● Consult with management on designing shift schedules that allow sufficient rest and provide the opportunity for adequate sleep. ● Review department meeting times and excessive overtime. Make recommendations to pre- vent sleep disruption. ● Conduct education sessions for employees and their families to minimize shift work risk factors, such as: – Establishing a regular sleep routine. – Creating an environment that promotes sleep by, for example, darkening the room, lowering the temperature, unplugging the phone, wearing earplugs, etc. – Eliminating caffeine at least 3 hours before bedtime. – Eating small well-balanced meals. – Planning time with family and friends. – Recognizing signs and symptoms of maladaptation. – Seeking health care for regular exams and for symptoms of maladaptation. – Taking immediate steps when drowsy so not to drive or operate machinery. Employees may need to nap before driving home, or may consider calling for a ride. Secondary Prevention ● Survey workers and conduct focus group discussions to assess employees’ perception of rota- tion schedules and whether any employees are experiencing negative effects of shift work. ● Analyze absenteeism and injury rates to identify potential problems. ● Monitor employees having difficulty adjusting or employees with chronic medical conditions that might be affected adversely by shift work (e.g., employees with insulin-dependent dia- betes, history of seizures, psychiatric disorders, and possible cardiovascular disease). ● Counsel employees regarding strategies to promote effective sleep and to minimize gastroin- testinal complaints (e.g., establishing regular sleep routines, eating small, frequent meals that include complex carbohydrates and protein, eliminating protein foods and caffeine 3 hours before bedtime, planning social and family activities, and planning regular exercise). An effective program can be planned in collaboration with other experts in the field. Employ- ees identified as having signs and symptoms of maladaptation syndrome should be referred to their health care provider. These symptoms would include severe sleep disturbance, gastroin- testinal distress, depression, or medical conditions exacerbated by shift work. The company EAP personnel can be a valuable asset for providing educational programs, supplying resource information, and counseling employees. The occupational health physician and the safety pro- fessional can add valuable insight when reviewing surveys and shift schedules to identify potential health and safety issues. Special safety considerations can be addressed and resolved as a team and should include any issues regarding extended work hours (10- or 12-hour work days) and shift work. Nursing Roles The OHN can be instrumental in influencing shift work policy and schedules. The nurse not only provides shift workers with the opportunity to participate in health promotion activities but also considers how these programs can meet workers’ special needs and demands. In addi- tion, the nurse often plans programs to reduce the discomfort or ill effects some employees experience on shift work. The OHN coordinates community resources to assist employees and arrange employee referrals as necessary. It is important for the nurse to stay abreast of research in this field and how the results can be applied to benefit employees. 294 Interdisciplinary Interactions and Collaboration