A scoping review of sleep education and training for nurses

What Control Measures Should I Use? Applying the Total Worker Health Hierarchy of Controls to Manage Workplace Fatigue

Increased fatigue risk has been associated with safety-critical events such as work-related injuries. While control measures are needed to reduce these risks, the wide range and complexities of fatigue risk management strategies can make it difficult for organizations to prioritize efforts given limited resources and time. Given these challenges, the aims of this commentary are two-fold. The first is to conceptualize fatigue risk management strategies within the Total Worker Health (TWH) Hierarchy of Controls, a conceptual framework used to prioritize strategies to advance worker safety, health, and wellbeing. As an extension to the traditional Hierarchy of Controls, the TWH version presents strategies in order of effectiveness, ranging from "eliminate," "substitute," "redesign," "educate," and "encourage" categories. The second aim of this paper is to use the TWH Hierarchy of Controls to identify control measures which reflect the level of fatigue risk for adverse safety and health outcomes.

Current status and influencing factors of sleep-related worry among nurses in the department of anesthesiology: a cross-sectional study

BACKGROUND

Anesthesiology, as the core field of the treatment of critically ill patients, carries great work risks and pressure. Due to the uniqueness of their working environment and nature, medical staff have become a high incidence group of sleep-related worry and sleep disorders.

OBJECTIVE

To investigate the sleep status of anesthesia nurses and analyze related influencing factors, so as to provide a reference for formulating targeted intervention measures.

METHODS

This study was a cross-sectional study design. From August to October 2024, convenience sampling was used to investigate 330 nurses in the Department of anesthesia in Sichuan Province of China with the general information questionnaire, Sleep-related Worry scale, Self-regulatory Fatigue Scale, Perceived Stress Scale, Athens Insomnia Scale and Perceived Social Support Scale. Single factor analysis, Pearson correlation analysis and multiple hierarchical regression analysis were used to explore the influencing factors of sleep-related worry of nurses in the department of anesthesiology.

RESULTS

The total score of sleep-related worry was (32.53 ± 12.00), the score of self-regulatory fatigue was (47.01 ± 9.25), the score of stress perception was (28.84 ± 7.96), and the score of insomnia was (17.18 ± 6.24). The score of perceived social support was (61.56 ± 14.93). Sleep-related worry was positively correlated with self-regulatory fatigue (r = 0.459, P < 0.001), perceived stress (r = 0.489, P < 0.001), Athens insomnia (r = 0.671, P < 0.001), and negatively correlated with perceived social support (r=-0.362, P = 0.002). The results of multivariate analysis showed that health status, self-regulatory fatigue, perceived stress, insomnia and social support were the influencing factors of sleep-related worry of nurses in the department of Anesthesiology, which could explain 51.1% of the total variation.

CONCLUSION

Anesthesiology nurses have serious sleep-related worry, which need to be further improved. Clinical nursing managers should pay attention to the special needs of nurses in the department of anesthesiology, and reduce the sleep-related worry of anesthesiology nurses by improving their insomnia symptoms, reducing their stress and self-regulatory fatigue, and improving the level of social support.

Occupational Burnout and Insomnia in Relation to Psychological Resilience Among Greek Nurses in the Post-Pandemic Era

Recent studies indicate that nurses experienced high levels of occupational burnout and insomnia during and after the pandemic and highlight resilience as a crucial competence for overcoming adversity. The aim of this study was to assess occupational burnout, insomnia, and psychological resilience and to explore their interrelations among Greek nurses 14 months after the official ending of the pandemic which was declared in May 2023. The study was conducted online in July 2024 and included 380 nurses currently working in Greek hospitals, who completed the Copenhagen Burnout Inventory (CBI), the Athens Insomnia Scale (AIS), and the Brief Resilience Scale (BRS). Overall, 56.1% of the nurses exhibited insomnia symptoms and 46.8% displayed signs of occupational burnout. Low resilience scores were observed in 26.3%. Multiple regression analysis indicated that CBI explained 34.4% of the variance in the AIS scores, while an additional 3% was explained by the BRS. Mediation analysis revealed that resilience operates protectively as a negative mediator in the relationship between burnout and insomnia. In conclusion, one year after the end of the pandemic the levels of occupational burnout and insomnia among nurses remain high, whereas psychological resilience seems to be retained at moderate levels. Consequently, there is an urgent need to regularly monitor for risk of burnout and insomnia and to implement resilience-building strategies for nurses to combat burnout and improve insomnia symptoms.

Shift work sleep disorder in nurses: a concept analysis

AIM

This study seeks to elucidate the concept of shift work sleep disorder (SWSD) among nurses, thereby offering a comprehensive understanding that can inform future research and practical interventions.

METHODS

Walker and Avant's concept analysis method was employed to guide the study. A systematic literature review was conducted utilizing various databases, including PubMed, Embase, EBSCO, Web of Science, CNKI, WanFang, and Sino Med. The inclusion criteria were specifically designed to focus on studies that define SWSD, along with its attributes, antecedents, consequences, and assessment tools relevant to nursing professionals.

RESULTS

The analysis identified four key attributes of SWSD: internal/external circadian rhythm imbalance, impaired sleep, multidimensional health problems, and dynamic changes in symptoms. Antecedents include individual factors like personal health, lifestyle, family support, shift patterns, work environment, and other organizational factors. Consequences of SWSD encompass physiological health issues, mental health challenges, impaired social adaptability, and decreased nursing performance.

CONCLUSION

SWSD has a significant impact on the health and performance of nurses. Understanding its attributes, antecedents, and consequences is crucial for developing targeted interventions. Enhancing sleep hygiene, fostering supportive work environments, and implementing appropriate shift scheduling can help mitigate the adverse effects associated with SWSD.

Determinants of sleep quality and their impact on health outcomes: a cross-sectional study on night-shift nurses

Purpose

This study aimed to identify determinants of sleep quality and explore their adverse health outcomes among night-shift nurses in China.

Method

Through convenience sampling, this cross-sectional study enrolled a total of 711 night-shift nurses aged 20-55 years who completed questionnaires from which details regarding their sociodemographic characteristics, health-related indicators and sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) were extracted. A generalized linear regression analysis was then created to identify factors influencing sleep quality. Pearson correlation analysis was used to analyze the relationship between sleep quality and chronic fatigue.

Results

The prevalence rate of poor sleep quality among night-shift nurses reached as high as 90.1%. Our results showed that education level, years of working experience, quality of make-up sleep before and after night shifts, daily routine and diet were the primary factors affecting sleep quality (p < 0.01). Nurse fatigue had a significant positive correlation with subjective sleep quality, sleep latency, sleep duration, sleep disturbance, medications to sleep, daytime dysfunctions and global sleep quality (p < 0.01). However, nurse sleep efficiency had a significant negative correlation with fatigue (p < 0.01).

Conclusions

Higher education level, longer working years, worse quality of make-up sleep before and after night shifts, daily routine and daily diet were risk factors for poor sleep quality among nurses. Poor sleep among night-shift nurses is strongly correlated with chronic fatigue.

Characterising Potential Subtypes and Influencing Factors of Sleep Quality in Psychiatric Nurses by Latent Profile Analysis

Background

Sleep is a crucial factor affecting an individual's physical and mental health. Psychiatric nurses work under high stress and load, and it is necessary to understand the sleep quality of psychiatric nurses and the influencing factors. However, individual-centred studies of psychiatric nurses' sleep are limited.

Aims

To explore the heterogeneity in sleep quality among psychiatric nurses, to identify the factors influencing different subtypes, and to provide targeted strategies and measures to improve their sleep quality.

Methods

From August to October 2022, 298 psychiatric nurses working in a mental health centre in Liaoning Province were selected as the participants. The study involved administering the following two questionnaires: the general information questionnaire and the Pittsburgh Sleep Quality Index (PSQI). Data analyses included latent profile analysis, Kruskal-Wallis H test, and multiple logistic regression.

Results

The prevalence of poor sleep quality (PSQI >5) among psychiatric nurses was 54.7%. The sleep quality of psychiatric nurses could be classified into the following three distinct profiles: good sleep quality, moderate sleep quality, and poor sleep quality. Nurses who were over 40 years of age, unmarried/divorced/separated/widowed, worked more than 40 hours per week, experienced significant life events in the past year, had poor nurse-patient relationships, and had chronic diseases were more likely to have poorer sleep quality.

Conclusions

There was significant heterogeneity in sleep quality among psychiatric nurses. Age, marital status, work schedule, total weekly working hours, night shifts, special life events, nurse-patient relationships, and chronic diseases were associated with their sleep quality. Implications. The heterogeneity and influencing factors of sleep quality in psychiatric nurses provided evidence for individualized interventions in the future. This trial is registered with ChiCTR2200062347.

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

AIMS

To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings.

DESIGN

A qualitative descriptive study. Data were collected via semi-structured interviews.

METHODS

In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized.

RESULTS

Six themes and 20 sub-themes were identified. Non-validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed.

CONCLUSION

Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness.

IMPACTS

The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post-cardiac event counselling.

REPORTING METHOD

Adherence to COREQ guidelines was maintained.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution as this study explored health professionals' experiences only.

Sleep Quality Should Be Assessed in Inpatient Rehabilitation Settings: A Preliminary Study

OBJECTIVES

In this preliminary, longitudinal study, our objective was to assess changes in sleep quality during an inpatient stay in a rehabilitation setting in the United States and to relate changes to patients' demographic and clinical characteristics (i.e., age, gender, BMI, ethnicity, reason for hospitalization, pre-hospital living setting, prior diagnosis of sleep disorders, and mental health status).

METHODS

A total of 35 patients participated in this preliminary study (age = 61 ± 16 years old, 50% <65; BMI = 30 ± 7 kg/m²; 51% female; 51% Caucasian). The average length of hospitalization was 18 ± 8 days. Reasons for hospitalization included orthopedic-related issues (28%), spinal cord injury (28%), stroke (20%), and other (23%). In this sample, 23% had prior sleep disorders (mostly sleep apnea), and 60% came from an acute care unit. Patients' sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) at admission and before discharge. Demographic and medical data were collected. Patients' mental health status was also assessed at the same intervals. Nighttime sound levels and the average number of sleep disturbances were also collected throughout the study (6 months).

RESULTS

Our data revealed that most patients had poor sleep (PSQI > 5) at admission (86%) and discharge (80%). Using a repeated ANOVA, a significant interaction was obtained between sleep quality and the presence of a diagnosed sleep disorder [F (1, 33) = 12.861, p = 0.001, η²_p = 0.280]. The sleep quality of patients with sleep disorders improved over their stay, while the sleep of patients without such disorders did not. The mean nighttime sound collection level averages and peaks were 62.3 ± 5.1 dB and 86.1 ± 4.9 dB, respectively, and the average number of sleep disturbances was 2.6 ± 1.1.

CONCLUSION

The improved sleep observed in patients with vs. without sleep disorders might be related to the care received for treating such disorders over the stay. Our findings call for the better detection and management of poor sleep in acute inpatient rehabilitation settings. Furthermore, if our findings are replicated in the future, studies on the implementation of quiet times for medical staff, patients, and family should be performed to improve sleep quality in the inpatient rehabilitation setting.