Sleep and Professional Burnout in Nurses, Nursing Technicians, and Nursing Assistants During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic may trigger sleep disorders and burnout in nursing professionals. PURPOSE: This study was designed to describe the occurrence of sleep disorders and burnout in a nursing team during the COVID-19 pandemic and to identify the associated factors. METHODS: A cross-sectional approach was used. The questionnaire was administered via the Internet. All of the participants were nursing professionals who had provided care during the COVID-19 pandemic, and data were collected between June and August 2020. Sociodemographic and work characterization instruments, the Jenkins Sleep Scale, and the Maslach Burnout Inventory were used. RESULTS: Five hundred seventy-two nursing professionals (nurses, nursing technicians, and nursing assistants) responded. Slightly over one quarter (26.4%) presented a sleep disorder, and 17.3% presented burnout. Professional category was a factor found to be associated with having a sleep disorder. Moreover, a lower prevalence both of disorders and of starting to use sleep medication was found among nurses than nursing assistants. Moreover, an association was found between having a high level of emotional exhaustion burnout and being a nursing technician, having a higher number of patients needing care, and starting to use sleep medication. The level of burnout related to depersonalization was significantly higher for nursing assistants, those with a weekly workload of 50 hours or more, and those starting to use sleep medication. Furthermore, burnout related to personal accomplishment was significantly higher in those starting to use sleep medication. Among the participants with sleep disorders, according to Jenkins Sleep Scale results, all of the participants presented a high or moderate level of emotional exhaustion and a high level of burnout related to personal accomplishment. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings indicate that the incidence of sleep disorders and burnout were high among nursing professionals during the COVID-19 pandemic and mainly related with starting to use sleep medication. The results demonstrate the importance of detecting and assessing the frequency of sleep disorders and professional exhaustion. Interventions that aim to improve sleep quality and working conditions for these professionals should be developed.

Nursing process documentation: rationale and methods of analytical study.

OBJECTIVE: to describe the methods used to analyze the associations between variables of service, nursing and the nursing process documentation in institutions of the Department of Health of the State of São Paulo. METHOD: multilevel analytical study with data obtained in the domains of institution, units of the institution and nursing professionals who work there, using standardized instruments. The analyses had as axis the degree of completeness of the nursing process documentation in units or institutions and their association with variables of nursing personnel, of units and of institutions. CONCLUSION: This study will provide important empirical evidence on the factors involved in the nursing process documentation.

Self-care in heart failure patients.

OBJECTIVE: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients. METHOD: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care). Association tests were applied, considering a descriptive level of 0.05. RESULTS: the mean age of participants was 57.7 (SD =11.3) years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0) years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3), selfcare management: 50.0 (SD = 20.3) and self-care confidence: 52.6 (SD=22.7)) and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%), self-care management (14.7%) and self-care confidence (19%). Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001), longer time of experience with the disease (p=0.05) and joint monitoring by physician and nurse (p=0.007). CONCLUSION: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement.

Rasch Analysis of the Power as Knowing Participation in Change Tool--the Brazilian version.

OBJECTIVES: the objective of this study was to evaluate the items contained in the Brazilian version of the Power as Knowing Participation in Change Tool (PKPCT). METHOD: investigation of the psychometric properties of the mentioned questionnaire through Rasch analysis. RESULTS: the data from 952 nursing assistants and 627 baccalaureate nurses were analyzed (average age 44.1 (SD=9.5); 13.0% men). The subscales Choices, Awareness, Freedom and Involvement were tested separately and presented unidimensionality; the categories of the responses given to the items were compiled from 7 to 3 levels and the items fit the model well, except for the following/leading item, in which the infit and outfit values were above 1.4; this item has also presented Differential Item Functioning (DIF) according to the participant's role. The reliability of the items was of 0.99 and the reliability of the participants ranged from 0.80 to 0.84 in the subscales. Items with extremely high levels of difficulty were not identified. CONCLUSIONS: the PKPCT should not be viewed as unidimensional, items with extremely high levels of difficulty in the scale need to be created and the differential functioning of some items has to be further investigated.

Sleeping difficulties reported by patients with heart failure.

The study aimed to describe the reports of heart failure patients on the factors that cause difficulties to sleep and the association of these factors with the quality of sleep. This cross-sectional study involved a non-probabilistic sample of 400 patients (mean age 57.8 years, 64.8% were men, average education of 6.1 years, 82.5% in functional class II or III) with heart failure. The main factors associated with sleeping difficulty were: nocturia, interrupted sleep at night and breathing difficulty. Sleeping difficulties in heart failure patients are diverse and there is an association between these difficulties and quality of sleep. Most of these disorders warrant professional nursing interventions.

[Factors associated to sleep pattern in heart failure patients]. / Fatores associados ao padrão de sono em pacientes com insuficiência cardíaca.

The objective of this study was to describe sleep patterns in patients with heart failure (HF) and analyze associations between sleep and the following variables: gender, age, fatigue, fatigue on exertion, physical activity, functional class, drug therapy, dyspnea, and body mass index. The nonprobability sample consisted of 400 patients (mean age 57.8 years; 64.8% were men, average schooling of 6.1 years; 82.5% Functional Class II or III). The prevalence of poor sleepers was 68.5%, and 46.5% rated sleep as poor or very poor. Scores suggest that the bad sleeper category was associated with: female, unemployed, fatigue, fatigue on exertion, dyspnea and higher functional classes of HF. The proportion of poor sleepers among patients with HF is among the highest in chronic diseases. Dyspnea and fatigue, common symptoms of this disease, significantly increase the chance of being a bad sleeper.