Sleep Quality and Its Relationship to Anxiety and Hardiness in a Cohort of Frontline Italian Nurses during the First Wave of the COVID-19 Pandemic

Samuele Baldassini Rodriguez; Yari Bardacci; Khadija El Aoufy; Marco Bazzini; Christian Caruso; Gian Domenico Giusti; Andrea Mezzetti; Alberto Lucchini; Pasquale Iozzo; Andrea Guazzini; Camilla Elena Magi; Paolo Iovino; Yari Longobucco; Laura Rasero; Stefano Bambi

doi:10.3390/nursrep13030103

Sleep Quality and Its Relationship to Anxiety and Hardiness in a Cohort of Frontline Italian Nurses during the First Wave of the COVID-19 Pandemic

Nurs Rep. 2023 Sep 7;13(3):1203-1215. doi: 10.3390/nursrep13030103.

Authors

Samuele Baldassini Rodriguez¹, Yari Bardacci¹, Khadija El Aoufy², Marco Bazzini¹, Christian Caruso³, Gian Domenico Giusti^{4

5}, Andrea Mezzetti³, Alberto Lucchini⁶, Pasquale Iozzo⁷, Andrea Guazzini^{8

9}, Camilla Elena Magi¹⁰, Paolo Iovino¹⁰, Yari Longobucco¹⁰, Laura Rasero¹⁰, Stefano Bambi¹⁰

Affiliations

¹ Emergency and Trauma Intensive Care Unit, Careggi University Hospital, 50134 Florence, Italy.
² Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
³ Emergency Medical System-AUSL Toscana Centro, 50122 Florence, Italy.
⁴ Medicine and Surgery Department, University of Perugia, 06100 Perugia, Italy.
⁵ Teaching and Quality Department, Perugia University Hospital, 06100 Perugia, Italy.
⁶ UOS Terapia Intensiva Generale e UOSD Emergenza Intraospedaliera e Trauma Team, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy.
⁷ Emergency Department, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, 90100 Palermo, Italy.
⁸ Department of Education, Languages, Intercultural Studies, Literatures and Psychology, University of Florence, 50135 Florence, Italy.
⁹ Center for the Study of Complex Dynamics (CSDC), University of Florence, 50134 Florence, Italy.
¹⁰ Department of Health Sciences, University of Florence, 50134 Florence, Italy.

Abstract

Introduction: The COVID-19 pandemic has had a considerable impact on the psychological and psychopathological status of the population and health care workers in terms of insomnia, anxiety, depression, and post-traumatic stress disorder. The primary aim of this study was to describe and evaluate the impact of the pandemic on insomnia levels of a cohort of Italian nurses, particularly those involved in the care of COVID-19 patients. The secondary aim was to identify the interaction between insomnia and hardiness, anxiety, and sleep disturbances.

Materials and methods: A descriptive-exploratory study was conducted using an online survey during the first wave of the COVID-19 pandemic (March to July 2020). The questionnaire consisted of multiple-choice, open-ended, closed, and semi-closed questions. The psychometric tools administered were the Dispositional Resilience Scale (DRS-15), the State-Trait Anxiety Inventory (STAI-Y), and the Insomnia Severity Index (ISI).

Results: a cohort of 1167 nurses fully completed the questionnaire (86.2% of total respondents). The insomnia scale survey showed an increase in post-pandemic scores compared to those before the pandemic, implying that insomnia levels increased after the first pandemic wave. Insomnia scores were directly correlated with anxiety levels (r = 0.571; p ≤ 0.05) and inversely correlated with hardiness levels (r = -0.324; p < 0.001). Multivariate analysis revealed the following protective factors: not having worked in COVID-19 wards, high levels of hardiness (commitment), and the presence of high pre-pandemic insomnia disorder. The main risk factor for insomnia reported in the analysis was a high anxiety score.

Discussion and conclusion: Anxiety represented the main risk factor for insomnia severity in our sample, while hardiness was confirmed as a protective factor. Thus, it is necessary to design further studies to identify additional risk factors for poor sleep quality and to develop educational courses and strategies aimed at enhancing rest and sleep quality, especially for frontline nurses.

Keywords: COVID-19; hardiness; healthcare professionals; healthcare workers; insomnia; nurses; pandemic.

Grants and funding

This research received no external funding.