Skip to main content Skip to main navigation menu Skip to site footer
Published: 2023-11-29

Sleep Quality and Stress Levels Among Nurses: A Single Center Study

Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan 25150, Malaysia
Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan 25150, Malaysia
Radiology Department, Sunway Medical Centre, Bandar Sunway 47500, Malaysia
nurses psychological wellbeing sleep quality  


The issue of nurses' sleep quality, which has a significant impact on their mental health, has not received enough attention. Nurses’ stress and mental health can affect patient care, so poor sleep quality in nurses can lead to stress and patient harm. Thus, this study examines the relationship between sleep quality and stress in nurses at a university hospital in Kuantan, Malaysia. This cross-sectional study used convenience sampling. A total of 101 nurses in the hospital were recruited to complete a series of questionnaires, including the Pittsburgh sleep quality index (PSQI) and the depression anxiety stress scale 21 (DASS21). SPSS version 23.0 was used to analyze the data. Hypothesis testing was conducted with an independent sample t-test. The mean age of the participants was 27.2 ± 4.15 years; 88.1% of the participants were Malay and 98.0% were female. Of these nurses, 86.1% reported having poor sleep quality. Most (76.2%) had normal stress levels, 9.9% were mildly stressed, and 5.0% were moderately stressed. According to the findings, 5.0% of nurses had extremely severe stress, and 4.0% had severe stress. Poor sleepers had a higher stress score (t 93.984 = -6.395, p < .001). This study suggests that sleep quality may have an impact on the psychological wellbeing of nurses. Thus, hospital administrations must address this issue for nurses to help them provide high-quality patient care.

Keywords: nurses, psychological wellbeing, sleep quality



Kualitas Tidur dan Tingkat Stres di Kalangan Perawat: Studi Pusat Tunggal. Masalah kualitas tidur perawat, yang memiliki dampak signifikan pada kesehatan mental mereka, belum mendapatkan cukup perhatian. Stres dan kesehatan mental perawat dapat memengaruhi perawatan pasien, sehingga kualitas tidur yang buruk pada perawat dapat menyebabkan stres dan bahaya bagi pasien. Oleh karena itu, penelitian ini menguji hubungan antara kualitas tidur dan stres pada perawat di sebuah rumah sakit universitas di Kuantan, Malaysia. Studi potong lintang ini menggunakan sampel kenyamanan. Sebanyak 101 perawat di rumah sakit direkrut untuk mengisi serangkaian kuesioner, termasuk Indeks Kualitas Tidur Pittsburgh (PSQI) dan Skala Depresi Kecemasan Stres 21 (DASS21). SPSS versi 23.0 digunakan untuk menganalisis data. Pengujian hipotesis dilakukan dengan uji t independen. Usia rata-rata partisipan adalah 27,2 ± 4,15 tahun; 88,1% dari mereka adalah orang Melayu dan 98,0% perempuan. Dari perawat tersebut, 86,1% melaporkan memiliki kualitas tidur yang buruk. Sebagian besar (76,2%) memiliki tingkat stres normal, 9,9% mengalami stres ringan, dan 5,0% mengalami stres sedang. Menurut temuan, 5,0% perawat mengalami stres sangat parah, dan 4,0% mengalami stres parah. Orang yang tidur buruk memiliki skor stres yang lebih tinggi (t 93,984 = -6,395, p < ,001). Studi ini menyarankan bahwa kualitas tidur dapat berdampak pada kesejahteraan psikologis perawat. Oleh karena itu, administrasi rumah sakit harus mengatasi masalah ini untuk membantu perawat memberikan perawatan pasien berkualitas tinggi.

Kata Kunci: kualitas tidur, perawat, psikologis perawat


  1. Arafa, A., Mohammed, Z., Mahmoud, O., Elshazley, M., & Ewis, A. (2021). Depressed, anxious, and stressed: What have healthcare workers on the frontlines in Egypt and Saudi Arabia experienced during the COVID-19 pandemic?. Journal of Affective Disorders, 278, 365–371. doi: 10.1016/j.jad.2020.09.080.
  2. Bazrafshan, M., Moravveji, F., Soleymaninejad, N., Zare, F., Rahimpoor, R., & Zolghadr, R. (2018). Prevalence and effects of sleep disorders among shift working nurse. Annals of Tropical Medicine and Public Health, 11(1), 13-18.
  3. Chan, S.L., Assim, M.I.S.A., & Lim, F.P. (2021). Contributor factors for psychological well-being: A qualitative study of teachers’ perspective in Malaysia. International Journal of Academic Research in Business and Social Sciences, 11(17), 166–175. doi: :10.6007/IJARBSS/v11-i17/11399.
  4. Chatterjee, I., & Saha, D. (2018). Mental health status and quality of sleep of critical ward and general ward nurses. Indian Journal of Health and Wellbeing, 9(6), 823–828.
  5. Cheung, T., & Yip, P.S.F. (2016). Lifestyle and depression among Hong Kong nurses. International Journal of Environmental Research and Public Health, 13(1), 135. doi: 10.3390/ijerph13010135.
  6. Djupedal, I.L.R., Pallesen, S., Harris, A., Waage, S., Bjorvatn, B., & Vedaa, Ø. (2022). Changes in the work schedule of nurses related to the COVID-19 pandemic and its relationship with sleep and turnover intention. International Journal of Environmental Research and Public Health, 19(14), 8682. doi: 10.3390/ijerph19148682.
  7. Dong, H., Zhang, Q., Zhu, C., & Lv, Q. (2020). Sleep quality of nurses in the emergency department of public hospitals in China and its influencing factors: A cross-sectional study. Health and Quality of Life Outcomes, 18(1), 116. doi: 10.1186/s12955-020-01374-4.
  8. Eun, H., & Shin, H. (2020). Effects of stress, sleep and depression on resilience of female nurses working in shift and fixed work schedules in general hospital. Sleep, 43(Supplement_1), A295. doi: 10.1093/sleep/zsaa056.771.
  9. Ghazwin, M.Y., Kavian, M., Ahmadloo, M., Jarchi, A., Javadi, S.G., Latifi, S., Tavakoli, S.A., & Ghajarzadeh, M. (2016). The association between life satisfaction and the extent of depression, anxiety and stress among Iranian nurses: A multicenter survey. Iranian Journal of Psychiatry, 11(2), 120–127.
  10. Haile, K.K., Asnakew, S., Waja, T., & Kerbih, H. B. (2019). Shift work sleep disorders and associated factors among nurses at federal government hospitals in Ethiopia: A cross-sectional study. BMJ Open, 9(8), e029802. doi: 10.1136/bmjopen-2019-029802.
  11. Hwang, E., & Yu, Y. (2021). Effect of sleep quality and depression on married female nurses’ work–family conflict. International Journal of Environmental Research and Public Health, 18(15), 7838. doi: 10.3390/ijerph18157838.
  12. Ibrahim, R.Z.A.R., Zalam, W.Z.M., Foster, B., Afrizal, T., Johansyah, M.D., Saputra, J., Bakar, A.A., Dagang, M.M., & Ali, S.N.M. (2021). Psychosocial work environment and teachers’ psychological well-being: The moderating role of job control and social support. International Journal of Environmental Research and Public Health, 18(14), 7308. doi: 10.3390/ijerph18147308.
  13. Kang, J., Noh, W., & Lee, Y. (2020). Sleep quality among shift-work nurses: A systematic review and meta-analysis. Applied Nursing Research, 52, 151227. doi: 10.1016/j.apnr.2019.151227.
  14. Kantor, C., Corlade-Andrei, M., Nedelea, P.L., Ursu, R.G., Bulgaru, D.I., & Cimpoeșu, C.D. (2023). Assessing the resilience of healthcare professionals in a Romanian emergency unit during the COVID-19 pandemic. The Medical-Surgical Journal, 127(1), 19–31. doi: 10.22551/MSJ.2023.01.04.
  15. Kim-Godwin, Y.S., Lee, M.H., Logan, J.G., & Liu, X. (2021). Factors influencing sleep quality among female staff nurses during the early COVID-19 pandemic in the United States. International Journal of Environmental Research and Public Health, 18(9), 4827. doi: 10.3390/ijerph18094827.
  16. Labrague, L.J. (2021). Pandemic fatigue and clinical nurses’ mental health, sleep quality and job contentment during the COVID-19 pandemic: The mediating role of resilience. Journal of Nursing Management, 29(7), 1992–2001. doi: 10.1111/jonm.13383.
  17. Maharaj, S., Lees, T., & Lal, S. (2018). Prevalence and risk factors of depression, anxiety, and stress in a Cohort of Australian nurses. International Journal of Environmental Research and Public Health, 16(1), 61. doi: 10.3390/ijerph16010061.
  18. Manzoli, J.P.B., Correia, M.D.L., & Duran, E.C.M. (2018). Conceptual and operational definitions of the defining characteristics of the nursing diagnosis disturbed sleep pattern. Revista Latino-Americana de Enfermagem, 26, e3105. doi: 10.1590/1518-8345.2582.3105.
  19. Musa, N.A., Moy, F.M., & Wong, L.P. (2018). Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country. Industrial Health, 56(5), 407–418. doi: 10.2486/indhealth.2018-0052.
  20. Nena, E., Katsaouni, M., Steiropoulus, P., Theodorou, E., Constantinidis, T.C., & Tripsianis, G. (2018). Effect of shift work on sleep, health, and quality of life of health care workers. Indian Journal of Occupational and Environmental Medicine, 22(1), 29–34. doi: 10.4103/ijoem.IJOEM_4_18.
  21. Olawale, O.O., Taiwo, O.A., & Hesham, A. (2017). Quality of sleep and well-being of health workers in Najran, Saudi Arabia. Indian Journal of Psychiatry, 59(3), 347–351. doi: 10.4103/psychiatry.IndianJPsychiatry_241_16.
  22. Pérez-Fuentes, M.D.C., Molero Jurado, M.D.M., Simón Márquez, M.D.M., Barragán Martín, A.B., & Gázquez Linares, J.J. (2019). Emotional effects of the duration, efficiency, and subjective quality of sleep in Healthcare Personnel. International Journal of Environmental Research and Public Health, 16(19), 3512. doi: 10.3390/ijerph16193512.
  23. Qiu, D., Yu, Y., Li, R.Q., Li, Y.L., & Xiao, S.Y. (2020). Prevalence of sleep disturbances in Chinese healthcare professionals: A systematic review and meta-analysis. Sleep Medicine, 67, 258–266. doi: 10.1016/j.sleep.2019.01.047.
  24. Rizky, K., & Hendra. (2018). Relationship of sleep quality and perceived fatigue among nurses at the Cibinong regional public hospital, 2017. KnE Life Sciences, 4(5), 399-406. doi: 10.18502/kls.v4i5.2570.
  25. Roskoden, F.C., Krüger, J., Vogt, L.J., Gärtner, S., Hannich, H.J., Steveling, A., Lerch, M.M., & Aghdassi, A.A. (2017). Physical activity, energy expenditure, nutritional habits, quality of sleep and stress levels in shift-working health care personnel. PLoS ONE, 12(1), e0169983. doi: 10.1371/journal.pone.0169983.
  26. Samsudin, K., Hussin, M.F., Ghazali, N.F.N., Ghani, N.H.A., Kamarudin, A.H., Sansuddin, N., Khan, Z.I., & Hussein, K. (2021). Association between workload and psychological well-being in Malaysia elite firefighter. Malaysian Journal of Public Health Medicine, 21(2), 374-381. doi: 10.37268/mjphm/vol.21/no.2/art.1067.
  27. Sarang, S.D., Shitole, R.B., & Karnam, A.G. (2019). To investigate the association between sleep and happiness among nurses with different personality traits: A cross-sectional study. The Indian Journal of Occupational Therapy, 51(1), 3-7. doi: 10.4103/ijoth.ijoth_7_19.
  28. Serrano-Ripoll, M.J., Zamanillo-Campos, R., Castro, A., Fiol-de Roque, M.A., & Ricci-Cabello, I. (2021). Insomnia and sleep quality in healthcare workers fighting against COVID-19: A systematic review of the literature and meta-analysis. Actas Españolas de Psiquiatría, 49(4), 155–179.
  29. Shah, M.K., Gandrakota, N., Cimiotti, J.P., Ghose, N., Moore, M., & Ali, M.K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469. doi: 10.1001/jamanetworkopen.2020.36469.
  30. Sheykhangafshe, F.B., Rezaeinasab, F., Kamrody, S.H., Larijani, Y., & Asgari, M. (2021). Burnout, posttraumatic stress disorder, and sleep quality among nurses during the COVID-19 pandemic: A systematic review. Journal of Multidisciplinary Care, 10(4), 173-179. doi: 10.34172/jmdc.2021.33.
  31. Shi, L., Liu, Y., Jiang, T., Yan, P., Cao, F., Chen, Y., Wei, H., & Liu, J. (2020). Relationship between mental health, the CLOCK Gene, and sleep quality in surgical nurses: A cross-sectional study. BioMed Research International, 2020, 4795763. doi: 10.1155/2020/4795763.
  32. Tarhan, M., Aydin, A., Ersoy, E., & Dalar, L. (2018). The sleep quality of nurses and its influencing factors. Eurasian Journal of Pulmonology, 20(2), 70-84. doi: 10.4103/ejop.ejop_35_18.
  33. Tran, T.T.T., Nguyen, N.B., Luong, M.A., Bui, T.H.A., Phan, T.D., Tran, V.O., Ngo, T.H., Minas, H., & Nguyen, T.Q. (2019). Stress, anxiety and depression in clinical nurses in Vietnam: A cross-sectional survey and cluster analysis. International Journal of Mental Health Systems, 13, 3. doi: 10.1186/s13033-018-0257-4.
  34. Zhang, L., Sun, D.M., Li, C.B., & Tao, M.F. (2016). Influencing factors for sleep quality among shift-working nurses: A cross-sectional study in China using 3-factor Pittsburgh sleep quality index. Asian Nursing Research, 10(4), 277–282. doi: 10.1016/j.anr.2016.09.002.

How to Cite

Shahadan, S. Z., Mohamad Ismail, M. F., & Kamaruzaman, K. N. (2023). Sleep Quality and Stress Levels Among Nurses: A Single Center Study. Jurnal Keperawatan Indonesia, 26(3), 142–152.