-work/

Phillpott, S. (2019). The advantages and disadvantages of working night-shifts. CareerAddict.

-in-working-night-shifts
Nichols H. (2017). Life hacks: How to cope with night-shifts. Medical News Today. Retrieved

from https://www.medicalnewstoday.com/articles/amp/319918