护士面临的另一个大流行挑战：睡眠问题 | 纽约大学护理学院

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Difficulty sleeping due to work stress and scheduling contributes to nurses’

anxiety and depression

More than half of nurses had difficulty sleeping during the first six months of the COVID-19 pandemic—and getting less sleep increased their odds of experiencing anxiety and depression, according to a new study led by researchers at NYU Rory Meyers College of Nursing.  

“Nurses are already at risk for higher rates of depression and insufficient sleep compared to other professions, thanks to the stress of patient care and the nature of shift work. The pandemic seems to have further exacerbated these issues to the detriment of nurses’ well-being,” said Amy Witkoski Stimpfel, PhD, RN, assistant professor at NYU Rory Meyers College of Nursing and the lead author of the study, which was published in the Journal of Occupational and Environmental Medicine.

Nurses have faced unparalleled challenges working on the frontlines of the COVID-19 pandemic, including staffing shortages, an early lack of personal protective equipment (PPE), and witnessing widespread suffering and death. Research is beginning to reveal the impact of these ongoing stressors on nurses’ mental health and well-being.

In this study, the researchers surveyed 629 nurses and interviewed 34 nurses from June through August 2020. The nurses, who worked across healthcare settings in 18 states, were asked about their experiences working during the first six months of the pandemic in the U.S.

The survey revealed high rates of depression (22 percent), anxiety (52 percent), and insomnia (55 percent) among nurses. Notably, difficulty sleeping was both a contributing factor to and an outcome of poor mental health.

Only sleeping for five hours or less before a shift increased the odds of depression, anxiety, and insomnia. However, nurses also described how anxiety and thinking about stressful working conditions—understaffing, being redeployed to a COVID unit, lack of PPE, and many patient deaths—led to difficulty falling asleep and waking up at night. In addition to stress-related sleep problems, changes in nurses’ work schedules from either working extra hours or abruptly switching between day and night shifts led to nurses getting fewer hours of sleep.  

“We found that sleep problems were interwoven with anxiety and depressive symptoms,” said Witkoski Stimpfel. “Prior research supports this bidirectional relationship between sleep and mental health. We know that getting sufficient sleep fosters mental and emotional resilience, while not getting enough sleep predisposes the brain to negative thinking and emotional vulnerability.”

To better support nurses and their well-being, the researchers urge employers to take action to address work stress and factors that influence sleep. In addition to making sure that nurses have the resources like staffing, beds, and PPE to effectively do their jobs, employers can offer training on stress management and provide referrals to mental healthcare professionals for those in need. Employers should also pay attention to scheduling, ensuring nurses have time away from work, protecting them from excessive overtime hours and shifts that quickly switch between day and night, and offering flexible working arrangements.  

“Our findings help us better understand the difficulty nurses are facing—and why some nurses are leaving their jobs or the field altogether—but also reveal opportunities for hospitals and other employers to support this critical workforce,” said Witkoski Stimpfel.

Additional study authors include Lloyd Goldsamt and Victoria Vaughan Dickson of NYU Meyers and Lauren Ghazal of the University of Michigan. The research was supported by an NYU COVID-19 Research Catalyst grant.

全文翻译（仅供参考）

由于工作压力和日程安排造成的睡眠困难导致了护士的焦虑和抑郁症

根据纽约大学罗里-梅耶斯护理学院的研究人员领导的一项新研究，超过一半的护士在COVID-19大流行的前六个月有睡眠困难--而且睡眠不足增加了他们出现焦虑和抑郁的几率。 

"由于病人护理的压力和轮班工作的性质，与其他职业相比，护士已经面临着更高的抑郁症和睡眠不足的风险。这场大流行似乎进一步加剧了这些问题，损害了护士的福祉，"纽约大学罗里-梅耶斯护理学院助理教授、RN博士Amy Witkoski Stimpfel说，她是这项研究的主要作者，该研究发表在《职业与环境医学杂志》上。

护士们在COVID-19大流行病的前线工作面临着无与伦比的挑战，包括人员短缺、早期缺乏个人防护设备（PPE），以及目睹广泛的痛苦和死亡。研究开始揭示这些持续的压力对护士的心理健康和幸福的影响。

在这项研究中，研究人员调查了629名护士，并在2020年6月至8月期间采访了34名护士。这些护士在18个州的不同医疗机构工作，他们被问及在美国大流行病的头六个月的工作经历。

调查显示，护士的抑郁症（22%）、焦虑症（52%）和失眠症（55%）的比例很高。值得注意的是，睡眠困难既是造成心理健康不良的一个因素，也是一个结果。

只有在轮班前睡了5个小时或更少，才会增加抑郁症、焦虑症和失眠的几率。然而，护士们还描述了焦虑和对紧张的工作条件的思考--人员不足、被重新部署到COVID单元、缺乏PPE和许多病人死亡--导致了入睡困难和夜间醒来。除了与压力有关的睡眠问题外，护士的工作安排发生变化，要么加班，要么突然在白班和夜班之间转换，导致护士的睡眠时间减少。 

"我们发现，睡眠问题与焦虑和抑郁症状交织在一起，"威特科斯基-斯廷普费尔说。"先前的研究支持睡眠和心理健康之间的这种双向关系。我们知道，获得充足的睡眠可以促进心理和情绪的恢复力，而没有足够的睡眠则使大脑容易产生消极的思维和情绪的脆弱性。"

为了更好地支持护士和他们的福祉，研究人员敦促雇主采取行动，解决工作压力和影响睡眠的因素。除了确保护士有资源，如人员配置、床位和个人防护设备，以有效地完成他们的工作，雇主可以提供压力管理的培训，并为有需要的人提供转介给心理保健专家。雇主还应该注意时间安排，确保护士有时间离开工作岗位，保护他们免受过长的加班时间和在白天和晚上快速切换的轮班，并提供灵活的工作安排。 

"我们的研究结果帮助我们更好地了解护士所面临的困难--为什么一些护士要离开他们的工作或完全离开这个领域--但也揭示了医院和其他雇主支持这一关键劳动力的机会，"Witkoski Stimpfel说。

其他研究作者包括纽约大学梅耶斯分校的Lloyd Goldsamt和Victoria Vaughan Dickson以及密歇根大学的Lauren Ghazal。这项研究得到了纽约大学COVID-19研究催化剂拨款的支持。

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