CHAPTER 1

THE PROBLEM AND ITS SCOPE Introduction

Every hospital has its own policy regarding shift pattern for nurses. These shifting patterns refer to the hourly schedule of nurses regarding service in the hospital. Different shifting patterns are as follows: 8-hour, 12-hour, and 16-hour (rare). In Pagadian City, only the Pagadian City Medical Center (PCMC) has adopted the 12-hour shift. This was adopted in response to the need for enhanced cost effectiveness in extending health services. However, there have been claims that this scheme makes nurses less effective in the work place. For example, according to the University of Maryland, Baltimore (UMB) study presented at the 24th annual meeting of the Associated Professional Sleep in San Antonio, that the common practice of successive 12-hour shifts for U.S. hospital nurses leaves many with serious sleep deprivation, higher risk of health problems, and more odds of making patient errors. According to Jeanne Geiger-Brown, PhD, RN, associate professor of the school of Nursing at UMB, the 12-hour shift trend started in the 1970s and 1980s when there were nursing shortages. Hospitals started giving nurses often prefer working a bunch of 12-hour shifts and then lost of time off, Geiger-Brown contended that it was not a good thing for nurse planning. In her article, Brown analyzed from several recent scientific studies of the safety risk involved with long work hours, and challenges the current scheduling paradigm. She pointed out the increasing evidence that 12hour shift adversely affect performance. In 10 previously published studies of the effects of 12hour shifts, none showed positive effects, while four showed negative effects on performance. Geiger-Brown cited a study that involved 80 registered nurses, working three successive 12-hour shifts, either day or night. The study found out that the nurses achieved short duration of sleep between 12-hour shifts. Over 50% of shifts were longer than 12.5 hours, and with long commutes and family responsibilities, nurses have very little opportunity to rest between shifts. The study also found out that the averaged total sleep time between 12-hour shifts was only 5.5

hours. Night-shift nurses averaged only about 5.2 hours sleep was extremely fragmented. They experienced micro sleep periods, little lapses in attention, and intershift fatigue. Most recent studies cited in her article point to an increase in patient care errors related to successive 12-hour shifts. Geiger-Brown cited one study of 393 nurses. In 5,317 shifts which were surveyed anonymously, the odds of making errors by those who reported working more than 12 hours in shifts were three times greater than nurses who reported working 8.5-hour shifts. Experiencing partial sleep deprivation chronically, over many years, is dangerous to the nurses health and to the patients. The most common problems with an over emphasis on 12-hour shift are needle-stick injuries, musculoskeletal disorders, drowsy driving, and other health breakdowns related to sleep deprivation. Another study by Carlson et al., 2000, twelve-hour shifts could alleviate emotional interference, which results from time spent recovering from mental fatigue on rest days. Twelve-hour shift workers may also need less time at home recovering if their shift system produces less conflict with sleep (Lowden, Kecklund, Axelsson and Akerstedt, 1996). Impaired or truncated sleep is perhaps the most frequent complaint of shift workers on traditional schedules and it is a particular problem on night shift (Akerstedt, 1998; Knauth, 2001). Shift workers are more likely to take naps during leisure hours, use days off to catch up on sleep (Winwood, Winefield, and Lushington, 2006). These sleep problems may be minimized under a 12-hour shift system because there are fewer night shifts. The reduction in night shifts is undoubtedly one of the most important potential benefits of 12-hour shifts as there is less disruption to sleep, and less conflict with internal timing mechanisms, both of which are known to cause health problems and fatigue in shiftworkers (Akerstedt 1988; Lowden, et al., 1996). While existing literature points to the deep impact of 12-hour shift has on the overall performance of nurses and on their health, there is an impending curiosity on the particular issue regarding the positive and negative effect of the shifting pattern. To address this issue, this particular study was conducted to specifically explore the impact of 12-hour work shift to the level of performance of nurses especially in relation to giving emotional and psychological support to patient and carry out interventions and orders and nurses health and well-being. Conceptual Framework
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The framework for this research is based on Kurt Lewins field theory. He postulated the needs to organize perception of the field and acting within it. He believed that behavior is purposeful and visualizes the individual as existing in a field of forces which included +valence forces which attract people, and valence forces which repel people. The blending of this field produced an approach/avoidance dynamic. In this field theory, a field is defined as the totality of co-existing facts which are conceived as mutually interdependent. Individuals were seen to behave differently according to the way in which tensions between perceptions of the self and of the environment were worked through.

The schematic diagram of this study is presented in Figure 1. As shown, the independent variable is the twelve-hour work shift while the dependent variables are the nurses performance and their health and well-being.

Twelve-Hour Work Shift

Work-Related

Effects on Nurses

Health-Related

Figure 1. Schematic Diagram

Statement of the problem The purpose of this research was to determine the effects of 12-hour work shift on the health and well-being of the nurses at PCMC as well as on their performance. This study sought to answer the following specific questions: 1. How does the 12-hour work shift affect the nurses health and well-being?
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2. How does the 12-hour work shift affect the performance of nurses particularly on the following aspects: 2.1 Carrying out interventions and orders 2.2 Giving emotional and psychological support to patients? Hypotheses of the Study 1. The 12-hour work shift does not adversely affect the nurses' health and well-being. 2. The 12-hour work shift does not adversely affect the nurses' performance particularly on the following aspects: 2.1 Carrying our interventions and orders 2.2 Giving emotional and psychological support to patients. Significance of the Study The findings of the study will benefit the following: Nurses. The results of the study will help them understand the underlying effects of the 12-hour work shift and its impact on their performance, health and well-being. In addition, the results would be advantageous to them in terms of developing their ethics of service. Doctors. Study findings may also provide information to the primary healthcare providers regarding the performances of the different staff, and the underlying effects of the shift to their cohealthcare worker. Hospital Administrators. The study will give them direction as to what steps should be taken to protect nurses from occupational stress that may have been caused by the 12-hour work shift in order to decrease nurses turnover which negatively affect safety and effectiveness of services provided. Other Researchers. This study will possibly serve as a prelude to further investigations to determine other aspects of 12-hour shift pattern. It is hoped that the results of this study may lend
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renewed insights into the 12-hour shift pattern and that the recommendations of this study, in particular, could be applied to the management of 12-hour shift pattern. Scope and Delimitation of the study The study focused on the effects of the 12-hour work shift on the performance of the nurses and on their health and well-being. It was conducted at Pagadian City Medical Center. It is confined in the nurses of Pagadian City Medical Center as the respondents. It covers 40 nurses working in different areas of the hospital namely: Emergency room, Operating room, Delivery Room, Intensive Care Unit, and Wards. The study was conducted last August 2011 until October 2011. The instrument used was questionnaire-checklist. Definitions of Terms To give a clearer understanding, the following words are defined operationally: Adverse Effects. circumstance. Effects that are unfavorable or acting against a person, goal or

In this study, the terms refer to effects that are unfavorable to the nurses

performance and health and well-being. Healthcare. The field wherein patients are the subject for health intervention by the healthcare providers such as the physician, nurses, etc. for maintenance and restoration of individuals health. Intervention. In this study, the term refers to the action that is to be provided to clients depending on their type of needs/problem. One example is that, providing an oral feeding to patient who unable to feed himself/herself. It may be independent (nurses action), dependent (with the aid of the physician) and collaborative (team action) intervention. Order. The term refers to the physicians plan of intervention that is being referred and/or responsibility of the nurse to intervene for the patient. Any order made by the physician should also be written or recorded in the patients chart. Example is the administration of medications. Pagadian City Medical Center (PCMC). The only tertiary hospital in Pagadian City that has complete state-of-the-art facilities and equipment.
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Performance. Refers to the staff nurses capability to behave and carry out orders and interventions in hospital settings. Shift Pattern. Refers to the work schedule of the staff nurses at PCMC. It may either be the 7:00 am 7:00 pm work shift (morning shift) or the 7:00 pm-7:00 am work shift (night shift), each of which is equal to 12 consecutive working hours. Staff Nurse. A licensed nurse who is assigned in any of the four clinical areas of the hospital namely, medical-surgical unit/ward, intensive care unit, operating/delivery unit, and emergency unit. A staff nurse provides primary interventions to the patient such as vital signs Well-being. In this study, the term is used to refer to the state of goodness of the nurses health including his body, mind, and soul.

CHAPTER 2 REVIEW OF RELATED LITERATURE AND STUDIES Related Literature

It has often been claimed that the 12-hour shift is best for both the nurses and patients. However, although the research has, indeed, found positive effects on satisfaction with working hours and free time, the effects on employee fatigue, health and performance has been neutral or
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negative. Below are some of the claims regarding both the positive and negative effects of the 12hour shift on nurses. Positive Effects of the 12-Hour Shift According to Moore-Ede et al of Circadian Technologies, Inc. (Moore-Ede 2007), impact of 12-hour shift includes increased productivity, fewer errors, increased continuity, reduced absenteeism, reduced turnover and better morale. In New York City hospitals (Stone 2006) nurses working 12-hour shifts were more satisfied with their jobs, had less emotional exhaustion, all without impacting patient outcomes. One key element to worker satisfaction with 12-hour shift seems to be how the change was developed and implemented. One of the potential beneficial aspects of 12-hour shift is the reduction in handoffs. In fact, in most hospitals reduction in handoffs is touted as the most important benefit of 12-hour shift because you only have two handoffs with 12-hour shift. According to Richardson (et al., 2007), some nurses perceive long work days (12 hour shifts) as a benefit by reducing the number of staff hand-offs and increasing continuity of care. They also prefer fewer days at work and therefore less commute time and easier scheduling of home life responsibilities. The study of Carlson (et al., 2000) shows that, 12-hour shift alleviate emotional interference, which results from time spent recovering from mental fatigue on rest days, and reduces both the quantity and quality of family contact time (Jackson et al., 1985). Emotional interference may be alleviated under 12-hour shifts because workers may be able to use their increased number of days off work to structure their recovery time around their partners, friends or childrens schedules. Despite the feelings of sleepiness, Williamson, Gower and Clarke (1994) state that 12-hour shift actually reduce feelings of tiredness throughout the work week. Other effects of 12-hour work shift in relation to tiredness included: decreased amount of time the employees woke up feeling tired; decrease in tiredness during their shift at work and decrease in tiredness after a day or a night shift. Thus, the effect of sleep deprivation day to day may have little effect, but longer periods of time may increase sleepiness that may consequently increase levels of fatigue some employees may feel.
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Baker, Olson and Morisseau (1994) more recently have argued that the 12-hour work shift may have positive consequences. For example, it may be safer to have employees work in order to finish a significant task. Here the authors argue that the 12-hour shift can reduce the number of shift turnovers which decreases the potential for error and may offset any potential error resulting from fatigue. Duchon, Keran and Smith (1994) used fatigue sensitive behavioral and physiological performance measures which showed no change or improvement with 12-hour shifts, concluding that 12-hour shifts do not pose a hazard with respect to occupational health or safety. Safety remains for everyone a central issue. Research into the impact on professionals has consistently identified a range of negative in nurses health related and work related outcomes. Negative Effects of the 12-Hour Shift The existing scientific studies indicate that shift work affect both sleep and waking by disrupting circadian regulation, familial and social life (Gordon, Cleary, Parker, & Czeisler, 1986; Labyak, 2002; Lee, 1992). Sleep obtained during the day at irregular times is poorer quality than that obtained during normal nighttime sleep. Chronically restricted sleep patterns and the subsequent sleep debt that accumulates over time may be most pervasive in such professions as health care delivery that functions 24 hours a day, 7 days a week. The disruption of the bodys natural circadian rhythms by shift work can result in changed sleep patterns, gastrointestinal disorders, chronic fatigue, weakened concentration or alertness, increased stress, pressures on ones family and social life, cardiovascular disease (Shields, 2002; Costa, 1996; Glazner, 1992; Williams, 2008). Twelve-hour shifts are infamous in nursing and many studies cite exhausted and dissatisfied staff as a reason for the negative press (Fitzpatrick et al 1999, Todd et al 1993). In particular, Todd et al(1989) claimed that the quality of patient care was negatively affected on wards that used a 12-hour shift pattern. An article of Jacqueline A. Miller, BSN, RN, NE-BC, When Time Isnt on Your Side: 12hour Shifts shows a concern about the negative effects that extended shifts can have on patients and staff. Research supports that long shifts of 12 hours or greater can have a negative effect on nurse performance and, therefore, a negative effect on patient care outcomes. In addition to fatigue,

12-hour shifts have also been shown to have adverse effects on the health of the nurse and may contribute to conditions such as diabetes, depression, unhealthy behaviors, and hypertension. Also, Geiger-Brown and colleagues presents the idea that 12-hour shift affects multiple parameters. These include needle stick injuries, musculoskeletal and other work related injuries, and increased rates of motor vehicle collisions or near-misses while driving home from extended shifts. They also discuss potential health consequences of long-term sleep deprivation. Related Studies A study by Bloodworth, Lea, Lane, & Ginn (2001) was conducted to assess whether changing a nursing shift pattern to incorporate 12-hour shifts would have positive effects for patients and staff in a ward environment. The results showed that the new shift pattern offer benefits for patients through improved communication, increased continuity of care and more content staff. The study illustrated potential a new nursing shift pattern involving 12-hour shifts has for patient care, as well as for staff job satisfaction and efficient management. Fields and Loveridge (1988) researched 8-hour and 12-hour shifts related to critical thinking and fatigue in a quasi experimental study. The two experimental groups 12(n=102) consisted of critical care nurses working either 8-hour or 12-hour shifts at an urban 415-bed hospital. The nurses were tested with the Three Minute Reasoning Test and the subjective symptoms of Fatigue. The two instruments were administered during the first three hours and last three hours of their shift, evaluating critical thinking and fatigue at the beginning and end of the shift. Findings indicated fatigue increased over the duration of the shift and it increased in both the 8-hour and 12-hour shifts. Nurses working 12-hour shift did not perceive significantly higher levels of fatigue than 8-hour nurses. No significant difference between groups was found on scores for the Three Minute Reasoning Test. The researchers did, however, find that critical thinking improve in the last three hours of the shift as compared to the first three hours of the shift for both 8-hour and 12-hour shift workers. Researchers found that although nurses were more fatigue by the end of both shift types critical thinking, was greater at the end of the shift. Therefore the conclusion was 12-hour shifts do not appear to decrease critical thinking or increase fatigue any more than 8-hour shift (Field and Loveridge 1998). Although there are some studies indicating that workers experience more fatigue on a 12 hour shift than on an 8hour shift especially during
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the end of the long shift there are other studies that reached the opposite conclusion. An evaluation of 8 and 12hour shifts at a power station (Mitchell, 2000) found that there was an increase in error rates at the end of a 12hour shift. This was attributed to increased fatigue with longer work hours. The conclusion of the authors, however, was that the employer should explore ways of reducing risk of error towards the end of a 12hour shift and ensure that more critical tasks be scheduled at the beginning of the shift. Cruzios (2008) study was carried out to compare to medical wards which had been operating at 12-hour shift for more than one year with two medical wards which had carried on with a conventional shift system over the same period of time. Staff questionnaire, patients interviews, documentation review, and analysis of a number of organizational issues were undertaken to evaluate the effect of the shift pattern worked. Viewing the shift pattern from a variety of perspective indicates that there were no significant differences between patterns with regard to the staff perception, patient, documentation and organizational issues. However, some aspects of the 12-hour shift produce more favorable responses from the staff; less fatigue was reported by those working the 12- hour shift and documentation was more complete on these wards, however the length of time available for the hand over was identified as a problematic area. Staff surveyed had chosen to work these are hours which may positively have influenced of this shift pattern on both staff and patients. This work demonstrates the complexities in evaluating patterns of work in providing patient care over 24 hours. A study of 54 nurses at NHS hospital in England (McGettrick, 2006) reported that nurses saw many positive impacts of 12hour shifts. The respondents felt there was improved patient care, more job satisfaction, more off duty time, and improved family life. Staff found that 12 hour shifts allowed for more flexibility, more time at home and enhanced family relationships. In the Australian hospital study, (Dwyer, 2007) the majority of health staff reported that they slept quite well or moderately well after moving to a 12hour shift. The end time of the shift was a greater factor contributing to fatigue than the length of the shift. One participant from the study commented, After an 8hour shift that finishes at 23:00 hours, I would feel quite lethargic and since there are no 12hour shifts finishing then, I feel much better now. In a study of 738 nurses in Israel, (Hanna, 2008) the researchers found that nurses who only worked day shift complained significantly more than shift nurses about health problems and sleep
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disturbances. Although this appears to contradict existing research on shift work (Glazner, 1992; Costa, 1996), the researchers were able to determine that gender, age and weight were significant factors that impact the wellbeing of nurses. The nurses who only worked day shifts tended to be older on average than the nurses who worked rotating shifts. The research also found lower absenteeism rates among the shift work nurses than among the daytime nurses, which the researchers felt could also be explained by differences in age. An article written by Shullanberger (2000) summarizes his comprehensive literature review of nursing staff issues. Shullanberger refers to a study by Gillespie and Curzio (1996) which found that nurses working 12hour shifts reported less fatigue than those who worked 8hour shifts. In interviews, 80% of respondents who worked 8hour shifts believed tiredness was a problem, compared with 20% of 12hour shift nurses. The results of the Nottingham evaluation (Lea, 2003) found that sporadic sickness during the trial year of longer shifts was almost half that of the previous years. The evaluation also showed fewer sharps and drug errors during the trial year compared to the previous year. Having fewer nurses involved with the care of a patient on a single day meant improved communication between nurses and health care professionals, which reduced the margin for communication breakdown and error. Fatigue may also be the result of shift workers cutting back on sleep to have more work life balance. Williams (2008) notes that shift workers are more likely to cut back on sleep to have more time for other tasks than regular daytime workers (70% vs. 50%). The impact of 12hour shifts on patient care. In the evaluation of the move to 12hour shifts from 8hour shifts in an Australian hospital (Dwyer, 2007), the majority (75%) of participants felt that the 12hour shift contributed to better continuity of patient care. Having fewer nurses involved with the care of a patient on a single day meant improved communication between nurses and health care professionals, which reduced the margin for communication breakdown and error. In another study published in the Journal of Nursing Management, (Richardson, 2007) two focus groups of nursing staff felt that the 12hour shift made planning and prioritizing patient care easier. The authors believe this may be related to the pacing effect which results in staff feeling less pressured to complete assigned responsibilities in a 12hour time frame. Staff feel
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rushed on shorter shifts, especially on the morning shift, and the longer period of 12 hours enables staff to obtain a better knowledge of the patient. McGettricks study (2006) also foundthat nursing staff overwhelmingly agreed that patient care improved under the 12hour shift rotation because staff has more time to plan care and spend time with both the patient and the patients family. In Shullanbergers summary of Gillespie and Curzios research, he noted that the researchers found that there was more complete documentation from the nurses who worked 12 hour shifts than from those who worked 8hour shifts. In terms of the impact on patient care, the same study found that patients cared for by 12hour shift nurses were more likely to know their nurses name than patients cared for by 8hour shift nurses. Lea and Bloodworth (2003) also report improved patient care with 12 hour shifts. The final evaluation of the yearlong trial concluded that the new shift system enhanced patient care and improved the health and wellbeing of nursing staff. All ward staff felt that the new system provided for continuity of care and gave them the chance to build a therapeuticrelationship between the nurse and the patients during the day and a longer period of time to monitor patients. The only study that raised concerns about risk to patient safety was one examining excessive working hours in the United States (Trinkoff, 2006). This study of 2,273 Registered Nurses found that more than a quarter of nurses typically worked 12 or more hours per day, and that almost onequarter of nurses with more than one job worked 50 or more hours per week. Many nurses worked in hospitals with mandatory overtime policies which contributed to the excessive work hours. The authors state that the average hours worked by nurses exceeds the recommendations of the Institute of Medicine and that this raises concerns about fatigue and health risks to nurses as well as the safety of patients.

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CHAPTER 3 METHODOLOGY

This chapter presents the research design, respondents of the study, research instrument, data gathering procedure and statistical tools used in the study. Research Design This research study design is a descriptive, quantitative, survey approach. Since the researchers endeavored to investigate the experiences and perceptions of nurses, a research design, which is quantitative and descriptive in nature, is found to be most appropriate for the study. In this regard, Likert scale questionnaire was selected as an appropriate tool to gather the data. The instrument designed by the researchers, required answers to closed- and open-ended questions. The application of this quantitative-descriptive approach using the questionnaire is also seen as survey approach. In this regard, surveys are said to be intended to give a general idea of representative sample of a large population as well as give descriptions of the phenomena practices, opinions, attitudes and other characteristics of people. (Mouton, 2001:152; Knapp, 1998:67).
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Research Environment The study was conducted with staff nurses at Pagadian City Medical Center (PCMC) which is the only tertiary hospital in Pagadian City. The hospital has an in-patient (24-hour) service area with a capacity of 100 beds. The in-patient service facility comprises 11 major clinical areas: Operating Room, Delivery Room, Hemodialysis Unit, Intensive Care Unit, Post-operative Care Unit/ Recovery Unit, Neonatal Intensive Care Unit, Emergency Room, Private Rooms, Female Surgical Ward, Male Surgical Ward, and Pediatric Ward. Research Subjects The study population consisted of 40 nurses working in 10 different major clinical areas of PCMC. Both male and female nurses were selected for the study. The respondents were selected using non-probability, convenience sampling. In this method, the nurses who were present at the time of distribution of the questionnaire were selected as the respondents of the study. Research Instrument The survey questionnaire was used as the main data-gathering instrument for this study (See Appendix B). The questions were formulated to explore the perceptions of nurses on the effects of 12-hour work on their health and well-being and on their performance. The questions were structured using the Likert scale. Five choices were provided for every item. The choices represent the respondents degree of agreement or disagreement to each item. The scale below was used to interpret the responses of the respondents for every item by computing the weighted mean:

Range 4.01 - 5.00 3.01 - 4.00 2.01 - 3.00 1.01 - 2.00 0.00 1.00
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Interpretation Strongly Agree Agree Uncertain Disagree Strongly Disagree

Data Gathering Procedure A letter of request was given to the Medical Director of the hospital asking his permission to allow the researchers to conduct a survey. Questionnaires were distributed to the nurses who were assisted by the researchers in answering the questions. The questionnaires were then retrieved. The data gathered were analyzed and interpreted.

Statistical Treatment After gathering all the completed questionnaires from the respondents, total responses for each item were obtained and tabulated. The data were computed using frequency distribution and weighted mean. Frequency distribution is an arrangement of the values that one or more variables take in a sample. Each entry in the table contains the frequency or count of the occurrences of values within a particular group or interval, and in this way, the table summarizes the distribution of values in the sample. Weighted mean is the average wherein every quantity to be averages has a corresponding weight. These weights represent the significance of each quantity to the average. To compute for the weighted mean, each value must be multiplied by its weight. Products should then be added to obtain the total value. The total weight should also be computed by adding all the weights. The total value is then divided by the total weight. Statistically, the weighted mean is calculated using the following formula: Formula: WM = FW N Where:
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F = Frequency W = Assigned Weight N = No. Of Respondents WM = Weighted Mean

CHAPTER 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA This chapter presents the data gathered which were analyzed and interpreted. Table 1 Frequency distribution and Weighted Mean of the Respondents Responses on Work-related Effects Work-related effects 5 4 3 2 1 W M A. Carrying out interventions and orders 1. Effective nursing intervention 2. Greater percentage of appro-priate medication administration 3. Better charting 4. Less minor incidents Average Weighted Mean 8 6 7 4 14 13 5 3 2.95 3.35 3.0 9 4 1 Uncertain Agree Agree 12 3 11 7 4 5 15 7 6 10 3 3.05 3 2 Uncertain Agree Rank Description

13 7

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B. Giving emotional and psychological support to patients 5. Giving emotional and psychological support to patients 6. Effective nurse-patient interaction 7. Effective maintenance of patients safety 8. Effective nurse-patient relationship 9. Longer nurse-patient interaction 10. Increased patients coping Average weighted mean 8 7 9 4 3 5 5 8 7 13 8 11 10 14 8 2.68 2.52 2.90 2.7 5 Total Average weighted mean 2.9 2 Uncertain 9 10 5 Uncertain Uncertain Uncertain Uncertain 7 7 6 8 5 5 14 11 8 9 2.75 2.82 8 7 Uncertain Uncertain 9 5 4 15 7 2.85 6 Uncertain

Average Weighted Mean

Carrying out interventions and orders 3.09 Agree Giving emotional and psycho-logical support to patients 2.75 Uncertain

Total Average Weighted Mean = 2.92 Uncertain Range 4.01 - 5.00 3.01 - 4.00 2.01 - 3.00
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Interpretation 5 Strongly Agree 4 3 Agree Uncertain

1.01 - 2.00 0.00 1.00

2 1

Disagree Strongly Disagree

Table 1 presents the frequency distribution and weighted mean of the nurses responses. This is to determine whether the 12-hour work shift had adversely affected their performance. Under Carrying out interventions and orders, item number 1, Effective nursing intervention, has a weighted mean of 3 and ranks 3rd which is interpreted as uncertain; item number 2, item number 3, Better charting, has a weighted Greater percentage of appropriate medication administration, has a weighted mean of 3.05 and ranked 2nd which is interpreted as agree; mean of 2.95 and ranks 4th which is interpreted as uncertain; and item number 4, less minor incidents, has a weighted mean of 3.35 and ranks 1st which is interpreted as agree. The average weighted mean of the respondents responses in terms of carrying out interventions and orders is 3.09 which are interpreted as Agree. Items number 5, 6, 7, 8, 9, 10 under Giving emotional and psychological support to patients have weighted means of 2.85, 2.75, 2.82, 2.68, 2.52, 2.90 and ranked 6th, 8th, 7th, 9th, 10th, 5th, respectively which are all interpreted as agree. The total average weighted mean of the respondents in terms of their performance is 2.92 interpreted as uncertain. Based on this data, it implies that the 12-hour work shift might or might not adversely affect the performance of the nurses as perceived by the nurses themselves.

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Table 2. Frequency Distribution and Weighted Mean of the Respondents Responses on health-related Effects Health-related Effects 5 4 3 2 1 WM Ran k A. Nurses health and well-being 1. Fatigue 2. Sleepiness during the shift 3. Low energy level 4. Disorientation 5. Exhaustion 6. Irritability 7. Insomnia Average Weighted Mean 24 8 0 3 2 2 6 0 5 1 2 10 4 4 5 4.08 4.4 4.15 3.08 4.22 3.7 3.6 3.89 4 1 3 7 2 5 6 Strongly Agree Strongly Agree Strongly Agree Agree Strongly Agree Agree Agree Agree DESCRIPTIO N

24 12 1 18 16 2 12 5 24 9 15 8 14 9 7 3

11 2 9 3

Range 4.01 - 5.00 3.01 - 4.00 2.01 - 3.00

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Interpretation 5 Strongly Agree 4 Agree 3 Uncertain

1.01 - 2.00 0.00 1.00

2 1

Disagree Strongly Disagree

Table 2 presents the frequency distribution and weighted mean of the nurses responses on whether the 12-hour work shift had adversely affected their health and well-being. Under Nurses health and well-being, item number 1, Fatigue, had a weighted mean of 4.08 and ranks 4th which is interpreted as strongly agree; item number 2, Sleepiness during the shift, had a weighted mean of 4.4 and ranked 1st which is interpreted as strongly agree; item number 3, Low energy level energy, had a weighted mean of 4.15 and ranked 3 rd which is interpreted as strongly agree; item number 4, Disorientation, had a weighted mean of 3.08 and ranked 1st which is interpreted as agree, item number 5, Exhaustion, has a weighted mean of 4.22 and ranks 2nd which is interpreted as strongly agree; item number 6, Irritability, had a weighted mean of 3.7 and ranks 5th which is interpreted as agree, and item number 7, Insomnia, had a weighted mean of 3.6 and ranked 2nd which is interpreted as agree. The average weighted mean of 3.89 implies that the 12-hour work shift had adversely affected the health and well-being of the nurses. Weighted mean: 1. Work-related effects: A. Carrying out interventions and orders = 3.09 B. Giving emotional and psychological support to patients = 2.75 2. Health-related effects: 3.89 3. General Weighted Mean? GWM: 2.92 + 3.89 = 3.41 Agree

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The general weighted mean of work-related and health-related effects is 3.41 which is interpreted as agree. Generally, the results reject the null hypothesis and accept the alternative hypothesis which establishes that there is a significant adverse effect of the 12-hour work shift on the overall performance of nurses.

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CHAPTER 5 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS This chapter presents the summary of findings, conclusions and recommendations of the study. Summary Based on the data gathered, it was found that the respondents expressed strong agreement that the 12-hour work shift adversely affect their health and well-being as it causes sleepiness during shift, exhaustion, low energy level, and fatigue. Lesser effects as perceived by the nurses were irritability, insomnia and disorientation. The findings also revealed that the respondents expressed disagreement that the 12-hour work shift has negative effects on their performance particularly on carrying out interventions and orders and on giving emotional and psychological support to patients.

Conclusion
After analysis of the findings, the researchers have come up with the conclusion that

the 12-hour work shift does not have a negative effect on the nurses performance; however, it does have negative effects on their health and well-being. Recommendations
For further studies the effects of the 12-hour work shift on nurses, the researchers would like to recommend the following:

1. To provide a more compelling information and discussion as to the effects of 12-hour shift to the nurses overall performance, future researchers are encouraged to do continuing study, in a wider range, about the work-related and health-related effects of 12-hour shift. This way, nurses and other concerned individuals will have more awareness on how to find solutions to problems affecting them.
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2. A comparative study of the effects of the 12-hour and 8-hour work shift among the nurses in the different hospitals in Pagadian City should also be done by researchers. 3. To make future studies more substantial, it is highly recommended to employ qualitative methods in order to complement the quantitative data and give the results more meaning. 4. The hospital management of should include in their plans and programs the conduct of seminars, trainings and orientations for the nurses and other medical personnel and staff of the institution at least twice a year to have consistency of evaluation and to provide feedback to the concerned individuals as to their performance and well-being for them to cater a more effective service to the patients.

BIBLIOGRAPHY A. Books Ann Marriner Tomey, Guide to Nursing Management and Leadership, Seventh Edition, Copyright 2004. Carol L. Macne, RN, PhD, Director of Research and Professor East Tennessee state University College of Nursing Johnson city, Tennessee, Understanding Nursing Research: Reading and Using Research in Practice. Reprint authorized by Lippincott Williams and Wilkins. Copyright by Lippincott Williams and Wilkins.
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 Denise L. Polit, PhD and Cheryl Tata no Beck, DNSc, CNM, FAAN, Professor School of Nursing University of Connecticut Storrs, Connecticut. Nursing Research Principle and Methods, Seventh Edition, Copyright by 2004 by Lippincott Williams and Wilkins. B. Journals Akerstedt, T., 1988. Sleepiness as a consequence of shiftwork. Sleep. 11 (1), 17-34. Akerstedt, T., 1998. Shift work and disturbed sleep/wakefulness. Sleep Medicine Reviews (2). 117128. Barton Cunningham, J., 1989. A compressed shift schedule: Dealing with some of the problems of shiftwork. Journal of Organizational Behavior. 10, 231-235.
Bohle, P., Tilley, A., 1989. The impact of night work on psychological well-being.

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APPENDICES
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Appendix A Letter to the Medical Director

MENDERO COLLEGE Pagadian City August 10, 2011 DR. SAMUEL J. MENDERO Medical Director Pagadian City Medical Center Pagadian City Sir: Good day! We, the students of Mendero College are currently conducting our study titled, EFFECTS OF 12-HOUR WORK SHIFT ON NURSES. respondents for our study. Along this line, may we request your good office to allow us to gather the necessary data that bear substantial importance to our present study. We hope that this request may grace acceptance and approval. Thank you and God Bless. Very Truly yours, BSN- IV STUDENTS We have chosen the nurses in your hospital as

Appendix B: Letter to Respondents

MENDERO COLLEGE
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Pagadian City August 10, 2011 Questionnaire-Checklist

Dear Sir/Madam: Good day! The undersigned are presently conducting a research study titled, EFFECTS OF THE 12HOUR SHIFT ON NURSES as part of the requirements for the degree of Bachelor of Science in Nursing (BSN). This study aims to determine whether the 12-hour shift has positive or negative effects on the nurses performance and health and well-being. In this connection, we would like to request you to be one of our respondents. Kindly accomplish the attached questionnaire. Rest assured that your responses will be held confidential. Thank you for the full support and cooperation.

Very truly yours, Yusop, Noridja Group Coordinator

Appendix C QUESTIONNAIRE 29

Instructions: Kindly indicate your agreement or disagreement to the following items by encircling number that corresponds to your answer. 5 - Strongly Agree 4 Agree 3 Uncertain 2 Disagree 1 Strongly Disagree 1) Possible effects on the Nurses Performance A.) Carrying out interventions and orders 5 Effective nursing interventions Greater percentage of appropriate Medication administration Better Charting Less minor incidents 4 3 2 1

B.) Giving Emotional and Psychological Support to Patients. 5

30

4 3 2

Giving emotional and psychological support to patients Effective nurse-patient interaction Effective maintenance of patients safety Effective nurse-patient relationship Longer nurse-patient interaction Increased patients coping

2.) Possible effect on the nurses health and well being:

5 4 3 2 1

Fatigue Sleepiness during the shift Low energy level Disorientation Insomnia Exhaustion Irritability Others: (You may add) specify: _________________
_________________

31