Factors Affecting Sleep Quality of Clinical Nurses Working in a Hospital

Minjeong An; JinShil Kim; Seongkum Heo; Seon Hee Kim; Yoon Young Hwang

doi:10.7475/kjan.2018.30.2.126

Journal List > Korean J Adult Nurs > v.30(2) > 1095600

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

An, Kim, Heo, Kim, and Hwang: Factors Affecting Sleep Quality of Clinical Nurses Working in a Hospital

Original Article

Korean J Adult Nurs 2018;30(2):126-135.

Published online: 21 April 2018

DOI: https://doi.org/10.7475/kjan.2018.30.2.126

Factors Affecting Sleep Quality of Clinical Nurses Working in a Hospital

Minjeong An¹, JinShil Kim², Seongkum Heo³, Seon Hee Kim¹, Yoon Young Hwang^4,

¹College of Nursing, Chonnam National University, Gwangju, Korea

²College of Nursing, Gachon University, Incheon, Korea

³University of Arkansas for Medical Sciences College of Nursing, Arkansas, USA

⁴Seoul Women's College of Nursing, Seoul, Korea

Corresponding author: Hwang, Yoon Young https://orcid.org/0000-0001-6663-7889 Seoul Women's College of Nursing, 38 Ganhodae-ro, Seodaemun-gu, Seoul 03617, Korea. Tel: +82-2-2287-1722, Fax: +82-2-395-8018, E-mail: hyy2115@hanmail.net

Received 16 November 201710 January 2018 Accepted 25 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify factors affecting sleep quality in nurses working in a tertiary hospital in Korea.

Methods

The sample of two hundred and sixty three nurses was drawn from one tertiary care hospital in Korea. Using a descriptive study design, clinical nurses completed the standardized questionnaires, including sleep quality, depressive symptoms, and resilience. Descriptive statistics were computed to describe the sample and study variables. Logistic regression analyses were used to identify factors affecting sleep quality which was classified into two categories.

Results

A total of 263 registered nurses participated in this study. Most of the participants were female (n=252, 95.8%) and single (n=148, 75.9%), with a mean age of 30.09±7.51 years. The average score of sleep quality was 8.57±3.24. Using a cutoff point of 5.0, 84.0%(n=221) were poor sleepers. After control-ling for demographic and job-related variables, the depressive symptoms and resilience were associated with poor sleep quality among clinical nurses (Odds Ratio [OR]=4.56, 95% Confidence Interval [CI]=1.02~20.49; OR=0.97, 95% CI=0.94~0.99, respectively). This model explained 19.5% of the variance in sleep quality.

Conclusion

The two factors reported to impact the quality of sleep were increased depressive symptoms and lower resilience levels. In order to improve nurses'sleep quality, researchers and nursing administrators need to develop and provide some strategies for decreasing depressive symptoms and enhancing their resilience.

Keywords: Hospitals, Nurses, Sleep, Depression

REFERENCES

1. Karagozoglu S, Bingöl N. Sleep quality and job satisfaction on Turkish nurses. Nursing Outlook. 2008; 56(6):298–307. https://doi.org/10.1016/j.outlook.2008.03.009.

2. Jeong JY, Gu MO. The influence of stress response, physical activity, and sleep hygiene on sleep quality of shift work nurses. Journal of the Korea Academia-Industrial Cooperation Society. 2016; 17(6):546–59. https://doi.org/10.5762/KAIS.2016.17.6.546.

3. Kim HS, Choi KS, Eom M, Joo EJ. Role of circadian types and depressive mood on sleep quality of shift work nurses. The Korean Journal of Psychopharmacology. 2011; 22(2):96–104.

4. Son YJ, Park YR. Relationships between sleep quality, fatigue and depression on health promoting behavior by shift-work patterns in university hospital nurses. Journal of Korean Biological Nursing Science. 2011; 13(3):229–37.

5. Jung YJ, Kang SW. Differences in sleep, fatigue, and neuro-cognitive function between shift nurses and non-shift nurses. Korean Journal of Adult Nursing. 2017; 29(2):190–9. https://doi.org/10.7475/kjan.2017.29.2.190.

6. Han KS, Park E, Park YH, Lim HS, Lee EM, Kim L, et al. Factors influencing sleep quality in clinical nurses. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2011; 20(2):121–31. https://doi.org/10.12934/jkpmhn.2011.20.2.121.

7. McGillivray CJ, Pidgeon AM. Resilience attributes among university students: a comparative study of psychological distress, sleep disturbances and mindfulness. European Scientific Journal. 2015; 11(5):33–48. http://epublications.bond.edu.au/fsd_papers/221.

8. Gillespie BM, Chaboyer W, Wallis M, Grimbeek P. Resilience in the operation room: developing and testing of a resilience model. Journal of Advanced Nursing. 2007; 59(4):427–38. https://doi.org/10.1111/j.1365-2648.2007.04340.x.

9. Mealer M, Jones J, Newman J, McFann KK, Rothbaum B, Moss M. The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey. International Journal of Nursing Studies. 2012; 49(3):292–9. https://doi.org/10.1016/j.ijnurstu.2011.09.015.

10. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research. 1989; 28(2):193–213.

11. Chien PL, Su HF, Hsieh PC, Siao RY, Ling PY, Jou HJ. Sleep quality among female hospital staff nurses. Sleep Disorders. 2013; 2013:1–6. https://doi.org/10.1155/2013/283490.

12. Downing Jr MJ, Houang ST, Scheinmann R, Yoon IS, Chiasson MA, Hirshfield S. Engagement in care, psychological distress, and resilience are associated with sleep quality among HIV- positive gay, bisexual, and other men who have sex with men. Sleep Health. 2016; 2(4):322–9. https://doi.org/10.1016/j.sleh.2016.08.002.

13. Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods. 2009; 41(4):1149–60. https://doi.org/10.3758/BRM.41.4.1149.

14. Sohn SI, Kim DH, Lee MY, Cho YW. The reliability and validity of the Korean version of the pittsburgh sleep quality index. Sleep and Breathing. 2012; 16(3):803–12. https://doi.org/10.1007/s11325-011-0579-9.

15. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001; 16(9):606–13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.

16. Donnelly PL. The use of the patient health questionnaire-9 Korean version (PHQ-9K) to screen for depressive disorders among Korean Americans. Journal of Transcultural Nursing. 2007; 18(4):324–30. https://doi.org/10.1177/1043659607305191.

17. Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety. 2003; 18(2):76–82. https://doi.org/10.1002/da.10113.

18. Baek HS, Lee KU, Joo EJ, Lee MY, Choi KS. Reliability and validity of the Korean version of the Connor-Davidson resilience scale. Psychiatry Investigation. 2010; 7(2):109–15. https://doi.org/10.4306/pi.2010.7.2.109.

19. Oh BH, Park JC, In HU, Kim KW. The sleep disorders of nighttime fixed nurses and shift-work nurses. Korean Journal of Family Practice. 2017; 7(4):551–6. https://doi.org/10.21215/kjfp.2017.7.4.551.

20. Lu H, While AE, Barriball KL. A model of job satisfaction of nurses: a reflection of nurses' working lives in Mainland China. Journal of Advanced Nursing. 2007; 58(5):468–79. https://doi.org/10.1111/j.1365-2648.2007.04233.x.

21. Lee SJ, Park CS, Kim BJ, Lee CS, Cha B, Lee D, et al. Resilience and characteristics of sleep and defense among shift work nurses. Sleep Medicine and Psychophysiology. 2014; 21(2):74–9. https://doi.org/10.14401/KASMED.2014.21.2.74.

22. Cho EJ. Influencing factors of subjective sleep quality among middle-aged women. Korean Journal of Women Health Nursing. 2007; 13(3):201–10.

23. Yi H. Sleep quality and its associated factors in adults. Journal of Korean Public Health Nursing. 2013; 27(1):76–88. https://doi.org/10.5932/JKPHN.2013.27.1.76.

24. Choe JY, Park JH. Poor sleep quality and its effect on quality of life in the elderly with late life depression. Korean Journal of Biological Psychiatry. 2014; 21(2):74–80.

25. Lee HY, Kim MS, Kim O, Lee IH, Kim HK. Association between shift work and severity of depressive symptoms among female nurses: the Korea Nurses' Health Study. Journal of Nursing Management. 2016; 24(2):192–200. https://doi.org/10.1111/jonm.12298.

26. Kemper KJ, Mo X, Khayat R. Are mindfulness and self-com-passion associated with sleep and resilience in health professionals? The Journal of Alternative and Complementary Medicine. 2015; 21(8):496–503. https://doi.org/10.1089/acm.2014.0281.

27. Smith GD, Yang F. Stress, resilience and psychological well- being in Chinese undergraduate nursing students. Nurse Education Today. 2017; 49:90–5. https://doi.org/10.1016/j.nedt.2016.10.004.

28. Kim BJ, Choi MR, Kim TH, Kim HW, Eun HJ. Psychosomatic symptoms of rotating shift and daytime working nurses in a general hospital. Korean Journal of Psychosomatic Medicine. 2014; 22(2):79–86.

29. Olinto MTA, Garcez A, Henn RL, Macagnan JBA, Paniz VMV, Pattussi MP. Sleep-related problems and minor psychiatric disorders among Brazilian shift workers. Psychiatry Research. 2017; 257:412–7. https://doi.org/10.1016/j.psychres.2017.08.018.

30. Pedersen ER, Troxel WM, Shih RA, Pinder E, Lee LD, Geyer CL. Increasing resilience through promotion of healthy sleep among service members. Military Medicine. 2015; 180(1):4–6. https://doi.org/10.7205/MILMED-D-14-00264.

Table 1.

Demographic and Job-related Characteristics of Participants

Characteristics	Categories	Total (N=263)	Good sleepers (n=42)	Poor sleepers (n=221)	x² or t	p
Characteristics	Categories	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t	p
Age (year)	(Range: 22~58)	30.09±7.51	34.05±10.51	29.35±6.58	2.76	.008
Gender^∗	Male	11 (4.2)	2 (4.8)	9 (4.1)	0.04	.690
Gender^∗	Female	252 (95.8)	40 (95.2)	212 (95.9)
Education^†	≤ BSN	249 (94.7)	36 (85.7)	213 (96.4)	7.97	.013
Education^†	≥ MSN	14 (5.3)	6 (14.3)	8 (3.6)
Marital status	Single	148 (75.9)	26 (61.9)	167 (75.6)	3.37	.086
Marital status	Married	47 (24.1)	16 (38.1)	54 (24.4)
Department	Ward	116 (44.1)	14 (33.3)	102 (46.2)	13.10	.001
	ICU/ER	85 (32.3)	9 (21.4)	76 (34.3)
	Outpatient	62 (23.6)	19 (45.3)	43 (19.5)
Duty type	Day shift only	60 (22.8)	20 (47.6)	40 (18.1)	17.47	.001
Duty type	3-shift	203 (77.2)	22 (52.4)	181 (81.9)
Clinical career (year)	(Range: 0~35)	7.57±6.72	11.84±10.85	6.75±6.69	2.93	.005
Intake of caffeinated drink^†	Yes	242 (92.0)	41 (97.6)	201 (91.0)	2.14	.215
Intake of caffeinated drink^†	(Range: 0~7)	1.66±1.04	1.67±0.87	1.66±1.07	0.05	.959
Alcohol drinking^†	None	55 (20.9)	12 (28.6)	43 (19.5)	2.64	.387
	1~2/month	138 (52.5)	21 (50.0)	117 (52.9)
	1~2/week	61 (23.2)	7 (16.7)	54 (24.4)
	≥3/week	9 (3.4)	2 (4.8)	7 (3.2)
Smoking^†	Yes	4 (1.5)	1 (2.4)	3 (1.4)	0.25	.504

BSN=bachelor of science in nursing; MSN=master of science in nursing; ICU=intensive care unit; ER=emergency room;

^† Fisher's exact test.

Table 2.

Sleep Quality, Depression, and Resilience of Participants

Variables	Categories	Total (N=263)	Good sleepers (n=42)	Poor sleepers (n=221)	x² or t	p	Range
Variables	Categories	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t	p	Range
Sleep quality	Total	8.57±3.24	4.12±0.97	9.42±2.80	-22.05	.001	2~18
	Subjective quality	1.44±0.59	0.86±0.35	1.55±0.56	-10.48	.001	0~3
	Latency	1.71±0.88	0.74±0.59	1.90±0.81	8.88	.001	0~3
	Duration	0.68±0.52	0.14±0.05	0.78±0.56	7.50	.001	0~3
	Efficiency	0.78±0.40	0.02±0.01	0.93±0.14	-11.28	.001	0~3
	Disturbance	1.06±0.45	0.74±0.45	1.13±0.42	5.24	.001	0~2
	Use of sleeping medication	1.44±0.59	0.86±0.35	1.55±0.56	-10.48	.001	0~3
	Daytime dysfunction due to sleepiness	1.46±0.73	0.76±0.58	1.59±0.69	8.25	.001	0~3
Depression	Total	6.88±4.27	4.64±3.88	7.31±4.02	3.80	.001	0~27
	Depressed (≥10)	55 (20.9)	2 (4.8)	53 (24.0)	7.88	.006
	Non-depressed (＜10)	208 (79.1)	40 (95.2)	168 (76.0)
Resilience	Total	57.81±13.70	65.36±13.37	56.38±13.31	4.01	.001	23~100
	Personal competence	18.03±5.10	20.90±5.07	17.49±4.93	4.10	.001	4~32
	Trust in one's instincts and tolerance of negative effect	18.04±4.64	20.33±4.25	17.60±4.59	3.58	.001	6~32
	Positive acceptance of change	12.39±2.79	13.57±2.70	12.16±2.76	3.05	.003	5~20
	Control	7.15±1.96	8.21±1.99	6.95±1.90	3.94	.001	2~12
	Spiritual influences	4.62±1.42	5.07±1.42	4.54±1.41	2.24	.026	1~8

Table 3.

Correlations of Sleep Quality, Depression, and Resilience (N=263)

Variables	Sleep quality	Depression	Resilience
	r (p)	r (p)	r (p)
Sleep quality	1
Depression	.44 (＜.001)	1
Resilience	-.21 (.001)	-.35 (＜.001)	1

Table 4.

Predictors Affecting Sleep Quality among Nurses (N=263)

Variables	Categories	Model 1					Model 2
Variables	Categories	B	SE	Wald	OR	95% CI	B	SE	Wald	OR	95% CI
Demographic and job-related variables	(Constant)	-0.03	2.95	0.00	0.97		0.54	3.13	0.03	1.72
	Age (year)	0.05	0.12	0.15	1.05	0.82~1.33	0.09	0.13	0.53	1.10	0.85~1.41
	Education^†	-0.61	0.74	0.69	0.54	0.13~2.31	-0.61	0.79	0.60	0.54	0.12~2.55
	Clinical career (year)	-0.07	0.12	0.31	0.94	0.74~1.18	-0.09	0.12	0.50	0.92	0.72~1.17
	Department Ward^†	0.57	0.55	1.11	1.78	0.61~5.18	0.64	0.57	1.25	1.90	0.62~5.83
	Department ICU/ER^‡	0.66	0.61	1.15	1.93	0.58~6.39	0.60	0.65	0.85	1.81	0.51~6.42
	Duty type^†	0.62	0.67	0.85	1.86	0.50~6.96	0.60	0.72	0.71	1.83	0.45~7.42
Independent variables	Depression^†						1.52	0.77	3.93	4.56	1.02~20.49
	Resilience						-0.03	0.01	5.47	0.97	0.94~0.99

OR=odds ratio; CI=confidence interval; ICU=intensive care unit; ER=emergency room; BSN=bachelor of science in nursing; Model 1: Nagelkerke R²=.120; Hosmer & Lameshow test (Goodness of Fit), p=.703; Model 2: Nagelkerke R²=.195; Hosmer & Lameshow test (Goodness of Fit), p=.684; References^† Education: BSN or less; Department: ICU/ER & Outpatient; Duty type: Non-shift; Depression: Non-depressed; References

^‡ Department: Ward & Outpatient.

TOOLS

Similar articles