Essay on Navigating Fatigue: Implications on Flight Nurse Performance and Insights into Sleep Physiology

A flight nurse who has just covered a 12-hour shift but is urgently required to take on another shift would lead to fatigue. Fatigue can affect the performance of this nurse, and within 12 hours, the nurse has not had a chance to sleep. Sleep is a physiological need that is considered urgent for any human being. After a 12-hour shift, it is bound that the flight nurse will be fatigued and feel the urge to sleep. Sleep is necessary for proper body functioning as well as enhanced brain function. Human beings can sufficiently work through the day in normalcy and stay awake for up to 12 hours compared to during the night, out of which, for adequate sleep, a minimum of 6 hours is necessary (Hirshkowitz et al., 2015). It should also be noted that having more sleep than usual can lead to a fatigued individual, the same as having less sleep than usual. In today's modern society and especially that of 2020, individuals have been forced to adapt to a 24-hour economy, meaning that working hours are increased an individual to enhance their income or for the entire needs that their work requires (Hirshkowitz et al., 2015). In order to meet the requirements of this changing world, the circadian rhythm has to be much affected. Abnormal circadian rhythm and lack of sleep can also lead to depression in working adults with this being part of the risk.

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In an organization such as the EMS, it is not operationally feasible to meet every person's needs due to the demands of the work itself. This article looks into the physiology of sleep and the circadian rhythm, taking into consideration ways in which fatigue and sleepiness with the use of drugs such as caffeine in the workplace and change of posture while exercising to manage effective working through prolonged continuous hours. It also looks into how fatigue affects an individual's overall performance, especially those working for emergency medical services, whereby on-call duty is somewhat unavoidable for such personnel.

Physiology of Sleep

Sleep is essential in all human beings; it is a part of life required for the sustainability of growth. It can be said that sleep as well as the production of hormones that are key in the sustenance of crucial roles within the body, including the maintenance of a healthy body, general mood, memory performance levels, and even cognitive functions within an individual's body (Hirshkowitz et al., 2015). Processes like metabolism considerably slow down during the sleep process, whereas the majority of other purposes tend to continue during sleep. There are two types of sleep that move in cycles, among them Rapid Eye Movement (REM) sleep and non-rapid Eye Movement (nREM) sleep (Hirshkowitz et al., 2015).

Quality and quantity of sleep are both outstanding. If a person has interrupted sleep within a period of sleeping for 8 hours, he or she will wake up and still feel that they had inadequate in sleep. On the other hand, excessive sleeping can also lead to an individual feeling sleepier as they go about their day-to-day activities (Hirshkowitz et al., 2015). Disrupted sleep can result from a sleep disorder or from changes within the environment during the time of sleep. After a period of deprived sleep, studies suggest that recovery sleep is more in-depth in comparison to the amount of sleep lost; it is more rooted in nREM 3 and nREM 4 (Hirshkowitz et al., 2015). Studies further suggest that during recovery sleep, the tested subject feels that they slept for longer, but they just happen to have slept deeper. During the undertaking of any study of sleep, it is of great importance to look into sleep inertia and sleep loss.

Sleep inertia is the period experienced by an individual during the transition period between waking up and sleep at the time of awakening. Sleep inertia has some undesirable effects, which can be related to several factors, such as the sleep period duration and the sleep debt amount. It should be noted that studies suggest that when awakening from a slow sleep wave such as nREM3 and nREM4, there are more pronounced effects of sleep inertia (Hirshkowitz et al., 2015). Further intensification of the sleep-wake cycle is seen when awakening happens at the point of physiologically programmed low points of being alert. Sleep inertia should be considered among employees.

Studies have shown that fatigue results in human error. The cause of fatigue can be attributed to sleep loss. Sleep loss can be divided into acute sleep loss, cumulative sleep loss, and chronic sleep loss. In these divisions, cumulative sleep loss is viewed to be in between severe sleep loss and chronic sleep loss (Hirshkowitz et al., 2015). On the other hand, acute sleep loss occurs in episodes of sleep that are shortened in one or two nights. An individual with severe sleep loss shows a decrease in levels of alertness and in levels of performance. The level of decline in alertness and performance can be documented over a period of one to two nights in a reduction of three to four hours in the calculation of the reasonable sleep time or even the usual sleep time.

It should be noted, however, that this is uncommon in today's society and especially in the workplace. As much as this looks like a small amount of loss of sleep, a night of sleep or recovery will not be efficient enough to return one's level of alertness and performance to the initial baseline values. There is also a tendency to have episodes of micro-sleep if an individual has changed in alertness levels and performance levels.

Physiology of Circadian Cycle

Circadian is a word with its origin from the word circa, which refers to dies and about hence referring to a day. Therefore, for there to be said to have been a circadian rhythm, it needs to be an approximate of 24 hours long, which can also be said to be one day in length (Chan & Debono, 2010). This circadian program in human beings aids in the performance of body functions such as regulation of the body's temperature, alertness levels, fatigue, which is subjective, plasma cortisol, sleep patterns, plasma melatonin, and other physiological functions (Chan & Debono, 2010).

The earth rotates on its own axis. Throughout the year, seasons are ranging between winters, summer, autumn, and spring. There is also day and night. In so doing in human life, there are sleep cycles, which allow us to go about our daily activities in normalcy, inability to sleep is harmful to one's health, too much sleep is also detrimental. The circadian cycle had been ignored up until the 1970s (Chan & Debono, 2010). The research was done to the discovery of a hypothalamic site that was small in size found above the optical chiasma, namely the suprachiasmatic nucleus, which leads to loss of circadian rhythm (Chan & Debono, 2010). The brain was also found to function as a clock essential to the body enabling the circadian rhythm through coordination from the suprachiasmatic nucleus. Other crucial functions of the brain are such as metabolic processes and hormone release. If there is a problem with the sleep-wake cycle, there are bound to be disturbances with the inability to maintain attention, irritability, heart diseases, and even heart diseases (Chan & Debono, 2010). An unfortunate circadian rhythm disruption will, in turn, lead to illness, although more studies need to be done on the subject. It should be stated that altered sleep patterns can, in turn, result in desynchrony which has been noted in night shift workers. Modern times can be attributed to altered sleep patterns in many individuals in this current day and age.

Issues of this Situation

In 2008, in October, according to the helicopter emergency medical system statistics, there were eight fatal accidents and 29 fatalities compared to the year 2007, when there were seven fatalities and two fatal accidents, which was noted as a sharp rise in accidents (Orem 2012). Thus, the Safety Board of transportation of the United States added a helicopter emergency medical system to the most wanted list in terms of improvement in transport. It is also noted that most of the accidents had an occurrence during the night time, which brings about the question as to whether the pilots experienced fatigue, thus resulting in the rise in the accidents (Orem 2012). Scientific studies are limited on the examination of fatigue in operations of air medical transport. This hence creates a challenge in examining the effects of fatigue due to deprivation of sleep (Orem 2012). Studies of fatigue as a result of depression and circadian disorders have been done and can hence provide more insight into this issue.

Effects of Fatigue on One’s Performance

Taking a closer look at how performance affects fatigue and especially sleepiness. Sleepiness can be described as a state whereby an individual experiences the urge to sleep. Fatigue, on the other hand, can be defined as a state whereby a person experiences a capacity that is decreased in the performance of tasks, especially those involving the mind as a result of prolonged hours of being awake (Barker & Nussbaum, 2011). Another definition of fatigue is that it is a state whereby an individual's performance is no longer what it used to be previously standard of performance. It should be noted that when it comes to fatigue and sleep, studies agree that they both decrease the level of performance in an individual.

Maintaining optimal alertness and neurobehavioral functioning in operational environments is critical to maintaining safety, efficiency, and success. Affirming high levels of alertness and performance are necessary to operate sophisticated technology and machinery and make essential decisions about a task (Barker & Nussbaum, 2011). Those working erratic schedules cannot adapt to schedule changes quickly or the conflicts between the endogenous circadian system and environmental time cues, and subjective, performance, and physiological changes occur unpredictably (Barker & Nussbaum, 2011). Performance levels and fatigue are worsened due to their effects on sleep duration and quality and the difficulties associated with maintaining alertness and high cognitive functioning at an adverse circadian phase.

Although individuals report feeling increasing levels of sleepiness and fatigue with the progression of sleep loss, research has shown that these subjective estimates are unreliable. Humans are not the best evaluators of their alertness state and can lose awareness of their fatigue levels. They are often sleepier than they report. Subjective estimates can also be affected by environmental conditions (Barker & Nussbaum, 2011). If an individual is in a highly engaged environment, involving physical activity or interaction with other individuals, the underlying sleepiness may not be as noticeable, and that person may rate himself or herself as being more alert than his or her physiological responses would indicate (Barker & Nussbaum, 2011). This creates challenges in the detection and management of sleepiness and fatigue in operational environments.

The mood is affected by fatigue; a sleepy individual tends to exhibit a low attitude and a lower level of communication and social interactions with different individuals. A study conducted on pilots during night and day times revealed that there was an increase in fatigue levels, especially between 0755 hours and 2100 hours (Barker & Nussbaum, 2011). There was also a decrease in vigor ratings at that time; the helicopter pilots also reported fatigue confusion and tension during those hours. The studies revealed that even a 2-hour loss of sleep in a day could result in poor performance and lowered levels of alertness, especially during early morning hours and late-night hours (Barker & Nussbaum, 2011).