key: cord-0895855-kq6khep2
authors: Krupa, Sabina; Paramedic, Dawid Filip; Mędrzycka-Dąbrowska, Wioletta; Lewandowska, Katarzyna; Witt, Paweł; Ozga, Dorota
title: Sleep disorders among Nurses and other Health Care workers in Poland during the COVID-19 pandemic
date: 2021-02-11
journal: Appl Nurs Res
DOI: 10.1016/j.apnr.2021.151412
sha: 86574a24f4d8be92fce9d5ad0c55cde723cad133
doc_id: 895855
cord_uid: kq6khep2

Background The 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. Aim Determining the relationship between the occurrence of sleep disorders and socio-demographic variables of medical personnel during the COVID-19 epidemic. Design This is a cross-sectional study conducted online involving 336 health professionals. Results Insomnia 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. Conclusion Taking 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.

It was important to create a tool that would allow to easily assess the severity of insomnia in different groups of people. Insomnia Severity Index Scale (ISI) is such a tool (Morin, et al. 2011 ). According to current literature, it is important to implement such elements at the stage of managing the health care unit that will allow to maintain full physical and mental health in professional groups. Insomnia is associated with many complications. Research conducted by Caruso et al. proved that nurses are particularly vulnerable to cardiovascular, mental and cancer diseases, as well as type 2 diabetes, hormonal disorders and many others. Insomnia can contribute to these conditions (Caruso, et al. 2019) .

Maintaining psycho-physical well-being in healthcare workers is of great importance when working during the COVID-19 pandemic. One of the elements that affects this element is sleep and its presence in the everyday life of each of us. According to Killgore, et al., there is an increased risk of suicide during a pandemic in vulnerable populations. Health care workers are one of these groups (Killgore, et al. 2020) . Every day they struggle with patients who are suspected or found of a virus that is currently taking its toll. The essence of our research was to show the level of severity of insomnia in healthcare professionals. Sleep, like many other elements, allows you to function properly every day. Sleep disturbance, if prolonged, can lead to serious complications related to human physiology (Lewandowska, et al. 2019) . One such complication is, among others delirium, which can develop in a short time and can have other serious complications (Krupa, et al. 2019) . According to research conducted by Killgore, et al, there is statistical evidence that suicidal thoughts are associated with the increase in insomnia (Killgore, et al. 2020) . It is important to intervene to prevent the spread of insomnia.

No research efforts have been made in Poland to assess the prevalence of sleep disorders among healthcare professionals in the light of COVID-19 pandemics. The aim of the appearance of the first cases infected with coronavirus, and the Government of the Republic of Poland demanded that Polish citizens stay at home. The survey was disseminated on websites related to health care (Facebook, Twitter, Nursing Organizations Websites; https://ptpaio.pl/), and by providing a prepared online form in the application for sending messages. The study has the approval of the Bioethics Committee (9/05/2020). We informed all participants about the purpose of the study. To ensure confidentiality of participant information, we did not provide any identifying information in the online questionnaire. In order to remain anonymity the IP addresses of the computers used by the participants were not tracked, and the information about their workplace or whether there was any contact with a suspected or COVID-19 positive patient, was coded.

The respondents' sleep quality was measured using the Insomnia Severity Index (ISI) (Morin, et al. 2011) . The ISI is a short instrument assessing sleep disturbances, The questionnaire covers problems with falling asleep and staying asleep at night as well as effects of these problems in daily functioning. Comprising seven questions, the survey asks respondents to rate their perceptions related to their sleep in the last 14 days. Each item is assessed using Likert scale (0 = no problem; 4 = very severe problem). The total score (0-28 points) helps to characterise the intensity of insomnia. The total ISI score was divided into no clinically significant insomnia (0-7), subthreshold insomnia (8-14), moderately severe clinical insomnia (15-21) and severe clinical insomnia (22-28) (Morin, et al. 2011 ).

All statistical calculations were carried out using the IBM SPSS 23 statistical package and the Excel 2016 spreadsheet. Qualitative type variables were presented using cardinalities and percentages, and the quantitative variable was characterized using an arithmetic mean and standard deviation. The significance of differences between more than two groups was checked by the Kruskal-Wallis test (if significant differences were obtained, Bonferroni's post hoc tests were used, and between the two groups by the Mann-Whitney U test. In all calculations, the significance level was p ≤ 0.05. To determine the sample size, a calculator was used to compute the minimum (required) number of people in the sample (in the study on a sample coming from the population), assuming individual parameters. The confidence level for the result was established, which means how confident we can be in the obtained results, α = 0.95 means that it is 95%. Subsequently, we indicated the fraction size 0.5, the maximum J o u r n a l P r e -p r o o f error was 6%. The required number of people in the study was 266. The population size was estimated on the basis of the data from the National Chamber of Nurses and Midwives, and, as of December 31st, 2019, there were 257,833 employed nurses and midwives (NIPiP., 2020).

Respondents were asked about sex, age, occupation, place of work. In subsequent questions, respondents were asked to provide information about whether they had contact with COVID-19 patients. The study group consisted of 336 people, of which 88.7% were women and 11.3% were men. Prior to relevant questions, the respondents were asked to provide their age, occupation, workplace and information on possible contact with patients infected with COVID-19. The data are presented in Table 1 . 

According to the authors of the ISI scale, insomnia should be divided into categories. The mean value of the ISI scale was 13.39 (± 6.51) and was slightly higher in women than in men -13.73 (± 6.37) and 10.73 (± 7.04), respectively. Every third respondent obtained 

For women, the risk of insomnia was more often reported than for men -13.73% (46 women) and 10.73% (36 men), respectively. 18.8% of people received standard results.

Analysis showed a relationship between variables. A statistically significantly higher level of insomnia severity was more common in women than men.

Studies have shown a relationship between variables. Statistically, the highest intensity of insomnia was found by nurses, higher than a paramedic, doctor and other profession (H (3) = 13.10; p <0.05). There were no statistically significant differences p> 0.05 between the remaining groups.

Further analysis by means of multiple comparisons showed that statistically significantly the smallest difficulty in falling asleep had subjects aged 20-25 years, significantly less than the remaining group of subjects (H (4) = 44.49; p <0.001). There were no statistically significant differences p> 0.05 between the remaining groups.

Analysis showed a relationship between variables. The subjects who worked in the hospital had a statistically significantly higher level of insomnia than those who worked in the clinic. It may also result from the fact that the hospital employees constituted 220 people (65.7%), and the clinic employees 115 people (34.3%).

The analysis by the method of multiple comparisons showed that statistically significantly the greatest intensity of insomnia had subjects who had contact with patients with COVID -19 or knew about it, significantly higher than subjects who did not have contact (H (2) = 17.48; p <0.001). There were no statistically significant differences p> 0.05 between the remaining groups.

It was demonstrated that statistically significant increase in insomnia was reported by subjects who suspected or did not know COVID-19 in one of their patients, significantly higher than subjects who did not suspect the virus in their patients (H (2) = 11.48; p <0.05).

There were no statistically significant differences p> 0.05 between the remaining groups. The analysis showed that statistically significantly the greatest severity of insomnia was observed in subjects with the possibility of contact with a patient with COVID -19 in the workplace and those who did not know it, significantly greater than subjects in whom there was no possibility of contact with a patient with COVID -19 at the workplace (H (2) = 6.14; p <0.05).

There were no statistically significant differences p> 0.05 between the remaining groups.

Information on the possibility of a virus in the respondent's ward significantly affected their severity of insomnia. research showed a relationship between the severity of insomnia at the age of respondents.

The relationship between age and insomnia was also described in his research by Patel et al.

which indicates that the older a person is, the more he is exposed to the medical and mental effects of insomnia (Patel, et al. 2018 ).

There must be balance in all aspects of human life -its loss leads to disorders, in this 

This study has several limitations. First, we only included nurses working in hospitals and clinics. Doctors and other employees accounted for a very small percentage of the respondents. Accordingly, the possibility of generalizing our findings may be limited. As

Facebook, Twitter, and Nursing Organizations Websites were used in this study, it is possible that only users with active accounts in the above-mentioned social media could participate in the survey.

Taking 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 outbrakes of future pandemics. o This article offers practical tips for hospitals managements and charge nurses, which should be taken into account during working healthcare in wards during a pandemic.

o Womens and people over the age of 50 are more affected by subthreshold insomnia o Caring for a patient with a confirmed result in the workplace COVID-19 is a risk factor for insomnia.

o Policy makers in health care are not always fully prepared for the virus epidemic. It is necessary to provide psychological and even psychiatric support among healthcare workers who are exposed to high stress and uncertainty related to contact with potential virus carriers. All these aspects can greatly affect the severity of insomnia among healthcare professionals.

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