Interventions to improve the sleep of nurses: A systematic review

Sleep of Nurses: A Comprehensive Scoping Review

AIM

To map the extent, range and nature of studies that examine sleep of nurses and identify how sleep has been examined in relation to the different aspects of nurses' health and nursing work and practice.

DESIGN

A scoping review.

DATA SOURCES

A search of five electronic databases including MEDLINE, Embase, EMcare, PsycINFO (using the Ovid platform) and Scopus was undertaken in May 2023 to identify primary studies that examined nurses' sleep.

REVIEW METHODS

This review was undertaken in accordance with the Joanna Briggs Institute methodology for scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

RESULTS

This review included 1040 studies from a wide range of countries. Most studies were observational in design and examined nurses working in the acute care sector. Studies were mostly descriptive (32%) or discussed sleep as a workforce issue (21%) or lifestyle behaviour that is important for the health of nurses working clinically (27%). A range of different sleep parameters were examined, with sleep quality the focus of most studies, especially in relation to well-being.

CONCLUSION

There has been an exponential increase in the number of studies that examine nurses' sleep. Efforts to examine the sleep of nurses are beginning to align with contemporary understandings and methodological approaches to examining sleep. However, this field of research could benefit from better consistency in the definition and reporting of sleep, prioritising objective measures of sleep and improving understanding of the relative and combined importance of different dimensions of sleep.

IMPACT

This review provides a comprehensive overview of studies that examine nurses' sleep. Findings highlight areas of growing interest, areas in need of further research and methodological considerations to strengthen research in this field.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. REGISTRATION DOI: https://doi.org/10.17605/OSF.IO/RZC4M.

Effects and implementation of an intervention to improve sleep, fatigue and recovery among healthcare workers with night shifts: A pre- and post-test study

BACKGROUND

Previous intervention studies among night workers mainly focused on single interventions and found inconclusive evidence for effectiveness. A comprehensive intervention approach that includes individual and environmental components has been argued as important. Gaining insight into contributing factors for the implementation of interventions for night workers and effectiveness is important to distinguish between theory and programme failure.

OBJECTIVES

To evaluate the effects and implementation of the PerfectFit@Night intervention to improve sleep, fatigue and recovery of night workers in healthcare, using the RE-AIM framework, which assesses reach, effectiveness, adoption, implementation and maintenance of interventions.

DESIGN

A prospective pre-post study design, with two measurements before and three and six months after the intervention.

SETTING

Twelve different departments of a university hospital in the Netherlands.

PARTICIPANTS

Healthcare workers working night shifts (n = 210).

METHODS

PerfectFit@Night consisted of environmental (provision of a powernap bed and healthy food, and workshop healthy rostering) and individual elements (e-learning and sleep coaching) and was implemented for three months in a phased manner. Questionnaires, logbooks and interview data were used. Effects of the intervention on sleep, fatigue and recovery were evaluated with mixed-effects models, and implementation factors of reach, adoption, implementation and maintenance were evaluated.

RESULTS

Night shift-related insomnia (-11 %-points, 95 % CI: -19 %, -4 % at three months), need for recovery (β: -2.45, 95 % CI: -4.86, -0.03 at six months) and fatigue (OR: 0.46, 95 % CI: 0.25, 0.86 at six months) decreased significantly after the intervention. No changes were found for subjective sleep quality and sleep duration. Barriers and facilitators for implementation were identified for each intervention element at individual (e.g., dietary preferences), organisational (e.g., responsibilities at work) and workplace levels (e.g., location of power nap bed), and for the intervention itself (e.g., useful information in e-learning). Although satisfaction was high and continuation was preferred, embedding of the intervention in the daily routine was limited. Facilitators for future implementation include a positive attitude towards the intervention, clear guidelines regarding intervention elements, appointment of night workers as ambassadors, and suitable conditions in terms of work demands and for the intervention elements.

CONCLUSIONS

The multi-faceted PerfectFit@Night intervention reduced insomnia, fatigue and need for recovery in night workers in healthcare. The most important facilitators to improve the implementation of PerfectFit@Night exist at the organisational level (e.g., positive attitude within the culture and suitable work demands). Combining effect and implementation evaluation is crucial to identify barriers and facilitators that hamper or enhance intervention effects.

TRIAL REGISTRATION

The study was registered in the Netherlands Trial Register on 17 January 2021 (trial number NL9224).

Balancing Knowledge and Health: A Comparative Analysis of Students and Healthcare Workers Nutrition Related Health Behaviors, a Cross-Sectional Study

The study aimed to investigate nutrition-related health behaviors among nursing and medical students compared to healthcare workers (HCWs), including nurses and physicians. A cross-sectional survey was conducted between May and November 2022, using the I-MEDAS and lifestyle-related behavior questionnaires. The participants included nursing and medical students, nurses, and physicians, with a total of 384 participants: 16.9% physicians, 23.17% nurses, and 59.9% students, 93% of whom were nursing students. The average I-MEDAS score (out of 17) was 7 for physicians, 8 for nurses, and 8 for students, with no significant differences in lifestyle behavior scores between the groups (p = 0.11), although nurses tended to score lower. Nurses also had a significantly higher BMI compared to physicians and students (p < 0.001). Physicians and nurses reported lower engagement in leisure activities and household chores, fewer sleep hours, and poorer sleep quality. The findings highlight a decline in healthy lifestyle behaviors and poor adherence to the Mediterranean diet among HCWs and students, particularly nurses, emphasizing the need for interventions to promote healthier habits in these groups.

Stress mindset and nurses' sleep quality: mediating effects of stress overload and anxiety

BACKGROUND

Previous studies have shown that overall sleep quality among Chinese nurses is relatively low, with a sleep disorder prevalence rate of approximately 66.4%. Against the backdrop of healthcare reforms, China has been striving to improve the mental health and sleep quality of nurses. Stress mindset can influence how individuals respond to stress, but there is limited research on how stress mindset affects nurses' sleep quality. This study aims to explore the impact of stress mindset on sleep quality among nurses, as well as the mediating roles of stress overload and anxiety in this relationship.

METHODS

The study was conducted online using a questionnaire from February 18 to February 22, 2024. It utilized the Stress Mindset Measure (SMM), the Stress Overload Scale-Short (SOS-S), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Pittsburgh Sleep Quality Index (PSQI) to survey 441 nurses in three regions of China: Chongqing, Hunan, and Shandong (M = 34.39, SD = 7.82, 95.7% female). A chain mediation model was employed to examine the mediating roles of stress overload and anxiety in the relationship between stress mindset and sleep quality.

RESULTS

The participants' average sleep quality score was 7.18 ± 3.47. Nurses' stress mindset was significantly negatively correlated with both stress overload and anxiety, and significantly positively correlated with sleep quality. Stress overload was significantly positively correlated with anxiety and significantly negatively correlated with sleep quality. Anxiety was also significantly negatively correlated with sleep quality. The direct effect of nurses' stress mindset on sleep quality was significant (effect size = -0.10, 95% CI: -0.19 to -0.01), as were the indirect effects through stress overload (effect size = -0.05, 95% CI: -0.11 to -0.01) and anxiety (effect size = -0.09, 95% CI: -0.13 to -0.05), along with their chain mediation effect (effect size = -0.10, 95% CI: -0.14 to -0.06).

CONCLUSION

Our study demonstrates that a higher level of nurses' stress mindset is associated with better sleep quality, with stress overload and anxiety mediating this relationship. A positive stress mindset helps nurses cope more effectively with professional challenges and reduces anxiety, leading to improved sleep quality. Healthcare institutions should therefore prioritize fostering positive stress mindsets in nurses, encouraging regular psychological training and workshops to support the development of effective coping strategies.

Personal and Workplace Characteristics as Predictors of Intent-To-Stay Among Registered Nurses: An Exploratory Quantitative Multicentre Study

AIM

This study aims to describe and examine the factors associated with registered nurses' intent-to-stay and subsequently identify predictors of nurses' intent-to-stay.

DESIGN

A quantitative, cross-sectional correlational design was used.

METHODS

A convenience sample of 270 registered nurses completed the questionnaire and was included in this study. Descriptive statistics were used to present the sociodemographic characteristics and scores of outcome measures. Pearson's correlation coefficient and multiple linear regression with backward selection were conducted to examine how nurses' characteristics and workplace factors influence nurses' intent-to-stay.

RESULTS

The mean age of the participants was 29.2 years. The mean scores for the outcomes were intent-to-stay (mean = 2.96), resilience (mean = 3.34), occupational self-efficacy (mean = 4.34), sleep quality (mean = 9.73) and workplace environment scores (mean = 3.15). The correlation analysis showed that resilience, occupational self-efficacy, self-realisation and workload were positively correlated to intent-to-stay while sleep quality was negatively correlated to intent-to-stay. Multiple linear regression analysis found occupational self-efficacy, sleep quality, workload, nervousness, nurses' designation and specialisation status to be significant factors associated with intent-to-stay.

CONCLUSION

Intent-to-stay is a complex and multidimensional construct influenced by a variety of personal and workplace factors. Hospital administrators should endeavour to develop measures to improve occupational self-efficacy, workload, nervousness and push for specialisation training to bolster nurses' intent-to-stay.

IMPACT

Against an everchanging healthcare landscape following the COVID-19 pandemic, the findings of this study contribute to a deeper understanding of the factors of registered nurses' intent-to-stay. The findings of this study alluded to the importance of professional development and workload as factors that can influence registered nurses' intent-to-stay. Hospital administrators can prioritise workforce retention policies by introducing strategies such as opportunities for upskilling, flexible working hours and streamlining work processes to promote nurses' intent-to-stay.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

How Shift Nurses' Presenteeism is Related to Insomnia and Care Left Undone: A Cross-Sectional Study Using Generalised Structural Equation Modelling

AIM

To examine the association between nurses' insomnia, presenteeism and care left undone and explore the mediating effect of presenteeism on the relationship between insomnia and care left undone among nurses in acute care hospitals, applying a dynamic model of presenteeism and absenteeism.

DESIGN

A cross-sectional design.

METHODS

A secondary data analysis was conducted using online survey data collected in January 2023. Participants were 1154 registered nurses who provided direct nursing care to patients in tertiary or general hospitals (hospitals with 300 or more beds) in South Korea. Poisson regression analysis was used to examine the association between nurses' insomnia, presenteeism and care left undone. Generalised structural equation modelling was performed to examine the mediating effect of presenteeism on the relationship between insomnia and care left undone.

RESULTS

The prevalence of insomnia was 15.3%. More than half of the participants (63.7%) reported experiencing presenteeism in the past 4 weeks. All reported at least one nursing care left undone during their last shift. Insomnia and presenteeism were positively associated with care left undone, and presenteeism mediated the relationship between insomnia and care left undone among nurses in acute care hospitals.

CONCLUSION

Nurses experienced insomnia and presenteeism, related to higher rates of care left undone. Nurses' insomnia had a direct effect on care left undone and an indirect effect through presenteeism.

IMPLICATIONS FOR THE PROFESSION

Nurse managers and administrators need to make greater efforts to reduce insomnia and presenteeism among nurses, thereby reducing care left undone and improving patient safety in acute care settings.

IMPACT

Nurse managers and administrators should consider proactive interventions to address nurses' insomnia and foster a workplace with healthy systems and culture to reduce sleep disturbance and presenteeism, which can effectively decrease care left undone.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The association between occupational stress, sleep quality and premenstrual syndrome among clinical nurses

OBJECTIVE

Premenstrual Syndrome is also known as premenstrual tension syndrome because of the pronounced premenstrual mental and emotional anomalies. This study focuses on the association between occupational stress, sleep quality and premenstrual syndrome in clinical nurses and the mediating role of sleep quality.

METHODS

A cross-sectional study was conducted to measure occupational stress, sleep quality and premenstrual syndrome in 415 clinical nurses using the Chinese Nurses Stressor Scale, the Pittsburgh Sleep Quality Index Scale, and the Premenstrual Syndrome Scale. SPSS was used to explore the relationship between the variables, and AMOS was used to explore the mediating role between the variables.

RESULTS

Nurses' occupational stress positively predicted PMS (β = 0.176, p < 0.001), and the regression coefficients for sleep quality were significantly different for both paths of nurses' occupational stress (β = 0.665, p < 0.001) and PMS (β = 0.261, p < 0.001). The mediation effect accounts for 49.57% of the total effect.

CONCLUSION

This study revealed a notably high incidence of PMS among clinical nurses in China, with occupational stress and sleep quality significantly correlated with PMS. Sleep quality played an intermediary role between occupational stress and PMS. Consequently, managers should prioritize addressing occupational stress, mitigating PMS symptoms, enhancing nurses' health and nursing quality, and preventing nursing risks through mental health support and improving sleep quality.

Poor sleep quality and overweight/obesity in healthcare professionals: a cross-sectional study

Objective

This study aimed to analyze the relationship between the sleep quality of healthcare professionals and the incidence of overweight and obesity, exploring the potential impact of sleep quality on the onset of overweight and obesity in order to provide a scientific basis for formulating effective health intervention measures.

Methods

A convenience sampling method was used to conduct a survey on the sleep characteristics and obesity status among healthcare professionals at Peking Union Medical College Hospital and Tianjin Dongli District Traditional Chinese Medicine Hospital. The survey was conducted via online questionnaires, which included demographic data, the Pittsburgh Sleep Quality Index (PSQI), height, weight, and related sleep, exercise, and dietary habits. Univariate and multivariate logistic regression analyses were applied to study the relationship between sleep quality and overweight/obesity among healthcare professionals.

Results

A total of 402 questionnaires were distributed, with a 100% retrieval rate, yielding 402 valid questionnaires. The average body mass index of the 402 participants was 23.22 ± 3.87 kg/m^2. Among them, 144 cases were overweight or obese, accounting for 35.8% (144/402) of the total. The prevalence of poor sleep quality among healthcare professionals was 27.4% (110/402), with an average PSQI score of 8.37 ± 3.624. The rate of poor sleep quality was significantly higher in the overweight and obese group compared to the normal weight group (36.1% vs. 22.5%, p = 0.003). The multivariate analysis indicated that gender, marital status, lower education level, sleep duration (odds ratio [OR] =1.411, 95% confidence interval [CI] 1.043-1.910, p = 0.026), and sleep disturbances (OR = 1.574, 95%CI 1.123-2.206, p = 0.008) were significant risk factors for overweight and obesity among healthcare professionals.

Conclusion

Overweight or obese healthcare professionals had poorer sleep quality compared to those with a normal weight. Sleep duration and sleep disorders were identified as independent risk factors for overweight or obesity in healthcare professionals. Increasing sleep duration and improving sleep disorders may play a positive role in controlling overweight and obesity among healthcare professionals.

Is it Time to Include Wearable Sleep Trackers in the Applied Psychologists' Toolbox?

Wearable sleep trackers are increasingly used in applied psychology. Particularly, the recent boom in the fitness tracking industry has resulted in a number of relatively inexpensive consumer-oriented devices that further enlarge the potential applications of ambulatory sleep monitoring. While being largely positioned as wellness tools, wearable sleep trackers could be considered useful health devices supported by a growing number of independent peer-reviewed studies evaluating their accuracy. The inclusion of sensors that monitor cardiorespiratory physiology, diurnal activity data, and other environmental signals allows for a comprehensive and multidimensional approach to sleep health and its impact on psychological well-being. Moreover, the increasingly common combination of wearable trackers and experience sampling methods has the potential to uncover within-individual processes linking sleep to daily experiences, behaviors, and other psychosocial factors. Here, we provide a concise overview of the state-of-the-art, challenges, and opportunities of using wearable sleep-tracking technology in applied psychology. Specifically, we review key device profiles, capabilities, and limitations. By providing representative examples, we highlight how scholars and practitioners can fully exploit the potential of wearable sleep trackers while being aware of the most critical pitfalls characterizing these devices. Overall, consumer wearable sleep trackers are increasingly recognized as a valuable method to investigate, assess, and improve sleep health. Incorporating such devices in research and professional practice might significantly improve the quantity and quality of the collected information while opening the possibility of involving large samples over representative time periods. However, a rigorous and informed approach to their use is necessary.