Rev Cuid. 2024; 15(2): e3452

https://doi.org/10.15649/cuidarte.3452

RESEARCH ARTICLE

Sleep quality and job satisfaction in Spanish nurses: the consequences of COVID-19

Calidad del sueño y satisfacción laboral en enfermeros españoles: las consecuencias de la COVID-19

Qualidade do sono e satisfação profissional em enfermeiros espanhóis: as consequências da COVID-19

Hospital Universitario Central de Asturias. Instituto de Investigación del Principado de Asturias. Oviedo. Spain. E-mail: albamaestrog@gmail.com Alba Maestro-González
Faculty of Medicine and Health Sciences. University of Oviedo. Hospital Universitario Central de Asturias. Oviedo. Spain. E-mail: zuazuadavid@uniovi.es Correspondence Author David Zuazua-Rico
León University Hospital, León, Spain E-mail: cjuangarcia@saludcastillayleon.es Carmen Juan-García
Hospital Universitario Central de Asturias. Oviedo. Spain. E-mail: salvillalgordo@gmail.com Salvador Villalgordo-García
Faculty of Medicine and Health Sciences. University of Oviedo. Oviedo. E-mail: mmosteirod@uniovi.es María Pilar Mosteiro-Díaz
León University Hospital, León, Spain. E-mail: miplazac@saludcastillayleon.es María Plaza-Carmona

Highlights

 

How to cite this article: Maestro-González Alba, Zuazua-Rico David, Juan-García Carmen, Villalgordo-García Salvador, Mosteiro-Díaz María Pilar, Plaza-Carmona María. Sleep quality and job satisfaction in Spanish nurses: the consequences of COVID-19. Revista Cuidarte. 2024;15(2):e3452. https://doi.org/10.15649/cuidarte.3452

Received: October 9th 2023
Accepted: May 27th 2024
Published: July 30th 2024

CreativeCommons 

E-ISSN: 2346-3414

Abstract

Introduction: Sleep is fundamental to the quality of life and can affect individuals' well-being and mental health. Objective: This study analyzed sleep quality and job satisfaction among Spanish nurses following the COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted using the Pittsburgh Sleep Quality Index (PSQI), Font Roja Job Satisfaction Questionnaire, and sociodemographic and work-related variables. A “snowball” sampling method was employed through social media dissemination. Results: The mean PSQI score was 9.75 ± 4,36 points. The poorest sleep quality was identified in participants without dependents (p=0.031; β=3.329; 95% CI=0.035-6.354) and those with dependents other than children (p=0.022; β=4.121; 95% CI=0.575-7.667). However, having a Ph.D degree (p=0.001; β=-3.406; 95% CI=-5.503-1.309) or specialist degree (p=0.021; β=-1.639; 95% CI=-3.031- -0.247) was associated with better sleep quality. Higher job satisfaction was found among women (p=0.034; β=0.104; 95% CI=0.007-0.201) who did not work with COVID-19 patients (p=0.049; β=-0.085; 95% CI=-0.174- -0.003). Discussion: Improving working conditions, such as the nurse-to-patient ratio and distribution of work shifts, is crucial to enhancing nurses' sleep quality. Conclusions: Spanish nurses reported poor sleep quality. Not having dependents or having dependents other than children were risk factors for poor sleep quality. Job satisfaction was higher among women who did not work with COVID-19 patients. No relationship was found between job satisfaction and sleep quality.

Key Words: COVID-19; Sleep; Sleep Hygiene; Job Satisfaction; Nursing.

Resumen

Introducción: El sueño es fundamental para la calidad de vida y puede afectar el bienestar y la salud mental de los individuos. Objetivo: Analizar la calidad del sueño y satisfacción laboral en enfermeras españolas tras la pandemia por COVID-19. Materiales y Métodos: Estudio transversal utilizando el Pittsburgh Sleep Quality Index (PSQI), el Cuestionario de Satisfacción Laboral Font Roja y variables sociodemográficas y laborales. Se empleó un muestreo en "bola de nieve" mediante divulgación en redes sociales. Resultados: La puntuación media del PSQI fue de 9,75 ± 4,36 puntos. La peor calidad del sueño se identificó en participantes sin personas a cargo (p=0,031;β=3,329;IC95%=0,035-6,354) y en aquellos con dependientes distintos de los hijos (p=0,022;β=4,121;IC95%= 0,575-7,667). Sin embargo, ser doctor (p=0,001;β=-3,406; IC95%=-5,503-1,309) o especialista (p=0,021;β=-1,639; IC95%=-3,031- -0,247) se asoció con una mayor calidad del sueño. La mejor satisfacción laboral se identificó en mujeres (p=0,034;β=0,104;IC95%=0,007-0,201), que no trabajaban con pacientes COVID (p=0,049;β=-0,085;IC95%=-0,174- -0,003). Discusión: Es crucial mejorar las condiciones laborales, como la ratio enfermera-paciente y la distribución de los turnos de trabajo, para mejorar la calidad del sueño de las enfermeras. Conclusiones: Las enfermeras españolas presentan una mala calidad del sueño. No tener personas a cargo y tener dependientes distintos de los hijos fueron factores de riesgo de mala calidad del sueño. La satisfacción laboral fue mayor en mujeres que no trabajaban con pacientes COVID-19. No se encontró relación entre la satisfacción laboral y la calidad del sueño de los trabajadores.

Palabras Clave: COVID-19; Sueño; Higiene del Sueño; Satisfacción en el Trabajo; Enfermería.

Resumo

Introdução: O sono é fundamental para a qualidade de vida e pode afetar o bem-estar e a saúde mental dos indivíduos. Objetivo: Este estudo analisou a qualidade do sono e a satisfação no trabalho entre enfermeiros espanhóis após a pandemia de COVID-19. Materiais e Métodos: Foi realizado um estudo transversal utilizando o Índice de Qualidade do Sono de Pittsburgh (PSQI), o Questionário de Satisfação no Trabalho Font Roja e variáveis sociodemográficas e relacionadas ao trabalho. Um método de amostragem “bola de neve” foi empregado por meio de divulgação em redes sociais. Resultados: A pontuação média do PSQI foi de 9,75 ± 4,36 pontos. A pior qualidade do sono foi identificada nos participantes sem dependentes (p=0,031; β=3,329; IC 95%=0,035-6,354) e naqueles com outros dependentes que não sejam filhos (p=0,022; β=4,121; IC 95%=0,575-7,667). Entretanto, possuir doutoramento (p=0,001; β=-3,406; IC 95%=-5,503-1,309) ou especialista (p=0,021; β=-1,639; IC 95%=-3,031- -0,247) esteve associado a melhor qualidade do sono. Maior satisfação no trabalho foi encontrada entre mulheres (p=0,034; β=0,104; IC 95%=0,007-0,201) que não trabalhavam com pacientes com COVID-19 (p=0,049; β=-0,085; IC 95%=-0,174- -0,003). Discussão: Melhorar as condições de trabalho, tais como o rácio enfermeiro/paciente e a distribuição dos turnos de trabalho, é crucial para melhorar a qualidade do sono dos enfermeiros. Conclusões: Os enfermeiros espanhóis relataram má qualidade do sono. Não ter dependentes ou ter outros dependentes além dos filhos foram fatores de risco para má qualidade do sono. A satisfação no trabalho foi maior entre as mulheres que não trabalharam com pacientes com COVID-19. Nenhuma relação foi encontrada entre satisfação no trabalho e qualidade do sono.

Palavras-Chave: COVID-19; Sono; Higiene do Sono; Satisfação no Emprego; Enfermagem.

 

Introduction

Historically, healthcare professionals have prioritized patient care at the expense of their own rest. They often endure long shifts with little sleep, work rotating shifts without fully understanding the implications, and expose themselves to critical situations arising from illness and emergencies1-4. Partial sleep loss has been linked to increased physiological stress responses, suggesting that shift workers are more susceptible to developing burnout syndrome5,6. Several studies have indicated that the nursing staff are among the groups with the highest rates of burnout, work-related stress, and workload, likely because they spend the most time with patients and are responsible for providing care around the clock7,8.

In terms of rest, all aspects of sleep were significantly affected by rotating shifts, including total sleep time, perceived sleep quality (well-being and satisfaction with sleep), restorative sleep (feeling physically refreshed upon waking), and nighttime awakenings (an index of sleep fragmentation). These findings align with studies describing that rotating-shift workers experience poorer sleep quality7,9 and more sleep disturbances, such as insomnia, snoring, and excessive daytime sleepiness, than workers on regular shifts10. Sleep quality is critical not only for health but also for quality of life, which is another factor that rotating shift workers often report as compromised11.

Tolerance of shift work is the ability to adapt to rotating shifts without adverse consequences. The effects of shift work can be biological (metabolic disruptions12, hormonal imbalances, sleep cycle disturbances, cardiovascular disorders7, gastrointestinal issues, certain types of cancer13,14, impaired mental agility, concentration, and reaction time), occupational (fluctuations in performance, errors, traffic accidents, and increased absenteeism)15, and social (difficulty balancing family responsibilities and limited time for social activities). Tolerance or adaptation to shift work depends on various personal characteristics, coping strategies, family and social conditions, work conditions, and, in particular, the organization of work hours. The outcomes of these interactions depend on the specific burden of each factor and its temporal patterns in the worker's life. Consequently, adaptation or tolerance to shift work is often assessed through symptoms, which indicate how many aspects of worker health and quality of life are affected16.

Moreover, chronic work stress during the COVID-19 pandemic exacerbated fatigue17. Healthcare professionals experience negative attitudes and feelings toward colleagues and their professional roles, leading to emotional exhaustion and burnout syndrome7,18. The high workload, increased demand, and limited social support during the pandemic may have contributed to lower job satisfaction among nurses due to constant stress, shift changes, variations in work assignments, insufficient safety protocols, and shortages of resources, both human and material. These factors can cause biochemical and psychological alterations19. This study aimed to analyze the sleep quality and job satisfaction of Spanish nurses after the COVID-19 pandemic.

 

Materials and Methods

Design

This descriptive cross-sectional study used data collected between March and April 2022.

Participants

The study was conducted among all Spanish nurses who used social networks and agreed to participate. No sample size was estimated because the study aimed to include the entire population. Inclusion criteria required participants to be in active nursing practice throughout the data collection period, regardless of the department in which they worked or their age. Exclusion criteria included participants diagnosed with a sleep disorder, those on sick leave due to a stressful event according to the DSM-5 diagnostic criteria20, or those undergoing treatment for elevated stress levels. A snowball sampling technique was employed, encouraging participants to share and distribute the questionnaire through their social media networks and professional connections, which allowed for broader distribution and a more diverse participant base. Invitations to participate in the study were sent via Twitter, Instagram, and WhatsApp. Following the initial dissemination, the snowball sampling approach was used to further encourage participants to share the questionnaire on their own social media profiles.

Data collection

Nurses who decided to participate in the project completed an online self-administered questionnaire. For this purpose, we designed a data collection sheet using Google Forms and distributed it on social media. The form included an introductory paragraph informing the participants about the study's objective and explaining that completing the questionnaire implied their consent to participate in the research. Anonymity was ensured by not collecting personal data. This instrument included sociodemographic variables (age, sex, relationship status, and dependents), work-related variables (education level, professional experience, shift type, department, and whether they worked with COVID-19 patients), the Spanish version of the Pittsburgh Sleep Quality Index (PSQI)21, and the Font Roja Job Satisfaction Questionnaire22. The database was stored in Zenodo23.

Ethical considerations

This study was designed in accordance with the principles outlined in the Declaration of Helsinki24, the Belmont Report25, the CIOMS Guidelines26 and the provisions of Spain's Organic Law 3/2018, dated December 5, concerning the Protection of Personal Data and the Guarantee of Digital Rights. This study was approved by the León and Bierzo Drug Research Ethics Committee (No. 2021/2193). Furthermore, all study participants provided informed consent and the study procedures complied with the provisions of the Organic Law on Personal Data Protection.

Data analysis

A descriptive analysis of each variable was performed to describe the demographic characteristics. Differences between the two groups were assessed using Student's t-test (with Welch's correction for different variances) or Wilcoxon's test for independent samples since the assumptions of normality (Shapiro-Wilk test), and homoscedasticity (Bartlett test and Ansari-Bradley test) could not be verified. Quantitative variables among the three categories were compared using the Kruskal-Wallis test and Dunn's post hoc test. Spearman's correlation coefficient and the corresponding hypothesis test were used to evaluate the linear relationship between the continuous variables. Finally, a linear model was constructed using variables with a p-value <0.10 in the bivariate analysis. Statistical significance was set at p < 0.05. Statistical analysis was performed using R software (R Development Core Team), version 4.4.0.

Validity and reliability/Rigor

The PSQI is one of the most widely used instruments for assessing sleep quality due to its ease of self-administration27. It is a 24-item questionnaire that evaluates seven components (regular sleep efficiency, sleep latency [the time taken to transition from wakefulness to sleep], total sleep duration, sleep quality, use of sleep medication, daytime dysfunction, and sleep disturbances) from which a final score is derived. The PSQI uses a Likert-type scale ranging from 0 to 3. For correction, a sleep profile was obtained for each component, ranging from 0 to 3, and an overall score ranging from 0 to 21. Higher scores indicated poorer sleep quality, whereas scores of 5 or below indicated good sleep.

The study also used The Font-Roja Job Satisfaction Questionnaire22. Similar to the PSQI, it employs a Likert-type scale to evaluate its 24 items divided into nine factors that assess different aspects of job satisfaction: general job satisfaction, job-related stress, job competition, job pressure, job promotion opportunities, interpersonal relationships with superiors, interpersonal relationships with peers, extrinsic status characteristics, and job monotony. The overall mean satisfaction score was obtained by summing up the 24 items and calculating the arithmetic mean. The answers to the set of questions for each factor followed a Likert scale ranging from 1 to 5 (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree). The score obtained for each factor is equal to the sum of the scores of its sections, divided by the number of sections, each section with values ranging from 1 to 5. This questionnaire does not have a reference scoring criterion, so the interpretation of the results relies on data from relevant literature.

 

Results

In total, 523 questionnaires were collected, constituting a representative sample of the national population. Regarding participant characteristics, 85.47% were women, with a mean age of 36.9±10.6 years. The majority held a bachelor's degree (56.65%), worked in hospitals (68.84%), and had fixed morning or afternoon shifts (48.83%). The average professional experience was 14.1±10.6 years; 77.53% worked with COVID-19 patients, 72.47% had a partner, and 63.72% did not have dependents (Table 1).

 

Table 1. Participants’ demographics and work information

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The mean score for the Pittsburgh Sleep Quality Index (PSQI) among the nursing staff was 9.75±4.36, indicating poor sleep quality, as scores of 5 or above denote poor sleep quality. When evaluating the different components of the PSQI, the component with the worst score was sleep latency, with a mean of 2.84 ± 1.81. Other components, in ascending order of severity, were subjective sleep quality (1.73 ±1.25), daytime dysfunction (1.64 ±0.85), sleep disturbances (1.43 ±0.58), habitual sleep efficiency (1.07 ±1.07), use of sleep medication (0.62 ±1.02), and sleep duration (0.43 ±0.55). In terms of actual sleep time, the nursing staff reported an average of 5.97 hours of rest per night (±1.10; range 3–10 hours) (see Table 2).

 

Table 2. Questionnaires’ information

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Table 2. Questionnaires’ information

N Mean Min Max
PSQI
Item 1: Subjective sleep quality 523 1.73 ±1.25 0 3
Item 2: Sleep latency 523 2.84 ±1.81 0 6
Item 3: Sleep duration 517 0.43 ±0.55 0 2
Item 4: Habitual sleep efficiency 513 1.07 ±1.07 0 3
Item 5: Sleep disturbance 523 1.43 ±0.58 0 3
Item 6: Use of sleep medication and daytime dysfunction 523 0.62 ±1.02 0 3
Item 7: Dysfunction during the day 523 1.64 ±0.85 0 3
Global PSQI 523 9.75 ±4.36 1 20
Font Roja
FACTOR 1. Job satisfaction 523 3.76 ±0.63 1.75 5
FACTOR 2. Work-related stress 523 3.01 ±0.83 1 5
FACTOR 3. Professional competence 523 2.56 ±0.80 1 5
FACTOR 4. Pressure at work 523 3.23 ±1.09 1 5
FACTOR 5: Career advancement 523 3.42 ±0.74 1 5
FACTOR 6. Interpersonal relationship with superiors 523 3.46 ±0.85 1 5
FACTOR 7. Interpersonal relationship with peers 523 2.32 ±1.22 1 5
FACTOR 8. Extrinsic status characteristics 523 2.94 ±0.76 1 5
FACTOR 9. Work monotony 523 2.48 ±0.89 1 5
FACTOR 10. Physical work environment satisfaction 523 2.06 ±0.90 1 5
Global satisfaction 523 2.98 ±0.35 1.77 4.04

* Crude prevalence ratios ** Adjusted prevalence ratios. Adjusted Nagelkerke R2model explains 17.72% of the variance).

 

A statistical association was found between the overall PSQI scores and several variables. Participants with poor sleep quality included those without dependents (p = 0.016; Dunn's test: p = 0.004), those with a master's degree (p < 0.001; Dunn's test: p = 0.001), those working in hospital care (p = 0.042; Dunn's test: p = 0.049), those caring for COVID-19 patients (p = 0.013), and those on rotating shifts (p = 0.011; Dunn's test: p = 0.008) (Table 3).

 

Table 3. Bivariate analysis of sleep quality and job satisfaction

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Table 3. Bivariate analysis of sleep quality and job satisfaction

PSQI Total Score Job Satisfaction
Mean ± SD ρ (rho) Mean ± SD ρ (rho)
Age 0.423 (rho -0.035) 0.984 (rho 0,001)
Professional experience 0.279 (rho -0.031) 0.690 (rho 0.011)
Sex 0.329** 0.013*
    Male 9.22 ± 4.20 2.88 ± 0.38
    Female 9.84 ± 4.37 3.00 ± 0.35
Civil Status 0.429** 0.005**
    With a partner 9.65± 4.38 2,98 ± 0.35
    Single 10.01± 4.27 2,94 ± 0.36
Dependents 0.016# 0.578#
    Both 7.36± 4.03 2.90 ± 0.50
     No 10.07± 4.46 2.97 ± 0.33
    Yes, children 9.11 ± 4.03 3.01 ± 0.38
    Yes, other people 11.11± 4.40 2.95 ± 0.46
Educational attainment <0.001# 0.633#
    Graduate 10.04± 4.21 2.97 ± 0.37
    PhD 6.90± 4.19 3.04 ± 0.31
    Nurse Practitioner 7.80± 3.95 3.02 ± 0.29
    Master's Degree 10.35± 4.49 2.96 ± 0.35
Work Centre 0.042# 0.163#
    Primary Care Center 8.84± 4.07 2.99 ± 0.36
    Private Center 9.15± 3.51 2.84 ± 0.40
    Emergency 10.20± 5.33 2.83 ± 0.48
    Hospital 10.13± 4.42 2.99 ± 0.35
    Other Centers 8.35± 4.66 2.94 ± 0.41
Service 0.124# 0.018#
    Primary Care 8.83± 4.08 2.99 ± 0.36
    Critical Care Unit 9.87± 4.08 2.89 ± 0.35
    Outpatient Services 9.73± 4.37 2.95 ± 0.40
    Inpatient unit 10.17± 4.62 3.01 ± 0.32
    Emergency 10.26± 4.43 3.08 ± 0.34
Rotating work shifts 0.011# 0.270#
    Fixed shift 9.20± 4.24 3.01 ± 0.38
    On-call duty 9.61± 4.72 2.94 ± 0.37
    Rotating work Shift 10.34± 4.34 2.95 ± 0.33
Working with COVID-19 patients 0.013** 0.038**
    No 8.94± 4.33) 3.04 ± 0.37
    Yes 10.11± 4.35 2.96 ± 0.34

* Student's t-test; ** Wilcoxon's test; # Kruskal-Wallis test

 

A linear model was constructed to predict the sleep quality. The only variables that showed a statistically significant association were the presence of dependents and the highest level of education. The model explained 5.5% of the variability in sleep quality and was statistically significant (adjusted R-squared: 0.055; p = 0.003). Participants without or with dependents other than children had higher PSQI scores, indicating poor sleep quality. Conversely, obtaining a PhD or specialist degree was associated with better sleep quality (Table 4).

 

Table 4. Linear models

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Table 4. Linear models

Coefficients Sleep Quality Linear Model Job Satisfaction Linear Model
β (95% CI) p-value β (95% CI) p-value
Sex
     Male 0 0 0 0
     Female 0,705 (-0.44 - 1.858) 0,230 0.104 (0.007 - 0.201) 0.034
Age 0,040 (-0.005 - 0.087) 0,086 -0.001 (-0.004 - 0.002) 0.564
Civil Status
     With a partner 0 0
     Single 0.014 (-0.064 -0.092) 0.721
Dependents
     Both 0 0
     No 3,329 (0.305 - 6.354) 0,031
     Yes, children 2,352 (-0.594 -5.300) 0,117
     Yes, other people 4,121 (0.575 - 7.667) 0,022
Educational attainment
     Graduate 0 0
     PhD -3,406 (-5.503 - -1.309) 0,001
     Nurse Practitioner -1,639 (-3.031 - -0.247) 0,021
     Master's Degree 0,192 (-0.760 - 1.145) 0,692
Work Centre
     Primary Care Center 0 0
     Private center -0,049 (-2.118 - 2.019) 0,962
     Emergency 0,594 (-2.753 - 3.942) 0,727
     Hospital 0,690 (-0.486 -1.868) 0,249
     Other Centers -0,052 (-2.443 -2.33) 0,965
Service
     Primary Care 0 0
     Critical Care Unit -0.103 (-0.215 -0.009) 0.072
     Outpatient Services -0.040 (-0.164 -0.083) 0.520
     Inpatient unit 0.010 (-0.084 - 0.104) 0.832
     Emergency 0.073 (-0.039 -0.186) 0.200
Rotating work shifts
     Fixed shift 0 0
     On-call duty -0,050 (-2.361 - 2.259) 0,965
     Rotating work Shift 0,789 (-0.178 - 1.756) 0,109
Working with COVID-19 patients
     No 0 0 0 0
     Yes 0,865 (-0.169 - 1.900) 0,101 -0.085 (-0.174 -0.003) 0.049
     (Intercept) 3,491 (-0,512 – 7,495) 0,087 3,007 (2.818 - 3.197) <0,001

 

The overall job satisfaction was 2.98 ± 0.35 points. The component with the lowest score was satisfaction with the physical work environment (2.06 ±0.90), followed by interpersonal relationships with colleagues (2.32 ±1.22), work monotony (2.48 ±0.89), professional competence (2.56 ±0.80), extrinsic status characteristics (2.94 ±0.76), job stress (3.01 ±0.83), job pressure (3.23 ±1.09), career advancement (3.42 ±0.63), interpersonal relationships with superiors (3.46 ±0.85), and job satisfaction (3.76 ±0.63) (Table 2).

A statistical association was found between the overall Font Roja Questionnaire scores and several variables. The lowest satisfaction levels were identified among men (p = 0.011), single workers (p = 0.005), those working in critical care (p = 0.018; Dunn's test: p = 0.047), and those caring for COVID-19 patients (p = 0.038) (Table 3).

A linear model was constructed to predict job satisfaction. The only statistically significant variables were sex and working with COVID-19 patients. The model explained 2.7% of the variability in job satisfaction and was statistically significant (Adjusted R-squared: 0.027; p = 0.016). Job satisfaction scores were higher among women who did not work with COVID-19 patients (Table 4). No significant relationship was found between overall job satisfaction and sleep quality (p = 0.359).

Discussion

The COVID-19 pandemic has significantly affected healthcare, causing stress and anxiety among healthcare professionals2830. This situation has resulted in frequent disruptions in sleep patterns and has led to a poor perception of sleep quality among nurses31,32. In this study, most participants exhibited poor sleep quality, with a mean Pittsburgh Sleep Quality Index (PSQI) score of 9.75.

Our findings are consistent with those of a study conducted in the United States33, where the mean PSQI score was 9.27, and poor subjective sleep quality was linked to low job satisfaction. Similarly, a study conducted among Chinese nurses34 showed that sleep quality is associated with psychological distress and job burnout (mean PSQI score = 9.10). Another study by Lyu et al.35, reported lower mean PSQI scores, but still indicated poor sleep quality (mean PSQI score of 7.00). This difference could be attributed to the lower exposure of COVID-19 patients, as the setting was psychiatric. Additionally, in an Italian study involving physicians and nurses36, researchers highlighted the negative impact of the pandemic on psychological and sleep-related aspects, especially among frontline nurses.

In Spain, the general population had a lower mean PSQI score (8.45)37 at the beginning of the pandemic than the score obtained in our study after two years, which could be due to nurse attrition over time. Similar results were found in an emergency department during the COVID-19 pandemic, with a comparable overall PSQI score of 8.2738. The poor perception of sleep quality among Spanish nurses is consistent with Moreno-Casbas’ findings39, which also noted poor sleep quality perception, with worse results for nurses working fixed night shifts (mean PSQI score = 7.93).

When assessing sleep quality across different services, special services yielded alarming values similar to those found in our study. Suleiman et al.40 reported a mean PSQI score of 8.76 in a sample of 200 emergency nurses. In the same context, it was noted that stress levels in Spain increased during the COVID-19 pandemic, with higher levels among those with poor sleep quality and increased sleepiness, both in the pre-pandemic phase and afterward41.

The mean age of our sample was 36 years, with a mean professional experience of 14 years. Factors potentially linked to physical and psychological strain resulting from shift work can lead to sleep disturbances. Studies such as those by Senol et al.42, in which the study sample was in its early years of work, had a lower average PSQI score (4.14), suggesting that the impact of shift work on sleep patterns might not yet have become apparent7.

When examining the components of the PSQI, sleep latency had the lowest score (2.84), which aligns with the findings of Maestro-González et al.37 during the lockdown period, in which sleep latency was also the lowest-rated component.

Despite these results, Kang et al.43 highlighted the need for assessment instruments tailored to shift work characteristics. The PSQI includes items such as average time to fall asleep and sleep duration at night, which may not be suitable for assessing sleep quality in shift workers. There is also an association between different circadian rhythm patterns and the risk of developing burnout, influenced by factors such as gender, work shift, service type, family environment, and education level, as noted in studies by Bagheri et al.44, and Giorgi et al.45.

In our study, we found significant differences in poor sleep quality among nurses with dependents and those with lower education levels. These results are similar to those obtained in Turkey, where higher education was associated with better sleep quality42. This contrasts with studies by Suleiman et al.40, McDowall et al.9 and Maestro-Gonzalez et al.37, in which sociodemographic variables did not significantly impact sleep quality. The reason for this discrepancy is unclear, indicating the need for qualitative research to explore the underlying causes.

Similarly, our study observed differences in occupational stress between sexes, with men experiencing higher stress levels, which differs from other studies46. When examining job satisfaction and stress, it was observed that stress due to workload can lead to difficulties in falling asleep and early or frequent awakenings, which can negatively affect sleep quality47. Continuous awakening was one of the most common symptoms reported in this study.

Our findings are consistent with those of Rahnavard48, who observed that professionals in special services, such as emergency departments, experienced lower job satisfaction. The worst satisfaction was identified among men who worked with COVID-19 patients, which aligns with Rouxel et al.49, who reported that high job demands were associated with increased emotional exhaustion and staff depersonalization. Burnout was more prevalent among professionals in intensive care units, possibly due to high physical and psychological pressures, consistent with other studies conducted during the COVID-19 pandemic50,51. However, another study in Portugal conducted during the third wave of COVID-19 showed higher job satisfaction among nurses working in services for COVID-19 patients52.

Given these factors, our study emphasizes the need to improve working conditions, such as nurse-to-patient ratios and shift distribution, to enhance sleep quality among nurses and potentially reduce their stress and burnout.

Limitations of this study stem primarily from its cross-sectional design. It was not possible to analyze the evolution of the participants’ sleep quality and job satisfaction over time. Additionally, although our participant selection strategy yielded a representative sample of Spanish nurses, we may have excluded those without Internet access. Future studies should consider cohort studies to explore the long-term evolution of these aspects. Additionally, it would be interesting to identify other variables that influence these factors because their explanatory power is small.

 

Conclusion

Spanish nurses experienced poor sleep quality following the COVID-19 pandemic, with sleep latency being the lowest-rated aspect. Risk factors for poor sleep quality included not having dependents or having dependents other than children while obtaining a doctorate or specialist degree served as a protective factor.

With regard to job satisfaction, the component with the lowest score was satisfaction with the physical work environment, followed by interpersonal relationships with colleagues. Factors that increased job satisfaction included being a woman and not working with COVID-19 patients. However, job satisfaction has decreased among men working in critical care. No significant relationship was observed between job satisfaction and sleep quality.

It is crucial to emphasize the importance of nurses' sleep quality to ensure that patients receive safe, high-quality care and that nurses experience greater satisfaction with their job performance and working conditions.

Conflict of Interest: Authors have no conflicts of interest to declare.

Funding: No funding received.

 

References

X

Referencias

Booker LA, Fitzgerald J, Mills J, Bish M, Spong J, Deacon-Crouch M, et al. Sleep and fatigue management strategies: How nurses, midwives and paramedics cope with their shift work schedules—a qualitative study. Nurs Open. 2024;11(1):e2099. https://doi.org/10.1002/nop2.2099

X

Referencias

Bae SH. Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review. Int Nurs Rev. 2022;69(3):392-404https://doi.org/10.1111/inr.12769

X

Referencias

Barion A, Zee PC. A clinical approach to circadian rhythm sleep disorders. Sleep Med. 2007;8(6):566-77. https://doi.org/10.1016/j.sleep.2006.11.017

X

Referencias

Booker LA, Barnes M, Alvaro P, Collins A, Chai-Coetzer CL, McMahon M, et al. The role of sleep hygiene in the risk of Shift Work Disorder in nurses. Sleep. 2019;43(2)zsz228. https://doi.org/10.1093/sleep/zsz228

X

Referencias

Brown JP, Martin D, Nagaria Z, Verceles AC, Jobe SL, Wickwire EM. Mental Health Consequences of Shift Work: An Updated Review. Curr Psychiatry Rep. 2020;22(2):1-7. https://doi.org/10.1007/s11920-020-1131-z

X

Referencias

Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210. https://doi.org/10.1136/bmj.i5210

X

Referencias

Membrive-Jiménez MJ, Gómez-Urquiza JL, Suleiman-Martos N, Velando-Soriano A, Ariza T, De la Fuente-Solana EI, et al. Relation between Burnout and Sleep Problems in Nurses: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022;10(5):954. https://doi.org/10.3390/healthcare10050954

X

Referencias

García-Tudela Á, Simonelli-Muñoz AJ, Rivera-Caravaca JM, Fortea MI, Simón-Sánchez L, González-Moro MTR, et al. Stress in Emergency Healthcare Professionals: The Stress Factors and Manifestations Scale. Int J Environ Res Public Health. 2022;19(7):4342. https://doi.org/10.3390/ijerph19074342

X

Referencias

McDowall K, Murphy E, Anderson K. The impact of shift work on sleep quality among nurses. Occup Med (Lond). 2017;67(8):621-5. https://doi.org/10.1093/occmed/kqx152

X

Referencias

Roman P, Perez-Cayuela I, Gil-Hernández E, Rodriguez-Arrastia M, Aparicio-Mota A, Ropero-Padilla C, et al. Influence of Shift Work on The Health of Nursing Professionals. J Pers Med. 2023;13(4):627. https://doi.org/10.3390/jpm13040627

X

Referencias

Shi H, Huang T, Schernhammer ES, Sun Q, Wang M. Rotating Night Shift Work and Healthy Aging After 24 Years of Follow-up in the Nurses’ Health Study. JAMA Netw Open. 2022;5(5):e2210450. https://doi.org/10.1001/jamanetworkopen.2022.10450

X

Referencias

Proper KI, Van De Langenberg D, Rodenburg W, Vermeulen RCH, Van Der Beek AJ, Van Steeg H, et al. The Relationship Between Shift Work and Metabolic Risk Factors. American Journal of Preventive Medicine. 2016;50(5):e147-57. https://doi.org/10.1016/j.amepre.2015.11.013

X

Referencias

Hwang SK, Lee YJ, Cho ME, Kim BK, Yoon YI. Factors Associated with Gastrointestinal Symptoms among Rotating Shift Nurses in South Korea: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(16):9795. https://doi.org/10.3390/ijerph19169795

X

Referencias

Lozano-Lorca M, Olmedo-Requena R, Vega-Galindo MV, Vázquez-Alonso F, Jiménez-Pacheco A, Salcedo-Bellido I, et al. Night Shift Work, Chronotype, Sleep Duration, and Prostate Cancer Risk: CAPLIFE Study. IJERPH. 2020;17(17):6300. https://doi.org/10.3390/ijerph17176300

X

Referencias

Alfonsi V. Sleep deprivation provokes aberrant dynamic brain activity and memory decline among night shift nurses. Evid Based Nurs. 2023;26(2):71.https://doi.org/10.1136/ebnurs-2022-103648

X

Referencias

Suleiman K, Hijazi Z, Al Kalaldeh M, Abu Sharour L. Quality of nursing work life and related factors among emergency nurses in Jordan. Jrnl of Occup Health. 2019;61(5):398-406. https://doi.org/10.1002/1348-9585.12068

X

Referencias

Rajcani J, Vytykacova S, Solarikova P, Brezina I. Stress and hair cortisol concentrations in nurses during the first wave of the COVID-19 pandemic. Psychoneuroendocrinology. 2021;129:105245. https://doi.org/10.1016/j.psyneuen.2021.105245

X

Referencias

Tosun A, Tosun H, Ödül Özkaya B, Erdoğan Z, Gül A. Sleep Quality and Depression Level in Nurses in COVID-19. Pandemic. Omega (Westport). 2022. https://doi.org/10.1177/00302228221123159

X

Referencias

Krishnamoorthy Y, Nagarajan R, Saya GK, Menon V. Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res. 2020;293:113382. https://doi.org/10.1016/j.psychres.2020.113382

X

Referencias

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Fifth edition. Arlington, VA: American Psychiatric Association; 2013.

X

Referencias

Macías-Fernández J, Royuela-Rico A. La versión española del índice de calidad del sueño de Pittburgh. Informaciones psiquiátricas. 1996;14(4):465-72. https://www.researchgate.net/profile/Angel_Royuela/publication/258513992_La_version_espanola_del_Indice_de_Calidad_de_Sueno_de_Pittsburgh/links/0c96052876d26b1b3b000000/La-version-espanola-del-Indice-de-Calidad-de-Sueno-de-Pittsburgh.pdf

X

Referencias

Núñez-González E, Estévez-Guerra G, Hernández-Marrero P, Marrero-Medina C. Una propuesta destinada a complementar el cuestionario Font-Roja de satisfacción laboral. Gac Sanit. 2007;21(2):136-41. https://doi.org/10.1157/13101040

X

Referencias

Maestro-González A, Zuazua-Rico D, Juan-García C, Villalgordo-García S, Mosteiro-Díaz MP, Plaza-Carmona M. Sleep quality and job satisfaction in Spanish nurses: the consequences of COVID-19. Zenodo; 2023.https://zenodo.org/records/8420660

X

Referencias

World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191-2194. https://doi.org/10.1001/jama.2013.281053

X

Referencias

Childress JF, Meslin EM, Shapiro HT. Belmont revisited: ethical principles for research with human subjects. Washington (D.C.): Georgetown University press; 2005.

X

Referencias

Ehni HJ, Wiesing U. Research ethics for a globalised world: the revised CIOMS international guidelines. Indian J Med Ethics. 2017;2(3):165-168. https://doi.org/10.20529/IJME.2017.046

X

Referencias

Buysse DJ, Reynolds CF, 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.https://doi.org/10.1016/0165-1781(89)90047-4

X

Referencias

Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976

X

Referencias

Alfonsi V, Scarpelli S, Gorgoni M, Couyoumdjian A, Rosiello F, Sandroni C, et al. Healthcare Workers after Two Years of COVID-19: The Consequences of the Pandemic on Psychological Health and Sleep among Nurses and Physicians. Int J Environ Res Public Health. 2023;20(2):1410. https://doi.org/10.3390/ijerph20021410

X

Referencias

Bilgiç Ş, Çelikkalp Ü, Mısırlı C. Stress level and sleep quality of nurses during the COVID-19 pandemic. WOR. 2021;70(4):1021-9.https://doi.org/10.3233/WOR-210538

X

Referencias

Boned-Galán Á, López-Ibort N, Gascón-Catalán A. Sleep disturbances in nurse managers during the early and late stages of the COVID-19 pandemic. Front Psychol. 2022;13:1070355. https://doi.org/10.3389/fpsyg.2022.1070355

X

Referencias

Pataka A, Kotoulas S, Tzinas A, Kasnaki N, Sourla E, Chatzopoulos E, et al. Sleep Disorders and Mental Stress of Healthcare Workers during the Two First Waves of COVID-19 Pandemic: Separate Analysis for Primary Care. Healthcare (Basel) 2022;10(8):1395. https://doi.org/10.3390/healthcare10081395

X

Referencias

Norful AA, Haghighi F, Shechter A. Assessing sleep health dimensions in frontline registered nurses during the COVID-19 pandemic: implications for psychological health and wellbeing. SLEEP Advances. 2023;4(1):zpac046. https://doi.org/10.1093/sleepadvances/zpac046

X

Referencias

Wang B, Lu Q, Sun F, Zhang R. The relationship between sleep quality and psychological distress and job burnout among Chinese psychiatric nurses. Ind Health. 2021;59(6):427-35. https://doi.org/10.2486/indhealth.2020-0249

X

Referencias

Lyu X, Li K, Liu Q, Wang X, Yang Z, Yang Y, et al. Sleep status of psychiatric nurses: A survey from China. Nurs Open. 2022;9(6):2720-8. https://doi.org/10.1002/nop2.972

X

Referencias

Proserpio P, Zambrelli E, Lanza A, Dominese A, Di Giacomo R, Quintas R, et al. Sleep disorders and mental health in hospital workers during the COVID-19 pandemic: a cross-sectional multicenter study in Northern Italy. Neurol Sci. 2022;43(4):2241-51. https://doi.org/10.1007/s10072-021-05813-y

X

Referencias

Maestro-Gonzalez A, Sánchez-Zaballos M, Mosteiro-Díaz MP, Zuazua-Rico D. Quality of sleep among social media users during the lockdown period due to COVID-19 in Spain. Sleep Medicine. 2021;80:210-5. https://doi.org/10.1016/j.sleep.2021.01.050

X

Referencias

García‐Tudela Á, Simonelli‐Muñoz AJ, Gallego‐Gómez JI, Rivera‐Caravaca JM. Impact of the COVID ‐19 pandemic on stress and sleep in emergency room professionals. Journal of Clinical Nursing. 2023;32(15-16):5037-5045. https://doi.org/10.1111/jocn.16738

X

Referencias

Moreno-Casbas MT, Alonso-Poncelas E, Gómez-García T, Martínez-Madrid MJ, Escobar-Aguilar G. Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System. Enfermería Clínica (English Edition). 2018;28(4):230-239. https://doi.org/10.1016/j.enfcle.2018.01.003

X

Referencias

Suleiman K, Hijazi Z, Kalaldeh MA, Sharour LA. Factors Associated with Sleep Quality Among Emergency Nurses in Jordan. Sleep Vigilance. 2020;4(1):11-6. https://doi.org/10.1007/s41782-019-00082-4

X

Referencias

Martin-Rodriguez LS, Escalda-Hernandez P, Soto-Ruiz N, Ferraz-Torres M, Rodriguez-Matesanz I, Garcia-Vivar C. Mental health of Spanish nurses working during the COVID-19 pandemic: A cross-sectional study. Int Nurs Rev. 2022;69(4):538-45. https://doi.org/10.1111/inr.12764

X

Referencias

Senol V, Soyuer F, Guleser GN, Argun M, Avsarogullari L. The Effects of the Sleep Quality of 112 Emergency Health Workers in Kayseri, Turkey on Their Professional Life. Turkish Journal of Emergency Medicine. 2014;14(4):172-178. https://doi.org/10.5505/1304.7361.2014.60437

X

Referencias

Kang J, Noh W, Lee Y. Sleep quality among shift-work nurses: A systematic review and meta-analysis. Applied Nursing Research. 2020;52:151227. https://doi.org/10.1016/j.apnr.2019.151227

X

Referencias

Bagheri Hosseinabadi M, Ebrahimi MH, Khanjani N, Biganeh J, Mohammadi S, Abdolahfard M. The effects of amplitude and stability of circadian rhythm and occupational stress on burnout syndrome and job dissatisfaction among irregular shift working nurses. J Clin Nurs. 2019;28(9-10):1868-78. https://doi.org/10.1111/jocn.14778

X

Referencias

Giorgi F, Mattei A, Notarnicola I, Petrucci C, Lancia L. Can sleep quality and burnout affect the job performance of shift-work nurses? A hospital cross-sectional study. J Adv Nurs. 2018;74(3):698-708. https://doi.org/10.1111/jan.13484

X

Referencias

Meneguin S, Ignácio I, Pollo CF, Honório HM, Patini MSG, de Oliveira C. Burnout and quality of life in nursing staff during the COVID-19 pandemic. BMC Nurs. 2023;22(1):14. https://doi.org/10.1186/s12912-022-01168-7

X

Referencias

Olagunju AT, Bioku AA, Olagunju TO, Sarimiye FO, Onwuameze OE, Halbreich U. Psychological distress and sleep problems in healthcare workers in a developing context during COVID-19 pandemic: Implications for workplace wellbeing. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2021;110:110292. https://doi.org/10.1016/j.pnpbp.2021.110292

X

Referencias

Rahnavard F, Sadati AK, Hemmati S, Ebrahimzade N, Sarikhani Y, Heydari ST, et al. The impact of environmental and demographic factors on nursing job satisfaction. Electron Physician. 2018;10(4):6712-7. https://doi.org/10.19082/6712

X

Referencias

Rouxel G, Michinov E, Dodeler V. The influence of work characteristics, emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers. Int J Nurs Stud. 2016;62:81-89. https://doi.org/10.1016/j.ijnurstu.2016.07.010

X

Referencias

Toscano F, Tommasi F, Giusino D. Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors. Int J Environ Res Public Health. 2022;19(19):12914. https://doi.org/10.3390/ijerph191912914

X

Referencias

Petrino R, Riesgo LGC, Yilmaz B. Burnout in emergency medicine professionals after 2 years of the COVID-19 pandemic: a threat to the healthcare system? Eur J Emerg Med. 2022;29(4):279-284.https://doi.org/10.1097/MEJ.0000000000000952

X

Referencias

de Pinho LG, Sampaio F, Sequeira C, Teixeira L, Fonseca C, Lopes MJ. Portuguese Nurses’ Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak. Int J Environ Res Public Health. 2021;18(7):3490. https://doi.org/10.3390/ijerph18073490

X

Referencias

n#

  1. Booker LA, Fitzgerald J, Mills J, Bish M, Spong J, Deacon-Crouch M, et al. Sleep and fatigue management strategies: How nurses, midwives and paramedics cope with their shift work schedules—a qualitative study. Nurs Open. 2024;11(1):e2099. https://doi.org/10.1002/nop2.2099

  2. Bae SH. Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review. Int Nurs Rev. 2022;69(3):392-404https://doi.org/10.1111/inr.12769

  3. Barion A, Zee PC. A clinical approach to circadian rhythm sleep disorders. Sleep Med. 2007;8(6):566-77. https://doi.org/10.1016/j.sleep.2006.11.017

  4. Booker LA, Barnes M, Alvaro P, Collins A, Chai-Coetzer CL, McMahon M, et al. The role of sleep hygiene in the risk of Shift Work Disorder in nurses. Sleep. 2019;43(2)zsz228. https://doi.org/10.1093/sleep/zsz228

  5. Brown JP, Martin D, Nagaria Z, Verceles AC, Jobe SL, Wickwire EM. Mental Health Consequences of Shift Work: An Updated Review. Curr Psychiatry Rep. 2020;22(2):1-7. https://doi.org/10.1007/s11920-020-1131-z

  6. Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210. https://doi.org/10.1136/bmj.i5210

  7. Membrive-Jiménez MJ, Gómez-Urquiza JL, Suleiman-Martos N, Velando-Soriano A, Ariza T, De la Fuente-Solana EI, et al. Relation between Burnout and Sleep Problems in Nurses: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022;10(5):954. https://doi.org/10.3390/healthcare10050954

  8. García-Tudela Á, Simonelli-Muñoz AJ, Rivera-Caravaca JM, Fortea MI, Simón-Sánchez L, González-Moro MTR, et al. Stress in Emergency Healthcare Professionals: The Stress Factors and Manifestations Scale. Int J Environ Res Public Health. 2022;19(7):4342. https://doi.org/10.3390/ijerph19074342

  9. McDowall K, Murphy E, Anderson K. The impact of shift work on sleep quality among nurses. Occup Med (Lond). 2017;67(8):621-5. https://doi.org/10.1093/occmed/kqx152

  10. Roman P, Perez-Cayuela I, Gil-Hernández E, Rodriguez-Arrastia M, Aparicio-Mota A, Ropero-Padilla C, et al. Influence of Shift Work on The Health of Nursing Professionals. J Pers Med. 2023;13(4):627. https://doi.org/10.3390/jpm13040627

  11. Shi H, Huang T, Schernhammer ES, Sun Q, Wang M. Rotating Night Shift Work and Healthy Aging After 24 Years of Follow-up in the Nurses’ Health Study. JAMA Netw Open. 2022;5(5):e2210450. https://doi.org/10.1001/jamanetworkopen.2022.10450

  12. Proper KI, Van De Langenberg D, Rodenburg W, Vermeulen RCH, Van Der Beek AJ, Van Steeg H, et al. The Relationship Between Shift Work and Metabolic Risk Factors. American Journal of Preventive Medicine. 2016;50(5):e147-57. https://doi.org/10.1016/j.amepre.2015.11.013

  13. Hwang SK, Lee YJ, Cho ME, Kim BK, Yoon YI. Factors Associated with Gastrointestinal Symptoms among Rotating Shift Nurses in South Korea: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(16):9795. https://doi.org/10.3390/ijerph19169795

  14. Lozano-Lorca M, Olmedo-Requena R, Vega-Galindo MV, Vázquez-Alonso F, Jiménez-Pacheco A, Salcedo-Bellido I, et al. Night Shift Work, Chronotype, Sleep Duration, and Prostate Cancer Risk: CAPLIFE Study. IJERPH. 2020;17(17):6300. https://doi.org/10.3390/ijerph17176300

  15. Alfonsi V. Sleep deprivation provokes aberrant dynamic brain activity and memory decline among night shift nurses. Evid Based Nurs. 2023;26(2):71.https://doi.org/10.1136/ebnurs-2022-103648

  16. Suleiman K, Hijazi Z, Al Kalaldeh M, Abu Sharour L. Quality of nursing work life and related factors among emergency nurses in Jordan. Jrnl of Occup Health. 2019;61(5):398-406. https://doi.org/10.1002/1348-9585.12068

  17. Rajcani J, Vytykacova S, Solarikova P, Brezina I. Stress and hair cortisol concentrations in nurses during the first wave of the COVID-19 pandemic. Psychoneuroendocrinology. 2021;129:105245. https://doi.org/10.1016/j.psyneuen.2021.105245

  18. Tosun A, Tosun H, Ödül Özkaya B, Erdoğan Z, Gül A. Sleep Quality and Depression Level in Nurses in COVID-19. Pandemic. Omega (Westport). 2022. https://doi.org/10.1177/00302228221123159

  19. Krishnamoorthy Y, Nagarajan R, Saya GK, Menon V. Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res. 2020;293:113382. https://doi.org/10.1016/j.psychres.2020.113382

  20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Fifth edition. Arlington, VA: American Psychiatric Association; 2013.

  21. Macías-Fernández J, Royuela-Rico A. La versión española del índice de calidad del sueño de Pittburgh. Informaciones psiquiátricas. 1996;14(4):465-72. https://www.researchgate.net/profile/Angel_Royuela/publication/258513992_La_version_espanola_del_Indice_de_Calidad_de_Sueno_de_Pittsburgh/links/0c96052876d26b1b3b000000/La-version-espanola-del-Indice-de-Calidad-de-Sueno-de-Pittsburgh.pdf

  22. Núñez-González E, Estévez-Guerra G, Hernández-Marrero P, Marrero-Medina C. Una propuesta destinada a complementar el cuestionario Font-Roja de satisfacción laboral. Gac Sanit. 2007;21(2):136-41. https://doi.org/10.1157/13101040

  23. Maestro-González A, Zuazua-Rico D, Juan-García C, Villalgordo-García S, Mosteiro-Díaz MP, Plaza-Carmona M. Sleep quality and job satisfaction in Spanish nurses: the consequences of COVID-19. Zenodo; 2023.https://zenodo.org/records/8420660

  24. World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191-2194. https://doi.org/10.1001/jama.2013.281053

  25. Childress JF, Meslin EM, Shapiro HT. Belmont revisited: ethical principles for research with human subjects. Washington (D.C.): Georgetown University press; 2005.

  26. Ehni HJ, Wiesing U. Research ethics for a globalised world: the revised CIOMS international guidelines. Indian J Med Ethics. 2017;2(3):165-168. https://doi.org/10.20529/IJME.2017.046

  27. Buysse DJ, Reynolds CF, 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.https://doi.org/10.1016/0165-1781(89)90047-4

  28. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976

  29. Alfonsi V, Scarpelli S, Gorgoni M, Couyoumdjian A, Rosiello F, Sandroni C, et al. Healthcare Workers after Two Years of COVID-19: The Consequences of the Pandemic on Psychological Health and Sleep among Nurses and Physicians. Int J Environ Res Public Health. 2023;20(2):1410. https://doi.org/10.3390/ijerph20021410

  30. Bilgiç Ş, Çelikkalp Ü, Mısırlı C. Stress level and sleep quality of nurses during the COVID-19 pandemic. WOR. 2021;70(4):1021-9.https://doi.org/10.3233/WOR-210538

  31. Boned-Galán Á, López-Ibort N, Gascón-Catalán A. Sleep disturbances in nurse managers during the early and late stages of the COVID-19 pandemic. Front Psychol. 2022;13:1070355. https://doi.org/10.3389/fpsyg.2022.1070355

  32. Pataka A, Kotoulas S, Tzinas A, Kasnaki N, Sourla E, Chatzopoulos E, et al. Sleep Disorders and Mental Stress of Healthcare Workers during the Two First Waves of COVID-19 Pandemic: Separate Analysis for Primary Care. Healthcare (Basel) 2022;10(8):1395. https://doi.org/10.3390/healthcare10081395

  33. Norful AA, Haghighi F, Shechter A. Assessing sleep health dimensions in frontline registered nurses during the COVID-19 pandemic: implications for psychological health and wellbeing. SLEEP Advances. 2023;4(1):zpac046. https://doi.org/10.1093/sleepadvances/zpac046

  34. Wang B, Lu Q, Sun F, Zhang R. The relationship between sleep quality and psychological distress and job burnout among Chinese psychiatric nurses. Ind Health. 2021;59(6):427-35. https://doi.org/10.2486/indhealth.2020-0249

  35. Lyu X, Li K, Liu Q, Wang X, Yang Z, Yang Y, et al. Sleep status of psychiatric nurses: A survey from China. Nurs Open. 2022;9(6):2720-8. https://doi.org/10.1002/nop2.972

  36. Proserpio P, Zambrelli E, Lanza A, Dominese A, Di Giacomo R, Quintas R, et al. Sleep disorders and mental health in hospital workers during the COVID-19 pandemic: a cross-sectional multicenter study in Northern Italy. Neurol Sci. 2022;43(4):2241-51. https://doi.org/10.1007/s10072-021-05813-y

  37. Maestro-Gonzalez A, Sánchez-Zaballos M, Mosteiro-Díaz MP, Zuazua-Rico D. Quality of sleep among social media users during the lockdown period due to COVID-19 in Spain. Sleep Medicine. 2021;80:210-5. https://doi.org/10.1016/j.sleep.2021.01.050

  38. García‐Tudela Á, Simonelli‐Muñoz AJ, Gallego‐Gómez JI, Rivera‐Caravaca JM. Impact of the COVID ‐19 pandemic on stress and sleep in emergency room professionals. Journal of Clinical Nursing. 2023;32(15-16):5037-5045. https://doi.org/10.1111/jocn.16738

  39. Moreno-Casbas MT, Alonso-Poncelas E, Gómez-García T, Martínez-Madrid MJ, Escobar-Aguilar G. Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System. Enfermería Clínica (English Edition). 2018;28(4):230-239. https://doi.org/10.1016/j.enfcle.2018.01.003

  40. Suleiman K, Hijazi Z, Kalaldeh MA, Sharour LA. Factors Associated with Sleep Quality Among Emergency Nurses in Jordan. Sleep Vigilance. 2020;4(1):11-6. https://doi.org/10.1007/s41782-019-00082-4

  41. Martin-Rodriguez LS, Escalda-Hernandez P, Soto-Ruiz N, Ferraz-Torres M, Rodriguez-Matesanz I, Garcia-Vivar C. Mental health of Spanish nurses working during the COVID-19 pandemic: A cross-sectional study. Int Nurs Rev. 2022;69(4):538-45. https://doi.org/10.1111/inr.12764

  42. Senol V, Soyuer F, Guleser GN, Argun M, Avsarogullari L. The Effects of the Sleep Quality of 112 Emergency Health Workers in Kayseri, Turkey on Their Professional Life. Turkish Journal of Emergency Medicine. 2014;14(4):172-178. https://doi.org/10.5505/1304.7361.2014.60437

  43. Kang J, Noh W, Lee Y. Sleep quality among shift-work nurses: A systematic review and meta-analysis. Applied Nursing Research. 2020;52:151227. https://doi.org/10.1016/j.apnr.2019.151227

  44. Bagheri Hosseinabadi M, Ebrahimi MH, Khanjani N, Biganeh J, Mohammadi S, Abdolahfard M. The effects of amplitude and stability of circadian rhythm and occupational stress on burnout syndrome and job dissatisfaction among irregular shift working nurses. J Clin Nurs. 2019;28(9-10):1868-78. https://doi.org/10.1111/jocn.14778

  45. Giorgi F, Mattei A, Notarnicola I, Petrucci C, Lancia L. Can sleep quality and burnout affect the job performance of shift-work nurses? A hospital cross-sectional study. J Adv Nurs. 2018;74(3):698-708. https://doi.org/10.1111/jan.13484

  46. Meneguin S, Ignácio I, Pollo CF, Honório HM, Patini MSG, de Oliveira C. Burnout and quality of life in nursing staff during the COVID-19 pandemic. BMC Nurs. 2023;22(1):14. https://doi.org/10.1186/s12912-022-01168-7

  47. Olagunju AT, Bioku AA, Olagunju TO, Sarimiye FO, Onwuameze OE, Halbreich U. Psychological distress and sleep problems in healthcare workers in a developing context during COVID-19 pandemic: Implications for workplace wellbeing. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2021;110:110292. https://doi.org/10.1016/j.pnpbp.2021.110292

  48. Rahnavard F, Sadati AK, Hemmati S, Ebrahimzade N, Sarikhani Y, Heydari ST, et al. The impact of environmental and demographic factors on nursing job satisfaction. Electron Physician. 2018;10(4):6712-7. https://doi.org/10.19082/6712

  49. Rouxel G, Michinov E, Dodeler V. The influence of work characteristics, emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers. Int J Nurs Stud. 2016;62:81-89. https://doi.org/10.1016/j.ijnurstu.2016.07.010

  50. Toscano F, Tommasi F, Giusino D. Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors. Int J Environ Res Public Health. 2022;19(19):12914. https://doi.org/10.3390/ijerph191912914

  51. Petrino R, Riesgo LGC, Yilmaz B. Burnout in emergency medicine professionals after 2 years of the COVID-19 pandemic: a threat to the healthcare system? Eur J Emerg Med. 2022;29(4):279-284.https://doi.org/10.1097/MEJ.0000000000000952

  52. de Pinho LG, Sampaio F, Sequeira C, Teixeira L, Fonseca C, Lopes MJ. Portuguese Nurses’ Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak. Int J Environ Res Public Health. 2021;18(7):3490. https://doi.org/10.3390/ijerph18073490