1. The Relationship Between
Inadequate Sleep and
Unintentional Injury
Group Two B:
Amanda Anderson, Trina Cluny, Barbara MacDonald,
Barbara Pernsky, Blake Webster
MHST/NURS603 - Facilitating Inquiry
Athabasca University
Dr. M.Myer
July 18, 2011

2. Objective
This objective of this presentation is to showcase
two studies conducted by Group Two B from the
MHST/NURS603 - Facilitating Inquiry class.
Following this presentation, students in the class
will participate in a discussion forum to provide
further insight into the research question.
The members of Group Two B appreciate your
engagement in reviewing the presentation and
participating in the discussion forum. Your
contribution will enhance our understanding of the
research question and process.

3. Introduction:
Research Process
Two small studies were conducted, one qualitative
and one quantitative.
The sample for the qualitative study consisted
of four students from Group Two B, leaving one
student as principal investigator.
The sample for the quantitative study consisted
of all students (n=18) in the MHST/NURS603 -
Facilitating Inquiry class
The same research question was examined in
both studies.

4. Introduction
Sleep is essential to sustaining life.
Inadequate sleep contributes to many health
issues and poorer health overall.
Is there a relationship between inadequate
sleep and unintentional injury?
(National Sleep Foundation, 2011)

5. Introduction:
Research Question
Findings from two small studies—one
qualitative and one quantitative, were used
to examine the following research question:
―What are Athabasca University
students’ perceptions about the
relationship between inadequate sleep
and unintentional injuries?‖

6. Literature Review
A substantial body of research exists that
links inadequate sleep and sleep problems
to increased risk of unintentional injuries in
children, adolescents and adults.
Adequate sleep has several determinants.
The degree of sleep efficiency, sleep
quality, and refreshing sleep affects an
individual’s ability to function the following
day (Rosekind & Gregory, 2010).

7. Literature Review
Sleep deprivation results in a decreased
ability to respond quickly to stimuli,
decreased attentiveness, and increased
daytime sleepiness (Spengler, Browning, &
Reed, 2004).
Shift workers sleep an hour less per day on
average when compared to daytime
workers as a result of a disruption in the
body’s circadian rhythms (Sleepdex, 2011).

8. Literature Review
Sleep deprivation is the number one most
common health complaint of shift workers
as it negatively affects quality of life and job
performance (Shields, 2003).
Sleep deprivation is a major contributing
factor in jeopardizing nurses’ psychomotor
performance, and creates opportunity for
unintentional injury to themselves, co-
workers, and patients (Johnson, Brown, &
Weaver, 2010).

9. Ethical Considerations
Ethical approval for the studies was not
obtained since this was an exercise in
student understanding of the processes
and application of qualitative and
quantitative research methods.
Participant information letters and consent
forms were developed for both lab
exercises to acknowledge the importance
of informed consent and adherence to
ethical guidelines in research studies
involving human participants.

10. Qualitative Study:
Theoretical Framework
Utilizing a phenomenological approach
each member of a focus group was asked
to provide personal insight regarding sleep
in an effort to understand their perception
of sleep and its relationship to unintentional
injuries.

11. Qualitative Study: Methods
Research Design
An on-line synchronous focus group was
conducted with four of the Group two/B
members acting as participants and one
member acting as Principal Investigator.
Focus groups can elicit information from
multiple participants creating a picture of
combined perspectives. Employing computer
technology to conduct focus group sessions
allows researchers to bring together
participants with similar characteristics
regardless of geographic location.

12. Qualitative Study: Methods
Sampling
All participants were students of Facilitating
Inquiry (MHST/NURS603 at AU).
Researchers & participants called Group Two/B
which was chosen randomly by Professor
Maggie Myers.
All participants were health care professionals
who have:
Varying levels of experience with computers and online
communication.
Participants – different cultures , ages, different work
experiences.
Participants from across Canada – different time zones with
one student traveling through Asia.

13. Qualitative Study: Methods
Measures and Data Collection
Data was collected from the four
participants during a single on-line focus
group session utilizing a Focus Group
Interview Guide which was developed by
all members of Group Two/B.

14. Qualitative Study: Methods
Study Procedures
A focus group meeting was scheduled via a chat
room session on the Athabasca University (AU) web
site created for the course Facilitating Inquiry,
MHST/NURS603.
The principal investigator facilitated dialogue between
the participants.
Verbatim transcripts were copied and pasted into a
table format according to the order in which the
questions were presented.
Common themes were identified and grouped
together to generate a single, composite response to
each of the questions.
Findings were validated as all participants
participated in data analysis and assisted in writing
the final report.

15. Qualitative Study: Findings
Defining Adequate Sleep
Participants felt quality of sleep is more
important than number of hours of sleep.
All participants felt they did not get enough
sleep.
Reasons for lack of adequate sleep ranged
from shift work, multiple responsibilities of work,
master courses, age, family.
All participants felt inadequate sleep negatively
impacted them physically, emotionally, and
spiritually.

16. Qualitative Study: Findings
Inadequate Sleep & Unintentional Injury
Participants related poor judgment
and lack of mental awareness to
inadequate sleep.
One participant stated feeling ―at risk
for injury as driving home after a night
shift is dangerous‖.

17. Qualitative Study: Findings
Polices to Decrease Unintentional Injury
Participants felt there should be
guidelines aimed at reducing
unintentional injuries related to
inadequate sleep.
Suggestions regarding who would be
responsible for such policies included:
unions, governments, nursing
associations, workplace safety
organizations.

18. Qualitative Study: Discussion
Interpretation of Results
Participants noted that inadequate sleep:
tends to negatively impact physical,
emotional, and spiritual well-being.
can contribute to making poor
judgments and a lack of mental
awareness.
may increase the likelihood of
unintentional injuries.

19. Qualitative Study: Discussion
Limitations of the Study
Related to the nature of the lab group
exercise and inexperienced researchers.
Sample size was limited to four
participants.
Single session does not provide as
much reliable data as multiple sessions.
Online chat session did not allow for
non-verbal interaction between the
group members.
There was inherent bias with the
researchers acting as participants.

20. Quantitative Study

21. Quantitative Study:
Theoretical Framework
Utilizing the findings from the qualitative
study, a descriptive quantitative study was
designed to continue examining the
relationship between inadequate sleep and
unintentional injury.

22. Quantitative Study: Methods
Research Design
A 10-item likert survey was designed utilizing
the results from a small qualitative study to
determine the relationship between inadequate
sleep and unintentional injury.
Two of the questions allowed for participants to
describe the unintentional injury or near miss
that they experienced.

23. Quantitative Study: Methods
Research Design
A coding framework was designed
assigning a value from 1-10 depending
on the amount of agreement the subject
indicated for each variable.
Selecting the number 10 indicated the most
agreement with the statement; 1 the least amount of
agreement.
If a question was left blank by the participant or the
participant selected N/A a value of 0 was assigned.

24. Quantitative Study: Methods
Sampling
Convenience sampling was used for the study,
with participants being all of the students
enrolled in the Spring Session of the course
MHST/NURS 603 (n=18)
Participants were students completing
graduate-level courses at Athabasca University
(AU) with a variety of experiences.
Specific demographic information was not collected
as this was a learning exercise and ethical approval
from AU’s REB was not sought.

25. Quantitative Study: Methods
Measures and Data Collection
Questionnaire contained 10 questions with
multiple responses based on qualitative
findings.
Likert scale used with consistent numerical
value (1 to 10) where:
1 = strongly disagree and
10 = strongly agree.
Three questions solicited ―Yes‖ or ―No‖
responses.

26. Quantitative Study: Methods
Study Procedures
Questionnaire implemented through
Survey Monkey
participants were notified by email and a
posting on AU discussion forum.
participants had a two day window to
complete survey.
Findings analyzed with Survey Monkey
and SPSS software.

27. Quantitative Study: Findings
Defining Adequate Sleep
82.3% of participants rated ―based more
on quality of sleep than quantity‖
between 8 and 10 on the Likert scale
39.3% of participants identified ―having
at least 8-hours of undisturbed sleep‖ as
a defining characteristic of adequate
sleep on the same scale

28. Defining Adequate
Sleep
90
80
70
60
50
40
30
20
10
0
Quality over Quantity
At Least 8 Hours
Feeling Rested

29. Do you get enough adequate
sleep the majority of the time?
28%
Yes
72%
No

30. Quantitative Study: Findings
Defining Inadequate Sleep
―Being restless and disturbed several times‖ being
identified by 82.4% of participants between 8 and
10 on the likert scale.
―Not feeling refreshed and rejuvenated‖ was
another important indicator of inadequate sleep
identified by 77.7% of participants on the same
scale.

31. Defining Inadequate Sleep
90
80
70
60
50
40
30
20
10
0
Being Restless/Disturbed
Not Feeling Refreshed
Not Defined by Specific # of
Hours

32. Quantitative Study: Findings
Unintentional Injury & Sleep
While only 16.7% of participants stated they
experienced an unintentional injury in the past 12
months that they related to inadequate sleep…
16.7
Yes
83.3
No

33. Quantitative Study: Findings
Unintentional Injury & Sleep
…when asked about ―near misses‖ 61.1% stated they
had a near miss (of unintentional injury) in the past 12
months.
38.9
61.1 Yes
No

34. Quantitative Study: Findings
Unintentional Injury & Sleep
40% of participants identified near misses with
medication administration to patients.
40% of participants identified near misses related
to driving accidents.
Other unintentional injuries/near misses identified
included illness and minor injuries related to being
less coordinated.

35. Quantitative Study: Findings
Unintentional Injury & Sleep
Correlation between lack of sleep and reported
occurrences of unintentional injury and/or near
misses were examined using a two-tailed
Spearman’s rho test.
A significant relationship (correlation coefficient
0.565) was identified between experiencing a near
miss of unintentional injury and belief that lack of
sleep is linked to increased mistakes.

36. Quantitative Study: Findings
Correlation between:
Lack of Sleep, Unintentional Injuries, Near Misses
A B C
A. Lack of sleep is linked to
increased mistakes & poor
1.00 0.565* 0.202
performance
B. Experienced a near miss
of unintentional injury
0.565* 1.00 0.306
C. Experienced an
0.202 0.306 1.00
unintentional injury
*Correlation is significant at the 0.05 level (2-tailed)

37. Quantitative Study: Discussion
Interpretation of Results
The study reflects the importance of quality sleep
and feeling refreshed upon awakening in relation
to one’s ability to perform and function the next
day.
Consistent with the literature, the findings from this
quantitative study indicate a link between
inadequate sleep to increased risk of unintentional
injuries and near misses.
Of particular concern is the rate of near misses
associated with inadequate sleep with a
statistically significant correlation demonstrated in
this study.

38. Quantitative Study: Discussion
Limitations of the Study
Related to the nature of the lab group exercise
and inexperienced researchers.
Sample size was limited to 18 participants.
Response rate to the survey was likely falsely
high, as all participants were encouraged to
complete the survey as part of their course
requirements
There was inherent bias with the researchers
acting as participants.
Convenience sampling increases the potential
for bias.

39. Implications of Both Studies
Both qualitative and quantitative studies confirm
the relationship between inadequate sleep and
unintentional injury.
The findings suggest the need for public
awareness campaigns to inform about the
relationship between inadequate sleep and
unintentional injury.
The findings draw attention to a need for the
development of industry specific standards and
public health policies that create supportive
environments where adequate sleep is
emphasized as a component of reducing the
risk for unintentional injuries.

40. Conclusion
Both of these small scale quantitative and
qualitative research studies confirm a relationship
of unintentional injury and inadequate sleep.
The National Sleep Institute urges an investigation
to create policies, identify and implement
strategies to increase awareness and reduce
unintentional injuries related to inadequate sleep.
More-extensive research is warranted to build a
stronger knowledge base and apply information
and strategies to impact health outcomes within
broader populations.

41. References
Johnson, A. L., Brown, K., & Weaver, M. T.
(2010). Sleep Deprivation and Psychomotor
Performance Among Night-Shift Nurses.
AAOHN: American Association of
Occupational Health Nurses, 58(4), 147-154.
National Sleep Foundation (2011) Retrieved from
www.sleepfoundation.org/
Rosekind, M. R., & Gregory, K. B. (2010).
Insomnia Risks and Costs: Health, Safety, and
Quality of Life. The American Journal of
Managed Care, 16(8), 617-626.

42. References
Shields, M. (2003).The Health of Canada’s Shift
Workers.Health Reports, 13(4), 21-25.
Sleepdex. (2011, June).Sleep problems among
shift workers. Retrieved from
http://www.sleepdex.org/shiftwork.htm
Spengler, S. E., Browning, S. R., & Reed, D. B.
(2004). Sleep Deprivation and Injuries in Part-
Time Kentucky Farmers: Impact of Self
Reported Sleep Habits and Sleep Problems
on Injury Risk. AAOHN: American Association
of Occupational Health Nurses, 52(9), 373-
382.