NURS 668 Week 6 Capstone Paper: First Draft Example

Fueling the Night: Eating Patterns of Night-Shift Nurses and a Three-Session Nutrition Education Program for an Emergency Department (First Draft)

Abstract

Night-shift nurses eat at irregular times, snack more between meals and often lack access to healthy food during their shifts, patterns associated with higher body mass index, poorer quality of life and worse sleep. This paper reviews eleven recent sources on the eating patterns of night-shift nurses, their consequences and causes, and interventions for shift workers. The literature shows consistent associations between night work and irregular eating, identifies organizational constraints and psychological strain as contributors, and finds that intervention research remains too uneven to support formal dietary guidelines for shift workers. In response, a three-session education program, Fuel for Nights, is proposed for the night staff of a 42-bed emergency department. The program teaches meal planning around night shifts, practical choices for food available on shift and mindful eating, and it pairs education with changes to the unit environment, including a protected meal break and a stocked staff refrigerator. Evaluation will measure eating patterns, meal-break completion and participant satisfaction.

Introduction

At 2:40 a.m. on a typical Friday in the emergency department where I work, the waiting room holds eleven patients, three ambulances are on their way, and the only food available to the night staff is a vending machine of chips and candy and whatever someone ordered for delivery before midnight. Most nurses will not sit down to eat until after 4 a.m., if at all. Many will eat a full meal when they get home at 8 a.m. and then try to sleep. Over months and years, these patterns add up. Nurses on my unit joke about "night-shift weight," and several have been told by their own providers to lose weight or lower their blood sugar.

The problem matters beyond individual nurses. Emergency departments depend on experienced night staff, and nurses who develop weight-related conditions, poor sleep or exhaustion are more likely to leave night work or the department altogether, taking hard-won skills with them. A nurse who has not eaten for eight hours is also working at a disadvantage when a trauma or a deteriorating patient arrives at 5 a.m. Yet unit wellness efforts usually focus on stress or sleep and rarely on food, perhaps because eating is seen as a private matter. This capstone argues that the conditions of night work make eating a shared, organizational concern as well as a personal one.

Nutrition is an important part of wellness for any adult, but it is particularly difficult for nurses who work nights. The body's internal clock regulates not only sleep but also hunger, digestion and the handling of glucose, and eating at night works against those rhythms. At the same time, the organization of night work, with unpredictable workloads, short or missed breaks and limited food options, shapes what and when nurses eat. The purpose of this capstone is to examine the evidence on night-shift nurses' eating patterns and to design an education program for the night staff of a 42-bed emergency department. Three questions guide the paper: how night-shift work affects nurses' eating, what consequences and causes the research identifies, and what an evidence-based education program for night nurses should include.

Literature Review

Sources for this review were located through CINAHL and PubMed using combinations of the terms night shift, shift work, nurses, eating, diet, nutrition, meal timing and emotional eating, and through the Journal of Christian Nursing for a faith-based perspective. Eleven sources published from 2025 onward were selected: eight studies of nurses, two systematic reviews of shift workers that included nurses, and one article describing a Christian whole-person health framework. Table 1 summarizes them. The review is organized in four themes.

Theme 1: How Night Work Changes Eating

The studies agree that night work changes when and how nurses eat, though they differ on what it does to diet quality. In an online survey of 408 Italian nurses, those who worked nights more often reported snacking between main meals, 49.8% compared with 22.3% of nurses who worked only days (Chang et al., 2026). Among 159 surgical intensive care nurses in Türkiye, questionnaires showed moderate acceptance of the food available and difficulty keeping meals regular and balanced during shifts, and interviews with 16 of them explained why: schedules, heavy workloads and fatigue broke up mealtimes, and nutritious, affordable food was hard to find (Özkan & Atasayar, 2026). In a study of 1,024 night-shift nurses in Hangzhou, three dietary patterns emerged, traditional, Western and balanced, and nurses following the Western pattern reported lower quality of life on most dimensions of a standard health survey (Liang et al., 2025).

One US study complicates the picture. Farrell et al. (2025) tracked the diets of 123 nurses for up to seven days and found short overnight fasting, a mean of 11.9 hours, and generally poor diet quality, but nurses on night or rotating shifts had less inflammatory diets than day-shift nurses. The sample was small, mostly White and female, and the finding may reflect who chooses night work. Taken together, these studies suggest that timing and regularity, more than any single food choice, are where night work most consistently disrupts eating. This conclusion has practical weight. If night nurses' food choices were simply poor, education about nutrition might be enough; if the main problem is that meals are pushed out of the shift by workload and then eaten at the wrong time of day, the solution must also involve the structure of the shift itself. The Italian and Turkish studies both point to structure, since snacking rose where meals could not be planned and interviewed nurses described meals lost to busy periods.

Theme 2: Why Eating Patterns Matter for Health and Sleep

Irregular eating is linked to outcomes that matter for nurses' health. Urbón and Salavera (2026) used structural equation modeling with 194 nurses and found that shift work was associated with psychological distress, distress with irregular eating, and irregular eating, measured as skipped meals and between-meal snacking, directly with higher body mass index. The indirect pathway from shift work to body mass index through irregular eating was significant, while the longer pathway through distress was not, which the authors interpreted to mean that the organizational constraints of shift work may affect eating more directly than stress alone. The design was cross-sectional, so the direction of these relationships cannot be confirmed.

Eating also appears connected to sleep. Among 328 female hospital nurses in Taiwan, healthier nutrition-related behaviors and more physical activity were each associated with lower odds of insomnia, while working 10 to 12 hours a day more than doubled the odds (Hu et al., 2026). A more extreme form of disordered night eating also occurs. In a survey of 311 nurses in three hospitals, 4.5% met criteria for night eating syndrome, and working in intensive care, night shift assignments, poor sleep quality and depressive symptoms were associated with it (Fang et al., 2025). The evidence suggests that a night nurse's plate, sleep and mood are linked, so a program that addresses one in isolation is likely to fall short.

Theme 3: What Drives Night-Shift Eating

Three drivers recur across the studies. The first is organizational: schedules, workload and the availability of food. The intensive care nurses in Özkan and Atasayar's (2026) interviews described missed meals during busy periods and limited options at night, and the modeling by Urbón and Salavera (2026) pointed to the constraints of shift work as a direct influence on irregular eating. The second driver is psychological strain. Liang et al. (2026) found substantial overlap between burnout and emotional eating among Chinese nurses, identified frequent night shifts as a key driver and found that professional experience was protective; they recommended limiting monthly night shifts and offering mindful eating support to newer nurses with heavy night loads. The third driver is individual chronotype. A systematic review of 29 studies, mostly of nurses and other health care workers, found that people with an evening chronotype, those whose natural rhythm favors later sleep, consistently ate less healthily, with irregular meal timing, skipped breakfasts, delayed eating and more energy-dense food (Franky Giltelin et al., 2026). These drivers suggest that an effective program must work on the environment and on stress as well as on individual knowledge. Chronotype also argues against a single schedule for everyone. A nurse whose natural rhythm runs late may adapt to nights more easily but may also be the one most prone to skipping breakfast and eating late, while a morning-type nurse may struggle more with alertness but keep steadier meals. Education that helps each nurse recognize their own pattern is likely to be more useful than a uniform meal plan.

Theme 4: What Interventions Have Shown

The evidence on interventions is thin. Booker et al. (2026) conducted a systematic review of nutrition interventions for shift workers, screening 6,909 articles and including 43 studies, mostly crossover trials and observational studies, with nurses and other health care workers making up 40% of the free-living samples. Common interventions adjusted macronutrients, restricted eating to certain hours or changed meal timing and size, and common outcomes were cardiometabolic health, cognitive performance and sleep. The authors concluded that heterogeneity, small samples and moderate to high risk of bias made the evidence insufficient to formulate dietary guidelines for shift workers. Farrell et al. (2025) found that 75% of their nurse sample were interested in time-restricted eating, which suggests that nurses would welcome structured guidance even while researchers cannot yet say which approach is best. The gap between nurses' interest and the strength of the evidence creates an ethical obligation for any education program. A program should not promise that a particular eating window or diet will prevent weight gain or diabetes when the research cannot support that claim. It can, however, teach principles that are consistent with what is known about circadian rhythms, such as avoiding large meals in the hours when the body is least able to handle them, and it can encourage nurses with specific health conditions to discuss eating plans with their own providers.

Faith and Whole-Person Health

Christian scholarship offers a framework that places nutrition alongside rest and other dimensions of well-being. Clark et al. (2026) describe CREATION Life, a framework used in a faith-based university's nursing programs, built on eight principles drawn from the creation account in Genesis: choice, rest, environment, activity, trust in God, interpersonal relationships, outlook and nutrition. The article describes an educational framework rather than an outcome study, but it supports approaching night nurses' eating as one part of caring for the whole person rather than as a matter of willpower. Paul's reminder that the body is a temple of the Holy Spirit (English Standard Version Bible, 2001/2016, 1 Corinthians 6:19-20) gives Christian nurses a reason to care for their own bodies with the same seriousness they bring to patients'.

Summary of the Literature

The literature shows that night work disrupts the timing and regularity of nurses' eating, that irregular eating is associated with higher body mass index, poorer quality of life and worse sleep, and that organizational constraints, psychological strain and chronotype all contribute. What it cannot yet do is justify fixed dietary rules for people who work nights. These conclusions point toward an education program that offers practical, flexible guidance rather than strict rules, addresses stress-driven eating, and is paired with changes to the work environment.

The Education Project: Fuel for Nights

Setting and Audience

Fuel for Nights is meant for the night staff of a 42-bed emergency department: 46 registered nurses and 12 emergency technicians, each scheduled for two or more nights in a typical month. A brief survey of 34 night staff before the program found that 27 rarely or never took an uninterrupted meal break, 21 relied on the vending machine or delivery food at least once per shift, and 19 described eating "whatever is fast" when stressed.

Theoretical Framework

The program is guided by the social ecological model, in which a person's habits are understood as the product of nested layers of influence: the individual, relationships, the organization and the wider community. The literature review found drivers at each of the first three levels: chronotype and knowledge at the individual level, peer habits such as shared delivery orders at the relationship level, and schedules, breaks and food availability at the organizational level. A program that worked only at the individual level would ask nurses to change behavior in an environment that keeps pushing them back. Adult learning principles shape the sessions themselves. Night nurses already know their eating is irregular, so each session begins with their experience, offers practical options they can use on the next shift and invites them to adapt the material to their own lives.

Goals and Objectives

The program's goal is to help night staff eat more regularly and choose more nourishing food during and around night shifts. After completing the three sessions, each participant should be able to plan meal timing for a run of night shifts, pack or select at least two balanced options for a shift, use a brief mindful eating practice when stressed, and describe the unit's protected meal-break process.

Program Design

Table 2 outlines the three sessions, each 30 minutes long and offered at 3:30 a.m. on several nights so that all staff can attend during a shift.

Because no dietary guideline for shift workers is yet supported by strong evidence (Booker et al., 2026), Session 1 presents meal-timing suggestions as options rather than rules, such as eating a main meal before the shift, a smaller meal in the early part of the night rather than near dawn, and a light snack rather than a large meal before daytime sleep. Session 3 responds directly to the link between burnout and emotional eating and to the recommendation for mindful eating support (Liang et al., 2026).

Environmental Changes

Education alone cannot fix eating in an environment that makes regular meals impossible. In partnership with the department manager, the program includes three changes: a protected 30-minute meal break for each nurse, which the charge nurse schedules when the shift begins, naming the colleague who will cover; a staff refrigerator stocked weekly with fruit, yogurt, nuts and sandwiches funded by the department; and replacement of half the vending machine's contents with healthier choices. These changes address the organizational driver that the literature identified most consistently (Özkan & Atasayar, 2026; Urbón & Salavera, 2026).

Christian Whole-Person Approach

The program frames eating within the CREATION Life principles (Clark et al., 2026), so that nutrition is discussed alongside rest, activity and relationships. Participants who wish may join a short closing reflection on stewardship of the body, and the program's materials invite nurses to see a shared meal break as a moment of community, much like the early church, which broke bread together "with glad and generous hearts" (English Standard Version Bible, 2001/2016, Acts 2:46).

Implementation Timeline and Barriers

The program will run over three months. In the first month, the manager and the project lead will secure the department's budget for the refrigerator and agree on the protected meal-break process with charge nurses. In the second month, the three sessions will be offered on rotating nights, and the refrigerator and vending changes will begin. In the third month, the charge nurse log and the week 4 questionnaire will provide early data, and the sessions will be repeated for staff who missed them.

Three barriers are expected. Protected meal breaks may be abandoned on the busiest nights, so the charge nurse log will record the reason whenever a break is missed, which will show whether the barrier is staffing or habit. Some nurses may feel that a nutrition program implies judgment about their weight, so the sessions will focus on energy, alertness and sleep rather than body size. Finally, the cost of stocking the refrigerator may be questioned after the first months, which is why use will be tracked weekly.

Evaluation Plan

The program will be evaluated over twelve weeks. Participants will complete a short eating-pattern questionnaire before the program and at weeks 4 and 12, measuring meals per shift, between-meal snacking and stress-related eating. The charge nurse log will record the proportion of nurses who complete a protected meal break each night. Refrigerator restocking records will track use, and participants will rate the sessions. Success will mean that the share of staff taking an uninterrupted meal break rises from roughly one in five to at least two in three, and if self-reported stress-related eating decreases at week 12.

Limitations of the Project

The program has several limitations. Its evaluation relies on self-reported eating patterns, which are prone to recall and social desirability bias. It does not measure weight, blood glucose or other clinical outcomes, because a twelve-week program is unlikely to change them and collecting them would raise privacy concerns. The literature it rests on comes largely from outside the United States and from cross-sectional designs. A larger evaluation over a year, with a comparison unit, would be needed to show whether the program changes health outcomes.

Conclusion

Night-shift nurses face a combination of biological, organizational and psychological pressures that disrupt their eating, with consequences for their weight, quality of life and sleep. The evidence is clear about these patterns but not yet strong enough to prescribe specific diets, which argues for practical and flexible education paired with changes to the work environment. Fuel for Nights responds to that evidence in three short sessions, a protected meal break, a stocked refrigerator and healthier vending, and frames the effort within a Christian understanding of the whole person. The final draft will incorporate instructor feedback on the literature review's organization and the evaluation plan.

Appendix: Session 1 Handout Outline

• Before the shift: eat a main meal two to three hours before leaving home
• Early in the night: plan a smaller meal before 1 a.m. if the department allows
• Late in the night: choose a light snack, such as fruit or yogurt, rather than a full meal
• After the shift: eat a light breakfast before sleeping instead of a large meal
• Days off: return gradually to daytime meals
• Questions for your provider: weight, blood sugar and medications that affect appetite

References

Booker, A. J., Powell, S., Fallowfield, J. L., & Gibson, R. (2026). A systematic review of nutrition interventions for shift workers, with subgroup analysis of first responder populations. Journal of Human Nutrition and Dietetics, 39(5), Article e70340. https://doi.org/10.1111/jhn.70340

Chang, Y. C., Mea, R., & Vitale, E. (2026). How shift work impacts on eating behaviours among nurses: A cross-sectional study. Nursing Open, 13(10), Article e70884. https://doi.org/10.1002/nop2.70884

Clark, J., Osa, A., Catala-Beauchamp, A., Rollins, E., Gold, J., Torres-Logan, D., Sebastian, N., Luther, N., Kyle, T., & Callender, L. (2026). Rooting nursing education in Creation Life: A whole-person framework. Journal of Christian Nursing, 43(3), 182-185. https://doi.org/10.1097/CNJ.0000000000001382

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Fang, S., Zhao, R., Feng, J., Wang, H., & Li, D. (2025). Prevalence and correlates of night eating syndrome among Chinese nurses: Focus on depression and sleep quality. Frontiers in Public Health, 13, Article 1687850. https://doi.org/10.3389/fpubh.2025.1687850

Farrell, E. T., Turner-McGrievy, G. M., Dawson, R. M., Heflin, K., & Wirth, M. D. (2025). SHift-working Investigation of Fasting and Timing (SHIFT) of diet: A cross-sectional assessment of nurses' dietary quality, fasting duration, and feasibility of completing a 7-day diet log. Chronobiology International, 42(8), 1048-1059. https://doi.org/10.1080/07420528.2025.2525463

Franky Giltelin, E. N., Mohd Fahmi Teng, N. I., Isa, S. N. I., Md Nor, N., Maluin, S. M., & Juliana, N. (2026). Chronotype and its association with eating behaviour and psychosocial well-being in shift workers: A systematic review. Chronobiology International. Advance online publication. https://doi.org/10.1080/07420528.2026.2703821

Hu, C. J., Huang, M. F., & Lin, Y. T. (2026). How physical activity and nutrition are associated with sleep health among female nurses: A cross-sectional study. Work. Advance online publication. https://doi.org/10.1177/10519815261470414

Liang, G., Hua, R., & Yang, F. (2025). Dietary patterns and quality of life among night-shift nurses in tertiary hospitals in Hangzhou: A cross-sectional analysis. Frontiers in Public Health, 13, Article 1638082. https://doi.org/10.3389/fpubh.2025.1638082

Liang, X., Wu, X., Zhang, H., & Zheng, B. (2026). Appetite for coping: A latent profile analysis of typological heterogeneity in nurse burnout and emotional eating. Frontiers in Nutrition, 13, Article 1884663. https://doi.org/10.3389/fnut.2026.1884663

Özkan, E., & Atasayar, B. Ş. (2026). Eating habits of surgical intensive care nurses during shifts: A mixed-methods investigation of food craving, acceptance and eating behaviours. Nursing in Critical Care, 31(5), Article e70643. https://doi.org/10.1111/nicc.70643

Urbón, E., & Salavera, C. (2026). Shift work and BMI in nursing professionals: A cross-sectional mediation analysis through psychological distress and irregular eating patterns. Work. Advance online publication. https://doi.org/10.1177/10519815261473912