While it's always a nursing staff's goal to function as a team, nurses work different shifts, varying from four to 12 hours long. As a result, teamwork and patient care often suffer. "Staff coming and going at different times creates tremendous chaos, a lack of continuity for the patients, potential for errors, and handoff problems," said Beatrice Kalisch, director of nursing business and health systems at the University of Michigan's School of Nursing. She and her colleagues examined how teamwork was affected at a 210-bed community hospital after converting a combination of eight- and 12-hour shifts to 12-hour shifts.

Four months later, nurses participated in focus groups to assess the change. Almost all the nurses (98%) agreed that continuity of care, safety, and team relationships had improved. One nurse said, "I was reluctant to go to [a 12-hour shift]. I myself liked working eight hours. But the teamwork is so much better with everyone on the same shift." The change to 12-hour shifts reduced the number of staff members working in one week from 59 to 49, and each staff member worked with about three fewer people. "Working with fewer different people has really made it possible for us to know each other's strengths and weaknesses," said another nurse. Among staff members who were initially against the change, only one expressed a desire to return to eight-hour shifts. When the study ended, the staff voted to continue the 12-hour shifts.

"The issue is not which is better, 12-hour shifts or eight-hour shifts," said Kalisch. "It's that what is better for nurses and patients on any given patient care unit is consistency." Kalisch agrees that during emergencies nurses can be scheduled every two or four hours, but she prefers that short shifts not be part of regular staffing.

NewsCAPS

A deadly children's game. At least 82 youths have died by strangulation since 1995-apparently from playing a choking game meant to invoke fleeting euphoria by reducing oxygen to the brain, reports the February 15 issue of Morbidity and Mortality Weekly Report. Researchers from the Centers for Disease Control and Prevention tallied such deaths reported in news media. Most were boys (87%) about 13 years old who were playing alone. Before 2005 the number of deaths reported each year was low, but 22 deaths were reported in 2005, 35 in 2006, and nine in 2007. The researchers warn parents, educators, and health care providers to become aware of the warning signs: "bloodshot eyes; marks on the neck; frequent, severe headaches; disorientation after [being] alone; and ropes, scarves, and belts tied to bedroom furniture or doorknobs."

Pain: it's all in your head. People with chronic pain undergo changes to the default mode network, a part of the cerebral cortex that oversees the brain's resting state, according to an article in the February 6 issue of the Journal of Neuroscience. These changes may contribute to the depression, sleep problems, and anxiety often associated with unrelenting pain. In pain-free volunteers performing a simple computer task, functional magnetic resonance imaging shows that some parts of the default mode network are activated, while other parts are deactivated, possibly to allow the brain to process surrounding information. In patients with chronic back pain performing the same task, that deactivation doesn't occur. Additionally, the level of deactivation detected correlates with the number of years a patient endures pain.

Carol Potera