Kathy Nelson

Date of Award

Spring 2023

Document Type

Open Access Dissertation


College of Nursing

First Advisor

Karen E. Wickersham


Background: Shift work is associated with detrimental effects on health and well-being, including poor sleep quality, shorter sleep duration, and abnormal sleep timing leading to augmented fatigue. In the United States, 15.2% of women are employed in shift work, which can lead to long-term disrupted circadian rhythms. It is vital to focus on women shift workers because, beyond the physiological changes shift work can make, it is difficult for women to protect their sleep and maintain a balanced domestic and social life. There is limited research on women shift workers beyond the nursing population.

Aims: In this study, we described (Aim 1) and identified (Aim 2) the relationships among disrupted circadian rhythm, sleep quality (perceived), levels of fatigue, and cognitive executive function in women shift workers. For Aim 3, we utilized qualitative descriptive methodology to explore the women’s perceptions of the variables examined in Aims 1 and 2.

Methods: This study employed a cross-sectional design utilizing a mixed-method sequential approach. The (N=118) women were recruited from 24-hour industrial and service organizations in the Southeast United States. Quantitative measures include a demographic questionnaire, Munich Chronotype Questionnaire-Shift (MCTQShift), Pittsburgh Sleep Index (PSQI), Fatigue Severity Scale (FSS), Montreal Cognitive Assessment (MoCA), National Institute of Health Eating at America’s Table (EATS) quick food scan, and Rapid Assessment of Physical Activity (RAPA). For Aim 3, (n=14) women from the original sample participated in one of four focus groups. The data analysis plan included descriptive statistics, correlations, multiple linear regression, and thematic analysis.

Findings: In this study, 86.4% of the total sample had a global PSQI score >5, 53.69 % reported perceived fatigue measured by the FSS, and 54.2% had decreased cognitive executive function. Eight themes were identified from Aim 3 data (1) lots of sleep lost, (2) day sleep difficulties, (3) negative consequences, (4) shift work sleepiness, (5) missing out, (6) not in my own thoughts, (7) health is harmed, and (8) drowsy driving.

Conclusions: The findings suggest shift work is associated with poor sleep quality, fatigue, day sleep difficulties, short sleep, and has a negative impact on women’s emotional, mental, and physical health.


© 2023, Kathy Nelson

Available for download on Thursday, May 15, 2025

Included in

Nursing Commons