1. CAT Critically Appraised Topic Molly Falkner SN, Tawny Nicoly SN, Elizabeth Van Tuinen SN Carroll University, Waukesha, WI Collaborating ICU Practice Council Member: Cat Zyniecki, BSN, RN Waukesha Memorial Hospital, Waukesha, WI Level of Evidence Fields, W., & Loveridge, C. (1988). Critical thinking and fatigue: how do nurses on 8- & 12-hour shifts compare? Nursing Economic$, 6(4), 189-191. Design: Quasi-Experimental Sample: 102 RNs in the Critical Care Department of an acute-care hospital in California. Of the 102, 50 worked an 8-hour shift and 52 worked a 12-hour shift. Findings: The Three-Minute Reasoning Test was completed by RNs in the first and last hour of their shift, and it was concluded that there was no significant difference in critical thinking ability between the 8-hour shift group and 12-hour shift group. Washburn, M. S. (1991). Fatigue and critical thinking on eight-and twelve-hour shifts. Nursing Management, 22(9), 80A, 80D, 80F-80H. Design: Quasi-Experimental Sample: 117 nurses at a hospital in Ohio. Of those nurses, 94 were RNs and 23 were LPNs. 46 RNs worked in critical care; 48 RNs and all 23 LPNs worked on medical/surgical units. 68 nurses worked an 8-hour shift and 49 worked a 12-hour shift. Findings: The Three-Minute Reasoning Test was completed by nurses in the first and last hour of their shift, and no statistical difference was found between the 8 and 12-hour shift nurses’ critical thinking scores. Critical thinking ability did not differ by department (critical care vs medical/surgical). Scott, L., D., Arslanian-Engoren, C., & Engoren, M., C. (2014). Association of sleep and fatigue with decision regret among critical care nurses. American Journal of Critical Care, 23(1), 13-23. doi:10.4037/ajcc2014191 Design: Descriptive, non-experimental Sample: Simple random sample of 605 full-time critical care nurses who were members of the American Association of Critical-Care Nurses. 475 nurses worked 12-hour shifts, 53 worked 8-hour shifts, and 16 worked other lengths of shift. (605/3500= 17% response rate) Findings: Results from the questionnaires showed that nurses who reported decision regret (regretted a clinical decision that they made at work when sleepy) were more likely to work nights and to work 12-hour shifts than were nurses without decision regret. Comments on the Evidence Strengths: The sample sizes were appropriate. A valid and reliable tool (Three-Minute Reasoning Test) was used to measure critical thinking ability. All studies focused on the ICU or broke down the results by department. Weaknesses: Some studies were not current and also lacked vital information about the study methodology and data analysis, decreasing their credibility. Decision regret has different conceptual and operational definitions than critical thinking ability. Applicability There is considerable support for the 12-hour shift in ICU nurses. Reasons include financial benefits for the hospital, increased flexibility in scheduling for nurses, and increased continuity of care. Older studies indicate no significant difference in critical thinking ability between ICU staff nurses who work 8 and 12-hour shifts. However, current sources that are relevant to this particular PICO question are scarce. Future studies with random assignment and more control over confounding variables are necessary in order to fully ascertain the effect of shift length on critical thinking ability in ICU staff nurses. ICU patients are a vulnerable population, so an ICU nurse’s critical thinking ability is paramount. Evidence Search Academic Search Premier, CINAHL, HealthSource, MedLine, PubMed Keywords Critical care, ICU, nurse, clinical reasoning, decision, critical thinking, shift length, 8-hour, 12-hour