Background: Newly graduated nurses often face demanding working conditions including high workload, stress, and irregular working hours. During the first years of practice, burnout symptoms are common. Recovery, including sleep, can be seen as a key protective factor in the associations between stress, shift work and negative health outcomes. Previously, a proactive, group-based intervention (recovery programme) for new nurses, promoting individual strategies for recovery, decreased burnout and fatigue symptoms post-intervention and showed preventive effects on somatic symptoms over time. To optimise the implementation and outcomes of an intervention, it is important to understand its mechanisms of impact (i.e., how it produces change) as well as to identify contextual factors influencing its implementation. Objective: To deepen the understanding of the recovery programme’s mechanisms of impact and to explore how its implementation, including participants’ opportunities for recovery and the feasibility of recovery strategies, was influenced by the context. Design: Qualitative descriptive design. Participants and setting: Twelve nurses (nine women) who had participated in the intervention at four Swedish hospitals, between 12 and 25 months (M = 19) after participation. Methods: Semi-structured individual telephone interviews were conducted and analysed using thematic analysis. Results: The programme’s proposed mechanisms of impact, including increased knowledge about sleep, enhanced motivation for behavioural change, and the use of recovery strategies, were confirmed. Motivation to apply recovery strategies was supported by a shift in mind-set regarding the importance of self-care; to improve readability; and follow-up on the behavioural change process during sessions. Contextual factors influencing recovery opportunities and the feasibility of strategies were related to both the work context and the individual. These factors included demanding schedules, extended and disrupted working hours, workload, opportunities for recovery at work, social norms, the organisation of work procedures, private life circumstances, and the deprioritisation of personal recovery needs. Booster sessions and reminders were suggested to facilitate the continued use of recovery strategies after the programme. Conclusions: When supporting nurses in developing individual recovery strategies, it is important to provide opportunities to share experiences with other new nurses and to follow-up on their behavioural change process. Importantly, several organisational factors should also be considered. Organisations should work systematically with the planning and management of working hours that promote recovery, create opportunities for recovery during work shifts, organise work procedures with recovery in mind, and continuously monitor and manage employees’ stress and fatigue symptoms. Together, such efforts could promote a social norm that supports recovery. Social media abstract: Nurses’ recovery can be supported through knowledge, individual strategies, follow-up, group reflections and organisational adaptations

As sleep restriction has negative effects on performance, ensuring sufficient sleep for shift workers is essential. Quick returns (< 11 h off between shifts) shorten sleep and are associated with increased fatigue and risk of accidents, but there is limited research on other aspects of cognitive performance and work performance. The aim of the present quasi-experimental field study was to investigate the effects of quick returns on objective and subjective measures of sleep, fatigue and cognitive performance. In total 36 newly graduated nurses were followed during two pre-scheduled work periods, with and without a quick return (evening–day–day vs. day–day–day). They kept diaries of sleep and work, wore actigraphy wristbands to record sleep and performed 3 × 3 min smartphone-based cognitive tests (simple reaction time, episodic memory and Stroop) several times daily. Quick returns were found to shorten sleep by 46 min on average, and participants felt less rested in the morning and sleepier throughout the day. Sleep fragmentation and sleep efficiency did not differ between conditions but participants reported poorer sleep quality. Although the nurses reported cognitive impairments after a quick return, the estimated effects on simple attention, episodic memory and Stroop were small and overlapped zero. There were also indications of lingering fatigue on the second day shift after a quick return, but estimates are uncertain. In sum, quick returns shorten sleep and decrease subjective alertness, which could contribute to increased fatigue-related risk at work, but people seem able to mobilise necessary resources to maintain performance on short cognitive tasks.

As sleep restriction has negative effects on performance, ensuring sufficient sleep for shift workers is essential. Quick returns (< 11 h off between shifts) shorten sleep and are associated with increased fatigue and risk of accidents, but there is limited research on other aspects of cognitive performance and work performance. The aim of the present quasi-experimental field study was to investigate the effects of quick returns on objective and subjective measures of sleep, fatigue and cognitive performance. In total 36 newly graduated nurses were followed during two pre-scheduled work periods, with and without a quick return (evening-day-day vs. day-day-day). They kept diaries of sleep and work, wore actigraphy wristbands to record sleep and performed 3 × 3 min smartphone-based cognitive tests (simple reaction time, episodic memory and Stroop) several times daily. Quick returns were found to shorten sleep by 46 min on average, and participants felt less rested in the morning and sleepier throughout the day. Sleep fragmentation and sleep efficiency did not differ between conditions but participants reported poorer sleep quality. Although the nurses reported cognitive impairments after a quick return, the estimated effects on simple attention, episodic memory and Stroop were small and overlapped zero. There were also indications of lingering fatigue on the second day shift after a quick return, but estimates are uncertain. In sum, quick returns shorten sleep and decrease subjective alertness, which could contribute to increased fatigue-related risk at work, but people seem able to mobilise necessary resources to maintain performance on short cognitive tasks.

OBJECTIVE:The objective of this cross-sectional study was to investigate the extent of perceived sleep disturbances in a cluster headache cohort, and to compare how sleep is perceived between participants in an active headache bout to participants in a headache-free remission period. BACKGROUND:Cluster headache is a primary headache disorder characterized by extremely painful headache attacks. These attacks commonly occur with a circadian rhythm, with a majority of patients experiencing nocturnal attacks. Sleep is affected in patients with cluster headache, but there are many uncertainties regarding the pathophysiological connection between cluster headache and sleep disturbances and to what extent sleep disturbances persist into remission. METHODS:A digital survey was sent out to 701 individuals with cluster headache between January and May 2024. The survey contained questions regarding general health, clinical cluster headache phenotype, and questions from the Karolinska Sleep Questionnaire, the Insomnia Severity Index, and the Dysfunctional Beliefs and Attitudes about Sleep-10. Scores extracted from each questionnaire were compared between study participants in an active bout versus study participants in remission, and study participants in short-term remission (<5 years) versus long-term remission (≥5 years). RESULTS:Of the 381 individuals who answered the survey, 325 were included in the final analysis. Participants in an active cluster headache bout reported increased sleep disturbances on all measurements compared to participants in remission (insomnia severity: adjusted odds ratio [aOR] = 1.12 [95% confidence interval (CI), 1.07-1.17] p < 0.001; sleep quality: aOR = 0.67 [95% CI, 0.53-0.83] p < 0.001; daytime sleepiness: aOR = 0.59 [95% CI, 0.44-0.78] p < 0.001; and dysfunctional beliefs: aOR = 1.03 [95% CI, 1.01-1.04] p = 0.001). Of the participants in an active bout, 46.5% scored above the Insomnia Severity Index threshold indicating moderate to severe insomnia (≥15) and 43.7% were considered as having poor sleep quality (≤3 on the Sleep Quality Index extracted from the Karolinska Sleep Questionnaire). This is in comparison to 22.0% of participants in remission being above the moderate insomnia threshold and 22.0% considered having poor sleep quality. Participants in long-term remission had better sleep scores overall compared to participants in short-term remission (insomnia severity: aOR = 1.09 [95% CI, 1.03-1.16] p = 0.005; daytime sleepiness: aOR = 0.67 [95% CI, 0.42-1.02] p = 0.072; and dysfunctional beliefs: aOR = 1.03 [95% CI, 1.01-1.05] p = 0.006). CONCLUSION:Individuals with cluster headache have a large degree of sleep disturbances that are exacerbated during an active bout and not completely alleviated during remission. Future studies are needed to determine if this gradual change in sleep disturbances after an active bout is due to physiological changes, which slowly revert to baseline levels after an active bout or connected to persisting negative behavioral or cognitive associations between sleep and headache.

OBJECTIVES: Quick returns (<11 hours of rest between shifts) have been associated with shortened sleep length and increased sleepiness, but previous efforts have failed to find effects on sleep quality or stress. A shortcoming of most previous research has been the reliance on subjective measures of sleep. The aim of this study was to combine diary and actigraphy data to investigate intra-individual differences in sleep length, sleep quality, sleepiness, and stress during quick returns compared to day-day transitions. METHODS: Of 225 nurses and assistant nurses who wore actigraphy wristbands and kept a diary of work and sleep for seven days, a subsample of 90 individuals with one observation of both a quick return and a control condition (day-day transition) was extracted. Sleep quality was assessed with actigraphy data on sleep fragmentation and subjective ratings of perceived sleep quality. Stress and sleepiness levels were rated every third hour throughout the day. Shifts were identified from self-reported working hours. Data was analyzed in multilevel models. RESULTS: Quick returns were associated with 1 hour shorter sleep length [95% confidence interval (CI) -1.23– -0.81], reduced subjective sleep quality (-0.49, 95% CI -0.69– -0.31), increased anxiety at bedtime (-0.38, 95% CI -0.69– -0.08) and increased worktime sleepiness (0.45, 95%CI 0.22– 0.71), compared to day-day transitions. Sleep fragmentation and stress ratings did not differ between conditions. CONCLUSIONS: The findings of impaired sleep and increased sleepiness highlight the need for caution when scheduling shift combinations with quick returns.

Background The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions. Objectives The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being. Design A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences. Methods Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study. Results The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes. Conclusion The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.

Short rest (<11h) between evening and day shifts-known as quick returns (QRs)-impede recovery and may impair health. Nevertheless, QRs remain popular among some shift workers. This study explores nurses' and nurse assistants' perceptions of the merits and demerits of QRs from individual and organizational perspectives. Participants were recruited from eleven wards at two Swedish hospitals as part of a larger quasi-experimental intervention study. The majority (79%) had influence over their work schedules. Frequency distributions of responses are presented. Ninety six undertook a baseline survey regarding recovery, tolerance and work performance in relation to QRs. A majority experienced difficulties unwinding before bedtime (76%), insufficient sleep (80%), and daytime fatigue (72%). A third experienced an increased risk of errors and mistakes. However, QRs appeared to facilitate taking reports from patients and planning work, as this task was more often rated as 'very easy' following a QR compared to other shift combinations. Tolerance of QRs varied substantially. In conclusion, QRs seem to benefit continuity in work processes, but may do so at the expense of recovery and safety. Wards planning to reduce QRs-through participatory or fixed schedule models-should consider impacts on work processes.

OBJECTIVES:To examine if a proactive recovery intervention for newly graduated registered nurses (RNs) could prevent the development of sleep problems, burn-out, fatigue or somatic symptoms.METHODS:The study was a randomised control trial with parallel design. Newly graduated RNs with less than 12 months' work experience were eligible to participate. 461 RNs from 8 hospitals in Sweden were invited, of which 207 signed up. These were randomised to either intervention or control groups. After adjustments, 99 RNs were included in the intervention group (mean age 27.5 years, 84.7% women) and 108 in the control group (mean age 27.0 years, 90.7% women). 82 RNs in the intervention group attended a group-administered recovery programme, involving three group sessions with 2 weeks between each session, focusing on proactive strategies for sleep and recovery in relation to work stress and shift work. Effects on sleep, burn-out, fatigue and somatic symptoms were measured by questionnaires at baseline, postintervention and at 6 months follow-up.RESULTS:Preventive effect was seen on somatic symptoms for the intervention group. Also, the intervention group showed less burn-out and fatigue symptoms at postintervention. However, these latter effects did not persist at follow-up. Participants used many of the strategies from the programme.CONCLUSIONS:A proactive, group-administered recovery programme could be helpful in strengthening recovery and preventing negative health consequences for newly graduated RNs.TRIAL REGISTRATION NUMBER:NCT04246736.

Harmful drinking may be a cause and an effect of psychological distress, and compromises the effects of treatment for psychiatric conditions. There is a paucity of studies investigating patterns of alcohol consumption among patients with stress-induced exhaustion disorder (SED). The aims of this investigation were (1) to assess the prevalence of self-rated hazardous drinking in a sample of 808 Swedish patients with SED (mean age 43 ± 9 years, 84% women), and (2) to investigate differences in sociodemographic variables, psychological symptoms, health-related quality of life, and sleep variables between patients with different drinking patterns The design was cross-sectional and data were collected with questionnaires at pre-treatment. Twelve percent of female and 13% of male patients reported Alcohol Use Disorder Identification Test (AUDIT) scores indicating hazardous drinking. Female patients with hazardous drinking reported higher levels of anxiety and depression and lower mental wellbeing, than other women. Female patients reporting no drinking reported poorer physical function and more pain, than other women. No differences were seen between male patients with different drinking patterns. Although patients with SED report a lower frequency of harmful drinking than other psychiatric samples, alcohol consumption needs to be addressed in the assessment and treatment of this condition.

Aims and objectives To explore newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed to understand what support should be provided. Background For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management and, at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk. Design and Methods Semi-structured interviews were conducted with nurses (N = 11) from four different Swedish hospitals, and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board in Stockholm. The COREQ checklist was followed. Results Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and nonexecutive cognitive function. Conclusion The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance to improve well-being among nurses and increase patient safety. Relevance to clinical practice This study highlights the importance of addressing sleep and fatigue issues in nursing education and work introduction programmes to increase patient safety and improve well-being among nurses.

Sleep disturbance is common in the working population, often associated with work stress, health complaints and impaired work performance. This study evaluated a group intervention at work, based on cognitive behavioral therapy (CBT) for insomnia, and the moderating effects of burnout scores at baseline.

Sleep disturbance is common in the working population, often associated with work stress, health complaints and impaired work performance. This study investigated if a group intervention at work, based on Cognitive Behavioral Therapy (CBT) for insomnia, may improve sleep and if the effects were moderated by burnout levels at baseline. This is a randomized controlled intervention with a waiting list control group. Participants were employees working at least 75% of full time, reporting self-perceived moderate sleep problems (N=51, 63% women). The intervention consisted of five group sessions at the workplace plus homework. Data were collected at baseline, post-intervention and at a three-month follow-up through diaries, wrist actigraphy and questionnaires including the Insomnia Severity Index (ISI) and the Shirom-Melamed Burnout Questionnaire (SMBQ). A multilevel mixed model showed no significant interaction effects for sleep. However, by adding burnout levels at baseline into the model, a moderating effect on insomnia symptoms was observed through a significant three-way interaction (Coeff.=3.28; p=0.009; C.I.=0.82–5.75). Individuals in the intervention group with low to moderate levels of burnout at baseline (SMBQ<3.75) displayed significantly reduced ISI score at follow-up as compared to individuals with high levels of burnout at baseline (Coeff.=2.51; p=0.005; C.I.=0.77–4.24). Group CBT for insomnia given at the work place did not reduce sleep problems, while there were some indications that the intervention reduced symptoms of insomnia in employees with low burnout levels. The results suggest that group CBT may improve sleep in individuals with primary insomnia.