Understanding how night work influences the everyday family lives of nurses, their husbands and ...

415 Pages·2013·18.48 MB·English

Understanding how night work
influences the everyday family lives of
nurses, their husbands and children
Elizabeth Thompson
--
Department of Sociology, University of Surrey
Submitted in part fulfilment of the Degree of
Doctor of Ph ilosophy
September 2009
Abstract
This study provides new insights into lived experiences of night work for women employed
as nurses, and for their husbands and children. Night work also acts as a "window" (Hislop
and Arber 2003a) onto daily lives in contemporary families, demonstrating the power of
normative ideology concerning gendered expectations and "good motherhood. "
Using mixed methods and a primarily inductive research design with a broadly interpretive
conceptual framework, this study involves twenty families, each including a female nurse
aged 30-55, their husband and co-resident children aged 8-18 years. In-depth qualitative
interviews are supported and furthered by audio sleep diaries, mood scale, sleep log and
saliva sample data collected daily for two weeks.
Findings demonstrate the importance of going beyond the focus within existing shift work
research on "impacts" for individuals to consider the social contexts in which night shifts are
worked, including family relationships and normative gendered expectations and identities
for women as wives and mothers.
Effects of night work are experienced by all family members in preparation and recovery
phases as well as during nurses' absence from home while working night shifts.
The power of normative gendered expectations of women as "good" wives and mothers is
clearly evident. Women in this study strive to moderate potential influences of night work on
their husbands and children, while experiencing significant reductions in sleep duration and
significantly worse mood and alertness levels.
Husbands experience increased responsibilities for childcare and other time-critical tasks,
alongside more freedom in organising their temporary responsibilities and their own leisure
time, often resulting in relaxed evenings and later bed times for husbands and children. For
children, their mothers' absence is important but not necessarily negative: they are in the
care of other people who may have different expectations of them; and family life feels
different without their mother's usual presence.
Understanding how night work influences the everyday family lives of nurses, their husbands and
children - Elizabeth Thompson
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(C) Elizabeth Thompson
This thesis and the work to which it refers are the results of my own efforts. Any ideas, data,
images or text resulting from the work of others (whether published or unpublished) are fully
identified as such within the work and attributed to their originator in the text, bibliography or
in footnotes. This thesis has not been submitted in whole or in part for any other academic
degree or professional qualification. I agree that the University has the right to submit my
work to the plagiarism detection service TurnitinUK for originality checks. Whether or not
drafts have been so-assessed, the University reserves the right to require an electronic
version of the final document (as submitted) for assessment as above.
Word count (Chapters 1-10): 102,591
Understanding how night work influences the everyday family lives of nurses, their husbands and
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Contents
Page
Abstract 2
List of Tables 12
List of Appendices 13
Acknowledgements 14
Chapter 1 : Introduction 15
1.1 RESPONSIBILITIES AND DEMANDS IN THE CONTEXT OF WOMEN'S
NIGHT WORK 15
1.2 PERSONAL MOTIVATIONS AND STUDY DEVELOPMENT 16
1.3 WOMEN'S NIGHT WORK 17
1.4 EXISTING RESEARCH CONCERNING NIGHT WORK'S IMPACTS 18
1.5 STUDY DESIGN AND METHODS 19
1.6 THESIS OUTLINE 20
Chapter 2: Night work in social contexts: limitations of current knowledge 22
2.1 INTRODUCTION 22
2.2 PHYSIOLOGY OF CIRCADIAN RHYTHMS, SLEEP AND NIGHT WORK 22
2.2.1 Circadian rhythms 23
2.2.2 Health risks 24
2.2.2. 1 Health risks for women 24
2.2.2.2 Least harmful ways of doing shift work 25
2.3 SOCIAL INFLUENCES AND CONSEQUENCES OF SHIFT WORK
WITHIN PHYSIOLOGICAL, ERGONOMIC AND OCCUPATIONAL
HEALTH RESEARCH 26
2.3.1 Social influences within optimal shift patterns 26
2.3.1.1 "Social factors" 26
2.3.1.2 'The social cycle" 27
2.3.1.3 Social factors affecting women's night work 27
2.3.2 "Tolerance", chOice, norms and structural constraints 28
2.3.2.1 "Tolerance" of night work 28
2.3.2.2 "Choice'; "commitment" and night work 29
2.3.3 Social consequences of night work within physiologically focused literature 31
Understanding how night work influences the everyday family lives of nurses, their husbands and
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2.3.3.1 Negative social consequences of night work without empirical
evidence? 31
2.3.3.2 Guidance for night workers 32
2.4 SOCIAL RESEARCH CONCERNING SHIFT WORK 34
2.4.1 Limitations of current understanding of night work's social influences 34
2.4.2 Social routine disruption 35
2.4.3 Normative gendered social roles 36
2.4.4 Children's wellbeing 37
2.4.5 Couple relationships 39
2.4.6 Conclusions - social research concerning shift work 40
2.5 SOCIOLOGY OF SLEEP 41
2.6 CONCLUSIONS - NIGHT WORK IN SOCIAL CONTEXTS: LIMITATIONS OF
CURRENT KNOWLEDGE 42
Chapter 3 - Night work within gendered and family contexts 44
3.1 INTRODUCTION 44
3.2 WORK AND FAMILIES 45
3.2.1 Work and family: "two spheres" 45
3.2.2 Work-family spillover and conflict 45
3.2.3 Integrated understanding of work and family 46
3.2.3.1 Family contexts 46
3.2.3.2 Families and "family practices" 47
3.3 GENDERED PATIERNS IN PAID AND UNPAID WORK 48
3.3.1 Time use and responsibilities for men and women 48
3.3.2 Responsibilities of mothers and fathers 49
3.3.3
Gendered division of emotional labour 50
3.3.4
Social class and gendered division of domestic labour 51
3.4
MOTHERS, PAID WORK, CARING AND HOUSEWORK 53
3.4.1 Gendered inequalities in employment 53
3.4.2. Gendered expectations of mothers 54
3.4.2.1 Continual care and "being there" 54
3.4.2.2
Balancing children's needs with paid employment 55
3.4.2.3 Gendered identities: acceptance, dissent and gendered expectations 56
3.4.3 Do women choose to work at night? 59
3.4.3.1 Motivations and requirements to work at night 59
Understanding how night work influences the everyday family lives of nurses, their husbands and
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60
3.4.3.2 Choice and gendered expectations
62
3.5 FATHERS, PAID WORK, CARING AND HOUSEWORK
62
3.5.1 Fathers' involvement in childcare and housework
63
3.5.2 Fathers' ability to care for children
64
3.5.3 Conclusions - Fathers, paid work, caring and housework
64
3.6 CHILDREN, PAID WORK, CARING AND HOUSEWORK
64
3.6.1 Children's opinions: communication and acceptance of parents' work
66
3.6.2 Children's perspectives on parents' night work
67
3.7 TEMPORAL ORGANISATION OF FAMILY LIVES
3.7.1 Family lives and routines 67
3.7.2 Shared time together in families, "hot spots" and "cold spots" 68
3.7.3 Conclusions - Temporal organisation of family lives 70
3.8 CHALLENGING THE NEGATIVE PARADIGM WITHIN SHIFT WORK
RESEARCH 70
71
3.8.1 Potential for positive consequences of night work
72
3.8.2 In what ways may night work have positive or negative effects?
72
3.8.2.1 Night work as positive or negative for mothers?
73
3.8.2.2 Limitations of sex role theory approach to night work
73
3.8.2.3 Limitations of positive/negative conceptualisations of night work
3.9 CONCLUSIONS - NIGHT WORK WITHIN GENDERED AND FAMILY
74
CONTEXTS
76
Chapter 4 - Methodology
76
4.1 INTRODUCTION AND RESEARCH OBJECTIVES
4.1.1 76
Methodology Overview
4.1.2
Research Objectives 77
4.2 78
CONCEPTUAL APPROACH
4.2.1 Interpretive 78
79
4.2.2 Acknowledging biological physicality of sleep
4.2.3 Perspectives of women, husbands and children within a whole family approach 82
83
4.3 METHODOLOGICAL APPROACH
83
4.3.1 Qualitative and quantitative methods
84
4.3.2 Inductive and deductive methods
4.3.3 Methodological aims 85
87
4.4 RESEARCH DESIGN AND REVIEW
Understanding how night work influences the everyday family lives of nurses, their husbands and
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4.4.1 Development and Pilot: Initial methods testing 87
4.5 SAMPLING FRAMEWORK 88
4.5.1 Inclusion criteria
88
4.5. 1. 1 Qualified hospital nurses 89
4.5.1.2
Rotating shifts including night shifts 90
4.5.1.3
Couples with children 91
4.5.1.4 Children
91
4.5.1.5
Language used to describe participants 92
4.5.2 Exclusion criteria
92
4.5.2.1 Sleep medication
92
4.5.2.2 No fluency in English
92
4.6 PARTICIPANT RECRUITMENT
93
4.6.1 Distribution of recruitment materials
93
4.6.2 Information for potential participants
94
4.6.3 Participants
95
4.6.3.1 Nurses
95
4.6.3.2 Husbands
96
4.6.3.3 Children
96
4.7 STUDY METHODS AND DATA COLLECTION 97
4.7.1 Participation Stage 1 - First Visit 97
4.7. 1. 1 Obtaining informed consent 98
4.7. 1.2 Instructions for participants
98
4.7.1.3 Joint couple qualitative interview 99
4.7.2 Participation Stage 2 - Two week daily data collection period 99
4.7.2.1
Two week participant booklets 100
4.7.2.2
Activity levels and sleep/wake patterns 100
4.7.2.3
Levels of cortisol and melatonin hormone levels from saliva samples 101
4.7.2.4
Sleep quality and sleepiness 102
4.7.2.5
Mood scales
102
4.7.2.6
Food, drink and sleep logs 103
4.7.2.7 AUdio sleep diaries
104
4.7.2.8 Sleep and health questionnaires 105
4.7.3 Collection of equipment and initial analysis 106
4.7.4 Participation Stage 3 -Individual qualitative interviews 106
4.7.4.1
Incentive payment 109
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109
4.8 ETHICAL CONSIDERATIONS
109
4.8.1 Ethical approval and procedures
110
4.8.2 Ethical considerations in practice
111
4.8.3 Informed consent
112
4.8.4 Confidentiality and anonymity
114
4.8.5 Participants' questions, concerns and difficulties
114
4.8.6 Ethical considerations specifically regarding children and young people
115
4.8.7 Outcomes for participants
116
4.9 RAPPORT AND ENGAGEMENT
118
4.10 DATA ANALYSIS
118
4.10.1 Qualitative data
120
4.10.2 Saliva samples
120
4.10.3 Logs, scales and questionnaires
121
4.10.4 Analysis of data collected by multiple methods
122
4.11 CONCLUSIONS - METHODOLOGY
124
Chapter 5 - Perspectives on night work from nurses' children
124
5.1 INTRODUCTION
5.2 DIRECT INFLUENCES OF NURSES' NIGHiWORK 125
5.2.1 Children's perspectives on mothers' absence, household tasks and "childcare" 125
128
5.2.2 Children's perspectives on fathers' roles during night work
132
5.2.3 Comparing mothers' and fathers' approaches to parenting
133
5.2.4 Older siblings' roles during night work
134
5.2.5 Grandparents' and other family members' roles
135
5.2.6 Changes in food and meals
137
5.2.7 Changes to sleep
137
5.2.7. 1 Going to bed later
139
5.2.7.2 Getting up later
141
5.2.7.3 Spending the night away from home
142
5.2.7.4 Awareness of impacts of night work on mothers' sleep
142
5.2.8 Changes in activities
143
5.2.8.1 Scheduling activities
143
5.2.8.2 Daytime following mothers' night shifts
145
5.2.9 Conclusions - Direct influences of nurses' night work
145
5.3 CHILDREN'S PERCEPTIONS OF THEIR MOTHERS' NIGHT WORK
146
5.3.1 Preferences about mothers' shift patterns
Understanding how night work influences the everyday family lives of nurses, their husbands and
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5.3.2 Mothers "being there" or not "being there" 147
5.3.3 Night work as "boring"
152
5.3.4 Night work does not affect me, makes no difference to me and is normal 153
5.4 CONCLUSIONS - PERSPECTIVES ON NIGHT WORK FROM NURSES'
CHILDREN:
156
Chapter 6 - Perspectives on night work from nurses' husbands 158
6.1 INTRODUCTION
158
6.2 COUPLES SHARING PARENTHOOD IN THE CONTEXT OF NIGHT SHIFTS 159
6.2.1
Husbands' working patterns
159
6.2.2
Co-ordinating childcare with wives
159
6.3
INFLUENCES OF NIGHT SHIFTS FOR NURSES' HUSBANDS:
RESPONSIBILITIES AND FREEDOM 164
6.3.1
Taking responsibility for children and increased housework 164
6.3.2
Caring for wives
169
6.3.3
Freedom in activities
172
6.3.4
Sleeping differently during wives' night work 176
6.4
HUSBANDS' PERCEPTIONS OF NURSES' NIGHT WORK 180
6.4.1
Night work extending before and after night shifts 180
6.4.2
Missing wife
182
6.4.3
Night work changes relationships 185
6.4.4
Rationale for night work
187
6.4.5
Acceptance of wives' night work 189
6.5
CONCLUSIONS - PERSPECTIVES ON NIGHT WORK FROM NURSES'
HUSBANDS
190
Chapter 7: Nurses' perspectives on their night work 193
7.1 INTRODUCTION
193
7.2 HOME AND WORK CONTEXTS FOR NURSES' NIGHT WORK 193
7.3 INFLUENCES OF NIGHT WORK FROM NURSES' PERSPECTIVES 197
7.3.1 Physical impacts 197
7.3.2 Preparing for night work
199
7.3.3 During periods of night work
202
7.3.4 Recovery from night work
210
7.4 NURSES' PERCEPTIONS OF NIGHT WORK
213
7.4.1
Nurses' overall opinions about night work
213
Understanding how night work influences the everyday family lives of nurses, their husbands and
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7.4.2 Perceived effects of night work on husbands and children 216
7.4.3 Influence of night work on "being there" and "being Mum" 218
7.5 CONCLUSIONS - NURSES' PERSPECTIVES ON THEIR NIGHT WORK 222
Chapter 8 - Impacts of night work on the sleep and mood of nurses, their
husbands and children 224
8.1 INTRODUCTION
224
8.1.1
Summary of methods
225
8.2
IMPACTS OF NIGHT WORK ON SLEEP TIMING 226
8.2.1
Timing of nurses' sleep
227
8.2.2
Timing of husbands' sleep
230
8.2.3
Timing of children's sleep
231
8.3
IMPACTS OF NIGHT WORK ON SLEEP DURATION 234
8.3.1
Nurses' sleep duration
235
8.3.2
Husbands' and children's sleep duration 236
8.4
IMPACTS OF NIGHT WORK ON SLEEP QUALITY AND
ALERTNESS/SLEEPINESS UPON WAKING 238
8.4.1
Nurses' sleep quality and alertness/sleepiness 239
8.4.2
Husbands' and children's sleep quality and alertness/sleepiness 239
8.5
IMPACTS OF NIGHT WORK ON MOOD 241
8.5.1
Nurses' mood scores
241
8.5.2
Husbands' mood scores 242
8.5.3
Children's mood scores
242
8.6
IMPACTS OF NIGHT WORK ON NURSES' SALIVARY CORTISOL 246
8.7
CONCLUSIONS - IMPACTS OF NIGHT WORK ON THE SLEEP AND MOOD
OF NURSES, THEIR HUSBANDS AND CHILDREN 248
Chapter 9 - Discussion: women's night work, family lives, expectations and
responsibilities 251
9.1
INTRODUCTION
251
9.2
SUMMARY OF FINDINGS: INFLUENCES OF t':IlGHT WORK FOR CHILDREN,
HUSBANDS AND NURSES
252
9.2.1
Children
252
9.2.2
Husbands
253
9.2.3
Nurses
253
9.3
THREE PHASES OF NIGHT WORK 254
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