Nurses' Sleep Quality and Burn-out Level during Phase 2 of Covid-19 Emergency in Italy: A Multicentric Crosssectional Study of Gruppo Italiano Trapianto di Midollo Osseo

ABSTRACT

Background: Italy was one of the first European Countries to deal with the Coronavirus Disease 2019 (COVID-19) outbreak, since its appearance in China. The virus spread from northern regions to central and southern ones with different intensity. Drastic emergency restrictions were introduced including quarantine and self-isolation measures. Initially, these were limited to Northern Italy then extended nationwide. The Italian Health System is organized on a regional basis with different funding, resources, institutional pathways. Health Care Professionals (HCPs) working in clinically demanding areas such as Emergency Departments and Intensive Care Units are at high risk of developing physical/mental health outcomes related to Coronavirus pandemic, such as stress, anxiety, depression, sleep disorders and burn-out symptoms (Luo et al., 2020). Nurses in Hematopoietic Stem Cell Transplant (HSCT) Units are caring for "complex" immune-compromised patients, being hospitalized for long period without seeing relatives. However, it is not known if nurses working in HSCT settings experience similar problems during the pandemic. The aim of the study was to investigate physical and psychological issues among nurses working in Italian HSCT Units during COVID-19 spread. Methods: A cross-sectional study was conducted between June and August 2020 through an online questionnaire sent to nurses working in Italian HSCT centers registered with GITMO (Gruppo Italiano per il Trapianto Midollo Osseo). Data were collected immediately after the lockdown period (during phase 2, consisting of a progressive reduction of lockdown measures) in order to-investigate the prevalence of sleep disorders and burnout symptoms with validated tools Pittsburgh Sleep Quality Index (PSQI) and Maslach Burnout Inventory (MBI), respectively.-explore significant correlations with other variables such as geographical areas (Northern Italy-NIT vs Central Sothern Italy-CSIT) according with COVID-19 incidence, its spread. Statistical analysis was performed using the Matrix Laboratory (MATLAB) Statistical toolbox version 2008 (MathWorks, Natick, MA, USA). Results: Three hundred and eight nurses working in 61 Italian HSCT Units responded to the survey 214 nurses from NIT and 94 nurses from CSIT. Nurses responding from CSIT were older (mean 47, p = 0.0001) and male (74.5%, p < 0.0001). More nurses from NIT did not have children compared to those from CIST (49.5% vs 30.9%, p = 0.0023). Symptoms like stress, anxiety and depression were more frequently reported by CSIT than NIT nurses (NIT 27.7% vs 12.6%, p = 0.0013). MBI results: NIT and CSIT nurses reported low level of emotional exhaustion (median score 14.0 vs 12.0 respectively) and depersonalization (3.0 vs 4.0);medium level of personal accomplishment (36.0 vs 34.5) were reported without significant differences between groups. Worst sleep quality was detected on nurse working in CSIT centers than NIT (global PSQI score 7.6 vs 6.5;p = 0.008) with the main differences in sleep duration (p = 0.006), sleep disturbance (p = 0.03), need of medication (p < 0.001). Conclusions: Despite cited differences on disease incidence and spread of infection, COVID-19 pandemic did not appear to have an impact on nurses' sleep quality or symptoms of burnout. Greater sleep disorders of nurses working in CSIT centers suggests that other factors influencing this issue.