Anxiety, Working Atmosphere, and Feelings of Depression are Independent Predictors of Poor Sleep Quality: A Random Sample Survey Among First-Line Shift-Working Nurses

Monday, July 11, 2011

Hui-Ling Lai, BSN, MSN, MS(PH), PhD, RN
Nursing, Tzu Chi University/ Buddhist Tzu Chi General Hospital, Hualien, Taiwan

Learning Objective 1: The learner will understand the independent predictors of poor sleep quality in random sampling first line nurses.

Learning Objective 2: The learner will be able to consider developing an effective method of improving wellbeing in the professional nursing workforce.


This study aims to determine the prevalence and associations of poor sleep quality in first line shift work nurses. According to a global survey of 2203 nurses in 11 countries only 33% of nurses in Taiwan are likely to remain in the profession over the next five years. Nurses often complain about poor sleep. Sleep disturbance can in turn become a salient factor in nurses’ decisions to leave the profession. Little is known about the sleep quality of nursing staff compared to the vast amount of knowledge pertaining to that of the general population.


We conducted a two-stage, cross-sectional, hospital-based study in different hospitals with varying levels of accreditation in Taiwan, in April 2010. We randomly selected nurses and administered a researcher-designed questionnaire with standardized instruments, to determine the characteristics and sleep quality of subjects. Sleep quality was identified using the Pittsburgh Sleep Quality Index (PSQI). Subjects completed the self-reported PSQI, together with a number of other questions designed for the purpose of the study. Multiple logistic regression analysis was employed to identify relationships between variables.


The response rate was 90.6%. Subjects (n = 661) ranged in age from 21 to 62 years, with a mean age of 31.86 (SD = 8.09). The prevalence of poor sleep quality was 59% (n = 390). Multivariate logistic regression analyses revealed that poor sleepers are more likely to have higher anxiety (OR= 1.06, 95% CI: 1.04-1.08), feelings of depression (OR=1.10, 95% CI: 1.01-1.20), and a poor working atmosphere (OR= 0.86, 95% CI: 0.80-0.92).


Anxiety, working atmosphere, and feelings of depression are independent predictors of poor sleep quality. The study findings may be used as outcome variables for developing an effective method of improving wellbeing in the professional nursing workforce.