Focus group interviews were performed on 45 intensive care nurses who worked 12-h shifts in a large metropolitan hospital. The purpose of this study was to identify nurses' perceptions of difficulties associated with shiftwork and coping strategies used to combat them. Overall, the findings were not different than those currently discussed in the literature. For example, nurses frequently utilized white noise, telephone answering machines, and light-darkening shades to improve the quality and quantity of day sleep. They also used exercise and increased early shift caffeine consumption to improve night work performance. However, the major incentive for performing night work for these nurses was a high shift differential that equaled approximately 20% of their hourly salary. Most nurses also felt that group educational interventions regarding shiftwork difficulties and coping strategies would be preferred to individual counseling. The most significant finding of this study was the discovery of an extremely high incidence (95%) of automobile-related injuries and near-accidents that occurred while driving to and from the workplace, potentially posing a significant public health risk.

Data for this review of chronobiology, chronopharmacology, chronotherapeutics and pain were derived from electronic searches of the medical literature (Medline) utilizing both Silver Platter and OVID search engines. Further information was obtained from personal conversations with members of the International Society for Chronobiology involved in chronopharmacology and pain research and reviews of non-Medline-referenced materials and journals such as Chronobiologia and the Annual Review of Chronopharmacology. A variety of data from proceedings were available, but was not utilized because of their nonrefereed status and the relative unavailability of such sources; however, peer-reviewed, published proceedings have been included in this review.A total of 62 studies were identified as relevant to this review of biological rhythms and pain; of these, only 6 were conducted by nurses. Studies were broadly categorized by purpose as experimental chronobiology in humans (9), experimental chronobiology in animals (12), clinical chronobiology (25), chronopharmacology in animals (6), chronopharmacology in humans (6), and chronotherapeutic interventions (4). All statistically significant findings were reported at the p < 0.05 level.

The objective of this study was to determine in a significant temporal pattern exists in the presentation of sickle cell vaso-occlusive pain crisis (SC-VPC) patients to an emergency department (ED) for treatment. This 28-month retrospective study of ED sickle cell crisis treatment involved 1128 presumably diurnally active SCVPC patients presenting to the ED of a university-affiliated hospital between January 1, 1991 and April 30, 1993. Data for adult subjects (> or equal to 15 years) were used for analysis. Date and time of presentation for each patient were recorded. Data were submitted to chi 2 and single cosinor analysis for determination of circadian and circannual patterns. chi 2 analysis suggested that the incidence of SCVPC events treated in the ED was not equally distributed throughout the 24 h. Single cosinor analysis identified a significant circadian rhythm (p < 0.001) for all subjects, with peak ED presentations occurring in the early evening. The best-fit cosine curve accounted for 50% of the sample variance. While the etiology of this finding is unclear, determination of a temporal pattern in SCVPC presentation to the ED may lead to identification and control of conditions that precede the occurrence of a SCVPC. Interventions for SCVPC may require modification based on chronobiological trends.

A middle-range theory for Chronotherapeutic Intervention in Postsurgical Pain (CIPP) is presented. This theory supports time-dependent approaches to pain assessment and intervention that may be implemented by nurses in the clinical setting. CIPP was inductively derived from chronobiologic literature and validated through investigations in three separate chronobiologic studies. A circadian rhythm in pain was identified in Study I, with 19 postsurgical gynecologic oncology patients, and validated in Study II, with 45 postsurgical patients. Study III, a randomized clinical trial of 71 gynecologic oncology patients, compared the efficacy of chronotherapeutic versus continuous fixed-rate basal and demand-only PCA therapy for postoperative pain relief.

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