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ORIGINAL PAPER
Gke Demir,
Lecturer, Ahi Evran University, School of Health, Nursing Department, Krehir, Turkey
Corresponding Author: Yrd.Do.Dr. Ayla nsal, Ahi Evran niversitesi Salk Yksekokulu
Hemirelik Blm 40100 Krehir, Turkey Email: ay_unsal@hotmail.com, aunsal@ahievran.edu.tr
Abstract
Background: Hospitalization can significantly disrupt sleeping patterns. Insomnia in the hospitalized
patient leads to increased fatigue.
Aims and Objectives: The aim of this study was to evaluate and compare sleep quality and fatigue of the
hospitalized patients and match healthy controls.
Methodology: This is a descriptive cross-sectional study. A total of 150 hospitalized patients (internal
clinics=75, surgical clinics=75) and 50 healthy controls constituted the sample. As the data gathering
tools, a questionnaire form, Pittsburgh Sleep Quality Index, and Visual Analogue Scale for Fatigue were
used. The data was evaluated after transferring to SPSS 11.0 database in percentage, mean, independent
groups t-test, one way-ANOVA, LSD post hoc, chi-square, cronbachs alpha coefficient, pearson
product-moment correlation.
Results: We found worse sleep quality and more fatigue in patients compared to controls. Female
patients reported greater sleep disturbances and more severe fatigue than did male patients. It was found
that the severity of fatigue was significantly correlated to sleep quality score.
Conclusions: These results suggest that sleep quality and fatigue of inpatients is worse than healthy
persons; there are significant relationships between sleep quality and fatigue, indicating the need for more
individualized supportive nursing care. Patients with hospitalized need professional support from nurse. It
is expected that nurses should have the basic knowledge about sleeping problems and fatigue in
hospitalized patients when providing care to patients because of possible interactions with other
treatments.
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latency, length of sleep, sleeping habits, sleep Windows software (SPSS 1999). The
disorders, usage of sleeping pills and daytime frequencies, percentage, mean and standard
activity disorder. The roommate or partner of deviations were calculated to give a general
the inpatient answered five questions. description of the data collected. Groups were
Question 19 is not taken into consideration at compared at the bivariate level using t-tests
scoring. Each component scores between 0 for continuous variables and chi-square tests
and 3 points. The total index score is between for categorical variables. Cronbachs alpha
0 and 21. The PSQI total score of 5 and above coefficient was used for reliability analysis.
indicates bad sleep quality. The time needed Pearson product-moment correlation was
to answer the PSQI was approximately 8-10 performed for relationship of scales. One
minutes. In this study, it was found that way-ANOVA analysis, independent groups t
Cronbachs alpha internal consistency test, and LSD post hoc test were used to
coefficient was .66. determine which of the socio-demographic
VAS-F, which measures patients perceived variables were related to the PSQI and VAS-
fatigue and energy, was developed in 1991 by F. For all the analyses, a P value less than .05
Lee et al. The scale consists of 18 items was considered to be statistically significant.
related to fatigue and energy, has simple
instructions, and is completed with minimal Results
time and effort. For each question, the
Participants
individuals are asked to choose a number
from 0 to 10. A zero (0) would mean no A general description of the patients and
fatigue and ten (10) would mean exceeding control groups is given in Table 1. Of the total
fatigue (Lee ett al. 1991). The validity and sample, 52% were male, 28.5% were of age
the reliability of the Turkish version of VAS- 65 and over, 64.5% were married, and 27%
F were established by Yurtsever and Bedk had at most primary school education. Patient
(Yurtsever & Bedk 2003). The time needed groups were less educated than were healthy
to answer the VAS-F was approximately 5-7 control groups, but a statistically significant
minutes. In this study, Cronbachs alpha of difference between their education levels were
fatigue subscale was .89 and energy subscale not found. Patients had higher scores than did
was .85. healthy individuals on the PSQI and VAS-F
Fatigue subscale. Control group had higher
Procedures scores than did patients on the VAS-F Energy
Since the hospital directors approval is subscale.
enough to carry out the descriptive studies in
Predictors of sleep quality
the hospital, the study was approved by the
director of the hospital. The participants were A statistically significant difference was
informed about the aim and method of the found between PSQI and gender (p<0.05) in
study; they were told that their participation patients. In this respect, the patients age,
was voluntary, and that they have the right to marital status, and education levels were not
withdraw at any point. Participants were told considered to influence the patients sleep
that all information would be kept strictly quality (p>0.05). In control group, gender
confidential. We applied the questionnaire, (p<0.01) and marital status (p<0.05) were
PSQI and VAS-F to patient and control found to be significant predictors of sleep
groups in different places. quality. In both groups, female individuals
had worse sleep quality than males. Single +
Statistical analysis widowed + divorce individuals had worse
All data management and statistical analysis sleep quality than married individuals in the
were performed using SPSS, Version 11.0 for control group (Table 2).
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(n=200)
(% primary school)
PSQI Score: mean (SD) 6.37 (3.38) 6.63 (3.34) 5.60 (3.41) t= 1.881; df 198
VAS-F Score: mean 83.66 83.52 (22.94) 84.08 (24.84) t= -.145; df 198
(SD) (23.37)
VAS-F Fatigue Score: 56.34 57.60 (24.04) 52.56 (29.64) t= 1.210; df 198
VAS-F Energy Score: 27.32 25.92 (10.06) 31.52 (11.23) t= -3.309; df 198
p<0.001
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Table 2. Socio-demographic variables to the Visual Analogue Scale for Fatigue (VAS-F) in patient and control groups individuals
PSQI VAS-F Scores PSQI VAS-F Scores
Socio-demographic Patient Scores Fatigue Energy Control Scores Fatigue Energy
variables group __ X SD X SD group __ X SD X SD
n (%) X SD n (%) X SD
Gender
-Female 73 (48.7) 7.283.45 62.1021.01 24.909.30 23 (46.0) 7.003.89 67.0830.22 28.1712.71
-Male 77 (51.3) 6.013.13 53.3326.02 26.8810.69 27 (54.0) 4.402.43 40.1823.17 34.379.09
t= 2.367 t= 2.264 t= -1.206 t= 2.864 t= 3.559 t= -2.002
p<0.05 p<0.01 p>0.05 p<0.01 p<0.01 p>0.05
Age
-20-34 36 (24.0) 6.113.24 56.3627.01 27.7711.57 20 (40.0) 5.603.25 50.1530.72 33.5512.17
-35-49 29 (19.3) 6.823.47 54.6826.72 26.3410.27 9 (18.0) 5.222.94 48.4427.15 30.777.88
-50-64 40 (26.7) 6.522.77 60.4025.13 26.159.54 9 (18.0) 4.331.87 56.6630.55 30.0011.86
-65 + 45 (30.0) 7.023.82 58.0018.67 23.959.01 12 (6.0) 6.834.66 56.5831.81 29.8312.08
F= .536 F= .354 F= 1.005 F= .968 F= .353 F= .222
p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05
Marital Status
-Married 102(68.0) 6.883.41 57.3923.61 25.779.82 27 (54.0) 4.662.67 49.5126.22 29.7010.39
-Single + Widowed + 48 (32.0) 6.103.17 58.0625.18 26.2210.65 23 (46.0) 6.693.90 56.1333.46 33.6512.03
Divorce
t= 1.332 t= -.159 t= -.257 t= -2.171 t= -.783 t= -1.245
p>0.05 p>0.05 p>0.05 p<0.05 p>0.05 p>0.05
Education level
-Illiterate 38 (25.3) 7.443.35 62.3415.75 22.978.37 9 (18.0) 5.663.27 60.3327.09 28.3312.54
-Literate 14 (9.3) 6.574.53 54.2123.06 24.1411.34 9 (18.0) 4.882.52 51.4427.67 35.665.52
-Primary school 47 (31.3) 6.252.90 54.1921.38 26.658.00 8 (16.0) 7.123.97 58.8728.86 22.0012.40
-Secondary school 18 (12.0) 6.503.46 70.5520.91 23.279.86 6 (12.0) 4.832.99 39.5019.36 36.337.94
-High school 14 (9.3) 6.783.04 46.7135.71 33.6412.35 9 (18.0) 7.004.52 68.7735.09 32.2214.60
-University 19 (12.7) 6.003.59 54.8432.14 28.1012.40 9 (18.0) 4.002.44 32.7726.71 35.116.66
F= .711 F= 2.306 F= 3.066 F= 1.175 F= 1.240 F= 1.943
p>0.05 p<0.05 p<0.05 p>0.05 p>0.05 p>0.05
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Table 3. The distribution of the mean PSQI in patient and control groups
Table 4. The distribution of the mean PSQI and VAS-F scores of patients
according to the clinics they were in
Table 3 presents the distribution of the mean subjects had less energy than the others in
PSQI in patient and control group. As seen in patient group (Table 2).
Table 3, the mean PSQI scores of the patients The mean VAS-F scores of the patients were
are found higher than that of control group, compared according to the clinics they were
but a statistically significant difference in, the difference was not found to be
between their sleep qualities were not found significant (p>0.05) and shown in Table 4.
(p>0.05). The surgical clinic patients were more
The mean PSQI scores of the patients in Table fatigued and less energetic than internal clinic
4 were compared according to the clinics they patients.
were in, the difference was not found to be The sleep quality was significantly correlated
significant (p>0.05). The sleep quality of to VAS-F score (r= .273, p= 0.001).
patients surgical clinics was worse than that
of internal clinic patients. Discussion
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Doan et al. (2005) and Trible et al. (2002) in hospitalized patients include the effects of
found that gender was related to sleep quality. illness, environmental sleep disruption,
These studies show that sleep quality of additional medication, anxiety, and
female individuals were worse than male depression. Besides, sleep quality effects
individuals. Similarly in this study, it was factors such as pain, breathing problems, pre
found that sleep quality was associated with or post operational problems, fear, worry,
gender, females in both in patient and control patients staying in a different environment
groups had worse sleep quality than males. that normal, temperature, noise produced by
The reason for this difference could be due to machines, footsteps, voices of staff, radio or
sexual discrimination by society, heavier television sounds, creaking doors, thoughts of
duties of females at home and in society, and not carrying out their responsibilities at home.
males having more often rest periods than Unit environmental and personal factors,
females during the day. However, Edll- factors that are amenable to therapeutic
Gustafsson et al. (2003) has found that men interventions, strongly influence the sleep
consider their quality of sleep to be experience (Buysse et al. 1989, Buysse et al.
significantly better than women. Vitiello et al. 1991, Lenhart & Buysse 2001, Tranmer et al.
(2004) found that a considerable 2003, Frighetto et al. 2004, Doan et al. 2005,
correspondence between subjective and Young et al. 2008, Humphries 2008, Lane &
objective sleep quality was observed for men, East 2008, Young et al. 2009).
but not for women. Past surveys have implied that internal clinic
Similarly, our findings are in line with an patients sleep quality was worse (Young et
another study that shows the difference al. 2008, Young et al. 2009). Different studies
between sleep quality and patients age, have showed that sleep quality of patients in
marital status, and education levels had no surgical clinics were worse than that of
statistical difference (Doan et al. 2005). In internal clinic patients (Tranmer et al. 2003,
this study, increasing age of individuals Doan et al. 2005, Lane & East 2008). Lane
worsened sleep quality. Increasing age was and East (2008) study found that
associated with less sleep quality. There are environmental noise, pain and tension were
many studies, which indicate sleep quality most likely to disrupt the sleep of surgical
gets worse and time of staying awake during patients. It has also suggested four
the night increases as age increases (Buysse et recommendations to improve the sleep of
al. 1991, Tribl et al. 2002, Doan et al. 2005, hospital patients. Thus, result reported in this
Potter & Perry 2009). This may be caused by study is in line with the results of the previous
lesser sleep requirements of older people. For studies. The reason for low quality of sleep in
sleep effectiveness, length of hospitalization patients hospitalized in surgical clinic might
resulted in lower scores. Thus, for patients be preoperative worries, fears and
with prolonged duration of hospital stay, postoperative pains experienced in
special attention should be paid to their sleep preoperative period. It was found that along
patterns (Frighetto et al. 2004). Vitiello et al. with worse sleep quality, also the fatigue
(2004) found that indicating that while aging levels were higher in surgical clinic patients
results in significant changes in sleep. compared to internal clinic patients. The
Another similarity in our study as compared relation between sleep quality and fatigue
to the previous report is that we found the supports this finding. In other words, low
highest mean PSQI score in the single + sleep quality may cause fatigue or fatigue may
widowed + divorced group than married cause low sleep quality.
group. We found that the highest mean sleep Fatigue is a common and generally
quality was found for the illiterate group overlooked symptom in chronic disease
(7.44), a result that is consistent with the population (Belza 1995, Swain 2000, Barnes
previous study (Doan et al. 2005). 2002, Wolfe 2004, Uhlin & Edll-Gustafsson
In this study, the mean PSQI scores of 2006, Theander et al. 2008, Hgglund et al.
patients are found higher than that of control 2008). Belza et al. (1995) and Huyser et al.
group. Previous investigations have revealed (1998) found that gender was related to
that the most common factors affecting sleep fatigue. However, patients reported a
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International Journal of Caring Sciences 2012 September- December Vol 5 Issue 3 318
moderate level of fatigue (mean of 44 on the nurses should be more sensitive to patients
SF-36); with no difference in the reports of sleeping problems. Nurses should also
men and women in Gift and Shepard study determine the factors that cause sleep problem
(Gift & Shepard 1999). These studies show and fatigue in patients. They should give
that women reported more fatigue than men. better service in regard to determined
In this study, it was found that there was a etiologies.
strong association between fatigue subscale
and gender, and the average fatigue level of Acknowledgments
female participants was higher than male
We appreciate the thoughtful suggestions and
participants. Secondary school graduate and
editorial support of the Academic Translation
illiterate individuals were more fatigued than
Team. The authors are grateful to the
the others. The reason for this might be the
inpatients and control groups for their
fact that the literate individuals are less
participation in this study.
capable of coping with fatigue.
This study showed that sleep quality was
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