Tag Archives: Chronic Disease Management

Nurses and Shiftwork: Sleep Well to Be Well, by Dr. Carolyn Gotay

It’s estimated that most people spend one-third of their lives sleeping, but until recently, the links between sleep and health were not well understood. Recent research has identified relationships between disrupted sleep and increased risk of obesity, diabetes, cardiovascular disease, and some cancers, suggesting that sleep has significant effects on health and well-being.

There are an estimated 4.1 million shift-workers in Canada, and approximately 1.9 million regularly work shifts between midnight and 5AM; these workers are the largest group at risk of disrupted sleep. According to a Statistics Canada Survey of nurses from 2005, six percent of B.C. nurses work permanent night shifts, and an additional 45 percent work mixed shifts, including nights. This suggests that slightly more than half of all 38,000 registered nurses in B.C. suffer from regular circadian disruption due to shiftwork. In fact, in 2010, IARC classified shiftwork with circadian disruption as Group 2A, “probably carcinogenic to humans.” In particular, IARC identified increased breast cancer risk in night shift-workers.

The ICOS study (Improving Cancer-related Outcomes in Shiftworkers) is funded by the Canadian Cancer Society and led by Dr. Carolyn Gotay, Canadian Cancer Society Chair in Cancer Primary Prevention at the University of British Columbia. The study tested whether a sleep hygiene intervention for women who work shifts could reduce their risk of breast cancer.

Study participants were 47 women (including 23 nurses) from the Vancouver region. On average, these women had worked seven night shifts per month for more than 16 years. At baseline, about four in five (79 percent) reported poor sleep. Since obesity is an additional risk factor for breast cancer that is linked to poor sleep, participants also self-reported their BMI and were categorized as normal weight, overweight, or obese.

The sleep intervention consisted of 10, telephone-delivered cognitive behavior therapy (CBT) sessions. CBT is a psychotherapeutic method that focuses on changing unhealthy patterns of behaviour and thinking, and it has been endorsed as a first-line treatment for insomnia by a National Institutes of Health Consensus Conference and the British Medical Association. The intervention was delivered by an experienced sleep counselor.

Six months after the intervention, the proportion of participants reporting poor sleep had decreased by more than one-third, from 79 percent to 49 percent. This positive impact was maintained when we went back to the women six months later, a year after they began the study. The effect was stronger in women with BMIs less than 25, but it was also statistically and clinically significant in women who were overweight and obese. This promising finding suggests that a sleep hygiene program like the one used in the ICOS study can result in significant and lasting improvements in sleep quality in night shift-workers.

We are still analyzing other data collected in the study, including information about health behaviours, objective measures of physical activity, and biological indicators in blood and saliva. We are very grateful to the nurses who took part in this research – we couldn’t have done it without them! We’ve already learned a lot from this study, and we plan to build on our findings in future research. In particular, we are thinking about providing sleep hygiene sessions for nurses who are just beginning their careers as night shift-workers.

If you have comments about this idea, suggestions for other sleep research that would be helpful to you, or if you’d like more information about the ICOS study, please contact Jennifer Parisi, Communications Director at the Centre of Excellence in Cancer Prevention (communications@cancerprevent.ca).

ABOUT DR. CAROLYN GOTAY, PhD

Gotay, Carolyn_high-resCarolyn Gotay, PhD, FCAHS is Professor and Canadian Cancer Society (CCS) Chair in Cancer Primary Prevention at the University of British Columbia (UBC). She also holds an appointment at the BC Cancer Agency. Dr. Gotay received her PhD in psychology from the University of Maryland, and she came to UBC in 2008 after positions at Gettysburg College, the University of Calgary, the (US) National Cancer Institute, and the University of Hawaii.

A Nursing Call to Action: Are we ready to respond?, by Jeanne Besner RN PhD

In the recently released report of the National Expert Commission (NEC), nurses were challenged to use their collective knowledge to be a mighty force in ensuring better health, better care and better value in healthcare delivery for all Canadians. The Commission noted that new models of care delivery “should be centred on what individuals and families need, should treat the individual as a whole person…, and should ensure that all professionals, including nurses, work to their full scope of practice.”1 But to what extent is the Registered Nurse community prepared to respond to that challenge?

There is no question that Registered Nurses (RNs) should be an entry point to health promotion and disease prevention as well as to illness care, and that nursing education currently equips RNs to address the shift from an illness model to keeping people well. But to what extent do RNs in practice actually champion excellent care, caring, and preventative care? 2

Research on nursing scope of practice 3 4 5 has revealed that we lack a compelling vision for nursing that differentiates the distinct roles of Nurse Practitioners (NPs), RNs, and Licensed Practical Nurses (LPNs) in care delivery.  There is little evidence that differences in education (i.e., in nursing knowledge) account for how nursing providers are utilized, which contributes to significant role overlap and duplication, as well as to tension and mistrust between RNs and LPNs in the workplace. This role ambiguity is sometimes also reflected in staffing decisions made by nurse managers, who may fail to consider the potential impact on patient outcomes of replacing one type of provider with another when dealing with staffing shortages.  RN practice in acute as well as in primary care has been demonstrated to over-emphasize the management of disease and illness, with insufficient time spent on assessment of population risk factors and individual health needs. The practice of many RNs has been narrowed to a heavy focus on the performance of tasks and activities related to the bio-medical management of patients, although many of those also fall within the scope of practice of other providers.

Developing a meaningful approach to achieving the vision for nursing and healthcare that is reflected in the NEC report will be impossible in the absence of a long-term, shared vision among decision-makers (i.e., employers),  educators, regulators, policy-makers and RNs themselves. RNs recognize they are currently not working to the full extent of their knowledge and skill and are unduly absorbed by the bio-medical needs of patients, at a time when all levels of government are calling for a renewed focus on promoting health and wellness. Shifting our system away from its almost singular focus on illness toward an equal preoccupation with health and wellness will simply not happen if nurses don’t lead the way. The sustainability of our health system depends on the willingness and ability of RNs to refocus their practice toward interprofessional models of service delivery that will allow them to more effectively engage in the promotion of health and well being with individuals sick or well, which is the very essence of professional nursing practice. This will require individual commitment and collaborative effort to move beyond talking to actually making change happen.

Is anyone ready to lead the way?


JeanneBesnerABOUT JEANNE BESNER

In April 2010, Jeanne retired from full-time work with Alberta Health Services, where she had been the director of the Health Systems and Workforce Research Unit, leading the development of a research agenda focused on promoting effective and efficient utilization of all members of the health care team through redesign of care delivery models in acute and primary care settings.

She is an adjunct associate professor with the faculty of nursing at the University of Calgary, as well as Adjunct Faculty with the School of Nursing at Mount Royal University. She is a former President of CARNA (2003 to 2005) and past member of the Board of Directors of CNA (1999 to 2005), where she served as the Primary Health Care representative from 1999 to 2003. She was appointed to the Health Council of Canada in 2003. Jeanne was awarded an Alberta Centennial Medal in 2005 for her contributions to health care. In 2008 she received a CNA Centennial Award and in 2010, the Canadian College of Health Service Executives Nursing Leadership Award. She was invested to the Order of Canada in 2011and was presented with the Queen’s Diamond Jubilee Medal in May 2012.

  1. National Expert Commission. (2012). A Nursing Call to Action: The health of our nation, the future of our health system. Ottawa, Canada Nurses Association. (p. 7)
  2. National Expert Commission. (2012)
  3. Besner, J., Doran, D., et al. (2005). A Systematic Approach to Nursing Scopes of Practice. Canadian Institutes for Health Research (www.cihr.gc.ca)
  4. White, D., Jackson, K., et al. (2009). Enhancing Nursing Role Effectiveness through Job Redesign. Health Workforce Research and Evaluation Unit. Alberta Health Services
  5. Besner, J., Drummond, J., et al. (2010). Optimizing the Practice of Registered Nurses in the Context of an Interprofessional Team in Primary Care. (www.cihr.gc.ca)

Better Health, Better Care: The Role of Nurses in Chronic Disease Management, by Patricia Foster RN

By Patricia Foster, RN

I have been privileged to work in a nurse led clinic for 17 years. The Comox Valley Nursing Centre began as a demonstration project, highlighting nurses working to the full scope of their practice, in partnership with the community.  Chronic illnesses and in particular chronic pain were the primary needs.

Patients and colleagues have taught us much: Continue reading