NURS 668 Week 8 Capstone Paper: Final Draft Example

Protecting the Daytime Sleep of Night-Shift Nurses: An Evidence Review and the Rest for the Night Shift Education Program

Abstract

Nurses who work nights must sleep during the day, against the body's internal clock, and research shows that most sleep poorly as a result. This capstone reviews fourteen recent sources on the scope, consequences, causes and treatment of sleep problems among night-shift nurses and presents an education program built on that evidence. The review found that poor sleep is widespread among night nurses and travels with fatigue, depressive symptoms, changes in brain function after a night shift and self-reported medication errors; that exposure to light before sleep, irregular noise and low physical activity are changeable contributors; and that structured, non-drug programs, particularly those teaching sleep skills and mindfulness, produce moderate improvements in sleep quality. Rest for the Night Shift is a four-week program for 40 night staff on a medical-surgical unit, combining one session at 3 a.m., three weeks of practice with sleep diaries and mindfulness, peer support and an optional reflection on rest. Evaluation uses the Pittsburgh Sleep Quality Index at baseline, four weeks and twelve weeks, with a target based on published effect sizes.

Introduction

Every morning at 7:30, the night nurses on my medical-surgical unit leave work as most people are starting their day. They drive home into the sunrise, return to houses where children are leaving for school and neighbors are mowing lawns, and try to sleep through the hours their bodies expect to be awake. Many do not succeed for long. In a survey I conducted on the unit before beginning this capstone, nineteen of twenty-seven night staff said a normal post-shift sleep lasted under six hours.

Sleep is a foundation of health, and its loss affects mood, metabolism, immunity and attention. For nurses, it also bears on the care they give, since the hours of the night shift that follow short daytime sleep are the hours when alertness is lowest. Yet hospitals rarely treat nurses' sleep as anything other than a private matter. Units track falls, infections and patient satisfaction in detail, but almost none track whether the nurses delivering that care have slept. On my unit, the only acknowledgment of night nurses' sleep is an informal rule against scheduling them for mandatory education the morning after a shift. That rule is a kindness, but it treats sleep as something to avoid interrupting rather than something the unit could help nurses protect and improve. This capstone sets out to weigh what recent research says about night-shift nurses' sleep and to offer a unit-level program built on that research. Three questions guide the paper: how common and consequential poor sleep is among night nurses, what causes it and what can be changed, and what a program grounded in that evidence should contain for a single unit.

Guiding Framework

The theory of comfort developed by Kolcaba (2003) guides both the review and the program. In that theory, comfort comes when someone's needs are met in three ways, through relief from distress, through a settled state of calm and through the strength to transcend what cannot be fixed, and these needs are answered across the physical, psychospiritual, sociocultural and environmental parts of life. Although it was developed for patients, it fits the night nurse's daytime sleep closely. Physical comfort concerns the body's struggle against its own clock; environmental comfort concerns the light and noise of a daytime bedroom; sociocultural comfort concerns the household and the family's schedule; and psychospiritual comfort concerns the racing mind after a difficult shift and, for some nurses, faith. The theory also predicts that when comfort needs are met, people engage more fully in health-seeking behaviors, which for nurses would include the habits a sleep program teaches. Each part of the program described later addresses one or more of these contexts, and the framework helped decide what to include and what to leave out.

Literature Review

The review drew on searches of CINAHL and PubMed for research published from 2021 onward on sleep, night or shift work, nurses, interventions and spirituality, and on the Journal of Christian Nursing for faith-based scholarship. Fourteen sources were retained: ten studies of nurses' sleep or its correlates, two systematic reviews of interventions, and two studies of spirituality and nurses' well-being. Table 1 lists them. Following feedback on the first draft, the review is organized around three questions, the problem, its causes and its solutions, rather than around individual studies.

The Problem: How Common and How Costly

The largest study reviewed, covering 132,910 nurses in 67 public tertiary hospitals, found that roughly a quarter reported disturbed sleep, with waking during the night and waking too early the most frequent complaints (Bin et al., 2025). Studies restricted to night workers report far higher figures. Of 1,667 nurses working nights during the pandemic, more than seven in ten slept poorly by a standard index (Gu et al., 2026), and a 2025 survey of 1,608 shift nurses found an average index score in the poor range and four distinct sleep profiles, the two smallest of which involved disordered sleep and sleeping-pill use (Chu et al., 2026). The pandemic study likely overstates the usual burden, yet the pattern is consistent: night work turns poor sleep from a common complaint into the typical experience.

The costs fall on nurses and may reach patients. Fatigue in the pandemic sample was closely tied to both depressive symptoms and poor sleep, and depressive symptoms carried about three-tenths of the link between fatigue and sleep (Gu et al., 2026). When 67 emergency nurses were tested on two occasions, after working a night and after a normal night's sleep at home, oxygenation in the prefrontal cortex during a word-generation task was lower after the night shift (Casas-Méndez et al., 2026), a measurable change in the brain region used for planning and attention. Among 213 perianesthesia nurses, insomnia and fatigue, though not overtime itself, were associated with more types of self-reported medication error (Kang et al., 2026). None of these studies tracked patient harm directly, but together they make a strong case that a night nurse's sleep is part of the conditions of safe care.

The Causes: What Nurses Can Change

Circadian disruption cannot be removed from night work, but several factors that worsen it can be changed. The strongest evidence concerns light. In a week of wrist-sensor monitoring, Hong Kong shift nurses who were exposed to more light in the period before sleep slept less, fell asleep later and woke earlier, and once light exposure was accounted for, their total sleep did not differ significantly from that of daytime office workers (Li et al., 2026). The authors' recommendation was direct: reduce personal light exposure before sleep.

Noise is a second factor. Among 360 nurses, most of them working nights, noise in the hour before and during sleep, and especially noise that rose and fell, was associated with weaker daily rhythms and more restless sleep even without full awakenings, and nurses newer to night work were more affected (Weng et al., 2026). For daytime sleepers surrounded by traffic and household activity, a steady masking sound may matter more than an occasionally quiet room. Physical activity is a third, weaker factor: among 400 night-shift nurses, more activity went with somewhat better sleep, while older and longer-serving nurses slept worse and used sleep medication more often (Zydziunaite, 2026). The factors that most shape a night nurse's daytime sleep are found on the drive home and in the bedroom, which is exactly where an education program can reach.

The Solutions: What Interventions Show

Two reviews published in 2026 address what helps. Combining the results of 11 controlled studies, Lee and Tse (2026) found a moderate overall improvement in sleep quality, a standardized mean difference of -0.63, with considerable heterogeneity; mindfulness programs, the most common intervention, were beneficial, while aromatherapy showed no significant effect. Deng et al. (2026) compared interventions across 18 randomized trials with 1,572 nurses using a Bayesian network meta-analysis and ranked structured sleep intervention programs first for overall sleep scores and mindfulness training first for sleep duration. The reviews differ in method and in the trials included, and network rankings depend on indirect comparisons, but both point toward structured programs that teach and rehearse sleep skills over several weeks.

Faith and Well-Being

Christian scholarship contributes a way of thinking about rest that the clinical studies lack. Templeton and Kapic (2026), writing in the Journal of Christian Nursing, describe human limits as part of God's good design and argue that personal and organizational failure to honor those limits feeds burnout and drives new nurses from the profession. Empirical studies in the same journal add support. Among 408 nurses at an academic medical center, burnout was lower among those who reported deep inner peace, a sense of God's guidance and gratitude (Denke et al., 2026). Correlations of this kind cannot show cause, and sleep itself was not measured, yet the finding suggests that faith-based reflection may support well-being for nurses who share that faith. Scripture itself presents rest as a gift, describing the anxious toil of early rising and late nights as futile because sleep is something God gives to those He loves (English Standard Version Bible, 2001/2016, Psalm 127:2).

Gaps

Most of the studies are cross-sectional and many come from Asian and European health systems, so US hospitals should apply them with some caution. The intervention trials were short and varied in quality. No study combined guidance on light, noise and activity with mindfulness and an optional spiritual component, and no study measured patient outcomes directly. These gaps shape both the design of the program and the modest claims of its evaluation.

The Education Project: Rest for the Night Shift

Setting and Participants

The program's audience is the unit's forty night staff, thirty-one of them registered nurses and nine of them patient care technicians. The unit's pre-program survey of 27 night staff found that most slept under six hours after a shift, half drove home without sunglasses, most used a phone in bed and six regularly took a sleep aid. The survey also identified the hour after 3 a.m. as the only reliable time for staff education.

Goals and Objectives

The program's goal is to improve the daytime sleep quality of night staff. Participants will be expected to explain how night work disrupts the sleep-wake cycle, identify their own sources of light, noise and inactivity, complete a written sleep protection plan, practice a five-minute mindfulness exercise on most days for three weeks and know how to seek help for persistent insomnia.

Design and Schedule

Table 2 presents the program's four weeks. The design follows the reviews in pairing teaching with several weeks of practice, rather than relying on a single in-service.

The opening session teaches three practical changes: wearing wraparound sunglasses on the drive home and keeping screens away for the last hour before sleep; darkening the bedroom and using a steady fan or sound machine to mask changing noise; and planning activity on days off. Each nurse drafts a sleep protection plan, shown in the Appendix, during the session. Two experienced night nurses serve as peer champions, completing the program first and leading the weekly check-ins, which builds the peer support that research on night nurses' fatigue recommends (Gu et al., 2026).

Christian Worldview

In the third week, the hospital chaplain leads an optional reflection on the moment Jesus told His worn-out disciples to step away with Him to a quiet place for rest (English Standard Version Bible, 2001/2016, Mark 6:31) and on the idea that rest honors the limits God built into human bodies (Templeton & Kapic, 2026). The reflection is voluntary so that nurses of other faiths or none can take part in the rest of the program without pressure, and it is scheduled separately from the practice check-ins so that choosing not to attend is never visible to colleagues.

Resources and Budget

The program costs about $1,900: paid session time for 40 staff, preparation time for the peer champions, a pair of wraparound sunglasses for each participant and printed materials. The mindfulness recording costs nothing, and pastoral care donates the chaplain's hour.

Implementation

Coverage during the 3 a.m. session comes from the charge and resource nurses. If a heavy night forces the session to be canceled, it moves to the next night. Participants keep their sleep diaries privately and share only practice counts, which addresses staff concerns about discussing sleep at work. The unit manager has agreed not to schedule mandatory meetings or education for night staff during the four weeks, so that the program does not compete with the sleep it is meant to protect. The peer champions will also keep a short log of questions raised at the huddles, which will help revise the materials for the next cohort. To reach the nurses who work nights only occasionally, the materials include a page on switching between day and night schedules, the situation in which sleep is often most disrupted. Nurses who report regular sleep aid use or persistent insomnia receive information on seeing their own provider or the employee health service.

Evaluation

Following first-draft feedback, the evaluation was revised to measure only what a four-week program can plausibly change. The main outcome, scored on the Pittsburgh Sleep Quality Index, is collected three times: at the start, at the end of week four and again at week twelve. Because the pooled effect in comparable trials was moderate (Lee & Tse, 2026), the target is an average improvement of at least two points at twelve weeks, not a shift of most participants into the good-sleep range. Behavior is measured through diary counts of nights the sleep plan was followed and days mindfulness was practiced, with a target that at least half of participants practice on four or more days a week. A knowledge test before and after the session and an anonymous satisfaction survey complete the evaluation. Medication errors and turnover, which were outcomes in the first draft, are now discussed only as possible measures for a larger, longer evaluation.

Response to First-Draft Feedback

The instructor's comments on the first draft led to three main revisions. First, the literature review was reorganized from five themes into the problem, causes and solutions, which shortened it and made the path to the program clearer. Second, the evaluation was rewritten to measure only what a short program can plausibly change, with targets derived from the pooled effect in comparable trials rather than from hopes about errors and turnover. Third, the faith component was made explicitly optional and its rationale was tied to the sources, after a comment that it read as an assumption that all staff share the same beliefs.

Ethical Considerations

A program about sleep touches nurses' private lives, so it is designed to protect their privacy and autonomy. Participation is voluntary and is not tied to performance reviews. Sleep diaries remain with the nurse, and only anonymous practice counts and survey results are reported. The program does not diagnose sleep disorders or advise on medication; nurses who report persistent insomnia or regular sleep aid use are directed to their own provider or employee health. Finally, the program must not shift responsibility for an organizational problem onto individual nurses. The conclusion therefore recommends that managers also review scheduling practices, such as long runs of consecutive nights, that the program itself cannot change.

Sustainability and Dissemination

If the twelve-week results meet the targets, every nurse hired into a night position will attend the 3 a.m. session during their first month, and the peer champions will repeat the program twice a year. The sleep plan template and mindfulness recording will remain on the unit's intranet page. Results will be shared with the unit practice council, the night charge nurses and the hospital's nursing research committee, and if the program is repeated on other units with a comparison group, the findings could be submitted to a professional nursing journal so that other hospitals can learn from them.

Conclusion

Night-shift nurses sleep poorly, and the evidence connects that poor sleep with fatigue, low mood, changes in brain function and self-reported errors. Light, noise and inactivity make the problem worse and can be changed, and structured programs teaching sleep skills and mindfulness produce moderate gains in controlled trials. Rest for the Night Shift applies that evidence to one unit in a form that fits the realities of night work, with a modest and honest evaluation. Its limitations include reliance on self-report, a short follow-up and evidence drawn mostly from outside the United States. A single unit of forty staff is too small to detect differences between groups, such as experienced and newer night nurses, and without a comparison unit any improvement could reflect seasonal changes in daylight or staffing rather than the program. The evaluation also cannot separate the effect of the opening session from the effect of the weeks of practice. These limits do not undermine the program's value for the unit, but they mean its results should be presented as a quality improvement report, not as proof of effectiveness. If the program meets its targets, the next steps are to make the opening session part of orientation for every new night nurse and to test the program on other units with a comparison group. For a Christian nurse, the project expresses a simple conviction: rest is part of God's design, and caring for the people who care for patients includes protecting their sleep.

Appendix: Sleep Protection Plan Template

• My usual time home after a night shift, and my target time asleep
• What I will do about light on the drive home and in the last hour before sleep
• How I will darken my bedroom and mask changing noise
• When I will be physically active on my days off
• My five-minute mindfulness time each day
• Who at home will help protect my sleep hours
• When I will seek help if my sleep does not improve

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

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

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

Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. Springer.

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

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