Spotlight on Research

Prompt and accurate decision-making is a necessity to deliver effective patient care. However, the impact of sleepiness during a nightshift may reduce cognitive functioning and clinical performance. This study sought to examine second-year paramedic students' clinical decision-making while they undertook a 13-hour simulated night shift concentrating on real-life clinical scenarios. Sleepiness, workload, and motivation were self-reported by participants, while clinical performance, reaction time, visual attention and task-switching were graded by assessors. Each scenario was videocaptured for analysis. Ten common cases were built into scenarios and the participants were given the choice of attending or driving. Each scenario allowed the student paramedic to clinically assess and deliver patient care from arrival at the patient to the point where transportation would be commenced. Participants were then asked to handover to the triage nurse.

Results showed that as the nightshift progressed, sleepiness increased with participants who were alert and wide awake at the start of the nightshift becoming tired and ‘foggy’ at the end of the shift. Students' performance levels showed a decline within the second half of the shift as the sleepiness increased. The perceived workload initially decreased for the first 3 hours but then increased as the shift progressed. Perhaps unsurprisingly, motivation levels decreased significantly during the latter part of the shift. Notably, there was no decline in visual attention and reaction time throughout the entire nightshift.