Sleep Quality among Emergency Team Members and its Associated Factors in the Military Hospitals

The current findings, showed those received training courses in time or sleep management exhibited lower poor sleep score than those who do not attend and could explained by the fact such training enhances individuals’ way of thinking in terms or balance their sleep and adjust with tension stressor. It’s worth noting that the effect of this factor was not reported in the literature, as no study investigated the effect of such courses. However Suleiman et al ⁽⁶⁾ found no association between sleep quality and emergency courses such as life support.

   The workload has demonstrated a positive correlation with poor sleep quality , this comes a matter of fact that the workload may increase fatigue level,  which in turn can reduce the ability to get adequate sleep and it’s worth noting that the factor was not captured directly in previous studies. However, it reported that long working hours and fatigue level were significantly correlated with poor sleep quality ^(36-37). Further, Weaver et al ⁽³⁸⁾ found high demanding work environment such as emergency department has correlated with poor sleep quality and quantity

Our regression analysis has shown that, neither marital status, education level nor gender exhibit a significant correlation with sleep disturbances and these results have agreed with Suleiman et al ⁽⁶⁾ and Han et all ⁽²⁶⁾ p>0.05, However our bivariate correlation showed that married and less educated had a higher score of sleep alternation, this may explained by the fact that married healthcare providers have dual roles as family caregivers and employees. Additionally the less educated may struggle to manage their work and balance their sleep due to insufficient knowledge or skill they have, besides in bivariate correlation, the shared relationship between two variables are examined without controlling for the effect of other variables as in regression

Finally, this study considers the first study conducted in Jordan involved both emergency nurses and physicians, the finding revealed that the nurses reported higher poor sleep quality than the physicians, this could explain by the fact of the variation of sample size between both groups. However this result was consistent with other global studies showed that the nurses reported higher sleep disturbances than the physicians ^{(6-7, 13-19)}

Limitations

The study’s limitation may stem from its’ design which the temporal relationship between independent and dependent variables cannot be guaranteed, the sleep quality and workload were measured on subjective bases through using self-reporting which may decrease the accuracy of obtained responses due to misunderstanding questions or not taking the survey seriously. Another limitation could effect was recall bias, since there were some questions required the respondents to recall some information during the last month which may have the possibility to over or under reporting. Moreover the study included emergency members who disclosed to participate voluntarily, the voluntary participation may effect on study findings generalizability, since the emergency team members who were unwilling to take place may differ from those did take part. The final limitation is, the participants’ psychological state (stress, anxiety) were not measured through the survey, and we might think such trait could interfere with self-reporting toward either sleep quality or workload level.

Conclusion

The study concluded that poor sleep quality is common trait among emergency team members and it reported in high percentage 86.7%. In final regression model, the poor sleep quality was not affected by married status and educational level, while having high workload level, did not attend any training courses and working on rotational fluctuation reported higher poor sleep quality level than their counterparts. In contrast, being older in age and having more experience in work and being physicians demonstrated lower poor sleep quality. Thus sleeping, workload and time management interventions are advisable.

Recommendations

Further studies are needed to examine sleep quality and associated factors among emergency team members in different healthcare sectors in Jordan not only the military hospitals, besides future studies may suggestible to measure the consequences of sleep disturbances on emergency team members’ quality of life , job productivity and patient safety . Mitigating interventions are required to enhance their sleep level 

Study findings implications

The frontlines healthcare providers (emergency nurses and physicians) are at risk for sleep disturbances, therefore experiencing of poor sleep quality may cause several physical and mental disorders which lead to commit medical mistakes.

Table (I) Emergency team members socio-demographical characteristics N=210

Table II: Sleep quality of emergency team members’ N=210

Table III: Relationship between sleep quality and emergency team members’ socio-demographical characteristics

^{Correlation range: 0.00-0.19 very weak, 0.20-0.39 weak, 0.40-0.59 moderate, 0.6-0.79 strong, >0.8 very strong}

^{rpb= point biserial correlation , r= Pearson correlation, rs= Spearman correlation, ns: not significant} 

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Appendix (A) Theoretical and operational definition

Appendix (B) proportional allocation of the sample size

(Appendix C)

A-  Pittsburgh Sleep Quality Index (PSQI)

The following questions relate to your usual sleep habits during the past month only. Your answers should indicate the most accurate reply for the majority of days and nights in the past month. Please answer all questions.

1.     During the past month, what time have you usually gone to bed at night?                                                                                                                                    

2.     During the past month, how long (in minutes) has it usually taken you to fall asleep each night?  

3.     During the past month, what time have you usually gotten up in the morning?     

4.     During the past month, how many hours of actual sleep did you get at night? (This may be different than the number of hours you spent in bed.)  

(Appendix D)

B-     (NASA-TLX)

This tool refers to the workload while performing a task. Click on each scale at the point that best reflects your experience with the task.

1-     Mental demand: how much thinking, deciding, or calculating was required to perform task?

2-     Physical demand: the amount and intensity of physical activity required to complete task.

3-     Temporal demand: – the amount of time pressure involved in completing the task.

4-     Effort: how hard does the participant have to work to maintain their level of performance?

5-     Performance:  the level of success in completing the task.

6-     Frustration level: how insecure, discouraged, or secure or content the participant felt during the task.

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