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Biphasic sleep in shift workers and its related outcomes: a scoping review protocol

Por: Moen · L. V. · Lie · J.-A. S. · Jorgensen · I. L. · Frojd · L. · Pallesen · S. · Matre · D.
Introduction

Shift work is associated with disrupted sleep, circadian misalignment and increased risks of adverse health, performance and safety outcomes. Although recommendations for shift workers typically focus on obtaining one long sleep period, many shift workers divide sleep into two episodes, referred to as biphasic sleep. Biphasic sleep may help mitigate sleep loss-related impairments, yet its prevalence, characteristics and potential benefits for shift working populations remain unclear. Existing reviews have examined sleep duration, mental health, or the consequences of shift work broadly, but none have specifically mapped evidence comparing biphasic and monophasic sleep between shifts. This scoping review will identify and summarise the available literature on biphasic sleep among adult shift workers. In addition, we will describe the outcomes and subsequently highlight any possible gaps to inform future research.

Methods and analysis

This review will follow the Joanna Briggs Institute methodology for scoping reviews and be reported in accordance with the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines. Biphasic sleep is defined as two distinct sleep episodes within a 24-hour period between work shifts, including two similarly timed sleep periods or one longer sleep combined with a shorter nap. A comprehensive search will be conducted in April 2026 in MEDLINE, Embase, PsycINFO, Web of Science and CENTRAL using controlled vocabulary (eg, Medical Subject Headings) and free-text terms related to shift work and split sleep. Peer-reviewed primary research examining biphasic sleep among adult shift workers will be included, and studies focusing solely on naps during work hours will be excluded. Two reviewers will independently screen titles/abstracts and full texts, with discrepancies resolved through discussion or by consulting a third reviewer. Data will be extracted using a standardised template including study characteristics, sleep parameters and reported outcomes. Results will be summarised descriptively and presented in tables and evidence maps. No statistical synthesis will be performed.

Ethics and dissemination

This scoping review will synthesise data from articles published in peer-reviewed journals. As no primary data will be collected and no human participants will be involved, the review is exempted from formal ethical approval. Findings will be disseminated in terms of a peer-reviewed publication and will inform future systematic reviews on sleep strategies among shift workers.

Trial registration number

This project is registered with the Open Science Framework accessible at 10.17605/OSF.IO/WY7KJ.

Why Do Nurses Carry Out Illegitimate Tasks? A Qualitative Study Through the Lens of Gender Theory and Nursing History

ABSTRACT

Aim

To identify illegitimate tasks performed by registered nurses (RNs) in surgical care and explore why they perform them through the lens of gender theory and nursing history.

Design

A qualitative study guided by gender theory, nursing history and the Fundamentals of Care framework.

Methods

RNs (n = 48) at three surgical wards attended a lecture on gender theory and a lecture on nursing history, each followed by focus group interviews (n = 12) with 6–8 participants. The analysis included two steps: (A) a content analysis of the interviews to identify illegitimate tasks and (B) a gender analysis using Connell's framework and nursing history.

Results

The RNs describe their work situation in clinical practice as fragmented by illegitimate tasks. The results show how this can be explained as induced by gender theory and nursing history, with the main theme RNs support overall patient care and work climate at the cost of nursing care—a behaviour explained by gender theory and nursing history, presented in four categories: (1) performing administrative tasks and information processing outside the nursing profession, (2) maintaining a pleasant workplace, (3) being constantly available, facilitating and compensating for physicians and (4) backing up nursing assistants.

Conclusion

Contemporary RNs frequently utilise their resources to carry out a wide range of illegitimate tasks. The findings illustrate that RNs remain influenced by their history and still integrate traditionally female-associated tasks and behaviours into the workplace, often without conscious awareness. This knowledge can be used to understand why RNs perform illegitimate tasks without being asked to do so. Primarily, managers and also RNs must consider their complex situation from this perspective to implement systematic organisational changes that ensure patients receive the nursing care they need.

Impact

There is a global shortage of registered nurses (RNs). Patients suffer from missed nursing care. RNs describe their work as fragmented, with frequent interruptions and illegitimate tasks they feel expected to prioritise, even if not prompted by routines or requests. RNs are influenced by nursing history, integrating traditionally female-associated tasks and behaviours into the workplace, often subconsciously. When nurse managers and RNs become aware of these problems, it can pave the way for change, which can free up nursing resources and improve patient care. By becoming aware of what constitutes illegitimate tasks and understanding why nurses perform them, organisational changes can be made to fully utilise RNs' competencies. The findings point to a systemic issue that calls for strategic leadership from managers to drive substantive change.

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