Sleep quality of nurses who worked in coping with COVID-19: an integrative review

Ribeiro, Ítalo Arão Pereira; Oliveira, Ana Lívia Castelo Branco de; Feitosa, Carla Danielle Araújo; Pillon, Sandra Cristina; Marziale, Maria Helena Palucci; Fernandes, Márcia Astrês

doi:10.1590/0034-7167-2023-0007

Ítalo Arão Pereira Ribeiro Corresponding author: Ítalo Arão Pereira Ribeiro, E-mail: italoaarao@hotmail.com

study/research conception or design

data analysis and/or interpretation

Universidade Federal do Piauí. Teresina, Piauí, Brazil

https://orcid.org/0000-0003-0778-1447

Ana Lívia Castelo Branco de Oliveira

study/research conception or design

data analysis and/or interpretation

Universidade Federal do Piauí. Teresina, Piauí, Brazil

https://orcid.org/0000-0002-2634-0594

Carla Danielle Araújo Feitosa

study/research conception or design

data analysis and/or interpretation

Universidade Federal do Piauí. Teresina, Piauí, Brazil

https://orcid.org/0000-0001-7347-6972

Sandra Cristina Pillon

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

https://orcid.org/0000-0001-8902-7549

Maria Helena Palucci Marziale

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

https://orcid.org/0000-0003-2790-3333

Márcia Astrês Fernandes

final review with critical and intellectual participation in the manuscript

Universidade Federal do Piauí. Teresina, Piauí, Brazil

https://orcid.org/0000-0001-9781-0752

Corresponding author: Ítalo Arão Pereira Ribeiro, E-mail: italoaarao@hotmail.com

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Rafael Silva

Health Sciences Descriptors
P	DC	Enfermeiras e Enfermeiros
P	DNC	Nurses; Enfermeras y Enfermeros; Enfermeira; Enfermeiro; Enfermeiro Registrado
I	DC	Sono
I	DNC	Sleep; Sueño; Hábito de Dormir
Co	DC	COVID-19
Co	DNC	COVID-19; COVID19; Pandemia COVID-19; Pandemia por COVID-19
Medical Subject Headings
P	DC	Nurses
P	DNC	Nurse; Registered Nurse
I	DC	Sleep
I	DNC	Sleeping Habits; Sleep Habit
Co	DC	COVID-19; COVID-19 Pandemic
Co	DNC	COVID 19; SARS-CoV-2 Infection
Search expression
( (MH “Nurses”) OR “nurses” OR “nurse” OR “Registered Nurses” ) AND ( (MH “Sleep”) OR “sleep” OR “Sleeping Habits” ) AND ( (MH “COVID-19”) OR “COVID 19” OR “SARS-CoV-2 Infection” OR (MH “COVID-19 Pandemic”) OR “COVID-19 Pandemic” )

Reference	Sample (n) and context	Disorders identified	Associated factors	Recommendations
Kandemir D(¹⁸18 Kandemir D, Temiz Z, Ozhanli Y, Erdogan H, Kanbay Y. Analysis of mental health symptoms and insomnia levels of intensive care nurses during the COVID-19 pandemic with a structural equation model. J Clin Nurs. 2022;31(5-6):601-11. http://doi.org/10.1111/jocn.15918 http://doi.org/10.1111/jocn.15918... )	n = 194 Intensive Care Unit	Mild (40.7%), moderate (21.6%) and severe (18.1%) insomnia.	Average weekly working time (49.78 hours), health problem (70.1%), perception that measures to prevent infection are insufficient (78.4%) and depression.	Expansion of the scientific base to propose coping strategies.
Nazari N(¹⁹19 Nazari N, Sadeghi M, Samusenkov V, Aligholipour A. Factors associated with insomnia among frontline nurses during COVID-19: a cross-sectional survey study. BMC Psychiatry. 2022;22(1):40. http://doi.org/10.1186/s12888-022-03690-z http://doi.org/10.1186/s12888-022-03690-... )	n = 680 Hospital care	Moderate and severe insomnia (35.8%).	Being female, neuroticism, difficulties in emotional regulation, psychopathological vulnerability.	Therapeutic programs.
Huang L(²⁰20 Huang L, Lei W, Liu H, Hang R, Tao X, Zhan Y. Nurses' Sleep Quality of "Fangcang" Hospital in China during the COVID-19 Pandemic. Int J Ment Health Addict. 2022;20(2):789-99. http://doi.org/10.1007/s11469-020-00404-y http://doi.org/10.1007/s11469-020-00404-... )	n = 966 Hospital care	Moderate sleep quality.	High demand for work, low support and family support, lack of training and qualification.	Strengthening and building support systems.
Silva AF(²¹21 Silva AF, Dalri RCMB, Eckeli AL, Uva ANPS, Mendes AMOC, Robazzi MLDCC. Sleep quality, personal and work variables and life habits of hospital nurses. Rev Latino-Am Enfermagem. 2022;30:e3577. http://doi.org/10.1590/1518-8345.5756.3577 http://doi.org/10.1590/1518-8345.5756.35... )	n = 42 Hospital care	Poor sleep quality (64.3%).	Age group 30-39 years old and living with a partner.	Monitoring strategies.
Sayilan AA(²²22 Sayilan A, Kulakaç N, Uzun S. Burnout levels and sleep quality of COVID-19 heroes. Perspect Psychiatr Care. 2021;57(3):1231-6. http://doi.org/10.1111/ppc.12678 http://doi.org/10.1111/ppc.12678... )	n = 384 Hospital care	Insomnia.	Emotional exhaustion, depersonalization, work unit.	Improvements in working conditions and scheduling to ensure adequate sleep.
Bernburg M(²³23 Bernburg M, Hetzmann MS, Mojtahedzadeh N, Neumann FA, Augustin M, Harth V, et al. Stress perception, sleep quality and work engagement of German Outpatient Nurses during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021;19(1):313. http://doi.org/10.3390/ijerph19010313 http://doi.org/10.3390/ijerph19010313... )	n = 199 Outpatient care	Significant reduction and impairment of sleep quality.	Stress.	Behavioral, organizational and occupational intervention studies.
Bilgiç S(²⁴24 Bilgiç Ş, Çelikkalp Ü, Mısırlı C. Stress level and sleep quality of nurses during the COVID-19 pandemic. Work. 2021;70(4):1021-9. http://doi.org/10.3233/WOR-210538 http://doi.org/10.3233/WOR-210538... )	n = 316 Hospital care	Low sleep quality.	Work shift, high stress level, co-worker with COVID-19 and having older family members.	Proactive approaches to psychological support and well-being promotion.
Sis CA(²⁵25 Sis Çelik A, Sönmez T. Comparison of the fear levels and sleep problems of nurses working in wards where patients with and without COVID-19 are hospitalized: a study from Turkey. Psychiatr Danub [Internet]. 2021[cited 2022 Oct 13];33(Suppl13):357-63. Available from: https://pubmed.ncbi.nlm.nih.gov/35150509/ https://pubmed.ncbi.nlm.nih.gov/35150509... )	n = 211 Hospital care	Low sleep quality.	Fear of acting on the front line and providing care to patients diagnosed with COVID-19.	Individual and institutional support, and better working conditions.
Chen X(²⁶26 Chen X, Liu P, Lei GF, Tong L, Wang H, Zhang XQ. Sleep quality and the depression-anxiety-stress state of frontline nurses who perform nucleic acid sample collection during COVID-19: a cross-sectional study. Psychol Res Behav Manag. 2021;14:1889-900. http://doi.org/10.2147/PRBM.S338495 http://doi.org/10.2147/PRBM.S338495... )	n = 248 Hospital care	Low latency, efficiency and sleep quality.	Anxiety (81.36%), depression (45.76%) and stress (42.59%).	Crisis management interventions and mental health adjustment.
Kim-Godwin YS(²⁷27 Kim-Godwin YS, Lee MH, Logan JG, Liu X. Factors influencing sleep quality among female staff nurses during the early COVID-19 Pandemic in the United States. Int J Environ Res Public Health. 2021;18(9):4827. http://doi.org/10.3390/ijerph18094827 http://doi.org/10.3390/ijerph18094827... )	n = 215 Teaching and health institution	Daytime dysfunction and dependence on hypnotic drugs.	Full-time job, low perceived health status, and impairment in self-regulation and self-care.	Intervention programs to improve the work environment, health status and work performance.
Li Y(²⁸28 Li Y, Lv X, Li R, Wang Y, Guan X, Li L, et al. Predictors of shift work sleep disorder among nurses during the COVID-19 Pandemic: a multicenter cross-sectional study. Front Public Health. 2021;9:785518. http://doi.org/10.3389/fpubh.2021 http://doi.org/10.3389/fpubh.2021... )	n = 4,275 Hospital care	Low sleep quality (48.5%).	Physical fatigue, psychological stress, night work, weekly workload of more than 40 hours, irregular meals and high-intensity physical activity.	Expansion of professional staff and rest hours, promotion of family and social support.
Liang M(²⁹29 Liang M, Chen Q, Li Y, Fan X, Wang Q, Wang J, et al. Status quo and influencing factors for anxiety, depression, and insomnia among 4.237 nurses in Hunan Province. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021;46(8):822-30. https://doi.org/10.11817/j.issn.1672-7347.2021.210212 https://doi.org/10.11817/j.issn.1672-734... )	n = 4,237 Hospital care	Moderate to severe insomnia (12.3%).	Being female, night shift work, low monthly income, and generalized anxiety.	Management policies, psychological support and protection of human resources.
Simonetti V(³⁰30 Simonetti V, Durante A, Ambrosca R, Arcadi P, Graziano G, Pucciarelli G, et al. Anxiety, sleep disorders and self-efficacy among nurses during COVID-19 pandemic: a large cross-sectional study. J Clin Nurs. 2021;30(9-10):1360-71. http://doi.org/10.1111/jocn.15685 http://doi.org/10.1111/jocn.15685... )	n = 1,005 Hospital care	Moderate sleep quality (71.4%).	Being female and anxiety.	Strategies for recognizing the degree of exposure and risk.
Tu ZH(³¹31 Tu ZH, He JW, Zhou N. Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: a cross-sectional study. Medicine (Baltimore). 2020;99(26):e20769. http://doi.org/10.1097/MD.0000000000020769 http://doi.org/10.1097/MD.00000000000207... )	n = 100 Hospital care	Low latency, difficulty initiating or maintaining sleep. Use of hypnotics.	Depression and anxiety.	Behavioral, psychosocial and individual strategies.
Zhan Y(³²32 Zhan Y, Liu Y, Liu H, Li M, Shen Y, Gui L, et al. Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: a cross-sectional survey. J Nurs Manag. 2020;28(7):1525-35. http://doi.org/10.1111/jonm.13094 http://doi.org/10.1111/jonm.13094... )	n = 1,794 Hospital care	Insomnia (52.8%).	Female sex, chronic diseases, care of confirmed cases, night shifts, family members with severe infection, fear, fatigue and perceived stress.	Interventions based on sleep predictors and determinants.

[1] Corresponding author: Ítalo Arão Pereira Ribeiro, E-mail: italoaarao@hotmail.com

Brasil

Brasil

Sleep quality of nurses who worked in coping with COVID-19: an integrative review

Calidad del sueño de enfermeros que actuaron en el enfrentamiento a la COVID-19: revisión integradora

ABSTRACT

Objective:

Methods:

Results:

Final considerations:

Author and journal	Title	Year	Country	Method/level of evidence
Kandemir D(¹⁸18 Kandemir D, Temiz Z, Ozhanli Y, Erdogan H, Kanbay Y. Analysis of mental health symptoms and insomnia levels of intensive care nurses during the COVID-19 pandemic with a structural equation model. J Clin Nurs. 2022;31(5-6):601-11. http://doi.org/10.1111/jocn.15918 http://doi.org/10.1111/jocn.15918... ) Journal of Clinical Nursing	Analysis of mental health symptoms and insomnia levels of intensive care nurses during the COVID-19 pandemic with a structural equation model	2022	Turkey	Longitudinal 2C
Nazari N(¹⁹19 Nazari N, Sadeghi M, Samusenkov V, Aligholipour A. Factors associated with insomnia among frontline nurses during COVID-19: a cross-sectional survey study. BMC Psychiatry. 2022;22(1):40. http://doi.org/10.1186/s12888-022-03690-z http://doi.org/10.1186/s12888-022-03690-... ) BMC Psychiatry	Factors associated with insomnia among frontline nurses during COVID-19: a cross-sectional survey study	2022	Iran	Cross-sectional 2C
Huang L(²⁰20 Huang L, Lei W, Liu H, Hang R, Tao X, Zhan Y. Nurses' Sleep Quality of "Fangcang" Hospital in China during the COVID-19 Pandemic. Int J Ment Health Addict. 2022;20(2):789-99. http://doi.org/10.1007/s11469-020-00404-y http://doi.org/10.1007/s11469-020-00404-... ) Int J Ment Health Addict	Nurses’ Sleep Quality of “Fangcang” Hospital in China during the COVID-19 Pandemic	2022	China	Cross-sectional 2C
Silva AF(²¹21 Silva AF, Dalri RCMB, Eckeli AL, Uva ANPS, Mendes AMOC, Robazzi MLDCC. Sleep quality, personal and work variables and life habits of hospital nurses. Rev Latino-Am Enfermagem. 2022;30:e3577. http://doi.org/10.1590/1518-8345.5756.3577 http://doi.org/10.1590/1518-8345.5756.35... ) Rev. Latino-Am. Enfermagem	Sleep quality, personal and work variables and life habits of hospital nurses	2022	Brazil	Cross-sectional 2C
Sayilan AA(²²22 Sayilan A, Kulakaç N, Uzun S. Burnout levels and sleep quality of COVID-19 heroes. Perspect Psychiatr Care. 2021;57(3):1231-6. http://doi.org/10.1111/ppc.12678 http://doi.org/10.1111/ppc.12678... ) Perspect Psychiatr Care	Burnout levels and sleep quality of COVID-19 heroes	2021	Turkey	Cross-sectional 2C
Bernburg M(²³23 Bernburg M, Hetzmann MS, Mojtahedzadeh N, Neumann FA, Augustin M, Harth V, et al. Stress perception, sleep quality and work engagement of German Outpatient Nurses during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021;19(1):313. http://doi.org/10.3390/ijerph19010313 http://doi.org/10.3390/ijerph19010313... ) Int J Environ Res Public Health	Stress Perception, Sleep Quality and Work Engagement of German Outpatient Nurses during the COVID-19 Pandemic	2021	Germany	Cross-sectional 2C
Bilgiç S(²⁴24 Bilgiç Ş, Çelikkalp Ü, Mısırlı C. Stress level and sleep quality of nurses during the COVID-19 pandemic. Work. 2021;70(4):1021-9. http://doi.org/10.3233/WOR-210538 http://doi.org/10.3233/WOR-210538... ) Work	Stress level and sleep quality of nurses during the COVID-19 pandemic	2021	Turkey	Cross-sectional 2C
Sis CA(²⁵25 Sis Çelik A, Sönmez T. Comparison of the fear levels and sleep problems of nurses working in wards where patients with and without COVID-19 are hospitalized: a study from Turkey. Psychiatr Danub [Internet]. 2021[cited 2022 Oct 13];33(Suppl13):357-63. Available from: https://pubmed.ncbi.nlm.nih.gov/35150509/ https://pubmed.ncbi.nlm.nih.gov/35150509... ) Psychiatr Danub	Comparison of the Fear Levels and Sleep Problems of Nurses Working in Wards Where Patients with and without COVID-19 Are Hospitalized: A Study from Turkey	2021	Turkey	Cross-sectional 2C
Chen X(²⁶26 Chen X, Liu P, Lei GF, Tong L, Wang H, Zhang XQ. Sleep quality and the depression-anxiety-stress state of frontline nurses who perform nucleic acid sample collection during COVID-19: a cross-sectional study. Psychol Res Behav Manag. 2021;14:1889-900. http://doi.org/10.2147/PRBM.S338495 http://doi.org/10.2147/PRBM.S338495... ) Psychol Res Behav Manag	Sleep Quality and the Depression-Anxiety-Stress State of Frontline Nurses Who Perform Nucleic Acid Sample Collection During COVID-19: A Cross-Sectional Study	2021	China	Cross-sectional 2C
Kim-Godwin YS(²⁷27 Kim-Godwin YS, Lee MH, Logan JG, Liu X. Factors influencing sleep quality among female staff nurses during the early COVID-19 Pandemic in the United States. Int J Environ Res Public Health. 2021;18(9):4827. http://doi.org/10.3390/ijerph18094827 http://doi.org/10.3390/ijerph18094827... ) Res Public Health	Factors influencing sleep quality among female staff nurses during the early COVID-19 pandemic in the United States	2021	USA	Cross-sectional 2C
Li Y.(²⁸28 Li Y, Lv X, Li R, Wang Y, Guan X, Li L, et al. Predictors of shift work sleep disorder among nurses during the COVID-19 Pandemic: a multicenter cross-sectional study. Front Public Health. 2021;9:785518. http://doi.org/10.3389/fpubh.2021 http://doi.org/10.3389/fpubh.2021... ) Front Public Health	Predictors of Shift Work Sleep Disorder Among Nurses During the COVID-19 Pandemic: A Multicenter Cross-Sectional Study	2021	China	Cross-sectional 2C
Liang M (²⁹29 Liang M, Chen Q, Li Y, Fan X, Wang Q, Wang J, et al. Status quo and influencing factors for anxiety, depression, and insomnia among 4.237 nurses in Hunan Province. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021;46(8):822-30. https://doi.org/10.11817/j.issn.1672-7347.2021.210212 https://doi.org/10.11817/j.issn.1672-734... ) Zhong Nan Da Xue	Status quo and influencing factors for anxiety, depression, and insomnia among 4237 nurses in Hunan Province	2021	China	Cross-sectional 2C
Simonetti V(³⁰30 Simonetti V, Durante A, Ambrosca R, Arcadi P, Graziano G, Pucciarelli G, et al. Anxiety, sleep disorders and self-efficacy among nurses during COVID-19 pandemic: a large cross-sectional study. J Clin Nurs. 2021;30(9-10):1360-71. http://doi.org/10.1111/jocn.15685 http://doi.org/10.1111/jocn.15685... ) J Clin Nurs	Anxiety, sleep disorders and self-efficacy among nurses during COVID-19 pandemic: A large cross-sectional study	2021	Italy	Cross-sectional 2C
Tu ZH(³¹31 Tu ZH, He JW, Zhou N. Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: a cross-sectional study. Medicine (Baltimore). 2020;99(26):e20769. http://doi.org/10.1097/MD.0000000000020769 http://doi.org/10.1097/MD.00000000000207... ) Medicine	Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: A cross-sectional study	2020	China	Cross-sectional 2C
Zhan Y(³²32 Zhan Y, Liu Y, Liu H, Li M, Shen Y, Gui L, et al. Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: a cross-sectional survey. J Nurs Manag. 2020;28(7):1525-35. http://doi.org/10.1111/jonm.13094 http://doi.org/10.1111/jonm.13094... ) J Nurs Manag	Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: A cross-sectional survey	2020	China	Cross-sectional 2C