NURS 668 Week 4 Capstone Paper: Literature Review Example

Sleep Health Among Night-Shift Nurses: A Review of the Literature on Scope, Consequences, Modifiable Factors, Interventions and Faith

Introduction

Nurses who work nights sleep against the body's internal clock, and many do so for years. The purpose of this literature review is to examine what recent research shows about sleep health among night-shift nurses, as the foundation for an education program for night staff on a 36-bed medical-surgical unit. I searched CINAHL, PubMed and the Journal of Christian Nursing for articles published from 2021 onward using combinations of the terms sleep, night shift, shift work, nurses, insomnia, intervention and spirituality. Thirteen articles were selected because they studied nurses who work nights or rotating shifts, reported original data or systematic reviews, or addressed rest and well-being from a Christian perspective. The review is organized into five themes: the scope of the problem, its consequences, modifiable factors, interventions and the contribution of faith.

Theme 1: The Scope of Sleep Problems Among Nurses

Sleep problems among nurses are common enough to be considered an occupational hazard. The largest study in this review analyzed baseline data from 132,910 nurses in 67 tertiary public hospitals in China and found that 24.1% reported sleep disturbance, most commonly difficulty staying asleep and early morning awakening, and the rates were highest among nurses working in intensive care, the emergency department, pediatrics and obstetrics (Bin et al., 2025). Factors linked to sleep disturbance included age in the thirties, female sex, mid-level professional titles and long working hours.

When samples are limited to nurses who work nights, the proportion with poor sleep rises sharply. Among 1,667 night-shift nurses surveyed during the COVID-19 pandemic, 70.7% scored in the range of poor sleep on the Pittsburgh Sleep Quality Index (Gu et al., 2026). A study of 1,608 shift nurses in four hospitals in 2025 reported a mean index score of 7.23, above the usual threshold for poor sleep, and used latent profile analysis to identify four groups: good sleepers made up 44.4%, moderate sleepers 40.7%, and two smaller groups had disordered sleep with either low or high use of sleeping pills, at 9.6% and 5.3% (Chu et al., 2026). These studies differ in timing and setting, and the pandemic study likely captured unusual stress, but together they suggest that poor sleep is the norm rather than the exception for nurses who work nights, and that a meaningful minority already relies on medication to sleep. The profile study adds a practical point for an education program: nurses are not one population with one problem. A program designed only for nurses with mild sleep difficulty would miss the group already using sleeping pills, who may need referral to a provider rather than education alone, while a program that assumes everyone sleeps badly would bore the 44% who sleep well. Screening at the start of a program would let the content be matched to the nurse.

Theme 2: Consequences for Nurses and Patients

Poor sleep is tied to the health of nurses and the safety of their work. In the study of 1,667 night-shift nurses, fatigue correlated strongly with both depressive symptoms and sleep disturbance, and depressive symptoms accounted for about 30% of the association between fatigue and poor sleep, while social support played a smaller role (Gu et al., 2026). The authors recommended scheduling changes and stronger peer and family support. Although the design was cross-sectional, the finding suggests that sleep, fatigue and mood form a cycle that an intervention would need to address together.

The effects reach cognition. Casas-Méndez et al. (2026) studied 67 emergency nurses twice, once after a night shift and once after a night of rest at home, with the order randomly assigned and two weeks between the assessments. After the night shift, nurses showed lower oxygenation in the prefrontal cortex during a verbal fluency task, alongside measures of sleep disturbance and anxiety. Because each nurse served as their own comparison, the study offers stronger evidence than a simple survey that a night shift itself changes brain function relevant to attention and decision making.

Medication safety is one place where those changes may matter. Among 213 perianesthesia nurses in South Korea, about a quarter had clinically significant insomnia and about two-thirds had significant fatigue, and both insomnia and fatigue were associated with a higher frequency of self-reported medication error types, while overtime work was not (Kang et al., 2026). Self-reported errors are an imperfect measure, and the sample was not night-shift specific, but the finding points toward sleep and fatigue themselves, rather than hours alone, as targets for safety efforts. That distinction matters for an education program, because nurses cannot always control how many hours they work, but they can learn to protect the quality of the sleep they do get. Across these studies, the night nurse's sleep appears less as a private matter than as part of the conditions under which patients receive care.

Theme 3: Modifiable Factors Before and During Daytime Sleep

Several studies identify factors that nurses can influence at home. Light is the most powerful. Using wrist-worn sensors for seven days, Li et al. (2026) compared 136 shift-working nurses in Hong Kong with 66 daytime office workers and found that greater personal exposure to artificial light before sleep was strongly associated with shorter total sleep time, later sleep onset and earlier waking, with bedroom light showing weaker associations. Total sleep did not differ significantly between nurses and office workers, which suggests that light exposure, rather than shift work alone, explained much of the variation. The authors concluded that sleep interventions should focus on reducing personal light exposure before bed.

Noise is a second factor. Weng et al. (2026) monitored noise in real time for 360 nurses in Hong Kong, of whom 78.1% worked nights, and found that noise in the hour before sleep and during sleep, especially fluctuating noise, was associated with weaker rest-activity rhythms and restless sleep, even when nurses did not fully wake. Nurses with fewer years of night work were more vulnerable. This finding is relevant to daytime sleepers, whose sleep coincides with traffic, deliveries and household activity.

Physical activity is a third. In a survey of 400 night-shift nurses, total physical activity was weakly but significantly correlated with better sleep quality, while older and more experienced nurses had worse sleep on most dimensions and used sleep medication more often (Zydziunaite, 2026). The correlation was small and the design cross-sectional, so physical activity is better treated as a supporting habit than a cure. Taken together, these three studies suggest that a night nurse's sleep is shaped in part by choices about light, noise and activity that education can address, although none of them tested an intervention. In practical terms, the evidence supports several specific behaviors that a program could teach: wearing dark glasses on the drive home after a night shift, avoiding bright screens in the hour before sleep, using blackout curtains, running a steady fan or other constant sound to mask fluctuating household and street noise, and building regular physical activity into days off. Each of these is inexpensive, and each addresses a factor that the studies linked to shorter or more restless sleep. Their weakness is that they depend on nurses' home circumstances; a nurse with young children or a noisy apartment may be able to adopt only some of them, which an education program should acknowledge rather than ignore.

Theme 4: Interventions That Improve Sleep

Two recent systematic reviews address which interventions help. Lee and Tse (2026) reviewed experimental trials from 2014 to 2024 on non-pharmacological interventions for shift nurses' sleep, including 15 studies in the narrative synthesis and 11 in a meta-analysis. The pooled effect showed a significant improvement in sleep quality, with a standardized mean difference of -0.63, but heterogeneity was high. Mindfulness programs were the most common intervention and showed benefit, whereas aromatherapy did not produce a significant improvement.

Deng et al. (2026) used a Bayesian network meta-analysis of 18 randomized trials involving 1,572 night or rotating-shift nurses to compare interventions directly. Structured sleep intervention programs ranked highest for improving total sleep scores, mindfulness training ranked highest for sleep duration, and other therapies ranked best for specific outcomes such as anxiety, depression and fatigue. Network meta-analyses rely on indirect comparisons and on trials of varying quality, so the rankings should be read cautiously. Still, the two reviews agree on the central point that structured, non-drug programs, particularly those that teach sleep skills and mindfulness, can improve shift nurses' sleep, and they disagree only on details of ranking that reflect differences in the trials included. The trials in both reviews typically ran for four to twelve weeks and combined teaching with practice, such as sleep diaries, guided breathing or body scan exercises, rather than relying on a single lecture. That pattern matters for program design. A one-hour in-service may raise awareness, but the interventions that changed sleep asked nurses to practice new habits over several weeks, often with reminders or group sessions. An education program for night nurses on a busy unit will need to balance that evidence against what staff can realistically attend, perhaps by combining a short initial session with brief weekly practice and follow-up.

Theme 5: Faith, Human Limits and Well-Being

Christian nursing scholarship adds a perspective the clinical literature does not. Writing in the Journal of Christian Nursing, Templeton and Kapic (2026) argue that human limitations, or finitude, are part of God's good design rather than a liability, and that failures by individuals and organizations to honor those limits contribute to burnout and to new nurses leaving the profession. Their argument is theological rather than empirical, but it reframes sleep as a limit to be honored instead of an obstacle to be overcome.

Two quantitative studies in the same journal connect spirituality to nurses' well-being. Denke et al. (2026) surveyed 408 nurses at an academic medical center and found negative correlations between burnout and several dimensions of spiritual experience, including feeling deep inner peace, feeling guided by God in daily activities and expressing gratitude. Wilson-Anderson et al. (2026) examined nursing students, clinicians and educators and found that those who reported daily spiritual experiences had lower burnout and higher resilience and compassion satisfaction. Both studies are correlational and cannot show that spirituality reduces burnout, and neither measured sleep directly. Together with the theological argument, however, they suggest that an education program for nurses at a Christian-affiliated hospital could include rest as a spiritual practice without forcing faith on anyone who does not share it. In practice, that might mean offering a short reflection on Sabbath rest and human limits as an optional part of the program, alongside the secular sleep content, so that nurses who draw strength from their faith can connect the two while others take what is useful to them.

A Framework for Interpreting the Evidence

The studies in this review can be read through a simple circadian framework. The body's internal clock, set mainly by light, favors sleep at night and alertness during the day. Night work forces nurses to be alert when the clock signals sleep and to sleep when it signals waking, so daytime sleep is shorter and lighter even under good conditions. Factors that strengthen the wrong signals, such as bright light on the drive home or fluctuating noise during daytime sleep, widen the gap, while factors that support the body's ability to sleep, such as darkness, quiet, physical activity and a calm mind, narrow it. This framework explains why light, noise and activity appear as modifiable factors in Theme 3, why mindfulness and structured sleep programs help in Theme 4, and why the consequences in Theme 2 accumulate over a run of consecutive nights. It also explains why no education program can fully remove the cost of night work, which is an important limit to communicate honestly to nurses.

Gaps and Limitations in the Literature

Most of the studies reviewed are cross-sectional, which limits conclusions about cause. Many were conducted in China, Hong Kong, South Korea or Europe, where shift patterns, housing and family structures may differ from those of US nurses. The intervention reviews include trials with high heterogeneity and variable quality, and few trials followed nurses for more than a few months. No study tested an education program that combined light, noise and activity guidance with mindfulness and a spiritual dimension, which is the combination this review suggests. Finally, few studies measured patient outcomes directly, so the link between nurses' sleep and patient safety rests on indirect evidence such as cognitive testing and self-reported errors.

Conclusion and Implications for the Education Program

The literature establishes that poor sleep is common among night-shift nurses, affecting most of them in some samples, and that it is linked to fatigue, depressive symptoms, reduced prefrontal function and self-reported medication errors. It identifies light before sleep, noise and low physical activity as factors nurses can change, and it shows that structured sleep programs and mindfulness training improve sleep in controlled trials. Christian scholarship adds a way of understanding rest as part of God's design and links spiritual experience with lower burnout. These findings point to an education program with four components: understanding the circadian cost of night work, practical sleep skills for managing light, noise and activity, a brief mindfulness practice, and an optional reflection on rest and human limits. The education program that follows will develop these components for the night staff of my unit.

References

Bin, C., Li, X., Tian, Y., Chen, Z., Liu, Y., Ning, M., Yang, J., Yu, Q., Huang, C., Zhang, D., Yuan, J., Ren, Z., & Li, Y. (2025). Prevalence of sleep disturbance and associated factors among nurses in Chinese tertiary public hospitals: A national cross-sectional study. Frontiers in Public Health, 13, Article 1735543. https://doi.org/10.3389/fpubh.2025.1735543

Casas-Méndez, C., Martín-Parrilla, M. Á., Cáceres, M. C., Montanero-Fernández, J., López-Jurado, C. F., & Durán-Gómez, N. (2026). Effects of night shifts on sleep, cognitive performance, and anxiety in emergency nurses: An observational within-subject study. Journal of Nursing Management, 2026, Article 1635579. https://doi.org/10.1155/jonm/1635579

Chu, X., Lv, J., Li, G., & Wang, D. (2026). Latent profile analysis of sleep quality and associated factors on sleep patterns in night-shift nurses: A cross-sectional study. Frontiers in Public Health, 14, Article 1800662. https://doi.org/10.3389/fpubh.2026.1800662

Deng, G., Zeng, L., Wang, F., Hou, H., Liu, L., An, Y., Lv, Y., & Hu, X. (2026). Non-pharmacological therapies for sleep and occupational stress regulation among nightshift nurses: A systematic review and Bayesian network meta-analysis based on randomized controlled trials. Frontiers in Public Health, 14, Article 1882224. https://doi.org/10.3389/fpubh.2026.1882224

Denke, L., Atem, F. D., & Rubin, M. A. (2026). Can spirituality help burnout in nurses? A correlational study. Journal of Christian Nursing, 43(3), 166-173. https://doi.org/10.1097/CNJ.0000000000001375

Gu, Y., Huang, Q., Ni, S., Dai, C., & Ren, W. (2026). Associations between fatigue and sleep among night-shift nurses: Mediating role of depressive symptoms and social support. Journal of Nursing Management, 2026(1), Article e5828649. https://doi.org/10.1155/jonm/5828649

Kang, Y., Choi, E. Y., Baek, W., Park, C., & Min, A. (2026). Associations of insomnia, fatigue, and overtime work with self-reported medication errors among perianesthesia nurses: A cross-sectional study. International Nursing Review, 73(3), Article e70233. https://doi.org/10.1111/inr.70233

Lee, A. Y. L., & Tse, L. A. (2026). Non-pharmacological intervention for shift nurses' sleep: Systematic review and meta-analysis. Occupational Medicine. Advance online publication. https://doi.org/10.1093/occmed/kqag085

Li, B., Liu, Y., Li, W., Ma, J. Y. T., Huss, A., Chan, J., Wing, Y. K., & Tse, L. A. (2026). Principal component analysis of pre-sleep artificial light at night exposure patterns and the associations with sleep disturbances in Hong Kong shift-working nurses and daytime office workers. Occupational and Environmental Medicine. Advance online publication. https://doi.org/10.1136/oemed-2026-111078

Templeton, S. J., & Kapic, K. M. (2026). The importance of understanding limitations in nursing. Journal of Christian Nursing, 43(4), 224-229. https://doi.org/10.1097/CNJ.0000000000001411

Weng, X., Tang, N. H. Y., Ma, J. Y. T., Wan, C. C. M., Liu, Y., Wang, F., Li, B., Liao, G., Li, W., Ho, A. W., Ho, C. S., Arrandale, V. H., & Tse, L. A. (2026). Association of real-time noise exposure with rest-activity circadian rhythms and sleep health: A 7-day longitudinal measure among Hong Kong nurses with night-shifts. Environmental Pollution, 406, Article 128644. https://doi.org/10.1016/j.envpol.2026.128644

Wilson-Anderson, K., Rothacker-Peyton, S., Fifer, P., Waldo, M., & Charbonnier, K. (2026). The impact of spirituality on the professional well-being of nurses. Journal of Christian Nursing, 43(4), 210-217. https://doi.org/10.1097/CNJ.0000000000001409

Zydziunaite, V. (2026). Sleep quality and physical activity of night shift nurses working at hospitals: A cross-sectional survey study. Nursing Reports, 16(7), Article 223. https://doi.org/10.3390/nursrep16070223