Factors Influencing Sleep Quality among Female Staff Nurses during the Early COVID-19 Pandemic in the United States

Factors influencing healthcare workers' performance before and after the coronavirus disease 2019 pandemic: A bibliometric analysis with supplementary comparative analysis

BACKGROUND

The performance of healthcare workers directly impacts patient safety and treatment outcomes. This was particularly evident during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE

This study aimed to analyze research trends on factors influencing work performance among healthcare workers through bibliometric analysis and conduct a comparative analysis from macro and micro perspectives before and after the COVID-19 pandemic to complement the existing research.

METHODS

This study involved a bibliometric analysis of 1408 articles related to work performance in the healthcare field published between 2010 and 2023, using the Web of Science, Scopus, and PubMed databases, and 37 articles were selected to determine the factors influencing work performance.

RESULTS

By conducting a bibliometric analysis of the articles based on country, institution, journal, co-cited references, and keywords, this study identified a significant growth trend regarding the factors influencing work performance in the healthcare field, and research hotspots shifted from organizational factors like standard towards psychological factors such as burnout, anxiety, and depression following the outbreak of the COVID-19 pandemic. Subsequently, this study extracted 10 micro-level and 9 macro-level influencing factors from the selected articles for supplementary analysis. Furthermore, this study conducted a comparative analysis of the impact of these factors on work performance before and after the COVID-19 pandemic.

CONCLUSIONS

This study addressed the limitations of previous studies regarding incomplete extraction of factors influencing work performance and unclear comparisons of parameters before and after the COVID-19 pandemic. The findings provide insights and guidance for improving the performance of healthcare workers.

Evaluating the role of heart rate variability in monitoring stress and sleep quality among nurses in the aftermath of the COVID-19 pandemic

AIM

To assess heart rate variability (HRV) as a measure to assess job stress and sleep quality among nurses in the post-COVID-19 period.

BACKGROUND

The COVID-19 pandemic significantly affected nurses, with heightened job stress and impaired sleep quality impacting their well-being and effectiveness in patient care. HRV could offer insights for supporting strategies in the pandemic aftermath.

DESIGN

A quantitative cross-sectional study.

METHODS

This study involved 403 clinical nurses recruited from a teaching hospital in Taiwan. Data on job stress, work frustration, sleep quality and HRV were collected and analysed.

RESULTS

Among the nurses surveyed during the COVID-19 pandemic, 72.7% reported poor sleep quality (PSQI = 9.369). Job stress emerged as a strong predictor of work frustration. High stress levels and poor sleep quality were correlated with significantly decreased HRV, indicating a potential physiological impact of stress on the nurses' health and well-being.

CONCLUSIONS

HRV is a valuable and cost-effective measure for monitoring and managing nurses' well-being in the post-COVID-19 era. Targeted interventions can be implemented to support nurses' overall performance and promote their well-being by identifying those at high risk of job stress and poor sleep quality.

Nurses' perceived health and occupational burnout: A focus on sleep quality, workplace violence, and organizational culture

AIM

This study investigates the mediation of sleep quality between perceived health and occupational burnout in hospital nurses, considering the moderation of workplace violence and organizational culture.

BACKGROUND

Occupational factors lead to physical and mental distress, burnout, and sleep issues in nurses. Approximately two-thirds of nurses experience burnout, impacting patient care quality and safety. Cultivating a positive organizational culture is essential for nursing workforce stability.

METHODS

This cross-sectional study employed convenience sampling to recruit 346 nurses from a teaching hospital in southern Taiwan in July-August 2020 (response rate: 87.3%). Self-administered questionnaires containing validated instruments were employed, including an adapted occupational burnout scale, the Chinese version of an organizational culture scale, a Perceived Health Questionnaire, a Workplace Violence Experience Scale, and the CPSQI; all instruments were reliable and valid. The analysis involved descriptive statistics, linear regression, and the Johnson-Neyman technique.

RESULTS

Nurses with better perceived health exhibited significantly lower occupational burnout (p < 0.001). Perceived health indirectly impacted burnout through sleep quality (p < 0.01) with organizational culture as a partial moderator. Bureaucratic organizational culture exacerbated this relationship. Additionally, decreased workplace violence moderated the connections among perceived health, sleep quality, and occupational burnout among nurses.

CONCLUSIONS

Given the inverse correlation between nurses' perceived health and occupational burnout and considering factors such as workplace violence, organizational culture, and sleep quality, healthcare institutions can proactively take steps to enhance nurses' overall well-being and mitigate burnout.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

By implementing wellness programs, mental health support, security training, robust reporting, and a zero-tolerance approach to violence, healthcare stakeholders can foster a safe and supportive work environment for nurses, thus improving well-being, patient outcomes, and healthcare quality.

Sleep quality of nurses who worked in coping with COVID-19: an integrative review

OBJECTIVE

to analyze sleep quality of nurses who worked coping with COVID-19 in scientific evidence.

METHODS

an integrative review, carried out in seven databases, including studies between December 2021 and June 2022, without language restrictions. The sample consisted of 15 primary studies.

RESULTS

nurses working in hospital, intensive care, outpatient care and teaching institutions constitute a vulnerable group for sleep disorders: latency, duration, efficiency and quality. The disorders identified involved insomnia at varying levels of severity: daytime dysfunction and morning sleepiness. Night work and low capacity for self-care were determinants of impaired sleep patterns.

FINAL CONSIDERATIONS

the COVID-19 pandemic contributed to greater vulnerability of nurses to changes in sleep, requiring strategies for risk management and well-being promotion.

Predictive factors of sleep quality and burnout in nurses working in transplant units during the COVID-19 lockdown - A cross-sectional study

Background: There is minimal information regarding sleep disturbance and burnout during COVID-19 in nurses working within haematology-oncology and hematopoietic stem cell transplantation (HSCT) settings.Aim: To identify socio-demographic and professional factors that predicted burnout and sleep disturbance during COVID-19 in nurses working in HSCT settings.Design/Methods: Data were collected using the Maslach Burnout Inventory and the Pittsburgh Sleep Quality Index. Descriptive statistics and linear regression examined relationships.Results: 308 responses were received. Nurses working in outpatient settings had greater emotional exhaustion (Rpartial = -0.12, n = 308, p = 0.03). Negative predictors for quality of sleep were transplant programme setting (Rpartial = -0.19, n = 308, p < 0.01) and years working in HSCT (Rpartial = -0.17, n = 308, p < 0.01). Other relationships were found on univariate analysis.Conclusion: Institutions must offer programmes for nurses to develop sleep strategies, self-care, and work-related stress management.

Sleep Quality, Insomnia, and Perceived Stress among Colombian Healthcare Workers during the COVID-19 Pandemic

Objective  The COVID-19 pandemic has imposed a great burden on healthcare workers worldwide. The aim of the present study was to assess sleep quality, insomnia, and perceived stress in healthcare workers of a high complexity hospital located in Bogota, Colombia. Methods  Cross-sectional study in which 1,155 healthcare workers at the Hospital Universitario San Ignacio in Bogotá, Colombia were included, between September and October 2020. Using an online-based survey, self-reported variables were assessed including demographics, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and 10 item Perceived Stress Scale (PSS-10). Associations between these variables were evaluated. Results  Fifty percent of the respondents were between 31 and 45 years old, and 76 percent were women. Most of the surveyed were the nursing staff. Poor sleep quality, insomnia, and high perceived stress was found in 74.9, 12.4, and 13.2%, respectively. Poor sleep quality was predominantly found in females, in the 31 to 45 years old group and in married personnel. Also, poor sleep quality was found in relation to a moderate to high perceived risk of COVID-19 infection by the family of the workers surveyed. Discussion  Poor sleep quality, moderate rates of insomnia, and perceived stress were found among healthcare workers committed to COVID-19 infected patients in Colombia. The identification of workers at greater risk and the implementation of targeted interventions are called upon as the results.

Nurses and midwives' sleep quality and its associated factors during the early COVID-19 pandemic in Iran

Objectives

Good sleep quality is crucial for medical staff especially nurses and midwives to prevent possible errors and injuries during the providing care. The aim here is to investigate the sleep quality of nurses and midwives during the early corona pandemic and its related factors.

Methods

An online observational and cross-sectional study included 340 medical staff who engaged in the treatment of patients with COVID-19 infection in 2020. Participants completed questionnaires about working characteristics, Pittsburgh Sleep Quality Index (PSQI), and Social Support Indexes (SSI). Pearson's correlation analysis and Multivariate logistic regression identified the interactions between these factors.

Results

The mean PSQI and SSI were 8.4 ± 4.46 and 28.6 ± 13.29, respectively, indicating poor sleep quality and moderate social support. The condition of the participants was serious in terms of sleep efficiency, and sleep disturbance. More than half of the participants reported severe and very serious daytime dysfunction. Poor sleep quality was more common, in nurses than in midwives (OR:0.074, CI; 0.032-0.098, P < 0.001), nurses working in intensive care units than in other wards (OR:1.082, CI; 1.003-4.023, P = 0.005), in people who had long shifts (OR:1.757, CI; 1.123-4.323, P = 0.003), and in people working more than 5 years (OR:4.949, CI; 1.673-6.023, P = 0.028). Social support has a statistically significant relationship with the quality of sleep (OR:0.013, CI; 0.001-0.244, P = 0.004).

Conclusion

The sleep quality of the medical staff has been impaired during the epidemic period, especially among nurses. Targeting staff who are more prone to sleep disturbance, such as nurses with longer work experience, helps us design an optimal strategy to support them through sleep hygiene education.

Sociodemographic Aspects and Healthy Behaviors Associated With Perceived Life Satisfaction in Health Professionals

BACKGROUND

Life satisfaction is a determining factor for the improvement of mental and physical health. Health care workers are a vulnerable population to suffer alterations in the factors that affect life satisfaction. Determining the influence of these factors on quality of life is important for their proper management.

OBJECTIVE

To examine sociodemographic factors and healthy behaviors influencing life satisfaction in Peruvian professionals.

METHODS

A cross-sectional study was conducted with 506 health care workers, who had a mean age of 40.34 years (SD = 10.39). A sociodemographic questionnaire, sleep quality, physical activity, eating habits, and life satisfaction were used. A regression model was fitted with the life satisfaction variable as the dependent variable.

RESULTS

In multivariable analysis, age (β = -.938, P < .01) and perception of poor health status (β = -4.743, P < .001) were found to be associated with lower life satisfaction. On the other hand, higher university education level (β = 1.667, P < .001), absence of smoking (β = 3.202, P < .01), absence of depressive symptoms (β = 3.390, P < .001), interest in daily activities (β = 3.503, P < .05), good sleep quality (β = 1.027, P < .01), a high frequency of physical activity (β = 1.056, P < .01), and healthy eating are variables associated with higher life satisfaction.

CONCLUSION

Sociodemographic aspects such as age and the perception of poor health are associated with lower life satisfaction. On the other hand, healthy behaviors such as absence of smoking, absence of depressive symptoms, interest in daily activities, good quality of sleep, high frequency of physical activity, and a healthy diet were associated with higher life satisfaction.

Well-Being, Occupational Fatigue, and Sleep Quality among Filipino Nurses working during COVID-19

Fatigue is a common symptom experienced by nurses before the pandemic, but this experience is heightened by the coronavirus (COVID-19) pandemic. The literature has ample evidence of nurses experiencing occupational or work-related fatigue. In addition, human error is a significant consequence of fatigue that can significantly impact patient outcomes and be devastating for a nurse. Guided by Lazarus and Folkman's Transactional Theory of Stress and Coping, we conducted a descriptive, correlational and cross-sectional study aimed to 1) explore the level of occupational fatigue and sleep quality among Filipino nurses working during the COVID-19; 2) determine the relationships between occupational fatigue, sleep quality, and subjective wellbeing among Filipino nurses working during COVID-19 pandemic. One hundred twenty-six Filipino nurses across the United States working during the pandemic were surveyed using RedCap. The study showed that Filipino nurses had moderate to high acute and chronic fatigue levels, lower intershift recovery, and good sleep quality. Evidence and opportunities for health care administrations to create strategies to enhance the wellbeing of their largest and most valuable workforce.

Investigation of Psychological Stress and Sleep Quality of Emergency Medical Technicians in Taiwan Fire Department during the COVID-19 Pandemic

When the coronavirus disease 2019 (COVID-19) began to ravage the world in 2019, the World Health Organization became concerned. The epidemic has a high mortality and contagion rate, with severe health and psychological impacts on frontline emergency medical service system practitioners. There are many hospital staff surveys, but few have covered the stress among emergency medical technicians. DASS-21, PSQI, and AUDIT questionnaires were used to evaluate the sources of psychological stress factors of firefighters in Taiwan. Multiple logistic regression was used to analyze the questionnaire content. We conducted questionnaire surveys from May 2022 to July 2022. Our sample comprised 688 participants. The odds ratios of increased depression, anxiety, and stress levels due to reduced family or peer understanding and support were 2.72 (95% CI: 1.50−4.92), p = 0.001; 2.03 (95% CI: 1.11−3.68), p = 0.021; and 3.27 (95% CI: 1.83−5.86), p < 0.001, respectively. The odds ratios of poor sleep quality due to depression, anxiety, and increased stress levels were 5.04 (3.18−7.99), p < 0.001; 2.44 (95% CI: 1.57−3.81), p < 0.001; and 4.34 (95% CI: 2.76−6.82), p-value < 0.001, respectively. During the COVID-19 pandemic, poor sleep quality and a lack of understanding and support from the Taiwan firefighting agency staff, family, or peers resulted in increased depression, anxiety, and stress levels.

Factors associated with sleep quality among nurse managers during regular prevention and control of the COVID-19 in China: a cross-sectional study

BACKGROUND

Nurse managers play a pivotal role in quality patient care and staff satisfaction and retention. An overwhelming amount of work tasks and responsibilities might result in their sleep problems which are expected to aggravate in the context of the COVID-19, thereby affecting their overall health and work quality. However, little attention has been paid to sleep quality among nurse managers. This study aimed to investigate the prevalence of sleep disorders among nurse managers and identify related factors of sleep quality during regular prevention and control of the COVID-19 pandemic in China.

METHODS

This cross-sectional online survey was conducted in 14 hospitals on a sample of 327 nurse managers in China. Participants were invited to complete the general demographic questionnaire, Pittsburgh Sleep Quality Index (PSQI) and Simplified Coping Style Questionnaire (SCSQ). Multiple linear regression analysis was used to explore the influencing factors of sleep quality among nurse managers.

RESULTS

In this study, 43.7% of nurse managers suffered from sleep disorders. Active coping style and frequent exercise were positive factors that could influence nurse managers' sleep quality, while passive coping style and age over 41 years old were negative predictors, collectively accounting for 52.0% of the variance of sleep quality.

CONCLUSIONS

The issue of sleep disorders among nurse managers during regular epidemic prevention and control period is underscored. Coping style and demographic factors including age and frequency of exercise can significantly affect nurse managers' sleep quality. Healthcare administrators should pay more attention to nurse managers' sleep disorders and implement targeted strategies based on influencing factors to ensure their sleep quality.

Sleep disturbances in nurse managers during the early and late stages of the COVID-19 pandemic

Introduction

Working conditions during the COVID-19 pandemic have affected health professionals' quality of sleep. To date, most of the studies that assess the impact of the COVID-19 pandemic on sleep have been carried out with front-line health personnel, and almost none of them have been carried out with managers.

Objective

To evaluate the quality of sleep and the level of stress in nurse managers during the early and late stages of the COVID-19 pandemic.

Methods

Cross-sectional studies were carried out at two time points: after the lockdown period (July 2020) and a year and a half after the start of the pandemic (October 2021). A total of 102 nurse managers of a tertiary hospital were invited to participate. The Perceived Stress Scale (PSS-14) and Pittsburgh Sleep Quality Index (PSQI) were administered to assess stress levels and sleep quality.

Results

The response rate was 85.2% in 2020 and 81.3% in 2021. Nursing managers showed alterations in sleep quality throughout the pandemic: 70.1% after confinement and 61.4% at the beginning of the second wave. In addition to stress, the fear of contagion by COVID-19 influenced sleep problems. More than a year after the start of the pandemic, the professionals' fear of contagion decreased. Perceived stress also decreased, but sleep disturbances remained.

Conclusion

High stress and poor sleep quality among nurse managers require special attention, and specific interventions need to be implemented. Hospitals should develop programs that help nurse managers develop skills to mitigate stress levels and thus improve sleep quality and professional quality of life.

Association Between Role Overload and Sleep Quality Among Chinese First-Line Nurses During the COVID-19 Outbreak: The Moderating Effect of Mindfulness

BACKGROUND

Nurses working during the coronavirus disease 2019 (COVID-19) pandemic have experienced a high incidence of insomnia because of exposure to life-threatening occupational risks. Good sleep is essential for nurses to maintain their ability to care for patients with infectious diseases.

PURPOSE

The aim of this study was to assess the influence of role overload on sleep quality and the moderating role of mindfulness.

METHODS

A cross-sectional survey design was used in this study, which was conducted between March 20 and April 5, 2020. The survey was completed by 357 nurses who had relocated from Fujian Province to the epicenter of the outbreak in China to treat patients with COVID-19. Role overload, sleep quality, and mindfulness in these nurses were evaluated using the Role Overload Scale, Pittsburgh Sleep Quality Index, and Five-Facet Mindfulness Questionnaire, respectively.

RESULTS

Hierarchical regression and other statistical methods were used to analyze the data. Role overload was shown to be positively related to poor sleep quality, and mindfulness was found to be effective in alleviating sleep disorders associated with role overload.

CONCLUSIONS

The high risk of sleep disturbance among frontline nurses may be alleviated by reducing their perceived role overload. The identification of mindfulness as a moderating mechanism in the relationship between role overload and sleep quality provides new insights to improve sleep quality in nurses.

Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression

OBJECTIVE

We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems.

METHODS

Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses.

RESULTS

A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQI_gen) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQI_gen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality.

CONCLUSIONS

We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.

"Should I stay or should I go?" Nurses' perspectives about working during the Covid-19 pandemic's first wave in the United States: A summative content analysis combined with topic modeling

BACKGROUND

The COVID-19 pandemic had its first peak in the United States between April and July of 2020, with incidence and prevalence rates of the virus the greatest in the northeastern coast of the country. At the time of study implementation, there were few studies capturing the perspectives of nurses working the frontlines of the pandemic in any setting as research output in the United States focused largely on treating the disease.

OBJECTIVE

The purpose of this study was to capture the perspectives of nurses in the United States working the frontlines of the COVID-19 pandemic's first wave. We were specifically interested in examining the impact of the pandemic on nurses' roles, professional relationships, and the organizational cultures of their employers.

DESIGN

We conducted an online qualitative study with a pragmatic design to capture the perspectives of nurses working during the first wave of the United States COVID-19 pandemic. Through social networking recruitment, frontline nurses from across the country were invited to participate. Participants provided long form, text-based responses to four questions designed to capture their experiences. A combination of Latent Dirichlet Allocation--a natural language processing technique--along with traditional summative content analysis techniques were used to analyze the data.

SETTING

The United States during the COVID-19 pandemic's first wave between May and July of 2020.

RESULTS

A total of 318 nurses participated from 29 out of 50 states, with 242 fully completing all questions. Findings suggested that the place of work mattered significantly in terms of the frontline working experience. It influenced role changes, risk assumption, interprofessional teamwork experiences, and ultimately, likelihood to leave their jobs or the profession altogether. Organizational culture and its influence on pandemic response implementation was a critical feature of their experiences.

CONCLUSIONS

Findings suggest that organizational performance during the pandemic may be reflected in nursing workforce retention as the risk for workforce attrition appears high. It was also clear from the reports that nurses appear to have assumed higher occupational risks during the pandemic when compared to other providers. The 2020 data from this study also offered a number of signals about potential threats to the stability and sustainability of the US nursing workforce that are now manifesting. The findings underscore the importance of conducting health workforce research during a crisis in order to discern the signals of future problems or for long-term crisis response.

TWEETABLE ABSTRACT

Healthcare leaders made the difference for nurses during the pandemic. How many nurses leave their employer in the next year will tell you who was good, who wasn't.

The impact of COVID-19 pandemic on sleep quality in healthcare workers in Turkey

Background

The COVID-19 pandemic has caused serious concerns and psychological distress globally. Healthcare workers remain one of the most affected groups due to life threatening risks in addition to increased working hours and labor intensity. All these factors may affect sleep quality of this population. The aim of this study is to evaluate the sleep behaviors of healthcare professionals working in secondary and tertiary hospitals in a large population in Turkey and to show how sleep quality is affected during the pandemic process using the easily applicable Jenkins Sleep Scale (JSS). The population of this cross-sectional descriptive study consists of two pandemic hospitals determined in Kahramanmaraş province. In our questionnaire, we asked subjective sleep quality, sleep time, time to fall asleep, total sleep time, and medication use. We also used JSS Turkish version (JSS-TR) to assess sleep quality and the Epworth Sleepiness Scale (ESS) for increased daytime sleepiness.

Results

Healthcare workers who participated in our survey reported that they started to go to bed later, fell asleep later (mean: 41.75 ± 35.35 min), their total sleep time (mean: 6.67 ± 1.88 h) was shortened, and they needed medication to sleep more (5.7%) after the COVID-19 pandemic. During the COVID-19 pandemic, bedtime behavior after 24:00 decreased from 80.1 to 43.9% of those who previously went to bed before 24:00. For those who went to bed after 24:00 before, it increased from 19.9 to 56.1%. In addition, sleep quality as assessed by subjective and JSS significantly deteriorated after the COVID-19 pandemic. Excessive daytime sleepiness increased. Those with ESS > 10 before and after COVID-19 were 3.9% and 14.1%, respectively (p < 0.001).

Conclusions

The COVID-19 pandemic has significantly adversely affected the sleep behavior and sleep quality of healthcare professionals. The JSS is an easily applicable scale for assessing sleep quality in large population studies.

Stress, coping, resilience, and sleep during the COVID-19 pandemic: A representative survey study of US adults

INTRODUCTION

The COVID-19 pandemic is a global health emergency resulting in widespread death and substantial disruption to daily life. Previous research has shown that novel disease outbreaks are associated with high stress levels and sleep impairments that lead to neuropsychiatric consequences. Therefore, it is vital to study both stress and protective factors such as coping and resilience that may hinder or help sleep quality during the COVID-19 pandemic. Further, as gender disparities exist in sleep quality, it is important to understand the relationship between pandemic-related stress, coping strategies, resilience, and sleep in bothgenders during the COVID-19 pandemic.

METHODS

Our study examined how gender, stress, coping, and resilience were associated with sleep cross-sectionally during the COVID-19 pandemic in a representative sample of US adults (N = 393).

RESULTS

Consistent with many recent studies, we found that worsened sleep quality in women compared to men persisted during the COVID-19 pandemic. Interestingly, pandemic-related stress was not significantly associated with sleep quality, but pandemicrelated coping was associated with sleep independent of robust controls and trait resilience.

CONCLUSIONS

Greater primary control engagement coping was associated with better sleep quality, while involuntary engagement coping was associated with poor sleep quality. Future research should extend the findings with actigraphy and explore ways to enhance beneficial coping and sleep health during pandemics.

Sleep Habits during COVID-19 Confinement: An Exploratory Analysis from Portugal

COVID-19 pandemic consequences are tragic, and many problems will persist after the health problem ends. Some studies have focused on mental health issues, reporting worrying percentages. It is known that there is a bidirectional relationship between mental health and sleep quality, and it would be expected that sleep would be affected by the pandemic. In order to know the Portuguese people’s habits before and during the confinement, we carried out a survey of 188 people aged 13 to 84 (38 ± 15) to find out the most frequent sleep patterns, habits and disorders before and during confinement. With this survey it was also intended to measure the most frequent changes in sleep patterns, habits, and disturbances on the general population and according to demographic data (gender, age group and professional status), sleep disorders arise, perceptions about sleep during confinement and if Portuguese think that in the future the sleep patterns will be the pre or during outbreak. Results indicate that, comparing before and during confinement, there is a slight correlation between gender and sleep disorders (before vs. during), a correlation between age group and professional status time to wake up, and between professional status and sleep disorders, and a strong correlation between the professional situation and changes in the invigorated feeling level (p < 0.001). Support for mental health and interventions to improve sleep quality should be offered to the population in general, and, according to our study, the Portuguese population.

Exploring the Association between Sleep Quality and Heart Rate Variability among Female Nurses

The quality of nurses' work has a direct effect on patient health, and poor sleep has been positively associated with nurses' medical errors. The aim of this study was to investigate the relationship between quality of sleep and heart rate variability (HRV) among female nurses. A descriptive cross-sectional correlational study design was used in January 2014 to study female nurses (n = 393) employed in a medical center in Taiwan. Data were obtained from several questionnaires. HRV was analyzed with five-minute recordings of heart rate signals obtained using a Heart Rater SA-3000P. Approximately 96% of the participants self-reported a poor quality of sleep. Compared to non-shift nurses, significant decreases were found in total power (TP) and low-frequency HRV among shift-work nurses. However, negative correlations were found between sleep quality and HRV, including total power, low frequency, and the low frequency/high frequency ratio (r = -0.425, p < 0.05; r = -0.269, -0.266, p < 0.05). In a stepwise multiple regression analysis, 23.1% of variance in quality of sleep can be explained by TP and heart rate. The sleep quality of female nurses was poor and this affected their autonomic nervous system, which can contribute unfavorable consequences for their health.