护理人员睡眠状况调查以及夜班工作对睡眠的影响

目的调查护理人员的睡眠状况,以及夜班工作对睡眠的影响.方法对348名护理人员、50名通讯值班员,100名夜勤人员进行匹兹堡睡眠质量指数测查和睡眠特征分析,采用DSM-Ⅳ标准进行失眠症诊断.结果护理人员中睡眠状况差者占71.86%,符合DSM-Ⅳ中原发性失眠诊断者占38.22%;通讯值班员该两项比例分别为74%和48%;夜勤人员分别为26.76%和7%.护理人员睡眠状况差与年龄、从事夜班年限有关;护理人员与通讯值班员的睡眠状况相似（ P〉0.05）,与夜勤人员的睡眠状况有非常显著性差异（ P＜0.01）.结论轮班工作方式对护理人员的睡眠状况影响较大,使其在入睡时间、睡眠时间、睡眠效率、日间功能等方面普遍存在一定障碍,但对此不倾向于使用药物治疗,可采用非药物疗法如穴位按摩、自我保健等.     

Insomnia,anxiety, and heart rate variability among nurses working different shift systems in Taiwan

This cross‐sectional comparative study investigated the levels of insomnia, anxiety, and heart rate variability of nurses members working different shift systems. One hundred and twenty‐four participants were recruited from members of the nurses of two Taiwanese hospitals. Data were collected using the Chinese versions of the Athens Insomnia Scale and Beck Anxiety Scale questionnaires and electrocardiograms recorded immediately upon completion of each participant's work shift. A binary logistic regression model was used for analysis. Insomnia, anxiety, and abnormal parasympathetic activity were more acute in nurses who worked a rotating shift than in those performing day or night shift work. Logistic regression analysis showed that age significantly increased the incidence and level of insomnia. Age, years of service, and nurses’ status as a parent significantly intensified incidences of anxiety and abnormal parasympathetic activity. Rotating shift work is one of the main factors causing adverse effects on the physical and psychological health of nurses; therefore, when a shift work system cannot be avoided, a practice of day and night shifts for nurses is preferable to rotating shifts.     

Sleep disorders among nurses and other health care workers in Poland during the COVID-19 pandemic

BackgroundThe profession of nurses involves exposure to harmful agents. Despite numerous international studies on the occurrence of sleep disorders in nurses, most studies lacked an assessment of the dependence on the occurrence of the situation causing fear and anxiety which is a highly contagious.AimDetermining the relationship between the occurrence of sleep disorders and socio-demographic variables of medical personnel during the COVID-19 epidemic.DesignThis is a cross-sectional study conducted online involving 336 health professionals.ResultsInsomnia among staff was determined at the level of Subthreshold insomnia and Clinical insomnia (moderate severity). Suspicion or confirmed COVID-19 had an effect on the occurrence of sleep disorders in the study group of medical personnel.ConclusionTaking into account the statistical error of 6%, the sleep disorders concern about 40% of professionally active nurses and midwives in Poland. Worsening of insomnia was observed in people with the possibility of contact with a patient with COVID-19 in the workplace. Insomnia was more common in respondents over 25 years of age. Psychosocial interventions are needed to help healthcare staff better respond to COVID-19 and future epidemics.     

Sleep in the older adult

Sleep problems tend to increase with age, so much so that insomnia can become entwined with other health issues among older people. This article looks at causes of sleep problems and explains how nurses can help assess their severity.     

临床护士不良睡眠习惯的调查研究

目的 调查了解临床护士不良睡眠习惯现况,探讨不良睡眠习惯发生的相关因素及对睡眠质量的影响.方法 采取整群抽样方法,应用自制〈不良睡眠习惯调查表〉对本院综合ICU、神经外科及胸心外科ICU、急诊、外科、内科及辅助科室的327名护士的不良睡眠习惯及影响因素进行调查,并作相关分析.结果 87.2%的护士存在不同程度的不良睡眠习惯;不同科室护士不良睡眠习惯发生率差异有统计学意义（P〈0.05）;ICU护士发生率最高,为100%;不同科室、轮班情况、工作忙碌程度对护士不良睡眠习惯的发生有影响;护士睡眠质量与轮班情况、不良睡眠习惯、科室有关（均P＜0.05）.结论 临床护士不良睡眠习惯发生率较高,是影响护士睡眠质量常见的原因,应引起管理者及护士自身的重视.     

Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors

Title. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors Aim. This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue, mood and quality of life in breast cancer survivors. Background. Women who receive primary treatment for breast cancer often complain of insomnia. Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue, mood and quality of life. Method. Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post‐completion of primary treatment without current evidence of disease. Women were randomly assigned to either the cognitive behavioural therapy for insomnia group, which received stimulus control instructions, sleep restriction therapy and sleep education and hygiene, or the component control group which received sleep education and hygiene only. The 10‐week study consisted of 2 weeks of pre‐treatment, 6 weeks of treatment and 2 weeks of post‐treatment. Fatigue, mood and quality of life were measured at pre‐ and post‐treatment. Findings. Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue, trait anxiety, depression and quality of life. The component control group also had statistically significant increases in quality of life, with a trend suggestive of lower depression at post‐treatment. Conclusion. Globally, as the number of survivors in this population continues to grow, it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue, anxiety and depression.     

综合护理干预对ICU失眠症护士睡眠质量的影响

目的探讨综合护理干预对改善ICU失眠症护士睡眠质量的有效性。方法2011年2月至2012年5月方便性抽样选取第二军医大学长征医院Icu（包括综合ICU、脑外科及胸心外科ICU）失眠症护士共76名,按照随机数字表法随机分为干预组和对照组各38例。两组护士均按常规给予睡眠健康宣教,遵医嘱每晚服用酒石酸唑吡坦片（商品名：思诺思）10mg;干预组在此基础上进行睡眠认知及行为、工作及休息环境、社会支持等护理干预3个月。结果睡眠时间无规律（55．26％）、准备睡觉前担心睡眠的能力（59．21％）是IGU失眠症护士最常见的不良睡眠卫生习惯。两组护士干预后不良睡眠卫生习惯发生率和睡眠进程各参数值比较,差异有统计学意义（均P〈0．01）,干预组护士的觉醒时间缩短、觉醒次数减少,睡眠效率和睡眠维持率均得以提高。结论以改变护士不良睡眠卫生习惯、改善工作及休息环境、提高护士应对工作压力的能力为目的的综合护理干预,可有效提高ICU失眠症护士的睡眠质量和生活质量。     

Sleep quality and morningness–eveningness of shift nurses

Aim and objective. The aim of the study was to analyse, while controlling for identified covariates, the effects of morningness–eveningness on sleep quality for shift nurses. Background. Shift nurses had greater difficulty falling asleep or staying asleep, thus resulting in higher rates of retiring from hospital. Existing research has addressed the effects of manpower demand and personal preferences on shift assignment; however, the concept of endogenous rhythms is rarely considered. Methods. This analysis included 137 nurses between the ages of 21–58. Nurses completed the Horne and Ostberg questionnaire to assess morningness‐eveningness and the Pittsburgh Sleep Quality Index (PSQI) questionnaire to measure self‐reported sleep quality over the last month. The 18‐point Chinese version had a Cronbach's reliability coefficient of 0·79 overall and 0·86 respectively. This study analysed correlates of sleep quality by comparing the groups with better or worse sleep quality according to the median of PSQI. Univariate and multivariate analyses were used for the risk factors of worse sleep quality. Results. The result showed that the strongest predictor of sleep quality was morningness–eveningness not the shift schedule or shift pattern for nurses under controlling the variable of age. Greater age and longer years employed in nursing significantly decreased the risk of worse sleep quality. The confounding age factor was properly controlled; evening types working on changing shifts had higher risk of poor sleep quality compared to morning types. Conclusions. Morningness–eveningness was the strongest predictor of sleep quality under controlling the variable of age in shift nurses. Implications for clinical practice. Our results suggested that determining if nurses were attributed to morning or evening types is an important sleep issue before deciding the shift assignment.     

Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain

Both cross-sectional studies of chronic pain and sleep deprivation experiments suggest a bi-directional relationship between sleep and pain. Few longitudinal studies, however, have assessed whether acute insomnia following traumatic injury predicts the development of persistent pain. We sought to evaluate (1) whether in-hospital insomnia independently predicts long-term pain after burn injury and (2) whether in-hospital pain predicts future insomnia symptoms. We analyzed data on 333 subjects hospitalized for major burn injury (72.7% male; mean age=41.1+/-14.5years) who were participating in the multi-site, Burn Model System project. Subjects completed measures of health, function (SF-36), and psychological distress (Brief Symptom Inventory) while in hospital, at 6, 12, and 24months after discharge. Participants were categorized as either having or not having sleep onset insomnia at discharge. Linear mixed effects analyses revealed that persons reporting insomnia at discharge (40.5%) had significantly decreased improvement in pain and increased pain severity during long-term follow-up (p<0.001). More severe pain during the week preceding hospital discharge, time from injury, lack of college education and older age also contributed independent effects on chronic pain (p<0.05). In a reciprocal model (N=299), more severe pain during the week preceding discharge predicted increased rates of long-term sleep onset insomnia. In-hospital insomnia and pre-burn mental health symptoms were also highly significant predictors of insomnia. This study provides support for a long-term, prospective and reciprocal interaction between insomnia and pain. Future work should ascertain whether treatment of insomnia and pain during acute injury can prevent or minimize chronic pain.     

Insomnia

Because sleep needs vary from person to person, insomnia is defined as the chronic inability to obtain the amount of sleep needed for optimal functioning and well-being. Insomnia, which is a symptom rather than a disease, can be classified into three main etiologic groups: insomnias related to other mental disorders (for example, depression and anxiety), insomnias related to known organic factors (for example, sleep apnea and "nonrestorative" sleep), and primary insomnia (for example, learned psychophysiologic insomnias and insomnia complaints without objective findings). The treatment for insomnia often involves a combination of pharmacotherapy, behavioral and short-term psychotherapy, and sleep hygiene guidelines. Sleep disorders centers can provide specialized knowledge and techniques for patients with severe chronic insomnia.     

Sharpening our Understanding of the Consequences of Insomnia: The Relationship Between Insomnia and Everyday Cognitive Failures

Previous research examining the link between insomnia and cognitive functioning is limited and mixed. The current study investigated this relationship using self-report in a large sample of college undergraduate students (N?=?941; 65% female, mean age of 20?years). Regression analyses revealed that insomnia severity predicted cognitive failures overall, as well as on each of four subscales of cognitive failures: memory, distractibility, blunder, and memory for names. Hierarchical regression further showed that the relationship between insomnia severity and cognitive failures was significant even after controlling for possible confounding variables of depression, negative affect, stress, and anxiety. Additionally, it was found that insomnia partially mediated the relationship between cognitive failures and depression, negative affect, and trait anxiety. Future work in this area would benefit from adding a measure such as ecological momentary assessment to expand on these findings. Possible limitations, explanations, and implications of the present study and future direction are discussed.     

Sleep quality and sleep disturbing factors of inpatients in a Chinese general hospital

Aims and objective. This study was undertaken to determine sleep quality and sleep disturbing factors of inpatients and to compare the perception of sleep disturbing factors between nurses and inpatients in a Chinese general hospital. Background. Sleep aids patients’ recovery. A variety of factors affect inpatients’ sleep quality. Current research on inpatients’ sleep quality in China is limited and narrowly focuses on patients in intensive care units or older patients. Design. Survey. Methods. This research was conducted in a Chinese general hospital. The Pittsburgh Sleep Quality Index and self‐designed questionnaires were used to examine inpatients’ sleep quality and compare perceptions of sleep disturbing factors between 397 inpatients and 101 nurses. The following statistical methods were used to evaluate the data: chi‐square test, logistic regression analysis and Z statistic. Results. Patients reported poor sleep quality (45·6%) during hospitalisation and a reduction in sleep quality after hospitalisation (57·4%). The chi‐square and logistic regression analysis showed that the main sleep disturbing factors were worries about illness, discomfort associated with diseases, using the toilet at night and noise from nurses’ shoes. There was a significant difference in the perception of sleep quality and sleep disturbing factors between inpatients and nurses. Conclusion. This study demonstrates that most inpatients reported sleeping problems stemming from multiple sources. Additionally, there was a significant difference in the perception of sleep disturbing factors between nurses and inpatients. Relevance to clinical practice. Our survey shows that most nurses are aware of inpatients’ poor sleep quality. However, many patients continue to suffer from poor sleep during hospitalisation because of a wide range of sleep disturbing factors. This suggests that nurses need to be better educated and trained to minimise sleep disturbing factors and improve sleep quality of inpatients.     

Nighttime Thought Control Strategies and Insomnia Severity

Strategies used to control unwanted thoughts during the evening have been shown to be significantly associated with insomnia, a common problem associated with numerous negative consequences. This study examined whether nighttime thought control strategies would predict insomnia severity among 460 college students (mean age = 18.8, 61 % female, and 72 % Caucasian) after accounting for well-established risk factors for the disorder such as anxiety, depression, sleep hygiene, and nighttime pain. The Insomnia Severity Index was used to measure insomnia severity and the Thought Control Questionnaire Insomnia-Revised was used to measure nighttime thought management strategies. Results from a hierarchical multiple linear regression showed that the strategy of cognitive distraction (attempts to withdraw from unwanted thoughts or think about more pleasant content) was negatively associated with insomnia severity and the strategy of aggressive suppression (the use of critical and punishing self thought) was positively associated with insomnia severity after accounting for other risk factors. These findings add to the growing literature highlighting arousing pre-sleep cognitions as a correlate of insomnia. These findings also add to emerging literature showing the ability to cognitively distract from the arousing thought as a correlate of good sleep.     

Sleep disturbances in patients with chronic heart failure and their holistic consequences-what different care actions can be implemented?

BACKGROUND: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively. AIM: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented. METHODS: MEDLINE and CINAHL databases were searched from 1989 to July 2004. FINDINGS: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45--82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness. CONCLUSION: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed.     

Sleep disorder in Taiwanese nurses: a random sample survey

This study determined the prevalence of and factors associated with insomnia in rotating-shift nurses. A two-stage, cross-sectional, hospital-based study was conducted in eastern Taiwan. Participants were randomly-sampled, rotating-shift nurses (n=661), ranging in age from 21 to 62 years, with a mean age of 31.86 (standard deviation=8.09). Insomnia disorder was identified using the Pittsburgh Sleep Quality Index. Nurses completed the self-reported Index, together with other questionnaires designed by the researchers for the purpose of the study. The prevalence of insomnia disorder was 59% (n=390). Multivariate logistic regression analyses revealed that poor sleepers are more likely to have higher anxiety, feelings of depression, and a poor working atmosphere. Anxiety, depression, and working atmosphere are independent predictors of insomnia. These results suggest that it is crucial to implement a more appropriate shift system and to develop prevention programs for nurses with insomnia to improve their occupational health.     

Daytime sleepiness, sleep habits and occupational accidents among hospital nurses

AIM: This paper reports a study to determine the prevalence of excessive daytime sleepiness and sleep habits among hospital nurses and to analyse associations between excessive daytime sleepiness and different types of medical error. BACKGROUND: It has been reported that sleep disorders, and the tiredness and sleepiness brought about by sleep disorders may be associated with occupational accidents. However, to our knowledge, there has so far been no report on associations between sleep disorders, excessive daytime sleepiness in particular, and occupational accidents among hospital nurses. METHODS: The study was a cross-sectional study targeting 4407 nurses working in eight large general hospitals in Japan. An anonymous self-administered questionnaire was used to investigate their sleep patterns and experience of occupational accidents. The data were collected in 2003. RESULTS: The prevalence of excessive daytime sleepiness among hospital nurses in the present study was 26.0%. A statistically significant relationship was observed between having or not having occupational accidents during the past 12 months and excessive daytime sleepiness. Multiple logistic regression analyses on factors leading to occupational accidents during the past 12 months showed statistically significant associations between (1) drug administration errors and (2) shift work and age, between (1) incorrect operation of medical equipment and (2) excessive daytime sleepiness and age, and between needlestick injuries and age. CONCLUSIONS: Excessive daytime sleepiness is an important occupational health issue in hospital nurses. It is possible that occupational policies and health promotion measures, such as a provision of sleep hygiene advice and social support at worksites, would be effective in preventing occupational accidents among hospital nurses.     

Improving sleep management in people with Parkinson's

This article considers the practicality and patient benefits of transferring evidence-based sleep management skills to community health professionals. Sleep disturbances are among the most frequently reported and poorly managed non-motor symptoms in Parkinson's. But, despite their prevalence, sleep problems in Parkinson's are often under-recognized, under-diagnosed and inadequately treated. To raise awareness and improve patient care in Parkinson's, a three-day sleep management course was developed for Parkinson's disease nurse specialists (PDNSs) practising within NHS Scotland. The course aimed to transfer skills in health education as applied to sleep and insomnia; the assessment of sleep; the practice of sleep hygiene; delivering relaxation methods; the use of stimulus control and sleep restriction procedures; and cognitive approaches to insomnia management. Between June 2010 and July 2011, 38 PDNSs and practising occupational therapists undertook the course. Interviews and evaluations with patients and professionals were carried out afterwards. Patients reported a reduction in anxiety over sleep problems, feeling able to manage their sleep, and having a sense of control over their sleep. Programme outcomes suggest that the training model used is feasible and practical; the resources designed for clinical use are practical and relevant; and that the initiative as a whole represents a valid and affordable investment in patient wellbeing.     

Insomnia, sleep quality, pain, and somatic symptoms: sex differences and shared genetic components

This study investigated the sex differences, and the shared genetic and environmental factors underlying the associations of sleep disturbances (insomnia and sleep quality) with pain and somatic symptoms in both adolescents and middle-aged adults. We recruited 259 adolescents (69 with current insomnia) and their parents (256 middle-aged adults, 78 with current insomnia). Insomnia severity and sleep quality were measured by the Insomnia Severity Inventory (ISI) and Pittsburgh Sleep Quality Index (PSQI), respectively. Pain and somatic symptoms were measured by the Somatic Symptom Inventory and Visual Analogue Scale for overall pain. Subjects with insomnia scored higher on all measures of pain and somatic symptoms than non-insomnia patients, in both adolescents and adults (P<.001). Both pain and somatic measures were associated with ISI and PSQI scores after controlling for age, sex, depressive and anxiety symptoms. There was an interaction effect between insomnia and female sex on pain and somatic symptoms (P<.05), especially in adults. Pain and somatic symptoms ran in family with moderate heritability (range h(2)=0.15-0.42). The phenotypic associations of ISI and PSQI with pain and somatic measures were both contributed by genetic (range p(G)=0.41-0.96) and environmental (range p(E)=0.27-0.40) factors with a major genetic contribution. In summary, insomnia and poor sleep quality are closely associated with pain and somatic symptoms. Insomnia seems to modulate the sex differences in pain and somatic symptoms, especially in the adult population. A shared genetic predisposition might underlie the associations of insomnia and sleep quality with pain and somatic symptoms.     

Self-reported sleep and health among Norwegian hospital nurses in intensive care units

Aim and background: Shift work, and especially night work, is associated with poor health. Nurses, work a variety of work schedules including night work. So far, few studies have specifically investigated sleep and health among intensive care nurses. Design and methods: We investigated sleep, sleepiness, fatigue, subjective health complaints, anxiety and depression in 150 intensive care nurses (convenience sample representing a response rate of 56·2%). The nurses worked at two major University hospitals in Norway and answered a questionnaire survey. Results: The intensive care nurses reported poorer sleep, more sleepiness, more fatigue, more anxiety and more depression compared to normative data. Poor sleep was reported by 70% and excessive sleepiness by 25% of the nurses; however, the design of the study did not allow us to determine the causes underlying these findings. Multiple linear regression analyses showed that age was positively associated with sleep problems, fatigue, subjective health complaints and anxiety and depression. In contrast, shift work experience was negatively associated with sleep problems, suggesting better coping with shift work over time. Conclusions: Nurses working in intensive care units reported poorer sleep, more sleepiness, more fatigue, more anxiety and more depression compared to Norwegian norm groups. Age was positively related to these complaints, whereas shift work experience was negatively related to poor sleep. More studies are needed on strategies to improve sleep and health in nurses.